OB/Peds Study Guide

What is the definition of infertility for individuals under 35?

after 12 months of regular, unprotected intercourse

What is the definition of infertility for individuals over the age of 35?

After 6 months of regular unprotected intercourse

What are common causes of infertility?

Ovulatory disorders, tubal factors, uterine or cervical abnormalities, hormonal imbalances, or unexplained causes.

How are omega-3 fatty acids beneficial to pregnancy?

Anti-inflammatory; found in fish, flaxseed oil, and fortified foods.

What do we have to keep in mind in regard to protein and pregnancy?

Emphasize plant-based sources when possible.

How do we get vitamin D?

Sunlight exposure and supplementation

Why is folic acid beneficial during pregnancy?

Crucial for DNA synthesis; found in leafy greens and supplements.

What are some harmful dietary factors to pregnancy?

Trans-fats, refined sugars, alcohol, and high caffeine. These can negatively affect fertility

What are some factors to increase chances of pregnancy?

Maintain a healthy body

Abstain or quit smoking

Prenatal Vitamins

Ovulation tracking

Getting adjusted

What are medical interventions to increase chances of conception?

Ovulation induction, Intrauterine insemination (IUI), In vitro fertilization (IVF)

When do we refer a patient under 35?

After one year of trying

When do you refer a patient over 35?

After 6 months of trying

When do you refer a patient over 40?

Immediately upon trying to conceive

What are the 6 components to a birth plan?

Location, delivery type, support people, pain management, intervention preferences, newborn care

What are the types of delivery?

Vaginal, Cesarean section, VBAC (vaginal birth after cesarean)

What are the indications for a C-Section?

Placenta previa, fetal distress, breech presentation

What are the risks to a C-Section?

Infection, blood clots, future pregnancy complications.

What is the expected recovery for a C-Section?

3-4 days in hospital; limited lifting/activity for several weeks

How many stages of labor are there?

4

What is stage one of labor?

Cervical dilation and effacement

What is the dilation during stage 1 early labor?

0-6cm dilation

What is the the dilation during the stage 1 active labor?

6-8cm dilation

What is the dilation during the stage 1 transition period?

8-10cm dilation

What is stage 2 labor?

Delivery of the baby

What is stage 3 of labor?

Delivery of the placenta

What is stage 4 of labor?

Immediate postpartum recovery (first few hours)

What is the typical baby position during birth?

Vertex/ Cephalic (head down) occiput anterior

What is breech position?

Buttocks or feet first; increased risks (cord prolapse, birth injuries)

What is the ECV or External Cephalic Version

Procedure to try to turn baby from breech to vertex

What delivery interventions did we talk about in class?

Episiotomy, vacuum extraction, forceps

What is an episiotomy?

Surgical cut to the perineum allowing more room for baby to pass through?

What is vacuum extraction?

Uses suction on the baby’s head for assisted delivery

What are forceps and what is the risk to baby and mom?

Tong-like instrument for assisted delivery

Can cause mother to tear or hemorrhage and can cause damage to the pelvic floor. Can bruise baby and cause skull or shoulder injuries

What is an APGAR score?

A rating given to baby on how strong and lively they are

A in APGAR

Appearance (skin color)

P in APGAR

Pulse (heart rate)

G in APGAR

Grimace (reflex irritability)

2nd A in APGAR

Activity (muscle tone)

R in APGAR

Respiration (breathing effort)

What is a normal APGAR score and how often is it taken?

7-10, 1 minute and 5 minutes postpartum until within good range

How do we classify postpartum hemorrhage?

Blood loss greater than or equal to 500mL (vaginal) or 1000mL (C-Section)

What is a possible result to postpartum hemorrhage?

Shock; requires prompt treatment

What are common postpartum infections?

Endometritis, mastitis, incision infections, or UTIs

What is the definition of Baby Blues?

Mild mood swings, anxiety, and irritability; usually resolves by 2 weeks

What is postpartum depression?

More severe feelings of hopelessness, possible inability to function, can appear any time in the first year postpartum. May require therapy, medication, and additional support

What are the maternal benefits to breastfeeding?

Reduced risk of breast/ovarian cancer, quicker postpartum recovery

What are the infant benefits to breastfeeding?

Ideal nutrition, immune protection, reduced infections.

How can breastfeeding be improved?

Lactation consultants, proper hydration/nutrition, pumps, and supportive environments

What is an ectopic pregnancy?

Fertilized egg implants outside the uterine cavity (often in fallopian tube)

What are symptoms of an ectopic pregnancy?

Sharp abdominal or pelvic pain, possible bleeding dizziness

What is the treatment of an ectopic pregnancy?

Methotrexate (if stable) or surgical intervention

What is a miscarriage

Loss of pregnancy before 20 weeks (spontaneous abortion)

What are the types of miscarriage?

Threatened, inevitable, complete, incomplete, missed, septic, recurrent

How do we manage miscarriage?

Expectant, medical (medications to expel tissue), or surgical (D&C)

What is placenta previa?

Placenta covers the cervical opening (partial or complete)

What are the symptoms of placenta previa?

Painless, bright red vaginal bleeding in the 2nd or 3rd trimester

How do we manage placenta previa?

Monitoring, bed rest, possible C-section if persistent at term

What is placenta abruption?

Premature separation of the placenta from the uterine wall

What are the symptoms of a placental abruption?

Painful bleeding, uterine tenderness, fetal distress

What is the treatment of placental abruption?

Depends on severity; urgent delivery if significant risk to mother or baby

What is polyhydramnios?

Excessive fluid. risk factors are diabetes, fetal anomalies, multiple gestation

What is oligohydramnios?

Low fluid. Risk factors are PROM, placental insufficiency, fetal renal issues

What is preeclampsia?

High blood pressure, proteinuria, or organ dysfunction after 20 weeks

What is eclampsia

Preeclampsia with seizures

How do we manage pre/eclampsia?

BP control, monitoring, possibly early delivery if severe

How do we screen for gestational diabetes?

1-hour glucose challenge; follow-up 3-hour OGTT if abnormal

What are the risks of gestational diabetes?

Macrosomia (large baby), increased Type 2 diabetes risk for mother.

What is the treatment for gestational diabetes?

Diet, exercise, glucose monitoring, possible insulin

What is hyperemesis gravidarum?

Severe nausea/vomiting leading to weight loss and dehydration

What is the management for hyperemesis gravidarum?

IV fluids, antiemetics (e.g. ondansetron, vitamin B6+doxylamine)

What is gestational trophoblastic disease (molar pregnancy)?

Abnormal growth of trophoblastic tissue (elevated hCG, “snowstorm” ultrasound)

What is the treatment for gestational trophoblastic disease (molar pregnancy)?

Suction curettage, possible chemotherapy if persistent

What are the musculoskeletal changes in pregnancy?

Increased lordosis, relaxin-induced hypermobility, “waddling” gait, possible diastasis recti

What are the cardiovasuclar changes in pregnancy?

Increased blood volume and cardiac output

What are the gastrointestinal changes during pregnancy?

Nausea, constipation, reflux, hemorrhoids

What are the skin changes in pregancy?

Linea nigra, melasma, stretch marks.

What are the exercise guidelines for pregancy?

150 minutes/ week of moderate intensity aerobic exercise

What activity should you avoid during pregnancy?

Contact sports, high fall risk activities, supine exercises after mid pregnancy and overheating.

What are the chiro care modifications for positioning?

Pregnancy pillow or special table cutout for prone adjustments, side-lying for lumbar/pelvic work

What are some chiro care modifications for technique?

Low force methods (drops, instruments adjusting) as needed. Avoid excessive rotation or thrust in hypermobile joints

What are the goals for chiro care in pregnancy?

Reduce pain, maintain normal biomechanics, and possibly assist in optimal fetal positioning