The Prenatal Journey pt 1

Primary prevention/intervention

health promotion

• disease prevention

• healthy habits

• vaccines

Secondary prevnetion/intervention

early detection

• pap smear

• mammogram

• pelvic exam

Tertiary prevention/intervention

health restoration

• inpatient or outpatient/treatment

• doula postpartum home care

Gynecologic information for adolescents (12-18)

common gynecologic problems

• menstrual irregularities

• pregnancy

• STIs

health promotion behaviors

• exercise/meds

• support system/role models

• contraception/sex education

Gynecologic information for young adults (19-39)

common gynecologic problems

• fertility

• endometriosis/vaginitis

• contraception/family planning

health promotion behaviors

• pre-conceptual education

• GYN evaluation

• contraception

Minimal intervention contraception types

• abstinence

• fertility awareness (FAM)

• lactational amenorrhea method (LAM)

Minimal intervention contraception effectiveness

• 71-75%

• LAM 98%

Minimal intervention contraception advantages

• no tools needed

• easy to start and stop

Minimal intervention contraception disadvantages

• planning/calculations

• high failure rate

• limited time of use

Barrier method contraception types

• condoms

• diaphragm/cervical cap

• sponge

Barrier method contraception effectiveness

80-85%

Barrier method contraception advantages

• no medications

• easy to start and stop

Barrier method contraception disadvantages

• fitting required

• messy

• require planning

• high failure rate

Hormonal contraceptive methods (combination) types

• daily pills

• weekly patch

• monthly ring

Hormonal contraceptive methods (combination) effectivness

95%

Hormonal contraceptive methods (combination) advantages

• cycle control

• treatment for GYN disorders

• easy to start and stop

Hormonal contraceptive methods (combination) disadvantages

• side effects (weight gain, mood, etc.)

• C/I (smokers w/ estrogen)

• effectiveness can be decreased w/ other meds (antibiotics, anti-TB, etc.)

Hormonal contraceptive methods (combination) action

suppress ovulation and thicken cervical mucus

Hormonal contraceptive methods (combination) SE

• DVT

• chest pain

• SOB

• worsening HA

• vision changes

Hormonal contraceptive methods (combination) contraindications

• stroke

• cardiac disease

• HA

• HTN

• smokers

Hormonal contraceptive methods (progestin ONLY) types

• daily mini pill (POP)

• injection (Depo) q3 months

• implant (Nexplanon) q3 years

Hormonal contraceptive methods (progestin ONLY) effectiveness

92-99%

Hormonal contraceptive methods (progestin ONLY) advantages

• no estrogen SE

• fewer C/I

• longer coverage (injection/implant)

Hormonal contraceptive methods (progestin ONLY) disadvantages

• unpredictable bleeding

• precise use required (POP)

• delay in fertility return after use (Depo)

• requires placement/removal procedure (Nexplanon)

IUD types

• progestin (Mirena, Skyla, Liletta, Kyleena) 3-5 years

• non-progestin (Paragard) 10 yrs

IUD effectiveness

98-99%

IUD advantages

• longer coverage

• minimal bleeding (progestin)

• normal menstrual cycle (non-progestin)

IUD disadvantages

• requires placement/removal procedure

• SE (weight gain, mood, etc.)

• risks/perforation

• irregular menses (progestin)

• heavy/painful menses (non-progestin)

Permanent contraceptive types

• bilateral tubal ligation (BTL)

• ESSURE (d/c)

• vasectomy

Permanent contraceptive effectiveness

96-99%

Permanent contraceptive advantages

• definitive procedure

  • are potential reversal procedures, but not guaranteed to work

• no hormonal SE

Permanent contraceptive disadvantages

• requires placement procedure/surgery

• definitive procedure

  • are potential reversal procedures, but not guaranteed to work

• compilations/SE (bleeding)

Clinical termination of pregnancy

performed to deliberately end a pregnancy before the fetus reaches a viable age

Pregnancy termination methods

medical

• mifeprex/methotrexate (tissue expulsion)

• usually done <9 weeks

surgical

• vacuum aspiration (elective, medically necessary)

• usually done <12 weeks

Pre-conceptual conseling

• average time of conception is 6 months

  • consider infertility with active cycle monitoring for >1 year

  • if the pt is >35 yrs, wait until 6 months for fertility consuleing

• lifestyle behaviors

Health promotion for pregnancy planning

• medication evaluation

• prenatal vitamins with folic acid

• genetic factors

Facilitating conception

• cycle/ovulation monitoring

• timed intercourse

Fertility

female factors

• ovulation

• anatomy/uterus (uterine fibroids, scar tissue, etc.)

male factors

• azoospermia = NO measurable sperm

Treatment for infertility

• address inhibiting factors

• facilitation/team approach

• assisted reproduction (IVF, IUI)

  • IVF eggs can be screened for genetic conditions before transfer

Presumptive signs of pregnancy

what does the pt feel?

• Period absent (amenorrhea)

• Really tired (fatigue)

• Enlarged breast

• Sore breast

• Urination increased

• Movement of fetus in uterus

  • quickening or fluttery sensation in lower abdomen

  • ~20th week for first time moms, may be a little earlier in 2nd+ time moms

• Emesis and nausea

Probable signs of pregnancy

what does the provider observe?

• Positive pregnancy test

• Returning of fetus against fingers when uterus is pushed during palpation (external ballottement)

• Outline of fetus can be palpated

• Braxton Hicks contractions (false labor)

• A softening of the cervix (Goodell’s sign)

• Bluish color to the vulva, cervix, vagina (Chadwick’s sign)

• Lower uterine segment becomes soft (Hegar’s sign)

• Enlarged uterus

Pregnancy tests

human chorionic gonadotropin (hCG)

• earliest biochemical marker of pregnancy

• pregnancy tests based on recognition of hCG or beta subunit of hCG

Positive signs of pregnancy

what do the tests confirm? ONLY explained by pregnancy

• Fetal movement felt by provider

• Electronic device detects fetal heart sounds (Doppler)

• The delivery of baby

• Ultrasound detects fetus

• See visible movement of baby by provider

Nagele’s rule

determines the due date of the baby

• first day of last menstrual period (LMP)

• subtract 3 months

• add 7 days (edit year if necessary)