Female Reproductive Disorders PDF

7/23/2024 OBJECTIVES FEMALE REPRODUCTIVE DISORDERS By the end of the session learners wil...

7/23/2024 OBJECTIVES FEMALE REPRODUCTIVE DISORDERS By the end of the session learners will be able: Female Reproductive Disorders: 1. Review the anatomy & physiology of female reproductive system ADULT HEALTH NURSING-I 2. Discuss the function of the supporting ligaments and pelvic floor muscles in maintaining the position of the pelvic organs 3. Discuss the alteration in estrogen and progesterone levels as a cause of dysfunctional menstrual cycle. Farhana Nisar 4. Discuss the causes, pathophysiology and manifestation of the following female reproductive disorders Lecturer 5. Discuss the diagnostic, medical and surgical management of the below mentioned disorders Dow Institute of Nursing & Midwifery 6. Apply nursing process including assessment, planning, implementation and evaluation of care provided to the clients with reproductive disorders 7. Develop a teaching plan for a client experiencing disorders of the reproductive system This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 1 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. Reproductive tract Infections Menstrual Disorders Dysfunctional uterine bleeding FUNCTION OF FEMALE REPRODUCTIVE SYSTEM Menopause Endometriosis Pelvic inflammatory disease Uterine prolapse Cystocele  The functions of the female reproductive system are: Rectocele  Formation of ova Fistulas Infertility  Reception of spermatozoa Ectopic Pregnancy  Provision of suitable environments for fertilization and fetal development Abortion Hydatidiform mole  Parturition (childbirth) Ovarian cyst  Lactation, the production of breast milk, which provides complete nourishment for the baby in its early life. Ovarian tumor and cancer Uterine tumor/ fibroids Breast cancer 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 4 INTERNAL GENITALIA EXTERNAL GENITALIA (VULVA)  The external genitalia are known collectively as the vulva, and consist of the following  The internal organs of the female reproductive system lie in the pelvic cavity and consist of: Labia majora The vagina Labia minora Uterus The clitoris Two uterine tubes (fallopian tubes) The vaginal orifice Two ovaries. The vestibule The hymen The vestibular glands (bartholin‘s glands). 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 5 6 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 1  7/23/2024 UTERUS VAGINA  The uterus is a hollow muscular pear-shaped organ, flattened anteroposteriorly.  It lies in the pelvic cavity between the urinary bladder and the rectum  The vagina is a fibromuscular tube lined with stratified squamous epithelium  Function:  It runs obliquely upwards and backwards at an angle of about 45° between the bladder in front and rectum and  Receives anus behind.  Retains  Functions of the vagina:  Nourishes fertilized egg=embryo The vagina acts as the receptacle for the penis during sexual intercourse (coitus) Provides an elastic passageway through which the baby passes during childbirth. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 7 8 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. STRUCTURE UTERINE TUBES  The walls of the uterus are composed of three layers  of tissue: The uterine (Fallopian) tubes are about 10 cm long and extend from the sides of the uterus between the body and the fundus.  Perimetrium: outer serous membrane The end of each tube has fingerlike projections called fimbriae.  Myometrium: middle muscle  Functions  Endometrium: inner mucosal lining The uterine tubes propel the ovum from the ovary to the uterus by peristalsis and ciliary movement.  Part of the uterus: The secretions of the uterine tube nourish both ovum and spermatozoa.  Fundus. This is the dome-shaped part of the uterus above the openings of the uterine tubes. Fertilisation of the ovum usually takes place in the uterine tube, and the zygote is propelled into the  Body. This is the main part. It is narrowest inferiorly at the internal os where it is continuous uterus for implantation. with the cervix.  Cervix (‗neck‘ of the uterus). This protrudes through the anterior wall of the vagina, opening into it at the external os. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 9 NonCommercial-NoDerivatives 4.0 International License. 10 STRUCTURE OF OVARY The Ovarian Cycle  Follicular phase(before release of the egg)  1st approx 14 days but variable Fibrous capsule is called tunica albuginea  Egg develops in a follicle Outer cortex houses developing gametes the oocytes, within follicles  FSH stimulate growth of follicles, most follicles die only one Inner medulla is loose connective tissue with largest vessels and nerves mature into Graafian follicle.  Estrogen produced from follicle stimulates release of LH & decrease level of FSH  Ovulation (egg release)  Egg released from follicle (LH surge)  Egg in abdominal cavity  Picked up by fimbria of fallopian tube  Luteal phase(after egg release)  Postovulatory phase 14 days (more constant)  Corpus luteum develops from exploded follicle  Produces progesterone as well as estrogen  Progesterone stimulates uterus to be ready for baby  If no pregnancy, corpus luteum degenerates into corpus albicans and decline level of Estrogen & Progesterone  Decline of Estrogen & Progesterone stimulate more FSH & LH This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 11 12 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 2  7/23/2024 Time: one cycle (approx 28 d.) THE CYCLIC CHANGES OF UTERINE WALL AND FOLLICLE ovulation *  Pituitary hormones  FSH: follicle stimulating hormone  LH: luteinizing hormone  Ovarian hormones If no baby, decreasing Follicular phase Luteal phase  Estrogen progesterone - slough  Progesterone Proliferative phase: Secretory phase: vascular rich glands rebuilds itself after slough enlarge: will sustain baby (needs progesterone: corpus luteum initially This work is licensed under a Creative Commons Attribution- then placenta) This work is licensed under a Creative Commons Attribution- 13 14 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. (inhibin: inhibits pituitary secretion of FSH) This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 15 NonCommercial-NoDerivatives 4.0 International License. OVARIES  The ovaries are the female gonads (glands producing sex hormones and the ova).  Structure  The ovaries have two layers of tissue.  Medulla:  This lies in the centre and consists of fibrous tissue, blood vessels and nerves.  Cortex:  This surrounds the medulla. It has a framework of connective tissue, or stroma, covered by germinal epithelium.  It contains ovarian follicles in various stages of maturity, each of which contains an ovum.  During the childbearing years, about every 28 days, one or more ovarian follicle (Graafian follicle) matures, ruptures and releases its ovum into the peritoneal cavity. This is called ovulation and it occurs during most menstrual cycles  Following ovulation, the ruptured follicle develops into the corpus luteum (meaning ‗yellow body‘), which in turn will leave a small permanent scar of fibrous tissue called the corpus albicans (meaning ‗white body‘) on the surface of the ovary. 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 18 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 3  7/23/2024 FUNCTIONS The ovary is the organ in which the female gametes are stored and develop prior to ovulation. Their maturation is controlled by the hypothalamus and the anterior pituitary gland, which releases gonadotrophins (follicle stimulating hormone, FSH, and luteinising hormone, LH), both of which act on the ovary. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 19 20 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License.  Oestrogen Development of secondary sexual characteristics at puberty  Follicle stimulating hormone (FSH), which promotes the maturation of ovarian follicles and the secretion of Stimulates and supports thickening of uterine lining during proliferative phase oestrogen, leading to ovulation. FSH is therefore predominantly active in the first half of the cycle. Its Triggers LH surge mid-cycle, stimulating ovulation secretion is suppressed once ovulation has taken place, to prevent other follicles maturing during the current cycle Stimulates anterior pituitary secretion of FSH and LH in first half of cycle  Luteinising hormone (LH), which triggers ovulation, stimulates the development of the corpus luteum and  Progesterone the secretion of progesterone. Stimulates and supports thickening and increased glandular development of uterine lining during secretory phase With oestrogen, inhibits secretion of FSH and LH from the anterior pituitary in second half of cycle 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 21 NonCommercial-NoDerivatives 4.0 International License. 22 ABNORMAL UTERINE BLEEDING Abnormal uterine bleeding is abnormal bleeding resulting from changes in the hormonal control of MENSTRUAL DISORDERS menstruation. Abnormal uterine bleeding (previously called dysfunctional uterine bleeding)  Menstrual disorders include:  Polymenorrhea: Occur more frequently (fewer than 21 days apart) Abnormal uterine bleeding  Metrorrhagia: vaginal bleeding occurring between regular menstrual periods. Absence of menstrual periods (amenorrhea)  Menorrhagia: Involve prolonged or excessive bleeding during regular menstruation. Menstrual cramps (dysmenorrhea) Premature menopause (primary ovarian insufficiency)  Menometrorrhagia: Involve more blood loss and occur frequently and irregularly between menses Premenstrual syndrome (PMS)  Oligomenorrhea: Reduced menstrual flow, often accompanied by irregular cycles and long interval.  Amenorrhea: absence of menstrual flow 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 23 24 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 4  7/23/2024 PATHOPHYSIOLOGY Level of estrogen remains high instead of decreasing as it normally does after an egg is released and is not fertilized. The high estrogen level is not balanced by an appropriate level of progesterone. In such cases, no egg is released, and the lining of the uterus (endometrium) may continue to thicken (instead of breaking down and being shed normally as a menstrual period). This abnormal thickening is called endometrial hyperplasia. Periodically, the thickened lining is shed incompletely and irregularly, causing bleeding. Bleeding is irregular, prolonged, and sometimes heavy. 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 25 26 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. TREATMENT  Other treatments:  Medication: Dilation and curettage (D and C). For a D and C, tissue from the uterine lining is removed by  Bleeding can be controlled using drugs, which may be hormones or not. scraping.This procedure may reduce bleeding.  Drugs that are not hormones are often used first, especially in younger women, because they have fewer side effects. These drugs include: If bleeding continues after a D and C, a procedure that destroys or removes the lining of the uterus  Nonsteroidal anti-inflammatory drugs (NSAIDs) (endometrial ablation) can often help control bleeding.  Tranexamic acid (antifibrinolytic agent) If the uterine lining contains abnormal cells (particularly in women who are older than 35 and who do When the uterine lining is thickened but its cells are normal (endometrial hyperplasia), hormones may be used to control bleeding. not want to become pregnant), a hysterectomy is done Often, a birth control pill that contains estrogen and a progestin (a combination oral contraceptive) is used. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 27 NonCommercial-NoDerivatives 4.0 International License. 28 AMENORRHEA TYPES OF AMENORRHEA Absence of Menstrual Periods, Having no menstrual periods is called amenorrhea.  There are two main types of amenorrhea:  Amenorrhea is normal in the following circumstances:  Primary: Menstrual periods never start. Before puberty  Secondary: Periods start, then stop. During pregnancy While breastfeeding After menopause 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 29 30 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 5  7/23/2024 CAUSES OF AMENORRHEA DYSMENORRHEA Secondary Amenorrhea  Painful Periods aka Menstrual Cramps, more common in nulliparous women. An absence of menses for three cycles or 6 months PRIMARY Menstrual cramps are pains in the lowest part of the torso (pelvis), a few days before, during, or after a after a normal menarche. Delayed menarche, a young woman by age 14 years has menstrual period. not begun developing secondary sex characteristics & Causes of Secondary amenorrhea: The pain tends to be most intense about 24 hours after periods begin and to subside after 2 to 3 days. has not started menstruation. Pregnancy Causes of primary amenorrhea: Breast feeding  Symptoms tend to be more severe if: Menopause Genetics  Menstrual periods started at an early age. Polycystic ovary Congenital disorders Emotional upset  Periods are long or heavy. Malnutrition Excessive exercise or medications Hyperthyroidism  Family members also have dysmenorrhea. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 31 32 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. TYPES OF DYSMENORRHEA Secondary dysmenorrhea: occurs with underlying pathology.  Primary dysmenorrhea: with no identifiable pelvic pathology.  Secondary dysmenorrhea is commonly caused by: May be caused by release of substances called prostaglandins during menstruation.  Endometriosis: Tissue that normally occurs only in the lining of the uterus (endometrial tissue) appears outside the uterus. Endometriosis is the most common cause of secondary Prostaglandin levels are high in women with primary dysmenorrhea. dysmenorrhea. Prostaglandins may cause the uterus to contract (as occurs during labor), reducing blood flow to the uterus.  Fibroids: These noncancerous tumors are composed of muscle and fibrous tissue and grow in These contractions can cause pain and discomfort. Prostaglandins also make nerve endings in the uterus more the uterus. sensitive to pain.  Adenomyosis: Endometrial tissue grows into the wall of the uterus, causing it to enlarge and swell during menstrual periods. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 33 NonCommercial-NoDerivatives 4.0 International License. 34 Less common causes of secondary dysmenorrhea:  Birth defects (narrowed cervix)  Cysts and tumors in the ovaries  Pelvic inflammatory disease  Use of an intrauterine device (IUD) This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 35 36 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 6  7/23/2024 TREATMENT AND NURSING CARE PREMATURE MENOPAUSE  Drug Therapy  NSAIDS/ Prostaglandin blockers -  Relaxation Techniques Premature Ovarian Failure; Primary Ovarian Insufficiency  Heat Therapy Premature menopause is the permanent end of menstrual periods before age 40..  Exercise It occurs because the ovaries no longer release eggs (ovulation) and become less able to produce  Nutrition hormones.  low-fat diet and nutritional supplements such as omega-3 fatty acids, flaxseed, Some women have no symptoms except being unable to become pregnant, and others have the same magnesium, vitamin B1, vitamin E, and zinc. symptoms as those of natural menopause (such as hot flashes or night sweats).  Other  Acupuncture  Transcutaneous nerve stimulation 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 37 38 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. PREMENSTRUAL SYNDROME (PMS) SIGN AND SYMPTOMS OF PMS A syndrome and not a disease! PMS is a group of physical and psychological symptoms that start several days before and usually end a few hours Physical symptoms: include: headache, fatigue, low back pain, painful breasts after a menstrual period begins. feeling of abdominal fullness, weight gain, acne.  PMS may occur partly because of the following: Behavioral and emotional symptoms: irritability, mood swings, fear of losing Estrogen and progesterone levels fluctuate during the menstrual cycle. Some women are more sensitive to these fluctuations. control, binge eating, food cravings and crying spells. Some women may have a genetic make-up that makes them more susceptible to PMS. Serotonin levels tend to be lower in women with PMS. Serotonin is a substance that helps nerve cells  *Symptoms can vary from month to month and women to women communicate (a neurotransmitter) and is thought to help regulate mood. A deficiency of magnesium or calcium may contribute. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 39 NonCommercial-NoDerivatives 4.0 International License. 40 GENERAL MEASURES DRUG THERAPY Get enough rest and sleep (at least 7 hours each night). Exercise regularly, which may help lessen bloating as well as irritability, anxiety, and insomnia. Use stress reduction techniques (meditation or relaxation exercises).  Selective Serotonin reuptake inhibitors  Prozac Avoid stressful activities.  Zoloft Consume more protein and less sugar and caffeine (including that in chocolate).  Diuretics - spironolactone Consume more fruits, vegetables, milk, complex carbohydrates (for example, in breads, pastas, beans, and root  Prostaglandin inhibitors - ibuprofen vegetables), high-fiber foods, low-fat meats, and foods high in calcium and vitamin D  Antidepressants, antianxiety - Xanax Consume less salt, which often reduces fluid retention and relieves bloating. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 41 42 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 7  7/23/2024 MENOPAUSE  Menopause occurs because as women age, the ovaries stop producing estrogen and progesterone.  Menopause is the permanent end of menstrual periods and thus end of fertility.  During the years before menopause, production of estrogen and progesterone begins to fluctuate,  Menopause is related to a decrease in the production of Estrogen and Progesterone. and menstrual periods and ovulation occur less often.  For up to several years before and just after menopause, estrogen levels fluctuate widely, periods  Eventually, menstrual periods and ovulation end permanently, and pregnancy can no longer occur become irregular, and symptoms (such as hot flashes) may occur. naturally. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 43 44 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. TREATMENT AND NURSING CARE MENOPAUSE CLINICAL MANIFESTATIONS  Drug Therapy Cessation of menses  NO longer encourage the use of Hormone Replacement Therapy – related to increase in risk for development of breast cancer, stroke, heart disease, DVT, Occasional vasomotor symptoms pulmonary emboli Atrophy of genitourinary tissue  Antidepressants Stress incontinence  Selective estrogen receptor modulators  raloxifene (Evista) Osteoporosis  Bisphosphonates  Fosamax or Actonel Sleep disturbances This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. ENDOMETRIOSIS  Non-hormonal Therapy  Cool environment  Loose fitting clothing  Moisturizing soaps and lotions  Healthy diet with vitamin D  In endometriosis, a benign lesion or lesions with cells similar to those lining the uterus grow  Vitamin and mineral supplements aberrantly in the pelvic cavity outside the uterus.  Exercise 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 48 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 8  7/23/2024 SIGN AND SYMPTOMS PATHOPHYSIOLOGY  Dysmenorrhea Ectopic endometrial tissue responds to estrogen and progesterone with proliferation  Dyspareunia and secretion.  Pelvic discomfort or pain During menstruation, ectopic tissue bleeds and causes inflammation of the  Dyschezia (pain with bowel movements) and radiation of pain to the back or leg may occur. surrounding tissues.  Endometrial tissue contained within an ovarian cyst has no outlet for the bleeding; this formation is referred to as a pseudocyst or chocolate cyst. Inflammation leads to fibrosis, and fibrosis leads to adhesions that produce pain and  Adhesions, cysts, and scar tissue may result, causing pain and infertility. infertility. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 49 50 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. TREATMENT OF ENDOMETRIOSIS PELVIC INFLAMMATORY DISEASE NSAIDs for pain Drugs to suppress the activity of the ovaries  Conservative surgery  Pelvic inflammatory disease (PID) is an inflammatory condition of the pelvic cavity that may begin with cervicitis and may involve the:  Laparoscopic laser surgery / laparotomy  Cervix (cervicitis)  Used in women who desire to bear children  uterus (endometritis)  fallopian tubes (salpingitis)  Definitive surgery  ovaries (oophoritis)  Hysterectomy  pelvic peritoneum or pelvic vascular system.  Used in women who no longer desire children  Infection, which may be acute, subacute, recurrent, or chronic and localized or widespread, is usually caused by bacteria but may be attributed to a virus, fungus, or parasite. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 51 NonCommercial-NoDerivatives 4.0 International License. 52 CAUSES SIGN AND SYMPTOMS Vaginal discharge, Dyspareunia Bacterial infections after childbirth or abortion Lower abdominal pelvic pain, and tenderness that occurs after menses. sexual transmission Pain while voiding or with defecation. Invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or IUD insertion Fever Gonorrheal infections, the gonococci pass through the cervical canal and into the uterus, where the environment, especially during menstruation, allows them to multiply rapidly. General malaise Anorexia Nausea, headache, and possibly vomiting. On pelvic examination, intense tenderness may be noted on palpation of the uterus or movement of the cervix (cervical motion tenderness). 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 53 54 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 9  7/23/2024 UTERINE PROLAPSE MANAGEMENT  In prolapse of the uterus, the uterus drops down into the vagina. It usually results from weakening of the connective tissue and ligaments supporting the uterus Broad-spectrum antibiotic therapy  Stage I – the uterus is in the upper half of the vagina. Intensive therapy includes: bed rest, intravenous fluids, and intravenous antibiotic. Treating sexual partners is necessary to prevent reinfection.  Stage II – the uterus has descended nearly to the opening of the vagina. Bed rest and in the semi-Fowler‘s position to facilitate dependent drainage.  Stage III – the uterus protrudes out of the vagina. Heat applied safely to the abdomen may also provide some pain relief and comfort. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 55 56 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. SIGN AND SYMPTOMS Pain in the lower back or over the tailbone Difficulty having a bowel movement Pain during sexual intercourse Feeling of heaviness or pressure—a feeling that pelvic organs are dropping out. Total uterine prolapse can cause pain during walking. Sores may develop on the protruding cervix (the lower part of the uterus) and cause bleeding, a discharge, and infection. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 57 NonCommercial-NoDerivatives 4.0 International License. 58 MANAGEMENT Pessaries   Kegel exercises : to strengthen the muscles that support the uterus. Surgery: the uterus is sutured back into place and repaired to strengthen and tighten the muscle bands. In postmenopausal women, the uterus may be removed (hysterectomy). 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 59 60 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 10  7/23/2024 CYSTOCELE & RECTOCELE  CYSTOCELE: Cystocele is a downward displacement of the bladder toward the vaginal orifice resulting from damage to the anterior vaginal support structures.  It usually results from injury and strain during childbirth.  RECTOCELE: type of prolapse where the supportive wall of tissue between a rectum and vaginal wall weakens. Without the support of these pelvic floor muscles and ligaments, the front wall of the rectum bulges into the vagina, and in severe cases, protrudes out of the vaginal opening. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 61 62 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. FISTULAS TREATMENT  An abnormal opening between two internal hollow organs.  Vesicovaginal fistula: is an opening between the bladder and the vagina. S/S: urine escape from vagina. Kegel exercises, which involve contracting or tightening the vaginal muscles, are prescribed to help strengthen  Rectovaginal fistula: an opening between the rectum and vagina. these weakened muscles. S/S: fecal incontinence and flatus is discharge with leucorrhea. Pessaries can be used to avoid surgery.  Cervical fistula: abnormal opening in the cervix  Enterovaginal fistula: between the intestine and the vagina 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 63 NonCommercial-NoDerivatives 4.0 International License. 64 CAUSES INFERTILITY Uterine displacement by tumors Congenital anomalies  Infertility is defined as a couple‘s inability to achieve pregnancy Inflammation.  after 1 year of unprotected intercourse. Semen and cervical secretions are alkaline, whereas normal vaginal secretions are acidic. STDs  Types of Infertility: Tuberculosis  Primary infertility : refers to a couple who has never had a child. mumps orchitis,  Secondary infertility: means that at least one conception has occurred, but currently the couple cannot achieve a impaired sperm production pregnancy. Endometriosis 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 65 66 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 11  7/23/2024 ECTOPIC PREGNANCY MANAGEMENT  Ectopic means ―Out of place‖ Hormonal supplements  Ectopic pregnancy: Pregnancy occurs somewhere other than in the uterine cavity. Attention to proper timing  Aka tubal pregnancies Recognition and correction of psychological or emotional factors.  Sites of Ectopic pregnancy : Artificial insemination Intestine Cannula with partner‘s semen Ampulla of fallopian tubes (most common site) Insemination with donor semen. In vitro fertilization 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 67 68 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. SIGN AND SYMPTOMS MANAGEMENT Light vaginal bleeding and pelvic pain are usually the first symptoms Nausea and vomiting with pain  Conservative surgery: include ―milking‖ an ectopic pregnancy from the tube. Sharp abdominal cramps  Resection of the fallopian tube with end-to-end anastomosis Pain on one side of your body  Salvage the tube with a Salpingostomy, which involves opening and evacuating the tube and controlling Dizziness or weakness bleeding. Pain in your shoulder, neck, or rectum  Removing the tube alone (salpingectomy) Rupture: Increased pain, referred shoulder pain, signs of shock  Removing of the tube with the ovary (salpingo-oophorectomy). 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 69 NonCommercial-NoDerivatives 4.0 International License. 70 ABORTION ABORTION Interruption of pregnancy or expulsion of the product of conception before the fetus is viable is called abortion. spontaneous induced A pregnancy that ends before 20 weeks‘ gestation, spontaneously or electively is called abortion. The fetus is generally considered viable any time after the fifth to sixth month of generation. Threatened Inevitable Therapeutic Criminal Pregnancy Missed complete Incomplete progress 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 71 This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 72 12  7/23/2024 TYPES OF ABORTIONS  SPONTANEOUS: Pregnancy ends because of natural causes. ASSESSMENT  INDUCED: Therapeutic or elective reasons exist for terminating pregnancy.  THREATENED: Spotting and cramping without cervical change occur.  INEVITABLE: Spotting and cramping occur and cervix begins to dilate and efface.  Spontaneous vaginal bleeding  INCOMPLETE: Loss of some of the products of conception occurs, with part of the products retained (most  Low uterine cramping or contractions often placenta is retained).  Blood clots or tissue through the vagina  Hemorrhage and shock can result if bleeding is excessive  COMPLETE: Loss of all products of conception occurs.  MISSED: Products of conception are retained in utero after fetal death.  HABITUAL: Spontaneous abortions occur in three or more successive pregnancies. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 73 74 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. INTERVENTION HYDATIDIFORM MOLE  Maintain bed rest as prescribed. Hydatidiform mole is a form of gestational trophoblastic disease that occurs  Monitor vital signs. when the trophoblasts, which are the peripheral cells that attach the fertilized ovum to the uterine wall, develop abnormally.  Monitor for cramping and bleeding. OR  Count perineal pads to evaluate blood loss, and save expelled tissues & clots. Hydatidiform mole, also called molar pregnancy, is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of  Maintain intravenous fluids as prescribed; monitor for signs of hemorrhage or shock. gestational trophoblastic disease (GTD).  Prepare the client for dilation and curettage as prescribed for incomplete abortion. The mole manifests as an edematous grape-like cluster that may be  Rho(D) immune globulin (RhoGAM) is prescribed for an Rh-negative woman. nonmalignant or may develop into choriocarcinoma.  Provide psychological support. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 75 NonCommercial-NoDerivatives 4.0 International License. 76 ASSESSMENT  Hydatidiform mole, or molar pregnancy, results from over-production of the tissue that is supposed to develop into the placenta. The placenta feeds the fetus during pregnancy. With a molar pregnancy, the tissues develop into  Fetal heart rate not detectable an abnormal growth, called a mass.  Vaginal bleeding, which may occur by the fourth week or not until the second trimester; may be bright red or dark brown in color and may be slight, profuse, or intermittent  Types of Molar Pregnancy  Symptoms of gestational hypertension, such as elevated blood pressure, edema, and proteinuria, before the twentieth week of gestation  Partial molar pregnancy:There is an abnormal placenta and some fetal development.  Fundal height greater than expected for gestational date  Complete molar pregnancy:There is an abnormal placenta but no fetus.  Elevated human chorionic gonadotropin levels  Characteristic snowstorm pattern shown on ultrasound 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 77 78 NonCommercial-NoDerivatives 4.0 International License. NonCommercial-NoDerivatives 4.0 International License. 13  7/23/2024 INTERVENTIONS BREAST CANCER  Prepare the client for uterine evacuation (before evacuation, diagnostic tests are done to detect metastatic Breast cancer is classified as invasive when it penetrates the tissue surrounding the mammary duct and disease). grows in an irregular pattern.  Evacuation of the mole is done by vacuum aspiration; oxytocin is administered after evacuation to contract the Metastasis occurs via lymph nodes. uterus.  Types of Breast Cancer:  Monitor for postprocedure hemorrhage and infection.  1. Ductal carcinoma: starts in the tubes (ducts) that move milk from the breast to the nipple. Most  Tissue is sent to the laboratory for evaluation, and follow-up is important to detect changes suggestive of breast cancers are of this type. malignancy.  2. Lobular carcinoma: starts in the parts of the breast, called lobules, that produce milk.  Human chorionic gonadotropin levels are monitored every 1 to 2 weeks until normal prepregnancy levels are attained; levels are checked every 1 to 2 months for 1 year.  Instruct the client and her partner about birth control measures so that pregnancy can be prevented during the 1-year follow-up. 7/23/2024 7/23/2024 This work is licensed under a Creative Commons Attribution- This work is licensed under a Creative Commons Attribution- 79 80 NonCommercial-NoDerivatives 4.0 International License.