Obstetrics and Gynecology Overview

Obstetrics and Gynecology

• Pregnancy: Gestational age is categorized as 20-37 weeks (preterm), 37-42 weeks (full term), and after 42 weeks (post term).
• Gravida: Number of times a woman has been pregnant.
• Para: Number of pregnancies that have resulted in a live birth after 20 weeks.
• Nulligravida: Woman who has never been pregnant.
• Primigravida: Woman pregnant for the first time.
• Multigravida: Woman pregnant for the second time or more.
• Nullipara: Woman who has not had a live birth after 20 weeks.
• Primipara: Woman who has had one live birth after 20 weeks.
• Multipara: Woman who has had two or more live births after 20 weeks.
• Abortion (AB): Pregnancy loss before 20 weeks.
• Antepartum (AP): Period of pregnancy before the onset of labor.
• Intrapartum (IP): Period of time from onset of labor to the birth of the baby and placenta.
• Stillbirth: Death of a fetus after 20 weeks of gestation.
• Viability: Ability of a baby to survive outside of the uterus.
• TPAL: A method of recording obstetric history (T=term pregnancies, P=preterm pregnancies, A=abortions, L=live births).
• Gestational age (GA) or Estimated gestational age (EGA): The time elapsed during a pregnancy, typically calculated from the first day of the woman's last menstrual period (LMP).
• Estimated date of confinement (EDC): Estimated date of delivery.
• Estimated date of delivery (EDD): Estimated date of delivery.
• Estimated date of birth (EDB): Estimated date of birth.

Introductory Concepts

• Goal of maternal newborn (MNB) nursing: To create a safe and satisfying experience for the mother and baby and her family.
• STEEEP: Safe/timely/effective/equitable/patient-centered.
• Family Involvement: Quality nursing care encompasses needs of all family members including grandparents, siblings.
• Hospital settings: Labor and delivery suites/rooms exist for childbirth as it is a normal family event.
• Advocate/Informed Consent: MNB nurses serve as advocates for all family members, providing information enabling informed medical decisions. Nurses ensure appropriate consent forms are signed.
• Cultural Competence: Important to provide/implement patient care that is culturally aware and considers individual cultural/social backgrounds.
• Nurse Practice Act: Defines the scope and limits of nursing practice, health maintenance, disease prevention and informs nurse practice (e.g., scope of practice).
• Standards of care: Sets the minimum criteria expected of competent professionals; protects the public and assesses quality of care.
• Legal Interpretation: Evaluation of actions made by nurses based on what is expected of nurses with appropriate qualifications/experience.
• ANA/AWHONN/AMA/ACOG: National organizations offering reference points to appropriate standards of care.
• Comprehensive Care: Comprehensive nursing care of women and infants is focused on individual/familial support and achievement of optimal health.

Informed Consent

• Shared Decision Making: The process of shared decision-making in patient care protects the patient's rights and autonomy.
• Physician/Midwife: Consent for procedures and treatment is usually given by the physician/midwife, with nursing staff (e.g. RNs) witnessing the signature.

Reproductive Anatomy and Physiology

• External Genitalia: Includes the vagina, used for passage of sperm, fetuses, and menstrual products.
• Parts of the reproductive system: includes the vagina, uterus, fallopian tubes, and ovaries.
• Uterus: Hollow, muscular organ, pathway for sperm and fetus
• Fallopian tubes: One on each side, site of fertilization.
• Ovaries: Structures located on each side of the pelvis.
• Ovarian Cycle: Follicular (mature follicle; FSH- anterior pituitary) and Luteal (ovum leaves follicle; LH, maturation; progesterone levels.)
• Uterine Cycle: Menstrual, proliferative, secretory, and ischemic phases.
• Hormones: FSH, LH, and estrogen. Estrogen, during cycle, develops breasts, body hair, and fat.
• Menstrual Cycle: Cyclic bleeding in response to hormonal changes. Typical cycle is from 21-42 days. Phases include menstrual (shedding), proliferative (development), and secretory (occurs after ovulation).

Conception and Fetal Development

• Meiosis: Cell division producing gametes (sperm & ova).
• Gametogenesis: Formation of gametes.
• Mitosis: Cell division producing diploid daughter cells.
• Fertilization: Fusion of sperm and ovum forming zygote.
• Nidation (implantation): Zygote(fertilized ovum) implants in the uterine wall. Stage at which it is referred to as an embryo.
• Cellular Differentiation: Cells divide and specialize into germ layers (endoderm, mesoderm, ectoderm), which eventually form all tissues and organs.

Statistics in MNB Nursing

• Birth rate: Number of live births per 1,000 persons.
• Infant Mortality Rate: Number of infant deaths under one year of age per 1000 live births.
• Neonatal Mortality Rate: Number of infant deaths under 28 days of age per 1000 live births.
• Fetal Death Rate: Death of fetus during pregnancy(20 weeks or later gestation).
• Trends in Infant Mortality: Factors associated with Infant Mortality include birth defects, preterm delivery, and maternal complications.
• Maternal Mortality: Death of a woman from a pregnancy-related cause (or within one year of pregnancy ending if due to a pregnancy-related condition).
• Racial Disparities: Significant racial disparities in infant and maternal mortality rates exist.

Physical and Psychological Changes of Pregnancy

• Uterus: Capacity grows from 10 mL to 5,000 mL.
• Cervix: Softening (Goodell's sign), bluish discoloration (Chadwick's sign), softening of uterine isthmus (Hegar's sign) occurs due to the physiological and vascular changes involved in pregnancy.
• Vagina: Increased vaginal discharge.
• Breasts: Enlarged and increase in glandular tissue. Colostrum (first milk) is produced and secreted in later stages.
• Respiratory system: Expansion of chest circumference, increase in nasal stuffiness are common.
• Cardiovascular system: Increase in cardiac output, slight drop in blood pressure, edema, and varicosities.
• Gastrointestinal system: Nausea, vomiting, constipation, and heartburn.
• Urinary system: Increased frequency, dysuria, and constipation may occur.
• Skin/Hair: Pigmentation, striae, and darkening of skin may be observed.
• Musculoskeletal system: Joint relaxation and backaches.
• Endocrine system: Thyroid, pituitary, and adrenal glands are involved in hormonal fluctuations during pregnancy.
• Water/Nutrient: Increased water retention, elevated protein/carb intake. Physiological/emotional: Psychological challenges and support/guidance needed. Common discomforts/changes/coping methods discussed.