PTL

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Author:
rhondak
ID:
221170
Filename:
PTL
Updated:
2013-05-26 11:29:58
Tags:
OB
Folders:

Description:
Preterm Labor
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  1. What must be present for true PTL
    • Gestational age <37 wks
    • Weight <2500gm
    • Regular U/Cs >4/hr
    • Cervical changes
  2. Requirements for PPROM
    Membranes rupture <37wks and 1+ hrs before onset of labor
  3. What are the MAJOR risk factors for PTL?
    • Hx of PTL
    • Uterine fibroids/anomaly/surgery
    • Uterine expansion (multifetal, polyhydramnios
    • Pelvic/uterine/severe systemic infection: BV, pyelo, pneumonia
    • PPROM
  4. What are the MINOR risk factors for PTL?
    • Substance abuse: drugs/tobacco
    • Age extremes <17, >35
    • Low SES
    • Employment: lifting or standing long hours
    • Living situation: abuse, stairs at home
  5. Neonatal risks with PTD:
    • Temp instability (less fat)
    • Resp immaturity (apnea, chronic lung disease)
    • Cardiovascular: PDA, BP dysregulation
    • Hematologic: jaundice, anemia
    • GI: difficulty feeding, poor digestion
    • Neurologic: poor tone, retinopathy
    • infections
  6. What basic techniques do you want to utilize first with PTL
    • Hydration
    • Tocolytics
    • Antibiotics
    • Steroids (Beta-methasone)
    • Transport (level III nursery)
  7. What type of exam is performed to check cervic with suspected PTL
    STERILE SPECULUM EXAM

    DO NOT USE HANDS
  8. What is the black box warning for Terbutaline?
    If used >3 days potential for serious maternal heart problems and death
  9. Name some drugs used for tocolysis:
    • Nifedipine (CCB)
    • MgSO4
    • B-mimetics (hypotension risk)
    • Progesterone
  10. What size is the uterus at 7 days, 14 days, and 6 wks?
    7 days: 50% weight decrease

    14 days: returned to pelvic organ

    6 wks: slightly larger than nulliparous
  11. What is suspected if Lochia Rubra lasts more than 7 days?
    There is some retained placenta in uterus
  12. What are names and colors of lochia
    • Rubra - red or pink - up to 7 days
    • Serosa - lt brown or yellow - up to 14 days
    • Alba - clear
  13. After how many wks with an open internal os do you suspect retained placental fragments?
    6 wks
  14. When do FSH levels rise and menses usually start?
    3 wks FSH begins to rise

    6-8 wks menses 

    79-90% of women ovulate by 12 wks
  15. What are some physical changes that affect libido?
    • Stria gravidarum
    • Breast changes
    • Abdominal laxity
    • FATIGUE
  16. Name the psychological changes tha have an effect on libido
    • Feelings of inadequacy
    • Increased dependency on partner
    • Role conflict (mother vs lover)
    • Work outside home
    • daycare issues
  17. What triggers lactation (milk production)?
    • HIGH Prolactin
    • LOW Pg and Estrogen 
    •        
    •          dropping Pg&E decreases PIF

    Continuation of this is dependent on suckling
  18. What facilitates let down
    Suckling stimulated Oxytocin release from PostPit

    • Causing contraction of alveoli
    • and Milk expulsion through ducts to sinuses
  19. What does colostrum contain?
    Protein and antibodies

    Lower in calories
  20. Engorgement management for Non-Lactating
    • Supportive bra
    • Ice packs 3-4x/day
    • Motrin or tylenol for pain
    • Hand expression 
    • Cabbage leaves
  21. Engorgement management for Lactating
    • Warm moist towels for 10-15 mins
    • warm shower
    • Breast massage
    • hand express
  22. Sore nipples management
    • Relax
    • air dry nipples
    • nurse frequently
    • rotate infant position
    • break suction with finger
  23. Treatment for Mastitis (staphylococcus)
    • Rest
    • warm compress
    • frequent nursing (start with affected side)
    • Antibiotics for fever (beta lactams Amoxicillin and Ceclor)
  24. Emotional phases posptartum (3)
    • 1st month: Fog
    • 3rd & 4th: absorbed in infant (loss of adult identity)
    • 5th month: external focus possible. Return of sexual feelings. Can attend to others

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