Notes:- "REPRODUCTIVE HEALTH"

 Notes:- "REPRODUCTIVE HEALTH"

By:- Nagraj Sir

REPRODUCTIVE HEALTH – PROBLEM AND STRATERIES:

• The programme “family planning” initiated in 1951.

• Reproductive and child health care (ACH)

• Sexually transmitted diseases (STD).

• Amniocentesis: A fetal sex determination test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo.

• ‘Saheli’ an oral contraceptive for female, developed by CDRI.

POPULATION EXPLOSION AND BIRTH CONTROL:

• Increased health facilities, better living conditions are the cause of population explosion.

• Out of 6 billion world population 1 billion are Indians.

• Rapid decline in death rate, maternal mortalility rate (MMR) and infant mortality rate (IMR) are major cause of population growth.

• Indian population growth rate is around 1.7 percent.

Characteristics of ideal contraceptive.

• User friendly.

• Easily available.

• Effective

• Nor or least side – effects.

• No way interferes with sexual drive.

BIRTH CONTROL METHODS:

Natural methods:

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

Periodic abstinence:

• Avoid or abstain from coitus form day 10 to 17 of the menstrual cycle when ovulation could be expected.

• Chance of fertilization is very high in this period.

• It is called fertile period.

Withdrawal or coitus interruption:

• The male partner withdraws his penis from the vagina just before ejaculation, so as to avoid insemination into the vagina.

Lactational amenorrhea:

• No menstruation during lactation period.

• Chance of fertilization is nil.

• It is effective upto six month.

Barrier methods:

• Principle of working: prevents physical meeting of sperm and ovum.

• Such methods available both for male and female.

Condoms:

• Barriers made of thin rubber/latex sheath.

• Used to cover the penis in male or vagina and cervix in the female.

• Used just before coitus so that semen not entered into the female reproductive tract.

• Male and female condoms are disposable.

• Prevents AIDS and STDs.

Diaphragm, cervical caps and vaults:

• Barriers made of rubber.

• Inserted into the female reproductive tract to cover the cervix.

• Prevents conception by blocking the entry of sperm through cervix.

• They are reusable.

Intra Uterine Devices:

• These devices are only used by female.

• Inserted by doctor or by expert nurses in the uterus through vagina.

• Non-medicated IUDs e.g. Lippes loop.

• Copper releasing IUDs (CuT, Cu7, Multiload 375)

• Hormone releasing IUDs (Progestasert, LNG-20)

Principle of working:

• Increase phagocytosis of sperm within the uterus.

• Cu ion released suppresses sperm motility and fertilizing capacity of sperm.

• Hormone releasing IUDs make the uterus unsuitable for implantation and the cervix hostile to the sperm.

Oral contraceptives:

• This methods used by female only.

• Used in the form of tablets hence popularly called pills.

• Pills contain progestogens or progestogen-estrogen combination.

• Pills have to be taken daily for a period of 21 days.

• Started within first five days of menstruation.

• Pills are very effective with lesser side effect.

• Saheli- a non steroidal preparation used as oral contraceptive pills.

Principle of working:

• Inhibit ovulation.

• Inhibit implantation.

• Alter the quality of cervical mucus to prevent/retard entry of sperms.

Injections or implants:

• Progestogens alone or in combination with estrogen used as injections or implants under the skin by female.

• Mode of action is similar as in pills

• It is very effective for long periods.

Emergency contraceptives:

• These methods are used within 72 hours of coitus, rape or casual unprotected intercourse.

• Administration of progestogens or progestogen-estrogen combination.

• Use of IUDs..

Surgical methods:

• It is also called as sterilization method.

• Advised to both male and female partner.

• Permanent or terminal method to prevent pregnancy.

• Sterilization process in male is called ‘vasectomy,

• Sterilization process in female is called ‘Tubectomy’

• In vasectomy, a small part of the vas deferens is removed or tied up.

• In Tubectomy a small part of the fallopian tube is removed.

• Reversibility is very poor. 

MEDICAL TERMINATION OF PREGNANCY:

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

 • MTP has significant role in decreasing population. 

• It accounts for 1/5th of the total number of conceived pregnancies.

 • Legal restriction only to reduce female foeticide. 

• This method is safe within 1st trimester. 

SEXUALLY TRANSMITTED DISEASES: 

• Diseases or infections which are transmitted through sexual intercourse. 

• Also known as Venereal diseases (VD) or reproductive tract infections (RTIs) 

• Gonorrhea, Syphilis, Genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B andHIV are some common STDs. 

• Except hepatitis-B, genital herpes and HIV infections, others are curable. 

Symptoms: 

• Itching, fluid discharge, slight pain, swelling in the genital region. 

• STDs remain asymptomatic in female and remain undetected for long. 

• In the later stage it may leads to Pelvic inflammatory diseases (PID), abortion, still births, ectopic pregnancy, infertility or even cancer in RT. 

Preventions: 

• Avoid sex with unknown partners/ multiple partners.

 • Always use condoms during coitus. 

• In case of doubt, consult with a qualified doctor for early detection.

 • Get complete treatment if diagnosed with disease.

INFERTILITY:

 • The couple unable to produce children inspite of unprotected sex. 

• The reason of infertility may be:-

 o physical, 

o congenital, 

o diseases, 

o drugs, 

o immunological or 

o Even psychological. 

• Problems of infertility may be in male or female. 

• Infertility clinic can diagnose and correct the cause of infertility. 

• In case there no corrections are possible, some special technologies used to have children called assisted reproductive technologies. (ART) 

Assisted reproductive technologies: 

(a) In vitro fertilization:

• Fertilization outside the body in the laboratory. 

• Condition created in laboratory similar to the body. (b) Embryo transfer: 

• Popularly known as test tube baby programme.

 • Ova from the wife/donor and sperm from the husband/donor are collected and induced to form zygote under simulated conditions in the laboratory. 

• The zygote or early embryos (with upto 8 blastomeres) could be transferred into the fallopian tube. 

• ZIFT- Zygote intra fallopian transfer. 

• IUT- Intra Uterine transfer (embryo with more than 8 blastomeres).

 • Further development taken place within the female body. 

• Embryo formed by in-vivo fertilization can also be transfer to assist those female who cannot conceive.

(c) Gamete intra fallopian transfer- GIFT 

• Transfer of ovum collected from the donor into the fallopian tube of another female who cannot produce it. 

• Such female can provide suitable environment for fertilization and development. 

(d) Intra cytoplasmic sperm injection (ICSI): 

• The sperm is directly injected into the ovum.

 • After in vitro fertilization either ZIFT or embryo transfer technique is followed. 

(e) Artificial insemination (AI) 

• Semen is collected either from the husband or donor is artificially introduced into vagina or into the uterus (IUI-intra uterine insemination) of the female.

 • Such technology is useful in cases either the male partner unable to inseminate the female or very low sperm counts in the ejaculates.