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PPN 301 - Week 5 With Complete Solutions
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PPN 301 - Week 5 With Complete Solutions
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Solution 2024/2025Pepper
PPN 301 - Week 5 With Complete Solutions
Preterm Labour
- Preterm labour: Cervical changes w/ uterine contraction occurring 20-37 wks
-- Rate higher among under 18 & over 35
- Preterm birth: Any birth occurring b/f 37 wks regardless of weight
Preterm Labour - Risk Factors
- Hx or prev. spontaneous preterm b/w 16 & 36 wks
- Family hx of preterm labour
- African
- Genital tract infeciton
- Uterine anomaly
- Assisted human reproduction
- Smoking, substance misuse
- Periodontal disease
- Multifetal gestation
- Bleeding of uncertain origin
- Low pregnancy weight
- Low SES
- Lack of access to prenatal care
- High levels of stress
Preterm Labour - Causes
- Infections
- Vaginal bleeding
- Hormone changes
- Stretching of uterus
Preterm Labour - S&S
, Solution 2024/2025
Pepper
Uterine Activity:
- Contractions more freq. than every 10 mins, persisting for 1hr
- Contractions painful of painless
Discomfort:
- Lower abdo cramping, similar to gas pains
- Dull, intermittent low back pain
- Painful, menstrual-like cramps
- Suprapubic pain or pressure
- Pelvic pressure or heaviness; "baby is pushing down"
Vaginal Discharge:
- Change in character & amount of usual discharge
-- Thicker (mucoid) or thinner (watery), bloody, brown or colourless, incr. amt, odour
Preterm Labour - Nursing Care
- Early recog & dx
- Goal: prevention; preconception counselling
- Prenatal: adressing risk factors & health promoting activities
- Admin of prophylactic progesterone (daily vaginal suppositories or creams & weekly IM injections)
Preterm Labour - 3 Diagnostic Criteria
- Gestational age b/w 20 & 36+6
- Regular UA, accompanied by cervical change
- Initial presentation w/ regular contractions & cervical dilation of 2cm or greater
Preterm Labour - Interdisciplinary Care
- Early recog & dx
- Suppression of UA: Tocolytics
- Promotion of fetal lung maturity: Antenatal glucocorticoids
- Management of inevitable preterm birth: Magnesium sulfate (neuro morbidity)
-- Nifedipine, indomethacin, magnesium sulfate
, Solution 2024/2025
Pepper
Preterm Labour - Patient Education
- Stop whatever they're doing
- Empty bladder
- Drink 2 or more glasses of water or juice
- Lie on side for 1 hr
- If symptoms cont, call HCP or go to hosp
- If symptoms go away, resume light activity
- Go to hosp immed if:
-- Uterine contractions every 10 mins or less for 1 hr or more
-- Vaginal bleeding
-- Leakage of amniotic fluid
Preterm Premature Rupture of Membranes
- pPROM: Rupture of membranes b/f completion of 37 wks
Risk Factors:
- Hx prior preterm birth, cervical sx or cerclage
- Urinary or genital tract infection
- Short (<25mm) cervical length in 2nd tri
- Preterm labour or symptomatic contractions in current preg.
pPROM - Interdisciplinary Care
- Based on estimated risk of maternal, fetal, & newborn complication
- Term: induction
- 34-36 wks: conservative mgmt if low risk of intrauterine infection
- Before 32 wks: expectant or conservative allow fetal lung maturity (not recc if certain complications)
- NST & BPP to det. fetal health status & estimate amniotic fluid vol
- Antenatal corticosteroids admin to pts 24 to 34+6 wks
- 7-day course of broad-spectrum antibiotics
- Magnesium sulfate if less than 34 wks
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