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38 Cards in this Set
- Front
- Back
Define preterm labor.
List factors associated with preterm labor. List signs and symptoms of preterm labor. Describe the management for preterm labor. Identify medications used in preterm labor. |
Objectives
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Most common cause of perinatal morbidity and mortality.
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preterm labor.
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Consequences of preterm labor and delivery increase in severity as gestational age ____
a) decreases b) increases c) I'm a dumbass |
decreases
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Common complications include: _________ syndrome (hyaline membrane disease), intravascular hemorrhage, necrotizing enterocolitis, sepsis, seizures.
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respiratory distress
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Long term complications: bronchopulmonary dys-____, developmental abnormalities
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dysplasia
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Preterm labor Defined as regular uterine contractions with cervical effacement, dilation or descent between _____ weeks gestation.
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20 and 37
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Diff b/w abruption and previa
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abrupt: placenta separates from uterine wall somewhere in the center, but not on the edges
previa: placenta edges separtate from the uterine wall |
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Factors associated with PTL
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Dehydration
Incompetent cervix Infections Smoking Excessive uterine enlargement Uterine distortion Placental abnormalities : abruption or previa Substance abuse |
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Signs and symptoms of PTL
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Menstrual like cramps
Low dull back ache Abdominal pressure/cramping Pelvic pressure Change in vaginal discharge Uterine contractions |
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Evaluation of PTL includes External fetal monitor and palpate what?
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abdomen
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When evaluating PTL, Cervical exam is best if examiner is what?
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consistent
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Labs ordered when evaluating PTL
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Labs: U/A and culture, CBC, GBS culture, GC, Chlamydia, wet prep
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When evaluating PTL, how do you check for gestational age, AFI (amniotic fluid index), placental location?
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Ultrasound
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With PTL, the Goal of management is what?
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to delay delivery as long a possible.
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What meds, etc, do you give the PTL pt?
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IV hydration and access
Sedation Tocolytics GBS prophylaxis; ampicillin, clindamycin, erythromycin, penicillin Steroids; betamethasone, decadron |
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Tocolytics
MgSO4 – competes with calcium going into cells to decrease ____ contraction |
myometrial
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Side effects of MgSO4: ______
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respiratory depression, loss of reflexes, toxicity, pulmonary edema, hypotension
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Always have on hand an amp of _____ to reverse MgSO4.
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calcium gluconate
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Dose of MgSO4– ___ Gm loading and run at 2 Gm/hr. May increase if needed. Watch for side effects.
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4
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Beta adrenergic for the PTL pt
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terbutaline, brethine
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Beta adrenergic tocolytic will Increases cAMP in cell which decreases free _____
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calcium
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Side effects of Beta adrenergic tocolytic
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hypotension, tachycardia, anxiety, chest pain, pulmonary edema
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Dose of Beta adrenergic tocolytic – 0.25cc terbutaline sq every 20 min until contractions stop for only __ doses.
2.5-5 mg brethine po every 4 hrs. |
3
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Calcium channel blockers tocolytic; _____
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nifedipine
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Calcium channel blockers tocolytic Prevents ____ entry into muscle cells.
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calcium
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Prostaglandin synthetase inhibitors used as tocolytics
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indomethacin
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Prostaglandin synthetase inhibitors used as tocolytics Decrease prostaglandins how?
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by blocking the conversion of free arachidonic acid to PG
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Side effects of Prostaglandin synthetase inhibitors;
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premature constriction of ductus arteriosus especially after 34 weeks, decrease amniotic fluid.
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How do you determine therapy for PTL pt?
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Gestational age. Baby is better in for as long as possible. Every day helps in extreme prematurity.
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No treatment needed after 36 weeks. Why?
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Fetal lungs usually mature.
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Best to deliver preterm infant at hospital with what service?
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a neonatal intensive care unit. May need to consider transfer.
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Contraindications to tocolysis.
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Advanced labor
Mature fetus Anomalous fetus. Intrauterine infection. Large amount of vaginal bleeding. |
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Advanced labor. If dilated __cm, usually can’t stop labor.
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5
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Mature fetus. Need ___ to determine
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amniocentesis
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Steroids help lungs mature by induction of proteins that regulate _____cells in fetal lungs that produce surfactant
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Type ll pneumocyte
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Dose – Betamethasone 12.5 mg IM every 12 hrs x 2 doses.
Decadron 6.25 mg IM every 6 hrs x 4 doses. |
FYI
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Fetal ______ test- detects enzyme released when the chorion separates from the decidual layer of the uterus. Only helps you determine negative for PTL
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fibrinectin
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ADCVANDIMLE?
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A = admit
D = Dx C = Condition V = VS A = Activity N = Nursing D = Diet I = IV M = meds L = labs E = everything else (imaging) |