OB/PEDS MIDTERM

What is infertility?

inability to conceive after 12 months of trying

Approximately _ women receive fertility services

1 in 8

What is infertility when it comes to people over 35 years old and people over 40 years old?

over 35→ 6 months

over 40→ talk about fertility counseling

85% of infertility are due to _ causes

identifiable

What are good sources of nutrition for fertility?

1. Omega 3 fatty acid

2. protein

3. vitamin D

4. folic acid

What are bad sources of nutrition for fertility?

1. Trans fatty acids

2. high caffeine consumption

3. added sugars

4. refined carbs

5. alcohol

What are good sources of omega 3s?

fish, flaxseed oil, fortified foods

What are good sources of proteins?

plant based proteins are better

What are good sources of vitamin D?

the sun and supplement

What are good sources of folic acid?

leafy greens/vegetables or supplement

What factors increase the chances of conceiving?

maintain a healthy body

abstain or quit smoking

prenatal vitamins→ folic acid and iron

ovulation tracking

getting adjusted

What is a birth plan?

a way for parents to communicate wishes to midwives and doctors who care for them during pregnancy

tells providers about the type of labor and birth patients would like to have

BIRTH PLANS ARE NOT SET IN STONE

What is in a birth plan?

labor, delivery, who’s in room, pain management, intervention preference, what happens once baby is born

What are the types of delivery?

vaginal

c-section

water birth

VBAC

What are some types of intervention preferences that are an option?

episiotomy

use of forceps or vacuum

when to transition to c-section

whose decision is all this?

What are some choices to make after delivery?

cord cutting

shots and eyes

when to hold baby

feeding

What are the pros and cons of home birth?

pros

1. comfortable/familiar

2. relaxing

3. can be surrounded with who you want

4. less medical intervention

5. lower cost

cons

1. not suggested in some cases

2. VBAC

3. less access to intervention

What are the pros and cons of hospital birth?

Pros

1. access to interventions

2. more health professionals

Cons

1. stressful environment

2. higher cost

3. support restrictions

What is an OB/GYN?

MD or DO that completed a residency in obstetrics and gynecology

What is a midwife?

specialist in care of healthy women anticipating a normal pregnancy and birth

FOCUS on wellness

no surgery training

What are the different types of midwives?

primary care professional→ care to women across the lifespan

CNM→ certified nurse midwife

CM→ certified midwife

What is a doula?

provides emotional support and advice for mom and family and suggestions for easing discomfort

“a woman who serves”

What are some pros of having a doula?

reduce occurrence of C-sections

improves birth outcomes

decreases interventions

lower rates of post partum depression

What is a cesarean section?

surgical procedure to deliver a baby through incisions in abdomen and uterus

steps

1. Incision→ abdominal incision and uterine incision

2. Delivery→ baby is gently lifted out and cord is clamped

3. Placenta removal

   1. Closure

What are some risks to consider with C-sections and considerations?

Risks→ infection, bleeding, future pregnancy complications and scarring

Considerations→ bonding delayed and breastfeeding may require additional support

What is a VBAC?

vaginal birth after cesarean

suitable for women with low transverse uterine scar

higher risk

What are the stages of labor and delivery?

Stage 1→ labor, early, active, transition (painful) (0-6cm)

Stage 2→ delivery of baby (6-8 cm)

Stage 3→ delivery of placenta (8-10 cm)

What are pre labor/ Braxton hicks contractions?

infrequent and irregular non painful contractions that prepare the body for actual labor

What is the difference between true labor and Braxton hicks?

True labor→ contractions are regular, progressively stronger, and closer together

Braxton hicks→ irregular, do not increase in intensity, and may stop with change in activity or position

What is stage 1 early labor?

0-6 cm

lower back pain, cramping, bloody show (mucus plug release)

What is stage 1 active labor?

4-8 hours

6-8 cm

stronger, more regular and closer together (3-5 min) contractions

water breaking (if not already)

What is stage 1 transition?

30 min to 2 hours

8-10 cm

very strong, 2-3 min apart contractions that last around 60-90 sec

What is effacement?

thinning of the cervix

What is stage two delivery of the baby?

fully dilated at 10 cm

very strong contractions lasting 60-90 seconds

mother actively pushes with each contraction

Baby’s head becomes visible (CROWNING)

What is stage 3 delivery of the placenta?

5-30 minutes after baby is born

placenta and remaining membranes are expelled

What is stage 4 recovery?

first 1-2 hours after delivery

mother and baby closely monitored

bonding→ skin to skin contact, initiation of breastfeeding

uterus continues to contract, bleeding gradually decreases

What is vertex presentation→ normal head down position?

occiput anterior-ideal

What is transverse lie?

baby lying sideways across the abdomen

Babies settle into the position they will likely be in for birthing process at _ weeks

36

What is external cephalic version?

turning babies

not attempted until one week- 4 days out

What is an episiotomy?

surgical cut to the perineum

used to prevent internal tissue damage

What is the vacuum intervention?

used in case of obstetric emergency where the anterior fetal shoulder becomes stuck on the maternal pubic symphysis

What are forceps?

tong like tool used to help pull baby out

baby side effects→ bruising, shoulder dystocia

TQ what is APGAR scoring?

A- activity

P- pulse

G- grimace

A- appearance

R- respiration

scoring done at birth about one minute post partum

at 5 minutes after birth

repeated if number stays low

What are the possible scores for APGAR?

7-10 → excellent condition

4-6 → moderately depressed

0-3 → severely depressed

What is cord clamping?

early cord clamping is usually done 10-15 seconds after birth

delayed cord clamping is after 30 seconds

significant health benefits for baby between 30-60s

What is a postpartum hemorrhage?

more likely with c-section

average amount of blood loss after birth of a single baby in vaginal delivery is about 500mL

s/s→ uncontrolled bleeding, decreased BP

A NEW MOTHER WITH A _ IS A CLINICAL RED FLAG TQ

FEVER

What are some post birth interventions?

Vitamin K

Hepatitis B vaccine

Erythromycin in the eyes

_ is the most critical time for proper nutrition leading ot growth and development

conception to age 2 (first 1000 days)

What is key nutrition for mothers?

Iron

Folate

calcium

Magnesium

Iodine

Zinc

Vitamin D

Vitamin A

Vitamin B12

Vitamin B6

Ginger and Vitamin B6 is a natural remedy for _

morning sickness

For healthy pregnant and postpartum women, the guidelines recommend at least _ TQ

150 minutes per week of moderate intensity aerobic activity

When exercising in pregnancy, what two things do we need to consider for the baby?

oxygen and calories

Typical term pregnancy lasts _ TQ

40 weeks

Premature babies are _

less than 37 weeks

20-22 weeks is considered _

viable

Which reflex checks how the baby responds to stimuli? TQ

Grimace reflex

Most pregnancies will be induced at or before 42 weeks which is considered _

post term

What are normal exam findings?

1. Blood pressure

2. Baby heartbeat

3. Maternal weight changes

What is “the pregnancy hormone?”

HCG

should double every 72 hours in the first 8-11 weeks

made by placental cells

What are red flags/contraindications to adjusting pregnant patients?

1. Vaginal bleeding

2. abdominal cramping

3. placental abruption

4. sudden increase of pelvic pain

5. bowel obstruction

6. elevated blood pressure

What is vena cava syndrome? TQ

vena cava is compressed by baby usually after 20 weeks

Vena cava syndrome is relieved by _

LAYING ON LEFT SIDE

VCS is an important consideration after how many weeks gestation?

20 weeks

What are the benefits of breastfeeding for both mother and infant?

maternal→ reduced risk of breast/ovarian cancer, quicker postpartum recovery

infant→ ideal nutrition, immune protection, reduced infections

_ is the primary source of nutrition in the first year

milk (breast or formula)

What is colostrum?

initially after birth

establishes healthy bowel flora for digestion

contains high levels of protein for rapid growth in the first few days

contains mothers’ antibodies

What is transitional milk?

days 7-14

increasing levels of lactose

When does mature milk occur?

after day 14

How is breast milk produced?

prolactin stimulates tissue growth and milk production

oxytocin is release when infant starts sucking and stimulates let down

stress hormones can lead to less production

What are some helpful options if there are struggles with breastfeeding?

1. lactation consultant

2. pump and bottle feed

3. syringe feeding

4. check and adjust the infant

When should you refer to a lactation consultant?

painful feeds

POOR WEIGHT GAIN

How can you increase your breastmilk supply?

express milk frequently

hydration

sleep

regular skin to skin contact

calories

OATS or leafy greens

Exclusive breastfeeding is recommended for _

first 6 months of life

After first 6 months of life, what should nutrition look like for the child?

6-18 months breastfeeding supplemented with age appropriate solids

What are baby blues?

common short term emotional response experienced by new mothers

begins a few days after childbirth and lasts up to two weeks

mild mood swings, anxiety, irritability

What causes baby blues?

rapid drop in estrogen and progesterone levels after childbirth

What is the treatment for baby blues?

support, self-care, reassurance

What is postpartum depression? (PPD)

more severe, long lasting form of depression that occurs after childbirth

s/s can begin anytime within first year after childbirth and last several months or longer

What are s/s of PPD?

persistent sadness

severe mood swings

excessive crying

feeling worthless or guilty

What is the treatment for PPD?

professional help (counseling, medications, therapy)

support systems

self care

What is the difference between baby blues and PPD?

PPD lasts longer

Baby blues have mild temporary symptoms vs PPD has severe symptoms

What are some extra resources for PPD?

office on women’s health- talking postpartum depression

CDC- PPD

National maternal mental health hotline

What is an ectopic pregnancy?

occurs when fertilized egg implants outside the uterus

What is the MC location for a ectopic pregnancy?

FALLOPIAN TUBES

What is common case presentation of ectopic pregnancy?

sharp stabbing pain in the pelvis or abdomen

shoulder pain

dizziness or fainting

What are some risk factors for an ectopic pregnancy?

previous ectopic pregnancy

tubal surgery or pelvic surgery

PID

infertility treatments

women aged 35-44

smoking

What is treatment for ectopic pregnancy?

surgical intervention→ laparoscopy or laparotomy

follow up→ monitor hCG levels

MEDICAL EMERGENCY

What is a miscarriage?

spontaneous loss of a pregnancy before the 20th week

occurs in 20% of known pregnancies

What is case presentation of a miscarriage?

presents with vaginal bleeding and abdominal pain

cramping, back pain, passing tissue or clots from the vagina

What is a threatened miscarriage?

pregnancy complicated by bleeding before 20 weeks

What is an inevitable miscarriage?

cervix has dilated, but products of conception have not been expelled

What is a complete miscarriage?

all products of conception have been passed without need for surgical or medical intervention

What is an incomplete miscarriage?

some but not all of the products of conception have been passed, retained products may be part of the fetus, placenta, or membranes

What is a missed miscarriage?

pregnancy in which there is a fetal demise but no uterine activity to expel the products of conception

What is a septic miscarriage?

complicated by intrauterine infection

What are recurrent spontaneous miscarriages?

three or more consecutive pregnancy losses

What are miscarriage risk factors?

higher risk in women over 35

previous miscarriages

chronic conditions

smoking, alcohol use

infections

structural issues

genetic factors

What is the treatment for a miscarriage?

expectant management

medical management

surgical intervention→ D and C or manual vacuum aspiration