Medical Ectopic Pregnancy

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Ectopic pregnancy (EP) is a pregnancy situated outside the uterine cavity (normal location). Early diagnosis of EP is possible with the advent of high resolution ultrasound and judicious use of serum Beta hCG levels (blood test), which in turn allow medical management in most cases. The choice of treatment should be guided by eligibility criteria and patient’s choice after discussing risks and benefits. Methotrexate (MTX) is the drug used for medical management of EP, sometimes in combination with mifepristone.

EctopicPregnancy

Pic courtesy:  http://www.innercircle.org/


Prerequisites for Medical Management

  • Asymptomatic women with unruptured EP who are clinically stable, have normal baseline blood investigations (blood counts, liver and kidney function tests) and are willing for regular follow-up for 4-6 weeks, can be offered medical management.
  • High serum Beta hCG levels (> 3500 mIU / ml), ectopic mass size > 3.5 cm and / or presence of cardiac activity in EP are relative contra indications to medical management.
  • It should not be offered to those with significant bleeding into the abdomen or those with a coexisting viable intrauterine pregnancy.

Methotrexate Administration

Two protocols are currently used for medical treatment of EP : “Single Dose” MTX therapy at a dose of 50mg/m2 of body surface area and “Multidose” regimen consisting of 1mg / kg of MTX alternating with 0.1mg / kg of leucovorin for upto 4 doses of each agent. Both regimens are found to be effective.

  • MTX can be given on Out Patient basis and intramuscular administration is the preferred route.
  • Multidose regimen is preferred in women with high serum Beta hCG levels or those with presence of cardiac activity on ultrasound. In the single dose regimen, further doses of MTX may be repeated (upto a maximum of 3) if there is an inadequate response (<15% drop in serum Beta hCG).
  • In the single dose regimen, further doses of MTX may be repeated (upto a maximum of 3) if there is an inadequate response (<15% drop in serum Beta hCG).

Laparoscopy is indicated if :

  • Severe abdominal pain or signs suggestive of tubal rupture develop.
  • There is no satisfactory drop in serum Beta hCG levels even after 3 doses in the single dose regimen or 4 doses in multidose regimen.

Anti D:

Regardless of the method of treatment Anti D should be given to all Rh negative women who have an EP.

Patient Should Be Advised To

  • Avoid sexual intercourse until Beta hCG is <10 mIU / ml.
  • Avoid pregnancy for three months after MTX injection, due to the theoretical risk of birth defects with MTX.
  • Avoid sun exposure to limit risk of MTX dermatitis.
  • Avoid foods and vitamins containing folic acid.

Post Treatment Management

Beta hCG  — Serial serum Beta hCG levels need to be checked on days 4 and 7 after MTX.

  • If there is >15% decrease between days 4 and 7, weekly follow up is advised until Beta hCG is <10 mIU / mL.
  • If <15% decrease is noted by day 7, 2nd dose of MTX is advised.
  • In multidose regimen, serum Beta hCG levels are checked every 48 hours till significant decrease is noted and weekly thereafter.

Ultrasound — It is generally not repeated except to evaluate severe pain or suspected rupture or for patients with cardiac activity in the EP.

After completion of treatment, an ultrasound is advised to check for resolution of the EP which may take upto 3 months at times.

Efficacy

  • Overall success of medical management is 88 – 90%.
  • Around 14% of patients require a 2nd dose and less than 1% of women require more than 2 doses of MTX.

Side Effects

Drug related

Adverse reactions to MTX are usually mild and self-limited. Approximately 30% of patients in the single dose protocol will experience side effects, the most common are mouth ulcers and conjunctivitis.

Separation pain

Up to 75% of patients may complain of pain between days 2-7 after receiving the medication. This pain is usually mild and can be managed with paracetamol. Women with severe pain require further evaluation to rule out rupture of EP and the need for surgery.

Subsequent Reproductive Performance

  • There is no evidence of adverse effects of MTX treatment on future pregnancies.
  • Studies have shown a subsequent intra uterine pregnancy rate of 60-90%.
  • The incidence of recurrent EP is approximately 7-15%.
  • Women should be instructed to undergo an early ultrasound evaluation in subsequent pregnancies to confirm normal intrauterine location.

Colposcopy

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What is Colposcopy ?

Colposcopy is a detailed examination of the cervix (neck of the womb). A colposcope is like a large magnifying glass which magnifies the image to approximately 15 times. It allows the doctor to look more clearly at cell changes in the cervix.

Colposcopy is simple, quick and generally painless. The actual examination takes only about 15 minutes. It is not done during menses. It can be done safely during pregnancy and will not affect delivery of the baby. However, treatment is usually postponed until after delivery.

Colposcopy

Pic courtesy:   http://dronuma.com.au/cervical-smears-colposcopy/

Why do I need a colposcopy ?

Colposcopy is usually indicated when the routine cervical screening test i.e. Pap smear test, has picked up abnormal cells from the cervix.

An abnormal result is not unusual – it happens in about one in twenty tests. An abnormal result usually means that small changes have been found in the cells on the cervix. It is important to remember that it is very rare indeed for these abnormalities to be cancer.

Colposcopy identifies the source of the cell change and helps to decide on further treatment. It is not a treatment by itself.

What exactly happens during a colposcopy ?

A speculum is passed into the vagina and the doctor applies different solutions onto the cervix to help identify and highlight any areas with abnormal cells. The abnormal areas will appear white after the application of vinegar (acetic acid 3 – 5 %). An iodine based stain may also be applied to the cervix to look for other abnormal areas. If any abnormal area is identified, a small sample of tissue (few mm in size) may be taken from the surface of the cervix for a biopsy. This is usually not painful.

It is necessary to wait for the biopsy results before deciding on further treatment. For some women the changes in the cervix return to normal by themselves. Other women may need some simple treatment.

What happens after colposcopy ?

After a colposcopic examination, normal activity can be resumed. If a biopsy has been taken, a light bloodstained discharge may occur for a few days following the procedure. This is normal and should clear by itself. It is best, however, to refrain from intercourse for up to five days to allow the biopsy site to heal.

Follow up

A review appointment with biopsy report will be scheduled in a week to 10 days’ time. Depending on the results of the biopsy, further treatment may be advised if required, or, one may be asked to return for a repeat pap smear in 6 months or routine screening.

Treatment options

If the biopsy warrants treatment, further procedures may be needed. Types of treatment vary, but all aim to destroy (cryotherapy) or to remove (loop excision) the abnormal cells. These treatments can be performed on an out-patient basis under local anaesthesia or under general anaesthesia.

Cryotherapy involves destruction of abnormal tissue by freezing it with nitrous oxide. It is a relatively painless procedure which takes around 15 to 20 minutes. After the cryotherapy, the frozen cells will slough off and new cells will grow underneath.

In loop excision, a small heated fine wire loop is used to remove the abnormal area from the cervix under local or general anaesthesia, and a sample is sent for analysis. The procedure may take around 20 to 30 minutes.

What happens after the treatment ?

Following cryotherapy, there may be watery vaginal discharge for 3 to 4 weeks.

Following loop excision, bloodstained vaginal discharge may be noticed for about two weeks, although it can last for 4 to 6 weeks.

The discharge should not be heavier than normal menses and should get progressively lighter. Abstinence from sexual intercourse is advised for six weeks. Follow-up is scheduled six weeks after cryotherapy or two weeks after loop excision.

Cervical Cancer

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Cervical Cancer CAN be avoided

The thought of cervical cancer is a particularly alarming one for all women, since no one knows exactly how it is caused. Many factors appear to be involved and not all of these will be present for every woman.

CervicalCancer

Pic courtesy:   http://www.healthcare-online.org/Cervical-Cancer-Symptoms.html

Why have a Cervical Smear Test?

Cervix is the lowermost part of the uterus. If detected early, the majority of cervical cancer cases can be avoided and the disease can be halted. Unfortunately, during the early stages there are no signs to tell a woman that she may be at risk. One of the simple ways to detect it, is by having a cervical smear test (also called a PAP SMEAR). Once it is discovered, treatment to counteract can be initiated. The early warning signals can be detected, which if left untreated could lead to cancer.

What is a Cervical Smear Test?

A smear test is a very simple way of checking the health of the cervix. By looking at the smear, experts can confirm if the cervix is normal and healthy, or abnormal. Presence of abnormal cells suggests cancer may develop in the future.

When to have the Smear Test?

  • Women between the ages of 20 – 60 years should do the test every 3 years.
  • Women who have excess / recurrent attacks of vaginal discharge or bleeding after sexual intercourse should do the test, regardless of their age.
  • It should be done within 10 days of the onset of periods.
  • There should be no bleeding at the time of the test.

How is a Smear Test done?

The smear test is a simple out patient procedure where the gynaecologist scrapes some of the cells from the cervix (the neck of the uterus), and smears it on a glass slide and sends it to the lab for examination.

What happens after the Test?

It takes 3-4 days to get the results from the lab. If the smear test is normal, (as it is in a majority of cases), then it should be repeated after 3 years.

If the test discloses some “abnormalities”, this usually means that some changes have occurred in the cells, which, if left untreated, could develop into cancer after many years. Remember, most women who have had an abnormal smear test are successfully treated.

Once treatment is started, it will be necessary to repeat the test after some months. If the subsequent smear tests are normal, then the tests should be done every 3 years.

If, however, the subsequent smear tests are not normal and continue to show some abnormalities, then it will be necessary to investigate further.

One of the easiest and most accurate ways of studying the cervix and confirming the disease is by undergoing a Colposcopy.

Cervical Cancer

Colposcopy?

Colposcopy is an in-depth examination of the cervix, through a special microscope called a colposcope. A colposcope acts like a magnifying glass with a light and allows the doctor to have a closer look at the cervix.

What happens during Colposcopy?

A Colposcopy examination is an out patient procedure, just like the smear test. A solution is applied to the cervix, which will cause any problem areas to turn white. The cervix is then viewed through the colposcope, which is placed just outside the vagina. If there are any abnormal areas on the cervix, a tiny sample of tissue is taken (biopsy) and sent to the lab for further testing.

After Colposcopy

There is no need for an overnight stay in the hospital after a Colposcopy. As mentioned earlier, it is an out patient procedure. If some tissue is taken from your cervix, you may experience some mild cramping or light bleeding for a few days, which can be relieved by any anti-inflammatory medication. It is advisable to abstain from sexual intercourse for a few days after a biopsy.

he results of the biopsy will determine the course of action to be taken. Feel free to talk to your gynaecologist about the type of treatment, the duration, and the options available.

Cervical Cancer

Prevention of Cervical Cancer (HPV Vaccine)

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What is HPV ?

HPV (Human Papilloma Virus) is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in late teens and early 20s.

There are many strains (types) of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers – like cancers of the anus, penis, vagina, and vulva (area around the opening of the vagina) and oropharynx (back of throat including base of tongue and tonsils). Other types of HPV can cause warts in the genital areas of men and women. These genital warts are not life-threatening. However, they can cause emotional stress and the treatment can be very uncomfortable.

HPV1

Pic courtesy:  http://www.virology.wisc.edu/virusworld/viruslist.php?virus=hpv

Why are HPV vaccines important ?

The vaccines target the HPV types that most commonly cause cervical cancer. One of the two currently available vaccines also protects against genital warts caused by HPV. Both vaccines are highly effective in preventing specific HPV types.

What is the vaccination schedule ?

The schedule is three doses of intramuscular injections, administered over a period of six months.

Who needs to get vaccinated ?

HPV vaccination is recommended for girls and women (9 to 45 years of age).

Can pregnant women take the vaccine ?

The vaccines are not recommended for pregnant women. Although studies show that HPV vaccines do not cause problems for babies born to women who received HPV vaccination when pregnant, more research is still needed. If the patient becomes pregnant in the middle of the vaccine series, then the doses should be completed after delivery. Vaccination can be given during breastfeeding.

Should girls and women be screened for cervical cancer before getting vaccinated?

Girls and women do not need to get an HPV test or Pap test to find out if they should get the vaccine. However it is important that women continue to be screened for cervical cancer, even after getting all three shots of the HPV vaccine.

How effective is the vaccination ?

It is a prophylactic vaccine. As with any vaccine, a protective immune response may not be elicited in all cases. The vaccines are less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccines can prevent HPV only before a person is exposed to it. HPV vaccines do not treat existing HPV infections or HPV-associated diseases.

How long does the vaccine protection last ?

Research suggests that the vaccine protection is long-lasting. Current studies (with up to about seven years of follow-up data) indicate that the vaccines are effective long term, with no evidence of decreasing immunity.

Do the vaccines protect against all HPV types ?

The vaccines do not protect against all HPV types. They are ineffective in about 30% of cervical cancers. It is important, therefore, for women to continue regular screening (Pap tests) for cervical cancer.

How safe is the vaccine ?

Both vaccines have been licensed by the Food and Drug Administration (FDA) and approved by Centre for Disease Control (CDC) as safe and effective. Common mild adverse events reported during these studies include pain at the injection site, fever, dizziness and nausea.

In what other ways can women prevent cervical cancer ?

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early treatable stage. There are HPV tests, which may be used with the Pap test in certain cases, to help determine the next step in cervical cancer screening. Use of condoms and limiting the number of sexual partners may lower the chances of getting HPV.

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early treatable stage. There are HPV tests, which may be used with the Pap test in certain cases, to help determine the next step in cervical cancer screening. Use of condoms and limiting the number of sexual partners may lower the chances of getting HPV.

Breast Cancer – Early Detection And Prevention

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Breast cancer is now becoming the most common cancer in women in India. For the year 2015, there will be an estimated 1,55,000 new cases of breast cancer and about 76,000 women in India are expected to die of the disease. The gap only seems to be widening, which means, we need to work aggressively on early detection. (Statistics of Breast Cancer in India: Global Comparison)

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Pic Courtesy: http://www.discussingbreastcancer.com/breast-cancer-prevention-and-early-detection-tips/


Tips for prevention and early diagnosis

Exercise :

Women who exercise about 30 minutes, three to four times a week, can decrease the risk of breast cancer by 26%.

Breastfeeding Your Child :

Women who breastfeed their children will have reduced risk of breast cancer.

Maintaining Weight :

Women who gained 25 kgs above what they weighed after the age of 18 have 45% risk of developing breast cancer compared to women who maintained their weight.

Weight Loss After Menopause :

Women who reduced 10 kgs after menopause compared to pre-menopause weight also reduce their risk of developing breast cancer by 45%.

Avoid Alcohol :

Women who have 1 or 2 alcohol drinks a day increase their risk of breast cancer by 10%. Even moderate alcohol intake increases endogenous estrogen levels and provide a potential mechanism for breast cancer development.

Regular Screening After Age 40 :

Breast cancer, if detected early, can be cured completely. Monthly breast self-examination, yearly medical check and mammogram will detect cancer in its early stage. Monthly breast self-examination should start as early as in teens.

Eating Right :

A plant-based diet of at least two cups of a variety of vegetables or fruits is beneficial. There is evidence that minerals, vitamins, and phytochemicals in plant foods interact in different ways to boost an individual’s anticancer effects.

The top picks for cancer prevention include beans, berries, cruciferous vegetables (broccoli, cauliflower, cabbage, brussels sprouts), dark leafy green vegetables (spinach, mustard greens etc), flaxseed, garlic, grapes/grape juice, green tea, soy, tomatoes and whole grains.

Central Obesity :

Excess belly fat seems to be particularly harmful, most likely because of its effects on inflammation and its association with elevated insulin levels. So if you tend to be more “apple shaped” and carry extra weight in your belly, it is especially important to lose weight. Exercise regularly, and limit refined grains, sugar sweetened beverages, and added sugar in your diet.

How To Do Breast Self-Examination

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Why Do  Breast Self-Examination

There are many good reasons for doing breast self-examination each month. It is easy to do. When you get to know how your breasts normally feel, you may be able to feel any changes. With practice, it should take about 15 minutes each month. Early detection of likely cancerous lumps is the key to successful treatment and cure.

Look for Changes

Look for changes in front of a mirror. View the front and each side in three positions. Relax arms at your sides. Look for changes in shape, colour, or any puckering, dimpling, skin changes or nipple discharge.

BreastExamination1

Raise hands above your head. Check again for puckering, dimpling and skin changes.

Place hands on hips, press down, and bend forward. Check nipple direction and general appearance.

Palpation Technique

Use the pads of the middle three fingers of each hand to examine the breast on the opposite side. Do not use fingertips. Keep fingers together.

BreastExamination2

Move fingers in small circles, using the three levels of pressure in each spot. Keep fingers, knuckles, and wrists straight. “Walk and slide” finger pads along so no breast tissue is missed.

Feel for Changes Lying Down

Pressure : Lumps can occur at any depth. Use three levels of pressure to examine each spot thoroughly.

Light : Use very light pressure on the first circle. The pressure should be just enough to move the skin without disturbing the tissue underneath. Pressing too hard at first could cause the lump to move out of the way.

 BreastExamination3

Medium : On the second circle, use medium pressure to feel for changes below the surface up to the mid-level of the breast tissue.

Deep : On the third circle, check for lumps deep in the breast tissue.

Pattern :  Use a vertical strip pattern to check the entire breast area. Imagine mowing a lawn with straight, vertical, overlapping rows. When you reach the end of each row, move over about one finger width and start the next row.

Once you start, do not lift fingers from the breast area. Be sure to examine the nipple with the same palpation technique you use to examine the rest of the breast tissue. The area to be examined includes sides, top and bottom of the breast. Sides include the line from the middle of the armpit (axilla), the area beyond the breast fullness, down to the bottom bra line and over to the middle of the breast bone.

BreastExamination4

The top starts after a two finger gap above the collar bone. Two finger-widths below the bra line indicate the bottom of the breast.

Check the Lymph Nodes

Lymph nodes drain the breast tissue. The lymph nodes that drain the breast tissue are located in three spots :

  • Above your collar bone—
  • Below your collar bone
  • In the armpit you will want to know if any nodes are enlarged, movable or unmovable

Position for Examination

BreastExamination5

Position 1 :  Spread the breast tissue evenly over the rib cage. Turn on your side with the knee bent. Lean the shoulder back towards the outside (away from your hip) and put your hand on your forehead. Place a pillow under your lower back to make it more comfortable. You are in the right position when your nipple seems to “float” at the top of the mound of your breast tissue.

BreastExamination6

Position 2 :  When the search pattern reaches the nipple, hold fingers in place on the nipple and roll back into a position. Lie flat on your back. The arm on the side being examined should now be extended directly away from the body (at a right angle).

When to Do Breast Self-Examination?

The best time to do breast self-examination is right after your periods, when the breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, choose a day and do it the same time every month.

Remember the ABCs of Breast Health

  • A Screening mammogram
  • Breast self-examination
  • Clinical breast examination

Breast self-examination can save your life. Most breast lumps are found by women themselves or their partner. Most lumps in the breast are not cancerous. Any lump or change should be checked by a doctor.

Early detection is your best protection!

Cerclage

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Cerclage is a procedure wherein a suture (stitch or tape) is placed around the cervix (neck of the womb) in a purse string manner to keep the mouth of the uterus (womb) closed and avoid miscarriage. The exact cause of premature labour or late miscarriages is not clear, but they may be caused by changes in the cervix such as shortening and opening. A cervical suture helps to keep the cervix closed.

Cerclage

Pic courtesy: https://alittlebitofcancer.wordpress.com/tag/transabdominal-cerclage/

 

Types

Cerclage may be done using a suture or a tape.

  • Vaginal route – McDonald or Shirodkar
  • Abdominal route – open or laparoscopy

Shirodkar or abdominal cerclage may be advised in women who had a previously failed McDonald cerclage.

Indications

Planned (Elective): Women with previous second trimester pregnancy losses or prior cervical surgeries such as conisation/LLETZ (history-indicated) or short cervix on ultrasound examination (USG-indicated).

Rescue (Emergency): When the cervix is found to be open incidentally and the bag of membranes is exposed to the vagina.

Timing

  • It is usually done after 3rd month scan (NT scan) between 12 to 16 weeks of pregnancy.
  • It can be done laparoscopically in the interval period between pregnancies.

Hospital Stay

It can be done under regional (epidural or spinal) or general anaesthesia. The hospital stay may be 12 to 24 hours for vaginal cerclage and up to 3 days following open abdominal cerclage.

Complications

During Procedure

  • Bleeding
  • Bladder injury
  • Rupture of membranes and fluid leak

Post Procedure

  • Risk of miscarriage/premature labour
  • Infection (more for rescue cerclage)

Post Cerclage Care

Bleeding can be expected for a few days after the procedure. Physical strain and sexual intercourse must be avoided in the initial few days of recovery. Complete bed rest is not recommended. Routine antenatal care should be continued as advised.

Removal

For Vaginal Cerclage:

The suture has to be removed at 36-37 weeks of pregnancy and vaginal delivery can be allowed.

For Abdominal Cerclage:

Delivery is by planned Caesarean section at 38 weeks and the tape may be left in situ for future pregnancies. Removal of the tape may be advised in cases of premature labour, leaking/bleeding per vaginum or fetal demise, which would require additional procedures under anaesthesia.

STEM CELLS – Frequently Asked Questions

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Q. What are stem cells?
A. Stem cells are the master cells of our body from which all the other 250 types of cells are formed. The umbilical cord blood mainly contains hematopoietic or blood cell forming stem cells i.e., stem cells that form Red Blood Cells, White Blood Cells and platelets.
Stem1

Pic courtesy:  http://nas-sites.org/stemcells/stem-cell-basics/download-stem-cell-figures/

Q. In what conditions can stem cells be used?
A. As of now, stem cells have been used to treat almost 70 blood related diseases. Some of them are blood cancers like Leukemia and Myelo-proliferative disorders, Inherited Red Cell abnormality like Thalassemia, Immune-deficiency disorders and inherited metabolic disorders.

Q. What is the difference between Public Cord Blood Banking and Private Cord Blood Banking?
A. In public cord blood banking, there is no cost to the family concerned. The family donates their baby’s cord blood to the bank for future use by any Indian, subject to HLA compatibility or for research purposes. The cells belong to the bank and the family has no claims on the cells.

In private cord blood banking, the family pays a fee for storing their baby’s cord blood ONLY for their future use. The cells belong to the family.

Q. What is the rationale for public banking?
A. When the stem cells are donated, these cells can be made available to anyone across the world who is a perfect HLA match. Hence the likelihood of usage is much more, especially for Indians in any part of the globe as these HLA proteins are similar in people of the same ethnic origins.

Q. Does collecting cord blood affect the baby?
A. No. Cord blood is collected only after the birth of the baby and after clamping of the umbilical cord. The baby is in no way deprived of blood as the routine process of delivery is not interfered with in any way.

Q. Does the cord blood collection harm the mother?
A. No, it does not harm the mother in any way. It is a completely safe, harmless and painless procedure.

Q. Can all pregnant women donate cord blood?
A. Every healthy pregnant woman who has a normal pregnancy and a healthy foetus can opt to donate the cord blood of her baby.

Q. Will a blood sample be collected from the mother?
A. Yes, a sample from the mother will be collected at the time of onset of labour.

Q. What is HLA testing?
A. HLA or Human Leukocyte Antigen testing is the test for specific proteins that are present on the surface of the leukocyte (white blood cell). If stem cells from one individual have to be used for another person, the HLA types of the donor and recipient need to match.
Stem2

Pic courtesy: http://www.stemcellclinic.com/scientists-learned-how-to-expand-successfully-cord-blood-stem-cells/?lang=en

Q. How do I benefit from donating my baby’s cord blood?
A. Your cord blood donation will help the public cord blood bank to create a large inventory of tested stem cell units ready for transplant and thus increase the chances of finding a match. In the unforeseen event of any of your children needing a unit of stem cells for treatment of any haematological diseases, the public cord blood bank will make all efforts to find a best match available. In such an instance, you will only have to pay any additional testing charges and cost of transportation of the unit to the place of treatment.

Q. What are the chances that any one of us may need stem cells?
A. For a family to make use of the cells banked for itself, the likelihood varies from 1 in 400 to 1 in 200,000, as the usefulness is limited to the close family alone. Most of the childhood illnesses and cancers have a genetic basis and as the stem cells will carry signs of any genetic illness, the likelihood of the child using its own stored cells is also very remote.

Q. What happens if I donate to the public bank and then I need the stem cells myself?
A. If the cells you have donated are required for anyone else, the public bank shall issue these cells and keep you informed. If the cells are still with the bank, they will make them available to you at a concessional cost. This cost is for any additional testing and transport of the cells to the transplant site.

Q. What if there are twins?
A. Ideally, 70 ml or more cord blood is required to get adequate numbers of stem cells for transplant. In twin pregnancies, the volume of cord blood collected from each twin is appreciably less, as the weight of each twin is also less than an average weight of a newborn. Hence only in rare instances is cord blood collection in twin pregnancies encouraged.

Healthy Habits for Women to Start

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Today’s women have become career achievers and also manage to cope with family responsibilities efficiently. However, they neglect health issues and seek help only when they have complications and medical conditions which are difficult to treat. Incidences of obesity, diabetes, hypertension, vitamin D deficiency, thyroid disorders, heart diseases and cancers have increased tremendously. Sedentary lifestyle, increasing stress and fewer children have contributed to rising health problems in women.

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Pic courtesy:  https://www.focusforhealth.org/stay-informed-stay-healthy/

Obesity

In the National Family Health Survey in 2007, Punjab ranked first in order of percentage of obese / overweight women with an incidence of 37.5% followed by Kerala at 34% and the erstwhile Andhra Pradesh at 22.7%.

Diabetes

Incidence of diabetes in Indian women is rising alarmingly. Approximately 29 million women are affected by high blood sugar. Women with diabetes still play a ‘caretaker role’ in the family and prioritise the health of others above their own. At a disadvantage compared to men, women have unequal access to resources preventing early diagnosis of the disease.

Hypertension

Since hypertension is easy to diagnose but not easy to treat, a few blood pressure recordings can confirm the disease and the treatment can be initiated early to prevent complications. The number of women affected by high blood pressure is very high – 17% as per one study in India and 22.6% in a WHO report on Indian women.

Vitamin D Deficiency

Vitamin D deficiency and reduced bone mineral density is widespread. Vitamin D deficiency is a common problem in India due to several factors:

  • Changing food fads and habits contribute to low dietary calcium and vitamin D intake.
  • With modernization, the number of hours spent indoors has increased thereby preventing adequate exposure to sun. This is particularly true in urban Indians.
  • Increased pollution can hamper the ultraviolet rays to adequately synthesize vitamin D in the skin.
  • Cultural and traditional habits prevalent in certain religions like “burqa” and the “pardah” have been well known to be associated with vitamin D deficiency.
  • Repeated and unplanned, and unspaced pregnancies in dietary deficient patients can aggravate vitamin D deficiency in the mother and the fetus.

Thirty minutes exposure of the skin on the arms and face to sunlight, without application of sunscreen, preferably between 10 am and 2 pm daily (as maximum ultraviolet B rays are transmitted during this time) is adequate to avoid vitamin D deficiency. An Indian study looked at 25-hydroxy Vitamin D and BMD in women of reproductive age group and post menopausal women in South India. They have reported vitamin D deficiency in 76% women of reproductive age, 70% in post menopausal women, and insufficiency in 16.5% in women of reproductive age and 23% in post menopausal women.

Thyroid Disease

Thyroid disease prevalence in women is high and the disorder mostly affects older women, especially the ones with hormonal imbalances, such as the one occurring around menopause, or during pregnancy etc. But in recent times, however, the incidence of thyroid disorders among urban women in their early 30s, has increased and is on the rise. Almost 30% – 35% of women belonging to this age group are affected.

According to clinical data, the current trend of abnormal thyroid status in younger women is because urban young women though highly educated, in an attempt to enhance their career or in order to follow the modern lifestyle, tend to neglect their health to a critical extent. Not only their diet is improper with deficiency in iodine, it is also unbalanced from the perspective of adequate and accurate nutrition. They also lack the required physical activity appropriate for their age.

While they are in hot pursuit of their career, leading to a stressful lifestyle, there sets in a scenario where these women tend to turn a blind eye to symptoms such as obesity, failure to lose weight, tiredness, bodyache, mood swings, excessive hairfall, balding scalp, irritability, menstrual disorders, difficulty in conception, repeated miscarriages etc., which typically point towards medical disorders, of which thyroid related ailments are the most common presenting with such symptomatology.

Diabetic women are more prone to a disturbed thyroid profile. Also, over-burden of toxins (endocrine disrupting toxins) caused by pollution through air, water, and food add to complications. An early diagnosis goes a long way in preventing these serious health disorders.

A change in lifestyle like a healthy diet, exercise, proper nutrition and stress reduction can help minimise the chance of developing thyroid disease. Sea kelp, selenium, flaxseed oil, zinc, multi-vitamins, etc can help in hypothyroid cases.

Heart Disease

Diagnosis of heart attacks in women is late because classic heart attack symptoms as in men are absent, but many experience vague or even “silent” symptoms which they will miss. There are six symptoms which are common in women –

  1. Chest pain or discomfort which may feel like a squeezing or fullness
  2. Pain in your arm(s), back, neck, or jaw
  3. Stomach pain
  4. Shortness of breath, nausea, or lightheadedness
  5. Sweating
  6. Fatigue

Heart disease is now the leading cause of death in women. There is a lack of information about the prevention and management of atherosclerotic heart disease in women from a range of communities that comprise the extremely diverse population of India. Westernization of Indian women has lead to smoking and alcohol addiction and this is also contributing to high cardiovascular disease in women.

Women and Cancer

Last, but not the least, incidence of cancer in women is on rise, and Indian women top the world with the highest number of cervical cancer deaths. Pap smear examination and knowledge about its value in detection of cervical cancer at the earliest is lacking. Experts say that now women marry late and give birth to fewer children, all of which leads to a dip in cervical cancer but rise in breast cancer.

Breast cancer is now more prevalent than cervical cancer. Educated as well as uneducated women lack knowledge about self breast examination and the awareness to seek help. Late marriages, fewer children, use of oral contraceptive pills, obesity, sedentary lifestyle and unhealthy eating habits are fuelling cancer growth in women.

Cervical cancer vaccine and Hepatitis B vaccine prevent cancers. Ask your doctor for vaccinations to prevent these cancers.

Now let us look at what every woman should do to look after themselves:

  • Weight should be checked every week. Maintaining body mass index of 23 is essential.
  • Exercise daily for 30 minutes. Household work is accustomed exercise and will not burn your calories.
  • Eat healthy; avoid high calorie carbohydrates, saturated fats. Increase vegetable intake and fruits in daily diet.
  • Check for thyroid swelling in the neck every day when you look into the mirror.
  • After the age of 30, get sugar, BP and thyroid tests done.
  • Every woman should get a Pap smear done 1 – 2 years after starting active sexual life. Getting cervical cancer vaccine before starting sexual activity is a very wise decision.
  • Self breast examination should be taught to every girl after attaining menarche (first menstrual period) and it should be done every month after bleeding stops.
  • Get your thyroids checked and diabetes risk checked before planning pregnancy.
  • Daily sun exposure for 30 minutes from 10 am to 2 pm will keep bones healthy. Drinking milk and taking calcium rich diet protects you from osteoporosis.
  • Yearly health checks and doctors consultation will go a long way in keeping healthy.

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Pic courtesy: http://phmastersjobs.com/masters-public-health/

A Healthy Woman Brings Up A Healthy Family!

MULTIPLE PREGNANCIES

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The phenomenon where more than one fetus results from a single pregnancy is termed as Twin Pregnancy or Multiple Pregnancy. It is caused due to the spontaneous competition between the sperms. These types of pregnancies are either natural or due to infertility treatments.

The chances of multiple pregnancies increase:

  • Through fertility treatments.
  • When the age of the mother is above 30.
  • With a personal or family history of fraternal (non-identical) twins.

How can complications be addressed?

Various complications occur during twin or multiple pregnancies due to high competition between the embryos. The most common one is ‘Pre-term Labour’. Apart from this, other complications that may arise are Anemia, Miscarriage and Vanishing twin, Preeclampsia, Intrauterine growth restriction (IUGR), Gestational diabetes and Post-partum hemorrhage. However, the good news is that twin or multiple pregnancies can lead to successful outcomes by ensuring Frequent antenatal visits, Frequent fetal assessment, Attention to nutritional needs, Assessment of cervix, Restricted physical activity and Neonatal care.

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Nutrition 

The mother has to pay close attention to her nutrition levels when expecting twins or multiples. A diet rich in good quality protein, iron, folic acid and calcium with optimum calories is recommended for better pregnancy outcomes.

Including wholesome nutritious foods like whole grains, fruits, milk and sprouts to the diet, rather than processed food, helps in giving the mother a balanced diet.

Special Clinics

Special clinics are dedicated to mothers experiencing multiple pregnancies. It helps them keep a track of the fetal growth by offering close monitoring and counseling thereby reducing complications or risks that may arise. Visiting these clinics is beneficial to parents and babies.

Fernandez Hospital started a specialized Twins Clinic in 2006, the only one of its kind in Telangana and Andhra Pradesh. This is a fully functional, multidisciplinary clinic comprising a dedicated obstetrician, fetal medicine specialist, nutritionist, lactation consultant and an excellent neonatal team that provides round the clock service. The Clinic deals with about 250 twin and 10 triplet pregnancies per year.

Mothers monitored by specialized clinics tend to give birth closer to term, reducing the risk of pre-term labour. More importantly, these clinics give an opportunity for parents in similar situations to meet, discuss and feel more at ease.

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