OB quiz 1 and midterm

• Spermicide is used as a chemical barrier that causes the vaginal flora to be acidic.
• Insert spermicide 15 min before sex. It is only effective for 1 hour. Do not remove until after 6 hours. Use with other methods of contraceptives.
• A diaphragm is made of silicone and is fitted snuggly over the cervix.
• A diaphragm must be fitted by a provider. replaced every 2 years. Refit for a 20% of weight change abdominal/pelvic surgery, and after each pregnancy.
• A diaphragm can be inserted up to 6hr before sex and must stay up to 6hr after (no more than 24hr)
• A diaphragm should be washed with mild soap and warm water after each use
• A diaphragm is not recommended for those with hx of TSS frequent UTI or uterine prolapse
• A cervical cap is rubber and fits around the base of the cervix. Caps come in 3 sizes
• A cervical cap should be placed up to 6hr before sex, and left in place for at least 6hr (no more than 48)
• A Cervical cap should be replaced every 2 years and refit after any surgery birth or major weight changes
• A Cervical cap is not recommended for those with abnormal Pap test results or hx of TSS
• A sponge contraceptive is one size. It is moistened with water prior to insertion. should be left in place for 6 hours after last sex act. It provides protection for up to 24 hours. Risk of TSS.
• Oral contraceptives offer some protection from certain cancers, reduces risk of benign breast disease, and protects against developing ovarian cysts.
• Oral contraceptives increase the risk of thromboembolism stroke heart attack hypertension gallbladder disease and liver tumor
• Oral contraceptives are not recommended for those that are pregnant, breastfeeding, less than 6 weeks postpartum, smoke (if over 35 years)
• Oral contraception decreases the effects of anticonvulsants antifungal sand some antibiotics
• Injectable contraceptive (medroxyprogesterone) is given every 11-13 weeks ( 4x a year)
• When taking injectable contraceptive maintsun an adequate diet of calcium and engage in weight bearing exercise (decrease risk of osteoporosis)

  poses a decreased risk of uterine cancer when taking long term
• Injectable contraceptives impair glucose tolerance for clients with diabetes and increase risk of diabetes for those without diabetes.
• A contraceptive ring should be replaced after 3 weeks and placement of a new ring within 7 days. insertion should occur on same day of the week monthly.
• An implant is effective for 3 years. However has an increased risk of ectopic pregnancy.
• An IUD is one of the most effective methods. They are monitored monthly. maintains effectiveness 3-5 years (hormonal) or 10 years (copper)

  copper is safe for those cautioned against hormonal birth control
• Presumptive signs of pregnancy:

  amenorrhea (missed period)

  Fatigue

  nausea/vomit

  breast change

  quickening

  uterine enlargement
• Probable signs of pregnancy:

  abdominal enlargement

  hegar - soft uterus

  Chadwick - purple/blue cervix

  goodell - soft cervix

  ballottement - rebound

  braxton hicks - false contractions relieved by walking/peeing

  positive pregnancy test

  fetal outline
• Positive signs of pregnancy:

  fetal heart sounds (110-160 by Doppler)

  ultrasound

  fetal movement
• nageles rule

  first day of last period, -3months , + 7 days and a year
• G gravida (pregnancies)

  T term births (37weeks)

  P preterm births (>37 weeks)

  A abortion/miscarriage

  L living children
• Changes include:

  urinary frequency, physical body changes, gums may bleed, GERD, heartburn
• Normal BMI for a pregnancy is 25-35
• Majority of birth defects occur between 2 and 8 weeks of gestation
• Goal is to have 13 visits.

  weeks 16-28 is monthly

  weeks 29-36 is every 2 weeks

  weeks 36+ is weekly till birth
• Alpha protein (Down syndrome) test is performed 15-22 weeks and assessed for neural tube defects
• Folic acid is crucial to prevent neural tube defects

  foods: leafy veggies dried peas/beans orange juice
• On the first visit expect a cbc rubella ultrasound ua STI vdrl
• Administer rhO immune im around 28 weeks who are rh negative
• Indirect coombs test identifies clients sensitived to rh positive blood
• pregnant people SHOULD get a flu vaccine but NO live vaccines