Term
| What are methods of contraception? |
|
Definition
Abstinence
Withdrawal method
Rhythm method
Basal body temperature
Cervical mucus
Condoms
Diaphragm and Spermicide
Oral Contraceptives (combined and minipill)
Emergency contraception
Transdermal patch
Injectable Progestins
Vaginal Ring
Implantable Progestin
IUD
Essure
Female sterilization (BTL)
Male sterilization (vasectomy) |
|
|
Term
|
Definition
| unable to conceive despite despite unprotected intercourse x 12 months |
|
|
Term
| What are common factors of infertility? |
|
Definition
| : decreased sperm production, endometriosis, ovulation disorders, tubal occlusions |
|
|
Term
| What are common assessment findings of infertility? |
|
Definition
|
|
Term
| What are common medical history findings of infertility? |
|
Definition
| atypical secondary sexual characteristics such as abnormal body fat distribution, hair growth indicative of endocrine disorder |
|
|
Term
| What are common surgical history findings of infertility? |
|
Definition
| pelvic or abdominal procedures |
|
|
Term
| What are common O.B. history findings of infertility? |
|
Definition
| spontaneous or optional abortion |
|
|
Term
| What are common GYN history findings of infertility? |
|
Definition
| scar tissue, abnormal contours, blockage of sperm or ovum |
|
|
Term
| What are common sexual history findings of infertility? |
|
Definition
| intercourse frequency, # partners, STIs |
|
|
Term
| What are common environmental risks of infertility? |
|
Definition
| teraatogen exposure at home or work |
|
|
Term
| What are common weight findings of infertility? |
|
Definition
|
|
Term
| What is important about males when assessing for infertility? |
|
Definition
| mumps during adolescence, substance abuse, teratogens |
|
|
Term
| What diagnostic tests can be performed to diagnose infertility? |
|
Definition
| semen analysis, pelvic exam, hormone analysis, endometrial biospy, US |
|
|
Term
| What interventions are necessary when dealing with infertility? |
|
Definition
discuss feeling, explain other options, disc genetic counselor, reproductive specialist, geneticist, pharmacist, assisted reproductive therapies (invitro, embryo transfer, surrogate parenting, adoption)
Support groups |
|
|
Term
| What is pre conceptive care? |
|
Definition
| Every woman of reproductive age who is capable of becoming pregnant is a candidate for preconception care, regardless of whether she is planning to conceive |
|
|
Term
| What is the aim of pre conceptive care? |
|
Definition
| To identify and modify biomedical, behavioral & social risks through preventive and management interventions |
|
|
Term
| What is assessed during pre conceptive care? |
|
Definition
Reproductive life plan
Reproductive history
Medical history
Medication use
Infections and immunizations
Genetic screening and family history |
|
|
Term
| What other risks are assessed for at the pre conceptive assessment? |
|
Definition
Nutritional assessment
Substance abuse
Toxins and teratogenic agents
Psychosocial concerns
Physical exam
Laboratory testing |
|
|
Term
| What other risks are assessed for at the pre conceptive assessment? |
|
Definition
Nutritional assessment
Substance abuse
Toxins and teratogenic agents
Psychosocial concerns
Physical exam
Laboratory testing |
|
|
Term
| What are the interventions for identified risks? |
|
Definition
Folic acid supplementation
Rubella testing, vac. If necessary
Control of pre-gestational DM
Management of hypothyroidism
Avoidance of teratogenic agents like accutane, coumadin, some anticonvulsants, alcohol, tobacco |
|
|
Term
| How do you implement the interventions for identified risks? |
|
Definition
In practice for FP’s – Well woman visit
Possibilities – Single or multiple pre-pregnancy office visits ? Billing
Ask reproductive age women about reproductive life plan
If plans to have child in next 1-2 yrs, she and partner should return for full visit.
Also can be promoted at work, school and in the community |
|
|
Term
| What are presumptive signs of pregnancy? |
|
Definition
SUBJECTIVE
LEAST TELLING
Amenorrhea
Nausea & vomiting
Fatigue
Urinary Frequency
Breast & Skin changes
Darkened areola
Linea nigra
Chloasma
Uterine enlargement
Quickening=fetal movement |
|
|
Term
| When does n/v start and end? |
|
Definition
| starts around 6 weeks and usually ends w/1st trimester at 14 weeks. |
|
|
Term
| When can you feel quickening? |
|
Definition
| 16-20 weeks/fluttering feeling |
|
|
Term
| What are probably signs of pregnancy? |
|
Definition
Objective indications that can be documented by an examiner. Primarily r/t physical changes of uterus.
May be caused by other conditions.
Abdominal Enlargement
Cervical/Vaginal changes
Chadwick’s Sign
Goodell’s Sign
Uterine changes
Hegar’s Sign-softening of lower uterus
Ballottement-fetus rises in amniotic fluid
Braxton Hicks Contractions
Palpation of the Fetal Outline
Uterine Souffle-ascultation of fe
Pregnancy Tests: Not diagnostic for pregnancy |
|
|
Term
|
Definition
|
|
Term
|
Definition
| blue-violet color of vaginal mucosa (due to increased vascularity) |
|
|
Term
|
Definition
| : sudden tap on the cervix during a vaginal exam may cause the fetus to rise in the amniotic fluid and then rebound to its original position. Strong indicator of pregnancy BUT same sensation may be caused by uterine or cervical polyps. |
|
|
Term
|
Definition
: soft, blowing sound auscultated over the uterus; caused by blood circulating through the placenta-corresponds w/maternal pulse---DOPPLER---NOT actually FHT’s!
FUNIC SOUFFLE which is the soft, purring sound heard over the umbilical cord and corresponds w/FHR |
|
|
Term
| Why are pregnancy tests not positive indicators of pregnancy? |
|
Definition
Not diagnostic for pregnancy…high probability but increased Hcg can be caused by other conditions (Molar pregnancy, tumor, etc)
Some very specific and can be done as early as 6-8 days after conception—may have incorrect results
Home preg tests |
|
|
Term
| What are the positive signs of pregnancy? |
|
Definition
Fetal heart sounds
Fetal movement palpated by examiner
Visualization by ultrasound |
|
|
Term
| What is important to note about fetal heart sounds? |
|
Definition
Audible by ≈10 weeks w/doppler
Normal range: 110-160 bpm
Auscultate mom’s pulse simultaneously to distinguish the two |
|
|
Term
| What is the physical exam associated w/ the initial antepartum exam? |
|
Definition
Vital Signs
Cardiovasular
Musculoskeletal
Neuro
Integumentary
Endocrine
GI |
|
|
Term
| What is the reproductive exam associated w/ the initial antepartum exam? |
|
Definition
Obstetric
Menstrual
Contraceptive
Medical & Surgical
Family Health
Psychosocial Antepartum
Assessment and Care Initial Visit |
|
|
Term
| What labs need to be assessed on the initial antepartum exam? |
|
Definition
-CBC
-Blood typing
-Rubella titer
-Hepatitis B
-HIV testing
-STI screen
-Cervical smears |
|
|
Term
| What is important to note about obstetric history? |
|
Definition
Gravida, para, abortions, living children
Weight of infants at birth, length of gestation
Labor experience, type of delivery
Type of anesthesia; any difficulties
Maternal complications (HTN, DM, etc)
Complications with the infant
Method of infant feeding planned
Special concerns |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| A woman who has never been pregnant |
|
|
Term
|
Definition
| A woman pregnant for the first time |
|
|
Term
|
Definition
| A woman in at least her second pregnancy |
|
|
Term
|
Definition
number of BIRTHS that have ended at 20 or
more weeks, whether or not the fetus was born alive |
|
|
Term
|
Definition
| no births more than 20 weeks |
|
|
Term
|
Definition
| one birth occurred after 20 weeks |
|
|
Term
|
Definition
| two or more to stage of viability |
|
|
Term
|
Definition
| - time from last menstrual period (LMP) up to present |
|
|
Term
|
Definition
| time of birth to 1 year of age |
|
|
Term
|
Definition
| minimum age for fetus survival ------24 weeks??? (NOTE: PARITY) |
|
|
Term
| What is a pre viable infant? |
|
Definition
| delivered prior to 24 weeks |
|
|
Term
| What is a preterm infant? |
|
Definition
| delivered between 20-37 weeks |
|
|
Term
|
Definition
| delivered between 38-42 weeks |
|
|
Term
| What is the first trimester? |
|
Definition
| up to 14 weeks of gestation |
|
|
Term
| What is the 2nd trimester? |
|
Definition
| 14 to 28 weeks of gestation |
|
|
Term
| What is the 3rd trimester? |
|
Definition
|
|
Term
|
Definition
G=# of pregnancies, including present
T=# born at term (37 weeks gestation)
P=# preterm births (before 37 weeks)
A=# abortions or miscarriages
L=# living children |
|
|
Term
| A woman is pregnant for the fourth time. She has one elective abortion in the first trimester, a daughter who was born at 40 weeks gestation, and a son born at 36 weeks gestation. |
|
Definition
G=4
Para (number of births past 20 wks)=2
T=1 daughter born at 40 weeks
P=1 son born at 36 weeks
A=1 (counted in gravidity/not counted in parity because occurred before 20 weeks)
L=2 (two living children) |
|
|
Term
| A woman is pregnant for the fifth time. She underwent on spontaneous abortion and one elective abortion in the first trimester for each. She has a son who was born at 40 weeks of gestation and a daughter who was born at 34 weeks of gestation. |
|
Definition
G 5 P 2
T=1 (son at 40 wks), P=1 (daughter at 34 wks), A=2, L=2.
The two abortions are counted in the gravida but not the para because they occurred before 20 wks.
Her GTPAL is 5-1-1-2-2 (Para is NOT included when written this way!) |
|
|
Term
|
Definition
First day of LMP-3months+7 days=EDD
LMP=January 30, 2014
Subtract 3 months=October 30, 2014
Add 7 days and change the year, EDD=November 6, 2014 |
|
|
Term
| What contraceptive history is assessed? |
|
Definition
Oral: estrogen/progestin may affect fetus
IUD: abortion, premature delivery, puncture of uterus |
|
|
Term
| What med/surg history is assessed? |
|
Definition
Chronic conditions: DM, HTN, renal disease
Infections: Hepatitis, STDs, hx of pyelonephritis
Previous surgeries, trauma
Childhood diseases, immunizations
Caffeine, alcohol intake; tobacco use
Prescription and other drugs
General nutrition history
Complementary or alternative therapies
Allergies and drug sensitivities |
|
|
Term
| What family health history is assessed? |
|
Definition
Woman and her partner
Chronic conditions, genetic abnormalities
Drug/alcohol abuse may affect ability to cope w/pregnancy and childbirth
If mom is Rh negative, dad’s blood type and Rh factor is needed to determine potential incompatibility. |
|
|
Term
| What vital signs are taken? |
|
Definition
BP, pulse
Respiratory effort
Temperature
FHT
R=16-24
T=infection if elevated
Begin to assess FHT’s at every visit/using DOPPLER/may monitor with Fetal Heart Monitor ( NST’s) at some visits |
|
|
Term
| What cardiovascular assessment is completed? |
|
Definition
Venous congestion: legs, vulva, rectum (varicosities); Mucuous membranes (epistaxis, sinus congestion)
Edema: legs, ankles may be normal
Pitting edema & edema to face or hands is not normal
Cardiac: cardiac output and blood volume increase to meet greater metabolic needs/HR increases during preg.
Pitting edema: when you press on the skin with a finger or thumb and a PERSISTENT depression is left. |
|
|
Term
| What musculoskeletal assessment is completed? |
|
Definition
Posture and gait (body mechanics-strain on lower back)
Height and Weight
Baseline weight
Preconception weight <100 lbs or height under 60 inches is associated w/preterm labor and low-birth-weight infants
Preconception weight >200 lbs is associated w/gestational diabetes and hypertension
Pelvic measurements: adequacy for delivery Abdomen
Fundal Height : discrepancy in fundal height in cm and weeks of gestation, may require further assessment
Fetal Heart Rate |
|
|
Term
| What neuromuscular assessment is completed? |
|
Definition
As needed by symptoms
Deep tendon reflexes (DTRs): hyperreflexia associated w/preeclampsia |
|
|
Term
| What integumentary assessment is done? |
|
Definition
Pallor may indicate anemia
Jaundice may indicate hepatic disease
Note pregnancy-related changes (chloasma, linea nigra, etc). |
|
|
Term
| What endocrine assessment is done? |
|
Definition
Thyroid gland slightly enlarged-2nd trimester
Gross enlargement/tenderness may indicate hyperthyroidism and requires further assessment |
|
|
Term
| What GI assessment is done? |
|
Definition
Mouth: gums may be tender, red, edematous
Intestine: Discuss constipation with patient. |
|
|
Term
| What urinary assessment is done? |
|
Definition
Clean-catch midstream sample
Protein= WNL= 0-trace
Glucose=WNL= 0-+1
Ketones=WNL=0
Bacteria=WNL= 0 |
|
|
Term
| What external reproductive assessment is done? |
|
Definition
symmetry, size, condition of nipples, presence of colostrum
External reproductive organs: growths, ulcerations, lesions, varicosities, warts, chancres, perineal scars. Cultures obtained as needed. |
|
|
Term
| What internal reproductive assessment is done? |
|
Definition
Speculum exam
Chadwick’s sign, Goodell’s Sign
Pap smear, routine cervical culture for gonorrhea and chlamydia are routine
Bimanual exam: size, contour, tenderness, and position of the uterus and ovaries (may not be palpable). |
|
|
Term
| What is Rh factors roll in pregnancy? |
|
Definition
Rh factor and antibody screen
If mother is Rh negative and father is Rh positive or antibodies are present, additional testing and treatment are required.
If antibody screen is negative for Rh positive antibodies (when mom is Rh negative), she’ll get RhoGAM at 26-28 weeks. |
|
|
Term
| What are the dates of the prenatal visits? |
|
Definition
Conception-28 weeks= q4weeks
29-36 weeks= q2-3 weeks
37 weeks-birth= weekly |
|
|
Term
| What are leopard maneuvers? |
|
Definition
| systematic method for palpating the fetus through the abdominal wall |
|
|
Term
| When does fetal activity occur? |
|
Definition
| quickening 16-20 weeks, movement gradually increases in frequency and strength; movement indicates a healthy fetus |
|
|
Term
| When does an ultrasound occur? |
|
Definition
12-20 weeks (around 18-19 is average)
gestational age, abnormalities (we’ll discuss at length tomorrow!) |
|
|
Term
| When is a glucose screen performed? |
|
Definition
|
|
Term
| When does immunizations occur? |
|
Definition
| Antibody test may be repeated at 26-28 weeks in women who are Rh negative when the father of the baby is Rh positive. If unsensitized, the woman should receive anti-D immune globulin (RhoGam) at this time. |
|
|
Term
| When are vital signs, weight, fundal height, urinalysis, FHR, signs of labor done? |
|
Definition
|
|
Term
| How are multifetal pregnancies diagnosed? |
|
Definition
Ultrasound
Fundal height often 4cm greater than singleton |
|
|
Term
| What maternal adaptations occur w/ multifetal pregnancies? |
|
Definition
500ml blood volume increase over singleton
Increased heart workload-fatigue
Uterine volume≈10 liters or more; 20lbs
Respiratory difficulty (greater elevation of diaphragm)
More pronounced supine hypotension
Greater compression of ureters: maternal edema, proteinuria |
|
|
Term
| What are common discomforts of pregnancy? |
|
Definition
Nausea & Vomiting
Heartburn
Backache
Round Ligament Pain
Urinary Frequency
Varicosities
Constipation
Leg cramps
Skin changes |
|
|
Term
| What should you do for n/v? |
|
Definition
Dry crackers or toast before rising in the morning
Small frequent meals
Drink fluids separate from meals
Avoid fried, greasy, or spicy foods or those w/strong odors
Distinguish between “morning sickness” and hyperemesis gravidarum (severe vomiting, weight loss, dehydration, electrolyte imbalance, ketosis)
May be PREGNANCY HORMONES r/t hCG and estrogen |
|
|
Term
| What should you do for heartburn? |
|
Definition
: several small meals/day
Avoid fatty or spicy food or foods that produce gas
Decrease smoking or coffee drinking(stimulate acid formation in stomach)
Sit upright for at least 1 hour after meals to reduce reflux
Don’t eat or drink just before bedtime; sleep w/extra pillow
Sip water to relieve burning sensation
Antacids (avoid those high in sodium (Alka Seltzer, baking soda); Recommend the ones high in calcium (Tums, Alka-Mints)). |
|
|
Term
| What should you do for backache? |
|
Definition
: Correct posture
Avoid high-heeled shoes
Squat, rather than bend at waist to pick up objects
When sitting, use foot supports, arm rests, and pillows behind the back.
Exercise (SEE next slide) Also in book on p. 274 Fig 13-13 |
|
|
Term
| What should you do for round ligament pain? |
|
Definition
Good body mechanics, avoid strenuous exercise
Avoid stretching and twisting at the same time
Bend toward the pain, squat, or bring the knees up to the hest to relieve pain by relaxing the ligament
Apply heat and lie on the right side to relieve the pain. |
|
|
Term
| What should you do for urinary frequency? |
|
Definition
| Kegel exercises to help maintain bladder control |
|
|
Term
| What medications can help with n/v? |
|
Definition
Vitamin B6 (100 mg twice a day)
Doxylamine (Unisom), ½ tab at bedtime (Antihistamine) or Benadryl
Emetrol liquid as directed
Ginger (250mg cap po qid)
If patient is unable to tolerate prenatal vitamin in the morning, they may try taking it in the evening or taking 2 chewable Flinstone vitamins daily
Category B: Meclizine, Reglan, Zofran
Category C: Phenergan, Compazine |
|
|
Term
| What medications can help with heartburn? |
|
Definition
Antacids are generally safe
Gaviscon is safe to take as directed
Tums, Maalox, Mylanta, Rolaids, Milk of Magnesia as directed for minor discomfort.
Pepcid AC or over the counter Zantac are safe.
Mylicon (simethicone) as directed for gas |
|
|
Term
| What are the behavioral changes that can fix backache? |
|
Definition
Tylenol as needed
Heating pads
At night sleeping with a pillow between the legs to improve hip/knee alignment. |
|
|
Term
| What causes ligament pain? |
|
Definition
| Caused by stretching of the ligaments that support the uterus as the uterus grows. |
|
|
Term
| What behaviors can be modified for ligament pain? |
|
Definition
| Applying heat, Tylenol and lying with a pillow between the knees at night. |
|
|
Term
| What causes urinary frequency? |
|
Definition
Due to the growing uterus
pushing down on the bladder.
Incontinence is usually of the
stress type- i.e. occurring with
coughing, sneezing or laughing
increases pressure on the bladder. |
|
|
Term
| What behaviors can be modified for urinary frequency? |
|
Definition
Educate patients to continue to drink plenty of fluids during the day, less so at night.
Educate patients regarding sx’s of urinary tract infection.
Symptoms of urinary incontinence can be improved by regular Kegel exercises |
|
|
Term
| What causes constipation? |
|
Definition
Due to slowed motility of the
gastrointestinal tract and growing size of
the uterus. |
|
|
Term
| What behavioral modifications can be made for constipation? |
|
Definition
Increasing fluid intake (2 quarts/day), fiber intake.
Regular exercise |
|
|
Term
| What medicines can be described for constipation? |
|
Definition
1st line:
Bulking agents- Fibercon, Benefiber, or Metamucil.
Stool softeners - Colace as directed.
2nd line: (Have patients consult you 1st)
Stimulant laxatives - Senekot
If no relief after the above measures, patients may try a glycerin suppository as directed
If no relief after above, patients may use as Ducolax suppository as directed
If no relief after above, patients may use Fleet enema as directed |
|
|
Term
| What medications are approved for pain? |
|
Definition
|
|
Term
| What medications are not approved for pain? |
|
Definition
Aspirin is not acceptable.
Advil, Motrin or Ibuprofen should be avoided, particularly in the third trimester.
Codeine and hydrocodone:
Found in most narcotics
Can affect the baby’s breathing if taken in the last trimester or during labor in large amounts.
Chronic use may cause withdrawal symptoms in the newborn.
In general try to avoid prescribing these medications if possible
They may be taken for short periods of time to treat specific pain conditions in the second and third trimester. |
|
|
Term
| What behavioral modifications can be made for colds/coughs/allergies? |
|
Definition
Educate patients to stay well hydrated, eat plenty of protein, and get extra rest
Steam inhalation/humidifiers also help
Have patients call you if Temp>100.5 |
|
|
Term
| What medications can be used for colds/coughs/allergies? |
|
Definition
Allergies:
Claritin or benadryl are safe.
Nasal steroid sprays such as Flonase, with long term use can be absorbed in sufficient amounts to impair the growth of the fetus. They may be used short term
Coughs:
Cough medicines often contain several ingredients- educate patients to check the safety of each one before use.
Cough expectorants, such as guaifenesin, are safe to use.
Educate patients to AVOID cough medicines containing iodine
Cough suppressants, such as codeine or dextromethorphan, can be used in the second and third trimester for short periods of time. Educate patients to avoid them in the first trimester.
Lozenges are the safest option. |
|
|
Term
|
Definition
| Mask of pregnancy”. Increased pigmentation over the face/neck. Hormonal- patients may try to avoid direct sun exposure/wear sun screen. Will fade after delivery |
|
|
Term
| What happens to the areola during pregnancy? |
|
Definition
| area around nipple becomes darker |
|
|
Term
|
Definition
| dark line between the belly button and pubic region. Normal in pregnancy. Will eventually fade after delivery. |
|
|
Term
|
Definition
| - Develop over the abdomen, hips, and breasts in over 50% of pregnant women. They will fade in color after delivery. |
|
|
Term
| What can you do to prevent stretch marks? |
|
Definition
| : There are no proven methods for preventing stretch marks- likely genetically determined. Cocoa butter and vitamin E creams may help with the itching that often accompanies striae formation |
|
|
Term
| What are the danger signs during pregnancy? |
|
Definition
Vaginal bleeding, with or without discomfort
Rupture of membranes
Swelling of fingers or puffiness of the face/eyes
Continuous pounding headache
Visual disturbances
Persistent or severe abdominal pain
Chills or fever
Painful urination
Persistent vomiting
Change in frequency or strength of fetal movements |
|
|
