MCF Modules: Reproduction, Pregnancy & Women's Health Notes

Normal Reproduction & Pregnancy

Reproductive Anatomy & Fertility (Ch 11, 31)
- Menstrual cycle hormones:
- FSH → follicle growth
- LH surge → ovulation
- Estrogen → thickens endometrium
- Progesterone → stabilizes lining for implantation
- Decline in fertility: accelerates after age 35
- Contraception methods:
- Barrier → condoms, diaphragm (STI protection)
- Hormonal → pill, patch, ring, injection, implant, IUD
  - ACHES = danger signs (Abd pain, Chest pain, HA, Eye probs, Severe leg pain → clot/stroke)
- Natural → fertility awareness, withdrawal, abstinence
- Sterilization → tubal ligation (female), vasectomy (male)
- Infertility causes: ovulatory disorders, tubal scarring (PID, endometriosis), sperm abnormalities
Conception & Prenatal Development (Ch 12)
- Fertilization = sperm + ovum → zygote (46 chromosomes) $46$ chromosomes
- Stages of development:
- Pre-embryonic (0–2w): cell division, implantation
- Embryonic (2–8w): organogenesis, highest teratogen risk
- Fetal (9w–birth): growth/refinement of organs
- Placenta functions:
- Metabolic: nutrients, waste
- Transfer: gas exchange
- Endocrine: hCG (maintains corpus luteum), hPL (↑ insulin resistance), estrogen, progesterone, relaxin
- Amniotic fluid:
- Normal = clear, 500–1000 mL
- Functions = cushions, temp regulation, allows movement
- Polyhydramnios (>2000 mL): maternal DM, fetal anomaly
- Oligohydramnios (<500 mL): renal agenesis, growth restriction
- Umbilical cord: 2 arteries, 1 vein; Wharton’s jelly prevents compression
- Fetal circulation: ductus venosus, foramen ovale, ductus arteriosus
Adaptations to Pregnancy (Ch 13)
- Signs of pregnancy:
- Presumptive (subjective): N/V, fatigue, breast changes
- Probable (objective): Chadwick’s (blue cervix), Goodell’s (soft cervix), Hegar’s (soft isthmus), positive pregnancy test
- Positive: FHR, ultrasound, examiner feels movement
- Fundal height:
- 12w: symphysis pubis
- 20w: umbilicus (~20 cm)
- 36w: xiphoid process
- After 36w: “lightening” (fundus drops as fetus engages)
- Body system changes:
- CV: ↑ blood volume 50%, ↑CO, physiologic anemia, hypercoagulable state
- Resp: ↑O₂ consumption, slight ↑RR
- Renal: ↑GFR, risk UTIs
- Endocrine: insulin resistance (risk GDM)
- Integumentary: linea nigra, striae, melasma
- Danger signs:
- Vaginal bleeding
- Severe HA, blurred vision (preeclampsia)
- Facial/hand edema
- Severe abdominal pain
- Decreased fetal movement
- Dating pregnancy: Naegele’s rule = LMP – 3 months + 7 days + 1 year
Nutrition in Pregnancy (Ch 14)
- Weight gain recommendations:
- Normal BMI: 25–35 lbs
- Underweight: 28–40 lbs
- Overweight: 15–25 lbs
- Obese: 11–20 lbs
- Pattern of weight gain:
- 1st tri: 1–4 lbs
- 2nd & 3rd tri: ~1 lb/week
- Nutritional needs:
- Calories: + $300$ kcal/day
- Protein: + $25$ g/day
- Iron: $27$ mg/day
- Calcium: $1000$ mg/day
- Folic acid: $600$ mcg/day (prevents NTD)
- Food safety: avoid raw fish, soft cheeses, deli meats, high-mercury fish
- Special considerations:
- Adolescents: higher nutrient needs
- Pica: craving nonfood → linked to anemia
- Lactation: + $500$ kcal/day, ↑ fluids
Prenatal Care & Diagnostic Tests (Ch 15)
- Initial visit: Hx, labs (CBC, Rh, HIV, Hep B, syphilis, GC/Chlamydia, rubella titer, UA)
- Visit schedule:
- Every 4w until 28w
- Every 2w until 36w
- Weekly after 37w
- Ultrasound: gestational age, anatomy, growth, position
- Maternal serum AFP (16–18w): screen for NTD, trisomy
- CVS (10–13w): chromosomal dx, miscarriage risk
- Amniocentesis:
- 15–20w → genetic dx
- 3rd tri → lung maturity (L/S ratio ≥2:1 = mature)
- NST (≥32w): reactive = 2 accelerations (15x15) in 20 min
- BPP: 8–10 reassuring
- Kick counts: ≥10/hr, start at 28w
Intrapartum & Birth
Labor & Birth Process (Ch 16)
- Critical Factors (“5 Ps”):
- Passenger → fetus (size, attitude, lie, presentation, position, station, engagement)
  - Attitude: flexion = optimal
  - Lie: longitudinal vs transverse
  - Presentation: vertex (most common), breech, shoulder
  - Position: LOA/ROA = most favorable; OP = back pain, long labor
  - Station: relationship to ischial spines (0 = engaged)
- Passage → maternal pelvis + soft tissues
  - Pelvic types:
  - Gynecoid (best)
  - Android (male-type, poor)
  - Anthropoid (okay)
  - Platypelloid (least favorable)
- Powers → contractions (frequency, duration, intensity) + pushing
- Psyche → maternal mental state (anxiety ↓ uterine perfusion)
- Position → upright/ambulation promotes descent & perfusion
- Signs of Labor:
- Premonitory: lightening, bloody show, nesting, ROM
- True labor: regular, stronger, closer contractions + cervical change
- False labor: irregular contractions, no cervical change, walking ↓ pain
- Stages of Labor:
1. First stage: onset → 10 cm
  - Latent (0–6 cm, mild contractions)
  - Active (6–8 cm, stronger)
  - Transition (8–10 cm, intense, N/V, urge to push)
2. Second stage: 10 cm → birth of baby
3. Third stage: delivery of placenta (5–30 min)
4. Fourth stage: first 1–2 hrs postpartum (greatest risk = hemorrhage)
- Cardinal Movements of Labor:
- Descent → Flexion → Internal rotation → Extension → External rotation → Expulsion
- Maternal changes in labor: ↑HR, ↑CO, ↑RR, ↓gastric emptying, slight temp ↑
- Fetal response: FHR accelerations, lung fluid squeezed out, ↓ O₂ during contractions tolerated
Fetal Monitoring (Ch 17)
- Purpose: evaluate fetal O₂ during labor
- Methods:
- Intermittent auscultation (low-risk)
- Continuous EFM (external vs internal)
- Baseline FHR: $110–160$ bpm
- Tachycardia: > $160$ (infection, drugs, hypoxia)
- Bradycardia: < $110$ (cord prolapse, hypoxia)
- Variability (fluctuations in baseline):
- Absent = BAD (hypoxia, acidosis)
- Minimal (<5 bpm) = concern
- Moderate (6–25 bpm) = reassuring
- Marked (>25 bpm) = may indicate hypoxia/cord problem
- Accelerations: ↑ $15$ bpm for $15$ sec (normal, reassuring)
- Decelerations:
- Early decels: mirror contractions, due to head compression, benign
- Late decels: begin after contraction peak → uteroplacental insufficiency → reposition, O₂ 8–10 L mask, IV bolus, stop oxytocin, notify provider
- Variable decels: abrupt drop, cord compression → reposition (side-to-side, knee-chest), amnioinfusion if persistent
- Nonreassuring patterns: absent variability, recurrent late decels, recurrent variables, bradycardia, sinusoidal pattern
- Nursing Interventions:
- Reposition to L side
- O₂ 8–10 L by mask
- IV fluid bolus
- Stop Pitocin
- Notify provider
- Prepare for C-section if unresolved
Pain Management (Ch 18)
- Nonpharmacologic:
- Breathing techniques (cleansing, paced, pant-blow)
- Counterpressure for back labor (OP position)
- Hydrotherapy, positioning, massage, relaxation, guided imagery
- Regional Analgesia/Anesthesia:
- Epidural:
  - Nursing care: Confirm consent, CBC/platelets; Preload 500–1000 mL LR; Continuous FHR
  - Side effects: hypotension (bolus, ephedrine), pruritus, fever, urinary retention
  - Complication: post-dural puncture HA (blood patch)
- Spinal (subarachnoid block): used for C-section; faster onset but higher risk of hypotension
- General anesthesia: last resort, ↑ risk aspiration & neonatal depression
- Systemic Analgesics: opioids → cross placenta → risk resp depression in newborn
- Nitrous Oxide: safe, self-administered, no neonatal harm
OB Procedures (Ch 19)
- Amniotomy (AROM):
- Purpose: induce/augment labor, allow internal monitoring
- Risks: cord prolapse, infection, abruption
- Nursing: check FHR before & after, assess amniotic fluid (clear vs meconium)
- Induction/Augmentation:
- Indications: post-term, GDM, preeclampsia, PROM, fetal compromise
- Contraindications: placenta previa, transverse lie, previous classical incision
- Bishop’s score: readiness (≥8 = successful induction likely)
- Oxytocin (Pitocin): monitor contractions (stop if >5/10 min or >90 sec)
- Tachysystole = >5 contractions in 10 min → stop Pitocin, side, O₂, bolus
- Amnioinfusion: warm saline via IUPC for variable decels (cord compression)
- External version:
- Turn breech → cephalic after 37w
- Risks: cord entanglement, abruption
- Nursing: monitor FHR, give RhoGAM if Rh–
Operative vaginal birth (forceps, vacuum):
- Indications: prolonged 2nd stage, fetal distress
- Risks: maternal trauma, neonatal cephalohematoma
Cesarean Section:
- Indications: previa, abruption, macrosomia, distress, malpresentation, cord prolapse
- Pre-op: consent, IV, labs, shave site, prophylactic antibiotics, Foley
- Post-op: fundus checks, ambulation, pain mgmt
VBAC: vaginal birth after cesarean
- Contraindications: classical incision, uterine rupture hx
- Nursing: continuous FHR, watch for rupture (sudden sharp pain, fetal distress)

Pregnancy Complications

Early Pregnancy Bleeding (Ch 25)
- Spontaneous Abortion Types
- Threatened: vaginal bleeding, cervix closed, no tissue passed
- Inevitable: bleeding, cramping, cervix dilates, no tissue passed
- Incomplete: some products expelled, retained tissue inside
- Complete: all products expelled, cervix closes
- Missed: fetus dies but not expelled → infection, DIC risk
- Recurrent (habitual): ≥3 consecutive losses → incompetent cervix, chromosomal issue
- Nursing Care
- Assess bleeding, pain, VS
- Emotional support, grief counseling
- If heavy bleeding → D&C, prostaglandins, misoprostol
- Rh– mother → RhoGAM
- Ectopic Pregnancy
- Implantation outside uterus (most commonly fallopian tube)
- Risk factors: PID, prior ectopic, IUD, smoking, tubal surgery
- Hallmark S/S: unilateral lower quadrant pain + vaginal spotting 6–8 weeks after missed period
- If rupture: sudden severe pain, shoulder pain, shock signs
- Dx: TV ultrasound, ↑hCG that rises abnormally
- Tx:
  - Medical: methotrexate if stable/unruptured
  - Surgical: salpingectomy if ruptured
- Nursing: monitor for rupture, educate on future fertility
Gestational Trophoblastic Disease (GTD / Molar Pregnancy)
- Abnormal trophoblast proliferation → grape-like vesicles
- Types: complete (empty egg, only paternal DNA), partial (abnormal embryo, non- viable)
- S/S: vaginal bleeding, very ↑hCG, uterine size > gestational age, hyperemesis, early preeclampsia
- Dx: ultrasound (“snowstorm”)
- Tx: D&C evacuation, serial hCG monitoring until normal for 12 months
- Teaching:
- No pregnancy for 1 year (interferes with hCG monitoring)
- Emotional support
- Possible chemo if hCG remains elevated (risk choriocarcinoma)
Late Pregnancy Bleeding (Ch 25)
- Placenta Previa
- Placenta implants over cervix
- S/S: painless, bright red bleeding in 2nd/3rd trimester
- Dx: ultrasound
- Nursing: o No vaginal exams! o Monitor bleeding, FHR. o Bedrest, IV access. o Prepare for C-section if complete previa
- Abruptio Placentae
- Premature separation of placenta from uterine wall
- Risk factors: HTN, trauma, cocaine, smoking, polyhydramnios
- S/S: painful, dark red bleeding (may be concealed), rigid/board-like uterus, ↓ fetal movement, uterine hypertonicity
- Severe cases: hypovolemic shock, fetal demise
- Nursing: o Emergency → prepare for immediate C-section. o Monitor VS, bleeding, FHR. o Two large-bore IVs, O₂, blood products
Hypertensive Disorders (Ch 25)
- Gestational HTN: HTN after 20w without proteinuria
- Preeclampsia: HTN + proteinuria or organ dysfunction after 20w
- Risk factors: 1st pregnancy,
- S/S: severe HA, vision changes, RUQ pain, edema hands/face, rapid wt gain, hyperreflexia
- Labs: proteinuria, ↑LFTs, ↑creatinine, ↓platelets
- Tx:
- Mild: rest, BP/kick counts at home
- Severe: admit, MgSO₄ infusion (seizure prophylaxis), antihypertensives, fetal monitoring
- Eclampsia: preeclampsia + seizures
- MgSO₄ during/after seizure
- Seizure precautions, O₂, suction, lateral position
- Complications: HELLP, DIC, abruption, stroke, fetal hypoxia
- HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets
- Occurs in 10–20% of severe preeclampsia
- S/S: epigastric/RUQ pain, N/V, malaise, bruising, ↑LFTs, ↓platelets
- Tx: stabilize mother, MgSO₄, delivery if viable
- Chronic HTN: HTN before pregnancy or before 20w
- Risk of superimposed preeclampsia
Other Pregnancy Complications
- Hyperemesis Gravidarum (Ch 25):
- Severe, persistent N/V → dehydration, wt loss, ketonuria, electrolyte imbalance
- Tx: hospitalization, NPO initially; IV fluids, antiemetics; small frequent meals, separate fluids from solids; monitor weight, urine ketones
- Nursing: oral care, comfort, emotional support
Gestational Diabetes (Ch 26)
- Screen 24–28w:
- 1h GCT (50 g glucose, no fasting)
- If ≥140 → 3h OGTT
- OGTT dx criteria:
- Fasting > 95
- 1h > 180
- 2h > 155
- 3h > 140
- Maternal risks: HTN, C-section, infections
- Fetal risks: macrosomia, hypoglycemia, RDS, stillbirth
- Tx: diet/exercise, glucose monitoring, insulin if needed
- Postpartum: mother’s insulin need ↓; infant at risk hypoglycemia
Concurrent Disorders (Ch 26)
- Cardiac Disease: monitor activity tolerance, prevent infection, avoid fluid overload
- Asthma: most women improve, some worsen; meds safer than hypoxia
- Anemia:
- Iron deficiency: pale, fatigue, low Hgb/Hct, microcytic cells
- Sickle cell: risk crisis (pain, infection, IUGR)
- Infections:
- CMV: common, can cause hearing loss, IUGR, microcephaly
- Varicella: congenital varicella syndrome if early pregnancy; vaccine postpartum
- Parvo B19: “fifth disease,” risk hydrops fetalis
- Group B strep: screen 36w, treat + women with IV penicillin in labor
- HIV: ART, C-section at 38w, no breastfeeding
TB: isoniazid, rifampin, ethambutol; if untreated, no contact with baby until therapy established
Blood Incompatibilities
- Rh incompatibility:
- Occurs when Rh– mother carries Rh+ fetus
- Maternal antibodies attack fetal RBCs → hemolytic disease of newborn
- Prevention: RhoGAM at 28w and within 72h postpartum if infant Rh+
- ABO incompatibility:
- O mother, infant A or B
- Can cause newborn jaundice

Women’s Health & Fertility (Ch 31)

Fertility & Family Planning:
- Fertility declines after age 35; pregnancy after 50 uncommon
- Perimenopause: ovulation may still occur → contraception needed until menopause confirmed
- Most common method >30 y/o: sterilization
- Hormonal contraception side effect warning – ACHES:
- A: Abdominal pain (liver/gallbladder issue)
- C: Chest pain/SOB (PE/MI)
- H: Headache (stroke/HTN)
- E: Eye problems (stroke/HTN)
- S: Severe leg pain (DVT)
Sterilization:
- Tubal ligation (female) → permanent, highly effective
- Vasectomy (male) → must confirm azoospermia after procedure

Breast Disorders (Ch 32)

Benign breast changes:
- Fibrocystic changes: nodular, tender, varies with cycle
- Fibroadenoma: firm, rubbery, mobile, non-tender
- Ductal ectasia: thick nipple discharge
- Intraductal papilloma: bloody nipple discharge
Breast cancer:
- 1 in 8 women lifetime risk
- Risk factors: age >55, BRCA mutation, early menarche, late menopause, nulliparity, 1st pregnancy after 30, obesity, alcohol, HRT use, chest radiation
- Management: lumpectomy/mastectomy + lymph node removal; radiation, chemo, hormone therapy (tamoxifen, aromatase inhibitors), immunotherapy
- Nursing: body image, lymphedema prevention, emotional support

Cardiovascular Disease in Women (Ch 32)

#1 cause of death in women
Risk factors: smoking, HTN, diabetes, obesity, poor nutrition, physical inactivity, menopause, family hx
Prevention: smoking cessation, diet/exercise, glucose control, aspirin therapy (if appropriate)

Menstrual Disorders (Ch 32)

Amenorrhea:
- Primary = no menses by 16
- Secondary = absence of menses for 3+ months in previously menstruating woman
Abnormal uterine bleeding: irregular, excessive, prolonged bleeding
Mittelschmerz: mid-cycle pain at ovulation
Dysmenorrhea: painful menstruation; prostaglandins involved
Endometriosis: endometrial tissue outside uterus → pelvic pain, infertility, dyspareunia
PMS: physical/emotional symptoms before menses
- Management: ↓ caffeine, salt, sugar; ↑ exercise, stress management, sleep, relaxation

Menopause & Perimenopause (Ch 32)

Avg onset: 45–50 years
S/S: hot flashes, vaginal dryness, mood swings, irregular menses → cessation
Estrogen loss complications: osteoporosis, CAD risk
Management:
- MHT (estrogen + progesterone if uterus intact; estrogen alone if hysterectomy)
- Risks: ↑ breast/uterine cancer, DVT, stroke
- Alternatives: SSRIs, clonidine, herbal therapy, lifestyle modifications
Osteoporosis:
- Risk factors: low Ca/vit D, sedentary, smoking, alcohol, long-term steroids, ↓ estrogen
- S/S: back pain, loss of height, fractures, kyphosis
- Prevention: Ca ( $1000–1200$ mg/day), Vit D ( $600–800$ IU/day), weight-bearing exercise, smoking/alcohol cessation
- Meds: bisphosphonates, SERMs, calcitonin, denosumab
- Screening: DEXA scan

Pelvic & Reproductive Tract Disorders (Ch 32)

Benign:
- Cervical polyps → irregular bleeding
- Uterine leiomyomas (fibroids) → menorrhagia, pelvic pain
- Ovarian cysts → usually benign, may cause pain or rupture
Malignant:
- Cervical cancer: linked to HPV, preventable with Pap smears & HPV vaccine
- Endometrial cancer: postmenopausal bleeding = RED FLAG
- Ovarian cancer: vague symptoms (bloating, early satiety, pelvic pressure)

Infectious Disorders of the Reproductive Tract (Ch 32)

PID: ascending infection, often from untreated STIs → risk infertility, ectopic pregnancy
STIs:
- Chlamydia & gonorrhea: often asymptomatic, may cause PID
- HPV: linked to cervical cancer; prevent with vaccine
- HSV: no cure, antiviral therapy reduces outbreaks
Symptoms requiring evaluation:
- Irregular or postmenopausal bleeding
- Abnormal discharge
- Dyspareunia
- Persistent vulvar/vaginal itching
- Pelvic pain, bloating, early satiety

Summary of Key Formulas, Ranges & Thresholds

Fetal chromosomes: $46$ chromosomes
Naegele’s rule for estimated due date: $EDC = ext{LMP} - 3 ext{ months} + 7 ext{ days} + 1 ext{ year}$
Amniotic fluid volumes:
- Normal: $500–1000 ext{ mL}$
- Polyhydramnios: > $2000 ext{ mL}$
- Oligohydramnios: < $500 ext{ mL}$
NST reactive criteria: 2 accelerations of ≥ $15$ bpm for ≥ $15$ sec within 20 min
Baseline FHR: $110–160$ bpm
Tachycardia: > $160$ bpm; Bradycardia: < $110$ bpm
Labour progression: First stage until 10 cm; Second stage to birth; Third stage placenta; Fourth stage 1–2 h postpartum
Bishop’s score for induction readiness: ≥8 suggests likely successful induction
Tachysystole: >5 contractions in 10 minutes
Pregnancy weight gain guidelines by BMI: see categories above

Connections & Practical Implications

Hormonal regulation of the menstrual cycle underpins contraception and fertility understanding.
Placental and fetal circulatory adaptations are essential for fetal oxygenation and nourishment; disruptions can lead to obstetric emergencies.
Early detection of pregnancy signs, dating, and growth assessment guide prenatal care and timing of interventions.
The 5 Ps framework helps clinicians assess labor risk and plan management.
Fetal monitoring decisions balance maternal comfort with fetal oxygenation; nonreassuring patterns prompt rapid clinical actions.
Pain management choices require consideration of maternal preferences, fetal status, and potential complications (hypotension, respiratory depression).
OB procedures (induction, augmentation, amnioinfusion, version) are chosen based on maternal-fetal status and safety; continuous fetal monitoring guides timely escalation.
Common pregnancy complications have defined risk factors, clinical signs, and management pathways to optimize maternal-fetal outcomes (HTN disorders, diabetes, infections, bleeding disorders).
Postpartum considerations include monitoring for hemorrhage, infection, and the implications of hypertensive or metabolic conditions on future pregnancies.

LaTeX & Numeric Details (quick reference)

46 chromosomes in a zygote: $46$
Naegele’s rule for due date: $EDC = ext{LMP} - 3 ext{ months} + 7 ext{ days} + 1 ext{ year}$
NST accelerations: $ext{two accelerations} <br /> ightarrow 2 ext{ accelerations } (15 ext{ bpm} imes 15 ext{ sec}) ext{ in } 20 ext{ min}$
Baseline fetal heart rate: $110 ext{–}160 ext{ bpm}$
Fetal fluid volumes: $500 ext{–}1000 ext{ mL}$ (normal), > $2000 ext{ mL}$ (polyhydramnios), < $500 ext{ mL}$ (oligohydramnios)
Weight gain ranges by BMI; example normal: $25 ext{–}35 ext{ lbs}$
Iatrogenic thresholds: tachysystole > $5$ contractions in $10$ min
L/S ratio threshold for lung maturity: $2:1$
Iron needs in pregnancy: $27$ mg/day; Calcium: $1000$ mg/day; Folic acid: $600 ext{ mcg/day}$
Protein needs: + $25$ g/day; Calories: + $300$ kcal/day

MCF Modules: Reproduction, Pregnancy & Women's Health Notes

Normal Reproduction & Pregnancy

Pregnancy Complications

Women’s Health & Fertility (Ch 31)

Breast Disorders (Ch 32)

Cardiovascular Disease in Women (Ch 32)

Menstrual Disorders (Ch 32)

Menopause & Perimenopause (Ch 32)

Pelvic & Reproductive Tract Disorders (Ch 32)

Infectious Disorders of the Reproductive Tract (Ch 32)

Summary of Key Formulas, Ranges & Thresholds

Connections & Practical Implications

LaTeX & Numeric Details (quick reference)

End of notes