Maternity Exam 1 Study Notes

• Study notes for Maternity Exam 1.

Pelvic Exams

• Performed in the lithotomy position.
• Used to inspect both external and internal genitalia annually.
• Inspection includes vulva, labia, cervix, vaginal walls, and uterus.
• Speculum utilized to open vaginal walls for internal inspection and sample collection.

Pap Smears

• Tests for cervical cancer and HPV.
• Recommended every 3 years for women aged 21-65.
• Recommended every 5 years with HPV co-testing for women 30-65.

Colposcopy

• Uses a colposcope to examine the cervix and detect abnormalities.
• Often follows an abnormal Pap smear.

STIs

• Common types include chlamydia, gonorrhea, syphilis, HIV, and trichomoniasis.
• Symptoms include discharge, itching, and painful urination.
• Treated with antibiotics like azithromycin for chlamydia and penicillin for syphilis.
• Key education to complete the full antibiotic course and practice safe sex.
• HIV in pregnancy requires routine testing and antiviral treatment to reduce transmission.

PID

• At-risk groups are typically young women, those with multiple sexual partners, and individuals with a history of STIs.
• Symptoms include pelvic pain, fever, vaginal discharge, and painful intercourse.
• Treatment combines antibiotics prenatally via oral and intramuscular routes.

Breast Self-Exams

• Should be performed 5-7 days after menstruation.
• Use pads of fingers to check for lumps using circular motions while lying down with a pillow under your shoulder and your arm behind your head.

Fibrocystic Breast Changes

• Expected findings include lumpy, tender breasts, especially before menstruation.
• Management includes decreasing sodium and caffeine intake.

Breast Cancer

• Screening methods include mammograms starting at age 40, self-breast exams, provider exams, genetic testing, biopsy, and ultrasound.
• Treatment includes surgery, radiation, and chemotherapy.
• Common side effects are fatigue, nausea, and hair loss.

Oral Contraception

• Prevents pregnancy by suppressing ovulation.
• Side effects include nausea, weight gain, and mood changes.
• Missed dose: Take as soon as remembered, or use backup contraception if needed.
• Contraindications include thromboembolic disorders, stroke, heart attack, CAD, gallbladder disease, cirrhosis, or liver tumor.
• Can have medication interference with antibiotics, anticonvulsants, and antifungals.

IUD

• Inserted through the cervix and placed in the uterus, releases a chemical substance to damage sperm.
• Side effects include the risk of PID, irregular bleeding, uterine perforation, bacterial vaginosis, or ectopic pregnancy.

Condom Use

• Education should include use on an erect penis, checking for expiration, and using water-based lubricants.

Diaphragm Use

• Can be inserted up to 6 hours before intercourse and must stay in place for 6 hours after intercourse, but for no more than 24 hours.
• Spermicide must be reapplied with each act of coitus.
• Empty bladder before insertion.
• Wash after use.
• Contraindications include a history of toxic shock syndrome (TSS), cystocele, uterine prolapse, or frequent recurrent UTIs.

Basal Temperature

• Tracks ovulation by recording body temperature changes.
• Measure temperature first thing in the morning before getting out of bed; temperature will rise slightly after ovulation.
• Must use a thermometer that records temperature to the tenths; this method is inexpensive, convenient, and has no adverse effects.

Emergency Contraception

• Must be taken within 72 hours of unprotected intercourse.

Infertility

• Factors: not enough eggs, scarring or clogging of the fallopian tube, uterine fibroids, endometriosis, and age (over 35).
• Can use hormone analysis, hysterosalpingography, semen analysis, ultrasound of testicles.
• Can use IUI and IVF which can cause multiple gestations.

Labs Tested in Pregnancy

• Common labs include blood type, Rh factor, CBC, glucose tolerance test, HIV, rubella titer, and group B streptococcus (GBS).
• Determines the risk for maternal-fetal blood incompatibility or neonatal hyperbilirubinemia.

Conception and Development Timing

• Conception: Fertilization of the egg by sperm.
• Implantation: Occurs 6-10 days after conception.
• Embryo stage lasts from 15 days to 8 weeks, followed by the fetus stage from 9 weeks to birth.

Signs of Pregnancy

• Presumptive: can only be felt by the mother.
• Amenorrhea (absent period), breast enlargement and soreness, nausea/vomiting, and quickening.
• Probable: Think "Doctor"
• Goodell's Sign (softened cervix), Chadwick's Sign (bluish color of the vulva, vagina, or cervix), Hegar's Sign (lower uterine segment soft), ballottement, and a positive pregnancy test.
• Positive: Think “Baby”.
• Fetal heart tones, fetal movement by the provider, and visualization by an ultrasound.

Changes during Pregnancy

• Quickening: first sensation of fetal movement felt by the pregnant person.
• Timing: Occurs between 16-20 weeks of gestation.
• Ballottement: Provider pushes up on the cervix during a pelvic exam, causing the fetus to move up and then rebound back down, which can be felt by the examiner.

Physical Changes in Pregnancy

• Integumentary - Skin Changes
• Striae Gravidarum (stretch marks), Chloasma "Mask of pregnancy” (hyperpigmentation of the cheeks, nose & forehead, Palmar Erythema (red, mottled appearance of the hands), Linea Nigra (vertical black line on belly), and Montgomery Glands.
• Musculoskeletal Changes
• Lordosis (inward curve of the spine), low back pain, carpal tunnel syndrome, calf cramps, and diastasis recti syndrome (stretching of the abdominal wall).
• Renal Changes
• Increased GFR, smooth muscle relaxation of bladder and renal pelvis and increased risk of UTI, increased urgency, frequency, nocturia, and progesterone.
• Hematological Changes
• Decreased hemoglobin/hematocrit and fibrinogen: increased risk of blood clots.
• Cardiovascular Changes
• Increased cardiac output, heart rate, stroke volume, and blood volume.
• Blood pressure stays the same.
• May develop a systolic murmur.
• Hypercoagulable

Respiratory

• Increased basal metabolic rate and O2 needs.
• Mild respiratory alkalosis.
• Chest increases in size to allow for fetal growth and lung expansion.
• Increased vascularity of the upper respiratory tract.

Gastrointestinal, Endocrine, and Hormone Changes

• Gastrointestinal: Nausea/Vomiting, Pyrosis (HeartBurn), Constipation, Hemorrhoids, PICA, and Swollen mouth & gums.
• Endocrine: Thyroid function is affected, and Gestational diabetes.
• Key hormones: hCG, Progesterone, and Estrogen.

Exercise during Pregnancy

• Kegel exercises squeeze and hold and this is done BEFORE, DURING AND AFTER pregnancy.
• Kegel exercises and involves contracting and relaxing the pelvic floor muscles.

Naegele's Rule

• Calculating estimated due date by using the first day of the last menstrual period (LMP), subtract 3 months + 7 days, + one year.
• Expected weight gain related to pre-pregnancy BMI.

Fundal Height and Nutrition

• Fundal height corresponds to the number of weeks of gestation between 18 and 30 weeks and aapproximates gestational age.
• Folic acid, protein, omega-3 fatty acids, iron, calcium, caloric intake, and caffeine
• Excess caffeine can lead to intrauterine growth restriction.

Immunizations

• Recommended: Tdap (Tetanus, Diphtheria, and Pertussis), Hepatitis B, and Influenza.
• Contraindicated: attenuated vaccines due to the risk of fetal infection.
• Measals, mumps and chicken pox

Medications, Risk Factors and Things to Avoid

• Rhogam prevents Rh incompatibility and is usually given at 28 weeks gestation.
• Ambivalence refers to mixed feelings about pregnancy and can be associated with certain age groups.
• Adolescents and elderly above 35 are at risk.
• TORCH infections such as Toxoplasmosis is important to avoid during pregnancy.
• Teratogenic drugs such as Thalidomide is important to avoid during pregnancy.