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Similar to Lifecare Centre Public Awerness tip on A to Z of TRAVEL During Pregnancy Dr. Jyoti Agarwal Dr. Sharda Jain
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Lifecare Centre Public Awerness tip on A to Z of TRAVEL During Pregnancy Dr. Jyoti Agarwal Dr. Sharda Jain
- 1. A to Z of TRAVEL During Pregnancy Dr. Jyoti Agarwal Dr. Sharda Jain
- 2. Today’s Generation is on the Move Today travel for business & leisure has increased exponentially Overseas travel today has become a Fashion & Status Symbol
- 3. • The holidays are a time of great anticipation , excitement and lots of joy • At times can bring stress Although it is perfectly safe to travel during pregnancy , one needs to do some extra planning and take a few additional precautions
- 4. KEY LEARNING POINTS • When to travel in pregnancy • Risk with travelling in pregnancy • How to minimize risks associated with travelling in pregnancy
- 5. Mode of travel • Safe to travel by car, bus, train, plane, or ship • Motorcycles and scooters are not recommended
- 6. When to Travel ?? Most women with healthy pregnancy can travel safely ACOG, RCOG 2013 Best time to travel is between 14 & 28 wks of pregnancy
- 7. • In the first 12 weeks of Pregnancy, there is a higher risk of Miscarriage or Ectopic Pregnancy • After 28 weeks , biggest issue with travel is the risk of Preterm Labour Risk of Travelling
- 8. ACOG algorithm for travel in pregnancy (2013) Pregnancy Travelling not recommended Gestation > 28 wksGestation 14 – 28 wks Gestation <14 wks Risk of miscarriage or ectopic pregnancy Higher risk of delivery in the aircraft Travelling considered safe Safe to travel Medical insurance, vaccination, malaria prophylaxis
- 9. When not to travel ….. • Medical risk factors • Obstetric risk factors • Travel to Hazardous destination
- 10. OBSTETRICAL RISK FACTORS • History of miscarriage • Incompetent cervix • Ectopic pregnancy • History of preterm labor or PROM • History of or existing placental abnormalities • Threatened abortion or vaginal bleeding • Multiple gestation • History of toxemia, hypertension, or diabetes • Primigravida at 35 years of age and older, or 15 years of age and younger
- 11. Each Indication Is Important Patients tend to Repeat their Performance
- 12. General Medical Risk Factors • History of thromboembolic disease • Pulmonary hypertension • Severe asthma or other chronic lung disease • Valvular heart disease ( NYHA class III or IV heart ds ) • Cardiomyopathy • Hypertension • Diabetes • Renal insufficiency • Severe anemia (Hb < 7.5 gm % ) or haemoglobinopathy , sickle cell disease • Otitis media & recurrent sinusitis
- 13. Travel NOT advised when planning to travel to potentially hazardous destinations • High altitudes (> 12,000 ft ) • Areas endemic for life-threatening food- or insect-borne infections • Areas where malaria is endemic • Areas where live virus vaccines are required Recent was Zika Virus Alert (WHO)
- 14. AIR TRAVEL
- 15. Airline issue guidelines for pregnant women • Many airlines do not allow women to fly after 36 completed weeks of gestation • Women with multiple pregnancies should not fly after 33 completed weeks of gestation Aerospace Medicine Association (USA)
- 16. CHOICE OF SEAT • Non- Emergency Exit row seats • Aisle Seat : To allow free mobility • Seat belts : Use seat belt constantly while seated passed between breast and below pelvic bones
- 17. Cabin Pressure is an issue with all aircrafts • Modern aircraft are not pressurized to a sea level equivalent • The altitude is between 1524m & 2438 m • The barometric pressure is significantly lower than at sea level
- 18. Reduced Barometric Pressure In Aircraft Cabin • Causes reduction in maternal blood oxygen saturation by upto 10 % • Compensated by favourable properties of foetal haemoglobin by – increasing oxygen carrying affinity –increasing fetal haematocrit
- 19. Considerations for air travel • Low cabin humidity by 10-20% , drying effect on airways , cornea & skin • Risk of deep vein thrombosis • Risk of delivery in the aircraft • Risk of radiation
- 20. WORLD HEALTH ORGANIZATION Recent WHO study has described a 2-4 fold increased risk of thrombosis with air travel Pregnancy is a thrombogenic state
- 21. Risk of Deep Venous Thrombosis • Aircraft seating is cramped • Passengers tend to remain immobile • Risk increased by presence of additional risk factors such as previous DVT or obesity
- 22. WHO study & Cochrane review • Risk decreased by regular walks every hour • Calf exercises while seated • Use of Graduated Elastic Compression Stocking would significantly reduce the risk of asymptomatic DVT
- 23. RCOG recommends If the women has additional risk factors • Previous DVT • Morbid obesity • Medical problem - nephrotic syndrome , SLE Prophylaxis with low molecular weight heparin should be started from the day of travel to several days thereafter Low dose aspirin should not be used in pregnancy for thrombo prophylaxis associated with air travel
- 24. RISK OF RADIATION 1) At security check 2) Cosmic radiation
- 25. X-Ray security devices • Hand-held metal detectors • Walk through metal detectors • Backscatter units Do not appear to pose hazard to pregnant women Exposure levels are 10,000 times lower than mobile phone
- 26. No information to suggest that a pregnant women should avoid any security system
- 28. Risk Of Cosmic Radiation • Earth's atmosphere absorbs much of the cosmic radiation • At high altitudes atmosphere is rarefied, so radiation levels are greater than at the sea level • US Department Of Transportation - pilots & aircrew exposure to cosmic radiation do not indicate exposure beyond safe limits • Aerospace Medical Association - expectant mothers are not at increased risk unless they are flying several times a week
- 29. Motion sickness • Common complaint • Antihistaminic, cyclizine antemetic (pyridoxine ) • Eat lightly • Drink plenty of fluid
- 30. Long distance travel during Pregnancy • Gradual adaptation • Mild tranquilizer JET LAG
- 31. Immunizations For Pregnant Travelers • Vaccinations prior to departure according to destination endemic diseases • Avoid travelling to endemic areas of malaria • Malaria is treated as a medical emergency in any pregnant traveler
- 32. Pregnancy and Vaccination WHO (2005) WHO, 2005. Op Cit
- 33. Safe vaccines in pregnancy • Hepatitis B • Influenza (inactivated ) • Tetanus-diphtheria (Td) • Tetanus-diphtheria-pertussis (Tdap) • Hepatitis A
- 34. No data are available on safety in pregnancy • Japanese encephalitis • Meningococcal meningitis • Pneumococcal • Polio,inactivated • Rabies • Typhoid (ViPSA)
- 35. Contraindicated Vaccines • Tuberculosis (BCG) • Measles-mumps-rubella • Human papillomavirus • Varicella • Yellow fever • Typhoid (Ty21a) Live bacterial • Influenza (live attenuated)
- 36. Yellow fever vaccine • live attenuated vaccine • Contraindicated in pregnancy • Fetal infection can occur • Non-immune pregnant women should be strongly discouraged from travelling to yellow fever endemic areas
- 37. Human Normal IG • Immunoglobulins, If indicated for pre- or post exposure use can be used with • No known risk to fetus
- 38. Malaria Chemoprophylaxis • Chloroquine (Chlorquin) – category D Small risk of neurological damage to the foetus during pregnancy. Taken weekly. Commence 1 week before departure and continue for 4 weeks after leaving malarial area. • Mefloquine (Lariam) – category B Not recommended in 1st trimester, otherwise safe. Taken weekly. Commence 1-2 weeks before travelling and continue for 4 weeks after leaving malarial area. • Proguanil (Paludrine) – category B Safe during pregnancy. Use only in combination with chloroquine. Folate supplementation required. Two tablets daily. • Atovaquone-proguanil combination (Malarone) – category B Folate supplementation required. Safety in pregnancy has not been established. 1 tablet daily 1-2 days before entering malarial area and continuing for seven days after leaving.
- 40. Food and Water Safety “Travellers Diarrohea” DO’S • Eat only cooked food served hot • Eat fresh fruits and vegetables only if one can peel them or wash them in clean water • Drink water or energy drinks that are bottled and sealed DONT’S • Do not eat raw or undercooked meat or fish • Do not eat unpasteurized dairy products • Do not drink anything with ice in it—ice may be made with contaminated water. Vegetarian diet is most safe for pregnant woman
- 41. SEA TRAVEL • Should be avoided after 28 wks • Special caution of motion and balance • Nausea can become worse • Can lead to decompression illness in the fetus
- 42. CAR TRAVEL • Frequent stops needed • Driving not more than 6 hrs • Presence of companion • Seat should be adjusted as far from the dashboard or steering wheel as possible • Seat belt is mandatory • Air bag instructions to be in mind in case of accidents
- 43. JAL Advisory for Pregnant women As pregnancy is not an illness, air travel does not usually present health concerns for pregnant women. However, we recommend careful planning in consideration of your destination and schedule. Precautions before travel • Consult your physician in advance to see if it is safe for you to fly. • Consult with your doctor if you have any symptoms such as bleeding or morning sickness, or if you have any complications including threatened miscarriage, anemia, or toxemia of pregnancy during pregnancy. • Reduce stress as much as possible. • The best time to travel during pregnancy is the stable period between 12 and 28 weeks. Cases when a medical certificate are required for international routes When the expected delivery date is in 4 weeks or less (36th week of pregnancy or after) • When the due date is in 14 days or less, an obstetrician must accompany the expectant mother. • The number of infant is restricted to one, and he or she needs to have his or her own confirmed seat. Also a child seat needs to be used for infants' safety. • When the due date is not certain. • When multiple births may be expected • When there were previous premature births Medical certificates • The doctor responsible must fill in the due date, whether or not it is safe for the woman to fly, and any special precautions that should be taken during travel. • Medical certificates must be completed 7 days or less before departure.
- 45. Travel if you Must only
- 50. Keep all your medical records along with important names and phone numbers
- 51. Every situation is different Recommendations should be individualized
- 52. Remind the patient that these precautions are not 100% protective
- 53. Thumb Rule for both Domestic & Foreign travels ‘ To Follow your Body’s Signal ’
- 54. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339 9599044257 011-22414049 WEBSITE : www.lifecareivf.in www.lifecarecentre.in www.lifecareabs.in ISO 14001:2004 (EMS) …..Caring hearts, healing hands ISO 9001:2008 Helpline : 9599044257 Web.www.lifecareivf.in Helpline : 9910081484 26 Year In your service