High Risk OB: Preterm Labor and Birth
The goal is to prevent all preterm births - t or f?
False
Once a patient experiences SROM, it is necessary to be delivered within 24 hours - T or F?
False, if patient is term (40 weeks), we want her delivered, but not always.
While receiving betamimetic (tocolytic) therapy for preterm labor, the client begins to experience muscle tremors and exhibit signs of nervousness. She reports, "My heart is racing." The nurse identifies that the client's pulse rate is 110 beats/min and regular. What should the nurse do next?
Reassure the client that these are expected side effects of the medication.
management of PTL (hospital)
Tocolysis - suppresses uterine activity, hydration (IV fluids, LR or normal saline wide open), steroids betamethasone, NICU consult, fetal monitoring, US
Patients often mistake PTL symptoms for normal discomforts of pregnancy - T or F?
True
medication for PTL
calcium-channel blocker - decreases contractions. SE: hypotension, tachycardia, headache
A client who is at 26 weeks' gestation tells a nurse at the prenatal clinic that she has pain during urination, back tenderness, and pink-tinged urine. A diagnosis of pyelonephritis is made. What is the most important nursing intervention at this time? a. limiting fluid intake b. examining the urine for protein c. checking for signs of preterm labor d. maintaining her on a moderate sodium diet
checking for signs of preterm labor (UTIs increase the risk of PTL)
A client who is in labor is admitted 30 hours after her membranes ruptured. For what condition does the nurse anticipate that the client is most at risk? a. cord prolapse b. placenta previa c. chorioamnionitis d. abruptio placentae
chorioamnionitis (inflammation of chorion and amnion - inside of uterus)
A client arrives at the clinic in PTL, and terbutaline (Brethine) is prescribed. For what therapeutic effect should the nurse monitor the client?
decreased frequency and duration of contractions
problems with preterm babies
fat storage, temperature regulation, organ immaturity (esp. respiratory)
medication for PTL
terbutaline (Brethine) - B2 adrenergic receptor agonist; cardiac and respiratory effects (bronchodilator) and relaxes uterus. SE: increases pulse, palpitations, headache, pulmonary edema, hyperglycemia (be careful with diabetic pt) SQ 0.25 mg q20min 3 doses. RN: Assess Mama's pulse, if > 120 bpm, hold dose.
management of PPROM in hospital
ultrasounds, CBC, monitor fetus, ROM, lay in Trendelenberg position, and prevent infection
preterm labor
uterine contractions and cervical change between 20-37 weeks (can result in birth)
preterm birth
delivery prior to the completion of week 37, maturity problem, most serious fetal complication of pregnancy
management of PPROM
depends on GA, possible home management (bedrest with BR privileges). If viable baby (28-29 wks), Mama stays in hospital, gets steroids, IV antibiotics or PO, monitor baby and wait. If non-viable baby (~23 wks), Mama goes home to wait and see.
The terms PTB and low birth weight (LBW) are interchangeable - T or F?
false; PTB is a maturity issue. A baby can be born full-term at LBW.
lab tests
fetal fibronectin, cervical length US, cultures for STIs (GC/Chl, rich, BV), UTIs, periodontal disease
fetal fibronectin
glue that attaches amniotic sac to uterus, present in vaginal discharge before 22 wks and at end of pregnancy (if in vaginal discharge before 22 wks-end, sign of PTL) do before all other vaginal lab tests!
management of PTL (conservative)
hydration, home monitoring
medication for PTL
magnesium sulfate - muscle relaxer
signs and symptoms of PTL dx
mild UC, abd cramping, backache, pelvic pressure, vaginal discharge
At 37 weeks' gestation, a client's membranes spontaneously rupture but she does not have contractions. What action is the most important in the nursing plan of care for this client? a. monitoring for the presence of a fever b. monitoring for signs of preeclampsia c. monitoring for heavy vaginal bleeding d. making preparations for fetal scalp pH sampling
monitoring for the presence of fever
A primigravida is concerned about the health of her baby and asks the nurse, "What is the most common cause of death in babies?" The nurse explains that the cause of more than half of neonatal deaths in the United States is: a. atelectasis b. preterm birth c. congenital heart disease d. respiratory distress syndrome
preterm birth
PPROM
preterm, premature rupture of membranes prolonged, premature rupture of membranes (longer than 24 hrs before)
medication for PTL
prostaglandin synthetase inhibitor: don't use after 34 weeks GA or longer than 48 hrs because fetal heart shunt will close
