Women’s Health

What is preeclampsia?

Preeclampsia is onset of high blood pressure (more than 140/90 mm of Hg) and protein in urine known as proteinuria (more than 300 mgs of protein in urine in 24 hours) after 20 weeks of gestation.

What is the cause of preeclampsia?

The actual cause or mechanism of development of preeclampsia is not clearly known, but the main abnormality in preeclampsia is endothelial dysfunction, hypertension, and proteinuria, which is most like due to decreased secretion of placental growth factor, which is in turn due to excessive placental secretion of fms-like tyrosine kinase 1 which is a naturally occurring vascular endothelial growth factor antagonist and oppose the endothelial growth factor.

What are the risk factors of development of preeclampsia?

The risk factors which may be associated with increased chance of developing preeclampsia are nulliparity (single pregnancy or single child), prior history of preeclampsia, diabetes mellitus, history of renal disease, chronic essential hypertension, extremes of maternal age (more than 35 years or less than 15 years), obesity, angiotensinogen gene T235, G20210A prothrombin gene mutation, antiphospholipid antibody syndrome, and multiple pregnancy like twins or triplets. If a woman develops there is risk of stroke even at near normal blood pressure due to certain susceptibility.

What is severe preeclampsia?

Severe preeclampsia is onset of high blood pressure with proteinuria accompanied by symptoms like headaches, blurred vision, seizures, coma etc. The blood pressure is generally very high (more than 160/110 mm Hg), protein in urine or proteinuria is also very high (more than 5 grams per day or 24 hours), along with scanty urine volume or renal failure, pulmonary edema, liver injury, thrombocytopenia (with platelet count less than 100,000/ml) and/or DIC (disseminated intravascular coagulation).

Preeclampsia is considered if there is only new onset hypertension with proteinurai and edema without any of the symptoms/signs of severe preeclampsia mentioned above.

The diagnosis of hypertension (high blood pressure) is different in pregnant women in compare to general population. Blood pressure in a pregnant woman should be checked in sitting position, because if blood pressure is taken in lateral recumbent position, as is the practice in general, blood pressure may be lower than in sitting position. The diagnosis of high blood pressure in pregnant woman requires measurement of at least two elevated blood pressure of at least 6 hours apart. Blood pressure of 140/90 mm of Hg is considered very high blood pressure during pregnancy as generally blood pressure is low during pregnancy due to reduction in vascular resistance. 140/90 mm of Hg is considered only mild hypertension in a normal subject, but in pregnant women the same pressure is considered very high blood pressure.

High blood pressure in pregnancy may cause intrauterine growth retardation, increased perinatal mortality etc. Pregnant women with hypertension are also at risk of development of medical problems like preeclampsia and abruptio placenta. To prevent the complications of hypertension, women with chronic hypertension should be thoroughly evaluated for to identify the remediable causes of hypertension and also to prevent adverse effects of anti hypertensive drugs during pregnancy.

Treatment of hypertension:

Pregnancy is an extraordinary situation and requires meticulous care in treating high blood pressure. The normally prescribed drugs for hypertension (ACE inhibitors like enalapril, angiotensin-receptor blockers like losratan) can not be used due to fear of development of fetal abnormality. The most commonly use antihypertensive drugs during pregnancy are alpha-Methyldopa, labetalol, and nifedipine, which have very little if any effect on growing fetus and considered safe during pregnancy. If the hypertension is due to pregnancy it will normalize after delivery.

Renal function should be evaluated to find out the chance of developing preeclampsia and to treat and manage early, should preeclampsia develop.

During pregnancy marked physiological changes occurs and for successful and happy outcome of pregnancy the female body has to undergo successful physiological adaptation. If the adaptation process is not perfect or appropriate medical disorders may occur during pregnancy. Some of the medical disorders are fairly common during pregnancy and increase in blood pressure is one such common medical problem during pregnancy.

During pregnancy the cardiac output (which the quantity of blood heart has to pump every minute) increases by approximately 40% and the heart rate or pulse rate increases by approximately 10 beats per minute mainly during the last three months of pregnancy. But despite the increase in heart rate the increase in cardiac output is mainly due to increase in stroke volume, which is the amount of blood heart pumps out in every heart beat.

During second trimester of pregnancy there is reduction in the vascular resistance and there is reduction in blood pressure in normal pregnant women. Blood pressure is the result of cardiac output and degree of vascular resistance and if there is reduction in the vascular resistance, blood pressure falls. That is the reason blood pressure of 140/90 mm of Hg is considered very high during pregnancy (mainly during second trimester), whereas the same pressure is considered only the beginning of high blood pressure in general population. High perinatal (4 weeks before delivery to 4 weeks after delivery is the perinatal period) mortality and morbidity is associated even at blood pressure of 140/90 mm of Hg.

Millions of women become pregnant every year and a significant proportion of these pregnancies are complicated by one or more of the medical disorders that can occur during pregnancy. Some of the medical disorders during pregnancy are common and some are less common and some of the medical disorders during pregnancy are rare. The pattern of medical disorders during is also changing. Medical science is advancing rapidly and many medical disorders which were considered contraindications of pregnancy few decades ago are no more considered contraindication of pregnancy. Due to advancement of obstetrics, neonatology, obstetric anesthesiology, and medicine, the expectation of happy outcome of pregnancy for the mother as well as the fetus has also increased to a great extent.

Marked physiological changes occur during pregnancy (e.g. marked increase in cardiac output and workload of heart, which is as much as 40% increase) and the mother’s body need to adapt to these physiological changes appropriately to have a good outcome of pregnancy. Medical disorders which interfere with physiological adaptations of pregnancy can increase the risk of a poor outcome of pregnancy and pregnancy may sometimes aggravate the preexisting medical disorder in a woman.

The medical disorders which can occur during pregnancy are preeclampsia (development of hypertension and presence of protein in urine after 20 weeks of pregnancy or gestation) which occurs in approximately 5-7% of all pregnancies, eclampsia, gestational hypertension, aggravation of existing essential hypertension, cardiovascular disorders (like mitral stenosis, mitral and aortic regurgitation etc.), renal disorders, pulmonary hypertension, pulmonary embolism, deep vein thrombosis, hormonal disorders (like diabetes, gestational diabetes, hypothyroidism or hyperthyroidism), blood disorders, neurological disorders, gastrointestinal disorders and liver diseases. The pregnant women are also prone to develop certain bacterial (urinary tract infection, which is very common medical problem during pregnancy) and viral infections (cytomegalovirus infection, rubella, herpes, HIV infection etc.).

Travel during pregnancy is a great concern for the pregnant woman. Before starting travel many important aspects should be considered. A woman’s medical history and itinerary, the quality of medical care at her destination, and her degree of flexibility should be the determining factors for travel during pregnancy. The safest part of pregnancy in which to travel can be done is between 18 and 24 weeks, when there is the least danger of spontaneous abortion and also premature labor, according to the American College of Obstetrics and Gynecology. Many obstetricians prefer that women should stay within a few hundred miles of home after the 28th week of pregnancy. But in general there is no danger in travel during pregnancy if the pregnant woman is healthy.

Travel should be avoided during pregnancy if there is a history of miscarriage, premature labor, incompetent cervix, or toxemia. Travel should also be avoided if there are general medical conditions like diabetes, heart failure, severe anemia, or a history of thrombo-embolic disease in pregnant woman. Pregnant women should not go to a place where there is excessive risk to the growing fetus as well as to the pregnant woman like those at high altitudes and those where live-virus vaccines are required or where multi drug-resistant malaria is endemic.

Pregnant women should be very cautious about traveler’s diarrhea during travel. Dehydration due to travelers’ diarrhea can lead to inadequate placental blood flow and lead to hypoxia and growth retardation to the fetus. The dehydration of traveler’s diarrhea should be promptly corrected by adequate fluid replacement.

Air travel is not risky to the healthy pregnant woman or to the fetus. The higher radiation levels reported at altitudes of more than 10,500 m (35,000 ft) during air travel also should pose no problem to the healthy pregnant traveler. Each airline has a policy regarding pregnancy and flying and it is best to check with the specific carrier when booking reservations. Domestic air travel is generally permitted till the 36th week of pregnancy, and international air travel is generally permitted till the 31st week of pregnancy.

There are no known risks for pregnant women for travel to high-altitude destinations and stay for short periods but there are no data of safety of pregnant women at altitudes of more than 4500 meter (15,000 ft).

Gynaecology and obstetrics is a specialized branch of medicine (can say women’s health) which deals in women health problems (gynaecology) and also pregnancy and delivery or child birth (obstetrics). Job as a gynaecologist can be very challenging as well as very rewarding. Job of a gynaecologist is challenging because like any other branch of medicine this branch is also changing rapidly and evolving very fast and to keep up to date with the subject is a challenging job in the present scenario. Job of a gynaecologist and obstetrician is rewarding because only a gynaecologist can understand and feel the satisfaction they bring to a family where he/she has delivered a new member of a family. The joy of the family and the joy for the obstetrician can not be expressed in words and if you have to understand the feeling of joy, you have to be either the parent or you have to be a gynecologist and obstetrician. Only gynaecologist can get the experience of seeing the smiling faces of parents and relatives of a new born baby. Gynaecologist get the satisfaction of job like any other doctor but the additional satisfaction they get can not be achieved by any other doctor.

A person willing to be a gynaecologist and considering a career in obstetrics and gynaecology should have a genuine and sincere concern for the health and well being of women. With out sincerity and willingness of providing service a gynaecologist can not succeed and also will not be a good gynaecologist.

Gynaecologists have a much bigger role to play in nation building also than any other doctor. They teach women how to take care during pregnancy and help delivering healthy babies. Healthy babies are the future of a nation and by presenting healthy babies the gynaecologists take a very important role in nation building. They provide the healthy foundation of a society and nation and without healthy foundation a nation can not progress.

Stretch marks develop commonly in women during pregnancy due to overstretching of skin of abdomen due to growing fetus in mother’s womb. Stretch marks can develop at any time other than pregnancy and it is also commonly seen in overweight and obese females. These stretch marks not only can cause cosmetic problem for women, it can also cause severe itching and weakening of skin in the abdomen and it increases the chances of skin infection and injury also.

Stretch marks are also seen in men and actually men are susceptible to stretch marks. One of the reasons of stretch mark is dryness of skin in men and women alike. So to prevent stretch marks you should use a moisturizer for keeping your skin moist throughout the day.

It may be very difficult to prevent stretch marks in some women during pregnancy. One thing has to be kept in mind is that you have to start the preventive measures for prevention of stretch marks before your abdomen starts to grow during pregnancy. So ideally you should start prevention plan if you find yourself pregnant. The problem is many women start preventive measures only after their tummy starts growing and the sad part is that it is already too late for prevention strategy to work properly.

Ideal stretch marks prevention creams should contain vitamin A, vitamin C, vitamin E, alpha hydroxyl and aloe vera. Many of the anti stretch mark creams contain aloe vera as the main ingredient. To prevent and reduce the stretch marks you should keep yourself hydrated by drinking plenty of water daily. But you should also remember that despite giving maximum effort in preventing stretch marks it may not be possible to prevent stretch marks. It is inevitable in some women and you should accept it without getting depressed.