MATERNAL & CHILD NURSING

Anatomy & Physiology

1. Reproductive System

a. Female Reproductive System

1) External Genitalia
2) Internal Genitalia
3) Types of Pelvic Ligaments

b. Male Reproductive System

1) External & Internal Features

2. Mammary Glands
3. Reproductive Hormones
a. Female Reproductive Hormones
b. Other Reproductive Hormones

4. Menstruation
a. Menstrual Changes
b. Menstrual Cycle
c. Ovarian Cycle
d. Endometrial / Uterine Cycle
e. Menstrual Disorders

5. Family Planning
a. Natural Conception
b. Barrier Methods
c. Pharmacological Methods
d. Birth Control Summary

Antepartal Period

1. Assessment of Prenatal Risk Factors

2. Physiological Changes in Pregnancy

a. Physiological Changes
b. Antepartum Health Promotion

3. Fertilization to Conception
a. Fertilization
b. Origin of Body Tissues

4. Fetal Development
a. Measuring Age of Gestation

5. Maternal & Fetal Diagnostic Tests

6. Electronic Fetal Monitoring
7. Laboratory Studies
8. Other Gynecological Procedures
9. Three Common Pregnancy Signs
10. Discomfort Signs of Pregnancy
11. Psychological Changes in Pregnancy
a. Maternal Changes in Pregnancy
b. Paternal Adaptations in Pregnancy
Antepartal Complications

1. Abortion
2. Ectopic Pregnancy
3. H-mole
4. Incompetent Cervix
5. Diabetes Mellitus of Pregnancy
6. PIH (Pregnancy Induced Hypertension)
7. Bleeding Disorders in Pregnancy
a. Placenta Previa
b. Abruptio Placenta

8. Vena Cava Syndrome

9. Disseminated Intravascular Coagulation
10. Hyperemesis Gravidarum

Intrapartum Care

1. Five Factors Affecting Labor (Table of Mechanics of Labor)

a. Passageway
1. Types of Pelvis
2. Pelvic Measurements

b. Passenger
1. Fetal Attitude
2. Fetal Lie
3. Fetal presentation
4. Fetal Position

c. Power
1. Three Phases of Contraction
2. Characteristics of Contractions

d. Placental Factors
e. Psyche

2. Labor
a. Signs of Impending Labor
b. Comparison of True & False Labor
c. Stages of Labor
1. Stations of Presenting Part
d. Nursing Considerations during Labor & Delivery
e. Nursing Care during labor
f. Assessing Fetal Heart Rate
g. Cardinal Mechanisms / Movements of Labor

4. Anesthesia
5. Obstetrical Procedures
a. Preterm Labor
b. PROM (Premature Rupture of the Membranes)
c. Prolapse Cord
d. Dystocia
e. Infection
f. Precipitate Delivery
g. Uterine Rupture
 h. Amniotic Fluid Embolism

Complications of Labor & Delivery

a. Preterm Labor
b. PROM ( Premature Rupture of the Membranes)
c. Prolapsed Umbilical Cord
d. Dystocia
e. Infection
f. Precipitate Delivery
g. Uterine rupture
h. Amniotic Fluid embolism

Postpartum

1. Postpartum Biophysical changes

a. Lochia
b. Uterus
c. Uterine Involution
d. Breast
e. GI Tract

2. Post Partum Discomforts

a. Perineal discomforts
b. Episiotomy
c. Breast Discomforts

3. Post partum Discharge Teachings

a. Breast feedings
b. Burping & Feeding
c. Psychological Adaptations

Neonatal Care

1. Initial Physical Examination & Care of the Newborn

a. Assessment
b. Implementation
c. Vital Signs
d. Body Measurement
2. Head to Toe Newborn Assessment
3. Gestational Assessment
4. Newborn Reflexes
5. Basic Teaching Needs of New Parents
6. Preterm Neonates
7. Post term Neonates

8. Other Newborn Abnormalities

a. RDS (Respiratory Distress Syndrome)
b. Hemolytic Disease
c. Hyperbilirubinemia
d. Erythroblastosis Fetalis
e. The Newborn of Addicted Mothers
f. SGA (Small Gestational Age)
g. Nervous System Anomalies

1. Spina Bifida
2. Meningocele
3. Myelomeningocele
 I.a External Genitalia (Vulva/ Pudendum)

MONS PUBIS
-Soft fatty tissue, lies directly over symphysis pubis & becomes covered w/ hair
just before puberty
It is where the pubic hair grows.

LABIA MAJORA LABIA MINORA

-W/ hair outside but smooth inside

-Thin, pink, smooth, hairless, extremely
fatty skin folds from MONS PUBIS
sensitive to pressure, touch and temperature.
to PERINEUM and protects the
The glands of labia minora lubricate the
labia minora , urinary meatus &
vulva. It is formed by the frenulum and the
vagina
prepuce of the clitoris which is also very
sensitive because it has rich nerve supply.

Covers and protects VESTIBULE

VAGINAL INTROITUS
CLITORIS
URETHRAL TWO GLANDS THAT LUBRICATE DURING SEX
MEATUS
 1. SKENES GLANDS (Paraurethral Glands): -Composed of glans
lubricates the external genitalia & shaft that is
-Entrance of urethra, partially covered by
opens approximately  2. Bartholins Gland (Vulvovaginal Glands): prepuce
1cm below clitoris alkaline in ph, helps improve sperm survival -GLANS is small
and round and is
 Doderleins Bacillus: causes the vaginal ph to be filled w/ many nerve
acidic, which forms lactic acid endings and rich
blood supply
Hymen: the elastic tissue, symbolizes virginity. -SHAFT is a cord
Thorn & bloody during forced sexual act connecting the glans
to the pubic bone;
 RUGAE: thick folds of membranous stratified w/in it is the major
epitheliums on the internal wall of the vagina, blood supply of
capable of stretching during the birth process, to clitoris
accommodate the delivery of the fetus.
Ib. Internal Genitalia

ORGAN FUNCTIONS STRUCTURE NOTES

Uterus Divisions of the uterus Layers of the Uterus:
Pear shaped
muscular organ I. Cervix : lowest portion , 1/3 1. Endometrium:
which has of the total uterus inner layer, most
three(3) main vascular, SHED
functions External Os: where the DURING
nurse obtain the Pap Smear MENSTRUATION.TH
1. receive the to the E NON-PREGNANT
ova from the SQUAMOCOLUMNAR UTERUS
fallopian tube JUNCTION cells. This is
where the cerclage is done 2. Myometrium:
2. provide a for incompetent cervix. LARGEST PORTION
place for EXPELS THE FETUS
implantation of A. Shirodkar Barter Suture- DURING THE BIRTH
the ova permanent closure of the PROCESS.
internal cervical os, until the The part that
3. Nourishment 38th week after which the contracts during
for fetal growth. suture is removed prior to hemorrhage. Prevents
delivery. – TREATMENT hemorrhage.
FOR INCOMPETENT
CERVIX and PREVIOUS 3. Perimetrium: Outer
ABORTION. most layer. For
support & added
B. Mc Donalds or Purse strength.
String Cerclage of the
external os: usually Normal
spontaneous delivery will be
done for the patient.

II. Isthmus: shortest portion

of the uterus, the portion that
is cut when the fetus is
 delivered during cesarean
birth.

III. Fundus: Upper segment,

this is the most vascular, the
portion also where palpation
is done.
*Touching it with the tip of
the fingers during contraction
is the best method to
determine the intensity of
contractions during labor.

Bandl’s Ring ( Pathological

Retraction Ring): seen in
Prolonged Labor or Dystocia

Fallopian Site of Fallopian tubes

tubes fertilization of 4 Parts of the Fallopian tubes transport the ova from
the ovum with 1. Interstitial : lies within the the ovaries to the
sperm uterine wall uterus.

2. Isthmus: the portion that is

cut or sealed in TUBAL
LIGATION ( site for
sterilization)

3. Ampulla: where
fertilization occurs , this is
also the LONGEST portion,
frequent site for ectopic
pregnancy.

4. Infundibular: covered by
the Fimbriae cells that help
guide the ova to the
Fallopian Tube.
Ovaries Ovulation (the Pair of follicle containing The ovaries lie in the
release of an organs on the other side of upper pelvic cavity.
ovum); Steroid the uterus
hormone
production > 4 by 2 cm in diameter, 1.5
cm thick.
> Responsible for the
production, maturation, and
release of ova

 Secretion of estrogen and

progesterone

 Cortex of the Ovaries;

developing and graafian
follicles are found here.
Vagina Organ for coitus; Fibromuscular organ
Birth canal; Tube extending from the lined with mucus
Conduit for introitus to cervix membrane
menstrual flow.
 Types of Pelvic Ligaments

1. Round ligament : remain lax during non-pregnant state & becomes

HYPERTROPHIED & elongated during pregnancy.

2. Cardinal ligaments : chief uterine support

3. Broad ligaments: drapes over the fallopian tubes, uterus & ovaries
Note: R = round ligament
B = broad ligament
C = cardinal ligament

MALE REPRODUCTIVE SYSTEM

External Features:

2 Erectile Tissues in the penis:

a. Corpus cavernosa
b. corpus spongiosum

Internal Features:

Epididymis: It is a narrow, tightly-coiled tube connecting the efferent

ducts from the rear of each testicle to its vas deferens.;
totals 20 ft. WHERE SPERMS ARE STORED ( cauda region)

Vas / Ductus Deferens: carries the sperm to the inguinal canal; they
transport sperm from the epididymis in anticipation of ejaculation

Seminal Gland / Vesicle: pair of simple tubular glands posteroinferior to

the urinary bladder of males; secretes SEMEN

Prostrate Gland: secretes SEMEN also.

Cowpers Gland/ Bulbo-urethral: secretes also semen

SEMEN sources: 1. prostrate gland : 60%

2. Seminal vesicles : 30%
 Accessory Structures

MAMMARY GLANDS- -2 mammary glands located on each side of chest wall

- --Each breast 15-20 lobes containing clusters of ALVEOLI

1. ACINI
> Saclike end of the glandular system
> Lined both w/ epithelial cells that secrete colostrum( which is rich in IgA) &
milk
> with muscles that expel milk

2. DUCTULES
> -Exit alveoli & join to form larger canals LACTIFEROUS DUCTS
> During lactation, milk flows to the alveoli and then thru the duct system
further
going to the balloon like storage sacs called LACTIFEROUS
SINUSES

3. NIPPLES
> -Sinuses merge into openings on nipple

HORMONES

1. Follicle Stimulating Hormone

*Stimulates Graafian follicle to mature and results in increase levels of estrogen
2. Lutenizing Hormone
-When follicle is ripe and mature, triggers follicular rupture and release of
ovum
-Peaks at 16-18 hours before ovulation.
-stimulates ovulation & development of corpus luteum

3. Estrogen
-Produced from ovaries, adrenal cortex, and placenta
-Assists in maturation of Graafian follicle
-Stimulates thickening of endometrium.

Other functions
>Contracts smooth muscles Inhibits the secretion of FSH
>Responsible for the increase vaginal secretion in the vagina (LEUKORRHEA)
>Thickens the endometrium
>SUPPRESSES THE FSH & Prolactin
>Responsible for the development of secondary sex characteristics in females
>Stimulates uterine contractions & muscular peristalsis of the fallopian tubes for the
passage of the ovum to the uterus.
>Mildly increases Na & water reabsorption
>Stimulates LH secretion & responsible for the production of cervical mucus associated in
ferning & spinnbarkeit

Progesterone
*Produced from corpus luteum, placenta
-Secretes thick/viscous cervical secretions.
>Preparation of the uterus to receive a fertilized ovum
>Decrease uterine motility/ contractility during pregnancy
>Increases basal metabolism
>Enhances placental growth
>Stimulates the development of acini cells in the breast(major cells for breast milk)
>Increase the endometrium’s supply of glycogen, oxygen & amino acids for maintaining
pregnancy

LUTENIZING HORMONE AND ESTROGEN peak immediately before ovulation

 Most women ovulate two weeks before the beginning of the next period.

Other Reproductive Hormones

1. Lactogenic Hormone (Prolactin)

-Stimulates lactation

2. Melanocyte Stimulating Hormone

-Responsible for the linea nigra & chloasma in pregnancy
-Secreted by the anterior pituitary hormone MELANOTROPIN
-Will end on the 2nd month of pregnancy

3. Human Chorionic Gonadotropin

-Increases in nausea and vomiting
 Responsible for Hyperemesis Gravidarum
MENSTRUATION

Menarche: 1st menstrual period, usually age 12, but may begin as early as 9.
Menopause: cessation of menstrual cycle that occurs normally from 40 & 55 yrs.old.

Menstrual Cycle:

Menstrual Phase ( 1 – 14 days)

-Corpus luteum dies. MENSTRUAL PHASE

-Menstruation
-Decrease in estrogen, decrease in progesterone
*- triggers/ stimulates the production of FSH.
-Endometrium degenerates/ sheds- menstruation occurs.

NOTE: Sexual intercourse during menstruation is not harmful.

Proliferative Phase- Estrogen Phase ( 6 – 14 days)

Graafian Follicle: Estrogen

Anterior Pituitary Gland secretes FSH stimulates the development of the
Graafian follicle (secretes Estrogen) suppresses FSH & stimulates LH LH
stimulates ovulation Increase Estrogen decreases FSH

> Hypothalamus secretes FSH Releasing Factor

> APG (anterior pituitary gland) secretes FSH= Maturation of Graafian follicle
> Increased estrogen= Hypothalamus stops FSH RF & starts LHRF
> APG stops FSH & starts LH secretion

Secretory Phase (15 to 21 days)

Progesterone Phase or Luteal Phase (Corpus Luteum: Progesterone)

After Ovulation-----release of mature ovum from the Graafian follicle-----Graafian Follicles

die and replaced by Corpus Luteum-----secretes progesterone

-Increase progesterone
> NO FERTILIZATION; corpus luteum degenerates 10 days after ovulation
> WITH FERTILIZATION- product of conception produces HCG that sustains life
**corpus luteum; progesterone level is maintained at high level

-Decrease Progesterone level

-Corpus albicans; Sloughing off of endometrial lining

Pre-Menstrual Phase (22 days to 28 days)

-If fertilization does not occur, corpus luteum begins to die

-Progesterone & Estrogen decreases
-Endometrium degenerates
-Menstruation stops during pregnancy because there is decrease in secretion
of hormones by the ovary.

OVARIAN CYCLE
(ACCORDING TO HORMONAL ACTIVITY)
 0 7 14 21 28

DEVELOPING FOLLICLES OVULATION CORPUS LUTEUM LUTEAL

REGRESSION

FOLLICULAR PHASE LUTEAL PHASE

Ovarian follicles mature under influence -mittelshmerz
of FSH and estrogen -cervical changes
LH surge causes ovulation -increase BBT

Menstrual Cycle

Menstrual Disorders

1. Dysmenorrhea

- Primary- No known cause

- Secondary- May be caused by tumor/ inflammatory conditions

2. Premenstrual Syndrome
- -Edema of lower extremities
- Abdominal bloating
- Weight gain
- Headache
-Breast tenderness
- Depression
- Crying
- Loss of concentration

3. Amenorrhea

- Primary- Never menstruated; structural / congenital abnormality

- Secondary– Cessation of menstruation

4. Menorrhagia

- Excessive or prolonged bleeding

 5. Metrorrhagia

- Irregular bleeding in between periods

FAMILY PLANNING AND CONTRACEPTION

 Before counseling a patient about contraceptive methods, the nurse must:

EVALUATE HER OWN BELIEFS & VALUES REGARDING FAMILY
PLANNING!!!!

Natural or Fertility Awareness Methods

A. Natural Contraceptives

1.  Billings Method (Cervical Mucus): with ovulation (peak day) the mucus
becomes thin and watery, transparent, CLEAR, THIN & ELASTIC- avoid having
sex in this phase). SPINNBARKEIT. Greatest Factor for Basal Body
Temperature DISTURBANCE---will be the presence of stress.

2.  Calendar Method: to determine her FERTILITY, subtract 18 days from the

SHORTEST MENSTRUAL CYCLE & 11 days from her longest cycle.

3.  Daily Basal Body Temperature: will drop from 0.2 – 0.8 degrees Fahrenheit
during ovulation in response to PROGESTERONE.

Don’t have sex on the 1st day of menses unt6il 3rd day of temperature
elevation.
Monitor for at least 3 months before analyzing the results!!!!
Most accurate reading, immediately after awakening, before arising!!!!

4.  Sympto thermal: mixture of Cervical Mucus & Basal Body Temperature

5.  Coitus Interruptus : oldest & least effective method.

Natural methods of birth control generally have a higher failure rate because it depends
on knowing when the ovulation occurs, since this is difficult to accurately determine, the
chance of miscalculation is high.

The determination of infertility is based on age.

 In a couple younger than 30 years old, infertility is defined as failure to conceive
after 1 year of unprotected intercourse.
 In a couple age 30 or older, the time period is reduced to 6 months of unprotected
intercourse.

CALENDAR METHOD
 Relies on abstinence from intercourse during fertile period

BASAL BODY TEMPERATURE

> * Measured by taking & recording e temperature rally rectally each morning before
waking after at least 3 hours of sleep
* Drops before ovulation and rises 0.2 F-0.8 F

 In Basal body temperature method the patient should take her temperature every
morning upon awakening and prior to any activity to avoid the temperature being
influenced by other factors

CERVICAL MUCUS METHOD

 . > * Uses the appearance, characteristics and amount of cervical mucus to identify
ovulation
Ovulatory: cervical mucus is clear and abundant
Pre-ovulatory / post ovulatory: cervical mucus is yellowish, less abundant, and sticky
(inhibit sperm motility)

SYMPOTHERMAL METHOD
* Couple makes use of combination of calendar, BBT, and cervical mucus method to
determine fertile period

MITTELSCHMERZ
* Between menstrual cycles, some women experience pain when the ovary releases egg

* Rarely accompanied by scant vaginal spotting

* Some couple uses this as signal of the beginning period and to avoid sexual intercourse
until the fertile period passes

COITUS INTERRUPTS
* Requires withdrawal of the penis from the vagina before ejaculation

B. Barrier Methods

FEMALE CONDOM (VAGINAL POUCH)

- Long polyurethane sheath that is inserted manually into vagina with a flexible internal
ring extending to cover the perineum
- Lubricated with a spermicide (non-oxynol-9)
- It can be inserted up to 8 hrs before intercourse

MALE CONDOM
- Rubber sheath that fits over the erect penis and prevents sperm from entering the
vagina

IUD
-Flexible device inserted into the uterine cavity
-It alters uterine transport of the sperm so fertilization doesn’t occur

DANGER SIGNS TO REPORT:

- Late or missed menstrual period
-Severe abdominal pain
-Fever and chills
- Foul vaginal discharge
-Spotting, bleeding, or heavy menstrual periods
- Spontaneous expulsion occur in 2%-10% of users in the first year
 Condom

The female condom during sex

During sex the penis is inserted into the center of the open ring at the opening of the
vagina. Until both partners are familiar with the Reality condom, the penis should be
guided by hand into the open ring. Otherwise there is the chance that the penis will be
inserted outside the condom into the vagina, thus defeating the condom's purpose. Use
of the male condom with the female condom is not recommended, because rubbing the
latex male condom against the polyurethane female condom creates friction that may
make intercourse difficult.

Removing the female condom

The female condom should be removed following intercourse and before standing up. To
remove, squeeze and twist the outer ring to ensure that semen remains inside the
condom. Gently pull the condom from the vagina. Discard in the trash. Do not attempt to
flush the condom down the toilet, as it may clog the toilet or sewer lines. Do not reuse.

Important points to remember when using the female condom

- The female condom works only if you use it every time you have sex.
- Use a new condom each time you have sexual intercourse. Do not reuse the female
condom.
- You can still become pregnant and transmit or acquire a sexually transmitted disease
while using the female condom. The risk is less than if you do not use the condom, but
there still is a slight risk.
- Although the Reality condom is prelubricated, it also comes with a tube of lubricant in
the package. You may wish to add a few drops of lubricant to the opening of the
condom or to the penis. Lubricants reduce friction and noise those results from friction.
- Remove tampons before inserting the female condom.
- Use caution to avoid tearing the female condom with a sharp fingernail, ring, or other
jewelry when inserting and removing the condom.

CERVICAL CAP VS DIAPHRAGM

CHARACTERISTICS CERVICAL CAP DIAPHRAGM

Small rubber plastic Flexible ring covered with dome
DESCRIPTION that fits snugly over shape rubber cap
cervix
80% with typical use
EFFECTIVITY NULLIPARA=80%
MLTIPARA=60%
Continuous protection On two hours prior to sexual
USAGE 24 hours regardless of intercourse and in place for 6
the number of times of hours after
sexual intercourse
Not necessary for Use every coitus
SPERMICIDE repeated coitus

Cervicitis Cystitis, cramps, rectal

SIDE EFFECTS prolapsed
Toxic Shock syndrome (TSS)
Fitted by health Same, refitted after birth and
HOW TO INSERT provider weight loss of 15lbs

Not longer than 48 Not longer than 24 hours

DURATION hours  A diaphragm should be left in
the vagina 6-8 hours after
sexual intercourse.
  Diaphragm: should remain in place 6-8 hours after sex & maybe left for 24 hours.
 ALWAYS CHECK FOR TEARS & HOLES!!!

Contraindications: 1. Frequent UTI 4. Cystocele

2. Prolapsed Cord 5. rectocele
3. Retroverted Uterus 6. acute cervicitis

Diaphragm

C. Pharmacologic methods

 Oral Contraceptive Pill: synthetic estrogen combined with small amounts of

synthetic progesterone-preventing ovulation by stopping FSH & LH.
- Stops LH & FSH

 STOP IF WITH THE FF: (ACHES)

- A- abdominal pain,
- C- Chest pain,
- H- Headaches,
- E- eye problems
- S-severe leg cramps

- ATTN: Severe Headache maybe an indication of Hypertension!!!!

CONTRAINDICATIONS:
 1 Thromboembolism
 2 CVA, HPN,
3. smoking
4.diabeticS
5. DIC

 For DIABETICS. The best are Barrier Contraceptives--Condom & Diaphragm

 Examples: Demulen (Ethinyl Estradiol Ethylnodiol ) a monophasic oral
contraceptive agent.

 If the patient forgets to take 2 tablets for the next 2 days, she should take 2
tablets NEXT 2 DAYS!!! And use another contraceptive method for the rest
of the cycle.
 If she misses 3 or more, she should discard the remaining tablets & use another
contraceptive method for the rest of the cycle.
 ORAL MINIPILLS SUBDERMAL SUBCUTANEOUS
CONTRCEPTIVES IMPLANTS INJECTIONS
Pills contain Six soft sillastic
Use to prevent progestin but no rods filled with Medroxyprogesterone
conception by estrogen synthetic (DMPA or
inhibiting ovulation progesterone DEPOVERA)
(inhibits release of Pills must be implanted into the
FSH and LH) taken each day woman’s arm
and preferably
Causes atrophic same time each Progesterone
changes in the day to achieve leaks into the
endometrium to maximal blood stream,
prevent implantation effectiveness inhibiting
of egg implantation into
Causes thickening of Thins and atrophy endometrium
cervical mucus to endometrium and
inhibit sperm travel thickens cervical Norplant
mucous Inserted
 Under ideal subdermally into
conditions the sperm ADVANTAGE: the midportion of
can reach the ovum can be use the upper arm
1 to 5 minutes after immediately about 8-10cm
ejaculation. postpartum if above the elbow
client is not crease.
Combined estrogen breastfeeding and
and progesterone 6 weeks if 6 implantable
preparation in tablet breastfeeding capsules are
form and are taken inserted at one
daily with  Women taking time
combinations of the minipill have
hormones a higher
 Oral incidence of tubal
contraceptives and ectopic
prevent pregnancy pregnancy,
by suppressing FSH possibly because
(follicle stimulating progestin slows
hormone) and LH ovum transport
(leutenizing through the
hormone) release fallopian tubes.
from the pituitary Endometriosis,
gland thereby female
blocking ovulation. hypogonadism,
and premenstrual
syndrome aren't
associated with
progestin-only
oral
contraceptives.

Birth Control Table

RISKS OR
POSSIBLE
BIRTH CONTROL METHOD ADVANTAGE PROBLEMS
Spermicides: chemicals in the form • Available over the • Only partially
of foams, creams, jellies, films, or counter effective against
suppositories that are inserted into sexually
the vagina to kill sperm before they • Can be used with transmitted
can enter the uterus; other methods to disease (STD)
> typical use effectiveness: 70% improve transmission
effectiveness
• Possible allergies
or irritation
Condom: • Effective against • Possible allergies
male condom is a sheath of latex or STD transmission to latex or
animal tissue placed on erect penis; spermicide
• Available over the
female condom is a plastic sac with counter • Lessens sensation
a ring on each end inserted into the
vagina; both may be used with a • Can be used with • May break during
spermicide; other methods to intercourse
further protect
typical use effectiveness: 84% against STD .Avoid using
(male) 79% (female) petroleum jelly of
oil base products;
it can cause
INCREASE
FRICTION which
will lead to
TEARING OF
THE LATEX
CONDOM.
Diaphragm: • Reusable • Not effective
shallow latex cup with flexible rim against STD
inserted into vagina over cervix to • Can last for one to transmission
prevent sperm from entering uterus; two years
used with spermicide; • Needs to be fitted
typical use effectiveness: 82% by a health care
professional

• Increased risk of
bladder infection

• Possible allergies
to latex or
spermicide
Cervical Cap: • Reusable • Not effective
thimble-shaped latex cap inserted against STD
into vagina over cervix to prevent
• Can last for one to transmission
sperm from entering uterus; used two years
with spermicide; • Needs to be fitted
typical use effectiveness: 82% by a health care
professional
 CERVICAL CAP: can be retained • Difficult to fit
upto 48 hours. It does not leak. women with an
Cannot be re-applied again after unusual cervix
use. size
May use spermicide before use. • Difficult for some
women to insert
Birth Control Pill: • More regular • Not effective
prescription drug containing female periods against STD
hormones; one pill taken daily transmission
prevents ovaries from releasing eggs • No action required
and/or thickens cervical mucus to prior to sexual • Rare but
prevent sperm from reaching egg; intercourse, permits dangerous
typical use effectiveness: 94% sexual spontaneity complications,
including blood
• Some protection clotting and
against ovarian and hypertension,
endometrial cancer, particularly in
noncancerous women over 35
breast tumors, years who smoke
ovarian cysts
• Must be taken
daily
Hormonal Implant (Norplant): • Protects against • Not effective
six small capsules inserted by a pregnancy for up to against STD
health care professional under the five years transmission
skin of upper arm that deliver small
amounts of hormone to prevent • No action required • Possible scarring
ovaries from releasing egg; prior to sexual or, rarely, infection
typical use effectiveness: 99% intercourse, permits at insertion site
sexual spontaneity
• Side effects
• Can be used while include irregular
breast-feeding bleeding,
beginning six headaches,
weeks after nausea,
delivering baby depression
Hormonal Injection (Depo-Provera): • Protects against • Not effective
injection given by a health care pregnancy for 12 against STD
professional in the arm or buttock weeks transmission
every 12 weeks to prevent ovaries
from releasing an egg and/or thicken • No action required • Side effects
cervical mucus to keep sperm from prior to sexual include irregular
reaching an egg; intercourse, permits bleeding, weight
typical use effectiveness: 99% sexual spontaneity gain, headaches,
depression,
• Can be used while abdominal pain
breast-feeding
beginning six weeks • Side effects do not
after delivering reverse until
baby medication wears
off
• Protects against
cancer of the • May cause delay
uterine lining and in becoming
iron deficiency pregnant after
anemia injections are
stopped
Intrauterine Device (IUD): small • Effective one to six • Not effective
device inserted by a health care years, depending against STD
professional into the uterus; prevents on type used transmission
eggs from being fertilized and/or
implanting in uterus; typical use • No action required • May cause
effectiveness: 96% prior to sexual spotting between
 intercourse, permits periods and
It interferes with the ability of the sexual spontaneity longer, heavier
ovum to develop as it transverses periods
the fallopian tube.
• Increased risk of
Most Frequent Side Effect: pelvic
a. Excessive Menstrual flow inflammatory
(menorrhagia) disorder(PID)
b. Spontaneous Expulsion of the within first four
device: Myometrium irritability months after
c. Cramping & fever insertion

Contraindications: • Rare risk of

 1. History of PID: a woman using uterine perforation
IUD has 50% chance of getting
PID.
2. Ectopic Pregnancy, AIDS

 Never use / give IUD to

NULLIPAROUS WOMEN!!!
 Return to the clinic for evaluation
after her 1st menses!!!

Intra uterine device (IUD)

Tubal Ligation: • Permanent • Not effective

surgical procedure to permanently protection from against STD
block woman's Fallopian tubes to pregnancy transmission
prevent eggs from reaching sperm;
typical use effectiveness: 99% • No action required • Reactions to
prior to sexual surgery may
 Tubal ligation: isthmus part in the intercourse, permits include infection,
fallopian tube is the usual part being sexual spontaneity bleeding, injury to
lighted. intestine, reaction
to anesthesia
• Increased chance
of ectopic
pregnancy
 • Irreversible
Vasectomy: surgical procedure in • Permanent • Not effective
which the male's vas deferens is cut protection from against STD
to prevent sperm from reaching pregnancy transmission
eggs;
typical use effectiveness: 99% • No action required • Reactions to
prior to sexual surgery may
The man can resume sex when the intercourse, permits include infection,
sperm count indicates 0 count or 2 sexual spontaneity blood clot near
negative sperm counts have been testes, bruising,
examined. swelling, or
tenderness of
 Generally it requires 6 – 36 scrotum
ejaculations to render negative.
sperm count • Irreversible

 In order to get for semen

analysis, collect them in a clean
glass not plastic, because it may
affect the spermatozoa. No sex
for 3 days before the semen
collection & no drinking of
alcohol for 1 day. The first
portion of the semen has a high
ration of sperm.

Natural Family Planning: • No medical or • Not effective

techniques, including checking body hormonal side against STD
temperature or cervical mucus daily effects transmission
or recording menstrual cycles on a
calendar, to determine the days • Inexpensive • Requires strict
when body is most fertile; recordkeeping
• Accepted by most
typical use effectiveness: 81% religions • Illness or lack of
sleep may affect
body temperature

• Vaginal infections
and douches may
affect cervical
mucus

• Requires
abstinence from
sexual intercourse
or alternative
contraception
during fertile days