Gynecology & Obstetrics Flashcards
(96 cards)
1
Q
What are disorders prior to pregnancy that are unique to women and the female reproductive system?
A
Gynecological conditions like acute or chronic infection, hemorrhage (vaginal bleeding), uterine rupture, and ectopic pregnancy
Some conditions can be life-threatening without prompt intervention
2
Q
What is the general rule regarding abdominal pain in women of childbearing years (age 12-55)?
A
Any abdominal pain (specifically lower quadrant) is considered gynecologic in origin until proven otherwise
3
Q
What medical specialty deals with conception, gestation, and childbirth?
A
Obstetrics
4
Q
List the external genitalia.
A
Mons pubis, Labia Majora, Labia Minora, Prepuce, Clitoris, Vestibule, Urinary meatus, Vaginal orifice, Hymen, Perineum, Anus
5
Q
What hormones are produced by the ovaries?
A
Estrogen and progesterone
6
Q
What is menopause? What is the average age of menopause?
A
Cessation of ovarian function and menstrual activity; late 40s
7
Q
What occurs during the proliferative phase (day 6-13) of the menstrual cycle?
A
Increase in endometrial thickness stimulated by estrogen increase. Anterior pituitary hormones are released and ovarian cycle is initiated. Phase is maintained by increased estrogen production
8
Q
What happens during the secretory phase (day 15-28) of the menstrual cycle?
A
Endometrium is prepared for gestation (period from fertilization until birth) influenced by estrogen and progesterone
9
Q
What is the average menstrual flow?
A
25 to 60 mL
10
Q
What structures are form during the embryonic stage of fetal development?
A
4 weeks - Heart begins to beat
8 weeks - All body systems and external structures are formed
Approximately 3 cm in size
11
Q
What is the purpose of the placenta during fetal development?
A
Provides nutrients and oxygen to the fetus and removes waste
12
Q
What are the early indications of pregnancy?
A
Cessation of menstruation, Hormonal changes, Nausea, Breast enlargement, Increased urinary frequency
13
Q
- Cause
A. Acute or chronic infection, gonorrhea, C. trachomatis, chlamydia, staphylococci, streptococci - Organs affected
A. Initial access through vagina, ascends to other organs
B. Cervix, uterus/endometrium, fallopian tubes, ovaries, support structures, liver - Complications
A. Sepsis and infertility - Specific assessment findings
A. Lower abdominal pain, guarding, fever, vaginal discharge, dyspareunia, shuffling walk (PID shuffle!!), acute onset one week of menstrual period, ill appearance - Management - supportive
A
Pelvic Inflammatory Disease
14
Q
- Incidence
A. Typically spontaneous
B. May be associated with mild abdominal injury, intercourse, or exercise - Cause
A. Typically a benign cyst
B. Thin walled fluid filled sac - Complications
A. Significant internal bleeding could occur, but is rare - Specific assessment findings
A. May have sudden onset of severe lower abdominal pain
B. Typically affects one side, may radiate to back
C. Rupture may result in some vaginal bleeding - Management - supportive
A
Ruptured ovarian cyst
15
Q
- Incidence - frequent
- Cause - infection (usually bacterial)
- Organs affected - bladder and ureters
- Complications - if untreated, may lead to pyelonephritis
- Specific assessment findings
A. Suprapubic tenderness, frequency of urination, dysuria, blood in urine - Management - general management
A
Cystitis
16
Q
- Incidence - typically midway into menstrual cycle
- Cause
A. Pain occurring at time of ovulation
B. Possibly related to peritoneal irritation secondary to follicular leakage/bleeding during ovulation - Organs affected - ovary and follicles
- Complications
A. Typically not immediate life-threat
B. Requires physician evaluation - Specific assessment findings
A. Unilateral lower quadrant abdominal pain
B. Low grade fever
C. Symptoms similar to ruptured ovarian cyst - Management - supportive
A
Mittelschmerz
17
Q
- Incidence - occurs most often after childbirth or abortion
- Cause
A. Infection, resulting in inflammation of the endometrial lining - Organs affected - uterus and fallopian tubes
- Complications
A. If untreated, may lead to sepsis and death; sterility - Specific assessment findings
A. Lower abdominal pain; purulent vaginal discharge - Management - supportive
A
Endometritis
18
Q
- Incidence
A. Most common in women who defer pregnancy
B. Average women in her late 30s, can strike extremely early - Cause
A. Growth of endometrial tissue outside of uterus - Organs affected - fallopian tubes, pelvic organs, bowel, bladder, ligaments
- Complications
A. Painful intercourse, menstruation, bowel movements - Specific assessment findings
A. Severe pain during and immediately following intercourse and bowel movement - Management - supportive/palliative
A
Endometriosis
19
Q
What is the primary concern with ectopic pregnancy?
A
Implantation occurs in the fallopian tube and can rupture, leading to severe bleeding.
20
Q
- Incidence
A. Common and rarely an emergency - Causes
A. Menstruation - never assume normal menstruation
B. Menorrhagia (heavy vaginal bleeding)
C. Abortion/miscarriage
- Assume always during first and second trimester of known or possible pregnancy
- Consider if last menstrual period > 60 days - May have history of similar events
A. Note particularly any tissue or large clots
B. If possible, collect material for pathological review - Emotional support extremely important
- Placenta previa/abruptio placentae
- Vaginal bleeding in third trimester - always a serious emergency
- Other causes - lesion, PID, trauma, onset of labor
- Complications
A. May be life-threatening; may lead to hypovolemic shock and death - Additional physical examination
A. Check for impending shock; orthostatic vital signs
B. Presence and volume of vaginal blood - Management - supportive; fluid resuscitation, treat for shock
A
Vaginal bleeding
21
Q
- Causes
A. Straddle injuries, blows to the perineum, blunt force to lower abdomen, assault, seat belt injuries, foreign bodies inserted into the vagina, abortion attempts, soft tissue injury - Complications
A. Severe bleeding, organ rupture, hypovolemic shock - Specific assessment findings
A. Consistent with severe internal injuries - Management - trauma, treat appropriately
A
Vaginal bleeding
22
Q
What is the general assessment of obstetrics?
A
- Initial assessment - general impression
- History - SAMPLE
A. Preexisting medical conditions - diabetes, heart disease, hypertension, seizure
B. Pain, vaginal bleeding or discharge, labor - Obstetrical history
A. Prenatal care and compliance, estimated date of conception (first day of LMP, minus 3 months, plus seven days); gravida, para, ab; c-sections - Physical examination
A. Vital signs, external examination of perineum, SpO2 and EtCO2, breath sounds, fetal heart tones, fundal height
23
Q
What is spontaneous abortion?
A
- Loss of pregnancy before 20 weeks
- S&S - cramping, abdominal pain, backache, and vaginal bleeding; fetus and placenta may be visible in vaginal discharge
- Management - treat for shock; supportive care, physically and emotionally
24
Q
What is pre-eclampsia?
A
Pregnancy-induced hypertension characterized by high blood pressure (140/90), edema, and proteinuria
Results in nervous system changes - syncope, headaches, photosensitivity, vision problems, nausea/vomiting
Indicates the potential for seizures from CNS stimuli
25
What is the recommended management for third trimester bleeding?
Rapid transport to facility with OB surgical capabilities, place in left lateral Trendelenburg, treat for shock
26
What is eclampsia?
'Toxemia of Pregnancy'; seizures
27
What is the management for eclampsia?
1. Prevent seizures first
A. Careful handling, reduce stimuli, transport slow and careful
B. Magnesium sulfate, 2-4 g IV over 5-10 minutes
2. For seizures, give benzodiazepines
28
What is HELLP syndrome?
Hemolytic anemia, Elevated Liver enzymes, and Low Platelet count
Associated with pre-eclampsia
29
What symptoms are associated with HELLP syndrome?
Progressive nausea and vomiting, upper abdominal pain, headache
30
What is the only treatment for HELLP syndrome?
Delivery of the infant; permanent liver damage may occur if delivery is delayed
31
What causes supine hypotension syndrome?
Fetus lying on mother's inferior vena cava resulting in decreased venous return and low blood pressure
32
How do you treat supine hypotension syndrome?
Place patient in left lateral recumbent position or elevate right hip
33
What is gestational diabetes?
Increased blood sugar levels in otherwise non-diabetic mother
This increases the risk of delivering large baby
34
What is a key characteristic of Braxton-Hicks contractions?
False labor that increases in intensity and frequency but does not cause cervical changes
NOT early labor, NOT all early contractions are Braxton-Hicks
35
What are some maternal, placental, and fetal factors that can lead to preterm labor?
1. Maternal factors
A. Cardiovascular disease, renal disease, diabetes, uterine and cervical abnormalities, maternal infection, trauma, contributory
2. Placental factors - placenta previa and abruptio placentae
3. Fetal factors
A. Multiple gestation, excessive amniotic fluid, fetal infection
4. Management - supportive care; make transport decisions carefully
36
What is the intrapartum period?
The time period surrounding the birth of the fetus
37
What are the stages of labor?
Stage one: first contraction to full cervical dilation
Stage two: delivery of baby
Stage three: delivery of placenta
38
What is the process of field delivery?
Set up delivery area, give oxygen to mother and start IV-NS TKO, drape mother with toweling from OB kit, monitor fetal heart rate, apply gentle pressure as head crowns, suction the mouth and then the nose, clamp and cut the cord, dry the infant and keep warm, deliver the placenta and save for transport with the mother
39
What is a nuchal cord?
Umbilical cord wrapped around the baby’s neck
40
What should be done if a nuchal cord is present?
Have mother stop pushing, carefully lift cord and remove from baby’s neck
41
What are the components of the APGAR score?
1. Appearance
A. Blue, pale: 0
B. Body pink, extremities blue: 1
C. Completely pink: 2
2. Pulse rate
A. Absent: 0
B. Below 100: 1
C. Above 100: 2
3. Grimace
A. Limp: 0
B. Grimace: 1
C. Cries: 2
4. Activity
A. No response: 0
B. Some flexion of extremities: 1
C. Active motion: 2
5. Respiratory effort
A. Absent: 0
B. Slow and irregular: 1
C. Strong cry: 2
Take at one and five minutes
Every five minutes for twenty minutes if below 7
42
What should be done for neonate CPR according to AHA guidelines?
3 compressions to 1 ventilation
43
What is breech presentation?
The buttocks or both feet present first
Most deliver without incident
Head will deliver slower than body
Support infant
If head does not deliver quickly - form airway for baby (place fingers into vagina and make “V” to create airway)
44
What does a prolapsed cord signify?
The umbilical cord presenting part is compressed as the fetus proceeds in delivery
HIGHLY risky situation with high legal consequences
Assess cord for pulse, place mother in lateral Trendelenburg or elevate hips
Place fingers into vagina to take pressure off cord (form “V” to allow cord to move through without compression)
45
What should be done if there is a limb presentation?
Considered undeliverable, transport to facility with OB surgery
46
What can cause cephalopelvic disproportion?
Infant’s head is too big to pass through pelvis easily
Causes include oversized fetus, hydrocephalus, conjoined twins, or fetal tumors
If not recognized, can cause uterine rupture
Usually requires cesarean section
47
What is precipitous delivery?
Delivery that occurs in less than 3 hours of labor
Usually in patients in grand multi para, fetal trauma, tearing of cord, or maternal lacerations
Be ready for rapid delivery, and attempt to control the head
Keep the baby warm
48
What is shoulder dystocia?
Infant’s shoulders are larger than its head
Turtle sign
Do not pull on the infant’s head
If baby does not deliver, transport the patient immediately
49
What is meconium staining?
Fetus passes feces into the amniotic fluid
If meconium is thick, suction the hypopharynx and trachea using an endotracheal tube until all meconium has been cleared from the airway
50
What defines postpartum hemorrhage?
Loss of more than 500 cc of blood following delivery
51
What is a common treatment for postpartum hemorrhage?
1. Establish two large-bore IVs of normal saline
2. Natural stimuli - nipple suckling, fundal massage
3. Treat for shock as necessary
4. Oxytocin, 10-20 units in 1000mL NaCl run at 10-20 gtts/min - titrated to effect
52
What is uterine inversion?
Uterus inverted, protruding through cervix
Can lead to significant blood loss
Treat for shock
Attempt once to replace
If unable, keep moist with wet dressing and transport
53
What is a pulmonary embolism?
Presents with sudden severe dyspnea and sharp chest pain
From amniotic fluids, atherosclerosis (from smoking and long term use of birth control pills)
Apply oxygen, establish an IV of normal saline, transport immediately
54
What is necessary for documentation after delivery?
Delivery gives you two patients
Legally, you need two patient reports
55
List the internal genitalia.
Ovaries, fimbrae, fallopian tubes, uterus, cervix, vagina
56
What are the layers of the uterine wall?
Perimetrium, myometrium, endometrium
57
Normal discharge of blood, mucous, and cellular debris from the uterine mucosa that is approximately every 28 days
Menstruation
58
What is menarche?
Initial onset of menstruation during puberty
59
What usually occurs 14 days from the beginning of the menstrual cycle where an egg is released from an ovarian follicle?
Ovulation
60
What hormones does the anterior pituitary gland release?
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
61
What occurs during the menstrual phase (day 1-6)?
Discharge lasting on average 4-6 day due to the ovum not being fertilized. Endometrium is shedding. This phase is absent during pregnancy and menopause
62
What occurs during implantation and fertilization?
Sperm usually finds ovum in lateral 1/3 of fallopian tube and this union forms a zygote. During next 72 hours, the zygote divides numerous times and forms a blastocyst as it travels to the uterus
63
What occurs during gestation?
Blastocyst divides into developmental area and gives rise to fetal structures, placenta, umbilical cord, and amniotic sac
64
What occurs during the fetal stage of fetal development?
12 weeks - urine produced
20 weeks - mother can feel movement
38 weeks - fetus fills uterine cavity
65
What structures are part of the fetal circulation?
Placenta, umbilical vein, ductus venosus, foramen ovale, ductus arteriosum, umbilical arteries
66
What are some respiratory system changes as the pregnancy continues past early stages?
Decreased airway resistance, increase in oxygen consumption, and increase in tidal volume
67
What are some cardiovascular system changes as the pregnancy continues past early stages?
Increased pulse and cardiac output, blood pressure usually normal, increased circulating blood volume by 45%, increased red blood cells by 20%
68
What are gastrointestinal changes as the pregnancy continues past early stages?
Slowing of peristalsis
69
What are urinary system changes as pregnancy continues past early stages?
Renal filtration increases
70
What is part of the “history of present illness” for the general assessment of gynecological emergencies?
SAMPLE
Associated symptoms: febrile, diaphoresis, syncope, diarrhea, constipation, urinary cramping
Check for pain or discomfort - OPQRST
Abdominal pain or discomfort
Dysmenorrhea, dyspareunia
Defecation
Present health
Note any preexisting conditions
71
What is dysmenorrhea?
Painful menstruation aggravated by walking
72
What is dyspareunia?
Pain during intercourse
73
What needs to be known regarding obstetric history in the general assessment?
Gravida, para, abortions/miscarriages
previous cesarean sections
LMP - date, duration, normalcy, bleeding between periods, regularity
Possibility of pregnancy - missed or late period, breast tenderness, urinary frequency, morning sickness, nausea/vomiting, sexually active, unprotected sex
Use of birth control - rhythm method, coitus interruptus, condom, diaphragm, spermicide, intrauterine device, hormone therapy (oral contraception, Norplant, depo-provera)
74
What is gravida?
Total number of pregnancies
75
What is para?
Number of pregnancies terminated after twenty weeks; number of live and/or still births
76
What is Ab?
Abortions/miscarriages; number of pregnancies lost prior to twenty weeks
77
What needs to be known regarding gynecological problems in a patient’s history during general assessment?
Infections, bleeding, miscarriage, abortion, ectopic pregnancy
Present blood loss - color, amount, pads per hour, duration
Vaginal discharge - color, amount, odor
78
What do you need to advocate for during physical examination?
Comforting attitude, protect modesty, maintain privacy, be considerate of reasons for patient discomfort
79
What do you need to assess for during physical examination?
Level of consciousness, general appearance
Skin and mucous membrane color (cyanosis, pallor, flushed)
Vital signs - orthostatic measurement discrepancies
Check for bleeding and discharge - color, amount, evidence of clots and/or tissue
Auscultate the abdomen - absence/hyperactive bowel sounds, fetal heart sounds
Palpate the abdomen - masses, areas of tenderness, guarding, distention, rebound tenderness
80
What is the general management of gynecological emergencies?
Support airway, breathing - oxygen (high flow PRN and ventilate as necessary)
Intravenous access - typically not necessary; for impending shock or has excessive vaginal bleeding, large bore IV in a large vein, normal saline or lactated ringers, flow rate based on patient presentation, consider a second line
Monitor and evaluate for serious bleeding - do not pack dressing in vagina, discourage use of tampon, keep count of pads used
Shock impending - trendelenberg
Position of comfort and care based on patient’s presentation - left lateral recumbent, knee/chest, hips raised/knees bent
Cardiac monitoring PRN and consider possibility of pregnancy - be prepared for delivery, consider ectopic pregnancy
Transport consideration - physician evaluation necessary, surgical intervention may be necessary, consider emergency transport to an appropriate facility (THR FW for high risk)
Psychological support - calm approach, maintain modesty/privacy, gentle care
81
1. History
A. Do not inquire regarding the patient’s sexual history or practices
B. Do not ask questions that may cause patient to have guilt feelings
2. Common reactions
A. May range from anxiety to withdrawal and silence
B. Denial, anger and fear are normal behavior patterns
3. Assessment
A. Examine the genitalia only if necessary
B. Presence of severe injury
C. Explain all procedures before doing an examination
D. Avoid touching the patient without permission
E. Maintain the patient’s privacy/modesty
F. Check for other physical injury
4. Management
A. Psychological support is very important
- Provide a safe environment
- Respond to victim’s wishes to talk or not to talk
- Do not use invasive procedures unless the situation is critical
B. This is a crime scene - preserve any evidence
- Handle clothing as little as possible
- Paper bag each item separately
- Ask the patient not to change clothes, bathe, or douche
- Do not clean wounds unless absolutely necessary
- Do not allow the patient to drink or brush their teeth
C. Maintain a non-judgmental/professional attitude
D. Be aware of your own feelings and prejudices
E. Have female personnel attend to the female patient whenever possible
- Ask if female personnel are preferred
F. Provide reassurance to patient of such; confidentiality is critical
Sexual assault
82
1. Number one killer of pregnant females
2. Uterus is thick and muscular
A. Distributes forces of trauma uniformly to fetus
- Reduces chances for injury
3. Risk increased with gestational age
4. Blunt trauma complications
A. Uterine rupture, abruptio placentae, premature rupture of amniotic sac
5. Look for signs of shock
A. PRETREAT: signs may not develop until 30% of blood volume is lost
B. Body shunts blood from GI/GU to primary organs
6. Vaginal hemorrhage
A. Uterine rupture vs. abruptio placentae
7. Positioning - left lateral recumbent; if on backboard, tilt only after secured
8. Oxygenation - high flow O2 based on SpO2, EtCO2, FHT; consider PPV by BVM if hypoxia ensues
9. Fluid resuscitation
Trauma complications of pregnancy
83
Complete expulsion of all uterine contents
Complete abortion
84
Partial expulsion of uterine contents
Incomplete abortion
85
Potential abortion, characterized by vaginal bleeding, slight cervical dilation, viable fetus remaining in uterus
Threatened abortion
86
Potential abortion characterized by vaginal bleeding, severe abdominal cramping and cervical dilation, non-viable fetus remaining in uterus
Inevitable abortion
87
Termination of pregnancy at the request of the mother
Elective abortion
88
Termination of pregnancy deemed necessary by a physician
Therapeutic abortion
89
Fetal death, prior to twenty weeks, but the fetus remains in the uterus
Missed abortion
90
Intentional termination of a pregnancy under any conditions not allowed by law
Criminal abortion
91
1. Implantation outside of the expected site - fallopian tube most common
2. Significant cause of abdominal pain in women
3. Management - treat for shock; supportive care, physically and emotionally
Ectopic pregnancy
92
Placenta occludes the vaginal canal
Usually presents with painless bleeding in the third trimester
Life-threatening to fetus
Placenta previa
93
Placenta detaches from the uterine wall
Painful third trimester bleeding, associated with shock
Extremely life threatening to both mother and fetus
Abruptio placentae
94
What is the management for third trimester bleeding?
Rapid transport to facility with OB surgical capabilities
Place in left lateral Trendelenburg (knees to chest is not recommended in moving ambulance)
Treat for shock Extremely life
95
When are the only times you can insert fingers into the vagina during childbirth?
Slow deliver breech birth, prolapsed cord, shoulder dystocia
96
What may occur with multiple births and what do you do?
Considered when mother’s abdomen is excessively large
Follow normal guidelines, but have additional personnel and equipment
In twin births, labor starts earlier and babies are smaller
Prevent hypothermia
