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Know thy ‘Labour’…

Labour…’ 

Labour pains

‘The process of expulsion of fetus, placenta and membranes’ is called Labour. The uterine musculature has a natural tendency to expel anything inside; however the fetus is contained in the uterine cavity for nine months for nurturing and growth. Once the growth schedule is over, the musculature gets ready to expel everything. The Uterus is a bag of muscles with opening at the bottom. It has to contract hard and push the fetus against the closed cervix (opening). Fetal head is pushed down on soft cervix which gets stretched and dilated to full 10cm diameter. This is the first stage of labour.

In second stage of labour the fetus is pushed through a narrow birth passage and out in the world, with a little effort of mother.

The third stage comprises of expulsion of remaining placenta and membranes. The uterus not only contracts but retracts too, which means every time the muscle fibre contracts, it does not relax again, it shrinks. So the muscle fibre contracts and shrinks (retracts) there by pushing its contents further down and out.

This process of expulsion once triggered can’t be stopped by any means. So once the uterine contraction begins, it starts to finish.

This whole process involves “A lot of WORK” by the uterus and mother…..that’s why it is called LABOUR = work.

There are many uncertainties involved in this journey of Baby being born naturally (read normally).

I will share some interesting facts about this physiological process, in my next blogs…

 

PCOD myths!!

Polycystic ovarian syndrome (PCOS) or Polycystic ovarian disease (PCOD) is a leading cause of infertility which affects some 35 per cent of women in their reproductive years. The incidence of PCOS is rising, perhaps due to changing lifestyles, particularly, altered diet and exercise patterns. Its primary cause remains unclear.

Young women who get diagnosed with PCOS commonly seek medical attention because of irregular menstrual periods, missed periods, obesity, infertility, acne, excessive hair growth and thinning of hair on the scalp. Symptoms begin to show up around puberty and start of menstruation. However, many do not develop symptoms until their mid 20s.

It has been shown that PCOS is an insulin-resistant state. This means there is too much insulin which is likely to cause testosterone overproduction by the ovaries. High levels of testosterone lead to absence of egg release (an ovulation), amenorrhea (missed periods) and infertility.

PCOS has also been linked to high cholesterol levels, high blood pressure and abdominal obesity. It increases the risk of type II diabetes, heart disease, endometriosis and cancer.

Diagnosis of PCOD has to be by Hormonal study. USG evidence of polycystic ovary can be due to other causes like Hypothyroid & high Prolactin as well. Diagnosis is confirmed by high levels of Insulin and Luteinising hormone along with high male hormones at times.

Weight loss is essential for obese women with PCOS. It has been shown that even a 10 to 15 per cent weight reduction resulted in spontaneous conception in about 75 per cent of obese infertile women with PCOS.

A healthy diet also helps. Low glycemic food products like wheat bran, barley, oats, grainy breads, whole seeds, lentils, kidney beans are recommended as they are digested slowly and induce less insulin secretion. They are associated with increased HDL, weight loss and improvement in insulin sensitivity and PCOS.

However changing lifestyle is the key factor. Increase fat burning exercises & healthy eating is the only way to keep PCOD away.

 

Adolescence

 

Adolescence” literally means to ‘grow up’. It is an important milestone in everyone’s life, when the innocence of childhood ends and maturity & responsibility of adulthood start appearing. This transition is usually leads to turmoil and frustration for parents as well as children. However this also is the time for foundation of healthy habits which are most essential for their future life.

An adolescent by definition is the young person between the ages of 10 and 19 years. Although adolescence and young adulthood are generally healthy times of life, several important public health and social problems either peak or start during these years. Examples include:

  • Malnutrition (under & over)
  • Lack of fitness
  • Depression/aggressive behaviour
  • Suicidal tendency
  • Motor vehicle crashes, including those caused by drinking and driving
  • Substance use and abuse
  • Smoking
  • Sexually transmitted infections, including human immunodeficiency virus (HIV)
  • Teen and unplanned pregnancies

Because they are in developmental transition, adolescents and young adults are particularly sensitive to environmental influences including family, peer group, school,

Family

  • Healthy habits starts at home, parent with healthy habits carry a major influence in the children’s mind.
  • Adolescents who perceive that they have good communication and are bonded with an adult are less likely to engage in risky behaviours.
  • Parents who provide supervision and are involved with their adolescents’ activities are promoting a safe environment in which to explore opportunities.
  • Parents, who guide their children with their peer group, help them keep healthy habits.
  • The children of families living in poverty are more likely to have health conditions and poorer health status, as well as less access to and utilization of health care.

School

  • Academic success and achievement are strong predictors of overall adult health outcomes.
  • High school graduation leads to lower rates of health problems
  • The school social environment affects students’ attendance, academic achievement, and behaviour.

 Neighborhoods

Adolescents growing up in distressed neighborhoods characterized by concentrated poverty are at risk for a variety of negative outcomes, including poor physical and mental health,  and risky sexual behaviour.

Parents as well as the society needs to focus on these growing children/adults. They need ‘tender loving care’ along with disciplinary hand in order to make them grow in to a healthy responsible citizen of the country.

 

 

 

History of Cesarean Section

Oxford English dictionary defines Caesarean birth as “the delivery of a child by cutting through the walls of the abdomen when delivery cannot take place in the natural way”, as was supposedly done in the case of Julius Cæsar’s birth.

Bindusar, the second Emperor of Mauryan dynasty of India is said to be the first child born by surgery. His mother, wife of Chandragupta Maurya, accidentally consumed poison and died when she was close to delivering him. Chanakya, the Chandragupta’s teacher and advisor, made up his mind that the baby should survive. He cut open the belly of the queen and took out the baby, thus saving the baby’s life.

Those days, Caesarean section usually resulted in the death of the mother; the first recorded incidence of a woman surviving a Caesarean section was in the 1580s, in  Switzerland Jacob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labour.

However, there is some basis for supposing that women regularly survived the operation in Roman times. For most of the time since the 16th century, the procedure had a high mortality rate. However, it was long considered an extreme measure, performed only when the mother was already dead or considered to be beyond help.

In Great Britain and Ireland, the mortality rate in 1865 was 85%. It is less than 200/100,000 (<2%) in India.

Key steps in reducing mortality were:

  1. Introduction of the transverse incision technique to minimize bleeding by Ferdinad Adolf Kehrer in 1881 is thought to be first modern CS performed.
  2. The introduction of uterine suturing by Max Saenger in 1882
  3. Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912)
  4. Adherence to principles of Asepsis
  5. Advanced Anesthesia
  6. Blood Transfusion
  7. Antibiotics

 

Laparoscopic Hysterectomy FAQs


H
ysterectomy is most commonly performed gynaecological operation in women. Thousands of women undergo hysterectomy for variety of conditions from endometriosis, Dysfunctional uterine bleeding, Fibroid uterus etc to cancer. Unfortunately more than 85% of these surgeries are still performed by abdominal incision (Laparotomy). This is known as Total abdominal hysterectomy (TAH).

Regardless of the pathology leading to hysterectomy (except cancer) most patients undergoing hysterectomy can have vaginal hysterectomy or Laparoscopic Hysterectomy and should be able to go home after 48 hours. Most are able to resume normal activities between 10-20 days following surgery.

Here is an attempt to answer some of the queries in a patient’s mind:

  • What is laparoscopy?
  • Laparoscope is a tiny ½” diameter telescope that allows surgeon to look inside the abdomen through a tiny hole at the umbilicus. A variety of surgeries can be performed with its help without making large incision. We can coagulate, cut, suture, repair and remove organ.
  • What procedures can you perform with laparoscopy?
  • Some of the procedures done laparoscopically include removal of ovary, ovarian cyst, ectopic pregnancy, extensive endometriosis and uterus as well. We can also perform fertility enhancing surgeries such as opening up obstructed fallopian tubes.
  • You mean you can do all that through a ½” laparoscope?
  • That’s right! With availability of improved video equipment and technology, we do the surgery by looking at the greatly magnified pictures on TV screen with the help of sophisticated camera, telescope, and bright cold light source. We then proceed to identify and separate the surrounding the organs surrounding the uterus, tubes and ovaries with the help of few more instruments through other ports. Telescope allows us to visualize inside the abdomen. As you know uterus and vagina is connected, so once uterus is freed from surrounding tissue the vagina opens up and uterus is removed from the vagina. We can then just close the tip of vagina with few dissolving sutures.
  • How many holes will there be on my abdomen?
  • Well, one 1cm at the umbilicus and two or three tiny 1/2cm size laterally below umbilicus, that’s all.
  • How long the surgery will take?
  • About 1 ½ hours on average. However it may vary from patient to patient and surgeon to surgeon.
  • What about gas pain? I had it at the time of my sterilization operation.
  • You may have little discomfort due to gas, because abdomen is distended by CO2 in order to see the pelvic organs. Once the surgery is over, gas is deflated and CO2 is absorbed within 24 hours, so you should not really have any problem.
  • Will I able to have a laparoscopic hysterectomy, if I have large fibroid uterus?
  • Yes, you can. Size of the uterus should not matter in performing laparoscopic surgery. Fibroid as large as 10-12cms can also be removed by variety of techniques.
  • Is it true, that one can not see as well inside abdomen while performing vaginal or laparoscopic surgery, as while during open surgery?
  • Well, laparoscope offers 6-8 times magnification and we can in fact see the entire pelvis much better than we could do so in an open surgery with naked eye. Difficult surgery can precisely be done better in this manner and this is a major advantage.
  • Is it risky to have this laparoscopic surgery? Isn’t it better to have it traditional way?
  • Procedure is absolutely safe in the hands of a skilled and sufficiently trained Gynecological surgeon. In fact the need for doing an open surgery for benign (not cancerous) conditions has been markedly reduced. We perform such laparoscopic hysterectomy and laparoscopic assisted vaginal hysterectomy in nearly 95% of non cancerous conditions.
  • I had a previous open surgery like Caesarean section or appendix; can one perform laparoscopic surgery after this?
  • Yes, it can be done with due precautions. Numerous studies have shown this to be completely safe.
  • I never been pregnant and never had a normal delivery, can you perform a vaginal hysterectomy?
  • Yes it can be done. Laparoscopically assisted vaginal hysterectomy and Total laparoscopic hysterectomy were developed with this situation in mind, where one procedure can be complimenting the other.
  • But then why this procedure is not offered by all doctors?
  • Well, it’s not a new technique anymore, but many gynecological surgeons are not trained and experienced in this technique. Most can do the open surgery very well (old golden standard); hence the open surgery is recommended.
  • Is this surgery very expensive?
  • Well, this type of surgery requires many sophisticated electronic gadgets and equipments, which are costly; hence some expenses are bound to be there. However considering the advantages of shorter stay in the hospital, less discomfort and pain-killers, early ambulation, early return to work; the comfort of the surgery has to be balanced. We think the money spend is a relative term, in relation to the comfort of the patient. It is gratifying to see a major surgery patient nearly pain free, comfortable and smiling immediately after surgery, and asking – ‘have you really done the operation?’, As against, a patient who has a major open surgery and can hardly move in bed due to pain for first few days and later need lots of pain killers to be comfortable.

Menopause Myths!

Menopause is a natural process in which menstruation definitively ceases and a whole array of unfamiliar symptoms appear. It is a transitional moment in a woman’s life, and almost every woman entering menopause is filled with questions and concerns. Menopause F.A.Q. is intended to answer all these questions, and to help improve women’s health and quality of life through a better understanding of menopause.

Q: What is Menopause?

A: Menopause is the end of menstruation and the end of childbearing years. You are not considered to have reached menopause until you have gone one full year without any bleeding or spotting. Menopause, often referred to as “the change of life,” is the natural transition out of childbearing years. Menopause in women is the reverse of puberty.

Q: What happens during Menopause?

A: Every woman is born with fixed amount of eggs in her ovaries, which are used up throughout her menstruating/child bearing years. During menopause, the ovaries gradually produce lower levels of estrogen and progesterone, the female hormones.

Q: What Estrogen & Progesterone do in our body?

A: Estrogen is known as a ‘female hormone’ and plays a key role in shaping the female body. One of estrogen’s primary roles is to promote the growth of cells in the breast and uterus and estrogen affects many aspects of women’s physical and emotional health. Progesterone is the second most important female hormone. Progesterone is primarily responsible for regulating the reproductive cycle.

Q. What is the average age of perimenopause?
A. The average age is 48 years old; however the physical and emotional changes of perimenopause can begin to occur as early as the late thirties.

Q. What are the symptoms of perimenopause?

A. The most common symptoms are the following: irregular periods, mood swings, difficulty getting to sleep, decrease energy, heart palpitations and occasional hot flashes.

Q. How do I know if I am in perimenopause or menopause?

A. You are in perimenopause if you are still having any periods of any length or frequency.

Q. Is there a blood test that I can take to determine if I am in menopause?

A. Follicle stimulation hormone (FSH) can be suggestive of menopause years.

Q. How long do menopausal symptoms last?

A. It varies from woman to woman. The majority of symptoms can last anywhere from six months to two years. Some women have complained of experiencing hot flashes occasionally for the rest of their life. This is the minority.

Q. What lifestyle changes would you recommend to a woman going through menopause?

A. During the time of menopause, a woman may find herself with more time to spare as circumstances in life take a change. It’s also a time to look at making life as healthy as possible. She can start exercising, doing yoga or Pilates. She can look at intimacy with her partner and ways to reconnect.

This is a time when a woman can really start to look at and care about her health – cholesterol, diet, exercise, and sex life. People are often more open to making changes at these times, since life may be less hectic.

In general, good health habits in women experiencing menopause are also good health habits in general. Here are some tips:

  • Get about 150 minutes of exercise each week, including Yoga & Pilates
  • Follow a low-fat, low-cholesterol diet.
  • Regular Meditation to keep mental harmony
  • Try to maintain healthy weight for your height.
  • Maintain bone strength. The physical activity you do each week should include weight-bearing exercises at least 2 times each week. WHO guidelines now recommend daily intake of 1,500 mg of calcium and 1,000 IU of vitamin D to keep bones healthy.
  • See your doctor regularly. Get a regular Pap test, mammogram, bone density test (if recommended by your doctor), and bowel exam.

Women today are living into their 80s, so they are spending one-third of their life in menopausal years. We want those years to be healthy and vibrant, not housebound or fragile. Don’t let menopause keep you from leading a fulfilling life.

 

Achieve and maintain a healthy weight in pregnancy

The amount of weight a woman may gain in pregnancy varies a great deal, and only some of it is due to increased body fat. The unborn child, placenta, amniotic fluid and increases in maternal blood and fluid volume all contribute to weight gain during pregnancy. A woman gains average 10 to 12 kg during her pregnancy. More than 12-14kg is hard to loose. An obese woman should not gain more than 8-10kg. Here are few tips to maintain healthy weight in pregnancy…

 

  • Dieting during pregnancy is not recommended as it may harm the health of the child.
  • Always eat breakfast
  • Eat frequently but watch portion
  • Avoid starchy food like maida, potato, too much rice, but include whole grain, beans, nuts sprouts, cereals
  • Avoid sweets and fats
  • Drink low fat milk
  • Have grilled meat instead of gravy
  • Add 4-5 portions of fruits & vegetables
  • There is no need to ‘eat for two’. Energy needs do not change in the first six months of pregnancy. Only in the last three months do a woman’s energy needs increase by around 200 calories per day.
  • Avoid sedentary habits
  • Moderate-intensity physical activity will not harm the mother or baby. At least 30 minutes per day of moderate intensity activity is recommended. This can include activities such as swimming or brisk walking. If women have not exercised routinely up to that point, they should begin with no more than three 15-minute sessions a week, increasing gradually to daily 30-minute sessions.
  • Regular stretching exercises must be included in the schedule to be fit and flexible

 

Eat smart, exercise regularly, remain active…let pregnancy be a motivation to be fit & healthy!!

 

 

 

 

Why your weight matters during pregnancy and after birth?

Most women who are overweight have a straightforward pregnancy and birth and deliver healthy babies. However being overweight does increase the risk of complications to both you and your baby. This information is about the extra care you will be offered during your pregnancy and how you can minimize the risks to you and your baby in this pregnancy, and in a future pregnancy. Your doctor will not judge you for being overweight and should give you all the support that you need.

What is BMI?

BMI is your body mass index which is a measure of your weight in relation to your height. A healthy BMI is above 18.5 and less than 25. A person is considered to be overweight if their BMI is between 25 and 29.9 or obese if they have a BMI of 30 or above. Almost 1 in 5 (20%) pregnant women have a BMI of 30 or above at the beginning of their pregnancy.

Your BMI is calculated at your first visit to the doctor.

What are the risks of a raised BMI during pregnancy?

Being overweight (BMI > 25) increases the risk of complications for pregnant women and their babies. With increasing BMI, the additional risks become gradually more likely, the risks being much higher for women with a BMI of 40 or above.

Risks for you associated with a raised BMI include:

Thrombosis

Thrombosis is a blood clot in your legs (venous thrombosis) or in your lungs (pulmonary embolism). Pregnant women have a higher risk of developing blood clots compared with women who are not pregnant..

Gestational diabetes

Diabetes which is first diagnosed in pregnancy is known as gestational diabetes. If your BMI is 30 or above, you are three times more likely to develop gestational diabetes than women whose BMI is below 30.

High blood pressure and pre-eclampsia

A BMI of 30 or above increases your risk of developing high blood pressure. Pre-eclampsia is a condition in pregnancy which is associated with high blood pressure and protein in your urine. This can be a serious condition and needs urgent attention.

Risks for your baby

Higher incidence of abortion, premature delivery, associated BP & Diabetes complication. Large baby can pose difficulty during labour.

Difficult Caesarean section and wound healing.

Post delivery lactation difficulties due to large heavy breasts.

So ladies please watch your weight…and remain healthy!!

 

 

Prepregnancy Counseling

Preconception counseling consists of two major issues.

1. Finding out if there is any associated medical problem, and correcting it.

2. Advice regarding additional nutritional & fitness demands

The goal of this counseling is to provide the information that a woman and her partner need in order to make informed choices about planning a pregnancy and to ensure the best possible outcome for the couple and the baby.

1. Medical assessment:

Your doctor should take your medical history & may also ask about the potential father’s medical history. This checkup may also include an overall physical exam, pelvic exam along with blood and urine tests. Pre-pregnancy visits especially benefit women with certain conditions that can make a pregnancy more difficult like those:

  • have heart or kidney disease, high blood pressure or other chronic conditions such as diabetes, lupus, or HIV/AIDS
  • have a history of unexplained stillbirths, miscarriage, or have had other children born prematurely
  • know you are at personal risk of having a child with birth defects or a genetic disorder
  • have or have had a sexually transmitted infection
  • have a weight problem
  • older than 35

2. General advice

  • Folic acid – Is essential for fetal development and lack of it can lead to fetal malformation. Folic acid is naturally available in green vegetables, fortified cereals, Oranges & beans. However it is difficult to get required Folic acid from diet alone, hence a tablet of Folic acid 5mg is recommended at least for 3months prior & 3months during early pregnancy to all expectant mothers.
  • Vit B12 – Need to be supplemented specially to completely vegetarian diet and those with deficiency.
  • Vit D – Along with Calcium helps to reduce pregnancy complications like Diabetes and Hypertension disorders.
  • AVOID – Smoking, alcohol, exposure to radiation, hazardous drugs & chemicals.
  • AVOID – self medication or unknown drugs including herbal medicines.
  • Always mention to your doctor that you are planning pregnancy. Since conception takes place before you miss a period and before you know that you are pregnant.
  • Weight management – Has been a concern to all. Excess weight in women during pregnancy poses lot of health hazards like hypertension, diabetes etc. Underweight women also face problems of poor growth of baby. Therefore it recommended to reach a near ideal weight before planning pregnancy.
  • Exercise – Yes. The more fit you are, the easier your pregnancy and delivery may be. But if you exercise too much, it can make getting pregnant harder. And overdoing it once you’re pregnant can be dangerous. If you haven’t been exercising, start before you get pregnant. While you are pregnant, you can probably keep up a light exercise program. Walking every day is good exercise along with gentle stretches keeps you fit & flexible.

 

We can discuss many more questions on this subject…if you have any.. please ask…

 

 

 

Welcome to my website!

Hello all! This is just an introductory blog post to introduce you to my professional website. The primary purpose of this site is to provide information about my medical practice as well host my blog. I plan to write articles on women’s health issues, particularly reproductive health. Occasionally I may post some articles targeting physicians and medical students.

I also have a new Facebook page. Be sure to ‘like’ it so as to get updates from me.

So what do you think about the website and this blog? Send me your ideas and suggestions in the comments below.