Category Women Health

Zika virus

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As the first case of the Zika virus is reported in Delhi at the RML hospital, there’s widespread buzz and panic about the virus and its effects on pregnant women. Let’s attempt to understand more about it. 

Zika virus was first detected in Uganda in 1947 and is transmitted by the bite of the Aedes mosquito ( Aedes aegypti and Aedes albopictus); these mosquitoes are found all over the world especially in tropical and subtropical areas and are both day and night biters. 

Zika virus causes outbreaks in Central, South and North America and also in and around West Africa. Because of increasing globalisation and international travel, it is likely that there may be infections reported in many more regions. 

When the mosquito bites a person infected with the Zika virus, it infects the mosquito, which in turn infects another person with its bite. It enters the person’s bloodstream and causes symptoms of the infection. 

The virus can also be transmitted from an infected person to another by unprotected sexual intercourse. Blood transfusion and organ donation by an infected person are also means of transmission. 

During pregnancy, an infected mother can spread it to the unborn fetus. This is a dangerous form. 

 

Risk factors

Living in areas where infections are rampant increase the chances of Zika virus infection. Moreover, unprotected sex with partners who have lived or travelled recently from endemic areas also run the risk of getting infected. 

 

Symptoms of Zika virus infection

Remember this infection is very mild. In fact, 4 out of 5 people infected are completely asymptomatic. Infections begin 2 days to 2 weeks after the bite of an infected mosquito. Symptoms are similar to dengue and like many viral fevers last about a week. Most people have a mild fever, rash, severe body ache, a feeling of being unwell, joint pains and red eyes or conjunctivitis. 

There is headache, eye pain and maybe accompanying abdominal pain too. Most people recover completely; however, some may have late-onset neurological complications as well as Guillain Barre syndrome even in people who never really had any symptoms of the disease. 

Pregnant girls infected with the virus may have a spontaneous miscarriage, preterm births and stillbirths. 

Congenital Zika syndrome is a serious birth defect in infants born to mothers who were infected during pregnancy. 

These include microcephaly( a much smaller brain and head size) with a partly collapsed skull. There may be brain damage and reduced brain matter, eye damage, hypertonus( too much muscle tone )leading to reduced body movement and joint problems. So as you can see, the virus causes very mild symptoms in the pregnant woman but there are huge ramifications on the unborn baby . 

 

Diagnosis of Zika virus infection 

This can be done by RT PCR using the infected person’s serum, urine and throat samples. If the RNA of the virus is detected, it confirms the infection.

 

Treatment of Zika virus infection

All that is needed is plenty of rest, oral fluids and hydration, paracetamol and over the counter medicines for fever and pain. 

 

Prevention 

Currently, there is no vaccine or antiviral treatment for this virus, so prevention by other means is the best bet. Prevent yourself from mosquito bites.

If you are pregnant or attempting to get pregnant, you must not travel to countries where Zika virus outbreaks are common. You must wait two to three months to try to conceive if you have travelled to these regions. 

Practising safe sex is important; more so if your partner lives in or has travelled to areas where outbreaks are common.

You must protect yourself from mosquito bites by wearing protective clothing like full-sleeved clothes, long trousers, shoes and socks. 

You must use mosquito repellents and if you live in areas that are heavily infested with mosquitoes, you must use a mosquito net as well. 

You must make sure that you destroy mosquito habitats such as stagnant water in coolers, flower pots, containers, used automobile tyres. 

As is the norm with dengue prevention, you must follow a weekly regime of emptying standing water sources in and around your home. Using oil over drains and other areas which harbour these mosquitos also help to reduce their population and hence chances of infection.

Mastitis

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Mastitis is an inflammation of breast tissue that is commonest in breastfeeding girls and may be associated with infection. This inflammation causes redness, wedge-shaped swelling, warmth and breast pain. 

It may cause flu-like symptoms too. Fever, chills and rigors are common. 

Mastitis can also occur in non-lactating women and also in men. 

Sometimes there may be chronic mastitis and occasionally a rare form of cancer called inflammatory cancer may mimic mastitis in older women. Patients with reduced immunity like those who have Diabetes, AIDS, those on steroids and drugs which suppress immunity can have mastitis. 

 

Why does this problem occur? 

A blocked milk duct due to incomplete feeding can cause one of the milk ducts to get clogged. Bacteria entering these ducts due to cracked nipples, mostly from the baby’s mouth can cause the same. Incorrect positioning of the baby while feeding and improper latching can also cause cracks in the nipple. 

In postmenopausal women, there is clogging of the ducts due to cells and debris that can precipitate this infection.

 

What are the risk factors? 

Previous bouts of mastitis when lactating , wearing too tight a bra , improper nursing techniques, poor nutrition , hygiene and smoking are risk factors . 

 

What are the signs and symptoms? 

Pain in the breast, generally on one side, redness, swelling, a breast lump, general malaise or high-grade temperature with chills. 

 

Complications? 

There may be a collection of pus or an abscess that may be caused due to mastitis. This may then require surgical drainage. 

 

What is the solution? 

Most times your doctor can make a diagnosis on physical examination. If there’s pus discharge from the nipple signifying an abscess, it will require a culture of breast milk or nipple discharge. 

Inflammatory Cancer may require an ultrasound of the breasts or mammography. 

 

Treatment 

Antibiotics, painkillers, hot compresses before completely emptying the breast and cold compresses after painful lactation, massaging the breast when feeding or pumping from the affected area towards the nipple are some of the tips in treatment. 

Proper latching techniques and continuing to breastfeed even alongside mastitis helps. Breastfeeding from the affected side first when your baby is hungrier helps to empty the breast due to stronger suckling.

Proper rest and hydration also help. 

Most times it resolves within days to a couple of weeks. If it does not, you must meet your doctor.

WHAT IS GESTATIONAL DIABETES?

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Sheetal (name changed) ,a 30-year-old Primigravida ,went for a blood test called an OGTT with 75 glucose load at 24 weeks pregnancy and was appalled when the results showed high blood sugars. She had a family history of Diabetes in both parents but prior to her pregnancy, she never had high blood sugars.

Sheetal is a typical case of Gestational DM, which is diagnosed for the first time during pregnancy. There is good news though. This affects your health and your baby’s but you can control it easily by diet, exercise, lifestyle modifications and occasionally medication. The bad news however is that it may lead to Type 2 Diabetes later in life and your baby too may suffer from childhood obesity and Diabetes.

RISK FACTORS

  • Obesity
  • Family history of DM
  • Race: We Asians are at a higher risk compared to Whites
  • If you’ve had a previous pregnancy with GDM or Prediabetes
  • If you’ve delivered a baby with a birth weight of 4.1 kg or more

WHAT ARE THE SYMPTOMS OF GDM?

There aren’t many symptoms except maybe increased thirst or urination. Most times it’s only detected when we test for sugars at 24-28 weeks or in the case of high-risk patients, at the first antenatal visit.

COMPLICATIONS:

Let’s divide these into complications for you and for your baby

For your baby, it may lead to

  • Increased birth weight
  • Birth injuries like shoulder dystocia and collar bone fractures etc.
  • 3 times greater risk of a Caesarean delivery
  • 4 times greater risk of NICU care
  • Hypoglycemia and some other biochemical derangements after delivery
  • Breathing difficulties, Respiratory Distress Syndrome
  • Stillbirths
  • Greater chance of obesity and DM later in life

For you, it may lead to

  • Increased chance of difficult vaginal delivery owing to a big baby
  • Vaginal and perineal tears
  • Caesarean delivery
  • Future DM

PREVENTION OF GDM:

As with most lifestyle illnesses prevention and first-line treatment is by lifestyle changes. Eating a healthy diet rich in green vegetables and fruits

lean meat, whole grains high in nutrition and low in calories and fats. Simple carbohydrates like sugars and desserts are to be limited. Regular meals and snacks with small portion sizes are desired. Talk to your nutritionist or doctor to help you with a diet chart.

Exercising 5-6 times a week for at least 30-45 minutes, unless contraindicated by your doctor is most vital.

Cutting alcohol and smoking completely is required and maintaining a healthy weight even before you become pregnant is vital to ease your journey with GDM.

You should not gain more weight than recommended.

TREATMENT

As mentioned above , lifestyle modifications are crucial to controlling high blood sugars in GDM, which in turn reduce the complications of the disease.

You will need to buy a glucometer and monitor your blood sugar levels 4 or more times a day.

Medication like Insulin or oral hypoglycaemic drugs may be needed depending on your blood sugar control or lack of it; the dose being adjusted accordingly.Most times it is only 10-20% patients who need medication.

Your baby’s growth is monitored by serial ultrasounds and other tests including checking for the amniotic fluid volume and Dopplers to determine blood flows.

Delivery is done at around 38 weeks or even later if all is well; your doctor is the best judge of it and you must have a frank and detailed chat with her about the birth plan . Sometimes, however a preterm delivery may happen owing to complications of the disease.

Following delivery ,your blood sugars will be checked , one OGTT will be repeated 6 weeks later and then you will need follow up at least every 2-3 years if not more frequently .

 

REMEMBER GDM IS EASILY CONTROLLED WITH DIET,EXERCISE, HEALTHY LIVING AND MEDICINES AND PREVENTION IS ALSO BY LIFESTYLE CHANGES. LETS STAY FIT AND BEAT THESE LIFESTYLE ILLNESSES -LETS BEGIN BEFORE PREGNANCY;IN FACT,LETS BEGIN NOW!

All You Need To Know About Covid Vaccination For Pregnant Women

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The long-term effects and safety of the vaccine on the foetus and child have yet not been established.

 

-Dr. Shelly Singh, MBBS, MD (Obstetrics and Gynecology) Senior Consultant – Obstetrics & Gynecology, Rosewalk Hospital, Delhi

Which group of pregnant women are at risk?

All pregnant women are at risk and they should definitely get the vaccine. A special mention for women who are:

Click here to read more

Menstrual Cups- A More Sustainable Way of Feminine Hygiene

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Menstrual cup

What is a Menstrual Cup? 

Menstrual cups are small, flexible, funnel-shaped cups made of silicone or rubber that are inserted inside the vagina to collect menstrual blood. They’ve been around since the 1930s but did not gain favour till recently when they’ve resurfaced as an eco-friendly method of feminine hygiene. 

Why use menstrual cups? 

If you’re interested in menstrual cups do speak to your gynaecologist. 

  • Menstrual cups are pocket friendly. They cost much less than the sanitary napkins and tampons you need to buy every month. 
  • They are safer to use compared to tampons as they collect rather than absorbing blood. They hold much more blood and need to be changed after 6-12 hours depending on the flow. Tampons, on the other hand, need to be changed 4-8 hourly. 
  • Tampons can cause the Toxic Shock Syndrome; since cups don’t absorb blood they are less likely to be a source of infection by bacterial invasion. 
  • These menstrual cups cause less odour unlike sanitary pads and tampons as they don’t absorb blood which comes in contact with environmental air that causes a bad smell. 
  • They are more eco friendly. Most can be used for up to 1 year or longer ( though some are disposable too); that means fewer trees cut and less waste in landfills due to pads, cloths and tampons. 
  • You can wear menstrual cups with an IUD during place though the thread of the IUD may need to be cut shorter so that it doesn’t get pulled out with the cup.
  • You can use it during sex as well. Most well-fitted cups are not even felt by you or your partner during intercourse. 

What are the disadvantages of using Menstrual Cups? 

  • They may be difficult to insert or remove initially till practice makes perfect.
  • The removal of a cup may be messy especially in public toilets and some people may be embarrassed doing the same. You need to carry bottles of water and tissue paper to clean them. Also, you may initially find it tough to pinch the base of the cup to release the vacuum and then pull at the stem. 
  • It may be tough to find the right fit. 
  • They may cause vaginal irritation if they are not cleaned or cared for properly.

How to use the menstrual cup?

Menstrual cups are available online and in different sizes. You need to get a size that’s appropriate for you. Please speak to your health care provider regarding the same. 

You need to wash your hands, apply a water-based lube or water to the rim of the cup,  fold the cup ( different styles of folding seen in the images) and insert it inside the vagina rim up. The cup is then rotated and it sits in the vagina just below the cervix after a vacuum is created. 

Once it is properly placed it is very comfortable and you won’t feel it . The seal of the cup is such that leaks are prevented. 

How to remove the cup? 

You need to empty the cup 6-12 hours later depending on the flow. Wash your hands, insert the index finger and thumb inside the vagina , feel the stem of the cup and reach up to the base. Pinch the base, release the vacuum and then pull at the stem bringing the cup out . This can now be emptied of blood, washed and re-inserted inside.

Reusable cups can be used from 6 months to 10 years while disposable ones can be thrown away after use.

Price of the menstrual cup? 

Most menstrual cups available online come at a price of 200 Rs up to around 1000 Rs. They come with a cloth bag in which the cup can be stored when not in use. 

So make an informed choice – your body, your choices! The menstrual cup is indeed a way of empowering yourself, of clean and safe periods and a hygienic and more eco-friendly and sustainable way of life! 

Make your daughter ready to hit her periods

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I’ve been asked to keep this really short and sweet. 

So let me, in my capacity as a mum myself and a gynaecologist try and make it a bit easier for you to educate your girls about the first period or “menarche”. Here’s what you can tell her. You may begin by making a diagram of the uterus ( your biology books will help ) or take the help of the net.

 

What are periods? 

Periods are bleeding along with shedding of some tissue of the uterus which happen every month in a young lady who can now bear a baby . Tell her that periods will come every 21-45 days. They may last 4-7 days. And they’re not more than 2-3 tablespoonfuls. She may fear she’ll gush like a tap. Reassure her that it’s not that much at all. Also when you tell her this openly she does not think it’s shameful or scary. You may tell her that you too have them and that she’s now joined the league of young women. 

 

When will she have her first periods? 

Generally at 11-12 years, though it may happen as early as 10 years and as late as 16 years depending on her body clock. We expect periods 2 years after the development of breast buds and about 6 months after pubic and armpit hair. 

 

What will happen if she starts bleeding suddenly in school? 

It’s a good idea to keep an emergency kit in her school bag or locker. This contains a panty liner, a sanitary pad and a clean panty. Most schools also have sanitary napkins handy so a trusted teacher and nurse in the infirmary may help. Tell her not to be scared of “ leaking” and if it happens she can just throw that panty away and use a fresh one. Also, tell her that other girls in her class are also going through similar changes and they can watch each other’s backs. 

 

What should she use during periods? 

There are some wonderful pictures on parenting sites on the net that show sanitary pads, tampons and menstrual cups. You can be a hands-on mum by showing her a sanitary pad that can be stuck on the panty using one of your own. It’s best, to begin with, these. Tampons can also be used but it’s better to use them slightly later once she gets used to her periods. You must teach her how to insert tampons( the teen ones which are narrowest) since it seems terrifying to insert these. 

You have to teach her hygiene. Tampons and pads must be changed every 4-8 hours depending on the flow. And she must wash herself every time she uses the washroom; keep herself clean since menstrual blood can lead to infection and bad odour. Disposal of napkins and tampons must be taught to your young one. It’s important to wrap it in a newspaper and dispose of this in the bin rather than flushing it down. 

 

What are the other things that can accompany periods? 

Tell her that there may be cramps, backache, thigh pain and headaches that may happen. But these can easily be cured with simple pain killers or a hot water bottle on the abdomen. Exercising may also help to take care of all this. 

In a nutshell, tell her this is part of a normal growing up process.  Empower her to continue with normal activities including sports and involve her in the beautiful world of youthfulness. Your little girl is now a young lady …. and do remember your own attitudes about menses will train her for life. So here’s to knowledgeable mommies with their assured, educated and empowered adolescent daughters capable of taking on menstruation and everything that comes with it! 

All You Need To Know About Covid Vaccination For Pregnant Women

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-Dr. Shelly Singh, MBBS, MD (Obstetrics and Gynecology) Senior Consultant – Obstetrics & Gynecology, Rosewalk Hospital, Delhi

Which group of pregnant women are at risk?

All pregnant women are at risk and they should definitely get the vaccine. A special mention for women who are:

  • Health line workers
  • Obese
  • Suffering from comorbid conditions
  • Hypertensive
  • Diabetic
  • More likely to get an infection due to living in areas that have a high load of cases
  • Older than 35 years of age
  • Have a history of clotting in the limbs
  • Exposed to people outside the household
  • Living in crowded areas and unable to practice social distancing
Click here to read more

Decoding the COVID Vaccine

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Currently, as we all know there are three vaccines available for use in India- COVISHIELD,  COVAXIN and SPUTNIK.

We began vaccinating our large population from January 16th this year and 6 months into the vaccine we are reasonably sure of their efficacy in preventing serious disease. The vaccine has been rolled out in phases and now includes the 18 + population including breastfeeding and new moms. It also gets the nod from ICMR for pregnant girls from the 25 th of June; in the latest development, we have also been given the go-ahead signal from the MOHFW, Government of India, as I write today.

LET’S TALK ABOUT THE VACCINES

Covaxin is indigenously developed in India; manufactured by the Bharat Biotech in collaboration with ICMR and the National Institute of Virology. It is an inactivated viral vaccine containing the whole virion inactivated virus which can’t infect a person but which prods the immune system to form antibodies against it.

Covishield is a vaccine developed by the Oxford Astra Zeneca and manufactured by the Serum Institute of India. This has been prepared using viral vector technology. A chimpanzee adenovirus-ChAdOx1 has been used to carry the spike protein of the virus into human cells. This again does not infect the person getting the vaccine but mounts an antibody response. Vectors are “vehicles” which carry this genetic material inside the cells.

Sputnik V is the Russian developed vaccine made by the Gamaleya Research Institute of Epidemiology which will be manufactured by Dr. Reddy’s laboratories. This uses the human adenovirus 26 and 5 to act as vectors for the Coronavirus spike protein.

Doses and timing of these

Both Covaxin and Covishield are given in 2 doses. 0.5 ml is administered intramuscularly into the deltoid muscle. Covaxin is given at an interval of 4-6 weeks apart and Covishield is prescribed at an interval of 12-16 weeks.

Sputnik vaccine is a double dose vaccine, also administered as an intramuscular dose. The interval between both doses is likely to be 21 days.

Even if one has had COVID, the vaccine must still be taken, however, delay the jab to 3 months after recovery from the disease.

If one gets COVID after the first dose of vaccine, it is recommended that one gets the second dose at the scheduled date provided one has no symptoms and the quarantine period is over.

Efficacy

The efficacy of Covaxin is around 81% in phase 3 trials whereas that of Covishield is around 90% . The efficacy of the Sputnik vaccine is 91.6 % as per global studies.

The chances of getting the disease after 2 doses of Covaxin are 0.4% and of Covishield are 0.3%

Side Effects

Pain at the site of injection, fever, headache, joint pain and weakness are common side effects of the vaccine which generally go away after 1-3 days. Rashes, nausea and vomiting are some other side effects.

Some serious side effects may be allergic reactions, breathing difficulties, palpitations, throat and face swelling but these are rare.

Some myths that need busting

  • COVID vaccine can infect one with the disease
  • COVID vaccine can cause one to become positive for infection
  • COVID vaccine can alter one’s DNA
  • COVID vaccine can’t be taken during one’s periods
  • The vaccine will decrease one’s fertility
  • After recovering from the disease one doesn’t require vaccination

Talk to your doctor; let’s all dispel myths and fears about the vaccine and move ahead in our fight against this terrible disease. 

 

WE WILL EMERGE VICTORIOUSLY; ALL WE NEED TO DO IS TO JOIN HANDS 

REMEMBER PREVENTION IS ALWAYS BETTER THAN CURE

Tips on Prenatal yoga by Dr. Shelly Singh

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Pregnancy…. It comes with its share of mixed feelings , elation , enthusiasm , positive anticipation as also fear , irritation and a host of other emotions you can’t label as positive. In these current COVID times we are all reeling under the stress and psychological trauma of this disease and its associated impact. 

I always reiterate the need for eating healthy and exercise. And what better than yoga? 

When is the best time during pregnancy to start yoga? 

You can start at any time as early as you like after talking to your doctor. Some girls may start in the second trimester though once the morning sickness of the first trimester has passed.

Health benefits of Prenatal Yoga: 

  • Your body remains flexible and supple. This always helps in labour and normal delivery.
  • Yoga and Pranayam also help in deep breathing and relieve you of stresses. It is one of the oldest forms of relaxation.
  • Yoga also helps in relieving some common problems of pregnancy like leg cramps, backache, constipation, leg oedema, nausea and gastritis.
  • Yogasanas help you recover faster post-delivery

Health benefits of Prenatal Yoga: 

  • Your body remains flexible and supple. This always helps in labour and normal delivery.
  • Yoga and Pranayam also help in deep breathing and relieve you of stresses. It is one of the oldest forms of relaxation.
  • Yoga also helps in relieving some common problems of pregnancy like leg cramps, backache, constipation, leg edema , nausea and gastritis.
  • Yogasanas help you recover faster post-delivery. 

What yogasanas are allowed and beneficial during pregnancy ? 

  • Cat stretch or Marjariasana
  • Konasana
  • Warrior pose or Veerbhadrasana
  • Triangle pose or Trikonasana
  • Butterfly pose or Badhakonasana
  • Shavasana
  • Yoga Nidra or Yogic sleep

Pranayamas or breathing exercises

  • Meditation 
  • These are huge stressbusters

Yogasanas not allowed in pregnancy:

  • Boat Pose
  • Cobra Pose
  • Superman Pose
  • Plough Pose
  • Sitting half spinal twist pose

Always remember

 

  • To begin with a warm-up and end with cool down
  • Set realistic goals for yourself after talking to your obstetrician.
  • To avoid asanas with inversion poses 
  • To avoid asanas that need you to lie on your back and hold it for long as the pregnant uterus puts pressure on the large blood vessels of the body and causes less blood supply to the brain leading to dizziness. 
  • Do standing poses as they strengthen the legs and increase their tone, improving circulation and even leg cramps
  • Reduce time holding asanas in the third trimester and do more of pranayam and meditation .
  • Stay cool and hydrated 
  • Wear well stretching yoga maternity gear.
  • Always enrol with an instructor who is well versed with prenatal yoga only after you get the go ahead from your doctor . Sometimes, exercises are completely prohibited like in cases of threatened miscarriage, bleeding in pregnancy, placenta previa, preterm labour etc. 
  • Listen to your body and do your yogic practice and exercises only till the point where you are not fatigued. 
  • Also let your instructor and doctor know about any associated medical condition during your past or current pregnancy . 
  • Moreover if you experience any pain or these red flag signals I’ve mentioned just stop immediately and consult your doctor. 
  • Let your yoga practice in pregnancy be fun , slow and relaxing rather than an intense workout.