How often do we read about the issues related to pregnancy, hormonal imbalance and other health problems on the internet and put the plan of meeting a gynaecologist on hold? Quite a lot, right? But the recent visit of Dr Sushma Sinha, Senior Consultant Gynaecologist, Indraprastha Apollo Hospital to our office, helped many discuss, share and seek advice on the most intimate facets of their body and overall health. Without any qualms women confided in Dr Sinha, spoke at length about the issues that have been bothering them and felt both enlightened and aware of medical complications that can occur as a result of sedentary lifestyle and eating disorders. During our candid chat with Dr Sinha, she talked about the most common health problems that women face and the ways to prevent them.
Pre-conception counseling It is always better for the patient to go for pre-conception counseling session with a gynecologist before she attempts to enter pregnancy. The session usually includes a pre-conception risk assessment where the patient is asked about her history, lifestyle, medical problems (individually and in her family). It is also done to find out if there is any high risk factor which may lead to potential complication in pregnancy. During the session, doctor also throws light on precautions that can be averted. This can also include the need to give Folic acid to reduce the incidents of Neural Tube defect. If the patient has diabetes then it is important for her to control her sugar level before she plans to conceive. This is because with high sugar level, she can suffer from conjunctive malformation and many other complications with babies, premature delivery, miscarriage, traumatic birth and high risk of caesarian section.
Along with sugar, blood pressure should also be controlled before the patient enters pregnancy. If she has been on medication like epilepsy drug then it should be changed before she plans to get pregnant. Multiple drugs should also be changed to single drug therapy. If there is any psychological issue - such as depression – it should be addressed. Other tests that the patient is advised to undergo are that of hemoglobin, Thalassaemia and rubella. These tests are done to ensure the baby is healthy.
How Folic acid prevents Neural Tube defects: Folic acid is one of the vitamins which is present in folias - meaning leafy vegetables - which ought to be part of one’s daily diet. But some patients can face deficiency in folic acid. This deficiency can result in high risk of Neural Tube Defect/Spina Bifida, which can cause disability in the baby. It was found that if the deficiency of Folic acid is curbed, the risk of Neuro Tube Defect also goes down. WHO has recommended that each and every woman who intends to get pregnant should be given Folic acid, especially in the first three months of pregnancy. And it was deduced that intake of Folic acid has reduced Spina Bifida, Neuro Tube problem tremendously. Folic acid is a cheap medication – it is just a simple vitamin which is easy available in the market. Since the dose of 400 microgram of Folic acid isn’t available in our country, we give the patient 5 milligram tablet of Folic acid per day. For those who are anemic, Folic acid helps in improving the hemoglobin level. So it is good to give Folic acid to the woman before she gets pregnant.
Polycystic Ovarian Disease and its effects: The most common hormonal imbalance nowadays is Polycystic Ovarian Disease. It’s not a new disease. It was discovered in 1930s by Stein-Leventhal. It is a condition in which a woman’s levels of the sex hormones - estrogen and progesterone - are not in balance. With the changes in lifestyle, food habits, stress level, pollution level, PCOS has become very common. I would say in the common OPD of mine I see 15-20% college going girls having this problem and approximately 60-70% patients who come for infertility have this syndrome. It may be the cause of obesity and pimples, hair growth on face, menstrual irregularities and even depression. So physically and psychologically it can be very bad for the patient. And it needs to be taken care of. Since the cause is not known, there is no one drug that can we prescribe. We have to look into the problem caused by it and address them.
Normal delivery is the best option: Normal delivery is definitely better than Cesarean Section. If one opts for Cesarean Section, the probability of her going for it the next time around is very high. C-section is an operation where the doctor has to give a cut in the patient’s tummy to help her deliver the child. Since anesthesia is used during delivery, it can result in some complications too. However, in normal delivery, the doctor doesn’t use anesthesia, but a normal injection to make the body part numb. And that doesn’t have much of side effects. So yes, normal delivery is much better than Cesarean Section as it reduces the chance of complications in the mother. It also helps in making the mother mobile immediately after the delivery and allow her to take care of the newborn.
Causes for miscarriage: There are several causes for miscarriage because pregnancy is the permutation and combination of multiple factors. And the most common cause of miscarriage – before 9-10 weeks of pregnancy – is the defect in the baby which is also referred to as chromosomal abnormality or structural abnormality in the baby. Defect in the uterus – due to a curtain in the uterus which is in medical term it is called septum – is another reason. Septum can be seen in various forms – small, big, septum throughout the uterus and septum going to the lower part of uterus. Several other anomalies of uterus are equally responsible. Patients also need to know about the early infections such as rubella infections and toxoplasma infection than can worsen the condition. Immunological causes and genetic problem in the parents can also result in miscarriage.
Breast cancer early detection: Best way to detect if you are suffering from breast cancer is by going for self examination. It is very easy to detect it yourself. Rotate the palm of the hands around the breast in one circle –both outer part and then the inner part. When you do it frequently, chances of missing the nodule that appears are less. Breast cancer isn’t deadly provided it is diagnosed early in the life cycle of the cancer and the treatment chosen early. One needn’t be scared as they needn’t go for breast removal. It is just the lump that is removed and the breast can be saved. If somebody has the history of breast cancer in the family – (mother, sister, maternal aunts, cousins) - then she is at a high risk of breast cancer. Apart from self examination, the patient should also go for mammography and ultrasound. Going by the increase in the number of cases of breast cancer, I would suggest this to normal people who don’t have medical history. Mammography should be done from the age of 40 – every two to three years to detect it. Those who are at high risk of breast cancer, are also at the risk of developing ovarian cancer and endometrial plasma.
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