Online Class Day 3

lauren tau nalang ang naiwan...

time is so fast during online class..ive been in from of my laptop since 5pm... i didnt even notice.. i guess this means that i love doing this...


thank u everyone..

Preterm birth is any birth that occurs before the 37th week of pregnancy. It is the cause of many infant deaths and lingering infant illnesses in the United States. Every pregnant woman needs to know about preterm labor and birth—why it happens and what she can do to help prevent it.
Preterm birth occurs in about 12 percent of all pregnancies in the United States, often for reasons we just don't understand. A normal pregnancy should last about 40 weeks. That amount of time gives the baby the best chance to be healthy. A pregnancy that ends between 20 weeks and 37 weeks is considered preterm, and all preterm babies are at significant risk for health problems. The earlier the birth, the greater the risk.

Babies who are born very preterm are at a very high risk for brain problems, breathing problems, digestive problems, and death in the first few days of life. Unfortunately, they also are at risk for problems later in their lives in the form of delayed development and learning problems in school. The effects of premature birth can be devastating throughout the child's life. The earlier in pregnancy a baby is born, the more health problems it is likely to have.

Why Does Preterm Labor Occur?
There are no easy answers. Stress might play a part for some women, personal health history or infection for others, or smoking or drug use for others.
If you have any of these three risk factors, it's especially important for you to know the signs and symptoms of preterm labor and what to do if they occur.

Lifestyle and Environmental Risks
Some studies have found that certain lifestyle and environmental factors may put a woman at greater risk of preterm labor. These factors include:

Late or no prenatal care
Smoking
Drinking alcohol
Using illegal drugs
Exposure to the medication DES
Domestic violence, including physical, sexual or emotional abuse
Lack of social support
Stress
Long working hours with long periods of standing
Medical Risks
Certain medical conditions during pregnancy may increase the likelihood that a woman will have preterm labor. These conditions include:

Urinary tract infections, vaginal infections, sexually transmitted infections and possibly other infections
Diabetes
High blood pressure
Clotting disorders (thrombophilia)
Bleeding from the vagina
Certain birth defects in the baby
Being pregnant with a single fetus after in vitro fertilization (IVF)
Being underweight before pregnancy
Obesity
Short time period between pregnancies (less than 6-9 months between birth and the beginning of the next pregnancy)
Researchers also have identified other risk factors. For instance, African-American women, women younger than 17 or older than 35, and poor women are at greater risk than other women.

Symptoms of Preterm Labor
Remember, preterm labor is any labor that occurs between 20 weeks and 37 weeks of pregnancy. Here are the symptoms:

Contractions (your abdomen tightens like a fist) every 10 minutes or more often
Change in vaginal discharge (leaking fluid or bleeding from your vagina)
Pelvic pressure—the feeling that your baby is pushing down
Low, dull backache
Cramps that feel like your period
Abdominal cramps with or without diarrhea
If you start to have any of these symptoms between 20 weeks and 37 weeks of pregnancy, follow the instructions in the section below "What to do if you have symptoms of preterm labor."

Don't let anyone tell you that these symptoms are "normal discomforts of pregnancy"! If any of them (you don't need to have all of them) happen before your 37th week of pregnancy, you need to do something about it.

What to Do if You Have Symptoms of Preterm Labor?
Call your health care provider or go to the hospital right away if you think you are having preterm labor. Your provider may tell you to:

Come to the office or go to the hospital for evaluation.
Stop what you are doing and rest on your left side for one hour.
Drink 2–3 glasses of water or juice (not coffee or soda).
If the symptoms get worse, or don't go away after one hour, call your health care provider again or go to the hospital. If the symptoms go away, take it easy for the rest of the day. If the symptoms stop but come back, call your health care provider again or go to the hospital.

When you call your provider, be sure to tell the person on the phone that you are concerned about the possibility of preterm labor. The only way your provider can know if preterm labor is starting is by doing an internal examination of your cervix (the bottom of your uterus). If your cervix is opening up (dilating), preterm labor could be beginning.

Teach her the following:

• If you are having signs of preterm labor, drink 2 to 3 glasses of water or juice (be sure it doesn't have caffeine), rest on your left side for an hour, and record the contractions you feel. If the warning signs continue for more than an hour, call your doctor. If they subside, try to relax for the rest of the day and avoid anything that makes the signs recur.

• On the use of the uterine monitoring device
Many women at risk for preterm delivery have benefited from home uterine activity monitoring (HUAM) and preterm labor management services. HUAM is an external monitoring device that a pregnant woman wears on her abdomen twice a day for one hour. The HUAM records contractions that may be too faint for the woman to detect on her own. The data is then transmitted over the phone to a nurse who then analyzes the information. If there are excessive contractions, the physician is then notified.

i came across a mangement that does not recommend coffee as well.. i ponder on it..


Coffee contains theophylline, a beta2 agonist, that promotes brochodilation.
This is also similar to the effect of terbutaline which is a bronchodilator as welll as a tocolytic.. the uterus is beta2 mediated, which is where these medications tka their effect. so why is coffee not recommended when it can also cause tocolysis?

i'll read more again..i am missing something again

Thank you Ara, Thea, Angel, Jenny, Raiza, Meg, and Lauren for participating in our discussion for tonight. It has been a fruitful and great one. Thank you and God Bless. I officially end our discussion. Goodnight.

agree

okie.. i agree to the posts..
thanks for the nice discussion. goodnight.

okay ara.

I agree..

>>For home management of Martha's case, the preparations that can be done are as follows:

Inform Family and client on the medication management (dose, schedule of intake, signs and symptoms of overdose to watch out for); activity restriction; diet; hydration; sexual activity limitations; contraction palpation techniques and signs and symptoms to notify physician.

guys, kindly read my summary for each question. do you agree? any more concerns? and additional information?

FIRST OF ALL, the following signs/symptoms should be felt by the mother before she reaches term i.e. before the 36th week of pregnancy because if the happen after then its no longer PTL

Premature Labor Signs and Symptoms

* A contraction every 10 minutes or more often within one hour (five or more uterine contractions in an hour)
* Watery fluid leaking from your vagina (could indicate that your water bag is broken)
* Menstrual-like cramps
* Low, dull backache
* Pelvic pressure that feels like the baby is pushing down
* Abdominal cramps that may occur with or without diarrhea
* Unusual or sudden increase of vaginal discharge
* Blood from your vagina

so far....

Conservative Measures in Prevention of Preterm Labor

Call health care provider (nurse, doctor or midwife).
Go to the hospital right away.
Stop what the woman is doing and and rest on her left side for one hour.
Drink 2-3 glasses of water or juice (not coffee or soda).


Thea, Angel, Ara and Meg mentioned about the test for preterm delivery through FETAL FIBRONECTIN TEST which is a protein produced during pregnancy and functions as a biological glue, attaching the fetal sac to the uterine lining. In most pregnancies, after 22 weeks, this protein is no longer detected until the end of the last trimester (one to three weeks before labor). Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negative values and a reduced risk of preterm birth, thereby avoiding unnecessary intervention. In women with symptoms of preterm labor, a positive fFN result, while less reliable, allows doctors and patients to take preventive measures to delay labor for as long as possible and to consider labor-suppressing (tocolytic) medications.

for jenny, what is the "clear picture" you are trying to say? can you at least give us examples of topic/discussion/education that you will give the patient?

letting her know that another pre-term delivery or an abortion could be possible if emotional stress and trauma is present as a result of the fight and leaving her partner, as it will affect her and the children financially and emotionally is better than waiting for another life or death situation. Women who have had physical abuse during pregnancy present a large increase in the risk of preterm delivery, independently from a large set of sociodemographic and behavioral characteristics usually recognized as determinants of preterm birth (Rodrigues, Teresa MD; Rocha, Lucia MPH; Barros, Henrique MD, PhD. 2008. American Journal of Obstetrics & Gynecology. 198(2):171e1-171e6, February 2008.
)

nice one loren, but based on your analysis what would be specifically applicable on the case? thanx!

Fetal fibronectin (fFN) is a protein produced during pregnancy and functions as a biological glue, attaching the fetal sac to the uterine lining. During the first trimester and for about half of the second trimester (up to 22 weeks of gestation), fFN is normally present in the cervico-vaginal secretions of pregnant women. In most pregnancies, after 22 weeks, this protein is no longer detected until the end of the last trimester (one to three weeks before labor).

The presence of fFN during weeks 24-34 of a high-risk pregnancy, along with symptoms of labor, suggests that the "glue" may be disintegrating ahead of schedule and alerts doctors to a possibility of preterm delivery.

Fetal Fibronectin (fFN): A Test for Preterm Delivery available at: http://www.marchofdimes.com/professionals/14332_1149.asp

i got my answer from this site: http://www.marchofdimes.com/prematurity/21239_5809.asp

Fetal fibronectin is a protein that acts as a "glue" during pregnancy, attaching the amniotic sac — the fluid-filled membrane that cushions your baby in the uterus — to the lining of the uterus.

Fetal fibronectin is often present in cervical secretions during early pregnancy. Fetal fibronectin also shows up again later in pregnancy, about one to three weeks before labor begins. If the client is being tested for possible preterm labor, the health care provider may test a swab from the woman's cervical canal for the presence of fetal fibronectin. A positive fetal fibronectin test is a clue that the "glue" has been disturbed and the woman is at increased risk of preterm labor.

http://www.ohiohealth.com/bodymayo.cfm?xyzpdqabc=0&id=6&action=detail&ref=4478&hr=Healthy%20Living&topic=Life%20Stages&subtopic=Adult

Fetal Fibronectin (fFN): A Test for Preterm Delivery
The American College of Obstetrics and Gynecology recommends that screening for the presence of fetal fibronectin (fFN) may be useful for some pregnant women with symptoms of preterm labor (1). The presence of fFN in the cervico-vaginal secretions of symptomatic women during weeks 24 through 34 of gestation (5 1/2 to 8 1/2 months) indicates an increased risk of preterm delivery. However, the absence of fFN is a much more reliable predictor, indicating that the pregnancy is likely to continue for at least another two weeks.

The Role of Fetal Fibronectin
Fetal fibronectin (fFN) is a protein produced during pregnancy and functions as a biological glue, attaching the fetal sac to the uterine lining. During the first trimester and for about half of the second trimester (up to 22 weeks of gestation), fFN is normally present in the cervico-vaginal secretions of pregnant women. In most pregnancies, after 22 weeks, this protein is no longer detected until the end of the last trimester (one to three weeks before labor).

The presence of fFN during weeks 24-34 of a high-risk pregnancy, along with symptoms of labor, suggests that the "glue" may be disintegrating ahead of schedule and alerts doctors to a possibility of preterm delivery.

A number of factors are associated with a high risk of preterm delivery. Leading risk factors include a previous preterm birth, multiple pregnancy, an incompetent cervix (a cervix that dilates too early in the pregnancy), uterine abnormalities and amniotic fluid infection. Additional risk factors include vaginal infections and sexually transmitted diseases, maternal smoking and drug abuse, poor nutrition, extremes of maternal weight, and lack of prenatal care. Stress, genetic predisposition and environmental toxins may also contribute to preterm delivery.

The fFN Test
A cotton swab is used to collect samples of cervico-vaginal secretions during a speculum examination (similar to a Pap smear). The analysis of the collected sample usually takes less than 24 hours to complete. The result is either positive (fFN is present) or negative (fFN is not present). The results are valid for up to two weeks from the date of the test.

Recommendations
The greatest value of the fFN test is the high level of reliability of a negative test result. According to ACOG, “Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negative values and a reduced risk of preterm birth, thereby avoiding unnecessary intervention” (1)

In women with symptoms of preterm labor, a positive fFN result, while less reliable, allows doctors and patients to take preventive measures to delay labor for as long as possible and to consider labor-suppressing (tocolytic) medications.

If the results of fFN negative screening would affect treatment, testing may also be appropriate for women who are asymptomatic, but at high risk of preterm birth. Screening for these women may be done at 24-34 weeks gestation to assist in clinical management (2). In these cases, a negative test result would help prevent unnecessary medical interventions, such as bedrest, prenatal corticosteroids, cervical cerclage, hospitalization and tocolytics.

ACOG currently does not recommend routine fFN screening of pregnant women, as its use has not been shown to be clinically effective in predicting preterm labor in low-risk, asymptomatic pregnancies.

Signs and symptoms of impending preterm labor that the mother should know.:

persistent, dull, low backache
intestinal crampingPersistent uterine contractions for every 20 minutes
Rupture of membranes
vaginal spotting
feeling of pelvic pressure or abdominal tightening
menstrual like cramping (like menstrual period)
increase vaginal discharge
Abdominal cramps with or without diarrhea

Angel mentioned about the danger signs that need immediate medical advice:

• Fever, chills, dizziness, vomiting or a bad headache
• Blurry vision or spots before eyes
• A significant change in baby’s movement

with regards to her smoking.. i (think) she has been doing it not as an outlet for stress but out of HABIT...

yes, perhaps the boyfriend maybe reminding her to stop but views the situation as "picking fight." the scenario may be biased on her POV

I found research regarding intimate partner violence. It was stated there that women with no formal education were more likely to have experienced IPV than women with some education and above. Furthermore, previous history of sexual abuse, alcohol use by male partner and having a partner with other sexual partners were all independently associated with being a target of IPV. In a study by Paterson et al [29] in New Zealand, education was protective against IPV. Lack of education may result in lack of job opportunity or other income earning potential. In a study by Wilson et al [30] in North Carolina in the United States, despite the small sample size, all 25 women seeking care for IPV studied were unemployed.

BMC Womens Health. 2008; 8: 17.
Published online 2008 October 10. doi: 10.1186/1472-6874-8-17. PMCID: PMC2570659

Joseph Ntaganira: jntaganira@yahoo.com; Adamson S Muula: muula@email.unc.edu; Florence Masaisa: kabasius@yahoo.fr; Fidens Dusabeyezu: dfidens@yahoo.fr; Seter Siziya: ssiziya@yahoo.com; Emmanuel Rudatsikira: erudatsikira@llu.edu
Received January 13, 2008; Accepted October 10, 2008.

Women experience contractions throughout pregnancy, and the frequency of contractions increases as the pregnancy progresses. This can make preterm labor particularly difficult to assess.

In fact, 13% of women with preterm labor have minimal symptoms and 10% of women with normal pregnancies have painful contractions. Further, women may misinterpret the signs of pelvic pressure or abdominal cramps as gas pains, intestinal cramps, or constipation.

Signs and symptoms of preterm labour:
• Bad cramps or stomach pains that don’t go away
• Bleeding, trickle or gush of fluid from vagina
• Lower back pain/pressure, or a change in lower backache
• A feeling that the baby is pushing down
• Contractions or change in the number of them
• An increase in the amount of vaginal discharge
• Contractions may feel more regular, do not go away if you move or lie down
Some women may just feel that “something is not right”
They should also need medical advice if they have:
• Fever, chills, dizziness, vomiting or a bad headache
• Blurry vision or spots before eyes
• A significant chane in baby’s movement

Preterm Labour: Signs and symptoms. Available at: http://www.beststart.org/resources/rep_health/pdf/preterm_broch_eng_04.pdf

this are the warning signs we can give her so as she can detect if she's having premature labor

-if she experiences contractions (the feeling of the abdomen tightening like a fist) every 10 minutes or more often.
- if she observes that there are changes in vaginal discharge (leaking fluid or bleeding from her vagina)
- presence of pelvic pressure—the feeling that her baby is pushing down
- she experiences low, dull backache
- she's having cramps that feels like she's having her menstrual period
- she also experiences bdominal cramps with or without diarrhea.

If she experiences any of these then she must;

-Call her health care provider (nurse, doctor or midwife) or go to the hospital right away. (even if she have only one sign.)

- Stop what she was doing. Rest on her left side for one hour.

- Drink 2-3 glasses of water or juice (not coffee or soda).

- remind her that if the symptoms get worse or do not go away after one hour, she has to call her provider again or go to the hospital. If the symptoms get better, relax for the rest of the day.

possible health teachings to the woman is she is experiencing the signs and symptoms:

>The woman should be on bedrest with bathroom priveleges to relieve the pressure of the fetus to the baby.
>Monitor the fetal heart rate and uterine contractions daily.
>TAke the prescribed tocolytic medication on time to maintain constant blood level.
>Avoid activities that could stimulate labor (nipple stimulation).
>Consult primary health care provider on concerns about sexual relations.
>Immediately report/consult to the doctor if there are: ruptured membranes, vaginal bleeding, UTI, pulmunary congestion due to tocolytic drugs use.
>Keep self well hydrated.
>If uterine contractions occur: Telephone health care provider to report incident and ask further care measures.