Dengue and Malaria Beware of the Fever During Pregnancy

Monsoon is the season where everyone starts enjoying their life. This season gets the child out in you. Many wants to play in the rain water, get drenched in the rain and the list goes on. Yes, enjoying is one part of monsoon. But getting ready to fall sick is another aspect which everyone needs to be careful during this season.

Dengue, Malaria, Chikungunya, Swine flu are common in the monsoon season. In the last 2 -3 years, there is a sudden spurt in the dengue cases everywhere. Most of the time hospitals will be completely filled with dengue patients and they turn away the patients because of the unavailability of the beds. But fever like dengue, malaria and swine flu could be dangerous during pregnancy if the care is not taken properly.

Dengue infection in pregnancy carries the risk of haemorrhage for both the mother and the new-born. Also there is a serious risk of premature birth and fetal death. In the case of infection developing close to the delivery time, there is a risk of vertical transmission.

Similarly malaria and swine flu during pregnancy can lead to miscarriage, congenital infections etc. Malaria can also cause anaemia in pregnant women and may result in convulsion, kidney failure. So it is important to monitor for dengue, malariaand swine flu during pregnancy.

Measures to be taken to avoid dengue, malaria and swine flu

Don’t travel to areas where dengue, malaria are prevalent
Keep your surroundings clean. Close the window in the morning and evening to avoid mosquitos entering the house
Wear protective cloths like long pants, long sleeve dresses
Use bed nets, preferably treated with an insecticide to prevent mosquito bite.

Simple treatments which a pregnant women can follow during dengue, malaria and

Drink plenty of fluids like water, fresh juice, coconut water. This will help to prevent dehydration.
Avoid taking medicines like aspirin for fever. This may lead to bleeding and other complication
Antipyretics helps to manage fever and body pain.
Meet the physician as early as possible.

World Hepatitis Day

28th July is recognized as World Hepatitis Day; and today we would help you understand the common causes and Effect of Hepatitis in Pregnancy.

Hepatitis is an infection and inflammation of the liver caused by a virus. Jaundice during pregnancy is mainly caused by Hepatitis.

Normally, being pregnant will not hasten the disease process or make it worse, unless a woman has hepatitis E.

Most of the times pregnant women are completely unaware that they have been infected with a hepatitis virus. Usually this is because any symptoms of the illness may only be felt or at times there are no symptoms at all. Good antenatal care and blood screening are important during pregnancy, to avoid and cure it at an early stage.

The common types of Hepatitis are:

Hepatitis A :

Hepatitis A is transmitted by the oral-fecal route, such as from contaminated water or diapers. The main treatment is rest and a nutritious diet, and usually the woman will recover within a month or two. If a newborn is exposed, the infection is usually mild and they will have a lifelong immunity to the disease. If a pregnant woman gets exposed, she will be given immune gamma globulin (IG) to help protect her from getting the disease. It is always recommended to the pregnant ladies who plans a travel to get immunized.

Hepatitis B:

Hepatitis B is one of the most highly transmitted forms of hepatitis from mother to child around the world. Usually, the disease is passed on during delivery with exposure to the blood and fluids during the birthing process.

When the infant is born, the newborn will receive hepatitis B immune globulin at birth, and should be vaccinated with a hepatitis B vaccine at one week, one month, and six months after birth.

Hepatitis C:

Hepatitis C occurs if a person is exposed through transfusions, contaminated needles, or injected drug use. Mostly women become pregnant during the years between 20 and 40, which is also the age group in which the incidence of hepatitis C, hence screening for hepatitis C before and during pregnancy is done. The risk of a pregnant woman passing the hepatitis C virus to her unborn child is generally low and has been related to the levels of quantitative RNA levels in the mother??s blood.

Hepatitis E:

Hepatitis E is a rare and sporadic viral infection of the liver. Its risk of transmission is highest in regions where there are low standards of sanitation. It is transmitted via the fecal-oral route through contaminated water. When this illness affects pregnant women, they may experience a more severe form of illness, which may possibly lead to acute liver failure.

1. What are the signs of hepatitis during pregnancy?

Common signs of Hepatitis are:

Nausea and vomiting
Loss of appetite
Fever
Abdominal pain
Yellowing of the skin and the whites of the eyes.

The problem is, depending on the type of virus, symptoms might not show up for months after infection, or you may have no symptoms at all.

2. How can we analyses that a person is infected with hepatitis during pregnancy?

Blood Test can indicate the presence of hepatitis. There are blood tests which can also show the liver condition.

3. How will hepatitis affect the unborn baby?

The baby would be fine throughout the pregnancy. Some risk factors involve only during the time of birth. That??s why all pregnant women are tested for hepatitis B. If the test shows the mother has been infected, doctor will take steps to minimize the baby’s chances of infection.

Dr. Sireesha Reddy

Obstetrics & Gynaecology

PCOS and Pregnancy

Polycystic ovary syndrome is a complex, commonest endocrine metabolic condition in the reproductive years of a woman. There is no single attributing factor. It is multifactorial.

Its impact on pregnancy is not elucidated entirely. Women with recurrent pregnancy loss, subfertility, obesity causing concerns are associated with PCOS.Spontaneous miscarriage is seen in almost 40% of patients in early pregnancy. Recurrent pregnancy loss and subfertility could be related due to increased secretion of LH hormone causing concerns with egg maturity and uterine lining receptivity. Pregnancy induced insulin resistance due to other pregnancy hormones puts patients at risk to develop Gestational diabetes, pregnancy induced hypertension.

In women who have been on insulin sensitizers like Metformin before pregnancy to decrease insulin resistance and in obese women , continuing them on Metformin after conception have been associated with less pregnancy losses, hence recommended to continue till 12 weeks of pregnancy. There is no additional risk of abnormalities by continuing Metformin.

Lifestyle modifications including diet and exercise will help women with PCOS contemplating pregnancy reduces the above mentioned risk

Dr. Madhushree Vijayakumar

Consultant OBGYN

Endometriosis – Everything You Need To Know

Many women learn to normalise pain they experience during their period and not to talk about out loud.We’re encouraging women and teenagers to break a taboo and talk about their menstrual health.Endometriosis (pronounced en- doh mee tree oh sis) affects more than just the physical body and can have a profound emotional impact on women and girls living with the condition. Don’t be afraid to ask your partner, friends or family for their support when you feel upset or confused. Endometriosis can affect all women and girls of a childbearing age, regardless of race o Endometriosis r ethnicity.

Food For A Healthy Mind & Pregnancy

Every day, pregnant and nursing women have to make important dietary decisions by consuming healthy meals that include essential nutrients such as folic acid, calcium and pre-natal vitamins. Omega-3 fatty acids, which are long-chain polyunsaturated essential fatty acids, are also crucial for the mother’s health and also for the overall development of a healthy baby.

Research indicates that one of the most essential Omega-3 fatty acids is DHA (docosahexaenoic acid), which is critical for the development and functioning of the brain, the eyes and the central nervous system. Since Omega-3 fatty acids are not generated by the human body, pregnant and lactating women must obtain it either through diet or supplements. Babies rely on their mothers to get the much-needed DHA.

The Benefits

The European Food Safety Authority Scientific Panel recommends that pregnant and nursing women should consume 350 to 450 mg of DHA every day. Research suggests that DHA helps pregnant women by reducing the risk of pre-term birth and postpartum depression. According to a recent study in The American Journal of Clinical Nutrition, taking DHA helps optimal pregnancy outcomes. By ingesting supplements during the last half of pregnancy, women have longer gestation cycles, bigger babies, and fewer preterm births.

DHA also benefits the baby. Research shows that it results in an increase in brain weight and a child’s IQ, better hand-eye coordination. Babies get DHA from breastmilk, where it is found naturally. Infant formulas are now being supplemented with DHA.

Research indicates that preterm infants born without the benefit of DHA in last trimester of the pregnancy did not perform well on cognitive mental tests. Low levels of DHA in children have been linked to an increased risk of Attention Deficit Hyperactivity Disorder (ADHD), vision problems and depression.

In India, there is a low level of importance given to DHA during pregnancy and lactation. DHA intake in India among pregnant women is 10 times lesser than the intake among mothers in developed countries.

There are different dietary sources of DHA such as:

Algae: Certain microalgae are natural sources of DHA. A natural vegetarian source of DHA can now be produced from microalgae, and is currently available in dietary supplements, fortified foods, and a number of infant formulas.
Fatty fishes such as anchovies, salmon, herring, mackerel, tuna and halibut
Organ meat such as liver
Fish oil
Poultry and egg yolks
Breast milk

Of the above, significant amounts of DHA are found in animal organs and fatty fish, which is a challenge for Indias huge vegetarian population. Non-vegetarians have the highest DHA levels. Not only that, pregnant women are usually advised to limit consumption of fish due to concerns over toxins such as mercury.

A common misconception that many have come across is the use of flaxseed and walnuts in the belief that these foods are a rich source of DHA. That is not true. Flaxseeds and flaxseed oil contain a particular omega-3 fat called ALA (alpha-linolenic acid), a precursor of DHA. While the body can convert small amounts of ALA into DHA, it is not sufficient. According to World Health Organisation, marine oil supplements are often recommended to pregnant women to fulfil their Omega-3 requirements as they contain fatty acids DHA and EPA, which are the precursors of prostaglandins. Marine oils are usually promoted as a treatment for hypertension among pregnant women and non-pregnant adults.

Women Health & Nutrition

A balanced diet is a cornerstone of health for Women. Nutrient-rich foods provide energy for women’s busy lives and help to prevent disease. Eating right as follows:

At least three servings of whole grains such as whole-grain bread, rice, roti, paratha etc can be taken.
Three servings of low-fat or fat-free dairy products including milk, buttermilk, yogurt or cheese, ragi, soya, almond milk etc
Five servings of protein such as lean meat, chicken, fish, eggs, beans or peas and nuts.
Three cups of fruits ?? fresh without added sugar.
Three cups of colorful vegetables ?? fresh without added salt / cooked.

Iron is one of the keys to good health and energy levels in women. Iron-rich food sources include red meat, chicken, fish, kale, spinach, green leafy vegetables, beans, lentils and fortified breads and cereals. Plant-based sources of iron are more easily absorbed by your body when eaten with vitamin C-rich foods. So the wise choice is to add tomatoes to lentil soup or add a pinch of lemon juice in your salads and cooking.

When women reach childbearing age, they need to eat good amount of folic acid to decrease risk of birth defects. The requirement is at least 400 micrograms of folic acid a day. Diet which contains folic acids such as Citrus fruits, leafy greens, beans and peas naturally contain folate. There are many folic acid fortified foods such as cereals, rice and breads can be used.

For healthy bones and teeth, women need to eat a variety of calcium-rich foods every day. Calcium keeps bones strong and prevents osteoporosis, a bone disease in which the bones become weak and break easily. Some calcium-rich foods include low-fat or fat-free milk, yogurt and cheese, sardines, tofu (if made with calcium sulfate) and calcium-fortified foods including juices and cereals.

To keep weight in check at any age, women should avoid a lot of excess calories from added sugars, fat and alcohol. Limit regular soft drinks, sugar-sweetened beverages, candy, baked goods and fried foods. Opt for low-fat dairy and meat products instead of their full-fat counterparts. Eat fewer foods that are high in saturated fat ?? the kind found in fatty meats, sausages, cheese and full-fat dairy products, baked goods and pizza.

Since women typically have less muscle, more fat and are smaller than men, you need fewer calories to maintain a healthy body weight and activity level. Moderately active women need 1,800 calories a day.

Exercise is an important part of a woman’s health. Regular daily activity helps with weight control, muscle strength and stress management.

Endometriosis & It’s Effect On Fertility

The most common complication of endometriosis is infertility and couples often find out about the problem when they take up tests to check fertility status. The relationship between endometriosis and infertility has been the topic of much debate. Research has shown that infertile women are six to eight times more likely to have endometriosis than fertile women. Some of the explanations given for decreased fertility in women suffering from this disorder include distorted pelvic anatomy, endocrine and ovulatory abnormalities, altered peritoneal and tubal function, altered hormonal and cell-mediated functions in the endometrium.

Based on common observations during laparoscopy, it has been found that the cysts and adhesions caused by the disease can lead to changes in anatomy of the pelvic organs. This impairs the fertilization process and in turn affects the release of eggs, thus leading to infertility.

Many women with mild to moderate endometriosis are able to conceive and carry a pregnancy to term. Doctors may advise women with endometriosis not to delay having children as the condition is likely to get worse over time. Interestingly the symptoms of endometriosis, especially pain, seem to disappear in women who are pregnant or breastfeeding.

Preeclamsia & Prematurity

Preeclampsia and Prematurity Insights on Managing Challenges in Pregnancy- Motherhood Hospital India

Pre – Eclampsia is a serious health problem affecting 5-8% of pregnancy worldwide

(8-10)% of pregnant women in India gets affected by it.

40% indicated or medically induced prematurity is caused by pre – Eclampsia and eclampsia in order to save life of mother and baby as delivery is the final option for this disease of placental origin.

Main indications of premature delivery are

Fetal:

Fetal disease
Intrauterine growth restriction
Oligo hydramnios
Placental abruption
Abnormal blood to fetus or abnormal doppler study

Maternal indications :

Recurrent eclampsia
HELLP syndrome
D/C
Liver hematoma
Renal failure
Hypertensive encephalopathy
Pulmonary edema

Can pre-elcampsia, eclampsia and prematurity can be prevented?

Primary prevention:

To prevent disease from happening

Avoid smoking and alcohol (It reduces disease by 30 – 40 %)
Maintain healthy weight
Avoid late marriage and late pregnancy
Diet rich in antioxidant such as Vit C, Vit E,Magnesium,. Zinc and calcium if positive family history of hypertension pre-eclampsia and eclampsia
Medication
Role of low dose of ecospirin is still no confirmed

SECONDARY PREVENTION

Medicines as such as Nifedipine, Labetalol, Hydralazsine
Sodium nitro prusside sodium

Tertiary Prevention to avoid recurrence by Magnesium sulphate

The main culprit of Pre-Eclampsia and eclampsia is placenta, which provides nourishment for baby.

There is no 100% effective screening method to prevent it. So, final outcome depends on experienced and dedicated obstetrician for early diagnosis organized antenatal care and family decision of delivery

Authored By : Dr Deepmala

Lamaze Simplifying Your Journey From Pregnancy To Childbirth

Lamaze Simplifying your journey from pregnancy to childbirth

While being in a room full of pregnant women discussing their hormonal changes may seem to be scary for a few husbands, Lamaze instructors make it comfortable for you by giving the serious issues some interesting twists.

Lamaze techniques involve not just written and oral instructions on birthing but also include

Practical exercises
Variety of activities
Visual Aid

To take you through the nine beautiful months of pregnancy and the process of birthing with ease.

Note To Fathers To Be

Hello Fathers To Be, this course will make your transition in the new role simpler. We expect you to be involved actively in the birthing process too. Just holding your partner’s hand during labour is not support. You need to actively participate in the process by giving soothing massages to your partner and help her move positions to ease labour pain.

The technique emphasizes on the benefits of natural birth and thus, trains you for giving birth with confidence without medical interventions.

One in four deliveries is to a woman educated in the Lamaze method

Lamaze is popularly known for its rhythmic breathing techniques, which emphasize active concentration and promote relaxation. The rhythmic breathing patterns help women turn their attention away from their contractions.

What should I expect in a Lamaze course?

Expecting Parents are advised to begin a class near the start of their seventh month of pregnancy. Here’s what the class covers:

Normal labor and birth (using videos of real births) and the early postpartum period
How to be active and informed participants during the birth
Focused breathing techniques for labor
Other relaxation techniques and natural strategies to help you work with labor pain, such as massage, walking, position changes, and hydrotherapy
Tips to help your partner encourage and support you during labor
The value of one-on-one professional support during labor
How to communicate with your healthcare team so your needs are met
Complications that could arise during labor and birth, and interventions that might be medically necessary
Epidurals and other options for managing pain with medication
Early interaction with your baby
Breastfeeding

Benefits Of The Lamaze Method

Management of pain without drug intervention gives the Lamaze method widespread appeal among parents who seek a natural childbirth experience.
Lamaze helps build your confidence in your body’s ability to give birth.
You can discuss your fears about labor and birth with the instructor and other couples with the same concerns.
Your partner will learn about childbirth and how to support you on the big day. You may find that attending lamaze classes together will create a special bond.
Lamaze supports evidence-based pregnancy, birth and parenting practices that are supported by research and experienced childbirth educators.
Lamaze guides you as you navigate all of your options, and their benefits and drawbacks.
Lamaze seeks to empower you as you explore how your body was designed for birth, and encourages you to work with your body’s natural abilities.
Lamaze provides strategies for comfort and coping with pain during labor, reducing unnecessary medical interventions, and receiving continuous support during labor and birth.
Lamaze encourages bonding between you and your baby, with the importance of skin-to-skin contact and time to get to know your new baby after birth.
Your instructor will discuss pain relief options, including massage, relaxation, breathing techniques, and medications.

Core Beliefs Of Lamaze Six Healthy Birth Practices

These six practices are as follows:

Healthy Birth Practice 1: Let labor begin on its own
Healthy Birth Practice 2: Walk, move around and change positions throughout labor
Healthy Birth Practice 3: Bring a loved one, friend or doula for continuous support
Healthy Birth Practice 4: Avoid interventions that are not medically necessary
Healthy Birth Practice 5: Avoid giving birth on your back and follow your body’s urges to push
Healthy Birth Practice 6: Keep mother and baby together It’s best for mother, baby and breastfeeding

Myths About Lamaze

Myth #1: Lamaze is all about breathing.

Reality: Breathing techniques are just one of many things that help women in labor.The goal of Lamaze classes is to increase women’s confidence in their ability to give birth. Women learn simple coping strategies for labor, including movement and positioning, labor support, massage, relaxation, warm baths/showers, and the use of heat and cold are some others.

Myth #2: Lamaze promises painless childbirth.

Reality: Many women are afraid of the pain that is a normal part of childbirth. The pain of labor and birth, like other pain, protects us. Responding to the pain of contractions by changing positions and moving, by massaging, by moaning actually strengthens the contractions, helps the baby settle into the pelvis and move through the birth canal, and reduces pain perception.Lamaze classes help women understand the value of pain and learn how to respond to pain in ways that both facilitate labor and increase comfort.

Myth #3: Lamaze childbirth means you can’t have an epidural.

Reality: Lamaze classes provide information about natural pain relief options as well as epidural analgesia. Eliminating pain completely makes it difficult to respond to contractions in ways that facilitate labor and birth. The ability to use many of the comfort techniques learned in Lamaze classes, such as changing positions, walking, and warm baths/showers may be limited. Lamaze education will assist women in making personal decisions that are right for them.

Myth #4: Lamaze doesn’t work.

Reality: Lamaze is working if women trust the natural process of birth, have confidence in their ability to give birth, have the freedom to work with their bodies as labor progresses, and are supported by health care providers, family and friends who wait patiently for nature to do its incredible work. Lamaze works if birth is allowed to work.

Myth #5: Lamaze is not for everyone.

Reality: Today, Lamaze childbirth classes provide the knowledge, skills, and support that help women give birth with confidence and joy as they have done for centuries. Lamaze preparation is for everyone!

Knowing that pregnancy and birth can be demanding on your body and mind, Lamaze seeks to help build your confidence and ensure that you have the support you need during pregnancy and birth.

MOOD SWINGS IN PREGNANCY

Why am I like this? Why have I become lot more forgetful? Can I go through this pregnancy for next 9 months? Will I be a good mother? I don??t think my husband understands me anymore These are the few questions which run through a to- be-mom??s thoughts. Pregnancy is a roller-coaster ride with huge excitement. As soon as a woman realizes she is pregnant, she is anxious with also many questions in her mind. Surge of pregnancy hormones, sleep deprivation, nausea, lack of appetite, anxiousness can cause overwhelming response with her mood. Telling her that its common to have mood swings, alleviating her fears about pregnancy concerns, making her understand that these changes are not permanent could help her go through the pregnancy well. Hydration, having small frequent meals, good sleep, talking it though to family and friends, gentle exercise, making time for some activities with friends and family should help het to cope up with the mood swings in a positive way. If anxiety or feeling low symptoms worsen she should seek help with her doctor. – Madhushree Motherhood, Hebbal