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1

Late preterm infant

34-47 weeks

2

Very preterm infant

Less than 32 weeks

3

Complex factors overlapping influence preterm labor

Genetics, medical conditions, environmental, psychosocial, infertility treatments, biological factors

4

Select factors of preterm labor

Drugs, tobacco, stress, low income, infection, domestic violence, age <17>35, IVF pregnancy, PROM

5

Warning signs of preterm labor

Contraction every 10 min or more
Vaginal bleeding, ROM
Pelvic pressure. Backache
Cramps that feel like menstrual period

6

Dignities of preterm labor

>20 or <37 weeks gestation
6 or more contractions in one hour AND
ROM or cervical dilation change >1 cm or 80% effaced

7

fFN

Fetal fibronectin-
Glue like protein helps the amniotic sac attach to the lining of uterus.
Cannot use if ROM

8

Contraindications for treating preterm labor

Fetal compromise
Fetal death
Severe maternal disease
Active hemorrhage
Chorioamnionitis
Previable gestation

9

Prevention of preterm birth

Adequate diet
Reduce risk of infection
Eliminate substance abuse
Report to triage if cramps persist

10

Nursing action immediate care of preterm birth

Hydration
Fetal monitoring
UC pattern
Medications
Obtain fFN, vaginal cultures
Monitor cervical dilation

11

Call your doctor or midwife if

Bag of waters breaks
Baby stops moving
Have more than ---- contractions in an hour
Low backache or cramps
Increase discharge
Fever 100.4
Feel something is not right

12

Tocolytic drugs

May prolong pregnancy for 2-7 days allowing steroids to improve fetal lung maturity or maternal transport to another facility

13

Magnesium sulfate

Relaxes smooth muscle
Loading dose 4-6g in 20 minutes, then 2g/hr

14

Magnesium sulfate therapeutic level

5-8mg/dl

15

Magnesium sulfate maternal side effects

PULMONARY EDEMA, headache, flushing, dry mouth, cardiac arrest, diplopia, weakness

16

Magnesium sulfate fetal side effects

Respiratory depression
Hypotonia

17

Magnesium sulfate antidote

Calcium gluconate

18

Nursing implications for magnesium sulfate

Monitor FHT, UC, serum levels, respirations. Output <30 mL per hour

19

Indomethacin naproxen

Depressed synthesis of prostaglandins. Delays delivery for 48+ hours. Used before 32 weeks

20

Indomethacin naproxen doses

Loading dose 50 mg oral then 25-50 mg po q6hrs

21

Contraindications of indomethacin naproxen

Significant renal and hepatic impairment

22

Side effects of indomethacin naproxen MATERNAL

Nausea, heartburn

23

Side effects of indomethacin Naproxen FETAL

Ateriousus constriction, pulmonary hypertension, hemorrhages

24

Nifedipine

Calcium channel blocker

25

Nifedipine dose

10-20 mg PO q4-6 hours

26

Side effects of nifedipine

Hypotension, tachycardia, flushing, HA, nausea

27

Contraindications of nifedipine

Do NOT use with terbutaline or cardiac disease

28

Nursing with nifedipine

May hold dose if BP <90/50
Or HR >120

29

Terbutaline

Beta adrenergic agonist
Suppress uterine activity
Meant for asthma
Can delay delivery for 3 days
Bronchodilator****

30

Terbutaline FDA warning

Injectable not used in pregnant women for prolong or preventable treatment for preterm delivery. Serious maternal heart problems, death