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Family Planning

NCLEX Review Guide: Maternal Newborn Health, Reproductive System & Family Planning

Reproductive System Anatomy & Physiology

Female Reproductive System

Ovarian cycle consists of follicular phase (days 1-14) and luteal phase (days 15-28), regulated by FSH and LH hormones
Menstrual cycle involves endometrial proliferation, secretory phase, and menstruation if fertilization doesn't occur
Normal menstrual flow lasts 3-7 days with blood loss of 30-40mL per cycle

Memory Aid: Hormone Functions

FLEP - FSH stimulates Follicle development, LH triggers ovulation, Estrogen builds endometrium, Progesterone maintains pregnancy

Key Points

Ovulation typically occurs on day 14 of a 28-day cycle
Cervical mucus becomes thin and stretchy during ovulation

Family Planning Methods

Contraceptive Options

Contraceptive Effectiveness Comparison

Method	Effectiveness	Key Teaching Points
IUD	99%	Check strings monthly, report severe cramping
Birth Control Pills	91-99%	Take same time daily, backup method if missed
Condoms	85-98%	Use with spermicide, check expiration dates
Diaphragm	88-94%	Leave in 6 hours post-intercourse, refit after weight change

Oral contraceptives are contraindicated in clients with history of thromboembolism, liver disease, or uncontrolled hypertension
Emergency contraception (Plan B) is most effective within 72 hours but can be used up to 120 hours post-intercourse

Clinical Scenario

A 25-year-old client wants to start birth control pills. She smokes 1 pack per day and has a BMI of 32. Priority nursing action: Discuss smoking cessation and alternative contraceptive methods due to increased thrombotic risk.

Prenatal Care & Assessment

Prenatal Visits & Monitoring

Fundal height measurement should equal gestational age in centimeters from 20-36 weeks (±2cm variance is normal)
First prenatal visit includes comprehensive health history, physical exam, and baseline laboratory studies including CBC, blood type/Rh, rubella titer, and STI screening
Fetal heart rate can be detected by Doppler at 10-12 weeks and by fetoscope at 18-20 weeks

Memory Aid: Prenatal Visit Schedule

"Every 4, Every 2, Every 1" - Every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until delivery

Leopold's Maneuvers Assessment

First maneuver: Identify fetal part in fundus (head vs breech)
Second maneuver: Locate fetal back and extremities
Third maneuver: Determine presenting part in pelvis
Fourth maneuver: Assess fetal descent and flexion

Common Pregnancy Complications

Gestational Hypertension & Preeclampsia

Preeclampsia triad: Hypertension (≥140/90), proteinuria (≥300mg/24hr), and edema, typically occurring after 20 weeks gestation
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe form of preeclampsia requiring immediate delivery

Warning Signs to Report

Severe headache that doesn't respond to acetaminophen
Visual disturbances (blurred vision, spots)
Epigastric pain or right upper quadrant pain
Sudden weight gain (>2 lbs/week)

Gestational Diabetes

Screening performed at 24-28 weeks using 1-hour glucose tolerance test (normal <140 mg/dL)
Management includes dietary modifications, blood glucose monitoring, and possible insulin therapy if diet-controlled measures fail

Labor & Delivery

Stages of Labor

Labor Stages Overview

Stage	Cervical Changes	Duration	Key Nursing Actions
First (Latent)	0-3cm dilation	8-12 hours	Encourage rest, hydration
First (Active)	4-7cm dilation	4-6 hours	Pain management, positioning
First (Transition)	8-10cm dilation	1-3 hours	Support, breathing techniques
Second	Complete-delivery	30min-3hours	Pushing coaching, perineal support

Prolonged labor increases risk of infection, fetal distress, and maternal exhaustion requiring close monitoring
Normal fetal heart rate is 110-160 bpm with variability indicating good fetal oxygenation

Postpartum Care

Normal Postpartum Changes

Lochia progression: Rubra (red, 1-3 days), serosa (pink-brown, 4-10 days), alba (white-yellow, 10-14 days)
Uterine involution occurs at rate of 1cm/day, returning to pre-pregnancy size by 6 weeks postpartum
Breastfeeding mothers may experience delayed return of menstruation due to prolactin suppression of ovulation

Memory Aid: Postpartum Assessment

BUBBLE-HE - Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy, Homans sign, Emotional status

Red Flag Signs

Temperature >100.4°F (38°C) indicating possible infection
Heavy bleeding (saturating pad in <1 hour)
Foul-smelling lochia suggesting endometritis
Calf pain/swelling indicating possible thrombophlebitis

Commonly Confused Concepts

Pregnancy-Induced Hypertension vs Chronic Hypertension

Aspect	Gestational HTN	Chronic HTN
Onset	After 20 weeks	Before pregnancy or <20 weeks
Proteinuria	May be present	Usually absent
Resolution	Within 12 weeks postpartum	Persists postpartum

Study Tips

Practice calculating due dates using Naegele's rule: LMP + 280 days
Remember danger signs acronym: DANGER (Decreased fetal movement, Abdominal pain, Nausea/vomiting, Gush of fluid, Elevated BP, Regular contractions)
Focus on normal vs abnormal findings for each trimester

Quick Check: Self-Assessment

I can identify normal vs abnormal lochia characteristics
I understand contraindications for hormonal contraceptives
I can recognize signs of preeclampsia
I know the stages of labor and appropriate nursing interventions
I can perform postpartum assessments using BUBBLE-HE

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