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HLTH 220 Final Exam study guide...

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Exam # 3 Terms, Topics and Concepts to Review Chapter 13: Human Reproduction Ovulatory vs Menstrual Cycles – relation to fertility 

menstrual cycle coincides perfectly with the ovarian cycle o ensures the union of sperm and egg at the best possible time to enhance successful implantation in the endometrium

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Ovarian (in 28 day cycle) o Follicular phase – approx. first 10 days  a follicle grows, preparing to release a mature egg. o Ovulatory phase – approx. days 11-14  final preparation for release of mature ova o Luteal phase – days 14 – 28  corpus luteum secretes progesterone to sustain endometrial lining

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Menstrual (in 28 day cycle) o Menstrual – approx. 3-5 days  uterus sheds endometrial lining o Proliferative phase – approx. 9 days  estrogen causes endometrial lining to thicken o Secretory phase – begins with ovulation and lasts approx. 14 days.  LH triggers the ruptured ovarian corpus luteum to secrete high levels of progesterone – causes endometrial lining to thicken further

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When menstruation begins an ovarian follicle is beginning to grow in preparation for ovulation The corpus luteum secretes progesterone which helps maintain the thickened endometrial lining and support early pregnancy.

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Body changes associated with ovulation 1. 2. 3. 4.

Cervical secretions – thin, slippery, cervical secretions – fertile cervical mucus. Basal body temperature – slight drop followed by an increase, signals ovulation Mittleshmertz – ovulatory pain LH surge – ovulation predictor kits measure LH surge that signals ovulation

Conception/fertilization – what happens and where? 

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Conception o fertilization of the egg by a sperm o occurs in upper 1/3rd of the fallopian tube Fertilized egg begins a process of rapid cell division, travels down the fallopian tube over a period of 3-4 days or longer Implantation – the fertilized egg attaches to the uterine wall o it is now referred to as an embryo o there is sometimes bleeding/spotting with implantation which may be misinterpreted as a menstrual period

Changes associated with developing embryo/fetus in each trimester 

1st trimester o conception until the 13th week. A period of differentiation – all organ systems develop in rudimentary form.  Miscarriage is most likely in the first 7 weeks o Maternal diet  adequate folic acid to prevent neural tube defects; make nutrient dense food choices - extra calories are not needed until the second trimester  make positive changes preconception! o Avoidance of teratogens is critical  teratogens = alcohol, certain drugs, radiation o Changing hormones  Mother feels fatigued, nauseous, emotional, irritable, etc o Chorionic villus sampling  can be performed between 10 and 12 weeks to test for chromosomal/genetic abnormalities o Pregnancy Loss  October is national Pregnancy and Infant loss awareness month. o “conspiracy of silence”  often used to refer to the silent suffering couples experience after a miscarriage or still birth. o Social support helps…what should you say?  Acknowledge the loss and the grief  Do not try to minimize or compare  Offer to listen and support

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2nd trimester o Marked by growth and maturation of all fetal systems o Fetus is active and sleeps and wakes regularly o Sex organs are distinct and can be seen on ultrasound by week 18-20 o Quickening – the first feeling of life perceived by the mother o Mother’s energy level is better and she needs 300 protein/calcium rich extra calories per day o Often perceived by the mother as the most pleasant trimester 3rd trimester o Fetal systems continue to grow and mature o Fetus responds to sound and light o By the 9th month the fetus gains ½ pound per week o Lightening  fetus moves downward and outward as its head meshes with the mothers pelvis in preparation for birth. o Brain and lungs develop rapidly o Mother experiences Braxton Hicks contractions, back pain, constipation, frequent urination, etc.  Managing weight gain, exercising regularly, and eating high fiber diet helps!

Function of the placenta 

Pass oxygen and nutrients through the umbilical cords to the fetus and passes waste products and carbon dioxide back to the mother

Preconception care – why is it so important? 

Identifies issues that could affect a pregnancy and allows for time to make changes before becoming pregnant

Health concerns during pregnancy – diet, weight gain, smoking, alcohol etc. 

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Diet o Calorie needs – 300 extra calories per day in the second and third trimesters only. o Choose NUTRIENT DENSE foods rich in calcium, protein, folic acid (deficiencies related to neural tube defects), and iron Weight Gain o Excess weight gain is related to gestational diabetes and hypertension, as well as other complications.

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o A “normal weight” woman (healthy BMI) should gain between 25-35 lbs. Smoking, alcohol, and other drugs can cause serious deformities in a fetus and lead to further problems

Prenatal testing – amniocentesis, chorionic villus sampling, sonogram, alpha-fetoprotein screening 

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Amniocentesis o can be performed between 14 and 20 weeks o test for gene/chromosomal abnormalities and abnormalities of the brain or spinal cord Chorionic villus sampling (CVS) o Small sample of cells taken from the placenta usually through the cervix, to screen for genetic abnormalities o conducted between 10-13 weeks of gestation  neural tube defects and structural deformities—to legs, arms, and so on— cannot be detected because it is done so early Sonogram o picture of the fetus produced by an ultrasound screening o shows heart, liver, kidneys and full skeleton o can be done at 16-20 weeks Alpha-fetoprotein screening (AFP test) o measures level of alpha-fetoprotein o results are combined with the mother's age and ethnicity in order to assess the probabilities of potential genetic disorders o High levels of AFP may suggest the developing baby has a neural tube defect such as spina bifida or anencephaly

Childbirth – the three stages, characteristics of each stage and phase 

Stage 1 – Labor o Phase 1 – Early Labor  contractions are mildly to moderately strong, lasting 30 to 45 seconds and ranging from 5 – 20 minutes apart  Cervix dilates from 0 cm to 5 cm  Mother may experience nausea, leg cramps, hiccups, backache, shakiness, exhaustion, bloody show, anger, irritability, etc  Generally you will go to the hospital at the end of this phase if planning to give birth in the hospital

What can the mother do to cope with labor during this phase? What could a birth partner do to help? o Phase 2 – Active Labor  Active labor lasts an average of 2 -3.5 hours  Contractions are generally three to four minutes apart and last for 40-60 seconds  Cervix dilates from 5- 8 cm  Mother experiences increasing back and leg pains, more bloody show, anxiety, irritability, nausea, exhaustion o Phase 3 – Transitional Labor  THE MOST PAINFUL STAGE OF LABOR AND DELIVERY!  Contractions are very strong, 60-90 seconds long, and two to three minutes apart.  The cervix dilates fully to 10 centimeters  Mother feels strong pressure in lower back and perineum from the baby’s head  Leg cramps, chills, nausea, exhaustion, overwhelming urge to push  pain management options during labor Stage 2: Delivery of Infant o This stage begins with the cervix complete dilated and ends with the delivery of the baby o Crowning – baby’s head can be seen in the vaginal opening o Episiotomy – a cut made in the perineum to widen the vaginal opening to allow for the baby’s head to pass through without tearing. Has become controversial in recent years…read about the pro’s and con’s and discuss with your doctor! o Once the baby is out of the birth canal and breathing on its own, the umbilical cord is cut Stage 3: Delivery of Placenta o shortest stage of labor, typically lasting 15-20 minutes. o Contractions are much less painful, but mother may feel shaky or hungry. o The placenta, afterbirth, is expelled – doctor or nurse midwife will examine the placenta to be sure no part has been left behind o Uterus then contracts tightly to close off blood vessels that supplied the placenta through the uterine wall. o If contractions do not occur there is the risk of postpartum hemorrhage. 

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Cesarean rates – contributing factors   

US rates reached a high of 32.9% of all births in 2009 o 60% rate increase from 1996. Women have about a 10% chance vaginal birth for future deliveries after having a csection Necessary reasons to have one o Placenta previa o Placental abruption o Breech position o Fetal distress (most common reason) o Active herpes outbreak o Multiple births o Repeat cesarean

Breastfeeding – benefits to baby and mother 

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Baby o Improves an infant’s immune response o Reduces the risk for sudden infant death syndrome and death from other causes o Reduces the risk for a variety of chronic diseases o Contributes to better cognitive skills o Stimulates bonding between mother and child o Promotes better health in premature infants o Allergy prevention o Lower asthma risk o Better mouth/tooth development for baby Mother o Easier transition into motherhood o May have an anti-anxiety effect and help promote bonding with the baby o Mood elevation o Convenient and is less expensive than formula o Environmentally friendly choice

Chapter 14: Fertility Control Family planning vs birth control vs contraception – what do the terms mean? 

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Family planning o Postponing children until the optimal point in one’s life o Implies the desire to have children at some point o May include reproductive technologies available to facilitate pregnancy  Includes adoption Birth control o The broadest term covering all methods designed to prevent the birth of a child  includes all contraceptive methods, what may be considered postconceptive methods, and abortion Contraception o Methods designed to prevent conception o Works by preventing the sperm from reaching the egg o Methods include noninsertive sexual activity, barrier methods, hormonal contraception, withdrawal, fertility awareness, and sterilization  Methods vary in effectiveness

Theoretical vs actual use effectiveness 

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Theoretical/perfect o Percentage of women who will become pregnant in one year even though they use the method effectively Actual/effectiveness o Percentage of women who get pregnant while using a contraceptive method for 1 year

Pro’s and con’s of various methods of contraception – what factors should be considered in determining the best method of contraception for a particular individual   

Provide nonpenetrative sexual pleasure o “outercourse” Prevent sperm from meeting egg o withdrawal, NFP, IUD Provide barrier between sperm and egg

o male and female condom, diaphragm, contraceptive sponge, cervical cap, and spermicides.

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Prevent release of egg o ovulation is suppressed by altering hormonal balance in the body  oral contraceptives, Nuva Ring, Implanon, emergency contraception and the Evra patch (potentially the IUD). Surgically blocking passage of sperm or egg o sealing off main transport routes for sperm and egg (fallopian tube and vas deferens)  Tubal ligation and Vasectomy Prevent Implantation o thin lining of the uterus to prevent successful implantation of fertilized egg o IUD and emergency contraception Terminate an established pregnancy abortion – both medical and surgical.

http://www.ashasexualhealth.org/pdfs/ContraceptiveOptions.pdf - a chart of various birth control methods and their advantages and disadvantages 

Printed Chart

Coitus interruptus – pay particular attention to effectiveness rates and factors influencing effectiveness  

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Latin term, literally meaning interrupting intercourse by withdrawing the penis prior to ejaculation probability of pregnancy is about 22% during the first year of use o 2 factors lead to lack of effectiveness  human error (not withdrawing the penis in time)  use during peak fertility (mid-cycle versus other times during a woman’s menstrual cycle) 78% effective No STD protection

Abortion – laws, controversies          

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Termination of an established pregnancy through surgical or nonsurgical techniques. Viability: fetus has a reasonable chance of living outside of the uterus usually at age of 24 weeks. Spontaneous abortion – termed miscarriage Induced abortion – involve purposely ending an established pregnancy. Induced abortions have been legal in the United States since 1973 – all first trimester abortions are legal for any reason states set standards for second and third trimester abortions. Abortion pill – mifepristone, used up to 9 weeks from last MC, works by blocking progesterone Without progesterone the lining of the uterus breaks down In clinic abortion – Aspiration (up to 16 weeks from last MC) or D & E (after 16 weeks from last MC) Maryland o Maryland's post-viability abortion restriction provides that abortion may be prohibited after viability unless necessary to preserve the woman's life or health or unless the fetus is affected by a genetic defect or serious deformity or abnormality. Md. Code Ann. Health-Gen. §20-209 (Enacted 1991). o In Maryland, a parent of a minor (under 18 years old) must be notified prior to an abortion being performed Abortion Values Continuum Objectives: o To differentiate when you find abortion acceptable or unacceptable o To identify your values concerning abortion. o Please be respectful of those whose values differ from your own. Please remember that someone in this class has likely experienced an abortion. o For some differing perspectives on abortion: o National Right to Life Committee o National Abortion Right League

Chapter 16: Sexual Coercion Sexual assault 

defined as any unwanted sexual contact

Sexual coercion 

Any nonconsensual sexual behavior that occurs as the result of arguing, pleading, and cajoling, and includes, but is not limited to force

Sexual victimization 

Depriving a person of free choice and forcing him or her to endure, observe, or comply with sexual acts

Sexual harassment  

unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature in the workplace or educational setting 3 attributes o Power differential in the relationship o Inappropriate approach o Pressure after the expression of disinterest

Rape – stranger, acquaintance, statutory     

the unlawful penetration of a person against the will of the victim, with use or threatened use of force, or attempting such an act stranger – rape by a person whom the target does not know acquaintance – rape by a dating partner o drugs used include alcohol, GHB, and Rohypnol marital – rape by a spouse statutory o person older than the legal age of consent having intercourse with a partner who is younger than the legal age of consent

Characteristics of rapists 

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likely to hold traditional beliefs about women and women’s roles and female stereotypes. o beliefs range from nonsexual views concerning a woman’s place (in the home) to sexual beliefs that men are the initiators during sex and that women want men to initiate. believe in rape-supportive myths o women secretly want to be overpowered during sex  they like it rough, no means yes, and other stereotypical beliefs about women use exploitative techniques such as coercing women into sex using alcohol and other drug accept the use of violence as a way to solve problems and dominate others more likely to vent their anger and express their need to dominate sexually rather than find other outlets for these feelings devalue all that is feminine o they are hostile toward feminine personality attributes such as nurturance and collaboration and devalue traditional female pursuits such as child care and homemaking generally more sexually active than their peers who do not rape

Binge drinking and sexual victimization – what is the relationship, what is binge drinking associated with?  

Binge drinking is associated with unplanned/unsafe sex The odds of committing sexual assault increase with men who party more

Child sexual abuse – molestation, incest      

Child sexual abuse: contact between an adult and a child who is under 18 years of age Child molestation: abuse of a child by nonfamily members Incest: Child sexual abuse involving genetically related family members Pedophile: adult who is sexually aroused by children and initiates contact with them out of sexual desire Child molester: One who makes indecent sexual advances to children Strategies for preventing Child Abuse o Provide sex education o Become an approachable parent o Discuss inappropriate sexual behavior with your children o Let your children know they can decide how, when, and by whom they want to be touched.

o Discuss refusal skills o Discuss escape skills o Discuss telling Meghan’s law – controversies?  

Legislation requiring notification that a sex offender has been released and is residing in a community The degree of risk that offenders pose to the community is measured by a “tiered system”.

Affirmative Consent – yes means yes  

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Affirmative Consent – refines the definition of consent from “not saying no to sex” to “saying yes with words or clearly enthusiastic actions” The legislation, which was introduced as a direct response to the current sexual assault crisis on college campuses, defines consent as an “affirmative, conscious, and voluntary agreement to engage in sexual activity” every step of the way House Bill 1142: Maryland adopted the affirmative consent standard (October 1, 2016). This means that all state funded colleges and universities must follow affirmative consent standards.

Bystander intervention strategies 

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Direct - Tell someone directly that their words or actions are not acceptable. You can intervene directly without being confrontational or escalating a situation. You can say: "that person is too drunk to go home with you," "did you ask the person in this video if it was ok to share it?" or "stop asking them if they want to hook up, they already said no." Distract - Create a distraction to diffuse an unsafe situation and help move people out of harms way. tell a joke, spill a drink, change the topic, or ask a random question to distract from an escalating unsafe situation. Delegate - Ask someone else for help. Good resources include your RA, a trusted friend who feels comfortable intervening, or the police in an emergency situation. Trust your gut. If you don't feel safe directly intervening, get help. Delay - If you didn't take action in the moment, it's not too late. You can always talk to someone after the fact. Offer campus resources or get help from others....