BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª gv I beRvZK

¯^v¯’¨‡mevi Rb¨ ÷¨vÛvW© Acv‡iwUs cÖwmwWDi (SOP)

cwievi cwiKíbv Awa`ßi
¯^v¯’¨ wkÿv I cwievi Kj¨vY wefvM
¯^v¯’¨ I cwievi Kj¨vY gš¿Yvjq
BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª gv I beRvZK
¯^v¯’¨‡mevi Rb¨ ÷¨vÛvW© Acv‡iwUs cÖwmwWDi (SOP)
 BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª gv I beRvZK
¯^v¯’¨‡mevi Rb¨ ÷¨vÛvW© Acv‡iwUs cÖwmwWDi (SOP)

cÖKvkKvj
Rvbyqvwi 2020

cÖKvkbvq
GgwmGBP mvwf©‡mm BDwbU
cwievi cwiKíbv Awa`ßi
¯^v¯’¨ I cwievi Kj¨vY gš¿Yvjq

cÖ”Q` wPÎ
wRGgwe AvKvk/ †mf `¨ wPj‡Wªb

wWRvBb I gy`ªY
wmwÏK wcÖ›Uvm©
115 bqv cëb, KvjfvU© †ivW, XvKv-1000.
 gyLeÜ

cwievi cwiKíbv Awa`߇ii cwiPvjbvq †`‡ki cÖvq mKj BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K›`ª n‡Z gvZ… I beRvZ‡Ki
¯^v¯’¨‡mevmn Ab¨vb¨ †mev cÖ`vb K‡i n‡”Q| Z¤§‡a¨ eZ©gv‡b 2,200 wU BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K›`ª avÎx we`¨vq
cÖwkÿYcÖvß †mevKg©x‡`i gva¨‡g 24/7 NÈv cÖme †mev w`‡”Q, hv cÖvwšÍK Rb‡Mvôxi gvZ… I beRvZ‡Ki g„Zz¨ n«v‡m ¸iæZ¡c~b©
Ae`vb †i‡L P‡j‡Q| cwievi cwiKíbv Awa`߇ii Gg wm GBP mvwf©m BDwbU †`‡ki cÖwZwU BDwbqb ¯^v¯’¨ I cwievi Kj¨vb
†K‡›`ª ch©vqµ‡g GB †mevi m¤úªmvi‡b e× cwiKi|

gv I beRvZ‡Ki †mev`v‡b cÖwgZ (Standardize) ¯^v¯’¨‡mev wbwðZKi‡Y g¨vUvibvj †nj_ ÷¨vÛvW© Acv‡iwUs cÖwmwWDi wUÕ
¯^xq Kg©‡¶‡Î †ckvMZ AwfÁZv m¤úbœ kZvwaK e¨w³i KvwiMix `¶Zvq ‰Zix nq| cieZ©x‡Z cwievi cwiKíbv Awa`߇ii
Gg wm GBP mvwf©m BDwbU GB †mevmg~‡ni ¯ÍiwfwËK GmIwc cÖYq‡bi cÖ‡qvRbxqZv Abyfe K‡i| GiB cwi†cÖw¶‡Z
BDGmGAvBwWÕi ÔgvgwbÕ gvZ… I beRvZK ¯^v¯’¨‡mev Dbœqb cÖKí (gvgwb GgGbwmGmwc) Gi mnvqZvq BDwbqb ¯^v¯’¨ I
cwievi Kj¨vb †K‡›`ª gv I beRvZ‡Ki ¯^v¯’¨‡mevi ÷¨vÛvW© Acv‡iwUs cÖwmwWDi (SOP) ˆZixi D‡`¨M MªnY Kiv nq| ÷¨vÛvW©
Acv‡iwUs cÖwmwWDi G BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K›`ª n‡Z cÖ‡`q †mevmg~‡ni ÷¨vÛvW©mg~n mwbœ‡ewkZ Kiv n‡q‡Q|
÷¨vÛvW© Acv‡iwUs cÖwmwWDiwU BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi ¯^v¯’¨‡mev cÖ`vbKvixM‡Yi hy‡Mvc‡hvMx Ges g‡bvfv‡ei
cÖ‡qv‡M Kvh©Kix f~wgKv cvjb K‡i gv I beRvZ‡Ki g„Zz¨nvi Av‡iv Kgv‡Z mnvqZv Ki‡e|

cwievi cwiKíbv Awa`߇ii cwiPvjK g‡nv`‡qi mvwe©K ZË¡veav‡b Gg wm GBP mvwf©m BDwbU Ges BDGmGBwWÕi gvgwb
GgGbwmGmwci m¤ú„³ m`m¨e„›`mn ¯^v¯’¨ Awa`ßi I wewfbœ Dbœqb mn‡hvMx ms¯’vi cÖwZwbwaiv GB SOP wU ˆZix‡Z
D‡jøL‡hvM¨ Ae`vb †i‡L‡Qb|

Avwg Avkv Kwi, BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi ¯^v¯’¨‡mev cÖ`vbKvixMY GB SOP wU mwVKfv‡e AbymiY Ki‡eb Ges
GwUi mdj ev¯Íevq‡bi gva¨‡g DwÏó Rb‡Mvôxi mvwe©K ¯^v¯’¨‡mev mn gv I beRvZ‡Ki ¯^v¯’¨‡mev cÖ`v‡b Ges gvZ… I
beRvZ‡Ki g„Zz¨ n«v‡mi KvwöZ j¶¨gvÎv AR©‡b ¸iæË¡c~Y© f~wgKv cvjb Ki‡eb| GB SOP wU ‰Zix‡Z mn‡hvwMZvi Rb¨
BDGmGBwWÕi gvgwb GgGbwmGmwci m`m¨‡`i AvšÍwiK ab¨ev` RvbvB|

Wvt †gvnv¤§` kixd

cwiPvjK (GgwmGBP-mvwf©‡mm) Ges jvBb WvB‡i±i (GgwmAviGGBP)
cwievi cwiKíbv Awa`ßi, XvKv
 evYx

eZ©gv‡b gvZ…g„Zy¨i nvi 169 cÖwZ 1 jÿ RxweZ R‡b¥ hv 2001 mv‡j wQj 322 cÖwZ 1 jÿ RxweZ R‡b¥| beRvZ‡Ki g„Zy¨i
nviI D‡jøL‡hvM¨ nv‡i n«vm †c‡q 2000 mv‡ji cÖwZ 1 nvRv‡i 66 †_‡K K‡g 2011 mv‡j cÖwZ 1 nvRv‡i 38 G †b‡g Av‡m|
GB gvZ…g„Zz¨ I beRvZ‡Ki g„Zy¨ n«v‡m BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K›`ª¸‡jv cwievi cwiKíbv Awa`߇ii ZË¡veav‡b
¸iæZ¡c~b© f~wgKv cvjb K‡i Avm‡Q | †UKmB Dbœqb j¶¨gvÎv-3 AR©b Ki‡Z n‡j gvZ…g„Zz¨ I beRvZ‡Ki g„Zy¨i nvi Av‡iv
Kwg‡q Avb‡Z n‡e| GB †cÖ¶vc‡U BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K›`ª n‡Z cÖ‡`q †mevi gv‡bvbœqb GLb AZ¨vek¨K|

BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi ÷¨vÛvW© Acv‡iwUs cÖwmwWDiwU †K‡›`ªi Rb¨ Dc‡hvMx K‡i g¨vUvibvj †nj_ ÷¨vÛvW©
Acv‡iwUs cÖwmwWDi hv gv I beRvZ‡Ki †mev`v‡bi Rb¨ GKwU m¤ú~Y©, cÖwgZ Ges cÖvgvwbK wK¬wbKvj mnvqK n‡Z ‰Zix Kiv
n‡q‡Q | GB ÷¨vÛvW© Acv‡iwUs cÖwmwWDiwU BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K›`ª n‡Z gvbm¤§Z †mev`v‡bi D‡Ï‡k¨ cÖYxZ|
cwievi Kj¨vY cwi`wk©KvMY GB ÷¨vÛvW© Acv‡iwUs cÖwmwWDiwUi mwVKfv‡e e¨env‡ii gva¨‡g gv I beRvZK‡K DbœZZi
†mev`v‡bi `¶Zvq cvi`k©x n‡eb|

cwievi cwiKíbv Awa`߇ii D‡`¨v‡M ¯^v¯’¨ Awa`ßi I wewfbœ Dbœqb mn‡hvMx ms¯’vi cÖwZwbwamn wiwfD KwgwU mKj
m`m¨e„‡›`i mw¤§wjZ cÖ‡Póvq Ges BDGmGAvBwWÕi ÔgvgwbÕ gvZ„ I beRvZK ¯^v¯’¨‡mev Dbœqb cÖKí (gvgwb GgGbwmGmwc)
Gi KvwiMwi mn‡hvMxZvq BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi gvZ… I beRvZ‡Ki ¯^v¯’¨‡mevi Dc‡hvMx K‡i ˆZix Kiv GB
÷¨vÛvW© Acv‡iwUs cÖwmwWDiwU cÖYq‡bi mv‡_ mswkøó mKj‡K RvbvB AvšÍwiK ab¨ev`|

Avwg `„pfv‡e wek^vm Kwi, GB ÷¨vÛvW© Acv‡iwUs cÖwmwWDiwUi h_vh_ Abymi‡Yi gva¨‡g cwievi Kj¨vY cwi`wk©KvMY gv I
beRvZ‡Ki ¯^v‡¯’¨i Dbœq‡b avivevwnKfv‡e D‡jøL‡hvM¨ Ae`vb †i‡L cÖksmbxq f~wgKv cvjb Ki‡eb|

Wvt †gvt kvgmyj nK

jvBb WvB‡i±i (GgGbwmGÛGBP)
¯^v¯’¨ Awa`ßi
 BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª gv I beRvZK ¯^v¯’¨‡mevi Rb¨ ÷¨vÛvW© Acv‡iwUs cÖwmwWDi
cÖYq‡b hviv Ae`vb †i‡L‡Qb

1. Wvt †gvnv¤§` kixd, cwiPvjK (GgwmGBP-mvwf©‡mm) Ges jvBb WvB‡i±i (GgwmAviGGBP), cwievi cwiKíbv
Awa`ßi, XvKv
2. Wvt †gvt kvgmyj nK, jvBb WvB‡i±i (GgGbwmGÛGBP), ¯^v¯’¨ Awa`ßi, XvKv
3. Wvt †gvt mv‡ivqvi evix, jvBb WvB‡i±i (wdì mvwf©m †Wwjfvix), cwievi cwiKíbv Awa`ßi, XvKv
4. Wvt †gvt gCbyÏxb Avn‡g`, jvBb WvB‡i±i (wmwmGmwWwc), cwievi cwiKíbv Awa`ßi, XvKv
5. Wvt †gvt gybxiæ¾vgvb wmwÏKx, cwiPvjK, GgGdGmwUwm, †gvnv¤§`cyi, XvKv
6. Wvt †gvkv‡qi Dj Bmjvg, Dc-cwiPvjK (GgGbwmGÛGGBP), †cÖvMÖvg g¨v‡bRvi (†gUvibvj †nj_), ¯^v¯’¨ Awa`ßi,
XvKv
7. Wvt dvnwg`v myjZvbv DcÑcwiPvjK (GgwmGBP) Ges †cÖvMÖvg g¨v‡bRvi (†gUvibvj †nj_), cwievi cwiKíbv Awa`ßi,
XvKv
8. Wvt †gvt dwi` DwÏb Avn‡g`, DcÑcwiPvjK (mvwf©‡mm) GgwmGBP BDwbU, cwievi cwiKíbv Awa`ßi, XvKv
9. Wvt b~iæb bvnvi †eMg, DcÑcwiPvjK I †cÖvMÖvg g¨v‡bRvi (†KvqvwjwU A¨vmy‡iÝ), wmwmGmwWwc, cwievi cwiKíbv
Awa`ßi, XvKv
10. Wvt Z„wß evjv, Dc-cwiPvjK (jxf wiRvf©), GgwmGBP-mvwf©‡mm BDwbU, cwievi cwiKíbv Awa`ßi, XvKv
11. Wvt †Rey‡bœmv †nv‡mb, Aa¨ÿ GdWweøDwfwUAvB, AvwRgcyi, XvKv
12. Wvt †n‡jbv †Rweb, wmwbqi Kbmvj‡U›U, GgGdGmwUwm, †gvnv¤§`cyi, XvKv
13. Wvt G we Gg mvgQzwÏb Avn‡g`, †cÖvMÖvg g¨v‡bRvi (mv‡cv©U mvwf©‡mm GÛ †KvwW©‡bkb), GgwmGBP BDwbU, cwievi
cwiKíbv Awa`ßi, XvKv
14. gwZDi ingvb, mnKvix cwiPvjK (mgš^q), cwievi cwiKíbv Awa`ßi, XvKv
15. Wvt G Gb Gg †gv¯Ídv Kvgvj gRyg`vi, mnKvix cwiPvjK (GgwmGBP), GgwmGBP BDwbU, cwievi cwiKíbv Awa`ßi,
XvKv
16. Wvt gvneyev bvwM©m, Rywbqi Kbmvj‡U›U GgwmGBPwUAvB, AvwRgcyi,
17. Wvt dvnwg`v kvnbvR, mnvKvix †Kv-AwW©‡bUi (†Uªwbs GÛ wimvP©) GgwmGBPwUAvB, AvwRgcyi, XvKv
18. Wvt iwngv LvZzb, †gwW‡Kj Awdmvi GgGdGmwUwm, †gvnv¤§`cyi, XvKv
19. Aa¨vcK jvqjv AviRygv›` evby, cÖv³b mfvcwZ-IwRGmwe
20. Wvt †mZviv ingvb, †cÖvMÖvg WvB‡i±i †gUvibvj †nj_, gvgwb GgGbwmGmwc, RvcvB‡Mv
21. Wvt G Gm Gg gwbiæ¾vgvb, †gUvibvj †nj_ A¨vWfvBRvi, gvgwb GgGbwmGmwc, RvcvB‡Mv
22. Wvt Zvnwgbv Av³vi, g¨v‡bRvi †gUvibvj †nj_, gvgwb GgGbwmGmwc, RvcvB‡Mv
23. Wvt Avdmvbv Kwig, wmwbqvi †UKwbK¨vj A¨vWfvBRvi (†gUvibvj GÛ wbDe©b †nj_) gvgwb GgGbwmGmwc, †mf `¨
wPj‡Wªb
24. Wvt wRqvDj Avnmvb, A¨vWfvBRvi, wbDeb© †nj_, gvgwb GgGbwmGmwc, †mf `¨ wPj‡Wªb, XvKv
25. Wvt Avnmvbyj Bmjvg, †Kv-AwW©‡bUi †nj_ wm‡÷g †÷ªs‡`wbs, †Kqvi evsjv‡`k
26. Wvt †Rey‡bœmv ingvb, wmwbqi †UKwbK¨vj A¨vWfvBRvi, RvcvB‡Mv, evsjv‡`k
27. Wvt KvwbR myjZvbv, mnKvix †cÖvMÖvg Awdmvi, ccy‡jkY KvDwÝj
28. Wvt Kgj KvwšÍ wek¦vm, †cÖvMÖvg g¨v‡bRvi, AvBcvm, evsjv‡`k
29. AvwRg †gvt DwÏb, wmwbqi A¨vWfvBRvi, AvBcvm, evsjv‡`k
 m~PxcÎ
BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª gv I beRvZK ¯^v¯’¨‡mevi Rb¨ ÷¨vÛvW© Acv‡iwUs cÖwmwWDi
welq cvZv bs
÷¨vÛvW© Acv‡iwUs cÖwmwWDi (SOP) Gi f‚wgKv 1-2
†mKkb 1t Mf©Kvjxb †mev 3-22
Mf©Kvjxb †mevi D‡Ïk¨ 5
Mf©Kvjxb †mevi mgqm~wP 5
Mf©Kvjxb †mevi wewfbœ wfwR‡U KiYxq 6-9
Z_¨, wkÿv, †hvMv‡hvM Ges civgk© cÖ`vb 10-14
Mf©Kvjxb †QvU-Lv‡Uv mgm¨v Ges Zvi cÖwZKvi 15-16
gyL¨ mgm¨v mbv³KiY Ges †idvivj 17-22
†mKkb 2t cÖmeKvjxb †mev 23-43
cÖme‡mevi Rb¨ cÖ¯‘wZ 25-28
¯^vfvweK cÖme 29-38
cv‡U©vMÖvd 38-40
cÖm‡ei mgq gyL¨ mgm¨v wPwýZKiY Ges e¨e¯’vcbv 41-43
†mKkb 3t beRvZK †mev 45-57
ZvrÿwYK cwiPh©vi avc 47-48
beRvZ‡Ki †nwís †eweR weª` (†Mv‡ìb wgwbU) 49-52
my¯’ wkïi AZ¨vek¨Kxq cwiPh©v 53-56
0-59 w`b eqmx wkïi msµgY mbv³KiY Ges e¨e¯’vcbv 57
†mKkb 4t cÖme-cieZ©x †mev 59-66
cÖme-cieZ©x †mevi D‡Ïk¨ 61
cÖme-cieZ©x †mevi mgqm~wP 61
cÖme-cieZ©x mg‡q gv Ges beRvZ‡Ki †mevi Dcv`vbmg~n 61
Z_¨, wkÿv, †hvMv‡hvM Ges civgk© cÖ`vb 61-63
cÖmecieZ©x mvaviY RwUjZvmg~‡ni e¨e¯’vcbv 64-65
cÖme-cieZ©x gyL¨ RwUjZvmg~‡ni e¨e¯’vcbv 66
†mKkb 5t Mf©cvZ-cieZ©x †mev 67-76
†mKkb 6t cwievi cwiKíbv 77-83
cwievi cwiKíbv †mevi ¸YMZ gvb 80-81
cwievi cwiKíbv c×wZ m¤ú‡K© KvD‡Ýwjs 82
c×wZ wbY©‡q kvixwiK Dchy³Zv 83
†mKkb 7t cÖme-cieZ©x cwievi cwiKíbv 85-137
cÖme-cieZ©x cwievi cwiKíbvi cÖKvi‡f` 87-89
AvaywbK Mf©‡ivaK c×wZmg~n Ges †mev e¨e¯’vcbv 90
KbWg 91-93
Rb¥weiwZKiY Lvevi ewo 94-103
Rb¥weiwZKiY Bb‡RKkb 104-110
AvBBDwmwW 111-122
K›Uªv‡mcwUf B¤úø¨v›U/Rb¥weiwZKiY Bgcø¨v›U 123-129
¯’vqx c×wZmg~n 130-134
Riæwi Mf©wb‡ivaK c×wZ 135-137
†mKkb 8t msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 139-164
†mKkb 9t †iKW© msiÿY I †idv‡ij 165-168
†mKkb 10t mshyw³ 169-178
†idv‡iÝ 179-181
 ÷¨vÛvW© Acv‡iwUs cÖwmwWDi (SOP) Gi f~wgKv
AwaKvsk gvZ… I beRvZK g„Zz¨ cÖwZ‡iva‡hvM¨| ¸bMZ gvbm¤úbœ †gŠwjK †mev cÖ`v‡bi gva¨‡g gvZ… I beRvZ‡Ki Rxeb
euvPv‡bv m¤¢e| MZ `yB `k‡K cÖvwZôvwbK cÖme †mev A‡bK AMÖMwZ n‡jI gv I beRvZ‡Ki g„Zz¨ axi MwZ‡Z n«vm cv‡”Q|
¯^v¯’¨‡mev‡K‡›`ª cÖm‡ei msL¨v e„w×i mv‡_ mv‡_, †mevi ¸YMZ gv‡bi w`‡K `„wó †`qv n‡”Q †Kbbv †mevi wb¤œgvb Amy¯’Zv
I g„Zy¨i w`‡K avweZ K‡i| wek¦ ¯^v¯’¨ ms¯’v (WHO) Ggb GKwU fwel¨‡Zi ¯^cœ †`‡L †hLv‡b, ÔcªwZwU Mf©eZx bvix Ges
beRvZK Mf©Kvjxb, cÖme Ges cÖme-cieZ©x mg‡q DbœZgv‡bi ¸bMZ gvbm¤úbœ †mev cv‡eÕ| GB jÿ¨ mvg‡b †i‡L wek¦
¯^v¯’¨ ms¯’v †mevi ¸YMZ gvb msÁvwqZ K‡i cÖm‡ei mgq gv I beRvZ‡Ki †mevi ¸YMZ gvb e„w× Ki‡Z GKwU KvVv‡gv
ˆZwi K‡i‡Q|

m¤úªwZ gvZ„ I beRvZ‡Ki g„Zz¨i nvi n«vm Ges G msµvšÍ RwUjZv Kgv‡Z evsjv‡`k miKvi gvZ…¯^v¯’¨ Dbœq‡bi Rb¨
(2019-2030) GKwU RvZxq †KŠkjcÎ cÖYqb K‡i‡Q| G mKj jÿ¨ AR©‡b, mKj cÖm‡ei mgq `ÿ avÎxi Dcw¯’wZ Ges
Dchy³fv‡e mw¾Z I ¯^v¯’¨Kg©x mgwš^Z ¯^v¯’¨ †mev‡K‡›`ª gvbm¤úbœ cÖme‡mev cvIqvi b¨h¨ AwaKvi wbwðZ Ki‡Z †KŠkj
wbiƒcY Kiv n‡q‡Q| RvZxq beRvZK ¯^v¯’¨ Kg©m~wP (NNHP) g~jZ ZvrÿwYK AZ¨vek¨Kxq beRvZK †mev (ENC)
wbwðZ Kivi gva¨‡g mKj beRvZ‡Ki Rb¨ †mev‡K cÖvavb¨ †`q|

BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª (UH&FWC) gv I beRvZK ¯^v¯’¨‡mevi Rb¨ ÷¨vÛvW© Acv‡iwUs cÖwmwWDi
(SOP) †Kb cÖ‡qvRb

evsjv‡`k 2030 mvj bvMv` cÖwZ‡iva‡hvM¨ wkï I gvZ…g„Zz¨i (EPCMD) Aemvb NUv‡Z cÖwZkÖæwZe× hv me©Rbxb ¯^v¯’¨
myiÿv BDwbfvm©vj †nj_ Kfv‡iR (UHC) AR©‡bi †PZbvq DÏxß Ges †UKmB Dbœqb jÿ¨gvÎvi (SDGs) mv‡_
m½wZc~Y©| hw`I AwaKvsk Mf©aviY Ges cÖme D‡jøL‡hvM¨fv‡e NUbvwenxb, ZeyI mKj Mf©aviY-B SuywKc~Y©| cÖvq 15%
Mf©eZx bvixi †ÿ‡Î m¤¢ve¨ Rxe‡bi SuywKc~Y© RwUjZv m„wó nq hvi Rb¨ `ÿ †mev cÖ‡qvRb, wKQzwKQz †ÿ‡Î g„Zz¨ Gov‡Z eo
ai‡bi cÖme-msµvšÍ A‡¯¿vcPv‡ii cÖ‡qvRb nq| GmwWwR (SDG) 3.1 AR©‡bi Rb¨, gvZ…g„Zz¨i nvi eZ©gvb gvÎv cÖwZ
100,000 RxweZ R‡b¥ 169 †_‡K D‡jøL‡hvM¨ nv‡i n«vm Ki‡Z n‡e| beRvZ‡Ki g„Zz¨i nviI axiMwZ‡Z Kg‡Q| gvZ… I
beRvZ‡Ki g„Zz¨ Ges Amy¯’Zvi nvi D‡jøL‡hvM¨ nv‡i n«vm Ki‡Z cÖm‡ei mgq `ÿ avÎxi Dcw¯’wZ e„w× Ab¨Zg cÖavb
f‚wgKv ivL‡Z cv‡i| UH & FWC Gi g~j¨vqb djvdj Abyhvqx, cÖm‡ei mg‡q gv I beRvZ‡Ki Rxeb-iÿvKvix
†mev`vb `ªæZ e„w× Ki‡Z BDwbqb ch©v‡q †mev‡K›`ª ¸‡jvi m‡e©v”P m¤¢vebv i‡q‡Q| GB SOP n‡jv UH & FWC Gi
Rb¨ GKwU MvBWjvBb hv evsjv‡`k Ry‡o cÖv_wgK ch©v‡q D”Pgv‡bi gvZ„ I ZvrÿwYK beRvZK ¯^v¯’¨‡mev cÖ`v‡bi Rb¨
BDwbqb ch©v‡qi †mev‡K‡›`ªi gvb wb‡`©k K‡i| GwU Abygvb Kiv hvq †h GB MvBWjvB‡bi Kvh©Ki cÖ‡qv‡Mi d‡j
evsjv‡`‡k gv I beRvZ‡Ki Amy¯’Zv I g„Zz¨i nvi AviI K‡g hv‡e| cÖgvYwfwËK Ávb Ges cÖhyw³MZ m¤ú` wewb‡qvM K‡i
GKwU gvbm¤úbœ c×wZ e¨envi Kiv n‡jv GB jÿ¨gvÎv AR©‡bi cÖavb nvwZqvi|

BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi (UH&FWC) Kvh©µg

MªvgxY RbM‡Yi Rb¨ ¯^v¯’¨ Ges cwievi cwiKíbv †mev wbwðZ Kivi j‡ÿ¨, evsjv‡`k miKvi †h mKj BDwbq‡b Dc‡Rjv
¯^v¯’¨ Kg‡cø· i‡q‡Q †m¸‡jv e¨ZxZ cÖwZwU BDwbq‡b GKwU K‡i UH&FWC Pvjv‡”Q| †K›`ªwU gvby‡li †`vi‡Mvovq Ges
25,000 †_‡K 30,000 gvbyl GLvb †_‡K wb¤œewY©Z †mev cv‡”Q:
l gvZ… ¯^v¯’¨ †mev
l wkï ¯^v¯’¨ †mev
l wK‡kvi wK‡kvix ¯^v¯’¨ †mev
l cÖRbb ¯^v¯’¨ †mev
l cywó †mev
l cwievi cwiKíbv †mev
l mxwgZ fv‡e †ivM wbivgq †mev
l ¯^v¯’¨ wkÿv
l RwUj †Km ¸‡jv †idvi Kiv
l gvwmK wbqwgZKiY (MR) †mev

01
 †gvU 3,590wU BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi g‡a¨, 2,200 wU BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K›`ª avÎx we`¨vq
cÖwkÿYcÖvß †mevKg©x‡`i gva¨‡g 24/7 NÈv cÖme †mev w`‡”Q| cwievi Kj¨vb cwi`wk©Kv-Gi Dcw¯’wZ I wbwðZ Kiv
n‡q‡Q hv‡Z Gme †K‡›`ª †idv‡ijmn ¯^vfvweK cÖme †mev †`qv hvq| GB SOP b¨vkbvj g¨vUvibvj †nj_ ÷¨vÛvW©
Acv‡iwUs cÖwmwWDi †_‡K M„nxZ Ges UH&FWC-Gi Øviv cÖ`vbK…Z gvZ… ¯^v¯’¨ Ges ZvrÿwYK I AZ¨vek¨Kxq beRvZK
†mevi Rb¨ wba©vwiZ|

SOP Gi mv‡_ cÖv_wgKfv‡e mswkøó hviv

l BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi (UH&FWCs) ¯^v¯’¨ Kwg©MY

l Rb¯^v¯’¨ Kg©KZ©v Ges mycvifvBRvi
l cÖwkÿY cÖ`vbKvix ms¯’¨vmg~n
l ¯^v¯’¨ Kg©m~wP g~j¨vqbKvix/ ev¯ÍevqbKvix
l AvšÍR©vwZK Dbœqb Askx`viMY
l bxwZ wba©viKe„›`

†mev`vbKvixe„›`
÷¨vÛvW© 1: cÖ‡Z¨K gv‡K wbqwgZ †mev Ges RwUjZvi e¨e¯’vcbv †mev`v‡bi Rb¨ `ÿ, AbycÖvwYZ †mev Kgx©i mve©ÿwYK
Dcw¯’wZ cÖ‡qvRb|

‡mev`vbKvix‡`i aib I msL¨v

†mev‡K‡›`ªi aib cÖ‡`q †mev †mevKg©x
BDwbqb ¯^v¯’¨ I cwievi l 24/7, gv I beRvZ‡Ki ¯^v¯’¨ l cwievi Kj¨vb cwi`wk©Kv (GdWweøDwf)
Kj¨vb †K›`ª (UH&FWC) †mev l DcmnKvix KwgDwbwU †gwW‡Kj Awdmvi
l †gŠwjK j¨ve‡iUix †mev (m¨vK‡gv)

02
 †mKkb 1t
Mf©Kvjxb †mev

Mf©Kvjxb †mev 03
04 Mf©Kvjxb †mev
 Mf©Kvjxb †mev
Mf©Kvjxb †mev Ggb GKwU mgwš^Z †mev hvi jÿ¨ n‡jv Mf©eZx bvix‡K †mev cÖ`vb K‡i Mf©¯’ wkïi ¯^vfvweK weKvk
wbwðZ K‡i gv I wkï Df‡qi Rb¨ GKwU ¯^v¯’¨Ki Mf© djvdj AR©b Kiv| GwU gvbm¤§Z †cÖv‡UvKj Abyhvqx wbqwgZ,
wbqgvbyM ZË¡veav‡b A_ev cÖwZwU bvixi Pvwn`v Abymv‡i MwVZ nq| Mf©Kvjxb †mev bvixi Mf© I cÖme msµvšÍ RwUjZv
Kgvq Ges g„Zev”Pv (w÷j ev_©) I †cwi‡bUvj g„Zz¨ Kgvq hv Mf©Kvjxb Ae¯’vq mgwš^Zfv‡e †`qv nq|

K. Mf©Kvjxb †mevi D‡Ïk¨

l cywó, e¨w³MZ ¯^v¯’¨wewa, wekÖvg Ges e¨vqvg, cÖme cwiKíbv Ges cÖme cieZ©x RwUjZv cÖ¯‘wZ, wbivc` †hŠbPP©v Ges
cwievi cwiKíbv m¤ú‡K© wkÿv cÖ`vb K‡i gv I beRvZ‡Ki kvixwiK, gvbwmK I mvgvwRK ¯^v¯’¨ Dbœqb Ges Zv eRvq
ivLv|
l Mf©ve¯’vq wPwKrmv, A‡¯¿vcPvi A_ev cÖmemsµvšÍ mgm¨v mbv³KiY Ges e¨e¯’vMÖnY |
l mwVKfv‡e ey‡Ki `ya LvIqv‡bvi cÖ¯‘wZ, ¯^vfvweKfv‡e cÖme cieZ©x Av‡ivM¨jvf Ges beRvZ‡Ki kvixwiK, gvbwmK
I mvgvwRKfv‡e ch©vß hZœ wb‡Z gv‡K mnvqZv cÖ`vb |

÷¨vÛvW© 2: BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi ¯^v¯’¨Kg©xMb KvD‡Ýwjsmn Mf©Kvjxb †mevi (ANC) mKj Dcv`vb
cÖ`v‡b cvi`k©x n‡q DV‡eb

L. Mf©Kvjxb †mevi (ANC) mgqm~wP

Mf©Kvjxb wfwR‡Ui Av`k© mgqm~wP n‡jv, Mf©ve¯’vi 28 mßvn ch©šÍ cÖwZ gv‡m 1evi, 36 mßvn ch©šÍ cÖwZ 2 mßv‡n 1evi,
Zvici †_‡K cÖm‡ei c~e© ch©šÍ cÖwZ mßv‡n 1 evi| wKš‘ wek¦ ¯^v¯’¨ ms¯’v (WHO) mycvwik Abyhvqx, hZ `ªæZ m¤¢e 16
mßv‡ni c~‡e© Mf©eZx bvixi Mf©Kvjxb †mev cvIqv DwPZ Ges wb‡Pi mgqm~wP Abyhvqx Kgc‡ÿ 4wU Mf©Kvjxb wfwR‡U hv‡e:
l 1g wfwRU: 4_© gvm/16 mßv‡n-1g wfwRU Mf© mbv³Ki‡Yi mv‡_ mv‡_B nIqv DwPZ
l 2q wfwRU:6ô-7g gvm/24-28 mßv‡n
l 3q wfwRU: 8g gvm/32 mßv‡n
l 4_© wfwRU:9g gvm/36 mßv‡n

hLbB GKRb bvix Mf©eZx wn‡m‡e wPwýZ n‡eb, ZLbB hZ `ªæZ m¤¢e (16 mßv‡ni g‡a¨) gvbm¤§Z †gwW‡Kj cªwkÿYcÖvcÍ
¯^v¯’¨Kg©x †_‡K Mf©Kvjxb †mev MÖn‡Y Zv‡K DrmvwnZ Ki‡Z n‡e| Mf©Kvjxb †mevi ¸YMZgvb wbwðZ Kivi Rb¨ †mevi
†gŠwjK gvb e„w× I Z`vbyhvqx KvR Kiv cª‡qvRb|

Mf©aviY wbY©q:
jÿY I DcmM© mg~n: ¯úó jÿY I wPýmg~n:
l gvwmK eÜ nIqvi BwZnvm l Mf©¯’ wkïi bovPov (20 mßvn ci)
l ¯Íb fvix I e¨_v‡eva nIqv
l Mf©¯’ wkïi ür¯ú›`b †kvbv (24 mßvn ci)
l ewg ewgfve Ges we‡kl K‡i mKvj †ejvq ewg nIqv
l K¬vwšÍ Ges wSgwSgfve
l Zj‡cU (1g UªvB‡g÷v‡ii ci) µgvš^‡q eo nIqv

Mf©Kvjxb †mev 05
06
M. wewfbœ Mf©Kvjxb †mevi (ANC) wfwR‡U KiYxq

1g wfwRU: 16 mßvn 2q wfwRU: 24-28 mßvn 3q wfwRU: 32 mßvn 4_©wfwRU: 36 mßvn

Mf©Kvjxb †mev
jÿ¨ - Mf©aviY wbwðZ K‡i m¤¢ve¨ cÖme Gi ZvwiL - gv I wkïi my¯’Zv hvPvB Kiv - gv I wkïi my¯’Zv hvPvB Kiv - gv I wkïi my¯’Zv hvPvB Kiv
(EDD) wnmve Kiv - Mf©Kvjxb D”P i³Pvc, i³¯^íZv, - Mf©Kvjxb D”P i³Pvc, - Mf©Kvjxb D”P i³Pvc,
- Mf©eZx bvixi wbeÜb GKvwaK Mf©¯’ wkï Av‡Q wK bv Zv i³¯^íZv, Rivqy‡Z Mf©¯’ i³¯^íZv, Rivqy‡Z Mf©¯’
- iæwUb Mf©Kvjxb †mev A_ev AviI we‡kl hvPvB Kiv wkï‡`i ¯^vfvweK e„w× K‡g wkï‡`i ¯^vfvweK e„w× K‡g
†mevi Rb¨ w¯Œwbs Kiv - cÖwZ‡ivaK e¨e¯’v ‡`qv hvIqv (IUGR) GKvwaK Mf©¯’ hvIqv (IUGR),
- mbv³KiY, wPwKrmv &Ges cÖwZ‡ivaK e¨e¯’v - cÖme I Riæwi Ae¯’vi cÖ¯‘wZ wkï Av‡Q wK bv Zv hvPvB Kiv A¯^vfvweK Ae¯’vb, GKvwaK
†`qv cwiKíbv ch©v‡jvPbv I cÖ‡qvR‡b - cÖwZ‡ivaK e¨e¯’v ‡`qv Mf©¯’ wkï Av‡Q wK bv Zv hvPvB
- cÖme I Riæwi Ae¯’vi GKwU cwiKíbv MÖnY cwieZ©b Kiv - cÖme I Riæwi Ae¯’v cÖ¯‘wZ Kiv
Kiv - civgk© `vb Ges KvD‡Ýwjs Kiv cwiKíbv ch©v‡jvPbv I - cÖwZ‡ivaK e¨e¯’v ‡bqv
- civgk© Ges KvD‡Ýwjs cÖ‡qvR‡b cwieZ©b Kiv - cÖme I Riæwi Ae¯’vi cÖ¯‘wZ
- civgk© `vb Ges KvD‡Ýwjs cwiKíbv ch©v‡jvPbv I
Kiv cÖ‡qvR‡b cwieZ©b Kiv
- civgk© `vb Ges KvD‡Ýwjs
- ch©vß IRb e„w× (cy‡iv
Mf©Kv‡j Kgc‡ÿ 9 †KwR)
Kvh©vewj: Riæwi jÿ‡Yi †ÿ‡Î memgq `ªæZ cÖv_wgK g~j¨vqb Ges e¨e¯’v MÖnY Kiæb, Dchy³ wPwKrmv w`b Ges cÖ‡qvR‡b nvmcvZv‡j †idvi Kiæb

BwZnvm l gvwm‡Ki BwZnvm
(wRÁvmv, cÖ_g gvwmK ïiæi eqm, Pµ
†PK (wbqwgZ/AwbqwgZ), mgq,
†iKW©) cÖevn-(‡ekx/Kg/¯^vfvweK), †kl gvwm‡Ki
ZvwiL Ges cÖm‡ei m¤¢ve¨ ZvwiL- (LMP
& EDD)
l c~‡e©i Mf©avi‡Yi BwZnvm
cÖme msL¨v, Mf©aviY msL¨v (Para,
Gravida), †kl ev”Pvi eqm, g„Z ev”Pv
(IUD), cÖm‡ei aib, cÖm‡ei ¯’vb,
- ¸iæZ¡c~Y© DcmM© g~j¨vqb, Mf©ve¯’vq
c~‡e©i RwUjZv Ges cÖ&vß wPwKrmv
†`Lvi Rb¨ †iKW© hvPvB Kiv|
- cybivq †kÖwYwefvRb Kiæb (hw`
cÖ‡qvRb nq)
- ¸iæZ¡c~Y© DcmM© g~j¨vqb,
Mf©ve¯’vq c~‡e©i RwUjZv Ges
cÖvß wPwKrmv †`Lvi Rb¨ †iKW©
hvPvB Kiv|
- cybivq †kÖwY wefvRb Kiæb
(hw` `iKvi/cÖ‡qvRb nq)
- ¸iæZ¡c~Y© DcmM© g~j¨vqb,
Mf©ve¯’vq c~‡e©i RwUjZv Ges
cÖvß wPwKrmv wK †c‡q‡Q †iKW©
hvPvB Kiæb|
- cybivq †kÖwYwefvRb Kiæb (hw`
`iKvi/cÖ‡qvRb nq)
 1g wfwRU: 16 mßvn 2q wfwRU: 24-28 mßvn 3q wfwRU: 32 mßvn 4_©wfwRU: 36 mßvn

Uvg©/wcÖ-Uvg©/‡cv÷-Uvg©, †kl Mf©Kvjxb

RwUjZv, Mf© cieZ©x RwUjZv, cÖmec~e©
†mevi BwZnvm, Ilya MÖn‡Yi BwZnvm
l cvwievwiK BwZnvm :
Wvq‡ewUm, D”P i³Pvc
l mvaviY †ivM mg~†ni BwZnvm:
ü`‡ivM, wKWwb†ivM, nuvcvwb, RwÛm, †hŠb
msµgY, h²v
l wU‡Ubvm wUKv MÖn‡Yi BwZnvm
l D‡jøL‡hvM¨ jÿY¸‡jv wbY©q, gvbwmK I
mvgvwRK BwZnvm MÖnY
l Mf©ve¯’v wbwðZ Kiæb Ges cÖm‡ei m¤¢ve¨
ZvwiL MYbv Kiæb (EDD)
l mKj bvix‡K †kÖwYwefvRb Kiæb
mvaviY - i³Pvc, bvwo¯ú›`b - i³Pvc, bvwo¯ú›`b, IRb - i³Pvc, bvwo¯ú›`b, IRb -
i³Pvc, bvwo¯ú›`b,IRb
cixÿvmg~n - i³¯^íZv - i³¯^íZv - i³¯^íZv, RwÛm, BwWgv -
i³¯^íZv, RwÛm, BwWgv
(‡`Lyb, - RwÛm - RwÛm - Rivqyi AvKvi GKB, Kg ev -
k¦vm-cÖk¦v‡m Kó
ïbyb, - D”PZv I IRb - BwWgv A¯^vfvweK eo -
Mf©¯’ wkïi e„w× I bovPov
Abyfe - cÖmemsµvšÍ cixÿv - Mf©¯’ wkïi e„w× I bovPov -
GKvwaK Mf©
Kiæb) - we Gg AvB1 -Mf©¯’ wkïi A¯^vfvweK Ae¯’vb
I Dc¯’vcb
w¯Œwbs - wn‡gv‡Møvweb (%) - wn‡gv‡Møvweb (%) - BDwib di A¨vjeywgb myMvi, - BDwib di A¨vjeywgb myMvi GÛ
cixÿv - BDwib R/M/E - BDwib R/M/E GÛ cvm †mj cvm †mj
2
mg~n - BDwib di myMvi GÛ A¨vjeywgb eøvW MÖæwcs, - eøvW myMvi - Avëªvm‡bvMÖvg - wn‡gv‡Møvweb%
Rh UvBwcs - wn‡gv‡Møvweb%
- Avëªvm‡bvMÖvg2

Mf©Kvjxb †mev
- GBPweGmGwR (HBsAg)

07
08
1g wfwRU: 16 mßvn 2q wfwRU: 24-28 mßvn 3q wfwRU: 32 mßvn 4_©wfwRU: 36 mßvn

Mf©Kvjxb †mev
cÖwZ‡ivaK - Avqib I †dv‡jU w`b - wU‡Ubvm U·‡qW4
e¨e¯’v - Mf©ve¯’vq g¨v‡jwiqvi Rb¨ AšÍe©Zx - Avqib I †dv‡jU
cÖwZ‡ivagyjK wPwKrmv (IPTP)3 - K¨vjwmqvg
- gvwëwfUvwgb I wgbv‡ij
- K…wgbvkK (Albendazole)
(GKevi, hw` bv †`qv n‡q _v‡K),
- Mf©ve¯’vq g¨v‡jwiqvi Rb¨ AšÍe©Zx©
cÖwZ‡ivagyjK wPwKrmv (IPTP)3
- Avqib I †dv‡jU
- K¨vjwmqvg
- gvwëwfUvwgb I wgbv‡ij
- K…wgbvkK (Albendazole)
(GKevi, hw` bv †`qv n‡q
_v‡K)
- Mf©ve¯’vq g¨v‡jwiqvi Rb¨
AšÍe©Zx© cÖwZ‡ivagyjK wPwKrmv
(IPTP)3
- wg‡mv‡cÖv÷j 400 gvB‡µvMÖvg
2wU U¨ve‡jU (evox‡Z cÖm‡ei
†ÿ‡Î) weZiY
- Avqib I †dv‡jU
- K¨vjwmqvg
- gvwëwfUvwgb I LwbR/wgbv‡ij
- Mf©ve¯’vq g¨v‡jwiqvi Rb¨
AšÍe©Zx© cÖwZ‡ivagyjK wPwKrmv
(IPTP)
- K…wgbvkK (Albendazole)
(GKevi hw` bv †`qv n‡q
_v‡K)
- wg‡mv‡cÖv÷j U¨ve‡jU 400
gvB‡µvMÖvg 2wU U¨ve‡jU
weZiY (hw` 3q wfwR‡U bv
†`qv n‡q _v‡K)

wPwKrmv- Dchy³ †mevKg©x Ges mgwš^Z †mev‡K‡›`ªi cÖvc¨Zv Abyhvqx mKj mgm¨vi wPwKrmv Kiæb ; cÖ‡qvRb Abyhvqx RwUjZvi wPwKrmvi Rb¨ †idvi Kiæb

¯^v¯’¨wkÿv - iæwUb Mf©Kvjxb †mevi ¸iæZ¡ - cÖme cwiKíbv I Riæwi Ae¯’vi - cÖme cwiKíbv I Riæwi - cÖme cwiKíbv I Riæwi
civgk©, - N‡i wb‡Ri hZœ cÖ¯ÍywZ hvPvB Kiæb Ae¯’vi cÖ¯ÍywZ hvPvB Kiæb Ae¯’vi cÖ¯ÍywZ hvPvB Kiæb
Ges - wekªvg, fvix KvR, fvix wRwbm DVv‡bv Gwo‡q - c~‡e©i KvD‡Ýwjs G †Rvi w`b - beRvZ‡Ki Acwinvh© hZœ, Rb¥ - beRvZ‡Ki Acwinvh© hZœ,
KvD‡Ýwjs Pjv KvD‡Ýwjs cieZ©x hZœ, ¯Íb¨cvb/ey‡Ki `ya Rb¥cieZ©x hZœ, ¯Íb¨`vb/ey‡Ki
- gv‡qi cywó l gvZ… ¯^v¯’¨ cvb `ªæZ ïiæ Kiv, cÖmecieZ©x `ya cvb `ªæZ ïiæ Kiv,
cÖme-cieZ©x cwievi cwiKíbv
- wbivc` mnevm Ges ¯^v¯’¨Ki RxebhvÎv - Lv`¨, cywó Ges Zij cwievi cwiKíbv Ges Rb¥
Ges Rb¥/mwVK Rb¥weiwZ
- ZvgvK e¨envi †_‡K weiZ _vKv - wekªvg e¨eavb Gi Dci KvD‡Ýwjs e¨eavb Gi Dci KvD‡Ýwjs
- Mf©ve¯’vi wec`wPýmg~n Ges cÖme RwUjZv - G¤^y‡jkb ¯^vfvweK nvUvPjv Kiv Kiæb Kiæb
- cÖme cÖ¯‘wZ I Riæwi Ae¯’vi cÖ¯‘wZ - Mf©Kvjxb †mevi ¸iæZ¡ - c~‡e©i KvD‡Ýwjs G †Rvi w`b - c~‡e©i KvD‡Ýwjs G †Rvi w`b
- mvaviY cwi”QbœZv I wb‡Ri hZœ - wg‡mv‡cÖv÷j wb‡q KvD‡Ýwjs - wg‡mv‡cÖv÷j wb‡q KvD‡Ýwjs
- gv‡qi wec` wPýmg~n Kiæb Kiæb
 1g wfwRU: 16 mßvn 2q wfwRU: 24-28 mßvn 3q wfwRU: 32 mßvn 4_©wfwRU: 36 mßvn

- cÖ¯ªve I cvqLvbv
- e¨vqvg
- cÖme cÖ¯‘wZ
- cÖme-cieZ©x cwievi cwiKíbv
- nvZ †avqv
l cÖme cÖ¯‘wZ
- cÖme Kiv‡bvi ¯’vb
- †ivMxi mnKvix Ges i³`vZv
†RvMvo Kiv
- A_©mÂq Kiv
- hvZvqvZ
l beRvZ‡Ki ¯^v¯’¨
- cÖ‡qvRbxq beRvZK †mev
- ZvrÿwYKfv‡e ïaygvÎ ey‡Ki `ya
cvb Kivb
- cÖme cieZ©x wfwR‡Ui ¸iæZ¡
- beRvZ‡Ki wec` wPýmg~n
- DòZv (STS, KMC)

†bvU:
1. we Gg AvB; IRb (†KwR)/D”PZv (wgUvi)2, <18.5-Kg IRb, <17 gvSvgvwS Kg IRb, <16 Zxeª Kg IRb|
2. †hLv†b cvIqv hv‡e
3. g¨v‡jwiqv cÖeY GjvKv
4. hw` 5wU †WvR m¤ú~Y© nq, Z‡e cÖ‡qvRb †bB

Mf©Kvjxb †mev
09
 N. Z_¨, wkÿv, †hvMv‡hvM Ges civgk© cÖ`vb

Mf©Kvjxb †PKAv‡ci mgq, Mf©eZx gv‡K ¯^v¯’¨wkÿv Ges civgk©`v‡bi cvkvcvwk Zvi ¯^vgx Ges cwiev‡ii mv‡_
†mev`vbKvixi †hvMv‡hvM AZ¨šÍ ¸iæZ¡c~Y©| Mf©eZx gv‡qi mv‡_ Zv‡`iI Z_¨¸‡jv Rvbv‡Z n‡e hv‡Z K‡i Zv‡`i e¨w³MZ
Ávb Ges AvPi‡Yi Øviv g„Zz¨ I AÿgZvi gvÎv Kwg‡q †mevi gvb Dbœqb Kiv m¤¢e nq|

Mf©eZx bvix Ges Zvi cwievi‡K wkÿv I civgk©`v‡bi †ÿ‡Î wb‡Pi Z_¨¸‡jv e¨envi Kiæb:

1. wU‡Ubvm U·‡qW wUKv`vb:

Mf©eZx gv‡K wUKv w`‡Z n‡e A_ev Zv‡K `iKvi n‡j wUKv`vbKvixi Kv‡Q cvVv‡Z n‡e| Rxebe¨vcx †ivM cÖwZ‡iv‡ai Rb¨
5 wU †Wv‡R wUwU wUKv †`qv nq:
l 1g †WvR (wUwU1)- 15 eQi eq‡m A_ev cÖ_g Mf©Kvjxb wfwR‡U
l 2q †WvR (wUwU2)- 1g †Wv‡Ri Kgc‡ÿ 1gvm (4mßvn) ci
l 3q †WvR (wUwU3)- 2q †Wv‡Ri Kgc‡ÿ 6gvm ci
l 4_© †WvR(wUwU4)- 3q †Wv‡Ri Kgc‡ÿ 1eQi ci
l 5g †WvR(wUwU5)- 4_© †Wv‡Ri Kgc‡ÿ 1eQi ci

wUwU wUKv wb‡¤œv³ Dcv‡q wU‡Ubv‡mi weiæ‡× myiÿv `vb K‡i:

l 1g †WvR (wUwU1)- wbivcËv wenxb
l 2q †WvR (wUwU2)- 2q †Wv‡Ri ci 3 eQ‡ii Rb¨ wbivc` (2q †WvR cÖ‡qv‡Mi 1 gvm ci †_‡K cÖwZiÿv ïiæ nq)
l 3q †WvR (wUwU3)- 3q †Wv‡Ri ci 5 eQ‡ii Rb¨ wbivc`
l 4_© †WvR (wUwU4)- 4_© †Wv‡Ri ci 10 eQ‡ii Rb¨ wbivc`
l 5g †WvR (wUwU5)- cÖRbbKvj ch©šÍ wbivc`

2. ¯^v¯’¨Ki Lvevi Ges cywó

Mf©ve¯’vq, gv‡q‡`i ch©vß K¨v‡jvwi mg„× mylg Lv`¨ LvIqv DwPZ hv‡Z mšÍvb avi‡Yi Rb¨ m„ó AwZwi³ Pvwn`v c~iY nq|
cÖwZw`b wZb‡ejv cÖavb Lvev‡ii mv‡_ evowZ `yB †ejv LvIqvi civgk© w`b| Lvev‡i mKj Acwinvh© Dcv`vb: Avwgl,
kK©iv, Pwe©, wfUvwgb I LwbR jeY _vKv evÃbxq|
cvwb: Mf©eZx bvix‡`i ch©vß cvwb cvb (8-12 Møvm, AvenvIqv I ZvcgvÎv Abyhvqx) Ges Av‡qvwWbhy³ jeY LvIqv DwPZ|

Avqib Ges dwjK GwmW

Mf©ve¯’vq i³¯^íZv cÖwZ‡iv‡a Avqib Ges dwjK Gwm‡Wi mycvwikK…Z gvÎv/Schedule

gvÎv Avqib 60 wgtMÖvt+ dwjK GwmW 400 gvB‡µvMÖvg
MÖn‡Yi mgq cÖwZw`b Lvev‡ii mgq
w¯’wZKvj Mf©ve¯’v wbw`©ó nIqvi ci n‡Z (Mf©ve¯’vi 12 mßvn n‡Z ïiæ K‡i cÖmecieZ©x 3 gvm ch©šÍ) †meb evÃbxq
Uv‡M©U MÖæc mKj Mf©eZx bvix

K¨vjwmqvg
Mf©ve¯’vq K¨vjwmqvg cÖ`v‡bi mycvwikK…Z gvÎv/Schedule
gvÎv 1.5-2 MÖvg K¨vjwmqvg/cÖwZw`b
MÖn‡Yi mgq cÖwZw`b m¤ú~Y© gvÎv‡K 3 fv‡M fvM K‡i (Lvev‡ii mv‡_ MÖnY evÃbxq)
w¯’wZKvj Mf©ve¯’vq 20 mßvn n‡Z cÖme ch©šÍ
DwÏó `j mKj Mf©ve¯’vi bvixi we‡klZ hviv Mf©Kvjxb D”P i³Pv‡ci SuywKc~Y©

10 Mf©Kvjxb †mev
Avqib : Mf©ve¯’vi Avqibhy³ Lvevi ( meyR kvK mewR, KwjRv, wWg) Ges wfUvwgb wm (†jey, †Uvgv‡Uv, AvgjwK) Ges
cÖvYxR Avwgl I meyR mewR ‡L‡Z n‡e| Mf©ve¯’vi 4_© gvm †_‡K cÖme cieZ©x 3 gvm ch©šÍ i³¯^íZv cÖwZ‡iva Kivi Rb¨
Wv³v‡ii civgk© Abyhvqx cÖwZw`b 1wU Avqib U¨ve‡jU LvIqv cÖ‡qvRb| Avqi‡bi cvk¦©-cÖwZwµqv (†KvôKvwVb¨) Ges Gi
mnR mgvavb (ch©vß cvwb, Bmye¸‡ji fzwm, cÖPzi kvKmewR) eywS‡q ej‡Z n‡e| cvqLvbvi is Avqib MÖn‡Yi Rb¨ Kv‡jv
n‡Z cv‡i, G‡Z wPšÍvi wKQz †bB| Mf©ve¯’vq 6-12 †KwR IRb evov‡Z n‡e|

Lv`¨ m¤úwK©Z Kzms¯‹vi: evsjv‡`‡k Lvevi wb‡q wewfbœ iKg Kyms¯‹vi Ges åvšÍ avibv cÖPwjZ Av‡Q| Gme åvšÍ avibvi
ÿwZKi cÖfve wb‡q Av‡jvPbv Ki‡Z n‡e|

3. wekÖvg Ges Ab¨vb¨ Kvh©µg

Mf©eZx bvix‡`i iv‡Z AšÍZ 8 N›Uv Nyg Ges `ycy‡ii Lvev‡ii ci 2 N›Uv wekÖvg †bqv cÖ‡qvRb| ¯^vfvweK Kvh©µg Pvwj‡q
wb‡Z Ges fvix kvixwiK cwikÖg Gwo‡q hvevi civgk© w`b| 1g Ges 3q UªvB‡g÷v‡i `~‡ii hvÎv Gwo‡q Pj‡Z n‡e|
AvuUmuvU †cvkvK bv civi civgk© w`b|

4. e¨w³MZ cwi”QbœZv I wbR¯^ cwiPh©v

Mf©eZx bvix‡`i cÖwZw`b †Mvmj, `vuZ gvRv, cwi®‹vi Kvco civ, Kvco ay‡q †iv‡` ïKv‡bv, LvIqvi Av‡M Ges Uq‡jU
e¨env‡ii ci mvevb w`‡q nvZ †avqv, bL KvUv I Zv cwi®‹vi ivLv BZ¨vw` civgk© w`b| G mgq cÖ‡qvRbxq gvbwmK mnvqZv
`vb Ki‡Z cwievi‡K ejyb| hw` Mf©cvZ nIqvi BwZnvm _v‡K Z‡e cÖ_g UªvB‡g÷v‡i mnevm Gwo‡q Pj‡Z civgk© w`b|

5. cÖ¯ªve I cvqLvbvi Af¨vm

Mf©ve¯’vq †KvôKvwVb¨ LyeB mvaviY NUbv| cÖPyi cwigv‡Y Zij, kvKmewR Ges `ya cvb K‡i wbqwgZ gjZ¨v‡Mi Af¨vm
Kiv DwPZ| g~Î_wji msµgY Ges Ab¨vb¨ RwUjZv Gov‡Z evi evi g~ÎZ¨vM Ges cwi”QbœZv eRvq ivL‡Z ejyb|

6. iæwUb Ges d‡jv-Avc wfwRU m¤ú‡K© civgk© cÖ`vb

cÖwZ wfwR‡U bv n‡jI Kgc‡ÿ GKwU wfwR‡U ¯^vgx A_ev cwiev‡ii †KvbI m`m¨‡K mv‡_ Avb‡Z Mf©eZx gv‡K DrmvwnZ
Kiyb|

7. cÖme Ges Riæwi Ae¯’v m¤ú‡K© cwiKíbv cÖYqb

cÖme cÖ¯‘wZ cÖYq‡b wbw`©ó †kÖYxi (†hgb, Mf©eZx gv, ¯^vgx, k¦ïievwoi m`m¨, cwievi I mvgvwRK ¯Í‡ii wm×všÍMÖnYKvix
e¨w³e‡M©i/ m`m¨‡`i) mv‡_ civgk© Ki‡Z n‡e Ges cÖvwZôvwbK cÖm‡e DrmvwnZ Kiv| BDwbqb ¯^v¯’¨ I cwievi Kj¨vb
†K›`ª (UH&FWC), Dc‡Rjv ¯^v¯’¨ Kg‡cø· (UHC), gv I wkï Kj¨vb †K›`ª (MCWC), ‡Rjv m`i nvmcvZvj
(DH), †gwW‡Kj K‡jR nvmcvZvj (MCH), †hLv‡b Zvi Rb¨ myweavRbK nq| hw` wZwb †mLvbKvi Ab¨ †KvbI
myweavcÖvß †K‡›`ª †h‡Z AvMÖnx nb, Z‡e Zv wb‡q I Av‡jvPbv Kiyb|

8. cÖm‡ei jÿY¸‡jv Av‡jvPbv

Mf©eZx bvixi wb‡Pi †KvbI GKwU jÿY †`Lv w`‡j Zv‡K ¯^v¯’¨‡K‡›`ª wb‡Z A_ev `ÿ avÎxi mv‡_ †hvMv‡hv‡Mi Rb¨ Zvi
cwievi‡K civgk© w`‡Z n‡e:
l AvVv‡jv, i³wgwkÖZ ¯ªve
l cÖvq 20 wgwbU ci ci e¨_vhy³ ms‡KvPb
l cvwb †f‡O hvIqv

9. Mf©ve¯’vq wec`wPý

gv I Zvi cwievi‡K Mf©ve¯’vq cÖme Kvjxb, cÖme-cieZ©x mg‡qi wec`wPý¸‡jv Rvbvb:

l Mf©ve¯’vq †hvbxc‡_ i³mªve Ges cÖme I cÖme cieZ©x mg‡q Zxeª i³cvZ
l Zxeª gv_ve¨v_v I Svcmv †`Lv

Mf©Kvjxb †mev 11
 l 3 w`b ev Gi †ewk mgq a‡i 100.40 dv. Gi †ewk R¡i, `yM©Ühy³ ¯ªve
l evavMÖ¯’ ev wejw¤^Z cÖme Ges Mf©¯’ wkïi A¯^vfvweK Ae¯’vb
l wLuPzwb

10. Mf©ve¯’vq Riæwi cÖ¯‘wZ Kxfv‡e wb‡Z n‡e Zv wb‡q Av‡jvPbv Kiæb

gv I Zvi cwiev‡ii mv‡_ wb‡Pi wel‡q Av‡jvPbv Kiyb, cÖwZwU cÖmec~e© wfwR‡Ui myweav e¨vL¨v Kiæb Ges cÖme cwiKíbv
Kiv n‡q‡Q wK bv Zv wK bv Zv wbwðZ Kiæb

welq Dcvq cÖwZ wfwR‡U †mevKg©xi KZ©e¨

wZwb †Kv_vq cÖme Kiv‡eb?
†K cÖme Kiv‡eb?
Riæwi Ae¯’vq wZwb †Kv_vq hv‡eb?
†mev‡K›`ª/ M„n: Wv³vi/bvm©/ cwievi
Kj¨vY cwi`wk©Kv/ wgWIqvBd/
KwgDwbwU w¯‹jW ev_© G‡Ub‡WÝ
(CSBA)
mgwš^Z Riæwi cÖm~wZ †mev †K‡›`ª
UHC / MCWC / DH
bvg I wVKvbv msM„nxZ n‡q‡Q wK bv
wbwðZ Kiæb
bvg I wVKvbv msM„nxZ n‡q‡Q wK bv
wbwðZ Kiæb

wZwb †mLv‡b Kxfv‡e hv‡eb? G¤^y‡jÝ/ Mvwo/wiKkv/f¨vb/ †bŠKv Zv‡`i mv‡_ †hvMv‡hvM n‡q‡Q wK bv
hvZvqv‡Zi e¨e¯’v Kiv n‡q‡Q wK bv? wbwðZ Kiæb

wZwb ch©vß A_© mÂq K‡i‡Qb wK bv/ Mf©ve¯’vi GK`g ïiy †_‡K cÖwZw`b Zv Kiv wbwðZ Kiæb
Riæwi Ae¯’vi Rb¨ A_© mÂq K‡i‡Qb A_© Rgv‡Z n‡e hv‡Z cÖm‡ei LiP
wK bv? I/A_ev Riæwi Ae¯’vq †mevi LiP
wg‡U hvq|
Riæwi Ae¯’vi Rb¨ wZwb i‡³i e¨e¯’v 2-3 Rb‡K cÖ¯‘Z ivL‡Z n‡e Riæwi i³`vZv‡`i mv‡_ i³`v‡bi Rb¨
Kxfv‡e Ki‡eb? Ae¯’vq i³`v‡bi Rb¨| Rvwb‡q †hvMv‡hvM wbwðZ Kiæb
ivLyb, A‡Pbv e¨w³ †_‡K i³ †bqv
wVK bq|

11. beRvZ‡Ki ZvrÿwYK Ges AZ¨vek¨Kxq hZœ

beRvZ‡Ki my¯’ Rxeb wbwðZ Kivi Rb¨ Acwinvh© cÖwZ‡ivaK e¨e¯’v MªnY Kiv cÖ‡qvRb| †m¸‡jv n‡jv:
l cÖme cÖ¯‘wZ
l msµgY cÖwZ‡iva
l cwi®‹vi, Dò, evqyc~Y© cÖme ¯’vb
l hš¿cvwZ, mieivn, IlyacÎ
l gv I beRvZ‡Ki Rb¨ Kvco-‡Pvco

gv I Zvi cwievi‡K †kLv‡Z n‡e:

l wkï‡K mv‡_ mv‡_ ïK‡bv K‡i gv‡qi kix‡ii ms¯ú‡k© †i‡L DòZv w`‡Z n‡e Kgc‡ÿ 2 NÈvi Rb¨ Ges Kvco
w`‡q Rov‡Z n‡e|
l wkkyi gv_v †X‡K ivL‡Z n‡e Ges Kgc‡ÿ 3 w`b c‡i †Mvmj Kiv‡Z n‡e
l bvwoi hZœ: cÖm‡ei ciB 7.1% †Køv‡iv‡nw·wWb bvwfi †Mvovq GKevi w`‡q cwi®‹vi K‡i ïKv‡Z n‡e| gv I
cwievi‡K e‡j w`‡Z n‡e bvwfi †Mvovq Ilya †`qv n‡q‡Q ZvB Zviv †hb Ab¨ wKQz bv †`q| GUv ¯^vfvweKfv‡e
ïwK‡q c‡o hv‡e|
l R‡b¥i 1 N›Uvi g‡a¨ Aek¨B ey‡Ki `ya cvb Kiv‡Z n‡e

12 Mf©Kvjxb †mev
 l beRvZK‡K aivi/¯úk© Kivi c~‡e© mKj †mev`vbKvix‡K Aek¨B nvZ ay‡Z n‡e
l gv/cwievi‡K wkïi Rb¥Kvjxb IRb Rvbv‡Z n‡e
l Rb¥ wbeÜb Ki‡Z n‡e
l gv I cwiev‡i‡K beRvZ‡Ki wec`wPý¸‡jv Rvbv‡Z n‡e
- fv‡jvfv‡e `ya †L‡Z bv cvi‡j
- kix‡ii ZvcgvÎv Kg (35.50 ‡m. ev 95.50 dv.) A_ev R¡i (37.50 †m ev 99.50 dv. Gi †ewk)
- `ªæZ k¦vm-cÖk¦vm (60/wgwbU ev Gi †ewk)
- Zxeªfv‡e ey‡Ki cvuRi †fZ‡i †`‡e hvIqv
- ïaygvÎ DÏxcbvq b‡o A_ev †KvbI bovPov †bB
- wLuPzwbi BwZnvm
- bvwfi jvj‡P fve Pvgovq we¯Í…Z

12. ey‡Ki `ya cvb Kiv‡bv

R‡b¥i 1 N›Uvi g‡a¨ ey‡Ki `ya LvIqv‡bv ïiæ Kiv
l ey‡Ki `y‡ai myweav Ges K…wÎg `y‡ai Amyweav m¤ú‡K© KvD‡Ýwjs
l c~Y© 6 gvm (180 w`b) ch©šÍ ïaygvÎ ey‡Ki `ya `vb
l 6 gvm ci †_‡K ey‡Ki `y‡ai mv‡_ evowZ Lvevi †`qv
l 2 eQi ch©šÍ ey‡Ki `ya cvb Kiv‡bv
l mwVK Ae¯’vb, mshyw³, ey‡Ki `ya †ei Kivi wbqg m¤ú‡K© civgk© I mnvqZv `vb

12.1 ey‡Ki `ya cvb Kiv‡bvi myweav

l wkï - m¤ú~Y© cywó cvq, h_vh_ kvixwiK e„wׇZ mnvqK nq, †ivM cÖwZ‡ivaÿgZv e„w×, Wvqwiqv Ges wbD‡gvwbqvi
nvi Kgv‡Z mvnvh¨ K‡i|
l gv - Mf©dyj wb®‹vk‡b mnvqK, cÖme cieZx© i³cvZ Kgvq, cwievi cwiKíbv Ges Rb¥ weiwZ evov‡Z mvnvh¨ K‡i,
Ges ¯Íb K¨vbmv‡ii Avk¼v Kgv‡Z mnvqK|
l cwievi Ges RvwZ - A_©‰bwZK myweav jvf K‡i|

13. cÖme-cieZx© cwievi cwiKíbv civgk©

cÖme-cieZ©x cwievi cwiKíbvi gva¨‡g bvix‡`i cÖm‡ei nvi Kgv‡bvi cvkvcvwk Rb¥ e¨eavb Kgc‡ÿ 2 eQi ivL‡Z
mvnvh¨ K‡i, hvi d‡j bvix I wkïi ¯^v¯’¨ Ges Rxe‡bi gvb DbœZ nq| cÖme-cieZ©x cwievi cwiKíbvi †ÿ‡Î Mf©eZx
Ges cÖm~wZ bvix‡`i wbw`©ó Pvwn`vi e¨vcviwU †Lqvj ivL‡Z n‡e| ïay wb¤œwjwLZ e¨vcv‡i mxgve× bv †_‡K †m¸‡jv AšÍ©fz³
Ki‡Z n‡e:
l Mf©eZx Ges cÖm~wZ bvixMY Rb¥wbqš¿Y wb‡q Av‡jvPbvq AvMÖnx bv I n‡Z cv‡ib, Zv‡`i B”Qv‡K m¤§vb Rvbv‡Z
n‡e|
l gv‡qiv cÖvqB ey‡Ki `y‡ai Dci Rb¥wbqš¿‡Yi †KvbI cÖfve co‡e wK bv Zv wb‡q `ywðšÍv K‡ib|
l Mf©eZx Ges cÖm~wZ bvixMY cÖvqB gvbwmK cwieZ©b, kvixwiK A¯^w¯Í Ges Ab¨vb¨ Pv‡c †fv‡Mb, hvi d‡j cwievi
cwiKíbv wb‡q wm×všÍ †bqv KwVb n‡q c‡o|
l A‡bK bvix cÖmecieZ©x mnev‡mi mvs¯‹…wZK wewa wb‡la †g‡b P‡jb ZvB `ªæZ cÖme cieZ©x Rb¥wbqš¿‡Yi cÖ‡qvRb
nq bv, Avevi A‡b‡K Zv †g‡b P‡j bv| cÖ‡qvR‡b Zvi ¯^vgx A_ev cwiev‡ii Ab¨ m`m¨ KvD‡Ýwjs †mk‡b _vK‡eb
wK bv, Zv wR‡Ám Ki‡Z n‡e|
Zv‡K eywS‡q ej‡Z n‡e, wZwb hw` wkï‡K †ewk K‡i ey‡Ki `ya cvb bv K‡i mnevm K‡ib, Zvn‡j cªm‡ei gvÎ Pvi mßvn
ciB wZwb Mf©eZx n‡Z cv‡ib| ZvB Zviv wK ai‡bi cwievi cwiKíbv c×wZ MÖnY Ki‡eb †m m¤ú‡K© `ªæZ wPšÍv Kiv
¸iæZ¡c~Y©| AviI ev”Pv †bqvi cwiKíbv Av‡Q wK bv Zv wRÁvmv Kiæb| hw` wZwb Ges Zvi ¯^vgx AviI mšÍvb Pvb, Zvn‡j
gv I wkïi ¯^v‡¯’¨i Rb¨, cybivq Mf©aviY Ki‡Z 2 eQi ch©šÍ A‡cÿv Kivi civgk© w`b| ey‡Ki `yacvb Kiv‡bvi Dci
wbf©i Ki‡e cÖm‡ei KZw`b ci †_‡K †Kvb cÖwµqvwU ïiæ Ki‡eb|
cÖme-cieZ©x cwievi cwiKíbv we¯ÍvwiZ Rvbvi Rb¨ cwievi cwiKíbv Aa¨v‡q †`Lyb|

Mf©Kvjxb †mev 13
 wb‡P GKbR‡i cÖwZ UªvB‡g÷v‡i KvD‡Ýwjs-Gi Av‡jvP¨ cÖ‡qvRbxq Dcv`vbmg~n:

cÖ_g UªvB‡g÷vi
l Mf© ïiæi w`b Ges m¤¢ve¨ cÖmeKvj (EDD) Av‡jvPbv Kiæb
l cÖ_g UªvB‡g÷vii cwieZ©b Ges †MŠY mgm¨v¸‡jv Av‡jvPbv Kiæb
l A¨vj‡Kvnj, gv`K, wmMv‡iU Ges R`©v Gwo‡q Pjvi civgk© w`b
l cwi‡e‡ki ÿwZKviK Dcv`vb Ñ Av‡m©wbK, Kzqvi cvwb, M¨v‡mvwjb †_‡K mxmv Ges Awbivc` Lv`¨ Gwo‡q Pjvi
civgk© w`b
l †hŠbevwnZ †ivM/ GBPAvBwf cÖwZ‡iva Ges `ªæZ wPwKrmvi civgk© w`b
l cÖme cwiKíbv Kiæb
l wec`wPý m¤ú‡K© AewnZ Kiæb
l cÖme-cieZx© cwievi cwiKíbvi ¸iæZ¡ m¤ú‡K© Av‡jvPbv Kiæb|

wØZxq UªvB‡g÷vi
l wØZxq UªvB‡g÷v‡ii cwieZ©b¸‡jv ch©v‡jvPbv Kiæb
l cywó m¤úwK©Z Z_¨ ch©v‡jvPbv Kiæb
l Mf©Kvjxb wec`wPý m¤ú‡K© cybivq AewnZ Kiæb
l cÖwZ gv‡m (1g UªvB‡g÷v‡ii ci †_‡K) 1 †KwR K‡i IRb evov‡Z n‡e
l cÖme cwiKíbvi ¸iæZ¡ I Dcv`vb m¤ú‡K© Av‡jvPbv Kiæb

Z…Zxq UªvB‡g÷vi
l cÖme cwiKíbv P~ovšÍKiY
l Z…Zxq UªvB‡g÷v‡ii cwieZ©b Av‡jvPbv Kiæb
l cÖK…Z Ges AcÖK…Z cÖm‡ei wPý¸‡jv e¨vL¨v Kiæb
l cÖm‡ei wec` wPý¸‡jv e¨vL¨v Kiæb
l wbivc` cÖme e¨vL¨v Kiæb
l cÖme-cieZ©x wfwR‡Ui ¸iæZ¡ e¨vL¨v Kiæb
l cÖme-cieZ©x wec`wPý¸‡jv
l cÖme-cieZ©x cwievi cwiKíbvi ¸iæZ¡
l kvj`ya Ges ïaygvÎ ey‡Ki `ya cvb Kiv‡bvi ¸iæZ¡ e¨vL¨v Kiæb
l cÖme-cieZx© cwievi cwiKíbv m¤ú‡K© Av‡jvPbv Kiæb

14 Mf©Kvjxb †mev
O. Mf©Kvjxb †QvU-Lv‡Uv mgm¨v Ges Zvi cÖwZKvi

÷¨vÛvW© 3: BDwbqb ¯^v¯’¨ I cwievi Kj¨vb †K‡›`ªi ¯^v¯’¨Kg©xMb Mf©Kvjxb †QvULv‡Uv RwUjZv e¨e¯’vcbvq cvi`kx© n‡q
DV‡eb|

Mf©eZx bvix wewfbœ ‡QvU Lv‡Uv mgm¨v wb‡q Avm‡Z cv‡ib| me‡P‡q cÖPwjZ mgm¨v¸‡jv wb‡q wb‡P Av‡jvPbv Kiv n‡jv:

†QvULv‡Uv mgm¨v e¨e¯’v

ewg ewg fve Ges ewg l Avk¦vm w`b
(Nausea and Vomiting) l mKv‡j weQvbv Qvovi Av‡M ïKbv †Uv÷ A_ev we¯‹zU †L‡Z civgk© w`b
†ewkifvM Mf©eZx bvixiB ewg ewg fve Ges Pwe©hy³ ev fvRv Lvevi Gwo‡q Pj‡Z ejyb Ges 3 †ejv cÖavb
nq Ges ewg K‡ib we‡klZ mKv‡j 4_© Lvev‡ii gv‡S Aí bvkZv †L‡Z ejyb
†_‡K 14Zg mcÍv‡ni g‡a¨ l G¸‡jv‡Z KvR bv n‡j ewgbvkK Ilya mvnvh¨ Ki‡Z cv‡i
l Zxeª ch©v‡q †M‡j mgwš^Z Riæix cÖm~wZ †mev †K‡›`ª †idvi Kiæb
K¬vwšÍ‡eva civgk© w`b:
(Tiredness) l ch©vß wekÖvg
K¬vwšÍ‡eva Mf©ve¯’vi cÖ_gw`‡Ki DcmM© wKš‘ l fvix KvR Gwo‡q Pjv
†k‡li w`‡K i³¯^íZvi wPý n‡Z cv‡i l cywóKi Lvevi LvIqv
d¨vKv‡m fve civgk© w`b:
(Pallor) l Mf©ve¯’vi cÖ_g gvm †_‡K dwjK GwmW U¨ve‡jU MªnY Ges 3q gv‡mi ci
Mf©ve¯’vq d¨vKv‡m fve †_‡K Gi mv‡_ Avqib wb‡Z n‡e
i³¯^íZvi Rb¨ n‡Z cv‡i l Avqib, wfUvwgb wm Ges G mg„× Lv`¨ †L‡Z n‡e
l mylg Lv`¨ I evowZ Lvevi †L‡Z n‡e

eyK R¡vjv‡cvov (AwZwi³ A¤øZv) Zv‡K ejyb:

(Heartburn/Hyperacidity) l evievi Aí K‡i †L‡Z
eyK R¡vjv‡cvov Mf©ve¯’vi GKwU mvaviY l Pwe©, gkjvhy³ Lv`¨ Ges a~gcvb Gwo‡q Pj‡Z
mgm¨v l Nygv‡bvi mgq GKwU DPz K‡i ivLv evwjk e¨envi Ki‡eb
l G¸‡jv‡Z KvR bv n‡j G›UvwmW LvIqvi civgk© w`b

†KvôKvwVb¨ cÖPzi Zij I kvKmewR, Mig `ya, Bmye¸‡ji fzwm †L‡Z civgk© w`b
(Constipation) G¸‡jv‡Z KvR bv n‡j wgé Ae g¨vM‡bwkqv (†Kvô cwi®‹viK) †bqvi civgk©
Mf©ve¯’vi GKwU mvaviY mgm¨v w`b
cv‡q e¨_v gy‡L Lvevi K¨vjwmqvg I wfUvwgb we w`b
(Pain in leg/Leg cramps) l dj I kvKmewR †L‡Z civgk© w`b
K¨vjwmqv‡gi NvUwZi Rb¨ GUv n‡q _v‡K l iv‡Z cv †X‡K Nygv‡Z ejyb

wc‡V e¨_v Zv‡K PvjPjb DbœZ Kivi (†mvRv, evuKv bq) civgk© w`b
(Backache) l fvix KvR Gwo‡q Pjvi Rb¨ ch©vß wekÖvg
cÖ_gevi Mf©ve¯’vi †kl gvm¸‡jvi w`‡K l G¸‡jv‡Z KvR bv n‡j gv‡Sg‡a¨ c¨vivwmUvgj †L‡Z w`b
wewfbœ gvÎvq wc‡Ve¨_v n‡Z cv‡i
cv‡qi wkiv dz‡j hvIqv (†fwi‡Kvm Zv‡K civgk© w`b:
†fBb) ch©vß wekÖvg wb‡Z
(Swelling of leg veins/Varicose veins) `xN©mgq `uvov‡bv ev emv †_‡K weiZ _vK‡Z n‡e
Mf©ve¯’vi †kl gvm¸‡jvi w`‡K cv‡qi em‡j cv Uz‡ji Dci, †kvqv Ae¯’vq cv‡qi wb‡P evwjk w`‡Z n‡e Bjvw÷K
wkiv dz‡j hvIqv evo‡Z cv‡i †µc e¨v‡ÛR e¨envi Kiv †h‡Z cv‡i cÖm‡ei ci GUv wVK n‡q hv‡e

Mf©Kvjxb †mev 15
 †QvULv‡Uv mgm¨v
†Mvovwj †dvjv (cv‡q cvwb Avmv):
(Ankle swelling/edema of leg)
AwZwi³ Zij hvi cÖgvb evowZ IRb
wn‡m‡e Rgv n‡Z cv‡i A_ev
wcÖ-GKjv¤úwmqv (D”P i³Pvc m¤úwK©Z
†Mvovwj‡Z cvwb Rgv) Av‡Q wK bv hvPvB
Ki‡Z n‡e
evievi cÖ¯ªve nIqv
(Frequency of micturition)
M‡f©i cÖ_g I †klw`‡K evievi cÖ¯ªve
nIqv ¯^vfvweK| wKš‘ hw` 12-36
mßv‡ni g‡a¨ n‡j g~Î_wji msµg‡Yi
Kvi‡Y n‡Z cv‡i
gjØv‡i cvBjm& (†n‡gvi‡qW);
(Anal piles/hemorrhoids)
gjØv‡i cvBjm& (†n‡gvi‡qW) i³cvZ I
e¨_vi g‡Zv A¯^w¯ÍKi RwUjZv ˆZwi K‡i
Ges Mf©ve¯’vq †cÖvjvá n‡Z cv‡i
†hvwbc‡_ ¯ªve
(Vaginal discharge)
†hvwbc‡_ ¯^vfvweK ¯ªve mvaviYZ
Mf©ve¯’vq e„w× cvq
16 Mf©Kvjxb †mev
e¨e¯’v
l kvixie„Ëxqfv‡e cvwb Rg‡j †KvbI wPwKrmvi `iKvi †bB
l cv nvjKv Dc‡i Zz‡j wekÖvg wb‡j wVK n‡q hv‡e
l WvBD‡iwUKm †`qv DwPZ bq
hw` g~Î_wji msµgY nq
- Zv‡K cÖPzi cvwb †L‡Z civgk© w`b
- Ggw·wmwjb 500wgMÖv 8N›Uv ci ci 5-10w`b
- cÖ¯ªve Gi iæwUb gvB‡µv‡¯‹vwcK cixÿvi Rb¨ Dchy³ †K‡›`ª †idvi Kiæb
l cÖPzi Zij, kvKmewR, Mig `ya, fzwm BZ¨vw` †L‡Z civgk© w`b|
l †cU big ivL‡Z gv‡Sg‡a¨ †j‡·wUf e¨envi Kiv hvq hv‡Z †n‡gvi‡qW
bv nq
l KLbB G‡bgv e¨envi Kiv hv‡e bv
l Avk¦vm I e¨w³MZ cwi”QbœZv Riæwi
l hw` msµgY, PzjKvwb, Zj‡c‡U e¨_v, cuyR A_ev i³ wgwkÖZ ¯ªve _v‡K
Z‡e mgwš^Z Riæix cÖm~wZ †mev†K‡›`ª †idvi Kiæb
P. g~L¨ mgm¨v mbv³KiY Ges †idvivj

eo mgm¨v wb‡q Avmv mKj Mf©eZx bvix‡K cÖv_wgK g~j¨vqb I w¯’wZkxj K‡i wbKU¯’ mgwš^Z Riæix cÖm~wZ †mev †K‡›`ª
†idvi Ki‡Z n‡e| cwievi‡K †idv‡i‡ji ¸iæZ¡ m¤ú‡K© h_vh_fv‡e KvD‡Ýwjs Ki‡Z n‡e Ges †idvi bv Kivi SzuwK¸‡jv
eySv‡Z n‡e| †idv‡i‡ji mnvqZv Kivi Rb¨ gv‡qi †KvbI m½xi `iKvi Av‡Q wK bv Zv hvPvB Kiæb| `iKvi n‡j mvnv‡h¨i
e¨e¯’v Kiæb|

÷¨vÛvW© 4: BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ªi mKj m¦v¯’¨Kg©xi Mf©Kvjxb †mev m¤úwK©Z cÖavb RwUjZvmg~n
mbv³ib, w¯’wZkxj Kiv Ges h_vh_fv‡e †idvi Kivi `ÿZv _vK‡e|

Mf©ve¯’vq i³¯ªve jÿY I DcmM© e¨e¯’vcbv

M‡f©i 28 mßv‡ni Av‡M i³¯ªve

Mf©cv‡Zi SzuwK
(Threatened abortion)
l A¨v‡g‡bvwiqv / gvwmK eÜ
l nvjKv i³¯ªve
l †K¬vRW mviwfK&m / Rivqyi gyLeÜ
l Rivqyi AvKvi mgq Abyhvqx wVK
Av‡Q
l Zj‡c‡U fxlY/Aí e¨v_v
l Zv‡K fvix KvR Ges mnevm †_‡K
weiZ _vKvi civgk© w`b wKš‘ m¤ú~Y©
wekÖvg `iKvi †bB
l hw` i³¯ªve eÜ nq, cÖmec~e©
†mev‡K‡›`ª d‡jvAv‡c _vK‡Z n‡e,
cybivq i³¯ªve n‡j cybtg~j¨vqb
Ki‡Z n‡e
l hw` i³¯ªve n‡ZB _v‡K, mgwš^Z
Riæix cÖm~wZ †mev‡K‡›`ª
(CEmOC) †K‡›`ª †idvi Kiæb

wbwðZ Mf©cvZ l A¨v‡g‡bvwiqv l Zvi mvgwMÖK kvixwiK Ae¯’v `ªæZ

(Inevitable abortion)
Am¤ú~Y© Mf©cvZ
(Incomplete abortion)
m¤ú~Y© Mf©cvZ
(Complete abortion)
l fvix i³¯ªve
l cÖmvwiZ RivqygyL A_ev RivqygyL
†_‡K Mf©RvZ e¯‘ Abyfe Kiv hv‡”Q
ev †ewi‡q Avm‡Q
l Rivqyi AvKvi mgq Abyhvqx wVK Av‡Q
l Zj‡c‡U fxlY/Aí e¨v_v
l Rivqy‡Z e¨v_v
l A¨v‡g‡bvwiqv
l fvix i³¯ªve
l cÖmvwiZ/‡Lvjv RivqygyL A_ev
RivqygyL †_‡K Mf©RvZ e¯‘ Abyfe
Kiv hv‡”Q ev †ewi‡q Avm‡Q
l Rivqyi AvKvi mgq Abyhvqx ‡QvU
l Zj‡c‡U fxlY/Aí e¨v_v
l Mf©c`v_© AvswkK ‡ei n‡e
l A¨v‡g‡bvwiqv
l Mf©c`v_© ‡ei nIqvi BwZnvm
l i³¯ªve eÜ n‡Z cv‡i
l RivqygyL eÜ
l Rivqyi AvKvi mgq Abyhvqx †QvU
A_ev ¯^vfvweK
gyj¨vqb Kiæb
l cwievi‡K KvD‡Ýwjs
l mgwš^Z Riæix cÖm~wZ †mev †K‡›`ª
†idvi Kiæb
l Zvi mvgwMÖK kvixwiK Ae¯’v `ªæZ
gyj¨vqb
l cwievi‡K KvD‡Ýwjs, hw` i‡³i
cÖ‡qvRb nq i³`vZvi mÜvb
l †idvi Kiæb- mgwš^Z Riæwi cÖme
†mev‡K‡›`ª
Rivqy wb®‹vkb mvaviYZ `iKvi nq bv
d‡jv Av‡c wbwðZ Kiæb:
l hw` †ewk i³¯ªve, e¨_v, R¡i _v‡K,
†idvi Kiæb mgwš^Z Riæwi cÖme
†mev‡K‡›`ª
l hw` RwUjZv bv _v‡K, 7w`b ci
d‡jvAvc Kiæb

Mf©Kvjxb †mev 17
 Mf©ve¯’vq i³¯ªve jÿY I DcmM© e¨e¯’vcbv
wgm&W A¨veikvb g„`y/ AwbqwgZ i³¯ªve/ ev`vgx ¯ªve/ †idvi Kiæb, 僇Yi Rxeb Ges DIC
(Missed Abortion) Rivqy †QvU ev ¯^vfvvweK †KvbI e¨_v wbY©‡qi BT/CT/ Platelet count K‡i
†bB- 僇Yi †KvbI boPo †bB, †`L‡Z n‡e
< 28 mßvn RivqygyL eÜ
†mcwUK A¨veikvb B”QvK…Z Mf©cv‡Zi BwZnvm _vK‡Z cv‡i K¨vcmyj A¨vgw·wmwjb 500 wg: cøvm
(Septic abortion) l A¨v‡g‡bvwiqv w`b I mgwš^Z Riæix cÖm~wZ †mev†K‡›`ª
l `xN©ÿY ¯’vqx i³¯ªve fwZ©i Rb¨ †idvi Kiæb
l A¯^w¯Í
l R¡i `yM©Ühy³ ¯ªve
l Zj‡c‡U e¨_v
l `ªæZ bvwo¯ú›`b
l i³Pvc ¯^vfvweK ev Kg
l Rivqy e¨v_v

G±wcK †cÖM‡bwÝ A¨v‡g‡bvwiqv Aí mg‡qi Rb¨, Zj †cU fvBUvj mvBb¸‡jvi `ªæZ g~j¨vqb, m¤¢e
(Ectopic pregnancy) Ges †cjwf‡m Zxeª e¨_v, AÁvb nIqv n‡j d¬zBW ïiæ Kiv (bigvj m¨vjvBb/
(wKQz †ÿ‡Î) wisMvi mjy¨kb), cÖv_wgK †mev w`b I
l hw` wQ‡o hvq, `ªæZ bvwo¯ú›`b h_vh_ e¨e¯’vcbvi Rb¨ mgwš^Z Riæix
(110/ wgwbU ev Gi †ewk) cÖm~wZ †mev†K‡›`ª †idvi Kiæb
l †cU dz‡j hv‡e
l wb¤œ i³Pvc
l nvB‡cvfj¨ywgqv

G±wcK †cÖM‡bwÝ m‡›`n n‡j †hvwbc‡_

cixÿv Kiv hv‡e bv

†gvjvi †cÖM‡bwÝ l ewgfve/ ewg †ivMwbY©q Ges h_vh_ e¨e¯’vcbvi Rb¨

(Molar Pregnancy) l Zj‡c‡U e¨v_v mgwš^Z Riæix cÖm~wZ †mev†K‡›`ª †idvi
l Mf©Kvjxb DcmM©¸‡jv AwZe„w× Kiæb
l gvSvgvwS †_‡K fvix i³¯ªve
l Rivqyg‡Li cÖmviY
l Av½y‡ii g‡Zv wKQzi AvswkK ewn©Mgb
l Rivqy mg‡qi Zyjbvq eo
l Rivq ¯^vfvwe‡Ki Zyjbvq big
l 僇Yi †KvbI wPý †bB

M‡f©i 28 mßv‡ni c‡i i³¯ªve

l Mf©dzj Rivqyi wbb¥vs‡k Mf©dzj Rivqyi wbb¥vs‡k Ae¯’vb l gv‡qi mvaviY Ae¯’vi `ªæZ g~j¨vqb,
Ae¯’vb jÿY I wPý hvi AšÍf©y³ fvBUvj mvBb
(Placenta Previa) l i³ÿib (bvwo¯ú›`b, i³Pvc, k¦vm-cÖk¦vm
l Mf©dzj mg‡qi Av‡M l e¨_v Qvov evi evi i³ hvIqv Ges ZvcgvÎv); ‡cU cixÿv, Rivqyi
wew”Qbœ nIqv l Rivqyi wkw_jZv Abyf~wZ, wkïi ür¯ú›`b, †hvwbc‡_
(Abruptio Placenta) l ev”Pvi Ae¯’vb A¯^vfvweK n‡Z cv‡i i³¯ªve
l Mf©¯’ wkï mvaviYZ fvj _v‡K l wkivc‡_ AvBwf d¬zBW (bigvj
l kK m¨vjvBb/ wisMvim mjy¨kb) cÖ‡qvM

18 Mf©Kvjxb †mev
 M‡f©i 28 mßv‡ni c‡i i³¯ªve
Mf©dzj mg‡qi Av‡M wew”Qbœ nIqv
jÿY I wPý
l i³ÿiY
l mve©ÿwYK †c‡U e¨_v
l Rivqy k³ I Uvb Uvb
l ev”Pvi Ae¯’vb mvaviYZ ¯^vfvweK
_v‡K
l Mf©¯’ wkï msKUvcbœ _vK‡e ev
ür¯ú›`b _vK‡e bv
l kK
Ab¨vb¨ RwUjZv
Mf©Kvjxb D”Pi³Pvc DcmM© I jÿY
(Gestational M‡f©i 20 mßvn ci 4N›Uv ci ci `ywU
hypertension) Wvqv‡÷vwjK Pv‡ci gvÎv 90-110
mm-Hg
l †cÖvwUwbDwiqv †bB
gvBì wcÖ-GKjv¤úwkqv (37 M‡f©i 20 mßvn ci 4N›Uv ci ci `ywU
mßv‡ni †P‡q Kg Mf©Kvj) Wvqv‡÷vwjK Pv‡ci gvÎv 90-110
(Mild pre-eclampsia) mm-Hg
l †cÖvwUwbDwiqv 2+
l †Kvb wec` wPý bvB
gvivZ¥K wcÖ-GKjv¤úwkqv I l ci ci `ywU Wvqv‡÷vwjK Pv‡ci
GKjv¤úwkqv (wLPzbx) gvÎv 110 mmHg ev †ewk
(Severe pre-eclaupsia & †cÖvwUwbDwiqv 2+ ch©šÍ
Eclampsia) l GK ev GKvwaK wec` wPý Av‡Q
- †Pv‡L Svcmv †`Lv
- cÖ¯ªve K‡g hvIqv (24 N›Uvq
400 GgGj Gi Kg)
- Dc‡ii †c‡U e¨v_v
l G ch©v‡q †hvwbc_ cixÿv Kiv hv‡e
bv
l †ivMx I cwievi‡K KvD‡Ýwjs Kiæb
l mgwš^Z Riæix cÖm~wZ †mev†K‡›`ª
†idvi Kiæb
l i³Pvc, cÖ¯ªve (†cÖvwUwbDwiqv) Ges
Mf©¯’ wkïi Ae¯’v ch©‡eÿY Kiæb
l gv Ges cwiev‡ii m`m¨‡`i
GKjv¤úwkqv Ges wcÖGKjv¤úwkqvi
wec`wPý m¤^‡Ü AewnZ Kiæb
l hw` ch©‡eÿbKv‡j mewKQz ¯^vfvweK
_v‡K c~b© Mf©Kvj ch©šÍ A‡cÿv
Kiæb
l hw` Wvqv‡÷vwjK †cÖmvi 90
mmHg Gi †ewk nq Z‡e
mgwš^Z Riæix cÖm~wZ †mev†K‡›`ª
wPwKrm‡Ki wbKU †idvi Kiæb|
l i³Pvc, cÖ¯ªve (†cÖvwUwbDwiqv) Ges
Mf©¯’ wkïi Ae¯’v cÖwZ mßv‡n
ch©‡eÿY Kiæb
l Mf©eZx gv Ges Zvi cwievi‡K
wcÖ-GKjv¤úwkqv Ges GKjvgwkqvi
wec` wPý m¤ú‡K© AewnZ Kiæb
l hw` Wvqv‡÷vwjK Pvc 90 mmHg
Gi †ewk nq mgwš^Z Riæix cÖm~wZ
†mev†K‡›`ª cieZ©x wPwKrmvi Rb¨
†idvi Kiæb
l fvBUvj mvBb¸‡jvi `ªæZ g~j¨vqb
Kiæb
l GKjv¤úwkqvi Rb¨ cÖwZ wbZ‡¤^
(Buttock) 5 gm K‡i 10 gm
(20ml) Inj-MgSo4 w`b Ges
Riæwi cÖm~wZ †mev‡K‡›`ª †idvi
Kiæb|
l †ivMx‡K GKjv¤úwUK Ae¯’v‡b
ivLyb| hw` wLPzwb _v‡K k¦vmbvwj
cwi®‹vi I mPj ivLvi Rb¨ gvD_
Mf©Kvjxb †mev 19
 Ab¨vb¨ RwUjZv
M¨M w`b| cwiev‡ii m`m¨‡`i
AewnZ ivLyb| k¦vm-cÖk¦v‡mi nvi
wbiƒcY Kiæb| dwjm K¨v‡_Uvi
w`b| Ges Riæwi cÖm~wZ †mev‡K‡›`ª
†idvi Kiæb|
Mf©ve¯’vq R¡i Ges A_ev l ZvcgvÎv 1000 dv. Gi †P‡q †ewk l gy‡L †ewk K‡i Zij Lvevi †L‡Z
`yM©Ühy³ ¯ªve l gv_ve¨v_v DrmvwnZ Kiæb
(Fever and/or l A¯^w¯Í l ZvcgvÎv Kgv‡Z cvLv ev ¯úb&R
Foul-smelling l ÿzavg›`v e¨envi Kiæb
discharge in l Kvwk l ZvcgvÎv 1000 dv. Gi †P‡q †ewk
Pregnancy) l g¨v‡jwiqvcÖeY GjvKvq Kuvcybx w`‡q n‡j c¨vivwmUvgj U¨ve‡jU
R¡i 500wg.MÖv. w`b
l Avk¦vm w`b Ges mgwš^Z Riæix
cÖm~wZ †mev†K‡›`ª cieZ©x cixÿv
wbixÿv Ges wPwKrmvi Rb¨ †idvi
Kiyb

mvaviY g¨v‡jwiqv (kyay l gv_ve¨v_v RDT (Rapid Diagnostic Test)

g¨v‡jwiqv-cÖeY GjvKvq) l R¡i Øviv †ivMwbY©q Ges RvZxq g¨v‡jwiqv
(Uncomplicated l Aw¯’mw܇Z e¨v_v wbqš¿Y †cÖvMÖvg MvBWjvBb Abymv‡i
malaria; Only in wPwKrmvi Rb¨ †idvi Kiyb
†hLv‡b cvIqv hvq wb‡‡Pi cixÿv¸‡jv
malaria endemic area)
†ivM wbY©q wbwðZ Ki‡e:
l w_K I w_b eøvW wdj¥ Gi
gvB‡µv¯‹wc, w_K eøvW wdj¥
c¨vivmvBU mbv³Ki‡Y †ewk
†mb‡mwUf (c¨vivmvBU Gi
Abycw¯’wZ g¨v‡jwiqvi Abycw¯’wZ
cÖgvY K‡i bv) w_b eøvW wdj¥
c¨vivmvBU Gi cÖRvwZ mbv³ Ki‡Z
mvnvh¨ K‡i
l i¨vwcW A¨vw›U‡Rb wW‡UKkb †U÷
RwUjZvc~Y© g¨v‡jwiqv †ivMx Zxeª R¡‡ii mv‡_ wb‡Pi Kgc‡ÿ mbv³KiY Ges nvmcvZv‡j †idvi Kiyb
(Severe/complicated GKwU DcmM© wb‡q Avm‡Z cv‡i:
malaria) l m¤ú~Y© kw³nxbZv (em‡Z AÿgZv)
l †PZbvi cwieZ©b
l †Kvgv
l Zxeª i³víZv
l wLuPzwb/ AÁvb nIqv
l cvb Kivi AÿgZv/ ewg
l Mvp Ges/A_ev Kg cÖ¯ªve nIqv

h²v l `xN© w`b Kvwki mv‡_ i³ _vK‡Z mbv³ K‡i cieZ©x cixÿv Ges wPwKrmvi
(Tuberculosis) cv‡i Rb¨ wØZxq A_ev Z…Zxq ¯Í‡ii
l IRb K‡g hvIqv †mev‡K‡›`ª †idvi
l ivw·Z R¡i wW‡i± Aemvi‡fkb †_ivwc (DOT)

20 Mf©Kvjxb †mev
 Ab¨vb¨ RwUjZv
l wUDeviKzwjb w¯‹b †U÷ DB_
wcDwidvBW †cÖvwUb †Wwi‡fwUf
(wcwcwW), ≥10wgwg n‡j cwRwUf
aiv nq we‡klZ wi¯‹ d¨v±i¸‡jv
_vK‡j
l †P÷ G·‡i (12 mßvn ci)
l Aviwj gwb©s ¯úyUvg di GwmW dv÷
e¨vwmwj (3 m¨v¤új)
l M¨vw÷ªK Iqvwks
l WvqvMbw÷K eªsK¯‹wc
l G·Uªv cvj‡gvbvix mvBU (wjç
†bvW)

Ab¨vb¨ mvaviY Ae¯’v

Zxeª i³¯^íZv l ÿzavg›`v hw` wn‡gv‡Møvweb 7 Mªvg/ †WwmwjUvi Gi
(Severe anemia) l Wvqwiqv Kg A_ev 20% Gi Kg †ngv‡UvwµU
l KvR Ki‡j k¦vmKó Ges eyK aodo (Zxeª i³víZv) nq Z‡e eøvW
l gyL I cv †dvjv UªvÝwdDk‡bi Rb¨ †cÖiY Kiæb Ges
l cvj‡ceªvj KbRvswUfv, wRnevq †ek wb¤œfv‡e Iivj Avqib Ges dwjK GwmW
d¨vKv‡k fve w`b: K) Kw¤^‡bkb Ae Avqib+dwjK
l ¯^í gvÎvq GbvmviKv GwmW (60 wg.MÖv + 400 gvB‡µvMÖvg)
l MømvBwUm U¨ve‡jU w`‡b `yBevi `yB gvm L) `yB gvm
l †nwgK gvigvi GU nvU© ci, †divm mvj‡dU A_ev †divm
l nvU© †dBjyi wdDgv‡iU 60 wg.MÖv mv‡_ dwjK GwmW
400 gvB‡µvMÖvg gy‡L Lv‡e w`‡b GKevi
K‡i 6 gvm M) †idvi
Mf©Kvjxb Wvq‡ewUm c~e© †_‡KB Wvq‡ewUm A_ev Wvq‡ewUm mbv³ K‡i cieZ©x cixÿv Ges wPwKrmvi
(Gestational Diabetes) Gi wi¯‹ d¨v±i Av‡Q Rb¨ wØZxq A_ev Z…Zxq ¯Í‡ii †mev‡K‡›`ª
†idvi Kiæb

Mf©Kvjxb ü`&‡ivM l k¦vmKó mbv³ K‡i cieZ©x cixÿv Ges wPwKrmvi

(Heart Dieseases in l wmb‡Kvc Rb¨ wØZxq A_ev Z…Zxq ¯Í‡ii †mev‡K‡›`ª
Pregnancy) l ey‡K e¨v_v †idvi
l †P÷ gvigvi
l KvwW©qvK GbjvR©‡gbU
l A¨vwi_wgqv
†ncvUvBwUm l Am¦w¯Í Avk¦vm w`b Ges mbv³ K‡i cieZ©x
(Hepatitis) l ÿzavg›`v cixÿv Ges wPwKrmvi Rb¨ wØZxq A_ev
l R¡i Z…Zxq ¯Í‡ii †mev‡K‡›`ª †idvi Kiæb
l ewgfve
l Mvp cÖ¯ªve Ges d¨vKv‡m gj
l RwÛm _vK‡Z cv‡i bvI _vK‡Z
cv‡i
l wjfvi eo n‡q †h‡ZI cv‡i bvI
cv‡i

Mf©Kvjxb †mev 21
 Ab¨vb¨ mvaviY Ae¯’v
l AvwU©‡Kwiqv
l fvBivj gvK©vi- we wm B

eªswKqvj GRgv c~e© †_‡KB GRgv k¦vmKó Avk¦vm w`b Ges mbv³ K‡i cieZ©x
(Bronchial Asthma) cixÿv Ges wPwKrmvi Rb¨ wØZxq A_ev
Z…Zxq ¯Í‡ii †mev‡K‡›`ª †idvi Kiæb

22 Mf©Kvjxb †mev
 †mKkb 2t
cÖmeKvjxb †mev

cÖmeKvjxb †mev 23
24 cÖmeKvjxb †mev
 cÖmeKvjxb †mev
K. cÖme‡mevi Rb¨ cÖ¯‘wZ

BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª cÖme Kÿ †mev`vbKvixi Rb¨ GKwU †gŠwjK I AwZe ¸iæZ¡c~Y© Ask| ¯^vfvweK
cÖme QvovI cÖmeK‡ÿ beRvZ‡Ki ZvrÿwbK cwiPh©v Kiv nq| ¸YMZ gvbm¤úbœ cÖme †mev †`qvi †ÿ‡Î ¯^v¯’¨‡K‡›`ª
cÖme‡mevi cÖ¯‘wZ I ¯^vfvweK cÖm‡ei MvBWjvBbmg~n †g‡b Pjv AZ¨vek¨K|

÷¨vÛvW© 5 t gv I beRvZK gh©v`v I m¤§v‡bi mv‡_ †mev jvf Ki‡e

D‡Ïk¨: ¯^v¯’¨‡K‡›`ª gv‡qi I beRvZ‡Ki gh©v`vc~Y© †mev

l ï‡f”Qv wewbgq
l wb‡Ri cwiPq w`‡q Dò Af¨_©bv Ávcb
l gv‡K (Amy¯’ n‡j ï‡Z ejyb) I m½x‡K em‡Z w`b
l gv I m½xi mv‡_ mnvbyf~wZ I m¤§v‡bi mv‡_ AvPiY Kiæb
l †ivMxi †MvcbxqZv I gh©v`v eRvq ivLyb
l Zvi mgm¨v gb‡hvM w`‡q ïbyb Ges Zvi cÖ‡kœi DËi w`b
l †mev cÖvwßi †ÿ‡Î mKj bvixi wbR¯^ cQ‡›`i ¸iæZ¡ w`b
l †KvbI Ace¨envi †hgb kvixwiK, †hŠb A_ev †gŠwLK wbh©vZb, ˆelg¨, Ae‡njv, Ab¨vq `vwe ev †mev`v‡b A¯^xKvi
Kiv hv‡e bv|

1. †mev ¯’v‡bi cÖ¯‘wZ

÷¨vÛvW ©6 t wbqwgZ gvZ„‡mev Ges RwUjZv e¨e¯’vcbvi Rb¨ ¯^v¯’¨‡K‡›`ª h_vh_ cwi‡ek, cvwb, cqtwb®‹vkb, we`y¨Z
mieivn, Ilya, hš¿cvwZ I miÄvg _vK‡Z n‡e|

cÖme I Rb¥Kvjxb Kvh©vw` (BwZnvm †bqv, kvixwiK cixÿv, cÖme ch©‡eÿY Ges mnvqZv BZ¨vw`) m¤úbœ Kivi ¯’vb n‡”Q
†mev ¯’vb| GB ¯’v‡bi wb‡¤œv³ ˆewkó¨ _vK‡Z n‡e:

1.1 cÖme ch©‡eÿY Kÿ

l gv‡qi Rb¨ weQvbv I nvZjmn †Pqvi _vK‡e
l gv‡qi wRwbmcÎ ivLvi Rb¨ †QvU †eWmvBW †Uwej _vK‡e
l weQvbv I †Pqv‡i _vKvKvjxb †MvcbxqZv iÿvi Rb¨ c`©v
l gv‡qi m½xi (cwiev‡ii m`m¨) Rb¨ emvi e¨e¯’v
l GKwU †W¯‹/ †Uwej Ges GKwU †Pqvi
l hš¿cvwZ ivLvi Uªwj ev †Uwej

1.2 †jevi/cÖme Kÿ
l Avivg`vqK, ivev‡i XvKv g¨v‡Uªm I evwjm mn cÖme weQvbv, ¯^vfvweK Av‡jv ‡cuŠQv‡bvi Rb¨ c`©vhy³ ev is Kiv
Rvbvjvi Kv‡Q weQvbvi cvqv _vK‡e
l cÖme †Uwej, weQvbv ev nvZjmn †Pqvi
l cvwbi RM I Møvm Ges gv‡qi wRwbmcÎ ivLvi Rb¨ †eW mvBW †Uwej
l cÖme weQvbv XvKvi Rb¨ c`©v
l msµgY cÖwZ‡iv‡ai Rb¨ cvÎ
l Uªwj; miÄvg, Ges hš¿cvwZ ivLvi Rb¨ cwi®‹vi Uªwj hv myweavRbK ¯’v‡b ivL‡Z n‡e

cÖmeKvjxb †mev 25
 l beRvZK wimvwm‡Ukb Kivi Rb¨ cwi®‹vi Dò ¯’vb (d¨vb ev G wm †_‡K h_vm¤¢e `~‡i)
l Ilya, hš¿cvwZ I miÄvg msiÿ‡Yi Rb¨ Avjwgiv
l ¯úU jvBU Ges ÷zj (GwcwmI‡Uvwg ev †Quov¯’vb wi‡cqvi Kivi Rb¨)
l Riæwi Ae¯’vi miÄvg ivLvi Rb¨ †QvU Uªwj
l GKwU †W¯‹ ev †Uwej I †Pqvi
l †nvqvBU †evW© - †ivMx I Wv³v‡ii bvg †jLvi Rb¨
l cvwb mieivnmn nvZ †avqvi RvqMv
l wj‡bb RvZxq `ªe¨vw` ivLvi Rb¨ ¯’vb

1.3 Uq‡jU
l Aek¨B cwi®‹vi n‡Z n‡e
l †jevi I cÖme K‡ÿi wbK‡U n‡Z n‡e
l nvB K‡gv‡Wi e¨e¯’v Kiv (m¤¢e n‡j)
l memgq cvwb mieivn _vK‡Z n‡e Ges wbqwgZ cwi®‹vi Ki‡Z n‡e

1.4 mvaviY cwi”QbœZv I ¯^v¯’¨Ki cwi‡ek

l ¯’vbwU n‡Z n‡e cwi®‹vi, †MvQv‡bv Ges Kÿ ZvcgvÎv 250-320 ‡m. Gi g‡a¨ eRvq _vK‡e
l e¨env‡ii Av‡M †g‡S RxevYy†ivax `ªeY- cvwb w`‡q gy‡Q wb‡Z n‡e
l Acwinvh© hš¿cvwZ Ges miÄvg (†hgb, cÖm‡ei Rb¨ cÖ‡qvRbxq hš¿cvwZ I wRwbmcÎmn †Wwjfvwi c¨vK)
mnRjf¨ Ges e¨env‡ii Rb¨ cÖ¯‘Z (cwi®‹vi Ges D”PgvÎvq wbe©xwRZ/ RxevYygy³) ivL‡Z n‡e| †m¸‡jv ¯^vfvweK
Ges RwUj cÖm‡ei e¨e¯’vcbvi Rb¨ †jevi BDwb‡Ui cÖ‡qvRbg‡Zv ch©vß cwigv‡Y msiwÿZ _vK‡Z n‡e|
l msµwgZ e¯‘ Ges c~‡e©i †ivMxi AveR©bv mwi‡q †dj‡Z n‡e ev h_vh_ cv‡Î ivL‡Z n‡e
l msµwgZ wj‡bb/ Kvco (†h¸‡jv ay‡Z n‡e) Ges msµwgZ hš¿cvwZ (RxevYygy³ Kiv n‡e) Gi Rb¨ wfbœ cvÎ
myweavRbK ¯’v‡b _vK‡e|
l wewfbœ cÖKvi eR¨© mwVK e¨e¯’vcbvi Rb¨ wfbœ wfbœ cvÎ myweavRbK ¯’v‡b _vK‡e, hvi g‡a¨ i‡q‡Q:
- mvaviY eR©¨ (wPwKrmv msµvšÍ ev msµwgZ bq) †hgb KvMR, †evZj I K¨vb BZ¨vw`
- †gwW‡Kj eR©¨ (†hgb i³ A_ev e¨v‡ÛR) Gi Rb¨ XvKbvhy³ Kb‡UBbvi
- aviv‡jv e¯‘ (†hgb muyB Ges Møvm ¯øvvBW) Gi Rb¨ wQ`ªwb‡ivaK Kb‡UBbvi
l mKj Kb‡UBbvi †j‡ej Kiv _vK‡e

1.5 cwi®‹vi cvwb mieivn

cwi®‹vi cvwb mieivn _vK‡Z n‡e| cvwb Kj, cv¤ú ev U¨vcmn enb‡hvM¨ Kb‡UBbvi †_‡K Avm‡Z cv‡i A_ev Kb‡UBbvi
ev †ewmb †_‡K cvwb Xvjv n‡Z cv‡i| me Kb‡UBbvi, †ewmb I RM cwi®‹vi _vK‡Z n‡e hv‡Z cvwb `~wlZ bv nq| cvwb
hw` cwi®‹vi bv nq (†hgb, XvKbvnxb ev gqjv Kb‡UBbvi †_‡K) Zvn‡j e¨envi Kiv hv‡e bv|

1.6 Av‡jvi Drm

cÖvK…wZK ev K…wÎg ch©vß Av‡jvi Drm _vK‡Z n‡e| mvaviY kvixwiK cixÿvi Rb¨ nqZ cÖvK…wZK Av‡jv h‡_ó| we`y¨r bv
_vK‡j GKwU †Rbv‡iUi ev AvBwcGm _vK‡Z n‡e| cixÿY Ask Rvbvjvi w`‡K _vK‡e wKš‘ K‡ÿi evwni †_‡K ¯’vbwU
†`Lv hv‡e bv| K…wÎg Av‡jvi Drm †hgb j¨v¤ú ev UP© (d¬vkjvBU), AviI †ewk Av‡jv w`‡Z cv‡i| wKQz cÖwµqv †hgb
†cjwfK cixÿv, †hvbx ev RivqygyL mviv‡bv ev beRvZ‡Ki gy‡Li †fZi cixÿvi Rb¨ Gme Av‡jvi Drm †ewk fv‡jv|

26 cÖmeKvjxb †mev
2. cÖme cÖ¯‘wZ
l GKRb mvnvh¨Kvix wba©viY K‡i Zv‡K Riæwi Ae¯’vi cwiKíbv eywS‡q ejyb
l hw` ev”Pv wbk¦vm bv †bq Zvi Rb¨ cÖmeKvjxb m½x ev Av‡iKRb `ÿ mnvqZvKvix‡K mvnvh¨ Ki‡Z cÖ¯‘Z Kiæb
- GKRb cÖmeKvjxb m½x gv‡K mvnvh¨ Ki‡Z cvi‡e Ges Av‡iKRb mvnvh¨Kvix‡K WvK‡Z cvi‡e
- wØZxq mvnvh¨Kvix ev”Pvi hZœ wb‡Z mvnvh¨ Ki‡Z cvi‡e
l Riæwi Ae¯’v cwiKíbvq D”PZi †mevi Rb¨ ‡hvMv‡hvM I hvbevnb AšÍf©~³ ivL‡Z n‡e|
l cÖm‡ei ¯’vb cÖ¯‘wZ: †h ¯’v‡b ev”Pv cÖme Kiv‡bv n‡e Zv n‡Z n‡e:
- Dò - `iRv Rvbvjv eÜ ivLyb Zvc mieivn ivLyb (†iwW‡q›U Iqvg©vi hw` _v‡K) we‡kl K‡i kxZKv‡ji Rb¨
- ch©vß Av‡jv - wkïi Ae¯’v g~j¨vq‡bi Rb¨ GKwU enb‡hvM¨ j¨v¤ú e¨envi
- cwi®‹vi - w¯‹b Uz w¯‹b †Kqv‡ii Rb¨ gv‡K Zvi nvZ I eyK ay‡Z mvnvh¨ Kiv

2.1 nvZ cwi®‹viKib

gv I wkï h‡Zœi Av‡M I c‡i mvevb I cwi®‹vi cvwb A_ev A¨vj‡Kvnjhy³ cwi®‹viK w`‡q fv‡jvfv‡e nvZ ay‡q wbb| i³
I †`‡ni Zij †_‡K msµgY cÖwZiÿvq Møvfm e¨envi Kiæb|

2.2 evqy PjvPj/†fw›U‡jk‡bi ¯’vb cÖ¯‘Z Kiæb Ges hš¿cvwZ †PK Kiæb

hw` wkïi †fw›U‡jkb cÖ‡qvRb nq, Zvn‡j Zvi Rb¨ GKwU cwi®‹vi, mgZj I wbivc` ¯’vb cÖ¯‘Z Kiæb| wbivc` †Wwjfvwi
wKU Gi mv‡_ wkïi wbk¦vm wb‡Z mnvqK hš¿cvwZI ivLyb|
l e¨env‡ii ci hš¿cvwZ Rxevbygy³ K‡i cwi®‹vifv‡e ivLyb
l †fw›U‡jkb ¯’v‡b e¨envh© mKj hš¿cvwZ I DcKiY †PK K‡i cÖ¯‘Z ivLyb
l †fw›U‡jkb e¨vM I gv¯‹ Gi Kvh©KvwiZv cixÿv Kiæb

2.3 ¯^vfvweK cÖm‡ei Rb¨ hš¿cvwZ I miÄvg

gv‡qi Rb¨ beRvZ‡Ki Rb¨

1) Møvfm 1) Møvfm
2) cwi®‹vi Z‡ji Rb¨ cøvw÷K wkU 2) `yB ev Gi †ewk cwi®‹vi kyK‡bv Kvco
3) Bb‡RKkb Aw·‡Uvwmb 3) gv_v XvKwb
4) ¯úÄ †nvwìs di‡mcm 4) KuvwP
5) Mvwj cU 5) RxevYyygy³ eÜbx- myZv ev KW© K¬¨v¤ú
6) js Kvf© Av©Uvwi di‡mc 6) 7.1% †K¬v‡iv‡nw·wWb mjy¨kb
7) wbWj †nvìvi 7) mvKkb wWfvBm
8) gv‡qvm wmRi 8) †fw›U‡jkb e¨vM I gv¯‹ (0 I 1 mvBR)
9) KW© KvwUs wmRi 9) †÷‡_v‡¯‹vc
10) wKWwb †Uª 10) UvBgvi (Nwo)
11) Avw¤^wjKvj KW© K¬¨v¤ú 11) IRb gvcK †¯‹j
12) wmgm †¯úKzjvg
13) wmwiÄ
14) cwi®‹vi Kvco ev m¨vwbUvwi c¨vW
15) m¨vjvBb †mU
16) IV d¬zBW
17) Uy_ wW†mKwUs di‡mcm
18) myPvwis g¨v†Uwiqvj (wbWj, K¨UMvU, wmé)

cÖmeKvjxb †mev 27
 2.4 Riæwi Ae¯’vi Uªwj I Ilya ev·

Riæwi Ae¯’v †gvKv‡ejvi Rb¨ cÖme K‡ÿ myweavRbKfv‡e cÖ‡qvRbxq hš¿cvwZ, miÄvg Ges Ilya ivLyb Ges wb‡Pi
ZvwjKvfz³ Dcv`vb¸‡jv AšÍ©fz³ n‡e| cÖwZw`b Riæwi Ae¯’vi Uªwj I Ilya ev· †PK Ki‡Z n‡e hvi g‡a¨ Ily‡ai †gqv`
DËx‡Y©i ZvwiL AšÍf©y³ Ges cÖ‡qvR‡b c~bivq c~Y© Ki‡Z n‡e|
l Bb‡RKkb A¨vgw·mwjb
l Bb‡RKkb K¨vjwmqvg Møy‡Kv‡bU
l Bb‡RKkb wj‡Wv‡KBb 2%
l Bb‡RKkb g¨vMmvj&d
l U¨ve‡jU wg‡mvcÖ÷j
l U¨ve‡jU wb‡dwWwcb
l U¨ve‡jU c¨vivwmUvgj
l UwcKvj Gw›Uev‡qvwUK A‡qb‡g›U
l I.V K¨vbyjv 16-18 wR- cÖwZwU 4 wU K‡i
l BbwdDkb †mU
l GqviI‡q wUDe
l G·vwg‡bkb Møvfm-4 †Rvov
l A¨vW‡nwmf †Uc

2.5 GKjv¤úwkqv wKU

l GqviI‡q wUDe (GWvë mvBR) / gvD_ M¨vM-3 wcm
l Bb‡RKkb g¨vMmvj&d 4 G¤úyj, cÖwZ G¤úyj 2.5 MÖvg (5 wg.wj)
l Bb‡RKkb nvU©g¨vb mjy¨kb, 1000 wg.wj- 1 e¨vM
l Bb‡RKkb bigvj m¨vjvBb, 1000 wg.wj- 1 e¨vM
l wWm‡cv‡Rej wmwiÄ 20 wmwm (1), 10 wmwm (2), 3 wmwm (2)
l wWwój&W IqvUvi 5 wmwm-10 A¨v¤úyj
l Bb‡RKkb K¨vjwmqvg Møy‡Kv‡bU, 1 MÖvg (10 wg.wj)
l Zzjv
l w¯úwiU
l dwjm ivevi K¨v‡_Uvi 14 mvBR- 1 wcm BD‡ive¨vM mn
l Rxevbyg~³ Møvf&m 6.5/7 BwÂ- 2 †Rvov

2.6 wcwcGBP wKU

l Bb‡RKkb Aw·‡Uvwmb (5 AvBBD) -6 G¤úyj (†iwd«Rv‡iU‡i 2-8 wWwMÖ †mjwmqvm ZvcgvÎvq ivL‡Z n‡e)
l U¨ve‡jU wg‡mvcÖ÷j (200 gvB‡µvMÖvg)-4
l Bb‡RKkb nvU©g¨vb mjy¨kb, 1000 wg.wj- 1 e¨vM
l Bb‡RKkb wisMvim j¨vK‡UU ev bigvj m¨vjvBb 1000 wg.wj- 1 e¨vM
l dwjm ivevi K¨v‡_Uvi 14 mvBR BD‡ive¨vM mn - 1 wcm
l †cøBb ivevi K¨v‡_Uvi - 1 wcm
l Rxevb~gy³ Møvf&m 6.5/7 BwÂ- 2 †Rvov
l m¨vjvBb †mU/ BbwdDkb †mU-3
l IV K¨vbyjv 18 wR-1, 20 wR-1
l wWm‡cv‡Rej wmwiÄ, 10 wmwm (1), 5 wmwm (4)
l GqviI‡q wUDe (GWvë mvBR) / gvD_ M¨vM-2

28 cÖmeKvjxb †mev
L. ¯^vfvweK cÖme

1. †jevi I cÖm‡ei mgq mnvqK hZœ

÷¨vÛvW© 7 t cÖ‡Z¨K bvix Ges Zvi cwievi gvbwmK mnvqZv cv‡e hv Zv‡`i Pvwn`vi cÖwZ ms‡e`bkxj n‡e Ges hv
bvixi mÿgZv‡K kw³kvjx Ki‡e

1. cÖmeKvjxb m½x 2. ‡hvMv‡hvM

l †jev‡ii mgq evQvBK…Z m½x‡K mnvqZv w`‡Z l Afq, cÖksmv, Aby‡cÖiYv w`b
AbycÖvwYZ Kiæb l mKj cÖwµqv e¨vL¨v Kiæb
l m½x‡K ejyb l me Z_¨ Ges AMÖMwZ AewnZ Kiæb
- memgq gv‡qi cv‡k _vK‡Z l ‡MvcbxqZv, m¤§vb I gh©v`v wbwðZ Kiæb
- Zv‡K AbycÖvwbZ GKs cÖksmv Ki‡Z
- Zv‡K nvU‡Z, k¦vm wb‡Z, wkw_j n‡Z mvnvh¨
Ki‡Z
- wc‡V gvwjk Ki‡Z
3. PjvPj 4. LvIqv Ges cvb Kiv 5. gj g~Î Z¨vM
l nvuU‡Z Drmvn w`b Ges l big kK©iv RvZxq Lvevi l Kgc‡ÿ 2 N›Uv cici
l cÖwZ ch©v‡q Zvi cQ›` g‡Zv †L‡Z DrmvwnZ Kiæb-iæwU, cÖ¯ªve Ki‡Z gv‡K DrmvwnZ
Ae¯’v‡b _vK‡Z mnvqZv wew¯‹U Kiæb
Kiæb l cywóKi Zij cvbxq Ges l †KvôKvwVb¨ n‡j wMømvwib
cvwb mv‡cvwmUvwi w`b
l G‡bgv †`qv hv‡e bv
6. cÖme‡e`bv Dckg
l nvuUvPjv Kiv, Ae¯’vb cwieZ©b Kiv, k¦vm-cÖk¦vm †bevi †KŠkj ‡`wLqv †`qv nvjKv Mig cvwb‡Z ‡Mvmj Ki‡Z
DrmvwnZ Kiv Ges wc‡V gvwjk Kiv
l hw` mve©ÿwYK e¨_v _v‡K Ges gv KvZi Ges DwØMœ _v‡Kb Zvn‡j KviY Luy‡R †ei Kiæb, †bvU Kiæb
l cÖ‡qvR‡b †idvi Kiæb
7. cwi”QbœZv 8. k¦vm cÖk¦v‡mi †KŠkj
l gv‡K nvjKv Mig cvwb w`‡q †Mvmj A_ev kixi l ¯^vfvweK k¦vm cÖk¦vm n‡”Q wK bv Zv gv †K eyS‡Z
ay‡Z Drmvn w`b †kLvb
l cixÿv Kivi Av‡M I c‡i mvevb w`‡q nvZ ay‡q l ms‡KvP‡bi mg‡q ax‡i Mfxifv‡e k¦vm wb‡q †Q‡o
wbb w`‡Z †kLvb
l †hvwbc_ cixÿvi †ÿ‡Î RxevYyygy³ Møvfm e¨envi
Kiæb
l †jevi Ges cÖm‡ei ¯’v‡bi 5wU cwi”QbœZv bxwZ
eRvq ivLyb
l wQU‡K cov gqjv cwi®‹vi Kiæb

cÖmeKvjxb †mev 29
 2. ¯^vfvweK cÖme PP©vi MvBWjvBb, wek¦ ¯^v¯’¨ ms¯’v (WHO)

wb‡`©wkZ PP©v
K. †hme KvR Dc‡hvMx Ges AbycÖvwYZ Kiv DwPZ

cÖme cwiKíbv

cÖm‡ei ¯’vb Ges †mev`vbKvix m¤ú‡K© wm×všÍ †bqvi Rb¨ Mf©eZx gv Ges Zvi ¯^vgx/ cwiev‡ii mv‡_ GKwU e¨w³MZ
cwiKíbv Kiv cÖ‡qvRb |

SuywK g~j¨vqb- Mf©Kvjxb †mev, cÖm‡ei mve©ÿwYK mgq Ges cÖme cieZ©x mg‡q SuywK g~j¨vqb Kiæb
1. gv‡qi cQ›` Abyhvqx wbivc` cÖm‡ei Rb¨ ¯^v¯’¨ †K›`ª / ¯’vb wba©viY Kiæb|
2. gv‡qi ÁvZ cQ›` Abyhvqx cÖm‡ei ¯’vb wba©viY m¤§vb Kiv
3. †jevi, cÖme Ges cÖme cÖwµqvi †k‡l gv‡qi kvixwiK Ges gvbwmK my¯’Zv ch©‡eÿY Kiæb
4. cÖm‡ei ¯’v‡b gv‡qi †MvcbxqZv iÿvi AwaKvi wbwðZ Kiæb
5. †jevi Ges cÖm‡ei mgq †mevKg©xi mnvbyfzwZc~Y© mnvqZv wbwðZ Kiæb
6. †jevi Ges cÖm‡ei mgq gv‡qi mv‡_ bvix msMx‡K _vK‡Z ‡`qv
7. gv hZUzKz Rvb‡Z Pvq ZZUzKz Z_¨ I e¨vL¨v `vb Kiv
8. †jevi Ges cÖm‡ei mgq Lvevi cvbxq †L‡Z ‡`qv
9. †jev‡ii mgq A-ÿwZKi, Ilyawenxb e¨_v Dckg c×wZ †hgb gvwjk, wkw_jKiY Ges k¦vm- cÖk¦vm †KŠkj Aej¤^b
Kiv
10. Avav NÈv ci ci ev”Pvi nvU© †iU AmKvj‡Uk‡bi gva¨‡g wkïi Ae¯’v ch©‡eÿY Kiv
11. †jev‡ii cy‡iv mgq Ae¯’vb I PjvP‡ji ¯^vaxbZv
12. †jev‡ii mgq bb-mycvBb cwRk‡b _vK‡Z Drmvn w`b/w`‡Z n‡e
13. †jevi Ges cÖm‡ei cy‡iv mgq wb®úwˇhvM¨ DcKiY GKevi e¨envi Ges cybe©¨envi‡hvM¨ DcKiY h_vh_fv‡e weï×
Ki‡Z n‡e
14. †hvwbc_ cixÿv, wkï cÖme Ges Mf©dzj aivi †ÿ‡Î Møvfm e¨envi Ki‡Z n‡e
15. WHO cv‡U©vMÖvd Abyhvqx cÖm‡ei AMªMwZ g‡bv‡hvv‡Mi mv‡_ ch©‡eÿY Ki‡Z n‡e
16. cÖme-cieZ©x i³ÿiY cÖwZ‡iv‡a cÖm‡ei 3q ch©v‡qi Kvh©Kix e¨e¯’vcbv
17. †hLv‡b Aw·‡Uvwmb AcÖZzj 3q ch©v‡qi Kvh©Kix e¨e¯’vcbvi †ÿ‡Î wg‡mv‡cÖv÷j e¨envi
18. RxevYygy³ c×wZ‡Z bvwo KvUv| 1-3 wgwbU †`wi‡Z bvwo euvav I KvUv
19. cøv‡m›Uv Ges †gg‡eª‡bi iæwUb cixÿv
20. bvwfi¾y †`wi‡Z K¬¨v¤ú Kiv
21. wkïi Kg ZvcgvÎv cÖwZ‡iva
22. gv I wkïi w¯‹b Uz w¯‹b ms¯úk© `ªæZ ïiæ Kiv Ges wek¦ ¯^v¯’¨ ms¯’vi wb‡`©kbv Abyhvqx cÖm‡ei 1 N›Uvi g‡a¨ ¯Íb¨`vb
ïiæ Ki‡Z mnvqZv w`‡Z n‡e

30 cÖmeKvjxb †mev
 AcÖ‡qvRbxq PP©v ÿwZKi PP©v
L. †h mKj KvR evievi AhvwPZfv‡e Kiv DwPZ bq M. †hme KvR ¯úóZ ÿwZKi A_ev AKvh©Ki Ges
†h¸‡jv eÜ Kiv DwPZ
1. †jev‡ii mgq Lvevi I cvbxq †L‡Z wb‡la Kiv
2. e¨_v Dckg Ki‡Z †`‡ni wfZ‡i Ilya cÖ‡qvM 1. †jev‡i G‡bgv, wcDweK †kwfs, wkivc‡_ Ilya Gi
wbqwgZ e¨envi
3. e¨_v Dckg Ki‡Z GwcWzivj A¨vbvj‡Rwmqv cÖ‡qvM
2. wbqwgZ AwMÖg cÖwZ‡laK e¨e¯’viƒ‡c wkivc‡_ K¨vbyjv
4. mve©ÿwYK B‡j±ªwbK wdUvj gwbUwis †`qv
5. †jevi Gi mgq gv¯‹ Ges RxevYygy³ MvDb civ 3. g~Î_wji K¨v‡_Uvi Gi wbqwgZ cÖ‡qvM
6. Rivqy ms‡KvPb m‡Ë¡I Aw·‡Uvwmb cÖ‡qvM e„w× Kiv 4. †jev‡ii mgq wPZ n‡q Ae¯’vb Kiv
7. †jev‡ii cÖ_g ch©v‡q `ªZ A¨vgvwbIUwg Kiv 5. ms‡KvPb e„w×i j‡ÿ¨ cÖ‡qvRbxqZv Ges Kvh©Ki
8. 2q ch©v‡qi ïiæ‡Z gv‡K wfbœ K‡ÿ wb‡q hvIqv ch©‡eÿY bv _vK‡jI cÖm‡ei Av‡M †h †KvbI mgq
9. gv‡qi wb‡Pi w`‡K av°v †`qvi Pvc Abyfe Kivi Aw·‡Uvwmb cÖ‡qvM
Av‡MB Rivqyi m¤úyY© cÖmviY n‡j av°v w`‡Z DrmvwnZ 6. †jev‡i wj‡_v‡Uvwg Ae¯’vb Gi wbqwgZ e¨envi
Kiv 7. evievi GKvwaK †mevKg©x Øviv †hvwbc_ cixÿv
10. gv I Mf©¯’ wkïi fv‡jv Ae¯’v Ges †jev‡ii AMÖMwZ 8. †jev‡ii 2q av‡c cÖm‡ei Rb¨ avivevwnK Pvc Gi
_vK‡jI †jev‡ii 2q ch©v‡qi wba©vwiZ mgq †hgb †Póv Kiv
1N›Uv †Z AvU‡K _vKv
9. †jev‡ii 2q av‡c †cwiwbqvg g¨v‡mR I cÖmviY Kiv
11. AcÖ‡qvRbxq A¯¿cvPviK…Z cÖme
10. cÖm‡ei mgq dvÛvj †cÖmvi †`qv
12. wbqwgZfv‡e GwcwkI‡Uvwgi e¨envi
11. cÖm‡ei 3q av‡c gy‡L ev wkivc‡_ Av‡M©v‡gwUªb Gi
13. cÖm‡ei 3q ch©v‡q wg‡mvcÖ÷‡ji wbqwgZ e¨envi wbqwgZ e¨envi
14. cÖm‡ei 3q ch©v‡qi Kvh©Ki e¨e¯’vcbvi ci evowZ 12. cÖm‡ei ci Rivqyi wbqwgZ j¨v‡fR
Aw·‡Uvwmb (wkivq †duvUvq †duvUvq) Gi wbqwgZ
e¨envi 13. cÖm‡ei ci Rivqyi wbqwgZ g¨vbyqvj G·‡cøv‡ikb

cÖmeKvjxb †mev 31
 3. cÖm‡e _vKv gv‡qi Ae¯’v g~j¨vqb

`ªyZ hvPvB/ KzBK †PK: BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª (UH & FWC)-‡Z †cuŠQv‡bvi ci cÖ_g †h e¨w³i mv‡_
gv‡qi †hvMv‡hvM n‡e Zvi DwPZ GKwU `ªyZ hvPvB m¤úbœ Kiv hv‡Z Rxe‡bi SuywK c~Y© RwUjZvmg~n hZ `ªæZ m¤¢e wbY©q
wbwðZ Kiv hvq|

l gv-†K ch©‡eÿY Kiæb/ m½x‡K wRÁvmv Kiæb Zvi †jev‡ii †KvbI jÿY/ DcmM© i‡q‡Q wK bv A_ev Zvi †KvbI
wec` wPý Av‡Q ev B`vbxs (MZ 24 N›Uvq) wQj wK bv|
l hw` gv‡qi †jev‡ii †KvbI jÿY/ DcmM© _v‡K wKš‘ †KvbI wec`wPý bv _v‡K Z‡e cÖv_wgK †jevi/ cÖme‡mev
w`b|

hw` gv‡qi †KvbI wec`wPý _v‡K, Z‡e ZvrÿwYKfv‡e wb‡Pi avc¸‡jv cvjb Kiæb:

- mvnv‡h¨i Rb¨ WvKzb

- wba©vwiZ Riæwi Ae¯’v †gvKv‡ejv cÖwµqv ïiæ Kiæb
- cÖwkwÿZ †mev`vbKvix‡K Rvbvb, whwb `ªæZ cÖviw¤¢K g~j¨vqb m¤úbœ Ki‡eb
- wPwKrmv ïiæ Kivi BwZnvm (Ilya ev ‡Kvb ai‡bi e¨eš’vcbv)

Avmbœ cÖm‡ei jÿY/ DcmM©mg~n

- wbqwgZ, Zxeª ms‡KvPb

- wb‡Pi w`‡K Pvc †`qvi B”Qv
- †hvwbc‡_ Zij †ei nIqv
- †MvOv‡bv

wec`wPýmg~n

- Zxeª gv_ve¨_v/ Svcmv ‡`Lv

- wLuPzwb/ †PZbv nvwi‡q †djv
- k¦vmKó
- R¡i (Zvc Abyfe Kiv)
- Zxeª †cU e¨_v
- Mf©¯’ wkïi bovPov Kg/ †bB
- `yM©Ühy³ †hvwbmªve
- †hvwbc‡_ i³ÿiY
- †hvwbgy‡L bvwfi¾y A_ev wkïi kix‡ii Ask †`Lv hvIqv
- †hvwbc‡_ g¨v‡Kvwbqvg wgwkÖZ Zij †ei nIqv
- †hvwbc‡_ i³ÿiY (Zxeª ev nVvr e„w×)
- cv‡qi †cQ‡bi As‡k (Kvd) e¨_v (†dvjv mn/ Qvov)
- KvUv / ÿZ ¯’vb †_‡K `yM©Ühy³ ¯ªve

32 cÖmeKvjxb †mev
 `ªæZ-cÖviw¤¢K g~j¨vqb- `ªæZ †PK-Avc
(`ªæZ hvPvB)

Avcwb †Kb G‡m‡Qb?

Kx mgm¨v?
wRÁvmv Kiæb I †iKW© †PK Kiæb;
hw` gv †ewk Amy¯’ nb, m½xi mv‡_ K_v ejyb
g~j¨vqb- †`Lyb, ïbyb, Abyfe Kiæb

DcmM©mg~n (†`Lyb, ïbyb) gv‡qi Av‡Q wKbv: AZ¨vek¨K wPýmg~n (†`Lyb, ïbyb, Abyfe Kiæb)
hw` gv‡qi †PZbv, bvwo¯ú›`b, i³Pvc, k¦v‡mi nvi. ZvcgvÎv
Zxeª e¨_v Av‡Q Lye Amy¯’/ cxwoZ/d¨vKv‡m A¨vwbwgqv, RwÛm, mvqv‡bvwmm, BwWgv, cvwbk~b¨Zv, jvsm
†jev‡i Av‡Qb A‡PZb _v‡Kb AmKvj‡Ukb, nvU© mvDÛ, Ae‡÷ªwUK cixÿv Kiæb-
cÖme wbKUeZ©x wLuPzwb A¨ve‡Wvwgbvj, f¨vRvBbvj
‡hvwbc‡_ i³ÿiY nq k¦vmKó

†kÖwYwefvM Kiæb

1. Riæwi †mev 2. cÖme e¨e¯’vcbv 3. wbqwgZ †mev

l mvnv‡h¨i Rb¨ WvKzb gv †K cÖme Iqv‡W© ¯’vbvšÍi Kiæb l Zv‡K I‡qwUs iæ‡g ivLyb
l gv I Zvi m½x‡K Afq w`b l e¨vL¨v Kiæb, civgk© I †mev
l cÖ‡qvRbyhvqx ABCD w`b
e¨e¯’v MÖnY Kiæb

Riæwi †mev ABCD e¨e¯’vcbv

(A&B) AIRWAY & BREATHING- (C) CIRCULATION (D) LEVEL OF

hw` k¦vm cÖk¦vm bv _v‡K CONSCIOUSNESS-
l †ivMx‡K SuvKzwb w`b l l i³msenb cÖwµqv
Ges mvnv‡h¨i Rb¨ e¨vM I gv¯‹ w`‡q g~j¨vqb Kiæb-bvwo †PZbvi gvÎv
WvKzb A_ev, gvD_ Uz gvE_ ¯ú›`b nvi- `ye©j I A (Alert)- mRvM
l †ivMx‡K wPZ K‡i †fw›U‡jU Kiæb `ªæZ ¯ú›`b
†kvqvb (M‡f©i †kl V (Vocal command)
ch©v‡q evg KvZ K‡i) l mvnv‡h¨i Rb¨ WvKzb - P‡g©i ZvcgvÎv- VvÛv, -mRvM bq wKš‘ K_v ej‡j
l 10 †m‡KÛ Gi Rb¨ l hw` k¦vm cÖk¦vm wb‡Z †fRv ey‡S
k¦vm cªk¦vm g~j¨vqb Kó nq (M‡f©i †kl - d¨vKv‡m fve
Kiæb P (Pain)- e¨_vq
ch©v‡q evg KvZ K‡i), cÖwZwµqvkxj
†`Lyb- ey‡Ki - wb¤œ i³Pvc
l
cÖcW Avc, Aw·‡Rb
DVv-bvgv, kybyb- Bb‡n‡jkb, jvs †em, - cÖ¯ªv‡ei cwigvY U ( Unresponsive)-A‡PZb
wbk¦v‡mi kã , Abyfe
Kiæb- wbk¦v‡mi Ges nvU© mvDÛ - 16-18 MR IV jvBb
MwZwewa l m‡›`n Kiæb- A¨vRgv / w`b
l k¦vmbvjx Db¥y³ Kiæb- nvU© †dBjyi - cv‡qi †kl fvM Dc‡i
gv_v KvZ Kiæb, _yZwb cvj‡gvbvwi, BwWgv/ ivLyb
DwV‡q, R _ªvm w`b, A¨vwbwgqv
†KvbI wKQz AvU‡K - K¤^j w`‡q †X‡K w`b
_vK‡j †ei Kiæb , - dwjÔm K¨v‡_Uvi w`b
†KvbI wbtmiY _vK‡j
cwi®‹vi Kiæb

cÖmeKvjxb †mev 33
 4. cÖm‡e I wkï R‡b¥i mgq gv I wkïi Ae¯’v g~j¨vqb

¯^vfvweK cÖme I wkï Rb¥

cÖme wbY©‡qi †cÖv‡UvKj (BwZnvm MÖnY I cwiPh©v)
cÖme ïiæ nIqv wbwðZ Ki‡Z AšÍf©y³ welqmg~n-
- cÖme ïiæ nIqv wbY©q I wbwðZKiY
- wdUv‡mi †cÖ‡R‡›Ukb, Ae¯’vb, Gb‡MR‡g›U I gv_v †b‡g Avmv g~j¨vqb
- †jev‡ii avc I ch©vq¸‡jv wbY©q

jÿY I DcmM©¸‡jv wbY©q - wbqwgZ e¨_vmn Rivqy ms‡KvPb -RivqygyL ax‡i ax‡i cvZjv I †QvU nIqv Ges Lyj‡Z _vKv
- jÿY _vK‡Z ev Zij ¯ªve n‡Z cv‡i

K. †jev‡i _vKv gv‡qi BwZnvm MÖnY
wRÁvmv, †PK K‡i †iKW© Kiæb
l cÖme †e`bvi e¨vwßKvj
l e¨_vi ZxeªZv I c~bive„wËi nvi
l KZ N›Uv Av‡M Mf©wSwjø wQu‡o‡Q
l †hvbxc‡_ i³mªve n‡j Zvi cwigvY
l wkïi bovPov
L. †jev‡i _vKv gv‡K cixÿv
(†Rbv‡ij, A¨ve‡Wvwgbvj)
†`Lyb, ïbyb, Abyfe Kiæb
l evwn¨K Ae¯’v †`Lyb
- fv‡jv Av‡Q/ K‡ó Av‡Q/ av°v
w`‡”Q
AZ¨vek¨K wPýmg~n †PK Kiæb
M. †jev‡i _vKv gv‡qi †hvwbc_ cixÿv
wRÁvmv, †PK K‡i †iKW© Kiæb
cixÿvi cÖwµqv e¨vL¨v K‡i Zvi AbygwZ
wbb
†`Lyb, ïbyb, Abyfe Kiæb
fvjfv †`Lyb
l †cwiwbqv‡gi evjwRs

l mswkøó mgm¨vmg~n l wdUv‡mi †KvbI Ask †`Lv hv‡”Q wK bv

l bvwo¯ú›`b
gv_ve¨_v, R¡i, Svcmv †`Lv, ewg, l i³Pvc l †hvwbc‡_ i³mªve

wbk¦vm I gjg~Î Z¨vM msµvšÍ l d¨vKv‡m fve l S‡i cov A¨vgwbIwUK Zij: cwi®‹vi/

RwUjZv l BwWgv g¨v‡Kvwbqvg hy³/ `yM©Ügq

l LMP I EDD †PK Kiæb
l wcÖ Uvg© (37 mßv‡ni Kg n‡j) /
†cv÷ †WU (EDD cvi n‡q †M‡j)
wba©viY Kiæb
c~e© Mf©ve¯’vi †iKW© †PK Kiæb
l cÖme/ Mf©cv‡Zi msL¨v
l cÖm‡ei c×wZ wmRvwiqvb †mKkb/
di‡mc/ f¨vKzqvg
l RwUjZv- GKjvgwkqv, wcÖ
GKjvgwkqv, cÖme cieZ©x i³ÿiY,
wi‡UBbW cøv‡m›Uv, 3q ch©v‡qi wUqvi
BZ¨vw`
l wkïi Ae¯’v
eZ©gvb Mf©ve¯’vi †iKW© †PK Kiæb
Urine R/M/E
l l
USG
l l
Hb% status
l l
Blood Group: ABO+Rh
l
l VDRL status
l HBsAg status
l Blood sugar
l wU‡Ubvm wUKv`vb Ae¯’v
l ANC ‡iKW©
l wkï‡K LvIqv‡bvi cwiKíbv
l cÖme cwiKíbv ch©v‡jvPbv
l cvwbk~b¨Zv †hvwbc_ cixÿv Kiæb
l ZvcgvÎv
1. gv‡qi Dfq cv fuvR K‡i duvK Kiæb
l RwÛm
2. cixÿv Kivi Av‡M I c‡i mvevb w`‡q
l cÖ¯ªve
nvZ ay‡q wbb
l ürwcÐ Ges dzmdzm cixÿv Kiæb
3. RxevYygy³ Møvfm ciæb
Zj‡cU cixÿv Kiæb 4. fv‡jvfv‡e I †cwiwbqvj GjvKv †_‡K
l c~‡e©i ÿZwPý Dci †_‡K wb‡Pi w`‡K †mvqve Kiæb
l g~Î_wj c~Y© wKbv 5. g„`yfv‡e †hvwbc_ cixÿv Kiæb Ges
wba©viY Kiæb
l AvKvi
l ms‡KvPb msL¨v- 10 wgwb‡U KqwU, (ms‡KvP‡bi mgq cixÿv ïiæ Ki‡eb bv)
w¯’wZKvj, `ywU ms‡KvP‡bi gv‡S wkw_j
l Rivqygy‡Li cÖmviY †m.wg. †Z
nIqv
l RivqygyL ax‡i ax‡i cvZjv I †QvU
l wdUvj †cÖ‡R‡›Ukb- †mdvwjK, weªP,
nIqv
UªvÝfvm©
l †cÖ‡Rw›Us cvU© †nW/weªP/‡kvjWvi
l wdUv‡mi bovPov
Mf©wSwjø AÿZ A_ev ‡Quov
l Zi‡ji cwigvY
KW© Abyfe Kiæb: Abyf~Z/ ¯ú›`bhy³
l ür¯ú›`b weU/ wgwbU
hw` †gg‡eªb wQ`ªhy³ nq, bvwfi¾y
l gvwëcj †cÖM‡bwÝ
†ewi‡q Avmv Ges jvBKv‡ii is †`Lyb
l †nW Gi †÷kb
l hw` i³mªve eZ©gv‡b A_ev Mf©ve¯’vi 7
gvm ci †h †KvbI mgq _v‡K Ges
cøv‡m›Uv wcÖwfqv m‡›`n Kiv nq-
†hvwbc_ cixÿv Kiv hv‡e bv

34 cÖmeKvjxb †mev
cÖm‡ei avc I ch©vqmg~n wbY©q

DcmM© I jÿYmg~n avc ch©vq e¨e¯’vcbv

u RivqygyL cÖmvwiZ bq AcÖK…Z cÖme - ch©‡eÿY/ civgk© w`‡q
cÖm‡e †bB wWmPvR© Kiæb
- e¨_vi wPwKrmv
u RivqygyL 4‡m.wg Gi Kg †Lvjv cÖ_g avc myß - mnvqK hZœ Ges wbðqZv w`b
u nvjKv ms‡KvPb Kiæb - ch©‡eÿY K‡i †iKW© wk‡U †iKW©
<3/ 10 wgwbU ¯’vwqZ¡<20 †m‡KÛ
u RivqygyL 4‡m.wg Gi †ewk †Lvjv cÖ_g avc Kvh©Kix - mnvqK hZœ Ges wbðqZv w`b
u cÖej ms‡KvPb - cv‡U©©vMÖvd c~iY Kiv ïiæ Kiæb
u AwZwi³ ms‡KvPb
>3/ 10 wgwbU _vK‡e> 20 †m‡KÛ
u cÖmvi‡Yi nvi>1 †m.wg/N›Uv
u wkïi gv_v bvg‡Z ïiæ Ki‡e

u RivqygyL m¤ú~Y© †Lvjv (10 †m.wg) wØZxq avc cª_g ch©vq - wbweo ch©‡eÿY
u wkïi gv_vi bvg‡Z _vK‡e (bb-G·cvjwmf) - mnvqK hZœ wbb
u wb‡Pi w`‡K Pvc †`qvi B”Qv n‡e - †iKW© wk‡U †iKW© Kiæb
bv - cÖm‡ei Rb¨ cÖ¯‘wZ wbb
u RivqygyL m¤ú~Y© cÖmvwiZ 10 †m.wg wØZxq avc †kl ch©vq - wbweo ch©‡eÿY
u cÖ`wk©Z Ask †cjwfK †d¬v‡i (bb-G·cvjwmf) - gv‡K †jevi †Uwe‡j wbb
bvg‡e - †iKW© wk‡U †iKW© Kiæb
u wb‡Pi w`‡K Pvc †`qvi B”Qv n‡e - cÖm‡ei Rb¨ cÖ¯‘wZ wbb
u †cwiwbqvj evjwRs, wcwcs Ae cÖme wbKUeZ©x - cÖm‡ei Rb¨ cÖ¯‘wZ wbb
†nW - cÖme cwiPvjbv Kiæb
u µvDwbs
u A¨vbvj M¨vwcs

cÖmeKvjxb †mev 35
 5. cÖm‡ei e¨e¯’vcbv

K. cÖm‡ei cÖ_g av‡ci e¨e¯’vcbv:

myß Ae¯’v mwµq Ae¯’v

DcmM© I jÿY wbY©©q
l †_‡g †_‡g Zj‡c‡U e¨_v l †_‡g †_‡g Zj‡c‡U e¨_v
l AšÍ©eZ©x nvjKv Rivqy ms‡KvPb, <3/ 10 wgwbU, ¯’vwqZ¡ l gv‡S gv‡S Zxeª Rivqy ms‡KvPb, 3/ 10 wgwbU, _vK‡e
<20 †m‡KÛ 20-40 †m‡KÛ
l jÿY l jÿY / cvwb fvOv
l RivqygyL †Lvjv <4 †m.wg l RivqygyL 4 †m.wg †Lvjv
mvaviY e¨e¯’vcbv
K. mnvqK hZœ I wbðqZv w`b K. mnvqK hZœ I wbðqZv w`b
L. cÖwZ NÈvq ch©‡eÿY Kiæb L. cÖwZ 30 wgwbU AšÍi ch©‡eÿY Kiæb
wec` wPý, ms‡KvP‡bi nvi I ¯’vwqZ¡, Mf©¯’ wkïi wec` wPý, ms‡KvP‡bi nvi, ZxeªZv I ¯’vwqZ¡, Mf©¯’
ür¯ú›`b, †gRvR I AvPiY wkïi ür¯ú›`b,†gRvR I AvPiY
M. †iKW© wk‡U †jev‡ii Z_¨¸‡jv ‡iKW© Kiæb M. cv‡U©vMÖv‡d Z_¨¸‡jv ‡iKW© Kiæb
N. Mf©wSjøx wQu‡o hvIqvi mgq I jvBKv‡ii is †iKW© N. cÖwZ 4 N›Uvq Rivqyg‡Li cÖmviY, gv_v †b‡g Avmv,
Kiæb i³Pvc, ZvcgvÎv g~j¨vqb Kiæb
O. cÖwZ 4 N›Uvq cÖm‡ei AMÖMwZ I RivqygyL ‡Lvjv
g~j¨vqb Kiæb
wbw`©ó e¨e¯’vcbv
P. 8 NÈv ci hw` O. hw` cv‡U©vMÖv†d RivqygyL †Lvjvi Aw¼Z †iLvi Dci
A_ev Gi ev‡g _v‡K
l ms‡KvPb bv ev‡o, Mf©wSjøx AÿZ, RivqygyL cÖmvi‡Y
AMÖMwZ bvB; gv‡K †Q‡o w`b Ges Avevi Avm‡Z ejyb
l ch©‡eÿY Kiæb Ges m¤ú~Y© cÖmvwiZ nIqv ch©šÍ
mnvqK hZœ wbb Ges cÖm‡ei 2q av‡ci e¨e¯’vcbv
l gv‡K c~b©g~j¨vqb Kiæb Ges ch©‡eÿ‡Y ivLyb hw` e¨_v MÖnY Kiæb
ev‡o, - Mf©wSwjø †d‡U hvq, i³ÿiY nq P. cv‡U©vMÖvd RivqygyL †Lvjvi Aw¼Z †iLvi Wv‡b _v‡K
l ms‡KvPb AviI Zxeª Ges AviI Nb Nb, wKšÍ Mf©wSjøx RivqygyL †Lvjvi †KvbI AMÖMwZ †bB
AÿZ, RivqygyL †Lvjvi †KvbI AMÖMwZ bv _v‡K, Z‡e - cybg©~j¨vqb Kiæb
- AwfÁ Kv‡iv mv‡_ civgk© Kiæb A_ev †idvi
- AwfÁ Kv‡iv mv‡_ civgk© Kiæb Kiæb
- K…wÎg Mf©wSwjø wQbœ Kiv (ARM) †h‡Z cv‡i - mnvqK hZœ Pvwj‡q hvb, g~Î Z¨vM, ch©vß Zij
- wbweo ch©‡eÿY Kiæb LvIqv
- Avav NÈv ci ci ch©‡eÿY Kiæb
- hw` ms‡KvPb `ye©j nq, Aw·‡Uvwmb A_ev ARM
Gi gva¨‡g e„w× Kiæb
Q. cv‡U©vMÖvd GKkb jvB‡bi Wvb w`‡K _vK‡j
- cybg©~j¨vqb Kiæb
- AwfÁ Kv‡iv mv‡_ civgk© Kiæb ev †idvi Kiæb

36 cÖmeKvjxb †mev
 L. cÖm‡ei 2q av‡ci e¨e¯’vcbv M. cÖm‡ei 3q av‡ci e¨e¯’vcbv
DcmM© I jÿY wbY©©q
l RivqygyL m¤ú~Y© †Lvjv l beRvZKwU gvÎ cÖme n‡q‡Q
l wdUv‡mi wb‡P †b‡g Avmv Pj‡Q l Mf©dzj Rivqyi †fZ‡i
l wb‡Pi w`‡K Pvc †`qvi Zxeª B”Qv

mvaviY e¨e¯’vcbv
l cÖwZ 5 wgwbU AšÍi wec` wPý¸‡jv ch©‡eÿY Kiæb
l ms‡KvP‡bi msL¨v, ZxeªZv I ¯’vwqZ¡Kvj
l Mf©¯’ wkïi ür¯ú›`b
l †cwiwbqvg cvZjv I dz‡j IVv
l wdUvj †nW wcwcs Ges µvDwbs
l gv‡qi †gRvR I AvPiY
l mewKQz †iKW© wk‡U †iKW© Kiæb
l gv‡K mnvqK hZœ, Drmvn I wbðqZv w`b
l gv‡K KLbI GKv ivL‡eb bv
cøv‡m›Uv †Wwjfvwi (AMTSL)
l 2q hgR Mf©¯’ wkï Av‡Q wK bv Zv eySvi Rb¨ gv‡qi
†cU ¯úk© K‡i cixÿv Kiæb
l cÖm‡ei 1 wgwb‡Ui g‡a¨ 10 IU Aw·‡Uvwmb IM †`qv
n‡q‡Q wK bv wbwðZ Kiæb
l cÖej ms‡KvP‡bi Rb¨ A‡cÿv Kiæb (2-3 wgwbU) Ges
bvwfi¾yi wbqwš¿Z Uv‡bi gva¨‡g cøv‡m›Uv †ei Kiæb
l Rivqy g¨v‡mR Kiæb
l Rivqy wVKfv‡e msKzwPZ n‡q‡Q wK bv Abyfe Kiæb
l mnvqK hZœ wbb

wbw`©ó e¨e¯’vcbv
l cÖme mnvqK mKj DcKiY cÖ¯‘Z Av‡Q wK bv Zv wbqwš¿Z bvwfi¾yi Uvb
wbwðZ Ki‡Z n‡e l wcDweK wmçvBwmm Gi Dc‡i GK nvZ (mvaviYZ
l g~Î_wj Lvwj Av‡Q wK bv wbwðZ K‡i, Avivg`vqK evgnvZ) Ggbfv‡e ivLyb †hb nv‡Zi Zvjy gv‡qi
Ae¯’v‡b _vK‡Z mnvqZv Kiæb Ges gvbwmK I bvwfi w`‡K _v‡K| G‡Z wbqwš¿Z KW© Uª¨vKk‡bi mgq
kvixwiKfv‡e mnvqZv w`b Rivqyi wecixZgyLx Uvb m„wó n‡e| GKB mg‡q K‡W©i
l ms‡KvP‡bi mgq †Kuv_ w`‡Z w`b Dci `„pfv‡e wb‡Pi w`‡K Uvb w`‡Z n‡e|
l hLb †cwiwbqvg ùxZ n‡e Ges gv_v †`Lv hv‡e- nvZ l hw` wbqwš¿Z KW© Uª¨vKk‡bi 30-40 †m‡KÛ Gi g‡a¨
ay‡q RxevYygy³ Møvfm ciæb cøv‡m›Uv wb‡P †b‡g bv Av‡m Zvn‡j Rivqy fv‡jvfv‡e
l ms‡KvP‡bi ga¨eZ©x mg‡q gv_v wbqwš¿Zfv‡e cÖme msKzwPZ bv nIqv ch©šÍ A‡cÿv Kiæb Zvici Avevi
n‡q‡Q wK bv wbwðZ Kiæb wecixZgyLx Uvb w`‡q wbqwš¿Z KW©Uª¨vKkb c~bivq
Kiæb|
l ev”Pvi Mjvi Pvicv‡k bvwfi¾y Av‡Q wK bv Zv
l †gg‡eªb wQu‡o hvIqv †iva Ki‡Z cøv‡m›Uv †ei n‡q
Avj‡Zvfv‡e Abyfe Kiæb
Avmvi mgq `yB nv‡Z aiæb
l gyLgÐj cwi®‹vi Av‡Q wK bv hvPvB Kiæb l hw` †gg‡eªb ¯^vfvweZfv‡e L‡m bv c‡o Zvn‡j `woi
l ¯^vfvweKfv‡e Kuv‡ai N~Y©‡bi Rb¨ A‡cÿv Kiæb g‡Zv †cuwP‡q †ei Kiæb
l Kuv‡ai m¤§yLfvM †ei Kivi Rb¨ ev”Pvi gv_vi `yB l cøv‡m›Uv †ei nIqvi ci Rivqy g¨v‡mR Kiæb
cv‡k nvZ †i‡L †cwiwbqv‡gi w`‡K nvjKv Pvc w`b l cøv‡m›Uv I †gg‡eªb AÿZ Av‡Q wK bv hvPvB Kiæb
Zvici Kuv‡ai †cQ‡bi Ask †ei Kivi Rb¨ gv_v l Rivqy fv‡jvfv‡e msKzwPZ n‡q‡Q wK bv Zv 5 wgwbU
Dc‡i Zzjyb AšÍi hvPvB Kiæb
l gv‡qi †c‡Ui Dci wkï‡K ivLyb l †cwiwbqvg, †hvwbi wb¤œvsk, fvjfv wQu‡o‡Q wK bv †PK
l wkï‡K m¤ú~Y©fv‡e ïwK‡q, Kvco cv‡ë w`b Kiæb
l ïKv‡bvi mgq wkïi k¦vm-cÖk¦vm jÿ¨ Kiæb cÖ‡qvR‡b l †jev‡ii 3q av‡c i³ÿi‡Yi cwigvY wba©viY K‡i
cybiæ¾xweZ Kiæb †iKW© Kiæb
l 3q ch©v‡qi e¨e¯’vcbv ïiæ Kiæb l †cwiwbqvg cwi®‹vi K‡i m¨vwbUvwi c¨vW A_ev cwi®‹vi
l 1-3 wgwb‡Ui g‡a¨ KW© †K‡U K¬¨v¤ú Kiæb Kvco fuvR K‡i w`b
l gv‡qi ey‡Ki Dci wkï‡K †i‡_ gv_vmn †X‡K w`b Ges l Kvco e`jv‡Z Zv‡K mvnvh¨ Kiyb
ey‡Ki `ya LvIqv‡bv ïiæ Ki‡Z Drmvn w`b

cÖmeKvjxb †mev 37
 N. cÖm‡ei 4_© av‡ci e¨e¯’vcbv (ch©‡eÿY)
gv‡K ch©‡eÿY wkï‡K cÖwZ 15 wgwbU ci ci ch©‡eÿY
cÖ_g 2NÈvq cÖwZ 15 wgwbU ci ci l k¦vm cÖk¦vm: wkï bxi‡e wbqwgZfv‡e k¦vm wb‡”Q wK bv,
l wec` wPý cuvRi †fZ‡i bvg‡Q wK bv Ges `ªæZ k¦vm-cÖk¦vm wb‡”Q
l Rivqy k³ n‡q‡Q wK bv wbwðZ Kiæb wK bv jÿ ivLyb
l †hvwbc‡_ i³mªve g~j¨vqb Kiæb l DòZv: cv‡qi cvZv VvÐv wK bv †PK Kiæb
l bvwoi ¯ú›`b, i³Pvc g~j¨vqb Kiyb l bvwfg~j: i³ÿiY n‡”Q wK bv †Lqvj Kiæb
l 3q ch©©v‡qi e¨vwßKvj I Z_¨mg~n †iKW© Kiæb
l mnvqK hZœ wbb

M. cv‡U©vMÖvd

cv‡U©vMÖvd n‡”Q cÖm‡ei AMÖMwZ Ges cÖm‡ei mgq gv I Mf©¯’ wkïi Ae¯’vi †jLwPÎ weeiYx| cÖm‡e _vKv gv‡K ch©‡eÿY
K‡i cÖvß Z_¨ mg~‡ni †iKW© n‡jv cv‡U©vMÖvd, hvi g~j ˆewkó¨ n‡jv †hvwbc_ cixÿv K‡i RivqygyL †Lvjvi †jLwP‡Îi gva¨‡g
†iKW© Kiv|

÷¨vÛvW© 9t mKj bvix †K cÖme †mevi mgq mwVK mnvqK †mev †`qv DwPZ| cÖm‡ei cÖ_g av‡c Rivqyi gyL 4 †m. wg.
cÖmvwiZ n‡j (cÖ_g av‡ci mwµq ch©v‡q) mKj bvixi Rb¨ GKwU cv‡U©vMÖvd ïiæ Ki‡Z n‡e| mKj g~j¨vqb Z_¨
cv‡U©vMÖv‡d wjwce× Ki‡Z n‡e|

38 cÖmeKvjxb †mev
 cv‡U©vMÖv‡di e¨envi
cv‡U©vMÖvd †`‡L mn‡RB eySv hvq cÖme ¯^vfvweK A_ev A¯^vfvweK wK bv|
l gv_v Ges †cjwf‡mi g‡a¨ (†mdv‡jv‡cjwfK) AmvgÄm¨ Zv mn‡R wba©viY Kiv hvq
l †jevi Iqv‡W© _vKv †mev`vbKvixMY `vwqZ¡ e`jv‡bvi mgq mn‡RB Z_¨ wewbgq Ki‡Z cvi‡eb
l m¤ú~Y© Z_¨¸‡jv bv wj‡L cv‡U©vMÖv‡d †jevi †iKW©¸‡jv Zz‡j mgq euvPv‡bv hv‡e
l †jev‡ii AMÖMwZ h_vh_fv‡e wba©viY Kiv hvq Ges mgqg‡Zv cÖ‡qvRbxq e¨e¯’v †bqv hv‡e

†ivMxi Z_¨: bvg c~iY Kiæb, Mª¨vwfWv, c¨viv, nvmcvZvj NÈv: cÖm‡ei Kvh©Kix ch©vq kyiæ †_‡K AwZµvšÍ mgq,
bv¤^vi, fwZ©i ZvwiL I mgq Ges Mf©wSwjø †d‡U hvIqvi cÖviw¤¢K mgq‡K Ò0Ó NÈv aiv nq
mgq mgq: cÖK…Z mgq ‡iKW© Kiæb
wkïi n«`¯ú›`b: cÖwZ AvaNÈvq †iKW© Kiæb| ms‡KvPb: cÖwZ NÈvi QK Kiæb, 10 wgwb‡U ms‡KvPb
A¨vgwbIwUK Zij: cÖwZevi †hvwbc_ cixÿvi †ÿ‡Î msL¨v, ¯’vwqZ¡Kvj (†m‡KÛ) Abyfe Kiæb| mg‡qi
A¨vgwbIwUK Zi‡ji is †iKW© Kiæb: jvB‡bi Wvb w`‡K †iKW© Ges `yB jvB‡bi `ywU ci ci e·
l I: †gg‡eªb AÿZ c~Y© Kiæb
l C: †gg‡eªb wQ`ª, cwi®‹vi Zij ¯’vwqZ¡Kvj:
l M: †g‡Kvwbqvghy³ Zij l 20 †m‡KÛ Gi Kg:
l A: Abycw¯’Z l 20 †_‡K 40 †m‡KÛ Gi g‡a:
l B: i³wgwkªZ Zij l 40 †m‡KÛ Gi †ewk:
†gvwìs: Aw·‡Uvwmb: hLb e¨envi Kiv nq cÖwZ 30 wgwb‡U IV
l 1: nvo¸‡j cvkvcvwk ¯’vwcZ d¬zB‡W Aw·‡Uvwmb Gi cwigvY Wªcm cvi wgwb‡U Zv †iKW©
l 2: nvo¸‡jv GKwU Av‡iKwUi Dci D‡V †M‡Q wKš‘ Kiæb|
mn‡RB miv‡bv hvq cÖ`Ë Ilya: Ab¨vb¨ Ilya †`qv n‡j †iKW© Kiæb
l 3: nvo¸‡jv GKwU Av‡iKwUi Dci D‡V †M‡Q wKš‘
mn‡RB miv‡bv hvq bv bvwo ¯ú›`b: cÖwZ 30 wgwb‡U †iKW© Kiæb Ges WU (l)
Gi gva¨‡g wPwýZ Kiæb|
†cU cixÿv K‡i wkïi gv_v wb‡P †b‡g Avmv g~j¨vqb Kiv
nq: i³Pvc: cÖwZ 4 N›Uvq †iKW© K‡i Zxi wPý Øviv wPwýZ
Kiæb
cÖwZevi †hvwbc_ cixÿvi Av‡M wmçvBwmm wcDwem Gi
Dc‡i gv_vi Ask (5 fv‡M fvM Kiv nq) hZUzKz ¯úk© K‡i ZvcgvÎv: cÖwZ 2 N›Uvq †iKW© Kiæb
Abyfe Kiv hvq; GKwU e„Ë (O) w`‡q Zv †iKW© Kiv nq| †cÖvwUb: fwZ©i mgq mKj †ivMxi †ÿ‡Î GB cixÿv Kiv
0/5 G, wmwÝcyU(S) wmçvBwmm wcDwem eivei _v‡K| n‡jI PET/GKjvgwkqv/ wKWwb †ivMxi Rb¨ cÖ‡qvRb
RivqygyL Ly‡j hvIqv: cÖwZevi †hvwbc_ cixÿvi mgq Abyhvqx cybivq cixÿv Kiæb
g~j¨vqb Kiv nq Ges GjvU© jvB‡b GKwU µm (X) w`‡q cÖ¯ªv‡ei cwigvY: cÖwZevi g~ÎZ¨v‡Mi cwigvY †iKW© Kiæb,
wPwýZ Kiv nq| 4 †m.wg. n‡j cv‡U©vMÖv‡d GjvU© jvBb g~ÎZ¨v‡M DrmvwnZ Kiæb
AuvKv ïiæ Ki‡Z nq Gwm‡Uvb: ïaygvÎ wb‡`©wkZ n‡j we‡kl K‡i Wvqv‡ewUm
GjvU© jvBb: RivqygyL 4 †mwg †Lvjv †_‡K ïiæ n‡q Ges g¨vUvibvj wWm‡Uªm n‡j cixÿvwU Kiæb|
RivqygyL m¤ú~Y© Ly‡j hvIqv ch©šÍ (¯^vfvweK wbq‡g cÖwZ
NÈvq 1 †m.wg. nv‡i) Aw¼Z †iLv
GKkb jvBb: GjvU© jvB‡bi mgvšÍivj Ges 4 N›Uv Wvb
w`‡K

40 cÖmeKvjxb †mev
N. cÖm‡ei mgq gyL¨ mgm¨v wPwýZKiY Ges e¨e¯’vcbv

÷¨vÛvW© 8 t cÖwZwU gv I beRvZK wbqwgZ cÖgvYwfwËK †mev jvf Ki‡e Ges wek¦ ¯^v¯’¨ ms¯’v (WHO) MvBWjvBb
Abyhvqx cÖme I cÖmeKvjxb RwUjZvmg~‡ni e¨e¯’vcbv cÖ`vb Kiv n‡e

gyL¨ mgm¨vmg~n DcmM© / jÿY e¨e¯’vcbv

36 mßvn ci A¯^vfvweK Ae¯’vb I
A¯^vfvweK Dc¯’vcb
(Malpositions and
Malpresentations after 36
weeks)
Mf©¯’ wkïi g„Zy¨
(Intra Uterine Foetal Death)
cÖm‡ei c~‡e© †gg‡eªb wQu‡o hvIqv
(Premature Rupture
Membrane)
A¯^vfvweK Ae¯’vb: fv‡U©· †cÖ‡R‡›Ukb
wK¯‘ Aw·cyU G‡›Uwiqi cwRk‡b †bB
A¯^vfvweK Dc¯’vcb: fv‡U©· †cÖ‡R‡›Ukb
e¨ZxZ Ab¨ mKj †cÖ‡R‡›Ukb †_‡K
wejw¤^Z A_ev `xN©vwqZ †jevi n‡Z cv‡i
Mf©¯’ wkïi bovPov I Mf©¯’ wkïi
ür¯ú›`b Abycw¯’Z
M‡f©i jÿY¸‡jv eÜ
Rivqyi D”PZv n«vm
wcÖ-Uvg© †jevi m‡›`n n‡j †ivMx‡K cixÿv
K‡i †`L‡Z n‡e
B›Uªv-GgwbIwUK Bb‡dKkb: †gg‡eªb wQu‡o
bv †M‡j wcÖUvg© †jevi Gi cÖ_g jÿY
Avk¦vm w`b Ges mbv³ K‡i cieZ©x
cixÿv Ges wPwKrmvi Rb¨ mgwš^Z Riæix
cÖm~wZ †mev‡K‡›`ª †idvi Kiæb
mbv³ K‡i cieZ©x cixÿv Ges wPwKrmvi
Rb¨ mgwš^Z Riæix cÖm~wZ †mev‡K‡›`ª
†idvi Kiæb
Avk¦vm Ges gvbwmK mnvqZv w`b
mbv³ K‡i cieZ©x cixÿv Ges wPwKrmvi
Rb¨ mgwš^Z Riæix cÖm~wZ †mev‡K‡›`ª
†idvi Kiæb

GKvwaK M‡f©i cÖme l Rivqy Mf©Kv‡ji †P‡q eo Avk¦vm Ges gvbwmK mnvqZv w`b
(Multiple Biths) l M‡f©i DcmM© I jÿYmg~n †e‡o hv‡e mbv³ K‡i cieZ©x cixÿv Ges wPwKrmvi
l Mf©¯’ wkïi AwZwi³ bovPov Rb¨ mgwš^Z Riæix cÖm~wZ †mev‡K‡›`ª
l AvjUvªvmvDÛ: GKvwaK Mf©¯’ wkï †idvi Kiæb

cÖm‡ei Am‡šÍvlRbK AMÖMwZ †mdv‡jv ‡cjwfK AmvgÄm¨ nq KviY Mf©¯’ gv I Mf©¯’ wkïi Ae¯’v `ªæ~Z g~j¨vqb K‡i
(Unsatisfactory Progress of wkï A‡bK eo A_ev gv‡qi †cjwfm Lye mnvqK †mev w`b| cv‡U©vMÖvd cybivq
Labor) †QvU| ch©‡eÿY Kiæb| cieZ©x e¨e¯’vcbvi Rb¨
Ae÷ªvKk‡bi Dcm‡M©i g‡a¨ i‡q‡Q mgwš^Z Riæix cÖm~wZ †mev †K‡›`ª †idvi
Kiæb|
Rivqyg‡Li cÖmvi‡Yi I †cÖ‡Rw›Us cvU©
AeZi‡Yi gva¨wgK MwZ‡iva Ges jvR©
K¨vcyU, 3q wWwMÖi †gvwìs, BwWgvhy³
RivqygyL, RivqygyL †hLv‡b †cÖ‡Rw›Us cvU©
wVKfv‡e mshy³ n‡Z cv‡i bv, wdUvj
wWm‡Uªm| †jev‡ii Am‡šÍvlRbK AMÖMwZi
cÖviw¤¢K mbv³KiY I e¨e¯’vcbvi Rb¨
†jev‡i _vKv mKj bvixi Rb¨ cv‡U©vMÖvd
e¨envi Acwinvh©|
A¯^vfvweK Ae¯’vb I A¯^vfvweK K) Aw·cyU †cv‡÷wiIi Ae¯’vb N‡U hLb K) gv‡qi mvaviY kvixwiK Ae¯’v `ªæZ
Dc¯’vcb wdUv‡mi Aw·cyU gv‡qi †cjwf‡mi wcQ‡bi g~j¨vqb Kiæb
(Malpositions and w`‡K Ae¯’vb K‡i L) wdUv‡mi Ae¯’v g~j¨vqb Kiæb
Malpresentations) L) Aw·cyU UªvÝfvm© Ae¯’vb: hLb wdUv‡mi M) Drmvn I mnvqK †mev`vb Kiæb
Aw·cyU gv‡qi †cjwf‡mi mv‡_ AvovAvwo N) ¯^v¯’¨‡K‡›`ª cÖm‡ei Rb¨ †idvi Kiæb
_v‡K
M) †eªv (åƒ/Kcvj) †cÖ‡R‡›Ukb: hLb
wdUv‡mi gv_vi AvswkK G·‡Ubkb n‡q
Kcvj Dc¯’vcbv nq ZvB wmwÝcy‡Ui †P‡q
Aw·cyU D”PZi nq|

cÖmeKvjxb †mev 41
 gyL¨ mgm¨vmg~n
KW© †cÖvjvá / bvwfi¾y †ei nIqv
(Prolapsed Umbilical Cord)
cÖmeKvjxb mg‡q wdUvj wWm‡Uªm
(Foetal Distress in Labor)
DcmM© / jÿY e¨e¯’vcbv
N) †dm †cÖ‡R‡›Ukb nq hw` wdUv‡mi gv_vi
nvBcvi G·‡Ubkb n‡q _v‡K
O) K¤úvDÛ †cÖ‡R‡›Ukb nq hLb Dc¯’vwcZ
A‡½i mv‡_ evû †ei n‡q Av‡m, †ei nIqv
evû I gv_v DfqB †cjwf‡m _v‡K
P) weªP †cÖ‡R‡›Ukb: hLb wbZ¤^ Ges/
A_ev cv Dc¯’vwcZ A½ n‡q _v‡K
wdUv‡mi †cÖ‡Rw›Us cvU© Gi wb‡P ev_© GKwU CemOC ‡K‡›`ª ZvrÿwYKfv‡e
K¨vbv‡j bvwfi¾y _vK‡j| Mf©wSwjø †d‡U †idvi Kiæb, hw` gv 2q av‡c _v‡K
†M‡j †hvwbc‡_ bvwfi¾y †`Lv hv‡e ¯^vfvweK cÖme Kiv‡bv hv‡e|
l ms‡KvP‡bi mgq ¯^vfvweK wdUvj nvU© l Aw·‡Uvwmb †`qv n‡j eÜ Kiæb
†iU ax‡i n‡Z cv‡i wKš‘ Rivqy wkw_j l gv‡K Zvi evgcv‡k KvZ Kiæb
n‡j c~e© Ae¯’vq wd‡i Av‡m l cieZ©x e¨e¯’vcbvi Rb¨ mgwš^Z
l ms‡KvPb Qvov wdUvj nvU© †iU Lye ax‡i Riæix cÖm~wZ †mev †K‡›`ª †idvi
n‡j A_ev ms‡KvP‡bi ci I axi Kiæb
_vK‡j Zv wdUvjwWm‡Uªm wb‡`©k K‡i|
wdUvj nvU© †iU gv‡qi R¡i _vK‡j,
Ilya (†KvjvBwUK) hv gv‡qi ür¯ú›`b
evovq, D”Pi³Pvc A_ev
A¨vgwbIbvBwU‡m `ªæZ n‡Z cv‡i;
gv‡qi ür¯ú›`b `ªæZ bv n‡q I wdUvj
nvU© †iU `ªæZ n‡j Zv wdUvjwWm‡Uªm
Gi jÿY aiv nq|
g¨v‡Kvwbqvghy³ A¨vgwbIwUK Zij
l wdUvm eo nIqvi mv‡_ mv‡_
g¨v‡Kvwbqvghy³ A¨vgwbIwUK Zij
†`Lv hvq, ïaygvÎ GwU wdUvjwWm‡Uªm
Gi wb‡`©kK bq|
l wdUvj nvU© †iU Gi A¯^vfvweKZv Qvov
nvjKv g¨v‡Kvwbqvghy³ Zij mZK©Zv
wb‡`©kK
l Nb meyRvf g¨v‡Kvwbqvg Øviv eySv hvq
n«vmK…Z A¨vgwbIwUK Zi‡j
g¨v‡Kvwbqvg hv‡”Q hv nqZ `ªæZ cÖme
Gi cÖ‡qvRbxqZv Ges cÖm‡ei mgq
g¨v‡Kvwbqvg A¨vmwc‡ikb cÖwZ‡iv‡a
beRvZ‡Ki k¦vmbvjxi Dcwifv‡Mi
e¨e¯’vcbv wb‡`©k K‡i

Rivqyi wfZi Mf©dzj †_‡K hvIqv
(Retained Placenta)
l †hvwbc‡_ AwZwi³ i³ÿiY
l Mf©dzj Rivqyi wfZ‡i
l Rivqy ms‡KvwPZ
l gv‡qi mvavib kvixwiK Ae¯’v `ªæZ
g~j¨vqb Kiæb|
l kK aviYv Kiv n‡j AwZmË¡i k‡Ki
e¨e¯’vcbv ïiæ Kiæb|
l wkivq m¨vjvBb ïiæ Kiæb
l g~Î_wj‡Z K¨v‡_Uvi Kiæb
l mgwš^Z Riæix cÖm~wZ †mev`vb‡K‡›`ª
¯’vbvšÍ‡ii Rb¨ hvbevn‡bi e¨e¯’v
Kiæb
l †idvi Kiæb

42 cÖmeKvjxb †mev
 gyL¨ mgm¨vmg~n DcmM© / jÿY e¨e¯’vcbv
wkw_j Rivqy cÖm‡ei ci AwZwi³ i³ÿib gv‡qi mvavib kvixwiK Ae¯’vi `ªæZ
(Atonic Uterus) g~j¨vqb Kiæb|
l kK avib Kiv n‡j AwZmË¡i k‡Ki
e¨e¯’vcbv w`b|
l i³ I RgvU evav i³ †ei Kivi
Rb¨ Rivqy g¨v‡mR Kiæb Ges
Aw·‡Uwmb w`b|
l wkivq m¨vjvBb kyiæ Kiæb
l g~Îbvjx‡Z K¨v‡_Uvi Kiæb
l Mf©dzj cÖme n‡q‡Q wKbv Ges
Mf©dzj cÖme n‡j m¤ú~Y© n‡q‡Q wKbv
cixÿv Kiæb|
l Rivqyi gyL, †hvbxc_ Ges †cwiwbqv‡g
ÿZ Av‡Q wKbv cixÿv Kiæb|
l mgwš^Z †mev`vb‡K‡›`ª ¯’vbvšÍ‡ii
Rb¨ hvbevn‡bi e¨e¯’v Kiæb
l ‡idvi Kiæb
RivqygyL, †hvbxc_ I †cwiwbqvg wQ‡o cÖm‡ei ci AwZwi³ i³ÿib l gv‡qi mvavib kvixwiK Ae¯’vi `ªæZ
hvIqv g~j¨vqb Kiæb|
(Tears of Cervix, Vagina l kK avib Kiv n‡j AwZmË¡i k‡Ki
orPerineum) e¨e¯’vcbv w`b|
l i³ I RgvUevav i³ †ei Kivi Rb¨
Rivqy g¨v‡mR Kiæb Ges Aw·‡Uwmb
w`b|
l wkivq m¨vjvBb kyiæ Kiæb
l g~Îbvjx‡Z K¨v‡_Uvi Kiæb
l Mf©dzj cÖme me n‡q‡Q wKbv Ges
Mf©dzj cÖme n‡j m¤ú~Y© n‡q‡Q wKbv
cixÿv Kiæb|
l Rivqyi gyL, †hvbxc_ Ges †cwiwbqv†g
ÿZ Av‡Q wKbv cixÿv Kiæb|
l mgwš^Z †mev`vb‡K‡›`ª ¯’vbvšÍ‡ii
Rb¨ hvbevn‡bi e¨e¯’v Kiæb
l ‡idvi Kiæb
Rivqy †d‡U hvIqv l ‡c‡Ui wfZi Ges A_ev †hvwbc‡_ l BwZnvm MÖnb Kiæb
(Ruptured Uterus) i³ÿib l gv‡qi mvavib kvixwiK Ae¯’vi `ªZ
l ‡c‡U cÖPÛ e¨v_v gyj¨vqb Kiæb
l wkïi kix‡ii Ask we‡kl †c‡U nvZ l G Ae¯’vq †hvbxc‡_ cixÿv Kiv
w`‡j Abyfe Kiv hv‡e hv‡eb
l m¤úªwZ cÖm‡ei BwZnvm l hw` kK avibv nq AwZmË¡i k‡Ki
e¨e¯’vcbv w`b
l wkivc‡_ m¨vjvBb ïiæ Kiæb
l mgwš^Z †mev`vb‡K‡›`ª ¯’vbvšÍ‡ii
Rb¨ hvbevnb e¨e¯’v Kiæb
l ‡idvi Kiæb

cÖmeKvjxb †mev 43
44 cÖmeKvjxb †mev
 †mKkb 3t
beRvZK †mev

beRvZK †mev 45
46 beRvZK †mev
 beRvZK ‡mev
¯^vfvweK beRvZ‡Ki ZvrÿwYK cwiPh©v

†ewkifvM beRvZKB R‡b¥i mgq †KvbI mvnvh¨ QvovB k¦vm †bq I Kuv‡`| wkïwU gvZ…M‡f© Dò (Kgc‡ÿ 99 wWwMÖ
dv‡ibnvBU) cwi‡e‡k wQj| R‡b¥i ci †m nVvr K‡i VvÐv cwi‡e‡k G‡m c‡o, R‡b¥i ci wkï‡K Dò ivLv ZvB AZ¨šÍ
Riæwi|

†h beRvZK fv‡jvfv‡e Kvu`‡Q ev k¦vm wb‡”Q Zv‡K cwiPh©v †`evi Rb¨ wb‡Pi avc¸‡jv AbymiY Kiæb|

ZvrÿwYK cwiPh©vi avc

wkï‡K fvjfv‡e gy‡Q ﮋ Ki‡Z n‡e

R‡b¥i ciciB wkï‡K fvjfv‡e gy‡Q ﮋ Ki‡Z n‡e| d‡j wkï Dò _vK‡e Ges k¦vm †bqvi Rb¨ DÏxß n‡e| cwi®‹vi
ïK‡bv Kvco w`‡q gv_v, wcV, nvZ, cv mn m¤ú~Y© kixi fvjfv‡e gy‡Q wkï‡K ﮋ Ki‡Z n‡e| KLbB fviwb· (Vernix)
IVv‡eb bv, fviwb· beRvZK‡K msµgY †_‡K iÿv K‡i | †fRv Kvco mwi‡q Av‡iKwU ïK‡bv Kvco w`‡q wkï‡K gywo‡q
w`‡Z n‡e Ges wkïi gv_vq Kvco/Uzwc w`‡Z n‡e|

A¨vgwbIwUK d¬zB‡W †g‡Kvwbqvg _vK‡j

R‡b¥i mgq hw` A¨vgwbIwUK d¬zB‡W †g‡Kvwbqvg _v‡K Z‡e wkï‡K gy‡Q ﮋ Kivi Av‡MB mvKvi w`‡q gyL I bvK cwi®‹vi
Ki‡Z n‡e| cÖ‡qvR‡b mvKkbhš¿ e¨envi Kiv †h‡Z cv‡i| k¦vmbvjx cwi®‹vi Kivi ci wkï‡K fvjfv‡e gy‡Q ïK‡bv Ki‡Z
n‡e| wkïwU‡K gy‡Q ﮋ Kivi mgq wbwðZ n‡Z n‡e †h, wkïwU wK Kvu`‡Q? AwaKvsk wkïB R‡b¥i ciciB Kvu‡` ev bxi‡e
wbqwgZ k¦vm †bq| Kvbœvi gv‡b wkïwU fvjfv‡e k¦vm wb‡”Q|

‡h wkïwU Kvu`‡Q Zv‡K bx‡P‡i avc AbymiY K‡i wbqwgZ cwiPh©v cÖ`vb Ki‡Z n‡e
l Dò ivLv: wkï‡K gv‡qi Z¡‡Ki ¯ú‡k© ivL‡Z n‡e| ïK‡bv Mig Kvco w`‡q †X‡K w`‡Z n‡e Ges gv_vq Kvco ev Uzwc
w`‡Z n‡e| wkïi Z¡‡K-Z¡K-¯úk© cwiPh©v R‡b¥i ci †_‡K ïiæ Ki‡Z n‡e Ges AšÍZ 2 NÈv ch©šÍ Pvwj‡q †h‡Z n‡e|
D³ mg‡q †KejgvÎ Riæwi cÖ‡qvR‡b †hgb- IRb †bqv, cwi®‹vi Kiv, BZ¨vw` †ÿ‡Î wkï‡K wKQyÿ‡Yi Rb¨ Avjv`v
Kiv †h‡Z cv‡i|
l k¦vm cÖk¦vm jÿ¨ Kiv: wkï bxi‡e wbqwgZfv‡e k¦vm wb‡”Q wKbv ev Kvu`‡Q wKbv Zv jÿ¨ Ki‡Z n‡e| wkï hw` fvjfv‡e
k¦vm †bq, Z‡e wkïi bvox KvU‡Z n‡e|
l bvox evav I KvUv: wkïi R‡b¥i ci cÖ_g K‡qK wgwbU ch©šÍ wkïi kix‡i i³mÂvjb Ae¨vnZ _v‡K| †m Rb¨ AšÍZt
GK ‡_‡K wZb wgwbU ch©šÍ A‡cÿv Ki‡Z n‡e| Zvici bvox †eu‡a/Kø¨v¤ú K‡i KvU‡Z n‡e|
l bvox evav I KvUvi c×wZ: bvox‡Z wZbwU wMU w`‡Z n‡e| 1g wMU †cU †_‡K `yB Av½yj `~‡i, 2 wMU 1g wMU †_‡K GK
Av½yj `~‡i Ges bvox †P‡c i³ mwi‡q wb‡q 2q wM‡Ui 4 Av½yj `~‡i 3q wMU w`‡Z n‡e| RxevYygy³ KvuwP ev †eøW w`‡q
2q wMU †_‡K Av½yj `~‡i KvU‡Z n‡e Ges bvox‡Z 7.1 †K¬vi‡nw·wWb `ªeY jvMv‡Z n‡e
l ¯^vfvweK wkïi cwiPh©vi ci gv‡qi ey‡Ki `ya LvIqv‡bv ïiæ Ki‡Z n‡e, R‡b¥i 1 N›Uvi g‡a¨ `ya LvIqv‡bvi Rb¨ gvÕ‡K
cÖ‡qvRbxq mnvqZv w`‡Z n‡e| gvÕ‡K w¯‹b-Uz-w¯‹b †Kqvi Ae¨vnZ ivL‡Z ej‡Z n‡e| 15 wgwbU AšÍi wkïi k¦vm-cÖk¦vm
ch©‡eÿY Ki‡Z n‡e Ges wkïi R‡b¥i mgq I ZvwiL †iKW© Ki‡Z n‡e|

beRvZK †mev 47
 l ¯^vfvweK wkïi cwiPh©vi ci gv‡qi ey‡Ki `ya LvIqv‡bv ïiæ Ki‡Z n‡e, R‡b¥i 1 N›Uvi g‡a¨ `ya LvIqv‡bvi Rb¨ gvÕ‡K
cÖ‡qvRbxq mnvqZv w`‡Z n‡e| R‡b¥i ci ci Pvwn`v gvwdK ey‡Ki `ya LvIqv‡j beRvZ‡Ki DòZv eRvq _v‡K Ges
kvixwiK e„w× h_vh_ nq|

*15 wgwbU AšÍi wkïi k¦vm-cÖk¦vm ch©‡eÿY Ki‡Z n‡e Ges wkïi R‡b¥i mgq I ZvwiL †iKW© Ki‡Z n‡e|

beRvZ‡Ki †nwís †eweR weª` (†Mv‡ìb wgwbU)

†mKkb: 1

k¦vm wb‡Z cÖv_wgK mnvqZv w`‡Z wkï‡K gy‡Q ﮋ Kivi ci wkïwU hw` bv Kuv‡`: k¦vmbvwj cwi®‹vi Kiv I DÏxß Kiv wkï
hw` R‡b¥i ciciB bv Kvu‡` ev gy‡Q ﮋ Kivi ciI wkïwU hw` bv Kuv‡` Zvn‡j k¦vmbvwj cwi®‹vi Ki‡Z n‡e Ges wkï‡K
DÏxß Ki‡Z n‡e|

Dò ivLv :

wkï‡K Z¡‡K-Z¡K-¯úk© cwiPh©v w`‡Z n‡e| hw` m¤¢e bv nq Z‡e Zv‡K GKwU Dò Kvco w`‡q gy‡o gv‡qi cv‡k ïB‡q
ivL‡Z n‡e|

wkïi gv_vi Ae¯’vb wVK Kiv:

k¦vmbvwj †Lvjv ivLvi Rb¨ wkïi gv_v GKUy wcQ‡bi w`‡K †nwj‡q ai‡Z n‡e| Ae¯’vb mwVK n‡j k¦vmbvwj †Lvjv _vK‡e
Ges K…wÎg k¦vm †`qv mnR n‡e| gv_v hw` mvg‡bi w`‡K Szu‡K _v‡K ev †ewk wcQ‡bi w`‡K P‡j hvq Z‡e k¦vmbvwj‡Z
mnRfv‡e evZvm XzK‡e bv|

k¦vmbvwj cwi®‹vi Kiv :

†c½yBb mvKvi/evj¦ mvKvi w`‡q cÖ_‡g wkïi gyL I c‡i bvK cwi®‹vi Ki‡Z n‡e| wkï cÖ_g k¦vm †bqvi Av‡MB ev Kvbœvi
Av‡MB Zvi gyL †_‡K Rjxq wbtmi‡Yi (wmK‡ikb) †ewkifvM cwi®‹vi Ki‡Z n‡e|

k¦vm wb‡Z DÏxß Kiv:

wki`vuov eivei wkïi wcV `„pfv‡e K‡qKevi Nlv w`‡Z n‡e| k¦v‡mi Ae¯’v g~j¨vqb K‡i `ªæZ wbwðZ n‡Z n‡e †h K…wÎg
k¦vm cÖ‡qvRb wK bv| wkï‡K gy‡Q ïK‡bv Kiv, k¦vmbvwj cwi®‹vi Kiv Ges DÏxß Ki‡Z GK wgwb‡Ui (†Mv‡ìb wgwbU) Kg
mgq jvMv DwPZ|

48 beRvZK †mev
beRvZK †mev 49
 wkïi k¦vmbvwj cwi®‹vi Kiv I DÏxß Kivi ci wkïi Ae¯’v wbiƒcY Ki‡Z n‡e, wkïwU wK fv‡jvfv‡e k¦vm wb‡”Q?

†h wkïwU fv‡jvfv‡e k¦vm wb‡”Q, †m nq

- Kvu`‡e
A_ev
- bxi‡e wbqwgZ k¦vm wb‡e|

†h wkïwU fv‡jvfv‡e k¦vm wb‡”Q bv, †m nq

- M¨vmwcs k¦vm wb‡e (Kó K‡i GKwU j¤^v k¦vm wb‡q †ek wKQzÿY weiwZ w`‡e)
A_ev
- GK`gB k¦vm wb‡e bv|

wkï hw` fv‡jvfv‡e k¦vm †bq, Z‡e

l wkï‡K Dò ivL‡Z n‡e
l bvwo †eu‡a I †K‡U 7.1% †K¬vi‡nw•wWb jvMv‡Z n‡e Ges
l wkï‡K gv‡qi `ya LvIqv‡Z mnvqZv w`‡Z n‡e|

†mKkb: 2

g„Zz¨ Ges c½yZ¡ †iva Ki‡Z k¦vmbvwj cwi®‹vi I DÏxß Kivi ciI wkïwU hw` fv‡jvfv‡e k¦vm bv †bq: e¨vM-gv¯‹ Gi
mvnv‡h¨ K…wÎg k¦vm w`b|

k¦vmbvwj cwi®‹vi Kivi ci Ges wki`vuov eivei DÏxß Kivi ciI wkï hw` fv‡jvfv‡e k¦vm bv †bq Zvn‡j e¨vM-gv‡¯‹i
mvnv‡h¨ `ªæZ K…wÎg k¦vm †`qv ïiæ Ki‡Z n‡e| R‡b¥i 1 wgwb‡Ui g‡a¨ ev †Mv‡ìb wgwb‡U K…wÎg k¦vm †`qv ïiæ Ki‡Z n‡e|
Ab¨_vq wkïwU gviv †h‡Z cv‡i ev †eu‡P _vK‡jI gw¯Í‡®‹i gvivZ¥K ÿwZi Kvi‡Y fwel¨‡Z wkï c½y n‡q †h‡Z cv‡i|

wkï‡K k¦vm wb‡Z mnvqZv Kivi †ÿ‡Î e¨vM-gv‡¯‹i mvnv‡h¨ K…wÎg k¦vm †`qv me‡P‡q Kvh©Ki c×wZ| †h wkïwU M¨vmwcs
k¦vm wb‡”Q, e¨vM-gv‡¯‹i mvnv‡h¨ †Rv‡i †P‡c k¦vm w`‡Z cvi‡j Zvi dzmdzm cÖmvwiZ n‡e Ges cieZ©x‡Z †m wb‡R wb‡RI
k¦vm wb‡Z ïiæ Ki‡e|

K…wÎg k¦vm †`qvi avc:

Comprehensive Newborn Care Package Gi BDwbqb ch©v‡qi ¯^v¯’¨ †mev`vbKvix‡`i cÖwkÿYv_©x mnvwqKvi
Òe¨vM-gv¯‹ Gi mvnv‡h¨ K…wÎg k¦vm w`bÓ ‡mkvbwU -AbzmiY Kiæb|

50 beRvZK †mev
†mKkb : 3

wkï‡K k¦vm wb‡Z mvnvh¨ Ki‡Z e¨vM-gv‡¯‹i mvnv‡h¨ K…wÎg k¦vm †`evi GK wgwbU ciI hw` fv‡jvfv‡e k¦vm bv †bq : K…wÎg
k¦vm †Rvi`vi Kiæb|

K…wÎg k¦vm 1 wgwbU †`qvi ciI hw` wkïwU k¦vm wb‡Z ïiæ bv K‡i, Z‡e K…wÎg k¦vm †Rvi`vi Ki‡Z n‡e Ges mvnv‡h¨i
Rb¨ WvK‡Z n‡e| cÖwZevi K…wÎg k¦vm †`qvi mgq wkïi eyK ¯^vfvweK k¦vm-cÖk¦v‡mi gZ DVvbvgv Ki‡Q wK bv jÿ Ki‡Z
n‡e| hw` eyK G‡Kev‡iB DVvbvgv bv K‡i ev fv‡jvfv‡e DVvbvgv bv K‡i, Zvn‡j K…wÎg k¦vm †Rvi`vi Ki‡Z cÖ‡qvRbxq
c`‡ÿc MÖnY Ki‡Z n‡e|

K…wÎg k¦vm †Rvi`vi Ki‡Z cÖ‡qvRbxq c`‡ÿc:

Comprehensive Newborn Care Package Gi BDwbqb ch©v‡qi ¯^v¯’¨ †mev`vbKvix‡`i cÖwkÿYv_©x mnvwqKvi
ÒK…wÎg k¦vm †Rvi`vi KiæbÓ ‡mkvbwU -AbzmiY Kiæb|

†mKkb: 4

K…wÎg k¦vm †Rvi`vi Kivi ciI hw` wkïwU fv‡jvfv‡e k¦vm bv †bq, ür¯ú›`b wbiƒcY Kiæb : K…wÎg k¦vm KZÿY Pvjv‡Z
n‡e Ges D”PZi †mev‡K‡›`ª †idvi Kivi wm×všÍ wb‡Z|

K…wÎg k¦vm †Rvi`vi Kivi 1 wgwbU ciI hw` wkï fv‡jvfv‡e k¦vm wb‡Z ïiæ bv K‡i Z‡e ür¯ú›`b wbiƒcY Ki‡Z n‡e|
l ür¯ú›`b ¯^vfvweK: wgwb‡U 100 ev Zvi †ewk
l ür¯ú›`b axi MwZi: wgwb‡U 100 Gi Kg|

†h wkïi ür¯ú›`b ¯^vfvweK wKš‘ fv‡jvfv‡e k¦vm wb‡”Q bv, Zvi K…wÎg k¦vm Pvwj‡q †h‡Z n‡e| wkïwU fv‡jvfv‡e k¦vm †bqv
ïiæ Ki‡j Ges ür¯ú›`b ¯^vfvweK n‡j K…wÎg k¦vm †`qv eÜ K‡i w`‡Z n‡e|

wkïwU fv‡jvfv‡e k¦vm wb‡j - wkï‡K gv‡qi Z¡‡K-Z¡‡K-¯ú‡k© ivL‡Z n‡e hv‡Z wkï Dò _v‡K Ges ch©‡eÿY Ki‡Z n‡e|
wkïi k¦vm cÖk¦vm, ür¯ú›`b, ZvcgvÎv Ges Z¡‡Ki is Ges gv‡qi `ya LvIqv ch©‡eÿY Ki‡Z n‡e|

hw` wkïwU 3-5 wgwbU K…wÎg k¦vm †`qvi ciI fv‡jvfv‡e k¦vm bv †bq, K…wÎg k¦vm Pvjy †i‡L Ges D”PZi †mev‡K‡›`ª †idvi
Ki‡Z n‡e

beRvZK †mev 51
 beRvZ‡Ki kvixwiK cixÿv
R‡b¥i 90 wgwb‡Ui g‡a¨ wkï‡K c~Y©v½ kvixwiK cixÿv Ki‡Z n‡e| wkïi kvixwiK cixÿvi †ÿ‡Î k¦vm-cÖk¦vm, n«`¯ú›`b,
ZvcgvÎv, bvfx, nvZ-cv bovPov, `ya LvIqv, BZ¨vw` †`L‡Z n‡e|

GKwU my¯’ ¯^vfvweK wkïi jÿY n‡jv

l wgwb‡U 30-59 evi k¦vm wb‡e
l ¯^vfvweK ZvcgvÎv 36.50 - 37.50 †m. (97.70 - 99.50 dv.) nvZ, cv, †cU ¯úk© K‡i wkïi kixi Dò bv VvÛv Abyfe
Kiv
l wkïi IRb (2500 MÖvg n‡Z 4000 MÖv‡g Kg)
l mn‡RB RvMv‡bv m¤¢e
l n«`¯ú›`b wgwb‡U 100-160 evi
l ¯^vfvweK ¯^‡i Kvu`‡e, `~e©j ev KK©k ¯^‡i bq
l RvMÖZ Ae¯’vq nvZ-cv Dfq cv‡k mvgÄm¨c~Y©fv‡e bovPov Ki‡e
l wkïi nvZ Ges cv cy‡ivcywi †mvRv _vK‡e bv, KbyB Ges nvUz‡Z †KŠwbK Ae¯’v eRvq ivL‡eb| gvsk‡ckxi †Uvb
¯^vfvweK, UvbUvb ev wkw_j bq
l Z¡‡Ki is †Mvjvcx, Z‡e R‡b¥i K‡qK N›Uv ch©šÍ nvZ/cv bxjeb© _vK‡Z cv‡i| k¨vgjv ev Mvp e‡Y©i wkï‡`i Z¡‡Ki
is †evSv KwVb Z‡e, Z¡‡Ki is wbwe©‡k‡l cÖwZwU wkïi gy‡Li wfZiUv †Mvjvcx eY© _v‡K
l bvwf ïKbv, bvwf‡Z i³ ev Ab¨ †Kvb cÖKvi ÿYY bvB
l gv‡qi `ya Pz‡l †L‡Z mÿg
*kvixwiK cixÿvq cÖvß Z_¨ ev djvdj ¯^vfvweK _vK‡jI Zv †iKW© Ki‡Z n‡e

Rb¥ cieZ©x wkïi †kªYxwefvM

Rb¥ cieZ©x wkïi †kªYxwefvM n‡jv: ¯^vfvweK mz¯’ wkï, wKQz mgm¨v Av‡Q I wkïi wec` wPý Av‡Q

¯^vfvweK mz¯’ wkï:

l wbi‡e wbqwgZfv‡e wgwb‡U 30-59 evi k¦vm ‡bq
l ZvcgvÎv 97.70 - 99.50 dv. (36.50 - 37.50 †m.)
l Rb¥ IRb 2500 MÖv‡gi †ekx wKš‘ 4000 MÖv‡gi Kg
l gv‡qi `ya fvjfv‡e †L‡Z cv‡i
l Ab¨ ‡Kvb mgm¨v bvB

wKQz mgm¨v Av‡Q:

l ZvcgvÎv 35.50 - <36.50 †m.(95.90 - <97.70 dv.)
l Rb¥ IRb 2000 MÖv‡gi Kg
l fvjfv‡e gv‡qi ¯Íb Py‡l `ya †L‡Z cv‡i bv

wkïi wec` wPý Av‡Q:

l †h †Kvb GKwU wec` wPý/jÿY _v‡K-
u wkïi ZvcgvÎv 36.50 †m./97.70 dv. Gi Kg Ges hw` we‡kl e¨e¯’v MÖnY K‡iI ZvcgvÎv e„w× Kiv bv hvq

Zvn‡j Zv wkïwUi wec` wPý

u wkïi ZvcgvÎv 37.50 †m./99.50 dv. Gi †ekx Avi Zv hw` cvwicvwk¦©K DòZv †hgb; mivmwi m~‡h©i Av‡jv ev

AwZwi³ Kvco Rov‡bvi Kvi‡Y bv n‡q _v‡K Zvn‡j †mUvI wec` wPý| G Ae¯’vq wkï‡K `ªæZ D”PZi
†mev‡K‡›`ª †idvi Ki‡Z n‡e|
l gvivZ¥K RwÛm
l 1500 MÖv‡gi Kg IRb

52 beRvZK †mev
my¯’ wkïi AZ¨vek¨Kxq cwiPh©v
l Z¡‡K-Z¡K-¯úk© cwiPh©v Ae¨vnZ ivLv
l msµgY cÖwZ‡iv‡a beRvZ‡Ki bvwfi hZœ
l ¯^vfvweK wkïi cwiPh©vi ci gv‡qi ey‡Ki `ya LvIqv‡bv ïiæ Ki‡Z n‡e, R‡b¥i 1 N›Uvi g‡a¨ `ya LvIqv‡bvi Rb¨ gvÕ‡K
cÖ‡qvRbxq mnvqZv w`‡Z n‡e|
l 15 wgwbU AšÍi wkïi k¦vm-cÖk¦vm ch©‡eÿY Ki‡Z n‡e Ges wkïi R‡b¥i mgq I ZvwiL †iKW© Ki‡Z n‡e|
l kvwiixK cix¶v, ZvcgvÎv I IRb wbY©q
l ¯^vfvweK ZvcgvÎv 36.50 - 37.50 †m. (97.70 - 99.50 dv.) eRvq ivLv| 72 NÈvi g‡a¨ †Mvmj bv Kiv‡Z gv-evev‡K
civgk© †`qv, KviY G‡Z beRvZ‡Ki kix‡ii ZvcgvÎv gvivZ¥Kfv‡e K‡g (nvB‡cv_viwgqv) †h‡Z cv‡i
l beRvZ‡Ki wec` wPý Av‡Q wKbv -Zv ch©‡eÿY Ki‡Z n‡e
l nvmcvZvj ‡_‡K QvocÎ cÖ`v‡bi c~‡e© gv-evev‡K evox‡Z wkïi cwiPh©v wel‡q Z_¨ w`‡Z n‡e

msµgY cÖwZ‡iv‡a Ki‡Z bvwfi cwiPh©v

wkïi m`¨ KvUv bvwo wkïi kix‡i RxevYy cÖ‡ek Kivi GKwU mnR c_|
wkï‡K aivi Av‡M nvZ †avqv Ges bvwoi mwVK hZœ msµgY cÖwZ‡iv‡a
mnvqK|

bvwo KvUvi ci ïaygvÎ GKevi 7.1% †K¬vi‡nw·wWb cÖ‡qvM Ki‡Z n‡e

Ges cieZx©‡Z ky®‹ ivL‡Z n‡e| 7.1% †K¬vi‡nw·wWb n‡”Q
WvBMøy‡Kv‡bU Gw›U‡mwÞK `ªeY | †K¬vi‡nw·wWb jvMv‡bvi ci †KvbI
e¨v‡ÛR †`qv hv‡e bv| bvwf‡Z cvqLvbv, cÖkÖve †j‡M †M‡j cwi®‹vi
cvwb w`‡q ay‡q cwi®‹vi Kvco w`‡q kzwK‡q wb‡Z n‡e| bvwf †_‡K i³ÿiY n‡j gy‡Q 1g wMu‡Ui Av‡M Av‡iKwU wMuU w`‡Z
n‡e|

†K¬vi‡nw•wWb e¨envi Gi mgqmxgv

bvwo KvUvi ciciB 7.1% †K¬vi‡nw·wWb KvUv bvwo‡Z e¨envi Ki‡Z n‡e| hw` Zv m¤¢e bv nq, Z‡e hZ `ªæZ m¤¢e Aek¨B
R‡b¥i 48 NÈvi g‡a¨ Zv e¨envi Ki‡Z n‡e|

beRvZ‡Ki bvwfi h‡Zœ †mev`vbKvixi f~wgKv

l R‡b¥i 24 NÈvi g‡a¨ ¯^v¯’¨ †mev`vbKvix cÖme cieZ©x †mev cÖ`v‡bi mgq wRÁvmv Ki‡eb beRvZ‡Ki bvwo‡Z 7.1%
†K¬vi‡nw·wWb †`qv n‡q‡Q wK bv| hw` bv †`qv n‡q _v‡K Z‡e Aek¨B R‡b¥i 48 NÈvi g‡a¨ 7.1% †K¬vi‡nw·wWb
beRvZ‡Ki bvwo‡Z w`‡Z n‡e|
l beRvZ‡Ki R‡b¥i cici KvUv bvwo‡Z 7.1% †K¬vi‡nw·wW‡bi e¨envi Gi ¸iæZ¡ m¤c‡K© gv I cwiev‡ii m`m¨‡`i
cÖmec~e© cwi`k©‡bi mgq cÖ‡qvRbxq KvD‡Ýwjs Ki‡eb|

gv‡qi `ya LvIqv‡Z mnvqZv

wkï‡K mdjfv‡e ey‡Ki `ya LvIqv‡bvi †ÿ‡Î mwVK KvD‡Ýwjs I Kvh©Ki mnvqZv LyeB ¸iæZ¡c~Y©| ‡h wkïwU Lvevi Rb¨
cÖ¯‘Z †m gv_v mvgvb¨ wcQ‡b †nwj‡q †PvL Nywi‡q ZvKv‡e, gyL nv Ki‡e, wRnŸv wb‡Pi w`‡K †ei Ki‡e Ges Av½yj PvU‡e|
Gme jÿY ev wPý †`L‡j eyS‡Z n‡e wkï LvIqvi Rb¨ cÖ¯‘Z| Zv‡K `ya LvIqv‡bvi Rb¨ mwVK Ae¯’v‡b wVK K‡i ai‡Z
n‡e|

beRvZK †mev 53
 wkï‡K ey‡Ki `ya LvIqv‡bvi mgq mwVK Ae¯’vb ej‡Z gv I wkïi kixi †h Avivg`vqK Ae¯’vq Av‡Q Zv eySvq| gv hw`
wkï‡K mwVKfv‡e (mshyw³/Attachment) a‡ib Z‡eB wkï gv‡qi ¯Í‡b wVKfv‡e †j‡M _vK‡Z cv‡i| KviY wkï gv‡qi
¯Í‡b wVKfv‡e †j‡M _vK‡j ‡m gv‡qi `ya mn‡RB Pzl‡Z cvi‡e I h‡_ó cwigvY `ya †U‡b †L‡Z cvi‡e| G‡Z gv‡qi h‡_ó
cwigvY `ya ˆZwi n‡e| mshyw³ wVK bv n‡j wkï mn‡RB `ya †U‡b ‡L‡Z cvi‡e bv Ges gv‡qi wewfbœ ai‡bi mgm¨v †hgb,
¯Í‡bi †evUv †du‡U hvIqv, ¯Íb dz‡j hvIqv BZ¨vw` †`Lv w`‡e|

fvj mshyw³i †ÿ‡Î

- wkïi gyL eo K‡i nv Ki‡e, wRnŸv wb‡Pi w`‡K †ei Ki‡e, Av½yj PvU‡e
- wkïi wb‡Pi †VvU evB‡ii w`‡K Dëv‡bv _vK‡e
- gv‡qi GwiIjv wkïi gy‡Li Dc‡ii w`‡K †ekx `„k¨gvb
- wkïi wPeyK ¯Íb ¯úk© Ki‡e

mwVK Ae¯’vb (Positioning): wkïi mwVK Ae¯’vb gvÕ‡qi ¯Í‡b wkï‡K fvjfv‡e mshyw³i Rb¨ LyeB Riæix| NygšÍ
Ae¯’vq gv wkï‡K ey‡Ki `ya cvb Kiv‡eb bv| †h †Kvb Avivg`vqK Ae¯’vq gv wkï‡K ey‡Ki `ya cvb Kiv‡Z cv‡ib| `ya
LvIqv‡bvi mgq wkïi gyL gv‡qi ¯Í‡bi Kv‡Q wb‡q Avm‡Z n‡e| gv wkïi w`‡K SzuK‡eb bv| wkïi gv_v gv‡qi KbyB‡q Ges
wkïi wbZ¤^ gv‡qi nv‡Zi Zvjy‡Z _vK‡e| wkïi gv_v, wcV I wbZ¤^ GKB †iLvq _vK‡e| `ya LvIqv‡bvi mgq gv Bs‡iwR
Aÿi ÔCÕ Gi gZ K‡i Zvi ¯Íb ai‡eb| Zvi PviwU Av½yj (ZR©wb †_‡K Kwbô ch©šÍ) Av½yj ¯Í‡bi wb‡P Ges e„×v½ywj ¯Í‡bi
Dc‡i _vK‡e| ¯Í‡bi †evuUvi KvQvKvwQ †Kvb Av½yj ivLv hv‡e bv|

`ya LvIqv‡Z mgm¨v

wkïi R‡b¥i cÖ_g GK †_‡K `yB mßv‡ni g‡a¨ cÖvqkB gvÕ‡qi ¯Í‡bi mgm¨v n‡q _v‡K hv mdjfv‡e gv‡qi `ya LvIqv‡bvi
GKwU cÖavb AšÍivq

P¨vÞv/Dëv‡bv †evuUv: G‡ÿ‡Î wkï‡K ¯Í‡b jvMv‡bvi Av‡M Av½yj w`‡q Avj‡Zvfv‡e N‡l †evuUv DÏxß Ki‡Z n‡e ev ¯Í‡bi
AMÖfvM ‡Mvj K‡i †evuUvi gZ evwb‡q wkï‡K ¯Í‡b mshy³ Ki‡Z n‡e|

‡dvjv ¯Íb: ‡dvjv-¯Íb n‡j Dfq cv‡ki ¯Íb A¯^vfvweK dz‡j `„p n‡q hvq I Z¡K PKPK K‡i| G‡ÿ‡Î wkï‡K evievi
LvIqv‡Z n‡e A_ev LvIqv‡bvi c~‡e© wKQz cwigvb `ya †M‡j †ei K‡i †dj‡Z n‡e|

†d‡U hvIqv ¯Í‡bi †evuUv: fvj mshy³ bv _vK‡j ev RxevYy msµgY n‡j GgbUv n‡Z cv‡i| G‡ÿ‡Î wkï‡K ¯Í‡b fvjfv‡e
mshy³ K‡i LvIqv‡Z n‡e| GKB mv‡_ †dvjv ¯Íb _vK‡j ZviI e¨e¯’vcbv w`‡Z n‡e| ¯Í‡bi †evuUvq mvevb, †gwW‡K‡UW
†jvkb ev gjg jvMv‡Z wb‡la Ki‡Z n‡e| gv‡qi ey‡Ki `y‡ai wcQ‡bi fv‡Mi `ya (Hind Milk) ‡M‡j †evuUvq cÖ‡jc
w`‡Z n‡e|

¯Í‡bi cÖ`vn/g¨v÷vBwUm: `y»bvjx eÜ n‡q †M‡j ev RxevYy msµg‡Yi Kvi‡Y ¯Í‡bi cÖ`vn ev g¨v÷vBwUm nq| AvµvšÍ Ask
dz‡j k³ Ges jvj‡P n‡q hvq, ¯Í‡b e¨v_v nq| gvÕ‡qi R¡i _vK‡Z cv‡i| `y‡ai cÖevn evwo‡q eÜ n‡q hvIqv bvwj Lyj‡Z,
wkï‡K evi evi `ya LvIqv‡Z n‡e ev wKQz cwigvb `ya †M‡j †ei K‡i †dj‡Z n‡e|

54 beRvZK †mev
evox‡Z †mev Pvwj‡q †h‡Z gv evev‡K civgk©

QvocÎ cÖ`v‡bi c~‡e© gv-evev‡K evox‡Z wkïi cwiPh©v wel‡q Z_¨ w`‡Z n‡e| wb‡Pi g~jevZ©v¸‡jv eywS‡q ej‡Z n‡e|
l ïaygvÎ gv‡qi `ya LvIqv‡bv: R‡b¥i c‡i Qq gvm ch©šÍ gv‡qi `ya LvIqv‡Z n‡e Ges wkï ch©vß `ya cv‡”Q wK bv gv Zv
wKfv‡e wbiæcY Ki‡eb †m m¤ú‡K© aviYv w`‡Z n‡e| †hgb: 24 N›Uvq 8-12 evi `ya LvIqv, `ya LvIqvi ci kvšÍfv‡e
Nygv‡bv BZ¨vw`|
l wkï‡K Dò ivLv: Kg IR‡bi wkï‡`i mwVK ZvcgvÎv eRvq ivL‡Z n‡e| kvixwiKfv‡e w¯’wZkxj wkï hv‡`i Rb¥ IRb
2000 MÖv‡gi Kg Zv‡`i wbw`©ó nvmcvZv‡j ev ¯^v¯’¨‡K‡›`ª ÔK¨v½viæ gv`vi †KqviÕ (KMC) Gi civgk© †`qv I †idvi
Kiv
l wkïi wec` wPý: wkïi wec`wPý mg~n wK wK Ges Riæix cwiw¯’wZ‡Z wK e¨e¯’v wb‡Z n‡e I †Kv_vq †idvi Ki‡Z n‡e
l bvfxi hZœ: bvwo KvUvi ci ïaygvÎ GKevi 7.1% †K¬vi‡nw•wWb cÖ‡qvM Ki‡Z n‡e Ges cieZx©‡Z bvwo ky®‹ ivL‡Z
n‡e| bvfx‡Z †Kvb wKPz bv jvMv‡bv |
l e¨w³MZ cwi”QbœZv: wkï‡K cÖwZevi aivi c~‡e© nvZ ay‡Z n‡e I AwZwi³ `k©bv_©x †_‡K wkï‡K `~‡i ivL‡Z n‡e
l ¯Í‡bi mvaviY mgm¨v: ¯Í‡bi mgm¨v †hgb-†dvjv ¯Íb, ¯Í‡bi †evuUv P¨vÞv ev †d‡U hvIqv ‡evuUv, g¨v÷vBwUm, BZ¨vw`
mgm¨v wKfv‡e wbiæcY Ki‡e I wK e¨e¯’v MÖnY Ki‡Z n‡e|
l wkïi wUKv: wUKv cÖ`v‡bi ¸iæZ¡ I mgqm~Px m¤ú‡K© Z_¨ †`qv | wkïi R‡b¥i ciciB h²vi wUKv (wewmwR) I †cvwjI
†iv‡Mi wUKv (Iwcwf) w`‡Z n‡e| wkïi eqm †`o gvm (45 w`b) c~Y© n‡j wUKv`vb †K›`ª †_‡K Aewkó wUKv¸‡jv ïiæ
Kivi Rb¨ gvÕ‡K civgk© w`‡Z n‡e Ges m¤¢ve¨ cvk©¦cÖwZwµqv I cÖ‡qvRbxq e¨e¯’vcbv m¤ú©‡K Z_¨ w`‡Z n‡e|
l cÖme cieZ©x mvÿvZ: wbw`©ó mgqm~Px Abyhvqx cieZ©x mvÿv‡Zi ZvwiL m¤ú‡K© ejv Ges Rb¥ wbe܇bi Rb¨ gv-evev‡K
civgk© †`qv|

¯^vfvweK ZvcgvÎv eRvq ivLv

beRvZ‡Ki ¯^vfvweK ZvcgvÎv 36.50 - 37.50 †m. (97.70 - 99.50dv.) | wkïi ZvcgvÎv ¯^vfvwe‡Ki †P‡q wKQzUv K‡g
(35.50 †m.-36.50 †m./95.90 dv.-97.70 dv.) †M‡j wbwðZ n‡Z n‡e †h K‡¶i ZvcgvÎv AšÍZt 250†m. Av‡Q wKbv Ges
K‡¶i g‡a¨ cÖengvb evZvm †bB| wkïwU ﮋ Av‡Q Zv c_Ö‡gB wbwðZ Ki‡Z n‡e| wkïwU hw` gv‡qi Z¡‡Ki ms¯ú‡k© bv
_v‡K Z‡e Zv‡K Dò Kvc‡o fvjfv‡e Rwo‡q ivLv n‡q‡Q wKbv ev gv_v XvKv i‡q‡Q wKbv Zv †Lqvj Ki‡Z n‡e|

wkïi ZvcgvÎv 35.50 †m./95.90 dv. Gi Kg _vK‡j Z¡‡K-Z¡K-¯úk© cwiPh©v (w¯‹b-Uz-w¯‹b †Kqvi) cyYivq Pvjy K‡i Zv
Ae¨vnZ ivL‡Z n‡e| gv I wkï Dfq‡K Av‡iKwU K¤^j/Pv`i w`‡q †X‡K w`‡Z n‡e| ¯^vfvweK bv nIqv ch©šÍ cÖwZ N›Uvq
GKevi wkïi ZvcgvÎv gvc‡Z n‡e| cyYivq Dò Kivi mgq wkï‡K evievi gv‡qi `ya LvIqv‡Z n‡e|

D³ e¨e¯’v mg~n MÖn‡Yi 4 N›Uvi g‡a¨ cÖvq cÖwZwU wkïi ZvcgvÎv ¯^vfvweK n‡q Av‡m| GgZve¯’vq 1 N›Uvi g‡a¨ wkïi
ZvcgvÎv hw` GKUzI bv ev‡o Zvn‡j a‡i wb‡Z n‡e †h, wkïwUi wec` wPý Av‡Q| G‡ÿ‡Î Z¡‡K-Z¡K-¯úk© cwiPh©v
(w¯‹b-Uz-w¯‹b †Kqvi) Ae¨vnZ ivL‡Z n‡e Ges wkï‡K `ªæZ Dc‡Rjv ¯^v¯’¨‡K‡›`ª †idvi Ki‡Z n‡e|

ZvcgvÎv 37.50†m./99.50dv. Gi Dci D‡V hvIqv wkïi R‡b¨ wec`RbK| hw` wkïi ZvcgvÎv 37.50†m./99.50dv. Gi
†ekx n‡q hvq, hv cvwicvwk¦©K DòZvi Kvi‡Y N‡U wb ev Zv‡ci Drm mwi‡q †bqvi ciI hw` wkïi ZvcgvÎv ¯^vfvweK bv
nq, Zvn‡j a‡i wb‡Z n‡e †h, wkïwUi wec` wPý Av‡Q| G‡ÿ‡Î wkï‡K `ªæZ Dc‡Rjv ¯^v¯’¨‡K‡›`ª †idvi Ki‡Z n‡e|

beRvZK †mev 55
 beRvZ‡Ki wec` wPý Ges e¨e¯’vcbv

R‡b¥i cÖ_g 28 w`b ch©šÍ beRvZ‡Ki †h †Kvb kvixwiK mgm¨v ev Amy¯’Zvi gvivZœK DcmM©‡KB wec` wPý eySvq|

beRvZ‡Ki wec` wPýmg~n

l gv‡qi `ya †L‡Z bv cviv ev bv †Pvlv
l wLuPzbx
l kvšÍ Ae¯’vq `ªæZ k¦vm (wgwb‡U 60 evi A_ev Zvi †P‡q †ewk)
l ey‡Ki LvuPvi wb‡Pi Ask gvivZœKfv‡e †`‡e hvIqv
l kix‡ii ZvcgvÎv †e‡o hvIqv ev R¡i (37.50‡m. ev 99.50dv. ev Zvi †ekx ZvcgvÎv)
l kix‡ii ZvcgvÎv K‡g hvIqv (35.50‡m. ev 95.90dv. Gi Kg)
l ‡bwZ‡q cov ev ¯^vfvwe‡Ki †P‡q Kg bovPov Kiv (DÏxß Kiv e¨ZxZ wkï bovPov K‡i bv A_ev G‡Kev‡iB bovPov
K‡i bv)
l bvfx cvKv

*Dc‡iv³ †h †Kvb wec` wPý †`Lv w`‡jB h_vh_ e¨e¯’vcbvi Rb¨ wbKU¯’ Dc‡Rjv ¯^v¯’¨‡K‡›`ª/m`i nvmcvZv‡j †idvi
Ki‡Z n‡e|

56 beRvZK †mev
0-59 w`b eqmx wkïi msµgY mbv³KiY Ges e¨e¯’vcbv
BD. Gb. AvB. wR. Gg. B. di PvBì, 2015 Abzmv‡i evsjv‡`‡k 21 % beRvZ‡Ki g„Z¨y N‡U msµgY ev †mcwm‡mi
Kvi‡Y | IMCI-N KY©vi I BDwbqb ch©v‡qi ¯^v¯’¨‡mev †K‡›`ª 0 - 59 w`‡bi Amy¯’ wkïi msµgY e¨e¯’vcbvi gva¨‡g
beRvZ‡Ki g„Z~¨i nvi Kwg‡q Avbv m¤fe|

BDwbqb ¯^v¯’¨ I cwievi Kj¨vY ‡K‡›`ª 0-59 w`b eqmx wkïi msµg‡Yi jÿY, †kÖYxwefvM, e¨e¯’vcbv I d‡jvAvc

msµg‡Yi
jÿY †kÖYxwefvM wPwKrmv e¨e¯’vcbv d‡jvAvc
q A‡PZb ev GK`g bovPov bv Kiv q Lye gvivZ¥K cÖ_g †WvR cÖ`vb I †idvi
q wLuPybx ev wLPyubxi BwZnvm †ivM-m¼Uvcbœ Amy¯’Zv
q GK`g ‡L‡Z bv cviv q Bb‡RKkb †R›UvgvBwmb
q wkïi kix‡ii we‡kl Ask bxj eY© q Ggw·wmwjb Wªc
aviY
q ¸iæZi i³cvZ nIqv
q Ny‡gi g‡a¨ 20 †m‡KÛ ev †ewk
mg‡qi Rb¨ k¦vm eÜ nIqv
q Rb¥ IRb 1500 MÖv‡gi Kg
q gv_vi Zvjy ùxZ
q ¸iæZi Rb¥MZ weKjv½Zv
q AwaK i³cvZ/mvwR©K¨vj KwÛk‡bi
Rb¨ nvmcvZv‡j fwZ cÖ‡qvRb
q ey‡Ki bx‡Pi Ask gvivZ¥K fv‡e q Lye gvivZ¥K †ivM- cÖ_g †WvR cÖ`vb I †idvi q wØZxq †WvR
†`‡e hvIqv m¤¢ve¨ gvivZ¥K q Bb‡RKkb †R›UvgvBwmb cÖ`vb
q wb¤œ ZvcgvÎv e¨vK‡Uwiqvj msµgY q PZz_© w`b
(ZvcgvÎv 95.90 dvt/ 35.50 ‡mt q Ggw·mwjb Wªc
d‡jvAvc
Gi Kg) hw` cwievi †ivMx‡K †idvi Ki‡Z bv
q D”P ZvcgvÎv ev R¡i Pvq, Zvn‡j- q 8g w`b
(100.40 dvt / 38.00 ‡mt Gi d‡jvAvc
q Bb‡RKkb †R›UvgvBwmb
†ewk)
(w`‡b 1 evi 2 w`b)
q ‡bwZ‡q cov ev ¯^vfvwe‡Ki †P‡q
Kg bovPov Kiv q Ggw·wmwjb Wªc
q wVKg‡Zv ‡L‡Z bv cviv (w`‡b 2 evi 7 w`b)
0-6 w`‡bi wkït q Lye gvivZ¥K †ivM-`ªæZ cÖ_g †WvR cÖ`vb I †idvi q PZz_© w`b
q `ªæZ k¦vm (wgwb‡U 60 ev Zvi †ekx) k¦vm wbD‡gvwbqv q Ggw·wmwjb Wªc d‡jvAvc

hw` cwievi †ivMx‡K †idvi Ki‡Z bv q 8g w`b

Pvq, Zvn‡j- d‡jvAvc
q Ggw·wmwjb Wªc
(w`‡b 2 evi 7 w`b)
7-59 w`‡bi wkït q `ªæZ k¦vm wbD‡gvwbqv wPwKrmv cÖ`vb: q PZz_© w`b
q `ªæZ k¦vm (wgwb‡U 60 ev Zvi †ekx) d‡jvAvc
q Ggw·wmwjb Wªc
(w`‡b 2 evi 7 w`b) q 8g w`b
d‡jvAvc
q bvfxi Pvicv‡k jvj ev bvfx †_‡K q ¯’vbxq mxwgZ msµgY wPwKrmv cÖ`vb:
cyuR cov q Ggw·wmwjb Wªc
q Z¡‡K cyuRewU (w`‡b 2 evi 5 w`b)

beRvZK †mev 57
58 beRvZK †mev
 †mKkb 4t
cÖme-cieZ©x †mev

cÖme-cieZ©x †mev 59
60 cÖme-cieZ©x †mev
 cÖme cieZ©x †mev
cÖm‡ei 1NÈv ci †_‡K 6 mßvn ch©šÍ gv Ges beRvZK wkïi hZœ †bqv‡K cÖme-cieZ©x †mev ejv nq| kZKiv Qvàvbœ fvM
gvZ…g„Zy¨ cÖm‡ei 24 NÈvi g‡a¨ n‡q _v‡K, G †_‡K eySv hvq, gvZ…g„Zz¨ Kwg‡q Avb‡Z `ªæZ cÖme-cieZ©x †mevi ¸iæZ¡
KZLvwb|

K. cÖme-cieZ©x †mevi D‡Ïk¨

l cÖme-cieZ©x mg‡q wPwKrmv, A‡¯¿vcPvi A_ev cÖme msµvšÍ RwUjZv¸‡jv cÖwZ‡iva A_ev mbv³ K‡i e¨e¯’v MÖnY
l bZzb GKwU cwievi KvVv‡gv MV‡b gv I Zv‡`i cwievi¸‡jv‡K mnvqZv cÖ`vb
l wec`wPý, cywó, wekªvg Ges e¨w³MZ ¯^v¯’¨wewa m¤ú‡K© wkÿv`vb Ges cÖ‡qvRb‡ev‡a gvB‡µvwbDwUª‡q›U¸‡jv
mieiv‡ni gva¨‡g gv I wkïi kvixwiK, gvbwmK, mvgvwRK Kj¨vY e„w× I eRvq ivLv
l cÖme-cieZ©x mg‡q †QvU Ges eo mgm¨v¸‡jv Ges Zv‡`i wPwKrmv m¤ú‡K© civgk© `vb
l gv‡K wU wU wUKv`vb (hw` 5wU †WvR c~iY bv nq †m †ÿ‡Î mgqm~wP Abyhvqx Pvwj‡q †h‡Z n‡e)
l RwUjZvi cÖ¯‘wZi Rb¨ gv, Zv‡`i cwievi Ges Zv‡`i mgv‡Ri gvbyl‡`i mv‡_ cwiKíbv Ki‡Z n‡e
l cwievi cwiKíbv c×wZmgyn m¤ú‡K© gv‡K Z_¨ w`‡Z n‡e hv‡Z wZwb †R‡b ey‡S evQvB Ki‡Z cv‡ib

L. cÖme-cieZ©x †mevi mgqm~wP

wPwKrmv‡K‡›`ª cÖm‡ei ci M„‡n cÖm‡ei ci

1g wfwRU: 2-3w`‡bi g‡a¨ 1g wfwRU: 24N›Uvi g‡a¨
2q wfwRU:7-14 w`‡bi g‡a¨ 2q wfwRU:2-3w`‡bi g‡a¨
3q wfwRU: 6ô mßv‡n 3q wfwRU:7-14 w`‡bi g‡a¨
4_© wfwRU: 6ô mßv‡n

M. cÖme-cieZ©x mg‡q gv Ges beRvZ‡Ki †mevi Dcv`vbmg~n

cÖme cieZ©x mg‡q gv Ges beRvZ‡Ki †mevi Dcv`vbmg~n wb¤œiƒc:
l Rb¥wbeÜb
l cÖme cieZ©x mg‡q gv‡qi hZœ
l cÖme cieZ©x cwievi cwiKíbv
l beRvZ‡Ki hZœ
l gv I beRvZ‡Ki RwUjZv¸‡jv Luy‡R †ei Kiv
l `iKvi n‡j, h_vh_ wPwKrmv cÖ`vb A_ev RwUjZv¸‡jvi cÖv_wgK wPwKrmv w`‡q †idvi Kiv
l gv‡K Avqib Ges wfUvwgb G cÖ`vb
l beRvZ‡Ki wUKv`vb
l ev”Pvi IRb cwigvc
l cwievi I e¨w³¯Í‡i AvšÍte¨w³MZ civgk©
- Acwinvh© beRvZK †mev
- cÖme cieZ©x gv‡qi hZœ
- ¯Íb¨`vb Ges m¤ú~iK Lv`¨
- gv‡qi cywó, wekÖvg, PjvPj, fvix KvR Gwo‡q Pjv
- cÖme cieZ©x gv‡qi wec`wPýmg~n
- beRvZ‡Ki wec`wPý mg~n
- wkïi wUKv`vb

N. Z_¨, wkÿv, †hvMv‡hvM Ges civgk© cÖ`vb

- †gŠwjK ¯^v¯’¨wewa Ges cywó m¤ú‡K© civgk©
- gv I Zvi cwievi wK †Lqvj ivL‡Z n‡e Ges KLb †mevi Rb¨ †h‡Z n‡e Zv Rv‡b wK bv wbwðZ nDb
- ZvrÿwYK Ges GKKfv‡e wkï‡K ey‡Ki `ya cvb Kiv‡bvi ¸iæZ¡ m¤ú‡K© civgk© w`b

cÖme-cieZ©x †mev 61
 - Rb¥ e¨eavb/weiwZ Ges cwievi cwiKíbvi ¸iæZ¡ m¤ú‡K© KvD‡Ýwjs Kiæb Ges cwievi cwiKíbv civgk© Ges
†mevi Rb¨ †idvi Kiæb
- cieZ©x cÖm‡evËi wfwRU¸‡jv‡Z gv‡K, Zvi ¯^vgx†K (A_ev GKRb cwiev‡ii m`m¨ ev eÜy‡K) wb‡q Avm‡Z civgk©
w`b hv‡Z Zviv Kvh©µg¸‡jv‡Z RwoZ n‡q, gv‡K Zvi gvZ…Z¡hvc‡b mnvqZv Ki‡Z wkL‡Z cv‡i
- 2q, 3q, 4_© wfwR‡Ui mgqm~wP wVK Kiæb

1. gv‡qi cywó Ges m¤ú~iK Lv`¨

hLb GKRb gv ey‡Ki `ya LvIqvb, Zvi cywóKi Lv`¨ (w`‡b 5 †ejv Lvevi mgcwigvY) Ges evowZ Zi‡ji `iKvi nq|
¯Íb¨`v‡bi GB Pvwn`v wgUv‡Z, cÖme cieZ©x mgqKv‡j AwZwi³ kw³i `iKvi| kw³ e„w×i Rb¨ Zv‡K †L‡Z n‡e:
l Avwglmg„× Lv`¨- wWg, gvsm, gvQ, `ya
l ch©vß cvwb (10-12 Møvm), meyR kvK mewR Ges dj
l cÖwZw`b `yB gy‡Vv †ewk fvZ Ges Wvj
l 3 gv‡mi Rb¨ Avqib Ges dwjK GwmW
l ZvgvK, a~gcvb, g` Ges gv`K Gwo‡q Pj‡Z n‡e
2. wekÖvg Ges Ab¨vb¨ KvR
l Zvi ch©vß wekÖvg †bqv cÖ‡qvRb (8 NÈv iv‡Z Ges w`‡b 2 N›Uv ); ev”Pv Nywg‡q †M‡j Zv‡KI wekÖvg wb‡Z n‡e
l KóKi KvR Ges fvix e¯‘ †Zvjv †_‡K weiZ _vK‡Z n‡e
l †cwiwbqvg Ges Zj‡c‡Ui †ckxi e¨qvg Ki‡Z n‡e
l Ach©vß wekÖv‡gi jÿY: ey‡Ki `ya Kg Drcbœ nIqv, Rivqy †`wi‡Z †QvU nIqv, †ewk i³cvZ, nZvkv, gv Zvi I
wkïi hZœ Kg wb‡Z cviv
3. e¨w³MZ ¯^v¯’¨wewa †g‡b Pjv
l †hvwbc‡_ †KvbI wKQz cÖ‡ek Kiv‡bv hv‡e bv
l Zvi I Zvi wkïi msµgY cÖwZ‡iv‡ai Rb¨ †aŠZKi‡Yi cÖ‡qvRbxqZv e¨vL¨v Kiæb:
- wkï‡K aiv, Lvevi LvIqv, ev”Pvi Lvevi ˆZwi, BZ¨vw`i Av‡M nvZ ay‡q wb‡Z n‡e
- cÖwZw`b Ges gjZ¨v‡Mi ci †cwiwbqvg ay‡Z n‡e
- †cwiwbqv‡gi ÿZ ïKbv I cwi®‹vi ivL‡Z n‡e
- cÖwZ 4-6 NÈv ci ci †cwiwbqvj c¨vW cwieZ©b Ki‡Z n‡e A_ev fvix ¯ªve n‡j AviI `ªæZ cwieZ©b Ki‡Z n‡e
- ey‡Ki `ya cvb Kiv‡bvi c~‡e© ¯Íb cwi®‹vi K‡i wb‡Z n‡e
- Zv‡K cÖwZw`b †Mvmj Ki‡Z n‡e
- †cwiwbqv‡gi ÿZ bv ïKv‡bv ch©šÍ Ges
- †hvwb¯ªve eÜ bv nIqv ch©šÍ Zv‡K mnevm Gwo‡q Pj‡Z n‡e
4. gj, g~Î Z¨v‡Mi Af¨vm
l gyÎbvwji msµgY Gov‡Z Zv‡K wbqwgZ cÖ¯ªve Ki‡Z n‡e
l †Kvô cwi®‹v‡ii Rb¨ ch©vß Zij I meyR kvK-mewR †L‡Z n‡e
5. ey‡Ki `ya LvIqv‡bv
gv‡K ey‡Ki `ya LvIqv‡bv ïiæ Ki‡Z mnvqZv Kiæb| gv‡K wb‡Pi e¨vcvi¸‡jv m¤ú‡K© †kLvb Ges civgk© w`b:
l kvj`y‡ai ¸iæZ¡
l mwVK Ae¯’vb Ges mshyw³
l Kvc ev Pvg‡P LvIqv‡bvi Rb¨ ey‡Ki `ya †ei Kiv
l Pvwn`vg‡Zv wkky‡K ey‡Ki `ya cvb Kiv‡bv
l cywó eRvq ivL‡Z cÖ_g 6 gvm ïaygvÎ ey‡Ki `yaB h‡_ó
l `yB eQi ch©šÍ ey‡Ki `ya cvb Kiv‡Z n‡e
l hw` wbqwgZ, Pvwn`v gvwdK, w`‡b Ges iv‡Z ey‡Ki `ya cvb Kiv‡bv nq, hw` wkï‡K Ab¨ †KvbI Lv`¨ A_ev cvbxq
†`qv bv nq Ges hw` gv‡qi gvwmK cybivq ïiæ bv nq (cÖme-cieZ©x Rb¥ wb‡ivaK cÖwµqvi g‡a¨ j¨vK‡Ukbvj
A¨v‡g‡bvwiqv †`Lyb) Zvn‡j ¯Íb¨`vb 6 gvm ch©šÍ Mf©aviY †_‡K myiÿv w`‡Z cv‡i|

62 cÖme-cieZ©x †mev
 l wkï ch©vß `ya cv‡”Q wK bv Zv Kxfv‡e eyS‡Z cviv hv‡e, gv Zv Rvb‡eb (¯^vfvweK AvPiY, w`‡b 6-8 evi cÖ¯ªve
Kiv, cÖ_g 24Ñ48 N›Uvq GKevi cÖ¯ªve Kiv h‡_ó )
l gv I wkï‡K GKB weQvbvq ivL‡Z n‡e

ey‡Ki `ya cvb Kiv‡bvi †KŠkjmg~n

l gv‡qi Ae¯’vb: GKRb gv wewfbœ Ae¯’v‡b †_‡K Zvi wkï‡K ey‡Ki `ya cvb Kiv‡Z cv‡ib| †hgb, wZwb wcV ‡VwK‡q
ï‡q A_ev KvZ n‡q, †Pqv‡i e‡m, cv AvovAvwo K‡i e‡m, Suy‡K, A_ev `uvov‡Z cv‡ib| cÖm‡ei wVK ci ci, gv‡K
wPZ K‡i ivLv nq| cÖme-cwiPh©vKvixi DwPZ gv‡K G Ae¯’vq ey‡Ki `ya cvb Kiv‡Z mvnvh¨ Kiv| gv wkï‡K a‡i
ivLvi mgq hv‡Z Avivg †eva K‡ib, hvi d‡j ey‡Ki `ya cvb Kiv‡bvi mgq ¯Í‡bi mv‡_ wkïi mshyw³ eRvq _v‡K|
l wkïi Ae¯’vb: mwVK Ae¯’v‡b _vKvi ˆewkó¨-
- wkïi gv_v Ges kixi GKB mij †iLvq _vK‡e
- wkïi gyL ¯Íb Ges Gi †evUvi wecix‡Z _vK‡e
- wkïi bvK gv‡qi ¯Í‡bi †evUvi wecix‡Z _vK‡e
- wkïwU gv‡qi Nwbô †Quvqvq _vK‡e
- ïaygvÎ gv_v Ges Nvo bq, wkïi cy‡iv kixi mv‡cvU© cv‡e
l ¯Í‡bi mv‡_ wkïi mshyw³: mwVKfv‡e mshy³ _vKvi ‰ewkó¨-
- gyL eo K‡i nvu Kiv _vK‡e
-wb‡Pi †VuvU evB‡ii w`‡K _vK‡e
-wPeyK ¯Íb Quy‡q _vK‡e
- wkïi gy‡Li wb‡Pi Ask †_‡K Dcwifv‡M A¨vwiIjv †ewk †`Lv hv‡e
l ey‡Ki `ya cvb Kiv‡bvi mgm¨v¸‡jv D‡jøL Kiv: †mevKg©xMY ¯Íb¨`vbKvix gv‡q‡`i A‡bKvs‡k mvnvh¨ Ki‡Z cv‡i|
Ae¯’vb m¤ú‡K© wb‡`©kbv †`qvi mv‡_ mv‡_, Zviv gv‡K Rvbv‡Z cv‡i †h, cÖm‡ei ci ciB `yacvb Kiv‡bv ïiæ Ki‡j
`ya Avm‡e Ges ch©vß `y‡ai cÖevn ˆZwi n‡e| ¯Íb fvix nIqv, iæÿ ¯Í‡bi †euvUv A_ev msµg‡Yi Kvi‡Y ¯Íb¨`v‡b
e¨_v †eva nq; Gme †ÿ‡Î Kxfv‡e `ya nvZ w`‡q †U‡b †ei Ki‡Z nq Ges msµgY A_ev e¨_v †m‡i †M‡j ¯Íb¨`vb
Kxfv‡e Pvwj‡q †h‡Z n‡e, Zv †mevKg©xMY gv‡q†`i wkwL‡q w`‡eb|
RvZxq IYCF wb‡`©kbv Abyhvqx †idvi Kiæb

6. †imvm-‡mbwmUvB‡Rkb Gi weiæ‡× cÖmecieZ©x c¨vwmf BgybvB‡Rkb

Rh-‡b‡MwUf bvix hvi kix‡i Mf©ve¯’vq Gw›U Rh-D Gw›UewW Drcbœ nq bv, hw` Zvi Rh-cwRwUf wkï Rb¥ ‡bq, †m ‡ÿ‡Î
Zv‡K cÖm‡ei 72 NÈvi g‡a¨ Gw›U Rh-D 300 gvB‡µvMÖvg w`‡Z n‡e| GwU GKwU Kvh©Kix cÖmecieZ©x wUKv`vb
c`‡ÿc| †jevi Ges cÖm‡ei mgq gv‡qi i³cÖev‡n cª‡ek Kiv 僇Yi Rh-D cwRwUf i³ KwbKv¸‡jv‡K GwU `~i K‡i|
†ewkifvM †ÿ‡Î Gw›U Rh-D Gi gva¨‡g gv‡qi Rh †mbwmUvB‡Rkb cÖwZ‡iva Kiv hvq| †hLv‡b m¤¢e, mKj Mf©eZx
gv‡qi Gi Rb¨ Rh-D w¯Œwbs Kiv DwPZ| hw` Zviv Rh-†b‡MwUf nq, Mf©ve¯’vi 32 mßv‡n Rh-D Gw›UewW mbv³ Ki‡Z
n‡e| R‡b¥i ci, Rh-‡b‡MwUf gv‡qi wkïi Rh-D Aek¨B mbv³ Ki‡Z n‡e| hw`, wkïi Rh-D cwRwUf nq, gv‡K Gw›U
Rh-D w`‡Z n‡e|

O. cÖme-cieZ©x wec` wPý mg~n

gv I beRvZ‡Ki wec`wPý¸‡jv m¤ú‡K© gv Ges Zvi cwievi Rv‡b wK bv Zv wbwðZ Kiæb
gv‡qi wec` wPýmg~n beRvZ‡Ki wec` wPýmg~n
l cÖPzi i³mªve A_ev i³mªve e„w× †c‡j l wVKg‡Zv Lv‡e bv
l gvSvgvwS †_‡K Zxeª D”P i³Pvc l kix‡ii ZvcgvÎv Kg (35.50 †m A_ev 95.50 dv.)
l wLuPzwb A_ev R¡i (37.50 †m. A_ev 99.50 dv.)
l Zj‡c‡U Zxeª e¨_v mv‡_ `yM©Ühy³ ¯ªve I R¡i l `ªæZ k¦vm cÖk¦vm (60/ wgwbU A_ev †ewk)
l ey‡K Zxeª e¨_v A_ev k¦vmKó l Zxeªfv‡e eyK cvuR‡ii w`‡K †b‡g hvIqv
l †hvwb w`‡q gj ev g~Î †ei nIqv l ïaygvÎ DÏxcbvq bovPov K‡i A_ev †KvbI bovPov †bB
l †hvwb w`‡q wKQz GKUv †ei nIqv l wLuPzwbi BwZnvm
l bvwfi jvj‡P fve Pvgov ch©šÍ we¯Í…Z
GB mg‡q mgm¨v mbv³ Kiæb, cÖ‡qvR‡b †idvi Kiæb

cÖme-cieZ©x †mev 63
 P. GKRb cÖm~wZ gv‡qi ¯^v¯’¨ fv‡jv Av‡Q eySv hv‡e hLb
l gv fv‡jv †eva Ki‡eb
l cÖm‡ei ci AwZwi³ i³ÿiY nevi BwZnvm †bB
l Rivqy wVKfv‡e msKzwPZ Ges k³
l Zvi †cwiwbqv‡g †KvbI †dvjvfve †bB
l Zvi i³Pvc, bvwoi ¯ú›`b, ZvcgvÎv ¯^vfvweK
l Zvi †KvbI d¨vKv‡k fve, †KvbI e¨_v/ R¡i Ges cÖ¯ªv‡e †KvbI mgm¨v †bB
l Zvi ¯Í‡b †KvbI mgm¨v †bB, Ges Zvi wkï fv‡jvfv‡e ey‡Ki `ya cvb K‡i

Q. cÖmecieZ©x mvavib RwUjZvmg~‡ni e¨e¯’vcbv

eZ©gvb DcmM© wRÁvmv Kiæb/ †`Lyb/ Abyfe m¤¢ve¨ †ivM wbY©q Ges KviY wPwKrmv
ev mgm¨v Kiæb
Zj‡c‡U e¨v_v KLb: cÖm‡ei ci cÖmecieZ©x e¨_v (RgvUe× l Rivqy g¨v‡mR
(Pain in lower ˆewkó: ms‡KvPbRwbZ e¨_v i³ A_ev bvwoi †QvU Ask l e¨_vi Ilya
abdomen) mgq/ cwimi: cÖm‡ei 2-4 †_‡K †M‡j) l Mig †muK
w`b ci
cÖ¯ªv‡e R¡vjv‡cvov, Kuvcywbmn R¡i Ges g~Îbvwji msµgY l ch©vß cvwb cvb Ki‡Z
evi evi `ªæZ Zj‡c‡U e¨_v (K¨v‡_UvivB‡Rkb A_ev Dc‡`k w`b
cÖ¯ªv‡ei ZvwM`, g~Î_wj‡Z AvNvZ, KvUv‡Quovi l K¨vcmyj A¨vgw·wmwjb
A¯^w¯Í‡eva Kvi‡Y) 500 wg.MÖv. 8 NÈv ci
(Burning during ci
urination, l Wv³vi †`wL‡q cÖ¯ªve
increased cixÿv Kivi Rb¨ gv-†K
frequency and
civgk© w`b
urgency of
urination,
feeling
unwell )
cv Ges †Mvovwj‡Z
e¨_v I †dvjv: GK cv‡q _ª‡¤^v‡d¬evBwUm (i³bvwjxi l Kg‡cÖmb ÷wKsm e¨envi
e¨_v /†dvjv A_ev `yB cv‡q AvNvZ Ges cÖ`v‡ni Kvi‡Y) l e¨_vi Ilya
(Pain/swelling is: jvj‡P fve l weQvbvq wekÖvg
of leg and e¨_v: cv‡q ev †Mvovwj‡Z l `ªæZ wPwKrm‡Ki Kv‡Q
ankle) e¨_v Av‡Q wK bv l †idvi
e¨_vhy³ ÿZ e¨_v: ÿZ¯’v‡b ÿZ¯’v‡b msµgY l nvmcvZv‡j †idvi Kiæb
R¡i is:ÿZ¯’v‡bi Pvicv‡k jvj‡P (mvifvBKvj / †cwiwbqv‡gi
(Painful fve KvUv‡Quov‡Z GwcwmIUwgi
wound fever) †dvjv: dz‡j hvIqv ÿZ ¯’v‡b A_ev wmRvwiqvb
¯ªve:ÿZ¯’v‡b `yM©Ühy³ ¯ªve R¡i Bbwmm‡b ÿZ)
¯Í‡b e¨_v Df‡q ¯Íb AvµvšÍ Ges mv‡_ †eª÷ GbMR©‡g›U l Avk¦vm w`b
(Pain in the A¯^w¯Í‡eva l AviI wbqwgZ ¯Íb¨cvb
breast) AvKvi: eo Kiv‡Z n‡e
MVb: k³ l gv‡K Ae¯’vb Ges
e¨_v: Av‡Q mshyw³ †`wL‡q w`b
KLb: cÖm‡ei 3-5 w`b ci l wbqwgZ `ya †ei K‡i
wb‡Z n‡e
l Mig A_ev VvÐv †muK w`b
l †idvi Kiæb

64 cÖme-cieZ©x †mev
 eZ©gvb DcmM© wRÁvmv Kiæb/ †`Lyb/ Abyfe m¤¢ve¨ †ivM wbY©q Ges KviY wPwKrmv
ev mgm¨v Kiæb

cv‡q †dvjv l wKQzw`b a‡i wW‡c‡Û›U wdwRIjwRKvj BwWgv l Avk¦vm w`b

(Swelling of BwWgv _vK‡Z cv‡i l wekÖvg wb‡Z civgk© w`b
legs) l i³Pvc Ges cÖ¯ªv‡e
R¡vjv‡cvov Av‡Q wKbv
†PK Kiæb
¯Í‡b e¨_v mn R¡i mvaviYZ †Kej GKwU ¯Íb g¨vw÷wUm l Avk¦vm w`b
(Pain in the AvµvšÍ nq l AviI wbqwgZ ¯Íb¨cvb
breast with is: jvj‡P, KxjK AvK…wZi Kiv‡Z n‡e
fever) †ÿÎ l wbqwgZ `ya †ei K‡i
e¨_v: Av‡Q wb‡Z n‡e
KLb: cÖm‡ei 3-4 mßvn ci l Mig A_ev VvÛv †muK
G †_‡K †eª÷ GbMR©‡g›U l cÖ‡qvRb n‡j
n‡Z cv‡i Gw›Uev‡qvwUK- K¨vcmyj.
d¬zK¬·vwmwjb- 500
wg.MÖv. 6 N›Uv ci ci 5
w`b
K¨vcmyj. †md«vwWb -
500 wg.MÖv. 6 N›Uv ci
ci 5 w`b
l †idvi Kiæb
¯Í‡bi †euvUvq e¨_v l `ya cv‡bi mgq e¨_v cv‡e KK©k ¯Í‡bi †euvUv l ¯Í‡bi mv‡_ wkkyi
(Sore nipples) l wkky ïaygvÎ wbcj Pzl‡e mwVKfv‡e Ae¯’vb Ges
l gv evi evi `ya cvb mshyw³
Kiv‡Z PvB‡eb bv l ¯Íb¨`vb Pvwj‡q †h‡Z
n‡e
l e¨_vhy³ ¯’v‡b ey‡Ki `ya
jvwM‡q evZv‡m ïwK‡q
wb‡Z n‡e
†cwiwbqv‡g Zxeª Dcwifv‡Mi wUmy¨¸‡jv weeY© †cwiwbqvj †ngv‡Uvgv (cÖm‡ei l e¨_vi Ilya
e¨v_v †cwiwbqvg A‡j †dvjv mgq †cwiwbqv‡gi i³bvwj‡Z l Gw›Uev‡qvwUK- †md«vwWb
(Severe pain AvNv‡Zi Kvi‡Y) 500 wg.MÖv. 6 NÈv ci
of the ci
perineum) l hZ `ªæZ m¤¢e †idvi
Kiæb
gvÎvwZwi³ cwigvY: AwZwi³ ev †gvUvgywU wejw¤^Z cÖme-cieZ©x i³cvZ l dvÛvj g¨v‡mR Ges
i³mªve i³ÿq (bvwoi wKQz Ask i‡q †M‡j, i³cv‡Zi cwigvY
(Excessive KLb: cÖm‡ei cÖ_g 24 NÈv cÖme cieZ©x msµgY ) wba©viY
vaginal ci l Bb‡RKkb Avi‡Mv‡gwUªb
bleeding) KZÿY: avivevwnK ev 2 A¨v¤úyj I/M
AwbqwgZ l `ya `vb AviI wbqwgZ
MÜ: `yM©Ü Ki‡Z n‡e Ges wekÖvg
l ZvrÿwYKfv‡e
nvmcvZv‡j †idvi Kiæb

cÖme-cieZ©x †mev 65
 eZ©gvb DcmM© wRÁvmv Kiæb/ †`Lyb/ Abyfe m¤¢ve¨ †ivM wbY©q Ges KviY wPwKrmv
ev mgm¨v Kiæb

cÖm‡ei ci 1000 dv. Gi †ewk R¡i wcDi‡civj †mcwmm dv÷© jvBb g¨v‡bR‡g›U
`yM©Ühy³ ¯ªve Zj‡c‡U e¨v_v Iivj Gw›Uev‡qvwUK
(Foul smell Zj‡cU †e`bvhy³ l K¨vcmyj. A¨vgw·wmwjb
discharge `yM©Ühy³ †hvwb¯ªve 500 wg.MÖv. 6 NÈv ci ci
after l U¨ve‡jU. †g‡UªvwbWvRj
childbirth) 400 wg.MÖv. 8 NÈv ci ci
l †idvi Kiæb
cÖ¯ªve, cvqLvbv l µgvMZ ev ZvwM` n‡j g~Îbvwji msµgY / l BDivbvwi A_ev wdKvj
Siv Ges evqy cÖ¯ªve Siv †fwm‡Kvf¨vRvBbvj wd÷zjv BbKw›U‡bÝ Gi DcmM©
wbM©Z n‡Z _vKv l gv‡qi Mv‡q cÖ¯ªv‡ei MÜ †i‡±vf¨vRvBbvj wd÷zjv I jÿYmg~n
(Leakage of n‡e cÖme-cieZ©x wfwR‡U,
urine, stool l cvqLvbv a‡i ivLv KóKi cÖm‡ei GK mßvn c‡i,
and flatus) n‡e Ges cÖm‡ei 6ô mßv‡n
l wdKvj BbKw›U‡bÝ: cixÿvi mgq wbY©q
Ki‡Z n‡e
µgvMZ ev hLb Ki‡e
l †cwiwbqv‡gi †ckxi
kw³ evov‡bvi e¨vqvg
Kivi Rb¨ KvD‡Ýwjs
Ki‡Z n‡e
l †idvi Kiæb

R. cÖme-cieZ©x gyL¨ RwUjZvmg~‡ni e¨e¯’vcbv

gyL¨ mgm¨v DcmM© e¨e¯’vcbv

cÖme cieZ©x i³ÿiY l AwZwi³ i³mªve (>500 wg.wj) K) gv‡qi mvaviY ¯^v¯’¨ Ae¯’v `ªæZ
(Postpartum haemorrhage) A_ev cÖjw¤^Z gvSvgvwS cwigvY g~j¨vqb Kiæb
i³mªve hvi d‡j cÖm‡ei ci gv‡qi L) kK m‡›`n n‡j `ªæZ wPwKrmv ïiæ Kiæb
Ae¯’v Lvivc nq M) BbwdDkb ïiæ Kiæb Ges
l `ªæZ bvwo ¯ú›`b, jNy i³Pvc, Aw·‡Uvwmb d¬zB‡W w`b
d¨vKv‡m fve N) eøvWv‡i K¨v‡_Uvi w`b
l kK O) CEmOC †K‡›`ª †idvi Kivi
l Mf©dzj †ei nqwb Rb¨ hvbevnb Gi e¨e¯’v Kiæb
l Rivqy wkw_j/ ms‡KvwPZ P) †idvi Kiæb
wcDi‡civj †mcwmm l cÖm‡ei 6 mßv‡ni g‡a¨ KvD‡Ýwjs K‡i †idvi Kiæb
(Puerperal sepsis) l `yM©Ühy³ †hvwb¯ªve
l Zj‡c‡U e¨v_v
l R¡i, ZvcgvÎv>38˚C
l cÖ¯ªv‡e R¡vjv‡cvov
l D`iùxwZ
l †cwiwbqvg/ †c‡Ui ÿZ †_‡K
cuy‡Ri g‡Zv ¯ªve
†hvwbc_ Ges †cwiwbqv‡gi mbv³ Kiæb f¨vRvBbvj c¨vK w`‡q †idvi Kiæb|
KvUv‡Quov cÖ‡qvR‡b I/V m¨vjvBb w`b
(Vaginal and/or perineal
tear)

66 cÖme-cieZ©x †mev
 †mKkb 5t
Mf©cvZ-cieZ©x †mev

Mf©cvZ-cieZ©x †mev 67
68 Mf©cvZ-cieZ©x †mev
 Mf©cvZ-cieZ©x †mev
m~Pbv
Dbœqbkxj †`k¸‡jvq mvaviYZ nvmcvZv‡j ¯¿x‡ivM wefv‡M Mf©cvZ-cieZ©x RwUjZvi †ivMx fwZ© nq Ges gvZ…g„Zz¨ I
Amy¯’Zvi Rb¨ GB RwUjZv D‡jøL‡hvM¨ f~wgKv iv‡L (Singh, S. 2006)| Awbivc` Mf©cvZ cÖwZ‡iv‡ai gva¨‡g gwnjv‡`i
Rxeb i¶v Kiv Ges Mf©cvZRwbZ RwUjZvi Rb¨ †h Riæwi †mevi cÖ‡qvRb Gi LiP Kgv‡bv m¤¢e|

Mf©cvZ-cieZ©x †mev (PAC) †Kb ¸iæZ¡c~Y©

l Mf©cvZ-cieZ©x †mev gwnjv‡`i ¯^v¯’¨‡K i¶v K‡i:
- Mf©cvZ-cieZ©x Dchy³ †mevi gva¨‡g gwnjv‡`i ¯^v¯’¨ myi¶v Kiv †h‡Z cv‡i Ges ZLb Mf©wb‡ivaK c×wZi
KvD‡Ýwjs I †mev cvIqv Zuv‡`i Rb¨ mnR nq|
l Mf©cvZ-cieZ©x †mev gwnjv‡`i Amy¯’ZvRwbZ Kó Kgvq:
- Awbivc` Mf©cvZ gwnjv‡`i kvixwiK I gvbwmK mgm¨vi m¤§yLxb K‡i hv †Kej mnvbyf~wZ myjf D”P ¸YMZ
gvbm¤úbœ †mevi gva¨‡g Kwg‡q Avbv †h‡Z cv‡i|
l Mf©cvZ-cieZ©x †mev gwnjv‡`i Mf©eZx nIqvi wm×všÍ MÖn‡Y mvnvh¨ K‡i:
- Mf©wb‡ivaK wel‡q KvD‡Ýwjs I †mev AbvKvw•ÿZ Mf© cÖwZ‡iva Ki‡Z Ges Mf©cvZ †mev I cieZ©x mg‡q Riæwi
Mf©cvZ-cieZ©x †mevi cÖ‡qvRbxqZv Kwg‡q Avb‡Z mvnvh¨ K‡i|
l Mf©cvZ-cieZ©x †mev gwnjv‡`i wewfbœ ¯^v¯’¨‡mevi cÖ‡qvRbxqZv †gUv‡Z my‡hvM m„wó K‡i:
- K‡qK gwnjvi †ÿ‡Î Mf©RwbZ RwUjZvq Riæwi wPwKrmvi mgqB AvbyôvwbK ¯^v¯’¨‡mev e¨e¯’vi m‡½ cÖ_g cwiPq
N‡U| Gfv‡e Mf©cvZ-cieZ©x †mev gwnjv‡`i Mf©wb‡ivaK c×wZi ch©vßZv m¤ú‡K© Z_¨ cÖ`v‡bi my‡hvM m„wó K‡i|
Gi cvkvcvwk Ab¨vb¨ cÖRbb ¯^v¯’¨‡mevmg~n Rvbvi my‡hvM m„wó K‡i|
l Mf©cvZ-cieZ©x †mev ¯^v¯’¨ †mevi LiP Kgvq:
- D”P gvbm¤úbœ Mf©cvZ-cieZ©x †mevi gva¨‡g ¸iæZ¡c~Y© ¯^v¯’¨‡mevi LiP †hgbÑ †jvKej, mieivn, AekKiY, i³
mÂvjb, A¨vw›Uev‡qvwUK, nvmcvZv‡ji weQvbv Ges A‡¯¿vcPv‡ii LiP Kwg‡q Avbv †h‡Z cv‡i|

Mf©cv‡Zi cÖKvi Ges ¯Íimg~n

Mf©cv‡Zi cÖKvi Ges ¯Íimg~n c„ôv-17 G e¨e¯’vcbv mn Mf©Kvjxb gyL¨ mgm¨v mbv³Kib I †idvi As‡k eY©bv Kiv n‡q‡Q

Mf©cvZ-cieZ©x RwUjZvi e¨e¯’vcbv

†hme gwnjv †hvwbc‡_ i³¶iY, A¯^vfvweK A_ev gvwmK eÜ Ges †c‡U †gvPov‡bv e¨_v A_ev Zj‡c‡U e¨_v wb‡q
¯^v¯’¨‡K‡›`ª Avm‡e Zuv‡`i cÖv_wgK Mf©RwbZ mgm¨v, we‡kl K‡i Am¤ú~Y© Mf©cvZ Ges Rivqyi evB‡ii Mf©ve¯’v n‡Z cv‡i
g‡b K‡i hvPvB Kiv cÖ‡qvRb| †mev cÖ`v‡bi cÖ_g c`‡¶c n‡”Q Mf©cvZRwbZ RwUjZv wb‡q G‡m‡Qb Ggb m‡›`n n‡j
h‡Zv `ªæZ m¤¢e gwnjvi kvixwiK I wK¬wbK¨vj Ae¯’v wbiƒcY Kiv|

cÖv_wgK evQvBKiY (Initial Screening)

†hme gwnjv Am¤ú~Y© Mf©cvZ, Mf©¯’ åƒY Rivqy‡Z Ae¯’vbRwbZ (Missed) Mf©cvZ Ges Rivqyi evB‡ii Mf©aviY
(GK‡UvwcK †cÖMb¨vwÝ) wb‡q Av‡m Zuv‡`i wb‡Pi GK ev GKvwaK j¶Y _vK‡Z cv‡iÑ
l †hvwbc‡_ i³¶iY|
l †gvPov‡bv e¨_v A_ev Zj‡c‡U e¨_v|
l gvwmK e‡Üi BwZnvm Z_v †kl gvwm‡Ki cÖ_g w`b †_‡K GK gv‡mi †ewk gvwmK eÜ _vKv|

Mf©cvZ-cieZ©x †mev 69
 Rxebmsnvix RwUjZvi Rb¨ evQvBKiY (Screening for Life Threatening Complications)
†hme gwnjv cÖv_wgK Mf© RwUjZvq †fv‡Mb Zuv‡`i †¶‡Î Rxebmsnvix †Kv‡bv RwUjZv i‡q‡Q wK bv Zv Riæwi wfwˇZ
evQvB Kiv cÖ‡qvRb| evQvBKi‡Yi g‡a¨ i‡q‡QÑ
l kK (Shock)|
l i³¶iY (Bleeding)|
l msµgY (Infection)|
l Rivqyi †fZ‡i AvNvZ| †hgbÑ Rivqy wQ`ª nIqv (Uterine Perforation) ev Rivqyi evB‡ii Mf©ve¯’v †d‡U hvIqv
(Ruptured Ectopic Pregnancy)|

cÖv_wgK ch©v‡q wPwKrmv Ges †ivMx‡K w¯’wZkxj Kivi Rb¨ Rivqy BfvKz‡qkb Kiv cÖ‡qvRb| Awbivc` Dcv‡q Mf© bó Kivi
†Póv Kiv fqven RwUjZvi Ab¨Zg KviY| A‡bK mgq wewfbœ AvBbMZ evav Ges mvgvwRK Kvi‡Y †gwW‡Kj Z_¨ cÖ`v‡bi
mgq Gme Z_¨ gwnjviv w`‡Z Pvb bv| Z‡e †ivMxi kvixwiK wPý Ges j¶Y hvPvB‡qi mgq Gme Avk¼vi K_v me mgq
g‡b ivLv cÖ‡qvRb|

mvwe©K wK¬wbK¨vj Ae¯’v g~j¨vqb ev hvPvBKiY (Complete Clinical Assessment)

GKB m‡½ wewfbœ Rxebmsnvix Ae¯’v n‡Z cv‡i| ZLb GKB mg‡q Zvr¶wYKfv‡e wPwKrmv †mev †`qv cÖ‡qvRb| GKwU
m¤ú~Y© wK¬wbK¨vj g~j¨vq‡bi gva¨‡g eZ©gv‡b †ivMxi Ae¯’v †Kvb ch©v‡q Av‡Q Zv wba©viY Kiv hv‡e Ges Zv‡K Kx Kx wPwKrmv
cÖ`vb Kiv cÖ‡qvRb G wm×všÍ †bqv hv‡e|

mvwe©K wK¬wbK¨vj g~j¨vqb ev hvPvBKiY

BwZnvm wRÁvmv Ges wb‡Pi Z_¨mg~n wjwce× KivÑ
l gvwmK eÜ (†kl gvwmK KLb n‡qwQjÑ LMP)|
l i³¶iY (K‡Zv w`b a‡i Ges Kx cwigvY i³¶iY n‡q‡Q)|
l †gvPov‡bv e¨_v (K‡Zv w`b a‡i Ges K‡ZvUv Zxeª e¨_v n‡”Q)|
l M‡f©i wUmy¨ †ewi‡q Avmv (gvsmwc‡Ði g‡Zv PvKv)|
l WªvM A¨vjvwR© (†Kv‡bv Ilya e¨env‡i A¨vjvwR© i‡q‡Q wK bv)|
l Mf© bó Kivi Rb¨ †Kv‡bv c`‡¶c †bqv n‡q‡Q wK-bv|
mvaviY †PKAvc/ l Vital signs cix¶v Kiv Ges wjwce× Kiv (bvwoi MwZ, ZvcgvÎv, k¦vm-cÖk¦vm Ges i‡³i
kvixwiK cix¶v Pvc)|
l mvaviY ¯^v¯’¨ Ges cywó wel‡qi Ae¯’v †`Lv (Acywó, i³¯^íZv)|
l dzmdzm, ürwcÐ, †cU Ges Ab¨vb¨ A½ cix¶v Kiv (†cU cix¶vi mgq cÖ_‡gB Bowel
sound cix¶v Kiv| Zvici †cU dz‡j Ges k³ (Uvb Uvb I PvKv †e‡a _vKv) n‡q Av‡Q
wK bv, †c‡U Pvc †`qvi mgq e¨_v‡eva nq bv wKš‘ Pvc †Q‡o †`qvi ci ciB e¨_v Abyf~Z
nIqv (Rebound Tenderness), †c‡U †Kv‡bv wcÐ Av‡Q wK bv Ges e¨_v Av‡Q wK bv,
_vK‡j †c‡Ui †Kv_vq e¨_v I K‡ZvUv Zxeª e¨_v|
l Kx cwigvY cÖmªve n‡”Q|
†cjwfK cix¶v †¯úKzjvg cix¶v KivÑ
l †hvwbc_ A_ev Rivqyi gy‡L Mf©¯’ 僇Yi †Kv‡bv Ask †`Lv †M‡j Zv †ei Kiv|
l `yM©Ühy³ mªve †ei n‡”Q wK bv Zv †Lqvj Kiv|
l i‡³i cwigvY wbY©q Ges †hvwbc_ ev Rivqyi gy‡L †Kv‡bv ¶Z Av‡Q wK bv Zv †Lqvj Kiv|
l evB-g¨vby‡qj †cjwfK cix¶v Ki| Rivqyi AvKvi wbY©q, Rivqy‡Z †Kv‡bv PvKv ev e¨_v Av‡Q
wK bv, _vK‡j †c‡Ui †Kv_vq e¨_v I K‡ZvUv Zxeª e¨_v, KLb e¨_v n‡”Q (Ggwb‡ZB e¨_v,
¯ú‡k© Ges Pvc w`‡j e¨_v, bvwK RivqygyL bovPov Kivi mgqe¨_v) Zv cix¶v Kiv|
l Rivqyi gyL †Lvjv, bv eÜ Zv cixÿv Kiv|

70 Mf©cvZ-cieZ©x †mev
 mvwe©K wK¬wbK¨vj g~j¨vqb ev hvPvBKiY
j¨ve‡iUwi cix¶v l j¨ve‡iUwi‡Z cix¶v mnvqK n‡Z cv‡i| wKš‘ Zv wPwKrmvi wej‡¤^i KviY nIqv DwPZbq|
mvwe©K i‡³i cixÿv| †hgbÑ wn‡gv‡Møvweb, i‡³i MÖæc I µm g¨vwPs Kiv|
l wewfbœ mgxÿvq wK¬wbK¨vj cix¶v| Rhesus (Rh) ISO. Immunization me mgq Kivi
cÖ‡qvRbxqZv cÖgvwYZ nqwb (WHO-2012)| †hLv‡b Rh-Negative gwnjv‡`i
wbqwgZfv‡e Rh-Immunoglobin cÖ`vb Kiv nq †mLv‡b Am¤ú~Y© Mf©cv‡Zi †mev
MÖnYKvix gwnjv‡`i †¶‡Î G bxwZgvjv cÖ‡hvR¨ nIqv DwPZ|

kK (Shock)
kK n‡”Q Rxebmsnvix Ae¯’v| G Ae¯’vq †ivMxi Rxeb i¶vi Rb¨ cÖ‡qvRb Zvr¶wYK I wbweo e¨e¯’vcbv| hLb †ivMx
Mf©cv‡Zi RwUjZv wb‡q Av‡mb ZLb k‡Ki j¶Ymg~n cÖ_‡g wbiƒcY Ki‡Z n‡e| hw` AwZwi³ i³¶iY, AvNv‡Zi wPý
A_ev †mcwmm cvIqv hvq Zvn‡j k‡Ki m¤¢ve¨Zv we‡ePbv Ki‡Z n‡e|

k‡Ki j¶Ymg~n
k‡Ki cÖv_wgK ch©vq k‡Ki †kl ch©vq

l mRvM, Aw¯’i, DwØMœ l †Kv‡bv wKQz eyS‡Z cvi‡Q bv Ggb Ae¯’v, Aa©‡PZb ev
l bvwoi MwZ ¯^vfvwe‡Ki †P‡q †ewk (wgwb‡U 110 ev Gi A‡PZb nIqv
†P‡q †ewkevi) l bvwoi MwZ LyeB `ye©j Ges A‡bK `ªæZ
l k¦vm-cÖk¦vm ¯^vfvwe‡Ki †P‡q GKUz `ªæZ (wgwb‡U 30 evi l k¦vm-cÖk¦vm LyeB `ªæZ Ges GKUz ci ciB k¦vm †bqv
ev AwaK) l d¨vKv‡m Ges kxZj
l d¨vKv‡m l i³Pvc ¯^vfvwe‡Ki †P‡q LyeB Kg _vKv
l i‡³i Pvc ¯^vfvwe‡Ki †P‡q wKQzUv Kg (wm÷wjK l dzmdz‡m cvwb Rgv
i³Pvc 90 mm of Hg-Gi wb‡P) l cÖmÖv‡ei cwigvY cÖwZ NÈvq 30 wmwmi Kg nIqv ev
l dzmdzm cwi®‹vi _vKv G‡Kev‡i eÜ nIqv
l cÖmªv‡ei cwigvY (cÖwZ NÈvq 30 wmwm ev †ewk nIqv)

k‡Ki e¨e¯’vcbv
K. cÖviw¤¢K wPwKrmv

†mevi G e¨e¯’vcbv cÖv_wgK ¯Í‡ii †mev‡K›`ª Ges cieZ©x ¯Í‡ii †mev‡K‡›`ª †idv‡ii AvM ch©šÍ I †idv‡ii mgq I w`‡Z
n‡e|

i. †ivMx‡K Dò ivLv: †ivMxi kix‡ii Zvc µgvš^‡q K‡g hvIqv cÖwZ‡iva Kiv| d‡j Peripharal shutdown Ges
Acidosis nq| G Rb¨ Mig K¤^j e¨env‡i DcKvi cvIqv hvq| †ivMx‡K evB‡i †_‡K Zvc w`‡j †hgbÑ Mig c¨vW A_ev
Mig cvwbi †evZj e¨envi Ki‡j cy‡o †h‡Z cv‡i|

ii. cv DuPz K‡i ivLv: m¤¢e n‡j †ivMxi cv‡qi w`‡K weQvbvUv DuPz K‡i w`‡j ürwc‡Ð i‡³i (Venous return) PjvPj
n‡q i³Pv‡ci DbœwZ nq| ï‡q _vK‡j hw` k¦vm wb‡Z Kó nq Zvn‡j cv wbPz Ges gv_v DuPz K‡i w`‡Z n‡e †hb dzmdz‡mi
Ici Pvc Kg c‡o|

iii. kix‡ii Ae¯’vb: †ivMxi gv_v I kixi GKw`‡K KvZ K‡i †kvqv‡Z n‡e hv‡Z ewg Ki‡jI Zv wM‡j †djvi Avk¼v Kg
_v‡K| hw` †ivMx A‡PZb _v‡Kb Zvn‡jI Zvi wRnŸv k¦vmbvwj‡K evavMÖ¯Í Ki‡e bv|

iv. gy‡L †Kv‡bv Lvevi bv †`qv: G‡Z k¦v‡mi m‡½ ewg k¦vmbvwj‡Z hvIqvi Avk¼v Kgv‡e|

Mf©cvZ-cieZ©x †mev 71
 v. d¬zBW (wkivi gva¨‡g †`qv)Ñ
l kix‡i Rjxq c`v‡_©i cwigvY wVK ivLvi Rb¨ h‡Zv `ªæZ m¤¢e wkivi gva¨‡g m¨vjvBb w`‡Z n‡e|
l GKwU eo wQ‡`ªi myP| †hgbÑ 16 †MR A_ev Gi †P‡q †ewk n‡j fv‡jv nq| Zvn‡j ZvovZvwo m¨vjvBb †`qv hv‡e
Ges cieZ©x mg‡q cÖ‡qvR‡b IB P¨v‡bj e¨envi K‡i i³ †`qv †h‡Z cv‡i|

500 †_‡K 1000 wg.wj. m¨vjvBb 15-20 wgwb‡U †`qv †h‡Z cv‡i| gwnjvi dzmdzm I ürwcÐ gwbUi Ki‡Z n‡e †hb d¬zBW
Ifvi‡jvW bv n‡q hvq| k‡K hvIqv gwnjvi w¯’wZkxjZv Avbvi Rb¨ 3 wjUvi ch©šÍ IV d¬zB‡Wi cÖ‡qvRb n‡Z cv‡i|
wPwKrmvq †ivMxi Ae¯’vi DbœwZ A_ev AebwZ n‡”Q wK bv ev GKB iKg Ae¯’v Av‡Q wK bv Zv Lye Mfxifv‡e gwbUi Ki‡Z
n‡e| gwnjv‡K AwZ mZ¡i h‡_vchy³ †mev‡K‡›`ª †idvi Ki‡Z n‡e|

†hvwbc‡_ i³¶iY
†hvwbc‡_ i³¶i‡Yi KviY:

Mf©cv‡Zi Kvi‡Y `xN©¯’vqx Ges AwZwi³ i³¶i‡Yi KviY n‡”QÑ

l Mf©¯’ 僇Yi Ask Rivqyi †fZ‡i †_‡K hvIqv (Am¤ú~Y© Mf©cvZ)|
l Rivqyi gy‡L AvNvZ m„wó nIqv ev wQu‡o hvIqv|
l Rivqyi †fZ‡i AvNv‡Z wQ`ª n‡q hvIqv|
l Rivqyi ms‡KvP‡bi ÿgZv bó n‡q hvIqv|

i³¶i‡Yi e¨e¯’vcbv:

kixi †_‡K wbM©Z Rjxq c`v_© cÖwZ¯’vc‡bi e¨e¯’v Kiv Ges i³¶i‡Yi KviY †ei K‡i Zv wbqš¿Y Kiv| gwnjv‡K AwZ
mZ¡i h‡_vchy³ †mev‡K‡›`ª †idvi Ki‡Z n‡e|

msµgY
hw` †ivMxi Rivqy‡Z A_ev Generalized msµgY nq Zvn‡j wb‡Pi welq¸‡jvi †h †Kv‡bvwU n‡Z cv‡iÑ

BwZnvm:
l Mf©ve¯’v bó Kivi Rb¨ Kx Kiv n‡qwQj, we‡kl K‡i Rivqy‡Z Ges Rivqyi gy‡L hš¿cvwZ e¨env‡ii BwZnvm|
l `xN©¯’vqx i³¶i‡Yi BwZnvm|

j¶Ymg~n (Symptoms):
l Zj‡c‡U e¨_v|
l mvaviY A¯^w¯Í (fvBivj d¬z Gi g‡Zv j¶Y)|

wPýmg~n (Signs):
l A¯^vfvweK ZvcgvÎv (R¡i A_ev nvB‡cv_viwgqv), kxZ kxZ Abyf~Z nIqv A_ev †N‡g hvIqv|
l †hvwb ev RivqygyL w`‡q `yM©Ühy³ mªve †ei nIqv|
l ¯úk© ev Pvc w`‡j Zj‡c‡U e¨_v (Rebound Tenderness _vK‡Z cv‡i Avevi bvI _vK‡Z cv‡i)|
l Rivqyi gyL w`‡q wgDKvm wbtmiY nIqv|
l evB-g¨vbyqvj cixÿvi mgq Rivqyi gyL bovPov Kivi mgq e¨_v‡eva nIqv|

msµg‡Yi e¨e¯’vcbv: gwnjv‡K AwZ mZ¡i Dchy³ cÖv_wgK e¨e¯’vcbv †`qvi ci †mev‡K‡›`ª †idvi Ki‡Z n‡e|

Rivqy BfvKz‡qkb
Am¤ú~Y© Mf©cv‡Zi †¶‡Î Rivqy ev Zj‡c‡U AvNv‡Zi wP‡ýi †Kv‡bv cÖgvY cvIqv bv †M‡j Rivqyi †fZ‡i †_‡K hvIqv
僇Yi Aewkó Ask †ei K‡i †dj‡Z n‡e| Rivqy BfvKz‡qk‡bi Rb¨ †Kvb c×wZ e¨envi Kiv n‡e Zv wbf©i K‡i gwnjv

72 Mf©cvZ-cieZ©x †mev
K‡Zv w`‡bi Mf©eZx wQ‡jb Ges Rivqyi AvKvi, cÖ‡qvRbxq Ilya, hš¿cvwZ, Ab¨vb¨ mieivn I `¶ †mev`vbKvix Av‡Qb wK
bv Gi Ici| hw` `¶ †mev`vbKvix, cÖ‡qvRbxq mieivn bv _v‡K Zvn‡j gwnjv‡K AwZ mZ¡i h‡_vchy³ †mev‡K‡›`ª †idvi
Ki‡Z n‡e|

Rivqy BfvKz‡qk‡bi mycvwikK…Z c×wZ n‡”Q f¨vKzqvg A¨vmwc‡imb Ges Ilya|

f¨vKzqvg A¨vmwc‡ikb

Rivqy BfvKz‡qkb c×wZ Ges GgwfG cøvm A¨vmwc‡iU‡ii mvnv‡h¨ Rivqy BfvKz‡qk c×wZ Abzmib Ki‡Z n‡e |

Mf©cvZ-cieZ©x †mevi Rb¨ Ily‡ai e¨envi

Am¤ú~Y© Mf©cvZ Ges wgmW A¨veik‡bi wPwKrmvq wg‡mvcÖ÷j e¨envi Kiv myweavRbK| mdjZv 84-93 kZvsk|
(Chung et al 1995; Shwerkerela et al 2007; Clark et al, 2007; Gynuity 2004; Rizzi et al 2006; Tang
2003; Zhang, 2005).

Am¤ú~Y© Mf©cvZ wPwKrmvq wg‡mvcÖ÷j e¨env‡ii myweavmg~nÑ

l wK¬wbK¨vwj e¨envi Kiv mnR|
l Ilya wU †ivMx wb‡RB e¨envi Ki‡Z cv‡ib|
l Rivqyi †fZi †Kv‡bv hš¿cvwZ e¨envi Kivi cÖ‡qvRb nq bv|
l hš¿cvwZ Av‡Q wK bv wKsev cÖwµqvRvZ Kiv wK bvÑ Gm‡ei Sv‡gjv †bB|
l cÖZ¨šÍ GjvKvi ¯^v¯’¨‡K‡›`ª cÖ`vb Kiv †h‡Z cv‡i| †hLv‡b wewfbœ mieiv‡ni NvUwZ Av‡Q †mLv‡b GwU e¨envi K‡i
†mevi gvb e„w× Kiv †h‡Z cv‡i|
l GwU e¨qeûj bq|
l GwU Kg ZvcgvÎvq msi¶‡Yi cÖ‡qvRb nq bv|
l gwnjv‡`i myweav Abyhvqx GwU wewfbœ c‡_ e¨envi Kiv hvq|
(Ref-WHO 2012)

Mf©cvZ-cieZ©x KvD‡Ýwjs
Mf©cvZ-cieZ©x KvD‡Ýwjs Mf©cvZ-cieZ©x †mevi Ask n‡Z n‡e| Mf©cvZ-cieZ©x KvD‡Ýwjs gwnjvi mywbw`©ó Pvwn`v Ges
Zvi Kx Kx Rvbvi Av‡Q Zv wPwýZ Ki‡Z cv‡i| Kvh©Ki Mf©cvZ-cieZ©x KvD‡Ýwjs wPwKrmv †mevi mgq, Av‡M I c‡i
gvbwmK Ges Av‡eMRwbZ mnvqZv w`‡Z cv‡i|

Mf©cvZ-cieZ©x KvD‡Ýwjs‡qi g~j j¶¨ n‡”QÑ

l †hme Ae¯’vq gwnjv‡`i AbvKvw•ÿZ M‡f©i w`‡K †V‡j †`q G m¤úwK©Z Pvwn`v †gUv‡Z mvnvh¨ K‡i|
l gwnjv I Zvi m½xi Rb¥weiZxKiY c×wZi Pvwn`v †gUv‡Z mvnvh¨ K‡i|
l gwnjv‡K Ges Zvi m½x h‡_vchy³ Rb¥wb‡ivaK c×wZ cQ›` Ki‡Z I Kvh©Kifv‡e Ges mgqg‡Zv e¨envi Ki‡Z
mvnvh¨ K‡i|

Am¤ú~Y© Mf©cv‡Z wg‡mvcÖ÷j †`qvi Av‡M KiYxqÑ

i. Am¤ú~Y© Mf©cvZ n‡q‡Q wK bv Zv wbwðZ Kiv

Am¤ú~Y© Mf©cvZÑ
l mZ©Kfv‡e BwZnvm MÖnY: cÖRbb¶g gwnjvi gvwmK eÜ i‡q‡Q, Mf©eZx nIqvi wPý Av‡Q Ges GLb Zvi †hvwbc‡_
i³ hv‡”Q|
l kvixwiK cix¶v: Mf©eZxi Rivqy eo Ges AvKvi 12 mßv‡ni Kg, Rivqyi gyL †Lvjv I †hvwbc‡_ i³ hv‡”Q, Mf©¯’
åæ‡Yi wKQz †ei n‡jI cy‡ivUv †ei nqwb| Am¤ú~Y© Mf©cv‡Zi j¶Ymg~n wbY©‡qi Rb¨ wbqwgZ Mf© cix¶v A_ev

Mf©cvZ-cieZ©x †mev 73
 AvjUªvm‡bvMÖvwd Kiv AZ¨vek¨K bq| (Bique et al 2007; Shwekerela et al 2007; Ngoc et al 2005; Weeks
et al, 2005)
iii. KvD‡Ýwjs
l e¨_vbvkK Ilya mieivn Ges G m¤ú‡K© Av‡jvPbvÑ
AvBeycÖ‡db A_ev Ab¨vb¨ NSAIDs mieivn Ki‡Z n‡e| NSAIDs wg‡mvcÖ÷‡ji Kvh©KvwiZvq †Kv‡bv cÖfve
†d‡j bv (Creinin, 1997)| DwØMœZv `~i Ki‡Z Ges e¨_vi Abyf~wZ Kgv‡Z fv‡jv KvD‡Ýwjs I gvbwmK mnvqZv
Kvh©Ki f~wgKv iv‡L| NSAIDs wg‡mvcÖ÷‡ji Kvh©KvwiZvq †Kv‡bv cÖfve †d‡j bv|
l wg‡mvcÖ÷j e¨env‡ii ci Kx Kx n‡Z cv‡i Zv gwnjvi m‡½ Av‡jvPbv Kiv cÖ‡qvRbÑ
†gvPov‡bv e¨_v, i³ hvIqv Ges Mf©¯’ åƒY †ewi‡q Avmv, ewg ewg fve, ewg Kiv A_ev Wvqwiqv, R¡i, kxZ kxZ jvMv|
mvaviYZ Ilya †me‡bi cÖ_g K‡qK NÈvi g‡a¨ wKQz j¶Y †`Lv hvq| Lye Kg msL¨K †ÿ‡Î wewfbœ cvk¦©cÖwZwµqv †`Lv
w`‡Z cv‡i| †hgbÑ ewg ewg fve, ewg, Wvqwiqv, R¡i Ges kxZ kxZ jvMv| Z‡e G¸‡jv nvjKv ai‡bi Ges mvaviYZ
24 NÈviI Kg mgq ¯’vqx nq (Clark-2007)|

†mev`vbKvixi m‡½ Zvr¶wYKfv‡e †`Lv Ki‡Z n‡e hw`

l cÖPzi i³¶iY nq:
- hw` gwnjvi 2 NÈvi †ewk mgq a‡i cÖwZ NÈvq `ywUi †ewk c¨vW wf‡R hvq|
- i³cvZ n‡Z _vKvq gwnjvi gv_v nvjKv †eva n‡e ev Aw¯’i jvM‡e|
l msµg‡Yi j¶Ymg~n kbv³ Kiv:
- 24 NÈvi †ewk mgq a‡i R¡i A_ev kxZ kxZ jvMv|
- µgvMZ †c‡U e¨_v|
- †hvwbc‡_ `yM©Ühy³ ev cyuRhy³ mªve †ewi‡q Avmv|
†hLv‡b msµgY wbwðZ n‡e †mLv‡b A¨vw›Uev‡qvwUKmn Dchy³ wPwKrmv †`qv DwPZ|

Am¤ú~Y© Mf©cv‡Zi Rb¨ wg‡mvcÖ÷‡ji weavb (Regimen)

Mf©Kvj cwigvY c_ mgqmxgv

Rivqyi AvKvi 600 gy‡L GK m‡½ wZbwU 200 gvB‡µvMÖvg * 91-99% (Shwekerela 2007,
12 mßv‡ni gvB‡µvMÖvg U¨ve‡jU †L‡Z n‡e Dao 2007, Weeks 2005, Bique
Kg n‡j 2007; Rakotovao et alal 2006)

400 wR‡fi 200 gvB‡µvMÖv‡gi 2wU U¨ve‡jU ** 95 kZvsk (Rizzi 2007, Blum
gvB‡µvMÖvg wb‡P wR‡fi wb‡P 30 wgwbU ivL‡Z n‡e| 2007)
Gici evwKUv wM‡j †dj‡Z n‡e

wg‡mvcÖ÷‡ji e¨enviÑ
l 200 gvB‡µvMÖv‡gi wZbwU wg‡mvcÖ÷j ewo gy‡L †L‡Z n‡e A_ev 200 gvB‡µvMÖv‡gi `ywU ewo wR‡fi wb‡P ivL‡Z
n‡e|
l GKB mg‡q e¨_vbvkK Ilya w`‡Z n‡e|
l 僇Yi Dcv`vbmg~n hv‡Z †ei n‡q Avm‡Z cv‡i G Rb¨ †ivMx‡K 30 wgwbU †mev‡K‡›`ª A‡c¶v Ki‡Z ejyb Ges Zvi
m‡½ _vKyb|
l hw` †ivMx 30 wgwb‡Ui g‡a¨ ewg K‡i Zvn‡j Zv‡K Avevi Ilya w`‡Z n‡e|

A¨vw›Uev‡qvwU‡Ki e¨enviÑ
l Am¤ú~Y© Mf©cvZ Ges wgmW A¨veik‡b wg‡mvcÖ÷j e¨env‡ii Rb¨ msµg‡Yi nvi LyeB Kg (Clark, 2007)|
l AvR ch©šÍ Mf©cvZ-cieZ©x wPwKrmvq wg‡mvcÖ÷‡ji e¨env‡ii m‡½ wbqwgZ A¨vw›Uev‡qvwU‡Ki e¨env‡ii
cÖ‡qvRbxqZvi †Kv‡bv Z_¨ cvIqv hvqwb|
l hw` †ivMxi BwZnvm Ges kvixwiK cix¶vq msµgY A_ev msµg‡Yi SzuwK _v‡K Zvn‡j A¨vw›Uev‡qvwUK e¨envi Kiv
DwPZ (Blum, 2007)|

74 Mf©cvZ-cieZ©x †mev
d‡jvAvc

wg‡mvcÖ÷j e¨env‡ii `yB mßvn ci GKwU d‡jvAvc wfwR‡Ui mgqm~wP wVK Ki‡Z n‡e| gwnjv‡K Rvbv‡bv †h, Ilya
MÖn‡Yi K‡qK NÈvi g‡a¨B Rivqyi BfvKz‡qkb n‡e| wKš‘GUvi Rb¨ mßvnLv‡bK a‡i mvgvb¨ i³¶iY Pj‡Z cv‡i (Pang
2001; Pandian et al 2001; Zhang et al 2005)|
d‡jvAvc wfwR‡Ui mgq hv hv KiYxq Zv n‡jvÑ
Mf©¯’ 僇Yi m¤ú~Y© Ask †ewi‡q‡Q wK bv Zv wbwðZ Kiv| G Rb¨ BwZnvm I kvixwiK cixÿv Ki‡Z n‡e|
l BwZnvm :
- gwnjvi cÖPzi i³¶iY ev †gvPov‡bv e¨_v n‡q‡Q wK bv|
- RgvUeuvav i³ A_ev wUmy¨ †ewi‡q G‡m‡Q| Z‡e GLb i³¶iY eÜ n‡q‡Q ev K‡g †M‡Q wK bv|
- Zj‡c‡U e¨_v, †hvwbc‡_ A¯^vfvweK mªve ev e¨_v|
- Mf©eZx Ae¯’vq †hme DcmM© wQj Zv †M‡Q wK bv|
l kvixwiK cix¶v :
- Rivqyi AvKvi ¯^vfvweK n‡q hvIqv (†QvU Ges `„p)|
- Rivqyi cvk¦©eZ©x As‡k ¯ú‡k© e¨_vi Abyf~wZ bv _vKv|
- Rivqyi gyL eÜ _vKv|
hw` cÖwµqv m¤úbœ bv nq Ges cix¶v K‡i gwnjvi Ae¯’v w¯’wZkxj cvIqv hvq Zvn‡j Zv‡K d‡jvAv‡ci mgq Avevi
cÖ‡qvRbxq wPwKrmv A_ev wg‡mvcÖ÷j w`‡Z n‡e (Gemzell- Danielsson, 2007; Blum, 2007)| AKvh©K‡ii †¶‡Î
msµgY A_ev AwZwi³ i³¶iY n‡j f¨vKzqvg A¨vmwc‡ikb we‡ePbvq Avb‡Z n‡e|

Mf©cvZ cieZ©x cwievi cwiKíbv

†hme gwnjvi m¤cÖwZ Mf©cvZ n‡q‡Q Zv‡`i we‡kl civgk© I †mevi cÖ‡qvRb i‡q‡Q| KviY Mf©cvZ Gi 2-4 mßv‡ni
g‡a¨B wZwb Avevi Mf©eZx n‡q co‡Z cv‡ib| G‡`i mv‡_ †Lvjv‡gjv K_v ej‡Z n‡e| Mf©cvZ Gi ci hw` †Kvb RwUjZv
ev msµgY bv _v‡K Zvn‡j 7 w`‡bi g‡a¨ cwievi cwiKíbv c×wZ wbivc‡` e¨envi Ki‡Z cv‡ib| GB Ae¯’vq cwievi
cwiKíbv m¤ú‡K© Zvi AwfÁZv wb‡q Av‡jvPbv Ki‡Z n‡e, we‡klZt cÖRbbZ‡š¿ msµgY, mnev‡m e¨_v, eܨvZ¡, BZ¨vw`
MÖnxZv‡K fvjfv‡e e¨vL¨v Ki‡Z n‡e|

Mf©cvZ-cieZ©x Mf©wb‡ivaK KvD‡Ýwjs Ges c×wZ mieiv‡ni ¸iæZ¡

Mf©cvZ-cieZ©x †mevi Ask wn‡m‡e Mf©wb‡ivaK KvD‡Ýwjs‡qi j¶¨ n‡”Q †Kv‡bv gwnjv hw` Mf©wb‡ivaK c×wZ e¨envi
Ki‡Z Pvb Zvn‡j KvD‡Ýwjs Zv‡K wm×všÍ MÖn‡Y mvnvh¨ Ges h‡_vchy³ c×wZ cQ›` Ki‡Z mnvqZv cÖ`vb K‡i| †Kv‡bv
mdj Mf©wb‡ivaK KvDwÝji †Kv‡bv gwnjvi e¨w³MZ Pvwn`v, cÖRbb j¶¨gvÎv I kvixwiK Ae¯’v g‡b †i‡LB KvR K‡ib|
Mf©wb‡iva wewfbœ Kvi‡Y gwnjv‡`i ¯^v¯’¨ Ges my¯’Zvi Rb¨ ¸iæZ¡c~Y©|

Mf©wb‡ivaK c×wZ e¨env‡ii d‡jÑ

l mxwgZ mšÍvb Rb¥`v‡bi gva¨‡g gwnjv‡`i ¯^v‡¯’¨i Dbœqb Ges AwaK mšÍvb Rb¥`vb cwinvi gv‡qi kix‡ii Rb¨
g½jRbK|
l GK mšÍv‡bi R‡b¥i ci Av‡iKwU mšÍvb B”Qvg‡Zv mg‡q wb‡Z cviv Ges †QvU cwievi MVb, wkïi Rxeb i¶v I wkï
¯^v¯’¨ Dbbq‡bi wbivc` Dcvq Aej¤^‡b gv‡K mvnvh¨ K‡i (Upadhyay and Robey, 1999)|
l gv‡qi RxebhvÎvi gvb Dbœqb, wk¶vi my‡hvM`vb Ges †ckvi †¶‡Î Dbœq‡b ¯^vaxbZv cÖ`vb K‡i|
l fwel¨‡Z AbvKvw•ÿZ Mf© cwinv‡ii gva¨‡g gvZ…g„Zz¨ I Amy¯’Zv Kwg‡q Avb‡Z Ges Awbivc` Mf©cv‡Zi d‡j g„Zz¨
ev Amy¯’Zvi m¤¢vebv Kwg‡q Avb‡Z gwnjv‡K mvnvh¨ K‡i|

Mf©cvZ cieZ©x cwievi cwiKíbv c×wZ

RwUjZvwenxb Mf©cvZ cieZ©x cwievi cwiKíbv c×wZ
†Kvb RwUjZv bv n‡j Mf©cvZ Ges GgAvi Gi ciciB mKj cwievi cwiKíbv c×wZ e¨envi Kiv hv‡e|

Mf©cvZ-cieZ©x †mev 75
 Mf©cvZ Gi ci RwUjZv m„wó n‡j †m‡ÿ‡Î cwievi cwiKíbv c×wZ
msµgY

hw` KL‡bv msµgY †`Lv hvq Zvn‡j msµgY fv‡jv bv nIqv ch©šÍ gwnjv‡K mnevm †_‡K weiZ _vKvi Rb¨ civgk© w`‡Z
n‡e| msµgY fv‡jv bv nIqv ch©šÍ wKQz c×wZ †`qv hv‡e bv| †hgbÑ wUD‡eKUwg I AvBBDwW| msµgY _vK‡j
wUD‡eKUwg-cieZ©x msµg‡bi SuzwK e„w× cvq| msµgY fv‡jv nIqvi Av‡M AvBBDwW MÖnY Ki‡j Zv Ae¯’vi AebwZ
NUv‡Z cv‡i| hZw`b ch©šÍ wUD‡eKUwg A_ev AvBBDwW ‡mev cÖ`vb Kiv hv‡e bv, ZZw`b ch©šÍ MÖnxZv cQ›`gvwdK Ab¨vb¨
c×wZ e¨envi Ki‡Z cvi‡e|

†hŠbv‡½ AvNvZ

†hŠbv‡½ AvNv‡Zi g‡a¨ i‡q‡Q Rivqy wQ`ª nIqv, Rivqyi gyL wQu‡o hvIqv, †hvwbc‡_ AvNvZ Ges †_uZ‡j hvIqv| Gme
AvNv‡Zi Rb¨ AvNv‡Zi ¯’vb Ges Ae¯’v ai‡bi Ici wbf©i K‡i Rb¥weiwZKiY c×wZi e¨envi wejw¤^Z n‡Z cv‡i| †hme
c×wZi Ici A¯’vqxfv‡e wewa-wb‡la _vK‡e †m¸‡jv n‡jv wUD‡eKUwg I AvBBDwW| Gme †¶‡Î †mev`vbKvix
AšÍe©Z©xKvjxb †Kv‡bv c×wZ e¨env‡ii Rb¨ mycvwik Ki‡eb Ges Zv kvixwiK Ae¯’v we‡ePbv K‡i †`‡eb ZZw`b ch©šÍ
MÖnxZv cQ›`gvwdK Ab¨vb¨ c×wZ e¨envi Ki‡Z cvi‡e|

AwZwi³ i³¶iY

AwZwi³ i³¶iY n‡j gwnjv‡K wUD‡eKUwg Kiv ev AvBBDwW cÖ`v‡bi cy‡©e Zvi i³¶i‡Yi cwigvY †Kgb Zv hvPvB Ki‡Z
n‡e| hw` j¨ve‡iUwi A_ev kvixwiK cix¶vq gwnjvi i³k~b¨Zv cvIqv hvq Zvn‡j †mB wUD‡eKUwg ZLbB Kiv hv‡e bv|
hZw`b ch©šÍ wUD‡eKUwg A_ev AvBBDwW ‡mev cÖ`vb Kiv hv‡e bv, ZZw`b ch©šÍ MÖnxZv cQ›`gvwdK Ab¨vb¨ c×wZ e¨envi
Ki‡Z cvi‡e|

Riæwi Mf©wb‡ivaK

Aiw¶Z †hŠbwgj‡bi ci A_ev Mf©wb‡ivaK c×wZ e¨_© n‡j Mf©aviY †iva Kivi Rb¨ Riæwi Mf©wb‡ivaK ¸iæZ¡c~Y© c×wZ|
†h gwnjviv GgAvi †mev MÖnY K‡ib Zuv‡`i AwMÖg Riæwi Mf©wb‡ivaK mieivn Ki‡j fwel¨‡Z AbvKvw•ÿZ Mf© cÖwZ‡iva
Kiv mnR nq| Z‡e Mf©aviY Kivi ci Riæwi Mf©wb‡ivaK c×wZ Mf©‡K bó A_ev evavMÖ¯Í Ki‡Z cv‡i bv|

GKbR‡i Mf©cvZ cieZ©x mg‡q cwievi cwiKíbv c×wZmg~n

cwievi cwiKíbv c×wZ Mf©cvZ cieZ©x mgq

KbWg hLb gwnjv g‡b Ki‡eb, wZwb †hŠbwgj‡bi Rb¨ cÖ¯‘Z

Lvevi ewo †mev †bqvi m‡½ m‡½
Bb‡RKkb †mev †bqvi m‡½ m‡½
Bgcø¨v›U †mev †bqvi m‡½ m‡½
AvBBDwW †mev †bqvi m‡½ m‡½
wUD‡eKUwg †mev †bqvi m‡½ m‡½
cÖvK…wZK cwievi cwiKíbv c×wZ †mev †bqvi ci GKUv gvwmK Pµ fv‡jvfv‡e n‡q hvIqvi ci
Riæwi Rb¥weiwZKiY wcj cÖ‡qvRb Abymv‡i AiwÿZ †hŠbwgj‡bi 5 w`‡bi g‡a¨
we.`ª. hLb †Kv‡bv RwUjZv _vK‡e bv ZLb GB QK AbymiY Kiv hv‡e

76 Mf©cvZ-cieZ©x †mev
 †mKkb 6t
cwievi cwiKíbv

cwievi cwiKíbv 77
78 cwievi cwiKíbv
 cwievi cwiKíbv
cjøx GjvKvi gvby‡li Rb¨ Mf©wb‡ivaK weKí¸‡jv evov‡bvi gva¨‡g cwievi cwiKíbv Kg©m~wP¸‡jvi †mevi Kvh©KvwiZv e„w×
Kiv hvq| †h‡nZz e¨w³ we‡k‡l Mf©wb‡iva‡Ki cQ›`, wek¦vm Ges Pvwn`v¸‡jv wfbœ nq, ZvB m¤¢ve¨ Mf©wb‡ivaK
e¨enviKvix‡`i g‡a¨ hZ †ewk m¤¢e weKí c×wZ Kg©m~wP‡Z AšÍf©~³ Kiv DwPZ| Zvi gv‡b GB bq †h cÖ‡Z¨KwU cwievi
cwiKíbv Kg©m~wP‡Z mKj c×wZ _vK‡Z n‡e, wKš‘ mvgwMÖK Kg©m~wP h‡_ó nIqv cÖ‡qvRb, hv‡Z K‡i m¤¢ve¨ e¨enviKvixMY
†hŠw³K, mgvbfv‡e wewfbœ c×wZ hvPvB Ki‡Z cv‡ib| cwievi cwiKíbv c×wZ MÖnb K‡i e¨w³ Ges `¤úwZ Zv‡`i Pvwn`v
Abyhvqx mšÍvb msL¨v wba©viY Ges Zv‡`i R‡b¥i e¨eavb Ges mgq wba©viY Ki‡Z cv‡ib|

cÖwZwU Mf© djvd‡ji †ÿ‡Î cwievi cwiKíbvi mivmwi cÖfve i‡q‡Q| AvaywbK Mf©wb‡ivaK c×wZ¸‡jvi mnRjf¨Zv
evwo‡q gvZ„g„Zz¨ 30% Gi KvQvKvwQ Kgv‡bv hvq Ges Zv beRvZK g„Zz¨ n«v‡m f~wgKv iv‡L| Gi KviY n‡jv Mf©avi‡Yi
Rb¨ my¯’¨ mgq I weiZx Ñ nIqv cÖ‡qvRb hv Awbivc` Mf© djvdj, †hgb wkïi AKvjRb¥, Acwyó Ges Le©KvqZvi D”Pnvi
†_‡K cÖwZ‡iva Ki‡e| ïaygvÎ `wi`ª Rb‡Mvôxi gv‡S bq, Mf©avi‡Yi gv‡S weiwZ fv‡jv cwiYwZi Rb¨ ˆewk¦Kfv‡e
cÖ‡hvR¨|

Rb¥weiwZKiY Gi cÖKvimg~n
evsjv‡`‡k cwievi cwiKíbvi wewfbœ c×wZ cÖPwjZ Av‡Q| miKvix Kg©m~Px‡Z 7wU AvaywbK c×wZ Pvjy Av‡Q|
1. mbvZb c×wZmg~n: wbivc` Kvj, AvRj, ey‡Ki `ya cvb Kiv‡bv wbfi© Rb¥weiwZKiY c×wZ
2. AvaywbK c×wZmg~n:
l A¯’vqx:
l ¯’vqx

Rb¥weiwZKiY c×wZmg~n

mbvZb c×wZmg~n: ey‡Ki `ya cvb Kiv‡bv wbf©i, AvaywbK c×wZmg~n

AcmviY/AvRj, wbivc` Kvj wbf©i|

A¯’vqx Rb¥weiwZKiY c×wZ ¯’vqx c×wZ

cyiæl ¯’vqx c×wZ gwnjv ¯’vqx c×wZ

¯^í †gqvw` `xN© †gqvw`
(GbGmwf) (wUD‡eKUwg)

Bgcø¨v›U AvBBDwmwW

Iivj wcj/Lvevi ewo KbWg Rb¥weiwZKiY B‡ÄKkb

wgkÖ Lvevi ewo ïaygvÎ †cÖv‡Rwób mg„× Lvevi ewo

cwievi cwiKíbv 79
 cwievi cwiKíbv †mevi ¸YMZ gvb
¸bMZ gvbm¤úbœ cwievi cwiKíbv †mevZLbB wbwðZ n‡e hLb †mev`vbKvixMY MÖnxZvi K_v ïb‡eb, MÖnxZv †R‡b-ï‡b
†¯^”Qvq cwievi cwiKíbv †mev m¤ú‡K© wm×všÍ wb‡Z cvi‡eb hv MÖnxZvi cÖ‡qvRb Abyhvqx n‡e, †MvcbxqZv iÿv n‡e Ges
h_vh_fv‡e msµgY cÖwZ‡iva PP©v n‡e|

MÖnxZvi AwaKvi
l †mev m¤ú‡K© Z_¨
l wbivc` Ges avivevwnK †mev wbwðZKiY
l wPwKrmv A_ev cwievi cwiKíbvi Mf©wb‡ivaK c×wZ cQ†›`i AwaKvi
l †Kvb Riæwi cÖ‡qvR‡b `ªæZ †mev cvIqv
l †MvcbxqZv iÿv
l cÖvcÍ †mev m¤ú‡K© we¯ÍvwiZ Z_¨ Rvbv
l cÖvß †mev m¤ú‡K© gZvgZ I gh©v`v
l cÖvß †mev m¤úwK©Z †iKW© Gi GKwU Kwc cvIqv
l hw` AwaKvi ÿzbœ n‡q _v‡K DaŸ©Zb KZ©…cÿ‡K Awf‡hvM cÖ`vb Ges Reve cÖvwß

†mev`vbKvix‡`i cÖ‡qvRb
l mnvqZvg~jK ZË¡veavb Ges e¨e¯’vcbv
l Z_¨, cÖwkÿY Ges Dbœqb
l mievn, hš¿cvwZ Ges AeKvVv‡gv

†mevi †gŠwjK wfwË

†mevi †gŠwjK wfw˸‡jv n‡jv Ñ c×wZ cQ‡›`i ¯^vaxbZv, wbivcËv Ges ¸YMZ gvb wbwðZKiY|

AewnZ Ges ¯^Ztù~Z©/ ‡¯^”Qvq wm×všÍMÖnY wbwðZKiY

GwU Ggb GKwU cÖwµqv hvi gva¨‡g GKRb e¨w³ cwievi cwiKíbv c×wZ MÖn‡Yi †ÿ‡Î cÖvß weKí¸‡jvi Ávb Ges m¤ú~Y©,
nvjbvMv`K…Z Z_¨ †R‡b Dcjwäi wfwˇZ ¯^v¯’¨‡mev m¤ú‡K© GKwU wm×všÍ MÖnY K‡i| cÖRbb ¯^v¯’¨ m¤úwK©Z GKwU mÁvZ
cQ‡›`i Rb¨, mvwf©‡mi weKí¸‡jv GKRb MÖvn‡Ki Rvb‡Z n‡e, MÖnY Ki‡Z n‡e Ges wm×všÍ MÖn‡Yi Rb¨ cÖvmw½K Z_¨
eyS‡Z n‡e| MÖnxZv-†mevKg©xi Kvh©Kix cÖwZwµqv Ges h_vh_ KvD‡Ýwjs Ges †idv‡i‡ji gva¨‡g, †mevKg©x GKwU
¯^Ztù~Z© wm×všÍMÖn‡Y mvnvh¨ K‡i|

wK¬wbKvj Kjv‡KŠkj Ges ‡mev`vb cÖwµqvi †ÿ‡Î wbivcËv wbwðZKiY

†gwW‡Kj wbivcËv MÖnxZv I †mevKg©x Df‡qi Rb¨ GKwU ¸iæZ¡c~Y© welq| GwU m¤úbœK…Z cÖwµqvmg~n &Ges †h wK¬wbKvj
cwi‡e‡k cÖwµqvwU m¤úbœ Kiv n‡q‡Q Zv wb‡`©k K‡i| wK¬wbKvj Kjv‡KŠkj Ges wPwKrmv cÖYvwjmg~n ZLbB wbivc` g‡b
Kiv nq hLb wK¬wbKvj †mev cwiPvjbv Kivi Rb¨ h_vh_ GKwU Avw½K KvVv‡gvi g‡a¨ `ÿ †mevKwg©MY, AvaywbK
cÖgvY-wfwËK gvb wb‡`©kbv Ges msµgY cÖwZ†iva †cÖv‡UvKj Abyhvqx wPwKrmv PP©v K‡i _v‡Kb|

wbiew”Qb ¸YMZ gvb wbwðZKiY I Dbœq‡b Rb¨ GKwU Kvh©c×wZ cÖwZôv Kiv:

D”Pgv‡bi †mev wbwðZ Kiv GKwU avivevwnK cÖwµqv| GRb¨ kw³kvjx/Kvh©Kix e¨e¯’vcbv I ¸YMZ gvb wbwðZKiY Ges
ZË¡veavb c×wZ cÖ‡qvRb hv GKwU mwµq I mnvqK cwi‡ek m„wó Ki‡e| ¸YMZ gvb Dbœqb/ Kg©ÿgZv Dbœqb/
AskMÖnYg~jK wkÿv Ges Kv‡Ri DcKiY GB c×wZmg~n cÖwZôv Ges ev¯Íevq‡b wb‡`©kbv w`‡Z cv‡i| Kvh©Kix ¸YMZgvb
wbwðZKiY cÖwµqvq †mevKg©x, e¨e¯’vcK, ZË¡veavqK, mgvR Ges K¬v‡q›U meviB Acwinvh© f~wgKv i‡q‡Q|

80 cwievi cwiKíbv
Ab¨vb¨ Dcv`vb
l †mev‡K‡›`ªi cÖ¯‘wZ Ñ cwievi cwiKíbv c×wZmg~‡ni ‡mev †`qvi Rb¨ ch©vßfv‡e mw¾Z †mev‡K‡›`ª AeKvVv‡gv,
we`y¨r Ges cvwb mieivn Aek¨B _vK‡Z n‡e Ges h_vh_ msµgY cÖwZ‡iva cÖwµqvmg~n Aek¨B cvjb Ki‡Z n‡e|
l cÖwkwÿZ, †hvM¨ Ges AbycÖvwYZ †mevKg©x Ñ †mev`vbKvixMY msL¨vq ch©vß n‡Z n‡e, mn‡R cvIqv hv‡e Ges cwievi
cwiKíbv †mev`v‡b cÖwkwÿZ n‡Z n‡e| Zv‡`i wbqwgZ ZË¡veavb Ges d‡jvAvc wfwRU Ki‡Z n‡e Ges ïaygvÎ
Mf©wb‡ivaB bq, msµgYmn †hŠb m¤úwK©Z Ges †hŠb evwnZ †ivM cÖwZ‡iv‡ai welq¸‡jv‡ZI K¬v‡q‡›Ui Pvwn`v Abyhvqx
e¨e¯’v wb‡Z n‡e, hv †h †KvbI †cÖvMÖvg mdj Kivi GKwU PvweKvwV|
l †cÖv‡UvK‡ji mnRjf¨Zv I mshyw³ Ñ wbw`©ó wKQz Mf©wb‡ivaK c×wZi e¨envi AMÖnY‡hvM¨ ¯^v¯’¨ SzuwK e‡q Avb‡Z cv‡i
MÖnxZvi Ggb Ae¯’v h_vh_fv‡e mbv³ Kivi Rb¨ †mevKg©x‡`i wb‡`©kbv, MÖnxZv KvW©, Ab¨vb¨ w¯Œwbs DcKiY,
†gwW‡Kj BwjwRwewjwU µvB‡Uwiqv (MEC) ûBj, Re GBW w`‡Z n‡e|
l `ªe¨/miÄvg Ñ ch©vß Ges h_vh_ hš¿cvwZ I mieivn wbwðZ Kiv cÖ‡qvRb Ges Zv eRvq I gRy` ivLv (†hgb,
Mf©wb‡ivaK miÄvg, msµgY cÖwZ‡iva cÖwµqvi Rb¨ hš¿cvwZ I mieivn)
l Bbdi‡gkb wm‡÷g Ñ DcvË msMÖn Ges wm×všÍMÖn‡Y DcvË e¨env‡ii Rb¨ Bbdi‡gkb wm‡÷g h_v¯’v‡b _vK‡Z n‡e|

cwievi cwiKíbv 81
 cwievi cwiKíbv c×wZ m¤ú‡K© KvD‡Ýwjs

fv‡jvfv‡e KvD‡Ýwjs MÖnxZvi mv‡_ gvwb‡q hvq Ggb cwievi cwiKíbv c×wZ evQvB I e¨envi Ki‡Z mvnvh¨ K‡i|
MÖnxZvi wfbœZvi mv‡_ Zv‡`i cwiw¯’wZ wfbœ n‡q _v‡K Ges Zv‡`i wewfbœ ai‡bi mn‡hvwMZv `iKvi nq| GKRb MÖnxZvi
Pvwn`v Dc‡hvMx KvD‡Ýwjs n‡jv me‡P‡q fv‡jv KvD‡Ýwjs|

KvD‡Ýwjs Gi g~jbxwZ
l mKj MÖnxZv‡K m¤§v‡bi mv‡_ †mev w`‡Z n‡e
l ¯^Zš¿ MÖnxZvi Pvwn`v, cwiw¯’wZ Ges D‡ØM m¤ú‡K© cvi¯úwiK Av‡jvPbv Ki‡Z n‡e
l MÖnxZvi mv‡_ Av‡jvPbv Kiæb, Zvi mwµq AskMÖnY wbwðZ Kiæb
l AZ¨waK Z_¨ Gwo‡q Pjyb
l MÖnxZvi Zv‡`i evQvBK…Z cwievi cwiKíbv c×wZ cÖ`vb A_ev Gi Rb¨ †idvi Kiæb A_ev K¬v‡q‡›Ui/MÖnxZvi g~j
mgm¨v wb‡q Av‡jvPbv Kiæb
l †ggwi GBW e¨envi I cÖ`vb Kiæb
l MÖnxZvi wPwýZ mgm¨vmg~n I Pvwn`v Abyhvqx h_vh_ Z_¨ cÖ`vb
l weKí¸‡jv we‡ePbvi gva¨‡g †R‡b ey‡S wb‡Ri B”Qvq wm×všÍ wb‡Z MÖnxZv‡K mvnvh¨ Kiæb
l cÖ‡kœi DËi w`b Ges mgm¨v wb‡q Av‡jvPbv Kiæb, MÖnxZvi cÖvß mKj Z_¨ ey‡S‡Q wK bv Zv wbwðZ Kiæb|

GKwU gvbvbmB Mf©wb‡ivaK c×wZ MÖn‡Y MÖnxZv‡K †mevKg©xi mnvqZv

MÖnxZvi aib mvaviY KvD‡Ýwjs Kvh©µg

mgm¨vnxb MÖnxZv cybivq Avm‡j
MÖnxZv mgm¨vmn wd‡i Avm‡j
bZzb MÖnxZv †KvbI c×wZ wPšÍv
K‡i G‡m‡Qb
MÖnxZv †KvbI c×wZ wPšÍv K‡i
Av‡mwb
l AviI mieivn w`b Ges wbqwgZ d‡jv-Avc Kiæb
l e¨eüZ c×wZwU mwVKfv‡e e¨envi K‡i‡Qb wK bv eÜzZ¡c~Y©fv‡e wRÁvmv Kiæb
mgm¨v ey‡S mgvavb Kiæb- mgm¨vwU n‡Z cv‡i cvk¦©cÖwZwµqv, c×wZ e¨env‡i
mgm¨v, Amn‡hvMx m½x A_ev Ab¨ †KvbI mgm¨v
l MÖnxZv wbf©yjfv‡e ey‡S‡Qb wK bv hvPvB Kiæb
l MÖnxZvi cQ›`‡K mnvqZv w`b hw` c×wZ MÖn‡b ¯^v¯’¨MZ mgm¨v bv _v‡K
l Kxfv‡e c×wZwU e¨envi Ki‡Z n‡e Ges cvk¦©-cÖwZwµqv Kxfv‡e gvwb‡q wb‡Z
n‡e, Av‡jvPbv Kiæb
l MÖnxZvi Ae¯’v, cwiKíbv, Ges GKwU c×wZi †ÿ‡Î Zvi Kv‡Q ¸iæZ¡c~Y© welq
wK Zv Av‡jvPbv Kiæb
l MÖnxZv‡K Zvi Rb¨ gvbvbmB c×wZ †e‡Q wb‡Z, cÖ‡qvRb n‡j wm×všÍ wb‡Z
mvnvh¨ Kiæb
l MÖnxZvi cQ›`‡K mnvqZv w`b, e¨env‡ii wb‡`©kbv Ges cvk¦©-cÖwZwµqv Kxfv‡e
gvwb‡q wb‡Z n‡e Av‡jvPbv Kiæb

82 cwievi cwiKíbv
cwievi cwiKíbv c×wZ wbY©‡q kvixwiK Dchy³Zv/Medical Eligibility Criteria (MEC):

Mf© wb‡iva‡Ki wbivc` I Kvh©Ki e¨envi MÖnxZv mwVKfv‡e evQvB Kivi Dci wbf©i K‡i| MÖnxZv evQvB wbf©i K‡i
1) †gwW‡Kj KwÛkb 2) eZ©gvb/ c~‡e©i †ivM/Amy¯’Zv 3) †ivM nIqvi SuywKc~Y© eZ©gvb ‰ewkó¨| Mf© wb‡iva‡Ki Rb¨ MÖnxZv
evQvB Kivi mgq evsjv‡`‡k wKQz mvgvwRK g~j¨‡eva I wPšÍv Ki‡Z nq| G mKj welq wPšÍv †i‡L B‡Zvg‡a¨ cwievi
cwiKíbv Awa`ßi (DGFP) GKwU †gwW‡Kj BwjwRwewjwU µvB‡Uwiqv ûBj, wW‡m¤^i 16 (MEC wheel, WHO 2015
†_‡K msM„nxZ) cÖKvk K‡i‡Q, hv‡Z †mevKg©xiv mn‡R MÖnxZv evQvB Ki‡Z cv‡ib| MÖnxZv evQvB I KvD‡Ýwjs Gi mgq
mKj †mevKg©x‡K MEC Uzj e¨envi Ki‡Z n‡e|

1
_
1
Z

4K

D
X

1 GB c×wZwU mKj †ÿ‡Î e¨envi Kiv hv‡e 3 c×wZwU mvaviYfv‡e e¨envi Kivi mycvwik
Kiv nqwb; wPwKrm‡Ki civgk© wb‡Z n‡e
2 c×wZwU mvaviYfv‡e e¨envi Kiv hv‡e 4 c×wZwU e¨envi Kiv hv‡e bv
GB c×wZ¸wj †hŠbevwnZ †ivM ev GBPAvBwf †ivM cÖwZ‡iva Ki‡Z cv‡i bv| hw` †hŠbevwnZ †ivM ev
GBPAvBwfi SuywK _v‡K, Z‡e GKgvÎ KbW‡gi mwVK Ges me©mg‡qi e¨envi mycvwik Kiv n‡q‡Q|
V

c¨viv‡gwWKMY GB PµwU e¨env‡ii/cÖ‡qv‡Mi mg‡q †Kvb wØav †eva

Ki‡j Aek¨B Wv³vi/we‡kl‡Ái mv‡_ civgk© Ki‡eb|
U

Mf©wb‡ivaK e¨env‡i/cÖ`v‡b ¯^v¯’¨MZ I mvgvwRK Dchy³Zvi

wb‡`©wkKvi Pµ, wW‡m¤^i 2016

cwievi cwiKíbv Awa`ßi wek¦ ¯^v¯’¨ ms¯’v RvwZmsN RbmsL¨v Znwej

cwievi cwiKíbv 83
84 cwievi cwiKíbv
 †mKkb 7t
cÖme-cieZ©x cwievi cwiKíbv

cÖme-cieZ©x cwievi cwiKíbv 85

86 cÖme-cieZ©x cwievi cwiKíbv
 cÖme-cieZ©x cwievi cwiKíbv
cÖm‡ei GK eQ‡ii g‡a¨ cwievi cwiKíbvi †h †KvbI c×wZ MÖnY Kiv‡K cÖme-cieZ©x cwievi cwiKíbv e‡j|
cÖme-cieZ©x mg‡q GKRb bvix Lye `ªæZ Mf©eZx n‡q co‡Z cv‡ib, hw` †KvbI cwievi cwiKíbv MÖnY bv K‡ib Ggb wK
Zvi gvwmK eÜ _vK‡jI| †ewkifvM bvix Rb¥ wb‡iva‡Ki Dcvq wn‡m‡e ey‡Ki `ya cvb Kiv‡bv‡K h‡_ó g‡b K‡ib, Gi
d‡j j¨v‡±kbvj A¨v‡g‡bvwiqv m‡Ë¡I AbvKvw•ÿZ Mf©aviY K‡i †d‡jb| GwU mgMÖ cwiev‡ii ¯^v¯’¨ I Kj¨vY‡K cÖfvweZ
K‡i Ges cwiev‡ii Dci A_©‰bwZK Ges mvgvwRK †evSv n‡q `uvovq| ZvB cÖme cieZ©x cwievi cwiKíbvi wm×všÍ †bqvi
Rb¨ Mf©Kvjxb †mev (ANC) Av`k© mgq| hw` Zv m¤¢e bv n‡q _v‡K, gv A_ev `¤úwZi Rb¨ Mf©avi‡Yi ¯^v¯’¨Ki mgq
Ges e¨eavb (HTSP) wbiƒc‡Y cÖm‡ei Rb¨ nvmcvZv‡j Ae¯’vb Kivi mgq, cÖme-cieZ©x mgq, beRvZ‡Ki †mevi mgq
A_ev wUKv`vb Kivi w`b KvD‡Ýwjs †mkb I †mevi e¨e¯’v Kiv hvq |

†h †KvbI c×wZMÖn‡Yi Dchy³ mg‡qi wfwˇZ cÖme-cieZ©x cwievi cwiKíbvi cÖKvi‡f`:

1) Mf©dzj †ei nIqvi cieZ©x mgq ev Post-Placental: Mf©dzj †ei nIqvi cieZ©x 10 wgwb‡Ui g‡a¨
2) ZvrÿwbK cÖme cieZ©x mgq ev Immediate Postpartum: cÖm‡ei 10 wgwbU ci †_‡K cieZ©x 48 N›Uvi
g‡a¨
3) wbKUeZ©x cÖme cieZ©x mgq ev Early Postpartum: cÖm‡ei 48 N›Uvi ci †_‡K 6 mßvn ch©šÍ
4) ewa©Z cÖme cieZ©x mgq ev Extended Postpartum cÖm‡ei 6 mßv‡ni ci †_‡K 1 eQi ch©šÍ

cÖme-cieZ©x cwievi cwiKíbv 87

88 cÖme-cieZ©x cwievi cwiKíbv
cÖme cieZ©x cwievi cwiKíbv KvD‡Ýwjs

evsjv‡`‡k cÖme-cieZ©x cwievi cwiKíbv AZ¨šÍ cÖ‡qvRbxq| 100 Rb cÖm~wZi g‡a¨ 44 Rb (44%) cÖm‡ei GK eQ‡ii
g‡a¨ †KvbI c×wZ MÖnY K‡iwb| G †ÿ‡Î AbvKvw•ÿZ Mf©avi‡Yi wekvj SuywK i‡q‡Q hv gv I beRvZ‡Ki Amy¯’Zv I g„Zy¨i
nvi e„w× K‡i| GB SuywK Gov‡Z cÖme-cieZ©x cwievi cwiKíbv m¤ú‡K© gv‡K KvD‡Ýwjs Kiv Lye ¸iæZ¡c~Y©| KvD‡Ýwjs Gi
gva¨‡g Avgiv `vwqZ¡kxj MÖnxZv †c‡Z cvwi Ges GwU `xN©‡gqv`x I ¯’vqx c×wZ (LARC & PM) e¨enviKvix evov‡bvi
Dcvq Ges AcmviY nvi n«vm K‡i| cÖme-cieZ©x cwievi cwiKíbv KvD‡Ýwjs Gi mgq †mev`vbKvix‡K Mf©eZx I cÖm~wZ
gv‡q‡`i we‡kl Pvwn`v¸‡jvi e¨vcv‡i wPšÍv Ki‡Z n‡e| cÖme-cieZ©x cwievi cwiKíbv KvD‡Ýwjs Gi mgq †h mKj Z_¨
w`‡Z n‡e-
l Mf©aviY ÿgZv wd‡i Avmvi m¤¢ve¨ mgq m¤ú‡K© KvD‡Ýwjs
l cÖm‡ei ci cÖ_g 6 gvm ïaygvÎ ey‡Ki `ya cvb Kiv‡bv Ges ey‡Ki `ya cvb Kiv‡bv wbf©i Rb¥weiwZKiY c×wZ
(LAM)
l hZ `ªæZ m¤¢e GKwU AvaywbK cwievi cwiKíbv c×wZ ïiæ Kiv
l Mf©avi‡Yi ¯^v¯’¨Ki mgq Ges e¨eavb m¤ú‡K© KvD‡Ýwjs Kiæb
l h_vh_ e¨eav‡bi ci ev”Pv †bqv n‡q‡Q wK bv A_ev ev”Pvi msL¨vi Dci wbf©i K‡i Avi ev”Pv bv-Pvb wK bv Zv wRÁvmv
Kiæb
l cwievi cwiKíbv c×wZi e¨envi e„w×
l gv I wkï ¯^v¯’¨ †mevi mv‡_ cwievi cwiKíbvi mgš^q Kiæb
l cwievi cwiKíbv †mev‡Z AšÍ©fz³-
- Mf©Kvjxb †mev Ges cÖme-cieZ©x †mev
- beRvZ‡Ki hZœ
- wUKv`vb

cÖm‡ei ci Mf©avib ÿgZv wd‡i Avmv

cÖme A_ev Mf©cv‡Zi ci Lye `ªæZ Mf©avib ÿgZv wd‡i Av‡m| gv‡K Mf©avib ÿgZv wd‡i Avmv m¤úK© Ges wbivc`
mnevm m¤ú‡K© wb‡¤œv³ civgk© w`‡Z n‡e:
Kgc‡ÿ 2 mßvn ch©šÍ mnevm †_‡K weiZ _vKv
l mnevm †_‡K weiZ _vKv A_ev wek¦vm‡hvM¨ AmsµwgZ cvU©bv‡ii mv‡_ mnevm Kiv hv‡Z †hŠbevwnZ msµgY †_‡K
`~‡i _vKv hvq
l hw` cÖ‡qvRb nq, mwVK Ges avivevwnKfv‡e KbWg e¨envi Kiv
l †hŠbevwnZ msµgY n‡Z cv‡i Ggb †KvbI †hŠb AvPiY †_‡K `~‡i _vKv

`¤úwZ KvD‡Ýwjs

cwievi cwiKíbv ¯^vgx Ges ¯¿x Df‡qi †hŠ_ `vwqZ¡| AZGe, G †ÿ‡Î `vwqZ¡cÖvß e¨w³‡`i GUv wbwðZ Ki‡Z n‡e †h,
`¤úwZ †h c×wZ †e‡Q wbK bv †Kb Zv‡Z †hb Zv‡`i Pvwn`v Ges B”Qvi cÖwZdjb nq; hw`I GKwU c×wZMÖn‡Y Df‡qi
cÖv_wgK `vwqZ¡ Av‡Q wKš‘ †h †KvbI GKRb‡K c×wZwU e¨envi Ki‡Z n‡e| M‡elYvq †`Lv †M‡Q, GKwU c×wZ evQvB Ges
e¨envi Ki‡Z †hme bvix Zv‡`i ¯^vgxi mnvqZv †c‡q‡Qb, Zv‡`i c×wZwU †Q‡o †`qvi nvi ZZ Kg| hw` `¤úwZ
KvD‡Ýwjs Kiv nq, Z‡e c×wZ MÖnY Ges e¨env‡ii m¤¢vebv †ewk _v‡K|

cÖme-cieZ©x cwievi cwiKíbv 89

 BDwbqb ¯^v¯’¨ I cwievi Kj¨b †K›`ª n‡Z cÖme cieZ©x †mev †`qvi Rb¨ †mev‡K›`ª cÖ¯‘ZKib
cÖme cieZ©x IUCD wKU
¯úÄ †nvwìs di‡mc
Mvwj cU
wmgm †¯úKzjvg
‡Kwjm cøv‡m÷vj di‡mc
(IUCD)
Gw›U‡mcwUK `ªeY
RxevYygy³ Møvfm&
RxevYygy³ Zzjvi ej
RxevYygy³ ‡Wªwcs kxU
cwievi cwiKíbv c×wZmg~n mieivn
l ïaygvÎ †cÖv‡Rw÷bmg„× Lvevi ewo
l AvB BD wm wW (IUCD), wgkÖ Lvevi ewo, Rb¥ weiwZKiY Bb‡RKkb
l KbWg
l w¯Œwbs Ges Kb‡m›U dig
l ‡iwR÷vi
l wi‡cvwUs di‡gU
MvBWjvBb/g¨vbyqvj/ReGBW
1. cÖme cieZ©x cwievi cwiKíbv g¨vbyqvj
2. cÖme cieZ©x cwievi cwiKíbv KvD‡Ýwjs g¨vbyqvj
3. cÖme cieZ©x cwievi cwiKíbv ReGBW

cÖme cieZ©x mg‡q AvaywbK Rb¥weiwZKiY/ Mf©wb‡ivaK c×wZmg~n Ges †mev e¨e¯’vcbv
¯^í †gqvw` Rb¥ weiwZKiY c×wZmg~n

Gme c×wZ Lye RbwcÖq Ges mPivPi e¨eüZ nq| †hgb-

l KbWg-mnev‡mi mgq mwVKfv‡e Ges avivevwnKfv‡e e¨envi Kiv cÖ‡qvRb
l Iivj wcj- cÖwZw`b GKwU K‡i wcj †L‡Z n‡e
l Rb¥weiwZKiY B‡ÄKkb (Depo-Provera)- cÖwZ 3 gvm ci ci w`‡Z n‡e

`xN© †gqvw` cÖwZeZ©b‡hvM¨ Rb¥ weiwZKiY c×wZmg~n (Long-Acting Reversible Contraceptive (LARC)
Methods)

GB c×wZ¸‡jv Lye Kvh©Ki Ges 3-10 eQ‡ii Rb¨ Mf©wb‡iva K‡i wKš‘ evsjv‡`‡k GLbI Lye RbwcÖq n‡q I‡Vwb| hLb
GKwU LARC c×wZ MÖnY Kiv n‡e, Kgc‡ÿ `yB eQi myiÿv w`‡e| evsjv‡`‡k `xN© †gqvw` c×wZ wn‡m‡e B¤úø¨v›U Ges
IUCD mnRjf¨|

l IUCD: 380A – 10 eQ‡ii Rb¨ Kvh©Ki

l B¤úøv›U: 3-5 eQ‡ii Rb¨ Kvh©Ki (B¤úøvbb; 3-eQ‡ii Ges †R‡Wj: 5-eQ‡ii)

¯’vqx c×wZmg~n

MÖnxZv Gi Mf©aviY Kivi ÿgZv ¯’vqxfv‡e GKwU A‡¯¿vcPvi cÖwµqvi gva¨‡g eÜ Kiv hvq hv fjv›Uvwi mvwR©Kvj
KbUªv‡mcwUf A_ev ¯’vqx c×wZ bv‡g cwiwPZ| `yB ai‡bi ¯’vqx c×wZ i‡q‡Q:
l bvixi Rb¨ ¯’vqx c×wZ n‡jv wUD‡eK‡Uvwg
l cyiæ‡li Rb¨ ¯’vqx c×wZ n‡jv f¨v‡mK‡Uvwg

90 cÖme-cieZ©x cwievi cwiKíbv

KbWg

KbWg n‡”Q cvZjv ivev‡ii AveiY hv †hŠb wgj‡bi wVK Av‡M Ges †hŠb wgj‡bi mgq DwÌZ cyiælv‡½ civ nq| GwU
GKwU cÖwZeÜK c×wZ hv bvixi †hvwb‡Z cyiæ‡li exh© cÖ‡e‡k evav w`‡q Mf©aviY cÖwZ‡iva K‡i|
÷¨vÛvW© 10: GKRb ¯^v¯’¨Kg©x Mf©aviY cÖwZ‡iv‡a KbW‡gi e¨envi Ges KbW‡gi e¨env‡i †KvbI ÎæwU n‡j mwVK
e¨envi m¤ú‡K© e¨vL¨v Ki‡Z cvi‡eb, Mf©aviY I †hŠbevwnZ †ivM Dfq cÖwZ‡iv‡a KbW‡gi ˆØZ f~wgKv e¨vL¨v Ki‡eb|

KLb e¨envi Ki‡Z n‡e: cÖwZevi †hŠbwgj‡bi mgq

KLb ïiæ Ki‡Z n‡e: MÖnxZvi B”Qv Abyhvqx †h †KvbI mgq cÖwZevi †hŠbwgjbKv‡j KbWg e¨envi Kiv nq

KbWg Kviv e¨envi Ki‡eb

l ‡h‡Kvb cÖRbb mÿg cyiæl Mf©aviY I †hŠbevwnZ †iv‡Mi msµgY †iv‡ai Rb¨ KbWg e¨envi Ki‡Z cv‡ib
l KbWg e¨env‡ii Rb¨ †Kvb Wv³vwi cixÿvi cÖ‡qvRb c‡o bv| ZvB †hme `¤úwZ †Kvb kvixwiK Kvi‡Y Ab¨vb¨ c×wZ
MÖnY Ki‡Z cv‡ib bv, Zviv Abvqv‡m KbWg e¨envi Ki‡Z cv‡ib
l Rb¥weiwZKi‡Yi Rb¨ †h mKj `¤úwZ ¯’vqx A_ev GK bvMv‡o †Kvb c×wZ MÖnY Ki‡Z Pvb bv, Zviv KbWg e¨envi
Ki‡Z cv‡ib
l ¯^vgx ev ¯¿xi g‡a¨ hw` Kv‡iv ev Df‡qi I †hŠbevwnZ †ivM _v‡K, Z‡e Zv‡`i GKR‡bi †_‡K Ab¨ R‡bi g‡a¨ †ivM
we¯Ívi †iv‡a KbWg AZ¨šÍ Dc‡hvMx
l Rb¥weiwZKi‡Yi Rb¨ Ab¨ †h‡Kvb c×wZ e¨envi Ki‡jI †hŠbevwnZ †ivM cÖwZ‡iv‡ai Rb¨ `¤úwZ‡K KbWg e¨envi
Ki‡Z n‡e|
l mšÍvb cÖm‡ei ci cÖ_g 6 gvm ¯Íb¨`vbKv‡j Kvh©Ki Mf©wb‡iv‡ai Rb¨ KbWg e¨envi Ki‡Z cv‡ib
l ‡h mKj `¤úwZ ¯’vqx/`xN©‡gqvw` c×wZ MÖn‡Yi Rb¨ A‡cÿv Ki‡Qb Zviv KbWg e¨envi Ki‡Z cv‡ib
l GbGmwf MÖnY Kivi ci ¯¿x hw` †Kvb c×wZ MÖnY bv K‡i †m‡ÿ‡Î ¯^vgx‡K 3 gvm ch©šÍ KbWg e¨envi Ki‡Z n‡e

KbWg e¨env‡ii myweav:

l †mev`vbKvixi mvnvh¨ QvovB GwU e¨envi Kiv hvq
l e¨envi mnR, m¯Ív Ges mnRjf¨
l mnvqK c×wZ wn‡m‡e ey‡Ki `ya`vbKvix bvix e¨envi Ki‡Z cvi‡eb (hw` COC wcj wgm nq)
l cwievi cwiKíbvq cyiæ‡li `vwqZ¡ fvM K‡i wb‡Z mnvqZv K‡i Ges †hŠbevwnZ msµgY cÖwZ‡iva K‡i Ges
wcÖg¨vwPIi B‡RKz‡jkb wPwKrmvq mvnvh¨ K‡i|
l GBPAvBwf (HIV), GBWmmn †hŠbevwnZ msµgY cÖwZ‡iva K‡i

KbWg e¨env‡ii Amyweav:

KbWg e¨env‡ii Amyweav¸‡jv n‡”Q GwU cÖwZevi mnev‡mi mgq e¨envi Ki‡Z n‡e, cyiæl m½xi mn‡hvwMZv `iKvi nq,
D”P ZvcgvÎvq A_ev Av`©ªZvq wQu‡o †h‡Z cv‡i Ges j¨v‡U· Gi cÖwZ ms‡e`bkxj n‡j e¨envi Kiv hv‡e bv|
Kvh©KvwiZv:

wbf©yjfv‡e e¨env‡ii Zzjbvq mvaviY e¨env‡i Mf©avi‡Yi D”Pnvi (10-14%) n‡Z cv‡i, wKš‘ KbWg †dBjyi Gi Kvi‡Y
bq, Am½Z Ges ÎæwUc~Y© e¨envi Gi cÖv_wgK KviY|
KbWg †dBjyi- wQu‡o hvIqv A_ev mnev‡mi mgq m¤ú~Y© †ei n‡q Avmv weij NUbv (WHO Fact Sheet-No. 243,
2000)

KbWg Kxfv‡e e¨envi Ki‡Z nq:

l c¨v‡KU †_‡K mveavbZvi mv‡_ †ei Kiæb
l KbWg cy‡iv‡bv, aŸsmcÖvß n‡j, c¨v‡KU †Quov _vK‡j, f½yi ev ïwK‡q †M‡j, A¯^vfvweKfv‡e AvVv‡jv n‡j, Amg I
cwiewZ©Z is n‡j e¨envi Ki‡eb bv|

cÖme-cieZ©x cwievi cwiKíbv 91

 l KbWgwU cy‡ivcywi †g‡j aiæb cyiælv‡½i wbP ch©šÍ
l I‡qj †eR jyweª‡K›U e¨envi Ki‡eb bv- †h †KvbI jyweª‡K›U IqvUvi †eR nIqv DwPZ
l exh© wbM©Z nevi ci KbWgwU cyiælv‡½i wbP ch©šÍ a‡i ivLyb hv‡Z †hvwb †_‡K †ei Kivi mgq öwjZ bv nq|
l cÖwZwU KbWg ïaygvÎ GKevi e¨envi Kiv DwPZ
l KbWg Quy‡o †djv DwPZ bq, Sv‡gjv/A¯^w¯Í A_ev j¾v‡eva Gov‡Z c¨v‡K‡U gywo‡q Zvici †djyb|

KbWg e¨enviKvixi wK Kiv DwPZ bq

wKQz KvR KbWg †Quovi SuywK evovq Ges G¸‡jv Gwo‡q Pjv DwPZ| hvi g‡a¨ i‡q‡Q:
l KbWg cÖ_‡g Ly‡j †d‡j Zvici cyiælv‡½ civi †Póv Ki‡eb bv
l I‡qj †eR jyweª‡K›U e¨envi Ki‡eb bv KviY †m¸‡jv j¨v‡U· Gi ÿwZ K‡i
l Amg I cwiewZ©Z is n‡j KbWgwU e¨envi Ki‡eb bv|
l KbWg f½yi ev ïwK‡q †M‡j, A¯^vfvweKfv‡e AvVv‡jv n‡j e¨envi Ki‡eb bv
l cybivq e¨envi Ki‡eb bv
l WªvB †m· Ki‡eb bv
l GKB KbWg wfbœ †cwbwUªwUf †m· cÖwµqvq †h‡Z †hgb A¨vbvj †_‡K f¨vRvBbvj †m· e¨envi Ki‡eb bv, G‡Z
e¨vK‡Uwiqv ¯’vbvšÍwiZ n‡Z cv‡i hv msµgY NUvq|

GKwU KbWg Kxfv‡e †dj‡Z n‡e

KbWgwU c¨v‡K‡U gywo‡q Zvici gqjvi Szwo A_ev Wvówe‡b †djyb| d¬vm Uq‡j‡U †dj‡eb bv KviY wb®‹vk‡b Sv‡gjv n‡Z
cv‡i|

KvD‡Ýwjs
KvD‡Ýwjs Gi mgq †mev`vbKvix MÖnxZv‡K wb‡Pi welq¸‡jv e¨vL¨v Ki‡Z n‡e:
l MÖnxZv mwVK e¨envi ey‡S‡Q wK bv wbwðZ nDb-MÖnxZv‡K ejyb KbWg civi cuvPwU †gŠwjK avc g‡Wj ev Ab¨ e¯‘‡Z
cwi‡q Ges Ly‡j e¨vL¨v Ki‡Z|
l c‡ii evi Avmv ch©šÍ KqwU KbWg jvM‡Z cv‡i wRÁvmv Kiæb, ch©vß KbWg w`b, hw` cvIqv hvq IqvUvi ev wmwjKb
†eRW jyweª‡K›U w`b
l mnev‡mi †ÿ‡Î KbWg e¨env‡ii ¸iæZ¡ e¨vL¨v Kiæb Ñ ïay GKevi AiwÿZ †hŠb AvPiY Gi d‡j Mf©aviY A_ev
†hŠbevwnZ msµgY A_ev DfqB n‡Z cv‡i| hw` GKevi †hŠb AvPi‡Yi Rb¨ KbWg e¨envi bv Kiv nq, cieZ©x evi
e¨envi Kivi †Póv Kiæb| GK wK `yB evi fzj Kiv gv‡b GB bq †h fwel¨‡Z KbWg e¨envi Kiv A_©nxb|

d‡jvAvc
cÖwZwU MÖnxKv‡K †h †KvbI mgq wd‡i Avm‡Z ¯^vMZ Rvbvb|

d‡jvAvc wfwR‡Ui m¤¢ve¨ KviY¸‡jv:

l mgm¨v, cÖkœ A_ev Ab¨ c×wZ MÖn‡Y B”QzK
l m¤¢ve¨ Mf©aviY wb‡q D‡ØM, hw` †KvbI bvix m¤úªwZ AiwÿZ †hŠbwgj‡b Ask wb‡q‡Q Ges Mf©aviY Gov‡Z PvB‡Q,
†m Riæix Mf©wb‡ivaK nqZ e¨envi Ki‡Z cv‡i|

cÖwZevi KbWg mwVKfv‡e e¨envi Ki‡Z mgm¨v n‡j Riæix Mf©wb‡ivaK Lvevi ewo (ECP) m¤ú‡K© e¨vL¨v Kiæb| KbWg
e¨env‡i fzj hvi g‡a¨ KbWg e¨envi bv Kiv i‡q‡Q, Mf©aviY cÖwZ‡iv‡a mvnvh¨ Ki‡Z Riæix Mf©wb‡ivaK Lvevi ewo
(ECP) m¤ú‡K© e¨vL¨v Kiæb| hw` _v‡K, Riæix Mf©wb‡ivaK Lvevi ewo (ECP) w`b| KbWg e¨envi wb‡q K_v ejvi Dcvq
m¤ú‡K© Av‡jvPbv Kiæb Ñ m½xi mv‡_ KbWg e¨envi wb‡q K_v ejvi `ÿZv I †KŠkj m¤ú‡K© Av‡jvPbv Kiæb| hw` GKRb
MÖnxZv †KvbI mgm¨v wb‡q Awf‡hvM K‡i, MÖnxZvi Gi D‡Ø‡Mi welq ï‡b civgk© w`b|

92 cÖme-cieZ©x cwievi cwiKíbv

c¦vk©-cÖwZwµqv e¨e¯’vcbv
AviI Z‡_¨i Rb¨ AbyMÖn K‡i †`Lyb cwievi cwiKíbv g¨vbyqvj, Ryb 2018, Aa¨vq 08 c„ôv-121
cvk¦© cÖwZwµqv
A¨vjvwR©K cÖwZwµqv Ñ †hvwbc_
A_ev cyiælv‡½i Pvicv‡k
R¡vjv‡cvov A_ev KbW‡gi cÖwZ
A¨vjvwR©K cÖwZwµqv
(Allergic reaction- Mild
irritation in or around
the vagina or penis or
mild allergic reaction to
condom)
KbW‡gi cÖwZ Zxeª A¨vjvwR©K
cÖwZwµqv (kix‡ii †ewkifvM
As‡k nvBf ev i¨vk, wSg wSg,
k¦vm Kó A_ev KbWg e¨env‡ii
mgq ev c‡i †PZbv nviv‡bv)
(Severe allergic reaction
to condom)
KbW‡g wPo aiv, cyiælv½ †_‡K
†ewi‡q Avmv A_ev e¨envi bv
Ki‡j
(Condom breaks, slips
off the penis or is not
used)
m½x‡K KbWg e¨envi wb‡q
†evSv‡Z mgm¨v n‡j A_ev
cÖwZevi KbWg e¨envi Ki‡Z bv
cvi‡j
(Difficnlty persuading
panther)
l KbWg e¨enviKvix I KbW‡gi eÈb m¤úwK©Z †iKW© FWA Zv‡`i †iwR÷v‡i ivL‡eb Ges KbWg eÈb †iwR÷v‡i
ivL‡eb
l cwievi Kj¨vY mnKvix wi‡cvU© Ki‡eb Gg AvB Gm dig 1 (MIS FORM 1) Gi gva¨‡g cwievi Kj¨vY
cwi`wk©Kv wi‡cvU© Ki‡eb Gg AvB Gm dig 3 (MIS FORM 3) Gi gva¨‡g
mgvavb
l Ab¨ †KvbI eª¨v‡Ûi KbWg e¨env‡ii civgk© w`b| G‡KK eª¨v‡Ûi KbW‡gi
cÖwZ G‡KK Rb †ewk ms‡e`bkxj n‡Z cv‡i
l hw` DcmM© †_‡K hvq, m¤¢ve¨ †hvwbc_ msµgY A_ev †hŠbevwnZ msµgY hv
nq Zvi Rb¨ †idvi Kiæb
l MÖnxZv‡K j¨v‡U· KbWg e¨envi Ki‡Z wb‡la Kiæb
l j¨v‡U·-Gi cÖwZ Zxeª A¨vjvwR©K cÖwZwµqv Rxe‡bi Rb¨ SuywKc~Y©
A¨vbvdvB‡jKwUK k‡Ki w`‡K wb‡q †h‡Z cv‡i ZvB wPwKrmvi Rb¨ †idvi
Kiæb
l Mf©avib cÖwZ‡iv‡a Gme †ÿ‡Î Riæix Mf©wb‡ivaK e¨envi Kiv †h‡Z cv‡i|
hw` GKRb e¨w³ KbW‡g †KvbI wPo †`‡L ev †ewi‡q Av‡m, Zvi bvix m½x‡K
ejv DwPZ hv‡Z wZwb PvB‡j Riæix Mf©wb‡ivaK e¨envi Ki‡Z cv‡i
l hw` AiwÿZ mnev‡mi ci MÖnxZvi †hŠbevwnZ msµg‡Yi jÿY ev DcmM©
_v‡K, g~j¨vqb A_ev †idvi Kiyb
l hw` MÖnxZv KbWg wQu‡o hvIqv ev †ewi‡q Avmvi Awf‡hvM K‡i:
nxZv‡K g‡Wj ev Ab¨ e¯‘i Dci †`Lv‡Z ejyb, wKfv‡e KbW‡gi c¨v‡KU
†Lv‡jb Ges e¨envi K‡ib, fzj n‡j mwVK wbqg †`wL‡q w`b
l MÖnxZv‡K g‡Wj ev Ab¨ e¯‘i Dci †`Lv‡Z ejyb, wKfv‡e KbW‡gi c¨v‡KU
†Lv‡jb Ges e¨envi Ki‡eb|
l m½xi mv‡_ KbWg wb‡q Kxfv‡e K_v ej‡Z nq Ges ˆØZ myiÿv bxwZ m¤ú‡K©
Av‡jvPbv Kiæb
l AviI fv‡jvfv‡e Mf©aviY cÖwZ‡iv‡a KbW‡gi mv‡_ Av‡iKwU Kvh©Ki
Mf©wb‡ivaK c×wZ mgš^q Kivi e¨vcv‡i fveyb
†iKW© iÿY I wi‡cvU© Kiv:
cÖme-cieZ©x cwievi cwiKíbv 93
 Rb¥weiwZKiY Lvevi ewo/Iivj K›Uªv‡mcwUf wcj (Iwmwc)

evsjv‡`‡k, Rb¥weiwZKiY Lvevi ewo me‡P‡q cÖPwjZ Mf©wb‡ivaK c×wZ wn‡m‡e e¨eüZ nq| AwaKvsk Rb¥weiwZKiY
Lvevi ewo 21 w`‡bi Rb¨ LvIqv nq, hvi c‡i 7 w`b †cøwm‡ev wcj †meb Kiv nq A_ev 7 w`b †KvbI ewo LvIqv nq bv|
mvZ w`b †cøwm‡ev wcj †meb Kiv A_ev eÜ ivLvi mgq ¯^vfvweK gvwmK n‡q _v‡K|

÷¨vÛvW© 11: †PKwj÷ e¨envi K‡i †mevKg©x Lvevi ewo MÖn‡Y MÖnxZvi Dchy³Zv wbY©q Ki‡Z Ges Gi †WvR, myweav, weiƒc
cÖwZwµqv, BZ¨vw` c~Y©v½ e¨vL¨v Ki‡Z cvivi cvkvcvwk cvk¦©-cÖwZwµqv mbv³ K‡i e¨e¯’v w`‡eb A_ev †idvi Ki‡Z
cvi‡eb| †mevKg©xi h_vh_ Z_¨ msiÿb Kiv DwPZ Ges MÖnxZv‡K d‡jvAv‡ci Rb¨ Avevi Avm‡Z ejv DwPZ|

Rb¥weiwZKiY Lvevi ewoi cÖKvi‡f`

B‡÷ªv‡R‡bi cwigv‡Yi Dci Lvevi ewoi aib wbf©i K‡i| ïaygvÎ †cÖv‡Rw÷b mg„× Lvevi ewo (POP) wgwb wcj bv‡g
cwiwPZ hv mwVKfv‡e †meb Ki‡j Kvh©Kix Mf©wb‡ivaK wn‡m‡e KvR K‡i| wgkÖ Lvevi ewo (K¤^vBÛ Iivj
K›Uªv‡mcwU‡f/COC) ¯^í gvÎvq B‡÷ªv‡Rb Ges †cÖv‡R‡÷ib `ywU ni‡gvb _v‡K|

Rb¥weiwZKiY Lvevi ewo `yB cÖKvi

1) wgkÖ Lvevi ewo (COC): B‡÷ªv‡Rb Ges †cÖv‡Rw÷b `ywU ni‡gvb _v‡K|
2) †cÖv‡Rw÷b Abwj wcj (POP): ïaygvÎ †cÖv‡Rw÷b _v‡K

wgkÖ Lvevi ewo (COC): RZxq cwievi cwiKíbv Kg©m~wP‡Z K¤^vBÛ Iivj K›Uªv‡mcwUf wcj ÔmyLxÕ bv‡g cwiwPZ|

wb‡`©kbv: wgkÖ Lvevi ewo MÖnY hv‡`i Rb¨ Dchy³/wb‡`©wkZ

l †hme `¤úwZ mnev‡m evavMÖ¯Í K‡i bv Ggb †KvbI c×wZ Pvq
l †hme bvix gvwm‡K i³cvZ A_ev e¨_v Kgv‡Z Pvq
l †hme bvix cÖwZw`b GKwU K‡i ewo †me‡bi wbðqZv w`‡Z cv‡i
l †hme `¤úwZ cÖwZeZ©b‡hvM¨ c×wZ‡Z AvMÖnx Ges
l wgkÖY Lvevi ewo MÖn‡Yi Rb¨ evQvB KiY †PKwj‡÷ DËxb©

‡h mKj Ae¯’vq ¯^í gvÎvi wgkÖ Lvevi ewo †`Iqv hv‡e bv

wb‡¤œ ewY©Z KviY ¸‡jv Qvov mKj mÿg gwnjv‡K ¯^í gvÎvi wgkÖ Lvevi ewo †`Iqv hv‡e|
l eZ©gv‡b AweevwnZ/weav/ZvjvKcÖvß/¯^vgx †_‡K c„_K
l gwnjv hw` Mf©eZx nb
l cÖme cieZ©x mg‡q †h me gwnjv wkï‡K ey‡Ki `ya cvb Kivb-cÖme cieZ©x mgq n‡Z < 6 gvm
l cÖme cieZ©x mg‡q †m me gwnjv wkï‡K ey‡Ki `ya cvb Kivb bv- cÖm‡ei 3 mßv‡ni g‡a¨ (< 3 mßvn)
l eqm 35 eQi I Z`y‡aŸ© (≥ 35)- a~gcvb: wmMv‡iU, wewo, ZvgvK, †mev ev ZvgvK RvZxq `ªe¨vw` †meb †hgb- ZvgvK
cvZv, ¸j, R`©v BZ¨vw`)
l n«rwcÛ I i³ msenbbvwji †ivM-e¨vwai GKvwaK SzuwK we`¨gvb (‡hgb: †ewk eqm, a~gcvb, ZvgvKcvZv/R`©v †meb,
Wvqv‡ewUm, D”P i³Pvc, i‡³ D”P gvÎvq Pwe© BZ¨vw`)
l D”P i³Pvc;
- wm÷wjK ≥ 160 wg. wg. cvi`, Wvqv÷wjK ≥ 100 wg. wg. cvi`
- wm÷wjK 140-159 wg. wg. cvi`, Wvqv÷wjK ≥ 90-99 wg. wg cvi` (wPwKrm‡Ki civgk© wb‡Z n‡e)
- D”P i³Pvc h_vh_ fv‡e wbqwš¿Z (wPwKrm‡Ki civgk© wb‡Z n‡e)
- D”P i³Pvc Gi BwZnvm Av‡Q (Mf©Kvjxb D”P i³Pvc mn) wKš‘ i³Pvc gvcv m¤¢e bq Ggb cwiw¯’wZ
e¨e¯’vcbvq|

94 cÖme-cieZ©x cwievi cwiKíbv

l i³enb bvwji e¨vwa we`¨gvb
l c~‡e© cv‡qi wkiv †dvjv ev e¨_v/cvj‡gvbvwi G¨v‡¤^vwjRg (DVT/PE) G AvµvšÍ n‡qwQj
l eZ©gv‡b cv‡qi wkiv †dvjv ev e¨_v/cvj‡gvbvwi G¨v‡¤^vwjRg Av‡Q
l `xN©w`‡bi Rb¨ nvuUv-Pjv eÜ _vK‡e Ggb †Kvb cwiw¯’wZ‡Z (‡Kvb `~N©Ubv ev †ivM ev eo ai‡bi Acv‡ik‡bi ci hw`
`xN©w`b weQvbvq ï‡q _vK‡Z nq)
l eZ©gv‡b Bm‡KwgK n«`‡iv‡M AvµvšÍ ev c~‡e© GB †iv‡M AvµvšÍ n‡qwQj
l c~‡e© †Kvb mg‡q ‡÷ªvK n‡q _vK‡j
l i‡³ D”P gvÎvi Pwe© (wjwcW/‡Kv‡j‡÷ij) we`¨gvb
l n«rwc‡Ûi fvj‡fi †ivM (RwUjZvmn)
l gvB‡MÖb: c~e©vfvm (Aura) mn
l ¯Í‡bi K¨vÝvi: eZ©gv‡b Av‡Q ev c~‡e© wQj
l wcËi‡mi wbM©g‡b cÖwZeÜKZv ev Rgvi evuavi (Cholestasis) BwZnvm
l fvBivm RwbZ wjfv‡ii cÖ`vn-eZ©gv‡b mwµq Av‡Q (Acute or flare)
l wjfv‡ii Ab¨vb¨ †ivM-gvivZœK wm‡ivwmm, wjfv‡ii wUDgvi, K¨vÝvi
l Jl‡ai mv‡_ wg_w¯Œqv-
K. widvgwcwmb, wicv‡evwUb
L. wLuPzwbi Jla-‡hgb †dbvBU‡qb, Kve©vgv‡RcvBb, eviwePz‡iUm, cÖvBwg‡Wvb, Uwciv‡gU, Aw•Kve©v‡RcvBb

wgkÖ Lvevi ewoi myweav

l mnev‡m evavMÖ¯Í K‡i bv
l AZ¨šÍ Kvh©Kix
l gvwm‡K i³cvZ A_ev e¨_v Kgvq
l Rivqy I wW¤^vk‡qi K¨vÝvi Ges A¨vwbwgqvi SuywK Kgvq

wgkÖ Lvevi ewoi Amyweav

l wbqwgZ †meb Avek¨K
l wKQz bvixi †ÿ‡Î mvaviY cvk¦©-cÖwZwµqv¸‡jv AMÖnYxq
l e¨enviKvixi ¯^vfvweK ni‡gvb P‡µ cÖfve †d‡j
l HIV / STI cÖwZ‡iva K‡i bv

wgkÖ Lvevi ewoi (COC) †WvR

Mf©aviY cÖwZ‡iva Ki‡Z gvwm‡Ki 1g †_‡K 5g w`b Gi †fZ‡i Lvevi ewo MÖnY †meb Ki‡Z n‡e| hw` GKRb bvix wbwðZ
_v‡Kb wZwb Mf©eZx bb, Z‡e wZwb gvwmK P‡µi †h †KvbI w`b †_‡K Lvevi ewo †meb ïiæ Ki‡Z cvi‡eb, wKš‘ cieZ©x
7 w`‡bi Rb¨ Zv‡K KbWg e¨envi Ki‡Z n‡e| 28wU ewoi †ÿ‡Î ni‡gvb-mg„× 21 wU mv`v ewo †kl Kivi ci 7 w`‡bi
Rb¨ Avqib mg„× ev`vgx ewo †meb Ki‡Z n‡e|

mgvRwfwËK †mevi †ÿ‡Î wgkÖ Lvevi ewo (COC) ïiæ Ki‡Z B”QyK MÖnxZv‡K †hme cÖkœ wRÁvmv Ki‡Z n‡e GwU Zvi
†PKwj÷| MÖnxZv‡K Gme cÖkœ wRÁvmv Kiæb-

cÖme-cieZ©x cwievi cwiKíbv 95

 MÖnxZv evQvB Gi †PKwj÷

cÖkœ bs cÖkœ nu¨v bv

1 Avcbvi gvwmK n‡Z wK †`wi n‡”Q Ges Avcbvi wK g‡b nq Avcwb Mf©eZx?

2 Avcwb wK eZ©gv‡b 6 gv‡mi Kg eqmx ev”Pv‡K ey‡Ki `ya cvb Kivb?

3 Avcwb wK a~gcvb K‡ib?

4 Avcbvi eqm wK 35 Gi †ewk?

5 Avcbvi wK gv_vi GK cv‡k cÖvqB Zxeª `c`‡c e¨_v nq, mv‡_ ewgfve nq Ges Av‡jv, kã
ev PjvPj Ki‡j ZxeªZv ev‡o?
6 Avcbvi wK D”P i³Pvc Av‡Q?
7 Avcbvi wK KLbI †÷ªvK, cv A_ev dzmdz‡m i³ RgvU, A_ev nvU© GUvK n‡q‡Q?

8 Avcbvi wK Wvqv‡ewUm Av‡Q (i‡³ kK©iv)?

9 Avcbvi wK ¯Íb K¨vÝvi wQj ev Av‡Q?

10 Avcbvi wK gvivZ¥K †KvbI hK…Z †ivM ev RwÛm (Pvgov A_ev †PvL njy`) Av‡Q?

11 Avcwb wK h²v, QÎvK msµgY A_ev g„Mx‡iv‡Mi Rb¨ wbqwgZ Ilya †meb K‡ib?

12 Avcbvi wK †hŠbwgj‡bi ci A_ev `yB gvwm‡Ki gv‡S i³cvZ nq?

MÖnxZvi †ÿ‡Î hw` Dc‡ii †KvbI cÖ‡kœi DËi nu¨v n‡q _v‡K, Zv‡K †gwW‡Kj Awdmv‡ii Kv‡Q †idvi Kiæb Ges Gi g‡a¨
e¨env‡ii Rb¨ Zv‡K KbWg w`b
MÖnxZvi †ÿ‡Î hw` Dc‡ii me cÖ‡kœi DËi bv n‡q _v‡K, wZwb wgkÖ Lvevi ewo (COC) e¨envi Ki‡Z cv‡ib wKš‘ wZwb
KLb †_‡K ïiæ Ki‡Z cvi‡eb Zv Rvb‡Z wRÁvmv Kiæb: Avcbvi KZ w`b Av‡M †kl gvwmK ïiæ n‡q‡Q? hw` MZ 7
w`‡bi g‡a¨ †kl gvwmK ïiæ n‡q _v‡K, Zv‡K GLb wgkÖ Lvevi ewo (COC) †`qv hv‡e
hw` MÖnxZvi †kl gvwmK 7 w`‡bi †ewk Av‡M ïiæ nq Ges wZwb GKwU Kvh©Ki Rb¥wbqš¿Y/Rb¥weiwZKiY c×wZ e¨envi
K‡i Avm‡Qb (weiZ _vKv mn), Zv‡K wgkÖ Lvevi ewo (COC) w`b| Zv‡K GLb †_‡K ïiæ Ki‡Z ejyb Ges cieZ©x 7
w`‡bi Rb¨ Aek¨B KbWg e¨envi A_ev weiZ _vK‡Z n‡e| Zv‡K KbWg w`b|
hw` wZwb GKwU Kvh©Ki Rb¥wbqš¿Y c×wZ (weiZ _vKv mn) e¨envi K‡i bv _v‡Kb, Zv‡K wgkÖ Lvevi ewo (COC) w`b,
wKš‘ Zvi cieZ©x gvwm‡Ki cÖ_g w`b A_ev cÖ_g 7 w`‡bi g‡a¨ e¨envi ïiæ Ki‡Z ejyb, Ges G mg‡q Zv‡K e¨env‡ii
Rb¨ KbWg w`b|

MÖnxZvi cixÿvq AšÍ©fz³ welqmg~n

BwZnvm MÖnY, RwÛm †PK Kiv, †fwi‡KvR †fBb Av‡Q wK bv †`Lv, wjfvi cv‡íU Kiv Ges i³Pvc wbY©q Kiv|

96 cÖme-cieZ©x cwievi cwiKíbv

KvD‡Ýwjs

wgkÖ Lvevi ewo †L‡Z fz‡j †M‡j KiYxq

1. hw` GKRb bvix GKwU ev `ywU wcj/ewo †L‡Z fy‡j hvb:

l hLbB g‡b co‡e ZLbB GKwU ewo Lv‡eb
l H w`‡bi ewowU h_vmg‡q Lv‡eb| Gi gv‡b `ywU ewo GKB w`‡b Ggb wK GKB mg‡q †L‡Z n‡Z cv‡i|
l evwK ewo¸‡jv memg‡qi g‡Zv Lv‡eb

2. hw` gwmK P‡µi cÖ_g ev wØZxq mßv‡n wZwb ci ci 3wU wcj/ewo †L‡Z fz‡j hvb:
l hLbB g‡b co‡e ZLbB GKwU ewo Lv‡eb
l H w`‡bi ewowU h_vmg‡q Lv‡eb| Gi gv‡b `ywU ewo GKB w`‡b Ggb wK GKB mg‡q †L‡Z n‡Z cv‡i|
l evwK ewo ¸‡jv memg‡qi g‡Zv Lv‡eb
l cieZ©x 7 w`b KbWg e¨envi Kiæb A_ev mnevm †_‡K weiZ _vKzb
l cÖ‡qvRb n‡j Bgv‡R©wÝ K›Uªv‡mcwUf wcj (ECP) /Riæix Mf©wb‡ivaK †meb Kiæb

3. hw` gvwmK P‡µi Z…Zxq mßv‡n wZwb ci ci 3wU wcj/Lvevi ewo †L‡Z fz‡j hvb:
l hLbB g‡b co‡e ZLbB GKwU ewo Lv‡eb
l H w`‡bi ewowU h_vmg‡q Lv‡eb| Gi gv‡b `ywU ewo GKB w`‡b Ggb wK GKB mg‡q †L‡Z n‡Z cv‡i|
l evwK mv`v (Kvh©Ki) ewo¸‡jv memg‡qi g‡Zv Lv‡eb
l cieZ©x w`b †_‡K bZzb c¨v‡KU †_‡K ïiæ Kiæb
l cieZ©x 7 w`b KbWg e¨envi Kiæb A_ev mnevm †_‡K weiZ _vKzb
l cÖ‡qvRb n‡j Bgv‡R©wÝ K›Uªv‡mcwUf wcj (ECP) †meb/MÖnY Kiæb

cÖme-cieZ©x cwievi cwiKíbv 97

 wewfbœ cwiw¯’wZ‡Z wgkÖ Lvevi ewo (COC) ïiæ Kiv: wewfbœ †ivMxi wewfbœ cwiw¯’wZ‡Z
KvD‡Ýwjs/bvixi wewfbœ cwiw¯’wZ wbf©i KvD‡Ýwjs
bvixi cwiw¯’wZ
gvwmKPµ Pj‡Q A_ev GKwU
ni‡gvb wenxb/bb-ni‡gvbvj c×wZ
†_‡K gv‡mi †h †KvbI mgq
cwieZ©b Ki‡Qb
ni‡gvbvj/ni‡gvb mg„× c×wZ †_‡K
cwieZ©b
ey‡Ki `ya cvb Kiv‡”Qb
ey‡Ki `ya cvb Kiv‡”Qb bv
gvwmK i³ÿiY †bB (cÖme ev ey‡Ki wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q wgkÖ Lvevi ewo
`ya cvb Kiv‡bvi mv‡_ m¤úwK©Z bq) ïiæ Ki‡Z cvi‡eb| ewo †me‡bi cÖ_g mvZ w`b ch©šÍ Zvi mnvqK c×wZi
Mf©cv‡Zi ci
98 cÖme-cieZ©x cwievi cwiKíbv
KvD‡Ýwjs
l hw` Zuvi gvwm‡Ki cuvP w`‡bi g‡a¨ †meb K‡ib Z‡e †KvbI mnvqK c×wZi
`iKvi †bB| hw` Zvi gvwm‡Ki cuvP w`‡bi †ewk nq Ges hw` wZwb m¤ú~Y©
wbwðZ _v‡Kb †h wZwb Mf©eZx bb Z‡e †h †KvbI mgq kyiæ Ki‡Z cvi‡eb|
ewo †me‡bi cÖ_g mvZ w`b ch©šÍ Zvi mnvqK c×wZi cÖ‡qvRb n‡e|
l hw` wZwb Mf©aviY K‡ibwb e‡j m¤ú~Y© wbwðZ bv n‡q _v‡Kb, Zvn‡j wgkÖ
Lvevi ewo (COC) w`‡q w`b cieZ©x gvwmK ïiæ n‡j †L‡Z ejyb|
l hw` MÖnxZv IUCD †_‡K cwieZ©b Ki‡Qb mv‡_ mv‡_ wgkÖ Lvevi ewo
(COC) ïiæ Ki‡Z cvi‡eb|
l †KvbI bvix hw` avivevwnK I mwVKfv‡e ni‡gvb mg„× Rb¥weiwZKiY c×wZ
e¨envi K‡i _v‡Kb A_ev m¤ú~Y© wbwðZ _v‡Kb †h wZwb Mf©eZx bb Z‡e
ZvrÿwYKfv‡e wgkÖ Lvevi ewo kyiæ Ki‡Z cvi‡eb| cieZ©x gvwm‡Ki Rb¨
A‡cÿv Kivi `iKvi †bB| G‡ÿ‡Î †KvbI mnvqK c×wZi `iKvi †bB|
l hw` wZwb Bb‡RK‡Uej †_‡K cwieZ©b K‡ib, cieZ©x Bb‡RKkb †`qvi
m¤¢ve¨ mg‡q wZwb wgkÖ Lvevi ewo ïiæ Ki‡Z cvi‡eb| G‡ÿ‡Î †KvbI
mnvqK c×wZi MÖn‡Yi cÖ‡qvRb †bB|
l hw` cÖm‡ei Qq gvm bv nq gv wgkÖ Lvevi ewo ïiæ Ki‡Z cvi‡eb bv, ejyb
Qq gvm c~Y© n‡j ïiæ Ki‡Z|
l hw` cÖmei Qq gv‡mi AwaK nq, gvwmK ïiæ bv nq, hw` wZwb m¤ú~Y© wbwðZ
†h Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q wgkÖ Lvevi ewo ïiæ Ki‡Z
cvi‡eb. ewo †me‡bi cÖ_g mvZ w`b ch©šÍ Zv‡K mnvqK c×wZ MÖnY Ki‡Z
n‡e| hw` wZwb m¤ú~Y© wbwðZ bv n‡q _v‡Kb †h Mf©aviY K‡ibwb, Zvn‡j wgkÖ
Lvevi ewo w`‡q cieZ©x gvwmK ïiæ n‡j †L‡Z ejyb| hw` gvwmK n‡q hvq
Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx wgkÖ Lvevi ewo ïiæ Ki‡Z
cvi‡eb|
l hw` cÖm‡ei 4 mßvn c~Y© bv nq gv cÖm‡ei 21-28 w`‡bi †h‡Kvb mgq wgkÖ
Lvevi ewo ïiæ Ki‡Z cvi‡eb, ejyb GB mvZ w`‡bi †h †KvbI mgq ïiæ
Ki‡Z| †KvbI mnvqK c×wZi `iKvi †bB|
l hw` cÖm‡ei 4 mßv‡ni †ewk nq, gvwmK ïiæ bv nq, hw` wZwb m¤ú~Y© wbwðZ
†h Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q wgkÖ Lvevi ewo ïiæ Ki‡Z
cvi‡eb| wcj †me‡bi cÖ_g mvZ w`b ch©šÍ Zvi mnvqK c×wZi cÖ‡qvRb
n‡e| hw` wZwb m¤ú~Y© wbwðZ bv n‡q _v‡Kb †h Mf©aviY K‡ibwb Zvn‡j wgkÖ
Lvevi ewo w`‡q cieZ©x gvwmK ïiæ n‡j †L‡Z ejyb| hw` gvwmK n‡q hvq
Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx wgkÖ Lvevi ewo ïiæ Ki‡Z
cvi‡eb|
cÖ‡qvRb n‡e|
l GKRb bvix ZvrÿwYKfv‡e ïiæ Ki‡Z cvi‡eb| hw` cÖ_g A_ev wØZxq
UªvB‡g÷v‡i Mf©cvZ nIqvi ci wZwb 7 w`‡bi g‡a¨ ïiæ K‡ib Zvn‡j †KvbI
mnvqK c×wZi `iKvi †bB|
 bvixi cwiw¯’wZ
Riæix Rb¥weiwZKib Lvevi ewo/
Bgv‡R©wbm K›Uªv‡mcwUf wcj
(ECP) †me‡bi ci
mvaviY cvk¦©-cÖwZwµqvi eY©bv/e¨vL¨v
w`b
cvk¦©-cÖwZwµqv m¤ú‡K© e¨vL¨v w`b
cvk¦©-cÖwZwµqv n‡j Kx Ki‡Z n‡e
e¨vL¨v Kiæb
KvD‡Ýwjs
l hw` cÖ_g A_ev wØZxq UªvB‡g÷v‡i Mf©cvZ nIqvi ci wZwb 7 w`‡bi †ewk
mgq, Zvn‡j wZwb ïiæ Ki‡Z cvi‡eb hw` wZwb m¤ú~Y© wbwðZ †h Mf©aviY
K‡ibwb Zvn‡j †h †KvbI mg‡q wgkÖ Lvevi ewo ïiæ Ki‡Z cvi‡eb| wcj
†me‡bi cÖ_g 7 w`b ch©šÍ Zvi mnvqK c×wZi cÖ‡qvRb n‡e| hw` wZwb
m¤ú~Y© wbwðZ bv n‡q _v‡Kb †h Mf©aviY K‡ib wb Zvn‡j wgkÖ Lvevi ewo w`‡q
cieZ©x gvwmK ïiæ n‡j †L‡Z/ïiæ Ki‡Z ejyb|
l ECP ‡me‡bi ci w`b †_‡K wZwb wgkÖ Lvevi ewo kyiæ Ki‡Z cv‡ib| ewo
ïiæ Ki‡Z cieZ©x gvwmK ïiæ nIqv ch©šÍ A‡cÿv Kivi †KvbI cÖ‡qvRb †bB
l GKRb bZzb wgkÖ Lvevi ewo e¨enviKvixi bZzb ewoi c¨v‡KU †_‡K ïiæ Kiv
DwPZ
l mKj bvixi ewo ïiæ Kivi cÖ_g 7 w`b †KvbI *e¨vKAvc c×wZ e¨envi Kiv
DwPZ n‡e|
l GKRb wbqwgZ e¨enviKvix hvi ewo †me‡bi fz‡ji Kvi‡Y ECP cÖ‡qvRb
nq, Zvi eZ©gvb c¨v‡K‡Ui †hLvb †_‡K †Q‡o †M‡Q †mLvb †_‡K ïiæ Ki‡Z
cv‡ib|
l mKj bvixi wcj †me‡bi cÖ_g 7 w`b mnvqK c×wZ cÖ‡qvRb n‡e
cÖ_g K‡qK gv‡m nvjKv, ¯^í Ges AwaK wbqwgZ gvwmK i³cv‡Zi †P‡q
AcªZ¨vwkZ mg‡q i³cvZ (AwbqwgZ i³cvZ); gv_ve¨_v, ¯Íb e¨_v, IRb
cwieZ©b, Ges m¤¢ve¨ Ab¨ cvk¦©-cÖwZwµqv n‡Z cv‡i
l cvk¦©-cÖwZwµqv Amy¯’Zvi jÿY bq
l †ewki fvM cvk¦©-cÖwZwµqv COC/ wgkÖ Lvevi ewo e¨env‡ii K‡qK gv‡mi
g‡a¨ K‡g ev eÜ n‡q hvq
l cvk¦©-cÖwZwµqv mvaviY e¨vcvi wKš‘ wKQz bvixi †KvbI cvk¦© cÖwZwµqv nq bv
l wgkÖ Lvevi ewo wb‡Z _vKzb| wcj ev` w`‡j Mf©avi‡Yi SuywK nq Ges wKQz
cvk¦©-cÖwZwµqv AviI Lvivc n‡Z cv‡i
- cÖwZw`b GKBmg‡q wcj †L‡j AwbqwgZ i³cvZ Kg‡Z cv‡i Ges g‡b
ivL‡Z myweav nq
- ewgfve Gov‡Z Lvev‡ii mv‡_ A_ev †kvqvi mgq wgkÖ Lvevi ewo
†meb Kiæb
l cvk¦©-cÖwZwµqv wb‡q wPwšÍZ n‡j K¬v‡q›U/MÖnxZv‡K Avevi Avm‡Z cv‡ib

* mnvqK c×wZi (Backup methods) g‡a i‡q‡Q weiZ _vKv, KbWg, ¯úvwg©mvBW Ges cÖZ¨vnvi| Zv‡K ejyb
¯úvwg©mvBW Ges cÖZ¨vnvi me‡P‡q Kg Kvh©Ki Mf©wb‡ivaK c×wZ| m¤¢e n‡j Zv‡K KbWg w`b
cvk¦©-cÖwZwµqv e¨e¯’vcbv
cvk¦©-cÖwZwµqv c×wZi Rb¨ n‡ZI cv‡i bvI n‡Z cv‡i| cvk¦©-cÖwZwµqvi Rb¨ m„ó mgm¨v¸‡jv MÖnxZvi mš‘wó Ges wgkÖ
Lvevi ewo e¨env‡i cÖfve †d‡j| Gme †ÿ‡Î †mevKg©xi g‡bv‡hvM †`qv cÖ‡qvRb| hw` MÖnxZv cvk¦©-cÖwZwµqv A_ev
mgm¨v¸‡jv wb‡q Awf‡hvM K‡ib, Zvi D‡Ø‡Mi welq¸‡jv ïbyb, Zv‡K civgk© w`b Ges h_vh_ n‡j wPwKrmv w`b|
cvk¦©-cÖwZwµqv _vKv m‡Ë¡I MÖnxZv‡K cÖwZw`b GKwU wcj †meb Ki‡Z AbycÖvwYZ Kiv cÖ‡qvRb| wcj †L‡Z fz‡j †M‡j
Mf©avi‡Yi SuywK ev‡o Ges wKQz cvk¦©-cÖwZwµqv AviI Lvivc n‡Z cv‡i| hw` K‡qK gvm a‡i wcj †meb K‡i _v‡Kb Ges
cvk¦©-cÖwZwµqv †_‡K hvq, hw` _v‡K Zvn‡j Zv‡K wfbœ digy‡jkb COC Gi w`b| bZzb wcj Kgc‡ÿ wZb gvm †meb
Ki‡Z ejyb| hw` wZwb Pvb, Zvn‡j Zv‡K Ab¨ c×wZ GLb MÖnY Ki‡Z A_ev mgm¨v †_‡K DËxY© n‡Z mvnvh¨ Kiæb

cÖme-cieZ©x cwievi cwiKíbv 99

 cvk¦©-cÖwZwµqv
ewg A_ev wSgwSg fve
(Nausea or dizziness)
¯Íb e¨_v
(Breast tenderness)
IRb cwieZ©b
(Weight change)
†gRvR cwieZ©b A_ev †hŠb B”Qvi
cwieZ©b
(Mood change or change in
sex drive)
eªY
(Acne)
AwbqwgZ i³cvZ (AcÖZ¨vwkZ
mg‡q i³cvZ hv
K¬v‡q›U‡K/MÖnxZv‡K wPšÍvq †d‡j)
(Irregular
bleeding/bleeding at
unexpected times that
bothers the client)
100 cÖme-cieZ©x cwievi cwiKíbv
e¨e¯’vcbv
ewgfve Gov‡Z Lvev‡ii mv‡_ A_ev †kvqvi mgq wgkÖ Lvevi ewo (COC) †meb
Kiæb, hw` DcmM© †_‡K hvq:
mvaviYfv‡e cÖwZKv‡ii K_v fveyb
hw` bZzb wc‡ji c¨v‡KU ïiæ Kivi ci ewg nq Zvn‡j `xN©Kvjxb e¨env‡ii
e¨vcv‡i wPšÍv Kiæb
l mv‡cvwU©f eªv civi (cwikÖghy³ KvR Ges Nygv‡bvi mgq I) wb‡`©kbv w`b
l Mig A_ev VvÛv †muK w`b
l A¨vmwcwib (325-650 wg. MÖv.), AvBey‡cÖv‡db (200-400 wg. MÖv.),
c¨vivwmUvgj (325-1000wg.MÖv) A_ev Ab¨ e¨_vbvkK civgk© w`b
l mvaviYfv‡e cÖwZKv‡ii K_v fveyb
Lv`¨ ZvwjKv ch©v‡jvPbv K‡i cÖ‡qvRbg‡Zv KvD‡Ýwjs Kiæb
l ni‡gvbwenxb mßv‡n wKQz bvixi †gRv‡R cwieZ©b †`Lv hvq (7 w`b hLb
GKRb bvix ni‡gvb mg„× wcj MÖnY K‡ib bv)| `xN©Kvj e¨envi Kivi Rb¨
ejyb
l Zvi Rxe‡b Ggb †KvbI cwieZ©b n‡q‡Q wK bv hv‡Z †gRvR A_ev †hŠb
B”Qvi cwieZ©b n‡Z cv‡i, msMxi mv‡_ m¤ú‡K©i cwieZ©b Gi g‡a¨
AšÍf©y³| cÖ‡qvRb Abyhvqx mnvqZv w`b
l †gRv‡Ri Zxeª cwieZ©b †hgb fxlY wW‡cÖmb/gvbwlK `ywðšÍv †`Lv w`‡j
†mevi Rb¨ †idvi Kiæb
l COC e¨env‡ii mv‡_ mvaviYZ fv‡jv nq, Kg msL¨K bvixi †ÿ‡Î AviI
Lvivc n‡Z cv‡i
l hw` K‡qK gvm a‡i wcj/Lvevi ewo †meb/MÖnY K‡i _v‡Kb Ges eªY †_‡K
hvq, hw` _v‡K Zv‡K wfbœ digy‡jk‡bi COC/ wgkÖ Lvevi ewo w`b| bZzb
wcj Kgc‡ÿ wZb gvm †meb Ki‡Z ejyb
l mvaviYfv‡e cÖwZKv‡ii K_v fveyb
l Zv‡K wbwðZ Kiæb †h COC/ wgkÖ Lvevi ewo e¨enviKvix A‡bK bvixi
AwbqwgZ i³cvZ n‡q _v‡K| GwU ÿwZKi bq Ges cÖ_g K‡qK gvm
e¨envi Kivi ci K‡g hvq A_ev eÜ n‡q hvq| AwbqwgZ i³cv‡Zi Ab¨vb¨
m¤¢ve¨ KviY:
- Lvevi ewo †L‡Z fz‡j †M‡j
- cÖwZw`b wfbœ mg‡q wcj †L‡j
- ewgfve Ges Wvqwiqv
- Gw›U Kbfvj‡m›U/wLPzwbi Jla A_ev widvgwcwmb †meb Ki‡j AwbqwgZ
i³cvZ Kgv‡bvi Rb¨
- cÖwZw`b GKB mgq GKwU K‡i wcj †L‡Z AbycÖvwYZ Kiæb
- wcj LvIqv bv n‡j, ewg ev Wvqwiqvi ci, Kxfv‡e Zv mwVKfv‡e c~iY Ki‡Z
nq Zv‡K wkwL‡q w`b|
- hLb AwbqwgZ i³ÿiY ïiæ nq, ¯^í †gqv‡` Av‡ivM¨ n‡Z, wZwb ˆ`wbK 3
†ejv Lvevi ci 5 w`‡bi Rb¨ 800 wg. MÖv. AvBey‡cÖv‡db A_ev Ab¨ †KvbI
(NSAID) †L‡Z cv‡ib| Bgúøv›U, †cÖv‡Rw÷b Ibwj B‡ÄK‡Uej Ges
IUCD Gi Rb¨ AwbqwgZ i³ÿiY n‡j NSAID Gi gva¨‡g wKQzUv
Av‡ivM¨ jvf Kiv hvq, †m¸‡jv G †ÿ‡ÎI DcKvix n‡Z cv‡i|
 bvixi cwiw¯’wZ
gvwmK i³ÿiY nq bv
(No monthly bleeding)
mvaviY gv_ve¨_v (bbgvB‡MÖbvm)
(Ordinary headaches
/non-migranous)
KvD‡Ýwjs
l hw` wZwb †ek K‡qK gvm †_‡K wcj †meb Ki‡Qb Ges NSAID mnvqK
n‡”Q bv, hw` _v‡K Zv‡K wfbœ digy‡jk‡bi COC w`b| bZzb wcj Kgc‡ÿ
wZb gvm †meb Ki‡Z ejyb
l hLb AwbqwgZ i³ÿiY Pj‡Z _v‡K A_ev K‡qK gvm ¯^vfvweK †_‡K
A_ev gvwmK bv nIqvi ci ïiæ nq A_ev Ab¨ †KvbI Kvi‡Y †KvbI
mgm¨v n‡”Q e‡j m‡›`n nq, e¨eüZ c×wZi mv‡_ m¤úwK©Z bq Ggb
AšÍ©wbwnZ cwiw¯’wZ¸‡jv we‡ePbv Kiæb| AbyMÖnc~e©K †idvi Kiæb|
l Zv‡K wRÁvmv Kiæb wbZvšÍ †KvbI i³ÿiY nq wK bv| Zvi nqZ AšÍe©v‡m
Lye mvgvb¨ `vM nq Ges gvwmK i³ÿiY wn‡m‡e eyS‡Z cv‡ib bv, G‡ÿ‡Î
Zv‡K Afq w`b|
l wKQz bvixi †ÿ‡Î COC/ wgkÖ Lvevi ewo e¨envi Ki‡j i³ÿiY eÜ n‡q
hvq, GwU ÿwZKi bq| cÖwZ gv‡m i³ÿiY nevi cÖ‡qvRb †bB| Mf©aviY
Kv‡j †hgb i³ÿiY nq bv, GwU Zvi g‡Zv| wZwb Abye©i bb| Zvi †fZ‡i
i³ ˆZwi n‡”Q bv (wKQz bvix gvwmK i³ÿiY nIqv †_‡K gyw³ †c‡j Lywk
nb)
l wZwb wK `ywU c¨v‡K‡Ui gv‡Si 7 w`b weiwZ w`‡q‡Qb (21 w`‡bi c¨v‡KU)
A_ev 7wU bb-ni‡gvbvj/ni‡gvbwenxb wcj (28 w`‡bi c¨v‡KU) ev`
w`‡q‡Qb? hw` Zv-B nq, Zv‡K wbwðZ Kiæb wZwb Mf©eZx bb, wZwb wgkÖ
Lvevi ewo (COC) e¨envi K‡i †h‡Z cv‡ib
l hw` wZwb wcj wb‡Z fz‡j hvb A_ev bZzb c¨v‡KU †`wi‡Z ïiæ K‡ib
(COC) wZwb e¨envi K‡i †h‡Z cv‡ib
l hw` GKRb bvix wZb ev Z‡ZvwaK wcj/Lvevi ewo wb‡Z fz‡j hvb A_ev
GKwU bZzb c¨v‡KU wZb ev Pvi w`b c‡i ïiæ K‡ib hw` Mf©avi‡Yi cÖviw¤¢K
jÿY I DcmM© †`Lv †`q Zvn‡j Zv‡K Avevi Avm‡Z ejyb|
wb‡Pi welq¸‡jv †Póv Kiæb (GKevi GKwU):
l A¨vmwcwib (325-650 wg.MÖv.), AvBey‡cÖv‡db (200-400 wg.MÖv.),
c¨vivwmUvgj (325-1000wg.MÖv) A_ev Ab¨ e¨_vbvkK civgk© w`b
ni‡gvbwenxb mßv‡n (7 w`b hLb GKRb bvix ni‡gvb mg„× wcj MÖnY K‡ib bv)
wKQz bvixi gv_ve¨_v n‡q _v‡K, COC/ wgkÖ Lvevi ewo e¨enviKv‡j †KvbI
cÖKvi gv_ve¨_v Zxeª A_ev †ewk n‡j g~j¨vqb Kiv DwPZ

d‡jvAvc

MÖnxZv †ivMx d‡jvAvc-Gi Rb¨ G‡j wRÁvmv I †PK Kiæb:

l Zvi wK GwU e¨envi Ki‡Z mnR †j‡M‡Q?
l †Kvb weiƒc cÖwZwµqv jÿ¨ K‡i‡Qb wK bv?
l Kxfv‡e wb‡Z n‡e wZwb ey‡S‡Qb wK bv?
l wcj †L‡Z fy‡j †M‡j wK Ki‡Z n‡e wZwb Rv‡bb wK bv?
l DB_Wªqvj weøwWs Gi cÖK…wZ wbqwgZ wK bv?
l †Kvb AwbqwgZ i³cvZ Av‡Q wK bv (BTB)?
l bZzb †gwW‡Kj wnw÷ª‡Z wKQz †hvM n‡q‡Q wK bv (†hgb. bZzb Ilya, A_ev mvgvwRK BwZnvm)?
l Mf©wb‡iv‡ai GLbI cÖ‡qvRbxqZv Av‡Q wK bv Ges wgkÖ ewo GLbI me‡P‡q mwVK I wbivc` c×wZ wK bv
l i³Pvc †PK Kiæb
l mvifvBKvj K¨vÝvi w¯Œwbs (VIA) A_ev wK¬wbKvj †eª÷ G·vwg‡bkb (CBE) evwK wK bv
l †ivMx‡K cÖkœ Kivi my‡hvM w`b

cÖme-cieZ©x cwievi cwiKíbv 101

 ïaygvÎ †cÖv‡Rw÷b mg„× Lvevi ewo

†cÖv‡Rw÷b Ibwj wcj(POP) ev wgwb wc‡j Lye Aí cwigv‡Y GK ai‡bi ni‡gvb †cÖv‡Rw÷b _v‡K| COC Gi Zzjbvq
†cÖv‡Rw÷b Gi A‡a©K †_‡K GK `kgvsk _v‡K| G¸‡jv ey‡Ki `ya `vbKvix gv‡q‡`i Rb¨ Lye Dc‡hvMx, `y‡ai cwigvY
Kgvq bv ey‡Ki `y‡ai wbf©i Rb¥weiwZKiY c×wZ Ges j¨vK‡Ukbvj A¨v‡g‡bvwiqvi Rb¨ AviI †ewk myiÿv jvf K‡i|
ÔAvcbÕ bv‡g RvZxq cwievi cwiKíbv Kvh©µ‡g †cÖv‡Rw÷b Ibwj wcj cvIqv hv‡”Q| †cÖv‡Rw÷b-Ibwj wcj (POP)
†KvbI weiwZ QvovB cÖwZw`b †L‡Z nq| K¤^vBÛ Iivj K›Uªv‡mcwUf wcj A_ev B‡÷ªv‡R‡bi †ÿ‡Î †hme bvixi
cvk¦©-cÖwZwµqv ev ÁvZ wb‡qavÁv i‡q‡Q, eqm 35 Gi Dci, hviv a~g cvb K‡ib, hv‡`i gvB‡MÖb gv_ve¨_v Av‡Q,
`ya`vbKvix gv‡qiv GB wcj e¨envi Ki‡Z cvi‡eb|

ïaygvÎ †cÖv‡Rw÷b mg„× Lvevi ewo (POP)

†cÖv‡Rw÷b Ibwj wcj (POP) Gi ÁvZ A_ev m‡›`nK…Z Mf©aviY Ges wbY©qnxb †hvwbc‡_ i³¯ªv‡ei Dcw¯’wZ e¨ZxZ
†KvbI Pig Ø›Ø †bB| †cÖv‡Rw÷b-Ibwj wcj (POP) Gi Mf© wb‡iv‡ai Kvh©KvwiZv ZË¡xqfv‡e 90 †_‡K 99 kZvsk|
m‡PZb bvixi †ÿ‡Î e¨_©Zvi nvi me‡P‡q Kg|

ïaygvÎ cÖ‡Rw÷bmg„× Rb¥weiwZKiY Lvevi ewo hv‡`i Rb¨ Dchy³

wb‡¤œ ewY©Z KviY ¸‡jv Qvov mKj mÿg gwnjv‡K cÖ‡Rw÷b mg„× Rb¥weiwZKiY Jla †`Iqv hv‡e|

‡h mKj Ae¯’vq cÖ‡Rw÷b mg„× Rb¥weiwZKiY ewo †`Iqv hv‡e bv|

l eZ©gv‡b AweevwnZ/weaev/ZvjvKcÖvß/¯^vgx †_‡K c„_K
l gwnjv hw` Mf©eZx nb
l ¯Í‡bi K¨vÝvi: eZ©gv‡b Av‡Q ev c~‡e© wQj
l eZ©gv‡b cv‡qi wkiv †dvjv ev e¨_v/cvj‡gbvwi G¨v‡¤^vwjRg Av‡Q
l wjfv‡ii †ivM- gvivZœK wm‡ivwmm, wjfv‡ii wUDgvi, K¨vÝvi
l Jl‡ai mv‡_ wg_w¯Œqv:
K. widvgwcwmb, wicv‡evwUb
L. wLuPzwbi Jla- †hgb †dbvBU‡qb, Kve©vgv‡RcvBb, eviwePz‡iUm, cÖvBwg‡Wvb, Uwciv‡gU, Aw·Kve©v‡RcvBb

Kxfv‡e cÖ‡Rw÷b mg„× Rb¥weiwZKiY Lvevi ewo e¨envi Ki‡Z nq

wbf©i‡hvM¨ djvd‡ji Rb¨ cÖwZw`b GKB mg‡q (wZb N›Uvi g‡a¨) wcj †meb Ki‡Z nq| GwU ¸iæZ¡c~Y© †h wgkÖ Lvevi
ewoi (OCP) g‡Zv †KvbI ewo †meb weiwZ †bB Ges 28 wU wc‡ji me¸‡jvB Kvh©Kix Ilya|

Kxfv‡e cÖ‡Rw÷b mg„× Rb¥weiwZKiY Lvevi ewo ïiæ Ki‡Z nq

l gvwm‡Ki 5g w`‡b
l ey‡Ki `ya cvb Kiv‡”Qb Ggb gv‡qiv cÖm‡ei ci ciB (48 N›Uvi g‡a¨) ïiæ Ki‡Z cv‡ib|
l ey‡Ki `ya cvb Kiv‡”Qb bv Ggb gv‡qiv †h‡Kvb mgq ïiæ Ki‡Z cv‡ib| hw` cÖm‡ei 4 mßv‡ni c‡i I gvwmK ïiæ
bv nq Zv‡K wbwðZ n‡Z n‡e wZwb Mf©eZx bb
l Mf©cv‡Zi 7 w`b ci †_‡K wcj ïiæ Kiv hv‡e
l wbqwgZ gvwmKPµ nIqv bvixiv gvwmK ïiæi 5 w`‡bi g‡a¨ ïiæ Ki‡Z cv‡ib, †KvbI mnvqK c×wZi cÖ‡qvRb †bB|
hw` gvwmK ïiæi 5 w`b ci †_‡K ïiæ K‡ib,ewo LvIqvi cieZ©x 7 w`‡bi Rb¨ KbWg e¨envi A_ev mnevm †_‡K
weiwZ wb‡Z n‡e|
l Ab¨ Mf©wb‡ivaK c×wZ eÜ Kivi ci ciB POP kyiæ Ki‡Z cv‡ib

102 cÖme-cieZ©x cwievi cwiKíbv

ïaygvÎ †cÖv‡Rw÷b mg„× ewo †L‡Z fz‡j †M‡j Kibxq

hw` GKwU wcj †L‡Z fz‡j hvq A_ev ewg I Wvqwiqv _v‡K, Kgc‡ÿ 48 N›Uv ch©šÍ †KvbI mnvqK Mf©wb‡ivaK c×wZ
(KbWg) Aek¨B e¨envi Ki‡Z n‡e| civgk© Abyhvqx ewo LvIqv Pvwj‡q wb‡Z n‡e

†iKW© iÿY I wi‡cvU© Kiv:

l wgkÖ Lvevi ewo (OCP) e¨enviKvix Ges weZi‡bi Z_¨ cwievi Kj¨vb mnKvix Zv‡`i †iwR÷ªv‡i Ges cwievi
Kj¨vb cwi`wk©Kv Lvevi ewo (FWV OCP) weZiY †iwR÷ªv‡i msiÿY/wjwce× Ki‡eb|
l cwievi Kj¨vY mnKvix wi‡cvU© Ki‡eb Gg AvB Gm dig 1 (MIS FORM 1) Gi gva¨‡g cwievi Kj¨vY cwi`wk©Kv
wi‡cvU© Ki‡eb Gg AvB Gm dig 3 (MIS FORM 3) Gi gva¨‡g

AviI Z‡_¨i Rb¨ AbyMÖn K‡i †`Lyb cwievi cwiKíbv g¨vbyqvj, Ryb 2018, Aa¨vq 04 c„ôv-31

cÖme-cieZ©x cwievi cwiKíbv 103

 Rb¥weiwZKiY Bb‡RKkb

Rb¥weiwZKiY Bb‡RKkb bvix‡`i Rb¨ evsjv‡`k RvZxq cwievi cwiKíbv Kvh©µ‡gi GKwU ˆÎgvwmK A¯’vqx cwievi
cwiKíbv c×wZ|

÷¨vÛvW© 12: †PKwj÷ e¨envi K‡i ‡mev`vbKvixMY Bb‡RKkb MÖn‡Yi Dchy³ MÖnxZv evQvB Ki‡Z cvi‡eb Ges
Bb‡RKkb Gi †WvR, Bb‡RKkb MÖnxZvi myweav, weiƒc cÖwZwµqv, BZ¨vw` c~Y©v½ e¨vL¨v Ki‡Z cvi‡eb †mB mv‡_
cvk¦©-cÖwZwµqv mbv³ K‡i e¨e¯’v A_ev †idvi Ki‡Z cvi‡eb| ‡mev`vbKvixM†Yi Z_¨ msiÿb Kiv DwPZ Ges
MÖnxZv‡K d‡jvAv‡ci Rb¨ wZb gvm ci Avevi Avm‡Z ejv DwPZ|

wek¦e¨cx `yB ai‡bi ïaygvÎ ‡cÖv‡Rw÷b mg„× Rb¥weiwZKiY Bb‡RKkb cvIqv hvq

1. wW‡cvU- wgWªw· †cÖv‡R÷ib Gwm‡UU hv DMPA wn‡m‡e cwiwPZ|

2. biBw_‡÷ib Bbvb‡_U A_ev ‡bU-Gb (NET-EN) hvi evwYwR¨K bvg bwi÷v‡iU (Noristerate) hv evsjv‡`‡ki
cwievi cwiKíbv Kvh©µ‡g Pvjy †bB|

†cÖv‡Rw÷b mg„× Rb¥weiwZKiY Bb‡RKkb †WvR

wW‡cv †cÖv‡fiv 150 wg.MÖv. wbZ‡¤^ ev EaŸ©evû‡Z Mfxi gvsm‡ckx‡Z Bb‡RKkb wn‡m‡e †`qv nq
1. cÖ_g †WvR gvwm‡Ki 5 w`‡bi g‡a¨ †`qv nq|
2. MÖnxZv Mf©eZx bb, GUv wbwðZ n‡j (†hgb, †kl gvwmK ‡_‡K mnevm K‡ib wb A_ev Ab¨ Kvh©Ki cwievi cwiKíbv
c×wZ mwVKfv‡e e¨envi Ki‡Qb) †h †KvbI mgq †`qv hvq
K) ey‡Ki `ya LvIqv‡Z _vK‡j cÖm‡ei Qq mßvn cvi n‡j
L) ey‡Ki `ya bv LvIqv‡j, cÖm‡ei ci ciB
3. Mf©cv‡Zi 7 w`‡bi g‡a¨
4. gvwmK wbqwgZKi‡Yi 7 w`‡bi g‡a¨
5. †KvbI AvaywbK cwievi cwiKíbv c×wZ eÜ Kivi ci ciB †`qv hvq

MÖnxZv evQvB:
cÖ_g evi †`qvi Av‡M MÖnxZvi e¨w³MZ, cÖRbb Ges †gwW‡Kj BwZnvm wb‡q kvixwiK cixÿv Ki‡Z n‡e| MÖnxZvi †bv‡U
BwZnvm Ges kvixwiK cixÿv †_‡K cÖvß Z_¨ †iKW© Ki‡Z n‡e|

Rb¥weiwZKiY Bb‡RKkb hv‡`i Rb¨ Dchy³

wb‡¤œ ewb©Z Kvib ¸‡jv Qvov mKj mÿg gwnjv‡K Rb¥weiwZKiY Bb‡RKkb †`Iqv hv‡e|

†h mKj Ae¯’vq Rb¥weiwZKiY Bb‡RKkb †`Iqv hv‡e bv

l eZ©gv‡b AweevwnZ/weaev/ZvjvKcÖvß/¯^vgx †_‡K c„_K
l gwnjv hw` Mf©eZx nb
l hv‡`i †Kvb mšÍvb †bB
l cÖme cieZ©x mg‡q †h me gwnjv wkï‡K ey‡Ki `ya cvb Kivb-cÖme cieZ©x mgq n‡Z < 6 mßvn
l ürwcÛ I i³ msenbbvwji †ivM-e¨vwai GKvwaK SzuwK we`¨gvb (‡hgb: †ewk eqm, a~gcvb, ZvgvKcvZv/R`©v †meb,
Wvqv‡ewUm, D”P i³Pvc, i‡³ D”P gvÎvq Pwe© BZ¨vw`)
l ¯Í‡bi K¨vÝvi: eZ©gv‡b Av‡Q ev c~‡e© wQj
l D”P i³Pvc: wm÷wjK ≥ 160 wg. wg. cvi`, Wvqv÷wjK ≥ 100 wg. wg. cvi`
l eZ©gv‡b cv‡qi wkiv †dvjv ev e¨_v/cvj‡gvbvwi G¨v‡¤^vwjRg (DVT/PE) Av‡Q
l eZ©gv‡b Bm‡KwgK n«`‡ivM AvµvšÍ ev c~‡e© GB †iv‡M AvµvšÍ n‡qwQj
l c~‡e© †Kvb mg‡q †÷ªvK n‡q _vK‡j
l ‡hvwbc_ i³mªve-hvi KviY Rvbv bvB
l wjfv‡ii †ivM-gvivZœK wm‡ivwmm, wjfv‡ii wUDgvi, K¨vÝvi

104 cÖme-cieZ©x cwievi cwiKíbv

l Wvqv‡ewUm-RwUjZv we`¨gvb †bd‡ivc¨vw_/‡iwU‡bvc¨vw_, i³ msenbbvvwji Ab¨vb¨ e¨vwa, A_ev 20 eQi I Zvi †ewk
mgq a‡i Wvqv‡ewU‡m AvµvšÍ

Rb¥weiwZKiY Bb‡RKk‡bi myweav

l myweavRbK, eQ‡i gvÎ Pvi evi w`‡Z nq
l Lye Kvh©Ki
l A¯’vqx c×wZ †Q‡o w`‡j Mf©aviY Kiv hvq/ cÖwZeZ©b‡hvM¨
l gvwmK eÜ _vKv/gvwm‡Ki mgq AwZwi³ i³ÿib, gvwm‡Ki mgq †gvPov‡bv e¨_v Ges Avqi‡bi AfveRwbZ
i³¯^íZv Ae¯’vi Dbœqb NUv‡Z cv‡i|RxebhvÎvi AvKvw•ÿZ cwieZ©b n‡Z cv‡i, AwZwi³ IRbavix bvix‡`i
wWmdvskbvj wgÝUªyqvj weøwWs Gi SuywK Kgv‡Z cv‡i|
l DMPA†Z B‡÷ªv‡R‡bi Abycw¯’wZi Kvi‡Y a~gcvqx, 35 eQ‡ii †ewk eqmx, ey‡Ki `ya cvb Kiv‡”Qb Ggb gv Ges
hv‡`i B‡÷ªv‡R‡bi wb‡lavÁv Av‡Q Zv‡`i Rb¨ h_vh_|
l G‡Ûv‡gwUªqvj K¨vÝv‡ii Su~wK 80 kZvsk ch©šÍ n«vm K‡i, eÜ Kivi c‡iI avivevwnKfv‡e myiÿv †`q
(WHO-medical eligibility criteria)
l wm‡Kj †mj A¨vwbwgqvi †ivMx‡`i mgm¨vi msL¨v I ZxeªZv Kgv‡Z cv‡i (WHO-medical eligibility criteria)
l wLuPzwbi cybive„wËi nvi Kgvq Ges g„Mx‡iv‡Mi Ily‡ai mv‡_ cÖwZwµqv †bB

Rb¥weiwZKiY Bb‡RKk‡bi Amyweav

l RwUjZv Ges cvk¦©cÖwZwµqv mv‡_ mv‡_ eÜ nq bv| Bb‡RKk‡bi Kvh©Kix Kvj ch©šÍ G¸‡jv _vK‡Z cv‡i, hv Kgc‡ÿ
wZb gvm
l eÜ Ki‡j De©iZv wd‡i Avm‡Z mgq jv‡M
l cÖvqB cvk¦©-cÖwZwµqv nq, we‡kl K‡i gvwm‡K Awbqg
l nv‡oi NbZ¡ Kgv‡Z cv‡i
l GBWmmn †hŠbevwnZ msµg‡Yi †ÿ‡Î †KvbI myiÿv †`q bv

cÖwµqv
l MÖnxZv‡K cwievi cwiKíbv Kvh©µ‡g cÖPwjZ Rb¥weiwZKi‡Yi mKj cwim‡ii c×wZ †`Lvb|
l MÖnxZv‡K Bb‡RK‡Uej m¤ú‡K© ejyb; Kxfv‡e KvR K‡i, Kvh©KvwiZvi e¨wßKvj, cvk¦©-cÖwZwµqv, Ges mZK©Zv wPýmg~n
Ges d‡jvAvc wfwRU m¤ú©‡K
l MÖnxZv‡K Bb‡RK‡Ue‡ji †PKwjó e¨envi K‡i hvPvB Kiæb
l Bb‡RKkb cÖ‡qvM Kivi mgq, Bb‡RKkb †`qvi RvqMvwU A¨vw›U‡mcwUK w`‡q gy‡Q w`b (e„ËvKvifv‡e †fZi †_‡K
evwn‡i)| fvqvj nvjKv SuvwK‡q wbb Ges wmwiÄwU cy‡iv cwigvb w`‡q c~Y© Kiæb| †fë‡qW A_ev MøywUqvj
gvsm‡ckx‡Z/EaŸ©evû ev wbZ‡¤^i Mfx‡i RxevYygy³ muyBwU cÖ‡ek Kivb Ges ax‡i-ax‡i cy‡iv cwigvY Bb‡R±/cÖ‡qvM
Kiæb
l Bb‡RKkb †`qvi RvqMvwU g¨v‡mR Ki‡eb bv
l cÖwµqvbyhvqx muyBwU †mdwU e‡· (Safety Box) †d‡j w`b
l MÖnxZv‡K e‡j w`b Bb‡RKkb †`qvi RvqMvwU bv Nl‡Z
l Bb‡RK‡Ue‡ji cieZ©x †Wv‡Ri ZvwiL w`b

d‡jvAvc wfwR‡Ui mgq, cvk¦©-cÖwZwµqvi †KvbI jÿY †`Lv †M‡j h_vh_fv‡e KvD‡Ýwjs Kiæb| MÖnxZv‡K Rvbvb †h cÖ`Ë
Zvwi‡Li `yB mßv‡ni Av‡M A_ev Pvi mßvn ch©šÍ B‡ÄKkb †`qv hv‡e hw` wZwb wnmveK…Z Zvwi‡L bv Avm‡Z cv‡ib, wKš‘
GwU wbqwgZ PP©v Kiv hv‡e bv|

cÖme-cieZ©x cwievi cwiKíbv 105

 QK: Rb¥weiwZKiY Bb‡RKkb KLb ïiæ Ki‡Z n‡e
bvixi cwiw¯’wZ
gvwmKPµ Pj‡Q A_ev GKwU
ni‡gvbwenxb c×wZ †_‡K gv‡mi †h
†KvbI mgq cwieZ©b Ki‡Qb
ni‡gvb mg„× c×wZ †_‡K cwieZ©b
ïaygvÎ A_ev ey‡Ki `ya cvb
Kiv‡”Qb Ggb gv‡q‡`i Rb¨
ey‡Ki `ya cvb Kiv‡”Qb bv Ggb
gv‡q‡`i Rb¨
gvwmK i³ÿiY †bB
Mf©cv‡Zi ci
106 cÖme-cieZ©x cwievi cwiKíbv
KLb ïiæ Ki‡Z n‡e
l hw` Zvi gvwm‡Ki 7 w`‡bi g‡a¨ ïiæ K‡ib Z‡e †KvbI mnvqK c×wZi
`iKvi †bB
l hw` Zvi gvwm‡Ki 7 w`‡bi †ewk nq wZwb hw` m¤ú~Y© wbwðZ _v‡Kb †h wZwb
Mf©eZx bb Z‡e †h †KvbI mgq Rb¥weiwZKiY Bb‡RKkb kyiæ Ki‡Z
cvi‡eb| Bb‡RKkb MÖn‡Yi cÖ_g mvZ w`b ch©šÍ Zvi mnvqK c×wZi*
cÖ‡qvRb n‡e|
l hw` MÖnxZv IUCD †_‡K cwieZ©b Ki‡Qb mv‡_ mv‡_ Bb‡RK‡Uej ïiæ
Ki‡Z cvi‡eb|
l †KvbI bvix hw` avivevwnK I mwVKfv‡e ni‡gvb mg„× c×wZ e¨envi K‡i
_v‡K A_ev m¤ú~Y© wbwðZ _v‡Kb †h wZwb Mf©eZx bb Z‡e ZvrÿwYKfv‡e kyiæ
Ki‡Z cvi‡eb| cieZ©x gvwm‡Ki Rb¨ A‡cÿv Kivi `iKvi †bB| †KvbI
mnvqK c×wZi `iKvi †bB
l hw` wZwb Av‡iKwU Bb‡RK‡Uej †_‡K cwieZ©b K‡ib, cieZ©x Bb‡RKkb
†`qvi m¤¢ve¨ mg‡q wZwb bZzb Bb‡RK‡Uej wb‡Z cvi‡eb| †KvbI mnvqK
c×wZi `iKvi †bB|
hw` cÖm‡ei Qq gvm c~b© bv nq
l hw` wZwb 6 mßv‡ni Kg mgq c~‡e© cÖme K‡ib, Kgc‡ÿ 6 mßvn bv nIqv
ch©šÍ cÖ_g Bb‡RKkb w`‡Z †`wi Kiyb
l hw` gvwmK ïiæ bv nq, wZwb cÖm‡ei 6 mßvn †_‡K 6 gv‡mi g‡a¨ †h †KvbI
mgq Bb‡RKkb ïiæ Ki‡Z cvi‡eb| †KvbI mnvqK c×wZi `iKvi †bB|
l hw` gvwmK nq, wZwb gvwmK nIqv bvixi Rb¨ civgk© Abymv‡i Rb¥weiwZKiY
Bb‡RKkb ïiæ Ki‡Z cvi‡eb|
hw` cÖm‡ei 6 gv‡mi AwaK nq, gvwmK ïiæ bv nq hw` wZwb m¤ú~Y© wbwðZ †h
Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q Bb‡RK‡Uej ïiæ Ki‡Z cvi‡eb.
Bb‡RKkb ‡`qvi cÖ_g mvZ w`b ch©šÍ Zv‡K mnvqK c×wZ MÖnY Ki‡Z n‡e| hw`
wZwb m¤ú~Y© wbwðZ bv n‡q _v‡Kb †h Mf©aviY K‡ibwb Zvn‡j wgkÖ Lvevi ewo
w`‡q cieZ©x gvwmK ïiæ n‡j Rb¥weiwZKiY Bb‡RKkb ïiæ Ki‡Z ejyb| hw`
gvwmK n‡q hvq Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx Rb¥weiwZKiY
Bb‡RKkb ïiæ Ki‡Z cvi‡eb|
l hw` cÖm‡ei Pvi mßv‡ni Kg n‡q hvq, wZwb Bb‡RK‡Uej †h †KvbI mg‡q
ïiæ Ki‡Z cvi‡eb| †KvbI mnvqK c×wZi `iKvi †bB|
l hw` cÖmei Pvi mßv‡ni AwaK nq, gvwmK ïiæ bv nq, hw` wZwb m¤ú~Y© wbwðZ
†h Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q Bb‡RK‡Uej ïiæ Ki‡Z
cvi‡eb| Bb‡RKkb †`qvi cÖ_g mvZ w`b ch©šÍ Zv‡K mnvqK c×wZ MÖnY
Ki‡Z n‡e|
hw` gvwmK n‡q hvq Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx
Rb¥weiwZKiY Bb‡RKkb ïiæ Ki‡Z cvi‡eb|
l hw` wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q
Rb¥weiwZKiY Bb‡RKkb ïiæ Ki‡Z cvi‡eb| Bb‡RKkb †`qvi cÖ_g 7
w`b ch©šÍ Zvi mnvqK c×wZi cÖ‡qvRb n‡e|
 bvixi cwiw¯’wZ
Riæix Rb¥weiZxKib Lvevi ewo/
Bgv‡R©wÝ K›Uªv‡mcwUf wcj (ECP)
†me‡bi ci
KvD‡Ýwjs
l GKRb bvix ZvrÿwYKfv‡e ïiæ Ki‡Z cvi‡eb| hw` cÖ_g A_ev wØZxq
UªvB‡g÷v‡i Mf©cvZ nIqvi ci wZwb 7 w`‡bi g‡a¨ ïiæ K‡ib Zvn‡j †KvbI
mnvqK c×wZi `iKvi †bB|
l hw` cÖ_g A_ev wØZxq UªvB‡g÷v‡i Mf©cvZ nIqvi ci wZwb 7 w`‡bi †ewk
mgq n‡q _v‡K, Zvn‡j wZwb Mf©aviY K‡ibwb GwU hyw³m½Zfv‡e wbwðZ
n&Iqvi ci †h †KvbI mg‡q Bb‡RK‡Uej ïiæ Ki‡Z cvi‡eb| Bb‡RKkb
†`qvi cÖ_g 7 w`b ch©šÍ Zvi mnvqK c×wZi cÖ‡qvRb n‡e|
l ECP †me‡bi w`b †_‡KB A_ev PvB‡j gvwm‡Ki 7 w`‡bi g‡a¨ wZwb
Rb¥weiwZKiY Bb‡RKkb kyiæ Ki‡Z cv‡ib
l Bb‡RKkb †`qvi cÖ_g 7 w`b mnvqK c×wZ cÖ‡qvRb n‡e
l hw` gvwmK bv n‡q Mf©avi‡Yi jÿY I DcmM© †`Lv †`q, Zvn‡j Zv‡K Avevi
Avm‡Z n‡e

* mnvqK c×wZi (Backup methods) g‡a¨ i‡q‡Q weiZ _vKv, KbWg, ¯úvwg©mvBW Ges AvRj| Zv‡K ejyb
¯úvwg©mvBW Ges cÖZ¨vnvi/ AvRj me‡P‡q Kg Kvh©Ki Mf©wb‡ivaK c×wZ| m¤¢e n‡j Zv‡K KbWg w`b|

l wbw`©ó wb‡`©kbv w`b-Bb‡RKkb †`qvi RvqMvwU g¨v‡mR Ki‡eb bv| MÖnxZv‡K Bb‡RKk‡bi bvg ejyb Ges wbw`©ó
GKwU Zvwi‡L cieZ©x Bb‡RKkb †`qvi Rb¨ Avm‡Z m¤§Z Kiæb|

Rb¥weiZxKiY Bb‡RKkb Gi mvaviY cvk¦©-cÖwZwµqv Ges e¨e¯’vcbv

l cÖ_g K‡qK gvm AwbqwgZ i³ÿiY, cÖjw¤^Z i³ÿiY, Nb Nb i³ÿiY n‡Z cv‡i
l c‡i gvwmK i³ÿiY nq bv
l IRb e„w× (eQ‡i 1-2 †KwR), gv_ve¨_v, wSgwSgfve Ges m¤¢ve¨ Ab¨vb¨ cvk¦©-cÖwZwµqv n‡Z cv‡i |

cvk¦©-cÖwZwµqv m¤ú‡K© e¨vL¨v Ñ cvk¦©-cÖwZwµqv Amy¯’Zvi jÿY bq, cvk¦©-cÖwZwµqv mvaviY e¨vcvi,wKš‘ wKQz bvixi †KvbI
cvk¦©-cÖwZwµqv nq bv| cvk¦©-cÖwZwµqv wb‡q wPwšÍZ n‡j MÖnxZv‡K mvnv‡h¨i Rb¨ Avevi Avm‡Z cv‡ib|
i³ÿi‡Yi aib cwieZ©b Ges Ab¨vb¨ cvk¦©-cÖwZwµqv m¤ú‡K© Bb‡RKkb †`qvi Av‡M m¤ú~Y©fv‡e KvD‡Ýwjs Ki‡Z n‡e|
GKRb bvix c×wZwU e¨envi Ki‡Z _vKvi Rb¨ i³ÿi‡Yi aib cwieZ©b wb‡q KvD‡Ýwjs me‡P‡q ¸iæZ¡c~Y© mvnvh¨ n‡Z
cv‡i|

cvk¦©-cÖwZwµqv e¨e¯’vcbv:

†hme mgm¨v cvk¦©-cÖwZwµqv wn‡m‡e Awf‡hvMK…Z Ñcvk¦©-cÖwZwµqv c×wZi Rb¨ n‡ZI cv‡i bvI n‡Z cv‡i|
cvk¦©-cÖwZwµqvi Rb¨ m„ó mgm¨v¸‡jv MÖnxvi mš‘wó Ges c×wZ e¨env‡i cÖfve †d‡j| Gme †ÿ‡Î †mevKg©xi g‡bv‡hvM †`qv
cÖ‡qvRb| hw` MÖnxZv cvk¦©-cÖwZwµqv A_ev mgm¨v¸‡jv wb‡q Awf‡hvM K‡i, Zvi D‡Ø‡Mi welq¸‡jv ïbyb, Zv‡K civgk©
w`b Ges cÖ‡qvRb n‡j wPwKrmv w`b| hw` mgm¨v n‡Z DËxY© bv nb A_ev MÖnxZvi B”Qvbyhvqx Zv‡K Ab¨ c×wZ cQ‡›`
mvnvh¨ Kiæb|

cÖme-cieZ©x cwievi cwiKíbv 107

 bvixi cwiw¯’wZ
gvwmK i³ÿiY †bB
(No monthly bleeding)
AwbqwgZ i³cvZ
(AcÖZ¨vwkZ mg‡q i³cvZ hv
MÖnxZv‡K wPšÍvq †d‡j)
(Spotting or irregular
bleeding/ Bleeding at
unexpected times that
bothers the client)
Zxeª A_ev cÖjw¤^Z i³ÿiY
(mvaviY mg‡qi †P‡q wظY cwigvY
A_ev 8 w`‡bi †ewk)
(Heavy or prolonged
bleeding/ Twice as much
as usual or longer than
eight days)
gvB‡MÖb gv_ve¨_v
(Migraine headaches)
†hvwbc‡_ Ae¨vL¨vZ i³ÿiY
(c×wZwUi mv‡_ m¤úwK©Z bq Ggb
†KvbI Amy¯’Zv n‡Z cv‡i)
(Unexplained vaginal
bleeding/ That suggests a
medical condition not
related to the method)
108 cÖme-cieZ©x cwievi cwiKíbv
KLb ïiæ Ki‡Z n‡e
l Afq w`b †h Rb¥weiZxKib Bb‡RKkb e¨enviKvix †ewkifvM bvixi
i³ÿiY eÜ n‡q †h‡Z cv‡i Ges GUv ÿwZKi bq
l cÖwZ gv‡m i³ÿiY nevi cÖ‡qvRb †bB| Mf©aviY Kv‡j †hgb i³ÿiY nq
bv, GwU Zvi g‡Zv| wZwb Abye©i bb| Zvi †fZ‡i i³ÿi‡bi cwi‡ek ‰Zwi
n‡”Qbv (wKQz bvix gvwmK i³ÿiY nIqv †_‡K gyw³ †c‡j Lywk nb)
l hw` gvwmK i³ÿiY bv nIqv Zv‡K wPšÍvq †d‡j, Z‡e wZwb Ab¨ †KvbI
c×wZ‡Z cwieZ©b Ki‡Z cv‡ib|
l Zv‡K wbwðZ Kiæb †h ïaygvÎ ‡cÖv‡Rw÷b mg„× Rb¥weiwZKiY Bb‡RKkb
e¨enviKvix A‡bK bvixi AwbqwgZ i³cvZ n‡q _v‡K| GwU ÿwZKi bq
Ges cÖ_g K‡qK gvm e¨envi Kivi ci K‡g A_ev eÜ n‡q hvq|
l AwbqwgZ i³cv†Zi Ab¨vb¨ m¤¢ve¨ KviY hvPvB Kiæb †hgb f¨vRvBwbwUm,
Rivqy K¨vÝvi, STI BZ¨vw`i †KvbIwU hw` _v‡K, Zvn‡j wPwKrmv w`b|
msµgY, STI _vK‡jB Rb¥weiwZKiY Bb‡RKkb e¨envi Pvwj‡q †h‡Z
cvi‡eb|
l i³ÿiY wbqš¿‡Y, ¯^í gvÎvi wgkÖ Lvevi ewo cÖwZw`b 1wU K‡i 21 w`b
†me‡bi civgk© w`b
l ïaygvÎ ‡cÖv‡Rw÷b mg„× Rb¥weiwZKiY Bb‡RKkb e¨enviKvix A‡bK bvixi
†ÿ‡Î Zxeª A_ev `xN©vwqZ i³ÿiY n‡q _v‡K| GwU mvaviYZ ÿwZKviK bq
Ges cÖ_g K‡qK gvm e¨env‡ii ci mvaviYZ K‡g A_ev eÜ n‡q hvq |
l RTI/Rivqyi K¨vÝvi n‡q‡Q wK bv hvPvB Ki‡Z n‡e- hw` i³¯^íZv nq,
Avqib U¨ve‡jU Ges Avqibhy³ Lvevi †L‡Z civgk© w`b
l i³ÿiY wbqš¿‡Y ¯^í gvÎvi wgkÖ Lvevi ewo cÖwZw`b 1wU K‡i 21wU U¨ve‡jU
†me‡bi civgk© w`b Ges Zv 2-3wU Pµ ch©šÍ Pvwj‡q †h‡Z n‡e
l ZviciI wbqš¿‡Y bv Avm‡j 30-50 gvB‡µvMÖvg Bw_wjb B÷ªvwWIj 7 †_‡K
21 w`‡bi Rb¨ Ges U¨ve‡jU AvBey‡cÖv‡db 400 wg.MÖv. 1wU U¨ve‡jU 12 NÈv
ci ci 7 w`‡bi Rb¨ LvIqvi ci †me‡bi civgk© w`b| hw` MÖnxZvi †ccwUK
Avjmvi _v‡K cÖ‡qvRbxq e¨e¯’v MÖnY Kiæb|
l hw` GKRb bvixi ¯œvqweK DcmM© Qvov gvB‡MÖb gv_ve¨_v _v‡K, Zvn‡j wZwb
PvB‡j c×wZwU Pvwj‡q †h‡Z cv‡ib|
l hw` ¯œvqweK DcmM©mn gvB‡MÖb nq Zvn‡j Zv‡K Bb‡RKkb w`‡eb bv
l †idvi Kiæb A_ev wnw÷ª, †cjwfK cixÿv K‡i g~j¨vqb Kiæb, †ivM wbY©q
K‡i h_vh_ wPwKrmv Kiæb|
l hw` i³ÿiY Gi †KvbI KviY bv cvIqv hvq, ïaygvÎ ‡cÖv‡Rw÷b mg„×
Rb¥weiwZKiY Bb‡RKkb eÜ Kivi wPšÍv Kiæb hv‡Z †ivM wbY©q Kiv mnR
n‡q hvq| cwiw¯’wZ g~j¨vwqZ Ges wPwKrmv nIqvi AvM ch©šÍ Zv‡K Zvi cQ›`
g‡Zv Av‡iKwU c×wZ (Bgcø¨v›U A_ev Kcvihy³ A_ev ni‡gvbvbvj
AvBBDwmwW Qvov) e¨envi Ki‡Z w`b
l hw` †hŠbevwnZ msµgY A_ev †cjwfK cÖ`v‡ni Rb¨ i³ÿiY n‡q _v‡K
Zvn‡j wZwb wPwKrmvi mgq ïaygvÎ ‡cÖv‡Rw÷b mg„× Rb¥weiwZKiY
Bb‡RKkb e¨envi Pvwj‡q †h‡Z cvi‡eb
 bvixi cwiw¯’wZ KvD‡Ýwjs
wbw`©ó m¼URbK ¯^v¯’¨ Ae¯’v l Rb¥weiwZKib Bb‡RKkb Gi evKx †WvR w`‡eb bv
(aviYvK…Z eÜ ev miæ n‡q hvIqv l cwiw¯’wZ g~j¨vwqZ nIqvi AvM ch©šÍ Zv‡K mnvqK c×wZ w`b
agwb,hK…Z †ivM, Zxeª D”P i³Pvc, l †ivMwbY©q I wPwKrmvi Rb¨ †idvi Kiæb hw` wPwKrmvaxb bv _v‡Kb
cv A_ev dzmdz‡mi Mfx‡i
wkivmg~‡n i³RgvU, †÷ªvK, ¯Íb
K¨vÝvi A_ev Wvqv‡ewUKmwRbZ
RwUjZv-‡bd‡ivc¨vw_, †iwU‡bvc¨vw_,
wbD‡ivc¨vw_ A_ev i³msenbbvjxi
Ab¨vb¨ e¨vwa)
(Certain serious health
conditions)
Mf©aviY K‡i‡Qb aviYv n‡j l Mf©aviY K‡i‡Qb wKbv g~j¨vqb Kiæb| Mf©aviY wbwðZ n‡j Bb‡RKkb eÜ
(Suspected pregnancy) Kiæb|
l Rb¥weiwZKib Bb‡RKkb e¨env‡i Mf©¯’ 僇Yi †KvbI ÁvZ SuywK †bB|

wejw¤^Z Bb‡RKkb e¨e¯’vcbv

l DMPA Bb‡RKkb cieZ©x wWD †Wv‡Ri ci 4 mßvn ch©šÍ †`Iqv hvq|
l GKRb MÖnxZvi DMPA Bb‡RKkb 4 mßv‡ni †ewk †`wi n‡j cieZ©x Bb‡RKkb w`‡Z cvi‡eb hw` ev`/fy‡j hvIqv
Bb‡RKk‡bi mg‡qi 2 mßvn ch©šÍ wZwb hw` mnevm bv K‡ib A_ev wZwb mnvqK c×wZ e¨envi K‡i‡Qb A_ev 2
mßv‡ni g‡a¨ AiwÿZ mnev‡mi ci Riæix Rb¥weiZxKib ewo (ECP) wb‡q‡Qb A_ev wZwb m¤ú~Y© ev cÖvq m¤ú~Y©fv‡e
¯Íb¨`vb wkï‡K ey‡Ki `ya cvb KivbGes cÖm‡ei 6 gvm c~Y© nqwb|
l Bb‡RKkb †`qvi cÖ_g mvZ w`b ch©šÍ Zvi mnvqK c×wZi cÖ‡qvRb n‡e| hw` MÖnxZvi DMPA B‡ÄKk‡bi 4
mßv‡ni †ewk †`wi nq Ges Dc‡ii ˆewkó¨ c~iY bv K‡ib, wZwb Mf©eZx wK bv Zv m¤ú~Y© hvPvB Ki‡Z evowZ avc †hvM
Kiv †h‡Z cv‡i (Mf©eZx mbv³KiY QK †`Lyb) GB avc¸‡jv cÖ‡qvRbxq KviY †cÖv‡Rw÷b Ibwj Bb‡RKkb
e¨enviKvix A‡bK bvixi Kgc‡ÿ wKQz gvm gvwmK i³ÿiY nq bv, GgbwK Ilya eÜ Kivi c‡iI| cieZ©x FZz¯ªv‡ei
mgq Zv‡K Avm‡Z ejv gv‡b Zvi cieZ©x Bb‡RKkb MÖnY AKvi‡Y †`wi n‡Z cv‡i| ‡m nq‡Zv Rb¥weiwZKiY c×wZ
MÖnY e¨ZxZ _vK‡Z cv‡ib|
l †Kb MÖnxZvi †`wi n‡q‡Q Ges mgvavb wK Av‡jvPbv Kiæb| Zv‡K g‡b Kwi‡q w`b cÖwZ wZb gv‡m DMPA Gi Rb¨
Zvi c~bivq Avmvi †Póv Kiv DwPZ| hw` mgqg‡Zv Avm‡Z cÖvq mgm¨v nq, cieZ©x Bb‡RKkb w`‡Z †`wi n‡j mnvqK
c×wZ e¨envi, ECP †meb A_ev Ab¨ c×wZ evQvB Kiv m¤ú‡K© Av‡jvPbv Kiæb|
l ‡Kvb MÖnxZvi †`ix n‡j Kvib Ges mgvavb wb‡q Av‡jvPbv Kiæb|

d‡jvAvc wfwRU
†hme †K›`ª n‡Z Rb¥weiZwKiY Bb‡RKkb †`qv n‡q‡Q †mLvb †_‡K Bb‡RK‡Ue‡ji MÖnxZv‡`i d‡jvAvc wbwðZ Kiv
cÖ‡qvRb| †hgb †gwW‡Kj K‡jR nvmcvZv‡ji g‡Wj wK¬wbK, †Rjv nvmcvZvj, gv I wkï ¯^v¯’¨ †K›`ª (MCWC),
Dc‡Rjv ¯^v¯’¨ †K›`ª (UHC), BDwbqb ¯^v¯’¨ Ges cwievi Kj¨vY †K›`ª ((UH&FWC), KgywbwU wK¬wbK (CC) Ges
m¨v‡UjvBU wK¬wbK (SC)| KviY d‡jvAv‡ci mgq, cvk¦© cÖwZwµqv¸‡jv Kgv‡bv hvq Ges MÖnxZvi Rb¨ MÖnY‡hvM¨ Kiv hvq|
MÖnxZv‡`i Bb‡RK‡Uej †`qvi mgq Ges ¯’vb Rvwb‡q Bb‡RK‡Uejej MÖnxZv‡`i S‡i covi nvi Kgv‡bv m¤¢e |
l MÖnxZv‡K wR‡Ám Kiæb c×wZwU e¨envi Ki‡Z †Kgb jvM‡Q, wZwb mš‘ó wK bv, Zvi †KvbI cÖkœ A_ev †KvbwKQy
Av‡jvPbv Kivi Av‡Q wK bv|
l we‡kl K‡i wR‡Ám Kiæb Zvi gvwmK i³ÿi‡Yi cwieZ©b wb‡q †KvbI mgm¨v Av‡Q wK bv,cÖ‡qvRb Abyhvqx Zv‡K Z_¨
ev mnvqZv w`b|
l Zv‡K Rb¥weiwZKib c×wZ w`b
l DMPA Bb‡RKkb wWD †Wv‡Ri cieZx© 4 mßv‡ni g‡a¨ †`qv hvq|

cÖme-cieZ©x cwievi cwiKíbv 109

 l cieZ©x Bb‡RKkb †`qvi cwiKíbv Kiæb
l cieZ©x Bb‡RKk‡bi ZvwiL wbav©iY Kiæb (DMPA Gi Rb¨ 3 gvm ev 13 mßvn)
l g‡b Kwi‡q w`b Zvi mgqg‡Zv Avmvi †Póv Kiv DwPZ wKš‘ †`wi n‡j hZ †`wiB †nvK bv †Kb Zvi Avmv DwPZ
l cÖwZ eQi i³Pvc cixÿv/wbY©q Ki‡Z n‡e
l `xN©‡gqv‡`i MÖnxZv‡K wR‡Ám Kiæb †kl wfwR‡Ui ci Zvi bZzb †KvbI ¯^v¯’¨ mgm¨v n‡q‡Q wK bv| mgm¨v¸‡jv
h_vh_fv‡e D‡jøL Kiæb|
l `xN©‡gqv‡`i MÖnxZv‡K wR‡Ám Kiæb Rxe‡b †KvbI eo cwieZ©b n‡q‡Q wK bv hv mšÍvb MÖn‡Yi cwiKíbv Ges
STI/HIV SuywK‡Z cÖfve †dj‡Z cv‡i| cÖ‡qvRb g‡Zv d‡jvAvc Kiæb|

†iKW© iÿY Ges wi‡cvwU©s:

l Bb‡RK‡Uej Mf©wb‡ivaK e¨enviKvix Ges d‡jvAvc †iKW© cwievi Kj¨vY mnKvix (FWA) Zv‡`i †iwR÷v‡i Ges
cwievi Kj¨vY cwi`wk©KvMY (FWV) cwievi Kj¨vY cwiPvwjKv Bb‡RK‡Uej Mf©wb‡ivaK diIqvW© †iwR÷v‡i †iKW©
Ki‡eb|
l cwievi Kj¨vY mnKvix wi‡cvU© Ki‡eb Gg AvB Gm dig 1 (MIS FORM 1) Gi gva¨‡g cwievi Kj¨vY cwi`wk©Kv
wi‡cvU© Ki‡eb Gg AvB Gm dig 3 (MIS FORM 3) Gi gva¨‡g

AviI Z‡_¨i Rb¨ AbyMÖn K‡i †`Lyb cwievi cwiKíbv g¨vbyqvj, Ryb 2018, Aa¨vq 05 c„ôv-49

110 cÖme-cieZ©x cwievi cwiKíbv

B›Uªv BD‡UivBb K›Uªv‡mcwUf wWfvBm

B›Uªv BD‡UivBb K›Uªv‡mcwUf wWfvBm (IUCD) GKwU †QvU T AvK…wZi bgbxq cøvw÷K hš¿ hv Rivqyi wfZ‡i cÖ‡ek Kiv‡bv
nq Mf©aviY cÖwZ‡iva Kivi Rb¨| evsjv‡`‡k Kcvi enbKvix IUCD e¨eüZ nq hvi `Û Ges evû¸‡jvi Pvicv‡k Kcvi
e¨vÛ †cuPv‡bv _v‡K| mvaviYZ mnRjf¨ e¨vÛ: Kcvi wU 380G

÷¨vÛvW© 13: †mev`vbKvixMY 1) MÖnxZv‡K Mf©wb‡ivaK mKj c×wZ m¤ú‡K© Rvbv‡eb Ges Zv‡K Zvi cQ›` Abyhvqx
GKwU h_vh_ c×wZ evQvB Ki‡Z KvD‡Ýwjs Kiæb, 2) MÖnxZv evQvB †PKwj÷ e¨envi K‡i D³ MÖnxZv‡K w¯Œb Kiæb 3)
GKwU m¤ú~Y© BwZnvm wb‡q MÖnxZv‡K cixÿv Kiæb (wKQz †ÿ‡Î j¨ve‡iUwi cixÿv `iKvi nq), 4) MÖnxZv‡K mKj weiƒc
cÖfve Ges cvk¦©-cÖwZwµqvi e¨e¯’vcbv m¤ú‡K© Rvbvb, 6) †iKW© msiÿY Kiæb Ges MÖnxZv‡K d‡jvAv‡ci Rb¨ Avevi
Avm‡Z ejyb

IUCD Gi Rb¨ Av`k© MÖnxZv

IUCD Gi Rb¨ Av`k© MÖnxZv n‡jv Ggb bvix hvi Kgc‡ÿ GKwU RxweZ mšÍvb i‡q‡Q Ges `xN© †gqv‡`i Rb¨ Mf©aviY
cÖwZ‡iva Ki‡Z Pvq Ges hv‡`i ni‡gvb mg„× Rb¥weiwZKib c×wZ e¨env‡i mgm¨v nq|

AvBBDwW cÖ`v‡b ¯^v¯’¨MZ I mvgvwRK Dchy³Zv

wb‡¤œ ewY©Z KviY ¸‡jv Qvov mKj mÿg bvix‡K AvBBDwW †`Iqv hv‡e|

†h mKj Ae¯’vq IUCD †`Iqv hv‡e bv

l eZ©gv‡b AweevwnZ/weaev/ZvjvK-cÖvß/¯^vgx †_‡K c„_K
l gwnjv hw` Mf©eZx nb
l hv‡`i †Kvb mšÍvb †bB
l cÖm‡evËi msµgY
l msµwgZ Mf©cvZ n‡j
l cÖme cieZ©x mg‡q ‡h me gwnjv wkï‡K ey‡Ki `ya cvb Kivb-cÖm‡ei 48 N›Uv †_‡K <4 mßvn g‡a¨
l ‡hvwbc‡_ i³mªve hvi KviY Rvbv †bB
l Rivqyi Uª‡dveøvw÷K †ivM
l wfAvBG (VIA) cixÿv cwRwUf (+VE) n‡j ev ¸iæZi †Kvb mgm¨v m‡›`n Kiv n‡j
l mvwf©· Gi K¨vÝvi
l G‡Ûv‡gwUªqvj K¨vÝvi
l wW¤^vk‡qi K¨vÝvi
l Rivqyi Mne‡ii MVbMZ cwieZ©b (Rivqyi MfxiZv 6 †m. wg. Gi Kg)
l Rivqyi MVZMZ ÎæwU ev A¯^vfvweKZv (Rb¥MZ ev Ab¨ ‡Kvb Kvi‡Y)
l Rivqy wb‡P †b‡g hvIqv- wØZxq wWwMÖ I Z…Zxq wWwMÖ
l Zj‡c‡U cÖ`vnRbwZ †ivM-eZ©gv‡b AvB wcAvBwW‡Z AvµvšÍ
l ‡hŠbevwnZ †ivM-eZ©gv‡b cyuRhy³ M‡bvwiqv ev K¬¨vgvBwWqv Øviv msµwgZ
l Zj‡c‡U hÿèv Av‡Q
l eZ©gv‡b GBWm we`¨gvb, A¨vw›U‡i‡Uªvfvj (GAviwf) †_ivwc wb‡”Qb|

we.`ª: mKj †mev`vbKvix MÖnxZvi Dchy³Zv hvPvB Gi †ÿ‡Î wW‡m¤^i 2016 †Z cwievi cwiKíbv Awa`ßi n‡Z gyw`ªZ Gi
MEC ûBj e¨envi Ki‡eb|

Avqib †Wwdwm‡qwÝ A¨vwbwgqv, _¨vjv‡mwgqv I wm‡Kj †mj wWwRR _vK‡j AvBBDwmwW cÖ‡qv‡M i³ÿiY †e‡o hvIqvi
SuywK _v‡K

cÖme-cieZ©x cwievi cwiKíbv 111

 cÖme cieZ©x AvBBDwmwW cÖ‡qv‡Mi †ÿ‡Î
l Mf©wSwjø wQu‡o hvIqvi 24 N›Uvi †ewk c‡i cÖme n‡j
l `xN©vwqZ cÖmeKvj (24 N›Uvi †ewk)
l R¡i (101 wWwMÖ dv‡ibnvBU Gi †ewk)
l cÖm‡evËi msµgY ev †mcwmm
l ‡hŠbv‡½ e¨vcK ÿZ
l cÖme cieZ©x AwZwi³ i³ÿiY

AvBBDwmwW MÖnxZv evQvB

MÖnxZv evQvB Gi Rb¨ BwZnvm MÖnY Ki‡Z n‡e &Ges mvaviY cixÿY (†hgb. i³¯^íZv) Ges †cjwfK cixÿv Ki‡Z n‡e|
†gwW‡Kj BwjwRwewjwU µvB‡Uwiqv Abyhvqx RTI Ges STI Ges Ab¨vb¨ wb‡lavÁv Av‡Q wK bv †`L‡Z n‡e| †ewkifvM
bvix hv‡`i GKRb RxweZ mšÍvb Av‡Q Zviv AvBBDwmwW e¨envi Ki‡Z cv‡ib|

AvBBDwmwWi Kvh©KvwiZv

cÖ‡ek Kiv‡bvi ci †_‡KB AvBBDwmwW Lye Kvh©Ki| Kcvi wU 380A 10 eQ‡ii Rb¨ Kvh©Ki Ges Kcvi wU 200 Kvh©Ki
5 eQ‡ii Rb¨| AvBBDwmwW Lye Kvh©Ki Ges wbivc`, mn‡R e¨envi‡hvM¨, `xN© †gqvw` myiÿv †`q, Lye Aí cvk¦©cÖwZwµqv
Ges †ei K‡i †djvi ci ciB Mf©avib ÿgZv wd‡i Av‡m|

AvBBDwmwWi myweav

AvBBDwmwW me‡P‡q RbwcÖq Mf© wb‡ivaK c×wZi GKwU, we‡klZ `xN© †gqvw` cÖwZeZ©b‡hvM¨ Mf© wb‡ivab †h‡nZz GwU
mn‡R cÖ‡qvM Kiv I †Lvjv hvq| GwUi myweav¸‡jv n‡”Q: Lye Kvh©Ki, AvBBDwmwWi 5 eQi e¨env‡i mdjZvi nvi 98-99
kZvsk
l cÖvq mKj bvix GwU e¨envi Ki‡Z cvi‡eb
l GwUi Kvh©KvwiZv 10 eQi ch©šÍ _v‡K hw` Gi g‡a¨ †ei Kiv bv nq
l ZvrÿwYK Kvh©KvwiZv ïiæ nq
l ey‡Ki `ya cvb Kiv‡”Qb Ggb gv‡q‡`i Rb¨ gvbvbmB
l e¨envi eÜ Ki‡j `ªæZ Mf©aviY ÿgZv wd‡i Av‡m
l IRb evovq bv

AvBBDwmwWi Amyweav

AvBBDwmwW Gi cªZ¨ÿ myweavm‡Ë¡I, GwUi gyL¨ I †MŠY mxgve×Zv Av‡Q, †hgb:

l AwZwi³ i³mªve GKwU mvaviY Awf‡hvM, †mB mv‡_ wWm‡g‡bvwiqv Ges cwj‡g‡bvwiqv| eÜ Kivi G¸‡jv gyL¨ KviY
l †hŠbevwnZ msµg‡Yi weiæ‡× †KvbI myiÿv †`q bv
l AvBBDwmwW †ei n‡q Avm‡Z cv‡i we‡kl K‡i cÖ_g 3 gv‡m gvwm‡Ki mgq ev Gi ci|

AvBBDwmwW cÖ‡qvM

cÖwµqv kyiæ Kivi Av‡M hš¿cvwZmg~n h_vh_fv‡e mvRv‡Z n‡e

112 cÖme-cieZ©x cwievi cwiKíbv

AvBBDwmwW cÖ‡qvM Gi Rb¨ hš¿cvwZmg~n

l RxevYygy³ IUCD c¨v‡KU l †dvweWb Av‡qvwWb mjy¨kb

l RxevYygy³ Kv¯‹‡Kvm evBfvjf f¨vRvBbvj †¯úKzjvg l g¨vwKb‡Uvm
(gva¨g AvKv‡ii) l gv¯‹
l mvifvBKvj †UbvKzjvg l †dvKvm jvBU A_ev UP©
l BD‡UivBb mvDÛ l †Wªwcs wkU
l †÷ªBU KvwUs wmRi l eR©¨ c`v‡_©i Rb¨ XvKbv mn bxj evjwZ
l KUb ej- 3 (1wU ïK‡bv Ges 2 wU †dvweWb l cøvw÷K wkUmn IUCD ‡Uwej
Av‡qvwW‡b †fRv‡bv) l ÷yj
l Mvwj cU l me hš¿cvwZ ivLvi †Uwej
l †÷ªBU AvUv©wi di‡mc
l Møvfm (2 †Rvov)

Kcvi wU 380 A cÖ‡qvM Kivi avcmg~n:

l cÖwµqv kyiæi Av‡M I c‡i nvZ ay‡q wbb
l cÖ‡UvKj Abyhvqx RxevYygy³ c×wZi cÖwµqv m¤úbœ Kiæb
l cy‡iv mgq Avj‡Zvfv‡e ¯úk©wenxb †KŠkj e¨envi Kiæb
l nvZ ay‡q wb®‹vkb‡hvM¨ A_ev RxevYygy³ Møvfm ciæb
l †¯úKzjvg cÖ‡ek Kivb| mviwf· Ges mvifvBKvj K¨v‡b‡ji cy‡ivUv‡Z Gw›U‡mcwUK/ †dvweWb Av‡qvwWb mjy¨kb
cÖ‡qvM Kiæb
l Nwoi KvuUv 10Uv Ges 2Uvi Ae¯’v‡b RxevYygy³ †UbvKzjvg w`‡q Avj‡Zvfv‡e aiæb| A¯^w¯Í Kgv‡Z ïaygvÎ cÖ_g Luv‡R
di‡mc eÜ Kiæb
l †UbvKzjvg w`‡q Avj‡Zvfv‡e UªvKkb eRvq †i‡L nvjKvvfv‡e HLD/ RxevYygy³ BD‡UivBb mvDÛ Gi cÖvšÍfvM
mvifvBKvj A‡mi †fZ‡i cÖ‡ek Kivb (mZK© _vK‡Z n‡e f¨vRvBbvj Iqvj hv‡Z mvDÛ Gi cÖvšÍfvM ¯úk© bv K‡i)
l Rivqyi Ae¯’vb Gi Rb¨ evB g¨vbyqvj A¨v‡mm‡g›U Gi Dci wfwË K‡i, mZK©Zvi mv‡_ nvjKvfv‡e mvDÛwU Rivqy
MnŸ‡i cÖ‡ek Kivb Ges †mB mv‡_ ¯úÄ di‡mc w`‡q w¯’ifv‡e wb‡Pi w`‡K I evwn‡ii w`‡K Uvb w`‡q a‡i ivLyb
l †UbvKzjvg w`‡q Avj‡Zvfv‡e UªvKkb w`‡q ivL‡j mvDÛ mn‡R cÖ‡ek Kiv‡bv hv‡e| hw` K¬v‡q‡›Ui †PZbv nviv‡bvi
A_ev ax‡i ür¯ú›`bmn d¨vKv‡m fv‡ei DcmM© †`Lv †`q, cÖwµqv eÜ K‡i †f‡mvf¨vMvj kK Gi e¨e¯’vcbv MÖnY
Kiæb|
l hLb ÿxY cÖwZeÜK Abyfe n‡e ZLb eyS‡eb †h BD‡UivBb mvDÛ-Gi cÖvšÍfvM dvbWv‡m †cuŠ‡Q‡Q, Rivqy Mne‡ii
AwfgyL jÿ¨ ivLyb
l mvD‡Û wgDKvm Ges/A_ev i‡³i D”PZv jÿ¨ K‡i Rivqyi ˆ`N©¨ wba©viY Kiæb| Mo Rivqy ˆ`N©¨ 6 †_‡K 8 †m.wg. |
IUCD cÖ‡ek Kiv‡bvi †Póv Ki‡eb bv hw` Rivqy 6 †m.wg. Gi Kg Mfxi nq|
l Kcvi wU Gi evû¸‡jv BbmvU©vi wUD‡e †jvW Kiæb| RxevYygy³ c¨vK Gi DcwifvM evû †jvW Kivi mgq Lyj‡eb bv|

cÖme-cieZ©x cwievi cwiKíbv 113

 wPÎ-2: Rivqyi mvDwÛs Kiv

wPÎ-1: `yB nv‡Z Zj‡cU, †hvwbc_ I Rivqy cix¶v

wPÎ-4: AvBBDwW c¨v‡K‡Ui wfZi †i‡L

e„×v½ywj Ges ZR©bx w`‡q †P‡c BbmvU©v‡i XzKv‡bv
wPÎ-3: mv`v iW BbmvU©vi wUD‡e cÖ‡ek Kiv

wPÎ-6: bxj MvW© mgvšÍivj Kiv

wPÎ-5:wUDe Nyiv‡bv I †Vjv

AvBBDwW c¨v‡K‡Ui wfZi †i‡L BbmvU©v‡i XzKv‡bv

wPÎ-7: cÖ‡qv‡Mi Rb¨ Kcvi-wU c¨v‡K‡Ui evB‡i †ei K‡i Avbv

114 cÖme-cieZ©x cwievi cwiKíbv

†jvWK…Z Kcvi wU 380A IUCD cÖ‡ek Kiv‡bvi Rb¨ wb‡`©kbv
l †UbvKzjvg AvuK‡o aiæb (Rivqy‡Z mvDÛ cÖ‡ek Kiv‡bvi ci hv GLbI Rivqygy‡L i‡q‡Q) Ges Rivqy MnŸi Ges
mvifvBKvj K¨v‡bj †mvRv Kivi Rb¨ Avj‡Zvfv‡e Uvb w`b| eøy †Wc_ MR‡K Avbyf~wgK Ae¯’v‡b †i‡L, mZK©Zvi
mv‡_ †jvW Kiv BbmvU©vi wUDewU mvifvBKvj Am G cÖ‡ek Kivb|
l Rivqy MnŸ‡ii Ae¯’vb I AwfgyL Abyhvqx, †jvW Kiv BbmvU©viwU AMÖmi Kiæb hZÿY ch©šÍ eøy †Wc_ MR mviwf• Gi
ms¯ú‡k© bv Av‡m A_ev Rivqyi dvbWv‡mi cÖwZeÜK Abyfe Kiv hvq| eøy †Wc_ MR Gi Avbyf~wgK Ae¯’vb wbwðZ
Kiæb|
l GK nv‡Z †UbvKzjvg Ges †nvqvBU iW w¯’ifv‡e aiæb| Lvwj nvZwU w`‡q (wb‡Ri w`‡K) BbmvU©vi wUDewU AcmviY
Kiæb hZÿY ch©šÍ GwU †nvqvBU iW Gi _v¤^ wMÖc ¯úk© bv K‡i| Gi gva¨‡g Kcvi wU 380 A-Gi evû¸‡jv Rivqyi
dvbWv‡mi D‡”P DV‡e|
l †nvqvBU iWwU †ei Kivi mgq BbmvU©vi wUDewU w¯’ifv‡e aiæb| iW †ei Kiv n‡j, Avevi Lye Avj‡Zvfv‡e mZK©Zvi
mv‡_ BbmvU©vi wUDewU Dc‡ii w`‡K av°v w`b, Rivqyi Dcwifv‡M hZÿY ch©šÍ ÿxY cÖwZ‡iva Abyfe K‡ib|
l GB avc wbwðZ K‡i †h wU Gi evû¸‡jv Rivqyi hZUzKz m¤¢e Dc‡i i‡q‡Q|
l mvifvBKvj K¨v‡bj †_‡K BbmvU©vi wUDewU‡K AvswkKfv‡e AcmviY Kiæb| hLb Zvi¸‡jv mvifvBKvj Am †_‡K
cÖvq 3-4 †m.wg. ch©šÍ ewa©Z n‡e, aviv‡jv KvuwP w`‡q Zvi¸‡jv KvUzb| GwU wbwðZ Ki‡e KvUv Zvi BbmvU©vi wUD‡e
_vK‡e Ges †ei Ki‡Z mnR n‡e|
l †UbvKzjvg †ei Kiæb| hw` ¯úÄ di‡mc aivi ¯’v‡b AwZwi³ i³cvZ nq, i³cvZ eÜ bv nIqv ch©šÍ HLD/
RxevYygy³ di‡mc w`‡q GKwU †mvqve Pvc w`‡q a‡i ivLyb|
l †Uwej †_‡K Av‡¯Í Av‡¯Í bvg‡Z K¬v‡q›U‡K mvnvh¨ Kiæb (m¤¢ve¨ wSg wSg fve n‡”Q wK bv mZK© _vKzb) Ges Kxfv‡e
I KLb w÷ªs/ Zvi †PK Ki‡Z n‡e Zv‡K wkwL‡q w`b| cÖ‡ek Kiv‡bvi 15-30 wgwbU ch©šÍ K¬v‡q›U‡K wK¬wb‡K A‡cÿv
Ki‡Z ejyb|

wUDewU
cÖ‡ek Kivb
mv`v
wUDewU iWwU wUDewU
mv`v iWwU mvg‡b wUDewU w¯’i ivLyb 3-4 †m.wg
aiæb †cQ‡b w¯’i
Uvbyb †Vjyb mv`v iWwU myZv †K‡U †djyb
ivLyb
†ei Kiæb

wPÎ-8: AvBBDwW cÖ‡qvM Kiv

AvBBDwmwW †ei Kivi avcmg~n

l Avcwb Kx Ki‡Z hv‡”Qb Zv MÖnxZv‡K eywS‡q ejyb Ges Zv‡K cÖkœ Ki‡Z Drmvn w`b
l RivqygyL I AvBBDwmwW Gi myZv †`Lvi Rb¨ †¯úKzjvg cÖ‡ek Kivb
l `yB †_‡K wZb evi RivqygyL Ges †hvwbc‡_ m¤ú~Y©fv‡e A¨vw›U‡mcwUK mjykb cÖ‡qvM Kiæb|

mvaviY AcmviY
l MÖnxZv‡K eywS‡q ejyb †h Avcwb GLb AvBBDwmwW AcmviY Ki‡Z hv‡”Qb| Zv‡K ax‡i Mfxi wbk¦vm wb‡q wkw_j n‡Z
ejyb| Zv‡K Rvbvb †h wKQzUv e¨_v n‡Z cv‡i GUv ¯^vfvweK|
l HLD/ RxevYygy³ ¯úÄ †nvjwWs di‡mc w`‡q Rivqygy‡Li Kv‡Q _vKv myZv AuvKwo‡q aiæb Ges ax‡i, `„pfv‡e Uvbyb|
mvaviYZ RwUjZv Qvov hš¿wU †ei Kiv hvq Ges myZv wQ‡o/†f‡O hvIqv Gov‡Z AwZwi³ ej cÖ‡qvM Ki‡eb bv, w¯’i
wKš‘ Avj‡Zvfv‡e Uvb w`b Ges ax‡i ax‡i AvBBDwmwW †ei Kiæb| hw` myZv wQ‡o/†f‡O hvq wKš‘ AvBBDwmwW ZL‡bv
†`Lv hvq, di‡mc w`‡q AuvK‡o a‡i †ei Kiæb|

cÖme-cieZ©x cwievi cwiKíbv 115

 RwUj AcmviY

hw` myZv †`Lv bv hvq, Mf©eZx bq wbwðZ n‡q, mvifvBKvj K¨v‡b‡j HLD/ RxevYygy³ †n‡gv‡÷U A_ev Ab¨ †QvU
HLD/RxevYygy³ di‡mc w`‡q nvjKv fv‡e w`‡q †`Lyb| hw` mvifvBKvj K¨v‡b‡j myZv Gi Ae¯’vb wbY©q Kiv bv hvq,
Rivqy MnŸ‡i HLD/RxevYygy³ A¨vwj‡MUi/ûK di‡mc w`‡q †`Lyb, G¸‡jv myZv A_ev IUCD-†K AuvKwo‡q ai‡Z e¨eüZ
nq|
l hw` Avcwb hš¿wU AvswkK †ei K‡i _v‡Kb wKš‘ mvifvBKvj K¨vbvj w`‡q †ei K‡i Avb‡Z mgm¨v n‡”Q, nvjKvfv‡e,
ax‡i †gvPo w`‡q evB‡ii w`‡K Uvb w`b hZÿY K¬v‡q›U ¯^w¯Í‡Z _v‡K| hw` evB g¨vbyqvj cixÿY K‡i g‡b nq Rivqy
I Rivqygy‡Li gv‡S Zxÿè †Kvbv cvIqv hv‡”Q, HLD/RxevYygy³ ¯úÄ di‡mc w`‡q Rivqygy‡L wbP I evB‡ii w`‡K
Av‡¯Í Uvb w`b, GKB mv‡_ AvBBDwmwW cybivq Av‡¯Í Uvb w`b| ej cÖ‡qvM Ki‡eb bv|
l K¬v‡q›U hw` Pvq Ges Ae¯’v wVK _v‡K bZzb GKwU AvBBDwmwW cÖ‡ek Kivb|

AvBBDwmwW cÖwZ¯’vcb
l Av‡iKwU cÖwZ¯’vcb Ki‡Z †KvbI weiwZKv‡ji `iKvi †bB|
l MÖnxZv hw` Mf©eZx n‡Z bv Pvb, Kvh©Kvj †kl n‡j mv‡_ mv‡_ Av‡iKwU AvBBDwmwW cÖ‡ek Kiv‡bv †h‡Z cv‡i|

MÖnxZvi cÖwZ wb‡`©kbv:

l cÖwµqv †k‡l MÖnxZv‡K wb‡`©kbv w`‡Z n‡e mZK©Zv wPýmg~n

cÖ‡qvM cieZ©x KiYxq

`ªóe¨: cÖwµqvi †KvbI ch©v‡q ejcÖ‡qvM Kiv hv‡e bv|

cÖme-cieZ©x AvBBDwmwW (PPIUCD):

di‡mc e¨envi K‡i AvBBDwmwW mwbœ‡ek Gi Rb¨ hš¿cvwZmg~n

l ¯úÄ †nvwìs di‡mc
l Mvwj cU
l wmgm ‡¯cKzjvg
l †Kwjm cøv‡m›Uvj di‡mc
l AvBBDwmwW
l Gw›U‡mcwUK `ªeY
l RxevYygy³ Møvfm&
l RxevYygy³ Zzjvi ej
l RxevYygy³ ‡Wªwcs kxU

cÖme-cieZ©x AvBBDwmwW cÖ‡qvM Kivi Av‡M hv †`L‡Z n‡e

l h_vh_ MÖnxZv evQvB Kiv n‡q‡Q
l h_vh_fv‡e KvD‡Ýwjs cÖvß
l MÖnxZv †hvM¨

†Kwj cøv‡m›Uvj di‡mc e¨envi K‡i AvBBDwmwW cÖ‡qv‡Mi avcmg~n

1. AvBBDwmwW MÖn‡Y MÖnxZvi AewnZ m¤§wZi wel‡q wbwðZ n‡Z n‡e| cÖ‡qvRbxq hš¿cvwZ I DcKiY †Uª/Uwj‡Z mvwR‡q
wb‡Z n‡e (wPÎ: 1)
2. cÖm‡ei Z…Zxq av‡ci mwµq e¨e¯’vcbv Ki‡Z n‡e (wPÎ: 2)
l cÖ‡Z¨K †ÿ‡Î ev”Pv cÖm‡ei 1 wgwb‡Ui g‡a¨ gvsm‡ckx‡Z 10 BDwbU Aw·‡Uvwmb w`‡Z n‡e
l cÖ‡qvR‡b bvwfi¾y‡Z wbqwš¿Z Uvb I Rivqy‡Z wecixZgyLx Pvc w`‡q Mf©dzj †ei Ki‡Z n‡e

116 cÖme-cieZ©x cwievi cwiKíbv

 l cÖ‡Z¨K †ÿ‡Î Mf©dzj cÖm‡ei ciciB cÖm~wZi †c‡Ui Dci nvZ w`‡q g¨vmvR Ki‡Z n‡e
3. ‡c‡Ui Dci nvZ w`‡q Rivqyi dvÛv‡mi D”PZv Abyfe Ki‡Z n‡e| Rivqyi D”PZv I AvKvi wbY©q Kiv LyeB Riæix|
GUv †_‡K aviYv cvIqv hv‡e †h, cÖ‡qv‡Mi ci AvBBDwW-i myZv mviwf‡·i evB‡i †ei n‡q _vK‡e wKbv|
4. ‡cwiwbqv‡g †Kv‡bv ÿZ ev †Quov Av‡Q wKbv †`L‡Z n‡e (wPÎ: 3)
5. cwi®‹vi RxevYygy³ Wª¨vwcs wkU MÖnxZvi †Kvg‡ii/wbZ‡¤^i wb‡P Ges Zj‡c‡Ui Dc‡i w`‡Z n‡e| bZzb GK‡Rvov
RxevYygy³ Møvfm ci‡Z n‡e| †hvwbc‡_ †¯úKzjvg w`‡q mviwf· `„k¨gvb Ki‡Z n‡e (wPÎ: 4)
6. mviwf· Ges †hvwbc_ A¨vw›U‡mcwUK `ªeY w`‡q gyQ‡Z n‡e Ges A¨vw›U‡mcwUK KvR Kivi Rb¨ mgq w`‡Z n‡e (wPÎ:
5)
7. mviwf· Gi mvg‡bi †VvuU (Anteiro lip) ¯úÄ ‡nvwìs di‡mc w`‡q bgbxqfv‡e ai‡Z n‡e| G mgq †UbvKzjvg
w`‡q mviwf· aiv hv‡e bv| KviY Zvn‡j mviwf· wQu‡o †h‡Z cv‡i| GKNi `vM ch©šÍ di‡mc Gi K¨vP AvUKv‡Z
n‡e (wPÎ: 6)
8. RxevYygy³ c¨v‡KU †_‡K †Kwj cøv‡m›Uvj/wis di‡m‡ci mvnv‡h¨ AvBBDwW ai‡Z n‡e| AvBBDwW-i Lvov `Û I
Wvbw`‡Ki Avbyf~wgK evû Ggbfv‡e ai‡Z n‡e †hb `Û Ges evû Df‡qiB wKQy Ask wi‡½i evB‡i _v‡K| AvBBDwWi
Lvov `Û I di‡m‡ci nvZj mgvšÍivj Ae¯’v‡b _vK‡Z n‡e| Gi d‡j dvÛv‡m AvBBDwW ¯’vcb mnR n‡e Ges
¯’vc‡bi ci di‡mc †ei K‡i Avbvi mgq mv‡_ AvBBDwW †ei n‡q Avmvi mgq SzuwK Kg n‡e (wPÎ:7)
9. mviwf· aiv di‡mcwU †mev`vbKvix eivei Dc‡ii w`‡K nvjKv Uvb ivL‡Z n‡e (wPÎ: 8)
10. AvBBDwW aiv di‡mcmwU mviwf‡·i wfZi w`‡q Rivqy I †hvwbc‡_i evuK ch©šÍ cÖ‡ek Kiv‡Z n‡e| AvBBDwW hv‡Z
†hvwbc‡_i ‡`qv‡j bv jv‡M †mw`‡K jÿ¨ ivL‡Z n‡e (wPÎ: 8)
11. Gevi mviwf· aivi di‡mcwU Ly‡j evg nvZ Zj‡cU dvÛv‡mi Dci †i‡L bgbxqfv‡e Rivqy‡Z bx‡Pi w`‡K Pvc w`‡Z
n‡e †hb Rivqy †mvRv Ges w¯’wZkxj nq| AvBBDwW hLb cÖ‡qvM Kiv n‡e ZLb Rivqy †c‡Ui Dc‡ii w`‡K hv‡Z bv
D‡V †mw`‡K †Lqvj ivL‡Z n‡e (wPÎ: 9,10)
12. MÖnxZvi hw` eZ©gv‡b f¨vRvBbvj †Wwjfvwi nq Ges Av‡M wmRvwiqvb Acv‡ikb nq Z‡e ¯úÄ †nvwìs di‡mc w`‡q
Rivqyi wcQ‡bi †`qv‡j Pvc †`qvi mgq we‡klfv‡e jÿ¨ ivL‡Z n‡e †hb AvBBDwW Av‡Mi Bbwmk‡bi †Kvb ÿZ
Av‡Q Ggb RvqMvq ¯’vcb bv Kiv nq| wkw_j Zj‡c‡Ui g‡a¨ w`‡q Rivqy‡K Abyfe Kivi m gq wbwðZ n‡Z n‡e †h
di‡mc-Gi gv_v dvÛv‡m Av‡Q|
13. Rivqyi Wvb w`‡K mvgvb¨ KvZ K‡i †Kwj/wis di‡mc Gi AvBBDwW aiv Ask‡K Ly‡j AvBBDwW dvÛv‡m ¯’vcb Ki‡Z
n‡e (wPÎ: 11)
14. di‡mc mvgvb¨ †Lvjv Ae¯’vq Rivqyi evg w`‡Ki †`qvj †Nu‡l di‡mc Av‡¯Í Av‡¯Í †ei K‡i Avb‡Z n‡e (wPÎ: 12,
13)
15. mviwf· cixÿv Ki‡Z n‡e| AvBBDwW cÖ‡qv‡Mi ïiæ‡Z hw` Rivqy eo _v‡K Ges mviwf‡·i evB‡i myZv †`Lv hvq
Z‡e a‡i †bqv †h‡Z cv‡i †h AvBBDwW dvÛv‡m ¯’vwcZ nqwb| G‡ÿ‡Î AvBBDwW Ly‡j ‡dj‡Z n‡e Ges RxevYygy³
Ab¨ GKwU di‡mc w`‡q bZzb AvBBDwW mwVK ¯’v‡b ¯’vcb Ki‡Z n‡e| (wPÎ: 14)
16. GwcwmIUwg †mjvB Kivi cÖ‡qvRb _vK‡j Ki‡Z n‡e|

cÖme-cieZ©x cwievi cwiKíbv 117

 wPÎ: 1 wPÎ: 8

wPÎ: 2 wPÎ: 9

wPÎ: 3 wPÎ: 10

wPÎ: 4 wPÎ: 11

wPÎ: 5 wPÎ: 12

wPÎ: 6 wPÎ: 13

wPÎ: 7 wPÎ: 14
wPÎ: †Kwj cøv‡m›Uvi ci‡mc e¨envi K‡i AvBDwmwW cÖ‡qv‡Mi avcmg~n

118 cÖme-cieZ©x cwievi cwiKíbv

 QK: MÖnxZvi cwiw¯’wZ Ges AvBBDwmwW cÖ‡qv‡Mi mgq
bvixi cwiw¯’wZ
gv‡mi †h †KvbI mg‡q gvwmKPµ
Pj‡Q
gvwmK Pµ wbqwgZ gv‡mi †h †Kvb
mgq IUCD cÖ‡qvM
Av‡iKwU c×wZ †_‡K cwieZ©b
cÖm‡ei ci ciB
gv‡mi †h †KvbI mg‡q gvwmKPµ
Pj‡Q
gvwmK Pµ wbqwgZ gv‡mi †h †Kvb
mgq IUCD cÖ‡qvM
m¤ú~Y© ev cÖvq m¤ú~Y©fv‡e ey‡Ki `ya
cvb Kiv‡”Qb (cÖm‡ei 6 gv‡mi Kg
mgq) Ggb bvix
m¤ú~Y© ev cÖvq m¤ú~Y©fv‡e ey‡Ki `ya
cvb Kiv‡”Qb (cÖm‡ei 6 gv‡mi
‡ewk mgq cvi n‡j)
gvwmK i³ÿiY †bB (cÖme ev `ya
LvIqv‡bvi mv‡_ m¤úwK©Z bq)
Mf©cv‡Zi ci
KLb ïiæ Ki‡Z n‡e
l hw` Zvi gvwm‡Ki ev‡iv w`‡bi g‡a¨ cÖ‡qvM K‡ib Z‡e †KvbI mnvqK c×wZi
`iKvi †bB|
l hw` Zvi gvwm‡Ki ev‡iv w`‡bi †ewk nq wZwb hw` m¤ú~Y© wbwðZ _v‡Kb †h
wZwb Mf©eZx bb Z‡e †h †KvbI mgq AvBBDwmwW cÖ‡qvM Ki‡Z cvi‡eb|
†KvbI mnvqK c×wZi `iKvi †bB|
l †KvbI bvix hw` avivevwnK I mwVKfv‡e c×wZ e¨envi K‡i _v‡Kb A_ev
m¤ú~Y© wbwðZ _v‡Kb †h wZwb Mf©eZx bb Z‡e ZvrÿwYKfv‡e cÖ‡qvM Ki‡Z
cvi‡eb| cieZ©x gvwm‡Ki Rb¨ A‡cÿv Kivi `iKvi †bB| †KvbI mnvqK
c×wZi `iKvi †bB|
l hw` wZwb Rb¥weiwZKib Bb‡RKkb †_‡K cwieZ©b K‡ib, cieZ©x
Bb‡RKkb †`qvi m¤¢ve¨ mg‡q wZwb AvBBDwmwW wb‡Z cvi‡eb| †KvbI
mnvqK c×wZi `iKvi †bB|
l cÖm‡ei 48 NÈvi g‡a¨ †h †KvbI mgq (cÖme cieZ©x AvBBDwmwW cÖ‡qvM
cÖwkwÿZ GKRb †mevKg©x cÖ‡qvRb) |
l cÖm‡ei 48 N›Uvi †ewk n‡j, cÖm‡ei Pvi ev Z‡ZvwaK mßvn cvi nIqv ch©šÍ
†`wi Kiæb|
l hw` Zvi gvwm‡Ki ev‡iv w`‡bi g‡a¨ cÖ‡qvM K‡ib Z‡e †KvbI mnvqK c×wZi
`iKvi †bB|
l hw` Zvi gvwmK cybivq ïiæ bv n‡q _v‡K, GKRb bvix cÖm‡ei Pvi mßvn
†_‡K Qq gv‡mi g‡a¨ †h †KvbI mgq AvBBDwmwW cÖ‡qvM Ki‡Z cvi‡eb|
†KvbI mnvqK c×wZi `iKvi †bB|
l hw` gvwmK n‡q hvq Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx
AvBBDwmwW mwbœ‡ek Ki‡Z cvi‡eb|
l gvwmK ïiæ bv nq, hw` wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Zvn‡j †h
†KvbI mg‡q AvBBDwmwW mwbœ‡ek Ki‡Z cvi‡eb| †KvbI mnvqK c×wZi
`iKvi †bB|
l hw` gvwmK n‡q hvq Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx
AvBBDwmwW mwbœ‡ek Ki‡Z cvi‡eb|
l wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q AvBBDwmwW
mwbœ‡ek Ki‡Z cvi‡eb| †KvbI mnvqK c×wZi `iKvi †bB|
l GKRb bvixi cÖ_g A_ev wØZxq UªvB‡g÷v‡i Mf©cvZ nIqvi ci †KvbI
msµgY bv _vK‡j wZwb ev‡iv w`‡bi g‡a¨ AvBBDwmwW mwbœ‡ek Ki‡Z
cvi‡eb| †KvbI mnvqK c×wZi `iKvi †bB|
l hw` cÖ_g A_ev wØZxq UªvB‡g÷v‡i Mf©cvZ nIqvi ci wZwb 12 w`‡bi †ewk
mgq nq Ges †KvbI msµgY bv _v‡K, Zvn‡j hw` wZwb m¤ú~Y© wbwðZ nb †h
Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q AvBBDwmwW mwbœ‡ek Ki‡Z
cvi‡eb|
cÖme-cieZ©x cwievi cwiKíbv 119
 bvixi cwiw¯’wZ KLb ïiæ Ki‡Z n‡e
l hw` msµgY _v‡K, wPwKrmv w`b A_ev †idvi Kiæb Ges MÖnxZv‡K Ab¨
†KvbI c×wZ evQvB Ki‡Z mvnvh¨ Kiæb| hw` ZviciI wZwb AvBBDwmwW
Pvb Z‡e msµgY m¤ú~Y© fv‡jv n‡j mwbœ‡ek Ki‡Z cvi‡eb|

l wØZxq UªvB‡g÷v‡i Mf©cvZ n‡j, AvBBDwmwW mwbœ‡ek Ki‡Z we‡kl cÖwkÿY

Riæwi Mf©aviY cÖwZ‡iv‡ai Rb¨
Riæix Rb¥weiZxKib Lvevi
ewo/Bgv‡R©wÝ K›Uªv‡mcwUf wcj
(ECP) †me‡bi ci
IUCD m¤ú‡K© fzj aviYv¸‡jv wVK
Kiv
cÖ‡qvRb| we‡kl cÖwkÿY bv _vK‡j Mf©cv‡Zi Kgc‡ÿ 4 mßvn ch©šÍ †`wi
Kiæb|
l AiwÿZ †hŠbwgj‡bi 5 w`‡bi g‡a¨|
l Ify‡jk‡bi mgq wn‡me K‡i, Gi 5 w`b ci ch©šÍ wZwb, AvBBDwmwW mwbœ‡ek
Ki‡Z cvi‡eb, KLbI AiwÿZ †hŠbwgj‡bi 5 w`b ciI n‡Z cv‡i|
l †me‡bi w`b †_‡K wZwb AvBBDwmwW mwbœ‡ek Ki‡Z cvi‡eb| †KvbI mnvqK
c×wZi `iKvi †bB|
u K`vwPr PID nq
u STI I HIV Gi SuywK evovq bv
u GKRb bvix AvBBDwmwW Acmvi‡Yi ci Mf©eZx n‡j Mf©cv‡Zi SuywK evovq
bv
u bvix‡K Abye©i K‡i bv
u Rb¥ÎæwUi KviY bq
u K¨vÝv‡ii KviY bq
u ürwcÛ A_ev gw¯Í‡®‹i w`‡K hvq bv
u mnev‡mi mgq bvixi A¯^w¯Í ev e¨_vi KviY nq bv

cvk¦©-cÖwZwµqvI RwUjZv e¨e¯’vcbv Ges KvD‡Ýwjs

l AvBBDwmwW mwbœ‡ek Kivi Av‡M i³ÿi‡Yi cwieZ©b m¤ú‡K© c~Y©v½ KvD‡Ýwjs Ki‡Z n‡e| i³ÿi‡Yi cwieZ©b
m¤ú‡K© c~Y©v½ KvD‡Ýwjs c×wZwU e¨envi Ki‡Z _vKv bvixi Rb¨ me‡P‡q ¸iæZ¡c~Y© mnvqZv `vb n‡Z cv‡i|
cvk¦©-cÖwZwµqv c×wZi Rb¨ n‡ZI cv‡i bvI n‡Z cv‡i| cvk¦©-cÖwZwµqvi Rb¨ m„ó mgm¨v¸‡jv MÖnxZvi mš‘wó Ges
AvBBDwmwW e¨env‡i cÖfve †d‡j| Gme †ÿ‡Î ‡mev`vbKvixMY g‡bv‡hvM †`qv cÖ‡qvRb| hw` MÖnxZvi cvk¦©-cÖwZwµqv
A_ev mgm¨v¸‡jv wb‡q Awf‡hvM K‡i, Zvi D‡Ø‡Mi welq¸‡jv ïbyb, Zv‡K civgk© w`b Ges h_vh_ n‡j wPwKrmv w`b|
hw` wZwb Pvb Zv‡K Ab¨ c×wZ GLb MÖnY Ki‡Z A_ev mgm¨v †_‡K DËxY© n‡Z mvnvh¨ Kiæb

QK: cvk¦©-cÖwZwµqv e¨e¯’vcbv

cvk¦©-cÖwZwµqv
Zxeª A_ev `xN©vwqZ i³ÿiY
(mvaviY mg‡qi †P‡q wظY cwigvY
A_ev 8 w`‡bi †ewk)
(Heavy or prolonged
bleeding/ Twice as much
as usual or longer than
eight days)
e¨e¯’vcbv
AvBBDwmwW e¨enviKvix A‡bK bvixi †ÿ‡Î Zxeª A_ev `xN©vwqZ i³ÿiY n‡q
_v‡K| GwU mvaviYZ ÿwZKviK bq Ges cÖ_g K‡qK gvm e¨env‡ii ci
mvaviYZ K‡g A_ev eÜ n‡q hvq |
¯^í mg‡qi Rb¨ wKQzUv Av‡ivM¨ n‡Z wZwb e¨envi Ki‡Z cv‡ib (cÖwZev‡i
GKwU): U¨ve‡jU †divm mvj‡dU 300µmg cÖwZw`b 1-2 gvm
l Avqibhy³ Lvevi †L‡Z ejyb
l K¬v‡q›U‡K d‡jvAvc Kiæb
l hw` Amn¨ e¨_v nq, AvBBDwmwW †ei K‡i †idvi Kiæb

120 cÖme-cieZ©x cwievi cwiKíbv

 cvk¦©-cÖwZwµqv
ms‡KvPbhy³ e¨_v
(Cramping and pain)
AvBBDwmwW AvswkK A_ev m¤ú~Y©
†ei n‡q Avmv
(Partial or total expulsion
of IUCD)
Zj‡c‡U msµgY
(Infection in lower
abdomen)
m‡›`nK…Z Rivqy wQ`ª A_ev Rivqy‡Z
AvBBDwmwW ¯’vwcZ
(Suspected uterine
perforation or IUCD
implanted in uterus)
mnev‡mi mgq m½x IUCD Abyfe
Ki‡Z cv‡i
(Partner can feel IUCD
strings during sex)
†hvwbc‡_ Ae¨vL¨vZ (hvi Kvib
wbY©xZ nq bvB) i³ÿiY (c×wZwUi
mv‡_ m¤úwK©Z bq Ggb ‡Kvb
Amy¯’Zv n‡Z cv‡i)
(Unexplained vaginal
bleeding that suggests a
medical condition not
related to the method)
Mf©aviY m‡›`n Kiv n‡j
IUD mn Mf©aviY _vK‡j
(Suspected pregnancy with
IUCD)
e¨e¯’vcbv
l i³Pvc, bvwo¯ú›`b I ZvcgvÎv †`Lyb
l Zj‡cU cixÿv Kiæb
l †¯úKzjvg cixÿv Kiæb RivqygyL I wbt¯ªv‡ei Ae¯’v †`Lvi Rb¨
l †hvwbc_ cixÿv K‡i Rivqyi Ae¯’v †`Lyb
l AvBBDwmwW myZv †PK Kiæb
l NSAID w`b
l AvswkK †ei n‡j AcmviY Kiæb
l wZwb Mf©eZx wK bv hvPvB Kiæb
l hw` †KvbI mgm¨v bv _v‡K, bZzb cÖ‡ek Kivb Ges Zv‡K K¨vcmyj
Ww·mvBwK¬b 100 wg.MÖv. 12 NÈv ci ci 7 w`‡bi Rb¨ w`b|
l hw` MÖnxZv wb‡Z cÖZ¨vL¨vb K‡ib Zv‡K KvD‡Ýwjs K‡i Ab¨ weKí c×wZ
†mev w`b|
l BwZnvm wbb Ges kvixwiK cixÿv Kiæb
l Ae¯’v g~j¨vqb K‡i Wv³v‡ii Kv‡Q †idvi Kiæb
l AvBBDwmwW mwbœ‡ek Kiv‡bvi mgq A_ev Rivqy‡Z mvDÛ ‡`qvi mgq, hw`
cvi‡dv‡ikb/ wQ`ª m‡›`n Kiv nq, cÖwµqvwU ZvrÿwYKfv‡e eÜ Kiæb
(AvBBDwmwW mwbœ‡ek Kiv n‡j †ei Kiæb)
l ZvrÿwYKfv‡e nvmcvZv‡j †idvi Kiæb
e¨vL¨v Kiæb †h G iKg KLbI KLbI nq hLb myZv Lye †QvU K‡i KvUv nq| hw`
m½x GwU weiw³Ki g‡b K‡ib, cÖvß weKí¸‡jv eY©bv Kiæb:
l m½x‡K wbwðZ Kiæb †h wZwb e¨_v cv‡eb bv| myZv AviI †QvU K‡i †K‡U
w`‡j mvifvBKvj K¨v‡bj w`‡q †ei n‡q Avm‡e bv|
l hw` Abyfe nq †h myZv `xN© Zvn‡j cÖ‡qvRb Abyhvqx KvUzb A_ev dvbWvm
†_‡K hw` AvBBDwmwW †ei nIqvi m¤¢vebv _v‡K, Zvn‡j AvBBDwmwW
AcmviY Kiyb|
l hw` myZv †QvU nq AvBBDwmwW AcmviY Kiyb Ges K¬v‡q›U PvB‡j bZzb
AvBBDwmwW mwbœ‡ek Kiæb|
l hw` MÖnxZv †KvbI myZv Luy‡R bv cvq, Zvn‡j AvBBDwmwW †ei n‡q †M‡Q wK
bv †`L‡Z n‡e| †¯úKzjvg cixÿv K‡i †`L‡Z n‡e myZv †`Lv hvq wK bv|
l cÖ‡qvRb †gvZv‡eK e¨e¯’v wbb, m¤¢e bv n‡j †idvi Kiæb|
l Wv³v‡ii Kv‡Q †idvi Kiæb
l Mf©aviY K‡i‡Qb wK bv hvPvB Kiæb, KvD‡Ýwjs K‡i (OB/Gyn we‡kl‡Ái
Kv‡Q †idvi Kiæb) cÖ‡qvRbxq e¨e¯’v wbb|
l wcÖUvg© cÖme A_ev Mf©cv‡Zi SuywK, Mf©ve¯’vq AvBBDwmwW Rivqy‡Z _vK‡j
cÖ_g A_ev wØZxq UªvB‡g÷v‡i msµwgZ Mf©cv‡Zi SuywK ev‡o hv Rxe‡bi Rb¨
Avk¼vRbK|
l KvD‡Ýwjs K‡i cÖ‡qvRbxq e¨e¯’v wbb|
cÖme-cieZ©x cwievi cwiKíbv 121
 d‡jvAvc
wbqwgZ d‡jvAvc:

wbqwgZ d‡jvAvc gv‡b †KvbI mgm¨v Av‡Q wK bv A_ev wVKfv‡e KvR Ki‡Q wK bv Rvbvi Rb¨ 3 evi d‡jv Avc Kiv
1g evi- mwbœ‡ek Kivi 1 gvm ci A_ev cÖ_g gvwm‡Ki ci A_ev 3-6 mßv‡ni g‡a¨
2q evi- mwbœ‡ek Kivi 6 gvm ci+ 1 gvm
3q evi- mwbœ‡ek Kivi 12 gvm ci+ 1 gvm
Riæwi d‡jvAvc: Riæwi d‡jvAvc Gi g‡a¨ i‡q‡Q hw` MÖnxZv †KvbI mgm¨v A_ev RwUjZvi Kvi‡Y ‡mev`vbKvixi Kv‡Q
A_ev wbKUeZ©x ¯^v¯’¨‡K‡›`ª MÖnxZv †idvi Ki‡j |

†iKW© iÿY I wi‡cvU© Kiv:

l AvBBDwmwW e¨enviKvix m¤ú‡K© cwievi Kj¨vY mnKvwi (FWA) Zv‡`i †iwR÷v‡i Ges cwievi Kj¨vY cwi`wk©Kv
AvBBDwmwW †c‡g›U †iwR÷v‡i †iKW© Ki‡eb
l cwievi Kj¨vY cwi`wk©Kv wi‡cvU© Ki‡eb Gg AvB Gm dig 3 (MIS FORM 3) Gi gva¨‡g

AviI Z‡_¨i Rb¨ AbyMÖn K‡i †`Lyb cwievi cwiKíbv g¨vbyqvj, Ryb 2018, Aa¨vq 07 c„ôv-89

122 cÖme-cieZ©x cwievi cwiKíbv

Rb¥weiZxKiY/K›Uªv‡mcwUf Bgcø¨v›U

B¤úø¨v›U¸‡jv n‡”Q †QvU bgbxq iW †h¸‡jv EaŸ© evûi Pvgovi wVK wb‡P ¯’vcb Kiv nq| ¯’vcb Kivi ci Gi ai‡bi Dci
wbf©i K‡i †m¸‡jv 3-5 eQ‡ii Rb¨ Mf©wb‡iv‡a myiÿv †`q| B¤úø¨v›U¸‡jv 99% Gi †ewk Kvh©Ki, gvbvbmB, wbivc`,
myweavRbK Ges Acmvi‡Yi ci `ªæZ Mf©aviY ÿgZv wd‡i Av‡m|

÷¨vÛvW© 14: ‡mev`vbKvix 1) MÖnxZv‡K Mf©wb‡ivaK mKj c×wZ m¤ú‡K© Rvbv‡eb Ges Zv‡K Zvi cQ›` Abyhvqx GKwU
h_vh_ c×wZ evQvB Ki‡Z KvD‡Ýwjs Ki‡eb, 2) MÖnxZv evQvB †PKwj÷ e¨envi K‡i MÖnxZv‡K w¯Œb Kiæb 3) GKwU
m¤ú~Y© BwZnvm wb‡q MÖnxZv‡K cixÿv Kiæb (wKQz †ÿ‡Î j¨ve‡iUwi cixÿv `iKvi nq), 4) MÖnxZv‡K cwi®‹vifv‡e †WvR
m¤ú‡K© wkLv‡eb, 5) MÖnxZv‡K mKj weiƒc cÖfve Ges cvk¦©-cÖwZwµqvi e¨e¯’vcbv m¤ú‡K© Rvbv‡eb, 6) Z_¨ msiÿY
Ki‡eb Ges K¬v‡q›U‡K d‡jvAv‡ci Rb¨ Avevi Avm‡Z ej‡eb

`yB cÖKv‡ii B¤úø¨v›U evsjv‡`‡k cwievi cwiKíbv Kg©m~wP‡Z cvIqv hvq. 1 iW, 2 iW wewkó GK-iWwewkó wZb eQ‡ii
Rb¨ Kvh©Ki B¤úø¨v›U| G‡Z †ewiqvg mvj‡dU _v‡K Ges GwU †iwWIiwk¥ A‡f`¨|

`yB-iWwewkó cuvP eQ‡ii Rb¨ Kvh©Ki B¤úø¨v‡›U †gvU 150 wg.MÖv. †j‡fvb‡R‡÷ªj _v‡K, cÖwZ i‡W 75 wg.MÖv K‡i _v‡K|
`yBwU wmwj‡Kvb K¨vcmyj (wmjvmwUK wUDe) Ges RxevYygy³ c¨v‡K‡Ui †fZ‡i Rv‡Wj Gi †UªvKvi _v‡K| cuvP eQ‡ii Rb¨
Kvh©Ki, miKvwifv‡e Ges mvgvwRK gv‡K©wUs †Kv¤úvwb‡Z cvIqv hvq| GwU KvR K‡i mvifvBKvj wgDKvm‡K Mfxi Kivi
gva¨‡g ïµvYy Pj‡b evavi m„wó K‡i Ges wW¤^ cwiùzUb eÜ K‡i| GwU BDwbqb, Dc‡Rjv Ges †Rjv ch©v‡qi nvmcvZv‡j
FWV-Gi mnvqZvq †gwW‡Kj Awdmvi Ges Kbmvj‡U›U‡`i Øviv †`qv nq| GK iW wewkó Bgcø¨v›U 3 eQ‡ii Rb¨|

B¤úø¨v›U MÖnxZv evQvB:

weevwnZvmn cÖRbbÿg mKj bvix

Bgcø¨v›U Gi Dchy³Zv I Abychy³Zv
wb‡¤œ ewY©Z KviY ¸‡jv Qvov mKj mÿg gwnjv‡K Bgcø¨v›U †`Iqv hv‡e|

‡h mKj Ae¯’vq Bgcø¨v›U †`Iqv hv‡e bv

l eZ©gv‡b AweevwnZ/weaev/ZvjvK-cÖvß/¯^vgx †_‡K c„_K
l gwnjv hw` Mf©eZx nb
l ¯Í‡bi K¨vÝvi: eZ©gv‡b Av‡Q ev c~‡e© wQj
l eZ©gv‡b cv‡qi wkiv †dvjv ev e¨v_v/cvj‡gvbvwi G¨v‡¤^vwjRg (DVT/PE) Av‡Q
l ‡hvwbc‡_ i³mªve hvi KviY Rvbv bvB
l wjfv‡ii †ivM-gvivZœK wm‡ivwmm, wjfv‡ii wUDgvi, K¨vÝvi

Bgcø¨v›U Gi myweav
l 3 eQ‡ii Rb¨ AZ¨šÍ Kvh©Ki Rb¥ wbqš¿Y
l mnev‡m evavi m„wó K‡i bv
l ¯Íb¨`vbKv‡j e¨envi wbivc`
l hvi B‡÷ªv‡Rb e¨envi Kiv DwPZ bq Ggb bvixI e¨envi Ki‡Z cvi‡eb
l Ifz‡jkb Gi e¨_v I ms‡KvPb Kgvq
l gvwmK i³ÿiY Kg
l a~gcvqx 35 eQ‡ii †ewk eqmxivI e¨envi Ki‡Z cvi‡eb
l Ly‡j †djvi ci `ªæZ De©iZv wd‡i Av‡m

B¤úø¨v›U Gi Amyweav
l AwbwðZ Ges AwbqwgZ FZz¯ªve
l cÖwkwÿZ ¯^v¯’¨ †mev`vbKvix Øviv cÖ‡qvM I AcmviY Ki‡Z n‡e

cÖme-cieZ©x cwievi cwiKíbv 123

 l gvwmK eÜ A_ev K‡g †h‡Z cv‡i
l †hŠbevwnZ †ivM/ HIVGi †ÿ‡Î myiÿv †`q bv
l gv_ve¨_vi KviY n‡Z cv‡i

B¤úø¨v›U KLb kyiæ Ki‡Z n‡e

l gvwm‡Ki 1-7 w`‡bi g‡a¨
l Lvevi ewo e¨enviKvix bvix‡`i Rb¨ wb‡`©wkZ mgq n‡jv †kl mv`v ewo †me‡bi ci A_ev eZ©gvb ewo¸‡jv †kl nevi
ci
l ‡cÖv‡Rw÷b wfwËK Ab¨vb¨ c×wZ e¨enviKvix bvix‡`i Rb¨
- †hw`b wgwbwcj †kl Ki‡eb
- †hw`b B¤úøv›U †Lvjv n‡e
- Bb‡RK‡Uej Mf©wb‡ivaK hL‡bv mwµq
l cÖm‡ei ci ci
l Mf©cv‡Zi ci ci
l MÖnxZv Mf©eZx bq wbwðZ n‡j †h †KvbI mgq

B¤úø¨v›U MÖnxZvi KvD‡Ýwjs

GKRb bvix Mf©eZx bq wbwðZ n‡j †h †KvbI mgq B¤úø¨v›U e¨envi ïiæ Ki‡Z cv‡ib

QK: MÖnxZvi cwiw¯’wZ Ges B¤úø¨v›U cÖ‡qv‡Mi mgq

bvixi cwiw¯’wZ / Ae¯’v KLb ïiæ Ki‡Z n‡e

gv‡mi †h †KvbI mg‡q
gvwmK Pj‡Q A_ev GKwU
ni‡gvbwenxb c×wZ †_‡K cwieZ©b
l hw` Zvi gvwm‡Ki 7 w`‡bi g‡a¨ ïiæ K‡ib (B¤úøvbb Gi Rb¨ 5 w`b) Z‡e
†KvbI mnvqK c×wZi `iKvi †bB
l hw` Zvi gvwm‡Ki mvZ w`‡bi †ewk nq (B¤úøvbb Gi Rb¨ cuvP w`‡bi †ewk)
wZwb hw` m¤ú~Y© wbwðZ _v‡Kb †h wZwb Mf©eZx bb Z‡e †h †KvbI mgq
Bgcø¨v›U cÖ‡qvM Ki‡Z cvi‡eb| ¯’vc‡bi cÖ_g 7 w`b ch©šÍ mnvqK c×wZi
`iKvi Av‡Q|
l hw` wZwb IUCD †_‡K cwieZ©b K‡ib, wZwb mv‡_ mv‡_B B¤úø¨v›U ¯’vcb
Ki‡Z cvi‡eb|

GKwU ni‡gvbhy³ c×wZ †_‡K l †KvbI bvix hw` avivevwnK I mwVKfv‡e ni‡gvb mg„× c×wZ e¨envi K‡i
cwieZ©b _v‡Kb A_ev m¤ú~Y© wbwðZ _v‡Kb †h wZwb Mf©eZx bb Z‡e ZvrÿwYKfv‡e
kyiæ Ki‡Z cvi‡eb| cieZ©x gvwm‡Ki Rb¨ A‡cÿv Kivi `iKvi †bB|
†KvbI mnvqK c×wZi `iKvi †bB
l hw` wZwb Bb‡RK‡Uej †_‡K cwieZ©b K‡ib, cieZ©x Bb‡RKkb †`qvi
m¤¢ve¨ mg‡q wZwb Bgcø¨v›U ¯’vcb Ki‡Z cvi‡eb| †KvbI mnvqK c×wZi
`iKvi †bB|

AwbqwgZ ey‡Ki `ya cvb Kiv‡”Qb
Ggb gv‡qiv
l hw` FZz¯ªve kyiæ bv nq, hw` wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Zvn‡j
†h †KvbI mg‡q Bgcø¨v›U mwbœ‡ek Ki‡Z cvi‡eb. Bgcø¨v›U mwbœ‡ek Kivi
cÖ_g mvZ w`b ch©šÍ Zv‡K mnvqK c×wZ MÖnY Ki‡Z n‡e|
l hw` gvwmK n‡q hvq Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx Bgcø¨v›U
cÖ‡qvM Ki‡Z cvi‡eb|

124 cÖme-cieZ©x cwievi cwiKíbv

 bvixi cwiw¯’wZ / Ae¯’v KLb ïiæ Ki‡Z n‡e

cÖm‡ei ci †_‡K †h †Kvb mgq
(hw` Mf©eZx bq Zv wbwðZ nIqv
hvq)
ey‡Ki `ya cvb Kiv‡”Qb bv Ggb
gv‡qiv
gvwmK i³ÿiY †bB (cÖme ev ey‡Ki
`ya cv‡bi mv‡_ m¤úwK©Z bq)
Mf©cv‡Zi ci
Riæix Rb¥weiZxKib Lvevi
ewo/Bgv‡R©wÝ K›Uªv‡mcwUf wcj
(ECP) †me‡bi ci
l cÖm‡ei mv‡_ mv‡_ cÖ‡qvM Kiv hvq
l 6 mßv‡ni Kg mg‡qi c~‡e© cÖme m¤úbœ n‡j
l hw` gvwmK wd‡i bv Av‡m 6 mßvn n‡Z 6 gv‡mi g‡a¨ (‡h‡Kvb mgq Bgcø¨v›U
cÖ‡qvM Ki‡Z cvi‡eb| †KvbI mnvqK c×wZi cÖ‡qvRb †bB|
l hw` gvwmK wd‡i Av‡m †m‡ÿ‡Î gvwmK P‡µi wbqg Abyhvqx Bgcø¨v›U cÖ‡qvM
Ki‡Z n‡e|
l hw` cÖm‡ei 4 mßvn c~Y© bv nq, Zvn‡j †h †KvbI mg‡q Bgcø¨v›U cÖ‡qvM
Ki‡Z cvi‡eb. †KvbI mnvqK c×wZi cÖ‡qvRb †bB|
l hw` cÖm‡ei 4 mßvn c~Y© nq, FZz¯ªve kyiæ bv nq, hw` wZwb m¤ú~Y© wbwðZ †h
Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q Bgcø¨v›U cÖ‡qvM Ki‡Z cvi‡eb.
B¤úøv›U mwbœ‡ek Kivi cÖ_g 7 w`b ch©šÍ Zv‡K mnvqK c×wZ MÖnY Ki‡Z
n‡e|
l hw` gvwmK n‡q hvq Zvn‡j gvwmK nIqv bvixi Rb¨ civgk© Abyhvqx B¤úøv›U
cÖ‡qvM Ki‡Z cvi‡eb
l hw` wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Zvn‡j †h †KvbI mg‡q Bgcø¨v›U
cÖ‡qvM Ki‡Z cvi‡eb. Bgcø¨v›U cÖ‡qvM Kivi cÖ_g 7 w`b ch©šÍ Zv‡K mnvqK
c×wZ MÖnY Ki‡Z n‡e|
l wZwb mv‡_ mv‡_B cÖ‡qvM Ki‡Z cvi‡eb| hw` Bgcø¨v›U cÖ_g A_ev wØZxq
UªvB‡g÷v‡i Mf©cvZ nIqvi ci wZwb 7 w`‡bi g‡a¨ cÖ‡qvM K‡ib Zvn‡j
†KvbI mnvqK c×wZi `iKvi †bB
l hw` cÖ_g A_ev wØZxq UªvB‡g÷v‡i Mf©cvZ nIqvi ci wZwb 7 w`‡bi †ewk
mgq, Zvn‡j hw` wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Zvn‡j †h †KvbI
mg‡q Bgcø¨v›U cÖ‡qvM Ki‡Z cvi‡eb. B¤úøv›U cÖ‡qvM Kivi cÖ_g 7 w`b ch©šÍ
Zv‡K mnvqK c×wZ MÖnY Ki‡Z n‡e|
cieZ©x gvwmK ïiæ nIqvi 7 w`‡bi g‡a¨ Bgcø¨v›U cÖ‡qvM Ki‡Z cvi‡eb
(B¤úøvbb Gi Rb¨ 5 w`b) A_ev wZwb m¤ú~Y© wbwðZ †h Mf©aviY K‡ibwb Z‡e †h
†KvbI mgq| (Zv‡K Bwmwc †kl nIqvi ci w`b †_‡K Bgcø¨v›U cÖ‡qvM Kivi c~e©
ch©šÍ mnvqK c×wZ A_ev Iivj K›Uªv‡mcwUf w`b)

B¤úø¨v›U cÖ‡qvM cieZ©x KvD‡Ýwjs

1. B¤úøv›U MÖnYKvix MÖnxZv KvW©wU c~iY Kiæb Ges MÖnxZv cÖ‡qvRbxq wb‡`©kbv Ges Zvi ¸iæZ¡ eySv‡bvi ci MÖnxZv‡K
KvW©wU w`b Ges Zv wbivc‡` msiÿY Ki‡Z ejyb
2. wK¬wb‡K cieZ©x mgq Avmvi mgq Avm‡Z d‡jvAvc KvW©wU wb‡q Avm‡Z ejyb|
3. MÖnxZvi Rb¨ civgk©:
l cÖ‡qvM ci ciB ¯^vfvweK KvR Ki‡Z cvi‡eb Z‡e NlvNwl, †ewk IRb enb A_ev cÖ‡qvM ¯’v‡b †Rv‡i Pvc †`qv
†_‡K weiZ _vKzb|
l MÖnxZv wb‡R cÖ_g e¨v‡bWRwU 24 NÈv c‡i Ges †fZ‡ii e¨v‡bWRwU 3-5 w`b c‡i Ly‡j †dj‡Z cvi‡eb| GB
mgq cÖ‡qvM ¯’vbwU †fRv‡bv hv‡e bv|
l A¨v‡bm‡_wmqvi cÖfve P‡j hvIqvi ci wKQzUv e¨_v n‡Z cv‡i, c¨vivwmUvgj †`qv †h‡Z cv‡i|
l cÖ‡qvM ¯’vbwU‡Z msµgY n‡j †hgb R¡i, †dvjv, MÖnxZv‡K ¯^v¯’¨‡K‡›`ª †h‡Z n‡e|
l cÖ‡qvM ¯’vbwU wKQzw`b jvj _vK‡Z cv‡i| †KvbI wPwKrmvi `iKvi †bB|

cÖme-cieZ©x cwievi cwiKíbv 125

 4. MÖnxZv‡K Rvbvb KLb wbqwgZ d‡jvAvc A_ev Riæwi Ae¯’vi Rb¨ Zv‡K wbKUeZ©x †mev‡K‡›`ª A_ev gvVKg©xi Kv‡Q
†h‡Z n‡e
5. MÖnxZvi Bgcø¨v›U m¤úwK©Z †KvbI cÖkœ _vK‡j DËi w`b

Bgcø¨v›U AcmviY cieZ©x KvD‡Ýwjs

l MÖnxZv‡K Rvbvb †h ¯’vbwU‡Z nvjKv e¨_v Ges jvj‡Pfve _vK‡Z cv‡i
l 24 NÈv c‡i UvBU e¨v‡bWRwU Ges †fZ‡ii e¨v‡bWRwU 3-5 w`b c‡i Ly‡j †dj‡Z cvi‡eb| GB mgq RL‡gi ¯’vbwU
†fRv‡bv hv‡e bv|
l Acmvi‡Yi ci `ªæZ Mf©aviY ÿgZv wd‡i Av‡m| MÖnxZv hw` mšÍvb bv Pvb, Zv‡K †h †KvbI c×wZ e¨envi Ki‡Z
civgk© w`b|
l cieZ©x wfwRU K‡e Zv Zv‡K Rvbvb
l MÖnxZvi †KvbI cÖkœ _vK‡j DËi w`b

cvk¦©-cÖwZwµqv Ges RwUjZv e¨e¯’vcbv

me‡P‡q cÖPwjZ cvk¦©-cÖwZwµqv¸‡jv eY©bv Kiæb| i³¯ªv‡ei aib e`‡j †h‡Z cv‡i, AwbqwgZ i³mªve hv cÖ_g eQ‡i 8
w`‡bi †ewk _vK‡Z cv‡i A_ev wbqwgZ, gv‡S-gv‡S ev c‡i †KvbI i³mªve bvI n‡Z cv‡i| GQvov gv_ve¨_v, †cU e¨_v,
¯Íb e¨_v, Ges Ab¨vb¨ cvk¦©-cÖwZwµqv n‡Z cv‡i

Bgcø¨v›U cÖ‡qv‡Mi Av‡M i³¯ªv‡ei ai‡bi cwieZ©b Ges Ab¨vb¨ cvk¦©-cÖwZwµqv m¤ú‡K© c~Y©v½ KvD‡Ýwjs Kiæb| i³¯ªv‡ei
cwieZ©b m¤ú‡K© KvD‡Ýwjs c×wZwU e¨envi Ki‡Z _vKv bvixi Rb¨ me‡P‡q ¸iæZ¡c~Y© mnvqZv`vb n‡Z cv‡i|

cvk¦©-cÖwZwµqv c×wZi Rb¨ n‡ZI cv‡i bvI n‡Z cv‡i| cvk¦©-cÖwZwµqvi Rb¨ m„ó mgm¨v¸‡jv MÖnxZvi mš‘wó Ges Bgcø¨v›U
e¨env‡i cÖfve †d‡j| Gme †ÿ‡Î ‡mev`vbKvixi g‡bv‡hvM †`qv cÖ‡qvRb| hw` MÖnxZv cvk¦©-cÖwZwµqv A_ev mgm¨v¸‡jv
wb‡q Awf‡hvM K‡i, Zvi D‡Ø‡Mi welq¸‡jv, ïbyb, Zv‡K civgk© w`b Ges h_vh_ n‡j wPwKrmv w`b A_ev †idvi Kiæb|
hw` wZwb Pvb, Zvn‡j Zv‡K GLb Ab¨ c×wZ MÖnY Ki‡Z A_ev mgm¨v †_‡K DËxY© n‡Z mvnvh¨ Kiæb|

QK: B¤úø¨v‡›Ui cvk¦©-cÖwZwµqv e¨e¯’vcbv

cvk¦©-cÖwZwµqv/ RwUjZv mgvavb

AwbqwgZ i³mªve (AcÖZ¨vwkZ
mg‡q i³mªve hv MÖnxZv‡K wPšÍvq
†d‡j)
(Irregular
bleeding/bleeding at
unexpected times that
bothers the client)
gvwmK i³mªve nq bv
(No monthly bleeding)
Zxeª A_ev `xN©vwqZ i³mªve (mvaviY
mg‡qi †P‡q wظY cwigvY A_ev 8
w`‡bi †ewk)
(Heavy or prolonged
bleeding/Twice as much as
†¯úKzjvg cixÿv Kiæb Ges RivqygyL †`Lyb
l i³¯^íZv hvPvB Kiæb
l Mf©aviY Av‡Q wK bv cixÿY Kiæb
l VIA ev †cc w¯§qvi cixÿv Kiæb
l Avqib dwjK GwmW U¨ve‡jU w`b w`‡b `yBevi wZb gv‡mi Rb¨
l Ae¯’v Abyhvqx U¨ve‡jU AvBey‡cÖv‡db 400-800 wg.MÖv. w`‡b 3 evi LvIqvi
ci w`b
l ¯^í gvÎvq wgkÖ Lvevi ewo w`b cÖwZw`b GKwU K‡i 1-3wU P‡µi Rb¨ w`b
l Avk¦vm w`b †h wKQz Bgcø¨v›U cÖ‡qvM Ki‡j i³mªve eÜ n‡q hvq, GwU ÿwZKi
bq| cÖwZ gv‡m i³mªve nevi cÖ‡qvRb †bB| Mf©aviY Kv‡j †hgb i³mªve
nq bv, GwU Zvi g‡Zv|
l hw` MÖnxZv Mf©eZx nb, Z‡e GwU c×wZwUi e¨_©Zvi Rb¨ n‡q‡Q, Bgcø¨v›U
AcmviY Kiæb
l Bgcø¨v›U e¨enviKvix A‡bK bvixi †ÿ‡Î Zxeª A_ev `xN©vwqZ i³mªve n‡q
_v‡K| GwU mvaviYZ ÿwZKviK bq Ges cÖ_g K‡qK gvm e¨env‡ii ci
mvaviYZ K‡g A_ev eÜ n‡q hvq |
l MÖnxZvi Rivqyi wUDgvi, Rivqy, RivqygyL, wW¤^vk‡q †KvbI A¯^vfvweKZv
Av‡Q wK bv, hvPvB Kiv cÖ‡qvRb

126 cÖme-cieZ©x cwievi cwiKíbv

 cvk¦©-cÖwZwµqv/ RwUjZv
usual or longer than eight
days)
mvaviY gv_ve¨_v A_ev gvB‡MÖb
(Ordinary headaches or
migraine)
eªY
(Acne)
IRb cwieZ©b
(Weight change)
¯Íb e¨_v
(Breast tenderness)
†gRvR cwieZ©b A_ev †hŠb B”Qvi
cwieZ©b
(Mood change or change in
sex drive)
ewg A_ev wSgwSg fve
(Nausea or dizziness)
cÖ‡qvM A_ev Acmvi‡Yi ci e¨_v
(Pain after insertion or
removal)
KvUv¯’v‡b msµgY (jvj‡Pfve, Mig,
e¨_v, cuyR)
(Infection at the insertion
site/Redness, heat, pain,
pus)
mgvavb
l i³¯^íZv cÖwZ‡ivv‡a Avqib dwjK GwmW U¨ve‡jU w`b w`‡b K‡qK gv‡mi
gv‡mi Rb¨
l Ae¯’v Abyhvqx U¨ve‡jU AvBey‡cÖv‡db 400-800 wg.MÖv. w`‡b 3 evi LvIqvi
ci w`b
l wgkÖ Lvevi ewo w`‡b `yBwU K‡i 3-7 w`‡bi Rb¨ Ges 1 P‡µi Rb¨ w`‡b
GKwU K‡i
l MÖnxZv‡K d‡jvAvc Kiæb hw` Ges i³ÿiY n‡Z _v‡K, Bgcø¨v›U AcmviY
Kiæb
l MÖnxZv‡K cixÿv Kiæb, KZ Nb Nb gv_ve¨_v nq, 2 mßvn †`Lyb ZviciI
wbqwš¿Z bv n‡j Bgcø¨v›U AcmviY Kiæb
l eªY Gi Rb¨ MÖnxZv Bgcø¨v›U e¨envi Ki‡Z bv PvB‡j wZwb wgkÖ Lvevi ewo
cwieZ©b m¤ú‡K© fve‡Z cv‡ib| wgkÖ Lvevi ewo e¨env‡ii mv‡_ A‡bK
bvixi eªY mvaviYZ fv‡jv nq
l mvaviYfv‡e cÖwZKv‡ii K_v fveyb
Lv`¨ZvwjKv ch©v‡jvPbv K‡i cÖ‡qvRb g‡Zv KvD‡Ýwjs Kiæb
l MÖnxZv‡K cixÿv Kiæb, Mf©aviY hvPvB Kiæb mv‡cvwU©f eªv civi (cwikÖghy³
KvR Ges Nygv‡bvi mg‡qI) wb‡`©kbv w`b
l Mig A_ev VvÐv †muK w`b
l A¨vmwcwib (325-650 wg.MÖv.), AvBey‡cÖv‡db (200-400 wg.MÖv.),
c¨vivwmUvgj (325-1000wg.MÖv) A_ev Ab¨ e¨_vbvkK MÖn‡Yi civgk© w`b
l mvaviYfv‡e cÖwZKv‡ii K_v fveyb
l Zvi Rxe‡b Ggb †KvbI cwieZ©b n‡q‡Q wK bv hv‡Z †gRvR A_ev †hŠb
B”Qvi cwieZ©b n‡Z cv‡i, m½xi mv‡_ m¤ú‡K©i cwieZ©b Gi g‡a¨ AšÍf©y³|
cÖ‡qvRb Abyhvqx mnvqZv w`b
l †gRv‡Ri Zxeª cwieZ©b †hgb cÖej welbœZv †`Lv w`‡j †mevi Rb¨ †idvi
Kiæb
l mvaviYfv‡e cÖwZKv‡ii K_v fveyb
l mvaviYfv‡e cÖwZKv‡ii K_v fveyb
l cÖ‡qv‡Mi ci e¨_v n‡j cixÿv Kiæb Zvi evûi e¨vb‡WR †ewk AuvUmuvU wK bv
l evû‡Z bZzb e¨vb‡WR w`b Ges Zv‡K civgk© w`b hv‡Z wKQzw`‡bi Rb¨
¯’vbwU‡Z Pvc bv †`q
l A¨vmwcwib (325-650 wg.MÖv.), AvBey‡cÖv‡db (200-400 wg.MÖv.),
c¨vivwmUvgj (325-1000wg.MÖv) A_ev Ab¨ ai‡bi e¨_vbvkK MÖn‡Yi
civgk© w`b|
l Bgcø¨v›U AcmviY Ki‡eb bv
l msµwgZ ¯’vb mvevb, cvwb ev A¨vw›U‡mcwUK w`‡q cwi®‹vi Kiæb
l 7-10 w`‡bi Rb¨ gy‡L A¨vw›Uev‡qvwUK w`b
l A¨vw›Uev‡qvwUK †kl nevi ci msµgY †_‡K †M‡j Avevi Avm‡Z ejyb Ges
msµgY †_‡K †M‡j Bgcø¨v›U Acmvi‡Yi Rb¨ †idvi Kiæb
l †ei n‡j A_ev AvswkK †ei n‡j msµgY N‡U hw` MÖnxZv †Lqvj K‡ib †h
Bgcø¨v›U †ei n‡q Avm‡Q Zvn‡j Avevi Avm‡Z ejyb
cÖme-cieZ©x cwievi cwiKíbv 127
 cvk¦©-cÖwZwµqv/ RwUjZv mgvavb
†dvov (msµg‡Yi Kvi‡Y Pvgovi l A¨vw›U‡mcwUK w`‡q ¯’vbwU cwi®‹vi Kiæb|
wb‡P cuy‡Ri _wj) l Bbwmk‡bi gva¨‡g cyuR †ei Kiæb|
(Abscess/Pocket of pus l ÿZ¯’v‡bi wPwKrmv Kiæb
under the skin due to l 7-10 w`‡bi Rb¨ gy‡L A¨vw›Uev‡qvwUK w`b
infection) l me A¨vw›Uev‡qvwUK †kl n‡jI hw` jvj‡Pfve, e¨_v A_ev ÿZ †_‡K
wbtmiY nq Zvn‡j MÖnxZv‡K wd‡i Avm‡Z ejyb, msµgY _vK‡j Bgcø¨v›U
AcmviY ev Gi Rb¨ †idvi Kiæb
GK ev AwaK Bgcø¨v›U wb‡R †_‡K l mvaviYZ Kg n‡q _v‡K| mvaviYZ cÖ‡qv‡Mi K‡qK gv‡mi g‡a¨ A_ev
†ei n‡q Av‡m msµgY n‡j n‡q _v‡K|
(Expulsion/When one or l hw` †KvbI msµgY bv _v‡K, †ei nIqv iW A_ev K¨vcmyj bZzbfv‡e †K‡U
more implants begins to Ab¨ iW ev K¨vcmyj ¸‡jvi KvQvKvwQ cybt¯’vcb Kiæb A_ev cybt¯’vc‡bi
come out of the arm) Rb¨ †idvi Kiæb|
Zj‡c‡U Zxeª e¨_v (GK‡UvwcK l A‡bK †ÿ‡Î Zxeª †cU e¨_v n‡Z cv‡i| G‡±vwcK †cÖM‡bwÝi Ab¨vb¨ jÿY
†cÖM‡bwÝ A_ev Ifvwiqvb wm÷ eo I Dcm‡M©i Rb¨ we‡klfv‡e mZK© _vKzb, GwU weij wKš‘ Rxe‡bi Rb¨
n‡j SuywKc~Y©| `qv K‡i ZvrÿwYKfv‡e †idvi Kiæb|
(Severe pain in lower
abdomen/ Suspected
ectopic pregnancy or
enlarged ovarian follicles
or cysts)
†hvwbc‡_ hvi Kvib Rvbv †bB l h_vh_ g~j¨vqb, †ivM wbY©q, wPwKrmvi Rb¨ †idvi Kiæb|
i³ÿiY (c×wZwUi mv‡_ m¤úwK©Z l hw` †hŠbevwnZ msµgY A_ev †cjwfK cÖ`v‡ni Rb¨ i³ÿiY n‡q _v‡K
bq Ggb †KvbI Amy¯’Zv n‡Z cv‡i) Zvn‡j wZwb wPwKrmvi mgq Bgcø¨v›U e¨envi Pvwj‡q †h‡Z cvi‡eb
(Unexplained vaginal
bleeding that suggests a
medical condition not
related to the method)
wLPzwbi wPwKwrmv / A¨vw›U l cieZ©x e¨e¯’vcbvi Rb¨ †idvi Kiæb
Kbfvj‡m›U A_ev widvgwcwmb w`‡q
wPwKrmv ïiæ Kiv
(Starting treatment with
anticonvulsants or
rifampicin)

gvB‡MÖb gv_ve¨_v l hw` GKRb bvixi gvB‡Mªb gv_v e¨_v _v‡K wZwb PvB‡j Bgcø¨v›U e¨envi
(Migraine headaches) Pvwj‡q †h‡Z cv‡ib|
l hw` ¯œvqweK DcmM© mn gvB‡MÖb nq Zvn‡j Bgcø¨v›U AcmviY Kiæb Ges
ni‡gvbwenxb c×wZ evQvB Ki‡Z mvnvh¨ Kiæb
wbw`©ó m¼URbK ¯^v¯’¨ Ae¯’v (cv A_ev l Acmvi‡Yi Rb¨ †idvi Kiæb
dzmdz‡mi Mfxi wkivmg~‡n i³RgvU,
hK…Z †ivM A_ev ¯Íb K¨vÝvi)
(Certain serious health
conditions/Suspected blood
clots in deep veins of legs
or lungs, liver disease or
breast cancer)

128 cÖme-cieZ©x cwievi cwiKíbv

 cvk¦©-cÖwZwµqv/ RwUjZv mgvavb
ü`‡ivM (Bk‡KwgK nvU© l Acmvi‡Yi Rb¨ †idvi Kiæb Ges Dc‡hvMx c×wZi Rb¨ †idvi Kiæb
wWwRR)A_ev †÷ªvK
(Heart disease (Ischemic
heart disease) or stroke)
Mf©aviY K‡i‡Qb aviYv n‡j l Mf©aviY wbwðZ K‡i D”PZi ‡mev †K‡›`ª Bgcø¨v›U †Lvjvi Rb¨ †idvi Kiæb
(Suspected pregnancy) l Bgcø¨v›Umn Mf©avib Ki‡j Rvbvg‡Z Mf©v¯’ wkïi Dci †Kvb SzuwK †bB|

d‡jvAvc

Bgcø¨v›U Acmvi‡Yi mgq Qvov †KvbI iæwUb d‡jvAv‡ci cÖ‡qvRb †bB| Z‡e MÖnxZv‡K ¯úó K‡i ejyb wZwb PvB‡j †h
†KvbI mgq Avm‡Z cv‡ibb|
1. MÖnxZv‡K wR‡Ám Kiæb c×wZwU e¨envi Ki‡Z †Kgb jvM‡Q, wZwb mš‘ó wK bv, Zvi †KvbI cÖkœ A_ev †KvbwKQz
Av‡jvPbv Kivi Av‡Q wK bv|
2. we‡kl K‡i wR‡Ám Kiæb i³¯ªv‡ei aib wb‡q †KvbI mgm¨v Av‡Q wK bv| Zvi cÖ‡qvRb g‡Zv Z_¨ ev mnvqZv w`b|
3. `xN© ‡gqv‡`i K¬v‡q‡›U‡K wR‡Ám Kiæb †kl wfwR‡Ui ci Zvi bZzb †KvbI ¯^v¯’¨ mgm¨v n‡q‡Q wK bv| mgm¨v¸‡jv
h_vh_fv‡e D‡jøL Kiæb| bZzb ¯^v¯’¨ mgm¨vi Kvi‡Y c×wZ cwieZ©b Ki‡Z n‡Z cv‡i|
4. `xN© †gqv‡`i MÖnxZv‡K wR‡Ám Kiæb Rxe‡b †KvbI eo cwieZ©b n‡q‡Q wK bv hv mšÍvb MÖn‡Yi cwiKíbv Ges
STI/HIV SuywK‡Z cÖfve †dj‡Z cv‡i| cÖ‡qvRb g‡Zv d‡jvAvc Kiæb|
5. hw` m¤¢e nq, B¤úø¨v›U e¨envi Ki‡Q, Ggb MÖnxZvi IRb gvcyb| hw` IRb cwieZ©b Zvi B¤úø¨v‡›Ui Kvh©Ki Kv‡j
cÖfve †d‡j Zvi Kv‡W© D‡jøL Kiæb| hw` KvW© _v‡K, Zvn‡j bZzb Kv‡W© mwVK ZvwiL w`‡q Zv‡K w`b|
hw` wZwb B¤úø¨v›U e¨envi Pvwj‡q †h‡Z Pvb Ges Gi Dci cÖfve †dj‡e Ggb †KvbI Amy¯’Zv bv _v‡K, Zvn‡j Zv‡K g‡b
Kwi‡q w`b Avi KZ mgq B¤úø¨v›UwU Mf©aviY †_‡K myiÿv w`‡e|

B¤úøv›U cÖ‡qvM Kivi ci d‡jvAv‡ci mgqm~Px

MÖnxZv‡K wZbwU d‡jvAvc Gi Rb¨ Avm‡Z n‡e:
1g d‡jvAvc: 1 gvm ±7 w`b cÖ‡qv‡Mi ci
2q d‡jvAvc: 6 gvm ± 1 gvm cÖ‡qv‡Mi ci
3q d‡jvAvc: 12 gvm ± 1 gvm cÖ‡qv‡Mi ci

hw` MÖnxZvi G ai‡Yi RwUjZv _v‡K Z‡e ¯^v¯’¨‡K‡›`ª Avm‡Z civgk© w`b:
l FZz¯ªve †bB / gvwmK eÜ
l Bgcø¨v›U cÖ‡qv‡Mi ¯’v‡b msµgY
l Zxeª Zj †cU e¨_v
l Bgcø¨v›U I iW †ewi‡q Avmv
l AwZwi³ gvwmK i³ÿiY
l Zxeª gv_ve¨_v A_ev Svcmv `„wó

†iKW© iÿY I wi‡cvU© Kiv:

l Bgcø¨v›U e¨enviKvix m¤ú‡K© cwievi Kj¨vY mnvKvwi (FWA) Zv‡`i †iwR÷v‡i Ges cwievi Kj¨vY cwi`wk©Kv
Bgcø¨v›U ‡c‡g›U †iwR÷v‡i †iKW© Ki‡eb
l cwievi Kj¨vY mnKvix wi‡cvU© Ki‡eb Gg AvB Gm dig 1 (MIS FORM 1) Gi gva¨‡g cwievi Kj¨vY cwi`wk©Kv
wi‡cvU© Ki‡eb Gg AvB Gm dig 3 (MIS FORM 3) Gi gva¨‡g

AviI Z‡_¨i Rb¨ AbyMÖn K‡i †`Lyb cwievi cwiKíbv g¨vbyqvj, Ryb 2018, Aa¨vq 06 c„ôv-63

cÖme-cieZ©x cwievi cwiKíbv 129

 ¯’vqx c×wZmg~n

MÖnxZv Gi Mf©aviY Kivi ÿgZv ¯’vqxfv‡e GKwU A‡¯¿vcPvi cÖwµqvi gva¨‡g eÜ Kiv hvq hv fjv›Uvwi mvwR©Kvj
KbUªv‡mcwUf A_ev ¯’vqx c×wZ bv‡g cwiwPZ| `yB ai‡bi ¯’vqx c×wZ i‡q‡Q:
l bvixi Rb¨ ¯’vqx c×wZ n‡jv wUD‡eK‡Uvwg
l cyiæ‡li Rb¨ ¯’vqx c×wZ n‡jv f¨v‡mK‡Uvwg

†h †KvbI ¯’vqx c×wZi Rb¨ MÖnxZv evQvB Kiæb

l MÖnxZv‡K weevwnZ n‡Z n‡e (†h †KvbI mg‡q weevwnZ)
l bvix MÖnxZvi eqm 49 eQ‡ii wb‡P
l `¤úwZi Kgc‡ÿ `ywU RxweZ mšÍvb _vK‡e hv‡`i eqm GK eQ‡ii Dc‡i hw` bv ¯’vqx c×wZi Rb¨ †gwW‡Kj wb‡`©kbv
_v‡K
l wØZxq wmRvwiqvb †mKk‡bi Acv‡ik‡bi mgq `¤úwZi Df‡qi AbygwZ ¯^v‡c‡ÿ
l MÖnxZv A_ev Zv‡`i m½x Aek¨B c~‡e© KLbI ¯’vqx c×wZ‡Z hvqwb (c~‡e©i ¯’vqx c×wZ MÖnY e¨_© n‡j cÖ‡hvR¨ bq)
l MÖnxZv‡K Aek¨B gvbwmKfv‡e my¯’ n‡Z n‡e hv‡Z ¯’vqx c×wZ MÖn‡Yi m¤ú~Y© Zvrch© eyS‡Z cv‡ib
l gvbwmKfv‡e Amy¯’ MÖnxZvi †ÿ‡Î Aek¨B GKRb g‡bv‡ivM we‡klÁ Øviv cÖZ¨vwqZ n‡Z n‡e Ges AvBbZ
AwffveK/m½x KZ„©K MÖnxZvi gvbwmK my¯’Zv m¤ú‡K© GKwU wee„wZ w`‡Z n‡e |

¯’vqx c×wZ hv‡`i Rb¨ Dcy³

l ‡h mKj `¤úwZi 02 (`yB) Rb RxweZ mšÍvb Av‡Q Ges †QvU mšÍv‡bi eqm Kgc‡ÿ 01 (GK) eQi Zv‡`i ¯^vgx ev
¯¿x Gi †h †Kvb GKRb‡K h_vµ‡g f¨v‡mKUwg ev wUD‡eKUwg †mev cÖ`vb Kiv hv‡e
l wØZxq wmRvwiqvb Acv‡ik‡bi mgq `¤úwZi m¤§wZµ‡g ¯¿x‡K wUDeKUwg †mev cÖ`vb Kiv hv‡e
l ‡h mKj `¤úwZi 02 (`yB) Rb RxweZ Av‡Q Ges ¯^vgx I ¯¿x Df‡qB ¯’vqx c×wZ cieZ©x mKj myweav I Amyweav
ey‡S-ï‡b †hŠ_fv‡e †¯^”Qvq c×wZ MÖn‡Y m¤§wZ cÖ`vb Ki‡j †h †Kvb GKRb‡K f¨v‡mKUwg ev wUD‡eKUwg †mev cÖ`vb
Kiv hv‡e|

bvixi Rb¨ ¯’vqx c×wZ, wUD‡eK‡Uvwg

wUDevj †÷wijvB‡Rkb Mf©wb‡iv‡ai GKwU ¯’vqx c×wZ †hLv‡b †d‡jvwcqvb wUDe wW¤^evnx bvjxi wKQz Ask eÜ K‡i †`qv
nq hv‡Z wW¤^vby wW¤^vkq †_‡K Rivqy ch©šÍ †b‡g Avm‡Z bv cv‡i| Aí K_vq, †d‡jvwcqvb wUDe¸‡jv n‡jv Ggb bvwj
†h¸‡jvi gva¨‡g wW¤^vby wW¤^vkq †_‡K Rivqy ch©šÍ †b‡g Av‡m| wUD‡eK‡Uvwgi †ÿ‡Î wUDe¸‡jv eÜ A_ev wef³ Kiv nq
hv‡Z hv‡Z wW¤^vby wW¤^vkq †_‡K Rivqy ch©šÍ †b‡g Avmv cÖwZ‡iva nq| GwU cieZ©x †KvbI Mf©aviY nIqv cÖwZ‡iva K‡i|
bvixi eܨvKiY n‡jv wUD‡e‡Uvwg eY©bvi Aci cš’v|

÷¨vÛvW© 15: ‡mev`vbKvix 1) MÖnxZv‡K Mf©wb‡ivaK mKj c×wZ m¤ú‡K© Rvbv‡eb Ges Zv‡K Zvi cQ›` Abyhvqx GKwU
h_vh_ c×wZ evQvB Ki‡Z KvD‡Ýwjs Ki‡eb, 2) MÖnxZv evQvB †PKwj÷ e¨envi K‡i MÖnxZv w¯Œb Ki‡eb 3) GKwU
m¤ú~Y© BwZnvm wb‡q MÖnxZv‡K cixÿv Ki‡eb (wKQz †ÿ‡Î j¨ve‡iUwi cixÿvi `iKvi nq), 4) MÖnxZv‡K cÖwµqvi Av‡M
wbb©q I c‡i KvD‡Ýwjs Ki‡eb, 5) MÖnxZv‡K mKj weiƒc cÖfve Ges cvk¦©-cÖwZwµqvi e¨e¯’vcbv m¤ú‡K© Rvbv‡eb, 6)
†iKW© msiÿY Ki‡eb Ges MÖnxZv‡K d‡jvAv‡ci Rb¨ Avevi Avm‡Z ej‡eb|

bvixi ¯’vqx c×wZ (wUD‡eK‡Uvwg) Acv‡ikb Kivi mgq

bvixi ¯’vqx c×wZ (wUD‡eK‡Uvwg) Kiv nq wmRvwiqvb †mKkb Acv‡ik‡bi mgq, ¯^vfvweK cÖm‡ei ci, gvwmK wbqwgZKiY
Mf©cv‡Zi ci Ges weiwZ Kv‡j|

130 cÖme-cieZ©x cwievi cwiKíbv

1. B›Uvifvj wUD‡eK‡Uvwg Kivi mgq
l cÖm‡ei 06 mßvn ci
l wbqwgZ gvwm‡Ki cÖ_g 7 w`‡b
l †KvbI AvaywbK Kvh©Ki c×wZ mwVK I wbqwgZfv‡e e¨env‡ii mgq
l hw` MÖnxZv †kl gvwm‡Ki ci mnevm bv K‡i

2. cÖme cieZ©x bvixi ¯’vqx c×wZ (wUD‡eK‡Uvwg) Kivi mgq

l ¯^vfvweK cÖm‡ei 48 NÈvi g‡a¨|
l cÖm‡ei ci †_‡K 6 w`‡bi g‡a¨ I bvixi ¯’vqx c×wZ (wUD‡eK‡Uvwg) Kiv hvq| GB mg‡q †cÖvdvB‡jKwUK
A¨vw›Uev‡qvwUK w`‡Z n‡e| Z‡e me‡P‡q fv‡jv n‡”Q ¯^vfvweK cÖm‡ei 48 NÈvi g‡a¨ bvixi ¯’vqx c×wZ
(wUD‡eK‡Uvwg) Kiv| wek¦ ¯^v¯’¨ ms¯’vi (WHO) wb‡`©kbv Abyhvqx cÖm‡ei 7-42 w`‡bi g‡a¨ bvixi ¯’vqx c×wZ
(wUD‡eK‡Uvwg) Acv‡ikb mg_©b K‡i bv |
l cÖm‡ei 6 gv‡mi g‡a¨, hw` wkï ¯Íb¨cvb K‡i Ges FZz¯ªve bv nq Z‡e †m mg‡q Kiv (cÖm‡ei 7-42 w`b e¨ZxZ)
l gv Mf©eZx bq wbwðZ n‡j Qq gvm †_‡K GK eQ‡ii g‡a¨
l wmRvwiqvb †mKk‡bi mv‡_

gvwmK wbqwgZKib/ Mf©cv‡Zi ci

l gvwmK wbqwgZKi‡bi 7 w`‡bi g‡a¨
l Mf©©cv‡Zi ci RwUjZv bv _vK‡j 7 w`‡bi g‡a¨

d‡jvAvc
d‡jvAvc 7 w`‡bi A_ev Kgc‡ÿ 2 mßv‡ni g‡a¨ Kivi Rb¨ †Rviv‡jv mycvwik Kiv nq| †KvbI bvixi GB e¨vcv‡i
Ae‡njv Kiv DwPZ bq, Ab¨_vq d‡jvAvc Kiv KwVb wKsev Am¤¢e n‡q hv‡e| ¯^v¯’¨ †mev`vbKvix KvUv ¯’vbwU hvPvB
Ki‡eb, msµg‡Yi †KvbI wPý Av‡Q wK bv †`L‡eb, †mjvB _vK‡j KvU‡eb| GwU wK¬wb‡K, MÖnxZvi evmvq (†hgb,
we‡klfv‡e cÖwkwÿZ c¨viv‡gwW‡Kj Kg©xi Øviv) A_ev Ab¨ †KvbI ¯^v¯’¨‡K‡›`ª Kiv hvq|

KvD‡Ýwjs Ges †idvi

cwievi Kj¨vY cwi`wk©Kv Ges cwievi Kj¨vY mnKvix MÖnxZv‡K KvD‡Ýwjs Ki‡eb Ges myweavRbK †K‡›`ª wUD‡eK‡Uvwgi
Rb¨ †idvi Ki‡eb|

wUD‡eK‡Uvwgi cvk¦©-cÖwZwµqv I RwUjZv e¨e¯’vcbv

RwUjZv e¨e¯’vcbv
KvUv¯’v‡b msµgY (jvj‡Pfve, Mig, e¨_v, cuyR) l msµwgZ ¯’vb mvevb, cvwb ev A¨vw›U‡mcwUK w`‡q
(Infection at the incision site/ Redness, cwi®‹vi Kiæb
heat, pain, pus) l 7-10 w`‡bi Rb¨ A¨vw›Uev‡qvwUK w`b
l †idvi Kiæb
msµg‡Yi Kvi‡Y Pvgovi wb‡P cuy‡Ri Rgv n‡j l †idvi Kiæb
(Abscess/ A pocket of pus under the skin
caused by infection)
Zj‡c‡U Zxeª e¨_v (G‡±vwcK †cÖM‡bwÝ aviYvK…Z) l Mf©aviY hvPvB (G‡±vwcK †cÖM‡bwÝ mn) K‡i †idvi
(Severe pain in lower abdomen/ Suspected Kiæb
ectopic pregnancy )

†iKW© msiÿY Ges wi‡cvwU©s

cwievi Kj¨vb mnKvix wi‡cvU© Ki‡eb MIS form 1 Gi gva¨‡g Ges cwievi Kj¨vY cwi`wk©Kv MIS form 3.Gi
gva¨‡g wi‡cvU© Ki‡eb

cÖme-cieZ©x cwievi cwiKíbv 131

 cyiæ‡li ¯’vqx c×wZ f¨v‡mK‡Uvwg

cyiæ‡li ¯’vqx c×wZ †bv-¯‹vj‡cj f¨v‡mK‡Uvwg (f¨v‡mK‡Uvwg) n‡jv AvaywbK c×wZ¸‡jvi GKwU hv 1960 mvj †_‡K
RvZxq cwievi cwiKíbv Kg©m~wP‡Z AšÍf©y³| evsjv‡`‡k 1988 mv‡j †bv-¯‹vj‡cj f¨v‡mK‡Uvwg (NSV) Acv‡ikb ïiæ
nq| 2001 mv‡j Ô¯’vqx c×wZ Kg©m~wP kw³kvjxKiYÕ-Gi mgq NSV cybiæ¾xweZ nq| evsjv‡`‡k m¤úªwZ †bv-¯‹vj‡cj
f¨v‡mK‡Uvwg Lye RbwcÖq n‡q‡Q|
†bv-¯‹vj‡cj f¨v‡mK‡Uvwg:
l †¯ŒvUv‡gi Pvgov‡Z †QvU (≤10 wgwg) wQ`ª , gvS eivei GKwU A_ev `yBcv‡k `yBwU
l fvm Ges †cwifvmvj wUm¨yZ b~¨bZg wW‡mKkb, fvm wis K¬¨v¤ú Ges fvm wW‡mKUi A_ev G ai‡bi we‡kl hš¿cvwZi
mvnv‡h¨ Kiv nq
÷¨vÛvW© 16: ‡mev`vbKvix 1) GKwU m¤ú~Y© BwZnvm wb‡q MÖnxZv‡K cixÿv Ki‡eb (wKQz †ÿ‡Î j¨ve‡iUwi cixÿvi `iKvi
nq), 2) MÖnxZv‡K cÖwµqvi Av‡M I c‡i KvD‡Ýwjs Ki‡eb, 3) MÖnxZv‡K mKj weiƒc cÖfve Ges cvk¦©-cÖwZwµqvi
e¨e¯’vcbv m¤ú‡K© Rvbv‡eb, 4) †iKW©/Z_¨ msiÿY Ki‡eb Ges MÖnxZv‡K d‡jvAv‡ci Rb¨ Avevi Avm‡Z ej‡eb

cwievi Kj¨vY cwi`wk©Kv Gi KvD‡Ýwjs-Gi `vwqZ¡:

l MÖnxZv‡K mKj ai‡bi Mf©wb‡ivaK †`Lvb Ges evQvBK…Z c×wZi ¯’vwqZ¡, SuywK Ges e¨_©Zv m¤ú‡K© ejyb
l MÖnxZv †¯^”Qvq AbygwZc‡Î mB K‡i‡Q wK bv wbwðZ Kiæb
l †¯ŒvUvj ev B½yBbvj mvR©vwi ev AvNvZ Gi BwZnvm wbb| †gwW‡Kj I Wªv‡Mi MÖn‡Y BwZnvm wRÁvmv Kiæb|
l †¯ŒvUvj ev B½yBbvj cixÿv Kiæb (Ges mvaviY †gwW‡Kj wnw÷ªi wfwˇZ cÖ‡qvRbxq Ab¨vb¨ cixÿv Kiæb)
l f¨v‡mK‡Uvwgi Av‡M †KvbI j¨ve‡iUwi cixÿvi cÖ‡qvRb †bB
†idvi: cwievi Kj¨vY cwi`wk©Kv Ges cwievi Kj¨vY mnKvix MÖnxZv‡K KvD‡Ýwjs Ki‡eb Ges myweavRbK †K‡›`ª
†f‡mK‡Uvwgi Rb¨ †idvi Ki‡eb|
RwUjZv e¨e¯’vcbv †bv-¯‹vj‡cj f¨v‡mK‡Uvwg (NSV)

mgm¨v
cÖwµqvi ci i³ÿiY A_ev
i³RgvU
(Bleeding or blood clots
after the procedure)
wQ`ª ev KvUv¯’v‡b msµgY
(jvj‡Pfve, Mig, e¨_v, cuyR)
(Infection at the puncture
or incision site/ redness,
heat, pain, pus)
mgvavb
l Zv‡K wbwðZ Kiæb, ÿxY i³cvZ Ges †QvU AmsµvwgZ RgvU i³ wPwKrmv
QvovB K‡qK mßv‡ni g‡a¨ P‡j hv‡e
l eo i³RgvU mvwR©Kvwj †WªBb Kiv jvM‡Z cv‡i| †idvi Kiæb
l msµwgZ ¯’vb mvevb, cvwb ev A¨vw›U‡mcwUK w`‡q cwi®‹vi Kiæb
l 7-10 w`‡bi Rb¨ A¨vw›Uev‡qvwUK w`b
l me A¨vw›Uev‡qvwUK †kl nevi ci msµgY †_‡K †M‡j Avevi Avm‡Z ejyb
Ges †idvi Kiæb

msµg‡Yi Kvi‡Y Pvgovi wb‡P l †idvi

cuy‡Ri _wj
K‡qKgvm a‡i e¨_v l †¯ŒvUvg Avivg`vqK AšÍ©evm A_ev c¨v›U A_ev GKwU A¨v_‡jwUK mv‡cvU©vi
(Pain lasting for months) w`‡q Dc‡i ivL‡Z civgk© w`b
l Mig cvwb‡Z †fRv‡Z ejyb
l A¨vmwcwib (325-650 wgMÖv), AvBey‡cÖv‡db (200-400 wg.MÖv),
c¨vivwmUvgj (325-100 wg.MÖv.), A_ev Ab¨ e¨_vbvkK
l msµgY m‡›`n n‡j A¨vw›Uev‡qvwUK w`b
l hw` e¨_v †_‡K hvq Ges mn¨ Kiv bv hvq cieZ©x wPwKrmvi Rb¨ †idvi Kiæb
d‡jvAvc wfwRU Ñ hw` mnRjf¨ nq, wZb gv‡mi g‡a¨ Zv‡K wm‡gb A¨vbvjvBwm‡mi Rb¨ †idvi Kiæb|

132 cÖme-cieZ©x cwievi cwiKíbv

 †iKW© msiÿY Ges wi‡cvwU©s
l cwievi Kj¨vY mnKvix wi‡cvU© Ki‡eb Gg AvB Gm dig 1 (MIS FORM 1) Gi gva¨‡g cwievi Kj¨vY cwi`wk©Kv
wi‡cvU© Ki‡eb Gg AvB Gm dig 3 (MIS FORM 3) Gi gva¨‡g

AviI Z‡_¨i Rb¨ AbyMÖn K‡i †`Lyb cwievi cwiKíbv g¨vbyqvj, Ryb 2018, Aa¨vq 09 c„ôv-131

cÖme-cieZ©x cwievi cwiKíbv 133

 HwZn¨MZ/mbvZb c×wZ

HwZn¨MZ/mbvZb c×wZ mg~‡ni g‡a¨, evsjv‡`‡k LAM (Locational Amenorrhea Method) eûj e¨eüZ|

LAM (Lacational Amenorrhea Method) ey‡Ki `ya wbf©i Rb¥weiwZKiY/Mf©wb‡ivaK c×wZ

ey‡Ki `ya cvb Kiv‡”Qb Ggb bvixi †ÿ‡Î kvixie„Ëxq ni‡gvbvj cwieZ©‡bi wfwˇZ GKwU A¯’vqx cÖme-cieZ©x
Mf©wb‡ivaK c×wZ|

ey‡Ki `ya wbf©i Rb¥weiwZKiY/Mf©wb‡ivaK c×wZ wb‡Pi ˆewk󨸇jv _vK‡j Kvh©Ki n‡e -

1. wZwb wkï‡K ïaygvÎ ey‡Ki `ya cvb Kiv‡”Qb (†hgb. w`‡b 4 NÈvi Ges iv‡Z 6 N›Uvi †ewk weiwZ‡Z ¯Íb¨`vb Kiv
n‡”Q bv)
2. Zvi gvwmK n‡”Q bv (FZz¯ªve c~bivq ïiæ nqwb) Ges
3. Zvi ev”Pvi eqm 6 gv‡mi Kg
ïaygvÎ ey‡Ki `ya-G G·K¬zwmf †eª÷wdwWs (wkïwU ey‡Ki `ya Qvov Ab¨ †KvbI Zij A_ev k³ Lvevi, GgbwK cvwbI cv‡”Q
bv)

cÖwZjÿY/ mZK©Zv

mKj ey‡Ki `ya cvb Kiv‡”Qb Ggb bvix wbivc‡` ey‡Ki `ya wbf©i Rb¥weiwZKiY c×wZ (LAM) e¨envi Ki‡Z cvi‡eb,
wKš‘ wb‡Pi cwiw¯’wZ¸‡jv‡Z Ab¨vb¨ Mf©wb‡ivaK c×wZ¸‡jvi e¨vcv‡i GKRb bvix wPšÍv Ki‡Z cv‡ib:
l †gwW‡Kj Dchy³Zvi wfwˇZ, †KvbI †gwW‡Kj KwÛkb LAM ey‡Ki `ya wbf©i Rb¥weiwZKiY c×wZ ev` w`‡Z cv‡i
bv †h‡nZz bvixi ¯^v‡¯’¨ Gi †KvbI ÿwZKi cÖfve †bB| ZeyI wKQz †ÿ‡Î ey‡Ki `ya cvb Kivi †ÿ‡Î mxgve×Zv
i‡q‡Q| HIV Ges †ncvUvBwUm msµgY- ey‡Ki `y‡ai gva¨‡g msµgY wkïi †`‡n †h‡Z cv‡i| Z‡e, hw` †KvbI
Lvevi bv cvIqv hvq A_ev msµvgK †iv‡M A‡bK wkï gviv hvq, Zvn‡j gv‡K ey‡Ki `ya cvb Kiv‡bv AbycÖvwYZ Kiv
DwPZ|
l hviv Ilya †meb K‡i, wkïi ¯^v‡¯’¨i weiƒc cÖwZwµqv n‡Z cv‡i| †hgb A¨vw›U-K¨vbmvi †iwR‡gb A_ev
A¨vw›Uev‡qvwUK|

cÖwµqv

wkïi R‡b¥i ci ciB (GK N›Uvi g‡a¨) A_ev hZ `ªæZ m¤¢e `ya cvb Kiv‡bv ïiæ Kiæb| cÖm‡ei cÖ_g K‡qK w`b, gv‡qi
¯Í‡b †h nj‡` Zij Drcbœ nq (kvj`ya) Zv‡Z wkïi ¯^v‡¯’¨i Rb¨ Lye ¸iæZ¡c~Y© Dcv`vb _v‡K|
gv LAM kyiæ Ki‡Z cv‡i †h †KvbI mgq hw`
l gv w`‡b I iv‡Z ey‡Ki `ya cvb Kivb, w`‡b 4 NÈvi †ewk Ges iv‡Z 6 NÈvi †ewk weiwZ‡Z ey‡Ki `ya cvb Kiv‡bv
n‡”Q bv Ges
l gv‡qi FZz¯ªve ïiæ nqwb Ges
l ev”Pvi eqm 6 gv‡mi Kg

134 cÖme-cieZ©x cwievi cwiKíbv

Riæix Rb¥weiwZKiY Bgv‡R©wÝ K›Uªv‡mckb (EC)

Bgv‡R©wÝ K›Uªv‡mckb/Riæix Mf©wb‡ivaK ev †cv÷ KqUvj K›Uªv‡mckb/mnevm cieZ©x Mf©wb‡ivaK GKwU mvaviY, wbivc`
c×wZ hv AiwÿZ †hŠbwgj‡bi ci Mf©avi‡Yi m¤¢vebv e¨vcKfv‡e n«vm K‡i| BwZg‡a¨ Mf©aviY n‡q _vK‡j GwU †KvbI
cÖfve †d‡j bv Ges †hŠbevwnZ msµgY †_‡K iÿv K‡i bv| Bgv‡R©wÝ K›Uªv‡mcwUf wcj RvZxq cwievi cwiKíbv
Kg©m~wP‡Z Ô BgKb 1Õ bv‡g cvIqv hvq| evsjv‡`‡k Ab¨vb¨ eª¨vÛMy‡jv n‡”Q Ô‡bvwi·Õ, ÔwUDwjcÕ, ÔwcDwjÕ BZ¨vw`|

÷¨vÛvW© 17: ‡mev`vbKvix GKwU m¤ú~Y© BwZnvm wb‡q MÖnxZv‡K cixÿv Ki‡eb, Ab¨ me cwievi cwiKíbv c×wZ
m¤ú‡K© Rvbv‡eb Ges MÖnxZv‡K cQ›`mB GKwU h_vh_ c×wZ evQvB Ki‡Z KvD‡Ýwjs Ki‡eb, Z_¨ msiÿY Ki‡eb
Ges MÖnxZv‡K d‡jvAv‡ci Rb¨ Avevi Avm‡Z ej‡eb

AiwÿZ †hŠbwgj‡bi ci GKRb bvix Mf©aviY Ki‡Z bv PvB‡j Riæwi Mf©wb‡ivaK e¨en„Z nq| †¯^”Qvq †hŠbwgj‡b †KvbI
Mf©wb‡ivaK e¨en„Z bv n‡j Ges GKwU Mf©wb‡ivaK c×wZ e¨_© n‡j A_ev mwVKfv‡e e¨eüZ bv n‡j †hgb. KbWg wQu‡o
hvIqv/ wQ`ª, ci ci 3wU LvIqvi ewo †L‡Z e¨_© n‡j,Rb¥weiwZKiY Bb‡RKkb wb‡Z 4 mßv‡ni †ewk †`wi n‡j, Abye©i/
wbivc` Kvj MYbv Ki‡Z fzj n‡j, cÖZ¨vnvi/Avmj c×wZ e¨_© n‡j, †hvwb‡Z A_ev ewn©‡hŠbv‡½ exh©cvZ n‡j Ges
A‰bw”QK †hŠbwgjb †hgb al©Y/ †hŠb jvÃbv BZ¨vw` †ÿ‡Î GwU e¨eüZ nq| hZw`b Mf©wb‡ivaK e¨_© n‡e Ges al©Y/
AcÖZ¨vwkZ †hŠb cwiw¯’wZ n‡e, Riæwi Mf©wb‡ivaK GKwU mvgvwRK Pvwn`v n‡q _vK‡e|

Riæwi Rb¥weiwZKiY c×wZ Ges cÖKvi‡f`

`ywU wfbœ c×wZ‡Z Riæwi Rb¥weiwZKiY mieivn n‡q _v‡K| Riæwi Rb¥weiwZKi‡bi wb‡Pi c×wZMy‡jv wbivc`, mnR Ges
mnRjf¨:

1. Bgv‡R©wÝ KbUªv‡mcwUf wcj (ECP)/ Riæix Rb¥weiwZKiY Lvevi ewo

`yB ai‡bi ECP i‡q‡Q:/Riæix Rb¥weiwZKiY Lvevi ewo

l K¤^vBÛ Bgv‡R©wÝ KbUªv‡mcwUf wcj (ECP) gy‡L Lvevi Mf©wb‡ivaK ewo hv‡Z _v‡K Bw_wbj B÷ªvwWIj Ges
wj‡fvbi‡Rm‡Uªj hv K¤^vBÛ Iivj KbUªv‡mcwU‡fi Zzjbvq D”P gvÎvq ¯^í mg‡qi g‡a¨ †bqv nq, Ges AiwÿZ
†hŠbwgj‡bi ci 120 N›Uvi (5 w`b) g‡a¨ Aek¨B ïiæ Ki‡Z n‡e|
l †cÖv‡Rw÷b-Ibwj Bgv‡R©wÝ KbUªv‡mcwUf wcj n‡jv LvIqvi Mf©wb‡ivaK ewo hv‡Z kyay wj‡fvbi‡Rm‡Uªj _v‡K hv
K¤^vBÛ ECP-Gi g‡Zv GKBfv‡e e¨eüZ nq|

2. Kcvihy³ IUCD
AiwÿZ †hŠbwgj‡bi ci cªvq 5 †_‡K 7 w`‡bi g‡a¨ mwbœ‡ek Kiv n‡j GwU Riæwi Mf©wb‡ivaK wn‡m‡e KvR Ki‡Z cv‡i|
Riæix Rb¥weiwZKiY|

ECP/ wW¤^vby cwiùzU‡bi Av‡M wb‡j wW¤^vkq †_‡K wW¤^vYy †ei nIqvi †`wi NUvq ev eÜ K‡i †`q, ïµvYy I wW¤^vYyi
wgjb‡K cÖwZ‡iva K‡i Ges Rivqyi †`qv‡j eøv‡÷vwm÷ mshy³ n‡Z †`q bv| AiwÿZ †hŠbwgj‡bi ci †h †KvbI cÖRbbÿg
bvix‡K †`qv hvq GgbwK hv‡`i‡K wbqwgZ c×wZ wn‡m‡e OCP/Lvevi ewo e¨envi Ki‡Z wb‡la Kiv n‡q‡Q, wKš‘ Mf©aviY
Ki‡j ev m‡›`n Kiv n‡j Ges †hme bvixi wWc †fBb _ª‡¤^vwmm A_ev cvj‡gvbvwi G‡¤^vwjmg Gi c~‡e©i wnw÷ª Av‡Q
Zv‡`i‡K †`qv hv‡e bv|

Riæix Rb¥weiwZKiY Lvevi ewo/ECP e¨env‡ii wbqg Ges †WvR

Riæwi Mf©wb‡ivaK e¨eüZ K¤^vBÛ Iivj K›Uªv‡mcwUf

1. ÷¨vÛvW© †WvR COC/mvaviY gvÎvi Lvevi ewo (†hgb: Kw¤^‡bkb-5): AiwÿZ †hŠbwgj‡bi ci 120 N›Uvi g‡a¨ hZ
`ªæZ m¤¢e 2wU wcj †L‡q wbb (1g †WvR) Ges 12 N›Uv ci AviI 2wU †L‡q wbb (2q †WvR) A_ev

cÖme-cieZ©x cwievi cwiKíbv 135

 2. Kg †WvR COC/¯^í gvÎvi Lvevi ewo (†hgb: myLx): AiwÿZ †hŠbwgj‡bi ci 120 N›Uvi g‡a¨ hZ `ªæZ m¤¢e 4wU
ewo †L‡q wbb (1g †WvR) Ges 12 NÈv ci AviI 4wU wcj Lvb (2q †WvR)

†bvU
l 28 w`‡bi c¨vK-G, cÖ_g 21wU wcj Riæwi Mf©wb‡iv‡a Kvh©Ki|
l ¯^í gvÎv A_ev ÷¨vÛvW© †WvR COC/mvavib gvÎvi Lvevi ewo: cÖwZ †Wv‡R _v‡K Kg c‡ÿ 100 gvB‡µvMÖvg (0.1
wg. MÖv.) Bw_wbj B÷ªvwWIj Ges 500 gvB‡µvMÖvg wj‡fvbi‡Rm‡Uªj (0.5 wg.MÖv.) (Ref: CTU manual- WHO,
Population Council)

ïaygvÎ †cÖv‡Rwób mg„× Riæix Mf©wb‡iaK Lvevi ewo/†cÖv‡Rw÷b-Ibwj Bgv‡R©wÝ K›Uªv‡mcwUf wcj
†hgb: †cvw÷bi 2 (cÖwZ U¨ve‡j‡U _v‡K Kg c‡ÿ 0.75 wgwjMÖvg wj‡fvbi‡Rm‡Uªj): AiwÿZ †hŠbwgj‡bi ci 120 NÈvi
g‡a¨ hZ `ªæZ m¤¢e 1wU wcj †L‡q wbb (1g †WvR) Ges 12 NÈvv ci AviI 1wU wcj Lvb (2q †WvR)

`ªóe¨: cÖwZ †Wv‡R Aek¨B _v‡K Kg c‡ÿ 0.75 wgwjMÖvg wj‡fvbi‡Rm‡Uªj (Ref: CTU manual- WHO,
Population Council) A_ev

BgKb 1: (cÖwZ U¨ve‡j‡U _v‡K 1.5 wgwjMÖvg wj‡fvbi‡Rm‡Uªj): AiwÿZ †hŠbwgj‡bi ci 120 NÈvi g‡a¨ hZ `ªæZ m¤¢e
1wU wcj †L‡q wbb (GKwU †WvR)

myweav
l AiwÿZ †hŠbwgj‡bi ci Mf©aviY cÖwZ‡iva K‡i
l wbivc`, Kvh©Ki Ges e¨env‡i mnR

mxgve×Zv
l cwievi cwiKíbvi wbqwgZ c×wZ wn‡m‡e e¨envi Kiv hv‡e bv
l STI/HIV/AIDS cÖwZ‡iva K‡i bv

Riæix Rb¥weiwZKib Lvevi ewo/ECP m¤ú‡K© Kv‡`i Ges wK KvD‡Ýwjs Ki‡Z n‡e

hw` GKRb MÖnxZv ECP Gi Rb¨ Aby‡iva K‡i, Zvn‡j wb‡Pi PviwU avc AbymiY Kiæb:
ECP †`qvi Av‡M hvPvB Kiæb ECP MÖnxZvi Rb¨ h_vh_ wK bv Zvici
1. Rvbvb- ECP Gi mwVK e¨envi m¤ú‡K© e¨vL¨v Kiæb, Kxfv‡e KvR K‡i, wbqwgZ Mf©wb‡ivaK wn‡m‡e e¨envi Kiv
hv‡e bv, Kvh©KvwiZv Ges e¨_©Zvi nvi
2. e¨vL¨v Kiæb- KLb ECP me‡P‡q Kvh©Ki Zv MÖnxZvi Kv‡Q eY©bv Kiæb
3. g‡b Kwi‡q w`b- cvk¦©-cÖwZwµqv Ges †m¸‡jvi e¨e¯’vcbv Av‡jvPbv Kiæb Ges d‡jvAv‡ci Rb¨ MÖnxZv KLb Avmv
DwPZ
4. wd‡i Avm‡j- wbqwgZ c×wZi Rb¨ MÖnxZv‡K Avm‡Z ej‡eb

ECP/Rb¥ weiwZKiY Lvevi ewoi cvk¦©-cÖwZwµqv Ges e¨e¯’vcbv

136 cÖme-cieZ©x cwievi cwiKíbv

QK: cvk¦©-cÖwZwµqv Ges e¨e¯’vcbv

cvk¦©-cÖwZwµqv e¨e¯’vcbv
ewg fve l LvIqvi ci ECP †me‡b ewg I ewgfve Kg‡Z cv‡i
(Nausea)
ewg l LvIqvi ci ECP †me‡b ewg I ewgfve Kg‡Z cv‡i
(Vomiting) l ECP †me‡bi Avav †_‡K 1 N›Uv Av‡M A¨vw›U GwgwUK U¨ve‡jU wb‡j wKQz
bvix (30%) fv‡jv †eva K‡ib
gv_ve¨_v c¨vivwmUvgj/ wWmwcwib Kvh©Ki
(Headache)
gvwm‡K mgm¨v †KvbI wPwKrmvi `iKvi †bB
(Menstrual problem)
nvjKv AwbqwgZ i³ÿiY l ECP-Gi Kvi‡Y nvjKv AwbqwgZ i³ÿiY n‡j †KvbI wPwKrmvi `iKvi
(Slight irregular bleeding) †bB
l Zv‡K Avk¦vm w`b GwU Mf©aviY ev Amy¯’Zvi wPý bq|
cieZ©x gv‡mi i³¯ªv‡ei mgq l cÖZ¨vwkZ mg‡qi Av‡M ev c‡i gvwmK i³ÿiY ïiæ n‡Z cv‡i| GwU
cwieZ©b A_ev Mf©aviY m‡›`nK…Z Mf©aviY ev Amy¯’Zvi wPý bq|
(Change in timing of next l hw` cieZ©x FZz¯ªve n‡Z 7 w`‡bi †ewk †`wi nq, Mf©aviY hvPvB Kiæb
monthly bleeding or l Mf©aviY cÖwZ‡iv‡a e¨_© n‡j Mf©¯’ 僇Yi †KvbI ÁvZ SuywK †bB
suspected pregnancy)
`ªóe¨: mvaviYZ, 20% Gi Kg bvix cvk¦©-cÖwZwµqvq †fv‡Mb Ges †KvbIUvB 24 NÈvi †ewk mgq a‡i _v‡K bv
Rb¥ weiwZKiY Lvevi ewo MÖnxZvi d‡jvAvc
ECP e¨envi Ki‡j iæwUb d‡jvAv‡ci `iKvi †bB| Z‡e MÖnxZvi wK¬wbK ev ‡mev`vbKvixi wbKU Avmv DwPZ hw`:
l hw` FZz¯ªve n‡Z 7 w`‡bi †ewk †`wi nq
l FZz¯ªv‡ei is Lye nvjKv nq
l wbqwgZ cwievi cwiKíbv c×wZ e¨envi Ki‡Z Pvq
l cvk¦©-cÖwZwµqvq †fv‡M
QK: ECP e¨env‡ii ci KLb Mf©wb‡ivaK ïiæ Ki‡Z n‡e
bvixi cwiw¯’wZ/ Ae¯’v KLb ïiæ Ki‡Z n‡e
K¤^vBÛ Iivj K›Uªv‡mcwUf wcj/wgkÖ l ECP †me‡bi ci w`b †_‡K wZwb wgkÖ Lvevi ewo kyiæ Ki‡Z cv‡ib|
Lvevi ewo cieZ©x gvwm‡Ki Rb¨ A‡cÿv Kivi cÖ‡qvRb †bB|
(†cÖv‡Rw÷b-Ibwj Bb‡RK‡Uej) l ECP †me‡bi w`b †_‡K ïaygvÎ †cÖv‡Rvw÷b mg„× Bb‡RK‡Uej kyiæ Ki‡Z
ïaygvÎ †cÖv‡Rvw÷b mg„× cv‡ib A_ev gvwmK ïiæ nIqvi 7 w`‡bi g‡a¨
Bb‡RK‡Uej l Bb‡RKk‡bi ci cÖ_g 7 w`b mnvqK c×wZ e¨envi Kiv cÖ‡qvRb
Bgcø¨v›U l ECP/Riæix Rb¥weiwZKib Lvevi ewo †meb †kl nIqvi ci FZz¯ªve ïiæ
bv nIqv ch©šÍ mnvqK c×wZ w`b|
IUCD (AvBBDwmwW) B›Uªv l IUCD Riæwi Mf©wb‡iv‡a e¨envi Kiv hvq, hv hviv IUCD e¨envi Ki‡Z
BD‡UivBb K›Uªv‡mcwWf wWfvBm Pvb Zv‡`i Rb¨ fv‡jv weKí
(Kcvi hy³ ev ni‡gvbhy³) l hw` wZwb ECP/ Riæix Rb¥weiwZKib Lvevi ewo †meb †kl nIqvi ci
IUCD e¨envi Kivi wm×všÍ †bb, Z‡e ECPs †me‡bi w`b IUCD
mwbœ‡ek Kiv hv‡e| †m‡ÿ‡Î †KvbI mnvqK c×wZ e¨envi Kiv cÖ‡qvRb †bB
AviI Z‡_¨i Rb¨ AbyMÖn K‡i †`Lyb cwievi cwiKíbv g¨vbyqvj, Ryb 2018, Aa¨vq 14 c„ôv-221

cÖme-cieZ©x cwievi cwiKíbv 137

138 cÖme-cieZ©x cwievi cwiKíbv
 †mKkb 8t
msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 139

140 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv
 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv
m~Pbv
msµgY n‡jv gv I beRvZ‡Ki g„Zz¨i gyL¨ KviY¸‡jvi g‡a¨ Ab¨Zg (cÖmeRwbZ msµgY Ges beRvZ‡Ki msµgY)|
evsjv‡`‡k hZRb gv I beRvZK gviv hvq Zvi D‡jøL‡hvM¨ Ask GB msµgYRwbZ Kvi‡Y gviv hvq| gvbm¤§Z msµgY
cÖwZ‡iv‡ai Abykxjb Ges msµg‡Yi `ªæZ wPwýZKiY Ges mg‡qvc‡hvMx wPwKrmv-B cv‡i GB g„Zz¨¸‡jvi weivU Ask‡K
cÖwZ‡iva Ki‡Z|

weMZ K‡qK `kK a‡i AZx‡Z wbqš¿Y Kiv n‡q‡Q, GgbwK wPwýZ Kiv hvqwb Ggb A‡bK †iv‡Mi cÖv`yf©ve jÿ Kiv hv‡”Q|
GBP.AvB.wf (HIV), †ncvUvBwUm wm (Hepatitis C), h²v (Tuberculosis), k¦vmZ‡š¿i Zxeª msµgY (Severe
Acute Respiratory Syndrome), bZzb Bbd¬z‡qÄv fvBivm (Avian or Swine Fluvirus) BZ¨vw` c„w_exi wewfbœ
As‡k †ivM I g„Zy¨i Rb¨ `vqx| Z`ycwi, nvmcvZvj mswkøó msµgY (Hospital Associated Infection) c„w_exi mKj
RvqMvq µgvMZ mgm¨v m„wó Ki‡Q, we‡kl K‡i H mKj msµgY †h¸‡jv Gw›Uev‡qvwUK-cÖwZ‡ivax AbyRxe ev RxevYy Øviv
n‡PQ| †hgb: †gw_wmwjb-cÖwZ‡ivax-†÷dvB‡jvK°vm Awiqvm (Methicillin- resistant Staphylococcusaurius),
†fb‡KvgvBwmb-cÖwZ‡ivax-G›Uv‡ivK°vm (Vencomycin-resistant Enterococcus), K¬mwUªwWqvg †Wwdwmwj
(Clostridium Defficile) BZ¨vw`|

÷¨vÛvW© 18: gv I beRvZ‡Ki ¯^v¯’¨ ‡mev`vbKvix mKj ¯^v¯’¨Kg©x Ges Zv‡`i mn‡hvMx mKj Kg©x Aek¨B msµgY
cÖwZ‡iv‡ai Abykxj‡bi g~jbxwZ m¤ú‡K© Rvb‡eb Ges Kg©‡ÿ‡Î cÖ‡qvM Ki‡eb|

¯^v¯’¨‡mev ¯’vcbvq msµgY

nvmcvZvj mswkøó msµgY Ggb GK ai‡bi msµgY hv mvaviYZ †ivMx ev MÖvn‡Kiv nvmcvZvj †_‡K †mev ev wPwKrmv MÖnY
Kivi mgq msµwgZ nq| GKB mgq, ¯^v¯’¨Kg©x Ges †mev‡K‡›`ªi Ab¨ Kg©xivI wbqwgZ †mev`vbKv‡j msµwgZ nIqvi
SuywK‡Z _v‡Kb| hw`I cÖvqkB Avgiv †hgbwU fvwe bv, ¯^v¯’¨ †mev‡K›`ª¸‡jv wKš‘ †ivM we¯Ív‡i Rb¨ wb¤œwjwLZ Kvi‡Y
wbqvgK wn‡m‡e KvR K‡i:
l Bb‡fwmf c×wZ‡Z ˆ`bw›`b †mev cÖ`vb Kiv hvi gva¨‡g †ivMx ev MÖnxZvi kix‡i RxevYy cÖ‡ek K‡i msµwgZ Ki‡Z
cv‡i|
l Kv‡Ri Ask wn‡m‡e mivmwi †mev`vbKvix ¯^v¯’¨Kg©xi Ges †K‡›`ªi Ab¨vb¨ Kg©xi cÖwZwbqZ SuywKc~Y© msµwgZ hš¿cvwZ
Ges †ivMxi ms¯ú‡k© _vKv|
l †mev wb‡Z Avmv cÖPzi MÖvn‡Ki Amy¯’Zv Ges bZzb K‡i msµwgZ nIqvi SuywK evovq|
l A‡bK mgq †ivMx wb‡R Ges ¯^v¯’¨Kg©x msµwgZ nq Ggb †ivMx GBPAvBwf (HIV), †ncvUvBwUm wm (Hepatitis
C)], m¤ú‡K© m‡PZb bv _vKv|
l A‡bK mgq ¯^v¯’¨‡K‡›`ªi ¯^í cwim‡i Ges ¯^í mg‡q A‡bK †ivMxi †mev cÖ`vb|

msµg‡Yi SuywK‡Z Kviv?

hviv ¯^v¯’¨‡K‡›`ª KvR K‡ib, †mevMÖnY K‡ib, †mev cÖ`vb K‡ib, †K‡›`ªi Av‡kcv‡k evm K‡ib, †K›`ª cwi`k©b K‡ib Ñ
mevB msµg‡Yi SuywK‡Z _v‡Kb| ZvB msµgY cÖwZ‡iva Kiv mK‡ji `vwqZ¡| †h‡nZz ¯^v¯’¨‡mevi mv‡_ mswkøó mK‡jB
msµg‡Yi SuywK‡Z _v‡Kb †m‡nZz cÖ‡Z¨K ¯^v¯’¨ †mev`vbKvix I ¯^v¯’¨‡K‡›`ª Kg©iZ cÖ‡Z¨‡Ki msµgY cÖwZ‡iv‡ai Rb¨
h_vh_ Abykxj‡b f~wgKv Av‡Q| Kvh©Kifv‡e msµgY cÖwZ‡iva Kivi Rb¨ cÖ‡Z¨K‡K wbR wbR f~wgKv cvjb Ki‡Z n‡e|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 141

 ¯^v¯’¨Kg©xi SuywK

¯^v¯’¨ †mev`vbKvix, j¨v‡e‡iUwii Kg©x Ges †K‡›`ªi Ab¨vb¨ mnvqK Kg©x cÖwZwbqZ msµwgZ i³, †`nim, ¯^v¯’¨ †mevi eR©¨
BZ¨vw`i ms¯ú‡k© _v‡K weavq cÖ‡Z¨‡K msµg‡Yi D”P SuywK‡Z _v‡K| †h mKj Kg©x hš¿cvwZ I Ab¨vb¨ `ªe¨
cÖwµqvRvZKiY, wewfbœ †mevi ci cwi®‹vi-cwi”QbœKiY, IwU (Operation Theater), cÖwmwWDi iæg
cwi®‹vi-cwi”QbœKiY, eR©¨ Acmvi‡Yi mv‡_ RwoZ Zviv msµg‡Yi D”P SuywK‡Z _v‡K| msµwgZ i³ Ges †`nim †_‡K
†mev`vb Kg©xMY †ivMx †_‡K msµwgZ n‡Z cv‡ib|

†mevMÖnxZvi SuywK

†mevMÖnxZvivI msµg‡Yi SuywK‡Z _v‡Kb| D`vniY ¯^iƒc: †mevKg©xMY †mev †`Iqvi Av‡M hLb nvZ wVKgZ †aŠZ K‡ib
bv, hLb wK¬wbK¨vj c×wZ‡Z †mev cÖ`v‡bi (Clinical Procedure) mgq †ivMx‡K mwVKfv‡e ˆZwi Kiv nq bv Ges hLb
e¨enƒZ hš¿cvwZ mwVKfv‡e cªwµqvRZKiY Kiv bv nq|

mgv‡Ri Rb¨ SuywK

RbmgvRI msµg‡Yi SuywK‡Z _v‡K we‡kl K‡i wPwKrmv e‡R©¨i AcmviY ev e¨e¯’vcbv mwVKfv‡e bv n‡j (†hgb: aviv‡jv
mu~P, ‡eøW, fv½v G¤úyj-fvqvj BZ¨vw`)|

¯^v¯’¨‡mev ¯’vcbvq msµgY we¯Ív‡ii gva¨g mg~n

¯^v¯’¨†mev ¯’vcbvq msµgY mvaviYZ PviwU gva¨‡g Qovq:

1. ms¯ú‡k©i gva¨‡g we¯Ívi (ContactTransmission)t

ms¯úk© msµgY Qov‡bvi ev we¯Ív‡ii me‡P‡q cÖPwjZ gva¨g|

l cÖZ¨ÿ ms¯úk©t G‡ÿ‡Î msµwgZ †jv‡Ki †`n †_‡K Ab¨R‡bi †`‡n †ivM RxevYy ev AbyRx‡ei mivmwi we¯Ívi ev
¯’vbvšÍi N‡U| GwU wewfbœfv‡e n‡Z cv‡i, †hgb: mivmwi ¯úk© (†÷dvB‡jvK°vm [Stephylococcus] A_ev fvBivm
RwbZ †n‡gv‡iwRK R¡i [Viral Hemorrhagic Fever]) A_ev my¯’ †jv‡Ki wgDKvm c`©v/wSwjø (Mucus
Membarne) ev wehy³ Pvgovi ev Pvgovi ÿ‡Zi (Broken Skin) ga¨ w`‡q msµwgZ i³ A_ev †`ni‡mi ms¯úk©
(†hgb - GBPAvBwf, †ncvUvBwUm)|

l AcÖZ¨ÿ ms¯úk©t G‡ÿ‡Î msµwgZ †jv‡Ki †`n †_‡K Ab¨R‡bi †`‡n †ivMRxevYy ev AbyRx‡ei mivmwi we¯Ívi ev
¯’vbvšÍi N‡U bv n‡q eis †KvbI e¯‘/hš¿cvwZ/ cÖwµqv ev e¨w³i gva¨‡g nq| †hgb: nv‡Zi gva¨‡g (D`vniY:
†÷dvB‡jvK°vm Awiqvm [Staphylococcus aurius], K¬mwUªwWqvg †Wwdwmwj [Clostridium Defficile],
fvBivmRwbZ †n‡gv‡iwRK R¡i [Viral Hemorrhagic Fever], A_ev wK¬wbK¨vj †mev (Clinical Procedure)
cÖ`v‡bi mgq e¨enƒZ hš¿cvwZi gva¨‡g (D`vniY: †ncvUvBwUmwe [Hepatitis B], GBPAvBwf [HIV],
†ncvUvBwUmwm [HepatitisC], wU‡Ubvm [Tetanus] A_ev wmD‡Wv‡gvbvm [Pseudomonas]),Lvev‡ii gva¨‡g
(D`vniY: mvj‡gv‡bjv [Salmonella] ev †ncvUvBwUm G [Hepatitis A]) A_ev cvwbi gva¨‡g (K‡jiv [Cholera]
ev wk‡Mjv [Shigella])|

2. ÿz`ªKYvi gva¨‡g we¯Ívi (Droplet Transmission)t

cwifvlvMZ ev cÖv‡qvwMK A‡_© GwU GK ai‡bi ms¯ú‡k©i gva¨‡g msµgY| GKRb msµwgZ e¨w³i nuvwP, Kvwk, K_v ejvi
mgq wbM©Z _yZz A_ev wewfbœ wK¬wbK¨vj c×wZ‡Z †mev cÖ`v‡bi (Clinical Procedure) (†hgb: k¦vmbvwji †fZi hš¿
cÖ‡e‡ki mgq/ mvK&kvb †`evi mgq) mgq wbtmwiZ msµwgZ ÿz`ª KYvi gva¨‡g msµgY ¯’vbvšÍwiZ nq ev we¯Ívi jvf K‡i|
GB ÿz`ª KYv¸‡jv e¨w³i wgDKvm wSwjø-‡Z (gyL ev bv‡Ki wgDKvm wSwjø) evwnZ n‡q ¯’vbvšÍwiZ nq| Bbd¬z‡qbRv Ges
k¦vmZ‡š¿i Zxeª msµgY (Severe Acute Respiratory Syndrome) ÿz`ª KYvi gva¨‡g msµg‡Yi D`vniY| GB
ai‡bi msµg‡Yi Rb¨ e¨w³‡`i cvi¯úwiK `~iZ¡ AvbygvwbK 1 wgUvi (3 dzU) n‡Z nq|

142 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

3. evZv‡mi gva¨‡g we¯Ívi (AirborneTransmission)t

GB ai‡bi ¯’vbvšÍ‡ii †ÿ‡Î †ivMRxevYy ev AYyRxe hLb evqy †¯ªv‡Zi AbyK~‡j evwnZ nq, `xN©Kvj evZv‡m fvmgvb _v‡K,
eû`~i Qwo‡q c‡o (†hgb : hÿ¥v, nvg, RjemšÍ)| GB †ÿ‡Î hw`I msµwgZ e¨w³i mv‡_ mivmwi †KvbI ai‡bi mswkøóZv
bvB ZviciI my¯’ e¨w³i msµwgZ nIqvi h‡_ó Avk¼v _v‡K|

4. KxU-cZ½ ev cÖvYxi/ evn‡Ki gva¨‡g we¯Ívi (Vector Transmission)t

hLb †KvbI A‡giæ`Ðx cÖvYx /KxU- cZ½ wewfbœ †ivM RxevYy ev AYyRxe ¯’vbvšÍi ev we¯Ívi K‡i (†hgb: gkvevwnZ g¨v‡jwiqv
(Malaria) ev B‡q‡jv wdfvi (Yellow Fever)|

msµgY cÖwZ‡iva

†mevKwg©MY wK¬wbK¨vj wewfbœ c×wZ Qvov Ggb †KvbIfv‡e †mev w`‡Z cvi‡eb bv †hLv‡b †mev`vbKvix, †mevMÖnxZv, wewfbœ
mnvqK Kwg©MY mvgvb¨ cwigv‡Y n‡jI msµg‡Yi SuywK‡Z co‡eb bv| Z`ycwi, †h‡nZz ¯^v¯’¨‡mev †K‡›`ª KvR Ki‡Z nq ZvB
†K‡›`ª _vKv †ivMx †_‡K cÖwZwbqZ msµg‡Yi SuywK †_‡KB hvq| hv‡nvK, A‡bK †ÿ‡ÎB Avgiv msµgY cÖwZ‡iva Ki‡Z
cvwi| msµgY cÖwZ‡iv‡ai GKwUgvÎ Dcvq n‡jv †ivM RxevYy ev AYyRx‡ei we¯Ívi cÖwZnZ Kiv|

msµgY cÖwZ‡iv‡ai g~jbxwZ

cÖwZwU e¨w³‡K (†mev`vbKvix I †mevMÖnxZv) msµwgZ wn‡m‡e we‡ePbv Kiv KviY A‡bK mgq msµgY DcmM©nxb ev
jy°vwqZ _v‡K

l cÖ‡Z¨K‡K msµg‡Yi SuywKi we‡ePbvq ivLv

l msµg‡Yi we¯Ívi †iv‡a nvZ †avqv hv AwZ ¸iæZ¡c~Y© Ges cÖv‡qvwMK c×wZ
l Pvgovi ÿZ ev wehy³ Pvgov, wgDKvm wSwjø, A_ev i³, †`nim ¯úk© ev bvovPvov Kivi mgq A_ev Bb‡fwmf
c×wZ‡Z †mev`vbKv‡j `yB nv‡Z Møvf&m cwiavb Kiv
l †mev`vbKv‡j i³ ev †`ni‡mi wQUKv‡bv ev S‡i covi m¤¢vebv _vK‡j h_vh_ cÖwZeÜK (Pkgv, gv¯‹, K¨vc,
g¨vwKb‡Uvk, G‡cÖvb ev ewne©vm) e¨envi Kiv
l ÿZ cwi®‹vi Kiv ev wewfbœ †mev cÖ`v‡bi cÖv°v‡j Pvgov ev wgDKvm wSwjø cwi®‹vi ev RxevYygy³Ki‡Yi mgq
RxevYybvkK ev Gw›U‡mcwUK `ªeY e¨envi
l mKj ¯^v¯’¨Kg©x Ges †K‡›`ªi Ab¨vb¨ Kg©xi wbivc` Kg©c×wZ Abykxjb Kiv (Safe Work Practice);
†hgb: e¨enƒZ mu~P bv euvKv‡bv, mu~‡Pi XvKbv cybivq bv jvMv‡bv, hš¿cvwZi h_vh_ cÖwµqvRvZKiY BZ¨vw`|
l ¯^v¯’¨‡K›`ª wbqwgZ cwi®‹vi-cwi”Qbœ ivLv Ges wPwKrmv ev nvmcvZvj e‡R©¨i myô e¨e¯’vcbv

gvbm¤§Z ev cÖvgvwYK mZK©Zv

msµgb cÖwZ‡iv‡ai me‡P‡q fv‡jv Dcvq n‡jv cÖvgvwbK mZK©Zv¸‡jv (Standard Precaution) ‡g‡b Pjv

wb‡P ewY©Z cš’v¸‡jv msµgY cÖwZ‡iv‡ai Rb¨ gvbm¤§Z ev cÖvgvwYK mZK©Zv| GB mycvwikgvjv AbymiY K‡i †K‡›`ªi
†mevcÖ`vbKvix I †mevMÖnYKvix‡`i wewfbœ msµwgZ e¯‘i ms¯ú‡k©i SuywK eûjvs‡k cÖkwgZ Kiv m¤¢e|

gvbm¤§Z ev cÖvgvwYK mZK©Zv¸‡jv n‡jv:

l nvZ cwi®‹viKiY (Hand Hygiene)/ nv‡Zi cwi®‹vi cwi”QbœZv

l e¨w³MZ myiÿvi/ wbivcËv miÄgvw` e¨envi Kiv
l k¦vmh‡š¿i cwi”QbœZvi mwVK wbqg †g‡b Pjv ev Kvwki Av`k© wkóvPvi (Coughetiquette) †g‡b Pjv
l aviv‡jv hš¿cvwZi AvNvZ Gwo‡q Pjv|
l hš¿cvwZi h_vh_ cÖwµqvRvZKiY
l cwi‡e‡ki cwi®‹vi-cwi”QbœZv eRvq ivLv Ges h_vh_ eR©¨ e¨e¯’vcbv
l e¨enƒZ/†fRv wj‡bb bvovPvov, cwienb Ges cÖwµqvRvZKi‡Yi mgq Av`k© wbqg AbymiY

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 143

 e¨w³MZ myiÿvi/wbivcËv miÄgvw`
e¨w³MZ myiÿvi/ wbivcËv miÄgvw` ¯^v¯’¨Kg©x I ¯^v¯’¨ †mevMÖnxZv‡`i †Quvqv‡P ev msµvgK RxevYy ev AYyRxe †_‡K myiÿv
†`q we‡kl K‡i †h ai‡bi †mevq i³ ev †`ni‡mi ms¯ú‡k© Avmvi m¤¢vebv _v‡K|

e¨w³MZ myiÿvi/ wbivcËv miÄgvw`

l Møvfm&
l ‡Pv‡Li cwiavb (Pkgv/MMj&m)
l gv¯‹, K¨vc
l ivevi ev cøvw÷‡Ki ewne©vm hv msµwgZ †`nim Ges †mev cÖ`vbKvixi Pvgov I †cvkv‡Ki g‡a¨ cÖwZeÜK wn‡m‡e KvR
K‡i
l ivevi ev cøvw÷‡Ki RyZv (MvgeyU) hv ¯^v¯’¨Kg©x‡K aviv‡jv e¯‘ I `yN©UbvekZ c‡o hvIqv fvix e¯‘i AvNvZ †_‡K myiÿv
†`q

msµgY cÖwZ‡iva PP©v

†hLv‡b gv, beRvZK Ges cÖRbb ¯^v¯’¨ †mev cÖ`vb Kiv nq †mLv‡b wb¤œwjwLZ msµgY cÖwZ‡iva c×wZi PP©v ev Abykxjb
we`¨gvb _vKv evÃbxq|
÷¨vÛvW© 19: gv I beRvZ‡Ki ¯^v¯’¨‡mev cÖ`vbKvix mKj ¯^v¯’¨Kg©x Ges Zv‡`i mn‡hvMx mKj Kg©x (cwi”QbœZvKg©x)
Aek¨B mycvwikK…Z msµgY cÖwZ‡iva c×wZi cÖvgvwYK mZK©Zv Abykxjb Ki‡eb|

nvZ cwi®‹viKiY (Hand Hygiene)/ nv‡Zi cwi®‹vi-cwi”QbœZv

msµgY cÖwZ‡iv‡ai †¶‡Î nv‡Zi cwi®‹vi-cwi”QbœZv GKwU AwZ ¸iæZ¡c~Y© I ev¯Íem¤§Z cÖv‡qvwMK cÖwµqv| nvZ †avqvi
gva¨‡g Avgiv cÖv_wgKfv‡e A‡bK †ivMRxevYyi msµgY cÖwZ‡iva Ki‡Z cvwi| eZ©gv‡b nv‡Zi cwi®‹vi-cwi”QbœZvi Rb¨
¯^v¯’¨ †mev‡K›`ªmg~‡n 60-80% Gj‡Kvnj wbf©i n¨vÛiv‡ei e¨envi me‡P‡q Kvh©Ki cš’v (Gold Standard) wn‡m‡e
we‡ePbv Kiv nq, †Kbbv GwU AwZ `ªæZZvi mv‡_ eû cÖRvwZi m¤¢ve¨ kw³kvjx AYyRxe‡K wbw®Œq Ki‡Z mÿg| ZvQvov,
nv‡Zi cwi®‹vi-cwi”QbœZvi Rb¨ evievi e¨env‡i nv‡Z †KvbI ai‡bi A¯^w¯Í ˆZwi K‡i bv|

KLb n¨vÛ nvBwRb Ki‡Z n‡e?

l MÖnxZv/‡ivMx‡K cixÿv Kivi Av‡M I c‡i
l Møvfm civi Av‡M Ges †Lvjvi c‡i
l MÖnxZv/‡ivMxi i³, cuyR ev †`n wbtm„Z c`v_© cixÿvi mgq nv‡Z jvM‡j A_ev e¨en«Z hš¿cvwZ ¯úk© Kivi c‡i
l LvIqvi Av‡M I c‡i
l Uq‡jU e¨env‡ii c‡i
l Kg©¯’‡j Avmvi ci Ges Kg©¯’j Z¨vM Kivi c~‡e©

mvaviYZ 2 Dcv‡q n¨vÛ nvBwRb Kiv nq-

K. A¨vj‡Kvnj n¨vÛive
L. mvaviY nvZ †avqv

n¨vÛ nvBwRb Gi Rb¨ cÖ‡qvRbxq DcKiY

l A¨vj‡Kvnj n¨vÛive `ªeY
l mvaviY ev RxevYybvkK mvevb
l mvevb, cÖevngvb cvwbi aviv (U¨v‡ci cvwb)| cÖevngvb cvwb hw` bv _v‡K Z‡e Kjhy³ cwi¯‹vi cvwbi cvÎ A_ev
evjwZ‡Z msiwÿZ cwi®‹vi cvwb I gM
l ïay wb‡Ri e¨env‡ii Rb¨ ïKbv I cwi®‹vi e¨w³MZ †Zvqv‡j ev iægvj

144 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

Gj‡Kvnj n¨vÛive

nvZ hw` `„k¨gvb i³ ev †ivMxi †`ni‡m mivmwi ms¯ú‡k© bv Av‡m, †`nim Øviv wm³ bv nq Z‡e, Gj‡Kvnj-wbf©i n¨vÛive
w`‡q nvZ cwi®‹vi-cwi”Qbœ Kiv me‡P‡q Kvh©Ki c×wZ| †Kbbv Gj‡Kvnj-wbf©i n¨vÛive w`‡q nvZ cwi®‹vi-cwi”Qbœ Kiv
mvevb-cvwb †_‡K A‡bK Kg mgq †bq hv ¯^v¯’¨Kg©x‡`i g‡a¨ nvZ cwi®‹vi-cwi”Qbœ ivL‡Z mvnvh¨ K‡i| hw`
Gj‡Kvnj-wbf©i n¨vÛ ive bv cvIqv hvq Z‡e mvevb I cÖengvb cvwb w`‡q nvZ †aŠZ Ki‡Z n‡e|
Gj‡Kvnj-wbf©i n¨vÛ ive e¨envi Kivi Dchy³ mgq

l Kg©¯’‡j KvR ïiæ Kivi Av‡M Av‡M

l cÖwZwU †ivMx †`Lvi Av‡M Ges c‡i
l msµwgZ n‡Z cv‡i Ggb †KvbI wRwbm ¯úk© Kivi ci
l †ivMxi i³, †`nim, kixi †_‡K wbM©Z c`v_©, wgDKvm wSwjø, Pvgovi ÿZ †Wªwms BZ¨vw`I ms¯ú‡k© Avmvi ci
l †ivMxi wewfbœ bgybv (Specimen) bvovPvov Kivi ci
l wewfbœ wK¬wbK¨vj c×wZi Av‡M Møvfm& civi c~‡e©
l †h †KvbI cÖKv‡ii Møvfm& †Lvjvi ci
l wewfbœ cÖKvi Bb‡fwmf wWfvBm (Invasive Device) bvovPvov Kivi c~‡e© ev Bb‡fwmf c×wZ‡Z †mev cÖ`v‡bi c~‡e©
l KvR †_‡K †divi Av‡M

A¨vj‡Kvnj n¨vÛive Gi avcmg~n

mgqKvj: 20-30 †m‡KÛ

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 145

 mvaviY nvZ †avqv/ mvevb (mvaviY ev AYyRxe cÖwZ‡ivax) I cÖengvb K‡ji cvwb w`‡q nvZ †aŠZKiY

ïaygvÎ nv‡Z `„k¨gvb gqjv _vK‡j ev A¨vj‡Kvnj n¨vÛive `ªeY cvIqv bv †M‡j mvaviY ev RxevYybvkK mvevb Ges
cÖevngvb cvwb e¨envi K‡i nvZ ay‡Z n‡e|
l nv‡Z hLb `„k¨gvb gqjv †`Lv hvq
l nvZ hLb i³ ev †`n im (†hgb: jvjv, gj-g~Î, ewg, cuyR BZ¨vw`) ‡j‡M hvq
l e¨enƒZ hš¿cvwZ nvZ w`‡q ¯úk© Kivi ci
l Uq‡jU e¨envi Kivi ci

mvaviY nvZ †avqvi avcmg~n

mgqKvj: 40-60 †m‡KÛ

146 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

 nvZ †avqvwelqK civgk©
l †QvU mvev‡bi evi e¨envi Kiv ev eo mvevb‡K †QvU †QvU UzKiv K‡i e¨envi Kiv
l mvev‡bi evi i¨v‡K Ggbfv‡e ivLv hv‡Z ïK‡bv _v‡K
l me mgq cÖevngvb cvwb e¨envi Kiv-cvwb‡Z nvZ bv Wzwe‡q ev Ave× ev †ewm‡b Rgv‡bv cvwb‡Z nvZ bv †avqv
l nvZ cwi®‹vi iægvj ev †Zvqv‡j w`‡q gy‡Q ïwK‡q †djv ev evZv‡m ïwK‡q †djv

nvZ RxevYywb‡iva Kiv

nvZ RxevYywb‡iva Kivi jÿ¨ n‡”Q nvZ †_‡K gvwU I gqjv m¤ú~Y© `~i Kivi cvkvcvwk nv‡Z we`¨gvb A¯’vqx I emevmKvix
†d¬viv `~i Kiv| nvZ RxevYy wµqvwb‡iva Kivi cÖwµqv mvevb-cvwb w`‡q nvZ †aŠZ Kivi gZB| GB cÖwµqvq nvZ
RxevYybvkK (†K¬vi‡nw·wWb, Av‡qv‡Wv‡dvi, wUªK‡jvmvb) mg„× mvevb ev cwi®‹viKviK (k³ A_ev Zij) I cvwb e¨envi
Kiv nq|

wb¤œwjwLZ Kvh© m¤ú`v‡bi c~‡e© nv‡Z Gw›U‡mwÞK e¨envi Kiv cÖ‡qvRb

l D”P SuywKc~Y© †ivMx‡`i †mev cÖ`v‡bi c~‡e© I c‡i (AcwiYZ beRvZK, e‡qve„× †ivMx, GBWm †ivMxi µvwšÍ j‡Mœ)
l Bb‡fwmf c×wZ‡Z †ivMx‡`i †mev cÖ`v‡bi Av‡M
l ms¯úk© †_‡K msµgY cÖwZnZ Kivi Rb¨ (†ncvUvBwUm ÔGÕ I ÔBÕ A_ev †gw_wmwjb-cÖwZ‡ivax- ‡÷dvB‡jvK°vm
Awiqvm (Methicillin-resistant Staphylococcusaurius) Øviv AvµvšÍ †ivMx)

Møvfm Gi e¨envi

msµvgK AYyRx‡ei weiæ‡× Møvfm GKwU evav wn‡m‡e KvR K‡i †mev MÖnYKvix I †mevcÖ`vbKvix Dfq‡K i¶v K‡i| †mev
cÖ`vbKvixi DwPZ Møvfm cwiavb Kiv hLbB wZwb g‡b K‡ib †h Zv‡`i nvZ †mev MÖnYKvixi i³, kix‡ii Ab¨vb¨ Zij,
ev wUm¨yi ms¯ú‡k© Avm‡Z cv‡i| †mev`vbKvixi nvZ wPwKrmv e‡R¨©i ms¯ú‡k© Avmvi Av‡MB Møvfm& ci‡Z n‡e| Møvfm&
mvaviYZ wZb ai‡bi nq:
1. †÷ivBj ev RxevYygy³ Møvfm&
2. cix¶vi Rb¨ GKevi e¨envi‡hvM¨ Møvfm&
3. BDwUwjwU Møvfm&
KLb GB mKj Møvfm& e¨envi Ki‡Z nq:
†÷ivBj ev RxevYygy³ Møvfm&:
l mKj ai‡bi kj¨ wPwKrmvq
l †hvwbc‡_ cÖme (†hvwbc‡_ cÖm‡ei mgq RxevYygy³ Møvfm& e¨envi Kiv DwPZ †Kbbv Mf©-wSwjø †Quovi ci msµg‡Yi
SuywK ev‡o)
l Bb‡fwmf †iwWIjwRK¨vj (Invasive Radiological) ev fvmKzjvi (Vascular) c×wZ‡Z †mev cÖ`v‡bi mgq
l †K‡gv‡_ivwc (Chemotherapy) ev wkiv-c‡_ cywó (Parenteral Nutrition) wPwKrmv cÖ`v‡bi mgq

cixÿvi Rb¨ GKevi e¨envi‡hvM¨ Møvfm&

i³ ev Ab¨vb¨ †`ni‡mi ms¯ú‡k© Avmvi mgq ev hLb m¤¢ve¨ msµvgK DcKi‡Yi ms¯ú‡k© Avmvi mgq †hgb;
wgDKvm wSwjø, ¶Z/KvUv Z¡K, wUm¨y bgybv BZ¨vw`| D`vniY ¯^iƒc:
l B›U«v‡fbvm K¨v‡_Uvi (Intravenous Catheter) jvMv‡bv ev miv‡bvi mgq
l i³ †bqvi mgq
l †W«wms cwieZ©‡bi mgq
l Zj‡cU Ges †hvwbc_ cix¶vi mgq
l cix¶vMv‡i (Laboratory) bgybv cix¶v

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 147

 BDwUwjwU Møvfm

hš¿cvwZ cÖwµqvRvZKiY, M…n¯’vwj Kvh©µg, ev eR¨© Acmvi‡Yi mgq hLb i³, †`nim ev †h †KvbI SuywKc~Y© msµwgZ
c`v‡_©i ms¯ú‡k© Avmvi m¤¢vebv _v‡K| D`vniY¯^iƒc:
l e¨enviK…Z hš¿cvwZ miv‡bv/ cwi®‹vi Kivi mgq
l nvmcvZvj ev wPwKrmv eR¨© c„_KxKiY Ges AcmviY Kivi mgq
l e¨enviK…Z wj‡bb miv‡bvi mgq
l wQU‡K cov i³ ev †`nim cwi®‹vi Kivi mgq
l ewgi cvÎ ev †ewmb cwi®‹vi Kivi mgq

KLb Møvfm civi cÖ‡qvRb †bB

hLb i³ ev Ab¨vb¨ †`ni‡mi ev msµwgZ cwi‡e‡ki ms¯ú‡k© Avmvi m¤¢vebv †bB| D`vniY¯^iƒc:
l †ivMxi i³Pvc, ZvcgvÎv ev bvwo cwigvc Kivi mgq
l Pvgovi wb‡P ev gvs‡m Bb‡RKkvb †`evi mgq
l †ivMx‡K †Mvmj, cwicvwU, ¯’vbvšÍi Kivi mgq
l wkiv-c‡_i Jl‡ai gvÎv wVK Kivi mgq

RxevYygy³ Kivi †KŠkj

RxevYygy³Ki‡Yi g‡a¨ Av‡Q
l cÖwZe܇Ki e¨envi
l A¯¿cvPv‡ii Rb¨ nv‡Zi cÖ¯‘wZ
l †mevMÖnxZv‡K cÖ¯‘ZKiY
l RxevYygy³ †ÿÎ cÖ¯‘ZKiY I eRvq ivLv
l Dchy³ kj¨ †KŠkj cÖ‡qvM Kiv
l kj¨ wPwKrmvi †mev cÖ`v‡bi Rb¨ wbivc` GjvKv ˆZwi Kiv

cÖwZe܇Ki (Barrier) e¨envi

l RxevYygy³ Møvfm e¨envi Kiv|
l K_v, Kvwk ev wbk¦v‡mi gva¨‡g †mevMÖnxZvi kix‡i AYyRx‡ei cÖ‡ek cÖwZ‡iva Ges †mevMªnxZvi kix‡ii i³ ev
†`ni‡mi ms¯úk© †_‡K †mev cÖ`vbKvixi gyL Ges bvK i¶v Ki‡Z gv¯‹ e¨envi Kiv|
l MvDb Ges cvwb-wb‡ivaK G‡cÖvb/ewne©vm e¨envi Kiv|
l †mev`vbKvix gv_vi Z¡K Ges Py‡ji AYyRx‡ei ms¯úk© ‡_‡K †mevMÖnxZv‡K i¶v Kivi Rb¨ cÖwZ‡iva K¨vc e¨envi
Kiv|
l cwi®‹vi Ges k³ Ry‡Zv (e× ivevi ev Pvgovi eyU/RyZv) A‡¯¿vcPvi/ wK¬wbK¨vj mvwf©m †`qvi GjvKvi g‡a¨ AYyRx‡ei
msL¨v Kgv‡Z mvnvh¨ K‡i|
A‡¯¿vcPv‡ii Rb¨ nv‡Zi cÖ¯‘wZ

1. Gj‡Kvnj-wbf©i RxevYybvkK w`‡q A‡¯¿vcPv‡ii Rb¨ nv‡Zi cÖ¯‘wZ

mbvZb mvwR©K¨vj n¨vÛ ¯Œv‡ei cwie‡Z© evwYwR¨Kfv‡e jf¨ Gj‡Kvnj-wbf©i `xN© †gqvw` RxevYybvkK ÿgZvm¤úbœ cY¨‡K
A‡¯¿vcPv‡ii c~‡e© nv‡Zi cÖ¯‘wZi Rb¨ mycvwik Kiv nq| nvZ Ges KbyB †_‡K Kwâ ch©šÍ mvevb I cvwb w`‡q ay‡q †djyb,
cy‡ivcywi ïwK‡q †djyb, Zvici Drcv`bKvixi wb‡`©kbv Abyhvqx nv‡Z Gj‡Kvnj-wbf©i `ªeY e¨envi Kiæb| eªvk ev ¯úÄ
e¨envi Ki‡eb bv| cy‡iv cÖwµqvq nvZ Gj‡Kvnj-wbf©i `ªeY Øviv †fRv _vK‡e| RxevYygy³ Møvfm cwiav‡bi Av‡M nvZ
Ges KbyB †_‡K Kwâ ch©šÍ Ask Aek¨B ïwK‡q wb‡Z n‡e|

A‡¯¿vcPvi K‡ÿ cÖ‡e‡ki ci Ges K‡ÿi Rb¨ wba©vwiZ †cvkvK cwiavb Kivi ci nvZ Aek¨B mvevb I cÖengvb cvwb Øviv
ay‡q †d‡j Zvici Gj‡Kvnj-wbf©i RxevYybvkK `ªeY e¨envi Ki‡Z n‡e| A‡¯¿vcPvi †k‡l, Møvfm& Ly‡j †djvi ci
Gj‡Kvnj-wbf©i RxevYybvkK w`‡q nvZ fv‡jvfv‡e N‡l wb‡Z n‡e bZzev mvevb I cÖengvb cvwb w`‡q nvZ fv‡jvfv‡e ay‡q
cwi®‹vi K‡i wb‡Z n‡e|

148 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

A‡¯¿vcPv‡ii Rb¨ Gj‡Kvnj wbf©i RxevYybvkK w`‡q nv‡Zi cÖ¯ÍywZ
1. Wvbnv‡Zi KbyB e¨envi K‡i wWm‡cbmvi †_‡K evgnv‡Zi Zvjy‡Z AvbygvwbK cuvP (05) wg.wj. Gj‡Kvnj-wbf©i
RxevYybvkK wb‡Z n‡e|
2. b‡Li wb‡Pi Ask RxevYygy³ Kivi Rb¨ Wvbnv‡Zi AvOz‡ji WMv evgnv‡Z †bqv `ªe‡Y Kgc‡ÿ cuvP (05) †m‡K‡Ûi
Rb¨ Wzev‡Z n‡e| Gici evg nvZ w`‡q Wvb nv‡Zi KbyB ch©šÍ `ªeYwU fv‡jvfv‡e †jcb Ki‡Z n‡e|
3. m¤ú~Y© `ªeYwU wgwj‡q bv hvIqv ch©šÍ nv‡Zi m¤ú~Y© As‡k PµvKv‡i Nywi‡q Nywi‡q †jcb Kiv wbwðZ Ki‡Z n‡e (10-15
†m‡KÛ)|
4. Gevi evg nv‡Zi KbyB e¨envi K‡i wWm‡cbmvi †_‡K Wvb nv‡Zi Zvjy‡Z AvbygvwbK cuvP (05) wgwj. Gj‡Kvnj-wbf©i
RxevYybvkK wb‡Z n‡e|
5. b‡Li wb‡Pi Ask RxevYygy³ Kivi Rb¨ evgnv‡Zi AvOz‡ji WMv Wvb nv‡Z †bqv `ªe‡Y Kgc‡ÿ cuvP (05) †m‡K‡Ûi
Rb¨ Wzev‡Z n‡e|
6. Gici Wvb nvZ w`‡q evg nv‡Zi KbyB ch©šÍ `ªeYwU fv‡jvfv‡e †jcb Ki‡Z n‡e|
7. m¤ú~Y© `ªeYwU wgwj‡q bv hvIqv ch©šÍ nv‡Zi m¤ú~Y© As‡k PµvKv‡i Nywi‡q Nywi‡q †jcb Kiv wbwðZ Ki‡Z n‡e (10-15
†m‡KÛ)|
8. Avevi Wvb nv‡Zi KbyB e¨envi K‡i wWm‡cbmvi †_‡K evg nv‡Zi Zvjy‡Z AvbygvwbK cuvP (05) wgwj. Gj‡Kvn-wbf©i
RxevYybvkK wb‡Z n‡e|
9. 20-30 †m‡KÛ Kwâ ch©šÍ `yB nvZ Nl‡Z n‡e|
10. Kwâ ch©šÍ `yB nv‡Zi mKj Ask †X‡K hvq Ggbfv‡e Gj‡Kvnj-wbf©i RxevYybvkK `ªeYwU wb‡q `yB nv‡Zi Zvjy
ci¯ú‡ii mv‡_ Nl‡Z n‡e|
11. Wvb nv‡Zi Zvjy w`‡q evg nv‡Zi †cQb w`K Kwâ ch©šÍ Dc‡i-wb‡P K‡i Nl‡Z n‡e Ges Ab¨ nv‡Zi Rb¨ cÖwµqvwUi
cybive„wË Ki‡Z n‡e|
12. nv‡Zi Zvjy w`‡q Ab¨ nv‡Zi DcwifvM Ges AvOz‡ji duvK GK‡Î Nlv Ges AcinvZ GKBfv‡e Nlv|
13. AvOz‡ji D‡ëv cvk Aci nv‡Zi Zvjyi mv‡_ GK‡Î Nlv|
14. evg nv‡Zi e…×v½yj Wvb nv‡Zi Zvjyi mv‡_ Nywi‡q Nlv Ges Aci nv‡Z Ges GKBfv‡e Kiv|
15. evg nv‡Zi Zvjy Wvb nv‡Zi AvOz‡ji m‡½ GKevi mvg‡b GKevi wcQ‡b Nywi‡q Nlv|
16. hLb nvZ ïwK‡q hv‡e ZLb RxevYygy³ kj¨ wPwKrmvi †cvkvK Ges Møvfm& cwiavb Ki‡Z n‡e|
Gj‡Kvnj wbf©i RxevYybvkK w`‡q mvwR©K¨vj nv‡Zi cÖ¯‘wZi Rb¨ cÖ‡qvRb‡ev‡a Dc‡i ewY©Z avc¸‡jvi cybive„wË Kiv
†h‡Z cv‡i(Mo e¨vwßKvj 60 †m‡KÛ), Z‡e Aek¨B Drcv`bKvix cÖwZôv‡bi mycwikK…Z mgqmxgvi g‡a¨ cÖwµqvwU
m¤úY© Ki‡Z n‡e|

2. cvwb I RxevYybvkK ev Gw›U‡mcwUK w`‡q mvwR©K¨vj ¯Œve Kivi cÖwµqv

3-5 wgwbU ch©šÍ †K¬vi‡nw·wWb ev Av‡qv‡Wv‡dvi RvZxq RxevYybvkK w`‡q nvZ ¯Œve Ki‡j †mev MÖnxZvi g‡a¨ msµg‡Yi
SuywK A‡bKvs‡k K‡g hvq|

cvwbwbf©i mvwR©K¨vj ¯Œve Kivi avcmg~n wb¤œiƒc

1. Avcbvi nvZ Ges Kwâi Dc‡ii me Mnbv Ly‡j ‡djyb|
2. e¨envh© cvwb‡K Dò ivLyb Ges m¤ú~Y© nvZ wfwR‡q †djyb| hw` nv‡Z gvwU ev Ab¨ †KvbI eR©¨ †j‡M _v‡K Z‡e mvaviY
mvevb I K‡ji cvwb w`‡q nvZ cwi®‹vi Kiæb|
3. GKwU KvwV ev eªvk w`‡q cÖwZwU b‡Li wbP cwi®‹vi Kiæb| mvaviYZ hviv A‡¯¿vcPvi Kvh©µ‡g AšÍfy©³ Zv‡`i AvOz‡ji
bL †QvU ivL‡Z n‡e|
4. nv‡Zi Kwâ ch©šÍ KbyB‡qi Dc‡i fvuR K‡i Gw›U‡mcwUK ev RxevYybvkK cÖ‡qvM Kiæb|
5. GK nv‡Zi bL †_‡K ïiæ K‡i Ges AvOy‡ji dvuK KbyB ch©šÍ e„ËvKvi c×wZ e¨envi K‡i nvZ Nl‡Z n‡e| GKBfv‡e
Av‡iK nvZI cwi®‹vi Kiæb| m¤ú~Y© cÖwµqvwU 3-5 wgwbU Kiæb|
6. cÖwZwU nvZ evû †_‡K Avjv`vfv‡e ay‡q cwi®‹vi Ki‡Z n‡e| cÖ_‡g nv‡Zi bL, nv‡Zi Kwâ ch©šÍ nv‡Zi KbyB-Gi
Dc‡i ivL‡Z n‡e|
7. GKwU RxevYygy³ iægvj e¨envi K‡i nv‡Zi bL n‡Z ïiæ K‡i KbyB ch©šÍ †Zvqv‡j/iægv‡ji wfbœ wfbœ w`K e¨envi K‡i
gyQ‡Z n‡e|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 149

 8. nvZ †Kvg‡ii Dc‡i ivL‡Z n‡e Ges mvwR©K¨vj Møvfm& cwiav‡bi Av‡M wKQy ¯úk© Kiv hv‡e bv|

RxevYygy³ Møvfm
hLb †KvbI †mev`vbKvixi nvZ †KvbI †mevMÖnxZvi i³ ev Pvgovi wb‡Pi †Kv‡li ev wUmy¨i im ms¯ú‡k© Avmvi m¤¢vebv
_v‡K ZLb RxevYygy³ Møvfm civ DwPZ| mwVK fv‡e Møvfm civ Ges AcmviY Kiv Riæwi| RxevYygy³ Møvfm msµwgZ n‡q
hvq hLb:
l Avcwb Avcbvi Lvwj nvZ w`‡q Møvf‡mi evB‡ii Ask ¯úk© K‡ib|
l Møvfm civi mgq hw` †KvbwKQyi ¯úk© jv‡M hv D”PgvÎvq msµgYgy³ ev Rxevbygy³ bq|
l †Kvg‡ii wb‡P Møvfm civ nvZ ivLv|
l †h †KvbI nv‡Zi Møvf‡m †Quov, dvUv ev dy‡Uv n‡j|

RxevYygy³ Møvfm civi avcmg~n

l Møvf‡mi c¨v‡KU †Lvjvi Rb¨ GKwU eo, cwi®‹vi, ﮋ RvqMv cÖ¯‘Z K‡i wb‡Z n‡e| nvZ †avqvi c~‡e© mvwR©K¨vj
Møvf‡mi evB‡ii c¨v‡KUwU Ly‡j Zv †ei K‡i wb‡Z n‡e A_ev nvZ ay‡q Ab¨ KvD‡K mvwR©K¨vj Møvf‡mi evB‡ii
AveiYwU Ly‡j w`‡Z ej‡Z n‡e|
l Møvf‡mi †fZ‡ii cvZjv AveiYwU Lyj‡Z n‡e, Zvn‡j fuvRmn Møvfm&wU ‡`Lv hv‡e|
l cÖ_‡g RxevYygy³ Møvfm&wUi fuv‡Ri RvqMvi wfZ‡ii w`‡K a‡i Zv Zz‡j wb‡Z n‡e| (ïaygvÎ Kv‡di wfZ‡ii Ask ¯úk©
K‡i cÖ_g Møvfm&wU Zyjyb)|
l GK nv‡Z Møvf‡mi fvR Kiv Ask a‡i _vKv Ae¯’vq, Ab¨ nvZwU Møvf‡mi g‡a¨ XyKv‡Z n‡e| mZK© _vK‡Z n‡e †hb
†KvbwKQyi ¯úk© bv jv‡M Ges Mvøfm&wU †Kvg‡ii Dc‡i _v‡K|
l wØZxq Møvfm&wUi fuvR Kiv As‡ki wfZ‡i Av½yj w`‡q Zyj‡Z n‡e| mZK© _vK‡Z n‡e †hb Møvfm& bv civ nvZ w`‡q
Møvfm& civ nvZwU msµwgZ bv nq, †Kbbv ZLbI wØZxq nv‡Z Møvfm& civ nqwb|
l Kvd a‡i wØZxq Møvfm&wU Lvwj nvZwU‡Z axi fv‡e †U‡b civ‡Z n‡e| Avivg Ges gvcmB nIqvi Rb¨ AvOzj Ges fuvR
Kiv Møvf‡mi Ask wVK K‡i wb‡Z n‡e|

RxevYygy³ Møvfm civi avcmg~n

01 02 03 04 05

Møvfm&& civi Av‡M nvZ fvjfv‡e Dc‡ii c¨v‡KUwU mZK©Zvi mv‡_ wQu‡o RxevYygy³ c¨v‡KUwU ¯úk©wenxb fv‡e cwi®‹vi ïKbv GK nv‡Zi e„×v½ywj Ges ZR©bx Møvf‡m&&i fuvR Kiv AskwU a‡i Aci nv‡Z
ay‡q ev A¨vj‡Kvnj e¨envi K‡i †djyb I ¯úk©wenxb fv‡e Møvfm&&mn RvqMvq ivLyb| c¨v‡KUwUi Dc‡ii `yB cv‡ki fuvR w`‡q Møvf‡mi fuvR Kiv AskwU Møvfm&wU GKev‡iB AvswkK c‡o †djyb|
cwi®‹vi K‡i wbb wfZ‡ii RxevYygy³ c¨v‡KUwU †ei Kiæb| Ly‡j †djyb Ges Møvfm&&¸‡jv D‡b¥vwPZ Kiæb| Kiæb| Z‡e fuvR Kiv AskwU †Lvjv hv‡e bv|

06 07 08 09 10

Møvfm&& cov nv‡Zi Av½yj w`‡q wØZxq Møvfm&wU Gi fuvR Kiv Møvfm&wenxb nv‡Z ¯úk© Qvov G‡Kev‡iB wØZxq Møvfm&wU m¤ú~Y©fv‡e c‡i †dj‡Z n‡e|
AskwUi wfZ‡i a‡i Zz‡j wbb|

11 12 13 14

`yÕnv‡Z Møvfm&& covi ci Møvfm&& cwiwnZ nv‡Zi Av½yj cÖ_g Møvfm&& cwiwnZ nv‡Zi AvswkK civ nv‡Z Møvfm&& civ n‡q‡Q Ges
cÖ‡qvR‡b nv‡Zi Av½yj¸‡jv Møvfm&wUi fuvR Kiv Ask †U‡b m¤ú~Y©fv‡e c‡i †dj‡Z n‡e| G‡ÿ‡Î GLb Møvfm&& civ nvZ †ivMx‡K
†b‡o‡P‡o wVK K‡i wbb| evB‡ii †Kvb ¯úk© †h‡bv bv jv‡M †mw`‡K †Lqvj ivL‡Z n‡e| ¯úk© Kivi Rb¨ cÖ¯‘Z|

150 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

Møvfm †Lvjvi avcmg~n
l GKwU Møvf‡m&i Kv‡di Kv‡Q a‡i †mB Møvfm&wU Dwë‡q AvswkKfv‡e Ly‡j wbb| g‡b ivL‡Z n‡e wØZxq Møvfm&wU †Lvjvi
Av‡M cÖ_g Møvfm&wU cy‡ivcywi †Lvjv hv‡e bv|
l cÖ_g MøvfmwU nv‡Z _vKv Ae¯’vq wØZxq Møvf‡m&i Kv‡di KvQvKvwQ a‡i Zv Dwë‡q Ly‡j †djyb| g‡b ivL‡Z n‡e wØZxq
MøvfmwUI AvswkKfv‡e Lyj‡Z n‡e|
l Gici mveav‡b `y‡Uv MøvfmB GKms‡M Ly‡j †djyb, †hb Lvwj nv‡Z RxevYy hy³ Møvf‡mi evB‡ii Ask Quy‡Z bv nq|
Møvfm †Lvjvi mv‡_ mv‡_B wbw`©ó e‡R©¨i cv‡Î †djyb|

Møvfm †Lvjvi avcmg~n

01 02 03 04

cÖ_g Møvfm&wU †Lvjvi Rb¨ Aci nv‡Zi Av½yj w`‡q Møvf‡m&&i Kv‡di Kv‡Q a‡i Dwë‡q AvswkKfv‡e Ly‡j †djyb| cÖ_g Møvfm&wU nv‡Z _vKv Ae¯’vq wØZxq
( wØZxq Møvfm&wU †Lvjvi Av‡M cÖ_g Møvfm&wU cy‡ivcywi †Lvjv hv‡e bv|) Møvf‡m&i Kv‡di KvQvKvwQ evB‡ii w`‡K
a‡i Dwë‡q AvswkKfv‡e Ly‡j †djyb|

05 06 07

mZ©KZvi mv‡_ `y‡Uv Møvfm&&B GKmv‡_ Ly‡j e¨eüZ Møvfm&& eR©¨ Acmvi‡Yi Møvfm&& †Lvjvi ci nvZ cwi¯‹vi
†djyb| †Lqvj ivLyb †hb Lvwj nv‡Z wbw`©ó cv‡Î †djyb| K‡i wbb|
RxevYygy³ Møvf‡m&&i evB‡ii Ask Quy‡Z bv nq|

mwVK kj¨wPwKrmvi cÖ‡qvM †KŠkj

mywe‡ePbvc~Y© mZK©Zv Ges ax‡i ax‡i kix‡ii wUmy¨ bvovPvov msµg‡Yi m¤¢vebv eûjvs‡k Kwg‡q †`q| †hgb:
- beRvZ‡Ki bvwfi¾y KvUv: bvwfi¾y‡Z Z…Zxq euvab †`qvi Av‡M bvwfi¾yi i³ Mf©dz‡ji w`‡K †P‡c mwi‡q w`‡j
bvwfi¾y KvUvi mgq i³ wQU‡K covi m¤¢vebv Kg|
- gv‡qi GK cv‡k `uvwo‡q wbqwš¿Zfv‡e Mf© wSwjø wQu‡o †dj‡j cvwbi DcwP‡q ev wQU‡K cov A‡bKvs‡k Kwg‡q Avbv
hvq|

wbivc` kj¨ wPwKrmv/ †mevcÖ`v‡bi ¯’vb cÖ¯‘ZKiY

kj¨wPwKrmv †mevcÖ`v‡bi Rb¨ GKwU Kÿ wbw`©ó Ki‡Z n‡e| hvbevnb, Kvh©µg, †jvKR‡bi mxwgZ PjvPj msµg‡Yi SuywK
Kwg‡q †`q| †jvKR‡bi Pjv‡div Ges Kv‡Ri cwigvY †ivMm„wóKvix AYyRx‡ei msL¨v‡K mivmwi cÖfvweZ K‡i| wbivc`
Kg© cwi‡e‡ki Rb¨:
l Kg© GjvKvq †jvKR‡bi Dcw¯’wZ Kwg‡q Avbv; ïaygvÎ Kg©iZ †jv‡Ki Rb¨ cÖ‡ekvwaKvi msiÿY Kiv
l †jvKR‡bi Pjv‡div I Kvh©vejx c~‡e©B wbw`©ó K‡i †`qv
l †mev cÖ`v‡bi mgq `iRv eÜ ivLv I c`©v e¨envi Kiv
l kj¨wPwKrmv cÖ`vb Kiv nq Ggb K‡ÿ †mev cÖ`vbKvixMY cwi®‹vi Kvco, K¨vc, gv¯‹, RyZv BZ¨vw` cwiavb K‡i
l ayjvevwj I †cvKv-gvK‡oi cÖ‡ek Kwg‡q Avbvi Rb¨ RvqMvwU hZ`~i m¤¢e wN‡i ivLv
l RvqMvwU m¤¢e n‡j kxZvZvc wbqwš¿Z Kiv
l K‡ÿ bZzb †ivMx cÖ‡e‡ki c~‡e© i³ ev †`nim Øviv msµwgZ n‡q‡Q Ggb mKj `ªe¨vw` RxevYy bvkK w`‡q
RxevYygy³KiY (Acv‡ikb/cixÿvi †Uwej, hš¿cvwZ I Uªwj jvB‡Ui nvZj BZ¨vw`)|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 151

 aviv‡jv hš¿cvwZi AvNvZ Gwo‡q Pjv

¯^v¯’¨‡K‡›`ª †mev`vbKvix‡`i i³RvZ RxevYy Øviv msµwgZ nIqvi cÖv_wgK KviYB n‡jv muyB Ges aviv‡jv hš¿cvwZ| mKj
†mev`vbKvix, hviv aviv‡jv e¯‘ bvovPvov K‡ib Zviv mevB msµg‡Yi SuywK‡Z _v‡Kb| ¯^v¯’Kg©xMY AvNvZcÖvß n‡Z cv‡ib:
l nvB‡cvWvwg©K muyB (Hypodermic Needle) fv½v, evuKv‡bv ev cybivq XvKbv (Recapping) jvMv‡bvi mgq
l wbivc` fv‡e aviv‡jv e¯‘enb Ki‡Q bv Ggb †jv‡Ki Øviv
l hLb aviv‡jv e¯‘ AcÖZ¨vwkZ RvqMvq cvIqv hvq, †hgb: weQvbvi Pv`‡ii Dci
l A‡bK aviv‡jv hš¿ e¨envi Ki‡Z nq Ggb ¯^v¯’¨ †mevq
l hw` †QvU cwim‡i A‡bK †mev`vbKvix‡`i KvR Ki‡Z nq
l aviv‡jv eR©¨ AcmviY Kv‡j
l Bb‡RKkvb †`evi mgq †ivMx nVvr b‡o DV‡j

aviv‡jv e¯Íi mwVK cwiPvjb

l mvnvh¨Kvix aviv‡jv e¯‘wU Ôwbivc` †RvbÕ-G ivL‡eb †hUv wbw`©ó †KvbI hš¿ ivLvi Uªwj n‡Z cv‡i ev wbw`©ó †KvbI ¯’vb
n‡Z cv‡i
l mnKvix †mev`vbKvix‡K Avk¦¯Í Ki‡eb †h, aviv‡jv e¯‘wU Ôwbivc` †RvbÕ-G Av‡Q
l †mev`vbKvix aviv‡jv hš¿ wb‡eb, e¨envi Ki‡eb Ges cybivq Ôwbivc` †RvbÕ-G †diZ w`‡eb

msµgY cÖwZ‡iv‡a hš¿cvwZ cÖwµqvRvZKiY

wK¬wbK¨vj Ges mvwR©K¨vj †mevq msµgY cÖwZ‡iv‡a mwVKfv‡e hš¿cvwZ cÖwµqvRvZKiY AwZ ¸iæZ¡c~Y©| mwVKfv‡e
cwiPvjb Ges cÖwµqvRvZKiY ¯^v¯’¨Kg©x‡`i g‡a¨I msµg‡Yi SuywK eûjvs‡k Kwg‡q †`q|

e¨enƒZ hš¿cvwZi Rb¨ msµgY cÖwZ‡iva cÖwµqv

msµgY cÖwZ‡iv‡ai bxwZgvjv h_vh_fv‡e AbymiY bv Ki‡j wm³ hš¿cvwZ, e¨enƒZ Møvfm, Ges Ab¨vb¨ cybte¨envi ‡hvM¨
miÄvgvw` wewfbœ †ivM Qov‡Z cv‡i| cÖwµqvwU wb‡¤œ †`qv n‡jv:

152 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

hš¿cvwZ cÖwµqvRvZKi‡Yi avcmg~n;

1. cwi®‹viKiY I ïKv‡bv
2. RxevYygy³KiY ev D”PgvÎvq msµgYgy³KiY Ges
3. e¨envi ev msiÿYb|

cwi®‹viKiY

cixÿvKiv

RxevYygy³KiY D”PgvÎvq msµgYgy³KiY

D”P Pv‡c ev®ú Øviv (A‡Uv‡K¬f) ﮋ Zvc ivmvqwbK dzUv‡bv ev®úxq ivmvqwbK

e¨envi ev
msiÿY

cwi®‹viKiY (Cleaning)

cwi®‹viKiY e¨eüZ wewfbœ hš¿cvwZ/ miÄvg I AvmevecÎ †_‡K i³, †`n-wbtm„Z im/ c`v_© ev †h †KvbI ai‡bi gqjv
AcmviY K‡i hv RxevYygy³ ev D”PgvÎvq msµgY gy³KiY cÖwµqv‡K e¨vnZ Ki‡Z cv‡i| cwi®‹viKiY hš¿cvwZ I Ab¨vb¨
miÄv‡gi Mv‡q †j‡M _vKv G‡Ûv‡¯úvimn RxevYyi msL¨v Kgvq| mvaviY A‡_© cwi®‹vi Ki‡Z eySvq eªvk, wWUvi‡R›U
cvDWvi Ges cvwb w`‡q Nlv Ges GwU cÖwµqvRvZKi‡Yi GKwU ¸iæZ¡c~Y© avc| cwi®‹viKiY bv n‡j cÖwµqvRvZKi‡Yi
cieZ©x avc Kvh©Ki nq bv|

miÄvgvw` I Ab¨vb¨ DcKiY cwi®‹viKi‡Yi mgq Aek¨B gv¯‹, †Pv‡Li AveiYx (Pkgv/MMjm), BDwUwjwU Møvfm& e¨envi
Ki‡Z n‡e| w÷‡ji ev avZzi gvRwb e¨envi bv Kiv fv‡jv| GB mKj gvRwb, avZz ev w÷‡ji miÄv‡g `vM †dj‡Z cv‡i
hv cieZ©x‡Z wewfbœ cÖKvi AYyRx‡ei eske„w×i ¯’vb n‡Z cv‡i| G¸‡jv cieZ©x‡Z miÄgvw`i ÿ‡q hvIqvi KviYI n‡Z
cv‡i|

cwi®‹viKi‡Yi Rb¨ cÖ‡qvRbxq DcKiY

cÖevngvb cvwbmn wm¼/ †ewmb, cøvw÷‡Ki Mvgjv, wWUvi‡R›U cvDWvi, Uz_ eªvk, BDwUwjwU Møvfm&&, †Uwej/cøvw÷K i¨vK,
†Zvqv‡j, cwi¯‹vi Kvco, g¨vwK‡›Uvm, gv¯‹ BZ¨vw`|

cwi®‹viKi‡Yi avcmg~n (Steps of Cleaning)

1g avc:
GKwU big gvRb (e«vk ev cy‡iv‡bv Uy_eªvk), cwi®‹viK (wWUvi‡R›U) Ges cvwb e¨envi K‡i fv‡jvfv‡e gvRv †hb me i³,
†`nim, wUmy¨, Ges Ab¨vb¨ c`v_© hš¿ †_‡K m¤ú~Y©iƒ‡c AcmvwiZ nq| hš¿cvwZ cwi®‹viKhy³ (wWUvi‡R›U) cvwbi g‡a¨
Wywe‡q gvR‡Z Ges cwi®‹vi Ki‡Z n‡e †hb cwi®‹viK/ wWUvi‡R›Uhy³ cvwb wQU‡K bv c‡i| mshy³ hš¿ ev DcKiYmg~n
Ly‡j †dj‡Z n‡e Ges LvuR, `vuZ I h‡š¿i †Rvov¸‡jv‡Z †hLv‡b ˆRe Dcv`vb Rgv ev †j‡M _vK‡Z cv‡i Zv gvRb ev eªvk
w`‡q cwi®‹vi Kiv wbwðZ Ki‡Z n‡e|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 153

 2q avc
hš¿cvwZ cwi®‹vi Ges K‡ji cÖevngvb cvwb w`‡q fv‡jvfv‡e ay‡q ‡dj‡Z n‡e †hb cwi®‹viK (wWUvi‡R›U) †j‡M bv _v‡K|

3q avc
cwi®‹viK…Z hš¿cvwZ evZv‡m ïKv‡Z n‡e ev cwi®‹vi †Zvqv‡j w`‡q gy‡Q ïKv‡Z n‡e|
†h mKj wel‡qi cÖwZ we‡kl `„wó ivL‡Z n‡e

wj‡bb (K¨vc, MvDb, gv¯‹ Ges Acv‡ik‡b e¨eüZ Kvco)

wj‡b‡bi RxevYygy³KiY ev¯Íem¤§Z bq Ges GUv mycvwik I Kiv nq bv| wj‡b‡b †j‡M _vKv i³, †`nim, †ivMxi
†`nwbtm„Z Ab¨vb¨ c`v_© Ggbfv‡e bvovPvov, cwienb Ges cÖwµqvRvZ Ki‡Z n‡e hv‡Z Ab¨ Kvc‡o, †ivMx ev cwi‡e‡k
AYyRxe ¯’vbvšÍwiZ n‡Z bv cv‡i| G¸‡jv‡K Ggbfv‡e SuvKv‡bv DwPZ n‡e bv hv‡Z G¸‡jv evZv‡mi gva¨‡g Qov‡Z cv‡i|
†avqvi Rb¨ wj‡bb Ggbfv‡e enb Ki‡Z n‡e hv‡Z msµwgZ Ask wj‡b‡bi Ab¨vb¨ ïK‡bv Ask Øviv Ave„Z _v‡K| wj‡bb
bvovPvov, cwienb Ges cÖwµqvRvZKi‡Yi mgq Aek¨B fvix BDwUwjwU Møvfm& e¨envi Ki‡Z n‡e Ges cÖwµqv †k‡l Møvfm&
Ly‡j nvZ ay‡q †dj‡Z n‡e| hw` †mev‡K‡›`ªi evwn‡i wj‡bb cÖwµqvRvZKiY Ki‡Z nq Z‡e whwb enb Ki‡eb Zv‡K Aek¨B
BDwUwjwU Møvfm& e¨envi Ki‡Z n‡e| Mig cvwb‡Z wWUvi‡R›U wgwk‡q ay‡Z n‡e Ges evievi cwi®‹vi cvwb‡Z Wywe‡q ay‡Z
n‡e| Zvici evZv‡m ev †gwk‡b ïKv‡Z n‡e| msµg‡Yi m¤¢vebv Kgv‡bvi Rb¨ wj‡bb †gwk‡b cwi®‹vi KivB DËg|
†gwk‡b cwi®‹vi Kiv m¤¢e bv n‡j hviv nv‡Z cwi®‹vi Ki‡e Zv‡`i cÖwZ‡ivaK miÄgvw`, †hgb-BDwUwjwU Møvfm&, cvwb‡ivax
(Water Proof) ewne©vm/ G‡cÖvb, †Pv‡Li AveiYx (Eye Protector) Ges gv¯‹ e¨envi Ki‡Z n‡e|

RxevYygy³KiY (Sterilization)

†÷wijvB‡Rkvb ev RxevYygy³KiY cÖwµqv e¨enƒZ miÄgvw`i e¨vK‡Uwiqvj G‡Ûv‡¯úvi (Bacterial Endospore) mn

mKj cÖKvi AYyRxe (e¨vK‡Uwiqv, fvBivm, QÎvK, ciRxex [Parasites]) †_‡K gyw³ wbwðZ K‡i hv †mevMÖnxZvi
msµg‡Yi Drm n‡Z cv‡i| †÷wijvB‡Rkvb ev RxevYygy³KiY cÖwµqv †h‡nZz mKj cÖKvi AYyRxe aŸsm Ki‡Z cv‡i
†m‡nZz †h mKj DcKiY, †hgb m~uP Ges A¯¿cvPv‡ii hš¿cvwZ †h¸‡jv Pvgovi wb‡P i³ ev †`n Kjvi (Tissue) ms¯ú‡k©
Av‡m †m¸‡jv †÷wijvB‡Rkvb ev RxevYygy³KiY Kivi Rb¨ mycvwik Kiv nq| hLb †÷wijvB‡Rkvb ev RxevYygy³KiY
Kivi myweav cvIqv hvq bv ZLb D”PgvÎvi msµgY gy³KiY GKgvÎ MÖnY‡hvM¨ weKí|

cieZ©x‡Z †÷wijvB‡Rkvb ev RxevYygy³Ki‡Yi g~j aviYv we¯ÍvwiZfv‡e Av‡jvPbv Kiv n‡q‡Q Zv †h c×wZ‡ZB
†÷wijvB‡Rkvb ev RxevYygy³KiY Kiv †nvK bv †Kb| cieZ©x‡Z †h welq¸‡jvi Dci Av‡jvKcvZ Kiv n‡q‡Q †m¸‡jv
ev¯Íem¤§Z Ges mxwgZ m¤ú‡`i †mev‡K‡›`ªi Rb¨ mnRjf¨|

D”PgvÎvi msµgY-gy³KiY (HighLevelDisinfection- HLD)-Gi e¨envi

D”PgvÎvi msµgY-gy³KiY (HLD) e¨vK‡Uwiqv, fvBivm, QÎvK, Ges ciRxex [Parasites] wbwðý K‡i, wKš‘
e¨vK‡Uwiqv GÛ‡¯úvi‡K (Endospore) aŸsm Ki‡Z cv‡i bv hv wU‡Ubvm Ges M¨vm M¨vsMÖxb ‡iv‡Mi KviY|
†÷wijvB‡Rkvb ev RxevYygy³KiY cÖwµqv †h‡nZz e¨vK‡Uwiqvj G‡Ûv‡¯úvi (Bacterial Endospore) mn mKj cÖKvi
AYyRxe (e¨vK‡Uwiqv, fvBivm, QÎvK, ciRxex [Parasites]) aŸsm Ki‡Z cv‡i †m‡nZz ‡hmg¯Í DcKiY ‡hgb m~uP Ges
A‡¯¿vcvPv‡ii hš¿cvwZ †h¸‡jv Pvgovi bx‡P i³ ev †`n Kjvi (Tissue) ms¯ú‡k© Av‡m †m¸‡jv †÷wijvB‡Rkvb ev
RxevYygy³KiY Kiv DwPZ| D”PgvÎvi msµgY-gy³KiY ZLbB e¨envi Kiv DwPZ hLb †KvbI †ówijvB‡Rkb ev
RxevYygy³KiY cÖwµqv mnRjf¨ bq|

D”PgvÎvi msµgY-gy³KiY Kvh©Ki Ki‡Z, cy•Lvbycy•Lfv‡e DcKiYmg~n †_‡K i³, wUm¨y, Ges gqjv cwi®‹vi Kiv
Acwinvh©| KviY GB Dcv`vb¸wj AbyRxe‡K myiÿv cÖ`vb Ki‡Z cv‡i|

dzUv‡bvi gva¨‡g D”PgvÎvi msµgY-gy³KiY (High Level Disinfection by boiling)

DcKiYmg~n‡K dyUv‡bv, D”PgvÎvi msµgY-gy³Ki‡Yi (HLD) me‡P‡q mvaviY cÖwµqv| GUv GKwU mnR D”PgvÎvi
msµgY-gy³KiY c×wZ, †hLv‡b cvwb Ges Zv‡ci Drm Av‡Q Ggb †h †KvbI ¯’v‡b GUv Kiv †h‡Z cv‡i| GB c×wZ
e¨envi K‡i hš¿ Ges Ab¨vb¨ DcKiY GKwU cvÎ ev eqjv‡i ivLv nq, Ges Zvici cvwb dyUšÍ Mig K‡i hš¿ I Ab¨vb¨
DcKiY 30 wgwbU a‡i dyUv‡bv nq|

154 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

dzUv‡bvi gva¨‡g D”PgvÎvi msµgY-gy³Ki‡Yi avcmg~n

1g avc:

†h mKj hš¿cvwZ Ges Ab¨vb¨ DcKiY D”PgvÎvi msµgY-gy³KiY Ki‡Z n‡e, †m¸‡jv cÖ_‡g cwi®‹vi K‡i wb‡Z n‡e|

2q avc

Kâv Av‡Q Ges mshy³ Ggb mKj hš¿cvwZ Ges Ab¨vb¨ DcKiY Ly‡j †dj‡Z n‡e ev hš¿vsk Avjv`v K‡i †dj‡Z n‡e|
Zvici DcKiYmg~n GKwU cvwbfwZ© cvÎ ev K‡›UBbv‡ii g‡a¨ Ggbfv‡e mvwR‡q ivL‡Z n‡e †hb hš¿¸‡jvi Dc‡ii Ask
Kgc‡ÿ GK (01) Bw cwigvY cvwbi wb‡P Wy‡e _v‡K|

3q avc

cvÎwU XvKbv w`‡q †X‡K w`‡Z n‡e ev eqjv‡ii wjW eÜ K‡i w`‡Z n‡e Ges cvwb dyUv‡bv ïiæ Ki‡Z n‡e|

4_© avc

hLb cvwb dyU‡Z ïiæ Ki‡e, ZLb †_‡K 30 wgwbU ch©šÍ A‡cÿv Ki‡Z n‡e| cvwb dyUvi ïiæ †_‡KB UvBgvi ev MYbvi
gva¨‡g mg‡qi wnmve ivL‡Z n‡e| GB mgq †_‡K †KvbI cvwb, hš¿cvwZ ev Ab¨ †KvbI DcKiY cv‡Î †`qv ev cvÎ †_‡K
Zy‡j †bqv hv‡e bv| Gici †_‡K cv‡Îi XvKbv wKsev eqjv‡ii wjW miv‡bv hv‡e bv|

5g avc

Zvc Kwg‡q w`‡Z n‡e †hb cvwb kvšÍ _v‡K wKš‘ Zv dyU‡Z _vK‡e| AwZwi³ dyUv‡j cvwb ev®úxf~Z n‡q †h‡Z cv‡i Ges
hš¿cvwZ I Ab¨vb¨ DcKi‡Yi ¶wZ Ki‡Z cv‡i ev DcKiYmg~n cv‡Îi †`qv‡j AvNvZ Ki‡Z cv‡i| Zvc Kwg‡q w`‡j
R¡vjvbx ev we`¨y‡ZiI mvkÖq nq|

6ô avc

30 wgwbU ci, D”PgvÎvi RxevYygy³ wjdUvi/di‡mc w`‡q (muvovwk, wPgUv) hš¿cvwZ Zz‡j Av‡iKwU D”PgvÎvi msµgYgy³
†U« ev cv‡Î (mvwR©K¨vj Wªvg) ivL‡Z n‡e hv n‡e †cvKvgvKo, a~jv †_‡K `~‡i| e¨envi ev msi¶Y Kivi Av‡M RxevYygy³
hš¿cvwZ/ DcKiYmg~n evZv‡m ïKv‡Z n‡e| dyUv‡bv hš¿cvwZ Ges DcKiYmg~n KLbB dzUv‡bv cvwb‡Z ivLv hv‡e bv KviY
VvÐv n‡q †M‡jB †m¸‡jv Avevi msµwgZ n‡q †h‡Z cv‡i|

7g avc

hš¿cvwZ Ges DcKiYmg~n `ªæZ e¨envi K‡i †dj‡Z n‡e ev D”PgvÎvi msµgYgy³ I ïK‡bv cv‡Î ivL‡Z n‡e Ges 24
NÈvi g‡a¨B e¨envi Ki‡Z n‡e| hš¿msiÿ‡Yi cv‡Î hš¿mg~‡ni e¨env‡ii †gqv` wj‡L ivLyb (dzwU‡q D”PgvÎvq RxevYygy³
Kivi ci 24 NÈvi g‡a¨ e¨envi Ki‡Z n‡e)|

g‡b ivL‡eb

†h Dcv‡qB RxevYygy³KiY Kiv †nvK bv †Kb, †KvbI hš¿cvwZB (wjdUvi, ¯‹¨vj‡cj, †eøW, KuvwP, †mjvB‡qi mu~P BZ¨vw`)
KLbIB m¨vfjb ev †KvbI Gw›U‡mcwUK I wWm&Bb‡dK‡U›U `ªe‡Y Wywe‡q ivLv hv‡e bv| memgqB †m¸‡jv ïK‡bv Ae¯’vq
msiÿY Ki‡Z n‡e| Gw›U‡mcwUK I wWm&Bb‡dK‡U›U `ªe‡Y RxevYy †eu‡P _vK‡Z Ges msµgY Qov‡Z cv‡i| Gw›U‡mcwUK
`ªeY g~jZ ˆZwi Kiv nq RxweZ Z¡K I wgDKvm †gg‡eª‡bi RxevYy aŸsm Kivi Rb¨, GUv Ro c`v‡_©i Dci †KvbI KvR
K‡i bv|

hw` †KvbI RxevYygy³ hš¿cvwZ ayjv, KxUcZ½ A_ev †KvbI msµwgZ e¯‘ ev e¨w³i ms¯ú‡k© Av‡m A_ev †Lvjv Ae¯’vq
_v‡K Z‡e †mUv msµwgZ nq ev n‡e| msµwgZ nIqvi GB D”P Avk¼vi Rb¨ RxevYygy³ e¯‘¸‡jv Lze `ªæZ e¨envi Kiv
DwPZ A_ev mwVKfv‡e msiwÿZ ivLv DwPZ| RxevYygy³KiY A_ev D”PgvÎvq RxevYygy³KiY cÖwµqvRvZ cvÎ RxevYygy³
Kivi ci 24 NÈvi †ewk mgq e¨envi Kiv DwPZ bq|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 155

 e¨envi ev msiÿY

RxevYygy³ hš¿cvwZ hv‡Z cybivq msµwgZ bv n‡q c‡o †m‡nZz cÖwµqvRvZKi‡Yi ciciB e¨envi Kiv †kÖq| mwVK
cwi®‹viKiY, D”PgvÎvi msµgYgy³KiY,†÷wijvB‡Rkvb ev RxevYygy³Ki‡Yi g‡ZvB mwVKfv‡e msiÿY Kiv AwZ
¸iæZ¡c~Y©| hw` hš¿cvwZmg~n mwVKfv‡e msiÿY Kiv bv nq, Zvn‡j cÖwµqvRvZKi‡Yi mv‡_ m¤úwK©Z mKj D‡`¨vM I
mieivn e¨_© n‡e Ges hš¿cvwZ¸‡jv cybivq msµwgZ n‡e|

cÖwµqvRvZKiY GjvKv cÖwZôvq civgk©

l msµwgZ hš¿cvwZ RxevYygy³Ki‡Yi ¸iæZ¡ m¤ú‡K© †K‡›`ªi Rbej‡K Rvbv‡bv Ges Abykxj‡b Af¨¯Í Kiv
l GKwU Kÿ‡K cÖwµqvRvZKiY GjvKv wn‡m‡e wbw`©ó Kiv Ges †j‡ewjs Kiv
l ayjv-evwj I †cvKv-gvKo `~‡i ivLvi Rb¨ cÖwµqvRvZKiY Kÿ‡K Av”Qbœ K‡i ivLv|
l m¤¢e n‡j `yBwU †ewmb ev wms‡Ki e¨e¯’v ivLv (GKwU cwi®‹vi Kivi Rb¨ I Ab¨wU cÖevngvb cvwb‡Z †avqvi)
l cwi®‹vi, RxevYygy³ hš¿cvwZ Ges Ab¨vb¨ `ªe¨vw` `iRvmn Zv‡K msiÿY Ki‡Z n‡e hv‡Z a~jv-gqjv BZ¨vw` †gvo‡Ki
Dci bv c‡o|

RxevYygy³KiY (Sterilization)

†÷wijvB‡Rkb ev RxevYygy³Ki‡Yi c~‡e© DcKiYmg~n †gvov‡bv

ïK‡bv Ges ev®úxq c×wZ‡Z †÷wijvB‡Rkb ev RxevYygy³Ki‡Yi c‡e© DcKiYmg~n †gvo‡K Av”Qvw`Z Ki‡j cybivq
e¨env‡ii Av‡M msµwgZ nIqvi m¤¢vebv Kg _v‡K|

ev®úxq c×wZ‡Z RxevYygy³KiY/ A‡Uv‡K¬wfs (Steam Sterilization/Autoclaving)

†÷wijvB‡Rk‡bi cÖPwjZ c×wZ mg~‡ni g‡a¨ †mev‡K›`ª¸‡jv‡Z hš¿cvwZ I Avbylvw½K miÄvgvw` RxevYygy³Ki‡Yi Rb¨
A‡Uv‡K¬wfs c×wZ e¨eüZ nq| ev®úxq c×wZ‡Z RxevYygy³Ki‡Yi Rb¨ Av`©ªZvc I Pv‡ci cÖ‡qvRb, ZvB Zvc Ges cvwb
Df‡qiB cÖ‡qvRb nq| A‡Uv‡K¬f †gwk‡bi ai‡bi Dci wbf©i K‡i Zvc Kxfv‡e cvIqv hv‡e (we`¨yr, †K‡ivwmb, M¨vm
BZ¨vw` R¡vjvwb)|

ev®úxq c×wZ‡Z RxevYygy³KiY c×wZi avcmg~n

1g avc

†h mKj hš¿cvwZ Ges Ab¨vb¨ DcKiY RxevYygy³KiY Ki‡Z n‡e, †m¸‡jv‡K cÖ_‡g cwi®‹vi Ges ïwK‡q wb‡Z n‡e|

2q avc

Kâv Av‡Q Ges mshy³ Ggb mKj hš¿cvwZ Ges Ab¨vb¨ DcKiY Ly‡j †dj‡Z n‡e ev hš¿vsk Avjv`v K‡i †dj‡Z n‡e|
A‡Uv‡K¬f AwZwi³ DcKiY w`‡q VvmvVvwm Kiv hv‡e bv| hv cÖwZwU DcKi‡Yi cvk w`‡q ev®ú cÖevwnZ n‡Z w`‡e bv Ges
ev®ú hš¿cvwZi mKj Z‡j mgfv‡e †cuŠQv‡Z cvi‡e bv|

3q avc

RxevYygy³Ki‡Yi c~‡e© †h mKj hš¿cvwZ †gvoK Øviv Av”Qvw`Z Ki‡Z n‡e †m¸‡jv `yB¯Í‡ii KvMR, wbDR †ccvi, mywZi
Kvco Øviv fv‡jvfv‡e gywo‡q wb‡Z n‡e| †h mKj hš¿cvwZi wewfbœ Ask †Lvjv hvq †m¸‡jv Ly‡j w`‡Z n‡e| AvU©vwi
di‡mc I Ab¨vb¨ di‡m‡ci K¨vP Ly‡j ivL‡Z n‡e| hš¿cvwZ¸‡jv mvwR©K¨vj Wªv‡g XywK‡q Wªv‡gi Rvbvjv Ly‡j w`‡Z n‡e|
A‡Uv‡K¬f AwZwi³ DcKiY w`‡q VvmvVvwm Kiv hv‡e bv|

4_© avc

mKj c¨v‡KU, Wªvg, †gvoKwenxb wRwbm (†hgb : j¨ve‡iUwii Kuv‡PicvÎ, Zij mn‡evZj) A‡Uv‡K¬‡fi †P¤^v‡i Ggbfv‡e
mvRv‡Z n‡e †hb ev®ú Aev‡a Pj‡Z cv‡i hv‡Z ev®ú DcKiY mg~‡ni mKj Z‡j mgfv‡e †cuŠQv‡Z cv‡i|

156 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

5g avc

†h‡nZz wewfbœ ai‡bi A‡Uv‡K¬f Av‡Q †m‡nZz GB cwi”Q‡` Avjv`v Avjv`vfv‡e wb‡`©kbv †`qv m¤¢e bq| ZvB wbw`©ó
A‡Uv‡K¬‡fi Rb¨ Drcv`bKvix cÖwZôv‡bi wb‡`©kbv AbymiY Kiv DwPZ| Z‡e mvaviYfv‡e †gvoKK…Z `ªe¨vw` 30 wgwbU Ges
†gvoKwenxb `ªe¨vw` 20 wgwbU a‡i 1210 †mjwmqvm Zvc I cÖwZeM© Bw‡Z 15 cvDÛ Pv‡c (106 kPa) RxevYygy³ Ki‡Z
nq| (A‡Uv‡K¬f Kvg¨ Zvc I Pv‡c bv †cuŠQv‡j mgq MYbv ïiæ Kiv hv‡ebv| hw` cÖwµqvi mgq MYbv Ki‡Z Avcwb fy‡j
hvb Z‡e hLb g‡b n‡e ZLb †_‡K mgq MYbv Ki‡Z n‡e|)

`ªóe¨: A‡Uv‡K¬‡fi †cÖmvi gvcvi h‡š¿ (Pressure Gauge) †h GKK e¨envi Kiv nq Zv wewfbœ †gwk‡b wewfbœ iKg n‡Z
cv‡i| wb‡P †`qv cwigvc †gvUvgywU fv‡e A‡Uv‡K¬‡fi Rb¨ Kvg¨Ñ cÖwZeM© Bw‡Z 15cvDÛ (15cvDÛ/BwÂ2, 106
wK‡jvcvmKjm (106 kPa), 1 GUg (1 GU‡gvmwdqvi), cÖwZeM ©†mw›UwgUv‡i 1 wK‡jvMÖvgej (1wK‡jvMÖvgej/‡mw›UwgUvi2),
776 wgwjwgUvi Ae gviKvwi|

6ô avc

hw` A‡Uv‡K¬f †gwkb ¯^qswµq nq, Zvn‡j RxevYygy³KiY cÖwµqv †kl n‡j Zvc eÜ n‡q hv‡e Ges Pvc Kg‡Z _vK‡e|
hw` A‡Uv‡K¬f †gwkb ¯^qswµq bv nq, Z‡e †gvoKK…Z `ªe¨vw` _vK‡j 30 wgwbU ci I †gvoKwenxb `ªe¨vw` _vK‡j 20 wgwbU
ci Zv‡ci Drm eÜ Ki‡Z n‡e| Pvc ev †cÖmvi gvcvi h‡š¿ (PressureGauge) Ô0ÕcÖ`k©b Kivi ci A‡Uv‡K¬f †gwk‡bi
wjW ev XvKbv Lyj‡Z n‡e| cy‡ivcywi ïKv‡bvi Rb¨ hš¿cvwZi c¨v‡KU¸‡jv A‡Uv‡K¬‡f †i‡L w`‡Z n‡e (m‡e©v”P 30 wgwbU)|
`ªóe¨: mKj c¨v‡KU ïK‡bv Ae¯’vq †ei Ki‡Z n‡e Ab¨_vq cybivq msµg‡Yi SuywK _v‡K|

7g avc

Ave…Z DcKiYmg~n A‡Uv‡K¬f †_‡K miv‡bv| hw` DcKiYmg~n A‡Uv‡K¬‡f Abve…Z Ae¯’vq ¯’vcb Kiv nq Zvn‡j,
DcKiYmg~n‡K miv‡Z RxevYygy³ wjdUvi e¨envi Kiæb| ev‡®úi Nbxfeb cÖwZ‡iva Kivi Rb¨ c¨v‡KU ev Wªvg KvMR ev
Kvco †`qv †Kvb Z‡j VvÐv bv nIqv ch©šÍ †i‡L w`‡Z n‡e| c¨v‡KU, Wªvg ev Abve…Z DcKiYmg~n K‡ÿi ZvcgvÎvi mgvb
bv nIqv ch©šÍ msiÿ‡Yi Rb¨ Zz‡j ivLv hv‡e bv (G‡Z K‡qK N›Uv mgq †j‡M †h‡Z cv‡i)|

8g avc

wb‡P ewY©Z c×wZ Abyhvqx RxevYygy³ DcKiYmg~n msiÿY Ki‡Z n‡e:

Av`k© msiÿ‡Yi Rb¨ RxevYygy³ c¨v‡KU¸‡jv e× Avjgvix ev †Kwe‡b‡U ivLv hv‡e †hLv‡b †jvKR‡bi hvZvqvZ Kg,
ZvcgvÎv mnbkxj, evZv‡mi Av`ª©Zv Kg ev AvenvIqv †gvUvgywU ïK‡bv| hw` c¨v‡K‡Ui RxevYygy³ Ae¯’v m¤ú‡K© †KvbI
m‡›`n _v‡K Z‡e c¨v‡KU msµwgZ e‡j we‡ePbv Ki‡Z n‡e Ges cybivq RxevYygy³ Ki‡Z n‡e|

Zzjvi ej KvMR, ¯úÄ-Gi gZ DcKiY hLb Wªv‡g RxevYygy³ Kiv nq ZLb msµwgZ nevi SuywK †ewk KviY Wªvg ev‡i ev‡i
†Lvjv I eÜ Kiv nq I cÖwZeviB wKQz bv wKQz bv †ei Kiv nq| hw` GB ai‡Yi DcKiY GBfv‡eB RxevYygy³ Ki‡Z nq
Zvn‡j †QvU †QvU Wªvg e¨envi Kiv DwPZ Ges msµgY cÖwZ‡iv‡a NbNb RxevYygy³KiY Kiv DwPZ| hš¿cvwZmg~n Aek¨B
RxevYygy³KiY cÖwµqv †kN nIqvi ci n‡Z 24 NÈvi g‡a¨B e¨envi Ki‡Z n‡e| 24 NÈv ci hš¿cvwZmg~†ni
RxevYygy³KiY eRvq _v‡K bv weavq e¨en†ii c~‡e© hš¿cvwZmg~n c~bivq RxevYygy³ K‡i wb‡Z n‡e|

Abve„Z RxevYygy³ DcKiYmg~n mv‡_ mv‡_ e¨envi Kiv DwPZ Ab¨_vq XvKbvhy³ ïK‡bv RxevYygy³ cv‡Î msiÿY Ki‡Z
n‡e|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 157

 RxevYygy³Ki‡Yi Kvh©KvwiZv cwiexÿY (Monitoring)

RxevYygy³Ki‡Yi Kvh©KvwiZv gwbUwis ev cwiexÿ‡Yi Rb¨ wZbwU c×wZ Av‡Q -

l hvwš¿K wb‡`©kK (Mechanical Indicators); GB ai‡bi wb‡`©kK¸‡jv RxevYygy³Ki‡Yi h‡š¿i †iK‡W©i Ask hv
cÖwµqv PjvKv‡j mgq, Zvc I Pv‡ci cwigvY BZ¨vw` ch©‡eÿY Kiv hvq|
l ivmvqwbK wb‡`©kK (Chemical Indicators) Gi g‡a¨ Av‡Q:
- `vMhy³ †Uc †hUv Kvg¨ ZvcgvÎvq †cuŠQv‡j is cwieZ©b K‡i
- Kuv‡Pi wUD‡ei g‡a¨ ÿz`ª ewo _v‡K hv M‡j †M‡j eySv hvq †h A‡Uv‡K¬‡fi Kvg¨ ZvcgvÎvq cÖwµqvwU m¤úbœ n‡q‡Q|
l ˆRweK wb‡`©kK (Biological Indicators)
†÷wijvB‡Rkvb ev RxevYygy³KiY n‡q‡Q wK bv Zv wbY©‡qi Rb¨ GB ai‡bi wb‡`©kK Zvc‡ivax e¨vK‡Uwiqvj
G‡Ûv‡¯úvi (Heat Resistant Bacterial Endospore) e¨envi K‡i|

mycvwikK…Z cwiexÿY (Monitoring) c×wZ

l A‡Uv‡K¬f w`‡q RxevYygy³ Kivi ci jMey‡K mKj Z_¨ (Kxfv‡e RxevYygy³ Kiv n‡”Q Zvi Dci wbf©i K‡i ïaygvÎ
ZvcgvÎv, Pvc, mgq A_ev wZbwUB) †jLv|
l †h c×wZ‡Z Zvc I ev‡®úi cÖ‡qvRb nq †m c×wZi Rb¨ c¨v‡K‡Ui wfZi I evwn‡i Zvc-Pvc ms‡e`bkxj wb‡`©kK
(Heat-Pressure Sensitive Indicators) e¨envi Kiv|
l ˆRweK wb‡`©kK (Biological Indicators) w`‡q mvßvwnKfv‡e cwiexÿY Kiv|
l hw` ivmvqwbK `ªe¨ e¨envi Kiv nq Zvn‡j †÷wijvB‡Rkvb ev RxevYygy³Ki‡Yi Av‡M Zi‡ji Kvh©KvwiZv wbY©‡q GKUv
wb‡`©kK e¨envi Kiv DwPZ Ges cÖ‡qvR‡b ZijwU cwieZ©b Kiv DwPZ|

nvDRwKwcs Ges eR©¨ e¨e¯’vcbv

nvDR wKwcs ej‡Z †g‡S, †`qvj, hš¿cvwZ, AmevecÎmn nvmcvZv‡ji ev ¯^v¯’¨‡K‡›`ªi ¯^vfvweK cwi”QbœZv eySvq|
Z`ycwi, Gi Øviv ¯^v¯’¨‡K‡›`ªi RxevYymsL¨v Kgv‡bv Ges Kvh©‡ÿ·K Kv‡Ri Rb¨ MÖnY‡hvM¨ Kivi wbwg‡Ë mvaviYfv‡e
cwi®‹vi-cwi”Qbœ Kiv Ges Zv eRvq ivLv hvq|

nvmcvZvj Ges ¯^v¯’¨‡K‡›`ª Drcvw`Z e‡R©¨i (KvMR, Dw”Qó Lvevi, c¨v‡KU, AveR©bv BZ¨vw`) g‡a¨ †ewki fvM eR©¨B
AmsµvgK Ges hviv eR©¨ bvovPvov K‡i Zv‡`i Rb¨ †gv‡UI SuywKc~Y© bq| GB mg¯Í eR©¨ ¯^vfvweK e¨e¯’vcbvi gva¨‡gB
AcmviY Kiv hvq| wKQz eR©¨ msµwgZ _v‡K †h¸‡jv mwVKfv‡e AcmviY bv Ki‡j mswkøó †jv‡Ki g‡a¨ msµwgZ nIqvi
SuywK _v‡K| i³, Ab¨vb¨ †`nim, DcKiYmg~n †h¸‡jv Gm‡ei ms¯ú‡k© Av‡m (†hgb e¨enƒZ †Wªwms) BZ¨vw` msµwgZ
e‡R©¨i g‡a¨ c‡o| †mRb¨ msµwgZ eR©¨ Avjv`vfv‡e AcmviY Ki‡Z n‡e (m¤¢e n‡j cywo‡q †dj‡Z n‡e)| aviv‡jv eR©¨
wQ`ª-‡ivax cv‡Î (Puncture-proof container) ivL‡Z n‡e Ges `yB-Z…Zxqvsk c~Y© n‡jB cywo‡q †dj‡Z n‡e|

GKwU ¯^v¯’¨‡K‡›`ªi mvaviY cwi®‹vi-cwi”QbœZv H †K‡›`ªi Kg©x Ges †mevMÖnxZv, `k©bv_©x Ges we¯Í…Z cwim‡i KwgDwbwUi
¯^v‡¯’i Rb¨ AwZ ¸iæZ¡c~Y©| mwVK nvDRwKwcs Ges eR©¨ e¨e¯’vcbv Kvh©Kix msµgY cÖwZ‡iv‡ai g~j wfwË| nvDRwKwcs
Ges eR©¨ e¨e¯’vcbvi mv‡_ RwoZ mKj Kg©x msµg‡Yi SuywK‡Z _v‡K †Kbbv Zv‡`i‡K me mgq Zv‡`i Kv‡Ri Ask wn‡m‡e
i³, wewfbœ †`nim, e¨enƒZ aviv‡jv e¯‘, Ab¨vb¨ msµwgZ e¯‘ BZ¨vw`i ms¯ú‡k© Avm‡Z nq| †K‡›`ªi e¨e¯’vcbv GKwU
cwi®‹vi-cwi”Qbœ Zvi wkwWDj ˆZwi Ki‡e Ges †K‡›`ª Szwj‡q †`‡e hv‡Z mevB Zv †`L‡Z cvq Ges wkwWDjwU wVKgZ gvbv
n‡”Q Zv wbwðZ Ki‡Z cvi‡e|

158 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

 ÷¨vÛvW© 20: gv I beRvZ‡Ki ¯^v¯’¨‡mev cÖ`vbKvix mKj ¯^v¯’¨Kg©x Ges Zv‡`i mn‡hvMx mKj Kg©x (cwi”QbœKg©x)
Aek¨B mycvwikK…Z eR©¨ e¨e¯’vcbv AbymiY I Abykxjb Ki‡eb|

mvaviY nvDRwKwcs-Gi wb‡`©wkKv

hw`I †KvbI †KvbI †ÿ‡Î we‡kl ai‡bi nvDR wKwcs-Gi cÖ‡qvRb nq, wb‡P ewY©Z wj÷wU †K‡›`ªi †h †KvbI ¯’v‡bi Rb¨
cÖ‡hvR¨ n‡e|
l cwi®‹vi Kivi mgq nv‡Z Møvfm cwiavb Kiæb (we‡klZ cyiæ BDwUwjwU Møvfm)
l ay‡jv Ges AYyRx‡ei we¯Ívi Kgv‡Z ﮋ Svov ev †gvQvi cwie‡Z© GKwU Av`©ª ev †fRv Kvco e¨envi K‡i †`qvj, †g‡S,
Ges wRwb‡mi DcwifvM gy‡Q †djyb
l cwi®‹vi Kivi mgq Nlv gvRv Kiæb †Kbbv GwU gqjv I RxevYy `~i Kivi Rb¨ me‡P‡q Kvh©Ki Dcvq
l cwi®‹vi Kivi mgq †`qvj Dci †_‡K wbP ch©šÍ †aŠZ Kiæb hv‡Z gqjv wb‡P c‡o Ges wb‡P ch©šÍ cwi®‹vi Kiv hvq|
Dc‡ii wRwbmwU Av‡M cwi®‹vi Kiæb Ges ch©vqµ‡g wb‡P bvgyb Ñ †hgb cÖ_‡g wmwjs, evwZ, Zvici ZvK, Zvici
†Uwej, Ges me‡k‡l †g‡S | cwi®‹vi Kivi `ªeYwU gqjv g‡b n‡jB cwieZ©b Kiæb, KviY `ªeY †ewk gqjv n‡j Zv
msµvgK AYyRxe wbg©~j Ki‡Z cv‡i bv|

cwi®‹vi Kivi Rb¨ e¨eüZ `ªeY

¯^v¯’¨‡K‡›`ª wZb ai‡bi `ªeY e¨envi Kiv nq Ges †KvbI ai‡bi `ªeY Kxfv‡e e¨envi Ki‡Z nq Zv m¤ú~Y©iƒ‡c eySv
nvDRwKwcs-Gi mv‡_ RwoZ Kg©xi Rb¨ AZ¨vek¨K|
l mvaviY wWUvi‡R›U Ges cvwb (Plain detergent and water)
l RxevYybvkK (†hgb 0.5% †K¬vwib `ªeY, wdbvBj/ jvBRj `ªeY) (Disinfectant)
l RxevYybvkK cwi®‹viK `ªeY (Disinfected Cleaning Solution)

KZevi cwi®‹vi Ki‡Z n‡e I c×wZ wK n‡e

Kg SyuwKc~Y© GjvKv (I‡qwUs iæg, cÖkvmwbK GjvKv): GB GjvKv mvaviYZ †KvbI ai‡bi AYyRxe Øviv msµwgZ nq bv
Ges msµg‡Yi SuywK AwZ bMY¨| evwo‡Z †hfv‡e cwi®‹vi-cwi”QbœZv eRvq ivLv nq, GB mg¯Í GjvKvi Rb¨ †mfv‡eB
h‡_ó| wWUvi‡R›U Ges cvwb‡Z †fRv‡bv GKwU Kvco ev Kvc‡oi UzKiv w`‡q cÖwZ mßv‡n GKevi cwi®‹vi Kiv (ev AviI
Nb Nb hw` gqjv †`Lvq) h‡_ó|

Uq‡jU, †jwUªb, ¯øyBm iæg

GB GjvKv¸‡jv AwZgvÎvq msµwgZ _v‡K Ges cÖwZw`b AšÍZ GKevi cwi®‹vi Kiv DwPZ| hw` †K‡›`ª †ivMxi msL¨v †ewk
_v‡K Zvn‡j AviI †ewkevi cwi®‹vi Kiv DwPZ| †ivMx‡`i †mev cÖ`v‡bi GjvKvq †h ai‡bi DcKiY w`‡q cwi®‹vi Kiv
nq, GLv‡bI GKB ai‡bi DcKiY e¨envi Kiv h‡_ó bq|

D”P SuywKc~Y© GjvKvmg~n

D”P SuywKc~Y© GjvKv n‡jv- wPwKrmv cÖ`v‡bi Kÿ, wi‡Kvfvwi Kÿ, Acv‡ikb cieZ©x Kÿ, hš¿cvwZ cÖwµqvRvZKiY GjvKv,
†ivMxi cixÿv kh¨v, DcKiY Uªwj Ges Uq‡jU AšÍf©y³|
l 0.5% †K¬vwib `ªeY w`‡q i³ ev kixi †_‡K cov Zij Øviv `„k¨Z `~wlZ RvqMvwU cwi®‹vi Kiæb
l †Kvb wKQz w`‡q aywjKYv gy‡Q ïwK‡q †dj‡eb bv ev cwi®‹vi Kivi †Póv Ki‡eb bv; KviY Gfv‡e ay‡jv Ges ÿz`ª RxevY~
Qwo‡q c‡o
l †ivMxi cixÿv kh¨v 0.5% †K¬vwib `ªeY e¨envi K‡i cwi®‹vi Ki‡eb Ges wgkÖYwU cÖwZw`b cvëv‡Z n‡e
l h‡š¿i Uªwj¸wj I †ivMxi Uªwj cwi®‹vi Kivi Rb¨ 0.5% †K¬vwib `ªeY e¨envi Kiæb hv cÖwZw`bB cwieZ©b Ki‡Z n‡e|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 159

 eR©¨ e¨e¯’vcbv

¯^v¯’¨‡K‡›`ª †_‡K Drcvw`Z e‡R©¨i e¨e¯’vcbv

cÖ‡Z¨K ¯^v¯’¨Kg©xi KZ©e¨ Ggbfv‡e eR©¨ AcmviY Kiv hv‡Z †m¸‡jv †_‡K †mevMÖnxZv, `k©bv_©x, Ab¨vb¨ ¯^v¯’¨ Kg©xi
msµwgZ nevi SuywK Lye Kg _v‡K|

¯^v¯’¨ †K‡›`ª Pvi ai‡Yi eR©¨ Drcvw`Z nq t

1. aviv‡jv eR©¨
2. aviv‡jv bq wKš‘ msµwgZ eR©¨
3. aviv‡jv bq I AmsµwgZ eR©¨ (mvaviY eR©¨)
4. wec¾bK ev SuywKc~Y© eR©¨

e‡R©¨i Dr‡mi Kv‡QB aib ey‡S e‡R©¨i †kÖwYKiY (Sorting) Ki‡Z n‡e hv‡Z cÖ‡Z¨K aibB mwVKfv‡e AcmviY Kiv
hvq| GUv g~j¨ mvkÖqx Ges cwi”QbœZv Kg©x I KwgDwbwUi g‡a¨ msµg‡Yi SuywK eûjvs‡k n«vm K‡i| GKwU gvSvwi ai‡bi
e¨¯Í ¯^v¯’¨‡K‡›`ª Drcvw`Z †ewki fvM eR©¨ AmsµvgK| hw` †K›`ª e‡R©¨i †kÖwYKiY bv K‡i Z‡e mKj eR©¨B msµvgK e‡j
we‡ePbv Ki‡Z n‡e| GUv e¨qeûj Ges eR©¨ AcmviY A‡bK †ewk KwVb n‡q hvq †Kbbv ZLb m¤ú~Y© eR©¨ msµvgK ev
AmsµvgK ev aviv‡jv ev aviv‡jv bq we‡ePbvq bv wb‡q cy‡ivUv nq gvwU‡Z cuy‡Z ev Av¸‡b cywo‡q †dj‡Z nq A_ev wbw`©ó
RvqMvq wb‡q wM‡q AcmviY Ki‡Z n‡j cwienb LiP A‡bK †e‡o hvq|

1. aviv‡jv eR©¨

e¨enƒZ ev Ae¨enƒZ muyB (nvB‡cvWviwgK, myPvi), ¯‹vj‡cj †eøW (Scalpel Blade), †U÷wUDe, wc‡cU, Ges Ab¨vb¨
Kuv‡Pi wRwbm (†hgb: Kuv‡Pi ¯øvBW, Kvfvi w¯øc), G¤úyj, fvqvj BZ¨vw` aviv‡jv e‡R©¨i AšÍf©~³|

aviv‡jv eR©¨ AcmviY

msµwgZ aviv‡jv e‡R©¨i mwVK e¨e¯’vcbv I AcmviY bv n‡j KwgDwbwU‡Z msµgY we¯Ív‡ii SuywK A‡bK †ewk|
aviv‡jv eR©¨ Acmvi‡Yi mgq AbvûZ AvNvZ ev RLg Gov‡Z n‡j:
l Lye cÖ‡qvRb bv n‡j wmwi‡Ä cybivq K¨vc ev XvKbv (Cap) jvMv‡bv hv‡e bv
l muyB euvKv‡bv, KvUv ev fv½v hv‡e bv
l Acmvi‡Yi c~‡e© wmwiÄ †_‡K muyB miv‡bv hv‡e bv
l Acmvi‡Yi mgq aviv‡jv eR©¨ wQ`ª-‡ivaxcv‡Î (Puncture-proof container) ivL‡Z n‡e, †hgb: avZzi cvÎ,
†gvUv KvW©‡ev‡W©i e• A_ev Lvwj cøvw÷‡Ki cvÎ
l aviv‡jv eR©¨ Acmvi‡Yi mgq BDwUwjwU Møvfm cwiavb Ki‡Z n‡e

aviv‡jv eR©¨ Acmvi‡Yi Rb¨ cvÎ

Acmvi‡Yi mgq aviv‡jv eR©¨ wQ`ª-‡ivaxcv‡Î (Puncture-proof container) ivL‡Z n‡e| wQ`ª-‡ivaxcvÎ
(Puncture-proof container) evRv‡i evwYwR¨Kfv‡e cvIqv hvq| A_ev cÖ‡qvR‡b †gvUv KvW©‡ev‡W©i e• Lvwj
cøvw÷‡Ki cvÎ, avZzicvÎ BZ¨vw` w`‡q ˆZwi K‡i †bqv †h‡Z cv‡i| †mev‡K‡›`ªi †h mg¯Í RvqMvq aviv‡jv hš¿cvwZ e¨enƒZ
nq †m mg¯Í RvqMvq wQ`ª-‡ivaxcvÎ (Puncture-proof container) ivL‡Z n‡e| †hgb: †h K‡ÿ Bb‡RKkvb †`Iqv
nq, †mev`vb Kÿ, Acv‡ikb w_‡qUvi (Operation Theater), cÖme ev †Wwjfvwi Kÿ, Ges j¨ve‡iUwi|

2. aviv‡jv bq wKš‘ msµwgZ eR©¨

†ivMwbY©©q (Diagnosis), wPwKrmv (Treatment), wUKv`vb (Immunization) BZ¨vw`i mgq Drcvw`Z wewfbœ `ªe¨mn
i³, i³RvZ cY¨, Ab¨vb¨ †`nim, i³ ev †`nim msewjZ e¨vb‡WR, mvwR©K¨vj ¯úÄ, mvwR©K¨vj I cixÿvi Rb¨ Møvfm&,
†`n Kjv (BodyTissue), gvbe †`‡ni Ask we‡kl BZ¨vw` aviv‡jv bq wKš‘ msµwgZ Ggb ai‡i e‡R©¨i AvIZvfz³|

160 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

 aviv‡jv eR©¨ Acmvi‡Yi Rb¨ wb‡`©wkKv
l e¨enƒZ ev Ae¨enƒZ muyB (nvB‡cvWviwgK, myPvi) Ges Ab¨vb¨ aviv‡jv hš¿cvwZ LyeB mZK©Zvi mv‡_I hZ`~i m¤¢e Kg
bvovPvov K‡i AcmviY Kiæb
l wmwi‡Ä cybivq K¨vc ev XvKbv (Cap) jvMv‡bv cwinvi Kiæb Ges †d‡j †`qvi Av‡M G¸‡jv evuKv‡eb bv, fvO‡eb bv,
ev KvU‡eb bv
l e¨env‡ii ci nvB‡cvWviwgK myuP ¯‹vj‡cj †eøW, myPvi) Ges Ab¨vb¨ aviv‡jv hš¿cvwZ wQ`ª-‡ivax cv‡Î (Puncture-
proof container) Awej‡¤^ (A_ev h_vm¤¢e `ªæZ) AcmviY Kiæb
l Aek¨B aviv‡jv eR©¨ Acmvi‡Yi mgq BDwUwjwU Møvfm cwiavb Kiæb
l cybivq e¨envi‡hvM¨ aviv‡jv eR©¨ †hgb KvuwP, †UªvKvi BZ¨vw` cÖwµqvRvZKi‡Yi mgq Aek¨B BDwUwjwU Møvfm cwiavb
Kiæb
l †mev`v‡bi mgq aviv‡jv hš¿cvwZ nvZgy³ Ae¯’vq (Hands-free) †`qv-‡bqv Kiæb

3. aviv‡jv bq I AmsµwgZ eR©¨ (mvaviY eR©¨)

GB ai‡Yi eR©¨ ÿwZKviK bq Ges AvNvZ ev msµg‡Yi SuywK ˆZwi K‡i bv| GUv A‡bKUv N‡ii e‡R©¨i gZB| KvMR,
ev·, cøvwó‡Ki †evZj-cvÎ, Lvev‡ii Dw”Qó, †Vv½v BZ¨vw` aviv‡jv bq I AmsµwgZ Ggb ai‡bi e‡R©¨i AvIZvfz³|

4. wec¾bK ev SuywKc~Y© eR©¨

gvivZ¥K `~wlZ I welv³ `ªe¨vw` GB ai‡bi e‡R©¨i AvIZvfz³| †hgb cwi®‹viK cY¨, RxevYybvkK cY¨, †gqv‡`vËxY© Jla,
cixÿvMvi ev j¨ve‡iUwii wewfbœ weKviK (Reagents), †Kvl-weaŸsmx Jla (Cytotoxic Drug), †ZRw®Œq
(Radioactive) c`v_© BZ¨vw` GB ai‡bi e‡R©¨i AvIZvfz³|

eR©¨ Acmvi‡Yi cwiKíbv cÖYqb:

nvmcvZvj, Wv³v‡ii †P¤^vi, †nj&_ †cv÷ BZ¨vw` †QvU-eo hvB †nvK bv †Kb cÖwZwU ¯^v¯’¨‡K‡›`ªi Rb¨ GKwU wjwLZ eR©¨
AcmviY cwiKíbv Ges mvwe©K mgš^‡qi Rb¨ GKRb wb‡ew`Z Kg©x _vK‡Z n‡e| mwVKfv‡e eR©¨ Acmvi‡Yi Rb¨
cwiKíbvwU‡Z Kg©x‡`i g‡a¨ mywbw`©ófv‡e `vwqZ¡eÈb Kiv _vK‡Z n‡e hv‡Z mKj Kg©x wb‡Ri `vwqZ¡-KZ©e¨ m¤ú‡K©
IqvwKenvj _v‡Kb I Z`vbyhvqx `vwqZ¡¡cvjb Ki‡Z cv‡ib|

1. c„_KxKiY /†kÖwYKiY (Sorting/ Segregation)

GKwU ¯^v¯’¨‡K‡›`ª †h cwigvY eR©¨ Drcvw`Z nq Zvi wKQz Ask aviv‡jv I msµwgZ ev ÿwZKviK eR©¨, †h¸‡jv Acmvi‡Yi
mgq we‡klfv‡e e¨e¯’v wb‡Z nq hv‡Z cieZ©x‡Z msµgY, AvNvZ BZ¨vw` cÖwZ‡iva Kiv hvq| mwVKfv‡e †gwW‡Kj eR¨©
e¨e¯’vcbv eR¨© mbv³KiY I c„_KxKi‡Yi Dci wbf©i K‡i| eR©¨ c„_KxKiY Kiv bv n‡j Zv eR©¨ e¨e¯’vcbvi cieZx© av‡c
cwi‡kvab c×wZ, AcmviY e¨q eivÏ I mswkøó gvbem¤c‡`i AšÍ©f~w³i Dci mivmwi cÖfve †d‡j|

c„_KxKiY/ †kÖwYKiY (Sorting/Segregation)-Gi Rb¨ wb‡`©kbv

aviv‡jv, aviv‡jv bq wKš‘ msµvgK bq, mvaviY eR©¨, ÿwZKviK eR©¨ BZ¨vw` Dchy³ cv‡Î ivL‡Z n‡e| Dchy³ cvÎ
e¨env‡i Kg©x‡`i mvnv‡h¨i wbwg‡Ë:
- cy‡iv †mev‡K‡›`ª myweavRbK RvqMvq Avjv`vfv‡e eR©¨ msMÖ‡ni Rb¨ cvÎ ivLyb
- iwOb cøvw÷‡Ki cvÎ, iOKiv Wªvg, mn‡R cov hvq Ggbfv‡e cv‡Îi Mv‡q †j‡ej jvMv‡bv BZ¨vw` e¨envi Kiv
hv‡Z mn‡RB wewfbœ ai‡bi eR©¨ mbv³ Kiv hvq| D`vniY¯^iƒc: aviv‡jv bq wKšÍ msµvgK e‡R©¨i Rb¨ jvj ev
njy` i‡Oi cvÎ e¨envi A_ev cvIqv †M‡j jvj ev njy` i‡Oi cwje¨vM e¨envi Kiæb|
- aviv‡jv eR©¨ msMÖ‡ni Rb¨ cvÎwU Ggbfv‡e ivLyb hv‡Z Kg©x‡K e¨enƒZ aviv‡jv eR©¨ †dj‡Z cy‡iv Kÿ Ry‡o nvuU‡Z
bv nq

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 161

 2. eR©¨ bvovPvov (Handling)

cwi”QbœZv Kwg©MY eR©¨ msiÿY I Acmvi‡Yi mgq hZUv m¤¢e Kg bvovPvov Ki‡eb| hZ †ewk eR©¨ bvovPvov Kiv n‡e
ZZ ‡ewk `yN©Ubvi SzuwK| AbvûZ AvNvZ I msµgY cÖwZ‡iv‡ai Rb¨ muyB I Ab¨vb¨ aviv‡jv eR©¨ Acmvi‡Yi mgq we‡kl
mZK©Zv Aej¤^b Kiv DwPZ| wK cwigvY eR©¨ bvovPvov Ki‡Z n‡e Zvi Dci wbf©i K‡i wbivcËvi Rb¨ miÄgvw` e¨envi
Ki‡Z n‡e| †hgb: gv¯‹, BDwUwjwU Møvfm, ivevi/ cøvw÷‡Ki ewne©vm ev G‡cÖvb, MvgeyU BZ¨vw`|

eR©¨ bvovPvov (Handling)-Gi Rb¨ wb‡`©kbv

- hZ Kg m¤¢e eR©¨ bvovPvov Kiv
- eR©¨ msMÖ‡ni cvÎ wKQz Lvwj _vK‡jI ev cÖwZw`b GKevi A¯¿cvPvi Kÿ, †mev`v‡bi Kÿ, ¯øyBmiæg BZ¨vw` RvqMv
†_‡K mwi‡q †dj‡Z n‡e|
- †h cv‡Î †gwWK¨vj eR©¨ msMÖn Kiv n‡q‡Q Zvi †fZ‡i nvZ †`qv hv‡e bv
- †mev`v‡bi Kÿ †_‡K msMÖnxZ eR©¨ †VjvMvwo ev PvKvhy³ Uªwj‡Z Db¥y³fv‡e Lvwj Kiv hv‡e bv| G‡Z Pviw`‡K
gqjv DcwP‡q co‡Z cv‡I, †hLvb †_‡K ¯^v¯’¨‡K‡›`ªi cwi‡ek, †mev`vbKvix, †mevMÖnYKvix, `k©bv_©xmn mevi
msµwgZ nIqvi SuywK †e‡o hvq|

3. eR©¨ AcmviY
AwZwi³ †evSvB e‡R©¨i cvÎ `yN©Ubvi SuywK evovq| eR©¨ msMÖ‡ni cvÎ cy‡iv fwZ© nIqvi Av‡MB A‡¯¿vcPvi Kÿ, †mev`v‡bi
Kÿ, ¯øyBmiæg BZ¨vw` RvqMv †_‡K mwi‡q †dj‡Z n‡e| Kgc‡ÿ cÖwZw`b GKevi cvθ‡jv Lvwj Kiv DwPZ| aviv‡jv
e‡R©¨i cvÎ wZb-PZz_©vsk c~Y© nIqvi c~‡e©B AcmviY Ki‡Z n‡e|

e‡R©¨i mvgwqK msiÿY (Storage)

m¤¢e n‡j, aviv‡jv bq wKš‘ msµvgK Ggb ai‡bi eR©¨ Lye `ªæZZvi mv‡_ P~ovšÍfv‡e AcmviY Ki‡Z n‡e, wKš‘ P~ovšÍ
Acmvi‡Yi Av‡M ¯^v¯’¨‡K‡›`ª mvgwqKfv‡e msiÿY KivB AwaK hyw³hy³| mvgwqK msiÿYvMviwU LyeB ¯^í mg‡qi Rb¨ Ñ
P~ovšÍ Acmvi‡Yi c~‡e© eo‡Rvo K‡qK NÈvi Rb¨ eR©¨ GLv‡b msiÿY Kiv †h‡Z cv‡i| aviv‡jv bq wKš‘ msµwgZ Ggb
ai‡bi eR©¨ †KvbI Ae¯’v‡ZB †mev‡K‡›`ª GK †_‡K `yB w`‡bi †ewk msiÿY Kiv hv‡e bv| Mi‡gi w`‡b GB ai‡bi eR©¨
24 NÈvi †ewk msiÿY Kiv hv‡e bv| P~ovšÍ Acmvi‡Yi c~‡e© hw` aviv‡jv I msµwgZ eR©¨ †mev‡K‡›`ª msiÿY Ki‡Z nq
Z‡e, wQ`ªwenxb, †j‡ej jvMv‡bv, XvKv †KvbI cv‡Î eR©¨¸‡jv XzwK‡q Kg©x, †ivMx, `k©bv_©x BZ¨vw`i Dcw¯’wZ Kg Ggb
RvqMvq ivL‡Z n‡e| †Lqvj ivL‡Z n‡e †hb hZ`~i m¤¢e Kg †jvKRb e‡R©¨i ms¯ú‡k© Avm‡Z cv‡i|

msiÿ‡Yi ci wb‡Pi KvR¸‡jv Ki‡Z n‡e

mvaviY eR©¨ KwgDwbwUi Ab¨vb¨ eR©¨ †hgbfv‡e AcmviY Kiv nq wVK †mfv‡eB AcmviY Kiv †h‡Z cv‡i| GB Aby‡”Q‡`
wb‡Pi e‡R©¨i Acmvi‡Yi Dci Av‡jvKcvZ Kiv n‡jv:
- aviv‡jv bq wKš‘ msµwgZ Ggb ai‡bi eR©¨
- Zij †gwWK¨vj ev wPwKrmv eR©¨ I
- msµwgZ ev AmsµwgZ aviv‡jv eR©¨

aviv‡jv bq wKšÍ msµwgZ eR©¨

†h †KvbI ai‡bi †gwWK¨vj ev wPwKrmv eR©¨ cwienb I Acmvi‡Yi mgq BDwUwjwU Møvfm I MvgeyU cwiavb Ki‡Z n‡e|
aviv‡jv bq wKšÍ msµwgZ Ggb KwVb ai‡bi eR©¨ m¤¢e n‡j †mev‡K‡›`ªi cÖv½‡Yi †fZi †KvbI wbw`©ó¯’v‡b P~ovšÍfv‡e
AcmviY Kiv †h‡Z cv‡i Ñ GUv †h ¯^v¯’¨ Kg©x SuywK m¤ú‡K© Rv‡bb Zvi c‡ÿ cy‡iv AcmviY cÖwµqv ZË¡veavb Kiv m¤¢e
n‡e|

¯^v¯’¨‡K‡›`ªi cÖv½‡Y eR©¨ Acmvi‡Yi Rb¨ wZbwU c×wZ Av‡Q:

1. cywo‡q †djv,
2. gvwU‡Z cuy‡Z †djv I
3. Ab¨Î Acmvi‡Yi Rb¨ cwienb Kiv|

162 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv

cywo‡q †djv

eR©¨ Acmvi‡Yi Rb¨ m‡e©vrK„ó c×wZ n‡jv cywo‡q †djv †Kbbv G‡Z Zv‡c AYyRxe¸‡jv aŸsm n‡q hvq Ges e‡R©¨i
cwigvYI K‡g Av‡m| Kj-KviLvbvq e¨enƒZ nq Ggb Bbwmbv‡iUi †cvov‡bv Rb¨ cÖK…ó| †Lvjv RvqMvq †cvov‡bvi Rb¨
mycvwik Kiv nq bv|

gvwU‡Z cuy‡Z †djv

eR©¨ Acmvi‡Yi Rb¨ wØZxq m‡e©vrK„ó c×wZ n‡jv gvwU‡Z cuy‡Z †djv| GB c×wZi Rb¨ †K‡›`ª Drcvw`Z mKj ai‡bi
msµwgZ eR©¨ (aviv‡jv Ges aviv‡jv bq) Acmvi‡Yi Dc‡hvMx eo MZ© ev wcU cÖ‡qvRb| eR©¨ †_‡K im †Pvqv‡bv e‡Üi
Rb¨ MZ© ev wc‡Ui †`qv‡j cøvw÷K, Kv`v ev wm‡g›U w`‡q cÖ‡jc w`‡Z n‡e| MZ© ev wcUwU Ggbfv‡e Ki‡Z n‡e †hb †K›`ª
†_‡K †`Lv hvqI †`qvj ev †eov w`‡q cÖ‡ekvwaKvi msiÿY Ki‡Z n‡e hv‡Z †h †KvbI ai‡bi `yN©Ubv I Rxe-Rš‘i cÖ‡ek
†iva Kiv hvq|

Ab¨Î Acmvi‡Yi Rb¨ cwienb Kiv

hw` †K‡›`ªi cÖv½‡Y cywo‡q †djv ev gvwU‡Z cuy‡Z †djv m¤¢e bv nq Z‡e Acmvi‡Yi Rb¨ Ab¨Î cwienb Ki‡Z n‡e|
†K‡›`ªi Kg©x Qvov Ab¨ †KD hw` eR©¨ Acmvi‡Y wbhy³ nq Z‡e D³ Kg©x‡K e‡R©¨i SuywK m¤ú‡K© AewnZ _vK‡Z n‡e|
†KvbI Bbwmbv‡iUi ev wbw`©ó cuy‡Z †djvi ¯’vb ch©šÍ cwienb KivB †kÖq| †Lvjv RvqMvq eR©¨ Acmvi‡Yi Rb¨ cwienb bv
KivB fv‡jv|

Zij †gwWK¨vj ev wPwKrmv eR©¨

Zij †gwWK¨vj ev wPwKrmv eR©¨ cwienY I Acmvi‡Yi mgq BDwUwjwU Møvfm& I MvgeyU cwiavb Ki‡Z n‡e| Zij
†gwWK¨vj ev wPwKrmv eR©¨ cwienb I Acmvi‡Yi mgq †Lqvj ivL‡Z n‡e hv‡Z eR©¨ wb‡Ri ev A‡b¨i Mv‡q, †g‡S‡Z ev
Ab¨ †KvbI Z‡j wQU‡K bv c‡o| cwi®‹viKviK `ªeY, RxevYybvkK `ªeY (†hgb MøyUvivjwWnvBW) I Zij †gwWK¨vj e‡R©¨i
g‡Zv K‡i AcmviY Ki‡Z n‡e:

- mveav‡b Zij eR©¨ wmsK, †ewmb, d¬v‡ki myweav msewjZ Uq‡jU ev cvqLvbvq †X‡j w`‡Z n‡e| hw` Zv m¤¢e bv
nq Z‡e KwVb †gwWK¨vj e‡R©¨i mv‡_ gvwU‡Z MZ© ev wcU ˆZwi K‡i Zv‡Z cuy‡Z †dj‡Z n‡e|
- Zij eR©¨ wmsK, †ewmb, d¬v‡ki myweav msewjZ Uq‡jU ev cvqLvbvq Xvjvi Av‡M †Lqvj Ki‡Z n‡e †h, †WªbwU
†Kv_vq †kl n‡”Q| hw` †WªbwU Aí wKQz`~i wM‡q †K‡›`ªi mxgvbvi †fZ‡i gvwU‡Z †kl nq Z‡e GB ai‡bi †Wª‡b
†gwWK¨vj Zij eR©¨ †djv hv‡e bv|
- wmsK, †ewmb, Uq‡jU ev cvqLvbv fv‡jvfv‡e N‡l cwi®‹vi Ki‡Z n‡e hv‡Z †Kv_vI Zij eR©¨ †j‡M _vK‡j Zv `~i
n‡q hvq| w`b‡k‡l RxevYybvkK `ªeY w`‡q RvqMv¸‡jv fv‡jv K‡i ay‡q wb‡Z n‡e Ges cÖ‡qvRb‡ev‡a AviI †ewk
evi|
- †avqvi Av‡M 0.5% †K¬vwib `ªe‡Y 10 wgwbU Wzwe‡q †i‡L cvÎwU we‡kvab K‡i wb‡Z n‡e|
- BDwUwjwU Møvfm& †Lvjvi Av‡M Møvfm&mn nvZ fv‡jv K‡i ay‡q wb‡Z n‡e|
- BDwjwU Møvfm &†Lvjvi ci fv‡jvfv‡e nvZ ay‡q wb‡Z n‡e|

msµwgZ I AmsµwgZ aviv‡jv eR©¨

hw`I †gwWK¨vj eR©¨ Acmvi‡Yi Rb¨ cywo‡q †djvB n‡”Q m‡e©vrK…ó cš’v, aviv‡jv eR©¨ cywo‡q aŸsm Kiv hvq bv
(wekvjvKvi evwYwR¨K Bbwmbv‡iUi Qvov)| evwYwR¨K Bbwmbv‡iUi cvIqv bv †M‡j aviv‡jv e‡R©¨i Rb¨ Avjv`v MZ© ev wcU
(eo avZzi Wªvg gvwU‡Z cyu‡Z ev Kswµ‡Ui †`qvj †Niv M‡Z©) e¨envi Ki‡Z n‡e| avZecvÎ muyB, cøvw÷‡Ki wmwiÄ, ¯‹vj‡cj
†eøW Øviv wZb-PZz_©vsk c~Y© n‡j †m¸‡jv‡K M‡Z© †X‡j Av¸b w`‡q cywo‡q †dj‡Z n‡e hZÿY bv Av¸b wb‡R wb‡R bv
†b‡f| Gfv‡e Ki‡j cøvw÷‡Ki wmwiÄ Zv‡c M‡j hv‡e Ges VvÐv nIqvi ci k³ cøvw÷K wc‡Ð cwiYZ n‡e| ‡cvov aviv‡jv
eR©¨¸‡jv ZLb eø‡Ki †fZi †cÖvw_Z Ae¯’vq _vK‡e| GB eøK¸‡jv ZLb aviv‡jv bq Ggb msµwgZ e‡R©¨i g‡Zv gvwU‡Z
MZ© ev wcU ˆZwi K‡i AcmviY Kiv hv‡e| hw` mKj msµvgK eR©¨ GK mv‡_ †K‡›`ªi cÖv½‡Y cuy‡Z †djv m¤¢e bv nq, Zvn‡j
aviv‡jv msµvgK eR©¨‡K AwaK cÖvavb¨ w`‡Z n‡e KviY GB ai‡bi eR©¨ AwaK gvÎvq SuywK ˆZwi K‡i|

AwaKZi Z‡_¨i Rb¨ AbyMÖn K‡i ¯^v¯’¨ Awa`ßi cÖYxZ ÔnvmcvZvj eR©¨ e¨e¯’vcbv MvBWjvBbÕ wWwRGBPGm †`Lyb|

msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv 163

164 msµgY cÖwZ‡iva Ges eR©¨ e¨e¯’vcbv
 †mKkb 9t
†iKW© msiÿY I †idv‡ij

†iKW© msiÿY I †idv‡ij 165

166 †iKW© msiÿY I †idv‡ij
 †iKW© msiÿY
÷¨vÛvW© 21: cÖwZwU gv Ges beRvZK †mev Dbœq‡b `ªæZ, h_vh_ e¨e¯’v wbwðZ Kivi Rb¨ ¯^v¯’¨ Z_¨ e¨e¯’v DcvË
e¨env‡i mwµq n‡e| (WHO ÷¨vÛvW©-2)

gv I beRvZ‡Ki Ae¯’v ch©‡eÿY Ges †mevi aviv AÿYœ ivL‡Z wbf©yj †iKW© ivLv Acwinvh©| †iKW©¸‡jv m¤ú~Y©, wbf©yj,
mnRcvV¨ Ges hLbB m¤¢e nq †ivMxi mv‡_ K_v ejvi mgq wjL‡Z n‡e|

cÖwZwU gv‡qi †iK‡W© wb‡Pi Z_¨¸‡jv AšÍf©y³ Ki‡Z n‡e:

l e¨w³MZ Z_¨ (gv‡qi bvg, eqm, wVKvbv BZ¨vw`)
l †ivMxi BwZnvm (†ivMxi ¯^v¯’¨‡K‡›`ª Avmvi KviY)
l wnw÷ª / BwZnvm, kvixwiK cixÿv, w¯‹¨wbs Ges Ab¨vb¨ †ivMwbY©‡qi cixÿv Ges cªwµqv †_‡K cÖvß Z_¨mg~n
l cÖ`Ë †mevi wek` eY©©bv
l †idvi Kiv n‡j Zvi weeiY

gv I beRvZ‡Ki †hme wbw`©ó †iKW© msiÿY Ki‡Z n‡e †m¸‡jv n‡jv:

l fwZ© wbeÜb
l MNC wbeÜb hv‡Z FP wbeÜb _vK‡e
l cv‡U©vMÖvd
l ANC KvW©/ PNC KvW©
l †idv‡ij dg©, cÖ‡qvRb n‡j
l wbeÜb
l QvocÎ
l Rb¥mb`

DcvË msMÖn, we‡kølY Ges cÖwZwµqv Ávcb

cÖmeKvjxb cÖwµqvi Dbœqb I ch©‡eÿ‡Yi Ask wn‡m‡e DcvË msMÖn, we‡kølY Ges cÖwZwµqv Ávc‡bi Rb¨ GKwU c×wZ
_vKv DwPZ| gvb Dbœq‡bi Rb¨ wbf©yj, m¤ú~Y© DcvË mgqg‡Zv h_vh_ ¯Í‡i Dc¯’vcb K‡i g„Zy¨nvi Ges Amy¯’Zvi nvi
ch©vqµ‡g ch©v‡jvPbvi Rb¨ e¨envi Kiv nq|

†iKW© msiÿY I †idv‡ij 167

 †idv‡ij
†ivMe¨vwa Ges g„Zz¨nvi Kgv‡Z ¯^v¯’¨ e¨e¯’vi D”PZi ¯Í‡ii cÖ‡qvR‡b GKwU †ivMx ¯’vbvšÍi Kivi Rb¨ GKwU mgwš^Z
e¨e¯’vMÖnY Kiv n‡q‡Q| †idv‡ij GK Dcv‡q (wb‡P †_‡K Dc‡i) ev `ywU Dcv‡q (wb‡P †_‡K Dc‡i Ges Dci †_‡K wb‡P)
n‡Z cv‡i| Dc‡Rjv †nj&_ Kg‡cø·‡K cÖ_g †idv‡ij †K›`ª, †Rjv nvmcvZvj‡K wØZxq Ges †gwW‡Kj K‡jR¸‡jv‡K
Z…Zxq †idv‡ij †K›`ª wn‡m‡e wPwýZ Kiv nq|

÷¨vÛvW© 22: cÖvß m¤ú‡`i gva¨‡g Kvh©Kifv‡e †h mKj bvixi Ae¯’v †gvKv‡ejv Kiv m¤¢e bq Zv‡`i h_vh_fv‡e †idvi
Ki‡Z n‡e| (WHO ÷¨vÛvW©-3)

†idv‡i‡ji Rb¨ cÖ‡qvRbxq avcmg~n

h_vh_ g~j¨vqb: †ivMxi GKwU m¤ú~Y© wnw÷ª Ges †Rbv‡ij G•vwg‡bkb wm×všÍ MÖn‡Yi Rb¨ Acwinvh© †ivMx Ges Zvi
cwievi‡K †ivMxi Ae¯’v e¨vL¨v K‡i †idvi Kivi cÖ‡qvRbxqZv I ¸iæZ¡ eywS‡q ej‡Z n‡e

- †ivMx Ges Zvi cwievi‡K Afq `vb

- †idvi Kivi Rb¨ h_vh_ myweavRbK Ges MÖnY‡hvM¨ ¯’vb wbe©vPb
- †idv‡ij KvW© c~iY Kiv
- †idv‡ij †K‡›`ªi mv‡_ †hvMv‡hvM ¯’vcb
- hvZvqvZ
- †idv‡ij †KmwUi d‡jv-Avc

†idvi Kivi †ÿ‡Î evavmg~n

1. Ab¨ ¯’v‡b hvevi Rb¨ †ivMxi AvcwËi KviY:

- e¨qfvi
- D”P e¨‡qi ¯^v¯’¨‡mevi c~e© AwfÁZv
- Ab¨‡`i mv‡_ AwfÁZv wewbgq

2. hvZvqvZ
- `~iZ¡
- iv¯Ívi Ae¯’v
- hvbevn‡bi myweav

3. Av_©-mvgvwRK Ae¯’v

4. †idviK…Z †K›`ª †_‡K cÖZ¨vLvb

168 †iKW© msiÿY I †idv‡ij

†mKkb 10t
mshyw³

mshyw³ 169
170 mshyw³

BDwbqb ¯^v¯’¨ Ges cwievi Kj¨vY †K‡›`ª gv I beRvZ‡Ki ¯^v¯’¨‡mevi Rb¨ Acwinvh© IlyacÎ
cÖ‡hvRbxq Ilyamg~n M„n
U¨ve‡jU. dwjK GwmW
U¨ve‡jU. †divm mvj‡dU
U¨ve‡jU. †divm
mvj‡dU+ dwjK GwmW
U¨ve‡jU. K¨vjwmqvg
U¨ve‡jU. wfUvwgb
U¨ve‡jU. Gw›U G‡gwUK
U¨ve‡jU. G›UvwmW
U¨ve‡jU. c¨vivwmUvgj
U¨ve‡jU. AvBey‡cÖv‡db
U¨ve‡jU. WvB‡K¬v‡dbvK
U¨ve‡jU WvqvwRcvg
U¨ve‡jU. wg‡mv‡cÖv÷j
g¨vwM‡bwmqvg mvj‡dU
Bb‡RKkb.
Aw·‡Uvwmb Bb‡RKkb.
Bb‡RKkvb. Avi‡Mv‡gwUªb
Bb‡RKkvb A¨vgw·wmwjb
Bb‡RKkvb wm‡cÖvd·vwmb
Bb‡RKkvb †g‡UªvwbWvRj
U¨ve‡jU. †g‡UªvwbWvRj
Bb‡RKkvb †R›UvgvBwmb
Bb‡RKkvb bigvj
m¨vjvBb
Bb‡RKkvb nvU©‡gb
mjykb
Bb‡RKkvb WvqvwRcvg
Bb‡RKkvb †c‡_wWªb
wewfbœ ¯Í‡i ¯^v¯’¨ †K›`ª
m¨v‡UjvBU wKøwbK
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
mshyw³ 1
KwgDwbwU wKøwbK BDwbqb ¯^v¯’¨ I
cwievi Kj¨vY †K›`ª
(BDGBP Ges
GdWeøywm)
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y Y
Y
Y
Y
Y Y
Y
Y Y
Y Y
Y
Y
Y
Y
Y Y
mshyw³ 171
 wewfbœ ¯Í‡i ¯^v¯’¨ †K›`ª
cÖ‡hvRbxq Ilyamg~n M„n m¨v‡UjvBU wKøwbK KwgDwbwU wKøwbK BDwbqb ¯^v¯’¨ I
cwievi Kj¨vY †K›`ª
(BDGBP Ges
GdWeøywm)
Bb‡RKkvb nvB‡WªvKwU©mb Y
7.1% †K¬v‡iv‡nw·wWb Y Y Y Y
mjykb
Aw·‡Rb Y
Iivj wcj Y Y Y Y
†cÖv‡Rw÷b Abwj wcjm Y Y Y Y
(POP)
wWcU †g‡Wªvw· Y
†cÖv‡R‡÷ib Gwm‡UU
(DMPA)
Bgv‡R©wÝ KbUªv‡mwÞf Y
wcj (ECP)

KbWg Y Y Y Y
AvBBDwmwW (IUCD) Y

172 mshyw³
 mshyw³ 2

BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª gv Ges beRvZ‡Ki ¯^v¯’¨‡mevq cÖ‡qvRbxq mieivn Ges hš¿cvwZ

mieivn Ges hš¿cvwZ BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K›`ª

FWA †iwR÷vi Y
ANC †iwR÷vi Y
FP †iwR÷vi Y
Mf©Kvj wbY©©‡qi K¨vjKz‡jUi A_ev K¨v‡jÛvi Y
cv‡U©vMÖvd Y
Rb¥mb` Y
QvocÎ Y
†idvivj dg© Y
wbeÜb jMeB Y
÷K †iwR÷vi Y
†ivMx cixÿvi †Uwej Y
IRbgvcK hš¿ Y
UP© jvBU Y
wewc †gwkb Y
†÷‡_v‡¯‹vc Y
gvcb wdZv Y
_v‡g©vwgUvi Y
KuvwP Y
MR Y
ANC KvW© (gv‡qi Kv‡Q ivLvi Rb¨) Y
†MvcbxqZvi Rb¨ c`©v Y
we wc KvW© Y
Mf©ve¯’v cixÿY wKU Y
†jevi †Uwej Y
¯úUjvBU Y
hš¿cvwZi Uªwj Y
m¨vjvBb ÷¨vÛ Y
MvDb Y
gv¯‹/ K¨vc Y

mshyw³ 173
 mshyw³ 2

BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª gv Ges beRvZ‡Ki ¯^v¯’¨‡mevq cÖ‡qvRbxq mieivn Ges hš¿cvwZ

mieivn Ges hš¿cvwZ BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K›`ª

†ewe †Uª Y
wkïi IRb gvcvi hš¿ Y
cwi®‹vi Kvco A_ev m¨vwbUvwi c¨vW Y
ïKbv Kvco wkï‡K ïwK‡q Rwo‡q †bqvi Rb¨ Y
KW© K¬¨v¤ú ev UvB Y
cwi®‹vi Kvco 1 wgUvi (2 UzKiv) Y
cwi®‹vi MR, †mvqve, ev Kvco, wkïi †PvL †gvQvi Rb¨ Y
wkïi gv_v XvKvi Rb¨ n¨vU Y
e¨vM-gv¯‹ Ges mvKvi, ev_© Gm‡dw•qv g¨v‡b‡Ri Rb¨ Y
BDwibvwi K¨v‡_Uvi Y
eÜ e¨vM ev Kb‡UBbvi K¨v‡_Uvi †WªB‡bi Rb¨ Y
f¨vRvBbvj †¯úKzjvg Y
wmwiÄ I muyB Y
†Wwjfvwi †mU G hv _vK‡e:
wKWwb †ewmb Y
Mvwj cU Y
AvU©vwi di‡mc (2) Y
¯úÄ †nvwìs di‡mc Y
†ewe †Uª Y
KW© KvwUs KvuwP Y
cwi®‹vi †cwiwbqvj c¨vW Y
Wª¨vc ev eøv‡¼U gv‡K XvKvi Rb¨ Y
cwi®‹vi cvwb mieivn Y
KUb IqvBc Ges A¨vj‡Kvnj Y
mvevb Y
A¨vj‡Kvnj-‡emW Gw›U‡mcwUK n¨vÛ ive Y
nvZ †gvQvi †Zvqv‡j Y
cy‡iv cv XvKv RyZv Y
IV Kiv, i³ †bqvi Rb¨ cwi®‹vi cixÿY Møvfm Y

174 mshyw³
 mieivn Ges hš¿cvwZ BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K›`ª
cÖme, ÿZhy³ Pg© ev Gi wb‡Pi wUm¨yi ¯úk© cÖwZ‡iv‡a Y
†÷ivBj ev HLD Møvfm

ivevi ev cøvw÷K Gc‡ivb Y

aviv‡jv hš¿ ivLvi cvÎ (wKWwb †ewmb) Y
A‡Uv‡K¬f (Ges A‡Uv‡K¬f †Uc), WªvB wnU, †KwgKvj Y
†÷wijvB‡Rkb (MøyUvivjwWnvBW mjykb, digvjwWnvBW)
A_ev dzUv‡bvi Rb¨ XvKbvhy³ cvÎ Ges Zv‡ci Drm

eªvk Y
†K¬vwib mjy¨kb (0.5%) Y
Avjv`v †gvoK (hš¿cvwZ wcÖ-‡÷wijvB‡Rkb) Y
cøvw÷K Kb‡UBbvi `~wlZ hš¿cvwZi Rb¨ Y
cwi®‹vi, ïKbv ¯’vb gRy` Kivi Rb¨ Y
cwi®‹vi Kivi Rb¨ Kvco Y
gqjv wj‡bb, †gwW‡Kj eR©¨, bb-‡gwW‡Kj eR©¨ ivLvi Rb¨ Y
Avjv`v XvKbvhy³ cvÎ)

†÷ivBj ev Kb‡UBbvi ( hw` hš¿ †gvo‡K bv _v‡K Y

BDwUwjwU Møvfm Y
16-18 MM IV K¨vbyjv Y
†W·‡UªvR mjykb (5%) Y
wisMvim j¨vK‡UU A_ev bigvj m¨vjvBb Y
A¨vW‡nwmf †Uc Y
Uwb©Kz‡qU Y
IqvUvi-†eRW jyweª‡K›U Y
BDwib di myMvi Y
BDwib di A¨vjeywgb Y
eøvW myMvi †U÷ Y

mshyw³ 175
 mshyw³ 3

GKwU †jevi iæg e¨e¯’vcbv (UH & FWC)

†Uwej
hš¿cvwZi Uªwj †dvg c¨vW

KvevW©

÷yj

†W¯‹ &I †Pqvi

c`©v
Uuq‡jU
†Pqvi

nvZ †avqvi wmsK

÷yj

†Wwjfvwi iæg

jKvi/ †Uwej

÷yj

vwjk/weQvbv

176 mshyw³
 mshyw³ 4

BDwbqb ¯^v¯’¨ I cwievi Kj¨vY †K‡›`ª (UH&FWC)-‡Z mieivnK…Z wPwKrmv Ges †mev
Labor and EmOC services
Y: Yes; N: No; I&R: Identify and Refer, R: Refer
mieivnK…Z wPwKrmv Ges †mev ‡mevcÖvwß
e¨w³MZ, †gwW‡Kj I Ae‡÷wUªK wnw÷ª Y

cixÿv Y
-Mf©¯’ wkïi Ae¯’vb
-Mf©¯’ wkïi ür¯ú›`b

†jev‡ii AMÖMwZ ch©v‡jvPbv: cv‡U©vMÖvd Y

†jev‡ii m~Pbv Y
¯^vfvweK cÖme cwiPvjbv Kiæb (cv‡U©vMÖvd, AMTSL, m¤§vbRbK gvZ…‡mev AšÍfz©³) Y
cÖme-msµvšÍ Riæwi Ae¯’v mbv³KiY Ges e¨e¯’vcbv I&R
(c„_KxKiY A_ev B/CEmonC)
-wejw¤^Z cÖme
- wcÖ-GKjv¤úwkqv/GKjv¤úwkqv
- i³ÿiY
- wcÖ-Uvg© †jevi, cÖm‡ei c~‡e© KwU©‡Kv‡÷i‡qW-cÖvß
A¯^vfvweK Ae¯’v‡bi e¨e¯’vcbv (†hgb weªP, KW© cÖjvá) I&R
gvivZ¥K wcÖ-GKjvgcwkwmqv Ges GKjvgcwkqv Y
cÖmec~e© i³ÿiY I&R
cÖme-cieZ©x i³ÿi‡Yi †gwW‡Kj e¨e¯’vcbv I&R
†kvìvi wWm‡Uvwmqv e¨e¯’vcbv I&R
Rivqy A¨v‡Uvwb eÜ Ki‡Z evB- g¨vbyqvj Kg‡cÖmb Y
cøv‡m›Uvi g¨vbyqvj wb®‹vkb (nvZ w`‡q Mf©d~j †ei Kiv) I&R
AšÍt¯’ c`v_©¸‡jv wb®‹vkb I&R
†hvwb I Rivqygy‡Li KvUv‡Quov wVK Kiv, GwcwmI‡Uvwg Y
B›Uªv‡fbvm d¬zBW, A¨vw›Uev‡qvwUK, A¨vw›UKbfvj‡m›U, Aw·‡Uvwmb Y
cÖmeKvjxb R¡i e¨e¯’vcbv Y
37 mßv‡ni Av‡M A_ev 37 mßv‡ni ci cÖme ïiæi Ab¨vb¨ wb‡`©kbv Qvov A¨vgwbIwUK †gg‡eªb R
Gi wcÖ-g¨vwPIi ivcPvi

Mf©¯’ wkïi A¯^vfvweK ür¯ú›`b Ges bovPov R

KvD‡Ýwjs Y
wK¬wbK †iKW© msiÿY Y
†iKW© msiÿY Ges wi‡cvU© Kiv Y

mshyw³ 177
 mieivnK…Z wPwKrmv Ges †mev ‡mevcÖvwß
ZË¡veavb I ch©‡eÿY Y
msµgY cÖwZ‡iva Y
Acwinvh© beRvZK †mevi Dbœqb Ges `ªæZ †mev`v‡bi Rb¨ beRvZ‡Ki wec` wPý¸‡jv wPwýZKiY Y
KW© cwi®‹vifv‡e KvUv Ges evuav Y
K‡W© 7.1% †K¬v‡iv‡nw·wWb GKevi cÖ‡qvM Y
nvD‡cv_vwg©qv cÖwZ‡iva Ges e¨e¯’vcbv Y
- ïKv‡bv Ges Rov‡bv
- gv‡qi Mv‡qi ms¯úk©
- †`wi‡Z †Mvmj (72 NÈvi ci)
k¦vm-cÖk¦v‡mi mgm¨v mbv³KiY Ges e¨e¯’vMÖnY (wWwRUvj w÷gy‡jkb, e¨vM I gv¯‹ wimvwm‡Ukb) Y
cÖm‡ei GK NÈvi g‡a¨ ¯Íb¨`vb Y
beRvZ‡Ki KbRvswUfvBwUm cÖwZ‡iva Y
Rb¥MZ ÎæwU mbv³KiY Y
RhoGAM Bb‡RKkb I&R

178 mshyw³
†idv‡iÝ

†idv‡iÝ 179
180 †idv‡iÝ
 †idv‡iÝ

l †gUvibvj †nj_ GmIwc, fjy¨g 1

l †gUvibvj †nj_ GmIwc, fjy¨g 2
l cwievi cwiKíbv g¨vbyqvj, Ryb 2018
l beRvZ‡Ki mgwš^Z †mev c¨v‡KR (wmGbwmwc)
l GmwfAviGm, weweGm 2018
l weGgGgGm 2016
l cÖme cieZ©x cwievi cwiKíbv KvD‡Ýwjs gwWDj

†idv‡iÝ 181
182 †idv‡iÝ
mn‡hvwMZvq t BDGmGAvBwWÕi ÔgvgwbÕ gvZ… I beRvZK ¯^v¯’¨‡mev Dbœqb cÖKí, 2020