Ovulatory Hormones I - Follicular Phase
- 0-14 Days
- GnRH Stimulates FSH and LH
- Follicle Secretes Estrogen
- Negative Feedback from Estrogen
- Increased Estrogen Leads to Positive Feedback
- FSH and LH Surge
- LH Spike Leads to Ovulation
Ovulatory Hormones II - Luteal Phase
- Days 15-28
- Corpus Luteum
- Secretes Progesterone
- Negative Feedback inhibits FSH and LH
- No pregnancy forms Corpus Albicans
- Stops Estrogen Secretion
- Endometrial Sloughing - Menses
- GnRH secretion produces new follicular phase
Placental Implantation Abnormalities
- Placenta Adheres Directly to Myometrium
- Placenta Accreta
- Placenta Increta
- Placenta Percreta
- Caused by Scar Tissue
- Hemorrhage
- Ultrasound is First-line, then MRI
- C-section Delivery
- Artery Ligation or Embolization
Abruptio Placentae
- Premature Separation of Placenta
- Tearing Pain
- Bleeding (Often Concealed)
- Rigid Uterus
- Contractions
- Corticosteroids as Needed
- Emergent Delivery
- Increased Risks for Neonate
- Rh (Rhesus) Incompatibilities
- Increased Risk for Shock
- Monitor Fetal Heart Rate
Placenta Previa
- Placenta Covers Cervical Os
- Painless
- Bright Red Vaginal Bleeding
- Stable Fetus
- Bed Rest
- Observation
- Unstable Fetus
- C-section Delivery
- Risk for Shock
- Magnesium Sulfate
- Tocolysis
Prenatal Nutrition
- Prenatal Vitamins
- Iron Supplement 30 mg Daily
- Folate/Folic Acid 400 mcg Daily
- Appropriate Weight Gain Recommendations
- 340 Calorie Increase
- 25 gram Protein Increase
- Coffee, Alcohol, Tobacco
- Fish Containing High Mercury Levels
Prenatal Care
- Prenatal Visits
- Vital Signs, FHR
- Fundal Height
- Urine Dipstick
- Weight
- Prenatal Screening
- Laboratory Testing
Ectopic Pregnancy
- Lower Abdominal Pain
- Delayed Menses
- Abnormal Vaginal Bleeding
- Shock
- Referred Shoulder Pain
- Cullen Sign
- Methotrexate
- Surgery
- RhoGAM
Hyperemesis Gravidarum
- Excessive Vomiting
- Significant Weight Loss
- Dehydration
- Hypotension
- Electrolyte Imbalance
- Antiemetics
- Frequent Small Meals
- IV Therapy
Discomforts of Pregnancy - First Trimester
- Breast Tenderness
- Supportive Bra
- Nausea and Vomiting
- Frequent Small Meals
- Urinary Frequency and Urgency
- Frequently Empty Bladder
- Leukorrhea
- Perineal Pad
- Ptyalism
Discomforts of Pregnancy - Second Trimester
- Supine Hypotension
- Side-lying Position
- Food Cravings
- Heartburn (Pyrosis)
- Constipation
- Moderate Exercise
- Varicose Veins
- Elevate Legs
- Backache
- Pelvic Tilt Exercise
- Nutrition
Discomforts of Pregnancy - Third Trimester
- Shortness of Breath (SOB)
- Rest Periods
- Return of Urinary Frequency and Urgency
- Empty Bladder Regularly
- Leg Cramps
- Stretching Exercises
- Ankle Edema
- Elevate Legs
Presumptive Signs of Pregnancy
- Amenorrhea
- Fatigue
- Urinary Frequency
- Nausea and Vomiting
- Breast Changes
- Quickening
Probable Signs of Pregnancy
- Goodell Sign
- Chadwick Sign
- Hegar Sign
- Positive Serum and Urine Sample
- Braxton Hicks Contractions
- Ballottement
Positive Signs of Pregnancy
- Fetus on Ultrasound
- Fetal Heart Rate by Doppler or Fetoscope
- Fetal X-ray
- Fetal Movements
Supine Hypotension (Vena Cava Syndrome)
- Compression of the Vena Cava and Descending Aorta
- Hypotension
- Dizziness
- Tachycardia
- Decreased Renal Perfusion
- Decreased Uteroplacental Perfusion
- Side-lying Position
Amniocentesis
- Transabdominal Puncture
- > 14 weeks gestation
- Genetic and Congenital Anomalies
- Fetal Hemolytic Disease
- Fetal Lung Maturity
- Miscarriage
- Hemorrhage
- Infection
- RhoGAM (Rh Immune Globulin)
Fetal Macrosomia
- Increased Birth Weight
- > 4500 g
- Maternal Obesity
- Gestational Diabetes
- Weigh Newborn at Birth
- Ultrasound
- Hadlock's Formula
- Birth Canal Trauma
- Neonatal Hypoglycemia
- Shoulder Dystocia
- Planned Cesarean Section
Gestational Diabetes
- Usually Asymptomatic
- Fetal Macrosomia
- Polyhydramnios
- Glucose Intolerance After 24 Weeks Gestation
- 3-hr 100g Glucose Tolerance Test
- Diet and Exercise
- Close Glucose Monitoring
- Insulin
- Ultrasound (or Nonstress Test (NST))
- Delivery
Gestational Hypertension
- New-Onset Hypertension
- > 20 Weeks Gestation
- Nulliparity
- Obesity
- African American Females
- > 35 years Old
- Multiple Gestations
- Family History of Gestational HTN (or Preeclampsia)
- IUGR
- Prematurity
- Abruptio Placentae
- Fetal Monitoring
- Alpha-Methyldopa
- Beta-Blockers (Labetalol)
- Calcium Channel Blockers
- Hydralazine
Preeclampsia Assessment
- After 20 Weeks of Pregnancy
- Hypertension > 140/90
- Proteinuria or End-Organ Dysfunction
- Hypertension > 160/110
- Progressive Renal Insufficiency
- Vision Changes
- HELLP Syndrome
- Pulmonary Edema
Preeclampsia Interventions
- Side Lying Position and Bedrest
- Antihypertensives
- Magnesium Sulfate
- Labor Induction
Severe Preeclampsia
- Vasospasm and Decreased Organ Perfusion
- Intravascular Coagulation
- Increased Permeability and Capillary Leakage
- Hypertension
- Proteinuria or End-Organ Dysfunction
- Hepatic Dysfunction and Hemolysis
- Elevated Liver Enzymes
- Low Platelet Counts
Spontaneous Abortion Overview
- Bleeding < 20 weeks Gestation
- Identify Type
- Bed Rest
- Monitor for Hemorrhage
- Save Pads and Linens
- RhoGAM
- Dilation and Curettage (DandC)
- Cerclage
- Emotional Support
Spontaneous Abortion Types
- Missed Abortion
- No Fetal Heartbeat, No Cervical Dilation, No Bleeding
- Threatened Abortion
- No Cervical Dilation and Minimal Bleeding
- Inevitable Abortion
- Bleeding and Cervical Dilation with No Loss of Products of Conception
- Incomplete Abortion
- Bleeding and Cervical Dilation with Loss of Some Products of Conception
- Complete Abortion
- Bleeding with No Cervical Dilation, with Loss of All Products of Conception
Pregnant Diabetic Patient Interventions
- Increase Insulin then Decrease
- Metformin
- Nutrition
- Exercise
- Increase Insulin
- More Likely to Develop Hypoglycemia than Hyperglycemia
- Double or Quadruple Insulin
- Early Delivery
- Drastically Decrease Insulin
- Monitor Neonate for Hypoglycemia
Eclampsia
- Increased Central Nervous System Irritability
- Hyperreflexia
- Positive Ankle Clonus
- Headaches
- Visual Disturbances
- Epigastric or RUQ Pain
- Seizures
- Coma
- Don't Leave Bedside
- Magnesium Sulfate
Mechanism of Labor
- Engagement
- Descent
- Flexion
- Internal Rotation
- Extension
- External Rotation (Restitution)
- Expulsion of Infant
Induction of Labor
- Premature Rupture of Membranes
- Danger to Fetus or Mother
- Prolonged Gestation
- Placenta Abnormalities
- Transverse Fetal Position
- Prolapsed Umbilical Cord
- Active Genital Herpes Infection
- Transfundal Uterine Incision
- Hemorrhage
Premature Rupture of Membranes (PROM)
- Rupture > 1 Hour Before Labor
- Infection
- PROM History
- Incompetent Cervix
- Fern Test
- Nitrazine Paper Test
- Ultrasound
- Consider Tocolytics
- Consider Antibiotics
- < 34 Weeks Gestation
- Corticosteroids
- > 34 Weeks Gestation
- Induction of Labor
True vs. False Labor
- Bloody Show
- Regular, Strong Contractions
- Progressive Effacement and Dilation
- Engagement of Presenting Part
- Irregular Contractions
- Cervix Soft
- No Engagement of Presenting Part
Early Decelerations
- Fetal Head Compression
- Uterine Contractions
- Placement of Internal Mode of Monitoring
- Vaginal Examination
- Fundal Pressure
- Normal Pattern
Decelerations (and Accelerations) Overview
- VEAL CHOP
- Variable Deceleration
- Cord Compression
- Early Deceleration
- Head Compression
- Acceleration
- Okay
- Late Deceleration
- Placental Insufficiency
Variable Decelerations
- Umbilical Cord Compression
- Abnormal Cord Position
- Transition Phase
- Oxygen with Non-Rebreather (8-10 L/min)
- Change Maternal Position
- Discontinue Oxytocin
Late Decelerations
- Uteroplacental Insufficiency
- Disruption of Oxygen Transfer to Fetus
- Abnormal Pattern
- Discontinue Oxytocin
- Oxygen with Non-Rebreather (8-10 L/min)
- Side-lying Position
- Elevate Legs
- Increase Rate of IV Solution
Cesarean Section - Indications
- Active Genital Herpes Infection
- Cervical Cancer
- Eclampsia (Preeclampsia)
- History of Uterine Surgery
- History of C-section (Vertical)
- Malpresentation
- Fetal Distress
- Cord Compression/Prolapse
- Failed Vaginal Delivery
- Cephalopelvic Disproportion
- Abruptio Placentae or Placenta Previa
Prolapsed Umbilical Cord
- Cord Prolapses
- Visualization of Cord
- Prolonged or Variable Decelerations
- Hips Elevated
- Insert 2 fingers in Vagina
- Saline Towel on Cord
- Oxygen
Postpartum Hemorrhage
- Uterine Atony
- Lacerations
- Retained Placenta
- Bleeding
- Hypotension
- Boggy Uterus
- Oxytocin
- Bimanual Compression of Uterus
- Surgery
- Blood Transfusion