Preterm Labor
The signs and symptoms of preterm labor.
What are onset before 37th week of pregnancy Uterine activity Discomfort (backache, rhythmic cramping) Vaginal discharge Changes in cervix
A patient presents to ob triage thinking her water broke. The questions you will ask to address your differential diagnoses.
What are: EDC (due date) to decide if preterm or term, OLDCARTS for the leaking, color of leakage, urine leakage, excessive vaginal discharge.
When may tocolytics be used in PPROM?
What is, they are not usually ordered is PPROM. However, it may be used by some providers for 48 hours to allow time for corticosteroid benefit?
The maternal risk factors for preterm labor
What are Age <17 or >35, less than high school education Low SES, Poor nutrition Single, Minority Previous preterm birth, increased parity, mult. gestation Infections, incompetent cervix, uterine fibroids Substance abuse
Risk factors for cervical insufficiency.
What are a history of second trimester pregnancy loss, or a history of cervical treatment for HPV (LEEP, Conization of cervix)?
What is a tocolytic?
What are medications used to slow down or stop uterine contractions in women experiencing preterm labor
Considered a sort cervix.
What is a cervical size of <25 mm?
The 3 common medications used in the management of preterm labor and what they are used for.
What is Nifedipine - calcium channel block prevents calcium from entering into the uterine smooth muscle - preventing contractions.
Magnesium sulfate (smooth muscle relaxant),
betamethasone/dexamethasone (steroids for fetal lung development).
What is risks associated with PPROM?
What are Preterm birth, Maternal and fetal infection, Prematurity, Low birth weight, & umbilical cord prolapse?
A negative fetal fibronectin test means what?
As an APRN rounding on the patient, what will you be looking at in the chart and assessing in the patient with PPROM?
What are review VS and assess for elevated pulse and temp which could mean infection, review fetal monitor strips and elevated FHR can mean infection and variables can mean cord compression, contractions and pain, S&S of labor - asking about vaginal discharge/color contractions, timing and limit vaginal exams and limit physical activity. Look at how premature and if betamethasone needs to be given. Also, Mag sulfate for neuroprotection and antibiotics if she has screened positive for group B strep from a UTI in the past.
The management of cervical insufficiency.
What is surgical suturing of the cervix to help keep the cervix closed.