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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

  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
  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
Card Set:
2013-05-26 15:29:58

Preterm Labor
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