Preterm labor

Preterm labor

uterine contractions lead to cervical changes
20 to 37 weeks

Risk Factors

History of PTL
Overstretching of the uterus
- Twins
Infection
Smoking and substance abuse

Signs and symptoms of PTL

Regular uterine contractions
Vaginal discharge
Pelvic pressure
Back pain

What is the #1 priority of PTL?

Reduce risk
1. Assess for hx of PTL
2. Prenatal appointments
3. Smoking and substance cessation

What to assess in PTL?

Cervical changes
- Effacement and dilatation
- Fetal fibronectin

Fetal Fibronectin

sign of placental inflammation
detection <34 weeks indicates PTL within 7 days

Intervention of PTL

Assess cervical changes
Identify and treat possible cause
-infection(give prophylactic antibiotics)
If <34 weeks, administer corticosteroid → fetal lung maturity
For active PTL:
1. Hospital admission to delay delivery
2. Administer tocolytics to slow or stop uterine contractions
3. Fetal monitoring

Tocolytics

Terbatuline
Magnesium Sulfate
Nifedipine
Indomethacin

Preterm newborn care

Pre-warm delivery room
Notify NICU
Gentle stimulation (to stimulate breathing)
Prevent Heat loss (incubator, radiant warmer)
Minimize Stress (cluster care, decrease stimulation)
Nutrition (IV or gavage feeding)

Postpartum Hemorrhage

blood loss of >1,000 ml

What are the 4 Ts of PPH?

Tone
Tissue
Thrombin
Trauma

Tone

Cause: Uterine Atony

Trauma

Cause: Laceration and hematoma

Tissue

Cause: Retained Placenta

Thrombin

Cause: DIC

What do you assess for Tone?

Boggy fundus

What do you assess for Trauma?

Laceration and hematoma

What do you assess for Tissue?

boggy fundus, continuous trickle of blood

What do you assess for Thrombin

excessive bleeding, petechiae

First line treatment for PPH

Oxytocin

Uterine Stimulants for PPH

Oxytocin
Methylergonovine
Carboprost Tromethamine

Methylergonovine

contraindicated for pt with HTN; check for BP

Carboprost Tromethamine

contraindicated for pt with Asthma; bronchoconstrictor

Intervention for tone

Fundal massage
Catheter

Intervention for tissue

laceration repair
ice to hematoma

intervention for trauma

placenta removal

intervention for DIC

blood transfusion

Notify the HCP if pt saturates a perineal pa din <__min. Where should you assess for hidden bleeding?

15 mins; buttocks

A gush of blood from the vagina after prolonged sitting or lying is an expected or unexpected finding?

expected

If the client has petechiae and oozing around VAD sites, the nurse should expect

DIC