How to properly care for Antepartum patients

[BSNbeauty, BSN, RN]

Hello,

I'm new to OB nursing and currently work on PP. We take antepartums as well and haven't had much experience with antepartum patients. I understand how to hook them up on the monitor and perform NSTs. I understand that leaking of fluids is a bad sign as it can indicate PROM. I also understand that abd. cramping is a bad sign too. I know I should make sure mom is well hydrated at all times. Always check their skin for our bedrest moms.

I pretty much have an idea on what to do if there are decels ( fluids, reposition, o2, and etc.) Are there any other signs I should be looking for? Any tips you can offer? If mom does rupture before 24 weeks, does it makes sense to put on a monitor sense the baby is viable?

[klone, MSN, RN]

Women who have PPROMed can remain pregnant for many weeks, so unless it looks like she's in active labor, you should treat it as a viable pregnancy. Even a 23-weeker may be given resuscitative measures at delivery. When we have a woman who presents with PPROM, we monitor her in-house, administer QID NSTs, monitor her WBCs and any s/sx of infection, and then just try to keep her pregnant until either 34 weeks or until she develops chorio.

You should also know how to take care of women on MgSO4. It's no longer given as a tocolytic, but it's used in cases of pre-eclampsia or if a preterm delivery is imminent, they will give it for fetal neuroprotection. Women on mag have very specific needs and need to be monitored closely.

[BSNbeauty, BSN, RN]

Thanks so much for the info. Klone, very informative! So the debate another day was whether moms who are in actively contracting with PROM, and is 22 weeks should be put on a monitor? Some nurses say yes and some say no because the fetus isn't viable.

[klone, MSN, RN]

I would lean towards no, but every situation is different, and consensus needs to be made after a long discussion between the parents, the OBs, and the neonates. Everyone needs to be on board with the plan of care.

[NicuGal, MSN, RN]

It depends on what the parents want, at least where I work it is dependent on that. We do resucitate 22 weekers (that is a whole can of worms). Our fellows go over and speak to the family and tell them odds, outcomes, what things can happen, etc. it is them up to the parents if they want the team to come over.

[L&DRN03]

Since your PP unit cares for AP patient, I'm going to assume you don't get too many high risk OB cases. Having worked on a strickly high risk OB floor we would get anything from PPROM to septic pregnant woman to baby's with severe developmental issues to chronically ill woman (diabetes, HTN, cardiac issues, kidney failure, etc...) who just happen to be pregnant. We've even had a few patients who were on dialysis. The trend seems to be heading to more unhealthy patients who are now becoming pregnant leading to a whole new set of complications we didn't see in the past. With that said find out your Hospital/NICU's policies on viability in pregnancy. Anything pre-viable does not require monitoring of the fetus but you need to make sure to continue to care for the mother. PPROM or bleeding even pre viable can lead to life threatening conditions to mother (chorio, hemorrhage) Also it's always good practice to assess and educate any bedridden patient on preventing DVT's

[BSNbeauty, BSN, RN]

Thank you so much ladies !!!!

[lovemyjoblandd]

The majority (not saying all) are patients that have pylo or stones, preterm labor, or PIH. I'm sure I'm forgetting something common but others can fill in those blanks lol. Having said that each of these require focus assessments depending on the problem. With pylo and stones its mainly pain management, fluid hydration, antibiotics, and filtering the urine for stones, watching for sepsis. Preterm laborers I would think would stay in L&D for betamethasone and tocolytics, CEFM, and signs of progressing. PIH is gonna be the one you really need to study up on if you will be managing their care. DTRs, Mag management, lab values and what they mean, signs of HELLP and DIC.