ATI Maternal Newborn
Chapter 1- contraception
Contraception refers to strategies or device used to reduce the risk of fertilization or implantation in an attempt
to prevent pregnancy
Natural family planning: behavioral methods
o Abstinence – no gentialia contact
o Withdrawal (coitus interruptus)
Choice for monogamous couple
Least effective methods
Risk for pregnancy
o Calendar methods
ovulation occurs about 14 days before the onset of her next menstrual cycle, and avoid
intercourse during that period
count at least 6 cycles
o basal body temperature
body temperature can drop slightly at the time of ovulation
measure oral temperature prior to getting out of bed each morning to monitor ovulation
inexpensive, convenient, and no adverse effects
Basal body temperature and the symptothermal method are fertility awareness methods.
o Lactational amenorrhea method
Barrier
o Condoms
Only water-soluble lubricants should be used with latex condoms to avoid condom breakage
o Diaphragm
Dome-shaped cup with a flexible rim made of silicon that fits snugly over the cervix with
spermicidal cream or gel placed into the dome and around the rim
Client should be properly fitted with a diaphragm by a provider
Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal or pelvic
surgery and after every pregnancy
Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or
cream that is applied to the cervical side of the dome and around the rim
The diaphragm can be inserted up to 6 hours before intercourse and must stay in place 6 hour
after intercourse but for no more than 24 hrs.
Spermicide must be reapplied with each act of coitus
Patient should empty bladder before insertion
Wash with soap and water after use
o Cervical cap
o Contraceptive sponge
o Question
Which method would the nurse identify as a barrier method of contraception?
a. Basal body temperature
b. Transdermal patch
c. Diaphragm
d. Symptothermal method
Hormonal
o Oral contraceptives
Adverse effect
Chest pain, shortness of breath, leg pain from a possible clot, headache, eye problems
form a stroke, and hypertensive, breast tenderness, nausea, breakthrough bleeding
(common adverse effects of estrogen component and progestin component)
Can increase the risk of thromboembolism, stroke, heart attack, hypertension, gallbladder
disease, liver tumor
, Effectiveness decrease when taking medications that affect liver enzymes, such as
anticonvulsants and some antibiotics
o Injectable contraceptives
Medroxyprogesterone is an IM or SQ injection given to a female client every 11 to 13 weeks
First injection should be during the first 5 days of period
In postpartum, 5 days after delivery
Maintain adequate intake of calcium and vitamin D
Very effective and require only 4 injections per year
Adverse effects
Decrease in bone mineral density, weight gain, increase depression and irregular
vaginal spotting or bleeding
Contraindicated for osteoporosis patient
Return to fertility can be a long as 18 months after discontinuation
o Transdermal patches
o Vaginal rings
o Implantable progestin
Minor surgical procedure to subdermally implant and remove a single rod contain etonogestrel on
the inner side of the upper arm
Disadvantage
Etonogestrel can cause irregular menstrual bleeding
Adverse effects
Irregular and unpredictable menstruation (most common)
Mood changes, headache, acne, depression, decreased bone density and weight gain
o Intrauterine contraceptives (IUD)
A chemically active T-shaped device that is inserted through the cervix and placed in the
uterus by the provider
Device must be monitored monthly by clients after menstruation to ensure the presence of
small string that hangs form the device into the upper part of the vagina to rule out migration
or expulsion of the device
IUD can maintain effectiveness for 1 to 10 years
Contraception can be reversed
Can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy
and can be expelled
A client should report to the provider later or abnormal spotting or bleeding, abdominal pain or
pain with intercourse, abnormal of foul-smelling vaginal discharge, fever, chills, a change in
string length or if IUD cannot be located
IUD can cause irregular menstrual bleeding
Must be removed in the event of pregnancy
o Emergency contraception
Morning-after pill that prevents fertilization from taking place
Pill is taken within 72 hr after unprotected coitus
Surgical methods
o Tubal ligation
Sterilization for women
A laprascope is inserted; fallopian tubes are grasped and sealed
o Vasectomy
Sterilization for men
Usually performed under local anesthesia
Involves cutting the vas deferens, which carries the sperm
, Chapter 3 – Expected physiological changes during pregnancy
Signs of pregnancy
o Presumptive, probable, positive
Presumptive: those changes felt by the woman
o e.g., breast changes (darkened areolae, enlarged Montgomery’s glands), uterine enlarged, quickening
(slight fluttering movements of the fetus feld by a woman, usually between 16 to 20 seeks of gestation)
o Skipping period is not reliable sign of pregnancy by itself but if it accompanied by nausea, fatigue, breast
tenderness, and urinary frequency, pregnancy would see very likely
Probable: those changes observed by an examiner
o Hegar’s sign – softening and compressibility of lower uterine segment or isthmus
o Ballottement
examiner pushes against the women's cervix during a pelvic exam and feels a rebound from the
floating fetus
rebound of unengaged fetus
o abdominal enlargement
o Chadwick’s sign – deepened violet-bluish color of cervix and vaginal mucosa
o Broxton Hicks contractions – falls contractions that are painless, irregular, and usually relieved by walking
o Positive pregnancy test
Human chorionic gonadotropin (HcG) is earliest biochemical marker for pregnancy
Production begins as early as day of implantation
Can be detected in maternal serum or urine as soon as 7 to 8 days before the expected menses
Urine sample should be first-voided morning specimens and follow the direction for accuracy
o Fetal outline felt by examiner
Positive: those signs attributed only to the presence of the fetus
o Confirm that fetus is growing in the uterus
o Fetal heart sound - hearing fetal heart tones (via Doppler)
o visualizing the fetus by ultrasound
o palpating fetal movements (20 weeks) by examiner
o Pulse sock on mom to get mom’s HR to ensure it’s not baby’s heart sound
Calculating delivery date and determine number of pregnancies for pregnant client
o Nagele’s rule
Date of last menstrual period (LMP)
Calculation of estimated or expected date of birth (EDB) or delivery (EDD)
Nagele’s rule
Use first day of LNMP 11/21/07
Subtract 3 months 8/21/07
Add 7 days 8/28/07
Adjust year 8/28/08 = EDB
Ultrasound is the best method of dating a pregnancy
o Kathy’s rule
Add 9 months and 7 days
o Measurement of fundal height
In centimeters form the symphysis pubis to the top of the uterine fundus (between 18 and 32
weeks of gestation)
Approximates the gestational age
o Gravidity – number of pregnancies
Nulligravid – never been pregnant
Primigravida – first pregnant
Multigravida – two or more pregnant
o Parity – number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy
Nullipara – no pregnancy beyond the stage of viability
Primipara – has completed one pregnancy to stage of viability
Chapter 1- contraception
Contraception refers to strategies or device used to reduce the risk of fertilization or implantation in an attempt
to prevent pregnancy
Natural family planning: behavioral methods
o Abstinence – no gentialia contact
o Withdrawal (coitus interruptus)
Choice for monogamous couple
Least effective methods
Risk for pregnancy
o Calendar methods
ovulation occurs about 14 days before the onset of her next menstrual cycle, and avoid
intercourse during that period
count at least 6 cycles
o basal body temperature
body temperature can drop slightly at the time of ovulation
measure oral temperature prior to getting out of bed each morning to monitor ovulation
inexpensive, convenient, and no adverse effects
Basal body temperature and the symptothermal method are fertility awareness methods.
o Lactational amenorrhea method
Barrier
o Condoms
Only water-soluble lubricants should be used with latex condoms to avoid condom breakage
o Diaphragm
Dome-shaped cup with a flexible rim made of silicon that fits snugly over the cervix with
spermicidal cream or gel placed into the dome and around the rim
Client should be properly fitted with a diaphragm by a provider
Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal or pelvic
surgery and after every pregnancy
Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly or
cream that is applied to the cervical side of the dome and around the rim
The diaphragm can be inserted up to 6 hours before intercourse and must stay in place 6 hour
after intercourse but for no more than 24 hrs.
Spermicide must be reapplied with each act of coitus
Patient should empty bladder before insertion
Wash with soap and water after use
o Cervical cap
o Contraceptive sponge
o Question
Which method would the nurse identify as a barrier method of contraception?
a. Basal body temperature
b. Transdermal patch
c. Diaphragm
d. Symptothermal method
Hormonal
o Oral contraceptives
Adverse effect
Chest pain, shortness of breath, leg pain from a possible clot, headache, eye problems
form a stroke, and hypertensive, breast tenderness, nausea, breakthrough bleeding
(common adverse effects of estrogen component and progestin component)
Can increase the risk of thromboembolism, stroke, heart attack, hypertension, gallbladder
disease, liver tumor
, Effectiveness decrease when taking medications that affect liver enzymes, such as
anticonvulsants and some antibiotics
o Injectable contraceptives
Medroxyprogesterone is an IM or SQ injection given to a female client every 11 to 13 weeks
First injection should be during the first 5 days of period
In postpartum, 5 days after delivery
Maintain adequate intake of calcium and vitamin D
Very effective and require only 4 injections per year
Adverse effects
Decrease in bone mineral density, weight gain, increase depression and irregular
vaginal spotting or bleeding
Contraindicated for osteoporosis patient
Return to fertility can be a long as 18 months after discontinuation
o Transdermal patches
o Vaginal rings
o Implantable progestin
Minor surgical procedure to subdermally implant and remove a single rod contain etonogestrel on
the inner side of the upper arm
Disadvantage
Etonogestrel can cause irregular menstrual bleeding
Adverse effects
Irregular and unpredictable menstruation (most common)
Mood changes, headache, acne, depression, decreased bone density and weight gain
o Intrauterine contraceptives (IUD)
A chemically active T-shaped device that is inserted through the cervix and placed in the
uterus by the provider
Device must be monitored monthly by clients after menstruation to ensure the presence of
small string that hangs form the device into the upper part of the vagina to rule out migration
or expulsion of the device
IUD can maintain effectiveness for 1 to 10 years
Contraception can be reversed
Can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy
and can be expelled
A client should report to the provider later or abnormal spotting or bleeding, abdominal pain or
pain with intercourse, abnormal of foul-smelling vaginal discharge, fever, chills, a change in
string length or if IUD cannot be located
IUD can cause irregular menstrual bleeding
Must be removed in the event of pregnancy
o Emergency contraception
Morning-after pill that prevents fertilization from taking place
Pill is taken within 72 hr after unprotected coitus
Surgical methods
o Tubal ligation
Sterilization for women
A laprascope is inserted; fallopian tubes are grasped and sealed
o Vasectomy
Sterilization for men
Usually performed under local anesthesia
Involves cutting the vas deferens, which carries the sperm
, Chapter 3 – Expected physiological changes during pregnancy
Signs of pregnancy
o Presumptive, probable, positive
Presumptive: those changes felt by the woman
o e.g., breast changes (darkened areolae, enlarged Montgomery’s glands), uterine enlarged, quickening
(slight fluttering movements of the fetus feld by a woman, usually between 16 to 20 seeks of gestation)
o Skipping period is not reliable sign of pregnancy by itself but if it accompanied by nausea, fatigue, breast
tenderness, and urinary frequency, pregnancy would see very likely
Probable: those changes observed by an examiner
o Hegar’s sign – softening and compressibility of lower uterine segment or isthmus
o Ballottement
examiner pushes against the women's cervix during a pelvic exam and feels a rebound from the
floating fetus
rebound of unengaged fetus
o abdominal enlargement
o Chadwick’s sign – deepened violet-bluish color of cervix and vaginal mucosa
o Broxton Hicks contractions – falls contractions that are painless, irregular, and usually relieved by walking
o Positive pregnancy test
Human chorionic gonadotropin (HcG) is earliest biochemical marker for pregnancy
Production begins as early as day of implantation
Can be detected in maternal serum or urine as soon as 7 to 8 days before the expected menses
Urine sample should be first-voided morning specimens and follow the direction for accuracy
o Fetal outline felt by examiner
Positive: those signs attributed only to the presence of the fetus
o Confirm that fetus is growing in the uterus
o Fetal heart sound - hearing fetal heart tones (via Doppler)
o visualizing the fetus by ultrasound
o palpating fetal movements (20 weeks) by examiner
o Pulse sock on mom to get mom’s HR to ensure it’s not baby’s heart sound
Calculating delivery date and determine number of pregnancies for pregnant client
o Nagele’s rule
Date of last menstrual period (LMP)
Calculation of estimated or expected date of birth (EDB) or delivery (EDD)
Nagele’s rule
Use first day of LNMP 11/21/07
Subtract 3 months 8/21/07
Add 7 days 8/28/07
Adjust year 8/28/08 = EDB
Ultrasound is the best method of dating a pregnancy
o Kathy’s rule
Add 9 months and 7 days
o Measurement of fundal height
In centimeters form the symphysis pubis to the top of the uterine fundus (between 18 and 32
weeks of gestation)
Approximates the gestational age
o Gravidity – number of pregnancies
Nulligravid – never been pregnant
Primigravida – first pregnant
Multigravida – two or more pregnant
o Parity – number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy
Nullipara – no pregnancy beyond the stage of viability
Primipara – has completed one pregnancy to stage of viability
