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Lec 2-OBS Flashcards

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1
Q

What are ovaries in reproduction?

A

Ovaries are located next to the uterus and contain FSH and LH hormones. Each month during the period, a single follicle survives while the rest die off.

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2
Q

What happens to FSH secretion during the menstrual cycle?

A

Hormones inhibit the secretion of FSH from the anterior pituitary gland, stopping further development of follicles.

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3
Q

What is the function of the fallopian tubes?

A

Fallopian tubes are 10 cm long, extend from the uterus, and stop before the ovary. They have three layers of tissues: serosa, muscularis, and internal mucosa.

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4
Q

Describe the uterus.

A

The uterus is a muscular, inverted pear-shaped organ that has a fundus, cervix, external os, uterine cavity, cervical canal, perimetrium, myometrium, and endometrium.

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5
Q

What are mammary glands?

A

Mammary glands are modified sweat glands that contain adipose tissue and produce milk, which is carried to the surface through ducts.

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6
Q

What occurs during conception and gestation?

A

Once the egg is fertilized and implanted in the endometrium of the uterus, it absorbs uterine fluid through its cell membrane, and cell division increases quickly to form the fetal membrane, placenta, and embryo.

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7
Q

What is a blastocyst?

A

A blastocyst is an egg that migrates to the endometrial wall, typically implanted approximately one week after conception.

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8
Q

What triggers the development of placental tissues?

A

The development of placental tissues is triggered by implantation, which stimulates the release of hCG hormone.

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9
Q

What does the corpus luteum do during pregnancy?

A

The corpus luteum makes hormones necessary for pregnancy.

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10
Q

When does the placenta develop and what are its functions?

A

The placenta develops in the 4th week of pregnancy and serves as an early liver, facilitates respiratory gas exchange, transports nutrients, excretes waste, transfers heat, and produces hormones.

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11
Q

What does the placenta act as?

A

The placenta acts as an enlarged endocrine gland.

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12
Q

What is the umbilical cord?

A

The umbilical cord connects the placenta to the fetus via the umbilicus (navel) and contains two arteries and one vein.

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13
Q

How many arteries and veins does the umbilical cord have?

A

The umbilical cord has 2 arteries and 1 vein.

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14
Q

Explain fetal circulation.

A

The umbilical vein carries oxygenated blood from the placenta to the baby, while the umbilical arteries carry deoxygenated blood back to the placenta, bypassing the fetus’s lungs until birth.

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15
Q

What is the amniotic sac?

A

The amniotic sac is a membranous bag that encloses the fetus in a watery fluid, providing a weightless environment.

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16
Q

How is the amniotic sac disposed of?

A

In the later stages of pregnancy, the fetus swallows amniotic fluid and passes waste into the fluid.

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17
Q

What happens between 4-8 weeks of gestation?

A

This period is critical for normal development, as major organs and body systems are forming. Prescription and OTC medications, as well as any substances the mother consumes, can harm the baby.

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18
Q

What is the gestational period?

A

The gestational period is the time it takes for an infant to develop in utero, normally lasting 38 weeks.

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19
Q

How can you calculate the due date of a baby?

A

The due date can be calculated by taking the first day of the last period, adding one year, subtracting three months, and adding seven days.

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20
Q

What is fetal alcohol syndrome in pregnancy?

A

Fetal alcohol syndrome can result from alcohol ingestion during pregnancy and is characterized by poor growth, facial abnormalities, and dysfunction of the CNS.

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21
Q

How does pregnancy affect the uterus physiologically?

A

Before pregnancy, the uterus weighs about 2g and holds 10ml. After pregnancy, it weighs 1kg and holds 5L.

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22
Q

How do we measure the length of gestation using the fundus?

A

The length of gestation is measured from the top of the pubic bone to the top of the fundus, with the length in centimeters corresponding to the weeks of gestation.

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23
Q

Does blood volume in women increase throughout gestation?

A

Yes, blood volume increases as the uterus shunts blood back into maternal circulation during contractions. The number of RBCs also increases, raising the need for iron.

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24
Q

How does the heart change during pregnancy?

A

The heart size increases, heart rate increases by 15-20 bpm per term, and ECG can show ectopic beats or SVT, as well as changes in T waves and QRS.

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25
What position causes the weight of the uterus to impinge on the inferior vena cava?
This occurs at 20 weeks of pregnancy, reducing venous return to the heart, which can decrease cardiac output and blood pressure, leading to lower extremity edema.
26
What position do women typically give birth in Canada?
Women typically give birth in the lithotomy position, lying down with legs back or squatting.
27
Why do abdominal muscles lose tone during pregnancy?
The uterus pushes the diaphragm up, allowing for more diaphragmatic respiration.
28
What are the respiratory stresses during pregnancy?
Maternal O2 demand increases, progesterone lowers the threshold of the medulla to CO2, and maternal O2 consumption goes up by 20-40%. Tidal volume increases by 40%, and pH slightly rises.
29
What O2 tool should we avoid in pregnant patients?
NPA (nasopharyngeal airway) and nasal intubation should be avoided.
30
What is relaxin?
Relaxin is a hormone released during pregnancy that causes collagen tissues to soften and produces generalized relaxation of ligament systems.
31
Why is the demand for carbohydrates increased during pregnancy?
The fetal demand for glucose increases, and since insulin cannot pass through the placental barrier, gestational diabetes can develop in predisposed women.
32
What are Braxton Hicks contractions?
Braxton Hicks contractions are intermittent uterine contractions that can occur every 10-20 minutes starting in the 3rd month of pregnancy, known as false labor.
33
What signs of withdrawal should you look for in a baby from a mother who has used drugs?
Signs of withdrawal include respiratory depression, bradycardia, tachycardia, seizures, and cardiac arrest.
34
What is the reading for preexisting chronic hypertension?
Chronic hypertension is defined as a reading equal to or greater than 140/90 before the 20th week of gestation or continuing postpartum, with diastolic pressure higher than 110 mm Hg.
35
What is gestational hypertension?
Gestational hypertension occurs after the 20th week of pregnancy and resolves postpartum. It is more common in women with diabetes and includes hypertension, preeclampsia, and transient hypertension.
36
What is preeclampsia?
Preeclampsia is characterized by high blood pressure, which normally resolves with delivery but can manifest postpartum. It is treated with IV magnesium.
37
What is the triad of preeclampsia?
The triad of preeclampsia includes edema, gradual onset of hypertension, and protein in urine.
38
What can cause seizures in pregnant patients?
Seizures can be caused by hypertension, preeclampsia, or epilepsy, and high flow O2 is needed.
39
What can cross the placental barrier that treats seizures and can cause fetal distress?
Diazepam and phenobarbital can cross the placental barrier and may cause fetal distress.
40
What is the treatment for seizures in pregnant patients?
Magnesium sulfate is used to treat seizures in pregnant patients.
41
What is gestational diabetes mellitus (GDM)?
GDM is the inability to process carbohydrates during pregnancy.
42
Can oral hypoglycemic agents cross the placental barrier?
Yes, oral hypoglycemic agents can cross the placental barrier.
43
What are some complications with asthma and pregnancy?
Complications may include premature labor, preeclampsia, respiratory failure, vaginal hemorrhage, eclampsia, low birth weight, growth retardation, and fetal death.
44
How does a mother with TB affect pregnancy?
A mother with TB can lead to premature delivery and spontaneous miscarriage.
45
Explain cystic fibrosis (CF) and its relevance to pregnancy.
CF is a hereditary condition that affects the entire body, is autosomal recessive, and women with CF have a higher chance of developing diabetes.
46
What is hyperemesis gravidarum?
Hyperemesis gravidarum is characterized by persistent nausea and vomiting during pregnancy, occurring 3-4 times daily and can include bile and blood.
47
How are kidneys affected by pregnancy?
Kidneys can increase in length by up to 2 cm, and ureters become longer, wider, and more curved, potentially leading to urinary stasis.
48
What does urinary stasis of the kidneys result in?
Urinary stasis can lead to low fetal birth weight, retardation, premature labor, and intrauterine fetal death.
49
What condition can create renal malfunctions from hypertension disorders?
Hyperemesis gravidarum can create renal malfunctions from hypertension disorders.
50
What is sickle cell disease?
Sickle cell disease is characterized by deformed RBCs, which inhibit smooth passage.
51
What are some complications of sickle cell disease?
Complications include vaso-occlusive crisis with severe pain, strokes, and targeted organ damage, especially to the spleen and liver.
52
What are pregnant patients with sickle cell disease at risk for?
They are at risk for bacterial infections (like pneumonia), pain, seizures, thrombosis, and anemia.
53
What are thalassemias?
Thalassemias are mutations that result in a decrease of normal hemoglobin, which can cause anemia and massive fluid accumulation in the fetus.
54
What is the most severe form of anemia?
The most severe form of anemia is Cooley anemia.
55
What is the Rh factor?
The Rh factor is a protein on RBCs. Maternal antibodies to it can cross the placenta in subsequent pregnancies, attacking fetal RBCs and potentially resulting in fetal death or hemolytic disease in newborns.
56
What is group B strep?
Group B strep is the leading cause of life-threatening infections in newborns. Anal swabs at 37 weeks can test for it.
57
What can strep B cause if passed on to the fetus?
It can cause respiratory problems, pneumonia, septic shock, and meningitis.
58
Explain epilepsy and pregnancy and how it can affect labor.
Women taking medications to control seizures may experience changes in hemodynamics during pregnancy, with 1/3 of patients having an increase in seizures. Onset of labor can trigger seizures.
59
Describe the thyroid.
The thyroid is a butterfly-shaped endocrine gland located in the neck behind the trachea, making hormones that regulate metabolism.
60
What does the thyroid secrete?
The thyroid secretes calcitonin, which controls calcium blood levels.
61
What is hyperthyroidism?
Hyperthyroidism occurs when the thyroid produces too much thyroid hormone.
62
What are the symptoms of hyperthyroidism?
Symptoms include fatigue, forgetfulness, constipation, bradycardia, feeling cold, and muscle and joint aches.
63
What is hypothyroidism?
Hypothyroidism occurs when the thyroid produces too little thyroid hormone.
64
What are the symptoms of hypothyroidism?
Symptoms include nervousness, irritability, tachycardia, and feeling warm.
65
What can hypothyroidism cause?
Hypothyroidism can lead to long-term neurologic or developmental deficits in the fetus and result in intellectual disability.
66
What is cholestasis?
Cholestasis is a liver disease where hormones affect the gallbladder by slowing down or blocking normal bile flow from the liver, causing bile acid to build up in the bloodstream.
67
What are some signs and symptoms of cholestasis?
Signs include profuse, painful itching of hands and feet, dark urine, and abnormally colored stools.
68
What is an ectopic pregnancy?
An ectopic pregnancy occurs when a fertilized ovum implants somewhere other than the uterus, usually in the fallopian tubes.
69
What are some signs and symptoms of ectopic pregnancy?
Signs include premature fetus delivery, severe pain, hypovolemic shock, and severe lower abdominal pain.
70
What is a molar pregnancy?
A molar pregnancy results from a malfunction of the egg or sperm, leading to an abnormal placenta.
71
What is a partial molar pregnancy?
A partial molar pregnancy occurs when two sperm fertilize the same egg, resulting in a child with an abnormal chromosome number.
72
What is a complete mole pregnancy?
A complete mole pregnancy occurs when an empty egg is fertilized, leading to normal progression of pregnancy without a fetus.
73
What is a miscarriage?
A miscarriage is the expulsion of a fetus from any cause before the 20th week of gestation.
74
What is a spontaneous miscarriage?
A spontaneous miscarriage occurs naturally and affects 1 in 5 pregnancies.
75
What are some causes of spontaneous miscarriages?
Causes include acute or chronic illness in the mother, maternal exposure to illicit drugs/substances, abnormalities in the fetus, and abnormal attachment of the placenta.
76
What is an abortion?
An abortion is the induced termination of pregnancy.
77
How do herbal medications work for abortions?
Herbal medications make the bloodstream too toxic for the baby to survive.
78
What is a threatened miscarriage?
A threatened miscarriage is when a miscarriage is attempting to take place, characterized by vaginal bleeding during the first half of pregnancy.
79
What is an incomplete miscarriage?
An incomplete miscarriage occurs when some products of conception are expelled, but some remain in the uterus, with the cervix dilated to expel the fetus.
80
When is an incomplete miscarriage most often encountered?
An incomplete miscarriage is most often encountered when a patient is found on the toilet.
81
What massage do you do for an incomplete miscarriage?
Fundal massage is performed for an incomplete miscarriage.
82
Do all expelled products need to be collected and delivered to a receiving facility?
Yes, all expelled products need to be collected and delivered.
83
What is a missed miscarriage?
A missed miscarriage occurs when the fetus dies within the first 20 weeks but remains in utero, often accompanied by brown vaginal discharge.
84
What is a septic miscarriage?
A septic miscarriage occurs when the uterus becomes infected following any type of miscarriage.
85
How much blood loss can occur for the mother before hypovolemia becomes apparent?
Hypovolemia becomes apparent after 40% blood loss.
86
Explain what abruptio placentae is.
Abruptio placentae is the premature separation of the placenta from the uterine wall, often presenting with continuous frank red blood.
87
What is the most common cause of abruptio placentae and when does it occur?
The most common cause is maternal hypertension, and it most commonly occurs in the last trimester of pregnancy.
88
What is placenta previa?
Placenta previa occurs when the placenta covers the cervix opening, leading to vaginal bleeding and pain, often with frank red blood.
89
What are some causes of third-trimester bleeding?
Causes include placenta previa and abruptio placenta.
90
Describe the 1st stage of labor.
The 1st stage of labor involves cramps and early contractions (5-15 mins apart), often ending when the water breaks or the cervix is fully dilated. It can last 8-12 hours.
91
Describe the 2nd stage of labor.
The 2nd stage begins after the water breaks, with contractions 2-3 minutes apart, crowning, and ends when the baby is delivered. It can last 1-2 hours.
92
What is the third stage of labor?
The third stage is the period from when the newborn is born until the placenta is delivered, usually occurring spontaneously within 30 minutes after delivery.
93
Describe the semi-Fowler birthing position.
The semi-Fowler birthing position involves the mother being propped up and able to lie back to rest between contractions.
94
Why are mothers placed on their left side during labor?
Mothers are placed on their left side to relieve pressure on the inferior vena cava.
95
What do you do to the baby immediately after delivery?
Warm, dry, and stimulate the baby for 30 seconds, calculate APGAR at 1 and 5 minutes, and monitor vital signs.
96
How far do we cut the cord from the baby?
The cord is cut 10-15 cm from the baby.
97
What do we encourage the mother to do when the placenta is visible?
Encourage the mother to bear down and push, ensuring the placenta is intact.
98
What is magnesium sulfate used for in pregnant mothers?
Magnesium sulfate is used in preeclampsia to prevent seizures and acts as a CNS depressant.
99
What is calcium chloride used for in pregnant mothers?
Calcium chloride is used for managing hypocalcemia and is the antidote for magnesium sulfate.
100
What is oxytocin used for in pregnant mothers?
Oxytocin is used to cause uterine contractions, induce labor, and manage postpartum bleeding.
101
What is shoulder dystocia and how do we manage it?
Shoulder dystocia occurs when the baby's shoulder is trapped on the pubic bone and sacrum, often seen in larger babies. Management includes suprapubic pressure, ALARM, and McRoberts maneuver.
102
What is breech positioning and how do we manage it?
Breech positioning occurs when the baby comes out butt first. Management includes placing the mother at the edge of the bed/stretcher, dislodging limbs without touching, and supporting the body.
103
What happens after 3 minutes in a breech delivery?
If the head hasn't delivered within 3 minutes, the Smelly V maneuver is used.
104
What is a prolapsed cord and how do we manage it?
A prolapsed cord occurs when the baby's head sits on the cord, cutting off circulation. Management involves placing the mother on hands and knees while supporting the head.
105
What are the requirements for preterm labor?
Preterm labor is defined as labor occurring before 37 weeks of gestation.
106
What should you do when using a bed or stretcher?
Dislodge limbs but otherwise no touching; support body.
107
What to do when you see a hairline during a breech delivery?
Grasp the baby and lift it up to dislodge the shoulder.
108
What happens if the head hasn't delivered within 3 minutes in a breech?
Use the smelly V maneuver.
109
What is a prolapsed cord?
Baby's head sitting on cord, cutting circulation off.
110
How do we manage a prolapsed cord?
Mum on hands and knees and support the head.
111
What are the requirements for preterm labour?
Less than 37 weeks and less than 2.5 kg.
112
What is meconium?
Sign of fetal distress. ## Footnote Yellow = meconium has been in amniotic fluid; greenish black = recent meconium, danger.
113
What is supine hypotensive syndrome?
Uterus compresses inferior vena cava.
114
What are the signs and symptoms of supine hypotensive syndrome?
Nausea, dizziness, tachycardia, claustrophobia, syncope, difficulty breathing.
115
What position should a patient be placed in for supine hypotensive syndrome?
Place in left lateral position; deliver fetus if possible.
116
What is a uterine rupture?
Occurs during labour; pts at greater risk are mums with a lot of kids and scars on uterus.
117
What are the signs of shock in uterine rupture?
May or may not bleed; s/s include dizziness, low BP.
118
What is a uterine inversion?
Placenta stays attached to uterus wall; uterus turns inside out.
119
What are the types of uterine inversion?
Incomplete/complete: uterus doesn't protrude externally; prolapsed: fundus of uterus can be seen protruding from vagina; total: both uterus and vagina protrude out.
120
What is the management of a uterine inversion?
Left lateral position, high flow O2 on NRB, start 2 IV lines of saline, consider oxytocin, make 1 attempt to replace uterus.
121
What is postpartum hemorrhage?
Blood loss over 500ml in first 24 hours of pregnancy.
122
What is the management of postpartum hemorrhage?
Uterine massage, encourage breastfeeding, add 20 units of oxytocin to the bag, notify receiving hospital, bimanual pressure.
123
What is a pulmonary embolism in a pregnant mother?
Clot arising in pelvic circulation; leakage of amniotic fluid into maternal circulation.
124
What are other reasons for a pulmonary embolism?
Clot arising from DVT, air or water entering vagina after water birth.
125
What are the signs of a pulmonary embolism in a postpartum mother?
Suspect if mum has dyspnea, tachycardia, a fib or hypotension post partum; can report sudden sharp chest pain or syncope.
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