OB Exam #2 > Preterm Labor > Flashcards

Preterm Labor Flashcards

(36 cards)

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1
Q

What is defined as preterm labor (PTL)?

A

Regular contractions accompanied by cervical change between 20 and 37 weeks of pregnancy

Contractions = < 10 minutes apart
Cervical change of > 2cm and 80% effacement

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2
Q

What is the definition of preterm birth?

A

Any birth prior to 37 weeks of pregnancy

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3
Q

What are the gestational weeks for late preterm birth?

A

34 to 36 weeks of gestation

Late preterm births are still considered at risk for complications.

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4
Q

What are the gestational weeks for very preterm birth?

A

Before 32 weeks gestation

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5
Q

What is the impact of preterm labor on families and society?

A
  • Leading cause of neonatal morbidity and mortality
  • Lifelong disabilities
  • Economic burden on hospitals and society

The daily cost of a day in NICU can exceed $3,000 to $20,000.

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6
Q

What is the goal of identifying preterm labor (PTL)?

A

Early identification of PTL who require intervention

Of those with threatened PTB, less than half go on to deliver early

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7
Q

What are some complications of preterm birth for the newborn?

A
  • Respiratory distress syndrome (RDS)
  • Neurodevelopment impairments
  • Infections
  • Thermoregulation problems
  • Jaundice
  • Hypoglycemia
  • Feeding issues
  • Life-long disability (cerebral palsy, hearing loss, vision loss)
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8
Q

What are the three most common risk factors for preterm birth?

A
  • Prior preterm birth
  • Multiple gestation
  • Uterine/cervical abnormalities

50% of women who deliver preterm have no identifiable risk factors.

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9
Q

List some medical risk factors for preterm labor.

A
  • Genital tract infections
  • UTIs, STDs
  • Second trimester bleeding
  • IVF (in vitro fertilization)
  • High blood pressure/preeclampsia
  • Obesity
  • Previous PTB
  • Multifetal gestation
  • Uterine/cervical changes
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10
Q

What are some lifestyle risk factors for preterm labor?

A
  • Smoking
  • Substance abuse
  • Domestic violence
  • Sexual abuse
  • Lack of social support
  • Stress
  • Late or no prenatal care
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11
Q

What are some symptoms of preterm labor?

A
  • Contractions every 10 minutes or more often
  • Change in vaginal discharge/leaking fluid
  • Vaginal bleeding
  • Low, dull backache
  • Cramps that feel like menstrual cramping
  • Abdominal cramps with or without diarrhea
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12
Q

What are the three most influential factors in predicting preterm birth?

A
  • Fetal Fibronectin (FFN) (positive result)
  • Shortened cervical length (CL) (US showing thinning)
  • Prior spontaneous preterm birth
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13
Q

What is Fetal Fibronectin (FFN)?

A
  • A glycoprotein ‘glue’ found in plasma, produced during fetal life
  • Normally appears in early and late pregnancy
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14
Q

What is the procedure for testing Fetal Fibronectin (FFN)?

A
  • 24-34 weeks gestation
  • No cervical intercourse or CL US within 24 hours of the test

A negative result indicates that PTL is unlikely to occur.

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15
Q

How is cervical length determined and when should it be done?

A
  • Transvaginal ultrasound
  • AFTER FFN test is performed
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16
Q

What are other assessments done on a suspected PTL patient?

Study These Flashcards
A

After FFN test is performed

  • Cervical exam
  • Sterile speculum exam for ROM
  • Screen for UTI (UA)
  • Screen for other infections (CBC)
  • Fetal monitoring
  • contraction monitoring
17
Q

If a patient is in preterm labor, why would you want to delay delivery for at least 48-72 hours?

Study These Flashcards
A

To be able to administer antenatal steroids to facilitate lung maturity

18
Q

What is the purpose of antenatal glucocorticoids?

Study These Flashcards
A

Reduces incidence of respiratory distress syndrome (RDS)

Administered between 24-34 weeks gestation.

19
Q

What is cervical cerclage?

Study These Flashcards
A

Stitches to hold the cervix closed

Used preventively for incompetent cervix or as an emergency measure.

20
Q

What are some psychosocial effects of preterm labor on mothers?

Study These Flashcards
A
  • Loss of control
  • Anxiety, anger
  • Depression
  • Guilt
  • Boredom
  • Loneliness
  • Mood swings
21
Q

What is the antidote for Magnesium Sulfate toxicity?

Study These Flashcards
A

Calcium gluconate

22
Q

List Preterm Labor Tocolytics

Study These Flashcards
A
  • Ibuprofen
  • Indocin
  • Toradol
  • Nifedipine
  • Terbutaline
  • Magnesium Sulfate
23
Q

What side effects do NSAIDS have when given for PTL?

Study These Flashcards
A
  • Can decrease amniotic fluid if given AFTER 32 weeks
  • AFI is needed if given
24
Q

What are two serious side effects of Indocin?

Study These Flashcards
A
  • Reduction in fetal urine production
  • Changes in fetal blood circulation
25
What do you need to watch when giving **Nifedipine** for **PTL**?
**Hypotension** ## Footnote **Given PO**
26
What are the **side effects** of **Terbutaline**?
* Nervousness * Tremor * Tachycardia * Palpitations ## Footnote **Given SQ, q30min x 3**
27
How is **Toradol** given for **PTL**?
**IV or IM**
28
What are the **side effects** of **Magnesium sulfate**?
* Hot flashes * sweating * burning at IV site * N/V * Muscle weakness
29
What is the nursing management when giving **Magnesium Sulfate**?
* Given IVPB * Infusion pump needed * Loading dose 6 g, maintenance 3g * Stay with patient during bolus * Requires a 2 RN sign off * Ice to IV site * Cool wash rags and cool room * Give zofran for nausea * Assess resp. status, DTR, change in LOC, oliguria *(less than 30 mL/hr)*
30
What is the most commonly used **antenatal glucocorticoid**?
**Betamethasone**
31
How is **betamethasone** administered?
**2 IM injections, 24 hours apart**
32
What are the contraindications for **antenatal glucocorticoids**?
**Women with systemic infections**
33
What are the cautions for **antenatal glucocorticoids**?
* Women on medication for GDM * Women with pregestational diabetes * Women with hypertension ## Footnote ***At risk for severe hyperglycemia, severe hypertension***
34
When is **prophylactic progesterone** given to pregnant women?
* Pt. with Hx of SABs - Given up to 12 weeks gestation * To women with a history of preterm birth, given between 16-34 weeks
35
When is a **cervical cerclage** given?
* Incompetent cervix * Used preventatively at 12-14 weeks * Used as an emergency when cervix length shows thinning * *Rarely used after 24 weeks*
36
What type of anesthesia is used for a **cervical cerclage**?
**General or regional** ***Epidural***
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