Well Woman Checkup at Getwell Medical Center

Pregnancy Induced Hypertension

What Is High Blood Pressure?

Blood pressure is the amount of force exerted by the blood against the walls of the arteries. A person's blood pressure is considered high when the readings are greater than 140 mm Hg systolic (the top number in the blood pressure reading) or 90 mm Hg diastolic (the bottom number). In general, high blood pressure, or hypertension, contributes to the development of coronary heart disease, stroke, heart failure and kidney disease.

What Are the Effects of High Blood Pressure in Pregnancy?

Although many pregnant women with high blood pressure have healthy babies without serious problems, high blood pressure can be dangerous for both the mother and the fetus. Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure. However, some women develop high blood pressure while they are pregnant (often called gestational hypertension).

The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother develops preeclampsia - or "toxemia of pregnancy"--which can threaten the lives of both the mother and the fetus.

What Is Preeclampsia?

Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia--the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth.

There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The only way to "cure" preeclampsia is to deliver the baby.

How Common Are High Blood Pressure and Preeclampsia in Pregnancy?

High blood pressure problems occur in 6 percent to 8 percent of all pregnancies in the U.S., about 70 percent of which are first-time pregnancies. In 1998, more than 146,320 cases of preeclampsia alone were diagnosed.

Although the proportion of pregnancies with gestational hypertension and eclampsia has remained about the same in the U.S. over the past decade, the rate of preeclampsia has increased by nearly one-third. This increase is due in part to a rise in the numbers of older mothers and of multiple births, where preeclampsia occurs more frequently. For example, in 1998 birth rates among women ages 30 to 44 and the number of births to women ages 45 and older were at the highest levels in 3 decades, according to the National Center for Health Statistics. Furthermore, between 1980 and 1998, rates of twin births increased about 50 percent overall and 1,000 percent among women ages 45 to 49; rates of triplet and other higher-order multiple births jumped more than 400 percent overall, and 1,000 percent among women in their 40s.

Who Is More Likely to Develop Preeclampsia?

·         Women with chronic hypertension (high blood pressure before becoming pregnant).

·         Women who developed high blood pressure or preeclampsia during a previous pregnancy, especially if these conditions occurred early in the pregnancy.

·         Women who are obese prior to pregnancy.

·         Pregnant women under the age of 20 or over the age of 40.

·         Women who are pregnant with more than one baby.

·         Women with diabetes, kidney disease, rheumatoid arthritis, lupus, orscleroderma.

What Are the Symptoms of Preeclampsia and How Is It Detected?

Unfortunately, there is no single test to predict or diagnose preeclampsia. Key signs are increased blood pressure and protein in the urine (proteinuria). Other symptoms that seem to occur with preeclampsia includepersistent headaches, blurred vision or sensitivity to light, and abdominal pain.

All of these sensations can be caused by other disorders; they can also occur in healthy pregnancies. Regular visits with your doctor help him or her to track your blood pressure and level of protein in your urine, to order and analyze blood tests that detect signs of preeclampsia, and to monitor fetal development more closely.

How Can Women with High Blood Pressure Prevent Problems During Pregnancy?

If you are thinking about having a baby and you have high blood pressure, talk first to your doctor or nurse. Taking steps to control your blood pressure before and during pregnancy-and getting regular prenatal care-go a long way toward ensuring your well-being and your baby's health.

Before becoming pregnant:

·         Be sure your blood pressure is under control. Lifestyle changes such as limiting your salt intake, participating in regular physical activity, and losing weight if you are overweight can be helpful.

·         Discuss with your doctor how hypertension might affect you and your baby during pregnancy, and what you can do to prevent or lessen problems.

·         If you take medicines for your blood pressure, ask your doctor whether you should change the amount you take or stop taking them during pregnancy. Experts currently recommend avoiding angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II (AII) receptor antagonists during pregnancy; other blood pressure medications may be OK for you to use. Do not, however, stop or change your medicines unless your doctor tells you to do so.

While you are pregnant:

·         Obtain regular prenatal medical care.

·         Avoid alcohol and tobacco.

·         Talk to your doctor about any over-the-counter medications you are taking or are thinking about taking.

Does Hypertension or Preeclampsia During Pregnancy Cause Long-Term Heart and Blood Vessel Problems?

The effects of high blood pressure during pregnancy vary depending on the disorder and other factors. According to the National High Blood Pressure Education Program (NHBPEP), preeclampsia does not in general increase a woman's risk for developing chronic hypertension or other heart-related problems. The NHBPEP also reports that in women with normal blood pressure who develop preeclampsia after the 20th week of their first pregnancy, short-term complications-including increased blood pressure-usually go away within about 6 weeks after delivery.

Some women, however, may be more likely to develop high blood pressure or otherheart disease later in life. More research is needed to determine the long-term health effects of hypertensive disorders in pregnancy and to develop better methods for identifying, diagnosing, and treating women at risk for these conditions.

Even though high blood pressure and related disorders during pregnancy can be serious, most women with high blood pressure and those who develop preeclampsia have successful pregnancies. Obtaining early and regular prenatal care is the most important thing you can do for you and your baby.

 Dr. Sarita Kapoor, MS (Ob & Gyn), Getwell Medical Center, Dubai

Infertility by Dr. Sarita Kapoor, Getwell Medical Center

Infertility

What is infertility?

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.

Is infertility a common problem?

Yes. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

What causes infertility in men?

Infertility in men is most often caused by:

·      A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man's testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.

·         Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man's risk of infertility?

A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

·         heavy alcohol use

·         drugs

·         environmental toxins, including pesticides and lead

·         smoking cigarettes

·         health problems such as mumps, serious conditions like kidney disease, or hormone problems

·         medicines

·         radiation treatment and chemotherapyfor cancer

·         age

What causes infertility in women?

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems are often caused bypolycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman's ovaries stop working normally before she is 40. POI is not the same as early menopause.

Less common causes of fertility problems in women include:

·      blocked Fallopian tubes due to pelvic inflammatory disease,endometriosis, or surgery for an ectopic pregnancy

·         physical problems with the uterus

·         uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.

How does age affect a woman's ability to have children?

Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman's chances of having a baby in the following ways:

·         Her ovaries become less able to release eggs.

·         She has a smaller number of eggs left.

·         Her eggs are not as healthy.

·         She is more likely to have health conditions that can cause fertility problems.

·         She is more likely to have a miscarriage.

How long should women try to get pregnant before calling their doctors?

Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:

·         Irregular periods or no menstrual periods

·         Very painful periods

·         Endometriosis

·         Pelvic inflammatory disease

·         More than one miscarriage

It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

Getwell Medical Center - Dr. Sarita Kapoor, MS (Ob & Gyn)

Benefits of Ultrasound

The main benefit of ultrasound is that it does not use radiation, which makes it safer to use in general. Ultrasound is particularly useful in pregnant women to image the fetus, as well as in newborns who are still undergoing tissue development which may be susceptible to radation.

Another major benefit of ultrasound is portability. Although the machines are expensive, they can be wheeled around on a cart, which makes it easy to do bedside imaging or imaging on critical patients who cannot be moved easily. Furthermore, this reduces expense as a dedicated ultrasound facility is not necessarily needed.

Is Middle East Climate Can Damage your Skin?

Middle Eastern and Arab skin is known to be darker in pigmentation, which makes it more susceptible to skin color changes after undergoing light-based dermatological procedures. The warmer climate in the Middle East automatically creates the need for constant hydration and sun protection. Therefore, as a result of direct sun exposure and less water intake, individuals may suffer from darker skin patches, skin damage, wrinkles and other dermatological disturbances caused by the surrounding environment.

The most common complaints resulting from Middle Eastern patients are skin hyper or hypo-pigmentation, Hirsutism, and Hypertricosis.

Hirsutism is the growth of excessive hair in unusual areas in women, associated with male hair growth patterns such as on the face, chest and back. These attributes are found in women who have polycystic ovarian syndrome which is hereditary, congenital adrenal hyperplasia or are of Middle Eastern and South Asian ancestry. Hypertricosis on the other hand is also characterised by excessive hair growth on men and women and its ability to be passed down genetically, however it is more aggressive in nature and is also referred to as Ambras Syndrome.

The most common dermatological treatments performed on Middle Eastern and Arab patients is chemical peels, laser assisted hair reduction, laser rejuvenation for acne scars and microdermabrasion. Additionally it is very important that patients select dermatologists or professional skin practitioners that are qualified with an excellent track record to avoid malpractice and unwanted consequences.

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