Module 4

1. Factors that Predisposes a Woman at an Increased Risk of Disorders of the

Reproductive System
A. Smoking
Smoking can have a serious impact on female reproductive health by
interfering with the bodys ability to create estrogen and thereby regulate
ovulation. It can also cause eggs to be more prone to genetic abnormalities,
is associated with an increased risk of miscarriage, and has been linked to
early onset of menopause. In addition to its impact on female reproductive
health and fertility, smoking has been tied to increases in the likelihood of
cervical cancer and pelvic infections.
B. Alcohol and Drugs
Moderation is the key with alcohol. In fact, many studies have shown
that there is some benefit in the consumption of small amounts of alcohol for
women. However, excessive consumption of alcohol and alcohol abuse can
lead to female reproductive health problems including; irregular ovulation,
amenorrhea (absence of menses), and the abnormal development of the
endometrial lining.
Illegal drugs, such as marijuana, heroin and cocaine, are universally
damaging to female fertility and female reproductive health. Perhaps more
difficult to manage are the risks that some legal and over-the-counter drugs
may have on fertility and female reproductive health. For example, some
prescription medications can interfere with ovulation.
C. Toxins
While the extent to which toxin exposure contributes to infertility is still
somewhat unclear, it should be considered as a preventable cause of female
reproductive health problems. Exposure to toxins has been linked to several
female reproductive health problems such as, irregular periods, hormone
changes, endometriosis and higher miscarriage rates in pregnant women
D. Social Characteristics
Being unmarried or in a lower socioeconomic group increases the risk
of problems during pregnancy. The reason these characteristics increase risk
is unclear but is probably related to other characteristics that is more
common among these women. For example, these women are more likely to
smoke and less likely to consume a healthy diet and to obtain appropriate
medical care.
E. Sexual History
The best way to prevent female reproductive health problems related
to sexual history is to practice safe sex above and beyond preventing
unwanted pregnancies. Many sexually transmitted infections (STDs) go
untreated for long periods of time because the symptoms are sometimes not

visible. This can pose a considerable threat to female reproductive health and
future fertility. STDs, when left untreated, can lead to pelvic inflammatory
disease, causing scarring or blocking of the fallopian tubes, and changes in
the cervix.
F. Unhealthy Eating Habits
By eating a high-fat diet or starving, there is an increase risk of
developing some serious medical conditions, like amenorrhea (the absence of
a period). According to British researchers, if you do not eat a healthy,
nutritious diet with all the essential vitamins and minerals, your hormones
levels can be seriously altered. Some theorise that an imbalanced diet
actually causes deficiencies that lead to PMS.
2. Health Promotion and Disease Prevention of Women in Reproductive Age
A. Brest Examination
Monthly breast self-examination is the best method for detecting
breast masses early. A woman who knows the texture and feel of her own
breast is far more likely to detect changes that develop. Thus, it is important
for a woman to develop the habit of doing routine BSE as early as possible,
preferably as an adolescent.
The effectiveness of BSE is determined by the womans ability to
perform the procedure correctly. She should do a BSE on a regular monthly
basis about 1 week after each menstrual period, when the breasts are
typically not tender or swollen.
B. Mammography
A mammogram is a soft- tissue x-ray of the breast without the injection
of a contrast medium. It can detect lesions in the breast before they can be
felt and has gained wide acceptance as an effective screening tool for a
breast cancer. Currently the American Cancer Society recommended that all
women age 40 and over have an annual mammogram. The National Cancer
Institute and the American College of Obstetricians and Gynecologist
recommend mammograms every 1-2 years for women ages 40-49 and
annually for all women age 50 and older.
C. Pap Smear and Pelvic Examination
The Papinicolaou test (Pap smear), a form of cervical cystology testing,
has helped dramatically decrease the incidence of death from cervical cancer.
Its purpose is to detect cellular abnormalities by a smear containing cells
from the cervix and the endocervical canal. A newer test, the Thin Prep Pap
smear, is proving even more effective than the traditional Pap smear in
detecting abnormalities. In this test, no slide is prepared. Instead the cervical
cells, gathered in the same way as the Pap smear, are transferred directly to
a vial of preservative fluid, thereby preserving the entire specimen.
The pelvic examination lets the healthcare provider assess a womans
vagina, uterus, ovaries and lower abdominal area. It is often performed after

the Pap smear but may also be performed without a Pap for diagnostic
purposes.
3. Complications of Placenta Previa, Abruptio Placenta and Placenta Accreta
A. Placenta Previa
Placenta previa can be associated with other abnormalities of the
placenta or of the umbilical cord. Some studies have shown a reduction in
fetal growth associated with placenta previa, and the presence of the
placenta in the lower part of the uterus makes breech or abnormal
presentation of the fetus more likely.
Slight and occasional bleeding may occur during the first and second
trimester of pregnancy. The bleeding occurs because as the pregnancy
progresses, the placenta gets detached from the uterine walls. In the third
trimester the uterine walls become thinner and spread to accommodate the
growing fetus. If placenta previa is present, the placenta is attached very low
on the uterine wall. This thinning makes the placenta stretch and tear away
from the uterine wall, leading to bleeding.The bleeding of placenta previa can
increase the risk for preterm premature rupture of the membranes (PPROM),
leading to premature labor.
B. Abruptio Placenta
Hemorrhage into the decidua basalis occurs as the placenta separates
from the uterus. Vaginal bleeding usually follows, although the presence of a
concealed hemorrhage in which the blood pools behind the placenta is
possible.
Hematoma formation further separates the placenta from the uterine
wall, causing compression of these structures and compromise of blood
supply to the fetus. Retroplacental blood may penetrate through the
thickness of the uterine wall into the peritoneal cavity, a phenomenon known
as Couvelaire uterus. The myometrium in this area becomes weakened and
may rupture with increased intrauterine pressure during contractions. A
myometrium rupture immediately leads to a life-threatening obstetric
emergency.
The fetus will also be affected because of the abruption placenta. In
severe cases in which most of the placenta has separated, the infant
mortality rate is near 100%. In less severe separation, fetal outcome depends
on the level of maturity and the length of time o birth. The most serious
complications in the newborn arise from preterm labor, anemia and hypoxia.
If fetal hypoxia progresses unchecked, irreversible brain damage or fetal
demise may result.
C. Placenta Accreta
Placenta accreta can cause serious complications, heavy vaginal
bleeding is one of them. Placenta accreta poses a major risk of severe vaginal
bleeding (hemorrhage) after delivery. The bleeding can cause a life-

threatening condition that prevents your blood from clotting normally

(disseminated intravascular coagulopathy), as well as lung failure (adult
respiratory distress syndrome) and kidney failure.
Premature birth is also a risk for placenta accreta. If you have placenta
accreta, you might begin labor early. If placenta accreta causes bleeding
during your pregnancy, you might need to deliver your baby early.

4. Nursing Management
A. Placenta Previa
1. Monitor maternal vital signs and FHR
Monitor the woman and her fetus to determine the status of bleeding
and responses of the mother and baby. Vital signs, intake and output, and
other pertinent assessment must be made frequently. Use the electronic fetal
monitor tracing to evaluate fetal status. Monitor maternal vital signs every 15
minutes in the absence of hemorrhage and every 5 minutes with active
hemorrhage. Connect the external tocodynamometer to the maternal
abdomen to monitor uterine activity continuously.
2. Start IV infusion and Prepare for blood transfusion
Assess the extent of blood loss to prevent the occurrence of shock.
Have a whole-blood setup ready for IV infusion and establish a patent IV
line before caregivers undertake any intrusive procedures.
3. Provide emotional support
Providing emotional support for the family is an important nursing care
goal. During the active bleeding, the direct the assessments and
management toward physical support. However, emotional aspects need
to be addressed simultaneously. Explain the assessments treatment
measures needed. Offer emotional support by staying with the family and
using touch.
4. Promoting neonatal physiologic adaptation
Check the newborns hemoglogin, cell volume and erythrocyte count
immediately and then monitor them closely. The newborn may require
oxygen, administration of blood, and admission into special care nursery.
B. Abruptio Placenta
1. Continuous evaluate maternal and fetal physiologic status, particularly:
Vital Signs every 5-15 minutes
Bleeding
Electronic fetal monitoring
Maternal monitoring tracings electronic monitoring of the uterine
contractions and resting tone between contractions
provides
information about the labor pattern

2.

3.

4.
5.

Signs of shock rapid pulse, cold and moist skin, decrease in blood
pressure
Decreasing urine output
Never perform a vaginal or rectal examination or take any action
that would stimulate uterine activity.
Level of fibrinogen to detect Disseminated Intravascular
Coagulation
Asses the need for immediate delivery. If the client is in active labor and
bleeding cannot be stopped with bed rest, emergency cesarean delivery
may be indicated.
Provide appropriate management.
On admission, place the woman on bed rest in a lateral position to
prevent pressure on the vena cava.
Insert a large gauge intravenous catheter into a large vein for fluid
replacement. Obtain a blood sample for fibrinogen level.
Monitor the FHR externally and measure maternal vital signs every
5 to 15 minutes. Administer oxygen to the mother by mask to
prevent fetal anoxia
Prepare for cesarean section, which is the method of choice for the
birth
Provide client and family teaching.
Address emotional and psychosocial needs. Outcome for the mother and
fetus depends on the extent of the separation, amount of fetal hypoxia
and amount of bleeding.

C. Placenta Accreta
1. Obtain a detailed obstetric history
2. Monitor for uterine bleeding
3. Assist with modalities implemented.
Medical management should be considered only when the woman
wishes to preserve her fertility and when no active uterine bleeding
is present (www.obgynnews.com/).
4. For clients taking Methotrexate, instruct the woman to increase fluid
intake to at least 2 L each day as uric acid formation is increased with the
drug use.
5. Provide emotional support to the woman and family.
5. Reducing risk at work or workplace during pregnancy

Workers should use good hygienic practices such as frequent handwashing to

prevent the spread of infectious diseases. In addition, they should use
universal precautionssuch as glove wearing and safe disposal of needles
to protect against disease-causing agents. Especially health care workers who

are exposed to cancer treatment drugs which can cause birth defects and low
birth weight.
Vaccination against varicella zoster virus and German measles is advised
before pregnancy if no prior immunity acquired because these can cause
birth defects and low birth weights. Workers with immunity through
vaccinations or earlier exposures are not generally at risk from diseases such
as hepatitis B, human parvovirus B9, German measles, or chicken pox. But
pregnant workers without prior immunity should avoid contact with infected
children or adult.
Participate in all safety and health education, training and monitoring
programs offered by employer.
Store chemicals in sealed containers when they are not in use and skin
contact with chemicals.