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labor
Series of events by which uterine contractions and abdominal pressure expel a fetus and placenta from a womans body. Regular contractions cause progressive dilatation of the cervix and muscular force to allow the baby to be pushed to the outside. Normally begins when a fetus is sufficiently mature to cope with extrauterine life yet not too large to 11

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SIGNS OF LABOR
Preliminary signs of labor: 1. Lightening descent of the fetal presenting part into the pelvis. It gives a woman relief from the diaphragmatic pressure and shortness of breath that she has been experiencing and in this way lightens her load. PRIMIPARA - occurs approximately 10-14 days before labor begins. MULTIPARA occurs on the day of labor 22 or even labor has begun.

2. Increase in level of activity - is related to an increase in epinephrine release that is initiated by a decrease in progesterone produced by the placenta. 3. Braxton Hicks contractions - these are false labor contractions which may be interpreted as true labor contractions. 4. Ripening of the cervix - an internal sign seen only on pelvic examination. Throughout pregnancy, the cervix feels softer than normal, similar to the consistency of an earlobe (Goodells sign). At term, the cervix becomes still softer (described as butter soft), and it 33 tips forward. Ripening is an internal

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TRUE CONTRACTIONS
1. Begin irregularly but become regular and predictable. 2. Felt first in lower back and sweep around to the abdomen in a wave. 3. Continue no matter what the womans level of activity. 4. Increase in duration, frequency and intensity. 5. Achieve cervical

FALSE CONTRACTIONS
1. Begin and remain irregular 2. Felt first abdominally and remain confined to the abdomen and groin. 3. Often disappear with ambulation and sleep. 4. Do not increase in duration, frequency, or intensity. 5. Do not achieve cervical dilatation. 44

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SIGNS OF TRUE LABOR

1. Uterine Contractions the surest sign that labor has begun is productive uterine contractions. 2. Show as the cervix softens and ripens , the mucus plug that filled the cervical canal during pregnancy is expelled. The exposed cervical capillaries seep blood as a result of pressure exerted by the fetus. The blood , mixed with mucus, takes on a 55 pink tinge and is reffered to as show

3. Rupture of the membranes considered to be as the beginning of labor; experienced either as a sudden gush or as scanty, slow seeping of clear fluid from the vagina. Early rupture of the membranes can be advantageous if it causes the fetal head to settle snugly 66 into the pelvis, this can

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COMPONENTS OF LABOR
I. Passage refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum. Because the cervix and vagina are contained inside the pelvis, a fetus must also pass through the bony pelvic ring. A. Cephalopelvic disproportion (CPD) a disproportion between the size of the normal fetal head and the

77

a. Inlet contraction it is the narrowing of the anteroposterior diameter to less than 11 cm, or of the transverse diameter to 12 cm or less. It usually is caused by rickets in early life or by an inherited small pelvis. Every primigravida should have pelvic measurements taken and recorded before week 24 of pregnancy. Based on these measurements and the assumption that the fetus will be of average size,

88

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b. Outlet contraction is narrowing of the transverse diameter at the outlet to less than 11 cm. This can be measured during the prenatal visit, so that the narrowed diameter can be anticipated before labor begins. It is also easily reassessed during labor. Management: 1. Trial labor this is allowed 99

Nursing management: 1. Emphasize, but do not overstress, that it is best for their baby to be born vaginally. If the trial labor fails and cesarean birth is scheduled, provide an explanation about why cesarean birth is necessary and now is the best route for the birth of the baby. 2. Reassure the mother and her support group that a CS is an 1010

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2. External Cephalic Version is the turning of the fetus from a breech to a cephalic position before birth. It may be done as early as 34-35 weeks, although the usual time is 3738 weeks of pregnancy. B. Shoulder dystocia occurs at the second stage of labor, when the fetal head is born but the shoulders are too broad to enter and be born through the pelvic outlet. The problem is not identified until the head has already been born and the

1111

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Management: Ask the woman to flex her thighs sharply on her abdomen (McRoberts maneuver)to widen the pelvic outlet and let the anterior shoulder be delivered. Applying suprapubic pressure may help the shoulder escape from beneath the symphysis pubis and be delivered.
1212

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II.

Passenger referred to as the fetus. The body part of the fetus that has the widest diameter is the head, so this is the part least likely to be able to pass through the
pelvic ring.

1313

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Fetal Position

1414

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fetal positions
Areas : anterior (A), posterior(P), transverse ( left (L) or right (R) ) Landmarks: occiput (O), mentum (M), Brow (B) sacrum (S), scapula (Sc), acromiodorso (AD)
RSP LSP

LMP

RST LMA

LST

LMT

RSA

LSA 1515

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FETAL MALPOSITION

1616

8/23/12

women

at risk: Android, anthropoid, or contracted pelves. NURSING CARE: 1. Counterpressure on the sacrum ( eg. Back rub, change of position) 2. heat or cold application 3. Encourage to void every 2 hours to keep bladder empty. 4. Provide emotional support and reassurance
1717

8/23/12

Medical

Management: 1. IV glucose solution to replace glucose stores used for energy. 2. Cesarean birth if contractions are ineffective, or if the fetus is larger than average or not in good flexion.

1818

MALPRESENTATION: ` I. Breech presentation means that either the buttocks or the feet are the first body parts that will contact the cervix. This presentation is more hazardous to a fetus than a cephalic presentation, because there is higher risk of the ff.complications: 1. anoxia from a prolapse cord 2. traumatic injury to the aftercoming head (possibility of intracranial hemorrhage or anoxia)
1919

FETAL

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3. fracture of the spine or arm 4. dysfunctional labor 5. early rupture of the membranes because of the poor fit of the presenting part.

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Types of breech presentation: 1. complete the fetus has thighs tightly flexed on the abdomen; both the buttocks and the tightly flexed feet present to the cervix. 2. frank the hips are flexed but the knees are extended to rest on the chest. The buttocks alone present to the cervix.

2020

 3.

footling neither the thighs nor lower legs are flexed. If one foot presents, it is a single-footling breech: if both present, it is a double-footling breech Causes of breech presentation: 1. gestational age less than 40 weeks 2. Abnormality in a fetus, such as anencephaly, hydrocephalus or meningocele. 3. hydramnios that allows for free

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2121

8/23/12

BREECH

1. Frank 2. Complete 3. Incomplete 4. Footling (double or single)

2222

4. Congenital anomaly of the uterus, such as a midseptum, that traps the fetus in a breech position. 5. Any space-occupying mass in the pelvis, such as a fibroid tumor of the uterus or a placenta previa, that does not allow the head to present. 6. Pendulous abdomen if the abdominal muscles are lax, the uterus may fall so far forward that the fetal head comes to lie outside the pelvic brim.

2323

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 7.

Multiple gestation. The presenting infant can not turn to a vertex position. 8. Unknown factors Dangers of Breech Birth: 1. cord coil- because the umbilicus precedes the head, a loop of cord passes down alongside the head. The pressure of the head against the pelvic brim automatically compresses this loop of cord. 2. intracranial hemorrhage tentorial tears, which can cause gross motor 2424

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BREECH DELIVERY

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2525

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II.

vertex malpresentation A. Face (chin/mentum)- this type of presentation is rare, but when it occurs, the head diameter the fetus presents to the pelvis is often too large for birth to proceed. This usually occurs in woman with a contracted pelvis or placenta previa. It also may occur in the relaxed uterus of a multipara or with prematurity, hydramnios, or fetal malformation.
2626

8/23/12

B.

Brow this is the rarest of the presentations. It occurs in a multipara or a woman with relaxed abdominal muscles. It almost invariably results in obstructed labor, because the head becomes jammed in the brim of the pelvis as the occipitomental diameter presents. Nursing Care: 1. Observe infant closely for patent airway babies have a great deal of facial edema and maybe purple from 2727 ecchymotic bruising.

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2.

gavage feedings maybe necessary to allow the infant to obtain enough fluid until he or she can suck effectively lip edema is so severe in some infants that they are unable to suck for a day or two. 3. The infant may be transferred to an ICU nursery for 24 hours for monitoring. 4. Reassure the parents that the edema is transient and will disappear in a few days, with no aftermath.
2828

8/23/12

III.Transverse

Lie this occurs in women with the following conditions: 1. pendulous abdomen 2. with uterine masses that obstruct the lower uterine segment 3. with contraction of the pelvic brim 4. with congenital abnormalities of the uterus. 5. hydramnios Also occurs in infants with the ff. conditions: 1. infants with hydrocephalus or other 2929

8/23/12

2.

also occurs in prematurity if the infant has room for free movement. 3. multiple gestation 4. if there is a short umbilical cord

Management:
of Delivery Cesarian Section

Mode

3030

8/23/12

Fetal attitude

3131

8/23/12

FETAL mALPRESENTATION

TRANSVERSE

COMPOUND

BROW / SINCIPUT PRESENTATION

FACE / CHIN / MENTUM

3232

8/23/12

Umbilical

Cord Prolapse a loop of the umbilical cord slips down in front of the presenting fetal part. It occurs most often with the following conditions: 1. premature rupture of membranes 2. fetal presentation other than cephalic 3. placenta previa 4. intrauterine tumors preventing the presenting part from engaging 5. a small fetus
3333

8/23/12

6.CPD

preventing firm engagement 7. Hydramnios 8. multiple gestation Assessment: To rule out cord prolapse, always assess fetal heart sounds immediately after rupture of the membranes. Therapeutic Management: 1. Management is aimed toward relieving pressure on the cord, thereby relieving the compression and the resulting fetal anoxia.

3434

8/23/12

This

may be done by placing a gloved hand in the vagina and manually elevating the fetal head off the cord, or by placing the woman in a knee-chest or trendelenburg position, which causes the fetal head to fall back from the cord. 2. Administer oxygen at 10L/min by face mask to the mother 3. Administer tocolytic agent as prescribed to reduce uterine activity and pressure on the fetus.
3535

8/23/12

4.

If the cord has prolapsed to the extent that it is exposed to room air, do not attempt to push any exposed cord back into the vagina but instead cover exposed portion with a sterile saline compress to prevent drying. 5. If the cervix is fully dilated at the time of prolapse, the physician may choose to deliver the infant quickly, possibly with forceps, to prevent fetal anoxia.
3636

8/23/12

6. If dilatation is incomplete, the birth method of choice is upward pressure on the presenting part, applied by the physicians hand in the womans vagina, to keep pressure off the cord until the baby can be delivered by cesarean birth.

FETAL DISTRESS uteroplacental insufficiency Acute : uterine activity, hypotension, previa&abruptio Chronic PIH, diabetes, post maturity Position client on left side, give O2, Monitor FHR

3737

8/23/12

III.

Power comes from or supplied by the fundus of the uterus, are implemented by uterine contractions, a process that causes cervical dilatation and then expulsion of the fetus from the uterus. Inertia /dysfunctional labor denotes the sluggishness of contractions. Occurs at any point in labor as primary or secondary. The risk of maternal postpartal infection and hemorrhage and infant mortality is higher in women who have a prolonged labor 3838

8/23/12

Common

causes of dysfunctional labor: 1. Inappropriate use of analgesia 2. Pelvic bone contraction that has narrowed the pelvic diameter so that a fetus can not pass 3. Poor fetal position 4. extension rather than flexion of the fetal head 5. Overdistention of the uterus, as with multiple pregnancy, hydramnios, or an excessively oversized fetus 6. cervical rigidity (unripe) 3939

8/23/12

7.

Presence of a full rectum or urinary bladder that impedes fetal descent 8. mother becoming exhausted from labor 9. primigravida status

I. Factors that causes prolonged labor:

hypotonic contractions the number of contractions is usually low or infrequent. The resting tone of the uterus remains less than 10 mmHg, and the strength of contractions does 4040

A.

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Therapeutic

management: 1. oxytocin infusion to augment labor by strengthening contractions and increasing their effectiveness. 2. amniotomy to further speed labor 3. palpate the uterus in the first hour after birth and assess lochia every 15 mins. to ensure that postpartal contractions are not also hypotonic and therefore inadequate to halt bleeding.

4141

8/23/12

B.

hypertonic contractions marked by an increase in resting tone to more than 15 mmHg. The intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, hypertonic ones tend to occur frequently and are most commonly seen in the latent phase of labor. Therapeutic Management: 1. provide rest and pain relief with a 4242 drug such as morphine sulfate.

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2.

Change linen and clients gown 3. darken room lights and decrease noise and stimulation 4. If deceleration in the fetal heart rate, an abnormally long first stage of labor, or lack of progress with pushing occurs, CS birth maybe necessary.

4343

8/23/12

Comparison of hypotonic and hypertonic contractions Criteria Hypotonic 1.Phase of labor Active 2. Symptoms Painless 3. Oxytocin Favorable administration reaction Hypertonic Latent Painful Unfavorable reaction
4444

Appearance of normal, hypotonic and hypertonic contractions

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4545

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II. Dysfunctional Labor and Associated Stages of Labor I. Dysfunction with the first stage of labor A. Prolonged Latent Phase a latent phase that is longer than 20 hours in a nullipara or 14 hours in a multipara. Etiology: 1. unripe cervix at the beginning of labor 2. excessive use of analgesic early in labor

4646

8/23/12

2. Administer adequate fluid to prevent dehydration. 3. If labor does not progress, CS or amniotomy and oxytocin infusion may be necessary to assist labor. B. Protracted Active Phase cervical dilatation does not occur at a rate of at least 1.2 cm/hour in a nullipara or 1.5 cm/hr in a multipara, or if the active phase lasts longer than 12 hours in a primigravida or 6 hours in a multigravida.

4747

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Etiology: 1. Cephalopelvic disproportion (CPD) 2. Fetal malposition Management: 1. If the cause is CPD or fetal malposition, CS may be necessary. 2. If CPD is not present, oxytocin may be prescribed to augment labor.

4848

8/23/12

C. Prolonged Deceleration Phase when it extends beyond 3 hours in a nullipara or 1 hour in a multipara . This often results from abnormal fetal head position. A CS is frequently required. D. Secondary Arrest of Dilatation this occurs if there is no progress in cervical dilatation for more than 2 hours. II. Dysfunction at the Second stage of labor A. Prolonged Descent the rate of descent is less than 1 cm/hour in a nullipara or 2 cm/hour in a multipara.

4949

8/23/12

Management: 1. encourage rest and fluid intake 2. If membranes have not ruptured, rupturing them may be helpful. 3. IV oxytocin may be used to induce the uterus to contract effectively. 4. Position mother to a semi-fowlers position, squatting, kneeling, or more effective pushing to speed descent.

5050

8/23/12

B. Arrest of Descent this results when no descent has occured for 1 hour in a multipara or 2 hours in a nullipara. The most likely cause is CPD. CS birth usually is necessary.

5151

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C. Retraction Ring (Bandls ring) usually appears as a horizontal indentation across the abdomen and is a warning sign that severe dysfunctional labor is occuring. It occurs at the junction of the upper and lower uterine segments. Management: 1. Administration of IV morphine sulfate or the inhalation of amyl nitrate may relieve a retraction ring.

5252

8/23/12

2. Tocolytic agent may be administered to halt contractions. 3. CS birth may be necessary to ensure safe birth of the fetus. 4. Manual removal of the placenta may be required if retraction ring does not allow the placenta to be delivered.

5353

Appearance of pathologic retraction ring

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5454

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III.

Precipitate labor and birth occur

when uterine contractions are so strong that the woman gives birth with a only a few, rapidly occuring contractions. It is often defined as a labor that is completed in fewer than 3 hours (Dudley 2003). Etiology: 1. Grand multiparity 2. post-induction of labor by oxytocin 3. amniotomy
5555

8/23/12

Dangers

of precipitate labor : 1. mother and fetal hemorrhage 2. fetal subdural hemorrhage 3. lacerations of the birth canal 4. mother feels overwhelmed by the speed of labor Management: 1. a tocolytic may be administered to reduce the force and frequency of contractions.
5656

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2.

If with previous history of precipitate labor, caution the woman by week 28 of pregnancy that her labor this time also may be brief. IV. Uterine prolapse - the uterus has descended in the vagina due to overstretching of uterine supports and trauma to the levator ani muscle.
Etiology: 1.

insufficient prenatal care 2. birth of a large infant

5757

8/23/12

3.

prolonged second stage of labor 4.bearing-down efforts or extraction of baby before full dilatation 5. instrument birth 6. poor healing of perineal tissue postpartally Possible symptoms: 1. vaginal pressure 2. low back pain Management: 1. Surgery to repair uterine supports
5858

8/23/12

2.

placement of pessary a plastic uterine support V. Uterine rupture this occurs when a uterus undergoes more strain than it is capable of sustaining. Etiology: 1. tear of a vertical scar from a previous cesarean birth 2. tear of a hysterotomy repair

5959

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Contributing

factors: 1. prolonged labor 2. abnormal presentation 3. multiple gestation 4. unwise use of oxytocin 5. obstructed labor 6. traumatic maneuvers of forceps or traction Types: 1. Complete rupture involves the endometrium, myometrium, and 6060 peritoneum

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Signs

and symptoms: 1. swellings on the womans abdomen a. Retracted uterus b. Extrauterine fetus 2. hemorrhage from the torn uterine arteries 3. signs of shock a. Rapid, weak pulse b. Falling blood pressure c. Cold, and clammy skin
6161

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d. Dilatation of the nostrils from air hunger e. Fetal heart sounds fade and then are absent 2. Incomplete rupture peritoneum is intact. A woman may experience only a localized tenderness and a persistent aching over the area of the lower uterine segment. Management: 1. administer fluid replacement therapy 2. administer IV oxytocin

6262

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4.

women are advised not to conceive again 5. cesarean hysterectomy or tubal ligation at the time of the laparotomy may be performed 6. Offer emotional support IV. PSYCHE refers to the psychological state or feelings that a woman brings into labor. For many women, this is a feeling of apprehension or fright. For almost everyone, it includes a sense of 6363 excitement or awe.

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Principles in Postpartum Care

Promote healing & involution Prevent complications Provide emotional support Establish & promote lactation Motivate use of Family Planning
6464

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Postpartum complications
I.

Hemorrhage loss of more than 500 ml of blood or more than 1% of body weight after delivery. Etiology: A. Early postpartal hemorrhage occurs within the first 24 hours Uterine Atony relaxation of the uterus and is the most frequent cause of postpartal hemorrhage.
6565

8/23/12

Management: 1.

massage the fundus to encourage contraction 2. If uterus can not remain contracted, IV infusion of oxytocin may be administered. Second possibility is methylergonovine (Methergine) IM may be administered. 3. If 1 and 2 are not effective, the physician may attempt bimanual compression. 4. Prostaglandin F2a may be injected
6666

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5. Provide perineal care including observing the characteristics of lochia. 6. Encourage voiding and evaluate for bladder distention; Catheterizing as indicated 7. Monitor vital signs frequently 8. Initiate IV infusion therapy, including a second IV line if necessary. 9. Start O2 therapy via face mask at

6767

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11.

Assist with packing the uterus, evacuating hematoma, or suturing lacerations as indicated. 12. Prepare for an emergency hysterectomy 13. Keep the client and family informed of condition and measures being performed. B. Late postpartal hemorrhage anytime after the first 24 hours during the remaining days of the 6-week puerperium

6868

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2.

primigravidas 3. birth of a large infant 4. use of a lithotomy position and instruments Types: 1. Cervical usually found on the sides of the cervix, near the branches of the uterine artery. It is difficult to assess and repair because the bleeding is so intense that it obstructs visualization of the area. 2. Vaginal easier to assess because

6969

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3.

Perineal usually occur when a woman is placed in a lithotomy position for birth.This position increases tension on the perineum. This type of laceration is sutured and treated as an episiotomy repair. Therapeutic Management: 1. Repair of laceration 2. Maintain a calm environment 3. Provide reassurance to the mother 4. Encourage increase fluid intake and provide stool softeners.

7070

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I. FIRST DEGREE

II. SECOND DEGREE

III. THIRD DEGREE

IV. FOURTH DEGREE

Vaginal mucous membrane and skin of the perineum to the fourchette Vagina, perineal skin, fascia, levator ani muscle, and perineal body Entire perineum, 7171

classification Description of involvement

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2.

Retained Placental Fragments portion of retained placenta keeps the uterus from contracting fully , thus uterine bleeding occurs. Etiology: 1. Placenta Succenturiata a placenta that has one or more accessory lobe connected to the main placenta by blood vessels. 2. Placenta Accreta a placenta that fuses with the myometrium because of an abnormal decidua basalis layer
7272

8/23/12

Assessment: 1.

If undetected retained fragment is large, bleeding is apparent in the immediate postpartal period. 2. If fragment is small, bleeding may not be detected until postpartum day 6 to 10. 3. On examination, uterus is not fully contracted. 4. retained fragments may be detected by sonography.
7373

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Therapeutic

Management: 1. Dilatation and curettage (D&C) 2. In cases of placenta accreta, methotrexate may be given to destroy the placental tissue. 3. Instruct client to continue to observe color of lochia discharges and to report any unusuallities. 3. Subinvolution incomplete return of the uterus to its prepregnant size and shape. At a 4 or 6 week postpartal visit, the uterus is still enlarged and soft.
7474

8/23/12

Etiology: 1.

retained placental fragment 2. mild endometritis 3. accompanying problem (e.g. Myoma) that is interfering with complete contraction. Therapeutic Management: 1. Methergine 0.2 mg 4x daily per orem 2. If due to endometritis, antibiotic may be administered.
7575

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4.

Perineal Hematoma - collection of blood in the subcutaneous layer of tissue of the perineum Etiology: 1. rapid, spontaneous births 2. women who have perineal varicosities Assessment: 1. severe pain in the perineal area or feeling of pressure between her legs. 2. area of purplish discoloration 3. swelling as small as 2cm or as large 7676

8/23/12

Therapeutic Management: 1. Report presence of hematoma, its size, and degree of the womans discomfort 2. administer mild analgesic as ordered 3. apply ice packs 4. If hematoma increases in size, the site may be incised and the bleeding vessel ligated. II. Puerperal Infection

7777

8/23/12

2.

rupture of membranes more than 24 hours before birth 3. postpartal hemorrhage 4. Preexisting anemia 5. Prolonged and difficult labor, particularly instrument births 6. Internal fetal heart monitoring 7. Local vaginal infection was present at the time of birth 8. Uterus was explored after birth for retained placenta or abnormal bleeding site 7878

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1.

Endometritis an infection of the endometrium caused by a bacteria. This may occur with any birth, but is associated with chorioamnionitis and cesarean birth. Assessment: 1. fever on the 3rd or 4th postpartum day. 2. chills, loss of appetite, and general malaise 3. uterus is not well contracted and painful to touch. She may feel strong
7979

8/23/12

Therapeutic

Management: 1. Administration of clindamycin (Cleocin) 2. Administration of Methergine 3. encourage to increase fluid intake 4. analgesic for pain relief 5. encourage sitting in a fowlers position or walking to facilitate lochia drainage 6. Encourage good hygiene
8080

8/23/12

2.

Infection of the Perineum a bacterial invasion to an episiotomy or a laceration repair. Assessment: 1. pain, heat and a feeling of pressure on the infected site 2. may or may not have an elevated temp. 3. inflammation with purulent discharge on the infected site Therapeutic Management: 1. Removal of perineal sutures by the 8181

8/23/12

2.

antibiotic administration 3. administer analgesic to alleviate discomfort 4. sitz baths or warm compresses to hasten drainage and cleanse the area 5. remind the woman to change perineal pads frequently 6. encourage good hygiene 3. Urinary Tract Infection bacteria is introduced into the bladder of a woman who is catheterized at the time of childbirth or during the postpartal

8282

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Assessment: 1.

burning sensation upon urination 2. blood in the urine (hematuria) 3. feeling of frequency to void 4. sharp pain and discomfort on lower abdomen during voiding 5. low-grade fever Therapeutic Management: 1. broad-spectrum antibiotic such as amoxicillin or ampicillin may be prescribed
8383

8/23/12

2.

encourage to increase fluid intake 3. oral analgesic may be given III. Thromboembolic Disease Etiology: 1. Normal changes in blood during pregnancy 2. Stasis Management: 1. Assess temperature 2. Encourage early ambulation 3. Detect positive HOMANS SIGN pain 8484 on the calf of the legon dorsiflexion of

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4.

Elevate legs 5. Provide heat and antibiotics 6. DO NOT RUB!

8585

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Post Partum Blues

Day 3-7; peak at day 5 Normal occurrence of roller coaster emotions, weeping, irritability,

let-down feeling, usually relieved with emotional support

Hormonal changes, exhaustion, physical discomfort, stress of life changes

8686

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Postpartum Depression/ Psychosis

Depression

1-12 mos PP Sadness, inability to stop crying, extreme fatigue, increased anxiety, insecurity, psychosomatic symptoms, mood fluctuations Counselling

Psychosis

Lost contact w/ reality; delusions & hallucinations Psychotherapy, drug therapy

8787

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Infertile Couple
DEFINITION

OF TERMS: 1. Infertility inability to conceive a child or sustain a pregnancy to childbirth Types: A. Primary infertility no previous conceptions B. Secondary infertility there have been a previous viable pregnancy but the couple is unable to conceive at 8888

8/23/12

2.

Sterility inability to conceive because of a known condition 3. Subfertility lessened ability to conceive Male infertility factors: 1. disturbance in spermatogenesis 2. obstruction in the seminiferous tubules, ducts, or vessels preventing movement of spermatozoa 3. qualitative or quantitative changes in the seminal fluid preventing sperm motility
8989

8/23/12

5.

problems in ejaculation or deposition preventing spermatozoa from being placed close enough to the womans cervix to allow ready penetration and fertilization Female Infertility Factors: 1. Anovulation 2. Tubal transport problems 3. Uterine problems 4. Cervical problems 5. Vaginal problems
9090

8/23/12

Fertility

Testing: 1. Semen analysis 2. Ovulation monitoring 3. Tubal patency Advanced Surgical Procedures: 1. Uterine endometrial biopsy 2. Hysteroscopy 3. Laparoscopy

9191

8/23/12

Therapeutic

Management: A. Correction of the underlying problem 1. Increase sperm count and motility 2. Reduce presence of infection 3. Hormone therapy 4. Surgery B. Assisted reproductive techniques: 1. artificial Insemination 2. In vitro fertilization (IVF)

9292

8/23/12

3.

Gamete Intrafallopian transfer 4. Zygote Intrafallopian transfer 5. Surrogate Embryo transfer 6. Preimplantation genetic diagnosis Alternatives to childbirth: 1. Surrogate mothers 2. Adoption 3. Child-free living

9393

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9494