The document discusses various methods of reproductive family planning. It describes natural family planning methods like abstinence, coitus interruptus, lactation amenorrhea, and fertility awareness methods using basal body temperature or cervical mucus monitoring. It also discusses barrier methods like spermicides, diaphragms, and female condoms. Hormonal methods, IUDs, and surgical sterilization methods are also briefly mentioned. The document provides information on how each method works, effectiveness rates, advantages and disadvantages to help individuals assess which family planning options meet their needs and values.
Original Description:
Original Title
ANG MOTIVATION KO AY MAY GALA AKO SA WEEKEND T__T (3)
The document discusses various methods of reproductive family planning. It describes natural family planning methods like abstinence, coitus interruptus, lactation amenorrhea, and fertility awareness methods using basal body temperature or cervical mucus monitoring. It also discusses barrier methods like spermicides, diaphragms, and female condoms. Hormonal methods, IUDs, and surgical sterilization methods are also briefly mentioned. The document provides information on how each method works, effectiveness rates, advantages and disadvantages to help individuals assess which family planning options meet their needs and values.
The document discusses various methods of reproductive family planning. It describes natural family planning methods like abstinence, coitus interruptus, lactation amenorrhea, and fertility awareness methods using basal body temperature or cervical mucus monitoring. It also discusses barrier methods like spermicides, diaphragms, and female condoms. Hormonal methods, IUDs, and surgical sterilization methods are also briefly mentioned. The document provides information on how each method works, effectiveness rates, advantages and disadvantages to help individuals assess which family planning options meet their needs and values.
REPRODUCTIVE FAMILY PLANNING ● The couple’s relationship
● It includes all decision an ○ Long term
individual and couple make about: ○ Short term ○ whether and when to ● Prior experiences with have children contraception ○ How many children to OTHER CONSIDERATION have ● It is necessary to understand ○ And how they are spaced various methods of contraception. IMPORTANCE OF REPRODUCTIVE ○ Work and compare benefits FAMILY PLANNING and disadvantages ● Some couples you will meet ● In assessing which best option a ○ Wants counseling and couple may choose. how to avoid conception ○ Safe sex practices must be ○ Want information on advised increasing fertility and ● Although there are many about their ability to contraceptive methods reliable to conceive avoid contraception. Condoms ○ Others need counseling provide protection against STD. because contraceptives ○ This is a special have failed. consideration if the PURPOSES OF relationship is a REPRODUCTIVE FAMILY PLANNING monogamous one. ● Because the method of ● Raising a child child requires contraception offers 100% significant amounts of resources protection against pregnancy, it is such as: important to answer questions ○ Time carefully. ○ Social ○ Financial WHAT TO ASSESS BEFORE BEGINNING ○ Environmental OF A NEW METHOD ● Planning can assure that ● VITAL SIGNS such as: resources are available. ○ PAP smear ● To the health of the mother and ○ Pregnancy Test child ○ Gonococcal and ● Helping to prevent HIV/AIDS Chlamydial Screening ○ HGB detection for anemia IMPORTANT CONSIDERATION ● OBSTETRICS HISTORY for STDs ● Personal Value ● SUBJECTIVE ASSESSMENT OF ● Ability to use method correctly THE PATIENT ● If the method will affect the sexual ○ Desires enjoyment ○ Needs ● Financial factors ○ Feelings ○ Understanding of NATURAL FAMILY PLANNING contraception ● Also known as PERIODIC ● Sexual practices ABSTINENCE CRITERIA IDEAL FOR CONTRACEPTIVE ● Involves to introduce or use ● It should be safe to use chemical or foreign materials into ○ Means free from any side the body of the female and the effects male. ● It should be reliable and effective ● Its effectiveness varies from 2% ● It should be easy to administer ideal failure rate to 25% failure and convenient rate depending mainly on the ● It should be cost effective couple from having coitus on fertile ● It should be culturally feasible and days. acceptable ABSTINENCE ● Free of bothersome side effects ● This involves completely refraining ● Free of effects on future from coitus and 0% failure. pregnancies ● However, due to natural human TYPES OF desire, couples may find it difficult REPRODUCTIVE FAMILY PLANNING to adhere to abstain. ● NATURAL FAMILY PLANNING ● It has very high failure rate ○ ABSTINENCE ADVANTAGES ○ COITUS INTERRUPTUS ● Acceptable to all religious group ○ LACTATION DISADVANTAGES AMENORRHEA METHOD ● Requires high motivation and also (LAM) self discipline ○ CALENDAR METHOD COITUS INTERRUPTUS ○ BASAL BODY ● One of the oldest methods of TEMPERATURE contraception. ○ CERVICAL MUCUS ● The penis is withdrawn from the METHOD vagina before ejaculation. ○ SYMPTOTHERMAL ● Coitus Interruptus is only about METHOD 82% effective and should be used ● BARRIER METHOD with caution. ○ PHYSICAL BARRIERS ADVANTAGE ○ CHEMICAL BARRIERS ● No cost ● HORMONAL METHODS ● Does not require any device ● INTRAUTERINE DEVICES ● With self control and discipline, it ● SURGICAL METHODS can be fairly effective. ○ VASECTOMY DISADVANTAGES ○ TABH-SO ● Requires a great deal of self control ● Failure rate is very high ● Slightest delay in withdrawal can DISADVANTAGE lead to pregnancy. ● Many factors affect basal body LACTATION AMENORRHEA METHOD temperature. ● A breastfeeding woman has ○ Illness natural suppression of both ○ Physical activity. ovulation and menses CERVICAL MUCUS METHODS ● It could be considered safe if: ● Change in cervical mucus that ○ An infant is under 6 months naturally occurs with ovulation. of age. ● A way to identify fertile times to ○ Being totally fed every 4 help you gauge the best days to hours during the day and have or avoid unprotected days. every 6 hours at night. HOW DOES IT WORK ○ No supplementary ● Before ovulation each month, the ○ Menses has not returned. cervical mucus is thick and does FERTILITY AWARENESS METHOD OF not stretch. NATURAL FAMILY PLANNING ● Just before ovulation , mucus ● CALENDAR METHOD secretion increases. ● BASAL BODY TEMPERATURE ● On the day of ovulation, cervical METHOD mucus becomes thin, copious, ● CERVICAL MUCUS METHOD watery, and transparent. ● SYMPTOTHERMAL METHOD ○ SPINNBARKEIT CYCLE BEADS ■ Cervical mucus ● Red bead first day of pregnancy stretches at least ● Dark brown beads, tells you if your 1 inch before the cycle is shorter than 26 days. strand breaks. ● Brown beads, pregnancy is very ● All the days that the cervical unlikely mucus is copious (3 to 4 days after ● White beads, pregnancy is most ovulation) are considered fertile likely. days where a woman should BASAL BODY TEMPERATURE abstain from coitus. ● This method is used by monitoring ADVANTAGES or taking the woman’s body ● Inexpensive temperature everyday upon ● Does not have side effects waking up. DISADVANTAGE ● Before the day of ovulation: the ● The feel of vaginal secretion is woman’s temperature is 0.5F. unreliable since the seminal fluid ● On the day of ovulation: the of the male has watery woman’s temperature. consistency and can be confused ● To make sure it is effective, it with ovulatory consistency. should be combined with a ● High failure rate because of calendar method. difficulty interpreting mucus status. BARRIER METHODS ● No health visit of prescription ● Forms of birth control that place a needed chemical or latex between the FEMALE CONDOM cervix and entering sperm into the ● Made of latex polyurethane uterine cavity. pre-lubricated with spermicide SPERMICIDES ● The inner ring covers the cervix ● Agent that kills spermatozoa and the outer ring rests against the before they can enter the cervix. vaginal opening. ● It changes the vaginal pH to a DIAPHRAGMS strong acid level which is not ● A circular rubber disk that is conducive to sperm survival. placed over the cervix before ADVANTAGES intercourse to mechanically block ● May be purchased without the passage of the sperm. prescription ● After coitus, diaphragm must ● When used together with other remain for 6 to 24 hours because contraceptives they increase the sperm is still viable. other methods of effectiveness. CONTRAINDICATION ● There are various forms to choose ● May not be effective if the uterus is from such as: prolapsed, retroflexed, or ○ Gel anteflexed which displaces the ○ Creams cervix ○ Sponges ● Diaphragms may cause UTI’s ○ Films ● Should not be used in cases of ○ Foams ○ Acute Cervicitis, ○ Vaginal Films ○ Herpes Virus Infection CONTRAINDICATION ○ Papillomavirus Infection ● Vaginallly inserted spermicides ○ Allergy to rubber or are contraindicated with women spermicides with acute cervicitis ● Do not leave diaphragm in place ● Bothersome for women because for more than 24 hours they are sticky. ● Do not use it during menstruation MALE CONDOM HORMONAL CONTRACEPTIVES ● A latex or rubber or synthetic ● Combined oral contraceptive pills material placed over the erect ● PROGESTIN-ONLY ORAL penis before coitus to trap the CONTRACEPTIVE PILLS sperm. ● INJECTABLES ● It has a failure rate of 15% (DEPO-PROVERA/DMPA) ADVANTAGES ● IMPLANTS ● Available in pharmacies and (NORPLANT,JADELLE) convenience stores ● Hormonal contraceptives are, as the name implies, hormones that cause such fluctuations in a ○ You are over 35 and normal menstrual cycle that smokes ovulation does not occur ○ You are overweight COMBINED ORAL CONTRACEPTIVES ○ You have migraines (COC’s) ○ You have some types of ● Composed of varying amounts of medication or herbal synthetic estrogen combined with medicines. a small amount of synthetic MONOPHASIC COC’s progesterone (progestin). ● Provide fixed doses of both ● 92% effective, and 99% effective if estrogen and progestin throughout taken correctly and continuously a 21-day cycle. PHYSIOLOGY BIPHASIC COC’s ● The estrogen acts to suppress ● Deliver a constant amount of follicle stimulating hormone estrogen throughout the cycle but (FSH) and LH, thereby an increased amount of progestin suppressing ovulation. during the last 11 days. ● The progesterone action TRIPHASIC COC’s complements that of estrogen by ● Triphasic preparations vary in both causing a decrease in the estrogen and progestin content permeability of cervical mucus, throughout the cycle. thereby limiting sperm motility ● Types more closely mimic a and access to ova. natural cycle, thereby reducing ● Progesterone also interferes breakthrough bleeding (bleeding with tubal transport and outside the normal menstrual endometrial proliferation to such flow). degrees that the possibility of EXTENDED CYCLE PILLS implantation is significantly ● These are typically used in a decreased. 13-week cycle. WHO CAN USE IT? ○ You take active pills for ● If you are healthy and do not 12 weeks, and during the smoke, you can keep taking the last week of the cycle, pill safely for many years. you take inactive pills ● You should not use this pill if you and have your period. have: ■ As a result, you ○ Had Heart Attack, Stroke, have your period or Blood Clot in you legs or only three to four lungs times per year. ○ A family member has a NOTE blood clot in their legs or ● Typical pills have 28-pill lungs dispensers ○ Of which 21 active pills and fertilizing the egg released 7 placebo pills) each month. BENEFITS OF COCs ○ This hormone also thins ● Oral contraceptives have the endometrial lining to noncontraceptive benefits such as make it inhabitable for a decreased incidences of: fertilizing egg, just in case ○ Dysmenorrhea, because the sperm penetrates the of lack of ovulation egg’s barrier. ○ Premenstrual dysphoric ■ Thinning your syndrome and acne, uterine directly because of the increased reduces the progesterone levels menstrual flow to ○ Iron deficiency anemia, provide you with because of the reduced relief from heavy amount of menstrual flow periods. ○ Acute pelvic ● To ensure the pill retains its inflammatory disease effectiveness in preventing (PID) and the resulting pregnancy, you must take it at tubal scarring the same time every day. ○ Endometrial and ovarian SIDE EFFECTS/ CONTRAINDICATION OF cancer, ovarian cysts, and ORAL CONTRACEPTIVE ectopic pregnancies ● Nausea ○ Fibrocystic breast ● Weight gain disease ● Headache ○ Possibly osteoporosis, ● Breast tenderness endometriosis, uterine ● Breakthrough bleeding (spotting myomata (fibroid uterine outside the menstrual period) tumors), and progression ● Monilial vaginal infections of rheumatoid arthritis ● Mild hypertension ○ Colon cancer ● Depression (Stubblefield, Carr-Ellis, & ● Advise all women taking COCs to Kapp, 2007) notify their health care provider if PROGESTIN-ONLY PILLS symptoms of myocardial or (MINI PILL) thromboembolic complications ● Also called the Mini Pill. occur. These are: ● The mini pill prevents pregnancy ○ Chest pain (pulmonary using progestin alone, instead of embolism or myocardial combining with estrogen. infarction) ○ Low dose of progestin ○ Shortness of breath actively thickens mucus (pulmonary embolism) to prevent sperm from ○ Severe headache (cerebrovascular accident) ○ Severe leg pain INTRAMUSCULAR INJECTION (thrombophlebitis) HORMONE (DEPO-PROVERA) ○ Eye problems such as ● A single intramuscular injection of blurred vision depot medroxyprogesterone (hypertension, acetate (DMPA) is a cerebrovascular accident) progesterones given every 12 SUBDERMAL HORMONE IMPLANTS weeks or 3 months which also has ● This is a progestin-filled minature the same effects as hormonal pills. rod not bigger than a matchstick, ● The effectiveness rate of this estrogenol implant. method is almost 100% making it ○ This can be inserted under a popular contraceptive method. the skin on the inside of the ● Because it only contains upper arm. progesterone, it can be used ○ This slowly release during breastfeeding, although progestin over a period of 3 women should wait 6 weeks after years which also birth before the first injection suppresses ovulation, ● ADVANTAGE: thicken cervical mucus, ○ Reduction of: and change the ■ Ectopic Pregnancy endometrium lining which ■ Endometrial Cancer make implantation difficult. ■ Endometriosis ○ The rod is inserted by the SIDE EFFECTS trained Physician under ● Irregular heavy menstrual bleeding local anesthesia not later for the first year and no menstrual than 7 days after menstrual bleeding after the first year. period to be certain the ● It also impairs glucose tolerance in woman is not pregnant. women at risk for diabetes so it SIDE EFFECTS/ CONTRAINDICATIONS must be used cautiously for these ● Weight Gain women. ● Breakthrough Bleeding ● It increases the risk for ● Amenorrhea osteoporosis for loss of bone ● Scar on the insertion site mineral density. ● Contraindication is when the ○ Calcium supplements must couple desire pregnancy within be advised. one year and undiagnosed uterine ● It is not advisable for use for more bleeding. than 2 years. ● Infection can also occur on the INTRAUTERINE DEVICE (IUD) insertion site. ● A small plastic device that is inserted into the uterus through the vagina, IUD’s can either be hormonal or non hormonal. ■ ParaGard last longer than IUD’s ○ It is effective for 10 years. ● MIRENA/LILETTA IUD ○ LEVONORGESTREL ■ Releasing intrauterine system 52 mg. ■ This contains a ● Although it has been used for drug reservoir of contraceptive purposes thousands progesterone in the of years back (used in camels) the stem which diffuses mechanism is still not fully into the uterus understood. which prevents ○ But it is used to prevent endometrial fertilization and to increase proliferation and sterile inflammatory thickens the process to prevent cervical mucus. implantation ■ It has also potential ● It is inserted by a trained to reduce OB/Midwife/ or nurse. endometrial cancer ● The following must be considered: ○ It is effective for 5 years ○ Before insertion: ● SKYLA IUD ■ Pelvic examination ○ LEVONORGESTREL ■ Clearance must be ■ Releasing performed intrauterine system ■ Contraindicated for 13.5 mg women with high ○ It has a lower dose of risk of STI’s progesterone. ■ It must be inserted ○ It is effective for 3 years. after menstrual flow and advised no coitus before insertion. TYPES OF IUD ● COPPER T380 ○ The copper triggers your immune system to prevent pregnancy. ○ It can cause your periods to be heavier, especially at first. CESAREAN BIRTH NURSING RESPONSIBILITIES FOR ● It is a procedure where birth is WOMAN ANTICIPATING A C/B accomplished through abdominal ● All women talk about their fears incision into the uterus. PRE OPERATIVE ● It is one of the oldest types of ● Obtain Health History before surgery and one with few administration of anesthesias. complications. ○ Previous Surgeries ● It is a latin word which means “to ○ Secondary illness cut” ○ Allergic Reactions or INDICATION FOR C/B Reaction to food and drugs MATERNAL FACTORS ○ Reaction to anesthesia ● Genital Herpes ○ Bleeding Problems ● Cephalo-Pelvic Disproportion ○ Current Medications taken (CPD) by the woman ● Disabling condition of the mother. ○ Women's knowledge about ○ Severe HPN the procedure ○ Heart Conditions ○ Length of hospitalization ● Previous C/S ○ Post-Surgical Equipment PLACENTAL FACTORS (IC/IVF) ● Placenta Previa ○ Special Precautions ● Premature Separation of the necessary for her infant. Placenta EFFECTS OF SURGERY ON A WOMAN ● Umbilical Cord Prolapse STRESS RESPONSE FETAL FACTORS ● Either physical or psychological ● Macrosomic Fetus in Fetal Lie ● The body responds to preserve ● Extreme Low Birth Weight functions of the major body. ● Fetal Distress ○ Increased Epinephrine and ● Fetal Anomalies Norepinephrine could ● Multigestation or Conjoined Twins cause: ● Transverse Fetal Lie ■ Increased Heart TWO TYPES OF C/S Rate and Bronchial SCHEDULED Dilation ● There is time for thorough ■ Increase Blood preparation for the experience Sugar throughout the antepartal period. ■ Peripheral EMERGENT Vasoconstriction ● Emergent cesarean births are ■ Increased Blood done for reasons such as placenta Pressure. previa, premature separation of ● These stress related changes the placenta, fetal distress, or minimize blood supply to lower failure to progress in labor. extremities could lead to OPERATIVE RISKS FOR A WOMAN thrombophlebitis. POOR NUTRITIONAL STATUS INTERFERENCE IN BODY RESPONSES ● Obesity interferes with wound ● The skin as the first line of defense healing is compromised. ○ Fatty tissue is difficult to ● Strict aseptic technique must be heal. observed following the days after ● Prolonged healing may result to the surgery to compensate for this infection or rupture of incision defense (dehiscence) ● If Cb is done after the membranes ● Increased workload for the heart of have ruptured, the increased risk the woman of infection such as endometritis ● Pneumonia may take place. ○ Lack of lung expansion INTERFERENCE WITH CIRCULATORY causes Pneumonia. FUNCTION ● Vitamin Deficiency ● Blood loss that occurs with surgery ○ Vitamin C and D may result in hypovolemia and ○ Protein deficiency is also a hypotension. risk for healing ● Ineffective tissue perfusion of all AGE VARIATION body tissues ● Old aged women is high risk for ● Normal blood loss during CB is CB 500-1000 ml ALTERED GENERAL HEALTH INTERFERENCE WITH BODY FUNCTION ● Persons that is high risk for ● Increased flow of fluid of the surgical procedures: surgical wound also disrupts ○ Diabetes Mellitus function ○ Heart Disease ● Displacement of the urinary ○ Anemia bladder leads to loss of sense of ○ Kidney Disease filling. FLUID AND ELECTROLYTE IMBALANCE ● Pressure on the intestine causes ● Lower than normal blood pressure paralytic ileus/halting intestinal may be felt by a mother more than function. one with normal blood volume. ● Thrombophlebitis FEAR ○ Impaired lower extremities ● Extreme worry or anxiety about blood flow. the surgery may need a detailed INTERFERENCE WITH SELF-MAGE OR explanation before the operative SELF-ESTEEM procedure ● Presence of incision scar CB PUTS NEWBORN AT RISK THAN ● CB also marks her as a woman VAGINAL BIRTH less than others because she was ● Inadequate respiration not able to give vaginal birth. ● Infection PREOPERATIVE DISCHARGE PLAN DIAGNOSTIC PROCEDURES ● Mother must be aware of the ● Assess the heart, kidney, restrictions in exercise or activity circulatory and fetal heart rate. such as: ○ Vital Signs determination ○ Do not lift heavy objects ○ Urinalysis more than 10lbs ○ CBC ○ Do not walk upstairs more ○ Coagulation Time and than once a day for the first Partial PT 2 weeks ○ Electrolyte and pH Balance ● Report or recognize possible ○ Blood Typing and Cross complications Matching ○ Redness or discharge the ○ Ultrasound to determine incision line Fetal presentation and ○ Lochia with heavier than maturity menstrual flow PREOPERATIONAL TEACHING ○ Abdominal pain other than ● Assess how much a woman the suture line or after pain already knows about the surgery discomfort. ○ Refresh the mother if she ○ Elevated body temperature already had post-CS ○ Frequency on urination ● NPO ○ Burning sensation ● DBE after the operation BLEEDING ● Indwelling Catheter and IVF PRIMARY CAUSES OF BLEEDING IN ● Early Ambulation PREGNANCY PREOPERATIONAL MEASURES FIRST TRIMESTER ● Informed Consent ● Uterine Abnormalities ● Overall Hygiene ● Chromosomal Problems ● Gastric emptying to decrease ● Unknown Causes gastric secretions ● Infection ● Baseline I&O ● Deficient Progesterone ● Hydration ● Metabolic Disorder ● Preoperative medication ANATOMIC DEFECTS OF THE UTERUS ● Patient Chart ○ Documentation must be completed PREVENTION OF COMPLICATION ● Deep Breathing Exercises ● Turning side to side ● Early ambulation after 4-6 hours for lower extremities circulation BLEEDING DURING FIRST TRIMESTER conception or the fetus and CLASSIFICATION placenta from the uterus ● Threatened Miscarriage ● Miscarriage is when an embryo or ● Imminent fetus dies before the 20th week of ● Missed Miscarriage pregnancy ● Incomplete Miscarriage ● Miscarriage usually happens early ● Complete Miscarriage in your pregnancy. ● Ectopic Pregnancy ○ 8 out of 10 miscarriages SECOND TRIMESTER happens in the first 3 ● Hydatidiform Mole months ● Premature Cervical Dilatation. PATHOPHYSIOLOGY OF MISCARRIAGE THIRD TRIMESTER 1. DUE TO ETIOLOGIC FACTOR ● Placenta Previa LIKE GENETIC ● Abruptio Placenta 2. TRISOMY CHROMOSOMES ARE ● Preterm Labor THE MOST COMMON ABORTION CHROMOSOMAL ANOMALIES 3. INSUFFICIENT HORMONAL ● The National Center for Health LEVEL Statistics, the Center for Disease 4. RESULT IS SPONTANEOUS Control and Prevention (CDC), MISCARRIAGE BEFORE 10 and the World Health Organization WEEKS OF GESTATION (WHO) define abortion as pregnancy termination prior to 20 PATHOLOGY OF ABORTION weeks gestation or a fetus FIRST 8 WEEKS GESTATION weighing less than 500g ● Separation of decidua basalis and ○ Despite this, definitions expulsion of the ovum vary widely according to ○ If retained within the state laws uterus, the ovum becomes ○ Fetus weighing less than surrounded by decidua and 500 grams blood clot ○ Before the 20th completed 8 TO 12 WEEKS OF GESTATION week of gestation ● Rupture of the decidua capsularis ○ Early abortion and late and expulsion of the product of abortion conception ○ 15% of clinically evident AFTER 12 WEEKS pregnancies ● Rupture of the membranes ○ 80% of abortions prior to followed by expulsion of the 12 weeks gestation product of the fetus MISCARRIAGE ● ● Abortion is the removal of ● pregnancy tissue, products of ● and the placenta in the uterus. PATHOLOGY to prevent infections and ● Hemorrhage into the decidua avoid further bleeding. basalis ● Necrosis and inflammation ● Uterine contraction and cervical IMMINENT MISCARRIAGE/ INEVITABLE dilatation ● A threatened miscarriage ● Expulsion of most or all the becomes imminent or inevitable if products of conception uterine contraction and cervical ETIOLOGY dilatation occur. ● Abnormal karyotype:50% ● Loss of products of conception ● Maternal Factors cannot be halted ○ TORCH MANAGEMENT ○ Infection ● Mother must visit OB for FHB ○ Immunologic factors assessment and ultrasound. ○ Maternal Systemic ● Save any tissue or fragments from Diseases bleeding and bring to OB ○ Anatomic Defects ● Tissue must be examined for H. ○ Trauma Mole ● Toxic Factors ● FHB and ultrasound absence may CHARACTERISTICS indicate D&E to extract remaining THREATENED ABORTION products of conceptus ● Usually bright red spotting ● Observe for saturation of sanitary ● Without cervical dilation pads for heavy bleeding. ● Without expulsion of products of TREATMENT conception ● Pathologic examination MANAGEMENT ● Dilation and curettage ● Mother must visit the OB for FHB ● Oxytocin assessment and ultrasound ● Ultrasound ● Blood is drawn for Hcg testing ● antibiotics repeated again after 48 hours CLINICAL FINDINGS ○ If placenta is still intact ● Severe Bleeding ● CBR is not necessary, ● INCOMPLETE ABORTION ○ It may cause pooling of ○ Expulsion of some but not blood and bleeding again all of the products from the when the mother conception ambulates ● THREATENED ABORTION ○ Bleeding must stop within ○ Expulsion of all the 24 hours products of conception ○ Restrict coitus for 2 weeks after the bleeding episode COMPLETE ABORTION ■ Hemorrhage is rare ● The entire product of conception ○ For incomplete abortion or are expelled spontaneously accompanying DIC without any assistance of D&E ■ Major hemorrhage ○ FETUS is a possibility ○ MEMBRANES ○ Complication may include ○ PLACENTA hypovolemic shock ● Bleeding slows within 2 hours and ● Infection then stops within a few days after ○ Tends to develop when the passage of the product of pregnancy occur over a conception. short time CLINICAL FINDINGS ○ It tends to develop when ● Products of conception pregnancy occurs over a ● Ultrasound short time. ● Bleeding ○ It tends to occur with MISSED MISCARRIAGE women who have lost a ● Also known as early pregnancy great deal of blood. failure ○ Advise mothers to look for ● The fetus dies in the utero but is signs of: not expelled. ■ Fever ● It is usually discovered during ■ Abdominal Pain prenatal examination when no ■ Tenderness increase in fundal height and there ■ Foul smelling is no FHB heard discharge from ● A woman may have had vagina symptoms of threatened HABITUAL ABORTION miscarriage and may have no ● Three or more successive clinical symptoms spontaneous pregnancy loss ● If pregnancy is over 14 weeks ○ If not successive it is called labor may be induced by repeated abortion. administration of Cytotec to dilate ● Causes the cervix followed by oxytocin ○ Cervical incompetence stimulation ○ Poor nutritional status TREATMENT ○ Hormonal disturbance ● DIC ○ Defective ova or ● ESTROGEN spermatozoa ● D&C ○ Rh incompatibility ● OXYTOCIN ○ Chronic Nephritis COMPLICATION OF MISCARRIAGE ● Treatment may cause such as cervical incompetence or ● Hemorrhage treatment of causative disease as ○ For complete abortion syphilis, DM, etc. LABORATORY FINDINGS HEMATOLOGIC DISORDERS ● Ultrasonography ● Disorder in blood formation and ● PT coagulation disorders ● Blood Count ● Anemia during pregnancy: ● Gestational Sac and Viable ○ Iron Deficiency Anemia Embryo with heart motin ○ Folic Acid Deficiency ● Hcg ○ Pseudo-Anemia ● Anemic ○ True Anemiia COMPLICATION PSEUDO ANEMIA ● Severe hemorrhage ● Resulting from expansion of blood ● Intrauterine Synechiae volume which results to anemia ○ Adhesion during early pregnancy ● Perforation TRUE ANEMIA SEPTIC ABORTION ● Present when HGB is less than ● An infection of the placenta and 33% during the first trimester the fetus of a previable pregnancy. NORMAL VALUES ● Infection is centered in the ● HGB placenta and there is risk of ○ 12-16g/dl of blood spreading to the uterus causing ● HCT pelvic infection or becoming ○ 37% to 47% systemic to cause sepsis and ● RBC potential damage of distant vital ○ 4.5 to 5.5 million/mm^2 organs IRON DEFICIENCY ANEMIA SIGNS AND SYMPTOMS ● Most common anemia of ● Tender uterus pregnancy complicating as many ● Offensive vaginal bleeding as 15%-25% of all pregnancies ● High temperature ● Characterized by microcytic and ● Rapid pulse hypochromic RBCs ● Unstable BP ● Factors ● Shock ○ Diet low in iron TREATMENT ○ Heavy menstrual period ● Isolation ○ Weight reducing programs ● Clinical bacteriological to identify ● HGB lower than 12g/dl and HCT the infectious organisms less than 33% ● Administrations of antibiotics as ● Result in decrease oxygen doctor orders transport to the body ● Intake and output chart should be ○ Associated with low weight kept and Preterm Birth ● Soiled pads should be properly ● S/Sy ● collected and burned. ○ Craving pica-pica and ice ○ Extreme fatigue ○ Poor exercise tolerance SICKLE CELL ANEMIA MANAGEMENT ● A recessively inherited hemolytic ● Iron supplements anemia caused by abnormal ● Diet rich in iron and vitamins anemia acid in the hemoglobin ● Juice with Vit. C ● Irregular shaped RBC SIDE EFFECTS OF IRON THERAPY ● Decreased capacity to transport ● Constipation HGB to the tissues ● Black Tarry Stool ● HGB is at 6-8g/dl/100 ml of blood ● Gastric Irritation ● Common among black women. FOLIC ACID DEFICIENCY SICKLE CELL ANEMIA ● Deficiency of Vitamin B9 ● Normal RBC are rounded and disk ○ B9 is needed for: shaped. ■ Normal formation of ○ In sickle cell anemia, some RBC RBC become deformed ■ Prevention of NTDs and looks like sickles. in the uterus ● A recessively inherited hemolytic ● It occurs mostly among women anemia caused by abnormal ○ Multiple pregnancy amino acid in the hemoglobin ○ Women with secondary ● Irregularly shaped RBC hemolytic disease ● Decrease capacity to transport to ○ Women taking the tissue anticoagulant agents which ● Decreased blood flow to the interferes with folate organs resulting to severe anemia absorption ● HGB is at 6-8g/dl/100ml of blood ○ Women taking oral ● Women in with this trait has higher contraceptives incidence of bacteriuria resulting to ○ Women who had gastric pyelonephritis bypass due to obesity. INCOMPETENT CERVIX FOLIC ACID DEFICIENCY ANEMIA ● Painless dilatation of the cervix ● Folic acid deficiency develops into without connotations megaloblastic anemia ● Cervical insufficiency is caused by ● Deficiency may take place several a structural weakness of the cervix weeks to develop and is ● When the cervix opens manifested on the 2nd trimester prematurely, a woman’s risk for MANAGEMENT preterm delivery greatly increases. ● Advised mother to take 400 to 600 ● Intrinsic deficiencies in cervical mg of folic acid daily for expectant collagen and elastin mothers ○ Collagen is the main ● Eat folate rich food component of cervical connective tissue, giving it rigidity. CONGENITAL INCOMPETENCE ○ Elective cervical cerclage ● Women exposed to DES or ■ Late first trimester diethylstilbestrol or early second ● The most common congenital trimester cause is the defect in the ■ Cerclage enforces embryological development of cervical muscle. Mullerian Ducts CARE OF THE WOMAN FOLLOWING AN ● The mullerian duct is the ELECTIVE CERCLAGE embryonic structure that develops ● Assessment of the vaginal into the female reproductive tract. bleeding DIETHYLSTILBESTROL ● Assessment of the uterine cavity ● A synthetic form of the female ● Assessment of vital signs hormone estrogen. ● Ultrasound ● It was prescribed to pregnant women to prevent miscarriage, premature labor, and related complications of the pregnancy ● 1940 and 1971 it is out of the market ACQUIRED CERVICAL INCOMPETENCE ● Inflammation or Cervicitis ● Infection ● Subclinical Uterine Activity ● Cervical Trauma ○ Sexual Penetration ○ STD ○ Pregnancy ● Increased Uterine Volume IDENTIFICATION OF WOMEN WITH INCOMPETENT CERVIX ● Repetitive second trimester losses ● Previous preterm birth ● Previous elective abortion ● Cervical manipulation MANAGEMENT ● CONSERVATIVE MANAGEMENT ○ Bed rest ○ Avoidance of heavy lifting ○ No coitus ● WOMEN WITH PREVIOUS LOSSE GENETIC DISORDERS ● Also known as EDWARD’S ● The possibility that a child could SYNDROME have genetic disorders usually ● A condition associated with crosses the minds of the pregnant abnormalities in many parts of the women and their partners at some body. point during pregnancy. ● Individuals with TRISOMY 18 COMMON CHROMOSOMAL often have slow growth before DISORDERS birth and on a low birth weight NUMERICAL ABERRATIONS ● Affected individuals may have heart defects and abnormalities of ● TRISOMY 13 SYNDROME other organs that develop before ○ PATAU SYNDROME birth. ○ 47XY12 ● TRISOMY 18 SYNDROME KLINEFELTER SYNDROM ○ EDWARD’S SYNDROME 47XXY ● TRISOMY 21 SYNDROME ● A genetic condition that results ○ DOWN SYNDROME when a boy is born with an extra ● TURNER’S SYNDROME 45X0 copy of X chromosome STRUCTURAL ABERRATIONS ● It affects males and it often isn’t ● CRI-DU-CHAT SYNDROME diagnosed until adulthood TRISOMY 18 SYNDROME ● It may adversely affect testicular growth, resulting in smaller than normal testicles, which can lead to lower production of testosterone. FEATURES ● Taller than average stature ● Longer legs, shorter torso and broader hips compared to other boys ● Absent, delayed, and incompetent puberty ● Small and firm testicles ● Small penis ● Enlarged breast tissue ○ GYNECOMASTIA WOLF-HIRSCHHORN SYNDROME ● A syndrome caused by irregularities on the short arm of chromosome 4 (4p). ● It is characterized by: ● 47XY18 ● Intellectual activities ● Greek warrior helmet appearance ○ Ultrasound to assess of the nose and forehead thickness and fetus neck ● As well as multiple defects and maternal blood draw ○ Skeletal ● Fetoscopy ○ Cardiovascular ○ Small camera and ○ Urogenital instruments passed into TURNER’S SYNDROME the amniotic sac to view the fetus ● Newborn Screening.
● A gonadal disorder or dysgenesis
where the only one X chromosome. ● `CLINICAL FINDINGS ○ Short height ○ Heart Defects ○ Child is sterile ○ Ovaries failed to develop ○ Sex characteristics do not develop ● It only affects females. DIAGNOSTIC TESTS TO DETERMINE CHROMOSOMAL DISORDERS ● KARYOTYPING ○ Visualization of the chromosomes ● Chorionic Villi Sampling ● Amniocentesis ● Nuchal Translucency