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OB Exam

exam 1

eptopic pregnancy outside the uterus implantation
myomectomy surgery for thyroids in the uterus
placentaprevia implantation in the lower uterus covering the cervix
bony pelvis serves 3 primary purposes protects the pelvis structures accomodates the growing fetus during pregnancy anchors the pelvic support structures
antropoid pelvis very uncommon in the world. unable to deliver vaginally
platyelloid pelvis very uncommon in the world. unable to deliver vaginally
gyneccoid pelvis most common pelvis and able to have a baby vaginally
android pelvis can possibly deliver baby vaginally but only very small baby
hormone ovaries release estrogen
menarche beginning of menstrual and reprodcutive function in the female
menstruation periodic uterine bleeding that occurs about 14 days after ovulation. average cycle occurs every 29 days but varies 21-35 days
puberty transition between childhood and sexual maturity.
ovulation release of a mature ovum from the ovary usually at regular monthly intervals at around day 14 of the cycle
estrogen controls female secondary sex characteristics assists in maturation of ovarian follicle causes endometrium to proliferate following menstruation
progesterone secreted by corpus luteum and found in greatest amount during secretory phase of menstrual cycle causes temperature rise that accompanies ovulation production increases during follicular maturation critical to follicular rupture
hypothalmic-pituitary cycle hypothalamus -> with low ovarian hormones at end of normal menstrual cycle -> GnRH -> anterior pituitary -> FSH -> Graddian follicle (corpus luteum) estrogen stimulation -> estrogen fall -> hypothalmic GnRH -> anterior pituitary -> LH and some estrogen ->
ovarian cycle 1. follicular phase: have follicles begin maturing under FSH with LH selecting a follicle -> oocyte maturation -> ovulation 2. luteal phase: begins immediately after ovulation and ends with menstration
endometiral cycle 1. menstrual phase 2. proliferative phase- time of restoring endometrium (day 5 to ovulation) 3. secretory phase- from ovulation to 3 days before menstruation -> mature, enriched endometrium ready for fertilized ovum 4. ischemic phase: no implantation
S&S predicting ovulation -BBT drops below 37C and rises after surge of progesterone. must check BBT q am before rising and chart it -then BBT increases about .3-.6 C 24 to 48 hrs after ovulation time -spinbarkeit-mucous-eleastic, stretches -mittelschmerz-abdominal pain due ovu
scrotum main purpose is to protect the testes and maintain a temperature that is lower than body temperature so spermatogenesis can occur
sperm head contains prostagladins prostagladins cause cervix to contract and pushes the sperm out. lube comes out of the penis before the sperm. it neutralizes acidity of vag
fertilization takes place in ampulla (outer third of the fallopian tube)
implantation occurs in the fundus betwee day 7-10 post fertilization. progesterone thickens the endometrium and vascularity in prep for implantation. at implantation have 2 fetal membranes :corion and amnion. once implantated, usually in the fundus
chorion part of the protection for the baby wraps around the sac
placenta development & circulation do not begin until 3rd week of embyronic development expansion continues till 20th week, thereafter becomes thicker not wider
decidua basalis dirty duncacn maternal portion of placenta
chorionic villi shiney schultz fetal portion of placenta
umbilical cord body stalk fuses with embryonic portion of placenta body stalks elongates to become umbilical cord 3 vessels: 2 arteries and 1 vein
2 arteries of umbilical cord carries deoxygenated blood from fetus back to placenta
1 vein of umbilical cord carries oxygenated blood from placenta to fetus
oligohydraminos not enough amniotic fluid
polyhydraminos to much amniotic fluid
placental functions fetal respiration nutrition excretion nutrient production hormonal production
pre-embryonic stage of human development fetilization till day 14 cell multiplication and differentation
embryonic stage of human development day 15 till 8th week development of major organ systems and main external features develope prenancy is MOST VULNERABLE to teratogens
fetal stage of human development 8th week till birth refining structures and perfecting function
4 to 8 week gestation heart beating and circulation begins arms and leg buds are present eyes and nose begin to form
general info after 8 weeks embryo called a fetus 12 weeks fetus is moving wont see unless US FHT 120-160 normal
12 week gestation spontaneoius movements made fetal heart tones (FHT) audible
20th week gestation "quickening" (mother feels fetus move between 16-20 weeks) respiratory movements suck and swallow fluid vernix gender is clear
nullipareous never had a baby before and pregnant now
primiparous first time mother after giving birth to first baby
multiparous had babies before
24th week gestation threshold of viability mature brain aveoli appear: gas exchange is possible reddish, wrinkled skin with vernix age of viability
32 week gestation eyes opening and closing for last month subcutaneous fat being laid down fingernails & toenails
36 week gestation lanugo disappearing few sole creases sebaceous glands producing vernix scrotum descends/labia minor and majora equally prominent
38-40 week gestation lecithin-sphingomyelin (L/S) ratio approaches 2:1, indicating lung maturity (if greater 2:1 lungs considered mature for fetus of diabetic mother) smooth, pink skin; vernix in skin folds, nails extend over tips rugi at scrotum/labia maj more prominent
fetal circulation o2 rich through umbilical vain bypassing liver via ductus venosus and flows to inferior vena cava to R atrium through foramen ovale to L atrium to flow to L ventricle to aorta
fetal cirulation con. some blood from superior vena cava to R atrium goes through tricuspid valve to R vetricle to pulmoary artery to bypass lung, blood flows through ductus arteriosus into descending aorta
umbilical vein o2 rich blood enters fetus
ductus venosus allows blood to bypass liver
foramen ovale allows blood to bypass pulmonary arteries and flow from R atrium to L atrium
ductus arteriosus how blood returning to SVC and entering RV is able to bypass liver
preterm labor labor occuring after 20 weeks but before 37 weeks. completed gestation
post-term labor labor occurring after 42 weeks
gravida any pregnancy regardless of duration including the present pregnancy
multigradvia woman who is in her second or any subsequent pregnancy
multipara a woman who has had 2 or more births at more than 20 weeks
stillbirth a fetus born dead after 20 week gestation
nuligravida woman who had never been pregnant
primigravida woman who is pregnant for 1st time
bishops score score to determin if woman is inducible 8/10 is inducible very low score would have C-section
CPD cephalopelvic disproportion baby's head cannot fit through inlet
first stage of labor 0-10 cm cevical dilation
second stage of labor 10 cm to birth of baby
third stage of labor birth of baby to birth of placenta
fourth stage of labor first 4 hours after placental delivery
postpartum period (PP) begins with fourth stage and ends at approximately 6 weeks after birth
first degree laceration tear extends to skin and structures superficial to the muscles
second degree laceration tear extends through muscles
third degree laceration tear involves anal spincter
fourth degree laceration tear extends through the rectal mucose to the lumen of rectum
involution rapid reduction in uterine size following birth of placenta
involution process placenta is delivered then posterior pituitary excretes oxytocin then uterine vessels contract (afterpains)then to hemostasis
lochia uerine debris discharged after birht
lochia rubra red first 2-3 days but may vary according to BF practice and parity-musty stale odor
lochia serosa pink day 3 to 10
lochia alba white continues until the cervix is closed which decreases chance of infection
diastasis recti separation of the musculature after pregnancy. usually in smaller woman heal within first few months post delivery no driving heavy lifting stairs
lactogenesis during pregnacy elevated hormore (E&P) evels promote breast duct and lobules preparation for lactation placenta's progeserone suppresses lactation
lactogenesis following delivery of placenta placenta out leads to progesterone levels to fall then inhibition is removed and milk production begins breast stimulation prolactin levels rise and milk production increases. oxytocin levels rise and milk ejects, uterus contracts
vital signs temp may be elevated 38C(100.4F) up to 24 hours after birth and increased 24 hours after milk comes in transient rise in BP early then normal bradycardia first 6-10 days p
physiological adjustments taking in seen during the first day or 2nd day: self centered, passive, dependent, takes care of "her" needs
physiological adjustments taking hold seen durings the 2nd to 3rd day: resuming control and ready for self/newborn care
physiological adjustments letting go seen during the 4th day on: new role to baby
BBUBBLE:HE Brain Breast Uterus Bladder Bowels Lochia Episiotomy Homans sign Emotional
B: Brain HA, blurred vision, sports before eyes are signs of preeclampsia dizzy/lightheaded
B: Breasts size, shape, consistency (full?filling?soft?) nupples- abnormalities/ signs of damage (cracks, bleeding, blisters)
U:Uterus position: horizontal (related to umbilicus) vertical (related to midline) tone: firm, boggy
B:Bowels flatus, BS, BM
B:Bladder assess of distention void at least 100 ml pp within 8 hr
E: Episiotomy perineal assessment: REEDA lochia presence/state of hemorrhoids
H: Homans sign look for redness swelling pain if present do not do homans sign searching for clots
E: emotional how is she feelings, care-giving skills
postpartum blues transient period of emotions depression; somtimes occues during first 10 days of postpartum
pp blues S&S mood swings anger weepiness anorexia difficulty sleeping feeling let down
Created by: 507336073