OB Ch 7 Study Guide .docx - Chapter 7 Families with Special...

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Chapter 7 : Families with Special Reproductive Concerns Infertility Failure to achieve successful pregnancy after 12 or more months of unprotected sex. Profound emotional, psychologic, and economic impact on affected couples and society. Sterility Absolute factor prevents reproduction Subfertility A couple that has difficulty conceiving because both people have reduced fertility. Primary infertility No prior pregnancies Secondary infertility unable to conceive after one or more successful pregnancies or cannot sustain a pregnancy. Table 7-1 p. 113 possible causes of infertility o Components for normal fertility are correlated with possible causes of deviation in the table. o 20% can be due to male o 40% due to female factor o Unknown cause (unexplained infertility) o Or a problem with both partners (30-40%) Professional intervention can help approx. 65% of infertile couples achieve pregnancy. Young couples without a hx suggestive of reproductive disorders should be referred for infertility evaluation if unable to conceive after at least 1 year of trying o Earlier workup for those with positive histories of fertility-lowering disease or advancing maternal age. o If woman is over 35, refer after only 6 months of trying, or earlier if indicated Most important determinant of a couple’s fertility= age of the woman. Infertility testing approaches o Easiest and least intrusive used first o Extensive testing avoided until data confirms timing of intercourse and length of coital exposure have been adequate o Nurse provides info about most fertile times to have intercourse during menstrual cycle o Teaching the couple, the signs and timing of ovulation, the most effective times for intercourse within the cycle, and other fertility awareness behaviors may solve the problem. o First- primary assessment: comprehensive hx (including genetic conditions) and physical exam for any obvious causes of infertility o Initial infertility evaluation Helps infertile couples maximize chances of delivering a healthy baby Prenatal vitamins often one of the earliest recommendations review importance of rubella and varicella immunity and the risk of congenital anomalies associated with exposure. address risks associated with alcohol, tobacco, and medications. may need a change in medications or stricter management of chronic illnesses. can affect the self-esteem of one or both partners provide comfort by offering a sympathetic ear, nonjudgmental approach, and appropriate info and instructions through dx and tx. Be comfortable with sexuality to est. rapport
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o The first interview Involves both partners Includes comprehensive hx and physical exam Table 7-2 p. 115 semen analysis should be one of the first dx o After thorough hx and exam Both partners undergo tests to identify causes of infertility Female evaluation includes: assessment of hypothalamic- pituitary axis in terms of
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