NCM 109 1.

Clomiphene citrate (Clomid, Serophene) –

estrogen antagonist, drug of choice to
Infertility Management – focuses on correction of
stimulate ovulation
underlying problem; involves treating the underlying
2. Human menopausal gonadotropins
cause– chronic disease, inadequate hormone
(Pergonal) – combi of FSH & LH in
production, endometriosis, or infection
conjunction wt admin of HCG, to produce
*if impossible, focus on conception thru assisted ovulation
reproductive techniques– in vitro fertilization or
Inability of spermatozoa to survive in scant or
sperm donation
tenacious vaginal secretion: low dose estrogen – to
Correction of underlying problem: ^ mucus prod during 5-10 days in cycle

1. ^sperm count and motility Surgery:

2. Reducing presence of infection
1. Myoma (fibroid tumor) – uncommon cause of
3. Hormone therapy
infertility; do myomectomy or tumor removal
4. Surgery
2. Tubal insufficiency from inflammation –
^ sperm count & motility: diathermy or steroid admin to reduce
adhesions
✓ Obstruction of vas deferens – usually difficult 3. Peritoneal adhesions or nodules of
or impossible to relieve by surgery endometriosis that hold tubes fixed & away
✓ Low spermatozoa count – abstain from from ovaries – removed by laparoscopy or
coitus or multiple ejaculations for 7-10 days laser surgery
Varicocele: Assisted repro techniques:
✓ Ligation ✓ Therapeutic insemination
✓ Advise changes in lifestyle (wear loose ✓ In vitro fertilization
clothing, avoid long sitting, avoid prolonged ✓ Gamete intrafallopian transfer
hot baths = reduced scrotal heat & ^sperm ✓ Zygote intrafallopian transfer
count) ✓ Surrogate embryo transfer
Immunologic factor: vaginal secretions immobilize ✓ Preimplantation genetic diagnosis
spermatozoa Therapeutic or Artificial insemination: installation of
✓ Response reduced by abstinence or condom sperm to female tract for conception; sperm instilled
use for 6mos. to cervix or uterus
✓ Avoid prolonged time interval, washing of ✓ Husband’s sperm or donor sperm TDI
spermatozoa & intrauterine insemination (therapeutic donor insemination) used
done ✓ When man lacks sperm count or wt genetic
✓ Admin of corticosteroids to woman defect; woman has vaginal or cervical factor
decreases sperm immobilization bc it interfering wt sperm motility, or no partner
reduces immune response ✓ Sperm is cryopreserved in bank before
Reducing presence of infection – infection treated therapy *to be available for insemination
accdg to causative agent based on culture reports In Vitro Fertilization: removing mature oocyte from
Hormone therapy: if problem appears to disturb ovary by lap & fertilizing it thru sperm exposure
ovulation under lab conditions, outside body

Mgt: Embryo Transfer – insertion of lab grown fertilized

ova to uterus 40hrs after fertilization
IVF-ET: used for couples not able to conceive bc of Maternal risk factors:
blocked or damaged fallopian tubes & for man wt
1. Age below 18y/o
oligospermia (low sperm count)
2. History of preterm labor
Gamete Intrafallopian Transfer (GIFT): 3. Poor ob history
4. Multiple pregnancy
1. ova from ovaries exactly as IVF-ET
5. Hydramnios
procedure
6. Smoking
2. ova & sperm instilled w/in hrs to open end of
7. Poor hygiene
patent fallopian tube
8. Poor nutri
3. fertilization in tube & zygote naturally moves
9. Employment
to uterus for implantation
4. has ***** rate slightly higher ***** Cardinal s/sx of antepartum complications
5. C/I if fallopian tubes are blocked
1. Dizziness
Zygote Intrafallopian Transfer (ZIFT) 2. N/v
3. Headache
1. Oocyte retrieval by transvaginal, ultrasound-
4. Fatigue
guided aspiration then cultured and
5. Abd pain or cramping
insemination of oocytes in lab
6. Uterine labor before EDD
2. Fertilized egg transferred by lap
Family risk factors:
Surrogate embryo transfer: for woman who don’t
ovulate; oocyte donated by friend or anonymously 1. Diabetes
2. Birth complications
✓ Menstrual cycles of donor & recipient woman
are in sync by gonadotropic hormones admin Cardinal s/sx of intrapartum complications
✓ At ovulation, donor’s ovum removed by
1. Sudden gush of vaginal fluid
transvaginal ultrasound-guided technique
2. Copious vaginal bleeding
✓ Oocyte fertilized by male partner’s sperm &
3. Uterine contractions wt or w/o abd pain
placed in uterus by ET or GIFT
4. Decrease fetal movement
Preimplantation Genetic Diagnosis:
Cardinal s/sx of postpartum complications
✓ Indi retrieval of oocytes by microsurgical
1. Altered bladder status & voiding problems
techniques = close inspection & recog of
2. Altered sleep & rest
differences in sperm
3. Poor appetite, nutri, hydration
✓ Before oocyte impregnation, it is examined
4. Tenderness, pain, discomfort
for genetic charac. or other abnormalities
5. No response to newborn
“high risk” – rarely just one causative factor
Identifying / Monitoring high risk pregnancy:
Focus of intervention: teaching & additional screening procedures, Dx tests & lab exams
measures to maintain health
Alpha feto protein (AFP) enzyme blood test:
Risk factors:
✓ Alpha-fetoprotein: a glycoprotein by fetal
1. Poverty liver
2. Lack of support ✓ ^ level in amniotic fluid (AFAFP) or maternal
3. Poor coping mechanisms serum (MSAFP) = chromosomal or spinal
4. Genetic inheritance cord disorder, open neural tube defects,
5. Past history of pregnancy complications spina bifida, anencephaly
✓ Decreased level = down syndrome
✓ If ^ for 2 samples = multiple pregnancies
 ✓ Ultrasonography & amniocentesis – for ✓ Observe for 30mins after: 1) labor
further confirmation contractions not beginning 2) FHT w/in
✓ Done at 14-16wks AOG normal range
✓ Can lead to compli: 1) hemorrhage from
Ultrasonography:
placental penetration 2) AF infection 3) fetal
✓ Measures response of sound waves against puncture
solid obj ✓ Nsg care: void, after test- 1) monitor uterine
✓ Much used tool in modern ob contractions, vaginal discharge 2) assess
FHT 3) teach to observe signs of infection 4)
Purposes of ultrasonography: encourage test
1. Diagnose pregnancy at 6wk AOG Non stress test (NST):
2. Confirm presence, size, & location of
placenta and AF ✓ Assess fetal well-being based on relationship
3. Establish that fetus is growing w/o gross between FHT & activity
anomalies like hydrocephalus, anencephaly, ✓ Evaluate FHT accelerations that normally
heart, kidney & bladder defects occur from fetal activity in good condition
4. Establish sex ✓ Reactive (good sign, healthy fetus) – FHT ^
5. Establish presentation & position of fetus by 15bpm above baseline & remain elevated
6. Predict maturity by parietal diameters of for 15sec; to label reactive, 5 responses
head obtained during 20mins record
7. Visualization: during 1st 20wks improved if wt ✓ Nonreactive – FHT doesn’t ^ w/ fetal
full bladder & not necessary after 20wks movements or fewer than 5 such responses
8. Nsg care: encourage fluids & refrain from w/in 20mins record
voiding before test ✓ Nsg care: 1) fasting not necessary 2)
observe fetal monitor 3) explain test to
Chorionic Villi Sampling (CVS): decrease anxiety 4) evaluate response to
✓ Retrieval & analysis of CV for chromosomal procedure
analysis Contraction stress test (CST)
✓ Tissue of fetal origin: to obtain samples of CV
to test genetic disorder in fetus ✓ Evaluate ability of fetus to w/stand stress of
✓ Done at 8-10wks or 5th week uterine contractions during labor
✓ Nsg care: may or may not be done w/ full ✓ Generally used after 34wks AOG
bladder depending on position of uterus & ✓ Used w/ decreasing frequency bc it may
placenta stress an already stressed fetus
✓ After test, monitor: 1) uterine contractions 2) ✓ Negative test: 1) 3 contractions of good
vaginal discharge 3) teach to observe for quality & duration 2) w/o late decelerations or
signs of infection other ominous response of FHT 3) indicates
enough placental sufficiency
Amniocentesis: ✓ Positive test: 1) occurrence of late
✓ Aspiration of AF from pregnant uterus thru decelerations or other ominous response of
abd wall FHT due to uterine contractions 2) placental
✓ 14-16th week sufficiency due to stress of uterine
✓ Purposes: 1) detect sex 2) chromosomal or contractions
biochemical defects 3) lung maturity 4) ✓ Equivocal or Suspicious: 1) has non-
^bilirubin level r/t Rh disease 5) persistent late decelerations 2) deceleration
phosphatidylglycerol (PG) – appears in AF associated w/ hyperstimulation (contraction
after 35thwk, indicates lung maturity frequency every 2mins)
 ✓ Nsg care: 1) void before test 2) monitor FHT 4. Indirect comb’s test – det if Rh antibodies are
for 30mins before test 3) evaluate response in Rh negative woman
to procedure 5. Antibody titires for rubella & hep B (HBsAg)
6. HIV screening (ELISA test & Western Blot)
Biophysical profile (BPP):
7. GTT – to rule out gestational diabetes
✓ Assess breathing movements, tone, AF
Pelvimetry:
volume, FHR reactivity (NST)
✓ Score of 2 assigned to each finding, w/ score ✓ Assess of female pelvis in relation to birth of
of 8-10 = healthy fetus (like APGAR scoring) baby
✓ For compromised fetus ✓ Also done thru radiography & MRI
✓ Nsg care: provide emotional support,
Pelvic planes:
evaluate response to procedure
1. Pelvic inlet – line bet narrowest bony point by
Maternal assess of fetal activity:
sacral promontory & inner pubic arch = ob
1. Contact physician, nurse or midwife: fewer conjugate (should be 11.5cm or more)
than 10 movements in 8hr period or no fetal transverse diameter = 13.5cm
movements in morning 2. Midpelvis – line bet narrowest bone points
2. For determining fetal vitality connects ischial spine; exceeds 12cm
3. Nsg care: teach to record & report 3. Pelvic outlet – distance bet ischial
movements tuberosities (normally > 10cm) & angulation
of pubic arch
Fetal scalp pH sampling:
Four types of pelvis
✓ Vaginal procedure when in active labor
✓ Capillary blood samples from fetal scalp in 1. Gynecoid – ideal shape, w/ round to slightly
utero oval (ob inlet slightly transverse) best
✓ Determine if fetus is getting enough oxygen chances for NSVD
✓ Normal: (7.25-7.35) Borderline pH: (7.20- 2. Android – triangular inlect, prominent ischial
7.25) spines, more angulated pubic arch
✓ Abnormal < 7.20pH: not enough oxygen; of 3. Anthropoid – widest transverse diameter <
acidosis is present = immediate birth needed the anteroposterior (ob) diameter
✓ Nsg care: cleanse vaginal area to avoid 4. Platypelloid – flat inlet w/ shortened ob
contamination during test diameter

Fetal Acoustic Stimulation Test (FAST) or RHD: origin 50% are rheumatic fever, congenital &
Vibroacoustic Stimulation Test (VST): mitral valve disorders are most common

✓ App of vibratory sound stimulus to abd of Hemodynamics of pregnancy that affect client w/
pregnant woman to induce accelerations HD:
✓ ^FHT = absence of fetal metabolic acidemia
✓ Oxygen consumption ^10%-20% r/t needs of
✓ Reactive test: 2 accelerations of 15bpm
growing fetus
lasting 15sec w/in 10mins
✓ Plasma level & blood volume ^ : RBC’s
✓ Non-reactive test: requires further evaluation
remain same (physio anemia)
✓ Test is non-invasive
✓ Nsg care: assess – prenatal period: v/s,
weight gain, diet patterns, emotional outlook,
self-care knowledge, signs of heart failure,
1. Test for syphilis (VDRL or rapid plasma
stress factors
reagent test)
✓ Assess – intra: v/s, respi changes (cough,
2. Blood typing
crackles, dyspnea), FHT patterns
3. Blood typing w/ Rh factor
✓ Assess – post: signs of fluid shifts, I&O
✓ Mgt – prenatal: teach impt of rest & avoid
stress, instruct use of elastic stockings &
periodic elevations of legs, appropriate diet
intake (enough calories, restrict Na intake),
admin meds
✓ Mgt – intra: encourage in semi-fowler’s or left
lateral position, continuous cardiac
monitoring, electronic fetal monitoring, assist
mother to cope w/ discomfort
✓ Mgt – post: early ambulation sched; apply
elastic stockings, monitor FHT: accelerated
HR of mother, adequate rest, admin
prescribed prophylactic antibiotic