Womens Health 9

© 2008 McGraw-Hill Higher Education. All rights reserved.

Chapter Nine

Designing Your Reproductive Life Plan


Family Planning

• Family Planning is more than a personal and family issue

• It has health, social, and political implications• Women and children have been impacted by:

• Governments• Religious bodies• Health care options• Political agendas

• Women need access to a variety of reproductive options


Benefits of Family Planning

• Contributes to decreasing poverty for women

• Provides women more time to spend on education and job opportunities

• Reduces the number of maternal and infant mortality

• Reduces global population

• Reduces the number of teens who give birth (unintended and premature births)

• Provides adolescents with more opportunities to succeed in life


Reasons for Selecting a Birth Control Method

• Availability of method• Prevent having

children• Reduce STD risks• Religious doctrine• Decision-making

process with partner

• Health risks• Financial and

emotional considerations for couples

• User effectiveness rate


Birth Control Methods

• Birth control methods are all strategies used to keep from having a baby and include the following:

• Contraceptive methods• IUD’s• Emergency contraception• Abortion

• Contraceptive choices are methods that prevent fertilization of the ovum such as:

• Hormonal methods• Barrier methods• Sterilization

See Table 9.1 for comparisons of effectiveness and cost


Abstinence

• Abstinence is the only sure method of birth control to prevent an unintended pregnancy or unwanted STIs

• Teenagers can be sexually intimate without risking pregnancy or STIs

• The latest trend is showing a decline in Abstinence-only programs

• These programs are not supported by peer reviewed research for prevention of STIs, HIV/AIDS, and unplanned pregnancies

• Furthermore, no research studies have shown abstinence only education to be consistently effective in delaying sexual activity in teens


Fertility Awareness Methods

Natural Family Planning Methods

•Cycle-based method (calculating the unsafe days of ovulation)

•Basal temperature (raise in body temperature could result in ovulation)

•Mucus (evaluate consistency of vaginal discharge to predict ovulation)

•Sympothermal (combines basal type and mucus together)

•Withdrawal (not a contraceptive method) penis is withdrawn from the vagina before ejaculation

Offers no protection against sexually transmitted diseases or infections

See illustration on next slide


Fertility Awareness (See Figure 9.1)


Barrier Methods

• Barrier methods prevent sperm from reaching the fallopian tubes, either by physical or chemical means

• Barriers include the following:• Spermicides• Condoms• Diaphragms• Cervical caps

• Barrier methods remain popular because of the protection they provide against HIV and other STIs


Barrier Methods, cont’d

Vaginal Spermicides

•OTC products In a recent study, women who used a condom and N-9 gel had a 50% higher HIV infection rate vs. a condom and placebo gel


Barrier Methods, cont’d

Male Condom OTC product 86-90% user rate effective

Condom with Spermicide OTC product 98% user rate effective

Female condom OTC product 78-88% user rate effective

Diaphragm Soft rubber cap, must be fitted by health care professional, used with spermicide

84-97% user rate effective

Cervical Cap Thimble shaped device fits over the cervix

87-98% user rate effective

Cervical Shield Silicone cup with air valve that fits over the cervix and comes in 1 size

N/A


Hormonal Contraceptives

• Hormonal contraceptives are convenient, effective, and reversible

• However, they provide no protection against HIV and other STI’s

• They are solely intended to prevent pregnancy• The primary methods available are:

• Oral contraceptives• Norplant• Injections i.e. Depo-Provera, Lunelle• Patch• Ring


Oral Contraceptives


Oral Contraceptives

• Oral contraceptives are considered the second most popular form of birth control in the United States

• Works by primarily inhibiting ovulation through suppressing FSH and LH

• Types:• Combination pills that contain estrogen and progestin• Progestin only types (mini-pill)


Health Benefits of OC’s

• Research suggests that Oral contraceptives provide the following benefits:

• Protection against epithelial ovarian and endometrial cancer

• Lowered risk for ectopic pregnancies and PID• Lighter and less painful menstrual flow• Decreases in iron deficiency anemia


Health Risks Associated with OC’s

• Estrogen use is associated with the following side effects:

• Nausea• Breast pain and soreness• Fluid retention

• Progestin-only pills are associated with:• Increased irregular menstrual cycles• Vaginal bleeding

• Other risks with OC’s include:• Blood clots• Strokes• Changes in bone density• Reproductive cancers


Other Forms of Hormonal Contraceptives

• Yasmin (contains synthetic progestin, drospirenone)

• Transdermal Patch (skin patch containing progestin/estrogen)

• NuvaRing (vaginal insert containing progestin/estrogen)

• Lunelle (monthly hormone injection)

• Implanon (progestin-only subdermal implant)

• Depo-Provera (progestin injection once every 3 months)


Emergency Contraception

• In 1998, the FDA approved the first combination pill (Preven)

• A year later, a progestin pill was developed (Plan B)• ECP’s reduce the risk of pregnancies by delaying or

inhibiting ovulation when taken within 120 hours of unprotected intercourse

• Effective rates improve when taken earlier vs. later • ECP’s do not induce a medical abortion or affect the

developing pre-embryos or embyros

Emergency IUP insertion is also considered a choice within 5 days of Unprotected intercourse and reduces pregnancy risk by 99.9%


Contraindications for Hormonal Methods

• If woman is pregnant• Active liver disease• Heart problems• Breast cancer• diabetes

• Hypertension• Migraine headaches• Epilepsy• History of blood

clotting


Intrauterine Devices

• The WHO and the AMA have called the IUD one of the safest, most effective and least expensive reversible methods of birth control available

• Past history with a faulty brand (Dalkon Shield, 1974) contributed to its lack of popularity in the U.S. as well as its stigma of being associated with abortion and PID’s

• The method works by reducing the amount and ability of sperm to reach the egg

• Other forms of IUD’s contain hormones, which allows the female to wear the IUD longer compared to others


Sterilization

• Vasectomy – separation of the vas deferens• Tubal ligation – separation of the fallopian tubes


Maternal Mortality

• Maternal mortality is defined as the death of a woman while pregnant

• They are divided into direct and indirect obstetrical deaths

• Direct: account for 80% of deaths and results from complications such as incorrect treatment, labor, pregnancy, or omissions, commonly due to hemorrhage

• Indirect: result from previous existing diseases or diseases caused by the physiological complications of pregnancy e.g. anemia

• The best mechanism to prevent maternal deaths is to improve the status of women


Infant Mortality

• Infant mortality is defined as the deaths of infants under 1 year while neonatal mortality is under 28 days

• Race and education are important indicators for infant mortality

• The primary causes for neonatal and infant mortality are:

• Congenital anomalies• Pre-term/low birth weight• SIDS• Respiratory Distress• Complications of Pregnancy


Pre-Pregnancy Planning

• Non-drug use

• Nutritional planning

• Exercise

• Time lapse of one menstrual cycle between contraceptive use and conception

• Immunizations

• Folic acid supplements

• Quit smoking

• Avoid alcohol beverages

• Avoid OTC drugs

• Avoid mega-dosing on nutritional supplements

Pre-pregnancy planning encompasses the following:


Conception

• Pregnancy begins with the union of the female egg and the male spermatozoa

• A one cell zygote is formed, containing characteristics of both parents

• The fallopian tubes provide the environment where cell division begins

• After 3 days, the fertilized ovum is transported to the uterus

• Once the chorionic villi cover the ovum, hCG (human chorionic gonadotropin) supports the endometrial growth


Amnion

• The amnion surrounds the embryo before it starts to evolve

• The amnion cavity is a fluid filled space between the amnion and the embryo

• It keeps the fetus at an even temperature, cushions, and provides nourishment

• By the 4th month, it can be sampled (amniocentesis) for possible genetic abnormalities


Placenta

• This is formed during the 3rd month• The function is to supply food to the fetus and

connects to the fetus through the umbilical cord• The placenta does the following tasks:

• Transfer gases and nutrients• Excretes waste• Transport heat• Produces various proteins and hormones• Brings maternal and fetal blood close together but are

completely separate


Early Signs of Pregnancy

• A missed period• A light period or

spotting• Tender, swollen

breasts• Fatigue

• Upset stomach• Vomiting• Feeling bloated• Frequent urination

Most home pregnancy tests measure Human Chorionic Gonadotropin (hCG) to determine whether you are truly pregnant. Most tests are accurate.


Fetal DevelopmentTable 9.2 (First Trimester)

• The heart beings to beat

• Bones have appeared-head, arms, fingers, legs, and toes

• The major organs and nervous systems are formed

• The placenta is formed

• Hair is starting to grow

• 20 buds for future teeth have appeared


Fetal DevelopmentTable 9.2 (Second Trimester)

• The fetus grows quickly from now until birth

• The organs are developing further

• Eyebrows and fingernails form

• The skin is wrinkled and covered with fine hair

• The fetus moves, kicks, sleeps and wakes, swallows, can hear, and can pass urine

• By the end of this time, the fetus is 11-14 inches long and weighs about 2-2.5 lbs.


Fetal DevelopmentTable 9.2 (Third Trimester)

• The fetus kicks and stretches, but as it gets bigger it has less room to move

• Fine body hair disappears

• Bones harden, but bones of the head are soft and flexible for delivery

• The fetus usually settles in a good position for birth

• At 40 weeks, the fetus will be full term. It is about 20 inches long and weighs 6-9 pounds


Pre-natal Care(First initial visit)

• Discussion of maternal nutritional needs, exercise, and drug use

• History of maternal, paternal, and family

• Physical exam including ht./wt. and blood pressure

• Exam of the reproductive organs

• Estimation of the due date

• Blood, urine ,and pap tests


Pre-natal Care(subsequent visits)

• Physical exam including ht./wt. and blood pressure

• Fetal heartbeat, growth, and position

• Urine test for protein and sugar

• Possible ultrasound, chorionic villus sampling, maternal serum screening, amniocentesis, anon stress test, a contraction stress test and a biophysical profile

Weekly prenatal checkup are recommended after week 36


Labor Signs

• Braxton Hicks contractions increasing in frequency and intensity

• Lightening occurs• Amniotic sac ruptures• The 3 stages of labor are:

1) Uterine contractions 15-20 mins. w/ “bloody show” with full cervix dilation

2) Crowning of the fetus’ head to fetal expulsion

3) Placental separation and expulsion


Birthing Options

• Midwives

• Doulas

• In-Hospital Deliveries

• Birth Centers

• Birthing Positions


Breast-feeding

• Breast-feeding has prevented nearly 6 million infant deaths each year world-wide

• Advantages are:• Inexpensive• Better nutritional quality• Ability to act as a birth control measure to limit

fertility• Reducing ovarian and premenopausal breast

cancer• Contains colostrum (initial milk produced by the

mother) which helps fight infections


Potential Problems During Pregnancy

• Ectopic Pregnancy• Tubal pregnancy• Occurs due to narrowing of the fallopian tubes• Can cause infertility and mortality

• Hypertensive disorders• Preeclampsia-elevated blood pressure due to

edema and/or proteinuria• Eclampsia-same as above except it progresses to

convulsions and/or coma


Infertility

• Health providers should determine the cause of having difficulty conceiving

• Primary infertility is the inability of a woman to become pregnant within a year of having unprotected intercourse

• Secondary infertility is the inability to carry the pregnancy to full term

• The most common reasons for primary infertility in women are failure to ovulate or a damaged uterus or fallopian tube while men have low sperm or abnormal counts


Assisted Reproductive Technology (ART)

• In vitro fertilization (IVF)• GIFT (gamete intrafallopian transfer)• ZIFT (zygote intrafallopian transfer)• ICSI (intercytoplasmic sperm injection)

– The majority of these procedures are IVF (75%)

– 69% were performed on women aged 30-39– The remainder were common among women aged 40

years or older


Other Procedures Used to Promote Motherhood

• Donor eggs

• Vasovasotomy

• Artificial Insemination

• Surrogacy

• Somatic stem cells


Abortion – Terminationof a Pregnancy

• First Trimester Procedures– Menstrual extraction – withdraw endometrial tissue during the 4th-

6th week

– Vacuum aspiration – 6th-9th week procedure performed the most by dilating the cervix and removing uterine contents

– D&C (Dilation & Curettage) - performed during 9th-14th week; dilation of cervix and scraping the wall of the uterine

– RU486 (Mifepristone) – blocks the action of progesterone and doesn’t allow implantation to occur


Abortion – Terminationof a Pregnancy, cont’d

• Second Trimester Procedures– D&C (Dilation & Curettage) - performed during 13th-15th week;

cervix is dilated and contents are removed by suction

– Hypertonic Saline procedure – 16th week procedure where saline is administered and the uterus is caused to expel contents

– Prostaglandin procedure – hormones cause contractions to expel uterine contents


Adoption

• Adoption is an alternative to assisted reproduction or abortion

• Adoptions can be ‘open ‘ or ‘closed’`• Couples who are making the decision have a

variety of issues to consider• Services can vary from matching children and

adoptive parents to educational and support services throughout the parenting years

See FYI: Facts on Adoption


Chapter Nine

Designing Your Reproductive Life Plan

Womens Health 9

Health & Medicine

Transcript of Womens Health 9