Chapter 7,9,12,13,14,15

 STI’s
o chlamydia
 asymptomatic
 causes: endometritis and preterm labor
o gonorrhea
 painful in males
 asymptomatic in females
 causes: infertility and blindness
o syphilis
 screening at initial visit with VDRL or RPR
 if untreated in pregnancy fetus may become infected
 causes: cognitive impairment, hearing loss, osteochondritis, fetal death
 treat with: penicillin
o PID
 more than one organism
o HPV
 most common
 viral: genital warts
 watch for increase in size
o HSV
 need c-section with outbreak
 acyclovir: suppresses outbreak
o Bacterial vaginosis
 trichomoniasis
 candidiasis
o HIV
 flu-like symptoms
 ELISA to test for
 transfer to baby
 during and giving birth, vertical infection and breast milk
 treatment
 antiviral twice daily from 14 weeks till full term
 IV antiviral during labor
 oral syrup to newborn in first 12 hours
 NO BREASTFEEDING
o Hep B
  blood and bodily fluids
 after born give bath then give Hep B vaccine and Hep B immunoglobins
o GBS
 normal flora in most females
 causes: pneumonia, meningitis, strep, temp imbalance, resp. distress
 infertility
o after 1 year of trying
o primary: never been pregnancy
o secondary: previous pregnancy but not able to get pregnant now
o sterility: not able to get pregnant at all
o female factors
 anovulation: no egg
 tubal transport problems
 uterine problems
 vaginal problems
 testing:
 home ovulation test
o male factors
 inadequate or poor-quality sperm (environment)
 obstruction or impaired sperm motility (hernia, STI, non-descending
testicles)
 ejaculation problems (psych problems and meds)
 semen analysis
 no sex 24-48 hours
 to lab within certain period of time
o management
 sex 4 times a week
 clomid, HcG
 stimulate ovulation
 SE: twins, cysts
 artificial insemination
 in vitro
 Conception and fetal development
o basal temp charting
 low temp= ovulation soon
o fertilization
 sperm approaches egg
 sperms acrosomal enzymes digest the eggs jelly coat
  proteins on the sperm head bind to receptors
 plasma membranes of egg and sperm fuse
 sperm nucleus enters the egg
 ferritization begins
o implantation
 2-8 weeks
 chorionic villi bring embryo into endometrium
 everything forms in the first 8 weeks (critical time period)
o presence of teratogens
 avoid live vaccines
 drugs, alcohol, cigarettes
 environmental
 maternal infections
 T- toxoplasmosis (cat litter, undercooked meat)
 O- other (Hep B and HIV)
 R- rubella (no pregnancy for 3 months after vaccine)
 C- cytomegaly virus (neurological deficit)
 H-herpes (1 fetal defect) (2- preterm labor)
o fetal surrounding
 chorion
 outer membrane
 forms fetal part of placenta
 amnion
 inner membrane/ encloses amniotic cavity
 forms fluid filled sac that surrounds embryo
 amniotic fluid
 surrounds, cushions, protects
 maintain fetal temp
 largely fetal urine
 fluid is clear and transparent
o yellow or amber: bilirubin
o green: fetal distress
o red: sac break
o polyhydramnios
 too much amniotic fluid >2000 mL
 patho: excessive fluid, associated with GI malfunctions
 symptoms: fundal height discrepancy with gestational age
 causes: tube defect, preterm labor knot in umbilical cord
o oligohydramnios
 too little amniotic fluid <300mL
 associated with fetal renal abnormalities
 management:
 before: non-stress test
 during: amino infusion (LR)
 causes: past term labor
o placenta
 umbilical cord
 two arteries and one vein encased in wartons jelly
 down the middle normal if not battle door placenta
 Rh- mom =isoimmunization to Rh – blood
 baby is tested and watched
 produces
 hCG: 7-10 days
o before birth
 lot of pressure in R side of heart
 high pressure in lungs
 umbilical vein
 left: liver
 short cut: ductus venousis (bypass liver)
o IVC (R leg and L leg)
 R atrium <- SVC (arms)
 R ventricle -> pulm artery -> lungs ( high
resistance, doesn’t want blood) -> foreman
ovale (RA to LA)
o L. atrium -> L ventricle -> aorta to
pulm artery use ducts arteriosus
 internal iliac artery ->
umbilical artery -> placenta
(low resistance, want blood)