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25 Mar 2016

NICU guide

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nicu-welcome-guideThis is  fantastic work from a group of mothers who aim to share their experience in the NICU at Mediclinic City Hospital.
It is full of the emotion and sincerity of the parents who have been there and had a first hand experience.
The full NICU Survival Guide can be found at the following link www.nicudubai.wordpress.com
Dr George Michailidis, Fetal Medicine Consultant, Obstetrician & Gynecologist

 

Zika virus and pregnancy in Dubai

What is Zika virus ?

How is Zika virus transmitted ?

Aedes_aegypti Zika virus is spread by the yellow fever mosquito Aedes aegypti . The specific mosquito can carry a number of other viruses as well like denque fever yellow fever. It is recognised by the white markings on its legs and a specific mark that resemble the music instrument lyra on it thorax . The mosquito has originated in Africa and now is spread in most subtropical regions throughout the word

 

 

 

 

 

 

How do I know if I am infected ?

Symptoms of Zika virus infection in pregnancy

 

 

109px-Zika.Virus.Rash.Arm.2014symptoms are fever, rash eye irritation ( conjactivitis). Muscle and joint pains as well as headaches are frequent symptoms as well

  • It is a self limiting infection that usually lasts a few days
  • Only one in 5 people who are infected with the virus do actually become ill

 

Diagnosis of Zika virus infection

  • Diagnosis is not easy and is based on a very high index of suspicion
  • Symptoms are very similar to those from dengue fever or chinkungunya . Both these viruses are transmitted from the same species of mosquitoes as Zika
  • Travel history during pregnancy in areas where zika virus is prevalent is important. CDC is regularly updating its travel information and this can be found online at http://wwwnc.cdc.gov/travel/notices/
  • Blood tests can help the diagnosis

Treatment for the pregnant mother with Zika virus infection

  • There is no specific medication or vaccine to treat or prevent Zika virus infection during pregnancy
  • Ensure good hydration
  • Paracetamol is safe to take during pregnancy in mothers with Zika virus infection to relieve some of the symptoms
  • In pregnant mothers with laboratory evidence of zika virus disease during pregnancy follow up by a fetal medicine specialist is recommended. Ultrasound scans are performed in 3-4 weeks interval looking for specifically for evidence of microcephaly or cerebral calcifications

Pregnancy advice and Zika virus

Pregnant women considering travelling in an area affected by Zika virus 

  • Pregnant women should be advised against travelling to areas known to be affected by zika virus. There are no vaccines or medication that can be used in pregnancy to prevent Zika virus.
  • The mosquitos responsible for transmitting Zika virus are most active during the day so appropriate measures to avoid mosquito bites should be taken . Wearing long sleeve shirts and long sleeve pants as well a appropriate use of insect repellants is strongly advised

Testing of pregnant women with a possible infection by Zika virus

  • zika virus interim guidance cdcTo date there is no commercially available test specific for Zika virus . Blood test utilising reverse transcription polymerase test can be used in symptomatic patients . In the US this is facilitated by the local health care departments

Effect of Zika virus to the baby

There is increasing evidence linking Zika virus infection during pregnancy and fetal microcephaly.

microcephaly-comparison-500pxWhat is microcephaly? The term microcephaly is used to describe a fetal head size that is smaller than expected at a certain gestational age. Different cut of points are used but most will take 3 standard deviations from the mean. This means that the circumference  of the fetal head is less than the 0.3 % expected for the gestation

The size of the fetal head is mostly dependent on the growth of the fetal brain. Most cases of microcephaly are due to genetic factors. However acquired microcephaly is well described due to infections like toxoplasmosis and rubella. Zika virus has been associated with the increased rate pregnancies affected by fetal micropcephaly in Brazil .

What is the treatment for microcephaly. There is no treatment for microcephaly as this is the result of the damage that has already happened to the fetal brain.

 

Dr George Michailidis

Fetal and Maternal Medicine Consultant

Obstetrician Gynaecologist

Genesis Perinatal Care Clinic Dubai
www.genesis-dubai.com

drgeorge@genesis-dubai.com

 

Further updated information 

Centers of Disease Control and Prevention – Zika virus 

http://www.cdc.gov/zika/index.html

Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016

Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016

http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm

 

Image acknowledgment

“Aedes aegypti” by Muhammad Mahdi Karim (www.micro2macro.net) Facebook Youtube – Own work. Licensed under GFDL 1.2 via Commons – https://commons.wikimedia.org/wiki/File:Aedes_aegypti.jpg#/media/File:Aedes_aegypti.jpg

 

“Zika.Virus.Rash.Arm.2014” by FRED – Own work. Licensed under CC BY-SA 3.0 via Commons – https://commons.wikimedia.org/wiki/File:Zika.Virus.Rash.Arm.2014.jpg#/media/File:Zika.Virus.Rash.Arm.2014.jpg

gestational-diabetes-diet-planGestational diabetes has a major impact in pregnancy care especially in Middle East. Lifestyle and diet interventions can help improve outcomes for baby and mother. Furthermore the set the foundations for a long term healthier lifestyle. The following is from the OBGYNnet referring to a recent publication from Diabetes Care ;

Best Diet for Gestational Diabetes | OBGYN.Net: Clinicians should prescribe a low glycemic index diet to women with gestational diabetes mellitus, according to new data from a meta-analysis.

The analysis found that a low glycemic index diet was associated not only with reducing insulin use but also with lower birth weights for the babies. Published in Diabetes Care, the analysis was based on data from nine randomized controlled trials.
Key Points:

– Physicians should recommend that women with gestational diabetes choose foods with a low glycemic index.
– Adhering to a low glycemic index diet will likely improve the health of women with gestational diabetes.
– Although associated with decreased need for insulin and reduced birth weight in infants, a low glycemic diet did not affect maternal weight gain or c-section rates.
A previous Cochrane review found no significant dietary benefit of a low glycemic index diet. However, this latest analysis included more trials that the Cochrane analysis, the authors said.
Total dietary restriction and low carbohydrate diets did not have similar impact on maternal or newborn health, the researchers found. However, a low glycemic index diet reduced the proportion of patients who needed insulin (relative risk, 0.767 [95% CI 0.597, 0.986]; P = 0.039).
“The less frequent use of insulin means that 13 out of 100 patients with GDM will not need to use insulin if they adopt a low GI diet during pregnancy,” the authors reported.
In addition, the average birth weight of babies born to pregnant women with gestational diabetes who consumed a low GI diet was 161.9 g less than that of babies born to women in the control diet group (95% CI: −246.4, −77.4; P = 0.000).
Using a glycemic index scale from 0 to 100 according to the extent to which a food raises blood glucose levels after eating, the authors categorized foods with a glycemic index of less than 55 as low glycemic index foods. Pumpernickel bread, oatmeal, muesli, sweet potato, corn, yam, lima beans, peas, lentils, most fruits, and carrots are among foods deemed to have a low glycemic index, according to the American Diabetes Association.
A low glycemic diet, however, did not affect maternal weight gain or c-section rates, the authors noted.
See more at: http://www.obgyn.net/gestational-diabetes/best-diet-gestational-diabetes

20 Jun 2014

Monochorionic twins

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IDENTICAL_TWIN Monochorionic twins (identical twins) present a real management challenge for the obstetric team.  In addition to the common twin pregnancy complications like preterm delivery and growth retardation monochorionic twin pregnancies can be affected by twin to twin transfusion syndrome.

Twin to twin transfusion syndrome is a pregnancy complication unique to monochorionic twins. It affects up to 18% of monochorionic twins and if left untreated can lead to loss of both babies. Treatment of choice is laser ablation of the communicating placental vessels.  This is not available in Dubai.

There are few centres of excellence around the word with a load of cases to get good level of expertise and good results. Most are in Western Europe and USA.

Given visa restrictions it is imperative that the parents have appropriate counselling and  as much notice as possible in order to prepare for possible treatment interventions.

At Genesis we offer a comprehensive monochrorionic twin pregnancy surveillance program aiming to identify early major complications like TTTS and preterm labour.

This includes

  • Certified Fetal Medicine Consultant supervision.
  • First trimester screening, TTTS risk assessment. Documentation preparation for those parents who may need to travel. 
  • US review from 16 weeks and every 2 weeks till 24 weeks gestation and then 2-3 weeks till delivery.

You can always reach our team for more information and appointments on 044498446.

Dr George Michailidis, MRCOG
Fetal & Maternal Medicine ConsultantObstetrician & Gynaecologist

Advanced Life Support in Obstetrics, Mediclinic City Hospital

ALSO2014 (2)

ALSO2014 (3)

 

 

 

 

 

Congratulations to all the Candidates who participated to the latest ALSO course at Mediclinic City Hospital Dubai. The Advanced Life Support Course aims to train healthcare professionals who to best respond to obstetric emergencies.

Many thanks to Dr Rabia, Gina and the rest of the course faculty who have been instrumental to the Course’s success.

Dr George Michailidis

physio_pregnancy_genesisA new service is now available at Genesis

Physiotherapy in pregnancy and postpartum period.

Genesis Physiotherapy is a team of professional physiotherapists from the UK. We create bespoke treatment plans for each patient enabling them to have a more comfortable pregnancy, easier birth and enjoyable time with their new baby and children.

Common Complaints;

Back pain, Pelvic pain, Joint and muscle pain, Incontinence, Pain post episiotomy /surgery

Prolapse, Recti abdominus diastasis –(separation of the stomach muscles)

Treatment techniques;

Manipulation / mobilization of joints

Clinical Pilates, Pelvic floor retraining through exercise, muscle stimulation, and biofeedback

Bladder training for urgency and stress incontinence, Post-natal education on return to exercise , practical posture advice on bathing and feeding your baby

 

“Whether you want to get back to walking around the park or you are an elite athlete, we can create a plan to get you back to where you want to be”

The Genesis Physio Team

Recent reported cases MERS-COV in UAE have brought a lot of anxiety to pregnant mothers.

What is MERS ?

Middle East Respiratory Syndrome is a severe viral illness first reported in Saudi Arabia in 2012. Patienta present with fever, cough and shortness of breath.

What causes MERS Middle East Respiratory Syndrome?

MERSMERS-CoV is a coronavirus that responsible for MERS.

It can affect the lower respiratory, kidney, intestinal (bowel) and liver cells.

Bats seem to be the primary reservoir for MERS-CoV with camel the most probable intermediate for transmission to humans.

How is MERS-CoV transmitted ?

Case clusters identified till now are suggestive of human to human transmission. Possible modes of transmission are droplets and direct contact transmission. Most cluster cases have been reported in family and health care settings and have been self limited with appropriate vigilance and isolation. WHO believes that MERS-CoV virus has a limited potential for a pandemic.


Clinical presentation and symptoms

Most patients present with severe pneumonia and respiratory distress syndrome

Some have acute renal failure

Incubation period is about 7 days

MERS and Pregnancy

MERS_PREGNANCY

There have been less of a handful cases of confirmed MERS and pregnancy. So it is very difficult to draw conclusions on the effect of MERS CoV to pregnancy. However traditionally pregnant mothers are considered to be in the high risk group for MERS complications due to the changes in their immune response and the fetal effects of a severe respiratory syndrome.

A team from Jordan and the US Centers for Disease Control and Prevention (CDC) published the findings in the Journal of Infectious Diseases about a pregnant mother who has miscarried after contacting MERS-CoV.

Her case was part of a family cluster with a close relative who died from MERS-CoV and her husband who had tested positive for MERS-CoV.

Treatment and vaccines for MERS and pregnancy

There is no specific anti viral treatment for MERS-COV-CoV infection. Patients are receiving supportive treatment

There are no vaccines for MERS-CoV

Prevention of MERS and pregnancy

Simple hygiene rules are very effective in preventing infection from MERS and pregnancy is not an extra reason to be vigilant;

Wash your hands often with soap and water and if this is not available use a sanitizer

Avoid contact with sick people

Avoid touching your eyes mouth and nose as germs spread this way

If you’re  ill report to your doctor early. Inform before you reach the clinic so appropriate arrangements can be made to avoid cross infection with other patients (separate waiting area etc)

Further up to date information about MERS can be found at

www.who.int/csr/disease/coronavirus_infections/en/

wwwnc.cdc.gov/travel/notices/watch/coronavirus-arabian-peninsula-uk

www.haad.ae/

 

Dr George Michailidis

Consultant if Fetal & Maternal Medicine

Obstetrician & Gynecologist

Genesis Perinatal Care Clinic, Dubai

 

Mirey_nutrition_pregnancy_genesis_dubaiWe are excited to announce a new service at Genesis Perinatal Clinic; Nutrition & Dietetics.

Mrs Mirey Karavetian has joined Genesis offering nutritional support and advice to mothers and their family members. Mirey earned her dietetics degree from the American University of Beirut. She has extensive experience as senior dietician in large hospitals in Lebanon.Further to her clinical work she has been teaching clinical nutrition and health quality.

Her blend of education in dietetics and health promotion alongside her great experience in personalised patient care will provide excellent support to our high risk mothers during their pregnancy and after delivery.

We had a great seminar in November with some of the best lecture in Obstetric Ultrasound given by Dr Aris Papageorgiou and Dr Hisham Mirghani.

A fantastic gathering of Obstetricians at the Ultrasound in Obstetric & Fetal Medicine Seminar

A fantastic gathering of Obstetricians at the Ultrasound in Obstetric & Fetal Medicine Seminar

Dr George lecturing at Ultrasound in Obstetrics & Fetal Medicine Seminar

Dr George lecturing at Ultrasound in Obstetrics & Fetal Medicine Seminar


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