Sterilization in men is less complicated than in women. The procedure, called a vasectomy, is usually done on an outpatient basis using a local anesthetic. The surgeon(generally a urologist) makes an incision on each side of the scrotum. The vas deferens on each side is then located, and a piece is removed from each. The ends are usually tied or sewn shut.
The man usually experiences some discomfort, local pain, swelling, and discoloration for about a week. In a small percentage of cases, more serious complications occur: formation of a blood clot in the scrotum(which usually disappears without medical treatment), infection, and inflammatory reactions. Because sperm are stored in other areas of the reproductive system besides the vasa deferentia, couples must use alternative methods of birth control for at least one month after the vasectomy. The man must check with his physician(who will do a semen analysis) to determine when unprotected intercourse can take place. The pregnancy rate in women whose partners have had vasectomies is about 15 in 10,000.
Many men are reluctant to consider sterilization because they fear the operation will affect their sexual performance. Such fears are unfounded(although not abnormal) and can be alleviated by talking to men who have already been vasectomized.
A vasectomy in no way affects sexual response. Because sperm constitute only a small percentage of the semen, the amount of ejaculate is not changed significantly. The testes continue to produce sperm, but the sperm are prevented from entering the ejaculatory duct because of the surgery. After a time, sperm production may diminish. Any sperm that are manufactured disintegrate and are absorbed into the lymphatic system.
Although a vasectomy should be considered a permanent procedure, surgical reversal is sometimes successful in restoring fertility. Recent improvements in microsurgery techniques have resulted in annual pregnancy rates of between 40 and 60 percent for women whose partners have had reversals. The two major factors influencing the success rate of reversal are the doctor’s expertise and the time elapsed since the vasectomy.
Cervical mucus method A birth control method that relies upon observation of changes in cervical mucus to determine when the woman is fertile so the couple can abstain from intercourse during those times.
Body temperature method A birth control method that requires a woman to monitor her body temperature for the rise that signals ovulation and to abstain from intercourse around this time.
Calendar method A birth control method that requires mapping the woman’s menstrual cycle on a calendar to determine presumed fertile times and abstaining from penisÂvagina contact during those times.
Sterilization Permanent fertility control achieved through surgical procedures.
Tubal ligation Sterilization of the female that involves the cutting and tying off of the fallopian tubes.
Hysterectomy The removal of the uterus.
Vasectomy Sterilization of the male that involves the cutting and tying of both vasa deferentia.
Healthy weight gain during pregnancy is beneficial in nourishing a growing baby. For a woman of normal weight before pregnancy, the acceptable weight gain during pregnancy ranges from 25-35 pounds; a woman carrying twins needs to gain about 35-45 pounds. Usually the mother can expect to gain about 10 pounds during the first 20 weeks and about 1 pound per week during the rest of the pregnancy.
Of the total number of pounds gained during pregnancy, about 6-8 are the baby’s weight. The baby’s birth weight is important, since low weight can mean health problems during labor and the baby’s first few months. Eating right and gaining enough weight helps reduce the chances of having a low-birththweight baby. If a woman gains an appropriate amount weight while pregnant, chances are that her baby will gain weight properly, too. Pregnancy is not a time to think about losing weight-doing so may endanger the baby.
As in all other stages of life, exercise is an important factor in weight control during pregnancy as well as in overall maternal health. A balanced 45-minute exercise session three days per week has been associated in one study with heavierÂbirthweight babies, fewer surgical births, and shorter hospital stays after birth. Pregnant women should consult with their physicians before starting any exercise program.
Teratogenic Causing birth defects; may refer to drugs, environmental chemicals, X-rays, or diseases.
Fetal alcohol syndrome(FAS) A collection of symptoms, including mental retardation, that can appear in infants of women who drink too much alcohol during pregnancy.
Other Factors A pregnant woman should avoid exposure to toxic chemicals, heavy metals, pesticides, gases, and other hazardous compounds. She should not clean cat-litter boxes because cat feces can contain organisms that cause a disease called toxoplasmosis. If a pregnant woman contracts this disease, her baby may be stillborn or suffer mental retardation or other birth defects.
Before becoming pregnant, a woman should be tested to determine if she has had rubella(German measles). If she has not had the disease, she should get an immunization for it and wait the recommended length of time before becoming pregnant. A rubella infection can kill the fetus or cause blindness or hearing disorders in the infant. If the woman has ever had genital herpes, she should inform her physician. The physician may want to deliver the baby by cesarean section, especially if the woman has active lesions. Contact with an active herpes infection during birth can be fatal to the infant.
Depo-Provera Depo-Provera is a long-acting synthetic progesterone that is injected intramuscularly every three months. Although used in other countries for years, the FDA did not approve it for use in the United States until 1992. Researchers believe that the drug prevents ovulation.
Depo-Provera encourages sexual spontaneity because the user does not have to remember to take a pill or to insert a device. Those who want to start a family can easily decide to do so without much of a waiting period. There are fewer health problems associated with Depo-Provera than with estrogenÂcontaining pills. The main disadvantage is irregular bleeding, which can be troublesome at first, but within a year, most women are amenorrheic(have no menstrual periods). Weight gain(an average of five pounds in the first year) is common . Other possible side effects include dizziness, nervousness, and headache. Unlike other methods of contraception, this method cannot be stopped immediately if problems arise,
Norplant Approved for use by the FDA in 1990 and marketed since February 1991 for use in the United States, Norplant is one the newest forms of hormonal contraception. It has been tested by more than 1 million women in 45 countries and is now approved for use in 14 countries. Increasing numbers of women in the United States are considering this option because of its convenience, effectiveness, and safety.
Six silicon capsules that contain progestin are surgically inserted under the skin of a woman’s upper arm, For five years, small amounts of progestin are continuously released. The progestin in Norplant works the same way as oral contraceptives do; it suppresses ovulation, prevents growth of uterine lining, and thickens the cervical mucus.
Norplant is one of the most effective methods of birth control ever developed, A serious disadvantage to Norplant use, however, is its lack of protection against STDs.
Norplant can be inserted by a specially trained doctor, nurse, or nurse practitioner in 10 to 15 minutes. A local anesthetic is administered to the upper arm, a small injection is made, and, with a special needle, the six capsules are placed just under the skin in a fan shape. The capsules are similarly removed after five years or, if necessary, at any point after their insertion.
The capsules usually cannot be seen, nor does insertion leave a scar in most women. At this time, no serious side effects are known, Less serious side effects include irregular bleeding and irregular menstrual periods, acne, weight gain, breast tenderness, headaches, nervousness, depression, and nausea.
Norplant is one of the most effective reversible methods of fertility control. In addition to being very convenient, the implant is easy for a trained practitioner to do, so there is little chance of error. It costs less than the pill-$550 compared to $1,180 over five years. Medical assistance programs in many states will pay this cost for poor women.
Vaginal Ring A method that is not yet approved by the FDA but that appears promising is the vaginal ring. Rings that are 2 to 3 inches in diameter and contain estrogen and progesterone or progesterone alone are placed by a woman in he vagina. They may be left in place continuously or removed every three weeks for one week to allow regular bleeding. The rate of effectiveness is similar to that of the pill.
Yeast infection during pregnancy is one of the most common infections noticed in pregnant women. Women who are pregnant are advised to go for doctoral help as soon as they notice yeast infection symptoms such as itching, rash, burning sensation, pain during physical intercourse, swelling of vulva, vaginal discharge, soreness and redness in the infected area. Yeast infection is likely to incur on moist body surfaces such as nipples and for that pregnant women should wipe off the nipples as frequently as possible. It is important to wipe off the sexual parts with cotton pad after having urination as bowel bacteria and yeast can lead to vaginal infection and skin breakdown.
Itching is one of the most unbearable signs in pregnancy, and expectant mothers can take home remedies, such as aloe Vera juice to reduce itching. Wearing loose clothes is also perfect precaution to allow air ventilation inside the body thereby reducing chances of yeast infection. Pregnant women should avoid tight fitted pants and pantyhose which can trap moisture near the perineum. It is advisable for pregnant women to air dry the perineum after moisture generating activities such as exercise, bathing and swimming. Wearing cotton underwear is best means available to avoid accumulation of moisture as cotton absorbs the extra moisture. If the yeast infection worsens even after taking all precautions and home remedies, then it is vital to consult gynecologists for proper handling of yeast infections and pregnancy.
The market is flooded with teeth whitening products. There are gels, cosmetic products and others to whiten your teeth. One stunning product is the teeth whitening paste. The teeth whitening paste comes as a revolution to those who don’t want to undergo a treatment from dentist fearing that he would adopt painful methods to clean their teeth. The process of using the whitening paste is simple. You just have to apply the paste on your teeth for ten minutes and then brush it normally for 2-3 minutes. While you apply the paste on your teeth, apply it properly both on the upper pain and lower pair of teeth.
he teeth whitening pastes are made of ingredients which can clear stains or yellowish fades from your teeth chemically without hurting your gums or health of teeth. As you use the paste your teeth becomes whiter and whiter day by day. They teeth whitening pastes are also a cost effective method to take care of your teeth. You don’t have to spend large sum of money paying dentist bills and other bills for your teeth whitening. Browse the web to find out good teeth whitening pastes which are recommended by Dental Associations. Make a good research to find out how much a product is reliable. If you are a men with nice body but bad teeth it affects your personality. Learn more on мебелиmens health.
It used to be held in obstetrics that “once a cesarean, always a cesarean.” This is no longer considered true, although one of the commoner reasons for cesarean is still that the last delivery was by cesarean. Most reasons for cesarean are present only for that pregnancy and are not likely to recur. This is true even of cephalopelvic disproportion(CPD), or a baby considered too large for the pelvis of the mother. In subsequent pregnancies, women often deliver babies as large as or even larger than the baby for whom this diagnosis was given. For this reason, CPD is used less after today as a diagnosis than “failure to progress.” Failure to progress can be caused by any of a number of reasons, none of which will necessarily recur .
Ninety years ago, virtually all cesareans were done through a classical incision. The risks to mother and fetus from the rupture of a classical cesarean incision exceed by far what is acceptable in obstetrics today. The classical scar in the upper muscular body of the uterus can tear directly into the peritoneal cavity. About 40 percent of the time the placenta is implanted on the front wall of the uterus under the scar and the rupture therefore initiates placental separation and consequent hemorrhage. Contractions of the uterus tend to push placenta and baby out through the defect whether or not the woman is in labor. If the placenta is on the back wall of the uterus, the baby is pushed into the peritoneal cavity and the placenta follows. The separation of the placenta cuts the baby off from its maternal support system and the fetus is likely to die of asphyxia, before it can be rescued by an abdominal operation. The inevitable serious hemorrhage in the mother due to this calamity results in a hundredÂfold increase in the maternal death rate. A planned, or elective, repeat cesarean will be scheduled at about 36 to 37 weeks of pregnancy in the few women who today have had classical cesarean deliveries.
When a previous low transverse scar ruptures, the body of the uterus usually remains intact. Uterine contractions, instead of causing the fetus to erupt into the peritoneal cavity, simply continue to push the baby down further into the birth canal. Since the placenta and its blood supply are in the body of the uterus, placental separation does not take place and bleeding usually is negligible. The baby remains in a position from which it can be delivered readily. The risks to mother and baby are only slightly greater than those of a normal pregnancy. The previous incision is not likely to be disrupted by a later twin pregnancy, by the presence of hydramnias, or by the stretching of the uterus to accommodate a baby much larger than the previous one.
Many studies do not make a distinction between serious and minor rupture of the uterus. Thus, the rate of dangerous rupture cannot be evaluated completely, but most studies report that less than 1 percent of VBACs result in uterine rupture. In most cases, this is not dangerous to mother or baby.
Today, women who have had previous cesarean deliveries are given the option of a vaginal birth for their next pregnancy. Often, this is referred to as a “trial of labor,” meaning that a cesarean will be performed if the labor is not successful. Studies have shown that women who have vaginal births have lower rates of fever, infection, and bleeding, although there is the small increased risk of uterine rupture with a trial of labor. For this reason, the American College of Obstetricians and Gynecologists advises that women with previous cesarean deliveries have their subsequent deliveries in a hospital with the capacity to perform an emergency cesarean operation if necessary.
Generally, in order to have a trial of labor, there will have to be documentation of the type of incision used in the cesarean. If you are delivering at the same hospital or with the same obstetrical practice, this is no problem. If you are not, you should request that your medical records be sent to your new physician or midwife early in your pregnancy. If, for whatever reason, you cannot get this documentation, then a careful history will be taken. If your cesarean was done for a baby that was premature, then it will be assumed to have been a classical incision, and you will not be able to labor. In most other cases, the scar will be assumed to be in the lower uterine segment and you will be able to labor, with close observation.
In most of the studies in which women with previous cesarean deliveries have gone into labor, 60 to 70 percent delivered vaginally and uneventfully. Some researchers have attempted to predict which women will experience successful vaginal delivery after cesarean and which will need a repeat cesarean. To date, this prediction has not been possible. The only consistent variable that seems to make VBAC more successful is having had a previous vaginal birth in addition to the previous cesarean. Some researchers have tried measuring the thickness of the lower uterine segment with ultrasound prior to the trial of labor. This may be promising for the future, but currently there is not enough data on this technique to use it to select women for a trial of labor.
Some practitioners examine(with gloved fingers) the scar inside the uterus immediately after the birth of the baby in a woman who has had a vaginal birth following a cesarean to be certain that it has remained intact. Unless active bleeding is present, however, a separation of the old scar, called a dehiscence, does not need to be repaired. This examination. then, may be unnecessary unless unusual bleeding is present.
Women who have delivered previously only by cesarean and who then deliver via the vagina are naturally pleased to find that the recovery from a vaginal birth is more comfortable and speedier than recovery from an abdominal delivery.
Beta-Adrenergic Receptor Agonists. A group of cells called adrenergic receptors are found on the surface of smooth muscle cells. An agonist is a drug or other substance that can combine with the receptor cells. In the uterine muscle, stimulation of the beta-adrenergic receptors by an agonist causes the receptors to inhibit uterine contractions. Two beta-adrenergic agonists used to stop preterm contractions are ritodrine and terbutaline, although only ritodrine is approved for this use by the Food and Drug Administration.
Studies have found that these medications, given intravenously, stop labor for a day or two, at most. While this doesn’t give the fetus much time to grow, it may allow for the adminstration of corticosteroids or maternal transfer.
Since beta-adrenergic receptors are found in smooth muscle cells all over the body, these drugs affect many body systems. This limits their use. They can cause heart and lung problems, as serious as rapid or irregular heartbeat, decreased blood pressure, chest pain, and pulmonary edema(fluid in the lungs). They cause changes in body chemistry, including increased blood sugar, decreased blood potassium, and increased blood insulin levels. They cause less serious but quite unpleasant side effects such as vomiting, headaches, fever, and hallucinations. They may cause anxiety in the woman.
Women receiving ritodrine or terbutaline must be hospitalized and watched with extreme care. Women with poorly controlled diabetes or poorly controlled high blood pressure should not be given beta-adrenergic agonists.
Magnesium Sulfate. Another medication used in the effort to stop preterm labor is magnesium sulfate, usually given intravenously. Studies show its effects on labor to vary from none to stopping labor for the same duration as ritodrine. Magnesium can depress maternal respiration, although this effect is rare. A woman must be closely observed while the drug is being given. Magnesium therapy may also cause nausea and vomiting, decreased blood pressure, and headache. Magnesium eventually crosses the placenta and may affect newborn respirations as well.
Magnesium sulfate cannot be used in women with kidney failure, low blood calcium levels, or a disease called myasthenia gravis(characterized by severe muscle weakness).
Prostaglandin Inhibitors. Prostaglandins are a group of body chemicals involved in normal uterine contractions. Prostaglandins can be given to induce labor. Conversely, prostaglandin inhibitors can be used to stop labor. These inhibitors work by either reducing the formation of prostaglandins or blocking their action. Indomethacin is an example of a prostaglandin inhibitor that has been used to arrest labor.
Research studies have found prostaglandin inhibitors more effective than beta-agonists for delaying labor up to 48 hours, with fewer maternal side effects. Prostaglandin inhibitors, however, are associated with severe adverse effects on the fetus, including cardiac defects and brain hemorrhage. They can also cause bleeding in the mother. The use of these drugs for stopping labor is still under investigation.
Indomethacin cannot be used with maternal asthma, coronary artery disease, gastrointestinal bleeding, kidney failure, and oligohydramnios. Suspected heart or kidney abnormalities in the fetus also preclude its use.
Calcium Channel Blocking Agents. Reducing calcium levels in muscle cells reduces muscle contraction. Calcium channel blockers stop the entry of calcium into cells. (These drugs are used to treat high blood pressure because they relax the muscles in blood vessels.) An example of a calcium channel blocker that has been used to stop preterm labor is nifedipine.
Studies have shown that nifedipine can postpone delivery by 3 daysÂa greater delay than that seen with ritodrine. Maternal side effects are less than with ritodrine. The effect of this drug on the fetus, however, has not been studied extensively. Because it relaxes the muscles in blood vessels, it could lead to decreased blood pressure in the mother. This, in turn, could lead to decreased blood flow to the placenta. The extent to which this occurs warrants further study.
Nifedipine should not be used with magnesium sulfate as it enhances the effect of magnesium, leading to serious lung and heart problems. Women with liver disease cannot use nifedipine.
Oxytocin Inhibitors. Atosiban is a type of drug currently under development. It works by inhibiting oxytocin, a chemical responsible for uterine contractions. Its use has been limited but it may prove to be beneficial in the future.
The search for safer and more predictable drugs continues. It is difficult to slow down or speed up the uterus without affecting other body systems. The best drug would be one that limits its effects to the uterine muscle. Such a substance has not been identified.
For many years every skilled obstetrician felt obligated to design his own forceps and to name them after himself. However, only a few basic types have survived to present-day use. All forceps have two blades that are readily separated from one another but can be joined together, much as the two blades of a pair of kitchen scissors are joined. The length of the handles and blades varies, and there are a number of curvatures. Some of the blades are solid where they wrap around the baby’s head and some have openings.
All forceps have two curves-one to fit the curve of the birth canal and the other to allow the blades to wrap properly around the baby’s head. These curves vary slightly from one forceps to another. The Simpson forceps, the Tucker-McLane forceps, the Luikart forceps, an instrument more slender and delicate than the first two, and the Kielland forceps, the most delicate of all, are most commonly used in the United States. The experience of an individual operator with a particular pair of forceps is probably more important to successful use than the particular variety of instrument used for a given delivery.
When Are Forceps Used?
The reasons for forceps delivery are divided into two broad classes, the fetal and the maternal.
The fetal indication for forceps is evidence of fetal distress appearing in the second stage of labor. This might be a persistent nonreassuring fetal heart rate pattern, with the awareness that some decelerations are perfectly normal in the second stage of labor. It might be a prolapsed umbilical cord or a separation of the placenta.
Maternal Reasons for Forceps
Maternal indications for forceps are not very clear-cut. A woman with a disease of the heart or lungs may have difficulty pushing. Sometimes a woman is able to bring the baby’s head into view at the entrance to the vagina but somehow lacks the strength for the final pushes. Women who are unfortunate enough to have had a long latent labor, especially if they have gone without solid food and sleep, may reach the second stage of labor fatigued and distraught, and may have difficulty pushing well. If contractions are strong and the baby is in a good position, usually they can manage. However, if the baby is posterior, for example, second stage may be prolonged, and maternal exhaustion may become great. If the head is low enough, forceps may be worthwhile in such a situation.
Safe Conditions for a Forceps Delivery
Delivery by forceps is safe only if specific conditions are met. The fetus must be in a vertex or face presentation. In a face presentation, the chin must be anterior(facing the mother’s front). The head of the child must fit deeply into the pelvis without serious obstruction from the mother’s pelvic bones. To ascertain this, the head must be engagedÂwedged between the ischial spines of the mother’s pelvis. This also is called 0(zero) station. The membranes must be ruptured, and the cervix completely dilated. The physician applying forceps must be certain of the position of the fetal head so the forceps can be applied properly. When the baby is presenting as a breech, forceps can be used, but only for the aftercoming head-after the breech and body have been born.
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