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April 16, 2012. NURS 330 Human Reproductive Health. Announcements. Office Hours Mondays, 5:30pm – 6pm SH C240 Class e-mail list Send your e-mail address by Mon, 4/23/12. Review 4/9/12 In-Class Assignment. Fertilization. Also referred to as conception Occurs in the Fallopian tube

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april 16 2012

April 16, 2012

NURS 330

Human Reproductive Health

announcements
Announcements
  • Office Hours
    • Mondays, 5:30pm – 6pm
    • SH C240
  • Class e-mail list
    • Send your e-mail address by Mon, 4/23/12
fertilization
Fertilization
  • Also referred to as conception
  • Occurs in the Fallopian tube
  • Oocyte = mature ovum is viable for

12-24 hours

  • Sperm are viable 3 to 5 days in woman’s body
the zygote
The zygote
  • Once fertilized, the egg is called a zygote.
  • Zygote travels four days to the uterus
    • Divides rapidly
  • Identical (Monozygotic) Twins
    • One egg fertilized by one sperm but divides into two separate masses
  • Fraternal (Dizygotic) Twins
    • Two separate eggs fertilized by two separate sperm
implantation
Implantation
  • The zygote continues to develop and becomes a blastocyst
  • The blastocyst floats around in the uterus for about 3 days before implanting itself in the uterine wall
  • Implantation, occurs 7 days after fertilization
length of pregnancy
Length of Pregnancy
  • 266 days (280 days after last normal menstrual period)
  • 40 weeks
embyronic period
Embyronic Period
  • From implantation until the 8th week of pregnancy (gestation), the blastocyst is now known as an Embryo
  • Embryo
    • Prenatal organism from implantation on uterine wall to 8th week of pregnancy
  • During this period, internal and external structures begin to form
the embyronic period cont
The Embyronic Period (cont)
  • Yolk sac
    • first element seen in the gestational sac during pregnancy, usually at 5 weeks gestation
  • Placenta
    • Develops at the site of implantation
    • Secretes human chorionic gonadotropin (hCG)
      • Effect on ovaries
      • Effect on corpus luteum
    • Nourishment, oxygen, elimination of waste products
  • Umbilical cord
    • Connects the developing embryo of fetus to the placenta
    • Waste products are removed from the fetus and nutrients are transported from the mother through the placenta
the embyronic period cont10
The Embyronic Period (cont)
  • Amniotic sac
    • Protective membrane around the fetus
  • Amniotic fluid
    • watery liquid surrounding and cushioning a growing fetus within the amnion.
    • allows the fetus to move freely without the walls of the uterus being too tight against its body.
fetal period
Fetal Period
  • From the 8th week of gestation to delivery, at about 40 weeks.
  • The embryo is now known as a fetus
  • When internal and external structures (organs that developed during the embryo period) grow and mature
prenatal sex differentiation cont
Prenatal Sex Differentiation (cont)
  • Nature is predisposed toward female development. Female development requires no added hormones.
  • For a male to develop, the testes must produce large amounts of testosterone between the 6th and the 12th week of the prenatal period.
  • For the vast majority, sex differentiation occurs flawlessly and normal genitalia develop. However, in rare instances, problems may occur.
prenatal care
Prenatal Care
  • Health care during pregnancy before the baby is born
  • Good prenatal care
    • Protects the mother’s health
      • Nutrition, diet, exercise
    • Enhance probability of having a healthy baby
pregnancy tests
Pregnancy Tests
  • All pregnancy tests look for a special hormone in the urine or blood that is only present when a woman is pregnant.
    • This hormone, human chorionic gonadotropin (hCG), is also called the pregnancy hormone.
  • Blood test detects HCG sooner than Urine tests
    • 7 days vs. 2 weeks
trimesters
Trimesters
  • First: 0 – 13 Weeks
  • Second: 14 – 26 Weeks
  • Third: 27 – 40 Weeks
early pregnancy signs and symptoms
Early Pregnancy Signs and Symptoms
  • Symptoms: missed period, breast tenderness, etc
  • Hegar’s Sign:
    • softening of the uterus just above the cervix, purplish hue of labia minora, vagina and cervix
pregnancy symptoms
Pregnancy Symptoms
  • First trimester
    • 2/3rds of pregnant women experience nausea, vomiting, fatigue and painful swelling of the breasts
  • Second trimester
    • Most nausea and vomiting subside, fetal movements = quickening
    • Braxton Hicks - False Labor
pregnancy symptoms18
Pregnancy Symptoms
  • During the third trimester
    • pressure on the internal organs causes heartburn, acid reflux and frequent urination.
    • Edema causes swelling of ankles, face, hands and feet.
diagnostic tests during pregnancy
Diagnostic Tests during Pregnancy
  • Amniocentesis
    • Genetic test - examination of chromosomes in amniotic fluid
    • Done during the 2nd trimester (weeks 14 and 20)
    • Recommended if:
      • woman is 35+
      • previous child has a chromosomal abnormality
  • Chorionic Villus Sampling
    • Genetic test – examination of tissue from the chorion of the placenta
    • Done during the 1st trimester (weeks 9 and 12)
    • Recommended if:
      • Woman is 35+
      • family history of an identifiable inherited genetic disorder
diagnostic tests during pregnancy21
Diagnostic Tests during Pregnancy
  • Ultrasound (Sonogram)
    • Picture of the internal structure of the fetus, can determine fetal age and location of the placenta.
    • Also used as a guide during amniocentesis and CVS
  • Alpha-fetoprotein (AFP):
    • Blood test - examination of the mother’s blood can detect spinal cord defects (spina bifida; also used to screen for Down’s Syndrome)
    • Done during weeks 15 and 18
postpartum period
Postpartum Period
  • The period consisting of the months or weeks immediately after childbirth.
  • It is a time when the woman adjusts, both physically and psychologically, to the process of childbearing
  • Marker events
    • Postpartum Blues
    • Postpartum Depression
    • Postpartum Psychosis
    • Breastfeeding
postpartum blues or baby blues
Postpartum blues or baby blues
  • Common – 50 – 70% women after pregnancy
  • State of short-term dysphoria that my accompany the feelings of happiness and excitement that follow the baby’s birth
  • Only lasts a few days
  • Symptoms include:

Bouts of crying Memory Lapses

Mild Confusion Mood swings

Irritability Fatigue

postpartum depression ppd
Postpartum Depression (PPD)
  • Not so common: 8% – 20% of women after pregnancy
  • More severe than baby blues.
  • Extreme sadness and feelings of worthlessness and inadequacy as a mother
  • May become suicidal
  • Most women improve on their own in 3 - 6 months
    • Others may require psychological intervention
  • Symptoms include:
    • Insomnia
    • Digestive problems
    • Unusual weight loss
postpartum psychosis
Postpartum Psychosis
  • Rare
  • Serious disorder that probably has underlying psychological causes
  • Requires psychological evaluation and treatment
  • Marked by extreme highs and lows
  • Symptoms
    • Extremely agitated
    • Paranoid
    • Delusions & hallucinations
breastfeeding
Breastfeeding
  • Facilitates uterine contractions
  • Colostrum
    • Produced in late pregnancy and for about 48 hours after birth
    • Contains no “milk”
    • Contains many nutrients and antibodies that are valuable for the newborn
pregnancy conditions complications
Spontaneous Abortion or Miscarriage

Ectopic Pregnancy

Incompetent Cervix

Preterm Labor

Low birth weight

Preeclampsia/Eclampsia

Gestational Diabetes

Placenta problems

Abruption, previa

Pregnancy Conditions/Complications
pregnancy conditions complications28
Pregnancy Conditions/Complications
  • High Risk Pregnancies:
    • Mother's health
    • Mother’s Age
      • Teenage mothers (17 and younger)
      • Mothers over 35 years of age
    • Health of the fetus (baby)
    • Complications unique to pregnancy
teratogens
Teratogens
  • Substances that can be dangerous to the health of the baby
  • Cause defects because they cross the placenta
  • Greatest teratogenic effect during the first trimester
slide30
Active Teratogens
  • Passive Teratogens
labor delivery preparing for labor
Labor & DeliveryPreparing for Labor
  • Woman may experience burst of energy
  • Lightening and engagement of fetus
    • descent of fetus into pelvic region
  • Cessation of weight gain
  • Dilation and effacement (thinning) of cervix
    • bloody show (due to bursting capillaries)
    • mucus plug expelled
  • Rupture of amniotic sac (the water breaking)
stage i
Stage I
  • Early phase
    • mild-moderate contractions dilate

cervix 0–3 cm

  • Active phase
    • moderate contractions dilate

cervix 3–7 cm

  • Transition
    • intense contractions dilate cervix 7–10 cm
stage ii
Stage II
  • Early or Rest phase
    • brief lull with no urge to push
  • Active or Decent phase
    • pushing during contractions
    • Moves baby down the birth canal
  • Transition or Crowning

and Birth phase

    • head and body delivered
stage iii stage iv
Stage III & Stage IV
  • Stage III
    • Placental phase
    • Placenta is delivered
  • Stage IV
    • Recovery phase
    • Mother and baby checked for complications
episiotomy
Episiotomy
  • The cutting of the perineum that allows more room for the baby to be delivered
drugs during labor
Drugs During Labor
  • Analgesics
    • Tranquilizers or narcotics
    • Help a woman relax and give some pain relief
  • Anesthesia
    • Lumbar epidural
    • Eliminates sensation from the belly down
    • May sometimes prolong or even stop labor
  • Risks associated with drugs
    • Can cross the placental barrier to the baby
    • Temporary side effects
      • Irregular or slowed heart beats
      • Higher rates of jaundice
      • Breathing problems
cesarean section
Cesarean Section
  • Most common when
    • fetus in the breech position
    • labor difficult or abnormal (dystocia)
    • fetus is distressed
    • woman had a previous c-section
breech positions
Breech Positions
  • By 36 weeks of pregnancy, most fetuses turn into a head-down, or vertex position. This is the normal and safest fetal position for birth.
  • A fetus with the feet, buttocks, or legs pointing down toward the cervix is said to be in breech position
  • Types
    • Complete
      • The buttocks are down near the birth canal
    • Frank
      • buttocks are in place to come out first during delivery
    • Footling
      • One leg (single footling) or both legs (double footling) are stretched out below the buttocks. The leg(s) are in place to come out first during delivery.
menopause
Menopause
  • Menopause is the medical term for the end of a woman's menstrual periods.
  • “Change of life.”
  • Average age: 51 years
    • As early as 40 years
    • As late as early 60s.
menopause41
Menopause
  • Natural
    • Occurs naturally after the woman’s supply of follicles has been depleted and menstruation ends completely
  • Surgical
    • Can be induced if the ovaries are surgically removed.
perimenopause
Perimenopause
  • This period usually begins a few years before the last menstrual cycle
  • May last a few years
perimenopause43
Perimenopause
  • Three stages of transition
    • Early
    • Middle
    • Late
early stage
Early Stage
  • Between ages 40 and 44
  • Marker:
    • Changes in menstrual flow
    • Changes in length of the cycle
    • Sudden surges in estrogen
middle stage
Middle Stage
  • Periods become irregular
  • Periods are NOT skipped
late stage
Late Stage
  • Women begin missing the periods until they finally stop.
  • Estrogen levels drop significantly
    • Triggers menopausal symptoms
    • Puts women at greater risk of certain conditions
estrogen depletion can lead to
Estrogen depletion can lead to:
  • Increase in heart disease
  • Loss of bone density
  • Memory loss
hormonal changes
Hormonal Changes
  • Ovaries
    • Stop producing estrogen and progesterone
    • Continue to produce small amount of testosterone
      • Can be converted to estrogen (estradiol) in fat
symptoms of menopause
Symptoms of Menopause
  • An array of symptoms, including:

-Hot flashes -Mood Changes

-Night sweats -Sexuality

-Heart pounding or racing -Forgetfulness

-Insomnia -Urine leakage

-Vaginal Dryness -Joint stiffness

  • Can last from six months to more than five years after the onset of menopause
remedies over the counter
Remedies: Over-the-counter
  • Non Steroidal Anti-Inflammatory Drugs (NSAIDs)
    • Painkillers such as aspirin, ibuprofen (Advil, Motrin)
    • Relief of menopausal symptoms
  • Lubricants
    • Vaginal dryness
  • Vitamin E
    • Helps with hot flashes
alternative therapies
Alternative Therapies
  • Acupuncture, meditation and relaxation techniques
  • Herbal or natural remedies
  • Pros
    • Some women report great benefits with these practices
  • Cons
    • Not regulated
    • Quality is not controlled
    • Some can contain toxic metals
dietary and lifestyle factors
Dietary and Lifestyle Factors
  • Mineral-rich Fruits and Vegetables
    • High in magnesium and potassium and can help preserve bones
    • Many help protect against heart disease and cancers
  • Effects of fiber
    • Important for the heart
  • Phytoestrogens
    • These are plant estrogens found in soy
    • Intake can result in lower risk for diseases associated with estrogen
  • Avoid fast foods and Limit salts
hormone replacement therapy hrt
Hormone Replacement Therapy (HRT)
  • Standard treatment for preventing many of the health problems that develop after menopause because of estrogen loss
  • May use estrogen alone or in combination with forms of progesterone
    • If hysterectomy – estrogen alone
    • If uterus is present – estrogen + progestin
hrt cont
HRT (cont)
  • Refers to providing a woman who has gone through menopause with hormones that her body has stopped producing.
  • Symptom relief in 80% of women
  • Does not prevent certain other problems associated with menopause such as thinning hair
how is hrt administered
How is HRT Administered?

1. Hormone Pills

  • most common form

2. Injections

  • Bypasses the liver

3. An estrogen-filled patch

  • Placed on the buttock or upper arm
  • Bypasses the liver

4. Implants

  • Placed under skin 2X per year; common in 1970s

5. Creams (estrogen & progesterone)

6. Vaginal Creams (estrogen only)

oral contraceptives
Oral Contraceptives??
  • Not suitable for replacement therapy
  • May reduce the risk of bone loss and alleviate early menopausal symptoms, such as hot flashes
  • Recommended and effective only during early stage.
benefits of hrt
Benefits of HRT
  • Relief of uncomfortable symptoms that may occur with menopause
    • Hot flashes, vaginal dryness, osteoporosis
  • Prevention of bone loss
    • improves balance; protects against falling
  • Improve cholesterol levels
  • Increasing blood flow and reducing blood pressure
    • Protects against stroke
  • Reduces risk of heart disease
  • Help prevent mental breakdown after menopause
risks for hrt
Risks for HRT
  • Depends on three factors:
    • treatment prescribed
    • whether the woman has a uterus
    • how long hormones are taken
      • with short-term therapy of less than 5 years, there appear to be few risks of treatment
risks of hrt
Risks of HRT
  • Breast cancer
  • Uterine Cancer & Other Reproductive Cancers
    • Estrogen alone
  • Heart Attack
    • Within the first two years in women with pre-existing conditions
  • Strokes
    • Within the first two years in women with pre-existing conditions
  • Blood clots
  • Endometriosis
side effects of hrt
Side Effects of HRT
  • Not medically serious but bothersome
  • Estrogen
    • breast tenderness, edema, nausea, headache, and breakthrough bleeding
  • Progestin
    • Fluid retention, acne, premenstrual-like symptoms, anxiety, depression, and irritability
who gets hrt
Who gets HRT?
  • Not every menopausal woman
  • First women should consider herbs, nutritional support, balanced diet, and exercise
  • HRT should come in second place and not last longer than five years
menopause and bone density
Menopause and Bone Density
  • Osteoporosis
    • Disease of the skeleton in which bones become brittle and prone to fracture
    • Bone loses density
    • Major risk factor for fracture in the spine and hip
  • After menopause
    • Extreme speed-up of bone breakdown (resorption)
male climacteric syndrome
Male Climacteric Syndrome
  • Male climacteric
    • Best name
    • Indicates a decline in testosterone
  • Aka Male Menopause
    • May be an inappropriate term as it indicates drop in hormones
  • Aka Aging Male Syndrome (AMS) or Andropause
  • Does not cause infertility
  • Occurs when testosterone production fall
  • Occurs in men ages 40 and 55
the role of testosterone
The role of Testosterone
  • A hormone that helps maintain sex drive, sperm production, pubic and body hair, muscle, and bone. Testosterone levels decrease over time. This decline is normal in healthy males as they age.
common symptoms of male climacteric syndrome
Symptoms as a result of a decline in testosterone levels

Depression, nervousness

Insomnia

Feeling fat/weight gain

Decreased libido

Erectile Dysfunction

Easily fatigued

Poor concentration and memory

Flushes and sweats

Common Symptoms of Male Climacteric Syndrome
diagnosis of testosterone deficiency
Diagnosis of Testosterone Deficiency
  • Testosterone Level Test
    • Test in the AM when testes produce more testosterone
  • Blood test
  • See an Endocrinologist, hormone specialist
testosterone replacement therapy
Testosterone Replacement Therapy
  • An option for men whose natural testosterone level is not within the normal range
  • Becoming increasingly popular but unsure of the following:
    • If it relieves symptoms of men with low testosterone.
    • how low testosterone levels affect men's health.
    • if testosterone therapy increases the risk of prostate cancer.
    • if testosterone therapy is safe
testosterone replacement therapy68
Testosterone Replacement Therapy
  • Benefits/Risks
    • Still being researched
reproductive health essay
Reproductive Health Essay
  • Due
    • 5/14/12 (in class AND on turnitin.com)
  • Set up Turnitin account
  • Essay Topic/Article Research
    • Sample articles will be sent via e-mail
  • Submit article for approval by 5/7/12
    • In class only. Will not be approved via email.
essay points scored as follows
Essay Points scored as follows:
  • Summary (10)
  • Identify and discuss Reproductive Health Issue (8)
  • Strengths/Weaknesses (10)
  • Moral /Ethical Issues (5)
  • Conclusion (7)
  • Grammar/Writing Ability (5)
  • Free of typographical Errors (5)
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