Vaginal discharge is a common problem of women. It is also a common complain in women it may caused by some conditions, they are like as follows-
Physiological
It may cause by just before menstruation or during pregnancy, or during ovulation. In this time discharge is mucoid, not blood stained, or foul smelling and not associated with itching of the vulva.
Candidial infection or Thrush
This is like as curd white patches on the vaginal mucosa accompanied by thick, curdy white discharge and itching at the vulva. This infection occurs commonly during pregnancy.
Parasitic infestation or trichomonal vaginitis
This is transmitted during sexual intercourse or by contact with contaminated articles. It is characterized by greenish yellow, frothy foul-smelling discharge accompanied by itching and redness of the genital area.
Gonorrhea
Gonorrhea is also a sexually transmitted disease, in women it is characterized at times by purulent discharge from the cervix and ureth ra but this may be mild and may pass unnoticed. These women may develop salpingitis at a later stage and may complain of pain in the lower abdomen and fever. And the untreated gonorrhea may result in infertility in women.
Puerperal or post abortal sepsis
This is an infection of the genital tract, which occurs following delivery or after an abortion. Taking proper sepsis is characterized by high fever, headache, and low abdominal pain and foul smelling, purulent vaginal discharge.
Following IUD insertion
This may be found quite often. This discharge is profuse and watery and usually subsides after the first menstrual period following insertion.
Cancer cervix
This generally occurs in older women. In the early stages, it is characterized by watery discharge, which later becomes bloodstained and fouls smelling. The woman usually complains of irregular vaginal bleeding in between periods or vaginal bleeding following sexual intercourse.

Signs and symptoms Up to 20 weeks
1. Early breast changes, i.e. breast grow bigger, darken and painful nipples.
2. Skin changes.
3. Amenorrhea i.e. missed menstrual period.
4. Morning sickness, i.e. Nausea and vomiting.
5. Frequent passing of urine.
6. Quickening felt by the mother, i.e. movement of baby.
Signs and symptoms Up to 20-36 weeks
1. Foetal heart sound.
2. Foetal movements
3. Foetal parts felt per abdomen
4. Enlarged uterus, i.e. fundal height measurement and abdominal girth measurement.
40 weeks
Fundal height comes down but flanks are full.
Check up before 12 weeks
1. Health status of mother
2. Record the pregnant women B, P. Weight, Hb, and Routine urine test.
3. Screen and detect risk factors.
4. Record of the last menstrual period (LMP).
5. Making a proper and good report.
Check up before 20 weeks
1. Detail history.
2. Hb estimation.
3. Screen for risk factors and medical conditions.
4. Record BP, weight and height.
5. General examination from head to toe.
6. Screen anemia.
7. Test urine for protein and sugar.
8. Take tetanus toxoid 1st dose.
9. Health education and counseling on diet, rest, sleep, exercise, clothing, sexual relationship and danger signals.
Women at risk in pregnancy or delivery are as follows-\
1. Age less than 18 years and more than 35 years.
2. Weight less than 38 kg and more than 70 kg.
3. Short status less than 4 feet and 10 inch or 145 cm.
4. Heart disease, diabetes and other medical problems.
5. More than 4 deliveries.
6. Problems in previous delivery.
Danger signs of pregnancy are as follows.
Bleeding or vaginal discharge, breathlessness, convulsion, swelling of face and hands, high grade fever, labor pain more than 12 hours, blurring or vision, epigastria pain, jaundice, excessive or less number of foetal movements, excessive vomiting, etc.
Every pregnant woman must get at least 3 check-ups during pregnancy.

Contraception
Why you use the method contraception, answer is very easy, to avoid unavoidable pregnancy. Contraception as a process used for all measures temporary or permanent designed to prevent pregnancy. There are two method of contraception used. One is temporary and another is permanent. The risk associated with contraception is much less than risk of pregnancy.M.T.P and child birth for high risk woman, therefore it is better avoiding pregnancy by use of contraceptives. There are so many methods for contraception. Like as follows;
Period of breast-feeding
Customary separation of abstinence of marital partners after birth of baby
Sex with out penile vaginal intercourse
Withdrawal method
Fertility awareness methods.
Breast feeding: – if you practice breast feeding 6 hourly and menstrual period has not returned. Breast feeding can be used as an effective methods of contraception for six months provided she practice exclusive breast feeding , take care that no substitute of breast milk. Frequent sucking causes high level of prolactin secretion in the mother. High level of prolactine is associated with suppression of ovulation. After 6 months many women will begin to ovulate even if their menses have not returned. Hence breast feeding can no longer be effective after 6 months post-partum.
Customary separation of abstinence of marital partners after birth of baby: – in some communities by observing social customs, the separation of spouses after birth of baby for varying periods, conception is avoided.
Sex with out penile vaginal intercourse: – expression of caring and fondness of partners with out penis in or near the vagina e.g. touching, hugging, masturbating. In this system sperms never reach the vagina. No possibility of pregnancy if ejaculation does not occur in or near the vagina. But in this system sometime one or both partners may make objection.
Withdrawal method: – in this method, during sexual intercourse, erect penis is withdrawn just before ejaculation. Semen is discharged out side the vagina. It is widely practiced method all over the world, in all cultures and by people of all religious. In this system sperms dropping out side the vagina. Responsibility for contraception is shared by the male partner.no physical side effect is caused.
Fertility awareness methods:- every women learn recognize the fertile days of the menstrual cycle over several months and avoid intercourses or use the barriers methods on those days. There are many fertility methods as follows,
Calendar method
Cervical Mucus Method
Basal body temperature
Symptom-thermal method
Calendar method:-keeps record of 6 menstrual cycles and then calculates the fertile days. From the record, the longest and shortest cycles are chosen. Substract 20 from the shortest cycle and 10 from the longest cycle, e.g. shortest cycle is 26 days and longest cycle is 34 days (26-20=6 and 34-10=24). So abstinence or barrier method has to be practiced from day 6 to day 24 of the cycle.
Basal body temperature:- basal body temperature method identifies the day of ovulation but not the beginning of fertile period. In this method, intercourse is to be avoided during first half of cycle until 3 days after the temperatures has risen, or use backup barrier methods. Record the temperature every morning before getting up from bed as soon as the woman is awake. The special BBT thermometer is useful. Record the temperature on BBT chart as a dot and connect the dots with a line. When BBT has risen 0.2 to 0.5 degree F and remains elevated for 3 days, the fertile phase is over.
Cervical Mucus Method: – In Cervical Mucus Method fertile period is indicated by a sensation of wetness at vulva or when mucus is observed. To observe mucus, one can wipe vulva with a tissue paper when one feels or sees mucus unless the partner uses condom till 4 days after peak symptom day. Peak symptom day is the day of maximum mucus. During period, sex is to be avoided as blood may mask mucus. If unsure of presence of mucus, use of condom by male partner is essential. Spermicidal, vaginal infection, drugs and intercourse can affect normal pattern of woman’s cervical mucus. Mucus can be recorded on a daily basis in a chart.
Symptom-thermal method: – Symptom-thermal method combines cervical mucus method and BBT. Beginning of fertile period is indicated by cervical mucus or even by calendar method and the end of fertile period by BBT. Fertile period ends 4 days after peak mucus or 3 days after sustained rise of BBT which ever is later.
Another some systems are available for contraception like as use of condom both male and female condoms. Uses of spermicidal, spermicidal are available in the form of creams and foaming tablets or suppositories. Women can use oral contraceptive pill to avoid unwanted pregnancy. These pills are available in chemist stores and uses also very easy, using direction is written on the tablets. Some women using copper T to avoid unwanted pregnancy. Copper T 200 B is a ‘T’ shaped plastic device made of polyethylene and impregnated with Barium sulphate to make it radio-opaque. It is 3.6 cm in length and 3.2 cm in width. Copper is wound round its vertical stem. Its surface area is 200 mm and the thread is attached to the lower end of the vertical stem.
However the latest discovery and modified contraceptive for emergency use is emergency tablet. This tablet is use to avoid unwanted pregnancy within 72 hours of last intercourse. It is available in chemist stores. Bur it is not for a permanent contraception.

Why you use the method contraception, answer is very easy, to avoid unavoidable pregnancy. Contraception as a process used for all measures temporary or permanent designed to prevent pregnancy. There are two method of contraception used. One is temporary and another is permanent. The risk associated with contraception is much less than risk of pregnancy.M.T.P and child birth for high risk woman, therefore it is better avoiding pregnancy by use of contraceptives. There are so many methods for contraception. Like as follows;
Period of breast-feeding
Customary separation of abstinence of marital partners after birth of baby
Sex with out penile vaginal intercourse
Withdrawal method
Fertility awareness methods.
Breast feeding: – if you practice breast feeding 6 hourly and menstrual period has not returned. Breast feeding can be used as an effective methods of contraception for six months provided she practice exclusive breast feeding , take care that no substitute of breast milk. Frequent sucking causes high level of prolactin secretion in the mother. High level of prolactine is associated with suppression of ovulation. After 6 months many women will begin to ovulate even if their menses have not returned. Hence breast feeding can no longer be effective after 6 months post-partum.
Customary separation of abstinence of marital partners after birth of baby: – in some communities by observing social customs, the separation of spouses after birth of baby for varying periods, conception is avoided.
Sex with out penile vaginal intercourse: – expression of caring and fondness of partners with out penis in or near the vagina e.g. touching, hugging, masturbating. In this system sperms never reach the vagina. No possibility of pregnancy if ejaculation does not occur in or near the vagina. But in this system sometime one or both partners may make objection.
Withdrawal method: – in this method, during sexual intercourse, erect penis is withdrawn just before ejaculation. Semen is discharged out side the vagina. It is widely practiced method all over the world, in all cultures and by people of all religious. In this system sperms dropping out side the vagina. Responsibility for contraception is shared by the male partner.no physical side effect is caused.
Fertility awareness methods:- every women learn recognize the fertile days of the menstrual cycle over several months and avoid intercourses or use the barriers methods on those days. There are many fertility methods as follows,
Calendar method
Cervical Mucus Method
Basal body temperature
Symptom-thermal method
Calendar method:-keeps record of 6 menstrual cycles and then calculates the fertile days. From the record, the longest and shortest cycles are chosen. Substract 20 from the shortest cycle and 10 from the longest cycle, e.g. shortest cycle is 26 days and longest cycle is 34 days (26-20=6 and 34-10=24). So abstinence or barrier method has to be practiced from day 6 to day 24 of the cycle.
Basal body temperature:- basal body temperature method identifies the day of ovulation but not the beginning of fertile period. In this method, intercourse is to be avoided during first half of cycle until 3 days after the temperatures has risen, or use backup barrier methods. Record the temperature every morning before getting up from bed as soon as the woman is awake. The special BBT thermometer is useful. Record the temperature on BBT chart as a dot and connect the dots with a line. When BBT has risen 0.2 to 0.5 degree F and remains elevated for 3 days, the fertile phase is over.
Cervical Mucus Method: – In Cervical Mucus Method fertile period is indicated by a sensation of wetness at vulva or when mucus is observed. To observe mucus, one can wipe vulva with a tissue paper when one feels or sees mucus unless the partner uses condom till 4 days after peak symptom day. Peak symptom day is the day of maximum mucus. During period, sex is to be avoided as blood may mask mucus. If unsure of presence of mucus, use of condom by male partner is essential. Spermicidal, vaginal infection, drugs and intercourse can affect normal pattern of woman’s cervical mucus. Mucus can be recorded on a daily basis in a chart.
Symptom-thermal method: – Symptom-thermal method combines cervical mucus method and BBT. Beginning of fertile period is indicated by cervical mucus or even by calendar method and the end of fertile period by BBT. Fertile period ends 4 days after peak mucus or 3 days after sustained rise of BBT which ever is later.
Another some systems are available for contraception like as use of condom both male and female condoms. Uses of spermicidal, spermicidal are available in the form of creams and foaming tablets or suppositories. Women can use oral contraceptive pill to avoid unwanted pregnancy. These pills are available in chemist stores and uses also very easy, using direction is written on the tablets. Some women using copper T to avoid unwanted pregnancy. Copper T 200 B is a ‘T’ shaped plastic device made of polyethylene and impregnated with Barium sulphate to make it radio-opaque. It is 3.6 cm in length and 3.2 cm in width. Copper is wound round its vertical stem. Its surface area is 200 mm and the thread is attached to the lower end of the vertical stem.
However the latest discovery and modified contraceptive for emergency use is emergency tablet. This tablet is use to avoid unwanted pregnancy within 72 hours of last intercourse. It is available in chemist stores. Bur it is not for a permanent contraception.

Abortion is that termination from unwanted pregnancy or termination of pregnancy. Generally abortion arrange before 20 weeks or below 500 gm weighing foetus. It is true that medical termination of pregnancy (MTP) is safe than any other system. It is hygienic, legal and deliberate termination of pregnancy up to 20 weeks. Here a nurse has to play a vital role in this by providing services to ensure safe abortion and follow up care. But unsafe abortion can be result in life threatening situation. Infections resulting to various life threatening situations like peritonitis, septicemia, renal failure and death. Excessive vaginal bleeding resulting in shock and death. It may result in vesico-vaginal or recto vaginal fistulae.

What is MTP?

MTP, whose full form is medical termination of pregnancy, during MTP the product of conception, is removed from the uterus, under observation of safe clean condition by a qualified doctor after assessing the woman’s health condition provided the woman fulfills the criteria for performing MTP.MTP is done in a running hospital or health care center which has been approved by govt. and has been requisite facilities and qualified manpower. Abortion may be done only under the MTP act. MTP and abortion may be done if the continuation of pregnancy will endanger the life of the woman and cause grave injury to her physical and mental health. Abortion may be done if there is danger of the child being born with handicaps or there is risk of child having physical and mental abnormalities. Abortion may be done if the pregnancy had been caused by rape. Also abortion may be done if the pregnancy is due to failure of contraceptive methods by woman or man. The best and safe period for abortion is between 6-10 weeks of gestation and it can be done up to 20 weeks.

Complications of Abortion : Incomplete evacuation, continuation of pregnancy, trauma to the cervix and uterus leading to haemorrhage and shock, perforation of uterus, haemorrhage and shock due to incomplete abortion, thrombosis or embolism. Some remote complications are also found in this stage as like, menstrual disturbances, chronic pelvic inflammation, recurrent mid trimester abortions due to cervical incompetence, ectopic pregnancy, premature labour.

Counseling for woman and family

It is better to use of contraceptive than going for MTP as the complication are more in MTP. Abortion should be done only in a recognized center by trained health personnel. Abortion should be done between 6-10 weeks to minimize the complications. Abortion performed after 10 weeks of gestation has greater risk even if it is done by trained personnel, by untrained personnel can result in life threatening situation. It can also lead to infertility, ectopic pregnancy, fistula and chronic pelvic inflammatory disease. Use of contraceptives after abortion is advisable instead of repeated MTPs.

Role of Doctor and nurse in safe abortion

Use clean equipments to perform MTP. Maintain asepsis before and during the procedure. Dispose the waste, keeping in mind the principles of infection prevention. to check temperature, pulse and blood pressure and record it,  advise to come for follow up services after 2 weeks. Finally encourage for bed rest.