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Contraception

Contraception. Nursing 353 February 7 th , 2005. Contraception. Voluntary prevention of pregnancy More than ½ pregnancies are unintended in specific age groups May be used incorrectly Must be informed about STIs

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Contraception

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  1. Contraception Nursing 353 February 7th, 2005

  2. Contraception • Voluntary prevention of pregnancy • More than ½ pregnancies are unintended in specific age groups • May be used incorrectly • Must be informed about STIs • In 1988, among 58 million women (aged 15-44), about 35 million were using some form of contraception

  3. Choosing the ‘Right’ one • Commitment • Number of partners • Level of involvement • Level of comfort • Informed consent is important • Partners willingness • Contraceptive ‘failure’ • Sexual History • Physical Exam • Labs

  4. Legal aspects for minors • Immancipated minor when becomes pregnant • Is able to make decisions for herself and fetus

  5. Types of contraception • Coitus interruptus • NFP • FAM • Calendar method • BBT method • Cervical mucus ovulation-detection method • Predictor test for ovulation • Lactation • Combined method • Abstinence

  6. Barrier methods • Spermicides • Condoms – female and male • Diaphragm • Cervical cap • Contraceptive sponge

  7. Condoms • Acceptability • Latex vs. skin • Latex sensitivity • Condom breakage • Condom slippage • Cost • Protection against HIV, STIs • Reduced sensitivity • Interruption • Decreased pleasure • May only be used with water based lubricant

  8. Spermicides • Failure rates 0-50% for typical users • Cost • Nonoxynol-9 destroys sperm cell membrane • OTC • Can be used as a ‘back-up method’ • Allergy • Failing to wait long enough after inserted • Using too little

  9. Female condom • One time use • Proper placement

  10. Contraceptive Sponge • Contains spermicidal • One size • OTC • Continuous protection up to 24 hrs

  11. Diaphragm • Rubber cup with a flexible rim • Used with spermicide • Can stay in place up to 6 hours • Must be in place for 6 hours after IC

  12. “It’s a long way from the exam room to the bedroom”

  13. Calendar Rhythm Method • Based on the number of days in each cycle • Calculate and monitor menstrual cycles for 6 months • Subtract 18 days from the shortest cycle (beginning of the fertile period) • Subtracting 11 days for the length of the longest cycle (end of the fertile period) • Abstain during the fertile period

  14. Cervical Mucus Method • Woman must recognize the cyclic changes of cervical mucus • No douching, vaginal washes, semen, medications

  15. Hormonal methods • OCPs – most popular • Lunelle • Depo-provera (DMPA) • Minipill • NuvaRing • Ortho Evra • Emergency contraception

  16. ACHES • A – Abdominal pain • C – Chest pain, SOB • H – Headaches, HTN • E – Eye problems • S – Severe leg pain

  17. OCPs • Progesterone-Estrogen pills • Suppresses the action of the hypothalamus and ant. Pituitary inappropriate sections of FSH and LH follicles do not mature ovulation is inhibited

  18. Nuva Ring

  19. Ortho Evra

  20. Contraceptive Injections

  21. Efficacy • Will it work? • Must determine contraceptive failure vs. contraceptive effectiveness • Typical user • DMPA vs. Lunelle (currently off the market) • Every 3 month injections vs. monthly • Cost factor

  22. Types of IUDs • Copper T • Mirena

  23. IUDs • Copper T – 7-10 years • Mirena – 5 years • Expensive, long term, monogamy is important, PID, pregnancy (ectopic)

  24. Sterilization • BTL • Vasectomy

  25. BTL • May be done after childbirth in hospital • Failure rate is 0.5% • Expensive • Permanent • Tubal reconstruction is costly

  26. Termination of Pregnancy

  27. Abortion • Induced • Elective (EAB) • Spontaneous (SAB) • Therapeutic (TAB)

  28. Rights of Nurses – NAACOG paper 1972 • Women have the right to expect and receive nonjudgmental supportive care • Nurses’ have the right refuse to assist with abortions according to own religious or moral beliefs, unless a woman’s life is in immediate danger, then we help even if our beliefs are violated

  29. Legal Status of Abortion • 1973-Allowed 1st trimester abortions at discretion of the woman and her physician • 2nd trimester abortions at discretion of individual states to regulate in ways reasonably related to health of mother • 3rd trimester abortions the state may regulate or prohibit abortions except when necessary by medical judgment to preserve the life or health of the mother.

  30. 1976 – state cannot impose requirement of consent by third party on woman’s right to abortion • 1980 – forbids expenditure of federal funds for abortion unless continuation of pregnancy threatens a mother’s life

  31. Reasons for Abortion • Preservation of life or health of mother • Avoidance of birth of offspring with serious developmental or hereditary disorder • Voluntary abortion – inability of parents to support or care for child; rape; mental incompetence; severe emotional problems

  32. Elective Abortion • Most women are: • Less than 24 years old • Unmarried • Caucasian • Using contraceptive but failed (60%) • Some women exhibit emotional stress after procedure • Influence from partner, family and friends

  33. First Trimester Abortion • Vacuum Aspiration • Most common • Suction curettage • Very quick procedure • Laminaria Tent • Dilates the cervix slowly • Reduces cervical lac. And bleeding

  34. Mifepristone (RU 486) • Can be used up to 5 weeks after conception • Early termination that is safe • Not readily available in US

  35. Methotrexate • Given IM • Followed by vaginal prostaglandin

  36. Misoprostil • Cytotoxic drug • No standard protocol • Up to 49 days of gestation

  37. 2nd Trimester Abortions • Dilation and Evacuation (D&E) • Can be performed up to 20 weeks • Usually done between 13-16 weeks • May have used laminaria prior to procedure • Nursing care and support

  38. Prostaglandin's • Inserted in suppository form or gel • May have side effects • May need repeated doses • Oxytocin

  39. Hypertonic solutions • Saline • May be injected directly into uterus • Amniocentesis • After several hours the labor begins, usually delivery in 24-72 hours

  40. Complications • Infection • Retained POC • Intrauterine blood clots • Continuing pregnancy • Cervical or uterine trauma • Excessive bleeding

  41. Infertility Chapter 10

  42. Infertility Definitions • Primary • Secondary • Sterility

  43. Female Problems • Anovulation • PCOS • Stress • POF • Tubal Factos • Uterine Factors • Vaginal-Cervical Factors

  44. Factors Contributing to Female Infertility and Diagnosis • Physical Exam • PID • Endometriosis • Ovarian Cysts • Fibroid Uterus, Uterine anomalies • Infection • Congenital Factors • PCOS • Hormonal Factors

  45. Exposure to reproductive hazard DES exposure in utero Menstrual cycle Surgical Hx Medical Hx Lab Data STI check FSH/LH/Estradiol TSH Prolactin level BS checked HSG Laparaoscopy Ultrasound Postcoital Tests Sperm Immobilization antigen-antibody reaction EMB Sperm penetration assay Serum assay of progest. BBT Cervical Mucous Diagnosis and Intervention

  46. Treatment • Psychosocial • Nonmedical • Ovulation kits • Treating ovulatory dysfunction • Clomid • Pergonal • Progesterone • Glucophage • hCG

  47. Surgical • Removal of fibroids, ovarian cysts • Laparoscopy/laparotomy • Microsurgery to reanastomose the tubes • HSG

  48. MORAL IVF-ET/TDI GIFT/ZIFT MORAL ETHICAL ETHICAL 1% OF BIRTHS 5% of IFERTILITY 1% OF BIRTHS IVF Legal issues Surrogacy, Intrauterine Insemination

  49. IVF-ET • Common • Expensive – $7800-$12,000 plus the cost of the meds for 1 cycle of IVF • Unexplained infertility • Embryos can be cryopreserved • Legality: Divorce, death, no longer desires embryos

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