gyno/OB --> obstetrics portion

what is obstetrics

branch of medicine and surgery concerned with childbirth and care of women giving birth

what complications do obstetricians handle during pregnancy

ectopic pregnancy

fetal distress

placental problems

pre ecamplsia

true/false: OB is there during delivery of the baby to handle complications that may arise before/after birth

true

what year was the first successful C section

1500

when was the American Association of OB and Gyno established

1888

when was spinal anesthesia first used in labor

1900

what year were there less than 5% births were in the hospital

1900

when was a lower uterine incision for C section introduced

1921

what year did thalidomine babies occur

1956

when were X-rays considered ok on pregnany women

1950-73

what year were ultrasounds introduced

1973

how many days does the sperm have to join the egg before it dies

6 days

it can take up to ___ to fertilize an egg after sex

6 days

when does the blastocyte get into the uterus

3-4 days post fertilization

what is implantation

ball of cells floats in uterus for a couple days and attaches to uterus

the _____ develops from the cells on the inside and the ____ develops from the cells on the outside of the "ball"

embryo

placenta

what are early signs of pregnancy

-missed period*

-swollen/tender breasts

-nausea and/or vomiting

-fatigue

-bloating

-constipation

-frequent urination (more than usual)

what is the first trimester

first 13 weeks or 3 months of pregnancy

true/false: most women know they are pregnant within the first few weeks

false

overall: what is happening during the first trimester, and what part of the team will be found?

no prominent baby bump

uterus expanding & blood volume increasing

-find OB +/or midwife

what forms during week 1-4 of pregnancy

-amniotic sac, placenta, and umbilical cord

-neural tube (brain + sc)

what dorms during week 5-8 of pregnancy

-major organs start*: lungs, heart, eyes, arms, legs

-bone replace tissue

what forms during weeks 9-12 of pregnancy

fetus now has toes, fingers, nails

urinary and digestive system function fully

when is the fetal heart beat present

around 12 weeks

what pregnancy symptoms possible during the first trimester

-sore breasts*

-nausea

-mood swings

-tired

-needing to pee

-acne or skin changes

-mild shortness or breath

what happens during the first trimester visit with OB

-physical exam

-pelvic exam

-pap test (if due)

-check for STIs

-urine test (bacteria, protein, glucose)

-blood test (Rh factor, iron, hormone levels)

-fetal heart rate

-screening tests (check fetal risk)

when is the second trimester

weeks 14-27

Overall characteristics of the second trimester

"Best part of pregnancy"

bump starts to show

morning sickness, fatigue start to fade

fetal development has progressed how in the second trimester

more like a human baby*

facial features forming

fingers and toes start defining

fetus moving more

when can the sex of the fetus be determined

around week 20

(anatomy ultrasound)

what are pregnancy symptoms possible during the second trimester

-increased appetite*

-achy body

-swelling of hands, feet, ankles

-stretch marks

what are OB visits during the second trimester for

test for:

-Rh factor

-gestational diabetes

-ultrasound to check for anatomy

(also determine birth plan)

what are signs and symptoms around the third trimester (~wk 28+)

-braxton hicks contractions* (pseudo contractions)

-backaches

-shortness of breath

-heartburn

-varicose veins and hemorrhoids

-frequent urination

what is the frequency of OB visits during the third trimester

starting at week 32: every 2 weeks

after week 36: every week

what screening is done during third trimester

-gestational diabetes

-iron deficiency anemia

-group B strep

check weight and blood pressure

maybe administer the Tdap vax

what is the purpose of the webster technique

detect and correct sacral subluxation and sacro iliac joint dysfunction

(flow is: bone, muscle, ligament)

what is the first step of webster technique

place pregnancy pillows depending on how far along patient is

what is patient position for webster technique the first part

ask patient to kneel at foot of table

instruct patient to lay down guiding them if needed

make sure patient's neck is in neutral and each ASIS is positioned equally on pillows

ask if comfortable and if patient has knee problems, injury, or surgery

What is doctor stance for the first part of Webster

-at the foot of the table, grasp ankles equally bringing both knees into flexion and the feet towards the buttock

-apply equal pressure to both legs to determine the more resistant leg.

-be careful not to rotate or let the feet touch each other.

what does the leg with more resistance indicate

sacral rotation --> posterior sacrum [positive]

(AI sacrum is the opp side of leg restriction)

what is the contact point for the prone sacral adjustment

*Same side of resistant leg

-sacral notch --> lateral and slightly inferior to S2 tubercle

what is the LOC for webster adjustment

P-A, 1 drop

(Want to post-check for equalization of resistance)

what is the prone muscle work for webster

piriformis sweep (after sacrum adjust)

Find the tighter one: perform 3-5 times

what is the prone ligament work for webster

logan sacrotuberous ligament contact and correction on opposite side of webster + side (AI side)

What is the "loc" for the prone ligament work

Pull up

want M-L, A-P

Patient and doctor position for the second part of Webster

Patient supine

Doctor at foot of table

Sequence for finding the supine adjustment side

Supine leg check, hopefully even

Place fist between patient's knees and have them squeeze knees together

what does one leg becoming short indicate when you ask the patient to squeeze your fist with their knees

superior pubic bone side

what is the supine bone adjustment for webster

Superior pubic bone, S-I

-activator best (or one hand), NO DROP due to laxity

how do you find the side of psoas tightness

traction arms above their head in superior direction, palms together, check for shorter hand --> contracted psoas side

what is supine muscle work for webster

psoas on short hand side

-bend patient’s knee and place on doctor’s sternum

-wrap inferior hand around top of ASIS/iliac crest (knife edge) and pump the patient's leg headward

(Watch for discomfort!)

where is the round ligament found

intersection between belly button and ASIS

-inferior and lateral 45 degrees from belly button

-inferior and medial 45 degrees from ASIS

what is the supine ligament work for webster

round ligament

-usually opp side of positive webster

-look for tightness then:

hold I-S contact until ligament relaxes (~3 minutes max)

rotate thumb in counter clockwise motion

what is ectopic pregnancy

fertilized egg implants and grows outside of main cavity of uterus

where do most ectopic pregnancies occur

fallopian tube (tubal pregnancy)

Other places ectopic pregnancy can happen

Ovary, abdominal cavity, lower part of uterus (cervix)

T/F: the fertilized egg can't survive and grow during an ectopic pregnancy

true

what are early signs of ectopic pregnnacy

-missed period

-breast tenderness

-nausea

Warning: light vaginal bleeding with pelvic pain

what are emergency symptoms of ectopic pregnancy

heavy internal bleeding causing:

-extreme lightheadedness

-fainting

-shock

what are risk factors for ectopic pregnancy

-previous ectopic pregnancy

-inflammation or infection

-fertility treatments (IVF)

-tubal surgery

-choice of birth control (IUD, ligation)

-smoking

what is prevention for ectopic pregnancy

-limiting number of sexual partners

-using condom to prevent STIs

-don't smoke

how do you diagnose ectopic pregnancy

pregnancy test

ultrasound

other blood tests

what is treatment for ectopic pregnancy

-medication (methotrexate)

-laparoscopic procedures (salpingectomy, salpingostomy)

-emergency surgery

what is miscarriage

spontaneous loss of pregnancy before 20th weeks

Rvw: what is spontaneous loss after 20 weeks

Stillbirth

what are symptoms of miscarriage

-vaginal spotting/bleeding

-pain or cramping in abdomen or low back

-fluid or tissue passing from vagina

what are causes of miscarriage

-blighted ovum (yolk in sac, but nothing there)

-intrauterine fetal demise (stopped developing)

-*molar pregnancy* (both chrom from father) and partial molar pregnancy (2 chrom from father, 1 from mother)

what maternal health conditions can cause miscarriage

-uncontrolled diabetes

-infections

-hormone problems

-uterus or cervix problems

-thryoid disease

what does NOT cause miscarriage

-exercise

-sexual intercourse

-working

what are risk factors for miscarriage

-age (25% @ 35; 40% @ 40; 80% @45)

-previous miscarriage

-chronic conditions

-uterine or cervix problems

-smoking, alcohol, illicit drug use

-weight (either extreme)

-invasive prenatal tests

what are complications of miscarriage

fever

chills

lower abdomen tenderness

foul smelling discharge*

what is prevention of miscarriage

seek regular prenatal care

avoid smoking, drinking, illicit drug use

take daily prenatal vitamins

limit caffeine intake

how do you diagnose miscarriage

pelvic exam

ultrasound

blood tests

tissue tests (if tissue is passed)

chromosomal tests*

Threatened miscarriage

Bleeding but cervix not dilated

Tx: rest, no exercise, no travel

Inevitable miscarriage

Bleeding + cramping + cervix dilated

Tx: allow it progress

Incomplete miscarriage

May pass fetal/placental material, some stay inside

Missed miscarriage

Placenta + embryonic tissue stay in uterus

Tx: D+C surgery

Complete miscarriage

Pass all pregnancy tissues (before 12 weeks)

Septic miscarriage

Sepsis -> infection

Fetus caused damage or necrotized

Tx: D+C surgery

What is the PUPPP rash

pruritic urticarial papules and plaques

-hive like rash

-harmless, but painful

when does PUPPP rash show up

35 weeks gestation

(1/160 preg)

when does PUPPP rash go away

when the baby is born

what causes PUPPP rash

no known cause

how does pemphigoid gestations (PG) differ from PUPPP rash

PG causes itchy hives like PUPPP

-PG is rarer and more concerning and can cause pregnancy complications

what increases chances of getting PUPPP rash

-caucasian

-carrying a male fetus

-first pregnancy

-carrying twins or triplets

what are symptoms of PUPPP rash

-scattered itchy bumps on or near stretch marks on belly

-rash spreads to thighs, butt, breasts, arms

-less melanin: look pink or red

-more melanin: same color of skin or darker

-itching from rash makes it thought to focus on sleep

what are home remedies for PUPPP rash

-oatmeal bath

-take cool baths or showers

-apply fragrance free moisturizer

-wear light weight, cotton clothes

-use cold compresses on bumps or rash

what medications can be used to treat PUPPP rash

-anti itch creams

-antihistamine pills

-corticosteroids

what is gestational diabetes

diabetes diagnosed for the first time during pregnancy

affects how blood cells use glucose

-maybe xp increased thirst and urinary frequency

what are risk factors for gestational diabetes

-being overweight or obese

-not being physically active

-having prediabetes

-having gestational diabetes during previous pregnancy

-having PCOS

-having immediate family member with diabetes

-having previously delivered a baby weighing more than 9 pounds

-being certain race or ethnicity (Afro-American, Hispanic, native, Asian-American)

what are complications of gestational diabetes that may affect the baby

-excessive birth weight (>9 lbs)

-preterm birth

-breathing difficulties

-low blood sugar

-obesity and type 2 diabetes

-stillbirth

what are complications of gestational diabetes that may affect the mom

-high blood pressure/preeclampsia

-having surgical delivery (trouble inducing)

-future diabetes*

what is prevention of gestational diabetes

eat healthy food

keep active during pregnancy

start pregnancy at a healthy weight

do not gain more weight than recommended

how do you diagnose gestational diabetes

-screened between 24-48 weeks gestation (earlier if needed)

-initial glucose challenge test

-follow up glucose tolerance test

what is treatment for gestational diabetes

-lifestyle changes

-blood sugar monitoring

-medication (if necessary)

what are symptoms of preeclampsia

-excess protein in urine and other signs of kidney problems

-decreased levels of platelets in blood

-increased liver enzymes = liver issue

-severe headaches

-changes in vision

-shortness of breath

-pain in upper belly

-nausea or vomiting

-high blood pressure

what causes preeclampsia

begins in placenta

what are higher risk factors for preeclampsia

-preeclampsia in previous pregnancy

-being pregnant with more than one baby

-chronic high blood pressure

-type 1 or 2 diabetes pre-pregnancy

-kidney disease

-autoimmune disorders

-use of IVF

what are moderate risk factors of preeclampsia

-first pregnancy

-obesity

-family history

-maternal age 35 or higher

-complications in previous pregnancy

-more than 10 years since previous pregnancy

what are complications of preeclampsia

-fetal growth restriction

-preterm birth

-placental abruption (sep from uterus)

-HELLP syndrome (hemolysis, elev. liver enzymes, low platelets)

-eclampsia (onset of seizure or coma)

-organ damage

-cardiovascular disease

-*postclampsia (headaches, high BP, proteinuria)