Chapter 10: Early Onset of Labor PDF

- **Preterm Labor** - Risk Factors - Infections of the urinary tract or vagina, HIV, active herpes infection, or intrauterine infection (infection of the amniotic sac) - Previous preterm birth - Multifetal pregnancy - Smoki...

- **Preterm Labor** - Risk Factors - Infections of the urinary tract or vagina, HIV, active herpes infection, or intrauterine infection (infection of the amniotic sac) - Previous preterm birth - Multifetal pregnancy - Smoking - Substance use - Violence or abuse - Lack of prenatal care - Uterine abnormalities - Low prepregnancy weight - Advanced maternal age - Findings - Uterine contractions - Pressure in the pelvis and menstrual-like cramping - Persistent low backache - Gastrointestinal cramping, sometimes with diarrhea - Urinary frequency - Vaginal discharge - Laboratory Tests/Diagnostic Procedures - Fetal fibronectin - Cervical cultures - CBC - Urinalysis - Vaginal swap - Measure for shortened endocervical length with a UA - Obtain cervical cultures - Biophysical profile - Nursing Care - Activity Restriction - Ensuring Hydration - ID and Treat Infections - Chorioamnionitis - Monitor FHR and Contraction Pattern - FHR greater than 160 can indicate infection - Medications - Nifedipine - Calcium channel blocker - Suppress contractions - Magnesium Sulfate - CNS depressant that relaxes smooth muscles - Terbutaline - Beta-adrenergic agonist used as a tocolytic that relaxes smooth muscles - Indomethacin - Betamethasone - Glucocorticoid that is administered IM - 2 injections 24 hr apart. Effective in 24 hr. - It enhances fetal lung maturity and surfactant production in fetuses between 24 to 34 weeks gestation. - **Early Rupture of Membranes** - Premature Rupture of Membranes (PROM) - Spontaneous rupture of the amniotic membranes prior to the onset of true labor. - Preterm Premature Rupture of Membranes (PPROM) - After 20 weeks if gestation and prior to 37 weeks of gestation. - Risk Factors - Infection - Prior preterm birth - Shortening of the cervix - Second/third trimester bleeding. - Pulmonary or connective tissue disorders - Low BMI - Copper or ascorbic acid deficiencies - Tobacco or substance use - Findings - Gush or leakage of clear fluid from the vagina - Laboratory Tests - A positing nitrazine paper test (blue, pH 6.5 to 7.5) - Or positive ferning rest on amniotic fluid - Nursing Care - Prepare for birth if indicated - Obtain vaginal/rectal cultures for streptococcus - Obtain vaginal cultures for chlamydia and gonorrhoeae. - Limit vaginal exams - Provide reassurance - VS q 2 hr. - Notify provider of temp greater than 100 degrees F - Monitor FHR and uterine contractions - Encourage hydration - Obtain a CBC - Anticipate prescription for 7 day antibiotics - Medications - Ampicillin - Betamethasone - Complications - Infection - Intrauterine infections are the most common - Other Complications - Umbilical cord compression or prolapse - Fetal pulmonary hypoplasia - death - Client Education - Limited activity with bathroom privileges - Hydrate - Self-assessment for uterine contractions - Record daily kick counts - Monitor for foul-smelling vaginal discharge - No sex - Avoid tub baths - Wipe from front to back - Take temp every 4 hr. notify provider with temp greater that 100-degree F.