● [Morgan] Naegele’s rule Women’s Health p783
○ The EDB for women with 28-day cycles can be determined by using Nägele’s rule: Add 7 days to
... [Show More] the first day of
the LMP, then subtract 3 months (Box 30-1).
○
● [Morgan] Hematological changes during pregnancy Women’s Health p777
○ During pregnancy, blood volume increases by 30% to 50%, or 1,100 to 1,600 mL and peaks at 30 to 34 weeks’
gestation. The increase in blood volume improves blood flow to the vital organs and protects against excessive
blood loss during birth. Fetal growth during pregnancy and newborn weight are correlated with the degree of
blood volume expansion.
○ Of the blood volume expansion occurring during pregnancy, 75% is considered to be plasma. There is also a
slight increase in red blood cell volume (RBC).
○ The blood volume changes result in hemodilution, which leads to a state of physiologic anemia during
pregnancy. As the RBC volume increases, iron demands also increase.
○ Leukocytosis occurs in pregnancy, with white blood cell counts increasing to as much as 14,000 to 17,000 cells
per mm3 of blood. Clotting factors increase as well, creating a risk for clotting events during pregnancy.
○ Systemic vascular resistance is reduced due to the effects of progesterone, prostaglandins, estrogen, and
prolactin. This lowered systemic vascular resistance, in combination with inferior vena cava compression, is
partly responsible for the dependent edema that occurs in pregnancy.
○ Epulis of pregnancy, or hypertrophy of the gums accompanied by bleeding, may also occur and is due to
decreased vascular resistance and increase in the growth of capillaries during pregnancy.
○
● Prescribing combined estrogen birth control (Kim) CH11 Women’s Health pg. 209-243
Combined Oral Contraceptives
■ Combined oral contraceptives (COCs) are a combination of estrogen and progestin
■ Most COC formulations now contain between 20 to 35 mcg of ethinyl estradiol plus one of 8 available
progestins.
■ A high number of unintended pregnancies are due to misuse or discontinuation of OCs.
■ Consider the “quick start” method when initiating oral contraceptives.
○ If last menstrual period (LMP) was within the last 5 days, the method can be started
immediately.
○ In unprotected sex within last 2 weeks, start the contraceptive method today and
advise patient to return to the clinic for a pregnancy test in 3 weeks.
■ Instruct women who are using the pill, patch, ring, injection, or implant to use backup contraception for
the first 7 days.
■ Sunday start- menstruation does not occur over the weekend, 7 days of back method [Show Less]