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Women over the age of 40 years are at a higher risk of early pregnancy complications such a miscarriage or ectopic pregnancy. They are also more likely to have pre-existing medical conditions which further increase their risk of early pregnancy pathology, for example, previous pelvic inflammatory disease leading to a tubal ectopic, or uncontrolled diabetes increasing the risk of a miscarriage. Women in this age group are also more likely to have conceived through fertility treatment, and may present with complications of this, such as multiple pregnancy or ovarian hyperstimulation syndrome. A woman’s history of assisted reproductive technology and pre-existing subfertility is significant not only in accurately dating the pregnancy but also with regards to the psychological impact in case of a poor outcome. Early pregnancy units have become well established in most hospitals as a dedicated department providing specialist early pregnancy care. This chapter provides an overview of the optminal management of the first trimester of pregnancy for women over 40 and the management of the common conditions.
In August 2018, India’s southern state of Kerala experienced its worst flooding in over a century. This report describes the relief efforts in Kozhikode, a coastal region of Kerala, where Operation Navajeevan was initiated.
Data were collected from a centralized database at the command center in the District Medical Office as well as first-hand accounts from providers who participated in the relief effort.
From August 15 through September 8, 2018, 36,846 flood victims were seen at 280 relief camps. The most common cause for presentation was exacerbation of an on-going chronic medical condition (18,490; 50.2%). Other common presentations included acute respiratory infection (7,451; 20.2%), traumatic injuries (3,736; 10.4%), and psychiatric illness (5,327; 14.5%).
The prevalence of chronic disease exacerbation as the primary presentation during Operation Navajeevan represents an epidemiologic shift in disaster relief in India. It is foreseeable that as access to health care improves in low- and middle-income countries (LMICs), and climate change increases the prevalence of extreme weather events around the world, that this trend will continue.
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