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

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Obstetrics Care of mother and fetus during pregnancy –40-week pregnancy –Puerperium—6 weeks following delivery

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Obstetrics and the TPMS

4. 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

5. 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

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Subsequent Prenatal Visits Vital signs –Blood work Measurement of fundus Nagele’s rule

7. 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

8. 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)

9. 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

10. 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

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Disorders of Pregnancy Hyperemesis gravidarum (excessive vomiting) –Severe dehydration can result Rh Incompatibility Impaired fertility

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Parturition (Labor) Three stages –Dilation –Expulsion –Placental Braxton Hicks contractions Amniotomy >>

13. 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

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Contraception Nonprescription –Condoms, sponges Prescription –Hormonal contraceptives, cervical cap, IUD, vaginal rings Sterilization

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gynecology Studies diseases of female reproductive tract

16. 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

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gynecologic Exam Cick to play the video

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gynecologic Exam PAP smear performed annually for detection of cervical cancer

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Breast Exam Breast exam –Checks for abnormalities –Medical assistant may teach patient about breast self-exam

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

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gynecological Diseases and Conditions Endometriosis –Endometrial tissue outside the uterus Cause unknown Treatment

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gynecological Diseases and Conditions Ovarian cysts –Cysts on ovaries –Detection –Treatment

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gynecological Diseases and Conditions Ovarian cancer –Difficult to diagnose –Symptoms –Diagnosis

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gynecological Diseases and Conditions Pelvic Inflammatory Disease (PID) –Usually caused by STDs –Diagnosis –Treatment Human Papilloma Virus –Gardisil vaccine

25. 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

26. 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)

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Diagnostic Tests Cryosurgery –Treat tissue with freezing temperatures Treatment for chronic cervicitis and cervical erosion –Procedure with probe

28. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Diagnostic Tests Wet prep/wet mount for yeast, bacteria, and trichomonas Potassium hydroxide for fungus

29. 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