Nursing 209

N209: Reproductive Health Study Guide • Discourage alcohol use: There is no safe amount of alcohol use during pregnancy or while trying to get pregnant. All types of alcohol are equally harmful. Alcohol passes through to the fetus via the umbilical cord and can cause miscarriage or stillbirth. It can also cause lifelong disabilities known as Fetal Alcohol Syndrome, which includes physical and learning disabilities and vision, hearing, heart, kidney and bone problems. • Counseling and treatment for STDs: STDs can interfere with the ability to conceive. The nurse should encourage testing and treatment prior to conception. Inform the patient of risks, such as preterm delivery, birth defects, and infant death. • Encourage medication reviewwith physician: This should be done prior to conception as some medications can cause birth defects. • Encourage 400 mcg of folic acid daily: Folic acid can help to prevent neural tube defects (spina bifida and anecephaly). • Avoid toxic substances: Toxic substances can lead to infertility, miscarriage, and birth defects. Review with patient the potential exposure at home and at work. • Obtain and update vaccinations: Recommend Varicella, Hepatitis B, and Rubella, preferably one month prior to trying to conceive. • Review family history: Review family history for the patient and partner and refer for genetic counseling for preconception assessment. • Discuss socioeconomic factors: Check access to adequate prenatal care, healthy and safe environment, and good nutrition (all socioeconomic factors affect both mom and baby). • Review age-related risk factors: Patients older than 35 are at an increased risk for infertility, miscarriage, and chromosomal abnormalities. Adolescents have an increased risk for stillbirth, preterm delivery, and low birthweight. • Discuss healthy weight management: Being overweight can increase the risk for gestational diabetes, preeclampsia (high blood pressure with signs of damage to another organ systems, often kidneys), infections (UTIs and postpartum infection), post-date pregnancy, labor problems (interference with pain medications and a higher incidence of need for labor induction), and puts the patients at an increased risk for C-section, macrosomia, and miscarriage. • Review pregnancy history: Look for complications, such as hypertension, gestational diabetes, preterm labor or delivery, and birth defects. • Address current medical conditions: Encourage the patient to seek treatment for any conditions prior to conception (thyroid disease, diabetes, seizure disorders, high blood pressure, eating disorders, etc.). 2.2 Infertility Infertility is the inability to conceive after 12 months of attempting to conceive with unprotected intercourse. It also refers to the inability to carry a pregnancy to term. For women over age 35, the time of trying to conceive is reduced to six months. Infertility affects approximately ten percent of the population (or one in eight couples) and is recognized as a disease by the WHO, ACOG, and ASRM

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