CH 42 Obstetrics

Is pregnancy considered a disease?

No, pregnancy is not a disease needing treatment.

What has modern medicine achieved in obstetrics?

Modern medicine has significantly reduced maternal and infant mortality rates.

What are the main female reproductive organs?

Ovaries, fallopian tubes, uterus, cervix, vagina, mammary glands, external genitalia.

How many follicles does each ovary contain?

About 200,000 follicles.

What hormones are released by the anterior pituitary gland?

Follicle-stimulating hormone and luteinizing hormone.

What signals uterine contractions and labor at the end of pregnancy?

Prostaglandins and oxytocin.

How does the ovum travel from the ovaries to the uterus?

Through the fallopian tubes via ciliary motion and smooth muscle contractions.

What develops from a fertilized egg?

An embryo and then a fetus.

Where does the fertilized ovum implant?

In the uterus.

What are the three layers of tissues in the uterus?

Perimetrium, myometrium, endometrium.

What are the functions of the vagina?

Receptacle for penis during intercourse, passage for menstrual flow, and childbirth.

What can happen if the vagina does not stretch enough during childbirth?

Tissues in and around the perineum can tear, causing significant pain and bleeding.

What is the primary purpose of mammary glands?

Lactation.

What signs indicate that a woman is most likely pregnant?

Breast enlargement, tenderness, and milk excretion.

What happens to the blastocyst after fertilization?

It migrates to the endometrial wall and becomes implanted.

What does the corpus luteum produce to support pregnancy?

Hormones until the placenta develops.

What major developments occur two weeks after conception?

The blastocyst evolves into an embryonic disc, and the embryo begins to draw on maternal circulation.

What functions does the placenta serve?

Acts as an early liver, produces antibodies, functions as fetal lungs, transports nutrients, excretes wastes, and forms a barrier against harmful substances.

What connects the fetus and placenta?

The umbilical cord.

What encloses the fetus in amniotic fluid?

The amniotic sac.

What is the normal gestational period?

38 weeks.

What significant changes occur in the uterus during pregnancy?

It increases in weight from about 70 g to 1100-1200 g and its fluid capacity increases from about 10 mL to 5000 mL.

What can measurement of the fundus indicate?

Uterine growth problems, breech position, or twins.

What happens to the smooth muscle in the GI tract during pregnancy?

It relaxes, causing the stomach to not empty as quickly.

What changes occur in the kidneys during pregnancy?

They increase in size and volume, and ureters increase in diameter.

What hormonal changes occur during pregnancy?

Hormones cause changes to the skin, hair, and eyes.

What is the percentage increase in blood volume during pregnancy?

Up to 50% more

What are the primary reasons for the increase in blood volume during pregnancy?

To meet fetal metabolic needs, adequately perfuse maternal organs, and help compensate for blood loss in delivery.

What changes occur in the number of blood cells during pregnancy?

The number of red and white blood cells increases.

What happens to clotting factors during pregnancy?

Clotting factors and concentrations of fibrinogen increase.

How does heart rate change by term during pregnancy?

It gradually increases by an average of 15 to 20 beats/min.

What ECG changes may occur during pregnancy?

Ectopic beats, supraventricular tachycardia, slight left axis deviation, and lead III changes.

What effect does lying supine have on a pregnant woman?

It can cause compression of the inferior vena cava, decreasing cardiac output if pressure is not relieved.

What is the standard birthing position in the United States?

The lithotomy position.

How does the diaphragm change during pregnancy?

It is pushed up by the uterus.

What hormone decreases the threshold to carbon dioxide during pregnancy?

Progesterone.

What respiratory changes occur during pregnancy?

Decreased expiratory reserve volume, functional residual capacity, and residual volume; increased tidal volume and inspiratory reserve volume.

What structural changes occur in the respiratory mucous membranes during pregnancy?

Increased vascularity and edema.

What is the average weight gain during pregnancy?

27 lb (12.3 kg).

What physiological changes contribute to maternal metabolism during pregnancy?

Increased blood volume, uterine growth, placental and fetal growth, and increased breast tissue.

What role does relaxin play during pregnancy?

It softens collagenous tissues and relaxes the ligamentous system.

What is gravidity?

The number of times a woman has been pregnant.

What does parity refer to in obstetrics?

The delivery of an infant who is alive.

What is a primigravida?

A woman who is pregnant for the first time.

What does multipara mean?

A woman who has had two or more deliveries.

What is the purpose of the AVPU scale in primary assessment?

To determine the level of consciousness.

What should be assessed early for life-threatening conditions during pregnancy?

Circulation and life-threatening bleeding.

What is the recommended transport position for a pregnant woman when not in imminent labor?

Lying on the left side.

What does the SAMPLE history acronym stand for?

Signs and symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up to the present illness/injury.

What are Braxton-Hicks contractions?

False labor contractions that occur every 10-20 minutes during the third trimester.

What should be determined if a woman's water has broken?

The color of the fluid.

What vital signs should be assessed for imminent delivery?

The woman's vital signs and fetal heart tones.

What position should a patient be placed in if there is time to reach the hospital for imminent delivery?

Left lateral recumbent position.

What should be done if there is not enough time to reach the hospital for delivery?

Find a private and clean area, allow support persons, and dismiss nonessential people.

What ongoing examinations should be performed during reassessment?

Vital signs, fetal heart rate, timing contractions, and checking interventions.

What should be done if delivery does not occur within 30 minutes or a complication occurs?

Notify staff and provide rapid transport.

What are the potential effects of illicit drugs on pregnancy?

Birth defects, addiction, and withdrawal signs.

What is Supine Hypotensive Syndrome?

A condition where the uterus compresses the inferior vena cava, diminishing venous blood return and potentially causing hypotension and fetal distress.

How can Supine Hypotensive Syndrome be managed?

Place the patient in the left lateral recumbent position, treat underlying causes, and monitor vital signs.

What are common cardiac conditions to assess during pregnancy?

Dysrhythmia, heart murmur, history of rheumatic fever, congenital heart defects, and episodes of dizziness.

What is Peripartum Cardiomyopathy?

An uncommon form of heart failure occurring during the last month of pregnancy or up to 5 months postpartum.

What defines chronic hypertension during pregnancy?

Blood pressure equal to or greater than 140/90 mm Hg.

What is gestational hypertension?

Hypertension that develops after the 20th week of pregnancy and resolves spontaneously.

What are the symptoms of preeclampsia?

SBP ≥ 140 mm Hg, DBP ≥ 90 mm Hg, low platelet count, renal insufficiency, impaired liver function, pulmonary edema, cerebral symptoms, and visual symptoms.

What risk factors are associated with preeclampsia?

First pregnancy before age 20, advanced maternal age, history of multiple pregnancies, hypertension, renal disease, and diabetes.

What is the recommended treatment for seizures during pregnancy?

Magnesium sulfate is recommended, but treatment is difficult due to potential fetal distress.

What is gestational diabetes mellitus?

Inability to process carbohydrates during pregnancy, treated with diet control and oral hypoglycemic medications.

What are common respiratory disorders during pregnancy?

Shortness of breath, dyspnea, and asthma.

What complications can maternal asthma cause during pregnancy?

Premature labor, preeclampsia, respiratory failure, vaginal hemorrhage, and eclampsia.

What is Hyperemesis Gravidarum?

Persistent nausea and vomiting leading to dehydration, malnutrition, and weight loss.

What are the symptoms of Hyperemesis Gravidarum?

Severe and persistent vomiting, projectile vomiting, severe nausea, pallor, and jaundice.

What prehospital treatment should be provided for Hyperemesis Gravidarum?

Check blood glucose levels, start IV normal saline, administer medications as per protocols, and transport to a hospital.

What changes occur in the renal system during pregnancy?

Kidneys increase in length, ureters get longer, leading to urinary stasis and increased urinary frequency.

What is Rh Sensitization?

Occurs when an Rh-negative mother has an Rh-positive fetus, leading to the production of maternal antibodies that attack fetal RBCs in subsequent pregnancies.

What are the potential consequences of urinary tract infections in pregnancy?

Can lead to respiratory problems, pneumonia, septic shock, and meningitis in the newborn.

How can HIV affect pregnancy?

Pregnant women may infect the infant during labor and delivery, but medication can control the infection.

What is cholestasis?

A condition where bile cannot flow normally, causing it to build up in the liver and spill into the bloodstream.

What are common symptoms of cholestasis?

Profuse, painful itching, right upper quadrant pain, and color changes in waste elimination.

What are high-risk factors for cholestasis?

Carrying multiple fetuses, familial history of cholestasis, and previous liver damage.

What is TORCH syndrome?

A group of infections that can pass through the placenta to the fetus, including Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, and Herpes simplex.

What causes Toxoplasmosis?

Handling or eating contaminated food or handling cat litter.

What is Cytomegalovirus (CMV)?

A member of the herpes virus family that can remain dormant in the body for years and poses risks during pregnancy.

What complications can newborns face from CMV?

Lung problems, blood problems, liver problems, swollen glands, rash, and poor weight gain.

What is a spontaneous abortion?

The expulsion of the fetus before the 20th week of gestation, also known as a miscarriage.

What is a threatened abortion?

An abortion attempting to take place, characterized by vaginal bleeding in the first half of pregnancy.

What are signs of an imminent abortion?

Severe abdominal pain, vaginal bleeding, and cervical dilation.

What is an incomplete abortion?

A condition where part of the products of conception remains in the uterus, leading to continuous vaginal bleeding.

What defines a missed abortion?

The fetus dies during the first 20 weeks of gestation but remains in utero.

What is septic abortion?

An infection of the uterus following an abortion, often presenting with fever and foul-smelling vaginal discharge.

What is an ectopic pregnancy?

A condition where the ovum implants outside the uterus, often causing severe abdominal pain and hypovolemic shock.

What is abruptio placenta?

The premature separation of the placenta from the uterine wall, leading to severe abdominal pain and vaginal bleeding.

What are the signs of placenta previa?

Painless vaginal bleeding with bright red blood and a soft, nontender uterus.

What is the greatest danger of third-trimester bleeding?

The potential for significant hemorrhage due to a large volume of blood.

What should be done for a patient with imminent abortion?

Establish an IV line of normal saline, administer 100% supplemental oxygen, and provide emotional support.

What are the signs of shock to monitor in pregnancy-related complications?

Changes in vital signs, including blood pressure and heart rate, as well as signs of hypovolemia.

What is the recommended position for a patient experiencing pregnancy complications?

Keep the patient in a left lateral recumbent position.

What is the role of OPQRST in assessing labor pain?

It is a mnemonic used to elaborate on the chief complaint of labor pain.

What should be done if a patient presents with severe lower abdominal pain and is of child-bearing age?

Consider ectopic pregnancy and treat for shock while providing rapid transport.

What is the management for a patient with septic abortion?

Establish an IV line of normal saline, administer 100% supplemental oxygen, and provide rapid transport.

What are the signs of a complete abortion?

All products of conception are expelled from the uterus.