Week 5 Flashcards
preterm labour
-cervical changes with uterine contraction occurring between 20-37
-Rate is higher among patients younger than 18 years of age or older than 35 years
preterm birth
-Any birth occurring before 37 weeks completion of pregnancy regardless of the weight of the infant
risk factors for preterm labour/birth
-hx of previous spontaneous preterm birth (20-36 wks gestations)
-family hx of preterm
-African decent
-genital tract infection
-uterine anomaly
-use of IVF
-smoking, substance abuse
-periodontal disease
-multifetal gestation
-bleeding of uncertain origin
-low pregnancy weight
-low socioeconomic status
-lack of access to prenatal care
-high levels of stress
what causes preterm labour?
-infections
-vaginal bleeding
-hormone changes
-stretching of the uterus
preterm labour and uterine contractions
-uterine contraction lasting more frequent than every 10 mins, persisting for 1 hour or more
-can be painful or painless
preterm labour discomforts
-lower abdominal pain
-urinary frequency
-diarrhea/gas pain
-pelvic pressure, feeling like the baby “is pushing down”
-suprapubic pain or pressure
-dull intermittent back pain below the waist
-painful menstrual-like cramps
think of like you’re having your period
what can we use to predict preterm labour and birth
-Fetal fibronectin test (FFN)-they barely use this now, not really evidence based
-Cervical length <30mm are risk preterm labour
vaginal discharge and preterm labour
Change in character and amount of usual discharge: thicker (mucoid) or thinner (watery), bloody, brown or colourless, increased amount, odour
-thick, blood and odour we are concerned
what can we do to try and prevent preterm labour?
-Administration of prophylactic progesterone-daily vaginal suppositories or creams and weekly intramuscular injections to decrease the rate of preterm labour and birth
early recognition and diagnosis is based on 3 major diagnostic criteria in preterm labour
-Gestational age between 20 and 36 6/7 weeks
-Regular uterine activity, accompanied by a cervical change
-Initial presentation with regular contractions and cervical dilation of 2 cm or greater
what medication can we use to suppress labour/uterine activity?
Tocolytics
what are the contraindications of Tocolytics? maternal
-Severe pre-eclampsia or severe gestational hypertension
-Significant vaginal bleeding
-Intrauterine infection (chorioamnionitis)
-Cardiac disease
-Medical or obstetrical condition that contraindicates continuation of pregnancy
what are the contraindications of Tocolytics? fetal
-Gestational age of 37 weeks or more
-Fetal demise
-Lethal fetal anomaly
-Evidence of acute or chronic fetal compromise
what can we do to promote fetal lung maturity
-Antenatal glucocorticoids
to accelerate fetal lung maturity by stimulating fetal surfactant production.
what is the management for inevitable preterm birth?
magnesium sulphate may be administered to reduce or prevent newborn neurological morbidity
Nursing Care for a Patient Receiving Tocolytic Therapy
-educate family/pt
-Position patient in lateral position to enhance placental perfusion and reduce pressure on the cervix.
-VS, lung sounds, RR, FHR
-assess for any adverse effects of mum/baby
-Determine labouring patient’s fluid balance by measuring intake and output.
-provide comfort/psychosocial support
-encourage relaxation
Educate patient about early symptoms of preterm labour.
Stop what you are doing.
Empty your bladder.
Drink two to three glasses of water or juice.
Lie down on your side for 1 hour.
Palpate for contractions.
If symptoms continue, call your health care provider or go to the hospital.
If symptoms go away, resume light activity but not what you were doing when the symptoms began.
If symptoms return, call your health care provider or go to the hospital.
If any of the following symptoms occur, call your health care provider or go to the hospital immediately:
Uterine contractions every 10 minutes or less for 1 hour or more
Vaginal bleeding
Fluid leaking from the vagina
what is PROM-preterm rupture of membranes
-Is the spontaneous rupture of the amniotic sac and leakage of amniotic fluid beginning before the onset of labour at any gestational age.
-before 37 weeks
risk factors of PROM
-hx of preterm birth- esp if associated with PROM
-hx of cervical surgery or cerclage -the irony
-urinary or genital tract infections
-short <25mm cervical length in the 2nd trimester identified transvaginal ultrasound
-low BMI/ low socioeconomic status
-smoking
-nutritional deficiencies in copper and ascorbic acid
-2nd/3rd trimester bleeding
-pulmonary disease
what is a sign of infection in preterm PROM
foul-smelling vaginal discharge, maternal and fetal tachycardia) should be reported immediately to the primary health care provide
what are the maternal complications of PROM
-Chorioamnionitis-bacterial infection of the amniotic cavity
-is the most common maternal complication of preterm PROM
-maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odour of amniotic fluid
-Management -intravenous (IV) broad-spectrum antibiotics (ampicillin or penicillin and gentamicin)
fetal complication of PROM
-intrauterine infection
-Cord prolapse and umbilical cord compression associated with oligohydramnios
what is post term or postdate pregnancy?
-Pregnancy that goes beyond the end of week 42 of gestation, or more than 294 days from the first day of the last menstrual period (LMP).
risk factors for post term or postdate pregnancy?
-first pregnancy, prior post-term
-pregnancy, a male fetus, obesity
-genetic predisposition
fetal risks to post term or postdate pregnancy
-Macrosomia/small for gestational age
-shoulder dystocia
-asphyxia
-cord compression- abnormal FHR
-compromising effects on the fetus “an aging” placenta
-still birth
-meconium- stained amniotic fluid, meconium aspiration
-low Apgar score
-convulsions of newborn
post term or postdate pregnancy -maternal complications
-labour dystocia
-severe perineal injuries
-chorioaminolitis
-endomyetritis
-postpartum hemmorahage
-caesaren birth
-anxiety
what happens if pregnant person chooses to delay induction past 41 weeks?
undergo an NST and Amniotic Fluid Volume assessment twice weekly
what is induction vs augmentation
-induction- women has no symptoms, no pain, contractions
-augmentation- she has pain and contractions but it has been 4 hours without any progression of dilation
Antepartum fetal assessment beginning at 41 weeks of gestation
-daily fetal movement counts, NSTs, AFV assessments, contraction stress tests, BPPs, and Doppler flow measurements
-Call your primary health care provider if your membranes rupture or if you perceive a decrease in or no fetal movement.
-Birth is recommended after 42 weeks and by 42+6 weeks of gestation to decrease the risk for perinatal morbidity and mortality
