Question

1) why would oxytocin be given to a woman after a cesarean section?

2) Describe the two strategies for diagnosing gestational diabetes. what are the advantages of each?

3) You are counseling a patient about DMPA. what do you tell her about this method of contraception?

Answer 1

Answer 1
Administering a uterotonic such as oxytocin at the time of delivery reduces the risk of PPH by approximately 66% and the risk of maternal blood transfusion by about 65%. In order to prevent uterine atony and PPH, oxytocin should be routinely administered following birth of the baby or after delivery of the placenta.
Answer 2
The tests are glucose challenge test and oral glucose tolerance test.
Oral glucose tolerance test.
The oral glucose tolerance test (OGTT) was the gold standard for making the diagnosis of type 2 diabetes.
It is still commonly used during pregnancy for diagnosing gestational diabetes.
With an oral glucose tolerance test, the person fasts overnight (at least 8 hours, but not more than 16 hours).
The next morning, the fasting plasma glucose is tested.
After this test, the person receives a dose of oral glucose (the dose depends upon the length of the test).
There are several methods employed by obstetricians to do this test, but the one described here is standard.
Usually, the glucose is in a sweet-tasting liquid that the person drinks.
Blood samples are taken up to four times at different time points after consumption of the sugar to measure the blood glucose.
Glucose challenge test
The glucose challenge test measures the body's response to sugar (glucose). The glucose challenge test is done during pregnancy to screen for gestational diabetes.
The glucose challenge test is done in two steps. First drinking a sugary solution. One hour later theblood sugar level is measured.
Glucose challenge test is quiete accepted because of its relatively fast and easy methods.
Answer 3
DMPA contains a progestogen. This is similar to the hormone progesterone, which is naturally produced by the female body. DMPA is given by injection every 12 weeks and is slowly absorbed into the blood stream to prevent pregnancy.
DMPA works by:
Preventing ovulation (egg release from the ovary)
Thickening of the mucus of the cervix so that sperm cannot enter the uterus (womb)
DMPA is between 99% (only if the injection is not late and there are no other reasons why the medication would be less effective) and 94% effective. This means that of 100 women using DMPA consistently over a year, it is possible that 1 to 6 woman may become pregnant. The 99% is only true if patients are not late with the injection.
Advantages of DMPA
Long acting, effective method of contraception
Inexpensive
Undetectable by other people
Suitable for women who can’t take contraceptives that contain oestrogen
Possible side effects of DMPA
DMPA has few side effects. However, side effects may include:
Small weight gain in some women
Headaches
Acne
Change in sexual interest
Mood changes
The injection is long acting and if side effects occur they may last up to 3 months (it is not possible to reverse the effects of an injection once it is given).
Some side effects (especially bleeding changes) may persist beyond 3 months although there are a number of treatment options available with varying success that may help reduce bleeding problems if they occur.
Starting DMPA
The first injection of DMPA is usually given during the first five days of a period. In some cases condoms will need to be used for seven days after the first injection.

It is very important that there is no chance of an early pregnancy at the time of injection as this may lead to a delay in the diagnosis of a pregnancy.
Special notes
Follow up DMPA injections are given every 12 weeks to continue protection against pregnancy.
If it goes beyond 12 weeks from the last injection there may be arisk of pregnancy.
To renew the DMPA prescription see a doctor for review once a year. A review of risks for loss of bone density (osteoporosis) will take place at this visit.