OB Exam 1 Flashcards
When do you auscultate the FHR in order to assess fetal response to contraction
Assess FHR during the contraction & 30 seconds after the contraction
The #1 indicator of fetal well-being
FHR variability
This medication causes the uterus to contract a lot
Pitocin
Accelerations and early decelerations do not need interventions, but what are interventions used for late or variable decelerations…
Reposition patient many times Give O2 (8-10L/min) Give fluids (NS)
What is the neumonic VEAL:CHOP
Variable decelerations means that there is cord compression
Early decelerations means that there is head compression
Accelerations means that the baby’s overall well being is good and they are well oxygenated
Late decelerations means that there is placental insufficiency and they do not have oxygen
When are contraction stress tests used.. (stress tests look for decelerations)
No earlier than 36 weeks
Bacterial STIs that are all treated with antibiotics on initial diagnosis, usually a broad spectrum antibiotic
Chlamydia Gonorrhea PID Syphilis Chancroid Lypmhogranuloma venereum Genital mycoplasmas
This bacterial STI is often asymptomatic (women) and men can have a drip
It causes PID, ectopic pregnancies, and infertility
It can cause infant eye infections and pneumonia
Treated with ANTIBIOTICS
Transmitted by vaginal, anal, oral sex, and child birth
Chlamydia
This bacterial STI if often asymptomatic (women) and men have a drip, purulent (pus-like) urethral discharge, and dysuria (painful or difficult urination)
To test it they do a culture under anaerobic conditions
Treated with ANTIBIOTICS (some types are resistant to penicillin) – abstinence until treatment comp
UP TO 40% OF PEOPLE WILL DEVELOP PID IF UNTREATED
Newborns can develop opthalmia neonatorum
Often coexists with chlamydia
Transmitted by vaginal, anal, oral sex, and child birth
Gonorrhea
Can occur from Gonorrhea or Chlamydia
Increases risk for ectopic pregnancy, infertility, pelvic adhesion’s, pain
Treatment includes ANTIBIOTICS, bed rest in semi fowlers (HOB up 30-45 degrees to allow gravity to help)
Be careful to watch for patient’s using IUDs to make sure they are not getting these because it could lead to not being able to have children
Pelvic Inflammatory Disease
Bacterial STI that has 3 stages of symptoms
Transmitted by sexual contact with an infected person
Treatment is ANTIBIOTICS (penicillin)
Testing consists of Non-Treponemal Screenings
Congenital types occur when it crosses over into the placenta and can cause snuffles and Hutchinson’s teeth
Syphilis
Stage 1 or primary Syphilis consists of..
Chancres (ulcers/sores)
Stage 2 or secondary Syphilis consists of..
Maculopapular rash on palms and soles of feet
Condyloma lata which looks like small white blisters everywhere
Stage 3 or tertiary Syphilis consists of..
After being latent for a while the symptoms whill reoccur as neurologic, musculoskeletal, or cardiovascular damage
Multi organ complications
Usually not reversible at this stage
Viral infections, these are treatable but cannot be completely eradicated by medication like antibiotics can do for bacterial infections
These can become latent or inactive in the body
HPV --warts Herpes simplex virus I & II Hepatitis HIV & AIDS
The most common viral STD in the US
Up to 50% or more of women are affected
50+ strains: 5 cause warts, 8 are associated with cervical and other cancers, 2 can cause laryngeal papillomas in infants and children
Having multiple sex partner greatly increases your risk
HPV
This viral STD has the appearance of single or multiple soft, fleshy, papillary or sessile painless keratinized (material of nails) growth around the vulvovaginal area: penis/vagina, anus, urethra, or perineum. It usually cannot be seen
HPV
A precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix, often seen with HPV, Usually a leep procedure is done to freeze it and remove it, but this decreased the chance of having a baby full term by 60% so they wait to see if it will go away on its own
Cervical dysplasia
Treatments/risk reduction for HPV
Treatment: acid, freeze, topical medicines, biopsies/cones
Women should get an annual pap smear
Quit smoking to reduce the risk of HPV and neoplasia (new abnormal growths)
Condoms wont completely protect because they dont cover all areas that could become infected
Type of HPV that may grow during pregnancy
Vaginal delivery is OK
But dont use podofilox topical (Condylox) during pregnancy
Warts
What are the instructions for the HPV vaccination Guardasil
Its a series of 3 shots from the ages of 9-26
It helps against 4 types: 2 cause warts, 2 high risk for cervical cancers
This infection occurs as single or multiple small clear vesicles that may be very PAINFUL
The vesicles may blend to form tender, ulcerated lesions
This infection never truly goes away
It can cause loss of pregnancy and preterm delivery
If the mother has primary lesions then the infant MUST be delivered cesarean and there is a 33-50% chance it will be passes on to the baby, but the baby can be delivered vaginally if the mom is put on an antiobiotic 6 weeks before pregnancy
Herpes simplex virus (HSV)
Treatment for herpes simplex virus
Zovirax (acyclovir)
Valtrex (valacyclovir)
How is hepatitis A trasmitted
By fecal-oral route
What are precautions to take for Hep A
Clean water, handwashing, thorough cooking especially seafood, avoid anal/oral intercourse
What vaccine is available for Hep A
Havrix
How is hepatitis B transmitted and what are precautions
Blood, semen, saliva, vaginal secretions and you use universal precautions
When does vaccination for hep B occur
In all babies at 1 day, 1 month, and 6 months
This hepatitis occurs with B
Hepatitis D
This hepatitis transmits the same as B and is associated with hepatic cancers
Hepatitis C
This hepatitis is enteric and transmits the same as A
Hepatitis E
This hepatitis is associated with Hep C (which transmits the same as B - blood)
Hepatitis G
How is HIV transmitted
Blood, semen, vaginal secretions, breast milk, and can be from an infected mother to her baby by vertical transmission (but it is still possible to do a vaginal delivery)
Condom use is emphasized and spermicides actually increase rate of transmission
What is HAART is relation to HIV
Highly Active Antiretroviral Therapy: a therapy that works to delay the onset of AIDS but it will not prevent AIDS. Unpleasant side effects such as nausea and diarrhea are common
Treatment for HIV that prevents up to 2/3 transmission to infants
Zidovudine
4 groups at high risk for HIV/AIDS
History of IV drug use (blood transfusion between 1978-85)
Born/live in areas with high rate of infection
Diagnosed with another STD
History of multiple sex partners/prostitutes
A protozoan that is sexually transmitted that appears to have caused a vaginal pH greater than 4.5
Has yellow - green frothy discharge, vulvovaginal burning, pruitis, dysuria (pain/difficult urination), urgency, frequency, dyspareunia (pain/difficult intercourse), post coital spotting, lower ab pain, or could even be asymptomatic
Trichomonas vaginalis
Commonly “a trichy chick has a strawberry cervix” means..
With trichomoas vaginalis there is usually petechiae on the cervix
Treatment for trichomonas vaginalis
Metronidazole (Flagyl)
Sex partners should be treated as well
There is no treatment allowed during the first trimester because there is an antabuse effect
This vaginal infection is not sexually transmitted and usually follows antibiotics, the infection thrives on heat, moisture, and sugar causing yeast to grow
This includes candidiasis, moniliasis, thrush, and yeast
Candida (monilia) vaginitis
Risk factors for Candida (monilia) vaginitis [candidiasis, moniliasis, thrush, yeast]
Pregnant Diabetic Systemic antibiotics Obese High amounts of sugar HIV/immunocompromised
Symptoms of candida (monilia) vaginitis [candidiasis, moniliasis, thrush, yeast]
Vaginal pH less than 4.5 CURDY WHITE DISCHARGE Itching Dysuria Dyspareunia
A systemic drug such as Fluconazole, or Clotrimazole, or Terconazole, and also Mycostatin-Nystatin are treatments for..
Candidiasis (the -azoles)
This is not considered an STI
Has a fishy odor, gray white milky discharge, and itching
The vaginal pH will be greater than 4.5
It can cause pelvic and intrauterine infections
This will have clue cells under the microscope
Bacterial Vaginosis
What is the treatment for Bacterial Vaginosis (BV)
Pregnant women will get Clindamycin,
not pregnant women can use Flagyl
This is common, approx 23% of pregnant will get it. There is a prenatal screening routine during the 3rd trimester and if found it will be treated with antibiotics during labor.
But it can cause maternal infection leading to premature labor (PTL) or a premature rupture of membranes (PROM) leading to fetal infection or death
Group Strep B
What is a TORCH infection
Toxoplasmosis (fungal infection) Other infection such as hepatitis Rubella Cytomegalovirus Herpes simplex
Caused by protozoan transmitted via raw meat, unpasteurized goat milk, and cat feces
–this is why women should not change litter boxes when pregnant
Toxoplasmosis (fungal infection)
Causes 74% congenital anomalies if pt has in first 4 months of pregnancy, but the vaccine is a live attenuated virus so it cannot be given during pregnancy
Rubella
This is severe and can be fatal if developed during pregnancy. The first trimester is associated with congenital anomalies such as limb or skin scarring, Horners syndrome which is paralysis of facial nerves, and also low birth weight LBW
Varicella (chicken pox)
–Varicella zoster immunoglobulin (VZIG) is administered to protect fetus
There is no treatment for this, if developed when pregnant the baby can develop CNS abnormalities
Cytomegalovirus (CMV)
Infections that occur with a pH greater than 4.5
Bacterial vaginosis
Trichomonas (protozoan)
Infections that occur with a pH less than 4.5
Candidiasis/thrush/yeast/vaginitis
Risks associated with male condoms
Latex allergy
Benefits of female condoms
Controlled by the woman
Eliminates post coital drainage
Protects against STIs
Risks/cons of female condoms
Allergy of polyurethane
Noisy during sex
Expensive for frequent use
Risks/cons of a diaphragm with spermicide
Does not protect against STIs: spermicide actually increases risk of STI transmission
Must be inserted 6-8 hours before sex (could be a benefit)
Requires fitting by healthcare provider
Allergy to latex, polyurethane, rubber, or spermicide
May have symptoms of toxic shock
May become dislodged in female
Benefits of diaphragm with spermicide
Does not use hormones
May protect a little against cervical cancers
Benefits of a cervical cap with spermicide
Provides continuous protection for 48 hours
No use of hormones
Risks/cons of a cervical cap spermicide
No STI protection Wait 30 minutes after insertion to have sex Wait 6 hours to remove it after sex Irritation may occur Allergic reactions Have an abnormal pap test Risk of toxic shock syndrome Requires fitting Odor may occur if left in too long
Benefits of a sponge with spermicide
Offers immediate and continuous protection for 24 hours
Risk/cons of a sponge with spermicide
Cannot left in for more than 24 hours
No STI protection
Can fall out of vagina with voiding, its not form fitting in the vagina
Watch for irritation, allergies, and toxic shock if left in too long
Benefits of oral contraceptives
Pill form so its easy to use against pregnancy
Estrogen forms: protect against ovarian and endometrial cancers
Progestin only forms: no estrogen side effects, may be used by lactating women, and women with a history of thrombophlebitis
Risks/cons of oral contraceptives
No STI protection, taken daily
Combination forms: dizziness, nausea, mood changes, high blood pressure, blood clots, heart attacks, stroke
Progestin only forms: must be taken at the same time every day, less effective than combination and may cause irregular bleeding, weight gain, increased incidence of ectopic pregnancy, should be screened for ovarian cysts, previous ectopic pregnancy, and hyperlipidemia
Benefits of patch (ortho evra)
Releases estrogen & progestin into circulation just as combination OC
Easy system to remember, apply a new patch each week, very effective like OC
Risks/cons of patch (ortho evra)
No STI protection
Less effective in women weighing more than 200 lbs
May cause skin irritation where its placed
May fall off without notice and provide no protection
Benefits of NuvaRing
Easy and effective like OC, ring inserted and releases estrogen and progestin
Risks/cons of NuvaRing
May cause a vaginal discharge and may fall out without noticing not offering protection
Danger signs are similar to OC
Back up plan to be used if ring falls out
Benefits of a Depo Provera Injection
Injectable progestin
Highly effective
Lasts 3 months
Estrogen free: can be used by smokers, and lactating women
Risks/cons of a Depo Provera Injection
May worsen depression Menstrual irregularities Dr visits every 12 weeks Weight gain and headaches Wont be fertile for 12 months after discontinuing
Benefits of an implant (Implanon)
Very effective, releases levonorgestrel for 3 years
Low dose of hormones and estrogen free
Reversible
Risks/cons of an implant (Implanon)
Will be infertile for 3-5 years Irregular bleeding Breast tenderness Headaches and weight gain Difficult to remove
Benefits of IUC/IUDs
Immediate and highly effective
Allows for spontaneity
Can be used during lactation
Periods are lighter, shorter, and less painful
Risks/cons of IUC/IUDs
Return to fertility takes possibly 6-12 months
Requires fitting and placement
Menstrual irregularities
Prolonged amenorrhea
Can be unknowingly expelled
Increased risk of PELVIC INFECTION (PID) causing infertility
Perforation of the uterus, cramps and bleeding are danger signs
Must regularly check placement of string monthly
Risks/cons of emergency contraceptives
Risk of ectopic (attachment of the embryo outside the uterus) pregnancy if EC fails
Nausea, vomiting, abdominal pain, fatigue, headache
Signs & symptoms of endometriosis
INFERTILITY Pain before and during menstrual periods Pain during or after sex Painful urination Depression Fatigue Painful bowel movements PELVIC PAIN Hypermenorrhea or heavy menses Pelvic adhesions Irregular or frequent menses Premenstrual vaginal spotting
How is endometriosis diagnosed
Usual finding is pelvic tenderness and nodular massess
An ultra sound will assess pelvic organ structures
Laproscopy is used to make a definitive diagnosis
Treatment for endometriosis
Healthy diet, exercise, sleep, and stress levels
Surgery or medications such as OC, Depo-Provera to suppress hormonal response, antiestrogens that decrease levels of estrogen that cause endometrium to grow
The order that secondary sex characteristics develop
Brest buds –> pubic hair –> growth spurt –> menarche
When the inner lining of the uterus (endometrium) is expelled from the body
Menstruation
Events that occur when going through menopause
Brain: hot flashes, disturbed sleep, mood and memory problems
Skeletal: loss of bone density, osteoporosis risk
Breasts: fat replaces duct and glandular tissues
Genitourinary: vaginal dryness, stress incontinence
Gastrointestinal: less absorption of calcium also associated with osteoporosis and fractures
Integumentary: dry and thin skin
Body shape: increased abdominal fat
Ways to manage vaginal dryness, dyspareunia, and vaginal atrophy during menopause
Increase estrogen levels, estrogen releasing vaginal ring lasting months, lubricants, moisturizers
Ways to manage/prevent osteoporosis during menopause
Daily weight bearing exercise
Avoid smoking and alcohol
Increase calcium and vitamin D
What is Naegel’s rule on EDD (estimated date of delivery)
From the first day of the last period
- subtract 3 months
- add 1 week
- add 1 year
What is GTPAL
G=gravida (any pregnancies at all) T=term (40 weeks +/- 2 weeks) (37 weeks and 6 days is preterm) (42 weeks and 1 day is post term) P=preterm A=abortion (delivery before 20 weeks) L=living children
