Presentation on theme: "C ATHERINE R AMOS M ARIN, MSN/ ED (C), WHCNP, RN."— Presentation transcript:
C ATHERINE R AMOS M ARIN, MSN/ ED (C), WHCNP, RN
D EMOGRAPHICS 62% of women practice contraception 31% do not because they are not sexually active, are infertile, are pregnant or trying to get pregnant 7% at risk of becoming pregnant, not using contraceptive Half of all pregnancies are unintended 4 in 10 are terminated by abortion
C HOOSING A M ETHOD OF C ONTRACEPTION 2 leading methods: pill for women < 30 y.o. and sterilization for women over 35 Made with full knowledge of advantages and disadvantages, effectiveness, side effects, contraindications and long term effects Cultural practices, religious beliefs, personality, cost, practicality of method, and self-esteem Consistency of use outweighs the reliability of the method chosen
C ONTRACEPTION M ETHODS Abstinence: refrain from sexual intercourse associated to just saying “no” most effective method abstinence during fertile periods can be used but requires an understanding of the menstrual cycle eliminates the risk of sexually transmitted infections if there is no genitalia contact Coitus Interruptus: withdrawal of the entire penis from the vagina before ejaculation. significant means of fertility control in the developing countries, effectiveness dependent on the man’s ability to withdraw prior to ejaculation
C ONTRACEPTION M ETHODS Lactational Amenorrhea: elevated prolactin levels and decrease of gonadotropin- releasing hormone during lactation suppress ovulation, duration of suppression varies and is influenced by the frequency and duration of breastfeeding Disadvantages: return to fertility is uncertain, should not be used if the mother is HIV positive Calendar Method: a woman records her menstrual cycle, calculates the fertile period based on the assumption that ovulation occurs roughly 14 days before the onset of the next menstrual cycle, and avoids intercourse during that time Note: sperms are viable for 48 to 120 hr and ovum is viable for 24 hrs. Most useful when used together with BBT or the cervical mucus method, inexpensive
C ONTRACEPTION M ETHODS Basal Body Temperature: temperature will drop prior to ovulation, increase a full degree at ovulation woman will take her oral temperature prior to getting out of bed each morning to monitor ovulation, inaccurate interpretation of temperature changes such as stress, fatigue, illness, alcohol, and warmth or coolness of sleeping environment Billings Method (cervical mucus method): ovulation occurs 14 days prior to next menstruation, following ovulation, the cervical mucus becomes thick and sticky under the influence of estrogen and progesterone to allow sperm viability and motility mucus could stretch between fingers: greatest time at ovulation…known as spinnbarkeit sign.
C ONTRACEPTION M ETHODS Condoms: a flexible sheath worn on the penis during intercourse to prevent semen from entering the uterus protects against sexually transmitted disease and involves the male in the birth control method, those made of latex should not be worn by those who are sensitive or allergic to latex, only water-soluble lubricants should be used to avoid condom breakage. Diaphragm: dome-shaped cup with a flexible rim made of latex or rubber that fits snuggly over the cervix with spermicidal cream or gel placed into the dome and around the rim female client has to be fitted with diaphragm properly by a primary care provider must be refitted every two years or if there is a significant change in weight (7 Kg), after full term pregnancy, or second term abortion Disadvantages: inconvenient, requires reapplication of spermicidal gel/cream with each act of coitus to be effective not recommended for those with history of Toxic Shock Syndrome (TSS) or frequent urinary infection
C ONTRACEPTION M ETHODS Combined oral contraceptives: hormonal contraception containing estrogen and progestin which acts by suppressing ovulation, thickening of cervical mucus to block the semen, and altering the uterine deciduas to prevent implantation medication requires prescription and follow-up appointments, instruct clients the side effects and danger signs: chest pain, shortness of breath, leg pain from a possible clot, headache, or eye problems from a CVA or hypertension Meds can alleviate dysmennorhea by decreasing menstrual flow and menstrual cramps, reduces acne Exacerbates conditions affected by fluid retention such as migraine, epilepsy, asthma, kidney, or heart disease Minipill: oral progestins that provide the same action as combined oral contraceptives, should take the pill at the same time daily to ensure effectiveness, has fewer side effects, less effective in suppressing ovulation a pill, will need another form of birth control during the first month of use to prevent pregnancy, has fewer side effects, less effective in suppressing ovulation
C ONTRACEPTION M ETHODS Emergency Oral Contraceptives- morning after pill, taken within 72 hrs. after unprotected coitus a provider will recommend an OTC antiemetic to be taken 1 hr prior to each dose to counteract the side effects of nausea that can occur with high doses of estrogen and progestin provide client counseling, pill is not taken on a regular basis, not used when there is undiagnosed abnormal vaginal bleeding Transdermal Contraceptive Patch: contains norelgestromin (progesterone) and ethinyl estradiol, which is delivered at continuous levels through the skin into the subcutaneous tissue apply on a subcutaneous tissue in areas of buttocks, abdomen, upper arm, or torso excluding breast area
T RANSDERMAL C ONTRACEPTIVE P ATCH & E MERGENCY P ILL
C ONTRACEPTION M ETHODS Injectable progestins (Depo-Provera) : an intramuscular injection given to a female client every 11 to 13 weeks start injection during the first 5 days of the client’s menstrual cycle and every 11 to 13 weeks thereafter very effective and only requires four injections a year, does not impair lactation do not massage the area of injection following administration to avoid accelerating medication absorption Implantable progestin levonorgestrel (Norplant): requires a minor surgical procedure to subdermally implant or remove 6 Silastic capsules containing levonorgestrel on the inner aspect of the upper arm avoid trauma on the area of implantation effective continuous contraception for 5 years reversible can cause irregular menstrual bleeding
C ONTRACEPTION M ETHODS Intrauterine Device (IUD): chemically active T-shaped device inserted through the woman’s cervix and placed in the uterus by the primary care provider, releases a chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization device monitored monthly by the client after menstruation to assure the presence of the small string that hangs from the device into the upper part of the vagina to rule out migration or expulsion of the device can maintain effectiveness for 1 to 10 years, can increase the risks of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy, there is a risk of bacterial vaginosis Female sterilization (Bilateral tubal ligation): a surgical procedure requiring anesthesia that may be local or general permanent contraception, sexual function unaffected risk of ectopic pregnancy if pregnancy occur.
C ONTRACEPTION M ETHODS Male sterilization (vasectomy): a surgical procedure consisting of ligation and severance of the vas deferens, scrotal support needed after the procedure sterility delayed until proximal portion of the vas deferens is cleared of all the remaining sperm (approximately 20 ejaculations) a permanent contraceptive method sexual function not impaired.
E LECTIVE T ERMINATION (I NDUCED A BORTION ) Procedure performed to end a pregnancy before viability AKA therapeutic, medical, or induced abortions A woman’s choice, should not be viewed as a method of contraception but as a remediation for failed contraception
L EGAL B ACKGROUND 1973, US Supreme Court legalized abortion as long as the pregnancy is less than 12 weeks Individual states can regulate second trimester termination and prohibition of third trimester termination that are not life-threatening One half of unintended pregnancies end with elective termination (CDC, 2009).
S URGICAL I NTERRUPTION OF P REGNANCY Widely used is vacuum curettage Major risks: perforation of uterus, laceration of cervix, hemorrhage, infection Unwanted or unintended pregnancy, sexual assault, lack of finances, maternal or fetal health Assess for need for support and counseling, post procedure support Provide information about the methods of abortion and associated risks, available alternatives to abortion, encourage verbalization of her feelings Provide physical comfort and privacy Post-abortion check-ups and contraception review
M EDICAL I NTERRUPTION OF P REGNANCY RU 486 or mifepristone (Mifeprex) FDA approved in 2000: to medically induce abortion during the first 7 weeks of pregnancy Oral dose taken at the MDs office and then 1-3 days later she returns to MD, and takes an oral or vaginal dose of prostaglandin misoprostol- induce contractions that expel the embryo/fetus
I NFERTILITY Lack of conception despite unprotected sexual intercourse for at least 12 months Sterility: an absolute factor preventing reproduction Subfertility: difficulty conceiving because both partners have reduced fertility Secondary infertility: unable to conceive after one or more pregnancies 16% of couples in their reproductive years bin the US are infertile
I NFERTILITY Male factor: 40% Female factor: 40% Unknown cause: 20% Professional intervention can help: 65%
I NITIAL I NVESTIGATION Use the easiest and least intrusive infertility testing first Gather data re: timing and length of intercourse, signs of ovulation, comprehensive health history, obvious causes in infertility 40% of infertility is related to male factor, semen analysis is done first Initiate preconception counseling Prenatal vitamins often the earliest recommendation, plus folic acid supplemenation(400 mcg) to reduce incidence of neural tube defects like anencephaly and spina bifida Discuss the risks associated with alcohol, tobacco, and medications Discuss the importance of rubella and varicella immunity
W AYS TO I MPROVE F ERTILITY Avoid douching and artificial lubricants that can alter sperm mobility Promote retention of sperm (male superior position, female remain recumbent at least 20-30 min) Avoid leakage of sperm (elevate the woman’s hips with a pillow after intercourse for 20-30 min) Maximize potential for fertilization (every other day during fertile period) Avoid emphasizing conception to decrease anxiety and sexual dysfunction Maintain adequate nutrition and reduce stress Seek counsel and advice from a valued friend or family member Consider incorporating culturally appropriate methods to enhance fertility
P OSSIBLE C AUSES OF I NFERTILITY (F EMALE ) 1. Favorable cervical mucus 2. Clear passage b/w cervix and tubes 3. Patent tubes with normal motility Cervicitis, cervical stenosis, use of coital lubricants, antisperm antibodies Myomas, adhesions, adenomyosis, polyps, endometritis, cervical stenosis Pelvic inflammatory disease, peritubal adhesions, IUD
P OSSIBLE C AUSES OF I NFERTILITY Ovulation and release of ova Endometrial preparation Primary ovarian failure, polycystic ovarian disease, hypothyroidism, pituitary tumor, periovarian tumor, lactation Anovulation, luteal phase defect, malformation, uterine infection
P OSSIBLE C AUSES OF I NFERTILITY (M ALE ) 1. Normal semen analysis congenital defect in testicular development, mumps after adolescence, gonadal exposure to Xrays, chemotherapy, smoking, alcohol abuse, constrictive underclothing
P OSSIBLE C AUSES OF I NFERTILITY Unobstructed genital tract Normal genital tract secretions Ejaculate deposited at the cervix infections, tumors, vasectomy, strictures, trauma Infections, autoimmunity to semen, tumors Premature ejaculation, impotence, hypospadias, obesity
N ORMAL S EMEN A NALYSIS 1. Volume 2. pH 3. Total sperm count 4. Motility 5. Normal forms Greater than 2 ml 7 to 8 Greater than 20 million/ml 50% or greater forward progression 30% or greater