Week 8 - Women's Sexual Health & Pregnancy Flashcards
Types of combined estrogen-progestin contraceptives
- COC
- transdermal patch
- vaginal ring
Estrogen-progestin oral contraceptives
‣ Highly effective
‣ Prevent ovulation
‣ Increased risk of VTE
‣ Reduced risk of ovarian and endometrial cancer
‣ Help with abnormal bleeding, mittelschmerz, dysmenorrhea, endometriosis, premenstrual symptoms, and the vasomotor symptoms of perimenopause
‣ Make cervical mucous thick and prevent ovulation
Progestin only pill
‣ Used continuously, no hormone free intervals
‣ Higher risk for abnormal bleeding
‣ High efficacy
‣ Must be taken at the same time every day
‣ improve menstrual symptoms, including dysmenorrhea, menorrhagia, premenstrual syndrome, and anemia
Tubal sterilzation
Permanent blockage of the fallopian tubes which prevents sperm from reaching the ovum.
‣ Highly effective with low failure rate – if failure, higher rate of ectopic pregnancy
Copper IUD
Non-hormonal. Releases copper ions that cause an inflammatory response that is toxic for sperm in the genital fluid tract (effective for 10 years)
‣ Can cause heavy menstrual bleeding
Levonorgestrel IUD (Mirena, Liletta, Kyleena, and Skyla)
Local delivery of progesterone only - thickens the cervical mucus- often suppresses ovulation (effective 5 Years)
May have unscheduled bleeding, benign ovarian cysts, period symptoms, amenorrhea
– 90% reduction in menstrual flow
Subdermal progestin implant
‣ Nexplanon – one of most effective methods of birth control
‣ Irregular bleeding, amenorrhea
Works for up to 3 years
Depo-provera
‣ Injection every 13 weeks
‣ Progesterone only
‣ Decreases bone mineral density
‣ Reduces seizures in epileptics
‣ Fertility can take 15-49 weeks to return
Presumptive signs of pregnancy
Amenorrhea, nausea, vomiting, increased urinary frequency, excessive fatigue, breast tenderness, quickening at 18 to 20 weeks
Probable signs of pregnancy
‣ Goodell sign (softening of cervix)
‣ Chadwick sign (cervix is blue/purple)
‣ Hegar’s sign (softening of lower uterine segment)
‣ Uterine enlargement
‣ Braxton Hicks contractions (may be palpated by 28 weeks)
‣ Uterine souffle (soft blowing sound due to blood pulsating through the placenta)
‣ Integumentary pigment changes
‣ Ballottement, fetal outline definable, positive pregnancy test (could be hydatidiform mole, choriocarcinoma, increased pituitary gonadotropins at menopause)
Goodwell’s sign
Softening of the cervix
Chadwick sign
Cervix is blue/purple tinged
Hegar’s sign
Softening of lower uterine segement. Occurs when the uterus bends in an anterior direction on the softened lower uterine segment or isthmus
Positive signs of pregnancy
‣ Fetal heart rate auscultated by fetoscope at 17 to 20 weeks or by Doppler at 10 to 12 weeks
‣ Palpable fetal outline and fetal movement after 20 weeks
‣ Visualization of fetus with cardiac activity by ultrasound (fetal parts visible by 8 weeks)
Assessment of gestation age
Gestational age is calculated from date of LMP
Prenatal care should include
‣ avoid many nonprescription medications
‣ check prescriptions for safety during pregnancy
‣ screen for alcohol use
‣ prenatal vitamin
‣ prenatal labs and STI testing
Fundal height
‣ 12 weeks’ gestation, the fundus is located at the level of the symphysis pubis
‣ 16 weeks’ gestation it rises to midway between symphysis pubis and the umbilicus.
‣ 20 weeks’ gestation, the fundus is typically at the same height as the umbilicus
Changes to the cervix during pregnancy
‣ 4 weeks’ gestation, the cervix becomes edematous and congested
‣ Hypertrophy and hyperplasia of the glands cause chadwicks sign (blue hue)
‣ Mucus plug develops in the cervical os to protect fetus agains intrauterine infection
‣ Effacement happens close to birth – softening and thinning of the cervix
‣ Moves from posterior to anterior position close to birth
‣ Uterine contractions stimulate cervical stretching and dilation
Vaccinations to avoid in pregnancy
‣ MMR
‣ Varicella
‣ Live flu vaccine
Nutritional counseling for pregnancy
‣ balanced diet with an increase of approximately 350 calories per day after the first trimester, spread over three meals and two snacks daily, is advised for most women.
‣ Prenatal vitamin containing folic acid and iron
Ectopic pregnancy
Implantation of the fertilized egg outside the uterus, usually in the fallopian tube.
Slow rising HCG levels that do not double within 48 hours indicate ectopic pregnancy
Risk factors for ectopic pregnancy
‣ PID
‣ Infertility
‣ Assistive reproductive technologies
Integumentary changes in pregnancy
o increased sweat, increased vascularity causing pigmentation changes, linea nigra may appear, stretch marks due to break down of connective tissue
Gastrointestinal changes in pregnancy
o peristalsis slows
o decreased intestinal contractility
o increased salivation
o sluggish gallbladder emptying
Cardiovascular changes in pregnancy
o Cardiac output in increases by 30 to 50 percent
o Stroke volume is increased during by 20 to 30 percent
o Blood volume increases by 30 to 50 percent - 1,100 to 1,600 mL
o Decreased vascular resistance
Respiratory changes in pregnancy
o increased edema of pharynx and larynx
o vasodilation of nasal capillaries causing engorgement and nosebleeds
o decrease in chest all compliance
o 30% increase in oxygen consumption
Renal, changes in pregnancy
o maintaining electrolyte and acid–base balance
o regulating increases in blood and extracellular fluid volume
o excreting maternal and fetal waste products
o conserving essential nutrients
o dilation of renal tubules leading to urinary stasis
Musculoskeletal changes in pregnancy
o relaxation of pelvic structures
o rise in diaphragm and increase in width of lower rib cage
o neck enlargement
o gait disturbance
Endocrine changes in pregnancy
o enlargement of thyroid 1st trimester
o pituitary gland increased x3
o 20-25% increase in basal metabolic rate
o Increase in insulin secretion
o Increased release of oxytocin and prolactin for breast feeding
Neurological changes in pregnancy
o decrease in ability to concentrate, emotional lability, irritability,
o optic and otic changes
o transient hearing loss and vertigo
o hoarseness and snoring
Factors that suppress breast milk production
- Anxiety/stress
- Supplementing with formula
- Getting sick
- Not eating/drinking enough
Oxytocin
‣ Levels increase throughout pregnancy in increasing amounts in preparation for birth and lactation
‣ Immediately after birth, the release of oxytocin facilitates a peaceful, loving feeling with the woman that can influence her.
‣ Breastfeeding and various newborn sounds and behaviors also enable oxytocin release
‣ Oxytocin can increase euphoria, decrease stress, and facilitate attachment
Effects of progesterone during pregnancy
‣ Proliferation of breast tissue
‣ Assists with uterine growth
‣ soften the ligaments and muscles of the pelvic floor.
‣ Systemic vascular resistance is reduced
‣ Decreased bladder tone
‣ Relaxation of pelvic structures
Effects of estrogen during pregnancy
‣ Stimulates growth of breast ducts
‣ Assists with uterine growth
‣ Cervical ripening
‣ Systemic vascular resistance is reduced
‣ Relaxation of pelvic structures
Effects of prolactin during pregnancy
‣ Systemic vascular resistance is reduced
‣ Stimulates lactation
Postpartum blues
Mild form of postpartum depression, symptoms last up to 14 days
Symptoms of post partum blues
‣ Tearful
‣ Irritability
‣ Mood swings
‣ Fatigue
‣ Appetite changes
Treatment for postpartum blues
‣ encouraged to rest when possible, increase nutrition and fluids, get fresh air, and ask for family support
Mastitis
‣ Inflammation of the breast, usually occurs in first two months post partum
S/S of mastitis
‣ unilateral localized erythema, breast tenderness, and warmth at the site, and they can present with accompanying fever and flu-like symptoms
‣ infective or non-infective (plugged ducts)
Treatment for mastitis
‣ continuation of breastfeeding, increased rest, fluids, nutrition, application of moist heat, antiinflammatory medications, and possible use of antibiotics (penicillinase-resistant penicillin or cephalosporin)
Lactation amenorrhea
infant suckling during breastfeeding increases maternal prolactin levels, which in turn inhibits ovulation
For lactation amenorrhea to be effective birth control the following must be true
‣ (1) exclusive or near-exclusive breastfeeding;
‣ (2) amenorrhea (no vaginal bleeding after 56 days postpartum); and (3) infant younger than 6 months
Kegel exercises
‣ Pelvic floor muscle exercises, also known as Kegel exercises, should begin during pregnancy and continue immediately after a vaginal birth. This particular exercise not only strengthens and tightens vaginal tone, but also increases urinary tone and circulation to the perineal area, thereby promoting healing
