Reproductive System Flashcards

(131 cards)

1
Q

Location of the breast

A

2nd-3rd rib to the 6th-7th rib; from the sternal margin to the midaxillary line

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2
Q

Male breast anatomy

A

consists of a small nipple and areola overlying a thin layer of breast tissue

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3
Q

Anatomy of the breast

A

Composed of glandular, firbrous tissue and subcu and retromammary fat.
Glandular tissue contains 15-20 lobes per breast that radiate to the nipple
Each lobe has 20-40 lobules

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4
Q

Acini Cells

A

Each lobule consists of milk-producing cells that empty into lactiferous ducts
Small and inonspicuous in nonpregnant/nonlactating women

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5
Q

Cooper ligament (suspensory ligament) and muscles supporting the breast

A

Extends through the breast, attaching to the underlying fascia, providing further support
Pectoralis major, minor, serratus anterior, latissimus dorsi, subscapularis, external oblique and rectus abdominis

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6
Q

Arteries of the breast tissue

A

Internal mammary artery, and lateral thoracic artery

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7
Q

Proportions of glandular tissue vary with

A

age, nutrition, pregnancy, lactation and genetics

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8
Q

Four quadrants of the breast

A
Upper inner 
Lower innner
Lower outer 
Upper outer - largest amount of tissue 
Tail of Spence - tissue extending into axilla
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9
Q

Nipple is composed of smooth muscle innervated by

A

tactile, sensory and autonomic stimuli

causes erection of nipple and lactiferous ducts to empty

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10
Q

Montgomery Tubercles

A

Sebaceous glands found on the areolar surface

Hair follicles found here too

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11
Q

Supernumerary nipples or breast tissue

A

Sometimes present along the mammary ridges that extends from the axilla to the groin

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12
Q

Lymphatics network of breasts

A

Superficial lymphatics drain the skin

Deep drain the mammary lobules

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13
Q

Axillary lymph nodes

A

easier to palpate when enlarged
anterior axillary (pectoral) nodes are located along the lower border of pec major
Midaxillary (central) high in axila close to ribs
Posterior axillary (subscapular) - lateral scapula, deep axillary psosterior fold
Lateral axillary (brachial) felt along upper humerus

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14
Q

Thelarche

A

Breast development
First sign of puberty
Occurs earlier in blacks

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15
Q

Onset of menses

A

Stage 3 = 25%
Stage 4 = 75%
Stage 5 = 10%
Appearance of breast bud (stage 2) to menarche is 2 years

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16
Q

Changes in pregnanct women

A

Luteal and placental hormones cause lactiferous ducts to proliferate and the alveoli to increase in size in number
Breasts enlarge 2-3x
Softer and looser
Colostrum is produced and accumulates in alveoli towards end of pregnancy

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17
Q

Areolar changes and vascularization in pregnant

A

Deeply pigmented and diameter increases
Nipples are prominent, darker and more erectile
Montgomery tubercles develop as sebaceous glands hypertrophy
Veins engorge and are visible on surface of skin

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18
Q

Lactating women

A

Colostrum secretes from breasts after delivery

Contains more protein and minerals then mature milk, antibodies and resistance factors

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19
Q

Surging prolactin levels 2-4 days after pregnancy

A

Milk production replaces colostrum in response to prolactin, estrogen, and stimulation of sucking
Breasts become full and tense as alveoli and lactiferous ducts fill
Tissue edema, delay in ejection reflex, produce engorgement

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20
Q

Termination of lactation

A

involution occurs over a period of 3 months
Breast size decreases without loss of lobular and alveolar components
Breasts rarely return to prelactation size

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21
Q

Older Adults

A

Menopause causes atrophy of grandular tissue and is replaced by fat
Inframmamary ridge at lower edge of breast thickens
Relaxation of suspensory ligaments lowers breasts
Nipples become small and flat and lose erectile ability
Skin becomes dry and thin, loss of axillary hair

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22
Q

Nonmodifiable risk factors for breast cancer

A

Age, gender, genetic factors (BRCA1 and BRCA2)
Personal Hx of breast cancer
FH
Previous breast biopsies
Race - white
Previous breast radiation (Hodgkin lymph)
Menarche before 12 and menopause after 55
Breast Density - more dense or fatty
Diethylstilbestrol therapy

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23
Q

Modifiable risk factors for breast cancer

A
Childbirth - nulliparity/late age of first child birth 
Hormone therapy - HRT after menopause 
Alcohol
Obesity/high-fat diet
Lack of PA
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24
Q

Breast inspection

A

compare size, symmetry, contour, skin color, texture, venous pattern and lesions
Check skin under each breast
Convex, pendulous, or conical
One breast is smaller then other
Male breasts are even c chest wall, obese men have a convex shape

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25
Skin texture on inspection of breasts
Smooth, contour should be uninterrrupted | Retractions or dimpling may indicate fibrotic tissue associated c carcinoma
26
A peau d'orange (orange skin)
indicates edema caused by blocked lymph drainage in advanced inflammatory breast cancer. Thick skin c enlarged pores healthy skin may look similar if pores are large
27
Venous network inpection of breasts
May be visible Pronounced in pregnant or obese women Patterns should symmetric Unilateral patterns produced by dilated superficial veins as a result of increased BF to a malignancy
28
inspection of nevi on breasts
Markings and nevi that are long-standing, unchanging or nontender are of little concern Changes in appearance of lesions always signal need for closer investigation
29
Inspection of nipples and areolae
Areola should be round or oval and bilaterally symmetrical Color ranges from pink to black Light-skinned women areola turns brown with the first pregnancy and remains dark Dark-skinned - areola is brown before pregnancy Nontender, nonsuppurative Montogomery tubercles is a common finding Surface should be otherwise smooth Peau d'orange seen on areola first usually
30
Contour of nipples
Most are everted If inverted, ask if always like that Recent inversion may signify malignancy Retraction is seen as flattening or pulling back of the nipple or areola, which indicates inward pulling by inflammatory or malignant tissue Firbrotic tissue of carcinoma can also change nipple axis, causing it to point in a different direction from other nipple
31
Color of nipples
Should be homogenous and match c areolae Smooth or wrinkled is OK, but free of crusting, cracking or discharge Color varies from light pink to very dark brown or black Inflammation of the sebaceous glands in areola can result in retention cysts that are tender and suppurative
32
Supernumerary nipples
More common in black women Occur mostly on embryonic mammary ridge They are pink or brown and mistaken for moles Can indicate congenital renal or cardiac abnormalities
33
Varied positions to inspect breasts
Seated c arms over head or flexed behind the neck | Tenses suspensory ligaments, accentuates dimples may reveal variations in contour and symmetry
34
Seated c hands pressed against hips c shoulder rolled forward
Contracts pectoral muscles | reveal deviations for contour and symmetry
35
Seated and leaning forward from the waist
Tension of suspensory ligaments Breasts should hang equally Helpful c contour and symmetry of large breasts Breasts should appear bilaterally symmetrical with an even contour and absence of dimpling, retraction or deviation
36
Chest wall sweep
Sit c arms at sides Sweep downward from clavicle to nipple feel for lumps
37
Bimanual Digital Palpation
Place palmar surface facing up under the patient's right breast Place finger of other hand over breast and walk over tissue feeling for lumps as you compress tissue between your fingers and your flat hand
38
Virchow Nodes
Supraclavicular and Infraclavicular Turning pt head to side being palpated and raise the same shoulder Bend pt head forward Sentinal nodes are indicators for invasion of the lymphatics by cancer
39
Three depths of palpation
Light, medium and deep Vertical strip - palpate down then up Circular - start at the outermost edge of breast tissue and work inward Wedge - palpate center and work out and repeat Avoid lifting your fingers
40
Breast mass characteristics
Location, size, shape, consistency, tenderness, mobility, borders, retraction, dimpling
41
Nipple compression
Palpate nipple well (behind nipple) Only should be done if pt reports discharge Is discharge bilateral or unilateral Single duct or multi duct? Concern = unilateral and from a single duct
42
Expected findings during a breast examination - FEMALE
Breast tissue will feel dense, firm and elastic Soft nondiscrete bumps diffusely dispersed throughout breast tissue Fine, granular feel in older women Inframammary ridge felt along lower edge of breast, which can be mistaken for a breast mass
43
Common response to hormonal changes during menstrual cycle
Cyclical pattern of breast enlargement, increased nodularity and tenderness Most likely premenstrually and during menses Least noticeable after menses
44
Expected findings during a breast examination - MALE
Thin layer of fatty tissue overlying muscle Obese men have thicker fatty layer - giving appearance of enlargement A firm disk of glandular tissue can be felt
45
Breasts of infants
enlarged from passively transferred maternal estrogen "Witch's milk" squeezed out of breast bud Enlargement rarely larger then 1 to 1.5 cm in diameter Disappears in 2 weeks and rarely lasts beyond 3 month
46
Breasts - Children and Adolescents
Asymmetry Breast tissue is homogeneous, dense, firm, and elastic Subareolar masses transient and common unilaterally or bilaterally in males Firm, tender, are concerning to patients Gynecomastia caused by illicit drugs. Biopsy may be required, usually temporary and benign
47
Examination in patients with mastectomy
Pay attention to scar, reoccurence of malignancy is typical at scar site Inspect for swelling, lumps, thickening, redness, color change, rash or irritation Note muscle loss or lymphedema Palpate surgical scar for swelling, lumps, thickening, or tenderness Palpate lymph nodes axillary and clavicular Perform normal breast exam even in those c a lumpectomy , augmentation, or reconstruction
48
Breast changes in pregnant
Enlargement during first trimester Sensation of fullnss c tingling, tenderness and bilateral increase in size Assess if pt is using adequate support
49
Nipples during pregnancy
``` Enlarge and more erectile Flattened or inverted Crust from dry colostrum can be evident Expect to see areolae that are broad and dark Montgomery tubercles are common ```
50
Palpation of pregnant breasts
Reveals generalized coarse nodularity and lobular feel d/t hypertrophy of the mammary alveoli Dilated subcu veins may create network of blue tracings across breasts
51
Telangiecstasias (spider angiomas)
``` Second trimester May develop on upper chest, arms, neck and face D/t elevated estrogen Bluish and do not blanch Striae may be evident ```
52
Inspection of breasts during lactation
Assess if there is an adequately fitting bra Palpate for degree of softness Full breasts that are firm, dense and slightly enlarged may become engorged Engorged breasts are hard, warm and are enlarged, shiny and painful Occur 24-48 hours May also be a sign of mastitis
53
Clogged Milk Ducts
Common in lactating women Inadequate emptying or a tight bra Creates tender spot that is lumpy and hot Frequent breast feeding, application of hear Can lead to mastitis
54
Nipples during lactation
Irritation signs (tender, red) Look for blisters or petechiae Cracked nipples may be sore or bleeding Lighter-color nipples more prone to damage Nipple damage d/t breast feeding After lactation, retain color and become less firm then pre-pregnant
55
Breast in postmenopause
Flat, elongated and more loose Smaller and flatter nipples Finer granular feel on palpation replaces lobular feel of glandular tissue Inframmatory ridge thickens and can be felt more easily
56
Vaginal Anatomy
Vulva, mons pubis, labia majora, labia minora, clitoris, vestibular glands, vaginal vestibule, vaginal orifice and urethral opening Symphysis pubis is covered by a pad of adipose tissue called mons pubis or mons veneris
57
Hymen
Connective tissue membrane that may be circular, crescentic or fimbriated After hymen tears and becomes divided, the edges either disappear or form hymental tags
58
Bartholin glands
secrete mucus into the introitus for lubrication
59
Vaginal Angle
45 degree posterior incline with the vertical plane of the body Anterior wall of vagina is separated from the bladder and urethra by connective tissue called the vesicovaginal septum Posterior wall separated from rectum and retrovaginal septum
60
Uterine Cervix
Dvidied into anterior, posterior and lateral fornicies | Internal pelvic organs can be palpated through these walls
61
Vagina
Menstrual flow from uterus, serves as terminal portion of the birth canal, and is receptive organ for penis
62
Uterus
Sits between bladder and rectum in pelvic cavity | Covered by the peritoneum and lined by endometrium, which is shed during menstruation
63
Pouch of Douglas
Formed by perotineum as it covers the lower posterior wall of the uterus and upper portion of the vagina separating it from rectum Flattened and inclined at 45 degree angle Can be anteverted, anteflexed, retroverted or retroflexed
64
Nulliparous uterine size
5.5-8cm long 3.5-4cm wide 2-2.5cm thick Parous women may have 2-3cm larger Nulliparous weight is 40-50g Multiparous is 20 to 30g heavier
65
Adnexa
comprises fallopian tubes and ovaries Each tube is 8-14cm and supported by mesosalpinx Rhythmic contractions of the tubal musculature transport the ovum to the uterus
66
Function of the ovaries
Secrete estrogen, progesterone which control menstrual cycle and support pregnancy
67
True pelvis
Lower curved bony canal, including the inlet, cavity, and outlet; fetus must pass through these during birth
68
Adolescence
Endometrial lining thickens and prepares for the onset of menarche Average age of menarche is 12-13 years Irregular menstrual cycles are not unusual during childhood as a result of anovulatory cycles (without ovulation)
69
Uterine enlargement
Occurs during first trimester due to estrogen and progesterone levels Third months causes enlargement d/t to fetal enlargement 12 weeks is reaches into abdominal cavity
70
Relaxin and progesterone
Softens pelvic cartilage, allowing mobility and "waddle" gait Resolution 3-5 months postpartum Lordosis likely
71
Increased uterine BF and lymph
Pelvic congestion and edema Chadwick sign - bluish color of cervix as a result of the uterus, cervix and isthmus softening Goodell sign - softening of cervix Mucus in cervical canal prevents infection of infant Vaginal canal can also exhibit bluish color
72
"Bloody show"
Dislodgement of the mucus layer in cervical canal | Exaggerated uterine anteflexion during first 3 months
73
candida infection
Acidic pH d/t increased in lactic acid production by vaginal epithelium prevents bacteria from multiplying but can cause candida infections
74
Older Adults - Endocrine changes
Ovarian function diminishes during woman's 40s Menstrual periods may cease but ovarian function may continue Median age of menopause is 51
75
Menopause
Defined as 1 year with no menses (amenorrhea) Estrogen levels decrease causing the labia and clitoris to become smaller Decrease in adrenal androgens and testosterone levels
76
Vaginal changes in older
Vagina constricts, narrows, shortens and loses rugae and mucosa becomes thin, pale and dry Dyspareunia - pain during intercourse Cervix becomes smaller and paler Uterus decreases in size and endometrium thins
77
Ovarian and pelvic changes in older
Ovaries decrease to 1-2 cm in size and becomes convoluted. Ovulation ceases 1-2 years before menopause Ligaments and connective tissue lose elasticity Vaginal wall loses integrity
78
Systemic effects of menopause
Increase in body fat and intraabdominal deposition of body fat - more of a male pattern distribution Total and LDL lipoprotein cholesterol increase Thermoregulation is altered - hot flashes common
79
Draping and Gloving
Cover knees and symphysis and depress the drape between her knees to see the woman's face Instruct pt you are going to begin, start with a neutral touch on her lower thigh, and move hand along thigh without breaking contact to the external genitalia
80
Inspection and Palpation
Hair distribution Notice mons pubis, labia majora Skin should be smooth and clean hair should be free of infestations
81
Labia Majora
Gaping or closed; dry or moist Symmetric, shriveled or full Soft and homogeneous tissue Look for excoriation, rahses or lesions associated c infection or inflammation Ask if female has been scratching Observe for discoloration, varicosities, stretching or signs of trauma or scarring Bartholin gland infection - labial swelling or redness or tenderness that is unilateral
82
Labia Minora
Separate labia majora Symmetric or asymmetric Inner surface should be moist and dark pink Soft, homogeneous tissue without tenderness Excoriation, inflammation, irritation, or caking of discharge which suggest vaginal infection or poor hygiene Discoloration or tenderness may be traumatic bruising Ulcers or vesicles = STI Palpate for irregularities and nodules
83
Clitoris
2 cm or less in length and 0.5 cm in diameter Enlargement may by masculinizing condition Observe for atrophy, inflammation or adhesions
84
Urethral Orifice
Appears as an irregular opening or slit Close or slightly within vaginal introitus, usually midline Inspect for discharge, polyps, caruncles and fistulas Cauncle is a bright red polypoid growth that protrudes from the urethral meatus; most cause no symptoms Irritation, inflammation or dilation suggest repeated UTIs or insertions of foreign objects Ask questions after the pelvic exam
85
Vaginal Introitus
Can be thin vertical slit or a large orifice with irregular edges from hymenal remnants Tissue should be moist Look for swelling, discoloration, discharge, lesions, fistulas and fissures
86
Skene and Bartholin Glands
Look for discharge and note any tenderness Note character if there is discharge Discharge from Skene usually means infection Palpate Bartholin glands at posterolateral portion of the labia majora noting tenderness, swelling, masses, hear or fluctuation Note discharge Swelling that is painful in infection of Bartholin gland
87
Perineum
Smooth, episiotomy scarring may be evident in women who have borne children Thick and smooth in nulliparous Thinner and rigid in multiparrous Should not be tender Look for inflammation, fistulas, lesions or growths
88
Anus
Darkly pigmented and coarse skin | Should be free of scarring, lesions and inflammation, fissures, lumps, skin tags or excoriations
89
Insertion of Speculum
Insert speculum the length of the vaginal canal and sweep upward to visualize the cervix.
90
Cervix- Color
Should be pink Blue indicates increased vascularity that indicates pregnancy Symmetric circumscribed redness around the os is expected finding Pale color indicates anemia Consider reddened areas as unexpected, especially if patchy or irregular borders
91
Position of Cervix
Should be anterior-posterior Retroverted = pointing anterior Anteverted = posterior Midposition = horizontal Deviation of the right or to the left may indicate pelvic mass, uterine adhesions or pregnancy Projection greater than 3 cm may indicate pelvic or uterine mass Childbearing women will have diameter of 2-3cm
92
Surface Characteristics of Cervix
Squamocolumnar epithelium may be symmetric reddened circle around os Cervical ectropion = eversion of endocervix collapses columnar epithelium Everted epithelium has a red, shiny appearance around the os that may bleed easily
93
Ectropion
Common in adolescents, pregnant women, or those taking estrogen-containing contraceptives Not abnormality
94
Nabothian cysts
Small, white or yellow, raised, round areas on the cervix Mucinous retention cysts of endocervical glands are considered expected Infected cyst may become swollen and distort the shape of the cervix vary in size and occur singly or multiples
95
Cervicitis, infection or carcinoma , cervical polyps
Friable tissue, red patcy, granular areas and white patches | Bright red, soft and fragile are cervical polyps
96
Usual discharge of cervix
Cervix or vaginal in origin Usual discharge is odorless, may be creamy or clear, may be thick, thin or stringy Heavier at midcycle or immediately before menstruation Bacterial or fungal infection will have an odor and vary in color from white to yellow, green or grey
97
Size and shape of cervix
Os of nulliparous is small and round or oval Mulliparous is horizontal slit c irregular or stellate Lateral, bilateral transverse or stellate scarring from childbirth
98
Bimanual Examination
Insertion of fingerss into the vaginal canal Palpate for smoothness, homogeneous, and nontender Feel for cysts, nodules, masses and growths
99
Bimanual Examination of Cervix
Feel for size length and shape Cervix is firm when nonpregnant and softer while pregnant Feel for nodules, hardness, and roughness Note position (pointing anterior or posterior) Should move 1-2cm Painful cervical movement suggests pelvic inflammatory disease or a ruptured tubal pregnancy
100
Examination of the Uterus
Deviations of the left or right could indicate possible adhesions, pelvic masses or pregnancy
101
Size, Shape and Contour of Uterus
Pear-shape 5.5-8cm long Larger in multiparous women If larger then normal during childbearing age is indicative of pregnancy, fibroid or tumor Countour = rounded, firm and smooth walls Fixed uterus = adhesions Tenderness = inflammation
102
Palpation of ovaries
firm, smooth, ovoid and 3x2x1cm in size Healthy ovary is moderately tender on palpation Marked tenderness, enlargement or nodules is irregular Palpate for adnexal masses Adnexa are generally difficult to palpate
103
Observe sphincter tone
Tight sphincter may be due to anxiety, scarring, or indicate spasticity caused by fissures, lesions or inflammation Lax sphincter is neurologic deficit Absent = improper repair after childbirth or trauma
104
Palpation of rectal wall
palpate for masses, polyps, nodules, strictures, irregularities, and tenderness Should be smooth and uninterrupted Palpate rectovaginal septum for thickness, tone and nodules May feel uterus if retroflexed
105
Palpation of the uterus
location, position, size, shape, contour, consistency and tenderness Used for retroverted uterus
106
Evaluate stool
and secretions | note color, presence of blood, prepare specimen for occult blood testing
107
Completion of Exam
Assist woman into a sitting position Provide sanitary pad if menstruating Either leave the room for her to dress then discuss findings or immediately discuss findings and ask her feelings on the exam
108
Changes in Infants
Use frog position Labia majora is widely separated and clitoris up to 36 weeks Majora and minora may be swollen, minora more prominent Hymen protruding, thick and vascular and may look like a mass enarged clitoris in newborns = congenital adrenal hyperplasia Imperforate hymen is rare but can cause difficulty Breech deliveries can cause bruised genitalia Unusual orifices in vulva should be explored prior to gender assignment whitish discharge common during newborn period - result of passive hormonal transfer from mother Adhesions common between minora during first months Sometimes cover vulva, may require separation Mucoid discharge common from irritation from diaper and powder
109
Indications for Examination - Children
Depend on age and parental concerns Inspection and palpation ONLY for well children Internal is performed when there is bleeding, discharge, trauma or suspected SA Bubble bath vaginitis does not require internal Parent may need to hold child at 30 degrees and at frog position Always necessary for a chaperone
110
Inspection and Palpation - Children
Anterior labial traction - view foreign bodies Bartholin and Skene glands usually not palpable Ask girl to cough and view hymen - if hymen bulge, if imperforated
111
Discharge - Children
Often irritates perineal tissues causing redness and excoriation Bubble bath, soaps, detergents and UTIs cause irritation
112
Injuries - Children
Swelling of vulvar tissues, accompanied by bruising or foul-smelling discharge should indicate SA Should be suspected if there is STI, or injury SA injuries are more posterior Use knee-chest position
113
Bleeding - Children
Unintentional, foreign body or SA | Further evaluation if precocious puberty
114
Rectal Examination - Children
Detect presence or absence of uterus or foreign body
115
Techniques for Adolescents
Most important examination Use models or illustrations Deep breathing, alternating tightening and relaxation Chaperone is necessary Increased secretions, stretched hymen before menarche
116
Gestational Age - Pregnancy
EDD - Estimated due date Naegle rule - add 1 year to the first day of LNMP, subtract 3 months and add 7 day Average duration of pregnancy is 280 days or 40 weeks
117
Uterus Size and Contour - Pregnancy
Estimate length of pregnancy, fetal growth and gestational age Use measuring tape to measure from upper part of pubic symphysis to superior uterine fundus 1cm inrease per week in fundal height is expected Twin pregnancy suspected if uterus is larger than expected during 2nd trimester based on EDD More than 2cm variation may indicated need for US
118
Factors affecting fundal height
Obesity, amount of amniotic fluid, multiple gestations, fetal size and position of uterus
119
Pelvic Exam - Pregnancy
``` Softened isthmus, firm cervix Second month - cervix, vagina and vulva acquire bluish color Cervix softens Fundus flexes easily Slight fullness and softening of fundus Increased vaginal secretions ```
120
Cervical Effacement and Dilation
Effacement - thinning of cervix, reducing length Shortening of cervix (less than 29mm) indicates preterm delivery Usually occurs before dilation in premipara Dilation - Opening of cervical canal to allow passage of fetus 10cm is complete dilation
121
Fetal Well-Being
Assess fetal heart rate and fetal movement Heard by doppler first then fetoscope Count FHR and compare it to mothers Note quality and rhythm
122
Fetal movement
Appreciated by mothers 16-20 weeks of gestation Cardiff count-to-10 method - mother counts 10 movements and noted length of time Usually 10 movements in 1 hour to 10 in 12 hours Fewer then 10 in 12 should alert HCP Risk factors for uteroplacental insufficiency, should start counting at 28 weeks
123
Leopold Maneuvers
Four steps used to assess fetal position
124
Presence of twins
Two fetal heart tones Abdominal palpation detects two distinct fetal parts Diagnose c ultrasound
125
Station
Relationship of the presenting part to the ischial spines of the mother's pelvis Vaginal examination and palpation are performed during labor to estimate the descent of presenting part Record findings for dilation, cervical length and station in that order
126
Contractions
Begin as early as the 3rd month of gestation Braxton Hicks contractions 4-6 contractions before 37 weeks needs evaluation Mild, moderate and strong - one that does not indent with fingertips Seconds from beginning to when relaxation occurs
127
Fetal Head Position
Vaginal exam when dilation has begun
128
Other pregnancy changes
Uterus more anteflexed during first 3 months from softening of the isthmus Fundus may press on bladder - increasing frequency
129
Examination in Older Adults
Older women likely to defer examination May need more time and assistance to get into lithotomy position Pts c orthopnea may need head raised and chest elevated
130
Inspection and Palpation of Older
Labia is flatter and smaller - loss of subcu fat Dry skin and shinier; clitoris smaller Relaxed perineal musculature will cause more posterior urinary meatus, almost into vaginal canal Introitus constricted, gaping, walls roll to opening Vagina is narrow, short, lack of rugae,, cervix less mobile Uterus smaller, hard to palpate and ovaries shrink Rectovaginal septum thin, smooth and pliable Anal tone diminished Look for incontinence and prolapse of uterus and vaginal walls Look for signs of inflammation, tenderness, trauma, mass, nodules, enlargement,
131
Alternative positions for pelvic exam
``` Knee-Chest Diamon shape Obstetric Stirrups M-shaped V-shaped ```