Obstetrical & Gynecologic (test 1) Flashcards
Amino -
Amniotic
Cervic/o
Cervix
Cop/o
Vagina
Could/o
Could de sac /retrouterine pouch
Fet/o
Fetus
Gon/o
Gonad/ ovaries
Gynec/o
Woman/ female
Hyster/o
Uterus
Lapar/o
Abdomen
Mamm/o
Breast
Mast/o
Breast
Men/o
Menstruation/ mensus
Metr/o
Uterus
Myom/o
Muscle/ myometrium
Nat/l
Birth
Oophor/o
Ovaries
Ovar/o
Egg/ ovum
Par/o
to give birth
Salping/o
Fallopian tubes
Uter/o
Uterus
Vagin/o
Vagina
Vulv/o
Vulva
Abortion
premature loss or expulsion of an embryo or fetus
spontaneous or induced
Amnion
one of four extraembryonic membrane, surrounds developing embryo or fetus
Chorion
Blood vessels form, first step in functional placenta, platform between mother and fetus for nutrients, oxygen, and waste
Embryo
development stage week 1-8
Fertilization
gametes (egg and sperm) form zygote
Fetus
week 9 to birth
Gestation
period of intrauterine development
Gravity
of pregnancies
Implantation
attachment of blastocyst into endometrium of uterine wall
Parity
of births, viable births
(20 weeks gestation)
Placenta
structure permits diffusion between fetal and maternal circulatory systems
Premature
Born before 37 weeks
Vulva
External
all structure that make up female genitalia
Labia
external
majora- outside skin
minora- inside skin
Clitoris
external
short sensitive erectile tissue
Vestibule
external
area between urethra and vagina
Vagina
Internal
entry into female
Perineum
external
area between vagina and anus
Glands (2 types)
Internal
Skene’s- paraurethral (upper)
Bartholin’s- greater vestibular (lower)
What are the phases of the menstrual cycle?
28 days in length
Menstrual phase
Proliferation/ Follicular phase
Secretory/ Luteal phase
Progestational/ Ischemic phase
Ovaries
Internal
hormone production- estrogen and progesterone
Oocyte formation
Ovarian ligament keeps in place
Fallopian tubes
Internal
conduct release of ovum from the ovary to the uterusU
Uterus
Internal
protects, nourishes, and removes waste for embryo and fetus
What are the parts of the Uterus?
Fundus -top
Corpus/ Body- middle
Cervix-lowest
Ligaments- suspend uterus in place
What are the four types of ligaments?
Round
Broad (batwing)
Cardinal
Uterosacral (uterus to sacrum)
What are the three uterine layers?
Endometrium- highly vascular
Myometrium- thick muscular
perimetrium- outer layer
What do the umbilical veins do?
moves oxygenated blood
What do the umbilical arteries do?
move deoxygenated blood
What is the foramen ovale?
right and left atrium
closes when born
What is the patent ductus arteriosus?
pulmonary artery and aorta
blood bypasses the lungs
fetus doesn’t breathe air
closes when born
What history should be ascertained?
obstetric history
menstrual
contraceptives
medical
surgical
social (sexual)
What instrument is used for physical inspection?
Graves bivalve speculum
What does bimanual mean?
one hand on abdomen and one hand in vagina
What does rectovaginal mean?
one finger in anus and one in vagina
What is inspected in a gyno visit?
external genitalia
vagina
cervix
pelvis
What is palpated in an examination?
cervix
uterus
adenexa (ovaries, fallopian tubes, and broad ligaments
What laboratory tests can be completed?
pregnancy
urinalysis
complete blood count (RBC, WBC, Hgb-hemoglobin- O2, Hct- hematocrit- red cells, and platelets)
Erythrocytes
blood chemistry
What is amenorrhea?
Absence of menstruation
What is dysmenorrhea?
Painful or difficult menstruation
What is menorrhagia
Excessive bleeding during menstruation
What is metrorragia?
Active uterine bleeding at times other then during menstruation
What is endometriosis?
Tissue implants outside of the uterus
Pain in abdomen during menstrual cycle
S/s of cervical cancer
Early- asymptomatic
Later- abnormal bleeding after intercourse- metrorrhagia
S/s of ovarian cancer
High mortality rate
Heavy menses, palpable abdominal mass
S/s uterine cancer
Watery discharge, menorragia
Dx- D&C
S/s of vulvar cancer
Menorrhagia, itching
What are 2 types of herniations?
Cystocele- bladder
Rectocele- rectum
Prolapse is another term
S/s of uterine prolapse
Weak pelvic support
Pain, incontinence, menstrual interruption, fertility problems
What is another name for a fibroid tumor?
Where are the 3 locations of fibroids?
Leiomyoma uteri
Originates in myometrium
Usually benign
Only removed if cause of pain
On fibrous connective tissue
Intramural (middle)
Submucosal (inner)
Subserous (outer)
What is an ovarian cyst?
Fluid filled sac attached to ovary
S/s unexplained pelvic pain, palpable mass
What is an ovarian torsion?
Ovary or fallopian tube twist on itself
Emergency- no blood supply
What is PID?
Pelvic inflammatory disease
STD (gonorrhea or chlamydia) migrated to fallopian tubes, uterus, and ovaries
Can cause adhesions, sterility, ectopic pregnancy
S/s lower abdominal pain, malaise, fever, purulent vag discharge
Tx- antibiotics
What is toxic shock syndrome?
Rare life threatening complication of bacterial disease infection
Recent surgery, open wounds, menstrual cups, tampons
Can spread to kidneys, CNS, gi system, hematologic system, CV system
S/s high fever low bp, vomit, diarrhea, rash on palms and soles
Tx- antibiotics, surgery
What are the 2 incisional approaches?
Abdominal and vaginal
What is the abdominal incision?
Vertical incision- midline or paramedics
Transverse incision-
30x stronger best cosmetic results, can compromise nerves,
Limits abdominal access,
What are the 3 types of transverse incisions?
Pfannenstiel
Marylard
Cherney
What is the vaginal incision?
Episiotomy
Can be straight from vagina to anus or at a 45 degree angle
What is cytology?
Exam of cells from fluid specimens
Pap smear- scrape cervix & endocervical tissue
Dx presence of cervical dysplasia
Endocervix and ectocervix
What is colposcopy?
Suspected carcinoma in-situ of cervix
Use binocular microscope
Many specimens taken
DO NOT prep patient
What is a colpotomy?
Incision into posterior cut-de-sac (vaginal wall)
Intraperitoneal palpation
Inspection pelvic organs
Determination of free fluid, blood, or pus You n pouch of Douglas
What is a culdoscopy?
Endoscopic exam of pelvic organs and structures
Small induction into posterior cut-de-sac
Investigate- unexplained pelvic pain, pelvic masses, ovarian disorders, infertility
What is culdocentesis?
Fluid removal- specimen- from posterior cul-de-sac
Spinal needle used
Dx- suspected ectopic pregnancy
What is Schillers test?
Vaginal vault and cervical squamous epithelium stained with Lugol’s solution- iodine based
Normal tissue -brown
Abnormal tissue- no stain
Biopsy on abnormal tissue
DO NOT prep patient
What is a biopsy punch?
Removes small pieces of tissue
Cervical biopsy forceps
(Look like the kerrisons)
What is LEEP?
Loop electrosurgical excision procedure
Excision of cone of tissue from cervix
Remove cancer lesion or obtain tissue bx
What is conization of cervix?
Aka cold knife biopsy
Dx or tx of cervical dysplasia
Lugol’s or acetic acid to stain tissue
Biopsy taken with colposcope and biopsy punch, ESU, blade, or LEEP
Multi sections examined
Excision of cone from cervix
What is Rubin’s test?
Aka- utero tubal insufflation
CO2 introduce to cervical canal
Checks patency of fallopian tubes
What are some indications of a hysteroscopy?
abnormal bleeding
locate and remove IUD
evaluation of infertility
Dx of pathologies
Tx of pathologies
What are some complications of a hysteroscopy?
perforation of the uterus
injury to intestines
injury to urinary tract
injury to uterine vessels
intravasation- absorption into body
What 5 solutions can be used and a hysteroscopy?
Which one is non-conductive?
1.5% Glycine
Dextran
Sorbitol non-conductive
0.9% NSS
Lactated ringers
What is a hysterosalpingography?
insertion of contrast into cervical canal
structure and function of uterus and tubes
can evaluate fertility
What is chromotubation?
determines patency of fallopian tubes
Methylene blue mixed with NSS
What areas of the body are seen in a laparoscopy/ Pelviscopy?
peritoneal cavity
pelvic anatomy
through anterior wall
Why are laparoscopy and pelviscopies performed?
unexplained pelvis pain
pelvic masses
ovarian disorder
infertility
What are some need to knows about a uterine manipulator?
usually placed before procedure
canula
change gloves after placement and before procedure
cannula and cone together makes up the instrument
What happens in a uterine curettage D&C?
tissue obtained for histogy
endocervical and endometrium tissues sent as specimens
What happens in a D,C, and E?
Dilation, curettage, and evacuation- remove tissue and products from conception
use curettes 7mm to 12mm
keep machine covered till patient is under
What are the 5 types of abortions?
Missed-
Incomplete-
Imminent-
Spontaneous-
Voluntary interrupted-
What are the 2 types of cervical cerclage techniques?
Shirodkar- closes the Internal Os
Macdonald- closed the outer Os
Tx of incompetent cervix- wont stay closed during pregnancy
Suture stays in place until vaginal delivery
What is Brachytherapy?
Internal radiation therapy
Tx cervical or endometrial malignancies
low or high dose
material placed in uterus or vagina
hospital stay 1-3 days, special precautions
What is endometrial ablation?
What 2 ways are used to perform procedure?
destroying of the uterine lining
Intrauterine thermal balloon kit- HOT H2O
or Novasure- electricity
What is a myomectomy?
removal of uterine muscle fibroids; without removing the uterus
What is a uterine fibroid embolization?
catheter placed in uterine arteries, small particles injected to block the branches, cuts off blood to the fibroids.
polyvinyl alcohol- course sand
gelatin sponge- gelfoam
microspheres
local anesthesia
What is an abdominal hysterectomy?
removal of uterus and cervix through an abdominal incision
What 4 ligaments are ligated in an abdominal hysterectomy?
Cardinal (posterior and anterior)
Uterosacral
Round
Broad
What is a subtotal hysterectomy?
removal of uterus
cervix stays
What is a vaginal hysterectomy?
removal of uterus through incision in vaginal wall and abdominal cavity
Auvard speculum used
indication of prolapsed uterus
What is an LAVH?
laparoscopic assisted vaginal hysterectomy-removal of uterus through vagina
endoscope used
if patient has endometriosis, nulliparity (no kids), pelvic adhesions
2 set ups usually
What is a robotic-assisted Hysterectomy?
LAVH and robot
What is a Wertheim-Meigs radical hysterectomy?
dissection and removal of all pelvic lymph nodes
removal of uterus, tubes, ovaries, ligaments, and upper vagina
What is a pelvic exenteration?
TX for persistent cancer
can tX vulvar, vaginal, rectal, endometrial cancer
complete removal of rectum, distal sigmoid colon, urinary bladder, internal iliac vessels, reproductive organs, lymph nodes, pelvic floor and peritoneum, levator muscles, and perineum
Define salpingectomy
removal of fallopian tubes
Define oophorectomy
removal of ovary
Define salpingoophorectomy
removal of fallopian tubes and ovaries
What is an ectopic pregnancy?
implantation in the fallopian tube
emergency surgery needed
risk factors:
history of PID
previous ectopic pregnancy
pregnant following sterilization
previous tubal reconstruction
IUD
infertility
What is a tuboplasty?
repair of the fallopian tubes
dilate with a balloon; free adhesions
repair with a suture
What is labiaplasty
Tx of protruding labia
What is a perineal laceration and what are the 4 degrees?
Tx of vaginal tear from childbirth, trauma
1st- vaginal mucosa torn
2nd- perineal muscles torn
3rd anal sphincter torn
4th rectum torn
What is a vulvectomy?
Tx of carcinoma of vulva
removal of labia majora, labia minora, glans clitoris, inguinal & pelvic lymph nodes
What is ablation of condyloma?
removal of genital warts with laser
wear N95 mask
What is marsupialization of Bartholin’s glands?
removal of a cyst
pouch is sutured open
What is a colpcleisis procedure?
closing of the vagina
Tx of uterine prolapse
for women who are not sexually active
What is a fistula?
opening between the vagina and another space
Tx is anterior or posterior repair
What is a rectovaginal fistula?
opening between vagina and rectum
What is a vesicovaginal fistula?
opening between vagina and bladder
What is a vesicouterine fistula?
opening between vagina and uterus
What is a urethrovaginal fistula?
opening between the vagina and urthra
What is a colporraphy?
repair of weakness in the vagina walls
removal of excess tissue
Tx vaginal fistula, uterine prolapse
What is a cesarean section (c-section)?
removal of fetus through abdomen
scheduled or emergent
-count when uterus id closed
Pfannenstiel incision
How is baby delivered in a c-section?
head first
what is immediate action when baby is first delivered
suction the airway
What is the most significant cause of morbidity during a c-section?
anesthesia problems
What retractor is used during a c-section?
Balfour or DeLee
What is the most common reason for a c-section?
cervix will not dilate
What is cephalopelvic disproportion (CPD)?
mothers pelvis is to small for fetus head
What are 3 abnormal presentations of the fetus?
Breech- butt first
Transverse- fetus cross-wise
footling- feet first
What is abruptio placenta?
placenta separates prematurely from wall of uterus
What is placento previa?
placenta implanted on uterine segment- abnormally
covering os cervix
Can the cervix have cancer?
yes carcinoma of cervix
What is disseminated intravascular coagulation(DIC)?
serious emergency
coagulopathy-heavy bleeding
overstimulation of clotting and anticlotting process
seen in abruptio placent
What is preeclampsia?
sudden hypertension, albuminuria, and edema of hands, feet, and face
What is nochal cord?
umbilical cord wrapped around fetus neck
What does APGAR stand for?
Appearance, Pulse, Grimace, Activity, and respiration
What are the three levels of the APGAR scoring?
0-3 severely depressed
4-6 moderately depressed
8-10 good
What anelgesics are used in OB/GYN?
Lidocaine- numb cervix
Meperidine hydrochloride/Demerol- during c-section
What is acetic acid 3% used for?
remove mucous
facilitate visualization of cervix in colposcopy
What anti-infection cream is used?
Sulfa- vaginal packing
cauterize or laser ablations
What is methylene blue/ indigo carmine used for?
check for tubal patency
verify uterus not injured
What is the Lugols solution used for?
What is the name of the test?
Schiller’s test
purple iodine
normal tissue turns brown
abnormal no change
What oxytocics are used?
Pitocin- stimulates uterus to contract
What lasers can be used in OB/GYN?
carbon dioxide
Holmium: YAG
wear proper PPE: glasses and mask
When doing a vaginal & abdominal procedures, which one is done first?
Diagnostic will be done first (D&C and TAH)
if both nondiagnostic (TAH and A&P repair)
What are some Special considerations when patient is catheterized?
prevents bladder distention
decompresses to prevent injury
can record urinalysis
bag checked for blood
