CHN MIDTERMS 2.

FOOD FORTIFICATION
1st TOPIC - Adding essential nutrients to widely
NATIONAL NUTRITION PROGRAM OF THE PHILIPPINES consumed food at level above its natural state
- Aida V. Garcia – : Flour – Iron & Vit.
MALNUTRITION: : Cooking Oil – Vit A
Nutritional Deficiencies : Refined Sugar – Vit A
1 ) Vitamin A Deficiency : Rice - Iron
(VAD) : Salt – Iodine
2 Iron Deficiency Anemia “FOOD FORTIFICATION ACT OF 2000”
(IDA) Mandatory Fortification of Staples Food
3 ) Iodine Deficiency (ID) “Sangkap Pinoy Seal” – Voluntary fortification of processed foods
MALNUTRITION: “Cost Effective & Sustainable Intervention”
Poor: Physical, Mental, Social & Economic Maternal & Child Health Services Package
Condition …Breast Feeding
NUTRITION PROGRAM …Complimentary Feeding
GOAL …Micronutrient Supplementation
1. Improve quality of life 4. Nutrition Information, Education, Communication (IEC)
- improve nutrition - training material
- improve health
2. Productivity 5. Food Production
STRATEGIES • Kitchens
1. Food – based, interventions 2. • Gardens in home, schools, in community
Complement nutrition intervention w/ (urban/rural)
other services • Est. of demonstration centers, nurseries
3. Geographical focus: needier areas • Distribution of planting materials
4. Life-span approach attention Food Assistance
: 0 – 3 y/o • Center – based (also in school) Complimentary feeding
: adolescent for wasted/stunted children & pregnant women
: pregnant (Delivering LBW).
: lactating • Rice Distribution in schools
1. MICRONUTRIENT SUPPLEMENTATION • Food Discounts – “Tindahan Natin Program”
- Twice a yr. 7. Livelihood Assistance
Distribution of Vit A capsules through • Credit & Livelihood Opportunities • Linkage w/:
“Araw Sangkap Pinoy” (ASAP) lending: financial institutions
“Garantisadong Pambata” (GP) or “Child • Functional Literacy Training
Health Week” Nutritional Guidelines for Micronutrient Supplementation
- 6 up to 71 months Iodine Supplementation
 - Iodized oil capsule 1 cap/yr.200 mg iodine 2. PREGNANT w/nightblindness
( xerophthalmia )
TARGETS • give upon dx. Regardless of AOG
1. (15 – 45 y/o) • 1 cap once a day x 4 wks only
2. Children (school age) Vitamin A for Post – Partum
3. Adult • 200,000 IU – 1 capsule only w/in 4 wks After delivery
• dose
IRON Supplementation PREGNANT & LACTATING Mo. • Do not give 200,000 IU to pregnant
Coated tablet 60mg Iron / Vitamin A ( Universal Supplementation )
400mcg Folic Acid 1. 1. Infants ( 6 – 11 mons )
PREGNANT MO. • 100,000 IU
• 1 tab OD x 6 mons ( 180 D ) • dose
- whole pregnancy prd. • @ 9th month ( measles immunization )
OR 2. Child ( 12 – 71 months )
• During 2 & 3rd tri 2 tabs / day (120 EI)
nd
• 200,000 IU
/ 800mcg • 1 cap every 6 months
2. LACTATING WOMEN Vitamin A for Xerophthalmia ( for all ages )
• 1 tab OD x 3 mons ( 90 days ) 1. 6 – 11 months
IRON Supplementation for Infants - 100,000 IU 1 cap Today,
15mg drops form 6 months – 11 months 2. 12 – 59 months Tom, After 2 wks
1. INFANT - 200,000 IU
• 0.6ml OD x 3 months 2nd TOPIC
2. LBW NATIONAL IMMUNIZATION PROGRAM
• 0.3ml OD starts @ 2 mons until 6 months Legal Basis
IRON Supplementation for Pre School Children ➢ PD 996 (1976)
30mg syrup form • EPI (Expanded Program in Immunization)
1. CHILDREN 1 – 5 y/o • Compulsory Basic Immunization for Infants and
• Per DAY ---------- 1 tbsp OD x 3 mons Children Below 8 years of Age
OR
• 6 Preventable Diseases (tuberculosis, poliomyelitis,
• Per Week -------- 30mg / wk x 6 mons diphtheria, tetanus, pertussis and measles)
2. CHILDREN 6 – 11 y/o anemic ➢ R.A. 7846
• Per DAY ---------- 2 tbsp OD x 6 mon. • - Compulsory Immunization against Hepa B below 8
Vitamin A Supplementation for Pregnant Women
years old
1. PREGNANT WOMAN
• Hepa B immunization within 24 hrs birth of babies
• 10,000 IU
women with hepa B
• 1 cap
➢ R.A. 10152
• 2x / wk … until delivery
 • Mandatory Infants & Children Health SCHEDULE OF NIP
Immunization Act of 2011
• National Immunization Programs VACCINE PREVENTABLE RECOMMENDED AGE
• 6 Preventable Disease in EPI + Hepa B, DISEASE
Mumps, rubella, diseases caused by Hib. At 1&½ 2&½ 3& ½ 9 1Year
• Up to 5 years Birth Months Months Months Months old
➢ DOH MEMORANDUM 2010-0161 BCG TUBERCULOSIS
• Administration of Routine 2nd dose
×
HEPA B HEPATITIS B
MEASLES containing vaccine for children
➢ DOH MEMORANDUM 2012-0157
×
PETAVALENT Diphtheria,
• Administration of ROTAVIRUS for Infants
➢ DOH MEMORANDUM 2012-0244
VACCINE Tetanus, HepB, × × ×
Pertussis,
• Administration of Haemophilus infuenzae Pulmonary
type B containing vaccine (DPT-HepaB-HB) Meningitis
GOALS OF NIP Oral Polio Polio
➢ Immunize all infants Vaccine (OPV) × × ×
➢ Sustain polio-free status Inactivated Polio
➢ Eliminate Measles Polio Vaccine ×
• Presidential Proclamation No. 4 s 1998 (IPV)
➢ Eliminate Maternal/neonatal tetanus Pneumococcal Pulmonya
• Presidential proclamation no. 1066 s 1997 Conjugate Meningitis × × ×
➢ Control – Diphtheria, Pertussis, HepB & Vaccine (PCV)
Measles, Measles,
German Measles
➢ Prevent Extrapulmonary TB
Mumps Mumps, × ×
Rubella Rubella
(MMR)
 ANTIGEN AGE DOSE ROUTE SITE ➢ Only monovalent vaccine HBV for birth…. DPT & hib
not for birth
BCG At Birth 0.05 ID Deltoid Area ➢ AMV1 – if not sure if w/ AMV1 >>> Give!
ml
➢ All children not given AMV 1 as sched >>> Give!
HBV At Birth 0.5ml IM Anterolateral ➢ After AMV1…. AMV2 one month after AMV 1
of thigh ➢ Rotavirus vaccine (first dose for 6 wks to 15 wks)….
muscle 2nd dose.. 10 wks up to max. of 32 wks)
(ATM) ➢ Entering Day care/ Grade 1 AMV…. Is mandatory
PENTA-HIB 6wk,10wks,14wks 0.5ml IM ATM ➢ No AMV…. Refer to nearest Health facility
PCV
OPV 6 wk, 10 wks, 2-3 ORAL Mouth CONTRAINDICATIONS
14wks gtts
➢ FALSE C/I
IPV 14 wks 0.5ml IM ATM
• Malnutrition
AMV 9-11 months 0.5ml SC Outer part of • Low Grade Fever
(attenuated Upper Arm • Mild Respiratory infection
measles (OPUA) • Diarrhea… if for OPV yes!!! . then OPV again
virus) ➢ GENERAL C/I
MMR 12 – 15 months 0.5 SC OPUA • Do not delay vaccine
ml • Non confinement cases
ROTAVIRUS 6wks, 10 wks 1.5ml Oral Mouth
➢ SPECIFIC C/I
• Age over 5 years old…. No Penta, DPT anymore
CONSIDERATIONS • Acute Neuro Doses/ Recurrent convulsion…. NO
Penta, DPT
➢ Use one syringe, needle per client • W/ convulsion within 3 days of DPT 1/ Penta 1…..No
➢ No need to restart vaccine series regardless DPT 2 & 3; Penta 2 & 3
of time elapsed between doses
• Hx of hypertension to previous dose, Intussusception,
➢ All NIP antigens are safe effective when
intestinal malformation, AGE…. No Rotavirus
administered simultaneously at diff. sites
• w/ s/s of Aids, autoimmune disease…No BCG
➢ Coadministration – OPV then Rotavirus
Vaccine VACCINE CONTENT
➢ OPV- do not let dropper touch mouth. Drop
➢ BCG
vaccine straight onto tongue
• Live Attenuated Bacteria
➢ Rotavirus – administer slowly down one
➢ OPV
side of mouth. Prevent spitting, failed
swallowing • Live Attenuated Virus – Trivalent
➢ AMV, MMR & ROTAVIRUS
• Live Attenuated Virus
 ➢ TT (TETANUS TOXOID) ➢ PREGNANT
• Weakened Toxin • TP x 3.5 %
➢ DPT-HepB-HiB (PENTAVALENT)
COLD CHAIN
• Diptheria Toxoid
• Inactivated pertussis bacteris ➢ OPV
• Tetanus Toxoid • -15 to -25°C stored in freezer
• Recombinant DNA Conjugate antigen ➢ ALL OTHER VACCINES
• Synthetic influenzae B bacilli • +2 to +8°C stocked in the shelves of refrigerator
➢ HEPATITIS B, PENTAVALENT, ROTAVIRUS VACCINE & TT
VACCINE FORM
• Damaged by FREEZING, wrap before storing in
➢ TT vaccine bag w/ COLD PACKS
• CLEAR, COLORLESS LIQUID….sometimes
3rd TOPIC
SLIGHTLY TURBID
➢ Hepa B MATERNAL, NB, CHILD HEALTH & NUTRITION (MCNHN)
• CLOUDY, LIQUID
CAUSES OF MATERNAL & NEONATAL DEATHS
➢ OPV
• CLEAR, PINKISH LIQUID ➢ Delays
➢ PENTA V ➢ Identification of Complication
• LIQUID ➢ Referral
➢ ROTAVIRUS V ➢ Management of Complication
• CLEAR, ODORLESS LIQUID IN A CONTAINER ➢ RISK FACTORS
w/ ORAL APPLICATOR • Unplanned, mistimed, unwanted, unsupported
pregnancy
EPI RECORDING & REPORTING
• No adeq. Care during pregnancy
➢ FULLY IMMUNIZED CHILDREN (FIC) • No skilled birth attendant
➢ COMPLETELY IMMUNIZED CHILDREN (CIM) • No Proper postpartum/ Postnatal care for mo & nb
• Completed at 12 – 23 Months
MNCHN STRATEGIES
➢ CHILD PROTECTED AT BIRTH (CPAB)
• 2x 1 month before delivery or 3 before ➢ UNIVERSAL ACCESS TO & UTILIZATION OF CORE
doses before delivery PACKAGES
➢ SERVICE DELIVERY NETWORK
TARGET SETTING
• BEmONC (Basic Emergency Obstetric Newborn Care)
➢ INFANTS • CEmONC (Comprehensive Emergency Obstetric
• TP x 2.7 % Newborn Care)
➢ 12 - 59 MONTHS ➢ ORGANIZED USE OF INSTRUMENTS FOR HEALTH
• TP x 10.8 % SYSTEMS DEVELOPMENT
 ➢ BUILD UP OF CAPABILITY OF DOH & • FHR, Fetal Movement
PHILHEALTH • Dx Exam, CBC, Blood Typing, U/A, Screening for STI’s,
Blood sugar screening, Pregnancy test, Cervical
MNCHN CORE PACKAGES (USING RISK APPROACH)
cancer screening, acetic acid wash & Papanicolaou
➢ PREPREGNANCY PACKAGE Smear
• NUTRITION ➢ Micronutrient Supplementation
▪ Counselling • Iron & Folate 60 mg/400 mcg, OD x 6 months or 180
▪ Micronutrient Supplementation tablets
- Iron 60 mg / 400 mcg Folic Acid 1 • Vit. A 10,000 IU twice a week, Starts at 4th month
tab daily 3 – 6 months • Iodine 200 mg once during pregnancy
- Vitamin A 5,000 IU q week or daily ➢ TT (Tetanus Toxoid)
multivitamin • IM Deltoid muscle 0.5 ml
• HEALTHY LIFESTYLE • NB Protection – Passive Immunity
▪ Smoking cessation
▪ Regular Exercise % Protection Interval Duration
▪ Mod. Alcohol Intake TT 1 0% ASAP 0
TT 2 80% 4 Weeks 3 Years
▪ Healthy Diet
TT 3 95% After 6 months 5 Years
• Advise on FP & FP services
TT 4 99% 1 Year 10 Years
• Previous/ Management of LIFESTYLE
TT 5 99% 1 Year Lifetime
RELATED DISEASES ➢ Promote Exclusive BF, NB Screening & Infant
• Previous/ Management of INFECTIOUS immunization
DISEASES PLUS DEWORMING ➢ Birth planning & promotion of facility-based delivery
• Counsel on STI, HIV, AIDS, Nutrition &
personal hygiene Home – Based Mother’s Record/MOTHER & CHILD RECORD
• ADOLESCENT HEALTH SERVICES (HBMR)
• ORAL HEALTH SERVICES ➢ 2 RECORDS
PRENATAL VISIT • FACILITY BASED RECORD
• HBMR
➢ 4 Prenatal Check Ups ➢ HBMR
• 1 in 1st and 2nd trimester • Promotes continuity of care
• 2 in 3rd trimester • Promotes earl recognition of women who are at risk
➢ Prenatal Assessment • Encourages self-care referral
• Height & Weight • Useful Records of care, health info & stat
• BP Monitoring • Guides h. workers in providing health educ. Needs of
• Measurement of funding height against client
AOG
 • 1. skilled birth attendance/ Skilled health
professional assisted delivery
• 2. Facility- based record
• 3. Use of PARTOGRAPH
▪ PARTOGRAPH
- It is a composite graphical record
of key data (maternal and fetal)
during LABOR entered against time
on a single sheet of paper
• MATERNAL DEATHS – Mostly occur during
labor of 1st 24 hr postpartum
• 4. EINC – Essential intrapartum & newborn
care
▪ Unang Yakap
▪ PRACTICES:
- Companion of choice during labor
and delivery
- Freedom of movement in labor
- Partography to monitor progress
• 5. Non drug pain relief before labor
anesthesia
• 6. Position of choice during labor/Delivery
is semi upright
• 7. Hand Hygiene
• 8. Non Routine Episiotomy
• 9. AMTSL
• 10. Access to BEmONC or CEmONC
➢ POSTPARTUM PACKAGES
• PP VISIT
▪ Within 72 hrs
▪ On the 7th day PP check for
infection/bleeding
• MICRONUTRIENT SUPPLEMENTATION
▪ Iron w/ Folate x 3 months
▪ Vit. A
• COUNSEL ON NUTRITION, CHILD CARE, FP & OTHERS
4th TOPIC
NEWBORN CARE PACKAGES
ESSENTIAL HEALTH SERVICES FOR NEWBORN
➢ Immediate drying of baby
➢ Early Skin-to-skin contact
➢ Timely cord clamping
➢ Non-Separation of mother & baby
➢ Giving Eye prophylaxis
➢ Vitamin K Administration
➢ Baby Weighing
➢ First Dose HBV
➢ First Dose BCG Vaccine
NEWBORN SCREENING
LEGAL BASIS
➢ R.A. 9228
• Newborn Screening Act of 2004
PROCEDURE
➢ Ideally 48th hour or at least 24 hrs from birth
➢ Must be screened again after 2 weeks
➢ HEEL PRICK METHOD
• Results
▪ 7 – 14 days
▪ Negative – Normal
▪ Positive – Relayed/Refer to specialist for
confirmatory
• 6 Diseases
▪ Congenital Hypothyroidism
- Severe Mental Retardation
▪ Congenital adrenal hyperplasia
- Death
 ▪
Phenylketonuria
- Severe Mental Retardation
▪ Glucose 6 Phosphate Dehydrogenase
(G6PD) Deficiency
- Severe Anemia, Kernicterus
▪ Galactosemia
- Death or Cataracts
▪ Maple Syrup Urine Diseases
➢ Expanded Newborn Screening
• DOH AO-2014-0045
• From 6 to 28 disorders preventable
NEWBORN HEARING SCREENING
LEGAL BASIS
➢ R.A. 9709
• Universal Newborn Hearing Screening and
Intervention act of 2009
PROCEDURE
➢ Performed at 24 – 48 hours of age or before
the baby leaves the hospital
➢ 2 TYPES
• Otoacoustic Emission
▪ Well settled baby
▪ Best possible environmental conditions
– close windows and doors with mobile
devices off
▪ Good ear piece fit ensuring a ¼ turn,
staying securely without support
• Automated Auditory Brainstem Response
▪ Well settled baby and best possible
environmental conditions – close
windows and doors with mobile
devices off
▪
Skin Preparation – 3-5 wipes in 1 direction using
prep pad on the 3 sensor sites
➢ RESULTS
• PASS
▪ Hearing from ear canal to cochlea intact
• REFER IF:
▪ Ear wax
▪ Further evaluation or testing
▪ Repeat: 1 – 3 months
• Not performed
➢ RISK FACTORS FOR HEARING LOSS
• Hyperbilirubinemia requiring transfusion
• Ventilation > 48 hrs
• NICU admission > 48 hrs
• Ototoxic Medication
• Family hx. Of permanent childhood hearing loss
• Craniofacial anomalies w/deformed pinna or ear
canal
• Features associated with syndrome
• In-utero infections
6th TOPIC
NATURAL FAMILY PLANNING (NFP)
➢ Definition (WHO)
• Method for planning, avoiding pregnancy by
observing natural s/s of fertile/ infertile phase of
menstrual cycle
• Pills, Traditional method and calendar method is not
included in here
➢ ADVANTAGES OF NFP
• Effective when used correctly
• Inexpensive
• No Side Effects
• No follow up
➢ ADVANTAGES OF NFP COUPLE
 • Shared Responsibilities ▪ Baby must not more than 6 months old
• Shared decision • ADVANTAGES
• Better Communication foster marriage ▪ High Effectiveness for postponing pregnancy
• Better understanding of sexual physiology ▪ Simple to use
➢ DISADVATANGES ▪ Does not require charting or abstinence
• 2 to 3 months observations before using ▪ Provides Benefits of breastfeeding practice
except SDM • DISADVATANGES
• Recording (Consistent/Accurate) Except ▪ Temporary, only as long as criteria is met
SDM ▪ May not work for women who go back to work
• ABSTINENCE, Diligence, Motivation after delivery
• No Protection STI ▪ Needs another fertility planning method that will
➢ METHOD AND DAYS TO ABSTAIN not disrupt breastfeeding
• SDM – 12 Days FERTILITY AWARENESS METHOD (FAB)
• TDM – 13 Days
• BOM – 18 Days ➢ Based on analysis of fertile time in menstrual cycle
• STM – 17 Days ➢ Also known as periodic abstinence
➢ PREGNANCY RATES WITH CONSISTENT & ➢ INCLUDES:
CORRECT USE • Standard Days Method
• SDM – 5 • Billings Ovulation Method
• Calendar Rhythm method – 9 • Two Days Method
• TDM – 4 • Basal Body Temperature
• BBT – 1 • Symptothermal Method
• BOM – 3 ➢ STANDARD DAYS METHOD
• STM – 2 • Based on physiology of mens cycle and lifespan of
ovum and sperm
NFP METHODS • Can be used on women mens cycle with 26 – 32 days
➢ LAM (Lactating Amenorrhea Method) only
• Breast feeding > Stimulates Hypothalamus • BRACELET (REMINDER) (CYCLE BEADS)
> Suppressing release of GRH…Ovarian ▪ Red Beads
Follicle > Low estrogen in blood & transient - Start of period
infertility. ▪ White Beads
- Day 8 -19 Fertile days
• Sucking > Prolactin > suppress ovulation
▪ Brown Beads
• 3 Criteria
- Day 1 – 7 Unfertile days
▪ Fully Breastfeeding
- Day 20 until next mens unfertile days
▪ Menses have not returned since
childbirth
➢ BILLINGS OVULATION METHOD/ CERVICAL
MUCUS METHOD
• Dr. John & Evelyn Billings
• CERVICAL MUCUS (CM)
▪ Fertile and Infertile are based on
mucus changes
▪ Fertile Mucus is characterized as wet,
clear, slippery, stretchy mucus.
▪ Bleeding days are considered fertile
day specially in last day if spotting
occurs
▪ If a presence of mucus is seen or felt,
ovulating is near.
▪ Nearing Ovulation, CM is thin, copious
and conducive for sperm penetration,
survival egg cell
▪ During Fertile Period, Woman feels
wet, slippery, watery and clear mucus.
This mucus nourishes and provides
channels to sperm to swim and reach
egg
▪ Infertile Period – Mucus will form a
plug that serves a natural barrier.
Women will feel dry and not see any
mucus at all, thick and scanty mucus
• REQUIREMENTS
▪ MENSTRUATION
▪ BASIC INFERTILE PATTERN (BIP)
- After Menstruation
- Dry and no vaginal Discharge or
unchanging pattern of it
▪ CHANGING PATTERN OF FERTILITY
- Vaginal Discharge is thinner and
clearer
- Sensation is wet and slippery
- Swelling of Vulva; Feeling of fullness
- AT LAST DAY: PEAK OF FERTILITY
▪ PEAK OF FERTILITY
- last day of SLIPPERY SENSATION
- Confirmed by checking loss of it next day
▪ POSTOVULATORY INFERTILE PHASE
- Last for 14 DAYS
- May feel dry again or some discharge but
NOT SLIPPERY
• HOW TO CHECK CERVICAL SECRETIONS
▪ Finger Method
▪ Toilet Paper method
▪ Underwear method
▪ Should be every pm or evening
• BOM: 4 RULES TO AVOID PREGNANCY
▪ NO!... on Menstrual Days…. will not notice mucus
▪ Every Other Evening – BIP
▪ No! – Changing pattern of Fertility until 4th day
after the peak
▪ 4th day after peak up to menstruation YES!
• CHART OF SYMBOLS FOR RECORDING
▪ R for bleeding days
▪ D for dry days
▪ X for wet days
▪ Encircled X for peak day
▪ M for dry feeling but sticky pasty mucus for
infertile days
• TO POSTPONE PREGNANCY, APPLY:
▪ Observe dry days following menstruation
▪ EARLY DAYS RULE
- On Dry days following menstruation,
intercourse is available on ALTERNATE
EVENINGS ONLY
▪ PEAK DAY RULE
 - On fourth day after Peak
intercourse is available NIGHT AND
DAY UNTIL NEXT MENSTRUATION
- Considered as ABSOLUTE
INFERTILE PHASE
➢ TWO DAYS METHOD
• INDICATOR: Cervical Secretions
• If a woman notices any secretions TODAY
OR YESTERDAY, she should consider
herself FERTILE AND AVOID INTERCOURSE
➢ BASAL BODY TEMPERATURE
• INDICATOR: body temperature during and
after ovulation
• It is the temperature of the body at rest
after at least 3 hrs of continuous sleep
before temperature taking
• Same Thermometer should be used
• OVULATION – TEMPERATURE DECREASES,
Due to LUTENIZING HORMONE
• AFTER OVULATION – TEMPERATURE
INCREASES UNTIL NEXT MENSTRUATION,
Due to increase PROGESTERONE LEVEL
• Slightly increase of BBT sustained for 3 days
or more indicates ovulation has taken
place (Fertile)
• Most Fertile - 2 – 3 days before Temp Rises
• Abstain from start of menstruation up to 3
– 4 days after Temp rises
• BBT CHARTING
▪ A SUSTAINED RISE OF 0.2 – 0.5
DEGREE IS A SIGN OF OVULATION
▪ COVER LINE -Point of reference to
identify rise in Temp
▪ RECORD BASELINE TEMP – 1st day of
mens up to 10th day
▪ Disregard first 5 days and focus on 6 to 10th days
▪ THERMAL SHIFT – 3 Consecutive temp. readings
above cover line
▪ To Determine Thermal shift – continuous taking
of temp until 3 higher temp recordings are above
the line
▪ Fertile Days are on the left of Vertical line
▪ Infertile days are on the right of the vertical line
• FACTORS THAT AFFECT BBT
▪ Stress
▪ Alcohol intake
▪ Changes in sleep pattern
▪ Illness
• BBT WILL BE DIFFICULT TO USE IF:
▪ There is VAGINAL INFECTION (Chlamydia)
▪ FEVER/COLDS that changes body temp
➢ SYMPTOTHERMAL METHOD
• Client identifies her fertile and infertile days by
combining:
▪ BBT
▪ Cervical Mucus Observations
▪ Other fertility Signs
• MITTELSCHMERZ
▪ One Sided Abdominal Pain occurs on ovulation
time
• SPINNBARKEIT
▪ Capacity of cervical mucus to STRETCH a distance
before breaking
• OTHER FERTILITY SIGNS
▪ BREAST TENDERNESS
▪ INCREASE LIBIDO
▪ MOOD SWING/CHANGES DEPRESSION
• AVOID UNPROTECTED SEX between 1st day of
monthly bleeding & either 4th day after peak cervical
secretions or the 3rd day after BBT rises
• Can have unprotected sex between end of
menses and beginning of secretion but
never on TWO DAYS IN A ROW