Barrier Method: Female Condom



Female Condom

Female Condom

Description

• A vaginal sheath made of polyurethane and lubricated with monoxynol 9;
• The inner ring (closed end) covers the cervix. The outer ring )open end) sests against the vaginal opening;
• Intended for one-time use and should not be used in combination with male condoms

Advantages

• It is 95% effective;
• It helps prevent the spread of STD;
• It can be purchased over-the-counter.

Disadvantages

• The female condom is more expensive than the male condom;
• It can be difficult to use and has not gained as much acceptance as a male condom;
• Pregnancy can occur as a result of failure to use or incorrect use;
• It may break or become dislodge;
• It is contraindicated in people or partners with latex alleries.

Implications

• Instruct the person on how to insert the female condom;
• Advise the person that the condom may be inserted for up to 8 hours before intercourse;
• Reinforce that the female condom is for one-time use only and must be discarded after use.

Preterm Birth

"Mommy I'm not yet ready"

A case study about Maternal and Child Health with emphasis on Preterm Birth

Description

• Refers to the birth of a neonate before the end of 37th week of gestation;
• Associated with numerous problems
• All body systems are immature;
• The extent of immaturity depends on gestational age and level of development at delivery;
• Preterm neonates between 28 and 37 weeks of gestation have the best chance of survival.

What happened?

• Preterm birth may occur because of maternal disease that necessitates delivery of the neonate for the health of the mother - example, preeclampsia (gestational hypertension);
• Preterm birth may also be a direct result of preterm labor.

Assessment findings

• Inspection findings
• Low birth weight
• Minimal subcutaneous fat deposits;
• Proportionally large head in relation to body;
• Wrinkled features;
• Thin, smooth, shiny skin that is almost translucent;
• Veins clearly visible under the thin, transparent epidermis;
• Lanugo hair over the body;
• Sparse, fine, fuzzy hair on the head;
• Soft, pliable ear cartilage; the ear may fold easily;
• Minimal creases in the soles and palms;
• Prominent eyes, possibly closed;
• Few scrotal rugae (males);
• Undescended testes (males);
• Prominent labia and clitoris (females)
• Neurologic examination findings
• Inactivity (although may be unsually active immediately after birth);
• Extension of extremeties
• Absence of sucking reflex;
• Weak swallow, gag, and cough reflex;
• Weak grasp reflex;
• Ability to bring neonate's elbow across the chest when eliciting the scarf sign;
• Ability to easily bring the neonate's heel to his ear
• Additional findings
• Inability to maintain body temperature;
• Limited ability to excrete solutes in the urine;
• Increased susceptibility to infection, hyperbilirubinemia, and hypoglycemia;
• Periodic breathing, hypoventilation, and periods of apnea.

Treatments

• Cardiac and respiratory assessment and assistance;
• Resuscitation if necessary;
• Maintenance of fluid and electrolyte balance;
• Nutritional support;
• Prevention of infection;
• Assessment of neurologic status;
• Maintenance of body temperature and neutral thermal environment;
• Monitoring of renal fuction;
• Emotional support to parents;
• Assessment of glucose and bilirubin levels

Interventions

• Closely assess all body systems;
• Anticipate the need for endotracheal intubation and mechanical ventilation;
• Administer oxygen as needed, avoiding concentrations that are too high;
• Monitor transcutaneous oxygen levels or pulse oximetry reading;
• Have emergency resuscitation equipment readily available.
• Administer medications to support cardiac and respiratory function;
• Institute measures to maintain a neutral thermal environment; anticipate the need for incubator or radiant warmer;
• Avoid vigorous stroking or rubbing; use firm but gentle touch when handling a neonate;
• Support the head and maintain extremeties close to the body during position changes;
• Monitor fluid and electrolyte balance, assess intake and output and administer intravenouos fluids as ordered;
• Provide emotional support, education and guidance to the mother and family;
• Explain the procedures and treatments to the parents, allow parents to verbalize their concerns, correct any misconceptions or  erroneous information;
• Assist with referrals for supportive services.

Human Immunodeficiency Virus Infection

AIDS Symbol - The Red Ribbon

The Wrath of AIDS

Definition

• HIV is the causative agent for acquired immunodeficiency syndrome (AIDS)
• Considered as an STD, it can have serious implications for the pregnant mother and her fetus.

The story behind it

• HIV infection is caused by a retrovirus that targets the helper T-lymphocytes that contain the CD4+ antigen.
• The virus integrates itself into the cell's genetic makeup, ultimately causing cellular dysfunction;
• The cells can no longer function in mounting an appropriate immune response, leaving the person vulnerable to opportunistic infections.
• The virus may be contracted through sexual intercourse, exposure to infected blood, vertical transmission across the placenta to the fetus during pregnancy, labor and delivery birth, or by breast milk to the neonate.

The clinical manifestations

• Lymphadenopathy
• Bacterial pneumonia
• Fever
• Night sweats
• Weight loss
• Dermatologic problems
• Thrush
• Thrombocytopenia;
• Diarrhea
• Severe vaginal yeast infection that is difficult to treat
• Abnormal pap smear result
• Frequent HPV infections, frequent and recurrent bacterial vaginosis, trichomonas, and genital herpes infections.

The test for AIDS

• Two positive enzyme-linked immunosorbent assays confirmed with the western blot test identifies the person as being positive for HIV
• CD4+ T-lymphocyte count is less than 200 cells/ul

How is it managed?

• Combination antiretroviral therapy in an attempt to reduce the mother's viral load and thus minimize the risk of vertical transmission of the infection to the fetus
• Supportive care

How is it intervened?

• Institute standard precautions when caring for the mother throughout the pregnancy and after delivery and when caring for the neonate;
• Teach the pregnant mother about the measures to minimize the risk of virus transmissions;
• Provide emotioanl support and guidance for the infected individual who is HIV positive and considering pregnancy;
• Allow the pregnant mother who is discovered to be HIV positive to verbalize her feelings and provide support for her;
• Monitor CD4+ T-lymphocyte counts and viral loads as indicated;
• Assess the infected individual for signs and symptoms of opportunistic infections;
• Encourage them to maintain prenatal follow-up to evauluate the status of pregnancy;
• Administer antiretroviral therapy as indicated:
• Teach the pregnanat mother how to administer the therapy;
• Assist with scheduling medications;
• Evaluate the mother for compliance on return visits
• Institute measures during labor and delivery to minimize the fetus's risk of exposure to maternal blood or body fluids;
• Avoid the use of internal fetal monitors, scalp blood sampling, forceps, and vacuum extraction to prevent the creation of an open lesion on the fetal scalp;
• Advise the mother that breast-feeding is not recommended because of the risk of possible virus transmission;
• Withhold blood sampling and injections on the neonate until maternal blood has been removed with the first bath;
• Educate the mother about the mode of HIV transmission and safer sex practices.

Barrier Method: Cervical Cap

Cervical Cap

Cervical Cap

Description

• A barrier-type method of contraception, similar to the diaphragm but smaller;
• A thimble-shape, soft rubber cup that the patient places over the cervix;
• Held in place by suction;
• The addition of a spermicide creates and additional chemical barrier;
• Persons who are not suited for diaphragms may use a cervical cap; failure of the cervical cap is commonly due to failure to use the device or inappropriate use of the device.

Advantages

• The cap requires less spermicide;
• It has an efficacy rate of 85% for nulliparous women and 70% for parous women when used correctly and consistently;
• It does not alter hormone levels;
• It can be inserted up to 8 hourse before intercourse;
• It does not require reapplication of spermicide before before repeated intecourse;
• It can remain in place longer than diaphragms because it does not exert pressure on the vaginal walls or urethra.

Disadvantages

• It requires possible reffiting after weight gain or loss of 15 lb *6.8 kg) or more, recent pregnancy, recent pelvic surgery, or cap slippage.
• It is more likely to become dislodged during intercourse;
• It may be difficult to insert or remove;
• It may cause an allergic reaction or vaginal lacerations and thickening of the vaginal mucosa;
• It may cause a foul odor of left in place for more than 36 hours;
• It can't be used during mesntruation or during the first 6 post-partum weeks;
• It should not be left in place longer than 24 hours;
• It is contraindicated in people with a history of toxic shock syndrome (TSS), a previously abnormal Pap test, allergy to latex or spermicide, an abnormally short or long cervix, history of pelvic inflammatory diseases (PID), cervicitis, papillomavirus infection, cervical cancer, or undiagnosed vaginal bleeding.

Implications

• Make sure that the person is properly fitted with the cap;
• The gap os space between the base of the cervix and the inside of the cervicl cap ring should be 1 to 2 mm (to reduce the possibility of dislodgement);
• The rim should fill the cervicovaginal fornix;
• If the cap is too small, the rim leaves a gap where the cervix remained exposed; if the cap is too large, it is not snug against the cervic and is more easily dislodged;
• Instruct the person on how to insert the cap properly;
• Re mind the person that the cap needs refitting after weight gain or loss of 15 lb or more, recent pregnancy, recent pelvic surgery or cap slippage.

Barrier Method: Diaphragm

Diaphragm and Spermicide

Diaphragm

Description

• A barrier-type contraceptive that mechanically blocks sperm from entering the cervix;
• Composed of a soft, latex dome that is supported by a round, metal spring on the outside;
• A diaphragm can be inserted up to 2 hours before intercourse;
• Optimum effectiveness is achieved by using it in combination with spermicidal jelly that is applied to ring of the diaphragm before it is inserted;
• Diaphragms are available in various sizes and must be fitted to the individual.

Advantages

• It is a good choice for people who choose not to use hormonal contraceptives or don't feel that they can be accurate in using natural family planning methods;
• When combined with spermicidal jelly, its effectiveness ranges from 80% to 90% for new users and increases to 97% for long term users;
• It causes few adverse reactions;
• It can help protect against STDs when used with spermicide;
• It does not alter the body's metabolic or physiologic process;
• It can be inserted up to 2 hours before intercourse;
• Providing it is correctly fitted and inserted, neither the partner can feel it during intercourse.

Disadvantages

• Some people dislike using a diaphragm because it must be inserted before intercourse;
• Although the diaphragm can be left in place for up to 24 hours, if intercourse is repeated before 6 hours (which is how long the diaphragm must be left in place after intercourse) more spermicidal gel must be inserted;
• The diaphragm can't be removed and replaced because this could cause sperm to bypass the spermicidal gel and fertilization could occur;
• It may cause more upper urinary tract infections (UITs) due to the pressure of the diaphragm on the urethra;
• The diaphragm must be refitted after birth, cervical surgery, miscarriage, dilatation and curettage (D&C), therapeutic abortion, or wieght gain or loss of more than 15 lb (6.8kg) because of cervical shape changes;
• It is contraindicated in people who have a history of cystocele, rectocele, uterine retroversion, proplapse, retroflexion, or anteflexion because the cervix position may be displaced, making insertion and proper fit questionable;
• It is contraindicated in people with a history of toxic shock syndrome (TSS) or repeated UTIs, vaginal stenosis, pelvic abnormalities, allergy to spermicidal jellies or rubber. It is also contraindicated in people who show an unwillingness to learn proper techniques for diaphragm care and insertion;
• it can't be used in the first 6 post-partum weeks.

Implications

• Intruct the person in proper insertion technique;
• Urge the person never to leave the diaphragm in place for longer than 24 hours;
• Instruct the individual to leave the diaphragm in place for about 6 hours after the intercourse;
• Advise the individual to use additional spermicide for additional intercourse;
• Urge the person to adhere to medical follow-up and to have the diaphragm refitted after birth, cervical surgery, miscarriage, D&C, therapuetic abortion, or weight gain or weight loss.

Barrier Methods: Condoms

Male Condoms

Male Condom

Description

• A latex or synthetic sheath that's placed over the erect penis before intercourse;
• Prevents pregnancy by collecting spermatozoa in the tip of the condom, preventing them from entering the vagina.

Advantages

• Many people favor the male condom because it puts the responsibility of birth control on the male;
• No health care visit is needed;
• Available over-the-counter in pharmacies and grocery stores;
• Easy to carry;
• Prevents the spread of STD.

Disadvantages

• A condom must be applied before any vulvar penile contact takes place because preejaculation fluid may contain sperm;
• It may cause an allergic reaction if the product contains latex and the male individual or his partner is allergic;
• It may break during use if it is used incorrectly or is of poor quality;
• It can't be reused;
• Sexual pleasure may be affected.

Implications

• Remind the male individual and his partner that the condom must be positioned so that it is loose enough at the penis tip to collect ejaculatory but not so loose that it comes off the penis;
• Reinforce that the penis must be withdrawn before it becomes flaccid after ejeculation, otherwise sperm may escape from the condom into the vagina.

Barrier Method: Female Condom

Female Condom

Female Condom

Description

• A vaginal sheath made of polyurethant and lubricated with monoxyl 9;
• The inner ring (closed end) covers the cervix. The outer ring (open end) rests against the vaginal opening;
• It is intended for one-time use and should not be used in combination with male condom.

Advantages

• It is 95% effective;
• It helps prevent the spread of STDs;
• It can be purchased over-the-counter.

Disadvantages

• The feale condom is more expensive than the male condom;
• It can be difficult to use and has not gained as much acceptance as a male condom;
• Pregnancy can occur as a result of failure to use or incorrect use;
• It may break or become dislodged;
• It is contraindicated in individuals or partners with latex allergies.

Implications

• Instruct the individual on how to insert the female condom;
• Advise the person that the condom may be inserted for up to 8 hours before intercourse;
• Reinforce that the female condom is for one-time use only and must be discarded after use.