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NURS 306_ Quiz 5_ Preterm labor, meds to stop contractions, abortion, GTD.
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NURS 306_ Quiz 5_ Preterm labor, meds to stop contractions, abortion, GTD.
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NURS 306: Quiz 5: Preterm labor, meds tostop contractions, abortion, GTD
Preterm labor and birth - ANS--Labor/birth occurring between 20 & 37 completed weeks
of gestation
-Why? Multifactorial
-Most serious complications of pregnancy lead to 90% of all neonatal deaths
-In the US, the incidence has not declined in >20 years. In fact, incidence has slowly
increased
-Rate of LBW (< 2500gms; 5lb8oz) and VLBW (<1500gms; 3lb5oz) also increased
DIFFERENT TYPES:
-Spontaneous preterm labor: refers to unintentional, unplanned delievrry befoee the
37th week of pregnancy
-Medically indicated preterm birth: when HCP reccomends preterm delivery in the
existence of a seeious medical conditon such as preeclampsia.
-Non-medically indicated preterm delievry: some late-term birthds result from inducing
or havinf a c section
-Late preterm infant: an infant born betwen 34-37 weeks
-very preterm infsnt: infant born before 32 weeks
RISK FACTORS:
-excessive uterine stretch or distention
-decidual activation: from hemorrhage, UTI
-intrauterine infection
-maternal or fetsl distress
-hormonal factors
-vascular insufficiency
-prior preterm birth
-multiple gestation
-uterine/cerivial abnormalities a
SIGNS AND SYMPTOMS:
-contractions less then 10 min greater then 6 mon per hour
,-low backache
-vaginal spotting
-pelvic pressure
-abdominal tightening
-cramping
-dehydration
-UTI
-choroomannionitis
DIANOSTIC:
-UA (urine analysis): looking for infection
-Transvaginal cervical ultrasonography: cerival length >30 mm reliably exlcudes preterm
labor and less then 20 is strong predictor
-Fetal fibronectin: has a low positive predictive value but a high positive predictive value
-if ruptured membrane present then test is invalid
MEDICAL MANAGMENT:
-Tocolytic Drugs: medications used to suppress uterine contractions in preterm labor
-progesterone
-antibiotics
NURSING ACTIONS:
-lie on side
-drink H2O
- palpate for UC and tim
Calcium Channel Blockers: EX Nifedipine and Procardia - ANS--drug of choice sending
moms home
-stops contractions
S/E:
-flushing
-dizziness
-hypotension
-nausea
-headache
, -palpitations
-edema
CONTRAINDICATIONS:
-low BP
-aortic insufficiency
NURSING CARE:
-assess for S/E
-assist women when they get up
-assess pulse snd BP before and after administering
-monitor hepatic enzymes
Corticosteroids: EX Betamethasone/ Dexamethasone - ANS--increases formation of
lung surfactant in neonate
-24-34 weeks given
beta-adrenergic receptors agonist: EX Terbutaline and Ritodrine - ANS-FIRST LINE OF
DEFENSE
-stops contractions
S/E: mother
-tachycardia
-arrthythmias
-palpitations
-SOB
-pulmonary edema
-hyperglycemia
-low potassium
-low BO
-tremors
S/E: fetus
-high HR
-alterations in fetal glucose metabolism
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