PPN 301 WEEK 5; LABOR AT RISK 4TH
TRIMESTER AND EARLY
POSTPARTUM
Preterm Labour - ANSWER cervical changes with uterine contraction
occurring between 20-37
Rate is higher among patients younger than 18 years of age or older
than 35 years
Preterm Birth - ANSWER Any birth occurring before 37 weeks
completion of pregnancy regardless of the weight of the infant
Causes of Preterm Labour - ANSWER Infections
Vaginal bleeding
Hormone changes
Stretching of the uterus.
Signs and Symptoms of Preterm labour
Uterine Activity - ANSWER Uterine contractions more frequent than
every 10 minutes, persisting for 1 hour or more
Uterine contractions painful or painless
Signs and Symptoms of Preterm labour
Discomfort - ANSWER Lower abdominal cramping similar to gas pains;
may be accompanied by diarrhea
Dull, intermittent low back pain (below the waist)
Painful, menstrual-like cramps
Suprapubic pain or pressure
Pelvic pressure or heaviness; feeling that "baby is pushing down"
Urinary frequency
Signs and Symptoms of Preterm labour
Vaginal Discharge - ANSWER Change in character and amount of usual
discharge: thicker (mucoid) or thinner (watery), bloody, brown or
colourless, increased amount, odour
,Predicting preterm labour and birth
Fetal fibronectin test (FFN)
Cervical length <30mm are risk preterm labour
Combination of both is better
Suppression of uterine activity
Tocolytics -used suppress labour -(no specific medication approved in
Canada)
Nifedipine, indomethacin, magnesium sulphate - ANSWER Tocolytics -
used suppress labour -(no specific medication approved in Canada)
Nifedipine, indomethacin, magnesium sulphate
Early recognition and diagnosis is based on three major diagnostic
criteria: - ANSWER 1. Gestational age between 20 and 36 6/7 weeks
2. Regular uterine activity, accompanied by a cervical change
3. Initial presentation with regular contractions and cervical dilation of 2
cm or greater
Contraindications of Tocolytics
Maternal - ANSWER Severe pre-eclampsia or severe gestational
hypertension
Significant vaginal bleeding
Intrauterine infection (chorioamnionitis)
Cardiac disease
Medical or obstetrical condition that contraindicates continuation of
pregnancy
Contraindications of Tocolytics
fetal - ANSWER Gestational age of 37 weeks or more
Fetal demise
Lethal fetal anomaly
Evidence of acute or chronic fetal compromise
Promotion of fetal lung maturity - ANSWER Antenatal glucocorticoids
to accelerate fetal lung maturity by stimulating fetal surfactant
production.
, Management of inevitable preterm birth - ANSWER magnesium sulphate
may be administered to reduce or prevent newborn neurological
morbidity
Nursing Care for a Patient Receiving Tocolytic Therapy - ANSWER
position patient in lateral position to enhance placental perfusion and
reduce pressure on the cervix.
Monitor vital signs, including lung sounds and respiratory effort, fetal
heart rate and pattern, and labour status according to hospital protocol
and professional standards.
Assess labouring patient and fetus for signs of adverse reactions related
to the tocolytic medication(s) being administered (see Medication Guide:
Tocolytic Therapy for Preterm Labour).
Determine labouring patient's fluid balance by measuring intake and
output.
Provide psychosocial support to the patient and their family as well as
opportunities for them to express feelings and concerns.
Education on early prererm labour signs and actions - ANSWER Stop
what you are doing.
Empty your bladder.
Drink two to three glasses of water or juice.
Lie down on your side for 1 hour.
Palpate for contractions.
If symptoms continue, call your health care provider or go to the hospital.
If symptoms go away, resume light activity but not what you were doing
when the symptoms began.
If symptoms return, call your health care provider or go to the hospital.
If any of the following symptoms occur, call your health care provider or
go to the hospital immediately:
Uterine contractions every 10 minutes or less for 1 hour or more
Vaginal bleeding
Fluid leaking from the vagina
Preterm Premature rupture Of Membranes RPROM - ANSWER -Is the
spontaneous rupture of the amniotic sac and leakage of amniotic fluid
beginning before the onset of labour at any gestational age.
TRIMESTER AND EARLY
POSTPARTUM
Preterm Labour - ANSWER cervical changes with uterine contraction
occurring between 20-37
Rate is higher among patients younger than 18 years of age or older
than 35 years
Preterm Birth - ANSWER Any birth occurring before 37 weeks
completion of pregnancy regardless of the weight of the infant
Causes of Preterm Labour - ANSWER Infections
Vaginal bleeding
Hormone changes
Stretching of the uterus.
Signs and Symptoms of Preterm labour
Uterine Activity - ANSWER Uterine contractions more frequent than
every 10 minutes, persisting for 1 hour or more
Uterine contractions painful or painless
Signs and Symptoms of Preterm labour
Discomfort - ANSWER Lower abdominal cramping similar to gas pains;
may be accompanied by diarrhea
Dull, intermittent low back pain (below the waist)
Painful, menstrual-like cramps
Suprapubic pain or pressure
Pelvic pressure or heaviness; feeling that "baby is pushing down"
Urinary frequency
Signs and Symptoms of Preterm labour
Vaginal Discharge - ANSWER Change in character and amount of usual
discharge: thicker (mucoid) or thinner (watery), bloody, brown or
colourless, increased amount, odour
,Predicting preterm labour and birth
Fetal fibronectin test (FFN)
Cervical length <30mm are risk preterm labour
Combination of both is better
Suppression of uterine activity
Tocolytics -used suppress labour -(no specific medication approved in
Canada)
Nifedipine, indomethacin, magnesium sulphate - ANSWER Tocolytics -
used suppress labour -(no specific medication approved in Canada)
Nifedipine, indomethacin, magnesium sulphate
Early recognition and diagnosis is based on three major diagnostic
criteria: - ANSWER 1. Gestational age between 20 and 36 6/7 weeks
2. Regular uterine activity, accompanied by a cervical change
3. Initial presentation with regular contractions and cervical dilation of 2
cm or greater
Contraindications of Tocolytics
Maternal - ANSWER Severe pre-eclampsia or severe gestational
hypertension
Significant vaginal bleeding
Intrauterine infection (chorioamnionitis)
Cardiac disease
Medical or obstetrical condition that contraindicates continuation of
pregnancy
Contraindications of Tocolytics
fetal - ANSWER Gestational age of 37 weeks or more
Fetal demise
Lethal fetal anomaly
Evidence of acute or chronic fetal compromise
Promotion of fetal lung maturity - ANSWER Antenatal glucocorticoids
to accelerate fetal lung maturity by stimulating fetal surfactant
production.
, Management of inevitable preterm birth - ANSWER magnesium sulphate
may be administered to reduce or prevent newborn neurological
morbidity
Nursing Care for a Patient Receiving Tocolytic Therapy - ANSWER
position patient in lateral position to enhance placental perfusion and
reduce pressure on the cervix.
Monitor vital signs, including lung sounds and respiratory effort, fetal
heart rate and pattern, and labour status according to hospital protocol
and professional standards.
Assess labouring patient and fetus for signs of adverse reactions related
to the tocolytic medication(s) being administered (see Medication Guide:
Tocolytic Therapy for Preterm Labour).
Determine labouring patient's fluid balance by measuring intake and
output.
Provide psychosocial support to the patient and their family as well as
opportunities for them to express feelings and concerns.
Education on early prererm labour signs and actions - ANSWER Stop
what you are doing.
Empty your bladder.
Drink two to three glasses of water or juice.
Lie down on your side for 1 hour.
Palpate for contractions.
If symptoms continue, call your health care provider or go to the hospital.
If symptoms go away, resume light activity but not what you were doing
when the symptoms began.
If symptoms return, call your health care provider or go to the hospital.
If any of the following symptoms occur, call your health care provider or
go to the hospital immediately:
Uterine contractions every 10 minutes or less for 1 hour or more
Vaginal bleeding
Fluid leaking from the vagina
Preterm Premature rupture Of Membranes RPROM - ANSWER -Is the
spontaneous rupture of the amniotic sac and leakage of amniotic fluid
beginning before the onset of labour at any gestational age.
