OB Test Map 2

HPO Axis

Hypothalamic-Pituitary-Ovarian

The neuroendocrine system that regulates the menstrual cycle. The hypothalamus releases Gonadotropin-Releasing Hormone (GnRH), which prompts the anterior pituitary to secrete Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH)

menarche

The very first onset of menstruation, typically occurring between ages 9 and 13. It is initiated by the maturation of the Hypothalamic-Pituitary-Ovarian (HPO) axis

Follicle stimulating hormone

The neuroendocrine system that regulates the menstrual cycle. The hypothalamus releases Gonadotropin-Releasing Hormone (GnRH), which prompts the anterior pituitary to secrete Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH)

luteinizing hormone

The anterior pituitary hormone that surges right before ovulation, triggering the release of the mature egg and converting the ruptured follicle wrapper into the progesterone-secreting corpus luteum

follicular phase

The first half of the ovarian cycle where the follicle matures. Estrogen is the absolute dominant hormone during this phase; low or excessive estrogen levels will prevent the LH surge, halting ovulation

ovulation

The release of a mature egg from the ovarian follicle into the fallopian tube. It occurs roughly 14 days before the start of the next menstrual period.

luteal phase

The second half of the ovarian cycle. The empty follicle (corpus luteum) secretes massive amounts of progesterone and some estrogen to prepare and maintain the uterine lining for implantation. If fertilization does not occur, the corpus luteum degenerates, hormone levels crash (PMS), and menstruation begins

four uterine phases

menstruation

proliferative

secretory

ischemic

5 days

sperm can live inside female for up to ____

unprotected intercourse

should be avoided for approximately 10 days surrounding ovulation (5 days before and 5 days after)

zygote

The initial fertilized, two-cell egg traveling down the fallopian tube

embryo

From week 3 to week 8 of gestation. This is the critical period of organogenesis and carries the highest risk for severe congenital anomalies if exposed to teratogens

fetus

From week 9 of gestation until delivery

decidua

The clinical name given to the endometrial lining during pregnancy. The blastocyst implants into the decidua between 4 and 10 days after fertilization, which can sometimes trigger mild, brief implantation spotting

Presumptive Signs of Pregnancy

Subjective changes felt and reported by the woman herself ("I think I am pregnant"). Examples include: Amenorrhea (missed period), fatigue, breast tenderness, nausea/vomiting, and urinary frequency

Probable Signs of Pregnancy

Objective changes observed by a trained examiner that strongly suggest pregnancy but are not 100% diagnostic ("It could be something else"). Examples include: Goodell sign (softening of the cervix), Chadwick sign (bluish-purple discoloration of the cervix/vagina due to increased blood flow), Hegar sign (softening of the lower uterine segment), ballottement ("bouncy baby" sensation), and positive home/clinical pregnancy tests (which detect Human Chorionic Gonadotropin, hCG)

positive signs of pregnancy

Definitive, objective proof that can only be attributed to a fetus ("I am 100% pregnant"). Examples include: Hearing fetal heart tones (using Doppler, verified as distinct from the maternal pulse), visual confirmation of the fetus via ultrasound, and fetal movement palpated/felt by a trained clinician

Nägele's Rule

The standard formula used to calculate the Estimated Date of Confinement (EDD/EDC). Formula: Subtract 3 calendar months, add 7 days, and add 1 year to the first day of the patient's Last Menstrual Period (LMP). This calculation is only accurate for women with regular, 28-day menstrual cycles.

umbilicus

At 20 weeks: The fundus should be level with the

xiphoid process

At 27 weeks: The fundus is halfway between the umbilicus and the

2 cm

Fundal height in centimeters should equal gestational age in weeks plus or minus

3-5 lbs

first trimester weight gain

1 pound

Second and Third Trimesters: A steady gain of approximately ____ per week

Supine Hypotensive Syndrome

(Vena Cava Syndrome)

DEFINITION: Occurs when a pregnant woman in her 2nd or 3rd trimester lies flat on her back, causing the heavy uterus to compress the inferior vena cava and descending aorta. This dramatically reduces venous return, causing maternal hypotension (faintness, dizziness, pallor) and severe placental hypoxemia (depriving the fetus of oxygen)

nausea and vomiting

Driven by rapid rises in estrogen and hCG, typically peaking between weeks 8 and 12 and resolving by the end of the first trimester

breast tenderness

Due to elevated progesterone, estrogen, and Human Placental Lactogen (HPL) stimulating ductal and alveolar development in preparation for lactation.

• Nursing Intervention: Instruct the patient to wear a highly supportive, well-fitting bra (without underwires) both day and night to minimize breast movement and jiggling

constipation

DEFINITION: Progesterone relaxes smooth muscles, leading to decreased gastrointestinal peristalsis. Uterine compression of the intestines and iron supplements further compound this.

Nursing Interventions: Encourage increased daily fluid intake (especially warm liquids), routine exercise, and a diet rich in natural fiber. Strictly teach patients to avoid castor oil, as it causes severe diarrhea and uterine irritation

Leukorrhea

DEFINITION: A profuse, thin, white/clear vaginal discharge stimulated by high estrogen levels. It is entirely normal and acts to create a protective mucous plug (operculum).

Nursing Interventions: Reassure the patient this is not an infection. Teach proper hygiene (wipe front to back), wear breathable cotton underwear, and avoid d douching under all circumstances, as it alters vaginal pH and drastically increases the risk of bacterial vaginosis and yeast infections

dehydration

DEFINITION: Severe nausea and vomiting can lead to dehydration and ketonuria (burning muscle instead of carbs for energy).

Nursing Assessment: Assess for dry mucous membranes, dry skin, and poor skin turgor. Dip the urine for specific gravity: a value creeping toward or exceeding 1.030 indicates highly concentrated urine and severe dehydration requiring medical intervention

nasal stuffiness

DEFINITION: Estrogen causes capillary engorgement, hyperemia, and edema of the nasal passages and throat.

Nursing Interventions: Recommend a cool-air humidifier/vaporizer and saline nasal sprays. Strictly teach patients to avoid Afrin or decongestant sprays containing epinephrine, as they cause localized vasoconstriction that can cross into the maternal bloodstream and constrict placental blood vessels

Round Ligament Pain

DEFINITION: A sharp, stabbing, or pulling pain in the lower abdomen or groin caused by the stretching of uterine support ligaments under the influence of relaxin.

Nursing Interventions: Teach patients to wear a supportive maternity belt (no tight girdles); rest frequently; apply localized heat; and flex the knee and hip on the affected side during an episode to slacken the ligament and relieve the pulling sensation.

hemorrhoids

DEFINITION: Rectal varicosities (blown vascular valves) caused by vascular dilation, increased pelvic pressure, and straining due to constipation.

Nursing Interventions: Instruct the patient on avoiding constipation (high fiber, fluids); apply topical anesthetic creams (Anusol); apply Tuck pads containing soothing witch hazel; and take warm sitz baths or cold ice packs to reduce swelling

Avoidance of Hot Tubs & Saunas

Pregnant women must strictly avoid hot tubs, saunas, steam rooms, and working in extreme heat (like 100°F sun). Prolonged exposure causes maternal peripheral vasodilation, diverting blood flow away from the uterus and placenta, which deprives the developing fetus of oxygen and nutrients

Maternal serum alpha fetoprotein

A routine maternal blood screening test performed between 15 and 20 weeks of gestation (with 16 to 18 weeks being optimal)

indicates risks for spina bifida and trisomy 21

MSAF

elevated MSAF

Indicates a high risk for Neural Tube Defects (NTDs), such as spina bifida, anencephaly, or microcephaly

decreased MSAFP

Indicates an increased risk for chromosomal trisomies, specifically Down Syndrome (Trisomy 21)

Gestational Diabetes Screen

DEFINITION: A routine screening test performed between 24 and 28 weeks of gestation. This is when the placenta secretes peak levels of Human Placental Lactogen (HPL), which acts as an insulin antagonist to divert glucose to the growing fetus.

Screening Interpretation: The patient drinks a 50g glucose solution without fasting. A 1-hour blood glucose of 130 mg/dL or greater is considered positive/abnormal and requires a diagnostic 3-hour fasting Oral Glucose Tolerance Test (OGTT)

Group Beta Streptococcus

DEFINITION: A routine vaginal and rectal swab performed at 36 to 37 weeks of gestation to detect GBS colonization. If the screen is positive, the mother is asymptomatic but can pass the bacteria to the newborn during vaginal delivery, causing life-threatening neonatal sepsis.

Nursing Intervention: Administer prophylactic IV antibiotics (typically Penicillin G) during labor and delivery to protect the infant

preeclampsia warning signs

DEFINITION: Critical clinical signs of severe gestational hypertension that must be reported to the provider immediately:

1. Visual disturbances (double vision, blurriness, or seeing spots).

2. Sudden or severe swelling of the face, hands, and sacrum.

3. A persistent, severe, continuous headache unrelieved by rest.

4. Persistent, intractable vomiting.

5. Severe epigastric or Right Upper Quadrant (RUQ) abdominal pain (indicates liver swelling/capsular stretch)

Diagnostic Amniocentesis

DEFINITION: An invasive procedure where a needle is inserted under ultrasound guidance to withdraw amniotic fluid for genetic testing or lung maturity studies.

Nursing Interventions: Verify the mother's blood type and Rh factor first. Ensure she empties her bladder before the procedure (to prevent uterine irritation and accidental bladder puncture). Monitor maternal vitals, contractions, and FHR during and for 30–60 minutes after the procedure. Always administer Rho(D) Immune Globulin (Rhogam) post-procedure if the mother is Rh-negative to prevent sensitization. Teach the patient to report contractions, fluid leaking, bleeding, or fever immediately

Toxoplasmosis (TORCH)

DEFINITION: A parasitic infection contracted by contact with cat feces/litter or consuming undercooked raw meat (especially hamburger, as steak is seared on the outside, but burgers are mixed through). If contracted in the first trimester, it carries severe risks of fetal brain calcifications, microcephaly, and blindness.

Nursing Interventions: Instruct pregnant patients to never change a cat's litter box; wash hands thoroughly after handling raw meats; and cook all meats entirely through

hepatitis A

DEFINITION: A viral liver infection transmitted via the fecal-oral route (often due to poor handwashing in restaurants or home settings). While perinatal transmission to the baby does not occur, the mother can suffer acute liver illness, fever, jaundice, and right upper quadrant pain.

Nursing Intervention: Teach rigorous hand hygiene and administer the Hep A vaccine/immunoglobulin prophylactically if exposed

hepatitis B

DEFINITION: A highly infectious, bloodborne liver virus that is extremely threatening to the fetus and neonate. Transmission typically occurs at delivery when the baby comes into contact with infected maternal blood.

Nursing Interventions: Screen all mothers. If the mother is Hep B-positive, the newborn must receive the Hepatitis B vaccine AND Hepatitis B Immunoglobulin (HBIG) intramuscularly within 24 hours of birth to prevent chronic infection

rubella

DEFINITION: A viral infection that is highly teratogenic. Exposure in the first 12 weeks of pregnancy leads to Congenital Rubella Syndrome, causing fetal deafness, eye cataracts, cardiovascular anomalies, and mental retardation.

Nursing Interventions: Screen maternal rubella titers at the first prenatal visit. The Rubella vaccine is a live virus and is strictly contraindicated during pregnancy. Non-immune mothers must be vaccinated in the immediate postpartum period (just before discharge) and taught to avoid getting pregnant for at least 1 month. Breastfeeding is safe after vaccination

Cytomegalovirus

DEFINITION: A highly elusive, common herpesvirus transmitted via contact with semen, blood, saliva, breastmilk, or urine. It can cross the placenta, leading to fetal brain calcifications, microcephaly, hepatosplenomegaly, and severe neonatal hearing loss.

Nursing Interventions: Teach patients working with infants/toddlers to wash hands thoroughly after changing diapers or handling toys. If a pregnant woman requires a blood transfusion, strictly verify that the blood bag is labeled CMV-negative

Herpes Simplex Virus

DEFINITION: A sexually transmitted viral infection presenting with painful, fluid-filled genital vesicles. If the baby is exposed to active lesions during vaginal birth, it can develop herpetic meningitis, blindness, and death.

Nursing Interventions: Prophylactically treat mothers with a history of HSV with oral antivirals (Acyclovir or Valtrex) starting at 34 weeks of gestation to prevent an outbreak at term. Perform a C-section if active herpetic lesions or prodromal symptoms (like tingling of genital tissues) are present when labor begins

first stage of labor

consists of the latent phase and the active phase

latent phase

0-5 cm dilated

active phase

6-10 cm dilated

second stage of labor

The stage of pushing. Begins when the cervix is completely dilated (10 cm) and ends with the birth of the baby. (Typically lasts up to 3 hours)

third stage of labor

The placental stage. Begins immediately after the birth of the baby and ends with the delivery of the placenta

Delivery of the placenta usually takes 5 to 20 minutes. If it exceeds 20 minutes, there is a serious concern for an abnormally adherent placenta (placenta accreta/increta/percreta), putting the mother at risk for massive hemorrhage

fourth stage of labor

The maternal physiological recovery and stabilization phase, lasting 1 to 2 hours (up to 4 hours if bleeding or anesthetic complications arise)

true contractions

Contractions are regular, become progressively closer together, stronger, and last longer. Walking or physical activity intensifies the contractions. Pain typically begins in the lower back and radiates around to the front of the abdomen. The defining diagnostic hallmark is progressive cervical dilation and effacement

false labor

Contractions are irregular, all over the place, and do not get closer together. Contractions often decrease in intensity or completely disappear with walking, hydration, or position changes. Pain is localized only to the front of the abdomen (around the umbilicus). There is absolutely no change in cervical dilation or effacement

Moderate Variability

Fluctuation of 6 to 25 bpm. This is the normal, desired finding indicating a highly oxygenated, neurologically intact fetus

marked variability

Fluctuation > 25 bpm; indicates acute fetal stress, early hypoxia, or maternal stimulant drug use

accelerations

A reassuring, abrupt increase in FHR above the baseline of at least 15 bpm lasting for at least 15 seconds (the 15x15 rule). This is the hallmark of a "Reactive" Non-Stress Test (NST), confirming excellent fetal oxygenation and an intact nervous system

early decelerations

Gradual decrease in fetal heart rate (FHR) in response to uterine contractions, typically associated with fetal head compression during labor.

late decelerations

Gradual decrease in fetal heart rate (FHR) occurring after the peak of uterine contractions, often indicative of fetal hypoxia or uteroplacental insufficiency.

variable decelerations

Abrupt decrease in fetal heart rate (FHR) not necessarily tied to contractions, often caused by cord compression. form a distinct V-shape, W-shape, or U-shape. They can occur at any time, completely independent of uterine contractions.

change maternal position, stop oxytocin if running

10min

fetal brady/tachy cardia has to last for ___- to be considered that

meconium

the first stool after birth

10

A healthy newborn is expected to lose some fluid weight in the first few days of life, but must not lose ____ % or more of their birth weight

uric acid crystals

Orange-red or pinkish crystals found in a newborn's diaper voids during the first 3 to 4 days of life. It is a normal, harmless finding due to concentrated urine and should disappear once the mother's mature milk volume increases

30-60

normal respirations

97.7-99.5

normal fetal temp