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NURS 6305 > Exam 1 Menstrual Cycle, contraception, preconception, antepartum > Flashcards

Exam 1 Menstrual Cycle, contraception, preconception, antepartum Flashcards

1
Q

hormonal birth control methods reduce the risk of what types of cancer

A

colon cancer
endometrial cancer
ovarian cancer

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2
Q

normal menstruation frequency

A

every 28 days

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3
Q

what hormone dominates the follicular phase

A

estrogen

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4
Q

what happens during the follicular phase

A

-primary follicle matures - starts secreting estrogen –> at first estrogen leads to negative feedback of FSH/LH, then turns to positive feedback –> LH surge
-ovulation = end of follicular phase
-endometrium: menstruation/shedding at start of follicular phase; lining thin

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5
Q

During the luteal phase, the corpus lutes produces what 3 hormones

A

estrogen
progesterone
inhibin

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6
Q

during the ____ phase of the menstrual cycle, a primordial follicle develops into a Graafian follicle and neighboring follicles become atretic

A

follicular

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7
Q

what ligament anchors the ovary laterally to the pelvic wall

A

suspensory ligament

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8
Q

Main hormone controlling follicular phase

A

Estradiol

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9
Q

this hormone causes cervical mucus to become copious, watery, and elastic during the follicular phase to aid sperm movement

A

estradiol

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10
Q

progesterone levels are high/low during the follicular phase

A

Low

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11
Q

At ovulation, the primary oocyte completes meiosis I to yield a ______ and ______

A

secondary oocyte and polar body

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12
Q

surge of what hormone causes ovulation

A

LH

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13
Q

what hormone stimulates growth of endometrium and elongation of spiral arteries

A

estradiol

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14
Q

hormone predominantly secreted by the corpus luteum

A

progesterone

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15
Q

throughout the follicular phase, rising ____ levels in the blood stimulates growth of the endometrium and myometrium of the uterus

A

estrogen

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16
Q

ectopic pregnancy

A

oocyte is fertilized in the peritoneal cavity or distal portion of the uterine tube and begins developing there

This is a risk because the Fallopian tubes are not continuous with the ovaries

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17
Q

FSH hormone stimulates the ovarian production of estrogens by the ____ cells of the ovarian follicle

A

granulosa

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18
Q

loss of the hormone ______ triggers shedding of the endometrium in the menstrual phase

A

progesterone

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19
Q

Effect of estrogen on HDL levels

A

increases HDL

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20
Q

hormone secreted by corpus luteum and placenta that functions to maintain pregnancy if fertilization occurs

A

progesterone

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21
Q

When is FSH the highest during the menstrual cycle

A

during the first week of the follicular phase when it recruits 5-7 follicles for entry into the cycle

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22
Q

moderate levels of estradiol during the follicular phase inhibit/stimulate GnRH secretion by the hypothalamus

A

Inhibit

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23
Q

the 3 naturally occurring estrogens in females

A

estrone
estradiol
estriol

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24
Q

during the follicular phase, ______ stimulates growth of the endometrium

A

estradiol

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25
Q

ovulation occurs ____ days before menses, regardless of the cycle length

A

14 days

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26
Q

progesterone is significantly higher during the ____ phase of the menstrual cycle compared to other phases

A

luteal phase

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27
Q

how does estrogen affect osteoclastic activity in bones

A

estrogen inhibits osteoclastic activity

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28
Q

progesterone affect on body temp

A

increases body temperature

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29
Q

the ____ phase of the menstrual cycle occurs from day 0 to 14 and the ___ phase occurs from day 15-28

A

follicular, luteal

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30
Q

How do hormonal contraceptive methods protect future fertility

A

decreasing the risk of endometriosis, ectopic pregnancy, pelvic inflammatory disease, and abortion related complications

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31
Q

best evidence-based resource for determining whether a woman is a candidate for particular birth control method

A

US Medical Eligibility Criteria for Contraceptive Use 2016 (CDC)

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32
Q

what are LARCs

A

long acting reversible contraception

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33
Q

LARC examples

A

IUD
nexplanon / subdermal implants

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34
Q

what type of contraception has the highest effectiveness level

A

LARCs

ACOG 2017 rec: offer LARC as first line method to all women *be vigilant of implicit bias / no coercion

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35
Q

benefits and barriers to LARC use

A

benefits: highest effectiveness, discrete, ease of use, can be used in women of any age or parity

barriers: high up front cost (although lower cost overall), provider inexperience, patient fears about safety

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36
Q

paragard IUD class

A

copper IUD

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37
Q

copper IUD MOA

A

released copper ions that cause inflammatory response - the ions are toxic for sperm in the genital tract fluid (sterile inflammatory response with spermicidal effects)

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38
Q

Kyleena/skyla/mirena MOA

A

IUD - contain reservoir that released levonorgestrel (type of progestin) at varying doses –> local delivery of progestin produces thickening of cervical mucus and an endometrial reaction

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39
Q

good IUD choices for nulliparous women / women with cervical stenosis or small uterine cavities

A

kyleena
skyla

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40
Q

how long is the copper IUD effective

A

10 years

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41
Q

how long is mirena / kyleena effective

A

Kyleena 5 years
Mirena 8 years

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42
Q

how long is Skyla effective

A

3 years

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43
Q

how to be reasonably certain a woman is not pregnant (6)

A

-less than or = to 7 days after start of normal menses
-has not had sex since the start of last normal menses
-has been correctly and consistently using reliable contraception
-is less than or = to 7 days after spontaneous or induced abortion
-is within 4 weeks postpartum
-if fully or nearly fully breastfeeding (greater than 85%), amenorrhea, and less than 6 months postpartum

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44
Q

expulsion rate for IUDs

A

2-10% - most happen in first 3 months

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45
Q

discuss common safety concerns patients have about IUDs

A

-uterine perforation: usually benign; occurs 1 in 1000; more likely in postpartum or breastfeeding women

-infertility: does NOT actually increase infertility

-ectopic pregnancy: tenfold lower for IUD users than in nonusers UNLESS pregnancy result of IUD failure

-infection: risk 1-10 in 1000 within 20 days after insertion

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46
Q

dysmenorrhea

A

menstrual cramps

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47
Q

LNG IUD

A

levonorgestrel IUD

48
Q

menorrhagia

A

heavy periods

49
Q

non contraceptive benefits of LNG IUDs

A

menstrual flow reduced (up to 90%)
reduced risk of endometrial cancer and cervical cancer

50
Q

side effects of progestin implant (nexplanon)

A

irregular bleeding
amenorrhea
headache
bruising at insertion site
weight gain
acne
breast tenderness

51
Q

major disadvantage and main reason for discontinuing nexplanon

A

irregular bleeding

make sure to educate patient on side effect

52
Q

side effects of tubal occlusion / sterilization

A

risk of ectopic pregnancy higher
risks related to surgery - hemorrhage, infection, complications
“post-tubal ligation syndrome” - increased dysmenorrhea and abnormalities in menstrual cycle

53
Q

benefit of addition of estrogen to progestin in combined birth control pill

A

more predictable bleeding pattern due to stabilization of the endometrium

estrogen and progestin’s synergistic activity makes it possible to use lower doses (would need to use too high of dose of estrogen only - high side effect risks)

54
Q

why does it take longer to return to fertility after discontinuation of systemic estrogen/progestin pills compared to POPs and LNG IUDs

A

POPs and LNG IUDs do not inhibit ovulation (local effects only - no effect on HPA axis (LH & FSH) - estrogen/progestin pills do –> when POP/LNG IUD dc’d fertility is expected right away

55
Q

primary MOA of systemic hormonal contraceptives

A

preventing ovulation

56
Q

benefits of hormonal birth control (COCs)

A

decreased risk of colon, ovarian, endometrial cancer
decreased risk of endometriosis, RA, asthma
protection against ovarian and uterine cancer may last 28 years after discontinuation
preservation of bone density - may persist up to age 80
decreased risk of PID and ectopic pregnancy

57
Q

combined oral contraception (COC) recommendations for patients with risk for breast cancer

A

NOT associated with increased risk of breast cancer even if BRCA carrier

58
Q

birth control considerations for postpartum women

A

COCs/estrogen-containing contraceptives contraindicated 2/2 high risk for DVT/PE after birth

Progestin only methods including IUDs and implants can be initiated right away postpartum

59
Q

medications that can reduce the effectiveness of COCs

A

antiretroviral therapy
rifampin (abx)
anticonvulsants (carbamazepine, phenytoin, primidone, topiramate, lamictal)
St. Johns wort

60
Q

safety / side effect considerations for COCs

A

VTE
may increase BP in some women
changes in libido
depression (rare)
increased cholesterol in bile (gallstones)
headaches
breast tenderness

61
Q

non contraceptive benefits of COCs

A

decreased risk ovarian cancer
deceased risk endometrial cancer by 50%
fewer ectopic pregnancies
decreased PID rates
helps acne
reduced risk of ovarian cysts
regulate menstrual cycles / abnormal bleeding
lighter periods (anemia)

62
Q

Tulane (contraceptive patch) MOA

A

patch worn on arm releases estradiol/progestin - systemic effect similar to COC pills
woman applies and one buttock, arm, abdomen, anywhere on upper torso except breast once every seven days, then takes one week off every 3rd week (like pills) for withdrawal bleed

63
Q

Vaginal ring (Nuvaring) MOA

A

releases estradiol and progestin - reaches steady state in serum
ring left in place in vagina for 21 days, then removed for 7 days

64
Q

disadvantages of the patch and ring

A

only one formulation available of each
ongoing costs
environmental - both methods both contain large amounts of hormones/active ingredients upon disposal

65
Q

progestin only pills efficacy

A

little data on efficacy, but less than COCs - do not suppress ovulation, rely mostly on thickening of cervical mucus

very time sensitive - need to be taken at same time each day - taking even 3 hours late may allow mucus to return to fertile state

66
Q

common side effects POPs

A

unscheduled bleeding (esp during first 6 months)
spotting

67
Q

benefits of POPs

A

improve menstrual symptoms - dysmenorrhea, menorrhagia, PMS, anemia
protective against PID

68
Q

Depo Provera / Depo MOA

A

IM or SubQ injection of DMPA (synthetic progestogen - different from synthetic progestin in PO contraceptives) - powerful inhibitor of HPA axis at level of hypothalamus –> suppresses ovulation

69
Q

Suzy had the MMR vaccine in your office 2 weeks ago - how long until she should wait to try to get pregnant?

A

Wait at least 4 weeks after MMR to try for pregnancy

70
Q

individuals who desire a pregnancy and have no history of neural tube defects should be advised to take how much foilc acid during preconception period

A

400 mcg folic acid in preconception period

71
Q

individuals who eat fish should be encouraged to eat which fish in preconception time period?

A

salmon
scallops
MN caught sunfish

Avoid: swordfish, MN caught walleye >20 inches

72
Q

what is Hegar’s sign

A

lower segment of the uterus becomes soft for a short period approximately 4-6 weeks after LMP / 2 weeks after conception - can compress lower segment on bimanual exam

73
Q

describe the two processes that cause uterine growth during pregnancy

A
  1. estrogen and progesterone induced hyperplasia of smooth muscle cells in myometrium
  2. hypertrophy of the uterine muscles later in pregnancy
74
Q

cervix length in non-pregnant persons

A

3 cm long

75
Q

Goodell’s sign

A

cervical softening occurring about 4 weeks after first day of LMP; due to increased estrogen

76
Q

Chadwick’s sign

A

bluish discoloration of cervix that occurs 6-8 weeks gestation

77
Q

when is Chadwick’s sign first evident during pregnancy

A

6-8 weeks gestation

78
Q

what is cervical ripening

A

term used to describe the process of accelerated remodeling and softening that begins weeks prior to the onset of labor

79
Q

hCG functions during pregnancy

A

-stimulates production of progesterone from corpus luteum
-prevents degeneration of corpus luteum
-promotes angiogenesis in uterine vasculature
-stimulates thyroid production of thyroxine in 1st trimester
-suppresses myometrial contractions

80
Q

human placental lactogen (hPL) functions during pregnancy

A

-increases insulin resistance
-stimulates production of growth hormones

81
Q

progesterone functions during pregnancy

A

-promotes systemic vasodilation
-prevents myometrial contractility
-inhibits uterine production of prostaglandins
-suppports mammary growth for lactation
-withdrawal at term –> uterine contractions

82
Q

estrogen functions during pregnancy

A

-increases uterine blood flod
-promotes growth of uterus and breast glandular tissue
-increases production of insulin-like growth factors
-increases myometrial sensitivity to oxytocin

83
Q

when is hCG first detectable

A

about 8-10 days after ovulation or shortly before the first missed period

84
Q

Human placental lactogen (hPL) functions during pregnancy

A

ensures adequate fetal nutrition (glucose) by altering maternal glucose metabolism so glucose is available for fetal uptake; increases maternal insulin resistance –> more glucose in blood for fetus

85
Q

suppresses maternal immune response to fetal antigens so fetal tissue is not rejected

A

progesterone

86
Q

describe the process of estrogen production during pregnancy

A

corpus luteum secretes until weeks 8-9

Fetus adrenal glands mature enough to produce estrogen precursors and placenta produces active form of estrogen –> process flies on input from both maternal and fetal adrenal cortex

87
Q

fertilization location (typically) and length

A

Fallopian tube; 18-24 hours

88
Q

gravida

A

total number of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants (ex: twins) were born from a pregnancy; current pregnancy IS included in gravid count

89
Q

nulligravida

A

a woman who has never been pregnant

90
Q

primigravida

A

a woman who is pregnant for the first time

91
Q

multigravida

A

a woman who has been pregnant more than twice

92
Q

para

A

the number of times a woman has given birth to a fetus of at least 20 weeks gestation (viable or not viable), counting multiple births as ONE birth event

93
Q

nullipara

A

a woman who has not remained pregnant beyond 20 weeks gestation

94
Q

primipara

A

a woman who has had one pregnancy in which the fetus or fetuses reached 20 weeks gestation; this woman has given birth once

95
Q

multipara

A

a woman who has had two or more pregnancies in which the fetus / fetuses reached 20 weeks gestation; this woman has given birth more than once (counting multiple births as one birth event)

96
Q

G2P0

A

woman who has been pregnant twice and no births; she may have had abortions or miscarriages

97
Q

G2P1

A

woman who is currently pregnant. She has had one prior pregnancy that resulted in an infant born at 38 weeks gestation

98
Q

Gravida/para/TPAL 4 digit nomenclature - what does TPAL stand for

A

T: term; number of term births the woman has experienced; term is any gestation of 37 weeks

P: preterm; number of preterm births the woman has experienced; preamature = born between 20 and 37 completed weeks gestation

A: abortion; number of pregnancies ending in abortion (spontaneous or induced); any delivered fetus before 20 weeks

L: living: number of children living currently

99
Q

G3 P2002

A

Woman who is currently pregnant with her third pregnancy; she gave birth to a full-term baby with each prior pregnancy; both of whom are living

100
Q

G2 P0101

A

woman who is currently pregnant. she gave birth to one preterm infant and has one living child.

101
Q

G2 P1103

A

woman who is currently pregnant w/ 3rd pregnancy; she gave birth to one full-term infant and preterm twins; all 3 offspring are alive

102
Q

First trimester, second trimester, and third trimester weeks gestation

A

First: week 1-12
Second: 13-28
Third: 28-40

post term = >40 weeks gestation

103
Q

normal hemoglobin pregnancy (each trimester)

A

1st trimester: 11.6-13.9
2nd: 9.7-14.8
3rd: 9.5-15

104
Q

normal hematocrit pregnancy (each trimester)

A

1st: 31-41
2nd: 30-39
3rd: 28-40

normal in non-pregnant = 32-45

105
Q

normal WBC count pregnancy (each trimester)

A

1st: 5,7-13.6
2nd: 5.6-13.8
3rd: 5.9-16.9

normal non-pregnant: 3.9-12.5

106
Q

when in pregnancy is chorionic villus sampling done

A

first trimester

107
Q

when in pregnancy is amniocentesis performed

A

second trimester

108
Q

Describe prenatal visit schedule throughout pregnancy

A

every 4 weeks up to 28 weeks, every 2 weeks from 28-36 weeks, and every 1 week from 36 weeks until delivery

109
Q

risk of gestational DM

A

-preeclampsia
-polyhydroamnios
-C-section
-infant with macrosomia, shoulder dystocia, hypoglycemia, and hyperbilirubinemia
-developing DM2 after pregnancy

110
Q

When do you screen for GDM during pregnancy

A

two times - early first trimester/entrance to care and second trimester 24-28 weeks

*If dx with DM in first trimester, dx with DM2. If dx with DM in second trimester, GDM.

111
Q

leading cause of early-onset newborn sepsis in the US

A

group B strep (normal flora in many women’s GU tract - screen for it before birth - around 35-37 weeks)

112
Q

woman’s vaginal/rectal culture is positive for group B strep - what do you do

A

discuss IV penicillin prophylaxis in active labor or after rupture of membranes to prevent sepsis in the newborn

113
Q

recommended total weight gain for underweight pregestational weight

A

28-40 lbs

114
Q

recommended Toal weight gain for normal pregestational weight (BMI 18-24)

A

25-35 lbs

115
Q

recommended total weight gain for overweight pregestational weight (BMI 25-29)

A

15-25 lbs

116
Q

recommended total weight gain for obese pregestational weight (BMI >30)

A

11-20 lbs

NURS 6305 (2 decks)

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