pregnancy complications

Common Pregnancy Risk Factors:

- Chronic conditions: HTN, DM, HIV

- Hx of pregnancy complications

- Pregnancy complications: GDM, preeclampsia

- BMI overweight/obese

- Multiple gestation (twins+)

- Age ≤18 or ≥35 (↑ risk: preeclampsia, DM)

Preterm Labor

● Gestation between 20 and 37 weeks

● Uterine activity

● Cervical change

Risk factors for PTL (preterm labor)

● Most common: hx of a previous PTB, nonwhite race, and multiplegestation

● Cause unknown. Infections (BV, UTI, STDs) may be a major factor

Warning Signs of Preterm Labor

- Instruct the patient to call her doctor or midwife or the hospital for any ofthe following:

○ Bag of waters breaks

○ Decreased fetal movement

○ More than 4-6 contractions in an hour

○ Low backache, menstrual-like cramps, pelvic pressure, or -intestinal cramps with or without diarrhea

○ Increased vaginal discharge

○ Fever higher than 100.4°F (38°C)

○ Feeling that something isn't right

Predictors of Preterm Birth

● Fetal fibronectin (FFN) - High incidence of false positives which maybe caused by vaginal exams or intercourse.

● Cervical length less than 25 mm

● History of previous preterm birth

● Presence of infection

Prevention of PTL

● Education on signs and symptoms of PTL

● Lifestyle modifications

● Bedrest, home care, and home contraction monitoring

● Suppression of uterine activity to prevent PTB

tocolytic medications

Terbutaline; ○ Beta- adrenergic receptor agonist works to relax smooth muscle

Used for preterm labor

Side effects: angina, tachycardia, restlessness, tremor

Contraindicated in gestation of 34 weeks or greater (Risk outweighs benefits) and cervical dilation greater than 6 cm.

○ Calcium channel blockers (nifedipine)

- relaxes myometrial muscles

○ NSAID (indomethacin)

○ Magnesium sulfate

- van be used as tocolytic but primarily used for fetal neuroprotection- works to relax smooth muscle

○ ALL have maternal side effects, contraindications

betamethasone

glucocorticosteroid given to enhance fetal lung maturity

contraindications to tocolysis

● Severe preeclampsia or eclampsia

● Intrauterine infection

● Vaginal bleeding

● Dilation greater than 4cm

● Maternal heart disease

● Any medical condition contraindicated during pregnancy

Nursing Care of the Client ReceivingTocolytic Therapy

● Know the potential complications of the medication your patient isreceiving.

● Assess for symptoms of pulmonary edema

○ untreated respiratory arrest will lead to cardiac arrest

● Assess I&O

● Evaluate uterine activity and FHR.

● Provide psychosocial support