Why PCOS is on the rise among Indian women

Rise of PCOS in Indian women and Explore causes and effective management PCOS - Motherhood Hospital India

There is a general lack of awareness regarding the condition and it often remains undetected for years.

One in every 10 women in India has polycystic ovary syndrome (PCOS), a common endocrinal system disorder among women of reproductive age, according to a study by PCOS Society. And out of every 10 women diagnosed with PCOS, six are teenage girls.

PCOS was described as early as 1935. However, even today there is a general lack of awareness regarding the condition in India and it often remains undetected for years. This health condition is estimated to affect about 10 million women globally.

A study conducted by the department of endocrinology and metabolism, AIIMS, shows that about 20-25 per cent of Indian women of childbearing age are suffering from PCOS. While 60 per cent of women with PCOS are obese, 35-50 per cent have a fatty liver. About 70 per cent have insulin resistance, 60-70 per cent have high level of androgen and 40-60 per cent have glucose intolerance.

In studies conducted in South India and Maharashtra, prevalence of PCOS was reported as 9.13 per cent and 22.5 per cent, respectively.

Many aspects of the disorder are not understood properly as its symptoms and severity vary greatly. Women with PCOS are often found to have higher than normal insulin levels. Insulin is a hormone thatŸ??s produced in the pancreas. It helps the body cells turn sugar (glucose) into energy.

If you don’t produce enough insulin, your blood sugar levels can rise. This can also happen if you’re insulin resistant, meaning you aren’t able to use the insulin you do produce effectively. If you’re insulin resistant, your body may try to pump out high levels of insulin in an effort to keep your blood sugar levels normal.

Too-high levels of insulin can cause your ovaries to produce more androgens, such as testosterone. Insulin resistance may also be caused by having a body mass index above the normal range. Insulin resistance can make it harder to lose weight, which is why women with PCOS often struggle with this issue.

The incidence of PCOS among women and teenage girls has risen to such an extent that the Indian Council of Medical Research (ICMR) has taken up a nationwide survey. The reason it is dangerous is that if this condition is left unchecked or undiagnosed, it can lead to infertility among other long-term health concerns.

Early diagnosis and treatment is key to help prevent health problems. At Motherhood Hospitals alone, we have seen 4-5 cases of teenage girls suffering from PCOS, which is significantly high compared to 10 years ago. This is mostly due to unhealthy lifestyles, unhealthy diets and lack of exercise.

Spectrum of symptoms

Girls and women suffering from PCOS exhibit a range of symptoms such as weight gain, fatigue, unwanted hair growth, thinning hair, infertility, acne, pelvic pain, headaches, sleep problems and mood changes. Most symptoms begin shortly after puberty and they can also develop during late teens and into early adulthood.

Girls with PCOS typically have irregular periods or amenorrhea, and heavy or scanty bleeding during menses. Doctors also look for elevated levels of the male hormone androgen (testosterone) and polycystic ovaries.

With PCOS, women can develop cysts due to ovaries not being released on time. The follicles keep growing and form multiple cysts, which appear like a string of pearls. Women are likely to develop PCOS if their mother or sister also has the condition.

Not just that, women with PCOS have a higher risk of developing other health complications such as hypertension, high cholesterol, anxiety and depression, sleep apnea, heart attack, diabetes and endometrial, ovarian and breast cancer. Women who have PCOS have a higher rate of miscarriage, gestational diabetes, and premature delivery.

Recommended treatment

Unfortunately, PCOS cannot be cured. It can, however, be managed to a large extent by controlling symptoms. Exercise and a healthy diet are the best bet for women with PCOS as this will help to regulate their menstrual cycle and lower blood glucose levels.

High-fibre foods can help combat insulin resistance by slowing down digestion and reducing the impact of sugar on the blood. This may be beneficial to women with PCOS. Great options for high-fibre foods include broccoli, cauliflower and sprouts, red leaf lettuce, green and red peppers, beans and lentils, tomatoes, spinach, almonds and walnuts, olive oil, fruits, such as blueberries and strawberries, and fatty fish high in omega-3 fatty acids, such as salmon.

Lean protein sources like tofu, chicken and fish don’t provide fibre but are filling and a healthy dietary option for women with PCOS.

Instead of three big meals they should have five small meals, which helps metabolise food and in maintaining weight.

If women with PCOS are suffering from infertility, then fertility drugs may be administered to aid ovulation. On the other hand, if a woman does not want to get pregnant, then birth control pills may be prescribed.

In order to stop excess hair growth and help reduce acne, using anti-androgens is the recommended course of action. While many women have been recommended to regularly exercise, (minimum 45 minutes a day, five times a week) one refrain that we commonly hear is that they don’t have time.

Up to 5-10 per cent of weight loss will help improve the symptoms, hormonal balance and regularisation of menstrual cycle. PCOS among women, especially adolescents, is an urgent public health problem that needs careful assessment, timely intervention and appropriate treatment.

Promotion of healthy lifestyles, the need for regular exercise and increased awareness programmes on PCOS is the need of the hour to enable a holistic solution to this problem.

Authored By :Dr SUNITHA P SHEKOKAR

Press Coverage:http://bit.ly/2ok4dU7

Endometriosis : The Silent Disease

Endometriosis insights: Symptoms, diagnosis, and treatments - Motherhood Hospitals India

All You Need To Know About Endometriosis.

Endometriosis-An invisible disease yet painful.The woman suffers and fights within herself.She fights the pain , she fights to explain the unbearable and the unpredictable.Such is the situation of a woman having endometriosis.She has to know as to why she is hurt.She has to know that she has the chance to be pain-free.The below write up will help you to clarify your thoughts regarding endometriosis and to help you to come out of the stigma as well.

What is endometriosis?

The endometrium is the tissue that lines the inside of the womb (uterus).

Endometriosis is a condition where endometrial tissue is found outside the uterus. It is ‘trapped’ commonly in the pelvic area that is the pelvic cavity (including the ovaries) , lower abdomen and, rarely, in other areas in the body.

Which age group of Women are affected ?

Endometriosis is found almost exclusively in women of reproductive age, with diagnosis done usually during her 30s. It is uncommon in the under-20s.

Endometriosis has a much higher prevalence in infertile women, estimated as between 25% and 40%.

Endometriosis is estimated to affect 10-15% of women of reproductive age.However, it is difficult to determine the prevalence because of the diversity of symptoms and their severity and because endometriosis may be sometimes asymptomatic.

What are the risk factors?

Risk factors include: an early menarche, late menopause, delayed childbearing, short menstrual cycles or long duration of menstrual flow.

Obstruction to vaginal outflow eg, hydrocolpos, female genital mutilation or defects in the uterus or Fallopian tubes.

Genetic factors: Sometimes it runs in families. Therefore, endometriosis is more common in close blood relatives of affected women. Risk for first-degree relatives of women with severe endometriosis is six times higher than that for relatives of unaffected women.

Endometriosis is rare in women past the menopause, as to develop endometriosis you need oestrogen, the female hormone. Oestrogen levels fall after the menopause.

The combined oral contraceptive pill reduces the risk of developing endometriosis. This protective effect may persist for up to a year after stopping ‘the pill’.

What are the causes of endometriosis?

There have been several theories over the years.One theory was that some cells from the endometrium gets outside the uterus into the pelvic area. They get there during the monthly periods by spilling backwards along the Fallopian tubes.This is called retrograde menstruation.Other theories are spreading through lymphatic or haematogenous spread, and metaplasia.

However, currently the consensus is that endometriosis has a multifactorial aetiology, involving possible genetic, immunological and endocrinological factors.

What are the symptoms of endometriosis?

The clinical presentation is variable, with some women experiencing several severe symptoms and others having no symptoms at all. The severity of symptoms tends to increase with age.

Women with endometriosis may have no symptoms and be diagnosed incidentally or during investigations for infertility.

The appearance or worsening of pain at the time of menstruation, or just prior to it, suggests endometriosis.

Painful periods The pain typically begins a few days before the period and usually lasts the whole of the period. The pain is different compared to normal period pain which is usually not as severe and doesn’t last as long.

Painful intercourse The pain is typically felt deep inside and may last a few hours after intercourse.

Pain in the lower abdomen and pelvic area. Sometimes the pain is constant but it is usually worse on the days just before and during a period.

Other menstrual symptoms may occur – for example, heavy bleeding during periods.

Difficulty becoming pregnant (reduced fertility). This may be due to patches of endometriosis in the ovary which forms cysts and does not allow eggs to grow.

Other symptoms include dysuria that is pain during urination, painful defecation, abdominal pain, backache, menstrual irregularity, and cyclical pain or bleeding (eg, epistaxis, haemoptysis) at extrapelvic sites.

What are the complications of endometriosis?

Infertility: moderate-to-severe endometriosis can cause tubal damage leading to infertility. Lesser degrees of endometriosis, even in the absence of any obvious tubal damage, are also associated with subfertility and increased risk of ectopic pregnancy.

Adhesion formation may occur due to the endometriosis or following surgery.

Women with endometriosis have an increased risk of inflammatory bowel disease.

Endometriosis may also be associated with an increased risk of breast and other cancers, autoimmune and atopic disorders.Rarely it may be associated with invasive ovarian cancer.

What are the other conditions mimicking endometriosis?

  • Pelvic inflammatory disease.
  • Ectopic pregnancy.
  • Torsion of an ovarian cyst.
  • Appendicitis.
  • Primary dysmenorrhoea.
  • Irritable bowel syndrome.
  • Uterine fibroids.
  • Urinary tract infection.

ItŸ??s time to start the conversation It’s the conversation of positivity.You need to open up the other side of the conversation.You need to know that you can have better life which is pain free,just by knowing what you need and how to deal with it more better.

How is endometriosis diagnosed and confirmed?

Transvaginal ultrasound scanning appears to be a useful test, both to make and to exclude the diagnosis of an ovarian endometrioma.

MRI scan may be a useful non-invasive tool in diagnosis, especially for subperitoneal deposits.

CA 125 measurement has limited value as a screening test or diagnostic test.

For a definitive diagnosis of most forms of endometriosis, laparoscopy is the gold standard investigation but it is invasive with a small risk of major complications – eg, bowel perforation.On laparoscopic findings, endometriosis is divided into Grade 1 to grade 4.Grade 1 is minimum disease,grade 2 is mild, grade 3 is moderate and Grade 4 endometriosis is severe form.

How is endometriosis treated?

The treatment of endometriosis is usually individually based, depending on the nature and severity of symptoms and the need for future fertility.

Medical treatment may reduce symptoms in 80-90% of patients but none of the treatment options has been shown to reduce recurrence of symptoms once treatment has stopped.

Pain management

The major goal of treatment is to reduce pain.There are 2 options in the management of pain one is non invasive medical line of treatment and the other is invasive surgical line of treatment.

Medical line of treatment

Non-steroidal anti-inflammatory drugsmay be effective in reducing the pain associated with endometriosis, although the evidence to date is inconclusive.Paracetamol, with or without added codeine, is an alternative.

Hormonal drugs: are equally effective: the COCP, danazol, oral or depot medroxyprogesterone acetate are as effective as the GnRH analogues and can be used long-term.Approximately 80-85% of patients improve with treatment.

Ablation of endometrioid lesions reduces endometriosis-associated pain. The smallest effect is seen in patients with minimal disease.

The levonorgestrel intrauterine system has also been shown to be effective.

Surgical line of treatment

Surgical options include removing severe and deeply infiltrating lesions (which may reduce pain related to endometriosis), ovarian cystectomy (for endometriomas), adhesiolysis and bilateral oophorectomy (often with a hysterectomy).Laparoscopic excision or ablation at the time of diagnostic laparoscopy.

The main conservative surgical techniques performed by laparoscopy are thermal or laser ablation, excision, ovarian cystectomy and denervation procedures.

Management of infertility associated with endometriosis

Medical treatment for endometriosis should be avoided for women who are trying to conceive.

In minimal-mild endometriosis, ablation of endometrioid lesions plus adhesiolysis is effective compared to diagnostic laparoscopy alone.

The use of laparoscopic surgery in the treatment of subfertility related to minimal and mild endometriosis may improve future fertility.

In moderate-to-severe endometriosis ,In vitro fertilisation (IVF) is appropriate treatment, especially if there are coexisting causes of infertility and/or other treatments have failed.

Success of treatment and side-effects

Overall, the hormone treatment options, all have about the same success rate at reducing pain.

What is the recurrence rate of endometriosis?

The natural course of the disease is variable and may or may not be progressive

In the five years after surgery or medical treatment, 20-50% of women will have a recurrence. Long-term medical treatment (with or without surgery) has the potential to reduce recurrence but there is no clear evidence for this.

Relapse following surgical treatment is common. 20% recurrence rate at two years and 40-50% at five years is known.

Effect of diet and exercise in endometriosis:

As we know there are a variety of treatments for endometriosisŸ??ranging from medications to surgeryŸ??lifestyle changes should not be neglected. We know that lifestyle changes, including what you eat and how much physical activity you get, affect estrogen-dependent conditions like endometriosis.

Unfortunately, there are very few studies on endometriosis and lifestyle focus on whether certain diets or levels of activity are connected to endometriosis.This doesn’t mean that they’re not worth a try.

Healthy diet and physical activity helps in improved immunity which inturn helps reduce inflammation in endometriosis to some extent.

The following are the lifestyle and dietary changes:

  • Following a balanced diet rich in iron, fibre and essential fatty acids (EFAs).
  • Increasing physical activity.
  • Drinking plenty of water.
  • Quitting smoking.
  • Avoiding drinking alcohol and caffeine.

VAGINAL DISCHARGE IN PREGNANCY IS IT A SIGN OF HIGH RISK PREGNANCY

PREGNANCY can be as confusing as it is elating and itŸ??s not always easy to tell which changes are normal and which are cause of concern .one such change is vaginal discharge; which can vary in consistency or thickness frequency and amount during pregnancy.

Not many women are aware that a certain amount of discharge during pregnancy is normal. It may vary time to time. It is important to monitor consistency and colour to prevent any risk to the pregnant mother and growing foetus. Early intervention and getting the specialized prenatal care for the same increases your chance of a healthy pregnancy.

What causes changes to the vaginal discharge:

As cervix and vagina softens with the ongoing pregnancy, the discharge increase in pregnancy. The babyŸ??s head may press against the cervix and often lead to increased discharge.

When is the discharge a cause to worry in pregnancy:

Lots of thin clear discharge could be amniotic fluid leak calls for an immediate visit with your clinical practitioner.

Discharge is tinged with blood and youŸ??re not yet 37 weeks then call your doctor immediately.

It smells strange and suggests infection you need to see your gynaecologist immediately.

 

PCOS – Polycystic Ovary Syndrome

Expert guidance on Polycystic Ovary Syndrome (PCOS) – Motherhood Hospital India

Classically, we thought of PCOS primarily as an infertility disorder or as a
cosmetic annoyance, but we now know it’s also a metabolic disorder and a
serious long-term health concern.

Polycystic ovary syndrome, widely known as PCOS is a condition characterised
by chronic failure of ovulation (anovulation) and excessive production of
male hormones (hyperandrogenism). It is characterised by a varied combination
of clinical (oligo/amenorrhoea, hirsutism and obesity) biochemical (increased
S.LH and androgens) and sonographic (enlarged polycystic ovaries) along with
insulin resistance and compensatory hyperinsulinemia.

The heterogeneous nature of the disease, along with lack of precise diagnostic
criteria has made the determination of true epidemiology of PCOS difficult.

Symptoms of PCOS:

  • Acne
  • Weight gain and trouble losing it.
  • Extra hair on face /chest/belly.
  • Thinning of hair on scalp.
  • Insulin resistance/Type 2 Diabetes.
  • Irregular periods/no/heavy periods.
  • Fertility issues/ not getting pregnant
  • Depression/sleep disorder/anxiety.

Tests and diagnosis of PCOS:

There is no single test to determine the presence of PCOS.A combination of medical history, physical examination, blood tests, ultrasound findings help to diagnose the same.

Treatment:

Management should consist of addressable of immediate complaints as well as planning preventive strategies for long term health sequale.

Healthy diet and exercise is the first line of treatment recommended. A 5 to 7 percent reduction of body weight over six-month period can lower insulin and androgen levels restoring ovulation and fertility in more than 75 percent of patients.

Birth control pills to regulate periods.

Diabetic medicine if necessary.

Fertility medicine if pregnancy desired.

Cosmetic treatment/spironolactone for hirsutism.

Conclusion:

Although the cause of PCOS are unclear, early diagnosis is important; if you think you may have PCOS, consult a doctor. If you have already been diagnosed, make sure to eat healthy and exercise.

Obstetrics & Gynaecology

DIET IN PREGNANT WOMEN IN FIRST TRIMESTER

A healthy pregnancy with expert advice on pregnancy diet first trimester - Motherhood Hospital India

The months of trying and fretting over conception are finally over and you can now feel part of that magical world of new parents:

Once you are pregnant, it is rather important you eat the right type of food, in right quantity, and right intervals, to ensure a healthy mother and a healthy foetus. A balanced diet, containing low carbs, high proteins, necessary vitamins, minerals, micro nutrients and antioxidants along with fats in moderate amounts is what very pregnant mother should look forward to.

Even though your doctor might have prescribed folic acid pills/supplement you still need to include folate rich foods in your diet. Foods rich in folate include enriched white rice, cooked lentils / cooked spinach, chick peas, oranges, broccoli & eggs.

Vitamin B6 is important during the first trimester as it can inhibit nausea and vomiting. Rather than taking medicines include vitamin B6 rich foods like whole grains/walnuts/bananas jowar in your pregnancy diet.

If you can digest it, milk is a wonderful source of protein, vitamins, calcium, water, healthy fats and fortified vitamin D, Dairy products like curds and yogurt can add variety to your meal.

Fruits are rich in vitamins, antioxidant, fibre and water content. They are a perfect recipe for healthy pregnancy.

Iodine rich diet like eggs, cow’s milk ,strawberry ,walnuts to ensure proper mental development of the foetus

Tips for a healthy pregnancy:

  • Aim for 5-6 meals per day
  • Eat when you are hungry & stop when your full
  • Select fruits & Vegetables from different colours of the rainbow,
  • Aim to eat all recommended groups.

Antenatal Ultrasound Scan

( KNOWING AND BONDING WITH YOUR BABY AT EVERY STAGE)

Ultrasound scan use sound waves to image your baby. The scans are completely painless and have no known side effects.

For most of the expectant mothers its very exciting to see their baby in the womb

Depending on the stage of pregnancy your doctor will offer you scan accordingly.

The scan can provide information that may mean you have to make further important decisions.

The first scan is called the dating scan or the viability scan. The purpose of this scan is:

  • Check your babies heart beat
  • Estimate the date of delivery based on the babies measurements
  • Say whether you are pregnant with one or more babies.
  • Detect where the embryo is implanted, inside the womb or outside( ectopic, usually in the fallopian tube)
  • To find out the cause of bleeding in case if you have

The next scan is usually prescribed at 11 weeks to 13 weeks of gestation .

  • This scan is usually called NT( Nuchal translucency) scan. This scan is performed to asses your baby’s risk for downs syndrome
  • To confirm the site of placental implantation
  • To asses the cervical length

The third scan offered to all women is called the anomaly scan, usually takes place between 18 to 22 week of pregnancy.

  • This scan checks for structural abnormalities of the baby
  • To examine the baby to see if all the organs are normal
  • Asses the amount of amniotic fluid
  • A Doppler scan also can be performed to study the blood flow to the baby and within the baby

An interval growth scan or a fetal well being scan can be performed in the last trimester :

  • To measure your baby’s growth rate and amniotic fluid
  • Check the baby’s weight
  • Presentation of the baby

Some are offered more number of scans depending on their health and their pregnancy

It is an opportunity for fathers also to bond with the baby.

Content Credits: Dr Elizabeth Jacob( Radiology)

Infections To Look Out For During Pregnancy

Expectant mothers are more susceptible to various viral, bacterial and other types of infections compared to regular people. Being aware and taking precautions is significant in ensuring the health of mother and baby

Pregnant women are at increased risk of acquiring infections because of the lower immunity levels.According to Dr Teena Thomas, Consultant Obstetrician and Gynaecologist at Motherhood Hospitals, it is common for pregnant women to catch infections as their immunity is generally low. Ÿ??Urinary tract Infections and conditions such as bacterial vaginosis are quite common but with the right advice and medical treatment, these types of problems during pregnancy can to resolved,Ÿ? says Dr Thomas.

At Motherhood Hospitals, doctors strive to ensure that all expectant mothers get the best quality care and assistance. All the necessary diagnostic tests are carried out for early detection of any infection and timely treatment is given for the same.

There are different types of infections that might affect women in pregnancy. These can be categorised into Ÿ??

VIRAL INFECTIONS

  1. Chicken Pox Ÿ?? This infection is rarely seen in pregnant women, as most people get chicken pox in childhood and because of this become naturally immune to the virus. But in women who have never been affected, there are chances of getting it during pregnancy. If affected by the chicken pox (varicella) virus, pregnant women are at risk of contracting pneumonia. It can be dangerous for the newborn if the virus affects the expectant mother at the end of the 1st trimester or very close to the delivery. In the first trimester, there is a one per cent chance of the baby developing a serious condition called Varicella syndrome, a rare condition in infants that results in low birth weight and certain developmental/brain abnormalities and hence may require terminations. If the mother is diagnosed with chicken pox very near to the delivery time, then there is a risk of the baby also getting infected.

Ÿ??If the non-immune expectant mother is infected nearing delivery. She can be administered the varicella zoster immunoglobin as soon as possible to minimise the effect of the infection. The infected newborn should also be administered the same immunoglobin and effective treatment for the ailment needs to be given by a team of specialists.We have had mothers with chicken pox coming in to the hospital and with timely care and treatment both baby and mother came out of danger,Ÿ? said Dr Thomas.

  1. Cytomegalovirus (CMV) Ÿ?? It is a common virus, belonging to the Herpes virus family and many people get infected by it at some point in their lives. But it rarely causes any symptoms. While CMV infection is quite rare, it can be a cause of concern in pregnancy, as 1-4 in 100 babies can get infected by the virus through their mothers. It may cause flu-like symptoms in the pregnant woman. Most infected babies donŸ??t have any problems but some may have congenital abnormalities including hearing loss, visual impairment and so on. The virus can be detected with a blood test and treated accordingly.
  1. Hepatitis B (HBV) Ÿ?? This virus is highly infectious and can be blood borne or sexually transmitted. It can cause liver problems later in life. Pregnant women who are infected by the virus can pass it on to the foetus. So babies at risk should be immunised at birth with HBV vaccine as this is 90-95 per cent effective in preventing the disease.

Ÿ??We screen expectant mothers for HBV as part of the antenatal care and if found positive, appropriate treatment is given,Ÿ? adds Dr Thomas.

  1. Hepatitis C Ÿ?? This virus is also passed on through the blood or sexually transmitted. If the mother passes on the infection to the newborn, medical assessment needs to be done and care is provided.
  2. Herpes Ÿ?? This viral infection can be of different kinds, most commonly oral herpes and genital herpes. Primary genital herpes is diagnosed by actively present blisters and ulcers in the vaginal area particularly dangerous for the baby and it can be passed on during a vaginal delivery. Normally, doctors advise a Caesarean section delivery to prevent transmission.
  3. HIV Ÿ?? A test for the virus is offered as part of antenatal care to all mothers. An HIV positive pregnant woman can pass on the infection to her baby. Ÿ??But constant monitoring and active treatment from 28 weeks of pregnancy, apart from an elective C-section can bring down the risk of transmission. Late booking patientŸ??s treatments can also be commenced at 36 weeks in labour.After birth also the baby is monitored for some time to rule out transmission,Ÿ? says Dr Thomas.
  4. Parvovirus Ÿ?? This is rare type of virus but if there is primary infection during pregnancy, the expectant mother might have mild rash and fever. Some complications of Parvovirus include miscarriage or the fetal anaemia. There is a test to diagnose the infection and can be treated with medications and requires fetal monitoring.
  5. Rubella Ÿ?? It is a contagious infection caused by the Rubella virus which causes fever, rashes, sore throat and swollen glands. In India, rubella infection is very rare as it is part of the standard immunisation plan. But Primary Rubella affects the mother in the first half of pregnancy it can lead to serious complications in the baby including blindness and mental retardation. In the later part of the pregnancy, it can result in pre-term labour.

Ÿ??We had a young mother who was diagnosed with Rubella at 28 weeks of pregnancy through a test. She was monitored carefully by the hospital and all necessary care was taken. She went into preterm labour and birth and the baby weighed only 1.1 kg. But with good care in the NICU, the baby went home healthy,Ÿ? recalls Dr Thomas.

PARASITIC

Toxoplasmosis Ÿ?? This is the most common parasitic infection seen during pregnancy and is caused by the parasite Toxoplasma gondii, found in cat faces. If the pregnant mother comes in contact with the parasite, by handling cat litter or eating raw contaminated food, there is a risk of passing it on to the foetus. The infection is dangerous in pregnancy as it can cause stillbirth, miscarriage and congenital abnormalities in the baby. Such infections can be easily prevented by taking necessary precautions but if the pregnant woman is found to be infected, antibiotic medications are administered till delivery.

BACTERIAL

Urinary tract infection (UTI) Ÿ?? The most common infection in pregnancy, it is an infection of the urinary tract caused by bacteria which causes burning sensation, fever and chills.Most women are checked for UTIs during antenatal screening and treated accordingly, Asymptomatic bacteria (without symptoms) also needs to be treated. It can cause complications such as low birth weight and preterm labour .

Bacterial Vaginosis (BV) Ÿ?? This is an infection caused by overgrowth of hormonal commensal bacteria of the vagina and is typically characterised by fishy odour in the vaginal discharge. BV in pregnancy can lead to complications such as preterm labour, miscarriage and premature rupture of the membrane and hence requires prompt treatment with Antibiotics.

Group B Streptococci Ÿ?? This is a bacterial infection that is mostly asymptomatic but in some pregnancies, it can cause serious complications in the baby. It results in preterm labour and premature rupture of membrane.

All the three bacterial infections can be treated successfully with antibiotics.

Sexually Transmitted Diseases (STDs) Ÿ?? There are a few common sexually transmitted diseases such as Gonorrhoea and Chlamydia that when present in a pregnant woman can cause problems. Complications include preterm labour, miscarriage & new-born infections. STDs should be diagnosed and detected early and treated with medications.

HOW TO PREVENT INFECTIONS

Sometimes a little bit of care and sound advice from the gynaecologist can go a long way in preventing harmful infections during pregnancy.

According to the Centers for Disease Control and Prevention, simple measures can prevent infection. These include Ÿ??

  1. Washing your hands often especially after touching raw food and meat, using the bathroom, playing with children, touching dirt and soil
  2. Avoid eating uncooked food and raw and processed meat.
  3. Drink lots of water to prevent UTIs. (around 2.5 l/ day)
  4. Stay away from animal droppings and cat litter.
  5. Get checked for infections such as HIV, STDs and Hepatitis B
  6. Make sure to get vaccinations
  7. Healthy diet and lifestyle remains till date the key to prevent it.

Content Credits: Dr Teena Thomas (Obstetrics & Gynaecology)

CERVICAL CANCER

Introduction

Cervical cancer is one of the commonest causes of cancer-related deaths amongst women in developing countries. Every year in India, 122,844 women are diagnosed with Cervical cancer and about half of them die due to this fatal disease. Worldwide, Cervical cancer accounts for 500,000 new cases every year and India contributes nearly 25%.

Who are prone to Cervical cancer?

The median age of diagnosis for women is 48 years, and the majority of cases are diagnosed between 35 and 55 years when women are in the prime of their lives.

What causes Cervical cancer?

Long-term use of hormonal contraceptives, high parity, early initiation of sexual activity, multiple sex partners, tobacco smoking and co-infection with HIV, immunosuppression, low socio-economic status, poor hygiene and diet low in antioxidants increase the likelihood of developing Cervical cancer

There is a firm establishment of a causal relationship between persistent infection with high-risk Human PapillomaVirus (HPV) genotypes and Cervical cancer.

HPV infection occurs in a high percentage of sexually active women. Most of these infections clear spontaneously within months to a few years, a small proportion of persistent infection will progress to cancer.

Symptoms

The first symptom is abnormal vaginal bleeding, usually postcoital. Vaginal discomfort, malodorous discharge, and dysuria are common symptoms.

The tumor grows by extending upward to the endometrial cavity, downward to the vagina, and laterally to the pelvic wall, who can then present with constipation, hematuria, vaginal fistula.

How can it be prevented?

Primary prevention involves intervention for sexual and health care-seeking behavior or through mass immunization against high-risk HPV.

The objective of Cervical screening/secondary prevention is to prevent invasive Cervical cancer from developing by detecting and treating women with precancerous lesions, and the effectiveness is determined by reduction in incidence and mortality.

What is screening and how is it done in Cervical cancer patients?

There are 2 types of tests used for Cervical cancer screening.

The PAP test can find early cell changes and treat them before they become cancer. The Pap test can also find cervical cancer early when it’s easier to treat.

The HPV (Human Papilloma Virus) test finds certain infections that can lead to cell changes and cancer. HPV infections are very common.

American Cancer Society recommends all women should begin Cervical cancer screening at the age of 21 years. Women between 21 and 29 years should have a PAP test every 3 years. Women between the age of 30 and 65 should have both a PAP test and an HPV test every 5 years or a Pap test alone every 3 years.

Women over age 65 who have had regular and normal results should not be screened. Women who have been diagnosed with Cervical pre-cancer should continue to be screened.

Women post hysterectomy who have their cervix removed need not to be screened.

Women who have had the HPV vaccine should still follow the screening recommendations for their age group.

Cervical cancer vaccination

Two vaccines licensed globally are available in India; a quadrivalent vaccine (Gardasil ) and a bivalent vaccine (Cervarix )

The recommended age for initiation of vaccination is 9 12 years. A total of three doses at 0, 2 and 6 months are recommended with Gardasil or 0, 1 and 6 months with Cervarix .

Treatment

The treatment of Cervical cancer varies with the stage of the disease. For early invasive cancer, surgery is the treatment of choice. In more advanced cases, radiation combined with chemotherapy is the current standard of care.

Preterm labor – be on the alert By Dr. Beena Jeysingh

Preterm labor is when your body gets ready for birth too early in your pregnancy. It is premature if it starts earlier than 3 weeks of due date.

Risk factors are overweight or underweight at time of conception, hypertension, diabetes, smoking, alcohol, pregnancy induced hypertension, gestational diabetes, uterine abnormalities, previous history of preterm delivery, any severe maternal infection. Report to obstetrician if severe backache, cramping in lower abdomen, fluid leaking from vagina, vaginal bleeding.

Preterm birth is the most important single determinant of adverse infant outcome hence prevention and early detection is important.

By
Dr.Beena Jeysingh

Morning Sickness -don’t fear! By Dr. Beena Jeysingh

It is an uncomfortable feeling of just nausea or nausea with vomiting experienced in the early
weeks of pregnancy due to hormones. About 50 percent of pregnant women experience it.
Usually starts around 6weeks of pregnancy and disappears by end of 3months though rarely can
stay until end of pregnancy. Report to obstetrician if excess vomitting, less or dark color urine,
blood in vomitus. Management is by intake of frequent small feeds and in severe cases
medications to reduce vomiting.

By

Dr.Beena Jeysingh