Delivery of Preconception Counselling Services: The Snags of Health Care Service Providers.

Purpose: This study investigates the difficulties the health care service providers encounter in the quest of rendering preconception counselling services in Ghana. Methodology: The study employed descriptive survey design with the use of both qualitative and quantitative research approaches using questionnaire as the main tool. The study employed simple random sampling to sampled 135 out of 675 health care service providers from 23 health facilities in the Bole District of the Savanna Region in Ghana. The quantitative data obtained for the study was analysed using Statistical Package for Social Solution (SPSS) whilst the qualitative data were subjected to descriptive and narrative discussion. Findings: The study revealed that, health care practitioners need continuous training programme. It also became clear that, there no any clear national guideline or policy on preconception counselling in Ghana. It came to light that, the healthcare service providers face a lot of difficulties to capture women of child bearing age to offer them the services. Inadequate knowledge and expertise to effectively offer the preconception counselling services was also identified as a challenge. Recommendations: The study therefore recommend that the Ministry of Health and Ghana Health Service should come out with a clear policy guideline on preconception counselling and also provide an intensive training for the health care professionals. The health care providers should also be provided with the needed resources to embark on sensitisation and advocacy campaigns to create the awareness for women of childbearing age to appreciate the need for preconception and genetic carrier risk counselling.

A SCIENTIFIC EXPLORATION OF SHADGARBHAKAR BHAVA (SIX PROCREATIVE FACTORS) FOR THE CAUSATION OF CHILDHOOD LEUKEMIA IN PURVIEW OF EPIGENETICS: A REVIEW

This is a systematic review article in which classical literature of Ayurveda & contemporary science on subject of Garbhavakranti were explored from the library of my parent institute and other relevant sources were used. The data obtained were critically analyzed and presented. Objectives of this work are to assess lag of Shadgarbhakar Bhava for causation of Childhood Leukemia, determine the embryological aspects of Shadgarbhakar Bhava as per Ayurvedic and Modern perspective of Childhood Leukemia and to suggest a protocol for prevention of said disease. Original Research and published articles available on google scholar Pub-med and Med-scape, Reference Materials, Textbooks, Review Articles are the source of data. Conglomeration of Shadgarbhakar Bhava play vital role in appropriate development of an embryo. Intra-uterine environment can be modified by proper practicing of Satmyaja Bhava, Satvaja Bhava and Rasaja Bhava which produces healthy impact on embryo while Matraja Bhava, Pitraja Bhava and Atmaja Bhava cannot be changed. Lag of Shadgarbhakar Bhava causes diseases in offspring. Childhood leukaemia is one of these, maternal and nutritional factor have major role in this. Occurrence of Childhood Leukemia can be prevented by proper preconception counselling, antenatal care, and good mode of conduct exhibited by mother and father.

Therapeutic plasma exchange for Graves’ disease in pregnancy

Graves’ disease in pregnancy may be associated with maternal, fetal and neonatal complications, which are proportionate to the severity of hyperthyroidism. Optimal management is detailed preconception counselling, achievement of an euthyroid state prior to conception, and close monitoring of thyroid function and thyroid-stimulating antibodies together with judicious use of anti-thyroid medications during pregnancy. A case of Graves’ disease in pregnancy, complicated by pancytopenia, with a deterioration in thyroid function following cessation of thionamide therapy is described here. Therapeutic plasma exchange was subsequently used to achieve rapid control prior to thyroidectomy. Therapeutic plasma exchange is an effective treatment for hyperthyroidism where thionamides are ineffective or contraindicated, as a bridge to definitive management.

Prescribing for pregnancy: managing chronic headache and migraine

Globally, headache disorders are an important cause of disability in adults. As many types of headache (eg, migraine, tension-type and medication-overuse) are more common in women and have peak incidence in reproductive years, chronic headache disorders are highly prevalent in pregnant women. Some women with a history of migraine may find that it improves during pregnancy while others may find that their migraines become more unpredictable. Ideally, women with migraine and problematic headache disorder should be offered preconception counselling to address pregnancy-related concerns and advice on the use of medicines, which should be supported by high-quality information. For women with history of headache, the use of effective non-pharmacological options should be maximised, and the smallest number of the safest medicines at the lowest effective doses should be used while preparing for pregnancy and during pregnancy. This article forms part of the series of prescribing for pregnancy and discusses the impact of headache and migraine on pregnancy, the impact of pregnancy on headache and migraine and options for prophylaxis and treatment.

The Use of Frozen Embryo Transfer and the Development of Pregnancy-Induced Hypertension: A Literature Review

The use of assisted reproduction techniques has been associated with obstetric complications. An understanding about which methods and treatment protocols produce better outcomes would provide greater opportunities for a successful pregnancy. The aim of this literature review was to identify whether frozen embryo transfer (FET) leads to a greater incidence of pregnancy-induced hypertension (PIH) compared to fresh embryo transfer. Fifteen studies were identified and subsequently reviewed. Eleven studies suggested FET increased the incidence of PIH–gestational hypertension and pre-eclampsia. The evidence suggests a correlation between FET and PIH. Exploration into why this is the case should be the focus of future studies. Implications for clinical practice involve extensive preconception counselling and potentially advising prophylactic low-dose aspirin with the aim of lower the incidence of PIH.

Pregnancy and the kidney

Renal disease may occur de novo during pregnancy and pregnancy may occur in women with pre-existing renal disease. The chapters in this section consider the causes and implications of acute kidney injury that may occur during pregnancy and the likely outcomes of pregnancy in women with pre-existing chronic kidney disease, including the possible maternal and foetal complications of preterm delivery and pre-eclampsia (PET). There is a high incidence of PET in women with renal disease during pregnancy and importance of diagnosis and safe treatment of hypertension during pregnancy is discussed. The authors present the current theories of the pathogenesis of PET and highlight the importance of prophylactic treatment with aspirin to reduce the risk of PET. Pregnancy is increasingly common following renal transplantation and this group requires special consideration. They may have other concurrent medical conditions that need to be considered during pregnancy, or they may be at higher risk of other medical complications e.g. urinary tract infection with potential implications for maternal health and foetal wellbeing. It is important to facilitate preconception counselling for women with pre-existing renal disease to discuss optimal timing of pregnancy, make necessary adjustments to medications, and to discuss the likely outcomes for mother and baby. Managing renal disease during pregnancy requires the input of nephrologists, obstetricians, midwives, and often other healthcare professionals which is optimally delivered in a multi-disciplinary antenatal clinic with an expertise in this area.

An audit to review the extent to which appropriate preconception advice is given to women being discharged from mental health wards on psychotropic medication, in line with NICE guidelines

AimsThe release of the Cumberlege Report in 2020 served as a reminder of the importance of informed consent for women when they are started on treatment that may affect their fertility or future pregnancies.Our aim was to evaluate current performance with regards to advice given to women of childbearing age around contraception, impacts of psychotropic medication on fertility and future pregnancies, and availability of preconception counselling.MethodStandard identified as NICE Guideline 192 (Antenatal and Postnatal Mental Health), sections 1.2 and 1.4.60 female inpatients were selected by looking at the most recent discharges prior to 03/11/2020 from 3 local acute adult wards. All females aged between 18 and 48 years were included.Electronic notes were reviewed for each patient. The discharge summary and last four ward round entries were reviewed, then key-word search of the patients’ records was performed using the terms “pregnan*”, “conception”, “contraception”, and “fertility”.The following information for each patient was documented in a spreadsheet:Discharge medicationIs there any discussion or advice around contraception?Have women taking antipsychotic medication been given advice regarding the possible impact on fertility?Has the potential impact of psychotropic medication on a future pregnancy been discussed?Has advice been given about the availability of preconception counselling should they plan a pregnancy in future?ResultOn discharge, a total of 33 women were taking one or more antipsychotics and 14 were prescribed a benzodiazepine. 24 women were discharged with antidepressants and 10 women were using a mood stabilising agent. 8 women were discharged without any psychotropic medication.Overall, 4 women received advice about contraception, and a further 8 women were already using contraception. The impact of taking an antipsychotic on fertility was not discussed with any patient. No women were advised about pre-conception counselling. The impact of taking psychotropic medication on a future pregnancy was discussed with one woman.ConclusionCurrent practice falls well below the standard set by NICE. Opportunities to inform women are being missed, and this has implications for the wellbeing of the patient and, potentially, future children.Action plan;Present findings at teaching.Deliver local teaching covering preconception counselling and the role of adult mental health teams when managing women of childbearing age.Produce a poster for inpatients wards and an information leaflet for women of childbearing age to aid with discussions.Create a poster for doctors’ offices to remind about NICE standards and documentation.Re-audit in 6 months.

Diverse presentation of connective tissue disorders in pregnancy

Connective tissue disorders (CTD) include a variety of chronic multisystem disorders including autoimmune conditions. Many of these conditions affect women of childbearing age and therefore pregnancy poses an important challenge for the caregivers. The precise knowledge of therapeutic safety and the effect of disease on pregnancy and vice versa are important to achieve best outcome. Hence, it is imperative to have a vast knowledge of disease with proper preconception counselling. We report series of cases of connective tissue disorders in pregnancy: tuberous sclerosis (TS), systemic lupus erythmatosis (SLE) and neurofibromatosis (NF) type 1. The first case with tuberous sclerosis was associated with obstetric complications. In both cases of SLE, we observed preterm delivery and IUGR. However, the course of SLE remained the same in both the cases. The case with NF 1 taught us that a normal obstetric outcome could be expected in pregnant women.

The Influence of Treatment of Inflammatory Arthritis During Pregnancy on the Long-Term Children’s Outcome

The management of reproductive issues in women with inflammatory arthritis has greatly changed over decades. In the 1980–1990s, women with refractory forms of arthritis were either not able to get pregnant or did choose not to get pregnant because of their disabling disease. Hence, the traditional belief that pregnancy can induce a remission of arthritis. The availability of biologic agents has allowed a good control of aggressive forms of arthritis. The main topic of discussion during preconception counselling is the use of drugs during pregnancy and breastfeeding. Physicians are now supported by international recommendations released by the European League Against Rheumatism and the American College of Rheumatology, but still they must face with cultural reluctance in accepting that a pregnant woman can take medications. Patient-physician communication should be centered on the message that active maternal disease during pregnancy is detrimental to fetal health. Keeping maternal disease under control with drugs which are not harmful to the fetus is the best way to ensure the best possible outcome for both the mother and the baby. However, there might be concerns about the influence of the in utero exposure to medications on the newborn’s health conditions. Particularly, studies suggesting an increased risk of autism-spectrum-disorders in children born to women with rheumatoid arthritis has raised questions about neuropsychological impairment in the offspring of women with chronic arthritis. As a multidisciplinary group of rheumatologists and child neuropsychiatrists, we conducted a study on 16 women with chronic forms of arthritis whose diagnosis was determined before pregnancy and their 18 school-age children. The children underwent a complete neurological examination and validated tests/questionnaires. Behavioral aspects of somatization and anxiety/depression (internalizing problem) or an “adult profile” were found in nearly one third of children. Children at a high risk of neurodevelopmental problems were born to mothers with a longer history of arthritis and were breastfeed for less than 6 months of age or were not breastfeed at all. No association was found with other maternal characteristics such as autoantibody existence and disease activity during and after the pregnancy.