Chapter 12 Flashcards
About 45% of all pregnancies in the US are unintended, and many are unwanted but for what reasons?
- couple doesn’t want the child at that time
- couple doesn’t want the child at all
Unintended pregnancy rates are higher among low-income, minority women in what age group?
15-24
Why do we see many unintended pregnancies in low-income minority women?
- stress and life disruption
- associated with poorer health outcomes
Women with unintended pregnancies are less likely to receive what?
adequate prenatal care
Women with unintended pregnancies are more likely to do and have what?
- drink and smoke
- babies with low birth weight (less than 5.5 pounds)
True or False?
Sexual minority women (lesbian, bisexual, or heterosexual with same-sex attraction) have an increased risk of unintentional pregnancy than do heterosexual women and are more likely to use less or no contraception.
True
Regular medical care during pregnancy, designed to promote the health of the mother and the fetus.
prenatal care
What is the only guaranteed way to prevent pregnancy and STD’s?
Abstinence
What are the benefits of abstinence?
- it’s free and available to all
- can be started at any time
What are the drawbacks from abstinence?
requires control and commitment
Come in pills, injections, patches, and vaginal rings to prevent ovulation. They can alter cervical mucus, making it harder for sperm to reach ova and affect uterine lining, so a fertilized egg is less likely to be implanted.
Hormonal contraceptives
Advantages of hormonal contraceptives:
- ease of use
- limited side effects
- do not permanently affect fertility
do not require action at the time of intercourse - reduce menstrual cramps
- reduce blood loss
- reduce premenstrual symptoms
- reduce ovarian cysts
- reduce endometriosis
- reduce risk of endometrial and ovarian cancer
- improve acne
Disadvantages of hormonal contraceptives:
- no protection against STD’s
- cause minor side effects and symptoms similar to early pregnancy
- cause mood swings and headaches
Recommended as the first option for all sexually active women. Don’t have to do anything else for years. Can be removed with a rapid return to fertility at any time.
long acting reversible contraceptives (LARC’s)
What are the most effective nonpermanent contraceptive options, also known as LARC options?
IUD and an implant
A small T-shaped device that, when inserted in the uterus, prevents conception. Alters the intrauterine and cervical fluids to reduce the chance that sperm will move up the Fallopian tubes, where they can fertilize the ovum. Requires little maintenance. Since it can move or fall out of the uterus, a woman using it should learn how to check it to make sure the device is located properly each month.
intrauterine device (IUD)
A small flexible plastic rod that contains progesterone and is inserted under the skin releasing hormone and provides effective contraception for 3 years. This prevents ovulation, alters cervical mucus, and thins uterus lining. Cause irregular menstruation and many women can stop having periods.
contraceptive implant
The most popular hormone contraceptives, combining estrogen and progesterone. Some contain only progesterone making them slightly less effective but can be used for women who can’t take estrogen like women who are breast feeding or have family history of blood clots.
Birth control
Slowly releases estrogen and progesterone into the bloodstream through the skin. It is changed each week and makes it good for women who cannot remember to take the daily birth control pill. Results in higher levels of estrogen in the blood so it creates twice the risk of blood clots than the pill.
transdermal patch
If a woman is not taking hormonal contraceptives but misses a period, it can signify a hormone imbalance that may be due to what?
- weight gain or loss
- stress
- health conditions
- overdoing exercise
- pregnancy
A soft, flexible plastic ring placed in the vagina and slowly releases estrogen and progesterone. It is left in place for 21 days and then remove for 7 days before inserting a new one. Rarely felt during intercourse.
vaginal contraceptive ring
Advantages of the vaginal contraceptive ring:
- once a month application
The only injectable contraceptive approved in the US. Only contains progesterone and is administered every 3 months. Highly effective and requires little action.
Depro-Provera
Disadvantages of Depro-Provera:
- cause menstrual changes
- irregular bleeding
- weight gain
-decreased bone density
What contraceptive can be less effective for women with a body mass greater than 30%?
contraceptive implant
Physically separate the sperm from the female reproductive tract. Some of their effectiveness increased by using spermicide, as well. If used correctly, the risk of pregnancy is very low. Include male condoms, female condoms, diaphragms, cervical cap, and contraceptive sponge.
Barrier methods
The diaphragm and cervical cap should be used with what?
spermicide
Chemical that kills sperm. Usually comes in a foam or jelly and can be purchased at a grocery or drug store.
spermicide
What contraceptive barrier method already has spermicide in it?
contraceptive sponge
A small, cuplike device that covers the cervix and prevents sperm from entering the uterus. It has to be fitted and replaced annually.
cervical cap
A circular rubber or silicone dome inserted in the vagina before intercourse. It fits between the pubic bone and the back of the vagina and covers the cervix. Spermicidal jelly or foam is placed in the dome, or cup, of this before inserted; thus the spermicide covers the cervix, where it provides the best protection.
vaginal diaphragm
a small, polyurethane foam device pre-saturated with one gram of the spermicide nonoxynol-9. It is available over-the-counter without a prescription. One size fits all. It may be less effective for women who have been pregnant before.
contraceptive sponge
Use of diaphragms and sponges has been linked to what?
toxic shock syndrome
It is a rare but potentially life threatening bacterial infection. There was a significant increase in the disease in the 1980’s in young women using superabsorbent tampons probably because they were left in too long, allowing bacteria to breed. The risk is low with diaphragms and sponges. Women should change tampons frequently and not leave female barrier methods in place beyond recommended time periods. Symptoms include a sudden high fever, vomiting or diarrhea, a rash that looks like a sunburn, muscle aches, headache, seizure, and confusion. It is usually treated in the hospital with IV antibiotics.
toxic shock syndrome
What form of contraception was associated with pelvic inflammatory disease but is now made safer and is regaining popularity?
intrauterine device (IUD)
An infection of the ovaries and fallopian tubes
pelvic inflammatory disease
Known as the rhythm method. The idea is to abstain from sex during ovulation.
fertility awareness method
Occurs 14 days before the menstrual cycle begins. For women with a 28 day cycle, this usually starts on day 14.
Ovulation
Most likely to become fertilized 24 hours after released from the ovary. However, this can remain viable for 4 days.
Ovum
Can survive 7 days in the cervical mucus. Any of this deposited in the vagina after day 8 of the menstrual cycle could still be around on day 14 when the woman ovulates.
Sperm
A calendar tracking method that can be used only by women who consistently have a regular menstrual cycle 26 to 32 days long, because abstinence or barrier methods must be used for 7 days before ovulation.
Standard days method
A woman’s basal body temperature (BBT) rises slightly with ovulation. To use this method, a woman must record her temperature when her body is at rest with a Basal Temperature Thermometer. Typically first thing in the morning before getting out of bed. A 0.1-).5 degree rise in basal body temp occurs with ovulation, and BBT stays slightly elevated until menstruation begins. Temperature spike mean ovulation has occurred, but it CANNOT predict when ovulation will occur. It is safe to have unprotected sex beginning with the fourth day after the temp spike until BBT drops with onset of menses.
Temperature method
Identifies when ovulation has occurred based on changes in cervical mucus. Becomes thinner and stretchier, resembling egg white, and increases in quantity just before ovulation, so the vagina feels wetter. Unsafe days begin 2 days before onset of the increase in cervical mucus and end 4 days after the peak of slippery mucus. Menses can mask the quality of cervical mucus; as a result, the days of menstruation are not considered safe days. In the 2-day method, a woman asks herself, “Did I have cervical mucus today? Did I have cervical mucus yesterday?” If the answer to either question is yes, it is an unsafe day for unprotected intercourse. If the answer to both is no, it is considered a safer day.
cervical mucus method
The removal of the penis from the vagina prior to ejaculation. College students use this method a lot. Less effective method than hormonal methods but is similar to barrier methods in effectiveness. Success depends on a man’s ability to know when he is about to ejaculate and to have self control to withdraw with impending orgasm. However, sperm can present in pre-ejaculation, so this method can fail even if a man withdraws prior to ejaculation.
Withdrawal method
Also referred to as the morning-after pill, post-sex contraception, or backup birth control. Can prevent pregnancy after unprotected intercourse. Most effective if taken 72 hours and must be taken within 5 days of unprotected intercourse.
Emergency contraception
Emergency contraception reduce the chances of pregnancy by preventing what?
Ovulation and fertilization
Emergency contraception will not cause termination of what?
An existing pregnancy
When is emergency contraception useful?
- when condom breaks or diaphragm or cervical cap slips out of position
- in cases of rape or incest
Available for men and women through surgical procedures. Most commonly used form of contraception who don’t want to have any more children.
Permanent contraception
Permanent contraception is also known as what?
Sterilization
Involves a small incision or puncture in the scrotum. Then the vas deferens is tied off or severed. This is the duct that carries sperm from the testes to he seminal vesicle where sperm would mix semen. It is quick, done with local anesthetic, and requires two or three days before resuming normal activities.
vasectomy
Involves the severing and tying or sealing of the fallopian tubes of women. Longer recovery period and more risk of complications than for a vasectomy.
tubal ligation or occlusion
The fertilized egg implants or attaches outside the uterus usually in the fallopian tube. This can be life threatening. Signs include severe lower abdominal pain or cramping on one or both sides, vaginal spotting or bleeding with abdominal pain, or light-headedness, dizziness, or fainting.
Ectopic pregnancy
What are things to consider when becoming a possible parent:
- what are your career plans?
- do you have a good relationship with your partner?
- are you emotionally mature enough to take on the responsibility?
- how is your financial situation?
- what is your health status and age?
- do you plan on being involved in the child’s life?
What are your choices if you are pregnant?
- keep the baby
- give up for adoption
- abortion
The biological parents help to choose the adoptive parents and can maintain a relationship with them and the child. The degree of involvement can range from the exchange of information through a third party to a close and personal relationship. This form of adoption can make it easier for parents to give up a baby, and it allows the child to know his biological parents and relatives.
Open adoption
More traditional form of adoption. Biological parents do not help choose adoptive parents, and the adoption records are sealed so that the adoptive and biological parents remain unknown to each other. In some states, the child can be given the ability to access the sealed records at age 18.
Closed adoption
True or False?
Legislation now allows adopted people from decades ago access their records after having the realization that knowledge about their biological parents can be important for both psychological and health reasons.
True
Voluntary termination of a pregnancy. Legal in the US. In the case of Roe v. Wade, the U.S. Supreme Court ruled that the decision to terminate a pregnancy must be left up to the woman, with some restrictions applying as the pregnancy advances through three trimesters (segments of the pregnancy that are each about 3 months long).
elective abortion
The embryo or fetus and other contents of the uterus are removed through a surgical procedure. Between 2-8 weeks of gestation, the term embryo is used; after the eighth week, the term fetus is used. Cervix is numbered with a local anesthetic and opened with a dilator. A catheter is inserted in the uterus and attaches to a suction machine to remove the uterus.
surgical abortion
When a medication is used to induce an abortion. Can be performed in early pregnancy (up to 8 weeks of gestation). Given the medication mifepristone (RU-486) which blocks progesterone. Between 24-72 hours later, a second medication, misoprostol is administered which causes the uterus to contract and expel the pregnancy. Most women have cramping and bleeding and aborts the pregnancy within 1-14 days.
Medical abortion
Necessary to maintain a pregnancy.
Progesterone
True or False?
Eighty-eight percent of abortions are performed in the first 12 weeks of pregnancy. International studies show that legality of abortion does not influence abortion rates. Women will have abortions regardless of legality, and if it is illegal, they are more likely to be unsafe and to be associated with a higher rate of maternal death. Abortions have lowest rates where it is legal in Western Europe and highest rates where it is illegal in Latin America. Emotions after abortions range from relief to depression.
True
The inability to become pregnant after not using any form of contraception during sex for 12 months.
Infertility
What can make both male and females infertile?
- age
Males: - low sperm count
-lack of sperm mobility
Women:
-blockage in fallopian tubes - scarring from pelvic inflammatory disease
-complication from STD
-lack of ovulation - abnormality in cervical mucus
-abnormality in anatomy
Treatments for infertility:
- stimulating egg production
- surgery to open blocked fallopian tubes
- fertility drugs
- artificial insemination to place sperm directly into a woman’s uterus
- vitro fertilization
Risk of treatments for infertility:
- expensive
- not covered by insurance
- infection
-pregnancy complications - have multiple pregnancy
- complications during procedures
When sperm is collected and placed directly into a woman’s uterus by syringe.
Intrauterine (artificial) insemination
Technique by which hormones are used to stimulate egg production in the ovaries, multiple eggs are collected through a surgical procedure, the eggs are fertilized in the clinic, and the fertilized eggs are transferred into the woman’s uterus.
vitro fertilization
Least health risk in pregnancy occurs when women are between what ages?
18-35
A woman’s body is still growing and developing. The increased The increased pressure of pregnancy leads to premature births and lower birth weights.
Before 18
A woman is more likely to have trouble getting pregnant because fertility declines with age. Also, women are more likely have a miscarriage, have medical problems during pregnancy, have a baby born prematurely, low birth weight, or have a genetic abnormality like Down syndrome. Men are twice as likely to be infertile as men in their early 20’s. Men over age 40 have an increased risk of fathering a child with autism, schizophrenia, or Down syndrome.
After age 35
Typically includes an evaluation of current health status, health behaviors, and family health history
Prepregnancy counseling
Factors that would be relevant in Prepregnancy counseling:
- smoking
-drinking - drugs
- weight loss
- adjusting to medications
- manage other medical conditions
Usually done if there is a family history of a disorder.
Genetic counseling
Hepatitis B is a highly infectious disease that causes liver damage and can be transmitted from mother to child during pregnancy and delivery in this process. It’s the transmission of an infection or disease from mother to child during pregnancy and delivery.
vertical transmission
Guidelines that women who might become pregnant or women of childbearing age need to follow:
- nutrition importance
- consume folic acid to reduce development problems of brain and spinal cord
-exercise - foodborne infections ( doctors specify would foods not to consume to avoid the transmission of this)
- maintain a healthy weight
- infections are an issue so stay on top of vaccinations to reduce vertical transmission
- mother having chronic health conditions can cause an issue so improve control over them and adjust meds
- don’t use drugs or alcohol
A substance (such as alcohol or tobacco) that can cause physical damage or abnormality in the fetus, especially if they are present during the first trimester, when rapid development of body organs is occurring.
teratogen
Babies living in environments where parents smoke increase risk for this. Unexpected death of a healthy baby during sleep.
sudden infant death syndrome (SIDS)
The combination of birth defects caused by prenatal exposure to alcohol, characterized by abnormal facial appearance; slow growth; intellectual disabilities; and social, emotional, and behavior problems.
fetal alcohol syndrome (FAS)
Risk of using tobacco and alcohol during and after pregnancy:
- spontaneous abortion
- low birth weight
- infant death
- FAS
- SIDS
- blood vessels constrict in placenta and fetus
-birth defects - behavior problems for baby
- babies are born addicted and experience withdrawal symptoms
Importance of prenatal care:
- screen for infections
- screen for health conditions
- monitor fetus growth and development
Why are mortality rates higher in ethnic and racial minority groups?
- lack of prenatal care
- lack of access to health information
- dietary differences
Alamance County research has shown the the top reasons women do not receive proper care is lack of the following:
- transportation
- services not provided during non-working hours
- childcare during appointments
A dangerous condition that can occur during pregnancy, characterized by high blood pressure, fluid retention, possible kidney and liver damage, and potential fetal death.
preeclampsia
A potentially life threatening disease for the mother that can develop during pregnancy, marked by seizures and coma.
eclampsia
Early pregnancy complications include:
- STD’s
- miscarriage
-diabetes
Late pregnancy complications:
-preeclampsia
-eclampsia
-preterm or early labor
Prenatal tests to help detect abnormalities before birth:
- Alpha Fetoprotein (AFP)
- ultrasound
-chorionic villus sampling (CVS)
A protein produced by the infant and released into the amniotic fluid. It then crosses into the mother’s blood where it can be measured and compared with normal ranges. Abnormally high levels are associated with problems in the brain and spinal cord development and abnormally low levels have been associated with chromosomal abnormalities, especially Down syndrome.
Alpha-Fetoprotein (AFP)
Use of high-frequency sound waves to produce a visual image of the fetus in the womb. It is used to determine size and gestational age of the fetus, its location in the uterus, and any major anatomical abnormalities. Measurements are taken of the head (cerebellum) and the fluid around the fetus. Can also reveal sex of a baby.
ultrasound
What is the most common chromosomal abnormality?
Down Syndrome
True or False?
The risk of Down syndrome in a 20 year old is 1 in 1,400, but the risk in a 40 year old is 1 in 100.
True
A needle is passed through the abdomen into the uterus. Fetal cells from the sample are subjected to chromosomal analysis. If a problem is detected, parents must decide whether to continue the pregnancy or terminate. These testing lead to ethical concerns for patients and physicians.
chorionic villus sampling (CVS
Begins when hormonal changes in both the fetus and the mother causes strong uterine contractions to begin. The contractions cause the cervix to dilate. This first stage can last from a few to many hours. When the cervix is completely open, the second stage of this begins. The baby moves slowly into the birth canal, which stretches open. When the top of the head appears at the opening of the birth canal, the baby is said to be crowning. After the head emerges, the rest of the body usually slips out easily. The third stage is the delivery of the placenta which usually takes another 10-30 minutes.
labor
Babies are evaluated at birth to determine whether they require medical attention or will need developmental support later. This used as a quick measure of physical condition. A score of 0-2 is given for heart rate, respiratory effort, muscle one, reflex irritability, and color. The scores are added for a total of 0-10. Most babies are pronounced healthy and are taken home in 24-48 hours
Apgar scale
Is perfectly suited to babies’ nutritional needs and digestion. Also, it contains antibodies reducing the risk of infections, allergies, asthma, and SIDS.
Breastmilk
Can increase bonding between mother and child, contributes to weight loss after pregnancy, and may decrease the risk of ovarian and breast cancers after menopause. Can be more convenient and less expensive than bottle-feeding. There are lactation consultants available and organizations for support. This is not a reliable form of birth control, though many women depend on it. Many women do not have periods while doing this, but ovulation and pregnancy may still occur. About 10% of women are unable to do this at all.
Breastfeeding
Provides adequate nutrition and allows parents to know how much the baby is consuming. It also gives the mother more freedom and gives other family members the opportunity to feed and bond with the baby.
Bottle-feeding
Starting at 2 months of age, children receive what against several childhood diseases that used to lead to serious illness and death?
Vaccinations
Parents spend much of their time feeding, changing, and trying to soothe their newborns. This is formed during this time, and the infant begins to have feelings of trust and confidence. This sense of trust is crucial for future relationships and social and emotional development. A healthy infancy lays the foundation for a healthy life
Strong attachment
