Intro to Maternal Child Flashcards
1
Q
Does the US lag behind rest of world in maternal/child mortality?
A
yes
2
Q
what are causes of child mortality?
A
low birth weight, education, antiseptic
3
Q
how is government involved?
A
beginning of state programs for women and children
4
Q
Family-Centered Maternity Care
A
safe, quality care which began to focus on the whole family
5
Q
goal of maternal/child health
A
meet the needs of the family unit
6
Q
Birth Centers
A
need to be a low-risk pregnancy, birth, and postpartum. Not only are these free standing facilities but they also provide women’s health care for non-pregnant women by delivering annual checks and family planning counseling
7
Q
Preconception counseling - women
A
- lower child mortality - Talk to men/women about conception long before you even think about it - What healthy choices do I need to make before I have a baby?
8
Q
Preconception counseling - men
A
- smoking effects sperm - Alcohol causes FAS, used to think that it was only Mom - Congenital defect, can it be changed prior to conception
9
Q
Home birth
A
- Facilitate family bonding - Once health of mom and baby are secured work on bonding - Really want Mom/Dad to go skin to skin right away to start bonding process
10
Q
home birth cons
A
- Client should have a low risk pregnancy - Certified midwife must have a DR backup - What is the time from home to hospital in the event of an emergency? - less support
11
Q
why is there less support for home birth?
A
- no nurses are available to provide maternal or infant care - Midwife is busy with mom
12
Q
home birth pros
A
- Keeps families together in their own environment - Facilitates family bonding
13
Q
Is it ok to have family in room?
A
ok as long as they don’t impede bonding
14
Q
what happened when we sent mothers home shortly after giving birth?
A
- Postpartum infection when moms were sent home early - Insurance companies backed off on sending Moms home so early
15
Q
How were children viewed in the earlier history of the United States?
A
- Slow to respond to the health care needs of children despite early studies on children. - Late 19th century strives were being made to decrease childhood mortality. - Discovery of vaccine, public health practices, child labor laws, etc
16
Q
Current Healthcare Trends
A
- Cost containment-managed care, HMO, PPO - Home care - Health Insurance - Healthcare Assistance Programs
17
Q
Healthcare Assistance Programs
A
- WIC - Healthy Start - March of Dimes
18
Q
Maternal mortality
A
- 12.1 per 100,000 live births for all women - 30.5 for African American women - 8.7 for white women
19
Q
Infant mortality
A
6.8 per 1000 live births
20
Q
Childhood mortality
A
ages 1-19
21
Q
Morbidity
A
ratio of sick to well person per 1000 people
22
Q
Ethical Issues
A
- abortion - Elective abortion - Mandated contraception - Fetal injury - Fetal therapy - Infertility treatment - Child Health Nursing - Cessation of treatment/terminate life support
23
Q
Abortion
A
- don’t comment - give facts - take care of people - If someone asks what you think about it - just provide information
24
Q
Elective abortion
A
- not our job to punish or criticize - must put views aside and take care of patient - Just provide info
25
Mandated contraception
- See with mentally ill/handicapped (1950s) - Not our place to judge - Be supportive - Court ordered
26
court ordered contraception...
- children repeatedly taken away - alcohol/drug abuse
27
Fetal injury
- mom tries to abort fetus on own - Chemical impairment
28
Fetal therapy
surgical interventions
29
Infertility treatment
If you are infertile is it right to use tissue made in a lab
30
Child Health Nursing
- Public health/Home health - Try to keep kids with parents
31
Cessation of treatment/terminate life support
mom or baby
32
Societal Issues
- cycle of poverty - homelessness - access to health care - prenatal care - Medicaid - violence - adoption
33
cycle of poverty
- can it be broken - poor parenting - can someone rise above
34
access to health care
- hopefully it gets better
35
prenatal care
- advocate for everyone
36
medicaid
help someone sign up
37
violence
- not always men/women - could be parent/kids and kids/parents
38
adoption
- always a choice - talk openly with parents
39
legal issues
- Nurse Practice Act - Standard of Care - Accountability - Malpractice - Documentation
40
Nurse Practice Act
- what does it say - std of care for women/child
41
std of care
what is acceptable and what is not
42
accountability
- highest place of malpractice (especially OB) - family practice shies away from delivering babies now because they always got sued
43
malpractice
Informed consent, competence, full disclosure, information, consent, refusal of care
44
documentation
most important part of nurse's job
45
Role of nurse
- care provider - teacher - collaborator - researcher - advocate - manager
46
care provider
direct care to patient
47
teacher
- education to promote health, prenatal care, and newborn care - extremely important, enormous amount of information to get to mom in a short time - have a plan to get information out
48
Collaborator
Lab, Doctor, OR staff, court
49
Researcher
apply research to practice
50
Advocate
- humanize and personalize care - Baby taken by court
51
Manager
delegate tasks and coordinate care
52
Advanced Practice Nurses
- Certified Nurse-Midwives (CNM) - Nurse Practitioner-primary care - Clinical Nurse Specialist (CNS)-not primary care
53
Certified Nurse-Midwives (CNM)
- provide complete care in uncomplicated pregnancies, during pregnancy, childbirth and postpartum - prescribes meds
54
Nurse Practitioner-primary care
- No deliveries - Yearly visit - Prescribes meds
55
Clinical Nurse Specialist (CNS)-not primary care
- Masters - Find specialty they want to work in (wound, ostomy) - Can prescribe wound methods but not meds
56
Family Issues
- Types of families - High risk families - Cultural influences - Religious influences - Parenting styles
57
Types of families
- traditional, nontraditional, single-parent, blended, adoptive, multigenerational, same-sex, and communal - whatever the patient says it is
58
High risk families
Social and physical
59
Cultural influences
- be open - why is it there? - is it hurting anyone? - leave if there is no harm
60
Religious influences
- female circumcision - virginal in arranged marriages - African tribes and mediterranean
61
parenting styles
- this is what the parent would like to happen - distinct wants
62
Mother’s ovum
X chromosome
63
Father’s sperm
X or Y chromosome
64
XX
female
65
XY
male
66
when is genetic sex determined?
conception
67
Sexually undifferentiated
even though sex is determined at conception, the reproductive systems of males/females is similar for the first 6 weeks
68
Sexually differentiation at 12 weeks
- 7th week internal organs begin differentiating - 9th week external organs begin differentiating - 12th week sexually differentiation is about complete
69
are sex glands active during infancy and childhood?
no
70
when do sex organs become functional?
puberty
71
average age of menstruating
9 yrs old
72
what cause girls to menstruate early?
hormones that they ingest
73
puberty
period of life when the body experiences a growth spurt, the reproductive organs develop to adult size and function
74
when does sexual development begin?
conception
75
is sexual development active during childhood?
no
76
what does the hypothalamus produce to begin puberty?
gonadotropin-releasing hormone
77
when do sex organs become fully functional?
during the phase of puberty
78
are girls born with all the eggs they will ever have?
yes
79
menarche
1st menstrual period
80
menses
normal flow of blood and tissue during menstruation
81
Menopause
normal cessation of menstrual function that usually occurs in the 5th or 6th decade of life; the final menstrual period
82
do you need to use birth control during pre-menopause?
yes
83
do men make sperm every day?
yes
84
when does sperm count begin to decrease?
when they are in their 60s
85
female changes in puberty
- breast - pelvis - body hair - growth spurt - external genitalia and reproductive organs - early menstrual cycles irregular
86
female changes in puberty - breast
first visible signs of change, nipples and areola protrude from enlargement, glandular and ductal tissue develops and fat deposits begin
87
female changes in puberty - pelvis
widens, hips become rounder/contoured from fat deposits, and becomes favorable for childbirth
88
female changes in puberty - body hair
pubic and axillary develop; becomes thicker with maturation, and varies among ethnic groups
89
female changes in puberty - growth spurt
Growth and changes begins and ends earlier than in males
90
female changes in puberty - external genitalia and reproductive organs
grow larger, vaginal mucosa changes, menstrual cycle begins
91
amenorrhea
absence of menstruation or first period has not begun
92
male puberty changes
- testes - penis - nocturnal emissions - body hair - increased muscle mass - skeletal growth - voice changes
93
male puberty changes - testes
Growth of testes (first) between 10 – 17 years of age
94
male puberty changes - penis
Penis lengthening and growth begins about 1 year after testicular growth begins
95
male puberty changes - nocturnal emissions
“wet dreams” common in adolescence, often during dreams of sexual content
96
male puberty changes - body hair
○ pubic hair begins at base of penis, axillary hair growth begins in about 2 years, facial changes from fine downy texture to the male beard, increased growth of chest and back hair. Amounts of hair growth varies in ethnic groups.
97
male puberty changes - increased muscle mass
cause by testosterone (50% more than female at maturity)
98
male puberty changes - skeletal growth
longer growth spurts than girls resulting in great height
99
male puberty changes - voice changes
caused by enlargement of the larynx and hypertrophy of the laryngeal mucosa
100
spermatogenesis
formation of male gametes (sperm) in the testes
101
climacteric
woman's ability to reproduce decreases over a period of years; physical/emotional changes that occur at the end of the reproductive period
102
perimenopause
the time from onset of symptoms associated with climacteric until at least 1 year after the last menstrual period
103
female reproductive anatomy
- mons pubis - Labia majora and minora - clitoris - vestibule - external vulva - hymen - perineum
104
mons pubis
- Protection, soft cushion over pubic, protect fetus
105
clitoris
Sexual pleasure
106
Vestibule
- structures enclosed by labia minora - urinary meatus - vaginal introitus - ducts of skene - bartholin glands
107
External “vulva”
- mons pubis - labia majora - labia minora - clitoris - vestibule
108
hymen
- thin fold of mucosa partially separating the vagina from the vestibule - should be there until 4, 5 or 6 years old - might be asked if hymen is intact if sexual abuse is suspected
109
Perineum
- fibrous and muscular tissue supporting the pelvic structures - distal portion of vulva to the superior part of rectum - below vaginal opening to opening of rectum
110
female reproductive anatomy - internal
- vagina
- uterus
- fallopian tubes
- ovaris
- cervix
111
uterus
* Should not have a septum
112
Bicornate uterus
- septum down middle of uterus
113
fallopian tubes
might have more than two
pathway between ovary and uterus
114
oviduct
fallopian tube
115
cilia
hairlike process that beat rhythmically toward the uterus to propel ovum through the tube
116
fallopian tubes - division
* interstial
* isthmus
* ampulla
* infundibulum
117
fallopian tube - interstitial
runs into the uterine cavity and lies within the uterine wall
118
fallopian tube - isthmus
narrow part of the tube adjacent to the uterus
119
fallopian tube - ampulla
wider area of the tube lateral to the isthmus, where fertilization occurs
120
fallopian tube - infundibulum
-shaped terminal end of the wide funnel-shaped
121
ovaries
* Produce estrogen and progesterone
* Produce an ovum with each cycle
* FSH is released (develops ovum) and LH continues process, egg released by ovary, into fallopian tube and brought into uterus
122
dysfunctional cycle
ovum is not release
123
cervix
* External os
* Cervical canal
* Internal os
124
external os
* opening of cervix
* papsmear should not be done here
125
where should papsmear be done?
cervical canal
126
Endometrial biopsy
* catheter has to go through internal os and be in uterus
* this procedure may hurt
127
internal os
* sterile
* tight opening
* will feel more resistance here when inserting cath
* opening to uterus
128
where is iud placed?
* uterus
* string should protrude from external os
* can wander but that is not common
129
Round and broad ligament
* no problems in non-pregnant
* pregnant get intense pains in abdomen when sit/stand, usually towards end of pregnancy
* may come in thinking they are in labor but if everything is ok it is probably the round/broad ligament
130
does the uterus lay on the bladder?
yes
131
why do women get urinary infection?
* Short distance between meatus and anus is why women get urinary tract infection
* Bacteria in GI tract
132
do you see urinary tract infection in men?
* not usually in men under 50 yrs
* more common in men over 50 yrs but is a sign of concern
133
what does a urinary tract infection in a man signify?
* usually something more serious
* have add'l tests
* could be a sign of bladder or prostrate cancer
134
support structures of female reproductive organs
* pelvis
* muscles
* ligaments
* blood supply
* nerve supply
135
female breast
* nipple
* areola
* montgomery tubercle
* alveoli
136
nipple
small raised area at center of breast
137
Areola
circular area around nipple
138
Montgomery tubercle
* small raised areas in areola
* Keeps nipple soft
* Secrete in women if they are going to nurse
139
Alveoli
secreting cells/produce milk
140
what is the most common length of the female reproductive cycle?
28 days
141
what two things happen at the same time during the reproductive cycle?
ovarian and endometrial cycles
142
what directly influences the endometrial cycle to happen?
ovarian cycle
143
will the endometrial cycle have a dysfunction if the ovarian cycle does?
yes
144
Corpus luteum
is the place on ovary where that particular ovum is growing; job to secrete high amount of progesterone, if conceived need high levels of progesterone to make pregnancy successful; if conception doesn’t occur the corpus luteum decreases secretion of progesterone
145
what are the phases of the ovarian cycle?
* Follicular phase
* Ovulatory phase
* Luteal phase
146
Follicular phase
* Days 1 - 14
* Decrease in estrogen and progesterone just before menstruation stimulates FSH and LH
* One follicle matures first
147
ovulatory phase
* 2 days before ovulation
* FSH and LH rise, slight decrease in estrogen, progesterone increase
* Ovulation occurs could be anywhere between 12 – 15 days; usually day 13 & 14
* Release of mature ovum
148
why is there a change in cervical mucus during ovulatory phase?
helps sperm get to where it needs to be
149
Luteal phase
* from ovulation to end of cycle
* single most important phase
* corpus luteum
* need it to last 13/14 days
150
corpus luteum
* is the place on ovary where that particular ovum grew and was release
* the left over/collapsed follicle remains and secretes high amount of progesterone
* if conception occurs need high levels of progesterone to make pregnancy successful
* if conception doesn’t occur the corpus luteum decreases secretion of progesterone
151
what happens if luteal phase is only 9 days long?
ovum gets to uterus too early
152
what happens is luteal phase lasts 17/18 days?
endometrial phase has started to slough
153
why may progesterone shots be given during ovarian cycle - luteal phase?
to support possible pregnancy
154
why would you give cholmid?
shorten luteal phase
155
what are the phases of the endometrial cycle?
* Proliferative phase
* Secretory phase
* Menstrual phase
156
Proliferative phase
* Days 1-14
* Ovum is now matured and secretes estrogen
* Rebuild, becomes thicker, prepare for conception
157
1. Secretory phase
* Near the end of ovulation phase; second half of ovarian cycle
* Increase of estrogen and progesterone from corpus luteum
* Progesterone stimulates enrichment of endometrium, very thick and nourished
* Strong enough to hold product of conception
158
Menstrual phase
* No conception leads to menstrual phase
* Necrotic areas of endometrium begin to separate from basal layers resulting in menstruation
* Blends into early start of next phase
159
how long does menstruation last?
typically 5 days
160
is it possible to conceive during menstruation?
yes; this shows that conception not the problem but the length of the cycles are
161
external male reproductive organs
* penis
* testes
162
penis
* delivers sperm to sperm to vagina
* carries urine from bladder to exterior during urination
*
163
Scrotum
holds testicles
164
will heat applied to scrotum kill sperm?
yes
165
internal male reproductive organs
* testes
* Epididymis/Vas deferens
* 3 glands - Seminal vesicles, prostate, bulbourethral
166
testes
* produces sperm
* billions of sperm are made each day
167
epididymis
* Sperm travel from the seminiferous tubules to the epididymis via the rete testis
* storage and final maturation of sperm
* Contains smooth muscle
* Empties into vas deferens then into pelvis to penis
168
vas deferens
* epididymus empties int vans deferens
* lareger # of sperm are stored here then the epididymis
* lead to pelvis where it joins the ejactulatory duct
169
3 glands of male reproductive organs
* Seminal vesicles, prostate, bulbourethral glands
* Active in mfg of sperm
* Add something to semen to make sperm conducive for conception
170
Prostrate gland
* Starts to get bigger as you age
* Hard to urinate
* Urinary tract infections start to occur
171
STD - men
* start infection in urethra
* urethritis
* infection may continue to extend along urethra
172
do you use heat to treat std?
no; heat on scrotum can cause infertility
173
circumsision
* Remove foreskin of penis
* Personal choice made by parents
* Don’t advocate one way over the other
174
parts of penis
Root, shaft, and glans penis
175
Prepuce
foreskin that covers the glans penis
176
what is the function of seminal vesicles, prostrate, and bulbourethral glands?
* nourish sperm
* transport sperm
* protect sperm
* enhance sperm motility
177
health promotion tests for females
* Breast Self-Exam (BSE)
* Clinical Breast Exam (CBE)
* Mammography
* Vulvular Self-Exam
* Pelvic Exam
* Pap Test
178
Breast Self-Exam (BSE)
* Most lumps are found by partner
* Recommendations differ between agencies
* Should be done monthly
179
Clinical Breast Exam (CBE)
* Depends on your history
* Frequencey varies
180
Mammography
* Baseline at 40 yr
* Every few years after that
* 45 to 50 - eavery year
181
Vulvular Self-Exam
* Look for lesions or sores
* Vulvular cancer is rare but requires radical surgery
182
Pap Test
* depends on history
* 2 to every 3 years
183
Health Promotion Tests for Males
* Breast Self-Exam (BSE)
* Clinical Breast Exam (CBE)
* Testicular Self-Exam (TSE)
* Clinical Testicular Exam
* Prostate Exam
* PSA blood test
184
Breast Self-Exam (BSE) - men
* 10% of breast cancers are in men
* Should be done monthly
185
Clinical Breast Exam (CBE) - male
Yearly to every three years
186
Testicular Self-Exam (TSE)
* Should be done monthly
* 15 to 30 years old - highest incidence of testicular cancer
* Feeling should be smooth, same shape; round, slide between fingers without feeling anything that is rough tender or firm
187
Clinical Testicular Exam
once per year
188
Prostate Exam
* Base at 40 years
* Yearly at age 50
189
PSA blood test
* Screening for prostrate cancer
* Becomes elevated when there is cancer
* PSA is normal no reason to do biopsy
* PSA is elevated reason to do biopsy
* Self test is good for man who will follow up on positive results
190
Family Planning
choosing the time to have children
191
Fertility
* capable of bearing offspring
* 90% of women who do not use contraceptive should conceive within one year
192
Infertility
* not able to get pregnant for one year
* will look at infertility in couples that are older sooner
193
Primary infertility
has never conceived together
194
Secondary infertility
conceived at least one time before
195
What is the nurses role in family planning or contraceptive care?
* Teacher, educator, advocate, listener
* No right to give advice
196
Informed consent
Educate
197
What do you need to think about when choosing a contraceptive method?
* Safety
* Sexually Transmissible Diseases
* Effectiveness
* Acceptability
* Convenience
* Education needed
* Side effects
* Benefits
* Spontaneity
* Availability
* Expense
* Preference
* Religion/Personal Belief
* Culture
198
contraceptive method - safety
based on current medical condition and family history
199
contraceptive method - STDs
abstinence, condom; iud increases std
200
contraceptive method - effectiveness
is it ok to get pregnant
201
contraceptive method - acceptability
religion, cultural, their feelings
202
contraceptive method - education needed
difference in talking with age levels
203
contraceptive method - Convenience
* if it is percceivedto be difficult to use there is less compliance
* desired to avoid menstruation
204
contraceptive methods - side effects
what can they tolerate
205
how many high school students report being sexually active?
50%
206
adolescent preganancy often occurs from...
* Knowledge/Misinformation
* Risk-Taking Behavior
207
how would you counsel adolescents about sexuality?
be nonjudgemental
208
are perimenopausal women able to get pregnant?
yes
209
perimenopause
one year prior to menopause
210
menopause
after 12 consectutive months of not having a period
211
can ovulation continue through perimenopause and menopause?
yes
212
perimenopausal women are less likely to conceive but more likely to...
experience an unintended pregnancy
213
Said to be safe from pregnancy if no menses for...
at least two years in the menopausal woman
214
Methods of Contraception
* Sterilization
* Hormonal Contraceptives
* Intrauterine devices
* Barrier methods
* Natural Family Planning Methods
215
sterilization
* 99% effective
* Female=Tubal ligation
* Male=Vasectomy
216
Male=Vasectomy
* semen sample – need to be zero sperm (6wks/18 ejaculations)
* use back up until no sperm in semen
217
Female=Tubal ligation
use contraceptive for one month
218
Hormonal Contraceptives
* effective as user
* 97-99% effective
* Don’t like weight gain, nausea, trial and error with dosing
* Not made for women over 35 and those who smoke
219
types of hormonal contraceptives
* Hormone implant - norplant
* Hormone injections - Depo provera
* Oral contraceptives
* Transdermal Patch
* Vaginal Ring
* Postcoital emergency contraceptives
220
Intrauterine devices
* not the best choice for someone who has never been pregnant
* in a non-pregnant cervix, trouble putting them in, may puncture cervical canal
* post-partum mom must be 6 wk, no problem with nursing
221
types of barrier methods
chemical and mechanical
222
is the barrier method good for women over 35 years?
yes
223
Chemical barriers - barrier method
* foam, gels, creams
* effectiveness 80-85%
* effectiveness with use of condom 99%
224
Mechanical barriers - barrier method
* condom
* diaphragm
* cervical cap
225
Diaphragm - mechanical barrier
* sized to fit, used with spermicide
* If female gain/lose weight need to be refitted
* check for holes, new one every year
* in place 6 to 8 hours
226
Cervical cap - mechanical barrier
* smaller than diaphragm
* in place 6 to 8 hours
227
Natural Family Planning Methods
* Calendar
* Basal Body Temperature
* Cervical Mucus/Ovulation
* Symptothermal Method
228
why would someone use natural family planning?
* not invasive
* learn to ready your body
229
Calendar - natutal family planning
* plot out dates
* avoid intercourse on days your think ovulation occurs
* sperm lives for 72 hours
230
Basal Body Temperature - natural family planning
* take temp everyday
* first part of phase temp is about the same each day; close to ovulation see a significant drop and then a rise (at least one degree) at ovulation/not a safe time for intercourse; and then the temp stays the same
231
Cervical Mucus/Ovulation - natural family planning
stretchy and thin ovulation is close/occurring
232
Symptothermal Method - natural family planning
combine Calendar, Basal Body Temperature and Cervical Mucus/Ovulation
233
what are other methods of contraception?
* Abstinence
* Breastfeeding
* Coitus Interruptus
234
Breastfeeding - contraceptive method
* most don’t ovulate but never know when you will ovulate
* do not use as protection
235
Coitus Interruptus - contraceptive method
* Withdrawal
* 80% effective
236
infertility factors in men
* Sperm abnormalities
* Abnormal erections
* Abnormal ejaculation
* Abnormal seminal fluid
237
Sperm abnormalities - infertility factor
* Abnormal sperm might be a sign of a genetic disorders
* Double heads/tails
* Disfigured
* Slow activity, low #
238
where would you refer a male with low # of sperm but everything else was fine?
endocrine
239
where would you refer a male with low # and slow activity of sperm?
urology
240
Abnormal erections - infertility factor
* Impotence
* Peryronie's
* Vericocele
* Spermatocele
241
Peryronie's
scar tissue along length of penis, painful
242
Vericocele
varicose veins in scrotum, changes temp and destroys sperm
243
Spermatocele
cyst near at the head of epididymis
244
Abnormal ejaculation - infertility factor in men
* Hypospadius
* Epispadius
* May have normal sperm count but it doesn't get where it needs to
245
Hypospadius
opening under side of penis
246
Epispadius
opening on top of penis
247
Abnormal seminal fluid - infertility factor in men
* Cloudy, clumps, made consistency different
* WBC - infection - treat to see if it can be cleared up; can take up to a few mos to treat
248
where might you refer someone who has cloudy, clumpy, or abnormal consistency of seminal fluid?
urology
249
infertility factors - women
* Ovulation disorders
* Abnormalities of fallopian tubes
* Cervical abnormalities
* Repeated pregnancy loss
* Infections
250
Ovulation disorders - infertility factor in women
* Has partial or no female organs - confirm with ultra sound
* Majority are just poor ovulation patterns
251
how long would you take basal body temp for to help diagnose ovulation disorders?
3 months
252
ovulation disorders - treatment
* Clomid
* Pergenol
* Depo provera or progesterone (oral or IM
253
Clomid
force to ovulate; make cycle more regular, DR needs to look at cycle, force to ovulate, side effect - possibility of multiple birth - typically twins; warm, acne
254
Pergenol
higher incidence of mult. Births - triplets, quads, quints etc….; if you use these meds are you ok with mult. births
255
Depo provera or progesterone (oral or IM)
may use to induce period in order to give clomid on a certain day
256
Abnormalities of fallopian tubes - infertily factor in women
* Ovulates ok, partner ok
* Are they there, are they open
* Blocked tubes, evaluate to see if it is possible to open them
257
Hysterosalpinogram
* air or dye through to see if tubes are open
* sometimes this opens tubes
258
what is a possible treatment for abnormal fallopian tubes?
* Invitro
* if tubes are block and ovulate is ok and partner is ok
* just cant get ovum to go down the tube
259
Cervical abnormalities - infertility factor in women
* Multiple cervix, can be common to have up to 3, only one goes somewhere others are "blind"
* Excessive/lack of mucus - mucus helps sperm get where they need to be, might be allergy related
260
Post coital test
* Plan to have intercourse no later than 2 hours before appt
* Physician put speculum in, will gather fluid from vaginal vault and look at slide
* If sperm is dead; it means she has hostile cervix/mucus
* Antihistamines may help - UCLA research study
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what are possible ways to treat cervical abnormalities?
* Be supportive and help patients through process
* Artificial insemination
* Cervical stenosis
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why would artifical insemination be a good treatment for an abnormal cervix?
* use partners semen and deliver it to the right place
* man brings in semen sample
* take semen and inject it into women
263
Cervical stenosis
* Significant menstrual cramps
* Very small opening of cervix
* Dilate cervix to get it large enough to allow sperm through
264
Repeated pregnancy loss - infertility factor in women
* Habitual abortion
* Incompetent cervix
* DES
* Fibroids
* Endocrine abnormalities
* Immune
* Exposure to toxin
265
Habitual abortion
3 or more miscarriages
266
why would you save fetal tissue from miscarriage?
test for chromosomal abnormalities, genetic counseling
267
incompetent cervix - repeated pregnancy loss
* cervix starts to open at about 12 weeks
* Look at length of cervix, + pregnancy test
* go in every week, if cervix gets shorter, dr will perform cerclage (stitch up cervix)
* depending upon how pregnancy is going will determine when stiches will be taken out
268
cerclage
stitch up cervix
269
DES - repeated pregnancy loss
* drug used to treat prostrate cancer
* gave to women in 1950s - 1960s
* generation that was born from DES mothers, saw abnormalities in female children
* now seeing problems in the children's children both girls/boys
270
Fibroids - repeated pregnancy loss
* benign tumors
* starts to grow because of pregnancy hormones
* crowds out baby
271
Endocrine abnormalities - repeated pregnancy loss
endocrinology issues
272
Immune - repeated pregnancy loss
* may refer to immunologist
* may have autoimmune disorder
* women react to fetus - reject fetus
* blood disorder - treat with levonex/heparin
273
Exposure to toxin - repeated pregnancy loss
* radiation
* alcohol
* Accutane (med for acne)
* lead
* mercury
* toxic substance
274
Infections - infertility issues in women
* Chroic low grade infection
* Endometritis
275
what is the most common cause of infertility in women?
luteal phase of ovarian cycle is too short
276
Evaluation of Infertility
* Counseling
* History and Physical
* Diagnostic Tests
* Therapies
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therapies - evaluation of infertility
* Meds
* Ovulation induction
* Surgical procedures
* Therapeutic insemination
* Egg donation
* Surrogate parenting
* Advanced techniques
278
in-vitro fertilization (IVF)
harvest her eggs and his sperm, re-implant
279
GIFT
retrieve ova and sperm in her tubes
280
ZIFT
fertilize ova outside body and implant in tube and make down to uterus
281
ICSI
fertilize 3 or more ova and implant at least 3
