Reproductive Health

Reproductive Health Definition of terms: HEALTH – state of physical, mental, social well – being and not merely the absence of disease or infirmity. REPRODUCTIVE HEALTH – addresses the reproductive processes, functions and system at all stages of life. REPRODUCTION – biological process where a new individual Human reproduction - is any form of sexual reproduction resulting in the conception of a child, typically involving sexual intercourse between a man and a woman. During intercourse, the interaction between the male reproductive system and the female reproductive system results in fertilization of the woman's ovum by the man's sperm, which after a gestation period is followed by childbirth. The fertilization of the ovum may nowadays be achieved by artificial insemination methods, which do not involve sexual intercourse. ANATOMY The human male The male reproductive system contains two main divisions: the penis, and the testes, the latter of which is where sperm are produced. In humans, both of these organs are outside the abdominal cavity. Having the testes outside the abdomen best facilitates temperature regulation of the sperm, which require specific temperatures to survive. The human female The female reproductive system likewise contains two main divisions: the vagina and uterus, which act as the receptacle for the semen, and the ovaries, which produce the female's ova. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the Fallopian tubes. At certain intervals, the ovaries release an ovum, which passes through the fallopian tube into the uterus. If, in this transit, it meets with Spermatozoon, the sperm penetrate and merge with the egg, fertilizing it. The fertilization usually occurs in the oviducts, but can happen in the uterus itself. The zygote then implants itself in the wall of the uterus, where it begins the processes of embryogenesis and morphogenesis. When developed enough to survive outside the womb, the cervix dilates and contractions of the uterus propel the fetus through the birth canal, which is the vagina. The ova, which are the female sex cells, are much larger than the spermatozoon and are normally formed within the ovaries of the fetus before its birth. They are mostly fixed in location with in the ovary until their transit to the uterus, and contain nutrients for the

later zygote andembryo. Over a regular interval, in response to hormonal signals, a process of oogenesis matures one ovum which is released and sent down the Fallopian tube. If not fertilized, this egg is flushed out of the system through menstruation. PROCESS Human reproduction is a long process, starting with sexual intercourse, followed by nine months of pregnancy before childbirth. Many years of parental care is required in order to finish with a mature human being. Sexual intercourse Human reproduction takes place as internal fertilization by sexual intercourse. During this process, the erect penis of the male is inserted into the female's vagina until the male ejaculates semen, which contains sperm, into the female's vagina. The sperm then travels through the vagina and cervix into the uterus or fallopian tubes for fertilization of the ovum. Upon successful fertilization and implantation, gestation of the fetus then occurs within the female's uterus, called pregnancy. This process is also known as "mating" or "having sex". Pregnancy Pregnancy is the period of time during which the fetus develops, dividing via mitosis inside the female. During this time, the fetus receives all of its nutrition and oxygenated blood from the female, filtered through the placenta, which is attached to the fetus' abdomen via an umbilical cord. This drain of nutrients can be quite taxing on the female, who is required to ingest slightly higher levels of calories. In addition, certain vitamins and other nutrients are required in greater quantities than normal, often creating abnormal eating habits. Gestation is 40 weeks in humans. Birth Once the fetus is sufficiently developed, chemical signals start the process of birth, which begins with the fetus squeezing through the vagina, and eventually out of the female. The newborn, which is called an infant in humans, should typically begin respiration on its own shortly after birth. Not long after, the placenta is passed as well. The end of the umbilical cord attached to the child's abdomen eventually falls off on its own.The midwife or nurse assisting the birth will usually detach the mother from the baby using a clamp, then cutting it off.

Parental care Human's babies and children are nearly helpless and require high levels of parental care for many years. One important type of parental care is the use of the mammary glands in the female breasts to nurse the baby.[1] Risks Factors : Hypertension: Pregnant women are considered to have chronic hypertension (CHTN) if hypertension was present before the pregnancy or if it develops before 20 wk of pregnancy. CHTN is differentiated from gestational hypertension, which develops after 20 wk of pregnancy. In either case, hypertension is defined as systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg on 2 occasions > 24 h apart. Hypertension increases risk of fetal growth restriction by decreasing uteroplacental blood flow and risk of adverse fetal and maternal outcomes (see Pregnancy Complicated by Disease: Hypertension in Pregnancy). Before attempting to conceive, women with hypertension should be counseled about the risks of pregnancy. If they become pregnant, prenatal care begins as early as possible and includes measurements of baseline renal function (eg, serum creatinine, BUN), funduscopic examination, and directed cardiovascular evaluation (auscultation and sometimes ECG, echocardiography, or both). Each trimester, 24-h urine protein, serum uric acid, serum creatinine, and Hct are measured. Ultrasonography to monitor fetal growth is done at 28 wk and every 4 wk thereafter. Delayed growth is evaluated with multivessel Doppler testing by a maternal-fetal medicine specialist (for management of hypertension during pregnancy, see Pregnancy Complicated by Disease: Treatment). Diabetes: Diabetes mellitus occurs in 3 to 5% of pregnancies, but incidence is increasing as the incidence of obesity increases. If pregnant women have preexisting insulin-dependent diabetes, risk is increased for pyelonephritis, ketoacidosis, preeclampsia, fetal death, major fetal malformations, fetal macrosomia (fetal weight > 4.5 kg), and, if vasculopathy is present, fetal growth restriction. Insulin requirements usually increase during pregnancy. If women have gestational diabetes, risk of hypertensive disorders and fetal macrosomia is increased. Gestational diabetes is routinely screened for at 24 to 28 wk or, if women have risk factors, also during the 1st trimester. Risk factors include previous gestational diabetes, a macrosomic infant in a previous pregnancy, family history of non-insulin–

dependent diabetes, unexplained fetal losses, and body mass index (BMI) > 30 kg/m2. Some clinicians think the diagnosis can be based on a fasting plasma glucose of > 126 mg/dL or a random plasma glucose of > 200 mg/dL. However, most accurate results are obtained with a glucose tolerance test. A 50-g, 1-h glucose tolerance test is used. If the result is 140 to 200 mg/dL, a full glucose tolerance test is done (see Table 2: Diabetes Mellitus and Disorders of Carbohydrate Metabolism: Diagnostic Criteria for Diabetes Mellitus and Impaired Glucose Regulation; if glucose is > 200 mg/dL, insulin is begun. If ≥ 2 test results are abnormal, women are treated for the rest of the pregnancy with diet and, if necessary, insulin or oral hypoglycemic drugs. Good control of plasma glucose during pregnancy almost eliminates the risk of adverse outcomes attributable to diabetes Sexually transmitted diseases (STDs): Fetal syphilis in utero can cause fetal death, congenital malformations, and severe disability. Risk of transmission of HIV from woman to offspring in utero or perinatally is 30 to 50% within 6 mo (see Human Immunodeficiency Virus (HIV): Transmission; see Human Immunodeficiency Virus (HIV) Infection in Infants and Children). During pregnancy, bacterial vaginosis, gonorrhea, and genital chlamydial infection increase risk of preterm labor and premature rupture of the membranes. Routine prenatal care includes screening tests for these infections at the first prenatal visit. Syphilis testing is repeated during pregnancy if risk continues and at delivery for all women. Pregnant women who have any of these infections are treated with antimicrobials. Treatment of bacterial vaginosis, gonorrhea, or chlamydial infection may prolong the interval from rupture of the membranes to delivery and may improve fetal outcome by decreasing fetal inflammation. Treating HIV with zidovudine 2 or nevirapine reduces risk of transmission by /3; risk is probably lower (< 2%) with a combination of 2 or 3 antivirals (see Human Immunodeficiency Virus (HIV) Infection in Infants and Children: Prevention). These drugs are recommended despite potential toxic effects in the fetus and woman. Pyelonephritis: Pyelonephritis increases risk of premature rupture of the membranes, preterm labor, and infant respiratory distress syndrome. Pregnant women with pyelonephritis are hospitalized for evaluation and treatment, primarily with urine culture plus sensitivities, IV antibiotics (eg, a 3rd-generation cephalosporin with or without an aminoglycoside), antipyretics, and hydration. Pyelonephritis is the most common nonobstetric cause of hospitalization during pregnancy. Oral antibiotics specific to the causative organism are begun 24 to 48 h after fever resolves and continued to complete

the whole course of antibiotic therapy, usually 7 to 10 days. Prophylactic antibiotics Acute surgical problems: Major surgery, particularly intra-abdominal, increases risk of preterm labor and fetal death. However, surgery is usually tolerated well by pregnant women and the fetus when appropriate supportive care and anesthesia (maintaining BP and oxygenation at normal levels) are provided, so physicians should not be reluctant to operate; delaying treatment of an abdominal emergency is far more dangerous. After surgery, antibiotics and tocolytic drugs are given for 12 to 24 h. If nonemergency surgery is necessary during pregnancy, it is most safely done during the 2nd trimester. Genital tract abnormalities: Structural abnormalities of the uterus and cervix (eg, uterine septum, bicornuate uterus) make fetal malpresentation, dysfunctional labor, and the need for cesarean delivery more likely. Although unlikely, uterine fibroids can cause placental abnormalities (eg, placenta previa), preterm labor, and recurrent spontaneous abortion. Fibroids may grow rapidly or degenerate during pregnancy; degeneration often causes severe pain and peritoneal signs. Cervical insufficiency (incompetence— see Abnormalities of Pregnancy: Cervical Insufficiency) makes preterm delivery more likely. If women have had a myomectomy before pregnancy in which the uterine cavity was entered, cesarean delivery is required because uterine rupture is a risk during subsequent vaginal delivery. Uterine abnormalities that lead to poor obstetric outcomes often require surgical correction, which is done after delivery. Maternal age: Teenagers, who account for 13% of all pregnancies, have an increased incidence of preeclampsia, preterm labor, and anemia, which often leads to fetal growth restriction. The cause, at least in part, is that teenagers tend to neglect prenatal care, frequently smoke, and have higher rates of sexually transmitted diseases. In women > 35, the incidence of preeclampsia is increased, as is that of gestational diabetes, dysfunctional labor, abruptio placentae, stillbirth, and placenta previa. These women are also more likely to have preexisting disorders (eg, CHTN, diabetes). Because risk of fetal chromosomal abnormalities increases as maternal age increases, genetic testing should be offered (see Prenatal Genetic Counseling and Evaluation: Genetic Evaluation). Maternal weight: Pregnant women whose BMI was < 19.8 kg/m2 before pregnancy are considered underweight, which predisposes to low birth weight (< 2.5 kg) in neonates. Such women are encouraged to gain at least 12.5 kg during pregnancy.

Pregnant women whose BMI was > 29.0 kg/m2 before pregnancy are considered overweight, making maternal hypertension and diabetes, postterm pregnancy, fetal macrosomia, and the need for cesarean delivery more likely. Such women are encouraged to limit weight gain during pregnancy to < 11.5 kg. Maternal height: Short (about < 152 cm) women are more likely to have a small pelvis, which can lead to dystocia with fetopelvic disproportion or shoulder dystocia. For short women, preterm labor and intrauterine growth restriction are also more likely. Exposure to teratogens: Common teratogens (agents that cause fetal malformation) include infections, drugs, and physical agents. Malformations are most likely to result if exposure occurs between the 2nd and 8th wk after conception (the 4th to 10th wk after the last menstrual period), when organs are forming. Other adverse pregnancy outcomes are also more likely. Pregnant women exposed to teratogens are counseled about increased risks and referred for detailed ultrasound evaluation to detect malformations. Common infections that may be teratogenic include herpes simplex, viral hepatitis, rubella, varicella, syphilis, toxoplasmosis, and cytomegalovirus and coxsackievirus infections. Commonly used drugs that may be teratogenic include alcohol, tobacco, cocaine, and some prescription drugs