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ACHIEVING PREGNANCYDEFINITIONAchieving Pregnancy is identifying and assessing clients who desire pregnancy. Counseling and education (including key messages on achieving pregnancy) and addressing misperceptions that many women, men and adolescents have about fertility and infertility will occur for clients who respond to the reproductive life plan question with a “desire for pregnancy.” SUBJECTIVEHistory must include:Reproductive Life Plan (RLP)RLP may include:When she/he/they want to get pregnantLength of time she/they have been trying to get pregnantHistory of pregnancies or infertilityPartner involvement and support system issues(Support system issues may include: family and community support, LGBTQ considerations, single parent considerations, cultural/familial considerations, financial concerns and awareness of other concerns or influences). Medical historyImmunizationsMedicationsPresent infectious or chronic health conditionsGenetic conditionsEnvironmental exposuresSocial history/risk behaviorsSexual health assessment and risk assessmentMental health Zika Risk Assessment- As per current CDC guideline- and partner(s)Past travel – where and whenPlans for future travel –where and whenInclude for Females:Reproductive historyObstetrical/gynecology historyFamily history Intimate partner violenceInclude for Men:Past medical/surgical history that might impair reproductive health Medical conditions associated with reproductive failure that could reduce sperm qualityOBJECTIVEAssessment must include:Height, weight, BMI (screen for obesity) BP (screen for hypertension)All clients—screen yearlyIf BP <120/80---screen yearly, continue yearlyIf BP 120-139/80-89 (either treated or untreated), recheck BP again in same visit and if average BP >140/90 recheck at next visit or in 1 week and refer if sustained BP >140/90.No physical exam is needed for Achieving Pregnancy. Exams may be needed to evaluate problems raised by review of systems or complaints raised by the client.LABORATORYMay include, as indicated based on client medical and sexual history STD testing Diabetic screening Consider Zika screening if indicated by Zika Risk Assessment.ASSESSMENT Assess and update the client’s physical, sexual and medical history. This may reveal additional issues in the person’s health history that need to be addressed. The results can also help determine the need for additional information like fertility awareness or other health services such as: STD screening, preconception care and counseling, infertility services, Zika sexual transmission counseling, and other preventative health services.PLAN (also see Fertility Awareness)While Fertility Awareness education is not required for clients who wish to achieve pregnancy, it can be very helpful (and interesting) for them to know:How pregnancy occurs, including the basics of male and female fertility, andWhen during the menstrual cycle a woman is most likely to get pregnant,Different ways to observe and keep track of naturally occurring signs of fertility,Tips for maximizing fertility while attempting conception, including how certain diet and lifestyle factors can enhance or reduce fertility.CLIENT EDUCATION (also see Preconception)Importance of regular preventive health care and chronic disease management. Some medications might be contraindicated in pregnancy, and any current medications taken during pregnancy need to be reviewed by a prenatal care provider (e.g., an obstetrician or midwife). Encourage to take a daily supplement containing (400-800 mcg) of folic acid (or a prenatal vitamin) while attempting conception.Avoid smoking, alcohol and other drugsAvoid eating fish that might have high levels of mercury (e.g., King Mackerel, Shark, Sword fish, Tile fish)Offer/Refer for any needed STD screening (including HIV)Refer for age appropriate vaccinations, if indicatedMenstrual calendar, cycle beads, fertility awareness,Timed coitus every other day at least 3 times starting 2-3 days prior to ovulation. Ovulation may be calculated using prior cycle lengths, cycle beads or urine ovulation detection tests. Nutritional counseling and recommend weight loss if client overweight.Zika virus education and prevention strategiesAvoid traveling to impacted areas Avoiding mosquito bites if traveling to impacted areas Using condoms to prevent transmission of virus Avoiding pregnancy if infected or partner infectedRisk to unborn fetusREFER TO MD/ERNoneREFERENCESCDC. Providing Quality Family Planning Services MMWR. April 25, 2014, Vol. 63, No. 4.Hatcher RA, et al (editors). Contraceptive Technology, 21st Ed. New York: Ayer Company Publishers, Inc..395-416.Centers for Disease Control and Prevention (CDC) Zika Virus Homepage-: 2020 ................
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