Ch.7 from notes

• terms
• premature labor
• preterm birth
• late preterm infant
• mod. preterm infant
• very preterm infant
• low birth weight infant
• very low birth weight infant
• extremely low birth weight infant

• preterm labor
• labor that occurs btwn 20-36 weeks gestation
• #1 cause for neonate mortality
• #2 cause for infant cause of mortality

abnormal uterine distention: multifetal pregnancy, plyhydramnios, structural uterine anomolies:uterine contraction, premature rupture of membranes.

decidual hemorrhage:abruption, thromnin activation:uterine contraction, premature rupture of membranes.

activation of maternal fetal HPA axis: prostaglandin production, placental estrogen, stress: uterine contraction, premature rupture of membranes

infection: uterine contractions, breakdown of membranes and cervix: uterine contraction, premature rupture of membranes

• tocolytic drugs (meds that help control uterine contractions)
• bed rest
• intravenous hydration (can get pulmonary edema)
• antibiotic therapy
• corticosteroid therapy (to the babys benefit)
• ex: betamethasone steroid to help mature fetal lungs

magnesium sulfate, nifedipine, terbutaline

magnesium sulfate: depresses myometrium contractility, relaxes smooth muscle of the uterus.

nifedipine: inhibits smooth muscle contractions of uterus by blocking calcium availability for muscle contraction, can delay delivery for 48-72 hrs

terbutaline: beta 2 adrenergic effects to suppress uterine activity, can delay delivery for 3 days

test to tell us if there is any protein in the cervix, if the test is positive then the mom will go into labor within the next 2 weeks

• -dilation greater than 4 cm
• -at risk for pregnancy inducted hypertension
• -lethal fetal anomaly-baby will die anyways
• -severe maternal disease
• -hemorrhage
• -acute fetal distress

purse string suture placed cervically to reinforce a weak cervix

rupture of the chorioamniotic membranes before the onset of labor

rupture of membranes with a premature gestation less than 37 weeks

• greater than 24 hours
• -baby at risk for infection
• -dry birth

• SROM
• -before onset of labor (term)

amniotic fluid infection

postpartal infection of endometrium which causes scar tissue

• -previous PPROM
• -previous preterm delivery
• -bleeding
• -multiple gestation
• -STD's
• -smoking
• -maternal infection: chorioamnionitis and endometritis

• -respiratory distress with PPROM
• -fetal sepsis-ascending pathogens
• -malpresentation
• -prolapsed cord-because cord can come first which is bad
• -non reassuring FHR
• -premature birth
• -cord compression-baby not getting o2
• -fetal deformities if PPROM is less than 26 weeks

mechanical defect in the cervix that results in painless cervical dilation and ballooning of the membranes into the vagina following by expulsion of a premature fetus during the second trimester

• -cerclage (18-20 weeks)may be placed prophylactically before cervical dilation or as needed
• -remove sutures if membranes rupture to decrease infection

pregnancies with more than 1 fetus

• from one zygote that divides in the first week of gestation
• -identical
• -same gender

• -fertilization of 2 eggs
• -may have same or different genders
• -placental types: monochorionic-1 chorion and dichorionic-2 chronions

• -preterm labor and delivery is 50% greater
• -PPROM
• -HTN, preeclampsia
• -gestational diabetes
• -antepartum, hemorrhage, abruptio placenta, placenta previa (placenta covers cervix)
• -anemia
• -SOB, etc
• -pulmonary edema
• -cesarean birth

• -increased morbidity and mortality rates
• -low birth weights
• -decreased intrauterine grown (IUGR)
• -increased fetal anomalies
• -prematurity
• -abnormal presentations
• -increased cord incidents

• vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid base imbalance and starvation ketosis.
• -due to rising chorionic gonadotropin and or estrogen levels

chronic metabolic disease characterized by hyperglycemia as a result of limited or no insulin production

result of autoimmunity of beta cells of the pancreas resulting in absolute insulin deficiency and is managed within insulin

• insulin resistance and inadequate insulin production
• -most prevalent form of diabetes
• -increasing because of obesity
• -controlled with diet, exercise and oral glycemic agents
• -oral hypoglycemic agents are not recommended for use during pregnancy in type 2 diatetic women

diabetes that begins during pregnancy (increased maternal adipose in mom, or increased hormones from placenta)

• hypoglycemia
• HTN, preeclampsia
• preterm labor
• spontaneous abortion
• polyhydramnios
• oligohydramnios
• c section
• infection-because of delayed would healing
• induction of labor

• hypoglycemia
• hypocalcemia/hypo magnesemia
• IUGR
• RDS-resp. disease syndrome
• polycythemia (ruddy(
• hyperbilirubinemia
• prematurity
• congenital defects(mainly heart probs)
• cardiomyopathy
• macrosomia
• stillbirth

• chronic hypertension
• preeclampsia (protein uria), eclampsia(diff.= seizures with eclampsia)
• preeclampsia superimposed on chronic HTN
• gestational hypertension/pregnancy induced hypertension

• pregnancy induced hypertension
• -includes preeclampsia (most common PIH)
• -primigravidas>multiparas
• -obesity
• -multiple gestation
• -family history
• -diabetes mellitus
• -seen more in teens less than 10 and greater in woman over 35
• -most often seen last 10 weeks of gestation, during labor or first 12-18 hours after delivery

• patho: increase arterial BP
• increased peripheral vascular resistance, vasospasms with arteriole vasoconstriction=decrease GFR and deacrease blood flow to all organs
• -cardinal symptoms: hypertension and proteinuria

• mild: preeclampsia: BP increased to 140/90 or greater
• -proteinurea 1+-2+
• -generalized edema of face, hands, ankles

• severe: preeclampsia: BP 160/100 or greater
• -proteinurea 3+-4+
• -oliguria-urine output less than 500 ml in 24 hours
• -increased generalized edema
• -frontal H/A, blurred vision, N/V, EPIGASTRIC PAINNNNNNN (cardinal sign of seizures)

before 20th week of gestation may put the woman at high risk for developing preeclampsia

pre: systemic disease with hypertension accompanied by proteinuria after 20th week of gestataction

eclampsia: convulsive stage

hypertensive women who develop new onset proteinuria before 20th week gestation or sudden uncontrolled hypertension

high blood pressure detected for the first time after mid pregnancy without proteinuria

• hemolysis, elevated liver enzymes, low platelets
• -complication of severe preeclampsia
• -only cure is to deliver

• occurs when placenta attaches to the lower segment of the uterus, near or over the internal os
• -low lying
• -marginal
• -partial
• -total
• -symptoms: painless bright bleeding
• -treatment is dependent on degree of previa

if marginal or low lying-woman may be allowed to labor

changes in FHR and meconium staining of amniotic fluid

if profuse bleeding-fetus is compromised, suffers hypoxia

FHR imperative on admission-if non reassuring FHR=c section

• -ultrasound
• -if no bleeding-bed rest with BRP
• -no vaginal exams because you can puncture the placenta
• -monitor blood loss, pain, contactions, fetal heart rate
• -Maternal VS
• -labs
• -H&H, urine, Rh, T&C
• -have 2 units of blood on hold
• -iv
• -anticipate c section

• -premature separation of normally implanted placenta, may be marginal, partial or complete
• -signs: vaginal bleeding(may not have), hypertonus, hypercontractility, abdominal pain or back pain
• -sudden and severe
• -uterine tenderness
• -uterine contractions

• -hemorrhage
• -DIC
• -preterm delivery
• -shock
• -renal failure

• -perinatal mortality
• -anemia
• -hypoxia
• -brain damage
• -demise

• abnormal implantation of the placenta
• -roots grow deep into the muscle wall of the uterus

invasion of trophoblast is beyond normal boundary

invasion of the trophoblast extends into uterine myometrium

invasion of the trophoblast extents into the uterine musculature and can adhere to other pelvic organs

• -induced
• -elective
• -therapeutic
• -spontaneous

• develops as a result of the blastocyte implanting somewhere other than the endometrial lining of the uterus
• -majority in the fallopian tube

benign proliferating growth of the trophoblast in which the chorionic villi develop...grapelike clusters without a viable fetus

toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex virus