Exam 2: Preterm Labor

Question 1

Preterm Labor (PTL)

Answer 1

cervical changes and uterine contractions between 20 and 36.6 weeks gestation

Question 2

Preterm Birth

Answer 2

birth between 20 and 36.6 weeks gestation

Question 3

Low Birth Weight

Answer 3

2500 grams or less; caused by IUGR

Question 4

IUGR

Answer 4

complications of pregnancy that interferes with utter-placental profusion

Question 5

Very Low Birth Weight

Answer 5

1500 grams or less

Question 6

Extremely Low Birth Weight

Answer 6

1000 grams or less

Question 7

Causes of PTL

Answer 7

Multifactorial
-Contractions/Cervical change/ROM
-Placental implantation bleeding
-Maternal/Fetal stress
-Uterine over-distention
-Allergic reaction
-Decreased progesterone level
-INFECTION

Question 8

Signs and Symptoms of PTL

Answer 8

-Change in type of vaginal discharge
-Increase in amount of discharge
-Pelvic or lower abdominal pressure
-Constant low backache
-Mild abdominal cramps
-Regular or frequent contractions
-ROM
-Urinary frequency

Question 9

Predictive Diagnostic Measures

Answer 9

-Fetal Fibronectin (fFN)
-Endocervical Length

Question 10

Interventions for Active PTL

Answer 10

-Bedrest in side-lying position
-Hydration
-Tocolytics
-Antenatal glucocorticoids

Question 11

Tocolytics

Answer 11

suppress uterine activity
Ex: mag sulfate, terbutaline, nifedipine (Procardia), indomethacin (indocin)

Question 12

Antenatal Glucocorticoids

Answer 12

-promote fetal lung maturity and reduce complications of prematurity
-given between 24-34 weeks who are at risk for preterm birth within 7 days

Question 13

Magnesium Sulfate

Answer 13

-Relaxes smooth muscle, including uterus
-4-6 g/30 min (IV) as loading dose, 1-4g/hr maintenance dose

Question 14

Mag Sulfate SEs

Answer 14

Hot flashes*, N/V, headache, dyspnea, hypocalcemia, blurred vision

Question 15

Mag Sulfate antidote

Answer 15

Calcium gluconate

Question 16

Terbutaline

Answer 16

-beta agonist
-relaxes smooth muscles
-Given Sub Q, 0.25 mg q 4 hrs

Question 17

Terbutaline SEs and Contraindications

Answer 17

SEs
-Tachycardia
-Hyperglycemia
Contraindications
-HR > 120 bpm
-Heart dx
-Severe preeclampsia/eclampsia
-Gestational DM
-Hyperthyroidism

Question 18

Nifedipine (Procardia)

Answer 18

-Calcium channel blocker
-Relaxes smooth muscles including uterus
-Initial dose: 10-20 mg PO, then q 3-6 hrs until contractions are rare

Question 19

Nifedipine SEs and Contraindications

Answer 19

SEs
-mild hypotension, headache, flushing, dizziness, nausea
Contraindications
-should not be given concurrently with mag or terbutaline

Question 20

Indomethacin (Indocin)

Answer 20

-Relaxes uterine smooth muscle by inhibiting prostaglandins
-50 mg PO or PV then 25-50 mgs q 6 hr x 48 hrs

Question 21

Indomethacin SEs and Considerations

Answer 21

SEs
-N/V, heartburn, prolonged bleeding, thrombocytopenia
Considerations
-Given only if < 32 weeks, only administer for 48 hrs
-Not given in presence of renal/hepatic disease, active PUD, poorly controlled HTN, asthma or coagulation disorder

Question 22

Maternal Contraindications to Tocolytics

Answer 22

-Severe preeclampsia
-Eclampsia
-Bleeding with hemodynamic instability
-Contraindications to specific medications

Question 23

Fetal Contraindications to Tocolytics

Answer 23

-Intrauterin fetal demise
-Lethal fetal anomaly
-Non-reassuring fetal status
-Chrioamnioitis
-Preterm Premature ROm (PPROM)