OB Final Exam

carrier screening

-what you might pass to your child

blood test + ultrasound

-can tell if there is down-syndrome or other genetic disorders

when can you do serum screening

-1st 2nd or both trimesters

cell-free DND (NIPT)

-sees genetic disorders

-ca do 9 or 10 weeks of pregnancy

which test is more accurate

-diagnostic testing

when can you do cvs testing

-10-13 weeks

when can you do amniocentesis

-15 + weeks

month 1

-blood cells taking shape + circulation begins (smaller than a grain of rice)

month 2

-facial features develop, arms, legs, fingers, toes, eyes are forming

-neural tube well formed… digestive, sensory organs develop

-bone starts to replace cartilage

-heartbeat can be detected

-is now a fetus instead of an embryo

month 3

-able to open and close fist and mouth

-external ears formed

-chance of miscariage drops

month 4

-can suck thumb, yawn, stretch, and make faces

-nervous system starts to function

-can tell the gender

month 5

-can feel baby move

month 6

-eyes open

-respond to sound

-baby can hiccup

month 7

-develop baby fat

-hearing is fully developed

-can respond to pain and light

month 8

-brain developing rapidly can see + hear

-lungs still immature

cystic fibrosis

-recessive carrier (need both to have disorder)

huntington’s chorea

-dominant (only need one to have it )

dysmenorrhea

-painful menstruation

-endometriosis most common cause of secondary dysmenorrhea

dysmenorrhea (symptoms)

-pain, nausea, vomiting, diarrhea, fatigue, fever, headache, dizziness

-bloating, water retention, weight gain, muscle aches

-food cravings, breast tenderness

dysmenorrhea (treatments)

-exercise

-pain medication

-hormonal birth control

-limit salty foods, increase water and fiber

-heat to back or abs

-stress mangement

-decrease smoking and alcohol

abnormal uterine bleeding (AUB)

-painless

-related to hormone disturbance

AUB therapeutic management

-normalize bleeding

-correct anemia

-prevent or diagnose early cancer

-restore quality of life

AUB pharmocotherapy

-medication or insertion of a hormone-secreting intrauterine system

AUB surgical intervention

-dilation and curettage, endometrial ablation, uterine artery embolization, or hysterectomy

^this can lead to infertility

premenstrual syndrome symptoms

-irritability, tension, dysphoria (most prominent and consistent

-anxiety, craving, depression, hydration, hot flashes, cold sweats, bowel changes, pain, acne

*may need and SSRI

PMS and PMDD drug therapy options

-NSAIDs (week before menses)

-OC (low dose)

-antidepressants (SSRI)

-anxiolytics (take during luteal phase)

-diuretics (to remove excess fluid)

-progestins

-GnRH agonists

-danazol

endometriosis

-when endometrial tissue adheres to other places in the abdominal cavity

-over growth of the lining

-extremely painful

-mini periods throughout the month

clomiphene citrate challenge test

-used to asses women’s ovarian reserve

hysterosalpingography

-gold standard for assessing patency of the fallopian tubes

laparoscopy

-performed early in menstrual cycle

-used when abnormalities are found

signs of complications of oral contraceptive

(ACHES)

a=abdominal pain may indicate liver or gallbladder problems

c=chest pain or shortness of breathe may indicate PE

h=headaches may indicate hypertension or impending stroke

e=eye problems may indicate hypertension or an attack

s=severe leg pain may indicate TE

signs and complications of IUDs (PAINS)

p= period late, pregnancy abnormal spotting or bleeding

a= abnormal pain, pain with intercourse

I= infection exposure, abnormal vaginal discharge

n=not feeling well, fever, chills

s= string length shorter, or longer, or missing

impact of menopause on the body

brain: hot flashes, sleep, mood and memory problems

heart: lower levels of HDL increase risk of CVD

bones: bone density loss, increase risk of osteoporosis

breasts: duct and gland tissue replaced by fat

genitourinary: vaginal dryness, stress incontinence, cystitis

gastrointestinal: less calcium absorbed, increased fractures

skin: dry, thin, collagen decreased

pelvic support disorders

-pelvic organ prolapse and urinary + fecal incontinence

causes related to

^vaginal childbirth

^advancing age

^heavy work

^poor nutrition

^increasing body mass

therapeutic management of pelvic organ prolapse

-surgery

-kegel exercise

-hormone replacement therapy

-dietary and lifestyle modifications

-pessaries

-colpexin sphere

pelvic organ prolapse: clinical manifestations

-usually asymptomatic

-feeling of dragging

-lump in vagina

-”something coming down”

uterine fibroids

-leiomyomas.. begin growth

-rapid growth during childbearing years due to estrogen dependency, shrink during menopause

-peak incidence around 45

treatment

-hormones

-uterine artery embolization

-myomectomy

-hysterectomy

-ultrasound

genital fistulas

types

-vesicovaginal

-urethrovaginal

-rectovaginal

*small heal on it’s down.. large = surgery

-normally happens after a hysterectomy

bartholin gland cyst

-blockage of a duct… possible infection or abscess

ovarian cyst

-follicular

-corpus luteum

-theca-lutein

-polycystic ovary syndrome

signs and symptoms

-hirsutism

-alopecia

-virilization

-menstral irregularities

-infertility

-high BMI

-insulin resistance

-metabolic syndrome

-acne

-less than 3 on own more than 3 surgery

risk factors for reproductive cancer

-early menarche

-late menopause

-STI

-use of hormonal agent

-infertility

-family history of cancer

-lifestyle behaviors

warning signs of reproductive cancer

-blood in bowel movements

-unusual vaginal discharge

-persistent abdominal bloating or constipation

-irregular vaginal bleeding

-persistent low back pain not related to standing

-elevated or discolored vulvar lesions

-bleeding after menopause

-pain or bleeding after intercourse

ovarian cancer

-eighth most common cancer in females

-most common between age 55-75

-typically not diagnosed until stage 3 or 4

-Laparoscopy for diagnosis and staging

-Total abdominal hysterectomy, bilateral
salpingo-oophorectomy, peritoneal biopsies,
omentectomy, and pelvic para-aortic lymph
node sampling

ovarian cancer early symptoms

-bloating

-early satiety

-fatigue

-vague abdominal pain

-urinary frequency

-diarrhea

-constipation

-unexpected weight loss or gain

ovarian cancer late symptoms

-anorexia

-dyspepsia (ingestion)

-ascites

-palpable mass

-pelvic pain

-back pain

endometrial cancer

-type 1 (most common): endometrial hyperplasia leads to carcinoma

-type 2: spontaneous appearing

surgery: hysterectomy and salpingo-
oophorectomy, remove ovaries

cervical cancer

-get pap smear for screening

-signs and symptoms

^abnormal vaginal bleeding after intercourse

vaginal cancer

-usually in females over 50

-treatment

^radiation

^laser surgery

^possible radical surgery if needed

vulvar cancer

-most common in older females 60-70s

-therapeutic management

^laser surgery

^cryosurgery

^electrosurgical incision

^radical vulvectomy

risk factors

^persistent vulvar itching

what can chronic annovulation lead to

-infertility and the long-term problem of hyperandrogenism

what would patients with advanced cervical cancer

-pelvic, back, or leg pain, weight loss, anorexia, weakness and fatigue, and fractures

prep for pap smear

-no intercourse, douching, tampons, vaginal lubricants 48 hr before

primary amenorrhea

-has never had a period

-may or may not have normal sexual characteristics

-correction of any underlying disorders and estrogen replacement therapy

secondary amenorrhea

-has normally had their period but it stops

-first rule out pregnancy

-start cyclic progesterone

-assess for eating disorder, BMI, hypothyroidism, obesity, hypothalamic failure

endometriosis risk factors

-young age starting menstrual cycle

-short or long menstrual cycle

-infertility

-family history

endometriosis therapeutic relief

-pain relief

-hormonal suppression

-surgery to remove lesions (it will come back)

alternatives for infertility

-donor eggs/ sperm

-surget

-IVF

-artificial insemination

contraception: behavioral methods

-abstinence

-basal body temperature= when it is raised fertile

-standard days method=28 day cycle… ovulate around day 14

-cervical mucus= increase in discharge

-withdrawal

-lactational amenorrhea method

contraception: barrier methods

-condoms

-diaphragm

-cervical cap

-contraceptive sponge

-need spermacide

contraceptive: hormonal method

-plan b (take within 72 hours)

-IUD (5-8 years)

-nexplanon (3-5 years)

-depo shot (3 months)

-birth control pill (daily around same time, miss one take as soon as you forget)

-nevo ring (3 weeks in 1 week out)

-birth control patch (on 3 weeks take off 1 week)

ovarian cancer risk factors

-1st degree relative with ovarian cancer, over 30 for first pregnancy, infertility, hormone replacement therapy

vaginal cadidiasis (yeast infection) manifestations

-pruritis

-thick, white, curd like discharge

-vaginal soreness

-vulvular burning

-external dysuria

vaginal cadidiasis (yeast infection) risk factors

-pregnancy

-oral contraceptives (with high estrogen content)

-antibiotic use

-diabetes

-obesity

-steroids and immunosuppressive drugs

-HIV infection

vaginal cadidiasis (yeast infection): nursing management

-reduce sugar and soda intake

-cotton underwear

-avoidance of irritants

-remove wet bathing suits promptly

-good body hygiene with mild, unscented soap

-avoidance of douching, vaginal sparays, super- absorbent tampons

vaginal cadidiasis (yeast infection): treatment

-miconazole cream or suppository

-clotrimazole tablet or cream

-terconazole cream or suppository

-fluconazole tablet

trichomoniasis

-parasite

-not always sexually transmitted, can live on damp/wet surfaces, poorly cleaned hot tubes

-visualized under microscope

trichomoniasis risk factors

-sexual intercourse with infection partner

-preterm birth and postpartum endometrtis

-more susceptible to HIV transmission in men and women

trichomoniasis female symptoms

-itching

-malodorous foamy discharge

-heavy yellow/green, gray frothy, or bubbly discharge

-pruritis valvular soreness

-dyspareunia

-bleeding after intercourse

-dysuria

-petechia on cervix

trichomoniasis: male symptoms

-usually asymptomatic

-heavy yellow/green, gray frothy, or bubbly discharge

-pruritis valvular soreness

-dyspareunia

-bleeding after intercourse

-dysuria

-petechia on cervix

trichomoniasis treatment

-metronidazole or tinidazole

^may need multiple treatments

^sexual partners need treatment

-abstinence until therapy is complete and symptom free

bacterial vaginosis

-can increase a women’s susceptibility to other STIs such as HIV, herpes, chlamydia and gonorrhea

-associated with preterm labor, premature rupture of membranes, chorioamnionitis, postpartum endometritis and PID

bacterial vaginosis risk factors

-multiple sex partners

-douching

-lack of vaginal lactobacilli

bacterial vaginosis clinical manifestations

*to diagnose ¾ criteria has to be met

1. thin white vaginal discharge

2. vaginal ph 4.5

3. positive whiff test: secreations mixed with potassium hydroxide creates a fishy smell

4. presence of clue cells under a microscope

chlamydia

-newborns can develop conjunctivitis

-transmitted by vaginal, anal, or oral sex

-highest rates of infection 15-19 years old

chlamydia clinical manifestations

-can be asymptomatic

-dysuria, urinary frequency

-mucus or pus-like discharge

-can cause inflammation of the rectum and conjunctiva

-can infect throat

-females: may lead to PID, ectopic pregnancy, infertility

-males: urethral tingling, sterility

chlamydia treatment

-azithromycin

-doxycycline

-erythomycin

-levofloxacin

-retesting in 3 months to rule out recurrence

gonorrhea

-often coinfected with chlamydia

-transmitted via vaginal, anal, and oral sex

-causes conjunctiva in newborns

-common among teenagers

gonorrhea clinical manifestations

-may be asymptomatic

-dysuria, urinary frequency

-rectal infection: discharge, itching, painful BM with fresh blood

-females: yellow + foul discharge, endocervicitis, PID ectopic pregnancy, infertility

gonorrhea treatment

-dual therapy with ceftriaxone and azithromycin

-re test after 3 months

herpes

-lifelong disease, no cure

1. oral secretions, can be spread to genitals

2. sexual contact with someone shedding virus during outbreak or period with no symptoms

-can be spread to newborns during childbirth

herpes clinical manifestations

-first ep is usually the worse

-itching, tingling, pain in the genital area

-small pustules and blister-like lesions

-dysuria, urine retention, fever, headache, malaise, muscle aches

herpes treatment

-antivirals

-acyclovir

-valcyclovir

-famciclovir

syphillis

-chronic and multi stage if untreated

-sexual conduct

-can be spread to newborn

-stages

^primary, secondary, early latent, late latent, tertiary

syphillis primary

-chancre (painless ulcer) disappears 1-6 weeks without interventions, highly infectious

syphillis secondary

-2-6 months after initial exposure

-flu-like symptoms

-rash on trunk, palms & soles, alopecia last appox 2 years

syphillis early latent

-absence of any symptoms, can last as long as 20 years

syphillis late latent/ tertiary

-life threatening heart disease

-neurologic disease that destroys heary, eyes, brain, central nervous system and brain

syphillis treatment

-penicillin G injection

-if allergic doxyclycline, tetracycline or erythromycin

genital warts (HPV)

-sexual transmission

-could lead to cancer of cervix, vulva, vagina, and anus

-vaccination for prevention

-can’t be cured

-warts can be removed but virus remaines

genital warts treatment

-may disappear without treatment

-can remove by creams, freezing, burning, laser treatment, surgical excision

vaccination recommended starting at 12

pelvic inflammatory disease (PID) risk factors

-teenagers

-multiple sex partners

-early onset sexual activity

-history of PID or STI

-recent. IUD insertion

-recent termination or pregnancy

-smoking

-douching

-unprotected sex

pelvic inflammatory disease (PID) treatment

-maintain hydration

-pain medication

-semi-fowlers

-antipyretic

-antibiotics

hepatitis

A= fecal-oral

^unclean water, uncooked shellfish, poor hand hygiene by infected person

B=saliva, blood, semen, vaginal secretions

^6 weeks to 6 months

^can survive 7 days outside of body

C= injection drug use

herpes symptoms

A&B= flue-like symptoms, skin rash, fatigue, nausea, fever, upper right quadrant pain

C= mostly asymptomatic

ectoparasitic infection

-bedbugs, scabies, crabs

-not always sexually transmitted

-easily passed from person to person

ectoparasitic infection symptoms

-bedbugs: visualize bugs, visualize bites

-scabies: female burrows under skin and lays eggs that hatch, diagnosed by appearance of burrows in the webs of fingers and genitalia but can be whole body

-pubic lice (crabs): visualize lice in pubic hair, axillary hair, eyebrows, beards, rash in pubic area

ectoparasitic infection treatment

-bedbugs: washing linens, clothing, may need pest control

-scabies: permithrin cream, oral invermectin, or benzyl benzoate

-pubic lice: permithrin cream rinse

-clean bedding and clothing with hot water

HIV

-no cure

-antivirals (ART therapy)

-ART given to newborns within 6-12 hrs after birth and continued for 6 weeks

stages of fetal development

-zygotic stage: fertilization of sperm and egg (conception)

-blastocyst stage: zygote divides into a solid ball of cells and attaches to uterus

-embryonic stage: end of second week through eight week

-fetal stage: differentiation and structure specialize by end of the eighth week until birth

ectoderm

-forms the central nervous system, special sense, skin, and glands