3rd Trimester - (Nonstress test, Group B Streptococcal, Preterm labor)

When is the third trimester?

27-40 weeks

What is considered Full Term?

40 weeks gestation

What will the woman report feeling during the third trimester?

hot flashes, flushing and/or feeling warmth

Why does a woman experience hot flashes in the 3rd trimester

They have an increased blood volume

(^ 45%)

How should the baby move during the third trimester?

MORE REGULAR AND OFTEN

if she notices decreased movement, come into the office

When is a nonstress (NST) done?

Further along in pregnancy (3rd Trimester)

Normally around 32-34 weeks

During an NST, how long is the EFM used?

20-40 minutes

What is the purpose of a nonstress test?

Assess the fetal well-being by monitoring FHR and uterine activity or contractions

During a NST, what indicates fetal well-being?

Acceleration of FHR & Variability

• 2 or more accelerations 15 bmp x 15 seconds in 20-40 mins

Is an NST invasive?

No, Noninvasive

Why might there be a loss of FHR reactivity?

fetal sleep cycle (Most Common)

CNS Depression

• hypoxia, acidosis, congenital anomalies

If it is nonreactive for 20 minutes what is done?

Give mom something sugary

test extended up to 40 mins

How often are NSTs performed?

one/twice weekly with certain risk factors

NST Procedure

• Have woman void

• Leopold Maneuver determines fetal postion

• Observe tracing for FHR acceleration of at least 15 BPM above baseline

  • Should see at least 2 that last 15 seconds over 20 minutes

• If criteria aren’t met, test is extended 20-40 mins

What is considered Advanced Maternal Age?

Over 35

When is a Group B Streptococcal Infections screened for?

35-37 weeks

S/S of Group B Streptococcal Infection (GBS)

Asymptomatic

Risks to newborn with GBS

Can cause significant infection

• Sepsis & pneumonia

When is the newborn at risk of coming into contact with GBS?

Vaginal birth and the woman is GBS positive

If woman are positive with GBS what is the intervention?

Treated with IV prophylaxis (Antibiotic: Penicillin) during labor

If no prenatal screening for GBS has been done what is the treatment?

Treated with IV prophylaxis (Antibiotic: Penicillin) during labor

Other reasons why prophylactic antibiotics would be given during labor

Delivery at less than 37 weeks

ROM >18 hours

Intrapartum temp >100.4

Assessments for Preterm labor (PTL)

cervical changes and regular uterine contractions

When is considered preterm labor

20-37 weeks

Who is at risk for preterm labor?

• AMA

• Low socioeconomic

• Abuse

• Hx of preterm

• PPROM

• Infection

• Placenta previa/Abruptio Placenta

• Pre-eclampsia

• DM

• Drug use

• Poor nutrition

• Stress

Dx of PTL

Regular UC

2 cm Dilated

S/S of PTL

Contractions (May be painful/painless)

Lower BACK pain

GT upset: Cramp/diarrhea

Pelvic pressure

Discharge/Bloody show

Management of PTL: Goal

reduce/inhibit strength and frequency of contractions, thus delaying the time of delivery, and optimize fetal status

What type of medications inhibit UC

Tocolytics

When are tocolytics effective?

up to 48 hours

only women whose fetuses would benefit from a 48 hour delay in delivery should receive tocolytic therapy

Why are tocolytics normally used?

When transferring the woman to a higher health care facility

Prolong pregnant to enable dose of steroid (corticosteroid) to improve fetal lung development

Drug class of terbutaline

Beta-2 receptor agonist

Side effects of Terbutaline

Restless, Nervous, Tremor, HA, Angina, HTN, N/V, low K+, pulmonary edema

Priority Assessment for a woman receiving terbutaline

Lung sounds

• Listen for crackles/dyspnea

• Indicate pulmonary edema

Fetal Side effect of terbutaline

Can cross through the placenta

Fetal Tachycardia

When can tocolytics be used?

20 - 34 weeks

Contraindications for tocolytics

Severe pre-eclampsia

Preterm premature ROM

active bleeding

Abnormal FHR

fetal death

What is nesting

A surge of energy women may feel before labor