ABORTION

Abortion is expulsion or extraction from its mother of an embryo or fetus weighing 500 gram or less when it is not capable of independent survival (WHO). This 500 gram of fetal development is attained approximately at 22 week of gestation. Expelled embryo or fetus is called aborties. Term miscarriage, which is mostly used, is synonymous with spontaneous abortion. 10-20% of all clinical pregnancies ends in miscarriage and another optimistic figure of 10% are induced illegally 75% of abortion occur before the 16th week, and about 75% of these occur before 8th week of pregnancy. Classification: I. II. Spontaneous Induced

Abortion

Spontaneous

Induced

Legal Isolated Recurrent

Illegal Criminal

Septic

Threatened

Inevitable

Complete

Incomplete

Mistake

Septic (Less Common)

Etiology
Etiology of spontaneous abortion is often complex and obscure. The following are potential causes: Genetic Factors Infections Endocrine and Metabolic Factors Immunological Anatomic Factors

 Others Genetic Factors Majority of early miscarriage are due conceptus. Tubosomal trisomy is the commonest cybgenee abnormality. Most common trisomy is trisomy 16 monosomy constitute 20% of cases. Endocrine and Metabolic Factors Leuteal phase defect results in early miscarriage as implantation and plancentation are not supported adequately. Deficient progesteron secretion from corpus leuteum or poor endometrial response to progesterone is the cause overt hypothyrsidism or hyperthyroidism are associated with increase fetal loss. Diabetic mellitus when poorly controlled causes increased miscarriage. Anatomical Factors Cervico uterine factors: These are related mostly to the second trimester abortion. 1. Cervical incompetence, either congenital or acquired is one of the most commons cause of mid-trimester abortion.

2.

Congental malfromation of uterus: this is in form of bicornuate or septate uterus may be responsible for midtrinester recuurent abortion. Cause of fetal loss are: Reduced intrauterine volume. Reduced expansile property of uterus. Reduced placental Vascularity when in septum. Increased uterine irritability and construability.

3. 4. Infection

Uterine fibroid Intra Uterine adhesions

Infection is the accepted cause of abortion transplacental fetal injection occur with most micro-organism and fetal loss may be caused by any infection could be: Viral Rubella, Cytomegalo, Variela, Vaccinrater HTV Parasitic Toxoplasma, Malaria Bacterial Brucella, Spirochetes

Immunological Autoimmune disease cause miscarriage usually in second trimester. These patients from antibodies against their own tissue and the placenta. These antibodies ultimately cause rejection of early pregnancy antibodies responsible are: Antinuclear antibodies ANA Antiphospholipid Antibodies Placental thrombosis, infarction and fetal hypoxia is the ultimate pathology to cause abortion.

Blood Group Incompatibility

Incompatible ABO group matings may be responsible for early pregnancy wastage and offen recurrent but RH incompatibility rarely cause death of the fetus before 28 week. Couple with group a husband and group O wife have got higher incidence of abortion. Premature rupture of membranes ineuitably leads to abortion. Environmental Factors Cigarette Alcohol

X-irradiation and antinesplastic drugs Drugs chemical and roxides agents There is a large no of abortion which cannot be explained on neighbor of above explained factors.

Common Causes of Abortion

First Trimester Genetic Factors 50% Endocrine disorders LPD, Diabetic Mollitus, Thyroid

Abnormalities Immunological Disorders Infections Unexplained

Second Trimester Anatomic abnormalities o Cervical Incompetence o Mellerian Fusion Defect o Uterine synechiae

o Uterine Fibried o Maternal Medical Illness Maternal Medical Illness Unexplained

Mechanism of Abortion
In the early weeks death of ovum first occurs followed by the expulsion. In the dater weeks maternal environmental factors are involved leading to expulsion of foetus which may have sign of life but is to small to survive. Before 8 weeks: The ovum, surrounded by the villi with the decidual covering is expelled out intact sometime external os fails to dilate so that the entire mass is accommodated in the dilated cervical canal and is called cervical abortion. 8-14 weeks: Expulsion of fetus commonly occurs leaving behind the placenta and the hemorrhage. A part of it may be partially separates with brisk hemorrhage or remain totally attached to uterine wall.

Beyond 14th week: The process of expulsion is similar to that of a mini-labour. The fetus is expelled first followed by expulsion of placenta after a verging internal.

Threatened Abortion
Definition: It is a clinical entity where the process of abortion has started but has not progressed to a slate from which recovery is impossible. C/F 1. Bleeding per vagonum: The bleeding is usually slight and bright red in colour. In rare occasion the bleeding may be brisk and sharp, specially in late second trimester, suggestive of law implantation of placenta bleeding usually stop spontaneously. 2. Pain Bleeding is usually painless, there may to mild backache or dull pain in lower abdomes. Pain appears usually following hemorrhage.

Pelvic Examination Speculum Examination reveals bleeding & escapes external OS any local lesion in cervix may coexist. Digital Examination reveals the closed external OS uterus corresponding to period of amenorrhea. Investigations: 1. CBC ABO, RH urine for immunological test of pregnancy is not riffile. 2. GVS 454 3. Serum Progesterone Value of 25 mg/ml or more generally indicate a viable pregnancy in about 95% of cases. Permally quantitative value of HCG should double by ever 48 hours. Treatment: Rest: The patient should be in bed for few days until bleeding stops.

Drugs: Sedition and relief of pain may be ensured by phenobarpitone 30 mg (gardenal) or diazepam 5 mg tablet twice daily. General Measures: 1. Patient should be advised to preserve the vulval pads and anything expelled out for vagimum. 2. To report if bleeding and pain become aggravated. 3. Routine notes of pulse, temp, vaginal bleeding Advise on Discharge Avoidance of heavy work Coitus is contra indicated Limitation of activities

Inevitable Abortion
Definition: It is a clinical type of abortion whose the changes have progressed to a slate from where continuation of pregnancy is impossible.

C/F Patient having the features of threatened abortion develop following manifestation: 1. 2. 3. Increased vaginal bleeding Aggravation of pain in lower abdomen which may be c di kg. General contraction of patient is proportionate to visible blood loss. 4. Internal examination reveals dilated internal OS of corvix through which product of conception are left. Management Principles in the Management are: To take appropriate measures to look after the gen condition. To accelerate the process of expulsion To maintain strict asepsis. General Measures: Excessive bleeding should be promptly controlled by administering methein 0.2 mg if cervix is dilated and the size of uterus is less than 12 weeks shock is corrected by intravenous fluid therapy and blood transfusion.

Active Management: Before 12 Weeks Dilation and evacuation followed by curettage of uterine cavity by plant currete decreased GA. After 12 Weeks: Uterine contraction is accelerated by oxytocin drip (10 units in 500 ml of normal soline) 40-60 drops per minute. It the fetus is expelled and the placenta is retained it is removed by ovum forceps, if lying separated. If bleeding is profuse with cervix closed (suggestive of low implantation of placenta) evacuation of uterus may have to be done by abdominal hysterectomy.

Complete Abortion
Definition: When the products of conception are expelled on masse it is called complete abortion. C/F There is H/o expulsion of fleshy noses per vaginum followed by subsidence of abdominal pain, vaginal bleeding become trace or absent.

Internal examination reveals Uterus is smaller than period of amenorrhea or a little firmer. Cervical OS is closed. Bleeding is biace Examination of fleshy mass is found infact. Management Effect of blood loss if any should, be assessed and treated. If there is doubt about complete expulsion of product uterine curettage should be done. Transvaginal Sonography (GVS-US4) is usefull to prevent unnecessary surgical procedure. Rh-negative Women: A RH-Negative patient without antibody in her system should be protected by Anti D gamma-globulin 50 microgram or 100 mg 9/m is case of early abortion or late abortion respectively with 72 hours. However anti-D may not be, required in a case with complete miscarriage before 12 week gestation where no instrumentation has been done.

Incomplete Abortion
Definition: When the entire products of conception are not expelled instead, a part of it is left inside the uterine cavity it is called incomplete abortion. C/F History of expulsion of a fleshy mass per vaginum followed by:Contribution of pain lower abdomen, coliky in nature although diminished in magnitude. Persistence of vaginal bleeding of varying magnitude. Internal Examination Reveals: Uterus smaller than the period of amenorrhea. Patulous cervical os after admitting tip of finger. Varying amount of bleeding. Os examination expelled out mass is found incomplete.

Termination: Product behind may lead to profuse bleeding Slips placental polyp u cheris carcinoma

Management In recent case same principles of inevitable abortion management of shock if patent in due to blood loss. Management in recent cases Same principles of inevitable abortion management of shock if patient in due to blood loss. Early abortion: - D & C which GA to be done. Late abortion: - The uterus is evacuated which GA and products are removed by ovum forceps or by plant currete.

Missed Abortion / Silent Abortion

Definition When the fetus is dead and retained inside the uterus for a variable period it is called missed abortion or silent miscarriage or early fetal demise. Pathology: Earse of prolonged retention of dead fetus in uterus is not clear.

Beyond 12 weeks retained fetus become macerated or mummified. The liqueur amni gets absorbed and placent become pale this ant may be adherent. Before 12 weeks pathological process differs when ovum is more or less completely surrounded by chorionic villi. C/F The patient usually presents features of threatened abortion followed by: 1. 2. 3. 4. 5. 6. 7. 8. Persistence of brownish vaginal discharge. Subsidence of pregnancy symptoms. Retrogression of breast changes. Cesstion of uterine growth which is fact become smaller. Cervix feele firm. Non-audibility of fetal heart sevinol. Immunological test for pregnancy become negative. Real time USG reveals on empty sac.

Uterus less than 12 weeks Vaginal Evacuation Suction evacuation or slow dilatation of cervix

Pilbwed by D&E which GA Uterus more than 12 weeks Induction is done Oxytocin: Started with 10-20 units of oxytocin in 500 ml NS at 30 drops/minute. Prostaglandins: Prostaglandins b1, analogue misprostate 200 mg tab inserted into posterior vaginal fonix every 4 hours for max of 5 such. 3/m administration of 15 methyle PGE2a caboprost

tromethamine 250 mg at 3H interval for a max of 10 such.

Septic Abortion
Definition Any abortion associated with clinical evidence of infection of uterus and its contents is called septic abortion although clinical criteria vary: 1. Abortion is usually considered septic when there are rise of temp of at least 100.4 F for 24 hours or more.

2. 3.

Offensive, purulent vaginal discharge. Other evidence of pelvic (inflammation) infection such as abdominal pain or tenderness.

Made of Infection Microorganism involved in the sepsis are usually those normally present in vagina micro-organism are: 1. Anaerobic Bacteriods group Strepto-cocce and welchii tetnus 2. Aerobic E.Coli Kllbsiella Staphybcoccus Pseudommas 3. C/F H/O illegal termination by unauthorized person is mostly concealed. Pyrexia is imp. Clinical manifestation associated chills and rigor suggest blood stream spread of infection. Mixed infection is more common

Pain abdomen of vargina degree is consistent feature. Rise of pulse rate of 100-100/mt or more is significant finding that even pyrexia it shows spread of infection beyond uterus.

Variable systemic and abdominal findings depending upon spread of infection.

Internal Examination reveals Offensive purulent vaginal discharge Tender uterus Clinical Grading Grade I Infection is located in uterus. Grade II The infection spread beyond uterus. Grade III Genralised peritonitis, endotoxic shock, jaundices or ARF. Investigations 1. Cervical Swab/High vaginal swab for Culture and sensitivity Gram Staining 2. CBC

3.

UR/E

Special Investigation USG Blood culture and sensitivities

Management of Septic Abortion

General Management Hospitalization is essential for all septic abortions: To control the sepsis To remove the source of infection To give supportive therapy to bring the normal homeostasis To asses the response of treatment. Drugs Antibiotics For gram positive aerobes Penicilling 5 millim units (9/v 6H) Ampicillin 500 mg 1 gram 6H For gram negative aerobes Gentamycin 1.5 mg/kg 9/v 8H Ceftrichoone 1 gram BD For anaerobes Metronidosole 500 mg 9/v 8H Clindemycin 600 mg 9/V 6H

Analgesic, ANG gentanus serum according to case supportive therapy is directed to treat generalized peritonitis by gastric suction and 9/V soline infusion. Management of ARF, shock if present should be done accordingly.

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tyksnj dh vklk/;rk
tc tyksnj vius iw.kZ:I ls izdV gks tkrk gS rc ml jksxh es ;s minzo gksrs gS%& oeu vfrlkj red okl r`.kk jksx

[kkl dk c<uk [kkalh vkuk fgpdh vkuk nqcZyrk gksuk ikoZkwy gksuk Hkkstu esa v:fp gksuk Lojean gksuk Ekw=d`PN ;k ew=k?kkr gksuk bu minzoksa ds gks tkus ij tyksnj ds jksxh dks vlk/; tkuuk pkfg;sA tyksnj dh blh vlk/;rk ds dkj.k bldh fpfdRlk dk ;Fkkkh?kz minsk fn;k x;k gSA blds vfrfjDr mnjksxksa dh vklk/;rk ds lEcU/k esa dgk x.k gS fd%& tks mnj jksxh cyoku gks] ftlds mnj jksx esa tyksnj u gqvk gks ftldk jksx u;k gks rks jksx izkjEHk esa gh iz;Ru iwoZd mipkj djus ls jksx lk/;

gks tkrk gSA blds Iyhgksnj] vfrfjDr okrksnj] tyksnj firksnj] budks dQksnj] mRrjksrj

lkfUuikrksnj]

d`PNlk/; ekuk x;k gS c) xqnksnj 15 fnu ds ckn e`R;qdkjd ekuk tkrk gS fdlh Hkh mnj jksx dk tyksnj esa ifjofrZr gksuk vlk/; gksrk gSaA

tyksnj dh fpfdRlk
tyksnj esa lcls igys ty ds fodkj dks uV djus okyk mipkj djuk pkfg;s tSls%& xksew= ;qDr rh+{.k vusd izdkj ds {kkjks ls ;qDr vkSkf/k;ksa dk iz;ksx djuk pkfg;s vfXu dks iznhIr djus okys vkSj dQ dks uV djus okys vkgkjks dk thou djuk pkfg;s rFkk ty vkfn nzo inkFkksZ ds lsou ls dzek% jksxh dk fu;U=.k djuk pkfg;sA blds vfrfjDr f=nksk kkUr djus okyh

fpfdRlk djuh pkfg;sA tc mnjxqgk es {ksk iw.kZ:I ls O;kIr gks tkrs gS rc tkBjkfXu eUn gks tkrh gS blfy;s lHkh mnjjksxks esa vfXu dks nhIr djus okys gRds vkgkj xzg.k djus pkfg;sA

tyksnj esa vi/;

mnjjksx vkSj tyksnj ls ihMhr O;fDr dks pkfg;s fd og ty&tUrqvksa RkFkk vkuqi nsk ds thoksa dk ekl iRrh okys kkd] pkoy ds vkVs ls cus inkFkZ vkSj fry u [kk;sA O;k;ke djuk] vf/kd iSny pyuk] fnokk;u djuk ?kksMs dh lokjh djuk NksM+ nsuk pkfg;sA m.k inkFkZ] uedhu oLrq] vEyinkFkZ]

fonkgh inkFkZ] Hkkjh inkFkZ bu xq.k okys vUuks dk ifjR;kx dj nsuk pkfg;sA vf/kd ty ihuk Hkh NksM+ nsuk pkfg;sA

tyksnj esa rd iz;ksx

tyksnj es jksxh dks ,slk eB~Bk nsuk pkfg;s tks cgqr xk<k u gks] Lokn esa e/kqj gks vkSj ftlesa ls fudky fn;k gksaA bl izdkj ds eB~Bs esa lksaB] ekfjp] ihij dk pw.kZ feyk gqvk rktk eB~Bk nsuk pkfg;sA

tyksnj esa kL=deZ

oS/k dks pkfg;s fd tc mnjkoj.k dyk esa ty dk lap; gks x;k gks rks ukfHk ds uhps okeHkkx es phjk yxk;s vkSj mlesa ukMh ;U= yxkdj Hkhrj Hkjk gqvk ty fudky ns vkSj gkFk ls mnj dk enZu djrs ty dks fudky rRipkr diMs+ ds iV~Vs ls mnj dks ifjosfVr dj cka/k nsaA bl izdkj ;fn oLrq vkSj fojspu vkfn ds }kjk Hkh ty fudy tkus ds dkj.k mnj tyghu gks tk;s rks Hkh diMs ls cMs+ iV~Vs ls mnj dk cU/ku dj nsuk pkfg;sA

pjd lafgrk esa o)ksnj] fN)ksnj tyksnj esa kY;kL= fl)gLr fpfdRld ds }kjk kY;deZ dk ladsr fn;k gSA tyksnj esa lqJqrksDr kL=deZ

tyksnj es fpfdRlk dze

1tyksnj eas loZizFke ty ds nksk dk gj.k djus okyh fpfdRlk djsaA blds fy;s rh{.k {kkj nzO;ksa dks xksew= ds lkFk iku djsa] nhiuk;q dQ ukkd vk/kj nzO;ksa dk lsou djsaaA 2tyksnj vkSk/kh; fpfdRlk ls Bhd u gksus ij kL= dEkZ djsaA kL=fof/k ls ty rFkk nksk fudyus ds ipkr ya?ku djk;sa blds Ikpkr~ Hkw[k yxus ij ?kh] rsy jfgr iss;k fiyk;saA fQj N% ekl rd ek= nw/k dk lsou djk;saA

3-

blds Ikpkr~ 3 ekl rd nw/k vkSj is;k fiyk;s mlds ckn 3 ekg rd laok ;k dksoks ds Hkkr ds lkFk nw/k nsa bl vof/k esa ued fufk/k gSA

4-

jksxh esa nkskksa ds iqu% vuqcU/k dks jksdus ds fy, vkSj cy dh izkfIr ds fy, jksxh dks nw/k nsrs jguk pkfg;sA dgk Hkh x;k gS

iz;ksx.kka rq losZkkeuq {khja iz;kst;sr~A nkskkuqcU/kj{kkFkZ cyLoS;kZ/keso pAA

tyksnj es vkSk/k ;ksx

nhiuh; ?k`r%& iapdksy ?k`r ;okfn ?k`r

ukxjkfn ?k`r fp=d ?k`r Xkzke mnjjksxukkd pw.kZ iVksyewyk/k pw.kZ gkqkknk ek=k 15&25

pw.kZ xok{;kfn pw.kZ pw.kZ ukjk;.k pw.kZ ek=k 2&3 xzke izkr % Lkk;a uhyhU;kfn

Enteric Fever (Typhoid and Paratypoid fever)

Enteric fever is endomic in India and several tropical countries where statnadard of personal hygine and sanitation are poor. Typhoid fever is primarily caused by salmonella enterica, subspecies enteric, serotype typhii. Salmonilla paratyphi A, S. Paratyphi B, S. paratyphich are other sero types that are host adopted to man and cause paratyphoid fever. Infected person excrete the bacilli in stool and urine. Food and water may be contaminated by hands of carriors, patient or through flies. Infection is transmitted by ingestion of the infected food milk on water. The period of communicability last as long as bacteria are present in the excreta. Some patients excrete salamonella for 3 month after the illness. They are called convalescent carriers. A few patients may however become permanent carriers. Disease is commin in hot summer months but may occur throught the year. Epidemics of typhoid fever are associated with ever crowding and breakdown in safe water supply and swage disposal system. Pathology: Follwing ingestion, salmonella penetrate through the intestinal mucosa to the dymphoid tissue of ileum where they prdiferate. Probability of

clinically evident disease is more with a high no. of infecting particles, reduced gestree motilily possession of V1 antigen by the organism. Macrophage engulf the bacteria which are then carried to the circulation via thoracic duct resulting in Primary Bacteremia. Invasion of blood stream marks the onset of fever. Organism is hemalogensusly carried to the liver, spleen, marrow where further multiplication occurs. Release of large no. of organism from reticulo-endothelial system eventuate the Secondary Bacteremia and herolds the clinical disease. Peyers patches are the most important site to get infiltrated which chronic inflammatory cells. At the end of 2nd week intestinal lymphoid tissue sloughs off forming shallow oval ulcers in the long axis of the intestine. Mesentric lymph nodes are swollen and the liver shows areas of focal necrosis. The spleen is congested and enlarged Bronkial inflammation is common. Poor prudential hygine leads to parotitis. Ostomylity may occur as a delayol complication.

Diagramatic Representation of Pathology of Enteric Fever

Ingestion of salmonella typhic Salmonella penelrate through

through infected waer, food stuff

intestinal mucosa to lymphoid tissue of ilium.

1 Bactermia Marks onset of fever 2 Bactermia Heralds clinical disease

Macrophage engulf bacteria which are carried to circulation Organism carried to liver spleen, marrow through blood where it multiplies. Intestinal lymphoid tissue sloughs of forming oval shallow ulcer. Mestric lymph nodes are swollon Liver = areas of focal necrosis Spleen congested and enlarged Bronchial inflammation.

Clinical Features
Incubation period is 14 days with a range of 3-60 days no age is exempt but typhoid fever is less common in children under 2 years due to

less chance of exposure to infected food from outside the house. First Week: Onset is gradual step ladder pattern of fever is seen among adults i.e. fever never fluctuates between high and low grade it gradually decreases from high to low grade fever like a ladder i.e. 104 to 103, to 102, 101.

Onset may be sudon with rapid elevation of temp. Often with headache and vomiting. Fever is generally continueus with little diurial variation. Constipation is frequent but some patients may presents with diarrhea and abdominal pain. Tongue is often coated in the center and clear at margins. Bradycordia is not always present pulse rate may rise propotionaly to high temperature typhoid rosh may be present on pigmented skin. When present it

occurs on 6th day of the illness.

Second and Third week of illness

Abdomen is usually distended and gives to tympanic note on gentle tapping. Ths is a usuful sign. Spleen is palpable 1 0r 2 cc below the coatal margin in over /3 of patients. Rales are often hard over bases of lungs. If toxemia is severe, the seneorium is drilled with apathy and stuper. The patient may have muttering delirium and may pick at bed clothes. This peculiar slate is called typhoid state.

Complications of enteric fever

Orodental: Poor orodental hygiene, parotitis Chest: Bronchitis, Pneumonia and pulmonary inforat Heart: Myocardilis Liver and gall bladder: Fathy liver, hepatitis, liver abseas, chdecyslitis, cholangities, pancrealilts. Gastrointestinal: Diarrhoea, Perpration of intesline, periotonitis,

hemorrhage from gut. Neurological: Encephalitis, Encephalopathy, Transverse myelitis

Meningitis, Peripheral Neuritis, Aphosia. Musculoskeltal: Chronic Osteomylites, supporative arthritis polymyositis. Misscellanous: Alopecia, Uveitis. Out of these complications hemorrhage and perforation are life threatening complication and may occur in second and third week of illness. Stool should be observed for frank or occult blood. Perpration may present as acute abdominal emergency or exidative peritonitis. In most case untreated fever lot for three weeks after which it comes down with lysis. Course is modified by administration of antibiotics. Permanent carries continue to excrete solmon in their stool for more than a year after an episode of enteric fever absent 1-4% of cases may become permanent carriers. Carrier state is more common in under 5 children. Relapses The relapse rate is 10-20% relapse usually occur within 1-6 weeks. Rarely second or even third relapse may occur. Prgonosis Mild and moderating severe cases response will to treatment

even without antibiotics. Moralality is about 10% in untreated case. Patient who are given normal diet during illness have a shorted convalc seence and recover foster, the prognosis is poor in infants. Antibiotic resistant strains, results in higher morbidity and morlality. Diagnosis Feed clinical signs are pathognomonic of typhoid fever. In the endomic areas typhoid fever should be a diagnostic possibility in all fevers of more than 7 days duration especially those without pcolising signs. Bradycordea when present is helpful Tuberculosis should always be considered in D/D. Deterisration of mental function in typhoid fever may suggest the possibility of thphoid on caphlopathy but L.P. must be done to exclude TBM (Fubercular Meningtits) Following disease should be also be considered in D/D Malaria Kala-Azar Brucellosis Subacute Bactereal ends corditus

Laboratory Investigations

eUFkdFkk vkfU=d Toj

EkUFkd Toj dk o.kZu vk;qosZn ds lafgrk xzUFkksa esa Lora=r;k ugh gS ijUrq bldk lekosk f=nkskt vkSilfxZd Toj esa fd;k tk ldrk gS blesa rhuks nkskksa ds y{k.k ik;s tkrs gSA ek/ko funku ifjfkV esa eU/kd Toj dk o.kZu bl izdkj fd;k gSA dhVk.koks oS flyl VkbQkslukedk %A n.Mdkk% eysAA Losns firkk;s Iyhfg fi.Mk d`rkoklk ew=kk;s

LokfU=ds oz.kSA Tku;fUr u`.kk nsgs Tojs izksDra fokskr%AA Ekk0 fu0 ifjfkV

vFkkZr xU/kd Toj dh mRifr dk iz/kku dkj.k vkU=Tojk.kq cSflyl VkbQksfl uked gS ;g lapj.kkhy thok.kq gS tks vUr% dkskh; fok dk fuekZ.k djrk gS ;g ew=kk; ds] ey LFkkuks ij fuokl djrk gSA budh o`f) gksus ij ;s vkfU=d oz.k] ew=kk;] fi=kk;] Iyhgk] jDr vkSj ylh dk xzfUFk;ksa esa mifLFkr feyrs gSa ;s thok.kq ey] ew=] Losn esa Hkh ik;s tkrs gSA {kqnz xzfUFk lewg esa ;s LFkku laJ; dgrs gSA budk lao/kZu ;d`r] Iyhgk] firkk;] o`Dd esa gksrk gSA funku% vf/kd ekxZ xeu] miokl ls mRiUu d`krk] nqxZU/k;qDr LFkku esa okl] ey] ew= ds lalxZ ;qDr ty dk iku] [kk| inkFkksZa ij ef{kdk vkfn dk laLikZ bu dkj.kks ls fokskdj xzhe_rq esa vkfU=d Toj

gksrk gSA blds vfrfjDr vk;qosZn lafgrk xzaFkks es Toj dk vkSj Lora= o.kZu gS dk;fpfdRlk dh

iqLrkdksa esa vk/kqfudks ds Enteric Fever dk lekosk djds mlh ds y{k.k] fpfdRlk dk o.kZu gSA

vkfU=d Toj dh vk;qosZnksDr fpfdRlk

LkkekU; fpfdRlk vkfU=d Toj es tks minzo gks ldrs gS muls cpus ds fy;s i{; dh O;oLFkk] kjhj dh fu;fer lQkbZ vkSj mRre ifjppkZ dk izcU/k djuk pkfg;sA IkF;%& vkenksk ds ikpu ds fy;s de ls de 1 LkIrkg rd ya?ku djuk pkfg;s Rk`.kk ;k nkg gksus ij kaMxikuh fiykuk pkfg;sA vfrlkj gksus ij lkSaQ dk vdZ nsuk pkfg;s vk/eku ;k mnjkwy gksu ij ukxj eksFkk]

foMsx firikiM+k] ykSax] 1 yhVj ty esa mcky dj fiykuk pkfg;sA focU/k gksus ij equDds ds cht fudkydj rus ij gydk Hkwudj 10&12 nkus [kkus dks nsaA nwljs lIrkg esa Toj dk rkieku vkSj foke;rk c< tkrh gS vr% buds ke.kkFkZ kMaxikuh; vFkok ukfjdsy ty 4&6 pEEkp dbZ ckj fiyk;saA r`rh; lIrkg esa ipdksy fl) nw/k ihus dks nsaA prqFkZ lIrkg es nw/k vkSj Qyksa dk jl nsaA TojeqDr pkfg;sA IkfjppkZ%& vkfU=d Toj ds jksxh dks dbZ lIrkg rd gks lds mruk foJke djuk pkfg;sA gksus ij izkr%dky ijoy nsuk

blds vfrfjDr izkr%dky lq[kks.k ty esa diMk fHkxksdj lEkLr kjhj dks iksaN ysuk pkfg;sA iguus ds diMs] dEcy vkfn dh lQkbZ j[kuh pkfg;sA jksxh dks LoPN goknkj dejs es j[kuk pkfg;s ftlls dh ok;q lh/ks kjhj ij u yxsA kkfjjhd vkSj ekufld n`fV ls iw.kZ vkjke nsuk pkfg;sA

vkofLFkd fpfdRlk
lkenksk ikpuk;Z lkSHkkX; oVh a vkuUn HkSjo jl & & 400 Mg

400 Mg

3&3 ?k.Vs ij pkj ckj vHkzd HkLe kqfDr HkLe Vad.k & & & 250 Mg 250 Mg 250 Mg

kqqDrk HkLe jlflUnqj &

& 125 Mg

125 Mg

;ksx tk;Qy

4 ek=k

tkfo=kh izR;sd ds 250 Mg pw.kZ vkSj e/kq ls yoax

f}rh; lIrkg 4&4 ?k.Vs ij rhu ckj eqDrk HkLe izoky ;ksxzsUnz jl & & 400 Mg 200 Mg & & 375 Mg 375 Mg

lkSHkkX; oVh ;ksx

3 ek=k

mxz larki keukFkZ High Grade Fever

lwrks[kj jl oLkUrekyrh jl xqMqphlRo

& & &

250 Mg 250 Mg 250 Mg & 300 Mg

fkyktRokfn ykSg ;ksx prqFkZ lIrkg

3 ek=k

iqViDofoke TojkUrd ykSg& olUrekyrh EkqDrkHkLe & & ;ksx dklkuqcU/k esa fpfdRlk PkUnzke`r pUnukfn rkfyikfn & & & 1 Gram

400 Mg 200 Mg 375 Mg 3 ek=k

1@2 Gram 4 Gram 4 ek=k

;ksx vfrlkj esa

dqjS;k dh Nky csy dk xwnk ekspjl ukxjeksFkk /kfu;k &

& &

6 Gram 6 Gram

6 Gram & & 6 Gram 6 Gram ek=k

;ksx

mijksDr dk 500 ml t yes Mkydj DokFk cuk;sa 10&20 ml fnu esa 3 ckj fiyk;saA vkU=xr jDr L=ko esa 2&2 ?k.Vs ij 5 ckj diwZj jl jkeck.k jl cksy ikoZVh & 1@2 Gram & & 1@2 Gram 1 Gram 1 Gram 1@2 Gram

kq) Lo.kZxSfjd & jDrfiRr dqy.Mu &

;ksx

4 ek=k