Lotus Birth

History of Lotus Birth
State of Lotus birth is the American pioneer. Lotus birth conducted as a precautionary measure to protect infants from infection of open wounds. Although Lotus birth is a new phenomenon, but the delay cutting the umbilical cord already exist in Balinese culture and the culture of Australian aborigines. And decisions Lotus birth and physiological effects that can occur is the responsibility of the client who has chosen and make that decision.

Primatologist Jane Goodall, was the first person to do any long-term study of chimpanzees in the wild animal, chimpanzees, which represents 99% of mammals with similar genetic material with humans, also in practice to let the placenta intact, do not ruin it even cut it. This is known as fact primatologis. Lotus-born chimpanzees Some practitioners refer to the practice as a natural exercise for humans as well.

Information about lotus birth is found in Buddhism, Hinduism, Christianity and Judaism.

In Tibetan and Zen Buddhism, the term "lotus birth" is used to describe the spiritual teachers like Buddha and Padmasambhava (Lien Mon-hua), emphasizing their entry into the world as a whole, children holy. Reference lotus birth is also found in Hinduism, for example in the story of the birth of Vishnu.

Until now there has been no further research on yellow fever and weight loss babies because the act of Lotus birth.

Understanding Birth Lotus (Lotus Birth)

After the baby is born, the umbilical cord attached to the baby and the placenta is left, without clamped or cut, and let the baby's umbilical cord separated from the natural. The umbilical cord and placenta is one unit and a unit that form the baby. Generally, the umbilical cord is naturally released two or three days after birth.

 

Placenta Treatment on lotus birth

Placenta newly born normally remove fluid, on the birth of the Lotus, the liquid is at capacity and stored in the basin or bowl, then brought near to the baby. Fabric used to cover the placenta should allow the exchange of air, so that the placenta does not stink and become dry. Some use sea salt to speed up the drying process of the placenta. Sometimes there are applying essential oils, like lavender or powdered herbs such as goldenseal, neem, mixed with lavender as an anti-bacterial. If draining the placenta is not done properly, then the placenta will release odor. The smell can be overcome by planting the placenta directly or cooled (store in refrigerator) after the first week after delivery. Lotus birth is rarely done in hospitals. More common in childbirth at home and birth centers Lotus. 

Benefits of Lotus Birth

• The umbilical cord is left up to allow the extension of maternal blood flow to the fetus.
• Oxygen is vital that through the umbilical cord can get to the baby before the baby really started breathing on his own.
• Lotus birth allows the baby cry immediately after birth.
• Baby stays close to the mother after childbirth. That allows bounding attachment longer.

Lotus birth is also called non-violent practice. Not only does not cut the umbilical cord, it just withers away usually on the third day. Children have time to get used to the world, without breaking suddenly from a warm and caring friend, who was accompanied in the womb for nine bulan.Hal is getting more and more momentum today, as parents realize the importance of birth for the development of psychological and health children.

The placenta is part of the baby. The placenta begins to develop at implantation from the same source as an infant - cystic explosion. The fetus depends on the placenta, not only for nutrition, but also for gas exchange, waste removal, endocrine and immune support. The development of true placenta is essential for embryonic and fetal development.

When born, the baby still relies on the placenta. Leave it attached to the baby after birth, you make a natural transition to take place. There is no hurry, and no confusion. placenta is the most valuable nutrients, hormones, immune support substances into the baby's body. Leaving the placenta intact also include keeping the baby from infections that may appear in cut rope placenta.

Cervical Cancer Early Detection with pap smear

Cervical Cancer Early Detection with pap smear

Cervical cancer is a malignancy that occurs in the cervix (cervical) which is the lowest part of the uterus protruding into the top hole intercourse (vagina). The cause is not known for certain, but 95% of cases found in HPV (Human Pappiloma Virus) positive. Cervical cancer is the cancer incidence rate of cancer ranked first in Indonesia.

Symptoms of cancer during the pre / early usually do not arise. Even if present, usually in the form of exit discharge are not typical. At the next stage can be found symptoms such as:

• Bleeding after intercourse
• Whitish / watery liquid smelling
• Bleeding outside of the menstrual cycle
• Bleeding after menopause
• Pain pelvic area

Risk factors for cervical cancer causes include:

• Getting married or having sex at a young age (<17 years)
• Frequently changing sexual partners and having sex with men who often have multiple sexual partners
• History of recurrent infections in the genital or pelvic inflammatory
• Women often give birth
• Female smokers have two times greater risk than women non-smokers

To make early detection of cervical cancer, among others by doing pap smear. Pap smear is an examination of the cervix (cervical) using a tool called a speculum and performed by the midwife or obstetrician. This examination is to determine the presence of HPV or carcinoma cells causes cervical cancer.

This examination is cheap, fast and can be done at the nearest health services such as: health centers, maternity hospital, Hospital, Midwife, Clinic, physician practices, etc.. This examination can be done anytime, but is menstruating or according to doctor's instructions. Pap smear should be done 1 time a year by every woman who has sexual intercourse.

When a positive pap smear examination results, the cells are abnormal, you should consult the nearest health workers to do the examination and further treatment by a gynecologist. Perform regular pap smear for cervical cancer found faster and more likely to recover.

Whitish or Flour Albus

Whitish or Flour Albus is abnormal vaginal secretion in women. Vaginal discharge caused by infection is usually accompanied by intense itching in the vagina and around the outer vaginal lips. which often cause vaginal discharge include bacteria, viruses, fungi or parasites as well. This infection can also spread and cause inflammation of the urinary tract, causing pain when the patient is urinating.

Symptoms Whitish

• The release of liquid or cream-colored white-gray of the vaginal canal. This fluid can dilute or condensed, and sometimes frothy. Perhaps this phenomenon is a normal process before or after a certain period in women.
• In certain patients, there is intense itching that accompanies it.

Usually a normal vaginal discharge is not accompanied by itching. Vaginal discharge can also be experienced by women who are too tired or weak body resistance. most of the liquid is derived from the cervix, despite originating from an infected vagina, or external genitalia.

• The new-born baby girl, within one to ten days, from her vagina to get out of fluid under the influence of hormones produced by the placenta or afterbirth.
• The young girl also sometimes have vaginal discharge just before puberty, usually these symptoms will disappear by itself.

Cause Whitish

The cause of vaginal discharge in general is:

• Frequent use when washing the female tissue, after urination and defecation.
• Wearing tight underwear of synthetic material.
• Frequent use of public toilets are dirty.
• No change panty liners
• Rinse the vagina from the wrong direction. Namely from the anus towards the vagina toward the front.
• Frequent exchange underwear / towel with other people.
• Lack of personal hygiene vagina.
• Fatigue is a very highly.
• Stress
• Does not replace the pads during menstruation
• Use any soap to wash vagina
• No lead a healthy life (not eating regularly, never exercise, lack of sleep)
• Living in the humid tropics
• Environmental sanitation dirty
• Often bath with warm water and heat. The fungus that causes vaginal discharge were more likely to grow in warm conditions
• Frequent changes in sex partner
• High sugar levels
• Hormones are not balanced
• Frequent scratching vagina 

While taking into account the fluid out, sometimes known cause of vaginal discharge.

• Infection with gonorrhea, for example, produces a thick fluid, purulent and yellow-green.
• Parasite Trichomonas vaginalis produces a lot of fluid, a watery liquid is yellow-gray.
• Whitish accompanied by foul odor can be caused by cancer.

8 Tips to prevent vaginal discharge

1. Clean the sex organs with a cleanser that does not disrupt the stability of the pH around the vagina. one of them cleaning products made from dairy ingredients. Products like these are able to maintain pH balance as well as increase the growth of normal flora and menekna unfriendly bacteria growth. Common antiseptic soaps are generally hard and and can be normal flora in the vagina. Vagina is not beneficial in the long term.
2. Avoid the use of powder in the female organs in order for vaginal fragrant and dry throughout the day. Powder having fine particles are easily tucked here and there and finally invite ajamur and bacteria lodged in the place.
3. Always dry the vagina before dressing.
4. Use a dry underwear. If wet or damp, try to quickly replace with a clean and unused. Nothing wrong with you bring a backup pair in a small bag just in case when necessary to replace it.
5. Use underwear that absorbs sweat, like cotton. Pants from satin or other synthetic create the atmosphere around the sex organs hot and humid.
6. Outerwear also need attention. jeans are not recommended because the pores are very tight. choose as a skirt or pants non-jeans material, so that air circulation around the sex organs to move freely.
7. When menstrual pads frequently change.
8. Use a panty liner in when necessary only. Do not be too long. Suppose that when traveling outside the house and let you return home.

 

  

Preeclampsia and eclampsia In Pregnancy

Preeclampsia and eclampsia In Pregnancy

Is Preeclampsia?

Also referred to as toxemia, preeclampsia is a condition that pregnant women can get. It is characterized by high blood pressure is accompanied by high levels of protein in the urine. Women with preeclampsia will often also experience swelling, feet legs and hands. Preeclampsia, if any, usually appear in the second half of pregnancy, generally in the last part of the second or third trimester, although it can occur earlier.

What is Eclampsia?

Eclampsia is the final and most severe phase of preeclampsia and occurs when preeclampsia is left untreated. In addition to the previously mentioned symptoms, women with eclampsia often have seizures. Eclampsia can cause coma and even death of mother and baby and can occur before, during or after childbirth.What Causes Preeclampsia and Eclampsia?The exact cause of preeclampsia and eclampsia are unknown, although some researchers suspect poor nutrition, body fat or a high enough blood flow to the uterus as possible causes.

Which affected Preeclampsia Risk?

Preeclampsia is most often seen in first pregnancies and in pregnant teenagers and women over 40. Other risk factors include:
A history of chronic high blood pressure before pregnancy.

• Previous history of preeclampsia
• A history of preeclampsia in mother or sister.
• Obesity before pregnancy.
• Carrying more than one baby.
• History of diabetes, kidney disease, lupus or rheumatoid arthritis.

How to Say Experience in Preeclampsia?

In addition to swelling, protein in urine, and high blood pressure, symptoms of preeclampsia can include:

• Rapid weight loss is caused by a significant increase in body fluids 
• Abdominal pain
• Severe Headaches
• Changes in the reflex
• Reduced urine output or no urine
• Blood in urine
• Dizziness
• Excessive vomiting and nausea

Does Swelling During Pregnancy is Preeclampsia?

Some swelling is normal during pregnancy. However, if the swelling does not go away with rest and accompanied by some of the above symptoms, be sure to see your doctor immediately.

How Preeclampsia Affect Babies?

Preeclampsia can prevent the placenta receive enough blood, which can cause your baby will be born very small. It is also one of the main causes of premature birth and the difficulties that can accompany them, including learning disabilities, epilepsy, cerebral palsy, and hearing and vision problems.

How Preeclampsia and Eclampsia treated?

The only real medicine for preeclampsia and eclampsia is the birth of a baby.
Mild preeclampsia (blood pressure greater than 140/90 that occurs after 20 weeks of pregnancy in women who have no previous hypertension, and / or have a small amount of protein in urine can be managed with careful hospital or home observation along with activity restriction.
If the baby is premature, this condition can be managed until your baby can be safely delivered. Health care provider may prescribe bed rest, hospital or medication to prolong pregnancy and increase the chances of your unborn baby to survive. If your baby close to term, labor may be induced.

Treatment for more severe preeclampsia (having vision problems, lung problems, abdominal pain, fetal distress, or signs and other symptoms) may require further treatment appeared - gave birth to a baby - regardless of infant age. Other Treatment:

• Magnesium can be injected into the blood vessels to prevent eclampsia-related seizures.
• Hydralazine or another antihypertensive drug to manage severe increase in blood pressure.
• Monitoring of fluid intake.

 
  
 
       
   

shock

Hemorrhagic shock and septic
Hemorrhagic shock
Classification of hemorrhagic shock
1. Lightweight, jka bleeding <20% blood vol
2. Medium, already arise oliguria and decreased organ perfusion to the liver, intestine and kidney
3. Weight, no palpable pulse and a decrease in consciousness

Pathophysiology of hemorrhagic shock

• On a mild decrease organ perfusion to reply durable against ischemia such as skin, normal arterial pH 
• Shock is a decline in organ perfusike yg pd ischemia lasting a short time, there was metabolic acidosis
• Shock weight, decreased perfusion to vital organs, there was a severe metabolic acidosis and acidosis respitarorik

Clinical symptoms of hemorrhagic shock

• Shock ringan.takikardi minimal, less hypotension, vasoconstriction edge light: skin cold, pale, wet. Urine normal / slightly berkurang.keluhan feel cold 
• Shock sedang.takikardi 100-120/m.hipotensi: 90-100 mmHg systolic, oliguria / anuria.keluhan has
• Shock berat.takikardi <120/m.hipotensi systolic <60 mmHg.Pucat once, anuria, agitation, decreased consciousness

Septic shock

• Stadium early, increased cardiac output, heart rate faster and mean arterial pressure menrun.Kemudian progressive journey with decreased cardiac output, marked with a decrease in central venous pressure 
• Pulmonary hypertension due to increased vascular resistance due to blockage of leucocytes in the pulmonary capillaries, marked with pulmonary failure, arterial pO2 down, hyperventilation, dispneu, cough, acidosis
• DIC because of damage to capillary endothelial

Clinical symptoms of septic shock

1. High fever> 38.9 C, often begins with chills, then the temperature dropped within a few hours
2. Tachycardia
3. Hypotension systolic <90 mmHg
4. Ptekia, leukocytosis or leukopenia who shifted to the left, thrombocytopenia
5. Hyperventilation with hypocapnia
6. Local symptoms such as abdominal tenderness, perirektal

Handling shock• Resuscitation of hemorrhagic shock

   1. Overcome tissue perfusion
   2. Lay on your back with legs elevated
   3. Exempt airway
   4. Give O2 5-10 l / m

Fluid resuscitation

1. Put abocath No. 16 G and take blood samples and pairs of central venous catheters
2. Give RL or Nacl physiological as much as 2-3 x blood which came out with a quick drop for 20-30 minutes
3. Maintain a central venous pressure 3-8 cmH2O
4. In severe hemorrhagic shock can diberika colloidal fluids such as dextran as much as 10-20 ml / kg

Giving medicines

• Sodium bicarbonate, when the arterial pH <7.2, is given with the formula base excess x BB x 1 / 3, half given iv bolus, the rest by infusion 
• vasoconstrictor, eg dopamine, are supplied liquid diberikanresusitasi
• Corticosteroids
• Antibiotics, high dose and combination eg clindamisin 600 mg/6jam and garamisin 2mg/kg bw / 8 hours
• Heparin in case of DIC

The success of shock therapy 
• Pressure CVP 3-8 cm H2O 
• Production of urine 0.5 ml / kg bw / hour 
• improved awareness• increased tissue perfusion 
• an increase in heart Rainfall> 3.5 L / m

hormone evaluations

I tap in my password and hit the return key.  The computer adds my electronic signature to the chart and I click onto the next patient on my schedule.  Reason for visit: hormone consult.  I sigh and begin to frame what I plan on saying to the patient about hormone testing, therapy, risks and benefits.  I walk to my exam room and lift the papers out of the chart rack by the door.  I turn them over and look at the name.  I raise my hand to knock on the door and I see her age.  12 years old.

"I want her hormones checked.  She has had two periods and they were more than a month apart.  She is angry one minute and crying the next.  She doesn't like boys but all her friends do and that makes her cry because all they want to talk about is boys.  Her boobs have just exploded!  She fights with me all the time and I am just tired of her. She needs to get her act together.  She needs her hormones fixed because there is just something wrong with her. And she needs on birth control.  I hate her....but it's OK honey, I really do still love you." 

I stare at the mom in disbelief.  I look at the girls eyes as they start to fill up with tears and then I see her turn angrily at her mother.  "Well that's OK cuz I hate you anyway." 

I spend the next twenty minutes explaining normal puberty, middle school angst, variable maturation rates of teenagers and try to explain why a hormone evaluation isn't needed.  I also try to explain as gently as I can why birth control is a bad idea for a 12 year old who doesn't like boys yet and who is still developing. After they leave my office I don't know whether to laugh or cry.  I spend five minutes tapping out a note about our visit.  I tap in my password and hit the return key.  Then I click onto the next patient on my schedule.

Cancer update

To those who have asked:

Yes, I did finally get to give the bad news to the pregnant mom with cervical cancer.  It is never easy to do.  It's hard and we both cried.  She has been referred to the oncologist.  Thankfully it is in a very early stage at this point.  They may consider just doing a LEEP (shaving off top layer of cervix) during the pregnancy and do more treatment after delivery.  Or they may not do anything until after delivery.  I am leaving that up to the oncologists.  

 I did call her back 24 hours later just to check on her.  I knew I had completely turned her world upside down and just wanted to let her know I was here to help if I could.  It also gave her some time to assimilate the initial shock and be ready to ask questions and hear the answers. 

On another note.  I will not be posting in the next few weeks.  I will be studying to take my national colposcopy exam.  I had to figure out how to squish study time into my days and  the only way to do that was to cut out the "non-essentials" in my life. I am cutting out Facebook time too.....think I may have withdrawals.

Examination Leopold On Pregnant Women

Examination Leopold I

To determine the height of fundus uteri and the fetus within the uterine fundus. 

Instructions on how to check:

• Set the position facing the examiner so that the mother's head. place the lateral side of the left index finger on top of the fundus uteri to determine the height fundus. Watch for the finger is not pushing the uterus down (if necessary, fixation continues below by putting your thumb and index finger right hand front section lateral to the right and left high above the symphysis)
• Raise the left index finger (and fix the radius of the uterus below).
• Place the tip of the left and right palm on uterine fundus and feel the baby is on the fundus by gently pressing and sliding the palm of the left and right hand alternately.
• Consistency of the uterus. 

Leopold II Examination

To determine the fetus is located on both sides of the uterus, on location latitude specify where the head of the fetus.

Hint examination:  

• Overlooking the patient's head, put tepakan left hand on the right lateral abdominal wall and right palm on the left lateral abdominal wall of mother secra parallel and at the same height.
• Starting from the top of the press in alternately or together (simultaneously) the palm of his left hand and right hand and slide it down and feel a part of the flat and elongated (back) or small parts (extremities). 

Leopold III Examination

To determine what fetal part is at the bottom and are already signed or still rocking.

Instructions on how to check:  

• Set the position of inspector on the right side and facing the feet of mothers.
• Set the position of women in the position of knee flexion,
• Place the tip of his left palm on the lower left lateral wall, right palm under the mother's abdomen.
• Press gently and simultaneously / alternately to mentukan baby's bottom (the hard, round and almost homogeneous is the head while the bulge is soft and less symmetrical are the buttocks)
• Use the right hand with the thumb and four fingers and then shake the lowest part of the fetus. 

Leopold IV Examination

To determine the presentation and "engangement".

Instructions and how to check:

• Place the tip of the left and right palm on the left and right lateral uterine bottom, the ends of your fingers left and right are on the edge of the symphysis.
• Find both left and right thumb Then Squeeze your all the fingers that touched bottom wall of the uterus.
• Notice the angle formed by the radius of convergent or divergent.
• After that move the thumb and index finger on the bottom left hand baby (when the presentation of the head to attempt to hold the head near the neck and buttocks when the presentation seek to hold the baby's waist.)
• Fixation passage to the door of the pelvis and then place the fingers of right hand and left hand between the symphysis to assess how far the bottom has entered the doors of the pelvis.

    

Inspection Palpation Leopold

Sources: - Guide CSL Reproductive System Medical Faculty of Hasanuddin University 2009

               - Rustam Mochtar, Synopsis of Obstetrics, Jakarta, 1998.

Immunization For Pregnant Women

 Immunization For Pregnant Women

Immunisation is a way to increase one's immunity against an antigen actively, so that when he later exposed by the same antigen, there will be no disease. In the immunization of pregnant women given tetanus toxoid, is a toxin (antigen) of the germ that has been weakened.
The purpose of immunization is epidemiologically to reduce the incidence of tetanus neonatarum to 1 per 10,000 live births. He was also pressing the tetanus death rate neonatarum be half of the CFR (case fatality rate) before, with a way to find the case and look for risk factors. The approach used is a risk approach that includes the status of tetanus toxoid immunization of pregnant women and aid delivery and cord care. Apart from giving tetanus toxoid, immunization of pregnant women are also given hepatitis B, hepatitis B, but this provision is only for pregnant mothers at high risk for hepatitis B. Pregnant mothers are at high risk for pneumonia or influenza is also given influenza vaccine.
Ideally, women of childbearing age should be immunized before pregnancy to protect their babies against serious diseases. For example, rubella caused serious damage to the unborn fetus and can be prevented with rubella vaccine. Varicella (chickenpox) can cause birth defects and fatal pneumonia in the mother, but can be prevented with the varicella vaccine. Tetanus in newborns, often fatal, preventable if the mother has been immunized, as with many diseases can be prevented with other vaccines.
Although many drugs, including some vaccines, which avoided during pregnancy because of potential hazard to mother or fetus, some actual vaccine is recommended for pregnant women. specific immunization during pregnancy will improve the health of mothers and others will protect the child by maternal antibodies which remain on the child for the first 3-6 months of life.

While certain drugs can harm the developing fetus, the risk of developing fetuses are harmed by vaccination of the mother during pregnancy is still only theoretical. Currently, there is no evidence of risk from the vaccination of pregnant women with viral or bacterial vaccines or toxoids. Live attenuated vaccines, including MMR and varicella, is a larger theoretical concerns, so it is recommended that women avoid pregnancy as a precautionary measure for at least 28 days after administration of the vaccine. 28-day rule is used although there is no evidence in the study before the damage to the fetus when pregnant women received one of the vaccine.
Pregnant women and health care providers should always consider the risks and benefits of the vaccine and the risk of this disease before giving or receiving the vaccine. Immunization before conception is always preferred for immunization during pregnancy to prevent disease in children. After childbirth, women are susceptible to rubella or varicella should be immunized with MMR or varicella vaccine before discharge from the hospital.
Breastfeeding does not interfere with response to vaccines recommended for adults. Although rubella vaccine virus has been found in human milk, this and other vaccines given to mothers during pregnancy or shortly after birth did not prove to interfere with children's immune response to vaccines. Also, no child has developed the disease from the vaccine given to their mothers. Breast milk contains antibodies and other factors which may help protect babies against many infectious diseases.
Center for Disease Control and Prevention (CDC) has issued the recommended adult immunization schedule, including for pregnant women.
 

The vaccine is recommended for all pregnant women 

Influenza.Pregnant women who are infected with influenza virus increases the risk of hospitalization, serious medical complications, and adverse pregnancy outcomes. Immunization of pregnant women with inactivated influenza virus vaccines are effective in reducing fever, respiratory tract infections in pregnant women. Immunization of mothers during pregnancy also protects a newborn baby because she was past the immune antibody in the placenta (influenza antibodies was higher in cord blood than in maternal blood). Infants with influenza virus infections account for many hospitalizations and tend to bacterial respiratory infections. Childhood mortality associated with influenza virus infection occurs most frequently in infants less than 6 months of age. Unfortunately, during the first 6 months of life, there is no vaccine or anti-viral influenza drugs available. For this reason, pregnant women should receive influenza virus vaccine and those who will help to care for newborn infants should be vaccinated as well. Studies of influenza vaccination of more than 2,000 pregnant women have shown no adverse effects to the fetus from the vaccine. However, the nasal influenza vaccine should not be given to pregnant women because it is a live virus vaccine.
 

Tetanus. 

Tetanus in newborns, so prevalent throughout America-preventable if the mother has been immunized. This is because maternal antibodies passed to the baby's immunity in the placenta. The mother is immune if he had been immunized before pregnancy or during pregnancy. A pregnant women against tetanus immunization status is uncertain or the last immunization more than 10 years ago must be immunized against tetanus. This is usually given in combination with diphtheria toxoid vaccine (product called Td). Recently, a new Td vaccine also contains pertussis vaccine has been licensed for adults (Tdap), including for use for women in fertile age group. Pregnancy is not a contraindication for Tdap immunization. However, at this time, CDC recommends that pregnant women who received the last tetanus toxoid vaccine containing less than 10 years ago to receive Tdap in the postpartum period in accordance with the recommendation of routine vaccination. If the last dose of tetanus toxoid-containing vaccine more than 10 years earlier, they would prefer that he would be immunized with Td during the second and third trimester rather than Tdap.
 

Vaccines that pregnant women should not receiveIn general, live attenuated vaccine is contraindicated for pregnant women due to theoretical risk of transmission of vaccine virus to the fetus. The following live, attenuated vaccines should not be administered during pregnancy except in unusual circumstances:

    * Live influenza virus vaccine (nasal spray)
    * Oral poliovirus vaccine
    * Measles-containing vaccines
    * Mumps-containing vaccines
    * Rubella-containing vaccines
    * Smallpox (vaccinia) vaccine
    * Typhoid vaccine (Ty21a)
    * Varicella (chickenpox) is a live virus vaccine
    * Yellow fever vaccine
 

Varicella. 

Varicella (or, chicken pox) vaccine is universally recommended for all children and nonpregnant adults who are vulnerable, but not given to pregnant women. Pregnant women who experience chickenpox (varicella) have increased risk of having severe disease and a small portion of their babies may be born with congenital varicella syndrome. Vulnerable women are exposed to varicella (or shingles, is caused by the same virus) should receive varicella-zoster immune globulin (VariZIG) within 96 hours, which may prevent or modify the infection. Anti-viral medication is usually reserved for pregnant women with severe chickenpox illness. Infants born to mothers who had chickenpox within 5 days of delivery are also given VariZIG within 48 hours after delivery to prevent them from having a serious illness. Vaccination with live virus varicella vaccine during pregnancy is not recommended, although vaccination is deliberately not being associated with an adverse outcome. A pregnant household member is not a contraindication to varicella immunization of a child in the household, however.
Varicella vaccine viruses rarely spread from vaccinated people who develop a rash to susceptible people in the household. Risk for susceptible pregnant women and the fetus should be very low after this type of exposure. However, pregnant women who believe that he is susceptible to chickenpox and who have household exposure to someone who developed a rash after varicella immunization should tell their doctors.
Ideally, women should be immune to chickenpox before becoming pregnant, or both of the chickenpox vaccine. At the end of pregnancy, women are vulnerable should receive the first dose of chickenpox vaccine before discharge from health facilities. The second dose should be given 4-8 weeks later.
 

Measles, mumps, and rubella. Measles, mumps, and rubella live-virus vaccine is usually given together as MMR, should not be administered during pregnancy. However, since measles increases the risk of spontaneous abortion or premature birth, pregnant women are vulnerable given immune globulin within six days after exposure. Mumps virus has not been associated with problems during pregnancy. Wild rubella virus infection in early pregnancy have a high risk cause congenital rubella syndrome (CRS) in the fetus. This is a devastating disease that can be prevented by use of the vaccine before pregnancy. Pregnant women are screened early in pregnancy to ensure that they are immune. If the vulnerable and open, pregnant women and doctors together will need to consider his options. Rubella susceptible women should be immunized with MMR in the period immediately post-partum. However, the CDC has followed the result of accidental rubella vaccination of pregnant women and no cases of CRS have been detected.
MMR vaccine virus transmission in the household has not been proven (except rubella virus from mothers to breastfeed their babies.) Thus, vulnerable children must be immunized whether or not any household contact pregnant.
 

Yellow fever. 

Live attenuated yellow fever vaccine are not known to cause malformations of development. It is only given to a pregnant woman if travel to an endemic area where he will risk for yellow fever is unavoidable.
 

Typhoid fever. 

Both the live attenuated Ty21a and Vi polysaccharide typhoid fever vaccine has been tested on pregnant or lactating women. Some experts might consider the polysaccharide vaccine for pregnant women or breastfeeding if travel to an endemic area is unavoidable and it may be at risk of Salmonella typhi (the cause of typhoid fever).
 

Vaccines for some pregnant women 

The following vaccines should be considered for pregnant women at risk for or are affected by this disease. Because spontaneous abortion occurred more frequently in the first trimester of pregnancy, some obstetricians prefer to avoid giving vaccines during this, if possible, to avoid possible temporal associations. Specific recommendations for travel by pregnant women (and others) can be obtained at www.cdc.gov / travel.
 

Hepatitis B virus. 

Hepatitis B (HBV) infection during pregnancy can cause serious illness for both the mother, fetus, and finally for the neonate. Recommended universal immunization in the United States for all people under the age of 18 years and those older than that who are at increased risk of exposure. Pregnancy is not a contraindication for immunization of HBV and the vaccine should be given to people with risk occupation or lifestyle, a special risk group of patients (such as those undergoing hemodialysis), those who have other sexually transmitted diseases, household and sexual contacts of HBV carriers, prison prisoners, and for international travelers to endemic areas. All pregnant women should have early prenatal screening for immunity and, if susceptible and if they have risk factors, should be immunized.
All pregnant women should be screened for infection with hepatitis B virus is active because most women who are infected do not know and, if they have hepatitis B infection, the newborn should receive a birth dose of hepatitis B vaccine and hepatitis B immune globulin-giving both within hours of birth reduces likelihood that children will become infected with hepatitis B virus and, if infected, to reduce the likelihood that infants will be infected chronically.
 

Pneumococcal infection. 

Pneumococcal polysaccharide vaccine (PPV23) is indicated for certain medical conditions (such as [the absence of the spleen] asplenia, metabolic, renal disease, heart, and lungs, and immunosuppression). Pregnant women with these conditions also should receive the vaccine, preferably before pregnancy, but can be given to a pregnant woman if she had never been immunized.
 

Rabies exposure. 

Rabies risk far exceeds the theoretical risk of vaccine if pregnant women have been affected by this disease.
Meningococcal infection. Studies of pregnant women immunized with meningococcal polysaccharide vaccine and their infants showed no adverse effects. This means that the vaccine is likely to be safe for pregnant women at high risk for meningococcal infection. Since the new meningococcal conjugate vaccine (MCV4) is the preferred vaccine for people 11-55 years, many scholars would prefer to give MCV4 in this setting, although there is no data about the safety of MCV4 during pregnancy.
 

Hepatitis A. 

Pregnant women at risk of contracting hepatitis A virus infection if there is someone infected in the household, if they have a job exposure, or if traveling to areas where hepatitis A is endemic. Although formal studies of hepatitis A vaccine in pregnant women has not been done, the vaccine is produced from inactive virus so that the theoretical risk to the fetus should be low. This vaccine has been used in pregnant women with no side effects have been reported. Because international travel is now the most common source of exposure for Americans to hepatitis A vaccination before traveling to endemic areas is very important. For pregnant women who have been exposed to hepatitis A virus, sensitivity tests can be justified but should not delay the administration of immune globulin ("gamma globulin").
 

Polio. 

wildtype polioviruses have been eliminated in the United States and as such does not exist is usually an indication for immunization of pregnant women except for women traveling to endemic areas. If the polio vaccine is indicated, only the inactivated vaccine should be given to a pregnant woman and not a live virus oral vaccine.
 

Anthrax. 

Women who are vaccinated against anthrax earlier in life had no problems with pregnancy or babies. No studies have been published regarding the use of anthrax vaccine in pregnant women, although a series of studies conducted by the Naval Health Research Center and National Center for Birth Defects and Development Disabilities shows that children born to mothers who were immunized with anthrax vaccine in the first trimester of pregnancy could have an increased risk of birth defects. Advisory Committee for Immunization Practices recommends that pregnant women are not vaccinated against anthrax. However, in situations of aerosol anthrax exposure (as might occur in a bioterror attack), the theoretical risk of vaccine likely to be much smaller than the risk of disease, pregnant women should be vaccinated against anthrax only if the potential benefits of vaccination outweigh the potential risks to the fetus.
Human papillomavirus. Although the initial clinical trial of human papillomavirus (HPV) vaccine specifically exempted pregnant women, 1244 pregnancies occurred in the vaccine group and 1272 occurred among women who received placebo. There was no difference in the rate of miscarriage, fetal death late in pregnancy, or birth defects in their babies. Infants from 500 women who breastfeed when they receive the vaccine have been no events worse than those who received placebo and no event is considered related to the vaccine. The FDA has established a registry to record pregnancy outcomes between women who inadvertently given the HPV vaccine during pregnancy.
 

H1N1 

For pregnant women, fair to worry about your health and your baby's health during a pandemic flu virus H1N1. During pregnancy, you may have heard a lot of advice about what to eat, how to exercise, and what should be avoided to protect the health of babies. Taking the H1N1 flu vaccine is one more thing you can do to reduce the risk that the H1N1 flu virus poses capture for your health and your baby.Pregnant women were no more likely to get flu virus H1N1 from other people, but when they get it, they are about five times more likely to be hospitalized and about three times more likely to suffer serious complications.Until now, the pregnant woman who has been hospitalized with the H1N1 flu virus, more than two-thirds are in their third trimester.Adjuvanted or Unadjuvanted - Who Gets What?You may be hesitant about taking the vaccine to protect against the H1N1 flu virus, or are not sure which type of vaccine is right for you. This is what we know about H1N1 flu vaccine.There are two types of H1N1 flu vaccine: adjuvanted and unadjuvanted. Most Canadians will receive the vaccine adjuvanted. adjuvant is a substance that increases the immune response. It is composed of natural oils, water and vitamin E. Unadjuvanted booster vaccine does not include this. Adjuvanted vaccine is available now across the country. Canada's supply of vaccine will unadjuvanted available in early November.

• unadjuvanted vaccine is recommended for all pregnant women at every stage of their pregnancy.However, if the vaccine unadjuvanted not easily available, some pregnant women should consider getting the vaccine adjuvanted• If you are more than 20 weeks pregnant, OR if you have a chronic illness (like asthma or diabetes), you are at greater risk for severe complications from influenza H1N1. You should consider getting adjuvanted vaccines are available nowThe potential benefits of early immunity against H1N1 influenza virus (from getting the vaccine) is greater than the possible risk receive flu vaccine adjuvanted.• If you have less than 20 weeks pregnant, and healthy, you can wait to get vaccines unadjuvanted. You tend to be less than women in the final stagespregnancy or women with severe chronic disease for developing complications from influenza. Get unadjuvanted vaccine as soon as it becomes available to you. If you want to immunization with adjuvanted vaccine, which is the choice for you.
 

What Benefits ... What Risk?
Your doctor can help you to consider your options, but the fact remains that immunization is the most effective way to prevent disease and protect the health of babies. Immunization benefits - preventing severe illness and death - greatly exceeds the risks associated with vaccines.
The H1N1 flu vaccine adjuvant has been tested in about 45,000 people without serious side effects were reported.
 

Unadjuvanted vaccine is recommended for use by pregnant women. Although there is no evidence that the adjuvanted vaccine was not safe for pregnant women, the type of vaccine has not been tested in pregnant women, so the vaccine unadjuvanted is the first choice for pregnant women.
Unadjuvanted vaccine is made in the same manner as regular seasonal flu vaccination, which has been used safely in pregnant women over the years.
 

Serious side effects (medical problems) after influenza immunization are rare. Usually there are about one serious side effects, such as a severe allergic reaction, for every 100,000 doses of flu vaccine were distributed. Some adverse events, such as Guillain-Barre syndrome (GBS), a disease resulting in paralysis, and even more rarely. There are about one case of GBS for every one million doses of flu vaccine were distributed.
 

It is important to note that these incidents are not always caused by the vaccine, they are reported as events following immunization. Each of these serious side effects were reported in Canada investigated to determine the cause.
 

Bibliography

 Gall, SA 2003. Maternal Immunization. Obstetrics and Gynecology Clinics of North America, 30 (4) :632-636. CDC (2008). Guideing principles for development of ACIP recommendations for Vaccination During pregnancy and breastfeeding. MMWR 57 (21): 580.CDC (2009). Recommended adult immunization schedule-United States, 2009.MMWR 57 (53): Q1-4.Zaman K, Roy E, Arifeen SE, et al. 2008. Effectiveness of maternal influenza immunization in mothers and Infants. N ENGL J Med 359: 1555-64.CDC. 2008. Summary of ACIP recommendations for prevention of pertussis, tetanus and diphtheria Among Pregnant and Postpartum Women and Their Infants. MMWR 57 (04) :48-9.CDC (2008). Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR, 57 (RR-07), 10-60.AAP, Committee on Infectious Diseases (2006). Varicella-Zoster Infections. In: LK Pickering (Ed.), Red Book: Report of the Committee on Infectious Diseases (27th ed., Pp. 711-25). Elk Grove Village, IL.AAP, Committee on Infectious Diseases (2006). Rubella. In: LK Pickering (Ed.), Red Book: Report of the Committee on Infectious Diseases (27th ed., Pp. 574-9). Elk Grove Village, IL.American College of Obstetricians and Gynecologists (2003). Immunization During Pregnancy. ACOG Committee Opinion 282.CDC (2006). General recommendations on immunization: recommendations of the Committee on Immuniazation Advisroy Practices (ACIP). MMWR 55 (RR15): 1-48.CDC (2002). Notice to Readers: Status of U.S. Department of Defense Preliminary Evaluation of the Association of Anthrax Vaccination and Congenital Anomalies. MMWR February 15, 2002/51 (06); 127.http://www.immunizationinfo.org/issues/general/vaccines-pregnant-womenhttp://www.sogc.org/h1n1/Pregnant% 20Women% 20 -% 20H1N1% 20Vaccine% 20Recommendations% 20EN.pdf

Puerperal Period

Period Definition Ruling

1. Puerperal period is the period beginning a few hours after the birth of the placenta to 6 weeks after delivery (Pusdiknakes, 2003:003).
2. Puerperal period begins after the birth of the placenta and ends when the means of returning the content of such a state before pregnancy that lasted about 6 weeks. (Abdul Bari, 2000:122).
3. Puerperal period is a period during labor and immediately after birth, including the following weeks at the time of the reproductive tract return to normal non-pregnant state. (F. Gary Cunningham, Mac Donald, 1995:281).
4. Puerperal period is the period after a mother gave birth to a baby who is used to recuperate back that generally takes 6-12 weeks. (Abraham C, 1998).

Ruling Period Objectives
The purpose of the provision of care during childbirth to:

1. Maintaining the health of mother and baby, both physically and psychologically.
2. Skrinning implement a comprehensive, early detection, treat or refer the case of complications in the mother and baby.
3. Provide health education regarding self care, nutrition, family planning, means and benefits of breastfeeding, immunization and infant care everyday.
4. Providing family planning services.
5. Getting emotional health.

Roles and Responsibilities of the Midwife In Ruling Period
Midwives have a vital role in providing postpartum care. The roles and responsibilities during childbirth include:

1. Provide continuous support during childbirth in accordance with the needs of mothers to reduce the physical and psychological strain during childbirth.
2. As a promoter of the relationship between mother and baby and family.
3. Encouraging mothers to breastfeed their babies by increasing the sense of comfort.
4. Making policy, health program planners regarding the mother and child and is able to perform administrative activities.
5. Detecting complications and the need for referral.
6. Provide counseling to mothers and families about how to prevent bleeding, recognize the signs of danger, maintaining good nutrition, and practice safe hygiene.
7. Doing care management by collecting data, establishing a diagnosis and plan of action and implement it to speed up the recovery process, preventing complications by meeting the needs of mothers and babies during childbirth period.
8. Provide care in a professional manner.

Ruling Period Stages
Puerperal period is divided into three stages, namely:
   1. Early Puerperium
      A recovery period where the mother is allowed to stand and walk.
   2. Puerperium intermedial
      A time when recovery from the reproductive organs for approximately six weeks.
   3. Remote puerperium

The time required to recover and return in the development of state of perfect health, especially the mother if the mother during pregnancy or during labor and delivery complications.

Involution Content Tools

1. The uterus gradually becomes small (involution) and eventually returned as before pregnancy.

Involution	Uterine Fundus Height	Uterus Weight
Babies born	High center	1000 grams
Uri was born	2  finger down the center	750 grams
1 week	Center mid symphysis	500 grams
2  week	No palpable above the symphysis	350 grams
6  week	Burn down	50 grams
8  week	Normal registration	30 grams

2. Former implantation uri: placental bed decreases due to contraction and protruding into the uterine cavity with a diameter of 7.5 cm, after 2 weeks to 3.5 cm, 2.4 cm in the sixth week, and eventually recovered.
3. The wounds in the birth canal if not accompanied by infection will heal in 6-7hari.
4. The pain, called after pain, (Merian or mules-mules) caused contractions of the uterus, usually lasts 2-4hari postpartum. Understanding needs to be given to the mother about this and if too disturbing to be given anti-sickness drugs and anti mules.
5. lochia is fluid secretions originating from uterine cavity and vagina during childbirth.
• Lochia rubra (cruenta): contains fresh blood and the remnants of the amniotic membranes, decidual cells, verniks kaseosa, lanugo, and meconium, during 2hari postpartum.
• Lochia sanguinolenta: yellow red of blood and mucus, 3-7 days postpartum.
• Lochia serosa: yellow, the liquid does not bleed anymore, at days 7-14 postpartum.
• Lochia alba: white liquid, after 2 weeks.
• Lochia purulenta: an infection, like pus discharge foul smelly
• Lochiostasis: lochia discharge is not smooth.  
6. Cervical: After childbirth, the cervix forms a funnel rather gaping like a red-black. Soft consistency, sometimes there are injury-minor injury. After the baby is born, his hand still bias into the uterine cavity; after 2hours to be passed by 2-3 fingers, and after 7 days can be passed only 1 finger.
7. ligament-ligament: ligament, fascia, and the pelvic diaphragm are stretched at the time of birth, after birth, gradually become shriveled and recover so that not infrequently the uterus falls back and becomes lax. After delivery, the habit of Indonesian women do "berkusuk" or "sequential", in which when dikusuk intra-abdominal pressure is getting higher. Because after childbirth ligaments, fascia, and supporting tissues become lax, if done kusu / candidacy, many women will "implies down" or "upside down". To revert back preferably with gymnastic exercises and post-delivery.

National Program Policy On Ruling Period
Policies and programs on post partum period is at least four times a visit during childbirth, with the aim to:

1. Assess the health condition of mother and baby.
2. Prevention of the possibilities of interference puerperal women and their babies.
3. Detect any complications or problems that occur during childbirth.
4. Dealing with complications or problems that arise and disrupt the puerperal women and their babies.

   Visit	Time	Upbringing
   I	6-8 hours post partum	Prevent bleeding during childbirth due to uterine atony.
   		Detection and treatment of other causes of bleeding and do a referral if bleeding continues.
   		Provide counseling to mothers and families about how to prevent bleeding due to uterine atony.
   		Breastfeeding early.
   		Teaches how to strengthen the relationship between mother and newborn.
   		Keeping your baby stay healthy through prevention hipotermi.
   		After the midwife doing childbirth aid, then the midwife must take care of mom and baby for the first 2 hours after birth or until the state of the mother and the newborn in good condition.
   II	6 days post partum	Ensuring barjalan with normal uterine involution, the uterus to contract properly, high fundus uteri under the umbilicus, there was no abnormal bleeding.
   		Assess any signs of fever, infection and bleeding.
   		Ensure mothers get adequate rest.
   		Ensuring the mother gets enough nutritious food and fluids.
   		Ensuring nursing mothers with a good and right and there are no signs of trouble breastfeeding.
   		Provide counseling about newborn care.
   III	2 weeks post partum	Care at 2 weeks post partum with the care given at 6 days post partum visit.
   IV	6 weeks post partum	Asking complications-complications experienced by the mother during childbirth.
   		Providing family planning counseling at an early stage.