Contraception, Abortion, and Pregnancy Symptoms

• The presentation covers contraception, abortion, and signs/symptoms of pregnancy.

Contraception

• Focuses on the intentional prevention of pregnancy
• Birth control includes devices or practices to lower the risk of conception
• Family planning involves consciously deciding when to conceive or avoid pregnancy
• There's still a risk of pregnancy with contraception

Nursing Care Management

• A multidisciplinary approach to assist women in choosing a contraceptive method is needed
• The ideal method should be safe, readily available, economical, acceptable, and simple to use
• The safety depends on the woman's medical history and needs to be considered

Contraception Methods

• Coitus interruptus is the withdrawal method
• Natural birth control methods rely on avoiding intercourse during fertile periods
• Fertility awareness methods (FAMs) combine charting the menstrual cycle with abstinence or other contraceptive methods
  • FAMs encompass natural family planning/period abstinence
  • Calendar rhythm method
  • Basal body temperature (BBT) method
  • Cervical mucus ovulation-detection method
  • Symptothermal method
  • Predictor test for ovulation
  • Lactational amenorrhea method (LAM)
• Barrier methods involves spermicides, male and female condoms (STI protection), diaphragms
  • Diaphragm requires proper fitting and poses a risk of toxic shock syndrome
  • Cervical cap requires proper fitting
  • Contraceptive sponges are a form of barrier method

Hormonal Methods

• Combined estrogen-progestin contraceptives (COCs) includes oral contraceptives and transdermal systems
  • Has potential adverse effects
  • Vaginal rings that are used for 3 weeks/1 week off
• Progestin-only contraceptives includes oral progestins (minipill) and injectable progestins (Depo Provera, administered every 3 months)

Continuous and Extended Hormonal Contraception

• Includes IUDs, and transdermal patches

Emergency Contraception

• Effective when used within 5 days of unprotected intercourse
• Options include progestin-only methods and insertion of an intrauterine device (IUD)
• IUDs are small, T-shaped devices placed in the uterine cavity
• Medicated IUDs containing copper or a progestational agent
• Offers no protection against STIs/HIV
• Highly effective with minimal side effects and is often the first choice.

Sterilization

• Sterilization is a permanent method of contraception for females and males
  • Tubal occlusion and tubal reconstruction are female sterilization methods
  • Vasectomy and tubal reconstruction are male sterilization methods

Abortion

• Abortion is defined as the intentional interruption of pregnancy before 20 weeks of gestation.
  • It can be either induced or performed due to certain indications
• Contributing factors, legal and moral issues, and nurses' rights are considerations related to abortion

Abortion Methods by Trimester

• First-trimester abortion can be performed through surgical (aspiration) abortion or through a combination of methotrexate and misoprostol.
• Second-trimester abortion can be performed through dilation and evacuation (D&E) or medical induction using prostaglandins, hypertonic, and uterotonic agents.
• Emotional considerations are a key aspect of abortion.

Preconception Care

• Includes discussion of pregnancy intention and access to care
• Use of folic acid, smoking cessation, screening, and management of STIs
• Recreational/prescription medication use and addressing mental health issues

Goals of Care

• Promoting the health of the mother, fetus, newborn, and family by promoting good health habits and minimizing risk factors
• Includes teaching healthy habits that may be continued after pregnancy
• Educating in self-care for pregnancy, developing a partnership with parents and family
• Providing physical care and preparing parents for parenthood

Terminology

• Gravida refers to a pregnant woman
• Nulligravida refers to a woman who has never been pregnant
• Primigravida refers to a woman who is pregnant for the first time
• Multigravida is a woman who has been pregnant before
• Parity (# that has reached 20 weeks) signifies the number of pregnancies that have reached 20 weeks of gestation
• Primipara refers to a woman who has given birth to her first child
• Multipara refers to a woman who has birthed 2 or more babies
• Nullipara is not given birth to a fetus over 22 weeks
• Abortion refers to a premature termination
• Gestational age indicates the age of the fetus
• Age of viability refers to the point at which a fetus is able to live outside of the uterus

GTPAL

• GTPAL is an acronym used to summarize a woman's obstetric history
  • G (Gravida): The number of all pregnancies, including the current one
  • T (Term): The number of births greater than 37 weeks' gestation
  • P (Preterm): The number of births between 20 and 37 weeks' gestation
  • A (Abortion): Any losses prior to 20 weeks' gestation, whether spontaneous or induced
  • L (Living): The number of living children the woman has

EDC/EDB: Estimated Date of Confinement/Birth

• Average pregnancy is 40 weeks (280 days) after the first day of LNMP, plus or minus 2 weeks
  • Nägele's rule involves identifying the first day of the last normal menstrual period (LNMP), counting forward 7 days, and adding 9 months
• Example questions given include how to determine EDD for a woman whose LMP began on June 7 and ended on June 12

Prenatal Care

• Intended to begin prior to pregnancy
• Aims to assist the woman in achieving optimal health before conception
• Complete history and physical exams are a component
  • Identifies problems and ensures healthy pregnancy

History

• Includes obstetrical, menstrual, and contraceptive history
• Considers any medical and surgical history, any family history, and psychosocial factors

Prenatal Appointment

• Evaluate the woman's physical health and nutritional status
• Identifies current physical/social problems and determines the estimated date of birth (EDB).

Signs of Pregnancy

• Presumptive signs includes amenorrhea (loss of menstruation), nausea, breast tenderness, fatigue and urinary frequency
• Probable signs includes Goodell's sign (softening of the cervix 4-8 weeks), Chadwick’s sign (bluish appearance of the cervix), and Hegar's sign (indentation felt in the lower uterine segment during a pelvic examination)
• Positive signs include the fetal heartbeat, fetal movement, and US examination

Fetal Ultrasound/Measurements

• 1st Trimester
  • Gestational Sac is assessed using Mean GSD
  • Yolk Sac, Nuchal Translucency is assessed
  • Corpus Luteal Cyst is detected around 2-3 cm
  • Heart Rate is assessed

Fetal Ultrasound/Measurements continued

• 2nd & 3rd Trimester
  • Lateral Ventricles < 10 mm
  • Cisterna Magna Depth is approximately 2-10 mm
  • Nuchal Fold Thickness < 6 mm
  • Heart Rate, Position is assessed
  • Renal Length, and Pelvis Diameter
  • Amniotic Fluid Index & Cervical Length is measured

Screening Tests

• Prenatal tests include ultrasounds for nuchal translucency, blood work between 11-14 weeks, a pap smear, and STI screening
• Other includes non-invasive prenatal testing (MSS) and US for fetal anatomy around 18-22 weeks

Hormones of Pregnancy

• Estrogen & Progesterone are important
  • HCG produced by chorion stimulates the corpus luteum to produce E&P
• Relaxin is a hormone that causes the connective tissue of the symphysis pubis to become moveable and softens the cervix
• Prolactin prepares breasts for lactation
• Oxytocin, released, contracts the uterus for labor and after to minimize bleeding
  • It stimulates the milk ejection reflex during breastfeeding
• A case study is presented regarding a woman's reproductive history and questions related to contraception, pregnancy, and hormones