STERILIZATION METHODS

What methods are available for surgical sterilization?

               

Male: vasectomy—ligation of vas  deferens preventing passage of sperm into seminal fluid

Female: 1. Ligation/removal of a section of the   fallopian tube—involves laparotomy or laparoscopy

        2. Mechanical blockage— using rings, coils, clips, or plugs

        3. Coagulation-induced blockage—usually through cauterization methods

What are the overall risks and benefits of female sterilization?   

Risks: 1. Anesthesia/surgical complications

        2. Ectopic pregnancy—failed procedures can result in an increased risk of ectopic pregnancies

       3. Regret of the procedure (especially in younger people)

       4. Does not stop the spread of HIV or other STIs Benefits:

1. Not coitally dependent

2. Decreased risk of ovarian  cancer

3. No evidence of menstrual irregularity or dysmenorrhea

What are the risks and benefits of each of the female sterilization procedures?

Ligation is one of the oldest methods of sterilization with the lowest failure rate (0.8%) but it is not easily reversed

Mechanical blockage with a clip is the most readily reversed method but it also has the highest failure rate (3.7%)

Coagulation-induced blockage with electrocautery is the fastest procedure with a low failure rate (2.5%), but there is increased  risk of electrical damage to  surrounding structures

What are some advantages and disadvantages of a vasectomy?               

Advantages: effectiveness is very high—typical first-year failure  rate 0.15%; simpler, surgically  safer, more cost-effective than  female sterilization; Males   share contraception  responsibility with females 

Disadvantages: does not protect against STIs

Is reversibility after a female sterilization procedure and vasectomy possible?

Reversibility after a female  sterilization procedure is generally very difficult and has been reported as only 60% effective.

As for vasectomy, men are generally counseled  that it is permanent. About 50–70% of  men who have a reversal become fertile.   The chance of becoming fertile decreases with increasing time after the procedure

If a woman in her early twenties with two  children requests tubal sterilization, what is the next appropriate recommendation?

Considering the woman’s age, you  must inform her of the risk for regret of the procedure and of the permanence  of tubal sterilization/ difficulty of reversal

Family Planning Methods

As promised, here’s the next topic which I hope you will learn from in studying about female physiology.

Family Planning

How many American women use                                  Between 89% and 93%; yet 53% of

contraception and what are the rates of                     births are either unintended or

unintended or mistimed pregnancy in the                   mistimed

United States?

What are some of the reasons for                                 Failure of the method; Incorrect use;

contraception failure?                                                      Nonadherence

What are the two measures for                                     1. Theoretical effectiveness (perfect

effectiveness of a contraceptive method? use)                      

  —the pregnancy rate among women who use the method

correctly every time

2. Actual effectiveness (typicaluse)

—includes the chances of inconsistent or incorrect use

What factors about each method must be                  Coital dependence, convenience,

considered when counseling about                              cost, duration of action, protection

contraception?                                                                   against sexually transmitted infections (STIs), effect on menses, religion, reversibility, acceptability,

and side effects

What are the five main classes of                                 1. Rhythm method

contraception?                                                                   2. Barrier methods

3. Hormonal contraceptives

4. Intrauterine devices (IUDs)

5. Sterilization

Rank the following contraceptives from

the highest to the lowest with respect to

actual effectiveness. What is the failure

rate associated with each?

Condom, diaphragm/cervical cap,                                IUDs (0.1–2%)

injectable/implantable hormonal                                   Sterilization (0.4–4%)

contraception, oral contraception, periodic

abstinence (fertility awareness method),                    Injectable hormonal contraception

spermicide, sterilization, withdrawal                            (<1%)

Oral contraceptives (5%)

Male condom (14%)

Diaphragm or cervical cap (20%)

Female condom (21%)

Periodic abstinence (25%)

Withdrawal (19%)

Spermicide (26%)

What is the fertility awareness method?                     Predicting the time of month when a

woman is most fertile and abstaining during that time. Also known as the rhythm method

What three methods can be used to predict               1. Date of the last menstrual period:

fertility and which days are women                              days 8–19 of the cycle

presumed to be fertile?                                                    (peri-ovulation)

2. Changes in body temperature:

after menstruation until 3 days after an increase in basal body temperature by 0.5–1°F

3. Changes in cervical mucus: when the mucus becomes clear and stretchy (peri-ovulation) known as spinbarkeit

Why are fertility awareness methods                           Because people do not always

unreliable?                                                                           abstain during this time and because there is always some chance of fertility on the “non-fertile” days.

Body temperature and cervical mucus (especially if used together) are moreeffective than the calendar method because of irregular cycle lengths

What is the withdrawal method?                                   The withdrawal method is when the male withdraws from the vagina before ejaculation. It is ineffective when not timed correctly or when the pre-ejaculatory fluid contains sperm

Is lactation an effective means of birth                        Lactation is somewhat effective as a

control?                                                                                means of birth control because of the prolactin-induced inhibition of GnRH, which leads to a delay in return

to ovulation. Additional contraception should be used by breast- feeding women to prevent pregnancy

What factors affect the effectiveness of                     The number of times a woman breast

lactation as a means of birth control?                          feeds each day; How effective breast feeding is (i.e., how much milk she is producing); If the child is getting any supplemental feeding

Next topic… Sterilization Methods..

Facts on Menstrual cycle

When I was still a student, I didn’t like maternal and child nursing or topics that pertain to taking care of pregnant women and the child. I really find it hard to understand and memorize facts about it and so I really am having difficulty appreciating it. But then again, when you are in this profession or whatever profession you are in right now you really could not get away from topics that you hated most back when you were studying. And so, I would like to take this opportunity to share to you some information’s from Maternal and child nursing which I think is very helpful not only for me but also for all of the students out there who are finding their way to becoming a nurse. Lets start from some basic concepts.

Menstrual Cycle Physiology

What is the average duration of the                              The average duration of the

menstrual cycle, duration of menses, and                  menstrual cycle is 28 days. The

amount of blood loss during menses?                         average duration of menstrual flow

is 4 days. On an average, women lose

less than 60 mL of blood during each

menses

What are the two phases of the menstrual                 Follicular (or proliferative) phase and

cycle and how long does each last?                             the luteal (or secretory) phase,

separated by ovulation. (Follicular/

luteal describe the ovarian changes,

proliferative/secretory describe the

endometrial changes)

By convention, day 1 marks the onset

of menses. The follicular phase begins

on day 1 and lasts approximately

14 days (days 1–14) in a 28-day cycle,

until ovulation occurs. The luteal

phase then commences and lasts until

approximately day 28 (days 14–28)

What causes the variability in the length                     The duration of the follicular phase

of the menstrual cycle?                                                    (the luteal phase is constant)

Describe the hormone pathway involved                    The cycle begins in the arcuate

in the menstrual cycle (see Fig. 4-1) and                     nucleus of the hypothalamus where

name which structures produce                                   gonadotrophin-releasing hormone

each hormone                                                                     (GnRH) is released in a pulsatile

fashion. GnRH stilmulates the

anterior pituitary to release folliclestimulating

hormone (FSH) and

luteinizing hormone (LH). These

gonadotropins then cause the ovaries

to release the sex steroid hormones

estradiol and progesterone.

Estrogenand progesterone feedback

negatively on both the hypothalamus

andthe pituitary gland

What is happening in the ovary during the                     The ovary beings with

menstrual cycle?                                                               approximately one million primordial

follicles at birth (20 million at week

20 in utero). Each follicle contains an

oocyte arrested in prophase of

meiosis. The oocyte is surrounded by

pre-granulosa cells and these are

surrounded by pre-theca cells. In the

follicular phase, FSH stimulates the

pre-granulosa cells to become

granulosa cells. The granulosa cells

secrete estradiol. The pre-theca cells

in turn become theca cells and secrete

androgens, which are aromatized by

the granulosa cells into estradiol.

One follicle with the highest number

of granulosa cells, FSH receptors, and

estradiol production becomes the

dominant follicle and all other

follicles become atretic. This follicle is

released during ovulation and

becomes the corpus luteum. The

corpus luteum secretes progesterone

and a smaller amount of estrogen

during the follicular phase of the

cycle. If fertilization does not occur, it

degenerates into the corpus albicans

What is the function of the corpus luteum?                Secretion of progesterone and

estradiol. It is the only structure that

produces progesterone in significant

quantities which sustains the

pregnancy until the placenta is

developed

What is happening to hormone levels in                      At menstruation, concentrations of

the follicular phase?                                                          estradiol, progesterone, and LH are

at their lowest point. FSH and LH

levels begin to rise in response to

the low estrogen and progesterone.

Estradiol levels, secreted from the

dominant ovarian follicle, begin to

rise by day 4. Just before ovulation,

estradiol levels peak. This peak

causes a positive feedback on LH

secretion, leading to the LH surge

and a smaller FSH surge, which

results in ovulation 30–38 hours

later. Progesterone levels remain low

throughout the follicular phase

 

What is happening to hormone levels in                      The LH surge causes granulosa and

the luteal phase?                                                                theca cells to secrete progesterone

and smaller amounts of estrogen.

Progesterone peaks 3–4 days after

ovulation.

Estrogen levels decrease immediately

after ovulation but slowly rise with

the growth of the corpus luteum.

Progesterone and estrogen (at low to

moderate levels) both act via negative

feedback to suppress LH and FSH. If

fertilization and implantation do not

occur, progesterone and estradiol

levels diminish after 11 days. FSH

increases as the corpus luteum

regresses

What is happening to the endometrium in                   At menses, the endometrium sloughs

the proliferative phase?                                                   off until it becomes a thin line. During

the proliferative phase estradiol levels

rise, resulting in the proliferation of

the uterine endometrium. The

endometrium becomes thicker and

more glandular and the spiral arteries

elongate. On ultrasound, it appears as

a “triple stripe” pattern

What is happening to the endometrium in                   The progesterone released from the

the secretory phase?                                                        corpus luteum leads to slowing of

endometrial proliferation,

reorganization of the glands (resulting

in a more edematous stroma), and

further coiling of the spiral arteries.

This results in the loss of the “triple

stripe” pattern and its replacement

with a uniformly bright

endometrium. If pregnancy does not

occur, the endometrium degenerates

What are the primary clinical                                          Estradiol

manifestations of estradiol and                                     Endometrium: thickens stroma and

progesterone during the menstrual cycle? elongates glands (creates proliferative

endometrium); Endocervix: stimulates

secretion of thin, watery mucus.

Produces “ferning” pattern when

spread on a glass slide;

Vagina: promotes vaginal thickening

Progesterone

Endometrium: causes tissue to

become edematous and blood vessels

to thicken and twist (creates

secretory endometrium);

Endocervix: thickens endocervical

mucus, causing it to become stringy;

Breast: stimulates acinar glands,

causing breasts to round;

Other: raises basal body temperature

by 0.6–1°F. Causes some women to

have the emotional, physical, and

behavioral changes of premenstrual

syndrome (PMS)

What layer of the endometrium sloughs                      The functionalis layer (inner layer)

off during menses?                                                           sloughs off after glandular and

stromal degeneration

What hormone mediates menstrual                             Prostaglandins, especially PGF2á. It is

cramps and how is it synthesized?                               released by the secretory

endometrium in response to

progesterone and causes uterine

contractions

That’s it. Hope you learned something from this. Next time, I will be posting about family planning.. till next time..

"Importance of having Breakfast"

Breakfast can help prevent strokes, heart attack and sudden death. Advice on not to skip breakfast! Healthy living. For those who always skip breakfast, you should stop that habit now! You've heard many times that "Breakfast is the most important meal of the day. Now, recent research confirms that one of the worst practices you can develop may be avoiding breakfast. Why?

 Because the frequency of heart attack, sudden death, and stroke peaks between 6: 00a.m. and noon, with the highest incidence being between 8: 00a.m. and 10:00a.m.What mechanism within the body could account for this significant jump in sudden death in the early morning hours? We may have an Answer. Platelet, tiny elements in the blood that keep us from bleeding to Death if we get a cut, can clump together inside our arteries due to Cholesterol or plaque buildup in the artery lining. It is in the morning hours that platelets become the most activated and tend to form these internal blood clots at the greatest frequency.
However, eating even a very light breakfast prevents the morning platelet activation that is associated with heart attacks and strokes. Studies performed at Memorial University in St.Johns,   Newfoundland found that eating a light, very low-fat breakfast was critical in modifying the morning platelet activation. Subjects in the study consumed either low-fat or fat-free yogurt, orange juice, fruit, and a source of protein coming from yogurt or fat-free milk. So if you skip breakfast, it's important that you change this practice immediately in light of this research. Develop a simple plan to eat cereal, such as oatmeal or Bran Flakes, along with six ounces of grape juice or orange juice, and perhaps a piece of fruit. This simple plan will keep your platelets from sticking together, keep blood clots from forming, and perhaps head off a potential Heart Attack or stroke. So never ever skip breakfast