Group 2 Case 1
- 2. GR is a 31 year-old female who would like to start a family Gravida 0 (has not been pregnant before) and para 0 (has never come to full term and given birth) She has been taking Ortho Novum 7/7/7 for 10 years for contraception and not for any other medical condition Appears slightly overweight She would like pertinent information on ovulation, ovulation kits, and also tips on conceiving A follow-up appointment has been scheduled to discuss this information with GR and her husband and to answer their questions
- 3. Ovulation occurs when a mature egg is released from the ovary, pushed down the fallopian tube, and is available to be fertilized. The lining of the uterus has thickened to prepare for a fertilized egg. If no conception occurs, the uterine lining as well as blood will be shed. The shedding of an unfertilized egg and the uterine wall is the time of menstraution.
- 5. At the beginning of ovulation, estrogen levels are low The body realizes this and in response, it releases follicle stimulating hormone (FSH). A follicle is a group of cells which holds an egg that has not yet matured. FSH triggers several follicles to develop mature eggs. One of these becomes the dominant follicle and releases its mature egg The remaining follicles disintegrate. As this is happening, the follicles are also sending out the hormone, estrogen. When estrogen levels are high enough, the body realizes that a mature egg has been made. At this point, your body also releases luteinizing hormone (LH). This is called the “LH surge” because the egg bursts through the ovary wall within 24-36 hours after it has matured. The mature egg is now able to travel down the fallopian tube to be fertilized
- 6. The follicle from which the mature egg was released is called the corpus luteum. The corpus luteum releases progesterone that helps thicken and prepare the uterine lining for implantation. The corpus luteum will produce progesterone for about 12-16 days (the luteal phase of the cycle.) If an egg is fertilized, the corpus luteum will continue to produce progesterone for a developing pregnancy until the placenta takes over. Pregnancy symptoms can begin as early as a week after fertilization.
- 7. If fertilization does not occur the egg dissolves after 24 hours from being released. Hormone levels will decrease and the uterine lining will begin to shed about 12-16 days from ovulation. This shedding is menstruation and serves as day 1 of the cycle. The cycle then begins all over again.
- 8. Estrogen is low FSH released (follicle stimulating hormone) Estrogen increases LH burst ( luteinizing hormone ) Progesterone released If egg is fertilized, progesterone stays elevated. If egg is not fertilized, progesterone level drops.
- 9. Each woman is born with millions of immature eggs that are awaiting ovulation Normally only one egg is released during each ovulation cycle An egg lives 12-24 hours after leaving the ovary Implantation of a fertilized egg normally takes place 6-12 days after ovulation Ovulation can be affected by stress, illness or disruption of normal routines Some women can feel a bit of pain or aching near the ovaries during ovulation Some women may experience some light blood spotting during ovulation Ovulation can occur even if a menstrual period has not occurred A menstrual period can occur even if ovulation has not occurred If an egg is not fertilized, it disintegrates and is absorbed into the uterine lining
- 10. Complete the remaining pack of the Ortho Novum 7/7/7. Do not stop in the middle of the pack. The menstruation cycle will be disrupted and it will not speed up conception. Conception should not be tried until 3 months after stopping birth control to regain regulation of cycle.
- 11. Both partners should stop smoking and avoid second hand smoke at all costs. A folic acid supplement of 400 mcg should be started at least 3 months before pregnancy to prevent birth defects in the infant. Avoid exposure to toxic substances such as fertilizer, pesticides, and cat feces. Men should change their clothes before coming into contact with their female partner if they must be exposed to these substances. Limit the amount of stress to both partners. Caffeine should be limited in women. It should be limited to a maximum of 300 mg per day. It is linked to delayed conception and an increased risk of miscarriage.
- 12. Both partners should avoid alcohol and illicit substances. Make sure vaccinations are up to date such as rubella, tetanus, diphtheria, pertussis, measles, mumps, and varicella. Schedule and keep regular appointments with your doctor. Have proper treatment of existing health conditions such as diabetes, hypothyroidism, HIV/AIDS, hepatitis B, PKU, hypertension, blood disease, and eating disorders. Review medications to determine their impact on the fetus. Always check with OBGYN or pharmacist before taking a new over the counter medication or herbal product. Males should be screened for sexually transmitted infections to avoid passing them onto the female.
- 13. Educate both partners on conception and pregnancy by reading books. Maintain a healthy weight by proper nutrition and exercise. Women with BMIs > or = to 26 kg/m2 should reduce caloric intake and increase physical activity. Excess weight can lead to complications in pregnancy or infertility.
- 15. Ovulation kits determine the most fertile time during a woman’s menstrual cycle. These work through detecting a brief LH (luteinizing hormone) surge that naturally occurs prior to the release of a mature egg.
- 16. Midstream Tests These work by holdining the tip of the testing bar in a stream of urine. Test Strips These work by filling a container full of urine and holding the strips in the container for an allotted time.
- 17. Ovulation tests should be conducted 16 days prior to the conclusion of the menstrual cycle. For example: If a woman has a 28 day menstrual cycle she should begin testing on day 12.
- 18. Positive ovulation tests indicate that the woman is at the most likely to become fertile within the next 1 to 3 days, with the peak possible fertility in 36 hours.
- 19. Health Care Problem Priority Therapeutic Goals Recommendations for Therapy Monitoring Parameters and Endpoint Preconception Primary Proper discontinuation of oral contraceptive. Overall good health. Discontinue Ortho Novum 7/7/7 at least three months before conceiving, but discontinue after completing the current pack. Begin taking 400mcg folic acid once daily, again, three months prior to conceiving. Limit caffeine intake. (<300mg daily) Avoid smoke, alcohol, and illicit substances. Follow up with patient in one month to ensure she has followed the recommendations listed and to ask if she has any further questions. Obesity Secondary to health conception Maintain BMI of less than or equal to 26 kg/m2. Maintain a healthy diet with the required nutrients needed for conception such as 400 mcg of folic acid daily. Exercise at least 30 minutes daily 5 days a week. See a nutritionist for optimal diet for preconception. Join a program such a Weight Watchers for support. Keep a food journal to assess food choices made. Weekly weight checks to assess progress. Weight loss should be about one pound per week. Endpoint should be a BMI of equal to or less than 26 kg/m2 before conception.
- 20. The information from this presentation was taken from the sources below… www.americanpregnancy.org - American Pregnancy Association http://www.cdc.gov/ncbddd/preconception/QandA.htm - Centers for Disease Control and Prevention http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937808010296.pdf American Journal of Obstetrics & Gynecology -Clinical Pharmacology electronic database