Care Of Mother And Child And Adolescent PDF

CARE OF MOTHER AND CHILD AND ADOLESCENT PRELIMS - BSN 24| FARA | (NCMA217) laydig’s cell = producing fructose that helps MALE REPRODUCTIVE ANATOMY the sperm cells to survive composed of:...

CARE OF MOTHER AND CHILD AND ADOLESCENT PRELIMS - BSN 24| FARA | (NCMA217) laydig’s cell = producing fructose that helps MALE REPRODUCTIVE ANATOMY the sperm cells to survive composed of: ○ internal and external parts epididymis EXTERNAL storage room for growth and maturation of the sperms penis 64 to 75 days to mature seminal fluid = fluid that lubricate the sperms organ of copulation (sexual intercourse / diff structure that produce seminal fluid coitus) ○ epididymis (producing 5% seminal not highly muscular, marami shang fluid) ligaments ○ cowper's gland (producing 5% seminal fluid) ○ prostate gland (60% producing NOTES seminal fluid) ○ seminal vesicle (30%) corpora cavernosa male producer of seminal fluid = prostate corpus spongiosum - came from the word gland sponge. capable of absorbing the blood. clear fluid = pre cum/ pre ejaculatory fluid nagkakaroon ng penile erection bcs of the withdrawal is not a good form of blood rush contraception (coitus interruptus) nasustain ung erection bcs of penile vein pag nag tapos ung orgasm baba na ung sexual stimulation then marereverse and vas deferens babalik ung artery sa normal size extension of corpus spongiosum = glans ampula penis glans penis = sit of sexual excitement for seminal vesicle male corpus spongiusum na nasa loob non - urethra ejaculatory duct male urethra - 5 to 9 inches, average of 7 nagpupush ng sperm male urethra = dual function. elimination, lubricate and reproduction (semen and urine) female urethra = 1 to 3. shorter urethra urethra which is why prone to uti organs connected to the urethra average length of fully length erect penis is ○ urinary bladder to 4 to 5 inches ○ ejaculatory duct ○ prostate gland ○ cowper's gland scrotum not even scrotal sock (merong rugae/folds) NOTES newborn has darker scrotum sa loob nito merong testes, inside the testes need mag push ung semen para hindi mag merong sperm stay ng matagal sa acidic vaginal canal; hit sensitive ang sperm cells acidic ang vaginal canal bcs of doderleine body temp mas mataas kesa sa scrotal temp bacilli (lactic acid) = pH 4-5, INTERNAL REPRODUCTIVE dept of vaginal canal is 3 to 4 inches when the woman is sexual stimulated, the cervix of girl is naiistretch which is why testes vaginal canal ay humahaba pa male gonad sex gland produce sex hormones = testosterone (to produce sex cells / gamete) male gamete = sperm spermatogenesis (process) = happens in testes spermatogenesis occur = seminiferous tubule = where sperm cells produce FRAVENTIJADO | 24 - BSN | 1  y (androsperm- small head, long tail, fast moving, non acid resistant) ○ mother 1 egg 23 chromosomes 22 autosomes 1 sex c x chromosomes ○ after fertilization nag pair na how many pair of chromosomes = 23 pair ○ how many pieces chromosomes = 46 pieces para magkaron ng twins NORMAL SPERM ANALYSIS RESULT ○ identical ml semen / ejaculation (semen = combination nagkaron ng union ung and seminal fluid) sperm and egg (fertilization) ○ 3-5 ml normal tawag na ay zygote -> will ○ pag marami, its not the sperm cells become partially divided cell but seminal fluid (cleavage) sperm count / ml if ung cleavage nagkaron ng ○ 20M-150 M rapid cell division -> split into ○ what is the minimum sperm count = two -> twins (monozygotic) 20M per ml (identical- same girl, same low sperm count mas boy) mababa sa 20 = oligospermia ○ fraternal aspermia = totally zero nag release ng egg -> kinuha clomid = increases sperm ng fibrae -> na fertilize -> production dizygotic twins (pedeng nd sperm count / ejaculation mag kamukha) ○ 400 M VASECTOMY ○ not all alive ung lahat sa 400M vasectomy - ligating or cutting the vas ○ 30% = 120M normal morphology deferens. vas deferens lang ginalaw ○ its possible na bad morphology ang After vasectomy will he continue to have an pumasok sa girl kaya namamatay erection? yes ○ 50% viability = 200 M will he continue to produce sperm? yes ○ motility 50% = 100 M ejaculation? yes pero seminal fluid nalang lifespan protection for pregnancy for the wife = yes ○ 3-5 days / 72 hrs protection for STD = no ○ saan buhay ang sperm after duration = permanent ejaculation = nasa fallopian tube ng can undergo reconstructive surgery = pede babae magkaron ng scar formation sa loob -> lumen ○ 90 secs pasok na sa matres ni liliit -> apektado sperm count -> low sperm mommy within 5 mins nasa loob na count in spite producing normal sperm count ng fallopian tube after vasectomy they need to use condom for ○ pede mabuntis kahit 5 days ago if 2 months aabot ng ovulation ○ pede mag release ng 30-40 pH ejaculation para mas mabilis (sperm ○ level = 7-8 count should be zero) (2 consecutive morphology 0 sperm count) ○ 30% FEMALE REPRODUCTIVE motility: ○ 50 EXTERNAL viability ○ 50 vulva Mons veneris/ mons pubis who determines the gender of the baby ○ thick tissue ○ father bcs of the x and the y ○ protects the pubic bone ○ father labia majora 23 chromosomes labia minora 1 sperm vestibule 22 autosomes ○ how many obvious openings can be 1 sex c found in the vestibule x (gymnosperm - big head, urethra meatus long tail, contains more vaginal opening alkaline, slow moving, acid clitoris resistant) ○ sensitive tissue ○ female landmark for correct catheterization fourchette FRAVENTIJADO | 24 - BSN | 2  perineum fundus area = makakapal na myo ○ episiotomy - cutting of the perineum upper uterine segment of the woman. (mga nanganganak) MYOMETRIUM OF THE FUNDUS (controlled wound) (to prevent LOCATED UNDER THE UPPER laceration UTERINE SEGMENT = malalakas na medial - straight contraction so they are pushing the can lead to fecal baby pababa contamination chodwick's sign - discoloration, mediolateral - diagonal, more bluish of vaginal mucosa preferred by the doctors goodell's sign - softening of the ○ lacerations - it is a wound, wound cervix edges are jagged. blood lumalabas hegar’s sign - softening of the ○ may nerve endings, pag napress ng isthmus baby yan macocompress (magiging (CHINESE GENERAL HOSPITAL) numb) (providing natural anesthesia) bkt mahina contraction sa baba? kasi manipis, para mag obliterate sha relaxation technique EVALUATING THE UTERINE INCREMENT (relaxation/interval) -> ACME CONTRACTION = PALPATION (contraction) -> DECREMENT (relaxation) surface of the fingers = more increment sensitive bcs of nerve endings ○ start of contraction ○ surface of the fingers acme duration = from increment of the 1st ○ peak of contraction and decrement of the same ○ doctor performs the cut contraction DECREMENT interval = from the decrement of the ○ end of contraction first to the increment of the second contraction * uterus is contracting, the baby is pushing downward frequency - from the increment of * ulo will compress the perineal area the 1st to the increment of the second contraction INTERNAL computation ○ duration = should be in seconds vaginal canal decrement - ○ depth - 3 to 4 inches increment = duration ○ rugae ○ frequency and interval = ○ normal flora - duoderlein bacilli minutes and seconds (produce lactic acid) (4-5 acidic) ○ interval formula ○ organ of copulation increment of the 2nd ○ birth canal - decrement of 1st ○ passageway of menstrual discharge ○ frequency formula increment of the 2nd uterus - the increment of 1st hollow muscular organ 2. site of implantation dimensions: (walang laman) endometrium ○ 3” long the site of implantation is the site of ○ 2” wide placental development ○ 1” thick ○ kung san na implant dun ○ 50-60 grams mag ggrow ung placenta 3 LAYER OF UTERUS placenta = upper uterine segment, ○ perimetrium endo ○ myometrium - thickest layer placental accreta = permanently (muscular layer) attach in the uterus ○ endometrium hysterectomy = removal of the uterus PARTS placenta previa = nasa baba ung ○ fundus - upper portion placenta, placenta is obstructing a ○ corpus - comprises uterine cavity birth canal. ○ isthmus - lower segment ○ pag humilab ang fundus, the ○ cervix - opening/ mouth (kwelyo ng uterus is pushing the baby matres) down and the mother SUGEMENT continues to bleed ○ upper uterine segment 3. Organ of menstruation ○ lower uterine segment 4. House and nourishes the POC (products of conception) FUNCTIONS cervix = malambot during pregnancy 1. aids in labor and delivery = uterine ○ PARTS contraction internal os - undergoing origin of uterine contraction - cervical effacement myometrium FRAVENTIJADO | 24 - BSN | 3  cervical canal - mucus, inner (narrowest) thicken, mucus plug ○ isthmus (operculum). it acts as a seal middle layer external os - cervical dilation site of bilateral tubal ligation ○ operculum natatanggal pag umano pinaka delikadong pregnancy na ung water ○ ampulla ○ effacement - pag nipis of internal os widest part percentage measurement = common site of fertilization 100 percent most common site of ectopic ○ dilatation - widening/ opening pregnancy external ○ infundibulum = not popular) 10 cm - full ectopic pregnancy HOW SOFT? ruptured tubal preg ○ non pregnant - tip of ur nose interstitial ○ early preg - earlobe ampullary pregnancy ○ late preg - lips, butter interstitial mas maraming blood DURATION OF LABOR AND DELIVERY FUNCTIONS primer = 12 - 16 hr 1. site of fertilization multipara = 6 - 8 hr 2. site of surgical sterilization for female BTL goodell’s sign 3. transport the fertilized egg from fallopian primer -> CE -> CD tube to the uterus multi -> CD -> CE/ CD / CE fertilized egg remain in fallopian tube = 3-4 days, increase of estrogen POSITION OF NON PREGNANT UTERUS (estrogen will encourages anteverted position = slightly leaning construction) forward ung cilia gagalaw -> fertilized egg will anteflexion position (abn) = kala ng bladder move (inwards) -> 3-4 days to reach weight ng uterus ay weight ng urine kaya ihi the uterus ng ihi ung mother also called as urinary implantation will happen how many frequency days after fertilization? 6-8 days 2 months pregnant anteverted average of 7 days present during 1st trimester = nagkakaron ng invasive implantation = accreta urinary frequency implantation = upper lower = dibrid DURING PREGNANCY UTERUS TUBAL LIGATION retroverted position = 2nd trimester of the pede magkaron ng scar formation pregnancy (normal position) isthmus, fallopian tube lang ung ginalaw retroflexion (abn) = nakasandal sa rectum reconstructive surgery if gusto uli ikabit ung matres = constipated continue to ovulate = yes during pregnancy uterus enlarges continue to have mens = yes HORMONES CAUSES UTERINE ENLARGEMENT protection from STD = no ESTROGEN pomeroy = pag may cut na talaga, ○ enlargest the uterus reconstructive ○ encourages UC modified pomeroy - tinalian lang hindi cinut ○ epistaxis = nosebleed sa ibabaw PROGESTERONE ○ prevent uterine construction ovaries ○ hormone of pregnancy (provide female gonad construction and provide produce estrogen and progesterone nourishment) responsible for oogenesis (production of egg ○ poor gi tract cell) ○ psychosis (heart burn) during pregnancy ovaries are not that active WHAT CAUSES THE UTERUS TO GO UP bcs may placental broad ligament ○ placental producing estrogen, and ○ keeps uterus and fallopian tube in progesterone place ○ relaxin = pinoproduce ni ovaries ○ pulls the fundus up to assume during pregnancy, kaya lumapad ROUND balakang ni buntis (to accommodate ○ provide upper support the enlarging uterus) CARDINAL BREAST ○ provide middle support adipose - fats, nagpapalaki ng dibdib ○ provide stability to the uterus pectoralis major PELVIC FLOOR granular tissue ○ provide lower support nipple hormones fallopian tubes / oviduct PROLACTIN ovi = ovum, duct = passageway ○ anterior pituitary gland 4 parts ○ stimulates milk production ○ interstitial OXYTOCIN connected to the walls / layers ○ posterior pituitary gland FRAVENTIJADO | 24 - BSN | 4  ○ release of the milk TRUE PELVIS PARTS inlet - pubic bone / symphysis pubis acini - responsible for milk production (cells found ○ AP inside the breast) cavity - bilugan cluster of lobes around 20 ave outlet - ischial spines (landmark for fetal lactiferous ducts - daanan ng gatas, passageway of station) (the rs of maternal ischial spines and the milk the fetal presenting part) daaan ung gatas kung iba iba angs shape ng inlet cavity and ampulla or lactiferous sinuses - dulo ng lactiferous outlet so the fetus need to ikot ikot ducts may malaki connected to the nipple opening maiipon nipple opening - lalabas anteropost transverse oblique cooper’s ligament - nagbubuhat ng adipos m/ buing erior breast mo pag nahatak, lawlaw ung dibdib pelvic inlet 11 13 12 wag ibabatak RELEASE OF MILK pelvic 12 12 12 at the end of the pregnancy, the anterior cavity pituitary gland becoming active naglalabas ng prolactin ang aciners cells begin to pelvic 13 11 (12) produce the milk outlet baby will sucks the nipple of the mother, sucking the nipple of the mother sends signal to the posterior pituitary gland (oxytocin) pag naglabas ung grandular tissues are contacting FETAL STATION if the head is along the ischial spines = station 0 above 0 = negative ○ hindi pa ipit, floating pa, with ballotment, ○ the head is located above ischial MILK EJECTION REFLEX also called let down spine reflex positive = below SELF BREAST EXAM ○ below 5 to 7 days after mens ○ if the head i already in positive 2 PELVIS define positive 2 station supports and protects the reproductive and ○ the head is located below 2 cm below other pelvic organs ischial spine bonering prominence ○ engaged, without ballottement, not 2 DIVISION floating TRUE PELVIS ○ malapit na manganak ○ daanan ng bebe ○ positive 4 and positive 5 = FALS PELVIS CROWNING ○ pataas ○ crowning = vaginal outlet ni mother bukang buka na, makikita na ung ulo ISCHIUM ni baby ischial tuberosities - one station is equal to 1 cm ○ naka upo ka yan ung nacacarry ng ballotment - bouncing of the baby in the body weight amniotic fluid ○ sitting bone ischial spine ○ sipitsipitan ○ d2 naiipit ung ulo ng baby ○ landmark of fetal station ○ (the rs of maternal ischial spines and the fetal presenting part FRAVENTIJADO | 24 - BSN | 5  frontal suture - bet frontal bone sagittal suture - between parietal lambdoidal suture- between parietal and occipital anterior fontanel - ung diamond sa mga suture na na form. bunbunan ○ closes after 12-18 mos after delivery posterior fontanel - triangle na naform sa likod ○ closest first after surgery ○ 2-3 mos after delivery REGIONS OF THE FETAL SKULL 1. face biggest mento-vertical diameter (mentochin) - 13.5 2. brown / sinciput big 4 TYPES OF PELVIS 3. vertex small GYNECOID 4. occiput gymnosperm= pang girl smallest true female pelvis first region na papasok sa inlet and round lalabas sa outlet can support labor and delivery smallest fetal head diameter - suboccipitobregmatic (SOB) - 9.5 ANDROID FETAL SKULL male pelvis ideal attitude: flexion heart shaped / triangular flexion not support labor and delivery ○ occiput una extension ○ mukha ung una ANTHROPOID FETAL PRESENTATION oblong can support labor and delivery cephalic ○ una ulo ○ most ideal presentation PLATYPELLOID ○ cannot support breech 6 MECHANISMS OF LABOR AND DELIVERY ○ una pwet DFIREERE transverse descent ○ una shoulder ○ pagbaba ni bebe FETAL LIE flexion relationship of the long axis of the uterus and ○ naka yuko ang baby long axis of the fetus internal rotation longitudinal - cephalic and breech ○ iikot sa loob (cavity) transverse - extension oblique - diagonal external rotation expulsion NORMAL * ung engagement ay req b4 mechanism of labor and delivery fetal presentation - cephalic * engagement - preliminary req ideal presenting part - occiput or vertex (SOB) *lightning - preliminary req fetal attitude - flexion lie - longitudinal FETAL SKULL RELATIONSHIP FETAL POSITION relationship of fetal landmark with the most important part of fetal body during maternal pelvic quadrant labor and delivery MATERNAL PELVIC QUADRANT most frequent presenting part (most common presentation is cephalic) largest part of the fetal body least compressible (hindi basta basta mapapaliit in the process of molding HEAD 3 BONES frontal bone parietal occipital joint - pag pinagdikit coronal suture - frontal and parietal FRAVENTIJADO | 24 - BSN | 6  OP - mLQ MENTO LMA - RLQ RMA - LLQ RMP - LLQ LMP - RLQ SACRUM RSA - RUQ RSP - RUP ASL - LUQ REFT ANTERIOR ASP - LUQ ○ nearest in the right abdomen LEFT ANTERIOR ○ near in the left abdomen RIGHT POSTERIOR ○ near in the right buttocks LEFT POSTERIOR ○ near in the left buttocks FETAL LANDMARKS occiput ○ posterior fontanel - malambot, maliit ○ TRIANGLE ○ malapit sa back face ○ chin ○ mentovertical diameter = mento (matigas) ○ malapit sa chest buttocks MENSTRUAL CYCLE ○ sacrum = sacro ○ malapit sa back MENSTRUATION LOA = left occiput anterior periodic discharge blood coming from the 80% uterus semi prone in the monthly reproductive organ is being left anterior - buttocks readied for pregnancy on a monthly basis, esp right posterior - baby is facing when the women entered the stage of RIGHT OCCIPUT TRANSVERSE puberty side lying the start of puberty is 9 - 17 yrs old right lying position average menarche - 12 (first onset) baby is facing left leg / left ischial spine OCCIPUT ANTERIOR MENSTRUAL PERIOD prone position number of days that the women is baby is facing posterior (buttocks) menstruating OCCIPUT POSTERIOR araw na nirregla ung ababe supine 3 to 5 days max of 7 days baby is facing abdomen / anterior RIGHT MENTO ANTERIOR MENSTRUAL CYCLE the baby is facing is right anterior likod is left posterior first day of the period to the first day of the LEFT SACRO ANTERIOR (LSA) next period baby is facing right posterior mens to mens cephalic average number of days- 28 AUSCULTATE normal range 23 to 35 days, max of 40 cephalic - lower quat (OCCIPUT) (MENTUM) (UPPER) REGULAR MENSTRUAL CYCLE breech - upper quadrant how to know if u r regular cycle SA BACK MAS MALAKAS 1. you have to count your menstrual cycle minimum of six months (ex. 30, 30, 30, 30, 30, LOA - LLQ 30) LOT - LLQ hindi porket lagi ka dinadatdatnan LOP - LLQ reg ka na, dapat same lagi ung days para masabing regular ROA - RLQ pede naman hindi same lagi bcs of ROP - RLQ the stress ROT - RLQ MENS - OVULATION - MENS cycle 28 days OA - Mid lower quadrant ○ minus 14 = 14th day mag ovulate FRAVENTIJADO | 24 - BSN | 7  cycle 30 HYPOTHALAMUS ○ minus 14 = 16th day mag ovulate gland that starts the menstrual cycle cycle 25 days stimulates APG ○ minus 14 = 11th day ovulate GnRH - hormone produced by hypothalamus constant -> minus 14 -> cycle 2 TYPES OF GnHR the length of the cycle affects the day of FSHR (follicle stimulating hormone releasing ovulation = yes factor) the date of the ovulation is based of the LHRF (luteinizing hormone releasing factor length of the cycle = yes first half of the cycle = estrogen dominated ANTERIOR PITUITARY GLAND pede magbago ung number of days second half of the cycle = progesterone dominated stimulates ovaries number of cycle that do not change releasing FSH if you are going to compute the ovulation this ○ once FSH is release it will cause the is the most accurate maturation of egg cells *for the nurse to accurately compute determine the ○ what hormone matures the egg cell? day of ovulation she must: FSH - minus 2 weeks at the end of the cycle ○ fsh will stimulate the ovaries * ovulation will happen: 2 weeks after the mens LH OVULATION ○ pagtaas na ang LH it will triggers ovulation one of the two ovaries release a mature egg ○ increasing LH will stimulate the cells ovaries to stimulate progesterone pag nag release ng mature egg cell = the woman is fertile OVARIES FERTILE WINDOW affect the uterus this are the days that the woman are fertile producing estrogen and progesterone from the day of ovulation deduct 5 days from estrogen the day of ovulation plus 3 ○ partner F 1-5 (menstrual period) - 14 (ovulation) - 28 ○ converts the follicle of the ovary to GF 14 -5 = 9, 14+3 = 17 (graafian follicle) FERTILE WINDOW = 9 - 17 days progesterone safe: 1-8 days and 18 - 28 days ○ partner L nakuha ung minus 5 bcs of the lifespan of the ○ converts GF into CL (corpus luteum) sperm and the plus 3 is the lifespan of the ○ CL - yellowing in appearance, 14 days egg lifespan (kaya always minus 14) day 9 = not yet ovulating, 5 days before ○ provides nourishment ovulation day 14 = ovulation 3 day- very low level of estrogen (may mens) day 17 = done na mag ovulate, 3 days after that will stimulate the hypothalamus to start ovulation the menstrual cycle the hypothalamus will produce fshrf 1st ques: misis are you regular or irregular ang cycle stimulating the apg to release fsh stimulating mo po ovaries to release estrogen affecting the 2ns ques: ilang araw naman po kayong nireregla uterus 13 day- high estrogen SLIGHTLY IRREGULAR 13 day- low progesterone minsan 32 cycle, minsan 28 cycle progesterone will stimulate the identify the longest cycle and the shortest hypothalamus will produce LHRF stimulating cycle the APG to release LH stimulating ovaries to LC - 11, SC - 18 (given) release progesterone affecting the uterus 14 day - highest progesterone magkakaroon ng ovulation MAY NABUO * day 14 nagkaron ng fertilization = mageextend si corpus luteum *What structure maintains, support pregnancy in the first 2 mos of pregnancy? corpus luteum STRUCTURAL AND HORMONAL CONTROL OF * after 2 mos hindi na embryo kundi fetus na * structured na lalabas and develop during 2nd MENSTRUAL CYCLE month of pregnancy = placenta * placenta = producing progesterone, (preventing 4 STRUCTURES THAT CONTROL THE contraction, providng nourishment) MENSTRUAL CYCLE * hanggang 9th month lang si placenta, = aging placenta FRAVENTIJADO | 24 - BSN | 8 * aging placenta= so baba ngayong si progesterone, What steps can I take to be as healthy as mawawalan ng contraction ,and mag provide ng possible? nourishment so the woman will enters the labor and What medical conditions (such as diabetes, delivery obesity, and high blood pressure) or other concerns (such as smoking, drinking alcohol, and using drugs) do I need to talk about with UTERUS my doctor? estrogen affects uterus that will undergo Is it possible I could ever change my mind thickening of endometrium and myometrium and want to have children one day? proliferation of endometrial and myometrial If you DO want to have children one day: phase Am I ready to have a baby? progesterone stimulates uterus that will have how old do i want to be when i start and increase vascularity, (tataas ang blood supply, when I stop having children oxygen, ) How many children do I want to have? how many years do I want between my children? What method do I plan to use to prevent pregnancy until I’m ready to have children? Am I sure that I or my partner will be able to use this method without any problems? What, if anything, do I want to change about FEG, HAOU , LPC my health, relationships, home, school, work, finances, or other parts of my life to get ready FAMILY PLANNING to have children? the use of a range of methods of fertility What steps can I take to be as healthy as regulation in order to: possible, even if I’m not ready to have children ○ Avoid unwanted births/pregnancy yet? ○ Bring about wanted births/pregnancy What medical conditions (such as diabetes, ○ Regulate the number of children born obesity, and high blood pressure) or other ○ Regulate intervals between concerns (such as smoking, drinking alcohol, pregnancies/ birth spacing and using drugs) do I need to talk about with ○ Control time at which birth occurs my doctor? Components: Family Planning- DOH 1. planning pregnancy The program is anchored on the following 2. preventing pregnancy basic principles. Responsible Parenthood which means that SEXUAL & REPRODUCTIVE HEALTH each family has the right and duty to Good sexual and reproduc?ve determine the desired number of children health is a state of complete physical, they might have and when they might have mental and social well-being in all matters them. And beyond responsible parenthood is relating to the reproductive health Responsible Parenting which is the proper It implies that people are able to have a upbringing and education of children so that satisfying and safe sex life, the capability to they grow up to be upright, productive and reproduce, and the freedom to decide if, civic-minded citizens. when, and how often to do so. Respect for Life. The 1987 Constitution states to maintain one’s sexual reproductive health, that the government protects the sanctity of people need access to accurate information life. Abortion is NOT a FP method: and the safe, effective affordable and Birth Spacing refers to interval between acceptable contraception method of their pregnancies (which is ideally 3 years). It choice enables women to recover their health they must be informed and empowered to improves women's potential to be more protect themselves from sexually transmitted productive and to realize their personal infections, and when they decide to have aspirations and allows more time to care for children, women must have access to service children and spouse/husband, and; that can help them have a fit pregnancy, safe Informed Choice that is upholding and delivery and healthy baby ensuring the rights of couples to determine REPRODUCTIVE LIFE PLAN the number and spacing of their children A plan for whether, when and how to have according to their life's aspirations and children. It includes personal goals, and states reminding couples that planning size of their how to achieve them. The plan is based on a families have a direct bearing on the quality person's priorities and goals with regards to of their children's and their own lives. life and children Natural Family Planning Methods If you DO NOT want to have children, you might ask yourself: How do I plan to prevent pregnancy? Am I sure that I or my partner will be able to use the method chosen without any problems? What will I do if I or my partner becomes pregnant by accident? FRAVENTIJADO | 24 - BSN | 9 Abstinence Requires cooperation between the Female And Male (FAM) Lactational amenorrhea method (LAM) Advantages: Inexpensive, no side effects, no harmful chemicals and gadgets Fertility Awareness Method (FAM) FAM-Calendar calendar or standard days method CALENDAR METHOD: Fertile Window two days method ?= Regular or Irregular cervical mucus test or billing’s test ?= Day of Ovulation basal body temperature symptothermal method ARTIFICIAL CONTRACEPTIVES Hormonal - Oral, Injectable, Implant, Patch Chemical- Spermicide Mechanical- Cervical Cap, Diaphragm, IUD Surgical- Bilateral Tubal Ligation and BILLING’S TEST, SPINNBARKEIT, Creighton’s- Vasectomy ESTROGEN PLANNING THE PREGNANCY CLEAR, ELASTIC, WATERY, SLIPPERY, thin, Proper nutrition and exercise abundant Lifestyle changes: If can be stretched by 5-10 cm without Remember: Smoking can cause SGA baby breaking, woman is fertile. ○ Alcohol can cause cognitive 2 day method impaired-baby FAM- BBT Medical History Taking and Check up is PROGESTERONE - sudden rise in BBT important during ovulation because of sudden rise in Genetic counseling progesterone (3days elevated BBT) PREVENTING PREGNANCY consistency is the key (same time, same contraceptive methods are used route: oral) Always remember that there is always a After Ovulation – temperature slightly rises possibility for the method of contraception to by 0.20C to 0.50C (thermal shift) fail thus pregnancy may occur. Natural Method: FAM- Symptothermal NATURAL METHODS Use of BBT and CMT CONCEPT: ○ No use of any chemical and ARTIFICIAL METHOD mechanical means of preventing pregnancy. BARRIER ABSTINENCE Refers to chemical, mechanical or the refraining from vaginal sexual intercourse combination of the two in preventing the different from STRICT ABSTINENCE sperm cells from entering certain points/ Advantages parts of the female reproductive canal. acceptable, 100% effective, no cost Barrier: SPERMICIDES Disadvantages: loss of self control-difficult to maintain Provides both physical and chemical barrier LAM Ex. Nonoxyno 9 (N9) kill spermatozoa before Use of this method reaching cervix requires regular and fulltime breast feeding make vaginal pH strongly acidic (Exclusive) no.1 contraindication: allergy Effective duringthe first 6 months post no.1 side effect: allergy, ↑incidence of partum birth defect, unpleasant taste No ovulation and no menstruation inserted into the vagina 10 minutes before Not effective after 6 months intercourse not more than 30 minutes After 6 months, woman may ovulate but wait 6-8 hours after coitus before douching withoutmenstruation COITUS INTERRUPTUS Barrier: MALE CONDOM Withdrawal of penis before ejaculation inside Collects semen during and after intercourse the vagina Protects the couple from some STIs, lowcost, Sperm may leak from the penis even before May break, cause allergy from latex and may ejaculation = pre-cum decrease sensation during intercourse Effectiveness is only 84% or vaginal sheath is a thin tube that is made No protection to STD/STI up of polyurethane with flexible rings at both Self-control is the key ends. FAM The identification of the woman’s Barrier: FEMALE CONDOM fertile and unfertile phases during her A. it collects the sperm before, during and menstrual cycle. after intercourse like the male condom FRAVENTIJADO | 24 - BSN | 10  B. advantages: Danger SIGNS ○ erection is not necessary to keep the J-Jaundice (Liver problem) condom in place A–abdominal pain -(liver problem) ○ external ring can provide extra clitoral C – chest pain and dyspnea (heart problem) stimulation H–headache (severe) HPN ○ available without prescription E – eye problems - HPN disadvantages - S– severe leg pain–(Thromboembolic disease) ○ difficult to apply FERTILE WINDOW ○ makes noise ○ can cause vaginal or penile irritation - LET’S RELATE MENSTRUAL CYCLE TO it may slip during vigorous CONTRACEPTION ! intercourse MENSTRUATION Barrier: Diaphragm and Cervical Cap s a shallow dome-shaped latex rubber device with flexible, circular wire rim that fits over the cervix. this is only available upon prescription in wide range of diameters between 50 and 90 mm and requires fitting by a trained practitioner it must be inserted before intercourse and should remain for 6 hours after. A diaphragm should not be left in place for 24 hours. CONTRACEPTIVE PILLS EFFECT ○ by suppressing oulation action ○ by keeping the levels of estrogen and progesterone in the blood of the woman high menstruate ○ yes when ○ AFTER THE 21ST PILL LET’S SUMMARIZE ! Hormonal: ORAL PILLS ESTROGEN – 3RD, 13TH Action : inhibits ovulation by suppressing FSH PROGESTERONE – 13TH, 14TH and LH HYPOTHALAMUS – INITIATOR Types: combined (COC) and mini (POP) PILLS – INHIBITS OVULATION BECAUSE Contraindications: ESTROGEN AND PROGESTERONE LEVELS ○ pregnancy and lactation smoking ARE HIGH ○ over 35 y/o - hx of thromboembolic disease,DM DANGER SIGNS: ○ hypertension, cardiac disease, liver A– ABDOMINAL PAIN problem C – CHEST PAIN AND DYSPNEA ○ cancer the breast and reproductive H – HEADACHE tract E – EYEPROBLEMS S – SEVERE LEG PAIN SIDE EFFECTS: WISH WEIGHT GAIN INCREASED CERVICAL DISCHARGE SPOTTING HEADACHE RULES BEFORE TAKING CP: PPP: PE, PELVIC EXAM AND PAP SMEAR DMPA DEPOT MEDROXY PROGESTERONE ACETATE (150mg) - DEPOPROVERA ACTION– INHIBITS OVULATION; THICKENS CERVICAL MUCUS FRAVENTIJADO | 24 - BSN | 11  Duration of Protection: 3 mos progestin-bearing device is effective for 5 to 7 Rule: Do not massage injection site. years and affects mucus and endometrial EFFECT: NO MENSTRUATION development LUNELLE: with menstruation side effects include cramping and bleeding upon insertion of the device and offers no protection for STIs HORMONAL IMPLANTS a small, flexible, plastic rod about the size of the matchstick and is inserted under the skin under local anesthesia. prevents pregnancy by causing sterile insertion takes approximately 4 minutes inflammatory reaction A. advantages: blocks the access of sperm cells to fallopian extremely effective birth control tube no daily pills to remember and no pap smear and pelvic exam must be done interference to sexual activity before insertion B. disadvantages: contraindicated in : PID, pregnancy, multiple weight gain sex partners, severe dysmenorrhea, cervical/ irregular bleeding patterns to some women uterine malignancy/ abnormalities no protection against STIs inserted during menstruation TRANSDERMAL PATCH CBQ – most common problem : spontaneous available upon prescription and provides expulsion of the device (signs s/x spotting and continuous supply of estrogen and progestin. uterine cramping) the patch is placed on the skin continuously CBQ – most common complaint : ↑ excessive for 3 weeks and remove for a week to allow vaginal discharge and dysparenunia (painful menses to occur sexual intercourse) A. advantage: Use condom for the first 3 months after with high rates on compliance insertion B. disadvantages: Wait 3 months after removal before decrease effectiveness on women over 198 attempting pregnancy pounds Check every month then after 6 months and with side effects such as headache and yearly application site reactions DANGER SIGN Ortho Evra P – period is late/ missed period VAGINAL RING A – abdominal pain (severe) soft flexible ring, approximately 2 inches in I – increase temperature diameter that contains estrogen and N – noticeable vaginal discharge (foul progestin. smelling) it is placed in the vagina once a month and S – spotting, bleeding, heavy periods removed after 21 days to allow menstruation STERILIZATION A. advantages: permanent method of birth control obtained with high effectiveness via surgical procedure. low incidence of hormone-related symptoms Passages of the ova and sperm cells are easy to insert and discreet to use occluded to render the person infertile. WHO: B. disadvantages: - with genetic abnormalities woman may feel un comfortable with the with medical conditions ring couple who reached the desired no. of may cause increase vaginal discharge children INTRAUTERINE DEVICE have no wish to have children CBQ – BTL : sterility is immediate a small T-shaped device that is inserted into CBQ – Vasectomy – sterility is achieved after 2 the uterine cavity (copper or negative sperm count results progestin-bearing) copper bearing device is effective for 4 to 10 FEMALE STERILIZATION years and acts as a contraceptive by by tubal ligation or tubal occlusion involves damaging the sperm in transit to the uterus blocking or ligating (tying) the fallopian tubes FRAVENTIJADO | 24 - BSN | 12  it may be done immediately after giving birth and is effective until 3 months until scars are fully healed IUD BTL fertilization none none menstruation yes yes ovulation yes yes protection none none from STD duration temporary permanent MALE STERILIZATION or vasectomy is the permanent sterilization in male. it takes one month until ejaculations are free from sperm vasectomy has no effect on the man’s ability to achieve or maintain erection and there is no interference in the production of testosterone Vasectomy Erection- yes Sperm Production - yes Fertilization - none Ejaculation - Yes Characteristic of ejaculate – Thin (absence of sperm) Duration - Permanent Protection from STD- None MMR-Mutual Monogamous Relationship FRAVENTIJADO | 24 - BSN | 13 FRAVENTIJADO | 24 - BSN | 14