Babies born too early are more likely to die than that of born at term. They are also more likely to have neurological and developmental disorders that carry long-term consequences for their quality of life, their families and for health and social services.

Perinatal health includes care for both mother and their new born babies. But we often forget about the care of the mothers during and after delivery. However, maternal deaths are less than babies. This is a tragic event as a significant proportion of these deaths are associated with substandard care.

When we talk about paediatrics (child care), it only deals with children. And the obstetricians deal with mothers only. But we need to set up a sturdy bridge in between these two separate entities. It is impossible to think about healthy child without healthy mother. In fact, perinatal science deals with a unique two in one health delivery system.

Bangladesh has made a significant progress in reducing maternal and infant death in recent years. This has been possible because of strong leadership of the Ministry of Health and Family Welfare (MOHFW) in creating a supportive policy environment, technical and financial commitment of donors and UN agencies, active engagement of professional bodies and academic institutions. National Neonatal Health Strategy has already been prepared by the MOHFW. Now we need to operationalise the recommendations outlined in the strategy and begin to roll out the crucial interventions needed to prevent unnecessary deaths.

Immediate and early postnatal care for mothers and newborns is one such crucial intervention. Most of maternal and newborn deaths occur within the first three days of childbirth. Therefore we need to deliver the services to them in those crucial days.

Neonatal sepsis (infection of the newborn) is the single largest contributor to neonatal mortality. We need to ensure that the health service providers at community level can prevent, detect and manage sepsis when it occurs. Now operation research is underway to see the feasibility of different approaches in order to determine the best way to deliver this service to the majority of the newborns who are born at home.

We need to strengthen the policies, guidelines and service providers’ capacity to ensure that the neonates and the mothers are not left without care. Unless we can scale up these services to reach the primary level of health system, we will not be able to attain the Millennium Development Goals by 2015. We need to create additional posts of neonatologists and obstetricians at the district hospital level as a starting point.

Prof M Shahidullah.

Bangladesh has one of the highest newborn deaths in the world. It is about 37 per thousand live births per year. Nearly 4 million babies die after delivery each year throughout the world out of which 98% die in developing countries including Bangladesh. Out of total deaths 45% die within first four weeks of life and 30% die within one year.

In order to decrease this huge number of deaths every year, a pragmatic coordinated approach is needed by all concerned, it is not possible for the government to solve this gigantic problem all alone, both government and non governmental organisations should make every effort in a combined way to mitigate this human tragedy.

MDG-5 is to reduce child mortality by two thirrd by the year 2015. It is heartening to note that the under 5 mortality in Bangladesh has come down significantly in the last decade, from 88 to 66 per 1000 live births per year.

But the main contributing factor affecting the high under-5 mortality is the bulk of the new born deaths that occur within the first 28 days of life. So it is imperative that we need to address the problems that affect the new born deaths more seriously in a coordinated way at the grass root level i.e. in the non urban areas, where a large proportion of deliveries take place in the home setting, compounded by meager medical facilities and man power within the vicinity.

We all know that the main cause of newborn death in Bangladesh is home delivery, lack of trained personals and medical facilities, delayed referral, transportation problem etc. To address these problems the most important thing is to produce skilled birth attendants (SBA) who will be trained to do the following things:

1) Conduct normal deliveries
2) Identify the danger signs
3) Quick referral and transportation to higher centers

At the same time we should put emphasis on:
1) Improve obstetric and neonatal care at thana and district level
2) Control population boom
3) Compulsory birth and marriage registration
4) Improve women education
In a country like Bangladesh institutional delivery is not possible, we need to utilise our human resources by producing more SBA’s in order to bring down neonatal mortality.

This is a huge task which needs to be jointly addressed by all.

According to medical science, Psoriasis is not necessarily a barrier to pregnancy, nor does it affect a woman’s ability to have children. Women with psoriasis generally progress through pregnancy and give birth just like anyone else. However, expectant mothers who suffer from psoriasis need special precaution in their treatment and should be aware of the hereditary nature of this condition, the effect of hormonal changes and tips for ease in breastfeeding.

Treatment options
Pregnant women with psoriasis need to be aware that some treatments for psoriasis may harm their babies. There are not many drugs available to treat pregnant women as most anti-psoriatic drugs are toxic for the fetus. The appropriate treatment for psoriasis in a woman who is pregnant, or who plans pregnancy, will depend on the extent and severity of the skin condition.

Topical treatment:
Topical treatments are first line treatments for psoriasis in pregnancy as most of systemic drugs are toxic to fetus. However, medications for external use are not free from side effects as they are absorbed by the body. Some should be completely avoided during pregnancy as they are potentially teratogenic (causes birth defect).

Emollients: Soothing and moisturising creams may be used without incurring any risk.

Vitamin A derivatives for local use should be avoided because of their teratogenic effect.

Vitamin D derivatives can be used in small quantities in very specific areas.

Corticosteroids (Cortisone): Dermatologists sometimes prescribe cortico-steroids in small quantities for use on very limited areas. It can increase the risk of stretch marks, so it should not be applied to certain parts of the body such as the breasts, abdomen and hips.

Exfoliants such as urea and Salicylic acid: These treatments can be used if their application is limited to small areas of the skin.

Systemic treatment:
Systemic treatments are often teratogenic. These risks are very high when medication is taken during the first trimester of pregnancy. Consequently, most orally administered medicines are stopped during pregnancy.

Dr Syeda Ishrat Jahan…

The study, of 724 women who were either pregnant or having trouble getting pregnant, found that nearly all were aware that age affects the chances of conceiving. However, they often did not know that older age increases the risk of certain pregnancy complications, and many had too much faith in the success of in-vitro fertilisation (IVF).

The decision to delay childbirth is a complex and personal one, the researchers note in a report in the journal Fertility & Sterility.

The point, they say, is that women should be fully aware of all the possible benefits and risks of their decision.

“The results of this and other studies suggest that women should be provided with the appropriate information on the possible outcomes of a decision to delay motherhood,” write Dr. Abha Maheshwari and colleagues at the University of Aberdeen in England.

When it came to IVF, Maheshwari’s team found that women tended to be overly optimistic about its success rates.

Only 53 percent of women with fertility problems knew that the chances of conceiving via IVF decline between the ages of 30 and 40. What’s more, 85 percent of them thought that fertility treatment can “overcome the effect of age.”

In reality, the researchers note, only 25 percent to 30 percent of women in their 20s and 30s give birth after IVF treatment. Among women older than 40, the success rate is closer to 10 percent.

Yet many people may not realise that IVF frequently fails, Maheshwari’s team writes — possibly because much of what they hear about IVF comes in the form of media stories on older women who have successfully conceived through fertility treatment.

“Many women are currently choosing to delay motherhood in the interests of personal and professional development,” the researchers write. “Although starting a family is a personal preference, free choices cannot be made without full knowledge of their consequences.”

The Food and Drug Administration (FDA) established five pregnancy categories to indicate the risk level of drugs to the fetus. The categories are A-B-C-D and X. The category A being the least dangerous during pregnancy and category X to be completely avoided

Category X: Highly dangerous
Adequate well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities or risks.

Quinolones: Sparfloxacin (1st trimester)

Category D
Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.

Tetracycline: Tetracycline, Doxycycline, Oxytetracycline

Others: Naproxen (3rd trimester)

Category C
Animal studies have shown an adverse effect but there are no adequate and well-controlled studies in pregnant women.

Quinolones: Cipro-floxacin, Levofloxacin, Moxifloxacin, Gatifloxacin, Ofloxacin, Sparfloxacin (2nd and 3rd trimester)

Macrolides: Clarithromycin

Aminoglycosides: Gentamicin

Others: Chloramphenicol

Category B
Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Penicillin: Amoxicillin, Ampicillin, Cloxacillin, Flucloxacillin

Cephalosporins: Cephalexin, Cefradine ( First generation); Cefuroxime ( Second Generation); Cefixime, Cefpodoxime, Cefotaxime, Ceftriaxone ( Third Generation)

Macrolides: Azithromycin, Erythromycin

Sulphonamides: Clotrimazole

Others: Metronidazoles, Naproxen (1st and 2nd trimester)

Category A: Least dangerous
Theoretically there are no antibiotics in this class for pregnancy.

Md Sojib Khan……