Chapter 26
Obstetrics and Gynecology
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Obstetrics
• Care of mother and
fetus during pregnancy
– 40-week pregnancy
– Puerperium—6 weeks
following delivery
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Obstetrics and the TPMS
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Obstetrics
• Initial prenatal visit
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Prevention of diseases and complications
Thorough history and physical
Pelvic measurements
Laboratory tests
• Blood and urine tests
– Patient education
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Obstetrics
• Prenatal history
– Identify high risk
– Attention given to risk factors
• Diseases
• Age
• OB history
– Gravida, Para
– Potential serious problems
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Subsequent Prenatal Visits
• Vital signs
– Blood work
• Measurement of fundus
• Nagele’s rule
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Subsequent Prenatal Visits
• Tests and procedures
– Alpha Fetal Protein (AFP)
• Performed at 16 weeks
– Amniocentesis
– Chronic Villi Sampling (CVS)
• Performed if history of abnormalities such as thalassemia,
sickle cell anemia, or Tay-Sachs
• Performed at 8–10 weeks gestation
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Subsequent Prenatal Visits
• Tests and procedures
– Ultrasonography/amniocentesis
• Ultrasound produces image of fetus
– Prep—1 qt. water 1 hour prior
• Amniocentesis—surgical puncture of amniotic sac
– Obtain sample of amniotic fluid
– Diagnose certain congenital abnormalities
– Fetal heart rate
• Nonstress test monitors (mother’s heart)
• Stress test monitors (fetal heart rate)
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Disorders of Pregnancy
• Abortion or interruption of pregnancy
• Eclampsia (toxemia)
– Life-threatening
• Gestational diabetes
– Usually disappears after delivery
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Disorders of Pregnancy
• Placenta previa >>
– Placenta may cover cervical
os
• Placenta abruption >>
– Placenta separates from
uterine lining
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Disorders of Pregnancy
• Hyperemesis gravidarum (excessive
vomiting)
– Severe dehydration can result
• Rh Incompatibility
• Impaired fertility
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Parturition (Labor)
• Three stages
– Dilation
– Expulsion
– Placental
• Braxton Hicks
contractions
• Amniotomy >>
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Postpartum Period
• Puerperium
– The body returns to a non-pregnant state
– The uterus involutes
• Lochia
• 6 week follow-up appointment
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Contraception
• Nonprescription
– Condoms, sponges
• Prescription
– Hormonal contraceptives, cervical cap, IUD, vaginal
rings
• Sterilization
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Gynecology
• Studies diseases of female reproductive tract
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Gynecologic Exam
• Assisting with
gynecological
examination (GYN)
– Consist of four or five parts
– Exam with PAP equipment
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Gynecologic Exam
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Gynecologic Exam
• PAP smear performed annually for detection of
cervical cancer
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Breast Exam
• Breast exam
– Checks for abnormalities
– Medical assistant may teach patient about breast
self-exam
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Gynecological Diseases
and Conditions
• Infertility
– Common causes
• Menopause
– Occurs between 35 and 58 years
• Ovaries produce less estrogen
• Surgical menopause
– Surgical removal of ovaries
– Signs and symptoms
– Treatment
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Gynecological Diseases
and Conditions
• Endometriosis
– Endometrial tissue outside
the uterus
• Cause unknown
• Treatment
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Gynecological Diseases
and Conditions
• Ovarian cysts
– Cysts on ovaries
– Detection
– Treatment
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Gynecological Diseases
and Conditions
• Ovarian cancer
– Difficult to diagnose
– Symptoms
– Diagnosis
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Gynecological Diseases
and Conditions
• Pelvic Inflammatory Disease (PID)
– Usually caused by STDs
– Diagnosis
– Treatment
• Human Papilloma Virus
– Gardisil vaccine
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Other Diagnostic Tests
• Colposcopy
– Exam of vagina and cervix by lighted instrument
– Performed after abnormal PAP
– Follow-up treatment of cervical cancer
• Endometrial biopsy/sampling
• Postmenopausal bleeding
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Other Diagnostic Tests
• Cervical punch biopsy
– Done with colposcopy
– Performed after abnormal PAP
• Cervical cone biopsy
• Loop electrosurgical excision procedure
(LEEP)
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Other Diagnostic Tests
• Cryosurgery
– Treat tissue with freezing temperatures
• Treatment for chronic cervicitis and cervical erosion
– Procedure with probe
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Other Diagnostic Tests
• Wet prep/wet mount for yeast, bacteria, and
trichomonas
• Potassium hydroxide for fungus
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Other Diagnostic Tests
• Laparoscopy >>
– Lighted view of pelvic
cavity
• Dilation and Curettage
(D&C)
– Surgical procedure
– Dilating and scraping of the
endometrial tissue
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