Obstetrics and Gynaecology Procedure

AUB (Abnormal Uterine Bleeding)

Abnormal Uterine Bleeding (AUB) is a common gynecological issue that affects many women across different age groups. Defined as any deviation from the normal menstrual cycle, AUB can have various causes and present with diverse symptoms.

Understanding Abnormal Uterine Bleeding

AUB is characterized by irregularities in the menstrual cycle, which may manifest as heavy or prolonged bleeding, irregular cycles, delayed menstrual cycles, reduced amount of bleeding/ no menses, or spotting between periods. To comprehend AUB, it's crucial to grasp the normal menstrual cycle. The menstrual cycle involves a complex interplay of hormones that regulate the growth and shedding of the uterine lining.

Causes of Abnormal Uterine Bleeding

Here are some cause of abnormal uterine bleeding:

• Hormonal Imbalances: Hormonal fluctuations, often due to conditions like polycystic ovary syndrome (PCOS) or thyroid disorders, can disrupt the normal menstrual cycle, leading to AUB.
• Structural Abnormalities: Anatomical issues, such as fibroids, polyps, or adenomyosis, can interfere with the uterus's ability to contract and shed its lining properly, causing abnormal bleeding.
• Blood Clotting Disorders: Conditions that affect blood clotting, like von Willebrand disease, can result in heavy menstrual bleeding and contribute to AUB.
• Medical Conditions: Certain illnesses, such as liver or kidney disease, can impact the body's hormonal balance and contribute to abnormal bleeding.
• Infections or Inflammation: Infections of the reproductive organs or chronic inflammation may cause AUB.
• Medications: Some medications, including certain types of contraceptives or anticoagulants, can affect menstrual bleeding patterns.

Recognizing Symptoms of AUB

• Heavy Menstrual Bleeding: Experiencing excessively heavy menstrual flow that requires frequent changing of pads or tampons is a common symptom of AUB.
• Frequent Menstruation: Menstrual cycle of less than 24 days
• Infrequent Menstruation: Menstrual cycle of more than 38 days
• Irregular Menstrual Cycles: AUB may manifest as irregular periods, with variations in the duration of the menstrual cycle and the amount of blood flow.
• Prolonged Menstrual Bleeding: Menstrual periods lasting longer than seven days can indicate AUB, especially if this is a deviation from one's usual pattern.
• Bleeding Between Periods: Spotting or bleeding between menstrual cycles is another potential sign of AUB and should be investigated by a healthcare professional.
• Menstrual Cramps: While mild cramping is normal during menstruation, severe or prolonged menstrual cramps can be indicative of AUB.

Seeking Diagnosis and Treatment

If you suspect AUB, it is essential to consult with a healthcare provider. Diagnosis typically involves a detailed medical history, physical examination, and sometimes imaging studies like ultrasounds. Abnormal uterine bleeding treatment options depend on the underlying cause and may include:

• Hormonal Therapy: Balancing hormones through contraceptives hormone replacement therapy or an Intrauterine system can regulate menstrual cycles.
• Non-Hormonal Medications: Medications like tranexamic acid may be prescribed to reduce heavy bleeding.
• Surgical Interventions: In cases of structural abnormalities, surgical procedures like hysteroscopy or endometrial ablation Removal of Fibroids (Myomectomy), Polyps(Polypectomy), and Uterus(Hysterectomy) may be recommended.
• Lifestyle Changes: Adopting a healthy lifestyle, including exercise, a balanced diet, and stress management, and maintaining a normal weight can contribute to menstrual regularity.

Conclusion

Abnormal Uterine Bleeding (AUB) is a multifaceted condition with diverse causes and symptoms. If you suspect you may be experiencing AUB, it's crucial to consult with a healthcare professional at Sakra World Hospital for a proper diagnosis and personalized treatment plan. Early intervention can help manage symptoms effectively and improve overall reproductive health. Remember, seeking timely medical advice is essential for addressing any potential underlying issues related to abnormal uterine bleeding.

PIH (Pregnancy- induced Hypertension)

Pregnancy is a miraculous and transformative journey for women, but it comes with its own set of challenges. Pregnancy-induced hypertension (PIH), also known as gestational hypertension, is one such challenge that can affect both the mother and the unborn child.

What is Pregnancy-Induced Hypertension?

PIH is a condition characterized by elevated blood pressure during pregnancy. It typically occurs after the 20th week of gestation and resolves after childbirth. While the exact cause remains unknown, factors such as a woman's age, family history of hypertension, and multiple pregnancies may contribute to its development.

Risks Associated with PIH

• Complications for Mother: PIH poses serious risks to the mother, including the development of preeclampsia, a more severe form of the condition. Preeclampsia can lead to organ damage, seizures (eclampsia), and even maternal death if left untreated.
• Complications for the Baby: PIH can adversely affect fetal growth and development, leading to low birth weight and preterm birth. In severe cases, it may result in stillbirth or other complications for the newborn.

Causes of PIH

The exact cause of Pregnancy-Induced Hypertension (PIH) is not fully understood, but several risk factors have been identified. These include

• First-time Pregnancy: Women experiencing their first pregnancy are at a higher risk of developing PIH.
• Age: Women under 20 and over 40 are more susceptible to PIH.
• Multiple Pregnancies: Carrying twins or multiples increases the risk of developing hypertension during pregnancy.
• Obesity: Women with a higher body mass index (BMI) are at an increased risk.
• Pre-existing Conditions: Chronic hypertension, diabetes, kidney disease, and certain autoimmune disorders can contribute to the development of PIH.

Symptoms of PIH

High Blood Pressure: Elevated blood pressure is the hallmark symptom of PIH. A blood pressure reading consistently higher than 140/90 mm Hg is indicative of the condition.

• Proteinuria: Protein in the urine, a condition known as proteinuria, is a common sign of preeclampsia. Regular prenatal check-ups are crucial to monitor this parameter.
• Swelling: Excessive swelling, especially in the hands and face, can be a sign of PIH. It is essential to distinguish between normal pregnancy-related swelling and that associated with hypertension.

Management and Prevention

Here are some pregnancy-induced hypertension treatments:

• Regular Prenatal Check-ups: Early detection of PIH is vital for effective management. Regular monitoring of blood pressure and urine for protein during prenatal visits can help identify the condition promptly.
• Healthy Lifestyle Choices: Adopting a healthy lifestyle is crucial in preventing and managing PIH. This includes maintaining a balanced diet, engaging in regular, moderate exercise, and avoiding smoking and excessive alcohol consumption.
• Medication and Bed Rest: In cases of severe PIH or preeclampsia, medication may be prescribed to lower blood pressure and prevent complications. Bed rest might also be recommended to reduce stress on the cardiovascular system.
• Hospitalization for Severe Cases: Severe cases of PIH may require hospitalization for close monitoring and to manage complications promptly. In extreme situations, early delivery through induction or cesarean section may be necessary.

Conclusion

Pregnancy-induced hypertension is a complex condition that requires careful monitoring and management to ensure the well-being of both the mother and the baby. Early detection, lifestyle modifications, and appropriate medical intervention play pivotal roles in mitigating the risks associated with PIH. By staying informed and maintaining a proactive approach to prenatal care, women can navigate through pregnancy with a reduced risk of hypertension-related complications, promoting a healthier start for both mother and child. It is essential to seek guidance from healthcare professionals at Sakra World Hospital to tailor a personalized care plan that addresses the specific needs of each individual during pregnancy.

High Risk Pregnancy

Pregnancy is a beautiful and transformative journey for many women, but it can also be accompanied by challenges. A high-risk pregnancy is one that need extra attention and care during the pregnancy to prevent complications for both the mother and the baby due to various risk factors. 

What is a High-Risk Pregnancy?

A high-risk pregnancy is a pregnancy that carries increased health risks for the pregnant woman, fetus, or both. These risks may be due to factors in the pregnancy itself, or they may arise from pre-existing medical conditions. 

Common Causes of High-Risk Pregnancy

Here are some common causes of high-risk pregnancy:

• Maternal Age: One of the most common factors is maternal age. Women who become pregnant at a very young age (under 17) or older age (over 35) are more likely to experience complications.
• Pre-existing Medical Conditions: Chronic conditions like diabetes, hypertension, heart disease, renal disease and autoimmune disorders, etc can increase the risk of complications during pregnancy.
• Multiple Pregnancies: Multiple pregnancies like twins or triplets can lead to a high-risk pregnancy as they often result in premature birth and low birth weight.
• Gestational Diabetes: Some women develop diabetes during pregnancy, known as gestational diabetes, which requires close monitoring and management.
• Preeclampsia: This condition, characterized by high blood pressure and damage to organs, typically occurs after the 20th week of pregnancy.
• Infections: Infections like HIV, herpes, or hepatitis B can pose risks to both the mother and the baby.
• Placental Issues: Problems with the placenta, such as placenta previa or placental abruption, can lead to complications. 
• Preterm Labour: Some women are at risk of going into labour before 37 weeks, which can lead to complications for the baby's health.
• Previous Pregnancy Complications: A history of preterm birth, preeclampsia, or stillbirth.

Management of High-Risk Pregnancy

Prenatal Care: Early and regular prenatal check-ups are crucial for monitoring the pregnancy's progress and addressing potential issues promptly.

• Specialized Healthcare Providers: High-risk pregnancies often require care from specialists, such as maternal-fetal medicine specialists or neonatologists, to provide expert guidance and intervention as a multidisciplinary team. 
• Medications: In some cases, medication may be prescribed to manage underlying medical conditions or to prevent complications like preterm labor.
• Fetal Monitoring: Continuous monitoring of fetal well-being through ultrasound and non-stress tests can help identify and address problems early.
• Lifestyle Changes: Maintaining a healthy lifestyle through proper nutrition, exercise, and avoiding harmful substances like tobacco and alcohol is advised. 

Support and Emotional Well-being

High-risk pregnancies can be emotionally and mentally taxing for expectant mothers. It's essential to have a strong support system, which may include:

• Pre-pregnancy counseling: Seeking professional counseling or therapy can be beneficial for managing the stress and anxiety associated with a high-risk pregnancy and also it helps in medical conditions being assessed before planning for the pregnancy. 
• Communication: Open and honest communication with your healthcare providers is vital. Express your concerns to ensure you receive the best care possible.

Potential Outcomes of High-Risk Pregnancy

The outcome of a high-risk pregnancy can vary widely depending on the specific risk factors and how they are managed. While the risk of complications is higher, advances in medical care have improved outcomes for both mothers and babies in many cases. However, it's essential to be prepared for potential challenges and make informed decisions throughout the pregnancy.

Conclusion

High-risk pregnancies are a reality for many women, and they require specialized care, attention, and support. The key to successfully navigating a high-risk pregnancy lies in early detection, regular monitoring, proper management, and maintaining emotional well-being. While these pregnancies may come with additional challenges, with the right care and support, most women can achieve a safe and healthy outcome for themselves and their babies.

Remember that every pregnancy is unique, and the support of healthcare professionals and loved ones can make a significant difference in ensuring a positive outcome. If you facing a high-risk pregnancy, reach out to healthcare providers at Sakra World Hospital to ensure the best possible care and peace of mind during this challenging but ultimately rewarding journey.

PCOD

Polycystic Ovary Syndrome (PCOD) is a common and complex hormonal disorder.  It can lead to various physical and emotional challenges, from irregular periods to fertility issues and metabolic complications. In this blog, we'll dive into the world of PCOD, exploring its causes, symptoms, management, and lifestyle changes that can help individuals not only cope but thrive with this condition.

Understanding PCOD

Polycystic Ovary Syndrome, often referred to as PCOD or PCOS (Polycystic Ovarian Syndrome), is a hormonal disorder that affects the ovaries. It's characterized by a range of symptoms, and while the exact cause isn't known, several factors contribute to its development:

• Hormonal Imbalance: PCOD is primarily driven by hormonal imbalances. Elevated levels of androgens (male hormones) can lead to irregular menstrual cycles, acne, and excess hair growth.
• Insulin Resistance: Many individuals with PCOD have insulin resistance, which means their bodies have trouble using insulin effectively. This can lead to weight gain and increased risk of Type 2 diabetes.
• Genetics: There's a genetic component to PCOD. If your mother or sister has it, your risk may be higher.

Common Symptoms

The symptoms of PCOD can vary from person to person, but some of the most common include

• Irregular Periods: Women with PCOD often experience irregular menstrual cycles, which may be infrequent or unpredictable.
• Ovulatory Dysfunction: PCOD can lead to the absence of ovulation, making it difficult to conceive for some women.
• Excess Hair Growth: Increased androgen levels may lead to hirsutism, causing excess hair growth on the face, chest, and back.
• Acne and Oily Skin: Hormonal imbalances can result in acne and excessively oily skin.
• Weight Gain: Many women with PCOD struggle with weight gain, particularly around the abdomen.
• Hair Loss: PCOD can lead to thinning hair or male-pattern baldness.
• Skin Darkening: Acanthosis nigricans, a condition where the skin in the body creases darkens, is more common in individuals with PCOD.

Diagnosis

Diagnosing PCOD requires a comprehensive evaluation that includes:

• Medical History: Your doctor will discuss your menstrual history, symptoms, and family history.
• Physical Examination: A physical examination may be performed to check for physical signs of PCOD, such as excess hair growth or acne.
• Blood Tests: Hormone levels, including androgens and insulin, are often measured to assess hormonal imbalances.
• Ultrasound: A pelvic ultrasound is commonly used to examine the ovaries for cysts or other abnormalities.

Management and Treatment

Management of PCOD  typically involves a combination of lifestyle changes, medications, and, in some cases, surgical interventions. Here are some key approaches to managing PCOD

• Lifestyle Modifications: Implementing a healthy lifestyle is often the first step in managing PCOD. This includes regular exercise, a balanced diet, and weight management, which can help improve insulin sensitivity and regulate hormonal imbalances.
• Medications: Depending on your specific symptoms, your doctor may prescribe medications to address hormonal imbalances, regulate menstrual cycles, and manage other symptoms. Commonly prescribed medications include birth control pills, metformin, and anti-androgen drugs.
• Fertility Treatments: Women with PCOD who are trying to conceive may benefit from fertility treatments, such as ovulation-inducing medications or in vitro fertilization (IVF).
• Surgical Interventions: In some cases, surgery may be necessary to treat PCOD-related issues, such as ovarian drilling to stimulate ovulation or the removal of ovarian cysts.

Coping with PCOD

Living with PCOD can be challenging, but it's essential to remember that it is a manageable condition. Here are some strategies to cope with PCOD effectively:

• Consult a Specialist: Consult with a healthcare provider who specializes in PCOD. They can provide tailored guidance and treatment options.
• Lifestyle Changes: Embrace a healthy lifestyle with a balanced diet and regular exercise. Even modest weight loss can significantly improve PCOD symptoms.
• Regular Check-ups: Keep up with regular medical check-ups to monitor your progress and make necessary adjustments to your treatment plan.

Conclusion

PCOD is a challenging condition, but it doesn't restrict you. With proper understanding, management, and support, individuals with PCOD can lead healthy, fulfilling lives. Remember, everyone's journey with PCOD is unique. Embrace self-compassion, stay informed, and make choices that nurture your physical and emotional well-being. At Sakra World Hospital, we are dedicated to providing the care and support you need to manage PCOD effectively. Our team of experts is here to guide you on your unique path to well-being.

Common Misconceptions about Hearing Aids and Cochlear Implants

Hearing aids and cochlear implants have transformed the lives of individuals with hearing impairments, enabling them to navigate the world of sound with greater clarity and ease. However, these remarkable hearing solutions often suffer from misconceptions and misunderstandings. 

In this blog, we will debunk some common myths about hearing aids and cochlear implants. We will also highlight the benefits of these treatments and provide important precautions to ensure their optimal usage. It's important to understand the truth about these treatments for hearing loss and take the necessary steps to ensure effective treatment and improved hearing abilities. By dispelling misconceptions and following precautions, individuals can make informed decisions about their hear loss treatment journey and experience the benefits of these solutions for better hearing and communication.

Prevalent myths of misconceptions about hearing loss and cochlear implants

Misconception 1: Hearing aids and cochlear implants are the same.

One of the most widespread misconceptions is that hearing aids and cochlear implants serve the same purpose. In reality, these devices differ significantly. Hearing aids are primarily recommended for individuals with mild to moderate hearing loss. They work by amplifying sounds, making them easier to hear. Cochlear implants, on the other hand, are designed for individuals with severe to profound hearing loss or those who do not benefit from hearing aids. Cochlear implants bypass damaged parts of the inner ear and stimulate the auditory nerve directly, allowing individuals to perceive sound signals.

Misconception 2: Hearing aids and cochlear implants restore hearing completely.

While hearing aids and cochlear implants greatly enhance hearing abilities, they do not restore hearing to normal levels. Hearing aids amplify sounds, but they cannot replicate the exact hearing experience prior to hearing loss. Similarly, cochlear implants provide access to sound, but the quality of sound perception may vary among recipients. Nevertheless, these devices significantly improve the wearer's ability to communicate and engage with their surroundings, leading to a more fulfilling life.

Misconception 3: Hearing aids and cochlear implants are only for the elderly.

It is a common misconception that hearing loss exclusively affects older individuals, leading to the belief that hearing aids and cochlear implants are solely intended for the elderly. However, hearing loss can affect people of all ages, including children and young adults. Early intervention with hearing aids or cochlear implants is crucial for children with hearing impairments as it aids in their speech and language development, academic performance, and social skills. For young adults, these devices can promote independence and improve the overall quality of life by overcoming communication barriers.

Misconception 4: Hearing aids are bulky, uncomfortable, and noticeable.

Advancements in technology have significantly improved the design and comfort of hearing aids. Many modern hearing aids are discreet, lightweight, and comfortable to wear. They come in various styles, including in-the-ear (ITE), behind-the-ear (BTE), and invisible-in-canal (IIC) options. These discreet designs address the stigma associated with visible hearing devices. Moreover, some hearing aids offer advanced features such as Bluetooth connectivity and rechargeable batteries, enhancing convenience and usability.

Misconception 5: Cochlear implants are only beneficial for those born deaf.

While cochlear implants have been highly successful in individuals born deaf, they are not exclusively for this group. Cochlear implants can be equally effective for individuals who have experienced hearing loss later in life due to factors such as age, illness, or injury. The key determinant for successful cochlear implantation is the health of the auditory nerve and the brain's ability to process auditory signals.

Benefits of Hearing Aids and Cochlear Implants

Enhanced Communication: Hearing aids and cochlear implants improve communication abilities, allowing individuals to engage more effectively in conversations and social interactions.

Increased Safety: By restoring or enhancing hearing, these devices enable individuals to be more aware of their environment, including warning signals, alarms, and approaching vehicles, thereby promoting safety.

Emotional Well-being: Improved hearing can alleviate feelings of isolation, depression, and anxiety that often accompany hearing loss. The ability to reconnect with loved ones and enjoy social activities contributes to emotional well-being.

Cognitive Stimulation: Hearing aids and cochlear implants provide essential auditory stimulation to the brain, which has been linked to improved cognitive function and reduced cognitive decline.

Precautions for Optimal Usage

Professional Evaluation: It is crucial to consult an audiologist or hearing healthcare professional for a comprehensive evaluation and appropriate device selection tailored to your specific hearing needs.

Proper Maintenance: Regular cleaning and maintenance of hearing aids and cochlear implants are essential to ensure optimal performance and longevity. Follow the manufacturer's instructions and seek professional assistance when needed.

Gradual Adaptation: It takes time for the brain to adjust to new sounds provided by hearing aids or cochlear implants. Gradual adaptation and consistent use will maximize the benefits over time.

Hearing Protection: It is important to protect your hearing from loud noises, as excessive exposure can damage the remaining hearing abilities and impact the effectiveness of hearing aids or cochlear implants.

Treatments for Hearing Loss:

Audiological evaluations: Undergo comprehensive audiological assessments to determine the type and degree of hearing loss. This information helps tailor the most appropriate treatment plan, whether it involves hearing aids, cochlear implants, or other interventions.

Rehabilitation and counseling: Hearing loss can be an adjustment, both physically and emotionally. Seek rehabilitation services, including speech therapy and counseling, to adapt to the changes and enhance communication skills.

Assistive listening devices: Explore additional assistive listening devices, such as FM systems or captioned telephones, which can complement the use of hearing aids or cochlear implants in challenging listening environments.

Conclusion

Hearing aids and cochlear implants are remarkable technologies that have revolutionized the lives of individuals with hearing impairments. By debunking common misconceptions, we can better understand the unique benefits they offer. These devices enhance communication, promote safety, and improve emotional well-being. It is important to take necessary precautions, such as professional evaluation, proper maintenance, gradual adaptation, and hearing protection, to ensure optimal usage and long-term benefit. Embracing these devices with accurate knowledge will empower individuals to lead fulfilling lives and fully participate in the rich auditory world around them. If you are facing hearing loss, don't hesitate to seek guidance from Sakra World Hospital, where you can find the best ear doctor in Bangalore to explore the best solution for improved hearing and communication. 

Pregnancy During Covid-19 Crisis: A Guideline For Expecting Mothers

Pregnancy is probably one of the most sensitive times in a woman’s life. The global Coronavirus outbreak that comes with loads of anxiety, fear and life like never before has made pregnant mothers even more worried. They are confused and not certain about what they should do and they should not. They have ample confusion and queries about whether the deadly virus can pose a threat to their newborns in the womb, what precautions they must take to remain safe from Covid-19 during the gestation and immediately after the delivery or how they keep their mental health fit during and post-pregnancy. Here is all a pregnant mum must know about the impact of a pandemic on the health of the mother and the new-born and the various ways both can remain healthy during the crisis time. 

How Covid-19 can affect pregnancy?

There is no evidence that reveals carrying a baby makes a woman more prone to contracting Coronavirus compared to other healthy adults without any co-morbidities. In case a pregnant woman tests positive for Covid-19, she may not be at a greater risk of developing severe complications as well. However, during pregnancy, the efficiency of one's immune system may decrease and that is why a pregnant woman must be more careful particularly at the present situation and follow the norms of social distancing and self-quarantine.

A pregnant woman may experience flu-like symptoms - mild to moderate, like most others. However, if the flu-like symptoms worsen in a pregnant woman or there is a delay in recovery, it may indicate the severity of the chest infection and that may require immediate hospitalization. 

Although Covid-19 is a new and evolving virus and not adequate evidence is available at present, it is not confirmed yet that Coronavirus may increase the risk of a miscarriage. Also, vertical transmission meaning direct transmission of the virus from the mother to the unborn baby has not been substantiated till now. A recently conducted Lancet study on women in their third trimester has shown that the risk of vertical transmission of Covid-19 is low and there is no evidence of foetal malformations due to maternal infection with Covid-19. 

Tips for pregnant women to remain safe from Coronavirus during pregnancy

Pregnancy is a critical time, especially the first trimester. Tackling Coronavirus during pregnancy certainly needs extra caution. These suggestions may result in a smooth pregnancy during the Covid-19 time.

• Be aware of the infection: It is essential for a would-be-mum to know about the virus - particularly its symptoms so that she can take immediate steps and visit a doctor in case they experience any. She must know the mode of transmission as well so that she can take necessary precautions to prevent contraction.

• Do not violate the prevention guidelines: It is wise to follow the social distancing guidelines set up by the government. Pregnant women must not visit crowded areas, wear a mask while going out in case of an emergency, know to use a mask appropriately and not touch the back and the front side of a mask must follow respiratory, hand hygiene and social distancing diligently.

• Maintain your regular check-ups: Skipping regular check-ups during pregnancy is not at all recommended. However, during the Coronavirus crisis, it is wise to opt for tele-consultancy/ online consultancy and get the routine check-ups done on time. ICMR has advised the mandatory visits to the hospital for pregnant women in 3rd, 5th, 7th and 9th months as they also involve other tests such as fetal scans and vaccines.

• Avoid touching face, eyes and nose: Despite washing hands thoroughly it is wise to not touch face, eyes and nose repeatedly as it may turn out to be harmful to the baby and the mother. 

• Sleep well: It is essential to get adequate sleep during pregnancy. Good sleep helps in enhancing body immunity and keeps one energetic. Sleep is particularly necessary for the baby in the womb. 

• Eat well: Due to decreased immunity during pregnancy, it is important to get a balanced and nutritional diet. The appropriate diet amps up the body's ability to fight against diseases. 

Coronavirus and breastfeeding - Things to keep in mind 

In case a new mum is tested positive for Covid-19, she can breastfeed her newborn. The reason, breastfeeding a child is far more beneficial compared to the risk of transmission of the virus through breast milk. However, there may be a risk of droplet infection due to close contact between the mother and the child during breastfeeding and the virus can spread to the baby while breaking. The following tips may help a Coronavirus positive new mum breastfeed her newborn without the fear of transmitting the virus.

1. Wash hands before feeding or touching the baby, breast pump or bottles

2. Try to avoid coughing or sneezing while feeding. Wearing a mask while feeding may help. 

3. While using a breast pump, follow instructions for cleaning and sterilizing properly.

4. Consider asking one of your healthy family members to feed your baby if you are expressing milk. 

 Following the doctor’s advice and working on mental health can make pregnancy, delivery and post-partum hassle-free and without worries during this crisis. 

Coronavirus and pregnancy: Keeping the mental health intact 

Social distancing and the complete lockdown have disrupted our lives to a large extent. Life will not be the same post lockdown as well. Social distancing may result in monotony, stress, anxiety and depression among the pregnant and the new mothers. Here are things that can help them keep their mental health fit.

• Do not panic: There is no need to panic and get scared about the Covid-19 outbreak. Take the required precautions and let go of panic and stress. 

• Stay away from news and fake content on social media: It is wise to not watch news related to Coronavirus continuously. Also, stay away from rumours related to the virus. 

• Keep in virtual touch with family: It is always good to remain among family and close friends during pregnancy as it keeps an expecting mother happy and stress-free. During the lockdown remain in touch with your family members online, do video calls and chat with them. 

• Remain physically and mentally active at home: Do exercises at home, sign in for online yoga and meditation classes, cook healthy food, try new recipes, engross in creative art, watch happy movies, listen to good music and de-stress. Keep away from smoking and drinking.

The Surprising Link Between Oral Health and Pregnancy

Can Oral Health Have an Effect on Pregnancy?

Recent research indicates a link between gum disease and childbirth complications. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small.

More studies are needed to confirm the exact correlation between gum disease during pregnancy and labor complications, but it appears that gum disease may trigger increased levels of biological compounds that induce labor. Data also suggests that when periodontal disease worsens during pregnancy, there's a higher risk of having a premature baby.

What Can I Do to Ensure I Have a Healthy Pregnancy?

Pregnancy and dental care are important for a healthy baby. Pregnant women and women who plan on getting pregnant should visit their dentist for a checkup and to treat any dental problems before conceiving.

Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce pregnancy dental problems.

What Oral Problems Might Develop During My Pregnancy?

Many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums.

Pregnancy gingivitis occurs due to increased levels of hormones that influence the way gums to react to the irritants in plaque.

Keeping your teeth clean, especially near the gum line, will help dramatically reduce or even prevent gingivitis during pregnancy. 

What Can I Expect When I Visit My Dentist During My Pregnancy?

First, be sure to let your dentist know you're pregnant when you schedule your appointment. It's best to schedule your dental visit during the fourth to sixth month of your pregnancy. Avoid seeing a dentist during the first three months of pregnancy, are thought to be of greatest importance in your child's development and the stress of a dental visit may be detrimental to the foetus.

Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless necessary. 

During the last trimester, prolonged sitting in a dental chair can become uncomfortable and a dental examination may be infeasible.

If you need to schedule an emergency visit, let the dentist know about your pregnancy before you arrive. Discuss any relevant medical history, stress factors, past miscarriages and medications you are taking as these can influence your dental care plan and outcomes.

Avoiding A Toothache During Pregnancy

It is recommended by dental specialists that women see a dentist before they plan a pregnancy. This way, the office can do a thorough checkup and cleaning, as well as treat any existing dental problems. Of course, you can also consult a dentist while pregnant.

When you experience a toothache or gum problems during pregnancy, see a dentist as soon as possible for treatment. Dental health issues can adversely affect your pregnancy and early intervention is important for both mother and child.

Avoiding Tooth Decay

Cavities are formed when the bacteria in your mouth use the sugars and carbohydrates present in food to produce acid, which dissolves the enamel on your teeth. 

Pregnant women are at increased risk for developing tooth decay due to a number of reasons: unhealthy food cravings, decrease in brushing and flossing and vomiting as a result of morning sickness can intensify the amount of acid in the oral cavity.

To prevent tooth decay, brush your teeth twice a day, using a soft brush and appropriate toothpaste. Keep sugary snacks to a minimum. Rinse your mouth with water when you aren't able to brush, and floss once a day. 

It's fairly common for an expecting mother to complain about bleeding gums when brushing or flossing. Hormonal changes that come along with pregnancy can cause inflammation, sometimes called pregnancy gingivitis. To keep this condition from developing into more serious gum disease, intensify your dental care routine by using an antibacterial mouthwash and seeing your dentist for more frequent cleanings.

Look Out for Gum Disease

Some pregnant women experience a raw-looking swelling of gum tissue called a "pregnancy tumor" grows between the teeth. These growths bleed easily and may be caused by excessive plaque. Consult a dentist if you suspect you have a pregnancy tumor, even though they are usually benign.

Another uncommon complication of pregnancy is loose teeth. This can develop due to hormones affecting the ligaments that hold the teeth in place.

Pregnancy dental care is an important part of your general health and the health of your baby. This is why, for a safe and healthy pregnancy, dentists and obstetricians encourage women to make their oral health a priority.

Oral hygiene maintenance during pregnancy

Unless it's a dental emergency, plan your dental visits throughout the entire pregnancy. Start by scheduling an appointment prior to becoming pregnant. That way, any necessary procedures can occur before you become pregnant. 

The first trimester isn't ideal for dental treatments as the fetus is in the initial stages of development. Instead, schedule non-emergency visits for the second trimester or early in the third trimester.

There a few experiences in a woman's life as special as being pregnant. Seeing a dentist while pregnant is often overlooked but it is important that you don't forget to maintain good oral health. That includes teeth cleaning while pregnant. 

Brush at least twice each day with good toothpaste and don't forget to floss, as it complements brushing by removing food particles that stick in places a brush can't reach. Taking care of your mouth ahead of time will allow you to focus on the joyful arrival of your child.

Management of High Risk Pregnancy

How can high-risk pregnancies be managed?

For all women who are diagnosed with a high-risk pregnancy, treatment options vary depending on the risk factors specific to the pregnancy and the woman’s medical history.

High Blood Pressure

It is important to regulate blood pressure during pregnancy which can be done by making some changes in the high blood pressure medication. Certain diet and lifestyle changes may also be recommended to keep the blood pressure under control.

Gestational Diabetes

Gestational diabetes, or developing diabetes during pregnancy, increases the risk of pregnancy complications. Often times the woman is diabetes only during pregnancy and is normal after the delivery. Many women having gestational diabetes have healthy pregnancies and healthy infants provided they follow a recommended diet and treatment plan. Some important points to be considered by a woman diagnosed with gestational diabetes include:

1. Regular monitoring of blood sugar level and maintaining control. A woman diagnosed with gestational diabetes must regularly track her blood sugar levels by testing several times a day.

2. Eating a healthy diet. A low carbohydrate diet with meals spread throughout the day helps to keep blood sugar under control. As diet plans may vary for each individual’s needs, one must always follow a diet as recommended by a dietician and the doctor.

3. Maintaining a healthy weight. The amount of weight gain that is healthy for a woman will depend on how much she weighed before pregnancy. It is important to track both overall weight gain and the weekly rate of weight gain.

4. Maintaining a daily record of diet, exercise, and glucose level. A woman with gestational diabetes should write down her blood sugar numbers, physical activity, and everything she eats and drinks in a daily record book.

Some women with gestational diabetes will also need to take medicine, such as an oral hypoglycemic tablet or insulin to help manage their diabetes.

HIV Treatment

HIV infection can be passed from a mother to her fetus as well as during childbirth and breastfeeding, but treatment can prevent transmission.

What steps can be taken to promote a healthy pregnancy?

Staying healthy is probably the first step that one needs to do to lower the risk of having a difficult pregnancy. With the increasing incidence of high risk pregnancies in the current times, it is highly recommended to follow a healthy lifestyle and also consider a pre conception evaluation by a health care providers to ensure fitness for a pregnancy.

Even during the pregnancy, there are steps that can be taken to reduce the risk of certain problems:

1. Taking at least 400 micrograms of folic acid (a type of vitamin B) every day before and during pregnancy.

2. Getting proper immunizations.

3.  Maintaining a healthy weight; eating a good diet; getting regular physical exercise.

4.  Smoking, alcohol, or drug use should be strictly avoided.

5.  Prenatal care appointments early during pregnancy and visiting a health provider for regularly scheduled appointments throughout the pregnancy should be given prime importance.

Management of High-Risk Pregnancies at Sakra World Hospital 

Sakra World Hospital being a multidisciplinary hospital has a highly qualified and experienced team of specialists from all departments. Our high-risk obstetrics team offers a well-coordinated comprehensive continuum of care for the management of complicated pregnancies throughout pregnancy, childbirth, and beyond to protect both the mother and the baby.

Being a tertiary care hospital, multidisciplinary team involvement is built in to give the best outcome. Experts in neonatology, critical care, endocrinology, rheumatology, cardiology, neurology, nephrology, gastroenterology, urology, interventional radiology, transfusion medicine, laboratory medicine are all available round the clock.

Sakra Advantages – All under one roof:

    1. Exclusive labor and delivery rooms specially designed to create a living and safe setting during childbirth.
    2. Options for painless labor using analgesic and breathing techniques
    3. Ultra-modern operation theatres dedicated to obstetrics
    4. Day assessment unit
    5. Early pregnancy assessment 
    6. High dependency unit 
    7. Intensive care unit
    8. Neonatal ICU
    9. Round the clock blood bank services
    10. Laboratory medicine 
    11. Interventional radiology

High Risk Pregnancy

What is a High Risk Pregnancy?

A high risk pregnancy is the one in which some conditions puts the mother or the developing fetus or both at higher than normal risk of developing complications during or after the pregnancy and birth. Such women and their babies need close monitoring and care throughout the pregnancy. It is essential to understand what causes a high risk pregnancy and to manage it properly at the right time. 

What are the factors that increase the chances of a High Risk Pregnancy?

Pre-existing conditions/factors that can increase the chances of a High Risk Pregnancy include:

    1. Heart disease
    2. High blood pressure
    3. Kidney problems 
    4. Diabetes
    5. Thyroid disorders
    6. Epilepsy
    7. Respiratory disorders like asthma
    8. Autoimmune diseases (like SLE, Rheumatoid arthritis, APLA)
    9. Blood disorders (anemia, thalassemia, sickle cell disease, ITP, etc.)
    9. Underlying mental health conditions 
    10. Family history of high risk pregnancies, or genetic conditions
    11. Problematic past pregnancies
    12. Including previous adverse pregnancy outcome, repeated pregnancy losses, preterm labor
    13. Habits like – smoking, drinking alcohol, using illegal drugs
    14. Being overweight or underweight
    15. Maternal age over 35 years

Pregnancy complications - Various complications that develop during pregnancy pose risks, such as problems with the uterus, cervix or placenta. 

Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization — a potentially serious condition that can occur when the mother’s blood group is Rh negative and the baby's blood group is Rh positive.

Other conditions/factors that can develop during pregnancy include:

    1. Preeclampsia (high blood pressure during pregnancy that can affect the mom-to-be’s liver, kidneys and brain)
    2. Gestational diabetes (diabetes that develops during pregnancy)
    3. Preterm labor (labor that starts before 37 weeks)
    4. Placenta praevia (placenta lying unusually low in the uterus so that it may be covering the cervix, which can cause excessive bleeding during delivery)
    5. Pregnancy with more than one baby (multiple pregnancies)

What else you must know about high-risk pregnancy?

Consult your health care provider about how to manage any medical conditions you might have during your pregnancy and how your health might affect labor and delivery. Ask your health care provider to discuss specific signs or symptoms to look out for, such as:

    1. Vaginal bleeding
    2. Persistent headaches
    3. Pain or cramping in the lower abdomen
    4. Watery vaginal discharge — in a gush or a trickle
    5. Regular or frequent contractions — a tightening sensation in the abdomen
    6. Decreased fetal activity
    7. Pain or burning with urination
    8. Changes in vision, including blurred vision

Also, find out which signs or symptoms should prompt you to contact your health care provider and when to seek emergency care.

A high-risk pregnancy might have ups and downs. Do your best to stay positive as you take steps to promote a healthy pregnancy.

How is a High risk pregnancy diagnosed?

A high risk pregnancy can be detected at an early stage in the pregnancy with a complete medical history of the mother, a thorough medical examination supported by certain investigations. Continuous monitoring of physical health and personal habits help a health care provider in identifying any risks/problems that develop during pregnancy. 

Once a diagnosis has been made, the woman with a high-risk pregnancy should receive specialized care from a team of health care providers adept in managing high risk pregnancies throughout the pregnancy to ensure that she carries the fetus or fetuses to term.

Get Closer to Your Baby’s Life Inside the Womb

Fetal medicine and its role in pregnancy

Fetal medicine is a specialty that provides a holistic approach towards fetal care and works in sync with Obstetrics and Gynecology to ensure a safe and healthy delivery. All kinds of specialized diagnostic and fetal screening tests necessary for monitoring the developing fetus are performed to ensure timely prenatal diagnosis and thus improved prognosis before and after birth. 

What to expect at your Appointment with a Fetal Medicine specialist?

Before your appointment 

    1. You should always try and go assisted by a family member for the appointment. It is also suggested to avoid taking small children along. 
    2. For Early Pregnancy Scan -  you need to have a full bladder, but not so full that you are uncomfortable
    3. For all other pregnancy scans: you do not need to have a full bladder for the scan.
    4. Always carry your maternity notes, scan reports, and prescriptions with you.

At your appointment:

During the Scan

    1. You will have to lie on your back in the scan room with your tummy uncovered.
    2. The lights in the room will be dim for a clear view of the screen.
    3. A gel will be spread on your tummy so that a hand-held probe can be easily moved backwards and forwards over it.  The probe sends sound waves through your tummy.  The sound waves bounce back off the      baby and are translated into an image on the screen.

After your scan

    1. The results will be explained to you and a scan report with details of the examination will be released in a few minutes.
    2. Your next scan will be scheduled accordingly.                     

What is the need of different ultrasound scans during pregnancy?

There are several reasons why it is essential to take different ultrasound scans for women between 11 to 14 weeks of pregnancy.

    1. To see the baby’s heart beating
    2. Check whether there is just one baby
    3. Confirm how many weeks pregnant you are by measuring the baby
    4. Check for any major abnormalities
    5. To do screening for Down’s Syndrome 

What are the different types of Scans?

Early pregnancy scan (5 to 11 weeks) 

 This scan is done to locate the pregnancy, check the baby’s heart beat and diagnose multiple pregnancies.

Nuchal translucency scan (11 to 13 weeks + 6 days) 

This scan is done to assess the risk of chromosomal problems and rule out fetal anomalies in the baby.

Early Anomaly Scan (16 to 17 weeks)

Routine Anomaly scan (18 to 20 weeks) 

This scan helps to assess the baby’s growth, basic echocardiography, rule out anomalies, and check the placenta.

Fetal Echo (18 to 24 weeks) 

Fetal echo is a complete study of the baby’s heart.

Growth scans (24 weeks onwards)

These scans can be done according to the need any time after 24 weeks and are mainly done to assess baby’s growth, the amniotic fluid around the baby and to assess the blood supply to the baby (Doppler study).

What are the tests done under fetal medicine?

SCREENING BLOOD TESTS

    1. Double marker (10 to 13 weeks + 6 days)
    2. NIPT (Non Invasive Prenatal Testing) (10 weeks onwards)
    3. Quadruple test (16 to 21 weeks)

DIAGNOSTIC TESTS

CVS (11 to 14 weeks)

CVS is a test carried out during pregnancy, which involves removing tissue from the placenta to detect chromosomal abnormalities such as Down syndrome and some other genetic conditions, such as sickle cell disease or thalassemia major, if your doctor has asked for you to be tested for these.

Amniocentesis (15 weeks onwards)

Amniocentesis is a test carried out during pregnancy which involves using a fine needle to remove a small amount of the amniotic fluid around your unborn baby. Amniocentesis is used to detect chromosomal abnormalities such as Down syndrome. It can also detect certain other genetic conditions, and fetal infections. 

OTHERS

    1. Amnio Drainage/ Reduction 
    2. FBS (2nd Trimester onwards)

How to breastfeed?

Women have been breastfeeding since the beginning of time, but it cannot be stated that every woman is always prepared to breastfeed. Every woman who experiences childbirth for the first time is completely new to breastfeeding as well. Nursing can be a little tough in the beginning, but with patience, effort, guidance and lots of support, both the mother and the baby can get a hold of it.

It is always good to try and learn breastfeeding in the hospital as soon as possible and be get guidance from a nurse or a lactation consultant. Though a newborn knows instinctively how to suck, getting his lips and your nipple in the right position (called "the latch") may take some time to settle. Minor adjustments might be required as the nipple may slip out of baby's mouth, or the baby may not know, or may cry, or may just be too sleepy from the birth process.

The mother should not get discouraged due to the small challenges that might come in the beginning. These can be dealt with the help of nurses and lactation consultants or an older women in the family and can develop an understanding and get comfortable with the whole process. Also even if does not get right for several hours (or a whole day), the baby will not starve. 

Since feeds can take anything from five to 40 minutes, the mother should always be seated in a comfortable position for breastfeeding. It is important to have calm and comfortable surroundings especially in the early days of breastfeeding until one gets accustomed to it. 

The baby should be held in a position that is comfortable for the baby as well as the mother to avoid any pain in the arm or the back. Cushions and pillows can be used to give support to the baby or the mother's hand and back. Every mother and baby is unique and will have their own breastfeeding style.

It the latching or the sucking hurts, the suction can be interrupted by inserting the little finger in the corner of the baby's mouth between the baby's gums and the nipple. Once the baby latches on properly, the feeding can resume.

Always let the baby feed fully from just one breast rather than alternating between both breasts, which can lead to the baby getting more of watery foremilk, but not enough of the fat-enriched hindmilk. This can lead to a fussy baby who wants to breastfeed often.

If the baby still feels hungry after feeding on the first breast, the second can be offered. But always remember to burp before restarting the feed. And after every complete feed.

Some Breastfeeding positions

What are the common problems that one can face in breastfeeding?

Some women adjust to breastfeeding easily while many new mothers find it hard to get used to it. A new mother’s breasts have never been subjected to the jaws of a hungry newborn before, so for most moms, it hurts in the beginning. In the first six weeks, as mother’s milk supply adjusts and the baby learns how to breastfeed, and the mother may suffer from some of the following problems:

1. Engorgement - overfull breasts

2. Mastitis – an infection in the breasts due to bacteria that enter the breast and multiply in the milk duct causing pain and inflammation.

3. Cracked, bleeding or sore nipples                                                     

Breastfeeding takes patience and practice. The mother should never lose hope and whenever faced with a problem should always seek help or advice. 

What is the right time and the right process to stop breastfeeding?

According to World Health Organization it is recommend that babies are given only breast milk for their first six months. This is called exclusive breastfeeding. It is also said that women should carry on breastfeeding even after their babies have started on solid food, until the end of the first year and beyond if they wish. 

Doctors advise breastfeeding exclusively for about six months. After which the baby can be supplemented with semi-solid diet while continuing to breastfeed, until the baby stops taking breast milk completely. Some mothers choose to stop breastfeeding (this is known as weaning) when the baby starts eating a wide variety of food.

Breastfeeding is not a choice. It is a responsibility

It is an act that not only helps you feed your baby but one that builds a special bond between you and your baby.

What are the benefits of breastfeeding for the baby?

It is the best source of nutrition for the baby as it contains all the essential vitamins, fats and proteins that are important for the baby’s growth, and are made available in a form that is easily digestible for the baby. Breast milk contains antibodies that boost immunity and helps your baby fight off various viral and bacterial infections.  It also protects the baby against many allergies and is known to significantly reduce the child’s risks towards cancers. It lowers your baby's risk of having asthma or allergies along with other common infections.

Breast feeding is also known to significantly reduce the incidence of stomach infections, lower respiratory infections, ear infection and meningitis in children. It also prevents children from a lot of diseases that develop later in life, like – type 1 and 2 diabetes, high cholesterol and inflammatory bowel diseases and conditions like obesity as well.

How does breastfeeding benefit the mother?

Breastfeeding is not only beneficial for the baby but also has many benefits for the mother. Apart from building the emotional bond between the mother and the baby, breastfeeding is very healthy for the mother as well. It even fastens the mother’s recovery from childbirth. The hormone oxytocin, released during breastfeeding, acts to return the uterus to its regular size more quickly and can reduce postpartum bleeding. 

It is also seen that women who breastfeed, experience reduced rates of breast and ovarian cancer later in life. Breastfeeding can also reduce the future risk of developing type 2 diabetes, rheumatoid arthritis, and cardiovascular disease, including high blood pressure and high cholesterol, in women. It can also help protect you against ovarian cancer and weak bones (osteoporosis) later in life. 

Exclusive breastfeeding also acts as natural form of contraception as it delays the return of the mother’s normal menstrual period, thus increasing the time between pregnancies. 

What is the essential diet and nutrition requirement of a breastfeeding mother?

It is important to have a good nutritional diet for a lactating mother for the following reasons:

    1. For sufficient production of breast milk  
    2. For providing adequate nutrients to the infant
    3. To meet the mother’s daily needs

The nutritional requirements of a breastfeeding mother are similar to those of a pregnant woman. It is recommended to continue eating just as they were eating during the pregnancy. However, breastfeeding mothers need a little more amount of calories. The lactation period demands an additional 500kcal in diet. Lactating mothers should also take a diet rich in proteins, vitamins, iron and calcium. 

High proteins products like – cereals, pulses, whole grains, dry fruits, eggs and chicken, are good for the mother and thus provide the necessary protein supplement to the baby.

Lactating mother should abstain from consumption of alcohol and aerated drinks as well. Healthier options like fresh fruit juices, tender coconut water and lime juice can be consumed to stay hydrated. Staying hydrated is very essential as it ensures regular supply of milk. It is advised to consume minimum 8 glasses of water a day, and try to drink one glass before every feed. 

Women can also continue the supplement of iron and calcium advised to them during pregnancy, until 3 months post-delivery.

Oatmeal, is also a good option for lactating mothers, as it is helps reduce cholesterol and regulate blood pressure. It's also seen to increase the milk supply and is a good nutritional diet for lactating mothers.

Blossoming on wheels!

0n 14th Feb 2017, while Sakra World Hospital was launching its new comprehensive maternity program – Birth and Blossom, one of their trained nursing staff was doing a miraculous emergency delivery in an ambulance. It was around 3 PM when patient - Ms. Smita (name changed) called the emergency of Sakra World Hospital complaining of pain abdomen and vomiting. An ambulance was immediately sent to the address with a nurse on board to assist the patient. As soon as they reached and examined the lady it was found that she being full term pregnant, was in labor and needed to be transferred to the hospital immediately. It was barely 10 months since they had left for the hospital when the nurse observed that the baby was crowning and she might deliver before they reached the hospital. Assessing the situation the nurse (Madhu Kumar) took the courageous decision to stop the ambulance and deliver the baby with the best possible resources available. He updated the hospital immediately and another ambulance with a doctor and some more essential supplies was immediately dispatched from the hospital. Meanwhile with constant telephonic support from the team at hospital and with the help of the husband and mother in law, Madhu prepared to deliver the baby in the ambulance. He performed the entire procedure with immense courage and confidence, and considering the situation he did a commendable job using every resource in the most efficient way possible. At the end of 45 minutes when the ambulances arrived at the hospital the baby and the mother were safely moved in and admitted at Sakra World Hospital. 

Silent Epidemic: Osteoporosis has affected 200 million women worldwide

Osteoporosis is estimated to affect 200 million women worldwide - approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90.Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Overall, 61% of osteoporotic fractures occur in women, with a female-to-male ratio of 1.6. Nearly 75% of hip, spine and distal forearm fractures occur among patients 65 years old or over. A 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures, and similarly, a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture. In India: Expert groups peg the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013.In a study among Indian women aged 30-60 years from low income groups, BMD at all the skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52%) and osteoporosis (29%) thought to be due to inadequate nutrition. It is projected that more than about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050.

As osteoporosis has no obvious symptoms. Traditional X-rays can’t measure bone density, but they can identify spine fractures. Bone mineral density (BMD) has to be measured by more specialised techniques. A number of different types of BMD tests are available, but the most commonly used is DXA (dual-energy X-ray absorptiometry), capable of detecting quite small percentages of bone loss. It is used to measure spine and hip bone density, and can also measure bone density of the whole skeleton. While most limb fractures (such as at the wrist or hip) are obvious, spinal fractures can be more difficult to diagnose. This is because they might be painless, or if there is pain, a person may not know it is caused by a fracture due to the many different causes of back pain.  More obvious signs of spinal fractures are:

• Loss of height

• Development of a curved upper back (sometimes called a Dowager's Hump)

Since there are usually no outward signs of osteoporosis developing, doctors will often recommend diagnostic testing depending on your age and if you have other risk factors for the disease.

Prevention: Calcium and vitamin D supplementation reduces rates of bone loss and also fracture rates in older male and female adults, and the elderly. Ensure a nutritious diet and adequate calcium intake, Avoid under-nutrition, particularly the effects of severe weight-loss diets and eating disorders, Maintain an adequate supply of vitamin D, Participate in regular weight-bearing activity, Avoid smoking and second-hand smoking, Avoid heavy drinking.

We in Sakra have started an “Osteoporosis Clinic” the first of its kind in Bangalore to tackle this silent epidemic on Monday, Wednesday and Friday afternoons under guidance of our Endocrinologist Prof.Dr.C.V.Harinarayan.