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Chapter 26

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Chapter 26

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  1. Chapter 26 Obstetrics and Gynecology

  2. Obstetrics • Care of mother and fetus during pregnancy • 40-week pregnancy • Puerperium—6 weeks following delivery

  3. Obstetrics and the TPMS

  4. Obstetrics • Initial prenatal visit • Prevention of diseases and complications • Thorough history and physical • Pelvic measurements • Laboratory tests • Blood and urine tests • Patient education

  5. Obstetrics • Prenatal history • Identify high risk • Attention given to risk factors • Diseases • Age • OB history • Gravida, Para • Potential serious problems

  6. Subsequent Prenatal Visits • Vital signs • Blood work • Measurement of fundus • Nagele’s rule

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

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

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

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

  13. Postpartum Period • Puerperium • The body returns to a non-pregnant state • The uterus involutes • Lochia • 6 week follow-up appointment

  14. Contraception • Nonprescription • Condoms, sponges • Prescription • Hormonal contraceptives, cervical cap, IUD, vaginal rings • Sterilization

  15. Gynecology • Studies diseases of female reproductive tract

  16. Gynecologic Exam • Assisting with gynecological examination (GYN) • Consist of four or five parts • Exam with PAP equipment

  17. Gynecologic Exam Click Here to play the video

  18. Gynecologic Exam • PAP smear performed annually for detection of cervical cancer

  19. Breast Exam • Breast exam • Checks for abnormalities • Medical assistant may teach patient about breastself-exam

  20. 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

  21. Gynecological Diseasesand Conditions • Endometriosis • Endometrial tissue outside the uterus • Cause unknown • Treatment

  22. Gynecological Diseasesand Conditions • Ovarian cysts • Cysts on ovaries • Detection • Treatment

  23. Gynecological Diseasesand Conditions • Ovarian cancer • Difficult to diagnose • Symptoms • Diagnosis

  24. Gynecological Diseasesand Conditions • Pelvic Inflammatory Disease (PID) • Usually caused by STDs • Diagnosis • Treatment • Human Papilloma Virus • Gardisil vaccine

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

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

  28. Other Diagnostic Tests • Wet prep/wet mount for yeast, bacteria, and trichomonas • Potassium hydroxide for fungus

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