Contraception and Abortion Flashcards
Contraception
-Intentional prevention of pregnancy
-Nurses Role
Explore best options for individuals:
-Reliability issues
-Relative cost
-Protection for STI’s
-Partners willingness
EDUCATION!
Inital Visit
Thorough History
- Menstrual
- Obstetric
- Medical
- Social
Initial Visit
Physical Examination - pelvic examination
Labratory tests
-Factors affecting methods of contraception
Frequency of intercourse Motivation to prevent pregnancies Understanding of how to use the method Provision of short-term or long-term protection Likelihood of pregnancy for individual Consistent use of method
Methods: Coitus interruptus
- Failure rate of 19%
- No protection against STI’s
Fertility Awareness Methods (FAM):
Identify
- Infertile phase: before ovulation
- Fertile phase: about 5-7 days around mid-cycle; including several days before and during ovulation and the day afterward
- Infertile phase: after ovulation
Pitfalls of using FAM
- Restriction on sexual spontaneity
- Rigorous daily monitoring
- Required training
- Risk of pregnancy during prolonged training
- Risk of pregnancy high on unsafe days
- Failure 25%
Types of FAM
- Periodic Absinence or Natural Family Planning
- Supported by Catholic Church
- Abstienence 3-4 days before and after ovulation
- Problem: ovulation can be unpredictable
- —–irregular menstrual cycles (short or long)
Barrier Methods
Protection
- Pregnancy
- STIs
-Types Spermicides Condoms Diaphragms Cervical Caps Contraceptive Sponge
Spermicides
- Avoid nonoxynol (N-9) if at high risk
- Diaphragms, condoms, cervical caps
- Can actually help transmit diseases
failure rate of 29% when used alone
Condoms
- STI protection
- Avoid oil- based lubricants
- Watch for latex allergy!!!
- Failure rate of 15%
Diaphragms
-Should be largest she can tolerate
-Use with spermicide (avoid N-9)
-16% failure
-Annual gynecological exam
-Refitted for weight fluctations and after pregnancies
-Toxic Shock Syndrome
Prompt removal (6-8 hours)
Signs: sunburn type of rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden high fever and vomitting
Cervical Caps
- Remain in place 6-48 hours
- Used with spermicide
- Dont use during menstruation and 6 weeks postpartum (risk of TSS)
- Failure 40% for parous and 20% for nulliparous
Hormonal Methods
- More than 30 formulations avaliable
- combined with estrogen-progestin
- or progestin only
Hormonal Methods
Administration:
- Oral
- Transdermal
- Vaginally
- Implantation
- Injection
- Combined Estrogen-Progestin
Hormonal Methods
-Suppresses action of hypothalamus and anterior pituitary = insufficient secretion of FSH and LH - no ovulation
Maturation of endometrium altered
-Less favorable for implantation
Cervical mucus thick
-Progestin influence
Withdrawl bleeding
- occurs 1-4 days after last pill taken
- less profuse than regular period with shorter duration
- Must be examined before prescription
TAKE AT SAME TIME EACH DAY
Maintains correct hormonal levels
Hormonal Methods: Benefits
- Decreased menstrual blood loss
- Decreased iron-deficency anemia
- Regulation of menorrhagia
- Regulation of irregular cycles
- Reduced incidence of dysmenorrhea & PMS
- Improve acne
- Decease ovarian cyst development
- Effectiveness: almost 100%
Risks of Hormonal Methods
Contraindications:
-History of thromboembolic disease, CVA, coronary artery disease, breast cancer, liver problems, lactation less than 6 weeks postpartum, smoker older than 35, headaches, hypertension, and diabetes (more than 20 years) with vascular disease
Signs of Potential Complications
A-abdominal pain (liver/gallbladder)
C-chest pain or shortness of breath (clots in lungs/heart)
H-Headaches (hypertension)
E-eye problems (vascular accident or hypertension)
S-severe leg pain (thromboembolic process)
Right product- lowest dose of hormones that prevents ovulation with fewest and least harmful side effects
Oral contraceptives and other meds
- Anticonvulsants decrease effectiveness of oral contraceptives
- Systemic antifungals
- Antituberculosis drugs
- Anti-HIV protease inhibitors
- Watch for over the counter medications!
- Broad spectrum antibiotics
Nursing Interventions
-Look at history of oral contraceptive use, side effects during past use, menstrual history, medical history, and drug interactions
Post oral contraceptives
- Fertility rate may be lower the first 3-12 months
- Amenorrhea most likely related to woman’s menstrual cycle before taking the pill
Medroxyprogesterone Acetate Depo-Provera
- Given IM -150 mg
- Deltoid or gluteus maximus
- Administer the first 5 days of menstrual cycle
- Every 11-13 weeks
- Do not massage area after administration
- —can shortern period of effectiveness
Depo Provera
-Does not impair lactation
-Return to fertility may be dalyed up to 18 months
-Failure rate 3%
Significant bone mineral density loss
-May not be reversible
-Counsel about calcium intake and exercise
Emergency Contracpetion
Plan B
- Over the counter sale (women 18 years and older)
- Take ASAP but within 120 hours of unprotected sex or birth control mishap
- side effect: nausea
- No medical contraindications
- If no period in 21 days- check for pregnancy
- Ineffective if pregnant !!!
Intrauterine Devices
- Small T shaped device with bendable arms inserted through cervix into uterine fundus with arms forward fallopian tubes
- Two strings hand from base through cervix into vagina
- Releases levonorgesteral
- Effective up to 5 years
- Failure less than 1%
- Copper is good for 10 years
- Inflames endometrium
Intrauterine Devices
Prior Considerations
-Negative pregnancy tests, treatment for dysplasia, STI’s ruled out, consent
Advantages
-Long term protection; immediate return to fertility when removed
Disadvantages
- Risk of PID, unintentional expulsion, infection, uterine perforation
- No protection from STI’s
Signs of complications
P- period late
A-abdominal pain or pain with intercourse
I-infection - abnormal vaginal discharge
N-not feeeling well, fever, or chills
S- String missing- shorter or longer
-Check for pregnancy, ectopic pregnancy
Tubal Ligation
- Laproscopic
- Electrocoagulation and ligation (bands or clips)
- Ovum disintegrates in adbominal cavity
- Reconstruction: success rates vary and put woman at risk for ectopic pregnancies
- —electrocoagulation is not reversible
Vasectomy
- Sealing, tying, or cutting of the vas deferens so that the sperm cannot travel from testes to the penis
- Pain, bleeding, possible infection
- Ice packs, moderate inactivity for 2 days
- One week to several months may be needed to clear the ducts of sperm present
- No effect on potency or volume of ejaculate
Reconstruction: Microsurgery to reanatomose the sperm ducts
-Fertility rate 50%
Abortion
Induced Abortion
- Purposeful interruption of pregnancy before 20 weeks gestation
- Elective: woman’s choice
- Therapeutic: reasons of fetal or maternal health
Abortion Reaons:
Reasons:
- Preservation of life of mother
- Genetic disorders of fetus
- Rape or incest
- Mother’s request
First Trimester
- Aspiration (vaccum or suction curretage)
- Local anesthesia
- 8-12 weeks gestation
- Risks: infection, excessive vaginal bleeding
- Medical Abortion:
- -Methotrextate, Misoprostol (Cytotec), Mifepristone
Second Trimester
- Injections of hypertonic solutions into uterus
- Dilation and Evacuation (up to 20 weeks)
Review Roe V Wade
Review Roe V Wade
Nurses Role
- Decide where you want to work
- Never push patients to make one decison or another- offer choices and let patient choose
- Institution that perform abortion
- Give information to woman- include alternatives
- Give support and allow woman to discuss her feelings
- Be careful not to communicate your personal thoughts or views on abortion
Nurses Role
-AWHONN continues to support nurses right to choose to participate or not in abortion procedures and advocate that you make you inform your employers at time of employment if your attitudes and beliefs will interfere with your job duties
Final thoughts
- Be aware of your own views and feelings
- Understand that many regret their final choice and need support later
- young women
- women with inadequate support systems
- Women with psychiatric history
- Women pressured into abortion
