OB > 6.5 Preterm > Flashcards

6.5 Preterm Flashcards

(49 cards)

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1
Q

Preterm (def)

A

Less than 37 weeks

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2
Q

Symptoms of Pre-term labor (6)

A

o Pelvic pressure
o Low, dull backache
o Menstrual-like cramps
o Change or increase in vaginal discharge
o Intestinal cramping with or without diarrhea.
o Ctxs occurring < or = q10 minutes

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3
Q

Risk factors for PTL (9)

A 
o	Infection
o	Long Distance Traveling
o	“On feet” > 50%
o	Stress: Acute or chronic
o	Poor nutrition, being underweight
o	Late or no prenatal care
o	Lower SES or education
o	ETOH, tobacco, illicit drug use
o	Pre-existing or pregnancy complications
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4
Q

Why is being on your feet a lot a risk factor for PTL?

A

Due to poor circulation, decreased venous return

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5
Q

Why is smoking a risk factor for PTL?

A

Vasoconstriction → decreased perfusion

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6
Q

What factors diagnose PTL?
• Documented _________
• Documented ________: (2)

A

1) Documented uterine contractions

2) Documented cervical change
• Effacement of 80%
• Dilation >1cm

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7
Q

What tool is used to detect PTL uterine contractions?

A

A tocometer

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8
Q

Biochemical markers to predict PTL

A

Best identify who will not experience PTL:
• Salivary estriol
• Fetal fibronectin (FFN)

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9
Q

Salivary Estriol: What does a negative test mean? How accurate is it?

A

A Negative test predicts the likelihood of not delivering in the next 2 weeks.

o 98% accurate that you will not go into preterm labor

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10
Q

Salivary Estriol: What does a positive test mean? How accurate is it?

A

A positive test predicts the likelihood of delivering in the next 2 weeks.

o Only right 7-25% of the time

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11
Q

Fetal Fibronectin: Its presence inthe birth canal between _____ weeks could indicate ____.

A

24-37 weeks

PTL

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12
Q

Fetal Fibronectin: What does a negative test mean? How accurate is it?

A

A negative test predicts the likelihood of not delivering in the net 2 weeks

o Correct 95% of the time

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13
Q

Fetal Fibronectin: What does a positive test mean? How accurate is it?

A

A positive test predicts the likelihood of delivering in the next 2 weeks.

o Only correct 25-40% of the time

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14
Q

Two tools that can help diagnose PTL

A

o Transvaginal ultrasound

o Home uterine activity monitoring (HUAM)

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15
Q

What is the purpose of tocolytic therapy?

A

Suppression of uterine activity

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16
Q

Five tocolytics

A
  • Ritodrine
  • Terbutaline
  • Magnesium sulfate
  • Indomethacin
  • Nifedipine
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17
Q

Ritodrine: Class / Action

A

Betamimetic: Relaxes smooth mucscle

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18
Q

Terbutaline: Class / Action

A

Betamimetic: Relaxes smooth muscle

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19
Q

Terabutaline: Possible ADEs

  • Cardiac (4)
  • Muscles and CNS (3)
  • GI and electrolyte (3)
  • Respiratory
A
  • Tachycardia
  • Dysrhythmias
  • Myocardial ischemia
  • Hypotension
  • Jitteriness, Apprehension
  • Tremors / muscle weakness
  • Headache
  • N/V
  • Hyperglycemia
  • Hypokalemia

• Pulmonary edema

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20
Q

Magnesium Sulfate: Class/Action

Study These Flashcards
A

CNS Depressant

21
Q

Magnesium Sulfate: Antidote

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A

Calcium Gluconate

22
Q

What are normal blood levels for magnesium sulfate? How often are labs drawn?

Study These Flashcards
A

Normal: 4-7 or 8

Labs drawn every 6 hours

23
Q

Magnesium sulfate: ADEs (4)

Study These Flashcards
A
  • Decreased RR
  • Absent or decreased deep tendon reflexes (DTRs)
  • Muscle weakness
  • Oliguria (decreased urine output).
24
Q

Normal urine output:

  • Per hour
  • Per 24 hours
Study These Flashcards
A

30 cc / hr

500 cc / 24 hour

25
Nifedipine: Class / Action
Calcium Channel Blocker
26
Toxolytics: How to position mom
Left Lateral Position to increase perfusion
27
Toxolytics: What to assess (5)
* Assess vital signs regularly * Maternal HR * Assess sxs of pulmonary edema * Assess urinary output Q1hr * Monitor for ketonuria
28
Toxolytics: When to notify a provider
Notify HCP if HR >120 (disorganized)
29
Sxs of pulmonary edema
Decreased breath or lung sounds
30
Bethamethazone (BM): Indications
To promote (accelerate) fetal lung maturity
31
Bethamethazone: Class
Glucocorticoid
32
Dexamethasone: Indication
To promote (accelerate) fetal lung maturity
33
Dexamethasone:Class
Glucocorticoid
34
How often are glucocorticoids administered?
May be repeated in 7 days (if birth has not occurred)
35
Contraindications of PTL drugs (8)
* Severe preeclampsia or eclampsia * Active vaginal bleeding * Intrauterine infection * Cardiac disease * Acute fetal distress * Chronic IUGR * Birth inevitable * Continuation of pregnancy impractical
36
________ = intrauterine infection
Choriamniotis
37
When is birth inevitable?
4cm
38
When is continuation of pregnancy impractical? (4)
* Fetal demise * Lethal fetal anomaly * EGA >37 weeks * EFW >2500g
39
PROM: Def
Premature Rupture of Membranes | • Def: > 1hour before the onset of labor – at ANY gestational age.
40
PPROM: Def
Preterm Premature Rupture | • Def: Rupture of membranes before 37 weeks
41
PPROM: Incidence
Occurs in 25% of all women who deliver preterm
42
Criteria for a PPROM mom to be able to stay at home (4)
o Temp Q4h when awake o Monitor sxs of infection o Assess for uterine ctx o Daily fetal movement counting
43
FMC
"Fetal Movement Counting" Counts or Kicks
44
PPROM Activity for mom (4)
- Modified bed rest - NPV - Proper hygiene - No tub baths
45
Biweekly tests done with PPROM (3)
* Fetal testing (NST, BPP) | * Amniotic fluid measurements
46
What is a normal amniotic fluid measurement at full term?
800-1200 ccs
47
Signs & Symptoms of Choriamniotis (4)
o Fetal tachycardia o Elevated maternal temp o Uterine tenderness o Decreased CTXs
48
Newborn Respiratory Risk
Respiratory Distress Syndrome (RDS)
49
What test checks for lung maturity? • How is it done? • What number puts infant at risk?
L/S Ratio • Via blood or via amniocentesis • < 3 if diabetic = risk for RDS
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