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ACP226 Obstetrics > Modules 1-3. A&P, Non-obs Emergency, Pregnancy Complications > Flashcards

Modules 1-3. A&P, Non-obs Emergency, Pregnancy Complications Flashcards

(103 cards)

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1
Q

1st degree vaginal tear

A

Skin. Inside the vagina or outside on perineum. May require sutures

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2
Q

2nd degree vaginal tear

A

Skin and muscle. Requires suture

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3
Q

3rd degree vaginal tear

A

Skin, muscle, anal sphincter. Sutures to area and sphincter

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4
Q

4th degree vaginal tear

A

Skin, muscle, anal sphincter, rectum. Direct passage from vaginal to rectum.

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5
Q

Episiotomy

A

Incision between vagina and anus to facilitate delivery of larger baby

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6
Q

Vagina

A

Flexible muscular tube approx 3 inches long.
Normally acidic at pH 4-5.

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7
Q

Pelvic inlet

A

Upper border of the true pelvis. Typically round in females.

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8
Q

Determination of size and shape of pelvic inlet

A

Diagonal conjugate: 12.5cm
Obstetric conjugate: smallest and most important
True conjugate: subtracting 1cm from diagonal conjugate
Transverse diameter: shape of inlet

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9
Q

Midpelvis

A

Curved canal longer posterior than anterior wall.
Anteroposterior diameter
Posterior Sagittal diameter
Transverse diameter

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10
Q

Pelvic outlet

A

Lower border of the true pelvis.
Size determined by:
Transverse diameter
Anteroposterior diameter
Posterior Sagittal diameter

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11
Q

False pelvis

A

Portion above the brim and supports the weight of the uterus as well as directing the fetal parts towards the true pelvis

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12
Q

True pelvis

A

Portion that lies below the pelvic brim

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13
Q

Caldwell-moloy classification

A

4 basic types of bony pelvis:
Gynecoid (rounded, most common)
Android (male, heart shaped)
Anthropoid (oval, slowed labour)
Platypelloid (kidney shape, not favourable)

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14
Q

Estrogen

A

Develops female characteristics
Assist in ovarian follicle maturation and proliferation of endometrial.
Inhibit FSH, stimulate LH
High levels at full term, suddenly drops after delivery

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15
Q

Progesterone

A

Secreted by corpus luteum.
Allows pregnancy to be maintained. Prevents contractions.
Levels drop after placenta delivery.

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16
Q

Prostaglandins

A

Produced by cells in endometrium
E: relax smooth muscle, vasodilator
F: vasoconstrictor, increases contractility

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17
Q

Follicle stimulating hormone

A

Maturation of ovarian follicle

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18
Q

Luteinizing hormone

A

Final maturation of follicle

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19
Q

Follicular phase of ovarian cycle

A

Days 1-14.
Follicle matures.
May experience mid cycle pain.
Body temperature increase 0.3-0.6 degrees for 24-48 hrs after ovulation and remains until menstruation

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20
Q

Luteal phase of ovarian cycle

A

Days 15-28.
Begins when ovum leaves follicle. If ovum fertilized it implants in endometrium and secretes hCG.
If not fertilized, corpus luteum degenerates about a week after ovulation.

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21
Q

3 phases of menstrual cycle

A

Menstrual: days 1-6 (endometrial shedding)
Proliferative: days 7-14
Secretory: days 15-26 (uterus readies for implantation)

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22
Q

Fertilization

A

Ova fertile for 6-24 hrs
Usually occurs in ampulla
Sperm can survive 48-72 hrs

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23
Q

Implantation (nidation)

A

Occurs between 7-10 days following fertilization

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24
Q

Preembryonic stage

A

First 14 days
Rapid cellular multiplication and establishment of primary germ layers and embryonic layers

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25
Embryonic membranes (chorion and amnion)
Form at implantation Chorion is first and outermost. Contains chorionic villi, some of which form fetal side of placenta. Amnion is second and is a protective membrane.
26
Amniotic fluid
Cushions embryo, controls temp, permits symmetrical growth, acts as extension of fetal extracellular space, prevents adherence, allows fetal movement. Slightly alkaline
27
Oligohydramnios
Less than 500ml of amniotic fluid
28
Hydramnios/polyhydramnios
More than 2000ml of amniotic fluid
29
Yolk sac
Functions only in early embryonic life. Incorporated into umbilical cord as embryos develop
30
Umbilical cord
Circulatory pathway 1 vein, 2 arteries. Contains whartons jelly (special connective tissue) 2cm across and 55cm (22”) long at 27-42wks
31
Placenta
Means of metabolic and nutrient exchange. Development and circulation begin in 3rd week. Expands until about 20 weeks. At 40 weeks is about 15-20cm diameter, 2.5-3cm thick, 400-600 grams
32
2 parts of placenta
Maternal (red/raw) Fetal (shiny/gray)
33
Cotyledons
15-20 segments which are subdivisions of the placenta. Each is highly complex and vascular.
34
Areas of greatest fetal circulation
Highest O2 concentration at head, neck, brain, and heart. Allows for cephalocaudal development
35
Embryonic stage
Day 15-8 weeks. Tissue differentiation. Embryo is most vulnerable to teratogens. 3wks: tubular heart forms 4wks: fetal heartbeat 5wks: C shaped body 6wks: fetal circulation begins 7wks: beginning of all essential structures 8wks: body organs formed, resembles human
36
Fetal stage
9-12wks: heartbeat heard by Doppler 13-16wks: rapid growth, movement, looks like a baby 17-20wks: kidneys secrete urine, FH heard with stethoscope 21-24wk: alveoli form, surfactant starts 25-28wk: fetus assumes head down 29-32wk: rhythmic breathing, increased body fat 33-38wk: testes in scrotum, lanugo disappears
37
Goodells sign
Softening of the cervix
38
Chadwick’s sign
Blue-purple discolouration of the cervix and vagina
39
Pregnancy and respiratory system
vT increase 30-40% Progesterone decreases airway resistance Oxygen consumption increase 15-20% Diaphragm elevates, increase in chest diameter
40
Pregnancy and cardiovascular system
Heart displaced up and to the left Systolic murmur (90%) Blood volume increase 30-50% CO increase 30-50% HR increase 10-15 BP decrease slightly Pseudoanemia
41
GI system pregnancy changes
N/V attributed to hCG Hyperemic gum tissue Stomach move superiorly Delayed gastric emptying Heartburn Hemorrhoids Gallbladder emptying time increase
42
Normal weight gain during pregnancy
25-35lbs
43
Hormones in pregnancy
hCG Human placental lactogen Estrogen Progesterone Relaxin Prostaglandins Oxytocin Cortisol Prolactin
44
Quickening
Mothers perception of fetal movement Primigravida: 18-20wks Multigravida: as early as 16wks
45
Hegars sign
Softening of the isthmus of the uterus
46
Naegeles rule
First day of LMP - subtract 3 months - add 7 days Accurate if woman has a 28 day cycle
47
Fundal height approximations
12wks: pubic symphysis 20wks: umbilicus 36wks: xiphoid process 37-40wks: regression
48
Antepartum
Time between conception and the onset of labour
49
Intrapartum
Time from onset of labour until the birth of baby and placental expulsion
50
Postpartum
Time from birth until the woman’s body returns to essentially pre pregnant condition. Typically 6 weeks.
51
Prenatal/antenatal
Time a female is pregnant before birth occurs
52
Gravida
Pregnancy regardless of duration
53
Para
Woman who has given birth after 20wks gestation
54
Vaginitis
Caused by abnormal organisms. Increased vaginal discharge Vulvar irritation Pruritus. External dysuria Pain/bleeding on intercourse
55
Bacterial vaginosis
Most prevalent vaginal infection. Caused by change in normal vaginal flora. Lactobacilli decreased, increased pH White or gray vaginal discharge. Whiff test (10% K hydroxide) Preterm birth and rupture, low birthweight
56
Vulvovaginal candidiasis
Fungal infection Second most common Drug resistant strains developing. Thick, white, curdy discharge Itching, dysuria, dyspareunia.
57
Trichomoniasis
Pruritus Dyspareunia Dysuria Petechiae on cervix pH 4.5 or higher Tx flagyl/tinidazole
58
Herpes genitals
HSV-1/HSV-2 Development of vesicles Pruritus Flu-symptoms Tingling Tx: acyclovir, valacyclovir, famciclovir
59
Gonorrhea
Neisseria gonorrhea Prurulent, green-yellow discharge Dysuria Urinary frequency Cervicitis, acute cystitis, vaginitis Bilat abdo or pelvic pain Tx: cephalosporins
60
Chlamydia
Chlamydia trachomatis. Thin or mucopurulent discharge. Cervical ectropion/friable cervix. Lower abdo pain Neonatal conjunctivitis Tx: doxycycline (teratogen)
61
Syphilis
Spirochete treponema pallidum. Primary stage: chancre, fever Secondary: 6wk to 6mo, wart like plaques, hepatosplenomegaly, iritis, non tender lymph nodes Latent: no lesions Tx: benzathine pen G
62
HPV
Condylomata acuminate. Over 100 types with 40 that can infect genital tract. HPV 6 and 11 account for 90% (low cancer risk), HPV 16 and 18 account for 80% of cancer
63
AIDS/HIV fetal/neonatal risks
Without ART rate of transmission is approx 25% With ART and caesarean rate drops to 1%
64
Pelvic inflammatory disease
Most common in women of childbearing age (especially sexually active) Syndrome of inflammatory disorders of female upper genital tract. Bilat sharp cramping LQ pn Fever greater than 38.8 Chills Irreg bleeding N/V
65
Urinary tract infection
Cystitis and urethritis: Dysuria, urgency, fever, hematuria, suprapubic/back pn Pyelonephritis: Acute chills, temp 39-44, costovertebral tenderness, flank pn, NV, sepsis,
66
Toxic shock syndrome
Most commonly staph. Aureus. Fever, HoTN, rash, multisystem involvement
67
Danger signs in first trimester
Spotting or bleeding Painful urination Hyperemesis gravidum Fever Lower abdo pn with dizziness and/or shoulder pn
68
Danger signs in second trimester
Regular uterine contractions DVT PROM Absence of fetal movement for more than 12 hrs.
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Danger signs in third trimester
GDM Preeclampsia Decrease in fetal movement for more than 24hrs Any first or second trimester warning signs.
70
Conditions associated with early bleeding during pregnancy
Spontaneous abortion Ectopic pregnancy Gestational trophoblastic disease Cervical insufficiency
71
Conditions associated with late bleeding during pregnancy
Placenta previa Abruptio placenta Placenta accreta
72
Medical abortion
Induced with methotrexate, misoprostol, or mifepristone.
73
Vacuum aspiration abortion
Manual or electric. Most common method.
74
Dilation and curettage abortion
Cervix is gently opened so tissue can be removed using a scraping tool
75
Spontaneous abortion
Most occur within first 12 wks. (Most likely due to fetal genetic abnormalities) Late abortion after 13wks (most likely related to maternal conditions)
76
Threatened abortion
Bleeding, cramping, back ache. Cervix is closed, no POC expelled. May result in abortion or May resolve.
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Inevitable abortion
Increased bleeding and cramping. Cervix dilated, membranes May rupture
78
Incomplete abortion
Some POC are passed, some are retained (usually placenta), cervix dilated
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Complete abortion
All POC expelled, uterus contracted, cervix may be closed
80
Missed abortion
Nonviable embryo retained in utero for at least 6wk. Absent uterine contractions, irreg spotting, brownish discharge, cervix closed.
81
Habitual abortion
Recurrent pregnancy loss. 3 or more spontaneous abortions.
82
Ectopic pregnancy
Most often occurs in ampulla of fallopian tube. Extrauterine pregnancy can occur elsewhere. Usually 6-8wks
83
Gestational trophoblastic disease
Two most common types: Hydatidiform mole Choriocarcinoma.
84
Cervical insufficiency
Congenital: two cavities joined together Acquired: inflammation, infection, trauma, late 2nd trimester elective abortion, multiple gestation, LEEP
85
Cerclage
Suture placed to prevent cervical dilation.
86
Placenta previa
Implanted placenta in lower uterus. Grade 1: low-lying. Does not reach os. 40-90% chance of c section Grade 2: marginal. Edge is at os. Grade 3: partial. Os partially covered Grade 4: complete. Os covered.
87
Placenta accreta
Placenta attaches deep to cervix. Increta: adhered to myometrium Percreta: invasion of myometrium to the peritoneal covering.
88
Abruptio placenta
Peaks between 24-26wks. Separation of placenta from uterus Grade 1: mild. Less than 500ml blood Grade 2: moderate. 1-1.5L Grade 3: severe more than 1.5L blood
89
Hyperemesis gravidum
N/V is normal, peaks at 8-12wks and resolves by 20wks. HG is excessive vomiting that does not subside, associated with dehydration, weight loss, electrolyte imbalances.
90
Gestational hypertension
New onset of hypertension during pregnancy
91
HELLP syndrome
Hemolysis Elevated Liver enzymes Low Platelet count Develops between 27-37wks
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Preeclampsia
New onset HTN during pregnancy Proteinuria Visual & cerebral symptoms Low platelet count Renal insufficiency Impaired liver function
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3 uses for magnesium sulfate
Preventing seizures in women with severe preeclampsia Slowing or stopping premature labour Protecting brains of premature babies.
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Dosing for mag sulfate (preeclampsia)
4g in 50ml NS over 20min 2g in 250ml D5 over 60min (do not exceed 40g/day)
95
Mag sulfate dosing (preterm labour)
4-6g over 20min Maintenance 2-4g/hr titrated to reflexes.
96
Gestational diabetes
Glucose intolerance with its onset or recognition during pregnancy. Usually around 24wks
97
Rh alloimmunization
Rh negative mother with Rh positive fetus. Mother develops aB against Rh cells, aB attack next Rh positive babies blood cells. Detectable titre 5-16wks after sensitization
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Group B streptococcus Infection
Common bacteria. Can affect mother and fetus. Most commonly threatening to newborns. Screening at 35-37wks
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Early term birth
37-38wks and 6 days
100
Full term birth
39-40wks and 6 days
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Late term birth
After 41st week Post term after 42wks
102
Preterm labour
20-37wks. Increased mortality and morbidity risk.
103
Premature rupture of membranes
Rupture after 37wks but before the onset of labour.

ACP226 Obstetrics (3 decks)

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