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What is follicular vs. lutial phase of the menstrual cycle?
- follicular: ovaries are preparing to release and egg.
- lutial: begins on day of ovulation and ends with 1st day of period (bleeding).
- For purposes of contraception or conception, the last 5 days plus day of ovulation are considered the fertility window. Fuck with caution.
What change in temperature indicates ovulation in the Basal Body Temp method?
Spike in temp.
What are some Cx's for combined hormonal contraceptives?
- thromboembolitic disorders
- CVA or heart disease
- BRCA or other estrogen dependent CA
- Smoking >15 cigarettes/day
- Impaired liver function
- vaginal bleeding
Which warning signs should you inform your pt about when taking a combined hormonal contraceptive?
- Adb pain
- chest pain
- weakness/numbness/pain/swelling in extremities
- visual problems
How long can you use a single IUD?
- Non-medicated: 10 years
- medicated: 5 years
How do you treat vaginal candida?
How do you treat bacterial vaginosis (BV)?
- topical flagel
- nfxn presents rist for preterm labor
What are SnSs of PID?
- Pelvic Inflammatory Disease
- Fever, pelvic pain, abnormal d/c, n/v, irregular vaginal bleeding.
What are SnSs of Gonorhea and what are it's associated pregnancy risks?
- Most women are asymptomatic
- burning pee
- purulent yellow-green d/c
- Complications include:
- --neonatal sepsis
- --Maternal pp sepsis
T/F Syphilis can cross the placental barrier only during the 2nd trimester
- False, you fiend! It can cross at any time during prenancy!
- Can cause PTD(preterm delivery), deformity, neuro defects, stillbirth, death.
- Tx with penis-ill'n.
What are the viral STIs?
- HPV: Most prevalent in ambulatory care setting. Can be transmitted without body fluid exchange making it the most boring of STIs to contract. Can cause resperitory papillomas in fetus.
- HSV I & II: Herpes=painful blisters on your naughty parts. Transmission to fetus 30-50% if aquired close to delivery. If transmitted, 50-60% mortality if complications are neurological.
What are the TORCH nfxns?
Pathogens capable of crossing placenta.
- Other nfxns (hepatitis, syphilis)
Effects of TORCH on fetus/neonate?
- T: SAB (), v birth weight, hepatospenomegaly, anema, neuros
- O: HepB
- R: deafness, eye defects, CnS problems, severe cardiac malformations
- C LBW/IUGR, hearing impairment, microcephaly, CNSs
- H: fatality, neuros.
What are some SnSs of ectopic pregnancy?
- Missed period.
- Abd pain, diffuse one side, low
- Vaginal spotting
- Rupture-->abd pain (see above)
- vBhCG levels
- No gestational sac on ultra sound u/s.
How do you Tx ectopic pregnancies?
- Methotrexate: cancer drug (tetarogenic) so it attacks rapidly dividing cells (zygote/embrio)
- Surgery to remove
What is the difference between a complete and partial mole?
- Complete: egg lacks nucleus, then gets fertilized. Vasculature of placenta looks like a cluster of white grapes. These are hydropic vessles and are diagnostic of gestational trophoblastic disease (GTD).
- Partial: Two sperm fertilize one egg-->3 chromos/pair
Both can lead to choriocarcinoma and must be treated with chemo, but most common with complete.
Usually seen in late 1st, early 2nd TM aeb dark "prune juice" bleeding.
SnSs of GTD
- Vaginal bleeding (prune juicy)
- passing of hydropic vesicles
- ^ hCG levels
- SnSs of preecampsia, but if <20wks, think GTD.
Nursing Tx of GTD?
- Remove mole
- Monitor hCG for 6mo to detect neoplasia
- NO PREGNANCY FOR 1 YEAR to reduce risk of choriocarcinoma.
What is a cerclage procedure?
- Used to mechanically close an incompetent cervix, which can also be treated with:
- bed rest
- progesterone supplements
- anti-inflamatories (may cause closure of patent ductus arteriosus and v amniotic fluid)
What is the biggest risk factor for developing hyperemesis and how do you treat it?
- ^hCG levels
- Tx with:
- zogran, ginger, genergan, reglan
- replace fluids/e-lytes/nutrition (esp vit B).
- Fast relief of symptoms by 3L fluid over 24 hours.
How do you diagnose preeclampsia?
- HTN after 20 weeks gestation + proteinuria > 300mg in 24hrs or >30mg/dL (at least 1+ on dipstick) in 2 or more random samples collects 6 hours apart.
- If <20wks, think GTD.
What not to comfuse for preeclampsia...
- Chronic HTN with superimposed preeclampsia: Preexisting HTN with developement of proteinuria in the 1st 20 weeks of gestation. 25% HTN patient will develope superimposed preeclampsia (the proteinuria component).
- Gestational HTN: HTN for first time after 20 weeks gestation but without proteinuria. Diagnosis is made pp.
What are risk factors for developing PreE?
- 1st kid w/new dad
- Hx of preE
- African American
- Multiple feti.
What are some pathophys characteristics of preE?
- 2nd half of pregnancy
- diffuse vasospasm and endothelial damage/swelling
- reduces organ perfusion
What organs are primarily affected by PreE?
- brain: HA not relieved with Tylenol because cerebral edema/hemorrhage. Also look for hyperreflexia.
- kidney: oliguria, v CC, calcium clearance, and uric acid. ^ protein in urine.
- liver: epigastric pain, fat deposits, periportal hepatic necrosis-->subcaspular hematoma (RUQ pain)
- eyes: blurring/x2 vision
- Coagulation disorders: Not an organ, but didn't want to make a new card just for this. thrombocytopenia activated by coagulation cascade-->depletion of available platelets-->v platelet count-->possible hemorrhage.
Adverse effects of HTN on pregnancy?
- fetal hypoxia
Home management of HTN/PreE
- Bed rest, left lateral is best
- monitor BP, weight, and urine protein daily.
- CBCs, LFTs, serum creatinine, uric acid
- Mg++ sulfate (for s/z, does not address HTN)
- fluid restriction
- Hydralizine (for HTN)
- DELIVERY (only cure)
SnSs of mag sulfate?
- CNS depression
- Treat with calcium gluconate wide open.
What can trigger a PreE s/z?
Urgent care for sz?
- lower HOB and turn head to side, prepare for suction
- doc time, duration, type of sz.
- call md.
- padded side rails.
What does HELLP syndrome stand for?
Peace, truth, and the American way. Or maybe its...
- Elevated Liver Enzymes
- Low Platelets
The above occur as a result of severe preeclampsia.
When are neonates at greatest risk for hyperbilirubinema/jaundice?
What is a Coombs test and what is the difference between direct and indirect?
- Tests for Rh antibodies
- Indirect: Tested on mom. Looks for IgG antibodies in blood
- Critical value is 1:16 or <
- Direct: Tested on baby. Will look for presence of antibodies or RBC surface
What are some treatments for blood type incompatabilities?
- RhoGAM (@28 wks if unsensitized, w/in 72hrs post delivery if sensitized)
When is RoGAM appropriate?
- after birth of Rh+ baby
- after abortion
- after ectopic
- after invasive procedure during pregnancy
- after maternal trauma, but w/in 72hrs.
What is polyhydramnios?
- >2000mL amniotic fluid
- uterine distention
- edema of lower extremities
- Tx with amniocentesis
What is Oligohydramnios?
- <500mL fluid during 2nd/3rd TM
- Risks include:
- --cord compression
- --pulmonary hypoplasia
- Tx with amnioinfusion