Final Flashcards
1
Q
Labor - Definition (long)
A
- Sequential, integrated set of changes with the myometrium, decidua, and uterine cervix that occur gradually over a period of days to weeks
- Change in myometrial contractility pattern from “contractures,” a pattern of long-lasting low-frequency activity, to “contractions,” high-intensity high-frequency activity resulting in effacement and dilation of the uterine cervix
2
Q
Labor - Definition (short)
A
- Clinical diagnosis
- Regular uterine contractions
- Progressive cervical effacement
- Progressive uterine dilation
3
Q
“False” Labor - Definition
A
- Regular uterine contractions
- No change in cervical dilation
4
Q
Term Pregnancy - Definition
A
- 37 - 42 weeks
5
Q
Onset of Labor - Hormones/factors Involved in Parturitional Cascade
A
- Prostaglandins
> Increased prostaglandins, especially PGE2 and PGF2, near initiation of labor soften cervix and can help cause contractions - Progesterone
> Progesterone withdrawal does not occur in all women before labor - Estrogen
> Up-regulates receptors on uterus, increasing contractility
6
Q
Onset of Labor - Oxytocin
A
- Synthesized in the hypothalamus and released from the posterior pituitary
- Stimulates uterine contractions
- Circulating levels of oxytocin do not change significantly during pregnancy or prior to the onset of labor
- Uterine myometrial receptors become increasingly sensitized to oxytocin during the second half of pregnancy
- Unlikely to stimulate labor, but definitely makes stronger uterine contractions
7
Q
Onset of Labor - Role of the Fetus
A
- Not well understood
- Potentially controls the timing and onset of labor, possibly due to increased fetal pituitary-adrenal activity
8
Q
First Stage of Labor - Definition
A
- Interval between the onset of labor and full cervical dilation (10cm)
9
Q
First Stage of Labor - Latent Phase
A
- Characterized by slow dilation
- Period between onset of labor and point at which the rate of cervical dilation increases **(up to 4cm dilation)
- *- Contractions often 5-10 minutes apart, lasting 30-45 seconds
- AKA: “early labor” or “prodromal labor”
10
Q
First Stage of Labor - Active Phase
A
- Characterized by a faster rate of dilation
- *- Usually begins by 4cm dilation
- *- Contractions often 2-4 minutes apart, lasting 60 seconds, more intense
- “active labor”
11
Q
First Stage of Labor - Transition
A
- Characterized by a mix of cervical dilation and descent of fetus
- *- 7-10cm
12
Q
Second Stage of Labor - Definition
A
- Characterized by the descent of the fetus through the maternal pelvis
- *- Interval between full cervical dilation (10cm) and delivery of infant
- There is usually a maternal desire to bear down with contractions and a sensation of pressure on the rectum
13
Q
Management of Normal L&D - Onset of Labor
A
- Regular firm contractions
- Bloody show
- Spontaneous rupture of membranes
14
Q
First Stage Initial Evaluation
A
- Establish baseline cervical status
- Review prenatal record for medical conditions
- Check for development for new disorders
- Evaluate fetal status
- Vitals
> BP
> Pulse
> Temperature - Fetal heart rate
- Frequency, duration, and strength of contractions
- Cervical examination (may defer if the membranes are ruptured)
> Dilation of cervix (0-10cm)
> Effacement of cervix (0-100%)
> Status of fetal head (-5cm - +5cm)
> Status of amniotic membranes/presence of meconium
> Presentation and position of fetus
15
Q
Monitoring During Labor
A
- Vitals every 4 hours (1-2 hours if abnormal)
- Assessment of uterine contractions
- Cervical examinations
> On admission
> 1-4 hour intervals during first stage
> 1 hour intervals during second stage
> When patient feels urge to push
> With any fetal heart rate abnormalities - Fetal heart rate
> Not mandatory for low-risk
> Every 15 - 60 minutes during first stage
> Every 5 minutes during second stage
> Listen during and after contractions
> Normal range is 110 - 160bpm
16
Q
Activities During Labor
A
- Food and drink should not be limited during labor for low-risk patients
> Suggest juices, popsicles, broth, yogurt, crackers, fruit - Encourage patient to empty their bladder frequently
- Give patient information
- Give patient privacy
- Factors associated with a satisfactory birth
> Personal expectations met
> Caregiver support
> Participation in decision making - Coaching
> Involve partner
> Soothing, calm tone of voice
> Give her visual images
> Acknowledge what she is experiencing
> Remind her that it will end and there will be breaks
> Give her positive feedback - Encourage patient to change positions fequently
> Standing, sitting, side-lying, squatting, hands-and-knees, kneeling - Pain relief/comfort measures
> Position changes
> Massage
> Counter-pressure
> Warm water
> Encouragement
> Homeopathy
> Emotional support
17
Q
Labor Augmentation
A
- Hydration (oral or IV)
- Calories
- Position changes
- Acupuncture
- Homeopathy
- Herbs
- Breast pump
- Amniotomy
18
Q
Second Stage of Labor - Details
A
- Push at either 10cm or when patient has urge to push
- Can use valsalva or physiologic (however patient wants) positions to push
- Length of second stage
> Primiparous average around 2 hours, but can push longer if there’s progress and no distress
> Multiparous average 1 hour or less - Episiotomy (unnecessary in normal births) indications:
> Fetal distress at +4 station
> Prolonged crowning
> Need for instrumentation
19
Q
Delivery - Steps in Assisting Birth
A
- Patient pushes to crowning
- Encourage patient to pant or give little pushes at crowning to stretch the perineum
- One hand on vertex of fetal head to keep head flexed
> Possibly apply counter-pressure - Other hand supports the perineum
- After head is delivered, allow for spontaneous restitution
> Restitution = baby’s rotational position changing to help deliver shoulders AP in pelvis
**- Reduce nuchal cord (cord around baby’s neck), if present - With next contraction, apply gentle downward traction toward the maternal sacrum to deliver the anterior shoulder
- As soon as the anterior shoulder becomes visible, deliver the posterior shoulder with upward traction
20
Q
Third Stage of Labor - Definition
A
- Interval between fetal delivery and complete expulsion of the placenta
21
Q
Third Stage of Labor - Length
A
- Risk of postpartum hemorrhage (PPH) increases with length of third stage
- Lengths
> Average length is 5-6 minutes
> 90% by 15 minutes
> 97% within 30 minutes - Gestational age is the major factor influencing the length of the third stage
> Pre-term deliveries are associated with a longer third stage
22
Q
Third Stage of Labor - Cord Clamping
A
- Often done by a family member
- 75% of placental blood is transferred to infant in the first minute
- Benefits of delayed cord clamping
> Higher hemoglobin levels
> Lower rates of anemia in ages 2-6 months
> Important for babies whose mothers have low ferritin
> Important for babies who will be breastfed without iron supplementation
> Important for low birth weight babies
> Lower risk for necrotizing enterocolitis
> Less intraventricular hemorrhage - Disadvantages of delayed cord clamping
> Higher rate of polycythemia
> Greater need for phototherapy for term infants with jaundice
23
Q
Third Stage of Labor - Cord Milking
A
- Alternative to delayed clamping
- Might help stabilize BP and increase urinary output in preemies
- Milking the cord 4x roughly equals 30 seconds of delayed clamping
> Similar benefits and disadvantages - Should not delay delivery or treatment in order to milk the cord
- Should not milk the cord if planning to collect cord blood
24
Q
Third Stage of Labor - Cord Blood
A
- For diagnostic purposes
> Allow blood to drain from the cut end into a glass tube prior to delivery of the placenta
> May be screened for type and Rh, as well as any necessary newborn conditions
> Not used for pH testing (collect for that using needle into umbilical artery) - For banking purposes
> Can be done with placenta in utero or ex utero
25
Third Stage of Labor - Placental Delivery
**- Signs of placental shearing
**> Gush of blood
**> Umbilical cord lengthening
**> Uterus becomes firmer and globular
**> Uterus moves upward
- Placental expulsion
> Spontaneous uterine contractions and patient bearing down
> Expectant management
^ Follows natural physiology
^ Usually involves delayed cord clamping
^ Monitor patient's vitals, bleeding, and for signs of placental shearing
^ Placenta will be expelled naturally
> Active management
^ Typically does not shorten third stage, but does lessen blood loss
^ Early cord clamping, cord traction, and prophylactic oxytocics
- Technique
> When tractioning the cord, prevent uterine prolapse by guarding the uterus
> Immediate nursing and/or nipple stimulation does not prevent PPH or significantly decrease blood loss
> Excessively massaging the uterus could negatively impact placental shearing and contribute to PPH
> Patient in upright position will help placental expulsion
**- Retained placenta
**> Herbal angelica
**> Homeopathic pulsatilla or sabina
- After normal delivery of placenta
> Check for firm uterus every 5-10 minutes to control bleeding
> Fundus should feel hard and be near the level of the umbilicus
> 1 cup of fluids every hour patient is awake
> Stay in bed for 2 days minimum except to use the bathroom
> Can shower after 12 hours if no dizziness or hemorrhaging
26
Third Stage of Labor - Blood Loss
**- Normal is 250-500mL
**- PPH is 500mL or more
- Etiologies
> Uterine atony - 80%
> Episiotomy
> Lacerations
> Placenta accrete (Emergency! - placenta implanted in myometrium)
- Risk factors
> Severe anemia
> Grand multiparity
> Hx of PPH in patient or family
> Low-lying placental implantation
> Placental abruption
> Precipitous labor
> Prolonged labor
> Chorioamniotitis
> Uterine fibroids
> Overdistended uterus
> Oxytocin use
> Mismanaged or prolonged third stage
- 4% of all births
- Signs and symptoms
> Rising fundus
> Vaginal bleeding
*> Tachycardia precedes BP drop
> Shock
- Sequelae
> Sheehan's syndrome
> Breastfeeding difficulties
> Postpartum endometritis
- Treatment
> IM or IV oxytocics
**> Uterine massage or bimanual pressure
> IV
> Homeopathy (after patient is stable)
^ Belladonna
^ Lachesis
^ Sabina
^ China
^ Phosphorus
> Herbal remedies
^ Cinnamon (30 ggts immediately)
^ Collonsonia (after stable)
^ Shepherd's purse (after stable)
^ Bayberry (after stable)
27
Third Stage of Labor - Cord
- Normally 2 arteries and 1 vein inserted into the center of the placenta
- Average 55cm long and 2cm thick
- Abnormal cord variations
> Length (long or short have different risks)
> Vessels (most common congenital anomaly is 1 artery and 1 vein - 1% of infants)
> Cord insertion (Battledore/Marginal - within 1.5cm of placental margin; vellamentous insertion - vessels travel through membranes before joining the cord)
28
***Tips for Emergency Delivery***
***
- Be calm and reassuring
- Keep everything as clean as possible - wash hands, use clean towels
- Use counter-pressure to slow the delivery of the head; encourage patient to pant to slow delivery
- Check for nuchal cord once head is delivered
> Fix it if it's there
- Ensure restitution happens
- Deliver carefully because slippery; will likely come out on its own after shoulders
- Dry baby and wrap it (including head) to keep it warm
> Prevents respiratory depression
- If baby isn't breathing, rub vigorously along spine; acupressure K1 (bottom of foot)
- Deliver placenta if unavoidable or patient is bleeding; fine to wait if stable
> If delivered, keep for later observation
- After delivering placenta, massage uterus to keep uterus firm and minimize blood loss
- Don't clamp and cut the cord until you have sterile instruments
29
Abnormal L&D - Prolonged Labor - Failure to Progress
```
- Risk factors
> Patient pelvis issues
> Inadequate uterine contractions
> Poorly flexed fetal head
> Emotional dystocia
```
30
Abnormal L&D - Prolonged Labor - Prolonged Latent Phase
```
- Associated with complications and less-successful labor (patient and uterus get tired)
> Fever
> Fetal distress
> C-section
> Neonatal resuscitation
> Thick meconium
> Increased NICU admissions
> Increased risk for PPH
- Management
> Decrease stress
> Rest
> Distraction
```
31
Abnormal L&D - Prolonged Labor - Other Issues
- Cephalopelvic disproportion (CPD)
> Head and pelvis don't fit together
- Deep Transverse Arrest
> Vertex in right or left occiput transverse position
> More common in platypelloid or android pelvis
- Persistent asynclitism
> Baby positioned asymmetrically
32
Abnormal L&D - Management of Prolonged Labor
- Position changes
- Epidural
- Anticipatory management (instrument delivery; c-section)
- Homeopathy
- Comfort and support
- Herbs to increase uterine activity
> Blue cohosh
> Black cohosh
> Raspberry
> Mitchella
> Mistletoe
- Chinese medicine
> Shiatsu
> Acupuncture/acupressure
33
Abnormal L&D - Second Stage
```
- Shoulder dystocia
> Anterior shoulder trapped behind pubic bone (flip patient to hands and knees)
> Increased time between delivering the head and the body
> Predisposing factors
^ Macrosomia
^ Abnormal pelvis
^ Excessive weight gain during pregnancy
^ Gestational diabetes
^ Increasing parity
^ Induction of labor
^ Post-term pregnancy
^ Short stature
^ Vacuum or forceps-assisted birth
> Fetal complications
^ Fractured clavicle or humerus
^ Brachial plexus injury
^ Asphyxia with neurological damage
^ Death
> Maternal complications
^ Bladder injury
^ 4th degree laceration
^ PPH
- Cord issues
> Cord prolapse
```
34
Abnormal L&D - Malpresentations
```
- Breech
> Prevention - encourage rotation during pregnancy
^ Homeopathy
^ Chinese medicine
^ External cephalic version
^ Slantboard
> Risks
^ Cord prolapse
^ Head entrapment
^ Abdominal organ damage
- Shoulder presentation
> Cannot deliver
> Either rotate or c-section
- Brow presentation
> C-section required (cannot deliver without flexion of head)
- Face presentation
> Usually related to short cord
- Persistent occiput posterior
> Causes complications from premature urge to push
^ Cervical laceration
^ Patient exhaustion
^ Fetal exhaustion/distress
^ Cervical edema
> Management
^ Positions to shift occiput off sacrum
^ Facilitation of rotation
^ Comfort measures
```
35
Abnormal L&D - Preterm Labor
** - Labor between 20-37 weeks gestation
- 10% of all deliveries in US
- Risk factors
> <18 or >40 yo
> Low socioeconomic status
> Physically demanding job
> Past history of preterm birth
> BMI < 19.8
> Uterine conditions
> Premature rupture of membranes (PROM)
> Placenta previa
> Placental abruption
> IUGR
> Preeclampsia
- Diagnosis
> Increase in uterine activity
> Cervical changes (effacement/dilation)
> TVUS for cervical length
> Fetal fibronectin
> Identify and treat infections
36
Abnormal L&D - Meconium Aspiration
- Can be a sign of maturation, not fetal distress
- In early labor, can be associated with lower Apgar scores, meconium aspiration syndrome, fetal ischemia, and chorioamnioitis
- Management
> Exclude breech
> Patient left-side lying with IV and O2
> Monitor patient's temperature every 2 hours
> Internal fetal monitoring
> Amnioinfusion
> Be prepared to resuscitate newborn
37
Breastfeeding - General
**- Human milk is recommended as the exclusive nutrient for term infants for the first 6 months, then in conjunction with solids for the next 6 months, and then continued for as long as is beneficial for parent and baby
38
**Breastfeeding - Physiological Preparation/Details
- First trimester
> Breast glandular tissue development and growth stimulated by hCG, progesterone, and *prolactin
- Second and third trimesters
> Lobule formation and enlargement
> Secretion begins
> Colostrum formed
- Labor and lactation
> Further growth and differentiation of lobule
> Colostrum secretion
> Secretion is activated
^ By a drop in progesterone after placental delivery
^ By the presence of prolactin and cortisol
^ Occurs 2-3 days postpartum
^ Maintenance of lactation require regular removal of milk and nipple stimulation
- Regulation of milk production
> Prolactin
> Breast emptying leads to increased milk volume by 5-15%
> Distention of mammary glands decreases milk production
- Milk ejection
> Tactile stimulation of the nipple leads to oxytocin release
> Oxytocin causes contraction of the mammary glands, pushing milk into the ducts and out through the nipple
39
**Breastfeeding - Colostrum
- Produced during second half of pregnancy
- Present for first 2 days after birth
- Thick yellow consistency
- Low volume, low in calories and fat
* *- High in minerals, protein, fat-soluble vitamins, and antibodies
* *- Helps establish gut flora
* *- Has laxative effects
40
Breastfeeding - Breast Milk
- Generally comes in 2.5 - 3.5 days after birth
- Increased volume compared to colostrum
- Has proteins (80% whey), lipids, and carbs
- Highly bioavailable iron, and other minerals
- Beneficial flora
- Antibodies
41
Breastfeeding - Functions of Breast Milk
- Immune modulating
- Anti-inflammatory
- Aids in digestion
- Promotes growth of crypt cells in intestinal tract
42
**Breastfeeding - Long-Term Benefits for Infants
- Fewer acute illnesses
- Reduced incidence of obesity
- Reduced incidence of cancer
- Decrease in cardiovascular risk factors
- Decreased risk of type 1 diabetes
43
**Breastfeeding - Benefits for Parent
- Quicker recovery from childbirth
- Reduction of stress response
- Postpartum weight loss
- Prolonged postpartum anovulation
- Reduced risk of breast and ovarian cancer
- Decreased risk of cardiovascular disease and obesity
44
*Breastfeeding - Initiation
**- Should be initiated within first hour after birth
**- Positioning
> Belly to belly
> Baby mouth aligned with nipple
> Neck slightly extended
> Ear, shoulder, and hips are in alignment
- Latch-on
> Form a tight seal with mouth around nipple and areola
**> Infant mouth wide open with lips splayed
- Milk transfer
**> Baby tongue squishes nipple to cause milk ejection
> Efficient transfer depends on coordination of suck/swallow
**> Tongue-tie affects eating, and eventually talking
^ SSx = reflux, spitting up, discomfort in car seat and lying on back
45
Breastfeeding - Timing of Feeding
- Feedings initiated by demand
- Offer both breasts each time, and try to empty them
- Average number of feedings is 8-12/24 hrs, 10-15 minutes/breast
46
Breastfeeding - Assessment of Intake
- Normal to lose up to 10% of body weight initially; should be back to birth weight by 2 weeks of age
*- Baby who wants to nurse all the time isn't getting enough
*> Might be sign of heart of liver disease
- Urine output
> 1 pee in first day
> 2-3 in day 2
> 4-6 in days 3-4
> 6-8 per day after day 4
- Stool output
> Meconium is tarry black lining of intestinal tract passed in first 3 days
> Transitional stool present by day 3
> Breastmilk stool present by day 5, 3x/day
47
Breastfeeding - Excessive Weight Loss
- Assess if >7% weight loss
- Reasons
*> Inadequate milk production
^ Tubular breasts
^ Delay in production
^ Parental medications
^ Previous breast surgery
*> Poor milk transfer
^ Infrequent feeding
^ Poor latch
^ Use of formula
^ Oral-motor or neurologic abnormalities
> Disease of newborn
^ Cardiac abnormalities
^ Kidney abnormalities
^ Gastrointestinal abnormalities
^ Newborn metabolic diseases
48
Breastfeeding - Excessive Weight Loss/Inadequate Weight Gain - Management
- Review histories, assess intake/output
- Encourage frequent and full feedings
> Put to each breast every 2-3 hours for 10-15 minutes each; keep baby awake while feeding
- Follow breastfeeding with 10 minutes of pumping to feed later
- Optimize parental milk production ability
> Sleep, water, calories, stress, confidence
- Galactogogue herbs
> Trigonella
> Foeniculum
> Cnicus
> Galega
> Medicago
- Galactogogue medications
> Domperidone (Motilin)
^ Okay for long-term use
^ 10-30mg TID
^ Increases prolactin
> Metoclopramide (Reglan)
^ 7-10 days only
^ 10-15mg TID
^ Increases prolactin
- Daily logs of weight, intake, output
- Supplement with pumped milk, donor milk, or formula
49
Nipple and Breast Pain - Causes and Evaluation
```
- Causes
> Engorgement
> Nipple injury
> Plugged ducts
> Nipple vasoconstriction
> Nipple/breast infection
- Evaluation
> History
> Physical examination of parent, infant, and feeding
```
50
Nipple Pain
- Normal to have sensitivy in first week, should subside within first minute of feeding
- Nipple injury
**> Pain lasts throughout feeding and past first week
> Exam for scabs, cracks, and/or blisters
- Management
* > Correct the latch (every time it's bad)
> Let the nipples air dry
> Nurse on unaffected side first
> Cool or warm compresses
> Apply expressed breast milk to nipples
> Apply lanolin or nipple butter to nipples
> Consider frenotomy if ankyloglossia present
- If nipple pain is refractory to conservative measures
> Consider using a nipple shield temporarily
> Consider an infectious source
^ Tx with APNO (all-purpose nipple ointment)
^ Try thrush treatments
> Consider areolar eczema
**> Consider nipple vasoconstriction
^ Possible history of Raynaud's
^ Nipple shows pallor, then cyanosis, then erythema
^ Burning pain with nursing, and possibly with cold exposure
^ Treatments
) Warm nipple before nursing
) Avoid caffeine and nicotine
) Magnesium
) Nifedipine (Ca-channel blocker)
51
Breast Pain - Engorgement
- Accumulated breast milk that causes breast to firm up and be painful
- Can inhibit latch
- Can happen as milk comes in, or if wait too long between feedings
- Management
> Remove milk from breasts
> Warm compresses or shower before feeding
> Cold compresses between feedings
> Cabbage leaves
> Cold gel packs
> Acupuncture
52
Breast Pain - Plugged Ducts
- Painful lump in breast tissue
- Localized areas of milk stasis
- Risk factors
> Poor feeding technique
> Ill-fitting bra
> Abrupt decrease in feeding
- Management
> Improve latch
> Aim chin towards affected area
> Completely drain the breast
> Warm compresses
> Manual massage
> Homeopathy
> Open the milk blebs with a sterile needle
53
**Breast Pain - Mastitis
- Local inflammation of the breast associated with fever, muscle pain, breast pain, and erythema
- Likely infectious
- Most common in first 6 weeks postpartum
- Symptoms
> Indurated, erythematous, tender area of breast
> Elevated parental temperature
- Risk factors
> Nipple trauma
> Infrequent feedings
> Inefficient milk removal
> Parental illness
> Milk oversupply
> Rapid weaning
> Pressure on breast
> Blocked milk duct
* > Parental stress, fatigue, or malnutrition
- Treatment
> Improve feeding technique
> Completely empty breasts
> Nurse on affected side first
> Increase frequency of feedings
> Alternating hot and cold compresses; ginger compress
> Rest
> Adequate food and water
> Homeopathy
^ Phytolacca
^ Belladonna
^ Bryonia
> Herbs
^ Combo products (like Bioveg)
^ Echinacea
^ Oregon grape
^ Phytolacca
^ Myrrh
^ Garlic
^ Topical ginger or phytolacca oil
^ AVOID hydrastis - decreases milk supply
> Antibiotics
^ Dicloxacillin 500mg QID
^ Cephalexin 500mg QID
^ Clindamycin 300mg QID
^ IV antibiotics if severe
- Treatment should be effective in 48-72 hours
54
**Breast Pain - Thrush
- Diagnosed clinically
- Symptoms
> Burning of the nipple
> Severe deep shooting or stabbing pain towards the breast wall
> Symptoms out of proportion to physical findings
> Shiny or flaking skin on affected nipple
> May see infant oral thrush or diaper candida
- Parental treatments
> Topical antifungals (nystatin less effective)
> 1% gentian violet in water applied to baby's mouth before feeding, 3-4x/day
> 1 Tbsp vinegar in 1 Cup water to rinse breast
> Grapefruit seed extract
> Probiotics
- Infant treatments
> Gentian violet
> Probiotics
> Nystatin oral suspension
55
Weaning
- Recommended to breastfeed at least one year
- Strategies to wean
> Drop a session every 2-5 days
> Shorten each session
> Introduce bottle or cup feedings
56
Formula Feeding
- Cow's milk
- Soy milk
- Partial whey hydrosylate formulas
- Extensive casein or whey hydrosylate formulas
- Amino acid based
57
Infertility - Definition and Evaluation
- No conception after one year of unprotected intercourse
- Professional advice should be sought after 6 months
> Female-bodied partner over 35
> Irregular or absent menstrual periods
> 2 or more miscarriages
> Hx of tubal disease or pelvic infection
> Hx or current prostate infection
> Endometriosis
> PCOS ssx
- Evaluation
> Sperm? Egg? Uniting issue? Implantation issue?
> Primary infertility = never conceived
> Secondary infertility = previous pregnancy
58
Infertility Etiologies - Female
```
- Ovarian issues
> Anovulation
> Oligoovulation
> Oocyte aging
- Fallopian tube abnormalities/pelvic adhesions
> PID
> Endometriosis
> Previous surgeries
> Inflammatory bowel disease
- Luteal phase defects (most common)
- Others
```
59
Infertility Etiologies - Male
- Varicocele
- Hydrocele
- Defective ejaculation
- Trauma
- Torsion
- Testicular cancer
- Hormonal issues
60
Infertility - Lifestyle Factors
- Lubricants that impair sperm motility (KY, Astroglide, olive oil, saliva)
- Tobacco use
- BMI in female
- Exercise helps or decreases depending on BMI and type/length of exercise in female
- Heavy alcohol use
- Diet - mixed results, Mediterranean Diet might be good
- Stress
- Environmental toxins
> BPA
> Lead
> Mercury
61
Infertility - Diagnosis
- Hx and PE
- Semen analysis
- Drug and medication eval
- LH, FSH, TSH, CBC, Prolactin, T
62
Infertility - Male Treatment
- Vitamin C
- Beta-carotene
- Vitamin E
- Zinc
- Copper
- Herbs
> Panax ginseng
> Avena sativa
> Saw palmetto
> Hops
63
Infertility - Female Treatment
```
- Hormone imbalance (anovulation)
> Vitex
> Vit E
> B complex
> Zinc
- Decreased ovarian function
> True unicorn root
> Beta-carotene
- Hormonal imbalance (decreased estrogen)
> Licorice
> Fennel
> Alfalfa
> True unicorn root
> Burdock
- Hormonal imbalance (decreased progesterone)
> Wild yam
> Vitex
> Sarsaparilla
> Lipotropic
> Progesterone
- General tx
> Caullophyllum
> Pulsatilla (herb)
> Black haw
- Fertility drugs for ovulation induction
**> Clomid (NOT used in women w/ low estrogen (older than 40ish)
```
