A changing face of women’s Health

1. A changing face of women’s Health Improvements and advancements are happening in every field, similar advances are happening in obstetrics and gynaecology care. Many new modalities have emerged in past few years and are routinely available. I am highlighting few important ones which are helpful to health conscious women.

2. Preconception counselling Preconceptional counseling and investigations have taken a new shape. Initially we use to counsel women about preonceptional counseling and its importance, as general awareness about this among women is less. Along with ordering common tests for diseases like Thalassemia, HIV, syphilis, thyroid status and rubella we also examine the women whether they are healthy enough for conception. Many subtle signs and symptoms of common problems like hypertension and diabetes are picked up in this preconceptional care clinics and controlling these conditions early leads to a healthy outcome. Like starting Folic acid in preconception phase has reduced the incidence of neural tube defects in the baby. Medicines for diabetes, epilepsy, hypertension or cardiac disorders may need to be changed to safer options before conceiving. Detecting Genetic Syndromes Pregnancy care has introduced tests for genetic diseases like Nuchal Translucency and Dual test at 12 to 14 weeks, and quadruple test and a targeted level 2 scan at 18 weeks. These tests help us to detect some of the common syndromes at very early gestation and can prevent the birth of affected child at very early stage of pregnancy. Women suffering from cardiac disorders, diabetes or other chronic illnesses are advised to undergo fetal echocardiography to diagnosed congenital heart diseases in utero and are councelled about their outcome. This saves the mental trauma of the couple. For the couples in whom first or second trimester screening has come positive, Prenatal invasive testing, i.e. chorionic villus testing and amniocentesis, are also available for confirming the diagnosis. Fetal cells that are obtained by these procedures are looked for any targeted genetic problems. These tests become more so important when a couple has an affected baby earlier also.

3. Epidural Analgesia (Painless Delivery) Delivery which used to be a painful and dreadful experience earlier has become a memorable and enjoyable experience now. Painless delivery which is also known as epidural analgesia has made it possible. Painless delivery is choice of the patient. Patient is informed about it during antenatal visits or classes. Patient should have an open mind for it, noting should be decided prior. As actual pain threshold patient will come to know when she is going to experience that pain. There are few minor side effects of this procedure (like weakness in legs, fever, low blood pressure), but it has a good overall safety. We target 1:1 nurse to patient ratio for all patients who are laboring. This allows us to have a better care of the patient and patient is more comfortable at the tough time. Allowing the husband to support the patient during delivery is also being increasing demanded by the couple and we support the patient for her choice of attendant during delivery for her psychological boosting for that particular matter. High Risk Pregnancy Mothers whose pregnancy is complicated by factors related to her present or past pregnancy or some medical disorder putting her life in danger are now taken care of with the help of multi-disciplinary approach, along with the services of blood bank, intensive care units. But as most obstetrical complications are unpredictable, every pregnant female is at the risk irrespective of her risk status. It is a critical moment and the female need immediate access to a quality obstetrical care unit.

4. Earlier there used to be many deaths related to such issues but now comprehensive care has made the pregnancy safer even in the females who are conceiving at 50 years of age with kidneys functioning less, heart responding low, blood pressures rising and sugars unstable. Babies who have come in this world before time or at very low weight, say 500 gms, have a good neurologically intact survival as the Doppler studies help us to time their removal from uterus at very accurate time. It’s the decision to prolong the pregnancy or to keep the fetus in utero which is very crucial in such cases. Ultrasound and Doppler help us to take this decision in a better way. Total Laparoscopic Hysterectomies Hysterectomies which used to be open surgeries earlier are now done as day care laparoscopic procedure. Patient has to be in the hospital for 4 to 7 days when open procedure was opted; but now patient enjoys the coziness of home within 24 hours. She can start up her daily chores in a day or two surgeries because she feels comfortable as there is no big scar on her belly. Even ovarian cysts and masses, tubectomies or recanalisation of tubes (opening the tubes) that have been earlier ligated, tuboplasty (repairing a tube) which is responsible for the infertility of the couple is dealt with laparoscopic technique very effectively. It has the advantage of early recovery of patient as well as fewer adhesions inside the abdomen. Preventive Health Checkups Everyone knows the importance of preventive health care checkups. Migration to foreign countries demanding the clearance of health status has helped us a lot to make our own people aware that it is not only for medical visa but also for their own self that

5. regular and right tests are done at right time of their life in a right manner. For females paps smear or liquid cytology with HPV DNA, sonomammography, bone mineral density, ultrasonography are all that is needed along with the routine tests of body fitness, general physical examination , and gynecological examination. Any positive history of cancers in first degree relative should also make you consult us early. Urinary Problems Usually urinary problems are the issues of menopausal females but there is no age bars to it. Even a female who have just delivered a baby can have urinary retentions or leakage, over the years newer drugs have helped us to do a justice to the life of females with this problem. Incontinence surgeries like Kelly’s repair, cystocele repair or putting a tape are giving good results to our patient making them live a better and confident life again. Hormone Therapy after Age 65 Females come to us very frequently to give them the hormone replacement therapy. I would like to point out here that studies are not favoring use of HRT and you should not take it just because you have turned menopausal. Egg Freezing Advances Help Women Stay Fertile – If a young female has to undergo cancer therapy it is a very good option to freeze the eggs that can be used later on. It will help the girl stay fertile.

6. 2014 has also marked the birth of baby from a uterus transplant. A female who was born with no uterus have received a transplanted uterus and the conceived in that uterus and a full term baby was born. This is just a small glimpse of advancement; obstetrics and gynecology have to go a long way. Obstetrics and Gynecology Hospital in Ludhiana www.spshospitals.com/ Dr. Venus Bansal Senior Consultant, Obstetrics and Gynecology Satguru Partap Singh hospital, Ludhiana.