Exam #1 OB/Maternal

Pain that comes with changing positions while pregnant

Round Ligament Pain

The most favorable type of pelvis for natural birth vs pelvis structure for c section birth

Favorable type- Gynecoid

Least favorable type- Platypelliod

"0 position, head is engaged” means what

Babies head is inline with ischial spine

How many female reproductive cycles are there

-Endometrial Cycle

-Hypothalamic-pituitary Cycle

-Menstral/Ovarian Cycle

What are the four stages of the endometrial cycle

1) Menstrual

2) Proliferative

3) Secretory

4) Ischemic

Menstrual Phase

1-6 days

Estrogen Low

Endometrium Shed

Proliferative Phase

7-14 days

Estrogen Peaks

Ovulation occurs → Cervical mucous is clear, thin, watery-like → favorable to sperm

Prior to ovulation → Temp down // After ovulation → Temp increase

Secretory Phase

15-26 days

Estrogen drops

Progesterone Increases

Ischemic Phase

27-28 days

Estrogen + Progesterone decreases

Endometrium becomes pale and deteriorates

Ovarian Cycle is composed of what two phases

1) Follicular Phase

2) Luteal Phase

What splits the follicular phase and luteal phase (ovarian cycle)

Ovulation due to mature follicule rupturing due to LH surge

What are the secondary symptoms of ovulation

-Spinbarkheit → Change of the cervical mucus

-Mittleschmerz→ Pain on one side while ovulation occurs

-Temp Changes

Ovarian cycle phase that oocyte grows inside the maturing follicle

This phase varies in length

Follicular Phase

The luteal cycle phase begins when the ovum leaves the follicle

LH helps develop the corpus lumen

-This phase is fixed in length

Luteal Phase

Hypothalamic-Pituitary Cycle is composed of what two hormones that peak at ovulation

A.FSH.F→ Anterior → FSH → Follicular Phase

P.LH.L → Posterior → LH → Luteral

Primary vs Secondary Amenorrhea

Primary → “Never had a period” → No menses by age 15 with secondary sex characteristics or No menses by age 13 without secondary sex characteristics

Secondary → “Do not have a period anymore.”

Endometrial tissue going outside of the uterus attaching itself to other body parts

Endometriosis (lots of scar tissue, diagnosis is scoping that can cause infertility)

High androgens, & high insulin resistance, with facial hair syndrome

PCOS

Factors Affecting Female Fertility

-Anovulation (no ovulation)

-Tube scaring

-Age over 40

-Genetic

-Lifestyle, or heart-shaped uterus

-Fibroids

Factors Affecting Male Fertility

Hormonal disorders affecting sperm production

Testicular factors → Sperm transport

Genetic factors → Klinefelter syndrome

Age

Lifestyle or environment

Non-medical Management of infertility

Healthy BMI, Exercise, abstain from alch, cigs, drugs, use lube, and decrease scrotal temp (no laptops on lap)

Medical management for infertility

Clomiphene citrate & Letrozole (PCOS treatment)

Metformin → Support ovulation (PCOS)

Stabilize chronic medical conditions & treat infections

What are the benefits of planned pregnancies

Avoid tetragoenic substances

Best timing to get pregnant

2 days before and the day of ovulation are the peak

How long does a sperm live after intercouse

3-5 days

Corrtius Interruptus is called

Withdrawl method (one of the least effective)

Standard Day Method Model

-Red dot is the first day of the menstrual cycle

-Brown = non-fertile = abstain from sex on days 8 to 19

-White = fertile = Have sex

A model that analyzed urinary metabolites of LH and estrogen to predict ovulation

Marquette Model

When should a diaphragm, cervical cap, or contraceptive sponge be placed and then taken out before and after sex

Before → 3 hrs

After → No more than 24 hrs

Estrogen-Progestin Contraceptives (Common Coc)

Suppresses FSH & LH, which affects the endometrial lining and thickens the cervical mucus

Do not give to patients with DVT or heart problems

Progestrine-Only Contraceptive

Inhibits ovulation, thickens & decreases cervical mucus, thins out the endometrium

Only use it for 2 years because it can cause osteoporosis

Must take at same time everyday

Emergency Contraption “Plan B”

Does not kill an already established pregnancy

What is the number one thing causing maternal mortality in the US vs MO

US → Mental health

MO → Cadiovascular

Care that should occur any time a HCP sees a person with female reproductive organs of childbearing age is called

Preconception Care

Prenatal Visit Interview

-Happens around 8 weeks

-Get all the history

-Occupation or social history

-Mental health screening

Presumptive vs Probable vs Positive signs of pregnancy

Presumptive → Subjective info pt tells you

Probable → Object sign from our assignment (Chadwick → Cervix is blue) & preg test

Positive → Ultrasound

G stands for what

Number of pregnancies

P stands for what

Number of deliveries OVER 20 weeks

TPAL stans for

Term → deliverers

Preterm → deliveries and (stillbirth after 20 weeks )

Abortion → miscarriage (before 20 weeks)

Living

Answer this GPTAL Question #1

Gravida→4

Para → 1

T→ 1

P→ 0

A→ 2

L → 1

Answer this GPTAL Question #2

Gravida → 3

Para → 2 (twins count as one delivery)

T→1

P→1 (twins count as one preterm)

A→ 0

L→ 3 (twins count individually)

McDonald’s Method is

Measuring from the pubic symphysis to the top of the fundus

Correlates with gestational age + or - 2cm

What is another word for fetal movement

Quickening

1st trimester lab screening

“All the blood tests”
-CBC → Look for anemia

-Blood type & RH factor (neg mom needs Rohgam)

-Urinalysis

-RPR → Screen for syphilis

-Hep B

-HIV

2nd Trimester lab screening

“Screen for that Diabetes”

-1 hr GTT → Above 130-140 mg/dl is fail → Go onto 3 hr test

3rd Trimester lab

“Repeat a few tests.”

-GBS

-Anemia test (H&H)

-STI test

Some personal hygiene tips for pregnant people

-Avoid Hot Tub

-Wear loose clothing

Why do you avoid laying supine during preganancy

Aorta Vena Cava or Supine Hypotensive Syndrome → Diminishes the blood supply & pressure in mother.

Braxton Hicks Contractions

-Non-laboring contractions
-Do not come regularly

-Stop when walking around

-Usually are weak and feel on one side

What are some assessments and screenings that occur on the fetus in the 1st trimester

-Transvaginal Ultrasound

-Doppler FHT

-Chronic Villus Sampling → High risk for infection!!

What are some assessments and screenings that occur on the fetus in the 2nd trimester

-Fetal Anatomy Survey Ultrasound → Is it a boy or a girl? Plus, are the major organs all intact

-Maternal Serum Alpha-Fetoprotein → Elevated levels can indicate neural tube defects

-Amniocentesis → Diagnostic test

-Quad Screening Test

What is an Amniocentesis

-Diagnostic test to look for and confirm any abnormalities

-Make sure mother has an empty bladder

-Rhogam is administered

-Can be risky

What are some assessments and screenings that occur on the fetus in the 3rd trimester

-Fetal Movement tests → After 24 weeks

-Non-Stress Test

-Biophysical Profile (BPP) → Ordered if the non-stress test comes up non-reactive

-Contraction Stress Test

Non-Stress Test need to know criteria

Reactive

-Normal baseline

-Moderate variability

-Two or more accelerations in 20 mins

-Absence of decelerations

Non-Reactive

-Absence of acceleration in 40 mins

-Abnormal everything else listed above

Biophysical Profile (BPP) looks for what 5 criteria

Shows baby oxygenation

1) Fetal breathing

2) Fetal movement

3) Fetal tone

4) Amniotic fluid index (AFI)

5) Non-stress test

Contraction Stress Test criteria

Ordered to see if the baby can have contractions and be delivered vaginally

Negative = Good ; Positive = Bad

Abortion that is pregnancy loss prior to 20 weeks pregnancy

Spontaneous Abortion

#1 Cause of bleeding in the 1st and 2nd trimesters

What is the most common cause of Spontaneous Abortion

Chromosomal Abnormalties

What are the types of abortion

-Threatened abortion

-Inevitable abortion

-Incomplete abortion

-Complete abortion

-Missed abortion

Clinical Manifestations of spotting/bleeding or cramping or back aches

-Cervix is closed

-Placenta remains attached to uterine wall

-May result in pregnancy loss or not

Threatened Abortion

Clinical Manifestation of increased cramping with mild to moderate bleeding

-Cervix dilates

-Placenta is separated from the uterine wall

Inevetable Abortion

Clinical Manifestation is increased cramping with severe vaginal bleeding that won’t stop

-Cervix is dilated

-Placenta is separated from the wall

-Fetal tissue is passed but some contents are still in uterus

-Need intervention to stop bleeding

Incomplete Abortion

(Complete is when all the stuff does come out)

The fetus is dead in the uterus, but has not been passed

-Cervix is closed

-Usually happens in the first trimester

-No more nausea and vomiting all of a sudden, mother feels really good

Missed Abortion

Partial detachment from the chorionic membrane to the uterine wall where blood accumulates between the placenta and the uterine wall during pregnancy is called what

Subchorionic Hematoma → Resolve spontaneously or leads to miscarriage

Implementation of a fertilized ovum outside the endometrial lining of the uterus, usually in the ampulla of the fallopian tube (12 weeks it would be ruptured)

Ectopic Pregnancy

Risk factors for Ectopic Pregnancy

-Tubal damage

-Endometriosis

-Increase in progesterone

-Hx of ectopic pregnancy

-Infertility

-Smoking

Clinical Manifestations of Ectopic Pregnancy

-Missed menses

-Abdominal Pain on one side

-Referred shoulder pain

-Low hCG levels

-Rigid tender abdomen

-Spotting

Lab & Diagnostic testing of Ectopic Testing

-Low hCG levels

-Increased WBC
-Ultrasound

What medication is giving to eliminate the Ectopic pregnancy

Methotrexate (can only do this if you catch it early so preach early pregnancy confirmation)

Pathological proliferation of trophoblastic cells that become fluid-filled vesicles

(Bengign neoplast or “empty egg”) is called what

Molar Pregnancy (Gestational Trophoblastic Disease)

Race at risk for Molar Pregnancy

Asian women

Complete vs Partial Molar Pregnancy

Complete → Empty egg gets fertilized by sperm → all 46 paternal chromosomes → Higher increase of choriocarcinoma

Partial → One Egg is fertilized by 2 sperm → 69 chromosomes → fetal parts may be present.

Clinical Manifestations of Molar Pregnancy

Hyperemesis, brown “prune juice” blood, uterine enlargment, and elevated hCG level

Treatment for Molar Pregnancy

-D & C surgery to remove it

-No pregnancy for 1 year

-Use that contraception

-Monitor hCG levels

Bleeding during the second half of pregnancy contains what two major conditions

Abruptions vs Previa

What happens to the placenta during an Abruption

Placenta separates from uterine wall

Placental Abruption Risk Factors

-Hypertension/preeclampsia (vasoconstriction)

-Trauma

-Cocaine use (vasoconstriction)

-Smoking (vasoconstriction)

Abruption Clinical Manifestations

-Painful

-Dark red bleeding on the inside

-Hard, rigid abdomen

Type of abruption where there is no bleeding

Central Abruption

Type of abruption where there is no bleeding and more than 50% of the placenta is removed

Complete Abruption

Complete Abruption interventions

Need have a preterm delivery immediately

Why do we give steroids to pregnant mothers

To mature the lungs of the baby becasue they are going to have a preterm delivery and they want those organs matured STAT.

Improper placental tissue that can cover the cervix

“Placenta Firtst”

Placenta Previa

Total vs Partial Previa

Total → placenta covers all of the cervix

Partial → Placenta covers part of cervix

Both require C section

Marginal vs Low Lying

Marginal→ Little piece covers the cervix

Low-lying → Placental is touching the cervix on the low end of uterus

Previa Clinical Manifestations

-Painless

-Bright red bleeding

-Non-tender, soft, and relaxed

Previa Nursing Management

-No vaginal exams unless with a speculum

-Avoid sexual intercourse

What is Vesa Previa

Umbilical Cord and blood vessels under the babi’s head → Emergency C Section

Cervical Insufficiency Treatment

IM Progesterone & Cercal Ceclage (have to loose one baby before going that)

The softening and compressibility of the cervix within the early weeks of pregnancy is called what sign

Godell’s sign

Anatomical Fundal Height Landmarks for 12 wks, 20 wks, 36 wks, 37-40 wks & (24 hr postpartum)

12 weeks → Pubic Symphysis

20 weeks → Umbilicus

36 weeks → Xiphoid process

37-40 weeks → Regression of fundal height due to the baby dropping into the pelvis, aka “lightening.”

24 hr Postpartum → Umbilicus

The softening of the lower uterine isthmus refers to what sign?

Hegar’s sign

What happens to the ovaries during pregancy?

Ovulation ceases

Vagina changes due to pregnancy

-Increase in thickness and acidity of secretions

-Leukorrhea →Thick, white, vaginal discharge due to an increase in estrogen

-Favors yeast

Breast pregnancy changes

-Increase size & tenderness (prominent in 1st trimester)

-Striae

-Areolae darken, and nipples are pronounced

-Colostrum

Blood volume increases by how much during pregnancy

50%

Blood pressure during pregnancy

Blood pressure decreases → Lowest at the 2nd trimester

Cardiac output & Heart rate during pregnancy

Both increase

Why do clients have physiological anemia of pregnancy

-Plasma volume increases faster than RBC

-Leads to Hemodilution

-Decrease in H&H

Does WBC increase or decrease during pregnancy

WBC Increases