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Placenta goes into myometrium ■invasive○Placenta percreta■Goes completely through the whole uterus or myometrium○Indication
■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 iscontractions) ■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
●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 sulfateoIf brethine doesn’t workoGive 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 ●