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TIPS FOR BREAST FEEDING

Breast feeding is not a choice it's a responsibility
When to start ?
Ideally start soon after your baby is born or half an hour following vaginal delivery and 1 hour or when patient recovers from caesarian delivery.
How Long ?
Exclusive breast feeding should be given for 6 months and continued complementary feeding for 2 years.
Common problems in breast ?
1) Breast engorgement-local rise in temperature, redness over breast, pain.
2) Mastitis
3) Crack nipple
4) Sore nipple
5) Breast abscess
In order to prevent above problems, feeding should be 2nd hourly and on demand feeding, and proper positioning of the baby and nipple care.
Breast feeding latch : proper position :
1) Hold baby with whole body facing your body, head end upwards.
2) Place your baby's nose and chin against your breast.
3) Support your baby's head, neck back.
4) ¾th of the areola to be covered, lower lip everted.
Benefits of breast feeding :
1) Breast milk contains antibodies that help baby fight against infections.
2) Decreases risk of asthma, allergies, respiratory illness in the baby.
3) Decrease risk of malnutrition obesity, heart disease
4) Mother-baby bonding is increased.
5) Economical, all time supply, sterile, immunologically safe, natural food, temperature perfect, deaths are reduced.
No supplements :
Don't give your baby sugar water or other supplements. This may actually interfere with baby's appetite for nursing and decreased milk supply.
A new born baby has only three demands. They need warmth in the Arms of its mother, food from her breasts, and security in the knowledge of her presence.
Breast feeding satisfies all three

POSTNATAL CARE OF MOTHER :

Post natal period is the period beginning immediately after the birth of a child and extending for about 6 weeks.
It is the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period.
Post natal diet is the most important part of postnatal care. A healthy diet plan is a pre-requisite if you plan to breast feed your baby depending on your total calorie intake you will need about 450 to 550 extra calories in the first 3 months to meet the nutritional needs of your child and your baby.
Diet rich in fresh fruits, vegetables, pulses, legume, milk and diary products, drink plenty of water.
Avoid drinking alcohol, quit smoking.
Start with simple exercises like pelvic floor exercise as they will gradually help to have control over your bladder and get you in shape.
Care should be taken towards breast, bladder, bowel perineal and caesarian wound. Sleep should be adequate 1 week following discharge women should visit doctor.
Can be resumed to work from 6 weeks following birth. Avoid lifting heavy weight/strenuous exercises.
Exclusively breast feeding mother should begin contraception from 6 weeks onwards and women who do not breast feed should start contraception from 3 weeks onwards.
Contraception in the form of exclusive breast feeding (lactactional amenorrhea method), progesterone only pills, injectables, vaginal rings, intrauterine copper T devices, sterilization methods. Combined oral contraception pills.

THYROID DISORDERS IN PREGNANCY

The thyroid disorders :
hyperthyroidism and hypothyroidism are relatively common in pregnancy and important to treat.
The thyroid is an organ located on the front of your neck that releases hormones that regulate your metabolism, heart and nervous system, weight, body temperature and many other process.
Untreated thyroid disorders in pregnancy may lead to premature birth, pre-eclampsia, (increased BP) miscarriage, low birth weight, deficit in development in infants.
Symptoms of hypothyroidism
1) Tiredness
2) Weight gain
3) Constipation
4) Sensitivity to cold temperature
5) Muscle cramps
Symptoms of hyperthyroidism :
1) Fatigue
2) Increase heart rate
3) nervousness
4) Sensitivity to hot temperature
5) Severe nausea or vomiting
6) Slight tremor
7) Weight loss
Diagnosis :
1) Symptoms
2) Examination
3) Blood test-TSH, T3, T4
Treatment for hyperthyroidism :
1) Propylthiouracil
2) Metinmazole
Treatment for hypothyroidism :
levothyroxine
Monitor thyroid function tests every 4-6 weeks during pregnancy.

COMMON CANCERS IN FEMALE

Uterine cancer : (endometrial cancer) :
 It is the cancer of the uterus.
 Most often happens in over 55 years and in women following menopause.
 The uterus is a muscular organ where a fetus grows. Uterine cancer can start in different parts of the uterus.
 Most uterine cancer starts in the endometrium.
Risk factors :
 Obesity
 Hypertension
 History of polycystic ovaries
 Patient on estrogen alone
 Radiation therapy to the pelvis
 On tamoxifen for breast cancer
 Family history of colon/ovarian/ endometrial cancer
Signs/symptoms :
 1-5% asymptomatic
 90% of Unusual vaginal bleeding
 10% of women present with purulent vaginal discharge, sometimes blood tinged.
 Pelvic discomfort, uterine enlargement.
 On examination- abdominal mass
 Ascities
 Metastases
 Uterus may be small/enlarged irregular, fixed.
 There is no standard or routine screening test for endometrial cancer.
 Tests that may detect are -
 PAP test
 Ultrasound TVS
 Endometrial sampling
Management :
 Surgery remains the cornerstone in the management of uterine cancer.
 Further treatment depends on the histo pathological report, staging, grading, of the hysterectomy specimen.
Cervical Cancer :
The cervix is the lower part of the uterus that opens into the vagina.
Cervical cancer is the cancer that starts in the cervix due to abnormal growth of cells that have the ability to invade or spread to other parts of the body.
It is the second most common cancer, next to breast cancer.
Although women between the ages of 55 to 59 are most vulnerable to this condition, it can occur at any age, can occurs between 15 and 44 years of age.
Risk factors :
 Smoking
 HIV/AIDS
 Sexually transmitted infections
 Obesity/over weight
 Birth control pills
 Early pregnancy/early sexual intercourse
 Poor hygiene
 Malnutrition
Good news ! cervical cancer is believed to be preventable, and in fact is one of the most preventable of all cancers.
 Being aware of risk factors, visit your Gynecologist regularly and ask all relevant questions to know how to take good care of your overall health.
 Maintain ideal weight-physical activity and healthy diet.
 Increase antioxidents-fruits, vegetables, whole grains.
 Regular screening with pap smear.
 Protection-avoid unprotected sex and practice safe sex to avoid the risk of other infections.
 HPV vaccination-reduce the risk of cancerous changes of the cervix.
 Eligible for vaccine-9 to 10 years onwards.
Signs and symptoms :
Early-no symptoms are seen.
Later-abnormal vaginal bleeding.
- Pelvic pain
- Lower back pain
- Unusual vaginal discharge
- Pain during sex
- Vaginal bleeding after sex
- Longer or heavier menstrual periods than usual.
- Post menopausal bleeding
- Frequent urination
Screening of Cervical cancer :
 Done with PAP smear
 Should begin after the age of 21 years
Symptoms :
 Consult gynecologist if above risk factors and symptoms are present.
 Done with PAP smear
 Should begin after the age of 21 years and sexually active women.
In early stages -
Local excisional procedures are available.
In later stages-
Hysterectomy
In advance stages -
Radiotherapy and chemotherapy
Breast cancer :
It is the cancer that develops from breast tissue. Incidence is more after the age of 40 years and highest over age of 70 years.
Risk factors :
 Hereditary
 Early menarche, multiparity, late menopause.
 Estrogen use
 Post menopausal hormone therapy
 Previous breast cancer
 Alcohol
 Obesity
Factors that decreases the risk :
 First pregnancy < 20-25 years
 Multiple pregnancy
 Breast feeding
 Regular exercises
Symptoms :
In most cases, patients with early breast cancer have no symptoms and their disease is discovered through mammography screening :
 Swelling/mass in the breast
 Swelling in the axilla
 Ulcer of skin of breast
 Retracted/inverted nipple
 Skin discoloration/skin dimpling
 Eczema thickening/paered orange
 Nipple discharge/blood stained secretion
Diagnosis :
Triple Diagnostics 1) Clinical examination
2) Imaging (ultrasound, mammography)
3) Needle biopsy
Self breast examination is a must for all the women and consult doctors in case of any problems.
Treatment :
Depends on the stage of the cancer either surgery (chemotherapy, Radiotherapy).

DENGUE FEVER

It occurs due to dengue virus. Which is transmitted from bite of Ades Egypti mosquito (tiger mosquito).
SYPMTOMS :
1) Fever
2) Generalized body ache, head ache
3) Cough and cold.
DANGER SIGNS :
1) Swelling around eyes, limbs, abdomen
2) Excessive lethargy
3) Severe abdomen pain
4) Decreased urine output
5) Vomiting, loss of appetite
6) Rashes
7) Bleeding manifestations
8) Altered sensorium, fits.
9) Loss of consciousness
TREATMENT :
There is no specific treatment for this disease. Treatment is symptomatic and for complications. It is very important to maintain good hydration and adequate urine output.
OUTCOME :
No need to panic if dengue fever is diagnosed. Not all patients will become very serious. If indentified early and treated with all supportive measures, outcome is good. Consult your doctor immediately.
PREVENTION :
As this disease spreads by bite of mosquitos, it is very important to stop breeding of Aedes mosquito. This mosquito grows in clear water and hence remove all articles surrounding your houses which can accumulate water (tyres, coconut shells, plastic containers etc). Next is to avoid mosquito bites by using mosquito mesh, repellents, creams etc.

Scorpion Bite

Get immediate medical help especially in infants as body surface area is small and complications are more even with small quantity of venom. Ice pack or cold compress can be applied .

Trauma

1 . Immobilise the limb, head and neck.
2. Apply pressure to stop bleeding.
3. Seek urgent medical help.

Importance of Vaccination

 Any vaccine can cause fever, pain and allergic reactions. DPT is known to cause more pain and fever.
 Immunization schedule can be altered by your doctor. There is no hard and fast rule that it has to be given in a particular way.
 Minor illness is not a contraindication for vaccination.
 If a dose is missed, it can be given at a later date. Your doctors will advise you.
 Brands of vaccines are interchangeable.
 Never come for vaccination before the recommended date. If you come few days late there is no problem.
 Keep your vaccination record safely and preserve it lifelong. Bring it during your visit to the hospital.
 There is nothing called optional vaccines. If you don't have financial problems it is better to take all available vaccinations including vaccines recommended in special circumstances.
 Usually vaccination does not cause major health problems. Benefits outweigh the risk.
 If available, combination of multiple vaccines can be given. By this we can avoid multiple pricks to the children.
 Majority vaccines are not available in Govt. Hospitals. Whatever vaccines are available in Govt. Hospitals are also available in Private Hospital. Hence it is advisable to take all vaccines at both Govt. and Private Hospitals or only at private hospitals. Ultimately aim is to give vaccinations for all diseases.
 If some vaccine is not available at a particular time, same can be given as per your doctor's advice at a later date. No age is an exception for most of the vaccinations. May be given at any age as per your doctor's advice.
Specific information :
1) BCG vaccine : This vaccine protects against tuberculosis which spreads through inhalation route. It is given through injection. After few days, there will be a swelling at the site of injection. Gradually it becomes soft and there may be discharge from the swelling. By 6-12 weeks a permanent scar will be formed at the site of injection. No need to apply any medications at the site of the injection during the period of the scar formation.
2) Polio vaccine : Two types of polio vaccines are available-oral and injectable. At present it is recommended that both should be given at different timings. These vaccines protect children from poliomyelitis disease which spreads by fecal oral route through contaminated food and water. OPV is given through oral route and IPV through injection. Now our country is free from polio. In coming days oral Polio vaccine will be stopped and injectable polio vaccine will be continued.
3) DPT vaccine : This vaccine gives protection against 3 dreaded diseases-Diphtheria, Pertusis and Tetanus. Diphtheria and Pertusis spreads through inhalation route and Tetanus spreads through contamination of wound. There are two types of DPT injections. One contains whole cell pertusis and the other contains acellular peritusis. Both are equally efficacious. However pain and fever is more in whole cell pertusis containing vaccine than in acellular pertusis containing vaccine. Both whole cell and acellular vaccines are available separately and also in combination with other vaccines. Acellular pertusis containing vaccines are more expensive than whole cell pertusis containing vaccines. Your doctor will prescribe medications for pain and fever. Whether to give whole cell or acellular pertusis containing vaccine is left to parents choice. It is given through injection.
4) Hib vaccine : It gives protection against meningitis, pneumonia and other infections caused due to H influenza b bacteria. It spreads by inhalation route. It is available separately and in combination with other vaccines. However it does not protect from meningitis, meningitis and other infections caused due to other organisms. It is given through injection.
5) Hepatitis B vaccine : It gives protection against dreaded infection caused by Hepatitis B virus (B Jaundice). It spreads from mother to child through placenta, contaminated needles/ sharps and through sexual route. It may lead to carrier state, chronic hepatitis, cirrhosis of liver and cancer of liver. It is available separately and in combination with other vaccines. It is given through injection. If mother is HBsAg carrier, we need to give Hepatitis B immunoglobulin along with vaccine at birth to the child. In most of the people with Hepatitis B carrier state, there won't be any problem.
6) Rota virus vaccine : It gives protection against gastroenteritis caused by rotavirus infection. It spreads by fecal oral route through contaminated food and water. 3 types of vaccines are available and all are recommended. It is given by oral route.
7) Pneumococcal Conjugate vaccine : It gives protection against pneumonia, meningitis and other infections caused due to pneumococcal bacteria. It spreads by inhalation route. Two types of vaccines are available. One protects against 10 strains and the other protects against 13 strains. The one which protects against 13 strains is more expensive. Both are recommended. Choice is left to parents. This vaccine does not give protection against meningitis and pneumonia caused due to other organisms. It is available separately and should be given through injection.
8) Pneumococcal polysaccharide vaccine : It gives protection against 23 strains of pneumococcal bacteria which spread by inhalation route. However it cannot be given before the age of 2 years. It is usually recommended in certain high risk group. However there is no harm in giving to normal people. It is given through injection.
9) MMR Vaccine : It gives protection against 3 diseases - Mumps, Measles Rubella. All these 3 diseases spread through inhalation route. Mumps can cause orchitis and pancreatitis. Measles can cause keratitis, pneumonia etc. Rubella in pregnant mother can affect the fetus in utero leading to deafness, cataract and heart disease. Hence it is very important to vaccinate all children especially females before marriage. It is given through injection.
10) Hepatitis A Vaccine : This vaccine gives protection against hepatitis (A Jaundice) caused due to Hepatitis A virus. It spreads by fecal oral route through contaminated food and water. Two types of vaccines are available. Live attenuated and killed vaccines. Live vaccine is single dose and killed vaccine is 2 doses. Both are recommended. Both are given through injection. Choice is left to the parents.
11) Typhoid vaccine : It gives protection against typhoid fever. It spreads through fecal oral route through contaminated food and water. Two types are available. One is Vi polysaccharide vaccine to be given once in every 3 years. It can be given only after 2 years of age. Its effect lasts for only 3 years. Other is conjugate vaccine to be given as 2 doses 1 year apart and no need to repeat the doses. After 2 doses, immunity lasts for a longer period. Conjugate vaccine is expensive as compared to polysaccharide vaccine and can be given before the age of 2 years. No need to give both the vaccines. Choice is left to the parents.
12) Chicken Pox vaccine : This vaccine gives protection against chicken pox disease. It spreads through inhalation route and direct contact. In some people chicken pox can cause brain infection (encephalitis), cerebellitis, pneumonia and other complications. It may cause ugly permanent scars. Hence it is highly recommended to give this vaccine. It is given through injection.
13) Flu vaccine : It gives protection against seasonal flu. It spreads through inhalation route. It is usually given to high risk patients like Asthma, allergic rhinitis. However there is no harm in giving to normal people. It is given through injection.
14) JE (Japanese Encephalitis) vaccine : It gives protection against Japanese Encephalitis. It spreads through bite of infected mosquitos (Culex). Usually it is recommended for people staying in areas where this disease is prevalent. However there is no harm in giving this vaccine to other people. It is given through injection.
15) Meningococcal vaccine : It gives protection against meningitis caused due to meningococcal bacteria. It spreads through inhalation route. It is usually recommended for people where this disease is more prevalent. However there is no harm in giving to other people. It is given through injection.
16) Rabies vaccines : This vaccine gives protection against dreaded disease called "Rabies" caused due to bite of animals like dog, fox, cat, monkey etc. Rabies is a fatal disease and there is no treatment once the person develops this disease. It can be given prior to the bite or after the bite. It is better and safe to take this vaccine prior to the bite as pre exposure prophylaxis. After the bite it is mandatory to take this vaccine. Your doctor may advice rabies immunoglobulin along with vaccination depending on the severity of the bite and nature of the animal. It is given through injection. As soon as animal bites, one should wash the wound with soap and water immediately and seek medical attention.
17) HPV vaccine : It is also called cervical cancer vaccine. However it does not protect from cervical cancer directly. It gives protection against human papilloma virus infection. It spreads through sexual/physical contact with infected partners. HPV is the major cause of cervical cancer. Hence if we prevent HPV infection chances of cervical cancer will be less. It is given through injection. It should be given to all females before the first coitus.

WEANING FOOD

Weaning is defined as the systematic process of introduction of suitable food to infants at the right time in addition to breast milk in order to provide needed nutrients to babies.
Time of weaning :
Complementary foods can be introduced at 4-6 months of age. If weight gain is good and mother is not planning to go out for work, weaning can be delayed till completion of 6 months. It should never be delayed beyond 6 months and should not be started before 4 months. If mother is planning to join work or weight gain is not very much satisfactory, we can introduce complementary feeding after 4months. However breast feeding has to be continued for minimum 1 year and maximum upto 2 years.
Types of weaning food :
Initially we should start with 1 type of cereals (i.e., ragi malt or rice ganji). Later we can use combination of 2 types of cereals and also cereal pulse combination. (i.e., rice with redgram or green gram). Along with cereals and pulse based food, we can give mashed banana, mashed potato, mashed sweet potato. We can add sugar, jiggery and ghee.
What to be avoided :
Avoid animal milk, egg and salt till the age of 1 year. Use water instead of milk to prepare any food.
Ragi Malt :
Soak ragi over 12 hours and dry it. Roast it for 10 minutes and prepare powder. Put this powder to boiling water and stir. Add sugar or jaggery and ghee and feed.
Rice Payasam :
Soak rice over 12 hours and dry it. Roast it for 10 minutes and prepare powder. Put this powder in boiling water and stir. Add sugar or jaggery and ghee and feed.
Dal Powder :
Wash red gram or green gram and dry immediately. Roast it and prepare powder. This powder can be added to ragi or rice powder in the ratio of 2:1. i.e., 2 parts ragi or rice powder and 1 part of red gram or green gram powder for preparing ragi malt and rice payasam.
Amylase rich Food :
Ragi, wheat, bajra, jowar, green gram can be converted to amylase rich food.
1) Soak ragi (3 cups) and green gram (1 cup) in 12 cups of water for 12 hours.
2) Drain the water and wrap in a cloth. Keep in a cool place for 48 hours. Keep sprinkling water in between.
3) Dry germinated seeds in sunlight for 8 hours.
4) Rub with a flat wooden board or hand to remove the sprouts.
5) Roast the dried grain in low flame for 10 minutes till they are brittle and malt aroma develops.
6) Grind the roasted grain into fine powder and store it in air tight container.
This powder can be added to ragi malt/ rice payasam/rice dal gruel to reduce the viscosity. It is easily digestible due to the presence of amylase.
Family Pot Feeding :
Once the baby is 1 year old, we can feed all food items cooked at home.

COMMON PAEDIATRIC SURGICAL PROBLEMS

1) Inguinal hernia
2) Hydrocele
3) Undescended testis
4) Umbilical hernia
5) Phimosis
6) Acute pain abdomen
7) constipation
Inguinal Hernia : it is the commonest problem seen in the age group of more than 6 months. It is due to non-closure of the deep inguinal ring. Normally deep inguinal ring closes at birth or within 1 week of life. It usually presents as swelling in the region of groin. Whenever the baby cries bowel loops are seen within the scrotum and may cause obstruction causing life threatening problems. Low birth weight, pre-maturity, intra-uterine growth retardation are the usual risk factors. Inguinal hernia doesn't resolve by itself and requires surgery at the earliest. Usually inguinal herniatomy is done under regional anesthesia with one day stay in the hospital.
Hydrocele : It is the collection of fluid within the scrotum. Hydrocele is due to non-closure of abdominal connections and hyper secreting surface of the inner layer of the scrotum. Hydrocele usually presents as swelling in the region of groin and scrotum. It usually settles or resolves within an year. Those hydroceles which doesn't resolve even after 2 years require surgery. Herniotomy under regional anesthesia with 1 day stay in the hospital.
Undescended testis : Normally both the testis descend into the scrotal sac at 9 months/birth or within 1 month. If it fails to descend even after 8 months it is labeled as undscended testis. Usually it is unilateral and can be bilateral in 15-20% of patients. Usually presents as absent testis within the scrotal sac. The commonest reason for undescended testis is prematurity, low birth weight sometimes familial. If once testis is palpable in the groin, we can wait until 1 year and if it doesn't, requires surgery (orchidopexy).
Undescended testis has to be differentiated from retractile testis. Retractile testis is a normal phenomenon where in which testis is pulled up spontaneously into the groin which comes down regularly. It is due to hyperfunctioning of scrotal musculature. If undescended testis is not operated at the correct age (1- 1 ½year) the chances of testicular regression, dysgenesis and malignancy risk is high.
Umbilical hernia : It is usually seen as swelling in the region of umbilicus whenever the baby cries, coughs. It usually presents in the age group 2 months to 2 years. Usually seen in pre-maturity, and IUGR babies. Most of the cases of umbilical hernia doesn't require surgery. If hernia size goes on increasing in size with features of intestinal obstruction (bilious vomiting) requires surgery. We generally wait upto 3-4 years of age. Spontaneous closure of umbilical hernia is seen in around 85-95% of cases.
Phimosis : Inability to retract penile skin is called phimosis. Usually presents as crying during urination/irritability, ballooning of genital area while passing urine. Most of the cases of phimosis are physiological. If urinary tract infection is evident we always do necessary investigation and plan for further course of action (circumcision surgery). USG abdomen (scanning) is done to rule out kidney abnormalities.
Acute Pain Abdomen : Pain abdomen is the most commonest paediatric surgical outpatient presentation between age group 2 years to 12 years. There are various causes for pain abdomen. Pain abdomen usually associated with symptoms like nausea, vomiting, fever, crying during urination, jaundice. Commonest causes for pain abdomen in children include
1) functional pain abdomen
2) mesenteric lymphadenitis
3) gastritis
4) constipation
5) gall stones/appendix/UTI.
Severe pain abdomen associated with greenish vomiting is always abnormal.

Balanced Diet-Food Pyramid

It gives a guidelines to the quantity of food items to be consumed everyday, so that we eat balanced diet.
1) Cereals and pulses form base of the pyramid and should constitute major part of the meal.
2) Fruits and vegetable are the next major food items to be consumed.
3) Meat, egg, milk are the next food items.
4) Sweet, oils, fats-to be consumed in least quantity.
As we go up the pyramid the quantity of food items to be consumed will be less.

INFERTILITY

When a couple is unable to conceive within one year of marriage it is called infertility.
Infertility can be due to problems in female reproduction mechanism and or male reproductive mechanism.
Female causes can be due to :
1) Hormonal
2) Uterine
3) Tubal
4) Cervical
These can be diagnosed by various hormonal tests like TSH, Serum prolactin, estradiol. Uterine causes can be tested by USG, laparoscopy, hysteroscopy.
Male causes of infertility are :
1) Sperm production, maturation
2) Hormonal deficiency
3) Problem in sperm conduction
4) Ejaculatory dysfunction, erectile dysfunction
Basic investigations starts with semen analysis, hormonal assay, USG of the scrotum.
Initially couples should visit the doctor rather than male and female separately. It is of utmost importance to look into the matter as a whole.
CAESARIAN DELIVERY : is a surgical procedure in which baby is delivered through an incision in mothers abdomen and uterus.
It is done in response to an unforeseen complications like in :
 When cervix stops dilating or the baby stops moving down the birth canal or when uterine contractions are not happening even after stimulation.
 When water breaks even before the labor starts when cervix is not yet open.
 When palcenta seperates from uterine wall before delivery of the baby.
 In some infections like genital herpes to avoid baby getting infected.
 When fetal distress is present where (extreme variation in heart beat).
Sometimes caesarian sections are planned like :
 Previous > C-section when there is significant risk that uterus can rapture during vaginal delivery.
 Previous surgeries like myomectoms (removal of fibroids).
 Short stature (less than 145cms).
 If you are carrying more than one baby (some twins can be delivered vaginally like when both the babies present as vertex).
 When expected weight of the baby is more like in uncontrolled diabetics.
 When baby is in a breech (bottom first) or transverse (horizontal ) position.
 When placenta is lying over the cervix or lower very near to cervix.
 In HIV positive mothers where viral load is high.
THREATENED PRE-TERM :
Onset of labor between 24-37 weeks of pregnancy is called threatened pre-term. Not always possible to explain the causes. Some of the causes are :
1) Previous pre-term birth.
2) Multiple pregnancy-twins, triplets.
3) Infections-urinary tract
4) Bleeding from uterus during pregnancy
5) Abnormalities of uterus
6) Excessive ammoniate fluid
7) Anemia.
8) Placental problems
9) Genetic problems
HOW TO RECOGNIZE :
 contractions which are regular and painful.
 Show–when a plug of mucus in the cervix comes away as vaginal discharge.
 rupture of membranes- water leaking slowly or sudden gush of fluid from vagina.
If you are considered to be at risk of pre-term birth admission is needed for continuous observation and management. You will be offered 2 doses of steroids injection to improve lung maturity of pre-mature babies which can reduce breathing difficulties at birth.
Medications to help flow or stop labor
If your condition stabilization you will be allowed to go hence with further instructions.
If the labor cannot be stopped then vaginal or cesarean - section will be decided upon the condition of the baby. Baby may need NICU (neonatal intensive care) care.
DANGER SIGNS OF PREGNANCY :
Many woman go through pregnancy with some uncomfortable symptoms. But no serious problem like nausea, heart burn, back ache and tiredness.
Some need special care and immediate care if occurring before 37 weeks of pregnancy.
• Contraction that are > 4 times an hour.
• Leaking of fluid from vagina
• Pain, pressure or cramping in your belly
• Vaginal bleeding.
• Fever, severe headache
• Vision problem, severe vomiting
• Less baby movements
• Lot of swelling of feet, ankles, face, heads.
• Pain during urination.
• Diarrhea
• Vaginal discharge which is itchy, of bad odor.

Pregnancy care

Hypertension in the commonest problem encountered in pregnancy.
When the woman develops high BP for the first time in pregnancy, then she has gestational HTN.
When the BP becomes uncontrolled and when patient has proteinurea then it is called as pre-eclampsia.
Severe PE is the 2nd commonest cause of maternal mortality in India.
WHICH TRIMESTER GEST HTN PRESENTS :
Usually it is in the 2nd is > 20 weeks or the third trimester.
WHO IS AT RISK :
 First pregnancy
 Multiple pregnancy
 Pregnancy in a mother whose age is less than 20 years or more than 40 years.
 Previous history of HTN in pregnancy.
 Family history of HTN.
WARNING SIGNS OF HYPERTENSION :
 Odema/swelling of legs, abdomen, hands, face.
 Persistent headache
 Persistant heart burn, or pain under the rib cage.
 Vomiting.
VISUAL DISTURBANCES :
Such as blurring of vision seeing dark spots etc.
Decrease in your baby' s movements.
It is very important to tell your gynecologist if you have any above symptoms. Your doctor will look for certain signs when assessing you for pre-eclampsia, including.
 High BP
 Protein in your urine
 Abnormal blood tests-tests done to assess how well your kidneys-liver are functioning and how well your blood is clotting.
 Gynecologist will assess how your baby is coping by
 Monitoring of the baby using CTG (NST machine).
 An ultrasound to assess your baby's growth, liquor / fluid content around the baby. And how the blood is supplying to the baby.
TREATMENT OF HYPERTENSION :
Admission to the hospital :
admission to the hospital should be done, and it is done usually to monitor the BP, lab investigations and timing of the medications. Because pre-eclampsia can get worsen if it is not controlled, and at times lead to eclampsia, i.e., seizures due to high BP.
Treatment of Hypertension :
there are medication for pre-eclampsia which are very safe for pregnancy but at times if BP is uncontrolled then medication can be given through IV drip.
Definitive treatment of hypertension :
Delivery of the baby is the only definitive treatment for pre-eclampsia. Early delivery may be needed if there is a progression to severe PE or eclampsia with worsening of either the maternal or the fetal condition.
Eclampsia and its complications :
Eclampsia is a very serious condition and a dread complication of hypertension, which causes convulsions (fits) in pregnant woman.
Complications of eclampsia :
 Intracranial haemorrhage
 Renal failure
 Pulmonary odema
 Liver failure
 DIC
 Death of the patient
Ante natal Care :
The care of the pregnant woman with the aim of achieving a healthy pregnancy and delivery of a normal baby are the main perspective of antenatal care. Good antenatal care helps a woman face labor in good health and in optimum condition.
When to consult your gynecologist :
 Consult your doctor as early as possible, preferably when you miss your periods.
 It is better to consult in the pre conceptional period i.e., before getting pregnant.
What is pre-conceptional counseling :
 The woman who is planning to conceive must consult a gynecologist wherein she will have her weight, blood pressure and few blood tests like Hb%, blood sugar, thyroid and rubella status checked. These tests are essential because if she needs any corrective measures, she can undergo them, before she conceives.
General advice in preconception :
 Folic acid intake to prevent neural tube defect.
 Rubella and hepatitis B vaccination in the non-immune.
 Weight reduction in obesity
 Cessation of smoking and alcohol.
 Advice regarding drug intake.
How often should you visit the hospital in pregnancy :
 Monthly up to 28 weeks (7 months)
 Two weekly between 28-36 weeks (in uncomplicated pregnancy)
 More frequent visits will be advised if any complicated pregnancies.
What to expect in each ANC visit :
 Meet your doctor as soon as you know that you are pregnant, because there can be a chances of ectopic pregnancies which has to be attended immediately.
 Monthly weight check.
 BP checkup in every visit.
 Per-abdomen examination
 Daily fetal kick count.
 Fetal heart beat monitoring after 24 weeks.
Investigations :
 Complete blood count.
 Glucose Tolerance Test (GTT)
 Blood grouping and Rh typing
 HIV
 HBsAg
 VDRL
 Urine routine
Tetanus Toxid (TT) Injection: 2 Injections given at booking visit or at 16-24 weeks followed by another dose 6 weeks later.
 One booster dose in women who have taken TT within 3 years.
 Fetal monitoring with NST after 32 weeks.
 Counselling will be provided regarding the :
 Diet
 Weight gain
 Rest
 Activity and exercise
 Coitus
 Care of breasts
 Travelling during pregnancy
 Dental care
Travel safe in pregnancy :
 Air or train travel is not contraindicated but certain precautions may be needed. Prolonged air travel can lead to venous thrombosis and so mobilsation, hydration and using compressor stocking may help.
 Women at risk of preterm delivery or having abruptio placenta/placenta previa are prohibited from travelling.
Ultra-sound in Pregnancy :
 1st scan as soon as possible to confirm intrauterine pregnancy.
 A scan between 11-13 weeks to look for the Nuchal translucency and look for any major congenital anomalies.
 Anomaly scan done between 18-24 weeks is mandatory to look for anomalies in fetus.
 Interval growth scan in third trimester is not routine, but indicated in complaints of IUGR and in high risk pregnancies.
Diabetes in Pregnancy :
If a women gets diabetes or high blood sugar when she is pregnant, but she never had before, then she has gestational diabetes.
Who is at risk ?
 Your Body Mass Index (BMI) is 30 or above.
 You have previously given birth to a large baby weighing 4.5kgs or more.
 You have had gestational diabetes before.
 You have a parent, sibling or child with diabetes.
 You have a family history of diabetes.
 Bad obstetric history
 Polycystic ovary syndrome.
When does it occur :
 During 2nd trimester (24-28 weeks)
How to diagnose GDM :
 The test done to diagnose GDM is called as 75gm GTT(Glucose Tolerance Test)
 Done between 24-28 weeks of pregnancy.
 Your doctor will ask you to come to the hospital empty stomach (i.e., early morning) when a fasting blood sample is taken.
 Then you will have to drink a 75gm glucose mixed in water, after which another blood sample is taken which will be after 2 hours.
 Further testing is required depending on 75gm GTT, results.
Complications of GDM :
In Mother :
 Preterm delivery.
 Infections : Urinary Infection
Vulvo vaginal infection
 Polyhydramnios
 Caesarian Section
 Post-partum haemorrhage
 Purpural sepsis and wound infection
Fetal Complications :
 Abortion in uncontrolled DM.
 Congenital malformation
 Unexplained intrauterine fetal death
 Pre-mature baby
 Macrosomia
 Shoulder dystocia.
 Hypoglycemia
 Hypocalcemia
 Polycythemia
 Hyperbilirubinemia

FEBRILE FITS

It is a condition which occurs between 6 months to 6 years. Child develops fits at the time of fever. Depending on the nature of fits, onset, duration, frequency, your doctor will categorize it as simple and complex febrile seizures. If there are no risk factors, birth history and development are normal., imaging and EEG are normal, continuous medications are not required and there is no additional risk of development of epilepsy in future. Your doctor will prescribe short term medications during fever episodes which is enough to prevent recurrence of fits. You should do tepid sponging and bring the temperature to normal along with prophylactic medications. Always keep stock of medications at home. Carry these medicines where ever you go. Keep thermometer and start these medications as soon as child gets fever (more than 1000F).
Need for EEG, MRI, long term treatment will be decided by your doctor depending on multiple factors. If there are episodes of fits without fever, recurrence of fits in spite of short term medications consult your doctor immediately.

First Aid for Poisioning

1. Change soiled clothes immediately
2. Get urgent medical help.
3. Don’t induce vomiting in case of corrosive or hydrocarbon poisoning (petrol, diesel, kerosene, primer oil, caustic soda etc)
4. Get the container to the hospital.
5. If eye is involved wash thoroughly with clear water and seek medical help.

Snake Bite

Immobilize the part if possible and apply a tourniquet lightly above the bite site. Get immediate medical help even if snake is non-poisonous.

Bee sting

Get immediate medical help as it may cause severe allergic reactions like breathing difficulty , swelling of tongue and lips and shock. Apply ice or cold compress to reduce pain.

Dog or animal bites

Wash the wound thoroughly with soap water and seek immediate medical help as it might need anti rabies vaccine and immunoglobulins. Apply pressure if bleeding is severe.

Human Bite

Human bites are normally not dangerous but if there is break in the skin consult your doctor.

FITS

1. Loosen the clothing and clear things away from the child.
2. Avoid crowding and allow good ventilation. Shift the child to safe surroundings
3. Put child in left lateral position to avoid aspiration
4. Don’t put anything in the mouth
5. If fits do not stop within 5 minutes to seek urgent medical help. Use nasal antiepileptic spray if available and already trained to use

New born Emergencies

1. Born with less weight/ born early (<36 weeks).
2. Not cried immediately after birth.
3. Meconium aspiration (aspiration of baby stool at birth).
4. Breathing problem, bluish discoloration.
5. Not feeding well, excessive lethargy
6. Fits/convulsion, unconsciousness/semi- consciousness
7. Decreased activity, decreased urine output.
8. Yellowish discoloration of body/ Jaundice, passing yellow colored urine and white colour stools.
9. Greenish vomiting and blood mixed vomiting.
10. Not passed urine/stools within 48 hours
11. Bleeding from any site.
12. Severe abdomen distention.

PEDIATRICS EMERGENCIES

1. Fits/convulsion, unconsciousness/semi-conscious, excessive lethargy, abnormal movements/Behavior, severe headache.
2. Respiratory distress/hurried breathing, bluish discoloration of body, difficulty in breathing.
3. Not passing urine/decrease urination, blood/red colored urine.
4. Vomiting blood/blood in stools.
5. Fall/road traffic accident with head injury, abdominal/chest injury.
6. Burns/electric shock/drowning
7. Poisoning, snake bite, scorpion bite, honey bee bite.
8. Foreign body aspiration like aspiration of buttons, batteries/shell, pins, coins, nuts (ground nut, coconut).
9. Greenish Vomiting
10. Severe abdomen pain, distention

BURNS

1. Move the child away from the site
2. Pour cold water immediately
3. Don't break any blisters formed
4. Burns anywhere in a child has to be seen by a doctor.