Ch 41 - Ob/GYN

An IUD (Intrauterine Device) is a type of birth control device. It is a small T-shaped device that is inserted into the uterus to prevent pregnancy. It works by releasing hormones or copper to inhibit fertilization and implantation of the fertilized egg. This method of contraception is highly effective and can last for several years before it needs to be replaced.

The appropriate question to ask in this situation is "Are you injured anywhere?" This question shows concern for the victim's well-being and focuses on their immediate physical needs. It allows the victim to disclose any injuries they may have sustained during the assault, which is important for their medical treatment and collecting evidence. It also acknowledges the trauma they have experienced without placing blame or making assumptions about their actions or clothing choices.

Asking the patient how many pads or tampons were soaked per hour can provide a more accurate estimation of the amount of vaginal blood lost. This question allows for a quantitative measurement of the bleeding, which can help determine the severity of the situation and guide appropriate medical intervention.

Touching the patient's shoulder or patting her on the leg often to reassure her is not appropriate in the care of a victim of sexual assault. Victims of sexual assault may have experienced trauma and may feel uncomfortable with physical touch. It is important to respect their boundaries and ask for permission before any physical contact. Reassurance can be provided through verbal communication and empathetic listening rather than physical touch.

D and C, also known as dilation and curettage, is a surgical procedure. It involves dilating the cervix and scraping the lining of the uterus to remove abnormal tissue or to treat certain gynecological conditions such as heavy or irregular bleeding, miscarriage, or to obtain a tissue sample for further testing.

Ovulation occurs as a result of an LH surge around day 14 of the menstrual cycle. LH, or luteinizing hormone, is responsible for triggering the release of the mature egg from the ovary. This surge in LH is a crucial event in the menstrual cycle and marks the fertile period for a woman. The release of the egg allows for the possibility of fertilization and subsequent pregnancy.

Many patients with pain caused by gynecological complaints prefer to be transported in a left-lateral recumbent position because this position allows for optimal comfort and support. It helps to relieve pressure on the lower abdomen and pelvic area, reducing pain and discomfort. Additionally, this position also ensures better blood flow and circulation, which is beneficial for patients experiencing gynecological pain.

The most likely cause of the symptoms described in the question is a spontaneous abortion, also known as a miscarriage. Vaginal bleeding and abdominal cramps are common signs of a miscarriage, especially during the first trimester of pregnancy. This occurs when the pregnancy ends on its own before the 20th week. It is important for the woman to seek medical attention in order to confirm the diagnosis and receive appropriate care.

Providing emotional support by a same-sex paramedic, if possible, is important for a sexual assault patient because it helps create a safe and comfortable environment. Sexual assault can be a traumatic experience, and having a same-sex paramedic can help the patient feel more at ease and reduce any potential distress caused by gender-related triggers or discomfort. This approach promotes sensitivity and respect for the patient's needs and can contribute to their overall well-being and recovery.

A midwife is a non-physical clinical healthcare practitioner who specializes in providing prenatal care and assisting with childbirth. They are trained professionals who support women during pregnancy, labor, and postpartum period. Midwives are knowledgeable about the physiological and emotional aspects of childbirth and provide personalized care to promote a safe and positive birthing experience. They often work in collaboration with obstetricians and other healthcare providers to ensure the well-being of both the mother and the baby.

The patient's symptoms, including headache, dizziness, puffy hands, and elevated blood pressure, are consistent with preeclampsia. Preeclampsia is a pregnancy complication characterized by high blood pressure and damage to organs, often affecting the liver and kidneys. It typically occurs after 20 weeks of gestation and can be life-threatening if left untreated. This patient's symptoms, along with her gestational age and elevated blood pressure, strongly suggest preeclampsia.

The correct answer is abruptio placentae. This term refers to the premature separation of the placenta from the uterine wall before the baby is born. It can cause severe bleeding and is a medical emergency. Placenta previa, on the other hand, is a condition where the placenta partially or completely covers the cervix. Spontaneous placentae and abortion are not accurate terms for describing the premature separation of the placenta.

Menarche is the term used to describe a girl's first menstrual period. It typically occurs around the age of 13, although there can be some variation. This is the age at which most girls start to experience the physical and hormonal changes associated with puberty, including the onset of menstruation. It is important for girls to be prepared for this milestone and have access to information and resources to manage their menstrual health.

In this scenario, the appropriate action is to establish IV access and provide fluid replacement. The patient is experiencing heavy bleeding from the vagina, indicating significant blood loss. IV access allows for the administration of fluids to restore blood volume and prevent hypovolemic shock. It is important to prioritize stabilizing the patient's condition before further examinations or procedures can be performed. Manual pelvic exam or speculum examination may exacerbate the bleeding, and packing dressings in the vagina may not address the underlying issue of blood loss.

PID, or pelvic inflammatory disease, is a known predisposing factor for ectopic pregnancy. PID is an infection of the female reproductive organs, often caused by sexually transmitted infections like chlamydia or gonorrhea. When left untreated, PID can lead to scarring and damage to the fallopian tubes, increasing the risk of ectopic pregnancy. In an ectopic pregnancy, the fertilized egg implants outside of the uterus, usually in the fallopian tubes. This can be a life-threatening condition and requires immediate medical attention. Therefore, PID is a correct answer as it is a known risk factor for ectopic pregnancy.

During the fourth month of gestation, the gender of the fetus can be differentiated. This is because by this time, the reproductive organs have developed enough to be identified through ultrasound or other medical techniques.

The correct answer is proteinuria. In this scenario, the patient is presenting with symptoms consistent with preeclampsia, a condition that typically occurs after 20 weeks of pregnancy. Preeclampsia is characterized by high blood pressure, excessive weight gain, and the presence of protein in the urine (proteinuria). Other symptoms may include headaches, dizziness, swelling, and changes in vision. Prompt medical attention is necessary to manage preeclampsia and prevent complications for both the mother and the baby.

In a breech birth, the head is delivered last instead of the usual position where the head is delivered first. This means that the baby's body is born first, followed by the head. This can be a more complicated delivery process as it increases the risk of complications such as umbilical cord compression or difficulties in delivering the head. Medical professionals need to be prepared to handle a breech birth to ensure the safety of both the mother and the baby.

Placing the mother in the knee-chest position is the correct answer because it helps relieve pressure on the cord and reduces the risk of cord compression or prolapse. This position allows gravity to pull the baby away from the cord, preventing further complications. It is important to keep the cord moist and elevated to maintain blood flow to the baby. Delivering the infant as quickly as possible may cause further damage to the cord or increase the risk of complications. Cutting and clamping the cord or replacing it into the vagina are not appropriate actions in this situation.

Endometriosis occurs when fragments of the endometrium, the tissue that lines the uterus, grow outside of the uterus in the peritoneal cavity. This can cause inflammation and pain in the affected areas. It is a condition that primarily affects women of reproductive age and can lead to symptoms such as pelvic pain, painful periods, and infertility. Treatment options for endometriosis include medication, hormonal therapy, and surgery.

Braxton-Hicks contractions are generally benign, meaning they are not harmful or dangerous. These contractions are a normal part of pregnancy and are often referred to as "practice contractions." They typically occur after 35 weeks of gestation and are characterized by a tightening or hardening of the uterus. Unlike true labor contractions, Braxton-Hicks contractions subside with rest or a change in position. They are not a sign that labor is starting, but rather a normal occurrence as the body prepares for childbirth.

Based on the information provided, the patient is experiencing contractions that are 2 minutes apart and feeling an urge to move her bowels. These are signs of imminent delivery, indicating that she is likely in active labor and will give birth soon.

The correct answer is cystitis. Cystitis is an infection of the urinary tract, specifically the bladder. The symptoms described, such as frequent urination, urgency, burning sensation, and lower abdominal pain, are all indicative of cystitis. Ovarian cysts are fluid-filled sacs that form on the ovaries and typically do not cause these urinary symptoms. Chlamydia is a sexually transmitted infection that can cause symptoms such as vaginal discharge and pelvic pain but does not typically cause urinary symptoms. PID (pelvic inflammatory disease) is an infection of the reproductive organs and can cause symptoms such as pelvic pain and abnormal vaginal discharge, but may not present with urinary symptoms like frequent urination and burning sensation.

First-time mothers are most likely to experience this condition, known as preeclampsia. Preeclampsia is a condition that typically occurs after 20 weeks of pregnancy and is characterized by high blood pressure, swelling, and protein in the urine. It can be dangerous for both the mother and the baby if left untreated. The patient in this scenario is exhibiting symptoms of preeclampsia, such as headache, dizziness, puffy hands, and high blood pressure. The fact that she is a first-time mother makes her more at risk for developing preeclampsia.

The patient's symptoms of dull, crampy pain in the pelvis that is different from normal menstrual discomfort, along with dyspareunia and frequent spotting, are consistent with endometriosis. Endometriosis is a condition where the tissue that normally lines the uterus grows outside the uterus, causing pain and other symptoms. Uterine fibroids are benign growths in the uterus and may cause pain, but they do not typically cause dyspareunia or spotting. Mittelschmerz refers to ovulation pain, which is usually a sharp, brief pain and does not cause dyspareunia or spotting. Endometritis is inflammation of the endometrium, which may cause pain and abnormal bleeding, but it is usually associated with other symptoms like fever and uterine tenderness.

Premature birth and multiple births are two factors that increase a baby's chance of a breech birth. Premature birth refers to when a baby is born before completing the full term of pregnancy, which can affect the baby's positioning in the womb. Multiple births, such as twins or triplets, can also increase the likelihood of a breech birth as there may be less space for the babies to move and position themselves head down.

Based on the patient's history, it is most likely that she is experiencing preterm labor. The patient is 36 weeks pregnant and complaining of abdominal pain after a fall, which could have caused trauma to the uterus. The onset of lower abdominal cramping and backache is consistent with preterm labor. Additionally, the patient's history of previous pregnancies and abdominal surgery may increase her risk for preterm labor. Placenta previa, Braxton-Hicks contractions, and uterine rupture are less likely based on the given information.

The symptoms described in the question, such as elevated heart rate, difficulty inhaling, warm skin, and sweating, are consistent with an amniotic fluid embolism. Amniotic fluid embolism occurs when amniotic fluid enters the maternal bloodstream, leading to an allergic reaction and causing respiratory distress, cardiovascular collapse, and disseminated intravascular coagulation. This can be a life-threatening condition and requires immediate medical attention. Hemorrhage, eclampsia, and hyperemesis gravidarum do not typically present with these specific symptoms.

During pregnancy, the body goes through various physiological changes to support the growing fetus. One of these changes is an increase in tidal volume and minute ventilation, which refers to the amount of air that is inhaled and exhaled in one breath and the total amount of air exchanged per minute, respectively. This increase is necessary to meet the increased oxygen demand of the mother and the fetus. Research has shown that tidal volume and minute ventilation typically increase by 30 to 40% during pregnancy.

The patient's frustration and statements like "I can't do it" and "Just get the baby out" suggest that she is experiencing intense emotions and feelings of helplessness, which are common during the transition phase of labor. This stage occurs right before the pushing stage and is characterized by strong and frequent contractions, as well as a rapid cervical dilation. The transition phase is often the most challenging and painful part of labor, but it also indicates that the baby's arrival is imminent.

The newborn's APGAR score is 8. The APGAR score is a quick assessment of a newborn's overall well-being and is determined by evaluating five factors: appearance (color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (breathing effort). In this case, the newborn has blue extremities indicating some cyanosis, a pink torso indicating good perfusion, a strong and active cry indicating good reflex irritability, a heart rate of 104 indicating a normal pulse, and some flexion of its extremities indicating good muscle tone. Based on these factors, the newborn's overall well-being is assessed as 8 out of 10.