Understanding the rise in twin pregnancies and managing associated risks
Twin births account for about 2% to 4% of all births worldwide. Over the last few decades, the number of twin and higher-order pregnancies has significantly increased, largely due to advancements in fertility treatments and their high success rates.TYPES OF TWIN PREGNANCIES: MONOZYGOTIC VS. DIZYGOTICMultiple pregnancies are categorised as either monozygotic or dizygotic based on the number of gametes involved. Monozygotic, or identical twins, result from the fertilisation of a single egg by a single sperm. If the embryo divides between the third and eighth days of fertilisation, the twins share a single placenta but have separate amniotic sacs. These are called Monochorionic Diamniotic (MCDA) twins.advertisementRISKS OF SHARING A PLACENTA: TTTS IN MCDA TWINSMCDA twins are at risk of developing Twin-to-Twin Transfusion Syndrome (TTTS), a condition caused by abnormal blood flow between the twins through vascular connections in the shared placenta. One twin (the Donor Twin) transfers blood to the other (the Recipient Twin), which can lead to complications such as Single Intrauterine Fetal Demise (SIUFD). TTTS affects approximately 8% to 10% of MCDA twin pregnancies.
Although TTTS may develop without symptoms, some expectant mothers experience rapid abdominal growth, pain, swelling, or contractions. Prenatal screening plays a key role in early detection. Ultrasound imaging can reveal differences in fetal size and amniotic fluid levels, while a Doppler scan can detect abnormal blood flow. In the first trimester, a Nuchal Translucency (NT) scan may help predict the risk of TTTS.TREATMENT OPTIONS AND MANAGEMENT STRATEGIESIf TTTS is diagnosed, timely intervention is critical. Patients are typically referred to fetal medicine specialists who tailor a treatment plan. Options include expectant management, amnioreduction, selective reduction, voluntary termination, or fetoscopic laser photocoagulation—a procedure that seals off abnormal blood vessels in the placenta. Before 28 weeks of gestation, laser surgery is preferred. After 28 weeks, early delivery may be necessary to protect both babies.Inputs by Dr. Laxmi Narayan Sahoo, Consultant - Fetal Medicine and Clinical Genetics, Manipal Hospital, Bhubaneswaradvertisement
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The Hindu
10-05-2025
- The Hindu
Concerns mount over waste-to-energy project at Deonar amid pollution fears
The Brihanmumbai Municipal Corporation's (BMC) proposed 1800 TPD Waste-to-Energy (WtE) plant at Deonar, the site of India's largest dumping ground, has drawn strong opposition from residents, activists, and legal professionals, who fear the plant will further deteriorate the already poor air quality in the Govandi area, leading to grave public health consequences. The WtE project, awarded to Chennai MSW Pvt. Ltd., is slated for commissioning by October 2025 at an estimated cost of ₹2,648 crore. The facility, spread over 8.2 hectares, is expected to process 600 metric tonnes of waste daily, generating an estimated 17 million units of energy annually. However, apprehensions persist regarding the emission of harmful gases and its potential to exacerbate respiratory ailments in a region already plagued by tuberculosis, asthma, and chronic obstructive pulmonary disease (COPD). Zakir (30), a long-time resident of Baiganwadi near the Deonar site, expressed anxiety over the project's implications. 'Every other house here has a TB or asthma patient. Adding another pollutant-emitting project will make survival even harder,' he said. The area, comprising over 200 informal settlements, houses more than one million people, many of whom live in close proximity to the Deonar dumping ground and already report high exposure to toxic emissions. 'This technology may claim to control emissions, but the ground reality is different. I work at the dumping site; I see what happens,' another Baiganwadi resident, also employed at the landfill, said. Residents also voiced concerns that the same area is being earmarked to rehabilitate families displaced under the Dharavi Redevelopment Project. Legal interventions have also begun to take shape. Advocate Abid Abbas Sayyed has filed formal objections to multiple authorities including the BMC Commissioner, Maharashtra Pollution Control Board (MPCB), and Central Pollution Control Board (CPCB). In his letter, he questioned the environmental clearances granted to the plant, warning that incineration will produce carcinogens, dioxins, furans, carbon monoxide, and sulphur oxides. 'What is the guarantee this plant will not worsen existing respiratory conditions?' Mr. Sayyed asked. He pointed out that the biomedical waste facility set up in 2009 at the same site operated for five years without MPCB clearance. Despite a court order over six months ago mandating its relocation, compliance remains pending. Residents of Shivaji Nagar, like Aditya (35), shared similar frustrations. 'We were told the biomedical plant was safe. But now we wake up to black soot on our vehicles and a constant foul smell,' he said. 'The average life expectancy here is reportedly just 39 years. How much more can the BMC extract from Govandi?' The Govandi New Sangam Welfare Society has filed a petition in the Bombay High Court demanding the closure of the biomedical waste facility run by civic contractor SMS Envoclean Pvt. Ltd. Meanwhile, the MPCB claims it conducted year-long studies before approving the Deonar WtE project. Officer Rakesh Dafade stated that pollution mitigation measures, such as a 50-metre-high chimney and a scrubbing system to remove toxins from exhaust gases, will be implemented. Still, critics argue that these technical provisions do not address the core issue: lack of waste segregation. 'Deonar receives a mix of biodegradable, plastic, hazardous, and biomedical waste with no source segregation,' said Mr. Aditya. 'How will the government ensure that only suitable waste is processed for energy recovery?' Citing Rule 15 of the Solid Waste Management Rules, 2016, Mr. Sayyed's objection letter highlights the BMC's alleged failure to ensure segregation at source, scientific processing, and proper waste stream management. He noted that Mumbai's high organic waste content lowers its calorific value, making it inefficient for incineration—a fact borne out by the closure of seven out of 14 WtE plants across India. Activists and residents have called for an immediate stay on the project and demanded a fresh Environmental Impact Assessment (EIA) with stakeholder consultations. They have also urged for comprehensive environmental and health impact studies in the area and the formation of a Special Investigation Team (SIT) to audit the functioning of existing WtE facilities nationwide. An RTI application has also been filed by Mr. Sayyed to seek detailed records on the plant's clearances, approval processes, and environmental assessments. As the debate continues, the people of Govandi await clarity on whether the pursuit of energy will once again come at the cost of their health.
India Today
08-05-2025
- India Today
Understanding the rise in twin pregnancies and managing associated risks
Twin births account for about 2% to 4% of all births worldwide. Over the last few decades, the number of twin and higher-order pregnancies has significantly increased, largely due to advancements in fertility treatments and their high success OF TWIN PREGNANCIES: MONOZYGOTIC VS. DIZYGOTICMultiple pregnancies are categorised as either monozygotic or dizygotic based on the number of gametes involved. Monozygotic, or identical twins, result from the fertilisation of a single egg by a single sperm. If the embryo divides between the third and eighth days of fertilisation, the twins share a single placenta but have separate amniotic sacs. These are called Monochorionic Diamniotic (MCDA) OF SHARING A PLACENTA: TTTS IN MCDA TWINSMCDA twins are at risk of developing Twin-to-Twin Transfusion Syndrome (TTTS), a condition caused by abnormal blood flow between the twins through vascular connections in the shared placenta. One twin (the Donor Twin) transfers blood to the other (the Recipient Twin), which can lead to complications such as Single Intrauterine Fetal Demise (SIUFD). TTTS affects approximately 8% to 10% of MCDA twin pregnancies. Although TTTS may develop without symptoms, some expectant mothers experience rapid abdominal growth, pain, swelling, or contractions. Prenatal screening plays a key role in early detection. Ultrasound imaging can reveal differences in fetal size and amniotic fluid levels, while a Doppler scan can detect abnormal blood flow. In the first trimester, a Nuchal Translucency (NT) scan may help predict the risk of OPTIONS AND MANAGEMENT STRATEGIESIf TTTS is diagnosed, timely intervention is critical. Patients are typically referred to fetal medicine specialists who tailor a treatment plan. Options include expectant management, amnioreduction, selective reduction, voluntary termination, or fetoscopic laser photocoagulation—a procedure that seals off abnormal blood vessels in the placenta. Before 28 weeks of gestation, laser surgery is preferred. After 28 weeks, early delivery may be necessary to protect both by Dr. Laxmi Narayan Sahoo, Consultant - Fetal Medicine and Clinical Genetics, Manipal Hospital, Bhubaneswaradvertisement
Hindustan Times
08-05-2025
- Hindustan Times
Eli Lilly looks set to steal Novo Nordisk's weight-loss crown
Being first to market with a drug can be crucial. Eli Lilly is proving that being second but better can also pay. Zepbound, the American firm's weight-loss jab, was approved in its home country in November 2023, more than two years after Wegovy, made by Novo Nordisk, a Danish rival. Yet in 2024 Zepbound yielded $4.9bn in revenue, more than half of Wegovy's $8.2bn. On May 7th Novo cut its sales forecast for 2025, citing 'lower-than-planned' growth in weight-loss drugs. S&P Global, a financial-data firm, expects sales of Lilly's obesity drugs to overtake Novo's by 2027 (see chart 1). PREMIUM Eli-Lilly-looks-set-to-steal-Novo-Nordisk-s-weight Investors are betting that Lilly will maintain its momentum. Its share price has climbed by a third since the start of 2024; Novo's has fallen by as much (see chart 2). Lilly's edge rests on a more effective drug, better execution, some keener pricing and a stronger pipeline. Zepbound and Wegovy belong to a class of treatments known as GLP-1 agonists. First developed for diabetes, they suppress appetite by slowing digestion. Wegovy mimics the GLP-1 hormone; Zepbound targets an additional hormone, GIP, thought to enhance weight loss. That dual action matters. In a head-to-head trial conducted by Lilly, patients on Wegovy lost 13.7% of their body weight; those on Zepbound, 20.2%. A third of Zepbound users shed at least 25%, twice the share for Wegovy. Prescribing has shifted: in the first quarter of 2025 Zepbound made up 60% of total weight-loss prescriptions in America and 75% of new ones. Lilly was quicker to expand production. With Novo caught out by soaring demand, Wegovy was placed on America's official shortage list until February. Lilly sorted out its own supply by October. That left Novo more exposed to 'compounding' pharmacies, which may copy branded drugs during shortages—often at much lower prices. Novo expects revenue to rise later this year, once the shortage ends, meaning sales of copycats must stop. Lilly has also been faster to find new sales channels. In August it began selling low-dose Zepbound vials directly to patients online for $399 (users supply their own syringes). In April it partnered with Hims & Hers, an online pharmacy, to expand sales. Novo followed after. Price has mattered, too. Many insurers, including Medicare, America's public-health scheme for the old, do not cover obesity drugs unless tied to another condition. IQVIA, a health-data firm, says that more than half of obesity prescriptions in America are paid for out of pocket. Wegovy is listed at around $1,350 a month, Zepbound at about $1,000. And the pipelines? CagriSema, Novo's prospective Zepbound rival, tied with Lilly's drug in recent trials. That will encourage few doctors to switch. The results wiped 20% off Novo's share price in a day. On the next front, oral drugs, Novo has a pill awaiting approval in America. But it is costly to make, with the same active ingredient as Wegovy. Patients must also take it first thing in the morning with minimal water and wait 30 minutes before eating. David Risinger of Leerink Partners, an investment bank, doubts Novo will launch it globally. Lilly's pill, orforglipron, is cheaper to make and can be taken without fasting. Patrik Jonsson, head of Lilly's weight-loss division, says it has 'millions of tablets' available, ahead of approval expected next year. Analysts reckon orforglipron will provide $16bn in annual sales by 2030. Both firms face trouble ahead. Donald Trump's tariffs, though on hold for now, could hurt. Neither makes its entire American supply locally. Last year Novo's parent agreed to pay $16.5bn for Catalent, an American manufacturer, to boost production. In February Lilly pledged to invest $27bn in production at home. Still, Mr Jonsson points out that 'reshoring takes time'. A factory takes at least three to four years to build. Battles over price regulation in America, the largest market, are another concern. Mr Trump wants to match prices abroad, which are typically lower. Medicare, which covers 66m Americans, has also dropped a plan to reimburse obesity drugs. Even so, both firms can look forward to fat profits. More than 100 companies are developing weight-loss drugs, but for now it is a duopoly. Analysts expect that by 2030 Lilly will have 47% of a $90bn-plus market, to Novo's 40%. And Denmark's former star still has time to shape up. To stay on top of the biggest stories in business and technology, sign up to the Bottom Line, our weekly subscriber-only newsletter. Eli-Lilly-looks-set-to-steal-Novo-Nordisk-s-weight
