NSG 3111: Preterm Labor

Preterm labor

Labor occurring between 20-37 weeks gestation; uterine activity, progressive cervical change (80% effacement, 2+ cm cervical dilation)

Fetal fibronectin

Swab vaginal secretions at 24 to 34 weeks; indicates loss of fetal membrane integrity; used to determine preterm labor

30mm

If the endocervical length is less than ____, the patient is at risk for preterm labor

Symptoms of preterm labor

Contractions more frequent than q 10 min lasting an hour, low back ache, pelvic pressure, urinary frequency, change in increase in vaginal discharge

True

True or false? No evidence exists to support bedrest as an effective intervention for preterm labor

Tocolytics

Medications that may delay preterm birth to allow maternal transport

False (no medications are approved as tocolytics, but some are used off label)

True or false? Nifedipine, indomethacin, and nitroglycerin are approved as tocolytics in Canada

Corticosteroids

Which medication is given during preterm labor to promote fetal lung development?

Magnesium sulphate

Which medication is given during preterm labor to reduce uterine contractions and protect the baby's brain?

PROM

Rupture of the membranes/amniotic sac before labor begins

PPROM

PROM before 37 weeks of pregnancy

Preterm infant

Baby born <37 weeks, regardless of birth weight

Extremely preterm

<28 weeks gestation

Very preterm

28 to <32 weeks gestation

Moderately preterm

32 - <34 weeks gestation

Late preterm

34 - <36+6 weeks gestation

Low birth weight

Infant birth weight of ≤2500 grams, regardless of gestational age; caused by preterm birth, intrauterine growth restriction, or both

1500 - 2500g

Low birthweight

1000 - 1499g

Very low birthweight

<1000g

Extremely low birth weight

Small for gestational age

<10th percentile

Symmetric IUGR

Growth restriction in weight, length, and head <10th percentile

Asymmetric IUGR

Growth restriction of weight <10th percentile BUT head and length >10th percentile

Symmetric

Which IUGR is more concerning in terms of fetal health?

Common difficulties of SGA/IUGR infants

Perinatal asphyxia, meconium aspiration, hypoglycemia, polycythemia, hypothermia

Compensation for decrease in oxygenation from placental insufficiency

Why does polycythemia occur in SGA/IUGR infants?

Risks to preterm infants

Infection, respiratory issues, hyperbilirubinemia, retinopathy of prematurity, digestive issues, intraventricular hemorrhage

Necrotizing enterocolitis

Baby's intestines are underdeveloped and vulnerable to blood flow issues and bacterial invasion, causing tissue death in parts of the intestines

Respiratory distress syndrome

Respiratory dysfunction in neonates caused by pulmonary surfactant deficiency; increased risk of intraventricular hemorrhage, tension pneumothorax, bronchopulmonary dysplasia

34-36 weeks

At what gestational age is surfactant produced in adequate amounts?

Treatment for RDS

Prenatal: corticosteroids

Postnatal: Respiratory support (intubation, NCPAP, O2 therapy, intratracheal surfactant)

CPAP

Continuous positive airway pressure; helps keep airways and alveoli open and inflated, often used when baby is grunting

Respiratory effort

What must the baby be showing signs of to use a CPAP machine?

Gavage feeding

Feeding method for infants unable to suck

Birth trauma

Physical injury sustained during labor and birth; caused by prolonged birth, abnormal fetal presentation; may require treatment, may resolve without over time

Clavicle

Which bone is most often fractured during birth?

Brachial plexus injury

Trauma to spinal roots of the 5th cervical nerve to the 1st thoracic nerve; shoulder dystocia, macrosomia, or difficult vertex/breech birth

Torticollis

Spasmodic contraction of the neck muscles, causing stiffness and twisting of the neck; also called wryneck

Sepsis

Presence of microorganism or their toxins in the blood or other tissues; significant cause of NB morbidity/mortality; e-coli (preterm), GBS (term)

Neonatal abstinence syndrome

Spectrum of clinical manifestations seen in neonates due to withdrawal from intrauterine drug exposure; irritability, high pitched cry, poor feeding, diaphoresis, difficulty settling

Finnegan Neonatal Abstinence Scoring System

Assesses /manage withdrawal symptoms in NBs exposed to opioids; 31-line score sheet to measure 21 specific signs and symptoms of withdrawal

Live birth

Regardless of gestation, NB displays signs of life at birth; HR, respiratory effort, movement

Abortion

Spontaneous or therapeutic, fetal demise at <20 weeks gestation and weighing <500 grams

Stillbirth

Fetal demise prior to birth but >20 weeks gestation or fetus weighing 500+ grams

Neonatal death

Death of infant, born alive, within 28 days of life

Phase 1 of grief

Shock an numbness; disbelief, denial, lack of concentration

Phase 2 of grief

Searching and yearning (loneliness, guilt, anger)

Phase 3 of grief

Disorientation (full awareness of loss, social withdrawal, impaired memory/disorganization)

Phase 4 of grief

Reorganization and resolution (functioning, has been search for meaning)