Obstetric Care for Monkey Pox in India: What Every Clinician Should Know

Monkeypox is a contagious viral disease that spreads between animals and people. The UK government guidance described the first case of 'Monkey Pox' in 1958, when it was found only in monkeys used for research purposes. Fortunately, for a third world fast developing country like India, monkeypox does not spread easily in the population but spread by close physical contact between people, and there is limited information available about the impact on pregnancy. The virus can enter the body through broken skin, the respiratory tract, or mucous membranes (the moist inner lining of cavities and some organs in the body). The signs and symptoms of monkeypox virus infection in people who are pregnant appear similar to those in nonpregnant people. The symptoms include fever, lymphadenopathy, lethargy, pharyngitis, headache, myalgias, and rash. Rash associated with monkeypox virus infection can be found in the anogenital area (most commonly reported location in this current outbreak), trunk, arms, legs, face, and the palms and soles. The diagnostic approach to a patient with suspected monkeypox virus infection is the same for pregnant and nonpregnant people. If a patient is present with signs and symptoms of monkeypox virus infection, diagnostic testing should be considered, especially if the person has risk factors for monkeypox virus infection. There are limited data on monkeypox infection during pregnancy. It is unknown whether pregnant people are more susceptible to monkeypox virus or whether infection is more severe in pregnancy. Monkeypox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth. Adverse pregnancy outcomes, including spontaneous pregnancy loss and stillbirth, have been reported in cases of confirmed monkeypox infection during pregnancy. Preterm delivery and neonatal monkeypox infection have also been reported. Monkeypox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth. Adverse pregnancy outcomes, including spontaneous pregnancy loss and stillbirth, have been reported in cases of confirmed monkeypox infection during pregnancy. Infection control practices for the care of patients who are pregnant with monkeypox infection are the same as those for patients who are not pregnant with monkeypox infection. This includes appropriate isolation of patients with monkeypox; training for health-care personnel on maternity and newborn care units on correct adherence to infection control practices and personal protective equipment (PPE) use and handling; and ensuring sufficient and appropriate PPE supplies are positioned at all points of care. Furthermore, visitors to pregnant or postpartum patients with monkeypox should be strictly limited to those essential for the patient's care and well-being, and should have no direct contact with the patient. Use of alternative mechanisms for patient and visitor interactions, such as video-call applications, should be encouraged for any additional support. CDC also recommends pregnant, postnatal, and breastfeeding women should be prioritized for medical treatment as there is a significant risk to the baby. They also identify these groups as eligible for treatment.

A study to review sex ratio at birth and analyze preferences for the sex of the unborn

OBJECTIVES

(1) To study the status of sex ratio at birth with increasing birth order, (2) To ascertain the relationship of declining sex ratio with respect to socio demographic factors. (3) To study outlook of patient towards sex preference, willingness to determine sex of the fetus, wish to terminate the pregnancy in case of unwanted sex of the baby.

METHODS

This is the retrospective study done in the Department of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital, Parel, Mumbai. The data was collected from the records maintained in Medical Record Department from January 2007 to December 2012 and were studied to determine the sex ratio as well as its relationship with the increasing parity. 95 % confidence interval for the sex ratios was calculated.

RESULTS

Average sex ratio of 6 years was 908 females per 1,000 males. Sex ratio was 972 females per 1,000 males in primi para, which decreased to 879 females per 1,000 males in second para, further reduced to 784 females per 1,000 males in third para and 864 females per 1,000 males in fourth para.

CONCLUSION

The 'sex ratio at birth', defined as the number of girls born for every 1,000 boys born, is a more accurate and refined indicator of the extent of prenatal sex selection.