Week 8 - Women's Sexual Health & Pregnancy

Question 1

Types of combined estrogen-progestin contraceptives

Answer 1

• COC
• transdermal patch
• vaginal ring

Question 2

Estrogen-progestin oral contraceptives

Answer 2

‣ 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

Question 3

Progestin only pill

Answer 3

‣ 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

Question 4

Tubal sterilzation

Answer 4

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

Question 5

Copper IUD

Answer 5

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

Question 6

Levonorgestrel IUD (Mirena, Liletta, Kyleena, and Skyla)

Answer 6

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

Question 7

Subdermal progestin implant

Answer 7

‣ Nexplanon – one of most effective methods of birth control
‣ Irregular bleeding, amenorrhea

Works for up to 3 years

Question 8

Depo-provera

Answer 8

‣ Injection every 13 weeks
‣ Progesterone only
‣ Decreases bone mineral density
‣ Reduces seizures in epileptics
‣ Fertility can take 15-49 weeks to return

Question 9

Presumptive signs of pregnancy

Answer 9

Amenorrhea, nausea, vomiting, increased urinary frequency, excessive fatigue, breast tenderness, quickening at 18 to 20 weeks

Question 10

Probable signs of pregnancy

Answer 10

‣ 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)

Question 11

Goodwell’s sign

Answer 11

Softening of the cervix

Question 12

Chadwick sign

Answer 12

Cervix is blue/purple tinged

Question 13

Hegar’s sign

Answer 13

Softening of lower uterine segement. Occurs when the uterus bends in an anterior direction on the softened lower uterine segment or isthmus

Question 14

Positive signs of pregnancy

Answer 14

‣ 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)

Question 15

Assessment of gestation age

Answer 15

Gestational age is calculated from date of LMP

Question 16

Prenatal care should include

Answer 16

‣ avoid many nonprescription medications
‣ check prescriptions for safety during pregnancy
‣ screen for alcohol use
‣ prenatal vitamin
‣ prenatal labs and STI testing

Question 17

Fundal height

Answer 17

‣ 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

Question 18

Changes to the cervix during pregnancy

Answer 18

‣ 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

Question 19

Vaccinations to avoid in pregnancy

Answer 19

‣ MMR
‣ Varicella
‣ Live flu vaccine

Question 20

Nutritional counseling for pregnancy

Answer 20

‣ 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

Question 21

Ectopic pregnancy

Answer 21

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

Question 22

Risk factors for ectopic pregnancy

Answer 22

‣ PID
‣ Infertility
‣ Assistive reproductive technologies

Question 23

Integumentary changes in pregnancy

Answer 23

o increased sweat, increased vascularity causing pigmentation changes, linea nigra may appear, stretch marks due to break down of connective tissue

Question 24

Gastrointestinal changes in pregnancy

Answer 24

o peristalsis slows
o decreased intestinal contractility
o increased salivation
o sluggish gallbladder emptying

Question 25

Cardiovascular changes in pregnancy

Answer 25

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

Question 26

Respiratory changes in pregnancy

Answer 26

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

Question 27

Renal, changes in pregnancy

Answer 27

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

Question 28

Musculoskeletal changes in pregnancy

Answer 28

o relaxation of pelvic structures
o rise in diaphragm and increase in width of lower rib cage
o neck enlargement
o gait disturbance

Question 29

Endocrine changes in pregnancy

Answer 29

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

Question 30

Neurological changes in pregnancy

Answer 30

o decrease in ability to concentrate, emotional lability, irritability,
o optic and otic changes
o transient hearing loss and vertigo
o hoarseness and snoring

Question 31

Factors that suppress breast milk production

Answer 31

• Anxiety/stress
• Supplementing with formula
• Getting sick
• Not eating/drinking enough

Question 32

Oxytocin

Answer 32

‣ 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

Question 33

Effects of progesterone during pregnancy

Answer 33

‣ 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

Question 34

Effects of estrogen during pregnancy

Answer 34

‣ Stimulates growth of breast ducts
‣ Assists with uterine growth
‣ Cervical ripening
‣ Systemic vascular resistance is reduced
‣ Relaxation of pelvic structures

Question 35

Effects of prolactin during pregnancy

Answer 35

‣ Systemic vascular resistance is reduced
‣ Stimulates lactation

Question 36

Postpartum blues

Answer 36

Mild form of postpartum depression, symptoms last up to 14 days

Question 37

Symptoms of post partum blues

Answer 37

‣ Tearful
‣ Irritability
‣ Mood swings
‣ Fatigue
‣ Appetite changes

Question 38

Treatment for postpartum blues

Answer 38

‣ encouraged to rest when possible, increase nutrition and fluids, get fresh air, and ask for family support

Question 39

Mastitis

Answer 39

‣ Inflammation of the breast, usually occurs in first two months post partum

Question 40

S/S of mastitis

Answer 40

‣ 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)

Question 41

Treatment for mastitis

Answer 41

‣ continuation of breastfeeding, increased rest, fluids, nutrition, application of moist heat, antiinflammatory medications, and possible use of antibiotics (penicillinase-resistant penicillin or cephalosporin)

Question 42

Lactation amenorrhea

Answer 42

infant suckling during breastfeeding increases maternal prolactin levels, which in turn inhibits ovulation

Question 43

For lactation amenorrhea to be effective birth control the following must be true

Answer 43

‣ (1) exclusive or near-exclusive breastfeeding;
‣ (2) amenorrhea (no vaginal bleeding after 56 days postpartum); and (3) infant younger than 6 months

Question 44

Kegel exercises

Answer 44

‣ 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