Contraceptive Methods and Ovulation

Diaphragm

• Dome-shaped barrier placed over the cervix to prevent sperm passage
• Should remain in place for 6 hours after intercourse; left in for 24 hours may cause toxic shock syndrome
• Spermicide increases effectiveness
• Replaced every two years
• Refits needed after 15-20 pound weight fluctuation, childbirth or abdominal surgery
• Not recommended for clients with a history of toxic shock, cystocele, UTIs, or uterine prolapse

Combined Oral Contraceptives

• Hormonal contraception containing estrogen and progestin, suppressing ovulation, and thickening cervical mucus to block semen
• Prevents implantation
• Monitor for complications (chest pain, shortness of breath, leg pain, headache, vision changes, hypertension)
• Not recommended for clients with thromboembolic disorders, smokers, or hypertension

Ovulation

• Determining fertile days by tracking menstrual cycle to estimate ovulation time, which occurs approximately 14 days before the next menstrual period
• Cervical mucus is thin, slippery, and stretchable during the fertile period

Placenta Function

• Transports nutrients and oxygen to the fetus.
• Filters waste, and acts as a barrier to certain toxins and substances like insulin.
• Attached to the baby by the umbilical cord (2 arteries, 1 vein)
• Secretes hormones:
  • hCG: Detected in maternal blood/urine as early as the first missed period, shortly after implantation
  • Progesterone: Maintains endometrial lining of uterus during pregnancy
  • Estrogen: Contributes to mammary gland development for lactation
  • Human placental lactogen: Regulates maternal glucose, protein, and fat levels for fetal use
  • Oxytocin & prostaglandin: Secreted later in pregnancy to facilitate labor

Nagele's Rule

• Calculating estimated delivery date
• Using the first day of the last menstrual cycle, subtract three months, add seven days, and potentially add a year

Amniocentesis

• Aspiration of amniotic fluid from the pregnant uterus for examination
• Empty bladder before procedure
• RhoGAM administration if mother is Rh-negative
• Lecithin/Sphingomyelin (L/S) ratio (2:1) primary for fetal lung maturity

Nonstress Test (NST)

• Noninvasive method to assess fetal well-being
• Measures fetal heart rate response to fetal movement
• Reactive NST: FHR accelerates at least 15 bpm above baseline for at least 15 seconds, occurring two or more times in 20 minutes
• If baby hasn’t moved, offer mom a drink/snack and activity

Reproductive System Changes

• Amenorrhea and breast tenderness are initial presumptive signs
• Probable signs include cervical changes:
  • Hegar's sign – softening and compressibility of lower uterus
  • Chadwick's sign – deepened violet-bluish color of cervix and vaginal mucosa
  • Goodell's sign – softening of cervical tip
• Fetal movement (quickening) begins around 16-20 weeks

Cardiovascular Changes

• Cardiac output increases 25-50%
• Blood volume increases 25-30%
• Impaired blood return from lower extremities can lead to edema
• Management includes increased rest, leg elevation, limited sodium, and increased fluid intake (12 cups of water daily)

Prenatal Care

Exercise During Pregnancy

• Recommended 3x per week, 30 minutes each session
• Warm-up (5 minutes), active phase (20 minutes), cool-down (5 minutes)
• Consume protein and complex carbohydrates 15 minutes before exercise
• Stay hydrated before and after exercise

Teratogenic Drugs

• Most drugs cross the placenta
• Avoid any unprescribed drug or supplement during pregnancy
• Risk-benefit analysis for any drug use during pregnancy

Preliminary Signs of Labor

• Lightening (fetal descent into pelvis) occurs approximately 10-14 days before labor
• Cervical ripening (internal sign); indicates imminent labor
• Cervical ripening due to prostaglandin release
• Medication (Cervidil, Cytotec) or manual ripening possible

Nutrition During Pregnancy

• Average recommended daily calories for childbearing age are 2,200, increase by 300 daily during pregnancy
• Should gain 25-35 pounds throughout the pregnancy
• BMI 25-29.5 target: 15-25 pounds
• Foods to avoid: raw fish, predatory fish, undercooked meat, lunch meats, hot dogs, soft cheeses, caffeine, and alcohol

Stages of Labor

• Engagement: Presenting part (fetal head) passes the pelvic inlet at the level of the ischial spines (station 0)
• Station: Relationship of presenting part to ischial spines
• Crowning around +4 station

Leopold Maneuvers

• Systematic method to determine fetal lie, presentation, position, engagement
• Have client empty bladder

Pain Relief During Labor

• Nonpharmacological:
  • Reflexology
  • Effleurage (light stroking of abdomen)
  • Sacral counterpressure
• Pharmacological:
  • Intravenous narcotics (latent labor)
  • Epidural anesthesia (active labor); preferable for certain medical conditions like heart disease, pulmonary disease, diabetes, gestational hypertension
  • Local anesthesia (third stage labor, lacerations)

Psychological Adaptation (During Pregnancy)

Heat Loss in Newborns

• Conduction, convection, radiation, evaporation cause heat loss in newborns
• Premature or low birth weight infants at increased risk due to lack of body fat
• Cannot shiver to generate heat

Infant Cardiac and Respiratory Adaptations

• Normal heart rate: 100-160 bpm
• Normal respiratory rate: 30-60 breaths/minute
• Functional murmurs reflect closing foramen ovale and/or ductus arteriosus

Infant Reflexes

• Moro: Extension and abduction of arms following head drop
• Babinski: Fanning of toes after stroking sole of foot
• Rooting: Turning toward stroked cheek

Fontanel and Head Assessment

• Fontanels should be soft and flat; depression = dehydration; bulging = increased intracranial pressure
• Anterior fontanel closes 12-18 months
• Posterior fontanel closes 8 weeks
• Cephalohematoma: Blood collection between periosteum and skull
• Caput succedaneum: Scalp swelling due to pressure during labor
• Molding: Temporary shape change

Hypoglycemia in Newborns

• Few symptoms; assessed with heel capillary blood sample
• Transitional hypoglycemia usually resolves within 48 hours
• Serum glucose <40 mg/dL (symptomatic); <45 mg/dL (asymptomatic) -Symptoms: jitteriness, lethargy, seizures

Breastfeeding

• Optimal nutrition source for newborns, promotes bonding
• Recommended for first 6 months
• Feed every 2-3 hours, monitor weight gain, urination, and rest
• Colostrum (days 1-3), Mature milk (days 4-10)
• Maternal benefits: uterine involution, potential cancer protection, faster weight loss, convenience
• Infant benefits: Lactoferrin, lysozyme, interferon, reduced obesity risk

Diabetes Mellitus in Pregnancy

• Gestational diabetes: Impaired glucose tolerance during pregnancy
• Management: Diet control, oral glycemic agents (glyburide/metformin), insulin (as needed)
• Exercise improves glucose regulation
• Carbohydrate intake limited to 50% calories
• Fetal risks: Hypoglycemia, macrosomia, electrolyte imbalance, birth trauma, congenital anomalies
• Maternal risks: Infections, hydramnios, ketoacidosis, glucose irregularities

Heart Disease in Pregnancy

• Varying effects depending on disease
• Rest periods (2-3 30 minute rest periods), left lateral recumbent position, elevated bedhead to prevent supine hypotension and stress

RhoGAM

• Used for Rh incompatibility
• Administrated at 28 weeks and within 72 hours of delivery (if Rh-positive baby)
• Give RhoGAM anytime fetal and maternal blood may mix

Preterm Labor

• Labor before 37 weeks
• Potential significant infant health risks
• Terbutaline (beta-adrenergic agonist) tocolytic to relax uterine muscles; risk of tachycardia (hold dose for HR >120)

This quiz covers essential information about various contraceptive methods, including diaphragms and combined oral contraceptives, along with ovulation tracking. It highlights usage guidelines, effectiveness, and contraindications for these methods. Test your knowledge of reproductive health and contraception!