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OB COMPREHENSIVE REVIEW STUDY GUIDE NOTES
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A&P Review: Labs Type Value HGB 13 – 17. HCT 38 – 50 RBC 4 – 6 M WBC 4,000 – 11, Platelet 150 – 450 K Female Anatomy:
Chapter 9 Physical and Psychologic Changes of Pregnancy Common Obstetrical Terms—KNOW THIS ▶ Gestation- The number of weeks of pregnancy since the first day of the last menstrual period. ▶ Term- The normal duration of pregnancy. 38-42 gestation ▶ Preterm/Premature- Labor that occurs after 20 weeks but before completing 37 weeks gestation ▶ Post term- After delivery ▶ Post term labor - Labor after 42 weeks ▶ Antepartum- Still pregnant, during pregnancy ▶ Intrapartum- The time from the onset of true labor until the birth of the infant and delivery of the placenta. ▶ Nullipara- A woman who has not delivered a viable fetus more than 20 weeks gestation ▶ Primipara- A woman who has given birth to her first child (past the point of viability), whether or not that child is living or was alive at birth. ▶ Postpartum - After giving birth. ▶ Nulligravida - Never been pregnant. ▶ Primigravida- First birth. ▶ Multigravida - Pregnant more than once. ▶ Abortion - Before 20 weeks. Birth fetus weighing less than 500g. Abbreviated as “ab” ▶ Stillbirth - Delivery of a dead infant. ▶ Gravida - Any pregnancy regardless of duration. Includes present pregnancy. Abbreviated as “G” ▶ Para - Denotes the # of pregnancies NOT the number of fetuses. Birth after 20 weeks gestation. Doesn’t matter if infant is born alive or dead. Abbreviated as p. ▶ Multipara -Woman who has had two or more births at more that 20 weeks
Cervix: Increase estrogen levels: ▶ Hyperplasia= Estrogen causes glandular tissue stimulationà increased in cell number. ▶ Endocervical gland formation of mucous plug ▶ Operculum/Mucous plug prevents organisms entering uterus acts as a barrier—“bloody show.” ▶ Expelled when dilation begins ▶ Cervix closed Increased cervical vascularity causes: ▶ Goodell’s sign- Softening of the cervix (probable sign of pregnancy) (6 weeks after pregnancy) ▶ Chadwick sign- Bluish/purplish discoloration (lots of blood going to cervix) Ovaries: ▶ Ovum production ceases ▶ Corpus luteum persists and secretes hormones until weeks 6- 8 ▶ Secretion of progesterone maintains endometrium till 7 th^ week until placenta assumes its function Vagina: Increased estrogen levels: ▶ Increased thickness of mucosa ▶ Increased vaginal secretions to prevent bacterial infections- AKA (leukorrhea) o Thick, white and acidic, 3.5-6. o Pregnant woman are more susceptible to Candida infection than usual. ▶ Connective tissue relaxes during pregnancy to permit passageway of the infant. ▶ D/T increased blood flow you see Chadwick’s sign as well àBluish, purplish color of the vaginal wall (Cervix, vulva-some consider presumptive-4 weeks) Breasts:
Increased estrogen and progesterone levels: For preparation of lactation ▶ Increase in size and number of mammary glands ▶ More nodular ▶ Fullness, tingling or tenderness ▶ Nipples more erectile and areolas darken ▶ Colostrum produced during third trimester/16th^ wk
Physiologic Anemia of Pregnancy (Pseudoanemia) ▶ Increased blood volume leads to increased plasma over red blood cells. ▶ Total RBC (erythrocytes) increases, Plasma increases, hematocrit DECREASES ▶ Iron supplements are necessary to meet RBC expansion. ▶ Increased leukocytes 5600-12,200/mm3, plasma and fibrin levels ▶ During Labor/postpartum may reach 20,000-30,000/mm3 or higher. ▶ Fibrin and plasma fibrinogen levels increase ▶ Clotting factors increased =hypercoagulable state ▶ WATCH OUT FOR CLOTS ~Very difficult to determine when they have infection, even after birth if you draw blood work you will be surprised you should wait at least 48 hours. ~Remember normal value is 4,000-11, Q: A pregnant client, at 16 weeks gestation, has a hematocrit of 35%. Her prepregnancy hematocrit was 40%. Which of the following statements by the nurse best explains this change? A. “Because of your pregnancy, you’re not making enough red blood cells.” B. “Because your blood volume has increased, your hematocrit count is lower.” C. “This change may indicate a serious problem that might harm your baby.” D. “You’re not eating enough iron-rich foods like meat.” Gastrointestinal System: ▶ Heartburn aka pyrosis, d/t relaxation of cardiac sphincter ▶ Constipation, flatulence- Due to displacement of the stomach and decreased peristalsis/gastric motility ▶ Nausea/vomiting/ morning sickness à Caused by increased human chorionic gontropin(HCG) and progesterone levels ▶ Hyperptyalism - Caused by increased estrogen levels=Excessive salivation ▶ Risk for gall stone formation due to elevated levels of cholesterol and smooth muscle relaxation caused by progesterone. ▶ Mouth: Gingival hypertrophy-Bleed easily (take calcium) ~Most pregnant woman when they eat, their digestion is very slow. Antacids before you go into labor, they may aspirate.
o More prominent in dark-haired women o Aggravated by exposure to the sun o Sweat and sebaceous glands are hyperactive ▶ Striae (Striae Gravidarum) o AKA Stretch Marks o Reddish, wavy streaks o Results from reduced connective tissue strength cx by: Elevated adrenal steroid levels o Appear on: Abdomen,thighs,buttocks & breasts ▶ Vascular spider nevi o Small, bright red elevation of skin radiating from central body o Cx = increase SQ blood flow d/t estrogen levels o May develop on: Chest, neck, face, arms, & legs
▶ Level of free fatty acids increases d/t human placental lactogen (hPL)àLevel of lipoproteins and cholesterol increase ✓ Increased fat or decreased carb production = Ketonuria ~Walk, lower Na. Around 18-20 weeks there is fetal movement.--- multigravida By 4 weeks they can know they gestational age. Mother will feel 16-20 weeks movement. Examiner 20- Endocrine System: ▶ Thyroid – Enlargement causes increased basal metabolic rate 20-30% ▶ Pituitary- Enlarges- Returns to normal size post birth. a. Anterior pituitary producesà FSH (Follicle stimulating hormone) and LH (Luteinizing Hormone) which stimulates ovum growth, ovulation and prolongs luteal phase. i. Also produces prolactin responsible for lactation. b. Posterior pituitary secretesà Oxytocin (contractions) and vasopressin. c. Parathyroid - Slight enlargement allows for better use of calcium and vitamin D. Thyroid ▶ Enlarges d/t increased vascularity and hyperplasia ▶ Estrogen cx increase in serum-bound iodine ▶ BMR increases 20-25% ▶ Neck : Slight hyperplasia of thyroid in the third trimester – Small, nontender node Adrenals ▶ Vasopressin (ADH) o Cx vasoconstriction = Increased BP o Regulates water balance ▶ Oxytocin o Promotes uterine contractility o Stimulates ejection of milk from breasts in postpartum - AKA the “letdown reflex” ▶ Increased estrogen = Increased cortisol ▶ Returns to normal 1-6 wks postpartum ▶ During early 2nd trimester
Pancreas ▶ Increased insulin needs ▶ May show signs of gestational diabetes ▶ In the first trimester decreased insulin production allows for more glucose availability for fetal growth. ▶ The rest of the pregnancy the woman has increased insulin needs. Nutrition : ▶ A pregnant woman needs an additional 300 cal/day. ▶ Total calories 2300-2400/day o Protein = 3 servings/day o Dairy = 4 8oz servings/day o Carbohydrate/Grain = 6 servings/day o Fruit = 2-4 servings/day o Vegetable = 3-5 servings/day
Human Placental Lactogen (hPL) ▶ Produced by synctiotrophoblast ▶ Antagonist of insulin ▶ Increases circulating free fatty acids for metabolic needs ▶ Decreases maternal glucose metabolism = Fetal growth ▶ Secreted by placenta Estrogen ▶ Controls development of female secondary sex characteristics. ▶ Assists in the maturation of the ovarian follicles. ▶ Causes endometrial mucosa to proliferate following menstruation. ▶ Causes uterus to increase in size and weight ▶ Increases myometrial contractility in both the uterus and fallopian tubes. ▶ Increases uterine sensitivity to oxytocin. ▶ Inhibits FSH production. ▶ Stimulates LH production ▶ Secreted by corpus luteum ▶ Produced by the placenta as early as 7th wk ▶ Stimulates uterine development to provide suitable environment for fetus ▶ Helps develop ductal system of breast to prep breasts for lactation Progesterone ▶ Produced by Corpus Luteum-Ist 5 wks of pregnancy and then by the Placenta until term. ▶ PLAYS GREATEST ROLE IN MAINTAINING PREGNANCY ▶ Maintains endometrium ▶ Inhibits spontaneous contractility = prevents spontaneous abortions aka miscarriages ▶ Helps acini and lobule development to prep for lactation ▶ Decreases uterine motility and contractility. ▶ Facilitates vaginal epithelium proliferation. ▶ Secretion of thick viscous cervical mucus. ▶ Increases breast glandular tissue in preparation for breast feeding 14
Relaxin ▶ Detectable in serum by the time of first missed period ▶ Inhibits uterine contractility ▶ Diminishes the strength of uterine contractions ▶ During labor this drops ▶ GIVEN DURING PRETERM LABOR ▶ Aids in softening of cervix ▶ Long-term effect of remodeling connective tissue ▶ Secreted by corpus luteum Prostaglandins ▶ These are fatty acids produced by the endometrium classified as hormones. ▶ Two primary types PGE and PGF—Given to enduce labor, also pitocen.
placenta ▶ Funic Soufflé -Soft, blowing sound o Blood pulsating through umbilical cord o Occurs at the same rate as the FETAL heart rate (”F” for Fetus) ▶ Changes in skin pigmentation-Nipples, areola, linea negra, facial melasma, striae ▶ Fetal Outline-May be palpated after 24 wks ▶ Ballottement- Passive fetal movement elicited when examiner inserts 2 fingers into vagina and pushes against cervix o Action pushes fetal body up, it falls back, examiner FEELS rebound Clinical Pregnancy Tests Detects the presence of hCG in maternal blood or urine -Not considered positive pregnancy ▶ Urine tests ▶ Serum tests ▶ Over-the-counter pregnancy tests
containing hCG. o These two tests are done on the woman’s first early morning urine because it is adequately concentrated. ^^ top one ▶ The tests become positive within 10-14 days after first missed period. B-subunit radioimmunoassay (RIA) Blood Test ▶ Uses antiserum with specificity for the B-subunit of hCG in maternal blood. ▶ Very accurate Immunoradiometric Assay (IRMA) (Neocept, Pregnosis) ▶ Uses radioactive antibody to identidy hCG serum presence ▶ 30 mins to perform ▶ Can detect low levels Enzyme-linked immunosorbent assay (ELISA) ▶ Uses substance that = color change after binding ▶ Sensitive and quick ▶ Can detect hCG in 7-9 days after ovulation and conception ▶ Which is 5 days before first missed period Most common Fluoroimmunoassay (FIA) ▶ Uses antibody tagged with fluorescent label to detect serum hCG ▶ Takes 2-3 hrs to perform ▶ Extremely sensitive ▶ Used to identify and follow hCG concentrations ➢ Home pregnancy tests are enzyme immunoessay tests, if results are negative…. ~Woman should repeat the test in 1 week if she hasn’t started period Diagnostic (Positive Changes) Fetal Heartbeat ▶ Can be detected with electronic doppler as early as 10-12 weeks, audible with stethoscope at 18-20 weeks. Fetal Movement 18
