OB Final

• Fertilization

  Ampulla= site of fertilization (wider, outer portion of the fallopian tubes)
• Pelvic Dimensions

  • Obstetric conjugate: shortest diameter of the pelvic inlet
  • Transverse diameter: smallest diameter of the midpelvis/entire pelvis
• Pelvic Types


  • Favorable: gynecoid, anthropoid
  • Non-Favorable: android, platypelloid
• Ovarian Cycle


  • Follicular phase: day 1-14
  • Ovulatory phase: day 1-14
  • Luteal phase: day 15-28
• Endometrial/Menstrual Cycle


  • Menstrual phase: day 1-5
  • Proliferative phase: day 6-14
  • Secretory Phase: day 15-26
  • Ischemic phase: day 27-28
• Typical cycle is 28 days
• Ovulation occurs on day 14 if 28 day cycle
• Mittelschmerz


  Mid-cycle ovulation pain
• Estrogen


  • Stimulates growth and development of ductal epithelium
  • Stimulates uterine growth and uterine placental blood flow
• Progesterone


  • Decreases uterine contractility and maintains endometrium; increases swelling, growth, vascularity, and tissue glycogen in endometrium in secretory phase; helps develop and thicken endometrium if implantation occurs
• FSH


  • Primarily responsible for maturation of the ovarian Graafian follicle
• LH


  • Final maturation of the Graafian follicle
  • Increases 12-48 hrs before ovulation
• Basal Body Temp Method

  1. Take temp every morning before arising; temp increases by 0.3-0.6 degrees C after ovulation that persists during the luteal phase

  2. Record for 3-4 months
• Contraindications for Hormonal Contraceptives

  • Pregnancy, history of thrombophlebitis, strokes, heart disease, liver disease, gall bladder disease, estrogen dependent carcinomas, undiagnosed uterine bleeding, heavy smoking, hypertension, diabetes, hyperlipidemia
• Warning Signs for Hormonal Contraceptives

  • Abdominal pain
  • Chest pain, cough, SOB
  • Headache, dizziness, weakness, numbness
  • Eye problems, speech problems
  • Severe leg pains
• Diaphragm must be rechecked for size after each childbirth and after change in weight
• Diaphragm should be replaced after 2 years
• Tubal Ligation


  Permanent; woman can still ovulate, transport of egg is prevented
• Birth Rate


  Number of live births per 1000 births
• Infant Mortality Rate


  Number of infant deaths per 1000 births in a year
• Leading cause of infant mortality is congenital malformations
• Adolescent


  • Increased risk for PE & lack of early prenatal care, preterm birth, poor nutrition, poverty, education issues
• Dysmenorrhea


  Painful menses (often due to decreased prostaglandin production)
• Causes of Dysmenorrhea

  • Primary: absence of underlying disease/anatomic abnormality
  • Secondary: associated with underlying pathologic condition (endometriosis, fibroids, etc)
• Care for Dysmenorrhea


  1. Education, heat massage, exercise, possible oral contraceptive use

  2. Diet: decreased salt/refined sugars; increased vitamins B&E

  3. Take ibuprofen
• Amniotic Fluid


  Amniotic fluid peaks at 34 weeks; normal 800-1000 ml
• Amniotic Fluid Amounts


  • Oligohydramnios: <500 ml; due to renal anomalies
  • Hydramnios (poly): >1500-2000 ml; due to GI abnormalities
• Functions of Amniotic Fluid


  • Body temp, protects from trauma, allows movement for musculoskeletal development, facilitates symmetric external growth, etc
• Meconium-Stained amniotic fluid indicates fetal hypoxia
• Implantation occurs 6 days after fertilization in the fundus
• Fetal Circulation


  1. Oxygenated blood from the placenta goes through the umbilical vein

  2. Ductus venosus helps blood bypass the liver and go to the inferior vena cava

  3. The foramen ovale allows blood to be delivered from the L atrium to the R atrium
• Presumptive Signs of Pregnancy


  • Amenorrhea, nausea, vomiting, excessive fatigue, urinary frequency, breast changes
  • Quickening: by 20 weeks
• Probable Signs of Pregnancy


  • Goodell's sign: softening of the cervix
  • Chadwick's sign: bluish purple color due to increased vascularity
  • Hegar's Sign: softening of the isthmus
  • Enlargement of the uterus, abdominal enlargement, Braxtons Hicks, uterine souffle, changes in pigmentation, ballottement
• Positive Signs of Pregnancy


  • Fetal heartbeat, fetal movement palpated by a trained examiner, ultrasound visualization of gestational sac or fetus
• First trimester common feeling


  Ambivalence, uncertainty, self is primary focus
• Decreasing Heartburn in Normal Pregnancy

  Small, frequent meals; avoid consuming excessive fluids with meals; consume fluids between meals; no lying down after eating
• Chloasma


  Melasma gravidarum (mask of pregnancy)
• Human Chorionic Gonadotropin


  • Side effects: nausea, vomiting
  • HcG maintains corpus luteum
• Pregnancy Changes in Blood Volume


  • Total volume increases by 40-45% (about 1500 mls)
  • Plasma volume increases by 45-50%
  • Erythrocytes increase by 30% if taking iron, 18% if not taking iron
  • Physiologic anemia (pseudoanemia): plasma volume is increasing more/faster than the erythrocyte volume
• Pregnancy Changes in Clotting Factors

  • Increase in fibrin and fibrinogen
  • Decrease in coagulation inhibiting factors
  • Hypercoagulable state causes increased thrombus risk