OB Exam 1

What is holistic care?

caring for the whole person, not just the condition

What are the physical aspects of holistic care?

nutrition, rest, discomfort, vitals

What are the emotional aspects of holistic care?

anxiety, fears, labor/parenting

What are psychological aspects of holistic care?

body image, mood changes

What are the social aspects of holistic care?

family support, finances, culture

What is the spiritual aspect of holistic care?

beliefs that affect care decisions

What falls under family care & involvement during a women’s pregnancy?

• partner involvement

• education for family members

• cultural practices

• support from family during labor and postpartum

What does leukorrhea discharge look like, and what is its meaning?

• thin, milky white

• normal in pregnancy

What does yeast discharge look like, and what is its meaning?

• thick, white, cottage cheese

• candidiasis

What does bacterial vaginosis discharge look like, and what is its meaning?

• gray, fishy odor

• Infection

What does trichomoniasis discharge look like, and what is its meaning?

• green/yellow, frothy

• STI

What does bloody discharge look like, and what is its meaning?

• pink/brown/red

• implantation, labor, or complications

How do you calculate a due date using Naegele’s Rule?

• From first day of last menstrual period

• add 7 days

• minus 3 months

• add 1 year

How long is a normal pregnancy in weeks and days?

• 40 weeks

• 280 days

What should you assess at each prenatal visit?

• BP

• Weight

• Urine(protein, glucose)

• Fundal Height

• Fetal Heart Tones(FHT)

• Fetal movement

• Edema

• Review of symptoms (headache, bleeding, pain)

• (These will help to early detect complications such as pre-eclampsia, diabetes, infection)

What is a normal maternal discharge during pregnancy?

Leukorrhea(increased estrogen)

What are the abnormal maternal discharges in pregnancy?

• bloody(abruption, previa)

• watery (rupture of membranes)

• foul-smelling(infection)

What prenatal vitamins should be taken by a pregnant woman?

• folic acid

• iron(prevents anemia)

• calcium(bones)

• Vitamin D

What is the dose for folic acid prenatal, and what does it prevent?

• dose:400-800mcg/day

• prevents neural tube defects

What is the normal range for FHTs?

110-160bpm

What are 3 abnormal findings for FHTs, and what do they signify?

• Tachycardia(>160)-infection, fetal distress

• Bradycardia(<110)-hypoxia

• decelerations-cord compression or uteroplacental insufficiency

What are the 3 strip readings?

• variability

• accelerations(reassuring)

• decelerations(early, variable, late)

What is the quickening? When is it felt?

• fetal movement

• felt around 16 to 20 weeks of gestation

• less movement=fetal distress

What are the 4 fetal positions?

• cephalic(head down)

• breech(buttocks first)

• transverse

• LOA(Left Occiput Anterior)- best for vaginal delivery

What is the bishop score and what does it access?

-used to assess readiness for induction

Assesses:

• cervical dilation

• effacement

• consistency

• position

• fetal station

• score greater or equal to 8=favorable for induction

What is the Biophysical Profile (BPP)and what are its components?

-assess fetal well-being after ultrasound + non-stress test

Components:

• fetal breathing

• movement

• tone

• amniotic fluid

• non-stress test

• Score: 8-10=normal, less than or equal to 6=not good

What are the layers of the fertilized egg from outer to inner& where does the placenta form from?

Outer to inner:

• chorion

• amnion

• yolk sac

• embryo

• placenta forms from chorion

What are the stages of fetal development?

• germinal:0-2wks-implantation

• embryonic:3-8wks-organ formation

• fetal:9wks-birth-growth and maturation

What is parturition(childbirth)?

expulsion or delivery of the fetus, placenta, and fetal membranes from the uterus through the birth canal

When is a preterm birth?

before 37 weeks

When is a post-term birth?

after 42 weeks

What does estrogen help with during pregnancy?

• increases sensitivity of uterus to oxytocin

• helps in ripening of cervix

What does relaxin help with during pregnancy?

• softens ligaments of pelvis

• dilates cervix for easy delivery

What do prostaglandins help with during pregnancy?

• stimulate uterine contractions

• help in cervical dilation

What is the mechanism of parturition (4steps)?

1. fully grown fetus sends signals to mother’s body

2. oxytocin release increases

3. stronger uterine contractions occur

4. more oxytocin is released

(cycle continues until baby is delivered)

What are the signs of parturition?

• regular labor pains

• back pain

• rupture of amniotic fluid

• cervical dilation

• bloody discharge

What is a threatened miscarriage?

• bleeding present

• cervix closed

• pregnancy may continue

• mild abdominal cramps

• Ultrasound: usually viable fetus

What is an inevitable miscarriage?

• bleeding + cramping

• cervix open

• miscarriage cannot be stopped

• products of conception have not yet passed

What is an incomplete micarrage?

• some pregnancy tissue has passed

• some tissue still inside uterus

• cervix open

• heavy bleeding and cramping may continue

What is a complete miscarriage?

• all pregnancy tissue has been expelled

• bleeding stops or decreases

• cervix closed

• uterus empty on ultrasound

What is a missed miscarriage(silent miscarriage)?

• baby has died but no symptoms

• cervix closed

• no bleeding, no pain

• diagnosed by ultrasound(no heartbeat)

What are some emergencies during pregnancy and labor?

• Preeclampsia/Eclampsia

• Placenta previa

• Placental abruption

• Umbilical cord prolapse

• Shoulder dystocia

• Postpartum hemorrhage

What are some warning signs in pregnancy?

• vaginal bleeding (especially heavy or persistent)

• severe abdominal pain (sudden or worsening pain)

• severe headache(persistent, not relieved by rest)

• blurred vision (visual disturbances)

• reduced fetal movements(decreased or absent movements)

• swelling of face or hands(sudden edema, Preeclampsia warning)

• High fever with chills(greater than or equal to 100.4)

• severe vomiting(unable to retain fluids)

• Leakage of fluid per vagina(suspected rupture of membranes)

• breathlessness or chest pain(possible cardiopulmonary cause)

• EARLY RECOGNITION SAVES MOTHER AND BABY

What does prolactin help with in pregnancy?

breast development and milk production

What does oxytocin help with in pregnancy?

• uterine contractions during labor

• milk ejection

What are the effects of balanced female hormones?

• regular menstrual cycles

• healthy fertility

• stable mood and energy

• healthy bones

• normal hair and skin

• proper reproductive function

What are the signs of a hormonal imbalance?

• irregular periods

• acne or hair loss

• weight changes

• low libido

• hot flashes

• infertility

What are the cervical and vaginal signs of pregnancy(3)?

• Goodell’s sign: softening of the cervix (6 wks)

• Chadwick’s sign: bluish color of the cervix and vagina (6-8 wks)

• Osianer’s Sign: pulsation i lateral fornix (8 wks)

What are the uterine signs of pregnancy?

• Hegar’s sign: soft lower uterine segment(uterus feels separate from cervix)

• McDonald’s Sign: uterus flexes on cervix

• Palmer’s Sign: rhythmic contractions

• Piscacek’s Sign: asymmetrical uterine enlargement (site of implantation)

What are the fetal-related signs of pregnancy(2)?

• Ballottement: fetus rebounds on tapping(felt after 16-20 wks)

• Braxton Hicks contractions(after 28 wks)

What are the breast signs of pregnancy(2)?

• Montgomery Tubercles- small, pimple-like bumps on the areola that often enlarge, multiply, and become more prominent during pregnancy (6-8 wks)

• colostrum secretion(16 wks onwards)

What is fetal distress?

compromised fetal oxygenation during pregnancy or labor

What are the causes of fetal distress(4)?

• placental insufficiency

• cord compression

• maternal hypoxia

• prolonged labor

What are the signs of fetal distress(4)?

• abnormal heart rate

- tachycardia (>160bpm)

-bradycardia(<110bpm)

• late and variable decelerations

• meconium-stained amniotic fluid(pea soup)

• reduced fetal movements

What are the immediate management strategies for fetal distress(5)?

• left lateral position

• oxygen to mother

• stop oxytocin

• iv fluids

• expedite delivery

What happens when fetal distress is left untreated(4)?

• fetal hypoxia and acidosis

• low Apgar score

• neurological injury

• stillbirth

What are the pregnancy trimesters?

• 1st trimester(0-12 wks)

• 2nd trimester (13-28 wks)

• 3rd trimester (29-40 wks)

What are the pregnancy blood tests in the 1st trimester(0-12 wks)(5)?

• CBC-anemia and infection

• Blood group and Rh- Rh incompatibility

• TSH- baby brain development

• HIV, HBsAg- maternal infection screening

• Urine Routine- UTI & protein

What are the pregnancy blood tests in the 2nd trimester(13-28 wks)(2)?

• Glucose test(OGTT)-gestational diabetes

• Hemoglobin(Repeat) - worsening anemia

What are the pregnancy blood tests in the 3rd trimester (29-40 wks)(4)?

• hemoglobin(Hb)- late pregnancy anemia

• Urine Routine- preeclampsia risk

• Growth Scan- Baby wt, AFI(amniotic fluid index), placenta

• Doppler(high-risk cases)- blood flow to baby

What are the types of breech(3)?

• frank breech: hips flexed, knees extended (most common)

• complete breech: hips and knees flexed(sitting posture)

• Footling breech: one or both legs extended downward(risk of cord prolapse)

What are the causes of breech(7)?

• prematurity

• multiple pregnancy

• polyhydramnios

• placenta previa

• uterine anomaly

• fetal anomalies

• previous breech

What are the complications of breech for baby(4) and mom(2)?

For Baby:

• birth injury

• cord prolapse

• asphyxia

• head entrapment

For Mom:

• operative delivery

• perineal trauma