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Flashcards in 6.5 Preterm Deck (49):
1

Preterm (def)

Less than 37 weeks

2

Symptoms of Pre-term labor (6)

o Pelvic pressure
o Low, dull backache
o Menstrual-like cramps
o Change or increase in vaginal discharge
o Intestinal cramping with or without diarrhea.
o Ctxs occurring < or = q10 minutes

3

Risk factors for PTL (9)

o Infection
o Long Distance Traveling
o “On feet” > 50%
o Stress: Acute or chronic
o Poor nutrition, being underweight
o Late or no prenatal care
o Lower SES or education
o ETOH, tobacco, illicit drug use
o Pre-existing or pregnancy complications

4

Why is being on your feet a lot a risk factor for PTL?

Due to poor circulation, decreased venous return

5

Why is smoking a risk factor for PTL?

Vasoconstriction → decreased perfusion

6

What factors diagnose PTL?
• Documented _________
• Documented ________: (2)

1) Documented uterine contractions

2) Documented cervical change
• Effacement of 80%
• Dilation >1cm

7

What tool is used to detect PTL uterine contractions?

A tocometer

8

Biochemical markers to predict PTL

Best identify who will not experience PTL:
• Salivary estriol
• Fetal fibronectin (FFN)

9

Salivary Estriol: What does a negative test mean? How accurate is it?

A Negative test predicts the likelihood of not delivering in the next 2 weeks.

o 98% accurate that you will not go into preterm labor

10

Salivary Estriol: What does a positive test mean? How accurate is it?

A positive test predicts the likelihood of delivering in the next 2 weeks.

o Only right 7-25% of the time

11

Fetal Fibronectin: Its presence inthe birth canal between _____ weeks could indicate ____.

24-37 weeks
PTL

12

Fetal Fibronectin: What does a negative test mean? How accurate is it?

A negative test predicts the likelihood of not delivering in the net 2 weeks

o Correct 95% of the time

13

Fetal Fibronectin: What does a positive test mean? How accurate is it?

A positive test predicts the likelihood of delivering in the next 2 weeks.

o Only correct 25-40% of the time

14

Two tools that can help diagnose PTL

o Transvaginal ultrasound
o Home uterine activity monitoring (HUAM)

15

What is the purpose of tocolytic therapy?

Suppression of uterine activity

16

Five tocolytics

• Ritodrine
• Terbutaline
• Magnesium sulfate
• Indomethacin
• Nifedipine

17

Ritodrine: Class / Action

Betamimetic: Relaxes smooth mucscle

18

Terbutaline: Class / Action

Betamimetic: Relaxes smooth muscle

19

Terabutaline: Possible ADEs

• Cardiac (4)
• Muscles and CNS (3)
• GI and electrolyte (3)
• Respiratory

• Tachycardia
• Dysrhythmias
• Myocardial ischemia
• Hypotension

• Jitteriness, Apprehension
• Tremors / muscle weakness
• Headache

• N/V
• Hyperglycemia
• Hypokalemia

• Pulmonary edema

20

Magnesium Sulfate: Class/Action

CNS Depressant

21

Magnesium Sulfate: Antidote

Calcium Gluconate

22

What are normal blood levels for magnesium sulfate? How often are labs drawn?

Normal: 4-7 or 8
Labs drawn every 6 hours

23

Magnesium sulfate: ADEs (4)

• Decreased RR
• Absent or decreased deep tendon reflexes (DTRs)
• Muscle weakness
• Oliguria (decreased urine output).

24

Normal urine output:
- Per hour
- Per 24 hours

30 cc / hr
500 cc / 24 hour

25

Nifedipine: Class / Action

Calcium Channel Blocker

26

Toxolytics: How to position mom

Left Lateral Position to increase perfusion

27

Toxolytics: What to assess (5)

• Assess vital signs regularly
• Maternal HR
• Assess sxs of pulmonary edema
• Assess urinary output Q1hr
• Monitor for ketonuria

28

Toxolytics: When to notify a provider

Notify HCP if HR >120 (disorganized)

29

Sxs of pulmonary edema

Decreased breath or lung sounds

30

Bethamethazone (BM): Indications

To promote (accelerate) fetal lung maturity

31

Bethamethazone: Class

Glucocorticoid

32

Dexamethasone: Indication

To promote (accelerate) fetal lung maturity

33

Dexamethasone:Class

Glucocorticoid

34

How often are glucocorticoids administered?

May be repeated in 7 days (if birth has not occurred)

35

Contraindications of PTL drugs (8)

• Severe preeclampsia or eclampsia
• Active vaginal bleeding
• Intrauterine infection
• Cardiac disease
• Acute fetal distress
• Chronic IUGR
• Birth inevitable
• Continuation of pregnancy impractical

36

________ = intrauterine infection

Choriamniotis

37

When is birth inevitable?

4cm

38

When is continuation of pregnancy impractical? (4)

• Fetal demise
• Lethal fetal anomaly
• EGA >37 weeks
• EFW >2500g

39

PROM: Def

Premature Rupture of Membranes
• Def: > 1hour before the onset of labor – at ANY gestational age.

40

PPROM: Def

Preterm Premature Rupture
• Def: Rupture of membranes before 37 weeks

41

PPROM: Incidence

Occurs in 25% of all women who deliver preterm

42

Criteria for a PPROM mom to be able to stay at home (4)

o Temp Q4h when awake
o Monitor sxs of infection
o Assess for uterine ctx
o Daily fetal movement counting

43

FMC

"Fetal Movement Counting"

Counts or Kicks

44

PPROM Activity for mom (4)

- Modified bed rest
- NPV
- Proper hygiene
- No tub baths

45

Biweekly tests done with PPROM (3)

• Fetal testing (NST, BPP)
• Amniotic fluid measurements

46

What is a normal amniotic fluid measurement at full term?

800-1200 ccs

47

Signs & Symptoms of Choriamniotis (4)

o Fetal tachycardia
o Elevated maternal temp
o Uterine tenderness
o Decreased CTXs

48

Newborn Respiratory Risk

Respiratory Distress Syndrome (RDS)

49

What test checks for lung maturity?
• How is it done?
• What number puts infant at risk?

L/S Ratio
• Via blood or via amniocentesis
• < 3 if diabetic = risk for RDS