Ward

strategies that reduce the risk of fertilization or implatation in an attempt to prevent pregnancy

• Ovulation begins 14 days before the onset of her period. and avoids intercourse during that period.
• Following ovulation mucus because thinner to allow sperm viability.avoid intercourse then.

• Must be used correctly in order to prevent pregnancy.
• do not use diaphram if had hx of TTS
• do not use latex condoms if have latex allergy.

• contain estrogen and progestin which suppresses avulation thicken mucus and alter uterine decidua
• -highly effective if taken correctly
• -decrease effectiveness if taken with antibiotics, anticonvulsants and meds that effect liver enzymes

• May need another form of Birthcontrol for first month of use.
• Safe to take while breastfeeding
• Increases occurence of ovarian cysts
• increases appetite
• -decrease effectiveness with antibiotics, anticonvulsants and those that effect liver enzymes
• -irregular vaginal bleeding, increased appitite, lowered libido

• Take within 72 hours of unprotected coitus
• Px fertilization
• does not terminate an established pregnancy
• if menstration does not start with in one week of taking then the patient may be pregnant.

• contains norelgestromin(progesterone) and ethinyl estradiol delivered in continuous levels through the skin into subcu tissue.
• -do not put on breast or brusises skin lesions.
• -avoids liver metabolism sincce not absorbed in gi tract

• injection given to client every 11-13 weeks
• maintain adequate intake of calcium and Vit D
• does not impair lactation
• use greater then 2 years
• decreases bone density
• -do not massage injection site.

• contains etonogestrel and ethinyl estradiol delivered vaginally continuously
• -some patients report discomfort during intercourse.
• -Bolood clots, stroke, HTN, heart attack, weight gain, nausea

• subdermal inner side of upper arm
• continuous for three years.
• -increased risk of ectopic pregnancy.

• inserted through the cerivix into the uterus. damages sperm in transit to uterine tubes
• -monitored monthly by client by palpating small string that hangs from device.
• -can maintain effectiveness for 10 years.
• -increased risk for ectopic pregnancy, pelvic inflammatory disease, uterine perforation
• -report signs of infection, bleeding, pain during intercourse.
• -risk for bacterial vaginosis uterine perforation or uterine expulsion.
• - contra in those who have not had a baby or are not in mongamous relationship

• small flexible agents inserted into the fallopian tubes
• -not effective for three months,
• -not reversible and requires no anesthesia

• permanent
• ectopic pergnancy risks if get pregnant.
• sexual fxn not impaired.
• alternate form of birth control must be used until vas deferens is clear

• -reduced menstral flow(amenorrhea)
• -weight gain breast tenderness
• -mild HTN or headache

• Age >35
• DX after 1 year of unprotected sex with no pregnancy
• Endocrine disorders(abnormal body fat, abnormal hair growth)
• Hx of abd. surgery, spontaneous abortion, alot of sex partners, STDs
• Over and under weight
• Environmaental exposures(teratogenic)

• encourage counseling, expressing of feelings, support groups.
• genetic counseling, provide information

amenorrhea, fatigue, N/V, urinary freq., breast changes, quickening(fluttering by fetus)uterine enlargment, linea nigra, chlosma( mask of pregancy) Striae gravidarum.

• -Abd. enlargement, cervical changes, Hegars sign(softening of the lower uterus)
• Chadwicks sign(violet blue color of the vaginal mucosa
• Goodells softening of the cervical tip
• Ballottment(rebound of unengaged fetus)
• fetal outline palpated by examiner

fetal heart sounds, US visualization, fetal movement.

• hCG(human chorionic gonadotropin)
• can be detected 6-11 days in serum and 26 days in urine. following implantation
• peaks at 60-70 days and declines to 80 days then increases again to term
• some meds can cause false positive.(anticonvulsants, diuretics, tranquilizers)
• use forsst voided specimen of morning

first day of last menstrual period subtract 3 months then add 7 days and one year

• measure fundal height in cm from symphysis to top
• gestational age is =to fundal height

• nulligravida=never pregnant
• Primigravida=first pregnancy
• Multigravida=2 or more pregnancies

• nullipara=no pregancy beyond viability
• primipara= one beyond
• multipara=2 or more beyond

• Gravidity=#of pregnancies
• Term Births=38 weeks or more
• Preterm births=20-37 weeks
• Abortions/miscarriage=<20 weeks
• Living children

• Cardiovascular:increases 45-50% HR increases
• Respiratory:Increases resp, decrease lung capacity
• Musculoskeletal:pelvic joints relax
• GI:constipation, N/V,
• Renal:filtration rate increases, urinary rate increases.

• BP same as prepregnancy for 1st tri
• -decreases 5-10 in 2nd
• -returns to prepreg after 20 weeks
• Pulse:increases 10-15 around 20 weeks
• Resps; increase 1-2

• Blood type, Rh factor(clients Rh- Coombs test repeated 24-28 weeks
• CBC, Hgb and Hct
• UA-pH specific gravity color, sediment protein, glucose, albumin, rbcs, wbcs,
• glucose tests.
• Pap, rubella titer, hepB STDs and HIV

N/V, breast tenderness, urinary freq, UTI, Fatigue, Heartburn, constipation, hemorrhoids, backaches, SOB, leg cramps, varicose veins and lower edema, gingivitis, nasal stuffiness, supine hypotension, braxton hicks

• gush of fluid(membrane rupture)
• vaginal bleeding
• Abd. pain
• changes in fetal activity
• persistant vomiting
• severe headache
• elevated temp
• dysuria
• blurred vision
• edema of face and hands
• epigastric pain
• flushed dry skin fruity breath(hyperglycemia)
• clammy pale skin, weakness tremors
• (hypoglycemia)

• Ultrasound:hi freq. sound waves
• -external and internal transvaginal
• -doppler flow(measures blood flow)
• Reasons for US:confirm pregnancy, gest age, maternal structures, placental grading, use with amniocentesis and biophysical profile
• :if patient has vaginal bleeding, decreased fetal movement, preterm labor, rupture of membranes
• Prep: have client drink 1-2 qts of fluid prior

• Biophysical Profile Use of real time US to visualize fetus amd observe responses to stimuli
• Use point system of 0-2 2 being good
• tests:FHR to nonstress test, breathing movements, gross body movements, fetal tone, amniotic fluid volume

• noninvasive procedure, doppler is used to monitor FHR and a tocotransducer used to monitor contractions when mom feels fetus move she pushes a buttin and then the trace is marked on the contraction sheet to determine FHR to Fetal movement
• Findings:reactive:if FHR is a normal baselinerate with moderate variablity accelerates 15 bpm for at least 15secs and occurs 2 or more times in 20min period
• Prep: semi fowlers position.
• anticipate CST(contraction stress test)
• , or BPP if nonreactive

• nipple stimulated for 2-3 minutes which causes pituitary gland to release oxytocin, stop nipple stim when experiences contraction
• -do not hyperstim uterus
• NEGATIVE CST is NORMAL FINDING
• =no late decelerations
• POSITIVE CST is ABNORMAL FINDING
• =late decelerations

• The aspriation of amniotic fluid
• preformed after 14 weeks
• reasons:maternal age >35
• previous birth with a chromosome abnormality
• parent is acarrier of chromosomal anomaly
• :L/S ratio is 2:1 =lung maturity
• reasons:
• meconium in fluid
• lung maturity assessment
• alpha fetoprotien

• Pregnancy terminated by week 20
• Types: threatened, inevitablem incomplete, complete, and missed
• Risks:maternal age, DM, chromosomal (50%)Trauma, injury, substance abuse, maternal infections
• Dx Procedures:US, Exam of cervix, D&C D&E
• refrain from sex for 2 weeks avoid pregnancy for 2 months

• abnormal implantationof the fertilized ovum outside of the uterus
• 2nd most leading cause of bleedig early in pregnancy
• Risks:pelvic inflammatory disease and IUD
• S/S: unilateral stabbing pain, dark red/brown in LAQ
• referred shoulder pain., N/V, shoch, hemorrhage, elevated WBC
• Meds:methotrexate:avoid alcohol consumption and folic acid to px toxicity

• grapelike clusters that makes the placenta swollen, fluid filled and the embryo fails to develop beyond a primitive state.
• rapid metastasizing malignancy
• types:Complete:paternally derived
• no genetic material, no placenta, 20%progress towards choriocarcinoma
• Partial:both materal and paternal fertilized by 2 or 1 sperm in which meiosis or chromosome reduction and divison do not occur
• 6% progress into choriocarinoma
• Risks:low protein intake, <18, >35
• S/S vag bleeding at 16 weeks.N/V

• occurs when placenta implants in the lower segment of the uterus. the abnormal implantation results in bleeding during the thrid trimester. as the cervix begins to dilate and efface
• Types: complete or total, incomplete or partial, marginal or low lying.
• Risks:Hx of placenta previa, uterine scarring, age>35, multifetal gestation, closely spaced pregnancies
• S/S painless bright red bleeding, soft relaxed uterus, fundal ht greater then usual, palpable placenta, decreasing urinary output
• Meds:corticosteroids(fetal lung maturation) anticipate cesearen birth.
• bedrest, blood replacement, nothing inserted into vagina

• premature separation of the placenta. occurs after 20 weeks, significant maternal and fetal morbidity, leading cause of maternal death
• Risk:maternal HTN, blunt trauma, cocaine abuse, smoking, short umbilical cord, multifetal prgnancy, high parity, advanced maternal age.
• S/S: sudden onset of intense localized uterine pain and bright red vaginal bleeding, board like abd. firm rigid uterus, hypovolumic shock.
• Tx:IV fluids, O2 8-10 via mask.
• give bllod and corticosteriods to develop fetal lungs.

• presence of fetal blood vessels crossing the amniotic membranes over the cervical os. high mortality fetal hemorrhage when cervix dilates,
• S/S:painless heavy bleeding, fetal brady.
• Tx:iv fluids, o2 8-10 mask, c