Pregnancy - Emergency Consultation

During the course of pregnancy a gravida consult

s obstetrician regularly as scheduled.  But sometimes there can be problems which necessitate the gravida to consult immediately.  The common problems which need to be attended to by the obstetrician are:

• Abdominal pain:  Any pain in the abdomen, particularly in the lower part, may be an early symptom of abortion or delivery.  There can also be other causes, first and foremost, the possibility of pain related to causes in pregnancy should be ruled out.  Some serious conditions in pregnancy which can compromise health of the mother and fetus also present with pain and may need hospitalization and appropriate management.
• Bleeding:  Any vaginal bleeding any time during the course of pregnancy needs immediate attention by the obstetrician.  The cause could be an impending abortion or delivery or certain serious conditions like bleeding from the placenta which is low down in the uterus or its premature separation.
• Watery discharge:  Breaking of bag of membranes which holds the fetus will cause sudden gush of watery discharge.  Some times it can be slow constant or occasional leak.  Depending on the duration of pregnancy and the amount of loss of fluid (amniotic fluid) treatment is instituted.
• Swelling of the body:  Sudden onset of swelling of feet, puffiness of face and stiffness of fingers could be due to increased blood pressure.  Early consultation with the obstetrician to identify the cause of swelling of the body will help in proper treatment to optimize maternal and fetal outcome in pregnancy.

• Severe headache, blurring of vision, pain in the upper part of the abdomen, vomiting, and convulsions could be presenting symptoms of high blood pressure which require immediate attention by the obstetrician.

These are important conditions when a gravida has to consult obstetrician earliest for better health of self and fetus.

Pregnancy - Diabetes Mellitus

November 14^th is the World Diabetes day.  In the present day of changed life style the incidence of Diabetes is increasing rapidly.  Asians, Indians in particular are more prone to diabetes because of their genetic constitution.  Along with diabetes there is also increase in diabetes in pregnant woman – gestational diabetes mellitus.

Diabetes in pregnancy could be two of types.  The woman who is diabetic has become pregnant or diabetes is diagnosed during pregnancy.  The diabetes which has its onset in the course of pregnancy will subside after delivery.  But these women are prone for diabetes in later life.  The risk factors for developing diabetes in pregnancy are:

• Ethnicity – Asians, Hispanics, Africans have more incidence.
• Diabetes in the family members – First degree relations.
• Obesity - over weight women.
• Age above 25 years.
• History of abortions, premature delivery, birth of overweight or underweight babies or abnormal babies in the previous pregnancies.

Gravida with any of the risk factors will have to undergo screening test for gestational diabetes mellitus (GDM). The obstetrician once recognises that a gravida is high risk for GDM will advise initial blood glucose test.  If this is normal – less than 100 mg% further screening test is done between 24 – 28 weeks (early in the 7^th month) of pregnancy.  The test is Glucose Challenge Test (GCT).  If this is normal further follow up test is done in the 9^th month.  If the result is abnormal another test Glucose Tolerance Test (GTT) is done.  Based on the report dietary suggestion, life style modification (exercise) and medication is instituted. 

Gestational diabetes complicating pregnancy is a high risk pregnancy, wherein the health of the fetus is affected adversely.   Certain complications of pregnancy like increased blood pressure – pre-eclampsia, premature delivery may increase. The chance of baby being large or of low birth weight is high.  This makes normal delivery difficult so operative delivery may required.  The possibility of still births and neonatal complications like respiratory disease or certain metabolic disturbances may also increase.  

Team management including physician, obstetrician, dietician and paediatrician will result in successful out come, healthy mother and baby.

In women who are diabetic and become pregnant the incidence of morning sickness, abortion, premature delivery, pre-eclampsia, very low birth weight or overweight baby, congenital malformations, still births and postnatal health problems to the baby will be high.  In these women early scans can help in diagnosing abnormal fetus.  When blood glucose levels are monitored and proper diabetic control is done fetal health will be improved. 

In the present day women are career oriented and marriage and child birth is being delayed to the third  decade.  These women should maintain healthy life style.  A healthy woman will give birth to healthy baby.

Chandrababu Naidu - Dielemma

A leader should be strong, physically and mentally, able to take decisions with brain, be unbiased and be able to carry his followers in unity with him.  He should have a comprehensive outlook towards a problem and decision should be taken with a vision to progressive development.  I thought Chandrababu Naidu is a politician with vision.  Present situation failed him as a leader who can take tough decisions.  He has become insane by repeatedly invoking emotional views, talking of two eyes and two sons.  In the emotional storm he is moving rudderless.  He is being carried away by the strategy of a rogue politician and political party.  He lost all his sanity and is simply aping a junior politician who is not acquitted of his financial crimes. 

As a leader he is not able to convince his cronies the decision taken in their politburo after extensive deliberations.  Seemandhra politicians are not acting in the interest of people of both regions, Andhra and Telangana.  They are thinking about their personal benefits.  Andhras separated from Madras as they felt being treated inequitably by Tamalians.  They did not learn lessons from that separation.  They never tried to work and develop their identity and their Andhra State.  Instead they influenced the Union government to form Andhra Pradesh on linguistic basis.  What they learnt under the British rule and what they suffered in Madras they practiced in Telangana and subjected Telanganites to discrimination and finally a stage had come that Telanganites have achieved separate state and Andhras have to pack up to their place. 

Andhraites who boast of developing Hyderabad of Telangana in their rule should now try to develop entire Andhra into a new planned state and prove their capabilities.  They have an opportunity to establish their long cherished identity and dignity by developing their new state of Andhra Pradesh into a model democratic state.

Chandrababu who had vision 2020 for Andhra Pradesh previously should think of his future state and its development.  Though I dislike him for the way he had come to power, imposing taxes to continue welfare schemes and then discontinuing the schemes, and by dodging Telangana issue causing death of more than 1000 youth of Telangana, I thought he is the only Seemaandhra politician who can plan to promote residuary Andhra Pradesh into 2050, if only he has strength to take decision and abide by it.  But what is happening now presents gloomy picture of TDP and its leader.  Chandrababu Naidu is not fit to be a leader.  A person who cannot solve an issue, who fails to present to people clear picture of situation and guide them, steer them out of ambiguity and desperation, can never be their ruler.  Chandrababu should now quit politics and enter ‘vanaprastha ashrama’. 

Pregnancy - Medicines

Pregnancy being a special condition, every pregnant woman takes special precaution in all her activities.  Gravida becomes cautious in what she eats and drinks.  Special precaution should be exercised even while using medicines during the course of pregnancy and breast feeding period.  Certain medicines and infections will have harmful effects on the fetus.  They can cause various system abnormalities and anatomical defects.  The period of pregnancy from day 31 to 71 is critical for differentiation and development of fetus.  Some drugs can have impact on the development of embryo-fetus, resulting in abnormalities.

A healthy gravida is advised simple folic acid tablets in the first three months of pregnancy.  This will help in the reduction of certain nervous system abnormalities.   After 4^th month iron and folic acid tablets are started and continued till 9^th month or delivery depending on the health of the gravida.  As more than 50% women are anemic in our country, ICMR recommends 60 mg of elemental with 500 mcg of folic acid for 100 days to all pregnant women.  A poorly nourished gravida not taking balanced diet is also recommended to take supplementation of all other vitamins and minerals especially calcium.  

Any other medication in pregnancy is taken only on specific indication.  A gravida suffering from any medical disorder like high blood pressure, diabetes or epilepsy has to continue according to the advice of the physician.  If the gravida develops any other serious illness like typhoid, malaria, urinary infection etc, should use medicines appropriate to the condition.  She should inform the physician of her pregnancy and its duration.  Even high temperature itself may be harmful to fetus and gravida.  So when any illness that is harmful to mother and fetus, as far as possible medications are given as not to harm the fetus.  When gravida’s condition is serious priority is given to the gravida and fetus then becomes secondary. 

Even during the course of pregnancy when the gravida has any abnormal bleeding or possibility of premature delivery hormonal treatment is given.  

Immunisation against tetanus is routinely practiced in our country.  Two T.T. injections are given in the 5^th and 6^th month in first pregnancy and from second pregnancy single dose is advised in the 8^th or 9^th month of pregnancy. 

Any pregnant woman should be cautious in using self medication, using medicines (other than folic acid) particularly in early pregnancy, the period of organ formation, is avoided

In short a healthy gravida taking a balanced diet does not need any medication other than iron supplementation.