OB Test 4 Flashcards
onset of labor before 37 weeks (uterine contractions and cervical changes that occur between 20 and 37 weeks
preterm labor
gestational age at birth <37 weeks
preterm birth
born after 20wks: before 37 wks
preterm/preterm infant
diagnosing preterm labor
gestational age >20 wks and <37 weeks
documented regular uterine contractions of >6/hr and at least one of the following:
rupture of membranes
cervical change (cervix > 1 cm dilated or 80% effaced
management of ______ labor is focused on _______ uterine contractions
preterm; stopping
medications used to suppress uterine contractions in preterm labor
tocolytic drugs
what are the 4 tocolytic drugs
magnesium sulfate
prostaglandin synthesis inhibitors
calcium channel blockers
beta adrenergic agonists
what is the antidote for magnesium sulfate toxicity
calcium gluconate
what are S/S or magnesium sulfate toxicity
absent DTRs resp <12 severe hypotension decreased LOC pulmonary edema chest pain urine output <30ml/hr
when should you not give prostaglandin synthesis *indomethacin
don’t give after 32 wks of pregnancy because it closes the PDA and we don’t want this done in utero
also DO NOT use longer than 48 hours
when should calcium channel blockers (Nifedapine, Nicardipine) NOT be used
should not be admin with magnesium sulfate or terbutaline
*hold dose for BP <90/50 or HR >120
what is given to stop contractions if baby is not looking good on the fetal monitor
beta adrenergic agonistist (terbutaline)
*monitor maternal HR and hold for HR >120
mechanical defect in cervix; results in painless cervical dilation in second trimester; can progress to bulging of membranes into vagina and premature delivery
incompetent cervix
for pets who have incompetent cervix what can be done
cerclage= purse string suture placed submucosally around the cervix to reinforce, strengthen and prevent cervical dilation
one chorion (one placenta)
monochorionic
two chorions (two placenta)
dichorionic
share same amniotic sac
monoamniotic
what is the problem with twins have monochorionic with 2 cords coming out (one placenta)
donor twin becomes anemic and small, recipient twin becomes bigger and may have cardiac problems because getting too much fluid
when babies are monochorionic and mono amniotic the cords can get
tangled and have a mortality rate that is high from twin to twin transfusion and tangling of cords
vomiting during pregnancy so severe it leads to dehydration, electrolyte and acid base imbalance, starvation ketosis, and weight loss; prolonged past 12 weeks gestation
hyperemesis gravidarum
abstaining form sexual intercourse
natural family planning abstinence
withdrawal of penis prior to ejaculation
coitus interruptus- withdrawal
what is important to teach pt about withdrawal method
be aware of fluid leaking form penis
*good choice for MONOGAMOUS couple with religious conviction
method that requires exclusive breastfeeding
lactational amenorrhea
what is important to teach pt about lactational amenorrhea
effectiveness is enhanced by frequent feedings or use of barrier method
disruption of breastfeeding or supplementation increases risk of pregnancy
need an alternate method if stopped breastfeeding, supplementing, menses returns, or if infant is 6 months
what is the disadvantage of lactational amenorrhea
the 1st ovulation is unpredictable
requires awareness of menstrual cycle
fertility awareness- based methods
what are the disadvantages of fertility awareness- based methods
not ideal for irregular periods, breastfeeding, and perimenopause
what are the fertility awareness methods
calendar method
basal body temp
cervical mucus
lactational amenorrhea
record cycles, calculate ovulation 14 days prior to cycle, avoid intercourse during fertile time
calendar method
what is important to teach pt about the calendar method
record number of day for each menstrual cycle starting on 1st day for 6 cycles
fertile period= subtract 18 from shortest and 11 from longest cycle
*avoid intercourse during this time
measure oral temp daily, to identify a slight temp DROP which occurs at ovulation
basal body temp
what is important to teach pt about basal body temp
measure oral temp each morning prior to getting out of bed
what are the disadvantages of basal body temp
reliability is affected by stress, fatigue, illness, environmental temperature
spinnbarkeit sigh- cervical mucus becomes thin, flexible and stretch between fingers at ovulation
cervical mucus
what is important to teach pt about cervical mucus contraception
hand hygiene
obtain and examine mucus for thinning characteristics from vaginal introitus
what are complications of cervical mucus examination
inaccurate intercourse when mucus is mixed with blood, semen, contraceptive foam, and discharge
*avoid intercourse when mucus is scratchy and egg white consistency
sheet covering worn over penis during intercourse, prevents sperms form entering uterus
male condom
what is important pt teaching about the male condom
place condom on erect penis, leaving empty space at tip for semen
after ejaculation, rim of condom is held to prevent spillage
heat accelerates deterioration, breaks
sheet inserted into the vagina prior to intercourse, prevents sperm from entering uterus
female condom
what is important pt teaching for female condom
insert condom gently pushing toward the back of vagina, making sure the inner ring fits over cervix and outer ring rest over vaginal opening
chemical gel, foam, cream or suppository inserted vaginally prior to intercourse to destroy sperm
spermicidal agents
what is important pt teaching of spermicidal agents
must be reapplied for multiple acts
inserted prior to intercourse
latex/silicone dome fitting over the cervix
diaphragm
what is important pt teaching about the diaphragm
refitting every 2 years, after childbirth, or 20% gain or loss of weight
insert with spermicide cream applied to rim and cervical side
must remain in place for 6 hours before removal
can remain in place for 24hrs for multiple acts
*reapply spermicide and wash with soap and water after use
soft, thimble shaped silicone or latex cup which fits snugly over the cervix
cervical cap
what is important pt teaching of cervical cap
coat inside of cap with spermicide
can keep in for 24hours
requires a prescription
refit every 2 years, after childbirth, weight gain or loss
must be left in for 6 hours after intercourse
clean with soap and water after each use
pillow shaped, soft, absorbent cup shaped sponge which fits over the cervix containing spermicide
vaginal sponge
what is important pt teaching about vaginal sponge
moistened with water and inserted vaginally
must remain in place for 6 hours after intercourse and can stay in up to 24 hours
*only good for one time use but can be used for multiple acts in 24hours
what is one of the complications of the vaginal sponge
absorbs vaginal secretions leading to vaginal dryness
estrogen and progestin- suppresses ovulation, thicken cervical mucus, alters uterine lining to prevent implantation
combined oral contraceptives
what are side effects of oral contraceptives
nausea, headache, spotting, weight gain, breast tenderness
who should avoid combined oral contraceptives
pt with history of blood clot, stroke, heart disease and cancer
progestin ONLY- suppresses ovulaiton, thickens cervical mucus, alters uterine lining to prevent implantation
minipill
what is important pt teaching about the minipill
one pill same time daily
missed dose requires alternate type of birth control
which oral contraceptive will docs prescribe to breastfeeding moms
minipill
subcutaneous continuous delivery of progesterone and ethinyl estradiol
transdermal contraceptive patch
what is important pt teaching of transdermal contraceptive patch
prescription apply patch for 3 wks to buttock, abd, upper arm or torso and remove on the 4th wk
- less effective on larger women
- avoids liver metabolism and not absorbed in GI tract
intramuscular injection of progestin given every 11-13wks. LONG term birth control >2years
depo-provera
what is important pt teaching of depo-provera
1st dose given during first 5 days of menstrual cycle
if postpartum, bottle feeding first 5 days/breastfeeding 6th week
*keep follow up appointments
*maintain adequate calcium and vit D for bone health
what is the disadvantage of the depo- provera injection
decreased bone density
*once the injections are stopped, bone density returns to normal
flexible soft vaginal ring filled with a low dose of combined hormones which are released continuously
nuvaring
what is important pt teaching of the nuvaring
requires a prescription
keep in refrigerator until use
-insert for 3 wks then remove for one week
if ring falls out must use alternate protection for one week
*ring does not need to be fitted
morning after pill high dose of estrogen and progestin that prevents fertilization
emergency oral contraceptive
what is important teaching of Plan B
take within 72 hrs of unprotected sex
not used regularly for birth control
older than 17 can purchase over the counter
*does not terminate an already established pregnancy
minor surgical implantation of a single hormone filled rod to the upper arm
implanon
what are the advantages of the implanon
continuous long acting contraception for 3 years
it is reversible
can be used if lactating once breastfeeding established for 4 wks
what is the disadvantage of implanon
removal required
chemical or hormone active device which is inserted into uterus, damages sperm, and prevents fertilixation
intrauterine device
what is important pt teaching of intrauterine device
inserted by provider in office
check device presence monthly after each menstrual cycle
safe for breastfeeding mothers
*COPPER IUD- emergency contraceptive if placed within 5 days of intercourse
metallic implant placed in fallopian tubes resulting in scar tissue, blocking the tunes to prevent conception
transcervical implant essure
what is important pt teaching of essure
office procedure wit quick return to normal activities
exam in 3 most following to ensure fallopian tubes are blocked
(use protection until confirmed)
*not reversible
fallopian tubes are surgically cut, tied, burned and blocked to prevent conception
bil tubal ligation salpingectomy
what is important pt teaching about tubal ligation
surgical procedure with anesthesia
*permanent sterilization
sexual function is unaffected
vas deferens is surgically severed and ligated under local anesthesia
vasectomy (male sterilization)
what is important teaching of a vasectomy
surgical office procedure
alternate birth control until confirmed with 2 negative sperm counts
considered irreversible
*sexual function not impaired
