Vol.6, Issue-1, 2019
theBirthplace The Perfect Partner Before, During, and After Pregnancy!
Perinatal Depression – A Less Addressed Maternity Condition Aishwarya Nawandhar Editor
T
he joy of having a baby, the bare happiness when you hold it for the first time in your arms, the feeling of having that tiny wrist wrapped around the finger is probably the best experience in the world. However, carrying, delivering, and nurturing a baby can sometimes be stressful. What’s worrying is that sometimes, this goes beyond normal stress. An intense depressed feeling during and after pregnancy is a serious mental condition known as Perinatal Depression. The long-lasting stress, severe anxiety, and many other such symptoms indicate that the parent needs professional attention and people, many a times, fail to recognize this. Caused by physical changes as well as emotional complications, perinatal depression should be treated in time and with care. While mood swings, crying, irritation, anxiety, appetite gain or loss, insomnia, sadness, overwhelming feeling, loss of concentration mark the issues of baby blues; the long-term, intense signs that can interfere with not just the day-to-day activities of a person, but in the care of the baby as well are related to perinatal depression. Perinatal depression is not only experienced by the mother, but also by the father, sometimes. The symptoms in the new dads are similar to that observed in mothers. It is essential for a person to opt for professional care if he/she notices the signs such as depression, excessive crying, disturbance in sleep patterns, appetite problems, fatigue, feeling hopeless, shameful, guilty, and worthless, social withdrawal, difficulty in bonding with the child, severe anxiety, panic attacks, suicidal thoughts, obsession over the baby, agitation, agitation, hallucination, and the thoughts of harming own self or the baby. It usually occurs during the pregnancy, after the delivery, or even a year after the child birth. Therefore, it is important to take any symptoms noticed throughout the pregnancy period as well as after the delivery seriously. People with a family history or past experiences about depression are more prone to develop this condition. People usually mistake perinatal depression for baby blues and nothing can be more harmful for the existing conditions than that. It will only prolong the problem and even worsen it. Awareness and education about the mental health of the parent can be extremely helpful and maternity hospitals can make it a practice to inform the pregnant couples about the same during their regular check-up sessions. People are unaware of this issue and are sometimes even embarrassed to share the problems with their loved ones or seek professional help. Mistaking perinatal depression for baby blues is common and can prove to be harmful for the parent as well as the child. We, as friends and family, should be supportive and address the problem if we see any change in the behavior of the new parents. Depression screening during and after the pregnancy, for both the parents, is always a better idea. It aids in timely analysis and addressing of perinatal depression.
Cover Story 10
theBirthplace The Perfect Partner Before, During, and After Pregnancy!
Articles 18
Quick Read
20
Five Minute Health Tips for Expecting Moms
30
Medical Emphasis Preterm Babies and the Risks Involved
Technovation A Hope to Conquer Infertility Naturally with a 5P Coin-sized Device
CXO Standpoints
26
38
Doctor’s Insight
Expert Column
High Risk Pregnancy Clinic
34
Sahyadri’s Gynaecology Department- A One Stop Solution for Women!
Intellectual Opinion New Ground Breaking IVF Technologies & other Art Techniques/in vitro Fertilization(IVF) 3 decades of clinical innovation and technological advancement
24
42 Dr L H Hiranandani Hospital Sculpting the Future of Care with Love and Excellence
Rainbow Hospitals
Refining Maternity and Child Care with Commitment and Compassion
In and Around Women’s Healthcare
G
ynecological care is an important health area for a woman throughout her life span. With appropriate professional expertise in gynecology and oncology, doctors can provide comprehensive care and help women overcome various diseases and complications. Alongside runs parental care. Pregnancy and childbirth are two very significant phases in any couple’s life. From preconception to pregnancy to post delivery, adequate care needs be provided to a mother and her baby. Focusing on this necessary sector in healthcare, in our special issue “The Most Trusted Gynecology and Maternity Hospitals”, we have highlighted the stories of the top-notch hospitals that are providing quality healthcare services with incredible medical expertise, world-class facilities, and latest equipment. Not only do they render the best gynecological and parental care, but also provide compassionate and comfortable environment and support to their patients. Featured on the cover is a leading, Bangalore-based hospital, the Birthplace. It is a single-specialty hospital focused on obstetrics, neonatology, and gynecology.
Apart from the gripping cover story, the edition also brings to you the stories of several other top leaders in the industry. This list includes Dr L H Hiranandani Hospital, an ISO 2001:2015 certified, NABH accredited 244bedded super-specialty hospital located in the Hiranandani Gardens in Powai, Mumbai, and Rainbow Children’s Hospitals offering high standard pediatric super specialty and maternal care services. We have also encompassed interesting articles from the industry experts viz; Anita Soni, Consultant Obstetrician and Gynecologist at Dr L H Hiranandani Hospital; Chandra Sekhar C, CEO at Apollo Health and Lifestyle Ltd.; and Dr. Supriya Puranik, Infertility IVF Specialist, Gynae Endoscopist, and High Risk Obstetrician at Sahyadri Speciality Hospital. Along with this, there are some intriguing articles by our inhouse editors, crafted specially for you! So, flip through the pages and enjoy a good read!
Editor-in-Chief Pooja M. Bansal Managing Editor Ashwini Deshpande Executive Editor Aishwarya Nawandhar Art & Design Head Amol Kamble Associate Designer Poonam Mahajan Art & Picture Editor Rahul Kavnekar Co- Designer Savita Pandav Business Development Manager Nandan Deshpande Business Development Executives Ruchi Patil Technical Head Pratiksha Patil Technical Specialist Amar, Aditya Digital Marketing Manager Prashant Chevale SME-SMO Executives Manoj Shelge Circulation Manager Tanaji sales@insightscare.com
June, 2019 Corporate Ofces: Insights Success Media and Technology Pvt. Ltd. Ofce No. 22 & 510, Rainbow Plaza, Shivar Chowk, Pimple Saudagar, Pune, Maharashtra 411017 Phone - India: +91 7410079881/ 82/ 83/ 84/ 85 Email: info@insightscare.com For Subscription: www.insightscare.com
Follow us on :
Insights Success Media Tech LLC 555 Metro Place North, Suite 100, Dublin, OH 43017, United States Phone - (614)-602-1754 Email: info@insightscare.com For Subscription: www.insightscare.com
www.facebook.com/InsightsCare/
https://twitter.com/Insightscare
We are also available on : Copyright © 2019 Insights Success Media and Technology Pvt. Ltd., All rights reserved. The content and images used in this magazine should not be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from Insights success. Reprint rights remain solely with Insights Success Media and Technology Pvt. Ltd. Insights Care is powered by Insights Success Media and Technology Pvt. Ltd.
Insights Success Media and Technology Pvt.Ltd. Off. No. 22 & 510, Rainbow Plaza, Shivar Chowk, Pimple Saudagar, Pune, Maharashtra 411017 Phone - India: +91 7410079881/ 82/ 83/ 84/ 85 Email: info@insightscare.com For Subscription: www.insightscare.com
Cover Story
theBirthplace The Perfect Partner Before, During, and After Pregnancy!
T
he market for obstetrics in India is primarily served by small nursing homes and large multi-specialty hospitals. Given the significance of the birth of a child in one’s family, there is a tremendous opportunity in creating an experience that is memorable, joyful, and hasslefree with the comfort of world class clinical care for the delivery. On one hand, the nursing homes provide a very transactional experience with a limited scope of services for the mother and the child and on the other hand, large multi-specialty hospitals provide a daunting experience for the family in a setting that is geared towards serving people with complicated ailments. The Birthplace, a leading gynecology and maternity single-specialty hospital, not only ensures safe but luxurious and
memorable delivery experience for a mother. With its motto being “Expect More”, the hospital caters to all the needs of its patients and offers even more! At the Birthplace, one delivers with all the conveniences and facilities that a woman and her family desire during pregnancy - from on time appointments with their doctors to 5 star amenities in their rooms. The Birthplace offers complete care and support from the pre-conception period to pregnancy and delivery period, extending up to after the child is born. With a team of highly qualified and expert doctors, backed with latest equipment and best-in-class infrastructural facilities, it provides world-class gynecology, maternity, and pediatric services. It has created a phenomenal experience out of the child
birth event for the mother and the family, backed by an uncompromising quality in the clinical and non-clinical infrastructure, people, and processes. About the Birthplace The Birthplace began its operations around six years ago with a focus on obstetrics, neonatology, and gynecology. The main facility of the hospital is 25 bedded, all in a private and suite setting, and the outreach clinic caters to everything that a woman needs up until the time of delivery. The Birthplace provides a full range of gynecological care to meet the needs of women of all ages. With the help of advanced imaging, diagnostics, and surgery services, thousands of women turn to the Birthplace each year, for expert care in a compassionate setting.
THE MOST TRUSTED
GYNECOLOGY & MATERNITY HOSPITALS
In the journey so far, the Birthplace has been recognized nationally for its brand identity by being honored with the Designomics grand prix award for strategic brand identity and the Kyoorius award for brand identity. It has been shortlisted within the top 3 in the country, as a trendsetter in customer service excellence in the New India Assurance Healthcare Achievers Awards in 2014 by a well-renowned media house. The hospital has also been ranked as the #1 Hospital for Gynecology in Hyderabad through a study conducted by prominent media house in March 2015 and Jan 2016 and #2 in South India and #10 in India in Jan 2016. In 2017, it was ranked as #1 in Hyderabad, #1 in South India, and #2 in India for its focused specialty of Obstetrics and Gynecology.
the hospital’s differentiator and competitive advantage is a result of its focus on the “guest” experience. The clients are treated as guests and not patients in its facility. From the training of its people to the design of the processes, the Birthplace has an intense focus on how to ensure that a guest at its facility will have an unmatched experience in delivering a baby.
Differentiated Appeal
The Birthplace owns its technology and this gives it a distinctive competitive advantage. Its technology
The Birthplace strongly believes that
No wait time for appointments, transparent delivery packages, flexible visiting hours, dedicated pregnancy manager, foot massages for the mom – these are just a few things that the Birthplace does to create a fantastic experience for the mother! Innovative Thinking
stack proves itself in enabling superior financial results for the Birthplace. Every system deployed at the hospital is focused on improving customer experience. Its out-patient services begin even before the patient walks in; they begin the moment a patient engages with its marketing effort. The customer is assigned a Single Point of Contact even before she walks into the facility. Although its marketing efforts are ruthlessly driven by numbers, the Birthplace’s customer engagement is extremely high touch. Impacting Lives The Birthplace has successfully handled several high risk pregnancies. Through its quality healthcare services, the hospital has saved several lives and made many others better. Talking of high risk pregnancy, one of the case was supervised by a senior gynecologist, where there was a
growth discordancy of 48% between twin fetuses. Under the team’s diligent care and observation, the babies quickly gained health and are doing well now. Another challenging case successfully handled by the hospital was when the gynecologist treated a first-time pregnant woman with fibroid complications in the uterus. This complex surgery involved first removing the large fibroid from the uterus without harming the baby and then bringing the baby out with a C-section. The doctor helped the mother successfully deliver a healthy baby, without significant discomfort or loss of blood. Throughout the course of the treatment, the gynecologists work along with a multidisciplinary team of
urologists, surgeons, radiologists, and other experts to ensure the most appropriate care. To address fertility concerns, it works with experts in fertility treatments, at the Birthplace and other centers of excellence.
dedicated. In fact, some remarkably tiny surviving babies, with birthweights as low as 700 grams, have been born at the Birthplace. They’re healthy toddlers today, partly because of the care they got at the Birthplace.
The Birthplace’s state-of-the-art NICU means that even parents of new-born babies, who need critical care, can be assured about delivering in not just a comfortable place but also a safe place tailored to the needs of the mother and baby, regardless of the criticality of care required for either of them. Caring for tiny, fragile babies is a big part of what the hospital does, at the Level III NICU. Here, premature babies and babies with complex medical needs get the expert care they need to survive and thrive. Additionally, they’re surrounded and supported by a team that is passionate, highly skilled, and
Whether it is about treating a woman who had an ovarian tumor weighing close to 5kg, to helping someone with a renal failure to conceive, to many successful Vaginal Births after C-section (VBAC), or delivering babies for mothers who have had a history of multiple miscarriages, the Birthplace is proud to be a place that brings together leading maternity and new-born care experts under one roof to ensure safe outcomes.
Five Minute Health Tips for Expecting Moms
18 | June 2019 |
Quick Read
-Aishwarya Nawandhar, Editor | June 2019 |
19
A HopeA HOPE to TO CONQUER Conquer Infer lity Naturally INFERTILITY NATURALLY WITH A 5P COIN-SIZED DEVICE with a 5P Coin-sized Device
5P COIN
20 | June 2019 |
Technovation
A few Bri sh scien sts have brought hope to numerous infer le couples yearning to have children by developing a ny device. This device can eliminate the need to turn to the arduous IVF treatment. The geniuses at the University of Southampton can now help diagnose the causes of unexplained infer lity with their device that is as small as a 5p coin. This sensor was devised by Professor Cheong along with a bioelectronics engineer Professor Hywel Morgan. They have established Vivoplex Medical, a Southampton University spin-out company, where they started developing this device. For the clinical trial of the gadget, the start of which is due in the next few months, the research branch of NHS- Na onal Ins tute for Health Research has provided them with of £850,000 grant.
The tool helps in monitoring the vital elements that have a major impact on fer lity- temperature, oxygen levels, and pH in a mother’s womb. It is to be implanted in the uterus by a doctor or a nurse, just like a contracep ve coil is inserted. The process of implanta on may not take more than a few minutes. The inserted device then monitors the womb’s condi ons for about seven days. The sensor is connected to an electronic device, say a smartphone or a computer. The data that it gathers is wirelessly transmi ed to a small transmi er that is worn on a piece of clothing. This transmi er, in turn, transfers the data to the electronic device.
Myriads of couples around the globe are facing the problem of infer lity. Un l now, fer lity doctors have had no reliable way of inves ga ng the natural condi ons of the womb- its temperature, oxygen, and pH factors. With this device, something as small and simple as aspirin can change the condi ons of the uterus. “Not only could it give doctors the ability to diagnose fer lity issues sooner – and poten ally reduce the burden that fer lity treatment brings to our pa ents – but it also has promising poten al to inform the development of new fer lity therapies and treatments,” says Professor Cheong.
-Aishwarya Nawandhar, Editor | June 2019 |
21
Dr L H Hiranandani Hospital Sculpting the Future of Care with Love and Excellence
D
r L H Hiranandani Hospital, founded in honor of the legend, Dr L H Hiranandani, was commissioned on 22nd February 2004. The hospital is a 244-bedded super-specialty hospital located at the picturesque Hiranandani Gardens in Powai, Mumbai. It addresses 50 + specialties and super specialties. Dr L H Hiranandani Hospital has always focused on quality and processes and hence, has been awarded and accredited by various prestigious organizations. It is an ISO 9001:2015 certified hospital. Its journey in quality started from inception and got the ISO certification in 2006. In 2007, it was the first hospitals in Western India to receive the prestigious NABH accreditation. It received the IMC Ramakrishna Bajaj National Quality Award for excellence in healthcare in 2008 and the coveted International
24 | June 2019 |
Working with love and social cause at our heart, we strive to provide the best possible care and facilities to all our patients
Asia Pacific Quality Award, famously known as the Malcolm Baldridge Award in the U.S., in 2009. Hiranandani is also the proud winner of International Asia Pacific Quality Award, in both 2009 & 2016, and is the only hospital from India to win this prestigious award.
The Greatest Source of Inspiration Dr L H Hiranandani was the inspiration behind the edifice of the hospital. Academically very well qualified and seasoned with years of experience in the healthcare sector as an ENT surgeon, he initiated several operative techniques which are known as “Dr Hiranandani’s Operations” globally. Dr. Hiranandani’s work earned him many prestigious accolades, like ENT Surgeon of the Millennium Award, SAARC Award, and many more. Social causes deeply motivated him. His humane nature made him stand up for the rights of people and fight against capital punishment and euthanasia. In 1972, the Government of India awarded him the Padma Bhushan, the third highest civilian national award, for his contribution to the nation. In 1987, he was conferred the
THE MOST TRUSTED
GYNECOLOGY & MATERNITY HOSPITALS
audiology and speech therapy center with facility for cochlear implant; advanced cancer care and oncology services; advanced gastroenterology and liver treatment; women’s care from womb to tomb with a special focus on high risk pregnancy and reproductive research; physical rehabilitation and sports medicine; advanced eye care and microsurgery under ophthalmology center; and executive health check-up. All departments are supported by the expert national and international medical specialists and staff and all the comprehensive services are provided under proper supervision. Additionally, the hospital has new patient rooms designed for maximum comfort and privacy, with an access to a host of new amenities. In addition to the worldclass accommodation and a warm ambience, the rooms feature a superior nurse call system, outfitted with the best that modern technology has to offer. The prime focus of Hiranandani hospital is on patient safety.
Dr. Sujit Chatterjee CEO Dhanvantari Award, awarded for the first time in the field of ENT, for his notable contribution to medical science. The Cornerstone of Love and Success Even before the inception of Dr L H Hiranandani Hospital, everyone associated with it could see that it was a more sublime affair than mere brick and mortar. Being a tribute to an iconic father by his almost equally accomplished sons, it transcended the question of honor; it became an act of love. At the heart of the Hiranandani mission is the passionate commitment to stay at par with global standards. The hospital performs the simplest to the most complex surgical procedures and is equipped with the medical equipment purchased from the foremost vendors in the world. Today, this multi-specialty tertiary and quaternary care hospital is a frontline provider of comprehensive healthcare. It has seen tremendous growth since its inception; not only in terms of added beds but also newer service modalities. The hospital is modernized and is in the same league with the best hospitals in the world. Top-notch Services Dr L H Hiranandani Hospital offers special services in multiple departments that are at par with the global standards of care. These services encompass cardiovascular and thoracic surgery; orthopedics, joint replacement, and spine surgery; advanced ENT care with a state-of-the-art
Breakthrough Obstetrics and Gynecology Department The department of Obstetrics and Gynecology at Dr L H Hiranandani Hospital is very vibrant with latest equipment and cutting edge technology, backed by a highly qualified team of experts. It also has latest suites for child birth and other high-class infrastructural facilities. The hospital has ensured that every need of the mother and child can be met with a warm ambience and the tender loving care. Dr L H Hiranandani hospital offers various services in this department, including pre-pregnancy counseling, antenatal clinic, high-risk pregnancy clinic, post-natal care and contraception clinic, antenatal exercise clinic, and genetic clinic. The Managing Team Dr. Sujit Chatterjee, M.D., is the CEO of Dr L H Hiranandani Hospital since its inception. He has successfully led the Hiranandani Group to arguably the first Public-Private partnership in healthcare with Navi Mumbai Municipal Corporation. Dr. Chatterjee’s area of specialization is obstetrics and gynecology and gynec-oncology. He has served as a doctor in the armed forces from 1976 to 1999 and was a professor of obstetrics and gynecology at Mumbai University. For his extraordinary contribution, he has been awarded the Chief of Naval Staff Commendation Medal for outstanding service rendered. Dr. Chatterjee has papers published under his name in various scientific journals and has won awards for the best scientific presentation. When asked about the future plans for the Dr L H Hiranandani Hospital, Dr. Chatterjee asserts, “We plan to create three established centers of excellence into the leading centers in the city and the country by year 2021.”
| June 2019 |
25
Dr. Anita Soni Consultant Obstetrician & Gynecologist Dr. L H Hiranandani Hospital
26 | June 2019 |
Doctor’s Insight
ABOUT THE AUTHOR Dr. Anita Soni is a practicing doctor at the well-renowned Dr. L H Hiranandani Hospital, Mumbai, practicing as a full time Consultant Obstetrician and Gynecologist. She has worked at the hospital since its inception in 2004. Dr. Soni is an expert in the field with the academic excellence as an MD, DNB, FCPS, DGO, and FICOG. She has special interest in the areas of High Risk Pregnancies, Gynecological Surgeries, Ultra Sonography, and Maternal Fetal Medicine. Today, there are a number of national and international publications to her credit.
High Risk
Pregnancy Clinic What is High Risk Pregnancy (HRP)? A high risk pregnancy is a condition during pregnancy that threatens the health and life of the mother and/or fetus. A high risk pregnancy needs special care, follow up and management. What are the aims of High Risk Pregnancy Clinic? • To provide education, surveillance and management of pregnancies at risk. • To provide Multidisciplinary Team (MDT) approach in managing the high risk pregnancies.
• To provide advanced facilities for managing and delivering the high risk pregnancies. Who falls in the category of High Risk Pregnancy? Pregnant women who seek consultation at our hospital are categorized under high risk. Pregnancy considering the below mentioned factors and are then enrolled in HRP clinic: • Past obstetric outcomes like recurrent pregnancy loss, bad obstetric history, previous preterm delivery, previous still birth, previous Down’s syndrome child
and neonatal death. • Events occurring during the present pregnancy like growth restriction, tendency for premature delivery, bleeding per vaginum (placenta previa, abruptio placentae, vasa previa), leaking of liquor per vaginum (preterm premature rupture of membranes), utero-placental insufficiency, oligohydramnios, polyhydramnios. • Medical diseases complicating pregnancy like high blood pressure ( Chronic hypertension, pre-eclampsia, gestational hypertension, chronic hypertension
| June 2019 |
27
• •
• • •
with superimposed pre-eclampsia), diabetes (Gestational diabetes mellitus, overt diabetes mellitus), hypothyroidism, hyperthyroidism, heart disease, liver disorders, kidney diseases, anaemia, obesity, thrombophilias, systemic lupus erythematosus, other collagen vascular diseases, rheumatoid arthritis etc. Infections during pregnancy like Toxoplasmosis, Rubella, CMV, Herpes, Chicken pox, Tuberculosis, HIV. Surgical disorders complicating pregnancy like fibroid uterus, previous history of myomectomy, previous classical caesarean section, ovarian cyst, renal and ureteric calculi, recent bariatric surgery etc. Extremes of age like elderly gravida and adolescent pregnancy. Multifetal gestations like Twins, Triplets or Quadruplets with or without associated complications. Special situations like pregnancy after renal transplant.
What are the Advantages of High Risk Pregnancy Clinic? • Multidisciplinary Team (MDT) approach is followed involving the Consultant Obstetrician, HRP Clinic Coordinator, Pediatricians, Neonatologist, Radiologist, Fetal Medicine Consultant and other specialists like Physician, Endocrinologist, Cardiologist, Hematologist, Nephrologist, Rheumatologist, Gastro-enterologist etc. according to the individual case scenario. • All specialists under one roof consulting as a team. • A multidisciplinary team involves a range of health professionals working together to deliver comprehensive patient care. • MDT approach has come out as a way of rendering comprehensive medical care by bringing together professionals from a broad range of disciplines in a coordinated and effective manner to upgrade maternal and neonatal outcomes. • State of the art Labour room and NICU facilities What are the Investigations and Services offered? • Genetic counselling • Pre-conceptional counselling • Prenatal screening and diagnosis with facilities which include biochemical marker screening like double marker, quadruple marker test; advanced ultrasound for the detection of fetal anomalies like NT scan and a detailed malformation scan, fetal 2D Echo whenever required; advanced procedures like chorionic villous sampling, selective fetal reduction, amniocentesis, fetal blood sampling, intrauterine transfusion in cases of Rh isoimmunisation, fetal therapy; other special
28 | June 2019 |
investigations like karyotype and microarray for products of conception etc. • Regular follow up with obstetrician in OPD. • Extensive ante-partum and intra-partum fetal surveillance. • State of the art LDRP suites with hydrotherapy, Labour Room and well equipped Operation Theatre. • Labour analgesia by the anaesthetists. • Blood bank facility in case of obstetric emergencies. • NICU with advanced neonatal care managed by neonatologist. How do we monitor a High Risk Pregnancy? • Monitoring includes more frequent visits to the doctor, routine blood tests, tests to monitor the medical problems, specific tests and procedures, several ultrasound examinations (routine and special) and fetal monitoring. • These tests and investigations are designed to track the condition of mother and fetus. How does High Risk Pregnancy differ from normal pregnancy? • Frequent antenatal visits • Close monitoring of maternal and fetal well being • Special investigations (other than the routine ) and management of risk factors • Multidisciplinary Team Approach How do we improve our maternal and fetal outcomes in High Risk Pregnancy Clinic? • Use of tools like Diet charts/ hand-outs for patients • Best practice protocols-evidence based • Improve outcomes by Standard Operating procedures, Pathway, Multidisciplinary Team approach, Training the students and staff adequately • Safety checklist • Complete documentation • Ensure continuity of care after discharge • Simulation programs • Continuing Medical Education (CMEs) • Clinical Audit is a process of quality improvement that seeks to enhance patient care and outcomes We have many success stories till date and wish to continue the good work and aim to optimize our maternal and fetal outcomes!
“I love these little people; and it is not a slight thing when they, who are so fresh from God, love us.� - Charles Dickens
30 | June 2019 |
Medical Emphasis
| June 2019 |
31
- Shambhavi Mhetre,Editor
32 | June 2019 |
New
& other
3 decades of clinical innovation and technological advancement
I
VF, which is an acronym for In-Vitro Fertilization was introduced to the world in 1978 and since then it has attracted and given hope to millions of couples aspiring to have a child. Assisted Reproductive Technology has emerged over the years with increased success rates. Laboratory technology and clinical practices have gone through many refinement cycles to emerge as a medical procedure that is efficient, safe, easily accessible and relatively affordable to a larger population than what it was way back in 1978. According to available records, more than 2 million children are born till date through IVF technology, which has the potential to widen its appeal and application with further enhancements for a larger section of society. Timeline of major milestones in assisted reproductive technologies. Abbreviations: Other types of assisted reproductive technology includes GIFT - Gamete Infra-Falloplan Transfer, HLA - Human Leukocyte Antigen, ICSI - Intra-Cytoplasmic Sperm Injection, IVF - In-Virto
34 | June 2019 |
Intellectual Opinion
About the Author
Chandra Sekhar C Chief Executive Ofcer Apollo Health and Lifestyle Ltd.
Chandra Sekhar C is the Chief Executive Ofcer of the Apollo Health and Lifestyle Ltd. He also has a strong academic background with an MBA from Osmania University, Hyderabad, India and Advanced Management Programs from the Indian School of Business and the Kellogg’s School of Management, Chicago, USA. Seasoned with the experience of over 25 years; he has played a signicant role in the Health Care and Health Insurance Industries in India. He has worked for over 18 years in the healthcare industry and has been a catalyst to the formation of a Standalone Health Insurance company in India. Other than this, he has successfully justied various management positions he was at in different spheres of healthcare. As the CEO of Apollo Health & Lifestyle (AHLL), the retail healthcare business of Apollo Hospitals Group, he leads eight business units - Apollo Clinics, Apollo Spectra, Apollo Cradle, Apollo Diagnostics, Apollo Sugar, Apollo White Dental, Apollo Dialysis and Apollo Fertility.
| June 2019 |
35
Fertilization and PGD - Preimplantation Genetic Diagnosis. Many women tend to postpone pregnancy to a later time due to various reasons. For some, it is not to have children until they achieve their career goals and for others, it is lack of knowledge and understanding about fertility and pregnancy coupled with stress and lifestyle issues. To many having a child before their mid-30s is low on priority and when they decide to have one, it’s rather too late causing problems in natural conception. That’s when they opt for advanced assisted reproductive techniques. Thanks to latest advancements, couples can now fulfill their dream of having a baby. Some of these technologies include: Fertility preservation (Vitrification): This is the latest technique that helps patients retain their fertility, or ability to procreate. Patients taking treatment for Beehcet’s disease, acute glomerulonephritis, systemic lupus erythematous, sarcomas, lymphomas, fertileukemia’s can also benefit from this. This latest advancement in reproductive medicine is indubitably a boon for men and women, as they can now hit “pause” on their biological clock, until they are ready to start a family. Preimplantation Genetic Screening (PGS): It is done to diagnose embryos to check for structural chromosomal abnormalities. The process can be termed as aneuploidy (missing or additional numbers of chromosomes) screening. Aneuploidy is a leading cause of miscarriage and implantation failure. Preimplantation Genetic Diagnosis (PGD): PGD can help diagnose single-gene disorders and chromosomal translocations. The main aim of this technique is to detect any possible chromosomal and/or genetic abnormalities. Thalassemia, Myotonic Dystrophy, Fragile X, and Cystic Fibrosis are some of the most common diseases tested. It has played a key role in putting an end to the transmission of a given condition to offspring and making sure that children are born healthy. ERA (Endometrial Receptivity Analysis): The expression of genes is evaluated by ERA (Endometrial Receptivity Analysis), which is a genetic test to ascertain whether the
36 | June 2019 |
endometrial lining is properly developed to accept an embryo. Some of the latest scientific technologies are used to analyse the expression levels of 236 genes in order to access the optimal time to place an embryo into the uterus resulting in successful implantation and pregnancy. Platelet-Rich Plasma (PRP): PRP (Platelet Rich Plasma) or PDGF (Platelet Derived Growth Factors) therapy can be applied to rejuvenation of Ovaries, Endometrium and Vagina. It is done under sedation with Anesthesia. This nonsurgical technique done under sedation with Anesthesia is used to inject the cells into the ovaries, Intrauterine or Vagina. INVOcell: Unlink the usual method of IVF where the embryo is grown in an incubator for a few days and then implanted in the uterus, this technology allows the sperm and the egg to be brought together in the form of a capsule that is inserted into the vagina for a few days of incubation period and then the embryos are implanted in the uterus. This method is considered more cost-effective compared to the regular IVF procedure. Addressing the needs of infertile men Conventional IVF was not much successful when semen parameters are below the reference values for morphology (teratozoospermia), motility (asthenozoospermia), and concentration (oligozoospermia). This leads to fewer embryos available for transfer, leading in lower fertilization rates. Intracytoplasmic sperm injection (ICSI), where a single spermatozoon is microinjected into the oocyte helps achieve fertilization rates of approximately 60%–70%. “Simple to advanced fertility treatment options are more numerous and varied than ever. A host of advanced assisted reproductive technologies, as well as other support services including fertility counseling, nutrition program provide couples with everything they need to be successful in building their family. At Apollo Fertility, we stay updated on the latest advancements with infertility treatments, and we’re able to offer the evidence based practice with the personalized and holistic approach for all our patients”
SAHYADRI’S GYNAECOLOGY DEPARTMENT A One Stop Solution for Women! ‘
M
edicine is not a book but mind, not a business but life.’ This is a popular saying by Farid F. Ibrahim and it truly describes the essence with which patients are cared for at the Department of Obstetrics and Gynaecology at Sahyadri Hospitals.
Started in 2004, Sahyadri Hospitals is today the largest chain of hospitals in Maharashtra. It is the brainchild of Dr. Charudutt Apte, a well renowned neurosurgeon and an ardent practitioner of ethical medical practices. It was his philosophy to make quality healthcare available, accessible, & accountable to all. Currently, Sahyadri group has 8 Hospitals with more than 900 beds and 200 ICU beds. It has more than 2000 clinicians along with 2600 supporting staff. With such reach, Sahyadri Hospitals has been successful in making a difference in the lives of more than 50 lakh people by providing quality care. In today’s times, lifestyle changes have brought with itself several diseases. Bad food habits and growing stress levels are affecting all. Women health
38 | June 2019 |
has become an area of serious concern and hence advancement in Obstetrics and Gynaecology has become very important. There is demand for more expertise and availability of advance medicine in this field to address complex health issues seen in women. Along with treatment, the need for counselling and tertiary healthcare facilities has also become the need of the hour. Understanding this, Sahyadri Hospital has been undertaking several initiatives to provide holistic healthcare facilities to women. Out of the various specialties offered at the hospital, the Department of Obstetrics and Gynaecology has made its unique mark offering state of the art diagnostic evaluation, clinical care and education for all women’s health needs. The hospital has consultants specializing in general obstetrics and gynaecology services as well as expertise in the area such as high-risk pregnancy, infertility, urogynaecology, gynaecologic cancer screening and treatment, pelvic pain, menopause etc. According to doctors from Sahyadri hospital, in recent years, late
pregnancies have become a norm in India and hence doctors have to be handled complex high-risk pregnancies like never before. Dr. Suprita Purnik, Head of IVF & Gynaecology department at Sahyadri Super Specialty Hospital said, “As we all know there is a problem of obesity in women and with advance age the egg quality deteriorates. There are chances of having fibroid in the uterus and the ovarian reserve goes down with age. Understanding all these complexities that can be involved with late pregnancies, women need to be given the right guidance and support. Thus, counselling has become an integral part of our treatment and encouraging women to exercise, meditate, practice yoga and eat right has become important.” Dr. Puranik said that Sahyadri hospital has been able to tackle various complex cases due to the huge technological support that it has along with the doctor expertise that the hospital boasts of. Speaking of a case, Dr. Puranik said, “We had a case in which a 34-year-old woman and her husband were trying to conceive for 5 years with donor eggs and surrogates and several rounds of
Expert Column
Dr. Supriya Puranik Infertility IVF Specialist, Gynae Endoscopist, & High Risk Obstetrician
About the Author Dr. Supriya Puranik, MBBS, DGO, DNB, is a renowned Infertility IVF Specialist, Gynae Endoscopist, and High Risk Obstetrician at Sahyadri Speciality Hospital, Pune. She is a passionate, hardworking, ambitious, and devoted doctor available for all those seeking the best treatment in fertility and high risk pregnancy. With around two decades of rich experience, she has developed the expertise in world-class IVF, operative hysteroscopy-laparoscopy, laparoscopic hysteroscopy, and highrisk obstetrics. Dr. Puranik has various achievements and successful cases under her name.
| June 2019 |
39
I
VF at many clinics but failed. They later approached us at Sahyadri Super Speciality Hospital Nagar Road and with IVF treatment, the patient was able to conceive with her own eggs.”
Dr. Puranik said that the success of IVF at Sahyadri hospital is mainly because multiple advanced methods of fertilisation are tried after understanding the case of the patient in a single fee. This has proven to be successful in helping couples conceive and having a healthy baby after a healthy delivery. The hospital today boasts of an experience of over 4000 cases which has been cost effective with handled with advanced technological help. Dr. Puranik also spoke of Late Prathamesh Patil’s case, in which Prathamesh was diagnosed with brain tumour. “Prathamesh Patil was in Germany at that time and preserved his semen before he began his treatment. Later he came back to India but unfortunately succumbed to the disease. Prathamesh’s mother, Mrs. Rajshree Patil later visited Sahyadri hospital with the preserved semen, of her son and was blessed with her two grandchildren with the help IVF. We still remember the joy that the grandchildren brought to his mother which became possible only due to IVF.” Taking this a step further, Sahyadri Hospital has launched a novel intervention model for a home-based pregnancy programme-Relax Mommy, wherein services for monitoring pregnancy will be provided well within the comfort of your home. Speaking about the initiative, Dr Puranik said, “Relax Mommy is a unique concept, which attempts to reduce the burden of regularly visiting the hospital; and also empowers the ‘would be mother’ to access necessary health services @ Home. This service will complement clinic visit and provide effective pregnancy care beyond clinic.” With all such systems in place, gynaecology department in Sahyadri hospitals is catering to every complication that may arise in women especially during pregnancy and ensures holistic care for all class of women.
40 | June 2019 |
Rainbow Hospitals Refining Maternity and Child Care with Commitment and Compassion
R
ainbow Children’s Hospitals is India’s leading group of children’s hospitals with almost two decades of experience in offering high standard Perinatal Care and Pediatric Super Specialty services. It is the first corporate children’s hospital in India. Today, it has the occupancy of 1200 beds, with 30% of beds dedicated to Neonatal and Pediatric Intensive Care services, with 12 units over Hyderabad, Bengaluru, Vijayawada, Delhi, and Chennai. Setting the benchmark in Neonatal and Pediatric Intensive Care, Rainbow has played a major role in saving thousands of
42 | June 2019 |
critically ill children and has emerged as one of the best children’s hospital group in the country.
We aim to provide high standards of care for the mother, fetus, newborn, and children, so that none of them is deprived of a tertiary care facility
The Group has a separate maternity wing, Birthright By Rainbow, under the same roof, which lays the foundation of a comprehensive model of complete care for a mother and her child, from conception to childhood. Backed up by state-ofthe-art infrastructure, it is driven by a highly motivated team of highly qualified and experienced consultants, dynamic team of residents and fellows, well trained nurses, and paramedical staff.
THE MOST TRUSTED
GYNECOLOGY & MATERNITY HOSPITALS
The Prodigious Leader Dr. Ramesh Kancharla, the Founder and Managing Director of the Rainbow Group of Hospitals pursued medicine to fulfill the dream his father had seen for him. Having completed his MBBS and MD (Pediatrics) from India, he went to UK for his further studies (MRCP-UK). There he worked in institutions like Great Ormond Street Hospital for Children & King’s College for Specialty Services, for several years. Following his return to India, he was hard-pressed to find a place to practice his clinical skills due to lack of meaningful dedicated pediatric hospitals in the country. Therefore, he, along with some of his expert friends, started the success giant known as Rainbow Children’s Hospitals. Comprehensive Pediatric and Maternity Services
Dr. Ramesh Kancharla Founder and Managing Director
Journey to the Top Incepted on 14th November 1999, on the occasion of Children’s Day, Rainbow set course towards success. Its cornerstone was established in Hyderabad by Dr. Ramesh Kancharla and a group of highly brilliant doctors. Rainbow was started as a pilot project to demonstrate the need of comprehensive maternal and child care under one roof. Currently, it is India’s first children’s hospital with NABH accreditation with clinical outcomes very close to the developed countries. Rainbow Group has always focused on patient safety, integrity, excellence, innovation, and team work and has created benchmarks in children’s healthcare and perinatal services. Although obstetrics care started at Rainbow from 2006, this special unit came to be known as Birthright By Rainbow in 2014. Today, the maternal care infrastructure of birthright is perhaps the best in the country with maternal ICU, fetal medicine, obstetrics, and neonatology under one roof. It strongly believes in the comprehensive maternal and child healthcare model, which is safer and addresses the patients’ special needs.
Having set high standards in pediatric and neonatal tertiary care, Rainbow Group has also made its mark in maternal care services under the brand birthright, addressing the profound effect of perinatal factors on child birth and future health. The services it provides includes: • 24X7 Consultant Availability • Advanced NICU, PICU and MICUs - Round the clock Emergency services with full monitoring and resuscitation capabilities • Dedicated children’s transport services, geared to carry long distance retrievals. • All pediatric super specialties under one roof – General Pediatrics, Neonatology, Pediatric Intensive Care, Pediatric Neurology, Pediatric Nephrology, Pediatric Gastroenterology, Pediatric Endocrinology, Pediatric Pulmonology and Allergy, Pediatric Surgery, Pediatric Urology, Pediatric Orthopedics, Pediatric ENT, Pediatric Metabolic Medicine, Child Psychology, Pediatric Physiotherapy and Rehabilitation and Pediatric Emergency. • Comprehensive Maternal Care Set-up – Obstetrics and Gynecology, Fetal Medicine, General Medicine, Fertility – IVF, IUI, and more. • Holistic Care Program – It believes that the first 1000 days, from conception to toddlerhood, are not only
| June 2019 |
43
the most joyous but also the most significant time of a child’s as well as mother’s life. It offers a 1000 Day program to spread awareness and assist the mothersto-be and new mothers in every possible way to bring up a healthy and happy child. • Recently, Rainbow Group has also established a dedicated pediatric cardiac care center–Rainbow Children’s Heart Institute—that offers comprehensive cardiac care services, including fetal cardiology. Why Rainbow Hospitals? Rainbow has strived to achieve excellence in the services it provides to children requiring super specialty care in a child-friendly environment with high medical standards, compassion, and care. Team Birthright specializes in providing tertiary level care to women with normal or high-risk pregnancy. The hospital also has fetal-medicine department to ensure that most problems in a newborn, which can be recognized during pregnancy, are addressed and the care can start when the child is in the womb. The integrated team, consisting of obstetricians, fetal medicine specialists, and geneticists, work closely in conjunction with neonatologists, medical sub-specialists, and maternal intensivists to optimize maternal and fetal outcomes. They are supported by the in-house Neonatal team at Rainbow and round-the-clock obstetric anesthesia and epidural facilities. A full-fledged pediatric set-up proves, evidently, a great advantage for post-natal care. Additional Facilities Birthright By Rainbow also ensures ultra-comfort for the mother and the child with specially designed delivery packages, including premium services for those who are looking for luxury birthing options. Additionally, birthright By Rainbow and Rainbow Children’s Hospitals has infrastructure at par with the international standards, equipped with state-of-the art technology and equipment to treat them. To understand the nerve of its patients, there are a bunch of internal applications in place to track treatment progress, keep the patient notified and up-to-date and record timely patient feedback.
44 | June 2019 |