Healthyvives Health Blog

Menopause means the final cessation of menstruation or a normal part of an aging. Menopause is a natural happening for women. Women can usually understand if she is approaching menopause because her menstrual periods starts changing. It is also happen by as the result of surgical removal of both ovaries. Otherwise it means 1 to 3 years period during which a woman adjusts to a diminishing and then absent menstrual flow and the physiologic changes somewhere mental changes that may be associated, hot flushes, night sweats, and vaginal dryness. In western societies the average age for menopause is 51 years. 40 years average was calculated as ovarian failure and menstrual cessation. Generally the age of menopause is from 45 to 55 years.But it somewhere it depend on genetic or autoimmune basis. In the other hand surgical menopause happened due to bilateral oophorectomy is common and can cause more severe symptoms owing to the sudden rapid drop in sex hormone level. In the time of menopause ovarian cessation is found and emotional disturbance come out. In this time changes the women personality, mood, depression and anxiety can occur at the menopause time. During this period women would loss of youth, and some women suffer with psychological distress. Natural menopause occurs in the women when the ovaries naturally begin decreasing their production of the sex hormones estrogen and progesterone hormones.
Cessation of menstruation symptoms: menstruation cycle become irregular and length of cycle also irregular. Menstrual flow usually diminishes in amount owing to decreased estrogen secretion, resulting in less abundant endometrial growth. With missed periods of spotting cycle become longer.
Hot Flushes: on account of decrease ovarian hormones hot flushes occur in eighty percent of women. Hot flushes can begin before the cessation of menses. Release of GnRH from the hypothalamus increase the causes of hot flushes. Hot flushes are to be considered as characteristic symptom during menopause. But hot flushes generally not found in the woman who are undergo surgical menopause.
Vaginal atrophy: decrease of estrogen secretion, vaginal mucosa and vaginal lubrication occurs and may lead to dyspareunia. After the menopause the ovaries are not normally palpable .vagina generally appear red, plumb, bright and moist during the menopause.
Osteoporosis: Osteoporosis is a problem of women during the periods of menopause. It can be also present without any symptoms for decades because osteoporosis doesn’t cause symptoms until bone fractures of women. Moreover, some osteoporosis fractures may escape detection for years when they do not cause any symptoms. So, patients may not be aware of their osteoporosis until they suffer a painful fracture at immediate or later. The symptom of patients associated with osteoporosis fractures usually is pain; and the location of the pain depends on the location of the fracture. Also the symptoms of osteoporosis in men are similar to the symptoms of osteoporosis in women. However this problem occurs during the period of menopause.

The means of “safe motherhood” to creating circumstances within which a woman is enabled to choose whether she will become pregnant, and if she does, ensuring she receives care for prevention and treatment of pregnancy complications, has access to trained birth assistance, has access to emergency obstetric care if she needs it and care after birth, so that she can avoid death or disability from complications of pregnancy and child birth.

There are three stages of pregnancy. They are Antenatal, Intra-natal, and Postnatal.

Care for post natal stage

Post natal care of the woman starts after completion of third stage of labour and it includes the first six weeks after delivery. During this time the reproductive organs return to the non pregnant stage, lactation is established and the mother recovers from the stresses of pregnancy and delivery and assumes responsibility of caring the newborn. In this time each individual mother requires in order to recover from physical stress of labour and to grow her confidence to take care of her baby.

Each individual mother needs constant observation by you immediately after delivery for at least 1 hour for PPH even when she is fast asleep.

Mother needs to help to put her child to breast as early as possible, preferably within 30 minutes after delivery.

Mother needs to check by observing the vital signs, like pulse, BP, Temperature.

Mother needs to feel for uterine fundus after she empties her bladder. It is usually at the level of umbilicus soon after delivery. The uterus should be well contracted and hard in consistency.

Mother needs to check for the amount of vaginal bleeding.

In case of any injury like perineal laceration, immediately arrange for suturing.

Advise her to keep the perineal area clean by washing with warm water mixed with antiseptic lotion and put sterile pad.

Advise to her to sleep for at least 10 hours, 2 hours in the afternoon and 8 hours at night.

Baby is kept in a-cot with the mother. Mother can be woken up from sleep at night only for breast-feeding.

Mother is allowed to take full diet from the day of delivery. Additional daily 700 calories are required during postnatal period so long as she breast-feeds her baby.

If mother has constipation, give milk of magnesia or cremaffin 4-6 teaspoonful full at bed time.

Give and advise mother to clean the nipples and breasts with sterile water before and after feeding.

Teach her to practice some simple exercise such as deep breathing to tone up abdominal and pelvic floor muscles.

Mother should undergo two postnatal examinations first one at the time of discharge and the second on 6^th post partum week. During first check up check her general health, pulse, BP, temperature, breast engorgement, inverted, involution, inspect perineum and lochia, bladder and bowel functions.

During second check up check mother’s duration of lochia, onset of first menses, sleep, perineal wound, bladder, bowel function, breast feeding or bottle feeding, weight, BP, pulse, breast, abdomen, perineum and pelivic organs and estimate her hb.

Check up for infant weight, skin condition, jaundice, eyes, condition of umbilical cord, feeding, stool, urination,

The means of “safe motherhood” to creating circumstances within which a woman is enabled to choose whether she will become pregnant, and if she does, ensuring she receives care for prevention and treatment of pregnancy complications, has access to trained birth assistance, has access to emergency obstetric care if she needs it and care after birth, so that she can avoid death or disability from complications of pregnancy and child birth.

There are three stages of pregnancy. They are Antenatal, Intra-natal, and Postnatal.

Care for Intra-natal stage.

Child birth is a normal physiological process but unforeseen complications may arise which required urgent management. Effective antenatal care reduces the hazards of delivery significantly to get an optimum outcome; the need for effective intra-natal care is indispensable, even if the delivery is going to be institutional and a normal on time.

How to know true labour of a pregnant woman

Pain felt at regular intervals which increase in frequency and last longer. Appearance of small quantity of blood stained mucus per vagina. regular painful uterine contractions which gradually increase in duration, frequency and intensity. Obtain accompanied by backache, abdominal tightening and discomfort. Dilatation and taking up of the cervix. Pain is not relieved by enema.

How to know false labour of a pregnant woman

Irregular painful uterine contractions which does not increase in duration frequency and intensity. Not accompanied by backache, may or may not be painful. Without any effect of dilatation of the cervix. Usually pain is relieved by enema and administration of sedative.

The labour is divided into three stages

First stage: from the time labour pain starts to the time cervix is fully dilated.

Second stage: from full dilatation of cervix to the delivery of the baby.

Third stage: from birth of baby to expulsion of placenta and membranes.

The three stages of labour together usually take up to 12 hours for the first delivery and about 6 hours for subsequent deliveries.

What should done at the first stage of labour for health staff

Admit the pregnant woman and ask for the card for her past and present pregnancy.

Ensure privacy for the woman.

Diagnose the onset of labour maternal well being, normal foetal presentation and position, normal foetal heart rate.

Shave public hair and the area should be washed with soap and water.

Encourage frequent emptying of the bladder.

Avoid pushing down to take deep breath.

Pregnant woman may be walk between labour pains till the bag of water ruptures.

Don’t leave pregnant woman alone.

Avoid taking solid food, tea, coffee, and milk once she starts labour.

Encourage a positive attitude.

Provide supportive care

Find out pregnant woman physical and psychological condition.

What should done at the second stage of labour for health staff

Help to pregnant woman to come and lie on delivery table in semi reclined dorsal position.

Swab the perineum, drape the delivery area with sterile towels and use pad to cover the anus.

Check the maternal pulse every 15 minutes.

Need to wear apron, plastic mask, cap and gloves.

Keep ready the sterile equipments which include warm antiseptic solution, cotton, wool, and pad, cord scissor and clamps.

Deliver the head slowly to prevent the tearing the perineum.

See whether the cord is around the neck.

Wait for the cord pulsation to stop and than tie the cord with cord ties at 2.5 cms from umbilicus and cut in between. Separate the baby.

What should done at the third stage of labour for health staff

The third stage starts after the delivery of the baby and ends with the delivery of the placenta and membranes. This normally takes 10 to 15 minutes and the placenta is usually delivered by the time it takes to cut the umbilical cord, wipe, dry, weigh baby and put the baby to the breast.

The means of “safe motherhood” to creating circumstances within which a woman is enabled to choose whether she will become pregnant, and if she does, ensuring she receives care for prevention and treatment of pregnancy complications, has access to trained birth assistance, has access to emergency obstetric care if she needs it and care after birth, so that she can avoid death or disability from complications of pregnancy and child birth.

There are three stages of pregnancy. They are Antenatal, Intra-natal, and Postnatal.

Care for antenatal stage.

Antenatal care is the care of the woman during pregnancy. Your aim in providing antenatal care is to achieve at the end of a pregnancy a healthy mother and a healthy baby. It is ideal if you begin the care soon after conception. Remember that the regular monitoring during pregnancy is essential to detect the complications early before they become life threatening emergencies.

Antenatal care.

What we need to do.

Enumerate the aims of antenatal care

Diagnose pregnant woman, register her early and explain the importance of early registration.

Elicit proper history, do clinical examination and routine investigation during the antenatal period and to ensure quality assurance.

Assess the risk factors and take appropriate action.

Give T.T. immunization and advise to take iron and folic acid tablets depending on hemoglobin level.

Identity the common complications of pregnancy and know how to manage them.

Maintain records.

What are the aims of antenatal care?

Detect and give special attention to the high risk woman.

Promote, protect and maintain the physical and mental health of the mother during pregnancy.

Anticipate complications and prevent them.

Provide health education regarding diet, exercise, rest and avoidance of unnecessary travel during pregnancy.

Prevent maternal as well as neonatal tetanus.

Explain the normal process of labour.

Educate the woman for delivery, breast feeding and subsequent care of her child and appropriate spacing of birth.

Ensure birth of a mature live and healthy newborn.

Diagnosis of Pregnancy

Diagnose the pregnancy by the following signs and symptoms

Up to 20 weeks

Early breast changes, breast may be grow bigger, darken and painful nipple.

Amenorrhea i.e. missed of menstrual period.

Morning sickness, i.e. Nausea and vomiting.

Frequent passing of urine.

Quickening felt by the mother.i.e. Movement of baby may begin.

Skin condition may be changes.

Up to 20-36 weeks

Enlarged uterus

Foetal parts felt per abdomen

Foetal heart sound.

Risk factors of pregnancy

Age less than 18 years or more than 35 years.

Weight less than 38 kg at first trimester or more than 70 kg.

Height less than 145 cm. or 4 feet and 10 inches.

More than 4 deliveries.

Illness such as heart disease, diabetes and problem in previous pregnancy, as like operative delivery, still birth, prolonged labour, retained placenta, ante partum and post partum hemorrhage and sepsis.

Problems in present pregnancy such as:

Bleeding any time during pregnancy

Eclampsia or Pre-eclampsia

Abnormal presentation

Twins over or distended uterus.

Very big or very small baby.

Severe anaemia.

Floating head in a primigravida at 38 week or later.

Pre mature rupture of membrance.

Preterm labour.

Danger Factors of pregnancy

Bleeding or vaginal discharge.

Jaundice.

Excessive vomiting.

Excessive or less number of foetal movements.

Epigastria pain.

Blurring of vision.

Breathlessness.

Convulsion.

Severe headache.

Swelling of face and hands.

High grade fever.

Labour pain more than 12 hours.

Advise for pregnancy

Pregnant women to be in bed for about 10 hours.hard and strenuous work should be avoided specially in the first trimester and the last 6 weeks.avoid long travel during early or late pregnancy., diet rich in protein, fibre and vitamins,such as milk, egg, plenty of green vegetables, cereals and fruits as available, encourage more fluid intake, check the weight, test urine for albumin, maintain fluid intake, check the BP Frequently time to time, check the foetal heart rate. Daily bath should be taken but to be careful against slipping in the bathroom due to imbalance. Teeth should be cleansed two times a day.  Breast should be kept clean by washing with water regularly. Retracted nipples are lifted up by fingers from 28 weeks onward. Arrange breast feeding early as care of newborn. Smoking and alcohol is avoided as it affects the growth of the baby. Intercourse should be avoided during the first trimester and last 6 weeks.