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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5990_Библиотеки_им_академика_М_И_Перельмана.pdf
63Preventive Healthcare
5. On withdrawal of the implant, pregnancy occurs as usual
hence contraception is reversible but the withdrawal again
needs a surgical procedure, e.g., Norplant.
Disadvantages
1. Requirement of surgical procedure for insertion, and
2. Irregularities of menstrual bleeding.
3. INTRAUTERINE DEVICES
Intrauterine devices (IUDs) are one of the world’s most widely
used methods of contraception, especially for long-term
reversible contraception, as they can be easily fitted and
removed. They are inserted into the uterus by doctors or expert
nurses. These may be either medicated or non-medicated.
Types of IUDs: (i) Medicated IUDS, and (ii) Non-medicated
IUDs.
IUDs are more expensive and are to be replaced from time
to time but they are quite effective.
4. POST-CONTRACEPTION METHODS
The post-contraceptional methods are the methods used after
the pregnancy has occurred.
i. Abortion
It means termination of pregnancy before the fetus becomes
viable. In India, abortion is allowed only up to 20 weeks. The
Medical Termination of Pregnancy Act 1971 prescribes (i) the
conditions under which a pregnancy can be terminated, (ii)
the persons who can perform such termination, and (iii) the
places where such termination can be performed.
ii. Menstrual Regulation
This is a relatively simple method of birth control. Uterine
contents are aspirated by vacuum aspiration using a small
diameter, clear plastic, flexible cannula in the uterus. It may be
performed without confirmation of pregnancy. Neither dilation
of the cervix nor anesthesia is usually required.
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iii. Menstrual Induction
In this method, normal progesterone-prostaglandin balance is
disturbed by intrauterine application of 1 to 5 mg solution of
prostaglandin F2. This results in sustained uterine contraction
lasting about 7 minutes followed by cyclic contraction for the
next 3 to 4 hours. The bleeding starts and continues for 7 to
8 days.
5. NATURAL METHODS
In this method, there is no need to use any drug or contraceptive
devices. Pregnancy can be avoided if the couples abstain from
sexual intercourse during the fertile period of the menstrual
cycle. Ways to determine the approximate time of ovulation
and the fertile period include: (i) a calendar method; (ii) a basal
body temperature method; (iii) a cervical mucus method
(Billings ovulation method); and (iv) a symptom-thermal
method.
i. Basal Body Temperature (BBT) Method
At the time of ovulation the production of progesterone
increases and it results in the rise of BBT by 0.3 to 0.5 ºC. The
body temperature does not rise if ovulation does not occur.
The temperature has to be measured in the morning before
getting out of bed. Abstinence is required until the 3rd day of
the temperature rise. Very few couples use this method because
abstinence is necessary for the entire pre-ovulatory period.
ii. Cervical Mucous Method or Billing’s Ovulation Method
The woman should be able to distinguish between different
types of mucus. The quantity and characteristics of mucus can
be observed by the woman by using tissue paper to wipe the
inside of the vagina. During the time of ovulation, the cervical
mucus becomes watery and clear like raw egg white, smooth,
slippery, and profuse. After ovulation, the mucus becomes
thicker and lesser in quantity due to the production of
progesterone. Billing’s method is also not very popular in
India.
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iii. Symptothermal Method
It is more effective than Billing’s method and is based on
identifying the fertile period by combined techniques of BBT,
cervical mucus, and calendar method. It serves as a double-
check if the woman is unable to interpret one sign.
iv. Natural Family Planning Method
Natural family planning methods can be practiced by those
who can impose self-discipline and understand sex. These
methods are not of much importance in developing countries.
6. TERMINAL/STERILIZATION METHODS
It means the operative techniques called vasectomy in males
and tubectomy in females. It is ideal for couples having two or
more children.
a. Vasectomy or Male Sterilization
Vasectomy is a relatively quick, simple, and less expensive
operation than tubectomy. Both the vas deferens are cut and
tied and hence sperm cannot enter the uterus.
b. Tubectomy or Female Sterilization
Each fallopian tube is cut and tied (tubal ligation) to stop the
transport of the egg. The tubal ligation can be performed 4 to
7 days after delivery and the operation takes only 2 to 3 minutes.
Sterilization offers many advantages over other contra-
ceptive methods:
1. It is a very effective and permanently safe method.
2. The risk of complications is small.
3. It is most cost-effective.
ROLE OF PHARMACIST IN MATERNAL AND CHILD HEALTH
Women’s healthcare is a major concern in India. A lot of
maternal deaths occur during pregnancy. Like any other
patient, mothers as well as children are benefitted from the
services rendered by pharmacists. The pharmacist understands
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the normal course of pregnancy and can play a role in
improving maternal and child health in the following ways:
1. Pharmacists can inform the mother about the importance
of hygiene and the management of pregnancy.
2. Pharmacists are connected with both in-patient and out-
door patients. They help to determine and alleviate risk
factors among pregnant women. During pregnancy,
women may be susceptible to diseases, such as gestational
diabetes mellitus, depression, eclampsia, and anemia.
Pharmacists assist in assessing women at risk of these
diseases during pregnancy and can refer them to the
appropriate healthcare professionals.
3. Pharmacists help pregnant women to meet their weight
loss goals after pregnancy.
4. Pharmacists can counsel women before pregnancy about
the risks connected with traditional medicines and
substances of abuse such as nicotine and alcohol.
Pharmacists are aware of the effect of these substances of
abuse on the health of pregnant women and may suggest
ways to reduce these risks.
5. During the delivery and postpartum periods, pharmacists
play a key role in analyzing maternal health status. During
the delivery and postpartum period, pharmacists can aid
maternal health by managing medication therapy.
Pharmacists can identify women at risk of postpartum
depression and can advise alternatives through the
provision of pharmaceutical care and seek help from other
healthcare professionals, if necessary.
6. Pharmacists can provide care and support to HIV-positive
mothers during the delivery and postpartum period to
lessen the risk of transmission from mother to infant. They
ensure that mothers and infants with HIV get the right
treatment.
7. Pharmacists can play an important role by guiding the
mother for the protection of the child by following a proper
immunization schedule.
8. Pharmacists can encourage the mother to breastfeed.
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9. Pharmacists can guide mothers about the medicines that
are contraindicated during breastfeeding.
Importance of Breastfeeding
Under any situation, breast milk would be an ideal food for
the infant. Breastfeeding must be started within half an hour
of birth, mainly because the newborn is extremely active during
the first hour of life and so reflexes are generally strong. Earlier
initiation of breastfeeding lowers the mother’s risk of
postpartum hemorrhage and also makes sure that the baby
receives colostrums positively. Exclusive breastfeeding needs
must be given for the first six months. Infants require feeding
at regular intervals around 6–8 times per day while older babies
need 5 times per day. Complimentary feeding needs to be
commenced from the 6th month onwards. During illness, the
calorie need is enhanced and it ought to be fulfilled.
Advantages
1. It is a safe, clean, and complete food containing all the
nutrients including vitamins and minerals in definite
proportions. In addition, it contains hormones, enzymes,
protective substances like macrophages, secretory IgA,
lymphocytes, anti-streptococcal factor, lysozyme as well as
lactoferrin.
2. It is digested easily and is best suited for normal as well as
premature babies.
3. It promotes the long-lasting bonding between the mother
and infant that is of psychological benefit for both of them.
4. Sucking assists in the development of jaws and teeth.
5. It safeguards the babies from the tendency to obesity.
6. It helps to prevent malnutrition and reduces infant
mortality.
7. It increases the intelligence quotient (IQ) of the child and
improves visual acuity.
8. It stimulates the overall growth and development of the
child.
9. Early initiation of breastfeeding decreases the chances of
postpartum hemorrhage and anemia, delays the next
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pregnancy, boosts the mother’s immune system, and
protects mothers from ovarian and breast cancer.
10. It helps in quick and early involution of the uterus.
Malpractices
1. Delay in initiation.
2. Discarding colostrums.
3. Giving pre-lacteal feeds.
4. Offering only one breast each time.
Disadvantages
1. Infant nutrition relies upon maternal nutrition.
2. Possible mastitis (inflammation of the breast).
3. Transport of drugs from the mother to the infant.
4. Transfer of viruses (Hepatitis B, HIV) from the mother to
the infant.
5. Transfer of allergens from maternal diet to infant.
Artificial Feeding
The primary indications of artificial feeding usually are failure
of breast milk, prolonged maternal health issues, and death of
a mother. It is essential to feed the baby “breast-like substitutes’’
like dried whole milk powder, fresh milk from a cow or other
animal, or commercial formula.
Dried milk: The safest milk is dried whole milk. It is free
from microorganisms. It is simple to reconstitute and does not
become sour. Mostly it is fortified with vitamins. But it is
expensive.
Cow’s milk: It is the cheaper alternative for baby feeding.
World Health Organization suggests the dilution of cow’s milk
during the first two months of life.
Infant Milk Substitutes and Bottle Feeding
Substitutes for infant milk are given to babies in case of low
milk production, death of mother after delivery, severe disease
condition, etc. Substitute milk contains fat, proteins, vitamins,
and minerals. Substitute milk mimics breast milk in color, smell,
taste, and composition.
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Ill effects of substituted milk and bottle feeding include
eczema, rashes, diarrhea, risk of choking, ear infections, tooth
decay, pneumonia, obesity, leukemia, and respiratory disease.
Weaning: It is a gradual withdrawal of a child from the
breast around the age of six months. Weaning should be done
properly otherwise diarrhea and retarded growth leading to
Kwashiorkar, Marasmus, and immunodeficiency may occur.
Homemade weaning foods like soft cooked rice, suji, dal, and
mashed vegetables should be given to the child during the
weaning period.
VACCINES
We are all familiar with the role vaccines played in the
management of the COVID-19 pandemic. Vaccines protect the
body against many serious diseases. The vaccine is a biological
preparation that triggers an immune response within the body.
A vaccine contains weakened or inactive parts of a particular
organism (antigen). It boosts the production of antibodies,
which provides immunity against diseases. A vaccine may
contain live-attenuated or killed microorganisms or parts or
products from them capable of stimulating a specific immune
response in the body.
Types of Vaccine
The different types of vaccines are as follows.
1. Inactivated Vaccine
Live attenuated vaccines (LAV) are prepared from disease-
causing pathogens that have been weakened under laboratory
conditions. Live attenuated microorganisms when given to a
person provide an immune response. Due to their weak
activity, attenuated microorganisms cause no illness, e.g.
tuberculosis (BCG) and oral polio vaccine (OPV).
2. Attenuated Vaccine
Attenuate means to make something less or weaker. Attenuated
vaccines can be made in several different ways. Some of the
most common methods involve passing the disease-causing
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virus through a series of cell cultures or animal embryos
(typically chick embryos). When the resulting vaccine virus is
given to a human, it will be unable to replicate enough to cause
illness, but will still provoke an immune response that can
protect against future infection.
3. Toxoid Vaccine
Toxoid vaccines are prepared from the toxin produced by
certain bacteria (e.g. diphtheria), e.g. tetanus toxoid (TT), and
diphtheria toxoid.
4. Subunit Vaccine
Subunit vaccines contain the parts of antigen. Like inactivated
vaccines it also does not contain the live components of antigen-
like surface protein, conjugated chemicals, polysaccharides,
etc., e.g. Haemophilus influenzae type B, Hepatitis B.
5. Conjugate Vaccine
Conjugate vaccines are made from coats of bacteria that are
chemically linked to a carrier protein, and the combination is
used as a vaccine, e.g. Tetanus Toxoid, Diphtheria Toxoid.
6. Valence Vaccine
Vaccines may be monovalent or polyvalent vaccine. A
monovalent vaccine can immunize the body against a single
antigen. A polyvalent vaccine can immunize the body against
two or more microorganisms or two or more strains of the same
microorganism.
7. mRNA Vaccine
An mRNA vaccine is a type of vaccine that uses a copy of a
molecule called messenger RNA (mRNA) to produce an
immune response. It is composed of the nucleic acid RNA
enclosed within a vector. Both the Pfizer-BioNTech and the
Moderna COVID-19 vaccines use mRNA.
IMMUNITY
Immunity is defined as the ability of the body to defend against
disease-causing organisms like bacteria and viruses.
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Types of Immunity
There are two types of immunity:
1. Innate immunity or natural immunity.
2. Acquired Immunity.
1. Innate immunity
This type of immunity is present by birth. This is activated
immediately when the pathogen attacks and the body starts
producing the antibodies on its own. Innate immunity includes
certain natural barriers and defense mechanisms that restrict
the entry of foreign agents into our bodies.
2. Acquired immunity
It is the immunity that an individual acquires over time. Unlike
innate immunity, this is not present by birth. In this, the
immune system adapts itself to disease and generates
pathogen-specific immunity. Acquired immunity is of two
types:
i. Active acquired immunity: It is the immunity that results
from the production of antibodies by the immune system
in response to the presence of a disease-causing organism
(antigen). Active immunity depends upon the humoral
and cellular responses of the host. Active immunity may
be acquired in 2 ways:
a. following infection, e.g., chickenpox, rubella, polio,
and measles.
2. following immunization with an antigen-containing
vaccine.
ii. Passive acquired immunity: In this type, the body does not
produce its antibodies. Readymade antibody-containing
preparations (immune globulin or antiserum) are directly
given to individuals to give protection against antigens. A
newborn baby acquires passive immunity from its mother
through the placenta. The main differences between active
immunity and passive immunity are compared in
Table 2.3.
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Table 2.3: Differences between active immunity and passive
immunity
Active Immunity Passive Immunity
It results from the production of It is produced by the introduc-
antibodies by the immune system tion of readymade antibody-
of the host in response to direct containing preparation into the
contact with an antigen host
Usually develops in several weeks Develops immediately
Active immunity is long-lasting Lasts only for a few weeks or
months
It produces an immunological It does not produce immuno-
memory logical memory
There are no side-effects It may cause reactions
IMMUNIZATION
The process of administering the vaccine is called vaccination
or immunization. Immunization is done to make a person
immune or resistant to infectious diseases. It is the safest and
most common way to gain immunity against bacteria or
viruses.
Diseases Protected by Vaccination under the Universal
Immunization Programme (UIP)
Under UPI, the Government of India is providing vaccination
to prevent the following vaccine-preventable diseases:
1. Diphtheria
2. Pertussis
3. Tetanus
4. Polio
5. Tuberculosis
6. Measles
7. Hepatitis B
8. Japanese Encephalitis (commonly known as brain fever)
9. Meningitis and pneumonia caused by Haemophilus
influenzae type b.