Exam 1 434

XX

female

HSV2 (herpes simplex virus) effects on fetus or newborn

IQ disabilities, blindness, seizures, premature birth, low birth wieght, death

when ovulation occurs, what will you see on a basal body temperature graph?

Ovulation occurs = sharp rise in temperature which is sustained for several days after ovulation If temperature declines, indicating she did not conceive, and progesterone declines.

MOA of estrogen and progestin contraceptives

1. lower levels of Estrogen inhibits FSH & LH release from anterior pituitary = no ovulation, eggs stay put in ovary! 2. Progestin makes cervical mucus non-receptive to sperm

Fetal Kicks counts:

1. moves 6 - 10 x's per hour 2. at 28 weeks/at third trimester

Dick-Read Method

"childbirth without fear" -uses controlled breathing and conscious and progressive relaxation of different muscle groups throughout the entire body Woman's attitude of birthing process influenced her labor Fear = primary pain-producing factor in normal labor; building tension, thus causing pain

para

# of pregnancies that reach viability (22-25 weeks)

gravida

# of pregnancies the patient has had in total

Trisomy 13

(Patau Syndrome) *Extra 13th* chromosome 47 instead of 46 chromosomes Severe birth defects: clefts, extra fingers/toes Often heart, brain or spinal abnormalities Short life span - Affects 1 of 16,000 - Life expectancy: few months. - Causative factor: maternal age Supportive care Abnormalities associated with trisomy 13: Microcephaly, cardiac defects, small eyes, kidney malformations, central nervous system anomalies, cleft lip and palate, cryptorchidism polydactyly, severe intellectual disability, severe hypotonia and seizure

Diploid

(genetics) an organism or cell having two sets of chromosomes or twice the haploid number 46 chrom.

Morula

(solid ball of 16 cells/developing zygote) Continue to divide until forming structures

Surgical therapies for female infertility

* Hysterosalpingography, Laproscopy, Hysteroscopy *Assistive Reproductive Techology (like IVF)

Gonorrhea effects on fetus or newborn

*Can be infected during delivery *Rhinitis, inflammation of sites of fetal monitoring, vaginitis, urethritis, chorioamnionitis (infection between placenta and ambiotic sac), premature birth, IUGR, ophthalmic neonatorum (can lead to blindness and sepsis)

Vaccine-preventable STIs

*Hepatitis A *Hepatitis B *Human papillomavirus (HPV)

Gestational carrier (surrogacy)

*Laboratory fertilization takes place and embryos are transferred to the uterus of another woman, who will carry the pregnancy. Or intrauterine insemination can be done with the male sperm *Medical-legal issues have resulted over the "true ownership" of the resulting infant indications: - cystic fibrosis for example - congenital absence - surgical removal of uterus - reproductively impaired uterus - uterine adhesions - medical condition that might be life threatening during pregnancy

Doppler flow studies (umbilical velocimetry) help to assess which of the following? 1. Placental function and sufficiency 2. Fetal heart rate 3. Fetal growth and fluid levels 4. Maturity of the fetal lungs

1. placental function and sufficiency

chlamydia

- Bacterial infection caused by Chlamydia trachomatis. - Curable STI. - Most common reported STI Most common risk factors = multiple sex partners, recent change in sex partners, lack of use of barrier Difficult to diagnose if asymptomatic, leads to PID, then infertility. *All pregnant individuals are screened at initial visit and if + rescreened in 3-4 weeks after completing therapy and in 3rd trimester Findings: Vaginal discharge Dysuria, urinary frequency Spotting and/or postcoital bleeding Treat: Azithromycin (broad spectrum antibiotic, if there's a co-infection which is VERY COMMON, also going to treat with rocephin and treating the sexual partners) or Doxycycline Both partners Reportable to state After birth of baby, most effective treatment is erythromycin ointment in the eye (prophylactic treatment for newborns bc of caustic effect if someone wasn't screened and were infected with chlamydia d/t potential blindness and sepsis) Education: Safe sex practices, condom Can decrease effectiveness of oral BC

labs for 1st prenatal visit

- CBC - blood type & Rh factor - UA - TORCH tests - STI tests

X-linked recessive disorders

- Expressed in females if they get two copies of the gene. - For males, only one copy of the gene is necessary. EX: Hemophilia A, Color blindness or Duchenne muscular dystrophy - Most commonly manifested in males - Receives from affected mother's X chromosome - Can pass to his daughters but not his sons - Daughters will be carriers of the trait if they get a normal x from mother and have disease if getting x from both mom and dad

Nursing Role in Perinatal Care

- Identification of those needing genetic counseling and testing --> Scheduling of genetic testing and explaining purposes of screening and testing --> Take a thorough and accurate family history - Maternal age > 35 - History of inherited disease, congenital abnormalities - - metabolic disorders, developmental disorders or chromosomal disorders - Two or more pregnancy losses - Stillbirth with congenital anomalies - Teratogen exposure or risk - Hx of infants born with any abnormalities - Pregnancy screening abnormalities

standard days method of contraception -- avoid unprotected sex on days ___ - ___

- Identifies fertile days using menstrual cycle - Remember the menstrual cycle begins on the first day of menstrual period - Standard menstrual cycle between 26 - 32 days = avoid unprotected intercourse on days 8 - 19

genital herpes simplex virus (HSV-2)

- Initial outbreak is by far the most viral loading - individuals will experience virimea (systemic viral loading = body aches, fever) -Re-triggers are usually less intense (can occur with high stress levels) Pregnancy: - If happens in 1st trimester = higher miscarriage rates - With pregnant women, imperative to do suppression therapy during pregnancy to decrease viral loading If they have lesions present, will have to have C-section bc of lethalness of vaginal birth Transmitted by contact- unaware of infection Incubation period: 3-7 days, may last 1-3 wks. Findings: - Blister-like lesions on vulva, vagina and perineal areas; dysuria, fever, headache, muscle aches - Can have major lymphadenopathy (major lymph involvement) Diagnostics: Virologic and serologic tests for HSV II Treatment: Acyclovir---suppress symptoms Manages suppression of viral load

fundal height measurement

- Measurement from pubic symphysis to the fundus (top of uterus) - Gestational age correlates with the measurement of the uterus in centimeters 15-16 weeks is when it starts to rise

Hepatitis C (HCV)

- Most common blood-borne infection in United States - 70% of patients with Hep C develop chronic Hepatitis - All pregnant women at high risk should be tested for Hep C antibodies @1st Prenatal visit - Risk factor for pregnant women is history of injecting IV drugs Treatment: Interferon alfa-2b (immunostimulant)

autosomal dominant disorders

- Not always expressed with same severity of symptoms - Predicting if child will have minor or severe abnormality is not always possible - Abnormal gene dominates over normal gene - Affected parent has 50% chance to pass on gene to children - Vertical pattern of inheritance - Females and males equally affected Common types: Marfan's syndrome Neurofibromatosis Huntington's disease Achondroplasia Polycystic kidney disease

egg and sperm donation (process, indications)

- Recommended for women > 40 y/o that has a h/o poor-quality eggs Process: - Donor oocytes (IVF procedure) or sperm used - Eggs inseminated - Embryos are transferred into recipients uterus (hormonally prepared with estrogen and progesterone therapy to make hospitable environment) during IVF procedure Potential situations for this need = - early menopause - surgical removal of ovaries - congenital absence of ovaries - autosomal/sex linked disorders - lack of fertilization - failed repeated IVF attempts - concerns or defects in oocyte/stromatazoa interaction - a male partner has a zoom spermatic?/ very low sperm count - the couple has a genetic defect and male partner has anti sperm antibodies

Healthy People 2030 Contraception Goals

- Reduce the proportion of unintended pregnancies. - Increase the proportion of adolescent females who used effective birth control the last time they had sex - Increase the proportion of women who get needed publicly funded birth control services and support - Increase the proportion of women at risk for unintended pregnancy who use effective birth control

Main Points for Nurses to Know About STI's

- Safer sex practices are key to STI prevention - STIs cause substantial mortality and morbidity, suffering, and economic burden - Reportable STIs vary by state: Syphilis, gonorrhea, chlamydia, chancroid, PID, HIV, and AIDS are reportable in every state. - Pregnancy confers no immunity from infection - Use universal precautions consistently

vasectomy

- Small incision into the scrotum, cutting vas deferens, thus blocking sperm - Complications are rare and minor: Infection, Hematoma, pain Must have semen analysis: two specimens with NO sperm present. Use alternative birth control until tested that there's no sperm present!

what is a diaphragm? when is it inserted?

- Soft latex dome, used with spermicide jelly/cream - Inserted up to 4 hours prior to intercourse and left in for 6 hours after intercourse Needs to be fitted by provider and prescription! Fits over cervical opening Not recommended if hx of UTI or toxic shock syndrome (TSS) Cost is around $75 not including fitting and consult fees Does not protect against STI's 88% effective

Endocrine changes in pregnancy

- Thyroid may increase slightly (TT4 increases) - Adrenal increases in cortisol and aldosterone - Pituitary gland increases in size d/t prolactin hormone increasing - Pancreas = hypoglycemia and hypoinsulinemia d/t not eating but Hyper can happen too Placenta becomes an endocrine organ producing hormones of pregnancy

Zika Virus

- Transmission via bite of infected Aedes mosquito - has also been reported through blood transfusions and sexual contact Pregnancy: Pregnant women can pass virus to fetus Will cause Microcephaly, a serious birth defect of brain Not compatible with life outside of uterus Most common symptoms: Fever, rash, headaches, bone pain, joint tenderness, and conjunctivitis CDC recommendations - Abstaining with anyone who has traveled to areas with documented active infections (6 months) Prevention measures: - avoid travel to areas of virus - caribbean, central, and south america - Wear insect repellant, long shirts/pants - Blood test available, but no vaccine to prevent zika

autosomal recessive inheritance

- Two abnormal genes needed to produce signs and symptoms of disease - Both parents are carriers; get a gene from both parents - Offspring have 25% chance of getting gene - Horizontal pattern of inheritance Typically observed in 1 or 2 siblings but not typically in earlier generations Males and females equally affected Genetic disorders: Cystic fibrosis Phenylketonuria - disorder of liver enzyme Tay-Sachs disease - Inefficient activity of enzyme that breaks down fatty substances in brain and nerve cells Sickle cell disease - RBC's carry ineffective type of hemoglobin?

multifactorial inheritance

- an interaction between genes and the environment that contributes to a phenotype or trait - Unpredictable inheritance

tubal ligation

- blocking the fallopian tubes to prevent fertilization from occurring, surgical - Laparoscopic surgery needing anesthesia; carbon dioxide gas distends abdomen allowing for visualization of fallopian tubes. - Interrupt fallopian tubes -cutting or blocking the egg and sperm from coming up - outpatient procedure but some recovery time involvement Permanent! Can be done w/in 24 - 48 hours after childbirth. Risk of tubal pregnancy

consistency of cervical mucus before ovulation occurs

- clear, slippery and smooth, elastic before ovulation occurs → shows lots of estrogen present favoring fertilization - Mucous helps sperm travel up and into fallopian tubes for fertilization - Mucous can be stretched between two fingers without breaking = spinnbarkeit mucous -***think of it as like a net trap for the sperm In other parts of the cycle = mucus is more thin and pasty

If NST comes back non-reactive (NO accelerations w/in 20 minute time frame)

-If this happens, further assessment is needed •Biophysical profile (BPP)

Barrier methods of contraception

-condom -diaphragm -cervical cap -spermicides (chemical) -vaginal sponge

Non-stress test (NST)

-ultra sound record movement, doppler measures fetal HR, assess fetal well being -evaluates FHR in response to movement -Reactive if two increases in FHR of >15 bpm lasting for at least 15 seconds in a 20 minute time span -done after 28 wks -picks up on contractions and fetal heart tones •Performed during the third trimester, @ 32 weeks, twice weekly to assess for intact fetal CNS. •For at risk-pregnancies

1 in 33 infants are born with birth defects or genetic disorders, causing ___ in 5 infant deaths

1 in 5

First trimester weeks and focus

1-13 wks Focus: fetal G&D, maternal changes, lifestyle, adjustment, testing, potential complications, dietary F/U **critical time, rapid cell differentiation, developing embryo highly susceptible to teratogenic events Symptoms: - N/V, ammenorhea, in morning - Breast swelling, tenderfness, fatigue, - increase vaginal secretions, constipation, - Serum pregnancy test 7-10 days after conception

Describe days 6-10 after fetilization

1. Blastocyst embeds into the endometrial wall 2. Implants in upper posterior wall of uterus (fundus) - bleeding or spotting may occur - May be overlooked as missed period

Describe the pre-embryonic layers

1. Ectoderm Central nervous system Special senses Skin Glands Enamel of the teeth 2. Mesoderm Skeletal Urinary Circulatory Reproductive organs 3. Endoderm Respiratory system Liver Pancreas Digestive system

Infections characterized by genital ulcers

1. Herpes Simplex (HSV) - Outbreaks can occur of both types in either location HSV-1 = Oral herpes, known as "cold sores" or "fever blisters" HSV-2 = Genital herpes 2. Syphilis

Hormones of Placenta

1. Human placental lactogen (hPL) 2. Progesterone (progestin) 3. Relaxin 4. Human chorionic gonadotropin (hCG) 5. Estrogen (estriol)

Describe the 3 stages of development

1. Pre-embryonic: fertilization through the 2nd week -Fertilization; cleavage; morula Blastocyst and trophoblast Implantation 2. Embryonic: end of 2nd week - 8th week -Basic structures of major body organs and main external features 3. Fetal: end of 8th week - birth

As a nurse, what vulnerabilities would you want to identify that could affect the pregnancy?

1. Safety oDomestic Violence oSeatbelts/helmets 2. Nutrition oThree years before conception 3. Avoiding toxins oCigarettes, alcohol, drugs, environmental chemicals 4. Socio-economic status oEducation Also: 5. Family Support 6. Finances $$$$ oIncome oHealth Insurance oAccess to health care 7. Life/Career Goals & Education

Tools for assessing male infertility

1. Semen analysis (Cervical mucus + sperm = watch for motility, survival and ability for sperm to penetrate ovum) At least a couple analyses need to take place usually 2. Ultrasonography

typical changes to uterus, cervix, vagina, ovaries and breasts during pregnancy

1. uterus increases in size x20 - Increases in strength and elasticity - Baxton hicks/uterine toning 2. Cervix increases in size and vasculatization becomes soft - Increased progesterone that produces thick mucous plug, blocking cervical oss/opening protecting fetus from bacteria 3. Vagina increases in vascularity + has thickening of mucosa and vaginal secretions 4. Ovaries are larger - Supplying hormones to support pregnancy until about 7 weeks then placenta produces progesterone 5. Breast changes in color from progesterone and estrogen changes, - Mcgumery glands enlarge, nipples become erect, increased blood flow, double in size

Assisted reproductive technology contributes to about _____% of all live births in the United States yearly (Cunningham, 2017).

1.6

when assessing fetal kick counts, what do we look for?

10 kicks in a certain period of time (time varies)

Copper (ParaGard T 380A) IUD

10 year Nonhormonal; creates inflammation, thus preventing implantation Releases copper ions-spermicidal Approved for emergency contraception

Ovulation occurs ~_____ days before menses begins

14

second trimester weeks and focus

14-26 wks Focus: fetal G&D, maternal changes, fetal movement, potential complications, feeding, & birth plan, CBE prep, dietary F/U - Uterine and fetal size increases substantially - Striations = stretch marks - Pigmentation changes = linea nigra, melasma - Diaphoresis, increase salivation, indigestion, constipation, edema, hemorrhoids - By week 20 the fetus is big enough for the mom to feel movements

Ballottement

16-28 weeks, passive fetal movement in response to tapping of cervix (shifting upward)

Alpha-fetoprotein (AFP)

A blood test that measures the level of alpha-fetoprotein in the mothers' blood during pregnancy as an indicator of possible birth defects in a fetus •levels are used as a screening tool for Neural tube defects in pregnancy •Screening is recommended for all pregnancies •detectable in the serum during pregnancy from 14 to 34 weeks •Values correlated with maternal factors

When does the embryonic period occur?

2-8 weeks after conception

to confirm normal anatomy of baby, a second ultrasound is done around week _____

20 check for: •Fetal Growth •Birth Defects •Screen for Genetic Aneuploidy (50-85% detection) -can be false positives! not a diagnostic!

All states must screen for (#)___ disorders during a newborn screening

21 wisconsin tests for >40 diseases

Each offspring has a total of __ pairs of chromosomes from each parent

23 22 pairs of non-sex chromosomes or autosomes 1 pair of sex chromosomes

1 case of PID = fertility decreases by __% 2 cases of PID = fertility decreases by __% 3 or more cases of PID = high rate of infertility

25%, 50%

third trimester weeks and focus

27-40 weeks Focus: fetal G&D, maternal changes, fetal movement, fetal evaluation, potential complications, prep. for feeding, birth prep. s/sx of labor, pain management, parenting & postpartum prep. - Braxon hicks contractions, increased uteran size, center of gravity changes (back ache)

___-___% of deliveries result in birth defects

3-5%

how many genes are in the human genome?

30, 000 genes in the human genome

Increase intake by ___ cal/day in 1st trimester Increase by ___ cal/day in 3rd trimester During breastfeeding, increase calories by ___-____ cals/day

340 500 500-1000

How long is pregnancy?

40 from date of LMP

main causes of birth defects

40-60% unknown cause 20-25% multifactorial cause 2-10% single gene 8-12% prenatal exposures 10-15% chromosomal

Mirena (levonorgestrel) IUD

5 year, but maybe effective up to 7 Releases low dose progestin causing thinning of the endometrium and thickening of cervical mucus-stops entry of sperm Reduces menstrual flow and dysmenorrhea

Despite availability of birth control, almost ______ % of all pregnancies in the US are unintended

50%

when does the heart beat begin? when can you hear it through doppler/ultrasound?

8 weeks, 14 weeks

how many glasses of water a day should you drink when pregnant?

8-10

in what weeks of pregnancy is the fetal stage?

9 weeks - birth

composition and volume of amniotic fluid

98% water and 2% organic matter (fetal waste), Slightly alkaline Normal volume at term: 600 ml to 800 ml

triploid

A chromosomal mutation where an organism has three sets of chromosomes (3n) instead of two (2n) 69 chrom.

Turner Syndrome (45, X)

A genetic condition in human females caused by a 45, X genotype. Such individuals are phenotypically female but are sterile. - A portion or all of X chromosome is missing - Most common deviation in females - Affects 1 in 2,000 live-born female infants Characteristics: -low posterior hairline, short stature, low hair line, low set ears, lymphedema of hands and feet, intelligence impaired, webbing of neck, short stature, broad skeletal abnormalities, kidney abnormalities, heart defects, scoliosis, puffy feet, underdeveloped secondary sec characteristics -Undeveloped ovaries - Paternal X or Y that is lost Treatment/Considerations: Cause infertility if not diagnosed earlier Given growth hormone Normal intelligence and live normal lives

Inborn Errors of Metabolism (IEM)

A group of congenital conditions that cause either accumulation of toxins or disorders of energy metabolism in the neonate. These conditions are characterized by an infant's failure to thrive and by vague signs such as poor feeding. - More than 350 errors that they've discovered - Most are autosomal recessive inherited disorders - Gene mutation interferes with enzymes normal metabolism (cannot occur) = accumulation of damaging product or absence of necessary product Newborn screening programs: - phenylketonuria, galactosemia, maple syrup urine disease, Tay-Sachs disease, sickle cell anemia, and CF - Screening takes place after 24 hours old, when they have the ability to introduce breast milk and start digesting - Each state varies on which EM disorders they are screening for

Lactational Amenorrhea Method (LAM)

A method of avoiding pregnancies based on the postpartum infertility that many women experience when they are breast-feeding - used in the first 6 months after baby is born - Heavily depends on the individual!! Must be feeding q4h! - Continuous breast-feeding stimulates prolactin and inhibits gonadotropin necessary for ovulation (NO MENSES) - Must breast-feed baby on demand, at least every 4 hours and every 6 hours at night - Baby is not consuming any other foods besides breast milk - 98% effective if exclusively breastfeeding

Gonorrhea

A sexually transmitted bacterial disease caused by a gonococcus bacterium that causes inflammation of the genital mucous membrane, burning pain when urinating, and a discharge Bacterial infection caused by Neisseria gonorrhoeae. - Curable STI - Pregnant individual screened at initial visit - If untreated, can lead to PID and infertility - Screen early! Findings: Dysuria, vaginal bleeding btwn periods. Dysmenorrhea, PID, Bartholin's abscess Yellowish -green discharge Treatment: Ceftriaxone(Rocephin)one injection IM and Azithromycin 1 g po Reportable disease to state lab Assuming we have chlamydia too since chlamydia likes to hang around gonorrhea so treat both!! After birth of baby, immediately manage with erythromycin bc of blindness threat and shiz Also associated with preterm premature rupture membranes, chorioamnionitis, premature labor, postpartum endometritis Education: Finish all of meds Safe sex practices May decrease effectiveness of oral BC Reportable to state labs Highly contagious! Spread genital/anal/oral- to - genital as well as to newborn @ birth 2nd highest reported - Women can be asymptomatic

bicornuate uterus

A uterus with paired uterine horns extending to the uterine tubes

things to consider for the fertility awareness method of birth control

Ovum lives for 24 hours after release Sperm can live up to 5 days after intercourse; therefore, "unsafe period" is 6 days (3 days before and after ovulation) Woman is aware of body changes i.e. cervical mucous Use other methods to determine fertility

Homozygous

An organism that has two identical alleles for a trait

Genotype

An organism's genetic makeup, or allele combinations.

in what cases do you need a refitting for a cervical cap?

Abortion Cervical manipulation pregnancy and weight changes

Noninvasive Prenatal Screen(NIPS) Cell-Free DNA Prenatal Screen

Advanced screen for trisomy 21, 18, 13 Maternal blood test that analyzes the relative fractions of cell free fetal DNA found in maternal blood, and quantifies the amount of fetal DNA that comes from chromosome 13, 18, 21, X and Y •Benefits: •Early (>10 weeks) •No risk to pregnancy •High detection rates (90-99%) •Quick (<10-14 days) •Less diagnostic testing Risks: •Lack of informed consent Limitations: •Not diagnostic •False positive •Insurance Coverage fairly new screening, used to be reserved for only high risk pregnancies

advantages and disadvantages of IUD

Advantages: Highly effective (99%) Low maintenance OK with breastfeeding Easily reversed Disadvantages: No protection against STIs Risk of PID with STI Menses changes Can be expelled High insertion cost but low overall cost Small risk of atopic pregnancies

Risk Factors for Female Infertility

Age Smoking Excess alcohol use Stress Poor diet Athletic training Being overweight or underweight Sexually transmitted infections (STIs) Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

menstural history to know about and why it's important

Age at menarche Days in cycle Flow characteristics Discomforts Use of contraception comes into play pospartum - what works, what doesn't, what's baseline

X-linked dominant inheritance

All females of the affected father are diseased. Affected mother can pass on the disease to both male and female offspring. Some lethal in males. When male is affected, all daughters, but none of his sons will be affected. If females is affected, then 50% chance for offspring to inherit the disorder. Rare. Ex: fragile X syndrome.

Postcoital test (PCT)

An examination that evaluates the cervical mucus, sperm motility, sperm-mucus interaction, and the sperm's ability to negotiate the cervical mucus barrier. Also called Sims-Huhner test. Testing done 8-10 hours after intercourse to evaluate cervical mucus and sperm viability. Normal Test Shows: -Clear mucus (egg white mucus) -- Spinnbarkeit mucus -- Elastic and stretches a distance before breaking + ferning on slide (looks like boston fern) 5-10 motile sperm

Haploid

An organism or cell having only one complete set of chromosomes 23 chrom.

Heterozygous

An organism that has two different alleles for a trait

Probable (objective) signs of pregnancy

findings noted by the healthcare provider that suggest a pregnancy is present temp raised, positive urine (hcg present), cervical changes (goodell's and chadwicks signs and hegar's sign), vulvar & vaginal changes, braxton hicks contractions, uterine changes, ballottement, enlargement of abdomen

positive sings of pregnancy

findings that confirm pregnancy - Ultrasound visualization of embryo or fetus - Fetal movement felt by examiner - Auscultation of fetal heart tones via Doppler

in what weeks of pregnancy is the unborn baby not susceptible to teratogenic substances?

first 2 weeks

STI's that are ectoparasitic infections

scabies, pediculosis pubis

Biophysical Profile (BPP)

uses a real-time ultrasound for visualization of physical and physiological characteristics of a fetus. Ultrasound for: ÷Fetal Breathing Movements ÷Fetal Activity ÷Fetal Muscle Tone ÷Amniotic Fluid Volume

teratogens that can lead to adverse outcomes with pregnancy

Anti-epileptic drugs Oral anticoagulants Smoking Alcohol (meds --> go off the meds or switch to different kind)

Lab tests for 24-28 weeks

Antibody screen- Anti-D immune globulin (RhoGAM) Complete blood count Diabetes screen 3-hour glucose tolerance test

what foods to avoid in pregnancy

Avoid fish -Mercury Avoid or limit caffeine Avoid deli meats/soft cheeses to prevent Listeriosis take calcium and folic acid supplements

amount of weight you can expect to gain during pregnancy based on pre-pregnancy BMI

BMI (18.5-24.9): 25-35 lbs Underweight (BMI < 18): 28 to 40 lbs Overweight (BMI 25-29.9): 15 to 25 lbs. Obese(BMI 30 or higher): 11 to 20 lbs approx. weight gain in general is 30 lbs

things to consider for basal body temp birth control

Biphasic pattern Slight decrease near ovulation Rises 24- 36 hours/3-4 days after ovulation Raised temp lasts at least 3-4 days after ovulation Remember: sperm live 48-72 hours (Can hang around longer to help implant the egg) Ova live 12-24 hours

Chadwick's sign

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion. 6-8 weeks

homozygous dominant

Both alleles (factors) for a trait are the same and dominant (AA)

homozygous recessive

Both alleles (factors) for a trait are the same and recessive (aa)

Syphilis effect on fetus

Can be passed in utero transplacentally Can result in fetal or infant death Congenital syphilis can manifest as skin ulcers, rashes, fever, ineffective cry, swollen liver and spleen, jaundice, anemia, and various deformities

viability of fetus

Capability of fetus to survive outside uterus At 24 weeks Pushing limits of viability ~ 22-23 wks after LMP

What we need to know about an STI

Causative organism Transmission Symptoms/findings Tests/screenings Treatment Prevention

Syphylis

Cause: treponema pallidum (spirochete bacteria) - curable! Reportable disease to state lab Risk factors: Multiple partners Unprotected sex Pregnancy: - Crosses placenta during pregnancy - Newborn can be born with congenital syphilis - During pregnancy: could be spontaneous abortion, prematurity, fetal death, death of newborn, PID, infertility Transmitted by sexual contact with infected person Screening/Dx: + Venereal Disease Research Laboratory (VDRL) and Rapid Plasma Reagin (RPR) Treponemal test to confirm dx Treatment: Penicillin G injection IM Primary, secondary and early/late phase = penicillin G 2.4 million units IM once latent or unknown duration = 7.2 million units are given divided into 3 weekly doses (2.4 each week x 3) Doxycycline, erythromycin Sexual partners tested and treated Reportable disease to state lab

In women, STI's can lead to...

Cervical cancer, infertility, ectopic pregnancy, chronic pelvic pain, even death

if the patient has an IUD, what abnormal findings should they report to their provider?

Change in string length or can't feel strings; she should check the length of string regularly Abnormal bleeding, abdominal pain, pain with intercourse, abnormal or foul-smelling vaginal discharge, fever, chills Expulsion of IUD

cervicitis is caused by what 2 STI's?

Chlamydia Gonorrhea

Monosomy

Chromosomal abnormality consisting of the absence of one chromosome from the normal diploid number have only 45 chromosomes/cells Product of normal gamete and gamete missing chromosome

Spinnbarkeit

Clear, slippery, stretchy quality of cervical mucus during ovulation.

Common congenital malformations

Cleft lip Cleft palate Spina bifida Pyloric stenosis Clubfoot Developmental hip dysplasia Cardiac defects

Pharmacologic therapies for female infertility

Clomid + Metformin + *Treat medical conditions (Infections, Inflammation, hormonal imbalances) - Hypothyroid issues → use thyroid supplementation - Treating of endometriosis → use of inducing ovulation after the endometriosis is treated - Adrenal hyperplasia → prednisone and treating any infections with antimicrobials

Nurses role when it comes to testing for genetic anomalies in fetus

Compassionate care -Support a patient during a vulnerable timeframe as they discover their genetic inheritance - Child-bearing decisions - Respect for cultural and religious beliefs Knowledge of genetic conditions and testing available -Complex area of health care -Disease prevention, development and treatment

lab tests for 32-36 weeks

Complete blood test Gonorrhea and chlamydia Group B Streptococcus (GBS) HIV and syphilis

the ___________ _____________ secretes hormones to support pregnancy until placenta takes over

Corpus luteum

causes for male infertility

could be d/t congenital disorders, tumors of pituitary gland or hypothalamus, trauma that has occurred to pituitary or hypothalamus, hyperprolactinemia (excess of androgens, estrogens or cortisol), substitutes or other prescribed medications, chronic illnesses, nutritional deficiencies, obesity, endocrine disorders (diabetes), testicular factors, traumas

Naegele's Rule

Date of LMP Subtract 3 months Add 7 days

what is chi-du-chat syndrome

Deletion of portion of 5th chromosome - Death is commonly d/t pneumonia, aspiration, congential heart defects and respiratory defects - Known as "Cry of the Cat" High-pitched distinctive cry of newborns, such as a mewing of a cat due to laryngeal defect Symptoms - hypotonia, microcephaly - Associated with severe intellectual disability, microcephaly, low birth weight, slow growth, hypotonia, failure to thrive, wide-set eyes, low set ears, organ malformations - Occurs 1 in 50,000 births No treatment

The arteries of the umbilical cord carry...

Deoxygenated blood and waste from the fetus

how is gestational diabetes diagnosed?

Diagnosed if two or more results from 3 hour glucose test are abnormal •Hemoglobin A1C (keep under 6) •Ketoacidosis •Further signs of diabetes-polydipsia, polyphagia, polyuria, glycosuria

supine hypotensive syndrome

Dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing return of blood to the heart and cardiac output. Signs/symptoms Dizziness, lightheadedness, pallor, clammy skin; fetal bradycardia Preferred position Left-lateral side, semi-fowlers Wedge under one hip

Trisomy 21

Down syndrome - Three copies of chromosome 21, instead of two copies - Affects 1 in 800 live-born babies Risk increases with maternal age; 1 in 1250 @ age 25 vs 1 in 30 @ age 45 Manifestations: Can be mild - moderate intellectual disabilities Treatment: Early intervention Characteristics of Downs Syndrome: Small, low-set ears, Hyperflexiblility, Muscle hypotonia, Wide-spaced eyes, Ulnar loop on second digit, Deep crease across palm, Flat facial profile, Small white, crescent-shaped spots on irises, Broad, short fingers Shortened lifespan (age 55) More common cardiac issues

Trisomy 18

Edwards syndrome - Affects 1 in 5,000 - High mortality rate - Life expectancy: few months Causative factor: maternal age Screening: Findings seen on ultrasound, IUGR, oligohydramnios, single umbilical artery, decreased fetal movement Decreased level of maternal serum alpha-fetoprotein (MSAFP) and hCG Findings: Most affected newborns are female 47 chromosomes (three at chromosome 18) Abnormalities: Severe intellectual disability, microcephaly, low-set ears, facial malformations, SGA, seizures, webbing of fingers, kidney and congenital heart defects, rocker-bottom feet

Considerations for birth control

Effectiveness Age Future childbearing plans (near, far, not on minds at all?) Contraindications due to health hx, comorbildities Personal preference Religious or moral factors Lifestyle Frequency of coitus Number of sexual partners Access to medical care Partners support and willingness to cooperate with plan

second trimester screening for fetal wellbeing

Evaluate fetal anatomy, amniotic fluid volume, placenta location and health

genetic and/or preconception counseling

Evaluation of an individual or family Purpose of evaluation: - confirm, diagnose, or r/o genetic conditions - calculate and communicate genetic risks - identify medical management - discuss ethical and legal issue - assist in providing and arranging psychosocial support *Prenatal testing can lead to serious ethical and moral issues for couples *Consideration of termination vs keeping pregnancy

when should pregnant people get tested for STI's?

Every pregnant individual should be checked for STIs during the first prenatal visit.

first trimester screening for fetal wellbeing

External abdominal or transvaginal ultrasound Confirm intrauterine pregnancy and fetal heart rate, fetal number, gestational age Evaluate suspected ectopic pregnancy, pregnancy loss, cause of vaginal bleeding

Factors that put teens at risk for STI's

Females due to anatomy Commoner epithelial cells in cervix are prone to infections/exposure to infection Invincibility, Unprotected intercourse, Partnerships of limited duration, Obstacles to using or accessing health care systems

What occurs between 25-28 weeks of pregnancy?

Fetus length = 15 inches Rapid brain development Eyelids open and close Nervous system controls some functions Fingerprints are set Subcutaneous fat is visible under the skin Blood formation shifts from spleen to bone marrow Fetus usually assumes the head-down position

hemoglobin levels for anemia in pregnancy

First trimester: < 11 g/dL Second trimester: < 10.5 g/dL Third trimester: < 11 g/dL

routine prenatal visit frequency

First visit, usually in first trimester Monthly until 28th week of gestation Biweekly from 28 to 36 weeks Weekly from 36 weeks until birth More frequent if high-risk pregnancy

Describe the 4 stages of syphylis infection

Four stages of Infection (findings) 1. Primary: chancre on area bacteria entered body 2. Secondary: rash, sore throat, swollen lymph nodes, flu-like symptoms 3. Latent: No symptoms, No longer contagious 4. Tertiary: damage to internal organs. --> If antibiotics aren't given in time = No longer reversible --> Damaging to internal organ --> Impact musculoskeletal --> Causes blindness

biggest difference between GIFT and ZIFT?

GIFT = sperm and egg not fertilized before being placed in fallopian tube ZIFT = fertilized egg (after zygote stage) placed in fallopian tube,

Pregnancy History terms to know G T P A L

Gravida - # of pregnancies in total Term = 37-42 weeks window of gestation Preterm = birth that occur between 20-37 weeks or weight of fetus is >500 grams, or after point of viability Abortions = spontaneous, terminated or selected - under 20 weeks gestation Living = living children , living now, living past 1 year or up to 1 year, live past neonatal period (30 days after birth)

molar pregnancy

HCG much higher than expected >100,000. Snow storm pattern

Risk Factors for Male Infertility

Heavy alcohol use Drugs Smoking cigarettes Age Environmental toxins, including pesticides and lead Health problems such as mumps, serious conditions like kidney disease, or hormone problems Medicines Radiation treatment and chemotherapy for cancer

how do high glucose levels cause yeast infections?

High glucose diet/levels causes yeast to get out of balance bc. Yeast feeds on high sugar level Altered pH of normal flora

Combined oral contraceptives

Hormonal contraception containing estrogen and progestin, which acts by suppressing ovulation, thickening the cervical mucus to block semen, and altering the uterine decidua to prevent implantation Advantages: - Regulation of dysfunctional bleeding, reduction of dysmenorrhea, and premenstrual symptoms - Offers protection against endometrial, ovarian, and colon cancer; improves acne; decreases benign breast disease and reduces functional ovarian cysts. Report side effects of: - Chest pain, shortness of breath, leg pain (clot), headache, visual disturbances, hypertension Education/Considerations: - Increased risk for blood clots!! - Report missing a dose - If one pill was missed, take it as soon as possible - If two or more pills have been missed, clarify how many and encourage to use back up birth control

Prescription Birth Control

Hormonal: Pill Patch Ring Shot Implant Barrier (Diaphragm & Caps) IUD/IUS

Non-curable STI's

Human Papilloma Virus (HPV) Herpes Simplex Virus (HSV) Type 1 (HSV-1) Type 2 (HSV-2) Hepatitis (HAV, HBV, HCV) Human immunodeficiency virus (HIV/AIDs) No cure for viral infections, but antiviral treatment may be appropriate for HSV and is appropriate for HIV.

nursing assessments for female infertility

Hx & PE -Height, weight, BMI -Androgen excess (extra body hair, pigmentation changes) will be noted I -infections? Comorbidities? Healthy functioning reproductive tract? -Diagnostic studies -Begin with thorough history factors associated with ovulation and pelvic organs -Blood work for ovarian function -Ovulation predictor kits -Pap smear and cervical culture to r/o STI -Diagnostic tests to assess female organs -Abdominal surgeries

skin changes in pregnancy

Hyperpigmentation of skin: Areola, genital skin, axilla, inner aspects of thighs and linea nigra: Striae gravidarum Thicker hair

Preimplantation Genetic Diagnosis (PGD)

In assisted reproductive technology, the determination of genetic abnormalities in the embryo before it is transferred to the uterus - Identifies genetic defects in embryos created through IVF before pregnancy - Both parents have a known genetic abnormality - Testing done on embryo to check for genetic abnormality - May have surrogate

Causes for female infertility

Inability to ovulate = common (Dysrhythmia in pituitary and hypothalamic hormones) Adrenal gland disorders not as common Underweight being a problem Increased prolactin levels or lactating Thyroid disorders Premature ovarian failure Medications (some oral contraceptives/progestin, antidepressants, antipsychotic drugs, corticosteroids, chemotherapy) congenital issues/anomalies of tubes

respiratory changes in pregnancy

Increase in maternal oxygen needs; total lung capacity decreases Shortness of breath SOB d/t enlarged uterus (INTERMITTENT) May need more pillows

If october 5th, 2020 was the date of LMP, when is the expected due date?

July 12th 2021

Maternal PKU

Lack of proper dietary therapy during pregnancy. - low phenylalanine diet before and during pregnancy Findings in infant: microcephaly, mental retardation, growth retardation, congenital heart defects.

progesterone in placenta

Maintains endometrium, decreases uterine contractions, stimulates maternal metabolism, prepares breasts for lactation Takes blame for morning sickness

XXY (Klinefelter Syndrome)

Male phenotype, Long arms and legs, underdeveloped testes in boys, breast development., infertile (mosaic klinefelter's syndrome can be fertile) - Caused by non-distinction during gametogenesis in either parent - 1 in 500 to 1,000 males - Abnormal development of testicles, resulting in decreased production of sperm and male sex hormones Characteristics: mild intellectual disability, small testes, infertility, long arms and legs, enlarged breast tissue, scant facial and body hair, decreased sex drive No treatment

What occurs on day 14 after fertilization?

Mass division of inner cells forming from pre embryonic layers

Fetal Teratogens

Maternal infections (TORCH) -Vaccines -Substance use -Environmental -Stress Any factor, chemical, or physical agent that adversely affects the fertilized ovum, embryo, or fetus.

Diagnostic Testing to Confirm Genetic Anomaly in Fetus

Maternal serum screening Ultrasounds Other diagnostic testing to confirm genetic anomaly in fetus: Amniocentesis Chorionic villus sampling (CVS) In infant = newborn screen

Depo-Provera

Medroxyprogesterone Progestin Contraceptive - Injectable progestin - no estrogens - Inhibits ovulation - Changes cervical mucus - Changes endometrium (less receptive to implanting ovum) - is given IM or SQ, depending on dose, every 11- 13 weeks (3 months) starting at the first 5 days of menstrual cycle. - Can also be given in postpartum period - May be used for people who are concerned about adhering to the oral pill schedule Advantages: - Very effective if patient returns for injection. Only 4 injections/year - Does not impair lactation - May eliminate period or decrease bleeding. Disadvantage: - Decrease in bone mineral density, weight gain, depression, irregular spotting or bleeding - Patient will need to take calcium and vitamin D to prevent bone loss - Should not be used as a long term birth control for more than 2 years.

amnion

Membrane that encloses the embryo in protective amniotic fluid

If Clomid doesn't work, which medication is used in conjunction with it?

Metformin - Takes into need for human menopausal gonadotropin, follicle stimulating hormone to stimulate follicle formation for women who did not respond by just clomid alone - Human chorionic gonadotropin (HCG) is used to induce ovulation when follicles are ripe , typically associated with recognition of pregnancy - Looking at triggers the oocytes to be released to be supportive of pregnancy to take place

Rh factor and pregnancy

Mom has Rh+ baby Mom build antibodies and no complications the first time 2nd pregnancy w a Rh+ baby Antibodies begin to cross the placenta and attack the fetus RBC's causing erythroblastosis fetalis

What occurs in ongoing prenatal visits?

Monitor weight, blood pressure Concerns, especially physical Monitor fetal development Fetal heart rate Fundal height Fetal movement Education Management of common discomforts of pregnancy

clinical manifestations of peritonitis

N/V, abdominal distension, rigidity, tenderness, abdominal or pelvic abscess

GI changes in pregnancy

Nausea and vomiting (from progesterone surge in 1st trimester) Increased bleeding of gums (from progesterone surge) Decreased gallbladder and stomach emptying Nasal stuffiness and nosebleeds Heartburn Hemorrhoids (d/t pressure on uterus)

Group B Streptococcus infection in pregnant women

Normal Flora, colonized to fetus during vaginal birth - Life threatening to newborns, causing sepsis, meningitis and newborn pneumonia - vertical transmission of GBS+ mother to newborn during birth Mother: chorioamnionitis, endometritis, and/or postpartum wound infection About 1/4th of healthy pregnant women carry + GBS status Risk factors Prevention Screening and diagnosis - Rectovaginal culture at 35-37 weeks Management: Penicillin G IV, initial bolus, then every 4 hours; at least 4 hours before birth Give GBS+ women and newborns with GBS+ penicillin G + bolus C-section if the water hasn't broken = will not need to receive prophylactic care The concern is that once the bag of waters is ruptured, the transmission from mother's GI tract/vaginal vault will transmit to colonize and infect the fetus Infected fetus can make the baby septic and be lethal

Warning Signs for IUD complications (infection or migration of IUD possible, could have been expelled or migrated further into uterus)

PAINS acronym P period late, abnormal spotting, bleeding A abdominal pain, pain with intercourse I infection exposure, abnormal discharge N not feeling well, chills, fever S string missing, shorter or longer

Non-Prescription Birth Control

OTC Behavioral methods Barrier Male condom Female condom Sponge Spermicide

Nursing assessment for STI's

Obtain sexual history Emotional support for diagnosis May be in abusive relationship, may see it as punishment Encourage safe sex practices, medication side effects, encourage vaccination Reporting to State Lab Sexual Behavior Screening for asymptomatic infection Risks Management: Completion of antibiotic therapy or viral therapy Counseling and education

What occurs at initial prenatal visit?

Obtaining a comprehensive health history Current pregnancy and OB history Medical & surgical history Establishment of a trusting relationship Nutrition Family: genetic disorders Current medications prescribed, OTC Substance use Mental Health Determine estimated date of birth based on LMP + dating ultrasound Baseline weight, vital signs, pelvic examination Flu vaccine Initial laboratory tests Education Referrals 1-3 horus method of prior births? complications? med surg hx? comorbidities? STI's? surgeries? allergies, eating disorders, genetic disorders, addictions, mental health?

what are some causes of polyhydroaminos?

Often d/t maternal diabetes, neural tube defects, chromosomal deviations, or malformation of central nervous system or fetal GI tract Inability of amniotic fluid to be maintained

examples of things that can weaken the latex of a condom

Oil based lubricants such as petroleum jelly, baby oil, or body lotion can weaken the latex Use only water-based lubricants, such as Astroglide or KY jelly.

Identical (Monozygotic) twins

One fertilized egg splits, dividing into 2 (or more) embryos Share one placenta, share genes, look alike and are same sex

the umbilical cord contains how many arteries and how many veins?

One large vein and two small arteries (AVA)

types of hormonal contraceptives

Oral contraceptives Emergency contraception Vaginal ring Transdermal patch Injectable IUS: implants

chorion

Outermost layer of the two membranes surrounding the embryo; it forms the fetal part of the placenta. Chorionic villi During early embryonic evaluation, site where testing is done Support maternal fetal circulation in weeks to come

monogenic or Mendelian disorders

Patterns due to single gene defect Autosomal - Autosomal dominant - Autosomal recessive X linked - X-linked dominant - X-linked recessive

What occurs between 29-32 weeks of pregnancy?

Rapid increase in body fat Increased central nervous system control over body functions Rhythmic breathing movements occur Lungs are not fully mature Pupillary light reflex is present Fetus stores iron, calcium, and phosphorus MAJOR AMOUNT OF FURTHER BRAIN DEVELOPMENT

Healthy People 2030 STI objectives

Reduce the syphilis rate in females Reduce the rate of mother-to-child HIV transmission Reduce congenital syphilis LGBT - Increase knowledge of HIV status - Preventive Care Increase the proportion of sexually active female adolescents and young women who get screened for chlamydia Reduce the syphilis rate in men who have sex with men Increase the proportion of adolescents who get recommended doses of the HPV vaccine

Polyhydroaminos

Polyhydramnios (>2,000 ml amniotic fluid at term) Excess

chorionic villus sampling (CVS)

Prenatal diagnostic technique that involves taking a sample of tissue from the chorion. detection >99% 1% risk done in week 12-14 TAT (turn around time) = 14 days Risk that it could perforate part of area, risk of bleeding, potential miscarriage

Preventable viral STI's

Preventable STI's with Vaccination: - Human Papillomavirus (HPV) - Hepatitis A and B - Hepatitis C Other Virus': - Zika Virus - Human Immunodeficiency Virus (HIV) - TORCH Infections - Group B Strep (GBS)

vaginal infections prevention

Prevention : - avoid douching with body washes, liquid bubble baths, powders, etc. in vaginal area → the uterus is a self cleaning oven, bad when normal flora is wiped away - Use of condoms, avoid tight nylon underwear or clothing, cotton underwear or no underwear at all esp. during bedtime, wipe from front to back, change out of wet bathing suits ASAP

How a copper vs. mirena IUD works

Prevents fertilization Inactivates sperm (Copper-T) Been around for a LONG time Lasts 10 years Thickens cervical mucus (Mirena) Has hormones in it 5 years May speed movement of ovum to uterus Changes endometrial lining

primary vs. secondary infertility

Primary infertility lack of conception despite unprotected intercourse after 12 months, < 35 years, or 6 months > 35 years Secondary infertility inability of a woman to conceive who was previously able to do so

Nursing Care Management (nonmedical and psychosocial) for Infertility

Psychosocial - Major stressor - Therapeutic communication --> Provide support, information, help to identify support and resources - Resolve, local support groups Nonmedical - Changes in lifestyle - referral to naturopath - Eliminate/decrease toxin exposures - nutrition, habits - Acupuncture - Herbal therapy - Yoga Some are successful, some may choose to adopt

Rh factor

Refers to the presence or absence of the Rh antigen on red blood cells.

Human placental lactogen (hPL) in placenta

Regulates glucose available to fetus, fetal and maternal metabolism Prepares breast for lactation

Oligohydroaminos

Scanty/few amnion water Oligohydramnios (<500 ml at term)

hCG (human chorionic gonadotropin) in placenta

Secretion of estrogen and progesterone from corpus luteum to maintain the endometrial lining of uterus until placenta functions Indication of pregnancy! Pregnancy test dx! Detected as early as 8-10 days after conception

symptoms of a latex allergy

Skin rash, itching, hives Itching or burning eyes Swollen mucous membranes Shortness of breath, difficulty breathing, wheezing Anaphylactic shock

what is a contraceptive sponge?

Small, round polyurethane sponge that contains N-9 Spermicide and fits over the cervix. May obtain this without a prescription; one size To use: wet with water, insert into vagina - Insert up to 24 hours before intercourse and left in place for 6 hours after intercourse; provides 12 hours of protection. If left in for more that 30 hours = risk of toxic shock syndrome If use properly, efficacy rate of the Today® Sponge is 76% to 88%. (Planned Parenthood 2020) Educate on TSS for sure!

estrogen in placenta

Stimulates uterine growth and prepares breasts for lactation Stimulates myometrial contractility Increased in estrogen and decrease in progesterone occur at time of labor

transcervical sterilization (Essure)

Taken off the market a few years ago -- caused too much scarring! Insertion of small flexible coils into fallopian tubes. Causes scar tissue formation in tubes. Surgical procedure; no general anesthesia Nonhormonal, 99.8% effective Must wait 3 months after procedure to ensure tubes are blocked! This is checked with dye during a hysterosalpingography Not reversible NO LONGER AVAILABLE: TAKEN OFF MARKET JULY 2018

what happens between 33-38 weeks of pregnancy?

Testes have descended into scrotum Lanugo disappears Strong hand grasp Increase body fat Earlobes formed and firm Fingernails reach end of fingertips Small breast buds present in both sexes Mother supplies antibodies to fetus Fetus is considered full term at 38 weeks Fetus fills uterus

Pregnancy quad screen

The quad screen is a simple blood test that screens pregnancies for Down syndrome, trisomy 18 and neural tube defects. -Four pregnancy hormones (AFP, hCG, Estriol, Inhibin) alpha fetoprotein, PAPP-A and hCG Low values in all 3 markers indicate trisomy 18 QUAD screen has placental hormone inhibin A to screen for down syndrome in babies of women <35 yo

TORCH

Toxoplasmosis Other viral diseases Rubella Cytomegalovirus Herpes simplex virus

Fraternal (Dizygotic) twins

Two separate eggs are fertilized by two separate sperm Each twin has their own placenta Share 50% of genes, can be different sexes, do not look alike More common than identical twins

renal changes in pregnancy

Urinary frequency common; filtration rate increases Kegel exercises, empty bladder frequently Increased risk for UTI and pyelonephritis -Dilation of ureters and renal pelvises allows bacteria to retrograde = more common UTI's -Educate on UTI prevention -Adequate water intake

RhoGAM

Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type -At 28 weeks get rhogam injection -If newborn's blood is Rh+, inject after birth -rH- infants would not need rhogam in mother then because no antibodies -If there was a prior pregnancy that pregnant person did not receive rhogam and the infant was rH+, the antibodies would attack the next fetus if got pregnant again -Contact with unborn baby's blood would also call for the injection

World Health Organization Precautions for the Use of Oral Contraceptive Pills Category 4 (refrain from use if you have...)

Venous thromboembolism Cerebrovascular or CAD Structural heart disease Diabetes with complications Breast cancer Pregnancy Lactation (< 6 weeks postpartum) Liver disease Headaches with focal neurologic symptoms Major surgery with prolonged immobilization Age >35 and smoke ≥20 cigarettes/day Hypertension (>160/100 mm Hg or with concomitant disease Less effective if BMI high

vaginitis

Vulvovaginal itching and discharge inflammation and infection of vagina Three organisms: Candida = fungus Trichomonas = protozoan Gardnerella = bacterium

Relaxin in placenta

Works with progesterone to maintain pregnancy Causes relaxation of pelvic ligaments, softens cervix in preparation for birth

Wharton's jelly

Yellow-white gelatinous material surrounding the vessels of the umbilical cord.

bacterial vaginosis

a condition in women in which there is an abnormal overgrowth of certain bacteria in the vagina Change in condition of normal bacilli in vagina, replaced by high concentration of anaerobic bacteria - caused by gram negative bacillus Gardnerella - Most common vaginal infection - untreated BV = increase PID caution: BV during pregnancy associated with preterm labor, PPROM, chorioamnionitis, PID, postpartum endometritis **Evaluation during 1st prenatal visit is key - puts patient at risk for preterm labor FINDINGS: - thin white or gray discharge with fishy odor, increases after sex. Diagnosis - PH >4.5. + clue cells. + "whiff test" speculum exam - with use of wet mount, normal saline and potassium hydroxide, smears are made and presence of clue cells (consistency of fried egg appearance) - Vaginal secretions can also be tested for pH on nitrazine paper Treat: Metronidazole (Flagyl) Education: No alcohol during treatment + 48 hours after completing meds because sever N/V can occur Avoid sun exposure Metallic taste in mouth - take with soda or something to cover the taste

Rh factor incompatibility

a condition that arises when the Rh protein is present in the fetus's blood but not in the mother's, causing the mother to build up antibodies. If these enter the fetus's system, they destroy red blood cells, reducing the oxygen supply to organs and tissues.

Fragile X Syndrome

a disorder produced by structural abnormality in X chromosome, producing mild to moderate mental retardation -Diagnosed by molecular DNA studies - Affects 1 in 4,000 males and 1 in 8,000 females; females are usually carriers and mildly affected Symptoms: Males exhibit full effects of syndrome: Intellectual disability, hyperactivity, large head, long face, short attention span, hand flapping, hypotonia, speech delay, autistic behavior, poor eye contact, continued repetition of words or phrases Treatment: No cure, a lot of therapy involvement, need intensive special education and counseling to be supportive to thrive

Clomid

a fertility drug that is used to stimulate ovulation and that has been associated with multiple births

Hepatitis A

a form of viral hepatitis transmitted in food, causing fever and jaundice. Spread via GI tract; polluted water, uncooked shellfish from contaminated waters, food handlers that are carriers of hepatitis with poor hand washing, or/and oral/anal sex. Feces of an infected person.

Nexplanon (Implanon) - how it works, SE, considerations

a plastic capsule inserted in a woman's upper arm that releases a low dose of progestin to prevent pregnancy -More long acting (long acting reversible contraceptive) - Subdermal time-released delivery of synthetic progestin which inhibits ovulation. - Provides highly effective protection for 5 years! Can do: Insertion immediately after abortion, miscarriage, childbirth, and can be used while breastfeeding Possible side effects: irregular bleeding and unpredictable bleeding, mood changes, headache, acne, depression, decreased bone density, and weight gain. Considerations: Do not use with history of undiagnosed vaginal bleeding, acute liver disease, jaundice

yolk sac

a specialized structure that leads to the digestive tract of a developing organism and provides it with food during early development Provides nutrients and oxygen Produces blood cells Eventually atrophies and becomes part of umbilical cord

contraceptive patch (Xulane)

a stick-on patch that delivers a precise dose of progesterone and estrogen into a woman's body through the skin, preventing ovulation - Change weekly - Patch on x 3 weeks and then off x1 week so menstruation occurs -applied to abdomen, upper outer arm, buttocks or upper torso. -Higher compliance than oral pills. Considerations: Increased risk of DVTs, Dependent upon BMI, Off week = get period, Risk of venous thromboembolism, Less effective with high BMI Side effects: similar to OCP since systemic hormone changes

Gravid uterus

a uterus containing a developing fetus

Human Papillomavirus (HPV) --> genital warts

a virus that can cause genital warts or asymptomatic infection - Most prevalent - One of the most common STI that leads to cancer Prevention: HPV vaccine has helped a ton to prevent this! Treatment: NO CURE; warts can be removed. Over 100 diff. Subtypes of HPV → associated with cervical, oralpharyngeal cancer Findings: wart-like lesions, clusters, raised or flat, small or large on vulva, cervix, vagina and anus Treatment: aimed at removing lesions by freezing, burning, laser or excision Trichloroacetic acid (TCA) or bichloracetic acid (BCA) as a form of weekly treatments depending on severity

when should a diaphragm be refitted?

after pregnancy weight loss or gain of 10 lbs pelvic surgery replace every 1-2 years Safe to use during lactation

Trichomonas vaginalis

an STD caused by a microscopic protozoan that results in infections of the vagina, urethra, and bladder Cause by protozoan parasite, Trichomonas vaginalis. Looks like a whip like critter - If left untreated, women can develop pelvic inflammatory disease and infertility - Live organisms live in wet warm surfaces Findings: Copious yellow-green frothy, mucopurulent, malodorous discharge, dysuria, dyspareunia , itching, petechiae mesa cervix (pin point bruises) Screening and diagnosis: Speculum exam - Inflammation, cervical spotting Pap smear & wet mount Treat: Metronidazole (Flagel) Education: No alcohol during treatment, don't use during 1st trimester Safe sex practices Take all the meds Decreases effectiveness of oral BC Avoid sex until both partners have been cured

PID is typically a results of what?

an STI, commonly gonorrhea or chlamydia

Pica

an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month - usually associated with nutritional deficiency like iron deficiency Soil or clay (geophagia) Ice (pagophagia) Laundry starch (amylophagia)

Minipill

an oral contraceptive containing progestin only Education: - Advise to take at the same time every day; cannot miss a pill - Needs another form of birth control for the first month of use - Used for individuals that are lactating and in women older than the age of 40 Advantages: - Fewer side effects than combination pills (no estrogen) - Safe to take while breastfeeding. - OK for smokers Disadvantages: - Less effective in suppressing ovulation than combined pills Adverse effects: breakthrough, irregular bleeding; vaginal bleeding; headache, nausea, and breast tenderness

Most commonly identified chromosomal abnormality in humans and leading genetic cause of intellectual disabilities

aneuploidy

What types of medications should a pregnant person with HIV be on?

antiretroviral meds

How much folic acid is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

b. 0.4 mg or 400 mcg!

which STI's are curable?

bacterial Chlamydia (CT) #1 Gonorrhea (GC) #2 Syphilis Trichomoniasis Bacterial Vaginosis (BV) Pelvic Inflammatory Disease (PID) All are curable with antibiotic therapy

why is it important to stay away from teratogenic substances specifically in the first 2-8 weeks of pregnancy?

because basic structure formation is happening - can be lethal!

if pregnant patient is on Coumadin regularly, what should they switch to while pregnant?

bridge to lovenox instead of coumadin

when can the mother begin to feel the baby moving?

by week 20 for first pregnancy, earlier for second pregnancy

why is HcG not necessarily conclusive of pregnancy?

can also be present with some forms of cancer

what should not be used by women with a hx of abnormal pap smear or toxic shock syndrome (TSS)?

cervical cap, diaphragm, and sponge

Presumptive (subjective) signs of pregnancy

changes that might make a woman think she is pregnant. such as amenorrhea, fatigue, nausea, vomiting, polyuria, breast changes(darkened areolae, enlarged Montgomery glands), quickening(slight fluttering movements of the fetus felt by the women, usually between 16-20 wks of gestation).

Chronic inflammation infection can be eliminated by use of ____________ (destruction of tissue with chemicals) or ___________ (destruction of tissues with heat/usually electricity) or _______________ (using extreme cold to destroy using liquid nitrogen)

chemocautery, thermocautery, cryosurgery

STIs characterized by cervicitis

chlamydia and gonorrhea

Polyploidy

condition in which an organism has extra sets of chromosomes

clinical manifestations of endosalpingitis

constant BL lower quadrant pain aggravated by movement, tenderness in one or both adnexal areas, abscesses

Explain what happens in week one after fetilization

development of embryo 1. Ampulla - Fetilization that takes place outside of fallopian tube 2. Zygote formed - Mitosis = cleavage 3. Zygote transported into uterus by tubal muscular movements 4. Morula (solid ball of 16 cells/developing zygote) Continue to divide until forming structures 5. Blastocyst = forms embryo and amnion 6. Trophoblast = outer layer = forms into embryonic membranes, chorion which forms placenta

pre-existing medical conditions that can lead to adverse outcomes with pregnancy

diabetes HIV/AIDS hypothyroidism materna phenylketonuria obesity STI

Three shunts in fetal circulation

ductus venosus, foramen ovale, ductus arteriosus 1. Ductus venosus Connects umbilical vein to inferior vena cava Delivers oxygenated blood to fetus while bypassing the fetal liver Placenta does all the work 2. Foramen ovale Oxygenated blood from right atrium to left atrium while bypassing fetal lungs to left side of heart, brain, and upper extremities and small portion travels to non functioning lungs 3. Ductus arteriosus Oxygenated blood from pulmonary artery to aorta and blood to rest of body

ways to determine due date

duration: Measured by first day of LMP to birth, approximately 280 days or 40 weeks Due date: Naegele's rule Pregnancy wheel/calculator Ultrasound Fetal heartbeat Uterine sizing Fundal height measurements

in vitro fertilization (IVF)

egg and sperm cells are combined outside the body in a laboratory dish (in vitro) to facilitate fertilization Indications: - Tubal obstruction - Endometriosis - Pelvic adhesions - Low sperm counts (create different environment outside of uterus then implantation) Procedure: - Medication to stimulate ovulation prior to procedure - Mature ovum retrieved by needle aspiration - Oocytes (female gonadocyte or germ cell involved in reproduction, immature ovum or egg cell) fertilized in lab in petri dish, then transferred to uterus - Very expensive!!! $12,000 for a cycle!

oral contraceptives suppress ovulation by doing what?

elevating estrogen and progestin levels to make the body think it's pregnant Implantation prevented by suppression of the building up of the endometrium

conization of the cervix

excision of a cone of tissue from the cervix performed to remove a lesion from the cervix or to obtain tissue for biopsy

Trisomy

extra chromosome, 47 Normal gamete + gamete with extra chromosome Most common autosomal aneuploidy condition Occur during oogenesis development

chlamydia effects on fetus

eye infections and pneumonia can cause low birth weight, pneumonia, premature births, stillborns, conjunctivitis (can lead to blindness and sepsis)

True or false: it is uncommon for obese people to lose weight during pregnancy

false - it is common!

amniotic fluid

fluid within the amniotic sac that surrounds and protects the fetus Volume increases as pregnancy progresses Mom's blood supply and fetus producing urine - Helps maintain a constant body temperature for the fetus - Buoyant environment that allow the fetus to move about and develop movement, can also keep the baby safe from injury - Permits symmetric growth and development - Cushions the fetus from trauma - Allows the umbilical cord to be relatively free of compression - Promotes fetal movement to enhance musculoskeletal development

tetraploid

four sets of chromosomes (92)

STIs characterized by genital ulcers

genital herpes simplex and syphilis

Lifelong recurrent viral infection, caused by virus that lives in the nervous system. No cure. More common in women

genital herpes simplex virus (HSV-2)

the crown to rump length on an ultrasound is used to detect what?

gestational age

emergency contraception

hormone pills or an IUD that can be used after unprotected intercourse to prevent pregnancy - NOT a regular method of birth control. - used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke. - Only available by prescription and states vary about is they dispense this --> Some states do not allow this Educate: Take as soon as possible/within 72 hours of failure of birth control

HIV

human immunodeficiency virus Transmission: Heterosexual transmission most common in women Body fluid exchange Risk factors: - AIDS = severe depression of cellular immune system associated with HIV infection Findings/symptoms: Fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash Screening and diagnosis: - Initial testing in pregnancy at first visit - Serious health disorder can be diagnosed before symptoms - Universal, routine testing of all pregnant women ASAP - Re-test in 3rd trimester for high-risk pregnancy - Counseling for HIV testing

what adjustments need to be made with levothyroxine for a pregnant patient who has hypothyroidism?

increase dose need for neurological development of fetus

Annoying natural side effects of progesterone

increased appetite, tiredness, depression, breast tenderness

FDA Pregnancy Categories

indicate a drug's potential or actual teratogenic effects. A = failed to demonstrate risk to fetus B = C = D = X = absolutely do not take

vertical pattern of inheritance

indicates a rare dominant trait common types: Marfan's syndrome Neurofibromatosis Huntington's disease Achondroplasia Polycystic kidney disease

horizontal pattern of inheritance

indicates a rare recessive trait

If close to term and the amniotic fluid volume is under 500mL, what does this indicate?

indication of uteroplacental insufficiency and fetal renal abnormalities

TORCH infections

infection of a developing fetus or newborn by any of a group of infectious agents → prevention is key - hand washing and vaccines --> Cross the placenta and cause teratogenic effects on fetus Symptoms: joint pain, flu-like symptoms, rash, lymph node enlargement if symptoms at all 1. Toxoplasmosis - Caused by eating raw or undercooked meat or ingesting or infection of cat feces (handling of soiled cat litter) 2. (Other)Hepatitis A/B, syphilis, mumps, parvovirus B19 and varicella-zoster 3. Rubella (German measles) - Rash 4. Cytomegalovirus - Transmitted by droplet, vaginal secretion, breast milk, placenta tissue, urine, feces, blood Prevent transmission by good hand hygiene No treatment 5. Herpes simplex virus (HSV) - Transmission to fetus during vaginal birth most concerning

pelvic inflammatory disease (PID)

inflammation and infection of organs in the pelvic region; endosalpingitis, oophoritis, endometritis, endocervicitis, peritonitis - needs to be treated early to prevent infertility

Hepatitis B

inflammation of the liver caused by the hepatitis B virus (HBV), which is transmitted sexually or by exposure to contaminated blood or body fluids - Disease of liver; often a silent infection - Typcially d/t IV drug use - Transmitted through saliva, blood serum, semen, menstrual blood, and vaginal secretions (intercourse, IV needles, razors, tooth brushes) not spread by water, food, sharing eating utensils, breast feeding, skin to skin contact, coughing or sneezing. Pregnancy: - Most threatening to fetus & neonate Transmission: - Parenterally, perinatally, orally (rare) and through intimate contact Prevention: Vaccination (given to all infants after birth) Screen all pregnant women routinely for hepatitis B surface antigen (HBsAg) during early prenatal visit high risk groups (men who have sex with men and IV drug users need vaccine) Diagnosis: requires serological testing Treatment: Supportive With HBsAg + mom - infant treated with HBIG and begin vaccinations

HPV effects on fetus or newborn

life threatening

muskuloskeletal changes in pregnancy

lordosis Relaxation and increased mobility of joints is d/t progesterone and relaxins separation of recti muscles Back aches common Encourage toning, yoga, stretching,

XY

male

Are males or females more affected by X linked disoders?

males, because they have only 1 X chromosome so all the genes will be expressed

McDONALDS RULE FOR CALCULATING EDD

measure fundus height in cm from the symphysis pubis to the top of the uterine fundus, between 18-30weeks the gestational age is equivalent to fundal height.

clinical manifestations of endometritis

mensural irregularity

Progestin only contraceptives

minipill and depo-provera injection

explain how to categorize multifetal pregnancies based on amnion and chorion

mono vs. di "mono" = they share it (either the chorion or amnion) "di" = each fetus has its own (either the chorion or amnion) Monochorion and monoamnion most concerning because sharing same resources

If the baby is found to be Rh+ after birth, what happens?

mother will receive rhogam again 72 hours after birth Contraindicated in hypersensitivity to immune globulin

annoying natural SE of estrogen

nausea, breast tenderness, fluid retention and irregular bleeding

amniocentesis

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis detection >99% <0.3% risk done in >16 weeks TAT (turn around time) = 10 days

if there is no rise in temperature during a mensural cycle, what does this indicate?

no ovulation Take temperature after at least 3 hours sleep and before getting out of bed

clinical manifestations of endocervitis

none, vaginal discharge, infection, inflammation, local tenderness

how can diabetes affect a pregnancy?

out of control BS can cause birth deficits or inability to become pregnant

veins in umbilical cord carry...

oxygenated blood from placenta to fetus

The 5 P's of STI Information to Discuss with Patient

partners pregnancy history and plans protection from STIs sexual practices, past STIs

If basal body temperature remains elevated past the time when a woman expects menstruation, what does this indicate?

pregnancy

Trichomonas effect on fetus/newborn

premature rupture of membranes, preterm birth, low birth weight

HIV/AIDS effect on newborn

preterm birth, low birth weight, transmits HIV to newborn or fetus, fetal loss, miscarriage

why take folic acid while pregnant?

prevent neural tube defects

vaginal ring (NuvaRing)

prevents release of FSH, progestins prevent ovulation, synthetic estrogen helps to prevent ovulation Flexible, soft, transparent ring inserted for 3-weeks, then removed for 1 week during which withdrawal bleeding occurs Discard ring after 3 weeks of use; may take out and wash if needed. Hormones, estrogen and progesterone are absorbed through the vaginal mucosa. Advantages: Fewer systemic side effects Disadvantages: possible discomfort with intercourse. Caution: Do not use if pelvic floor is weak, Does not protect from STI

zygote intrafallopian transfer (ZIFT)

procedure in which an egg is fertilized in the laboratory and then placed in a fallopian tube Similar to GIFT + IVF - After IVF, the ovum are placed in the uterine tube after the zygote stage - Fertilization is in vitro - Lab fertilized eggs (zygotes) are inserted into the fallopian tube - Outcomes depend on fertility problems and age i.e. young women = healthier eggs= higher success rate Indications same as GIFT: - Tubal obstruction - Endometriosis - Pelvic adhesions - Low sperm counts (create different environment outside of uterus then implantation) - in tact fallopian tubes (not the case in IVF)

Gamete intrafallopian transfer (GIFT)

procedure in which the sperm and ovum are placed directly in a fallopian tube - Couples own oocytes and sperm are combined in a catheter, placed into fibrated end of fallopian tube, allowing natural fertilization in uterine tube - Indication is same as IVF but must have normal tubal anatomy & patency, absence of previous tubal disease in at least one uterine tube -Controlled ovarian hyperstimulation -Done via laparoscopic surgery, needing anesthesia

metabolic functions of the placenta

respiration, nutrition, excretion, and storage

behavioral methods of birth control

rhythm method (scheduling sex around ovulation), withdrawal (pulling out) or abstinence, Lactational amenorrhea method (LAM), basal body temp

Diabetic screening in pregnancy

screening done between 24-28 weeks 1. 1 hour glucose test - 50 g oral glucose given, check 1 hr after - if >140 mg/dl = hyperglycemia -further testing 2. 3 hour glucose test - 100 g oral glucose - fasting > 95 -1 hour > 180 -2 hours >155 -3 hour >140

ampulla

site of fertilization outside of fallopian tube

intrauterine device (IUD)

small, T-shaped device inserted by a physician inside the uterus to prevent pregnancy -Minimal maintenance except cramping initially, checking string, acceptable for lactating - Long term approach - Can be hormonal based or non hormonal based MOA: Creates a hostile environment; thus preventing pregnancy, but also can be used to control menstrual irregularities Provider placed in office; consent and time out done prior to insertion Contraindications: multiple sex partners (does not prevent against STI's), pregnancy, active pelvic infection, abnormal uterine bleeding

what is a cervical cap?

smaller version of a diaphragm high degree of displacement and failure associated with cervicitis and toxic shock syndrome Insert up to 12 hours before intercourse and left in place for 8 hours after intercourse Protection for 48 hours Replace every 1-2 years Fitted and prescribed by licensed provider

Goodell's sign

softening of the cervix occurs at 5 weeks

hegar's sign

softening of the lower uterine segment 6-8 weeks

Most important indicator of male infertility

sperm count adequate amount, healthy and mature, and must penetrate and fertilize the egg

amniotic fluid index

sum of the four quadrants of amniotic fluid - Volume important in determining fetal well-being - Fetus swallows and voids amniotic fluid - Alterations of volume associated with problems with fetus/mother -Tells us how fetus is doing from GI and renal standpoint - The fetus Produces amniotic fluid through production of kidneys working

McDonald's Rule

take the tape measurer from the symphysis pubis to the top of the fundus. the measurement should match the number of weeks you are fundal height in cm's equals wks gestation w/in 2 wks

what is cervical mucus like when estrogen is high?

thin, stretchy Increased amount rises near ovulation = fertile time

Beta-HCG (human chorionic gonadotropin)

test to detemine pregnancy - Detected as early as 7-8 days after conception - Expected to double every 48-72 hours until peak at 60-70 days after fertilization - Decreases at 100-120 days of pregnancy - Also used as a marker to differentiate normal from abnormal gestation (ectopic pregnancy # is lower than expected)

Genome

the complete instructions for making an organism, consisting of all the genetic material in that organism's chromosomes

Zygote

the fertilized egg; it enters a 2-week period of rapid cell division and develops into an embryo

Quickening

the first movement of the fetus in the uterus that can be felt by the mother - detected by ultrasound 5-6 weeks after LMP - detected by mother approx. 16-22 weeks in

spermatazoon

the formal name for male sex cells

symptothermal method of contraception

the most effective of periodic abstinence methods - combines cervical mucus and temperature methods other things they look for: increased libido, mittelschmerz (german word meaning "middle pain" - occurs during ovulation) , pelvic fullness or tenderness, and breast tenderness

Karyotype

the number and pattern of chromosomes in each cell

what is cervical mucus like when progesterone is high?

thick, sticky scant amount - non-fertile

Bradley (Partner-Coached) Method

uses various exercises and slow, controlled abdominal breathing to accomplish relaxation Husband-Coached Childbirth by Dr Robert Bradley Denver Advocated unmedicated labor and birth, by using various exercises and slow controlled breathing to promote relaxation. Concentrate on the pleasurable sensations felt during labor and "turning on" their body. Partner: active participation in labor; massage and comfort techniques

Lamaze method of childbirth

using breathing and concentration techniques to distract a woman from the pain of childbirth- women who respond to this method tend to have hight hypnotic ability Dr Fernand Lamaze, a French obstetrician Psychoprophylactic (mind prevention) method, promoting specific breathing and relaxation techniques Cleansing breath taken at onset and end of each contraction; symbolizing mind free from worries Slow-paced breathing associated with relaxation Focal point - visual fixation on an object Effleurage - light abdominal massage Imagery - journey of mind Conquer fear through knowledge and support Focus on delivery of baby, not pain.

laproscopy

visual examination of the abdomen - Women with uterine abnormalities/reconstruction needs to take place - Performed during menstrual cycle - NOT usual part of infertility evaluation - Used to evaluate abnormalities found on ultrasound or hysterosalpingogram What is done: - Day surgery with anesthesia - Endoscope inserted through a small incision in abdomen - Look for endometriosis, pelvic adhesions, tubal occlusions, fibroids, polycystic ovaries

hysteroscopy

visual examination of the uterus Used to diagnose or treat problems of the uterus A hysteroscope is a thin, lighted telescope device inserted into the vagina. Image of uterus transmitted onto a screen. Identifies: - Abnormal uterine bleeding - Removal of adhesions - Dx cause of repeated miscarriage - View IUD - Perform sterilization procedure - Placement of coils into fallopian tubes (permanent)

biggest difference between IVF and GIFT/ZIFT?

with IVF, the fertilized eggs are inserted directly into the uterus so in tact fallopian tubes are not necessary

hysterosalpingography

x-ray imaging of the uterus and fallopian tubes after injection of contrast material - During the laparoscopy, delicate adhesions may be divided and removed and endometrial implants may be destroyed by electrocoagulation/laser - Laparotomy and microsurgery may be required for extensive repair of damaged tube - Prognosis depends on degree to which patency and function can be restored -Scheduled 8-10 days after last period What is done: - Opaque contrast injected into endocervical canal through a catheter. - Patency of tubes and uterus visualized during fluoroscopy and radiography - Dye will flow upward, through uterus, tubes and eventually into the peritoneal cavity = patency of tube

Vulvovaginal candidiasis

yeast infection, Normal flora has been taken over. Risk/Prevention: - Antibiotic therapy, diabetes, pregnancy, obesity, high sugary diets, corticosteroid use, immune suppressed agents Findings: - Pruritus of vulva - White, "cottage cheese" discharge - Vulva is excoriated, erythematous - During spec exam, adherent white patches Screening and diagnosis: - Speculum exam - Vaginal pH, KOH, wet mount Treatment: Antifungal: Miconazole cream or suppository If not pregnant, could take oral tablet Education: No intercourse until symptoms have subsided No tampons - want healthy flora to rebuild Use condoms until treatment is subsided If untreated during pregnancy, newborns can develop thrush which can be life threatening at this time

1st trimester screenings

•11-14 weeks to detect Down syndrome (detected 90-95%) and trisomy 18 •Blood test for pregnancy associated plasma protein (PAPP-A) and hCG •Ultrasound (nuchal translucency) Nuchal translucency and two pregnancy hormones (hCG and PAPP-A )

2nd trimester screening

•15-20 weeks to detect Downs, trisomy 18 and neural tube defects- less sensitive test - Combined first and second trimester screening: increase accuracy of detecting Downs syndrome - detection: 65-85% - Cell Free Fetal DNA: woman's plasma done @ 10 weeks to check for trisomy 13, 18 & 21