Motherhood poses the biggest challenge to any woman. Different women take the challenge differently. Pregnancy is a phase in a woman’s life that many look forward to and experience the joy of giving birth to a life, whilst some have reservations over getting pregnant. These are individual choices that women make and therefore needs to be respected.
The birth of a healthy baby is a result of good care that a pregnant woman receives right through her pregnancy – from her family, her doctor and also because she takes good care of herself with a healthy, nutritious diet, adequate rest and exercise, positive thoughts etc., Whilst most pregnancies result in healthy babies, some pregnancies develop complications, resulting in adverse outcomes for both the mother and the baby.
“One such complication in pregnancy that is now increasingly noticed is Preeclampsia or Gestosis,” says Dr Girija Wagh (M.D, FICOG, DIP ENDO, FICS). She had handled many such cases in her professional duty. She is a highly qualified obstetrician and gynaecologist. With experience of 29 years in this field, she is a certified fertility and IVF specialist based in Pune, Maharashtra.
Medical textbooks describe preeclampsia as a hypertensive disorder in pregnancy. Sudden and high blood pressure during pregnancy, especially from the fifth month onwards, and elevated levels of biochemistry tests suggestive of liver/kidney damage or circulatory problems from low haemoglobin and platelets are typically how Preeclampsia presents itself.
An Expert Par Excellence
Dr Wagh’s expertise comprises high-risk obstetrics. Her extensive practice focuses on all gynaecological procedures including, but not limited to, fertilisation, impregnation and childbirth complications, advanced evidence-based pre/post-natal care and support through the gestation period. The practice also constitutes high-risk pregnancy procedures that include preventive care in gestational diabetes, hypertensive disorders in pregnancy, pre-term birth, and recurrent pregnancy loss.
She further specialises and provides services in tubectomy/tubal ligation, no-cut-no-hole gynae-surgery (along with high-end sophisticated ART procedures), cervical cerclage, IVF infertility treatment, Intracytoplasmic Sperm Injection (ISCI), intrauterine insemination, hysterectomy, fibroid removal, laparoscopic hysterectomy, laparoscopic myomectomy, endometriosis surgeries, and hysteroscopic surgeries.
Her track record vouches for her impeccable surgical acumen, sound diagnosis, extremely competent guidance for patients, and her composed and organised approach towards emergencies and high-risk circumstances.
According to Dr Wagh, hypertensive disorders in pregnancy is estimated to be nearly 20-25% of all pregnancies in India, which is relatively high, given the high incidence of lifestyle diseases such as obesity, diabetes, late pregnancies etc. Whilst normal blood pressure is 120/80mm Hg, preeclampsia results in blood pressure shooting up suddenly and unexpectedly to 140/90mmHg or more. Bleeding, epileptic fits, neurological complications are other serious complications that can arise if not diagnosed and managed correctly.
A few symptoms include puffiness of the face, swelling of feet, episodes of abdominal pain, sudden and additional weight gain of 3-6 kg instead of 1-1.5 kg, within 2-4 weeks unexpectedly etc., Preeclampsia results in the delivery of many babies earlier than the term of 38-40 weeks (preterm birth) as delaying the delivery can result in survival issues for the baby and in some cases the mother as well.
The Puzzle of Preeclampsia
Dr Wagh is one of the most professional and knowledgeable gynaecologists in India. She is presently practising as a Consultant Gynaecologist and Laparoscopic Surgeon at her practice in Primrose Wellness & Care, Kothrud, Pune. She also provides Gynecology and Obstetrics consultation and IVF, pregnancy and childbirth treatment at Apollo Hospital (Saras Baug, Pune), Cloudnine (SB Road, Pune) and Bharati Hospitals, Katraj, Pune.
She further divulges that the causative factors of preeclampsia are not well understood yet. It is believed to be of metabolic origin, causing the placenta to become dysfunctional. A dysfunctional placenta causes a host of downstream events, such as elevation in blood pressure, organ damage, etc. Most obstetricians can detect preeclampsia after the disorder has expressed itself.
Treating Preeclampsia
Diagnoses and detection are through clinical assessment lab and ultrasound reports. If preeclampsia presents itself closer to the term of the pregnancy, emergency intervention and delivery of the baby are the usual ways of managing the disorder. The challenge is, in case the disorder manifests itself before 34 weeks of gestation. Early-onset preeclampsia, as it is called in medical parlance, may require admission of the baby in neonatal ICU and often the mother too after delivery and where indicated. Every extra day/week that is gained to deliver the baby closer to 34 weeks of gestation is that much more beneficial for the baby as it helps improve survival rates.
Diagnoses and detection of Preeclampsia are through a combination of clinical assessment, ultrasound reports and lab tests. Individually each of these methods has low sensitivity and poor predictability hence the need to do them together to improve detection. Researchers have been aiming to unravel the origin of preeclampsia and determine suitable biomarkers that can confirm the presence of the disorder at an early stage and predict its onset.
Advanced research using mass spectrometry, protein sequencing, etc., has helped identify several proteins that were activated/overexpressed in preeclampsia. One of the biochemical protein markers that were investigated quite early and as far back as 1984 is Fibronectin. Fibronectin plays several critical roles in the human body.
Eliminating the Risks
In pregnancy, fibronectin is thought to play an important role in embryogenesis (development of the foetus). A set of researchers have shown that the protein, Fibronectin gets elevated in preeclampsia by measuring the protein in different stages of the pregnancy and in pregnancies that developed preeclampsia.
It is now easy to assess the risk of preeclampsia in pregnancies by measuring the concentration of this protein. A device similar to a blood sugar meter is now available in India that enables Fibronectin to be measured in ten minutes from a finger stick sample of the pregnant woman. The test can be done in the obstetrician’s clinic and is found to be helpful in the assessment of risk. A trained nurse or technician can run the test as it is simple and easy to use. This saves valuable time for the doctor and the pregnant woman and is helpful where there is a rapid progression of the disease, and an intervention decision needs to be made.
Paving a Path of Equality
The test of Fibronectin in the blood also gives results that help the clinician categorise the patient as mild, moderate, and severe. This test can be placed in the pregnancy surveillance at 12 weeks gestation as a screening tool, especially in women identified as at risk of developing gestosis. The test can also be performed when the woman presents with raised Blood pressure and thus help in identifying the mothers needing closer surveillance and monitoring and those who can be managed on an outpatient basis.
Being a passionate doctor, Dr Wagh believes in contributing to the bigger picture and paving a path towards a more equitable and cohesive community by empowering women through their knowledge of health, nourishment, and nurturing.
