The Most Trusted Gynecology and Maternity Hospitals

1. Vol.6, Issue-1,2019 theBirthplace The Perfect Partner Before, During, and AfterPregnancy!

4. PerinatalDepression – A Less Addressed MaternityCondition AishwaryaNawandhar Editor

5. Tcarrying,delivering,and nurturing a baby cansometimesbe stressful.What’s worrying is thatsometimes,this he joy of having a baby, the bare happiness when you hold it for the first time in your arms, the feelingof having that tiny wrist wrapped around the finger is probably the best experience in the world.However, goes beyond normal stress. An intense depressed feeling during and after pregnancy is a serious mentalcondition known as Perinatal Depression. The long-lasting stress, severe anxiety, and many other such symptoms indicate that the parent needs professional attention and people, many a times, fail to recognize this. Caused by physical changesas well as emotional complications, perinatal depression should be treated in time and withcare. While mood swings, crying, irritation, anxiety, appetite gain or loss, insomnia, sadness, overwhelming feeling, loss of concentration mark the issues of baby blues; the long-term, intense signs that can interfere with not justtheday-to-day activities of a person, but in the care of the baby as well are related to perinatal depression. Perinatal depression is not only experienced by the mother, but also by the father, sometimes. The symptoms in the new dads are similar to that observed inmothers. It is essential for a person to opt for professional care if he/she notices the signs such as depression, excessive crying, disturbance in sleep patterns, appetite problems, fatigue, feeling hopeless, shameful, guilty, and worthless, social withdrawal, difficulty in bonding with the child, severe anxiety, panic attacks, suicidal thoughts, obsession over the baby, agitation, agitation, hallucination, and the thoughts of harming own self or the baby. It usually occurs duringthe pregnancy, after the delivery, or even a year after the child birth. Therefore, it is important to take any symptoms noticed throughout the pregnancy period as well as after the delivery seriously. People with a family history or past experiences about depression are more prone to develop thiscondition. People usually mistake perinatal depression for baby blues and nothing can be more harmful for the existing conditions than that. It will only prolong the problem and even worsen it. Awareness and education about themental health of the parent can be extremely helpful and maternity hospitals can make it a practice to inform the pregnant couples about the same during their regular check-upsessions. People are unaware of this issue and are sometimes even embarrassed to share the problems with their loved ones or seek professional help. Mistaking perinatal depression for baby blues is common and can prove to be harmful forthe parent as well as the child. We, as friends and family, should be supportive and address the problem if we see any change in the behavior of the new parents. Depression screening during and after the pregnancy, for both theparents, is always a better idea. It aids in timely analysis and addressing of perinataldepression.

6. CoverStory theBirthplace The Perfect Partner Before, During, and AfterPregnancy! 10 Articles QuickRead Five Minute Health TipsforExpectingMoms Technovation A Hope to Conquer InfertilityNaturally witha 5P Coin-sized Device 18 20 MedicalEmphasis Preterm Babiesand the RisksInvolved 30

7. CXOStandpoints 26 38 Expert Column Sahyadri’s Gynaecology Department- AOne Stop Solution forWomen! Doctor’s Insight HighRiskPregnancy Clinic 34 IntellectualOpinion New Ground Breaking IVF Technologies & other Art Techniques/in vitroFertilization(IVF) 3 decades of clinical innovation and technologicaladvancement 24 42 Dr L H HiranandaniHospital Sculpting the Future of Care withLove and Excellence Rainbow Hospitals Refining Maternity and Child Care withCommitmentandCompassion

8. In and Around Women’sHealthcare Gwomen overcome various diseases andcomplications.Alongside runs parentalcare. Pregnancy and ynecological care is an important health area for a woman throughout her life span. Withappropriate professional expertise in gynecology and oncology, doctors can provide comprehensive care andhelp childbirth are two very significant phases in any couple’s life. From preconception to pregnancy topost delivery, adequate care needs be provided to a mother and her baby. Focusing on this necessary sector in healthcare, in our special issue “The Most Trusted Gynecology and Maternity Hospitals”, we have highlighted the stories of the top-notch hospitals that are providing quality healthcare services with incredible medical expertise, world-class facilities, and latest equipment. Not onlydo they render the best gynecological and parental care, but also provide compassionate and comfortable environment and support to theirpatients. Featured on the cover is a leading, Bangalore-based hospital, the Birthplace. It is a single-specialtyhospital focused on obstetrics, neonatology, andgynecology. Apart from the gripping cover story, the edition also brings to you the stories of several other top leaders in the industry. This list includes Dr L H Hiranandani Hospital, an ISO 2001:2015 certified, NABH accredited244- bedded super-specialty hospital located in the Hiranandani Gardens in Powai, Mumbai, and Rainbow Children’s Hospitals offering high standard pediatric super specialty and maternal careservices. We have also encompassed interesting articles from the industry experts viz; Anita Soni, Consultant Obstetrician and Gynecologist at Dr L H Hiranandani Hospital; Chandra Sekhar C, CEO at ApolloHealth and Lifestyle Ltd.; and Dr. Supriya Puranik, Infertility IVF Specialist, Gynae Endoscopist, and High Risk Obstetrician at Sahyadri Speciality Hospital. Along with this, there are some intriguing articles by our in- house editors, crafted specially foryou! So, flip through the pages and enjoy a goodread!

9. Editor-in-Chief ManagingEditor ExecutiveEditor Pooja M. Bansal AshwiniDeshpande AishwaryaNawandhar Art & DesignHead AssociateDesigner Art & Picture Editor Co-Designer Amol Kamble PoonamMahajan RahulKavnekar SavitaPandav Business Development Manager NandanDeshpande Business Development Executives RuchiPatil Technical Head PratikshaPatil TechnicalSpecialist DigitalMarketingManager SME-SMOExecutives CirculationManager Amar, Aditya PrashantChevale Manoj Shelge Tanaji sales@insightscare.com June,2019 CorporateOfces: Insights Success Media Tech LLC 555 Metro Place North, Suite100, Dublin, OH 43017, United States Phone -(614)-602-1754 Email:info@insightscare.com For Subscription:www.insightscare.com Insights Success Media and TechnologyPvt.Ltd. Ofce No. 22 & 510, Rainbow Plaza,ShivarChowk, Pimple Saudagar, Pune, Maharashtra411017 Phone-India:+917410079881/82/83/84/85 Email:info@insightscare.com For Subscription:www.insightscare.com https://twitter.com/Insightscare Follow uson: www.facebook.com/InsightsCare/ We are also available on: Copyright © 2019 Insights Success Media and Technology Pvt. Ltd., All rights reserved. The content and images used in this magazine should not be reproduced or transmittedinanyformorbyanymeans,electronic,mechanical,photocopying,recordingorotherwise,withoutpriorpermissionfromInsightssuccess. Reprint rights remain solely with Insights Success Media and Technology Pvt. Ltd. Insights Care is powered by Insights Success Media and Technology Pvt.Ltd.

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13. CoverStory theBirthplace The Perfect Partner Before, During, and AfterPregnancy!

14. Tsmall nursing homes andlarge memorable delivery experience for a mother. With its motto being “Expect More”, the hospital caters to all the needs of its patients and offers even more! At the Birthplace, one delivers with all the conveniences andfacilities that a woman and her family desire during pregnancy - from on time appointments with their doctors to 5 star amenities in theirrooms. The Birthplace offers complete care and support from the pre-conception period to pregnancy and delivery period, extending up to after the child is born. With a team of highly qualified and expert doctors, backed with latest equipment and best-in-class infrastructural facilities, it provides world-class gynecology, maternity, and pediatric services. It has created a phenomenal experience out of thechild birth event for the mother and the family, backed by anuncompromising quality in the clinical and non-clinical infrastructure, people, andprocesses. About theBirthplace The Birthplace began its operations around six years ago with a focus on obstetrics, neonatology, and gynecology. The main facility of the hospital is 25 bedded, all in a private and suite setting, and the outreach clinic caters to everything that a woman needs up until the time of delivery. The Birthplace provides a full range of gynecological care to meetthe needs of women of all ages. With the help of advanced imaging, diagnostics, and surgery services, thousands of women turn to the Birthplace each year, for expert care in a compassionatesetting. he market for obstetricsin India is primarily servedby multi-specialty hospitals. Giventhe significance of the birth of a childin one’s family, there is a tremendous opportunity in creating an experience that is memorable, joyful, and hassle- free with the comfort of world class clinical care for the delivery. On one hand, the nursing homes provide avery transactional experience with a limited scope of services for the mother and the child and on the other hand, large multi-specialty hospitals provide a daunting experience for the family in a setting that is geared towards serving people with complicatedailments. The Birthplace, a leading gynecology and maternity single-specialtyhospital, not only ensures safe but luxuriousand

15. THE MOSTTRUSTED GYNECOLOGY &MATERNITY HOSPITALS In the journey so far, the Birthplacehas been recognized nationally for its brand identity by being honored with the Designomics grand prix award for strategic brand identity and the Kyoorius award for brand identity. It has been shortlisted within the top 3 in the country, as a trendsetter in customer service excellence in theNew India Assurance Healthcare Achievers Awards in 2014 by a well-renowned media house. The hospital has also been ranked as the #1 Hospital for Gynecology in Hyderabad through a study conducted by prominent media house in March 2015 and Jan 2016and #2 in South India and #10 in India in Jan 2016. In 2017, it was ranked as #1 in Hyderabad, #1 in South India, and #2 in India for its focused specialty of Obstetrics and Gynecology. DifferentiatedAppeal The Birthplace strongly believesthat the hospital’s differentiator and competitive advantage is a result ofits focus on the “guest” experience. The clients are treated as guests and not patients in its facility. From the training of its people to the design of the processes, the Birthplace has an intense focus on how to ensure that a guest at its facility will have an unmatched experience in delivering a baby. No wait time for appointments, transparent delivery packages, flexible visiting hours, dedicated pregnancy manager, foot massages for the mom– these are just a few things that the Birthplace does to create a fantastic experience for themother! InnovativeThinking The Birthplace owns its technology and this gives it a distinctive competitive advantage. Itstechnology stack proves itself in enablingsuperior financial results for theBirthplace. Every system deployed at thehospital is focused on improving customer experience. Its out-patient services begin even before the patient walksin; they begin the moment a patient engages with its marketing effort. The customer is assigned a Single Point of Contact even before she walks intothe facility. Although its marketingefforts are ruthlessly driven by numbers, the Birthplace’s customer engagement is extremely hightouch. ImpactingLives The Birthplace has successfully handled several high risk pregnancies. Through its quality healthcareservices, the hospital has saved several livesand made many others better. Talking of high risk pregnancy, one of the case was supervised by a senior gynecologist, where there wasa

17. growth discordancy of 48% between twin fetuses. Under the team’sdiligent care and observation, the babies quickly gained health and are doing wellnow. Another challenging casesuccessfully handled by the hospital was when the gynecologist treated a first-time pregnant woman with fibroid complications in the uterus. This complex surgery involved first removing the large fibroid from the uterus without harming the baby and then bringing the baby out witha C-section. The doctor helpedthe mother successfully deliver a healthy baby, without significant discomfortor loss ofblood. Throughout the course of the treatment, the gynecologists work along with a multidisciplinary teamof urologists, surgeons, radiologists,and other experts to ensure the most appropriate care. To address fertility concerns, it works with experts in fertility treatments, at the Birthplace and other centers ofexcellence. The Birthplace’s state-of-the-art NICU means that even parents of new-born babies, who need critical care, can be assured about delivering in not just a comfortable place but also a safe place tailored to the needs of the mother and baby, regardless of the criticality of care required for either of them.Caring for tiny, fragile babies is a big part of what the hospital does, at the Level III NICU. Here, premature babies and babies with complex medical needsget the expert care they need to survive and thrive. Additionally, they’re surrounded and supported by a team that is passionate, highly skilled,and dedicated. In fact, some remarkably tiny surviving babies, with birth- weights as low as 700 grams, have been born at the Birthplace. They’re healthy toddlers today, partlybecause of the care they got at theBirthplace. Whether it is about treating a woman who had an ovarian tumor weighing close to 5kg, to helping someonewith a renal failure to conceive, to many successful Vaginal Birthsafter C-section (VBAC), ordelivering babies for mothers who have had a history of multiple miscarriages, the Birthplace is proud to be a place that brings together leading maternityand new-born care experts under oneroof to ensure safeoutcomes.

20. Five Minute Health Tipsfor ExpectingMoms 18 |June 2019 |

21. QuickRead -Aishwarya Nawandhar,Editor |June 2019 | 19

22. A HopeA HtoOPE TOCONQUER CIoNnFEqRuTeILrITInYfNeArTtiUliRtAyLNLYaWtuITrHalAly5P with a5CPOICNo-SiInZ-EsDizDeEdVIDCEevice 5P COIN 20 |June 2019 |

23. Technovation A few British scientists have brought hope to numerous infertile couples yearning to have children by developing a tiny device. This device can eliminate the need to turn to the arduous IVF treatment. The geniuses at the University of Southampton can now help diagnose the causes of unexplained infertility with their device that is as small as a 5p coin. This sensor was devised by Professor Cheong along with a bioelectronics engineer Professor Hywel Morgan. They have established Vivoplex Medical, a Southampton University spin-out company, where they started developing this device. For the clinical trial of the gadget, the start of which is due in the next few months, the research branch of NHS- National Institute for Health Research has provided them withof £850,000grant. The tool helps in monitoring the vital elements that have a major impact on fertility- temperature, oxygen levels, and pH in a mother’s womb. It is to be implanted in the uterus by a doctor or a nurse, just like a contraceptive coil is inserted. The process of implantation may not take more than a few minutes. The inserted device then monitors the womb’s conditions for about seven days. The sensor is connected to an electronic device, say a smartphone or a computer. The data that it gathers is wirelessly transmitted to a small transmitter that is worn on a piece of clothing. This transmitter, in turn, transfersthedatatotheelectronicdevice. Myriads of couples around the globe are facing the problem of infertility. Until now, fertility doctors have had no reliable way of investigating the natural conditions of the womb- its temperature, oxygen, and pH factors. With this device, something as small and simple as aspirin can change the conditions of theuterus.“Notonlycoulditgivedoctorstheabilitytodiagnosefertilityissues sooner – and potentially reduce the burden that fertility treatment brings to ourpatients–butitalsohaspromisingpotentialtoinformthedevelopmentof newfertilitytherapiesandtreatments,”saysProfessorCheong. -Aishwarya Nawandhar,Editor |June 2019 | 21

26. DrLHHiranandaniHospital SculptingtheFutureofCarewithLoveandExcellence Dlegend,DrLHHiranandani, The Greatest Source of Inspiration Dr L H Hiranandani was the inspiration behind the edifice of the hospital. Academically very well qualified and seasoned with years of experience in the healthcare sector as an ENT surgeon, he initiated several operative techniques which are known as “Dr Hiranandani’s Operations” globally. Dr. Hiranandani’s work earned him many prestigious accolades, like ENT Surgeon of the Millennium Award, SAARC Award,and many more. Social causes deeply motivated him. His humane nature made him stand up for the rights of people and fight against capital punishment andeuthanasia. In 1972, the Government of India awarded him the Padma Bhushan,the third highest civilian national award, for his contribution to the nation. In 1987, he was conferredthe r L H HiranandaniHospital, founded in honor ofthe Working with love and social cause atour heart, we strive to provide the best possible care and facilities toall ourpatients was commissioned on 22ndFebruary 2004. The hospital is a 244-bedded super-specialty hospital located atthe picturesque Hiranandani Gardens in Powai, Mumbai. It addresses 50 + specialties and superspecialties. Dr L H Hiranandani Hospital has always focused on quality and processes and hence, has beenawarded and accredited by various prestigious organizations. It is an ISO 9001:2015 certified hospital. Its journey in quality started from inception and got the ISO certification in 2006. In 2007, it was the first hospitals in Western India to receive the prestigious NABH accreditation. It received the IMC Ramakrishna Bajaj National Quality Award for excellence in healthcare in 2008 and the covetedInternational Asia Pacific Quality Award,famously known as the Malcolm Baldridge Award in the U.S., in 2009. Hiranandani is also the proud winner of International Asia Pacific Quality Award, in both 2009 & 2016, and isthe only hospital from India to win this prestigiousaward. 24 |June 2019 |

27. THE MOSTTRUSTED GYNECOLOGY &MATERNITY HOSPITALS audiology and speech therapy center with facility for cochlear implant; advanced cancer care and oncology services; advanced gastroenterology and liver treatment; women’s care from womb to tomb with a special focuson high risk pregnancy and reproductive research; physical rehabilitation and sports medicine; advanced eye careand microsurgery under ophthalmology center; and executive healthcheck-up. All departments are supported by the expert national and international medical specialists and staff and all the comprehensive services are provided under proper supervision. Additionally, the hospital has new patient rooms designed for maximum comfort and privacy, withan access to a host of new amenities. In addition to the world- class accommodation and a warm ambience, the rooms feature a superior nurse call system, outfitted with the best that modern technology has to offer. The prime focus of Hiranandani hospital is on patientsafety. Breakthrough Obstetrics and Gynecology Department The department of Obstetrics and Gynecology at Dr L H Hiranandani Hospital is very vibrant with latest equipment and cutting edge technology, backed by a highly qualified team of experts. It also has latest suites for child birth and other high-class infrastructural facilities. The hospital has ensured that every need of the mother and child can bemet with a warm ambience and the tender loving care. Dr L H Hiranandani hospital offers various services in this department, including pre-pregnancy counseling, antenatal clinic, high-risk pregnancy clinic, post-natal care and contraception clinic, antenatal exercise clinic, and genetic clinic. The Managing Team Dr. Sujit Chatterjee, M.D., is the CEO of Dr L H Hiranandani Hospital since its inception. He has successfully led the Hiranandani Group to arguably thefirst Public-Private partnership in healthcare with Navi Mumbai Municipal Corporation. Dr. Chatterjee’s area of specialization is obstetrics and gynecologyand gynec-oncology. He has served as a doctor in thearmed forces from 1976 to 1999 and was a professor of obstetrics and gynecology at Mumbai University. For his extraordinary contribution, he has been awarded the Chief of Naval Staff Commendation Medal for outstanding service rendered. Dr. Chatterjee has papers published under his name in various scientific journals and has won awards for the best scientificpresentation. When asked about the future plans for the Dr L H Hiranandani Hospital, Dr. Chatterjee asserts, “We plan to create three established centers of excellence into the leading centers in the city and the country by year2021.” Dr. SujitChatterjee CEO Dhanvantari Award, awarded for the first time in thefield of ENT, for his notable contribution to medicalscience. The Cornerstone of Love andSuccess Even before the inception of Dr L H Hiranandani Hospital, everyone associated with it could see that it was a more sublime affair than mere brick and mortar. Being a tribute to an iconic father by his almost equally accomplished sons, it transcended the question of honor; it became an act of love. At the heart of the Hiranandani mission is the passionate commitment to stay at par with global standards. The hospital performs the simplest to the most complex surgical procedures and is equipped with the medical equipment purchased from the foremost vendors in theworld. Today, this multi-specialty tertiary and quaternarycare hospital is a frontline provider of comprehensivehealthcare. It has seen tremendous growth since its inception; not only in terms of added beds but also newer servicemodalities. The hospital is modernized and is in the same leaguewith the best hospitals in theworld. Top-notchServices Dr L H Hiranandani Hospital offers special services in multiple departments that are at par with the global standards of care. These services encompasscardiovascular and thoracic surgery; orthopedics, joint replacement, and spine surgery; advanced ENT care with astate-of-the-art |June 2019 | 25

28. Dr. Anita Soni ConsultantObstetrician & Gynecologist Dr. L H HiranandaniHospital 26 |June 2019 |

29. Doctor’sInsight ABOUT THEAUTHOR Dr. Anita Soni is a practicing doctor at the well-renowned Dr. L H Hiranandani Hospital, Mumbai, practicing as a full time Consultant Obstetrician and Gynecologist. She has worked at the hospital since its inception in 2004. Dr. Soni is an expert in the field with the academic excellence as an MD, DNB, FCPS, DGO, and FICOG. She has special interest in the areas of High Risk Pregnancies, Gynecological Surgeries, Ultra Sonography, and Maternal Fetal Medicine. Today, there are a number of national and international publications to hercredit. HighRisk PregnancyClinic • and neonataldeath. • Events occurring during the present pregnancy like growth restriction, tendency for premature delivery, bleeding per vaginum (placenta previa, abruptio placentae, vasa previa), leaking of liquor per vaginum (preterm premature rupture of membranes), utero-placental insufficiency, oligohydramnios,polyhydramnios. • Medical diseases complicating pregnancy like high blood pressure ( Chronic hypertension, pre-eclampsia, gestational hypertension, chronichypertension • What is High RiskPregnancy (HRP)? • A high risk pregnancy is acondition during pregnancy that threatens the health and life of the mother and/or fetus. A high risk pregnancy needs special care, follow up and management. • What are the aims of HighRisk Pregnancy Clinic? • To provide education, surveillance and management of pregnanciesat risk. • To provide MultidisciplinaryTeam • (MDT) approach in managingthe high riskpregnancies. • To provide advanced facilitiesfor managing and delivering thehigh riskpregnancies. • Who falls in the category ofHigh Risk Pregnancy? • Pregnant women who seek consultation at our hospitalare categorized under highrisk. • Pregnancy considering thebelow • mentioned factors and arethen enrolled in HRPclinic: • Past obstetric outcomes like recurrent pregnancy loss, bad obstetric history, previouspreterm delivery, previous still birth, previous Down’s syndromechild |June 2019 | 27

30. with superimposed pre-eclampsia), diabetes(Gestational diabetes mellitus, overt diabetes mellitus), hypothyroidism, hyperthyroidism, heart disease, liver disorders, kidney diseases, anaemia, obesity, thrombophilias, systemic lupus erythematosus, other collagen vascular diseases, rheumatoid arthritisetc. • Infections during pregnancy likeToxoplasmosis, • Rubella, CMV, Herpes, Chicken pox,Tuberculosis, HIV. • Surgical disorders complicating pregnancylike • fibroid uterus, previous history of myomectomy, previous classical caesarean section, ovarian cyst,renal and ureteric calculi, recent bariatric surgeryetc. • Extremes of age like elderly gravida andadolescent • pregnancy. • Multifetal gestations like Twins, Triplets or Quadruplets with or without associatedcomplications. • Special situations like pregnancy after renaltransplant. • What are the Advantages of High RiskPregnancy Clinic? • Multidisciplinary Team (MDT) approach isfollowed involving the Consultant Obstetrician, HRP Clinic Coordinator, Pediatricians, Neonatologist, Radiologist, Fetal Medicine Consultant and other specialists like Physician, Endocrinologist, Cardiologist,Hematologist, Nephrologist, Rheumatologist, Gastro-enterologist etc. according to the individual casescenario. • All specialists under one roof consulting as ateam. • A multidisciplinary team involves a range of health professionals working together to delivercomprehensive patientcare. • MDT approach has come out as a way of rendering comprehensive medical care by bringing together professionals from a broad range of disciplines in a coordinated and effective manner to upgrade maternaland neonataloutcomes. • State of the art Labour room and NICUfacilities • What are the Investigations and Servicesoffered? • Geneticcounselling • Pre-conceptionalcounselling • Prenatal screening and diagnosis with facilities which include biochemical marker screening like double marker, quadruple marker test; advanced ultrasoundfor the detection of fetal anomalies like NT scan and a detailed malformation scan, fetal 2D Echo whenever required; advanced procedures like chorionic villous sampling, selective fetal reduction, amniocentesis,fetal blood sampling, intrauterine transfusion in cases of Rh isoimmunisation, fetal therapy; otherspecial • investigations like karyotype and microarrayfor products of conceptionetc. • Regular follow up with obstetrician inOPD. • Extensive ante-partum and intra-partumfetal surveillance. • State of the art LDRP suites with hydrotherapy,Labour • Room and well equipped OperationTheatre. • Labour analgesia by theanaesthetists. • Blood bank facility in case of obstetricemergencies. • NICU with advanced neonatal care managedby neonatologist. • How do we monitor a High RiskPregnancy? • Monitoring includes more frequent visits to the doctor, routine blood tests, tests to monitor the medical problems, specific tests and procedures, several ultrasound examinations (routine and special) andfetal monitoring. • These tests and investigations are designed to trackthe • condition of mother andfetus. • How does High Risk Pregnancy differ from normal pregnancy? • Frequent antenatalvisits • Close monitoring of maternal and fetal wellbeing • Special investigations (other than the routine )and management of riskfactors • Multidisciplinary TeamApproach • How do we improve our maternal and fetaloutcomes in High Risk Pregnancy Clinic? • Use of tools like Diet charts/ hand-outs forpatients • Best practice protocols-evidencebased • Improve outcomes by Standard Operating procedures, Pathway, Multidisciplinary Team approach, Trainingthe students and staffadequately • Safetychecklist • Completedocumentation • Ensure continuity of care afterdischarge • Simulationprograms • Continuing Medical Education(CMEs) • Clinical Audit is a process of quality improvementthat seeks to enhance patient care andoutcomes • We have many success stories till date and wish to continue the good work and aim to optimize ourmaternal and fetaloutcomes! 28 |June 2019 |

32. “I love these little people; and it is not a slight thing when they, who are so fresh from God, loveus.” - CharlesDickens 30 |June 2019 |

33. MedicalEmphasis |June 2019 | 31

34. - ShambhaviMhetre,Editor 32 |June 2019 |

36. &other New 3 decades of clinical innovation and technologicaladvancement ITechnology has emerged over the years with increased success rates.Laboratorytechnologyand VF, which is an acronym for In-Vitro Fertilization was introduced to the world in 1978 and sincethen it has attracted and given hope to millions of couples aspiring to have a child. AssistedReproductive clinical practices have gone through many refinement cycles to emerge as a medical procedure thatis efficient, safe, easily accessible and relatively affordable to a larger population than what it was way back in 1978. According to available records, more than 2 million children are born till date through IVF technology, which has the potential to widen its appeal and application with further enhancements for a larger section of society. Timeline of major milestones in assisted reproductivetechnologies. Abbreviations: Other types of assisted reproductive technology includes GIFT - GameteInfra-Falloplan Transfer, HLA - Human Leukocyte Antigen, ICSI - Intra-Cytoplasmic Sperm Injection, IVF -In-Virto 34 |June 2019 |

37. IntellectualOpinion About theAuthor Chandra Sekhar C is the Chief Executive Ofcer of the Apollo Health and Lifestyle Ltd. He also has a strong academic background with an MBA from Osmania University, Hyderabad, India and Advanced Management Programs from the Indian School of Business and the Kellogg’s School of Management, Chicago, USA. Seasoned with the experience of over 25 years; he has played a signicant role in the Health Care and Health Insurance Industries in India. He has worked for over 18 years in the healthcare industry and has been a catalyst to the formation of a Standalone Health Insurance company in India. Other thanthis,he has successfully justied various management positions he was at in different spheres ofhealthcare. As the CEO of Apollo Health & Lifestyle (AHLL), the retail healthcare business of Apollo Hospitals Group, he leads eight business units-Apollo Clinics, Apollo Spectra, Apollo Cradle, Apollo Diagnostics, Apollo Sugar, Apollo White Dental, Apollo Dialysis and ApolloFertility. Chandra SekharC Chief Executive Ofcer Apollo Health and LifestyleLtd. |June 2019 | 35

38. Fertilization and PGD - Preimplantation GeneticDiagnosis. Many women tend to postpone pregnancy to a later time due to various reasons. For some, it is not to have children until they achieve their career goals and for others, it islack of knowledge and understanding about fertility and pregnancy coupled with stress and lifestyle issues. Tomany having a child before their mid-30s is low on priority and when they decide to have one, it’s rather too late causing problems in natural conception. That’s when they opt for advanced assisted reproductive techniques. Thanks to latest advancements, couples can now fulfill their dream of having a baby. Some of these technologiesinclude: Fertility preservation (Vitrification): This is the latest technique that helps patients retain their fertility, orability to procreate. Patients taking treatment for Beehcet’s disease, acute glomerulonephritis, systemic lupus erythematous, sarcomas, lymphomas, fertileukemia’s can also benefit from this. This latest advancement in reproductive medicine is indubitably a boon for men and women, as they can now hit “pause” on their biological clock, until they are ready to start afamily. Preimplantation Genetic Screening (PGS): It is done to diagnose embryos to check for structural chromosomal abnormalities. The process can be termed as aneuploidy (missing or additional numbers of chromosomes)screening. Aneuploidy is a leading cause of miscarriage and implantationfailure. Preimplantation Genetic Diagnosis (PGD): PGD canhelp diagnose single-gene disorders and chromosomal translocations. The main aim of this technique is to detect any possible chromosomal and/or geneticabnormalities. Thalassemia, Myotonic Dystrophy, Fragile X, and Cystic Fibrosis are some of the most common diseases tested. It has played a key role in putting an end to thetransmission of a given condition to offspring and making sure that children are bornhealthy. ERA(EndometrialReceptivityAnalysis):Theexpression of genes is evaluated by ERA (Endometrial Receptivity Analysis), which is a genetic test to ascertain whetherthe endometrial lining is properly developed to accept an embryo. Some of the latest scientific technologies areused to analyse the expression levels of 236 genes in order to access the optimal time to place an embryo into the uterus resulting in successful implantation andpregnancy. Platelet-Rich Plasma (PRP): PRP (Platelet Rich Plasma) or PDGF (Platelet Derived Growth Factors) therapy can be applied to rejuvenation of Ovaries, Endometrium and Vagina. It is done under sedation with Anesthesia. Thisnon- surgical technique done under sedation with Anesthesia is used to inject the cells into the ovaries, Intrauterine or Vagina. INVOcell: Unlink the usual method of IVF where the embryo is grown in an incubator for a few days and then implanted in the uterus, this technology allows the sperm and the egg to be brought together in the form of a capsule that is inserted into the vagina for a few days of incubation period and then the embryos are implanted in the uterus. This method is considered more cost-effective compared to the regular IVF procedure. Addressing the needs of infertilemen Conventional IVF was not much successful when semen parameters are below the reference values for morphology (teratozoospermia), motility (asthenozoospermia), and concentration (oligozoospermia). This leads to fewer embryos available for transfer, leading in lowerfertilization rates. Intracytoplasmic sperm injection (ICSI), where a single spermatozoon is microinjected into the oocyte helps achieve fertilization rates of approximately60%–70%. “Simple to advanced fertility treatment options are more numerous and varied than ever. A host of advanced assisted reproductive technologies, as well as other support services including fertility counseling, nutrition program provide couples with everything they need to be successful in building their family. At Apollo Fertility, we stay updatedon the latest advancements with infertility treatments, and we’re able to offer the evidence based practice with the personalized and holistic approach for all ourpatients” 36 |June 2019 |

40. SAHYADRI’S GYNAECOLOGYDEPARTMENT AOneStopSolutionforWomen! Mlife.’This is apopular ‘ edicine is not a bookbut has become an area of seriousconcern and hence advancement in Obstetrics and Gynaecology has become very important. There is demand for more expertise and availability of advance medicinein this field to address complex health issues seen in women. Along with treatment, the need for counselling and tertiary healthcare facilities has also become the need of thehour. Understanding this, Sahyadri Hospital has been undertaking severalinitiatives to provide holistic healthcare facilities to women. Out of the various specialties offered at the hospital, the Department of Obstetrics and Gynaecology has made its uniquemark offering state of the art diagnostic evaluation, clinical care and education for all women’s healthneeds. The hospital has consultants specializing in general obstetrics and gynaecology services as well as expertise in the area such as high-risk pregnancy, infertility, urogynaecology, gynaecologic cancer screening and treatment, pelvic pain, menopauseetc. According to doctors from Sahyadri hospital, in recent years,late pregnancies have become a norm in India and hence doctors have to be handled complex high-riskpregnancies like never before. Dr. Suprita Purnik, Head of IVF & Gynaecology department at Sahyadri SuperSpecialty Hospital said, “As we all know there is a problem of obesity in women and with advance age the egg quality deteriorates. There are chances of having fibroid in the uterus and the ovarian reserve goes down withage. Understanding all these complexities that can be involved with late pregnancies, women need to be given the right guidance and support. Thus, counselling has become an integral part of our treatment andencouraging women to exercise, meditate, practice yoga and eat right has become important.” Dr. Puranik said that Sahyadrihospital has been able to tackle various complex cases due to the huge technological support that it has along with the doctor expertise that the hospital boastsof. Speaking of a case, Dr. Puranik said, “We had a case in which a 34-year-old woman and her husband were tryingto conceive for 5 years with donor eggs and surrogates and several roundsof mind, not a businessbut saying by Farid F. Ibrahim and it truly describes the essence with which patients are cared for at theDepartment of Obstetrics and Gynaecology at SahyadriHospitals. Started in 2004, Sahyadri Hospitalsis today the largest chain of hospitals in Maharashtra. It is the brainchild ofDr. Charudutt Apte, a well renowned neurosurgeon and an ardent practitioner of ethical medical practices. It was his philosophy to make quality healthcare available, accessible, & accountable toall. Currently, Sahyadri group has 8 Hospitals with more than 900 bedsand 200 ICU beds. It has more than 2000 clinicians along with 2600 supporting staff. With such reach, Sahyadri Hospitals has been successful in making a difference in the lives of more than 50 lakh people byproviding qualitycare. In today’s times, lifestyle changeshave brought with itself severaldiseases. Bad food habits and growing stress levels are affecting all. Womenhealth 38 |June 2019 |

41. ExpertColumn Dr. SupriyaPuranik Infertility IVF Specialist, GynaeEndoscopist, & High RiskObstetrician About theAuthor Dr. Supriya Puranik, MBBS, DGO, DNB, is a renowned Infertility IVF Specialist, Gynae Endoscopist, and High Risk Obstetrician at Sahyadri Speciality Hospital, Pune. She is a passionate, hardworking, ambitious, and devoteddoctoravailable for all those seeking the best treatment in fertility and high risk pregnancy. With around two decades of rich experience, she has developed the expertise in world-class IVF, operative hysteroscopy-laparoscopy, laparoscopic hysteroscopy, and high- risk obstetrics. Dr. Puranik has various achievements and successful cases under hername. |June 2019 | 39

42. I VF at many clinics but failed. They later approached us at Sahyadri Super Speciality Hospital Nagar Road and withIVF treatment, the patient was able to conceive with her owneggs.” Dr. Puranik said that the success of IVF at Sahyadri hospital is mainly because multiple advanced methods of fertilisationare tried after understanding the case of the patient in a single fee. This has proven to be successful in helping couples conceive and having a healthy baby after a healthy delivery. The hospital today boasts of an experience of over 4000 cases which has been cost effective with handled with advanced technologicalhelp. Dr. Puranik also spoke of Late Prathamesh Patil’s case, in which Prathamesh was diagnosed with brain tumour. “Prathamesh Patil was in Germany at that time and preserved his semen before he began his treatment. Later he came back to India but unfortunately succumbed to the disease. Prathamesh’s mother, Mrs. Rajshree Patil later visited Sahyadri hospital with the preserved semen, of her son and was blessed with her two grandchildren with the help IVF. We still remember the joy that the grandchildren brought to his mother which became possible only due toIVF.” Taking this a step further, Sahyadri Hospital has launched a novel intervention model for a home-based pregnancy programme-Relax Mommy, wherein services for monitoring pregnancy will be provided well within the comfort ofyour home. Speaking about the initiative, Dr Puranik said, “Relax Mommy is a unique concept, which attempts to reduce the burden of regularly visiting the hospital; and also empowers the ‘would be mother’ to access necessary health services @ Home.This service will complement clinic visit and provide effective pregnancy care beyondclinic.” With all such systems in place, gynaecology department in Sahyadri hospitals is catering to every complication thatmay arise in women especially during pregnancy and ensures holistic care for all class ofwomen. 40 |June 2019 |

44. RainbowHospitals RefiningMaternityandChildCarewith Commitment andCompassion Rgroup of children’s hospitals critically ill children and has emerged as one of the bestchildren’s hospital group in thecountry. ainbowChildren’s Hospitals is India’sleading with almost two decadesof The Group has a separate maternity wing, Birthright By Rainbow, under the same roof, which lays the foundation of a comprehensive model of complete care for a mother and her child, from conception to childhood. Backed up by state-of- the-art infrastructure, it is driven bya highly motivated team of highly qualified and experienced consultants, dynamic team of residents and fellows, well trained nurses, and paramedicalstaff. experience in offering high standard Perinatal Care and Pediatric Super Specialty services. It is the first corporate children’s hospital inIndia. We aim to provide high standards of care for the mother, fetus, newborn, and children, so that none of them is deprived of a tertiary carefacility Today, it has the occupancy of 1200 beds, with 30% of beds dedicated to Neonatal and Pediatric Intensive Care services, with 12 units over Hyderabad, Bengaluru, Vijayawada, Delhi, and Chennai. Setting the benchmark in Neonatal andPediatric Intensive Care, Rainbow has played a major role in saving thousandsof 42 |June 2019 |

45. THE MOSTTRUSTED GYNECOLOGY &MATERNITY HOSPITALS • The Prodigious Leader • Dr. Ramesh Kancharla, the Founder and Managing Director of the Rainbow Group of Hospitals pursued medicine to fulfill the dream his father had seen for him. Having completed his MBBS and MD (Pediatrics) from India, he went to UK for his further studies(MRCP-UK). There he worked in institutions like Great OrmondStreet Hospital for Children & King’s College for Specialty Services, for several years. Following his return to India, he was hard-pressed to find a place to practice his clinical skills due to lack of meaningful dedicated pediatric hospitals in the country. Therefore, he, along with some of his expert friends, started the success giant known as Rainbow Children’sHospitals. • Comprehensive Pediatric and MaternityServices • Having set high standards in pediatric and neonatal tertiary care, Rainbow Group has also made its markin maternal care services under the brand birthright, addressing the profound effect of perinatal factors on child birth and future health. The services it provides includes: • 24X7 ConsultantAvailability • Advanced NICU, PICU and MICUs - Round the clock Emergency services with full monitoringand resuscitationcapabilities • Dedicated children’s transport services, gearedto carry long distanceretrievals. • All pediatric super specialties under one roof – General Pediatrics, Neonatology, Pediatric Intensive Care, Pediatric Neurology, Pediatric Nephrology, Pediatric Gastroenterology, PediatricEndocrinology, Pediatric Pulmonology and Allergy, Pediatric Surgery, Pediatric Urology, Pediatric Orthopedics, Pediatric ENT, Pediatric Metabolic Medicine, Child Psychology, Pediatric Physiotherapy and Rehabilitation and PediatricEmergency. • Comprehensive Maternal Care Set-up – Obstetrics and Gynecology, Fetal Medicine, GeneralMedicine, Fertility – IVF, IUI, andmore. • Holistic Care Program – It believes that the first1000 days, from conception to toddlerhood, are notonly Dr. RameshKancharla Founder and ManagingDirector Journey to theTop Incepted on 14thNovember 1999, on theoccasion of Children’s Day, Rainbow set course towards success.Its cornerstone was established in Hyderabadby Dr. Ramesh Kancharla and a group of highly brilliant doctors. Rainbow was started as a pilot project to demonstrate the need of comprehensive maternal and child care under one roof. Currently, it is India’s first children’s hospital with NABH accreditation with clinical outcomes very close to the developed countries. Rainbow Group has always focused on patient safety, integrity, excellence, innovation, and team work andhas created benchmarks in children’s healthcare and perinatalservices. Although obstetrics care started at Rainbow from 2006, this special unit came to be known as Birthright By Rainbow in 2014. Today, the maternal careinfrastructure of birthright is perhaps the best in the country with maternal ICU, fetal medicine, obstetrics, and neonatology under one roof. It strongly believes in the comprehensive maternal and child healthcare model, which is safer and addresses the patients’ specialneeds. |June 2019 | 43

46. the most joyous but also the most significant time ofa child’s as well as mother’s life. It offers a 1000 Day program to spread awareness and assist the mothers- to-be and new mothers in every possible way to bring up a healthy and happychild. • Recently, Rainbow Group has also established a dedicated pediatric cardiac care center–Rainbow Children’s Heart Institute—that offers comprehensive cardiac care services, including fetalcardiology. • Why Rainbow Hospitals? • Rainbow has strived to achieve excellence in theservices it provides to children requiring super specialty care in a child-friendly environment with high medical standards, compassion, and care. Team Birthright specializes in providing tertiary level care to women with normal or high-risk pregnancy. The hospital also hasfetal-medicine department to ensure that most problems in a newborn, which can be recognized during pregnancy, are addressed and the care can start when the child is in the womb. • The integrated team, consisting of obstetricians, fetal medicine specialists, and geneticists, work closely in conjunction with neonatologists, medicalsub-specialists, and maternal intensivists to optimize maternal and fetal outcomes. They are supported by the in-house Neonatal team at Rainbow and round-the-clock obstetric anesthesiaandepiduralfacilities.Afull-fledgedpediatric set-up proves, evidently, a great advantage for post-natal care. • AdditionalFacilities • Birthright By Rainbow also ensures ultra-comfort forthe mother and the child with specially designed delivery packages, including premium services for those who are looking for luxury birthing options. Additionally, birthright By Rainbow and Rainbow Children’s Hospitals has infrastructure at par with the international standards, equipped with state-of-the art technology and equipment to treat them. To understand the nerve of its patients, there are a bunch of internal applications in place to track treatment progress, keep the patient notified and up-to-date and record timely patient feedback. 44 |June 2019 |