Reproductive A&p

Front 1

Why has the rate of C-sections skyrocketed?

Back 1

To avoid malpractice claims

Front 2

A baby is considered a newborn at what age?

Back 2

Birth to 28 days

Front 3

What is Evidence Based Practice?

Back 3

Practices that are backed by nursing research

Front 4

With informed consent, what is the nurse's role?

Back 4

Only to witness the signature

Front 5

When does sex differentiation occur?

Back 5

Week 8 of fetal life
(ovaries & testes)

Front 6

What are the 3 layers of the Uterus?

Back 6

Perimetrium
Myometrium
Endometrium

Front 7

Perimetrium location:
Made of:

Back 7

Outer layer composed of peritoneum

Front 8

Myometrium location:
Made of:
Function:

Back 8

inner layer primarily in the fundus; 3 distinct layers; causes cervical effacement and power to express the baby

Front 9

Endometrium location:
Function:

Back 9

Innermost layer; produces endometrial milk, undergoes monthly regeneration

Front 10

Myometrium- Where are longitudinal fibers found? What is their importance?

Back 10

Mainly over the fundus; mostly involved with birth of fetus

Front 11

Myometrium- What kind of fibers make up the middle layer? Function?

Back 11

Fibers interlaced with blood vessels in Figure 8 pattern; helps stop bleeding

Front 12

Myometrium- What kind of fibers make up the inner layer? Function?

Back 12

Circular fibers concentrated around fallopian tubes and cervical os; helps keep cervix closed

Front 13

What purpose does the Isthmus serve?

Back 13

Joins the corpus (uterine body) to the cervix; site for lower C-section

Front 14

Purpose of Cervix?

Back 14

-Passage of menses & sperm
-Produces mucus in response to cyclic hormones

Front 15

Where does uterine cancer often occur?

Back 15

Cervix

Front 16

What is efacement?

Back 16

Shortening of the cervix

Front 17

Purpose of the Broad ligament?

Back 17

stabilizes uterus, covers uterus anteriorly & posteriorly

Front 18

Purpose of the Round ligament?

Back 18

helps keep uterus in place from the sides; pain on sides late in pregnancy

Front 19

Purpose of Ovarian ligament?

Back 19

anchors lower part of ovary, helps catch ovum in fimbriae

Front 20

Purpose of the Cardinal ligament?

Back 20

on inside-chief uterine support, prevents uterine collapse

Front 21

Purpose of Uterosacral ligament?

Back 21

Support for uterus at level of the ischial spine, source of menstrual pain

Front 22

Function of fallopian tubes?

Back 22

Passageway for ovum into uterus, site for fertilization

Front 23

What is Fimbriae? Function?

Back 23

Most distal part of fallopian tubes; wavelike motion that pulls ovum into tube

Front 24

Where is the site for fertilization?

Back 24

Apulla (part of fallopian tube)

Front 25

Where is isthmus located?

Back 25

Close to uterus, site for BTL (bilateral tubal ligation)

Front 26

Function of ovaries?

Back 26

-Ovulation
-Produce hormones

Front 27

Do ova develop after birth?

Back 27

No, at birth all ova are contained within immature follicles

Front 28

Purpose of pelvic floor?

Back 28

Provide stability and support for surrounding structure, designed to overcome force of gravity-provides capacity for dilatation

Front 29

False pelvis location? function?

Back 29

Portion above pelvic brim or inlet; supports pregnant uterus

Front 30

What does the True Pelvis determine?

Back 30

If vaginal delivery is possible (this is as big as it's gonna get)

Front 31

What does the Diagonal Conjugate measure? Can it be measured manually?

Back 31

from bottom of sacral promontory to symphysis pubis; can be measured manually during pelvic exam

Front 32

What does Obstetric conjugate measure?

Back 32

Extends from middle of sacral promontory to 1 cm below the pubic crest; subtract 1.5 cm from Diagonal Conjugate to determine

Front 33

What does Conjugate Vera measure?

Back 33

From top of syphysis pubis to sacral promontory

Front 34

What is the most common pelvic type in females?

Back 34

Gynecoid

other types for females:
Anthropoid
Platypelloid (not adequate)
Android (not adequate)

Front 35

What are the 3 main female sex hormones?

Back 35

Estrogen, Progesterone, Prostaglandins

Front 36

Role of Estrogen?

Back 36

-Maturation of secondary sex characteristics (breast development etc)
-Proliferation of endometrial mucosa
-Causes increase in size and weight; closure of long bones
-Increases myometrial and fallopian tube activity
-Increases uterine sensitivity to oxytocin (Oxytocin causes uterus to contract)
-Maintains bone density

Front 37

What does Estrogen do to FSH & LH?

Back 37

Inhibits FSH production
Stimulates LH production

Front 38

Where does Progesterone come from?

Back 38

LH stimulates corpus luteum to secrete progesterone

Front 39

Role of Progesterone?

Back 39

-Decrease motility & contractility of uterus
-proliferates vaginal epithelium
-causes cervix to secrete thick mucus
-prepares breast tissue for lactation

Front 40

How can women tell that ovulation has occured?

Back 40

Temperature rises
-Progestrerone is at its highest and it is thermogenic

Front 41

Where are Prostaglandins produced?

Back 41

Endometrium

Front 42

What are Prostaglandins essential for?

Back 42

Ovulation

Front 43

Role of Prostaglandins?

Back 43

-Causes expulsion of the ovum
-Produces progesterone withdrawal (which makes uterus more contractile)
-Facilitates tissue digestion to cause endometrial shedding

Front 44

Neurohormonal basis of the reproductive cycle are controlled by:

Back 44

interaction between nervous & endocrine systems and their target tissues (hypothalamus, anterior pituitary, ovaries)

Front 45

CNS tells the Hypothalamus to release:

Back 45

GnRF (FSHRH & LHRH)

Front 46

GnRF causes Anterior Pituitary to release:

Back 46

FSH & LH

Front 47

FSH & LH stimulate:

Back 47

gonads (ovaries) to secrete hormones (Estrogen & Progesterone)

Front 48

Name the Ovarian Cycle Phases

Back 48

-Follicular Phase
-Luteal Phase

Front 49

When does the Follicular Phase start?

Back 49

Starts with day 1 menses; 1-14 days (varies)

Front 50

What happens during the Follicular Phase?

Back 50

-multiple follicles are maturing; one is selected and is surrounded by fluid (forms a cyst)
-Comes close to surface of ovary, forms a blister, ovum pushed out of the follicle near the fimbria (ovulation)
-Pulled into fallopian tube & travels to ampulla where fertilization can occur

Front 51

Luteal Phase begins when?

Back 51

Begins with ovulation

Front 52

What develops from the ruptured follicle?

Back 52

Corpus luteum (site where egg has been released)

Front 53

What else happens in the Luteal Phase if the ovum is fertilized?

Back 53

If fertilized, the ovum implants into endometrium
-Ovum secretes HCG to maintain corpus luteum; the corpus luteum secretes progesterone & estrogen

Front 54

What else happens in the Luteal Phase if the ovum is NOT fertilized?

Back 54

If no fertilization, ovum degenerates in about a week
-Estrogen & Progesterone decrease which stimulates FSH & LH to be released
-14 days after ovulation, menses begins

Front 55

What 4 phases make up the Endometrial Cycle?

Back 55

-Menstruation
-Proliferative
-Secretory
-Ischemic

Front 56

Menstruation- What is it? When does it happen?

Back 56

Cyclic uterine bleeding in response to hormone changes (partial shedding of the endometrium) Begins 14 days after ovulation

Front 57

What is menarche?

Back 57

onset of menstruation; happens at age 9-16

Front 58

What is a normal cycle length?

Back 58

21-36 days

Front 59

What can alter a menstruation cycle?

Back 59

illness, fatigue, stress, vigorous exercise (because fat stores estrogen)

Front 60

What happens in the Proliferative phase?

Back 60

-Endometrium increases 6-8Xs
-Estrogen peaks
-cervical mucus thins
-BBT drops at ovulation then increases

Front 61

What happens in the Secretory phase?

Back 61

-Estrogen decreases
-Progesterone dominates
-Uterus becomes more vascular
-glands begin to secrete endometrial milk for fertilized ovum

Front 62

Ischemic phase happens if no fertilization. What happens here?

Back 62

-Corpus luteum degenerates
-Estrogen & Progesterone levels fall
-Tissue necrosis & small blood vessels rupture
-arteries constrict decreasing blood supply to endometrium
-menses begins

Front 63

What are the 3 pregnancy periods?

Back 63

-Antepartum- from conception to onset of labor
-Intrapartum- from onset of labor to the first 1-4 hrs. after delivery
-Postpartum- 6 wks after delivery

Front 64

How many trimesters are there? How many months in each?

Back 64

3 trimesters
each are 3 months long

Front 65

What are Braxton-Hicks?

Back 65

Irregular contractions, usually painless, felt throughout pregnancy "practice contractions"

Front 66

What happens to the uterus during pregnancy?

Back 66

increases in capacity & size; requires one sixth of maternal blood flow

Front 67

What happens to ovaries during pregnancy?

Back 67

stop ovulation; corpus luteum continues to produce hormones until 6-8 wks

Front 68

What happens to the cervix during pregnancy?

Back 68

secretes mucus that forms a plug to protect growing embryo from infection

Front 69

What's Goodell's sign?

Back 69

Softening of the cervix

Front 70

What's Chadwick's sign?

Back 70

bluish color of the cervix during pregnancy (due to high blood content)

Front 71

What happens to the vagina during pregnancy?

Back 71

mucosa thickens and connective tissue relaxes, pH acidic

Front 72

What happens to breasts during pregnancy?

Back 72

increase in size & number of glands

Front 73

What is colostrum?

Back 73

1st milk produced; thin yellow secretion high in protein & immune properties

Front 74

What happens to cardiac output during pregnancy?
Pulse?

Back 74

CO increases 30-40%
Pulse increases 10-15 bpm

Front 75

What happens to BP?

Back 75

decreases in 1st & 2nd trimesters; 3rd trimester increases to pre-pregnant levels

Front 76

What is Vena Cava Syndrome?
Signs/symptoms?

Back 76

Uterus compresses the Vena Cava
-S/SX: pallor, dizzy, clammy skin

Front 77

How should pt. lay to prevent Vena Cava Syndrome?

Back 77

Lay on left side (NOT flat on her back)

Front 78

What happens to blood volume during pregnancy?

Back 78

increases 45%

Front 79

What happens to RBC's?

Plasma?

Back 79

RBC's-increase 18-30% H&H up

Plasma- volume increases 50% so BP rises

Front 80

What are normal H&H levels for pregnant pt?

Back 80

Hgb 10-14

Hct 32-42

Front 81

What is physiologic anemia?

Back 81

More diluted; more plasma is added but not RBC's

Front 82

What are changes in Respiratory System occuring during pregnancy?

Back 82

O2 demands increase
-nasal stuffiness & epistaxis from increased estrogen

Front 83

What can happen to teeth/gums?

Back 83

-bleeding gums
-oral hygiene important to prevent preterm labor

Front 84

What happens to their gate?

Back 84

"Waddling" due to relaxation of pelvic joints

Front 85

What is physiologic lordosis?

Back 85

lumbar spinal curvature increases compensating for weight of uterus

Front 86

What is Diastasis recti?

Back 86

Separation of the rectus abdominal muscle?

Front 87

What causes N/V in 1st trimester?

Back 87

HCG

Front 88

What do increased Progesterone levels cause in the GI system?

Back 88

Decreased peristalsis causing reflux & constipation

Front 89

Constipation & inreased pressure on blood vessels in the rectum can cause:

Back 89

hemorrhoids

Front 90

What is Chloasma?

Back 90

Mask of pregnancy; darker pigmant on cheeks, etc.

Front 91

What is Linea nigra?

Back 91

darkly pigmented line from umbilicus to the pubic area

Front 92

What is Striae gravidarum?

Back 92

Stretch marks

Front 93

What is normal weight gain for pt who is normal weight before pregnancy?

Back 93

25-35 pounds

Front 94

Does metabolism increase or decrease during pregnancy?

Back 94

Increases

Front 95

How much weight should you gain during 1st, 2nd, & 3rd trimesters?

Back 95

3-5 lbs. during 1st trimester

1 lb. per wk during 2nd & 3rd trimesters

Front 96

Why do pregnant women retain water?

Back 96

Because of increased sex hormones & decreased serum protein

Front 97

Where does HCG come from?

Back 97

-fertilized egg secretes HCG to maintain corpus luteum

Front 98

What does the hormone Relaxin do?

Back 98

Helps the cervix remain soft

Front 99

What does Estrogen do?

Back 99

Helps the uterus develop & prepares breasts for lactation

Front 100

What do Prostaglandins do to uterus?

Back 100

Prevent contractility of uterus

Front 101

Signs/Symptoms of Pregnancy
Name the 3 categories

Back 101

-Presumptive
-Probable
-Positive

Front 102

Presumptive category- who reports it & what S/SX do they report?

Back 102

Women reports it (SX could be caused by something else)
-Amenorrhea
-N/V
-Fatigue
-Urinary frequency
-Breast changes
-Quickening (can feel mvmnt)

Front 103

Probable category- who checks for it? S/SX?

Back 103

-noted by examiner
-Goodell's sign
-Chadwick's sign
-Hegar's sign-softening of lower uterine segment
-enlarged abdomen
-pigmentation changes
-stretch marks
-ballottement (bouncing)
-positive preg. test
-palpatation of fetal outline

Front 104

Positive category- S/SX

Back 104

ONLY caused by pregnancy
-Fetal heartbeat (18-20wks)
-Fetal mvmnt palpable by examiner
-visualize fetus by ultrasound

Front 105

Maternal reaction during 1st trimester:

Back 105

-feelings of disbelief
-baby does not seem real
-focus on herself
-mood swings
-early s/sx pregnancy
-fantasize about miscarriage

Front 106

Maternal reaction during 2nd trimester:

Back 106

-quickening
-mom excited about pregnancy
-has body image changes
-concern about partner's support
-plans for her and childs future

Front 107

Maternal reaction during 3rd trimester:

Back 107

-pride in pregnancy
-anxious about labor
-concern about baby health
-surge of energy close to delivery date

Front 108

Rubins Maternal Tasks (4)

Back 108

1. ensuring safe passage for fetus
2. seeking acceptance of fetus by others
3. assumption of mother role
4. learning to give of oneself on behalf of one's child

Front 109

Paternal responses to pregnancy

Back 109

-pride in pregnancy
-ambivalence
-stress
-couvades (sympathy symptoms)