1. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 26 Obstetrics and Gynecology

2. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Care of mother and fetus during pregnancy –40-week pregnancy –Puerperium—6 weeks after delivery Normal uterine pregnancy>>

3. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics

4. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Initial prenatal visit –Health promotion for expectant mother and her baby –Diagnosis and treatment of maternal disorders –Growth and development of fetus followed –Ongoing assessment of expectant mother and fetus –Early detection and management of conditions

5. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Initial prenatal visit –Thorough history and physical examination –Monthly and then weekly visits –Check weight, blood pressure, test blood and urine –Education about nutrition, activity, rest –Preparing for childbirth –Laboratory tests and procedures

6. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Prenatal history –Emphasis on identification of high-risk patient –Gravidity: total number of pregnancies –Parity: number of pregnancies carried to viability –Multigravida: woman pregnant more than once –Nullipara: woman who has not carried pregnancy to viability

7. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Subsequent or return prenatal visits –Vital signs –Blood work –Measurement of fundus –Fetal heart measurements

8. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Subsequent or return prenatal visits –EDB (expected date of birth) –EDC (expected date of confinement) Nägele’s rule Pregnancy wheels Vaginal examinations Lamaze method of childbirth

9. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Subsequent or return prenatal visits –Tests and procedures Alpha fetoprotein Chorionic villus sampling (CVS) Ultrasonography Amniocentesis Fetal heart rate

10. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Disorders of pregnancy –Abortion/interruption of pregnancy Spontaneous Complete Missed Incomplete Threatened Induced –Ectopic pregnancy –Eclampsia

11. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Disorders of pregnancy –Gestational diabetes –Hyperemesis gravidarum –Placenta previa –Placenta abruptio –Impaired fertility –Incompatibility

12. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Placenta previa >> –Placenta implants low in uterus and partially or completely covers cervical os or opening of uterus Placenta abruption >> –Placenta prematurely and abruptly separates from uterine lining

13. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Parturition (labor) –Three stages Dilation Expulsion Placental –Braxton Hicks contractions Amniotomy >>

14. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Postpartum period –Puerperium Body returns to non-pregnant state Uterus involutes –Lochia Vaginal discharge –Postpartum depression –6 week follow-up appointment

15. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Contraception –Nonprescription Condoms Contraceptive foam Spermicide Sponges

16. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Contraception –Prescription Hormonal contraception Implanon ® Diaphragm Cervical cap Intrauterine device RU-486

17. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Obstetrics Contraception –Sterilization: surgical procedure that renders individual infertile Woman: fulgaration and ligation Man: vasectomy

18. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Studies diseases of female reproductive tract and breasts

19. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology The gynecologic examination –Assess female’s health –Screen for cancer of reproductive organs –Breast and pelvic examination –Pap smear –Offered screening mammogram annually

20. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Human papillomavirus (HPV) and Gardasil –Gardasil protects against four HPVs –2 of the 4 viruses responsible for 70% of all cervical cancers –HPV spread through sexual contact –Can infect sexually active males and females –50% of sexually active people will contract genital HPV in their lifetime

21. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Scheduling Pap smear tests –Annual gynecologic examination on date easy to remember –Every woman should have annual examination even if Pap test not included –Health practices related to culture, values, belief systems

22. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Female circumcision –Ancient cultural custom practiced worldwide for more than 2000 years Removal of prepuce of clitoris Clitoridectomy: removal of prepuce and clitoris Removal of prepuce, clitoris, upper labia minora, some labia majora Infibulation: removal of all external genitalia

23. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Female circumcision –Also known as female genital mutilation (FGM) –Infections and hemorrhages common –Opposition basis it is human rights violation –Always view patients as individuals whose cultural beliefs and practices may differ greatly from your own

24. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Breast examination –Checks for abnormalities –MA teach patient about breast self-examination (BSE) –Breast cancer 2 nd leading cause of death in women in United States Mammography Tissue biopsy MRI Ultrasound MRI-guided breast biopsies

25. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Assisting with gynecologic examination –Inspection of external genitalia –Pelvic examination of cervix, vagina, uterus, tubes, ovaries –Rectal examination –Breast examination

26. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecologic exam –Instruments and supplies provider needs to perform gynecologic or pelvic examination with Pap test

27. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Assisting with gynecologic examination –Last normal menstrual period –Hormonal therapies –Surgical history –Sexual history/habits –Symptoms of diseases/disorders

28. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Pap smear performed annually for detection of cervical cancer

29. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Please refer to the video library on the Instructor Resources CD to view video “PAP Exam.”

30. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Pap smear –Scraping cervix with spatula and cytology brush and smearing cells onto microscopic slide –ThinPrep Pap test significantly more effective –AutoPap: computerized method –ViraPap: screen for HPV in Pap smear

31. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecological diseases and conditions –Infertility Common causes –Menopause Permanent cessation of menstrual activity Occurs between 35 and 58 years Ovaries produce less estrogen Surgical menopause: surgical removal of ovaries Hormone therapy (HT)

32. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecological diseases and conditions –Do not smoke –Keep blood pressure within normal limits –Keep cholesterol level within normal limits –Exercise regularly –Maintain healthy weight

33. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecological diseases and conditions –Get regular mammograms with ultrasound if necessary and Pap tests –Practice good nutrition –Avoid regular alcohol use

34. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecological diseases and conditions –Endometriosis Endometrial tissue outside uterus Cause unknown Long-term hormonal treatment Hysterectomy may be necessary

35. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecological diseases and conditions –Ovarian cysts Cysts on ovaries Most resolve without treatment Laparoscopy to drain or remove cyst Contraceptive therapy

36. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecological diseases and conditions –Ovarian cancer Fifth most common cancer in women Difficult to diagnose Symptoms Diagnosis Cause not known

37. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Gynecological diseases and conditions –Pelvic inflammatory disease (PID) Sexually transmitted pathogen (gonorrhea or chlamydia) Diagnosis Treatment

38. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Other diagnostic tests –Colposcopy Exam of vagina and cervix by lighted instrument Performed after abnormal Pap test Follow-up treatment of cervical cancer –Endometrial biopsy/sampling Abnormal periods, postmenopausal bleeding, thickened uterine lining as diagnosed by ultrasound

39. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Other diagnostic tests –Cervical punch biopsy Done with colposcopy Performed after abnormal Pap test –Cervical cone biopsy –Loop electrosurgical excision procedure (LEEP)

40. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Other diagnostic tests –Cryosurgery Treat tissue with freezing temperatures –Treatment for chronic cervicitis and cervical erosion Procedure with cryo probe

41. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Other diagnostic tests –Wet prep/wet mount for yeast, bacteria, and trichomonas –Potassium hydroxide prep for fungus

42. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Other diagnostic tests –Amplified DNA probe test for chlamydia and gonorrhea Screening tool for men, women, all pregnant women Not a culture ProbeTec ® blue kit for urethral specimens from male ProbeTec ® pink kit for endocervical specimens from female

43. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Other diagnostic tests –Laparoscopy >> Lighted view of pelvic cavity –Dilation and curettage (D&C) Surgical procedure Dilating and scraping of endometrial tissue

44. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gynecology Complementary therapy in obstetrics and gynecology –Helpful easing discomforts of pregnancy and labor –Neonatal intensive care unit infants benefit Stress reduction Imagery Acupuncture Biofeedback Massage therapy Music therapy