LAGUARDIA COMMUNITY COLLEGE CITY UNIVERSITY OF New York DEPARTMENT OF NATURAL & APPLIED SCIENCE PRACTICAL NURSING PROGRAM Class: SCL 115 – Introduction to Maternity & Pediatric Nursing A List and Definitions of Key Terms From Chapter 8 Through Chapter 11 By Anaise E. Ikama List of Key Terms Advance Practice Nurses – a nurse with a masters degree is called an Advanced Practice Nurse (APN), and they come in four varieties: Nurse Practitioners (NP) - provides basic care focused on a specific population or health need, including writing prescriptions. Certified Nurse Anesthetist (CRNA) - administer anesthesia for all types of surgery. Clinical Nurse Specialist (CNS) - provide specialist care in a number of areas: cardiology, oncology, neonatology, OB/GYN, pediatrics, neurology, and mental health. Certified Nurse Midwife (CNM) - provide prenatal care, delivers babies, and provide postpartum care to normal healthy women. Advocate – is a person who intercedes or pleads on behalf of another person. E.g.: pediatric nurses are increasingly assuming the role of a child advocate. Birthing centers – provide comprehensive care, including antepartum, labordelivery, postpartum, mothers’ classes, lactation classes, and follow-up family planning Clinical Nurse Specialist - provide specialist care in a number of areas: cardiology, oncology, neonatology, OB/GYN, pediatrics, neurology, and mental health. Clinical pathway – also known as critical pathway or care maps (multi disciplinary action plans), are collaborative guidelines that define multidisciplinary care in terms of outcomes within a timeline. Cost containment – is the efficient and effective use of resources. It includes monitoring and regulating expenditures of funds and involves budgets of an institution. E.g. At fist, cost containment influenced maternity care by requiring the discharge of mother and newborn in 24h or les after delivery. Now, current legislation allows a 48h hospital stay for viginal delivery and a stay of 4 days for a cesarean section Critical thinking – entails applying creativity and ingenuity to solve problem: combining basic standards principles with data specific to the patient. Cultural awareness - Cultural Awareness is the foundation of communication and it involves the ability of standing back from ourselves, and becoming aware of our cultural values, beliefs and perceptions. Cultural competence – is the level of knowledge-based skills required to provide effective clinical care to patients from a particular ethnic or racial group. Cultural sensitivity – is a recognition that there are differences between cultures. These differences are reflected in the ways that different groups communicate and relate to one another, and they carry over into interactions with health care providers. Culture – is a body of socially inherited characteristics that one generation hands down to the next generation. It consists of values, beliefs, and practices that are shared by members of the group. Culture becomes a patterned expression of the thoughts and actions (called traditions) and affects the way patients respond to health care. Diagnosis Related groups (DRGS) - A medicine system that determines payment for a hospital stay based on the patients diagnosis. Documentation – Is a legal responsibility of the nurse. When a medication is given or a treatment is performed, it is accurately documented on the patient’s chart. It includes head-to-toe assessment of the patient and a recording of data pertaining to the diagnosis and response to treatment. Empowerment - The nurse’s role in maternity and pediatric family centered care is to enter into a contract or partnership with the family to achieve the goals of health for its members. Family Care Plan - The nursing care plans expands so that the nurse provides care to the patient in the home. Full Inclusion - Signifies an expansion of the mainstream policy. Early infant intervention programs for children with developmental disabilities attempt to reduce or minimize the effects of the disability these services may be provided in a clinic or in the home. Genomic - Is the study of the functions of all of the genes in the human body with a focus on the interactions with each other and the environment. Health Information Portability and Accountability Act (HIPAA) - It was enacted in 2003, to set standard to protect patients’ health information. Health Maintenance Organization (HMO) - An organization that act as an alternative medical care delivery systems. Healthy People 2010 - Is a statement of National Health Promotion and disease prevention objectives, facilitated by the federal government. The objectives are designed to use the vast knowledge and technology of health care that was developed in the twentieth century to improve the health and quality of life of Americans in the twenty-first century. Labor, Delivery and Recovery (CDR) Room - The patient is not moved from one area to another, but receives care during labor and delivery and then remains in the same room to recover and care for her new infant. The rooms are often decorated to look homelike. Mainstream: It is used to describe the process of integrating a physically or mentally challenged child into society. Midwife - A register nurse who has graduated from an accredited midwife program. Provides comprehensive prenatal and postnatal care and attends uncomplicated deliveries. Morbidity: The number of sick persons or cases of disease in relationship to a specific population. Mortality - The number of deaths in a population. Nursing care plan - It is a written instrument of communication among staff members that focuses on individualized patient care. Nursing process - The systematic problem solving approach nurses use to identify, prevent, or treat actual or potential health problems. (The steps include assessment, nursing diagnosis, planning, implementation and evaluation.) Obstetrician - A physician specializing in the care of women during pregnancy, labor, birth, and the postpartum period. Obstetrics - The branch of medicine that pertains to care of women during pregnancy, childbirth, and the postpartum period. Pediatric Nurse Practitioner: Pediatrics - The branch of medicine that deals with the child’s development and care and the their treatment. Preferred provider organization (PPO) - A preferred provider organization contracts with providers for services on a discounted fee-for-service basis for members. Puerperium - The period of 42 days following childbirth and expulsion of the placenta and membranes. Also known as postpartum period (afterbirth) Statistics - refers to the process of gathering and analyzing numerical data concerning birth, illness (morbidity) and death (mortality). It also provides valuable information for determining the needs of a population. Bi-ischial diameter – is the transverse diameter of the outlet, which is the measurement of the distance between the inner surfaces of the ischial tuberosities. Climacteric – a period of years during which the woman’s ability to reproduce gradually declines Diagonal conjugate – is the distance between the suprapubic angle and sacral promontory. The health care provider assesses this measurement during a manual pelvic examination. Dyspareunia – is the weakness of the pelvic or painful intercourse. Often result from improper healing of the perineum after episiotomy (incision) during childbirth Embryo - the pre-fetal product of conception from implantation through the eight week of development External os – is the opening into the vigina Internal os – internal opening near the uterine corpus Menarche – the begging of menstruation that occurs at age between age 11 to 15 years Menopause – refers to the final menstrual period Obstetric Conjugate - (the smallest inlet diameter): Estimated by subtracting 1.5 to 2 cm from the diagonal conjugate (the approximate thickness of the public bone. This measurement determines if the fetus can pass through the birth canal. Obstetrical Perineum - A fold of tissues just below the vagina, where the labia majora and the labia minora meet. Ovulation - The periodic ripening and rupture of the mature graafian follicle and the discharge of the ovum from the cortex of the ovary. Ovum - (egg). The female reproductive or germ cell; capable of developing into a new organism of the species. Puberty - A period of rapid changes in the lives of boys and girls during which the reproductive system mature and becomes capable of puberty. Rugae - This makes stretching of vagina during delivery possible by transverse ridges of the mucous membrane. Semen - The seminal plasma and sperm together. Smegma - is the secretion of the sebaceous glands, specifically, the thick, cheesy odoriferous secretion, found under the labia minora, the glans, clitoridis or under the male prepuce. Spermatogenesis - The formation of mature functional spermatozoa. In the process, undifferentiated spermatogonia become primary spermatocytes, each of which divides to form two secondary spermatocytes. Each of these divides to form two spermatids, which transform into functional motile spermatozoa. In the process, the chromosome number is reduced from the diploid to the haploid number. Transverse Diameter - The largest diameter of the inlet. It determines the inlet’s shape. Zygote - The cell produce by the union of two gametes; the fertilized ovum. Age of Viability: By weeks 20 of gestation the lungs have matured functionally enough for the fetus to survive outside the uterus, but special care in the neonatal intensive care unit (NICU) would be required. Amniotic Sac: This is formed the chorion and amnion which gets filled with fluid (bag of Water) that permits the embryo to float freely. Autosome: Each body cell contains 46 chromosomes, made of 22 pairs of (body chromosomes) and one pair of sex chromosomes that determine the sex of the fetus. Chorion: The chorion develops from the trophoblast (outer layer of embryonic cells) and envelops the amnion, embryo, and yolk sac. It is a thick membrane with fingerlike projections called villi on its outermost surface. Decidua: The endometrium is now called the deciduas; the area under the blastocyst is called the deciduas basalis and give rise to the maternal part of the placenta. Diploid: The 46 chromosomes in the body cell are diploid number of chromosomes. Dizygotic: Also called fraternal twins, may or may not be of the same sex and develop from two separate ova fertilized by two separate sperm. Fertilization: When the sperm and ova unite, the new cell contains 23 chromosomes from the sperm and 23 from the ova, thus returning to the diploid number of chromosomes (46); traits are therefore inherited from both the mother and father. Gametogenesis: The formation of gametes (sperm or ova) by this type of cell division is called gamateogenesis. Germ Layer: After implantation the zygote in the blastocyst stage transforms its embryonic disc into three primary germ layers known as ectoderm, mesoderm and endoderm. Haploid: During meiosis the number of chromosomes in each cell is reduced to half, or 23 chromosomes per cell, each including only one sex chromosome. Monozygotic: Monozygotic (MZ) are twins, often called identical twins, are genetically identical, are of the same sex, and look alike, because they develop from a single fertilizes ovum. Oogenesis: The process of mitosis in the ovum. Placenta: (Afterbirth) is a temporary organ for fetal respiration, nutrition, and excretion. It also functions as an endocrine gland. Spermatogenesis: The process of mitosis in the sperm. Teratogen: Cause damage to growing cells, causing abnormal development to the Embryo. Often, it is influenced by the external environment, such as maternal drug use, maternal under nutrition, or smoking. Wharton’s Jelly: It covers and cushions the cord vessels and keeps the three vessels separated. Abortion: termination of pregnancy before viability (20 weeks of gestation), either spontaneously or induce. Antepartum: (Prenatal) one of the three phases of pregnancy (before birth). Aortocaval Compression (Vena Cava Syndrome): may occur if the woman lies on her back. The supine position allows the heavy uterus to compress her inferior Vena Cava, reducing the amount of blood returned to her heart. Birth Plan: Culture assessment data collection tool to assist in developing an individualizes plan of care Braxton Hicks Contractions: Are irregular, painless uterine contractions that begin in the second trimester. They become progressively more noticeable as term approaches and are more pronounced multiparas. They may become strong enough to be mistaken for true labor. Uterine fibroid (benign tumors) may also cause these contractions. Chadwick’s sign: the purplish or bluish discoloration of the cervix, vagina, and vulva caused by increased vascular congestion. Cloasma: the increased pigmentation of the face, breasts, and abdomen during pregnancy. Colostrum: the nutritious thin yellow fluids secreted by the breasts shortly before and after a woman gives birth: precedes the production of breast milk. It is high in protein, fat-soluble vitamins, and minerals but is low in calories, fat, and sugar. Estimated date of delivery (EDD): is the calculation based on the last normal menstrual period. Gestational age: the prenatal age of the developing fetus calculated from the first day of the woman’s LMP. Goodell’s sign: the softening of the cervix and the vagina caused by increased vascular congestion Gravida: any pregnancy, regardless of duration. It also has been referred to as the number of pregnancies, including the one in progress, if applicable. Hegar’s sign: the softening of the lower uterine segment. Intrapartum: the phase of pregnancy during childbirth. Lactation: the period of breastfeeding after childbirth, beginning with the release of colostrum and continuing until the infant is weaned. Last normal menstrual period (LNMP): last day that of a woman’s menstrual cycle this can be heavy flow of blood or spotting. Lightening: is the descent of the presenting part of the fetus into the pelvis; this often occurs 2-3 weeks before the first stage of labor begins. Multipara: a woman who has given birth to 2 or more children (past the point of viability), regardless of whether the children were alive at birth or are presently alive. The term is also used informally to describe a woman before the birth to her second child. Nagele’s rule: is used to determine the EDD. To calculate the EDD, one identifies the first day of the LNMP, counts backwards 3 months, and then adds 7 days. The year is updated if applicable. The EDD is the estimated date; many normal births occur before and after this date. Para: a woman who has given birth to one or more children who reached the age of viability (20 weeks of gestation), regardless of the number of fetuses delivered and regardless of whether those children are now living. Post-partum: the phase of pregnancy after birth. Primigravida: a woman who is pregnant for the first time. Primipara: A woman who has given birth to her first child (past the point of viability), regardless of whether the child was alive at birth or is now living. The term is also used informally to describe a woman before the birth of her first child Pseudoanemia: Also known as a dilutional anemia or false anemia. It is due to increase fluid (plasma) part of the blood during pregnancy. Quickening: the fetal movement felt by the mother at about 16 to 20 weeks of gestation as a faint fluttering in the lower abdomen. Supine hypertension syndrome: Also known as aortocaval compression or venacava syndrome, often occurs if the woman lies on her back for certain period of time. Trimester: A period or term of three months. Pregnancy is divided into three 13week parts called trimester. Abortion (miscarriage): is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. Cerclage: is the placement of stitches in the cervix to hold it closed. This procedure is often used to keep a weak cervix (incompetent cervix) from opening early. Sometimes, cervical cerclage prevents the cervix from opening before the 37th week of pregnancy and triggering preterm labor and delivery. Disseminated intravascular coagulation (DIC): Is a complex disorder that may complicate abruption placenta. This forms large clots behind the placenta and consumes clotting factors, which leaves the rest of the mother’s body deficient in these factors. Postpartum hemorrhage may also occur, because the injured uterine muscle does not contract. Eclampsia: Coma and convulsive seizure’s between the 20th weeks postpartum. It develops in 1 out of 200 patients, with pregnancy –induced hypertension and is usually fatal if untreated. Erythroblastosis Fetalis: This is when maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes. Hydramnios: An excess of amniotic fluid, which leads to an over distention of the uterus and the possibility of malpresentation of the fetus. Incompetent Cervix: Cervix opens when the growing fetus presses against it. It is successful in most cases. Isoimmunization: this is when fetal Rh-+ blood leak into the Rh- of the mother’s circulation, her body may respond by making antibodies to destroy the Rh+ erythrocytes. Macrosomia: Is a term used to describe an overside fetus. The common cause of macrosomia is maternal diabetes. Macrosomia can lead to trauma during birth and a greater chance of cesarean delivery. Preclamsia: A complication of pregnancy characterized by increasing hypotension, proteinuria, and edema. Products of conception (POC): This is products inside the cervical wall that is suctioned through a plastic cannula during termination of pregnancy. Teratogen: A substance that causes an adverse effect on the developing embryo or fetus. Tonic- clonic seizure: This occurs when the woman has one or more generalized seizures. Acrocyanosis: is the bluish color of hands and feet of the newborn that is normal and is caused by sluggish peripheral circulation. Adjustment: is the outcome of coping at a specific point in time. Amnioinfusion: If membranes have ruptured an amnioinfusion technique, in which IV fluid is infused into the amniotic cavity through an intrauterine pressure catheter, may be done to add a fluid cushion around the cord. Amniotomy: The membranes may rupture spontaneously or the health care provider may rupture them artificially. Bloody Show: Is thick mucus mixed with pink or dark brown blood. Cold Stress: Hypothermia can also cause cold stress, in which the increased metabolic rate required to generate body heat causes increased respiratory rate and oxygen consumption. Coping: Is a dynamic process in which emotions and stress affect and influence each other, coping can also change the relationship between the individual and the environment. Crowning: Is when about 2 to 3 cm of the fetal head is visible at the vaginal opening. Doula: a person whose only job is to support and encourage the woman in the task of giving birth. Dilate: contractions cause the cervix to open and allow the fetus to descend in the birth canal. Efface: Is the thinning of the cervix caused by contractions, which in turn allows the fetus to descend in the birth canal. Episiotomy: is the incision of the perineum at the end of the second stage of labor to avoid spontaneous laceration of the perineum and to facilitate delivery. Fontanelle: the wider area of the fetal head, where the sutures meet. Leopold’s maneuver: the technique used in determining the fetal position and presentation by abdominal palpations. Lie: describes how the fetus is oriented to the mother’s spine Molding: this is when the sutures and fontanelles of the fetal head allow it to change shape as it passes through the pelvis. Neutral thermal environment - the stage in which heat loss is minimal and oxygen consumption needs are the lowest. Nitrazine test - the test performed to determine if the pregnant mother’s membranes have ruptured. Nuchal cord – occurs when the umbilical cord is being compressed often, because it is around the fetal neck. Ophthalmia neonatorum – is conjunctivitis in the newborn, which is caused by Neisseria gonorrhoeae that is prevented by giving all newborn infants specific eye care. Station – describes the level of the presenting part (usually the head) in the pelvis. Station is estimated in centimeters from the level of the ischial spines in the mother’s pelvis (a zero station). Minus stations are above the ischial spines; plus stations are below the ischial spines. As the fetus descends, the minus numbers decrease and the plus numbers increase. Suture – are strong connective tissue that separate several bones of the fetal head. Uteroplacental insufficiency: is insufficient blood flow to the placenta during pregnancy. The term is also, sometimes, used to designate late decelerations (decrease in heart rate) of fetal heart rate. Vaginal birth after cesarean (VBAC): vaginal birth after cesarean delivery of an infant through the vagina in a female who has had a prior cesarean section. Blood patch: is procedure done by the nurse anesthetist when a pregnant woman develops a postspinal headache, most likely because of spinal fluid loss. Blood patch may provide dramatic relief from postspinal headache. The procedure is done by withdrawing 10 to 15ml of the woman’s blood from her vein and injected into the epidural space in the area of the subarachnoid puncture. The blood clots and forms a gelatinous seal that stops spinal fluid leakage. Bradley method: was originally called “husband-coached children” and was the first to include the father as an integral part of labor. It emphasizes slow abdominal breathing and relaxation techniques Cleansing breath: is a deep inspiration and expiration, similar to a deep sigh. It helps the woman to relax and focus on relaxing. Effeurage: is a technique that stimulates the large-diameter nerve fibers that inhibit painful stimuli traveling through the small-diameter fibers by stroking the women abdomen in a circular motion during contractions. Endorphins: They are natural body substance similar to morphine. Endorphin’s levels increase during pregnancy and reach a peak during labor. Endorphins may explain why women in labor often need smaller doses of an analgesic or anesthetic than might be expected in a similarly painful experience. Focal point: The woman fixes her eyes on a picture, an object, or simply a particular spot in the room. Some women prefer to close their eyes during contractions and focus on an internal focal point. Opioids: Are the most common means of labor analgesia in the United States. They are used in small doses to avoid fetal respiratory depression. Opioids do not provide complete pain relief during labor, but they do help the woman cope with tolerable level of intermittent labor pains. Pain threshold: Also called pain perception, is the least amount of sensation that a person perceives as painful. Pain threshold is fairly constant, and it varies little under different conditions. Pain tolerance: Is the amount of pain one is willing to endure. Unlike the pain threshold, one’s pain tolerance can change under different conditions. A primary nursing responsibility is to modify as many factors as possible so that the woman can tolerate the pain of labor. Vaginal birth after cesarean (VBAC): Women in vaginal birth after cesarean classes may need to express unresolved feelings about their previous cesarean birth. Depending on the reason for the cesarean delivery, they may be more anxious about the forthcoming. Artificial rupture of membranes (AROM): by using a sterile sharp instrument performed by a physician or nurse mid- Wife. Cephalopelvic disproportion: Inability of the fetus to pass through the mother’s pelvis. Chignon: The vacuum extractor causes a harmless area of circular edema on the infant’s scalp (chignon) where it was applied. Chorioamnionitis: Is that treatment is based on weighing the risks of early delivery of the fetus against the risks of infection in the mother and sepsis in the newborn. Dysfunctional labor: Abnormal labor, does not progress. Dystocia: is the term used to describe a difficult labor Fibronectin test: is a cervical or vaginal fetal test that has been approved by the Food and Drug Administration for clinical use in the United States. Fibronectin is a protein produced by the fetal membranes that can leak into the vaginal secretions if uterine activity, infection, or cervical effacement occurs. Hydramnios: overdistention of uterus or multifetal. Laminaria: is a narrow cone of a substance that absorbs water and is known as an “osmatic dilator.” Macrosomia: A large fetus is generally considered to be on that weight 4000g (8.8pounds) at birth. Oligohydramnios: Decrease in amniotic fluid. Shoulder Dystocia: Difficult labor may occur, usually when the fetus is large. The fetal head is born, but the shoulders become impacted above the mother’s symphysis pubis. Spontaneous Rupture of Membranes (SROM): A woman’s membranes rupture spontaneously. Tocolytic: Drugs that stop labor. Version: Is a method of changing the fetal presentation usually from breech to cephalic. After pains: intermittent uterine contractions that similar to menstrual cramps. The discomfort is self-limiting and decreases rapidly within 48 hours post portion. Attachment: Is an affectionate tie that occurs over time as infant and caregivers interact. Bonding: Is a strong emotional tie that forms soon after between parents and the newborn. Colostrum - is the yellowish fluid rich in protective antibodies secreted by the breasts late in pregnancy and for the first few days after birth providing protein, vitamins A and E, and essential minerals. Diastasis recti: this is when the longitudinal abdominal muscles that extend from the chest to the syphilis pubis are separated. Fundus: is the upper portion of the body of the uterus. Galactagogue: breast milk stimulator. Involution: the changes that the reproductive organs, particularly the uterus, undergo after birth to return them to prepregnancy size and condition. Let-down reflex - the delivery of the milk from the alveoli through the duct system to the nipple. Lochia: the vaginal discharge after delivery composed of endometrial tissue, blood, and lymph. Postpartum blues: the conflicting feelings of joy and emotional letdown during the first few weeks after birth experienced by new mothers. Puerperium: is the 6 weeks following childbirth often referred to as the fourth trimester of pregnancy. Suckling: is specifically related to giving or taking nourishment at the breast. Atony: describes a lack of normal muscle tone. Curettage: scraping or vacuuming the inner lining of the uterus. Endometritis: an inflammation of the inner lining of the uterus (endometrium). Hematoma: a collection of blood within the tissues resulting from birth trauma usually on the vulva or inside the vagina; seen as a bulging bluish or purplish mass. Hypovolemic shock: occurs when the volume of blood is depleted and cannot fill the circulatory system. Involution: is the return of the uterus to its non-pregnant condition after birth. Mama: hyperactivity, excitability, euphoria, and a feeling of being invulnerable Mastitis: an infection of the breast, usually occurs about 2 or 3 weeks after giving birth when organism from the skin or the infant’s mouth enter small cracks in the nipples or areolae. Mood: A pervasive and sustained emotion that can color one’s view of life. Postpartum “blue” or “baby blue” are common after birth. The woman has periods when she feels let down but overall she finds pleasure in life and in her new role as mother. Her roller- coaster emotions are usually self-limiting as she adapts to the challenge in her life Psychosis: Involves serious impairment of one’s perception of reality. Postpartum depression and postpartum psychosis are disorders that are more serious than “postpartum blues.” Puerperal sepsis: Is infection or septicemia after childbirth. Tissue trauma during labor, the open wound of the placental site, surgical incision, cracks in the nipples of the breasts and increased pH of the vagina after birth are all risk factors for post partum woman. Subinvolution: Is a slower- than - expected return of the uterus to its non-pregnant condition. Amenorrhea: Is the absence of menstruation. It is normal before menarche, during pregnancy, and after menopause. Climacteric: (change of life) is also known as the perimenopausal period, which extends for 2 to 8 years before menstruation ceases. Coitus interruptus: Is withdrawal of the penis before ejaculation. It demands more self – control than most man can achieve. Dysmenorrhea: Painful menses or “cramps” affects many women. It occurs soon after the onset of menses and is spasmodic in nature. Dyspareunia: painful sexual intercourse. Endometriosis: is the presence of tissue that resembles endometrium outside the uterus. This tissue responds to hormonal stimulation just as the uterine lining does. The lesions may cause pain, pressure, and inflammation to adjacent organs as they build up pressure and slough during menstrual cycles. It causes pain in many women that is either sharp or dull. Leiomyomas: uterine fibroids, which are benign growths of uterine muscle cells and are a very common gynecological condition. They grow under the influence of estrogen, and they are thus most prominent during the childbearing years and often atrophy after menopause. Menopause: according to the World Health Organization (WHO), menopause is the cessation of menstrual periods for a 12-month period because of changes in estrogen production. Menorrhagia: refers to menstrual bleeding that is excessive in amount. The average woman loses about 35 ml of blood during normal menstruation. Blood loss greater than 80 ml per month is considered excessive and often results in anemia. Metrorrhagia: is uterine bleeding that is usually normal in amount but occurs at irregular intervals. Mittelschmerz: (“middle pain”) is pain that many women experience around ovulation, near the middle of their menstrual cycle. Mild analgesics are usually sufficient to relieve this discomfort. Myoma: benign uterine muscle tumors. Osteoporosis: occurs when a loss of bone mass accelerates as estrogen levels fall. It is a leading cause of vertebral, hip, and other fractures in post-menopausal women because the bones become very fragile. Retrograde ejaculation: is where semen is released into the bladder rather than from the penis. Some drugs and nervous system disorders may cause retrograde ejaculation. Spermicides: are inserted into the vagina before intercourse to neutralize vaginal secretions, destroy sperm, and block entrance to the uterus. Most spermicides are effective for no more than 1 hour. Spinnbarkeit: is the stretching of the cervical mucus at the time just prior to ovulation. Stress incontinence: is leakage caused by a sudden increase in intraabdominal pressure (as occurs with sneezing or coughing).