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Pregnancy related complications-(prev HR Ante-2) STUDENT Spr 2021.pptx

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Pregnancy RelatedComplications(prev. High Risk Antepartum – 2)NURS 368Sharon Hitchcock, DNP, RNCMcKinney Chapters 25, 27, 12–multiples
Outline of Topics CoveredPre-term Labor/Birth (PTL/PTB)Premature Rupture of Membranes (PROM)Incompetent CervixHypertensive Disorders of PregnancyMultiple Gestation
Introduction…
Why…Primer on Public Health Terms and Concepts… Article (D2L) to Read!What are health disparities?What is health equity?What are social determinants of health?Why do social determinants of healthmatter?What is health literacy?How is health literacy linked to healthdisparities?Yes, we are going to test you on these basic terms and concepts!
Pre-term Labor (PTL)/Pre-termBirth (PTB)Labor occurring from 20 to 366/7weeks of gestation(McKinney says 37 6/7 – sources vary)Uterine activity WITH cervical changeIncidence of PTB in US is 9.63%(2017-CDC)Many theories speculate about the onset of labor. Exactetiology of PTL is still not fully understood
Significance of ProblemPrematurity accounts for 75% of allinfant mortalityAt risk for lifelong problemsGreat financial and HUMAN costsDisruptive to the familyRacial/ethnic disparitiescanstockphoto.com
Situations PTL/B May Occur1.*Spontaneous~70-80%2.Medically indicated~25%Preeclampsia, prolonged ROM, diabetes, IUGR, etc.3.Non-medically indicated (elective inductions)* Our main focus here…
Associated/Risk FactorsHx of pre-term labor and delivery – strongest indicator!Maternal disorders such as infection, anemia, HTNdisorders, diabetes, multiple gestation, obesityPsychosocial factorsStress, substance use, domestic violenceLack of social supportAge (<16 or >35)Low socioeconomic status, low education levelGenetic –Familial. Single gene polymorphismsCervical, uterine, placental factorsSee McKinney Table 27.2
Pathophysiology1.Premature activation of thefetalormaternalhypothalamic-pituitary-adrenal (HPA) axis (the stress response)2.Placental abruption (decidual bleeding)-Thrombin activation, inflammation3.Exaggerated inflammatory response/infection-UTI, abnormal vaginal flora, periodontal disease, chorioamnionitis4.Pathological uterine distention5.The above 4 processes may then lead to pathologicalcervicalshortening, dilation, effacement (cervical insufficiency)
Up To Date, 2019
Signs & Symptoms of Pre-term LaborMenstrual like crampingPelvic PressureIntestinal cramping/diarrheaLow backacheChange in or increase of vaginal dischargeSense that something is not right
Other Assessment ComponentsCultures for infectionFetal fibronectin test (next slide)Vaginal exam to check for cervical change/ROMElectronic fetal monitoring for ctx and FHRUltrasound for cervical length –25-35 mm normal length<20 mm strong positivepredictive value>30 mm reliably excludes PTL

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Term
Spring
Professor
ConnieMiller
Tags
Obstetrics, pulmonary edema, eclampsia

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