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From gynaecologists and obstetricians to neonatologists and paediatricians, Medcare Women & Children Hospital is a one-stop solution provider for all health-related needs of women and children. In addition, the hospital offers the whole gamut of medical services to patients through other departments such as endocrinology, family medicine, gastroenterology, general surgery, dentistry, dermatology, diet and nutrition, and plastic surgery.

GN Focus speaks to three doctors at the hospital to learn more about the gynaecological and pregnancy-related issues women in the UAE face and how the hospital tackles them.

What are the most common gynaecological disorders seen in women in the UAE?

Dr Sura Alwan, Specialist Obstetrics & Gynaecology: The most common gynaecological disorder in the UAE is vaginal infections, which are usually caused when there is an imbalance in the normal vaginal bacteria. What’s important with vaginal infection is accurate diagnosis, which will guide the treatment. Consult a doctor immediately if you have vaginal discharge, irritation, pain or itching. It is more common here in the UAE because of the hot and humid climate. Follow good hygiene and drink a lot of water to prevent infections. Reduce the amount of sugar in diet because that can sometimes trigger certain types of yeast infection.

Another gynaecological problem that we see mostly in the UAE is abnormal menstruation, which can be due to pathological issues as well as lifestyle problems such as weight gain or weight loss. One of the pathological causes is fibroids. A fibroid is a benign growth that develop from the cells that make up the muscles of the uterus, causing bleeding and pelvic pain under pressure. Endometriosis, which causes painful menstruation or pelvic pain, is also seen in the UAE.

Polycystic ovarian syndrome is widely seen in the UAE. Why? Should women worry about it?

Dr Sura Alwan: Polycystic ovarian syndrome, or PCOS, is more common nowadays. There are so many causes, but mostly it’s related to sedentary lifestyle – more and more women are becoming overweight – and also exposure to more stress, industrial pollution, more toxins and radicals.

PCOS can cause many symptoms such as irregular menstruation, infertility, excessive hair growth on the face, acne, etc. Its treatment depends on the symptoms as well as the long-term effect of the syndrome.

PCOS is an endocrinological problem, a hormonal imbalance. One of the most common 
hormones that disturb is the insulin.

The first line of treatment for PCOS is lifestyle modification. We advise patients to not increase their weight and try to follow a healthy diet and a healthy level of exercise.

If overweight women lose 5-10 per cent of their body mass index or weight, they will have so much improvement in their symptoms.

Medication such as metformin can be given to reduce weight or maintain a good level of insulin and sugar.

Some hormonal treatments can also be given to regulate irregular menstruation caused by PCOS.

If a woman develops fertility issues due to PCOS, she will need specific treatment for that.

Overall, PCOS is not dangerous. It will not affect a woman as long as she manages her symptoms through regular exercise, a healthy diet and follow doctors’ directions.

Can you take us through the importance of maternal foetal medicine?

Dr Shiva Harikrishnan, Senior Consultant, Obstetrics & Gynaecology: For the best pregnancy outcome, both mother’s and the foetus’ health is important. We have to carefully monitor and identify any problems in both mother and the foetus. We have foetal medicine specialists who take care of foetal health from the beginning of pregnancy. This is done through a detailed scan at 12 weeks to identify foetal abnormalities as well as chromosomal or gene abnormalities. We have Down Syndrome screening, double marker, NT scan (to check the neck thickness of the baby) by high resolution ultrasound, and a couple of blood tests such as BHCG and PAPPA from the maternal blood from which we will be able to calculate whether the patient is at high risk for Down Syndrome or any other chromosomal anomalies.

The obstetrician and the foetal medicine specialist work hand in hand to give the best treatment for intra-uterine growth restriction, if the baby is very small, when the water around the baby is very less or when the blood flow for the baby is reduced.

At our hospital, we have internal medicine doctors and endocrinologists who work together with obstetricians to deliver positive outcomes for both the baby and mother.

Is endometriosis underdiagnosed and undertreated in the UAE too? What are the challenges?

Dr Shiva Harikrishnan: Yes. Over the past few years, there’s been an increase in awareness among patients as well as doctors, but there is still a long way to go because usually women feel painful period is healthy and there is nothing to worry. When there is period pain you don’t have to worry, but you should know the difference between the usual pain, which occurs on the first day of the period, and congestive dysmenorrhea, the pain that comes before the period, doesn’t go down after the start of the period and may last even after the period is over. When patients with dysmenorrhea or painful period come to our hospital, we use pain score and symptoms to identify whether it is endometriosis. We have an endometriosis centre, where we do a lot of work in advance laparoscopy and special scan called dynamic scan to check deep infiltrating endometriosis. We have radiology doctors who are well versed with dynamic pelvic scanning to identify endometriosis and deep-infiltrating endometriosis into the uterosacral ligaments or the ligaments of the uterus or the womb and also to the bowel.

At Medcare Women & Children Hospital, we specialise in endometriotic surgery where we have a team of doctors including a colorectal surgeon, urologist and gynaecologist who is experienced in advanced laparoscopic surgery, which is the best treatment for endometriosis and deep-infiltrating endometriosis. We have doctors who are accredited as Master Surgeon in Minimal Invasive Surgery from the Surgical Review Corporation, USA. For those who are not willing to go for surgical treatments, we offer Dienogest, an oral progestogen that reduces the size of endometriosis and gives temporary relief, in addition to injections that will produce a menopause-like state called GnRh.

Who are at risk of high-risk pregnancies? What can women do to mitigate the risks?

Dr Mansi Joneja, Internal Medicine Specialist: Some pregnancies become high risk as they progress, however some women are at high risk even before their pregnancy. Women older than 35 and adolescent age; very thin women (with BMI less than 19.8) and overweight (BMI- 25-29.9) before pregnancy; shorter women

(height less than 5 feet); structural abnormalities of reproductive tract (uterus or cervix); chronic diseases such as hypertension, diabetes, kidney disorders, autoimmune diseases, thyroid disorders, heart disease, blood disorders such as sickle cell disease; and infections like HIV predispose them to risks during pregnancy.

However, sometimes healthy women develop complications during pregnancy such as raised blood pressure, infection in fluid surrounding the foetus, multiple births, and high sugars during pregnancy in non-diabetic women, which make their present pregnancy high risk.

Exposure to certain drugs, chemicals, radiation, infections like herpes, cytomegalovirus, rubella, chicken pox, consumption of alcohol, cocaine, smoking also add to the risk.

So, it is essential to plan pregnancy at the right age. Pre-existing conditions must be controlled with treatment. Healthy lifestyle measures need to be followed, with the start of prenatal supplements. Achieving the optimal weight, abstinence from alcohol and smoking, with prior necessary immunisation help mitigate the risks.

It’s wiser to work on controlling as many risk factors as possible rather than worrying about them. Consult the maternity team before planning pregnancy so that risks can be assessed and treated before conception. Once the risk factors are identified, a multidisciplinary approach to the patient with involvement of concerned specialty along with the maternity team at the very onset helps to take care of high-risk pregnancies well.

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