Placenta goes into myometrium invasive placenta

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 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

● 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
●