General Health

History of Cigarette Smoking Cigarette smoking has become the order of the day all in the name of managing stress and other addictive benefits, yet the detrimental effects of it cannot be overemphasized. Well, let us trace the origins of cigarette smoking. The origins of inhaling smoke for its psycho-active and pharmacological effects was dated back to least 3000 years BC, when the burning of dried herbs and incense in magical, religious and ceremonial practices among the Egyptians and the Maya Indians in South America was practiced until the spreading of tobacco smoking in the fifteenth century, after Spanish explorers had been introduced to it by Mexicans and Caribbean Indians, inhalation of smoke and fumes remained primarily only a priestly to a common prayer habit. Table of content Why Smokers Smoke Nicotine which is an addictive drug that acts on the brain primarily is the only know psychoactive (chemical substances that affects the brain sustaining or causing changes in behavior, mood, and consciousness) ingredient in tobacco smoke. Addicted smokers smoke mainly to get their accustomed dose of nicotine.  As once remarked by famous British smoke researcher M.A.H. Russell, if it were not for the nicotine in the tobacco smoke, people would be little more inclined to smoke Cigarettes than they are to blow bubbles or light sparklers. Immediately nicotine enters the brain, it begins to mimic or imitate the action of the neurotransmitter called acetylcholine, and to stimulate synthesis of a number of the brain’s most powerful chemical messengers: adrenaline (epinephrine), norepinephrine, dopamine, vasopressin, arginine and beta-endorphin. Note: Acetylcholine is an organic molecule that acts as a neurotransmitter in many organisms including humans. It is involved in alertness, pain reduction, learning and memory. Non- epinephrine is the stress hormone that affects parts of the brain where attention and responding actions are controlled. It is also the hormone that regulates alertness an arousal. Dopamine is a neurotransmitter that helps the brain’s reward and pleasure, and also helps to regulate movement and emotional responses; it enables us equally to take actions and its deficiency causes Parkinson disease, people with low dopamine activity may be prone to addiction. Beta-endorphins are substance secreted by the pituitary gland that works as a neurotransmitter, neurotransmitters are endogenous chemicals that transmit signals from a neuron to target cell across synapse. Beta-endorphins are brain’s own natural analgesic (a medicine that takes away physical pain) can reduce anxiety (a normal reaction to stress, unpleasant state of the mind which is followed by behavior) and pain. The resultant effect is a temporarily improvement in the brain chemistry that is experienced by the smokers as enhanced pleasure, decreased anxiety and a state of alert relaxation. One of the most common adverse effects of smoking is atherosclerosis (hardening of the arteries due to deposition of Carbon and fats which eventually lead to hypertension, heart attack and others. Effects of Cadmium during cigarette smoking Smoking also results in an increased intake and accumulation of Cadmium (metal commonly found in industrial areas) in human being due to the appreciable absorption of Cadmium from the lungs, about 25.50%. It is established that cigarette smoking is indeed likely to the largest source of Cadmium found in the tissues when more than 20 cigarettes are smoked daily. Absorbed Cadmium accumulates mainly in the kidneys for instance, when liver, kidneys and lungs obtained at autopsy (specialized surgical procedure that consist of a thorough examination of corps to determine the cause of the death, evaluate the disease that may be present) from 172 subjects were analyzed, results shown that concentration in the kidneys of cigarette smokers was approximately twice as high as a non-smokers.  That is, concentration seemed to have risen with the number of cigarette smoked. Other detrimental or harmful effects of Cadmium are damage to the liver, necrosis (decay of testis), hypertension and probably certain chronic lesions in the connective tissues of the body. Cadmium intake also reduces considerably male semen quality and fertility status Dr. Neil Ward with his team at Surrey University, England conducted a study among 367 couples suffering from fertility problems and found higher Cadmium concentrations in men with low sperm count, malformed sperm and poor sperm motility.  The gas phase of cigarette smoke contains nitric Oxide (gas that occurs naturally in the body) and nitric oxide (one of various nitrogen gases) which can also be termed as unpaired electron and hence, toxic and capable of initiating further fee radical chain reaction. Current studies by Dr. Irving Godstein with his team at the New England Male reproductive Health Centre, Boston University Medical School, found a possible link that among a population of 1011 men with erection dysfunction, 78% were smokers more than twice the number of men with erection problem. Conclusively, the researchers opined that decrease in potency might result from the negative effects of smoking on the blood vessels leading to the male reproductive organs. Similarly, other researchers measured the blood flow to the penis in 120 men who have come to their clinic with erectile dysfunction; they found that decrease in blood flow was directly proportional to the number of cigarette smoked.  Dr. Godstein then confirmed that smoking is the premium leading cause of impotency – smoking adversely affects the fertility of male smokers by reducing sperm motility as well as altering the sperm shape. It also inhibits the male hormone (androgen) secretion. Effects of Cigarette Smoking on Female Reproductive system There is about 43% decline in fertility for women who smoke heavily. Female smokers are three times more likely than non-smokers to be infertile. Also, they have fewer reproductive years and they reach menopause earlier than non-smokers. “Tobacco smokers are liable to die young”, Federal Ministry of Health warns. Yeah, smokers die young but also cause serious harm to unborn child. To curtail the effects of smoking on your baby, stop smoking for about  four months before planned pregnancy to ensure that the reproductive system are as healthy as possible before conception takes place. Effects of Cigarette Smoking on

Puerperal sepsis is an infection of the genital tract that occurs at any time between the rupture of membranes in labour and 42 day following delivery or abortion threatens the well-being of both mother and child in postpartum period. This is may be caused by endogenous bacteria or exogenous bacteria. What is puerperal sepsis? Puerperal sepsis is an infection of the genital tract during the first 6–8weeks of delivery or abortion.  Pyrexia in puerperium is often caused by postpartum sepsis or extragenital causes like pyelonephritis, mastitis, and pneumonia. In some developed countries, puerperal pyrexia is a notifiable case if the temperature gets to 37.7oC within 14 days. Signs and symptoms of postpartum infection Causes of puerperal sepsis In considering the causes of postpartum sepsis, the midwife should ponder of these three factors: The organisms causing puerperal sepsis The microbes responsible for puerperal sepsis are under four groups: Anaerobic streptococci from the patient’s bowel can infect her.  Infection with Clostridium tetani or welchii can occur due to taking delivery in unhygienic environment or use of rusty, unsterile instruments. Risk/predisposing factors to genital tract infection/postpartum infection For better understanding these risk factors for puerperal sepsis include:  Common sites of puerperal infection Women are vulnerable to infection because the placental site is large, warm, dark moist, rich to grow microorganisms very quickly.  During delivery, traumatized tissue or tear in the vagina or perineal area is susceptible to infection. Types of puerperal infection Genital tract Infections or postpartum infections are grouped into: . The source of postpartum infection The source of the infection may be attributed to: Autogenous source of postpartum infection In this case, the source of the infection is from the patient’s respiratory tract. Septic foci in her body can also be a source of infection. Endogenous source of postpartum infection This is often from microbes already present in the patient’s vagina and bowel. These organisms are non-pathogenic in normal conditions but they become virulent and pathogenic if there is laceration of the birth canal. Exogenous source of postpartum infection Organisms from the patient’s respiratory tract and septic foci of the patient’s care provider, the dust in the air of maternity wall from blankets, sheets, and so on are the main sources of this infection.  Unfortunately, most of hospital staff (doctors, nurses and midwives) harbour staphylococci and streptococci in their respiratory tract and would readily infect their patients if proper precautions are not taken. Infections gotten from hospital are called nosocomial infections How to manage postpartum infection Prevention of puerperal sepsis The following tips would be of great help to prevent postpartum infection:

Post-Abortion Care: Nearly 20, 000 women die each year from complications of unsafe abortion and 13 percent of pregnancy-related deaths are attributable to this. It is estimated that one quarter to one-thirds of all pregnancy-related deaths are a consequence of unsafe abortion.  It is unfortunate to know that about 19 million abortions each year are unsafe.  Maternal death has far reached consequences for community motherless children 3 to 10 times more likely to die within 2 years than are children who live with both parents. An estimated 5 to 7.5 million women every year suffer debilitating non-fetal health problems as a result of unsafe abortion. For every maternal death, 10 – 15 women suffer morbidity. What is post-abortion care(PAC)? Post-abortion Care (PAC) consists of medical and related interventions designed to manage the complications of spontaneous and induced abortion, both safe and unsafe. What are objective of PAC?  The aim of post-abortion care is to reduce maternal morbidity and mortality and to improve women’s sexual and reproductive health and lives. What are elements of post-abortion care?  The model for post-abortion care consists of five elements: Does Post-abortion Care involve maintaining patient’s rights? Yes; all women have right to prompt, highly-quality post-abortion medical care and counseling, whether their abortion was spontaneously or induced and regardless of the legal status of the abortion. Women also have the right to information about their medical condition and make informed decisions regarding their medical and reproductive options. What are the sexual and reproductive health rights? The International Planned Parenthood Federation (IPPF) has produced a formal statement declaring women’s sexual and reproductive rights essential components of human rights. The IPPF charter includes twelve rights based on international human rights agreement. How to Provide Post-abortion Care Clinical assessment guides the diagnosis and treatment for each woman. For women presenting for post-abortion care (PAC), these findings and symptoms can generally be organized into four main clinical conditions, each describing a diagnosis and thereafter should be properly addressed.  The bottom line Tofort focuses on providing clear, reliable, respectful and evidence-based facts to ensure the safety of mothers and children. No woman should to die of pregnancy, labour, and puerperium. Therefore, let us unite and improve maternal and child health in wherever you are. Provide post-abortion care with least or no harm always. Safety to all mothers and children! Thanks for reading.

Women requiring post-abortion care (PAC) have both physical and emotional needs. Proper and effective counseling is a successful means through which the providers offer emotional care to women. Right to high-quality counseling is a fundamental right of women requiring PAC. Counseling is a way of providing support to patient; helping her to assess her feeling, coping ability, managing her anxiety and understanding information in order to enable her make inform decision. What is counseling? Counseling is defined as structured interaction whereby an individual voluntarily receives emotional support and guidance from a trained person in conducive environment that promote sharing thoughts, feeling and perceptions. Counseling is: Counseling is not: Role of PAC Counselor Benefits of Counseling in a PAC Setting Counseling in PAC Setting In order to provide effective counseling, the provider should give counseling before, during and after medical treatment whenever the woman’s health is not at risk of delay and she is in a state to make an informed decision.  Counseling in PAC helps the woman plan for her future to ensure her wellbeing. All elements of PAC must be employed for effective counseling. Guiding Principles in PAC Counseling The counselor must have these principles as a guide in counseling a woman with post abortion needs. The counselor must assess her biases, beliefs, attitudes. She should separate her beliefs, personal values, attitudes and biases from her professional practices and empathy to all clients regardless of their reproductive behaviours and decision. Health providers’ attitude to patient has great impact. Self-reflection will help her not to oppose her beliefs, values and attitudes to client. She should recognize how their attitudes could negatively or positively affect counseling. Empathy is the ability to understand another person’s feelings and opinion (view) and to communicate at same level with cent. It is putting oneself in another man’s shoes. Empathic provider will always have it in his/her mind to treat others how they would want to be treated. Patients respond most favourable to counselors who: Create a positive rapport between you and the woman which is the bedrock of quality health care. Effective communication skills are necessary in PAC setting because women’s physical and emotional distress may interfere with her ability to accurately explain their physical conditions respond to questions and understand information. She should adapt her behaviour and language to client’s cues especially at the beginning of clinical interactions. She should make patients active participants of their own care through sharing of information. She should provide privacy and treat information confidentially for counseling and that which is essential in promoting woman’s sense of dignity. If patient loose trust, it may be difficult to regain. Therefore, health worker must maintain trust by posting the facility confidential policy in strategic places in PAC setting. Caring areas and sharing it verbally with all clients. Patient’s right to privacy must be respected in PAC setting. It is essential that counseling should take place where nobody can hear and see her. Meeting privately, especially at the initial meet will help the client to be open and give out information. Effective woman-centered care is a two-way communication.  When there is good rapport, patient opens up easily and from her history, proper diagnosis will be made and appropriate treatment would be provided. Conclusion Counseling should be devoid of discrimination, racism and favouritism. The counselor should provide safe and evidence-based facts to enable patients take decision in his or her care. When patients are involved in decision-making, they tend to show maximum cooperation and quick recovery from the ill-health.

Manual Vacuum Aspiration is one of ways to carry out uterine evacuation, which is the removal of the contents of the uterus such as incomplete abortion or other retained products of conception. What is Manual Vacuum Aspiration (MVA)? World Health Organization (WHO) in union with UNPFA, UNICEF and the World Bank and the endorsement by FIGO and ICM approved MVA as an essential technology for uterine evacuation. MVA is typically used in PAC treatment for uterine evacuation in the first trimester.  To perform the MVA procedure, a cannula of the appropriate size (depending on gestation age/uterine size) is inserted through the cervix into the uterus. A hand-held plastic 60ml aspirator that is charged with a vacuum is than attached to the cannula. The vacuum is released by depressing the buttons on the aspirator and then the cannula is gently and slowly rotated while being moved back and forth in the uterus. The aspirator serves as the source of vacuum to pull to tissue through the cannula into the cylinder of the aspirator. What are indications for MVA? What are contra-indications for MVA? Features and Parts of IPAS MVA Plus The IPAS instrument was manufactured by IPAS since 1973.  IPAS MVA plusTm aspirator provides vacuum 24 – 26 inches or 609.6 – 660.4 mm of mercury. It is composed of the following parts: Ipas EasyGrip Cannulae Ipas EasyGrip Cannulae have the same dimensions and aperture (openings) as the flexible Karman cannulae. However, Ipas EasyGrip cannulae are slightly more rigid and have a permanently fixed base with a wing design. This helps the base to directly to the IPAS MVA Plus aspirator without requiring a separate adapter. Ipas EasyGrip Cannulae are available in sizes 4, 5, 6, 7, 8, 9, 10 and 12mm. the smaller cannulae (4, 5, 6, 7 and 8mm) have 2 opposing apertures. The larger (9, 10 and 12mm) have a single scoop aperture to allow for removal of thicker tissue. There are dots for calibration on the cannulae at 1cm intervals. How to determine the cannula size to use during MVA This depends on uterine size in relation to Last Menstrual Period (LMP), i.e. the gestational age of the pregnancy What are advantages of MVA? Procedures for Uterine Evacuation with IPAS MVA PLUS To provide woman-centered care, the woman’s safety and comfort during in MVA must be assured. The following ten steps below would guide you to perform uterine evacuation using manual vaccum aspirator effectively STEP 1: Prepare Instruments – Charge the Instrument STEP 2: Prepare the Patient STEP 3: Perform Cervical Antiseptic Preparation Maintain aseptic technique throughout, using sponge – holding forceps, pick sponge (gauze, swab) to clean cervical OS vaginal walls if desired. With each new sponge start at the cervical os to clean and spiral outward without retracting previously cleaned areas. Continue until the cervical os has been completely cleaned with antiseptic. STEP 4: Give Anaesthetics STEP5: Dilate Cervix             Cervical dilation is not required in some cases. Dilation is not required when cannula of appropriate size fits into the OS. If cervix is closed and not efficiently dilated, use a bigger cannula to dilate gently. Do not use force because it can cause cervical tear, injury to pelvic organs and uterine perforation. STEP 6: Insert Cannula STEP 7: Suction Uterine Content What are signs that the uterus is completely empty? Once the manual vaccum aspirator is in uterus and you notice these signs below, and then know that uterus has been evacuated: STEP 8: Inspection of Tissue Inspect the tissue for: STEP 9: Perform Any Concurrent Procedure Other concurrent procedure such as insertion of IUD if consent was obtained when the procedure is complete is allowed. Step 10: Process Instruments Immediately wash the instruments (MVA), rinse in a clean water and insert in a jik solution 1:10 for 10 minutes. Discard needles and sharps appropriately. Other post procedural tasks are: What are challenges arising when using MVA? Vacuum can decrease before completion of the procedure. They following may be the cause. What are the medications to give patient after manual vaccum aspiration? Prescribe necessary drugs for patient such as: Tab Paracetamol twice daily for three days. What are complications of manual vaccum aspiration? Using manual vaccum aspiration is an option to treat missed or incomplete abortion is safe provided it is done by skilled provider and under strict aseptic and antiseptic techniques. However, MVA performed by unskilled provider and without aseptic precautions can result in the following complications:

Precipitate labour is very important for Midwives and Obstetricians to know what to do in such situation. Hence, in this article, we shall discuss precipitate labour, its causes, management and complications. We shall also consider back labour . Most women especially primigravidae do not want to waste time in labour and experience that excruciating pain. They want everything speedily so that they could be free and have their baby. However, they fail to know that labour associated with high speed has many risk factors to both mother and baby. What is precipitate labour? Precipitate labour is a labour that lasts for fewer than three (3) hours. This trial of labour often makes women give birth in the church, market place and so on. Those who thought were smart and started rushing to hospital, would be born on their way or at the hospital gate. Such babies are described as “born before arrival”. Risk factors for rapid labour Effects of the labour on the mother Feto-neonatal complications of precipitate labour How to manage a woman with precipitate labour A woman with needs close monitoring and preparations for emergency delivery to ensure safe outcome for mother and baby. Proper history taking will help the nurse educate the woman on proper birth plan to come to facility as early as possible. Precipitate Labour Vs Back labour About  one-thirds of women in labour report that their backs hurt during labour, more so than their abdomens.  Sometimes, the pain of back labour does not go away during the break in uterine contractions, and this is often blamed on the baby being in an occipitoposterior  position(turned to face the mother’s front).  Ways to manage Back Labour Below are the strategies for ameliorating the pain associated with back labour and also help move a baby out of the posterior position. Therefore, try them if your back is hurting more than your belly during labour.  Sacral massage/counter pressure:  This involves steady, firm pressure or massage on the lower back based on maternal request. It helps to sooth pain through release of endorphins —body’s natural pain killer.

What is Puerperal psychosis? Puerperal psychosis is a serious or life-threatening mental condition which affects the personality of the woman during puerperium (mostly primipara). Its onset is rapid and usually occurs within the first few days after   delivery.   The   symptoms characterized by this mental illness are similar with those   of   depressive psychosis, manic illness and schizophrenia in some cases. The affected mother shows bizarre behavior, loses touch with reality and may suffer from hallucinations. The onset of these symptoms may be heralded by a time of acute restlessness and inability to sleep. Frequently the mother may deny that her baby belongs to her and in rare cases she may harm the baby. How common is puerperal psychosis? Psychiatric disorders can occur during pregnancy, labour or puerperium. Puerperal psychosis is not common (about 1 or 2 in every 1000 births) but tends to be more common in primigravida.  Most women experience a phase of depression called “maternity blues” during puerperal period, in which its poor treatment can result in a fatal mental state, known as puerperal psychosis or postpartum psychosis Causes of puerperal psychosis The causes of puerperal psychosis are complex and multi-layered. These include genetic factors, environmental factors (social isolation, brain injury/ trauma, and stress), lifestyle (drug or alcohol abuse) and psychological factors (mood disorders, anxiety disorders, schizophrenia or bipolar disorder and personality traits). The cause of puerperal psychosis is likely involves a combination of these factors above. It is believed that some people may be more likely to develop this condition if they are living in an area with high levels of pollution or if they are living in an area with a history of mental illness. However, getting treatment as soon as possible to helps prevent further damage to the individual and their family. Risk factors of puerperal psychosis Signs and symptoms of puerperal psychosis How to treat postpartum psychosis The patient must be treated promptly by admission to a psychiatry unit under the care of a consultant. In most cases, the baby will be allowed to accompany his mother to hospital and this should be encouraged if there is availability of adequate vital and skilled psychiatric nursing care. This involves use of medication (antipsychotic medications and mood stabilizers), psychotherapy, lifestyle changes and electroconvulsive therapy The prognosis of postpartum psychosis With prompt treatment, the prognosis is good. However,  unfortunately, it is likely that further episodes of the illness will occur throughout the woman’s life around  there  is  a  high  risk  of  recurrence  in  subsequent pregnancies. Summary Puerperal psychosis is an illness that affects young adults in their late teens and early twenties after delivery. It is a mental disorder that causes elevated mood, energy and activity levels, delusions, hallucinations, irrational thoughts and other psychiatric symptoms.  It is also known as juvenile schizophrenia. Symptoms of puerperal psychosis can last for months or even years. There is no one cause of puerperal psychosis. It is believed to be caused by a combination of genetic and environmental factors. Some people are more likely to develop puerperal psychosis than others. The prognosis for puerperal psychosis is very uncertain and can vary greatly depending on the individual.  Some people may have a milder form of the disorder and may not require any treatment, while others may have a more severe form and may require long-term treatment. There is no known cure for puerperal psychosis, but it can be managed with medication and therapy.