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| Sunday, 1 August 2004 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Caring for the unborn baby
For those with chronic medical conditions and previous bad obstetrical outcome, or who are expecting multiples births pregnancy can be a time of intense fear and uncertainty. Families can cope more successfully with a high-risk pregnancy, with appropriate medical intervention, education, and a strong support system, says Dr. Vandana Bansal, Consultant Fetomaternal Medicine at Apollo Hospitals Colombo, in conversation with Carol Aloysius. Q: What is fetal medicine? A: Initially, the fetus was clinically seen as part of the mother. Now we see the fetus as in individual with a right to be born as healthy as possible.
"Fetus," the unborn baby, lives a complete life in the mother's womb for nine months. It makes gestures, smiles, cries, swallows, sucks its thumb and even passes urine. So the fetus has been given the status of an individual patient with its own medical problems which also need to be addressed like that of the mother. The concept of fetal medicine and fetal care was developed, as we now know that the mother's pregnancy related complications, or the fetal's own medical problems can jeopardise its life. Q: What is high risk pregnancy? A: Pregnancy, itself, is not a high-risk condition. It is a normal part of our reproductive life. Most pregnancies have a healthy and happy outcome. Unfortunately, some pregnancies are 'high risk' or 'complicated' when the life or health of the mother or baby may be at risk. These pregnancies are at 'high risk' for developing problems and having a poor outcome. Q: What makes a pregnancy "high risk?" A: Maternal age is one factor that contributes to pregnancy risks. The chances of pregnancy-induced high blood pressure or diabetes in the mother and abnormal development of the baby increase with the mother's age. The mother's height and weight are also important factors. Women who weigh less than 100 pounds (45 kgs) are likely to deliver underweight babies. Those who are overweight more than 85 kgs put themselves at risk for gestational diabetes and hypertension. Women with chronic medical conditions, such as Thyroid Diseases, Diabetes, heart problems high BP, Kidney Disease, Epilepsy or Arthritis, are all at risk for complicated pregnancies. Also, a family history of mental retardation, birth defects or genetic diseases can indicate a high-risk pregnancy. Likewise, women who have experienced miscarriages, pre-term deliveries, stillbirths, or neonatal deaths need specialized care to ensure a healthy pregnancy and birth. Q: How do we know that the fetus has a problem? A: The Fetal Medicine expert does a periodic checkup of baby's health before birth and monitors its growth and well-being during the entire pregnancy using ultrasound. With the advent of high resolution Ultrasound with Doppler capabilities, fetal diseases/disorders are diagnosed and can be offered treatment in-utero leading on to delivery of a healthy baby. Fetal problems consist of multiple gestations (two or more fetuses per pregnancy), congenital abnormalities and growth abnormalities. These twin pregnancies are at risk for preterm labour and growth problems. Each fetus in multiple gestation should be monitored individually for its growth and well-being using ultrasound. Congenital abnormalities complicate two to five per cent of all pregnancies. The abnormalities range from minor problems to severe complications. Birth of child with undiagnosed defects like cleft lip and palate, club foot gives sudden psychological trauma to parents. Prenatal diagnosis of such abnormalities gives the parents enough time for emotional adjustment and time to seek help from plastic surgeon for repairing these defects. Fetal Echocardiography (ECHO) is an essential component of fetal sonographic evaluation, because cardiac defects are the commonest congenital defects seen in our population. Prenatal diagnosis of congenital cardiac defects, allows immediate cardiac assessment and treatment of the newborn at birth by paediatric cardiologist and avoid delay in diagnosis and complications. If defects are correctable like Ventricular Septal Defect, Fallot's Tetralogy, Patent Ductus Arteriosus etc. timely surgery can be offered in initial stages before newborn succumbs to cyanotic attacks. Some of the birth defects and chromosomal anomalies are diagnosed using special, minimally invasive antenatal procedures like fetal blood sampling, amniocentesis and Chorionic Villus Sampling. Q: Mention some birth defects that can be detected when the fetus is inside the womb. A: Cardiac defects; a foetus suffering from genetic defects like Down Syndrome. Q: Can a fetus with abnormalities be treated for its defects while still in the mother's womb? A: There are certain conditions which can be treated inutero e.g. fetal arrythmia (irregular heart beat), thyroid disorders. We can also treat renal obstructive disorders. Q: How can this be done? A: We inject drugs into the amnotic fluid. We have also small instruments (needles and coils) by which obstruction can be relieved by surgery. Q: How are high risk patients managed? A: Women at high risk require special attention, pre-pregnancy planning, close maternal fetal monitoring and medication adjustment during pregnancy. With proper care, 90 to 95 per cent of high-risk pregnancies produce healthy, viable babies. The earlier a problem is detected, the better the chances that both mother and baby will stay healthy. Women with diabetes must be especially careful about planning pregnancy. Blood sugar control for diabetic women must be optimised to protect the developing organ systems in the fetus in the early weeks to months of pregnancy. Q: What is the future of fetal medicine as regards the health of a new born? A: Inutero treatment and fetal surgery of birth disorders before the disease becomes uncorrectable, is a new specialty which offers much hope for unborn babies. ###### Healthy weight advice: One size doesn't fit all ! Evidence is clear that those who control their total body fat, are much less likely to experience premature chronic degenerative diseases such as Heart Disease, Stroke, High Blood Pressure, Diabetes and High Blood Lipids. However, experts are beginning to understand that the relationship between body weight and the likelihood of developing chronic degenerative diseases is more complicated than a simple overweight - increased risk formula. Here are some recommended methods for assessing individual health status, using individual vital statistics and some simple mathematics: Body mass index (BMI) The global standard for classification of body weight as normal, underweight, overweight or obese is Body Mass Index (BMI). BMI is calculated by dividing a person's weight in kilograms by their height in metres squared. Until recently, the same classification standards have been used in all parts of the world, to assess and categorise body weight: A BMI of 18.5 to 25 is traditionally classified as normal, 25 to 30 as overweight and is associated with increased risk of developing weight-related disorders, and above 30 is classified as obese and at high risk of developing weight-related illness. In recent years, experts, have observed that weight-related disorders are more common in some Asians ethnic groups at BMI levels above 23. An expert group of the WHO has therefore recommended a lower BMI scale for Asians: 18.5-23 for increasing but relatively low risk of developing weight-related ill-health; 23-27.5 for increased risk; and 27.5 or more signals high risk. (2) Waist Circumference Waist circumference is measured around the narrowest point between ribs and hips when viewed from the front after exhaling. Waist circumference, is a measure of abdominal fat and a good indicator of health status, even when the BMI calculation falls within the range classified as normal. Waist measurements of over 102 cm (40 inches) in men and over 88 cm (35 inches) in women were set as the global thresholds for determining increased likelihood of developing weight-related disorders. Waist-to-Hip-Ratio (WHR) Waist-to-hip ratio (WHR) is the radious of a person's waist circumference to hip circumference. This measurement can be calculated by dividing waist circumference by hip circumference. WHR, like waist circumference is a tool to assess distribution of body fat. For most people, and perhaps especially Asian populations, abdominal fat causes more health problems than carrying extra weight around their hips or thighs. A WHR of 0.90 or less is considered healthy for men and a ratio of 0.80 or less is considered a sign of good health for women. A waist: hip ratio of 1 or higher signals increased risk of ill health and an indicator that action to shed some body fat from the tummy would be wise. Together, these three measures of body size, provide some very useful criteria against which to assess body weight and determine action targets, to maintain, lose weight or recognise and halt gradual weight gain. Thirty to sixty minutes every day of moderate to vigorous physical activity such as brisk walking, or swimming, helps in weight maintenance and weight loss, and regardless of body weight, massively reduces individual risk of developing Heart Disease, Strokes and other Chronic Disease. |
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