Tuesday March 26, 2019

ESC Directs Women With Heart Disease To Give Before 40 Weeks

While women with heart disease can have a healthy pregnancy, they should be aware of a higher risk of obstetric complications.

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Pregnancy, Breast Cancer
High blood pressure, which had long been defined as a top reading of at least 140 or a bottom one of 90, dropped to 130 over 80 under guidelines adopted in 2017.

Pregnant women with heart disease should give birth at no later than 40 weeks gestation, beyond that harm can be caused to the mother, new guidelines by the European Society of Cardiology (ESC) recommends.

Besides pre-pregnancy risk assessment and counselling, a delivery plan should be devised at 20-30 weeks, specifying vaginal or caesarean delivery, whether an epidural or forceps will be used, and the duration of hospital stay after delivery, the guidelines said.

“Pregnancy is a risky period for women with heart disease because it puts additional stress on the heart, so the guidelines advise inducing labour or a caesarean section at 40 weeks,” said Jolien Roos-Hesselink, Professor at the Erasmus University in Rotterdam, Netherlands.

 

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Since carrying more than one baby puts more stress on the heart, women with heart disease undergoing IVF are strongly advised to transfer a single embryo.
Pixabay

 

“Beyond 40 weeks, pregnancy has no added benefit for the baby and may even have negative effects,” Roos-Hesselink added.

Heart disease is the main reason women die during pregnancy in western countries, because they have a 100-fold greater risk of death or heart failure than their healthy peers.

An estimated 18-30 per cent of the offsprings have complications and up to 4 per cent of neonates die.

The new guidelines, published in the European Heart Journal, also recommended against in vitro fertilisation (IVF), contraception, and termination of pregnancy for women with heart disease.

It is because IVF often uses high doses of hormones, which increases the risk of thrombosis and heart failure, so women with heart diseases need a cardiologist’s confirmation.

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The new guidelines, published in the European Heart Journal, also recommended against in vitro fertilisation (IVF). Pixabay

“Since carrying more than one baby puts more stress on the heart, women with heart disease undergoing IVF are strongly advised to transfer a single embryo,” the guidelines said.

Also Read: Stress During Pregnancy Increases Risk of Mood Disorder in Daughters

While women with heart disease can have a healthy pregnancy, they should be aware of a higher risk of obstetric complications including premature labour, pre-eclampsia, and post-partum bleeding.

Moreover, girls with congenital heart disease should take advice before using contraceptives because some methods are contraindicated in patients with certain types of heart disease, the guidelines noted. (IANS)

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Sikkim Holds Exceptionally Steady And Silent Progress In Improving The Lives Of Ordinary People

Given the track record, it may be safe to predict that Sikkim might be the first Indian state to offer solutions to the rest of India - and the world.

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Sikkim, along with Meghalaya, occupies the top two positions in the best performing region of Northeast on women's empowerment index comprising of participation of women in household decisions, ownership of land, cell phones and bank account, and instances of spousal violence. Pixabay

Everyone knows that Sikkim is a small extraordinarily picturesque mountainous state tucked away in the Himalayas in the northeast of India. That indeed it is. Even today, there are only around 650,000 people living in the state. However, much less known about Sikkim to the rest of India – and also the world – is the exceptionally steady and silent progress in improving the lives of ordinary people that the state has recorded over the past two decades.

How did Sikkim achieve this? The obvious answer is that Sikkim, like many countries in the world, has ensured that policies that promote economic opportunities go hand-in-hand with policies that ensure an equitable expansion of health, education, nutrition and essential basic social services.

Less obvious is the critical role of political leadership in ensuring improvements in the lives of people. Ensuring that the additional tax revenues from economic growth are invested in expanding human capabilities does not happen automatically. Chief Minister Pawan Chamling – the longest serving Chief Minister of any Indian state – has prioritized investments in health, education and infrastructure like no other political leader has. After all, ensuring adequate funds for the social sectors is as much a function of the funds available as it is of making it a political priority. Very few political leaders in India and elsewhere recognize the importance of investing in people as Chamling does.

What goes even more unnoticed is the role that women have played in Sikkim’s development success. Traditionally women have enjoyed greater freedom in Sikkim than in many other parts of the country. The Sikkim Human Development Report revealed that the state had the best gender parity performance among the northeastern states, with female labour force participation at 40 per cent, much higher than the national average of around 26 per cent. In recent times, with the support of the state, they have played an active role in various spheres of life.

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Traditionally women have enjoyed greater freedom in Sikkim than in many other parts of the country.Pixabay

Sikkim’s women have exercised leadership by taking advantage of the available educational and development opportunities. This is revealed by the progress on multiple indicators from NFHS 3 to NFHS 4 recorded by Sikkim. According to the National Family Health Survey (NFHS 4), 41 per cent women in the state have 10 or more years of schooling – much better than the country’s average of 36 per cent. Only 15 per cent women, age 20-24 years, were married before age of 18 years as against the national average of 27 per cent. There are only 3 per cent teenage pregnancies in the state placing Sikkim as the best among the northeastern states. The infant mortality rate in the state is 30 against national average of 34. Sikkim has improved its performance with regard to safe delivery remarkably by 43 per cent points from NFHS 3 to 97 per cent in NFHS 4, the best in northeastern states.

Sikkim, along with Meghalaya, occupies the top two positions in the best performing region of Northeast on women’s empowerment index comprising of participation of women in household decisions, ownership of land, cell phones and bank account, and instances of spousal violence.

Women in Sikkim are more empowered to take decisions than women in other parts of the country. According to NFHS-4, in 2015-16, 85 per cent women have the freedom of movement, including to market, health facility and places outside the village or community compared to national average. Almost all (95 per cent) of currently married women in Sikkim participate in household decisions as against national average of 84 per cent. Nearly 80 per cent women in the state have mobile phones for personal use against 46 per cent at the national level. Close to two-thirds (64 per cent) of women in Sikkim – as against just over half 953 per cent) of women across India – have a bank or savings account that they themselves operate. Only 3 per cent ever married women have ever experience spousal violence as against 29 percent nationally – the lowest across Indian states.

Sikkim has, however, many things to worry about. This includes creating jobs for its young people within the state, improving the quality of education, protecting residents from natural disasters, expanding infrastructure and so on. Equally worrisome is the sharp decline in total fertility rate (TFR) – 1.2 in 2015-16 – which is well below the replacement level of 2.1. This sharp decline in TFR might have also contributed to the worsening of the female-to-male ratio at birth from 984 in 205-06 to 809 in 2015-16.

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Sikkim has, however, many things to worry about. This includes creating jobs for its young people within the state, improving the quality of education, protecting residents from natural disasters, expanding infrastructure and so on. Pixabay

The reduced TFR is not good news as it may result in an age-structural transformation wherein Sikkim, like Kerala, will have to address the challenges of an aging population. This could get manifested in the short supply of workers as well as a further decline in the sex ratio. With shrinking active labour force, Sikkim’s economy could experience loss in economic output and possibly a decline in income levels. There could also be an increase in the elderly dependency ratio and morbidity levels on account of a rise in non-communicable diseases. Sikkim will have to mobilize the resources needed to extend financial support of the elderly and make provisions to address, in particular, their health care needs. It will also have to deal with the challenge of declining fertility rates.

Also Read: Millennium City Is Witnessing Rise In Illegal Trade Of Marijuana

These challenges may not come as a surprise to the political leadership in Sikkim. They should not given how well Chief Minister Chamling and the executive are connected the people. Given the track record, it may be safe to predict that Sikkim might be the first Indian state to offer solutions to the rest of India – and the world. (IANS)