ems obgyn overview lystra wilson-celestine, facog may 21th 2015

Download EMS OBGYN OVERVIEW LYSTRA WILSON-CELESTINE, FACOG May 21th 2015

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  • Slide 1
  • EMS OBGYN OVERVIEW LYSTRA WILSON-CELESTINE, FACOG May 21th 2015
  • Slide 2
  • OBJECTIVES Review female anatomy and reproductive system Review female anatomy and reproductive system Normal pregnancy, labor and delivery Normal pregnancy, labor and delivery Assessing a pregnant patient Assessing a pregnant patient Common complications and emergencies of pregnancy Common complications and emergencies of pregnancy Newborn care Newborn care Review of case scenarios Review of case scenarios
  • Slide 3
  • Definition of Terms Gravity: # of pregnancies Gravity: # of pregnancies Parity: # of pregnancies >20wk Parity: # of pregnancies >20wk Nulliparous: never pregnant Nulliparous: never pregnant Primagravid: first pregnancy Primagravid: first pregnancy
  • Slide 4
  • Definition of Terms Presentation: leading part in birth canal- crown, rump, face, arm. Presentation: leading part in birth canal- crown, rump, face, arm. Term : 37 to 42wks. Term : 37 to 42wks. Preterm : 42wks Abortus: Fetus /embryo delivered
  • Slide 5
  • External Genitalia
  • Slide 6
  • Pelvic Anatomy
  • Slide 7
  • Reproductive Organs
  • Slide 8
  • Physiology of Pregnancy Genital Tract Genital Tract Vagina, perineum: Vagina, perineum: Increased vascularity, hyperemia, edema Increased vascularity, hyperemia, edema Increased secretions (thick white discharge) Increased secretions (thick white discharge) Acidic pH( 3.5-6) Acidic pH( 3.5-6) Increased vaginal wall length Increased vaginal wall length Chadwicks sign- violet color of vagina/vulva Chadwicks sign- violet color of vagina/vulva
  • Slide 9
  • Normal cervix
  • Slide 10
  • Chadwicks sign and leucorrhea
  • Slide 11
  • Chadwick sign- pregnant
  • Slide 12
  • Physiology of Pregnancy Uterus 500-1000 fold increase in size 500-1000 fold increase in size Wt. at term +/- 1100gm Wt. at term +/- 1100gm Out of pelvis by end of 12 th wk. Out of pelvis by end of 12 th wk. Dextrorotated Dextrorotated Blood flow increases from 100 to 650ml/min Blood flow increases from 100 to 650ml/min Limited auto regulation Limited auto regulation
  • Slide 13
  • Physiology of Pregnancy Uterus Limited Auto regulation Limited Auto regulation Maximum uterine vessel dilation leave little auto regulation to improve flow during perfusion pressure changes Maximum uterine vessel dilation leave little auto regulation to improve flow during perfusion pressure changes Decreased maternal cardiac output blood flow shift away from placenta to maternal brain, kidney and heart. Decreased maternal cardiac output blood flow shift away from placenta to maternal brain, kidney and heart. Uterine Hypertrophy Uterine Hypertrophy Venous compression fall in venous return, fall in cardiac output Venous compression fall in venous return, fall in cardiac output Compensation: Supine hypotension syndrome, nausea, dizziness, syncope, relief by position change Compensation: Supine hypotension syndrome, nausea, dizziness, syncope, relief by position change
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  • Physiology of Pregnancy Cervix Thickened mucus Thickened mucus Chadwick sign Chadwick sign Eversion of columnar cervical glands Eversion of columnar cervical glands
  • Slide 16
  • Physiology of Pregnancy Ovaries Suspended follicular maturation Suspended follicular maturation Enlarged ovarian veins Enlarged ovarian veins Single corpus luteum Single corpus luteum Functional 4-5wks post ovulation Functional 4-5wks post ovulation Produces progesterone, relaxin Produces progesterone, relaxin
  • Slide 17
  • Physiology of Pregnancy Skin Vascular Vascular Spider angiomas Spider angiomas Palmar erythema- also seen thyroid disease, lung CA or inherited Palmar erythema- also seen thyroid disease, lung CA or inherited Striae gravidarum Striae gravidarum Genetic disposition Genetic disposition
  • Slide 18
  • Palmar erythema
  • Slide 19
  • Slide 20
  • Spider Angioma
  • Slide 21
  • Striae gravidarum
  • Slide 22
  • Physiology of Pregnancy Skin Increased pigmentations due to estrogen, progesterone, melanocytes simulating hormones Increased pigmentations due to estrogen, progesterone, melanocytes simulating hormones Linea negra Linea negra Chloasma/Melasma gravidarum Chloasma/Melasma gravidarum
  • Slide 23
  • Linear Negra
  • Slide 24
  • Molasma Gravidarum
  • Slide 25
  • Physiology of Pregnancy Breast Tender/tingling sensation in early preg Tender/tingling sensation in early preg Nipple enlarges, broader areolae with increased pigmentation Nipple enlarges, broader areolae with increased pigmentation Increase size from ductal growth and alveolar hyperplasia Increase size from ductal growth and alveolar hyperplasia Colostrum production Colostrum production
  • Slide 26
  • Physiology of Pregnancy Musculoskeletal Lumbra lordosis low back pain Lumbra lordosis low back pain Relaxation of pubic symphysis and sacroiliac joints Relaxation of pubic symphysis and sacroiliac joints Relaxed muscles leading to hernia and easily strained muscles Relaxed muscles leading to hernia and easily strained muscles All compounded by weight gain. All compounded by weight gain.
  • Slide 27
  • Lordosis of pregnancy
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  • Physiology of Pregnancy Hematologic 50% increases in blood volume 50% increases in blood volume Plasma volume increases 50-70%; starts at 6wks Plasma volume increases 50-70%; starts at 6wks RBC mass increase 20-35%: starts at 12wk RBC mass increase 20-35%: starts at 12wk Physiologic anemia Physiologic anemia Hemodilutional Hemodilutional Anemia nadirs at 30-34wks Anemia nadirs at 30-34wks
  • Slide 30
  • Physiology of Pregnancy Hematology Iron Deficiency Anemia Iron Deficiency Anemia Increased iron requirements, supplements recommended Increased iron requirements, supplements recommended term Hgb
  • Slide 31
  • Physiology of Pregnancy Hematology Coagulation Coagulation Fibrinogen increases 50% Fibrinogen increases 50% Changes in clotting factors and regulatory protein Changes in clotting factors and regulatory protein Cardiac output Cardiac output Begins to increase by 5 th wk Begins to increase by 5 th wk Peaks at 20-24wks Peaks at 20-24wks Rises by 40% by 20-24wks Rises by 40% by 20-24wks Overall 50% increase Overall 50% increase
  • Slide 32
  • Physiology of Pregnancy Hematology Initially increase in heart rate Initially increase in heart rate Reduced systemic vascular resistance Reduced systemic vascular resistance CXR: displaced heart to left upward and pericardial effusion CXR: displaced heart to left upward and pericardial effusion
  • Slide 33
  • Physiology of Pregnancy Test Interpretation BP: SBP increases by 5-10mmHg; DBP by 10- 15mmHg (before 24wks). BP: SBP increases by 5-10mmHg; DBP by 10- 15mmHg (before 24wks). Each contraction pushes 300-500ml from uterus to circulation Rise in arterial BP 10mmHg during Ctx. Each contraction pushes 300-500ml from uterus to circulation Rise in arterial BP 10mmHg during Ctx.
  • Slide 34
  • Physiology of Pregnancy Respiratory Estrogen hyperemic, edematous nasopharynx and increased mucous secretions. Symptoms: stuffiness, epistaxis, chronic cold. Estrogen hyperemic, edematous nasopharynx and increased mucous secretions. Symptoms: stuffiness, epistaxis, chronic cold. chest circum. and transverse diameter; Diaphragm pushed up 4cm Changes in lung volumes and pulmonary function test. chest circum. and transverse diameter; Diaphragm pushed up 4cm Changes in lung volumes and pulmonary function test. Oxygen consumption increases 15-20% Oxygen consumption increases 15-20% BOTTOM LINE BOTTOM LINE State of hyperventilation with chronic respiratory alkalosis
  • Slide 35
  • Physiology of Pregnancy Urinary Mechanical Mechanical Ureteric obstruction from uterus Ureteric obstruction from uterus Incomplete bladder empting Incomplete bladder empting Vesicoureteral reflux Vesicoureteral reflux Physiology Physiology 75% renal blood flow with increase in GFR 50% 75% renal blood flow with increase in GFR 50% Multiple trips to bathroom Multiple trips to bathroom Glucosuria, Proteinuria Glucosuria, Proteinuria
  • Slide 36
  • Physiology of Pregnancy Gastrointestinal Increased appetite (300kcal/d) Increased appetite (300kcal/d) Ptyalism (1-2L/d) spitting Ptyalism (1-2L/d) spitting Gingivitis Gingivitis Lower tone of Gastroesophageal sphincter reflux Lower tone of Gastroesophageal sphincter reflux Delay gastric emptying (60% of meal emptied in 90mins for non-pregnant; doubled time for pregnant) Delay gastric emptying (60% of meal emptied in 90mins for non-pregnant; doubled time for pregnant)
  • Slide 37
  • Physiology of Pregnancy Gastrointestinal Increased small bowel transit time 58 vs 52hrs Increased small bowel transit time 58 vs 52hrs Stomach and intestinal displacement appendix at right flank Stomach and intestinal displacement appendix at right flank Constipation/Hemorrhoids Constipation/Hemorrhoids Gallbladder changes increased risk of stones Gallbladder changes increased risk of stones
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