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NURSING 232 - OB Exam #1 Study Guide.
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OB Exam #1 Study Guide Contraception
o Coitus Interuptus (“pulling out”)
Involves the male partner withdrawing the penis from the woman’s vagina
before he ejaculates
One of the lease effective methods of contraception
o Fertility Awareness Based Methods (periodic abstinence or natural family planning)
Provide contraception by relying on avoidance of intercourse during fertile
periods
When women who want to use FABs are educated about the menstrual cycle-
three phases identified
Infertile phase- before ovulation
Fertile phase- about 5 to 7 days around the middle of the cycle,
including several days before and during ovulation, and the day
afterward
Infertile phase- after ovulation
The human ovum can be fertilized no later than 12 to 24 hours after ovulation
Advantages of these methods include low to no cost, heightened awareness and
understanding of personal fertility, increased self-reliance, absence of chemicals,
instant availability, increased involvement and intimacy with partner, and the
ability of the couple to follow religious and cultural traditions
Calendar Based Methods
o Calendar Rhythm Method
Based on the number of days in each cycle, counting
from the first day of menses
With this method the fertile period is determined after
accurately recording the lengths of menstrual cycles for
at least 6 months
The beginning of the fertile period is estimated by
subtracting 18 days from the length of the shortest cycle
The end of the fertile period is determined by
subtracting 11 days from the length of the longest cycle
o Standard Days Method
Essentially a modified form of the calendar rhythm
method that has a “fixed” number of days of fertility for
each cycle- days 8-19
Day 1 of the menstrual flow is the first day to begin
counting
Symptom Based Methods
o Two Day Method
Based on the monitoring and recording of cervical
secretions
, Does NOT involve analyzing the characteristics of the
secretions
Each day the woman asks herself:
“Did I note secretions today?”
“Did I note secretions yesterday?”
If the answer to either question is yes, the woman
should avoid coitus or use a backup method of birth
control
If the answer to both questions is no, the woman’s
probability of getting pregnant is very low
o Cervical Mucus Ovulation Detection Method
Requires the woman recognized and interpret the cyclic
changes in the amount and consistency of cervical
mucus that characterize her own unique pattern of
changes at the time of ovulation
To ensure an accurate assessment of changes, the
cervical mucus should be free from semen,
contraceptive gels or foams, and blood or discharge
from vaginal infections for at least one full cycle
Intercourse is considered safe without restriction
beginning the fourth day after the last of wet, clear,
slippery mucus, which would indicate that ovulation has
occurred 2 to 3 days previously
o Basal Body Temperature Method
The basal body temperature is the lowest body
temperature of a healthy person taken immediately
after waking and before getting out of bed
The BBT usually varies from 36.2-36.3 degrees C during
menses and for approximately 5-7 days afterward
Before ovulation. 96-98 degrees F is normal in many
women- after ovulation, temperature increases to 97-99
degrees F. The temperature remains on an elevated
plateau until 2-4 days before menstruation- then BBT
decreases to the low levels recorded during the
previous cycle unless pregnancy has occurred, in which
the temperature would remain elevated
To use this method, the fertile period is defined as the
day of the first temperature drop, or first elevation,
through 3 consecutive days of elevated temperature
Abstinence begins the first day of menstrual bleeding
and lasts through 3 consecutive days of sustained
temperature rise (at least 0.2 degrees C)
o Symptothermal Method
, Combines the BBT and cervical mucus methods with
awareness of secondary phase-related signs and
symptoms of the menstrual cycle
The woman gains fertility awareness as she learns the
psychologic and physiologic signs and symptoms that
mark the phases of her cycle
Secondary signs and symptoms include:
Increased libido
Midcycle spotting
Mittelschmerz (cramp-like pain prior to
ovulation)
Pelvic fullness or tenderness
Vulvar fullness
The woman is taught to palpate her cervix to assess for
changes indicating ovulation:
The cervical os dilates slightly
The cervix softens and rises in the vagina
Cervical mucus is copious and slippery
Biological Marker Methods
o Home Predictor Test Kits for Ovulation
The urine predictor test for ovulation
Addition to the NFP and fertility awareness methods to
help women who want to plan the time of their
pregnancies and for those who are trying to conceive
Unlike BBT, this test is not affected by illness, emotions,
or physical activity
The luteinizing hormone that occurs approximately 12-
24 hours before ovulation- a positive response indicates
an LH surge- noted by the color change on the test
o The Marquette Model
Developed by the Marquette University College of
Nursing Institute for Natural Family Planning
Uses cervical monitoring along with ClearPlan Easy
Fertility Monitor
The ClearPlan monitor is a handheld device that
uses test strips to measure urinary metabolites
of estrogen and LH
o Spermicides and Barrier Methods
Gained popularity not only as a contraceptive method but also as protection
against the spread of STIs
Users of a barrier method of contraception must also be aware of emergency
contraception options in case there is a failure of the method
Spermicides
, Serve as chemical barriers against semen and inhibit the ability of the
sperm to fertilize the ovum
Nonoxynol-9 (N-9) works by reducing the sperm’s mobility
o May increase the transmission of HIV
o Women with high risk behaviors that increase their likelihood of
contracting HIV are advised to avoid products containing N-9
Must be reapplied for each additional act of intercourse even if a barrier
method is used
Condoms
Male- thin, stretchable sheath that covers the penis before genital, oral,
or anal contact and is removed when the penis is withdrawn from the
partner’s orifice after ejaculation
Barrier to sperm and STIs including HIV except for those lubricated with
N-9
Female- a vaginal sheath made of nitrile with flexible rings at both ends
Male condoms should not be used concurrently with female condoms
because the friction from both sheaths can increase the likelihood of
either or both tearing
Diaphragms
Shallow dome-shaped latex or silicone device with a flexible rim that
covers the cervix
4 types
o Coil spring
o Arcing spring
o Flat spring
o Wide seal rim
The diaphragm should the largest size the woman can wear without her
being aware of its presence
Should be inspected before every use, replaced every 2 years, and may
have to be refitted for a 20% weight fluctuation, after any abdominal or
pelvic surgery, and after every pregnancy
Disadvantages
o Reluctance of some women to insert and remove it
o Irritation of tissues related to contact with spermicides
Risk of toxic shock syndrome-the nurse should instruct the woman
about ways to reduce her risk for TSS
o Prompt removal 6-8 hours after intercourse
o Not using the diaphragm or cervical caps during menses
o Learning and watching for the danger signs of TSS
Contraindicated for women with pelvic relaxation (uterine prolapse) or a
large cystocele
Cervical Caps
FemCap- only type of cervical cap available in the US
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