NURS 330

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April 16, 2012

• NURS 330
• Human Reproductive Health

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Announcements

• Office Hours
• Mondays, 530pm 6pm
• SH C240
• Class e-mail list
• Send your e-mail address by Mon, 4/23/12

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Review 4/9/12 In-Class Assignment      

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Fertilization

• Also referred to as conception
• Occurs in the Fallopian tube
• Oocyte mature ovum is viable for
• 12-24 hours
• Sperm are viable 3 to 5 days in womans body

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The zygote

• Once fertilized, the egg is called a zygote.
• Zygote travels four days to the uterus
• Divides rapidly
• Identical (Monozygotic) Twins
• One egg fertilized by one sperm but divides into
  two separate masses
• Fraternal (Dizygotic) Twins
• Two separate eggs fertilized by two separate
  sperm

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Implantation

• The zygote continues to develop and becomes a
  blastocyst
• The blastocyst floats around in the uterus for
  about 3 days before implanting itself in the
  uterine wall
• Implantation, occurs 7 days after fertilization

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Length of Pregnancy

• 266 days (280 days after last normal menstrual
  period)
• 40 weeks

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Embyronic Period

• From implantation until the 8th week of pregnancy
  (gestation), the blastocyst is now known as an
  Embryo
• Embryo
• Prenatal organism from implantation on uterine
  wall to 8th week of pregnancy
• During this period, internal and external
  structures begin to form

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The Embyronic Period (cont)

• Yolk sac
• first element seen in the gestational sac during
  pregnancy, usually at 5 weeks gestation
• Placenta
• Develops at the site of implantation
• Secretes human chorionic gonadotropin (hCG)
• Effect on ovaries
• Effect on corpus luteum
• Nourishment, oxygen, elimination of waste
  products
• Umbilical cord
• Connects the developing embryo of fetus to the
  placenta
• Waste products are removed from the fetus and
  nutrients are transported from the mother through
  the placenta

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The Embyronic Period (cont)

• Amniotic sac
• Protective membrane around the fetus
• Amniotic fluid
• watery liquid surrounding and cushioning a
  growing fetus within the amnion.
• allows the fetus to move freely without the walls
  of the uterus being too tight against its body.

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Fetal Period

• From the 8th week of gestation to delivery, at
  about 40 weeks.
• The embryo is now known as a fetus
• When internal and external structures (organs
  that developed during the embryo period) grow and
  mature

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Prenatal Sex Differentiation (cont)

• Nature is predisposed toward female development.
  Female development requires no added hormones.
• For a male to develop, the testes must produce
  large amounts of testosterone between the 6th and
  the 12th week of the prenatal period.
• For the vast majority, sex differentiation occurs
  flawlessly and normal genitalia develop. However,
  in rare instances, problems may occur.

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Prenatal Care

• Health care during pregnancy before the baby is
  born
• Good prenatal care
• Protects the mothers health
• Nutrition, diet, exercise
• Enhance probability of having a healthy baby

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Pregnancy Tests

• All pregnancy tests look for a special hormone in
  the urine or blood that is only present when a
  woman is pregnant.
• This hormone, human chorionic gonadotropin (hCG),
  is also called the pregnancy hormone.
• Blood test detects HCG sooner than Urine tests
• 7 days vs. 2 weeks

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Trimesters

• First 0 13 Weeks
• Second 14 26 Weeks
• Third 27 40 Weeks

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Early Pregnancy Signs and Symptoms

• Symptoms missed period, breast tenderness, etc
• Hegars Sign
• softening of the uterus just above the cervix,
  purplish hue of labia minora, vagina and cervix

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Pregnancy Symptoms

• First trimester
• 2/3rds of pregnant women experience nausea,
  vomiting, fatigue and painful swelling of the
  breasts
• Second trimester
• Most nausea and vomiting subside, fetal movements
  quickening
• Braxton Hicks - False Labor

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Pregnancy Symptoms

• During the third trimester
• pressure on the internal organs causes heartburn,
  acid reflux and frequent urination.
• Edema causes swelling of ankles, face, hands and
  feet.

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Average
Distribution of Weight Gain Pounds
Baby 7.5
Placenta 1.5
Amniotic Fluid 2
Uterus 2.5
Breasts 1.5
Increased blood 3
Increased fluids 4
Maternal fat stores 8
Total 29
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Diagnostic Tests during Pregnancy

• Amniocentesis
• Genetic test - examination of chromosomes in
  amniotic fluid
• Done during the 2nd trimester (weeks 14 and 20)
• Recommended if
• woman is 35
• previous child has a chromosomal abnormality
• Chorionic Villus Sampling
• Genetic test examination of tissue from the
  chorion of the placenta
• Done during the 1st trimester (weeks 9 and 12)
• Recommended if
• Woman is 35
• family history of an identifiable inherited
  genetic disorder

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Diagnostic Tests during Pregnancy

• Ultrasound (Sonogram)
• Picture of the internal structure of the fetus,
  can determine fetal age and location of the
  placenta.
• Also used as a guide during amniocentesis and CVS
• Alpha-fetoprotein (AFP)
• Blood test - examination of the mothers blood
  can detect spinal cord defects (spina bifida
  also used to screen for Downs Syndrome)
• Done during weeks 15 and 18

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Postpartum Period

• The period consisting of the months or weeks
  immediately after childbirth.
• It is a time when the woman adjusts, both
  physically and psychologically, to the process of
  childbearing
• Marker events
• Postpartum Blues
• Postpartum Depression
• Postpartum Psychosis
• Breastfeeding

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Postpartum blues or baby blues

• Common 50 70 women after pregnancy
• State of short-term dysphoria that my accompany
  the feelings of happiness and excitement that
  follow the babys birth
• Only lasts a few days
• Symptoms include
• Bouts of crying Memory Lapses
• Mild Confusion Mood swings
• Irritability Fatigue

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Postpartum Depression (PPD)

• Not so common 8 20 of women after pregnancy
• More severe than baby blues.
• Extreme sadness and feelings of worthlessness and
  inadequacy as a mother
• May become suicidal
• Most women improve on their own in 3 - 6 months
• Others may require psychological intervention
• Symptoms include
• Insomnia
• Digestive problems
• Unusual weight loss

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Postpartum Psychosis

• Rare
• Serious disorder that probably has underlying
  psychological causes
• Requires psychological evaluation and treatment
• Marked by extreme highs and lows
• Symptoms
• Extremely agitated
• Paranoid
• Delusions hallucinations

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Breastfeeding

• Facilitates uterine contractions
• Colostrum
• Produced in late pregnancy and for about 48
  hours after birth
• Contains no milk
• Contains many nutrients and antibodies that are
  valuable for the newborn

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Pregnancy Conditions/Complications

• Spontaneous Abortion or Miscarriage
• Ectopic Pregnancy
• Incompetent Cervix
• Preterm Labor

• Low birth weight
• Preeclampsia/Eclampsia
• Gestational Diabetes
• Placenta problems
• Abruption, previa

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Pregnancy Conditions/Complications

• High Risk Pregnancies
• Mother's health
• Mothers Age
• Teenage mothers (17 and younger)
• Mothers over 35 years of age
• Health of the fetus (baby)
• Complications unique to pregnancy

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Teratogens

• Substances that can be dangerous to the health of
  the baby
• Cause defects because they cross the placenta
• Greatest teratogenic effect during the first
  trimester

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• Active Teratogens
• Passive Teratogens

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Labor DeliveryPreparing for Labor

• Woman may experience burst of energy
• Lightening and engagement of fetus
• descent of fetus into pelvic region
• Cessation of weight gain
• Dilation and effacement (thinning) of cervix
• bloody show (due to bursting capillaries)
• mucus plug expelled
• Rupture of amniotic sac (the water breaking)

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Stage I

• Early phase
• mild-moderate contractions dilate
• cervix 03 cm
• Active phase
• moderate contractions dilate
• cervix 37 cm
• Transition
• intense contractions dilate cervix 710 cm

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Stage II

• Early or Rest phase
• brief lull with no urge to push
• Active or Decent phase
• pushing during contractions
• Moves baby down the birth canal
• Transition or Crowning
• and Birth phase
• head and body delivered

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Stage III Stage IV

• Stage III
• Placental phase
• Placenta is delivered
• Stage IV
• Recovery phase
• Mother and baby checked for complications

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Episiotomy

• The cutting of the perineum that allows more room
  for the baby to be delivered

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Drugs During Labor

• Analgesics
• Tranquilizers or narcotics
• Help a woman relax and give some pain relief
• Anesthesia
• Lumbar epidural
• Eliminates sensation from the belly down
• May sometimes prolong or even stop labor
• Risks associated with drugs
• Can cross the placental barrier to the baby
• Temporary side effects
• Irregular or slowed heart beats
• Higher rates of jaundice
• Breathing problems

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Cesarean Section

• Most common when
• fetus in the breech position
• labor difficult or abnormal (dystocia)
• fetus is distressed
• woman had a previous c-section

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Breech Positions

• By 36 weeks of pregnancy, most fetuses turn into
  a head-down, or vertex position. This is the
  normal and safest fetal position for birth.
• A fetus with the feet, buttocks, or legs pointing
  down toward the cervix is said to be in breech
  position
• Types
• Complete
• The buttocks are down near the birth canal
• Frank
• buttocks are in place to come out first during
  delivery
• Footling
• One leg (single footling) or both legs (double
  footling) are stretched out below the buttocks.
  The leg(s) are in place to come out first during
  delivery.

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• Video Having a Healthy Baby

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Menopause

• Menopause is the medical term for the end of a
  woman's menstrual periods.
• Change of life.
• Average age 51 years
• As early as 40 years
• As late as early 60s.

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Menopause

• Natural
• Occurs naturally after the womans supply of
  follicles has been depleted and menstruation ends
  completely
• Surgical
• Can be induced if the ovaries are surgically
  removed.

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Perimenopause

• This period usually begins a few years before the
  last menstrual cycle
• May last a few years

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Perimenopause

• Three stages of transition
• Early
• Middle
• Late

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Early Stage

• Between ages 40 and 44
• Marker
• Changes in menstrual flow
• Changes in length of the cycle
• Sudden surges in estrogen

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Middle Stage

• Periods become irregular
• Periods are NOT skipped

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Late Stage

• Women begin missing the periods until they
  finally stop.
• Estrogen levels drop significantly
• Triggers menopausal symptoms
• Puts women at greater risk of certain conditions

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Estrogen depletion can lead to

• Increase in heart disease
• Loss of bone density
• Memory loss

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Hormonal Changes

• Ovaries
• Stop producing estrogen and progesterone
• Continue to produce small amount of testosterone
• Can be converted to estrogen (estradiol) in fat

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Symptoms of Menopause

• An array of symptoms, including
• -Hot flashes -Mood Changes
• -Night sweats -Sexuality
• -Heart pounding or racing -Forgetfulness
• -Insomnia -Urine leakage
• -Vaginal Dryness -Joint stiffness
• Can last from six months to more than five years
  after the onset of menopause

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Remedies Over-the-counter

• Non Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Painkillers such as aspirin, ibuprofen (Advil,
  Motrin)
• Relief of menopausal symptoms
• Lubricants
• Vaginal dryness
• Vitamin E
• Helps with hot flashes

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Alternative Therapies

• Acupuncture, meditation and relaxation techniques
• Herbal or natural remedies
• Pros
• Some women report great benefits with these
  practices
• Cons
• Not regulated
• Quality is not controlled
• Some can contain toxic metals

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Dietary and Lifestyle Factors

• Mineral-rich Fruits and Vegetables
• High in magnesium and potassium and can help
  preserve bones
• Many help protect against heart disease and
  cancers
• Effects of fiber
• Important for the heart
• Phytoestrogens
• These are plant estrogens found in soy
• Intake can result in lower risk for diseases
  associated with estrogen
• Avoid fast foods and Limit salts

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Hormone Replacement Therapy (HRT)

• Standard treatment for preventing many of the
  health problems that develop after menopause
  because of estrogen loss
• May use estrogen alone or in combination with
  forms of progesterone
• If hysterectomy estrogen alone
• If uterus is present estrogen progestin

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HRT (cont)

• Refers to providing a woman who has gone through
  menopause with hormones that her body has stopped
  producing.
• Symptom relief in 80 of women
• Does not prevent certain other problems
  associated with menopause such as thinning hair

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How is HRT Administered?

• 1. Hormone Pills
• most common form
• 2. Injections
• Bypasses the liver
• 3. An estrogen-filled patch
• Placed on the buttock or upper arm
• Bypasses the liver
• 4. Implants
• Placed under skin 2X per year common in 1970s
• 5. Creams (estrogen progesterone)
• 6. Vaginal Creams (estrogen only)

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Oral Contraceptives??

• Not suitable for replacement therapy
• May reduce the risk of bone loss and alleviate
  early menopausal symptoms, such as hot flashes
• Recommended and effective only during early
  stage.

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Benefits of HRT

• Relief of uncomfortable symptoms that may occur
  with menopause
• Hot flashes, vaginal dryness, osteoporosis
• Prevention of bone loss
• improves balance protects against falling
• Improve cholesterol levels
• Increasing blood flow and reducing blood pressure
• Protects against stroke
• Reduces risk of heart disease
• Help prevent mental breakdown after menopause

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Risks for HRT

• Depends on three factors
• treatment prescribed
• whether the woman has a uterus
• how long hormones are taken
• with short-term therapy of less than 5 years,
  there appear to be few risks of treatment

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Risks of HRT

• Breast cancer
• Uterine Cancer Other Reproductive Cancers
• Estrogen alone
• Heart Attack
• Within the first two years in women with
  pre-existing conditions
• Strokes
• Within the first two years in women with
  pre-existing conditions
• Blood clots
• Endometriosis

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Side Effects of HRT

• Not medically serious but bothersome
• Estrogen
• breast tenderness, edema, nausea, headache, and
  breakthrough bleeding
• Progestin
• Fluid retention, acne, premenstrual-like
  symptoms, anxiety, depression, and irritability

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Who gets HRT?

• Not every menopausal woman
• First women should consider herbs, nutritional
  support, balanced diet, and exercise
• HRT should come in second place and not last
  longer than five years

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Menopause and Bone Density

• Osteoporosis
• Disease of the skeleton in which bones become
  brittle and prone to fracture
• Bone loses density
• Major risk factor for fracture in the spine and
  hip
• After menopause
• Extreme speed-up of bone breakdown (resorption)

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Male Climacteric Syndrome

• Male climacteric
• Best name
• Indicates a decline in testosterone
• Aka Male Menopause
• May be an inappropriate term as it indicates drop
  in hormones
• Aka Aging Male Syndrome (AMS) or Andropause
• Does not cause infertility
• Occurs when testosterone production fall
• Occurs in men ages 40 and 55

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The role of Testosterone

• A hormone that helps maintain sex drive, sperm
  production, pubic and body hair, muscle, and
  bone. Testosterone levels decrease over time.
  This decline is normal in healthy males as they
  age.

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Common Symptoms of Male Climacteric Syndrome

• Symptoms as a result of a decline in testosterone
  levels
• Depression, nervousness
• Insomnia
• Feeling fat/weight gain

• Decreased libido
• Erectile Dysfunction
• Easily fatigued
• Poor concentration and memory
• Flushes and sweats

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Diagnosis of Testosterone Deficiency

• Testosterone Level Test
• Test in the AM when testes produce more
  testosterone
• Blood test
• See an Endocrinologist, hormone specialist

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Testosterone Replacement Therapy

• An option for men whose natural testosterone
  level is not within the normal range
• Becoming increasingly popular but unsure of the
  following
• If it relieves symptoms of men with low
  testosterone.
• how low testosterone levels affect men's health.
• if testosterone therapy increases the risk of
  prostate cancer.
• if testosterone therapy is safe

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Testosterone Replacement Therapy

• Benefits/Risks
• Still being researched

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Reproductive Health Essay

• Due
• 5/14/12 (in class AND on turnitin.com)
• Set up Turnitin account
• Essay Topic/Article Research
• Sample articles will be sent via e-mail
• Submit article for approval by 5/7/12
• In class only. Will not be approved via email.

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Essay Points scored as follows

• Summary (10)
• Identify and discuss Reproductive Health Issue
  (8)
• Strengths/Weaknesses (10)
• Moral /Ethical Issues (5)
• Conclusion (7)
• Grammar/Writing Ability (5)
• Free of typographical Errors (5)