Placenta goes into myometrium invasive Placenta percreta Goes completely

Placenta goes into myometrium invasive placenta

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Placenta goes into myometrium invasive Placenta percreta Goes completely through the whole uterus or myometrium Indication
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No cord lengthening after delivery of baby Management Accreta may pass on its own Increta and percreta will not Have to do a c-section and hysterectomy Preterm labor Incidence 1 in 8 babies Born prior to completion of 37th week Premature ROM (PROM) Membranes ruptured prior to beginning of labor (true beginning of labor is contractions) Concern if not preterm: infection -- check temp and pulse every hour Preterm premature ROM (PPROM) Membranes ruptured before completion of 37th week May or may not have contractions afterwards Usually in mothers who smoke Concerns: infection and lung maturity Risk factors for preterm labor Dehydration – hydrate patient via IV hydration if its early Multiple gestation Fetal abnormalities Hx of preterm birth Underweight BV, UTI DM HTN Periodontal disease Poor weight gain Drug use Smoking Hx of cervical surgeries can cause imcopetent cervix DES exposure Predicting preterm births Cervical length 1 inch or smaller or 2cm or shorter Previous hx etiology of PROM + fetal fibronectin (FFN) screening Normally found in cervical and vaginal secretion Normal up to 20 weeks of gestation, should disappear until close to time of labor Preterm may happen if FFN is pos prior to becoming full term Can get a false pos from recent sexual intercourse, STIs, cervical exam, vaginal bleeding, or vaginal infections If pos FFN educate mother she may be put on bedrest and about s/s of preterm labor and come into hospital at the first sign of labor
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If preterm labor is caught early and brethine is given you can stop the labor Management of preterm labor Identify cause Can be as simple as dehydration-- may just need to hydrate PO or IV Steroid therapy for fetal lung maturity Celestone Given 24 hours prior to birth IM Every 6 hours for a total of 4 doses Betamethasone Promote an enzyme that induces that production of surfactant Can cause sodium retention, insomnia, and nervousness Limit activity / bedrest Increase hydration Tocolytics (stops labor) Terbutaline (brethine) Beta adrenergic Decreases effects of smooth muscles so decreases uterine activity Can be given PO, IV, or SC Dose is usually 0.6 mg Nursing imp Anxiety and restlessness Can cause maternal and fetal tachycardia Assess mother for pulmonary edema RR, BP, lung sounds Check pulse before admin Can be given every 4-6 hours If HR is too high may have to hold off Magnesium sulfate o If brethine doesn’t work o Give one dose Labor at < 25 weeks Usually a poor outcome If labor is stopped will most likely happen again A lot of problems for the baby Labor at < 34 weeks Lungs are a little more mature
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