Exam 2: Preterm Labor

Question 1

What is considered preterm labor?

Answer 1

Occurrence of regular contractions accompanied by cervical change before the end of the 37th week
Leading cause of death within the first month of life
One of the biggest contributors to perinatal morbidity and mortality
Most common obstetric complication

Question 2

Preterm births account for __% of neurological development disorders

Answer 2

75%

Question 3

Risk factors for preterm labor

Answer 3

History of preterm delivery
African American
Multiple gestation
Low socioeconomic status
Smoking, ETOH, elicit drug use
Hypertension
Diabetes
Current infections
Maternal age
Poverty
BV
Nutrition
Short pregnancy intervals
Stress
Late/no prenatal care
Domestic violence
Periodontal disease
Reproductive technology
Bleeding

Question 4

History of preterm delivery increases risk for preterm labor by how much?

Answer 4

Triples risk

Question 5

African American race increases risk for preterm labor by how much?

Answer 5

Doubles risk

Question 6

Bacterial vaginosis increases risk for preterm labor by how much?

Answer 6

50% increased risk

Question 7

Signs and symptoms of preterm labor

Answer 7

Abdominal pain
Cramping
Contractions (more than 6/hour)
Low, dull backache
Pelvic pressure
PROM
Increased vaginal discharge
Dilation/effacement of cervix
N/V, diarrhea

Question 8

Preterm premature rupture of membranes (PPROM)

Answer 8

30-40% of preterm labor
May occur spontaneously
Exact cause unknown (may be associated w/ injection, abnormal placental implantation, abruption)
Likely to occur in subsequent pregnancies

Question 9

Preterm labor diagnosis

Answer 9

Presence of cervical change
Fetal fibrocetin (fFN) can get a lot of false positives, negative result is important because it indicates you won’t deliver in the next 7 days

Question 10

What are the associated neonatal risks to preterm labor?

Answer 10

Respiratory distress syndrome
Infection
Congenital heart defects
Thermoregulation problems (acidosis, intraventricular hemorrhage)

Question 11

What is the first line of evidence-based therapeutic management for preterm labor?

Answer 11

IV hydration with isotonic solution

Question 12

What is given for fetal lung maturity?

Answer 12

Steroids, Betamethasone (IM)
Stimulates surfactant production
May elevate maternal glucose levels
Needs 24 hours to be effective

Question 13

What is given for neuro-protection?

Answer 13

Magnesium sulfate

Question 14

Magnesium sulfate

Answer 14

Relaxes uterine muscle to arrest contractions
Antidote: Calcium gluconate

Question 15

Indomethacin

Answer 15

Suppresses preterm labor by blocking production of prostaglandins, which inhibits uterine contractions
Can cause premature closure of ductus arteriosus
Can cause oligohydramnios

Question 16

Nifedipine

Answer 16

Calcium channel blocker used to suppress contractions
Monitor BP hourly if given with magnesium sulfate

Question 17

Nursing management for preterm labor

Answer 17

Treat with tocolytics as ordered
Monitor VS
I&O
Encourage bed rest and rest on left-side
Limit vaginal exams
Education
Psychological support

Question 18

Treatment for PT with preterm labor

Answer 18

Avoid traveling long distances
Avoid lifting heavy objects
Visit dentist routinely
Stop smoking
Pelvic rest
Well balanced diet
Avoid use of substances (marijuana, cocaine, heroin)
Identify and reduce stressors

Question 19

Warning signs of PTL

Answer 19

Contractions, low back pain
Pelvic pressure, fullness
Increase in discharge
N/V, Diarrhea
Leakage of fluid

Question 20

What should a PT do if they are experiencing contractions (PTL)?

Answer 20

Empty bladder
Hydrate with 2-3 glasses of water
Lie on left side for 1 hour
Contact healthcare provider if symptoms persist

Question 21

Emotional support for PTL

Answer 21

Half have no risk factors
Prepare for birth
Neonatal consult
Keep informed, what to expect
Monitor closely

Question 22

What does an early GBS infection look like in a neonate?

Answer 22

Pneumonia

Question 23

What does a late GBS infection look like in a neonate?

Answer 23

Meningitis

Question 24

By which route is the GBS culture taken?

Answer 24

Vaginal and rectal cultures