Chapter 9 Lecture

 

Designing Your Reproductive Plan

Reproductive Health

• In the U.S. almost half of pregnancies are unplanned.

• A woman’s reproductive life begins during fetal development and ends with menopause.

Birth Control Methods

• Birth control methods are all strategies used to keep from having a baby and include the following:
• Abstinence
• Contraceptive methods
• IUDs
• Emergency contraception
• Contraceptive choices are methods that prevent fertilization of the ovum such as:
• Hormonal methods
• Barrier methods
• Sterilization

Continuous Abstinence

• Continuous abstinence is the only sure method of birth control to prevent an unintended pregnancy or unwanted STIs
• Teenagers can be sexually intimate without risking pregnancy or STIs--outercourse
• The latest trend is showing a decline in Abstinence-only programs
• Periodic abstinence is sometimes referred to as fertility awareness
• Sexually transmitted diseases and teen pregnancy rates are at their lowest in decades
• Which works better: Comprehensive or Abstinence-Only Sexuality Education?

Fertility Awareness

Barrier Methods

• Barrier methods prevent sperm from reaching the fallopian tubes, either by physical or chemical means

• Barriers include the following:
• Spermicides
• Condoms
• Diaphragms - Soft rubber cap, must be fitted by health care professional, used with spermicide
• Cervical caps - Thimble shaped device fits over the cervix

• Barrier methods remain popular because of the protection they provide against HIV and other STIs
Hormonal Contraceptives
• Hormonal contraceptives are convenient, effective, and reversible
• However, they provide no protection against HIV and other STIs
• They are solely intended to prevent pregnancy
• The primary methods available are:
• Oral Contraceptives
• Transdermal (Skin) Patch
• Vaginal Ring
• Hormonal Injections
• Emergency Contraception
• Implants

Health Benefits of OCs

• Research suggests that Oral contraceptives provide the following benefits:
• Protection against epithelial ovarian and endometrial cancer
• Lowered risk for ectopic pregnancies and PID
• Lighter and less painful menstrual flow
• Decreases in iron deficiency anemia
Health Risks Associated with OCs
• Estrogen use is associated with the following side effects:
• Nausea
• Breast pain and soreness
• Fluid retention
• Progestin-only pills are associated with:
• Increased irregular menstrual cycles
• Vaginal bleeding
• Other risks with OCs include:
• Blood clots
• Strokes
• Changes in bone density
• Reproductive cancers

Emergency Contraception

• Postcoital contraception has been available since the early 1970s
• ECPs reduce the risk of pregnancies when taken within 72 hours of unprotected intercourse
• The sooner the regimen, the better the outcome
• Emergency contraception is available without a prescription to women over the age of 17 (and with a prescription for those under 17)
• ECPs do not induce a medical abortion or affect the developing pre-embryos or embyros

Contraindications for Hormonal Methods

• If woman is pregnant
• Active liver disease
• Heart problems
• Breast cancer
• diabetes
• Hypertension
• Migraine headaches
• Epilepsy
• History of blood clotting

Other Birth Control Methods:

Intrauterine Devices

• The WHO and the AMA have called the IUD one of the safest, most effective and least expensive reversible methods of birth control available
• The method works by preventing fertilization, by reducing the amount and ability of sperm to reach the egg
• Other forms of IUDs contain hormones, which allows the female to wear the IUD longer compared to others

Sterilization

• Vasectomy – separation of the vas deferens
• Tubal ligation – separation of the fallopian tubes
Maternal Mortality
• Maternal mortality is defined as the death of a woman while pregnant
• They are divided into direct and indirect obstetrical deaths
• Direct: account for 80% of deaths and results from complications such as incorrect treatment, labor, pregnancy, or omissions, commonly due to hemorrhage
• Indirect: result from previous existing diseases or diseases caused by the physiological complications of pregnancy e.g. anemia
• The best mechanism to prevent maternal deaths is to improve the status of women
Infant Mortality
• Infant mortality is defined as the deaths of infants under 1 year while neonatal mortality is under 28 days
• Race and education are important indicators for infant mortality
• The primary causes for neonatal and infant mortality are:
• Congenital anomalies
• Pre-term/low birth weight
• SIDS
• Respiratory Distress
• Complications of Pregnancy
Promoting Healthy Pregnancy Outcomes: Pre-Pregnancy Planning
• Non-drug use
• Nutritional planning
• Exercise
• Time lapse of one menstrual cycle between contraceptive use and conception
• Immunizations
• Folic acid supplements
• Quit smoking
• Avoid alcohol beverages
• Avoid OTC drugs
• Avoid mega-dosing on nutritional supplements
Promoting Healthy Pregnancy Outcomes: Conception
• Pregnancy begins with the union of the female egg and the male spermatozoa
• A one cell zygote is formed, containing characteristics of both parents
• The fallopian tubes provide the environment where cell division begins
• After 3 days, the fertilized ovum is transported to the uterus
• Once the chorionic villi cover the ovum, hCG (human chorionic gonadotropin) supports the endometrial growth

Promoting Healthy Pregnancy Outcomes

Twins and Multiple Births

• Blastocyst - early embryonic cells before a cell layer has formed

• Multiple births are created when a small cluster of cells that project into the cavity of a blastocyst subdivides to form two separate groups of cells.

• Fraternal offspring are no more genetically similar than siblings from different births.

Amnion

• The amnion surrounds the embryo before it starts to evolve
• The amnion cavity is a fluid filled space between the amnion and the embryo
• It keeps the fetus at an even temperature, cushions, and provides nourishment
• By the 4th month, it can be sampled (amniocentesis) for possible genetic abnormalities

Placenta

• This is formed during the 3rd month
• The function is to supply food to the fetus and connects to the fetus through the umbilical cord
• The placenta does the following tasks:
• Transfer gases and nutrients
• Excretes waste
• Transport heat
• Produces various proteins and hormones
• Brings maternal and fetal blood close together but are completely separate
Early Signs of Pregnancy
• A missed period
• A light period or spotting
• Tender, swollen breasts
• Fatigue

• Upset stomach
• Vomiting
• Feeling bloated
• Frequent urination

Fetal Development

First Trimester

• The heart begins to beat

• Bones have appeared-head, arms, fingers, legs, and toes
• The major organs and nervous systems are formed
• The placenta forms

• Hair is starting to grow

• 20 buds for future teeth have appeared

• Fetus is about 4 in. long and weighs just over 1 oz.

Second Trimester

• The fetus grows quickly from now until birth

• The organs are developing further

• Eyebrows and fingernails form

• The skin is wrinkled and covered with fine hair

• The fetus moves, kicks, sleeps and wakes, swallows, can hear, and can pass urine

• By the end of this time, the fetus is 11-14 inches long and weighs about 2-2.5 lbs.

Third Trimester

• The fetus kicks and stretches, but as it gets bigger it has less room to move

• Fine body hair disappears

• Bones harden, but bones of the head are soft and flexible for delivery
• The fetus usually settles in a good position for birth

• At 40 weeks, the fetus will be full term. It is about 20 inches long and weighs 6-9 pounds

Prenatal Care and Delivery

• Primary Care Services

• • Discussion of maternal nutritional needs, exercise, and drug use
  • Family history
  • Physical exam and exam of the reproductive organs (blood, urine, and pap tests)
  • Estimation of the due date

• Subsequent Visits

• • Physical exam, including urine test for protein and sugar
  • Fetal heartbeat, growth, and position
  • Possible ultrasound, chorionic villus sampling, maternal serum screening, amniocentesis, anon stress test, a contraction stress test and a biophysical profile

Labor and Delivery

• Braxton Hicks contractions (false labor)
• Lightening occurs
• “Water breaks” - amniotic sac ruptures
• The 3 stages of labor are:
• Uterine contractions 15-20 mins, “show,” effacement, complete dilation
• Crowning of the fetus’ head to fetal expulsion
• Placental separation and expulsion

Birthing Options

• Labor Assistants: midwives, doulas, childbirth educators

• • They can assist a low-risk pregnant mother with prenatal care, childbirth, and/or infant care
  • The majority of births are still attended by a physician and delivered in a hospital.
  • Cesarean delivery rates have increased to 32.9% in the U.S.
    Breast-feeding

 Breast-feeding and complementary feeding practices can save the lives of 1.5 million children under the age of 5 annually
• Inexpensive
• Better nutritional quality
• Ability to act as a birth control measure to limit fertility
• Reducing ovarian and premenopausal breast cancer
• Contains colostrum (initial milk produced by the mother) which helps fight infections
Potential Problems During Pregnancy
• Ectopic Pregnancy
• Tubal pregnancy
• Occurs due to narrowing of the fallopian tubes
• Can cause infertility and mortality
• Hypertensive disorders
• Preeclampsia-elevated blood pressure due to edema and/or proteinuria
• Eclampsia-same as above except it progresses to convulsions and/or coma
Infertility
• Health providers should determine the cause of having difficulty conceiving
• Primary infertility is the inability of a woman to become pregnant within a year of having unprotected intercourse
• Secondary infertility is the inability to carry the pregnancy to full term
• The most common reasons for primary infertility in women are failure to ovulate or a damaged uterus or fallopian tube while men have low sperm or abnormal counts

Assisted Reproductive Technology (ART)

• In vitro fertilization (IVF)
• GIFT (gamete intrafallopian transfer)
• ZIFT (zygote intrafallopian transfer)
• ICSI (intercytoplasmic sperm injection)

• • The majority of these procedures are IVF (75%)
  • 69% were performed on women aged 30-39
  • The remainder were common among women aged 40 years or older

• Donor eggs
• Vasovasostomy
• Epididymovasostomy
• Egg retrieval
• Artificial Insemination
• Surrogacy
• Somatic stem cells

Abortion

• 22% of women worldwide, will terminate their pregnancy by abortion. 20 million are obtained illegally.

• Abortion is defined as the spontaneous or deliberate termination of a pregnancy.
• Spontaneous (miscarriages)
• Therapeutic - procedures conducted terminate a pregnancy that threatens the life of the mother or fetus
• Voluntary (elective)

• Surgical Abortion

• • Vacuum aspiration
  • Dilation and curettage (D&C)
  • Dilation and evacuation (D&E)
• Medical Abortion
  • RU-486 or Mifepristone
  • Side effects: headaches, nausea, diarrhea, vomiting, heavy bleeding, cramping

Postabortion Issues

• A recent study found no increased risk for any mental disorder within the 12 months post-abortion period, compared with the 9 month pre-abortion period
• The majority of women feel a mixtures of feelings, with a predominance of positive feelings
Adoption
• Adoption is an alternative to assisted reproduction or abortion
• Adoptions can be “open” or “closed”
• Couples who are making the decision have a variety of issues to consider
• Services can vary from matching children and adoptive parents to educational and support services throughout the parenting years