Notes: Chapter 6 - Reproductive Life Planning
1. Definition
● Includes all decisions an individual/couple make about having children.
● Choice of contraceptive requires complete knowledge of advantages,
disadvantages, and side effects.
2. Things to Consider When Choosing a Method
● Personal Values
● Ability to use method correctly
● How it affects sexual enjoyment
● Financial factors
● Status of couple’s relationship (short or long term)
● Prior experiences with contraception
● Future plans
3. Ideal Contraceptive Is:
● Safe, Effective
● Compatible with spiritual/cultural beliefs
● Free of bothersome side effects
● Convenient, easily obtainable, affordable
● Needs few instructions
● Free of effects on future pregnancies after discontinuation.
4. Assessment Information Needed
● Vitals, Pap smear, pregnancy test, STI screening, hemoglobin.
● Obstetric history: STIs, past pregnancies, abortions, past method
failure/compliance.
● Subjective assessment: Patient’s desires, needs, feelings, understanding of
conception (e.g., a teen may think she can't get pregnant).
● Sexual practices: Frequency, number of partners, feelings about sex, body image.
5. Family Planning Methods
A. Natural Methods
● Abstinence: Refraining from sex. 0% failure rate, best for preventing STIs.
● Lactation Amenorrhea: Breastfeeding suppresses ovulation. Not dependable;
advise another method after 6 months.
● Coitus Interruptus: Withdrawal before ejaculation. Offers little protection; sperm
may be deposited in vagina.
● Calendar/Rhythm Method: Abstain on fertile days (3-4 days before & after
ovulation). Track 6 cycles. Shortest cycle - 18. Longest cycle - 11 to find safe days.
● Basal Body Temperature (BBT) Method: BBT falls half a degree before ovulation
and rises a full degree at ovulation due to progesterone. Take temp immediately
upon waking.
● Cervical Mucus (Billings) Method: Mucus changes with ovulation.
○ Before ovulation: Thick, doesn't stretch (Spinnbarkeit).
○ At ovulation (peak day): Copious, thin, watery, transparent, slippery,
stretches +1 inch.
● Two-Day Method: Assess for vaginal secretions daily. If secretions for 2 days in a
row, avoid coitus that day and the next.
● Symptothermal Method: Combines cervical mucus and BBT methods.
● Fertility/Cycle Beads: Color-coded beads for a 26-32 day cycle. Visual tool to track
fertile days.
● Ovulation Awareness: Use OTC kit to detect luteinizing hormone (LH) surge in
urine 12-24 hours before ovulation.
B. Artificial Methods
● Barrier Methods & Spermicides
○ Male Condom: Latex/synthetic sheath over erect penis. Deposits sperm in
tip.
○ Female Condom: Polyurethane sheath. Inner ring covers cervix, outer ring
rests at vaginal opening. Do not use with male condom.
○ Diaphragm: Circular rubber disc over cervix. Leave in for 6 hours, not longer
than 24 hours.
■ Contraindications: History of Toxic Shock Syndrome (TSS), allergy
to rubber/spermicides, recurrent UTIs.
○ Cervical Cap: Soft rubber, thimble-shaped. Fits over cervix. Can remain
longer than diaphragm (24-48 hrs max).
● Hormonal Contraception
○ Oral Contraceptives (Pills/OCs/COCs): Contain estrogen & progestin.
■ Estrogen suppresses FSH and LH to suppress ovulation.
■ Progesterone decreases cervical mucus permeability, limiting sperm
access.
■ Types: Monophasic (fixed dose), Biphasic (constant estrogen,
varying progestin), Tri/Tetraphasic (vary both).
■ Start methods: Sunday start, Quick Start, First Day, After
Childbirth.
○ Mini Pills (Progestin-only): For women who can't take estrogen (e.g.,
danger of thrombophlebitis). Progestin prevents endometrium from
developing.
○ Transdermal Patch: Releases estrogen/progesterone. 3 weeks on, 1 week
off. Apply to arm, torso, abdomen, buttocks.
○ Vaginal Rings (NuvaRing): Flexible ring with estrogen/progestin. 21 days in,
7 days out.
○ Subdermal Implants: Slowly release hormone to suppress ovulation, thicken
mucus, change endometrium. Inserted/removed with local anesthesia.
Costly.
○ Intramuscular Injections (DMPA/Depo-Provera): Given every 12 weeks.
Inhibits ovulation, alters endometrium, changes mucus.
● Hormonal Contraception & Pregnancy/Fertility
○ COCs: Stop if pregnant (high estrogen can harm fetus). Fertility may be
delayed 1-8 months after stopping.
○ Rings/Patches: No effect on fetus. Fertility returns immediately.
○ Implants: Remove if pregnant, no effect on fetus. Fertility returns almost
immediately.
○ DMPA: No effect on fetus. Fertility may be delayed 6-12 months after
stopping.
● Intrauterine Devices (IUDs): Small plastic device inserted into the uterus.
C. Surgical Methods
● Vasectomy: Incision in scrotum, vas deferens is cut and tied/cauterized/plugged.
○ KEY POINTS:
■ Does NOT interfere with sperm production.
■ Testes still produce sperm, but sperm are absorbed and don't pass.
■ Man still has full erection capacity, produces testosterone and
seminal fluid.
■ He will ejaculate seminal fluid with no sperm.
● Tubal Ligation: Fallopian tubes occluded by cautery, crushing, clamping
(Essure).
○ Prevents passage of sperm and ova. Should be considered permanent and
irreversible.
6. Effects on Sexual Enjoyment
● A factor to consider for all methods.
Notes: Chapter 7 - Genetic Assessment and Counselling
1. Genetic Disorders
● Definition: Disorders passed from one generation to the next due to a disorder in the
gene or chromosome structure.
● They occur at the moment an ovum and sperm fuse.
2. Nature of Inheritance
● Genes: The basic units of heredity. Composed of DNA and form chromosomes.
● Chromosomes: In each body cell (except sperm/ova): 46 chromosomes (44
autosomes + 2 sex chromosomes).
○ Sperm & Ova: 23 chromosomes each.
○ XX chromosomes: Females
○ XY chromosomes: Males
● Phenotype: A person's outward appearance (expression of genes).
○ Example: Height, blood type, eye color.
● Genotype: A person's actual gene composition.
○ Example: heterozygous and homozygous.
● Genome: The complete set of genes (about 50,000-100,000). Normal is 46XX or
46XY.
3. Mendelian Inheritance: Dominant and Recessive Patterns
● Homozygous: Has two like genes for a trait (e.g., two healthy genes).
● Heterozygous: Has two different genes for a trait (e.g., one healthy, one
unhealthy).
4. Genetic Counseling and Testing
● Purpose of Counseling:
○ Provide information on inheritance and inherited disorders.
○ Reassure people concerned about inheritance.
○ Allow people to make informed choices about future reproduction.
○ Pursue potential interventions (e.g., fetal surgery).
○ Begin preparation for a child with special needs.
● Who should get counseling?
○ A couple with a child with a congenital disorder or inborn error of
metabolism.
○ A couple whose close relatives have a child with a genetic disorder.
○ Any individual who is a known carrier of a chromosomal disorder.
○ A consanguineous (closely related) couple.
○ Any woman >35 and any man >55.
○ Couples of ethnic backgrounds where specific illnesses are known to occur.
● Nurse Responsibility: Ensure understanding. Never impose personal
values/opinions.
5. Assessment for Genetic Disorder
● History Taking: Include all relatives. Note mother’s age, consanguineous
parents, family’s ethnic background, and create a family genogram.
● Physical Assessment: Includes Dermatoglyphics (study of skin markings).
Unusual fingerprints, palmar creases, etc., can indicate disorders.
6. Diagnostic Testing
● Preimplantation Diagnosis: Testing embryo after in vitro.
● Nuchal Translucency: Ultrasound scan.
● Chorionic Villi: Placental tissue with same genetic material as fetus.
● Amniocentesis: Test of amniotic fluid (fluid surrounding the baby).
● Percutaneous Umbilical Blood Sampling
● Fetoscopy
● Sonography
● Karyotyping: Test to examine chromosomes in a sample of cells.
7. Specific Syndromes
● Trisomy 13 (Patau syndrome): 47XY13+ or 47XX13+. Severely cognitively
challenged. Cleft lip/palate, heart disorders, abnormal genitalia.
● Trisomy 18: 47XY18+ or 47XX18+. Severely cognitively challenged. Low-set ears,
small jaw, heart defects, misshapen fingers, rocker-bottom feet.
● Turner Syndrome: 45X0. Short stature, streak ovaries. Extra neck skin on
sonogram. Treated with estrogen.
● Klinefelter Syndrome: 47XXY. Males with an extra X chromosome. Secondary sex
characteristics do not develop; small testes, ineffective sperm, gynecomastia.
● Fragile X Syndrome: 46XY23Q−. Maladaptive behaviors (hyperactivity,
aggression, autism), reduced intellectual functioning, deficits in speech/arithmetic.
● Down Syndrome (Trisomy 21): 47XY21+ or 47XX21+. Management includes early
education, good hand washing, feeding slowly, and an X-ray for neck stability.