Final Flashcards
definition of infertility
No conception after 1 year of unprotected intercourse
Professional advice should be sought after 6 months if any of the following factors are present
- Female partner over age 35
- Irregular or absent menstrual periods
- 2 or more miscarriages
- Prior history of tubal disease or pelvic infection
- History or current infection of the prostate
- Reversal of surgical sterilization of either partner
- Endometriosis
- Breast discharge
- Excessive acne or hirsutism
basic causes of infertility for females
Ovarian issues (oligoovulation, anovulation, oocyte aging) Fallopian tube abnormalities/pelvic adhesions (PID, endometriosis, previous surgeries, IBD) Uterine issues (reduced implantation, leiomyomas) Luteal phase defects (abnormalities of corpus luteum causing inadequate progesterone) Cervical factors (cervical mucus, stenosis)
basic causes of infertility for males
varicocele hydrocele defective ejaculation cryptochordism antisperm antibodies infection hormonal issues congenital disorders and chromosomal testicular cancer trauma torsion
Testing for infertility
semen analysis
menstrual hx
LH surge assessment in urine and/or luteal phase progesterone
Day 3 Serum FSH and estradiol levels
Naturopathic treatments for infertility (males)
Supplements: Vit C (1-5 qd), Vit E (400 IU qd)
Botanicals: ginseng (5-30 gtts BID), oats (15-30 gtts TID)
Naturopathic treatments for infertility (females)
Vitex angus castus with aletris, cimicifuga (1/2 tsp BID)
Supplements: Vit E (400 IU QID), Zn (50 mg QID)
Labor
regular uterine contraction
progressive cervical effacement
progressive uterine dilation
term pregnancy
37-42 weeks
what stimulates contractions?
oxytocin (oxytocin levels don’t increase but rather receptors become more sensitive)
Hormones/factors involved in the parturitional cascade (during onset of labor)
Prostaglandins: increased to soften cervix and help contractions
Progesterone: withdrawal (doesn’t always occur)
Estrogen: up regulates receptors in uterus increasing contractility
Fetal secretions of what starts the cascade?
Cortisol appears to increase placental CRH, CRH enhances prostaglandins and potentiates the effects of oxytocin
First stage of labor
interval between the onset of labor and full cervical dilation
full cervical dilation
10 cm
the 3 phases under first stage?
- Latent phase: slow dilation, contraction are 5-10 min apart, lasting 30-45 sec
- Active phase: faster rate of dilation, begins at 4 cm dilation, contraction often 2-4 min apart, lasting 60 seconds
- Transition phase: begins at 7cm, characterized by a mix of dilation and descent of fetus
Second stage of labor
refers to the interval between full cervical dilation and delivery of infant
this is where the maternal desire to bear down (push) with contractions usu starts
what are the cardinal movements?
flexion and descent
internal rotation
extension of head
restitution once head is free (external rotation)
delivery of ant. shoulder, then posterior shoulder
3 P’s of labor
power (strength of uterine contractions)
passenger (refers to fetus)
pelvis
what indicates onset of labor?
regular firm contractions
bloody show (cervical changes)
spontaneous rupture of membranes (rupture of amniotic sac)
Initial examination
dilation of cervix (0-10 cm) effacement of cervix (0-100%) station of fetal head (-5 to +5) status of amniotic membranes/presence of meconium presentation and position of fetus
widest part of head to deliver through narrows part of pelvis?
biparietal diameter through the ischial spines of pelvis
monitoring during labor
vital every 4 hrs if normal (1-2 hrs with abnormalities)
assessment of uterine contractions
cervical examinations
fetal heart rate (every 15-60 min during first stage, every 5 min during second stage, listen during and after contractions, normal range is 110-160 bpm)
what activity should you encourage in a woman during labor?
empty their bladders regularly
change positions frequently (every 1-2 hrs)
what are some easy pain relief measures?
position changes
massage
warm water
homeopathy
what can you do to augment labor (make it stronger)
hydration calories (sugar, protein and fat) acupuncture herbs (black cohosh, mistle toe) breast pump
what is amniotomy and why might you do it?
artificial rupture of membranes
to encourage labor
positions for pushing in second stage?
follow mom’s lead
consider squatting, hands and knees, sitting in tub
pushing techniques
valsalva - pull back knees, tuck in chin, take a deep breath and hold it and push
physiologic - she pushes when she feels a need
on avg how long does second stage last?
2 hrs (with multiparous 1 hr)
Steps in assisting birth
- Woman pushes to crowning
- At crowning, coach her to pant or give little pushes to allow perineum to stretch
- Place one hand on the vertex of the fetal head to keep head flexed. Can also apply some counter-pressure
- After head is delivered, allow for spontaneous restitution
- Reduce nuchal cord (umbilical cord around baby’s neck) if present
- With next contraction, apply gentle downward traction toward the maternal sacrum to delivery the anterior shoulder
- As soon as anterior shoulder becomes visible, deliver posterior shoulder with upward traction
what stimulates breast tissue development during pregnancy?
hCG, progesteron and prlactin
after delivery what leads to colostrum secretion?
drop in progesterone
presence of prolactin and cortisol
what leads to milk ejection?
tactile stimulation of the nipple by infant leads to release of oxytocin (cause contraction of mammary glands, pushing milk into ducts and out through nipple)
when is colostrum produced? what’s in the stuff?
- present first 2 days of life
- low in calories and fat
- high in minerals, protein, fat-soluble vitamins, antibodies
role of colostrum?
helps establish gut flora
laxative effects
when does breastmilk come in? what’s in the stuff?
- at 2 1/2 to 3 1/2 days
- protein (whey and casein), lipids, carbs (lactose), minerals (bioavailable iron), beneficial flora and antibodies (IgA and IgG)
role of breastmilk?
- Bacteriostatic and immune modulating
- Fewer infections of any kind in nursing infants
- Anti-inflammatory
- Aids in digestion
- Promotes growth of crypt cells in the infant’s intestinal tract
infant long-term benefits of breastfeeding?
decreases risk of obesity
decreases risk of type 1 diabetes
maternal benefits to breastfeeding?
prolong postpartum anovulation
postpartum weight loss
accelerates recovery from childbirth
how soon after deliver should breastfeeding be initiated?
within 1st hour
breastfeeding positions
Baby belly to belly with mom
Baby’s mouth aligned with mom’s nipple
Neck slightly extended
Ear, shoulder, and hips are in alignment
cradle or cross cradle position or seated
initiation of breastfeeding
latch-on: formation of a tight seal of the infant’s lips around the mother’s nipple and areola, infants mouth must be wide open
milk transfer: infant tongue elongates the nipple and compresses the ducts
efficient transfer depends on coordination of which two actions?
suck/swallow
when to feed?
demand feeding (in response to infant cues like licking, rooting, sucking and crying)
8-12 X per 24 hrs
10-15 min per breast
weight loss/gain of infant
- normal to lose up to 10% of body weight in first 5 days of life (due to colostrum)
- should be back to birth weight by 2 weeks
- avg gain thereafter is 15-40 g per day (1/2 to 1 1/2 oz daily)
stool changes
- meconium- black tarry lining of intestinal tract present at birth to first 3 days
- transition stool- should be present by day 3
- breast milk stool- orange/yellow and seedy, should be present by day 5, should see at least 3 per day
normal nipple sensitivity
first week of breastfeeding, painful latch that should subside 1 minute into breastfeeding
management of nipple pain
let nipples air dry
cool or warm compresses
apply expressed breast milk to nipples
causes of breast pain and tx
- engorgement- accumulation of breast milk that results in firmness of breast tissue (tx: completely drain breasts, compresses, cabbage leaves)
- plugged ducts- localized areas of milk statis (tx: above plus manual massage, homeopathy)
- mastitis- local inflammation of the breast assoc. with fever, muscle pain, breast pain and erythema (tx: improve breastfeeding technique, completely empty breasts, nurse on affected side first, increase frequency of feeding, hydrotherapy)
specific homeopathy and herbal treatments for mastitis?
- homeopathy- phytolacca, belladonna, bryonia
- herbs- biovegetarian, echinacea, topically apply ginger
pharmaceuticals for mastitis?
antibiotics (dicloxacillin, cephalexin, climdamycin)
breast abscess
localized collection of pus within the breast tissue (bigger than plugged duct)
when to consider US?
for any mastitis refractive to treatment
increasing pain
strategies for weaning
nurse until at least 1 year old
drop session every 2-5 days
shorten each breastfeeding session
introduce bottles, cup feedings
types of formula
- cow’s milk
- soy
- partial whey hydrolysate
- extensive casein or whey hydrolysate
- amino acid based
what’s thirst stage?
the interval between fetal delivery and complete expulsion of the placenta
Risk of Post partum hemorrhage (PPH) increases with?
length of third stage
benefits to delayed cord clamping?
- assoc. with higher hemoglobin levels
- reduced the incidence of anemia in half
- increase value to preterm infants
disadvantages to delayed cord clamping?
- contributes to a higher rate of polycythemia in neonates
- Greater incidence of phototherapy needed for jaundice in term infants
what’s cord milking? what’s the benefit here?
- the umbilical cord can be milked or stripped to enhance blood transfusion, would do this instead of delayed cord clamping
- helps to stabilize bp and increase urinary output
- higher hemoglobin levels
normal placental separation
uterine muscle thickens following delivery of the infant reducing surface area and placental shearing takes place: upper area detaches last
signs of placental shearing
- gush of blood
- umbilical cord lengthening
- uterus becomes firmer and globular
- uterus moves upward
what could help mother with placental expulsion?
upright position
what volume of blood is considered post partum hemorrhage (PPH)
blood loss of 500 ml or greater
causes of PPH?
- uterine atony
- episiotomy
- retained products of conception
- maternal coagulation defects
characteristics of cord
2 arteries, 1 vein
inserted into center of placenta
55 cm long
emergency delivery
-Sterility: wash hands, and keep everything else as clean as possible.
-Slow delivery of head: give slight resistance to prevent head from just popping out. Ease it out. May need to tell mom to slow down. Panting to slow delivery
-Check for nuchal cord once the head is delivered
Get slack into cord and slip it over head if at all possible
-Deliver body carefully, they are slippery. Most babies come on their own after shoulders deliver.
-Dry them off and then wrap baby to keep it warm.
-If infant is not immediately breathing, rub the baby vigorously, along spine; and or acupressure to Kidney 1
-Deliver placenta if unavoidable or mother is bleeding, otherwise wait for help if she is stable: get it delivered and keep it for later observation.
-Massage uterus after placental delivery to decrease blood loss and keep uterus firm
-Don’t bother to clamp and cut the cord. It won’t hurt the baby, even if attached for hours. Better to wait for sterile instruments
