Modules 1-3. A&P, Non-obs Emergency, Pregnancy Complications Flashcards
1st degree vaginal tear
Skin. Inside the vagina or outside on perineum. May require sutures
2nd degree vaginal tear
Skin and muscle. Requires suture
3rd degree vaginal tear
Skin, muscle, anal sphincter. Sutures to area and sphincter
4th degree vaginal tear
Skin, muscle, anal sphincter, rectum. Direct passage from vaginal to rectum.
Episiotomy
Incision between vagina and anus to facilitate delivery of larger baby
Vagina
Flexible muscular tube approx 3 inches long.
Normally acidic at pH 4-5.
Pelvic inlet
Upper border of the true pelvis. Typically round in females.
Determination of size and shape of pelvic inlet
Diagonal conjugate: 12.5cm
Obstetric conjugate: smallest and most important
True conjugate: subtracting 1cm from diagonal conjugate
Transverse diameter: shape of inlet
Midpelvis
Curved canal longer posterior than anterior wall.
Anteroposterior diameter
Posterior Sagittal diameter
Transverse diameter
Pelvic outlet
Lower border of the true pelvis.
Size determined by:
Transverse diameter
Anteroposterior diameter
Posterior Sagittal diameter
False pelvis
Portion above the brim and supports the weight of the uterus as well as directing the fetal parts towards the true pelvis
True pelvis
Portion that lies below the pelvic brim
Caldwell-moloy classification
4 basic types of bony pelvis:
Gynecoid (rounded, most common)
Android (male, heart shaped)
Anthropoid (oval, slowed labour)
Platypelloid (kidney shape, not favourable)
Estrogen
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
Progesterone
Secreted by corpus luteum.
Allows pregnancy to be maintained. Prevents contractions.
Levels drop after placenta delivery.
Prostaglandins
Produced by cells in endometrium
E: relax smooth muscle, vasodilator
F: vasoconstrictor, increases contractility
Follicle stimulating hormone
Maturation of ovarian follicle
Luteinizing hormone
Final maturation of follicle
Follicular phase of ovarian cycle
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
Luteal phase of ovarian cycle
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.
3 phases of menstrual cycle
Menstrual: days 1-6 (endometrial shedding)
Proliferative: days 7-14
Secretory: days 15-26 (uterus readies for implantation)
Fertilization
Ova fertile for 6-24 hrs
Usually occurs in ampulla
Sperm can survive 48-72 hrs
Implantation (nidation)
Occurs between 7-10 days following fertilization
Preembryonic stage
First 14 days
Rapid cellular multiplication and establishment of primary germ layers and embryonic layers
Embryonic membranes (chorion and amnion)
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.
Amniotic fluid
Cushions embryo, controls temp, permits symmetrical growth, acts as extension of fetal extracellular space, prevents adherence, allows fetal movement.
Slightly alkaline
Oligohydramnios
Less than 500ml of amniotic fluid
Hydramnios/polyhydramnios
More than 2000ml of amniotic fluid
Yolk sac
Functions only in early embryonic life.
Incorporated into umbilical cord as embryos develop
Umbilical cord
Circulatory pathway
1 vein, 2 arteries.
Contains whartons jelly (special connective tissue)
2cm across and 55cm (22”) long at 27-42wks
Placenta
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
2 parts of placenta
Maternal (red/raw)
Fetal (shiny/gray)
Cotyledons
15-20 segments which are subdivisions of the placenta. Each is highly complex and vascular.
Areas of greatest fetal circulation
Highest O2 concentration at head, neck, brain, and heart.
Allows for cephalocaudal development
Embryonic stage
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
Fetal stage
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
Goodells sign
Softening of the cervix
Chadwick’s sign
Blue-purple discolouration of the cervix and vagina
Pregnancy and respiratory system
vT increase 30-40%
Progesterone decreases airway resistance
Oxygen consumption increase 15-20%
Diaphragm elevates, increase in chest diameter
Pregnancy and cardiovascular system
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
GI system pregnancy changes
N/V attributed to hCG
Hyperemic gum tissue
Stomach move superiorly
Delayed gastric emptying
Heartburn
Hemorrhoids
Gallbladder emptying time increase
Normal weight gain during pregnancy
25-35lbs
Hormones in pregnancy
hCG
Human placental lactogen
Estrogen
Progesterone
Relaxin
Prostaglandins
Oxytocin
Cortisol
Prolactin
Quickening
Mothers perception of fetal movement
Primigravida: 18-20wks
Multigravida: as early as 16wks
Hegars sign
Softening of the isthmus of the uterus
Naegeles rule
First day of LMP - subtract 3 months - add 7 days
Accurate if woman has a 28 day cycle
Fundal height approximations
12wks: pubic symphysis
20wks: umbilicus
36wks: xiphoid process
37-40wks: regression
Antepartum
Time between conception and the onset of labour
Intrapartum
Time from onset of labour until the birth of baby and placental expulsion
Postpartum
Time from birth until the woman’s body returns to essentially pre pregnant condition.
Typically 6 weeks.
Prenatal/antenatal
Time a female is pregnant before birth occurs
Gravida
Pregnancy regardless of duration
Para
Woman who has given birth after 20wks gestation
Vaginitis
Caused by abnormal organisms.
Increased vaginal discharge
Vulvar irritation
Pruritus.
External dysuria
Pain/bleeding on intercourse
Bacterial vaginosis
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
Vulvovaginal candidiasis
Fungal infection
Second most common
Drug resistant strains developing.
Thick, white, curdy discharge
Itching, dysuria, dyspareunia.
Trichomoniasis
Pruritus
Dyspareunia
Dysuria
Petechiae on cervix
pH 4.5 or higher
Tx flagyl/tinidazole
Herpes genitals
HSV-1/HSV-2
Development of vesicles
Pruritus
Flu-symptoms
Tingling
Tx: acyclovir, valacyclovir, famciclovir
Gonorrhea
Neisseria gonorrhea
Prurulent, green-yellow discharge
Dysuria
Urinary frequency
Cervicitis, acute cystitis, vaginitis
Bilat abdo or pelvic pain
Tx: cephalosporins
Chlamydia
Chlamydia trachomatis.
Thin or mucopurulent discharge.
Cervical ectropion/friable cervix.
Lower abdo pain
Neonatal conjunctivitis
Tx: doxycycline (teratogen)
Syphilis
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
HPV
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
AIDS/HIV fetal/neonatal risks
Without ART rate of transmission is approx 25%
With ART and caesarean rate drops to 1%
Pelvic inflammatory disease
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
Urinary tract infection
Cystitis and urethritis:
Dysuria, urgency, fever, hematuria, suprapubic/back pn
Pyelonephritis:
Acute chills, temp 39-44, costovertebral tenderness, flank pn, NV, sepsis,
Toxic shock syndrome
Most commonly staph. Aureus.
Fever, HoTN, rash, multisystem involvement
Danger signs in first trimester
Spotting or bleeding
Painful urination
Hyperemesis gravidum
Fever
Lower abdo pn with dizziness and/or shoulder pn
Danger signs in second trimester
Regular uterine contractions
DVT
PROM
Absence of fetal movement for more than 12 hrs.
Danger signs in third trimester
GDM
Preeclampsia
Decrease in fetal movement for more than 24hrs
Any first or second trimester warning signs.
Conditions associated with early bleeding during pregnancy
Spontaneous abortion
Ectopic pregnancy
Gestational trophoblastic disease
Cervical insufficiency
Conditions associated with late bleeding during pregnancy
Placenta previa
Abruptio placenta
Placenta accreta
Medical abortion
Induced with methotrexate, misoprostol, or mifepristone.
Vacuum aspiration abortion
Manual or electric. Most common method.
Dilation and curettage abortion
Cervix is gently opened so tissue can be removed using a scraping tool
Spontaneous abortion
Most occur within first 12 wks. (Most likely due to fetal genetic abnormalities)
Late abortion after 13wks (most likely related to maternal conditions)
Threatened abortion
Bleeding, cramping, back ache. Cervix is closed, no POC expelled.
May result in abortion or May resolve.
Inevitable abortion
Increased bleeding and cramping. Cervix dilated, membranes May rupture
Incomplete abortion
Some POC are passed, some are retained (usually placenta), cervix dilated
Complete abortion
All POC expelled, uterus contracted, cervix may be closed
Missed abortion
Nonviable embryo retained in utero for at least 6wk.
Absent uterine contractions, irreg spotting, brownish discharge, cervix closed.
Habitual abortion
Recurrent pregnancy loss. 3 or more spontaneous abortions.
Ectopic pregnancy
Most often occurs in ampulla of fallopian tube. Extrauterine pregnancy can occur elsewhere.
Usually 6-8wks
Gestational trophoblastic disease
Two most common types:
Hydatidiform mole
Choriocarcinoma.
Cervical insufficiency
Congenital: two cavities joined together
Acquired: inflammation, infection, trauma, late 2nd trimester elective abortion, multiple gestation, LEEP
Cerclage
Suture placed to prevent cervical dilation.
Placenta previa
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.
Placenta accreta
Placenta attaches deep to cervix.
Increta: adhered to myometrium
Percreta: invasion of myometrium to the peritoneal covering.
Abruptio placenta
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
Hyperemesis gravidum
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.
Gestational hypertension
New onset of hypertension during pregnancy
HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low Platelet count
Develops between 27-37wks
Preeclampsia
New onset HTN during pregnancy
Proteinuria
Visual & cerebral symptoms
Low platelet count
Renal insufficiency
Impaired liver function
3 uses for magnesium sulfate
Preventing seizures in women with severe preeclampsia
Slowing or stopping premature labour
Protecting brains of premature babies.
Dosing for mag sulfate (preeclampsia)
4g in 50ml NS over 20min
2g in 250ml D5 over 60min (do not exceed 40g/day)
Mag sulfate dosing (preterm labour)
4-6g over 20min
Maintenance 2-4g/hr titrated to reflexes.
Gestational diabetes
Glucose intolerance with its onset or recognition during pregnancy. Usually around 24wks
Rh alloimmunization
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
Group B streptococcus Infection
Common bacteria. Can affect mother and fetus. Most commonly threatening to newborns.
Screening at 35-37wks
Early term birth
37-38wks and 6 days
Full term birth
39-40wks and 6 days
Late term birth
After 41st week
Post term after 42wks
Preterm labour
20-37wks. Increased mortality and morbidity risk.
Premature rupture of membranes
Rupture after 37wks but before the onset of labour.
