HSC 160 Week 5 Notes
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Date Created: 02/14/16
HSC 160 WEEK 5 Reproductive Choices Chapter 5 Quiz (bold questions are iclicker questions) 1. What lubricant could you safely use with latex condom a. WATERBASED LUBRICANT 2. Why is it recommended to not use lamb skin condoms a. THEY DON’T PROTECT AGAINST STDS 3. What does it mean by the failure rates of contraceptive use? a. THE NUMBER OF TIMES A WOMEN GETS PREGNANT WHEN SHE DOESN’T WANT TO 4. Which of the following is a barrier contraceptive? a. FEMCAP 5. Twenty year old Emily is in her monogamous relationship with her boyfriend. She has a hard time remembering to take the pill. Which contraceptive would you recommend a. NEXPLANON 6. What is the most commonly used method of firsttrimester abortion a. SUCTION CURETTAGE 7. Toxic chemicals, pesticides, xrays, and other hazardous compounds causing birth defects are called: a. TERATOGENS 8. What prenatal test involves snipping tissue from the developing fetal sac? a. CHRIONIC VILLUS SAMPLING 9. In an ectopic pregnancy, the fertilized egg implants itself in the a. FALLOPIAN TUBE 10. The number of American couples who experience infertility is a. 1/10 ______________________________________________________________________________ 1. Barrier Methods a. Work on the principle of preventing sperm from reaching the egg by using a physical or chemical barrier during intercourse. b. Male Condom: thin sheath designed to cover erect penis and catch semen before it enters the vagina i. Latex, polyurethane, lambskin ii. Types of lubricant: foams, creams, jellies, or other waterbased lubricants iii. Advantages 1. 98% effective, prevent spread of STI’s and HIV iv. Disadvantages 1. Easy availability = potential for user error 2. Breakage, leakage, slipping c . Female Condom: single use, soft, loosefitting sheath for internal vaginal use made from nitrile. Flexible ring on each end for insertion and covering i. Advantages 1. 95% effective, prevents the spread of HIV and STI’s 2. Can be inserted before intercourse ii. Disadvantages 1. Potential for user error, breaking, slipping, leaking 2. Disruptive, noisy, and weird 3. Vaginal irritation 2. Other Barrier Methods a Spermicides i. Active ingredient is nonoxynol9 (N9) ii. Provide chemical barrier that kills sperm and a physical barrier that stops sperm from continuing toward egg iii . Jellies and creams 1. Come in tubes, foams, aerosol cans iv . Suppositories 1. Capsules inserted into the vagina that melt 2. Must be inserted 1020 minutes before intercourse but no more than 1 hour or they lose their effectiveness v . Vaginal Contraceptive Film 1. A thin film infused with spermicidal gel and inserted into the vagina that covers the cervix 2. Film dissolves into a spermicidal gel effective for up to 3 hours b. Advantages i. Most effective when used with another barrier method ii. Used alone = 7282% effective iii. Inexpensive and available over the counter c. Disadvantages i. Can be messy and must be reapplied for each act of intercourse ii. N9 does not prevent STI’s (gonorrhea, chlamydia, HIV) iii. Irritation / breaks down the mucous layer or skin of the genital tract d. Contraceptive Sponge i. Made of polyurethane foam and contains N9 ii. Before insertion it is moistened with water to activate spermicide, then folded and inserted into vagina covering cervix, creating a barrier against sperm e. Advantages i. 91 % effective when used consistently and correctly ii. Protections begins upon insertion and lasts for 24 hours f. Disadvantages i. Allergic reaction/ irritation ii. Increased risk of STI’s and yeast infections iii. Toxic Shock Syndrome (TSS) iv. Difficult to remove g . The Diaphragm i. First widely used birth control method for women ii. Soft, shallow cup made of latex and rubber that fits behind the pubic bone in front of the cervix iii. Must be used with spermicidal cream or jelly that is applied to the inside of the diaphragm before inserting h. Advantages 1. 94% percent effective if used consistently and correctly 2. Also offers protection against gonorrhea, chlamydia, and HPV 3. Can be used for multiple acts of intercourse i. Disadvantages 1. Diaphragm must stay in place for 68 hours afterward to allow the chemical to kill any sperm remaining 2. Insertion is awkward, easy to insert wrong, can slip out, be difficult to remove, and requires a fitting j . The Cervical Cap (FemCap) i. One of the oldest methods used to prevent pregnancy ii. Made of beeswax, silver, or copper. Now available in a clear silicone cup that fits over the cervix iii. Comes in 3 sizes and must be fitted by a practitioner iv. Held in place by suction created during application k. Advantages 1. Reasonably effective (up to 86%) 2. Protect against gonorrhea, HPV, and Chlamydia 3. Can be inserted before intercourse l. Disadvantages 1. Difficult to insert because of size and requires fitting 2. Can become dislodged during intercourse and placement must be checked frequently 3. Cannot be used during the menstrual period or for longer than 48 hours 3. Hormonal Methods: Oral Contraceptives a. Refers to birth control containing synthetic estrogen and progestin found naturally in women’s ovaries. Alters a women’s biochemistry, preventing ovulation (release of an egg) and makes it more difficult for sperm to reach egg b. Thickens cervical mucus, hindering sperm movement and thins the uterine lining, making it less likely for egg to implant in uterine wall 4. Oral Contraceptive (combination pills): a. Pills were first marketed in the 60’s, modern pill is 99% effective b. Taken in a cycle (3 weeks, 1 week placebo) c. Women can expect to have a menstrual period every 3 months i. Advantages 1. Highly effective at preventing, more than 99% 2. Easy to use with little user error 3. Does not interfere in lovemaking and lessen menstrual difficulties (cramps and PMS). Also have a lower risk of ovarian cancers, osteoporosis, ovarian cysts ii. Disadvantages 1. Increased risk of severe serious health problems among older woman (risk of blood clots, heart attack, stroke) 2. Spotting between periods, breast tenderness, nausea, acne, weight gain 3. Must be taken every day and price 5 . ProgestinOnly Pills (minipills) a. Pills only include progestin (28day packs) i. Advantages 1. Good choice for women at a high risk of estrogenrelated side effects or can’t estrogencontaining pills 2. Safe for women over 35 or breastfeeding mothers 3. 99% with perfect use and 91% with typical use ii. Disadvantages 1. Important to be taken each day at the same time 2. Irregular menstrual bleeding or spotting, mood changes, does not protect against STI’s 6. Hormonal Methods: The Path, Ring, Injections, and Implants a . Contraceptive Skin Path i. Ortho Evra: a square transdermal (through the skin) adhesive path 1. Advantages: a. 99.7 % effective with perfect use and hard for user to use wrong 2. Disadvantages a. Requires initial exam, prescription path changes, and ongoing monthly expense b. No protection against STI’s b . Vaginal Contraceptive Ring i. Nuva Ring: a soft, flexible plastic, 2 inch, hormonal contraceptive ring 1. Advantages: a. 99.7 % effective with normal use and 91% with typical use b. Less likelihood for user error and once inserted there isn’t anything to remember to keep up with 2. Disadvantages: a. Initial exam and prescription, monthly ring changes, ongoing monthly expense, and no protection against STI’s c . Contraceptive Injections i. DepoPovera (inserted intrmuscularly) and DepoSubQ Provera (injected just below the skin in lower dose ii. Prevent ovulation, thicken cervical mucus, and thin uterine linging 1. Advantages: a. Takes effect quickly, little room for user error, 99.8 % effective with perfect use. Can be used with breastfeeding 2. Disadvantages: a. Initial exam, prescription, and followup visits every 3 month b. No protection against STI’s d . Contraceptive Implants i. A singlerod implantable contraceptive, Nexaplon (Implanon) is a small, soft plastic capsule that is inserted just beneath the skin on the inner side of a woman’s arm 1. Advantages: a. Discreet, 99.95% effective, not subject to error, replaced only every 3 years 2. Disadvantages: a. insertion and removal must be performed by clinician b. Initial cost is high and may not be covered by health insurance c. No protection against transmission of STI’s 7. Intrauterine Contraceptives (IUD) a. A small, plastic, flexible device with a nylon string attached that I placed in uterus through the cervix and left there for 310 years at a time b. ParaGard, Mirena, and Skyla IUD’s i. ParaGard: Tshaped plastic device with a copper wrapped sheath, does not contain any hormone, and can be left for 10 years ii. Mirena: effective for 5 years and releases small amounts of progestin 1. Advantages: safe, discreet, highly effective (99%), immediately effective, only replaced every 310 years, no hormones can be used while breast feeding 2. Disadvantages: discomfort, cost of insertion, potential complications a. Does not protect against STI’s b. Recommended only for women who have had children 8. Emergency Contraceptive a. Emergency Contraceptive Pills (ECPs) i. “morning after pills” (NOT the abortion pill) 1. ECPs will not harm an existing pregnancy, and are not to be confused with the "abortion pill", which is used to terminate a pregnancy that is already established. ii. Prevent pregnancy by delaying or inhibiting ovulation, inhibiting fertilization, or blocking implantation of fertilized egg iii. 99% of sexually active women have used at least one form of birth control 9. Behavior Methods and Fertility Awareness Methods a. Some methods require more selfcontrol, diligence, and commitment i. Withdrawal: involves removing penis from the vagina just prior to ejaculation ii. Abstinence: deliberately avoiding intercourse 1. The only method that is 100% effective for avoiding pregnancy iii . Fertility Awareness Methods (FAMs) 1. Rely on altering sexual behavior during certain times of the month a. Cervical Mucus Method: tracking changes in vaginal secretions b. Body Temperature Method: requires tracking subtle changes in woman’s basal body temperature c. Calendar Method: recording the menstrual cycle for 12 months b . Fertility Cycle (28day Cycle) i. Menstruation: relatively safe for unprotected intercourse (days 15) ii. Sperm deposited during this period may remain viable at ovulation (days 68) iii. Unprotected Intercourse should not happen (days 913) iv. Ovulation (day 14) v. Unprotected Intercourse should not happen (days 1516) vi. Ovum may remain viable through this point (days 1718) vii. Relatively safe for unprotected intercourse (days 1928) 10. Surgical Methods a. Sterilization: (second leading method of contraception for women of all ages) i . Female Sterilization 1. Tubal ligation: fallopian tubes are sealed to block sperm access to released eggs 2. Hysterectomy: removal of the uterus (requires major surgery) a. Advantages: i. 99.5% effective, permanent, and once done there is no more cost b. Disadvantages: i. Surgical risks, expenses, lost protection against STI’s ii . Male Sterilization 1 . Vasectomy a. Frequently done on an outpatient basis, involves cutting the vasa deferentia b. Advantages: i. Highly effective and permanent c. Disadvantages: i. No protection against STI’s and surgical risk 11. Abortion a. During the first trimester of pregnancy, a woman and her practitioner have the right to terminate the pregnancy through abortion without legal constrictions i. Can lead to mother death via hemorrhaging, infection, or infertility from internal scarring ii . Methods of abortion 1. Surgical abortions: a. (Majority of abortions in US) if preformed in first trimester = relatively low health risk b. Suction curettage: (most common method in first trimester) also called “vacuum aspiration” 2. Dilation and Evacuation (D&E) a. (for pregnancies in second trimester) b. Cervix is dilated for 12 days, combination of instruments and vacuum aspiration to empty uterus c. Causes: moderatesevere uterine cramping and blood loss 3. Induction Abortion: a. (for third trimester) “partial birth abortion” i. Not legal in US ii. Risks: infection, excessive bleeding, cervical/uterine trauma 4. Medical Abortion a. Preformed without entering the uterus i. Mifepristone: 1. A steroid hormone that induces abortion by blocking the action of progesterone 2. More than 99% of women experience a complete abortion when used in the early stages of pregnancy 12. Planning a Pregnancy a . Emotional Health i. Ask yourself the questions that clarify you are ready for pregnancy: 1. EX: “Do you have enough social support?” or “Are you ready to make those sacrifices?” b . Maternal Health i. Factors that can Affect the Fetus: 1. Drug use / alcohol abuse 2. Age of the mother 3. Toxic chemicals / unbalanced diets c . Paternal Health i. Father needs to consider all of the above as well in order to create a healthy baby d . Financial Evaluation e . Contingency Planning i. Plan what would happen to the child in the event that both parents would pass away 13. The Process Of Pregnancy a. From Ovulation to Implantation b. Fertilization usually occurs in the upper 1/3 of the fallopian tube c. Implantation takes place in uterus about 6 days later i. At ovulation 1. A mature ovum is released from the ovary and begins moving down the fallopian tube a. Surrounded by the zona pellucida ( a thick inner membrane and outer layer of cells ) ii. Sperm 1. The efforts of hundreds of sperm may allow one sperm to penetrate the corona radiate and zona pellucida 2. This step is “fertilization” iii. Zygote 1. The sperm nucleus fuses with the egg nucleus at fertilization a. This produces a “zygote” i. The combination of male and female genetic material occurs 2430 hours after iv. Dividing of Cells 1. As the zygote travels down the fallopian tube towards the uterus; cells are rapidly dividing v. Blastocyst 1. Occurs after 6 days: zygote becomes a “blastocyst” 2. Attaches itself to the uterine lining (endometrium) vi. Implantation 1. The blastocyst implants itself into the endometrium 2. About day 11 or 12 d. Early Sign of Pregnancy i. Missed menstrual cycle (or spotting) ii. Tender breasts iii. Emotionally upset iv. Extreme fatigue v. Sleeplessness vi. Nausea or vomiting e. First Trimester i. (first 2 months) the embryo differentiates and develops its various organ systems (nervous and circulatory systems) f. Second Trimester i. Physical changes in mother begin to become visible ii. Placenta: (the network of blood vessels that carries nutrients and oxygen to fetus and fetal waste products) is established g. Third Trimester i. (months 69) ii. Period of most fetal growth / depends on mother for nutrition and requires large amounts of: 1. Calcium 2. Iron 3. Protein 14. Changes in a Woman’s Body During Pregnancy a. Respiratory rate and total blood volume increase b. Diaphragm rises as abdominal organs press against it c. Production of urine increases d. Requirements for nutrients increase e. Ligaments between pelvic bones widen/ become more flexible f. Breasts enlarge as milk glands increase in size g. Nipples/areolas enlarge and darken h. Uterus enlarges to 5060 times original size i. Navel is pushed out