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CHAPTER 18

CHAPTER 18. Obstetrics. Video links. Female reproductive/ovulation/basic baby implantation: http://www.argosymedical.com/Reproductive/samples/animations/Female%20Reproductive/index.html Birth animation http://www.youtube.com/watch?v=Xath6kOf0NE&feature=relmfu monty python

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CHAPTER 18

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  1. CHAPTER 18 Obstetrics

  2. Video links • Female reproductive/ovulation/basic baby implantation: http://www.argosymedical.com/Reproductive/samples/animations/Female%20Reproductive/index.html • Birth animation • http://www.youtube.com/watch?v=Xath6kOf0NE&feature=relmfu • monty python • http://www.youtube.com/watch?NR=1&feature=fvwp&v=NcHdF1eHhgc • entire C-section w/layers • http://www.youtube.com/watch?v=BgijW3-y8FQ&feature=related • fast c-section • http://www.youtube.com/watch?v=rgS9N5OldBM&feature=related

  3. Obstetrics Overview • Obstetrics • Field of medicine that deals with pregnancy (prenatal), delivery of the baby, and the first six weeks after delivery (postpartum period)

  4. Obstetrics Overview • Pregnancy • Nine calendar months or 10 lunar months • Forty weeks or 280 days • Divided into trimesters • Three intervals of three months each • Known as gestational period

  5. Pregnancy • Fertilization or conception • Union of a sperm and a mature ovum • Takes place in outer third of the fallopian tube • Zygote • Initial name for fertilized ovum

  6. Pregnancy • Fertilization or conception • Embryo • Name of product of conception from second through 8th week of pregnancy • Fetus • Name of product of conception from 9th week through duration of gestational period

  7. Pregnancy • Two major accessory structures of pregnancy • Amniotic sac • Strong, thin-walled membranous sac that envelops and protects the growing fetus • Also known as the fetal membrane

  8. Pregnancy • Two major accessory structures of pregnancy • Amniotic sac • Outer layer of sac is called the chorion • Inner layer of sac is called the amnion • Amniotic fluid within sac cushions and protects fetus during pregnancy

  9. Pregnancy • Accessory structures of pregnancy • Placenta • Temporary organ of pregnancy • Provides for fetal respiration, nutrition, excretion • Functions as an endocrine gland by producing hormones necessary for normal pregnancy • Human chorionic gonadotropin (HCG), estrogen, progesterone, and human placental lactogen (HPL)

  10. Pregnancy • Accessory structures of pregnancy • Maternal side of placenta • Attached to wall of uterus • Has a “beefy” red appearance

  11. Pregnancy • Accessory structures of pregnancy • Fetal side of placenta • Has shiny, slightly grayish appearance • Contains arteries and veins that intertwine to form umbilical cord • Umbilical cord arises from center of placenta and attaches to umbilicus of fetus

  12. Question The 2 major accessory structures of pregnancy are: • vagina and uterus • cervix and vagina • placenta and uterus • placenta and amniotic sac

  13. Answer d. Both are temporary structures but vital to pregnancy.

  14. Physiological Changes During Pregnancy • Amenorrhea • Absence of menstruation • Menstruation stops as a result of hormonal influence during pregnancy • Changes in the uterus • Small, pear-shaped organ before pregnancy • Grows to accommodate growing fetus, placenta, amniotic sac, and amniotic fluid during pregnancy

  15. Physiological Changes During Pregnancy • Changes in the cervix • Chadwick’s sign • Cervix and vagina take on a bluish-violet hue due to local venous congestion • Goodell’s sign • Cervix softens in consistency in preparation for childbirth

  16. Physiological Changes During Pregnancy • Changes in the vagina • Vagina takes on same bluish-violet hue of the cervix during pregnancy • Increase of glycogen in vaginal cells • Causes increased vaginal discharge and heavy shedding of vaginal cells • Leukorrhea • Thick, white vaginal discharge during pregnancy

  17. Physiological Changes During Pregnancy • Changes in breasts • Increase in size and shape • Nipples increase in size and become more erect • Areola become larger and more darkly pigmented • Montgomery’s tubercles become more active and secrete substance that lubricates the nipples

  18. Physiological Changes During Pregnancy • Changes in breasts • Colostrum is secreted • Thin, yellowish discharge from nipples throughout pregnancy • Forerunner to breast milk

  19. Physiological Changes During Pregnancy • Changes in blood pressure • May experience hypotension during second and third trimesters (4th to 9th month) • Weight of pregnant uterus presses against descending aorta and inferior vena cava • When woman is lying on her back (supine hypotension syndrome or vena cava syndrome) • May complain of faintness, lightheadedness, and dizziness

  20. Physiological Changes During Pregnancy • Changes in urination • First trimester • Urinary frequency due to increasing size of uterus, creates pressure on bladder • Second trimester • Uterus rises up out of the pelvis and pressure on bladder is relieved • Third trimester • Frequency returns due to pressure of baby’s head on bladder

  21. Physiological Changes During Pregnancy • Changes in posture • Waddling gait • Manner of walking in which the feet are wide apart and the walk resembles that of a duck • Due to softening of pelvic joints and relaxing of pelvic ligaments • Pregnant woman’s center of gravity is offset

  22. Physiological Changes During Pregnancy • Changes in the skin • Possible increased feeling of warmth and sweating • Due to increased activity of the sweat glands • Possible problems with facial blemishes • Due to increased activity of sebaceous glands

  23. Physiological Changes During Pregnancy • Changes in the skin • Chloasma • Hyperpigmentation (brown patches) seen on forehead, cheeks, and bridge of nose • Known as the “mask of pregnancy” • Linea nigra • Darkened vertical midline between the fundus and the symphysis pubis on the abdomen

  24. Physiological Changes During Pregnancy • Changes in the skin • Areola • Becomes darker as pregnancy progresses • Striae gravidarum • Stretch marks on the abdomen, thighs, and breasts that occur during pregnancy

  25. Physiological Changes During Pregnancy • Changes in weight • Recommended weight gain during pregnancy • Ranges from 25 to 30 pounds • Pattern of weight gain is important • 1st to 3rd month = 3 to 4 pounds total • 4th to 9th month = 1 pound per week

  26. Physiological Changes During Pregnancy • Changes in weight • Critical to monitor weight gain for unexpected increases • Fluid retention • Pregnancy-induced hypertension

  27. Question True or False: Goodell’s sign is the softening of the cervix in preparation for childbirth.

  28. Answer True. This softening enables the cervix to dilate during labor.

  29. Question A woman’s body goes through the following changes during pregnancy EXCEPT: • changes in skin • changes in urination • changes in bone structure • changes in breasts

  30. Answer c. Ligaments and joints change and soften, but the bones do not.

  31. Signs and Symptoms of Pregnancy • Presumptive signs • Expectant mother • Suggests pregnancy but are not necessarily positive • Include amenorrhea, nausea and vomiting, fatigue, urinary disturbances, and breast changes

  32. Signs and Symptoms of Pregnancy • Presumptive signs • Quickening • Movement of fetus felt by the mother • Occurs around 18 to 20 weeks’ gestation • Described as a faint abdominal fluttering

  33. Signs and Symptoms of Pregnancy • Probable signs • Observable by examiner • Much stronger indicators of pregnancy but can be due to other pathological conditions • Should not be used as sole indicator of pregnancy • Include Goodell’s sign, Chadwick’s sign, uterine enlargement, hyperpigmentation of skin, abdominal striae, palpation of fetal outline, positive pregnancy tests

  34. Signs and Symptoms of Pregnancy • Probable signs • Hegar’s sign • Softening of the lower segment of the uterus • Braxton Hicks contractions • Irregular contractions of the uterus • May occur throughout the pregnancy and are relatively painless

  35. Signs and Symptoms of Pregnancy • Probable signs • Ballottement • Technique of using the examiner’s finger to tap against the uterus, through the vagina, to cause the fetus to “bounce” within the amniotic fluid and feeling it rebound quickly

  36. Signs and Symptoms of Pregnancy • Positive signs • Fetal heartbeat • Detected by ultrasound at approximately 10 weeks’ gestation • Detected by fetoscope at 18 to 20 weeks’ gestation • Rate can vary from 120 to 180 beats per minute

  37. Signs and Symptoms of Pregnancy • Positive signs • Identification of embryo or fetus by ultrasound • Can be detected as early as 5 to 6 weeks with 100 percent reliability • Provides earliest positive confirmation of a pregnancy • Fetal movements felt by examiner • Palpable by physician/examiner by the second trimester of pregnancy

  38. Question True or False: A positive sign of pregnancy is Braxton Hicks contractions.

  39. Answer False. It is a probable sign.

  40. Calculation of Date of Birth • Birth date for the baby • Expected date of confinement (EDC) • Expected date of delivery (EDD) • Expected date of birth (EDB)

  41. Calculation of Date of Birth • Nagele’s rule for calculation of date • Subtract 3 months from beginning of last menstrual period (LMP) • Add 1 year and 7 days to date = expected date of delivery

  42. Discomforts of Pregnancy • Temporary discomforts of pregnancy • Backache • Common during second and third trimester • Edema • Swelling of lower extremities not uncommon • Fatigue • Usually occurs during first trimester

  43. Discomforts of Pregnancy • Temporary discomforts of pregnancy • Heartburn • Mainly during last few weeks of pregnancy • Hemorrhoids • Develop as result of increasing pressure on area

  44. Discomforts of Pregnancy • Temporary discomforts of pregnancy • Nausea • Usually occurs during first trimester • Varicose veins • Occur as result of blood pooling in the legs

  45. Question Nagele’s rule for calculation of date uses what benchmark? • last date of intercourse • last menstrual period • last date of pregnancy • last date of delivery

  46. Answer b. For estimated date of delivery, subtract 3 months from LMP and then add 1 year and 7 days.

  47. COMPLICATIONS OF PREGNANCY Obstetrics

  48. Abortion • Pronounced • (ah-BOR-shun) • Defined • Termination of a pregnancy before the fetus has reached a viable age, that is, an age at which the fetus could live outside of the uterine environment

  49. Abruptio Placenta • Pronounced • (ah-BRUP-she-oh pla-SEN-tah) • Defined • Premature separation of a normally implanted placenta from the uterine wall • After the pregnancy has passed 20 weeks’ gestation or during labor

  50. Ectopic Pregnancy • Pronounced • (ek-TOP-ik PREG-nan-see) • Defined • Abnormal implantation of a fertilized ovum outside of the uterine cavity • Also called a tubal pregnancy • Approximately 90 percent of all ectopic pregnancies occur in the fallopian tubes

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