Contraception and birth control Archive

Bleeding

While a minor cut will eventually stop bleeding, a severe injury may require elevation and direct pressure on the wound. The goals of first-aid treatment are to control bleeding and prevent infection. If disposable surgical gloves are readily available, use them.

Butterfly Bandages

Direct Pressure for Bleeding and Pressure Points for Bleeding

How to Stop a Nosebleed

Birth of the Placenta

The placenta, which has provided the fetus with nourishment, is attached to the umbilical cord and is delivered about 20 minutes after the baby. Do not pull on the cord; delivery of the placenta occurs on its own. You can help by gently massaging the woman’s lower abdomen. The uterus will feel like a hard round mass.

Massaging the abdomen helps the uterus contract, which also helps stop bleeding. After the placenta is delivered, place it in a plastic bag to take with the woman and baby to the hospital. It is normal for more bleeding to occur after delivery of the placenta. Continue gently massaging the woman’s lower abdomen.

Butterfly Bandage

Direct Pressure to Stop Bleeding

A wound that is deep, bleeding heavily, or has blood spurting from it (caused by bleeding from an artery), may not clot and may not stop bleeding.

Immediate care
Call out for someone to get help, or call 911 yourself. Elevate the wound and apply direct pressure.

Benign Prostatic Hyperplasia (BPH), or Enlarged Prostate

Questions to Discuss With Your Doctor:

• Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
• Over the past month, how often have you had to urinate again less than two hours after you finished urinating?
• Over the past month, how often have you found you stopped and started again several times when you urinated?
• Over the past month, how often have you found it difficult to postpone urination?
• Over the past month, how often have you had a weak urinary stream?
• Over the past month, how often have you had to push or strain to begin urination?
• Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
• If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?
• Have you had blood in your urine, or urinary tract infections?
• Have you ever had surgery on your prostate, bladder, or kidneys?
• Do you have gastrointestinal problems such as diverticulitis or constipation?
• Do you have diabetes?
• Does anyone in your family have diabetes?
• Have you been unusually thirsty or had unintentional weight loss?
• Have you ever had a stroke or nervous system disease?
• Have you ever had a back injury or back surgery?
• What medications are you taking (prescription and over-the-counter)?
• What do you know about medical and surgical treatment options used in the treatment of benign prostatic enlargement?
• Do you know the side effects that can occur with medications?
• Do you know the complications associated with surgery?
• Do you know how much benefit you can expect from each type of treatment?
• Do you know the risks of waiting, and doing nothing at all?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal examination
• Neurological examination
• Digital rectal examination
• Genital examination

Your Doctor Might Order the Following Lab Test or Studies:

• Urinalysis (for glucose, red blood cells, white blood cells, and bacteria)
• Blood tests (for kidney function and prostate-specific antigen or PSA)
• Cystoscopy
• Ultrasound of the bladder after you urinate (post void residual)
• Ultrasound of the kidneys
• Pelvic CT scan

Dysfunctional Uterine Bleeding

Questions to Discuss with Your Doctor:

• Do you have regular menstrual cycles?
• When was your last period?
• Is your bleeding always heavy or prolonged?
• How old were you when you started menstruating?
• How long ago did you develop abnormal bleeding?
• Are you sexually active?
• How many times have you been pregnant?
• What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
• Have you ever had difficulty getting pregnant?
• What medications are you taking (including over-the-counter drugs and herbal remedies such as ginseng)?
• Are you taking hormone replacement therapy or birth control pills?
• Have you ever had medications injected (Depo-Provera or Norplant) for birth control?
• Have you ever taken estrogen or tamoxifen?
• Are you taking warfarin or other blood thinners?
• Have you ever had an abnormal Pap smear?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, heart rate, weight
• Abdominal examination
• Pelvic exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Pregnancy test
• Blood tests such as complete blood count, coagulation (clotting) studies, and certain hormone tests (such as thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, testosterone)
• Pelvic ultrasound
• Pap smear
• Endometrial biopsy.

Erectile Dysfunction or Impotence

Questions to Discuss with Your Doctor:

• Do you smoke cigarettes?
• Have you been screened for other medical problems such as high cholesterol, high blood pressure, heart disease, and diabetes?
• Do you exercise regularly? How much? How often?
• Do you have a neurologic disease or sickle-cell disease?
• Are you taking any medications (prescription or over-the-counter)?
• Has your erectile dysfunction worsened since starting any new medications?
• What effect is your erectile dysfunction having on your relationship? Your self-esteem?
• How long have you had erectile problems?
• Do you have erectile problems sometimes or all of the time?
• Have you ever had any psychologically stressful sexual experiences?
• Are you less interested in sex (diminished libido)?
• Are you having difficulty achieving an erection or sustaining it?
• Do you ever awaken with early morning or nocturnal erections?
• Do you have pain with erections?
• Penile bumps or lumps?
• History of penile trauma?
• History of pelvic surgery?
• What are your goals in receiving treatment?
• What therapies have you tried?
• Do you know how much benefit you can expect from medical therapies?
• Do you know the side effects and important drug interactions?

Your Doctor Might Examine the Following Body Structures or Functions:

• Genital examination
• Rectal examination
• Pulses in the groin and feet
• Neurologic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests (complete blood count or CBC, glucose, cholesterol panels, thyroid function tests, prolactin level)
• Blood testosterone level (if libido is decreased)
• Nocturnal penile tumescence (NPT)
• Neurologic testing (nerve condition studies)
• Your doctor may decide to do some vascular tests to establish whether the arteries that supply blood to the penis during erections are narrowed.

Pregnancy: 1st Trimester

Questions to Discuss with Your Doctor:

• Your age and how it will affect your pregnancy.
• Have you been pregnant before? If so, what was the outcome of each pregnancy. Did you have a full-term pregnancy (your baby was born close to your due date)? Did you give birth via a vaginal delivery or a cesarean section ("C-section") surgery? If you had a C-section, what type of C-section was it? Did any of your pregnancies end in miscarriage, voluntary abortion, or an ectopic (tubal) pregnancy?
• Does this pregnancy come at a good time for you?
• When was the first day of your last menstrual period?
• What is the usual length of your menstrual cycle?
• Do you have any medical problems such as diabetes, high blood pressure, thyroid problems, asthma, tuberculosis, epilepsy, or heart disease?
• Have you ever had any sexually transmitted infections such as gonorrhea, herpes, syphilis, or human papilloma virus (HPV)?
• Do any medical problems tend to run in your family such as sickle cell anemia, cystic fibrosis, Down syndrome, or hemophilia?
• Are you taking any medications (including over-the-counter medications)? If so, what are they?
• Do you smoke? If so, how many packs per day?
• In an average week, how many alcoholic beverages do you consume?
• Do you use any recreational drugs?
• Did you have any problems getting pregnant?
• Do you eat a well-balanced diet? Are you taking any vitamins, including folic acid (folate)?
• Do you exercise regularly?
• What is your home situation like? Who do you live with? Is your partner supportive of this pregnancy? If not, has your partner hit or threatened you?
• Are you having any problems with morning sickness (that is, nausea and vomiting)?
• Are you having any bleeding from your vagina?

Your Doctor Might Examine the Following Body Structures or Functions:

• Temperature, blood pressure, pulse, weight
• Chest exam
• Heart exam
• Abdominal exam
• Pelvic exam with Pap smear and cervical cultures
• Leg exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Confirm pregnancy with blood or urine test
• Complete blood count and blood type
• Blood tests for syphilis, rubella antibodies, hepatitis B, HIV
• Urinalysis
• Portable Doppler instrument or stethoscope to measure fetal heart sounds
• Urine culture
• "Triple screen" (also known as "AFP-3" or "Enhanced AFP"
• Genetic testing

Pregnancy: 3rd Trimester

Questions to Discuss With Your Doctor:

• Do you have adequate support at home from family or friends?
• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had any pain or uterine cramping?
• Have you had any discharge or leakage of fluid from your vagina?
• Have you noticed swelling of your face or ankles?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you noticed a change in the frequency or intensity of fetal movement?
• Are you planning to breast-feed or bottle-feed?
• Have you selected a pediatrician for your baby?
• Are you taking classes on labor and delivery?
• Have you added health insurance coverage for your new baby?
• Have you purchased a special car seat to hold your baby when riding in your car?
• Have you decided on whether the baby will have a circumcision, if a boy?
• Have you talked with your doctor about the length of your stay in the hospital?
• Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).

Your Doctor Might Examine the Following Body Structures or Functions:

• Breasts (to see if your nipples are inverted)
• Abdominal exam, including measurement of the height of your fundus (top of the uterus)

Your Doctor Might Order the Following Lab Tests or Studies:

• Culture of the vagina and rectum for Group B streptococcus bacteria
• Fetal ultrasound

Pregnancy: 2nd Trimester

Questions to Discuss with Your Doctor:

• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had persistent vomiting?
• Have you had any pain or uterine cramping?
• Have you noticed swelling of your face or fingers?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you had any vaginal discharge?
• Have you noticed fetal movement?
• Are you planning to breast-feed or bottle-feed?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, weight
• Abdominal exam including measurement of the height of your fundus (top of the uterus) and using a portable Doppler instrument or stethoscope to measure fetal heart sounds

Your Doctor Might Order the Following Lab Tests or Studies:

• Consider repeat complete blood count
• Fetal ultrasound
• Glucose tolerance test

Your Doctor Might Order the Following Treatment:

• Rhogam (Rh-Immunoglobulin), if your blood type is Rh negative (see p. 920)