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Ovarian Hyperstimulation Syndrome (OHSS)
Ovarian hyperstimulation syndrome (OHSS) is a condition where the ovaries react abnormally to drugs administered for inducing conception. It is characterized by significant ovarian enlargement due to multiple ovarian cysts, and a fluid shift in the tissue space. While most cases of OHSS are mild, severe cases do occur, although they’re rare.
What Is Ovarian Hyperstimulation Syndrome (OHSS)?
OHSS majorly affects women undergoing fertilization induction treatments and taking hormonal preparatory injections and drugs to promote the growth of eggs in the ovaries.
An excess dose of hormonal remedies or hormone-mimicking drugs can lead to OHSS, in which the ovaries become enlarged and are painful. It is usually mild or moderate, but a few women may have a severe form of this condition, which may lead to excess weight gain, pain in the stomach, vomiting and breathing difficulties.
Spontaneous ovarian hyperstimulation syndrome is not related to fertility treatments and is rare.
Who Is At Greater Risk Of Developing OHSS?
The following factors have been linked to an increased prevalence of ovarian hyperstimulation syndrome or OHSS:
Young age: Young women in the reproductive age group, usually under 35 years of age
Polycystic Ovarian Syndrome or PCOS: Women who suffer from or have a history of PCOS, a condition of young women wherein the ovary is filled with small cysts and cause menstrual irregularities
Assisted Reproductive Techniques (ART): Women undergoing treatments for either primary or secondary infertility with techniques like IVF, IUI or OI. ART is the most common cause found to be associated in most of the cases diagnosed with OHSS
A previous history of OHSS increases the OHSS risk
Causes
Human Chorionic Gonadotropin (hCG) is a hormone normally produced and responsible for fertilization. It is medically supplemented in deficient women, and it is this hormone that may cause OHSS if present in excess amounts. OHSS occurs only after the eggs are released from the ovary (ovulation).
Injectable Hormonal medications: After a dose of human chorionic gonadotropin (hCG), the patient may develop symptoms of OHSS.
Repeated or high doses of ovarian stimulators: Patients who get more than one dose of hCG after ovulation may develop OHSS.
Pregnancy: If a woman becomes pregnant (as a result of her normal ovulation) during this cycle of treatment, the externally administered hormone may overstimulate the ovary and cause OHSS.
About 3 to 6% of women who undergo IVF develop OHSS after embryo transfer as a complication of treatment.
Symptoms
OHSS usually develops about 10 days after fertility treatments.
Symptoms of mild to moderate OHSS
Mild pain in the tummy
Bloating of abdomen
Vomiting
Loose motions
Pain on touching the lower abdomen around the ovaries
Drastic weight gain of about 3 kgs
Symptoms of Severe OHSS
Rapid weight gain - 15 kgs in about 10 days
Severe abdominal pain
Severe gastric upset including vomiting and nausea
Increased viscosity of blood in the lower limbs
Reduced urine output
Breathing difficulties
Tense, distended abdomen
Complications
Usually, OHSS risk is mild to moderate. But about 1 in 100 women undergoing stimulation of ovaries develop a severe grade of OHSS.
Hemodynamic and electrolyte disturbances: Drastic fluid shifts out of the blood vessels may affect the blood pressure and salts of the body (sodium, potassium, etc.)
Thrombotic states: As oestrogen is a pro-coagulant hormone, one may develop hemoconcentration (excessively thick and viscous blood) and hence abnormal blood clots in large vessels, usually in the lower limbs
Acute kidney failure
Twisting of the ovary (ovarian torsion)
Rupture of a cyst (fluid or blood-filled cavity) in an ovary, which can lead to serious bleeding
Excess fluid causes shortness of breath
Miscarriages or abortions
Death (OHSS may be fatal in severe cases)
Diagnosis
OHSS is based on a combined approach with clinical examination and tests including blood tests and sonography. Abnormal weight gain, increased waist circumference, attributes like abdominal pain, breathing difficulties or urinary complaints may alert your doctor to investigate you for OHSS.
You may need a vaginal ultrasound, which shows enlarged ovaries usually containing fluid-filled cysts. A very high beta hCG level or deranged kidney function tests may hint towards a diagnosis of OHSS.
Treatment
Mild OHSS usually resolves spontaneously in about a week’s time after diagnosis. You may require an OHSS diet. Eating a high-protein diet is recommended. Please consult your doctor before starting any new diet.
Moderate OHSS requires close monitoring of vital parameters. Adequate fluids prevent dehydration.
Severe OHSS usually necessitates hospitalization and aggressive treatment, including IV fluids, anticoagulants (blood thinners), electrolyte corrections, blood components and intensive care including cardiovascular backup and OHSS radiology management.
Are There Any Home Remedies To Cure Ovarian Hyperstimulation Syndrome (OHSS)?
There are no scientifically documented home remedies for the treatment of OHSS. It is recommended to refrain from drinking excessive amounts of water or consuming any anti-inflammatory medicines such as aspirin as this can affect your kidneys. Also ensure to keep moving your legs periodically to lower the risk of blood clots.
Prevention
Certain medical measures help prevent OHSS.
Reducing excessive gonadotropins: Low dose gonadotropin protocols have been publicized to prevent OHSS in high-risk patients with a past history or PCOS. It includes various steps like:
Cycle cancellation (withholding hCG)
Coasting or Soft landing (in case you have high oestrogen levels or many developed follicles, your doctor may recommend waiting for a few days before administering hCG, which triggers ovulation)
Modification of ovulation-triggering agent: Replacement of hCG by exogenous or endogenous LH (central hormone controlling the activity of ovaries)
When to call a Doctor?
It is advisable to consult your gynecologist as soon as you notice any abnormal symptoms, abdominal or urinary, or a general sense of being unwell.
Conclusion: Since OHSS is usually a side effect or complication of fertility treatment, it should have a high index of suspicion by the treating gynecologist. It may be prevented if diagnosed in the early stages. Consult your doctor if you suspect any symptoms. OHSS can be treated effectively with an integrated approach of a gynecologist, a physician, and an intensivist (critical care physician). Read more
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Thalassemia in Pregnancy - An Overview
If you have any genetic disorders then it is quite likely that you may pass it on to your baby. Thalassemia is one such genetic disorder that you may transfer to your baby. Thalassemia in pregnancy may pose some serious complications. We shall discuss in detail how you may effectively manage your pregnancy if you have thalassemia.
What is Thalassemia?
Haemoglobin is an iron-rich protein that is found in our red blood cells. This protein is required to carry oxygen to various parts of our body and carry carbon dioxide which gets expelled from the lungs. Thalassemia is a genetic blood disorder that hampers the healthy production of haemoglobin by our body. This malfunction may cause serious cases of anaemia. These abnormal or deformed genes may get transferred from the parents to their children.
If you are pregnant, you should get in touch with your doctor to know more about thalassemia and pregnancy.
Types of Thalassemia
Haemoglobin in our blood comprises of matching protein chains, alpha chains and beta chains. The severity or the extent of complications associated with thalassemia varies, depending upon the number of mutated genes in these protein chains. The two main types of thalassemia are alpha and beta thalassemia.
Alpha thalassemia
Alpha thalassemia occurs when there is gene mutation in the alpha protein chains. This may happen in the following ways:
In a case where only one gene is affected or mutated: Not very substantial symptoms may be noticed.
In a case where two genes are mutated: Mild anaemia may be seen, this condition is also known as thalassemia trait.
In a case where three genes are mutated: It may lead to haemoglobin H or HbH disorder. This condition requires a regular blood transfusion to deal with the severe case of anaemia.
In a case where all four genes are mutated: This may cause a life-threatening condition called alpha thalassemia major or Hb Bart’s syndrome. Babies who get affected with this genetic disorder rarely survive pregnancy or birth.
Beta thalassemia
Beta thalassemia results from a gene mutation in the beta protein chains. This gene mutation may occur in following ways:
In a case where one gene is mutated: This mutation may cause mild (thalassemia trait) as well as severe (thalassemia intermedia) cases of anaemia.
In a case where the mutation occurs in both the genes: This mutation causes a serious condition known as beta thalassemia major or Cooley’s anaemia.
Sub Types
Alpha and Beta thalassemia have been further categorized into two sub-categories:
Thalassemia Minor
When the defected genes are inherited or transferred only from a single parent, then you may have a condition called thalassemia minor. People who have this condition are called the carrier of the disease. If you have this condition you may not have any health complications, but you may pass this defected gene to your baby.
Thalassemia Major
When the defected genes are inherited from both the parents, then it may lead to a life-threatening condition called beta thalassemia major. Thalassemia major causes serious complications in unborn babies. Most babies with alpha thalassemia major do not make it up to the pregnancy or birth. Beta thalassemia major is more common in babies and children than alpha thalassemia major.
What Causes Thalassemia in Pregnancy?
You may have thalassemia in pregnancy in following cases:
You may inherit the defective gene from either of your parents.
You may inherit the deformed genes from both your parents.
You are more likely to inherit the defected genes if you belong to Asian, African, Middle Eastern or Mediterranean ethnicities.
How To Know If You Have Thalassemia?
Following points may help you know if you have thalassemia in pregnancy:
You may already be on medication and treatment if you are suffering from a serious case of thalassemia.
Your doctor may prescribe you blood tests during your first antenatal visit. These tests also include thalassemia test during pregnancy.
You may get blood tests done for you and your partner before getting pregnant, to know if you or your partner has thalassemia.
You may not know that you are suffering from thalassemia if you have alpha or beta minor thalassemia, your blood tests will help you determine it.
How To Know If Your Unborn Baby Has Thalassemia?
Thalassemia is an inherited disease, therefore if either you or your partner or both have thalassemia; there is a great possibility that your unborn baby may have it too.
In case if a single parent is a defective gene carrier, the chances of the unborn baby getting this gene are one in two. However, if both the parents have deformed genes carriers, then the baby has following chances of inheriting thalassemia:
25% chances that your baby has a severe case of thalassemia
25% chances that your baby is neither the carrier nor has any associated disease
50% chances that your baby is an asymptomatic carrier
In a case where you or your partner has thalassemia trait, following tests may be prescribed by your doctor for prenatal diagnosis of thalassemia:
Your doctor may test your amniotic fluid after fifteen weeks of pregnancy. This test to check the amniotic fluid around your baby is known as amniocentesis.
Your doctor may take a sample of your placenta at around eleven to fourteen weeks of pregnancy. The placenta is taken for DNA testing and this test is known as chorionic villus.
Your doctor may do foetal blood sampling. This test may be done around eighteen to twenty-one weeks of pregnancy. The blood for the umbilical cord is taken for testing.
In a case where the unborn baby is diagnosed with alpha thalassemia major, there are very dim chances of survival. The doctor may recommend terminating the pregnancy as the baby may not sustain till delivery or birth.
How Does Thalassemia Affect Pregnancy and Baby's Birth?
If you have thalassemia, you will be closely monitored by your midwife and doctor throughout your pregnancy. Your doctor may prescribe you folic acid as it would reduce the risk of your baby getting neural tube defects (spina bifida). The dosage may vary according to your condition.
In case you are beta thalassemia minor, your doctor may keep a regular tab on your iron levels in the body. You may be prescribed iron tablets to replenish the body’s iron requirement in pregnancy.
In case you are alpha thalassemia minor, you may have a mild or severe case of anaemia. You may require a blood transfusion to ward off anaemia.
In case you are beta thalassemia major, you may have severe complications in your pregnancy. You may require constant monitoring, medication and blood transfusion to sustain a healthy pregnancy.
Thalassemia may cause complications during birth. Therefore, it is recommended to go in for a hospital delivery. In case you are beta thalassemia major, which may affect your bones severely; vaginal delivery may become not possible and may require a c-section in the hospital.
Treatment
The treatment options for thalassemia vary according to the severity and complexity of each case. However, the following are some of the common treatment options that may be suggested to you by your doctor:
You may be prescribed supplements and medicines
You may be advised for blood transfusion
You may be recommended to go in for bone marrow transplant
You may be advised for surgery (in severe cases) to remove your gallbladder or spleen
Will Your Baby Have Thalassemia?
Here’s how you will know if your baby will have thalassemia or not:
If you or your spouse is thalassemia minor: There are equal chances of your baby either inheriting your defected genes or your baby may not inherit the defected genes at all. However, your baby will not be thalassemia major in this case.
If you and your spouse both are thalassemia minor: The chances are one in four, that your baby does not inherit the defected genes at all. Though your baby has the same amount of chances to be born with thalassemia major. However, the chances are one in two that your baby is born with thalassemia minor.
The above-mentioned possibilities remain same in each case of pregnancy, of the same couple. This means no matter how many kids the same couple has, the above-mentioned possibilities will apply in each case.
If your pregnancy tests show that you have thalassemia then you may have to undergo various other tests to determine the presence of this genetic disorder in your unborn child. In case it is established that your unborn baby is affected with thalassemia, your doctor may advise you to go in for genetic counselling. The counsellor will help you understand your situation and also recommend various treatment options that you may consider. The prompt and timely action will ward off any major complication that may arise because of this genetic disorder.
Also Read: Triple Marker Test During Pregnancy: Why, When & How Read more
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Chicken Kheemaa
Chicken kheema is an enticing dish, made from minced chicken along with spices and herbs. The luscious flavour of the dish will leave you tempting for more. It serves well with pav or bun. This kheema can also become the stuffing for your samosas, sandwiches and so on. It can be served as a snack in its own right or with rotis or chapatis for main course.
Serves
Preparation Time
Cooking Time
5 People
15 - 20 Minutes
40 - 45 Minutes
Ingredients
500 gm chicken, minced
2 large onions, chopped
1/3 cup tomato puree
1 tbsp ginger garlic paste
1 tbsp coriander leaves, chopped
1 tbsp mint leaves, chopped
1/2 tsp pepper powder
2 green chilli
1/2 tsp coriander powder
1 tbsp garam masala
1/2 tsp lime juice
2 tbsp oil
Salt to taste
Method
Step 1
Wash, clean and drain minced chicken.
Step 2
Heat oil in a pan. Saute onions till it turns golden.
Step 3
Add ginger garlic paste and mix well.
Step 4
Add tomato puree and give it a good stir.
Step 5
Once tomato is cooked, add all the dry powders and saute until oil separates.
Step 6
Add minced chicken and saute. Close the lid and cook for about 20 minutes.
Step 7
Add mint, coriander leaves, green chilli and lime juice to it.
Step 8
Mix well and allow it to cook for another 5 - 10 minutes.
Step 9
Chicken kheema is ready. You can serve it hot with bread bun / pav.
Nutritional Information
Calories
267 K cal
Proteins
29.6 g
Fats
11.7 g
Carbohydrates
10.8 g
Cholesterol
73 mg
Sodium
172 mg
Potassium
239 mg
Tip: You may add boiled green peas along with kheema. Read more
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Should You Feed Puffs to Your Baby?
FEATURE IMAGE SSID: (1577745421) (ALT<(Should You Feed Puffs to Your Baby?>)
Puffs – they are our favourites, and we can’t imagine a world without them. If your baby is getting used to eating finger foods and purees, you might be wondering if it’s the right time to introduce them to puffs. But, before introducing anything to your little one, it is important to learn whether whatever you are introducing them to is safe and healthy or not because it is the babies we are talking about. So, should you feed puffs to your baby or are puffs safe for babies? Let’s dig in!
At What Age Can Babies Start Eating Puffs?
Babies can start eating puffs when they are 9 to 12 months old. There are a couple of signs to watch out for when you first start giving them puffs:
Your baby is already comfortable eating various finger foods like graham crackers, fruits, and vegetables.
Your baby is able to use the pincer grip to eat his/her finger foods.
Their jaws move up and down when they munch on what they eat (very important).
They don’t gag constantly (this is a sign they’re not ready to eat puffs yet).
Why Are Packaged Puffs Not Good for Your Baby?
FEATURE IMAGE SSID: (1919703635) (ALT<(Should You Feed Puffs to Your Baby?>)
Are puffs good for babies? It depends, but it’s definitely a big no if they come packaged or made commercially. There are a number of reasons why packaged puffs are not good for not just you but for your baby too! In a recent study, it was found that not all products marketed for infant/toddler consumption comply with AAP recommendations and consumers should carefully consider them before introducing them to their children.
Here’s a list of the main ones below:
1. They Contain Arsenic
Packaged puffs are not good for your baby because they contain harmful baby puff ingredients, like synthetic flavourings, chemicals, arsenic, and added things that aren’t good for your baby. Since your child’s organs are developing, it’s always a good idea to go organic and eat naturally. Arsenic poisoning can impair your baby’s development and show growth defects in their later years, both cognitively and physically.
2. The “Added” Sugar Problem
Brands try to use a fancy word for added sugar known as “cane syrup” or “organic sugar”. The problem is that added sugar may lead to a host of lifestyle conditions, like diabetes, heart attacks, and obesity. “Fruit juice concentrates” are also not recommended.
3. Zero Fiber
Most of the packaged puffs you get in stores are made from white grains and not whole brown rice or complete grains. They are processed, refined, and stripped of fibre, essential vitamins and nutrients. The result? You get just a white blob of crunchy mush with zero nutritional value to it.
FEATURE IMAGE SSID: (2102639488) (ALT<(Should You Feed Puffs to Your Baby?>)
4. BPA-Packaging
Not all packaged puffs feature BPA-free packaging, and you know that plastic contains chemicals known to interfere with hormone regulation in your baby’s body. That’s altogether bad news!
5. Change in Consistency
Packaged foods, when left in the open air or original packaging, may quickly change consistency, presenting a choking hazard for children.
So, what puffs to give to your baby?
Try homemade puffs made with baby-safe and organic ingredients.
Homemade Puff Recipes for Infants
If you’re planning to introduce baby puffs to your little ones and want to make some at home, you’ve come to the right place. Here are our top two recipes on organic puffs for infants.
1. Vegan Baby Puffs
If your child is lactose-intolerant, this plant-based recipe is just what they need. It’s one of the best baby puffs healthy recipes for sure.
Ingredients
1 cup of organic oat flour
1 tablespoon of coconut oil
1/2 a cup of pureed fruits
1 tablespoon of grounded raw flaxseed
1 teaspoon of baking powder
1/4 cup of breastmilk or water
1 tablespoon of molasses (optional)
How to Make
Get your parchment paper ready and preheat the oven to 350 degrees
Blend the ingredients well to the point they are lump-free
Place them on the sheet and start baking. After 15 minutes, dial the temperature down to 200 degrees and bake for a few more minutes until they are crunchy and ready to eat.
2. Apple and Kale Green Baby Puffs
If you’re trying to pack in serious nutrition, give your baby these green puffs, and they will go bonkers over it! – Just like we do.
Ingredients
1 kale leaf
1 tablespoon of coconut oil
1 teaspoon of baking powder
1 teaspoon of applesauce
Half a cup of rice cereal
Two egg yolks
How to Make
Blend the ingredients together in a food processor until smooth
Transfer the blend to a chef’s plastic paper wrap. Cut it in a way that there’s a small hole at the end.
On a sheet of parchment paper, create “green” dollops by squeezing the bag.
Bake these green blobs in an oven for 10 mins at 350 degrees. Reduce the temperature to 200 degrees and keep baking for another 30 mins. Your green baby puffs are now ready!
FAQs
Here are some frequently asked questions about feeding puffs to your babies and what to know about them.
1. Can Babies Choke on Puffs?
Choking is not a normal response, and babies don’t choke on puffs. Gagging, however, is something that’s more common when they try to eat puffs for the first time. Since puffs easily dissolve in the mouth, there is a very low possibility of choking on puffs. However, if your little one gets easily choked or gagged by normal foods, it is best to consult your little one’s doctor whether or not it is the right time to do so.
2. Can Babies Eat Puffs Without Teeth?
Babies can eat puffs without teeth. All they have to do is munch up and down, using their mouth to mash the puffs until they melt and dissolve. But remember to introduce puff for babies when they have started on solid foods.
Eating puffs is one of the greatest joys in the world, and when you introduce your baby to it – there’s nothing like it. Make your own puffs at home, eat naturally, and your baby will surely enjoy it. And the best part? You eat guilt-free without worrying about what pesky ingredients are added to your puffs. Just make sure they don’t overeat and keep track of those calories to make sure your child grows healthy and beautiful.
References:
1. Awadalla. N, Pham. T, Milanaik. R; Chew on This: Not All First Finger Foods Are Created Equal; Clinical Pediatrics; Sage Journals; https://journals.sagepub.com/doi/10.1177/0009922817733701; October 2017
Also Read:
Foods to Avoid Feeding Your Baby
Healthy and Nutritious Baby Foods
Cup Feeding a Baby: Benefits and Disadvantages
Health Benefits of Dates for Babies
Read more
Dr Priyanka Kalra has added a new answer
Guardian of 0 children
4 hours ago
Q. In my growth scan doctor found that 2 round cord has been partly around baby necks. Is there any problem with this. will I get normal delivery?
Dr Priyanka Kalra
Obstetrician and Gynaecologist
1 min ago
A. better cesarean. better to show to specialist always as they get the correct diagnosis. try to avoid self and extra medication that will only complicate this and create more damage to the child
Dr Ghouse has added a new answer
Guardian of 0 children
2 hours ago
Q. I m preganant in 5 month in twin baby. Last lmp is 22/12/2023. my expected due date
Dr Ghouse
Paediatrician
1 hour ago
A. 29.9.24. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Sunita Mahato has added a new answer
Mom of a 1 m old child
2 hours ago
Q. #asktheexperts How to increase quantity of milk production?
Sunita Mahato
Mom of 3 children
2 hours ago
A. to increase milk take latction supplement as lactare...
take green papaya bottle gourd bitter gourd fennel seeds garlic oats ragi dalia sabudana ...
regular pumping increase milk use Babyhug electric breast pump...
Dr Ghouse has added a new answer
Expecting Mom due in 4 months
2 hours ago
Q. hi doctor from two days i am eating milk cream with sugar and i want to burn it in my stomach I am 5 month pregnant plzz help ??
Dr Ghouse
Paediatrician
1 hour ago
A. at present weight no exercise is other than moderate walking. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Dr Ghouse has added a new answer
Guardian of 0 children
1 hour ago
Q. I am in my 8th month of pregnancy (last week), and for some reason I am continously facing lot of fatigue. I am feeling deprived of energy and I don't have any energy to do anything. resting isn't Helping in any way and taking small walks isn't too. what can be the possible reason and how to overcome this.
Read moreDr Ghouse
Paediatrician
1 hour ago
A. yes that can be both physical and psychological problems during pregnancy ok. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Sai Prasanthi R L has added a new answer
Trying To Conceive
15 mins ago
Q. hi,
pls advice , after hcg tigger injection can we do intercourse to conceive and till when we can do ...trying to conceive
Sai Prasanthi R L
Mom of a 10 yr 2 m old boy
13 mins ago
A. Hello dear! We understand your eagerness and concern. It is advisable to check with your consulting doctor regarding this matter. Clarify your concerns and follow your doctor’s advice. Maintain a good personal hygiene routine and a healthy lifestyle
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