Cervical changes and regular uterine contractions

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Introduction to Probability and Statistics
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Chapter 5 / Exercise 23
Introduction to Probability and Statistics
Beaver/Mendenhall
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Cervical changes and regular uterine contractions occurring between 20-37 weeksoMorbidity and mortalityBecause of technology, NICU and improved medications 50% survival rate at 25 weeks90% survival rate at 28 weeksoSubtle signs/symptomsBack ache, pelvic ache, menstrual-like cramping, increased vaginal discharge oDiagnosis for preterm labor is made when the following criteria is met: Gestation of 20 to 37 weeksDocumented persistent uterine contractions every 4 to 20 minutes or 8 in 1 hourDocument cervical effacement of 80% or greaterCervical dilation of more than 0.4 inch (1cm)Infection has also been implicated in preterm laboroBiochemical markersFetal fibronectin“glue”that attaches the fetus to the uterusSecreted until 20 weeks, their presence between 24 to 34 weekscan be an indication of preterm laborSalivary estriolAn estrogen produced by fetal trophoblastsIn the mother’s saliva –levels have been shown to increase right before a preterm laboroManagement goalsInhibit/reduce contraction strength/frequencyOptimize fetal statusMedications such as Tocolysis – inhibits uterine contractionsoContraindications for TocolyticsHypertension- eclampsia or severe preeclampsiaAntepartum hemorrhageCardiac diseaseGestational age greater than 37 weeks
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Introduction to Probability and Statistics
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Chapter 5 / Exercise 23
Introduction to Probability and Statistics
Beaver/Mendenhall
Expert Verified
11Advanced cervical dilationFetal demisePremature Rupture of Membranes (PROM)oPremature rupture of membranes is defined as rupture of membranes before the onset of labor at any gestational ageoPretermrupture of membranes is defined as rupture of the membranes before 37 weeks- common cause of preterm labor, preterm delivery & chorioamniontisoPreterm prematurerupture of the membranes (PPROM) is defined as a combination of both terms. Rupture occurs before 37 weeksoSigns/symptoms:gush/trickle of fluid from vagina- increased vaginal discharge should be evaluated- decreased in amniotic fluid (oligohydraminos)oManagement factorsEstablish gestational ageUltrasound to assess fetusAssess for advanced labor, infectionIf advanced labor or infection, deliver fetusMaintain bed rest Hypertensive DisordersoMost common medical complication of pregnancyoClassifications:ChronicHypertension before pregnancyor that is diagnosed before the 20thweekBP 140/90Preeclampsia-eclampsia Eclampsia is the grand mal seizures in women with preeclampsia after 20 weeksWith proteinuriaChronic hypertension with superimposed preeclampsiaHypertension before pregnancy with proteinuriaGestational/transientHigh blood pressure without proteinuria first time during in pregnancyBlood pressure falls within normal range by 12 weeks postpartumPreeclampsiaoIncrease in blood pressure AFTER the 20thweekoMultisystem, vasopressive disease that targets the cardiac, renal, hepatic and CNSoDisease of placentaoSPASMSSignificant blood pressure changesProteinuriaArterioles – edemaSignificant lab changes (LFT and platelet count)Multiple organ systems involvedS

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