OB Infertility and Antepartal Flashcards Preview

Nursing N366 OB > OB Infertility and Antepartal > Flashcards

Flashcards in OB Infertility and Antepartal Deck (107):
1

incompetent cervix

Incompetent cervix _ when weight of what inside uterus ~ 1lb = 20-22 wks then the cervix just opens up without contractions

2

what can be done to fix incompetent cervix during pregnancy

stitch it close during pregnancy, but very irritating to cervix;

usually know incompetent because mother has lots of prior preterm labor

3

Healthy male repro function requirements for conception

Adequate Sex drive
Ability to obtain normal ejaculation
Ability to transmit sperm to female vagina

4

uterus must not be __________ for healthy conception

scarring

5

bicornuate uterus

heart shaped uterus due to septum in middle; baby can only implant on one side so baby will be very cramped, and mother will have preterm labor/miscarriage

can have to cervixs if septum goes all the way down

6

Primary infertility

Primary: couple has never conceived, despite unprotected intercourse
For at least 12 months

7

Secondary infertility

Secondary: Has previously conceived, but is subsequently unable to conceive
within 12 months despite exposure to unprotected intercourse.

8

definition of infertility for men

For males: Inability to impregnate a female after 12 months regular unprotected intercourse.

9

definition of infertility for women

inability to achieve and bear a living child after 12 months of regular, unprotected intercourse

10

recurrent pregnancy loss

The woman is able to conceive but unable to produce a live birth (unable to carry fetus to viable age).

11

When are couples generally most fertile

~25 yo

12

Healthy reproductive anatomy and physiology including:

Vagina: no scarring obstructions

Normal cervical mucus to allow passage of sperm to upper reproductive track

Cervix: no scarring

Uterus: no scarring and correct shape no septum

Fallopian tubes: must be patent, so motility must be present

Regular ovulatory cycles: 14 days prior to when she is supposed to start next period. Because she needs those 14 days for implantation. So, sometimes if too soon in a woman you see chronic misscarriage

Adequate Progesterone to maintain pregnancy

13

10-50% below female baseline weight will decrease

fertility

14

fertility r/t obesity

at least 12% of infertile couples have an abnormal body weight as a cause for their infertility and 70% of women will conceive if their weight disorder is corrected. Male obesity causes low sperm count and poor sperm motility.

15

male obesity re: fertility

low sperm count

16

HTN in med, but rather the meds to treat HTN can cause

erectile dysfunction

17

men responsible for

20% of couple infertility

18

women responsible for % of infertility in couples

40%

19

chlamydia and gonorrhea re: fertility

chlamydia and gonorrhea these can cause infertility bc typically do not seek treatment quickly and that causes scarring and adhesions

cause scarring both male and female repro tracts

20

ruptured appendix and peritonitis can cause

pelvic inflammatory disease and so decrease infertility

21

ectopic labors put at risk for

infertility

22

Pituitary tumors affect

FSH and LH so can cause infertility

23

Stress is a factor in infertility, but

many couples do not take favorably to this even though this is a factor due to infertility

24

increase or decrease in thyroid hormone can?

affect ovulation

25

Fibroids

can be benign and get still pregnant, but MANY INTERFERE with pregnancy

26

Illegal terminations put at risk for

damage or infection

27

Alcohol re infertility

decrease conception and increase in spontaneous loss

28

tobacco infertility

decrease conception and increase spontaneous
and sperm quality affected

29

sickle cell infertility

decreased placental perfusion

30

Cryptorchidism

Cryptorchidism: undescended testes at birth can increase rate of testicular cancer, usually come down by yr old, if don't then have to do surgery.

31

oligospermia

inadequate number of sperm, drugs, weed, tobacco, ETOH

32

Orchitis

inflammation of testes, w/ any infection bad for fertility

33

Mumps in kids before puberty _____ but after puberty ____

in men especially before puberty ok but after puberty bad for infertility.

34

autoimmune response to own ______ can happen in men

autoimmune to sperm can occur

35

Does technique and timing affect fertility?

Yes, most direct way to get sperm into female tract is missionary. So, will discourage female from being on top. Will suggest put hips on pillow and woman stay there on pillow with hips elevated.

Timing - critical there is that time 14 days after; cervical mucus changes

36

antibodies to sperm?

possible women have antibodies to sperm, so literature suggests wear condoms except during ovulation

37

Autoimmune disorders can cause what in pregnancy

spontaneous abortion

38

Men generally produce sperm until?

death

39

frequency of intercourse

couples that have intercourse once a wk 17% will achieve within 6 mo and goes up with number of times of intercourse

Recommend having sex every other day.

40

Timing of intercourse re: fertility

_ Egg is penetrable for 12-24 hours
_ Every other day beginning 3-4 days prior to ovulation and continuing for 2-3 after the expected time of ovulation may be best chance
_ Sperm survive ~ 72 hours

41

Multiple Sex Partners Infertility issues

_ Increased risk of STIs for both partners and PID for females
_ Increased for cervical dysplasia, thus cervical incompetence
_ Increased risk of female developing antibodies to sperm, but this is rare

42

Weed

zaps sperm count, undeniably

43

Evidence about elective abortions and fertility?

There is NO evidence that there is increased risk of infertility with first trimester elective terminations.

44

Initial consultation of infertility

good initial education about timing of intercourse, get on prenatal vitamins, manage chronic diseases etc.
generally will not treat after 1st year

45

Urologists see men with ____________ problems

infertility

46

Partners are interview ___________ and then they are interviewed _______________ for infertility assessment

interviewed together and then separately

because men and women are reluctant to speak about past sexual history

47

Least __________ procedures for infertility done first

invasive

48

fertility clinical female hx:

Selected aspects of history and physical exam: chronic diseases, nutrition, meds, surgeries, menstrual hx, menarche, freq, duration, problems, symptoms of ovul, LMP, sexual hx, STI, PID, Prev Preg, Age at conception, intervals of unprotected intercourse, loss of any preg, freq of current intercourse, pain, social hx, lifestyle, work, stress, smoking drugs

49

fertility clinical male hx

Selected aspects of history and physical exam.: chronic illness, mumps after puberty, damage to testes/trauma, sexual and reprod hx, STI, previous fathering, social hx, occupation, heat exposure, toxic substances, lead, radiation, type of underwear, use of hot tubs, substance use, ETOH

50

Taking ______________ ________________ ______________ is vital to infertility

basal vital temperatures really helpful

51

BBT DX test

As ovulation approaches, production of estrogen increases and at its peak may cause a slight drop, then rise in the basal temp. After ovulation there is a surge of luteinizing hormone (LH), which stimulates production of progesterone. Because progesterone is thermogenic it causes a 05-1 degree F sustained rise in basal temp during the second half of the menstrual cycle. At menses, temp falls.

52

Sperm Analysis DX test:

if done at home, must be brought in within 1 hour. Normal: greater than 20 million/ml, greater than 50% forward progression

MUST BE COLLECTED 2-3 days after abstinence

53

Tests for Ovulation & Ovarian Hormone Function: Serum Progesterone DX Test

need increased progesterone for pregnancy, so check levels

54

Endometrial Biopsy DX test

must be done late in cycle to determine proper development; performed 2-3 days prior to menses

55

Tubal patency Tests: Hysterosalpingogram DX

shoot dye up to check patency of fallopian tubes; dye shooting can clear; so have to do it before ovulation or will kill the blastocyte.

56

Hysteroscopy or Laparoscopy:

scope inserted to view internal structure; scan also remove adhesions

57

uterine treatments

clear adhesions, meds for endometriosis

58

tubal treatments

can try tubal repair

59

ovarian treatments: Clomid

clomid stimulates ovaries to ripen follicles and release eggs; actually induces ovulation in 70% of women (30-40% of those achieve pregnancy)

10% multiple conception rate with this drug
Timing is crucial with taking the drug and intercourse
SEs: HA, mood swings, weight gain, and visual disturbances

60

Sperm production Tx:

try to correct causes of low count
Can surgically deposit sperm; i.e., therapeutic insemination

61

Shared causes tx:

many different technologies

62

Issues surrounding fertility

ethical, insurance cost, issues around embryos fertilized outside of the body - women's bodies were not made to carry litters of babies. Risk to multiples - some survive being barely viable. Psychosocial issues - denial, blame, what do wrong, starting later, too many partners, GRIEF RESPONSE, embarrassment, unfairness (how can 13 yo have a baby easily and bad care and I not?), DEEP SADNESS WITH EVERY PERIOD EVERY MONTH (FIRST SIGHT OF BLOOD), grandparent pressure, and being very difficult to talk about.

63

Routine assessment of fetal health done at

each prenatal visit

64

Interim assessment is done by

Interim assessment is done by the mother
*fetal movement recording - kick counts (starts at 28 wks; 3X a day 20-30 min.

65

fetal kick count observations requiring healthcare provider follow-up

_ Call provider anytime- fewer than 10 movements in 3 hours, decrease in fetal movements, abrupt change in fetal movements, no movement in the morning, fewer than 3 movements in 8 hours

66

fetal movement influenced by

time of day, gest age, glucose load, smoking, meds, fetal sleep

67

fundal height should correlate w/?

symphasis pubis to top of funds this should correlate with date

68

Milestone FHT and baby activity

ex: if 15 wks and no fetal heart tones, should be able to hear, so either wrong conception date, or baby not alive. So FHT and Activity need to match up

69

ultrasound first trimester

*MUST BE DONE PRIOR TO GENETIC TESTING
*detect multiples
*detect maternal abnormalities
*good for confirming viability,
*confirm multiples
*check for ectopic
***earlier done the more accurate it is for dating the bay, so 5 wk ultrasound confirms very well, accurate w/n day or 2***

70

ultrasound second trimester

*better than nothing for confirming date but not as accurate as first trimester
*confirm viability
*External Cephalic Version
*amniotic fluid volume
*detect congenital anomalies
*Look for IUGR
*confirm placental placement
*visual for amnioscentesis

71

ultrasound third trimester

*IUGR
*head in tact/size
*macrosomia = baby too big
*congenital anomalies
*fetal position
*previa
*abruption - placenta pulls away from uterine wall
*external aversion
*amnioscentesis
*BPP - biophysical profile
*amniotic fluid volume
*doppler flow study

72

BPP about

biophysical profile
electronic fetal monitoring and ultrasound combined to score baby in five areas; two points if there, if not there 0 and no partial credit like 1 in APGAR
CRITERIA VERY SPECIFIC - but will not ask specifics

73

Doppler Blood Flow Analysis

used with mothers suspecting IUGR, looking for properly perfused placenta.

UPI = Uteroplacental insufficiency

74

UPI

Uterplacental insufficiency if determined by doppler blood flow analysis to determine whether baby better inside or outside

75

amnioscentesis

*Taking fetal cells and growing them this is DIAGNOSTIC
*lung maturity = test for surfactant
*chromosomal analysis
*Left lateral tilt to prevent hypotension due to
pressure on inferior vena cava
*if just ultrasound you want bladder full
*if doing amnio want bladder empty because can nick it
*complications - vaginal spotting, amnio leaking, injuries

76

quadscreen

SCREENING TOOL - it screens, if abnormal value it will recommend further testing on confirm or DX anything
*maternal serum afp
*detects 80-90%
*4 things: Alphafetoprotein (AFP), human chorionic gonadotropin (hcg), unconjugated estriol (UE), and inhibin-A.

77

Alpha Fetal Protein

found in Mom's serum, this helps detect neurotube defects, so will do ultrasound to confirm; these things are not chromosomal so amnio not done because structural, but found that trisomies have very very low AFP and so will try to look for trisomy on

78

Chorionic Villus Sampling (CVS):

Diagnostic, detect genetic abnormalities, limb defect if done before 10 wks so why not done before 10-12 wks; may be better for genetic abnormalities.

79

Non-Invasive Prenatal Testing (NIPT):

*ACOG RECOMMENDED
*NOT FDA approved yet; highly accurate but not diagnostic, so considered SCREENING;
*Fetal genetic fragments found in mother's blood done at 10 wks
*DETECTS TRISOMY 21&18 with 99% accuracy, 13 (79%), 1% false positive rate
*Indications: abnormal quad screen and maternal age
*DOES NOT DETECT NEUROTUBE DEFECTS

80

Non stress test (NST)

*does not use ultrasound
*WANT REACTIVE NST, nonreactive may require follow-up
*FHR monitor around mom
*detects fetal movements; looking for accelerations with movement
*NO CONTRAINDICATIONS, INEXPENSIVE, NO REASON NOT TO DO
*Pattern of fetal heart rate can be affected by numerous factors
*wake baby up with acoustic vibrator

81

Pattern of fetal heart rate

not do well if: hypoxic, acidodic, drugs, congenital defects, or sleeping

82

contraction stress test

what is baby's heart rate in reaction to a contraction. So, mother could be having natural contractions or have them in some way we made her have.

**CONTRAINDICATIONS - PRETERM, OR THIRD TRIMESTER BLEEDING, OR ANYONE WHO SHOULD NOT HAVE CONTRACTIONS
*INDICATIONS IF BABY IS GOING TO TOLERATE BEHAVIOR
*NEGATIVE IS GOOD no late decels while positive is bad because had some latex

83

Tests for lung maturity

*use amniotic fluid
*always measuring surfactant _ L/S or Lecithin/Sphingomyelin surfactant ratio:
*2/1 ratio considered mature
* Phosphatidylglycerol (PG) another component of surfactant, study either positive or negative

*if blood contaminating amnio fluid not accurate

84

little bit of fetal stress can?

produce surfactant and cause lungs to mature, but we never intentionally stress fetus

85

TORCH

infections bad for pregnant women
*Toxoplasmosis
*Other
*Rubella
*Cytomegalovirus
*Herpes

86

toxoplasmosis

*cat feces, undercooked meats, bird droppings
*should not be changing liter box
*gardening wearing gloves
*eat only cooked meats
*wash vegatables
*90% asymptomatic
*can cause physical anomalies all depends on when contract it
*ONCE YOU HAVE TOXOPLASMOSIS YOU ARE IMMUNE, AT WORSE FEEL LIKE FLU THOUGH MOST ARE ASYMPTOMATIC, EXCEPT BAD TO CONTRACT DURING PREG. MISCARRIAGE
*transmission rate low, 15% at 1st trimester, but damage more severe - microcephaly, hydrocephaly, brain damage

87

syphilis

lesions and rash on baby
transplacentally
IUGR
spontaneous loss

88

rubella

*BLUEBERRY MUFFIN RASH - has to be a TORCH
*cannot get vaccine while pregnant, but if not vaccinated then in postpartum try to give rubella; don't want to get pregnant for a month after you had rubella

German measles microceph, visual, cardiac,
1in 4 women of childbearing IUGR, cataracts, petechial
Age non-immune, rash, hepatosplenomegaly
10-20% pop non-immune
Infants are infectious and should be isolated, may have rash, muscular aches, joint pain.
Vaccinate all children, young adult women and newly postpartum women who are non-immune.

89

first outbreak of herpes has?

most virus shedding and subsequent has a lot less
*mostly with herpes - transmission at time of L&D
*newborns are usually asymptomatic at birth but at 2-12 days of life fever
*baby can have systemic herpes and not get lesions
*CNS involvement likely
*active lesion only 50% transmission rate
*INFANTS WITH ACTIVE INFECTION HALF WILL DIE.
*HALF OF BABIES WITH SYSTEMIC HERPES ARE BORN TO WOMEN WITH NO HX OF THE DISEASE (MOTHERS MAY HAVE IT BUT DON'T KNOW IT) POSSIBLE TO TRANSMIT DISEASE FROM HANDS THOUGH
*NO ACTIVE LESION THEN VAGINAL BIRTH

90

Babys born to mom's with HPV r/t warts

babies can lyropharangeal warts from this, but rare

91

HBV

can be sexually transmitted
usually occurs during delivery or early post partum
***MOTHER CAN RECEIVE VACCINE WHILE PREGNANT****

Hep B: Transmission is sexually or through blood. Women can have: fever, jaundice, liver disease, malaise, PTL. Can be fatal
Newborns: Infection usually occurs during delivery or early PP
Hep B vaccine to all newborns. Mom can receive vaccine during preg.

92

HIV & pregnancy


Since mid-1990_s, a 90% decline in the number of children perinatally infected in the United States.

*All pregnant women should be screened
*18% of all people with HIV do not know their HIV status,
*Can occur in preg and breastmilk but most occur in L&D.
*good drug management, down to 1-2% with good drug management and C-Section at 38 weeks prior to ROM.

93

Transmission of HIV with no treatment

only 25%, but if do c-section before membrane rupture they can prevent transmission to children and cut it down to 1-2%; NO BREAST FEEDING

94

Prognosis for HIV infected child

very very poor

95

Nearly _________ woman is GBS at some point.

*every woman is GBS positive at some point
*just give mother antibiotics during labor and decrease transmission to almost zero.
*only 10% cases fatal
*Bring mother in, give antibiotics, and induce her SLOW

_ Women who have previously given birth to a baby with GBS should be treated.

_ If status is not known in labor, if she is preterm, ROM longer than 18 hours or has a temp of 100.4_. TREAT.

No treatment necessary if:
_ C-section and intact
_ Previous +GBS culture but now is -

96

Leading cause of neonate sepsis

GBS

97

Biophysical Profile (BPP) five scoring areas

*Fetal Breathing Movements
*Fetal Movements
*Fetal tone (i.e. extension and flexion)
*Amniotic Fluid (oligo too little)
*Fetal Heart Rate Reactivity (movement of baby associated with increase of HR)

98

Full bladder is a requirement for an ultrasound by itself because?

*bladder nice landmark
*early pregnancy the bladder pushes up uterus so can more easily visualize

99

placental previa

when placental partially or totally covers the cervix

100

External Cephallic Version

Another way of saying "Breech Baby" that is the head is facing up towards chest rather than down towards pelvis

101

Confirmation of Baby as HIV Positive

A child less than 18 months of age is categorized as definitely HIV infected if mother HIV positive and baby has 2 virologic HIV-positive results from separate specimens.

102

chlamydia and pregnancy woman

*still birth
*postpartum endomitritis = i.e. postpartum infection
*rupture membrane
*preterm labor
*pain and discharge
*bleeding post coidus
*cervicitis - inflamed cervix

103

chlamydia and fetus

*conjunctivitis - pink
*chlamydial pneumonia
*ophthalmia neonatorum - tissue inflamation around eyelids

104

gonorrhea and pregnant woman

PROM - premature rupture of membranes
preterm labor
pain urinating discharge
miscarriage
chorioamnionitis - inflammation of fetal membranes i.e., amniotic membrane etc

105

gonorrhea and fetus

*IUGR
*ophthalmia neonatorum - can lead to blindness
*Sepsis and meningitis

106

syphilis and pregnancy/fetus

charted as BDRL
*spontaneous loss
*preterm loss/still birth
*fetal demise
*growth restriction

107

rubella about immunity and mothers

1 in 4 women of childbearing age are non immune, and doesn't mean didn't get shots but DIDN'T KEEP IMMUNITY; CANNOT GET VACCINE WHILE PREGNANT, BUT TEST YOU FOR IMMUNITY WHILE PREGNANT AND SHOT IN POSTPARTUM