Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 26 Obstetrics and...

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 26

Obstetrics and Gynecology


Obstetrics

• Care of mother and fetus during pregnancy– 40-week pregnancy

– Puerperium—6 weeks following delivery


Obstetrics and the TPMS


Obstetrics

• Initial prenatal visit– Prevention of diseases and complications

– Thorough history and physical

– Pelvic measurements

– Laboratory tests• Blood and urine tests

– Patient education


Obstetrics

• Prenatal history– Identify high risk

– Attention given to risk factors• Diseases

• Age

• OB history

– Gravida, Para

– Potential serious problems


Subsequent Prenatal Visits

• Vital signs– Blood work

• Measurement of fundus• Nagele’s rule



• Tests and procedures– Alpha Fetal Protein (AFP)

• Performed at 16 weeks– Amniocentesis

– Chronic Villi Sampling (CVS)• Performed if history of abnormalities such as thalassemia,

sickle cell anemia, or Tay-Sachs

• Performed at 8–10 weeks gestation



• Tests and procedures– Ultrasonography/amniocentesis

• Ultrasound produces image of fetus– Prep—1 qt. water 1 hour prior

• Amniocentesis—surgical puncture of amniotic sac– Obtain sample of amniotic fluid

– Diagnose certain congenital abnormalities

– Fetal heart rate• Nonstress test monitors (mother’s heart)

• Stress test monitors (fetal heart rate)


Disorders of Pregnancy

• Abortion or interruption of pregnancy

• Eclampsia (toxemia)– Life-threatening

• Gestational diabetes– Usually disappears after delivery



• Placenta previa >>– Placenta may cover cervical

os

• Placenta abruption >>– Placenta separates from

uterine lining



• Hyperemesis gravidarum (excessive vomiting)– Severe dehydration can result

• Rh Incompatibility

• Impaired fertility


Parturition (Labor)

• Three stages– Dilation

– Expulsion

– Placental

• Braxton Hicks contractions

• Amniotomy >>


Postpartum Period

• Puerperium– The body returns to a nonpregnant state

– The uterus involutes

• Lochia

• 6 week follow-up appointment


Contraception

• Nonprescription– Condoms, sponges

• Prescription– Hormonal contraceptives, cervical cap, IUD, vaginal

rings

• Sterilization


Gynecology

• Studies diseases of female reproductive tract


Gynecologic Exam

• Assisting with gynecological examination (GYN)

– Consist of four or five parts

– Exam with PAP equipment


Gynecologic Exam

• Cick to play the video


Gynecologic Exam

• PAP smear performed annually for detection of cervical cancer


Breast Exam

• Breast exam– Checks for abnormalities

– Medical assistant may teach patient about breastself-exam


Gynecological Diseasesand Conditions

• Infertility– Common causes

• Menopause– Occurs between 35 and 58 years

• Ovaries produce less estrogen

• Surgical menopause– Surgical removal of ovaries

– Signs and symptoms

– Treatment



• Endometriosis– Endometrial tissue outside

the uterus• Cause unknown

• Treatment



• Ovarian cysts– Cysts on ovaries

– Detection

– Treatment



• Ovarian cancer– Difficult to diagnose

– Symptoms

– Diagnosis



• Pelvic Inflammatory Disease (PID)– Usually caused by STDs

– Diagnosis

– Treatment

• Human Papilloma Virus– Gardisil vaccine


Other Diagnostic Tests

• Colposcopy– Exam of vagina and cervix by lighted instrument

– Performed after abnormal PAP

– Follow-up treatment of cervical cancer

• Endometrial biopsy/sampling

• Postmenopausal bleeding



• Cervical punch biopsy– Done with colposcopy

– Performed after abnormal PAP

• Cervical cone biopsy

• Loop electrosurgical excision procedure (LEEP)



• Cryosurgery– Treat tissue with freezing temperatures

• Treatment for chronic cervicitis and cervical erosion

– Procedure with probe



• Wet prep/wet mount for yeast, bacteria, and trichomonas

• Potassium hydroxide for fungus



• Laparoscopy >>– Lighted view of pelvic

cavity

• Dilation and Curettage (D&C)– Surgical procedure

– Dilating and scraping of the endometrial tissue

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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 26 Obstetrics and...

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