Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 26 Obstetrics and...
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Transcript of 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
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Obstetrics
• Care of mother and fetus during pregnancy– 40-week pregnancy
– Puerperium—6 weeks following delivery
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Obstetrics and the TPMS
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Obstetrics
• Initial prenatal visit– Prevention of diseases and complications
– Thorough history and physical
– Pelvic measurements
– Laboratory tests• Blood and urine tests
– Patient education
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Obstetrics
• Prenatal history– Identify high risk
– Attention given to risk factors• Diseases
• Age
• OB history
– Gravida, Para
– Potential serious problems
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Subsequent Prenatal Visits
• Vital signs– Blood work
• Measurement of fundus• Nagele’s rule
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Disorders of Pregnancy
• Abortion or interruption of pregnancy
• Eclampsia (toxemia)– Life-threatening
• Gestational diabetes– Usually disappears after delivery
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Disorders of Pregnancy
• Placenta previa >>– Placenta may cover cervical
os
• Placenta abruption >>– Placenta separates from
uterine lining
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Disorders of Pregnancy
• Hyperemesis gravidarum (excessive vomiting)– Severe dehydration can result
• Rh Incompatibility
• Impaired fertility
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Parturition (Labor)
• Three stages– Dilation
– Expulsion
– Placental
• Braxton Hicks contractions
• Amniotomy >>
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postpartum Period
• Puerperium– The body returns to a nonpregnant state
– The uterus involutes
• Lochia
• 6 week follow-up appointment
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Contraception
• Nonprescription– Condoms, sponges
• Prescription– Hormonal contraceptives, cervical cap, IUD, vaginal
rings
• Sterilization
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecology
• Studies diseases of female reproductive tract
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecologic Exam
• Assisting with gynecological examination (GYN)
– Consist of four or five parts
– Exam with PAP equipment
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecologic Exam
• Cick to play the video
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecologic Exam
• PAP smear performed annually for detection of cervical cancer
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Breast Exam
• Breast exam– Checks for abnormalities
– Medical assistant may teach patient about breastself-exam
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecological Diseasesand Conditions
• Endometriosis– Endometrial tissue outside
the uterus• Cause unknown
• Treatment
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecological Diseasesand Conditions
• Ovarian cysts– Cysts on ovaries
– Detection
– Treatment
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecological Diseasesand Conditions
• Ovarian cancer– Difficult to diagnose
– Symptoms
– Diagnosis
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gynecological Diseasesand Conditions
• Pelvic Inflammatory Disease (PID)– Usually caused by STDs
– Diagnosis
– Treatment
• Human Papilloma Virus– Gardisil vaccine
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Other Diagnostic Tests
• Cervical punch biopsy– Done with colposcopy
– Performed after abnormal PAP
• Cervical cone biopsy
• Loop electrosurgical excision procedure (LEEP)
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Other Diagnostic Tests
• Cryosurgery– Treat tissue with freezing temperatures
• Treatment for chronic cervicitis and cervical erosion
– Procedure with probe
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Other Diagnostic Tests
• Wet prep/wet mount for yeast, bacteria, and trichomonas
• Potassium hydroxide for fungus
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Other Diagnostic Tests
• Laparoscopy >>– Lighted view of pelvic
cavity
• Dilation and Curettage (D&C)– Surgical procedure
– Dilating and scraping of the endometrial tissue