OB: Test One Flashcards
The rounded, uppermost portion of the uterus that extends above the points of attachment of the Fallopian tubes =
Fundus
Where is the site for implantation?
Endometrial lining
What do we measure during pregnancy to see where the baby is?
Fundal height
At what week is the fundus located at the umbilicus?
20 weeks
What is the funnel-like enlargement with many finger-like projections reaching out to the ovary (which try to pick up the eggs)?
fimbria (the projections that pick up the eggs are the fimbriae).
What part to we palpate to get contractions?
the fundus.
What is the innermost layer of the uterine corpus called?
The endometrium.
From menarche to menopause, the _____ undergoes monthly renewal and degeneration in the absence of pregnancy.
endometrium
The distal end of the uterus that opens up to connect with the vagina =
cervix.
What are the two hormones the ovaries are responsible for?
Estrogen and progesterone.
The bone that protects organs behind it formed from two pubic bones =
symphysis pubis
We want implantation high up in the endometrial lining because if it happens low, this condition can occur =
Placenta previa (the placenta is improperly implanted in the lower uterine segment which causes the placenta to be torn from the uterine wall=bleeding).
What do you do if a woman is in labor and she feels like she has to poop and asks you to go to the restroom?
Have to be careful because that is what it can feel like right before the baby comes out.
Where is GnRH (Gonadotropin-releasing hormone) secreted from?
hypothalamus
What does GnRH do?
tells the anterior pituitary to secrete FSH and LH
How long does the average menstrual cycle last?
28 days +/- 7 days
Hormone primarily responsible for the maturation of the ovarian follicle to mature into a Graafian follicle =
FSH
As the Graafian follicle matures, the more ___ is produced
estrogen
When estrogen levels are high ___, ____ levels are low.
FSH
Once estrogen gets to a certain level, there is a surge of ____secreted by the anterior pituitary.
LH
Where is the site where the ruptured follicle pops out of the ovary midway through the menstrual cycle?
corpus luteum
When does estrogen peak?
just before ovulation
What are some basic functions of estrogen?
- Contractility in uterus/fallopian tubes
- Tissue building: breast tissue, uterus, skin tone & reproductive tone, body hair, widening of hips
- Inhibit FSH production & stimulate LH production
- secreted by Graafian follicle
- in synergy with FSH, promote growth/development of primary follicle
- produces physical characteristics of mature follicle
- helps prepare endometrium for implantation through proliferation
Estrogens inhibit ___ production and stimulate ___ production.
FSH; LH
Go over hormone levels of reproductive cycle…
p 206
Ovulation occurs ____ after LH surge
10-12 hours
FSH and LH are secreted from the ____
ant. pituitary
What hormone completes maturation of the ovarian follicle?
LH
What hormone is responsible for the increase in secretion of progesterone?
LH
Which hormone is responsible for the maturation of the Graafian follicle which secretes increasing amount of estrogen?
FSH
What hormone prepares the uterus for pregnancy by promoting secretory endometrial cells?
Progesterone
Where is progesterone secreted from?
corpus luteum
What is the “hormone of pregnancy” and why?
Progesterone; inhibits uterine contraction to prevent abortion of embryo; also allows vaginal epithelium to proliferate and thus the cervix secretes thick, viscous mucus
What happens when the corpus luteum degenerates?
it drops estrogen and progesterone, and causes ischemia of the vessels=bleeding=menstrual period starts over again
When does ovulation occur?
14 days before she starts her period (day 14 of 28 day cycle, day 16 of 30, etc.)
Explain the 3 phases of the ovarian cycle:
1) Follicular Phase (days 1-14): Low level of estrogen signal hypothalamus to secrete GnRH, which stimulates ant. pit. to produce FSH; FSH stimulates follicle to mature; one follicle becomes dominant (graafian follicle); Cells surrounding follicle secrete estrogen; endometrium becomes thick; Anterior pituitary release surge of Lifehouse to complete maturation of follicle
2) Ovulation: Graafian follicle ruptures out of ovary about 12-24 hours after LH surge
3) Luteal Phase: day 14-28: Ovum leaves follicle; development of corpus luteum where the ovum ruptured; With pregnancy, the CL increases in size and produces progesterone; prog. causes endometrium to mature for possible implantation; If pregnancy occurs, hCG (from embryo) will maintain the CL.
Signs of ovulation:
Mittelschmerz (cramp that occurs when ovulation occurs); Midcycle spotting; Increase in body temp (.5-1 degree) under influence of progesterone; change in vaginal (cervical discharge)–becomes “favorable”=lots of it, thin/clear, sperm easily attach
Describe 4 phases of endometrial cycle:
1) Menstrual Phase: day 1-6: endometrium sloughs off uterine wall
2) Proliferative Phase: day 6-14: at end of menstruation, endometrium is thin/ischemic; within 2nd week, estrogen increases and endometrium thickens; cells undergo proliferative growth; predominant hormone is estrogen
3) Secretory Phase: Begins day 14: under influence of estrogen and progesterone, the endometrial glands grow; blood supply increases–allows for nutritive layer if conception occurs; Progesterone is predominant hormone
4) Ischemic Phase: If fertilization doesn’t occur, function of corpus luteum wanes and estrogen/progesterone levels drop; lining of endometrium becomes ischemic/cells degenerate causing rupture and endometrium sloughs off uterine wall.
What is the dominant hormone in the proliferative phase of the endometrial cycle?
Estrogen
What is the dominant hormone in the secretory phase of the endometrial cycle?
progesterone
What is the dominant hormone in the first half of the endometrial cycle?
estrogen
What is the dominant hormone in the second half of the endometrial cycle?
progesterone
When is sex determined for a baby?
at conception (but we can’t tell physically for a while)
How many pairs of chromosomes do we have?
23 (22 autosomes and one pair of sex chromosomes–XX in females, XY in males)
Process of cell division that results in daughter cells that are exact copies of the original cell =
Mitosis
5 Stages of Mitosis =
1) Interphase 2) Prophase 3) Metaphase 4) Anaphase 5) Telophase
What is the phase in Mitosis and Meiosis when DNA will double?
Interphase
Process of cell division that occurs in maturation process of ova and sperm (aka gametogenesis) =
Meiosis
This process decreases number of chromosomes from diploid (46) to haploid (23) =
Meiosis
This process allows random assortment of maternal and paternal chromosomes =
Meiosis
Oogenesis is a ____ division.
noncontinuous (begins in ovary during fetal life then stops until it re-begins in puberty).
The cell division process that results in 2 identical cells, each with the same # of chromosomes as the original cell =
Mitosis
What is the major function of estrogen during the female reproductive cycle?
a) Increases supply of glycogen and amino acids in the endometrium
b) decreases uterine and Fallopian tube contractility
c) Initiates the development of the germ layers
d) Enhances growth of the Graafian follicle
D
Development of the baby occurs in a ___ pattern.
Cephalocaudal (head to toe)
When does Organogenesis occur?
weeks 3-8
The outermost membrane surrounding the embryo, amnion, & yolk sac that developed from the trophoblast and develops into the placenta =
Chorion
The membrane developed from the ectoderm layer within the blastocyst that contains amniotic cavity, amniotic fluid, embryo, and yolk sac =
Amnion
The most critical stage of development for an unborn child occurs from the __ to ___ weeks.
3-8th
Term used for the endometrium during pregnancy =
decidua
“False labor”–irregular contractions of the uterus that occur intermittently during pregnancy =
Braxton Hicks contractions
Hegar’s sign =
softening of lower uterine segment which occurs at about 6-8 weeks of pregnancy
When do Braxton Hicks contractions usually occur?
4th month; about 20 weeks
The process of the baby settling or lowering into the pelvis before labor is called ______
Lightening
Chadwick’s sign=
blue-purple discoloration of the cervix
Goodell’s sign=
softening of the cervix (due to increased vascularization)
The thick mucus that accumulates and thickens sealing the endocervical canal and prevents ascent of bacteria or other substances into the uterus =
Mucous Plug
Normal vaginal discharge that is thin, white, non-odorous that is increased during pregnancy =
Leukorrhea
An anti-body rich, yellow secretion from the breasts developed after the 12th week and may leak from the breasts during the last trimester =
colostrum
Blood volume increases __% during pregnancy.
45%
What is the average blood loss for a vaginal delivery?
500 mL
What is the average blood loss for a C-section?
1000 mL!
When is HTN normal in pregnancy?
never
Progesterone causes ____ during the beginning of pregnancy which can cause the BP to ___, resulting in _____
vasodilation; drop; ortho hypo
What happens to the HR during pregnancy?
increase of about 10-15 bpm
What are some cardiovascular changes during pregnancy?
Increased HR (10-15bpm); heart enlarged d/t blood volume; diaphragm pushes heart up/left; Grade II systolic murmur (common and will go away once preg. is over); S1 & S2 splitting, S3 louder; Increase in development of varicose veins (b/c of high pressure in legs); physiologic anemia; Hypercoagulability state (inc. clotting factors); physiologic leukocytosis (inc. WBC’s)
When the enlarging uterus puts pressure on the vena cava when the woman is supine =
Vena caval syndrome (aka Supine Hypotensive syndrome)
What do you do for Vena Caval Syndrome?
after about 20 weeks, will not be able to lie supine for long periods anymore; Have to turn on left side
Why does physiologic anemia occur during pregnancy?
There is a plasma volume increase of about 50%. Because this increase is greater than the erythrocyte increase (30%), the hematocrit (which measures the portion of whole blood that is composed of erythrocytes) decreases slightly.
What is a normal Hematocrit (Hct)?
37-47%
What is a normal Hemoglobin (Hgb)?
12-16
What causes rhinitis of pregnancy?
The nasal stuffiness and congestion are not uncommon. Same with Epistaxis (nosebleeds). They are primarily the result of estrogen-induced edema and vascular congestion of the nasal mucosa.
What happens to the WBC count during pregnancy?
It can rise up to 20,000; probably due to stress; don’t do anything about it unless signs of infection.
What are some GI changes during pregnancy?
- Hemorrhoids
- Intestines and stomach displaced
- Swelling, softening, bleeding of gums
- Decreased gastric motility/delayed gastric emptying (constipation/heartburn)
- Decreased muscle tone around stomach and esophagus–GERD
- Decreased tone and distention of gallbladder
What are some renal system changes during pregnancy?
- Increased urinary frequency during 1st and 3rd trimesters
- Increased GFR (40-50%)
- Decreased threshold for glucose= Glycosuria
- Asymptomatic UTI’s common; linked to PTL
What is linea nigra?
during pregnancy the dark vertical line that extends down the abdomen (increased pigmentation)
Irregular pigmentation of the cheeks, forehead, and nose that occurs in many women during pregnancy or when taking oral contraceptives =
Chloasma (melasma gravidarum)
_____ may develop on the chest, neck, face, arms, and legs during pregnancy; small, bright-red elevations of the skin radiating from a central body; caused by increased sub-q blood flow in response to increased estrogen
Vascular spider nevi
What is a posture change that can occur during pregnancy?
lordosis
What is Diastasis recti?
Abdominal wall muscles relax and separate; can occur during pregnancy
What can increased anxiety lead to during pregnancy?
- Increased uterine artery resistance
- Increased miscarriage
- Prematurity
- Fetal hypoxia
- LBW
- Low Apgar score
What prenatal weeks do you get a complete blood count to look at hematocrit, hemoglobin, and WBC’s?
Initial visit, 28, and 36 weeks
What prenatal weeks should you get a 50 g 1 hr glucose challenge test?
24-28 weeks
What prenatal weeks should u get a group B strep culture?
35-37 weeks
What prenatal weeks should u get an Antibody screen (Indirect Coombs)?
Initial visit and 28 weeks
What weeks should you get a GC/Chlamydia probe?
Initial visit and 36 weeks
Number of times a woman has been pregnant, regardless of duration and including present pregnancy =
Gravida
Birth after 20 weeks gestation, regardless of whether the infant is born dead or alive =
Para (or parity)
TPAL=
T= # of term infants born (number of infants born at the completion of 37 weeks gestation or beyond); P= #of preterm infants born (number of infants born after 20 weeks but before the completion of 37 weeks gestation, whether living or stillborn); A= # of pregnancies ending in either spontaneous or therapeutic abortion; L=# of currently living children to whom the woman has given birth
What is Nagele’s Rule?
Used to determine the EDB: begin with the first day of the LMP, subtract 3 months, and add 7 days.
When the mom starts to feel fetal movements = ? When does this occur?
Quickening; Around 20 weeks average (16-22)–especially around week 16 for multips.
What are some danger signs in pregnancy?
Sudden gush of fluid from vagina; vaginal bleeding; abdominal pain; temp above 101 and chills; dizziness/blurring of vision/double vision/spots before eyes; persistent n/v; severe h/a; edema of hands or face; seizures or convulsions; epigastric pain; dysuria; absent or decreased fetal movement
Name some signs of preterm labor:
Painful menstrual-like cramps; dull low backache; suprapubic pain/pressure; pelvic pressure/heaviness; change in character or amount of vaginal discharge (bloody, thinner, thicker); diarrhea; uterine contractions felt every 10 minutes for 1 hour; leaking of water from vagina
What are some labs pregnant women get on the initial visit?
CBC, Blood Type, Rh Factor, VDRL, STS, Rubella titre, Antibody Screen (Indirect Coombs), Hep B antigen, Sickle cell screen, HIV, UA, Pap Smear for Gonorrhea and Chlamydia cultures.
What is Ptyalism?
Excessive, often bitter salivation.
What is pyrosis?
Heartburn
What should you tell women about exercising during pregnancy?
Depends on what you did before pregnancy. Can continue what they normally do, but see how body responds–may have to cut back if having side effects. If haven’t exercised before, need to start slow (walk, swim…and increase slowly..); Mild to moderate exercise is beneficial (about 30 mins a day). However, after 12- 20 weeks, can’t do exercise that requires lying supine (vena cava syndrome).
What are the absolute contraindications to exercise by the ACOG? (8)
Rupture of membranes; Preeclampsia/eclampsia; Incompetent cervix (cerclage); Persistent vaginal bleeding in 2nd or 3rd trimesters; multiple gestation at risk for preterm labor; history of preterm labor in the prior or current pregnancy; placenta previa after 26 weeks gestation; chronic medical conditions that might be negatively impacted by vigorous exercise such as significant heart disease or restrictive lung disease
What should a woman think about with bathing during pregnancy?
- caution because of balance problems as pregnancy advances (rubber tub mats and safety devices)
- Vasodilation from warm water=faintness
- Tub baths contraindicated in presence of vaginal bleeding or membranes ruptured
- During first trimester, avoid hyperthermia associated with hot tub or whirlpool bath (inc. risk of neural tube defects)
Should a pregnant woman be employed?
Pregnant women who have no complications can usually continue to work until they go into labor.
Can pregnant women travel?
If no medical or pregnancy complications are present, there are no restrictions on travel. They should avoid travel if there is a history of bleeding or preeclampsia or if multiple births are expected. In a car, they should wear the seatbelt (shoulder and lap belts properly positioned). Should get out of car and walk every couple hours or so. Some airlines restrict travel after a certain amount of weeks (ie 36) so check with airline for travel restrictions.
What do we say about sexual activity during pregnancy?
In a healthy pregnancy, there is no medical reason to limit sexual activity. Intercourse is contra in those with ruptured membranes or if placenta previa is diagnosed. During the first and third trimesters, sexual desire may be down, but during the 2nd it may be increased due to vascular congestion in the pelvis.
What is the pregnancy classification system for meds?
Category A: Safest; Controlled studies have shown No risk to animals or fetus
B: Animal studies show no risk and no controlled studies in women OR studies of animals demonstrate risk but controlled human studies fail to show risk
C: No adequate studies of animals/women OR animals indicate a teratogenic risk and no controlled studies in women available. Does benefit outweigh risk?
D: Evidence of fetal risk does exist. Benefit may outweigh risks.
X: Fetal risk outweighs any benefit.
What pregnancy category is ASA?
D
What can ASA do to a pregnant woman?
Decrease blood clotting near delivery; increase gastroschisis
birth defect in which an infant’s intestines stick out of the body through a defect on one side of the umbilical cord =
Gastroschisis
What pregnancy category is Ibuprofen?
B
What does Ibuprofen increase the risk for during pregnancy?
Gastroschisis
What do sulfonamides increase the risk for during pregnancy?
hemolysis in the fetus
What does Streptomycin increase the risk for in pregnancy?
deafness
What side effect can tetracycline cause?
tooth discoloration.
Dilantin and Valium are considered ____. What can they cause during pregnancy?
teratogens; SAB, IUGR, cleft lip/palate, limb anomalies.
What can Lithium and Haldol cause during pregnancy?
cardiac anomalies, microcephaly, mental retardation, limb deformity.
What are some live virus vaccines contraindicated during pregnancy?
MMR, varicella, influenza (LAIV), zoster
What vaccinations do we normally give during pregnancy?
we treat them like meds given during pregnancy–only really give them if you have to. An exception is influenza. There’s no evidence of risk from vaccination of pregnant women with inactivated virus, bacterial vaccines, or toxoids (ie. Tetanus-diptheria, seasonal influenza, meningococcal, quadrivalent HPV, and Hep B).
What are some risks of using tobacco during pregnancy?
LBW, SAB, PTL, placenta problems, PROM, cleft lip and palate, SIDS, resp. and middle ear infections, learning disabilities.
When is a safe time to drink alcohol during pregnancy?
There is no safe time.
What are some birth defects that can be caused by alcohol ingestion during pregnancy?
ARBD (alcohol related birth defects): growth deficiencies, facial abnormalities, CNS impairment, behavioral disorders, impaired intellectual development.
What are some birth defects that can be caused by the used of illegal drugs during pregnancy?
Abruptio placentae, PTL, MSF, MAS, Asphyxia in utero, LBW, Mental retardation/learning disabilities, Newborn withdrawal syndrome, SIDS.
Maternal nutrition is especially important to the fetus during the ___ trimester.
3rd
What mineral is greatest concern prior to pregnancy and at beginning of pregnancy? What is it’s recommended amount?
Folic acid; 400 mcg.
Why is folic acid important during pregnancy?
prevents spina bifida and other neural tube defects
