Preterm Labor Lecture Notes PDF

o incompatibility between mother and fetus’s blood. Kernicterus o Higher incidence in babies born before 37 wks as the liver is not fully developed yet. o Dx: Heel prick (total serum bilirubin level) ▪ Check for jaundice every –8-12 hrs in the first 48 hrs and again before 5...

o incompatibility between mother and fetus’s blood. Kernicterus o Higher incidence in babies born before 37 wks as the liver is not fully developed yet. o Dx: Heel prick (total serum bilirubin level) ▪ Check for jaundice every –8-12 hrs in the first 48 hrs and again before 5 days of age o Rx: ▪ Infant put under UV light; increased fluids/milk; extreme case = blood exchange/transfusion o Complications: Athetoid cerebral palsy; hearing loss; vision problems; stained tooth enamel; intellectual disabilities 7. Preterm labor What is it? o MC cause of perinatal morbidity and mortality in the U.S. o Delivery and associated cervical changes occurring before 37 weeks gestation. Sxs: o Spontaneous rupture of membranes (SROM), aka water breaking, before the onset of labor. ▪ 9/10 women go into labor w/in 24 hours of SROM. ▪ If labor has not occurred w/n 24 hrs, an induction of labor is recommended o Premature rupture of membranes (PROM)- membrane rupture after 37 wks gestation o Preterm premature rupture of membranes (PPROM)- occurs before 37 wks gestation Assess Rupture of Membranes (ROM): o * Gold standard for Dx of ROM- pooling of fluid in the vagina, or leakage of fluid from cervix. ▪ * Ferning of the dried fluid under microscopic exam ▪ Alkalinity of the fluid via nitramine paper- turns yellow to blue ▪ Amniotic fluid: pH is 7.1-7.3 Rx: o Bedrest; monitor for: infection, hemorrhage, umbilical cord compression, fetal assessment (serial US and FHR), and labor. o Delivery is recommended w/ any maternal/fetal distress. o * give baby corticosteroids (betamethasone or dexamethasone) for lung development ▪ Single course injection given between 24-34 weeks gestation to those at risk for preterm delivery w/in 7 days ▪ Corticosteroids DECREASE risk of fetal respiratory distress syndrome! Very preterm birth (VPT) o (34 weeks). o Bed rest, hydration, sedation o Weekly IM injections of progesterone in certain women. Monitor mother for: o Infection: GBS (admin intrapartum abx prophylaxis) o chorioamnionitis (prompt delivery; regardless of age!) Chorioamnionitis: amniotic sac is broken for long time before birth, allowing bacteria in the vagina to ascend into the uterus. Complications o for mom: bacteremia, sepsis o for infant: pneumonia, meningitis, brain damage, death. S&S: maternal fever, purulent smelling fluid from cervical os, fetal tachycardia, uterus is tender to palpation. Dx: CBC w/ diff, UA & urine C&S, culture the amniotic fluid, US Rx: Broad spectrum abx (ampicillin and gentamicin; when endometritis is suspected give clindamycin or metronidazole) Metritis What is it? o infection of uterus: endometrium, myometrium or parametrium What causes it? o E. coli, staph, group A/B strep (occurs w/in 10 days post abortion or delivery) S&S: o fever, chills, malaise, abd pain, uterine cramping & tenderness, foul-smelling lochia, tachycardia Dx: o CBC (WBC < 20k); blood cx; UA & urine cx; lochia cx Rx: o Broad spectrum abx, Antipyretics (Tylenol), pain meds Neonatal respiratory distress syndrome (RDS) AKA) hyaline membrane disease What is it? o Occurs in infants whose lungs have not fully developed (born before 37-39 wks) o * Caused by lack of surfactant in lungs ▪ Surfactant is necessary to break alveolar surface tension in fetal lung starting at 20th week. ▪ Without surfactant, alveolar collapse occurs. Infant Assessment: o Assess them immediately after birth for appearance, color and breathing efforts (APTGAR) o Chest x-ray of lungs, blood gas levels (possible low O2 and high CO2), echocardiography (to r/o PDA). o Respiratory support by mechanical vents w/ continuous pos airway pressure is used to prevent  alveoli from collapsing. RX: o can receive surfactant therapy immediately after birth (instilled down the trachea via artificial airway). o Respiratory support via mechanical ventilators w/ cont. positive airway pressure (CRAP) o Despite all effort, infants can develop bronchopulmonary dysplasia 8. Contraception, sterilization & infertility Stats: o 45% of all pregnancies in the U.S. are unintended. o Most occurred in women who didn’t use contraception or used it incorrectly o * Pill, OCPs, OCs, or BC pills = most effective pregnancy prevention ▪ Includes injectable preparations: Implantable rod, IU systems, patches and rings Hormonal Contraceptive Side Effects (discontinue and start a nonhormonal method) o Loss of vision, diplopia; unilateral numbness, weakness; severe chest/neck pain; severe leg pain/tenderness; hemoptysis, acute SOB; hepatic mass, tenderness. Hormonal Contraceptive Side Effects (continue but access why its occurring) o Amenorrhea (possible pregnancy); breast mass (possible cancer); RUQ pain (cholecystitis, cholelithiasis); Severe headache (stroke, migraine headache); galactorrhea (pituitary adenoma) Contraceptives- combo pills What is it? o Most contain combo of estrogen and progesterone o Prevents ovulation, but if ovulation does occur... ▪ Progesterone will thicken the cervical mucus, which inhibits sperm migration, creating an atrophic endometrium (difficulty implanting) ▪ Estrogen will increase the efficacy of the progesterone & stabilize the endometrium o Classic regime is 21 days of active hormones, 7 days of placebo pills. Some pts do a continuous regime giving them only 1 period 3 or 12 months. o Breakthrough bleeding occurs in 30% of women on low dose OCs (usually resolves spontaneously) Counterindications (CI): o * women >35 yrs who smoke; Hx of thromboembolism; Hx of CAD, CHF, CVA; Hx of migraine w/ or w/out aura. Discontinue combo contraceptive pills if: o increased BP or worsening migraines Benefit of the combo pill: o Shorter, less painful periods o lower incidence of endometrial and ovarian Ca, benign breast and ovarian diseases, pelvic infection, ectopic pregnancies, Progestin Only Pills “mini pill” What is it/what does it do? o Makes the cervical mucus thick and relatively impermeable o Take it at approx. the same time every day. If >3hrs late another form of BC must be used for 48 hrs Indicated for: o lactating women; women >40 yrs; when estrogen formulas are CI Transdermal Patch What is it? o combo patch that lasts for 1 week o Start during first 5 days of menses replace weekly X 3 weeks, 4th week is patch free o Place on clean, dry skin (butt, upper outer arm, or lower abd) o * Has decreased efficacy in those >198 lbs Rings What is it? o Releases the same amount of hormones daily o used once a month (place in vagina at start of menses and left in place for 3 weeks) o Withdrawal bleeding occurs w/ removal of ring Diaphragms What is it? o Barrier method and dependent on proper use; o Dome shaped latex device; fits over anterior vaginal wall & cervix. o Inserted 6 hrs prior to sex & left in place for 6-8 hrs after intercourse. However, don’t leave in >24 hrs o * no talcum powder but use the diaphragm in combo w/ contraceptive jelly/cream. o Requires fitting from healthcare Side effects: o higher rate of UTIs Cervical caps What is it? o Barrier method and dependent on proper use; o Covers only the cervix; o easier to displace and harder to fit. o Must remain in place 6 hrs post sex but not >48 hrs. o * Higher incidence of toxic shock syndrome (TSS) and cervicitis Sponges What is it? o Barrier method and dependent on proper use; o Small, pillow-shaped sponge that fits over cervix containing spermicide o Can remain in place for 24 hrs, more effective in nullip women Side Effects: o increased risk of TSS if left >30 hrs Long acting reversible contraceptives What is it? o Includes IUDS and hormone eluting subdermal implants o Very effective (99%) but higher up-front costs Indicated for: o Pts w/ contraindications to estrogen containing compounds o Those who desire rapid return to fertility IUDS * All must be checked for placement in weeks Ideal Candidate: o * Adolescents are ideal candidates per AAP