OB

trichomoniasis

asymptomatic or mild yellow green frothy dishcharge and itching of vulva. cervial hemorrhages. may also complain of dysuria and dyspareunia

• microscope - trichomonads and leukocytes
• pH 4.5 or higher
• positive whiff test

flagyl 2gm single dose or 500mg BID for 7 days for BOTH partners. NO intercourse until treatment is complete

• strawberry-like red spots (visible to naked eye)
• smaller areas may be visible with a colonoscope

ETOH

abdominal pain, nausea, flushing or tremors

Chlamydia (Chlamydia trachomatisis)

asymptomatic

thick mucopurulent discharge, friable cervix (bleeds easily), burning and frequency of urination and lower abdominal pain

culture of cervical cells

DNA probe

azithromycin 1 gmorally or doxycycline 100mg PO BID x 7days

no sex for 7-8 days (length of tx)

pregnancy: amoxicillin or azithromycin

PID, infertility and ectopic pregnancy

epidiymitis and infertility

chlamydial pneumonia; ophthalmia neonatorum(chlamydial conjuctivitis) (responds to erythromycin opthalmic oitment but not to silver nitrate eye prophylaxis)

asymptomatic

purulent green-yellow discharge, dysuria, urinary freguency

culture of cervix, urethra, throat, rectum

ceftriaxone IM and doxycycline or azithromycin orally(dual for CZ)

can also use oflaxacin and cipro

treat partners even if asymptomatic and no sex until cured

cephlosporin IM and be sure to re-culture

single or multiple blister like vesicle on genital area, vagina, cervix, urethra and anus

culture of lesion or noted on pap smear may do antibody testing

no cure. 1st episode give oral acyclovir, valacyclovir or famicyclovir. use in future prodromal stages and pregnancy

do NOT deliver vaginally if vesicle are present on any portion of genital tract during childbirth; could have fatal effect

Syphilis

painless ulcer

wartlike plaques, arthritis, liver and spleen enlargement, chronic sore throat with hoarsness

microscopic exam of chancre for spirochetes or VDRL or RPR or FTA-ABS (more specific)

venereal disease research laboratries

Rapid plasma reagent

flourescent treonemal antibody absorption test

pregnant or nonpregnant is 2.4 million units of Benzathine penicillin G IM

same medcian and does but given IM x 3 weeks

condylomata acuminata (venereal warts or HPV)

cervical cancer

multiple or single soft, graysish, pink cauliflower like lesion in genital area

sometimes biopsy but usually by visual appearance or present on pap smear

podofilox solution or gel.

cyrotherapy, liquid nitrogen, trichloracetic acid (TCA), bichloracetic acid (BCA), surgical removal, shave excision or curettage or laser surgery

Pediculosis Pubis/pubic lice

sexucal contact or linen sharing

itching in pubic and anal area

1% permethrin cream rinse to area and washing of linens

retreatment as often as necessary

all contacts must be treated

saroptes scabiei - Scabies

sexual contact and contact with household members

itching worse at night and warmth; erythematuous paular lesions or furrows present

1% lindane (Kwell) lotion - apply and wash off 8 hrs later - WASH all clothing and linen and DRY

Permethrin 5% in pregnancy

must treat partner

pain, embarassment

thorough sexual hx; identify patients at risk and educate

1% of sexually active women

multiple partners, early onset sexual activity, recent Gyn procedure, recent IUD placement, women who douche regularly

clamydia, gonorrhea, BV

bilateral sharp cramping pain in LQ, fever, chills, vaginal discharge, irregular cycles, malaise, N&V, or asymptomatic

clinical exam, chandelier sign, cultures, palpable mass, laparoscopy confirms

often hospitalization or treat outpatient with cefotetan plus doxycycline, clindamycin and gentamicin

• risk factors
• IUD use
• assess for aching pain, foul smelling discharge, malaise, fever
• education

physical, emotional, sexual, economic, social isolation, destruction, threats of violence to others, stalking

• 1. battering occurs in a small percentage of the populatino
• 2. battered women provoke men
• 3. ETOH and drug abuse cause battering
• 4. battered women were battered children
• 5. they can easily leave
• 6. domestic violence is a low-income or minority issue
• 7. batter women will be safer when they are pregnant

• 1. childhood experiences
• 2. male dominance in family
• 3. marital conflict
• 4. unemployment/low socioeconomic status
• 5. traditional definitions of masulinity/hypernasculinity

• 1. tension building phase
• 2. acute battering incident
• 3. tranquil phase (honeymoon period)

demonstrates power and control; anger, arguing, blaming woman for external problems; possible minor battering incidents; woman feels at fault; will last from weeks to years

triggered by some external event or internal state of batterer; episode of acute violence; blames woman for abuse, woman will accomodate to survive; will last few hours to a few days

extremely loving, kind and contrite behaviors; making up to woman; gift buying and promises that it wont happen again; this will end and cycle will repeat

Neurologic, gynecologic, obstetric, gastrointestinal, musculoskeletal, psychiatric, constitutional, trauma and other misc

headaches - including those following trauma or concussion, tension or migraine; dizziness; paresthesias; unexplained stroke from strangulation; hearing loss; detached retina

dyspareunia (painful intercourse), STI, frequent vaginal infections; sexual dysfunction, mentrual disorders, pelvic pain

late onset of prenatal care, premature labor, low birth weight of infant, excessive concern over fetal well being, recurrent therapeutic abortion, recurrent spontaneous abortion

dyspepsia, IBS, globus (sensation of lump in throat),

arthralgias (painful joints), chronic pain, osteoarthritis, fibromyalgia

anxiety, panic, PTSD, mood disorders, depression, suicide attempts, somatization, eating disorders, substance abuse, child abuse and neglect

fatigue, weight loss, weight gain, mulitple somatic complaints, contusions, abrasions, sleep and appetite disturbances, decreased concentration, freqent use of pain medications or tranquilizers

any injury to female organs, extensive accident hx, old fractures, sexual trauma

hx of missed appts, low self esteem (seen in woman's dress, appearance and way she relates to HCP)

blitz (stranger), acquaintence(date), power, anger, sadistic, gang

purpose is control or mastery; places woman in powerless position; often a planned stranger attack, but most acquaintence rapes are also power rapes

used to express feelings of rage and retaliation; considerable brutality; attacks on older women are often anger rape

by antisocial person who delights in torture and mutilation; usally strangers and planned; hand in hand with homicide

sudden and unexpected and more likely to threaten violence with a weapon or murder

victim has previously had a nonviolent interraction and is deceived by rapist; marital rape is included in this; most of time sex is planned but will result in rape if denied by victim;

acquaintence rapes (victim knows rapist)

multiple rapist on one victim

cluster of symptoms in three phases:

• acute phase
• outward adjustment phase
• reorganization

• few days to 3 weeks
• experience fear, shock, disbelief, denial, humiliated, unclean, angry, anxious, powerless, may supress her emotion or reveal them

appears to be coping but is in denial and suppressing feelings; may move and take alternative security measures

integration and recovery, silent reaction; will want to talk about rape, alters self concept and resolves feelings; may develpe phobias, sexual dysfunction and sleep disorders

decrease in temp followed by an increase for several days

color and consistency of discharge

unprotected intercourse or surprise breakage of condom or diaphragm slip or missed Depo Prevera injection.

male sterilization through severing vas derens in scrotum

6 wks

in 6-12 mos.

38-82%

• female sterilization through clipping, electrocoagulation, bonding, or
• ligation fallopian tubes preventing ovum and sperm from meeting.

postpartum period

1/1000

0-75%

lifestyle, safety, age, cost, support of spouse, motivation

tip to base roll - do NOT reuse

MUST fit correctly- has to be left in for 6 hrs after intercourse- MUST be washed after each use- may be put in 4 hrs before intercourse, then reapply spermicide before

- 48 hrs- 20 min- 4 hrs

• - IUD's
• -string

- encourage partner participation- complete history- contraindications- cultural beliefs- bias - age- side effects- written information-follow up visits

once a month, one week after menses

premenstrual breast swelling

x-ray of breast soft tissue

35 - initial appt; then annual after 40

40-49

cessation of menses for 1 full year

45-52; most women live about 1/3 of their life with menopause

change of life, psychological and physical alterations occuring around time of menopause

• - hot flashes (LH surge) vasomotor instability- osteoporosis
• - changes fat distribution
• - wrinkling

HRT - elevates HDL, lowers LDL, moves Ca into bonealternative therapies

anovulation-amenorrhea-follicle-stimulating hormone levels increase-estrogen decreases-endometrium this and myometrium, fallopian tubes, and ovaries atrophy-thinning and dryness of vaginal mucosa-vaginal pH increases-pubiv hair thins and turns gray or white-Labia shrink and lose pigmentation-pelvic fascia and muscles atrophy-breast become pendulous-changes in cognitive function

- climacteric- psychological aspects- physical aspects- osteoporosis- HRT- counseling regarding adjustment to life- sexual questions contraception? dryness?- concern and caring, self worth, esteem

decrease in bony skeletal mass associated with low estrogen and androgen levels

hip and vertebrae

- asian-european american- small boned- thin- family history- lack of weight bearing exercise- nulliparity- early menopause- low Ca intake in teen years- cigarrette smoking- heavy alcohol intake

-bone density scan- ERT if no contraindications- prevention is the most important- over age 50 needs 1200mg Ca/day- exercise- no smokding, no alcohol, no caffeine- Vitamin D

placenta previa

painless vaginal bleeding most often after 20 wks gestation

by S&S and US

H&H, cell volume and erythrocyte count; may require O2 and blood and admittance to NICU

FVD, altered tissue perfusion, anxiety, impaired gas exchange; monitor mother and baby if bleeding persists

abruptio placentae

painful uterin irritability/hard contractions; external or concealed bleeding; hard uterus; rigid ABD

schock, DIC, hysterectomy

• Grade 0 - no S&S, clot noted after delivery
• Grade 1 - Vag bleeding may have mild uterine tenderness, tetany, no fetal or maternal distress
• Grade 2 - ABD tenderness/tetany, may be vag bleeding, fetal distress in 25-50%
• Grade 3 - Tetany severe, schock, vag or concealed bleeding, may have coagulopathy >50%

hydramnios

1% of all pregnancies

the fluid volume gradually increases; a problem of the third trimester; most common

volume increases rapidly over a period of a few days; diagnosed betwwen 20 adn 24 weeks' gestation

SOB and edema in the LE; intense pain

if severe enough - hospitalization and removal of excess fluid, can be done vaginally by AROM (not able to remove fluid slowly) or by amniocentesis

artificial rupture of membranes

oligohydramnios

when the largest vertical pocket of amniotic fluid visible on US is 5cm or less

during antepartum period - when uterus does not increase in size; fetus is easliy palpated and outlined; fetus is not ballottable

if occuring in the first part of pregnancy - adhesions are possible

during gestational period - fetal skin and skeletal abnormalities may occur b/c fetal movement is impaired; pulmonary hypoplasia may develop

during labor and birth - cord compression is more likely

fetus - can be assessed with BPP, NST, and serial ultrasounds

during labor - monitor by continouous electronic fetal monitoring to detect cord compression

amnioinfusion can replace some fluid volume and remove pressure on umbilical cord

• inappropriate behavior
• angry, caustic, abusive reactions, paranoia
• disorientation, smell of ETOH
• inflamed nasal mucosa, excessive fetal activity and tachycardia
• high BP, dilated or constriced pupils, diaphoresis

• spontaneous abortion
• abruption placentae
• low maternal weight gain
• preter labor and birth, fetal death
• LBW, IUGR, SIDS, fetal ETOH syndrom (FAS)
• neonatal withdrawal
• STD's, HIV, Hepatitis, cirrhosis, malnutrition

forms primitive red bloods cells during the first 6 wks of embryo development until the liver takes over the process.

yolk sac

umbilical cord

space between the amniotic membrane and the embryo

the amnion, embryo and yolk sac

• cushion to protect against injury controls temperature, permits
• external symmetric growth, prevents adherence to amnion, allows freedom
• of movement, aids in musculoskeletal development, acts as a source of
• oral fluid as well as a waste repository and assists in lung development

initially by diffusion from maternal blood; fetus urinates into fluid, greatly enhancing volume

1200 ml @ delivery

alkaline

600ml a day and 400ml a day flows out of lungs

amnion at day 14 and is called "connecting stalk or body stalk"

the embryo to yolk sac, contains blood vessels and extends into chorionic villi

umbilical cord

one large vein and two smaller arteries

connective tissue that surrounds the blook vessels in the umbilical cord

2cm (.8 inches) across and 55cm (22in) long

develops at the site where the embryo attaches to the uterine wall. thin disc shape temporary organ.

• early (endocrine gland) later 4th wk metabolic and nutrient exchange
• between embryo and meteranl circulation, storage, and respiration

hCG, progesterone, estrogens, hPL

maternal blood pressure

maternal (red and flesh like) and the fetal portion (shiny, gray appearance)

diffusionfacilitated and active transport (substances with high molecular weight)pinocytosis (large molecules)

begin with first day of last period, subtract 3 months and add 7 days (EDB/gestational wheel uses same premise) to calculate due date

3-5 lbs in 1st trimester, then avg 1lbs per week

NST - non stress test

bi weekly

3 accelerationsin 15-20 minutes greater than 15x15, LTV>10bpm

does not meet reactive criteria and must move to BPP or CST

N/V, urinary frequency, fatigue, increased vaginal discharge, breast tenderness, nasal stuffiness and epitaxis, ptyalism

severe vomitting (hyperemesis, gravidarum, chills, fever, dysuria, diarrhea, abdominal cramping and bleeding (miscarriage)

heartburn, edema, varicose veins, constipation/flatulence, hemorrhoids, backache, leg cramps, SOB, diff. sleeping, faintness, round ligament pain, carpal tunnel syndrome

hyperemesis, HTN, PIH, PROM, miscarriage, previa, abruptio placenta, infection, kidney stones or infection, preterm labor, and gestational diabetes

avoid odors or causative factors; eat dry cracker or toast before arising in the morning; have small but frequent meals, avoid greasy or highly seasoned food; take dry meals with fluids between meals; drink carbonated beverages

void when urge is felt; increase fluid intake during the day; decrease fluid intake ONLY in the evening to decrease nocturia

plan time for a nap or rest period daily, go to bed earlier, seek family support and assistance with responsiblities so that more time is available to rest

wear well fitting supportive bra

promote cleanliness by daily bathing, avoid douching, nylon underwear, and pantyhose; cotton underwear are more absorbent; powder can be used to maintain dryness if not allowed to cake

may be unresponsive but cool air vaporizor may help; avoid use of nasal spray and decongestants

use astringient mouthwashes, chew gum or suck on hard candy

eat small and more frequent meals, use low sodium antacids, avoid over eating, fatty and fried foods, lying down after eatingand sodium bicarb

practice frequent dorsiflexion of feet when prolonged sitting or standing is necessary, elevate legs when sitting or resting, aviod thight garters or restrictive pants or bands around legs

elevate legs frequently, wear supportive hose, avoid crossing legs at the knees, standing for long periods, garters, and hosiery with constrictive bands

avoid constipation, apply ice packs, topical oitments, anesthetic agents, warm soaks, or sitz baths; gently reinsert into rectum as necessary

increase fluid intake, increase fiber in diet, exercise; develop regular bowel habits, use stool softeners as recommended by MD

use proper body mechanics, practive the pelvic tilt exercise, avoid uncomfortable working heights, high-heeled shoes, lifting heavy loads and fatigue

practice dorsiflexion of feet to stretch affected muscle; evaluate diet; apply heat to affected muscles; arise slowly from resting position

avoid prolonged standing in warm or stuffy environments; evaluate H&H

use proper posture when sitting and standing; sleep propped up with pillows for relief if problem occurs at night

avoid gas-forming foods; chew food thoroughly; get regular daily exercise; maintain normal bowel habits

avoid aggravating hand movements; use splint as prescribed; elevate affected arm

Sickle Cell Anemia

nephritis, heaturia, anemia, crisis, fetal death, prematurity, IUGR

BPP (biophysical profile)

• 1. FHR acceleration
• 2. fetal breathing
• 3. fetal movements
• 4. fetal tone
• 5. amniotic fluid volume

NST

US

identify compromised fetus and confirm healthy fetus

decreased fetal movememnt, mgt of intrauterine groth restriction, preterm labor, gestational diabetes, postterm pregnancies, and premature rupture of the membranes (PROM)

• NST - reflects the intactness of the nervous system
• amniotic fluid index (AFI) - reflectes kidney perfusion

• 10/10 - normal
• 8/10 (normal fluid) - risk of fetal asphyxia extremely rare
• 8/8 if no NST done
• 8/10 (abnormal fluid) - chronic fetal asphyxia suspected
• 6/10 - possible fetal asphyxia
• 4/10 - probable fetal asphyxia
• 2/10 - almost certain fetal asphyxia
• 0/10 - certain fetal asphyxia

• Urine testing - sugar and ketones
• 50 g oral glucose tolerance test (1hr)
• if 1 hr abnormal then do 3 hr 100g oral glucose tolerance test (OGTT)
• will need to eat high CHO diet for 3 days, then fasting for 8 hrs; glucose is tested at fasting 1, 2, 3 hrs

• fasting >105
• 1 hr >190
• 2 hr > 165
• 3 hr > 145

any pregnancy, regardless of duration including present pregnancy

birth after 20 weeks' gestation regardless of whether the infant is born alive or dead

• G - gravida
• T - term (full -term 37-40 wks)
• P - preterm (infants born >20wks but <37 wks)
• A - abortions (pregnancies ending in spontaneous/therapeutic abortion)
• L - living

EVERYONE

Seizure prevention

• decrease in BP
• decrease in contractions

• 1st pregnancy
• non-caucasian
• age <18, >35
• lower socioeconomic status
• hydatiform mole (GTD), diabetes
• multiple gestation, Rh incompatibility
• Family Hx (mother, sister) of PIH

HA, blurred vision, protenuria

cause is unknown; increased senstivity to pressors; vasospasm and early hemodynamic alteration are responsible for S&S; prostacyclin (vasodilator) decrerased in pregnancy; thromboxane (produced by platelets) causes vasoconstriction and clumping of platelets; impaired placental profusion; reduced kidney profusion; decreased liver profusion; vasospasm and decreased blood flow to retina - visual disturbances; vasospasm in brain - cerebral edema, CNS irritability, hyperreflexia, HA, seizures, LOC and affect changes; coagulation abnormalities; decreased albumin, fluid shifts edema

• Mild - increase of systolic BP >30, increase of diastolic >15 or baseline BP of > 140/90 readings on 2 occasions 6hrs apart
• Severe - BP of >160/110 on 2 occasions 6 hrs apart
• Eclampsia - convulsion or coma

Protenuria 1-2+ (<5g/2H); edema, dependent, some face and hands; absent - transient HA no visual dist.; urninary output >30mL/hr; Labs, normal platelets, creatinine, liver enzymes; fetal growht WNL, no placental aging

protenuria > 3+(>5G/24H); edema, generalized, pulmonary edema; HA, > 3+ DTRs, clonus, visual distrub, epigastric pain, irritability; urinary output <30mL/hr; labs - thrombocytopenia, >creatinine, liver enzymes and HCT; fetal growth restriction and placental aging

increasing edema; HA, disorientation; visual disturbances; hyperreflexia, clonus; decreasing urniary output; N&V disorientation, epigastric pain; bleeding gums c/o not feeling well

• H - hemolysis
• EL - elevated liver enzymes
• LP - low platelets

N&V, malaise, epigastric pain, flu-like sx,; assoc with severe pre-elalampsia, but may develop before onset of PIH sx; occurs prior to 36 weeks in 90% of cases

occurance of seizure or coma; likely related to vasospasm, edema, hemorrhage, ischemia, HTN or metabolic encephalopathy

dark spots or flashing lights; epigastric pain, vomitting, severe HA; pulmonary edema, cyanosis, neuro hyperactivity

• asses seizure - OLDCARTS
• status of fetus - signs of abruption
• maintain airway give O2
• position on side to avoid aspiration
• SR up and padded
• give MgSO4 as bolus ordered
• admin her meds as ordered

• activity restrict
• high protein diet
• fetal surveillance
• teach of worsening S&S
• monitor well being

• complete bed rest (hospitalization);
• diet - high protein, mod Na
• anticonvulants - MgSO4
• corticosteroids
• F&E replace
• sedatives
• anti HTN

both arms relaxed; both arms above head; both hands on hips while leaning forward