reproductive health

total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural and social.

Therefore, a society with people having

1. physically and functionally normal reproductive organs and

2. normal emotional and behavioural interactions among

them in all sex-related aspects might be called reproductively healthy

1. india

2. 1951

3. family planning

4. Reproductive and Child Health Care (RCH) programmes’.

5. tasks-

   1. awareness among people about various reproduction related aspects

   2. providing facilities and support for building up a reproductively healthy society

6. requires-

   1. infrastructure

   2. expertise

   3. material support

7. These are essential to provide medical assistance and care to people in reproduction-related problems like

• pregnancy

• delivery,

• STDs

• abortions

• contraception

• menstrual problems

• infertility

8. by providing-

   1. better techniques

   2. new strategies

audio visual

1. parents

2. friends

3. teachers

4. close relatives

sex education in schools

1. reproductive organs

2. adolescence and related changes

3. safe and hygienic sexual practices

4. sexually transmitted diseases (STD)

5. AIDS

Educating people, especially fertile couples and those in marriageable age group, about

1. available birth control options

2. care of pregnant mothers

3. post-natal care of the mother and child

4. importance of breast feeding

5. equal opportunities for the male and the female child, etc.

Awareness of problems due to

1. uncontrolled population growth

2. social evils like sex-abuse and sex-related crimes,

need to be created to enable people to think and take up necessary steps to prevent them and thereby build up a socially responsible and healthy society.

1. amniocentesis

2. because-

   1. to check female foeticides

   2. massive child immunisation

3. examine the fluid surrounding the developing embryo

4. check for genetic abnormalities (like downs and sickle cell anaemia).

5. the fluid has cells and hair of the baby which can be examined/tested for the genes.

6. structural abnormalities like cleft lip

1. 2 billion

2. 6 billion

3. 7.2 billion

1. 350 million

2. 1 billion

3. 1.2 billion

sixth

1. decreased infant mortality rate

2. decreased maternal mortality rate

3. increase of people in reproducible age

1. RCH

2. only marginal

1. 1.7 per cent, i.e., 17/1000/year

2. double the population in 33 years

3. Such an alarming growth rate could lead to an absolute scarcity of even the basic requirements, i.e., food, shelter and clothing, in spite of significant progress made in those areas

1. is to motivate smaller families by using various contraceptive methods

2. You might have seen advertisements in the media as well as posters/bills, etc., showing a happy couple with two children with a slogan Hum Do Hamare Do (we two, our two)

3. Many couples, mostly the young, urban, working ones have even adopted an ‘one child norm’

4. • female to 18 years and that of males to 21 years

   - incentives given to couples with small families

1. user friendly

2. no or least side effects

3. easily available

4. effective

5. reversible

1. natural/traditional

2. barrier

3. IUDs

4. oral contraceptives

5. injectables

6. implants

7. surgical methods

1. work on the principle of avoiding chances of ovum and sperms meeting

2. example-

   1. periodic abstinence

   2. withdrawal method

   3. lactation amenorrhea

periodic abstinence

. Periodic abstinence is one such method in which the couples avoid or abstain from coitus from day 10 to 17

of the menstrual cycle when ovulation could be expected. fertilisation chances are v high during 10-17 therefore its called fertile period

is another method in which the male partner withdraws his penis before ejaculation to avoid insemination

(absence of menstruation) method is based on the fact that ovulation and therefore the cycle do not occur during the period of intense lactation following parturition. Therefore, as long as the mother breast-feeds the child fully, chances of conception are almost nil. However, this method has been reported to be effective only upto a maximum period of six months following parturition. As no medicines or devices are used in these methods, side effects are almost nil. Chances of failure, though, of this method are also high.

the mother must continuously feed child- every 2 hours or so

otherwise the hormone levels start becoming normal which is not good

main hormone during lactation is prolactin.

prolactin disrupts GnRH from hypothalamus.

1. FSH affects regular pulsing of FSH- normal growth of follicles is disrupted

2. LH no graafian follicle-no ovulation- theca interna decreases- oestrogen

1. Condom

2. Diaphragms

3. cervical caps

4. vaults

1. Condoms are barriers made of thin rubber/ latex sheath

2. used to cover the penis in the male or vagina and cervix in the female, just before coitus so that

3. the ejaculated semen would not enter into the female reproductive tract. This can prevent conception

4. Use of condoms has increased in recent years due to its additional benefit of protecting the user from contracting STDs and AIDS.

5. disposable, can be self-inserted and thereby gives privacy to the user.

nirodh for males

1. FEMIDOMS- caps barriers made of rubber that are inserted into the female reproductive tract to cover the cervix during coitus. They prevent conception by blocking the entry of sperms through the cervix

2. Spermicidal creams, jellies and foams are usually used alongwith these barriers to increase their contraceptive efficiency

IUD

intra uterine device

1. nurse or doctor in uterus through vagina

2. types-

   1. non medicated

   2. copper releasing

   3. hormone releasing

3. who want to delay pregnancy and/or space children. It is one of most widely accepted methods of contraception in india

1. Lippe’s Loop

2. double S shaped - fits into the uterine cavity

3. placed in uterine body like plastic → had a immune reaction

4. it -

   1. sperms will die due to friction/ stuck/ wait there and die

   2. presence of foreign body → immune reaction → attract leucocytes → phagocytosis of sperm

      UTERUS is unfriendly for sperm

5. it can fall out

1. CuT, Cu7, Multiload 375

2. CuT is T shaped. has serations therefore Fits into the fundus

3. Cu ions released -

4. suppress sperm motility

5. suppress fertilising capacity of sperms

6. IUDs increase phagocytosis of sperms within the uterus

7. stay there for 3-5 years

8. cannot be self inserted, need a doctor or nurse to insert

1. (Progestasert, LNG-20)

2. make The hormone releasing IUDs, in addition,

• make the uterus unsuitable for implantation

• cervix hostile to the sperms.

• progestatert → secrete progesterone → cervical mucus plug v thick

3. IUDs increase phagocytosis of sperms within the uterus

1. progesterone / progesterone estrogen combination

2. They are used in the form of tablets and hence are popularly called the pills

3. Pills have to be taken daily for a period of 21 days starting preferably within the first five days of menstrual cycle. After a gap of 7 days (during which menstruation occurs) it has to be repeated in the same pattern till the female desires to prevent conception

4. they keep oestrogen and progesterone at a constant level - and

• prevent a LH surge therefore no ovulation → no corpus luteum

• constant oestrogen so no fall so no FSH stimulus, FSH is inhibited→ follicle doesnt develop properly

• in Uterus- wont proliferate much because Oestrogen is less- Not enough to sustain pregnancy.

ARTIFICIAL MONITER of hormone levels in body

5. 28 pills. 21 have hormones, 22-28 have nothing/iron in india

6. saheli- NON STEROIDAL once a week - v few side effects

7. effects-

   1. No Ovulation

   2. Thickens Cervical Mucus Plug

   3. Inhibit Implantation

8. side effects-

   1. forget to take pill

   2. nausea

   3. weight gain

1. 72

2. within 72hours

   1. IUD

   2. I-Pills

   3. Pills 72

3. progesterone/progestogen-estrogen combinations

4. very effective as emergency contraceptives as they could be used to avoid possible pregnancy due to rape or casual unprotected intercourse.

1. central drug research institute Lucknow.

2. non steroidal/ non hormonal + once a week

3. SERM- selective estrogen receptor modulator

1. Anti Oestrogenic

2. prevent proliferation of endometrium therefore no implantation could occur

3. It does not effect ovulation

4. less side effects

   high contraceptive value

1. norplant

2. adv-

   1. remain for 5 years

   2. release progesterone- no LH surge/ no ovulation

3. insert surgically

1. progesterone injection→ Depo provera

2. every 3 months- keeps levels steady

1. sterilisation

2. generally advised for the male/female partner as a terminal method to prevent any more pregnancies

3. Surgical intervention blocks gamete transport and thereby prevent conception

4. vasectomy- vas defarans is cut and tied-

5. through a small incision on the scrotum

6. tubectomy- fallopian tubes tied and cut

7. or tied up through a small incision in the abdomen or through vagina

8. These techniques are highly effective but their reversibility is very poor.

. However, their possible ill-effects like

1. nausea

2. abdominal pain

3. breakthrough bleeding

4. irregular menstrual bleeding

5. even breast cancer, though not very significant, should not be totally ignored

medical termination of pregnancy

1. Intentional or voluntary termination of pregnancy before full term is called medical termination of pregnancy (MTP) or induced abortion.

2. Nearly 45 to 50 million MTPs are performed in a year all over the world which accounts to 1/5th of the total number of conceived pregnancies in a year

3. Obviously the answer is –to get rid of unwanted pregnancies either

• due to casual unprotected intercourse or

• failure of the contraceptive used during coitus or rapes.

• MTPs are also essential in certain cases where continuation of the pregnancy could be harmful or even fatal either to the mother or to the foetus or both.

1971

Such restrictions are all the more important to check indiscriminate and illegal female foeticides which are reported to be high in India.

MTPs are considered relatively safe during the first trimester, i.e., upto 12 weeks of pregnancy.

registered medical practitioner needs to approve

Second trimester abortions are much more riskier

1. majority of the MTPs are performed illegally by unqualified quacks which are not only unsafe but could be fatal too

2. misuse of amniocentesis to determine the sex of the unborn child. if the foetus is found to be female, it is followed by MTP- this is totally against what is legal. Such practices should be avoided because these are dangerous both for the young mother and the foetus.

effective counselling -

1. to avoid unprotected coitus

2. risk factors in illegal abortions

3. more health care facilities

before 24 weeks-

medical opinion of 2 doctors is needed

1. fatal to mother

2. foetus shows congenital anomalies as to be seriously handicapped

Diseases or infections which are transmitted through sexual intercourse are collectively called sexually transmitted diseases (STD

VD- venereal diseases

RTI- reproductive tract infections

STI- sexually transmitted infections

1. bacterial

2. viral

3. protozoa

1. syphilis

2. chlamydiasis

3. chancroid/ soft sore

4. gonorrhea

1. Triponema pallidum

2. spirillum

3. 3-4 weeks

4. ulcer at site of entry= primary syphillus

   chacre+ hard sore, painless, spontaneously resolves

   -x-till this stage u can diagnose and fully cure.

1. chlamydia trachomatin

1. Haemophilus ducreyi

1. Neisseria gonorrhoe

2. dipplococcus

3. 2-14 days

4. 7-21 days

5. signs-

• Pus from urogenital tract - fustular discharge

• pain

• itching

• burning

6. if mother has gonorrhea, the baby will catch the infection while passing through the birth canal- will have Pus around eye- Opthalmia neonatarum / gonococcal opthalmia

bacterial- if caught appropriate time

Except for hepatitis-B, genital herpes and HIV infections, other diseases are completely curable if detected early and treated properly

1. genital herpes

2. HIV

3. Genital Wartz

4. Hepatitis B

1. HSV- herpes simplex virus

2. not completely

3. signs-

   1. water filled vesicles= burning around a nerve

   2. extremely painful

1. HPV- human papilloma virus

2. cauliflower like growth

1. Hepatitis B virus

2. blood transfusion, drug IV, shared injected needles

1. trichomonalis

1. trichomonas vaginal

fluid discharge,slight pain, swellings

Infected females may often be asymptomatic and hence, may remain undetected for long.

1. still birth

2. PID- pelvic inflammatory disease

3. irregular breathing

4. ectopic pregnancy

5. cancers

by sharing of injection needles, surgical instruments, etc., with infected persons, transfusion of blood, or from an infected mother to the foetus too

everyone- 15-24 years

i) Avoid sex with unknown partners/multiple partners.

(ii) Always use condoms during coitus.

(iii) In case of doubt, one should go to a qualified doctor for early detection and get complete treatment if diagnosed with disease.

inability to produce kids after 2 years if sexual cohabitation without contraception

1. physical

2. congenital

3. diseases

4. drugs

5. immunological

6. psychological.

but more often than not, the problem lies in the male partner

1. Specialised health care units (infertility clinics, etc.) could help in diagnosis and corrective treatment of some of these disorders and enable these couples to have children

2. ART- assisted reproductive technologies

in vitro fertilisation

test tube baby

v expensive

1. uterus

2. fusion → embryo → early morula stage (8 blastomere max)

3. 2 cases

   • early morula in fallopian tube - ZIFT- zygote intrafallopian transfer

   • morula in uterus - IUT intra uterine transfer

ZP starts to dissapear.

trophoblast secretes lytic enzymes which will dig into the FT → ectopic pregnancy

GIFT-

gamete intrafallopian transfer

from one woman to another gamete is transfered from FT

the woman has suitable environment in uterus to sustain pregnancy

ICSI

intra cytoplasmic sperm injection

o form an embryo in the laboratory in which a sperm is directly injected into the ovum.

1. oligospermia-sperm count low

2. azoospermia- zero sperm out

3. problem w ejaculation

1. sperm from donor

2. sperm from husband

In this technique, the semen collected either from the husband or a healthy donor is artificially introduced either into the vagina or into the uterus (IUI – intra-uterine insemination) of the female.

progesterone / in comb w estrogen

mode of action similar to pills

effective periods arelonger

2017

The Medical Termination of Pregnancy (Amendment) Act, 2017 was enacted by the government of India with the intension of reducing the incidence of illegal abortion and consequent maternal mortality and morbidity. According to this Act, a pregnancy may be terminated on certain considered grounds within the first 12 weeks of pregnancy on the opinion of one registered medical practitioner. If. the pregnancy has lasted more than 12 weeks, but fewer than 24 weeks, two registered medical practitioners must be of the opinion, formed in good faith, that the required ground exist. The grounds for such termination of pregnancies are:

(i) The continuation of the pregnancy would involve a risk to the life of the pregnant woman or of grave infury physical or mental health; or

(ii) There is a substantial risk that of the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.