Toni - Week 6 - Exam 4 Flashcards
what is the definition of preterm labor?
contractions/cervical change 20 - 37 weeks (36 6/7 week)
what are the risk factors for preterm labor?
short cervix, overstretched uterus (multigravida, twins, large baby), or infection (chorioamnionitis, UTI, STI)
what are the s/sx of preterm labor?
UCs, pelvic pressure, backache.
What can pregnant women do at home to determine if they are having PTL?
- Empty bladder, PO fluids, side-lying
- If UCs >/= 6 UCs/hr, call MD/CNM
In the hospital, what are interventions that we can do for a woman in PTL?
- vaginal exam
- bedrest
- hydration PO
- external fetal monitor
- rule out contraindication to continuing pregnancy ( evidence of chorioamonitis)
PTL Management: what two characteristics predict that delivery is unlikely within the next 2 weeks?
- negative fetal fibronectin test ( protein found in mother’s mucous, made by infant; doesn’t show up until two weeks before birth)
- cervical length > 3 cm (via transvaginal ultrasound)
PTL management: what can delay delivery???
tocolytics - relax smooth muscle
PTL management: what are 3 different types of tocolytics?
- IV magnesium sulfate
- SubQ terbutaline (airway med; ability to quiet contractions right away) - SHORT TERM
- PO nifedipine (Ca2+ channel blocker)
PTL management: how can we accelerate fetal lung maturity?
with betamethasone (corticosteroid)
PTL management: when is betamethadone indicated?
Indicated for PTL between 24 - 34 weeks
PTL management: what is the betamethadone dose and how long is the effect?
2 doses IM 24hrs apart
- ideally give 2nd dose 24hr before delivery
- **effect on fetal lungs lasts for 7 days `
what is dystocia?
abnormal labor
what are the different types of dystocia?
- precipitate (rapid) labor
- FTP: failure to progress - despite everything
- CPD: cephalopelvic disproportion - too big to fit through pelvic
- Macrosomic fetus too large to pass through pelvis
- Malpresentations
What are 2 charcteristics of FTP?
- cervix fails to dilate
- fetus fails to descend (needs to get passed 0 station)
what are the 3 malpresentations?
breech, face/brow, occiput posterior
what are 5 non-medication ways to induce labor?
- nipple stimulation
- castor oil
- soap suds enema
- stripping of membranes (MD)
- amniotomy (AROM) - crochet hook
what is proper nipple stimulation?
one breast at a time; one nipple for 5 minutes, wait 15 minutes → cease if UC
what is the stripping of the membranes?
a vigorous vaginal exam; irritate attachment of cervix
what are the 2 different pharmaceutical inducement methods?
- prostaglandin inserted close to cervix to soften + efface
- oxytocin (pictocin) IV
what are the names of the 2 different prostaglandin drugs used to induce labor?
dinoprostone insert (cervidil) misoprostol tablet (cytotec)
how is oxytocin IV administered and why?
solution is administered with a second pump with primary tubing that is piggy backed into the most proximal port of primary tubing infusing her primary IV - small amount of med is in tubing if have to stop med quickly.
what is the usual order as far as titrating oxytocin IV?
Titrated until UC q 2 - 3 min and 60 - 90 sec
when should the oxytocin infusion be decreased? D/C?
- Decrease infusion if
- UCs become closer than q 2 min
- UC duration > 90 sec
- **D/C infusion if fetal distress
T/F oxytocin IV crosses the placental barrier?
FALSE; it doesn’t cross