Signs of Pregnancy

Within a decade, the astonishing impact of that care was apparent. (Breckinridge recruited Louis Dublin, vice president and statistician at the Metropolitan Life InsuranceMET +1.02% Company, to do the numbers; the results were published in 1932.) The women the Frontier Nursing Service cared for, who were desperately poor and usually gave birth at home, were 10 times less likely to die in childbirth than the average American at the time. The nation as a whole wouldn't catch up until the 1950s, after the widespread acceptance of antiseptic and the discovery of antibiotics.

There was nothing mystical about this improvement. The midwives simply understood that, instead of focusing narrowly on the birth, they needed healthy families to produce healthy babies. They treated snakebites, fevers and men shot in feuds. They made frequent house calls—18 prenatal visits and 12 postpartum checkups were standard for an uncomplicated pregnancy.


Today, there are a few modern Breckinridges. Among low-income minority women in Washington, D.C., 15% give birth before term, and 14.5% of their babies are dangerously small. But when those women work with the midwives at the Family Health and Birth Center, the preterm birthrate is just 5%, and the rate of low-weight babies is 3%.

The standard response to health problems in the U.S. is more: more hospitals, more highly skilled surgeons, more access to the top technology. But we know for sure that at least some of the increasing danger of birth has been driven by the medicalization of the process. For example, a rare but often deadly condition where the placenta grows into a scar left by an earlier C-section has increased fivefold since the 1980s.

 

Ob-gyns sound alarm on "contraceptive sabotage"

- Doctors should ask teen girls and women whether their partners are trying to force them to get pregnant or otherwise "reproductively coercing" them, according to a group of ob-gyns.


That could include pressuring women to have sex - possibly without a condom or other birth control, forcing them to continue (or end) a pregnancy or intentionally exposing them to sexually transmitted infections, according to The American College of Obstetricians and Gynecologists (ACOG).


"What we're talking about is specific to women and girls' ability to contracept, to control their reproductive health," said Jay Silverman, who studies violence against women at the University of California, San Diego School of Medicine.


"What we've found is that many male partners are more actively involved than we would have thought in really blocking women and girls' ability to do that, as a form of control that's part of a larger picture of violence against women and girls," added Silverman, who wasn't part of the ACOG committee.


One study of the National Domestic Violence Hotline found a fourth of callers had experienced reproductive coercion.


"All the different forms of violence and coercion of women and girls from male partners are based in the entitlement to control their lives, physically and otherwise," Silverman said. "They also feel entitled to decide whether she's going to get pregnant or not."


The Centers for Disease Control and Prevention reports close to three in 10 U.S. women have experienced rape, stalking or physical violence by a partner. Other studies suggest as many as half of women will experience psychological aggression from an intimate partner at some point in their lives.


OFFERING ‘SAFE SPACE'


Earlier this month, the government-backed U.S. Preventive Services Task Force called on doctors to screen women of childbearing age for domestic violence and refer those who need it to intervention services.


"I think this is a very common problem - it's extremely underreported," said Dr. Eduardo Lara-Torre, a member of the ACOG committee from the Virginia Tech Carilion School of Medicine, of reproductive coercion.


In cases of reproductive coercion or "contraceptive sabotage," the ob-gyn group said doctors can help women obtain safe and concealable birth control, such as emergency contraceptive pills packaged in plain envelopes or intrauterine devices with trimmed strings.


Doctors can also give women safety cards, hotline numbers and referrals to domestic violence services, according to the committee opinion published in Obstetrics & Gynecology.


"For this particular scenario, (doctors need to) be able to offer them a safe space to discuss it, number one… as well as offer them alternatives and strategies so they don't get sabotaged," Lara-Torre told Reuters Health


In addition, he said, doctors should "offer them help and assistance, including shelters, for whatever else they might need."


Silverman agreed that doctors and other clinic staff should ask women and girls about reproductive coercion, especially when they come to the office for contraception.


"It is incredibly important that these are issues that are asked about, because if we don't understand the context in which a woman is attempting to contracept, then we are not often giving her the tools to be effective to do that," he told Reuters Health.


"It may be that she needs a long-acting control method that her partner has no control over and may not be able to detect."

Ob-gyns issue statement on abuse during pregnancy

Homicide is a leading cause of death for pregnant women in the United States, according to new guidelines issued by the American College of Obstetricians and Gynecologists.

In addition to lethal violence, many abused girls and women have male partners who intentionally sabotage their contraception, deliberately give them sexually transmitted infections or force them into having unwanted pregnancies or abortions.

In the new guidelines, the College describes reproductive and sexual coercion as a pattern of physical violence and/or psychologically coercive behaviors intended to control a woman’s sexual decision-making, contraceptive use and/or pregnancy. Sabotaging a woman’s contraceptive method, pressuring her to become pregnant unwillingly or forcing her to end or continue a pregnancy against her will all are examples of reproductive coercion.

Some male partners go as far as to forcefully remove intrauterine devices and vaginal rings, poke holes in condoms or destroy birth control pills. Repeated pressure to have sex, forcing sex without a condom and intentionally exposing a partner to an STI are examples of sexual coercion.

The College calls for ob-gyns to routinely screen teens and women for sexual and reproductive coercion at annual exams, new patients’ visits, prenatal visits and postpartum. Both unintended pregnancies and STI and HIV infections in women may be red flags because both are highly related to abusive relationships. Intervention strategies can help women to leave unhealthy relationships and reduce unwanted pregnancies.

Ob-gyns can employ a number of strategies to help women experiencing reproductive and sexual coercion. They can recommend long-acting contraceptives such as IUDs, the implant and the injection, which are more difficult than other contraceptives for partners to detect. As an additional safety measure, IUD strings can be trimmed short to avoid detection and forced removal. Providing emergency contraceptive pills and advising women to store them in a plain envelope to disguise them is another harm-reduction strategy.

 Criteria of a normal term newborn

 

1.Gestational age :37-42 completed weeks

 2.Birth weight: 2500- 4000 gm

 3.Spontaneous , regular breathing and rate between 30-59 per minute

 4.Colour: pink but slight peripheral cyanosis soon after birth is considered normal

 5.Heart rate:100-160 beats per minute

 6.Axillary temperature: 97.7-99.5 degree F(36.5-37.5 degree C)

 7.OFC: 33-37.5 cm

 8.No obvious congenital malformation.

Vesicoureteral Reflux

 

Overview. Vesicoureteral reflux (VUR) occurs when urine stored in the bladder flows back up into the ureters (the tubes that carry urine down from the kidneys to the bladder), and often back up into the kidneys. This can cause hydronephrosis (swelling of the kidney) and kidney damage. It is particularly common in children, usually caused by a congenital abnormality and often diagnosed during a prenatal ultrasound or when the infant or child has a urinary tract infection (UTI). VUR is discovered in approximately one in three children diagnosed with a UTI. When not treated through either antibiotic therapy or, when necessary, surgery, VUR can allow bacteria that grow in urine to enter the kidneys, which can lead to kidney infection, kidney damage, and chronic kidney failure.

 

Types. In a normal urinary tract, the kidneys filter waste products from the bloodstream and produce urine, which drains down the ureters to the bladder to be stored until it is emptied from the body through the urethra. As the ureter makes a tunnel through the bladder wall, a “flap valve” is created to prevent urine in the bladder from backing up and returning to the ureter. In VUR, the flap valve at the junction of the ureter and the bladder is abnormal, causing some of the urine to go back up.

 

In cases of primary VUR, the child is born with a faulty valve – usually either because the ureter is too short for the valve to close properly, or because the ureter is inserted abnormally into the bladder. Often, the reflux will resolve itself as the child grows, though sometimes intervention is necessary. In secondary VUR, a UTI or obstruction somewhere in the urinary tract is responsible.

 

Symptoms. UTI is the most common symptom of VUR, particularly in young children. For older children, symptoms can include nocturnal enuresis (bedwetting) or other urinary problems, high blood pressure, hydronephrosis, an abdominal mass from the swollen kidney, protein in the urine, and kidney failure.

 

Diagnosis. The two most common diagnostic tests for VUR are a voiding cystourethrogram (VCUG), which examines the urinary tract through X-ray images as the bladder fills and empties; and a renal ultrasound, which produces sound waves to transmit a picture of the kidney and bladder that can reveal abnormalities. Based on these tests, the severity of the reflux is graded, with grade 1 being the most mild and grade 5 being the most severe. Higher-grade reflux is less likely to get better without treatment.

 

Treatment. Children who are expected to outgrow their reflux are followed closely and monitored with VCUG, renal ultrasound, and other tests. Even when surgery isn’t required, antibiotics are needed to prevent or immediately treat infections in order to ensure that there is no kidney damage. When the reflux is severe enough that infection can’t be controlled by antibiotics, surgery may be needed. The surgical approach usually involves either severing and then reattaching the ureter to the bladder to make a longer tunnel or create a new angle, or using a bulking agent (inserted through a telescope) to strengthen the flap valve.