UNIT 3- REPRODUCTION CONTRACEPTION & INFERTILITY Flashcards
1
Q
In pubery the hypothalamus secretes what hormones?
A
- Gonadotropin-releasing hormone (GnRH)
2
Q
In puberty the anterior pituitary secretes what hormones?
A
- Follicle-stimulating hormone (FSH)
- Leteinizing hormone (LH)
3
Q
During puberty what is happening with the ovaries and testes doing?
A
Increasing production of sex hormones (gametes)
4
Q
Male and female reporductive systems are similar in utero for how long?
A
until the 1st 6 weeks
5
Q
What secretes the primary sex hormones?
A
Ovaries and testes
6
Q
During childhood the sex glands are…. active or inactive
A
inactive
7
Q
When do reporductive organs become functional?
A
Puberty
8
Q
What should we know about puberty changes in males?
(when does it happen, what triggers it, and what secondary sex characteristics will we see?)
A
- Puberty- capable of reproduction- 13.5 y/o age
- Triggered by the production of testosterone
- secondary sex characteristics
- Skeletal growth
- increases in body composition
- devleop body hair- facial, axillary and pubic
- Voice changes
- Enlargment of testes and penis
- noctural emissions (wet dreams) not usually mature sperm tho
9
Q
What should we know about female puberty changes?
(when does it happen, what triggers it, and what secondary sex characteristics will we see?)
A
- Puberty- capable of reproduction- 8-13 y/o age
- Triggered by the production of estrogen
- Secondary sex characteristics
- Develope body hair-axillary, legs & pubic area
- Body contours-widening of hips
- Skeletal growth
- Reproductive organs
- Breast changes- mamary ducts & nipples erect
- 1st menstrual period-2-2.5 years after puberty
10
Q
What are the structures of a female reproductive system?
A
- Ovaries
- Fallopian tubes
- Uterus
- Cervix-internal and external os
- Vagina
11
Q
The anterior pituitary hormone FSH’s function is?
A
Helps control menstrual cycle & production of eggs by ovaries
12
Q
The anterior pituitarys hormone LH’s function is
A
A surge causes ovulation and results in formation of corpus luteum
13
Q
The ovaries release estrogen and its funciton is?
A
- THickens uterine lining and regulates growth, development & physiology of reproductive system
14
Q
The ovaries release progesterone and its function is?
A
- Prepares the lining of the uterus to impant and grow a fertilized egg; inhibits FSH & LH
15
Q
What are the 4 phases of the menstrual cycle?
A
- Menstrual phase
- Proliferative phase
- Ovulatory phase
- Luteal phase
16
Q
In the menstrual cycle what is the menstrual phase?
A
- Day 1 to Day 5
- changes we might see- mood swings, tender breast, cravings, irritable
17
Q
In the menstrual cycle what is the proliferative phase?
A
- Day 5-14 end of menstral- pituitary secretes FSH which makes the egg, LH which houses the egg and starts produceing progesterone
18
Q
In the menstrual cycle what is the ovulatory phase?
A
- This is where your best shot of pregnancy occurs- marked increase in the LH and FSH hormone, getting ready for egg.
- Only 1 egg per month
Think 0 for egg
19
Q
In the menstrual cycle what is the luteal phase?
A
- During this phase, levels of FSH and LH decrease in response to higher levels of estrogen and progesterone. If the ovum is fertilized it secreats a hormone that causes persistence of corpus luteum to maintain an early pregnancy
- If the ovum is not fertilized, FSH and LH fall to low levels and the corpus luteum regress.
- Decline of estrogen and progesterone along with corpus lutum regression results in menstrauation as the uterine lining breaks down.
20
Q
The menstrual cycle is caused by
A
hormone changes
21
Q
What are the 4 phases in the endometrial cycle?
A
- menstrual phase
- Proliferative phase
- Secretory phase
- Ischemic phase
22
Q
The endometrial cycle is driven by…
A
What is happening to the lining physcially
23
Q
In the endometerial cycle what is the menstrual phase?
A
Vasocontriction and shedding of the lining which sloths off
24
Q
In the endometrial cycle what is the proliferative phase?
A
- Occurs as the ovum matures and is released during the first half of the ovarian cycle. After completion of a menstrual period, the endometrium is very thin. The basal layer of the endometrial cells remain after menstration. These cells multply to form new endometrial epithelium and endometral glands under the stimulation of estrogen secreated by the maturing ovarian follicles. Endometrial sprial arteries and endometerial veins elongate to accompany thickening of the functional endometrial layer and nourish proliferating cells. As oculation approches, the** endometrial glands secrete thin, stringy mucus that aids entry of sperm into the uterus.**
25
In the endometrial cycle what is the secretory phase?
1. The secretory phase occurs during the last half of the menstrual cycle as the uterus is prepared to recieved a fertilized ovum. The endomentrium contines to thicken under the influence of estrogen and progesteron from the corpus luteium. Reaching its maxium thickness.
2. If pregnancy does not occur lining will be shed off again
26
In the endometrial cycle what is the ischemic phase?
Vasospasm of the endometrial blood vessels causes the endometrium to become ischemic and necrotic. THe necrotic areas of the endometrium separate from basal layers, which results in the menstrual flow.
27
What conditions must be met for fertilization to happen?
1.Fallopian tubes are patent
2.Semen is supportive to pregnancy
3.Adequate progesterone & thickening endometrium of uterus(endometrial biopsy)
4.Live,motile, normal sperm are present (postcoital test)
28
What are signs of ovulation?
1. Drop in basal body temp: Occurs 1 day before ovulation and remains elevated 10-12 days
2. Spinbarkeit Mucus: abundant, watery thin, clear, stretchy (egg white)
3. Cervical os dilates slightly, softens and rises in the vagina
4. Mittelschmerz occurs: localized abdoinal pain
5. Saliva ferning: seen under microscope
6. Increased libido
29
What is spinnbarkeit mucus?
Abundant, watery thin, clear stretch (eggwhite) mucus
30
What does the cervical os do during ovulation?
Dilates slightly, softens and rises in the vagina
31
What is Mittelschemez?
Localized abdominal pain during ovulation
usually on one side and occurs about 14 days before the next period
32
While educating a patient on the reporductive cycle, the nurse should plan to inculde that ovulation occurs when the....
blood level of LH is too hihgh
33
What is infertility?
Inability to conceive/maintain a pregnancy after 12 mos. of unproteted intercourse
if older than 35 then only 6 months
34
What is primary infertility?
Never conceived
35
What is secondary infertility?
Couples who have concieved before but are unable to conceive again
36
Why types of stress can infertility cause?
1. Mentally-inability to concieve
2. Financially-expenses
3. Emotionally- effect on couples relationship can be see as a crisis in the relationship
37
What are some causes of infertility in men?
1. Abnormal erections
2. Abnormal ejection
3. Abnormalities of seminal fluid
4. Abnormalities of sperm
5. abnormal hormonal stimulation
6. Acute or chornic illness (mumps, cirrhosis of the liver, renal function)
7. Anatomic abnormalities such as varicocele (enlargment of veins behind teste, absence of a teste)
8. Exposure of toxins such as lead, pesticides or other chemicals
9. Antineoplastic drugs-- chemo or radiation
10. Excessive alcohol intake; use of illicit drugs-effects sperm motility
11. elevated scrotal temps
12. Immunologic factors produced by man or women
38
How can abnormal ejection in men cause infertility?
1. Retrograde ejaculation- semen enters the bladder instead of the penis
2. Diabetes
3. Neuologic disoder
4. Antihypertensives and psychotropics
39
How can abnormalities of seminal fluid in men cause infertility?
1. Obstructions/infection of the gential tract
40
How can abnormalities of the sperm cause infertility?
1. Azoospermia
2. Oligospermia
41
What is Azoospermia?
Absent sperm in semen
42
What is oligospermia?
Decreased sperm in semen
43
How does infections of the gential tract cause infertility?
r/t inflammation which can cause sperm to clump so it isnt able to move as fast or penatrate and that cause it not be able to fertilized
44
How can elevated scrotal temps can cause infertility what things might we teach male patients so they know what might cause the elevated temps?
1. febrile illness
2. use of saunas or hotubs or sitting for long periods
45
What types of disorders in ovulation can cause infertility in women?
1. Hypothalamus or pituitary gland dysfunction-not able to secrete needed hormones
2. Failure of ovaries to respond to follicle stimulating hormone(FSH)
- PCOS: most common
- cranial tumors
- stress
- obesity or anorexia
- systemtic disease
- abnormalities in ovaries or other endocrine glands- polyps cause scaring which creates a hostile cervical mucus so instead of thinning it might thicken
46
What abnormalities of the fallopian tubes can cause infertility in women?
1. Endometriosis- tissue lining has grown outside of the uterus where it does not belong
47
What abnormalities in the cervix can cause infertility in women?
1. Estrogen levels decreased preventing the developement of spinnbarkeit- if this is decreased we have thick cervical mucus which causes sperm to not be able to travel
48
Recurrent pregnancy loss is considered part of infertility in women what factors in this can cause infertility?
1. Abnormalities of fetal chromosomes
2. Abnormalties of the cervix or uterus
3. endocrine abnormalities
4. immunologic and thrombotic factors- increase risk of miscarrage
5. environmental agents
6. Infections- effect uterine lining which effects implantation and egg cannot implant
49
During our evaluation of infertility what information should we collect during the history and physical exam
| ask
1. Reproductive medical history
2. menstrual history- how periods have been normal or irregular
3. any pregnancies, complications and outcomes
4. Contraceptives methods-past and present
5. Fertility with other partners (pervious success)
6. Pattern of intercourse
7. Exposure to toxins
8. Medications-RX or OTC
9. Family history of pregnancy loss
10. Home tests/other methods use (test for ovulation)
50
What diagnostic tests for men can we run to look at fertility?
Men are usually tested first-cheaper and quicker
1. Semen analysis- collection after 2-3 days of abstinence
2. Ultrasonography- checking for obsturction & abnormalities
3. Hormone analysis
- FSH, LH, Testosterone & prolactin
4. Testicular biopsy- usually done for little or no sperm
5. Sperm penetration assay- "hamster test" human sperm mixed with pretreated hamster eggs to see if it can penetrate it
51
What diagnostic test can we run to look at fertility in women?
1. Ovulation prediction-basal body temp.. spinbarket assesment to look at the details of cervical mucus
2. Xray of uterus & fallopian tubes to determine patency
3. Hormone analysis- progesterone, FSH, estrogen, LH & prolactin
52
What are nonmedical therapies and alternative measures used to help faciliate pregnancy?
1. Nutritional and dietary changes- losing weight-- 5-10% loss can usually resotre ovulation
2. Exercise, yoga and stress managment
3. Lifestyle changes-no smoking/drinking
4. Ovulation predictor- knowing whats going on in the body
5. Use water soluable lubricant for intercourse- avoid chemical because it can misleaad ovulation reading cause it causes cervical mucus to thin maturely so you think your ovulating when you are not
53
What is a pharmocologic therapy we can use to help facilitate pregnancy?
Clomiphene citrate and letrozole
1. ACTION: stimulates pituitary gland to increase secretion of luteinizing hormone (LH) & FSH, can cause ovarian hyperstimulation syndrome
- Ovarian stimulation
- Oral medication
- Risk of multiple gestations
2. Metformin: adjunctive treatment for infertility due to PCOS
54
What are the side effects of of clomiphene citrate and letrozole?
1. hot flashes
2. blurred vision
3. n/v
4. Pain in pelvis
5. bloating
6. Headache
55
Clomiphene citrate and letrozole is contraindicated with
1. Bleeding diorders or liver disease
56
What is In Vitro fertilization- embryo transfer (IVF-ET)?
Reporductive technology- Eggs are collected from ovaries, fertilized in the lab with sperm; embryo then transferred to the uterus
Fertilization outside of the body
57
What is intrauterine insemination (IUI)
Reproductive technology- places prepared sperm in the uterus at time of ovulation
Fertilization inside the body
58
What is intracytoplasmic sperm injection?
Assisted reporduction- single sperm selected and injected directly into mature oocyte in the lab
fertilization outside the body
59
What is gamete intrafallopian transfer (GIFT)
Assisted reproduction- oocytes retrieved placed with prepared motile sperm; then placed in fallopian tubes
Fertilization inside body
60
What are our nursing implications and interventions for fertility help/procedures?
1. Educate on available options for reporductive assistance and encourage couples to discuss feeling about infertility
2. Educate couple on roles of specialists they will see
3. Monitor for adverse effects associated with associated with infertility treatments
4. Teach that infertility medications that can increase risk of multiple births
5. Refer for psychosocial counsling if needed
6. Educate regarding assisted reorductive therapies and available options such as surrogacy and adoptions
61
What should we know about the development of the placenta?
1. Formed from both fetal and maternal tissue
2. Exchange of substances between mother and fetus occurs in intervillous spaces of placenta
- Placental membrane seperates to prevent maternal and fetal blood mixing; gasses, nutrients and electrolytes are exhanged via umbilical cord
3. Viruses (such as **rubella & cytomegalovirus** and drugs CAN cross placental membrane and enter fetal circulation
62
What is a degenerative placenta?
Infarcts & calcifications that interfere with uterine-placental-fetal oxygen exchange
63
When is a degenerative placenta more likely?
1. severe preeclampsia
2. smokers
3. drug abuse
4. post date
64
The amniotic sac is formed by what two membranes?
Amnion and Chorion; they appear to be one membrane-usually rupture together
65
What contined within the amniotic sac?
Embryo and amniotic fluid
66
What is the purpose of amniotic fluid?
1. Cushions impact to maternal abdomen
2. Prevents adherence of fetus to amniotic membranes
3. Allows freedom freedom of fetal movement
4. Provides a consistent thermal enviroment
5. Essential for fetal lung development
6. Allows symmetric development as major body surfaces fold to midline
67
What is oligohydramnios?
Abnormally small quanity of fluid (<50% of amount expected for gestion or <400ml at term)
68
What can oligohydraminos cause?
1. poor placental blood flow
2. Preterm premature rupture of membranes
3. Failure of kidney development
4. Blocked urinary tract
5. Fetal effects
6. Poor fetal lung development
7. Malformation such as skeletal abnormalities
69
Oligohydraminos causes an increase risk of....
Cord compression because the fluid is what helps prevent and cushion
70
what is polyhydraminos?
1. Quantity of fluid may exceed 2000 mL
71
What can polyhydraminios cause?
1. Poorly controlled maternal diabetes mellitus resulting in large quantities of fetal urine excretion having elevated glucose level
2. Malformations of CNS, cardiovasular system of GI tract
3. Chromosomal abnormailities
4. Multifetal gestation
Sometimes has no known cause
72
Polyhydraminos can cause increased risk of...
PPH due to streatching of uterus
73
What is the lifeline between the fetus and placenta?
Umbilical cord
74
The umbilical cord consists of?
1. two umbilical arteries
2. One umbilical vein
3. Vessels surrounded wharton's jelly (collagenous substance), which protects it from compression
4. Cord usually inserted in center of placenta
75
If there is not good fetal circulation through the umbilical cord the baby is at risk for?
IUGR
76
What are some umbilical cord abnormalities?
1. Cogential absence of umbilical cord arter
2. Cord insertion variation- want at center for optimal oxygenation
3. Cord length variations
77
Average length of umbilical cord is?
55cm
78
Short umbilical cords are associated with...
1.Umbilical hernias
2.Abruptio placentae
3.Cord Rupture
79
Long umbilical cords tend to....
Twist, tangle around fetus
80
What are monozygotic twins?
| must know
One zygote- genetically identical
81
What are dizygotic twins?
| must know
Faternal twins
82
What is monochroionic?
| must know
Placental type for twins- one chorion(placenta)
83
What is monoamniotic?
| must know
Placeta types for twins- twins that share the same sac and one placenta
84
What is dichorionic?
| MUST KNOW
Placenta types for twins- two chorions (placentas)
85
What complications are associated with monochorionic?
1. twin to twin transfusion: Imbalance of bloow flow through the vascularcure of the placenta
86
What complications are associated with monoamniotic?
1. sharing same sac they have increased risk of mortality due to the increased risk of tangling of umbilical cords
87
What will our education for mutlifetal pregancies include?
Educate multple gestations contribute disproportionately to maternal, fetal and neonatal morbidity and mortality.
1. Risk increases with each number of fetuses
2. Risk for women
3. Risk for fetus and newborn
4. Conjoined twins
88
What is our managment of multifetal pregnancies?
1. Ultrasounds for discordant growth- ensure babies are growing proportionally amoung each other
2. Genetic testing
89
What do we monitor for in multifetal pregnancies?
1. Preterm labor; prevent preterm birth
2. maternal anemia; gestational diabetes
3. Hypertension, preeclampsia and hydramnios
4. antenatal hemorrhage, intrauterine hemorrhage
5. intrautrine fetal demise- kick counts
6. Increased fetal surveillance, inclduing NST, BPP
7. Montior fundal height and educate mom that it will be highter due to carring twins
90
What education should be given for contraception?
1. types of contraception available
2. risks and benefits of each
3. Proper use of each method
4. Backup method if needed
5. What to if changing method
6. What to do if an error is made
7. emergency contraception
8. Anwser questions and concerns
91
What are the 5ps of taking a sexual health history?
1.Partners- the number in the last 12 months (men, women or both)
2.Pregnancy- planning or preventing
3.Protection from STI- always, sometimes, never
4.Practices- vaginal, anal, oral
5.Past history of sti's- no, yes, if yes which sti
ask open ended questions
92
How should we educate our adolecent population about sex related topics?
1. Sensitive to adolecents feelings
2. Reassure the teen of confidentiality
3. Encourage discussion with parents
4. Reduce anxiety related to 1st pelvic exam
5. Provide education utilizing understandable terminology and audiovisual aids
6. encourage condom use for STI prevention
93
What considerations are there for choosing a contraceptive method?
1. Expense/availablity
2. Effectiveness
3. Risk, benefits, and side effects
4. Protection against STI
5. Covenient and readily available
6. Interfere with spontaneity
7. Acceptable based on religious, cultureal and personal believes
8. Other considerations-family planning goals
94
What are contraceptivie options?
Startegy or device used to reduce the risk of fertilization or implantion to prevent a pregnancy
1. contraceptive methods
2. natural family planning
3. barrier
4. hormaonl
5. intrauterine devices
6. surgical procedures
CONSISTENCY outweighs reliability
95
What is abstinence as a form of contraceptive?
Refraining from sex
96
What should we know about abstinence from sex used as a constraceptive method?
1. Most effective if practiced perfectly
2. Patient education needed
3. Allow other gratifying sexual activites but requies good self control
97
What are the risk and benifits of abstinence?
RISK: non if abstinence is maintained
BENEFIT: failure rate is 0%
98
What is lactational amenorrhea (contraception)
Exclussive breastfeeding for 6 months to avoid ovulation and menses
99
What patient education do we need to provide for a women using lactational amenorrhea as a form of contraception?
1. Disruption of breastfeeding or supplemention increases risk of pregnany
2. Effectiveness enhanced by frequent feeding or use of barrier method
3. Alternate method once menses requried
4. pregnancy can still occur
100
What are the advantages, disadvantages and risk of using lactational amenorrhea as a form of contraception
Advantage: inexpensive
Disadvantage: failure rate-1st ovulation unpredictable
RISK: unplanned pregnancy
101
What is the withdrawl/coitus interrupts method of contraception?
AKA Pull our method-- removal of penis prior to ejaculation
102
What patient education should we provide if a patient is using the withdrawl/coitus interrupts method for contraception?
1. Pre-ejaculate fluid may contain sperm & can leak prior to ejaculation
103
What are the advantages, disadvantages and risk to using the withdrawl/coitus interrupts?
Advantages: Choice for monogamous couples w/religous convictions
-
Disadvantage: Railre rate-22%, no protection agaisnt STIs, require self-control on males part
-
RISKS: unplanned pregnancy
104
What is the natural family fertility awareness (contraception)
Fertility awareness or periodic abstinence method which requires awareness of menstrual cycle
1. Fertile days- sperm is 4-5 days & ovum is 24-48 hours
2. Mittelschmerz (pain in the ovary region, mid-cycle during ovulation)
105
What are the advantages and disadvantages of using natrual family planning fetility awareness?
Advantage: Works best with regular mentrual cycles, acceptable to religions who prohibit the use of birth control
Disadvantage: interfere with sexual spontaneity, poor choice for irregular cycles, brestfeeding, perimenopause.
106
What should we know about the calandar method for contraception?
1. Calandar based on ovulation occurs wapproximately 14 days prior to menses
2. Standard days method- used to determine fertile day with varied cycles
3. NEED 6 months of accurate counting
4. Least reliable method of family planning
107
What patient education should be given to someone using the calandar method as a form of contraception?
1. Determine fertile period- over 6 cycles- number of days/cycle
2. Start of fertile time (shortest cylce)
3. End of fertile time (longest cycle)
4. Avoid intercourse during fertile days
108
What are the advantages, disadvantages and risk to using the calandar method as a form of contraception
Advantages
1. Inexpensive
2. No drug or hormones
3. Combined with barrier method improves the effectiveness
Disadvantages
1. Failure rate of 24%
2. No protection against STIs
3. Unpredictable menstrual cycles/ovulation
4. Compliance with abstinence during the fertile period
Risk- Unplanned pregnancy
!!! Stress can affect cycle-- making this method ineffective!!!
109
What is the fertility awareness symptothermal method of contraception?
Assessment of basal body temperature, cervical mucus, mittelschmerz & other symptoms near ovulation
110
What patient education should we provide to a patient using symptothermal method as a form of contraception?
1. Measure BBT (basal body temp) same time each morning prior to getting out of bed- put on calandar, nothing to drink prior
2. BBT will be lower before ovulation and increase after ovulation
3. BBT will then lower 2-4 days before menses or remain elevated if pregnant
4. Aboid intercourse until 3rd night after increase of BBT
111
What are the advantages, disadvanges and risk of the symptothermal method of contraception?
Advantage
1. Inexpensive
2. Acceptable by most religions
Disadvantage
1. Stress, fatigue, illness, or environemental temperature can effect
2. no protection against STIs
Risk-unplanned pregnancy
112
What is the method of contraception using cervical mucus?
Cervical mucus- mucus becomes thin, flexible, slippery and stretches between fingers at ovulation
AKA: spinnbarkeit or billing sign
113
What patient education should we provide to a patient using cervical mucus assessment as a form of contraception?
1. Good hand hygiene
2. Obtain mucus from entrance of vagina
3. Examine for consistency starting on the last day of the cycle
4. Observing for thinning charactersitc
5. Once you feel cervical mucus thining avoid having sex for 4 days. Peak of cervical mucus is when its very transparent egg white and slipperly
6. hormone responsible for this is estrogen
114
What are the advantages, disadvantage and risks for using cervical mucus assessment as a form of contraception?
Advantage
1. Women becom knowledgeable regarding mucus
2. Self-evaluation dignostically helpful in recognizing ovulation
3. Breastfeeding, menopause, planning pregnancy
Disadvantage
1. Failure rate of 24%
2. Uncomfortable touching her own genitals & mucus
3. No protection against STIs
Risks
1. Inaccurate if mixed with blood, semen, contraceptive foam or discharge
2. Unplanned pregnancy
115
What are chemical barriers (contraception devices)
Spermicides- chemical gel, foam, cream, or suppository inserted deep into the vagina 15 mins prior to intercourse to destroy sperm
116
What patient education should we provide to patients using chemical barriers as a form of contraception?
1. Instered into the vagina prior to intercourse
2. Must be reapplied for multiple acts
117
What are the advantages, disadvanges and risks of using chemical barriers as a form of contraception?
Advantage
1. Inexpensive, readily available, easy to use
Disadvantage
1. Failure rate of 28%
2. irritation, allergic reaction
3. Must be reappled for multiple acts
4. No protection from STIs
5. May be seen as messy
Risk:unplanned pregnancy
118
What is a male condom
thin rubber sheth worn over the penis during intercourse, prevents sperms from entering the uterus
119
What patient education should we provide to a patient using condoms as a form of contraception?
1. Roll condom onto the errect penis, leaving empty space at the tip
2. Used with spermicide increases the effectiveness
3. Following ejaculation- remove from errect penis by holding rim of condom to prevent semen spillage and discard
120
What are special considerations when using condoms
1. Heat accelerates deterioration- avoid stroage in hot places
2. Used water-soluable jelly for lubercation- petrolum jelly can cause deterioration
121
What are advantages, disadvantages and risk for using condoms as a form of contraception?
Advantages
1. Protects against STIs
2. Involves male in birth control
3. Inexpensive, lightweight and readily available
Disdavantage
1. failure rate of 18%
2. reduces spontaneity and non-complience
3. One time use- do not reuse
Risks
1. Allergic reaction, contraindicated with latex allergy
2. Rupture or leak resulting in unwanted pregnancy
122
What is a female condom?
Synthetic rubber shelth inserted into the vagina prior to intercourse which prevents sperms from entering the uterus
123
What is our patient education for the use of female condoms as a form of contraception?
1. Insert closed end of condom into the vagina
2. Push toward the back of the vagina
3. Make sure the inner ring fits over the cervix
4. open outer ring covers labia/perineum
5. following intercourse-twist outer ring, remove and discard
124
What are the advantages, disadvantages and risk of using female condoms as a form of contraception?
Advantages
1. Non-latex protects against STI's
2. 79% effective
3. No prescription is needed
Disadvantages
1. Failure rate is 21%
2. Reduces spontaneity & non-complience
3. Noisy during sex
4. cumbersome feel
5. one-time use
6. **must be placed 8 hours prior**
risks- allergic reaction, no use of oild based products-negate latex protection
125
What is a mechanical barrier contraceptive device known as a sponge?
Sponge- pillow-soft, cup-shaped, absorbant sponge which fits over the cervi containing spermicide
126
What patient education should we provide a patient using a sponge as a form of contraception?
1. one size fits all
2. Remains in place for 6hours- up to 48 hours after intercorse
3. Proper insertion- empty bladder, wash hands, moisten sponge with water, insert into vagina and position over cervix
127
What are the advantages, disadvanges, and risks of using a sponge as a form of contraception?
Advantage
1. Available OTC
2. One-time use- but may use for mulitple acts in 24 hours
3. Can be insterted just before or hours ahead of time
Disadvantage
1. Difficult to insert and remove
2. does not protect against STIs
Risks
1. Failure rate 12% no prior birth & 24% failure rate if prior birth
2. irritation & allergic reaction
3. Absorbs vaginal secreations- vaginal dryness
4. Toxic shock syndrome
Cervical os may be slanted after birth increasing risk of raiure
128
What is the mechinal barrier diaphragm contraceptive device?
Dome-shaped latex or silicone cup which fits over the cervix
129
What are the risk associated with using a diaphragm?
Places pressure on the urethra
1. may cause irritation or utis
2. Voiding after sex helps prevent infection
3. If patients have hx of UTIs this device is not for them
130
What should we know about the diaphragm contraceptive device
1. Increased risk of UTIs- not the choice for someone with recurrent UTIS
2. voiding after sex helps prevent infection
3. Must be left in place for 6 hours after intercourse
4. Check for placement- cervix is felt through diaphragm
131
What is a cervical cap contraceptive device?
Soft, cup which fits over cercix to prevent sperm from entering
132
What should we know about the cap contranceptive devices
1. No pressure placed on bladder
2. Can stay in place for 48 hours
3. Keep in place 6-8 hours after intercourse
4. papsmere encouraged at least every 3 years if using this device
133
What should our patient education be for patients using the diaphragm or cap as a contraceptive device?
1. Requires fitting & refitting- every 2 years, or after childbirth, or a 20% weight gain or loss
2. Requires proper insertion prior to intercourse
- empty bladder & perform HH
- Apply spermicide & insert into vagina covering the cervix
- Clean with soap and water after removal
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What are the advantages, disadvantages and risks of using a diaphragm or cap as a contraceptive device?
Advantage-
1. Reduced incidence or cervical gonarrhea/chlamydia
Disadvantage
1.requires fitting and prescription
2.Spermicidal cream must be applied & reapplied
3.Difficult to insert and remove
4.Does not protect agaisnt STIs
Risk
1. irritation, latex allergic reactions
2. can be associated with cervical changes
3. Toxic shock syndrome
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What is estrogen progestin combination pill?
Oral hormonal contraceptive- suppress ovulation and thickens cervical mucus usuing both estrogen and progesterone
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What is the progestin only (mini) pill?
Oral hormal contraceptive- less effective- causes thickening of the cervical mucus
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Oral contraceptives are often used to
1. Regulate menstrual cycles
2. Reduce dysmenorrhea
3. Blood loss for excessive menstrual cycles and anemia
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Fertility returns in how many months after stopping oral contraceptives?
3 months-- have 2-3 normal periods before they have can concieve
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What do we need to know about the combination pill?
1. It is a combination of estrogin and progestin which inhibits ovulation
2. 21 or 28 pills- 3 weeks of active pills and 4th week of placebo or no pills
3. 84 pills- 11 weeks of active pills and then one week of placebo pills
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What is our patient education for the combo pill?
1. Requires prescription
2. Miss 1 pill- take asap
3. Miss 2-3 must use back up method
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What are the risks of taking the combo pill?
1. Postpartum & lactation- increased risk for DVT & decreased milk production
2. **dont use if smoker or over age of 35**
3. Not a good choice for patients with HTN
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What should we know about the "mini" pill?
Progestin-only is less effective at inhibiting ovulation, causes thickening of the cervical muscus prevents sperm penetration and alters uterine lining preventing implantation.
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What is are patient education for the "Mini Pill"
1. Requires a prescription
2. One pill at the same time daily to ensure effectiveness
3. Take pill 3 hours late must use back up method
4. If diarrhear or voimiting use back up method
5. Postpartum & lactation- a better choice for breastfeeding women
6. Will cause some irrugular bleeding or no bleeding
7. Fertility returns faster
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What are the advantages of oral contraception?
Improves
1. Acne
2. Benign breast disease
3. Endometriosis
4. Fibriod bleeding
5. Premenstrual symptoms
6. Hirsutism
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What are the disadvantages of oral contraception?
Side effects
1. Breast tenderness
2. Excessive cervical mucus
3. N/V
4. Headache
5. Hypertension
6. Breakthrough bleeding
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What are the risk factors of oral contraceptives?
1. Failure 3%
2. No protection for STIs
3. Increased-miggraines, hypertension, strokes, thromboebolic disease
4. altered blood glucose levels
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What are some medication interactions with oral contraceptives?
1. Antibiotics decrease effectiveness
2. avoid hepatotocix medications
3. Interfere with anticoagulants
4. Increase toxicity of tricyclic antidepressant
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What is orthoevra transdermal patch?
Transdermal contraceptive patch- releases continous small amounts of estrogen and progestin that is absorbed by the skin supressing ovulation and thickening cervical mucus
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What is our patient education for patient wanting to use a transdermal contraceptive patch?
1. Requires a prescription
2. An alternate method of irth control is needed for 1st week following inital application
3. Apply patch to buttocks, abdomen, upper arm same day of the week for 3 weeks
4. Remove patch for 4 week (menses occurs)
5. No oils,lotions in area of application
6. Dont cut or alter shape
7. Do not use more than 1 patch at a time
8. If 3 days or more late in changing patch use back up method for 7 days
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What are the advantages, disadvantages and risks of using the trandermal contraceptive patch?
Advantage
1. Apply weekly, as effective as oral contraceptives
2. regulates menstrual cycle
Disadvantage
1. Skin irritation
2. Visible if wanting to keep contraceptive unknown
RIsk
1. Failure 9%
2. less effective for larger women **198lbs**
3. Higher risk for VTE since exposure to estrogen is greater
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What is the nuvaring?
Vaginal ring- soft, flexible, vinyl ring which releases small amounts of estrogen and progestin continously to prevent ovulation
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What is our patient education for nuvaring?
1. Requires a prescription
2. Change monthly
3. Must be refrigerated
4. 1st insertion use backup method unless placed the 1st 5 days of menses
5. 48 hours withou a ring, 1st two weeks requires a back up method for 7 days
6. Breakthrough bleeding is less common
7. Can be instered immediately after delivery of placenta
8.
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When does fertility return with the transdermal patch?
about 1 month
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What are the advantages, disadvantages and risks of the nuvaring?
Advantage
1. Fitting not required
2. can remove for 3 hours without loss of effectiveness
3. Not visible
4. decreased risk of forgetting to take pill
Disadvantage
1. Must remember to remove and reinsert
2. Expulsion resulting in an unplanned pregnancy
3. no STI protection
Risk
1. If not able to take oral contraceptives, same risk apply with vaginal ring
2. Side effects include breast tenderness, nausea and baginitis
3. Vaginal prolapse
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When does fertility return with the nuvaring?
few weeks to a month
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What is an IUD?
| long acting contraceptive
Intrauterine device- chemical or hormone active device which is inserted into the uterus, damages sperm & prevents fertilization
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What patient education would we provide about the intrauterine device IUD mirena?
1. inserted by a provider in the office
2. check for string monthly to confirm placement
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The IUD is contrindicated for?
1. Diabetics
2. Anemia
3. Abonormal paps
4. Hx of PID
5. Fertility
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What are advantages, disadvantages of the IUD meirena?
Advantages
1. Stays in place all the time
2. Effective for 5-10 years
3. safe for breastfeeding mother
4. Decreases dysmenorrhea and menstrual blood loss
5. Copper IUD- Emergency contraception if placed within 5 days of intercourse
Disadvantage
1. No protection against STIs
2. Increased cramping & bleeding 1st few cycles which resolves
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What are potention side effects and complications of an IUD
1. Menorrhagia- heavy bleeding lasting more than 7 days
2. PID- endometrial inflammation turns into PID which can lead to infertility
3. Ectopic pregnancy or spontaneous abortions if pregnancy occurs
4. Perforation of the uterus
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What is the contraceptive implant?
Implant- a progestin-filled rod that is placed in the upper arm under a local anesthetic the progestin inhibits ovulation, thickens the cercial mucus and thins the edometrium
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What is our patient education for contraceptive implants?
1. Requires a minor surgical office procedure
2. Effective within 24 hours of insertion
3. Increased risk of ectopic pregnancy
4. Fertility-immediately
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What are the advantages and disadvantages of the implant
Advantage
1. Continous long-acting contraceptive (3yrs)
2. Reversible
3. Lactacting-once breastfeeding is established for 4 weeks
disadvantage
1. 1% failure rate
2. no protection against STIs
3. Irregular and or unpredictable menstrual bleeding
4. Acne, minimal weight gain or skin irritation at site
5. removal required
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What is the depo-provera contraception?
Depo-provera- is an IM hormone injection of progestin which prevents pregnancy for 15 weeks, repeat injections should be given every 3 months
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Our patient education for the depo-provera includes?
1. 1st dose given during 1st 5 days of a menstrual cycle
2. keep follow-up appts
3. decreased bone density
- Calcium & vitamin D for bone health
4. May take up to 1 year after stopping to become pregnant
5. Fertility- may take up to a year.
6. Immediately effective
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What are your advantages and disadvantages of the depo-provera?
Advantages
1. long-term birth control- injections every 3 months
2. DOes not impair lactaction once breastfeeding is established
3. Decrease bleeding or absence of period
Disadvantages
1. Failure 4%
2. Amenorrhea, spotting, irregular bleeding
3. Nervousness, dizziness, GI distubance, headaches, fatigue, weight gain
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What are the contraindication for the depo-provera?
History of breast cancer, stroke, blood clots, liver disease, increases cholesteroal
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What do we need to know about the plan b, next choice pill?
1. progestin levoneorgestrel or progestin-only
2. Inhibits ovulation, thicken mucus & interferes with corpus leteum fucntion (house egg)
3. No prescription needed for all ages
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What should we know about ella?
AKA ulipristal acetate
1. Delays surge of LH, ovulation, and implantation
2. Requires pregnancy test as it can disrupt an early pregnancy
3. Prescription **required** for all ages
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What is our patient education for the "morning after pill"
1. Taken within 72 hours of unprotected intercourse
2. Not to be used as a regular form of birth control
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What are the advantages of the morning after pill?
1. reduces risk of pregnanty for one-time unprotected sex
2. Over-the counter (plan B)
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What are the disadvantages of the morning after pill?
1. Failure depends on the time taken after unprotected sex
2. No protection against STI
3. n/v/d, headache, fatigue
4. Abdominal pain or cramping, heavier menstrual bleeding
5. Possible pregnancy if cycle does not occur within 21 days
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What is bilateral tubal ligation salpingectomy?
Fallopian tubes are surgically cute, tied, burned and/or blocked to prevent conception
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What patient education do we need to give patient interested in bilateral tubal ligation salpingectomy
1. surgical procedure under anesthesia
2. Pre-op & post-op care
3. Considred permanent and difficult to revese
4. Slight vaginal bleeding following
5. No backup contraceptive method is needed
6. No sex or lifting heavy objects for 1 week post op
7. Notify of fever or bleeding/drainage at incision site
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What are the advantages, disadvantages and risk/complications of a tubal?
Advantages
1. Permenant contraception
2. Sexual function is unaffected
Disadvantages
1.no protection agasit STI
2.Surgical procedure which requires anesthesia
3. Should be considered irreversible if future pregnancies are desired
Risk & complications
1. Surgical complications- pain, ifections & bleeding
2. RIsk for ectopic pregnancy if pregnancy occurs
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What is vasectomy?
Vas deferens is surgically severed so sperm can no longer pass into semen
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What patient education should we provide for vasectomy?
1. Surgical office procedure
2. Ligated under local anesthesia
3. Limit activity for a couple days
4. Scotoal support for 48 hours
5. Take mild analgesics and place ice to area
6. Notify of severe pain, fever, bleeding or discharge or severe swelling
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What are the risks of a vasectomy?
1. Bleeding, infection, and anesthesia reactions
2. Permanent sterilization may not occur for 3 months so risk of getting pregnant
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What are the advantages and disadvantages of a vasectomy?
Advantages
1. Permenent contraception; reversal
2. Short, safe, simple office procedure requiring local anesthesia only
3. Sexual function is not impaired
4. Less expensive since can be done in office
5. Can resume intercourse in 1 week
Disadvantages
1. failure 1%
2. no protection against sti
3. discomfort for 2-3days
4. Considered irreversible- future pregnancies are desired
5. alternate contraception until 2 negative sperm counts
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