Dr Nameeta Bhalerao studies the 18-week scan of her pregnant patient, keeping her eyes peeled on every shadow and bulge on the image that indicates the size of organs developing in the foetus. The gynaecologist, who runs a clinic in Pune’s suburbs of Baner, goes over the bones, heart, brain, spinal cord, face, kidneys and abdomen. There are no indications of abnormality. She pans the brain again, double-checking its shape and size as marked by a sonographer before she gives the all-clear sign.
The 37-year-old pregnant woman sitting in her chamber breathes a sigh of relief as she had contracted zika, a viral infection spread by the Aedes Aegypti mosquito, about three weeks ago. Since abnormalities are detected as early as two weeks after onset of symptoms, she rushed to Dr Bhalerao’s clinic as soon as her waiting period ended. There’s a lot at stake for both the doctor and patient. “She had a miscarriage during her first pregnancy and had conceived again with an in-vitro fertilisation (IVF) procedure. Meanwhile, there was an outbreak of the zika virus infection in these parts and she got worried when she had a mild fever and an itchy rash in the 15th week of her pregnancy. Fearing it had caused birth defects and other complications in the foetus, she had been on the edge as she waited for screening,” Dr Bhalerao says.
HOW ZIKA AFFECTS PREGNANT WOMEN
The zika virus, which is transmitted by mosquitoes when they bite humans, spares the adults but not the developing foetus as it reaches it via the mother’s bloodstream and placenta. It can damage the foetal nervous system, affecting how the brain and nervous tissues function. It can shrink the baby’s head, what is known as microcephaly, affect brain development, trigger feeding problems, hearing loss, vision problems, seizures and decrease joint movement. The mother could even miscarry, have a stillbirth or deliver pre-term.
Pregnant women, especially those in the first trimester, have reasons to be concerned.
“The 18th week anomaly scan has boosted my patient’s confidence levels but she will have to be monitored constantly. Infected pregnant women need foetal ultrasounds every third or fourth week to check for developmental disorders. Abnormalities have been detected anywhere between two and 29 weeks after onset of infection. Otherwise, she can be on a normal diet and health protocols,” says Dr Bhalerao, who has her hands full these days with Pune reporting the highest numbers of zika cases in Maharashtra.
Pregnant women, especially those in the first trimester, have reasons to be concerned. Babies born with congenital zika syndrome, due to the viral infection during pregnancy, are at more than 11 times greater risk of dying during the first three years of their lives than those born without the syndrome, according to a study published in The New England Journal of Medicine. The most recent research suggests that the rate of infection for a foetus may be between one and 13 per cent if a pregnant woman contracts the virus in the first trimester. The chances of a foetus getting infected in the second and third trimesters are lower but cannot be ruled out as more research is needed. That’s why all pregnant women in known zika zones should go in for screening and anomaly scans. Those with foetal anomalies in the first trimester (12 weeks) are advised abortion. Doctors usually do a thorough counselling session so that patients can make an informed decision based on risks to their unborn child. If an abortion is needed between 12 and 20 weeks on the outside chance that an anomaly is detected later, then two signatures of different gynaecologists are required.
Just 10 km away from Baner is Dr Ameet Dravid’s private clinic on Bhandarkar Road. It’s 3 pm on a Friday afternoon, far beyond his OPD hours, but he is still attending to patients, some of whom have travelled from as far as Belgaum in Karnataka. “If there is a zika infection in the first trimester, the chance of an anomaly is anywhere between three and five per cent,” he adds. He then advises 50-year-old Reena to watch over her pregnant daughter with a hawk’s eye. “Ensure she wears full-length clothes, stays in a room with net screens, sleeps with mosquito nets and stays hydrated. She must wear socks and shoes,” he tells her. Dr Dravid advises against use of non-steroidal anti-inflammatory drug (NSAID) family of painkillers (like ibuprofen, naproxen and diclofenac). “Paracetamol and codeine can be safely used at any time,” he adds.
FOR ADULTS, IT’S JUST ANOTHER FEVER
Dr Dravid is attending to a middle-aged woman, whose back and knees hurt a lot. She has a headache and persistent fever that has affected others in her village. During the clinical examination, he first looks for tell-tale red and purple spots and is almost convinced it is not a case of the zika virus. Given her shooting joint pain, he feels it could be chikungunya. “Ideally, any patient with overlapping symptoms like fever, chills, body ache, light sensitivity, pain in the eye, nausea and vomiting during this season should get tested for all mosquito-borne infections, including zika, dengue and chikungunya. But most patients shy away as the tropical fever panel test costs upwards of Rs 5,000 and is not free in the government sector. Hence, we rule out these diseases with simple blood tests,” he says while prescribing medicine. Zika is largely asymptomatic in 80 per cent of patients. A majority have mild symptoms and may develop conjunctivitis. But it could get complicated in those with underlying conditions.
The zika virus, which is transmitted by mosquitoes when they bite humans, spares the adults but not the developing foetus as it reaches it via the mother’s bloodstream and placenta. (File photo) 
Pregnant women, especially those in the first trimester, have reasons to be concerned.
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