Week 2: Antepartum Care

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Sex and Fertilization
SEX
Act of copulation / “coitus
SEXUAL RESPONSE CYCLE
4 Stages of Sexual Response:
1. EXCITEMENT PHASE
- Physical and psychological stimulus
- Arterial dilatation and venous constriction in the genital
area  
Physiological changes in woman:     Functional life of a spermatozoa is about 48h, possibly as
- clitoris increase in size long as 72h
- Lubrication     - Ova about 24h possibly as long as 48h
- Vagina widens     - The ovum is surrounded by a ring of mucopolysaccharide
- Breast nipples become erect fluid (zona pellucida) and a circle of cells (corona radiata) -
- Increase BP, HR, RR serve as protection from injury
Physiological changes in men:
- Erection
- Scrotal thickening
- Elevation of the testes
- Increase BP, HR, RR
2. PLATEAU PHASE
- Reached first before orgasm
- Women: formation of orgasmic platform, increased nipple
engorgement
- Men: full distention of the penis Fertilization usually occur in the outer 3rd of the Fallopian
3. ORGASM PHASE tube, the ampullae portion
- Discharge of accumulated sexual tension - Normally, an ejaculation of semen averages 2.5 ml of fluid
- Shortest stage containing 50M - 200 million spermatozoa per milliliter or an
4. RESOLUTION STAGE average of 400 million / ejaculation
- External and internal organs return to their uncrossed state - Spermatozoa deposited in the vagina during intercourse
Generally takes 30 min generally reach the cervix within 90 sec and the other end of
the Fallopian tube within 5 min after deposition
CAPACITATION
- Final process that sperm must undergo to be ready for
fertilization
- The sperm move toward the ovum
 Changes in the plasma membrane of the sperm head, reveals
the sperm - binding receptor sites

FERTILIZATION
CONCEPTION / IMPREGNATION / FECUNDATION
- Union of ovum and spermatozoon
- Fertilized egg is called ZYGOTE
OVUM - from ovulation to fertilization
ZYGOTE - from fertilization to implantation HYALURONIDASE
EMBRYO - from implantation to 5-8 weeks - Proteolytic enzyme
FETUS - From 5-8 weeks until term  Released by the spermatozoa and acts to dissolve the layer of
CONCEPTUS - developing embryo / fetus and placental cells protecting the ovum
structures throughout pregnancy
 Normally, only one spermatozoon is able to penetrate the cell
membrane of the ovum. Once it penetrates the zona After implantation, the endometrium is called the DECIDUA
pellucida, the cell membrane becomes impervious to other Once implanted, the zygote is called an EMBRYO
spermatozoa.
After the spermatozoon penetrates the ovum, its nucleus is
released into the ovum, its tail degenerates and its head
enlarge and fuses with the nucleus of the ovum. This fusion
provides the fertilized ovum, called a zygote with 46
chromosomes. The spermatozoon and ovum each carried 23
chromosomes (22 autosomal and 1 sex chromosome)

3 SEPARATE FACTORS FOR FERTILIZATION TO OCCUR

1. Maturation of both sperm and ovum
2. Ability of sperm to reach the ovum
3. Ability of the sperm to penetrate the zona pellucida and cell
membrane and achieve fertilization
IMPLANTATION
- Occurs when the cellular wall of growing structure / zygote
implants itself in the endometrium of the anterior or
posterior fundal region, 8-9 days after fertilization after the Antepartum Care
corona and zona pellucida degenerates
- After fertilization. It takes 3-4 days for the zygote to reach to
the body of the uterus (free floating). During this time,
mitosis cell division, or cleavage begins.
- Day 2 - 1st cell division
- Day 3 - morula; bumpy appearance; consists of 16-50 cells;
body of the uterus; floats free in the uterine cavity for 3-4
days
Day 4

- Blastocyst; large cells collect at the periphery of the ball,
leaving a fluid space surrounding an inner cell mass
- this structure attaches to the uterine endometrium
- the cells in the outer ring are known as trophoblasts which
will form into placenta and membranes
the inner cell mass (enclosed within the trophoblast will form
the embryo)
DIAGNOSIS OF PREGNANCY
SIGNS AND SYMPTOMS OF PREGNANCY
PRESUMPTIVE
Presumptive means speculation or unconfirmed.
Presumptive signs and symptoms of pregnancy are those
signs and symptoms that are usually noted by the patient,
which impel her to make an appointment with a physician.
These signs and symptoms are not proof of pregnancy but
they will make the physician and woman suspicious of
pregnancy.
1. Amenorrhea (Cessation of Menstruation).
(1) Amenorrhea is one of the earliest clues of pregnancy. The
majority of patients have no periodic bleeding after the onset
of pregnancy. However, at least 20 percent of women have
some slight, painless spotting during early gestation for no
apparent reason and a large majority of these continue to
term and have normal infants.
(2) Other causes for amenorrhea must be ruled out, such as:
(a) Menopause.
(b) Stress (severe emotional shock, tension, fear, or a strong
desire for a pregnancy).
(c) Chronic illness (tuberculosis, endocrine disorders, or
central nervous system abnormality).
(d) Anemia.
(e) Excessive exercise.
1. Nausea and Vomiting (Morning Sickness).
(1) Usually occurs in early morning during the first weeks of
pregnancy.
(2) Usually spontaneous and subsides in 6 to 8 weeks or by
the twelfth to sixteenth week of pregnancy.
(3) Hyperemesis gravidarum. This is referred to as nausea and
vomiting that is severe and lasts beyond the fourth month of
pregnancy. It causes weight loss and upsets fluid and
electrolyte balance of the patient.
(4) Nausea and vomiting are unreliable signs of pregnancy
since they may result from other conditions such as:
(a) Gastrointestinal disorders (hiatal hernias, ulcers, and
appendicitis).
(b) Infection (influenza and encephalitis).
(c) Emotional stress, upset (anxiety and anorexia nervosa).
(d) Indigestion.
MGT: Dry toast / crackers before arising in the morning; avoid
greasy / fatty foods; avoid highly seasoned foods; eat small,
frequent meals
1. Frequent Urination.
(1) Frequent urination is caused by pressure of the expanding
uterus on the bladder.
(2) It subsides as pregnancy progresses and the uterus rises
out of the pelvic cavity.
(3) The uterus returns during the last weeks of pregnancy as
the head of the fetus presses against the bladder.
(4) Frequent urination is not a definite sign since other factors
can be apparent (such as tension, diabetes, urinary tract
infection, or tumors).
MGT: Decrease fluid intake in the evening
Avoid caffeine and tea
Void as soon as the urge is felt
Teach how to perform Kegel’s exercise
Report signs of UTI at once
1. Breast Changes.
(1) In early pregnancy, changes start with a slight, temporary
enlargement of the breasts, causing a sensation of weight,
fullness, and mild tingling.
Breast Changes during Pregnancy
(2) As pregnancy continues the patient may notice:
(a) Darkening of the areola–the brown part around the
nipple.
(b) Enlargement of Montgomery glands–the tiny nodules or
sebaceous glands within the areola.
(c) Increased firmness or tenderness of the breasts.
(d) More prominent and visible veins due to the increased
blood supply.
(e) Presence of colostrum (thin yellowish fluid that is the
precursor of breast milk). This can be expressed during the
second trimester and may even leak out in the latter part of
the pregnancy.
(3) These breast changes can be more positive if the patient
has not recently delivered and is not presently breastfeeding.
1. Vaginal Changes.
(1) Chadwick’s sign. The vaginal walls have taken on a deeper
color caused by the increased vascularity because of
increased hormones. It is noted at the sixth week when
associated with pregnancy. It may also be noted with a
rapidly growing uterine tumor or any cause of pelvic
congestion.
(2) Leukorrhea. This is an increase in the white or slightly gray
mucoid discharge that has a faint musty odor. It is due to
hyperplasia of vaginal epithelial cells of the cervix because of
increased hormone level from the pregnancy. Leukorrhea is
also present in vaginal infections.
1. Quickening (Feeling of Life).
(1) This is the first perception of fetal movement within the
uterus. It usually occurs toward the end of the fifth month
because of spasmodic flutter.
(a) A multigravida can feel quickening as early as 16 weeks.
(b) A primigravida usually cannot feel quickening until after
18 weeks.
(2) Once quickening has been established, the patient should
be instructed to report any instance in which fetal movement
is absent for a 24-hour period.
(3) Fetal movement early in pregnancy is frequently thought
to be gas.
1. Skin Changes.
(1) Striae gravidarum (stretch marks). These are marks noted
on the abdomen and/or buttocks.
(a) These marks are caused by increased production or
sensitivity to adrenocortical hormones during pregnancy, not
just weight gain.
(b) These marks may be seen on a patient with Cushing’s
disease or a patient with sudden weight gain.
(2) Linea nigra.
(a) This is a black line in the midline of the abdomen that may
run from the sternum or umbilicus to the symphysis pubis.
  

This patient has both striae gravidarum (stretch marks) and

the midline linea nigra
(b) This appears on the primigravida by the third month and
keeps pace with the rising height of the fundus.
(c) The entire line may appear on the multigravida before the
third month.
(d) This may be a probable sign if the patient has never been
pregnant.
(3) Chloasma. This is called the “Mask of Pregnancy.” It is a POSITIVE
bronze type of facial coloration seen more on dark-haired - Absolute evidence
women. It is seen after the sixteenth week of pregnancy. 1. FHR
(4) Fingernails. Some patients note marked thinning and Funic soufflé
softening by the sixth week. Uterine soufflé
1. Fatigue. 1. FETAL MOVEMENT
This is a common complaint by most patients during the first - When felt by the examiner, after the 16th week but usually
trimester. Fatigue may also be a result of anemia, infection, about 5 months
emotional stress, or malignant disease. 1. ULTRASONOGRAPHY
1. Positive Home Test. - Maybe detected as early as the 6th week of gestation,
These tests may not always be accurate, however, they are although usually done at 16 - 18 weeks
very effective today if they are performed properly. 1. ROENTGENOGRAPHY
- X-ray of fetal skeleton; usually done at 14th - 20th week

PHYSIOLOGIC CHANGES OF PREGNANCY

1. REPRODUCTIVE SYSTEM
- Uterine changes
- “Practice contractions” - Braxton Hick’s contractions
- Amenorrhea
- Cervical changes
- Vaginal changes
- Ovarian changes
- Changes in the breasts
1. INTEGUMENTARY SYSTEM
- Hyperactive sweat and sebaceous glands
- Hyperpigmentation
- Palmar erythema & increase angiomas
- Increase hair & nails growth
1. RESPIRATORY SYSTEM
- Increase vascularization of the respiratory tract caused by
increased estrogen levels
- Shortening of diaphragm caused by the enlarging uterus
- Increase tidal volume causing slight hyperventilation
- Slight increase (2 bpm) in respiratory rate
1. METABOLIC
- Increase water retention caused by higher levels of steroids
sex hormones
 - Decrease serum CHON levels
- Increase intra-capillary pressure and permeability
- Increase levels of serum lipids, lipoproteins, and cholesterol
- Increase iron requirements
- Increase CHO needs
- Increase body temperature
Weight gain 25 - 30 lb (11.3 - 13.6 kg)
Allowable weight gain in pregnancy
1st trimester - 2-4 lb
2nd trimester - 11 - 13 lb
3rd trimester - 11 - 13 lb
1. CARDIOVASCULAR
Heart
- Increase cardiac workload > increase cardiac output > left
ventricular hypertrophy > palpitations, increase heart rate
- Stroke vol >increase 10 - 30%
- Heart displaced up and the left, PMI shifts about 1.5 cm to
the left
Blood
- Increase iron demand
- Increase water retention
- Decrease blood viscosity and increase blood flow
->pulmonic and apical systolic murmurs
- Increase progesterone > increase fibrinogen > increase
clotting factor XII, IX, and X at term
Blood Volume
- Circulating blood volume increase by 30-50% by water and
Na retention approximately 1,500 cc Blood Pressure
- Brachial artery pressure highest when sitting; lowest when
at lateral recumbent position
- 2nd & 3rd trimester - increase relaxin > vasodilation,
muscle relaxation and decrease muscle tone > decrease
peripheral resistance > decrease BP
- Venous compression > increase venous stasis > pronicity to
thrombosis
- BP is lowest on the 2nd trimester because of pseudoanemia
- Compression of iliac veins leads to.
- Supine hypotensive syndrome
- increase hydrostatic pressure in leg veins > varicose veins
and dependent edema
1. GASTROINTESTINAL
- Stomach displaced upward > increase reflux of acids in the
lower esophagus > heartburn (pyrosis) and flatulence -
related to increase HCG, progesterone
- Increase progesterone > decrease GI motility and emptying
> tendency for N&V
EPULIS OF PREGNANCY due to estrogen
A pregnancy epulis is a benign (harmless) tumor and does not
have the potential to become cancerous. Some women may
have the epulis removed during pregnancy for cosmetic
reasons, or because the diagnosis is uncertain. However, if
left alone, the epulis will usually become smaller or disappear
after childbirth.
Hemangiomas of gingival capillaries (epulis of pregnancy) are
treated with proper dental hygiene and avoidance of trauma.
Surgical excision, cryotherapy, and electrodesiccation can
cause unnecessary blood loss or permanent disfigurement
and should be avoided. The lesion usually resolves
spontaneously after delivery.
- Thicker bile secretion due to progesterone
PTYALISM due to increase level of estrogen
Ptyalism gravidarum (PG) also known as hypersalivation or
sialorrhea is a condition of hypersalivation that affects
pregnant women early in gestation. Symptoms include
massive saliva volumes (up to 2 liters per day), swollen
salivary glands, sleep deprivation, significant emotional
distress, and social difficulties.
Management:
 Chewing on ice
 Using a minty mouthwash
 Brushing your teeth often with a minty toothpaste — it's also
good for dental care, which is extra important during
pregnancy
 Chewing sugarless gum
 Eating or drinking something sour, like sucking on lemon
slices
 Always carry paper towels and a tissue with you, so you can
blot any saliva that escapes from your mouth
 

 
1. URINARY SYSTEM
- Diuresis > pressure of enlarging uterus to bladder in 1st
trimester
- Relieved when uterus rises out of the pelvis in 3-4 months
but returns with LIGHTENING (2 weeks before onset of labor)
1. SKELETAL SYSTEM
Postural Changes
- Lumbosacral curve increases accompanied by a
compensatory curvature in the cervicodorsal region
- Characteristic posture in pregnancy: Backward tilt of torso
to balance the weight of the enlarging abdomen > strain on
back and thigh muscles and ligaments > back pains and
cramps later in pregnancy
- Waddling-Gait of Pregnancy - duck-like movement of pelvis
when walking due to pelvic instability caused by the enlarging
abdomen and relaxation of sacro-iliac joint and symphysis
pubis
- Enlarging uterus > anterior abdominal wall stretching >
umbilical stretched > DIATASIS RECTI
I.ENDOCRINE SYSTEM
- The major endocrine gland during pregnancy is the
PLACENTA
- Increase BMR (up to 25% at term)
- Increase iodine metabolism from slight hyperplasia of the
thyroid gland
- Slight parathyroidism
- Production of PROLACTIN
- ESTROGEN & PROGESTERONE > GnRH suppression >
decreases gonadotrophic hormones > no ovulation
- Increase HCG > (+) pregnancy test > prolongs life of corpus
luteum > continued production of estrogen and progesterone
> continued vascularity of endometrium > support life of
embedded embryo / fetus
- Increase HPL detectable as early as 3 weeks and found in the
maternal blood by 6th week > decrease ability of the mother
to use insulin (anti-insulin effect) > increase maternal serum
glucose supply to support the fetus & placenta > may cause
GESTATIONAL DIABETES
- Increase maternal cortisol / steroids > also has anti-insulin
effect > increase maternal serum glucose supply to support
the fetus and placenta > may contribute to development of
Gestational DM
- Increase OXYTOCIN (later part of pregnancy) > stimulates
the milk let-down reflex for the release of milk after delivery
of the baby and stimulates labor contractions to occur at
term
1. IMMUNOLOGIC SYSTEM
- Only maternal IgG cross placental barrier to provide the
baby with antibodies in the early neonatal period
- IgA is secreted in colostrum providing baby with additional
gastrointestinal protection during
breastfeeding
- Fetal immune system develops as early as the 7th week and
antigen recognition by 12th week
- Fetus develops all types of immunoglobulins by 12th week,
except IgA with highest amount at term before delivery
PSYCHOLOGICAL / EMOTIONAL RESPONSES TO PREGNANCY
1. AMBIVALENCE
- Refers to the interwoven feelings of wanting and not
wanting that always exist at high levels
- Normal response in both the woman and her partner
- Lack of knowledge of or preparation for parenthood and
children may also contribute to ambivalence
2. GRIEF
- Commonly occurs as a result of changes in the woman’s role
3. NARCISSISM
- Self-centeredness / egocentrism
- Generally an early reaction to pregnancy
- Occurs as the woman becomes focused on herself and the
changes occurring in her body
4. INTROVERSION / EXTROVERSION
- Some pregnant women become introverted during
pregnancy, focusing entirely on their bodies and themselves
- Other women become extroverted - may increase their
participation in activities and appear more outgoing, they
may view their expanding abdomen with a sense of
fulfillment
5. STRESS REACTION
- For some women pregnancy can be a time of stress
- The woman and her partner may view the pregnancy as
interfering with his or her ability to accomplish daily tasks
- Adequate support systems can help alleviate some of this
stress and aid in adapting to the pregnancy
6. EMOTIONAL LABILITY
- Mood changes occur frequently
- May be the result of the woman’s introversion and
narcissism
- Additionally, hormonal changes, specifically increase
estrogen and progesterone contribute to this lability
- Feelings are easily hurt by remarks that would have been
laughed off before
7. COUVADE SYNDROME
 - Partner may experience discomforts such as nausea & 5. Leukorrhea
vomiting, fatigue or weight gain, similar to or possibly more 6. Fatigue
intense than those that the pregnant woman experiences SECOND TRIMESTER
- The more he is involved or attuned to the changes of his 1. Heartburn / pyrosis
partner’s pregnancy, the more symptoms he may experience 2. Constipation
- These discomforts are normal and temporary and become 3. Hemorrhoids
problematic only if the partner becomes delusional or - commonly known as PILES
emotionally disruptive - Over dilation of veins under the mucous membrane in the
8. CHANGES IN SEXUAL DESIRE rectal / anal area or both related to the weakness in the walls
- During the 1st trimester, most women report a decrease in of the rectum
libido because of the nausea, fatigue and breast tenderness - Maybe INTERNAL or EXTERNAL and straining related bowel
- During the 2nd trimester, as blood flow to the pelvic area movement may cause bleeding
increases to supply the placenta, libido and sexual enjoyment - Pressure on the pelvic veins by the enlarging uterus, which
rise markedly interferes with venous circulation
- During the 3rd trimester, it may remain high or decrease MGT:
because of the awkwardness of finding a comfortable - Avoid constipation
position and increasing abdominal size - Avoid prolonged standing
9. BODY IMAGE & BOUNDARY - Avoid constrictive clothing
- The way your body appears to yourself - Topical ointments / anesthetic
- A zone of separation you perceive between yourself and - Sitz baths or apply warm soaks
objects or other people - Lie on her side with feet slightly elevated
DEVELOPMENTAL / PSYCHOLOGICAL TASKS OF PREGNANCY - Re-insert external hemorrhoids, by placing patient in side
FIRST TRIMESTER - Acceptance of the Pregnancy lying / knee-chest position, using a lubricant and using only
- “I am pregnant” gentle pressure
- Pregnancy confirmation may leave some couples with 4. Backache
disbelief, shock, or amazement 5. Leg Cramps
- The woman & her partner must learn to accept the reality of 6. Ankle Edema
the pregnancy 7. Shortness of breath
- Some couples experience some degree of ambivalence 8. Fainting spells / Hypotension
- Feeling the fetus move or seeing the fetus on an ultrasound 9. Varicose veins
can help the couple achieve acceptance 10. Braxton Hick’s contractions
SECOND TRIMESTER - Acceptance of the Baby - are normal throughout the entire pregnancy, maybe more
- “I’m Going to Have a Baby” pronounced in the latter part of pregnancy
- The woman and her partner work to accept the baby 11. Headache
- Acceptance of the baby refers to acknowledgment that the DANGER SIGNS OF PREGNANCY
fetus is a distinct individual, separate from the mother 1. Severe, persistent vomiting
- Feeling the fetus move or hearing its heartbeat 2. Vaginal bleeding
demonstrates that the fetus is an active being 3. Sudden escape of fluid from the vagina
- The woman and her partner begin active preparations for 4. Chills and fever
the baby 5. Epigastric / Abdominal or Chest pain
- A good way to measure the level of a woman’s acceptance 6. Swelling of finger / face
of the coming baby is to measure how well she follows 7. Vision disturbances
prenatal instructions 8. Seizures / muscular irritability
THIRD TRIMESTER - Preparation for Parenthood 9. Frequent, severe headaches
- “I’m going to be a Mother” 10. Decrease urine output
- The couple work on preparing to become parents 11. Rapid weight gain
- The couple begin to demonstrate “nesting” behaviors such 12. Increase or decrease fetal movements
as preparing the baby’s room, shopping for necessary baby
items, and discussing names Estimated Date of Delivery / EDC - Expected Date
- The couple may attend childbirth education classes of Confinement
- The couple may review relationships with their own parents Pregnancy Timeline
and engage in role-playing and fantasizing about being a
parent
MATERNAL DISCOMFORTS ASSOCIATED WITH PREGNANCY
FIRST TRIMESTER
1. Nausea & Vomiting
2. Breast enlargement and tenderness  
3. Urinary frequency and urgency Terms:
4. Nasal stuffiness, discharge, or obstruction
Gravidity is defined as the number of times that a woman has years ago she had a miscarriage at 10 weeks gestation. What
been pregnant, regardless the outcome. Either twins or is her GTPAL?*
multiples count as ONE.      G=7, T=4, P=1, A=1, L=5
Parity is defined as the number of times that she has given A 27 year old female is currently 16 weeks pregnant. She has
birth to a fetus with a gestational age of 24 weeks or more, 2 year-old twins that were born at 39 weeks gestation and a 5
regardless of whether the child was born alive or was year-old who was born at 40 weeks gestation. She had no
stillborn. history of miscarriage or abortion. What is her GTPAL?*
Nullipara a woman (or female animal) that has never given       G=3, T=2, P=0, A=0, L=3
birth. Estimated Date of Delivery / EDC - Expected Date of
Primigravida a woman who is pregnant for the first time. Confinement
Nulligravida a woman who has never been pregnant     NAGELE’s Rule
Multigravida a woman who has been pregnant more than     - Count back 3 calendar months from the 1st day of LMP
once then add 7 days.
Grand multipara is a woman who has already delivered five     - e.g. Oct 5 , ---> 10-3, 5+7
or more infants who have achieved a gestational age of 24                                =. 7.     12
weeks or more, and such women are traditionally considered                                    July 12
to be at higher risk than the average in subsequent     DATE OF QUICKENING
pregnancies.     Primigravida:
      - Date of quickening + 4 months and 20 days = EDC
Grand multigravida has been pregnant five times or more. Multigravida:
      - Date of quickening + 5 months and 4 days = EDC
Great grand multipara has delivered seven or more infants     First three months = +9 +7
beyond 24 weeks of gestation. AGE OF GESTATION
A 28-year-old female gives birth to twins at 38 weeks 1. MC DONALD’S rule
gestation. This is her first pregnancy. best describes the - uses fundal height to determine duration of pregnancy
patient’s gravidity and parity - Measurement is made from the notch of the woman’s
  symphysis pubis to over the top of the
Gravida 1, para 1 uterine fundus as the woman lies supine
  - Typically, the distance from the fundus to symphysis pubis in
Gravida 1, para 1… Gravida is the number of times the centimeters is equal to the week of gestation between 20th -
woman has been pregnant, regardless the outcome. The 31st week
patient has been pregnant just once (twins or multiples count Mc Donald’s rule becomes inaccurate during the 3rd
as ONE). Parity is the number of births (hence completed trimester of pregnancy
pregnancies) that occurred at greater than 20 weeks
gestation. The patient’s parity is 1 (twins or multiples count as
ONE).
 
A more elaborate coding system used elsewhere, including
America, is GTPAL (G = gravidity, T = term deliveries, P =
preterm deliveries, A = abortions or miscarriages, L = live
births).
A full-term pregnancy lasts between 39 weeks, 0 days and 40
weeks, 6 days. This is 1 week before your due date to 1 week
after your due date.
     At 37 weeks, your pregnancy is considered full-term. The
average baby weighs around 3-4kg by now. Your baby is 2. Bartholomew’s Rule of Fours
ready to be born. Your baby's lungs, liver, and brain go - Measures age of gestation by determining the position of
through a crucial period of growth between 37 weeks and 39 the fundus in the abdominal cavity
weeks of pregnancy. Waiting until 39 weeks, now called "full Normal length of pregnancy:
term," gives your baby the best possible chance for a healthy
start in life.
Preterm birth is when a baby is born too early, before 37
weeks of pregnancy have been completed.
Abortion termination of a human pregnancy during the first
28 weeks of pregnancy.
A 30 year old female is 25 weeks pregnant with twins. She has
5 living children. Four of the 5 children were born at 39 weeks
gestation and one child was born at 27 weeks gestation. Two
  Days - 267 - 280 DECIDUA VERA/PARIETAL - remaining area of the endometrial
Weeks - 40 - 41 weeks lining
Lunar months - 10 ENDOCRINE FUNCTIONS OF THE DECIDUA
Calendar months - 9 - Secretes PROLACTIN to promote lactation
Trimesters – 3 - Secretes RELAXIN, which relaxes the connective tissue of the
symphysis pubis and pelvic ligaments; also promotes cervical
The Fetus dilation
STAGES OF FETAL DEVELOPMENT: - Secretes PROSTAGLANDIN, important for mediating several
1. Pre-embryonic Period physiologic functions
- Begins with fertilization and last a about 3 weeks 1. CHORIONIC VILLI
- As the zygote passes through the Fallopian tube, it - Develops on the 11th / 12th day
undergoes a series of mitosis divisions, or cleavage - Miniature villi or probing fingers that reach out from the
- Once formed, the zygote develops into morula and then single layer of cells into the uterine endometrium
blastocyts eventually becoming attached to the 2 layers:
endometrium. SYNCYTIOTROPHOBLAST / SYNCYTIAL LAYER
2. Embryonic Period - Produces HCG, somatomammotropin (HPL), estrogen and
- Begins with the 4th week of gestation and ends with the 7th progesterone
week (2wk - 8 wks) - Outer layer
- Germ layers develop, giving rise to organ systems CYTOTROPHOBLAST / LANGHAN’S LAYER
- The embryo is highly vulnerable to injury from maternal - Inner layer
drug use, certain maternal infections and other factors - Develops after fertilization - 12 days gestation
3. Fetal Period - Functions in early pregnancy by protecting the growing
- Begins with the 8th week of gestation and continues until embryo and fetus from certain infectious organisms
birth (9 weeks/2months-birth) 1. PLACENTA
- During this period, the embryo, now called a FETUS - Latin for pancake
matures, enlarges and grows heavier - is formed by the union of chorionic villi and decidua basalis
-The head is disproportionately larger when compared its - Contains 15 - 29/30 subdivisions called COTYLEDONS
body - lacks subcutaneous fat - Maturity: 12 weeks/3 months; functions most effectively
through 40 - 41 weeks
EMBRYONIC AND FETAL STRUCTURES - Weighs 400-600 gm; 1/6 of the weight of the baby;
measures from 15-20cm in diameter and 2-3cm in depth at
term
2 parts:
Maternal side - has a rough surface
Fetal side - shiny and gray

1. DECIDUA MECHANISMS OF PLACENTA

-refers to the endometrial lining during pregnancy 1. SCHULTZ’ mechanism
3 Separate layers: - fetal side goes out first
DECIDUA BASALIS - lies directly under the embryo; it’s where - Most common; 80% of deliveries
trophoblasts connect to the maternal blood vessels 1. DUNCAN’s mechanism
DECIDUA CAPSULARIS - Stretches over or forms a capsule - 20%
over the trophoblast; enlarges as the embryo grows; FUNCTIONS OF THE PLACENTA
eventually coming into contact & fusing at the opposite side 1. Respiration, circulation
of the uterine wall  - 1 Umbilical vein - carries oxygenated blood
 - 2 Umbilical arteries - carry deoxygenated blood
- Foramen ovale - septal opening between the atria of the
fetal heart
- Ductus arteriosus - connects the pulmonary artery to the
aorta, allowing blood to shunt around the fetal lungs
- Ductus venous - carries oxygenated blood from the umbilical
vein to the inferior vena cava bypassing the liver
2. Nutrition
- supplies the fetus with CHO, H2O, fats, CHON, minerals and
inorganic salts
3. Protection
- transfers passive immunity via maternal antibodies (IgG)
4. Excretion
- it carries end products of fetal metabolism to the maternal
circulation for excretion
5. Endocrine function
- produces hormones
 HCG - first hormone produces
 Estrogen - hormone of women
- primarily Estriol
- contributes to the mother’s mammary gland development
- stimulates uterine growth to accommodate the developing
fetus
 Progesterone - hormone of mothers
- necessary to maintain the endometrial lining of the uterus
during pregnancy
- reduce the contractility of the uterine musculature during
pregnancy, which prevents premature labor
 HPL / Human Chorionic Somatomammotropin
- Growth promoting and lactogenic properties
- Regulates maternal glucose, CHON, and fat levels
UMBILICAL CORD
- Originates from the amnion and chorion
- Serves as the lifeline from the embryo to the placenta;
provides circulatory pathway
- About 53 - 55 cm (21 inch) in length at term
3 Parts:
1 vein
2 arteries
Wharton’s jelly - gelatinous substance that helps prevent
kinking of the cord in uterus (cord coiling / nuchal cord); gives
the cord body and prevents pressure on the veins and
arteries
FETAL MEMBRANES & AMNIOTIC FLUID
- The chorionic villi on the medial surface of the trophoblast
gradually thin and leave the medial surface of the structure
smooth
- The smooth chorion eventually becomes the chorionic
membrane, the outermost fetal membrane
 Chorion - outer wall of blastocyst
- covering of the fetus
- holds the sac of amniotic fluid
Amniotic / amniotic membrane - holds / lines amniotic fluid
- inner fetal membrane
- forms beneath the chorion
- also produces the fluid (amniotic fluid)
Amniotic fluid - source is the fetal urine and amnion
secretions
Characteristics:
- clear / yellowish
- 800 - 1200 cc
- 7.2 pH
Amniotic fluid is responsible for:
 Protecting the fetus: The fluid cushions the baby from
outside pressures, acting as a shock absorber.
 Temperature control: The fluid insulates the baby, keeping it
warm and maintaining a regular temperature.
 Infection control: The amniotic fluid contains antibodies.
 Lung and digestive system development: By breathing and
swallowing the amniotic fluid, the baby practices using the
muscles of these systems as they grow.
 Muscle and bone development: As the baby floats inside the
amniotic sac, it has the freedom to move about, giving
muscles and bones the opportunity to develop properly.
 Lubrication Amniotic fluid prevents parts of the body such as
the fingers and toes from growing together; webbing can
occur if amniotic fluid levels are low.
 Umbilical cord support: Fluid in the uterus prevents the
umbilical cord from being compressed. This cord transports
food and oxygen from the placenta to the growing fetus.
Normally, the level of amniotic fluid is at its highest around 36
week of pregnancy, measuring around 1 quart. This level
decreases as birth nears.
When the waters break, the amniotic sac tears. The amniotic
fluid contained within the sac then begins to leak out via the
cervix and vagina.
The waters usually break toward the end of the first stage of
labor. When this happens, it is time to contact the health
provider as delivery may be imminent.
Problems of Amniotic Fluid:
Oligohydramnios - lesser amount of amniotic fluid (300cc)
Polyhydramnios- excessive amount of fluid (3000-5000cc)
Embryonic Germ Layers:
The endoderm is the innermost of the three germ layers.
Cells derived from the endoderm eventually form many of
the internal linings of the body, including the lining of most of
the gastrointestinal tract, the lungs, the liver,
the pancreas and other glands that open into the
gastrointestinal tract, and certain other organs, such as the
upper urogenital tract and female vagina. Endoderm cells give
rise to certain organs, among them the colon, the stomach,
the intestines, the lungs, the liver, and the pancreas.
The ectoderm, on the other hand, eventually forms certain
“outer linings” of the body, including
the epidermis (outermost skin layer) and hair.
The mesoderm also is the precursor to mammary glands and
the central and peripheral nervous systems.
EMBRYONIC AND FETAL STRUCTURES
1. Cardiovascular System
- One of the 1st systems to become functional in intrauterine
life
- Single heart tube forming as early as the 16th day of life,
beating as early as the 24th day
- Heart beat may be heard with a Doppler as early as the 10th
- 12th week of pregnancy; 16th - 20th week with a
stethoscope
https://www.youtube.com/watch?v=-IRkisEtzsk&t=6s
2. Respiratory System
- 3rd week, respiratory and digestive tracts exists as a single
tube
- End of 4th week, a septum begins to divide the esophagus
from the trachea. At the same, lung buds appear on the
trachea
- Spontaneous respiratory movements begins as early as 3
months
- SURFACTANT, a phospholipid substance is formed and
excreted by the alveolar cells at about 24th week. This
decreases alveolar surface tension on expiration, preventing
alveolar collapse
Surfactant has 2 components:
- 35th weeks - lecithin and sphingomyelin
- Ratio: 2:1
- With fetal lung movements, surfactant mixes with amniotic
fluid
3. Nervous System
- Develops during 3rd and 4th week of life
- Neural plate (thickened portion of ectoderm) is apparent by
3rd week of gestation
- Brain waves can be detected on EEG by the 8th week
- By 24th week, the ear is capable of responding to sound; the
eye exhibit a pupillary reaction, indicating sight is present
4. Endocrine System
- They mature in intrauterine life
5. Digestive System
- Separated from the respiratory tract at about 4th week
- MECONIUM forms in the intestines as early as the 16th
week. It consists of cellular wastes, bile, fats, mucoproteins,
mucopolysaccharides, and portions of the vernix caseosa
- Meconium is black or dark green (obtaining its color from
bile pigment and sticky
- Sucking and swallowing reflexes are not mature until the
fetus is about 32 weeks or the fetus weighs 1500 gm
6. Musculoskeletal System
- Quickening - 1st fetal movements perceived by the mother
16th week - multiparous
20th week - primipara
- Fetus can be seen to move on ultrasound as early as 11th
week
7. Reproductive System
- Child’s sex is determined at the moment of conception
- Can be determined as early as 8 weeks by chromosomal
analysis
- Gonads form at about 6th week
- Testes first form into the scrotal sac late in intrauterine life
at the 34th - 38th week
8. Urinary System
- Rudimentary kidneys are present as early as the end of the
4th week
- Urine is formed by the 12th week and is excreted into the
amniotic fluid by the 16th week of gestation
- At term, fetal urine is being excreted at the rate of 500 ml/
day
9. Immune System
- IgG maternal antibodies cross the placenta into the fetus
primarily during the 3rd trimester of pregnancy, giving a fetus
temporarily passive immunity against diseases for which the
mother has antibodies
- The level of passive IgG immunoglobulins peaks at birth and
then decreases over the next 9 months
10. Integumentary System
 Skin covered by soft downy hairs (lanugo), and a cream
cheese like substances Vernix Caseosa - secreted by
sebaceous glands, important for lubrication, provide warmth,
and keeping skin from macerating.
     NON-REACTIVE if no accelerations occur with the fetal
FETAL WELL-BEING
ASSESSMENT of FETAL WELL-BEING
1. FETAL MOVEMENT
- Also called quickening; described as light fluttering
- Typically follows a consistent pattern, usually on the average
of at least 10x / day
- Sandovsky method, to assess the fetal movement, ask the
woman to lie in a recumbent position after a meal and record
the number of fetal movements within an hour. In every 10
minutes, the fetus normally moves at least twice or 10 to 12
times in an hour.
- CARDIFF method – A way to assess intrauterine well-being in
which the expectant woman records fetal movement during
her usual activities. There should be at least 10 movements
within a 12-hour period; if fewer than 10 movements are
perceived, further medical evaluation is needed.
2. FETAL HEART SOUNDS / RATE
- Heart rate should be 120 - 160 beats/min throughout
pregnancy
1. RHYTHM STRIP TESTING
- Assessment of the FHR in terms of baseline and long and
short variability
- BASELINE - refers to the average rate of the fetal heartbeat
per minute
- SHORT-TERM VARIABILITY / BEAT-TO-BEAT VARIABILITY
small changes in rate that occur from second to second
- LONG-TERM VARIABILITY - the differences in heart rate that
occur over the 20-minute time period
- Rhythm strip requires the mother to remain in a fixed
position for 20 minutes
1. NON-STRESS TEST (NST)
- Measures the response of the FHR to fetal movement
- The woman pushes a button attached to the monitor
whenever she feels the fetus move
- Fetal movement typically results in an increase in FHR of
about 15 beats/min
- This increase should be sustained for about 15 seconds and
turn to baseline or average when fetus quiets down
- Absence of an increase in FHR with movement is highly
suggestive of fetal hypoperfusion / fetal hypoxia
- Non-stress test is usually done for 10-20 minute (20-40)
- The test is REACTIVE if two accelerations of FHR (15 beats or
more) lasting for 15 seconds occur after movement within the
chosen time period.
movements
1. STRESS TEST / CONTRACTION STRESS TEST / OXYTOCIN
CHALLENGE TEST (OCT)
- Method of evaluating fetal ability to withstand decrease O2
supply and the physiologic stress of an oxytocin
- induced contractions before true labor begins
- IV oxytocin is administered, usually starting at 0.5mU/min at
15-20 min intervals until three high quality uterine
contractions are obtained within 10 minutes
- Can be used at 32 - 34 week gestation
1. NIPPLE STIMULATION STRESS TEST (breast self-
stimulation)
- Carries the risk of hyper stimulation or embarrassment
because it can’t be controlled if there’s hyper stimulation
- May require nipple rolling or application of warm
washcloths to one nipple
- Induces contractions by activating sensory receptors in the
areola, triggering the release of oxytocin by the posterior
pituitary gland
- Exhibits the same reactive pattern as the reactive NST result
and the same pattern as the abnormal OCT result
3. BIOPHYSICAL PROFILE
- Assesses several variables
Fetal breathing movements
Fetal body movements
Fetal muscle tone
Fetal amniotic fluid volume
Fetal heart rate reactivity
Placental grade
- Each variable is scored as 0 - 2, with 0 indicating abnormal
finding and 2 indicating a normal finding; some institutions
use a scoring system of 0, 1 and 2; total score is then
calculated
- This profile is commonly referred to as the FETAL APGAR
SCORE because scoring is similar to that of the Neonatal
APGAR Score
- Can detect CNS depression
4. ULTRASOUND
- Provides immediate results without potential harm to the
fetus or the mother
- Non-invasive and painless
 - Provides info about fetal presence, size, position, and
presentation, placental location, amniotic fluid and
gestational maturity via biparietal measurements
- Evidence of normal fetal growth or possible defects or
malformations, fetal death, malpresentations, placental
abnormalities, multiple gestation and hydra nips or
oligohydramnios
- It is helpful if the mother has a full bladder at the time of the
procedure
- May also be done by an intravaginal technique
5. BIPARIETAL DIAMETER
- The widest transverse diameter of the fetal head; a side to
side measurement obtained using ultrasound
- Measurements can be made by 12-13 weeks of gestation
- Typically, if the biparietal diameter is 8.5 cm or more, the
fetus will weigh more than 5.5 lb (2,500g)
6. DOPPLER UMBILICAL VELOCIMETRY
- Measures the velocity at which RBC in the uterine and fetal
vessels are traveling
7. PLACENTAL GRADING
- Placentas can be graded by ultrasound as 0 (a placenta 12-
24 weeks), 1 (30-32 weeks), 2 (36 weeks), 3 (38 weeks)
 Because fetal lungs are apt to be mature at 38 weeks; a grade
3 placenta suggests that the fetus is mature
Video: placental grade
https://www.youtube.com/watch?v=OCL9R4Lg8ow
8. AMNIOTIC FLUID VOLUME ASSESSMENT
- Amount of amniotic fluid present is an important fetal
assessment measure because a portion of the fluid is formed
by fetal kidney output
9. ELECTROCARDIOGRAPHY
- May be recorded as early as the 11th week of pregnancy
10. MRI
- Has the potential to replace or complement ultrasound as a
fetal assessment technique
- It may be most helpful in diagnosing complications such as
ectopic pregnancy / trophoblasts disease
11. MATERNAL SERUM ALPHA-FETOPROTEIN
- Requires a blood sample obtained via venipuncture to
evaluate the level of alpha fetoprotein in the mother’s serum
- Fetal liver produces alpha fetoprotein
- This CHON crosses the placenta and appears in the mother’s
serum
- Alpha-fetoprotein begins to rise at 11 weeks gestation, then
steadily increases until term
- Elevated maternal serum AFP (MSAFP) level suggest a neural
tube defect or other neural tube anomaly (open
spinal/abdominal defect) - open body defects
- Decrease MSAFP levels are associated with Down Syndrome
- Definitive diagnosis requires ultrasound and amniocentesis
12. TRIPLE SCREENING
- Involves a blood sample that tests 3 parameters: Maternal
serum for alpha fetoprotein, unconjugated estriol, HCG
13. CHORIONIC VILLI SAMPLING (CVS)
- Involves removal and analysis of a small tissue specimen
from the fetal portion of the placenta to determine the
genetic make-up of the fetus
- Done at 10-12 weeks of pregnancy
- COELOCENTESIS- is an alternative method to remove cells
for fetal analysis; transvaginal aspiration of fluid from the
extra embryonic cavity
- Complications: carries the risk of spontaneous abortion,
infection, hematoma, and intrauterine death
Video:
https://www.youtube.com/watch?v=sxEf_ddmpZk
14. AMNIOCENTESIS
- Refers to a needle insertion into the uterus trans
abdominally to aspirate amniotic fluid for analysis
- Can be performed as early as 12 - 13th week of gestation,
when uterus has moved into the abdominal cavity
- Requires only 1 ml of fluid for analysis
- Is indicated for women age 35 and older and women with
family history of chromosomal / neural tube defects or inborn
errors of metabolism
USED FOR ASSESSMENT, DX, AND EVALUATION
- Amniotic fluid color
Normal - color water
Slightly yellow tinge - late in pregnancy
Strong yellow color - blood incompatibility
Green color - meconium staining
-Lecithin/Sphingomyelin ratio 2:1
- Phosphatidyl glycerol & desaturated phosphatidyl - choline
(present only with mature lung function)
- Bilirubin determination - analyzed if a blood incompatibility
is suspected
- Chromosome analysis - few fetal skin cells are always
present in amniotic fluid. These cells many be cultured and
stained for karyotyping
- Inborn errors of metabolism
- Alpha-fetoprotein
Video: amniocentesis vs. chorionic villi sampling
 https://www.youtube.com/watch?v=bZcGpjyOXt0 anger and/or the age of the father
https://www.youtube.com/watch?v=GB0JkmMhGnQ • Planning pregnancy
15. PERCUTANEOUS UMBILICAL BLOOD SAMPLING (PUBS) - Good health and avoiding exposure to harmful substances
- Also called CORDOCENTESIS / FUNICENTESIS are significant contributing factors for a successful pregnancy
- Is an invasive procedure during which a needle is inserted and a healthy baby
through the mother’s abdomen and uterine wall into a vessel - Any woman of childbearing age should be aware of health
in the umbilical cord under direct ultrasound guidance problems or medication regimens that may
- Provides direct access to the fetal circulation to obtain fetal - adversely affect pregnancy and the birth of healthy baby
- It is recommended for women to optimize their intake of
blood samples or to transfuse the fetus in utero
folic acid several months before becoming pregnant
- Access to the fetal circulation allows for direct drug
- Regular aerobic exercise conditions the body systems
administration - Smoking cessation is an important consideration when
- Used when the fetus is at risk for congenital and planning for pregnancy
chromosomal abnormalities, congenital infection or anemia - Alcohol intake can affect the developing child especially in
- Also used to assess acid balance of fetuses with intrauterine the earliest weeks of pregnancy
growth retardation - A woman with chronic illness is at higher risk for poor
- Can be done anytime after 16 weeks gestation pregnancy outcome
16. AMNIOSCOPY • Preventing pregnancy
- Visual inspection of the amniotic fluid through the cervix - The best contraceptive method is the one that is most
and membranes with an amnioscopy (a small fetoscope) comfortable and natural for the partners, and the one that they
- Use to detect meconium staining will consistently use correctly
- Risk for membrane rupture Natural or Fertility Awareness Methods:
17. FETOSCOPY 1. Calendar (Rhythm method)
- Actual visualization of the fetus by inspection through a - Relies on abstinence from intercourse during fertile periods
fetoscope - Fertile periods are calculated by recording 12 consecutive
- Amniotic may occur; mother is placed on 10-day antibiotic menstrual cycles
- Subtract 18 days from the shortest cycle and 11 days from
therapy after the procedure
the longest cycle = fertile period
- Effectivity rate is 13%
Advantages:
SPECIAL ISSUES OF REPRODUCTION & - Inexpensive and convenient
WOMEN’S CARE - Encourages communication
• HEALTH SCREENING FOR WOMEN - No side effects
- Breast cancer screening - Ethically and morally non-controversial
- Pelvic examination and pap smear - Appropriate for sexual education programs
- Vulvar self-examination Disadvantages:
• COMMON DISORDERS OF THE FEMALE - Requires long periods of abstinence and control
REPRODUCTIVE TRACT - Requires correct calculations and regular menstruations to be
- Menstrual disturbances effective
> Amenorrhea - Confusing irregular uterine bleeding with a menstrual period
> Atypical uterine bleeding day lead to incorrect calculations
Menorrhagia - Effectiveness is unreliable and depends on many variables
Metrorrhagia Natural or Fertility Awareness Methods:
> Dysmenorrhea 2. Cervical Mucus method
> Post-menstruated syndrome - Relies on abstinence from intercourse during fertile periods
- Endometriosis - Cervical mucus in the ovulatory period is clear and slippery
- Infectious disorders and more abundant
- Pelvic Inflammatory disease - Pre-ovulatory and post-ovulatory periods, cervical mucus is
• COMMON DISORDERS OF THE UTERUS yellowish, less abundant, thick and sticky (inhibits sperm
& OVARIES motility)
- Cervical polyps - Effectivity is about 20%
- Uterine fibroids Advantages:
- Ovarian cysts - Inexpensive
REPRODUCTIVE LIFE CYCLE ISSUES - No side effects
FAMILY PLANNING - Ethically and morally non-controversial
- Family planning consists of two complementary Disadvantages:
components: - Not as effective as other methods
> Planning pregnancy
> Preventing pregnancy
- Family planning gives the woman control over the number of
children she wishes to have and allows her to determine when
births will occur in relation to each other and in relation to her
 2. Intrauterine Device
- Flexible device inserted in the uterine cavity during
menstruation
- This alters uterine transport of sperm so fertilization don’t
occur
- Side effects:
> Dysmenorrhea
> Increased menstrual flow
> Uterine infection or perforation
> Ectopic pregnancy
- Danger signs to report
> Late or missed menstrual period
> Severe abdominal pain
> Fever and chills
3. Symptothermal method
> Foul vaginal discharge
- Couple makes use of the combination of calendar, basal body
>Spotting, bleeding, or heavy menstrual periods
temperature, and cervical mucus method to determine fertile
>Spontaneous expulsion occur in 2-10% of users in the first
period
year
- Effectivity can be as high as 13-20% among typical users
Advantages:
- Inexpensive
- No side effects
- Encourages communication
- Provides the couple with more information
Disadvantages:
- More complex and difficult to learn
- Requires regular and daily effort Advantages:
4. Lactation Amenorrhea Inexpensive for long term use
- As long as a woman is breastfeeding an infant, there is some - Reversible
natural suppression of ovulation - May be use with lactating women
- The woman may not be menstruating but may be ovulating; - Requires no attention other than checking that it is in place
the woman may still be fertile even if she has not had a period Disadvantages:
since childbirth - Available only through a health care provider
Artificial Methods: Barrier Methods - Contraindicated if woman has an active infection of pelvis,
1. Male Condom postpartum infection, endometrial hyperplasia or carcinoma,
- A latex or rubber sheath that fits over the erect penis and uterine anomalies, women who have an increased risk of
prevent sperm from entering the vagina STDs or women with multiple sexual partners
- Effectivity is 86% 3. Cervical cap
Advantages: - Is a reusable rubber cap that fits tightly over the cervix. The
- No side effects cervical cap is inserted into the vagina with spermicide before
- Helps prevent conception and STDs sex to prevent pregnancy.
- Available over the counter - For people who’ve never given birth, the cervical cap is 86%
- Condom helps maintain erection longer Advantages:
- Prevents sperm allergies - Convenient and give you control
- Discretely carried by men and women - Cervical caps don’t interrupt sex
Disadvantages: - Cervical caps don’t have hormones
- Decreases spontaneity and sensation - Lasts a long time > only need to be replaced every year with
Disadvantages: proper care
- Should be used with vaginal jelly if condom or vagina is dry
- Contraindicated to men and women with latex allergy

Disadvantages:
- Cervical caps don’t protect against sexually transmitted
infections spermatic cord
- You have to use it every time you have sex. Difficult / hard - Each vas deferens is lighted and cut
to use correctly for some people to do, also, spermicide can - May experience some pain, bruising, and swelling
have side effects - May apply ice pack, scrotal support, and a mild oral
- Changes in the body over time can mess up the fit of the analgesic
cervical cap. You have to get refitted for a new size if you 1-2 days moderate activities because of scrotal tenderness
have a baby, miscarriage, or abortion - Sutures are removed about 4-7 days
4. Cervical diaphragm - Must use another method of birth control for at least
- Is a shallow, bendable cup that you put inside your vagina. 1 month until a negative sperm count verifies sterility
It’s a shallow cup like a little saucer that’s made of soft - The man still has the ability to achieve and maintain erection
silicone. You bend it in half and insert it inside your vagina to or on the volume of ejaculate
cover your cervix Pharmacologic Methods
- Adding spermicide is used to make it more effective 1. Oral Contraceptives
- 88% effective - that means about 12 out of 100 people who - Used to prevent conception by inhibiting ovulation
use it will get pregnant each year - Causes atrophied changes of the endometrium to prevent
Advantages: implantation
- Convenient and give you control - Causes thickening of cervical mucus to inhibit sperm travel
- Don’t interrupt sex - Regulates menstrual cycle
- Lasts a long time up to 2 years with proper care - Combined estrogen and progesterone in table form
Disadvantages: - Effectivity is about 97-100% if properly used
- You have to use it correctly Side effects:
- Some people have trouble inserting the diaphragm - breakthrough bleeding
- Spermicide may have side effects - Nausea and vomiting
- Susceptibility to vaginal infections
- Thrombus formation
Edema and weight gain
- Irritability
- Missed periods
Advantages:
- Most reliable contraceptive method
- Convenient to use
- Tend to decrease menstrual cramps and pain
Disadvantages:
- Contraindicated to women who are smoking
Surgical Methods - Contraindicated to women with history of thrombophlebitis,
1. Tubal Ligation CVA, varicosities, DM, estrogen dependent carcinoma, liver
- The Fallopian tubes are surgically lighted or cauterized either disease, older than 35 years of age
through mini laparotomy or laparoscopy - Needs reassessment and re-evaluation every 6 months
- Effectivity is 100% - Does not offer protection against STDs
Advantages: 2. Contraceptive Implants
- Highly effective - Is a very small plastic rod about the size of a matchstick. A
- Usually permanent doctor inserts it into the upper arm, right under the skin. It
- Can be performed immediately postpartum releases progestin hormone into the body to prevent pregnancy
Disadvantages: - Prevents pregnancy by blocking the release of eggs. It also
- Invasive procedure thickens cervical mucus
- May be irreversible - Implants must be removed after 3 years. At that time, another
- High risk of ectopic pregnancy after reversal implant can be inserted
- No protection against STD Advantages:
- One of the highest levels of effectiveness of all
contraceptives
- No need to worry about birth control for 3 years
- Fertility returns as soon as the implant is removed
- Appropriate for women who can’t use birth control that
contains estrogen
Disadvantages:
- No protection against STIs
- High up-front cost
- Insertion requires a doctor’s visit
- Must be removed after 3 years
2. Vasectomy
- This procedure takes about 20 minutes
- Small incision is made on each side of the scrotum over the