Exam 3 Flashcards
What education is given for condoms?
many contain latex, use only water-based lubricants
What education is given for diaphragm?
Use with spermicide jelly/cream
Can be inserted up to 4 hours before intercourse and left in for 6 hours after intercourse
Needs provider for fitting and a prescription
Refitted after: pregnancy, weight loss/gain of 10lbs, pelvic surgery, replace 1-2 years
Not recommended if hx of UTI or toxic shock syndrome
What education is given for cervical caps?
Covers only cervix, used with spermicide
Insert up to 12 hrs before intercouse and left in 8 hrs after
Protect for 48 hours
Replace every 1-2 years
Fit and prescribed by provider
Refitted after: abortion, pregnancy, weight changes
Not recommended if hx of abnormal pap smear or TSS
What education is given for sponge contraception?
Nonhormonal
May be obtained without prescription
One size
To use: wet with water, insert into vagina
Insert up to 24 hrs before intercourse and left in place for 6 hrs after intercourse
Provides 12 hrs of protection
If left in for more than 30 hrs increase risk of TSS
What education is given for the nuvaring?
Inserted for 3 weeks, discarded to allow for 1 week to allow for withdrawal bleeding
Estrogen and progesterone are absorbed through vaginal mucosa
Disadvantages: possible discomfort with intercourse, does not protect from STI
Do not use if pelvic floor is weak
What education is given for the patch contraception?
Change weekly, on x3 weeks and off x1 week
Estrogen and progesterone
Higher compliance than OCP but with similar side effects
Disadvantages: less effect with high BMI, risk of VTE
What education is given for nexaplon?
Protects for 5 years
Insert immediately after abortion, miscarriage, childbirth, can be used during breastfeeding
Reversible
Possible side effects: irregular bleeding, unpredictable bleeding, mood changes, headache, acne, depression, decreased bone density, weight gain
Do not use with hx of undiagnosed vaginal bleeding, acute liver disease, jaundice
What education is given for IUD contraceptions?
Placed in office
Types: Copper T (inactivates sperm) and Mirena (thickens cervical mucosa)
Contraindicated: multiple sex partners, pregnancy, active pelvic infection, abnormal uterine bleeding
Advantages: highly effective, low maintenance, ok with breastfeeding, easily reversed
Disadvantages: no protection against STIs, risk of PID with STI, menses changes, can be expelled, high insertion cost but low overall cost
Warning signs: PAINS
Period late, abnormal spotting, bleeding
Abdominal pain, pain with intercourse
Infection exposure, abnormal discharge
Not feeling well, chills, fever
String missing, shorter, or longer, expulsion of IUD
What education is given for combination OCS?
Estrogen and progestin
Estrogen will inhibit ovulation
Progestin will make cervical mucus non-receptive to sperm
Most popular
Lower estrogen will decrease health risks
Advantages: regulation of dysfunctional bleeding, reduction of dysmenorrhea, premenstrual symptoms, offers protection against cancers, improves acne, decreases benign breast disease and functional ovarian cysts
Side effects: chest pain, sob, leg pain, headache, visual disturbances, HTN
Of estrogen: nausea, breast tenderness, fluid retention, irregular bleeding
Of progesterone: increased appetite, tiredness, depression, breast tenderness
If one pill is missed, take it ASAP
If two or more are missed, clarify how many and use back up birth control
Will decrease effectiveness of some drugs and potentiate others and will have effects decreased with other drugs
What education is given for the minipill OCS?
Progestin only of low dosage
Need another form of birth control for the first month of use
Advantages: fewer side effects than combo pills, safe to take while breastfeeding, ok for smokers
Disadvantages: less effective in suppressing ovulation than combo
Side effects: breakthrough, irregular bleeding, vaginal bleeding, headache, nausea, breast tenderness
What education is given for depo-provera?
Inject every 3 months
Inhibits ovulation
Chanages cervical mucus and endometrium
Advantages: very effective, only 4 shots/year, does not impair lactation, may eliminate or decrease period bleeding
What education is given for emergency contraception?
Not a regular method of birth control
Used after no BC used during sex or if BC failed
What types of behavioral contraceptions are there?
abstinence
withdrawal
lactation amenorrhea method
fertility awareness
What is lactation amenorrhea method?
Temporary method of contraception used in first 6 months after fetus is born
Continuous breast feeding stimulates prolactin and inhibits gonadotropin necessary for ovulation
98% effective if exclusively breastfeeding
What is fertility awareness contraception?
Monitoring physical signs and symptoms of hormonal changes to predict times of fertility
Advantages: no health risk or side effects, compatible with religious beliefs, inexpensive
Disadvantages: learning takes time and effort, requires commitment, risk of pregnancy
What are the risks of infertility for males?
Heavy alcohol
Drugs
Smoking cigarettes
Age
Environmental toxins, including pesticides and lead
Health problems such as mumps, serious conditions like kidney disease, or hormone problems
Medicines
Radiation treatment and chemotherapy for cancer
What are the risks of infertility for females?
Age
Smoking
Excess alcohol use
Stress
Poor diet
Athletic training
Being overweight or underweight
Sexually transmitted infections (STIs)
Health problems that cause hormonal changes
(Such as polycystic ovarian syndrome and primary ovarian insufficiency)
What are the causes of vaginal infection?
candidiasis
trichomonas
gardnerella
What are the s/s, treatment, and perinatal complications of candidiasis?
Signs and symptoms:
White, “cottage cheese” discharge
Vulva is excoriated, erythematous with painful itching
During spec exam, adherent white packages
Treatment: antifungal Miconazole or fluconazole (teratogenic)
Perinatal complication: if untreated newborns may develop thrush
What are the s/s, treatment, and perinatal complications of trichomonas?
Signs and symptoms
Copious yellow-green frothy, mucopurulent, malodorous discharge, dysuria, dyspareunia, itching, petechiae of cervix
Treatment: Metronidazole
No alcohol during treatment
Do not use during first trimester of pregnancy
Decrease effectiveness of OBC
Abstain from sex until both partners are cured
Perinatal complication: preterm rupture of membranes and low weight babies, postpartum endometritis
What are the s/s, treatment, and perinatal complications of gardnerella?
Signs and symptoms
Thin white or gray discharge with fishy odor, increases after sex
Some can be asymptomatic
Treatment: Metronidazole
No alcohol during treatment
Avoid sunlight exposure
Metallic taste in mouth may occur
Perinatal complication: increase PID, associated with preterm labor, chorioamnioitis, premature rupture of membranes, postpartum endometritis
What are the causes of cervicitis?
Chlamydia and gonorrhea
What are the s/s, treatment, and perinatal complications of chlamydia?
Signs and symptoms
Vaginal discharge
Dysuria, urinary frequency
Spotting and/or postcoital bleeding
Treatment: azithromycin or doxycycline
If coinfected with gonorrhea treat with ceftriaxone
Perinatal complications: can lead to PID and infertility
What are the s/s, treatment, and perinatal complications of gonorrhea?
Signs and symptoms
Dysuria
Vaginal bleeding between periods
Dysmenorrhea
PID
Bartholin’s abscess
Yellowish-green discharge
Treatment: ceftriaxone and azithromycin
Perinatal complications: can be spread to fetus at birth
What are the s/s, treatment, and perinatal complications of HSV-2?
Signs and symptoms
Vesicles: blister-like lesions on vulva, vagina and perineal areas
Dysuria
Fever
Headache
Muscle aches
Treatment: no cure, acyclovir to suppress symptoms
Perinatal complications: 1st outbreak is most severe and if happens in 1st trimester there are higher rates of miscarriage
What are the s/s, treatment, and perinatal complications of syphilis?
Signs and symptoms
Primary: chancre on area bacteria entered body
Secondary: rash, sore throat, swollen lymph nodes, flu-like symptoms
Latent: No symptoms, No longer contagious
Tertiary: damage to internal organs, damage to musculoskeletal, blindness
No longer reversible
Treatment: penicillin
Perinatal complications: can cross placenta and cause congenital syphilis
What are the s/s, treatment, PN complications of HPV?
Signs and symptoms
Wart-like lesions that are
Clusters, raised or flat, small or large on vulva, cervix, vagina and anus
Treatment: remove lesions by freezing, burning, laser, excision, trichloracetic acid or bichloracetic acid
PN complications: excessive bleeding from lesions after birth, IUGR, can be inherited
What are the types of hepatitis?
A – spreads via GI with polluted water, undercooked shellfish from contaminated water, oral/anal sex, feces of infected person
B – spread through bodily fluids
Perinatal complication: most threatening to fetus and neonate as it is a disease of liver and often a silent infection
Treatment: supportive, HBsAg positive mother and negative infant treated with HBIG and begin vaccinations
C – most common blood borne in US
What are the s/s and perinatal complications of Zika?
Signs and symptoms
Fever
Rash
Headache
Bone pain
Joint tenderness
Conjunctivitis
Perinatal complications: can pass virus to fetus
What are the s/s, treatment, and perinatal complications of HIV?
Signs and symptoms
Fever
Headache
Night sweats
Malaise
Generalized lymphadenopathy
Myalgias
Nausea
Diarrhea
Weight loss
Sore throat
Rash
Treatment: Retrovir
Begin at 14 weeks
Perinatal complications:
Avoid amniocentesis, forceps/vacuum extraction, internal fetal monitoring and/or episiotomy due to risk of maternal blood exposure
Planned cesarean section at 38 weeks
No breastfeeding
Newborn treated with antiretroviral syrup within 12 hours after birth to reduce transmission and then for 6 weeks
What are the treatment and perinatal complications of group B streptotoccus?
Treatment: penicillin
Initial bolus, Q4H during labor, at least 4 hours before birth
Perinatal complication
Life threatening to newborns, causes sepsis, meningitis, newborn pneumonia
If pregnant person is having a cesarian section and water hsn’t broken they do not need prophylactic antibiotics
What are the s/s and perinatal complications of TORCH?
Signs and symptoms
Joint pain
Flu-like symptoms
Rash
Lymph node enlargement
Perinatal complication: cross placenta and causes teratogenic effects
What are the main hormones of female reproductive health? What do they do?
Progesterone
Causes cervical mucous to be thick, sticky
Estrogen
Causes cervical mucous to be thin, stretchy and increases amount near ovulation
Beta HCG (human chorionic gonadotropin)
Earliest biochemical marker for pregnancy
7 to 8 days
hCG doubling time every 48 to 72 hours until peak around 60 yo 70 days after fertilization and decreases around 100-120 days
Ectopic pregnancy or miscarriage hCG will be lower
Molar pregnancy or multiple-gestational pregnancy or genetic abnormality hCG will be higher
What are the names of the stages of fetal development? And time ranges?
pre-embryonic (fertilization through 2nd week), embryonic (end of 2nd week through 8th week), fetal (end of 8th week until birth), viability (24 weeks)
What happens in the pre-embryonic stage?
Fertilization in the ampulla (outside of fallopian tube)
Mitosis = cleavage
Morula: solid ball of about 16 cells of developing zygote that will continue to divide until cells specialize
Blastocyst: forms embryo and amnion
Trophoblast: outer layer that forms into embryonic membranes, chorion (forms placenta)
Implantation
Blastocyst embeds into endometrial wall in fundus (upper posterior wall of uterus)
Bleeding or spotting may occur
What happens in the embryonic stage?
Basic structures of major body organs and main external features
Ectoderm, mesoderm, endoderm
Two embryonic membranes
Chorion: outer layer covering fetal side of placenta
Chorionic villi: vascular projections that will support fetal circulation
Amnion: inner layer, expands to chorion, forms amniotic sac
Critical time of development due to organogenesis
400 mg of folic acid is recommended to avoid neurotubular abnormalities
What is the circulation of the fetus?
three shunts that close at birth
Ductus venosus
Connects umbilical vein to inferior vena cava
Delivers oxygenated blood to fetus while bypassing the fetal liver
Foramen ovale
Oxygenated blood from right atrium to left atrium while bypassing fetal lungs
Ductus arteriosus
Oxygenated blood from pulmonary artery to aorta
What are the functions of the placenta?
Corpus luteum secretes hormones to support pregnancy until placenta can take over
Exchange between pregnant person and fetus
Site of attachment: fundal of uterus
Pregnant person’s side will be red and vascularized
Fetus side will be shiny or white with villi
Metabolic function
Hormone factory
What are the function of human placental lactogen?
Regulates glucose available to fetus, fetal and maternal metabolism
Prepares breast for lactation
What are the functions of progesterone?
Maintains endometrium, decreases uterine contractions, stimulates maternal metabolism, prepares breasts for lactation
Can cause morning sickness
What are the functions of relaxin?
Works with progesterone to maintain pregnancy
Causes relaxation of pelvic ligaments (causes pregnant waddle), softens cervix in preparation for birth
What are the functions of human chorionic gonadotropin?
Maintain endometrial lining of uterus (until placenta functions) - Secreted by corpus luteum
Main hormone thought of to diagnose pregnancy
- Can be detect 8 to 10 days after conception
Can also be secreted due to tumors
What are the functions of estrogen?
Stimulates uterine growth and prepares breasts for lactation
Stimulates myometrial contractility
At the time of labor estrogen will increase and progesterone will decrease
What occurs during preconception?
Union of ovum and sperm
Zona pellucida reaction occurs
Clear protein layer that blocks sperm from egg
Determination of sex occurs by sperm
What are common autosomal dominant disorders?
Marfan’s syndrome
Neurofibromatosis
Huntington’s
Achondroplasia
Polycycstic kidney disease
What are common autosomal recessive disorders?
CF
PKU
Tay-sachs
Sickle cell
What are common X-linked recessive disorders?
Hemophilia A
Color blindlness
Duchenne muscular dystrophy
What are presumptive pregnancy signs?
Amenorrhea
Breast tenderness/enlarged Montgomery glands and darkened areolae
Fatigue
Nausea and vomiting
Quickening – feeling of fetal movement
Skin changes
Urinary frequency
What are probable signs of pregnancy?
Positive pregnancy test - Not definitive because HCG can be present in some forms of cancer
Abdominal enlargement
Ballottement
Around 16 to 28 weeks
Passive fetal movement in response to tapping of lower portion of uterus or cervix
Braxton Hicks contractions
Uterine toning
Cervical changes on exam:
Goodell’s sign: softening of cervix
Chadwick’s sign: bluish mucus membranes of vagina, cervix, and vulva due to increased vascularity
Hegar’s sign: softening of lower uterine segment
What are positive signs of pregnancy?
Ultrasound visualization of embryo or fetus
Fetal movement palpated by examiner
Auscultation of fetal heart tones via Doppler
What are the nutritional needs of pregnancy?
Eat a variety of foods from all food groups with portion control
Lower intake of saturated fats, trans fats and cholesterol
Increase intake of fruits, vegetables, and whole grains
Fluids: 8-10 glasses of water or other fluids/day
Dehydration can cause perterm labor
Balance calorie intake with exercise to maintain healthy weight
Will increase up to 500c/day during third trimester
Increase vitamins, minerals, and dietary fiber
Consume Folic acid from supplements or fortified foods
Take 400 ug of folic acid
Avoid fish – Mercury
Avoid or limit caffeine
Avoid lunch meats
Listeriosis
Calcium
What reproductive changes occur during pregnancy?
Uterus
Increase in size by 20x
Increase strength and elasticity
Cervix
Increase in size and vascularization
Progesterone will cause secretion of mucus to plug the cervical oss to protect fetus from bacteria
Vagina
Increase vascularity, mucosa, secretions
Ovaries
Increase size and production of hormones until 7 weeks
Breasts
Changes in color
Montgomery glands enlarge
Nipples become erect
Vasculature increases
What respiratory changes occur during pregnancy?
Increase in maternal oxygen needs
Total lung capacity decreases
Intermittent shortness of breath
What renal changes occur during pregnancy?
Urinary frequency common as filtration rate increases due to hormones
Increase water intake
Kegel exercises, empty bladder frequently
Increased risk for UTI and pyelonephritis due to dilation of ureters and renal pelvises allowing for bacteria to move upward towards the kidneys
Cotton or no underwear
What are skin changes occur during pregnancy?
Hyperpigmentation of skin:
Areola, genital skin, axilla, inner aspects of thighs and linea nigra (midline darkening pigment)
Striae gravidarum = stretch marks
Thicker hair
Nail growth increases
What musculoskeletal changes occur during pregnancy?
Pelvis tilts forward shifting center of weight forward
Lordosis = further curvature of lumbar
Relaxation and increased mobility of joints due to hormones (relaxin)
Pubic symphysis widens causing waddle
Backaches are common
Separation of recti muscles
Culprit of why some look pregnant event though they aren’t
Round ligament pain
Common in first and third trimester
As uterus enlarges it will pull and cause sharp pain
Occurs commonly when turning side to side in bed
What cardiac changes occur during pregnancy?
Increased CO, HR (by 10-15 bpm), and blood volume
Heart enlarges and is displaced upward and left
Benign ejection murmur after 20 weeks
Clotting factors increase for prevention of post-partum hemorrhage
Poor circulation and leg cramping
Increase water intake
Avoid prolonged sitting or standing
Varicose veins and lower extremity edema
Compression stockings
Vena cava syndrome – supine hypotension
What are the s/s and education about vena cava syndrome?
Decrease of venous blood flow to heart causes maternal hypotension and fetal hypoxia
Signs/symptoms
Dizziness, lightheadedness, pallor, clammy skin; fetal bradycardia
Preferred position
Left-lateral side, semi-fowlers
Do not prolong lying supine
Wedge under one hip
What GI changes occur during pregnancy?
Nausea and vomiting
Increased bleeding of gums due to progesterone
Decreased gallbladder, peristalsis, and stomach emptying
Increased risk of gallstones and constipation
Increased salivation
Increased nasal stuffiness and nosebleeds
Heartburn
Small frequent meals and sitting up after eating
Hemorrhoids
Side sitting
Sitz baths
Impaired glucose control
Hypoglycemic until 24 to 28 weeks where there’s hyperglycemia
What endocrine changes occur during pregnancy?
Thyroid glands increase T4
Adrenal glands increase cortisol and aldosterone
Pituitary gland enlarged due to prolactin
Pancreas hyperglycemia and hyperinsulinemia
Placenta becomes an endocrine organ producing hormones of pregnancy
How long is pregnancy approximately?
280 days
What tools can be used to calculate the due date?
Naegele’s rule
pregnancy wheel/calculator
ultrasound
McDonald’s rule
What is Naegele’s rule?
To determine due date
Date of LMP
Subtract 3 months
Add 7 days
What is the best time to assess due date by ultrasound?
12 weeks
What is the McDonald’s rule?
Best for one fetal pregnancy
Measurement from pubic symphysis to the fundus (top of uterus)
In cm
Should be roughly equal to week of gestation
At week 20 it will be at umbilicus
Fundus will begin to rise out of pelvic ridge pronounced and able to palpate at 14 weeks
Bad if there is stagnant growth or too large
What is quickening?
1st fetal movement felt by pregnant person
What assessments are done to monitor fetal development?
heart rate
fundal height
fetal movement
What is an ultrasound at 20 weeks going to indicate?
structural anatomy and ruling out anomalies
What are maternal-serum markers?
triple markers = alpha fetoprotein (AFtP), unconjugated estriol, hCG: done during first trimester to indicate chromosomal disorders
if AFP and estiol are low and hCG is high = downs
if all three are low = trisomy 18
QUAD = triple marker and inhibin A
done during second trimester to detect chromosomal and neural tube defects but is less sensitive but combined with first trimester test increase accuracy for detecting downs
What is NIPS?
For high-risk pregnancy
Advanced screen for trisomy 21, 18, and 13
Maternal blood that quantifies the amount of cell free fetal DNA that comes from chromosome 13, 18, 21, X, and Y
What is a non-stress test?
Most used eval for fetal well-being for at risk pregnancies
Evaluates fetal HR in response to uterine contractions
Monitor for at least least 20 minutes
Looking for accelerations of the fetal HR of at least 15 bpm for at least 15 seconds at least twice in this window
Reactive tracing
Indicates good oxygenation and good neurologic function
How to read strip
Big vertical thick lines is 60 seconds, and each little column is 10s
The top wiggly line is the fetal heart tone
Bottom line is pressure sensation monitoring uterine contraction
If nonreactive test results further assessment is needed, biophysical profile
What is the biophysical profile?
looks at NST and ultrasound (fetal breathing movements, fetal activity (gross body movements = at least 3 limbs or body extensions of flexion occur within 30 min), fetal muscle tone (at least one extension and return to flexion), and amniotic fluid volume (at least one pocket of fluid measuring 2cm)
each aspect given 0 or 2 points and a max score of 10
What can doppler blood flow assess?
fetal blood flow across placenta and umbilical cord
What are the danger signs of pregnancy?
Fetal alarm signal: no fetal movements within 12hrs
Gush of fluid from vagina
If it’s clear think amniotic fluid or urine
If it’s a little amount it could be vaginal congestion
Vaginal bleeding
Abdominal pain
Temperature >101
Persistent vomiting
Visual disturbances
Edema of hands & face
Severe headache
Epigastric pain
Dysuria
Could be UTI, labor start (infections could induce labor)
Decreased fetal movement
How can pregnancy history be assessed?
G - gravida: totality number of pregnancies including current pregnancy if applicable
T- term: Birth at 37 and above
P- preterm: Birth at 20 to 36 6/7 weeks
A- abortion: Spontaneous, terminated, or selected
Fetus <20 weeks
L- living children: Currently living children
What are the TORCH infections?
Toxoplasmosis
Other agents
Rubella
Cytomegalovirus
Herpes simplex
