Women’s Health Exam 2 Study Guide
Chapter 5: STIs











STIs: infections of the repro tract caused by microorganisms + transmitted through vaginal, anal, or oral
sexual intercourse.
o 2/3 of STIs occur in people < 25 years of age.
o Adolescent groups at highest risk: African American, abused, homeless, gay men, and LGBTQI
youths
o Female anatomy (columnar epithelial cells) makes microbial penetration easy.
Infections characterized by vaginal discharge:
o Vulvovaginal candidiasis
o Trichomoniasis
o Bacterial Vaginosis
Infections characterized by cervicitis:
o Chlamydia
o Gonorrhea
Infections characterized by genital ulcers
o Genital Herpes Simplex
o Syphilis
Vulvovaginal Candidiasis
o Pruritis, thick, white, vaginal discharge, vaginal soreness, vulvular erythema and burning,
dysparenunia
o Newborn: sepsis
o NOT considered an STI
o Treatment: antifungals (azole)
Trichomoniasis
o Possibly asymptomatic, urinary frequency + dysuria, greenish-gray, frothy, vaginal discharge,
irritation of genitals, dyspareunia
o Newborn: premature rupture of membranes, preterm birth, low birth weight
o Transmitted sexually and through hot tub and drains
Bacterial vaginosis
o May be asymptomatic + “stale fish” odor to vaginal discharge
o Diagnostics (3 out of 4 must be met): tin, gray, white vaginal discharge, vaginal pH > 4.5, positive
“whiff test”, and clue cells
o Treatment of partner has not been proven to be effective.
Chlamydia (most common STI)
o Possibly asymptomatic, vaginal discharge, endocervicitis, inflammation of the rectum and lining
of the eye, can infect the throat
o Newborn: eye infections, pneumonia, low birth weight, preterm birth, stillbirth
Gonorrhea
o Possibly asymptomatic, dysuria, urinary frequency, vaginal discharge, dyspareunia, edocervicitis,
arthritis, pelvic inflammatory disease, rectal infection
o Newborn: opthalmia neonatorum (blindness + sepsis)
Syphillis
o 4 stages
 Stage 1: Chancre at entry site
 Stage 2: Maculopapular rash, sore throat, lymphadenopathy, flu-like symptoms,
condylomata (lesions involving vulva + anus)
 Stage 3: no symptoms (latent)
 Stage 4: CNS symptoms, CV symptoms, tumors on the skin, bones, and liver (typically
irreversible)
o Newborn: jaundice
Genital Herpes
o Blister-like genital lesions, dysuria, fever, headache, muscle aches
o Newborn: intellectual disability, blindness, seizures, premature birth, low birth weight, death
 Pelvic Inflammatory Disease
o Chronic pelvic pain, pelvic abscess formations, pelvic adhesions, scarring and loss of tubal
function, ectopic pregnancy, and infertility
o Usually from untreated chlamydia or gonorrhea
 Human Immunodeficiency Virus (HIV)
o Three distinct phases
 Acute primary infection: fever, pharyngitis, rash, and myalgia
 Asymptomatic Infection
 Progression to AIDS: symptoms and severity correlate to the virla load and amount of
immunosuppression
o Newborn: possible transmission
o Pregnant Women Treatment:
 Oral antiretroviral agent: 14 weeks gestation – end of pregnancy
 Antiretroviral agent given to mother via IV, during labor, until delivery
 Antiretroviral syrup admin to infant within 12 hours of birth
 Antiretroviral treatment decreased transmission to 1-2% C/S birth recommended.
 Ectoparasitic Infections
o Pruritis, skin rash, secondary infections
 Hepatitis A
o Transmission: fecal – oral route
 Hepatitis B
o Flu like symptoms, malaise/fatigue, anorexia, nausea, pruritus, fever, upper right quadrant pain
o Newborn: chronic carrier, liver cancer, cirrhosis
 HPV
o Soft, moist, flesh-colored wart-like lesions on the vulva, cervix, and inside surrounding the vagina
and anus
o Newborn: development of warts in the throat
 Zika Virus
o May be asymptomatic, fever, rash, headaches, bone pains, joint tenderness, conjunctivitis
o Newborn: microcephaly, brain damage, eye damage, club foot, restricted body movement
Chapter 10: Fetal Development and Genetics




Fetal development: measured in number of weeks after fertilization
o Normally 40 weeks
Three stages of fetal development: pre-embryonic stage, embryonic stage, and fetal stage
o STAGE 1: Pre-embryonic Stage: fertilization – 2nd week
 Fertilization; cleavage, 16 cell morula – morula continues to divide until it becomes a
blastocyst
 Blastocyst and trophoblast
 Blastocyst: inner cells mass made of the amnion + embryo
 Trophoblast: outer cell layer made of the chorion and placenta
 Implantation
Fertilization location: ampulla of the fallopian tube
Implantation location: endometrium
o STAGE 2: Embryonic Stage 2nd week – 8th week
 Chorion: made of trophoblast + a mesodermal lining. Chorionic villi help dig into uterine
wall to attach.
 Amnion: comes from ectoderm and encloses the embryo, contains amniotic fluid
 Amniotic sac: chorion + amnion
Ectoderm
-CNS
-special senses
-glands
-hair and nails




Mesoderm
-skeletal system
-urinary organs
-circulatory organs
-reproductive organs
Endoderm
-respiratory system
-liver
-pancreas
-digestive system
Placenta functions:
o Interface between mom and baby
o Makes hormones (control physiology of mom)
o Induces mom to bring more food in
o Removes waste
o Protects fetus from immune attack by mom
o Makes hormones that mature fetal organs
Hormones produced by placenta
o Human chorionic gonadotropin
o hPL/hCS
o estrogen
o progesterone
o relaxin
Umbilical Cord
o Formed by the amnion, lifeline of baby, one vein and two small arteries (brings O2, nutrients, and
takes away waste products), wharton’s jelly surrounds vessels, and its 22 inches long, 1 inch wide
Amniotic Fluid
o Maintains body temp, permits symmetric growth, cushions fetus from trauma, keeps umbilical
cord free crom compression, promotes fetal movement and use of musculoskeletal system
 Hydramnios: too much amniotic fluid
 Oligohydramnios: too little fluid
o STAGE 3: Fetal Stage 8 weeks – birth
 Period of dramatic growth + refinement of organ systems
 Called fetus in this stage. Before 8 weeks, it is called embryo.
Genetics
 Pharmacogenomics: study of genetic and genomic influences on pharmacodynamics and
pharmacotherapeutics
 Genome: person’s complete set of DNA(blueprint)
 Chromosome: a long, continuous strand of DNA, carrying genetic info
o Gene: a small section of the DNA consisting of base pairs
 Karyotype: pictorial analysis, commonly used white blood cells and fetal cells to create it.
 Alleles: specific version of a gene (there are 2 alleles of each gene)
o Dominant
o Recessive
Monogenic Disorders: a single, defective gene

Autosomal: the defect occurs on an autosome (chromosome 1-22)
o Autosomal Dominant Inheritance: neurofibromatosis, Huntington’s disease, and polycystic kidney
disease
o Autosomal Recessive Inheritance: two copies of abnormal gene are needed to produce the
recessive phenotype
 CF, sickle cell, PKU, tay-sachs disease
o X-linked Dominant
o X-linked Recessive
 Males are more effected than females because – they only get ONE X.
 Daughters of effected males become carriers.
 Ex: hemophilia, color blindness, Duchenne Muscular Dystrophy
o X-linked dominant inheritance
 Ex: fragile x syndrome, Rickets
Multifactorial Disorders
 Caused by genetic and environmental factors
Nontraditional Inheritance
 Mitochondrial inheritance: it always come from mother! If mother has it, they all have it.
 Genomic imprinting: where only 1 allele is expressed
 Numerical Abnormalities
o Down Syndrome (Trisomy 21)
o Edward Syndrome (Trisomy 18)
o Patau Syndrome (Trisomy 13)
Structural Abnormalities
 Deletions: portion of the chromosome is missing
 Duplications: portion of chromosome is duplicated
 Inversions: part of chromosome breaks off at 2 points and turns upside down and reattches
 Translocations: part of one chromosome is transferred to another chromosome and an abnormal
rearrangement is present
 Ex of structural abnormalities:
o Cri du Chat Syndrome: chromosome 5 piece is missing
o Fragile x syndrome: missing portion of X
Balanced vs. Unbalanced
 Balanced: rearrangement of genetic material with neither gain nor loss
 Unbalanced: results in genetic/clinical consequences
Chromosomal Abnormalities
 Turner Syndrome: missing or damaged X in females
o Underdeveloped sex characteristics
 Klinefelter Syndrome: extra x chromosome in males
o Inadequate testosterone, infertility, gynecomastia
Genetic Counseling
 Women > 35 yrs
 Men > 50 yrs
 Two or more pregnancy losses
Prenatal Diagnostics
 Amniocenteisis: aspirate amniotic fluid – CF, sickle cell – is a definitive test
 Fetal Nuchal Translucency: ultrasound measuring fluid between subcutaneous space between skin +
cervical spine
o Indicates: trisomy 13, 18, or 21
 Cell-free fetal DNA: uses maternal plasma to determine sex linked conditions + RhD genotyping
Chapter 11



Presumptive signs: subjective signs, the least reliable
o Fatigue, breast tenderness, NV, amenorrhea. Urine frequency, and quickening (fetal movements),
breast enlargement, uterine enlargement, hyperpigmentation of skin.
Probable signs: objective signs, detected by a provider on a physical exam
o Goodells signs, Chadwicks sign, Hegars sign, positive pregnancy test (serum + urine), Braxton
hicks contraction (false labor contractions that do not dilate the cervix), ballottement (digital exam
for bouncy baby head)
 False positive urine and serum pregnancy tests: can be caused by tumors
 Chadwicks sign: bluish, purple coloration of the vaginal mucosa and cervix
 Goodell’s sign: softening of cervix
 Hegar’s sign: softening of the lower uterine segment or isthmus
Positive Signs: 100% the woman is pregnant















o Ultrasound, fetal heart tones, fetal mvmt
Pregnancy Tests: detects hCG as early as 7-10 days after conception. hCG production begins at
implantation in the uterus.
Uterus adaptations: ascend into abdomen after first 3 months, fundal height by 20 weeks’ gestation at level
of umbilicus 20cm. # of cm = # of weeks
o To measure: measure from pubic symphysis to top of fundus (top of baby bump)
o After 36 weeks, this method is not accurate because baby starts to drop. The drop is called
lightening.
Cervix
o Mucus plug: does NOT mean labor is coming RN! It just means it is coming.
o Chadwick sign: vascularization of cervix
Vagina: increased vasculature and lengthing of vaginal vault, leukorrhea ( WHITE vaginal discharge)
Ovaries: enlargement until 12-14 weeks gestation + cessation of ovulation
Breasts: increase in size, tenderness, and vascularity
o Areola: increases in diameter, gets darker
o Montgomery tubercles: these lubricate the breast during breast feeding
o Colostrum: “liquid gold” – full of nutrients and vitamins and antibodies
GI system adaptations
o Gums: swollen, red, gingivitis, ptyalism (overproduction of saliva)
o Decreased peristalsis – causes reflux and vomiting
o Constipation which may lead to hemorrhoids
o Slowed gastric emptying and decreased esophageal tone – heart burn
o Prolonged gallbladder emptying causing gallstones
CV
o 50% more blood
o Cardiac output and heart rate increases
o BP decreases
o Increased # of RBC and plasma – increased iron demands, fibrin, and plasma fibrinogen levels
o Physiologic amenia: happens because the plasma DILUTES the RBC.
Respiratory
o Decreased lungs space, diaphragm moves up 4 cm
o Breathing becomes more diaphragmatic + breathing is faster and deeper to comepensate
Renal/Urinary
o Dilation of the renal pelvis, kidneys enlarge
 Right ureter elongates and widens
 Laying down makes them want to pee
Musculoskeletal
o Lordosis and waddle gate
o Diastasis recti abdomisis: separation of muscles
Skin
o Hyperpigmentation
o Linea nigra: black line runs up belly
o Striae gravidarum = stretch marks
o Decline in hair growth and increase in nail growth
Endocrine
o Thyroid enlarges
o Pituitary gland: increases prolactin, gradual increase of oxytocin throughout pregnancy, and drop
in progesterone at the end.
Pancreas
o Increased demand for glucose = increase insulin
o Fetus produces its own insulin (mom insulin cant gross placenta)
Adrenal Glands
o Increase in cortisol: regulates metabolism
o Increase in aldosterone: water and electrolyte balance
Placental Hormones Produced
hCG
Human chorionic somatommotropin (hCS)
Relaxin
Progesterone
Estrogen


Maintains corpus luteum, preg test indicator
Prepares mammary glands for lactation and antagonist
of insulin
Helps maintain pregnancy with progesterone, increases
flexibility, suppresses oxytocin (delays contractions)
Hormone of pregnancy, maintains
Promotes enlargement and growth, relaxes ligaments
and joints
Nutrition: increase protein, iron, folic acid, and calories
o Avoid fish due to mercury content
o Basically, just eat a healthy diet and eat 2 servings of fish a week.
o 2 quarts of water daily
Foods to Avoid:
o Listeria: bacteria that causes preterm birth, miscarriage, and still birth
 Hot dogs, lunch meats, soft cheese, meat spreads, refrigerated smoked sea food, raw
milk, salads made at store
Maternal Weight Gain
 Underweight BMI (<18.5)
o 28-40 total weight gain
 Normal weight BMI (18.5-24.9)
o 25-35 lbs. total weight gain
 Overweight BMI (25-29.9)
o 15-25 lbs. total weight gain
 Obese BMI (30 or greater)
o 11-20 lbs. total weight gain
*Caffeine and soda – 1 per day*
Maternal Emotional Responses
 Ambivalence: having conflicting feelings
 Introversion: focus on oneself and fetus
Most sexual during 2nd trimester!
Couvade Syndrome: sympathetic response to their partner’s pregnancy – gain weight can have N/V
Give RhO(D) (RhoGAM) at 28 weeks gestation
Maternal phenylketonuria: increase in ketones which cause fetal microcephaly, retardation, heart disease (avoid
anything high in protein and aspartane)
Chapter 12:

Risk factors for adverse pregnancy outcomes
o Accutane
o Alcohol misuse
o Seizure drugs
o Diabetes
o Folic acid deficiency
o Hep B – get vaccine
o HIV/AIDs
o Hypothyroidism
o Maternal phenylketonuria (PKU)
o Obesity
o Oral anticoagulant: warfarin is a teratogen
o STIs
o Smoking
1st prenatal visit: trusting relationship, health history, PE, labs, detection/prevention of future problems, and
education
o Comprehensive Health History: date of last period, S+S of preg, hCG test
o Menstrual history: age at menarche (first period), days in cycle, flow characteristics, discomforts,
and use of contraception
o Nagele’s Rule
 Determine 1st day of LMP
 Subtract 3 calendar months
 Add 7 days
 Add 1year
o Ultrasound is the best method to date a pregnancy
o Memorize obstetric history terms (slide 11)
 Calculating GTPAL
o G (gravida): current pregnancy is included in the count
o T (term birth): # of term gestations delivering between 38-42 weeks
o P (preterm birth): # of births ending between 20-37 weeks
o A (Abortions): # of pregnancies ending before 20 weeks or the age of viability
o L (Living): # of children currently living
 Physical Exam
o Urine (clean catch), vital signs, height and weight
o Gynecoid shape: most favorable shape for pelvis
 “true female pelvis”
First 28 weeks appointments
 Appointment every 4 weeks
 24-28 weeks: test for gestational diabetes
 Edema – gestational hypertension (29-36 weeks)
 STI testing (37 weeks to birth)

Fetal HR: 110-160 = WDL