Question

25 y/o presents to Labor and Delivery with complaints of uterine cramping and lower back pain. Denies any vaginal bleeding at this time. Has related history of a preterm birth at 32 weeks gestation with her last pregnancy. The baby is 3 years old now and has no developmental issues. Her current gestational age is 30 weeks. She is O+ and all other lab values are normal. No noted STI's. 1. Group Beta Strep is missing from the labs - most often is obtained at 35 - 37 weeks gestation. 2. Without this information it is often determined to treat the patient anyway - presumptively to protect a premature baby from the risk. 3. What other information would you like to ask her? 4. What nursing intervention will you provide? 5. What screening tests are often obtained to help determine her risk for preterm labor. 6. And if it is determined she is in preterm labor what medications may you want to use with a doctors order? 7. Please also give dose, side effects and possible result of the medication.

Answer 1

1.Group Beta strep B is usually diagnosed in 35 to 37 weeks.Now the patient is in her 32 weeks.it can be checked later.

2.Without knowing correct information,there is no need to start antibiotics.Initiating antibiotic prophylaxis greater than 4 hours before delivery is considered to be adequate antibiotic prophylaxis and is effective in the prevention of transmission of GBS to the fetus.However antibiotic prophylaxis administered at a shorter interval will provide some protection.

3.There is no symptoms of infection in pregnancy for GBS positive in pregnancy.We can collect information through history collection.In the above situation,patient did not have a history of GBS positive.

4.proper history collection(STD's,use of iv drugs,),ask for clinical manifestations like PROM,preterm birth,systemic fetal condition.

5.The main screening tests includes pelvic examination,ultrasound,uterine monitoring,lab tests of vaginal secretions for infections and fetal fibronctin,urine sample examination for presence of bacteria.

6.Medications are corticosteroids(promote baby's lung maturity),steroids,magnesium sulphate(if high risk of delivery between 24 and 32 weeks of pregnancy) Tocolytics to slow down the contractions.surgical procedure cervical encircklage

7.Intramascular administration of betamethasone 12 mg every 24 hours for 2 doses.nifidipine 20 mg orally followed by 20 m orally after 30 minutes.it has fewer maternal side effects than the currently used drugs,and appears to have no adverse fetal effects