UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
TOPIC OUTLINE
A. Alternative Methods of Birth
a. The Leboyer Method
b. Lamaze Method
c. Bradley Method
d. Hydrotherapy and the Water Birth
e. Unassisted Birthing
f. Home Birth
g. Hypnosis
h. Acupuncture and Acupressure
B. Common Reproductive Issues
a. Infertility in Women
b. Dysmenorrhea
c. Menorrhagia
d. Amenorrhea
e. Endometriosis
f. Uterine Fibroids
g. Gynecologic or Cervical Cancer
h. HIV/AIDS
i. Interstitial Cystitis
j. Polycystic Ovary Syndrome (PCOS)
k. Sexually Transmitted Diseases (STDs)
l. Primary Ovarian Insufficiency (POI)
m. Gonorrhea and Chlamydia
n. Cervical Dysplasia
o. Pelvic Floor Prolapse
C. Reproductive Health Bill and Other existing
DOH Programs on Maternal and Child Care
a. Reproductive Health Bill
i.
What is RHB?
ii.
What consists RHB?
iii.
What are the advantages and
disadvantages of RHB?
iv.
Issues on RHB?
b. Other existing DOH programs on
Maternal and Child Care
i.
Safe Motherhood Program
ii.
Maternal and Child Care
Program
ALTERNATIVE METHODS OF BIRTH
●
While most people still deliver in a hospital,
home births have been on the rise in recent
years and medical providers have been
adapting to the increased interest in
alternative childbirth.
The Leboyer Method
●
●
●
●
●
●
●
Sometimes referred to as “birth without
violence.”
The focus of this method is to primarily
improve the quality of the birth experience
for the baby
It was introduced by Frederick Leboyer, a
French obstetrician who believed that the
traditional hospital births of the time (1975)
were traumatic for the infant.
In 1975, he published a book entitled “Birth
without Violence.”
○ Where the depth of a newborn’s
sensitivity and the importance of how
the baby is handled by the people
around him were emphasized.
○ He pointed out that babies born in a
less stressful environment were more
content.
Leboyer postulated that moving from a
warm, fluid-filled intrauterine environment to
a noisy, air-filled, brightly lit extrauterine
environment creates a major distress to the
newborn.
He believed that holding a newborn upside
down at birth and cutting his/her cord
immediately from the mother is not
beneficial to the baby.
With the Leboyer method, the birthing room
is darkened so there is no sudden contrast
in light.
○ The environment is kept pleasantly
warm, not chilled; soft music is played,
or at least harsh noises are kept to
minimum;
1
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
○
●
The infant is handled gently; the cord
is cut late; and the infant is placed
immediately after birth into warm
bath water.
Some neonatologists are questioning the
principle of warm baths because doing so
can reduce spontaneous respiration and
allow a high level of acidosis to occur.
○ Cutting of the cord until it stops
pulsating can lead to excess RBC in
the neonate’s circulatory system that
could lead to extra blood viscosity.
○ Soft music, gentle handling, and a
welcoming atmosphere are important
components for all birth attendants
to incorporate into birth.
○ Providing dim lights (or at least
bright, glaring ones) and providing a
warm temperature could be given
more
consideration
in
most
institutions.
Benefits of the Lamaze Method
● It prepares the mother and her partner with
a number of tools to use to get through
labor and delivery naturally
● The breathing and relaxation techniques
reduce the perception of pain and keep
labor moving smoothly.
● The Lamaze courses help the couple be
prepared with what to expect over the first
few days and weeks together.
Disadvantage of the Lamaze Method
● Learning the Lamaze method takes time.
○ The couple must plan ahead and
attend classes starting in the second
trimester of pregnancy.
Bradley Method
Lamaze Method
●
●
●
●
●
Lamaze method is typically known for
controlled breathing techniques but it
includes a number of comfort strategies
that can be used during labor.
Breathing techniques increase relaxation
and decrease the perception of pain.
This method is taught in a series of classes
attended by both the mother and her
partner, when possible.
○ It doesn’t explicitly encourage or
discourage medications but seeks to
educate women about their options
so they can make a birth plan that
suits their individual needs.
●
Also known as “husband-coached natural
childbirth.”
The emphasis is on being prepared for an
unassisted vaginal birth without medication,
and this method is taught over 12 weeks
along with a reading workbook.
Midwives often recommend the Bradley
method preparation classes.
○ In addition to learning ways to reduce
the pain of vaginal birth, the method
teaches about nutritional dn other
aspects of natural health.
Benefits of the Bradley Method
● This method is beneficial to prepare the
parents for unassisted births.
● It helps the couple be prepared with
techniques to reduce the perception of pain
2
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
and
stay
relaxed
through
natural
unmedicated childbirth.
It also teaches the couple about things they
need to know to take care of themselves as
new parents and what to expect when the
infant arrives.
Unassisted Birthing
●
●
●
Disadvantages of the Bradley Method
● For couples who are uncertain if they want
to try for an unassisted vaginal birth without
medication, the Bradley method might be
best.
● The course and training take quite a long
time.
○ Couples need to begin classes in the
second trimester.
Hydrotherapy and Water Birth Method
●
●
●
●
●
●
Hydrotherapy is immersion in warm water
during labor.
○ It can be used during any part of
labor, including early labor and active
labor, as well as the late (“pushing”)
phase.
○ It is offered as a comfort measure,
providing relaxation and pain relief
○ It is different from a water birth
During a water birth, the baby is delivered
underwater in a special water birth tub.
Hydrotherapy on the other hand, is used
during labor - but not during delivery.
Reclining or sitting in warm water during
labor can be soothing; the feeling of
weightlessness that occurs under water as
well as the relaxation from the warm water
both can contribute to reducing discomfort
in labor.
Using this principle, many birthing settings
encourage women to not only labor in warm
showers or tubs but also to give birth in spa
tubs of warm water.
One disadvantage is that because most
women expel feces from pushing in the
second stage of labor, the water bath may
become contaminated.
Most womens who choose underwater birth,
however, enjoy the experience and are
pleased that they chose this method.
●
●
Also called free birthing.
Freebirth is the deliberate delivery of a baby
by a woman without the assistance of a
midwife or medical professional.
Women who opt for natural childbirth are
typically willing to make their own decisions
regarding the timing and location of the
birth.
A woman may also select a freebirth
because she feels a connection to a
particular location, typically her home.
She may find freebirth to be an appealing
option because she feels strongly connected
to her home environment.
ADVANTAGES:
● Without the assistance of a doctor or
midwife, the person in labor determines how
to approach birth, which some women
describe as the most fulfilling event of their
lives.
● Childbirth without assistance is essentially
free.
DISADVANTAGES:
● The most serious risk of an unassisted birth
is death of either the baby or the mother.
● Labor complications may not be detected
and treated in time.
● The mother is at risk for bleeding before,
during, or after delivery, undiagnosed
health issues like high blood pressure,
failure to progress in labor, uterine rupture,
retained placenta, damage to the perineum
or pelvic floor, and infection in the mother or
her child.
● The baby may be at risk for abnormal
presentation,
low
birth
weight
or
prematurity, cord prolapse or compression,
a cord around the neck, and changes in the
baby's heart rate.
Home Birth
●
A planned home birth occurs when you give
birth at home rather than in a hospital or
birthing center.
3
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
●
●
During labor and delivery, you will still
require the aid of an experienced and
certified person such as a certified
nurse-midwife, a certified professional
midwife, and a medical doctor who practices
obstetrics.
Home birth is not viable for patients who
have previously had a stillbirth, a C-section,
a shoulder dystocia leading in damage, a
severe postpartum hemorrhage, an active
herpes
infection,
hypertension,
or
gestational
diabetes
that
requires
medication.
It is also not recommended for individuals
who are in preterm labor, expecting
multiples, the baby is breech or transverse,
or there is evidence of fetal defects that
require prompt evaluation.
However, the Maternal, Newborn and Child
Health and Nutrition Strategy policy, also
known as the "no home birth" policy, was
implemented in the Philippines in 2008.
ADVANTAGES:
● Mothers who opt for home birth can choose
their own labor positions and other aspects
of the birthing process.
● Lower costs than hospital labor.
● Women have more confidence in themselves
and felt empowered to make their own
judgments.
● It was more satisfying and less stressful for
the family to give birth in their own house,
on their own terms, in a familiar setting.
● Some women felt they were not given
options in the hospital setting, while others
believed their thoughts and opinions were
not acknowledged.
DISADVANTAGES:
● An increased risk of newborn death,
seizures, and nervous system abnormalities
is connected to planned home births.
● A nearly twofold increase in the probability
of perinatal death (2 in 1,000 births for
planned home births compared with 1 in
1,000 for hospital births)
Hypnosis
●
●
●
●
●
Also called Hypnobirthing.
Hypnotic birth is a birthing method that
focuses on preparing you for a pleasant
birth.
Hypnosis has been practiced for over a
century, but it is necessary to be trained by
a hypnotist or a hypnotherapist.
The main goal of HypnoBirthing is to assist
women in overcoming any fears or anxieties
they may have regarding childbirth.
It uses a variety of relaxation and
self-hypnosis techniques to help the body
relax before, during, and after childbirth.
HYPNOBIRTHING TECHNIQUES:
1. Controlled breathing
● This is a technique in which the
mother breathes deeply in through
their nose and out through the
mouth.
● Controlled breathing can help the
mother to stay relaxed and calm
during labor.
2. Cognitive-Behavioral Hypnotherapy (CBH)
● Cognitive-behavioral therapy is a
modern, evidence-based therapeutic
technique that can be used to treat a
wide range of problems which
focuses on the current issue and how
to resolve it.
3. Guided visualization
● Visualization helps the mother focus
their attention on positive things.
● The theory is that by adopting these
techniques, they will be able to give
birth in a state quite similar to
daydreaming.
4. Meditation
● Meditation diverts attention away
from the discomfort and stress of
labor.
HYPNOBIRTHING VS LAMAZE AND BRADLEY
METHODS:
● The birth partner or coach is essential with
both Lamaze and the Bradley Method.
● A support person is recommended when
using HypnoBirthing, but a woman can
self-hypnotize.
4
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
In other words, success of hypnobirthing
does not always require the assistance of
another person.
ADVANTAGES:
● When a mother utilizes this therapy, she is
less likely to use anesthesia or painkillers.
● The initial stage of labor may be shortened
with the aid of hypnosis during delivery.
● People who have had traumatic birth
experiences or who have a general anxiety
of labor and delivery may benefit most from
hypnobirthing.
● It promotes mothers' comfort with what's
happening during labor and their sense of
security and power.
● It can help support the postpartum
experience.
DISADVANTAGES:
● HypnoBirthing or similar treatments do not
guarantee pain-free.
COMMON REPRODUCTIVE ISSUES
Infertility in Women
●
●
Acupuncture and Acupressure
●
●
Acupuncture is a traditional Chinese
method of stimulating spots on the body,
typically with thin needles deliberately
placed, to assist balance the natural flow of
energy or qi.
Acupressure
manually
stimulates
corresponding points, such as by pressing
on them with the hand or fingertips.
ADVANTAGES:
● Acupuncture may improve pain alleviation
satisfaction while decreasing the use of
pharmaceutical pain relievers.
● Acupuncture may speed up cervical
ripening.
● Acupressure may lessen the discomfort and
length of labor.
DISADVANTAGES:
● Acupuncture has no effect on how much
oxytocin or epidural analgesia is given or
how long induced labor lasts.
● Acupressure has not been found to speed
up cervical ripening or start labor.
Due to a lack of research, the negative
impact and mechanism of acupressure and
acupuncture is unknown.
●
●
It is a medical condition in which the ability to
get pregnant and give birth to a child is
impaired or limited in some way.
For heterosexual couples, infertility is usually
diagnosed after one year of trying to get
pregnant.
○ Depending on other factors, it can be
diagnosed sooner.
For heterosexual couples:
○ One third of causes of infertility are due to
male problems.
○ One third of causes of infertility are due to
female problems.
○ One third are due to a combination or
unknown reasons.
Female infertility: the cause of infertility is from
the female partner.
EPIDEMIOLOGY
● According to a study conducted by the National
Survey of Family Growth that interviewed 12,000
women in the United States, the prevalence of
infertility decreased as the woman’s age
increased.
● As a woman gets older, the chances of being
infertile increases.
● Infertility rates of women aged:
○ 15 to 34 years: 7.3 to 9.1%
○ 35 to 39 years: 25%
○ 40 to 44 years: 30%
5
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
Infertility rates are higher in Eastern Europe,
North Africa, and the Middle East.
Worldwide:
● 2% of women aged 20 to 44 were never able
to have a live birth.
● 11% with a previous live birth were unable to
have an additional birth.
ETIOLOGY
● A large multinational study was performed by
the World Health Organization to determine
gender distribution and infertility etiologies.
● In 37% of infertile couples, female infertility was
identified to be the cause.
● In 35% of couples, both male and female causes
were identified.
● In 8% of couples, male factor infertility was
identified.
● The study also determined the most common
identifiable factors of female infertility:
○ Ovulatory disorders: 25%
○ Endometriosis: 15%
○ Pelvic adhesions: 12%
○ Tubal blockage: 11%
○ Other tubal/uterine abnormalities: 11%
○ Hyperprolactinemia: 7%
RISK FACTORS
● There are several factors that may put a woman
at higher risk of infertility:
○ Age: The quality and quantity of a woman’s
eggs begin to decline with age which makes
conception difficult and increases the risk of
miscarriage.
○ Smoking: It poses several risks such as
damaging the woman’s cervix and fallopian
tubes, increasing the risk of miscarriage and
ectopic pregnancy, ageing the woman’s
ovaries,
and
depleting
their
eggs
prematurely.
○ Weight: Being overweight or significantly
underweight may affect ovulation.
○ Sexual history: STIs such as chlamydia and
gonorrhea can damage the fallopian tubes.
○ Alcohol: Excess consumption of alcohol can
reduce fertility.
SIGNS AND SYMPTOMS
● Main symptom: inability to get pregnant.
●
●
A menstrual cycle that is too long, too short,
irregular, or absent can mean that a woman is
not ovulating.
No other signs or symptoms may occur.
EVALUATION
● Infertility evaluation is indicated in women with
unsuccessful pregnancy after 12 months of
unprotected regular intercourse or 6 months if
they are over 35 years old.
● Male infertility evaluation is also essential and
should be initiated simultaneous with female
infertility evaluation.
● History taking of the infertile woman should
include the following:
○ Duration of infertility
○ Obstetrical history
○ Menstrual history, to include molimina
○ Medical, surgical, and gynecological history
(include history of sexually transmitted
infections)
○ Sexual history to include coital frequency
and timing
■ Focus should also be on the male
partner, including issues with erection
and ejaculation.
○ Social and lifestyle history, including:
■ Cigarette use
■ Alcohol use
■ Illicit drug use
■ Exercise
■ Diet
■ Occupation
○ Family history, screening for genetic issues,
history of venous thrombotic events,
recurrent pregnancy loss, and infertility.
● Physical examination should include the
following:
○ Vital signs and Body Mass Index (BMI)
○ Thyroid evaluation
○ Breast exam for galactorrhea
○ Signs of androgen excess; dermatological
and external genitalia exam
○ The appearance of abnormal vaginal or
cervical anatomy
○ Pelvic masses or tenderness
○ Uterine enlargement or irregularity
○ Transvaginal ultrasonography (often done at
the bedside as part of the initial physical
exam).
6
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
●
Five diagnostic evaluation categories:
○ Semen analysis
○ Assessment of ovarian function and reserve
○ Assessment of the uterine cavity
○ Assessment of the fallopian tubes
○ Endocrinological serum studies
Fertility tests might include:
○ Ovulation
testing:
An
at-home,
over-the-counter ovulation prediction kit
detects the surge in luteinizing hormone
(LH) that occurs before ovulation.
○ Hysterosalpingography:
During
hysterosalpingography, X-ray contrast is
injected into the uterus and an X-ray is
taken to check for problems inside the
uterus. It also shows whether the fluid
passes out of the uterus and spills out of the
fallopian tubes. If any problems are
identified, the woman will likely need further
evaluation.
○ Ovarian reserve testing: It helps determine
the quality and quantity of eggs available
for ovulation. Women at risk of a depleted
egg supply might have this series of blood
and imaging tests.
○ Other hormone testing: Other hormone
tests check levels of ovulatory hormones as
well as thyroid and pituitary hormones that
control reproductive processes.
○ Imaging tests: A pelvic ultrasound looks for
uterine or fallopian tube disease.
Depending on the situation, testing might
include:
○ Laparoscopy: It involves making a small
incision beneath the navel and inserting a
thin viewing device to examine the fallopian
tubes, ovaries, and uterus. It can identify
endometriosis, scarring, blockages, or
irregularities of the fallopian tubes, and
problems with the ovaries and uterus.
○ Genetic testing: It helps determine whether
there are any changes to the woman’s genes
that may be causing infertility.
TREATMENT/MANAGEMENT
● Treatment for infertility depends on the cause,
age, how long the woman has been infertile, and
personal preferences.
● It involves significant financial, physical,
psychological, and time commitments.
●
●
Infertility treatments can either attempt to
restore fertility through medication or surgery,
or help a woman get pregnant with
sophisticated techniques.
Medications to restore fertility:
○ There are medications that regulate or
stimulate ovulations.
○ These are known as fertility drugs.
○ Fertility drugs: main treatment for women
who are infertile due to ovulation disorders.
○ They generally work like FSH and LH to
trigger ovulation.
○ They’re also used in women who ovulate to
stimulate a better egg or an extra egg.
○ Fertility drugs include:
■ Clomiphene citrate: A drug that is taken
orally and stimulates ovulation by
causing the pituitary gland to release
more FSH and LH, which stimulate the
growth of an ovarian follicle containing
an egg. It is considered as a first-line
treatment for women younger than 39
who are not diagnosed with PCOS.
■ Gonadotropins:
These are injected
treatments that stimulate the ovary to
produce multiple eggs. Gonadotropin
medications include human menopausal
gonadotropin or hMG (Menopur) and
FSH (Gonal-F, Follistim AQ, Bravelle).
Human chorionic gonadotropin (Ovidrel,
Pregnyl) is also used to mature the eggs
and trigger their release at the time of
ovulation. There are concerns that using
gonadotropin increases the risk of
conceiving multiples and having a
premature delivery.
■ Metformin: This drug is used when
insulin resistance is a known or
suspected cause of infertility, usually
indicated for women who are diagnosed
with PCOS. It helps improve insulin
resistance, which improves the likelihood
of ovulation.
■ Letrozole: It belongs to a class of drugs
known as aromatase inhibitors and
works in a similar fashion to clomiphene.
It is usually used for women younger
than 39 who are diagnosed with PCOS.
■ Bromocriptine: It is a dopamine agonist
that might be used when ovulation
7
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
●
●
problems
are
caused
by
excess
production of prolactin by the pituitary
gland.
There are several surgical procedures that can
correct problems or improve female fertility.
However, surgical treatments are rare due to the
success of other treatments.
Surgical procedures include:
○ Laparoscopic or hysteroscopic surgery: The
surgery might involve correcting problems
with
the
uterine anatomy, removing
endometrial polyps and some types of
fibroids that misshape the uterine cavity, or
removing pelvic or uterine adhesions.
○ Tubal surgeries: A laparoscopic surgery
might be recommended if the fallopian
tubes are blocked or filled with fluid. This
surgery removes adhesions, dilates a tube
or creates a new tubal opening. This surgery
is rare as pregnancy rates are usually better
with IVF.
Methods of reproductive assistance:
○ Intrauterine insemination (IUI): During IUI,
millions of healthy sperm are placed inside
the uterus around the time of ovulation.
○ Assisted reproductive technology: This
involves retrieving mature eggs, fertilizing
them with sperm in a dish in a lab, then
transferring the embryos into the uterus
after fertilization is completed.
■ In vitro fertilization (IVF): This is the most
effective
assisted
reproductive
technology.
■ An IVF cycle takes several weeks and
requires frequent blood tests and daily
hormone injections.
PROGNOSIS
● Pregnancy rates collected from a retrospective
analysis of 45 separate studies:
○ No treatment: 1.3 to 3.8%
○ IUI alone: 4%
○ Clomiphene citrate (CC) alone: 5.6%
○ CC with IUI: 8.3%
○ Gonadotropin alone: 7.7%
○ Gonadotropins with IUI: 17.1%
○ IVF: 20.7%
COMPLICATIONS
●
●
●
●
There
are
three
primary complications
associated with infertility treatments: Multiple
Gestations, Ectopic Pregnancy, and Ovarian
Hyperstimulation Syndrome.
Multiple Gestations:
○ The risk of multiples has been a problem for
artificial reproductive technologies since the
inception of the practice.
Ectopic Pregnancy:
○ There is a two-to-threefold increase of
ectopic
pregnancies
among
infertility
patients. This is thought to be associated
with a high percentage of tubal factor
infertility.
○ The highest associated risk of ectopic
pregnancy is after a tubal surgery to correct
tubal factor infertility.
○ The rates of ectopic pregnancy following
tubal
reconstructive
surgery
is
approximately 9% with other reports as high
as 30%.
Ovarian Hyperstimulation Syndrome (OHSS):
○ This is an iatrogenic complication of
controlled ovarian hyperstimulation that
results in a broad range of signs and
symptoms,
ranging
from
abdominal
distention, nausea, vomiting, enlarged
ovaries, third-spacing of fluids, renal failure,
venous
thrombosis,
acute
respiratory
distress
syndrome,
electrolyte
derangements, cardiac arrhythmias, and
sepsis.
Dysmenorrhea
●
●
It is the Greek term for “painful monthly
bleeding”.
It can be classified as primary or secondary
dysmenorrhea.
8
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
●
●
Primary dysmenorrhea: lower abdominal pain
happening during the menstrual cycle, which is
not associated with other diseases or
pathology.
Secondary dysmenorrhea: usually associated
with other pathology inside or outside the
uterus.
Dysmenorrhea is a common complaint among
women during their reproductive age.
It is associated with psychological, functional,
and emotional health impacts.
EPIDEMIOLOGY
● It is one of the most common gynecological
problems among all women regardless of age or
race.
● It is also one of the most frequently identified
etiology of pelvic pain in females.
● Prevalence of dysmenorrhea: varies between
16% to 91% in women of reproductive age, with
severe pain observed in 2% to 80%.
● According to Agarwal et al., the prevalence of
dysmenorrhea in adolescents is 80%.
● Approximately 40% of adolescents had severe
dysmenorrhea.
ETIOLOGY
● Primary dysmenorrhea:
○ Prostaglandin F (PGF): main contributor to
the cause of dysmenorrhea.
○ The time of the endometrial shedding
during the beginning of menstruation is
when the endometrial cells release PGF.
○ Prostaglandin
(PG)
causes
uterine
contractions, and the intensity of the
cramps is proportional to the amount of
prostaglandins released after the sloughing
process that started due to dropping
hormonal surge.
● Secondary dysmenorrhea:
○ Presentation of secondary dysmenorrhea is
a clinical situation where menstrual pain
can be due to an underlying disease,
disorder, or structural abnormality within or
outside the uterus.
○ Common
causes
of
secondary
dysmenorrhea:
■ Endometriosis
■ Fibroids (endometriomas)
■ Adenomyosis
■
■
■
Endometrial polyps
Pelvic inflammatory disease
Use of an intrauterine contraceptive
device.
RISK FACTORS
● The associated risk factors with dysmenorrhea
are:
○ Age
○ Smoking
○ Attempt to lose weight
○ Higher body mass index
○ Depression or anxiety
○ Earlier age of menarche
○ Nulliparity
○ Longer and heavier menstrual flow
○ Family history of dysmenorrhea
○ Disruption of social networks
PATHOPHYSIOLOGY
● The pathophysiology of primary dysmenorrhea
is not well understood.
● The
identified
cause
is
due
to
the
hypersecretion of the prostaglandins from the
inner uterine lining.
● Prostaglandin
F2alpha
(PGF-2a)
and
Prostaglandin PGF 2: increases the uterine tone
and also causes high-amplitude contractions of
the uterus.
● Uterine contractility is observed to be more
prominent in the first two days of the menstrual
period.
● Progesterone levels drop before menstruation
which leads to increased production of
prostaglandins,
which eventually triggers
dysmenorrhea.
● Vasopressin: has been linked to primary
dysmenorrhea.
○ It increases the uterine contractility and can
cause
ischemic
pain
due
to
its
vasoconstriction effects.
● Endometriosis and adenomyosis: most common
causes
of
secondary
dysmenorrhea
in
premenopausal women.
SIGNS AND SYMPTOMS
● The signs and symptoms
dysmenorrhea include:
associated
with
9
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
○
○
○
○
○
Gastrointestinal symptoms, such as nausea,
bloating, diarrhea, constipation, vomiting,
and indigestion.
Irritability, headache, and low back pain
(prevalent among women presenting with
primary dysmenorrhea).
Tiredness
Dizziness
EVALUATION
● To diagnose dysmenorrhea, the medical history
of a woman should be evaluated.
● A complete physical and pelvic exam should
also be done.
● Other tests for diagnosis include:
○ Ultrasound: This uses high frequency sound
waves to create an image of the internal
organs.
○ Magnetic resonance imaging (MRI): This test
uses large magnets, radiofrequencies, and a
computer to create detailed images of body
structures and organs.
○ Laparoscopy: This test involves inserting a
laparoscope into an incision in the
abdominal wall to see into the pelvic and
abdomen area, and detect abnormal
growths.
○ Hysteroscopy: This is the visual examination
of the cervical canal and the inside of the
uterus.
TREATMENT
● Pharmacological treatment:
○ Nonsteroidal
anti-inflammatory
drugs
(NSAIDS): These are considered to be the
first line treatment for dysmenorrhea.
○ Oral contraceptive pills (OCPs): These are
reported to be effective in reducing
dysmenorrheic pain compared to placebo
among adolescents.
○ Progestin-only pills (POPs): These are
suitable for patients with secondary
dysmenorrhea related to endometriosis. Its
effectiveness as a treatment for primary
dysmenorrhea is not evident.
● Non-pharmacological Treatment:
○ Maintaining an active lifestyle and a
balanced diet are recommended for better
health outcomes.
○
○
A healthy lifestyle and a diet rich in vitamins
and minerals are useful to reduce the
intensity of dysmenorrhea.
Different types of exercise are recommended
due to their health benefits and because it
helps reduce the intensity of dysmenorrhea.
Heat is effective compared to NSAIDS and it
seems to be the preferred therapy option by
many patients with no side effects.
COMPLICATIONS
● Primary dysmenorrhea complications:
○ It can be summarized by the intensity of the
pain affecting the woman’s well-being and
their daily activities.
○ Primary dysmenorrhea is not linked to any
pathology or disease so there are no known
complications.
● Secondary dysmenorrhea complications:
○ It varies depending on the etiology.
○ It may include infertility, pelvic organ
prolapse, heavy bleeding, and anemia.
Menorrhagia
●
●
●
It is a menstrual bleeding that lasts more than 7
days.
It can also be bleeding that is very heavy.
Menorrhagia is also called abnormal uterine
bleeding (AUB).
EPIDEMIOLOGY
● Abnormal uterine bleeding or menorrhagia is a
predominant complication among women in the
United States.
● Annual prevalence rate: 53 per 1000 women.
10
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
AUB is one of the leading causes of outpatient
gynecological visits with 20% to 30% of women
presenting with this complaint.
○
ETIOLOGY
● The possible causes of menorrhagia falls into
three areas:
○ Uterine-related problems:
■ Growths or tumors of the uterus that are
not cancer and can be called uterine
fibroids or polyps.
■ Cancer of the uterus or cervix.
■ Certain types of birth control such as
IUD.
■ Problems related to pregnancy, such as
miscarriage or ectopic pregnancy.
○ Hormone-related problems
○ Other illnesses or disorders:
■ Bleeding-related disorders or platelet
function disorder.
■ Nonbleeding-related disorders, such as
liver, kidney, or thyroid disease, pelvic
inflammatory disease, and cancer.
○
○
○
RISK FACTORS
● The risk factors of menorrhagia vary with age
and whether a woman has other medical
conditions.
● Menorrhagia in adolescent girls is typically due
to anovulation.
● Menorrhagia in older reproductive-age women
is usually due to uterine pathology, including
fibroids, polyps, and adenomyosis.
PATHOPHYSIOLOGY
● The pathophysiology of abnormal uterine
bleeding is diverse.
● It can be caused by a pelvic pathology such as:
○ Distortion of the endometrial cavity due to
fibroids
○ Endometrial protrusions into the cervix or
vagina (polyps)
○ Friable endometrial tissue.
SIGNS AND SYMPTOMS
● A woman might have menorrhagia if she has the
following signs and symptoms:
○ Soaking through one or more sanitary pads
or tampons every hour for several
consecutive hours
○
○
Needing to use double sanitary protection
to control your menstrual flow
Needing to wake up to change sanitary
protection during the night
Bleeding for longer than a week
Passing blood clots larger than a quarter
Restricting daily activities due to heavy
menstrual flow
Symptoms of anemia, such as tiredness,
fatigue, or shortness of breath
EVALUATION
● The following tests might be needed to find out
if a woman has a bleeding problem:
○ Blood test: In this test, the woman’s blood is
taken using a needle, then it will be
examined to check for anemia, problems
with the thyroid, or problems with the way
the blood clots.
○ Pap test: In this test, the cells in the cervix
are removed and then looked at to find out if
the woman has an infection, inflammation,
or changes in the cells that might be cancer
or might cause cancer.
○ Endometrial biopsy: In this test, tissue
samples are collected from the inner lining
of the uterus or the endometrium to find out
if the woman has cancer or any other
abnormal cells.
○ Ultrasound: This test uses sound waves and
a computer to show what the blood vessels,
tissues, and organs look like, how they are
working, and to check the blood flow.
● From the results of the previous tests, the
doctor might recommend the following tests:
○ Sonohysterogram: This is done after fluid is
injected through a tube into the uterus by
the way of the vagina and cervix. This test
allows the doctor to look for problems in the
lining of the uterus.
○ Hysteroscopy: This procedure allows the
doctor to look at the inside of the uterus to
check for fibroids, polyps, or other problems
that might be causing the bleeding.
○ Dilation and Curettage (D&C): This is a
procedure that can be used to find and
treat the cause of bleeding. During this test,
the inner lining of the uterus is scraped and
examined to find out what might be causing
the bleeding.
11
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
TREATMENT
● The type of treatment depends on the cause of
bleeding and how serious it is.
● Drug Therapy:
○ Iron supplements: To get more iron into your
blood to help it carry oxygen if you show
signs of anemia.
○ Ibuprofen (Advil): To help reduce pain,
menstrual cramps, and the amount of
bleeding. In some women, NSAIDS can
increase the risk of bleeding.
○ Birth control pills: To help make periods
more regular and reduce the amount of
bleeding.
○ Intrauterine contraception (IUC): To help
make periods more regular and reduce the
amount of bleeding through drug-releasing
devices placed into the uterus.
○ Hormone therapy (drugs that contain
estrogen and/or progesterone): To reduce
the amount of bleeding.
○ Desmopressin Nasal Spray (Stimate®): To
stop bleeding in people who have certain
bleeding disorders by releasing a clotting
protein or “factor”, stored in the lining of the
blood vessels that helps the blood to clot
and temporarily increasing the level of these
proteins in the blood.
○ Antifibrinolytic medicines (tranexamic acid,
aminocaproic acid): To reduce the amount of
bleeding by stopping a clot from breaking
down once it has formed.
●
Surgical Treatment:
○ Dilation and Curettage (D&C): A procedure in
which the top layer of the uterus lining is
removed to reduce menstrual bleeding.
○ Operative
hysteroscopy:
A
surgical
procedure, using a special tool to view the
inside of the uterus, that can be used to
help remove polyps and fibroids, correct
abnormalities of the uterus, and remove the
lining of the uterus to manage heavy
menstrual flow.
○ Endometrial ablation or resection: Two types
of surgical procedures using different
techniques in which all or part of the lining
of the uterus is removed to control
menstrual bleeding.
○
Hysterectomy: It involves surgically removing
the entire uterus. After having this
procedure, a woman can no longer become
pregnant and will stop having her period.
COMPLICATIONS
● Abnormal uterine bleeding can lead to other
medical conditions such as:
○ Anemia: Menorrhagia can cause blood loss
anemia by reducing the number of
circulating red blood cells.
■ Menorrhagia may decrease the level of
iron enough to increase the risk of iron
deficiency anemia.
○ Severe pain: Painful menstrual cramps may
occur along with heavy menstrual bleeding.
Amenorrhea
●
●
●
●
●
It is defined as the absence of menstruation
during the reproductive years of a woman’s life.
There are two classifications of amenorrhea:
primary and secondary.
Primary amenorrhea: absence of menstruation
in someone who has not had a period by age 15.
Secondary amenorrhea: absence of three or
more periods in a row by someone who has had
menstrual periods in the past.
In general, if a woman does not have menses for
6 months, she has amenorrhea.
EPIDEMIOLOGY
● In the US, amenorrhea affects about 1%
women.
of
ETIOLOGY
● Causes of primary amenorrhea:
○ Pregnancy
○ Hypogonadotropic Hypogonadism
○ Endocrine lesions
○ Congenital abnormalities
12
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
○ Tumors
Causes of secondary amenorrhea:
○ Weight loss
○ Chronic ovulation
○ Pituitary tumor
○ Cushing syndrome
○ Ovarian tumors
RISK FACTORS
● The factors that may increase a woman’s risk of
developing amenorrhea include:
○ Family history: Amenorrhea may have been
inherited if other women in the family have
experienced it.
○ Eating disorders: A woman who has an
eating disorder, such as anorexia nervosa
and bulimia nervosa, is at higher risk of
developing amenorrhea.
○ Athletic training: A woman who performs
rigorous athletic training can increase her
risk of amenorrhea.
○ History of certain gynecologic procedures: If
a woman had a D&C, especially related to
pregnancy, or a procedure known as loop
electrodiathermy excision procedure (LEEP),
her risk of developing amenorrhea is higher.
PATHOPHYSIOLOGY
● The absence of menses in a woman of
reproductive age is related to the disturbance
of normal hormonal, physiological mechanisms,
or female anatomic abnormalities.
● During a normal female menstruation cycle,
gonadotropin-releasing hormone (GnRH) is
released from the hypothalamus.
● It works on the pituitary gland to release
follicle-stimulating
hormone
(FSH)
and
luteinizing hormone (LH).
● These two hormones act on the ovaries, and the
ovaries finally make estrogen and progesterone
to work on the uterus to carry out the follicular
and secretory phase of the menstrual cycle.
● Any defect at any level of this normal physiology
of females can cause amenorrhea.
● Deviation from the normal anatomy of the
reproductive organs of a female can also cause
amenorrhea.
SIGNS AND SYMPTOMS
●
●
Main symptom: absence or lack of menstrual
periods.
Depending on the cause, a woman may also
experience other symptoms such as:
○ Hot flashes
○ Nipples leaking milk
○ Vaginal dryness
○ Headaches
○ Vision changes
○ Acne
○ Excess hair growth on the face and body
EVALUATION
● The evaluation for amenorrhea should include
the following:
○ Beta hCG test: To rule out pregnancy
because pregnancy is the most common
cause of amenorrhea.
○ Prolactin level test: To rule out prolactinoma
○ Testosterone and DHEAS test: To rule out
hyperandrogenism.
○ FSH and LH test: For hypothalamic
amenorrhea.
○ Pelvic ultrasound and adrenal CT: For
androgen-secreting tumors and other
anatomical
defects
such
as
Mayer-Rokitansky-Kauser-Hauser syndrome.
○ Progesterone challenge test: To differentiate
between the anovulation, anatomic, and
estradiol
deficiency
as
causes
of
amenorrhea.
TREATMENT
● Treatment for amenorrhea depends on the
underlying cause of amenorrhea.
● Birth control pills or other hormone therapies
can restart the menstrual cycle.
● Amenorrhea caused by thyroid or pituitary
disorders may be treated using medications.
● If amenorrhea is caused by a tumor or
structural blockage, surgery may be necessary.
COMPLICATIONS
● Amenorrhea can cause other complications
such as:
○ Infertility and problems with pregnancy: If a
woman does not ovulate and does not have
menstrual periods, she can’t become
pregnant. When the cause of amenorrhea is
hormonal
imbalance,
it
can
cause
13
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
○
○
○
miscarriage
or
other problems with
pregnancy.
Psychological stress: It can be stressful for a
woman, especially young girls who are
transitioning into adulthood, to not have
their periods when their peers are having
their.
Osteoporosis and cardiovascular disease:
These two problems can be caused by not
having enough estrogen.
Pelvic pain: If an anatomical problem is
causing amenorrhea, it may also cause pain
in the pelvic area.
Endometriosis
Key Facts
●
●
●
●
●
●
●
Endometriosis is a disorder in which tissue
identical to the uterine lining grows outside
the uterus, causing pain and/or infertility.
Endometriosis affects approximately 10% (190
million) of reproductive-age women and girls
worldwide.
It is a chronic disease characterized by
severe, life-altering pain during periods,
sexual
intercourse,
bowel movements,
and/or urine, persistent pelvic discomfort,
stomach bloating, nausea, exhaustion, and,
in some cases, depression, anxiety, and
infertility.
Endometriosis is difficult to diagnose due to
its changeable and broad symptoms, and
many people who suffer from it are unaware
of the ailment. This can result in a
significant delay between the development
of symptoms and the diagnosis.
Endometriosis currently has no known cure,
and treatment is often directed at symptom
management.
Access to early diagnosis and effective
endometriosis treatment is critical, but it is
limited in many settings, particularly lowand middle-income countries.
More research and awareness raising are
required around the world to provide better
disease prevention, early diagnosis, and
improved disease management.
OVERVIEW
Endometriosis is a painful condition in which tissue
identical to the endometrium, which normally lines
the interior of your uterus, grows outside your
uterus. Endometriosis most usually affects the
ovaries, fallopian tubes, and pelvic tissue.
Endometrial-like tissue can occasionally be
detected outside of the pelvic organs.
Endometrial-like tissue thickens, breaks down, and
bleeds with each menstrual cycle in endometriosis.
However, because this tissue has no way out of your
body, it becomes imprisoned. Endometriomas are
cysts that can grow when endometriosis affects the
ovaries. Surrounding tissue can become inflamed,
resulting in scar tissue and adhesions—bands of
fibrous tissue that can cause pelvic tissues and
organs to bind together.
Endometriosis can cause considerable pain,
especially during menstruation. Fertility issues can
also arise. Fortunately, effective treatments are
available.
Types of Endometriosis
The 3 ​types of endometriosis, based on where it is:
●
●
●
Superficial peritoneal lesion- This is the
most common kind. You have lesions on your
peritoneum, a thin film that lines your pelvic
cavity.
Endometrioma (ovarian lesion)- These dark,
fluid-filled cysts, also called chocolate cysts,
form deep in your ovaries. They don’t
respond well to treatment and can damage
healthy tissue.
Deeply infiltrating endometriosis- This type
grows under your peritoneum and can
involve organs near your uterus, such as
your bowels or bladder. About 1% to 5% of
women with endometriosis have it.
14
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Stages of Endometriosis
The four stages of endometriosis:
●
●
●
●
Stage I (minimal) - You have a few small
lesions but no scar tissue.
Stage II (mild) - There are more lesions but
no scar tissue. Less than 2 inches of your
abdomen are involved.
Stage III (moderate) - The lesions may be
deep. You may have endometriosis and scar
tissue around your ovaries or fallopian
tubes.
Stage IV (severe) - There are many lesions
and maybe large cysts in your ovaries. You
may have scar tissue around your ovaries
and fallopian tubes or between your uterus
and the lower part of your intestines.
The stages don’t take pain or symptoms into
account. For example, stage I endometriosis can
cause severe pain, but a woman who has stage IV
could have no symptoms at all.
SYMPTOMS
● Endometriosis' primary symptom is pelvic
pain, which is frequently accompanied with
menstrual periods. Although many women
suffer cramps throughout their menstrual
periods, individuals who have endometriosis
often report significantly severe menstrual
discomfort.
● Pain may also worsen over time.
● Common
signs
and
symptoms
of
endometriosis include:
● Painful periods (dysmenorrhea) - Pelvic
pain and cramping may begin before
and extend several days into a
menstrual period. You may also have
lower back and abdominal pain.
● Pain with intercourse - Pain during or
after
sex
is
common
with
endometriosis.
● Pain
with
bowel
movements
or
urination You're most likely to
experience these symptoms during a
menstrual period.
● Excessive bleeding You may
experience occasional heavy menstrual
periods or bleeding between periods
(intermenstrual bleeding).
●
●
Infertility - Sometimes, endometriosis
is first diagnosed in those seeking
treatment for infertility.
Other signs and symptoms - You may
experience
fatigue,
diarrhea,
constipation, bloating or nausea,
especially during menstrual periods.
DIAGNOSIS
●
●
●
●
Pelvic Exam- Your doctor might be able to
feel cysts or scars behind your uterus.
Imaging tests- An ultrasound, a CT scan, or
an MRI can make detailed pictures of your
organs.
Laparoscopy- Your doctor makes a small cut
in your belly and inserts a thin tube with a
camera on the end (called a laparoscope).
They can see where and how big the lesions
are. This is usually the only way to be totally
certain that you have endometriosis.
Biopsy- Your doctor takes a sample of tissue,
often during a laparoscopy, and a specialist
looks at it under a microscope to confirm
the diagnosis.
CAUSES
● Retrograde menstruation - In retrograde
menstruation, menstrual blood containing
endometrial cells flows back through the
fallopian tubes and into the pelvic cavity
instead of out of the body. These
endometrial cells stick to the pelvic walls
and surfaces of pelvic organs, where they
grow and continue to thicken and bleed over
the course of each menstrual cycle.
● Transformation of peritoneal cells - In what's
known as the "induction theory," experts
propose that hormones or immune factors
promote transformation of peritoneal cells
— cells that line the inner side of your
abdomen into endometrial-like cells.
● Embryonic cell transformation- Hormones
such as estrogen may transform embryonic
cells — cells in the earliest stages of
development into endometrial-like cell
implants during puberty.
● Surgical scar implantation- After a surgery,
such as a hysterectomy or C-section,
endometrial cells may attach to a surgical
incision.
15
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
RISK FACTORS
● Never giving birth
● Starting your period at an early age
● Going through menopause at an older
age
● Short menstrual cycles — for instance,
less than 27 days
● Heavy menstrual periods that last
longer than seven days
● Having higher levels of estrogen in
your body or a greater lifetime
exposure to estrogen your body
produces
● Low body mass index
● One or more relatives (mother, aunt or
sister) with endometriosis
● Any medical condition that prevents
the passage of blood from the body
during menstrual periods
● Disorders of the reproductive tract
Endometriosis normally appears several years
after
menstruation
begins
(menarche).
Endometriosis symptoms may improve temporarily
during pregnancy and disappear completely with
menopause, unless you are taking estrogen.
COMPLICATIONS
●
The primary problem with endometriosis is
infertility. Endometriosis prevents one-third
to one-half of all women from becoming
pregnant. In order for pregnancy to occur,
an egg must be released from an ovary,
travel through a neighboring fallopian tube,
be fertilized by a sperm cell, and connect to
the uterine wall to begin development.
Endometriosis can restrict the tube,
preventing the egg and sperm from
combining. However, the illness appears to
have an indirect effect on fertility, such as by
causing sperm or egg damage. Despite this,
many women with mild to moderate
endometriosis can conceive and carry a
pregnancy to term. Doctors occasionally
encourage endometriosis patients not to
put off having children because the
condition can worsen with time.
Endometrial cell transport- The blood
vessels or tissue fluid (lymphatic) system may
transport endometrial cells to other parts of
the body.
Immune system disorder- A problem with the
immune system may make the body unable
to recognize and destroy endometrial-like
tissue that's growing outside the uterus.
●
Cancer
Ovarian cancer occurs at greater than
predicted
rates
in
women
with
endometriosis. However, the overall lifetime
risk of ovarian cancer is minimal to begin
with.
Some
research
implies
that
endometriosis raises that risk, but it remains
quite
modest.
Although
uncommon,
endometriosis-associated adenocarcinoma
can occur later in life in persons who have
had endometriosis.
TREATMENT
There’s no cure for endometriosis. Treatments
usually include surgery or medication. You might
need to try different treatments to find what helps
you feel better.
● Pain
Medicine
Your
doctor
may
recommend
an
over-the-counter pain
reliever. Non-steroidal anti-inflammatory
drugs (NSAIDs) like ibuprofen (Advil, Motrin)
or naproxen (Aleve) work for many people. If
these don’t relieve your pain, ask about
other options.
● Hormones - Hormonal therapy lowers the
amount of estrogen your body creates and
can stop your period. This helps lesions
bleed less so you don’t have as much
inflammation, scarring, and cyst formation.
Common hormones include:
Infertility
16
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
○
●
Birth control pills, patches, and
vaginal rings
○ Gonadotropin-releasing
hormone
(Gn-RH) agonists and antagonists
such as elagolix sodium (Orilissa) or
leuprolide (Lupron)
○ Progestin-only contraceptives
○ Danazol (Danocrine)
Surgery - Your doctor might recommend
surgery to take out as much of the affected
tissue as possible. In some cases, surgery
helps symptoms and can make you more
likely to get pregnant. Your doctor might use
a laparoscope or do a standard surgery
that uses larger cuts. Pain sometimes comes
back after surgery.
In the most severe cases, you may need a surgery
called a hysterectomy to take out your ovaries,
uterus, and cervix. But without them, you can’t get
pregnant later.
Uterine Fibroids
OVERVIEW
Uterine fibroids are a common condition in women.
But since uterine fibroids frequently don't manifest
any symptoms, you might not be aware that you
have them. During a pelvic exam or a prenatal
ultrasound, your doctor may uncover fibroids by
chance.
SYMPTOMS
Many women with fibroids exhibit no symptoms.
Symptoms can be altered by the location, size, and
quantity of fibroids in persons who have them.
The most prevalent signs and symptoms of uterine
fibroids in women who have symptoms are:
●
●
●
●
●
●
●
Heavy menstrual bleeding
Menstrual periods that last more than a
week
Pelvic pressure or pain
Urinating frequently
Difficulty emptying the bladder
Constipation
Backache or leg pain
When a fibroid outgrows its blood supply and
begins to die, it can cause severe pain.
Fibroids are generally categorized according to
their location.
●
●
●
Non-cancerous uterine growths called uterine
fibroids frequently develop in women who are
pregnant. Uterine fibroids, also known as
leiomyomas or myomas, aren't related to an
elevated risk of uterine cancer and usually never
develop into cancer.
Fibroids can range in size from tiny, visually
invisible seedlings to big, obtrusive masses that
can stretch and expand the uterus. Fibroids can be
single or multiple. Multiple fibroids can cause the
uterus to enlarge so much that it approaches the
rib cage and adds weight in severe situations.
Intramural fibroids- Develop within the
muscular uterine wall.
Submucosal fibroids- Protrude into the
uterine cavity.
Subserosal fibroids- Protrude from the
uterus.
DIAGNOSIS
●
Ultrasound- If confirmation is needed, your
doctor may order an ultrasound. It uses
sound waves to get a picture of your uterus
to confirm the diagnosis and to map and
measure fibroids.
A doctor or technician moves the ultrasound
device (transducer) over your abdomen
(transabdominal) or places it inside your
vagina (transvaginal) to get images of your
uterus.
17
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
Lab tests- If you have abnormal menstrual
bleeding, your doctor may order other tests
to investigate potential causes. These might
include a complete blood count (CBC) to
determine if you have anemia because of
chronic blood loss and other blood tests to
rule out bleeding disorders or thyroid
problems.
Magnetic resonance imaging (MRI)- This
imaging test can show in more detail the
size and location of fibroids, identify
different types of tumors, and help
determine appropriate treatment options.
An MRI is most often used in women with a
larger uterus or in women approaching
menopause (perimenopause).
●
Hysterosonography- Also called a saline
infusion sonogram, uses sterile salt water
(saline) to expand the uterine cavity, making
it easier to get images of submucosal
fibroids and the lining of the uterus in
women attempting pregnancy or who have
heavy menstrual bleeding.
●
Hysterosalpingography- Uses a dye to
highlight the uterine cavity and fallopian
tubes on X-ray images. Your doctor may
recommend it if infertility is a concern. This
test can help your doctor determine if your
fallopian tubes are open or are blocked and
can show some submucosal fibroids.
●
Hysteroscopy- The doctor inserts a small,
lighted telescope called a hysteroscope
through your cervix into your uterus. Your
doctor then injects saline into your uterus,
expanding the uterine cavity and allowing
your doctor to examine the walls of your
uterus and the openings of your fallopian
tubes.
CAUSES
● Genetic changes- Many fibroids contain
changes in genes that differ from those in
typical uterine muscle cells.
● Hormones- Estrogen and progesterone, two
hormones that stimulate development of the
uterine lining during each menstrual cycle in
preparation for pregnancy, appear to
promote the growth of fibroids.
Fibroids contain more estrogen and
progesterone receptors than typical uterine
muscle cells do. Fibroids tend to shrink after
menopause due to a decrease in hormone
production.
● Other growth factors - Substances that help
the body maintain tissues, such as
insulin-like growth factor, may affect fibroid
growth.
● Extracellular matrix (ECM) - The material
that makes cells stick together, like mortar
between bricks. ECM is increased in fibroids
and makes them fibrous. ECM also stores
growth factors and causes biologic changes
in the cells themselves.
RISK FACTORS
Factors that can have an impact on fibroid
development include:
●
Race- Although all women of reproductive
age could develop fibroids, black women are
more likely to have fibroids than are women
of other racial groups. In addition, black
women have fibroids at younger ages, and
18
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
they're also likely to have more or larger
fibroids, along with more-severe symptoms.
Heredity- If your mother or sister had
fibroids, you're at increased risk of
developing them.
Other factors- Starting your period at an
early age; obesity; a vitamin D deficiency;
having a diet higher in red meat and lower in
green vegetables, fruit and dairy; and
drinking alcohol, including beer, appear to
increase your risk of developing fibroids.
TREATMENT
● Watchful waiting
Many
women
with
uterine
fibroids
experience no signs or symptoms, or only
mildly annoying signs and symptoms that
they can live with. If that's the case for you,
watchful waiting could be the best option.
Fibroids aren't cancerous. They rarely
interfere with pregnancy. They usually grow
slowly or not at all and tend to shrink after
menopause, when levels of reproductive
hormones drop.
●
Medications
Medications for uterine fibroids target
hormones that regulate your menstrual
cycle, treating symptoms such as heavy
menstrual bleeding and pelvic pressure.
They don't eliminate fibroids, but may shrink
them. Medications include:
❖ May have hot flashes while using GnRH
agonists
❖ Used for no more than three to six months
because symptoms return when the
medication is stopped and long-term use
can cause loss of bone.
❖ Progestin-releasing intrauterine device (IUD)
- Relieve heavy bleeding caused by fibroids.
A progestin-releasing IUD provides symptom
relief only and doesn't shrink fibroids or
make them disappear. It also prevents
pregnancy.
❖ Tranexamic acid (Lysteda, Cyklokapron) This non hormonal medication is taken to
ease heavy menstrual periods. It's taken only
on heavy bleeding days.
❖ Other medications Your doctor might
recommend other medications. For example,
oral contraceptives can help control
menstrual bleeding, but they don't reduce
fibroid size.
❖ Nonsteroidal
anti-inflammatory
drugs
(NSAIDs) - Not hormonal medications, may
be effective in relieving pain related to
fibroids, but they don't reduce bleeding
caused by fibroids. Your doctor may also
suggest that you take vitamins and iron if
you have heavy menstrual bleeding and
anemia.
● Noninvasive procedure
❖ Gonadotropin-releasing hormone (GnRH)
agonists - Treat fibroids by blocking the
production of estrogen and progesterone,
putting
you
into
a
temporary
menopause-like
state.
As
a
result,
menstruation stops, fibroids shrink and
anemia often improves.
GnRH agonists include
❖ Leuprolide:
➢ Lupron Depot
➢ Eligard
❖ Goserelin:
➢ Zoladex
❖ Triptorelin:
➢ Trelstar
➢ Triptodur Kit
MRI-guided focused ultrasound surgery (FUS) is:
❖ A noninvasive treatment option - For uterine
fibroids that preserves your uterus, requires
no incision and is done on an outpatient
basis.
19
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
❖ Performed while you're inside an MRI
scanner - Equipped with a high-energy
ultrasound transducer for treatment. The
images give your doctor the precise location
of the uterine fibroids. When the location of
the fibroid is targeted, the ultrasound
transducer
focuses
sound
waves
(sonications) into the fibroid to heat and
destroy small areas of fibroid tissue.
❖ Newer technology - Researchers are learning
more
about
long-term
safety
and
effectiveness. But so far data collected show
that FUS for uterine fibroids is safe and
effective
● Minimally invasive procedures
Procedures that can destroy uterine fibroids
without actually removing them through surgery.
They include:
❖ Uterine artery embolization - Small particles
(embolic agents) are injected into the
arteries supplying the uterus, cutting off
blood flow to fibroids, causing them to
shrink and die.
This technique can be effective in shrinking
fibroids and relieving the symptoms they
cause. Complications may occur if the blood
supply to your ovaries or other organs is
compromised. However, research shows that
complications are similar to surgical fibroid
treatments and the risk of transfusion is
substantially reduced.
❖ Radiofrequency ablation - In this procedure,
radiofrequency energy destroys uterine
fibroids and shrinks the blood vessels that
feed them. This can be done during a
laparoscopic or transcervical procedure. A
similar
procedure
called
cryomyolysis
freezes the fibroids.
❖ With laparoscopic radiofrequency ablation
(Acessa) - Also called Lap-RFA, your doctor
makes two small incisions in the abdomen to
insert
a
slim
viewing
instrument
(laparoscope) with a camera at the tip. Using
the
laparoscopic
camera
and
a
laparoscopic ultrasound tool, your doctor
locates fibroids to be treated.
After locating a fibroid, your doctor uses a
specialized device to deploy several small
needles into the fibroid. The needles heat up
the fibroid tissue, destroying it. The
destroyed fibroid immediately changes
consistency, for instance from being hard
like a golf ball to being soft like a
marshmallow. During the next three to 12
months, the fibroid continues to shrink,
improving symptoms.
Because there's no cutting of uterine tissue,
doctors consider Lap-RFA a less invasive
alternative
to
hysterectomy
and
myomectomy. Most women who have the
procedure get back to regular activities
after 5 to 7 days of recovery.
The transcervical — or through the cervix —
approach
to
radiofrequency
ablation
(Sonata) also uses ultrasound guidance to
locate fibroids.
❖ Laparoscopic or robotic myomectomy - In a
myomectomy, your surgeon removes the
fibroids, leaving the uterus in place.
If the fibroids are few in number, you and
your doctor may opt for a laparoscopic or
robotic procedure, which uses slender
instruments inserted through small incisions
in your abdomen to remove the fibroids from
your uterus.
Larger fibroids can be removed through
smaller incisions by breaking them into
pieces (morcellation), which can be done
inside a surgical bag, or by extending one
incision to remove the fibroids.
Your doctor views your abdominal area on a
monitor using a small camera attached to
one
of
the
instruments.
Robotic
myomectomy
gives
your
surgeon
a
magnified, 3D view of your uterus, offering
more precision, flexibility and dexterity than
is possible using some other techniques.
❖ Hysteroscopic myomectomy- This procedure
may be an option if the fibroids are
contained inside the uterus (submucosal).
Your surgeon accesses and removes fibroids
using instruments inserted through your
vagina and cervix into your uterus.
❖ Endometrial
ablation- This treatment,
performed with a specialized instrument
inserted into your uterus, uses heat,
microwave energy, hot water or electric
current to destroy the lining of your uterus,
either ending menstruation or reducing
your menstrual flow.
20
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Typically, endometrial ablation is effective in
stopping abnormal bleeding. Submucosal
fibroids can be removed at the time of
hysteroscopy for endometrial ablation, but
this doesn't affect fibroids outside the
interior lining of the uterus.
Women aren't likely to get pregnant following
endometrial ablation, but birth control is
needed to prevent a pregnancy from
developing in a fallopian tube (ectopic
pregnancy).
With any procedure that doesn't remove the uterus,
there's a risk that new fibroids could grow and
cause symptoms.
before surgery, morcellating the
fibroid in a bag or expanding an
incision to avoid morcellation.
❖ All myomectomies carry the risk of
cutting into an undiagnosed cancer,
but younger, premenopausal women
generally have a lower risk of
undiagnosed cancer than do older
women.
❖ Complications during open surgery
are more common than the chance of
spreading an undiagnosed cancer in
a fibroid during a minimally invasive
procedure. If your doctor is planning
to use morcellation, discuss your
individual risks before treatment.
Gynecologic or Cervical Cancer
OVERVIEW
● Traditional surgical procedures
❖ Abdominal myomectomy - If you have
multiple fibroids, very large fibroids or very
deep fibroids, your doctor may use an open
abdominal surgical procedure to remove the
fibroids. However, scarring after surgery can
affect future fertility.
❖ Hysterectomy- This surgery removes the
uterus. It remains the only proven
permanent solution for uterine fibroids.
Hysterectomy ends your ability to bear
children. If you also elect to have your
ovaries removed, the surgery brings on
menopause and the question of whether
you'll take hormone replacement therapy.
Most women with uterine fibroids may be
able to choose to keep their ovaries.
●
Morcellation during fibroid removal
❖ A process of breaking fibroids into
smaller pieces
❖ May increase the risk of spreading
cancer if a previously undiagnosed
cancerous
mass
undergoes
morcellation during myomectomy.
❖ There are several ways to reduce that
risk, such as evaluating risk factors
Cervical cancer is a form of cancer that develops in
the cells of the cervix, which connects the uterus to
the vagina.
Most cervical cancers are caused by different
strains of the human papillomavirus (HPV), a
sexually transmitted infection.
When the body is exposed to HPV, the immune
system usually stops the virus from causing harm.
However, in a small number of people, the virus
lives for years, contributing to the process by which
some cervical cells develop into cancer cells.
Cervical cancer can be reduced by having
screening tests and obtaining a vaccine that
protects against HPV infection.
21
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Types of Gynecologic
●
●
●
●
●
Cervical Cancer- begins in the cervix, which
is the lower, narrow end of the uterus. (The
uterus is also called the womb.)
Ovarian Cancer- begins in the ovaries, which
are located on each side of the uterus. Some
ovarian cancers can also begin in the
fallopian tubes or peritoneum.
Uterine Cancer- begins in the uterus, the
pear-shaped organ in a woman’s pelvis
where the baby grows when she is pregnant.
Vaginal Cancer- begins in the vagina, which
is the hollow, tube-like channel between the
bottom of the uterus and the outside of the
body.
Vulvar Cancer- begins in the vulva, the outer
part of the female genital organs.
Each gynecologic cancer is unique, with different
signs and symptoms, different risk factors (things
that may increase your chance of getting a
disease), and different prevention strategies. All
women are at risk for gynecologic cancers, and risk
increases with age. When gynecologic cancers are
found early, treatment is most effective.
Types of Cervical Cancer
The type of cervical cancer that you have helps
determine your prognosis and treatment. The main
types of cervical cancer are:
Early-stage cervical cancer generally produces no
signs or symptoms.
Signs and symptoms of more-advanced cervical
cancer include:
●
●
●
Vaginal bleeding after intercourse, between
periods or after menopause
Watery, bloody vaginal discharge that may
be heavy and have a foul odor
Pelvic pain or pain during intercourse
DIAGNOSIS
If cervical cancer is suspected, your doctor will
most likely begin by examining your cervix
thoroughly. To look for aberrant cells, a special
magnifying equipment called a colposcope is
employed.
Squamous cell carcinoma- This type of
cervical cancer begins in the thin, flat cells
(squamous cells) lining the outer part of the
cervix, which projects into the vagina. Most
cervical
cancers
are squamous cell
carcinomas.
Adenocarcinoma- This type of cervical
cancer begins in the column-shaped
glandular cells that line the cervical canal.
Your doctor will most likely collect a sample of
cervical cells (biopsy) during the colposcopic
examination for laboratory testing. Your doctor
may employ the following methods to harvest
tissue:
● Punch biopsy- Involves using a sharp tool to
pinch off small samples of cervical tissue.
● Endocervical curettage- Uses a small,
spoon-shaped instrument (curet) or a thin
brush to scrape a tissue sample from the
cervix.
Sometimes, both types of cells are involved in
cervical cancer. Very rarely, cancer occurs in other
cells in the cervix.
If the punch biopsy or endocervical curettage is
worrisome, your doctor may perform one of the
following tests:
●
●
SYMPTOMS
●
Electrical wire loop- which uses a thin,
low-voltage electrified wire to obtain a small
22
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
tissue sample. Generally this is done under
local anesthesia in the office.
Cone biopsy (conization)- which is a
procedure that allows your doctor to obtain
deeper layers of cervical cells for laboratory
testing. A cone biopsy may be done in a
hospital under general anesthesia.
from tumors to spread (metastasize) elsewhere in
the body.
It is unknown what causes cervical cancer, but HPV
is known to play a role. HPV is quite prevalent, and
the majority of people who have it never get cancer.
This indicates that other factors, such as your
environment or lifestyle choices, influence whether
you develop cervical cancer.
Staging
If your doctor determines that you have cervical
cancer, you'll have further tests to determine the
extent (stage) of your cancer. Your cancer's stage is
a key factor in deciding on your treatment.
Staging exams include:
●
●
Imaging tests- Tests such as X-ray, CT, MRI
and positron emission tomography (PET)
help your doctor determine whether your
cancer has spread beyond your cervix.
Visual examination of your bladder and
rectum- Your doctor may use special scopes
to see inside your bladder and rectum.
CAUSES
Cervical cancer develops when healthy cells in the
cervix undergo genetic changes (mutations). The
DNA of a cell carries instructions that teach it what
to do.
Healthy cells proliferate and replicate at a
predetermined
rate
before
dying
at
a
predetermined period. The mutations cause the
cells to proliferate and reproduce uncontrollably,
and they do not perish. A mass of aberrant cells
forms as they accumulate (tumor). Cancer cells
invade neighboring tissues and can break away
RISK FACTORS
●
●
●
●
●
●
Many sexual partners- The greater your
number of sexual partners and the greater
your partner's number of sexual partners
the greater your chance of acquiring HPV.
Early sexual activity- Having sex at an early
age increases your risk of HPV.
Other sexually transmitted infections (STIs)Having other STIs such as chlamydia,
gonorrhea, syphilis and HIV/AIDS increases
your risk of HPV.
A weakened immune system- You may be
more likely to develop cervical cancer if your
immune system is weakened by another
health condition and you have HPV.
Smoking- Smoking is associated with
squamous cell cervical cancer.
Exposure to miscarriage prevention drug- If
your
mother
took
a
drug
called
diethylstilbestrol (DES) while pregnant in the
1950s, you may have an increased risk of a
certain type of cervical cancer called clear
cell adenocarcinoma.
TREATMENT
Treatment for cervical cancer is determined
by a number of criteria, including the stage of the
cancer, any other health issues you may have, and
your personal preferences. Surgery, radiation,
23
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
chemotherapy, or a combination of the three may
be employed.
●
combined with chemotherapy as the primary
treatment for locally advanced cervical
cancers. It can also be used after surgery if
there's an increased risk that the cancer will
come back.
Surgery
Early-stage cervical cancer is typically
treated with surgery. Which operation is best
for you will depend on the size of your
cancer, its stage and whether you would like
to consider becoming pregnant in the
future.
Radiation therapy can be given:
➢ Externally, by directing a radiation
beam at the affected area of the body
(external beam radiation therapy)
➢ Internally, by placing a device filled
with radioactive material inside your
vagina, usually for only a few minutes
(brachytherapy)
➢ Both externally and internally
Options might include:
➢ Surgery to cut away the cancer onlyFor a very small cervical cancer, it
might be possible to remove the
cancer entirely with a cone biopsy.
This procedure involves cutting away
a cone-shaped piece of cervical
tissue, but leaving the rest of the
cervix intact. This option may make it
possible
for
you
to
consider
becoming pregnant in the future.
➢ Surgery to remove the cervix
(trachelectomy)- Early-stage cervical
cancer might be treated with a
radical trachelectomy procedure,
which removes the cervix and some
surrounding
tissue. The uterus
remains after this procedure, so it
may be possible to become pregnant,
if you choose.
➢ Surgery to remove the cervix and
uterus
(hysterectomy)Most
early-stage cervical cancers are
treated with a radical hysterectomy
operation, which involves removing
the cervix, uterus, part of the vagina
and
nearby
lymph
nodes.
A
hysterectomy can cure early-stage
cervical
cancer
and
prevent
recurrence. But removing the uterus
makes it impossible to become
pregnant.
If you haven't started menopause yet,
radiation therapy might cause menopause. If you
might want to consider becoming pregnant after
radiation treatment, ask your doctor about ways to
preserve your eggs before treatment starts.
●
A drug treatment that uses chemicals to kill
cancer cells. It can be given through a vein
or taken in pill form. Sometimes both
methods are used.
For locally advanced cervical cancer, low
doses of chemotherapy are often combined
with radiation therapy, since chemotherapy
may enhance the effects of the radiation.
Higher doses of chemotherapy might be
recommended to help control symptoms of
very advanced cancer.
●
Radiation
Radiation therapy uses high-powered energy
beams, such as X-rays or protons, to kill
cancer cells. Radiation therapy is often
Targeted therapy
Focus on specific weaknesses present within
cancer cells. By blocking these weaknesses,
targeted drug treatments can cause cancer
cells to die. Targeted drug therapy is usually
combined with chemotherapy. It might be an
option for advanced cervical cancer.
●
●
Chemotherapy
Immunotherapy
A drug treatment that helps your immune
system to fight cancer. Your body's
disease-fighting immune system might not
attack cancer because the cancer cells
24
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
produce
proteins
that
make
them
undetectable by the immune system cells.
Immunotherapy works by interfering with
that
process.
For
cervical
cancer,
immunotherapy might be considered when
the cancer is advanced and other
treatments aren't working.
●
Supportive (palliative) care
Specialized medical care that focuses on
providing relief from pain and other
symptoms of a serious illness. Palliative care
specialists work with you, your family and
your other doctors to provide an extra layer
of support that complements your ongoing
care.
When palliative care is used along with all of the
other appropriate treatments, people with cancer
may feel better and live longer.
Palliative care is provided by a team of doctors,
nurses and other specially trained professionals.
Palliative care teams aim to improve the quality of
life for people with cancer and their families. This
form of care is offered alongside curative or other
treatments you may be receiving.
You can have HIV without having any symptoms.
This is why it’s important to get tested even if you
don’t feel sick. Sometimes you’ll have flu-like
symptoms when you first get infected with HIV.
These can include:
● Fever
● Chills
● Fatigue
● Sore throat
● Muscle aches
● Night sweats
● Rash
● Swollen lymph nodes
● Mouth sores
Stages of HIV
HIV has three stages:
● Stage 1: Acute HIV: Some people get flu-like
symptoms a month or two after they’ve been
infected with HIV. These symptoms often go
away within a week to a month.
●
Stage 2: Chronic stage/clinical latency: After
the acute stage, you can have HIV for many
years without feeling sick. It's important to
know that you can still spread HIV to others
even if you feel well.
●
Stage 3: AIDS: AIDS is the most serious stage
of HIV infection. In this stage, HIV has
severely weakened your immune system and
opportunistic infections are much more
likely to make you sick.
HIV/AIDS
Key Facts:
● AIDS is the final and most serious stage of
an HIV infection. People with AIDS have very
low counts of certain white blood cells and
severely damaged immune systems. They
may have additional illnesses that indicate
that they have progressed to AIDS.
● Without treatment, HIV infections progress
to AIDS in about 10 years.
● HIV stands for human immunodeficiency
virus. HIV infects and destroys cells of your
immune system, making it hard to fight off
other diseases. When HIV has severely
weakened your immune system, it can lead
to acquired immunodeficiency syndrome
(AIDS).
● Because HIV works backward to insert its
instructions into your DNA, it is called a
retrovirus.
SYMPTOMS
Opportunistic infections are ones that someone
with a healthy immune system could typically fight
off. When HIV has advanced to AIDS, these illnesses
take advantage of your weakened immune system.
You’re more likely to get certain cancers when you
have AIDS. These cancers and opportunistic
infections together are called AIDS-defining
illnesses such as
To be diagnosed with AIDS, you must be infected
with HIV and have at least one of the following:
●
Fewer than 200 CD4 cells per
millimeter of blood (200 cells/mm3)
cubic
25
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
DIAGNOSIS
HIV is diagnosed with either a test of your blood or
your spit (saliva). You can take a test at home, in a
healthcare provider’s office or at a location that
provides testing in your community.
If your test comes back negative, no further testing
is required if you:
●
●
●
you might have been exposed to HIV within
the past few weeks, your health care
provider may recommend NAT. NAT will be
the first test to become positive after
exposure to HIV.
An AIDS-defining illness.
Haven’t had a possible exposure in the
previous three months before testing with
any kind of test
Haven’t had a possible exposure within the
window period for a test done with a blood
draw. (Ask your healthcare provider if you
are unsure what the window period is for a
test you took.)
If you have had a possible exposure within
three months of testing, you should consider
retesting to confirm the negative result.
If your test comes back positive, the lab may do
follow-up tests to confirm the result.
Types of HIV tests
HIV can be diagnosed through blood or saliva
testing. Available tests include:
● Antigen/antibody tests. These tests usually
involve drawing blood from a vein. Antigens
are substances on the HIV virus itself and
are usually detectable — a positive test — in
the blood within a few weeks after exposure
to HIV. Antibodies are produced by your
immune system when it's exposed to HIV. It
can take weeks to months for antibodies to
become
detectable.
The
combination
antigen/antibody tests can take 2 to 6 weeks
after exposure to become positive.
● Antibody tests. These tests look for
antibodies to HIV in blood or saliva. Most
rapid HIV tests, including self-tests done at
home, are antibody tests. Antibody tests can
take 3 to 12 weeks after you're exposed to
become positive.
● Nucleic acid tests (NATs). These tests look for
the actual virus in your blood (viral load).
They also involve blood drawn from a vein. If
If the test comes back positive, the healthcare
provider is likely to recommend other tests to
assess your health. These may include a complete
blood count (CBC), along with:
●
●
●
●
●
Viral hepatitis screening
Chest X-ray
Pap smear
CD4 count
Tuberculosis
CAUSES
HIV is caused by a virus. It can spread through
sexual contact, illicit injection drug use or sharing
needles, contact with infected blood, or from
mother to child during pregnancy, childbirth or
breastfeeding.
HIV destroys CD4 T cells — white blood cells that
play a large role in helping your body fight disease.
The fewer CD4 T cells you have, the weaker your
immune system becomes.
RISK FACTOR
Anyone of any age, race, sex or sexual orientation
can be infected with HIV/AIDS. However, you're at
greatest risk of HIV/AIDS if you:
●
●
●
Have unprotected sex. Use a new latex or
polyurethane condom every time you have
sex. Anal sex is riskier than is vaginal sex.
Your risk of HIV increases if you have
multiple sexual partners.
Have an STI. Many STIs produce open sores
on your genitals. These sores act as
doorways for HIV to enter your body.
Use illicit injection drugs. People who use
illicit injection drugs often share needles
and syringes. This exposes them to droplets
of other people's blood.
TREATMENT
Currently, there's no cure for HIV/AIDS. Once you
have the infection, your body can't get rid of it.
26
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
However, there are many medications that can
control HIV and prevent complications. These
medications are called antiretroviral therapy (ART).
Everyone diagnosed with HIV should be started on
ART, regardless of their stage of infection or
complications.
ART is usually a combination of two or more
medications from several different drug classes.
This approach has the best chance of lowering the
amount of HIV in the blood. There are many ART
options that combine multiple HIV medications into
one pill, taken once daily.
Each class of drugs blocks the virus in different
ways. Treatment involves combinations of drugs
from different classes to:
● Account for individual drug resistance (viral
genotype)
● Avoid creating new drug-resistant strains of
HIV
● Maximize suppression of virus in the blood
Interstitial Cystitis
KEY FACTS:
● Often called as “Bladder Pain Syndrome or
BPS”
● Is a chronic condition causing bladder
pressure, bladder pain and sometimes
pelvic pain.
○ The pain ranges from mild to severe
pain.
● The condition is a part of a spectrum of
diseases
known
as
painful
bladder
syndrome.
● Difficult to diagnose as there is no single
test that confirms the condition
● Interstitial cystitis most often affects women
and can have a long-lasting impact on
quality of life.
○ There’s no cure for it, medications
and other therapies are the most
options.
PHYSIOLOGY
● The bladder is a hollow, muscular organ that
stores urine, it expands until it's full and then
signals the brain that it's time to urinate,
communicating through pelvic nerves and
creates the urge to urinate for most people.
● With interstitial cystitis, these signals mixed
up, the person will feel the need to urinate
more often and with smaller volumes to
urinate than the most people.
SIGNS AND SYMPTOMS
● The signs and symptoms of Interstitial
Cystitis vary from person to person.
○ If one has interstitial cystitis, the
symptoms may also vary over time.
■ Periodically flaring in response
to common triggers, such as
menstruations, sitting for a
long time, stress, exercise and
sexual activity.
● Some people may experience symptom-free
periods.
● Signs and symptoms of Interstitial Cystitis
may resemble some of the Chronic Urinary
Tract Infection.
○ However, usually there’s no infection.
○ Symptoms may worsen if a person
with Interstitial Cystitis gets a Urinary
Tract Infection (UTI)
● Interstitial cystitis signs and symptoms:
○ Pain in the pelvis or between the
vagina and anus of women
○ Pain between the scrotum and anus
(perineum) in men
○ Chronic pelvic pain
○ A persistent, urgent need to urinate
27
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
○
○
○
Frequent urination, often of small
amounts, throughout the day and
night (up to 60x a day)
Pain or discomfort while the bladder
fills and relief after urinating.
Pain during sex especially in women
CAUSES
● The exact cause of Interstitial Cystitis is
unknown.
○ Many factors contribute to it.
○ For instance, patients with Interstitial
Cystitis may also have a defect in the
protective lining (epithelium) of the
bladder.
○ A leak in the epithelium may allow
toxic substances in urine to irritate
the bladder wall.
● Other possible but unproven contributing
factors include an autoimmune reaction,
heredity, infection or allergy.
● Some theories of its causes includes:
○ A defect in the bladder tissue, which
may allow irritating substances in the
urine to penetrate the bladder.
○ A specific type of inflammatory cell,
called a mast cell. This cell releases
histamine and other chemicals that
lead to IC/BPS symptoms
○ Something in the urine that damages
the bladder
○ Changes in the nerves that carry
bladder sensation so pain is caused
by events that are not normally pain
(such as bladder filling)
○ The body’s immune system attacks
the bladder. This is similar to other
autoimmune conditions
○ Some patients may be more likely to
get IC/BPS after an injury to the
bladder such as infections.
RISK FACTORS
● These factors are associated with a higher
risk of interstitial cystitis:
○ Sex
■ Women are often diagnosed
with interstitial cystitis than
men.
○ Age
■
○
Most people with interstitial
cystitis are diagnosed during
their 30s or older
Chronic Pain Disorder
■ Interstitial cystitis may be
associated with other chronic
pain
disorders
such
as
irritable bowel syndrome or
fibromyalgia.
COMPLICATIONS
● Reduced bladder capacity
○ Interstitial
cystitis
can
cause
stiffening of the bladder wall, which
allows the bladder to hold less urine.
● Lower quality of life
○ Frequent urination and pain may
interfere with social activities, work
and other activities of daily life.
● Sexual Intimacy Problems
○ Frequent urination and pain may
strain the personal relationships, and
sexual intimacy may suffer.
● Emotional troubles
○ The chronic pain and interrupted
sleep associated with interstitial
cystitis may cause emotional stress
and can lead to depression.
TREATMENT
● Tablets and capsules may be used to treat
people with Interstitial Cystitis which
includes:
○ Over-the-counter painkillers
■ Paracetamol and ibuprofen
○ Medicines for nerve pain
■ Amitriptyline, Gabapentin and
Pregabalin
○ Reduces the urgency to pee
■ Tolterodine, solifenacin and
mirabegron
○ Prescribed medicine that helps by
reblocking the effect of a substance
in the bladder
■ Histamine
○ Prescribed reducing pain medicine
■ Pentosan Polysulfate Sodium
(Elmiron)
28
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Polycystic Ovary Syndrome (PCOS)
●
●
●
●
●
●
●
Is a condition in which the ovaries produce
an abnormal amount of androgens (male
sex hormones that are usually present in
women in small amounts.
PCOS describes the numerous small cysts
(fluid-filled sacs) that form in the ovaries.
○ Some women with this disorder do
not have cysts, some women without
the disorder to develop cysts
The small fluid-filled cysts contain immature
eggs these are called follicles
○ The follicles fail to regularly release
eggs.
In some cases, women don't make enough of
the hormones needed to ovulate.
○ When ovulation doesn’t happen, the
ovaries then can develop many small
cysts.
PCOS is very common - up to 15% of women
of reproductive age have it.
○ A woman can get PCOS any time after
puberty.
○ Most people are diagnosed in their
20s or 30s when they are trying to get
pregnant.
A woman has a higher chance of getting
PCOS if they are overweight or have obesity.
The exact cause of PCOS is unknown.
SIGNS AND SYMPTOMS
● Missed periods, irregular periods or very
light periods
● Ovaries that are large or have many cysts
● Excess body hair, including the chest,
stomach and back (hirsutism)
● Weight gain, especially around the belly
(abdomen)
●
●
●
●
●
Acne or oily skin
Male-pattern baldness or thinning hair
Infertility
Small pieces of excess skin on the neck or
armpits (skin tags)
Dark or thick skin patches on the back of
the beck, in the armpits and under the
breasts.
CAUSES
● Factors that might play a role include:
○ Insulin resistance
■ Insulin is a hormone that the
pancreas makes.
■ Too much insulin might cause
the body to make too much of
the male hormone androgen.
■ The body could have trouble
with ovulation, the process
where eggs are released from
the ovary.
○ Low-grade inflammation
■ White
blood
cells
make
substances in response to
infection or injury and this
response is called low-grade
inflammation.
■ Research shows that people
with PCOS have a type of
long-term,
low-grade
inflammation
that
leads
polycystic ovaries to produce
androgens which can lead to
heart
and
blood
vessel
problems.
○ Heredity
■ Research
suggests
that
certain genes might be linked
to PCOS.
■ Having a family history of
PCOS may play a role in
developing the condition.
○ Excess androgen
■ Women with PCOS, the ovaries
produce
high
levels
of
androgen.
■ Having too much androgen
interferes with ovulation.
● This means that eggs
don’t develop on a
29
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
■
regular basis and aren’t
released
from
the
follicles
where
they
develop.
Excess androgen may result in
hirsutism and acne.
COMPLICATIONS
● Complications of PCOS can include:
○ Infertility
○ Gestational
diabetes
or
pregnancy-induced
high
blood
pressure
○ Miscarriage or premature birth
○ Non-alcoholic steatohepatitis
■ a severe liver inflammation
caused by fat buildup in the
liver
○ Metabolic syndrome
■ A
cluster
of
conditions
including high blood pressure,
high
blood
sugar
and
unhealthy
cholesterol
or
triglyceride
levels
that
significantly increase your risk
of heart and blood vessel
(cardiovascular) disease
○ Type 2 diabetes or prediabetes
○ Sleep apnea
○ Depression, anxiety and eating
disorders
○ Cancer
of
the
uterine
lining
(endometrial cancer)
DIAGNOSIS
● Taking of medical history and symptoms by
the healthcare professionals.
● Physical exam (pelvic exam)
○ This exam checks the health of your
reproductive organs, both inside and
outside of the body.
● Tests includes:
○ Ultrasound
■ Uses sound waves and a
computer to create images of
blood vessels, tissues and
organs.
■ This test is used to look at the
size of the ovaries and see if
they have cysts.
■
○
This test can also look at the
thickness of the lining of the
uterus (endometrium)
Blood tests
■ These look for high levels of
androgens
and
other
hormones.
■ Patients health care provider
may also check the blood
glucose levels
TREATMENT
● PCOS treatment depends on a number of
factors.
○ These may include age, how severe
the symptoms are, and the overall
health.
● The type of treatment may also depend on
whether you want to become pregnant in the
future.
● If the patient do plan to become pregnant,
the treatment include:
○ A change in diet and activity
■ A healthy diet and more
physical activity can help the
patient lose weight and reduce
the symptoms
■ They can also help the body to
use insulin more efficiently,
lower blood glucose levels and
may help ovulate.
○ Medications to cause ovulation
■ Medications can help the
ovaries
to
release
eggs
normally.
■ These medications also have
certain risks.
■ It can also increase the
chance for multiple birth (twins
or more)
■ It
can
cause
ovarian
hyperstimulation
● This is when the ovaries
release
too
many
hormones
● Can cause symptoms
such
as
abdominal
bloating
and
pelvic
pain.
30
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
If the patient do not plan to become
pregnant, the treatment includes:
○ Birth control pills
■ These
help
to
control
menstrual
cycles,
lower
androgen levels, and reduce
acne.
○ Diabetes medication
■ This is often used to lower
insulin resistance in PCOS. It
may
also
help
reduce
androgen levels, slow hair
growth and help the patient to
ovulate more regularly
○ Change in diet and activity
■ A healthy diet and more
physical activity can help the
patient to lose weight and
reduce the symptoms.
■ It can also help the body to
use insulin more efficiently,
lower blood glucose levels, and
may help the women to
ovulate.
○ Medications to treat other symptoms
■ Some medications can help
reduce hair growth or acne.
Sexually Transmitted Diseases (STDs)
●
●
Different but related to Sexually Transmitted
Infections or STI.
○ However, an STD will always start out
as an STI. But not all STIs turn into
STDs
○ An STD may start with a symptomatic
STI but remember that not all STIs
have symptoms.
Are infections or bacterias, viruses or
parasites that are passed from one person
to another through sexual contact.
○ The contact is usually blood, semen,
vaginal, oral, or anal sex.
○ Sometimes can spread through other
intimate contact
■ Some STDs, like herpes and
HPV are spread by skin-to-skin
contact.
○ Sometimes
infections
can
be
transmitted nonsexually, such as
●
from mothers to their infants during
pregnancy or childbirth or through
blood transfusions or shared needles.
There are more than 20 types of STDs
including, but these are the common:
○ Chlamydia
■ Common, but treatable type of
STD
■ If left untreated, chlamydia
can make it difficult for a
woman to get pregnant
○ Human Papillomavirus (HPV)
■ Viral infection that is passed
between
people
through
skin-to-skin contact
■ Usually passed through sexual
contact and can affect the
genitals, mouth or throat.
○ Genital herpes
■ Common STD, but most people
with the infection do not know
they have it.
■ No cure, there are medicines
available that can prevent or
shorten outbreaks.
○ Gonorrhea
■ A common STD that can be
treated
with
the
right
medication.
■ If left untreated, it can cause
very serious health problems.
○ HIV/AIDS
■ People who have STDs are
more likely to get HIV, when
compared to people who do
not have STDs
○ Pubic lice
■ Tiny insects that usually live in
the pubic or genital area of
humans
○ Syphilis
■ Can
have
very
serious
problems when left untreated.
■ It is simple to cure with right
treatment
○ Trichomoniasis
■ Do not have any symptoms
SYMPTOMS
● All STDs are caused by an STI
31
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
STDs don’t always cause symptoms or may
only cause mild symptoms.
○ It is possible to have an infection and
not know it but can still be passed to
others
Symptoms includes:
○ Unusual discharge from the penis or
vagina
○ Sores or warts on the genital area
(depending
on
what
type
of
causation)
○ Painful or frequent urination
○ Itching and redness in the genital
area
○ Blisters or sores in or around the
mouth
○ Abnormal vaginal odor
○ Anal itching, soreness or bleeding
○ Abdominal pain
○ Fever
DIAGNOSIS
● If the patient is sexually active, they should
talk to the healthcare provider about the
risk for STDs and whether they need to be
tested
○ This is important since many STDs do
not usually cause symptoms
● Some STDs may be diagnosed during a
physical exam or through microscopic
examination of a sore or fluid swabbed from
the vagina, penis, or anus.
● Blood tests can diagnose other types of
STDs
PREVENTION AND TREATMENTS
● Antibiotics can treat STDs caused by
bacteria or parasites
● There is no cure for STDs that are caused by
viruses
○ But medicines often help with the
symptoms and lower the risk of
spreading the infection
● Correct usage of latex condoms greatly
reduces, but does not completely eliminate
the risk of catching or spreading STDs.
● The most reliable to avoid infection is to not
have anal, vaginal or oral sex
● There are vaccines to prevent HPV and
hepatitis B.
STDs and Pregnancy
● Some STIs can be transmitted to a fetus
during pregnancy or a newborn during
childbirth.
○ But this isn’t the case for all STDs
● Syphilis can be passed to an unborn baby,
resulting in a serious infection, miscarriage
or stillbirth
● Genital warts can also pass to a baby, but it's
extremely rare.
● Consideration for pregnant women:
○ Get Screened for STIs
■ Including HIV and syphilis, to
avoid
complications
by
ensuring any infection that
can be detected and treated.
○ Speak with a healthcare professional
if you have an STD
■ They may need to check that a
medication is safe for the
patient to use or delay
treatment where necessary.
○ Note that a CS delivery may be
needed
■ Particularly if genital warts
make it difficult for the vagina
to stretch.
Primary Ovarian Insufficiency
Primary ovarian insufficiency (POI) is a condition
that occurs when a person’s ovaries fail earlier
than average. Your ovaries are small glands
located on both sides of the uterus that produce
and release eggs during ovulation. The ovaries also
make important hormones for menstruation,
pregnancy and other bodily functions.
The usual age for egg production to stop, known as
menopause, is around 51. For some people, POI
happens abruptly, and they suddenly stop having a
regular menstrual period. But, for others, a
diagnosis of POI comes after months or years of
irregular periods.
Primary ovarian insufficiency was previously known
as premature ovarian failure. However, healthcare
providers prefer “insufficiency” rather than “failure”
because research has shown that people with POI
32
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
can have intermittent ovulation. This means you
may still release an egg and get pregnant if you
have POI. In fact, around 5% to 10% of those with a
diagnosis of POI will spontaneously get pregnant
without treatment for infertility. For this reason, POI
is often also called “decreased ovarian reserve.”
SYMPTOMS
The most common sign of POI is irregular or missed
periods. Some people with primary ovarian
insufficiency don’t have any noticeable symptoms.
Other symptoms can include:
●
●
●
●
●
●
●
●
●
Irregular or missed periods
Trouble getting pregnant
Decreased sex drive
Difficulty concentrating
Irritability
Dry eyes
Hot flashes and night sweats
Vaginal dryness
Painful sex due to vaginal dryness
DIAGNOSIS
The healthcare provider will perform a physical
exam and a pelvic exam. They’ll also ask about the
health history of the client.
Next, they will likely order blood tests to measure
levels of certain hormones in the body. These
include follicle stimulating hormone (FSH), estrogen
and prolactin.
Other tests your provider may use include:
● A blood test (karyotype testing) to look for
genetic disorders
● A pelvic ultrasound (to look at your ovaries
and uterus)
● Antibody tests to check for autoimmune
disorders.
Providers diagnose POI if you’re younger than 40
and:
● Have no periods or abnormal periods.
● Lab tests show the hormone levels are that
of a person in menopause.
CAUSES
In the majority of cases, healthcare providers don’t
know what causes primary ovarian insufficiency
(idiopathic POI). However, research shows that up to
one-third of
component.
cases
may
have
a
hereditary
Some other causes of POI include:
● Autoimmune disorders like Addison disease,
rheumatoid arthritis or thyroid disease.
● Cancer treatments such as chemotherapy
and radiation.
● Genetic
disorders
including
Turner
syndrome (genetic disorder involving an
abnormality in one of a person AFAB’s two X
chromosomes) or Fragile X syndrome (a
genetic disorder involving changes in the
gene FMR1).
● Hysterectomy (surgery to remove your
uterus).
● Infections like mumps and HIV. (This is
thought to happen due to antibodies that
attack your ovary.)
● Prolonged
exposure
to
chemicals,
pesticides, cigarette smoke and other toxins.
TREATMENT
Healthcare providers treat POI in different ways. It
depends on your age, symptoms and if you wish to
get pregnant. Primary ovarian insufficiency
treatment involves:
● Replacing hormones that the ovaries no
longer produce
● Treating symptoms or side effects of POI (like
night sweats, vaginal dryness, etc.)
● Lowering the risk for conditions that POI
causes.
● Treating underlying conditions that worsen
POI symptoms.
Gonorrhea and Chlamydia
KEY FACTS
● Chlamydia and gonorrhea are both sexually
transmitted infections (STIs) caused by
bacteria. They can be contracted through
oral, genital, or anal sex.
● The symptoms of these two STIs overlap, so
if someone has one of these conditions, it’s
sometimes hard to be sure which one it is
without having a diagnostic test at a
doctor’s office.
● Some people with chlamydia or gonorrhea
may have no symptoms. But when symptoms
33
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
occur, there are some similarities, such as an
abnormal, bad-smelling discharge from the
penis or vagina, or a burning feeling when
you pee.
Chlamydia is more common than gonorrhea.
According to a 2017 report, over 1.7 million
cases of chlamydia were reported in the
United States, while just over 550,000 cases
of gonorrhea were documented.
SYMPTOMS
Both men and women can get chlamydia or
gonorrhea and never develop any symptoms. With
chlamydia, symptoms may not appear for a few
weeks after you’ve contracted the infection. And
with gonorrhea, women may never experience any
symptoms at all or may only show mild symptoms,
while men are more likely to have symptoms that
are more severe.
A couple of the most telltale symptoms of these
STIs overlap between the two (for both men and
women), such as:
● Burning when you pee
● Abnormal, discolored discharge from the
penis or vagina
● Abnormal discharge from the rectum
● Pain in the rectum
● Bleeding from the rectum
● With both gonorrhea and chlamydia, men
may also experience abnormal swelling in
their testicles and scrotum, and pain when
they ejaculate.
Chlamydia symptoms
With chlamydia, women may experience more
severe symptoms if the infection moves upward to
the uterus and fallopian tubes. This can cause
pelvic inflammatory disease (PID).
PID can cause symptoms such as:
● Fever
● Feeling sick
● Vaginal bleeding, even if you’re not having a
period
● Intense pain on the pelvic area
DIAGNOSIS
Both STIs can be diagnosed using similar
diagnostic methods. The doctor may use one or
more of these tests to ensure that the diagnosis is
accurate and that the right treatment is given:
●
●
●
●
Physical examination to look for symptoms
of an STI and determine the overall health of
the client
Urine test to test the urine for the bacteria
that cause chlamydia or gonorrhea
blood test to test for signs of bacterial
infection
Swab culture to take a sample of discharge
from your penis, vagina, or anus to test for
signs of infection
CAUSES
Both conditions are caused by an overgrowth of
bacteria. Chlamydia is caused by an overgrowth of
the bacteria Chlamydia trachomatis. Gonorrhea is
caused by an overgrowth of bacteria called
Neisseria gonorrhoeae
RISK FACTOR
You're at increased risk for developing these and
other STIs if you:
● Have multiple sexual partners at one time
● Don’t properly use protection, such as
condoms, female condoms, or dental dams
● Regularly use douches which can irritate
your vagina, killing healthy vaginal bacteria
● Have contracted an STI before
Sexual assault can also increase the risk of both
chlamydia or gonorrhea.
TREATMENT
Both STIs are curable and can be treated with
antibiotics, but you’re more likely to contract the
infection again if you’ve had either STI before.
Treatment for chlamydia
● Chlamydia is usually treated with a dose of
azithromycin (Zithromax, Z-Pak) taken either
all at once or over a period of a week or so
(typically about five days).
● Chlamydia can also be treated with
doxycycline
(Oracea,
Monodox).
This
antibiotic is usually given as a twice-daily
oral tablet that you need to take for about a
week.
34
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Treatment for gonorrhea
● The doctor will likely prescribe ceftriaxone
(Rocephin) in the form of an injection into
the buttock.
● The
CDC
previously
recommended
ceftriaxone plus azithromycin, but the
guidelines were changed because the
bacteria causing gonorrhea are becoming
increasingly resistant to azithromycin.
Using both antibiotics helps clear the infection
better than using only one treatment alone.
Gonorrhea is more likely than chlamydia to become
resistant to antibiotics. If you contract the infection
with a resistant strain, you’ll need treatment with
alternative antibiotics, which the doctor will
recommend.
Cervical Dysplasia
Cervical dysplasia is a precancerous condition in
which abnormal cells grow on the surface of your
cervix. The cervix is the opening to your uterus
that’s attached to the top portion of your vagina.
Another name for cervical dysplasia is cervical
intraepithelial neoplasia, or CIN. “Intraepithelial”
means that the abnormal cells are present on the
surface (epithelial tissue) of your cervix and have
not grown past that surface layer. The word
“neoplasia” refers to the growth of abnormal cells.
SYMPTOMS
Cervical dysplasia doesn’t usually cause symptoms.
Instead, the healthcare provider may diagnose you
with cervical dysplasia after finding abnormal cells
during a routine Pap smear. Some people may have
irregular vaginal spotting or spotting after
intercourse.
DIAGNOSIS
The healthcare provider will most likely notice signs
of cervical dysplasia during a routine Pap smear. If
the Pap smear is unclear or reveals abnormal cells,
the next step might be a colposcopy to examine the
cervix.
A colposcopy can take place in the healthcare
provider’s office. During the procedure, the
healthcare provider looks through a lighted
instrument called a colposcope to check for
abnormal cells in cervix or vaginal walls.
They might perform a biopsy to remove tissue
samples that’ll be examined in a laboratory. They
may order a DNA test to see whether a high-risk
form of HPV is present, too.
CAUSES
Someone can get cervical dysplasia if become
infected with HPV, a virus that’s spread through
sexual contact. In many cases, the immune system
will get rid of the virus. Over 100 strains of HPV
exist. Some strains, such as HPV-16 and HPV-18, are
more likely to infect your reproductive tract and
cause cervical dysplasia.
Scientists estimate that more than 75% of sexually
active cisgender women are infected with HPV at
some point during their lives. About 50% of HPV
infections occur between the ages of 15 and 25.
Often, the infections go away without causing
permanent problems. In rare cases, abnormal cells
form over time, leading to cervical dysplasia.
RISK FACTOR
● Being over age 55: Studies have shown that
HPV infections often last longer in people
over 55. Infections often clear up more
quickly in people who are 25 or younger.
● Smoking cigarettes: Smoking and using
products that contain tobacco can double
your risk of cervical dysplasia.
● Having a weakened immune system: Using
immunosuppressant drugs can make it
harder for your body to fight an HPV
infection. Becoming infected with the human
immunodeficiency virus (HIV) makes it
harder for your body to fight infection, too. A
weakened immune system, along with an
HPV infection, can lead to cervical dysplasia.
TREATMENT
Treatment depends on various factors, including
the severity of your cervical dysplasia, age, health
and treatment preferences. Procedures to treat
cervical dysplasia can impact future pregnancies.
●
Monitoring abnormal cells: With low-grade
cervical dysplasia, classified as CIN 1, you
likely won’t need treatment. In the majority of
these cases, the condition goes away on its
own. Only about 1% of cases progress to
35
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
cervical cancer. Your healthcare provider
may choose a conservative approach that
calls for periodic Pap smears to monitor any
changes in abnormal cells.
●
Removing or destroying abnormal cells: If
your cervical dysplasia is more severe (CIN 1
or CIN 2), your healthcare provider can
remove the abnormal cells that may become
cancerous or destroy them.
These procedures may include:
● Loop electrosurgical excision procedure
(LEEP) uses a small, electrically charged wire
loop to remove tissue. LEEP can also remove
tissue samples for further analysis. About 1%
to
2%
of
people
may
experience
complications following the procedure, such
as delayed bleeding or narrowing of their
cervix (stenosis).
● Cold knife cone biopsy (conization) involves
your healthcare provider removing a
cone-shaped piece of tissue containing the
abnormal cells. It was once the preferred
method of treating cervical dysplasia, but
now it’s reserved for more severe cases.
Conization can provide a sample of tissue
for further testing. It has a somewhat higher
risk of complications, including cervical
stenosis and postoperative bleeding.
● Hysterectomy involves removing your uterus.
A hysterectomy may be an option in cases
where cervical dysplasia persists or doesn’t
improve after other procedures.
Pelvic Floor Prolapse
.
KEY FACTS
● Pelvic floor prolapse or Pelvic organ
prolapse (POP) is a condition in which the
pelvic floor (the muscles, ligaments and
tissues that support your pelvic organs)
become too weak to hold the organs in
place.
● The pelvic floor muscles act like a powerful
sling that supports organs like the vagina,
uterus, bladder and rectum. If it becomes
too loose or sustains damage, the organs it
supports shift out of place.
● With mild cases of Pelvic floor prolapse, the
organs may drop. In more severe cases, the
organs may extend outside of the vagina
and cause a bulge.
● Pelvic organ prolapse is one type of pelvic
floor disorder, along with urinary and fecal
incontinence.
Sometimes
these
other
disorders occur together with Pelvic floor
prolapse.
Different types of POP:
The type of prolapse you have depends on where
the weaknesses are in your pelvic floor and what
organs are affected.
●
Anterior vaginal wall prolapse (dropped
bladder): Weakened pelvic floor muscles
above your vagina can cause your bladder
to slip out of place and bulge onto your
vagina. This type of prolapse is also called
cystocele. Anterior vaginal wall prolapse is
the most common type of POP.
36
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
●
●
●
Urethrocele: Weakened pelvic floor muscles
can cause the tube that carries pee from
your bladder to outside your body (urethra)
to droop. A dropped urethra often
accompanies a dropped bladder.
Posterior vaginal wall prolapse (dropped
rectum): Weakened pelvic floor muscles in
between your vagina and rectum can cause
your rectum to bulge onto the back wall of
your vagina. This type of prolapse is also
called rectocele.
Enterocele: Weakened muscles in your pelvis
can cause your small intestine to bulge onto
the back wall or the top of your vagina.
Uterine prolapse (dropped uterus): A
weakened pelvic floor can cause your uterus
to drop down into your vaginal canal.
Vaginal vault prolapse: Weakened pelvic
floor muscles can cause the top part of your
vagina (vaginal vault) to drop into your
vaginal canal.
SYMPTOMS
The most common symptom is feeling a bulge in
your vagina, as if something were falling out of it.
Other symptoms include:
●
●
●
●
●
●
●
●
Bulge, fullness or pressure in your vagina.
Fullness, pressure or aching in your pelvis.
Aching or pain in your low back.
Pressure, hitting sensation or pain during
intercourse (dyspareunia).
Bulge or pressure that worsens throughout
the day.
Bulge or pressure that worsens if you cough
or if you’re on your feet too long.
Having to shift protruding organs with your
finger in order to pee or poop.
Vaginal spotting.
Stress incontinence, urge incontinence and fecal
incontinence often coexist with POP because they
share similar risk factors. Symptoms include:
●
●
●
Leaking pee when you cough, laugh or
exercise (stress incontinence).
A frequent urge to pee that’s hard to control
(urge incontinence).
Constipation or being unable to control
when you poop (fecal incontinence).
DIAGNOSIS
During appointment, the healthcare provider will
review the symptoms and perform a pelvic exam.
During the exam, the provider may ask to cough so
that they can see the full extent of the prolapse
when straining and relaxed. They may examine you
while you’re lying down and while you’re standing.
Often, a pelvic exam is all it takes to diagnose a
prolapse.
Additional tests may include:
●
●
Bladder function tests that allow your
provider to look for signs of urinary issues
that are common with POP. Tests may
include a cystoscopy, a procedure that
allows your provider to see inside your
bladder and urethra. Your provider may also
perform a urodynamics test to see how well
your bladder and urethra are storing and
releasing pee.
Imaging procedures that allow your provider
to view inside your pelvic cavity. Your
provider may order a pelvic floor ultrasound
or MRI to determine the extent of your
prolapse. Imaging isn’t often used except in
complex cases.
CAUSES
The pelvic floor can weaken for many reasons. A
weak pelvic floor increases the likelihood of a
prolapse.
●
●
●
Vaginal childbirth is the most common
factor associated with developing POP.
Multiple vaginal deliveries, having twins or
triplets, or carrying a larger than average
fetus (fetal macrosomia) all increase the
odds that the pelvic floor muscles will
sustain injuries that may lead to POP.
The aging process can cause the muscles to
lose strength, including the pelvic floor
muscles. One factor is declining estrogen.
During menopause, the body produces less
estrogen. The decline can cause the
connective tissues that support the pelvic
floor to weaken.
Having a heavier body increases the risk for
POP. Studies have shown that people who
are clinically overweight or have obesity are
37
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
●
more likely to develop POP than people who
are in the normal weight range.
Long-term pressure in your abdominal
cavity can overwork the pelvic floor muscles,
causing
them
to
weaken.
Chronic
constipation,
chronic
coughing
and
frequent heavy lifting all increase the
chance of developing POP.
A family history of POP may increase the
odds of developing POP. Research into the
genetic components of POP is ongoing, but
it’s possible that you inherited a weaker
pelvic floor.
Collagen irregularities can weaken the
connective tissues in your pelvic floor,
increasing the likelihood you’ll develop POP.
People with connective tissue disorders, like
Ehlers-Danlos Syndrome, and who have
more movement in their joints are at a
greater risk for developing POP.
TREATMENT
Because any surgical procedure may pose risks or
create complications, nonsurgical procedures are
usually the first line of treatment for POP.
●
●
●
●
●
Nonsurgical treatments
Treatments include:
● Vaginal pessary: A removable silicone device
that your provider can insert into your
vagina to hold a sagging organ in place.
● Pelvic floor exercises (Kegel exercises):
Strengthening exercises for your pelvic floor.
Your provider may refer you to a physical
therapist to test the strength of individual
muscles and teach you targeted exercises to
train these muscles.
Surgical treatments
Surgery may be an option if your symptoms haven’t
improved with conservative treatments and if you
no longer wish to have children. Childbirth following
surgery may increase the risk of your prolapse
returning.
●
Colpocleisis is an obliterative procedure
that results in a shortened vagina. It
prevents any organs from bulging outside
your body. It’s a good option if you’re too
frail for reconstructive surgery and don’t
wish to have penetrative sex anymore.
Colporrhaphy
treats
anterior
and/or
posterior vaginal wall prolapse. With
colporrhaphy, your healthcare provider
performs surgery through your vagina. They
reinforce your vaginal walls with dissolvable
sutures to support your bladder and rectum.
Sacrocolpopexy
treats
vaginal
vault
prolapse and enterocele. It may involve an
incision into your abdomen or a less
invasive procedure, called laparoscopy.
During the procedure, your provider
attaches surgical mesh on your vaginal walls
and then attaches it to your tailbone. The
mesh lifts your vagina back into place.
Sacrohysteropexy treats uterine prolapse.
Your provider attaches surgical mesh to
your cervix and vagina and attaches it to
your tailbone, lifting your uterus into place.
Sacrohysteropexy is an option if you don’t
want to have your uterus removed (a
hysterectomy).
Uterosacral or sacrospinous ligament
fixation uses your tissues to treat uterine
prolapse or vaginal vault prolapse. Like
colporrhaphy, it’s performed through your
vagina. During the procedure, your provider
attaches the top of your vagina to a
ligament or muscle in your pelvis, using
dissolvable sutures. This type of surgery is
sometimes called native tissue repair.
REPRODUCTIVE HEALTH BILL AND OTHER
EXISTING DOH PROGRAMS ON MATERNAL AND
CHILD CARE
Reproductive Health Law
Two types of surgeries are available: obliterative
surgery and reconstructive surgery. Obliterative
surgery sews your vaginal walls shut, preventing
organs from slipping out. Reconstructive surgery
repairs the weakened parts of your pelvic floor.
38
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
The Philippines was one of the signatory
countries to participate in the International
Conference on the Action of Reproductive
Health in Cairo in 1994. To support the
effective implementation of promoting
reproductive
health,
the
Responsive
Parenthood and Reproductive Health Act of
2012, or the Reproductive Health Bill, is now a
law that guarantees universal and free
access to nearly all modern contraceptives
for all citizens, including the people within
impoverished areas. The law also promotes
sex
education within schools, which
recognizes a woman’s right to abortion in
alignment with reproductive health care.
Following several controversies and endless
debates, the Republic of the Philippines
recently passed a law emphasizing women's
freedom to choose and make their own
health and family decisions, as well as
inclusivity and equality within society.
3. Prevention
of
abortion
and
management
of
post-abortion
complications
4. Adolescent and youth reproductive
health guidance and counseling
5. Prevention and management of the
reproductive tract infection (RTIs),
HIV’/AIDS and sexually transmitted
infections (STIs)
6. Elimination
of violence against
women and children and other forms
of sexual and gender-based violence
7. Education
and
counselling
on
sexuality and reproductive health
8. Treatment of breast and reproductive
tract cancers and other gynecologic
conditions and disorders
9. Male responsibility and involvement
and men’s RH
10. Prevention,
treatment
and
management of infertility and sexual
dysfunction
11. RH education for the adolescents
12. Mental health aspect of reproductive
health care
Other Priorities of the RH Law
●
●
The Elements of the Reproductive Health Law
●
According to Nancy Northup during the
speech at the Center for Reproductive
Rights, "The reproductive health law
provided a lot of advantages towards free
access to modern contraception, and
millions of Filipino women will finally be able
to regain control of their fertility, health, and
lives." There are 12 elements that are enacted
into the law. The following are listed:
1. Family planning information and
services
2. Maternal, infant and child health and
nutrition, including breastfeeding
●
Midwives for skilled birth attendance
○ The law requires every city and
municipality to employ an adequate
number of midwives and other skilled
attendants.
Emergency obstetric care
○ Each province and city shall ensure
the establishment and operation of
hospitals with adequate facilities and
qualified personnel that provide
emergency obstetric care.
Hospital-based family planning
○ Family planning is the foremost
intervention in attaining appropriate
reproductive health. It allows couples
to freely decide on the number and
proper spacing of births. The
approach by the RH law ensures that
every family is given health care and
services in a holistic manner thus
making the patient a client-centered
taking
approach
with
the
39
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
●
●
●
consideration of their particular
needs.
Contraceptives as essential medicines
○ The law also focuses upon preventing
and decreasing the statistics upon
the rate of infection within sexually
transmitted infections (STIs) and
HIV/AIDS. Promoting the use of
contraceptives such as condoms is
an effective method to prevent
infections and disease transmissions.
Reproductive health education
○ Reproductive
health
and
sex
education shall be taught by the
teachers to their students in an
age-appropriate study curriculum.
Employers’
responsibilities
towards
reproductive health rights
○ Employers
shall
respect
the
reproductive health rights of all their
workers.
○ Women shall not be discriminated
against in the matter of hiring,
regularization of employment status
or selection for retrenchment.
○ Employers
shall
provide
free
reproductive health services and
education to workers.
Capability building of community-based
volunteer workers
○ Community-based
workers
shall
undergo additional and updated
training
on
the
delivery
of
reproductive health care services
and shall receive not less than 10%
increase
in
honoraria
upon
successful completion of training.
Advantages Upon the RH
Prohibited Acts that is Punishable by the RH Law
●
●
As the law promotes empowerment towards
women's rights, including having free access
to contraceptives and maternal services
offered by the government, it also abides by
acts that can be punishable by this law.
Some of the acts are:
giving false information that gives malicious
intention to its audience about the RH
programs and services provided by the law.
●
●
●
●
Refusing to perform voluntary ligation and
vasectomy and other legal and medically
safe reproductive health care services on
any person of legal age on the ground of
lack of spousal consent or authorization
refusing to provide reproductive health care
services to an abused minor and/or an
abused pregnant minor, whose condition is
certified by an authorized DSWD official or
personnel, even without parental consent,
particularly when the parent concerned is
the perpetrator.
refusing to extend reproductive health care
services and information on account of the
patient’s civil status, gender or sexual
orientation,
age,
religion,
personal
circumstances, and nature of work
requiring a female applicant or employee, as
a condition for employment or continued
employment,
to
involuntarily
undergo
sterilization, tubal ligation, or any other
form of contraceptive method.
Arguments Issued Upon the RH Law
●
●
While the article on reproductive health law
focuses on family planning methods,
contraceptives, and education regarding
empowering women and their reproductive
rights, there is another side of the story
where the biggest opposition, the Catholic
Church, says that it is the procreation of
God’s legacy to his people.
According to statistics, contraceptive use
remained disturbingly low among poor
couples because they lacked information
and access. For instance, among the
40
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
●
poorest 20 percent of women, over half did
not use any method of family planning
whatsoever, while less than a third used
modern methods. Regardless of whether the
law was pro-health among impoverished
people, a lack of access to contraception
had serious health consequences.
The issue is not abortion at all. It is a totally
different aspect of the entire discussion. The
issue is giving the people a choice about
whether they will adapt the family planning
methods that have been suggested for them.
It is for them to take it or leave it. If the
people desire that they choose from among
the artificial family planning methods
available, then it is their choice. The bottom
line is that this information should be made
available to everyone and explained to them,
most especially to those who have no
capacity to learn and understand. These
people are the most vulnerable.
Safe Motherhood Program
●
The National Safe Motherhood Program
places a priority on the health and welfare
of
pregnant
women.
Additionally,
it
incorporates
teen
pregnancies
and
addressing women’s unmet needs for family
planning contraception into its priority
agenda through 2030. With the help of the
program, Filipino women would have better
access to high quality medical care for safer
pregnancy delivery. Its aim is to advance the
health and happiness of mothers in the
family.
THE ADVANTAGES OF SAFE MOTHERHOOD
●
THE “SIX
PROGRAM
1.
2.
3.
4.
5.
THE MAIN GOAL OF SAFE MOTHERHOOD
●
An initiative of safe motherhood was started
in 1987 with the aim of ensuring that the
women experience pregnancy and childbirth
safely and give birth to healthy children.
○ This initiative was strengthened by
inclusion
of reducing maternal
mortality
in
the
Millennium
Development Goals of 2000-2015.
Safe motherhood reduces morbidity and
death among mothers and their children.
Although safe motherhood practices can
avoid the majority of maternal and newborn
fatalities, maternal mortality and morbidity
from preventable causes afflict millions of
women globally.
6.
PILLARS”
OF
SAFE
MOTHERHOOD
Family Planning - To guarantee that people
and couples have the knowledge and
resources necessary to organize their
pregnancies timing, number, and spacing.
Antenatal Care - To provide vaccines,
vitamin
supplements,
and
screening
identifying risk factors in order to, when
possible, avert complications, and to ensure
that
pregnancy-related
problems
are
identified quickly and treated appropriately.
Obstetric Care - To ensure that all birth
attendants have the information, abilities,
and tools necessary to carry out a clean
and safe delivery and to guarantee that all
women who require emergency care for
high-risk pregnancies and problems may
access it.
Postnatal Care - To make sure that the
mother and baby receive postpartum care,
including help with breastfeeding, family
planning services, and monitoring warning
signs.
Postabortion
Care
To
prevent
complications where possible and ensure
that complications of abortion are detected
early and treated appropriately; to refer
other reproductive health problems; and to
provide family planning methods as needed.
STD/AIDS Control - To evaluate the risk of
future infection, to screen, prevent, and
manage transmission of the baby, to offer
voluntary consultative and testing, to
promote prevention, and if necessary, to
extend services to address mother-to-child
transmission.
41
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Maternal and Child Health Program
EARLY CHILDHOOD DEVELOPMENT
●
The primary focus of the Safe Motherhood
Program is on the health and welfare of pregnant
women. In addition, it addresses the unmet needs
of women in terms of family planning contraception
and adolescent pregnancies. With the help of this
program, Filipino women would have better access
to high-quality medical care for a safer pregnancy
and delivery. Its objective is to advance the health
and happiness of mothers in Filipino families.
OBJECTIVES:
●
●
●
●
●
To advance the health and happiness of
mothers in Filipino families.
Encourage initiatives aimed at promoting
secure food access and healthy eating.
In order to live a healthy lifestyle, increase
physical activity.
Increased
information
exchange
and
knowledge creation will help community-led,
evidence-based initiatives.
Create alliances to expand the influence of
health promotion and primary preventive
initiatives.
MATERNAL AND CHILD HEALTH NURSES CAN:
●
●
●
●
●
●
Provide guidance on a number of subjects
and information, assistance, (including
parenting, development and learning, child
health, family health and wellbeing, safety,
immunization, breastfeeding, nutrition and
family planning).
In the early years, keep track of your child's
growth and development through a series of
one-on-one meetings at predetermined
intervals.
Help with sleeping, feeding and behavior
problems.
Organize parents’ groups where you can get
information and have the chance to meet
other parents in the local area.
Help to contact specialist services if
necessary (such as early parenting).
Offer additional support and services to
families experiencing difficulties.
●
●
Aboriginal Infant Development Program –
works together with families to support the
growth and development of young children.
Aboriginal Supported Child Development – a
program for children with developmental
delays or disabilities and their families.
Community Action Program for Children –
promotes the healthy development of young
children (0-6) who are living in conditions of
risk.
TYPES OF SERVICE:
PhilHealth Benefit Package
➔ Maternity Care Benefit Package
➔ Newborn Care Benefit Package
Trainings
➔ Basic Emergency Obstetric and Newborn
Care for Doctors and Nurses.
➔ Basic Emergency Obstetric and Newborn
Care for Midwives.
➔ Maternal Death Surveillance and Response.
Implementation Support Materials
➔ Pregnancy, Childbirth, Postpartum and
Newborn Care (PCPNC) Manual.
➔ BEmONC Module for Midwives.
➔ Maternal Death Reporting and Review
System: A Guide to LGU Users.
REFERENCES
403
Forbidden.
(n.d.).
https://doh.gov.ph/health-programs/safe-motherho
od-program
7 Childbirth Delivery Methods and Types:
Differences & Benefits. (2022, April 15). MedicineNet.
https://www.medicinenet.com/7_childbirth_and_deliv
ery_methods/article.htm
Amenorrhea & secondary amenorrhea: Causes,
diagnosis & treatment. Cleveland Clinic. (n.d.).
Retrieved
November
28,
2022,
from
https://my.clevelandclinic.org/health/diseases/3924
-amenorrhea
42
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Brennan, D. (2021, June 18). Hypnotic birth:
Approaches, benefits, and more. WebMD. Retrieved
November
28,
2022,
from
https://www.webmd.com/baby/what-is-hypnotic-birt
h
2022,
from
https://www.hopkinsmedicine.org/health/conditions
-and-diseases/dysmenorrhea#:~:text=To%20diagnos
e%20dysmenorrhea%2C%20your%20health,image%
20of%20the%20internal%20organs.
Birth Methods: Which One Is Right For You? (2017).
Mustela USA.
https://www.mustelausa.com/blogs/mustela-mag/bi
rth-methods-which-one-is-right-for-you
Ernst, H.. (2022, March 14). What’s the Difference
Between Chlamydia and Gonorrhea. (Retrieved
November
28,
2022,
from
https://www.healthline.com/health/sexually-transmi
tted-diseases/chlamydia-vs-gonorrhea#risk-factor
s
Cabral, E. (2013, April 23). Reproductive Health Law
in the Philippines. ASEAN-endocrine Journal.
https://www.asean-endocrinejournal.org/index.ph
JAFES/article/view/48/471
Cleveland Clinic medical professional. (2021,
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43
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
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44
UNIT VIII
MATERNAL AND CHILD HEALTH NURSING [LECTURE]
BSN 2-6 GROUP 5 - Raspado, Krishlaine | Rodriguez, Maria Andrea | Rodriguez, Sofia | Salibio, Ariane Joyce | Santiago, Franchezca Lei | Templa,
Berlourenz | Teodoro, Frances Kay | Tolon, Danica
Walker, M. H., Coffey, W., & Borger, J. (2022,
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45