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What must be present for true PTL
- Gestational age <37 wksWeight <2500gm
- Regular U/Cs >4/hrCervical changes
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Requirements for PPROM
Membranes rupture <37wks and 1+ hrs before onset of labor
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What are the MAJOR risk factors for PTL?
- Hx of PTL
- Uterine fibroids/anomaly/surgery
- Uterine expansion (multifetal, polyhydramnios
- Pelvic/uterine/severe systemic infection: BV, pyelo, pneumonia
- PPROM
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What are the MINOR risk factors for PTL?
- Substance abuse: drugs/tobacco
- Age extremes <17, >35
- Low SES
- Employment: lifting or standing long hours
- Living situation: abuse, stairs at home
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Neonatal risks with PTD:
- Temp instability (less fat)
- Resp immaturity (apnea, chronic lung disease)
- Cardiovascular: PDA, BP dysregulation
- Hematologic: jaundice, anemia
- GI: difficulty feeding, poor digestion
- Neurologic: poor tone, retinopathy
- infections
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What basic techniques do you want to utilize first with PTL
- Hydration
- Tocolytics
- Antibiotics
- Steroids (Beta-methasone)
- Transport (level III nursery)
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What type of exam is performed to check cervic with suspected PTL
STERILE SPECULUM EXAM
DO NOT USE HANDS
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What is the black box warning for Terbutaline?
If used >3 days potential for serious maternal heart problems and death
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Name some drugs used for tocolysis:
- Nifedipine (CCB)
- MgSO4
- B-mimetics (hypotension risk)
- Progesterone
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What size is the uterus at 7 days, 14 days, and 6 wks?
7 days: 50% weight decrease
14 days: returned to pelvic organ
6 wks: slightly larger than nulliparous
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What is suspected if Lochia Rubra lasts more than 7 days?
There is some retained placenta in uterus
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What are names and colors of lochia
- Rubra - red or pink - up to 7 days
- Serosa - lt brown or yellow - up to 14 days
- Alba - clear
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After how many wks with an open internal os do you suspect retained placental fragments?
6 wks
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When do FSH levels rise and menses usually start?
3 wks FSH begins to rise
6-8 wks menses
79-90% of women ovulate by 12 wks
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What are some physical changes that affect libido?
- Stria gravidarum
- Breast changes
- Abdominal laxity
- FATIGUE
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Name the psychological changes tha have an effect on libido
- Feelings of inadequacy
- Increased dependency on partner
- Role conflict (mother vs lover)
- Work outside home
- daycare issues
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What triggers lactation (milk production)?
- HIGH Prolactin
- LOW Pg and Estrogen
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- dropping Pg&E decreases PIF
Continuation of this is dependent on suckling
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What facilitates let down
Suckling stimulated Oxytocin release from PostPit
- Causing contraction of alveoli
- and Milk expulsion through ducts to sinuses
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What does colostrum contain?
Protein and antibodies
Lower in calories
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Engorgement management for Non-Lactating
- Supportive bra
- Ice packs 3-4x/day
- Motrin or tylenol for pain
- Hand expression
- Cabbage leaves
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Engorgement management for Lactating
- Warm moist towels for 10-15 mins
- warm shower
- Breast massage
- hand express
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Sore nipples management
- Relax
- air dry nipples
- nurse frequently
- rotate infant position
- break suction with finger
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Treatment for Mastitis (staphylococcus)
- Rest
- warm compress
- frequent nursing (start with affected side)
- Antibiotics for fever (beta lactams Amoxicillin and Ceclor)
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Emotional phases posptartum (3)
- 1st month: Fog
- 3rd & 4th: absorbed in infant (loss of adult identity)
- 5th month: external focus possible. Return of sexual feelings. Can attend to others
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