Women's Health Exam 2 PDF

Intra partum & postpartum: https://quizlet.com/1001428078/exam-2-intrapartum-and-postpartum-flash- cards/?funnelUUID=b2e87d1e-686e-4e5c-b6c9-a9a877e5fe6e HTN & gestation DB https://docs.google.com/document/d/16QUhB7Tvy4eodsBXWsKyUtcBViNyINBo/edit Post partum care https://quizlet.com/1001978587/ex...

Intra partum & postpartum: https://quizlet.com/1001428078/exam-2-intrapartum-and-postpartum-flash- cards/?funnelUUID=b2e87d1e-686e-4e5c-b6c9-a9a877e5fe6e HTN & gestation DB https://docs.google.com/document/d/16QUhB7Tvy4eodsBXWsKyUtcBViNyINBo/edit Post partum care https://quizlet.com/1001978587/exam-2-post-partum-care-flash-cards/?funnelUUID=9d54da88-9cc8- 4c4e-9142-13687355a218 WOMEN’S HEALTH EXAM 2 1. Preconception and Antepartum care Preconception o Discuss folic acid supplementation to prevent neural tube defects (NTD)- when attempting and during 1st trimester o Discuss strict metabolic control for those w/ diabetes or phenylketonuria (PKU) o Maintain good control of HTN, asthma, thyroid disorders, IBD, seizures and SLE o Maintain healthy weight, exercise, prevent HIV infection, no tobacco/alcohol, avoid preg w/in 1 month of receiving a live attenuated vaccine (rubella) Diagnosis of Pregnancy o Urine pregnancy test: qualitative, positive 4 weeks post LMP o Serum pregnancy test: measures Beta-HCG, qualitative (yes or no) or quantitative (provides #) --> can provide gestational age o Abdominal US: used first usually, gestational sac visualized at 5-6 weeks o Transvaginal US (TVUS): gestational sac visualized at 4.5-5 weeks, cardiac activity at 5.5-6 weeks o PE: “quickening” ▪ pts initial perception of fetal movements (16-20 weeks) --> feels like flutters ▪ heart tones w/ doppler (10-12 wks) o Chadwick’s sign: bluish discoloration of cervix, vagina, and labia (8-12 weeks) o Hegar’s sign: softening of the cervix at 6 weeks, widening Maternal Physiology o Earliest and most dramatic changes occur in CV system (hyperdynamic) ▪ CO increases by 30-50%, blood volume increase by 6-8 weeks (peaks at 45% at 32 weeks) o CO may decrease late in pregnancy due to pressure from the gravid uterus ▪ Venous return from the IVC can be impeded- *esp in supine position, *L side is best o At term, >1/5 of CO goes through the uterus- increased risk of postpartum hemorrhage o During uterine contractions of labor, CO increases approx. 40% > than in late preg o CO increases immediately after delivery- venous return to heart is no longer impeded by gravid uterus, extracellular fluid is quickly mobilized ▪ Increased risk for stroke or MI ▪ Those w/ weakened heart or connective tissue disorder may not be able to handle this o Normal (hyperdynamic) findings on PE: increased 2nd heart sound split w/ inspiration, distended neck veins (bc increased CO), low grade systolic ejection murmurs, HR increased by 10-15BPM above normal ▪ Diastolic murmurs should always be further eval if found during preg --> send to cardiology o BP: highest when seated, lowest when lying on her side o *>20 wks gestation- managed in left lateral position to reduce aortocaval compression by gravid uterus (or uterus may be manually displaced)  ▪ fundal height is around belly button o Lungs: 15% increase O2 demand and 25% decrease in functional residual capacity o Hematology: Increase in plasma volume, red cell volume, & *coagulation factors (VII, VIII, IX, XII) ▪ 1000mg of additional iron needed o Renal system: enlarges due to increased renal blood flow o GI systems: stomach & intestines are displaced as uterus enlarges ▪ Progesterone lowers esophageal sphincter tone --> reflux (GERD) ▪ Morning sickness (between 4-8 wks of gestation) --> related to increased levels of hormones ▪ Hemorrhoids can develop o Skin changes: striae gravidarum, chloasma gravidarum, Linea nigra o Pregnancy is considered a hypercoagulable state ▪ Increased to 5.5x normal risk ▪ Likely adaptive mechanism to reduce risk of hemorrhage during/after delivery Fetal Physiology o Placenta: crucial point of connection between mother and fetus ▪ O2 & CO2 dissolve across here, uses glucose for metabolism o Fetal blood is oxygenated in placenta, not the lungs ▪ Fetal lungs are bypassed until birth o Patent ductus arteriosus (PDA) ▪ ▪ Connects main pulmonary artery to left branch of the proximal descending aorta ▪ Allows most of the blood from RV to bypass fetus fluid-filled non- functioning lungs ▪ Abnormal if it remains after neonatal period o Foramen Ovale ▪ Allows blood to enter the LA from RA ▪ 1 of 2 fetal cardiac shunts, other being ductus arteriosus (allows blood that escapes to RV to bypass pulmonary circulation) ▪ Normally closes as BP rises in the left side of the heart after birth  If doesn’t close is an abnormality o Ductus venosus ▪ Shunts a portion of left umbilical vein blood flow directly to IVC ▪ Allows oxygenated blood from placenta to bypass the liver o *There should be 2 umbilical arteries and 1 umbilical vein (there is an abnormality if these #s are incorrect) Antepartum care o First Visit ▪ History OBGYN hx, PMH, diet, meds, tobacco, ETOH, Drug use, risk assessment, physical exam, pelvic exam ▪ Routine labs Blood type (ABO) & Rh factor, CBC, cervical cytology in women > 21, U/A, urine culture, Rubella titer STIs (syphilis, chlamydia, gonorrhea), HIV, Hep B & C, TB o Routine ultrasound ▪ Fetal #, fetal lie, biometry (measures dimensions to estimate age & weight), documents fetal cardiac activity, placenta appearance & location, surveys fetal anatomy, assesses amniotic fluid volume o Determining Gestational Age (EDD) ▪ Estimated Date of Delivery ▪ Gestational Age: # of wks from 1st day of LMP to current date ▪ Typical preg: 40 wks +/- 2 wks ▪ Nagels rule: LMP + 1 year, - 3 months, + 7 days *know how to do an example ▪ US (most accurate) (+/- 2 wks): repeated after 36 wks gestation as EDD gets closer ▪ o Antenatal Evaluation ▪ Office visits: every 4 wks until 28 wks, every 2 wks from 30-36, weekly after 36 ▪ History at each visit: vaginal bleeding or discharge, N/V, dysuria, decreased fetal movement Normal to have some mucoid discharge Bloody or odorous NOT normal ▪ *U/A for glucose & protein at every visit ▪ PE at every pre-natal visit: maternal BP, weight, U/A for ketones, protein, glucose, assess for edema (facial more worrisome), Fetal heart tones o Fetal heart tones  ▪ Good indicator of fetal well being ▪ Audible at 10 wks gestation by US, at 8-14 wks using fetal doppler (normal 120-160) o Obstetric PE findings ▪ From 18-20 wks, assess uterine size by pelvic exam (state as # weeks size) ▪ After 20 weeks, measure fundal height using tape measure *at 20 weeks, fundus is at height of umbilicus ▪ After 34 wks palpate uterus for fetal presentation Cephalic (head down) head is hard Breech (bottom down) bottom is soft Prenatal Labs o Screening tests assess risk of having a common birth defect (this is a personal choice) ▪ Cannot tell whether fetus actually has a birth defect ▪ No risk to the fetus o Dx test can detect many, but not all, birth defects ▪ May be done instead of screening if a couple: +FH birth defect, certain ethnic, has a child w/ defect ▪ Available for all preg women, regardless of risk factor ▪ Can involve small risk of preg loss (CVS, amniocentesis) o Initial assessment ▪ By end of 1st trimester: Fetal nuchal translucency (enlargement of hypoechoic space in posterior fetal neck, Down Syndrome) plus PAPP-A (preg associated plasma protein A) OR free or total B- hCG o Screens for trisomy 21,18 & 13 ▪ 15-18 weeks- maternal serum AFP Screens for open neural defects ▪ 15-20 weeks- quad screen (serum B-hCG, unconjugated estriol, AFP, inhibin) Done if 1st tri screening is missed o Chorionic Villus Sampling (CVS) ▪ For prenatal sx of genetic disorder (Down Syndrome) ▪ Samples of placenta are obtained for chromosome or DNA analysis ▪ Same info as amniocentesis but faster, low risk fetal loss w/in 30 days, safer than early amniocentesis ▪ 2 methods: transcervical, transabdominal ▪