OB Exam #1 Flashcards
Absence of menses
- normal in prepubertal, pregnant, postpartum, and postmenopausal females
- primary vs. secondary
- treatment is dependent on type (correct underlying factors)
- Causes: weight loss/gain, excessively exercising, stress, depression, PCOS, etc.
- Dx: draw labs to identify cause; pregnancy test
amenorrhea
Painful menstruation
- common in adolescence & caused by increased prostaglandin production causing increased uterine contractions
- can also be secondary to other pelvic or uterine issues (most commonly endometriosis)
- goal is to provide adequate pain control to maintain ADLs
- Tx: pain relief, contraceptive (hormones), OTC remedies
- Dx: CBC (anemia), UA, pregnancy test, pap smear (STDs), pelvic/vaginal US, laparotomy
dysmenorrhea
painless endometrial bleeding that is prolonged, excessive, & irregular
- most common at the beginning and end of reproductive years & is related to hormone disturbance
- Common causes: polyp, endometrial tissue growing in uterine wall, fibroids, cancer, coagulation issues
- Tx: treat & normalize bleeding; correct anemia; prevent or diagnose cancer; restore quality of life; contraceptives; NSAIDs; D&C; ablation; biopsy; hysterectomy (last resort)
abnormal uterine bleeding (AUB)
recurrent symptoms that occur during the last half of menstruation
- wide variety of S&S: dysphoria, breast pain, bloating, weight gain, tension headache, retain fluid, social withdrawal, interruptions w/ sleep or want to sleep more
- difficult to define & hard to diagnose
- exact cause = unknown
- Tx: lifestyle changes & meds (NSAIDs, contraceptives, antidepressants, diuretics); vitamins
premenstrual syndrome (PMS)
functional endometrial tissue implants in areas other than the uterine cavity such as the ovaries, fallopian tubes, outer surface of uterus, bowels, anal verge, pelvic wall
- this tissue responds the same way as endometrial lining during the menstrual cycle
- S&S begin as early as adolescence & stop after menopause
- cause = unknown
- Tx: surgical removal or ovarian suppressive agents; NSAIDs; hormonal suppression
endometriosis
inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception – secondary is the inability to conceive after previous pregnancies
- impacts emotional, social, and economic well-being of couples
- Female causes: ovarian dysfunction or tubal/pelvic pathology; anovulation, tubal damage, endometriosis, ovarian failure
- Male causes: low or absent numbers of motile sperm in the ejaculate; erectile dysfunction
- Tx: lifestyle changes; medication to promote ovulation; intrauterine insemination; IVF
infertility
refraining from sexual activity
- Failure rate: none
- Pros: costs nothing
- Cons: difficult to maintain
- STI protection, unless, body fluids are exchanged in other ways
abstinence
refrain from sex during fertile period
- Failure rate: 25%
- Pros: no side effects, acceptable to most religions
- Cons: high failure rate w/ incorrect use
- STI protection: none
- Methods: cervical mucus ovulation; basal body temperature; symptothermal; standard days
fertility awareness-based methods
male withdraws before ejaculation occurs
- Failure rate: 27%
- STI protection: none
- oldest & most widely used means of preventing pregnancy in the world
- one of the least effective ways of preventing pregnancy
withdrawal (coitus interruptus)
continuous breastfeeding can usually postpone ovulation & prevent pregnancy
- only works for about 6 months [must be exclusively breastfeeding– this is when kids are introduced to solid foods]
- important to educate women that pumping or manual milk expression can reduce effectiveness
- common method for postpartum women
lactational amenorrhea method
thin sheath placed over penis or into the vagina to block sperm
- Failure rate: 15%
- Pros: widely available, low cost, physiologically safe
- Cons: breakage risk, decreased sensation & spontaneity
- STI protection: provides protection
- made of latex (allergy alert) or polyurethane
condom [barrier method]
shallow latex cup that is placed in the vagina
- Failure rate: 16%
- Pros: no hormones, medically safe, cervical cancer prevention
- Cons: requires accurate fitting by healthcare professional, increased UTIs
- STI protection: none
diaphragm [barrier method]
pill that suppresses ovulation by combined action of estrogen & progestin
- most common and used by millions of women
- needs to be taken at same time everyday to be most effective
- can be used for Tx of acne, PMS, endometriosis, reduce risk of endometrial cancer & protects from PID
- Failure rate: 8%
- Pros: easy to use, high rate of effectiveness
- Cons: must take pill at exact same time everyday, possible undesirable effects, prescription needed
- STI protection: none
- ACHES: abdominal pain (liver or gallbladder issues); chest pain/SOB (PE); headache (HTN, impending stroke); eye problems (HTN); severe leg pain (DVT)
oral contraceptives [hormonal method]
injectable progestin that inhibits ovulation
- Failure rate: 3%
- Pros: long duration (3-MOS), highly effective, estrogen-free, can be used by smokers & lactating women
- Cons: menstrual irregularities, return visits every 12 weeks, return to fertility up to 12 months
- STI protection: none
Depo-Provera [hormonal method]
transdermal patch that releases estrogen and progestin into circulation
- Failure rate: 8%
- Pros: easy system to remember, very effective – once they stop using, fertility is restored pretty quickly
- Cons: skin irritation possible, may fall off and not be noticed providing no protection
- STI protection: none
Ortho Evra [hormonal method]
vaginal contraceptive ring about 2” in diameter that is inserted into the vagina; releases estrogen and progestin
- Failure rate: 8%
- Pros: easy system to remember, very effective
- Cons: may cause vaginal discharge; can be expelled w/o noticing and not offer protection
- STI protection: none
NuvaRing [hormonal method]
a time-release implant (one rod) of levonorgestrel for 3 yrs
- Failure rate: 0.05%
- Pros: long duration of action; low dose of hormones; reversible; estrogen-free
- Cons: irregular bleeding; weight gain; breast tenderness; headaches; difficulty in removal
- STI protection: none
Nexplanon [hormonal method]
a T-shaped device inserted into the uterus that releases copper or progesterone or levonorgestrel
- Failure rate: 1%
- Pros: immediately & highly effective; allows for sexual spontaneity; can be used during lactation; return to fertility not impaired; requires no motivation by user after insertion
- Cons: insertion requires skilled professional; menstrual irregularities; prolonged amenorrhea; can be unknowingly expelled; may increase the risk of pelvic infection
- STI protection: none
intrauterine devices (IUD) [hormonal method]
combo of levonorgestrel-only pills; combined estrogen & progestin pills
- used within 72-120 hours of unprotected sex, more effective the quicker they take it
- reduce risk of pregnancy by almost 90%
- Pros: provides a last chance to prevent a pregnancy
- Cons: risk of ectopic pregnancy if EC fails
- STI protection: none
emergency contraceptives (Plan-B) [hormonal methods]
- occur in older women around 30-50
- caused by overgrowth of fibrous tissue, in response to the monthly progesterone & estrogen levels
- rare in postmenopausal women
- S&S: palpable, movable lump; nipple discharge; breast tenderness
- Tx: supportive bra; decrease caffeine; ibuprofen; biopsy/aspiration
fibrocystic changes
- occurs in women age 15-30
- caused by hormone replacements (birth control), pregnancy, lactation
- benign, solid breast tumors
- S&S: round, movable lump; may have tenderness
- Tx: monitor; lump aspiration/biopsy; surgical removal
fibroadenomas
- caused by bacteria and result in inflammation/infection in breast tissues
- S&S: localized swelling, redness, warmth, tenderness of breast, flu-like symptoms
- Tx: warm compress; pain meds; antibiotics; expressing breastmilk
mastitis
- Types: ductal, tubular, colloid, medullary
- 2nd leading cause of cancer in women, much rarer in men
- Non-modifiable risk factors: female, age, genetics, history, race, timing of menarche/menopause
- Modifiable risk factors: hormone therapy; childbirth; non-breastfeeding; alcohol consumption; smoking; obesity
- Early S&S: none – why self breast exam & mammograms are important
- S&S: changes in color of breast, shape/contour of breast, lump in breast in one, changes in nipple-discharge, retraction, inverted, tenderness
- Dx: mammograms, needle aspiration, biopsy
- Tx: mastectomy, chemo, radiation, hormonal therapy
invasive breast cancers
bladder drops into the vagina
cystocele
rectum sags/bulges into the vagina
rectocele
small intestine bulges into the vagina
enterocele
uterus drops into the vagina
uterine prolapse
any organ that is herniated or protruding into or outside the vaginal canal affecting urination, defecation, sexual activity, and quality of life
- non-life threatening
- Risk factors: obesity; atrophy/weakening of pelvic floor; pregnancy/childbirth; hysterectomy; family Hx; increased abdominal pressure
- Tx: Kegels; hormone replacement therapy; diet & lifestyle modifications; pessaries devices; surgical interventions
pelvic organ prolapse
- small growth, usually benign
- results from infection, chronic inflammation, high levels of estrogen, or local congestion of cervical vasculature
- malignancy is higher in perimenopausal or postmenopausal women, common in middle age women and those who have bared children
- S&S: asymptomatic; abnormal vaginal bleeding after intercourse
- Appearance: endocervical = cherry red; closer to cervix = grayish white
- Dx: pap smear, US, hysteroscopy
- Tx: removal & biopsy
polyps
- benign tumor made up of composed smooth muscle & fibrous C.T., found in uterus
- slow-growing, vary in size
- highly evident during child-bearing years
- S&S: chronic pelvic pain; low back pain/sciatic; constipation/bloating; dysmenorrhea; dyspareunia; menorrhagia
- Predisposing factors: age, genetics/ethnicity, HTN, obesity, PCOS, diabetes
- Tx: hormone replacement, myomectomy, laser surgery, hysterectomy
uterine fibroid
- occurs more often than thought of as Bartholin glands are in the labia minora and produce lubrication during sexual arousal can be occluded and lead to infected abscess
- S&S: swollen, redness, painful, fluid-filled abscess on labia
- Dx: physical exam
- Tx: sitz bath, analgesics, antibiotics, I&D, word catheter placement
Bartholin cyst
most common endocrine syndrome in women
- cyst-like follicle within the ovary, interfering w/ ovarian function
- eggs never mature & no ovulation occurs
- multifaceted disorder – hyperandrogenemia; hyperinsulinemia; other issues (sleep apnea, obesity, elevated BP, etc.)
- most common cause for infertility
- Dx: hyperandrogenism, ovarian dysfunction
- Tx: contraceptive; antihyperglycemic drugs; ovulation agents; lifestyle changes
polycystic ovary syndrome (PCOS)
malignancy in uterine cervix and most common cause is HPV
- 3rd most frequently diagnosed cancer in women & most treatable cancers when detected early
- Risk factors: age of menarche; age of first intercourse; # of sexual partners; contraceptive use; unprotected sex; family Hx; smoking
- S&S: asymptomatic
- Dx: pap smear, colposcopy
- Tx: cryotherapy; cone biopsy; LEEP; hysterectomy; chemotherapy; radiation
- Preventive care: Gardasil vaccine
cervical cancer
abnormal growth of cells within uterine lining & high incidence of metastasis – the 4th most common cancer in women
- Risk factors: nulligravida; Hx; Hx of uterine fibroids; infertility; obesity; timing of menarche/menopause; diabetes; HTN; PCOS
- S&S: dyspareunia; back/pelvic pain; weight loss; change in GU/GI patterns; vaginal bleeding
- Dx: pelvic exams; transvaginal US; endometrial biopsy
- Tx: total hysterectomy; radiation; chemo
uterine/endometrial cancer
abnormal growth of ovarian cells occurring in women older than 63 & is the 5th most common cancer and deaths of women due to being undiagnosed & metastasizing
- develops slowly & advances before the women experiences symptoms
- Risk factors: age, genetics, Hx, infertility, nulligravida, timing of menarche/menopause, hormonal therapy, obesity
- S&S: pelvic/abdominal pain; urinary issues; increased abdominal size
- Dx: labs & US
- Tx: total hysterectomy, radiation, chemo
ovarian cancer
fertilization through 2nd week
- includes the zygotic & blastocyst stage
Pre Embryonic/Germinal Stage
End of 2nd week through 8th week
- not an embryo until week 2
Embryonic Stage
End of 8th week until birth
- full-term birth –> 37-40 weeks
Fetal Stage
outer layer that forms the CNS, senses, skin, and glands
ectoderm
middle layer that forms skeletal system, urinary, circulatory, and reproductive organs (heart is first organ to form)
mesoderm
inner layer that forms respiratory, digestive, and endocrine system (liver, pancreas)
endoderm
individual unit of heredity of all traits
- organized into long segments of DNA
- occupy a specific location on a chromosome
- determine a particular characteristic in an organism
gene
any change in gene structure
- can alter the amount of protein produced
mutation
specific genetic makeup of an individual
- internally coded inheritable info
- individual genetic blueprint
- what the gene itself looks like
genotype
observed, outward characteristics of an individual
- what you see on the outside (outward characteristics)
- what the gene does
phenotype
only 1 copy of gene to express the disorder – only 1 parent has to have the disorder
- i.e., achondroplasia, dwarfism, PKD, Huntington’s
autosomal dominant inheritance disorders
need 2 copies to express the disease – only need 1 copy to carry disease but both parents have to have the disease or be carriers
- i.e., sickle cell disease, cystic fibrosis
autosomal recessive inheritance disorders
genetic disorder that affects X chromosome, since males only have 1-X, they have less chance of having compared to female who has 2-X chromosomes
X-linked inherited disorders
both X’s need to be altered for the female, male needs 1-X to be altered
- i.e., color blindness, hemophilia
X-linked recessive inheritance
RARE, male must have abnormal X and female must have abnormal X – both sons and daughter of mom affected w/ chromosome has 50/50 chance of getting since she is carrier, males are affected more severely since they only have 1-X
- i.e., fragile X syndrome (developmental & cognitive delay)
X-linked dominant inheritance
signs that the mother can perceive
- most obvious sign: absence of menstruation
- LEAST reliable indicator as any one of the signs can be caused by conditions other than pregnancy
- fatigue (12 weeks); breast tenderness (3-4 weeks); N/V (4-14 weeks); amenorrhea (4 weeks); urinary frequency (6-12 weeks); hyperpigmentation (16 weeks); fetal movements–quickening; breast enlargement (6 weeks)
presumptive signs
signs that can be detected on physical exam by a healthcare provider
- Braxton Hicks contractions (16-28 weeks); positive pregnancy test (4-12 weeks); abdominal enlargement (14 weeks); ballottement (16-28 weeks); Goodell sign –softening of cervix (5 weeks); Chadwick sign –bluish-purplish vaginal mucosa & cervix(6-8 weeks); Hegar sign –softening of lower uterine segment (6-12 weeks); uterine enlargement (7-12 weeks)
probable signs
signs are a confirmation that a fetus is growing in the uterus
- US verification of embryo or fetus (4-6 weeks); fetal movement felt by experienced clinician (20 weeks); auscultation of fetal heart tones via doppler (10-12 weeks)
positive signs
each trimester is ______ weeks
13 weeks
identifies gestational diabetes, UTI
urinalysis (UA)
identifies anemia, infection, hypercoagulation
CBC
identifies blood compatibility & transfusion
blood typing/RH factor
assesses immunity
rubella titer & Hep-B surface antigen
STI poses risk on fetus, important to identify
HIV, VDRL, RPR testing (STI screening)
identifies pregnancy complications
US
identifies structural abnormalities, umbilical cord
doppler flow studies
indicates chromosomal disorder, if high level than nuchal translucency is ordered
alpha-fetoprotein analysis
indicates chromosomal disorder in 1st trimester
nuchal translucency screening
performed in 2nd trimester to assess amniotic fluid, lots of risks
amniocentesis
looking at chorionic villi from placenta and test for chromosomal disorders, lots of risks
chorionic villus sampling (CVS)
HR patterns and response to fetal movement; assess well-being of the fetus, education/steps
nonstress test
fetal movement, fetal tone, fetal breathing, amniotic fluid, nonstress (NST) findings
biophysical profile
- weight, VS, UA, fundal height, heart tones
- US to assess for malformations or number of fetuses
- AFP @ 12-18 weeks
- gestational diabetes screening @ 28 weeks
- assess fetal movements
- receive Rhogam if she is RH-
- Education –> know what to report to Dr
until 28 weeks [1 visit every 4 weeks]
- weight, VS, UA, fundal height, heart tones
- US @ 34 weeks to assess fetal size & placenta
- GBS swab @ 36 weeks
- assess fetal movements & educate them to monitor
- Education –> birth plan
28-36 weeks [1 visit every 2-3 weeks]
- weight, VS, UA, fundal height, heart tones
- GBS test if not done already
- assess fetal position
- monitor fetal kick count
- discuss infant car safety
- Education –> labor process, gestational HTN, preeclampsia
36 weeks and up [1 visit/week until delivery]
- increase in size, weight, length, width, depth, volume, and overall capacity
- enhanced uterine contractility (Braxton Hicks)
- positive Hegar’s sign
- pear shape to oval shape
uterus changes
maternal vena cava compression
- reduces venous return, decrease CO, and decrease BP
- results in feeling weak, dizzy, syncope
- Intervention: left lateral side position
supine hypotension syndrome
- softening cervix (Goodell sign)
- mucus plug (protection from infection)
- increased vascularization (Chadwick’s sign)
cervical & vaginal changes
- enlargement
- cessation of ovulation
ovary changes
- increase in size & nodularity to prepare for lactation
- increase in nipple size (more erect & pigmented)
- production of colostrum
breast changes
- heartburn/GERD
- Gums: hyperemic, swollen, & friable
- ptyalism (excess alvia)
- dental problems – encourage visits
- decreased peristalsis & smooth muscle relaxation [constipation]
- hemorrhoids
GI changes
- dilation of renal pelvis, elongation, widening, and increase in curve of ureters – increased urinary stasis – risk of UTI
- increase in GFR; increased urine flow & volume
renal changes
- increase in blood volume, CO, and HR –> can lead to hemodilution
- slight decline in BP until mid pregnancy, then returning to pre-pregnancy levels
- body has increased risk of blood coagulation (DVT prevention education)
cardiovascular changes
- breathing is more diaphragmatic than abdominal
- increase in oxygen consumption
- congestion secondary to increased vascularity
respiratory changes
- ligament relaxation from relaxin leads to changes in posture & gait
- lordosis, waddle gait
musculoskeletal changes
- hyperpigmentation (facial Melasma)
- linea nigra
- striae gravidarum [stretch marks]
- varicosities
- palmar erythema
- decline in hair growth; increase in nail growth
integumentary changes
- thyroid gland: slight enlargement, increased activity, increased BMR
- pituitary gland: enlargement, decreased in TSH & GH, inhibition of FSH & LH, increased in prolactin, gradual increase in oxytocin w/ fetal maturation
- pancreas: baby must make own insulin, gets glucose from mother
- adrenal glands: increase in cortisol & aldosterone secretion
- prostaglandin secretion
- placental secretion: hCG, relaxin, progesterone, estrogen
endocrine changes
- defends from antigens
- innate immunity
- suppression of adaptive immunity
- inflammatory responses
immune changes
begins when woman discovers pregnancy (happy, scared, nervous, excited)
ambivalence
mother becomes more focused on herself to support the fetus
introversion
mother accepts changes
- typically around the 2nd trimester
acceptance
highs & lows in mood
- can be hard on partner
mood swings
ensure mother feels support and loved
changes in body image
Naegele Rule
- use first day of LMP
- subtract 3 months
- add 7 days
- add 1 year
- urinary frequency or incontinence [encourage Kegels]
- fatigue [encourage short naps]
- N/V [small, frequent meals]
- breast tenderness
- constipation [increase fiber]
- nasal stuffiness
- bleeding gums [good hygiene]
- epistaxis [humidified air]
- cravings
- leukorrhea
first-trimester discomforts
- backache [warm heating pad, supportive shoes]
- varicosities of the vulva & legs
- hemorrhoids [avoid straining, warm sitz bath]
- flatulence w/ bloating
second trimester discomforts
- return of first-semester discomforts
- SOB & dyspnea [avoid large meals]
- heartburn & indigestion [limit spicy foods, eating smaller meals]
- dependent edema [avoid sodium & drink fluids]
- Braxton Hicks contractions [occurs w/ dehydration, increase water intake; resting on left lateral side]
third-trimester discomforts
- HepB
- Flu shot
- TDap
- Rabies
safe vaccines
- Flu nasal spray
- Varicella
- Rubella
- TB
- Typhoid
contraindicated vaccines
