1.Nifedipine- considered after 32 weeks to be considered viable. This is what followsindomethacin treatment, usually because of GA> so decrease indomethacin and transitionyou into nifedipine.Magnesium Sulfate-given to preeclamptic patients as a seizure prophylaxis. It is a CNSdepressant, used for fetal neuroprotection, so prevents intracranial hemorrhage in infants. Onlyuse up to 32 weeks only!KNOW HOW TO COUNT RATE FOR MAG SULFATENeuroprotection and CAN act as a tocolytic but not well.Nursing care with women on MgSO4.For women at risk of PTD, MgSO4 provides neuroprotection, specifically against cerebral palsy.Only used up to 32 weeks.See pg 545&554 in your text for nursing considerations.See pg 189, display 7-9 in your text for nursing consideration ns.Use this scenario to answer the last couple questions: Ms. Patel is being treated for preeclampsia.Her orders read: 4 gm Magnesium Sulfate bolus over 20 minutes followed by 2 gm/hourmaintenance dose until 24 hours afterdelivery. You have a 500cc LR bag with 50 gm MgSO4.What rate is your pump set at for the bolus? Include units and time in your answer. What rate isyour pump set at for the maintenance dose? Include units and time in your answer.Principles of Tocolytic Therapy1.Find the fit2.Load first
3.No more than 1 at a time4.Switch after 48 hours- Fit considers gestational age, maternal health factors, and goals of therapy. The use of MgSo4and other tocolytics can be done with understandable caution(Recent research does not support the use of magnesium as a tocolytic)Contraindications for TocolysisAcute fetal compromiseintraamniotic infection,eclampsia or severe preeclampsia- we deliveryIUFD- intrauterine fetal death-lethal anomaly-fetal maturity,placental abruption,PPROM,pulmonary HTN,maternal hemodynamic instabilityPROM PPROM- Risk factorsRisks factors for include previous prom/pproom,cigarette smoking,antenatal bleeding,genital tract infection like BV.Risks of includeinfection, esp for fetus/newbornProlapse- Transverse breech, since head is in the wayDiagnosis hinges on PE (physical exam, so use speculum exam and look for pooling (fluid in theback of vagina) then you do the ferning, nitrazine (dark green or dark blue, amniotic fluid) .Week – most women with prom/pprom will deliver within a week.Debate – when to deliver is debated. No debate regarding infection, abruption, no reassuringFHTs, or high prolapse risk. If none of these exist do not intervene until 34 weeksNursing care for PTLReminder: Get NICU for delivery! Advocate for consults with neonatology, physical therapy (ifstay will be extended), other? These can be long stays – mental health support is critical.
Acute BleedingOverview of Causes of Acute Bleeding in Pregnancy1sttrimester-Spontaneous or induced abortion-Ectopic2ndtrimester- L&D-Placenta previa-Placental abruption-Placenta accrete/precerta-Vasa previa-Uterine rupture-Uterine inversionPostpartum-Postpartum hemorrhageBleeding Disorders-Placenta previaoDefinition: PP placenta is improperly implanted into the lower uterine segment
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