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Chapter 32

Chapter 32. Obstetrics & Gynecology. Learning Objectives. Define key terms related to obstetrics and gynecology (OB-GYN) Describe function of female reproductive system Identify structures of female reproductive system Identify role of medical assistant in OB-GYN.

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Chapter 32

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  1. Chapter 32 Obstetrics & Gynecology

  2. Learning Objectives • Define key terms related to obstetrics and gynecology (OB-GYN) • Describe function of female reproductive system • Identify structures of female reproductive system • Identify role of medical assistant in OB-GYN

  3. Learning Objectives • Identify instruments for the gynecological examination • Assist with examinations and procedures • Explain diagnostic procedures related to OB-GYN • Describe prenatal and postpartum care • Calculate estimated due date (EDD)

  4. Learning Objectives • Define stages of labor • List common complications of pregnancy • Describe menopause • Identify common diseases and disorders related to OB-GYN • Provide patient education • Perform patient teaching for breast self-examination

  5. Female Reproductive System • Internal structures • Ovaries, fallopian tubes, fimbriae, uterus, cervix, vagina, endometrium, myometrium

  6. Internal Structures • Ovaries—flat, oval shaped, located each side of uterus in lower abdominal cavity • Fallopian tubes do not connect directly to ovary • Fimbriae—wavelike structures at end of fallopian tubes • Uterus—thick-walled muscular organ consisting of fundus, corpus, cervix

  7. Female Reproductive System • External structures • Vulva includes clitoris, urethral meatus, labia, mons pubis, Bartholin glands

  8. External Structures • Clitoris—elongated erectile tissue • Urethral meatus—opening to urinary bladder • Labia—two layers covering clitoris, urethral meatus, and vaginal opening • Mons pubis—pad of fatty tissue covers pubic bone

  9. Female Reproductive System • Internal structure functions: • Ovaries—primary sex organs, produce ovum, estrogen, progesterone • Fallopian tubes—pathways for ovum from ovary to uterus • Uterus—houses developing fetus, expands during pregnancy, cervix dilates, contractions are multidirectional

  10. Female Reproductive System • External structure functions: • Labia—protect other external and internal structures • Clitoris—responds to stimulation causing orgasm • Vagina—passageway for intercourse, birth canal • Breasts—lactation to nourish neonate

  11. Breasts • During puberty increased secretion of estrogen causes breasts to develop • Areola—pigmented tissue, center is nipple • Mammary glands surrounded by connective and adipose tissue

  12. Female Reproductive Cycle • Menarche—onset of menses, average age 13 • Menstruation—menstrual cycle every 28 days, includes: • Follicular phase—hormones stimulate growth of ovum • Luteal phase—ova expelled from ovary • Menstrual phase—uterus discharges necrotic endometrial tissue if no conception does not occur

  13. Menstrual Cycle • Follicular phase—day 9–14 • Luteal phase • Menstrual phase— lasts between 5 and 7 days

  14. Pregnancy • Zygote—fertilized egg with one sperm; reaches uterus 4–6 days after conception and implants • Placenta—organ of nutrition for zygote • Zygote develops into embryo, then fetus • Pregnancy, also called gestation • Trimesters—three equal time periods throughout pregnancy

  15. Embryonic and Fetal Development • First trimester—12 weeks • Second trimester—15–28 weeks gestation • Third trimester—end of pregnancy, maternal weight gain may be 1 pound per week

  16. Birth Process • Contractions stimulate start of birth process • Dilation—increased diameter of cervical opening • Effacement—thinning of cervix • First stage of labor can last from 1–24 hours • Analgesics may be given for discomfort

  17. Birth Process • Second stage of labor involves delivery of infant • Oxytocin released from pituitary gland • Episiotomy—incision into perineum to ease delivery • Third stage of labor is delivery of placenta

  18. Menopause • Menopause—cessation of menstrual cycle • Symptoms vary • Hot flashes, chills, night sweats, excitability, fatigue, apathy, mental depression • Maintain diet high in calcium, vitamins, and minerals • HRT—hormone replacement therapy

  19. Common Diseases and Disorders • Obstetric and gynecological diseases and disorders include: • Vaginal infections, menstrual disorders, uterine disorders, complications of pregnancy, infertility, fibrocystic breast disease, and cancer

  20. Candidiasis • Yeast infection • Can occur in mouth (thrush) • Disruption of normal flora of vaginal area • Pruritus, odorless, white vaginal discharge

  21. Chlamydia • Bacterial vaginal infection, considered a sexually transmitted disease (STD) • Annual screening for sexually active women • 75% are asymptomatic • Diagnosed by culture • Treatment—antibiotics

  22. Genital Herpes • Viral sexually transmitted infection • Local pain and itching, burning, dysuria, eruption of rash with vesicles • Diagnosed by sample of cells or fluid, viral culture • No cure • Treatment includes antivirals

  23. Genital Warts • Human papillomavirus • Most patients are asymptomatic • Some report itching or burning • Diagnosed by visual inspection • No cure • Treatment destroys warts, may return after treatment

  24. Gonorrhea • Bacterial sexually transmitted disease • May be asymptomatic, some experience greenish-yellow discharge or pain • Diagnosed by culture • Treatment includes antibiotics with loading dose • Recheck culture after treatment

  25. Syphilis • Bacterial sexually transmitted disease • Incubation period 10 days to 2 months • Chancres—painless ulcers on genitals, widespread body rash, fever, headaches • End-stage infection includes central nervous system damage • Diagnosed by blood test • Treatment includes antibiotics

  26. AIDS • Acquired immune deficiency syndrome • Most advanced stage of HIV infection • Opportunistic infections, fatigue, fever, chills, night sweats, oral ulcerations • Diagnosed by blood test • Without treatment, survival rate is 9–11 years • With antiviral treatment, 20 years

  27. Trichomoniasis • Protozoan infection of vagina • Frothy, white or yellow vaginal discharge • Characteristic foul odor • Diagnosed by wet preparation • Treatment includes oral metronidazole

  28. Bartholin Gland Cyst • Duct of gland becomes blocked, cyst becomes inflamed and tender • Tender or painful lump near vaginal opening • Diagnosis based on visual inspection • Treatment includes warm compresses, possible incision, and drainage

  29. Menstrual Disorders • Dysmenorrhea—painful menstruation • Lower back pain, headache, nausea, diarrhea • Symptoms usually begin 12–24 hours prior to menstruation, continuing for 3–5 days • Treatment may include analgesics, warm or cold compresses, medications to reduce uterine contractions, and oral contraceptives

  30. Amenorrhea • Amenorrhea—absence of menses, 3 or more consecutive months • Causes may include hypothalamic, pituitary, and endocrine dysfunction • Diagnosis based on patient information • Treatment directed at cause, HRT can regulate hormonal disruptions

  31. Ovarian Cysts • Sacs of fluid or semisolid masses that grow within ovary • Most are asymptomatic and benign; symptoms can produce lower back pain, nausea, vomiting, and abnormal uterine bleeding • Diagnosed in infertility issues, amenorrhea • Treatment—oral contraceptives, surgery

  32. Premenstrual Syndrome • Range of symptoms 7–14 days prior to menstruation • Cause unknown • Diagnosis based on patient’s symptoms • Treatment—medications

  33. Toxic Shock Syndrome • Rare bacterial infection • Symptoms include fever, rash, peeling skin, hypotension, syncope, GI disturbances • Treatment—antibiotics, patient education regarding tampon use • Change tampon often and discontinue if fever occurs during tampon use

  34. Uterine Disorders • Infections of uterus may be caused by sexually transmitted diseases, poor hygiene, and untreated vaginal infection • Also caused by growth of abnormal tissue and uterine malposition • Common disorders include endometriosis, PID, uterine fibroids, and uterine prolapse

  35. Endometriosis • Growth of endometrial tissue outside of uterus • Tissue responds to hormonal changes • Treatment includes hormones, surgery

  36. Pelvic Inflammatory Disease • PID—any acute or chronic infection of the female reproductive system • Caused by untreated vaginal infection • Patient may be symptomatic or asymptomatic • Diagnosis based on culture • Treatment includes medications

  37. Uterine Fibroids • Benign, smooth tumors • Grow during reproductive years, regress after menopause • Ultrasound confirms diagnosis • Treatment varies

  38. Uterine Prolapse • Displacement of uterus into cervix • Causes increase with age • Three stages of prolapse • Treatment—surgery

  39. Complications of Pregnancy • Common complications include: • Ectopic pregnancy • Abortion • Gestational diabetes • Placenta previa • Abruptio placentae • Eclampsia

  40. Ectopic Pregnancy • Implantation of fertilized ovum in wall of fallopian tube instead of in uterus • Diagnosis based on positive pregnancy test, abdominal ultrasound • 50% result in miscarriage • 50% require surgical intervention

  41. Abortion • Spontaneous or therapeutic loss of pregnancy less than 20 weeks gestation • Spontaneous abortion is called a miscarriage • 30% of all first pregnancies and 15% of all pregnancies end in miscarriage • Therapeutic abortion—patient’s choice for medical reasons

  42. Gestational Diabetes • Development of Type 2 diabetes mellitus during pregnancy • All obstetric patients are screened • Treatment includes calorie-restricted diet, regular exercise, blood glucose monitoring, and possible insulin injections • 50% chance of developing Type 2 later

  43. Placenta Previa • Placenta implants in lower uterine segment • Three degrees of placenta previa • Treatment includes bedrest, possible cesarean delivery

  44. Placenta Previa (cont.) Centralis Marginalis Lateralis

  45. Abruptio Placentae • Sudden premature detachment of placenta • Three levels • Treatment varies, including bedrest, medications

  46. Abruptio Placentae (cont.) Grade 3 Grade 1 Grade 2

  47. Eclampsia • Preeclampsia—severe hypertension in pregnancy, if untreated can lead to eclampsia, including convulsions and coma • Symptoms include hypertension, proteinuria, and edema • Diagnosis based on blood tests • Treatment directed at managing seizures, and monitoring blood pressure

  48. Female Reproductive System Cancers • Some of the most common forms of cancer are cancers of the female reproductive system • Common cancers include: • Breast cancer • Cervical cancer • Uterine cancer • Ovarian cancer

  49. Breast Cancer • Risk factors include family history, early onset menses or late menopause, no children or first child after age 35 • Signs may include a mass or nipple discharge • Diagnosis is based on mammogram, ultrasound, and needle aspiration • Treatment—surgery, chemotherapy, radiation

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