RHESUS INCOMPATIBILITY

A mother with Rh negative type of blood(like A-ve,B-ve,AB-ve) can develop antibodies to the child's blood,if the child's blood is Rh positive type.This may lead to the birth of a child with severe anaemia,jaundice,or in severe cases still birth or intrauterine death.The development of antibodies in the mother's body may be due to "leak" of baby's blood into mother's blood or a previous procedure such as abortion,amniocentesis,previous delivery.
A Rh-ve mother therefore should have tests to detect whether she has such antibodies.Treatment with anti-Rhpositive immunoglobulins is highly effective in reducing the condition and preventing its future recurrence.

BLEEDING IN PREGNANCY

BLEEDING IN PREGNANCY
Any vaginal bleeding should be seen by a doctor immediately!
Bleeding in the first few weeks may be harmless(spotting),and resolves with bed rest..but a doctor MUST be consulted,no matter however little or painless the bleed is.
Bleeding can be due to Placental separation(abruptio placentae),Placenta in the lower part of uterus(placenta previa),Preterm labor,Abortions,Ectopic pregnancy(foetus away from normal position in uterus,like inside the fallopian tube).Molar pregnancy
ABRUPTIO PLACENTA
Most common cause of vaginal bleed after 28th week,usually associated with severe pain,cramps,faints.
The placenta becomes separated from the uterus either in part or in total,leading to death of foetus,if not attended to immediately.The common causes are smoking,alcohol,drugs,hypertension during pregnancy,blunt injury.Bleeding can be mild to severe,and requires urgent hospitalisation.In mild cases,the pregnancy is continued,with bed rest.More severe cases will need delivery of child through cesarean section.Mother may need blood transfusions.
PLACENTA PREVIA
The placenta may cover the cervical opening either partially(marginal) or totally(complete),and is detected during examination,or ultrasound scan.Usually the pregnancy proceeds to full term and normal delivery is possible in the partial type ,but will require delivery by cesarean in the complete type.
PRETERM LABOR.
Labor before 37th week(Normal is at 40th week).Exact cause not known,but usually seen in very young or very old mothers.Also in mothers with smoking,alcohol,infections of vagina,bladder,multiple pregnancy,large amount of fluid in uterus(polyhydramnios).
The mother may feel abdominal cramps,increasing in intensity,with vaginal discharge of blood.
Most are managed with bed rest and drugs to reduce uterine contractions,but in advanced cases may require delivery and care of baby in ICU if delivered before 37th week.If possible,delivery may be delayed by two days to give the mother 2 doses of corticosteroids to help the maturation of the baby's lungs.
ECTOPIC PREGNANCY
In this condition,the foetus develops away from the normal place in the uterus,usually in the tubes.The mother experiences pain in one side of the abdomen,irregular bleed,usually by the 7-8 week.If there is rupture of the tube,in untreated cases,severe bleeding may cause shock and death.
Causes could be previous surgeries,Intrauterine contraceptive devices,infections in the past,which cause block or obstruction to movement of the egg,after its release from ovary.
Will need to be removed as soon as diagnosed.
MOLAR PREGNANCY
sometimes a part of placenta,or remnants of placenta from a previous pregnancy,may develop as a tumor that looks like a bunch of grapes.The patient will experience all the symptoms of a normal pregnancy,like increase in abdominal size,cessation of menses,severe morning sickness(vomiting),but will have occasional episodes of vaginal bleed with discharge of grapes like masses.An ultrasound scan and blood test for HCG(very high levels) will reveal the condition.
Treatment is removal of the mass(Along with the foetus if present,which does not develop,or is abnormal).Usually cured completely after removal.The patient will require periodic checkups to look for recurrences.Sometimes may require chemotherapy.

PREGNANCY and Diabetes

PREGNANCY and diabetes
1.Some females may develop Diabetes during pregnancy,called as 'gestational diabetes'.This is due to the action of certain hormones which have an 'anti-insulin' effect.The condition is usually seen in obese individuals,or in those with a family history of diabetes.The condition is diagnosed by a simple blood test (Glucose Tolerance Test).Get it done if you have excess thirst,excess urination,or feeling very tired and hungry.
Most often, a diet regulation (high proportion of starchy food,low sugars) is enough to control the condition,but in some severe cases may require medications(usually in the form of Inj.Insulin).
If not properly controlled,the Baby may be big and cause delay in labour.they may also have low blood sugars at birth.severe cases can go in for still birth.
The mother may have similiar condition in later pregnancies also.She is also at a higher risk of getting diabetes mellitus("true diabetes") at a later age.
2.Preexisting diabetes mellitus in Pregnancy.
This needs to be controlled at the very initial stages.Most often,the oral drugs will be stopped and replaced with Insulin injections.Regular blood tests will be needed.Severe uncontrolled Diabetes may cause still-birth,intrauterine death,hypertension in the mother(pre/eclampsia) and other complications.

PREGNANCY and hypertension

PREGNANCY and Hypertension(Increased blood pressure)
Some females may develop Hypertension during the later half of their pregnancy,called Pre-eclampsia.The exact cause is not known,but is more common in obese(overweight) females & diabetics.
If you experience dizzy spells,swelling in the feet and face,pass thick,cloudy urine,get to the doctor immediately!Hypertension in pregnancy needs prompt treatment,A delay could be very dangerous to both mother and child.
Often,low salt diet,total bed rest and mild sedatives would be suggested but in more severe cases the doctor will admit you for intensive care.If untreated,the person may have seizures and later may go into coma and die.With prompt treatment,the prognosis is good,with pregnancy continuing for the full term and normal delivery thereafter.
Severe cases(Eclampsia) may need termination of pregnancy,if diagnosed before 24th week,to save the mother.
If after 36th week,labour will be induced (to deliver the child alive) and the mother treated with intravenous medicines.
The condition may repeat in future pregnancies also and will need special care(high risk pregnancy) throughout the period of pregnancy.Medications will be continued after delivery for a few weeks or months,and in most cases will be stopped after blood pressure returns to normal.

TESTS in high risk pregnancy

PREGNANCY TESTS
in a high risk pregnancy,the doctor may order certain tests,apart from the ultra sound scan.
1.chorionic villi sampling
This is done between 8th to 11th week of pregnancy.
This will be a 10 to 15 minutes procedure.A flexible tube is inserted through the vagina under ultra sound guidance and a small part of the placenta is removed for testing.The sac sorrounding the child is not pierced.
2.Amniocentesis or amniotic fluid analysis
This is done between 14th to 18th week of pregnancy.
This is also a 10-15 minutes procedure,wherein a needle is inserted through the abdominal(tummy) wall,under ultra sound guidance,to pierce the sac around the foetus(growing child) and small amount of fluid around the child is withdrawn for testing.
In both these procedures,Some amount of pain may be present.Small risk of miscarriage is also present,being more in the latter.

PREGNANCY-GENERAL CARE

PREGNANCY
GENERAL CARE
A planned pregnancy is better than an unplanned one!It helps in the allotment of resources for both partners,such as time,money,space,and emotions.
Conceiving at an older age(female above 40),can increase certain risks to the mother(miscarriages.abortions) as well as child(Down's syndrome),and will need a visit to the doctor,especially if it is the first pregnancy.
DIET:
The pregnant female should increase her caloric supply by 300 calories a day over her usual intake.It should include double the usual amount of starchy food such as rice,bread,fruits and vegetables,and proteins in the form of meat,fish,eggs.Do not take any of these in the raw,All food should be cleaned thoroughly.Eating uncooked eggs can cause salmanellosis(causing loose stools,vomiting,fever,cramps ) Semicooked meat ,cheese can cause Listerellosis,which can harm the unborn child.So AVOID Cheese,less-than-well-cooked-meat(no pink meat!) or raw eggs.Avoid alcohol & over the counter drugs.Make home a strict NO SMOKING area!A cigarette smoking father can cause injury to the growing child(passive smoking).
Take folic acid tablets in first 3 months as this helps in preventing spinal tube defects in child.
Iron supplements will also be needed,especially if diet is poor.(excess vomiting in first three months)
EXERCISE....TAKE CARE NOT TO HURT YOURSELF OR STRAIN TOO MUCH.
Brisk walking is good as long as can be done without strain.Swimming is good as water takes the weight off the tummy.Simple stretching,yoga,Breathing exercises are good.No jumping,running exercises please!
REST
While sitting,prop your legs up a chair or stool,over a pillow.While sleeping,lie onto one side, use one soft pillow under your abdomen,and one between your thighs.
COMMON PROBLEMS
First trimester(the first three months).Most females will have vomiting in the morning(morning sickness)which will make them averse to certain/all types of food.Some may require Glucose infusions at a day care centre.Eating starchy food before getting up from bed,eating small portions more frequently rather than one or two large portions help.Avoid spicy,fried,oily food.
Milk,Curd help in heartburn.Do not take antacids without asking your doctor.
The final three months: though the vomitting is now absent or reduced,the growing baby would be putting pressure over the organs in the lower part of the tummy,causing swelling of feet,urinary complaints(sometimes urinary infections......painful urination,cloudy urine,fever,chills....needs a visit to the doctor) ,constipation,dizzy spells,etc.
Drinking lots of water,urinating frequently,eating vegetables and fruits.,moving around(!),putting up your legs help these complaints.
VISITS TO THE DOCTOR
After pregnancy is confirmed at least two visits to the doctor,one at fifth month & another at eighth month are a must.Usually more visits will be needed,especially if you had problems in your previous pregnancies,or a condition such as hypertension,diabetes,asthma,etc.Do as advised by your doctor.
A couple of ultrasound scans help a lot .These are "photos" projected on a computer screen by passing harmless 'sound waves' over your tummy.They are totally safe to both child and mother.They are extremely helpful in finding defects in the child.
If you have handled a lot of cats before pregnancy,tell your doctor & get a blood test done for Toxoplasmosis.Any rashes and fever,get to your doc at once!!Get blood pressure checked at all visits.
New methods of delivery without pain(using epidural anaesthesia,wherein drug is injected to your back(spinal column) to take away all lower body sensations without you losing consciousness)are available.Discuss any doubts or options with your doctor.
Delivering in a swimming pool or tub of warm water is supposed to be a strainless procedure for both mother and child,and is done in countries such as Russia.

DIET AND NUTRITION

DIET AND NUTRITION
what we eat is what we are!The daily food we eat determines the way our lives are shaped-and our bodies!
A well balanced,nutritious diet contains
1.Carbohydrates :"complex" carbohydrates..like bread,rice,pasta,cereals.vegetables like potato & fruits.These should form the major portion of the daily diet.These provide sustained release of energy as opposed to "simple" carbohydrates like sweets,candies,cakes which provide a sudden release of energy,but which if consumed in excess can lead to weight gain.These sudden "glucose-challenges"are also thought to lead to to diabetes at a later stage.Complex natural carbohydrates also have fibres which are essential in keeping the blood vessels in healthy condition.A high fibre diet is known to reduce the chances of colorectal cancer.Too much of carbohydrates can cause weight gain,as ANY unutilised energy sources are converted by the body into fat.
2.Proteins : these are derived from meat,fish egg,nuts,legumes,oils.Proteins are the tissue builders,they are needed for repairing our body,helping it fight against infections(in the form of immunoglobulins),,maintaining its normal status (in the form of hormones).
Proteins should form 1/4 to 1/6 of the energy source.Too much of Proteins can lead to weight gain in the form of body fat.
3.Fats: these should be to the minimum,particularly with increase in age,or decreased activities.Fats are essential in the development of the nervous tissue,help provide protection to inner organs,helps in insulating the body,and act as reservoir of energy,being utilised when there is shortage of energy/food.Vitamin "D" is produced by the skin with the help of fat.
Fats in the form of 'unsaturated oils' like cannola oil,sunflower oil are good for the body,whereas saturated fats like "dalda" i.e hydrogenated fats,animal fats are dangerous to the heart and blood vessels.Fats should form a small part of everyday diet.
4.Vitamins and Minerals are usually got from the normal diet,and need to be supplemented only in certain conditions.Too much of vitamins(particularly. vit D) can be harmful to the body .Minerals though needed in extremely small quantities,are a very essential part of the chemical "soup" that make up the body.Zinc and chromium are essential elements in the insulin-carbohydrate mechanism.Iron is needed in the formation of haemoglobin,through which blood is able to carry oxygen and carbon dioxide.Many diseases are due to excess of metals in our diet as a result of industrial pollution(Lead,Arsenic,Chromium,Cadmium,Mercury).Taking extra minerals is usually not required when a well balanced diet is followed
5.Fluids.:Water is the medium of life,making up more than 85% of the body.There is water even in your teeth and bones!It acts as the medium of "cellular respiration",THE most definitive and final level of respiration that is the basis of Life.Even the oxygen that is breathed in is finally dissolved in water before taken into a cell.
There are entire systems of alternative medicines based solely on making a person drink water!!
Drink at least 8 glasses of water in a day.Too much of water in a sedentary/elderly person can be harmful.Do not overdo anything too much!Too much of plain water in an exercising person is also not good,adding a bit of salt and sugar is a must.
6.Salt.in moderation is very essential for the normal functioning of the nerves & muscles,for the chemical signalling occurring at the cellular level.,but too much of salt is harmful and may bring about hypertension.(persistently elevated blood pressure).
TIPS!
Eating 5 or 6 small meals a day is better than eating 2 or 3 large meals a day
Drinking milk along with some biscuits at bed time helps you sleep better.
Green tea is rich in flavenoids and other powerful antioxidising agents,and help in preventing tissue damage due to old age and exposure to industrial pollutants.
Avoid cabbage if you have a thyroid problem.
Avoid alcohol,or use in moderation.Red wine is good for the heart.
An egg a day will not lead to any great dangers of cholesterol.It is the most 'complete food',easily digested by children and old people alike.
Milk contains organic calcium,which helps in REDUCING fat,particularly around the tummy.So,if on a diet,include milk(or better still- yogurt,curds) on your menu,and cut others!
It has not been proved that swimming after a meal leads to cramps..actually swimming on an empty stomach may lead to cramps.
If you need to LOSE weight,cut down your "low quality calories",i.e those coming from sweets & fats.Reduce your overall food intake and EXERCISE!
Exercises should be low grade but for long duration with high repetitions.Example:If it is dumble lifting,then use LOW WEIGHTS,HIGH REPETITIONS,do not go on increasing weights as the exercise becomes 'easier',but increase the repetitions.
If you are trying to GAIN weight ,increase your diet in the form of complex carbohydrates,and proteins.Exercise with HEAVY WEIGHTS,LOW REPETITIONS,go on progressively increasing the weights.
Exercise increases muscle mass,and this increases BMR(basal metabolic rate),which means that even when you are resting,the body continues to burn energy.The controversial ATKINS DIET prescribes a high protein,low carbohydrate diet for weight loss,but usually not approved by doctors.
See HERE for more dieting,recipes and nutrition tips!

CONVULSIONS OR FITS

CONVULSIONS(FITS OR EPILEPSY)
A person about to have fits may show alteration in his behavior .He may cry out before falling down,or in some instances may fall without any warning.His entire body may be twitching and jerking ,with foam coming out of his mouth.There may be tongue biting and bleeding from mouth.
1.Do NOT put anything inside the mouth.
2.Do NOT hold the person by force.
3.Loosen his clothing,at the neck.Ask the bystanders to stand away,to let in air.
4.If the fits stop in 5 minutes or less(most of them DO!),stay with the person until he is comfortable,ask him his name,whether he remembers his home address,whether hi needs to go to a hospital.FITS OF MORE THAN 5 MINUTES DURATION,OR FITS OCCURING MORE THAN ONCE WITHIN 10 MINUTES NEED IMMEDIATE MEDICAL ATTENTION-CALL AN AMBULANCE!!
5.If the person is having fits for the FIRST time, REFER him to a Doctor at the earliest.
6.A person after having fits may lose conscious for some period of time.Make sure he is breathing,Turn him onto his stomach with face turned to one side.Monitor his pulse and breathing.
Many times,the person may not be able to recall his name or address for some period of time.Stay with him or get help in moving him to his home.

INSECT AND SNAKE BITES

POISONOUS STINGS
If the person is stung by an insect(scorpion,spider),he will have severe pain and swelling of the area.
1.Place a cold pack over the bite area.Place the limb above the level of the heart.
2.If the sting is from a BEE,WASP,HORNET the stinger or "horn' may be embedded in the skin.DO NOT remove it with a tweezer or forceps.This may "pump" in more poison.Remove the horn with a needle.Later apply cold pack..
3.If the person has difficulty in seeing things,sounds hoarse,has difficulty in breathing,has vomitting or has shown such a history in the past after insect bites,GET IMMEDIATE MEDICAL HELP.IF THE DOCTOR OR HOSPITAL IS NOT REACHABLE,AND IN THE WORST OF THE SITUATIONS,IF THE PERSON STOPS BREATHING OR THERE IS NO PULSE(HEART BEAT),GIVE INJ.ADRENALINE 1CC INTO THE INNER PART OF THE THIGH AND START CPR.Once the person starts breathing and has heart beats,get to the nearest hospital.
SNAKE BITES
1.Many snake bite victims die of fear.Calm them,Assure them that even non-poisonous snake bites are painful.
2.Lie down the victim,Elevate the limb that has been bitten above the level of the heart.Ensure that the bitten limb is moved as little as possible.DO NOT APPLY COLD PACKS ON A SNAKE BITE INJURY.
Recent research indicates that the age old practices of tightly bandaging the limb 'above' the bite,or cutting the bite area with a blade and drawing out blood(by sucking or otherwise),may not be beneficial.But these can be resorted to,at least to keep the person less anxious!.
4.SEEK IMMEDIATE MEDICAL HELP.BE PREPARED TO GIVE CPR WHENEVER NECESSARY..

HYPO & HYPERTHERMIA

HYPOTHERMIA
This means the lowering of the body's core temperature following prolonged exposure to cold or freezing conditions.
1.Wrap the person in a polythene sheet,lots of warm clothes.
2.Make the person sit with legs,thighs,arms and forearms tucked in.
3.Give lots of warm liquids.
4.Make him breathe in air blown OVER a bowl of hot water or hot electric stove.This will be more helpful than warming the person by putting hot water bags or hot pads of clothes OVER his body.
5.Get medical help at the earliest.
HYPERTHERMIA
This means the body's core temperature has risen beyond the normal values.
Most often seen during intense exertions(physical activity) in the young athlete, or in extremely hot conditions(sun stroke).The victim may NOT be hot to touch.
He may complain of "cramps" in his limbs,belly,may be pale & sweating,complain of vertigo,vomiting or may become unconscious.
1.Remove the person away from the heat into a cooler place; Remove clothing.
2.Give lots of fluids(fruit juices,lime-juice with sugar & 2 pinches of salt,or plain water with sugar & salt,ORS--oral rehydrating solution),AVOID plain water.
DO NOT give Aspirin,Paracetamol etc..
3.Wipe entire body with tepid water.Place icepacks under armpits,groin,neck,head.
4.Blow cool air(fan)over body
5.Get medical help.