REPRODUCTIVE HEALTH

INTRODUCTION
Reproductive health refers to the healthy reproductive organs with normal functions.

It is a state of complete physical, mental and social well being,and not merely the
absence of reproductive disease or infirmity.

According to the World Health Organisation (WHO), reproductive health means a total
well-being in all aspects of reproduction, i.e., physical, emotional, behavioural and
social.

REPRODUCTIVE HEALTH PROBLEMS AND STRATEGIES

 India was amongst the first countries in the world to initiate the programmes
called ‘family planning’ in 1951 which were periodically assessed over the past
decades.
 Reproductive health in a society forms a crucial part of general health. Some
crucial concerns are as follows-
 complication of pregnancy, childbirth and unsafe abortion.
 maximum infection rates of sexually transmitted diseases (including HIV/AIDS)
among the young people (15 to 24 years).
 less education and lower future income for young mothers due to early
pregnancy and child bearing.
 Improved programmes covering wider reproduction-related areas are currently in operation
under the popular name ‘Reproductive and Child Health Care (RCH) programmes’.
 Health and education of young people and marriage and childbearing during
more mature stages of life are important attributes to the reproductive health of
a society.
 Reproductive health programmes :
 create awareness in both males and females about various reproduction related
aspects with the help of audio-visual and print media.
 provide sex education in schools to save the young school goers from myths and
misconceptions about the sex related issues.
 provide proper information about reproductive organs, adolescence and safe
hygienic sexual practices.
 educate the fertile couples and those in marriageable age group about birth
control measures, prenatal and post natal care of mothers and child etc.
POPULATION EXPLOSION AND BIRTH CONTROL
 The rapid increase in human population size over a relatively short period is called human
population explosion.
 With 17.5 % of the world population, India is today the second largest
populous country of the world.
 As on March 1,2011 when the last census was conducted, the country’s
population stood at 1.21 billion.
 Demography- The study of human population their size composition and
distribution across a place and the process through which population
change.
 Births, deaths and migration are the ‘big three’ factors of demography,
jointly producing population stability or change.
 Population growth rate depends on factors like fertility, natality, mortality,
migration, age and sex structure.

CAUSES OF POPULATION EXPLOSION

There are two main causes of population explosion:
i.Social Cause ii.Economic Cause

SOCIAL CAUSES:
Some of the socio-cultural causes are responsible for high birth rate in India.
High Birth Rate
Marriage is also a religious duty and practice of early marriage system is still working in
India.
More than 80% of girls are married during the fertile period of 15-20 years of age and
give birth to a number of children.
Polygamy
Some people in India prefer to have more than one wife and such polygamy system give
birth to more children.
Preference For a Son
Every family in India prefer a son.
There are some religious rites which can be performed by a son.So, the parents in spite
of a number of girls they wait for a son.
Widow Marriage
The widow marriage system in modern society helps in the growth of population.

ECONOMIC CAUSES:
Poverty
40% of the population of India are below poverty line.
They consider children as their asset who can earn at a very low age and bring wages.
It result in the rapid population growth.
Illiteracy
In India 65.46 % of women are literate and 82.14% of men are literate.
Illiteracy promotes poverty,ignorance and superstition,the people do not know the use
of contraceptives which results in population growth.
Lack of Birth Control Devices
The birth control devices are not sufficient and not given in the right time.
Control of Famines’ And Epidemics
Adequate transport and communicational facilities are made.There is development in
medicines and surgical operation. So the epidemics like plague, cholera, malaria,
influenza, has been checked and it reduced the death rate.
Availability of Medical Facilities
Better medical facilities and public health services resulted in a rapid decline in death
rate,MMR and IMR along with the increase in number of people in reproducible age.
Maternal and Child Health Services
Care has been taken for the health of the pregnant and nursing mothers,new born
babies and arrangement have been made for the safe delivery of the babies and so the
death rate of pregnant women and new born babies has declined.

CONSEQUENCES OF POPULATION EXPLOSION

Increase in population creates many consequences or problems, which affects basic
necessities of life like;
Space
Increase in population requites more accommodation which results in conversion of
agricultural land into urban land for habitation.
This has other effects like soil erosion, less rainfall etc..
Food
Thicky populated nations with less per capita income faces the problem of food.
People suffering from malnutrition develop into less fit members of the society.
Employment
Population increase leads to large scale under employment.
All schemes of Government are made useless by the over population.

Medical Aid
Larger families can not afford better medical aid because of their less income.
It is very difficult to provide better medical facilities to ever increasing population in any
country.
Sanitation
Increase in population or urbanization has caused the problem of sanitary disposal and
resulted in pollution.
POPULATION CONTROL
Population explosion is the main obstacles to the smooth development of the Indian
economy.
This problem is getting intense day by day, it is obvious to take appropriate measures
to keep it under control.
Rise in Per-capita Income
When per-capita income increases, people do not desire more children in order to
supplement their income.
Urbanization and Industrialization
A nucleus family is generally found in an urbanized and industrialized economy.
Hence our efforts should be to industrialize and urbanize our economy to reduce the
high birth rate.
Late Marriage
We have to raise the minimum age of marriage in our country in order to control the
birth rate.
Lowering Infant Mortality rate
In India, infant mortality rate is 72/1000. Poor people in order to ensure that some
children do survive, reproduce more. So proper child and maternity care should be
taken to reduce the infant mortality rate.
Spread of Education
In India 48% total population are illiterate. They regard children as the gift of God and
are not conscious about the evils of population growth.
To remove illiteracy and superstition, spread of education is very much essential.
Women Education and Employment
In India only 32.92% of women are literate and much less are employed. It is necessary
that government take effective steps to promote women empowerment so that they
can understand the evils of population growth.
Family Planning Facilities
In India, family planning facilities are available only in the urban centers and semi-urban
areas.
Therefore, family planning centers with trained personnel should be set up in rural areas
to provide this facility at their door step.
Incentives
The Government should provide both monetary and real incentives to people for
adopting family planning measures.
Publicity
The message of family planning should reach the people of rural areas through
newspaper, radio, and television.
Legislation
Family planning is a voluntary measure. However, Government should enact laws for
directly lowering the birth rate.
Problems to Control Population
The success of family planning greatly depends on women and their status. India, being
a diverse country, has people from all religion and of different family backgrounds.
Every religion have some religioustic approach regarding to child birth like children’s
ate considered to be ‘Gift of God’, ‘Abortion’ is considered as a sin etc.
Thus, the people from such sects of society do not follow gamily planning so, there is a
need to make them aware about the evil of population explosion

Census

Birth Control And Contraception

The regulation of conception by preventive methods or devices to limit the number of offsprings is
called birth control.
A birth control method which deliberately prevents fertilization is referred to as contraception.
Contraceptive methods are preventive methods and are of 2 types –
i)Temporary. ii)Permanent.
Temporary methods includes natural method, chemical method, mechanical means, physiological
devices or hormonal methods.
Permanent method includes sterilization.
Natural methods
It works on the principle of avoiding chances of ovum and sperm meeting.
It includes safe period, periodic abstinence, coitus interruptus and lactational amenorrhea.
Safe Period
Also called rhythm method.
A week before and a week after menses is considered as safe period for sexual
intercourse. The idea is based on the following facts-
Ovulation occurs on the 14th day of menstruation.
Ovum survives for about 2 days.
Sperms remain alive for about 3 days.
Periodic abstinence
It is one such method in which the couples avoid or abstain from coitus from day 10 to 17 of the
menstrual cycle when ovulation could be expected.
As chances of fertilization are very high during this period, it is called the fertile period.
Therefore, by abstaining from coitus during this period, conception could be prevented.
Withdrawal or Coitus Interruptus
It is the oldest method.
It is another method in which the male partner withdraws his penis from the vagina just before
ejaculation so as to avoid insemination.
This method has some drawbacks like male produces some lubricating fluid containing some sperm
from his Cowper’s gland before ejaculation.
Lactational amenorrhea
Absence of menstruation method.
It is based on the fact that ovulation and therefore the cycle do not occur during the period of intense
lactation following parturition.
Therefore, as long as the mother breast feeds the child fully, chances of conception are almost nil.
Mechanical Methods
Also called Barrier methods.
In this method ovum and sperm are prevented from physically meeting with the help of barriers.
Such methods are available for both males and females.
Condoms:
Condoms are barriers made of thin rubber/latex sheath that are used to cover the penis in the male
just before coitus so that the ejaculated semen would not enter into the female reproductive tract.
This can prevent conception.
It is of two types:
i) Male Condom
It is a bag-like tube that is closed on one end typically with a small reservoir to
hold semen and open on the other.
Example- Nirodh
ii) Female Condom
Also called ‘femidom’.
It is a polyurethane sheath that is closed at one end and open at the other.
Each end has a ring that holds the condom in place.
Vaginal Diaphragms:
It is a thin rubber dome with a springy and flexible rim.
It is inserted into the vagina, fits over the cervix and is held in place by vaginal muscles.
It holds spermicide in place over the opening to the uterus which kills sperm and
prevent fertilization.
Advantage:
Can be inserted 2 hrs. before sex.
Easy to carry around, is comfortable.
Does not alter menstrual cycle.
Does not affect future fertility.
Disadvantage:
Does not protect against HIV/AIDS
Require a fitting in a clinic.
Possible allergic reactions.
May inverse risk of bladder infection.

Cervical Caps:
It is made of latex, thimble shaped device that is inserted into the vagina and fits
closely over the cervix.
Suction keeps the cap in place.
It provides barrier to block sperm from entering the uterus and prevent fertilisation.

Advantage:
Can be inserted many hrs. before sex.
Easy to carry around, is comfortable.
Does not alter menstrual cycle.
Does not affect future fertility.
Disadvantage:
Does not protect against HIV/AIDS
Require a fitting in a clinic.
Possible allergic reactions.
Can be dislodged during intercourse.

Vaults Caps:
It looks almost the same as diaphragm but without the metal rim.
It is a dome like rubber or plastic cap with a thick rim which is meant for fitting over the
vaginal vault over the cervix.
Chemical Methods
Spermicides:
It is also birth control barrier that are bought over the counter.
Spermicide is 71-85% effective when used by itself.
Spermicide consists of chemicals such as lactic acid, citric acid, boric acid, potassium
permanganate and zinc sulphate.
Spermicides are available in various forms such as foams, jellies, pastes and creams, if
introduced before sexual intercourse into the vagina, adhere to the mucous membrane and
immobilize and kill the sperm by inhibiting oxygen intake.

.Intra Uterine Devices (IUDs)

It is inserted by doctors in the uterus through vagina.
These Intra Uterine Devices are presently available as:
Non-medicated IUDs:
The early IUDs were non-mediated e.g., Lippes loop.
Copper releasing IUDs
In this a copper wire is wound around the stem of the T-shaped IUD.
IUDs increase phagocytosis of sperm within the uterus and the Cu ions released
suppress sperm motility and fertilizing capacity of sperm.
The copper IUD can stay in place for at least 10 years and is highly effective form of
contraceptives.
*Copper is toxic to sperm.
It makes the uterus and fallopian tube to secrete such a liquid which kills sperm.
Example- CuT, Cu7, Multiload 375

Hormone Releasing IUDs

The hormone releasing IUDs, in addition, making the uterus unsuitable for implantation
and the cervix hostile to the sperm.
It is a form of the hormone progestin.
It is slightly more effective than copper IUDs.
It is effective for at least 5 years
Example- Progestasert, LNG-20 (Levonorgestrel)
*IUDs are ideal contraceptives for the females who want to delay pregnancy and/or space children.
It *is one of the most widely accepted methods of contraception in India.

Physiological (oral) Contraceptives:

It includes birth control pills.
Oral administration of small doses of either progestogens or progestogen–estrogen combination is
another contraceptive method used by the females.
These are used in the form of tablets and hence are popularly called the pills.
Birth control pills check ovulation by inhibiting the secretion of FSH and LH that are
necessary for ovulation.
Saheli is the new oral contraceptive for the females contains a non-steroidal preparation. It was
developed by scientists at Central Drug Research Institute (CDRI) in Lucknow, India.
The pill Saheli is taken weekly.
Mala-D is taken daily.
Subcutaneous Implants:
It is very effective and low maintenance method, lasts for maximum of 5 years and
could be reversed any time.
It consists of one flexible, thin rod filled with levonorgestrel.
It contains six matchstick sized capsules which are inserted in the fan like shape under
woman’s skin in the upper inner arm.
Minor surgical process is required for the implantation.
Effectiveness of this implant is 99.5%
*Progestogens alone or in combination with estrogen can also be used by females as
injections or implants under the skin.
Surgical methods
It is also called sterilization.
Generally advised for the male/female partner as a terminal method to prevent any more
pregnancies.
Surgical intervention blocks gamete transport and thereby prevent conception.
Sterilization procedures in the male is called ‘vasectomy’ and that in the female, ‘tubectomy’.
Vasectomy:
In this method a small part of the vas deferens is removed or tied up through a small incision on
the scrotum.
Advantage:
A one time, relatively inexpensive.
More dependable than any other form of birth control.
Posses less medical risk than female sterilization.
Easier to reverse than female sterilization.

Disadvantage:
Relatively permanent can also be a disadvantage if a man later decides he wants to be
father of children.
Reversing is possible but is a difficult and expensive operation with no guarantee of
success.

Tubectomy:
In this method a small part of the fallopian tube is removed or tied up through a small incision in
the abdomen or through vagina.

Advantage:
Effective method without hormones.
No need for hospitalization.
Effective immediately.
Disadvantage:
Does not prevent sexually transmitted infection.
Not reversible.
Must be sure that you do not want ant more children

Fig. : Vasectomy and Tubectomy

MEDICAL TERMINATION OF PREGNANCY (MTP)
Intentional or voluntary termination of pregnancy before full term is called medical termination of
pregnancy (MTP) or induced abortion.
Nearly 45 to 50 million MTPs are performed in a year all over the world which accounts
to 1/5th of the total number of conceived pregnancies in a year.
Government of India legalized MTP in 1971 with some strict conditions to avoid its
misuse.
MTPs are considered relatively safe during the first trimester, i.e., up to 12 weeks of
pregnancy.
Misoprostol (a prostaglandin) along with mifepristone (anti progesterone) is an effective
combination.
Vacuum aspiration and surgical procedure are adapted thereafter.
MTP is used to get rid of unwanted pregnancies and where continuation of the
pregnancy could be harmful or even fatal either to mother or to the foetus or both.

Medical Abortion:
It is the process of terminating a pregnancy using medicines or pills.
This is a non-surgical method to undergo an abortion and must be done under the
supervision of a physician.

Surgical Abortion:
Also called suction aspiration abortion.
In this method the patient is given a general anesthesia and then the uterine cavity is
cleaned using a special instrument.
After suction evacuation sealing off the cut blood vessels inside the uterus to reduce
bleeding.
There are three different steps of surgical abortion which are as follows:
SEXUALLY TRANSMITTED DISEASES (STDs)
Diseases which are transmitted through sexual intercourse are collectively called sexually
transmitted diseases (STD) or venereal diseases (VD) or reproductive tract infections (RTI).
These disease are caused by a wide range of bacterial, viral, protozoan, fungal agents and
ectoparasites.
These disease lead to complication later like pelvic inflammatory disease (PID),
abortions, still births, ectopic pregnancies, infertility and even cancer of reproductive
tract.
Some of these infections like hepatitis–B and HIV can also be transmitted by sharing of
injection needles, surgical instruments, etc., with infected persons, transfusion of blood,
or from an infected mother to the foetus too.
Except for hepatitis-B, genital herpes and HIV infections, other diseases are completely
curable if detected early and treated properly.
Transmission of sexually transmitted disease can be avoided by-
Avoiding sex with multiple partners or unknown partner.
Using condoms during coitus.
Consulting qualified doctors for early detection and get complete treatment if diagnosed
with disease.

Table : Some STDs and their pathogens

GONORRHOEA:
It is one of the most common STDs caused by bacterium Neisseria
gonorrhoea.
It can not be transmitted from toilet seats or door handles.
It can not live outside the body for more than a few minutes at most, nor it
can live on the skin of hands, arms, or legs.
SYMPTOMS:
Many people do not having any symptoms.
If left untreated, it can cause infertility without ever showing symptoms.
Men-
Discharge from the penis- white/yellow
Experiencing a burning sensation during urination
Anal discharge/irritation
Blood being discharge from the penis.
Women-
Discharge from the vagina- white/yellow/green
Experiencing a burning sensation during urination
Anal discharge/irritation
Severe pain during intercourse
TREATMENT:
It is treated with antibiotics.
SYPHILIS:
It is caused by bacterum Treponema pallidum, a microscopic organism called
a spirochete.
SYMPTOMS:
Early signs may include a small, painless, firm sore in or around the vagina,
penis, mouth or anus.
Followed by rashes on the body that is noticeable on the palms of the hands
or soles of the feet.
TREATMENT:
It can be treated and cured easily with an injection of penicillin or 14 days of
antibiotics
CHLAMYDIASIS:
It is caused by bacterium Chlamydia trachomatis.
SYMPTOMS:
Many people do not having any symptoms.
Men-
Discharge from the penis- white and waterish
Experiencing a burning sensation during
Red/spore tip of the penis.
Itching, burning of testicles.
Women-
Discharge from the vagina-mucus like
Experiencing a pain/burning sensation during urination
Experiencing a pain in abdomen
Bleeding even when not menstruating
TREATMENT:
It is treated with antibiotics.

CHANCROID:
It is caused by a bacterium Haemophilus ducreyi.
This disease is common in sub- Saharan Africa among men who have
frequent contact with prostitutes.
SYMPTOMS:
This infection begins with the appearance of painful open sores on the
genitals, sometimes accompanied by swollen, tender lymph nodes in the
groin.
In women often less noticeable and may be limited to painful urination or
defecation, painful intercourse, rectal bleeding or vaginal discharge.
TREATMENT:
It can be treated with antibiotics.
VAGINITIS:
It is caused by bacterium Gardnerella vaginalis
It is the most common vaginal infection in women of reproductive age.
It occurs when there is an over growth of certain bad bacteria in the vagina.
SYMPTOMS:
There are no symptoms at all.
But sometimes it is accompanied by unusual discharge, strong odour, painful
urination, itching or burning.
TREATMENT:
It can be treated with antibiotic pills or vaginal creams.

GENITAL HERPES:
It is a common STDs and a lot of people who have it don’t even know.
It is caused by a virus HSV-2 (DNA).
SYMPTOMS:
Blisters around the genitals or anus.
The first outbreak of sores is usually the worst.
TREATMENT:
There is no cure for herpes, but there is a treatment that can lessen
symptoms and decrease the likelihood of passing it on to someone else.
GENITAL WARTS:
A warts occur in the moist skin of the genitals or around the anus.
It is caused Human Papilloma Virus (HPV).
The HPVs are transmitted through sexual contact.
HPV can also be transmitted from mother to baby during childbirth.
SYMPTOMS:
Most of the time there are no symptoms.
Several types can cause genital warts or lead to vaginal, anal, throat and
cervical cancer.
TREATMENT:
The body will usually clear HPV infection on its own within a couple of
months
It can be treated by applying creams, gels and solution prescribed by doctor.
AIDS:
It is caused by HIV.
It is a retrovirus.
*A retrovirus has an RNA genome and a reverse transcriptase enzyme.
HIV is also called human lymphotropic virus type -iii.
SYMPTOMS:
Weight loss, fever, regular headache, tiredness, breathlessness
Severe diarrhoea, recurring night sweats, spots and mark on face and
around the mouth.
Swelling up of lymph glands.
TREATMENT:
There is no cure for HIV.
Treatment options now a days that allow HIV-positive individuals to live long,
healthy lives.
TRICHOMONIASIS:
It is the most common curable STI.
It is caused by a protozoan Trichomonas vaginalis
SYMPTOMS:
Women-
Excessive, frothy, yellowish or greenish vaginal discharge.
Swelling of vulva and labia along with painful urination.
Foul smell from discharge.
Burning sensation in the genital area.
Men-
Painful urination with lesions on the penis.
Pain during ejaculation.
Painful swelling in the scrotum.
But most men with trichomoniasis will have no symptoms.
TREATMENT:
It can be treated and cured with antibiotics.

INFERTILITY
Inability to conceive or produce children even after 2 years of unprotected sexual cohabitation is
called infertility.
MALE INFERTILITY:
In about 40% of infertile couples, the cause is traced to the man.
Common problems includes-
Low sperm count (oligospermia)
Poor sperm motility
Malformed sperm
Sperm antibiotics
Blocked sperm ducts.

FEMALE INFERTILITY:
In another 40% of cases, the woman is diagnosed with a problem.
Common problems includes-
Irregular ovulation
Blocked fallopian tube
Abnormalities in the cervix or uterus.

Various methods are now available to help such couples.

Assisted reproductive technology (ART)
It includes all fertility treatment in which both sperms and eggs are handled. Art procedure involves
surgically removing eggs from a mothers ovaries, combining them with sperm in the laboratory and
returning them to the woman's body or donating them to another woman.
The main ART-techniques include:
In vitro fertilization (IVF)
Gamete intra fallopian transfer (GIFT).
Zygote intra fallopian transfer (ZIFT)
Intra cytoplasmic sperm injection (ICSI).
Intrauterine Insemination(IUI).
Surrogacy or surrogate motherhood.
In vitro fertilization (IVF):
In vitro fertilization followed by transfer of embryo into the female genital tract is one such method
and is commonly known as the ‘Test Tube Baby’ Programme.
First attempt to produce a test tube baby was made by a Italian scientist, Dr. Petrucci
(1959 A.D.). Although this human embryo survived for only 29 days, but his experiment
opened a new file of biological science.
The first test tube baby was born to Lesley and Gilbert Brown on July 25, 1978, in
Oldham, England. Mrs. Brown had obstructed fallopian tubes.
Dr.Patiricke Steptoe and Dr. Robert Edward both from England experimented on Mrs.
Brown successfully.
The world's first test tube baby (a baby girl) was named as Louise Joy Brown. Later, test-tube
babies were also born in Australia, United States and some other countries.
India's first test tube baby was born Durga on 3rd October, 1978 in Kolkata. Her parental name
was Kanupriya Aggarwal and was created by Dr. Subash Mukherjee.
In test-tube baby programme, ova from the wife/donor (female) and sperms from the husband/donor
(male) are collected and are induced to form zygote under simulated conditions in the laboratory.
The zygote or early embryos (with upto 8 blastomeres) could then be transferred into the fallopian
tube (ZIFT–Zygote Intra Fallopian Transfer) and embryos with more than 8 blastomeres, into the
uterus (IUT – Intra Uterine Transfer), to complete its further development. Embryos formed by in-
vivo fertilization (fusion of gametes within the female) also could be used for such transfer to assist
those females who cannot conceive.

Gamete intra fallopian transfer (GIFT).

Gamete Intra-Fallopian Transfer (GIFT) is the latest technique to produce the child.
Sperm (obtained by masturbation/electro ejaculation) and ovum obtained by laproscopy are injected
into the mid part of the oviduct by a separate catheter in a cycling female (in proliferative stage).

Zygote intra fallopian transfer (ZIFT)

This method is called tubal embryo transfer
It combines IVF and GIFT.
It involves the same retrieval of ova and semen, and fertilization and growth
in the laboratory up to the zygote stage, at which point the zygote are placed
in the fallopian tube.
In includes following steps:
Eggs are aspirated from the ovary.
Eggs are placed in the prepared semen sample.
Fertilized embryos or zygotes are transferred into the fallopian tube.

Intra cytoplasmic sperm injection (ICSI)

Intra cytoplasmic sperm injection (ICSI) is another specialised procedure to form an embryo in
the laboratory in which a sperm is directly injected into the ovum.
Infertility cases either due to inability of the male partner to inseminate the female or due to very low
sperm counts in the ejaculates, could be corrected by artificial insemination (AI) technique.
In this technique, the semen collected either from the husband or a healthy donor is artificially
introduced either into the vagina or into the uterus (IUI – intra-uterine insemination) of the female.

Intrauterine Insemination(IUI)
It is a procedure designated to place sperm directly into a woman’s uterus through artificial
means.
The sperm is prepared for this procedure in the laboratory and then deposited inside the
endometrial cavity using a small catheter passed through the endocervical canal.
It results in a signifivant increase in the anount of sperm that reach the uterus because the
procedure bypasses the vagina and the cervix.
It can be helpful in women with thick cervical mucous and also in men who have lower
sperm counts.

Surrogacy or surrogate motherhood

Surrogate motherhood is a by product of the artificial insemination.
It means that a woman allows a fertilized ovum of another couple to be infected into her womb.
Then she carries to its full term for other couple.

SCREENING TESTS
Many screening tests offered during pregnancy:
Amniocentesis:
Amniocentesis is a pre-natal diagnostic technique to determine.
Sex of the developing baby.
Genetically controlled congenital diseases.
Metabolic disorders in foetus.
Process of amniocentesis involves the following steps :
Location of the foetus is determined by a technique called sonography (using high frequency
ultrasound waves) to prevent accidental damage to the foetus.
A fine hollow needle is passed through the abdominal and uterine wall of a pregnant female (about
14th to 15th week after conception) into the amniotic cavity.
A small amount of amniotic fluid is withdrawn. It contains foetal skin cells and a number
of proteins, especially enzymes. The cells can be cultured in vitro for further
examination.
 Fig. : Amniocentesis

SIGNIFICANCE OF AMNIOCENTESIS

SEX DETERMINATION

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

CONGENTIAL DISEASE

By karyotypic studies of somatic cells, abnormalities due to changes in chromosome

number like Down's syndrome, Turner's syndrome, Klinefelter's syndrome etc. can be
determined.

METABOLIC DISORDER

By the enzyme analysis of amniotic fluid, different types of inborn metabolic disorders
like phenylketonuria, alkaptonuria etc. can be detected.
These inborn errors are caused by the absence or inactivity of specific enzymes due to
gene mutations. So with the help of amniocentesis, if it is confirmed that the child is
likely to suffer from some incurable, congenital defect, the mother can go for abortion.

DRAWBACKS OF AMNIOCENTESIS

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 a normal child.
So Govt. of India enforced the Pre-natal Diagnostic Techniques (Regulation and
Prevention of Misuse) Act, 1994, since January 1, 1994 under which all genetic
counselling centres and laboratories are required to apply for registration.
The violation of this act can bring a fine of ` 50,000 and imprisonment for two years.
The doctor's registration is also cancelled till the complaint is disposed of.

Chorionic Villus Sampling (CVS):

Amniocentesis is possible without a chance of injuring the foetus with the needle only after the
sixteenth week of pregnancy.
At this time, abortion is not safe.
A new technique, named Chorionic Villus Sampling (CVS), can be done during the eighth to tenth
week of pregnancy when abortion is safe for the woman. For CVS, cells are sucked into a catheter
passed through the cervix. CVS technique provides a mass of rapidly dividing foetal cells, thus
facilitating the examination of chromosomal disorders.

Fig: Chorionic Villus Sampling(CVS)