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ACP226 Obstetrics > Modules 1-3. A&P, Non-obs Emergency, Pregnancy Complications > Flashcards

Modules 1-3. A&P, Non-obs Emergency, Pregnancy Complications Flashcards

1
Q

1st degree vaginal tear

A

Skin. Inside the vagina or outside on perineum. May require sutures

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2
Q

2nd degree vaginal tear

A

Skin and muscle. Requires suture

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3
Q

3rd degree vaginal tear

A

Skin, muscle, anal sphincter. Sutures to area and sphincter

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4
Q

4th degree vaginal tear

A

Skin, muscle, anal sphincter, rectum. Direct passage from vaginal to rectum.

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5
Q

Episiotomy

A

Incision between vagina and anus to facilitate delivery of larger baby

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6
Q

Vagina

A

Flexible muscular tube approx 3 inches long.
Normally acidic at pH 4-5.

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7
Q

Pelvic inlet

A

Upper border of the true pelvis. Typically round in females.

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8
Q

Determination of size and shape of pelvic inlet

A

Diagonal conjugate: 12.5cm
Obstetric conjugate: smallest and most important
True conjugate: subtracting 1cm from diagonal conjugate
Transverse diameter: shape of inlet

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9
Q

Midpelvis

A

Curved canal longer posterior than anterior wall.
Anteroposterior diameter
Posterior Sagittal diameter
Transverse diameter

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10
Q

Pelvic outlet

A

Lower border of the true pelvis.
Size determined by:
Transverse diameter
Anteroposterior diameter
Posterior Sagittal diameter

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11
Q

False pelvis

A

Portion above the brim and supports the weight of the uterus as well as directing the fetal parts towards the true pelvis

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12
Q

True pelvis

A

Portion that lies below the pelvic brim

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13
Q

Caldwell-moloy classification

A

4 basic types of bony pelvis:
Gynecoid (rounded, most common)
Android (male, heart shaped)
Anthropoid (oval, slowed labour)
Platypelloid (kidney shape, not favourable)

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14
Q

Estrogen

A

Develops female characteristics
Assist in ovarian follicle maturation and proliferation of endometrial.
Inhibit FSH, stimulate LH
High levels at full term, suddenly drops after delivery

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15
Q

Progesterone

A

Secreted by corpus luteum.
Allows pregnancy to be maintained. Prevents contractions.
Levels drop after placenta delivery.

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16
Q

Prostaglandins

A

Produced by cells in endometrium
E: relax smooth muscle, vasodilator
F: vasoconstrictor, increases contractility

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17
Q

Follicle stimulating hormone

A

Maturation of ovarian follicle

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18
Q

Luteinizing hormone

A

Final maturation of follicle

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19
Q

Follicular phase of ovarian cycle

A

Days 1-14.
Follicle matures.
May experience mid cycle pain.
Body temperature increase 0.3-0.6 degrees for 24-48 hrs after ovulation and remains until menstruation

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20
Q

Luteal phase of ovarian cycle

A

Days 15-28.
Begins when ovum leaves follicle. If ovum fertilized it implants in endometrium and secretes hCG.
If not fertilized, corpus luteum degenerates about a week after ovulation.

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21
Q

3 phases of menstrual cycle

A

Menstrual: days 1-6 (endometrial shedding)
Proliferative: days 7-14
Secretory: days 15-26 (uterus readies for implantation)

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22
Q

Fertilization

A

Ova fertile for 6-24 hrs
Usually occurs in ampulla
Sperm can survive 48-72 hrs

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23
Q

Implantation (nidation)

A

Occurs between 7-10 days following fertilization

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24
Q

Preembryonic stage

A

First 14 days
Rapid cellular multiplication and establishment of primary germ layers and embryonic layers

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25
Q

Embryonic membranes (chorion and amnion)

A

Form at implantation
Chorion is first and outermost. Contains chorionic villi, some of which form fetal side of placenta.
Amnion is second and is a protective membrane.

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26
Q

Amniotic fluid

A

Cushions embryo, controls temp, permits symmetrical growth, acts as extension of fetal extracellular space, prevents adherence, allows fetal movement.
Slightly alkaline

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27
Q

Oligohydramnios

A

Less than 500ml of amniotic fluid

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28
Q

Hydramnios/polyhydramnios

A

More than 2000ml of amniotic fluid

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29
Q

Yolk sac

A

Functions only in early embryonic life.
Incorporated into umbilical cord as embryos develop

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30
Q

Umbilical cord

A

Circulatory pathway
1 vein, 2 arteries.
Contains whartons jelly (special connective tissue)
2cm across and 55cm (22”) long at 27-42wks

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31
Q

Placenta

A

Means of metabolic and nutrient exchange.
Development and circulation begin in 3rd week. Expands until about 20 weeks.
At 40 weeks is about 15-20cm diameter, 2.5-3cm thick, 400-600 grams

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32
Q

2 parts of placenta

A

Maternal (red/raw)
Fetal (shiny/gray)

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33
Q

Cotyledons

A

15-20 segments which are subdivisions of the placenta. Each is highly complex and vascular.

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34
Q

Areas of greatest fetal circulation

A

Highest O2 concentration at head, neck, brain, and heart.
Allows for cephalocaudal development

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35
Q

Embryonic stage

A

Day 15-8 weeks. Tissue differentiation. Embryo is most vulnerable to teratogens.
3wks: tubular heart forms
4wks: fetal heartbeat
5wks: C shaped body
6wks: fetal circulation begins
7wks: beginning of all essential structures
8wks: body organs formed, resembles human

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36
Q

Fetal stage

A

9-12wks: heartbeat heard by Doppler
13-16wks: rapid growth, movement, looks like a baby
17-20wks: kidneys secrete urine, FH heard with stethoscope
21-24wk: alveoli form, surfactant starts
25-28wk: fetus assumes head down
29-32wk: rhythmic breathing, increased body fat
33-38wk: testes in scrotum, lanugo disappears

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37
Q

Goodells sign

A

Softening of the cervix

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38
Q

Chadwick’s sign

A

Blue-purple discolouration of the cervix and vagina

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39
Q

Pregnancy and respiratory system

A

vT increase 30-40%
Progesterone decreases airway resistance
Oxygen consumption increase 15-20%
Diaphragm elevates, increase in chest diameter

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40
Q

Pregnancy and cardiovascular system

A

Heart displaced up and to the left
Systolic murmur (90%)
Blood volume increase 30-50%
CO increase 30-50%
HR increase 10-15
BP decrease slightly
Pseudoanemia

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41
Q

GI system pregnancy changes

A

N/V attributed to hCG
Hyperemic gum tissue
Stomach move superiorly
Delayed gastric emptying
Heartburn
Hemorrhoids
Gallbladder emptying time increase

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42
Q

Normal weight gain during pregnancy

A

25-35lbs

43
Q

Hormones in pregnancy

A

hCG
Human placental lactogen
Estrogen
Progesterone
Relaxin
Prostaglandins
Oxytocin
Cortisol
Prolactin

44
Q

Quickening

A

Mothers perception of fetal movement
Primigravida: 18-20wks
Multigravida: as early as 16wks

45
Q

Hegars sign

A

Softening of the isthmus of the uterus

46
Q

Naegeles rule

A

First day of LMP - subtract 3 months - add 7 days
Accurate if woman has a 28 day cycle

47
Q

Fundal height approximations

A

12wks: pubic symphysis
20wks: umbilicus
36wks: xiphoid process
37-40wks: regression

48
Q

Antepartum

A

Time between conception and the onset of labour

49
Q

Intrapartum

A

Time from onset of labour until the birth of baby and placental expulsion

50
Q

Postpartum

A

Time from birth until the woman’s body returns to essentially pre pregnant condition.
Typically 6 weeks.

51
Q

Prenatal/antenatal

A

Time a female is pregnant before birth occurs

52
Q

Gravida

A

Pregnancy regardless of duration

53
Q

Para

A

Woman who has given birth after 20wks gestation

54
Q

Vaginitis

A

Caused by abnormal organisms.
Increased vaginal discharge
Vulvar irritation
Pruritus.
External dysuria
Pain/bleeding on intercourse

55
Q

Bacterial vaginosis

A

Most prevalent vaginal infection.
Caused by change in normal vaginal flora.
Lactobacilli decreased, increased pH
White or gray vaginal discharge.
Whiff test (10% K hydroxide)
Preterm birth and rupture, low birthweight

56
Q

Vulvovaginal candidiasis

A

Fungal infection
Second most common
Drug resistant strains developing.
Thick, white, curdy discharge
Itching, dysuria, dyspareunia.

57
Q

Trichomoniasis

A

Pruritus
Dyspareunia
Dysuria
Petechiae on cervix
pH 4.5 or higher

Tx flagyl/tinidazole

58
Q

Herpes genitals

A

HSV-1/HSV-2
Development of vesicles
Pruritus
Flu-symptoms
Tingling

Tx: acyclovir, valacyclovir, famciclovir

59
Q

Gonorrhea

A

Neisseria gonorrhea
Prurulent, green-yellow discharge
Dysuria
Urinary frequency
Cervicitis, acute cystitis, vaginitis
Bilat abdo or pelvic pain

Tx: cephalosporins

60
Q

Chlamydia

A

Chlamydia trachomatis.
Thin or mucopurulent discharge.
Cervical ectropion/friable cervix.
Lower abdo pain
Neonatal conjunctivitis

Tx: doxycycline (teratogen)

61
Q

Syphilis

A

Spirochete treponema pallidum.
Primary stage: chancre, fever
Secondary: 6wk to 6mo, wart like plaques, hepatosplenomegaly, iritis, non tender lymph nodes
Latent: no lesions

Tx: benzathine pen G

62
Q

HPV

A

Condylomata acuminate.
Over 100 types with 40 that can infect genital tract.
HPV 6 and 11 account for 90% (low cancer risk), HPV 16 and 18 account for 80% of cancer

63
Q

AIDS/HIV fetal/neonatal risks

A

Without ART rate of transmission is approx 25%
With ART and caesarean rate drops to 1%

64
Q

Pelvic inflammatory disease

A

Most common in women of childbearing age (especially sexually active)
Syndrome of inflammatory disorders of female upper genital tract.
Bilat sharp cramping LQ pn
Fever greater than 38.8
Chills
Irreg bleeding
N/V

65
Q

Urinary tract infection

A

Cystitis and urethritis:
Dysuria, urgency, fever, hematuria, suprapubic/back pn
Pyelonephritis:
Acute chills, temp 39-44, costovertebral tenderness, flank pn, NV, sepsis,

66
Q

Toxic shock syndrome

A

Most commonly staph. Aureus.
Fever, HoTN, rash, multisystem involvement

67
Q

Danger signs in first trimester

A

Spotting or bleeding
Painful urination
Hyperemesis gravidum
Fever
Lower abdo pn with dizziness and/or shoulder pn

68
Q

Danger signs in second trimester

A

Regular uterine contractions
DVT
PROM
Absence of fetal movement for more than 12 hrs.

69
Q

Danger signs in third trimester

A

GDM
Preeclampsia
Decrease in fetal movement for more than 24hrs
Any first or second trimester warning signs.

70
Q

Conditions associated with early bleeding during pregnancy

A

Spontaneous abortion
Ectopic pregnancy
Gestational trophoblastic disease
Cervical insufficiency

71
Q

Conditions associated with late bleeding during pregnancy

A

Placenta previa
Abruptio placenta
Placenta accreta

72
Q

Medical abortion

A

Induced with methotrexate, misoprostol, or mifepristone.

73
Q

Vacuum aspiration abortion

A

Manual or electric. Most common method.

74
Q

Dilation and curettage abortion

A

Cervix is gently opened so tissue can be removed using a scraping tool

75
Q

Spontaneous abortion

A

Most occur within first 12 wks. (Most likely due to fetal genetic abnormalities)
Late abortion after 13wks (most likely related to maternal conditions)

76
Q

Threatened abortion

A

Bleeding, cramping, back ache. Cervix is closed, no POC expelled.
May result in abortion or May resolve.

77
Q

Inevitable abortion

A

Increased bleeding and cramping. Cervix dilated, membranes May rupture

78
Q

Incomplete abortion

A

Some POC are passed, some are retained (usually placenta), cervix dilated

79
Q

Complete abortion

A

All POC expelled, uterus contracted, cervix may be closed

80
Q

Missed abortion

A

Nonviable embryo retained in utero for at least 6wk.
Absent uterine contractions, irreg spotting, brownish discharge, cervix closed.

81
Q

Habitual abortion

A

Recurrent pregnancy loss. 3 or more spontaneous abortions.

82
Q

Ectopic pregnancy

A

Most often occurs in ampulla of fallopian tube. Extrauterine pregnancy can occur elsewhere.
Usually 6-8wks

83
Q

Gestational trophoblastic disease

A

Two most common types:
Hydatidiform mole
Choriocarcinoma.

84
Q

Cervical insufficiency

A

Congenital: two cavities joined together
Acquired: inflammation, infection, trauma, late 2nd trimester elective abortion, multiple gestation, LEEP

85
Q

Cerclage

A

Suture placed to prevent cervical dilation.

86
Q

Placenta previa

A

Implanted placenta in lower uterus.
Grade 1: low-lying. Does not reach os. 40-90% chance of c section
Grade 2: marginal. Edge is at os.
Grade 3: partial. Os partially covered
Grade 4: complete. Os covered.

87
Q

Placenta accreta

A

Placenta attaches deep to cervix.
Increta: adhered to myometrium
Percreta: invasion of myometrium to the peritoneal covering.

88
Q

Abruptio placenta

A

Peaks between 24-26wks. Separation of placenta from uterus
Grade 1: mild. Less than 500ml blood
Grade 2: moderate. 1-1.5L
Grade 3: severe more than 1.5L blood

89
Q

Hyperemesis gravidum

A

N/V is normal, peaks at 8-12wks and resolves by 20wks.
HG is excessive vomiting that does not subside, associated with dehydration, weight loss, electrolyte imbalances.

90
Q

Gestational hypertension

A

New onset of hypertension during pregnancy

91
Q

HELLP syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelet count
Develops between 27-37wks

92
Q

Preeclampsia

A

New onset HTN during pregnancy
Proteinuria
Visual & cerebral symptoms
Low platelet count
Renal insufficiency
Impaired liver function

93
Q

3 uses for magnesium sulfate

A

Preventing seizures in women with severe preeclampsia
Slowing or stopping premature labour
Protecting brains of premature babies.

94
Q

Dosing for mag sulfate (preeclampsia)

A

4g in 50ml NS over 20min
2g in 250ml D5 over 60min (do not exceed 40g/day)

95
Q

Mag sulfate dosing (preterm labour)

A

4-6g over 20min
Maintenance 2-4g/hr titrated to reflexes.

96
Q

Gestational diabetes

A

Glucose intolerance with its onset or recognition during pregnancy. Usually around 24wks

97
Q

Rh alloimmunization

A

Rh negative mother with Rh positive fetus. Mother develops aB against Rh cells, aB attack next Rh positive babies blood cells.
Detectable titre 5-16wks after sensitization

98
Q

Group B streptococcus Infection

A

Common bacteria. Can affect mother and fetus. Most commonly threatening to newborns.
Screening at 35-37wks

99
Q

Early term birth

A

37-38wks and 6 days

100
Q

Full term birth

A

39-40wks and 6 days

101
Q

Late term birth

A

After 41st week

Post term after 42wks

102
Q

Preterm labour

A

20-37wks. Increased mortality and morbidity risk.

103
Q

Premature rupture of membranes

A

Rupture after 37wks but before the onset of labour.

ACP226 Obstetrics (3 decks)

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