ob exam 1

what are the pelvic types?

what are the pelvic types?

gynecoid (typical female pelvis)

android (typical male pelvis)

anthropoid (oval in anterior-posterior plane rather than the lateral plane)

platypelloid (broad & flat)

how does a female produce eggs?

born with all the eggs she will ever have

do any of the structures within male or female reproductive anatomy have the same function?

no

what does FSH do?

stimulates growth & development of graafian follicle

what does estrogen do?

creates endometrium

what does LH do?

stimulates development of the corpus luteum

what does progesterone do?

prepares uterus for fertilized ovum & prevents miscarriage

what are the phases of the uterine/endometrial cycle?

menstrual phase starts with vaginal bleeding

proliferative phase (end of menses through ovulation - day 14)

secretory phase (ovulation to just before menses)

ischemic phase (2 days before menses)

what are the phases of the hypothalamic-pituitary-ovarian cycle?

follicular phase (menstruation to ovulation)

luteal phase (ovulation to menstruation)

when do FSH, LH, estrogen, & progesterone rise & fall throughout the menstrual cycles?

FSH: rises before ovulation & falls during ovulation

LH: rises before ovulation & falls during ovulation

estrogen: rises during mid-follicular & mid-luteal phases, then falls after ovulation & at the end of menses

progesterone: rises & falls with luteal phase

is testosterone prominent throughout any part of the menstrual cycle?

no

what changes occur with cessation of menses?

as people age, everything slows down & dries up

what are some methods for management of menopausal symptoms?

hormone replacement therapy

exercise, acupuncture, meditation

what are some behavioral methods of contraception?

natural family planning, coitus interruptus, lactational amenorrhea, abstinence

what are some barrier methods of contraception? (& important information)

diaphragm: can stay in for 8 hours, custom fit

cervical cap

condom: only method that truly protects from STDs

spermicide: not promoted outside of diaphragms

contraceptive sponge: increased risk for toxic shock

what are some hormonal methods of contraception?

oral contraceptives, low-dose progestin-only contraceptive pills, transdermal contraceptive patch, vaginal contraceptive plug, injectable contraceptives (ex: Depo, Nexplanon), IUDs, emergency contraception (ex: postcoital ECPs - plan B)

what is some information about oral contraceptives?

monophasic: fewer side effects

combined: contraindications include high BMI, smoking, history of clots

what is some information about low-dose progestin-only contraceptive pills?

usually in conjunction with lactation, needs to be given at the same time every day

what is some information about transdermal contraceptive patch?

can cause irritation since it is only changed once a month

what is some information about injectable contraceptives?

Depo can cause increased weight gain & infertility; it can take up to a year to get pregnant once getting off the injection

what is some information about IUDs?

hormonal or non-hormonal (ex: copper IUD); increased risk for ectopic pregnancies

what is some information about postcoital ECPs?

induces a period with a very high dose of hormones; only addresses one intercourse

what is some information about female & male sterilization?

bilateral tube ligation: done under general anesthesia, affects menstrual cycle, increases cramps

vasectomy: outpatient, likely reversible

what are some non-contraceptive uses of oral contraceptives?

acne, painful or long periods, inducing of a period, PID, endometriosis

what are some male & female disorders that contribute to infertility?

female: endometriosis, PCOS, lack of regular ovulation, PID, uterine polyps or scarring, advanced maternal age

male: poor semen quality, low sperm count, cancer, small testes

male evaluation is easier, so it is done first even though the majority of infertility is a female issue

what are some potential alternatives for clients experiencing infertility?

intrauterine insemination: sperm is cleaned of semen & is injected into the uterus with a long catheter; 3% success but more affordable

in vitro fertilization: puts a woman into menopause & starts her cycle from scratch to be very regulated; eggs are harvested & fertilized, then the embryos are implanted

what is the process of fertilization, implantation, & placental development?

sperm fertilizes egg in fallopian tube during ovulation

after 6 days, embryo implants in the uterine lining

placenta begins to form after 10 weeks & serves as the heart & lungs for the embryo

what is multifactorial inheritance?

genetic factor plus an environmental factor work together to express a certain trait (ex: predisposition plus lack of folic acid = neural tube defect)

what is the difference between a genotype & phenotype?

genotype: genetic makeup

phenotype: observable expression of genotype (ex: physical features)

what is the structure & function of the umbilical cord?

connects the embryo to the yolk sac

two arteries, one vein

wharton’s jelly is the connective tissue that surrounds the umbilical cord

what is the structure & function of the placenta?

acts as the heart & lungs for the baby (without a viable placenta, there is no circulation to the baby)

takes over around 10 weeks

how do you interpret a baseline fetal heart rate?

normal range is 110-160

varies beat to beat, so focus on where most points peak at

what are the roles of amniotic fluid?

cushions fetus & protects from injury, helps maintain body temperature, allows for symmetrical growth, prevents adherence of the sac to the fetus, aids in musculoskeletal development, essential to fetal lung development

what are the major events of fetal development during each trimester?

first (first day of LMP to 13 weeks): organogenesis, most susceptible to teratogens

second (13 to 27 weeks): organ maturation & function (at 20 weeks you can see a four-vessel heart)

third (27 to 40 weeks): brown fat formation & neurological development

what are some threats to fetal wellbeing?

high temperatures & deficiency of folic acid contribute to development of NTDs

methylmercury, fat-soluble vitamins, alcohol, tobacco, caffeine, cocaine & crack, opiates, sedatives, amphetamines, cannabis, radiation, lead, pesticides, TORCH infections (toxoplasmosis; other: varicella, HIV, hep B, parvo, syphilis; rubella; CMV; HSV)

advanced maternal age

when should folic acid be taken & at what dose?

all women of childbearing age should consume 0.4 to 0.8 mg daily

what are some risks of genetic testing?

alpha-fetoprotein has a high risk of false-positives

chorionic villus sampling is high risk

carrier screening is only done with a family history

what are some physiological changes of the uterus during pregnancy?

increased blood flow, hyperplasia & hypertrophy of myometrial & muscle fibers, change in size/shape/position (abdominal organ)

what are some physiological changes of the cervix during pregnancy?

chadwick’s sign: bluish-purple discoloration

goddell’s sign: cervical softening

what are some physiological changes of the vagina & vulva during pregnancy?

vaginal mucosa thickens & rugae is more prominent, estrogen & progesterone cause proliferation of mucus production, operculum (mucus plug)

what are some physiological changes of the breasts during pregnancy?

enlargement/tingling/sensitivity, areola darkens, prominent superficial veins, montgomery tubercles provide lubrication for nipple tissue, stretch marks (striae gravidarum), pre-colostrum & colostrum

what are some physiological changes of the cardiovascular system during pregnancy?

heart shifts upward & to the left, HR increases by 10 to 15, CO increases, supine hypotension syndrome, vena cava syndrome

what are some physiological changes of the hematological system during pregnancy?

40 to 50% increased circulatory volume, increased blood flow to uterus, lower H/H due to dilution, increased WBCs, decreased platelets & albumin due to dilution, fibrinogen volume may increase to promote clotting & prepare for delivery, increased plasma proteins

what are some physiological changes of the respiratory system during pregnancy?

tidal volume increases, increase in oxygen consumption by 15 to 20%, increased vital capacity, chest circumference increases, loss of vertical diaphragm movement but increase in lateral movement

what are some physiological changes of the eyes & nose during pregnancy?

blurred vision (corneal thickening), nasal congestion (due to progesterone & estrogen; edema of nasal mucosa; epistaxis/nosebleeds)

what are some physiological changes of the oral system during pregnancy?

gingivitis, ptyalism gravidarum (excess saliva production), hyperemesis, pyrosis (heartburn)

what are some physiological changes of the liver & gallbladder during pregnancy?

stasis of bile (may cause itching), altered liver function due to additional workload, increased risk for cholecystitis, prolonged emptying time, elevated cholesterol levels

what are some physiological changes of the urinary system during pregnancy?

relaxation of urethra/sphincter musculature/bladder, reduced peristalsis, elongation & dilation of ureters, enlarging uterus can obstruct urine flow, increased risk for UTIs (E. coli & chlamydia can contribute to miscarriage or preterm labor), kidneys enlarge slightly

what are some physiological changes of the endocrine system during pregnancy?

thyroid enlarges, more calcium is needed (1200 mg per day in divided doses), pituitary & placenta contribute to prolactin & oxytocin levels (placenta removal triggers pituitary to make milk; oxytocin helps uterus retract & prevents PPH), adrenals enlarge, prostaglandins help start labor, hCG causes positive pregnancy test

what are some physiological changes of the musculoskeletal system during pregnancy?

abdominal wall weakens, lumbar lordosis, lower back pain, lax sacroiliac joint, widened symphysis pubis, change in gait

what are some physiological changes of the integumentary system during pregnancy?

linea nigra, cholasma/molasma, striae gravidarum (do not go away), palmar erythema

what are some physiological changes of the neurological system during pregnancy?

tingling, Charlie horses, carpal tunnel, etc. are common

what are some psychosocial changes during pregnancy?

maternal attachment starts during pregnancy, readiness for motherhood, acceptance of pregnancy, anxiety & body image, developmental tasks, readiness for fatherhood (couvade syndrome - father exhibits pregnancy traits), adaptation of siblings & grandparents, maternal adaptation with absence of significant other, intimate partner violence

how do you use naegele’s rule to calculate an estimated due date?

add 7 days to first day of LMP, then subtract 3 months & add a year (or just add 7 days & 9 months)

what are some presumptive signs of pregnancy?

amenorrhea, breast tenderness, fatigue, N/V

what are some probable signs of pregnancy?

abdominal enlargement, positive pregnancy test

what are some positive signs of pregnancy?

fetal heartbeat by doppler, ultrasound visualization, fetal movements palpated by provider

what are the guidelines for routine prenatal care appointments & testing?

initial prenatal appointment at 8 weeks: 90 minutes, big on education, check for rubella, UTIs, & blood type

provider appointment at 10 to 12 weeks

more frequent appointments closer to due date

every appointment, check FHR, urine test (protein = preeclampsia, ketones = GDM), & fundal height

genetic testing: blood test done at 10 weeks or AFP at 13 weeks

how is leopold’s manuever performed?

palpate fundus to feel for butt (toco goes on fundus)

follow does baby’s back (FHR monitor goes here)

check for head at bottom of pelvis (shake for butt vs. head)

push hands under pelvic bone for anterior vs. posterior positioning

what are some nutritional needs during pregnancy?

to sustain pregnancy, extra 300 calories per day; to sustain breastfeeding, exyta 500 calories per day

protein, heme iron & iron-fortified foods (use iron skillet), water, vitamin-c rich foods, prenatal vitamins (folic acid & calcium)

what is the ideal weight gain during pregnancy?

overall, ideal is 25 pounds

bmi > 30, 0 to 10 pounds

bmi < 20, 35 to 45 pounds

what are the recommendations for exercise during pregnancy?

regular, moderate-intensity physical activity for 30 minutes a day is encouraged unless contraindicated

maintain the same level

at 20 to 24 weeks, don’t go flat on back

what are the various methods of childbirthing education?

classes in second trimester

all methods usually require a supportive partner (ex: doula)

hypnobirthing: dissociation

lamaze: breathing as a distraction technique

bradley method: “our bodies were made to do this; work through the pain; stay in control”

what is ectopic pregnancy?

fertilized egg implants outside uterine cavity

rupture can lead to blood loss, shock, or death

risk factors include scarring (ex: PID), history of ectopic pregnancy or endometriosis, previous pelvic surgery, or use of IUDs or IVF

what is the treatment for ectopic pregnancy?

salpingectomy (removal of fallopian tube) or salpingostomy (incision of the fallopian tube) to remove pregnancy

methotrexate to stop rapid cell production

what is spontaneous abortion?

loss of pregnancy before 20 weeks

1 in 4 pregnancies end in miscarriage

what are the different kinds of spontaneous abortions?

complete: complete expulsion of all products of conception

incomplete: partial expulsion of POC

inevitable: no expulsion but bleeding & dilation

threatened: intrauterine bleeding but fetus is alive

missed: death with complete retention of POC

septic: infection during the process

recurrent: 3 or more pregnancies resulting in spontaneous abortion

elective/therapeutic: POC removed for medical or personal reasons

which kinds of spontaneous abortion have treatments & what are they?

incomplete: if death is before 15 weeks, dilation & curettage; if death is between 15 & 20 weeks, delivery (or dilation & evacuation in some states)

threatened: progesterone (only if levels are low)

what is cervical insufficiency?

inability of the cervix to remain closed & support growing pregnancy

painless dilation

usually caused by short cervix (anatomy or LEEP procedure)

what is the treatment for cervical insufficiency?

cerclage (stitch cervix closed 15 to 19 weeks until 38ish weeks)

what is hyperemesis?

extreme persistent, continuous N/V in pregnancy

can cause electrolyte imbalance, dehydration, alkalosis, ketonuria, & discrete weight loss

what is the treatment for hyperemesis?

IV fluids (usually through PICC due to dehydration), anti-nausea medication (Dramamine, Phenergan, ondansetron), B6, Diclegis, Reglan

what is placental previa?

painless bright red bleeding

complete, partial, or marginal

what are some interventions for placental previa?

vitals & fetal monitoring, IV & blood typing, delivery if severe

nothing in the vaginal vault!!

what is placental abruption?

premature separation of a normally implanted placenta (painful & with or without bright red bleeding in the third trimester)

medical emergency if mother hemorrhages

risk factors include domestic violence, HTN, & illicit drug use

what is the treatment for placental abruption?

vitals & fetal monitoring, IV & blood typing, delivery if severe

if mild & baby is being perfused, monitor

what is preterm labor?

any labor before 38 weeks

what is the treatment for preterm labor?

goal is to buy time (tocolytics to stop contractions, fluids, rest)

hydrate & sedate (IV fluids, meperidine, Phenergan, magnesium)

if mother continues to contract, give two steroid shots 24 hours apart

fetal fibronectin testing to measure broken down protein (cannot be done if anything is in the vagina 24 hours prior)

what is premature rupture of membranes?

rupture of membranes before labor/delivery

most common cause is bacteria/infection in genital tract

increases risk of infection & requires continuous monitoring (FHR is first sign)

what is preeclampsia?

HTN & proteinuria after 20 weeks

what is the treatment for preeclampsia?

delivery

magnesium sulfate to raise excitability threshold: calcium gluconate in case of emergency, monitor for toxicity (deep tendon reflexes, urine output, RR)

low stimulating room

what are some complications of preeclampsia?

HELLP: severe preeclampsia, hemolysis/elevated liver enzymes/low platelets, symptoms are multiorgan failure

disseminated intravascular coagulopathy: causes widespread external or internal bleeding

what is the treatment for UTI?

most common bacterial infection of pregnancy

Bactrim (cannot be given in third trimester)

what is group B strep?

asymptomatic bacteria of the vaginal tract that can cause UTIs, chorioamnionitis, endometritis, or neonatal sepsis

screening at 36 weeks: if positive, two doses of antibiotics 4 hours apart during labor

what is Rh isoimmunization?

hemolytic disease of the fetus/newborn

maternal antibodies against antigens present on the baby’s RBCs

this can provoke an immune reaction

what is the treatment for Rh isoimmunization?

RhoGAM: given at 28 weeks, immediately postpartum, & with any bleeding episode during pregnancy

what are some risk factors for gestational diabetes?

age older than 25, obesity, insulin resistance, PCOS, history of LGA infants, hydramnios, history of stillbirth or miscarriage, family history of T2DM

what is BPP vs. NST vs. CST vs. fetal monitoring?

BPP: noninvasive fetal exam predicting fetal wellbeing; combines EFM & US

NST: monitors how baby is doing without contractions; EFM for 20 minutes, monitoring FHR & uterine activity

CST: contraction stress test; monitors fetal response to induced contractions

fetal monitoring: focuses on FHR

what are some risk of adolescent & geriatric pregnancies?

pregnancy is the leading cause of death in patients ages 15 to 19

geriatric pregnancy increases the risk of chronic diseases