Flashcards in Preterm Labor and Infants Deck (51):
What is preterm labor?
Any true labor experienced between 20 and 37 weeks
What does true labor include?
Cervical change, dilation of 2cm+, 80% effacement, and uterine contractions.
What is premature rupture of membranes?
Rupture of amniotic sac and leakage of fluid beginning before the onset of labor at any gestational age
What is preterm premature rupture of membranes (PrePROM)?
ROM before 37 weeks gestation. Unknown etiology, possibly because of weak membrane or inflammation
What does a prePROM put the mother and infant at risk for?
Infection, placental abruption, cord prolapse
What are the two most common biochemical markers?
Fetal Fibronectin and Salivary Estriol
What is Fetal Fibronectin?
Glycoproteins found in plasma and fetal live found between 24 and 34 weeks
What is Salivary Estriol?
A form of estrogen that is produced by the placenta and increases 2-3 weeks before labor
What does the endocervical length have to do with predicting preterm labor?
A shortened length may increase changes of preterm labor.
What are risk factors of pre term labor?
Spontaneous preterm birth, african american race, multifetal pregnancy, genital infection, 2nd trimester bleeding, low prepregnancy weight, smoking, no prenatal care
What are signs and symptoms of pre term labor?
Uterine contractions greater than every 10 minutes, lower back pain, pelvic pressure, cramps, urinary frequency, vaginal discharge change, trickle from ROM
What is the criteria for treatment of pre term labor?
Contractions with progressive change in cervice, dilation 2-4 cm, effaccement 80%+, fetus is viable
Management for pre term labor patients
Limited activity, modified bedrest, 2L of fluid/day, urinate frequently, limit sex, visit HCprovider.
Management for PrePROM patients
Assess for infection, assess for uterine contraction, count fetal movement, no baths, antibiotics
Management in the hospital for patients
Modified bedrest, hydrate, meds, fetal monitoring
What do beta andrengic agents do?
Relax smooth muscle inhibiting uterine activite- Terbutaline (Brethine)
What does magnesium sulfate do?
Depresses CNS relaxing smooth muscle in uterus, inhibits contractions
What do calcium channel blockers do?
Reduce contractions, inhibits calcium movement to smooth muscle- Nifedipine (Procardia)
What do prostaglandin inhibitors do?
Relax smooth muscles including uterus- Indomethacin (indocin)
When are glucocorticoids not recommended?
If a cord has prolapsed, chorioamnionitis, abruptio placenta
What do glucocordicoids do?
Stimulate fetal lung maturation and promote release of enzyme to produce or release surfactant (Betamethasone and Dexamethasone)
When are antibiotics given?
To treat maternal infections- group B Strept and chorioamnionitis- Penicillin unless allergy or ampicillin
Etiology of preterm birth
Unknown- cervical insuffiency, PPROM, infections
What weight is a low birth weight infant?
Under 2500 g
What weight is an extremely low birth weight infant?
under 1000 g
What age is a preterm infant?
less than 37 weeks
What age is a late preterm infant?
What are characteristics of preterm infants?
Transparent/fragile skin, little/no lanugo, increased vernix, fused eyelids, flat and poor recoiled ears, smooth male scrotum, prominent labia minor and clitoris
What should you assess in a preterm infant?
Everything- respiratory, cardiac, temperature, CNS function, renal function, nutrition status, blood studies, infection prevention
What is Respiratory Distress Syndrome?
When the lungs are immature and there is a lack of surfactant.
What are signs and symptoms of Respiratory Distress Syndrome?
Cyanosis, Tachypnea, grunting, nasal flaring, retractions, apnea, atelectasis
How do you manage RDS?
Maintain airway, ventilation, and oxygenation, surfactant therapy- watch O2 Levels
Nursing Care for RDS
Assess degree of respiratory distress, evaluate response to therapy, warm humidified oxygen as per order, wean from o2
What is Apnea of Prematurity?
Periods of apnea for >20 seconds that may or may not be associated with bradycardia, desaturations, or color change
What is treatment for apnea of prematurity?
caffeine, CPAP, or mechanical ventilation
What is Bronchopulmonary Dysplasia (BPD)?
Lung damage resulting from long term mechanical ventilation. Recovery can take months with complications.
How do you treat Bronchopulmonary Dysplasia?
PREVENT! Bronchodilator, diuretics, steriods
What is Retinopathy of Prematurity (ROP)?
An aquired disease of the blood vessels of the retina resulting in an eye injury with possible blindness.
What is the etiology or cause of ROP?
Changes in retinal vasculature due to abnormal blood vessel growth in response to high levels of O2, retinal immaturity, and exposure to light
How to you treat ROP?
Maintain SpO2 in target range, eye exams, laser surgery to prevent detachment.
What is Necrotizing Enterocolitis (NEC)?
Acute inflammation of the bowel from ischemic injury to intestinal mucosa, presence of bacteria, feedings, immature GI tract.
What are risk factors associated with NEC?
Asphyxia, hypoxia, extremely low birth weight
What are symptoms of NEC?
Feeding intolerance, abdominal distension, blood in stool, lethargic, VS instability
How do you treat NEC?
NPO, suction, antibiotics, colostomy/bowel repair
What is Intraventricular Hemorrhage (IVH)?
Bleeding around or into the ventricular system of the brain- fragile blood vessels rupture easily in response to sudden changes
What are symptoms of IVH?
Apnea, flaccidity, full fontanel
What is the treatment of IVH?
Minimize trauma and discomfort, stress, and heat loss, assess seizure activity, measure head circumference
What should you assess related to nutrition?
Glucose levels, swallowing, I&O, Calories, weights
What is gavage feeding?
Feeding into the stomach
What should you take into consideration when planning discharge?
Home care needs, knowledge deficits, referrals for resources and home health assistance, resources for equipment, transportation