BIRTH CONTROL - Morning-after Pill
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VAGINAL INFECTIONS
Conditions that manifest in the female external genital region with burning, itching and discharge symptoms are called "vaginal infection (vaginitis)".
What are the causes of vaginitis?
Vaginitis may be caused by bacterial, fungal and protozoal infections and can also be a result of allergens. Pathogens, allergens that come into contact with the external genital region or the disruption of the natural structure (flora) of the vagina may cause vaginitis.
How does vaginitis occur?
In most of the organs in our body, there are beneficial bacteria that have a protective function and that thrive on the normal organ tissue called flora. These bacteria living in the natural acidic pH of the vagina -the natural element of the vaginal flora- are called lactobacillus and prevent hazardous bacteria from propagating in the vagina. The most important factors that cause a decrease of lactobacillus in numbers are use of antibiotics, frequent use of vaginal showers and changes in the pH of the vagina. The likeliness of infections developing in the vagina is higher in these situations.
What are the symptoms or vaginitis?
The most frequent symptom in vaginal infections is vaginal discharge. It is important to distinguish between vaginitis-related discharges and regular physiological discharges seen every month in women. Physiological discharges are colorless and odorless. However, vaginitis-related discharges are usually dark yellowish or greenish and malodorous.
Fungi, bacteria and parasites may be factors of vaginitis.
Candidal Vaginitis (Yeast Infections)
This condition is usually seen in pregnant women, women using antibiotics and birth control pills and women with diabetes. Keeping wet bathing suits or underwear alike on after pool or sauna sessions pave the way for yeast infection-related vaginitis. Discharges caused by candidal vaginitis are very typical. Mostly having a cheese-like or milk-clot-like appearance, the discharge is usually itchy. The itching may take on the form of vulvitis by spreading to the external genital region and to the labia. The fungal factor can be treated with tablets, suppositories and creams. No sex partner treatment is needed.
Bacterial Vaginitis
The most frequent factor for bacterial vaginitis is gardnerella vaginalis. This type of vaginitis is characterized by a yellowish-green, malodorous (fishy) discharge. Malodor increases following sexual acts. The disease may increase likelihood of miscarriage during pregnancy. Treatment consists of tablet or suppository antibiotics. No sex partner treatment is needed.
Parasitic Vaginitis
The most frequent cause of the condition is a parasite called Trichomonas Vaginalis. This parasite is transmitted through sexual intercourse and the patient presents with greenish, malodorous discharge. Symptoms of vaginitis are usually accompanied by a burning sensation while urinating. Treatment includes antiparasitic tablets or vaginal ovules. This type of vaginitis also necessitates sex partner treatment.
PREGNANCY
Your child's physical and mental development largely starts during the pregnancy phase. Therefore, an adequate and balanced diet is very important to ensure that both you and your baby are healthy. To that end, you must make sure you take the following recommendations into consideration.
- Eat two matchbox-sized pieces of cheese per day, drink at least 2 glasses of milk (pasteurized or UHT are preferable) or yoghurt or the same amount of ayran.
- Try to consume at least 1 egg, 1 serving of vegetables with meat or legumes (beans, chickpeas, lentils, etc.).
- Try to consume fresh vegetables and fruits -rich sources of vitamins- regularly at each meal.
- Check your weight increase during pregnancy to make sure you take 1 to 1,5 kilos per month and 7 to 14 kilos in total.
- Be sure to use iodized salt during meals. Keep the iodized salt in a dark glass jar. Keep it away from direct light, sunlight and damp environments. Hence, you can prevent loss of iodine. Add the iodized salt when the meal is nearly cooked or after it is cooked.
- Do not skip meals. Eat in small bites and frequently.
- Ensure you get enough sunlight hours for your bone health.
- Throughout your pregnancy, avoid food whose ingredients are unknown and which contain high amounts of preservatives.
- Opt for vegetable oils during meals. Ensure you also consume olive oil throughout the day. Avoid margarine, tallow oil and tail fat. Do not add extra fat to meals containing meat.
- Increase liquid consumption during pregnancy to satisfy the rising need in fluids. Drink at least 10 glasses of water every day. Increase your liquid intake by consuming milk, ayran, freshly squeezed fruit juices.
- To avoid constipation, ensure you also consume pulpy foods aside from liquids (such as legumes, fresh vegetables and fruits).
- Anemia is seen more frequently during pregnancy. To prevent it, you can consume foods such as eggs, red meat, molasses, legumes and fresh vegetables, fruits or freshly-squeezed fruit juices. Do not drink tea or coffee one hour prior to or after meals.
- Do not smoke or drink alcohol. Avoid smoking environments.
- Since agriproducts contain pesticides, wash fruits and vegetables thoroughly before you eat them.
- Wash your hands thoroughly before you prepare food.
Folic acid supplementation during pregnancy
The neural tube where the brain and spine develop is created during the first four weeks of fetal life. In some cases where the root cause is not completely known but where combined genetic and environmental factors are known to play a role, the neural tube is not able to complete its development and severe congenital anomalies called neural tube defects (NTD) such as anencephaly, encephalocele, meningocele, myelocele, spina bifida occur. Infants with anencephaly die shortly after birth. Other NTDs are the causes for severe lifelong impairments. Aside from the moral burden the disease brings, the lifelong care cost of a child with NTD to society has been calculated at approximately 532,000 dollars in the USA.
NTD is one of the most frequent congenital anomalies. Research conducted in Turkey has shown that its prevalence is 3 in one thousand. This rate is 1 in a thousand in Europe, 2 in a thousand in the USA. The likeliness of couples having a second child with NTD after a first one is indicated to be 2-3%. Furthermore, it is thought that an unknown number of pregnancies end due to NTD-related miscarriages.
Studies carried out in the last three years show that NTDs can be prevented up to 70% with a daily intake of 0,4 mg of folic acid by the mother, starting from prior to pregnancy and throughout the first three weeks of pregnancy.
Fundamentally, practices aiming at the prevention of NTDs are the responsibility of primary care teams and administrators.
Recommendations
When taking into consideration that the prevalence of NTD in Turkey is relatively high, it is expected that use of folic acid during pregnancy contributes significantly to the reduction of NTD prevalence. To reduce prevalence of NTD in Turkey, the implementation of the following measures would be beneficial.
All couples who have a child with NTD, have / or whose close relatives have a history of NTD should be informed on the importance of folic acid intake before a new pregnancy. Genetic counselling should be given and the mother-to-be should start using 4-5 mg of folic acid per day.
All women who plan on becoming pregnant in the near future should take 0,4 mg of folic acid daily prior becoming pregnant. When taking into consideration that 40% of pregnancies in Turkey are unplanned, implementing this may be difficult.
ANEMIA
Anemia is characterized by a drop of hemoglobin levels under 11 g in 100 cc of blood. A slight decrease in hemoglobin levels due to the increase of plasma volume from the second trimester of pregnancy onward is considered normal. Accordingly, from the second trimester on, pregnant women whose hemoglobin levels stay under 10.5g / 100 cc are considered anemic.
According to the data of the World Health Organization, approximately 30% of the world population, and more than half of pregnant women in the world, are estimated to be anemic. More than 1/3 of women worldwide have anemia. That is why anemia is an important problem that needs to be dealt with as part of women's and pregnancy health. Severe anemia causes a 5-fold increase in maternal mortality. Low levels of blood loss during delivery or miscarriages in mothers with anemia may have severe results and may even cause maternal mortality if it is accompanied by heart failure. Moreover, anemia may negatively impact the mother's overall health and increase the risk of spontaneous abortion, preterm labor, postpartum bleeding and puerperal sepsis.
Causes of anemia during pregnancy
Due to the fetus' needs and the increase in blood volume during pregnancy, iron consumption increases. Iron need to be increased during the second and especially the third trimester. The amount of iron needed throughout the pregnancy is 1000 mg (300 mg for the fetus, 50 mg for the placenta, 450 mg for the increasing erythrocyte volume, 240 mg for the mother's continued basal iron use). The iron need that is of 0.8 mg / day during the first trimester rises to 6.3 mg/day during the second and third trimesters. Following delivery and throughout lactation as well, daily need is high. Although iron absorption increases in pregnant women, the amount taken through diet is not enough to satisfy the need. When necessary, the body's iron storage might need additional supply.
In developing countries, most women have very low iron storage levels due to malnourishment, infections, frequent and high numbers of pregnancies. When mothers are not administered any iron supplementation, a period of 2 years must pass before iron storage levels come to the required pre-pregnancy levels.
What are the causes of iron deficiency anemia in pregnant women?
Increase in iron need
During pregnancy, the need for iron increases due to the needs of the fetus and the increase in blood volume. Although iron absorption increases especially during the second and third trimesters of pregnancy, the amount taken through diet is not enough to satisfy the need, therefore iron supplementation is necessary.
Deficiency in iron storage may be caused by the following:
- Malnourishment
- Frequent deliveries and miscarriages
- Frequent infections and especially parasitic diseases (ancylostoma, necator, malaria) cause a draining of iron storage and storage is at low levels.
- Malabsorption in the intestines
What should be done to protect from anemia?
- Dietary training and dietary adjustments
- Iron and folate supplementation
- Ensuring that medications are taken regularly
- Control of parasitic infections
- Dietary enrichment practices
Symptoms and findings or iron deficiency
- Drowsiness
- Fatigue
- Loss of appetite
- Digestive disorders
- Nail thinning
- Shortness of breath
- Paleness of the palms and of conjunctiva
Although the above-stated are seen in normal pregnancies, specific examination should be carried out for anemia.
Possible effects of anemia on the mother and the baby in pregnant women
Effects on the mother
- Increase of risk of disease and of mortality in the mother and the baby
- Increase in the risk of low weight birth
- Weakening of the immune system and decrease in immune function capacity
Effects on the baby and the child
- Defects in motor development and coordination
- Growth and development retardation
- Language and school development disorders
- Decreased physical activity
- Fatigue
- Attention deficit and decrease of resistance to infections
