Wells 11-29-07 Preterm Labor

Front 1

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.

Back 1

Objectives

Front 2

Most common cause of perinatal morbidity and mortality.

Back 2

preterm labor.

Front 3

Consequences of preterm labor and delivery increase in severity as gestational age ____
a) decreases
b) increases
c) I'm a dumbass

Back 3

decreases

Front 4

Common complications include: _________ syndrome (hyaline membrane disease), intravascular hemorrhage, necrotizing enterocolitis, sepsis, seizures.

Back 4

respiratory distress

Front 5

Long term complications: bronchopulmonary dys-____, developmental abnormalities

Back 5

dysplasia

Front 6

Preterm labor Defined as regular uterine contractions with cervical effacement, dilation or descent between _____ weeks gestation.

Back 6

20 and 37

Front 7

Diff b/w abruption and previa

Back 7

abrupt: placenta separates from uterine wall somewhere in the center, but not on the edges

previa: placenta edges separtate from the uterine wall

Front 8

Factors associated with PTL

Back 8

Dehydration
Incompetent cervix
Infections
Smoking
Excessive uterine enlargement
Uterine distortion
Placental abnormalities : abruption or previa
Substance abuse

Front 9

Signs and symptoms of PTL

Back 9

Menstrual like cramps
Low dull back ache
Abdominal pressure/cramping
Pelvic pressure
Change in vaginal discharge
Uterine contractions

Front 10

Evaluation of PTL includes External fetal monitor and palpate what?

Back 10

abdomen

Front 11

When evaluating PTL, Cervical exam is best if examiner is what?

Back 11

consistent

Front 12

Labs ordered when evaluating PTL

Back 12

Labs: U/A and culture, CBC, GBS culture, GC, Chlamydia, wet prep

Front 13

When evaluating PTL, how do you check for gestational age, AFI (amniotic fluid index), placental location?

Back 13

Ultrasound

Front 14

With PTL, the Goal of management is what?

Back 14

to delay delivery as long a possible.

Front 15

What meds, etc, do you give the PTL pt?

Back 15

IV hydration and access
Sedation
Tocolytics
GBS prophylaxis; ampicillin, clindamycin, erythromycin, penicillin
Steroids; betamethasone, decadron

Front 16

Tocolytics
MgSO4 – competes with calcium going into cells to decrease ____ contraction

Back 16

myometrial

Front 17

Side effects of MgSO4: ______

Back 17

respiratory depression, loss of reflexes, toxicity, pulmonary edema, hypotension

Front 18

Always have on hand an amp of _____ to reverse MgSO4.

Back 18

calcium gluconate

Front 19

Dose of MgSO4– ___ Gm loading and run at 2 Gm/hr. May increase if needed. Watch for side effects.

Back 19

4

Front 20

Beta adrenergic for the PTL pt

Back 20

terbutaline, brethine

Front 21

Beta adrenergic tocolytic will Increases cAMP in cell which decreases free _____

Back 21

calcium

Front 22

Side effects of Beta adrenergic tocolytic

Back 22

hypotension, tachycardia, anxiety, chest pain, pulmonary edema

Front 23

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.

Back 23

3

Front 24

Calcium channel blockers tocolytic; _____

Back 24

nifedipine

Front 25

Calcium channel blockers tocolytic Prevents ____ entry into muscle cells.

Back 25

calcium

Front 26

Prostaglandin synthetase inhibitors used as tocolytics

Back 26

indomethacin

Front 27

Prostaglandin synthetase inhibitors used as tocolytics Decrease prostaglandins how?

Back 27

by blocking the conversion of free arachidonic acid to PG

Front 28

Side effects of Prostaglandin synthetase inhibitors;

Back 28

premature constriction of ductus arteriosus especially after 34 weeks, decrease amniotic fluid.

Front 29

How do you determine therapy for PTL pt?

Back 29

Gestational age. Baby is better in for as long as possible. Every day helps in extreme prematurity.

Front 30

No treatment needed after 36 weeks. Why?

Back 30

Fetal lungs usually mature.

Front 31

Best to deliver preterm infant at hospital with what service?

Back 31

a neonatal intensive care unit. May need to consider transfer.

Front 32

Contraindications to tocolysis.

Back 32

Advanced labor
Mature fetus
Anomalous fetus.
Intrauterine infection.
Large amount of vaginal bleeding.

Front 33

Advanced labor. If dilated __cm, usually can’t stop labor.

Back 33

5

Front 34

Mature fetus. Need ___ to determine

Back 34

amniocentesis

Front 35

Steroids help lungs mature by induction of proteins that regulate _____cells in fetal lungs that produce surfactant

Back 35

Type ll pneumocyte

Front 36

Dose – Betamethasone 12.5 mg IM every 12 hrs x 2 doses.
Decadron 6.25 mg IM every 6 hrs x 4 doses.

Back 36

FYI

Front 37

Fetal ______ test- detects enzyme released when the chorion separates from the decidual layer of the uterus. Only helps you determine negative for PTL

Back 37

fibrinectin

Front 38

ADCVANDIMLE?

Back 38

A = admit
D = Dx
C = Condition
V = VS
A = Activity
N = Nursing
D = Diet
I = IV
M = meds
L = labs
E = everything else (imaging)