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preterm labor
for final exam
| Question | Answer |
|---|---|
| What is preterm labor? | -occurs before the end of 37 wks. gestation-pattern of labor more than 1hr with contractions of 30 secs. and q10min apart-Always serious |
| Causes of preterm labor? | -unclear-more freq. with young adolescents and African American-associated with dehydration, UTI and chorioamniotis, women in strenuous jobs, long shifts, extreme fatigue. |
| Signs and Symptoms of preterm labor? | -persistant,dull, low backache-vaginal spotting-feeling of pelvic pressure or abd. tightening-mestrual-like cramping- > vaginal discharge-uterine contractions w/pattern-FFN- fetal fibronectin= neg. predictor seen after 20wks. |
| Attempt to stop labor IF... | -intact-absent fetal distress-NO s&s of bleeding-Cervix not dilated >4-5cm-Effacement not >50% |
| Therapeutic management of Preterm labor... | Admit to hospital, bedrest, IV fluids, Vag and cervical cultures, clean-catch to r/o infection |
| What drugs may possibly be administered for preterm labor? | Corticosteroids, betamethasone,tocolytic agents, prostagladin antagonists,magnesium sulfate,and/or beta-sympathomimetic. |
| Corticosteroid | accelerates lung development -given while labor is being halted-takes 24 hours-lasts 7 days-may have to be repeated-concern about giving to diabetic mom = increases sugar |
| Betamethasone | -accelerates lung development-decreases necrotizing enterocolitis-decreases intraventricular hemorrhage (in brain) |
| Tocolytic agent | halts laborcalcium channel blocker |
| prostagladin antagonist | -danger of decrease fetal urine output (oligohydraminos)-premature closure of ductus arteriosis |
| Magnesium sulfate | -#1 drug of choice-cathartic, CNS depressant- check deep tendon reflex-resp. rate <12 WARNING SIGN-urine output <30ml WARNING SIGN-calcium gluconate- antidote-magnesium level >10 WARNING SIGN-severe hypotension |
| Beta-sympathomimetic drugs | Ritodrine HCL (Yutopar), Terbutaline (brethine): both relax smooth muscleSide effects: hypotension, hypokalemia, >blood glucose levels,headache, n&v, nursing implications. |
| Prior to tocolytic drug administation: | check baseline lab datahctserum glucoseK+, NaClCo2EKGExt. uterine and fetal monitoring |
| Inderal | -beta blocker -may be used to counteract decreased diastolic b/p-daily weights |
| Ritodrine | -mix w/ringer's lactate, NO dextrose. -piggyback: stop if tachycardia or arrhythmia - microdrip/infusion- cal. initial rate: may >q10min until uterine activity halts, max. 0.35mg/min. -assess pulse,b/p q15min while >infusion then q30 till contract. halt. |
| Assessments with Ritodrine | pulse >120, b/p <90/60, arrhythmias. chest pain and dyspnea, lungs for rales, I/O qhour= intatke NOT TO EXCEED 100ml/hr.fetal heart tones-tachycardia, late decelerations, or varible decelerations. |
| If meds successfully halt contractions: | cont. infusion for 12-24hr. then oral ritodrine or terbutaline. -give 1st dose oral 30min before IV stopped.(build blood level up). cont. PO until 37wks or fetal lungs mature. -teach mom to monitor her pulse: call if >120, palp. or extreme nervousness. |
| If labor occurs at home: | -empty bladder. - assume side-lying postition (left preferred- wt.off superior vena cava) -drink 3-4cups H2O. -palp. abd. for uterine contractions. -rest 30min and slowly resume act. if Symp. subside. -contact health provider if S&S persist |
| Fetal assessment by mom: | -daily fetal movement count- take snack- lie on side- fetus typically moves 10-12 x's in 3hrs.- report if it takes 2x's as long after repeating.- determine fetal well-being |
| IF labor CANNOT be halted.... | If membranes ruptured, 50% effaced, 3-4 dilated, labor. -caution with analgesics.-montior FHT(provides reassurance to mom) -episiotomy.-forceps-cord clamped right away- support mom |
| Premature rupture of membranes | -cause unknown -infection -pressure on cord(prolapsed cord)(impaired gas exchange)- potter-like syndrome (distorted facial features) |
| Assessment of premature ruptured membranes | check if amniotic fluid or urine - c+s, WBC.amniotic fluid- alkolytic, ferning test |
| therapeutic management of premature ruptured membranes | bedrest-antibiotics(profolactive)-risk for infection(temp >100.4,palpate abd. for tenderness,faul smelling discharge.- NO bath, NO sex, NO douche, Labs: WBC >18,000 infection. Before 34wks give betamethasone |
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