Obstetrics

• - meiosis- genetic variabilty, later fertilization facilitation and energy system that may support embryonic development.
• Metaphase II- egg is released from ovary
• Cumulus oophorus- when egg enters the fallopian tube. surrounded by clear zona pellucida- both the egg and polar body are now here
• Spertazoa travel through the cervical mucus and unterus into fallopian tubes
• Sperm undergo 2 changes- capacitation and acrosome rxn- sperm head changes with enzyme activation that allow it to go through the zona pellucida and cumulus oophorus

• generally 3 days after embryo enters uterus. depends on trophpblast cells during the blastula stage. The trrophoblast cells digest away the zona pelucida and allow the embryo to implant on the uterin wall and burrow into the endometrium
• Syncytiotrophoblast penetrat the endometrial cells

• amenorrhea- one or more missed periods folowing a time of sexual activiey without effective contraception are storng suggestors
• nausea w/wo vomiting- causes may be psychological, k and fluid depletion, and metabolic alkalosis
• breast enlargement and tenderness- increased levels of prolactin
• polyuria and dysuria
• fatique

• initial fetal movement
• typically not before 16-18 weeks in multiparous may be more around 20 in primaparous

1 cm per week after 4 weeks of gestation

6

• 12
• chadwick sign- bluish coloration of vagina
• hegar sign- softening of the cervix

• fuller and tende
• areolar darkening
• venous patterns visible
• FAV breast changes!

detected by doppler at 10-12 weeks, earlier in thin patients

• heart displace by enlargeing uterus
• increased BV- increased ventricular wall size

30-50%, may decrease later in preg secondary to occlusion of IVC by enlarging uterus

• increased second heart sound in inspiration, mild jvd, mild systolic ejection murmor
• diastolic is never normal
• inferior VC syndrome occurs as gravid uterus occludes IVC- leads to dizziness, light headed, syncome (1/10 women)

• diaphragm elevatin- enlarging uterus
• oxygen consumption increase 20%
• uterus and contents 50% of the increase
• 30% by heart and kidneys
• 18% resp muscles

metabolic alkalosis- compensated- ABG

• collecting system enlarges and dilates
• increased plasma volume- increased GFR

common- need to r/o UTI however

• predispsoes women for pyelonephritis
• 20% of women will experience stress incontinence

edema +-

• euthyroid
• hCG- may stimulate t4- subsequent transient increase in ft4
• decline of hCG in second trimestor normalize ft4

• spider angiomata- upper torso, face and arms
• palmar erythema- 50% of pts associated with estrogen regresses after delivery
• mask of preg- aka Chloasma/ melasma

• resp and metabolite exhange
• fetal blood oxygenation
• hormone syn and reg

glucose- 70% of glucose transferred by mother is used by the placenta

after implantation(6-12 days after ovulation)

• every 29-53 hrs duting first 30 days after viable implantation
• slow rise is indicative of abnormal preg

• 4.5 to 5 weeks - transvaginal US detects gestational sac of intrauterine fluid
• 5-6 weeks yolk sac until week 10

early morning conc is highest

week 12

• Gravida- # of preg
• parity# of births
• full term 38 weeks
• prem less than 38
• abortion
• living children

first preg

has been preg for more than one preg

nevr been preg

women who is preg for first time or has given birth once

women who has given birth to multiple children

women who has never been preg or had a preg progress through gestational age of an abortion

• 280 days after LMP and 266 days after date of contraception
• only 4% of women delivery on EDD

count back 3 months from the lmp and add 7 days

• first trimester sonogram is more accurate than second
• EDD in the first half of preg is superior to dating based on LMP or PE

• when lmp is unknown
• conception via hormonal methods
• also when uterine size estimated via PE is different from that predicted by menstraul dating

US- also potential uses for fetal dating and detecting fetal anomalies

• Crown-rump length- longest straight line measurement of embryo measured from the outer margin of the cephalic pole to the rump
• measurement best at 7-10 weeks

detects gestational age w/in 7 days when measured between 14-20 weeks of gestation

• 12 weeks palpate abdominally above pubc symphosis
• 16 weeks uterine fundus palpable midway between pubis and umbilicus
• 20 weeks palpable at umbilicus

• maternal fetal activity- first indirect measurement
• Non-stress test- FHR and accelerations through external transducer typically for 20 mins

doe snot require an IV

• oxytocin challenege test- myometrium contraction and reduced placental blood flow
• see reflux slowing of fetal heart reveals poor fetal reserve
• negative cst- 2 or more fhr acceleration during a cst
• absence of accelerations on a baseline fhr tracig is associated with adverse perinatal outcomes

infectious dz screens

• sonogram of nuchal translucency and biochemical markers PAPP-A and BetahCG
• 11-14 weeks typically

• quad test- AFP, hCG, estriol, inhibin A
• 15-20 weeks gestation to screen for NTD and aneuploidy 52
• at 15 weeks maternal serum AFP- for NTDs

25-28 weeks

35-36

q 4 week until 28 weeks, then q 2 weeks until 36 weeks, then q week until delivery

fundal height, FHR, and Fetal presentation (leupold maneuvers)

nonstress test and US fetal assessment combined and given points for amniotic volume, fetal breathing movements, body movements, and reflex/tone/ flex extension

biophysical profile

between breats and lateral to th uterus, lap belt below the uterus across the hips

NTD

brucelliosis

18-26 days after conception

400-800 mcg

less than 200mg/ day

too much may be teratogenic

• 1.1 g/ kg/ day
• majority should be consumed in the last 6 months of gestation

175 g / day compared to 130 in nonpreggers

• enhancement of nonheme iron enhanced by vit c, most iron comes from heme iron
• 15 mg day to 30

• timing, dosing, and fetal susceptability(what organ is forming then)
• X- contraindicated drug

• acetaminophen good in preg for pain
• nsaids should be avoided
• opiods- chronic should be avoided
• abx- cephalosporins, penicillins and erythromycin are safe

• increase mothers confidence in her ability to give birth
• understand how to cope with pain in ways that facilitate labor and promote comfort as labor progresses, focused breathing and movement and massage

• quiet dim lit room, avoid head pulling, avoid overstimulation of infant sensorium, maternal-infant bonding encouragment,
• unneccasry intervention is encourages, the back is massaged while cord pulsation cease, the baby is then put in a war tub of water by he father and is gently supported.

sporadic uterine contractions thought to be in preperation of labor. May occur multiple times for a few minutes,

• hydration
• urination
• breathing
• movements

iron supplement, folate

history

felt over the uterine fundus with radiation to the low back and abdomen, are of increasing strength and freq- normally leading to dilation of the cervix

• dilate the cervix
• push the fetus throught the birth canal

• powers- uterine contraction- measured by external tocodynamometry
• passenger- fetus- size, postion, presentation, attitude(head extension or flexion)