Diaphragm:
- Education:
o Should be fitted per provider
o Replaced every 2 years and refitted for a 20% fluctuation in weight (15lbs), after abdominal
... [Show More] or pelvic surgery, and after every pregnancy, second term abortion
o Spermicide applied with each act of coitus (sex)
o Remain in place for 6hrs after coitus, no longer than 24hrs
Hormonal Contraceptives:
- Adverse effects:
o Chest pain, SOB, leg pain from possible clot, HA, eye problems from a stroke, and HTN
- Contraindications:
o Hx of thromboembolic disorder, stroke, heart attack, CAD, gallbladder disease, HTN, breast or estrogen-related cancers, smokers
Depo-Provera:
- Injectable contraceptive
- Can cause decrease bone mineral density or calcium (want to make sure that have adequate calcium and Vitamin D intake)
IUDs:
- Can increase the risk of pelvic inflammatory disease, can cause uterine perforation or ectopic pregnancy
- Increases risk of ectopic pregnancy
- Look out for: change in string length, fowl smelling vaginal discharge, pain with intercourse
Infertility:
- Inability to conceive after trying for 12 months
- Work up: usually start with the male (sperm analysis), then if clear then turn attention to woman
- Look at test for female
Male Sterilization
- Need to use form of birth control until said to be sterile, follow up
- 20 ejaculations before deemed sterile, permanent
Transcervical Sterilization
- Need to continue use of birth control until about 3 months
Tubal Ligation
- Permanent
- Surgery
- Does not affect sexual activity
Ch. 3:
Signs of Pregnancy
- Presumptive
o Amenorrhea, fatigue, nausea, vomiting, urinary frequency, breast changes, quickening, uterine enlargement
- Probable
o Abdominal enlargement, Hegar’s sign, Chadwick’s sign, Goodell’s sign, Ballottement, Braxton Hicks contractions, positive pregnancy test, fetal outline
- Positive
o Fetal heart sounds, visualization of fetus by ultrasound, fetal movement
Naegel’s Rule
- Minus 3 months, plus 7 days
GTPAL
- G=how many pregnancies
- T=term (>/=37 wks)
- P=pre-term (<37 wks)
- A=abortion (less than 20 wks)
- L=living children Ch. 4
- FHR: can be detected at early appts by US. Can be heard by doppler late in the first trimester. Listen at the midline, right above the symphysis pubis
Ch. 5 & 6:
Weight gain during pregnancy:
- Normal weight gain 25 to 35lbs
- If someone is overweight then less 15-25
- Underweight 28-40lbs
- During first trimester: no more than 2.2 to 4.4lbs for entire trimester
- 1lb per week for 2nd and 3rd trimester
- Extra calories of 340 calories per day for 2nd trimester
- Extra calories of 452 per day for 3rd trimester
- If breastfeeding need an 450 to 500 extra calories per day
- Folic acid prevents fetal neural tube defects 400mcg for childbearing and 600mcg for women that become pregnant(sources of folic acid: dark green leafy veggies, OJ, dried peas and beans, and seeds, breads, cereals, grains)
- Drink 2 to 3 L of water per day
- No more than 200 mg of caffeine
- No alcohol
Diagnostic tests:
- Ultrasound
o Bladder full (helps sound waves)
- Amniocentesis
o Empty bladder prior
o Done around 14 weeks
o Checking for genetic abnormalities
o AFP: alpha-feta protein if high, associated with neural tube defects
o If AFP low associated with chromosomal disorder-such as Downs
o Check LS ratio testing for fetal lung maturity
o Complications: amniotic fluid embolic, hemorrhaging, infection, leaking of amniotic fluid, ruptured membranes, miscarriage
- Biophysical profile (BPP)
o Score between 0 and 10 (8 to 10 is normal healthy baby)
o Measures 5 areas: reactive HR, breathing, body movements, fetal tone, amniotic fluid volume (each area gets a score of 2)
- Non-stress test
o Non-invasive
o Measures fetal well-being within last trimester
o Measures response of FHR to fetal movement
o Give mom a button to press when feels fetal movement
o Reactive normal: if FHR is a normal baseline rate with moderate variability, accelerates at least 15/min (10/min prior to 32weeks) for at least 15 seconds and occurs two or more times during a 20 min period
o Non-reactive is abnormal (bad)
- Contraction Stress Test
o Bring on a contraction by giving Pitocin
o Monitor FHR to see if late decelerations occur
o If no decelerations occur that is a negative result for CST and that is good
o If late decels occur that’s positive and a bad result
- Chorionic-villus sampling
o Can be done between 10 to 12 wks
o Test for genetic abnormalities
o Advantages: done earlier, identify abnormalities earlier
o Can be done instead of amniocentesis
Ch. 8
Treatment of Gonorrhea:
- Administer erythromycin to all infants following delivery
- Administer Ceftriaxone IM and azithromycin PO for treatment of mom (these will decrease effectiveness of oral contraceptives)
Ch. 7 & 9:
Ectopic Pregnancy
- Ovum is planted outside uterus instead of fallopian tube
- Unilateral stabbing pain in lower abdominal quadrant is main symptom Molar Pregnancy
- Symptom of bleeding that resembles prune juice (dark brown in color) Placenta Previa
- Can be complete, incomplete, partial
- Symptom is painless bright red vaginal bleeding in 2nd and 3rd trimester
- Dangerous may hemorrhage
- Fundal height measures can be greater than gestational ag [Show Less]