Antepartum Unit Clinical Questions

Define preterm labor. What are common signs?

Preterm labor is defined as uterine contractions and cervical changes that
occur between 20 and 37 weeks of gestation.
Increase, change or blood in vaginal discharge
Change in cervical dilation
Premature rupture of membranes
Regular uterine contractions with a frequency of every 10 minutes or
greater, lasting 1 hour or longer
3 medications used to treat preterm contractions are: magnesium sulfate,
terbutaline, and nifedipine.
What is a tocolytic?
Tocolytics are medications used to suppress premature labor. They are given
when delivery would result in premature birth.
Why might terbutaline cause an increased heart rate in mom and/or baby?
It is a beta-adrenergic agonist that relaxes uterine smooth muscle by
stimulating beta-2 receptors in the smooth muscle fibers to inhibit uterine
activity. Since it is a beta agonist, it works by stimulating the sympathetic
nervous system. Thus, increasing heart rate.
Why might a patient on nifedipine be at an increased risk for falls?
Nifedipine is a calcium channel blocker and it is used to decrease blood
pressure. It dilates arterioles/veins and a potential side effect is peripheral
edema (swelling in legs). Therefore, it may cause an increased risk of falls.
Magnesium Sulfate is often given to women in preterm labor. How does
this drug work to treat preterm labor?
It relaxes the smooth muscle of the uterus and thus inhibits uterine activity
by suppressing contractions.
When a patient is being given magnesium sulfate, the RN needs to
regularly assess these parameters: I&O, respiratory rate, lung sounds, and
DTRs (usually patellar reflexes). Explain why each should be regularly
assessed and what an abnormal finding might look like.

An order for magnesium sulfate typically begins with a loading dose of 4

grams IV to be given over 30 minutes. If magnesium sulfate is supplied in
a concentration of 1 gram in 25 ml IV fluids, what is the correct rate of
administration for the loading dose?

Why are antibiotics commonly given to women experiencing preterm

labor?

For glucocorticoids given IM to a woman likely to delivery preterm, what

are three benefits to the baby? What are 2 possible adverse effects for
mom?
Betamethasone is a glucocorticoid that is administered IM and requires a 24hr period to be effective. The therapeutic action is to enhance fetal lung
maturity and surfactant production.
Side effects for mom: pulmonary edema and hyperglycemia
For a patient with preterm premature rupture of membranes (pPROM), the
RN needs to assess for signs of chorioamnionitis. What is
chorioamnionitis?
Chorioamnionitis is the infection of the amniotic membranes.
What are 4 clinical (subjective or objective) indications that the patient
might have chorioamnionitis? What should the RN do if she suspects
chorio?
Maternal temperature
Increased maternal or FHR
Foul-smelling fluid or vaginal discharge
Abdominal tenderness
Know that chronic hypertension and preeclampsia are treated
differently and understand why.

What is the most common antihypertensive medication used to treat

chronic hypertension in pregnancy? Why would this medication be the
preferred antihypertensive in pregnancy?

A medication often used for patients who have preeclampsia is magnesium

sulfate. What complication is magnesium sulfate intended to prevent (for
someone with preeclampsia) and how does it do this?

What are some common symptoms (subjective) of preeclampsia?

Define preeclampsia, eclampsia and gestational hypertension and chronic

hypertension. How are they different?

Define hyperemesis gravidarum. How is it usually treated?

What are normal blood glucose values in an adultfasting and 2-hour

postprandial?