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Flashcards in Intro to Maternal Child Deck (281):
1

Does the US lag behind rest of world in maternal/child mortality?

yes

2

what are causes of child mortality?

low birth weight, education, antiseptic

3

how is government involved?

beginning of state programs for women and children

4

Family-Centered Maternity Care

safe, quality care which began to focus on the whole family

5

goal of maternal/child health

meet the needs of the family unit

6

Birth Centers

need to be a low-risk pregnancy, birth, and postpartum. Not only are these free standing facilities but they also provide women’s health care for non-pregnant women by delivering annual checks and family planning counseling

7

Preconception counseling - women

- lower child mortality - Talk to men/women about conception long before you even think about it - What healthy choices do I need to make before I have a baby?

8

Preconception counseling - men

- smoking effects sperm - Alcohol causes FAS, used to think that it was only Mom - Congenital defect, can it be changed prior to conception

9

Home birth

- Facilitate family bonding - Once health of mom and baby are secured work on bonding - Really want Mom/Dad to go skin to skin right away to start bonding process

10

home birth cons

- Client should have a low risk pregnancy - Certified midwife must have a DR backup - What is the time from home to hospital in the event of an emergency? - less support

11

why is there less support for home birth?

- no nurses are available to provide maternal or infant care - Midwife is busy with mom

12

home birth pros

- Keeps families together in their own environment - Facilitates family bonding

13

Is it ok to have family in room?

ok as long as they don't impede bonding

14

what happened when we sent mothers home shortly after giving birth?

- Postpartum infection when moms were sent home early - Insurance companies backed off on sending Moms home so early

15

How were children viewed in the earlier history of the United States?

- Slow to respond to the health care needs of children despite early studies on children. - Late 19th century strives were being made to decrease childhood mortality. - Discovery of vaccine, public health practices, child labor laws, etc

16

Current Healthcare Trends

- Cost containment-managed care, HMO, PPO - Home care - Health Insurance - Healthcare Assistance Programs

17

Healthcare Assistance Programs

- WIC - Healthy Start - March of Dimes

18

Maternal mortality

- 12.1 per 100,000 live births for all women - 30.5 for African American women - 8.7 for white women

19

Infant mortality

6.8 per 1000 live births

20

Childhood mortality

ages 1-19

21

Morbidity

ratio of sick to well person per 1000 people

22

Ethical Issues

- abortion - Elective abortion - Mandated contraception - Fetal injury - Fetal therapy - Infertility treatment - Child Health Nursing - Cessation of treatment/terminate life support

23

Abortion

- don't comment - give facts - take care of people - If someone asks what you think about it - just provide information

24

Elective abortion

- not our job to punish or criticize - must put views aside and take care of patient - Just provide info

25

Mandated contraception

- See with mentally ill/handicapped (1950s) - Not our place to judge - Be supportive - Court ordered

26

court ordered contraception...

- children repeatedly taken away - alcohol/drug abuse

27

Fetal injury

- mom tries to abort fetus on own - Chemical impairment

28

Fetal therapy

surgical interventions

29

Infertility treatment

If you are infertile is it right to use tissue made in a lab

30

Child Health Nursing

- Public health/Home health - Try to keep kids with parents

31

Cessation of treatment/terminate life support

mom or baby

32

Societal Issues

- cycle of poverty - homelessness - access to health care - prenatal care - Medicaid - violence - adoption

33

cycle of poverty

- can it be broken - poor parenting - can someone rise above

34

access to health care

- hopefully it gets better

35

prenatal care

- advocate for everyone

36

medicaid

help someone sign up

37

violence

- not always men/women - could be parent/kids and kids/parents

38

adoption

- always a choice - talk openly with parents

39

legal issues

- Nurse Practice Act - Standard of Care - Accountability - Malpractice - Documentation

40

Nurse Practice Act

- what does it say - std of care for women/child

41

std of care

what is acceptable and what is not

42

accountability

- highest place of malpractice (especially OB) - family practice shies away from delivering babies now because they always got sued

43

malpractice

Informed consent, competence, full disclosure, information, consent, refusal of care

44

documentation

most important part of nurse's job

45

Role of nurse

- care provider - teacher - collaborator - researcher - advocate - manager

46

care provider

direct care to patient

47

teacher

- education to promote health, prenatal care, and newborn care - extremely important, enormous amount of information to get to mom in a short time - have a plan to get information out

48

Collaborator

Lab, Doctor, OR staff, court

49

Researcher

apply research to practice

50

Advocate

- humanize and personalize care - Baby taken by court

51

Manager

delegate tasks and coordinate care

52

Advanced Practice Nurses

- Certified Nurse-Midwives (CNM) - Nurse Practitioner-primary care - Clinical Nurse Specialist (CNS)-not primary care

53

Certified Nurse-Midwives (CNM)

- provide complete care in uncomplicated pregnancies, during pregnancy, childbirth and postpartum - prescribes meds

54

Nurse Practitioner-primary care

- No deliveries - Yearly visit - Prescribes meds

55

Clinical Nurse Specialist (CNS)-not primary care

- Masters - Find specialty they want to work in (wound, ostomy) - Can prescribe wound methods but not meds

56

Family Issues

- Types of families - High risk families - Cultural influences - Religious influences - Parenting styles

57

Types of families

- traditional, nontraditional, single-parent, blended, adoptive, multigenerational, same-sex, and communal - whatever the patient says it is

58

High risk families

Social and physical

59

Cultural influences

- be open - why is it there? - is it hurting anyone? - leave if there is no harm

60

Religious influences

- female circumcision - virginal in arranged marriages - African tribes and mediterranean

61

parenting styles

- this is what the parent would like to happen - distinct wants

62

Mother’s ovum

X chromosome

63

Father’s sperm

X or Y chromosome

64

XX

female

65

XY

male

66

when is genetic sex determined?

conception

67

Sexually undifferentiated

even though sex is determined at conception, the reproductive systems of males/females is similar for the first 6 weeks

68

Sexually differentiation at 12 weeks

- 7th week internal organs begin differentiating - 9th week external organs begin differentiating - 12th week sexually differentiation is about complete

69

are sex glands active during infancy and childhood?

no

70

when do sex organs become functional?

puberty

71

average age of menstruating

9 yrs old

72

what cause girls to menstruate early?

hormones that they ingest

73

puberty

period of life when the body experiences a growth spurt, the reproductive organs develop to adult size and function

74

when does sexual development begin?

conception

75

is sexual development active during childhood?

no

76

what does the hypothalamus produce to begin puberty?

gonadotropin-releasing hormone

77

when do sex organs become fully functional?

during the phase of puberty

78

are girls born with all the eggs they will ever have?

yes

79

menarche

1st menstrual period

80

menses

normal flow of blood and tissue during menstruation

81

Menopause

normal cessation of menstrual function that usually occurs in the 5th or 6th decade of life; the final menstrual period

82

do you need to use birth control during pre-menopause?

yes

83

do men make sperm every day?

yes

84

when does sperm count begin to decrease?

when they are in their 60s

85

female changes in puberty

- breast - pelvis - body hair - growth spurt - external genitalia and reproductive organs - early menstrual cycles irregular

86

female changes in puberty - breast

first visible signs of change, nipples and areola protrude from enlargement, glandular and ductal tissue develops and fat deposits begin

87

female changes in puberty - pelvis

widens, hips become rounder/contoured from fat deposits, and becomes favorable for childbirth

88

female changes in puberty - body hair

pubic and axillary develop; becomes thicker with maturation, and varies among ethnic groups

89

female changes in puberty - growth spurt

Growth and changes begins and ends earlier than in males

90

female changes in puberty - external genitalia and reproductive organs

grow larger, vaginal mucosa changes, menstrual cycle begins

91

amenorrhea

absence of menstruation or first period has not begun

92

male puberty changes

- testes - penis - nocturnal emissions - body hair - increased muscle mass - skeletal growth - voice changes

93

male puberty changes - testes

Growth of testes (first) between 10 – 17 years of age

94

male puberty changes - penis

Penis lengthening and growth begins about 1 year after testicular growth begins

95

male puberty changes - nocturnal emissions

“wet dreams” common in adolescence, often during dreams of sexual content

96

male puberty changes - body hair

○ pubic hair begins at base of penis, axillary hair growth begins in about 2 years, facial changes from fine downy texture to the male beard, increased growth of chest and back hair. Amounts of hair growth varies in ethnic groups.

97

male puberty changes - increased muscle mass

cause by testosterone (50% more than female at maturity)

98

male puberty changes - skeletal growth

longer growth spurts than girls resulting in great height

99

male puberty changes - voice changes

caused by enlargement of the larynx and hypertrophy of the laryngeal mucosa

100

spermatogenesis

formation of male gametes (sperm) in the testes

101

climacteric

woman's ability to reproduce decreases over a period of years; physical/emotional changes that occur at the end of the reproductive period

102

perimenopause

the time from onset of symptoms associated with climacteric until at least 1 year after the last menstrual period

103

female reproductive anatomy

- mons pubis - Labia majora and minora - clitoris - vestibule - external vulva - hymen - perineum

104

mons pubis

- Protection, soft cushion over pubic, protect fetus

105

clitoris

Sexual pleasure

106

Vestibule

- structures enclosed by labia minora - urinary meatus - vaginal introitus - ducts of skene - bartholin glands

107

External “vulva”

- mons pubis - labia majora - labia minora - clitoris - vestibule

108

hymen

- thin fold of mucosa partially separating the vagina from the vestibule - should be there until 4, 5 or 6 years old - might be asked if hymen is intact if sexual abuse is suspected

109

Perineum

- fibrous and muscular tissue supporting the pelvic structures - distal portion of vulva to the superior part of rectum - below vaginal opening to opening of rectum

110

female reproductive anatomy - internal

- vagina

- uterus

- fallopian tubes

- ovaris

- cervix

111

uterus

  • Should not have a septum

112

Bicornate uterus

- septum down middle of uterus

113

fallopian tubes

might have more than two

pathway between ovary and uterus

114

oviduct

fallopian tube

115

cilia

hairlike process that beat rhythmically toward the uterus to propel ovum through the tube

116

fallopian tubes - division

  • interstial
  • isthmus
  • ampulla
  • infundibulum

117

fallopian tube - interstitial

runs into the uterine cavity and lies within the uterine wall

118

fallopian tube - isthmus

narrow part of the tube adjacent to the uterus

119

fallopian tube - ampulla

wider area of the tube lateral to the isthmus, where fertilization occurs

120

fallopian tube - infundibulum

-shaped terminal end of the wide funnel-shaped

121

ovaries

  • Produce estrogen and progesterone
  • Produce an ovum with each cycle
  • FSH is released (develops ovum) and LH continues process, egg released by ovary, into fallopian tube and brought into uterus

 

122

dysfunctional cycle

ovum is not release

123

cervix

  • External os
  • Cervical canal
  • Internal os

124

external os

  • opening of cervix
  • papsmear should not be done here

125

where should papsmear be done?

cervical canal

126

Endometrial biopsy

  • catheter has to go through internal os and be in uterus
  • this procedure may hurt

127

internal os

  • sterile
  • tight opening
  • will feel more resistance here when inserting cath
  • opening to uterus

128

where is iud placed?

  • uterus
  • string should protrude from external os
  • can wander but that is not common

129

Round and broad ligament

  • no problems in non-pregnant
  • pregnant get intense pains in abdomen when sit/stand, usually towards end of pregnancy
  • may come in thinking they are in labor but if everything is ok it is probably the round/broad ligament

130

does the uterus lay on the bladder?

yes

131

why do women get urinary infection?

  • Short distance between meatus and anus is why women get urinary tract infection
  • Bacteria in GI tract

132

do you see urinary tract infection in men?

  • not usually in men under 50 yrs
  • more common in men over 50 yrs but is a sign of concern

133

what does a urinary tract infection in a man signify?

  • usually something more serious
  • have add'l tests
  • could be a sign of bladder or prostrate cancer

134

support structures of female reproductive organs

  • pelvis
  • muscles
  • ligaments
  • blood supply
  • nerve supply

135

female breast

  • nipple
  • areola
  • montgomery tubercle
  • alveoli

136

nipple

small raised area at center of breast

137

Areola

circular area around nipple

138

Montgomery tubercle

  • small raised areas in areola
  • Keeps nipple soft
  • Secrete in women if they are going to nurse

139

 Alveoli 

secreting cells/produce milk

140

what is the most common length of the female reproductive cycle?

28 days

141

what two things happen at the same time during the reproductive cycle?

ovarian and endometrial cycles

142

what directly influences the endometrial cycle to happen?

ovarian cycle

143

will the endometrial cycle have a dysfunction if the ovarian cycle does?

yes

144

Corpus luteum

 is the place on ovary where that particular ovum is growing; job to secrete high amount of progesterone, if conceived need high levels of progesterone to make pregnancy successful; if conception doesn’t occur the corpus luteum decreases secretion of progesterone

145

what are the phases of the ovarian cycle?

  • Follicular phase
  • Ovulatory phase
  • Luteal phase

146

Follicular phase

  • Days 1 - 14
  • Decrease in estrogen and progesterone just before menstruation stimulates FSH and LH
  • One follicle matures first

147

ovulatory phase

  • 2 days before ovulation
  • FSH and LH rise, slight decrease in estrogen, progesterone increase
  • Ovulation occurs could be anywhere between 12 – 15 days; usually day 13 & 14
  • Release of mature ovum

148

why is there a change in cervical mucus during ovulatory phase?

helps sperm get to where it needs to be

149

Luteal phase

  • from ovulation to end of cycle
  • single most important phase
  • corpus luteum
  • need it to last 13/14 days

 

 

150

corpus luteum

  • is the place on ovary where that particular ovum grew and was release
  • the left over/collapsed follicle remains and secretes high amount of progesterone
  • if conception occurs need high levels of progesterone to make pregnancy successful
  • if conception doesn’t occur the corpus luteum decreases secretion of progesterone

151

what happens if luteal phase is only 9 days long?

ovum gets to uterus too early

152

what happens is luteal phase lasts 17/18 days?

endometrial phase has started to slough

153

why may progesterone shots be given during ovarian cycle - luteal phase?

to support possible pregnancy

154

why would you give cholmid?

shorten luteal phase

155

what are the phases of the endometrial cycle?

  • Proliferative phase
  • Secretory phase
  • Menstrual phase

156

Proliferative phase

  • Days 1-14
  • Ovum is now matured and secretes estrogen
  • Rebuild, becomes thicker, prepare for conception

157

  1. Secretory phase

  • Near the end of ovulation phase; second half of ovarian cycle
  • Increase of estrogen and progesterone from corpus luteum
  • Progesterone stimulates enrichment of endometrium, very thick and nourished
  • Strong enough to hold product of conception

158

Menstrual phase

  • No conception leads to menstrual phase
  • Necrotic areas of endometrium begin to separate from basal layers resulting in menstruation
  • Blends into early start of next phase

159

how long does menstruation last?

typically 5 days

160

is it possible to conceive during menstruation?

yes; this shows that conception not the problem but the length of the cycles are

161

external male reproductive organs

  • penis
  • testes

162

penis

  • delivers sperm to sperm to vagina
  • carries urine from bladder to exterior during urination
  •  

163

Scrotum

holds testicles

164

will heat applied to scrotum kill sperm?

yes

165

internal male reproductive organs

  • testes
  • Epididymis/Vas deferens
  • 3 glands - Seminal vesicles, prostate, bulbourethral

166

testes

  • produces sperm
  • billions of sperm are made each day

 

 

167

epididymis

  • Sperm travel from the seminiferous tubules to the epididymis via the rete testis
  • storage and final maturation of sperm
  • Contains smooth muscle
  • Empties into vas deferens then into pelvis to penis

 

168

vas deferens

  • epididymus empties int vans deferens
  • lareger # of sperm are stored here then the epididymis
  • lead to pelvis where it joins the ejactulatory duct

169

3 glands of male reproductive organs

  • Seminal vesicles, prostate, bulbourethral glands
  • Active in mfg of sperm
  • Add something to semen to make sperm conducive for conception

170

Prostrate gland

  • Starts to get bigger as you age
  • Hard to urinate
  • Urinary tract infections start to occur

171

STD - men

  • start infection in urethra
  • urethritis
  • infection may continue to extend along urethra

172

do you use heat to treat std?

no; heat on scrotum can cause infertility

173

circumsision

  • Remove foreskin of penis
  • Personal choice made by parents
  • Don’t advocate one way over the other

174

parts of penis

Root, shaft, and glans penis

175

Prepuce

foreskin that covers the glans penis

176

what is the function of seminal vesicles, prostrate, and bulbourethral glands?

  •  nourish sperm
  • transport sperm 
  • protect sperm
  • enhance sperm motility

177

health promotion tests for females

  • Breast Self-Exam (BSE)
  • Clinical Breast Exam (CBE)
  • Mammography
  • Vulvular Self-Exam
  • Pelvic Exam
  • Pap Test

178

Breast Self-Exam (BSE)

  • Most lumps are found by partner
  • Recommendations differ between agencies
  • Should be done monthly

179

Clinical Breast Exam (CBE)

  • Depends on your history
  • Frequencey varies

180

Mammography

  • Baseline at 40 yr
  • Every few years after that
  • 45 to 50 - eavery year

181

Vulvular Self-Exam

  • Look for lesions or sores
  • Vulvular cancer is rare but requires radical surgery

182

Pap Test

  • depends on history
  • 2 to every 3 years

183

Health Promotion Tests for Males

  • Breast Self-Exam (BSE)
  • Clinical Breast Exam (CBE)
  • Testicular Self-Exam (TSE)
  • Clinical Testicular Exam
  • Prostate Exam
  • PSA blood test

184

Breast Self-Exam (BSE) - men

  • 10% of breast cancers are in men
  • Should be done monthly

185

Clinical Breast Exam (CBE) - male

Yearly to every three years

186

Testicular Self-Exam (TSE)

  • Should be done monthly
  • 15 to 30 years old - highest incidence of testicular cancer
  • Feeling should be smooth, same shape; round, slide between fingers without feeling anything that is rough tender or firm

187

Clinical Testicular Exam

once per year

188

Prostate Exam

  • Base at 40 years
  • Yearly at age 50

189

PSA blood test

  • Screening for prostrate cancer
  • Becomes elevated when there is cancer
  • PSA is normal no reason to do biopsy
  • PSA is elevated reason to do biopsy
  • Self test is good for man who will follow up on positive results

190

Family Planning

choosing the time to have children

191

Fertility

  • capable of bearing offspring
  • 90% of women who do not use contraceptive should conceive within one year

192

Infertility

  • not able to get pregnant for one year
  • will look at infertility in couples that are older sooner

193

Primary infertility

has never conceived together

194

Secondary infertility

 conceived at least one time before 

195

What is the nurses role in family planning or contraceptive care?

  • Teacher, educator, advocate, listener
  • No right to give advice

196

Informed consent

Educate

197

What do you need to think about when choosing a contraceptive method?

  • Safety
  • Sexually Transmissible Diseases
  • Effectiveness
  • Acceptability
  • Convenience
  • Education needed
  • Side effects
  • Benefits
  • Spontaneity
  • Availability
  • Expense
  • Preference
  • Religion/Personal Belief
  • Culture

 

198

contraceptive method - safety

based on current medical condition and family history

199

contraceptive method - STDs

abstinence, condom; iud increases std

200

contraceptive method - effectiveness

is it ok to get pregnant

201

contraceptive method - acceptability

religion, cultural, their feelings

202

contraceptive method - education needed

difference in talking with age levels

203

contraceptive method - Convenience

  • if it is percceivedto be difficult to use there is less compliance
  • desired to avoid menstruation

204

contraceptive methods - side effects

what can they tolerate

205

how many high school students report being sexually active?

50%

206

adolescent preganancy often occurs from...

  • Knowledge/Misinformation
  • Risk-Taking Behavior

207

how would you counsel adolescents about sexuality?

be nonjudgemental

208

are perimenopausal women able to get pregnant?

yes

209

perimenopause

one year prior to menopause

210

menopause

after 12 consectutive months of not having a period

211

can ovulation continue through perimenopause and menopause?

yes

212

perimenopausal women are less likely to conceive but more likely to...

experience an unintended pregnancy

213

Said to be safe from pregnancy if no menses for...

at least two years in the menopausal woman

214

Methods of Contraception

  • Sterilization
  • Hormonal Contraceptives
  • Intrauterine devices
  • Barrier methods
  • Natural Family Planning Methods

215

sterilization

  • 99% effective
  • Female=Tubal ligation
  • Male=Vasectomy

216

Male=Vasectomy

  • semen sample – need to be zero sperm (6wks/18 ejaculations)
  • use back up until no sperm in semen

217

Female=Tubal ligation

use contraceptive for one month

218

Hormonal Contraceptives

  • effective as user
  • 97-99% effective
  • Don’t like weight gain, nausea, trial and error with dosing
  • Not made for women over 35 and those who smoke

219

types of hormonal contraceptives

  • Hormone implant - norplant
  • Hormone injections - Depo provera
  • Oral contraceptives
  • Transdermal Patch
  • Vaginal Ring
  • Postcoital emergency contraceptives

220

Intrauterine devices

  • not the best choice for someone who has never been pregnant
  • in a non-pregnant cervix, trouble putting them in, may puncture cervical canal
  • post-partum mom must be 6 wk, no problem with nursing

221

types of barrier methods

chemical and mechanical

222

is the barrier method good for women over 35 years?

yes

223

Chemical barriers - barrier method

  • foam, gels, creams
  • effectiveness 80-85%
  • effectiveness with use of condom 99%

224

Mechanical barriers - barrier method

  • condom
  • diaphragm
  • cervical cap

225

Diaphragm - mechanical barrier

  • sized to fit, used with spermicide
  • If female gain/lose weight need to be refitted
  • check for holes, new one every year
  • in place 6 to 8 hours

226

Cervical cap - mechanical barrier

  • smaller than diaphragm
  • in place 6 to 8 hours

227

Natural Family Planning Methods

  • Calendar
  • Basal Body Temperature
  • Cervical Mucus/Ovulation
  • Symptothermal Method

228

why would someone use natural family planning?

  • not invasive
  • learn to ready your body

229

Calendar - natutal family planning

  • plot out dates
  • avoid intercourse on days your think ovulation occurs
  • sperm lives for 72 hours

230

Basal Body Temperature - natural family planning

  • take temp everyday
  • first part of phase temp is about the same each day; close to ovulation see a significant drop and then a rise (at least one degree) at ovulation/not a safe time for intercourse; and then the temp stays the same

231

Cervical Mucus/Ovulation - natural family planning

stretchy and thin ovulation is close/occurring

232

Symptothermal Method - natural family planning

combine Calendar, Basal Body Temperature and Cervical Mucus/Ovulation

233

what are other methods of contraception?

  • Abstinence
  • Breastfeeding
  • Coitus Interruptus

234

Breastfeeding - contraceptive method

  • most don’t ovulate but never know when you will ovulate
  • do not use as protection

235

Coitus Interruptus - contraceptive method

  • Withdrawal
  • 80% effective

236

infertility factors in men

  • Sperm abnormalities
  • Abnormal erections
  • Abnormal ejaculation
  • Abnormal seminal fluid

 

237

Sperm abnormalities - infertility factor

  • Abnormal sperm might be a sign of a genetic disorders
  • Double heads/tails
  • Disfigured
  • Slow activity, low #

238

where would you refer a male with low # of sperm but everything else was fine?

endocrine

239

where would you refer a male with low # and slow activity of sperm?

urology

240

Abnormal erections - infertility factor

  • Impotence
  • Peryronie's
  • Vericocele
  • Spermatocele

241

Peryronie's

scar tissue along length of penis, painful

242

Vericocele

varicose veins in scrotum, changes temp and destroys sperm

243

Spermatocele

cyst near at the head of epididymis

244

Abnormal ejaculation - infertility factor in men

  • Hypospadius
  • Epispadius
  • May have normal sperm count but it doesn't  get where it needs to

245

Hypospadius

opening under side of penis

246

Epispadius

opening on top of penis

247

Abnormal seminal fluid - infertility factor in men

  • Cloudy, clumps, made consistency different
  • WBC - infection - treat to see if it can be cleared up; can take up to a few mos to treat

248

where might you refer someone who has cloudy, clumpy, or abnormal consistency of seminal fluid?

urology

249

infertility factors - women

  • Ovulation disorders
  • Abnormalities of fallopian tubes
  • Cervical abnormalities
  • Repeated pregnancy loss
  • Infections

250

Ovulation disorders - infertility factor in women

  • Has partial or no female organs - confirm with ultra sound
  • Majority are just poor ovulation patterns

251

how long would you take basal body temp for to help diagnose ovulation disorders?

3 months

252

ovulation disorders - treatment

  • Clomid
  • Pergenol
  • Depo provera or progesterone (oral or IM

253

Clomid

force to ovulate; make cycle more regular, DR needs to look at cycle, force to ovulate, side effect - possibility of multiple birth - typically twins; warm, acne

254

Pergenol

higher incidence of mult. Births - triplets, quads, quints  etc….; if you use these meds are you ok with mult. births

255

Depo provera or progesterone (oral or IM)

may use to induce period in order to give clomid on a certain day

256

Abnormalities of fallopian tubes - infertily factor in women

  • Ovulates ok, partner ok
  • Are they there, are they open
  • Blocked tubes, evaluate to see if it is possible to open them

257

Hysterosalpinogram

  • air or dye through to see if tubes are open
  • sometimes this opens tubes

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what is a possible treatment for abnormal fallopian tubes?

  • Invitro
  • if tubes are block and ovulate is ok and partner is ok
  • just cant get ovum to go down the tube

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Cervical abnormalities - infertility factor in women

  • Multiple cervix, can be common to have up to 3, only one goes somewhere others are "blind"
  • Excessive/lack of mucus - mucus helps sperm get where they need to be, might be allergy related

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Post coital test

  • Plan to have intercourse no later than 2 hours before appt
  • Physician put speculum in, will gather fluid from vaginal vault and look at slide
  • If  sperm is dead; it means she has hostile cervix/mucus
  • Antihistamines may help - UCLA research study

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what are possible ways to treat cervical abnormalities?

  • Be supportive and help patients through process
  • Artificial insemination
  • Cervical stenosis

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why would artifical insemination be a good treatment for an abnormal cervix?

  • use partners semen and deliver it to the right place
  • man brings in semen sample
  • take semen and inject it into women

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Cervical stenosis

  • Significant menstrual cramps
  • Very small opening of cervix
  • Dilate cervix to get it large enough to allow sperm through

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Repeated pregnancy loss - infertility factor in women

  • Habitual abortion
  • Incompetent cervix
  • DES
  • Fibroids
  • Endocrine abnormalities
  • Immune
  • Exposure to toxin

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Habitual abortion

3 or more miscarriages

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why would you save fetal tissue from miscarriage?

test for chromosomal abnormalities, genetic counseling

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incompetent cervix - repeated pregnancy loss

  • cervix starts to open at about 12 weeks
  • Look at length of cervix, + pregnancy test
  • go in every week, if cervix gets shorter, dr will perform cerclage (stitch up cervix)
  • depending upon how pregnancy is going will determine when stiches will be taken out

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cerclage

stitch up cervix

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DES - repeated pregnancy loss

  • drug used to treat prostrate cancer
  • gave to women in 1950s - 1960s
  • generation that was born from DES mothers, saw abnormalities in female children
  • now seeing problems in the children's children both girls/boys

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Fibroids - repeated pregnancy loss

  • benign tumors
  • starts to grow because of pregnancy hormones
  • crowds out baby

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Endocrine abnormalities - repeated pregnancy loss

endocrinology issues

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Immune - repeated pregnancy loss

  • may refer to immunologist
  • may have autoimmune disorder
  • women react to fetus - reject fetus
  • blood disorder - treat with levonex/heparin

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Exposure to toxin - repeated pregnancy loss

  • radiation
  • alcohol
  • Accutane (med for acne)
  • lead
  • mercury
  • toxic substance

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Infections - infertility issues in women

  • Chroic low grade infection
  • Endometritis

275

what is the most common cause of infertility in women?

luteal phase of ovarian cycle is too short

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Evaluation of Infertility

  • Counseling
  • History and Physical
  • Diagnostic Tests
  • Therapies

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therapies - evaluation of infertility

  • Meds
  • Ovulation induction
  • Surgical procedures
  • Therapeutic insemination
  • Egg donation
  • Surrogate parenting
  • Advanced techniques

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in-vitro fertilization (IVF)

harvest her eggs and his sperm, re-implant

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GIFT

retrieve ova and sperm in her tubes

280

ZIFT

fertilize ova outside body and implant in tube and make down to uterus

281

ICSI

fertilize 3 or more ova and implant at least 3