Makan Antibiotik Saat Hamil

Ini pertanyaan yang sering diajukan bumil yang kebetulan mendapatkan antibiotik dari dokter nya. Khusus untuk wanita hamil, obat2an diberi kategori oleh FDA dengan kategori A, B, C, D dan X. Penjabaran untuk masing2 kategori bisa dilihat dalam tabel di bawah ini. Jadi amankah obat yang dimakan oleh bumil ?

Category	Description
A	Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities.
B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well-controlled studies in pregnant women. or Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus.
C	Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women.
D	Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk.
X	Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.

Jawaban pastinya susah...kenapa? Berdasarkan kategori diatas, obat2an diuji keamanannya pertama ke hewan percobaan kemudian diuji ke orang dewasa. Karena wanita hamil biasanya jarang dimasukkan ke dalam uji coba (di barat sana nggak banyak/jarang ada bumil yang mau jadi orang percobaan) dan efek samping yang terjadi (terutama yang jangka panjang) pada bayi sangat sulit dipantau (terlalu lama).

Khusus untuk antibiotika, aman tidaknya antibiotika tergantung berbagai faktor, diantaranya jenis antibiotika, berapa banyak makannya serta berapa lama makannya. Dalam memberikan antibiotika perlu ditimbang antara efek obat yang dimakan dengan bahaya yang terjadi jika kondisi penyakitnya tidak diobati. Jika pemberian antibiotika merupakan satu-satunya cara menyembuhkan penyakit, maka biasanya dokter akan memberikan obat yang paling aman.

Kategori A
Secara umum antibiotika yang masuk kategori ini sangat dikit. Salah satunya adalah
Nystatin vaginal (Mycostatin) (=anti jamur)

Kategori B
Umumnya antibiotika masuk kategori ini, belum diketahuinya ada hubungan dengan cacat bayi atau komplikasi kehamilan lainnya obat tersebut kemungkinan aman. Termasuk di dalamnya :
Amoxicillin
Ampicillin
Augmentin (amoxicillin-clavulanate)
Dicloxicillin
Macrobid (nitrofurantoin)
Flagyl (metronidazole) (masih kontroversi pada Trimester I)
Cephalosporins including: Keflex (cephalexin), Ceclor (cefaclor), Duricef (cefadroxil)
Cleocin (clindamycin)
Erythromycin
Zithromax (azithromycin)
Golongan Sulfa (sampai hampir cukup bulan)
Famvir (famciclovir)
Zovirax (acyclovir)
Valtrex (valacyclovir)
Clotrimazole-vaginal (Mycelex, Lotrimin)

Kategori C
Bactrim
Trimethoprim
Biaxin (clarithromycin)
Cipro (ciprofloxacin)
Diflucan (fluconazole)
Monistat (miconazole)
Terazol (terconazole)
Isoniazid
Rifampin
Vermox (mebendazole)
Tetanus booster (tetanus toxoid)
Vaksin: hepatitis A, hepatitis B, influenza, meningococcus, pneumonia (pneumococcus), polio
Vaksin: Cacar, Mumps, Rubella

Kategori D
Obat ini jelas ada efek-nya ke bayi dan kehamilan. Hanya dipakai jika tidak ada alternatif yang lebih baik. Termasuk di dalamnya:
Tetracycline (dan turunannya), dapat menyebabkan perubahan warna gigi : tetracycline, doxycycline (Vibramycin), Minocin (minocycline)
Golongan Sulfa - Jika mendekati persalinan (karena bisa menyebabkan kuning yang berat pada bayi baru lahir)

Kategori X
Estrogen, Obat2an kemoterapi dll

NB
Di setiap negara ada kategori sendiri2, misalnya di Jerman kategorinya seperti di bawah ini

Kategori	Deskripsi
Gr 1	For extensive application in humans has no suspicion of embryotoxic / teratogenic revealed. Animal studies provide no evidence of embryotoxic / teratogenic effects
Gr 2	For extensive application in humans has no suspicion of embryotoxic / teratogenic revealed.
Gr 3	For extensive application in humans has no suspicion of embryotoxic / teratogenic revealed. Animal studies, however, provide evidence of embryotoxic / teratogenic effects. These seem to be without significance.
Gr 4	No adequate and well-controlled studies on humans. Animal studies have shown no embryotoxic/teratogenic effects.
Gr 5	No adequate and well-controlled studies on humans.
Gr 6	No adequate and well-controlled studies in pregnant women. Animal studies have shown embryotoxic/teratogenic effects.
Gr 7	There is a risk that the drug is embryotoxic/teratogen to the human fetus. (first Trimester).
Gr 8	There is a risk that the drug is fetus toxis. (second and third Trimester).
Gr 9	There is a risk that the drug causes prenatal complication or abnormalities.
Gr 10	There is a risk that the drug causes hormone specific action on the human fetus.
Gr 11	There is a known risk that the drug is a mutagen/carcinogen.

*Terjemahin sendiri ya

Perubahan Tubuh pada Kehamilan Trimester III

Trimester III kehamilan dimulai dari usia hamil 25 to minggu s/d kelahiran. Selama periode ini banyak hal2 yang kurang nyaman TM II tetap berlanjut. Akibat pertumbuhan janin, maka organ sekitarnya mendapat tekanan sehingga memperburuk keadaan serta menimbulkan keluhan baru. Sementara itu ukuran janin dan posisinya tekadang membuat bumil merasa tidak nyaman dan susah tidur, ditambah lagi dengan lelah akibat membawa tambahan bobot tambahan sampai bayi dilahirkan. Berikut perubahan2 yang sering ditemukan pada TM III.

Pembesaran perut. Rahim terus membesar, sampai ke 36 ukuran uterus mencapai pinggir bagian bawah tulang iga teredah pada dada. Pembesaran perut sering membuat puser/udel jadi menonjol.

Nyeri perut kiri atas (Heartburn). Heartburn sering dialami oleh bumil, terutama di TM III. Akibat pertumbuhan janin, rahim akan mendorong lambung, sehingga mengakibatkan mengalirnya asam lambung kearah kerongkongan dan menimbulkan rasa nyeri terutama setelah makan.

Perubahan kadarhormon bisa memperlambat proses pencernaan dan merelaksasi otot lambung sehingga asam lambung keluar ke kerongkongan dan menimbulkan sensasi heartburn spt diatas. Sehingga dianjurkan bumil untuk menghindari makanan yang pedas. berminyak dan goreng2an, serta makan dalam porsi kecil2 dan sering. Setelah makan dianjurkan posisi tetap tegak (jangan berbaring), untuk mencegah terjadinya aliran balik makanan dari lambung ke kerongkongan.

Bengkak/edema. Tubuh menhasilkan dan menyimpan cairan tambahan selama hamil, akibatnya banyak bumil yang mengalami bengkak, terutama di akhir kehamilan. Bengkak sering timbul di kaki , tumit, dan wajah. Penekanan pembesaran uterus padapembuluh vena mengakibatkan darah balik dari bagian bawah tubuh terhambat, sehingga menyebabkan kaki dan tungkai bawah menjadi edema. Dianjurkan untuk banyak minum, mengkompres dingin, memakai sepatu longgar dan meninggikan kaki pada saat duduk atau istirahat. Jika pembengakakan terjadi dengan cepat serta berlebihan ini mungkin merupakan tanda pre-eklampsia.

Pembesaran payudara. Diakhir kehamilan payudara semakin membesar guna mempersiapkan proses ngASI. Pertambahan jaringan payudara bisa mencapai 1.4 kg, sehingga menimbulkan rasa nyeri dan tdk nyaman. Dianjurkan untuk memakai bra khusus untuk mensuport payudara. Payudara juga bisa mengeluarkan kolustrum (ASI awal), sehingga dianjurkan untuk memasang pad khusus didalam bra, agar asi nggak berceceran kemana2.

Nyeri dan sakit. Akibat lain dari pembesaran raim adalah nyeri di bagian perut, selangkangan dan paha. Tekanan kepala bayi, penambahan BB, dan longgarnya sendi akibat hormon juga dapat menyebabkan sakit pinggang dan rulang2 panggul.

Varises pembuluh vena. Akibat tekanan pembuluh vena besar yang terletak dibelakang uterus, darah balik dari tubuh bagian bawah terhambat dan menyebabkan peningkatn tekanan pembuluh vena, akibatnya muncul varises. Vena membesar dan terasa nyeri. Lokasi tersering munculnya adalah betis, paha dan vagina. Sehingga dianjurkan untuk jangan berdiri lama, berbaringlah dengan posisi miring atau duduk dengan kaki ditinggikan.

Hemoroid. Sama halnya dengan varises, pembuluh darah vena didaerah anus juga membesar. Diperparah lagi akibat tekanan kepala terhadap vena di rektum (bgian dalam anus). Konstipasi berkontribusi dalam menimbulkan pecahnya hemorid sehingga menimbulkan perdarahan. Untuk menghindari pecahnya pembuluh darah ini maka dianjurkan untuk mengkonsumsi banyak serat, banyak minum, buah dan sayuran.

Susah bernafas. Sering dikeluhkan berupa sesak nafas,akibat pembesaran uterus yang menghalangi pengembangan paru-paru secara maksimal. Bumil dianjurkan untuk manarik nafas dalam dan lama.

Perubahan rambut dan kuku. Terjadi perubahan tekstur dan tingkat pertumbuhan rambut. Kebanyakannya pertumbuhan lebih lebat/tebal, akibat rangsangan hormon. Sementara ada sebagian yang mengalami perubahan warna, lebih kering atu lebih berminyak dari biasanya. Keluhan lain adalah tumbuhnya bulu pada tempat2 yng tidk diinginkan seperti pada wajah, perut dan puting susu. Hormon yng dihasilkan selama hamil bisa mengakibatkan pertmbuhan kuku yang cepat serta lebih keras dari biasanya. Ada juga yang mengalami kukunya mudah patah. Perubahan ini hilang setelah kelahiran.

Keringat meningkat. Sering terjadi peningkatan produksi keringat. Ini akibat meningkatnya metabolisme (pembakaran kalori) tubuh wanita hamil. Jika udara panas, agar tidak over heating, dianjurkan meminum air dingin, beristirahat, serta mandi air dingin.

Stretch mark dan perubahan warna kulit. Garis2 parut berwarna merah, pink atau keunguan atau kehitaman bisa muncul diperut, paha, bokong da payudara. Munculnya terutama mulai TM II dan bertambah bnyak di TM III. Separuh wanita hamil mengalami ini. Setelah lahir stretch mark akan memudar sampai minimal, tetapi tidak bisa hilang.

Perubahan warna kulit. Mulai TM II terjadi perubahan warna kulit menjadi lebih gelap. Daerah puting juga bisa menghitam, juga timbul garis hitam dibagian tengah perut mulai dri udel ke darah diatas bulu kemaluan (linea nigra). Juga bisa menimbulkan hitam atau coklat hidung, jidat dan pipi, dikenal dengan istilah melasma atau chloasma (topeng hamil). Perubahan ini lazim menghilang setelah persalinan.

Sumber: ACOG

Natural Suplements

As we know, our healthy bodies can be maintained by taking some vitamin, mineral and doing exercise regularly. If one of them is less then our bodies will not function maximally and effectively. In a healthy body theres is a good immunity, that will defense our bodies, so we can't get sick easily.

Another way to improve our immunity from a disease is by taking suplemen which can stimulate our immun system. One of the best is Poly MVA. Poly MVA is a promising new dietary supplement that may assist in boosting immune response, and healing damaged cells. It is a uniquely formulated nutritional supplement containing a proprietary blend of Palladium and alpha-lipoic Acid (which we refer to as LAPd), Vitamins B1, B2 and B12, Formylmethionine, Acetyl Cystiene, and trace amounts of Molybdinum, Rhodium, and Ruthenium. It is designed to provide energy for the compromised body systems by changing the electrical potential of human cells, increasing the charge density of DNA within the cell.

Poly MVA is a new, nontoxic, powerful antioxidant dietary supplement. While definitive studies on it's effect in human nutrition and health are under way, early studies and anecdotal information indicate that the active ingredients in Poly MVA may be beneficial in protecting cell DNA and RNA, assisting the body produce energy, and provide support to the liver in removing harmful substances from the body. Some studies indicate that ingredients of Poly MVA can assist in preventing cell damage, and removing heavy metals from the bloodstream. As a powerful antioxidant, it can help to neutralize the free radicals within the body that are thought to influence the aging processes and convert them into energy. Other ingredients are involved in DNA synthesis, production of the myelin sheath that protects nerves, and red blood cell production, and playing an important role in immune and nerve function.

From a variety of mineral suplemen products, one of it is intraMAX ™. Most illnesses, diseases and ailments can be traced to mineral or nutritional deficiencies in the body. intraMAX™ may be effectively used to treat many different patient problems by providing the missing elements for good health. Without a doubt, minerals are "the gift of life" and cellular function becomes impossible without them! The 74th Congress, 2nd Session of United States declared 99% of Americans are mineral deficient because our foods no longer contain adequate amounts of essential Organic trace minerals critically necessary to maintain health, promote healing, and prevent illness. In the absence of sufficient Organic trace minerals, our bodies cease to function properly.

Sometimes we bored and depressed to our daily job rutinity. It's better for you to take something that will not harm you, so you can get relaxed. Lithium is the most common element used for stabilizing mood swings, mania and depression. Lithium orotate (the lithium salt of orotic acid) is 20 times more bio-active than other lithium salts, allowing a reduction in dosage greatly reducing the likelihood and severity of potential side effects. Orotate is an organic "carrier" that transports the natural Lithium exactly where it needs to be delivered so that it reaches the blood cells of our brain. This is where chemical imbalances occur. When organic Lithium is combined with Orotate, it is reported to be many times more effective than the chemical, inorganic Lithium and to have NO side effects.

Lithium Orotate may provide a natural help with the following : Mood Swings, Chemical Dependency, Depression, Mania, Bi-Polar, Fibromyalgia, Gout, Cluster Headaches, Alzheimer's and Brain Aging.

Masturbasi pada anak

Masturbasi pada anak seringkali kita temukan, seringkali hal tersebut membuat malu orang tua. Hal ini sebetulnya tidak membahayakan perkembangan seksual anak. Yang jelas masturbasi tidak memiliki efek samping mental dan fisik sampai dilakukan secara berlebihan /ekstrim.

Masturbasi secara ekstrim merupakan kelainan tingkah laku (behavioral disorder). Penelitian memperlihatkan bahwa kecenderungan masturbasi pada anak yang masih kecil sebaiknya diacuhkan , karena mereka melakukannya tanpa sadar/tahu. Jangan sampai membuat anak merasa bersalah karena hal tersebut justru akan mengganggu kejiwaannya. Berdasarkan kamus, masturbasi adalah self-abuse, sehingga tidak mungkin seorang anak kecil melakukan self-abuse.

Berikut penyebab - penyebab masturbasi pada anak:
* Kurangnya perhatian dari orang tua: Ini biasanya terjadi pada keluarga yang broken serta anak yang tak dihiraukan orang tua karena tidak ada waktu/sibuk.
* Sexual Abuse : Oleh orang lain atau pun anggota keluarga sendiri.
* Kesepian dan kurang interaksi sosial : anak sering sendiri, tidak punya teman bermain serta tidak ada aktifitas/hiburan yang menyenangkannya.

Untuk itu orang tua harus lebih meluangkan waktu dengan anaknya dan bermain bersama dengan aktifitas yang menyehatkan. Membawa anaknya untuk berinteraksi sosial, serta aktifitas konstrukstif lainnya, sehingga si anak tidak lagi memikirkan kegiatan masturbasinya

Child Behavior Basics: Childhood Masturbation

Efek Caffein Pada Kehamilan

Bagi ibu atau calon ibu pencinta kopi atau minuman bercaffein lainnya baiknya anda membaca tulisan ini. Karena kebiasaan yang satu ini pastinya akan sulit ditinggal kan selama hamil.

Caffein bersifat stimulan (membuat mata melek) dan diuretik (jadi banyak pipis). Karena sifat stimulannya, caffein meningkatkan tekanan darah dan frekuensi nadi, yang mana kedua hal ini sebaiknya tidak terjadi pada kehamilan. Caffeine juga meningkatkan frekuensi pipis yang mana hal ini menyebabkan berkurangnya cairan tubuh dan dehidrasi.


Caffein dapat menembus plasenta dan sampai ke bayi. Jika tubuh ibu masih mampu menghandle sejumlah caffein, tetapi tidak demikian halnya dengan bayi. Metabolisme bayi belum sempurna sehingga tidak bisa sepenuhnya mengolah caffein yang masuk.

Disamping kopi, caffein juga ditemukan dalam teh, soda (coca cola), coklat dan obat2an (obat flu atau sakit kepala).

Caffein bisa menyebabkan cacat pada bayi manusia? Beberapa penelitian dengan mempergunakan hewan percobaan didapatkan caffein bisa menyebabkan cacat bawaan, persalinan kurang bulan, mengurangi kesuburan dan meningkatkan risiko bayi lahir dengan berat badan kurang (low-birth weight). Sedangkan penelitian pada manusia belum menghasilkan sesuatu yang konklusif. Tapi alangkah baiknya untuk main aman saja terhadap sesuatu yang inkonklusif.

Caffein mengganggu kesuburan? Beberapa penelitian memperlihatkan hubungan antara mengkonsumsi caffein dalam jumlah banyak dengan lambatnya hamil.

Caffein dapat menyebabkan keguguran? Terdapat beberapa penelitian mendaptkan terjadinya peningkatan kejadian abortus pada wanita yng mengkonsumsi lebih dari 300 mg (3 gelas kopi) sehari. Efek lainnya yang juga meningkat adalah persalinan kurang bulan serta BBLR sehingga lebih aman menghindari caffein sebisa mungkin.

Wanita hamil tidak boleh mengkonsumsi caffein sama sekali ? Para ahli mengatakan bahwa konsumsi caffein dalam kadar menengah tidak memiliki efek terhadap kehamilan. Batasan moderat disini adalah antara 150-300 mg.

Sumber: APA

Vagina berbau (tak sedap)

Emangnya baunya sedap ? Hahaha .... memang agak susah menerjemahkannya. Pakai bahasa Inggrisnya saja biar lebih enak kedengarannya: Vaginal Odor. Secara normal sebetulnya vagina sehat memiliki bau yang khas. Setiap orang (co) akan memberikan gambaran/mendiskripsikannya secara berbeda. Ini salah satu kutipan diskripsinya.

I would describe it as a sweet smell of innocence mixed with a touch of naughtyness and delightful excitement!!! . A irrisistible combination that once experienced you'll always remember her.

Kalau ingin tahu diskripsi unique smell and taste-nya silakan baca ini
Berikut ini daftar penyebabnya:
# Bacterial vaginosis
# Bowel cancer
# Cervical Cancer
# Cervicitis
# Cervix cancer
# Chlamydia
# Endometritis
# Foreign body in vagina
# Forgotten tampon
# Granuloma inguinale
# Lodged condom
# Lodged contraceptive device
# Normal vaginal odor
# Pelvic Inflammatory Disease
# Puerperal fever
# Salpingitis
# Sensitivity to odor
# Septic abortion
# Trichomoniasis
# Uterine cancer
# Vaginal cancer
# Vaginal discharge
# Vaginal infection
# Vaginitis

Dari sekian banyak penyebab vaginal odor diatas, sebagai penyebab yang paling ditemukan adalah Bacterial Vaginosis (BV) yang disebabkan akibat pertumbuhan yang berlebihan dari organisme yang secara normal ada di vagina. Bau yang dihasilkan akibat infeksi kuman ini biasanya berbau amis (fishy smell)m semakin jelas baunya setelah habis berhubungan badan. Gejala lain infeksi ini adalah rasa gatal taua iritasi divagina, dan cairan yang keluar berawarna putih ke abu-abuan.

Penyebab lain yng sering adalah hygiene yang rendah. Sangat baik untuk rajin mebersihkan vagina bagian luar dengan dengansedikit sabun yang mild secara rutin waktu mandi kemudian dibilas dengan air yang banyak. Tidak perlu melakukan "Douching =menyemprot kan pembersih ke dalam liang vagina). Karena akan menggangu keasaman vagina yang berfungsi menjaga vagina dari infeksi jamur dan kuman.

Penyebab lainnya yang jarang :
* Tampon vagina yang tertinggal/terlupa.(Wah bahaya nich, bisa kena sue) .
* Fistula Rectovaginal , biasanya akibat trauma/cedera saat menjalani proses persalinan, sehingga terbentuk hubungan antara vagina dan rektum, akibatnya feces keluar melalui vagina.
* Kanker leher rahim atau kanker di daerah vagina.

Pengobatan tentunya disesuaikan dengan penyebabnya, kalau infeksi tentunya akan diberikan antibioyika yang sesuai.

Sumber : Gado-gado

Herpes Genitalis dalam Kehamilan

Herpes genitalis adalah infeksi virus herpes simpleks pada atau disekitar vagina, vulva (bibir vagina) dan anus (wanita). Herpes dapat menyebabkan luka pada daerah mulut, dan hidung , pada daerah kemaluan (laki2 dan wanita) dan daerah anus, atau pada mata, jari dan tangan. Terdapat dua jenis virus herpes simpleks yaitu herpes simpleks 1 and 2.

Herpes dapat ditularkan orang perorang dengan cara: kontak kulit ke kulit (dengan lesi), hubungan seks (segala macam jenis lubang) dan dari ibu ke bayi saat melahirkan.

Gejalanya berupa luka yang terasa nyeri atau benjolan berisi cairan disekitar bulu kemaluan, vagina, vulva atau anus. Bsia juga terasa nyeri saat pipis. Serta gejala infeksi virus umunya seperti demam, rasa tidak badan serta sangat lelah.

Luka herpes genital bisa muncul disekitar vagina, vulva, liang vagina atau anus. Begitu terinfeksi virus ini virus akan menetap di tubuh dan bisa aktif berkali2. Gejala awalnya bisa berupa rasa geli/gatal pada daerah yang terkena.

Bayi yang tertular herpes saat dilahirkan disebut herpes neonatal. Herpes neonatal dapat menginfeksi kulit bayi, mata atau mulut dan bisa merusak otak serta organ lain. Bayi bisa sangat sakit bahkan meninggal. Pengobatan yang diberikan kepada bayi bisa mencegah serta mengurangi dampat yang ditimbulkan pada bayi.

Kekebaln yang dimiliki ibu biasanya juga melindungi bayi dan bertahan sampai usia bayi tiga bulan setelah kelahiran. Jika wanita terkena infeksi sebelum hamil dan tidak kambuh selama hamil dan persalinan, maka tidak akan menularkan ke bayi. Jika ternyata kambuh selama persalinan, risko bayi tertular juga rendah.

Jika terkena infeksi diakhir usia kehamilan, maka tubuh belum sempat menghasilkan imunitas serta mentransfernya ke bayi, sehingga bayi berisiko tertular saat dilahirkan pervagina.

Jika pertama kali terkena herpes saat hamil maka akan diberikan pengobatan antivirus (acyclovir) selama lima hari. Guna obat ini adalah memendekkan masa infeksi serta mengurangi beratnya gejala yang timbul.

Jika infeksi terjadi diakhir kehamilan, maka diberikan acyclovir selama 4 minggu terakhir kehamilan. Hal ini bertujuan agar herpes tidak kambuh menjelang kelahiran bayi. Acyclovir juga akan diberikan jika terjadi kekambuhan terutama di TM III.

Tidak terdapat bukti adanya risko terhadap bayi dalam kandungan jika mengkonsumsi acyclovir selama kehamilan serta umumnya tidak merasakan efek samping obat (ibunya).

Bagaimana cara kelahiran yang aman ? Jika terkena infeksi pertama dalam 6 bulan pertama kehamilan maka bayi bisa dilahirkan pervagina. Jika terkena infeksi pertama kali dalam 6 minggu terakhir kehamilan maka akan dilakukan tindakan cesar berencana untuk melahirkan bayi . Jika infeksi muncul saat perslinan maka dilakukan bedah cesar untuk melahirkan bayi. Jika terkena infeksi sebelum hamil dan kambuh saat persalinan maka bayi bisa dilahirkan pervagina. Tindakan operasi bertujuan mengurangi risiko menularkan ke bayi.

sumber RCOG

Metode memilih jenis kelamin pada IUI

Pemilihan jenis kelamin dimungkinkan dengan adanya kromosom yang mentukan jenis kelamin. Tubuh manusia terdiri atas milyar sel dan setiap sel mengandung 23 pasang kromosom (total 46). Khusus sel-sel reproduksi, sperma dan sel telur hanya mengandung 23 kromosom.

Selama pembuahan, keduanya bergabung sehingga menghasilkan embryo yang memiliki 23 pasang kromosom atau 46 buah. Salah satu pasangan kromosom ini akan menentukan jenis kelamin bayi yang akan dikandung, yang dikenal dengan istilah kromosom seks. Setiap kromosom seks terdiri atas kromosom X atau Y. Y adalah kromosom penentu jenis kelamin laki-laki, dan X yang perempuan. Sel telur hanya mengandung kromosom X, sedangkan sperma mengandung kedua2nya.

Pada awal tahun 70-an, ilmuwan menemukan sampel sperma dengan konsentrasi Y atau X yang lebih tinggi. Tahun 1975, Ronald J. Ericsson, melakukan penelitian klinis apakah sampel sperma yang diperkaya akan menghasilkan kehamilan dengan gender yang sesuai dengan keinginan. Hasilnya ternyata sangat baik dan sekarang prosedur ini (Metode Ericsson) banyak dipakai oleh ilmuwan2 diseluruh dunia.

Dengan alat yang sudah dipatenkan, sperma X dan Y dapat dipisahkan dengan proses penyaringan. Sperm diletakkan diatas serum albumin manusia dan sperma tersebut akan "berenang" ke bawah (kearah serum) dan berkumpul pada bagian dasarnya.

Fraksi sperma Y diinseminasikan jika menginginkan bai laki2 (angka keberhasilan 70-75%) begitu juga sebaliknya X jika ingin anak perempuan (angka keberhasilan 70-72%). Secara keseluruhan rata-rata angka keberhasilan 70-75% sesuai dengan gender yang diinginkan. Sudah lebih dari 5 ribu bayi dilahirkan dengan metode.

Sexually Transmitted Diseases in Women Who Have Sex with Women

Relatively few data are available to inform estimates of the risk of female-to-female sexual transmission of STDs. The available data come primarily from four sources.

First, review of records from clinics that provide STD services (STD clinics) has provided estimates of some outcomes, including diagnosis of STD syndromes, laboratory results, and risk reporters. Such studies have the advantages of capturing a reproducible population
of women who can be characterized relative to heterosexual women attending the same venue and of relying on clinician-based or laboratory-defined reports of outcomes,
but are limited primarily by the relatively small number of WSW who attend these clinics.

Second, several studies have recruited women who either self-identify as lesbian or who report recent samesex behavior, regardless of stated identity. Although this of WSW and frequently includes laboratory diagnosis of STDs, the sample of women included is likely biased due to self-selection for enrollment.

Third, although population-based surveys attempt to enroll a more representative sample of women, including WSW, because these surveys are generally expensive and complex to undertake, most do not include laboratoryconfirmed assessment of STDs but rely on self-reported STD history.

Finally, case reports of STD transmission between women provide the only documented evidence available for some STDs. Despite their obvious limitations, these reports are valuable in that they can demonstrate the potential for STD transmission between women and, as such, help to emphasize the need for more robust, population-based data to inform WSW patients and their providers about the true risks associated with samesex behavior between women.
Numerous studies have demonstrated that important barriers to health care exist for WSW. These barriers include, but are not limited to, lack of patient educational materials aimed at their specific risks and circumstances, lack of knowledge among providers, low socioeconomic
status, absence of spousal benefits, and impact of negative experiences within the health care system.

Among the latter are included outright instances of homophobia and general invisibility. For example, many office registration materials still list options for marital status as “single” or “married”—terms that do not apply to WSW who may be in domestic partnerships, particularly those that are not recognized by regulatory authorities. Even providers who are comfortable assessing STD-related risks may not be knowledgeable about the sexual practices engaged in
by many WSW, or about the limited disease-specific information in the literature. For these reasons, education of providers in this area is paramount.

Because recent national (USA) surveys indicate that same-sex behavior among women is relatively common, providers should familiarize themselves with information about this patient population, and be aware of referral options for more detailed information. Available information on transmission of specific STDs in WSW is discussed later,
under Laboratory Studies. Risk Assessment Risk assessment in WSW should begin the way all STDrelated risk assessment begins in every patient: with a thorough sexual history. Most importantly, providers should not make assumptions about sexual practices based on the patient’s self-reported identity—in this case, specifically, as a lesbian. Assuming that a self-identified lesbian has not previously been or is not currently sexually
active with men is usually incorrect. In one study, 74% of self-identified lesbians had male partners in the past, and of self-identified bisexual women, 98% had
prior or current male partners. Among lesbians recruited for studies in Seattle, 80–86% reported prior sex with men, 23–28% had had sex with a man in the last year, and the median number of male and female lifetime partners was the same. In a sample of women
evaluated at a London STD clinic, 69% of those identifying as lesbian had prior male partners, and at another London clinic specializing in the sexual health of lesbians,
91% had prior male partners. Heterosexual intercourse transmits the full range of STDs, some of which (notably, chronic viral infections, including HPV, genital
herpes, hepatitis B virus, and HIV) may remain undetected for years.
Important components of the sexual history include number of recent (prior 2 months and 1 year) and lifetime sexual partners, both male and female. Other key components should include types of sexual practices that could pose a risk of transmission of STDs. Some
sexual practices—including oral-genital sex; vaginal or anal sex using hands, fingers, or penetrative sex toys; and oral-anal sex—are practiced commonly between
female sex partners. Practices involving digital-vaginal or digital-anal contact, particularly with shared penetrative sex toys, present a plausible means for transmission
of infected cervicovaginal secretions.

In several studies, women who report sex with both men and women report more sex partners over their lifetimes than women who have sex exclusively with either
men or women. One population-based survey in lowincome neighborhoods found that women who had sex with men only reported a mean of 16 lifetime partners, whereas women reporting sex with men and women reported a mean of 307 lifetime partners.

Similarly, among patients attending an STD clinic in Seattle, women with only female partners in the previous 2 months reported 3.4 partners in the past year; women with only male partners, 5.3 partners in the past year; and women with male and female partners, 16.5 partners in the past year. Women who report sex with both men and women are likely to be at higher risk for STDs than women who report sex with women or men only.

WSW may have male partners who are at higher risk for HIV and STDs than the partners of women who have sex with men only. In one study of patients at an STD clinic, 10% of women who had sex with only women in the previous 2 months had a prior male partner who was gay or bisexual, compared with 6% of women reporting sex with men only. Of women reporting sex with both men and women in the prior 2 months, 29% had a prior gay or bisexual male partner.

Women who reported sex with both men and women in the previous 2 months were also more likely than women who had sex with only men or only women to have had more than four male sexual partners in a year, more likely to exchange sex for money or drugs, and more likely to
have used intravenous drugs. In summary, lesbian and bisexual women may have past or current sex partners at high risk for HIV and other STDs.

Risk Reduction Counseling
No studies have directly addressed the acceptability or efficacy of STD risk reduction interventions among WSW. However, measures that reduce the potential for transmission of cervicovaginal secretions are likely to be effective in reducing STD transmission.
For women who practice digital-vaginal or digital-anal sex (hands or fingers in partner’s vagina or anus), the risk is probably low unless secretions are actually transferred on the hands from the infected partner to the other.

Interrupting this progression by avoiding the behavior or by using and removing gloves after contact is likely effective.

For minimizing transfer of infected secretions associated with insertive sex toys, several approaches are likely effective. These include minimizing sharing of unclean
sex toys (either not sharing toys at all or cleaning them between use by one partner and the other), use of condoms on sex toys, and avoiding use of sex toys anally and
vaginally in succession.

With regard to oral sex and STDs, WSW may be at increased risk of genital herpes infection with herpes simplex virus type 1 (HSV-1) due to a relatively higher frequency of orogenital sex. Serologic screening for HSV-1 is not useful to screen for potential infectiousness, because most adults are infected with HSV-1 orally, and serology does not distinguish between oral and genital infection.

However, women should be counseled to avoid performing oral sex when lesions consistent with an oral herpes outbreak (eg, a cold sore, recurrent ulcer, or vesicle) are evident or if a recognizable prodrome (eg, ear pain or local lymphadenopathy) is underway.
Other important components of complete risk reduction counseling for all patients include a discussion of sex partner selection, sexual network assessment, and the patient’s ability to negotiate safer sex practices.

Olah raga selama kehamilan

Untuk menjaga kesehatan dan vitalitas tubuh, disamping cukup zat gizi dan istirahat, juga dibutuhkan olahraga. Wanita hamil sama seperti yang lainnya juga butuh olahraga guna menjaga kesehatan tubuh dan kehamilannya. Namun demikian terdapat perubahan-perubahan dalam tubuh wanita hamil yang bisa mempengaruhi kemampuan berolahraga.

Hormon yang dihasilakn oleh kehamilan menyebabkan urat (ligamen)yang men-suport persendian menjadi relaks. Hal ini membuat sendi lebih mobile dan lebih berisiko mengalami cidera. Oleh karenanya hindari olahraga yang berifat high-impact seperti berlari, melolompat dll

Akibat berat badan yang bertambah serta pusat gravitasi tubuh yang berubah (lebih berat pada bagian perut), menyebabkan beban yang berlebihan pada otot dan urat pada daerah panggul dan pinggang bagian belakang bawah. Sehingga sering menimbulkan nyeri pinggang dan lebih mudah kehilangan keseimbangan serta terjatuh terutama pada akhir kehamilan.

Akibat penambahanan cairan yang banyak selama hamil, jantung wanita hamil lumayan bekerja kerasm jadi jangan ditambah berat lagi dengan tehnik olahraga yang tidak benar. Intensitas olahraga yang sedang. Patokannya adalah wanit hamil masih bisa berbicara normal saat melakukan olahraga.

Manfaat yang bisa didapatkan dengan olahraga selama kehamilan adalah:
* Mengurangi nyeri pinggang, konstipasi, kembung dan bengka
* Dapat mencegah dan mengobati dibetes dalam kehamilan
* Meningkatkan energi
* Memperbaiki mood
* Memperbaiki postur
* Meningkatkan kekuatan dan ketahanan otot
* Membantu tidur lebih nyenyak
* Meminimalisir nyeri saat persalinan

Pastikan dulu ke dokter, bahwa ibu tidak memiliki kontra indikasi untuk melakukan olahraga selama hamil. Kondisi dibawah ini dilarang melakukan olahraga:
* Memiliki risiko persalinan kurang bulan
* Perdarahan pervagina
* Ketuban pecah sebelum waktunya

Saat berolahraga ikuti panduan umum sebagai berikut:
* Setelah TM I, hindari olaharag yang melibatkan pinggang
* Hindari olahraga dalam cuaca panas
* memakai pakain yang nyaman/dingin
* Memakai bra yang men-suport payudara
* Banayk minum agar jangan sampai terlalau panas dan dehidrasi
* Pastikan mengkonsumsi kalori yang cukup untuk kehamilan

Pada umumnya berbagai bentuk olahraga adalah aman selama kehamilan. Berikut ini beberapa olahraga yang aman dilakukan selama kehamilan:
* Berjalan
* Berenanag
* Bersepeda (sebaiknya sepeda statis agar terhindar dari jatuh)
* Aerobics (yang khusus dirancang untuk wanita hamil, low impact atau aerobik di air)
* Latihan kekuatan otot

Berikut ini olahraga yang harus dihindari:
* Olaha raga yang mempergunakan raket
* Olahraga kontak
* Scuba diving
* Gymnastics, water skiing, dan menunggang kuda

Olahraga selama kehamilan dilakukan lebih mudah pada 24 minggu pertama. Selama 3 bulan terakhir biasanya akan sulit melakukan olahraga dan merupakan hal yang lumrah.
Mulai sedikit demi sedikit. Awalnya lakukan selam 5 mmenit perhari, naikkan bertahap sampai akhirnya bisa 30 menit perhari.

Sebelum berolahraga, lakukan pemanasan (warming-up) selama 5–10 menit, dengan melakukan aktifitas ringan seperti berjalan. Selama warming up lakukan peregangkan otot. Setiap regangan lakukan selama minimal 10–20 detik. Selesaa berolah raga, lakukan pendinginan (cool down) dengan mengurangi aktifitas perlahan-lahan selama 5–10 menit.

Segera hentikan olahraga jika ditemukan hal-hal berikut ini:
* Perdarahan pervagina
* Pusing atau ingin pingsan
* Nafas tersengal-sengal
* Nyeri dada
* Sakit kepala
* Otot terasa lemas
* Nyeri betis
* Kontraksi rahim
* Penurunan gerak bayi
* Keluar cairan pervagina (Pecah ketuban)

Sumber: ACOG

genital wart therapy

Treatment options for genital warts include therapies that are patient applied and those that are clinician administered, based on the size and location of lesions.
Some patients elect to forgo treatment, because many lesions regress spontaneously. However, many patients have recurrent disease within 3–6 months after treatment,
particularly those who are infected with HIV. The goals in treatment of external genital warts are to provide symptomatic relief or cosmesis, or to alleviate anxiety. The type of treatment chosen depends on the size and location of the lesion, and the reasons for treatment.
Other factors that may influence treatment choices include patient preference, cost, adverse effects of treatment, and provider experience.

As noted below, some treatment options are contraindicated in pregnancy, and this needs to be considered. In general, smaller lesions are easier to treat than larger ones. Warts that are smaller than 1 cm2 at the base are more likely to be successfully treated by topical therapy alone. In contrast, diffuse and large lesions may require surgical intervention.
outlines a treatment algorithm for genital warts. We sometimes choose not to treat large, circumferential perianal genital warts if they are not symptomatic. The reason for this is that multiple staged procedures are usually needed for complete treatment, surgery is
painful, and lesions are often recurrent. We would only recommend surgery in these cases to remove foci of disease that are causing symptoms, or if the goal is to rule
out invasive cancer.

Warts that are located on dry surfaces, are chronic (duration >1 year), or are multiple (>10) are more difficult to treat. Many patients require multiple treatments before successful removal of genital warts, and warts may recur after several months. There is no evidence
that one therapeutic modality is superior to another, and the agent chosen may depend on local availability or experience of the clinician in using a particular treatment modality. The impact of treatment on the transmission of genital warts is unknown.

A. PATIENT-APPLIED THERAPIES

Imiquimod 5% cream (Aldara) is a topical immune response modifier that induces cytokines locally without a direct antiviral effect. Patients apply 5% cream once daily
before bedtime, three times a week for up to 16 weeks. Six to ten hours following the application, the affected area should be washed off with soap and water. Unlike podophyllotoxin (discussed below), there is no limit to the surface area that can be treated.

The major adverse effect is mild to moderate local erythema. The safety of imiquimod in pregnancy has not been established, and it should not be used by pregnant women (category C).
Podofilox 0.5% solution or gel (Condylox Gel) works by arresting the cell cycle in metaphase, leading to cell death. Patients can apply the gel with a finger, or the
solution with a cotton swab to palpable warts. Podofilox is used twice daily for 3 days, followed by no therapy for 4 days. Up to four cycles may be performed. A maximum
surface area of 10 cm2 is recommended, and the total daily volume of podofilox should not exceed 0.5 mL.

Adverse effects include mild skin irritation, but local ulceration and pain can occur depending on the duration of use. Safety in pregnancy has not been established
(category C).

B. PROVIDER-APPLIED THERAPIES

Cryotherapy can be performed in the office using liquid nitrogen spray, a liquid nitrogen–soaked swab, or a cryoprobe cooled with nitrous oxide. The freeze-thaw cycle produces cell lysis and destruction of the wart. The freeze margin should extend 2–3 mm beyond the margins of
the wart. Cryotherapy can be repeated every 3 weeks.
Adverse effects include some pain during and for a variable time after the procedure. Swelling and erythema may also occur. This treatment modality is safe for use during pregnancy.
Podophyllin resin 25% in tincture of benzoin (Podocon-25; Paddock Laboratories, Minneapolis, MN) is similar to podofilox except that it is provider applied. The liquid is applied to the affected area, allowed to dry, and washed off after 6 hours. Total volume should not
exceed 0.5 mL per session. Therapy may be repeated in 1 week. Adverse effects include skin irritation, ulceration, and pain, depending on how much solution is applied.
Rarely, polyneuritis, paresthesias, leucopenia, and thrombocytopenia may occur. Safety in pregnancy has not been established (category C).

Trichloroacetic acid (TCA), 80%, destroys affected tissue by protein coagulation. Typically, a small quantity of TCA is applied to the lesion until it appears white or
frosted; the acid is then allowed to dry. Care should be taken to ensure that TCA does not run off the lesion to cover areas of normal skin. To provide greater control,
we soak the stick end of a cotton swab in a small amount of TCA and apply it by touching the stick end to the lesion. Temporary burning may occur at the time of application to the wart. If too much TCA is applied, or if surrounding tissue is inadvertently treated—resulting
in substantial pain—talc, liquid soap, or sodium bicarbonate can be used to neutralize the acid. A barrier of petroleum jelly could also be used to protect areas adjacent
to the wart undergoing treatment. As with cryotherapy multiple treatment applications are often necessary. TCA is safe for use during pregnancy.

C. SURGICAL OPTIONS
Use of an infrared coagulator (Redfield Corporation, Rochelle Park, NJ) is an FDA-approved option for the treatment of genital warts. The infrared coagulator uses
light technology to generate intense heat at the tip of the device, producing coagulative necrosis without a smoke plume. This procedure can be performed in the office using local anesthesia only. The infrared coagulator is particularly useful for larger lesions that would have normally required intraoperative fulguration or laser surgery.
Laser surgery is an option for extensive genital warts, particularly those that have been refractory to other treatment modalities. Trained operators focus the laser
on affected tissue. Laser energy is converted into heat, vaporizing the genital wart. The maximum recommended depth of tissue destruction is 1 mm. Adverse effects include pain and scarring, and operators may develop warts by dispersion of virions during the procedure.

This procedure is performed in the operating room under anesthesia and is one of the most expensive treatment options for genital warts. It can also be done in the office.
Scissor excision and other excisional procedures are considered first-line therapy by some providers for large warts causing obstructive symptoms. After local anesthesia,
the wart is usually excised down to normal tissue or mucosa (using fine scissors or a scalpel), and the roots of the lesion are destroyed by electrocautery, with no
further hemostasis required. Suturing is rarely needed.

Complications include strictures and scarring, particularly if subcutaneous tissue or submucosal fat is inadvertently cauterized.

D.OTHER TREATMENT OPTIONS

5-Fluorouracil (5-FU) can be used as a gel with epinephrine and injected intralesionally for the treatment of genital warts. 5-FU acts by blocking the methylation of
deoxyuridylic acid, arresting DNA synthesis and causing cell death. Adverse effects—pain and ulceration, with dysuria if used in the urethra—limit the use of this drug.
5-FU is not recommended during pregnancy (category D). Cidofovir disrupts viral chain elongation by competitively inhibiting the incorporation of deoxycytidine
triphosphate (dCTP) into viral DNA. Applied topically as a 1% gel, cidofovir has been demonstrated to be effective in a randomized controlled trial of the treatment of
genital warts. This therapy is still experimental.

Interferon alfa can be given systemically, topically (not generally effective), or, as is more often the case,intralesionally. Intralesional interferon is not FDAcleared for the treatment of genital warts although it is used widely.

Kehamilan dan Radikal Bebas

Radikal bebas (selanjutnya disebut radikal) adalah atom atau sekelompok atom yang memilki sejumlah elektron yang tidak berpasangan dan dapat terbentuk jika oksigen berinteraksi dengan molekul tertentu. Begitu terbentuk akan menimbulkan reaksi berantai seperti domino.

Sumber radikal bebas adalah bisa berasal dari dalam tubuh misalnya akibat proses autooksidasi oleh enzim tubuh ataupun yang berasal dari luar seperti: obat2an, radiasi, merokok, debu (asbes atau silikon), gas (asap kendaraan), olah raga yang berlebihan dan lain2.

Lokasi utama kerusakan akibat radikal adalah DNA dalam mitokondria. Mitokondria merupakan membran pada sel yang menghasilkan energi bagi sel. DNA berlokasi pada inti sel, yang berfungsi sebagai pusat komando. Karena itu kerusakan DNA lama kelamaan akan mematikan mitokondria, menyebabkan sel mati dan organisme menjadi tua.

Tempat lainnya yang di rusak adalah membarn sel. Membran ini terbuat dari lemak tak jenuh. Yang mana molekulnya2 sangan sukseptibel terhadap radikal bebas sehinggan akan menyebabkan rekasi berantai yang tidak terkontrol. Dinding sel menjadi keras sehingga tidak mungkin bagi sel mendapatkan makanan yang cukup, mendapatkan sinyal yyang cukup dari sel lain untuk bekerjasama, serta banyak aktifitas sel lainnya akan terganggu.

Adanya radikal bebas yang bisa merusak endotel pembuluh darah akan menyebabkan kenaikan tekanan darah pada wanita hamil yang dikenal dengan preeklampsia (tekanan darah tinggi dalam kehamilan, murni karena kehamilannya).

Antioksidan adalah molekul yang dapat berikatan dengan radikal dengan aman dan menghentikan reaksi berantai sebelum kerusakan sel terjadi. Yang termasuk didalamnya adalah vitamin E, beta-carotene, dan vitamin C. Tubuh manusia tidak bisa menghasilkan sendiri zat2 ini sehingga disupply dari makanan.

Vitamin E (d-alpha tocopherol). Vitamin yang larut dalam lemak, banyak ditemukan pada kacang, biji2an, sayuran dan minyak ikan, gandum, cereal, dan buah apricot. Kebutuhan sehari2 adalah 15 IU per-hari (Co) dan 12 IU (Ce) (Nature E 400 IU).

Vitamin C (Ascorbic acid) merupakan vitamin yang larut dalam air, ditemukan dalam jeruk, lada hijau, kol, bayam, broccoli, kiwi, dand strawberri. Kebutuhan hariannya sebesar 60 mg per-hari. Mengkonsumsi lebih dari 2000 mg perhari akan menyebabkan efek samping.(CDR 1000 mg vit C)

Beta-carotene merupakan zat pembentuk vitamin A atau retinol. Ditemukan dalam hati, kuning telur, susu, mentega, bayam, wortel, broccoli, tomat dll. Karena beta-carotene dirubah oleh tubuh menjadi vitamin A, maka tidak ada jadi tidak ada kebutuhannya berapa perharinya.

Antioksidan juga berfungsi mencegah kanker, memperlambat penuaan, mencegah sakit jantung dan stroke, tetapi semua data2nya masih non-konklusif. Sehingga dari sudt pandang kesehatan publik terlalu prematur untuk merekomendasikan suplemen antioksidan untuk mencegah kelainan2 diatas.

Namun tidak ada ruginya untuk mencobanya. Jadi selama hamil usahakan cukup mengkonsumsi antioksidan.

online classes for medical assistants

Nowaday to study any subject is not difficult anymore. What was in the past is not the same today since the invention of internet. We can learn and study anything via online just from our convenience home using our pc or notebook.

If you one of those who love to help people and care for them, or one that is interested in medical assistant field, and want to look for a new career but already has prior commitments such as a job or children so you have no time to enter any medical assistant schools, the medical assistant program from St. Augustine School of Medical Assistants will solve your problem.

At St. Augustine School of Medical Assistants they strive hard to help you achieve your career goal of becoming a Medical Assistant. A medical assistant certificate can mean greater career opportunity, faster promotion, and higher income. Their program makes a medical assistant education very affordable and yet completely flexible to suit your personal needs. This "anytime e-Learning" distance edcuation program allows you to study online at your own pace and take classes at your convenience. All programs are available online 24 hours and 7 days a week. To make your medical assistant training and education more effective their team comprises of experts in the field of healthcare and education, so you can earn your certificate in the most convenient and efficient way possible.

Here are the lists of Medical Assistants Program Classes Online they provide :

Medical Terminology, Human Body Planes, Basic Human Anatomy and Physiology, Medical Office Professionalism, Patient Communication, Medical Records, Basic Medical Law, Scheduling Appointments, Medical Billing and Insurance Claims, Infection Control, Surgical Instruments, Emergency Care, Clinical Equipment, Patient History and Physicals, EKG and Lab Testing, Specimen Collection and Lab Safety, Introduction to Patient Medications.

Online Medical Assistant Clinical Labs: Virtual Phlebotomy Lab (Collecting a Blood Sample), Virtual Injection Lab , Medication injections, Measuring A Pulse, Introduction to CPR and Basic Ultrasound.

So remember this message anytime you look for a medical assistant online class.

Diagnosis Kehamilan

Dalam post ini aku nggak akan menulis segala hal tentang bagaimana mendiagnosa suatu kehamilan, karena akan sangat tehnis sekali. Tulisan ini aku buat terinspirasi dari kasus yang ditemukan di lapangan.

Kasus I
Ce masih SMA, dengan pembengkakan pada perut, yang oleh pengirim rujukannya dikatakan tumor dalam perut.
Kasus II
Ce baru tamat SMA, sudah berobat kemana2 dengan diagnosa magh yang parah (mual muntah yang parah)
Kasus III
Wanita anak satu, yang tidak haid2 karena suntik KB, setelah di periksa hamilnya sudah 6 bulan (yang mirip ini banyak kasusnya)

Pada kasus2 diatas sering keluarga pasien surprise dan gak yakin kalau dikatakan anak/isterinya hamil. "Masak sih dokter?" gitu responnya..."coba periksa betul2 lagi dok..." gitu respon selanjutnya.

Apakah tenaga kesehatan kita begitu bodohnya sehingga tidak bisa/sulit menilai/mendiagnosa suatu kehamilan ? Jawabnya tidak lah...tapi kenapa terjadi juga/ luput ? (seperti contoh2 diatas).

Jawabnya :
1. Terlalu lugu.
Lugu artinya nggak punya pikiran macam2 sehingga tidak berpikir kreatif. Contohnya pada kasus I dan II, Nggak kepikiran sama petugas kalau anak sekarang dalam bergaul terkadang sudah melebihi ambang "batas" (susila dan agama)

2. Terlalu percaya.
Mirip dengan yang pertama. Percaya saja dengan status "gadis/nona", sehingga gak memikirkan kemungkinan lain (kehamilan)

3. Terlalu under estimate.
Contohnya pada kasus yang nomor III. Memang sering ditemukan suntik KB membuat akseptor tidak haid, tetapi jangan sampai "terlena" dan tidak memperhatikan keluhan pasien, secara berkala tetap juga dilakukan pemeriksaan kehamilan (murah dan mudah) dengan test strip kehamilan. Karena angka kebobolan KB-kan ada (walau kecil jika dilaksanakan dengan benar).

Aku jadi teringat senior yang juga guru dalam pendidikan yang dalam menguji mahasiswa kedokteran selalu menanyakan diagnosis kehamilan. Katanya sebagai dokter jangan sampai nggak bisa mendiagnosis kehamilan .

Mohon maaf, tulisan ini tidak bermaksud apa2, cuma sebagai pengingat saja agar selalu bersikap profesional dalam bekerja. Jangan terlalu lugu, terlalau percaya serta under estimate...(over estimate juga gak boleh kan )

ZOIC Nutrition Drink

View ZOIC Nutrition Drink, Belgian Chocolate (Pack of 24)


Product Description
ZOIC – meaning “pertaining to life” – was created to satisfy increasing consumer demand for healthy and convenient nutritional products. ZOIC is different from most other nutritional beverages that typically have high calories, high-fructose corn syrup or other added sugars, and/or high fat content. It was specially formulated to provide an optimum mix of 21 grams of high-quality proteins, 26 vitamins & minerals including antioxidants, and dietary fiber. Each serving has only 110 calories, 2 net grams of carbohydrates with no sugar added, and is 99% fat free. ZOIC’s nutrient composition makes it ideal for general nutrition, weight management, exercise & fitness, and glycemic control. ZOIC is certified by the American Heart Association [AHA], qualified under the US FDA Heart Health Claim, meets all American Diabetic Association [ADA] meal plan guidelines, and is USDA inspected as true to content. Additionally, ZOIC is Union Orthodox Kosher certified - an independent verification of quality, integrity & purity. 11oz cans/24 per case -- 19.4 lbs per case -- case dimensions 5"H x 16.25"L x 10.75"W

Lipton 100% Green Tea, Tea Bags, 20-Count Boxes (Pack of 12)

View Lipton 100% Green Tea, Tea Bags, 20-Count Boxes (Pack of 12)


About the Brand
Lipton is the world's best-known and best-selling brand of tea, and is the global market leader in both leaf and ready-to-drink tea, with a global market share nearly three times larger than its nearest rival. Available in more than 110 countries, Lipton is particularly popular in Europe, North America, and the Middle East and parts of Asia.

Lipton is a member of the Unilever family of brands.

About Unilever
Unilever brands are trusted everywhere; in fact, 150 million times a day, someone somewhere chooses a Unilever product. Among its many well-known food brands are Bestfoods, Knorr, Birds Eye, Bertolli, Lipton, and Ben & Jerry's. Many of its home care and personal care products are market leaders, including Brilhante, Cif, Comfort, Dove, Lux, Pond's, Rexona and Sunsilk. In other words, look in your refrigerator, freezer, or bathroom cabinet, and you're likely to find a Unilever product.

Slim-Fast Low-Carb Ready To Drink, Creamy Chocolate

View Slim-Fast Low-Carb Ready To Drink, Creamy Chocolate, 11-Ounce Cans in 4-Count Boxes (Pack of 6)


Important Information
Ingredients
Water, Calcium Caseinate, Milk Protein Concentrate, Canola Oil, Cocoa (Processed With Alkali), Potassium Phosphate, Mono and Diglycerides, Cellulose Gel, Glycerine, Maltodextrin, Cellulose Gum, Salt, Soybean Lecithin, Guar Gum, Sucralose (A Nonnutritive Sweetener), Artificial Flavor, Carrageenan, Sodium Citrate and Citric Acid. Vitamins and Minerals: Magnesium Phosphate, Sodium Ascorbate, Calcium Phosphate, Vitamin E Acetate, Zinc Gluconate, Ferric Orthophosphate, Niacinamide, Calcium Pantothenate, Manganese Sulfate, Vitamin A Palmitate, Pyridoxine Hydrochloride, Riboflavin, Thiamin Mononitrate, Folic Acid, Chromium Chloride, Biotin, Sodium Molybdate, Potassium Iodide, Phylloquinone (Vitamin K1), Sodium Selenite, Cyanocobalamin (Vitamin B12) and Cholecalciferol (Vitamin D3).

HELLP Syndrome

HELLP nya sedikit plesetan dari HELP , karena memang jika mengalami kondisi ini sangat mebutuhkan pertolongan/pengobatan segera. Sesuai dengan namanya sindroma merupakan kumpulan dari gejala/tanda. HELLP merupakan singkatan dari Hemolisis (pecahnya sel darah merah), Elevated Liver enyme (meningkatnya enzim2 di hati akibat kerusakannya) dan Low Platelet count (menurunnya kadar sel trombosit, mudah berdarah dan sulit membeku).

Kondisi ini merupakan komplikasi dari preeklampsia (tekanan darah tinggi dalam kehamilan disertai bengkak pada kaki serta bocornya protein lewat pipis)/eklampsia (preeklampsia plus kejang). Kondisi ini sering timbul pada trimester III kehamilan.

Diklasifikasikan ringan-beratnya berdasarkan kadar trombositnya. Derajat satu jika kadar trombosit masih diatas 100, Derajat II : 50 - 100 ribu dan derajat III : kurang dari 50 ribu. Untuk informasi, perdarahan spontan (mimisan, perdarahan gusi, bercak2 dikulit, perdarahan via anus dll) baru timbul jika kadar trombosit kurang dari 20 ribu. Derajat ini gunanya untuk memprediksi prognosa (baik/buruknya) perjalan penyakit.

Pengobatan yang terbaik adalah mengakhiri kehamilan sesegera mungkin setelah diagnosa ditegakkan, selambat2nya dalam 48 jam pertama, sering bayi harus dilahirkan kurang bulan. Dapat diberikan kortikosteroid dosis tinggi berupa dexametason 2 kali 10 mg. Transfusi jika terjadi anemia dan perdarahan. Kondisi penyakitnya akan membaik setelah 2-3 hari paska melahirkan.

Tidak ada cara pencegahannya, jika ibu sudah mulai mengalami kenaikan tekanan darah, maka harus rajin memeriksakan diri, serta segera menemui dokter jika merasakan adanya kelainan (sakit kepala) , mata kabur atau nyeri ulu hati.

Bayi Mogok nyusu

Bayi mogok menyusui istilah kerennya nursing strike bisa disebabkan oleh berbagai sebab. Mogok nyusu merupakan cara bayi memperlihatkan bahwa ada sesuatu yang tidak beres. Sehingga ibu harus mencari penyebabnya seperti layaknya seorang detektif .

Menurut La Leche League International beberapa penyebab mogok menyusui disebabkan oleh hal-hal sebagai berikut :

Adanya nyeri pada rongga mulut akibat tumbuh gigi, sariawan (sore) atau infeksi (thrush)

Pada bayi yang lebih besar, bisa akibat ketakutan karena jeritan atau marah ibunya seperti saat digigit sang ibu menjerit atau marah.

Infeksi telinga, yang membuat saat menyusui menjadi susah dan nyeri.

Hidung bayi yang tersumbat, akibatnya bayi susah bernafas saat menyusui.

Terlalu sering memakai botol atau dot (kempeng)

Gangguan rutinitas bayi, seperti ibu yang harus bekerja sehingga jadwal menyusui terganggu.

Lama berpisah dengan bayi.

Rasa asi yang berubah akibat vitamin, obat atau makanan tertentu. Gejalanya pada bayi berupa kembung dan banyak mengeluarkan gas.

Apa yang harus dilakukan jika bayi mogok menyusui?
Mogok menyusui merupakan hal yang sulit untuk ditanggulangi bahkan pada seorang ibu dengan dedikasi yang tinggi untuk menyusui sekalipun. Dengan kesabaran dan dukungan semua pihak pemogokan ini biasanya bisa diatasi.

Hal-hal berikut ini dapat diterapkan untuk mengatasinya:

Coba menyusukan bayi saat bayi sedang tidur atau saat bayi mengantuk. Banyak bayi yang nggak mau menyusui saat terbangun akan mau saat sedang mengantuk.

Periksakan ke dokter anak akan adanya kemungkinan penyebab infeksi dll.

Variasikan posisi menyusui.

Melakukan rocking saat menyusui seperti menggoyang-goyangkan tubuh kekiri-kekanan dll.

Usahakan menyusui ditempat yang tenang dan tidak menarik perhatian bayi ke suasana sekitarnya.

Berikan sebanyak mungkin kontak kulit ibu dengan kulit bayi misalnya dengan menyusui tanpa memakai baju. (weh sexy nich...)

Hindari makanan yang dapat merangsang bayi seperti cafein, makanan pedas, coklat.

Dengan kesabaran dan ketelatenan seorang ibu inya Allah masalah ini akan teratasi.

Genital wart what is it ?

Genital wart or Condyloma Acuminata is a Gray or flesh-colored, pedunculated, and moist papules on the penis, urethra, vulva, cervix, anus, or perineal and perianal areas. One or several grouped lesions may be present, ranging in size from a few millimeters to several centimeters.

Genital warts should not be confused with manifestations of other Sxually Transmitted Diseases such as condylomata lata of secondary syphilis. Condylomata lata are characterized
by large, white or gray, raised, moist, and flat lesions. In contrast, external genital warts are typically dry and cauliflower-like. If condylomata lata are suspected, serologic tests for syphilis (rapid plasma reagin [RPR], Venereal Disease Research Laboratories [VDRL], with confirmatory treponemal tests such as the Treponema pallidum particle agglutination assay [TP-PA]) will be positive, and surface scrapings of the lesion will reveal spirochetes under darkfield microscopy.

The lesions of the poxvirus, molluscum contagiosum, are shiny and umbilicated papules that may appear anywhere on the body except the palms and soles. These flesh-colored lesions are 2–5 mm, appear singly or in groups, and may sometimes be difficult to distinguish from genital warts. Unlike genital warts, however, molluscum contagiosum causes smooth and only rarely pedunculated lesions that may express cheesy material. Although most self-resolve in immunocompetent patients, the lesions can be particularly recalcitrant in AIDS patients with low CD4 T-cell counts.

A normal anatomic variant of the corona in men, pearly penile papules, can sometimes be mistaken for genital warts. Analogous lesions in women occur in the vulvar introitus. One clue to the diagnosis of these variants of normal anatomy is to look at the base of the lesions. In the normal variants, each normal papilla can be seen to arise from its own base; by contrast, in anogenital warts, multiple papillae typically arise from a single base. Lichen planus, nevi, and seborrheic keratoses may also be rarely confused with genital warts.

CAUSE
Human papillomavirus (HPV) is one of the most common sexually transmitted diseases (STDs) and is the cause of genital warts (condylomata acuminata), anogenital dysplasia, and invasive cancer. Oral warts may also occur as a direct consequence of HPV infection during sexual activity. At least 75% of sexually active men and women acquire one or more genital HPV types at some point in their lifetime.

The incubation period from HPV infection to condyloma is usually 3–4 months, with a range of 1 month to 2 years, but many infected persons have subclinical disease or have regression of disease before it becomes clinically apparent. HIV-infected patients have a higher prevalence of genital warts than HIV-uninfected patients. These may proliferate further during immune reconstitution following the initiation of antiretroviral therapy.

There are more than 100 different HPV types; 40 of these can cause anogenital lesions. HPV types 6 and 11 are most commonly associated with genital warts; these types have a low risk of malignant transformation. Other types (eg, 16, 18, 31, 33, and 35) have a strong association withcervical and other anogenital cancers. Thus, genital warts lie on one spectrum of a continuum of HPV-associated.

PATHOGENESIS
Most anogenital HPV is believed to be acquired via sexual transmission. Following acquisition of infection, HPV infection is established initially in the basal cells of the anogenital epithelium. As the basal cells differentiate and rise to the epithelial surface, HPV replicates and virions
form. A spectrum of disease occurs, depending on the degree of mitotic activity and replacement of the epithelium with immature basaloid cells. In the cervix, this ranges from genital warts or mild dysplasia (CIN 1) to moderate or severe dysplasia (CIN 2 and CIN 3).

SYMPTOMS AND SIGN
Genital warts appear as characteristic well-circumscribed, exophytic papules that may be pedunculated. Some warts may be flat. The adjacent skin usually appears normal. They range in size from a few millimeters to several centimeters, with some warts coalescing to form larger plaques. The median number of warts in an individual patient is seven although there is a large range from patient to patient.

Most genital warts in circumcised men occur in the penile shaft. In uncircumcised men, they occur mainly in the preputial cavity where the penile shaft meets the glans. Other common locations for genital warts in men include the perianal area, particularly among men who have sex with men (MSM), and the urethral meatus. Less frequently, genital warts are seen on the scrotum and perineum.intra-anal warts can be very common as well. Among women, most lesions are found in the posterior introitus, the labia majora and minora , and the clitoris. Other less common locations in women are the perineum, vagina, anus, cervix, and urethra.

Symptoms of genital warts may include burning, itching, pain,
and fullness (urethra, vagina, or anus); however, many patients are asymptomatic.

Patients with genital warts may complain of itching, burning, bleeding, and pain. Patients with large genital warts may have a sensation of fullness and this may interfere with intercourse, vaginal delivery, and defecation. However, many patients have no symptoms.

Most genital warts are diagnosed by the characteristic appearance on clinical examination only. If lesions look atypical or have features that may be consistent with malignancy such as induration, ulceration, and pigmentation, biopsy with histologic evaluation should be
considered.

PREVENTION
The most reliable method of preventing HPV acquisition is abstinence from sexual activity, including skin-to-skin contact. However, there is strong evidence that male tion, as well as HPV-associated diseases such as genital warts, CIN 2 or 3, and invasive cervical cancer. Although not recommended by the US Centers for Disease Control and Prevention (CDC), partner evaluation may offer an opportunity to screen and provide education on HPV and other STDs.

Preventive vaccines are promising new options. A multivalent vaccine against four HPV subtypes (6, 11, 16, and 18) was approved by the Food and Drug Administration (FDA) for use in women and girls aged 9–26 years in June 2006. These immunizations use components of the major HPV capsid proteins that assemble into viruslike particles that contain no HPV DNA and thus are not infectious.

Vaccination with viruslike particles is designed to induce neutralizing antibodies prior to initial HPV exposure by the host. In large, randomized controlled trials, excellent
efficacy has been demonstrated against certain HPV types, including 6, 11 (which can cause anogenital warts), and 16 and 18 (which can cause invasive cervical and other
anogenital cancers). Future trials will test the efficacy of combined vaccines for additional types.

COMPLICATIONS
Genital warts have little risk of progression to invasive cancer. However, individuals with genital warts usually have shared risk factors for oncogenic HPV types that cause high-grade CIN and anal intraepithelial neoplasia.These are the true precancerous lesions and are the target of Pap screening programs.

In relation between Genital warts and pregnancy, it is know that genital warts may proliferate and increase in size during pregnancy and can obstruct the pelvic outlet during vaginal delivery. A rare complicationin children born to women with genital warts is recurrent respiratory papillomatosis. Warts develop in the infants’ throats, commonly the vocal cords, causing hoarseness or stridor. These warts are frequently removed, usually by laser surgery, to prevent the possibility of respiratory failure. Because the prevalence of recurrent respiratory papillomatosis is so low, cesarean delivery is not usually recommended as a preventive measure in pregnant women with genital warts.

western union cash untuk publisher google adsense Indonesia

Good news for Indonesian Google adsense publisher, now western union cash is available for payment method. It's now easy, quick and free to receive your google salary. Keep blogging pals :)

Kabar gembira untuk publisher google adsense di Indonesia karena Google telah menggunakan jasa western union cash untuk membayar kita. Kalau sebelumnya kita mesti nunggu dulu cek google yang dikirim ke alamat rumah kita blum lagi mesti dicairkan di bank yang kadang membutuhkan waktu lama dan biaya tambahan, maka dengan western union segalanya jadi mudah,cepat dan gratis alias tanpa biaya tambahan. Untuk melihat alamat cabang western union di daerah anda silahkan kunjungi www.paypment-solutions.com/agent.asp

Untuk selengkapnya berikut kutipan email dari google yg nyampe tadi siang :

Hello,

We're excited to introduce Western Union Quick Cash as a new payment method
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and will be available for pickup at your local Western Union agent the day
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names and not to businesses.

* Payments must be picked up within 60 days of issuance or they will expire.
If this happens, a payment hold will be placed on your AdSense account and
the payment will be credited back to your account.

*Payments will be made in US dollars, but depending on your local Western
Union agent, they may be picked up in your local currency.

To sign up for this new payment method, please follow these instructions:
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visiting our Help Center
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We hope you enjoy this new payment option!

Sincerely,

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Google Inc.
1600 Amphitheatre Parkway
Mountain View, CA 94043
USA

Rubella dalam kehamilan

Rubella atau German measles, sangat membahayakan janin jika terjadi dalam 16 minggu pertama kehamilan. Rubella dapat menyebabkan keguguran, lahir mati dan cacat bawaan pada bayi berupa : tuli, kerusakan otak, kelainan jantung dan katarak.

Kelainan2 ini dinamakan congenital rubella syndrome. Masuknya virus ke bayi melalui plasenta. diluar negri kasus ini sudah semakin jarang karena vaksinasi sudah dilakukan sedini mungkin saat masih sekolah atau bagian dari vaksin MMR.

Rubella ditularkan dari orang ke orang melalui batuk dan bersin. Jika sudah terimunisasi maka bayi yang dikandung akan aman terhadap infeksi Rubella. Namun demikian ada baiknya untuk mengecek imunitas atau kekebalan diri terhadap Rubella sebelum merencanakan kehamilan.
Karena imunisasi yang sudah lama tidak memberikan lagi perlindungan.

Jika tidak terdapat imunitas, imunisasi tidak bisa diberikan saat sedang hamil. Setelah imunisasi juga harus menunda kehamilan sekurang-kurangnya 1 bulan, karena vakisnnya mengandung virus Rubella yang dilemahkan. Gejala infeksi Rubella hanya berupa gejala2 infeksi pada umumnya seperti demam, sakit kepala, nyeri sendi dan sakit tenggorokan. Kemudian muncul bintik merah-pink.

Risiko terhadap kehamilan berdasarkan usia kehamilan terkena infeksi :
Trimester I ( 0 s/d 13 minggu): sangatberisiko karena 90 bayi akan terkena, semakin dini usia kehamilan maka semakin besar risikonya terhadap bayi.

Trimester II ( 14 s/d 26 minggu): Pada usia kehamilan ini untuk usia 14 - 15 minggu masih terdapat risiko pada bayi berupa gangguan penglihatan dan pendengaran. Setelah kehamilan 16 minggu biasanya risikonya menjadi rendah. Sehingga risiko pada trimestretiga juga rendah. Cara penecahan terbaik adalah menhindari kontak dengan orang yang terkena infeksi Rubella.

Tidak ada pengobatan spesifik untuk membunuh virus ini. Karena gejalanya ringan biasanya tidak membutuhkan pengobatan. Cukup istirahat dan diet bergizi serta pengobatan gejala2 jika diperlukan berupa obat demam, obat batuk dll. Jika tidak terjadi komplikasi maka gejala2nya akan hilang sendiri dalam 7 - 10 hari.

Saat terkena infeksi virus ini, tubuh akan membuat antibodi untuk melawan dan menyingkirkan infeksi. Sekali terkena virus ini biasanya akan imun seumur hidup. Sangat jarang sekali ada infeksi untuk kedua kalinya (tapi ada)

Zyrtec Allergy Relief (10 mg), 45-Count Tablets

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Product Description
ZYRTEC (cetirizine HCl) is a prescription medicine that treats both indoor and outdoor allergy symptoms. And it also treats itching due to chronic hives. Studies show that 1 dose of ZYRTEC works for a full 24 hours. ZYRTEC is also great for the whole family. ZYRTEC is approved to treat indoor and outdoor allergy symptoms in adults and children as young as 2 years old. And it's also approved to treat indoor allergy symptoms in infants as young as 6 months. It's easy to recognize ZYRTEC. ZYRTEC tablets are white in color. And they have the name ZYRTEC engraved on them. ZYRTEC chewable tablets are purple in color. They also have the ZYRTEC name engraved on them. Another formulation is ZYRTEC syrup, which is a clear liquid with a banana-grape flavor.

Product Description
Cetirizine HCl/Antihistamine 10 mg tablets. Original prescription strength. Indoor & outdoor allergies. 24 Hour Relief of Sneezing Runny nose Itchy, watery eyes Itchy throat or nose 45 Tablets 10 mg each - Individual blisters. Made in USA. Temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: runny nose sneezing itchy, watery eyes itching of the nose or throat

Glucerna Shake Strawberries n Cream, 8 Ounce Bottles (Pack of 24)

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Clearblue Easy Fertility Monitor Test Sticks, 30-Count Box

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Product Description
Helps Maximize Your Chances of Conceiving Your Baby. 30 test sticks - 3 Month Supply. Only for use with the Clearblue Easy Fertility Monitor - Monitor sold separately. Unipath Research - Quality Tested. Helps Reduce the Time it Takes to Conceive Your Baby. Nearly all couples who conceive do so as a result of having intercourse during the six days leading up to and including ovulation. The Clearblue Easy Fertility Monitor is the first and only technology based solely on hormone monitoring that provides you with personalized daily fertility information for pregnancy planning. The Clearblue Easy Fertility Monitor: Displays your most fertile days unmistakably. Identifies your personal level of fertility every day. Tells you which days to test. The Clearblue Easy Fertility Monitor Test Sticks are an essential part of the Clearblue Easy Fertility Monitor. No other Test Sticks can be used with the Fertility Monitor. This package contains 30 Fertility Monitor Test Sticks, which is a 3 month supply. Please read the enclosed instruction leaflet before using the Test Sticks. Instructions appear in English and Spanish. The majority of women will need 10 test sticks each cycle. Monitor sold separately. For questions, call the Clearblue Easy Toll-Free Helpline Mon - Fri 8:30 a.m. - 5:00 p.m. ET: 1-800-321-EASY. Made in U.K.

Product Description
Nearly all couples who conceive do so as a result of having intercourse during the six days leading up to and including ovulation. The Clearblue Easy® Fertility Monitor is the first and only technology based solely on hormone monitoring that provides you with personalized daily fertility information for pregnancy planning.

Sponge One Box of 3 Contraceptive Sponges

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Product Description
The Today Sponge is a hormone-free birth control option that provides women with what they most often look for in a contraceptive: effectiveness, safety, easy to use, confidence, and spontaneity. And because its available without a prescription, and doesn't require any additional messy spermicide creams or gels, its also very convenient. Made of a soft, disposable medical grade polyurethane foam that feels like natural vaginal tissue, the Today Sponge contains the widely used spermicide nonoxynol 9. The Today Sponge measures only 1.75 inches in diameter and .50 inches in thickness. After the Today Sponge is moistened with water and inserted into the vagina, it becomes effective immediately and protects against pregnancy for the next 24 hours without the need to re-apply messy spermicidal creams or gels even with repeated acts of intercourse. The Today Sponge gives women a hormone-free birth control option that meets their individual needs and fits a variety of lifestyles. Its a great choice for many women for many different reasons. Discover the benefits of the Today Sponge for yourself: Explore our website to learn more about the women who use the Today Sponge, as well as its history, how it works, and why its recommended by physicians and healthcare professionals.