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Womens Health 9

Womens Health 9






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  • The International Agency for Research on Cancer (IARC), the cancer research agency of WHO, in its press release of the 29th of July 2005, informed of the publication of Monograph 91 on the carcinogenicity of combined estrogen-progestogen oral contraceptives (COC) and combined estrogen-progestogen menopausal therapy (HRT), based on the conclusions of an international Working Group of 21 scientists from 8 countries. Please see
    http://www.who.int/reproductivehealth/publications/ageing/cocs_hrt_statement.pdf and
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    Womens Health 9 Womens Health 9 Presentation Transcript

    • Chapter Nine Designing Your Reproductive Life Plan
    • Family Planning
      • Family Planning is more than a personal and family issue
      • It has health, social, and political implications
      • Women and children have been impacted by:
          • Governments
          • Religious bodies
          • Health care options
          • Political agendas
      • Women need access to a variety of reproductive options
    • Benefits of Family Planning
      • Contributes to decreasing poverty for women
      • Provides women more time to spend on education and job opportunities
      • Reduces the number of maternal and infant mortality
      • Reduces global population
      • Reduces the number of teens who give birth (unintended and premature births)
      • Provides adolescents with more opportunities to succeed in life
    • Reasons for Selecting a Birth Control Method
      • Availability of method
      • Prevent having children
      • Reduce STD risks
      • Religious doctrine
      • Decision-making process with partner
      • Health risks
      • Financial and emotional considerations for couples
      • User effectiveness rate
    • Birth Control Methods
      • Birth control methods are all strategies used to keep from having a baby and include the following:
          • Contraceptive methods
          • IUD’s
          • Emergency contraception
          • Abortion
      • Contraceptive choices are methods that prevent fertilization of the ovum such as:
          • Hormonal methods
          • Barrier methods
          • Sterilization
      See Table 9.1 for comparisons of effectiveness and cost
    • Abstinence
      • Abstinence is the only sure method of birth control to prevent an unintended pregnancy or unwanted STIs
      • Teenagers can be sexually intimate without risking pregnancy or STIs
      • The latest trend is showing a decline in Abstinence-only programs
      • These programs are not supported by peer reviewed research for prevention of STIs, HIV/AIDS, and unplanned pregnancies
      • Furthermore, no research studies have shown abstinence only education to be consistently effective in delaying sexual activity in teens
    • Fertility Awareness Methods See illustration on next slide Offers no protection against sexually transmitted diseases or infections
      • Cycle-based method (calculating the unsafe days of ovulation)
      • Basal temperature (raise in body temperature could result in ovulation)
      • Mucus (evaluate consistency of vaginal discharge to predict ovulation)
      • Sympothermal (combines basal type and mucus together)
      • Withdrawal (not a contraceptive method) penis is withdrawn from the vagina before ejaculation
      Natural Family Planning Methods
    • Fertility Awareness (See Figure 9.1)
    • Barrier Methods
      • Barrier methods prevent sperm from reaching the fallopian tubes, either by physical or chemical means
      • Barriers include the following:
          • Spermicides
          • Condoms
          • Diaphragms
          • Cervical caps
      • Barrier methods remain popular because of the protection they provide against HIV and other STIs
    • Barrier Methods, cont’d In a recent study, women who used a condom and N-9 gel had a 50% higher HIV infection rate vs. a condom and placebo gel
      • OTC products
      Vaginal Spermicides
    • Barrier Methods, cont’d N/A Silicone cup with air valve that fits over the cervix and comes in 1 size Cervical Shield 84-97% user rate effective Soft rubber cap, must be fitted by health care professional, used with spermicide Diaphragm 87-98% user rate effective Thimble shaped device fits over the cervix Cervical Cap 78-88% user rate effective OTC product Female condom 98% user rate effective OTC product Condom with Spermicide 86-90% user rate effective OTC product Male Condom
    • Hormonal Contraceptives
      • Hormonal contraceptives are convenient, effective, and reversible
      • However, they provide no protection against HIV and other STI’s
      • They are solely intended to prevent pregnancy
      • The primary methods available are:
          • Oral contraceptives
          • Norplant
          • Injections i.e. Depo-Provera, Lunelle
          • Patch
          • Ring
    • Oral Contraceptives
    • Oral Contraceptives
      • Oral contraceptives are considered the second most popular form of birth control in the United States
      • Works by primarily inhibiting ovulation through suppressing FSH and LH
      • Types:
          • Combination pills that contain estrogen and progestin
          • Progestin only types (mini-pill)
    • Health Benefits of OC’s
      • Research suggests that Oral contraceptives provide the following benefits:
          • Protection against epithelial ovarian and endometrial cancer
          • Lowered risk for ectopic pregnancies and PID
          • Lighter and less painful menstrual flow
          • Decreases in iron deficiency anemia
    • Health Risks Associated with OC’s
      • Estrogen use is associated with the following side effects:
          • Nausea
          • Breast pain and soreness
          • Fluid retention
      • Progestin-only pills are associated with:
          • Increased irregular menstrual cycles
          • Vaginal bleeding
      • Other risks with OC’s include:
          • Blood clots
          • Strokes
          • Changes in bone density
          • Reproductive cancers
    • Other Forms of Hormonal Contraceptives
      • Yasmin (contains synthetic progestin, drospirenone)
      • Transdermal Patch (skin patch containing progestin/estrogen)
      • NuvaRing (vaginal insert containing progestin/estrogen)
      • Lunelle (monthly hormone injection)
      • Implanon (progestin-only subdermal implant)
      • Depo-Provera (progestin injection once every 3 months)
    • Emergency Contraception
      • In 1998, the FDA approved the first combination pill (Preven)
      • A year later, a progestin pill was developed (Plan B)
      • ECP’s reduce the risk of pregnancies by delaying or inhibiting ovulation when taken within 120 hours of unprotected intercourse
      • Effective rates improve when taken earlier vs. later
      • ECP’s do not induce a medical abortion or affect the developing pre-embryos or embyros
      Emergency IUP insertion is also considered a choice within 5 days of Unprotected intercourse and reduces pregnancy risk by 99.9%
    • Contraindications for Hormonal Methods
      • If woman is pregnant
      • Active liver disease
      • Heart problems
      • Breast cancer
      • diabetes
      • Hypertension
      • Migraine headaches
      • Epilepsy
      • History of blood clotting
    • Intrauterine Devices
      • The WHO and the AMA have called the IUD one of the safest, most effective and least expensive reversible methods of birth control available
      • Past history with a faulty brand (Dalkon Shield, 1974) contributed to its lack of popularity in the U.S. as well as its stigma of being associated with abortion and PID’s
      • The method works by reducing the amount and ability of sperm to reach the egg
      • Other forms of IUD’s contain hormones, which allows the female to wear the IUD longer compared to others
    • Sterilization
      • Vasectomy – separation of the vas deferens
      • Tubal ligation – separation of the fallopian tubes
    • Maternal Mortality
      • Maternal mortality is defined as the death of a woman while pregnant
      • They are divided into direct and indirect obstetrical deaths
          • Direct: account for 80% of deaths and results from complications such as incorrect treatment, labor, pregnancy, or omissions, commonly due to hemorrhage
          • Indirect: result from previous existing diseases or diseases caused by the physiological complications of pregnancy e.g. anemia
      • The best mechanism to prevent maternal deaths is to improve the status of women
    • Infant Mortality
      • Infant mortality is defined as the deaths of infants under 1 year while neonatal mortality is under 28 days
      • Race and education are important indicators for infant mortality
      • The primary causes for neonatal and infant mortality are:
          • Congenital anomalies
          • Pre-term/low birth weight
          • SIDS
          • Respiratory Distress
          • Complications of Pregnancy
    • Pre-Pregnancy Planning
      • Non-drug use
      • Nutritional planning
      • Exercise
      • Time lapse of one menstrual cycle between contraceptive use and conception
      • Immunizations
      • Folic acid supplements
      • Quit smoking
      • Avoid alcohol beverages
      • Avoid OTC drugs
      • Avoid mega-dosing on nutritional supplements
      Pre-pregnancy planning encompasses the following:
    • Conception
      • Pregnancy begins with the union of the female egg and the male spermatozoa
      • A one cell zygote is formed, containing characteristics of both parents
      • The fallopian tubes provide the environment where cell division begins
      • After 3 days, the fertilized ovum is transported to the uterus
      • Once the chorionic villi cover the ovum, hCG (human chorionic gonadotropin) supports the endometrial growth
    • Amnion
      • The amnion surrounds the embryo before it starts to evolve
      • The amnion cavity is a fluid filled space between the amnion and the embryo
      • It keeps the fetus at an even temperature, cushions, and provides nourishment
      • By the 4 th month, it can be sampled (amniocentesis) for possible genetic abnormalities
    • Placenta
      • This is formed during the 3 rd month
      • The function is to supply food to the fetus and connects to the fetus through the umbilical cord
      • The placenta does the following tasks:
          • Transfer gases and nutrients
          • Excretes waste
          • Transport heat
          • Produces various proteins and hormones
          • Brings maternal and fetal blood close together but are completely separate
    • Early Signs of Pregnancy
      • A missed period
      • A light period or spotting
      • Tender, swollen breasts
      • Fatigue
      • Upset stomach
      • Vomiting
      • Feeling bloated
      • Frequent urination
      Most home pregnancy tests measure Human Chorionic Gonadotropin (hCG) to determine whether you are truly pregnant. Most tests are accurate.
    • Fetal Development Table 9.2 (First Trimester)
      • The heart beings to beat
      • Bones have appeared-head, arms, fingers, legs, and toes
      • The major organs and nervous systems are formed
      • The placenta is formed
      • Hair is starting to grow
      • 20 buds for future teeth have appeared
    • Fetal Development Table 9.2 (Second Trimester)
      • The fetus grows quickly from now until birth
      • The organs are developing further
      • Eyebrows and fingernails form
      • The skin is wrinkled and covered with fine hair
      • The fetus moves, kicks, sleeps and wakes, swallows, can hear, and can pass urine
      • By the end of this time, the fetus is 11-14 inches long and weighs about 2-2.5 lbs.
    • Fetal Development Table 9.2 (Third Trimester)
      • The fetus kicks and stretches, but as it gets bigger it has less room to move
      • Fine body hair disappears
      • Bones harden, but bones of the head are soft and flexible for delivery
      • The fetus usually settles in a good position for birth
      • At 40 weeks, the fetus will be full term. It is about 20 inches long and weighs 6-9 pounds
    • Pre-natal Care (First initial visit)
      • Discussion of maternal nutritional needs, exercise, and drug use
      • History of maternal, paternal, and family
      • Physical exam including ht./wt. and blood pressure
      • Exam of the reproductive organs
      • Estimation of the due date
      • Blood, urine ,and pap tests
    • Pre-natal Care (subsequent visits)
      • Physical exam including ht./wt. and blood pressure
      • Fetal heartbeat, growth, and position
      • Urine test for protein and sugar
      • Possible ultrasound, chorionic villus sampling, maternal serum screening, amniocentesis, anon stress test, a contraction stress test and a biophysical profile
      Weekly prenatal checkup are recommended after week 36
    • Labor Signs
      • Braxton Hicks contractions increasing in frequency and intensity
      • Lightening occurs
      • Amniotic sac ruptures
      • The 3 stages of labor are:
            • Uterine contractions 15-20 mins. w/ “bloody show” with full cervix dilation
            • Crowning of the fetus’ head to fetal expulsion
            • Placental separation and expulsion
    • Birthing Options
      • Midwives
      • Doulas
      • In-Hospital Deliveries
      • Birth Centers
      • Birthing Positions
    • Breast-feeding
      • Breast-feeding has prevented nearly 6 million infant deaths each year world-wide
      • Advantages are:
          • Inexpensive
          • Better nutritional quality
          • Ability to act as a birth control measure to limit fertility
          • Reducing ovarian and premenopausal breast cancer
          • Contains colostrum (initial milk produced by the mother) which helps fight infections
    • Potential Problems During Pregnancy
      • Ectopic Pregnancy
          • Tubal pregnancy
          • Occurs due to narrowing of the fallopian tubes
          • Can cause infertility and mortality
      • Hypertensive disorders
          • Preeclampsia-elevated blood pressure due to edema and/or proteinuria
          • Eclampsia-same as above except it progresses to convulsions and/or coma
    • Infertility
      • Health providers should determine the cause of having difficulty conceiving
      • Primary infertility is the inability of a woman to become pregnant within a year of having unprotected intercourse
      • Secondary infertility is the inability to carry the pregnancy to full term
      • The most common reasons for primary infertility in women are failure to ovulate or a damaged uterus or fallopian tube while men have low sperm or abnormal counts
    • Assisted Reproductive Technology (ART)
      • In vitro fertilization (IVF)
      • GIFT (gamete intrafallopian transfer)
      • ZIFT (zygote intrafallopian transfer)
      • ICSI (intercytoplasmic sperm injection)
        • The majority of these procedures are IVF (75%)
        • 69% were performed on women aged 30-39
        • The remainder were common among women aged 40 years or older
    • Other Procedures Used to Promote Motherhood
      • Donor eggs
      • Vasovasotomy
      • Artificial Insemination
      • Surrogacy
      • Somatic stem cells
    • Abortion – Termination of a Pregnancy
      • First Trimester Procedures
        • Menstrual extraction – withdraw endometrial tissue during the 4 th -6 th week
        • Vacuum aspiration – 6 th -9 th week procedure performed the most by dilating the cervix and removing uterine contents
        • D&C (Dilation & Curettage) - performed during 9 th -14 th week; dilation of cervix and scraping the wall of the uterine
        • RU486 (Mifepristone) – blocks the action of progesterone and doesn’t allow implantation to occur
    • Abortion – Termination of a Pregnancy, cont’d
      • Second Trimester Procedures
        • D&C (Dilation & Curettage) - performed during 13 th -15 th week; cervix is dilated and contents are removed by suction
        • Hypertonic Saline procedure – 16 th week procedure where saline is administered and the uterus is caused to expel contents
        • Prostaglandin procedure – hormones cause contractions to expel uterine contents
    • Adoption
      • Adoption is an alternative to assisted reproduction or abortion
      • Adoptions can be ‘open ‘ or ‘closed’`
      • Couples who are making the decision have a variety of issues to consider
      • Services can vary from matching children and adoptive parents to educational and support services throughout the parenting years
      See FYI: Facts on Adoption
    • Chapter Nine Designing Your Reproductive Life Plan