5cm cervical length by Trans Vaginal US greater risk of delivery 35 weeks

5cm cervical length by trans vaginal us greater risk

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<2.5cm cervical length (by Trans Vaginal US) greater risk of delivery <35 weeks Contraction frequency alone not diagnostic of preterm labor Fetal fibronectin (fFN) Glycoprotein produced by fetal tissues Check for presence if pt presents with s/s PTL Absence at 20-24 weeks gestation Strong predictor no preterm birth or premature rupture of membranes in the next 2 weeks Presence at 20-34 weeks gestation Possibility of birth Requires further follow up RISK Big 3 Premature ture baby in the past Pregnant with multiples (twins, triplets) Problems with cervix or uterus now or in the past (cervical insufficiency, anatomical complication) Signs/symptoms, nursing assessment S/S (of note are similar to normal labor so always teach to call medical provider and report) Abdominal pain/contractions; menstrual cramps Low, dull backache Pelvic pain/pressure Vaginal bleeding/discharge Urinary frequency N/V/D COMPLICATION Systemic maturation deficiencies in the neonate THERAPY Primary prevention Screening for h/o PTL or S/S Fetal fibronectin Cervical length Diagnosis and treatment of infections Cervical cerclage Progesterone injection in second trimester Promotes uterine relaxation. Secondary Prevention Tocolytic drug therapy Medication to inhibit UC
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Primary goal for tocolysis Delay birth for 48 hours to maximize benefits of steroids or transport to facility with NICU Steroids: betamethasone (to increase maturation of lungs) Given 24-24 weeks 12mg IM, q24 hours x2doses Decreases likelihood of prematurity associated RDS Tocolytic therapy—goal, mechanism of action of 4 major categories, nursing care Beta adrenergic agonist Terbutaline (Brethine) Mechanism: Smooth muscle relaxation Route: IV,IM, SQ, PO Adverse effects: hypotension, tachycardia, palpitations, hyperglycemia Magnesium Sulfate Mechanism: displaces intracellular Calcium thus inhibits UC Route: I V infusion Adverse effects: flushing, feeling warm, HA, nausea, dry mouth, dizziness, lethargy Calcium Channel Blocker Nifedipine (Procardia) *get baseline vitals) Mechanism: decreases calcium into myometrium to inhibit UC Route: PO Adverse effects: r/t arterial dilation, facial flushing, hypotension, tachycardia, HA Prostaglandin Synthetase Inhibitors Indocin (Indomethacin) NSAID Route :PO Adverse Effects: Fetal effects: oligohydramnios, premature closure of ductus arteriosis with prolonged use, not recommended after 34 weeks gestation or for longer than 48 hours CARE Health promotion education S/S PTL UC self eval Call provider if UC or loss of fluid Hospital care Promote rest; VS; FHR with UC Decrease anxiety Arrange conults inf requested Corticosteroid therapy Steroids: betamethasone (to increase maturation of lungs) Given 24-24 weeks 12mg IM, q24 hours x2doses Decreases likelihood of prematurity associated RDS Premature, Prolonged, and Preterm Premature Rupture of Membranes Definition RISK: bleeding/abruption, infection, prior PPROM, incompetent cervix, smoking Premature rupture (PROM) DEFINITION Spontaneous rupture before labor onset any time AFTER 37 completed weeks Prolonged ROM DEFINITION
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