4-REPRODUCTIVE HEALTH

CHAPTER NO.4 REPRODUCTIVE HEALTH

A30

INTRODUCTION

DEFINITION:

According to World health organisation (WHO), reproductive health is defined as

TOTAL WELL-BEING IN PHYSICAL, EMOTIONAL, BEHAVIOURAL AND SOCIAL ASPECTS OF REPRODUCTION.

PROBLEMS:

1. Explosion in population causes shortage of food, space, employment essential goods and education. This affects well-being of reproductive health.

2. Due to lack of sex education, people have little knowledge of personal

hygiene and hygiene of reproductive organs. This causes sexually transmitted diseases (STD's).

3. Early marriages lead to high maternal and infant mortality rate.

4. Lack of knowledge leads to myths and misconceptions about sex related

issues in young minds.

5. Illegal abortion of female foetuses.

6. Congenital or acquired infertility.

STRATEGIES OF REPRODUCTIVE HEALTH

1. India was the first country in the world to initiate actions and plans to attain

total reproductive health as a social goal.

2. Family Planning programmes were started in 1951 in India.

3. Reproductive and Child Health Care (RCH) programmes were launched on 15" October 1997.

RCH programmes have following aims:

i) Create awareness among people about various reproduction related aspects.

ii) Provide facilities and support for building up a reproductively healthy

society.

4. With the help of audio-visual aids and print media, both government and

non-government agencies are creating awareness among people about reproduction related aspects.

5. Introduction of sex education in schools to give right information to young

minds about reproductive organs, dolescence and related changes.Thus, save them from myths and misconceptions.

6. Impart knowledge about available birth control options, care for pregnant

mothers, post-natal care of mother and child and importance of breast feeding.

7. Compulsory ban on amniocentesis to legally check increasing female

foeticides. This will give equal opportunities to male and female child.

8. Consequences of problems due to uncontrolled population growth and

social evils like sex abuse, drugs, etc.

LET US KNOW WHAT WE LEARNT!

PART-A VERY SHORT ANSWER TYPE QUESTIONS

a) MCQ’s

1. Reproductive health is a total well-being in:

a) Physical Aspects

b) Emotional Aspects

c) Social Aspects

d) All of Above

2. Marriageable age for females and males is:

a) 18 & 21 Years

b) 21 & 18 Years

c) 15 & 21 Years

d) 19 & 21 Years

3. We can control population explosion by:

a) Raising age of marriage

b) Family planning

c) Amniocentesis

d) Botha &b.

4. Which was the first country in the world to initiate family planning program?

a) India

b) China

c) Pakistan

d) Japan

5. Measures taken by an individual to prevent STDs are :

a) Avoid sex with unknown partner

b) Use condoms

c) Knowledge of occurrence of STD's

d) All of the above

b) FILL UPS

1. RCH stands for .

2. technique has been banned in our country.

c) TRUE/FALSE

1. Creating awareness about sex related aspects is an effective method to improve reproductive heaith of the people.

2. Rapid increase in infant mortality rate and maternal mortality rate has caused population explosion.

3. Family planning programs were started in India in 1951.

ANSWER KEY: PART -A.

a) MCQ’s

1. (d). All of above-(because reproductive health includes all the aspects of reproduction physical, emotional, social and behavioral.)

2. (a). 18 & 21 Years— (This is done to control population control)

3. (d). Both a & b. —( Raising age of marriage and family planning helps to

control population growth.)

4. (a) . India. — (India was the first country in the world to initiate actions

and plans to attain total reproductive health as a social goal.)

5. (d). All of the above — (As STD's are transmitted from infected person to

healthy person through sexual intercourse so use of condoms,knowledge of occurrence of STD's and avoiding sex with unknown

partners helps to control these diseases. )

b) FILL UPS:

1. Reproductive and child healthcare.

2. Amniocentesis.

c) TRUE/FALSE:

1. True

2. False— (Rapid decline in infant mortality and maternal mortality rate has

caused population explosion.)

3. True

PART B: SHORT ANSWER TYPE QUESTIONS

1. What is a reproductively healthy society?

Ans : Society is said to be reproductively healthy if the people have physically

and functionally normal reproductive organs. They also have normal emotional

and behavioral interactions among them in all sex related aspects.

2. List two measures to develop a reproductively healthy society.

Ans : Measures to develop reproductively healthy society are :

|. Create awareness about reproduction in people.

Il. Provide medical help and care during pregnancy, delivery, STD's, etc.

Ill. Ban on amniocentesis legally check increasing female foeticides.

3. Is sex education necessary in schools? Why?

Ans. Yes, introduction of sex education is necessary in schools. It gives right

information to young minds about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, cause of occurrence of STD's, AIDS,etc. This Knowledge will save them from myths and misconceptions about sex

related aspects. It will help them to lead a reproductively healthy life later on.

PART-C: LONG ANSWER TYPE QUESTIONS

1. Suggest aspects of reproductive health which need to be given special attention in present scenarios.

2. What are the problems associated with reproductive health?

A31

POPULATION DEFINITION:Group of individuals of the same species in a well defined geographical area which share or compete for similar resources and can potentiallyinterbreed.

CHARACTERISITCS OF POPULATION :

BIRTH RATE(Natality): It is expressed as increase in number because of births with

respect to the number of individuals in a population.

DEATH RATE(Mortality): It is expressed as decrease in number because of deaths

with respect to total number of individuals in the population.

SEX RATIO: An individual has sex male or female but a population has sex ratio.

Example — 60% of the population are females and 40% aremales.

AGE DISTRIBUTION: Various age groups in population determine its reproductive

status. Three stages are referred to as pre-reproductive, reproductive and post-

reproductive.

POPULATION EXPLOSION: Increased health facilities along with better living conditions had an explosive impact on the growth of population. The world

population which was around 2 billion in 1900 rocketed to about 6 billion by 2000

and 7.2 billion in 2011. A similar trend was observed in India to. Our population

which was approximately 350 million at the time of our independence reached close to the billion mark by 2000 and crossed 1.2 billion in May 2011. That means every sixth person in the world is Indian.

REASONS FOR POPULATION EXPLOSION:

1. Rapid decline in death rate.

2. Decline in maternal mortality rate(MMR)

3. Decline in infant mortality rate(IMR)

4. Increase in number of people in reproductive age.

Through our RCH Programs we could bring down the population growth rate,though it was only marginal. According to the 2001 census report the population growth rate was still around 1.7 percent i.e. 17/1000 per year a rate at which our population could double in 33 years. The government was forced. To take up serious measures to check this population growth rate. The most important of these is to motivate smaller families by various contraceptive methods.

CONSEQUENCES OF OVERPOPULATION: Overpopulation is associated with negative environmental and economic outcomes ranging from the impacts of over-farming, deforestation, and water pollution to eutrophication and global warming.

Emission of large quantities of green house gases leading to global warming.

LET US KNOW WHAT WE LEARNT

PART A: VERY SHORT ANSWER TYPE QUESTIONS

(A) MCQs :-

1. The world Population was around 2 billionin:

(a) 1900

(b) 1905

(d) 1908

2. At time of our Independence our population was approximately:

(a) 340 million

(b) 350 million

(d) 150 million

3. MMR is:

(a) Mortality maternal rate

(b) Minimum Mortality rate

(d) Maximum Mortality rate

4. What is population explosion?

(a) Increase in Population.

(b) Small increase in Population

(d) Large increase in Population

5. What is Global Warming?

(a) Temperature Change

(b) Rise in Temperature

(d) Low Pressure.

(B) True/False

1. Increase in number of people in reproductive age leads to population

explosion.

2. Every sixth person in world is anIndian.

3. Contraceptive methods increase population.

(C) Fill ups

1. Our Population could in 33 years.

2. Graphic representation of different age groups is called :

3. Number of births during a givenperiod is called :

ANSWER KEY :- PART-A

(A) MCQs -

1. (a)

2. (b)

3. (c)

4. (d)

5. (b)

(B) TRUE/FALSE --

1. True

2. True

3. False

(C) Fill Ups —

1. Double

2. Age Pyramid

3. Natality

PART B: SHORTANSWER TYPE QUESTIONS

1.What is population?

2.What is population explosion?

PART C: LONG ANSWER TYPE QUESTIONS

1.What are the consequences of overpopulation?

2.What is Global Warming and its causes?

A32

INTRODUCTION

As you all have known up till now that Fertilisation is necessary for the formation of embryo and then young one. For fertilization to take place there should be union of male gamete (sperm) and female gamete (egg).In this assignment we will study about the different methods that

stop the meeting of sperm and egg, so as to stop fertilization and hence to stop the birth.

BIRTH CONTROL METHODS:The most important step to overcome the population explosion is to motivate smaller families by using Contraceptive or Birth Control methods.

CHARACTERISTICS OF AN IDEAL CONTRACEPTIVE:

It should be user friendly easily available, effective with no or least side effects.

it should not interfere with sexual desire and act.

CONTRACEPTIVE METHODS:

A) NATURAL/TRADITIONAL METHODS:

1. Periodic abstinence--Avoid coitus during the fertile period (day 10-17 )of

menstrual cycle.

2. Coitus interrupts--Withdraw penis from vagina before ejaculation.

3. Lactation amenorrhea-lt is the absence of menstrual cycle and ovulation due to intense lactation after parturition.

Natural methods have no side effects but chances of failure are high.

B) BARRIERS:

1. Condoms-They are made of rubber or latex sheet .Condoms for males cover the penis and condoms for females cover the vagina and cervix. They prevent the entry of semen into the reproductive tract of females.

2. Diaphragms, cervical caps and vaults- Made of rubber and are inserted into the female reproductive tract to cover the cervix.

3. Intrauterine Devices (IUDs)- These are inserted by doctors or nurses in the uterus through vagina. They increase phagocytosis of sperms.

Types of IUDs:

a. Non medicated IUDs:Retard sperm motilityE.g.- Lippies loop.

b. Copper releasing Ds:CuT,Cu7,Multiload375 etc., suppress the motility of

sperms.

c. Hormone releasing |UDs: These IUDs make the uterus unsuitable for implantation and cervix hostile for the sperms.e.g.Progestasert,_LNG-20.

4. Oral contraceptives: Oral administration of progestogens or progestogen-oestrogen combination in the form of tablets (pills) inhibit ovulation and implantation and thicken cervical mucus to prevent entry of

sperms. Pills are very effective with lesser side effects.Saheliis a new oral contraceptive with very few side effects and high contraceptive value.

5. Injectable and Implants:Progestogen or progestogen-oestrogen combinations are used by females as injections or implants under skin.Their effective periods are much longer than pills.

6. Surgical methods:(sterilisation) :lt helps to block gamete transport and

thereby prevents conception .It is very effective but reversibility is very poor.

Vasectomy is the sterilisation procedure in males .In this a small part of the

vas deferens is removed or tied .Tubectomy is the sterilisation procedure in females.in this ,a small part of

the fallopian tube is removed or tied up .

Nausea ,abdominal pain, breakthrough bleeding ,breast cancer etc. are

some of the side effects of anti-natural contraceptives.

C) MEDICAL TERMINATION OF PREGNANCY (MTP)

Voluntary termination of pregnancy before full term is called MTP or induced abortion.Many countries have not legalised MTPs due to some Ethical, Religious, and

Social issues.The Government of India has legalised it with many restrictions to check Female foeticides. It is done to avoid any major abnormality in future child.

LET US KNOW WHAT WE LEARNT!

A) MCQs:

1) An ideal contraceptive should be:

a) Costly

b) User friendly

c) With side effects

d) None of the above

2) The fertile period in the female is:

a) (5-10) day of menstrual cycle

b) (10-17) day of menstrual cycle

c) both a and b

d) none of the above

3) Oral contraceptives:

a) Inhibit ovulation

b) Inhibit implantation

c) Thicken cervical mucus

d) All of the above

4) Copper releasing IUDs include:

a) CuT

b) Multiload 375

c) Both a and b

d) None of the above

5) Side effects of anti-natural contraceptives include:

a) Nausea

b) Breast cancer

c) Abdominal pain

d) all of the above

B) FILL UPS:

1. lUDs increase ............. of sperms.

2. Injectables and implants are combinations of ............ and ............. hormones.

3. The sterilisation procedure in males is called .............

C) TRUE/FALSE:

1. Condoms are made up of rubber or latex (True/False).

2. Cervical caps are inserted into the female reproductive tracts (True/False).

3. Tubectomy is the sterilization procedure in males (True/False)

ANSWER KEY: PART-A

A) MCQs:

1. b) user friendly

2. b) (10-17) day of menstrual cycle

3. d) All of the above(hormone combinations prevent all activities leading to

pregnancy.

4.c) Bothaandb.

5. d) All of the above.

B) FILL UPs:

1. Phagocytosis

2. Progesterone and estrogen

3. Vasectomy

C) TRUE/FALSE:

1. True

2. True

3. False: It is the sterlisation process in females. (“Tube” means fallopian tube or

Oviduct)

PART B: SHORT ANSWER TYPE QUESTIONS

Q.1 Mention few characteristics of a contraceptive.

Q.2 How natural contraceptives are different from other contraceptives?

Q.3 Write a note on MTP.

PART C: LONG ANSWER TYPE QUESTIONS.

Q.1 Explain the method of sterilisation for contraception in males and females.

Q.2 Explain Barrier methods of contraception.

A33

INTRODUCTION

Hello, dear students, we have discussed different birth control methods in

previous assignment. Now today we will discuss about different sexually

transmitted diseases i.e. the diseases that pass on from an infected person to

his or her healthy partner at the time of sexual intercourse or sexual contact.

SEXUALLY TRANSMITTED DISEASES :

Diseases or infections which are transmitted through sexual intercourse are

collectively called sexually transmitted diseases (STD) or venereal diseases

(VD) or reproductive tract infections (RTI).

Examples are: GONORRHOEA, SYPHILIS and AIDS.These are generally acquired diseases and usually affect the reproductive

system of the person but may spread to other body parts as well. Though these

can affect persons of all the age-groups, but their incidence rate is found to be

very high among persons in the age group of 15-24 years.

STDs CAUSED BY BACTERIA CHLAMYDIASIS

PATHOGEN - Chlamydia trachomatis

Symptoms characterized by a thick pus like discharge from the penis and painful

urination in males, while causes inflammation of cervix, uterus and uterine tubes in females. If remain untreated then may transform into pelvic inflammatory disease.

GONORRHOEA (CLAP)

PATHOGEN - Neisseria gonorrhoeae

SYMPTOMS - Characterized by inflammation of mucous membrane of urinogenital tract. It may also cause arthritis, female sterility.

SYPHILIS

PATHOGEN - Treponema pallidum

SYMPTOMS - A hard dry and becteria filled sore, called chancre, appears on the

genitalia or may appear on lips or fingers.

STDs CAUSED BY VIRUSES

(i) AlDS(Acquired Immuno Deficiency Syndrome)

(ii) Hepatitis B(Serum Hepatitis) —

PATHOGEN - Double- stranded DNA virus, hepatitis B virus(HBV) SYMPTOMS - Fatigue, nausea, abdominal pain, arthritis and damage to liver cells releasing bilirubin which causes jaundice(yellowing of skin and eyes).

(iii) GENITAL WARTS —PATHOGEN — Human Papilloma Virus(HPV) SYMPTOMS - Appearance of warts on the genital organs like penis, labia, around anus, in vagina and on the cervix.

(iv) GENITAL HERPES — PATHOGEN - Herpes Simplex Virus(HSV-2) SYMPTOMS - The primary symptoms of genital herpes are periodically recurring watery blisters on the genitalia or buttocks, fever, painful urination and swollen lymph nodes in the groin.

EARLY SYMPTOMS : Itching, fluid discharge, slight pain and swellings in the genital region.

COMPLICATIONS DUE TO CHRONIC STDs :Pelvic inflammatory diseases (PID) Abortions

Still births : is the death or loss of a baby before or during delivery.Ectopic pregnancies : in which fertilized egg implants outside the uterus.

Infertility

Even cancer of the reproductive tract.

PREVENTION : Prevention is better than cure.

1. Avoid sex with unknown partners/ multiple partners.

2. Always use condoms during coitus.

3. In case of doubt, one should go to a qualified doctor for early detection

and get complete treatment if diagnosed with the disease.

LET US KNOW WHAT WE HAVE LEARNT

PART-A VERY SHORT ANSWER TYPE QUESTIONS:

(a) MCQs

Q.1. 1 December is celebrated as :-

a) World population day

b) World Environment day

c) World AIDS day

d) World Science & Technology day

Q.2. Which of the following is a STDs:-

a) Cancer

b) Malaria

c) Pneumonia

d) Trichomoniasis

Q.3. Chlamydiasis is caused by :-

a) Neisseria

b) Treponema

c) Chlamydia

d) HSV-2

Q.4. Which one of the following groups includes all sexually-transmitted

diseases?

(a) AIDS, Syphilis, Cholera

(b) HIV, Malaria, Trichomoniasis

Q.5. Match the sexually-transmitted diseases (column-) with their causative

agent(column-il) and select the correct option: II

1.Gonorrhoea (i) HIV

2.Syphilis (ii) Neisseria

3.Genital warts (iif) Treponema

4.AIDS (iv) Human Papilloma Virus

Options :

1 2 3 4

(@) 6) =i) Sw)

(b) (iii) (Vv) (ii)

(d) (i) (iii) (ii) (ili)

(b) TRUE/FALSE:

1. All reproductive tract infections (RTIs) are STDs and all STDs are RTIs.

2. AIDS specifically affect sex organs.

3. All sexually transmitted diseases are completely curable.

(c) Fill in the Blanks:

1. STDs are reported to be very high among persons in the age group years.

2. Gonorrhoea is caused by .

3. STDs are also called .

ANSWER KEY: PART-A

a) MCQ:

1. (c) World AIDS day ; (World environment day is on 5" June. World population

day is on 11™ July. World science and technology day is on 11™ May.)

2. (d) Trichomoniasis

3. (c) Chlamydia

4. (c) Gonorrhoea, Hepatitis-B, Chlamydiasis

5. (a)

b) TRUE/FALSE:

1. False. HINT: - STDs includes sexually-transmittable diseases and include

Chlamydiasis, Syphilis, Gonorrhoea, Genital warts, Genital herpes, Hepatitis-B,

and AIDS, etc. Out of these, Hepatitis-B and AIDS are not RTls as these do not

cause infections in reproductive tracts but are also transmitted through unprotected sexual intercourse so are also STDs. On the other hand, other diseases are STDs as well as RTIs.

2.False. HINT :- HIV of AIDS attack and kills Helper T-lymphocytes so causes

immunodeficiency. It spreads through sexual contact with infected person.

3.False. HINT :- Hepatitis-B, Herpes, HIV and HPV are not curable.

c) FILL IN THE BLANKS:

1.15-24 years.

2. Neisseria gonorrhoeae.

3. Venereal diseases.

PART-B SHORT ANSWER TYPE QUESTIONS

Q.1. What are sexually transmitted diseases in Human beings? Name two sexually transmitted diseases. Name their causative agents.

Q.2 Mention early and chronic symptoms of STDs.

Q.3. What are the measures one has to take to prevent from contracting STDs?

PART-C LONG ANSWER TYPE QUESTIONS

Q.1 What are STDs? Explain Bacterial and Viral STDs. How can these be

prevented?

A34

INTRODUCTION

When there is no fertilization even after unprotected sexual intercourse and that is too during the days of ovulation, then it

seems that there is some reason that renders the formation of Zygote. This condition is called INFERTILITY.

Infertility may be because of physical, congenital, psychological or

immunological disorder. Drugs may also cause infertility.ARTs (Assisted Reproductive technologies) - ARTs are the techniques by which an infertile couple is assisted to have children.

TYPES OF ARTs:

1. IVF- ET (In vitro fertilization - embryo transfer) / Test Tube Baby — In this

technique, an ovum is collected from female ovary and the sperms are collected from male which are then fertilized together in glass container outside the body of the mother, in laboratory conditions to produce a Zygote.Zygote is allowed to undergo mitosis and at some stage transferred to the uterus of female for further development. The process involves various steps.

It is of two types:

a) ZIFT (Zygote Intra Fallopian Transfer) - In this technique, a zygote is developed,in vitro, to an 8 celled stage, and it is then transferred to fallopian tube for further development.

b) IUT (Intra uterine transfer) - In this technique, the in vitro zygote is developed

to16 cell stage, and it is then transferred directly to the uterus.

2. GIFT (Gamete Intra fallopian transfer) - If in a female, ovum from ovary does nottransfer because of defaulted functioning of fimbria or some other

obstacle , or female produces Antisperm antibodies, gametes (may be ovum or

sperm or both) are transferred to fallopian tube artificially. Further development

is in - vivo.

3. AIT (ARTIFICIAL INSEMINATION TECHNIQUE) If the male partner has low sperm count, thesperms are collected from the male partner or donor and injected in the genital tract of female, to ensure the fertilization.

4. INTRA CYTOPLASMIC SPERM INJECTION (ICSI)- The sperm is injected directly in the cytoplasm of the ovum in laboratory conditions.

LET US KNOW WHAT WE HAVE LEARNT!

PART A - VERY SHORT ANSWER TYPE QUESTIONS

(a) MCQ’s

1. Which of the following is ART?

(a) |UDs

(b) GIFT

(d) Both (b) & (c)

2. The technique called Gamete Intra Fallopian Transfer (GIFT) is recommended for those females:

(a) who cannot produce an ovum.

(b) who cannot retain the foetus inside uterus

(d) all of these

3. Which of these can be used to cure infertility in couples where male partner has very low sperm count?

(a) |UD

(b) GIFT

(d) None of these

4. The method of directly injecting a sperm into ovum in assisted reproductive technology is called

(a) GIFT

(b) ZIFT

(d) ET

5. The test-tube baby programme employs which one of the following techniques?

(a) Zygote intra Fallopian transfer (ZIFT)

(b) Intra uterine insemination (IU1)

(d) All of these

b) FILL UPS

1. Infertility is the of a couple to produce child inspite of unprotected sexual

cohabitation.

2. In vitro fertilisation is a technique that involves transfer of into the

fallopian tube.

C) TRUE / FALSE

1. Test tube baby is an in - vivo technique.

2. It is never possible to have child from an infertile couple.

3. In IUT technique, embryo at 16 cell stage is transferred to uterus.

ANSWER KEY: PART-A

a) MCQ’S

1. (d) - Both (b) & (c) (IUD is a pregnancy controlling device)

2. (a) - Who cannot produce an ovum (once ovum is transferred, they can support

fertilization and embryo development)

3. (c) - UI (sperm being in low count, are directly inserted in uterus to ensure

fertilization)

4. (c) - ICSI (The sperm is injected into cytoplasm of ovum, directly in laboratory

conditions to ensure fertilization)

5. (a) Zygote intra Fallopian transfer (ZIFT) (GIFT and IUI are practiced only when there is low sperm / ovum count)

b) FILL UPS

1. Incapability

2. Early zygote

c) TRUE/FALSE

1. False; it is an in- vitro or ex — vivo, i.e. out side the body with minimum

alterations of natural conditions.

2. False : ARTs help in taking child from infertile couple, dpending upon the

problem.

3. True: In GIFT or ZIFT itis of 8 — celled stage.

PART B SHORT ANSWER TYPE QUESTIONS

1. What is infertility?

2. What are reasons of infertility?

3. Name the various Assisted Reproductive techniques.

4. Under what conditions, artificial insemination is needed?

PART C -LONG ANSWER TYPE QUESTIONS

1. Explain ART’s applied under conditions of low sperm or egg count.

2. Explain assisted reproductive techniques applied to infertile couple, to have child.

A35

INTRODUCTION

Dear students, after fertilization, during the formation of embryo, there are four extra embryonic membranes, formed around the foetus. From outer to inner, these are;

Chorion, Amnion, Allantois and Yolk sac. Amnion is the second layer that surrounds

the embryo. It encloses AMNIOTIC CAVITY that is filled with a fluid, known as AMNIOTIC FLUID. Amniocentesis is a diagnostic procedure, during pregnancy, in which the amniotic fluid is taken out from the amniotic cavity with the help of fine and long needle to study the foetal cells to know the genetic defects or infections if any.The foetus is surrounded by the amniotic fluid that contains foetal cells and other substances such as alpha foetoprotein. It also protects the foetus from any mechanical injury and helps in regulating the temperature of the foetus. The cells and substances present in the amniotic fluid provide important information about the baby’s health

before birth.

Why is Amniocentesis performed?

Aim: The amniocentesis technique is performed to check:

If the karyotype (the chromosomes) of the baby is (are) normal;

If there is evidence of a neural tube defect (birth defects of the brain, spine orspinal cord);

If there is evidence that the baby might have had an infection;

If the lungs of the baby are ready to breathe;

Sex (male/ female)of the developing baby;

Genetically controlled congenital ( inborn) diseases;

Metabolic disorders in the foetus (by abnormal chemical reactions that alterthe

normal metabolic process).

1. LiThe patient is made to lie down on the table and asked to place the

handsbehind the head.

2. The blood pressure, heart rate and breathing rate are checked.

3. An ultrasound is performed to scan the heart rate of the foetus, position of

the placenta, foetus, umbilical cord and locate the pocket of amniotic fluid.

4. The abdomen is cleansed with an antiseptic and is injected with anaesthesia.

5. A long, thin, hollow needle is inserted through abdominal and uterine wall of

a pregnant female (about 14" to 15" week after conception)into the amniotic

cavity of uterus to collect the amniotic fluid.

6. The collected fluid is placed in a light protected container.

7. The heart rate of the foetus and the patient are reassessed.

8. The collected fluid is sent to the laboratory for examination.

SIGNIFICANCE OR USES:

a. SEX DETERMINATION :The somatic cells of foetal skin drawn with amniotic fluid are stained to determine the presence of sex chromatin (barr body).Presence of barr body indicates that the developing foetus is female (as female is with 2X chromosome out of which one X- chromosome is active while

other X-chromosome is heterochromatised into darkly stained barrbody).

b. CONGENITAL DISEASES (INBORN DISEASES): By _ karyotypic (the chromosomes) studies of somatic cells abnormalities due to changes in chromosome number (Down's syndrome: having additional copy of

chromosome number 21 or trisomy of chromosome 21), (Turner's syndrome:

absence of one of the X chromosome resulting in the karyotype 45+XO),

(klinefelter’s syndrome) having an additional copy of X chromosome resulting

in karyotype 45+XXY) can be determined.

c. METABOLIC DISORDERS :By the enzyme analysis of amniotic fluid ,different types of inborn metabolic disorders like phenylketonuria (mental disorder due to lack of enzyme phenylalanine hydroxylase), alcaptonuria (dark urine excreted due to lack of enzyme level required to breakdown homogentisic acid in the body )etc. can be detected.These inborn errors are caused by theabsence or inactivity of specific enzymes due to gene mutations.So with the help of this, it is confirmed that the child is likely to suffer from some

incurable, congenital defect, and the mother can go for abortion.

DRAWBACKS:

1. MISUSE: However, these days, the amniocentesis is being misused also.

Mothers even get their normal foetus aborted if it is a female. This is just

equivalent to killing of normal child. So Government of India enforced Pre-natal

Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, since

January 1, 1994 under which all genetic counseling centers and laboratories are

required to apply for registration. The violation of this Act can bring a fine of Rs.50,000 and imprisonment for two years .The doctor's registration is also

cancelled till the complaint is disposed of.

2. RISKS INVOLVED IN AMNIOCENTESIS INCLUDE:

Risk of Miscarriages( loss of foetus)

Risk of Injuries.

Cramping(painful contraction of a muscle)

Leaking of amniotic fluid from the puncture site or vagina

Preterm labour (labour after week 20 of pregnancy and before week 37 of

pregnancy )

Occasionally a baby might also die after a normal amniocentesis due to

unexplained reasons.1. Amniocentesis is a process to

(a) determine any disease of heart performing the Amniocentesis test is

(b) determine any disease of embryo

(d) grow cells on culture medium foetus

2. The fluid sample required for

(a) The amnion

(b) The placenta

(d) All of the above

3. How many days are required for the Amniocentesis tests results?

conception.

(a) 1 day

(b) 1-2 days

(d) 3-4 weeks

4. The amniocentesis procedure is not done before the ___ week after

(a) 4-5"

(b) era

(d) 15-16"

5. Amniocentesis has helped

(a) The childless couples

(b) Anti female demographic snow ball set in motion

(d)waste of money

6. Amniocentesis is a prenatal diagnostic

test,which can also determine whether an unborn child will have ______ or not.

(a) Obesity established.

(b) Diabetes

(d) All of the above

TRUE /FALSE :

1. Amniocentesis technique used to determine prenatal detection of many genetic and metabolic disorders in the embryo.

2. Location of foetus is determined by sonography.

3. A fine hollow needle is inserted into the amniotic cavity of pregnant female (6 or 8" week after conception).

FILL UPS:

1. The amniotic fluid contains skin cells and a number of enzymes.

2. Amniocentesis is a process to determine of the embryo.

3. Amniocentesis technique is being for illegal detection of sex of the

foetus.

ANSWER KEY: PART-A

MCQs

1. b

2.C

3. d

4.d

5. a

6.c

TRUE / FALSE :

1. True

2. True

3. False (Hint: 14 or 15" week after conception).

FILL UPS:

1. Foetal

2. Sex

3. Misused

PART B. SHORT ANSWER TYPE QUESTIONS

1. Name the act by which amniocentesis is banned in our country?

2. Amniocentesis is misused in pregnancy termination; is it true? Why?

3. Why has the Government imposed a statutory ban on Amniocentesis, in

spite of its importance in the medical field?

PART C: LONG ANSWER TYPE QUESTIONS:

1. What is amniocentesis technique? Give its uses? How has this technique

being misused?

Dear students, now let us Know what we have learnt!

PART A: VERY SHORT ANSWER TYPE QUESTIONS:

MCQs

Chapter 4 Reproductive Health

Plus Two

Saturday, 30 January 2021

Chapter 4 Reproductive Health

Chapter 4 Reproductive Health

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