1
Q
viability threshold is
A
- between 22-25 weeks gestation
2
Q
what assessments would be done to assess for ROM
A
- nitrazine and ferrying tests
- assess pad/underwear for (COAT)
3
Q
when should fibronectin testing be done?
A
- done before digital exams or trasnvaginal US
4
Q
indications for fetal fibronectin testing include:
A
- threatened PTL between 24-34 weeks
- intact amniotic membranes
- cervix less than 3cm dilated
- established fetal well-being
5
Q
contraindications for fibronectin testing:
A
- ROM
- active vaginal bleeding
- VE or intervourse within 24 hours
6
Q
what to do is fibronectin test is positive?
A
- send to tertiary care
- is negative do a follow-up US
7
Q
if cervix is greater than 3cm dilated:
A
- treat for preterm labour
- discard fetal fibronectin swab
8
Q
if cervix dilated less than 3cm with contractions:
A
- send fetal fibronectin swab
- if positive treat for preterm labour
9
Q
tocolytics
A
- slow down or suppress uterine activity to allow time to give corticosteroids, and transfer to higher level of care
- indomethacin or nifedipine
10
Q
when to NOT use tocolytics
A
- infection
- bleeding
- severe preeclampsia
11
Q
corticosteroids (glucocorticoids)
A
- betamethasone
- accelerate fetal lung maturity , stimulating fetal surfactant
12
Q
antenatal glucocorticoids reduce the incidence of:
A
- respiratory distress syndrome
- intraventricular hemorrhage
- necrotizing enterocolitis
- and death in neonates
13
Q
when should corticosteroids be administered?
A
- SOGC says between 34-34+6 weeks gestation when preterm is expected within 7 days
- SOGC also says between 34-36+6 weeks
- CPS for extremely preterm birth suggests as early as 22 weeks if resuscitation is planned.
14
Q
antibiotics for preterm birth
A
- when membranes are ruptured to increase time to delivery and decrease maternal/neonatal morbidity
- offered if mom is GBS positive or unknown
15
Q
use of magnesium sulphate
A
- is a neuroprotective agent, given when preterm birth is imminent at less than 34 weeks
- aids in protecting against cerebral palsy
16
Q
how is imminent birth defined
A
- high likely hood of birth within 24 hours (activ labour or planned birth )
17
Q
when should magsulf be discontinued
A
- signs of toxicity
- delivery is no longer imminent or there has been 24 hours of treatment
18
Q
what are 4 minor side effects of mag sulf
A
- flushing
- sweating
- nausea/vomiting
- pain at IV site
19
Q
what are 4 serious side effects of mag Sulf
A
- hypotension
- tachycardia
- respiratory depression
- pulmonary edema
20
Q
two potential neonatal side effects of high doses of MagSulf
A
- hypotonia and apnea
21
Q
A
21
Q
extremely preterm
A
- less than 28 weeks gestation
22
Q
moderately preterm
A
- 28-34 weeks gestation
23
Q
late pre-term
A
- 34-36+6 weeks gestation
24
consequences of preterm birth include
- respiratory distress
- asphyxia
- thermoregulation
- feeding problems
- infection
- hyperbilirubinemia
- cardio and hematological issues
25
risk factors for spontaneous preterm birth
- previous Hx
- Hx of genital tract infections
- bleeding during pregnancy
- uterine anaomoly
- assisted reproductive technology
- multifetal
- substance use
26
PWSOAC frameworks stands for
- pink
- warm
- sweet
- organized
- attached
- clean
27
Pink:
- maintain and establishing respirations
- can be affected by hypothermia
- for preterm births - respiratory distress syndrome is most common
28
respiratory support for preterm infants
- supplementary oxygen
- continuous O2 monitoring
- CPAP
- continuous distending pressure (CDP)
- mechanical ventilation
- surfactant replacement therapy
29
how does hypothermia affect oxygenation
- thermogenesis increases oxygen consumption and depletes glycogen stores
- apnea, bradycardia, central cyanosis occurs then pulmonary vasoconstriction
30
how is sweet affected for preterm infants
- low glycogen stores
- high energy expenditures (WOB)
- low caloric intake
- high risk for hypoglycaemia
- poor suck, swallow, and breathing coordination
- immature GI tract (reflux, malabsorption, slow motility)
31
how to help a preterm infant feed (sweet)
- creating a feeding plan for gestational age
- could do parenteral nutrition
- gavage feeds
- oral feeds
32
issues with organization for the preterm infant
- immature organs
- high stress environment
33
how to help preterm infants become organized
- stabilize sleep/wake states
- respiratory and heart rates
- metabolic processes
- blood chemistry levels
- eating patterns
- develop independence
34
individualized developmentally supportive care
- aims to reduce environmental stressors, increase capacity to read individual infant behavioural cues, and promote parental involvement in care
35
how to promote attachment for preterm infants
- skin to skin care (kangaroo care)
- helps improve physiological stability, improve sleep/wake cycles, reduce stress and crying, reduce pain
36
how to help a preterm infant stay clean
- strict handwashing
- restricting visitors
- reducing the risk of infection
37
mothers of preterm infants experience:
- higher PPD, distress, anxiety, PTSD
38
preterm breastmilk has more:
- protein
- lipids
- higher IgA concentration
39
benefits of breastfeeding preterm infant
- protects against NEC
- infections
- increased feeding tolerance
- decreased risk for allergy
- improved neurocognitive development
40
complications that can occur for premature infants
- respiratory distress syndrome
- retinopathy of prematurity
- bronchopulmonary dysplasia
- patent ductus arteriosus
- NEC
NSPN 7200
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