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OB Test #1

OB test 1

Avg menstrual cycle 28 days
Ovarian Cycle Follicular, Ovulation, Luteal phases
Uterine/Endometrial Cycle Menstrual, Proliferative,(ovulation), Secretory, Ischemic
Ovulation mid-cycle for both
Follicular phase days 1-14, hypothalamus secretes GnRH->stimulates anterior pituitary gland->secrete FSH and LH->matures ovarian follicle
Ovulation drop in estrogen 10-12hr after LH peaks, mature ovum leaves ovary->enters fallopian tubes->current to uterus, 14 days before menstruation, ^body temp 1-2 days after
Luteal Phase corpus luteum develops from ruptured follicle->secretion of proges ^->fert ovum able to implant into endometrium->secretion of hCG, in absence of fertilization-corpus luteum degenerates-corpus albicans->decrease in estrogen & progesterone->^ in LH & FSH
Three layers of uterus Perimetrium/outside, Myometrium/middle, Endometrium/inside
Menstrual phase day 1-6, 14 days after ovulation, low estrogen levels-spirial arteries rupture, shed endometrial lining->menses
Proliferative phase day 7-14, enlargement of endometrial glands, blood vessels enlarge & dilate, ^ in thickness 6-8 fold, changes in cervical mucus-clear & thin/sperm in, ^estrogen levels, ovulation day 14
Secretory phase follows ovulation-day 15-26, influenced by progesterone, ^ uterine vascularity, myometrial glandular secretions
Ischemic phase day 27-28, if fertilization does not occur, ischemic phase begins->corpus luteum begins to degenerate, estrogen and progesterone levels hair, areas of necrosis under endometrial lining
For Reproduction necessary hormones and secretions->stimulate and support reproduction
Estrogen scrtd by ovaries,cntrls dvlpmt 2ndry sex charactcs,mature of ovar foll,endomet mucosa prolif following menses,uterus^in sz/wt, prdcd by maturing foll,^myomet cntractil in uterus/fallop tubes,^uterine senstvty to oxy, inhbts FSH prod,stim LH prod,drops aft
Progesterone pregnancy hormone
Progesterone is/does secreted by corpus luteum, decreases uterine motility and contractility, facilitates vaginal epithelium proliferation, secretion of thick viscous cervical mucus, ^breast glandular tissue for breastfeeding
Prostaglandins produced by uterine endometrium, regulatory effects, ^during follicular maturation, cause extrusion of ovum from Graafian follicle, ^during labor
Contraception voluntary prevention of pregnancy
NFP and FAM natural family planning and fertility awareness methods
NFP and FAM involve relies on avoidance of intercourse during fertile periods, charting, basal body temp, cervical mucus ovulation, calendar
Fertility Awareness at ovulation mucus elasticity ^, viscosity decreases, stretch 8-10cm as ovulation approaches-abstain from sex peak day of wetness/clear
Basal Body Temp preovulatory-temp below 36.7, then rise, postovulation-progesterone^ 0.5-1.0, release of ovum 24-36 hours before 1st temp elevation, most fertile 3-4 days prior & 2-3 days after ovulation
Calendar Method/Rhythm Method least reliable fertility awareness method, based of assumptions that ovulation occurs 14 days before menses, sperm viable 48-72hrs, ovum 24hrs, fertile phase-18 days before end of shortest cycle thru 11 days from end of longest cycle
Spermicides chemical barriers, minimal effectiveness used alone
Barrier Methods protective against STIs, condoms, vaginal sheath, diaphragm, cervical cap, contraceptive sponge
Hormonal Methods alters hormones in body, estrogen and progestin or progestin alone, highly effective, combined oral contraceptives, minipill, depo-provera
COC disadvantages ^blood clots, contraindicated; smokers, cardio disorders, thromboembolic disease, notify HCP of ACHES
ACHES abd pain, chest pain, h/a, eye disturbance, severe leg pain
Oral progestin(minipill) use if contraindication to estrogen, hx of thrombophlebitis, breastfeeding, thickens cervical mucosa
Depo-Provera long-acting progestin, suppress ovulation 3 months, blocks LH surge, thicken cervical mucus, single inj 150mg IM, delayed return of fertility, SE; h/a, weight gain, breast tenderness, depression, breakthrough bleeding
Emergency Contraception Preven/Plan B, use w/in 72hrs of unprotected intercourse, decreases pregnancy by 80%
Intrauterine Devices IUD, small t-shaped device, medicated w/ copper or progestational agent, check placement, effective 5-10 years, SE/bad signs
Sterilization female-Bilateral Tubal Ligation w/w/o Bilateral Salpingo Oophrectomy, male-vasectomy
Contraception Assessment-BRAIDED Benefits, Risks, Alternatives, Inquiries, Decisions, Explanations, Documentation
GP used in relation to pregnancies not # of fetuses, pregnancies and births
GTPAL pregnancies, term, preterm, abortion, living, multiples
Breast Exam age 20-39 every 3yrs, 40+ every yr, self-exam same time every month
Mammography yearly beginning at age 40
Infertility lack of contraception for at least 12 months, 16% of reproductive age population, 40% male, 40% female, 20% unexplained or both, ^ in 24-44 age group
Female Infertility congenital or developmental/hormonal, tubal or peritoneal/uterine, vaginal-cervical/isoimmunization
Male Infertility structural and hormonal disorders-hypospadias, vericocele, low testosterone levels, ^scrotal heat
Hysterosalpingography/Hysterogram(HSG) installation of radiopaque substance in uterine cavity during proliferative phase, oil-based dye & inj pressure is therapeutic
Non-medical Fertility Awareness avoid douching/lubricants, promote retention of sperm, avoid leakage of sperm, maximize potential for fertilization(coitus no greater than 48hr intervals, cervical mucus, basal body temp)
Gamete intrafallopian transfer(GIFT) placement of oocytes and washed motile sperm into the fimbiated end of the fallopian tube
Zygote intrafallopian transfer(ZIFT) transfer of already fertilized ovum to the fimbriated end of the fallopian tube
Endometriosis often diagnosed w/ infertility, endometrial tissue outside endometrial cavity, bleeding & inflammation/scarring and adhesions, may grow into ovaries or block fallopian tubes
Endometriosis Tx observation, analgesics, NSAIDS, COC’s, Medroxy-progesterone acetate, Gonadtropin-releasing hormone agonist, Danazol, Surgical tx
Endometriosis-Danazol tx weak male hormone, lowers estrogen and progesterone levels, stops or decreases menstruation, pain relief, SE; oily skin, weight gain, tiredness, smaller breasts, hot flashes
Moment of Fertilization when nuclei unite, sperm penetration causes chem reaction blocks more sperm penetration, chromosomes pair up to produce diploid zygote
Zygote fertilized egg, each nucleus contains haploid # of chromosomes-23pairs, union restores diploid #46, zygote contains new combo of genetic material
Sex of Zygote determined at moment of fertilization, two chromosomes of 23rd pair, either XX or XY
Cleavage rapid mitotic division, blastomeres grow to morula(solid ball of 12-26 cells)
Morula divides into solid mass blastocyst, surrounded by outer layer of cells-trophoblast
Trophoblast becomes placenta and chorion
Implantation occurs in 7-10 days, blastocyst attaches to endometrium/decidua, outer layer of cells of blastocyst (trophoblast) contains chorionic villi-attach to decidua
Placental Barrier no direct contact btw blood of fetus and mother, serves as pass-thru-O2, nutrients, carbon dioxide, waste products-diffusion
Fraternal Twins dizygotic, arise from two separate ova, fertilized by two separate sperm, two placentas, two chorions, two amnions, like two siblings
Identical Twins monozygosity, single fertilized ovum, same sex, same genotype, single placenta
Cell Differentiation 10-14days, blastocyst differentiates into three germ layers; ectoderm, mesoderm, endoderm
Embryonic membranes form at implantation, chorion and amnion-grow and connect to form amniotic sac
Amniotic Sac 98%water, 2%organic matter, provide protection, symmetrical growth & dvlpmt, constant body temp, decrease umbilical cord compression, promotes musculoskeltal growth
Umbilical Cord develops from amnion, fuses w/ embryonic portion of placenta, pathway from chorionic villi to embryo, two arteries & one vein, surrounded by Wharton’ jelly, circulatory pathway to embryo
Placenta begins at 3rd wk of embryonic dvlpmt, develops from trophoblast, metabolic and nutrient exchange btw embryonic and maternal circulation, two parts; maternal/dirty duncan & fetal/shiny gray
Placental Functions Endocrine-produce hormones, Nutrition-supplies nutrients, Respiratory-supplies O2 & removes CO2, Renal-removes waste, Sterile environment-protects from immune attack by mother
Fetus Growth-4wks 4-6mm, heart beats
Fetus Growth-6wks 12mm, respiratory system begins
Fetus Growth-12wks 8cm, ossification of skeleton begins, liver produces red cells, insulin present in pancreas, heartbeat heard by ultrasound
Fetus Growth-16wks 13.5cm, meconium collects in intestines, baby’s sex can be seen, fetus looks like baby
Fetus Growth-20wks 19cm, Point of Viability, suck & swallow begins, lanugo covers body, vernix begins to protect body, mother feels movement, hands can grasp
Fetus Growth-24wks 23cm, respiration and surfactant production begins, increased activity, sucking
Fetus Growth-28wks 27cm, eyes are open, can breathe
Fetus Growth-36wks 35cm, earlobes soft with little cartilage, few sole creases
Fetus Growth-40wks 40cm, adequate surfactant, vernix in skin folds, earlobes firm, weight 6-7lbs
Signs of Prgnancy-Subjective presumptive, changes woman experiences and reports; amenorrhea, N/V, fatigue, urinary freq, breast changes, quickening
Signs of Pregnancy-Objective probable, examiner can perceive changes; Hegars sign, Chadwicks sign, Braxton hicks, pregnancy tests
Signs of Pregnancy-Diagnostic positive, conclusive proof; abd enlargement, fetal movement palpable, fetal heartbeat, visualization of fetus
Recommended Pregnancy Weight Gain 25-35lbs, 3.5-5lb 1st tri, 1lb weekly 2nd & 3rd
Nutritional Requirements preg-^300kcal/day, lactation-^another 200kcal/day for total of 500kcal/day
Percutaneous Umbilical Blood Sampling-PUBS needle inserted through maternal abdominal wall into fetal umbilical cord to check for fetal abnormalities
Chorionic Villus Sampling-CVS small sample of chorionic villi from placenta to determine genetic disorders, transvaginally or transcervically, incidence of fetal loss is higher than w/ amnio, performed btw 10-12wks, lithotomy position
Indirect Coombs Test detects presence of Rh antibodies, if – give Rhogam at 28 weeks
Maternal Adjustment-taking in 1-2days after birth, dependent and passive, focus on self, easily follows suggestions, slow to make decisions
Maternal Adjustment-taking hold 2nd or 3rd day after birth, ready to resume control, shifts focus to infant, uncertain about newborn care
Maternal Adjustment-letting go interdependence-know when to call dr, acceptance of newborn and self-care, interacts w/ staff and receptive to teaching
Glucose Testing 24-28wks, 1-hour GTT: drinks 50-g oral glucose solution, provides blood sample 1hr later, >140mg/dl indicates further testing
3hour GTT 100-g, high carb diet x3days prior, fast for 8hours, fasting levels drawn 1/2/3h, positive for GDM if fasting-95, 1hr-180, 2hr-155, 3h-140
GDM-S/Sx Polyuria, Polyphagia, Polydipsia, Weight loss, Blurred vision, Recurrent infections
Heart Disease preg ^ cardiac output, heart rate ^10-15bpm, blood vol^, remember to: rest freq, well balanced diet, med-digitalis, iron sup, eval edema, assess stress of preg on heart, limit activity, signs of cardiac fail, fetal assessment
Respiratory Conditions prevent hypoxic conditions, relieve acute attacks, adequate O2, Bronchodialators-Brethine/terbutiline
Hemorrahagic Conditions assess VS, fetal heart tones, pain, bleeding, infection, coping, administer Rhogam w/in 72hr if Rh-
Ectopic Pregnancy S/Sx progesterone <5, HCG levels not doubling every 48-72hrs/<1500, sharp unilateral pain, syncope, lower abd pain, tender adnexal mass, vag bleeding
Hyperemesis Gravidarum intractable, excessive vomiting, dehydration, wt loss->fluid/electrolyte imbalance, ketosis, hypovolemia, ^Hct, hypotension, tachycardia, decreased urine output, ^BUN
Hyperemesis Gravidarum-Management relieve N/V, antiemetic’s, PTN, IV fluid w/ vitamins/minerals, NPO->cl liq (gut rest), high protein/low-fat, Monitor: emesis, I&O, Wt, FHT, jaundice, coping
Gestational Trophoblastic Disease assessment arise from placental trophoblast; hydatiform mole, invasive mole, choriocarcinoma- S/Sx: uterine enlargement greater than gestational age, HCG extremely high, vag red/brown bleeding, scant or profuse, Hyper G, HTN before 24wks, US
Gestational HTN after 20 wks, no protein, BP 140/90 or higher on 2 occ at least 6hrs apart
Preeclampsia after 20wks, BP 140/90 or higher on 2 occ at least 6hrs apart, accompanied by Proteinuria, progressive, edema, wt gain
Severe Preeclampsia BP 160/110 or higher while on bedrest on 2 occ at least 6hrs apart, edema ++, proteinuria ++, 2 random samples at least 4hrs apart, oliguria, visual/cerebral disturbances, H/A, vision changes, scotomata, impaired liver funct, epigastric pain, hyper-reflex
Eclampsia most severe form of preeclampsia, generalized seizures/coma, life-threatening, anytime in preg or early postpartum, superimposed on chronic HTN is worst possibility
HELLP Syndrome HTN state w/ Sx in addition to preeclampsia, multiple-organ-failure syndrome, liver involvement, poor outcomes, diagnosed by lab values
HELLP Lab Values H-hemolysis, EL-elevated liver enzymes-AST-LDH, LP-low platelets-low <100,000/mm3-thrombocytopenia, decreased GFR, renal perfusion, creatinine, BUN, intravascular vol, ^uric acid levels, sodium retention, extracellular vol, viscosity of blood, Hct
Nonstress Test/NST baby’s heart rate accelerates 15 beats, for 15 sec, twice in 20 minutes-reactive
Biophysical Profile/BPP 5 variables assessed; fetal breathing movement, fetal movements of body or limbs, fetal tone, amniotic fluid volume, reactive FHR w/ activity/NST-total score 8-10 is normal
GHTN Tx intense maternal monitoring, anticonvulsant meds, antihypertensive meds, EFM(preferably internal), nurse to pt ratio 1:1, VS q15-30min, lateral or semi-recumbant position, hourly I/O(foley), lab workups, urine q 1hr for protein, assess hypereflexia q 1hr,
Magnesium Sulfate anticonvulsant, relaxes muscles, DTRs/clonus, fall risk, warm/flushed, oliguria, respiratory distress, loading dose-4-6g/30min, therapeutic level 4.8-9.6, antidote: calcium gluconate-1g/3min IV
Preterm Labor educate every pt about Sx; uterine contractions every 10 min unrelieved by rest, cervical changes, pain, pelvic pressure or cramps, blood-tinged mucus, trickle or gush of fluids, goal is to maintain sufficient uterine bloodflow!
Preterm Labor-Meds Yutopar/ritodrine, Brethine/terbutaline sulfate, Magnesium sulfate, Indocin, Procardia/Nifedipine
Indocin limited in use to preg <32wks, adverse effects; premature closure of ductus arteriosus, elevated bilirubin, altered platelet function, urinary effects, maternal; GI effects, ^bleeding, antipyretic effects mask infection symptoms
Premature Rupture of Membranes/PROM associated w/ infections, previous hx, mult gestation, hydramnios, incomplete cervix, bleeding during preg
Premature Rupture of Membranes-fetal risks respiratory distress syndrome, fetalsepsis, malpresentation, prolapse cord, ^morbidity and mortality
Rh isoimmunization Rh – client pregnant w/ Rh + fetus, may carry to term or miscarry, Rh+ fetal blood enters mother’s bloodstream-antibodies formed, or at birth placenta separates-antibodies formed
Rh isoimmunization-to prevent give Rhogam at 28wks, and after each abortion, w/in 72hrs postpartum, amniocentesis & placenta previa, stillbirth, procedures that cause bleeding
ABO incompatibility mother has O, infant has A B or AB, antibodies occur naturally, cross placenta, cause hemolysis of fetal red blood cells-hyperbilirubinemia
Post-term Care Management daily fetal movement-10kicks/1-2hr, non-stress tests weekly, amniotic fluid assessment, cervical examinations, stress, anxiety, coping skills, educate purpose of tests, prepare for induction or surgery, report meconium, keep hydrated
TORCH Toxoplasmosis, Other-hepatitis, syphilis, gonorrhea, Rubella, Cytomegalovirus, Herpes virus type II
Created by: neffielewis
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