OB test 1
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| Avg menstrual cycle | 28 days
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| Ovarian Cycle | Follicular, Ovulation, Luteal phases
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| Uterine/Endometrial Cycle | Menstrual, Proliferative,(ovulation), Secretory, Ischemic
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| Ovulation | mid-cycle for both
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| Follicular phase | days 1-14, hypothalamus secretes GnRH->stimulates anterior pituitary gland->secrete FSH and LH->matures ovarian follicle
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| 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
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| 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
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| Three layers of uterus | Perimetrium/outside, Myometrium/middle, Endometrium/inside
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| Menstrual phase | day 1-6, 14 days after ovulation, low estrogen levels-spirial arteries rupture, shed endometrial lining->menses
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| 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
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| Secretory phase | follows ovulation-day 15-26, influenced by progesterone, ^ uterine vascularity, myometrial glandular secretions
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| 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
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| For Reproduction | necessary hormones and secretions->stimulate and support reproduction
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| 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
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| Progesterone | pregnancy hormone
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| 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
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| Prostaglandins | produced by uterine endometrium, regulatory effects, ^during follicular maturation, cause extrusion of ovum from Graafian follicle, ^during labor
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| Contraception | voluntary prevention of pregnancy
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| NFP and FAM | natural family planning and fertility awareness methods
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| NFP and FAM involve | relies on avoidance of intercourse during fertile periods, charting, basal body temp, cervical mucus ovulation, calendar
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| Fertility Awareness | at ovulation mucus elasticity ^, viscosity decreases, stretch 8-10cm as ovulation approaches-abstain from sex peak day of wetness/clear
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| 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
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| 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
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| Spermicides | chemical barriers, minimal effectiveness used alone
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| Barrier Methods | protective against STIs, condoms, vaginal sheath, diaphragm, cervical cap, contraceptive sponge
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| Hormonal Methods | alters hormones in body, estrogen and progestin or progestin alone, highly effective, combined oral contraceptives, minipill, depo-provera
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| COC disadvantages | ^blood clots, contraindicated; smokers, cardio disorders, thromboembolic disease, notify HCP of ACHES
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| ACHES | abd pain, chest pain, h/a, eye disturbance, severe leg pain
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| Oral progestin(minipill) | use if contraindication to estrogen, hx of thrombophlebitis, breastfeeding, thickens cervical mucosa
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| 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
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| Emergency Contraception | Preven/Plan B, use w/in 72hrs of unprotected intercourse, decreases pregnancy by 80%
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| Intrauterine Devices | IUD, small t-shaped device, medicated w/ copper or progestational agent, check placement, effective 5-10 years, SE/bad signs
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| Sterilization | female-Bilateral Tubal Ligation w/w/o Bilateral Salpingo Oophrectomy, male-vasectomy
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| Contraception Assessment-BRAIDED | Benefits, Risks, Alternatives, Inquiries, Decisions, Explanations, Documentation
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| GP | used in relation to pregnancies not # of fetuses, pregnancies and births
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| GTPAL | pregnancies, term, preterm, abortion, living, multiples
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| Breast Exam | age 20-39 every 3yrs, 40+ every yr, self-exam same time every month
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| Mammography | yearly beginning at age 40
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| 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
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| Female Infertility | congenital or developmental/hormonal, tubal or peritoneal/uterine, vaginal-cervical/isoimmunization
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| Male Infertility | structural and hormonal disorders-hypospadias, vericocele, low testosterone levels, ^scrotal heat
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| Hysterosalpingography/Hysterogram(HSG) | installation of radiopaque substance in uterine cavity during proliferative phase, oil-based dye & inj pressure is therapeutic
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| 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)
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| Gamete intrafallopian transfer(GIFT) | placement of oocytes and washed motile sperm into the fimbiated end of the fallopian tube
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| Zygote intrafallopian transfer(ZIFT) | transfer of already fertilized ovum to the fimbriated end of the fallopian tube
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| Endometriosis | often diagnosed w/ infertility, endometrial tissue outside endometrial cavity, bleeding & inflammation/scarring and adhesions, may grow into ovaries or block fallopian tubes
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| Endometriosis Tx | observation, analgesics, NSAIDS, COC’s, Medroxy-progesterone acetate, Gonadtropin-releasing hormone agonist, Danazol, Surgical tx
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| 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
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| Moment of Fertilization | when nuclei unite, sperm penetration causes chem reaction blocks more sperm penetration, chromosomes pair up to produce diploid zygote
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| Zygote | fertilized egg, each nucleus contains haploid # of chromosomes-23pairs, union restores diploid #46, zygote contains new combo of genetic material
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| Sex of Zygote | determined at moment of fertilization, two chromosomes of 23rd pair, either XX or XY
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| Cleavage | rapid mitotic division, blastomeres grow to morula(solid ball of 12-26 cells)
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| Morula divides into solid mass | blastocyst, surrounded by outer layer of cells-trophoblast
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| Trophoblast | becomes placenta and chorion
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| Implantation | occurs in 7-10 days, blastocyst attaches to endometrium/decidua, outer layer of cells of blastocyst (trophoblast) contains chorionic villi-attach to decidua
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| Placental Barrier | no direct contact btw blood of fetus and mother, serves as pass-thru-O2, nutrients, carbon dioxide, waste products-diffusion
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| Fraternal Twins | dizygotic, arise from two separate ova, fertilized by two separate sperm, two placentas, two chorions, two amnions, like two siblings
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| Identical Twins | monozygosity, single fertilized ovum, same sex, same genotype, single placenta
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| Cell Differentiation | 10-14days, blastocyst differentiates into three germ layers; ectoderm, mesoderm, endoderm
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| Embryonic membranes | form at implantation, chorion and amnion-grow and connect to form amniotic sac
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| Amniotic Sac | 98%water, 2%organic matter, provide protection, symmetrical growth & dvlpmt, constant body temp, decrease umbilical cord compression, promotes musculoskeltal growth
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| 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
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| 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
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| Placental Functions | Endocrine-produce hormones, Nutrition-supplies nutrients, Respiratory-supplies O2 & removes CO2, Renal-removes waste, Sterile environment-protects from immune attack by mother
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| Fetus Growth-4wks | 4-6mm, heart beats
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| Fetus Growth-6wks | 12mm, respiratory system begins
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| Fetus Growth-12wks | 8cm, ossification of skeleton begins, liver produces red cells, insulin present in pancreas, heartbeat heard by ultrasound
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| Fetus Growth-16wks | 13.5cm, meconium collects in intestines, baby’s sex can be seen, fetus looks like baby
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| Fetus Growth-20wks | 19cm, Point of Viability, suck & swallow begins, lanugo covers body, vernix begins to protect body, mother feels movement, hands can grasp
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| Fetus Growth-24wks | 23cm, respiration and surfactant production begins, increased activity, sucking
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| Fetus Growth-28wks | 27cm, eyes are open, can breathe
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| Fetus Growth-36wks | 35cm, earlobes soft with little cartilage, few sole creases
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| Fetus Growth-40wks | 40cm, adequate surfactant, vernix in skin folds, earlobes firm, weight 6-7lbs
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| Signs of Prgnancy-Subjective | presumptive, changes woman experiences and reports; amenorrhea, N/V, fatigue, urinary freq, breast changes, quickening
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| Signs of Pregnancy-Objective | probable, examiner can perceive changes; Hegars sign, Chadwicks sign, Braxton hicks, pregnancy tests
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| Signs of Pregnancy-Diagnostic | positive, conclusive proof; abd enlargement, fetal movement palpable, fetal heartbeat, visualization of fetus
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| Recommended Pregnancy Weight Gain | 25-35lbs, 3.5-5lb 1st tri, 1lb weekly 2nd & 3rd
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| Nutritional Requirements | preg-^300kcal/day, lactation-^another 200kcal/day for total of 500kcal/day
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| Percutaneous Umbilical Blood Sampling-PUBS | needle inserted through maternal abdominal wall into fetal umbilical cord to check for fetal abnormalities
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| 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
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| Indirect Coombs Test | detects presence of Rh antibodies, if – give Rhogam at 28 weeks
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| Maternal Adjustment-taking in | 1-2days after birth, dependent and passive, focus on self, easily follows suggestions, slow to make decisions
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| Maternal Adjustment-taking hold | 2nd or 3rd day after birth, ready to resume control, shifts focus to infant, uncertain about newborn care
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| Maternal Adjustment-letting go | interdependence-know when to call dr, acceptance of newborn and self-care, interacts w/ staff and receptive to teaching
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| Glucose Testing | 24-28wks, 1-hour GTT: drinks 50-g oral glucose solution, provides blood sample 1hr later, >140mg/dl indicates further testing
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| 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
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| GDM-S/Sx | Polyuria, Polyphagia, Polydipsia, Weight loss, Blurred vision, Recurrent infections
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| 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
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| Respiratory Conditions | prevent hypoxic conditions, relieve acute attacks, adequate O2, Bronchodialators-Brethine/terbutiline
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| Hemorrahagic Conditions | assess VS, fetal heart tones, pain, bleeding, infection, coping, administer Rhogam w/in 72hr if Rh-
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| 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
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| Hyperemesis Gravidarum | intractable, excessive vomiting, dehydration, wt loss->fluid/electrolyte imbalance, ketosis, hypovolemia, ^Hct, hypotension, tachycardia, decreased urine output, ^BUN
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| 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
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| 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
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| Gestational HTN | after 20 wks, no protein, BP 140/90 or higher on 2 occ at least 6hrs apart
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| Preeclampsia | after 20wks, BP 140/90 or higher on 2 occ at least 6hrs apart, accompanied by Proteinuria, progressive, edema, wt gain
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| 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
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| Eclampsia | most severe form of preeclampsia, generalized seizures/coma, life-threatening, anytime in preg or early postpartum, superimposed on chronic HTN is worst possibility
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| HELLP Syndrome | HTN state w/ Sx in addition to preeclampsia, multiple-organ-failure syndrome, liver involvement, poor outcomes, diagnosed by lab values
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| 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
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| Nonstress Test/NST | baby’s heart rate accelerates 15 beats, for 15 sec, twice in 20 minutes-reactive
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| 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
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| 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,
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| 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
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| 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!
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| Preterm Labor-Meds | Yutopar/ritodrine, Brethine/terbutaline sulfate, Magnesium sulfate, Indocin, Procardia/Nifedipine
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| 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
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| Premature Rupture of Membranes/PROM | associated w/ infections, previous hx, mult gestation, hydramnios, incomplete cervix, bleeding during preg
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| Premature Rupture of Membranes-fetal risks | respiratory distress syndrome, fetalsepsis, malpresentation, prolapse cord, ^morbidity and mortality
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| 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
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| Rh isoimmunization-to prevent | give Rhogam at 28wks, and after each abortion, w/in 72hrs postpartum, amniocentesis & placenta previa, stillbirth, procedures that cause bleeding
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| ABO incompatibility | mother has O, infant has A B or AB, antibodies occur naturally, cross placenta, cause hemolysis of fetal red blood cells-hyperbilirubinemia
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| 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
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| TORCH | Toxoplasmosis, Other-hepatitis, syphilis, gonorrhea, Rubella, Cytomegalovirus, Herpes virus type II
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