5cm cervical length by trans vaginal us greater risk

<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

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