combined ob guide full of week 1 to week 6 lecture notes PDF

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combined guide of each weeks lectures, they are from week 1 to week 6 notes...

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Study Guide from Week 1 Content (Chapters 3, 4 and 5) Chapter 3 Genetics Common genetic (inherited) conditions that you would counsel and screen patients either prior to pregnancy or at their first prenatal visit. A gene is a segment of DNA that is passed down from parents to children and confers a trait to the offspring. - Dad determines if the baby will be XX (girl) or XY (boy) - Genes can be either dominant or recessive. When there is both a dominant and a recessive gene in the pair, the traits of dominant gene will overpower it. - The traits of the recessive gene are present when both genes of the pair are recessive. - Genetic diseases or disorders are usually related to a defective recessive gene and present in the developing fetus when both pairs of the gene have the same defect. - 2 dominant genes will be the trait that is expressed - Genetic diseases are on the recessive genes which is a good thing because it is not as common for the parents to have the same recessive genes. Mendelian Inheritance - Autosomal Dominant: The affected person has affected parent, there’s a 50% chance of passing the trait, males and females are equally affected (dad can pass to son). (Huntington) - Autosomal Recessive: Can have clinically normal parents, but both parents must be carriers, 25% chance of affected child, 50% chance child is carrier, males and females affected equally Common Genetic Recessive Disorders The best time to test for these diseases are before. About 50% of pregnancies are unplanned, it is hard to know ahead of time. Sickle Cell Anemia: Inherited red blood cell disorder - Most common genetic disease among people of African ancestry - Test both mother and father for it - Preconception counseling is also good Cystic Fibrosis: Production of thick mucus clogs in bronchial tree & pancreatic ducts - Most severe effects are chronic respiratory infections & pulmonary failure Tay Sacs Disease: - Most common genetic disease among people of Jewish ancestry - Causes too much fatty substance to build up in tissues and nerve cells of brain - Degeneration of neurons & the nervous system, results in death by age 2

Thalassemia: blood disorder where the body makes an abnormal form or low amount of hemoglobin Phenylketonuria: A genetic condition that causes increased levels of phenylalanine (an amino acid) in the body. - Leads to severe mental & physical retardation - Effects may be prevented by diet (beginning at birth) that limits phenylalanine - Babies foot get pricked & blood is tested for Metabolic disorder including PKU - With PKU, the earlier we know, the earlier we can help the baby. - We are going to squeeze their heel and get blood to check for metabolic diseases.

Testing women of advanced maternal age (AMA) (and WHO is considered AMA) and increased risk of chromosomal abnormalities Advanced maternal age (AMA) Woman age of 35 and older: - There is an increased risk of chromosomal abnormalities - Down syndrome - Deletion - Translocation. - After 35 it starts to rise, and after 40 it takes a huge spike in the risk for babies with down syndrome - Medical abnormalities can happen such as, diabetes, high blood pressure - It is a strain on the body to be pregnant at that age Age + risk for down syndrome - Age 20 = 1/1667 - Age 35 = 1/952 - Age 45 = 1/30 Tests done: - Screening test: picks up anyone at risk - Diagnostic test: tells you if they have abnormality - Risk factors for conceiving a child with genetic disorders - Preimplantation Testing - Perinatal genetic testing - Parental decision to terminate or maintain pregnancy - Newborn Screening Nursing Responsibilities: - Obtain thorough and complete medical history - Assess for signs and symptoms of genetic disorders - Offer support - Assist in clarification - Educate on procedures and tests

Teratogens and at what crucial time exposure will cause the most damage Teratogens are defined as any drugs, medications, viruses, infections or other exposures in the environment that can cause embryonic/fetal developmental abnormality such as: - Alcohol - Drugs - Medications - Infections/viruses: Rubella, zika, syphilis, toxoplasmosis - Environmental toxins: chemicals, metals, radiation, ciggz - Drugs such as cocaine, meth, heroin - Caffeine in high doses can be teratogenic, you want to limit your intake to 300 mg/day. *Alcohol is the most common Teratogen *Crucial time exposure: 8 weeks. Embryo most vulnerable at this time

Fetal alcohol syndrome physical characteristics: IUGR: Intrauterine growth restriction = Small for gestational age Craniofacial deformities: - Low nasal bridge - Minor ear abnormalities - Indistinct philtrum - Micrognathia - Epicanthal folds - Short palpebral fissures - Flat midface and short nose - Thin upper lip - low birth weight - Microcephaly (head circumference smaller than normal) - mental retardation - unusual facial features due to midfacial hypoplasia Zika virus physical characteristics: Getting bit by mosquito -

microcephaly (small head) damage to brain seizures, blindness, hearing defects, impaired growth, problems with feeding (difficulty swallowing) problems moving limbs and body it will live in dads sperm for 6 months if mother was bit

Menstrual Cycle Consists of two cycles working simultaneously (ovarian and endometrial) Ovarian Follicular Phase (Making of the egg) Begins on first day of menstruation and lasts 12-14 days (creating follicle) = (Fluid filled sac) Follicle is maturing under influence of LH and FSH Hormones that influence follicle and getting egg ready Follicle is producing estrogen (starting things up)

Ovulatory Phase (day 14 - ovulating) Estrogen levels peak LH surges and releases oocyte (egg) into fallopian tube Luteal Phase (Prepping) Begins after ovulation and Lasts 14 days Corpus luteum forms which holds follicle together If fertilization occurs, corpus luteum continues to release estrogen and progesterone to maintain pregnancy If no fertilization occurs corpus luteum declines and period begins. Note: Corpus responsible for hormone production

Endometrial Proliferative Phase Cells are multiplying and spreading Occurs following menstruation and ends with ovulation The minute she starts period things start to build back up Once we hit ovulation, we aren’t gona build things up anymore Estrogen increases and makes endometrium thicker and more vascular for egg implantation and blood supply for embryo Secretory Phase (Matches with luteal phase) Begins with ovulation, ends with onset of period Effect of progesterone from corpus maintain endometrium and cause it to thicken If pregnancy occurs endometrium will secrete glycogen. (energy for baby, and cells to divide) If no pregnancy occurs endometrial tissues declines and you start period Menstrual Phase Sharp decline in hormonal levels causing endometrial lining to shed Cramping occurs which means its shedding

What is considered a woman’s LMP (and that this is Day #1 of her cycle) LMP = last menstrual period Important because it will help you determine estimated delivery date/gestational age What happens at time of ovulation (typically what day during the cycle, what the ovaries are doing, the hormone levels and what the endometrial lining is doing) - Ovulation happens 14 days before next period - Estrogen levels peak, LH rises, and releases oocyte (Egg) - Increasing estrogen makes endometrium thicker & more vascular (building up lining) - After ovulation if there is no pregnancy, she will start period Basically: LH rises, ovulation begins, endometrial lining thickens How many days after ovulation does conception occur? (Sperm travels and fertilizes egg) - Conception occurs 7-8 days after implantation

- Spotting can occur, reassure mom that its normal - Fertilization occurs at outer third of fallopian tube, in one of the ovaries - Fertilization….cell division….conception. (Order) - Cell division happens with multiple gestation (more than one developing embryo) Monozygotic twins = one fertilized ovum splitting during the early stages of cell division. Genetically the same. (2 eggs have been fertilized) Dizygotic twins = two separate ova fertilized by two separate sperm. Genetically different (2 different sperms, 2 different eggs) When does implantation occur? (When sperm meets ovum) - The blastocyst is implanted in the uterine endometrium. (can cause spotting) - 7-8 days after What happens if the embryo tries to implant too early (in the tube) or too late (Miscarriage) Too early = Ectopic pregnancy: Sperm meets egg early in fallopian tube; egg divides and proliferates but implants in tube. -

Normally: fertilized egg attaches (implants) to uterus lining Ectopic: fertilized egg attaches (implants) to outside uterus (e.g. fallopian tube) Also known as tubal pregnancy Causes unilateral cramp like abdominal pain

Too Late: Miscarriage: - Most occur in the first 12 weeks of gestation - Late pregnancy losses between 12-20 weeks gestation - Early pregnancy losses typically are related to an abnormality of the zygote, embryo, fetus, placenta - *EX. If the sperm hits the egg too late, and it travels through, it won’t have time to proliferate & implant; it will just go straight through (miscarriage) - Ideally you want sperm to meet egg in outer third of fallopian tube for fertilization; then it divides as it travels through fallopian tube & then implant in uterus Embryonic and Fetal Development When to expect to see fetal cardiac activity on ultrasound: - Heart starts beating at 3 weeks embryonic age. - You can hear a heartbeat at 5 weeks and 2 days. (gestational age) Difference between identical and fraternal twins - Identical = monozygotic - Identical twins have one ovum, this means they share a placenta and a chorion. They each have their own amnion. - Fraternal = dizygotic

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Fraternal twins have 2 OVA, this means that they have 2 placentas, 2 chorion, and 2 amnion. Amnion = Inner membrane, contains amniotic fluid Chorion = outer membrane, forms fetal portion of placenta

Fetal circulations (ductus venosus, foramen ovale, ductus arteriosis) Ductus venosus: connects umbilical vein to the inferior vena cava - Found at liver and umbilical vein which helps push/pull oxygenated blood to inferior vena cava Foramen ovale: opening between right and left atria to shunt highly oxygenated blood to flow from the right atrium to the left atrium. - Shunts blood away from lungs so it wont go into right ventricle to pulm arteries Ductus arteriosus: connects pulmonary artery with descending aorta - it helps shunt mixed oxygenated/deoxygenated blood away from lungs and flows directly into aorta and travels to umbilical *Opening will close after babies first breathe Basic concepts of placenta physiology and it’s purpose -

The placenta serves as the fetal lungs, kidneys, and GI tract and as a separate endocrine organ throughout the pregnancy. Placental circulation established as early as 3rd week of pregnancy. Grows to 15-20 separate “lobes” called cotyledons By 20 weeks gestation, covers about ½ surface of the uterus No direct exchange of blood between the embryo and the mother during pregnancy Exchange is through selective osmosis. The body basically grows a whole other organ. It is and endocrine organ because it produces hormones. At 20 weeks your uterus is at the level of the umbilicus. The placenta covers half of it, there is no direct blood exchange between blood and baby. The fetal side is called Schultz!!! Shiny Shultz… after the baby is delivered, we can look and make sure that the placenta is intact. The maternal side is called Duncan!!!! this is the side that is a little meaty.

Deliver: - O2 (fetal lungs) - nutrients - hormones (hCG, progresterone, estrogen) Remove: - CO2 - waste (fetal kidneys)

Hormones produced by the placenta (and how they have an effect on insulin resistance --→ → gestational diabetes) Human chorionic gonadotropin (hCG) • Pregnancy hormone that turns positive when you are pregnant. • hCG rises rapidly during first trimester & then rapidly declines • Stimulates corpus luteum so that it will continue to secrete estrogen & progesterone until placenta is mature enough to do so. Human placental lactogen (hPL) • For when you are ready to start lactating. • promotes fetal growth by regulating available glucose & stimulates breast development in preparation for lactation Progesterone • facilitates implantation & decreases uterine contractility • maintains pregnancy Estrogen • stimulates enlargement of breasts & uterus • Starts everything up Purposes of amniotic fluid • • • •

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Amnion is the inner membrane that contains amniotic fluid Chorion is the outer membrane that forms the fetal portion of placenta The amniotic sac holds all the water and the baby in there for example like a hardboiled egg. Amniotic fluid protects and cushions fetus, maintain normal body temperature, symmetrical fetal growth, freedom of movement, essential for normal fetal lung development Low amniotic fluid sometimes causes the baby to not be developed properly and sometimes they can be developed without a hand Amniotic fluid = Fetal urine & lung secretions primary contributors - Slightly alkaline - Contains antibacterial, other protective substances (supposed to be sterile) -Amount: 800 mL at 24 weeks

Normal structure of the umbilical cord Structure (AVA) • Two umbilical arteries • One umbilical vein • Arteries carry deoxygenated blood while vein carries oxygenated blood

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Whartons jelly – covers arteries and vein to protect from compression The function of the umbilical cord is to transfer nutrients and transfer waste back Fetal development happens from 9 weeks of gestation until birth. The organ systems are growing and maturing.

Infertility Definition of infertility Unable conceive + maintain pregnancy after 12 months regular unprotected sex 6 months for women over the age of 35 Common causes of infertility 80% known reasons 20% unknown reasons Female infertility causes: -Endocrine Disturbances - Anomalies of Uterus - Endometriosis - Ovulatory Failure - Tubal Damage - Immunological Factors - Urogenital Infection - Acquired Factors - Congenital Anomalies - Unexplained Male Infertility causes: -Immune System Factors - Hypogonadism - Varicocele - Systemic Disease - Sexual Factors - Urogenital Infection - Undescended Testicles - Unexplained - Other causes Basic work up for infertility Screening for STIs (Untreated or history of STDs can be reason for infertility) Assessment of hormonal levels Semen analysis Assessing for ovulatory dysfunction Hysterosalpingogram (HSG): inject dye into tubes to see if fallopian tubes are patent

Endometrial biopsy Assisted Fertility - Testicular sperm aspiration - Artificial Insemination (AI) - In vitro fertilization (IVF) - Zygote intrafallopian transfer (ZIFT) - Gamete intrafallopian transfer (GIFT) Chapter 4 Prenatal Care Essential for ensuring overall health of newborns & moms - Decreases incidence of low birth weight babies - Decreases incidence of complications - Should be started early o Preconception visit (before pregnancy – workup & started on folic acid) o As soon as woman learns of pregnancy Purposes - Establish baseline of present health - Determine gestational age of fetus - Monitor fetal development - Identify women at risk for complications - Minimize risk of possible complications - Provide time for education Trimesters - First trimester: 12 weeks - Second trimester: 13-26 weeks - Third trimester: 27-40 weeks or until delivery

Diagnosing pregnancy (know presumptive, probable and positive signs of pregnancy… Presumptive: changes that woman experience that make her think she may be pregnant; subjective signs of pregnancy • • • • • •

Amenorrhea – absence of period (4wk) Nausea/Vomiting (week 4-14) 1st trimester) Enlargement of breast, tingling, (3-4) (1st trimester) Fatigue (common in 1st trimester) (12wks) Urination frequency and enlargement (because of pressure on bladder) (6-12wk) Quickening- a womans awareness of fetal movement (16-20 wks)

Probable - include physical & anatomical changes that can be perceived by health care provider (are physical assessment findings/objective) • • • • • • • •

Chadwicks sign – Bluish purplish color of vagina mucosa,cervix, vulva (seen 6-8 wks) Goodells signs – Softening of cervical tip/vagina with increased leukorrheal discharge (palpated at 5 wks) Hegars sign – Softening of lower uterine segment (palpated at 6-12 wks) Braxton hicks – false contractions that are painless, relieved by walking (16wk) Ballottement- returning of fetus when pushed with fingers (16-28 weeks) Positive pregnany test serum (4-12wk) Urine –(6-12) Fetal outline felt by examiner Abdominal enlargement – related to changes in uterine, size, shape and position (part of hegars sign) pigmentation changes, stretch marks

Positive signs – Objective signs of pregnancy (Confirmed) • • •

Fetal heart sounds by ultrasound (6wk) Steto – (17-19) Visualization of fetus by ultrasound (5-6) Fetal movement – palpated by examiner (19-22)

PHYSIOLOGIC CHANGES OF PEGNANCY** Common physiologic changes of pregnancy and the discomforts they cause in the pregnant patient. Teaching and patient education on how to alleviate some of those symptoms (Ex: GI changes → slowed gastric motility → constipation→ increasing fluids, fiber and exercise) Fatigue? (1st/3rd) Eat enough iron (r/t anemia), Encourage rest periods Nausea/Vomiting? (1st and 3rd trimester) Eat crackers or dry toast,Avoid having empty stomach, No spicy, greasy, gas foods, Drink fluids between meals Insomnia? Sleep hygiene, Relaxation techniques, Stop caffeine Breasts tender? (1st trimester) Well-fitting bra Breasts leaking colostrum? Breast pad Braxton Hicks? (1st trimester onward increases intensity in 3rd) “false” labor pains, walk to subside contractions, notify doc

Urinary Frequency? (occurs 1st and 3rd trimester) Empty bladder frequently, Decrease fluids before bed, Kegal exercise UTI Wipe peri front to back, cotton undies, 8 glass water, do not retain go pee, let doc know if pee contains blood, cloudy, has smeel Heartburn ( 2nd, 3rd trimester) Small frequent meals, Check with doc before using antacids, Do not lie down after u eat Happens cause of rise of progesterone which slows gastro motility and digestion Constipation? (2nd/3rd trimester) Fluids, eat foods high in fiber, exercise daily Hemorrhoids (2nd/3rd) Sitz bath, witch hazel, ointments Backache (2nd/third) Pelvic tilt exercise, side lying position, mechanics to lift legs, exercise daily Leg Cramp (3rd) Extend affected leg, toe towards head, heat, massage, notify provider if it continuous Happens cause of compression to lower extremities of nerve blood by enlarging uterus Calcium/phospho imbalance Varicose veins/Edema (2nd/3rd trim) Rest with legs/hips elevated, avoid tight clothes, wear support hose, don’t stay in 1 position for a long time, sleep in left lateral position, exercise, Supine hypotension Side lying position, or semi sitting position with knees flexed Occurs when lay on back and weight of uterus compresses vena cava which reduces blood supply to fetus How often a patient should have prenatal visits depending on the trimester Every 4 weeks for the first 28 weeks of gestation (once a month) Every 2 weeks until 36 weeks of gestation Once a week from 36 weeks until 40 weeks (due date) Twice weekly from due date until delivery What happens at a first prenatal visit- procedures and work up (know all the prenatal labs that need to be drawn) We get and extensive health hx We use a screening tool that IDs factors that may adversely affect the pregnancy Establish rapport and trust Family/ social profile Hx of past illness, family, illness, current medical hx. Obstetric hx Identify high risk factors

Lab work of CBC, ABO and Rh type, antibody screen, rubella titer, VDRL or RPR (syphilis) hep B, gonorrhea culture, chlamydia culture, HIV screen, Urine: glucose, protein, ketones by dipstick, Urinalysis: RBCs, leukocytes, bacteria. Hereditary disease screening: sickle cell, tay-sachs, and cyst...