OB-Preterm Birth

Card Set Information

Author:
choward04
ID:
221016
Filename:
OB-Preterm Birth
Updated:
2013-05-25 16:58:44
Tags:
Preterm Birth
Folders:

Description:
Ob Exam 2
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user choward04 on FreezingBlue Flashcards. What would you like to do?


  1. Contraction Physiology
    Myokinase light-chain kinase (MLCK) uses free intracellular CA+ to initiate a reaction between myosin and actin-->uterine contractions
  2. What decreases uterine contractions
    Tocolytics decreases intracellular CA+ stopping enzyme production
  3. What is PTL
    • Gest age >37 weeks
    • WT <2500 gm (1/3 growth restriction)
    • Regular contractions: >4/hr & cervical changes
  4. PROM is
    membrane rupture <37 weeks
  5. Risk Factors PTL-Genetics
    • Women w/ sisters (80%)
    • grandparents who preterm
    • prior PTB
  6. Risk Factors-Uterine
    • Anomaly, surgery
    • multiple gestation, polyhydramnios
    • fibroids
    • myomectomy
  7. Risk Factors-Placenta
    • Placenta abnormalities
    • -previa or abnormalities
    • PROM (50% start labor w/in 24hrs) &
    • 75-90% w/in 7 days
  8. Risk Factors PTL-Uterine
    • Established-Treponema, N.Gonorrhea, Group B Strep, Gardnerella
    • Possible-chlamydia, trich, ureaplasma
    • Amniotic fluid infection
  9. Risk Factors-Urinary Tract
    Microalbuminuria-due to PIH

    Other: Coitus/orgasm, low Mg levels, fetal fibronectin levels
  10. Risk Factors-PTL Non-Uterine
    • Asymptomatic bacteruria (2X's)
    • pyelonephritis, pneumonia, malaria/typhoid fever
  11. Risk Factors PTL-Idiopathic
    • 50% cannot be predicted
    • no risk factors
  12. Risk Factors PTL-Maternal Factors
    • Race: 2 fold AA
    • Age: <17 & >35
    • Lower SES
    • Prenatal care: inadequate/non-existent
  13. Risk Factors PTL-Lifestyle and Employment
    Proven: cigarettes/nicotine, drug abuse

    • Possible: prolonged standing, fatigue/long hrs
    • heavy lifting, normal lifting in predisposed
    • weight gain extremes (obese or underweight)
  14. Neonatal Risk with PTL
    • Temp instability (low body fat)
    • Resp. immaturity-hyaline mem. disease, chronic lung disease, apnea, incomplete lung development
    • CV: PDA, low HR, Problems w/ BP regulation
  15. Neonatal Risk with PTL
    • Hematologic/metabolic: anemia, jaundice, electrolyte imbalances, immature renal function
    • GI: difficulty feeding, poor digestion, NEC
  16. Neonatal Risk with PTL
    -Neurologic
    • Neuro:
    • --intraventricular hemorrhage, periventricular leukomalacia, poor muscle tone, seizures, retinopathy

    Infections
  17. PTL-Maternal Risk
    • Medications to treat PTD
    • increase risk of stroke
  18. Management of PTL (threatened delivery)
    Basics
    Hydration, tocolytics, antibiotics, steroids (beta-methesone), level 3 nursery (before delivery)
  19. Management of PTL-Exam
    • Sterile Speculum Exam
    • -pooling, ferning, nitrazine, cervical visualization, fetal fibronectin, wet-prep
    • cultures (GBS, GC/Chlamydia)
  20. Management of PTL-Steroids
    • Steroids: proven to improve fetal survival
    • -reduces RDS, IVH, NEC & mortality
    • Criteria:
    • -del. likely in 7 days
    • -fetus 24-34 weeks gestation
    • if delivery not imminent-delay 24-48 hrs
  21. Management of PTL Fetal Fibronectin
    Maintains placental attachment due to decidua
  22. Management of PTL-Initial Hosp. Management
    • To increase uterine blood flow
    • -bedrest, hydration (500-1000ml bolus/hr)
    • Continuous uterine activity monitoring
    • Tocolytic therapy
  23. Management PTL Mg Sulfate
    Poorly understood-competes w/ Ca++

    • narrow therapeutic range can be toxic (resp. & cardiac arrest: monitor DTR
    • Short term use 24-48 hrs-poss benefit= <CP
    • SE: hot flashes & Altered LOC
  24. Management of PTL/PTD-Beta-Mimetcs
    • Ritrodrine
    • Terbutaline more commonly used-black box for >3 day use (serious maternal problems/death)
    • --acts on B2 receptors¬†
    • Cardiac effects: decrease if maternal HR >120
  25. Management of PTD Beta-Mimetics
    • Hyperglycemia
    • PE
    • hypotension
    • increased incidence of neonatal intraventricular hemorrhage
  26. Management of PTD-Oral B Mimetics
    Effects on maternal HR limits use
  27. Management PTD-Nifedipine
    • comparable to MgSO4¬†
    • selectively efficacy & fewer side effects
    • -hypotension, headache, flushing, mild tachycardia
  28. Management Progesterone
    inhibits oxytocin effect of prostaglandin FA2 & stimulation of alpha adrenergics

    Weekly IM: 250-1000mg from 16-32 weeks
  29. Management-Hydroxprogestone Caproate, Makena
    • single fetus
    • hx of 1 PTD
    • weekly injections between 16 & 37 weeks
  30. PRB Education
    • Modify activity levels
    • Teach S/S of PTL (changes in contractions & increase)
    • Fluid intake
    • Fetal kick counts
    • Vag d/c
    • uterine tone
  31. PTL/PTB Contraction Types (4)
    • Braxton Hicks
    • Low Backache
    • Menstrual
    • Pelvic pressure
    • *intestinal cramping and diarrhea-be aware of those too
    • Watch for vaginal changes
  32. PTL Monitoring
    • U/S for cervical length
    • -NL: <3.5-4

What would you like to do?

Home > Flashcards > Print Preview