Reproductive Health in Developing Countries
16. List the nine components of comprehensive EmONC.
- Having a delivery system that is integrated to provide MNCH services that are comprehensive at all district levels.
- Ensuring that midwives are trained and deployed.
- Ensuring that there are comprehensive family planning services that are provided.
- Providing communication that is strategic for child health care, the newborn as well as maternal health care.
- Ensure that the Program Management is strengthened.
- Ensure that the EmONC services is provided at all times within the THQ and DHQ Hospitals
- Ensure that fundamental EmONC Services are provided.
- Ensure that precautionary MNCH services can be provided at both the RHC/BHU
- See to the establishment of different clinics such as the well baby clinic, and ensure that these services are provided within all health facilities.
17. Describe the possible adverse consequences for the woman procuring an unsafe abortion.
There are several adverse consequences that a women can face when procuring abortions. This risk is especially heightened if the abortion is done in a manner that is unsafe. The consequences are lasting and they include: severe bleeding which if prolonged could eventually result in the death of the mother; the uterus is torn and in the end, a woman may be unable to conceive again. In other instances, her uterus may be weak and even if she does conceive, she would be unable to carry the child to full term. There is also risk of blood poisoning as well as internal infection. Abortion also causes death of an infant there increasing the mortality rate of children. According to a WHO research carried out on the issue, two percent of the women that have attained the reproductive age are said to be infertile due to the unsafe abortions they procured before. Another five percent are said to suffer from chronic infection brought on by the use of improper equipment and poor sanitary conditions. Unsafe abortions are also responsible for the large number of premature births, spontaneous abortions as well as ectopic pregnancies.
18. What are the three treatment choices for inducing an abortion in a woman who is less than 12 weeks pregnant?
Several methods can be used to induce an abortion. However all these are dependent on the size of your pregnancy. For a pregnancy that is less than twelve weeks old, there are certain procedures that can be used. They include the Medical abortion and the surgical abortion. The medical abortion is also referred to as the abortion pill. It involves the taking of two types of medication after forty-eight hour interval. This medication will induce the abortion, having effects that are quite similar to those of a miscarriage.
The surgical abortion on the other hand involves two procedures, the vacuum aspirator or the dilation and evacuation. However, the method that is commonly used for fetus that is under twelve weeks is the former. The vacuum aspirator method is also referred to as the suction method. This procedure has to be carried out when the patient is under a general or local anesthetic. The fetus is then removed using a gentle suction. The procedure is very simple and only takes ten minutes to complete. Recovery time for the patient is usually two hours.
19 What is one serious consequence of prolonged or obstructed labor, excluding the death of a woman or fetus? Explain why this occurs.
There are several consequences that come with prolonged labor. Among these serious consequence include; neurological injuries to both the child and the mother. This means that the nervous system can be damaged. For the mother it would be due to pressure on the spine and for the child it would be due to increased intracranial pressure, which is brought about by the prolonged stay within the penineum. It can also be caused by the supermoulding of the child’s head.
20. Explain what is meant by ‘syndromic’ management of reproductive tract infection and what is used in resource-poor settings.
Syndromic management of reproductive tract infections basically refers to the different approaches used when treating infections caused by infections of the tract. Although the diagnosis of the diseases are best done by a laboratory, this is however not possible in many cases, especially where the resource settings are poor. What happens in this case is that the some guidelines are followed so that the systems of the ailment are determined. They include vaginal discharge, genital ulcer, lower abdominal pains, urethral discharge as well as inguinal bubo. Once this has been established, treatment can then be given. Syndromic management of the reproductive tract infection may require the use of antibiotics if a person is to become well.
21. Explain the term ‘Voluntary Counseling and Testing (VCT)’.
Voluntary Testing and Counseling refers to the services offered for patients suffering from HIV or those who want to learn more about the disease and known of their status. Voluntary Counseling and Testing involves having two sessions of counseling. One counseling session has to be done before the test is carried out, known as the pre-test counseling, and the other is done once the test has been completed the post-test counseling. It focuses on the HIV infection as well as the AIDS disease, testing and behavior change depending on the outcome of the results.
22. Describe the WHO classification of types of female genital mutilation.
Female genital mutilation is done is several ways like partial removal of the genitalia or total removal of the external part of the female genitals. The World Health Organization has classified the act of female genital mutilation into four different types. These kids of classifications have brought to out the ambiguities related to this issue, incorporating modifications in order to ensure that all concerns as well as shortcomings are accommodated. They include: type I, which involves the partial and in some instances the total removal of the female genitals, that is the clitoris and the prepuce which is also known as the clitoridectomy.
The second type of FGM involves the total or the partial removal of the labia minora and the clitoris. In some cases, this can also involve the excision of the labia majora. Type III, involves the narrowing of a woman’s vaginal orifice such that a covering seal is created. This is done by the cutting of the labia minora and sometimes the labia majora and appositioning it. It may also involve the excision of the clitoris, infibulation. The four type of female genital mutilation refers to any other harmful procedures that are directed towards the female genitalia, without any medical reasoning. It inclusive but not exclusive of: piercing, pricking, incising, cauterization and scraping.
23. Explain the medical treatment you would give to a woman who tells you she was raped 24 hours ago.
Before any action can be taken, it is important that the victim feel that they are in a safe place. Therefore, it is necessary that they be placed in this kind of environment. After this has been done then medical care can begin. It is important that the woman does not take a bath, change clothes, urinate or douche. This is because the necessary evidence that could be used for prosecution will be lost. The first treatment administered to rape victims is the provision of emotional support. Once this has been established then the physical treatment can begin. The postexposure prophylaxis, PEP is usually the first treatment administered. This is an antiretroviral medication, which is used to reduce infection odds of HIV. After, emergency contraceptives are given to reduce the possibility of getting pregnant. After this is completed, any other sexually transmitted infections are tested for and treated accordingly. Once a patient is physically sound, the psychological healing can then begin.
24. WHO estimated that the maternal mortality ratio for Bangladesh in 2005 was 570/100,000. Explain what this means.
Maternal mortality ratio, abbreviated as MMR refers to the yearly figure of female demises that are caused or related to pregnancy, childbirth and issues pertaining to its management. This does not include any incident or accidental causes. It is calculated by dividing the recorded death of mothers by the total number of recorded live births that have taken place within the same period. When WHO says that the maternal mortality ratio within Bangladesh was 570/100,000 it means that out of 100,000 live births 570 of this births resulted in the death of the mother.
25. WHO estimated that the neonatal mortality rate for Asia in 2000 was 32/1000. Explain what this means.
Neonatal mortality rate is also known as infant mortality rate and it is abbreviated as IMR. This refers to the number of dead infants in a year as compared to 1000 live births carried out within the same year. The neonatal period usually starts when a child is born and is completed once the child is 28 days old. When WHO says that the neonatal mortality rate within Asia was 32/1000 it means that out of 1000 live births during that year, 22 of the children born died before 28 days was over.
26. List three hormonal method of contraception.
- The Combined Oral Contraceptive (COC). This is a pill containing two main hormone, oestrogen as well as progesterone.
- Progesterone only pill (POP).
- Contraceptive patch and ring.
27. You are supervising a reproductive health programme in Liberia when the local doctor states that a pregnant woman requires a caesarean section because the fetus is in the breech position. What other option/s could you suggest he explore before he decides on the mode of delivery?
Before caesarean section can be considered, it is important that all other solutions are exhausted first. It is the same when it comes to a breech pregnancy. A pregnancy is said to be breech if the baby is positioned feet first at the opening of the birth canal during delivery. Although a breech baby can be delivery through the vagina, this method is not safe. This is because there are higher risks of complication; the baby can be strangled by the umbilical code and onsets of birth defects. In the case of a breech pregnancy, the following can be considered: the baby can be turned around so that they are positioned in the right manner. This procedure is known as the external cephalic version. Once this has failed then the caesarean section can be carried out as a last resort.
28. Discuss the advantages of having a standardized treatment regime for the management of reproductive traction.
Having a standardized treatment that deals with the management of reproductive traction is very important. This is because it outlines clearly the steps to be taken in determining whether patient has a problem with the reproductive tract. It outlines different symptoms and using this patient can receive the necessary medication that is also indicated in the treatment regime.
29. Explain the initial priorities when caring for a neonate.
There are certain initial steps that have to be taken once a baby is delivered. This is because this is the most critical period when a child is born. It is during this time that high mortality rates are observed. The first thing that is done when an infant is born is to weight them. Once weight is recorded, the auxiliary temperature is then taken. The blood pressure also needs to be determined. The infant is then bathed cotton balls and neural soap. Once all this is carefully done, the nutritional needs can then be considered.
30. Describe two natural method of birth control.
Natural methods of contraception are those that do not require any use of mechanicals or manipulation of hormones. They include but are not exclusive to ovulation method and rhythm method. The ovulation method requires a woman to know when her ovulation period is. It is therefore important that close attention is paid to this. Ovulation period can be calculated by dividing the cycle by half. For most women this comes to between the 12 and 16 day of the cycle. This is the time when a woman is the most fertile as the egg is present in the womb. The egg stays in the womb for 3 to 5 days. Therefore, if intercourse takes place then, then she is likely to get pregnant. It is also important to know that the male sperm also lives to 72 hours and even five days if the woman’s mucus is fertile. It is therefore important that these days be well calculated. The rhythm method is where by the man withdraws from the vagina before ejaculation. This means that the sperm will not enter the vaginal canal and pregnancy can be avoided.
31. List 10 Possible health consequences for women with female genital mutilation.
- Recurrent urinary, bladder and reproductive tract infections.
- Presence of Cysts.
- Could cause damage to the uterus and lead to Infertility
- An augmented risk of having complications during childbirth and therefore also resulting in an increase in the number of newborn deaths.
- Later on there will be need for surgeries to rectify the problems. A common example is that the FGM type III which involves the sealing as well as the narrowing of the opening of the vagina, will require cutting, if a person is to give birth or have sexual intercourse. This could be quite risky.
- Intense pain as well as hemorrhaging.
- Could end up in anemia due to the massive amounts of blood that is lost.
- Could cause wound infection therefore leading to tetanus.
- Increased morbidity both of the child and the mother due to obstructed labor.
- High risk of transmitting HIV and other infections.
32. What are the advantages to using a manual vacuum aspirator over dilation and curettage when managing a woman with an incomplete abortion?
A vacuum aspirator is preferred over dilation and curettage method of abortion. This is because it is usually very fast, as it only requires 10 to 15 minutes to be completed and a recovery period of two hour. It does not require hospitalization and it can be done from any clinic. The dilation and curettage on the other hand takes a long while to recover from and require a patient to be hospitalized. It also takes a large amount of time to complete. The vacuum aspirator is also preferred as it is cheaper and it can be used for early pregnancies, which is not the case with the dilation and curettage.
33. What can be done for the pregnant woman to protect her baby from contracting neonatal tetanus?
Neonatal tetanus can occur when a deliver is done in conditions that are unsanitary. This is especially true if the umbilical cord is contaminated after it has been cut. In order for this to be prevented it is important that sanitation is adhered to and maintained. This can also be prevented by immunizing the mother from the infection, who can then transfer the antibodies to the child.
34. In your African hospital there is a nurse trained to administer anesthesia. What factors would you take into account when deciding whether to use ketamine or spinal anesthesia for a woman requiring a caesarean section for eclampsia?
Before determining the anesthetic to use, it is important to research the patient’s history to determine if they have any conditions. Spinal anesthesia can only be used if no epidural analgesia has been used on the patient. If a patient has already been given the analgesia, then the ketamine or the epidural aesthesia is what is to be used. The advantage that this has on the spinal aesthesia is that it is stronger.
35. In a context where there is no access to caesarean section what are three procedures that may be used by trained health care providers to manage a woman with an obstructed labor? Explain each procedure.
There are other methods that can be used to deliver after obstructed labor. A vaginal delivery can be carried out. Although it may be difficult, it is not impossible to do in the current situation. There are also certain instruments that can be used to pull the baby out. They include forceps
36. What are the signs and symptoms would you expect if a woman has a hydatidiform mole.
The signs that can be seen in a hydatidiform mole patient include; abnormal uterus growth; vomiting and nausea, which could cause a person to be hospitalized; Frequent bleeding from the vagina during the first trimester; hyperthyroidism; high blood pressure, and weight loss that is unexplained. Other symptoms can also include placenta cysts as well as vaginal cysts, tender breasts, swollen feet, proteinuria and excessively enlarged uterus.
37. How would you manage woman with hydatidiform mole in a resource-poor setting?
Once the symptoms have been seen, diagnosis can be done using simple renal tests. Once this is done, a way should be found of evacuating the mole. This can be done through suction curettage and the use of hCG monitoring which are available in such areas. Hydatidiform in poor resource areas can also be managed using prophylactic chemotherapy. Prophylaxis is beneficial because it does not require to be followed closely.
38. What are you looking for when following up a woman after diagnosis of a hydatidiform mole?
Although a majority of the hydatidiform moles is usually benign and outcome after the treatment is administered is usually good, it is still very important for a follow up to be carried out. Patients are usually given contraceptives so that they can avoid pregnancy for the next six to twelve months. In some cases, the hydatidiform mole may continue and develop unto other moles known as evasive moles. This brings on another condition referred to as persistent trophoblastic disease (PTD). These are dangerous, as they could cause hemorrhaging and other complications. The check will be able to detect this. Some moles can also develop into choriocarcinoma. It is malignant, mestatic as well as fast growing cancer form. Check ups are therefore very important.
39. Why is there higher incidence and mortality from cervical cancer in developing countries?
Cervical cancer is more common in countries that are developing than in already developed countries, recording about 370,000 cases each year with a mortality rate of fifty percent. The reason for this is due to the lack of knowledge these countries have on cervical cancer, and the human papillomavirus, HPV. Also in developing countries, it is very difficult to find the vaccine for HPV or the necessary screening test. Therefore, many women remain exposed to the disease.
40. Describe the visual methods of screening for cervical cancer that are showing promise as alternatives to the conventional Pap smear according to WHO. Why are they considered so promising?
In many developing countries, cytology screening is an inaccessible service. This is because it requires intensive laboratories, highly trained personnel and a lot of capital for financing. This has lead to the introduction of other means of screening such as the HPV DNA testing. This mode is considered very promising as it is cost effective and results are obtained in a few hours.
41. Using the instructions on the following page, ‘Using the partograph’, look at the partograph below and explain what has been going on with the labor of Mrs. M.
When Mrs. M was admitted, her cervix was already dilated four centimeters and this was reflected on the alert line. This shows that when she was admitted, she was past the latent phase and labor was in the active phase. The dilations were one centimeter apart every hour. She was admitted at ten in the morning and the dilations were at four centimeters. At two in the afternoon, she had dilated three more centimeters. The level of the fetal head was marked immediately she came in and after four hours. Labour started at six in the evening and at this time, the head started descending. There were two contractions every ten minutes each lasting twenty seconds.
42. From the partograph what should have been done for Mrs. M and when?
According to the partograph, it started at ten in the morning by which time it was already too late and she was past the latent phase of labor. The membrane ruptured and she had mesonium stained fluid. She had mild contractions of less than twenty seconds. Her blood pressure could have been recorded after every four hours to ensure her safety. Her urine volume was also not recorded.