MCN Lec Group 1 Written Report

MCN II LECTURE [GROUP 1]
BACHELOR OF SCIENCE IN NURSING – PLM
• Maternal and child health nursing (MCN) can

be visualized within a framework in which
GROUP MEMBERS nurses uses a variety of methods such as the
Ching, Kyla Isabel Q. Ordoyo, Therese M.
Cabrigas, Joyce Noelyn S. Ramirez, Russiela Blesy L. nursing process, nursing theories, nursing
Caseres, Glaiza Mia C. Rodriguez, Sofia O. research, and evidenced-based practice,
Macalino, David Nico P. Templa, Berlourenz L. care for families during childbearing and
Malicdem, Keisha L. Teodoro, Frances Kay C
. childrearing years through the four phases of
health care.
OUTLINE
4 PHASES OF HEALTHCARE
I. Framework III. Care of At-
for Maternal Risk / High-
1. Health Promotion
and Child Risk and Sick
Health Mother and ➢ Educating clients to be aware of good
Nursing Child health through teaching and role
(MCN) modeling.
Focusing on 2. Health Maintenance
At-Risk, ➢ Intervening to maintain health when risk
High-Risk, IV. Evidence-
Based of illness is present.
And Sick
Client Interventions: 3. Health Restoration
Nursing Care ➢ Promptly diagnosing and treating illness
II. Nursing Care of At-Risk / using interventions that will return clients
of The Male Sick Mother
to wellness most rapidly.
and Female 4. Health Rehabilitation
Clients With ➢ Preventing further complications from an
General And
Specific
illness; bringing an ill client back to an
Problems In optimal state of wellness or helping a
Reproduction client to accept an inevitable death.
And
Sexuality
MOST COMMON DIRECT CAUSES OF
MATERNAL INJURY AND DEATH
FRAMEWORK FOR MATERNAL AND CHILD
➢ Excessive blood loss
HEALTH NURSING FOCUSING ON AT-RISK,
➢ Infection
HIGH RISK, AND SICK CLIENT
➢ High blood pressure
➢ Unsafe abortion
➢ And obstructed labor
NATIONAL HEALTH SITUATION ON MCN
➢ as well as indirect causes such as anemia,
malaria, and heart disease.
MATERNAL HEALTH
• Most maternal deaths are preventable with
• This refers to the health of women during timely management by a skilled health
pregnancy, childbirth, and postnatal period. professional working in a supportive
• Maternal and child nursing is a continuum environment. Ending preventable maternal
practice, and the primary goal of maternal
death must remain at the top of the global
and child health nursing care is simply the
agenda. At the same time, simply surviving
promotion and maintenance of optimal
family health to ensure cycles of optimal pregnancy and childbirth can never be the
childbearing and childrearing. marker of successful maternal health care. It
is critical to expand efforts reducing maternal
injury and disability to promote health and
FRAMEWORK FOR MATERNAL AND CHILD well-being.
HEALTH NURSING CARE
1
• HIV infection is an increasing threat. Mother-

Main Cause Number Percent
to-child transmission of HIV
• continues to be a major problem, with up to
Complications 660 38.4 45 per cent of HIV-infected mothers
related to transmitting infection to their children.
pregnancy
occurring in the STATISTICS ON MCN
course of labor, • More women and their children are surviving
delivery, and today than ever before, according to new
puerperium child and maternal mortality estimates
released today by United Nations groups led
Hypertension 605 35.2
by WHO and UNICEF.
complicating
o Still, the new estimates reveal that 6.2
pregnancy,
childbirth, and million children under 15 years died in
puerperium 2018, and over 290,000 women died due
to complications during pregnancy and
Postpartum 298 17.3 childbirth in 2017.
hemorrhage o Of the total child deaths, 5.3 million
occurred in the first 5 years, with almost
Pregnancy with 156 9.1 half of these in the first month of life.
abortive outcome Women and newborns are most
vulnerable during and immediately after
Total 1719 100 childbirth.
Figure: Leading causes, numbers, and percent o An estimated 2.8 million pregnant women
distribution of maternal deaths in the Philippines. and newborns die every year, or 1 every
11 seconds, mostly of preventable
• The figure shows the leading causes of causes.
maternal deaths, in which the majority of • According to the NDHS 2017, 9% of Filipino
maternal deaths is the result of pregnancy women aged 15-19 have begun childbearing:
complications occurring during labor, delivery 7% are already mothers and an additional 2%
and postpartum. This is followed by are pregnant with their first child. Young
hypertension complicating pregnancy, women from Davao are most likely to be
childbirth, and puerperium; postpartum mothers or pregnant (18% have begun
hemorrhage and pregnancy with abortive childbearing).
outcome (DOH, 2011).
FACTORS THAT AFFECT THE RISK OF

MATERNAL DEATH
• Frequency and spacing of births.

• Nutrition level (maternal undernutrition)
• Stature and maternal age
• Appropriate medical and midwife support
• Access to emergency and intensive
treatment if were necessary.
• Lack of management capacity in the health
system.
• No political will and lack of management
capacity in the health system. Majority of
these deaths and disabilities are preventable, GENETICS AND GENETIC COUNSELING
being mainly due to insufficient care during
pregnancy and delivery.
2
GENETICS PATTERN OF INHERITANCE
• Genetics is the study of heredity and the

variation of inherited characteristics.
• Cytogenetics is the study of chromosomes by
light microscopy and the method by which
chromosomal aberrations are identified.
• Inheritance is the passing of familial elements
from one generation to the next.
• DNA is a nucleic acid that contains the
genetic instructions specifying the biological
development of all cellular forms of life.
• Genome is the collection of genetic
information.
• Although the number three leading cause of • Genes are the basic units of heredity that
infant mortality is chromosomal determine both the physical and cognitive
abnormalities, limited attention has been characteristics of people. It is composed of
given to birth defects and other genetic segments of DNA; they are woven into
conditions. strands in the nucleus.
• Chromosomes are threadlike structures of
Causes Estimated nucleic acids and protein found in the nucleus
Prevalence of most living cells, carrying genetic
information in the form of genes.
• Human cells contain 23 pairs of
Dominant single-gene 7
chromosomes. 22 pairs of autosomal and
disorders
one pair of sex chromosomes.
• 23 chromosomes inherited from mother and
Recessive single gene 2.3 23 chromosomes from father.
disorders • Sex chromosome for females is XX and XY
for male.
X-linked recessive single- 1.3 • Mutant Gene is an abnormal gene which
gene disorders cannot perform its function in the proper way.
• Affected individual is someone who is known
to have the disease.
Chromosomal Disorders 4.2 • Carrier individual is someone who appears
normal but has one copy of a mutant gene.
Malformations 63.9 • Phenotype refers to a person's outward
appearance or the expression of genes.
Figure: Prevalence of congenital disorders by • Genotype refers to a person’s actual gene
cause in the Philippines composition. It is impossible to predict a
person’s genotype from the phenotype, or
• The figure describes the prevalence of outward appearance.
congenital disorders by cause in the • Genome is defined as the complete set of
Philippines. This situation has been genes present in an individual.
aggravated by the small number of • A normal genome is abbreviated as 46XX or
geneticists and genetic counselors who can 46XY.
provide genetic diagnosis, management, and
counseling services to patients. The delivery COUNSELING
of medical genetic services thus remains a
• A process of communicating between two or
challenge in both private and public sectors.
more persons who meet to solve a problem,
3
resource a curse or take decision on various o Educate people about inherited

matters. disorder and the process of
• It is not a one-way process where the inheritance.
counselor tells the client what to do nor is it a o Offer support by skilled health
forum for presentation of the counselor’s professionals to people who are
values. affected by genetic disorders.
• According to Smith (1955), he defined o The role of genetic counseling is to
counseling as “a process in which the provide the genetic information. It is
counselor assists the counselee to make the genetic counselor’s skills,
interpretations of facts relating to a choice, including their ability to empathically
plan, or adjustments which he needs to connect with the patients that leads
make.” to the demands for their skills.
• The genetic counseling process follows these • 5 Clinical Geneticists in the Philippines
basic characteristics of a counseling process. o Birth Defects Surveillance Project
It is undertaken with families confronted with o Telegenetics Project
genetic and inherited disorders. o Newborn Screening Program
o Philippine Genome Center
GENETIC COUNSELING
• The genetic counseling is defined as the

process of checking the family medical STEPS IN GENETIC COUNSELING
history and other medical records, ordering
1. Diagnosis (Based on the accurate family
genetic tests, evaluating the results of these
history, medical records, examinations, and
tests and records, helping parents to
investigation)
understand and reach decisions about what
2. Risk assessment
to do next.
3. Communication
• Genetic counseling aims to provide the family
4. Discussion of Options
with complete and accurate information
5. Long-term contract and support
about genetic disorders.
o Promoting informed decisions by COMPONENTS OF GENETIC COUNSELING
involved family members.
o Clarifying the family’s option ➢ Information Gathering
available treatment and prognosis ➢ Diagnosis
o Explaining to alternatives to reduce ➢ Risk Assessment
the risk of genetic disorders. ➢ Information giving
o Decreasing the incidence of genetic ➢ Psychological Assessment and counseling
disorder ➢ Help with decision making
o Reducing the impact of genetic ➢ On-going client support
disorder
BIOETHICS
• Genetic counseling provides the following:
• Large-scale moral dilemmas that the medical
o Provide concrete, accurate
profession faces are covered by bioethics.
information about inherited
Individual ethical dilemmas that result from
disorders.
scenarios between a care provider and
o Reassure people who are concerned
patient are dealt with by nursing ethics.
that their child may inherit a particular
disorder that the disorder will not • The field bioethics field wrestles with
occur. questions such as:
o Allow people who are affected by o What is the right thing to do?
inherited diseases to make informed o What is worthwhile?
choices about future reproduction. o Who is responsible, to whom and for
what?
4
o What are our obligations to one ▪ The ethic of beneficence fits

another? this problem.
o What is the fitting response to this o Eugenics: Researchers can enhance
moral dilemma, given the context? the genetic quality of a population
o On what moral grounds are such through gene editing and selection. But
claims made? now the debate is whether scientists
ought to benefit from this. To avoid
• Bioethics concerns itself with four major disorders, a scientist could alter or delete
principles: certain genes from an embryo.
1. Respect for Autonomy ▪ But it can be a slippery slope
a. Under the assumption of agency, every when scientists are able to
patient has the right to make their own eliminate undesirable
healthcare decisions. The concept of features.
informed consent is based on this idea. ▪ The beneficence concept is
2. Nonmaleficence aligned with eugenics.
a. This rule requires that healthcare
professionals never purposefully hurt a
patient, whether accidentally or on NURSING CARE OF THE MALE AND FEMALE
purpose.
CLIENTS WITH GENERAL AND SPECIFIC
3. Beneficence
PROBLEMS IN REPRODUCTION AND
a. All medical personnel have a duty to act
SEXUALITY
in the patients' best interests and to avoid
damage.
4. Justice
GENERAL PROBLEMS
a. This idea relates to equality and
➢ INFERTILITY
fairness. In other words, the objective is
• A disease of the male or female reproductive
to attempt an equitable distribution of the
system known as infertility is characterized by
limited resources.
the inability to conceive after 12 months or
more of frequent, unprotected sexual activity.
• Below are a few bioethical issues that arise
➢ SUB INFERTILITY
in modern times.
• Couples that have the potential to conceive
o Euthanasia: A controversial
but are just less able to without additional
practice, involves taking a patient's
life to lessen their suffering. They let help.
a patient have a peaceful, honorable, ➢ SEXUAL DYSFUNCTION
or "good death" as opposed to a • FOUR CATEGORIES OF SEXUAL
slow, agonizing one. DYSFUNCTION:
▪ Two different methods of o Desire disorders: lack of interest in
euthanasia exist. The first having sex or sexual desire.
kind of euthanasia is known o Arousal disorders: the incapacity to
as active euthanasia, which get excited or aroused physically
includes actively killing a during sexual intercourse.
patient, such as by o Orgasm disorders: the delay or lack
administering a deadly of an orgasm (climax).
amount of medication. o Pain disorders: pain when having
▪ The other sort of euthanasia sex.
occurs when a medical o
professional removes a
HEALTH CONDITIONS OF THE MALE
patient's access to life-
sustaining measures like a REPRODUCTIVE SYSTEM
ventilator. BALANITIS
5
• Inflammation of the glans (head) of the penis • A urethra that doesn't fully form causes
is known as balanitis. Balanoposthitis is the epispadias, an uncommon birth abnormality
medical term for the condition if the foreskin that makes it difficult for a person to properly
is also irritated. expel urine from their body. Epispadias can
occur in both boys and girls at birth. Boys who
have it typically have an unusually bent,
small, broad penis at birth. The urethra may
not open at the tip of the penis, but instead
may open on the upper side or even the
entire length of the penis.
• Symptoms:
o Penile pain
o Swelling
o Itching
o Rash on the penis PEYRONIE’S DISEASE
o Foul-smelling discharge
• Causes: • When plaque, or scar tissue, builds up inside
o Most frequently brought on by the penis, Peyronie's disease, a penile
uncircumcised guys' inadequate disorder, results in painful, curved erections.
hygiene There are no issues with the modest curve
o Bacteria, perspiration, dead skin that many men's erect penises have.
cells, and debris can accumulate
around the glans in the penis
beneath the foreskin if it isn't
cleansed thoroughly, which can
result in inflammation.
o An uncircumcised male who has
phimosis (difficulty retracting the
foreskin) and is unable to clean
behind the foreskin runs a higher
risk of developing inflammation.
o Dermatitis and infection are some
more causes of balanitis (yeast
infection or sexually transmitted
infection).
HYPOSPADIAS
• Treatment:
o If infection is the root of the problem,
antibiotic or antifungal medicine will
be used as treatment. Circumcision
might be the best course of action for
severe or recurring balanitis.
EPISPADIAS
6
the foreskin is challenging when you have

paraphimosis. Uncircumcised boys and men
can develop both problems (have not had
their foreskin removed).
• In certain situations, boys who require

surgery to correct hypospadias—the most
common congenital penis deformity—may • The inability to put the foreskin back in its
enter adolescence with a penis that differs proper place, problems urinating and
from their friends'. ejaculating, darkening, or bruising of the
penis, and swelling of the penis are all signs
of paraphimosis. A physician should always
be consulted straight away to assess and
PENILE CANCER treat paraphimosis, which might be a medical
• Penile cancer, as it is commonly known, emergency. Treatment methods include
almost invariably starts in the skin cells of the foreskin manipulation and lubrication to
penis. Penile cancer can come in five realign it, circumcision (if other therapies are
different basic forms: squamous cell unsuccessful), and creating a small incision
carcinoma, melanoma, basal cell cancer, in the foreskin to lessen edema and/or
adenocarcinoma, and sarcoma. bulging.
PRIAPISM
PHISMOSIS AND PARAPHIMOSIS • A persistent erection that lasts more than four
hours and is not released by orgasm is
• The condition phimosis makes it challenging referred to as priapism. This disorder can
to retract the penis' foreskin. Repositioning cause painful erections that are not always
7
related to sexual activity. Medication, alcohol enlargement of the veins within the loose bag
and drug misuse (particularly cocaine and of skin that holds the testicles (scrotum).
marijuana), spinal cord issues, and specific • A varicocele typically develops on the left side
blood illnesses are among the common of the scrotum and frequently shows no
reasons. The medical emergency of symptoms at all.
priapism. You should visit an emergency • Potential Symptoms:
department for care if your erection has o Pain – Standing or late in the day are
persisted longer than four hours. Blood is more likely to have a dull, agonizing
typically removed from the penis as part of pain or discomfort. Pain is frequently
treatment. There may also be a need for relieved by lying down.
blood vessel-shrinkage medications. Seldom o A mass in the scrotum – A lump
will surgery be required to resolve the issue resembling a "bag of worms" may be
and avoid doing long-term harm to the penis. discernible above the testicle if a
varicocele is sufficiently large. A tiny
varicocele cannot be seen but may
VARICOCELE be detectable by touch.
o Differently sized testicles – The
• A persistent erection that lasts more than four testicle that is afflicted could be
hours and is not released by orgasm is visibly smaller than the other testicle.
referred to as priapism. This disorder can o Infertility – While some varicoceles
cause painful erections that are not always can make it difficult to become a
related to sexual activity. parent, not all of them do.
• Medication, alcohol, and drug misuse • How is Varicocele Diagnosed?
(particularly cocaine and marijuana), spinal o Physical exam
cord issues, and specific blood illnesses are ▪ Your doctor will probably
among the common reasons. The medical check your testicles while
emergency of priapism. You should visit an you are standing up and
emergency department for care if your lying down because a
erection has persisted longer than four hours. varicocele can't always be
Blood is typically removed from the penis as felt or seen when you're lying
part of treatment. There may also be a need down.
for blood vessel-shrinkage medications. o Valsalva maneuver
Seldom will surgery be required to resolve the ▪ Smaller varicoceles are
issue and avoid doing long-term harm to the frequently diagnosed with
penis. this method. You normally
have to stand up, take a big
breath, hold it, and bear
down while the doctor
examines your scrotum in
order to perform the Valsalva
technique.
o Scrotal ultrasound
▪ A scrotal ultrasonography
could be required in several
circumstances. This enables
your doctor to obtain a
thorough, precise picture of
• A varicocele is an enlargement of the veins the situation and helps
that transport oxygen-depleted blood away quantify the spermatic veins.
from the testicle. A varicocele is an • Treatment
8
o You may occasionally find that typically removed from the penis as part of
support from tight underwear or treatment. There may also be a need for
a jockstrap helps to relieve pain blood vessel-shrinkage medications. Seldom
or discomfort. If your symptoms will surgery be required to resolve the issue
worsen, further therapy such as and avoid doing long-term harm to the penis.
varicocelectomy and varicocele
embolization can be required.
o Varicocelectomy
▪ A varicocelectomy is an
in-patient procedure
done on the same day.
Your pelvis or abdomen
will be used by a
urologist to clamp or tie
off the aberrant veins.
After that, blood can
pass through the
aberrant veins and into
the healthy ones. Ask • The epididymis, a coil-like tube near the back
your doctor for advice on of the testicle, can become inflamed, which is
how to be ready for the known as epididymitis. Sperm are carried and
procedure and what to stored in the epididymis. Any age male can
expect afterwards. develop epididymitis.
o Varicocele embolization • The most frequent cause of epididymitis is a
▪ The same-day bacterial infection, which includes STIs like
varicocele embolization gonorrhea and chlamydia. A testicle can
technique is less occasionally become inflamed as well; this
invasive. A tiny catheter condition is known as epididymo-orchitis.
is placed into a vein in • Antibiotics and painkillers are frequently used
the neck or groin. The to treat epididymitis.
varicocele and catheter • Symptoms:
are both then filled with a o a scrotum that is bloated, discolored,
coil. This prevents blood or heated.
from reaching the o Testicular discomfort and
unusual veins. tenderness, typically on one side,
that frequently develops gradually
o When you urinate, it hurts
EPIDIDYMITIS o a sudden or ongoing urge to urinate
o Discharge of the penis
• A persistent erection that lasts more than four o Lower abdominal or pelvic pain or
hours and is not released by orgasm is discomfort
referred to as priapism. This disorder can o A blemish in the sperm
cause painful erections that are not always o Occasionally, fever
related to sexual activity. Medication, alcohol • How is epididymis diagnosed?
and drug misuse (particularly cocaine and o Your doctor will inspect your scrotum
marijuana), spinal cord issues, and specific to look for a tender spot or lump in
blood illnesses are among the common order to determine whether you have
reasons. The medical emergency of epididymitis.
priapism. You should visit an emergency o To check for bacteria in your pee,
department for care if your erection has they could also request a urinalysis
persisted longer than four hours. Blood is (urine test). Ultrasound technology
9
may be utilized to acquire diagnostic o Abnormal Testicular Lie (Often

pictures of your scrotum in some Horizontal)
situations of epididymitis. o Rotation, so that epididymis is not in
• Treatment: normal posterior position
o Antibiotics are used in the treatment
BELL-CLAPPER DEFORMITY
of epididymitis. Doxycycline,
ciprofloxacin, levofloxacin, or • A bell-clapper deformity is one of the causes
trimethoprim-sulfamethoxazole are of testicular torsion.
among the most popular drugs. • Normally, the testicle is fixed posteriorly to
Treatment with antibiotics typically the tunica vaginalis. A bell-clapper
lasts one to two weeks. deformity is where the fixation between the
• Discomfort can be lessened by: testicle and the tunica vaginalis is absent.
o Resting. The testicle hangs in a horizontal position
o Their scrotum being raised. (like a bell-clapper) instead of the typical
o Using cold packs to treat the injured more vertical position. It is also able to rotate
region. within the tunica vaginalis, twisting at the
o Consuming fluids. spermatic cord. As it rotates, it twists the
o Taking NSAIDs (non-steroidal anti- vessels and cuts off the blood supply.
inflammatory medicines) to treat the • Testicular torsion is a urological emergency,
pain. and there is an urgent requirement for
treatment. Any delay in treatment will prolong
TESTICULAR TORSION
the ischaemia and reduce the chances of
saving the testicle.
• Refers to twisting of the spermatic cord with • Management:
rotation of the testicles. It is a urological o Nil by mouth, in preparation for surgery
o Analgesia as required
emergency, and a delay in treatment
o Urgent senior urology assessment
increases the risk of ischaemia and necrosis o Surgical exploration of the scrotum
of the testicle, leading to sub-fertility or o Orchiopexy (Correcting the position of the
infertility. testicles and fixing them in place)
o Orchidectomy (Removing the testicle) if the
• Who are at risk:
surgery is delayed or there necrosis
o The typical patients are teenage • A scrotal ultrasound can confirm the diagnosis.
boys, but it can occur at any age. However, any investigation that will delay the patient
o “There may be a history of recurrent going to the theater for treatment is not recommended.
Ultrasound can show the whirlpool sign, a spiral
symptoms in patients where there is
appearance to the spermatic cord and blood vessels.
intermittent testicular torsion”.
• Examination: GYNECOMASTIA
o Testicular torsion is often triggered by
activity, such as playing sports. Ask • Gynecomastia is the enlargement of the
what the patient was doing at the breast tissues in boys or men. It is due to the
time when the pain started. imbalance of estrogenic and androgenic
o It presents with an acute rapid onset hormones on glandular breast tissue.
of unilateral testicular pain and may • It can affect one or both breasts, and the way
be associated with abdominal pain of enlargement may be equal in both or may
and vomiting. Sometimes abdominal be uneven. It is not usually harmful or
pain is the only symptom in boys, and serious, but it can be tough to cope with the
testicular examination to exclude condition. In some cases, it can result in sore
torsion is essential. breast tissue or pain, swelling and nipple
• Examination findings: discharge in one or both nipples. Seek
o Firm Swollen Testicles immediate medical care if you experience
o Elevated (Retracted) Testicles this. Men and boys may feel embarrassed,
o Absent Cremasteric Reflex
10
and this may cause psychological and o Some Antibiotics (Isoniazid,

emotional problems. Metronidazole or Flagyl)
• Common during: o Anti-Ulcer drugs (Cimetidine or
o Infancy Tagamet HB)
o Puberty o Heart Medication (Digoxin or
o Middle-aged to Older men Lanoxin)
• Who does it affect? o Calcium Channel Blocker for
o It affects about 1 in 4 men between Treating Heart Attack
ages 50-69 o Tricyclic Antidepressant
o It’s a common condition, with a (Amitriptyline)
reported prevalence of 36% in men o Anti-Anxiety Medications
between the ages of 17-58. (Diazepam)
• Causes: • Health Conditions that can cause
o Gynecomastia is triggered by an Gynecomastia:
imbalance of the hormone’s estrogen o Tumors (those affecting the Testes,
and testosterone. Adrenal Glands, Pituitary Gland)
o The male body produces both o Kidney Failure
estrogen and testosterone, although o Malnutrition and Starvation
estrogen is normally found in small o Liver Failure and Cirrhosis
quantities. The hormone o Hyperthyroidism
testosterone and estrogen are • Symptoms:
responsible for the development of o Breast Tenderness
sex characteristics in both men and o Swollen Breast gland Tissue
women. • Diagnosis:
o Testosterone controls: o To diagnose gynecomastia, a careful
▪ Muscle Mass medical history including your drug
▪ Body Hair use, medical and family history may
▪ Affects a man’s sex drive be important. In most cases
and mood diagnosis is made by a physical
o Estrogen controls (female trait): examination that may include careful
▪ Breast development assessment of your breast tissue,
• “Larger breasts may develop in a man if the abdomen and genital.
levels of testosterone are especially low in o Initial tests that may be
comparison to estrogen”. recommended:
o This decrease may be caused by ▪ Blood Test (To examine the
natural hormone changes, Liver, Kidney and Thyroid
medications or conditions that function)
reduce testosterone level or increase ▪ Mammogram (May be
estrogen level. ordered if Cancer is
o Natural hormones changes as seen suspected)
in infants, puberty and aging men ▪ CT scans, MRI scans,
• Medications that can cause Tissue Biopsies and
Gynecomastia: Testicular Ultrasound (For
o Drug Abuse (Amphetamines, further testing may be
Marijuana, Heroin and Methadone) required depending on the
o Cancer Chemotherapy initial test result)
o Anti-Androgen (Flutamide, • Treatment:
Finasteride {used in treating prostate o Most cases of the condition
cancer and some other conditions}) especially in pubertal males
o Herbals (lavender and Tea Tree Oil) relapse over time with no
treatment.
11
o If your condition is caused by an

underlying medical condition
such as malnutrition or cirrhosis, • Auscultation
such a condition may need o refers to the use of a stethoscope to
treatment. listen to the sounds from the
o Your doctor may recommend abdomen. It aids in the assessment
stopping or substituting any of abdominal sound and abdominal
medication you are taking if that bruits. Grumbling bowel sounds or
is the cause of your condition. high-pitched noises may indicate a
o Breast Cancer medication bowel obstruction.
(Aromatase Inhibitors o Diarrhea is associated with
{Arimidex}, Tamoxifen increased bowel sounds. If bowel
{Soltamox}) sound is absent, it may indicate
o Surgery paralytic ileus or peritonitis.
▪ Liposuction (Removing • Palpation
the breast fats and not o typically performed twice, Lightly
the breast gland tissue) and Deeply
▪ Mastectomy (The breast o Light palpation
gland tissue is removed) ▪ The examiner tests for
palpable mass, pain or
o For coping and support rigidity. Rigidity may
(Counseling, talk to your friends, indicate peritoneal
family or people that has the inflammation.
same condition) o Deep palpation
▪ The examiner tests for
HEALTH CONDITIONS OF THE FEMALE enlargement of liver,
REPRODUCTIVE SYSTEM spleen, gallbladder, or
kidneys.
o Note: During palpation, it is
GYNECOLOGIC EXAMINATION important for the examiner to be
aware of the response of the
• Refers to the examination of a woman’s
patient’s abdominal muscles
reproductive system. This includes
including watching their face for
examination of the abdomen and pelvic
signs of discomfort.
organs. However many gynecologic
problems have symptoms that involve other • Percussion
organ systems. The gynecologist should be o can be very useful in
ready to perform a general physical revealing whether there’s
examination. abdominal levels of fluid in
• Abdominal Examination: the abdomen.
o Auscultation o If an abdominal pelvic mass
o Palpation is discovered after a
o Percussion suprapubic examination, it is
• The examiner will note: generally essential to note
o Abdominal Swelling the:
o Bruising ▪ Characteristics
o Scars ▪ Size
o Stoma ▪ Consistency (hard if
o Herniae fibroid or soft if it’s
o Any other visible external sign in the pregnancy)
abdomen ▪ Regularity
12
▪ The presence of any • “Any vaginal discharge present is assessed

tenderness for normalcy in color, consistency and odor”.
PELVIC EXAMINATION SPECULUM EXAM
• It is an inspection of the external and internal • A small spatula is inserted into the cervix and
genital areas and an assessment of the a sample of cervical cells is removed and
health of the reproductive system and sent to the lab for analysis to see if there are
organs. any abnormal cells which could indicate
cancerous or precancerous changes.
➢ The external genitalia is first inspected for
normalcy of appearance and hair distribution. BIMANUAL EXAMINATION
➢ The pubic hair is inspected for pubic lice and
the pattern of hair growth. • Is carried out after the speculum has been
➢ The labia majora is examined for ulcers, removed. “The uterus is evaluated and its
inflammation, warts, and rashes. Their size, mobility and position is noted”. It is
position and symmetry are evaluated. abnormal for the examiner to feel the
➢ The labia minora are also inspected and fallopian tube.
presence of tearing, inflammation and • The rectum is also checked and should be
swelling is noted. smooth.
➢ The opening of the uterus is also checked. No • Any developmental abnormalities discovered
urine is expected to leak when patients will be discussed.
cough. Leaking may indicate stress or MENSTRUAL DISORDERS
weakened pelvic structure.
➢ The vaginal opening is checked for: • Is an umbrella term used to describe
✓ Position abnormal conditions that occur within a
✓ Presence of hymen woman’s menstrual Cycle.
✓ Bruising • Normal menses
✓ Tearing o Menstruation is dependent on
✓ Inflammation ovulation, estrogen, progesterone.
o Average age of menarche is 12.7
• “If sexual abuse is suspected, questions years.
should be directed to the patient AFTER and o ⅔ of girls experience menarche in
not during the examination”. genital tanner stage IV
• The anus is checked for lesions, o Normal menstrual cycles are
inflammation, or trauma. between 21 and 35 days in length.
• A speculum exam is used to assess the • Menstrual Cycle Terminology
health of the vagina. It is inserted to visualize o Oligomenorrhea
the internal organs. ▪ Menstrual interval > 35 days
• Note: If it is the first pelvic exam of the < 9 menses per year
patient, the examiner will show the patient the o Polymenorrhea
speculum, explain its use and answer any ▪ Menstrual intervals that
questions. occur < 21 days (period
o The cervix is inspected for lesion, comes too frequently)
polyps, and inflammation. o Menorrhagia
• Samples of the vaginal fluids may be taken to ▪ Regular but excessive
check acidity of the vagina and screen for the menstrual flow > 80 ml > 7
sexually transmitted infections and other days (you have too much
types of infections. flow)
o Metrorrhagia
13
▪Irregular bleeding between • Physical Exam in Primary Amenorrhea

menses o Assess Tanner Stage
o Amenorrhea ▪ Growth Parameter
▪ No menses (either primary • Low BMI can delay
or secondary) onset of menses.
• Short stature
AMENORRHEA
(genetic or
• Is the absence of menstruation, often defined endocrine disorder)
as missing one or more menstrual periods. o Endocrinopathy or genetic disease
• The 2 Kinds of Amenorrhea: ▪ Genital exam
o Primary Amenorrhea ▪ Hymenal opening
▪ No menarche by age 14 in obstructed by thin
absence of pubertal membrane
development ▪ Enlarged clitoris:
▪ No menarche by age 16 excess androgens
regardless of pubertal ▪ Tanner stage
development ▪ Vaginal exam
• Etiologies of Primary Amenorrhea • Diagnosis for Primary Amenorrhea
• Causes:
o Genetic Signs Causes
o Endocrine
o Nutritional Absent breast Inadequate estrogen
development production
o Anatomic Defects
• The ovaries are not producing sufficient Absence of uterus Abnormal Mullerian
estrogen to proliferate uterine lining or induce development or XY
ovulation. karyotype
• 2 Major Causes:
o Hypogonadotropic hypogonadism Presence of uterus & Obstruction of menstrual
▪ An inadequate release of breasts flow or HPO axis problems
gonadotropins (LH, FSH) • Laboratory Testing
from the pituitary. o Pregnancy test
o Hypergonadotropic hypogonadism o Hormone levels
▪ An inadequate ovarian ▪ Androgens
response to gonadotropins. ▪ Thyroid function
• Anatomic Problem with Reproductive ▪ Proactin
Tract o Karyotype
o Absent Uterus ▪ If absence of uterus on exam
o Genital Outlet Obstruction (Imperfect ▪ No signs of puberty by 14
Hymen) • Radiology Findings
• Signs & Symptoms of Primary o Pelvic ultrasound to evaluate
Amenorrhea anatomy.
o Other signs of pubertal progression o MRI of head/pituitary if elevated
o Age of menarche in mother, sisters prolactin level or abnormal
o Menstrual, gynecologic, pubertal neurologic findings
problems in family • Treatment of Primary Amenorrhea
o Sexual activity o Hypergonadotropic/hypogonadotropi
o Abdominal pain or cramping c hypogonadism: Estrogen &
o Diet and exercise habits Progesterone Therapy
o Underlying hormonal problems o Imperforate hymen: Surgical
Correction
14
o Endocrinology consults if needed o Late-onset congenital adrenal

o Diet and exercise regimen if hyperplasia
suspected hypothalamic o Virilizing tumor
dysregulation due to malnutrition or • Laboratory Testing
excessive exercise. o Pregnancy test
o Ultrasound for undescended testes if o Thyroid Stimulating hormone, free T4
androgen insensitivity syndrome (thyroxine)
o Prolactin
o Free and total testosterone
SECONDARY AMENORRHEA
o LH and FSH
• Absence of menses for > 6 months in o Insulin level (elevated in PCOS)
previously menstruating female • Radiology Findings
• Pubertal development o Pelvic ultrasound: Most useful to
• Anovulatory cycles in young adolescents evaluate reproductive anatomy
• Disruption in HPO axis o Obtain MRI of head/pituitary if
o Inadequate GnRH release elevated prolactin
o Dual-energy X-ray absorptiometry
o Inadequate LH, FSH release
o Insufficient estrogen to stimulate LH (DEXA) scan
surge and ovulation • Progesterone Challenge Test
o Administer oral
• Signs and Symptoms of Secondary
Amenorrhea medroxyprogesterone acetate for 5-
o Sexual activity 10 days
o Look for withdrawal bleed after
o Eating behaviors
o Competitive athlete/excessive medroxyprogesterone cessation.
exercise ▪ A positive response:
o History of chemotherapy or pelvic • Any bleeding more
radiation than light spotting
o Family history of menstrual or that occurs within 2
gynecologic problems weeks after the
o Psychotropic medications or illicit progestin is given
drugs • Will usually occur 2-
o Underlying hormonal problems 7 days after the
• Physical Exam in Secondary Amenorrhea progestin is finished.
o Assess Tanner Stage (Know where • How to interpret this test?
they are in their pubertal o Bleeding
development) ▪ Endometrium has been
o Weight, height, BMI primed by estrogen.
o Genital exam ▪ Patient likely has
▪ Clitoromegaly: excessive anovulation.
androgens (testosterone) ▪ Consider polycystic ovarian
▪ Bimanual exam: assess syndrome.
uterus, ovaries. o No Bleeding
o Skin exam for hirsutism, acne, striae, ▪ Evaluate for hypothalamic
acanthosis nigricans pituitary insufficiency
o Endocrinopathy ▪ Consider outflow tract
• Diagnosis for Secondary Amenorrhea obstruction
o Prolactinoma • Treatment of Secondary Amenorrhea
o Hyperthyroidism o Nutrition counseling
o Hypothyroidism o Endocrinology referral vs.
o Polycystic ovarian syndrome gynecology referral
15
o Psychological interview for eating o Associated with underlying pelvic

disorders, psychosocial stressor abnormality (10%)
o Consider OCP therapy • Etiologies of Secondary Dysmenorrhea
• Treating PCOS Management: • Pathology
o Endometriosis
OCP o Congenital Mullerian anomaly
o Pelvic inflammatory disease
(estrogen + progesterone) o Adhesions from prior surgery
o Ectopic pregnancy
• Restores regular menses. o Ovarian cyst
• Decreases testosterone. o Ovarian torsion
• Protects against endometrial o Uterine fibroids
hyperplasia. o Presence of an inserted uterine
• Drospirenone as progestin device (IUD)
component (antiandrogen properties)
• Diagnosis for Dysmenorrhea
o Take a good history
o Important Historical Findings
Insulin-Sensitizing Agents
(Interview the adolescent alone)
o Few questions to be ask:
(metformin) ▪ Pain timing?
▪ Description of pain?
Cramping?
• Decrease circulating androgens. ▪ Symptoms present since
• Improve reproductive function menarche?
• Improve metabolic complication; ▪ Do NSAIDS provide relief?
helps with weight loss (Common in primary
dysmenorrhea)
▪ Previous abdominal or pelvic
surgeries?
▪ Sexual
DYSMENORRHEA activity/contraception?
▪ Associated symptoms?
• Pain associated with menstruation/ Painful
o Do a physical exam
menstruation. The most common
o Physical Exam Findings (Clinical
gynecologic complaint among female
presentation)
adolescents.
o Abdominal Exam
2 Kinds of Dysmenorrhea ▪ Mild suprapubic tenderness
▪ Rebound tenderness
• PRIMARY DYSMENORRHEA concerning for secondary
o Clear physiologic etiology causes
o No identifiable pelvic pathology (90% o Pelvic Exam
cases where it just hurts) ▪ Inspect external genitalia
• Etiologies of Primary Dysmenorrhea ▪ Bimanual exam- identify
• Pathology Pelvic inflammatory disease
o Release of prostaglandins from (PID), ovarian mass or cyst,
endometrium after progesterone uterine malformation, fibroid
withdrawal ▪ Rectovaginal exam to
o Potent vasoconstriction & uterine evaluate endometriosis
contraction o Diagnostic testing
o Ischemia & pain o Diagnostic Workup
• SECONDARY DYSMENORRHEA o Laboratory data (rule out causes)
16
▪ Pregnancy test out into the pelvis and peritoneum. This is

▪ Gonorrhea and chlamydia called retrograde menstruation. The
test endometrial tissue then seeds itself around
▪ Non gynecologic pain: Urine the pelvis and peritoneal cavity.
culture, stool, ESR, CRP • Other possible methods for endometrial
o Radiologic imaging tissue exiting the uterus have been proposed:
o Pelvic ultrasound o Embryonic cells destined to become
o Laparoscopy endometrial tissue may remain in
▪ Diagnosis of endometriosis areas outside the uterus during the
• Treatment of Dysmenorrhea development of the fetus, and later
o Target Endometrial Prostaglandins develop into ectopic endometrial
o How to treat Endometrial Pain: tissue.
▪ NSAIDS o There may be spread of endometrial
▪ Oral contraceptives cells through the lymphatic system,
▪ Injected prostaglandin in a similar way to the spread of
therapy cancer.
▪ Heat, acupuncture (limited o Cells outside the uterus somehow
data) change, in a process called
• Treatment for Patients with Underlying metaplasia, from typical cells of that
Pelvic Pathology May Require: organ into endometrial cells.
• Surgical intervention
Pathophysiology of the Symptoms
o Antibiotics to manage PID
o Oral contraceptive pills (OCPs) to • The main symptom of endometriosis is pelvic
manage endometriosis pain. The cells of the endometrial tissue
o Gonadotropin releasing hormone outside the uterus respond to hormones in
(GnRH) agonists to manage the same way as endometrial tissue in the
endometriosis uterus. During menstruation, as the
endometrial tissue in the uterus sheds its
lining and bleeds, the same thing happens in
ENDOMETRIOSIS the endometrial tissue elsewhere in the body.
This causes irritation and inflammation of the
tissues around the sites of endometriosis.
• A condition where there is ectopic This results in the cyclical, dull, heavy or
endometrial tissue outside the uterus. A lump burning pain that occurs during menstruation
of endometrial tissue outside the uterus is in patients with endometriosis.
described as an endometrioma. • Deposits of endometriosis in the bladder or
Endometriomas in the ovaries are often bowel can lead to blood in the urine or stools.
called “chocolate cysts”. Adenomyosis refers • Localised bleeding and inflammation can
to endometrial tissue within the myometrium lead to adhesions. Inflammation causes
(muscle layer) of the uterus. damage and development of scar tissue that
• The exact cause of endometriosis is not clear, binds the organs together. For example, the
but there are several theories. No specific ovaries may be fixed to the peritoneum, or the
genes have been found to cause uterus may be fixed to the bowel. Adhesions
endometriosis; however, there does seem to can also occur after abdominal surgery.
be a genetic component to developing the Adhesions lead to a chronic, non-cyclical pain
condition. that can be sharp, stabbing or pulling and
• One notable theory for the cause of ectopic associated with nausea.
endometrial tissue is that during • Endometriosis can lead to reduced fertility.
menstruation, the endometrial lining flows Often it is not clear why women with
backwards, through the fallopian tubes and endometriosis struggle to get pregnant. It
may be due to adhesions around the ovaries
17
and fallopian tubes, blocking the release of endometriosis. It is worth being aware of this
eggs or kinking the fallopian tubes and staging system; however, it is not mentioned
obstructing the route to the uterus. in the NICE guidelines, and does not
Endometriomas in the ovaries may also necessarily predict the symptoms or the
damage eggs or prevent effective ovulation. difficulty in managing the condition. NICE
recommend documenting a detailed
Presentation description of the endometriosis rather than
• Endometriosis can be asymptomatic in some using a specific staging system. The ASRM
cases, or present with a number of staging system grades from least to most
symptoms: severe:
o Cyclical abdominal or pelvic pain ➢ Stage 1: Small superficial lesions
o Deep dyspareunia (pain on deep ➢ Stage 2: Mild, but deeper lesions
sexual intercourse) than stage 1
o Dysmenorrhea (painful periods) ➢ Stage 3: Deeper lesions, with lesions
o Infertility on the ovaries and mild adhesions
o Cyclical bleeding from other sites, ➢ Stage 4: Deep and large lesions
such as hematuria affecting the ovaries with extensive
• There can also be cyclical symptoms relating adhesions.
to other areas affected by the endometriosis: Management
o Urinary symptoms
o Bowel symptoms • Helpful guidelines for the management of
• Examination may reveal: endometriosis are the RCOG Green-top
o Endometrial tissue visible in the guideline 41 on chronic pelvic pain (2012),
vagina on speculum examination, the ESHRE guidelines on endometriosis
particularly in the posterior fornix (2013) and the NICE clinical knowledge
o A fixed cervix on bimanual summaries (2020).
examination • Initial management involves:
o Tenderness in the vagina, cervix and o Establishing a diagnosis
adnexa o Providing a clear explanation
o Listening to the patient, establishing
Diagnosis their ideas, concerns and
expectations and building a
• Pelvic ultrasound may reveal large
endometriomas and chocolate cysts. partnership
Ultrasound scans are often unremarkable in o Analgesia as required for pain
patients with endometriosis. Patients with (NSAIDs and paracetamol first line)
suspected endometriosis need referral to a • Hormonal management options can be tried
gynecologist for laparoscopy. before establishing a definitive diagnosis with
• Laparoscopic surgery is the gold standard laparoscopy:
way to diagnose abdominal and pelvic o Combined oral contractive pill, which
can be used back-to-back without a
endometriosis. A definitive diagnosis can be
established with a biopsy of the lesions pill-free period if helpful
during laparoscopy. Laparoscopy has the o Progesterone only pill
added benefit of allowing the surgeon to o Medroxyprogesterone acetate
remove deposits of endometriosis and injection (e.g., Depo-Provera)
o Nexplanon implant
potentially improve symptoms.
o Mirena coil
o GnRH agonists
Staging • Surgical management options:
o Laparoscopic surgery to excise or
• The American Society of Reproductive ablate the endometrial tissue and
Medicine (ASRM) has a staging system for remove adhesions (adhesiolysis)
18
o Hysterectomy • It describes the physical and emotional

o Laparoscopic treatment may symptoms that a woman may experience one
improve fertility. Hormonal therapies to two weeks before her menstrual cycle. It is
may improve symptoms but not a very common condition and it is estimated
fertility. that as many as 3 of every 4 menstruating
women, have experienced some form of
Explanation of Treatment Options
premenstrual syndrome. Symptoms often
• Cyclical pain can be treated with hormonal vary between women and resolve around the
medications that stop ovulation and reduce start of bleeding.
endometrial thickening. This can be achieved • “A more severe form of PMS that has greater
using the combined oral contraceptive pill, psychological symptoms is the premenstrual
oral progesterone-only pill, the progestin dysphoric disorder (PMDD)”.
depot injection, the progestin implant • PMDD affects 3-8 percent of premenopausal
(Nexplanon) and the Mirena coil. women.
• The cyclical pain tends to improve after the • The physical and emotional changes
menopause when the female sex hormones experienced in PMS may vary from just
are reduced. Therefore, another treatment slightly noticeable all the way to intense. PMS
option for endometriosis is to induce a occurs more in women in their late 20’s and
menopause-like state using GnRH agonists. early 40’s.
Examples of GnRH agonists are goserelin • Causes:
(Zoladex) or leuprorelin (Prostap). They shut o The exact cause of premenstrual
down the ovaries temporarily and can be syndrome is unknown, but several
useful in treating pain in many women. factors may contribute to the
However, inducing the menopause has condition:
several side effects, such as hot flushes, ▪ Changes in hormones
night sweats and a risk of osteoporosis. during the menstrual cycle
• Laparoscopic surgery can be used to excise seem to be an important
or ablate the ectopic endometrial tissue. In factor.
women where there is chronic pelvic pain due ▪ Levels of estrogen and
to adhesions, surgery can be used to dissect progesterone increase
the adhesions and attempt to return the during certain times of the
anatomy to normal. month. An increase in these
• Hysterectomy and bilateral salpingo- hormones can cause mood
oophorectomy is the final surgical option. swings, anxiety and
During the procedure, the surgeon will irritability.
attempt to remove as much of the ▪ Serotonin levels affect
endometriosis as possible. Importantly, this is mood, it is a brain chemical
still not guaranteed to resolve symptoms. that is thought to play a
Removing the ovaries induces menopause, crucial role in moods,
and this stops ectopic endometrial tissue emotions and thoughts.
responding to the menstrual cycle.
• Infertility secondary to endometriosis can be • “Fluctuations of serotonin could trigger PMS
treated with surgery. The aim is to remove as symptoms”. Stress and emotional problems
much of the endometriosis as possible, treat such as depression, do not cause the
adhesions and return the anatomy to normal. condition but may make the symptoms
This improves fertility in some but not all worse.
women with endometriosis. • Factors that may increase your chance of
having PMS are:
o Family history
o Family history of depression
PREMENSTRUAL SYNDROME
19
o Have a past medical history of either • Certain conditions may mimic PMS
postpartum depression or a mood including:
disorder. o Chronic Fatigue Syndrome
o Having at least 1 child o Thyroid Disorders
• Signs & Symptoms o Pregnancy
o Emotional Symptoms may Include: o The doctor may order a thyroid
▪ Change in interest in sex hormone test, a pregnancy test and
▪ Poor Concentration possibly a pelvic exam to check for
▪ Crying Spells any gynecological problems.
▪ Mood Swings and Irritability • Treatment
or Anger • lifestyle changes may be enough to relieve
▪ Appetite Changes and Food symptoms in certain women. But depending
Cravings on the severity, your doctor may prescribe
▪ Insomnia one or more medications. Such as:
▪ Depressed Mood o Antidepressants (Selective
▪ Tension or Anxiety Serotonin Reuptake Inhibitors
▪ Social Withdrawal {SSRIs} Fluoxetine, Paroxetine and
o Physical Symptoms may Include: Sertraline) have been successful in
▪ Headache reducing mood symptoms.
▪ Fatigue o NSAIDs (Ibuprofen or Naproxen) can
▪ Joint or Muscle Pain ease cramping.
▪ Breast tenderness or o Hormonal Contraceptives (to stop
Swelling ovulation and bring relief from PMS
▪ Acne Flare-ups symptoms)
▪ Alcohol Intolerance • Lifestyle Changes may Include:
▪ Lower back pain o Drinking plenty of fluids
▪ Constipation o Eating a balanced diet
▪ Bloating o Taking Supplements (Folic Acid,
• The exact symptoms and its severity vary Vitamin B-6, Calcium and
from woman to woman. Most women with Magnesium)
PMS only experience a few of the possible o Sleeping at least 8 hours per night to
symptoms, in a relatively predictable pattern. reduce fatigue.
You should see your doctor if the symptoms o Exercising
start to affect your daily life, or if the
symptoms don’t go away.
• Diagnosis ABNORMAL UTERINE BLEEDING (AUB)
• No unique physical finding or lab tests exist • Abnormal uterine bleeding (AUB) is any form
to physically diagnose PMS. Your doctor may of uterine bleeding that is irregular in amount,
have you keep a diary (Maya Example) of duration, or timing and is not related to
your symptoms or use a calendar to record regular menstrual bleeding. Although often
your symptoms for at least two menstrual used interchangeably, the terms AUB and
cycles to help establish a premenstrual dysfunctional uterine bleeding (DUB) are not
pattern. You will be expected to note the day synonymous. DUB is any abnormal uterine
that you first notice PMS symptoms and the bleeding that does not have a pathogenic
day they disappear. Also, the days your cause.
period starts and ends. You may also ask for
any family history of depression or mood
disorder. This may help in determining
whether your symptoms are that of PMS or
another condition.
20
• For mild cases, give iron supplements and

ask the adolescent to keep a diary to monitor
menstrual patterns. The most effective
medical treatment of acute bleeding episodes
is administration of combined oral
contraceptives (estrogen and progestin). For
mild bleeding, start with twice-daily dosing of
the contraceptives, but adolescents with
moderate bleeding should start with 3 to 4
doses per day and taper over 2 weeks.
Adolescents with severe bleeding may
require intravenous estrogen along with a
combined oral contraceptive. The oral
• AUB can be anovulatory or ovulatory but is contraceptive is given for at least 3 to 6
most commonly caused by anovulation. months after the acute phase has passed.
When no surge of LH occurs or if insufficient Such long-term treatment will help prevent
progesterone is produced by the corpus recurrence of the pattern of AUB and
luteum to support the endometrium, it will hemorrhage. If the woman wants
begin to involute and shed. This process contraception, she should continue to take
most often occurs at the extremes of a OCPs. If she has no need for contraception,
woman’s reproductive years, when the the treatment may be stopped to assess the
menstrual cycle is just becoming established woman’s bleeding pattern.
at menarche or when it draws to a close at
menopause. AUB also occurs with any Nursing Care Management
condition that gives rise to chronic
• Nursing assessments for adolescents or
anovulation associated with continuous
young women who have a menstrual disorder
estrogen production. Such conditions include
include the following:
obesity, hyperthyroidism and hypothyroidism,
o Taking a thorough menstrual,
polycystic ovarian syndrome, and any of the
obstetric, sexual, and contraceptive
endocrine conditions discussed in the
history
sections on amenorrhea. A diagnosis of AUB
o Exploring the adolescent’s
is made only after ruling out all other causes
perceptions of her condition, cultural
of abnormal menstrual bleeding.
or ethnic influences, lifestyle, and
Possible causes of Abnormal uterine bleeding patterns of coping
(AUB) o Evaluating the amount of pain or
bleeding experienced and its effect
• Pregnancy-Related Conditions on daily activities
o Threatened or spontaneous o Noting any home remedies and
miscarriage prescriptions to relieve discomfort; a
o Retained products of conception symptom diary, in which the
after elective abortion adolescent records emotions,
o Ectopic pregnancy behaviors, physical symptoms, diet,
o Placenta previa/placenta abruption and exercise and rest patterns, is a
o Trophoblastic disease useful diagnostic tool.
• Lower Reproductive Tract Infections • Expected outcomes for the adolescent are
o Cervicitis that she will do the following:
o Endometritis o Verbalize her understanding of
o Myometritis reproductive anatomy, cause of her
o Salpingitis disorder, medication regimen, and
diary use
Therapeutic Management
21
o Verbalize her understanding and

accept her emotional and physical
responses to her menstrual cycle
o Develop personal goals that benefit
her emotionally and physically
o Choose appropriate therapeutic
measures for her menstrual
problems
o Adapt successfully to the condition if
cure is not possible
• In addition to the medical, surgical, and
• Normal vaginal secretions (or physiologic
nursing interventions discussed with each
leukorrhea) are clear to cloudy in
problem, additional nursing interventions
appearance, nonirritating, and have a mild,
may include the following:
inoffensive odor. The discharge may turn
o Accepting the woman’s symptoms as
yellow after drying. Normal vaginal secretions
valid
are acidic, with a pH range of 4.0 to 5.0. The
o Correlating data from the daily diary
amount of leukorrhea differs with phases of
of emotional status, subjective
the menstrual cycle, with greater amounts
feelings, and physical state with
occurring at ovulation and just before
physiologic changes
menses. Leukorrhea is also increased during
o Encouraging the woman to express
pregnancy.
her feelings about her symptoms
o Providing information about • Normal vaginal secretions contain lactobacilli
therapeutic options (pharmacologic and epithelial cells. Vaginitis, or abnormal
and nonpharmacologic) so the vaginal discharge, is an infection caused by a
woman or she and her partner can microorganism. The most common vaginal
make choices considered best for infections are bacterial vaginosis (BV),
them candidiasis, and trichomoniasis.
o Providing information about local a. Bacterial Vaginosis (BV)
support groups
• Care has been effective when the woman • Bacterial vaginosis is a type of vaginal
reports improvement in the quality of her life, inflammation caused by the overgrowth of
skill in self-management, and a positive self- bacteria naturally found in the vagina, which
concept and body image. upsets the natural balance. Women in their
reproductive years are most likely to get
bacterial vaginosis, but it can affect women of
VAGINAL INFECTIONS any age. The cause isn't completely
understood, but certain activities, such as
• Vaginal discharge and itching of the vulva unprotected sex or frequent douching,
and vagina are among the most common increase your risk.
reasons a woman seeks help from a health
care provider. More women complain of
vaginal discharge than any other gynecologic
symptom; however, vaginal discharge
resulting from infection must be distinguished
from normal secretions.
22
• Bacterial vaginosis signs and symptoms may b. Candidiasis

include: • Candidiasis is a fungal infection caused by a
o Thin, gray, white or green vaginal yeast (a type of fungus) called Candida.
discharge (BV discharge is usually Some species of Candida can cause infection
profuse, thin, and white, gray, or in people; the most common is Candida
milky in appearance) albicans. Candida normally lives on skin and
o Foul-smelling "fishy" vaginal odor inside the body, such as the mouth, throat,
o Vaginal itching gut, and vagina, without causing problems.
o Burning during urination When a woman has too much Candida in her
o Some women also may experience vagina, then we say she has a yeast
mild irritation or pruritus, although infection. A yeast infection is not considered
some women with BV remain a sexually transmitted disease (STD)
asymptomatic. because you don't have to have sex to get it.
Screening and diagnosis
• A focused history may help distinguish BV

from other vaginal infections if the young
woman is symptomatic. Reports of fishy odor
and increased thin vaginal discharge are
most significant, and a report of increased
odor after intercourse is also suggestive of
BV. You should question women with
previous occurrence of similar symptoms,
diagnosis, and treatment because women
with BV often have been treated incorrectly
because of misdiagnosis. Microscopic
examination of vaginal secretions is always
• Clinical observations and research have
performed. Both normal saline and 10%
suggested that tight-fitting clothing and
potassium hydroxide (KOH) smears are
underwear or pantyhose made of
made. The presence of clue cells (vaginal
nonabsorbent materials create an
epithelial cells coated with bacteria) on wet
environment in which a vaginal fungus can
saline smear is highly diagnostic because the
grow. The most common symptom of yeast
phenomenon is specific to BV. Nitrazine
infection is vulvar and possibly vaginal
paper is sensitive enough to detect a pH of
pruritus. The itching may be mild or intense,
4.5 or greater. In the whiff test, a fishy odor of
interfere with rest and activities, and occur
vaginal discharge will be released when KOH
during or after intercourse. Some women
is added to vaginal secretions.
report a feeling of dryness. Others may have
Therapeutic Management painful urination as the urine flows over the
vulva, especially in women who have
• First-line treatment of BV includes oral excoriations resulting from scratching. Most
metronidazole (Flagyl), although vaginal often the discharge is thick, white, lumpy, and
preparations (e.g., metronidazole gel, cottage cheese–like. Commonly the vulva is
clindamycin cream) are also used. When the red and swollen, as are the labial folds,
woman is taking oral metronidazole, advise vagina, and cervix. Although there is no odor
her to avoid drinking alcoholic beverages or characteristic of yeast infections, sometimes
she will experience severe side effects of a yeasty or musty smell is noted.
abdominal distress, nausea, vomiting, and
headache. Treatment of sexual partners is Screening and Diagnosis
not recommended routinely.
• Physical examination should include a
thorough inspection of the vulva and vagina.
23
A speculum examination is always done. transmitted through sexual activity and the
Commonly amine (KOH) wet smear and dozens of clinical syndromes that they cause.
vaginal pH are obtained. The amine test is Adolescents and young adults between the
negative, and the vaginal pH is normal (<4.5) ages of 15 and 24 years acquire half of all
with a yeast infection. The characteristic new STIs each year.
pseudohypha (bud or branching of a fungus)
may be seen on a wet smear.
Therapeutic Management
• A number of antifungal preparations are

available for the treatment of C. albicans.
Many topical medications (e.g., miconazole
[Monistat] and clotrimazole [Gyne-Lotrimin])
are available as over-the-counter (OTC)
agents. Oral medications include a variety of
azole medications including fluconazole or
itraconazole. Exogenous lactobacillus (in the
form of dairy products [yogurt] or powder,
tablets, capsules, or suppository Prevention
supplements) is commonly used among
women; however, there is limited evidence • Preventing infection (primary prevention) is
providing the effectiveness of this treatment the most effective way of reducing the
due to poorly designed studies, and most adverse consequences of STIs for
experts provide no recommendations for use. adolescents and young women. Risk-free
The first time a woman suspects that she may options include complete abstinence from
have a yeast infection, she should see a sexual activities that transmit semen, blood,
health care provider for confirmation of the or other body fluids. Involvement in a
diagnosis and treatment recommendation. If mutually monogamous relationship with an
she has another infection, she may wish to uninfected partner also eliminates the risk of
purchase an OTC preparation and self-treat. contracting STIs. Prompt diagnosis and
• Not wearing underpants to bed may help treatment of current infections (secondary
decrease symptoms and prevent prevention) can also prevent personal
recurrences. Completing the full course of complications and transmission to others.
treatment prescribed, even during • Preventing the spread of STIs requires that
menstruation, is essential to removing the adolescents at risk for transmitting or
pathogen. Adolescent girls should be acquiring infections change their behavior. A
counseled not to use tampons during menses critical first step is to include questions about
because the medication will be absorbed by an adolescent’s sexual history, sexual risk
the tampon. If possible, intercourse is behaviors, and drug-related risky behaviors
avoided during treatment; if this is not as a part of every assessment. When the
feasible, the woman’s partner should use a nurse identifies risk factors or risky behaviors,
condom to prevent introduction of more there is an opportunity to provide prevention
organisms counseling. To be motivated to take
preventive actions, the adolescent must
SEXUALLY TRANSMITTED INFECTIONS believe that acquiring a disease is serious
(STIs) and that he or she is at risk for infection. Most
individuals tend to underestimate their
• Sexually transmitted infections (STIs) are
personal risk of infection in a given situation.
infections or infectious disease syndromes
Nurses have a responsibility to ensure that
transmitted primarily by sexual contact. The
adolescents have accurate, complete
term sexually transmitted infection includes
knowledge about transmission and
more than 25 infectious organisms that are
24
symptoms of STIs and the behaviors that or both may be present, and the woman may
place them at risk for contracting an infection. complain of irritation. The cervix and vaginal
• An essential component of primary walls may demonstrate characteristic
prevention is counseling the woman “strawberry spots” or tiny petechiae, and the
regarding sexual practices so she can avoid cervix may bleed on contact. In severe
acquiring or transmitting STIs, including infections the vaginal walls, the cervix, and
attaining knowledge of her partner, reducing occasionally the vulva are acutely inflamed.
her number of partners, practicing low-risk
sex, avoiding the exchange of body fluids,
and obtaining vaccinations. Reducing the
number of partners and avoiding partners
who have had many previous sexual partners
decrease a woman’s chances of contracting
an STI. Discussing each new partner’s
previous sexual history and exposure to STIs
augments other efforts to reduce risk;
however, sexual partners are not always
truthful about their sexual history
• Anal-genital intercourse, anal-oral contact,
and anal-digital activity are high-risk sexual
behaviors and should be avoided. The Screening and Diagnosis
physical barrier promoted for the prevention
of STIs, including human immunodeficiency • In addition to obtaining a history of current
virus (HIV), is the latex male condom. The symptoms, obtain a thorough sexual history.
nurse should remind women to use a condom Note any history of similar symptoms in the
with every sexual encounter; use latex or past and the treatment used. Determine
polyurethane male condoms; use a condom whether partners were treated. The pH of the
with a current expiration date; use each one discharge is greater than 5.0. Because
only once; and handle it carefully to avoid trichomoniasis is an STI, once diagnosis is
confirmed, the appropriate laboratory studies
damaging it with fingernails, teeth, or other
for other STIs should be carried out.
sharp objects.
• Vaccination is an effective method for the Therapeutic Management
prevention of some STIs such as hepatitis B
and HPV. Hepatitis B vaccine is • The recommended treatment is
recommended for all adolescents. A vaccine metronidazole or tinidazole orally in a single
is available for HPV types 6, 11, 16, and 18 dose. Although the male partner is usually
and is recommended for girls and women 9 asymptomatic, he should receive treatment
to 26 years of age also because trichomonads often harbor in
the urethra or prostate. If partners are not
treated, the infection will likely recur.
SEXUALLY TRANSMITTED PROTOZOA
INFECTIONS SEXUALLY TRANSMITTED BACTERIAL
INFECTIONS
a. Trichomoniasis
• Trichomoniasis is caused by T. vaginalis, an a. Chlamydia
anaerobic, one celled protozoan with • These infections are often silent and highly
characteristic flagella. Although destructive; their sequelae and complications
trichomoniasis may be asymptomatic, men are very serious. Chlamydial infections are
present with urethritis whereas women difficult to diagnose; the symptoms, if
commonly experience characteristically present, are nonspecific, and the organism is
yellowish to greenish, frothy, malodorous expensive to culture. The most serious
discharge. Inflammation of the vulva, vagina, complication of chlamydial infections is pelvic
25
inflammatory disease leading to infertility, • Gonorrhea is caused by the aerobic, gram-

ectopic pregnancy, and chronic pelvic pain negative diplococci Neisseria gonorrhoeae. It
Chlamydial infection of the cervix causes is almost exclusively transmitted by sexual
inflammation, resulting in microscopic contact. The bacteria infects mucosal
cervical ulcerations that may increase the risk membranes, including the cervix, uterus,
of acquiring HIV. Infants born to mothers with
fallopian tubes, urethra, rectum, mouth,
chlamydia may develop ophthalmia
throat, and eyes. Women are often
neonatorum (conjunctivitis) or pneumonia
after perinatal exposure asymptomatic, but when they are
symptomatic, they may have a greenish-
yellow purulent endocervical discharge or
vaginal bleeding. Infected men usually have
symptoms and report purulent discharge and
dysuria. Individuals with rectal gonorrhea
may be completely asymptomatic or
conversely may experience severe
symptoms with profuse purulent anal
discharge, rectal pain, and blood in the stool.
Rectal itching, fullness, pressure, and pain
with bowel movements are also common
SCREENING AND DIAGNOSIS symptoms. Pharyngeal infection is usually
asymptomatic but may cause a sore throat.
• Although infection is usually asymptomatic, Gonococcal infections in pregnancy
some women may experience vaginal potentially affect both mother and infant
bleeding, mucoid or purulent cervical
discharge, abdominal pain, or dysuria; men
may report testicular pain, penile discharge,
or dysuria. Laboratory diagnosis of chlamydia
is by culture. All pregnant women should
have cervical cultures for chlamydia at the
first prenatal visit. Screening late in the third
trimester (36 weeks) may be carried out if the
woman was positive previously or if she is Screening and Diagnosis
younger than 25 years, has a new sex
partner, or has multiple sex partners. • All pregnant women should be screened at
the first prenatal visit, and infected women
Therapeutic Management and those identified with risky behaviors
should be rescreened at 36 weeks of
• The treatment of chlamydial infections
gestation. Gonococcal infection cannot be
includes doxycycline or azithromycin.
diagnosed reliably by clinical signs and
Because chlamydia is often asymptomatic,
symptoms alone. Individuals may have
caution the woman to take all medication
“classic” symptoms, vague symptoms that
prescribed. Azithromycin is often prescribed
may be attributed to a number of conditions,
when compliance is a problem because only
or no symptoms at all. Vaginal specimens are
one dose is needed. Individuals should
the preferred testing in women, but urine, oral
abstain from sexual intercourse for 7 days
swabs, or anal swabs can also be used.
after treatment and all exposed sexual
partners should be treated. Adolescents Therapeutic Management
should be screened again in 3 to 6 months
after treatment to evaluate for reinfection. • Management of gonorrhea is becoming more
challenging as drug resistant strains are
b. Gonorrhea increasing. The treatment of choice for
uncomplicated urethral, endocervical, and
26
rectal infections in pregnant and nonpregnant appearance of the chancre. The infected
women is ceftriaxone given intramuscularly individual also may experience fever,
once. headache, and malaise. If untreated, the
• Gonorrhea is highly communicable. Recent individual enters a latent phase that is
(past 60 days) sexual partners should be primarily asymptomatic. Neurologic,
examined, cultured, and treated with cardiovascular, musculoskeletal, or
appropriate regimens. Most treatment multiorgan system complications can
failures result from reinfection. The develop in the latent stage.
adolescent needs to be informed of this and
Screening and Diagnosis
of the consequences of reinfection in terms of
chronicity, complications, and potential • All women who are diagnosed with another
infertility. Adolescents are counseled to use STI or with HIV should be screened for
condoms. All adolescents with gonorrhea syphilis. All pregnant women should be
should be offered confidential counseling and screened for syphilis at the first prenatal visit,
testing for HIV infection. again in the late third trimester, and at the
time of giving birth if high risk.
c. Syphilis Therapeutic Management

• Syphilis, one of the earliest described STIs, is • Penicillin G is the preferred drug for treating
caused by Treponema pallidum, a motile patients with all stages of syphilis, including
spirochete Syphilis is a sexually transmitted pregnant women. Individuals with a penicillin
infection (STI) that can cause serious health allergy should be desensitized rather than
problems without treatment. The disease can offer treatment with an alternative
also be transmitted through kissing, biting, or medication. Monthly follow-up is mandatory,
oral-genital sex. Transplacental transmission so repeated treatment may be given if
may occur at any time during pregnancy; the needed.
degree of risk is related to the quantity of
spirochetes in the maternal bloodstream. SEXUALLY TRANSMITTED VIRAL
Syphilis rates have been decreasing among INFECTIONS
heterosexual individuals but are increasing
a. Human Papillomavirus
among homosexual males. Syphilis is a
complex disease that can lead to serious • HPV, a double-stranded DNA virus, has more
systemic disease and even death when than 40 serotypes that can be sexually
untreated. transmitted and consists of two categories:
low-risk HPVs, which cause skin warts but
not cancer, and high-risk HPVs, which cause
cancer. High-risk HPVs primarily cause
cervical, anal, and oropharyngeal cancers. In
women HPV lesions are most commonly
seen in the posterior part of the introitus.
Lesions also are found on the buttocks, vulva,
vagina, anus, and cervix. Typically the lesions
are small (2 to 3 mm in diameter and 10 to 15
• Primary syphilis is characterized by a primary mm in height), soft, papillary swellings
lesion, the chancre, which appears 14 to 21 occurring singly on the genital and anal-rectal
days after infection. This lesion often begins region but may also appear as a cauliflower-
as a painless papule at the site of inoculation like mass. Flat-topped papules, 1 to 4 mm in
and erodes to form a nontender, shallow, diameter, are seen most often on the cervix.
ulcer that is accompanied by The lesions are usually painless, but they
lymphadenopathy. Secondary syphilis occurs may be uncomfortable, particularly when very
6 weeks to a few months after the large, inflamed, or ulcerated.
27
CARE OF AT-RISK/HIGH-RISK AND SICK

MOTHER AND CHILD
CARE OF AT RISK/HIGH-RISK MOTHER
IDENTIFYING A HIGH-RISK PREGNANCY:
● High-risk pregnancy is one in which a

concurrent disorder, pregnancy-related
complication, or external factor
jeopardizes the health of the woman, the
fetus, or both.
Screening and Diagnosis
○ Some women enter pregnancy
• A woman with HPV lesions may complain of with a chronic illness that,
symptoms such as a profuse, irritating when superimposed on the
vaginal discharge; itching; dyspareunia; or pregnancy, makes it high risk.
postcoital bleeding. Physical inspection of the
vulva, the perineum, the anus, the vagina, ○ Other women enter pregnancy
and the cervix is essential whenever HPV in good health but then
lesions are suspected or seen in one area. develop a complication of
The HPV-DNA test can be used to screen for pregnancy that causes it to
the high-risk types of HPV that are likely to become high risk.
cause cancer.
• Therapeutic Management Many warts may FACTORS THAT CATEGORIZE A
resolve on their own so treatment may not be PREGNANCY AS HIGH RISK:
necessary. Treatment does not eradicate
HPV but may reduce the signs and symptoms
of warts. Women who have discomfort
associated with genital warts may find that
bathing with an oatmeal solution provides
some relief. Keeping the area clean and dry
also decreases the growth of the warts.
Cotton underwear and loose-fitting clothes
that decrease friction and irritation may
lessen discomfort. Women should be advised
to maintain a healthy lifestyle and be
counseled regarding diet, rest, stress
reduction, and exercise. Patient counseling is
essential. Women must understand the virus,
how it is transmitted, that no immunity is
conferred with infection, and that reinfection
is likely with repeated contact.
Prevention
• Preventive strategies that have been

suggested including abstinence from all
sexual activity, staying in a long-term
monogamous relationship, and prophylactic
vaccination. Three HPV vaccines have been EXAMPLES OF HIGH-RISK PREGNANCY:
licensed for use in adolescents.
28
● The pregnancy of a woman who is internist, obstetrician, and nurse. Ideally,

diabetic is automatically termed one a woman should visit her obstetrician or
with greater than normal risk because family physician before conception so the
it forces a fetus to grow in an environment health care team can become familiar
in which hyperglycemia (increased with her state of health when she is not
serum glucose levels) becomes the rule. pregnant and establish baseline
During such a pregnancy, a woman, evaluations of her heart function, such as
worrying that something will happen to with an echocardiogram (Hameed &
her baby, may fail to begin the Akhter, 2007).
“pregnancy work” that she must do so
bonding can take place. At birth, her child Cardiovascular Disorders That Most
Commonly Cause Difficulty During Pregnancy
is in double jeopardy: not only is the baby
born with altered glucose metabolism, 1. Pregnant woman with left-sided heart failure
but he or she also is at high risk for poor 2. Pregnant woman with right-sided heart failure
maternal–child attachment. 3. Pregnant woman peripartum heart disease
● A preterm infant born to a teenage girl,

likewise, could have this double problem. Assessment of a Woman with Cardiac
Not only is the infant immature (and at Disease
risk for all the complications that ● Nurses play a major role in the care of a
accompany immaturity), but also he or pregnant woman with cardiovascular disease
she may have a mother who is immature because continuous assessment of a
as well. woman’s health status, health education, and
health- promotion activities are so essential.
● A woman living in extreme poverty
who does not have access to community
support would be at high risk for poor Assessment of a Woman with Cardiac
nutritional intake during pregnancy, Disease begins with:
whereas a woman with a similar income
who could depend on a nutritional
assistance program such as WIC and • A thorough health history to document her
counseling from a community health pre-pregnancy cardiac status.
nurse might be only at minimal risk. • Ask about her level of exercise performance
(what level she can do before growing short
of breath and what physical symptoms she
CARDIOVASCULAR DISORDERS AND experiences, such as cyanosis of the lips or
PREGNANCY nail beds).
• Ask if she normally has a cough or edema.
• Instruct women with cardiac disease to
● Cardiovascular disease is still a always report coughing during pregnancy,
concern in pregnancy because it can because pulmonary edema from heart failure
lead to serious complications: it is may first manifest itself as a simple cough.
responsible for 5% of maternal deaths • Never assess edema in women with heart
during pregnancy (Crombleholme, 2009). disease lightly as the normal edema of
Because of improved management of pregnancy.
women with cardiac disorders, women
who might never have risked pregnancy ○ The normal edema of pregnancy
in the past are able to complete involves only the feet and ankles, but
pregnancies successfully today. edema of either pregnancy-induced
hypertension or heart failure also
● A woman with cardiovascular disease begins this way.
needs a team approach to care during
pregnancy, combining the talents of an
29
○ If the edema is a sign of heart ● Hematologic disorders during pregnancy

failure, it can begin at any time and involve either blood formation or coagulation
other symptoms will probably also be disorders.
present:
● Because the blood volume expands during
1. Irregular pulse pregnancy slightly ahead of the red cell
2. Rapid or difficult respirations count, most women have a pseudo-anemia of
3. Chest pain on exertion early pregnancy.
○ Record a baseline blood pressure,
pulse rate, and respiratory rate in ○ This condition is normal and should
either a sitting or lying position at the not be confused with true types of
first prenatal visit; then, at future anemia that can occur as
health visits, always take these in the complications of pregnancy.
same position for the most accurate
● True anemia is present when a woman’s
comparison.
hemoglobin concentration is less than 11 g/dL
Nursing Interventions That Can Be Done (hematocrit 33%) in the first or third trimester
1. Promote Rest of pregnancy or hemoglobin concentration
2. Promote Healthy Nutrition is less than 10.5 g/dL (hematocrit 32%) in the
3. Educate Regarding Medication second trimester
4. Educate Regarding Avoidance of
Infection 4. Pregnant woman with iron-deficiency
5. Be Prepared for Emergency Actions anemia
5. Pregnant woman with folic acid–deficiency
anemia
HEMATOLOGIC DISORDERS AND 6. Pregnant woman with thalassemia
7. Pregnant woman with malaria
PREGNANCY
8. Pregnant woman with Sickle Cell Anemia
● Hematologic disorders during pregnancy
involve either blood formation or coagulation Coagulation Disorders
disorders.
● Because the blood volume expands during ● Most coagulation disorders are sex linked or
pregnancy slightly ahead of the red cell occur only in males and so have little effect
count, most women have a pseudo-anemia of on pregnancies.
early pregnancy. Nursing Interventions That Can Be Done
○ This condition is normal and should 1. Take Prenatal Vitamins Containing An Iron
not be confused with true types of Supplement
anemia that can occur as 2. Periodic Exchange Transfusions (For
sickle cell anemia)
complications of pregnancy.
3. Take Folic Acid or Folacin
● True anemia is present when a woman’s
hemoglobin concentration is less than 11 g/dL
(hematocrit 33%) in the first or third trimester RENAL URINARY DISORDERS AND
of pregnancy or hemoglobin concentration PREGNANCY
is less than 10.5 g/dL (hematocrit 32%) in the ● Adequate kidney function is important to a
second trimester successful pregnancy outcome because a
woman is excreting waste products not only
Hematologic Disorders That Most Commonly for herself but also for the fetus.
Cause Difficulty During Pregnancy
1. Pregnant woman with iron-deficiency ● This dual function makes any condition that
anemia interferes with kidney or urinary function
2. Pregnant woman with folic acid–deficiency potentially serious.
anemia
3. Pregnant woman with thalassemia
30
Renal and Urinary Disorders that most ● If you experience any aches and pains, take
commonly cause difficulty during pregnancy: aceta- minophen (Tylenol) every 4 hours. Do
➢ Pregnant woman with urinary tract not take acetylsalicylic acid (aspirin) during
infection pregnancy.
➢ Pregnant woman with chronic renal
disease ● Use a room humidifier, especially at night, to
moisten nasal secretions and help mucus
Nursing Interventions That Can Be Done drain.
1. Voiding frequently (at least every 2 hours)
● Use only over-the-counter cough drops or
2. Wiping front to back after voiding and bowel
movements syrups that contain natural ingredients such
3. Wearing cotton, not synthetic fiber, as honey and lemon to help reduce coughing.
underwear ● Apply a medicated vapor rub to your chest if
4. Voiding immediately after sexual intercourse
you pre- fer to help relieve nasal congestion.
5. Women with renal disease may need a
nutrition consulta- tion during pregnancy if ● Use cool or warm compresses to relieve
they are on a low potassium diet to avoid a sinus headaches.
buildup of potassium that accumulates
because their diseased kidneys do not ● Check with your healthcare provider
evacuate this well regarding the use of over-the-counter cough
drops, syrups, or decongestants to be certain
RESPIRATORY DISORDERS AND that any drug you take is safe during
PREGNANCY pregnancy.
➢ Respiratory diseases range from mild (the
common cold) to severe (pneumonia) to RHEUMATIC DISORDERS AND PREGNANCY
chronic (tuberculosis or chronic obstructive ● Several rheumatic disorders occur in young
pulmonary disease [COPD]). adult women and so are seen during
➢ Any respiratory condition can worsen in pregnancy. Because most of these illnesses
pregnancy because the rising uterus
result in discomfort, potential or actual pain
compresses the diaphragm, reducing the
related to disease, pathology is the primary
size of the thoracic cavity and available lung
space. nursing diagnosis used.
➢ Any respiratory disorder can pose serious Rheumatic Disorders that most commonly
hazards to the fetus if allowed to progress to cause difficulty during pregnancy:
the point where the mother’s oxygen–carbon
1. Pregnant woman with rheumatoid arthritis
dioxide exchange is altered or the mother or
2. Pregnant woman with systemic lupus
fetus cannot receive enough oxygen.
erythematosus
Respiratory Disorders that most commonly
Nursing Interventions That Can Be Done
cause difficulty during pregnancy:
● Taking of corticosteroids and nonsteroidal
➢ Pregnant woman with acute nasopharyngitis
➢ Pregnant woman with influenza anti-inflammatory drugs (NSAIDs) to prevent
➢ Pregnant woman with pneumonia joint pain and loss of mobility. Some women
➢ Pregnant woman with severe acute may be taking oral aspirin therapy. Although
respiratory syndrome they should continue to take these
➢ Pregnant woman with asthma medications during pregnancy to prevent
➢ Pregnant woman with tuberculosis joint damage, large amounts of salicylates
➢ Pregnant woman with chronic obstructive may lead to increased bleeding at birth or
pulmonary disease prolonged pregnancy.
Nursing Interventions That Can Be Done GASTROINTESTINAL DISORDERS AND

● Be sure to get extra rest and sleep and eat a PREGNANCY
diet high in vitamin C (orange juice and fruit) ● Although minor gastrointestinal discomforts
to help boost the immune system. (such as nausea, heartburn, constipation) are
31
common during pregnancy, acute abdominal ● Women of childbearing age have falls or
pain and protracted vomiting are causes for other accidents that lead to bone fractures or
concern. muscle sprains.
● Pregnancy complications such as premature ● A chronic musculoskeletal disorder that may

separation of the placenta or ectopic be seen with pregnancy is scoliosis.
pregnancy often manifest with acute
abdominal pain, so differentiating the cause Musculoskeletal Disorders that most
commonly cause difficulty during pregnancy:
of abdominal pain is important.
● In other instances, abdominal pain is

associated with a condition completely PREGNANT WOMAN WITH SCOLIOSIS
unrelated to pregnancy such as ulcerative Scoliosis (lateral curvature of the spine) begins
colitis, hepatitis, hiatal hernia, or cholecystitis. to be noticed first in girls between 12 and 14
These conditions may be known to a woman years of age. If it is uncorrected at this time, the
before she becomes pregnant, or they may curvature progresses until it causes deformity,
develop or be discovered during her interfering with respiration and heart action
pregnancy. because of chest compression. Pelvic distortion
can interfere with childbirth, especially at the
Gastrointestinal Disorders that most pelvic inlet. If a woman’s spine is extremely
commonly cause difficulty during pregnancy: curved, spinal or epidural anesthesia may be
➢ Pregnant woman with appendicitis difficult to administer for pain management in
➢ Pregnant woman with gastroesophageal labor.
reflux disease or hiatal hernia
➢ Pregnant woman with cholecystitis and
cholelithiasis ENDOCRINE DISORDERS AND PREGNANCY
➢ Pregnant woman with pancreatitis Endocrine disorders have the potential to be
➢ Pregnant woman with inflammatory bowel serious complications of pregnancy because
disease enzymes or hormones control so many specific
body functions.
NEUROLOGIC DISORDERS AND Endocrine Disorders that most commonly
PREGNANCY cause difficulty during pregnancy:
● Neurologic illness, as a whole, does not occur 1. Pregnant woman with a thyroid dysfunction
at a high incidence in women of childbearing 2. Pregnant woman with hypothyroidism
age. 3. Pregnant woman with hyperthyroidism
4. Pregnant woman with diabetes mellitus
● However, any neurologic disease with
symptoms of seizures must be carefully Education Regarding Exercise During
managed during pregnancy because the Pregnancy:
anoxia that could be caused by severe
seizures could deprive a fetus of oxygen. Exercise is another mechanism that lowers the
serum glucose level and thereby the need for
Neurologic Disorders that most commonly
cause difficulty during pregnancy: insulin. If a woman begins an exercise program
for the first time during pregnancy, she may notice
1. Pregnant woman with a seizure disorder
2. Pregnant woman with myasthenia gravis excessive glucose fluctuations at first. Therefore,
3. Pregnant woman with multiple sclerosis she should begin her exercise program before
pregnancy, when glucose fluctuation can be
evaluated and food and snacks adjusted
MUSCULOSKELETAL DISORDERS AND accordingly before a fetus is involved.
PREGNANCY
Insulin
● Early in pregnancy, a woman with
diabetes may need less insulin than
32
before pregnancy because the fetus Postpartum Adjustment

is using so much glucose for rapid ● During the postpartum period, a
cell growth. Later in pregnancy, she woman who came into pregnancy
will need an increased amount with diabetes must undergo yet
because her metabolic rate needs to another readjustment to insulin
increase. regulation. With insulin resistance
gone, often she needs no insulin
Blood Glucose Monitoring during the immediate postpartum
● All women with diabetes need to do period; in another few days, however,
blood glucose monitoring to she will return to her prepregnant
determine whether hyperglycemia insulin diabetic requirements.
or hypoglycemia exists.
CANCER AND PREGNANCY
Insulin Pump Therapy (Continuous
Cancer occurs in about 1 in 1000 pregnancies
Subcutaneous Insulin Infusion)
(Cunningham, 2008b). The malignancies most
● Because a woman will have some
commonly seen with pregnancy are those that
periods of relative hyperglycemia
and hypoglycemia no matter how occur most frequently in women during
carefully she maintains her diet and childbearing years:
balances her exercise level, an ● Cervical
effective method to keep serum ● Breast
glucose constant is to administer ● Ovarian
insulin by a continuous pump during ● Thyroid
pregnancy ● Leukemia
● Melanoma
Tests for Placental Function and Fetal Well- ● Lymphomas
Being
● Monitoring of fetal well-being is MENTAL ILLNESS AND PREGNANCY
individualized depending on the ✓ Mental illness may precede or occur with
woman’s overall health. Because pregnancy.
women with diabetes tend to have ✓ Schizophrenia tends to have its highest
infants with a higher-than-normal incidence in adolescents and young adults
incidence of birth anomalies, a and so occurs in young pregnant women.
woman will have a serum alpha- ✓ Depression occurs almost four times more
fetopro- tein level obtained at 15 to commonly in women than in men, and often
17 weeks to assess for a neural tube in young adults. It is the most common mental
illness seen in pregnant women.
defect and an ultrasound
✓ Even normal levels of stress make it difficult
examination performed at
to use effective coping mechanisms so
approximately 18 to 20 weeks to pregnancy or childbirth may be the additional
detect gross abnormalities. stress that reveals mental illness for the first
time.
Timing for Birth
✓ A woman with a psychiatric disorder should
● Before women with diabetes were
be cared for by both a psychiatric care team
managed with maximum control and a prenatal care group to ensure that the
during pregnancy, the timing of birth stress of pregnancy is not exacerbating the
was a chief concern. Among the most mental illness, and distorted perceptions or
hazardous times for a fetus is at depression do not complicate the pregnancy.
weeks 36 to 40 of pregnancy (when ✓ Any psychotropic medication taken by a
the fetus is drawing large stores of pregnant woman should be evaluated for
maternal nutrients because of its possible fetal harm.
large size). ✓ Mental illness may also occur in the
postpartum period
33
CARE FOR AT RISK/HIGH RISK CHILD ● If a newborn does not draw in a first breath
spontaneously, suction the infant’s mouth and
nose with a bulb syringe again and rub the back
8 NEWBORN PRIORITIES DURING FIRST to see if skin stimulation initiates respirations
DAYS OF LIFE
● If a newborn does not draw in a first breath
1. INITIATING AND MAINTAINING spontaneously, suction the infant’s mouth and
RESPIRATIONS nose with a bulb syringe again and rub the back
to see if skin stimulation initiates respirations.
● Most newborn deaths occur during the first 48
hours after birth because of the newborn’s
inability to establish or maintain adequate
respiration. LUNG EXPANSION
● Any infant who sustains some degree of asphyxia ● Once an airway has been established, a
in utero may already be experiencing acidosis at newborn’s lungs need to be expanded.
birth and may have difficulty before the first 2
● Infant who breathes spontaneously but then
minutes of life.
cannot sustain effective respirations may need
oxygen from a bag and mask to aid lung
expansion.
RESUSCITATION
● FACTORS PREDISPOSING INFANTS TO

RESPIRATORY DIFFICULTY IN THE FIRST DRUG THERAPY
FEW DAYS OF LIFE
● Stimulants have little place in newborn
1. Low birth weight resuscitation unless an infant’s respiratory
2. Maternal history of diabetes depression appears to be related to the
3. Premature rupture of membranes administration of a narcotic such as morphine or
4. Maternal use of barbiturates or narcotics meperidine (Demerol) to the mother during labor.
close to birth
5. Meconium staining Irregularities detected by ● A narcotic antagonist such as naloxone (Narcan)
fetal heart monitor during labor injected into an umbilical vessel or
6. Cord prolapse intramuscularly into a thigh will relieve
7. Lowered Apgar score (<7) at 1 or 5 minutes depression.
8. Postmaturity
9. Small for gestational age DRUGS USED IN NEWBORN
10. Breech birth RESUSCITATION:
11. Multiple birth
12. Chest, heart, or respiratory tract anomalies ➢ Atropine
13. Resuscitation becomes important for infants ➢ Calcium chloride
who fail to take a first breath or have ➢ Dopamine
difficulty maintaining adequate respiratory ➢ Epinephrine
movements on their own. ➢ Lidocaine
14. Resuscitation follows an organized process: ➢ Sodium bicarbonate
15. establish and maintain an airway ➢ Surfactant
16. expand the lungs ➢ Nitric oxide
17. initiate and maintain effective ventilation ➢ Liquid ventilation
2. ESTABLISHING EXTRAUTERINE
AIRWAY CIRCULATION
● For a well term newborn, usually bulb syringe ● If an infant has no audible heartbeat, or if the
suction removes mucus and prevents aspiration cardiac rate is below 80 beats per minute, closed-
chest massage should be started.
34
● Health care personnel with infections have a

professional and moral obligation to refrain
3. REGULATING TEMPERATURE from caring for newborns.
● All high-risk infants may have difficulty 7. ESTABLISHING PARENT-INFANT
maintaining a normal temperature. BONDING
● It is important to keep newborns in a neutral- ● Parents of a high-risk newborn are kept
temperature environment, one that is neither too informed of what is happening during
hot nor too cold because doing so places less resuscitation at birth.
demand on them to maintain a minimal metabolic
rate. 8. ANTICIPATING DEVELOPMENTAL NEEDS
● Methods to use to prevent newborn from ● High-risk newborns need special care to
becoming chilled after birth: ensure that the amount of pain they
experience during procedures is limited to the
➢ Radiant Heat Sources least amount possible and that they receive
➢ Incubators adequate stimulation for growth.
➢ Skin-to-Skin Care
THE NEWBORN AT RISK BECAUSE OF
4. ESTABLISHING ADEQUATE NUTRITIONAL ALTERED GESTATIONAL AGE
INTAKE Appropriate for gestational age (AGA)
○ infants who fall between 10th and 90th
● Preterm infants should be breastfed, if possible, percentile of weight for their age
because of the immune protection this offer
Small for gestational age (SGA)
● If an infant’s respiratory rate remains rapid and ○ infants below 10th percentile of
Necrotizing enterocolitis (NEC) has been ruled weight for their age
out, gavage feeding may be introduced.
○ small for their age because they have
experienced intrauterine growth
5. ESTABLISHING WASTE ELIMINATION restriction (IUGR) or failed to grow at
the expected rate in utero
● Most immature infants void within 24
hours of birth, they may void later than Large for gestational age (LGA)
term newborns because, because of all ○ those who fall above the 90th
the procedures that may be necessary percentile in weight
for resuscitation, their blood pressure ○ baby appears deceptively healthy at
may not be adequate to optimally supply birth because of the weight, but a
their kidney gestational age examination will
● Immature infants also may pass stool reveal immature development
later than the term infant because
ILLNESS IN THE NEWBORN
meconium has not yet reached the end of
the intestine at birth. • A number of illnesses occur specifically in
newborns. These automatically cause the
6. PREVENTING INFECTION infant to become at high risk.
● All persons coming in contact with or caring a. Respiratory Distress Syndrome (RDS) –
for infants must observe good handwashing Often occurs in preterm infants, infants of diabetic
technique and standard precautions to mothers, infants born by cesarean birth, or those
reduce the risk of infection transmission. who for any reason have decreased blood
perfusion of the lungs, such as occurs with
meconium aspiration. The cause of RDS is a low
level or absence of surfactant, the phospholipid
35
that normally lines the alveoli and reduces j. Hemorrhagic Disease of the Newborn – results
surface tension to keep the alveoli from from a deficiency of vitamin K. Vitamin K are
collapsing on expiration. essential for the formation of prothrombin by the
liver. Lack of it causes decreased prothrombin
b. Transient Tachypnea of the Newborn (TTN) function and impaired blood coagulation.
- Transient tachypnea may reflect a slight Newborns with vitamin K deficiency show
decrease in production of phosphatidyl glycerol or petechiae from superficial bleeding into the skin.
mature surfactant but is a direct result of retained They may have conjunctival, mucous membrane,
lung fluid. Retained lung fluid limits the amount of or retinal hemorrhage. They may vomit fresh
alveolar surface that is available for oxygen blood or pass black, tarry stools because of
exchange. This limitation requires an infant to bleeding into the gastrointestinal tract.
increase respiratory rate and depth of
respirations to better use the surface available. k. Twin-to-Twin Transfusion – Twin-to-twin
transfusion is a phenomenon that can occur if
c. Meconium Aspiration Syndrome - An infant twins are monozygotic (identical; share the same
may aspirate meconium either in utero or with the placenta) or if abnormal arteriovenous shunts
first breath at birth. Meconium can cause severe occur that direct more blood to one twin than the
respiratory distress in three ways: it causes other.
inflammation of bronchioles because it is a
foreign substance; it can block small bronchioles l. Necrotizing Enterocolitis – The bowel
by mechanical plugging; and it can cause a develops necrotic patches, interfering with
decrease in surfactant production through lung digestion and possibly leading to a paralytic ileus.
trauma. Perforation and peritonitis may follow. NEC may
occur as a complication of exchange transfusion.
d. Apnea - a pause in respirations longer than
20 seconds with accompanying bradycardia. m. Retinopathy of Prematurity (ROP) – An
Beginning cyanosis also may be present. acquired ocular disease that leads to partial or
total blindness in children, is caused by
e. Sudden Infant Death Syndrome (SIDS) – vasoconstriction of immature retinal blood
Sudden unexplained death in infancy. vessels.
f. Periventricular Leukomalacia (PVL) –
THE NEWBORN AT RISK BECAUSE OF
Abnormal formation of the white matter of the
MATERNAL INFECTION OR ILLNESS
brain. It is caused by an ischemic episode that
interferes with circulation to a portion of the brain. MATERNAL INFECTION
Currently, no medical treatment is available for ● Newborns are susceptible to infection at birth
PVL; prevention and close developmental follow- because their ability to produce antibodies is
up are the only options. immature
g. Hemolytic Disease of the Newborn – It INFECTIONS CONTRACTED FROM

occurs when your baby's red blood cells break EXPOSURE TO VAGINAL SECRETIONS AT
down at a fast rate. It’s also called BIRTH:
erythroblastosis fetalis. ➢ β-Hemolytic, Group B Streptococcal
Infection
h. Rh Incompatibility – Condition that develops ➢ Ophthalmia Neonatorum
when a pregnant woman has Rh negative blood, ➢ Hepatitis B Virus
and the baby has Rh positive blood ➢ Generalized Herpesvirus Infection
➢ Human Immunodeficiency Virus
i. ABO Incompatibility – Happens when the
mother’s blood type is O and her baby’s blood
type is A or B. The mother’s immune system may INFANT OF A WOMAN WHO HAS DIABETES
react and make antibodies against her baby’s red MELLITUS
blood cell. ● Infant of a woman who has diabetes
mellitus whose illness was poorly
36
controlled during pregnancy is typically ● An infant needs follow-up so any future

longer and weighs more than other problems can be discovered.
babies (macrosomia)
● The mother needs follow-up to see if she can
● To avoid a serum glucose level from reduce her alcohol intake for better overall
falling this low, infants of diabetic women health.
are fed early with formula or administered
a continuous infusion of glucose
INFANT OF A DRUG-DEPENDENT MOTHER EVIDENCE-BASED INTERVENTIONS:

● Infants of drug-dependent women tend to be NURSING CARE OF AT-RISK/SICK MOTHER
SGA
BREAST DISORDERS
● Infant may show withdrawal symptoms: ACCESSORY NIPPLES
● SIGNS: ✓ Additional breast nipples
✓ Occur along the mammary lines and can
➢ Irritability be present in either male or female
➢ Disturbed sleep pattern ✓ present from birth but usually are not as
➢ Constant movement, possibly leading to protuberant as true nipples
abrasions on the elbows, knees, or nose ✓ it lacks areola pigmentation
➢ Tremors ✓ Parents should be told what they are, so
➢ Frequent sneezing that they can inform their
➢ Shrill, high-pitched cry ✓ daughter later, because some growth in
➢ Possible hyperreflexia and clonus accessory nipples may occur at
➢ Convulsions ✓ puberty or during pregnancy in response
➢ Tachypnea to estrogen stimulation.
➢ Vomiting and diarrhea
● Specific therapy for an infant is individualized
according to the nature and severity of the BREAST HYPERTROPHY
signs. Maintenance of electrolyte and fluid • Abnormal enlargement of breast tissue
balance is essential. • In the average girl, breast development
halts after puberty, as soon as
INFANT WITH FETAL ALCOHOL EXPOSURE progesterone levels rise to mature
● newborn with fetal alcohol syndrome has strength.
several possible problems at birth • Progesterone levels are low until
menstruation cycles are fully established;
● Characteristics that mark fetal alcohol
however, if this process is a lengthy one,
syndrome
breast growth may last for several years,
○ Prenatal and postnatal growth resulting in larger than usual breasts
restriction
○ Cognitive challenge
○ Microcephaly
○ Cerebral palsy
○ Distinct facial feature (short

palpebral fissure and thin upper
lip)
● Growth deficiencies may remain throughout

life
37
• Breast hypertrophy can lead to both ● Older women require special attention when
physical and emotional stress. reviewing the need for regular BSE. Fixed
• A girl may feel pain and fatigue in the incomes limit many older women; thus they fail to
back or shoulders from attempting to pursue regular clinical breast examination and
maintain good posture despite the mammography.
weight of heavy breast tissue.
• She may feel self-conscious and try to ○ Unfortunately many older women ignore
minimize her breast size by slouching, changes in their breasts, assuming that
resulting in poor posture or rounded they are a part of aging
shoulders
Adolescent girls with large breasts
● Find it difficult to adapt to such a new
appearance.
● Treated as provocative sex objects
● Believe they should live up to this image.
● This can make it difficult for them to find their
own identity.
● They may hear comments such as, “i wish i
had your problem,” rather than receiving
support and understanding from parents,
peers, and health care providers
Breast cancer Screening?

If breast hypertrophy interferes with a girl’s
Breast cancer screening is a process of regularly
physical and emotional well-being,
examining your breasts to look for changes that
○ Surgical breast reduction is a possibility
may indicate the presence of cancer.
■ need to seriously consider the
What is Importance of BSE:
consequences of the procedure,
There is no one definitive answer to this question
however, before undertaking it at this
as the importance of breast self examination
early age.
(BSE) can vary depending on a person's
■ if a large amount of glandular tissue individual health and medical history. However,
is removed, breastfeeding may no many experts believe that BSE is an important
longer be possible way to screen for health problems, including
cancer, and can help women identify any
○ The adolescent needs to be told realistically changes in their breasts that may be indicative of
that changing her physical appearance will a problem. Additionally, BSE can help women
reduce physical discomfort, but changing her identify any potential health risks associated with
self-concept must come from within. their breast cancer treatment, such as side effects
BREAST SELF EXAMINATION from chemotherapy or radiation therapy.
● BSE done once a month helps women become Endometriosis
familiar with the usual appearance and feel of ● Abnormal growth of extrauterine endometrial
their breasts. Familiarity makes it easier to notice cells, often in the cul-de-sac of the peritoneal
any changes in the breast from one month to cavity or on the uterine ligaments or ovaries
another. Early discovery of a change from
“normal” is the main idea behind BSE ● Endometriosis is the abnormal growth of
extrauterine endometrial cells, often in the cul-de-
● For women who menstruate, the best time to do sac of the peritoneal cavity or on the uterine
BSE is the fourth through the seventh day of the ligaments or ovaries.
menstrual cycle or right after the menstrual cycle
ends, when the breasts are least likely to be ● This abnormal tissue results from excessive
tender or swollen endometrial production and a reflux of blood and
38
tissue through the fallopian tubes during a

menstrual flow.
2. Ovarian cysts:
● As many as 25% of women in the United States Ovarian cysts are
have endometriosis, and as many as 50% of fluid-filled sacs that
adolescents seen for dysmenorrhea have develop on or within
endometriosis (Yates & Vlahos, 2007). the ovary.
● The condition tends to occur most often in white
nulliparous women, but there is also a familial
tendency.
● Daughters of women with endometriosis may

develop symptoms of dysmenorrhea early in life.
3. Ovarian torsion:
They may want to consider having children before
This is a rare but
overgrowth of the endometrium becomes so
serious condition in which the ovary twists on its
extensive that it interferes with conception.
blood supply, cutting off its circulation.
● The excessive production of endometrial tissue
may be related to a deficient immunologic
response.
● In many women, it appears to be related to

excess estrogen production or a failed luteal
menstrual phase.
Ovarian Disorders
There are several ovarian disorders that can
affect nursing care of the pregnant client. Some
of the most common ovarian disorders include:
1. Polycystic ovary syndrome (PCOS): This is

a hormonal disorder in which the ovaries produce
too much androgen, a male hormone.
4. Ovarian cancer: Ovarian cancer is a relatively
rare form of cancer that can be difficult to detect
in its early stages.
39
PELVIC FLOOR DISEASE the end of the day or is related to a

The pelvic floor is the group of muscles that form bowel movement
a sling or hammock across the floor of the pelvis. ● See or feel a “bulge” or “something
Together with surrounding tissues, these muscles coming out” of the vagina
hold the pelvic organs in place so they can ● Have difficulty starting to urinate or
function correctly. The pelvic organs include the emptying the bladder completely
● Leak urine when coughing, laughing, or
bladder, urethra, intestines, and rectum. A
exercising
woman’s pelvic organs also include the uterus,
● Feel an urgent or frequent need to
cervix, and vagina. urinate
● Feel pain while urinating
● Leak stool or have difficulty controlling
What is a PFD gas
A PFD occurs when the pelvic muscles and ● Have constipation
connective tissue weaken or are injured. The ● Have difficulty making it to the bathroom
most common types of PFDs are the following: in time
● Pelvic organ prolapse. “Prolapse” happens in CAUSES

women when the pelvic muscles and tissue can
no longer support one or more pelvic organs, The complete picture about what contributes to
causing them to drop or press into the vagina. For the development of pelvic floor problems is not
clear and is quite complex, but the following
instance, in uterine prolapse, the cervix and
conditions are being studied as risk factors for
uterus can descend into the vagina and may even
the development of PFDs:
come out of the vaginal opening. In vaginal ● Childbirth. Pregnancy, childbirth, and their link to
prolapse, the top of the vagina loses support and pelvic floor problems have been an active area of
can drop toward or through the vaginal opening. research, but the connection is not clear. A study
Prolapse also can cause a kink in the urethra, the showed that, among first-time mothers, mode of
tube that brings urine from the bladder to the delivery (such as vaginal versus surgical) was
outside of the body. linked to risk for PFDs. In some studies, the risk
● Bladder problems. Urinary symptoms can increases with the number of children a woman
include urinating too often in the day or night, has delivered. The risk may be greater if forceps
strong urgency to urinate, or urinary leakage. The or a vacuum device is used during delivery.
leaking of urine, a problem called urinary However, because pelvic problems also affect
incontinence, can occur in women or men. This women who have never been pregnant, and
leakage may occur as a result of an exertion (like because delivering via cesarean section only
a cough or sneeze) or other factors involving the reduces but does not eliminate the risk of pelvic
bladder muscles. floor problems, the relationship among
pregnancy, childbirth, and PFDs remains unclear.
● Bowel control problems. The leaking of liquid or
solid stool from the rectum, called fecal ● Factors that put pressure on the pelvic floor.
incontinence, can occur in women and men. It These factors include overweight or obesity,
can result from damage to or weakening of the chronic constipation or chronic straining to have
anal sphincter, the ring of muscles that keeps the a bowel movement, heavy lifting, and chronic
anus closed, or from other causes. coughing from smoking or health problems.
SYMPTOMS: ● Getting older. The pelvic floor muscles can

weaken as women age and during menopause.
Because there are different types of PFDs,
symptoms of different PFDs can vary or overlap. ● Having weaker tissues. Genes influence the
For example, women with PFDs may: strength of a woman’s bones, muscles, and
connective tissues. Some women are born with
● Feel heaviness, fullness, pulling, or conditions that affect the strength of connective
aching in the vagina that gets worse by
40
tissues, and they are more likely to have pelvic rectum while the patient is having a bowel
organ prolapse. movement.
● Surgery. Previous hysterectomy and prior TREATMENT

surgery to correct prolapse are associated with
higher risks of PFDs. Treatment can often help when symptoms are
bothersome or restrict a woman’s activities. Some
DIAGNOSIS types of treatments include the following.
A healthcare provider may be able to diagnose a Lifestyle Changes

PFD with a physical exam. In some cases, a - Limit foods and drinks that
woman’s healthcare provider will see or feel a stimulate the bladder.
bulge during a routine pelvic exam that suggests
a prolapse. In other cases, a woman may see her - For certain bowel problems, eat
doctor about symptoms she is experiencing, such a high-fiber diet.
as problems with bladder or bowel control. In - Lose weight
addition to a physical exam, a doctor also will ask
about medical history, including whether a Nonsurgical Treatment
woman has been pregnant, has had surgery, and - Bladder training
takes any medicines.
- Pelvic floor muscle training
Depending on the findings from the exam or the (PFMT).
severity of the symptoms, a healthcare provider
may do tests. Some tests used to help with the - Medicine
diagnosis or with treatment planning include: - Vaginal pessary
Bladder control problems Surgical Treatment
● Cystoscopy. This test examines the - For prolapse. Surgery involves
insides of the bladder to look for repairing the prolapse and
problems, such as bladder stones, attempting to restore a well-
tumors, or inflammation. supported anatomy.
● Urinalysis. This urine test can detect if - For bladder control problems.
you have a bladder infection, kidney The type of surgery used most
problems, or diabetes. often is a mid-urethral sling. The
● Urodynamics. This test is used to surgeon places material under
evaluate how the bladder and urethra are the urethra to support it and
working. It can help determine the plan prevent urine leakage during
for surgery to treat certain forms of activity.
bladder control problems. - For bowel control problems.
Bowel control problem Surgery may be needed to repair
● Anal manometry. This test evaluates the a damaged anal sphincter
strength of the anal sphincter muscles. muscle, inject medications into
the sphincter, or implant a
● Colonoscopy or sigmoidoscopy. This stimulator for the nerves that
procedure examines the inside of the control the bowel function.
colon or the sigmoid (the part of the
bowel near the rectum) to look for signs
of disease or inflammation that may be
causing symptoms.
● Dynamic defecography. This test is

used to evaluate the pelvic floor and
41
CYSTOCELE
CAUSES:
Pelvic floor consists of muscles, ligaments and

connective tissues that support your bladder and
other pelvic organs. The connections between
your pelvic organs and ligaments can weaken
over time, or as a result of trauma from childbirth
or chronic straining. When this happens, your
bladder can slip down lower than usual and bulge
into your vagina (anterior prolapse).
Causes of stress to the pelvic floor include:

Anterior vaginal prolapse, also known as a ● Pregnancy and vaginal childbirth
cystocele or a prolapsed bladder, is when the ● Being overweight or obese
bladder drops from its usual position in the pelvis ● Repeated heavy lifting
and pushes on the wall of the vagina. ● Straining with bowel movements
DIAGNOSIS:
The organs of the pelvis — including the bladder,
uterus and intestines — are typically held in place Your healthcare provider will review your medical
history and do a physical and pelvic exam. Other
by the muscles and connective tissues of the
tests may include:
pelvic floor. Anterior prolapse occurs when the
pelvic floor becomes weak or if too much ● Cystourethrogram (also called a
pressure is put on the pelvic floor. This can voiding cystogram). This is an X-ray of
happen over time, during vaginal childbirth or with the bladder taken while the woman is
chronic constipation, violent coughing or heavy urinating and with the bladder and
lifting. urethra filled with contrast dye. It shows
the shape of the bladder and any
ANTERIOR PROLAPSE IS TREATABLE. For a
blockages.
mild or moderate prolapse, nonsurgical treatment
is often effective. In more severe cases, surgery ● MRI can be used to determine the extent
may be necessary to keep the vagina and other of bladder prolapse
pelvic organs in their proper positions.
TREATMENT:
SYMPTOMS:
Treatment depends on prolapses you have
In mild cases of anterior prolapse, you may not symptoms, how severe your anterior prolapse is
notice any signs or symptoms. When signs and and whether you have any related conditions,
symptoms occur, they may include: such as urinary incontinence or more than one
type of pelvic organ prolapse.
● A feeling of fullness or pressure in your
pelvis and vagina
● In some cases, a bulge of tissue in your
vagina that you can see or feel
● Increased pelvic pressure when you
strain, cough, bear down or lift
● Problems urinating, including difficulty
starting a urine stream, the feeling that
you haven't completely emptied your
bladder after urinating, feeling a frequent
need to urinate or leaking urine (urinary
incontinence)
42
● A supportive device (pessary). A vaginal

pessary is a plastic or rubber ring
inserted into your vagina to support the
bladder. A pessary does not fix or cure
the actual prolapse, but the extra support
the device provides can help relieve
symptoms. Your doctor or other care
provider fits you for the device and shows
you how to clean and reinsert it on your
own. Many women use pessaries as a
temporary alternative to surgery, and
some use them when surgery is too risky.
RECTOCELE
• A posterior vaginal prolapse is a bulge of

tissue into the vagina. It happens when the
tissue between the rectum and the vagina
weakens or tears. This causes the rectum to
push into the vaginal wall. Posterior vaginal
prolapse is also called rectocele.
If you do have symptoms of anterior prolapse, first • Childbirth-related tears, chronic straining to
line treatment options include: pass stool (constipation) and other activities
● Pelvic floor muscle exercises. These that put pressure on pelvic tissues can lead
exercises — often called Kegel exercises or to posterior vaginal prolapse. A small
Kegels — help strengthen your pelvic floor prolapse might not cause symptoms.
muscles, so they can better support your • With a large prolapse, you might notice a
bladder and other pelvic organs. Your bulge of tissue that pushes through the
provider or a physical therapist can give you opening of the vagina. To pass stool, you
instructions for how to do these exercises and might need to support the vaginal wall with
can help you determine whether you're doing your fingers. This is called splinting. The
them correctly. bulge can be uncomfortable, but it's rarely
painful.
KEGEL EXERCISES may be most successful at
• If needed, self-care measures and other
relieving symptoms when the exercises are
nonsurgical options are often effective. For
taught by a physical therapist and reinforced with
severe posterior vaginal prolapse, you might
biofeedback. Biofeedback involves using
need surgery to fix it.
monitoring devices that help ensure you're
tightening the proper muscles with optimal SYMPTOMS:
intensity and length of time. These exercises can
help improve your symptoms but may not A small posterior vaginal prolapse (rectocele)
decrease the size of the prolapse. might cause no symptoms.
43
Otherwise, you may notice: ultrasound to check if your small intestine

● A soft bulge of tissue in the vagina that has prolapsed (enterocele). They may
might come through the opening of the order a special X-ray called a
vagina defecography. A defecography shows the
changes in your rectum when you poop.
● Trouble having a bowel movement It can show how severe a rectocele is.
● Feeling pressure or fullness in the rectum TREATMENT:
● A feeling that the rectum has not Treatment depends on how severe your prolapse
completely emptied after a bowel is. Treatment might involve:
movement
● Observation: If the posterior vaginal
● Sexual concerns, such as feeling prolapse causes few or no symptoms,
embarrassed or sensing looseness in the simple self-care measures — such as
tone of the vaginal tissue performing Kegel exercises to strengthen
CAUSES: pelvic muscles — might give relief.
Posterior vaginal prolapse results from pressure ● Pessary: A vaginal pessary is a silicone
on the pelvic floor or trauma. Causes of increased device that you put into the vagina. The
pelvic floor pressure include: device helps support bulging tissues. A
pessary must be removed regularly for
● Birth-related tears cleaning.
● Forceps or operative vaginal deliveries Surgery to fix the prolapse might be needed if:
Pelvic floor strengthening exercises or using a
● Long-lasting constipation or straining pessary doesn't control your prolapse symptoms
with bowel movements well enough.
● Long-lasting cough or bronchitis
Other pelvic organs are prolapsed along with the
● Repeated heavy lifting rectum, and your symptoms really bother you.
Surgery to fix each prolapsed organ can be done
● Being overweight at the same time.
DIAGNOSIS: Surgery often involves removing extra, stretched
tissue that forms the vaginal bulge. Then stitches
Gynecologists can often diagnose a rectocele
are placed to support pelvic structures. When the
with a thorough medical history and physical
uterus is also prolapsed, the uterus might need to
exam.
be removed (hysterectomy). More than one type
Diagnosis may include: of prolapse can be repaired during the same
● Pelvic exam: In addition to examining surgery.
your vaginal canal for signs of prolapse,
your provider may test your pelvic floor
strength during the exam. They may ask
you to squeeze and relax your pelvic floor
muscles as if you were stopping a stream
of pee. They may also ask that you apply
pressure to your gut or strain as if you
were pooping. Doing this makes your
prolapse more visible.
● Imaging: Imaging isn't often used for

rectocele diagnosis. In rare instances,
your provider may order a transvaginal
44
UTERINE PROLAPSE THE STAGES OF A PROLAPSED UTERUS:
Uterine prolapse is evaluated in stages to identify

the severity and overall location of the uterus in
WHAT IS UTERINE PROLAPSE? the vagina. Uterine Prolapse is classified into four
● Prolapse of the uterus occurs for women stages:
when the uterus, also known as the womb,
descends toward or into the vagina. 1. Stage 1 - The uterus is in the upper half of
the vagina.
2. Stage 2 - The uterus has now descended

nearly into the opening of the vagina
3. Stage 3 - The uterus has protruded out of the

vagina
4. Stage 4 - The uterus is completely out of the

vagina
SYMPTOMS:
● Vaginal bleeding or an increase in vaginal

discharge
TYPES OF PROLAPSED UTERUS: ● Pelvic heaviness or pulling
Uterine prolapse can be classified as either ● Difficulties or pain with sexual intercourse
incomplete or complete. ● Urinary leakage
● Bladder infections
● Incomplete uterine prolapse: this occurs ● Lower back pain
when the uterus is partially fallen into the ● Sensations of sitting on a ball or that
vagina but is not protruding something is falling out of your vagina
● Constipation or other bowel movement
● Complete uterine prolapse: this occurs difficulties
when a portion of the uterus protrudes from ● Discomfort when walking
the vaginal opening
CAUSES:
The pelvic floor muscles are a set of muscles and

ligaments that hold your uterus in place within
your pelvis. When these muscles weaken, your
uterus can no longer be held in place, causing it
to sag. The pelvic floor muscles can deteriorate
due to a variety of factors, including:
45
➢ Pregnancy INTERVENTIONS / TREATMENT:

➢ Factors relating to childbirth delivery PREVENTION
➢ Getting older, especially after - Repeated childbirth with short
menopause intervals cause UV prolapse.
➢ Frequent heavy lifting
➢ Chronic coughing - Women should be advised to
➢ History of pelvic surgery avoid pregnancies in quick
➢ Genetic factors succession.
DIAGNOSIS: PHYSIOTHERAPY
A diagnosis of uterine prolapse often occurs - Early cases of UV prolapse are
during a pelvic exam. During the pelvic exam your helped by pelvic floor exercises,
health care provider may have you: particularly during puerperium
and while waiting to undergo
● Bear down as if having a bowel surgical treatment.
movement. This can help your provider
assess how far the uterus has slipped - Kegel exercises are used to tone
into the vagina. up pelvic musculature. This is
done 3 times a day for 20 mins.
● Tighten your pelvic muscles as if you're
stopping a stream of urine. This test PESSARY
checks the strength of pelvic muscles. - A mechanical device for
correcting and controlling UV
prolapse.
IS IT POSSIBLE TO GET PREGNANT WITH
CONGENITAL UTERINE PROLAPSE? - It does not cure the prolapse; it
It is possible to become pregnant if you have holds the genital tract in position.
stage 1 uterine prolapse, but you should visit your
- Advised for patients who cannot
doctor first. The best suggestion is to finish your undergo surgery.
treatment and then become pregnant.
SURGICAL TREATMENT
Being pregnant with uterine prolapse makes it - Vaginal Hysterectomy: most
harder to maintain the pregnancy. Pregnant common operation and its
women are normally evaluated every 4 weeks, indications are: post-
while pregnant women with uterine prolapse have menopausal prolapse; uterine
antenatal check-ups every 2 weeks. pathology such as small fibroids;
When you reach levels 2 and 3, the uterus has menstrual disorders such as
descended below the vagina, leaving no room for dysfunctional uterine bleeding;
growth, which might result in stillbirth. Worse, and prolapse during childbearing
when the fetus is not fully grown, it can drift out. age.
The baby may die, be deformed, or increase the - Burch operation: for relief of
mother's risk of bleeding. symptoms of cystocele.
There are several additional complications, such - Anterior Colporrhaphy: for
as urethral, bladder, and rectum prolapse. If the anterior vaginal wall prolapse.
condition is not addressed promptly, a
hysterectomy may be required due to - Posterior Colporrhapy: for repair
inflammation and loss of intrinsic elasticity. of the posterior vaginal wall and
perineum
- Manchester Repair (Fothergill’s

Operation): for repair of
uterovaginal prolapse; carried
out in women of childbearing age
46
and insists on the preservation of women with dense breasts. Because

uterus. these breast changes can cause a delay
in diagnosis, breast cancer is frequently
CANCER OF THE FEMALE REPRODUCTIVE discovered at a later stage in these
SYSTEM: BREAST, UTERUS, AND OVARIES women.
● Breast exams should be part of prenatal

BREAST CANCER and postnatal care.
SIGNS:
● A lump or thickening in or near the breast

or in the underarm area.
● A change in the size or shape of the

breast.
● A dimple or puckering in the skin of the

breast.
● A nipple turned inward into the breast.

● Fluid, other than breast milk, from the
nipple, especially if it's bloody.
● Scaly, red, or swollen skin on the breast,

nipple, or areola (the dark area of skin
around the nipple).
● Dimples in the breast that look like the

● A disease in which malignant cancer cells skin of an orange, called peau d’orange.
form in the tissues of the breast.
DIAGNOSIS:
● Sometimes breast cancer occurs in
women who are pregnant or have just ● Physical exam and health history: An
given birth. Breast cancer affects around exam of the body to check general signs
one in every 3,000 pregnancies. It is of health, including checking for signs of
more common in women aged 32 to 38. disease, such as lumps or anything else
Because many women are delaying that seems unusual. A history of the
having children, the incidence of new patient’s health habits and past illnesses
instances of breast cancer during and treatments will also be taken.
pregnancy is projected to rise.
● Clinical breast exam (CBE): An exam of
● It may be difficult to detect breast cancer the breast by a doctor or other health
early in pregnant or nursing women. professional. The doctor will carefully feel
When a woman is pregnant, the breasts and under the arms for lumps
breastfeeding, or has recently given birth, or anything else that seems unusual.
her breasts typically become bigger,
● Ultrasound exam: A procedure in which
sensitive, or lumpy. This is due to the
high-energy sound waves (ultrasound)
usual hormonal changes that occur
are bounced off internal tissues or organs
during pregnancy. Small lumps can
and make echoes. The echoes form a
become difficult to identify as a result of
picture of body tissues called a
these changes. Breasts may get denser
sonogram. The picture can be printed to
as well. Breast cancer detection with
look at later.
mammography is more challenging in
47
● Mammogram: An x-ray of the breast. A ● Radiation therapy

mammogram can be done with little risk ● Chemotherapy
to the fetus. Mammograms in pregnant Radiation therapy and chemotherapy should not
women may appear negative even be given during the first 3 months of pregnancy.
though cancer is present.
SPECIAL ISSUES ABOUT BREAST CANCER
● Biopsy: The removal of cells or tissues DURING PREGNANCY:
so they can be viewed under a
● Lactation (breast milk production) and
microscope by a pathologist to check for
breast-feeding should be stopped if
signs of cancer. If a lump in the breast is
surgery or chemotherapy is planned.
found, a biopsy may be done.
INTERVENTIONS/TREATMENT: ● Breast cancer does not appear to harm

the fetus.
● Treatment options for pregnant women
depend on the stage of the disease and the ● Pregnancy does not seem to affect the
trimester of the pregnancy. survival of women who have had breast
cancer in the past.
● Three types of standard treatment are used:
UTERINE OR ENDOMETRIAL CANCER
1. Surgery
2. Radiation therapy
3. Chemotherapy
● Ending the pregnancy does not seem to
improve the mother’s chance of survival.
● Treatment for breast cancer may cause side

effects.
Pregnant women with early-stage breast cancer

(stage I and stage II) are usually treated in the
same way as patients who are not pregnant, with
some changes to protect the fetus. Treatment
may include the following:
● Modified radical mastectomy, if the ● The most frequent type of gynecological

breast cancer was diagnosed early in cancer is uterine cancer (also known as
pregnancy. endometrial cancer).
● Breast-conserving surgery, if the breast ● Endometrial cancer risk in women has
cancer is diagnosed later in pregnancy. been closely linked to the number of full-
Radiation therapy may be given after the term pregnancies, with the first full-term
baby is born. pregnancy providing significant
protection and successive full-term
● Modified radical mastectomy or breast- pregnancies providing additional
conserving surgery during pregnancy.
protection.
After the first 3 months of pregnancy,
certain types of chemotherapy may be ● Endometrial cancer develops in the
given before or after surgery. endometrium, the inner lining of your
uterus. It’s one of the most common
There is no standard treatment for patients with
gynecologic cancers — cancers affecting
late-stage breast cancer (stage III or stage IV) your reproductive system.
during pregnancy. Treatment may include the
following: ● Gynecological cancers are connected
with a higher risk of infertility than other
48
types of cancer because they directly INTERVENTIONS/TREATMENT:

damage a woman's reproductive system.
However, endometrial cancer is most • While the major goal of uterine cancer
commonly found in postmenopausal treatment is to enhance a patient's outcome
women who are no longer interested in and quality of life, fertility is a secondary but
having children. critical issue that must be addressed if a
woman wants to have children in the future.
SYMPTOMS: • Hysterectomy is the most common therapy
for uterine cancer. The uterus and cervix of a
Symptoms of endometrial cancer include:
woman are removed during this surgical
• Vaginal bleeding between periods before surgery.
menopause.
• Bilateral salpingo-oophorectomy, which
• Vaginal bleeding or spotting after involves the removal of both ovaries and
menopause, even a slight amount. fallopian tubes, is also performed on some
• Lower abdominal pain or cramping in women. Infertility is a certain result of this
your pelvis, just below your belly. therapy strategy.
• Thin white or clear vaginal discharge if • Chemotherapy may be considered as an
you’re postmenopausal. alternative to surgery in rare situations.
• Extremely prolonged, heavy or frequent However, because this treatment disperses
vaginal bleeding if you’re older than 40. powerful cancer-fighting drugs throughout a
RISK FACTORS: woman's body, there is a chance that healthy
cells will be damaged. A woman's eggs or
● Age another portion of her reproductive system,
for example, may be affected in such a way
● Diet high in animal fat that she is unable to conceive or bring a baby
● Family History to term.
● Diabetes
OVARIAN CANCER
● Obesity
● Ovarian diseases
DIAGNOSIS:
Talk to your healthcare provider if you notice

possible signs of uterine cancer. Your provider
will:
• Ask about your symptoms, risk factors

and family history. ● The essential thing to remember is that
• Perform a physical exam. most ovarian tumors discovered during
• Perform a pelvic exam. pregnancy are not cancerous, and those
Your provider may perform one or more tests to that are are usually in the early stages.
confirm the diagnosis of uterine cancer. This For most women, this signifies that the
includes: baby's life is not in danger. Furthermore,
many women can protect their fertility (if
• CA-125 assay
desired) through conservative surgery
• CT scans
that involves removing only the afflicted
• MRI scans
ovary and fallopian tube.
• Transvaginal Ultrasound
• Endometrial biopsy ● Cancer is unlikely to have an impact on
• Hysteroscopy the fetus's health or development.
• DIlation and curettage (D&C) Cancer cells would have to penetrate
49
past the placental barrier to impact the • During pregnancy, surgeons may perform
fetus. ovarian cancer surgery with relative safety.
However, if surgery is performed during the
● Although nutrition and oxygen from the first trimester, the risk of miscarriage is
mother's blood supply pass through the somewhat increased. Although there may be
placenta to the fetus, cancer cells seldom a slight rise in risk to the fetus, surgery should
spread to the placenta and even less not be postponed if it is necessary.
frequently to the fetus.
• Chemotherapy is safest for the fetus if
HOW CAN YOU DIFFERENTIATE THE administered during the second or third
SYMPTOM OF PREGNANCY VS SYMPTOM OF trimesters of pregnancy. The fetus develops
OVARIAN CANCER? organs during the first trimester. With
By the time you start experiencing symptoms, chemotherapy in the first trimester, there is a
your doctors will have discovered an abnormal 10-20% probability of fetal deformity and a
tumor on your ovaries during routine ultrasounds 1.3% chance of malformation in the second
and will have started a treatment plan. However, or third trimester.
if you have a family history of ovarian, breast, or
colorectal cancers or are aware of a cancer risk REFERENCES:
gene mutation in your family or personal genetics, A. (2021, December 30). Ovarian Cancer During
you should always consult your doctor about any Pregnancy. American Pregnancy Association.
changes in your symptoms. https://americanpregnancy.org/healthy-
Bloating, frequent urination or an urgent need to pregnancy/pregnancy-complications/ovarian-
urinate, lower abdomen pain, feeling full cancer-during-pregnancy/
quickly/difficulty eating, lethargy, constipation, Beaumont Health. (2019). Types of Penile
backaches, and pain during intercourse are Conditions and Diseases. Beaumont.org.
common signs of ovarian cancer. Because most, https://www.beaumont.org/conditions/types-of-
if not all, of these symptoms might be attributed penile-conditions-diseases
to pregnancy, it can be difficult to determine the
cause on your own. One of the reasons it is Breast Cancer Treatment During Pregnancy
critical to keep your doctor up to speed on your (PDQ®)–Patient Version. (2022, December 14).
symptoms is that they may be a sign of a problem, National Cancer Institute.
such as reproductive cancer. The majority of https://www.cancer.gov/types/breast/patient/preg
ovarian cancer patients found during pregnancy nancy-breast-treatment-
are asymptomatic. pdq#:~:text=Sometimes%20breast%20cancer%
20occurs%20in,of%20prenatal%20and%20post
RISK FACTORS: natal%20care.
• Older age Cleveland Clinic. (n.d.). Sexual Dysfunction &
• Inherited gene changes Disorders: Treatment, Symptoms & Diagnosis.
• Family history of ovarian cancer https://my.clevelandclinic.org/health/diseases/91
• Being overweight or obese 21-sexual-
• Postmenopausal hormone replacement dysfunction#:~:text=Sexual%20dysfunction%20g
therapy enerally%20is%20classified
• Endometriosis
• Age when menstruation started and ended Cleveland Clinic. (n.d.). Epididymitis.
https://my.clevelandclinic.org/health/diseases/17
• Never having been pregnant
697-epididymitis
INTERVENTIONS/TREATMENTS:
Chances of Having Children After Uterine
• Treatment for ovarian cancer, which includes Cancer. (n.d.-b). Moffitt Cancer Center.
surgery and chemotherapy, may be more https://moffitt.org/cancers/endometrial-uterine-
dangerous to the fetus than cancer itself. cancer/faqs/what-are-my-chances-of-having-
children-after-uterine-
50
cancer/#:~:text=Is%20it%20possible%20to%20b Uterine (Endometrial) Cancer: What Is It?(n.d.).

ecome,a%20woman's%20uterus%20and%20cer Cleveland Clinic.
vix https://my.clevelandclinic.org/health/diseases/16
409-uterine-cancer
Geng, C. (2021b, October 30). Ovarian cancer
and pregnancy: A guide. World Health Organization (WHO). International
https://www.medicalnewstoday.com/articles/ovari Classification of Diseases, 11th Revision (ICD-11)
an-cancer-and-pregnancy#during-pregnancy Geneva: WHO 2018.
Healthline. (2022, January 13). Varicocele:

Causes, Symptoms, and Diagnosis.
https://www.healthline.com/health/varicocele#tre
atments
Joshi, A. (2017, February 25). Prolapse of Uterus.

https://www.slideshare.net/AbhishekJoshi151/pr
olapse-of-uterus-72577242
Mayo Clinic. (n.d.). Varicocele - Symptoms and

causes.https://www.mayoclinic.org/diseases-
conditions/varicocele/symptoms-causes/syc-
20378771#:~:text=A%20varicocele%20is%20an
%20enlargement
Ovarian cancer - Symptoms and causes - Mayo

Clinic. (2021, August 31). Mayo Clinic.
https://www.mayoclinic.org/diseases-
conditions/ovarian-cancer/symptoms-
causes/syc-20375941
Pillitteri, Adele. (2010). Maternal & Child Health

Nursing: Care of the Childbearing & Childrearing
Family (Edition 6). Philadelphia: Wolter Kluwer.
Staff, I. H. (2022, September 26). Bioethics in

nursing. Incredible Health. Retrieved March 27,
2023, from
https://www.incrediblehealth.com/blog/bioethics-
in-nursing/
Stortz, K. (2021, November 22). Going From

Prolapse to Powerful: The Complete Guide to
Uterine Prolapse. BraceAbility.
https://www.braceability.com/blogs/info/prolapse
d-uterus
The possibility of pregnancy and childbirth with

uterine prolapse. (n.d.). Vinmec.
https://www.vinmec.com/en/news/health-
news/obstetrics-gynecology-and-assisted-
reproductive-technologies-art/the-possibility-of-
pregnancy-and-childbirth-with-uterine-prolapse/
51

MCN Lec Group 1 Written Report

Uploaded by

Copyright:

Available Formats

MCN Lec Group 1 Written Report

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

MCN Lec Group 1 Written Report

Uploaded by

Copyright:

Available Formats

MCN II LECTURE [GROUP 1]

BACHELOR OF SCIENCE IN NURSING – PLM

• Maternal and child health nursing (MCN) can

• HIV infection is an increasing threat. Mother-

FACTORS THAT AFFECT THE RISK OF

• Frequency and spacing of births.

GENETICS PATTERN OF INHERITANCE

• Genetics is the study of heredity and the

resource a curse or take decision on various o Educate people about inherited

• The genetic counseling is defined as the

o What are our obligations to one ▪ The ethic of beneficence fits

the foreskin is challenging when you have

• In certain situations, boys who require

may be utilized to acquire diagnostic o Abnormal Testicular Lie (Often

and this may cause psychological and o Some Antibiotics (Isoniazid,

o If your condition is caused by an

▪ The presence of any • “Any vaginal discharge present is assessed

PELVIC EXAMINATION SPECULUM EXAM

▪Irregular bleeding between • Physical Exam in Primary Amenorrhea

o Endocrinology consults if needed o Late-onset congenital adrenal

o Psychological interview for eating o Associated with underlying pelvic

▪ Pregnancy test out into the pelvis and peritoneum. This is

o Hysterectomy • It describes the physical and emotional

• For mild cases, give iron supplements and

o Verbalize her understanding and

• Bacterial vaginosis signs and symptoms may b. Candidiasis

Screening and diagnosis

• A focused history may help distinguish BV

• A number of antifungal preparations are

inflammatory disease leading to infertility, • Gonorrhea is caused by the aerobic, gram-

c. Syphilis Therapeutic Management

CARE OF AT-RISK/HIGH-RISK AND SICK

CARE OF AT RISK/HIGH-RISK MOTHER

IDENTIFYING A HIGH-RISK PREGNANCY:

● High-risk pregnancy is one in which a

• Preventive strategies that have been

● The pregnancy of a woman who is internist, obstetrician, and nurse. Ideally,

● A preterm infant born to a teenage girl,

○ If the edema is a sign of heart ● Hematologic disorders during pregnancy

Nursing Interventions That Can Be Done GASTROINTESTINAL DISORDERS AND

● Pregnancy complications such as premature ● A chronic musculoskeletal disorder that may

● In other instances, abdominal pain is

before pregnancy because the fetus Postpartum Adjustment

● FACTORS PREDISPOSING INFANTS TO

● Health care personnel with infections have a

g. Hemolytic Disease of the Newborn – It INFECTIONS CONTRACTED FROM

controlled during pregnancy is typically ● An infant needs follow-up so any future

INFANT OF A DRUG-DEPENDENT MOTHER EVIDENCE-BASED INTERVENTIONS:

○ Distinct facial feature (short

● Growth deficiencies may remain throughout

Breast cancer Screening?

tissue through the fallopian tubes during a

● Daughters of women with endometriosis may

● In many women, it appears to be related to

1. Polycystic ovary syndrome (PCOS): This is

PELVIC FLOOR DISEASE the end of the day or is related to a

● Pelvic organ prolapse. “Prolapse” happens in CAUSES

SYMPTOMS: ● Getting older. The pelvic floor muscles can

● Surgery. Previous hysterectomy and prior TREATMENT