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Final Flashcards

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1
Q

definition of infertility

A

No conception after 1 year of unprotected intercourse

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2
Q

Professional advice should be sought after 6 months if any of the following factors are present

A
  • 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
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3
Q

basic causes of infertility for females

A 
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)
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4
Q

basic causes of infertility for males

A 
varicocele
hydrocele
defective ejaculation
cryptochordism
antisperm antibodies
infection
hormonal issues
congenital disorders and chromosomal
testicular cancer
trauma
torsion
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5
Q

Testing for infertility

A

semen analysis
menstrual hx
LH surge assessment in urine and/or luteal phase progesterone
Day 3 Serum FSH and estradiol levels

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6
Q

Naturopathic treatments for infertility (males)

A

Supplements: Vit C (1-5 qd), Vit E (400 IU qd)
Botanicals: ginseng (5-30 gtts BID), oats (15-30 gtts TID)

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7
Q

Naturopathic treatments for infertility (females)

A

Vitex angus castus with aletris, cimicifuga (1/2 tsp BID)

Supplements: Vit E (400 IU QID), Zn (50 mg QID)

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8
Q

Labor

A

regular uterine contraction
progressive cervical effacement
progressive uterine dilation

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9
Q

term pregnancy

A

37-42 weeks

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10
Q

what stimulates contractions?

A

oxytocin (oxytocin levels don’t increase but rather receptors become more sensitive)

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11
Q

Hormones/factors involved in the parturitional cascade (during onset of labor)

A

Prostaglandins: increased to soften cervix and help contractions
Progesterone: withdrawal (doesn’t always occur)
Estrogen: up regulates receptors in uterus increasing contractility

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12
Q

Fetal secretions of what starts the cascade?

A

Cortisol appears to increase placental CRH, CRH enhances prostaglandins and potentiates the effects of oxytocin

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13
Q

First stage of labor

A

interval between the onset of labor and full cervical dilation

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14
Q

full cervical dilation

A

10 cm

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15
Q

the 3 phases under first stage?

A
  • 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
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16
Q

Second stage of labor

A

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

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17
Q

what are the cardinal movements?

A

flexion and descent
internal rotation
extension of head
restitution once head is free (external rotation)
delivery of ant. shoulder, then posterior shoulder

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18
Q

3 P’s of labor

A

power (strength of uterine contractions)
passenger (refers to fetus)
pelvis

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19
Q

what indicates onset of labor?

A

regular firm contractions
bloody show (cervical changes)
spontaneous rupture of membranes (rupture of amniotic sac)

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20
Q

Initial examination

A 
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
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21
Q

widest part of head to deliver through narrows part of pelvis?

A

biparietal diameter through the ischial spines of pelvis

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22
Q

monitoring during labor

A

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)

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23
Q

what activity should you encourage in a woman during labor?

A

empty their bladders regularly

change positions frequently (every 1-2 hrs)

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24
Q

what are some easy pain relief measures?

A

position changes
massage
warm water
homeopathy

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25
what can you do to augment labor (make it stronger)
``` hydration calories (sugar, protein and fat) acupuncture herbs (black cohosh, mistle toe) breast pump ```
26
what is amniotomy and why might you do it?
artificial rupture of membranes | to encourage labor
27
positions for pushing in second stage?
follow mom's lead | consider squatting, hands and knees, sitting in tub
28
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
29
on avg how long does second stage last?
2 hrs (with multiparous 1 hr)
30
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
31
what stimulates breast tissue development during pregnancy?
hCG, progesteron and prlactin
32
after delivery what leads to colostrum secretion?
drop in progesterone | presence of prolactin and cortisol
33
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)
34
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
35
role of colostrum?
helps establish gut flora | laxative effects
36
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)
37
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
38
infant long-term benefits of breastfeeding?
decreases risk of obesity | decreases risk of type 1 diabetes
39
maternal benefits to breastfeeding?
prolong postpartum anovulation postpartum weight loss accelerates recovery from childbirth
40
how soon after deliver should breastfeeding be initiated?
within 1st hour
41
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
42
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
43
efficient transfer depends on coordination of which two actions?
suck/swallow
44
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
45
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)
46
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
47
normal nipple sensitivity
first week of breastfeeding, painful latch that should subside 1 minute into breastfeeding
48
management of nipple pain
let nipples air dry cool or warm compresses apply expressed breast milk to nipples
49
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)
50
specific homeopathy and herbal treatments for mastitis?
- homeopathy- phytolacca, belladonna, bryonia | - herbs- biovegetarian, echinacea, topically apply ginger
51
pharmaceuticals for mastitis?
antibiotics (dicloxacillin, cephalexin, climdamycin)
52
breast abscess
localized collection of pus within the breast tissue (bigger than plugged duct)
53
when to consider US?
for any mastitis refractive to treatment | increasing pain
54
strategies for weaning
nurse until at least 1 year old drop session every 2-5 days shorten each breastfeeding session introduce bottles, cup feedings
55
types of formula
- cow's milk - soy - partial whey hydrolysate - extensive casein or whey hydrolysate - amino acid based
56
what's thirst stage?
the interval between fetal delivery and complete expulsion of the placenta
57
Risk of Post partum hemorrhage (PPH) increases with?
length of third stage
58
benefits to delayed cord clamping?
- assoc. with higher hemoglobin levels - reduced the incidence of anemia in half - increase value to preterm infants
59
disadvantages to delayed cord clamping?
- contributes to a higher rate of polycythemia in neonates | - Greater incidence of phototherapy needed for jaundice in term infants
60
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
61
normal placental separation
uterine muscle thickens following delivery of the infant reducing surface area and placental shearing takes place: upper area detaches last
62
signs of placental shearing
- gush of blood - umbilical cord lengthening - uterus becomes firmer and globular - uterus moves upward
63
what could help mother with placental expulsion?
upright position
64
what volume of blood is considered post partum hemorrhage (PPH)
blood loss of 500 ml or greater
65
causes of PPH?
- uterine atony - episiotomy - retained products of conception - maternal coagulation defects
66
characteristics of cord
2 arteries, 1 vein inserted into center of placenta 55 cm long
67
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

Natural Childbirth (2 decks)

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