Obstetrics and Gynecology 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 (see Procedure 26-1 in the text) (discuss the Critical Thinking Box)

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 (discuss the Critical Thinking Box)

Subsequent Prenatal Visits 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

Subsequent Prenatal Visits 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) (discuss the Critical Thinking Box)

Disorders of Pregnancy Abortion or interruption of pregnancy Eclampsia (toxemia) Life-threatening Gestational diabetes Usually disappears after delivery

Disorders of Pregnancy Placenta previa >> Placenta may cover cervical os Placenta abruption >> Placenta separates from uterine lining

Disorders of Pregnancy Hyperemesis gravidarum (excessive vomiting) Severe dehydration can result Rh Incompatibility Impaired fertility

Parturition (Labor) Three stages Braxton Hicks contractions Dilation Expulsion Placental Braxton Hicks contractions Amniotomy >>

Postpartum Period Puerperium Lochia 6 week follow-up appointment The body returns to a nonpregnant state The uterus involutes Lochia 6 week follow-up appointment

Contraception Nonprescription Prescription Sterilization 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 Watch 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 breast self-exam (discuss the Critical Thinking Box and see Procedure 26-2 in the text)

Gynecological Diseases and 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

Gynecological Diseases and Conditions Endometriosis Endometrial tissue outside the uterus Cause unknown Treatment

Gynecological Diseases and Conditions Ovarian cysts Cysts on ovaries Detection Treatment

Gynecological Diseases and Conditions Ovarian cancer Difficult to diagnose Symptoms Diagnosis

Gynecological Diseases and Conditions Pelvic Inflammatory Disease (PID) Usually caused by STDs Diagnosis Treatment Human Papilloma Virus Gardisil vaccine (discuss the Critical Thinking Box)

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 (discuss the Critical Thinking Box)

Other Diagnostic Tests Cervical punch biopsy Done with colposcopy Performed after abnormal PAP Cervical cone biopsy Loop electrosurgical excision procedure (LEEP)

Other Diagnostic Tests Cryosurgery Treat tissue with freezing temperatures Treatment for chronic cervicitis and cervical erosion Procedure with probe

Other Diagnostic Tests Wet prep/wet mount for yeast, bacteria, and trichomonas Potassium hydroxide for fungus (see Procedure 28-4 in the text)

Other Diagnostic Tests Laparoscopy >> Lighted view of pelvic cavity Dilation and Curettage (D&C) Surgical procedure Dilating and scraping of the endometrial tissue