1. Different Methods of delivery:
1.) birthing chair – bed convertible to chair – semifowlers
2.) birthing bed – dorsal recumbent pos
3.) squatting – relives low back pain during labor pain
4.) leboyers – warm, quiet, dark, comfy room. After delivery, baby gets warm bath.
5.) Birth under H20 – bathtub – labor & delivery – warm water, soft music.
IX. Intrapartal Notes – inside ER
A. Admitting the laboring Mother:
Personal Data: name, age, address, etc
Baseline Data: v/s esppecially BP, weight
Obstetrical Data: gravida # preg, para- viable preg, – 22 – 24 wks
Physical Exams,Pelvic Exams
B. Basic knowledge in Intrapartum.
b. 1 Theories of the Onset of Labor
1.) uterine stretch theory ( any hallow organ stretched, will always contract & expel its content) – contraction action
2.) oxytocin theory – post pit gland releases oxytocin. Hypothalamus produces oxytocin
3.) prostaglandin theory – stimulation of arachidonic acid – prostaglandin- contraction
4.) progesterone theory – before labor, decrease progesterone will stimulate contractions & labor
5.) theory of aging placenta – life span of placenta 42 wks. At 36 wks degenerates (leading to contraction – onset labor).
b.2. The 4 P’s of labor
1. Passenger
a. Fetal head – is the largest presenting part – common presenting part – ¼ of its length.
Bones – 6 bones S – sphenoid F – frontal - sinciput
E – ethmoid O – occuputal - occiput
T – temporal P – parietal 2 x
Measurement fetal head:
1. transverse diameter – 9.25cm
- biparietal – largest transverse
- bitemporal 8 cm
2. bimastoid 7cm smallest transverse
Sutures – intermembranous spaces that allow molding.
1.) sagittal suture – connects 2 parietal bones ( sagitna)
2.) coronal suture – connect parietal & frontal bone (crown)
3.) lambdoidal suture – connects occipital & parietal bone
Moldings: the overlapping of the sutures of the skull to permit passage of the head to the pelvis
Fontanels:
1.) Anterior fontanel – bregma, diamond shape, 3 x 4 cm,( > 5 cm – hydrocephalus), 12 – 18 months after birth- close
2.) Posterior fontanel or lambda – triangular shape, 1 x 1 cm. Closes – 2 – 3 months.
4.) Anteroposterior diameter -
suboccipitobregmatic 9.5 cm, complete flexion, smallest AP
occipitofrontal 12cm partial flexion
occipitomental – 13.5 cm hyper extension submentobragmatic-face presentation
2. Passageway
Mom 1.) < 4’9” tall
2.) < 18 years old
3.) Underwent pelvic dislocation
Pelvis
4 main pelvic types
1. Gynecoid – round, wide, deeper most suitable (normal female pelvis) for pregnancy
2. Android – heart shape “male pelvis”- anterior part pointed, posterior part shallow
3. Anthropoid – oval, ape like pelvis, oval shape, AP diameter wider transverse narrow
4. Platypelloid – flat AP diameter – narrow, transverse – wider
b. Pelvis
2 hip bones – 2 innominate bones
3 Parts of 2 Innominate Bones
Ileum – lateral side of hips
- iliac crest – flaring superior border forming prominence of hips
Ischium – inferior portion
- ischial tuberosity where we sit – landmark to get external measurement of pelvis
Pubes – ant portion – symphisis pubis junction between 2 pubis
1 sacrum – post portion – sacral prominence – landmark to get internal measurement of pelvis
1 coccyx – 5 small bones compresses during vaginal delivery
Important Measurements
1. Diagonal Conjugate – measure between sacral promontory and inferior margin of the symphysis pubis.
Measurement: 11.5 cm - 12.5 cm basis in getting true conjugate. (DC – 11.5 cm=true conjugate)
2. True conjugate/conjugate vera – measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. Measurement: 11.0 cm
3. Obstetrical conjugate – smallest AP diameter. Pelvis at 10 cm or more.
Tuberoischi Diameter – transverse diameter of the pelvic outlet. Ischial tuberosity – approximated with use of fist – 8 cm & above.
3. Power – the force acting to expel the fetus and placenta – myometrium – powers of labor
a. Involuntary Contractions
b. Voluntary bearing down efforts
c. Characteristics: wave like
d. Timing: frequency, duration, intensity
4. Psyche/Person – psychological stress when the mother is fighting the labor experience
a. Cultural Interpretation
b. Preparation
c. Past Experience
d. Support System
Pre-eminent Signs of Labor
S&Sx:
- shooting pain radiating to the legs
- urinary freq.
1. Lightening – setting of presenting part into pelvic brim - 2 weeks prior to EDD
* Engagement- setting of presenting part into pelvic inlet
2. Braxton Hicks Contractions – painless irregular contractions
3. Increase Activity of the Mother- nesting instinct. Save energy, will be used for delivery. Increase epinephrine
4. Ripening of the Cervix – butter soft
5. decreased body wt – 1.5 – 3 lbs
6. Bloody Show – pinkish vaginal discharge – blood & leukorrhea
7. Rupture of Membranes – rupture of water. Check FHT
Premature Rupture of Membrane ( PROM) - do IE to check for cord prolapse
Contraction drop in intensity even though very painful
Contraction drop in frequently
Uterus tense and/or contracting between contractions
Abdominal palpations
Nursing Care;
Administer Analgesics (Morphine)
Attempt manual rotation for ROP or LOP – most common malposition
Bear down with contractions
Adequate hydration – prepare for CS
Sedation as ordered
Cesarean delivery may be required, especially if fetal distress is noted
Cord Prolapse – a complication when the umbilical cord falls or is washed through the cervix into the vagina.
Danger signs:
PROM
Presenting part has not yet engaged
Fetal distress
Protruding cord form vagina
Nursing care:
- Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy.
- Slip cord away from presenting part
- Count pulsation of cord for FHT
- Prep mom for CS
Positioning – trendelenberg or knee chest position
Emotional support
Prepare for Cesarean Section
Difference Between True Labor and False Labor
False Labor | True Labor |
Irregular contractions No increase in intensity Pain – confined to abdomen Pain – relived by walking No cervical changes | Contractions are regular Increased intensity Pain – begins lower back radiates to abdomen Pain – intensified by walking Cervical effacement & dilatation * major sx of true labor. |
Duration of Labor
Primipara – 14 hrs & not more than 20 hrs
Multipara – 8 hrs & not > 14 hrs
Effacement – softening & thinning of cervix. Use % in unit of measurement
Dilation – widening of cervix. Unit used is cm.
Nursing Interventions in Each Stage of Labor
2 segments of the uterus
1. upper uterine - fundus
2. lower uterine – isthmus
1. First Stage: onset of true contractions to full dilation and effacement of cervix.
Latent Phase:
Assessment: Dilations: 0 – 3 cm mom – excited, apprehensive, can communicate
Frequency: every 5 – 10 min
Intensity mild
Nursing Care:
- Encourage walking - shorten 1st stage of labor
- Encourage to void q 2 – 3 hrs – full bladder inhibit contractions
- Breathing – chest breathing
Active Phase:
Assessment: Dilations 4 -8 cm Intensity: moderate Mom- fears losing control of self
Frequency q 3-5 min lasting for 30 – 60 seconds
Nursing Care:
M – edications – have meds ready
A – ssessment include: vital signs, cervical dilation and effacement, fetal monitor, etc.
D – dry lips – oral care (ointment)
dry linens
B – abdominal breathing
Transitional Phase: intensity: strong Mom – mood changes with hyperesthesia
Assessment: Dilations 8 – 10 cm
Frequency q 2-3 min contractions
Durations 45 – 90 seconds
Hyperesthesia – increase sensitivity to touch, pain all over
Health Teaching : teach: sacral pressure on lower back to inhibit transmission of pain
keep informed of progress
controlled chest breathing
Nursing Care:
T – ires
I – nform of progress
R – estless support her breathing technique
E – ncourage and praise
D – iscomfort
Pelvic Exams
Effacement
Dilation
a. Station – landmark used: ischial spine
- 1 station = presenting part 1cm above ischial spine if (-) floating
- 2 station = presenting part 2 cm above ischial spine if (-) floating
0 station = level at ischial spine – engagement
+ 1 station = below 1 cm ischial spine
+3 to +5 = crowning – occurs at 2nd stage of labor
b. Presentation/lie – the relationship of the long axis (spine) of the fetus to the long axis of the mother
-spine of mom and spine of fetus
Two types:
b.1. Longitudinal Lie ( Parallel)
cephalic - Vertex – complete flexion
Face Brow Poor Flexion
Chin
Breech - Complete Breech – thigh breast on abdomen, breast lie on thigh
Incomplete Breech – thigh rest on abdominal
Frank – legs extend to head
Footling – single, double
Kneeling
b.2. Transverse Lie (Perpendicular) or Perpendicular lie. Shoulder presentation.
c. Position – relationship of the fatal presenting part to specific quadrant of the mother’s pelvis.
Variety:
Occipito – LOA left occipito ant (most common and favorable position)– side of maternal pelvis
LOP – left occipito posterior
LOP – most common mal position, most painful
ROP – squatting pos on mom
ROT
ROA
Breech- use sacrum LSA – left sacro anterior
- put stet above umbilicus LST, LSP, RSA, RST, RSP
Shoulder/acromniodorso
LADA, LADT, LADP, RADA
Chin / Mento
LMA, LMT, LMP, RMP, RMA, RMT, RMP
Monitoring the Contractions and Fetal heart Tone
Spread fingers lightly over fundus – to monitor contractions
Parts of contractions:
Increment or crescendo – beginning of contractions until it increases
Acme or apex – height of contraction
Decrement or decrescendo – from height of contractions until it decreases
Duration – beginning of contractions to end of same contraction
Interval – end of 1 contraction to beginning of next contraction
Frequency – beginning of 1 contraction to beginning of next contraction
Intensity - strength of contraction
Contraction – vasoconstriction
Increase BP, decrease FHT
Best time to get BP & FHT just after a contraction or midway of contractions
Placental reserve – 60 sec o2 for fetus during contractions
Duration of contractions shouldn’t >60 sec
Notify MD
Mom has headache – check BP, if same BP, let mom rest. If BP increase , notify MD -preeclampsia
Health teachings
1.) Ok to shower
2.)NPO – GIT stops function during labor if with food- will cause aspiration
3.)Enema administer during labor
a.)To cleanse bowel
b.)Prevent infection
c.)Sims position/side lying
12 – 18 inch – ht enema tubing
Check FHT after adm enema
Normal FHT= 120-160
Signs of fetal distress-
1.) <120 & >160
2.) mecomium stain amnion fluid
3.) fetal thrushing – hyperactive fetus due to lack O2
2. Second Stage: fetal stage, complete dilation and effacement to birth.
7 – 8 multi – bring to delivery room
10cm primi – bring to delivery room
Lithotomy pos – put legs same time up
Bulging of perineum – sure to come out
Breathing – panting ( teach mom)
Assist doc in doing episiotomy- to prevent laceration, widen vaginal canal, shorten 2nd stage of labor.
Episiotomy – median – less bleeding, less pain easy to repair, fast to heal, possible to reach rectum ( urethroanal fistula)
Mediolateral – more bleeding & pain, hard to repair, slow to heal
-use local or pudendal anesthesia.
Ironing the perineum – to prevent laceration
Modified Ritgens maneuver – place towel at perineum
1.)To prevent laceration
2.) Will facilitate complete flexion & extension. (Support head & remove secretion, check cord if coiled. Pull shoulder down & up. Check time, identification of baby.
Mechanisms of labor
- Engagement -
- Descent
- Flexion
- Internal Rotation
- Extension
- External rotation
- Expulsion
Three parts of Pelvis – 1. Inlet – AP diameter narrow, transverse diameter wider
2. Cavity
Two Major Divisions of Pelvis
- True pelvis – below the pelvic inlet
- False pelvis – above the pelvic inlet; supports uterus during pregnancy
Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that divides the false and true pelvis.
Nursing Care:
To prevent puerperal sepsis - < 48 hours only – vaginal pack
Bolus of Ptocin can lead to hypotension.
3. Third Stage: birth to expulsion of Placenta -placental stage placenta has 15 – 28 cotyledons
Placenta delivered from 3-10 minutes
Signs of placental separation
- Fundus rises – becomes firm & globular “ Calkins sign”
- Lengthening of the cord
- Sudden gush of blood
Types of placental delivery
Shultz “shiny” – begins to separate from center to edges presenting the fetal side shiny
Dunkan “dirty” – begin to separate form edges to center presenting natural side – beefy red or dirty
Slowly pull cord and wind to clamp – BRANDT ANDREWS MANEUVER
Hurrying of placental delivery will lead to inversion of uterus.
Nsg care for placenta:
- Check completeness of placenta.
- Check fundus (if relaxed, massage uterus)
- Check bp
- Administer methergine IM (Methylergonovine Maleate) “Ergotrate derivatives
- Monitor hpn (or give oxytocin IV)
- Check perineum for lacerations
- Assist MD for episiorapy
- Flat on bed
- Chills-due dehydration. Blanket, give clear liquid-tea, ginger ale, clear gelatin. Let mom sleep to regain energy.
4. Fourth Stage: the first 1-2 hours after delivery of placenta – recovery stage. Monitor v/s q 15 for 1 hr. 2nd hr q 30 minutes.
Check placement of fundus at level of umbilicus.
If fundus above umbilicus, deviation of fundus
1.) Empty bladder to prevent uterine atony
2.) Check lochia
a. Maternal Observations – body system stabilizes
b. Placement of the Fundus
c. Lochia
d. Perineum –
R - edness
E- dema
E - cchymosis
D – ischarges
A – approximation of blood loss. Count pad & saturation
Fully soaked pad : 30 – 40 cc weigh pad. 1 gram=1cc
e. Bonding – interaction between mother and newborn – rooming in types
1.) Straight rooming in baby: 24hrs with mom.
2.) Partial rooming in: baby in morning , at night nursery
Complications of Labor
Dystocia – difficult labor related to:
Mechanical factor – due to uterine inertia – sluggishness of contraction
1.) hypertonic or primary uterine inertia
- intense excessive contractions resulting to ineffective pushing
- MD administer sedative valium,/diazepam – muscle relaxant
2.) hypotonic – secondary uterine inertia- slow irregular contraction resulting to ineffective pushing. Give oxytocin.
Prolonged labor – normal length of labor in primi 14 – 20 hrs
Multi 10 -14 hrs
> 14 hrs in multi & > 20 hrs in primi
- maternal effect – exhaustion. Fetal effect – fetal distress, caput succedaneum or cephal hematoma
- nsg care: monitor contractions and FHR
Precipitate Labor - labor of < 3 hrs. extensive lacerations, profuse bleeding, hypovolemic shock if with bleeding.
Earliest sign: tachycardia & restlessness
Late sign: hypotension
Outstanding Nursing dx: fluid volume deficit
Post of mom – modified trendelenberg
IV – fast drip due fluid volume def
Signs of Hypovolemic Shock:
Hypotension
Tachycardia
Tachypnea
Cold clammy skin
Inversion of the uterus – situation uterus is inside out.
MD will push uterus back inside or not hysterectomy.
Factors leading to inversion of uterus
1.) short cord
2.) hurrying of placental delivery
3.) ineffective fundal pressure
Uterine Rupture
Causes: 1.)
1.)Previous classical CS
2.)Large baby
3.) Improper use of oxytocin (IV drip)
Sx:
a.) sudden pain
b.) profuse bleeding
c.) hypovolemic shock
d.) TAHBSO
Physiologic retraction ring
- Boundary bet upper/lower uterine segment
BANDL’S pathologic ring – suprapubic depression
a.) sign of impending uterine rupture
Amniotic Fluid Embolism or placental embolism – amniotic fluid or fragments of placenta enters natural circulation resulting to embolism
Sx:
dyspnea, chest pain & frothy sputum
prepare: suctioning
end stage: DIC disseminated intravascular coagopathy- bleeding to all portions of the body – eyes, nose, etc.
Trial Labor – measurement of head & pelvis falls on borderline. Mom given 6 hrs of labor
Multi: 8 – 14, primi 14 – 20
Preterm Labor – labor after 20 – 37 weeks) ( abortion <20 weeks)
Sx:
1. premature contractions q 10 min
2. effacement of 60 – 80%
3. dilation 2-3 cm
Home Mgt:
1. complete bed rest
2. avoid sex
3. empty bladder
4. drink 3 -4 glasses of water – full bladder inhibits contractions
5. consult MD if symptoms persist
Hosp:
1. If cervix is closed 2 – 3 cm, dilation saved by administer Tocolytic agents- halts preterm contractions.YUTOPAR- Yutopar Hcl)
150mg incorporated 500cc Dextrose piggyback.
Monitor: FHT > 180 bpm
Maternal BP - <90/60
Crackles – notify MD – pulmo edema – administer oral yutopar 30 minutes before d/c IV
Tocolytic (Phil)
Terbuthaline (Bricanyl or Brethine) – sustained tachycardia
Antidote – propranolol or inderal - beta-blocker
If cervix is open – MD – steroid dextamethzone (betamethazone) to facilitate surfactant maturation preventing RDS
Preterm-cut cord ASAP to prevent jaundice or hyperbilirubenia.
X. Postpartal Period 5th stage of labor
after 24hrs :Normal increase WBC up to 30,000 cumm
Puerperium – covers 1st 6 wks post partum
Involution – return of repro organ to its non pregnant state.
Hyperfibrinogenia
- prone to thrombus formation
- early ambulation
Principles underlying puerperium
1. To return to Normal and Facilitate healing
A. Physiologic Changes
a.1. Systemic Changes
1. Cardiovascular System
- the first few minutes after delivery is the most critical period in mothers because the increased in plasma volume return to its normal state and thus adding to the workload of the heart. This is critical especially to gravidocardiac mothers.
2. Genital tract
a. Cervix – cervical opening
b. Vaginal and Pelvic Floor
c. Uterus – return to normal 6 – 8 wks. Fundus goes down 1 finger breath/day until 10th day – no longer palpable due behind symphisis pubis
3 days after post partum: sub involuted uterus – delayed healing uterus with big clots of blood- a medium for bacterial growth- (puerperal sepsis)- D&C
after, birth pain:
1. position prone
2. cold compress – to prevent bleeding
3. mefenamic acid
d. Lochia-bld, wbc, deciduas, microorganism. Nsd & Cs with lochia.
1. Ruba – red 1st 3 days present, musty/mousy, moderate amt
2. Serosa – pink to brown 4 – 9th day, limited amt
3. Alba – créme white 10 – 21 days very decreased amt
dysuria
- urine collection
- alternate warm & cold compress
- stimulate bladder
3. Urinary tract: Bladder – freq in urination after delivery- urinary retention with overflow
4. Colon: Constipation – due NPO, fear of bearing down
5. Perineal area – painful – episiotomy site – sims pos, cold compress for immediate pain after 24 hrs, hot sitz bath, not compress
sex- when perineum has healed
II. Provide Emotional Support – Reva Rubia
Psychological Responses:
- Taking in phase – dependent phase (1st three days) mom – passive, cant make decisions, activity is to tell child birth experiences.
Nursing Care: - proper hygiene
- Taking hold phase – dependent to independent phase (4 to 7 days). Mom is active, can make decisions
HT:
1.) Care of newborn
2.) Insert family planting method
common post partum blues/ baby blues present 4 – 5 days 50-80% moms – overwhelming feeling of depression characterized by crying, despondence- inability to sleep & lack of appetite. – let mom cry – therapeutic.
- Letting go – interdependent phase – 7 days & above. Mom - redefines new roles may extend until child grows.
III. Prevent complications
- Hemorrhage – bleeding of > 500cc
CS – 600 – 800 cc normal
NSD 500 cc
I. Early postpartum hemorrhage– bleeding within 1st 24 hrs. Baggy or relaxed uterus & profuse bleeding – uterine atony. Complications: hypovolemic shock.
Mgt:
1.) massage uterus until contracted
2.) cold compress
3.) modified trendelenberg
4.) IV fast drip/ oxytocin IV drip
1st degree laceration – affects vaginal skin & mucus membrane.
2nd degree – 1st degree + muscles of vagina
3rd degree – 2nd degree + external sphincter of rectum
4th degree – 3rd degree + mucus membrane of rectum
Breast feeding – post pit gland will release oxytocin so uterus will contract.
Well contracted uterus + bleeding = laceration
- assess perineum for laceration
- degree of laceration
- mgt episiorapy
DIC – Disseminated Intravascular Coagulopathy. Hypofibrinogen- failure to coagulate.
- bleeding to any part of body
- hysterectomy if with abruption placenta
mgt: BT- cryoprecipitate or fresh frozen plasma
II. Late Postpartum hemorrhage – bleeding after 24 hrs – retained placental fragments
Mgt: D&C or manual extraction of fragments & massaging of uterus. D&C except placenta increta, percreta,
Acreta – attached placenta to myometrium. Increta – deeper attachment of placenta to myometrium hysterectomy
Percreta – invasion of placenta to perimetrium
Hematoma – bluish or purple discoloration of SQ tissue of vagina or perineum.
- too much manipulation
- large baby
- pudendal anesthesia
Mgt:
1.) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs
2.) shave
3.) incision on site, scraping & suturing
Infection- sources of infection
1.)endogenous – from within body
2.) exogenous – from outside
1.) anaerobic streptococci – most common - from members health team
2.) unhealthy sexual practices
General signs of inflammation:
1. Inflammation – calor (heat), rubor (red), dolor (pain) tumor(swelling)
2. purulent discharges
3. fever
Gen mgt:
1.) supportive care – CBR, hydration, TSB, cold compress, paracetamol, VITC, culture & sensitivity – for antibiotic
prolonged use of antibiotic lead to fungal infection
inflammation of perineum – see general signs of inflammation
2 to 3 stitches dislocated with purulent discharge
Mgt:
Removal of sutures & drainage, saline, between & resulting.
Endometriosis – inflammation of endometrial lining
Sx:
Abdominal tenderness, pos.
Fowlers – to facilitate drainage & localize infection oxytocin & antibiotic
IV. Motivate the use of Family Planning
1.) determine one’s own beliefs 1st
2.) never advice a permanent method of planning
3.) method of choice is an individuals choice.
Natural Method – the only method accepted by the Catholic Church
Billings / Cervical mucus– test spinnbarkeit & ferning (estrogen)
- clear, watery, stretchable, elastic – long spinnbarkeit
Basal Body Temperature 13th day temp goes down before ovulation – no sex
- get before arising in bed
LAM – lactation amenorrheal method – hormone that inhibits ovulation is prolactin.
breast feeding- menstruation will come out 4 – 6 months
bottle fed 2 – 3 months
disadvantage of lam – might get pregnant
Symptothermal – combination of BBT & cervical. Best method
Social Method – 1.) coitus interuptus/ withdrawal - least effective method
- coitus reservatus – sex without ejaculation –
- coitus interfemora – “ipit”
- calendar method
OVULATION –count minus 14 days before next mens (14 days before next mens)
Origoknause formula –
- monitor cycle for 1 year
- -get short test & longest cycle from Jan – Dec
- shortest – 18
- longest – 11
June 26 Dec 33
- 18 -11
8 - 22 unsafe days
21 day pill- start 5th day of mens
28day pill- start 1st day of mens
missed 1 pill – take 2 next day
Physiologic Method-
Pills – combined oral contraceptives prevent ovulation by inhibiting the anterior pituitary gland production of FSH and LH which are essential for the maturation and rupture of a follicle. 99.9% effective. Waiting time to become pregnant- 3 months. Consult OB-6mos.
Alerts on Oral Contraceptive:
-in case a mother who is taking an oral contraceptive for almost long time plans to have a baby, she would wait for at least 3 months before attempting to conceive to provide time for the estrogen and progesterone levels to return to normal.
- if a new oral contraceptive is prescribed the mother should continue taking the previously prescribed contraceptive and begin taking the new one on the first day of the next menses.
- discontinue oral contraceptive if there is signs of severe headache as this is an indication of hypertension associated with increase incidence of CVA and subarachnoid hemorrhage.
Signs of hypertension
Immediate Discontinuation
A – abdominal pain
C – chest pain
H - headache
E – eye problems
S – severe leg cramps
If mom HPN – stop pills STAT!
Adverse effect: breakthrough bleeding
Contraindicated:
1.) chain smoker
2.) extreme obesity
3.) HPN
4.) DM
5.) Thrombophlebitis or problems in clotting factors
- if forgotten for one day, immediately take the forgotten tablet plus the tablet scheduled that day. If forgotten for two consecutive days, or more days, use another method for the rest of the cycle and the start again.
DMPA – depoproveda – has progesterone inhibits LH – inhibits ovulation
Depomedroxy progesterone acetate – IM q 3 months
- never massage injected site, it will shorten duration
Norplant – has 6 match sticks – like capsules implanted subdermally containing progesterone.
- 5 yrs – disadvantage if keloid skin
- as soon as removed – can become pregnant
Mechanism and Chemical Barriers
Intrauterine Device (IUD)
Action: prevents implantation – affects motility of sperm & ovum
- right time to insert is after delivery or during menstruation
primary indication for use of IUD
- parity or # of children, if 1 kid only don’t use IUD
HT:
1.) Check for string daily
2.) Monthly checkup
3.) Regular pap smear
Alerts;
- prevents implantation
- most common complications: excessive menstrual flow and expulsion of the device (common problem)
- others:
P eriod late (pregnancy suspected)
Abnormal spotting or bleeding
A bdominal pain or pain with intercourse
I nfection (abnormal vaginal discharge)
N ot feeling well, fever, chills
S trings lost, shorter or longer
Uterine inflammation, uterine perforation, ectopic pregnancy
Condom – latex inserted to erected penis or lubricated vagina
Adv; gives highest protection against STD – female condom
Alerts:
Disadvantage:
- it lessen sexual satisfaction
- it gives higher protection in the prevention of STDs
Diaphragm – rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus. REVERSABLE
Ht:
1.) proper hygiene
2.) check for holes before use
3.) must stay in place 6 – 8 hrs after sex
4.) must be refitted especially if without wt change 15 lbs
5.) spermicide – chem. Barrier ex. Foam (most effective), jellies, creams
S/effect: Toxic shock syndrome
Alerts: Should be kept in place for about 6 – 8 hours
Cervical Cap – most durable than diaphragm no need to apply spermicide
C/I: abnormal pap smear
Foams, Jellies, Creams
Surgical Method – BTL , Bilateral Tubal Ligation – can be reversed 20% chance. HT: avoid lifting heavy objects
Vasectomy – cut vas deferense.
HT: >30 ejaculations before safe sex
O – zero sperm count, safe
