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60 Cards in this Set
- Front
- Back
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% of deliveries that are preterm |
12 |
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2 causes of preterm delivery |
Incompetent cervix
Preterm Labor |
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Preterm Labor details |
20 - 36 weeks Uterine contactions that do not lessen with rest Cervical change . 1 cm Cervical effacement > 80% |
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Incompetent cervix details |
20 - 24 weeks Premature dilation / shortening of cervix Intermittent pelvic pressure / back ache Gross Rupture Of Membranes (ROM) |
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S/S of PTL |
UC’s q10min or more frequency Cramps in the lower abdomen Pelvic pressure Low back ache Gross Rupture Of Membranes Change in vaginal discharge |
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S/S Incompetent Cervix |
Vaginal bleeding Mild back pain Increased vaginal discharge ROM |
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PTL historical risks |
Prior preterm delivery Multiple gestation Smoking Low socioeconomic status Ethnicity Extremes of age Vaginal bleeding |
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Prediction of PTBirth |
Fetal fibronectin Cervical length |
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Fetal Fibrinogen results in |
Best available predictor of preterm delivery Avoid unnecessary usage!
Negative means no delivery in the next 7 to 14 days. Postive means opposite |
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Sonographic Cervical Length |
More accurate for predicting preterm birth than digital examination
Long cervical length - negative for preterm birth |
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Interventions to PTBirth |
Cervical cerclage Screening for and treatment of infection Prophylactic antibiotics for PPROM Tocolytic / Progestin therapy Bedrest |
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Rescue Cervical Cerclage |
Decreased hospital stay Later gestational age at delivery Increased birth weight Tocolytics and prophylactic Amniocentesis to exclude infection before surgery |
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Preparation for Cervical Cerclage |
Explaination of procedure Informed consent by MD Epidural for pain control Tocolytic for relaxation |
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Post Cervical Cerclage |
Lower extremity sensation and movement Voiding ability S/S of ROM Contractions Vaginal bleeding Fetal Heart Tracing Maternal vital signs |
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Post Cervical Cerclage teaching |
Small amount of spotting is expected. Patient will be on pelvic rest
Worsening cramping or bleeding - notify provider immediately |
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Cervical Cerclage assessment at term |
Removed at 35 wks
C/S and leave cerclage in place.
Contact provider if labor occur before removal
Laboring could cause severe complications |
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Treatment of Bacterial vaginosis (Antibiotics) |
Treatment reduces preterm delivery rate
Use of antibiotics to treat PTL in the absence of infection is not recommended
Therapy for PPROM is the standard of care. |
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Tocolytic drug usage |
Prolongs pregnancy for up to 48 hrs |
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Mag Sulfate actions |
Relaxes smooth muscle
CNS depressant when used for pre-eclampsia |
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Magnesium Sulfate side effects |
Flushing / Sweating N/V, constipation Blurry vision Slurred speech Headache Pulmonary edema / Respiratory Depression |
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Giving Magnesium Sulfate |
IV via infusion pump Load: 4-8g over 20-60min Maintain: 2-4g/hr via pump Contraindication: Myesthenia Gravis |
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Magnesium Sulfate Toxicity |
Increased in impaired renal function Depressed or absent reflexes Oliguria Confusion Respiratory depression / paralysis Circulatory collapse If these occur- stop infusion and notify provider immediately large doses can cause cardiac arrest |
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Magnesium Sulfate Nursing Considerations |
Monitor: BP q10 during infusion RR If <12/min stop and notify. Auscultate for rales/crackles Assess reflexes Urine output FHR continuously |
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Calcium Gluconate |
Antidote for MgSO4. Usual dose is 1gm IV over 3min. Kept on hand in case of toxicity |
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Terbutaline |
Used off-label to treat PTL Beta-2 Agonist Shown to increase fetal risk of IVH Used only in urgent situations in a hospital setting for no more than 48 - 72hrs |
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Indomethiacin |
NSAID; inhibits prostaglandins Most effective < 32wks gestation Possible closure of ductus arteriosius. isk of necrotizing enterocolitis (NEC) and IVH |
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Nifedipine |
Relaxes smooth muscle More effective > 32 wks Calcium Channel Blocker used off label |
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Progesterone |
Relaxes smooth muscle Blocks oxytocin Inhibits inflammation
Can reduce the risk in a woman with a short cervix |
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Myths about preventing Preterm birth |
Prenatal care Cessation of tobacco, drug, and alcohol use Nutritional interventions Bedrest Hydration |
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Treatment for the fetus |
Reducing risks: Corticosteroids - RDS & IVH Magnesium Sulfate - cerebal palsy Antibiotics - GBS infected mothers |
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Corticosteroids use |
Betamethasone / Celestone
PTL between 24-34 weeks should receive to reduce the risk of RDS & IVH
If ROM give up until 32 weeks |
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How to prepare for premature birth |
Transfer to Level III nursery.
Have staff visit family and discuss
Have family visit the NICU |
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Nursing staff prep for premie |
Crash cart Notify NICU / Anesthesia Isolette pre-warmed with O2 & equipment.
After stabilization allow family to see. |
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Smoking effects on neonates |
Causes vasoconstriction Decreases O2 and nutrients Smaller babies |
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(LGA) Large for Gestational Age Neonate Facts |
Delivered by C/S Diabetic mothers Higher risk for hypoglycemia after birth |
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Assessment of Large for Gestational Age neonate |
Ecchymosis (bruising) Jaundice (breakdown of RBC's)
Movement of extremities Symmetry of chest (phrenic nerve damage)
Intracranial pressure: Bulging fontanels Dilated pupils / uncoordinated eyes High pitched cry (cat cry) Seizures |
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Fetal causes of (SGA) |
Genetics Infections Multiples |
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Another name for SGA |
"Small for dates" IUGR |
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Maternal causes for SGA |
Smoking HTN Alcohol / Drugs Diabetes Renal issues Sickle Cell Young mother X-Rays |
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Two types of IUGR |
Symmetrical: Everything smaller - Hypoxia the cause Earlier detection Won't usually catch up
Asymmetrical: Acute issue Late detection Head normal - body smaller Will catch up |
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Complications of SGA |
Hypoglycemia Heat loss Aspiration syndromes Perinatal asphyxia |
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Examples of Placental sepsis |
"TORCH"
Toxoplasmosis Rubella CMV Herpes Rubella |
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Neonate sepsis signs |
Temp. Instability Abdominal distension Lethargy Poor feeding |
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NEC - necrotizing enterocollitis |
Develops after birth Abdominal distension Caused by hypoxia Deterioration of bowel
Signs: + heme test in stool, Vomiting, Aspirate |
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Rh Hemolytic disease |
Rh - mother Rh + fetus
Mother develops antibodies against fetus (Coombs) and attacks fetal RBC's
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Treatment for Hemolytic disease |
RhoGam - prevents mother from forming antibodies against fetal blood |
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ABO Hemolytic disease |
O - Mother
A or B - fetus
A or B antibodies attack fetal RBC's |
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Neonate hypoglycemia |
< 45 Often hypo at birth but stabilizes 4 - 8 hrs.
High risk group: SGA, Diabetic mothers, Hemo disease, hypothermia, preterms |
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Signs of neonate hypothermia |
Cat cry Irritability Jittery |
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Hypoglycemic interventions |
Early feeding Oral glucose
Treatment: IV dextrose 10% glucose solution Non stress environment Pacifier |
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Hypocalcemia in neonate |
< 7 - normal is 8 - 10.5
At high risk: SGA, asphyxia, DM |
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S/S of hypocalcemia |
Cat cry Irritability Jittery / twitching Adb. distension Vomiting |
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Treatment of hypocalcemia |
IV calcium CARDIAC MONITORING (arrhythmia's) Decrease stimulation (pacify) |
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Post term neonate |
> 42 weeks
fetal distress with placental dysfunction Mecomium aspirate C/S when overdue |
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Post term neonate physical condition |
Less lanugo / more scalp hair Fingernails Parchment skin Decreased vernix Wasted appearance Depletion of subQ fat (thin) |
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Preterm survival with weight |
100% when over 1500 grams (3.3 lbs) |
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Feeding issues in premie |
Weak suck reflex: < 32 weeks - gavage > 36 weeks - nipple
Requires more calories - vitamin supplement Smaller more frequent feedings |
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RDS in Premie |
Low L/S ratio (less than 2) Caused by immature surfactant |
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Goals of preterm treatment |
Delay birth Hasten fetal lungs (O2, vent)
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2 Chronic health problems in premies |
Retinopathy of prematurity - monitor O2 levels - treat by freezing & lasers
Bronchopulmonary dysplasia - low birth weight, exposure to O2 - vent
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