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Stages of labour

2011-04-08T12:05:00.000-07:00

Labor is the onset of pain full uterine contraction with progressive dilatation and effacement of cervix and culminating with the delivery of the baby with its placenta and membranes.

Labor and subsequent delivery is a sequence of events. For some fortunate woman it can be over in a matter of few hours with moderate pain, may be just a backache.But for few who are first time moms it can be a real trial of physical and mental strength.As every woman is different and unique so also is each labor. It can vary from one pregnancy to other in the same woman.Presuming everything goes normal labor is divided into three stages.

1st stage of labour:-It is the longest of all corresponds to the onset of labour pain and contractions and progressive dilatation and effacement (thinning out)of cervix till it attains full dilatation of about 10 cms .If you are experiencing labour for the first time , effacement happens first and then the cervix progressively dilates. In case of experienced mothers effacement and dilatation usually happens simultaneously..The median duration of 1st stage is about 12 hour in 1st timers and 6 hours in experienced moms.This stage is further divided into

Early or latent phase and
Active phase

Early or latent labour

It is the beginning or rather preparation of labour.It can extend upto days.The contractions are usually the intensification of Braxtonhicks which starts aeound 26 weeks . In this stage your cervix starts thinning(effacement) and dilating.You will experience mild painfull contraction or backache.The pain is usually not unbearable.You should expect to get pain every 5 to 20 minutes which stays for about 40 to 60 seconds.You may also experience reddish mucoid discharge vaginally .This is due to the dislodgement and expulsion of the mucus plug in your cervix as it dilates progressively.

Duration of latent labor

Well you have to be patient.As i have already stated 1st stage is the longest of all and this particular stage can stretch for days specially if you are a first timer.

What You should do

Try to relax
take light easily digestible snacks
maintain proper cleanliness and maintain hygiene
you can carry out light household works also if you prefer
choose a position which gives you maximum comfort
You can stay at home until your labour pain grew stronger ,which is an indication itself that you are going into active stage and you should had for a specialised delivery unit.
Usually your membranes do not ruptures at this stage , but if it does you should head straight to your labour and delivery unit even if you do not have strong pain.

Active Phase

This is the period where the actual work takes place ,both by you and your baby. Your contractions will grew more stronger and will come more frequently.Your pain will also increase in intensity at the same time.You will start to get 3 to 4 contractions within a period of 10 minutes.On an average your cervix will open up at the rate of about 1.2cm/hour in case of primigravida(1st time mom) and about 1.5cm/hour in case of multigravidas(experienced moms)Your membranes may rupture at any stage.You may have backache also. You might have a tendency to push but you should wait till your doctor says you are ready . premature pushing may lead to edema of your cervix which might delay the pregress of your labour.Also at times it might lead to trauma to your cervix and lead to bleeding during pregnancy.As you grew nearer to your second stage you may not have an actual pain free period and will have a tendency to push as the baby reaches lower down

What can you do to help yourself

Try to relax in between contractions
Take deep breath during contractions
Do not push unless told to do so
choose a position whichever comforts you more
can have a gentle massage on your back to ease the pain
If you want to walk you can do so,but if you have ruptured your membrane it is better not to do so .
You can ask for pain less delivery if you want.your doctor will arrange for what is best for you.

2nd stage :- Delivery of the baby

Now its the time to bring your angel to this world.It may last for 1 to 2 hours.Multigravidas as usual will have a shorter course.you will have a strong urge to push

What you should do

Push with the contractions
Try to relax in between contractions
Do not shout unnecessarily as you might exhaust yourself
When you push do not put tension in your face and neck .
Choose a position which is comfortable for you. Most prefer a semi reclining position with the legs and thighs bent
You can hold to something if it helps you to push better.

What your doctor does at this stage?

Will assess you whether its time to push or not
Might do an episiotomy(A little incision given in your perineum if it threatens to tear)
Will give you a jab of local anaesthesia prior to episiotomy
Might ask you not to push gently or not at all to allow vaginal tissue to stretch naturally in between contractions
After your baby"s head is born she will clear her airways and see for any turns of cord around baby"s neck.If there is will remove it before delivering rest of the body
Rest of the baby"s body usually soon follow a gentle pull

3rd stage :- delivery of the after products , namely placenta and membranes.

After the birth of your baby you will have a great sense of relief.You can hold your baby and feed her too.feeding your baby early actually helps in the expulsion of placenta .

If you have decided to go for stem cell banking blood will be collected from your placenta before it is delivered once your baby is out.

You may be asked to push one more time to deliver your placenta.Your Doctor will make sure that you have expelled the whole placenta and membranes. She will also control your bleeding if there is any and repair any tear or episiotomy incision.

You will be observed for a period of at least 2 hours after delivery to check for any bleeding or any complication

Now is the time to cherish and care for your baby after all these hard work. So enjoy your motherhood and stay healthy.

Heart burn in pregnancy

2011-04-05T23:39:00.000-07:00

Heartburn is a common condition for many, unfortunately, is even more common for women during pregnancy. The acidity is caused by stomach acid to escape and move into the esophagus. It can create pain, pressure and burn the women during pregnancy and naturally women would like a natural and effective solution that will not affect your growing baby.

There are two reasons why the heartburn becomes a particular issue for pregnant women

First, the growing baby restricts a woman's organs. The stomach, in particular, is pushed up and restricted. This physical pressure can force stomach acid into the esophagus causing pain and can damage the esophagus.

Secondly, during pregnancy, progesterone levels rise.Progesterone serves many beneficial functions to protect the growing fetus and the strengthening of the placenta. The disadvantage is the high level can also cause swelling and relax the esophageal sphincter allowing acid to escape the stomach. Progesterone also may slow the digestion process.

Resources are available over the counter, but pregnant women should really take the advice of doctor before taking any of these remedies. A better approach might be to adopt some simple lifestyle changes.
The following steps should be helpful...

Try to eat smaller meals and eat 5-6 meals a day instead of the traditional three large meals. To distribute food in this way you are allowing your stomach to digest food more efficiently and are avoiding creating more pressure than necessary.

Try eating more slowly. Chewing food thoroughly is also compatible with your digestive system. One way to curb your power is to put your fork down between mouthfuls.

Avoid spicy foods and foods high in acidity.. Also note any food that seems to be a trigger for heartburn.

Foods high in fat, particularly animal fats, can be difficult to digest. Eat in moderation

Drink plenty of water, as it will help your digestive system. A glass of water will also provide very fast, unfortunately temporary, acid wash solution into the stomach.

Wear comfortable clothing that does not restrict the stomach.

Never go to bed with a full stomach. . Staying vertical will allow gravity to help keep the acid in the stomach.

You can use pillows to support the upper body to help you sleep.

Finally, if you have not stopped smoking to protect your growing baby , then here's another good reason to quit smoking as well make heartburn less common.

The good news is that the symptoms of acid reflux is likely to ease after the birth of your baby...

Using the methods I have described will also help control symptoms during pregnancy.

Mumps in pregnancy

2011-04-02T01:27:00.000-07:00

   Mumps is caused by a virus of paramixovirus family which attacks your salivary glands. mostly the parotid glands.Usually there is bilateral involvement but unilateral involvement is also seen .
   The incubation period(The time taken for the virus to enter your body and produce symptoms) is usually 14 to 18 days , but may vary from 7 to 23 days . Once you are infected you are Most infectious 3days prior to 4 days after the onset of symptoms.
   The incidence in pregnancy is 0.8 to 10 case per 10,000 pregnancies. Mumps is highly contagious and it spreads by droplet infection as mentioned below

coughing.
sneezing
or using used hand towel , linens etc
Sharing utensils.

What are the risk if you have mumps during pregnancy

Till now there is no report of any congenital anomaly of the baby which has been specifically associated with Mumps during pregnancy.However If contacted in 1st trimester( Initial three months ) of pregnancy there is a higher incidence of spontaneous abortion. There is however a questionable association of intrauterine mumps and endocardial fibroelastosis.

If your baby gets infected with mumps inside your uterus while you had Mumps infection it may leads to respiratory distress after delivery of your baby.Also neonatal thrombocytopenia and spleenomegaly has been seen in perinatal infection(Infection acquired within7 months in utero to 7 days of birth).

Usually your baby is protected from Mumps upto about 18 months by the maternal antibodies which he gets through your milk.So do not forget to feed your baby your milk.

Symptoms of Mumps infection

Fever
Loss of appetite,
Sore throat,
Chills,
Headache
Malaise,
Body ache and
Swelling and tenderness of one or more salivary glands most commonly the parotid gland.These are located within your cheek near your jaw line below your ear.
One third of patients might not have any symptoms.

symptoms usually improves after 1 to 2 weeks .

Complications of Mumps infection

Aseptic meningitis : Inflammation of the membranes covering brain
Encephalitis : Inflammation of the brain itself
Glomerulonephritis : Inflammation of the kidney .
Myocarditis, : Inflammation of the muscles of heart
Mastitis : Inflammation of the breast
Oophorotis, : Inflammation of the ovaries
Thyroiditis : Inflammation of the Thyroid glands located infront of your neck
Pancreatitis : Inflammation of the pancreas
Arthritis : Inflammation of the joints
Hearing loss usually permanent..

Thankfully these complications are very very rare.

preventing mumps during pregnancy

There is a vaccine called MMR to protect you from mumps and two other diseases namely measles and rubella. It is given in childhood between 1 to 5 years.If you have not been given MMR in your childhood and you have never had mumps before you can take the shot if you are planning for pregnancy.Once you get the shot do not get pregnant for at least 1 month.

you can not take MMR vaccine during your pregnancy as it can cause infection to your baby as it is a live vaccine.

Other measures which might help are

frequent hand wash with soap and water
do not share utensils .
do not touch your eyes nose or mouth with your hands.
avoid getting close to persons with active mumps or suspected mumps infection.

How to diagnose Mumps Infection

High degree of suspicion and the tell tale signs of infection are usually sufficient to diagnose

treatment of Mumps in pregnancy

As such there is no treatment of mumps.we only provide you symptomatic relief.

Medications such as ibupruphen or acetaminophen can be used to bring down fever.
Take plenty of fluid to keep yourself well hydrated.
Use hot or cold fomentation to decrease pain and swelling.
Well nutritious soft blend diet.
Take enough rest
Warm saline water gurgle.
Do not take any fruit juice or acidic food as it might lead to stimulation of salivary glands and cause pain.

Man"s role in pregnancy

2011-03-29T09:54:00.000-07:00

Many a times I get patients who complain about their husband being very indifferent towards them during pregnancy . So i decided this little piece to be dedicated to the" papa to be".

   I know that you are also apprehensive and probably has lots of queries and insecurities yourself,or may be you yourself do not know what you can do for your girl. but plz consider the fact that your girl is actually the one carrying the baby so give priorities to her problems first.If you want to talk to her about anything which is bothering you plz be very straight forward and talk to her.Hiding from problems will not lead you anywhere.instead of running to garage or your friends place be brave and face your problems and insecurities head on.
   It really does not matter whether your wife is pregnant for the first time or the 4th, every pregnancy is different from the other so do not think that if your girl is pregnant before she will not need the emotional and physical support this time.
   when a woman is pregnant there are lots of changes that takes place in her body.
During 1st 3 months.:
   This is usually the most trying time as her body is experiencing the changes for the first time.she is most of the time not feeling well and might have lost appetite or worst may be vomiting also , so please do not expect her to be in best of her mood all the time.try to be sympathetic to your girl and be less demanding both physically and emotionally.
   You may also be bombarded with lots of baby talk as your girl might be only interested in talking about her new guest in life.It really does not signifies that she is going to love you less .remember the new person is also a part of you.Try to get involved with her during baby talk take interest in choosing the color of nursery or choosing your baby"s name.
During 4th month onwards:

Her appetite will grow so do not be annoyed if you find her in the kitchen at 2am gorging on something.Instead you can help her by preparing a meal of her taste.Remember that now she has to eat for 2 person.This is also the time when your lady will start putting on weight and her tummy might just start to show its baby bulge. her clothes will start to get tight so take her out shopping and gift the mumma to be something nice and cozy to wear.Do not forget to complement on her look. If you look closely enough you will actually notice that your girl has a radiant glow of motherhood that really make her look prettier than before.So do not hold your self back.Go ahead and complement on her look.It is also the time when she might crave for the wrong food at the wrong time.It may not be possible to fulfill all the time but try to give her whenever possible.
From 7th month onward
   Her heart is working twice the amount it worked before .so help her in her house hold chores as she might be out of breath sometime.Also later she may start to waddle so be cautious where you leave your shoes as she might trip over.also try to remove the slippery floor whenever possible.Also go through books and web and talk to her doctor regarding the onset of labor pain and how you can know that its time to go to Hospital.
At the time of delivery
   When you are with your girl at the delivery room . you must know that she is going through immense pain. She needs all the love and support she can get from you.talk to her ,soothe her, tell her she is doing great.
Is having sex ok during pregnancy ?
   We do not forbid sex during pregnancy.but ask for a little precaution in the initial 3 months and last 6 weeks.Remember that your lady is running 4 times the hormones she usually has before.so plz bear with her if she does not feel or have the right mood for it.Or it might be the other way round.You may not like to have sex with a pregnant woman where as your lady might be fully charged. As i have already stated there is no harm if you avoid the periods i already stated.
   So i think i have said enough so go on support each other while preparing for the arrival of your little angel and best of luck

symptoms of labor pain

2011-03-25T05:58:00.000-07:00

The audio visual media has greatly dramatised labor pain.The woman in labor shouts with all her might and perspire and the baby appears in no time with a vigorous cry. but reality is far from reel-lity.If you are experiencing labor for the first time your pain may drag over a period of 8 to 12 hours.In case of experienced moms the period tends to be shorter.Once you start to come closure to your THE date of expected delivery , every time you can not help but think of the slightest wince you have, to be labor pain.But till now unfortunately WE Doctors have not been able to predict with 100% accuracy on which date you will start to have labor pain.
How to calculate EDD(Expected date of delivery)
We calculate your EDD from the 1st day of your last menstrual period , add 9 months and 7 days to it and you get your EDD. Still confused ? say your 1st day of last menstrual period is 2nd Jan , then your EDD will be Oct the 9th. 40 weeks or 280 days if you want to know in terms of weeks and days.You should be cautious ahead of the date by 2 weeks as its an approximate not an absolute date
Symptoms of labor pain

Once you approach your EDD you might feel

Dropping /lightening : you can breath properly and sleep properly.It is because your baby descends into your pelvis near EDD so the height of your tummy decreases and the pressure on your lungs somewhat lightens.
The Minor ailments which you have faced in the early part of your pregnancy returns . such as increase frequency of micturition and constipation. The reason behind that is as the baby descends it again presses upon your bladder and rectum thereby causing those symptoms
Braxton Hicks contraction : Uterus usually contracts infrequently throughout your pregnancy.These contractions are usually painless.As you approach labor these contractions intensifies although infrequently and might lead to discomfort.It can lead you to believe as if you are having labor pain.The differentiation points are that these are irregular and infrequent. Its intensity neither gradually increases nor leads to changes in your cervix
back pain: Before your labor pain starts some of you might get backache. There might also be pain in your hips radiating down from your back
Vaginal discharge/shaw : You might also notice blood mixed mucus vaginal discharge.As there are progressive taking up of cervix once labor initialised, the os gradually starts to open up.the mucus plug which has been blocking the mouth of your cervix gets dislodged and comes out as mucoid vaginal discharge It might also contain blood as there might be rupture of superficial vessels on the cervix with the dilatation process. Then it is often termed as the BLOODY SHAW. It is usually harmless and nothing to be alarmed of.
Rupture of membrane: The baby is housed inside within a bag of membranes containing a fluid called amniontic fluid.Its job is to protect and cushion your baby.Sometimes you might rupture your membranes before the onset of labor pain. it is called pre mature rupture pf membrane.or PROM.This is also highly dramatised in movies and daily soaps.As the lady cheerfully announces that she had ruptured her membrane she is rushed off to a hospital where she gave birth. But actually rupture of membrane is not a sign of onset of labor pain.But if you do not get labor pain soon labor has to initiated by your doc as with time you and your baby"s chances of getting infection increases as you have lost the protective armour. Rupture of membrane should ideally take place in active labor.you should suspect to have ruptured your membranes if you suddenly leak a gush of watery fluid vaginally.you might also notice a constant dribble after the first episode. if you are not sure whether you are leaking urine or have rupture membrane contact your doctor immediately.
nesting :You might wake up one morning feeling energetic, raring to attack dust bunnies under the couch,set up the crib and arrange your Baby"s outfit according to color. The urge to clean and organise is commonly known as nesting.It is vaguely developed in humans and mostly seen in other life forms.No one knows for sure why it happens.may be a primal instinct which dates back to a time when physical preparation are necessary for a safe childbirth.Nesting might begin months before your actual labor but usually is strongest just before birth.
Uterine Contraction. Once your actual labour starts You start getting pain as your uterus starts contracting to push your baby out.These contractions are regular .these initially stays for about 30 second and as you advance it might stay as long as 90 minutes.The contractions grows stronger and closure as you progress ,so also your pain. If you have not ruptured your membranes early you might rupture it now as contractions as well as pain intensifies.During the terminal stage you actually feel the urge to push your baby out as the baby"s head presses upon your rectum.

Labor pain varies from one individual to other. In some its just an annoying back ache. In some its lots of pain.One thing keep in mind not to loose your patience and exhaust yourself by unnecessary screams. Always remember shouting will not lead you anywhere only good pushing effort will help you in delivering your baby and that too at the right time .The appropriate time will be told to you by your care giver who will do an internal examination from time to time to check and assess your progress and the well being of your baby.Labor pain is the most natural thing that can happen to a woman.Only knowledge and patience will bear you your fruit.So feel free to ask your doc anything you want to know before hand.

foods to avoid to increase your chances of getting pregnant

2011-03-20T12:31:00.000-07:00

Everyone knows that there are things that must be avoided throughout a pregnancy, but most people don't realize that avoiding certain foods, before pregnancy occurs, can increase chances of becoming pregnant. Some specific foods and drinks have repeatedly shown in research studies to have a directly negative effect on chances of conception. Additionally, foods high in calories and fat can lead to weight gain, which is also known to keep women from getting pregnant. Stay away from these six below mentioned food groups, your fertility chances will increase, and your overall health will be a better environment for a baby's health and development.

Outlaw Food #1 - Alcoholic drinks.

Most women are careful to eliminate alcohol from their diets during a pregnancy because of its harmful effects on the baby. But it is just as important for women trying to conceive to eliminate alcohol completely. Alcohol disrupts hormonal balances, and can cause women to stop ovulating. Not ovulating means there is no chance of pregnancy. Often, the advice is to drink in moderation, but when getting pregnant, alcohol needs to be completely eliminated. Stay away from the booze!

Outlaw Food #2 - Caffeine.

Again, while most women decrease caffeine intake during a pregnancy, less women do the same when they are trying to conceive. Studies have shown that large amounts of caffeine can cause miscarriage. While it is likely that you don't have to eliminate all caffeine completely, it is a good idea to minimize the intake of it as much as possible.

Outlaw Food #3 - Refined flour and sugar products.

Generally, processed food made with white sugar and flour is bad for your health. Consuming large quantities of these types of foods can lead to weight gain, which leads to hormonal imbalances or even Polycystic Ovarian Syndrome. Instead, consume whole grains and eat naturally occurring sugar that is found in fruit.

Outlaw Food #4 - High fat meat.

Meat with a high fat content can also add to weight gain. Additionally, some researchers believe that hormones found in non-organic meat can decreases fertility chances.

Outlaw Food #5 - High fat dairy.

To increase your chances of getting pregnant, avoiding high fat dairy products such as cheese, cream, and whole milk is a good idea. Consuming large quantities of these foods can lead to weight gain. Additionally, the hormones found in the milk used to make these foods are thought to have some adverse effects on fertility chances.

Outlaw Food #6 - Mercury laden fish.

While you likely aren't trying to increase the levels of mercury in your body, you may be doing so inadvertently. Higher levels of mercury can harm a baby and affect fertility. Mercury levels can build up in the body over time. So, if you have been eating a lot of fish, you may want to talk to your doctor about waiting to try and conceive until the levels of mercury decrease. Staying completely away from fish isn't a good idea, either, as fish contain Omega-3, which is extremely good for health and pregnancy.

So what to do

A good rule of thumb when eating for conception is to eat whole foods with color and avoid processed foods that are white. If you are overweight, it is wise to lose the weight prior to trying to conceive. Avoiding these six groups of food, in addition to regular exercise, can help that weight loss occur and can help to eliminate potentially harmful effects on fertility chances and pregnancy. Making this sacrifice now can lead to gift of a healthy baby. You owe it to yourself and your baby to make these dietary chances.

Cracked nipple

2011-03-19T07:20:00.000-07:00

Feeding your baby is a Divine experience.When you hold your baby for the first time in your hand and look into his tiny face , feeling of motherhood fills your soul.Its rightfully said that " with the birth of a baby a mother is also born.Before the birth of your baby you are a woman.you become a mother only after you hold your baby and feed him. Breast feeding is something which connect you to your baby both physically and emotionally.But if it becomes a horrendous time for you it might lead to lack of bonding on your part. Cracked or sore nipple usually starts bothering once you start breast feeding as both of you are new at it. But with time and patience it cures on its own

Prepare your breast for feeding

Check your breast and nipple when you are pregnant. sometimes colostrum or sebum accumulate around your nipple and make it dry as time pass by making it vulnerable to crack.Gently clean your nipple with warm water and a mild soap if that is the case.Apply moisturizer cream to keep it soft and supple.Check your nipple if they are flat.If yes then gently massage the nipple and elevate it from its base .You need to do it from 37 weeks onwards not before that as stimulating nipple may lead to premature onset of labour.

What are the symptom?

You will feel pain ever time you baby feed on your breast
your nipple is sore to touch
the skin on your nipple is cracked and painful

Why do i have cracked/sore nipple

The main cause is faulty position while feeding ie improper latch. Always give feeding in a comfortable position.You should get a straight back chair with arm rest.If possible should get a small stool to support your leg so that there is no pressure on your hips while feeding. If you need , put a pillow behind your back and another on your lap to put your baby.While feeding , your baby"s tummy should be touching your tummy.that means tummy to tummy.support your baby"s head in the crook of your elbow .Let your baby open his mouth wide (as in yawning) and then put not only your nipple but the areola too in his mouth. You should be able to put one to one and half inch of your nipple and areola in to his mouth.Only than he will get milk properly.Milk is stored behind the areola and not in your nipple , so if baby gets only the nipple he will have to work hard and suck harder thus leading to cracked nipple.You get a little discomfort when your baby starts sucking and your breast tissue gets stretched way inside baby"s mouth , it should disappear within few minutes but if it persists that means baby is chewing or gumming your nipple so break the latch and try again.
If baby has yeast or oral thrush infection in his mouth. you will have a shooting pain every time he takes a feed. Its more common if your baby is getting supplementary feed also.
If you have very dry skin or eczema
Improper use of breast pump can also lead to cracked nipple

What i can do to get relief

Proper position and latch on
rub ice on your nipple before each feed. it will numb the pain
Some gets relief by putting tea bags on their nipple too
You can also soak your nipple fully in saline solution .
Put baby on the better breast first then he will be more gentle on the second breast as he is satisfied.
Give frequent feeds but for a shorter period.
Rub a little breast milk after each feed and let it dry. It helps in healing.
If you still get pain ,you can use simple pain killers like aspirin.
You can use lanoline containing cream like nip care or sood before and after feed.Do not forget to wipe off any residue before each feed.
you can also try nipple shield if all the measures are not helping.

Can i continue breast feeding ?

Yes , you can .Crack nipple is not an indication to stop breast feeding your baby.

When to get to your Doctor

If you are still getting severe pain after using these methods
Your breast becomes hot and tender and engorged
You start getting fever
There are obvious sign of infection in your nipple.

It is difficult to tell a mother to keep on feeding if she is experiencing cracked or sour nipple. Only with patience and shear pursuance you can achieve a successful lactation. So do not give up. These are minor hurdles. I am sure with Dedication and determination you will definitely be able to breast feed successfully. So good luck.

Emergency Contraception

2011-03-17T09:08:00.000-07:00

This is a contraceptive method which you use before you miss your period, to prevent pregnancy when you have unprotected sex.There are different nomenclature for this such as post coital pill , the morning after pill.They all mean basically the same.
These pills does not cause abortion.so if you are already pregnant these can not help .

History : In older days women tried various harmful methods to prevent pregnancy following unprotected sex , such as They used to take

Brews and concoctions orally
Hot or cold vaginal douching with or without astringent
Herbal drugs.

These methods were not only ineffective but was harm full too.Many oral preparations were toxic and vaginal douching frequently caused burns.

Who can use emergency contraception:

You miscalculated your safe period . Many a times even when you have sex in your safe period you might not be well protected, as your cycles might vary.
Ruptured condom
Forced intercourse as in rape or incest
For aged couple who meet very infrequently
Unprepared sex while otherwise you use conventional methods

How does it work :The exact mode of action is not very sure.But it may act through

Inhibition or delay of ovulation .as no ovum to meet sperm so no pregnancy
Prevention of implantation in an altered endometrium(the mucosal lining of your uterus).
Prevention of fertilization due to quick transport of sperm or ova
The hormone in morning after pill also thickens the cervical mucus making it impenetrable by sperm

What are the methods:

There are two methods

Hormonal
Mechanical--IUCD(Intra uterine contraceptive device)

Hormonal Emergency Contraceptives:

They are again of two types

Combine Estrogen and Progesterone Pills eg The usual pills you take for contraception
Levenorgestrel only pills eg I pill , Unwanted 72

Combine Estrogen and Progesterone Pills

The use of combined Estrogen and Progesterone pills are also known as "yuzpe regimen".

It should be taken within 72 hours of unprotected intercourse.
It consists of oral dose of Estrogen 0.1mg with 1 mg of dl-nogestrel repeated after 12 hours of 1st dose , When pills specially packed for emergency contraception are available ( such as Norgynon,Noral,Ovidon etc).
Can also take 2 tabs of OCP which contains high doses of 50 microgm EE and 250 microgm levenorgestrel (or 500 micro gm levenorgestrel) such as ovral. 2 tabs within 72 hours preferrably within 12 hour of unprotected sex and 2 tabs after 12 hours.
When only low dose pills containing 30 microgm of EE and 150 microgm of levenorgestrel(300 microgm dl-norgestrel) such as ovral L are available 4 pills should be taken within 72 hours of unprotected sex and again after 12 hours.

Is there any risk to my baby if i become pregnant even after using these pills

There are potentially two risks

Development of vaginal adenosis and adenocarcinoma of children owing to the exposure to the estrogen in the womb.
Developement of limb defect and cardiovascular defect.

The good news

The chances of occurence of these disorder are very remote as

The drug is given for a very short time and that too for a very short time.
The drug is given before organogenesis starts.
The blastocyst(very early stage of baby) is resistant to drugs before or soon after implantation.

Levenorgestrel only pills

Levenorgestrel is given in two doses 0.750mg tablets at an interval of 12 hours or more recently as 1.5mg single dose within 72 hour of unprotected intercourse. When these pills are not available you can also take minipill(30microgm).But it is not convenient as it requires you to take 25 pills at the same time.(Overette Method)

Are there any side effects : yes there are few

Nausea : It can occur in 50% of woman.But thankfully it does not last for more than 24hours.Nausea is less if you take the pills at bed time or with milk or food. you can also try antiemetics.
Vomiting : 20% of you will have vomiting.If you vomit within 2 hours of taking pills than you must repeat the dose.In case of excessive vomiting you can apply the dose vaginally also. Antiemetics are usually sufficient to stop vomiting.
Irregular uterine bleeding : Few of you will have spotting after taking pill.57% of you will have your period within 3 days.15% may expect it even earlier.and in some(say around13%)menstruation will be delayed by 7 days.If there is delay of menstruation for more than 7 days you should do a urine pregnancy test .
Other minor side effects : such as headache, dizziness,fatigue,breast tenderness may be there.Simple medication such as Aspirin or other pain relieving drugs are usually sufficient to relieve headache and breast tenderness.

Are these effective

The Yuzpe regimen protects about 75% pregnancies which would otherwise be expected to occur.
Approximately 8% women can be expected to be pregnant after a single act of unprotected intercourse on a random day of the menstrual cycle.But only 2% become pregnant if they use the yuzpe regimen.
Prevention of pregnancy rates decreases from 95% where the contraceptive is used within the first 12 hours to 47% where the interval was as long as 61 to 72 hrs.
If you continue to have intercourse after taking these pills upto your next period there is greater chance of failure.

Which one is better? regular pills or Levenorgetrel pills?

Failure rate in Yuzpe regimen is 3.2% to 1.1% in levenorgestrel pills
Side effects are more with regular birth control pills than in levenorgestrel pills.

So if you need emergency contraception levenorgestrel pills are the choice.

When do I report back to my doctor?

You should report to your doctor after your next period or if you do not get your period even after 7 days of taking these pills whichever is earlier.
If you have acute pain in your tummy(to rule out ectopic pregnancy).
You have severe pain in your calf muscle.
You have difficulty in breathing/pain in your chest.
Severe headache/numbness/dizziness or weakness.
Blurred vision,difficulty in speaking
If you develop Jaundice(yellowish tint in the white of your eye,skin or mucus membrane )
As these methods are not regular contraceptive measures ,you should talk to your doctor regarding which contraceptive method is and by better for you in your visit.

Mechanical Emergency Contraception:

IUDs such as cuT or lippes loops can be used upto 5 days of unprotected intercourse.It needs to be introduced into your uterus by an expert.

Who are the ideal candidate ?

If you want to continue taking it as your regular contraceptive methods.
If there is any contraindication to the use of hormonal methods.

How does it act?

By making changes in endometrium thereby making it unsuitable for implantation of the embryo.
By damaging the blastocyst directly around the time of insertion.

Other drugs tried as emergency contraceptives

Ulipristal Acetate(ella) : It works up to 120 hours after intercourse.It prevents pregnancy by delaying or inhibiting ovulation and inhibiting follicle rupture.
Mifepristone(RU486,MT pill,Mifegest) : 10mg dose is effective as emergency contraception up to 5 days following unprotected inter course with fewer side effects .

Must remember:These methods do not protect you from sexually transmitted diseases such as HIV/AIDS.

Common ailments during pregnancy

2011-03-13T07:55:00.000-07:00

Hi. Today I thought I will discuss with you regarding some common ailments which you might face during your pregnancy.I get lots of phone calls every day from my patients regarding this particular subject which are bothersome to them but usually is of innocuous in nature.

As you miss your 1st period you take your 1st step to wards your pregnancy. usually you should expect to have the following symptom

What to expect

Nausea and loss of appetite:- common term as we know is morning sickness ,about which i have discussed in my previous blog.Keep in mind that it will wear off once you cross your initial 3 months and hardly stays till you complete 4 month.So nothing to worry if you are keeping yourself well hydrated.But if its bothering more your doc will give you some simple emetics which are completely safe in pregnancy and you should expect to get better in no time.
weakness and Easy fatiguebility- as your baby starts growing inside you there are lots of changes which takes place inside your body. so you could easily deplete your sugar reserve in your body if you skip your meal.so as i have already mentioned in my blog regarding diet in pregnancy always keep something in your bag in case you feel giddiness to pop in..But if it is bothering you more do not hesitate to talk to your doc about it as you might have some complications like anaemia too
Breast discomfort:-As your breast prepares itself to feed your baby it starts enlarging so some amount of discomfort such as tingling or needling in your breast is quite common.you might also notice few veins growing on your breast.Don't worry as your breast grows it needs more blood supply so there is growth of blood vessels.Also your nipple and aerola (area surrounding nipple) will start getting more pigmented.Do not be surprised if some sticky fluid comes out when you press over your nipple It is called colostrum it can be expressed as early as 12 weeks.If you have given birth before you might notice this even earlier.
Bladder discomfort :- As your Uterus grows it give pressure to your bladder .So you might feel the increase necessity to use the toilet.plz keep in mind that at this particular time you are also prone to have urinary tract infection as your bladder may not be able to evacuate properly because of pressure from the uterus.So do not forget to drink lots of water.Some of you might restrict drinking water thinking it to be the cause to visit the toilet more often. But as i have told you its simply not the cause. if you restrict water intake you will be more prone o have urinary tract infection and end up complicating things.
Constipation: For this one blame it on your hormone progesterone.It cause your bowel to move slowly.Lack of physical activity and also pressure of growing uterus on your pelvic colon are the factors to blame.Try taking lots of water and green vegetables in your diet.A glass of warm milk at night might also help.
Back ache:-As i have already mentioned in my blog regarding backache you might expect varying degree of back ache during your pregnancy. more so if you have had it from before.it is specially more bothersome during your later months.Relaxation of your joints because of your hormones mainly progesterone,faulty posture leading to increase lumbar lordosis,muscular spasm,urinary tract infection and constipation are also contributory factors.Improvement of posture,well fitted pelvic girdle belt which correct lumbar lordosis during walking , sleeping on a firm bed often relieve the symptom.Massaging the back muscle,some light analgesics(which your doctor will prescribe) and rest often relieve pain due to muscle spasm.
Acidity and heart burn: As your growing uterus gives pressure on your stomach it gets displaced upwards and also there is relaxation of the lower esophageal sphincter so some amount of heart burn and acidity will be there.So try few simple tips like regular bowel habit, restriction of fatty/spicy foods should help.If not your doctor will prescribe you few antacids which should be enough.
Feeling of increase warmth:: Because your body is experiencing increased metabolic activity you might feel more warm than usual.
Ankle edema : Some amount of swelling around ankle is expected provided you do not have a condition called pre eclampsia.This sort of physiological edema usually gets relieved by taking rest and placing your legs at a slightly higher level while sleeping also helps.
Varicose vein,Hemorrhoids: Some of you might also complaint of prominent veins in your lower limb and also few might have hemorrhoids.If its not troublesome nothing much to be done.
Leg cramps:It can be due to deficiency of calcium or excess phosphorus in your body.Calcium supplementation, Massaging of affected area,local heat application and Vit B1 daily30 mg is usually effective .You should also avoid wearing high heels and switch to wearing flat foot wear which are comfortable.
Pica : it is the craving for strange food which is sometimes seen in pregnant ladies.Sometimes when you are having Iron deficiency anaemia you might have this. But it is actually of historical interest as not all women who has iron efficiency anaemia will experience this. Legend goes like this " A woman in 16th century craved a bite from the arm of a baker and refused all kind of food.Her husband paid the baker for 3 bites.After enduring only 2 bite the baker backed out of the deal.subsequently she gave birth to triplets and one baby was still born " This tale was cited up until the 1940s to support the popular belief that the longings of pregnant woman should not be denied and that to refuse their demand was to put the child at risk.But trust me its more of a legend than reality.
Chloasma :You might see some darker pigmentation on your cheek.do not be alarmed it usually goes after your delivery
Striae: As your tummy grows you might notice ugly looking striae on your tummy.It usually starts on the sides first. For this try applying Vit E rich cream on your sides from 4th month onwards.If possible you can start applying it even sooner.you might also notice these marks on your breast. The solution is same for both the case.
Pityalism:Its profuse salivation which sometimes bothers pregnant ladies.It is usually seen if you take lots of starch in your diet, but in most case the cause is unexplained.
Increase Vaginal discharge: Usually you might have increase vaginal discharge due to the effect of estrogen on your cervical glands. in most of the case it is physiological. If you are finding it troublesome you might try douching your vagina with water mildly acidified with vinegar. but if you are experiencing curd like or foamy discharge with itching or irritation go visit your doctor immediately as you might have some infection like Candidiasis or trichomoniasis.Also if you experiencing water like discharge you must visit your doctor to rule out whether you have ruptured your membranes in advanced pregnancy.

These are just objective complaints which might bother you.But whenever you feel you should go visit your doctor plz do so immediately , as proper examination only rules out whether you have some complication or have any minor ailments.till next time stay healthy and take care.

Diet for diabetic pregnancy

2011-03-11T22:50:00.000-08:00

When a lady is pregnant and she develops Diabetes for the first time during her pregnancy its termed as Gestational Diabetes. It usually shows during pregnancy and leaves you after delivery.However if not detected and treated promptly it might cause great harm to your baby. In any kind of Diabetes whether you are pregnant or not , the first line of treatment is to follow a nutritious diet plan and regular exercise regimen...and also the diet plan should be formulated well so is to incorporate all the necessary nutrients required for a pregnant lady . The basic goal of diet control is

To provide necessary nutrients for the growing baby and the mother.
To control glucose level.
To prevent starvation Ketosis.

The idea is to have small, frequent meals and a lot of water. The diet should have 3 meals and 3 snacks. The food should be of high fiber and less sugar like whole grain bread , beans , fresh fruits and vegetables.all those junk foods , colas , chocolates and Candis are a big no no. as these can easily shoot up your sugar to a dangerously high level.Check food items which has added lots of extra sugar.and also watch out for those saturated fats like butter , whole milk , dairy and other animal fat.
But one thing always keep in mind is you can not stop intake of sugar all together as it is the absolutely necessary for energy to you and your growing baby. also fasting hypoglycemia is very common in pregnancy , more so if you are diabetic so always keep something in your bag in case you have attacks of hypoglycemia in between meal.

Here are few suggestions which you can follow

Stay out of sugars,sweeteners and concentrated sweets.Do not have pies , pastries,cakes , cookies,jam , marmalade,soft drinks,table sugar,honey,and fruit juices with added sugar.Food containingsucrose,fructose,dextrose,honey,malasses,corn starch,corn syrup .
Make sure to eat a very small but healthy brekfast,comprising of proteins.Do not drink juice or eat fruits and corns. Avoid eating pastas,rotis and paranthas.Instead opt for eggs,lentil broth,skinned chicken or brown bread spread with pea nut butter.
Instead of eating large meals divide your meals into small portions and eat every 3 to 4 hours.Increase the intake of lean proteins and see that you include a rich protein source like meat(low fat),fish(skinned),eggs,cottage cheese,nuts,pea nut butter etc in each meal.
Introduce high fibre and lots of green foods in your diet.Fresh and leafy vegetables,whole grain bread,cereals,pulses,beans and fresh should be consumed in large quantities.Ensure that you eat fruits only for lunch or dinner and do not have them for brekfast.
Refrain from eating deep fried and fatty foods.Cooking oil should be sparingly used.possibly avoided.Instead of frying foods(even fish and meat),bake,boil or steam them.You can also eat barbequed meat and fish.Avoid meat with high fat content like pork.
To reduce the intake of fat use only skim or low fat milk and dairy products.Thickcream,butter,cheese , mayonnaise,margarine and sour cream are to be replaced with low fat food and proteins.

Here is a meal plan:

Break Fast meal: 30 Gms of carbs

Any amount of protein

Moderate fat

Brunch Snack :30 Gms of carbs

Any amount of protein

Moderate fat

Lunch Meal: 45 Gms of carbs

Any amount of protein

Moderate fat

Evening Snack 30 Gms of carbs

Any amount of protein

Moderate fat

Dinner: 45 Gms of carbs

Any amount of protein

Moderate fat

Late Night Snack: 30 Gms of carbs

If you eat more vegetables and proteins you might escape eating just a little bit more carbohydrate.Always remember to drink lots of water.

Burn calories by regularly going for slow walks.

Avoid stress and anxiety.

Relax meditate and you can also try a prenatal yoga club.

So till we meet again stay healthy and live healthy,

Any amount of protein

Moderate fat

Natural Methods of contraception

2011-03-11T04:35:00.000-08:00

As the name implies these are the contraceptive practices that do not use medication in any form to prevent conception.Now are we not interested ? well of course we are........These practices are in vogue from the prehistoric time. But even now many of you well educated couples are practicing even if u have to face a risk of accidental pregnancy.
If these methods r to be classified they would fall under the following category....

Natural family planning methods.(NFP)
lactational amenorrhoea method(LAM)
Withdrawal method
Minor method

1Natural family planning methods.(NFP)

These refers to methods of planning and preventing pregnancy by observation of the naturally occurring signs and symptoms of the fertile and infertile phases of the menstrual cycle, of course with the avoidance of intercourse during the fertile phase if pregnancy is to be avoided.
Now let me tell u something.. during ur entire reproductive period u will shed around 300 - 400 eggs from ur ovaries, usually one in each cycle alternately. This is called ovulation.Very rarely a second ovulation occurs within 24 hours of the 1st ovulation.Ur egg is very precious , it can only be fertilized within 24 hours after it is shed. after that its gone. After ejaculation sperm gain entry into the uterine cavity within minutes and reach the outer end of ur tubes within 1 - 1 1/2 hrs(see how rest less they are ..even in their miniature form).Now these sperms can live inside vagina upto 5 days and rarely upto 7 days.But they regain the ability to fertilize ur egg for a mere 3 days. Now once u avoid intercourse this period u are a free gal...
Now the million dollar question is how to know when u r ovulating....Usually the most fertile period of a woman is from 10th (rarely 9th ) day of her cycle to the 18th day , provided the cycle is of 28 days. To know when is ur fertile period u can try the following methods , which i will discuss one by one...

Rhythm method
Basal body temp method
cervical mucus method
Symptothermal method.

1.Rhythm Method:

This method is also called the calender method.It is based on "Ogino-Knaus theory") that ovulation takes place about 14+/_2 days before the next period. But variations are there , specially in adolescents when you are yet to come in terms with your hormones , and in pre menopausal woman when your hormones are planning to leave you. also in times of stress , travel , some medications and not to forget about is fever.as atleast 20% of you will experience abnormal cycle , a record of 1st day of menstruation (called day 1 ) should be marked on a calender for 6 months. The longest and the shortest cycle is thus noted.

Now the tricky part...by subtracting18 days from the length of your shortest previous cycle , you will know about the day on which you will have your first fertile period. substract 11 days from the length of your longest previous cycle ,and voila ...you get the last day of your fertile period.

Still confused....?... OK let me explain more , say during the last six months which you had been marking laboriously on a calender...the shortest cycle you got is 28 days...do the calculation ..its 10. and now say the longest cycle you got is 32...so deduct 11 and you got is 21.. So your fertile period starts from 10th day to 21 days of your present menstrual cycle. Nd you should avoid intercourse during those days if you are to avoid being pregnant.

Draw back of this method

High failure rate
It greatly reduces the days of safe days of intercourse.

2.Basal Body Temperature Method

As we all know that we have two female hormones in our body Estrogen and Progesterone. This method is based on the fact that after ovulation progesterone level in blood rises, increasing the basal metabolic rate and causing rise of body temperature by 0.5 to 0.8 degree F or 0.2 to 0.4degree F in Luteal Phase (the period after you ovulate ,till you menstruate is termed as luteal phase.)

This method too could not escape few fallacies. sometimes the rise of temperature is gradual , taking several days , and at times two rises can also happen.

lets not go further into technical detail and straightway tell you how you should do it. You should record your temperature before getting up from bed in the morning and before washing or taking any food. A thermometer ( A special ovulation thermometer graduated from 36 to 38 degree C is easier to read but if its not available , the usual one is enough.) should be kept under the tongue for about 3 to 5 minutes.vaginal and rectal records are better but most of you dislike it.The record should be plotted in a BBT chart and read daily for any temperature change. you are free from pregnancy if you avoid intercourse at least for 3 days after the temperature rises.

It has been found by simultaneous hormonal study that ovulation usually takes place before two to after three days of BBT change.

Draw back of this method

The end of pre ovulatory safe period can not be detected by this method.

They have to there fore avoid intercourse or use other contraceptive methods during pre ovulatory and ovulatory period.

3.Cervical Mucus Method:

Just before ovulation maily because of the effect of estrogen the cervical discharge can be stretched between two fingers(Spinnbarkeit test)This discharge again becomes scanty and thick after ovulation in post ovulatory phase mainly due to the affect of progesterone and remain so till next menstruation. To help you understand more about what to expect from your cervical discharge , i am going to describe variations in your discharge pattern as your cycle proceeds.

Cervical Mucus Pattern

Following menstruation most of you will have 1 or 2 days in which no mucus is observed,and the vaginal area feels dry.These are called dry days and are recorded as such.
Following dry days mucus start to appear in vagina.Initially it is cloudy,white or yellow and has a sticky consistency.Since this mucus has very little moisture the vaginal area feels dry or some of you might term it as sticky.Once you start experiencing this type of mucus pattern you should realize that you may be fertile as your ovulation is approaching.
Just before and at the time of ovulation the mucus becomes more copious,clear and slippery,resembling the white of a raw egg , and it can be stretched slowly between two fingers.The vagina and vulva feel moist or wet.This persists for about 3 days.These are called "wet days".The last day of wet mucus is called the "pick day". These days mark the peak of fertility.
Following the wet days , the mucus again becomes scanty,cloudy and sticky , and your vagina will again feel dry.This is post ovulatory phase which will persist till next menstruation.

As you are well aware by now about what your mucus pattern will be you should start checking your discharge at the vagina. If necessary by putting a finger inside your vagina or wiping the discharge with a tissue and note its amount , stickiness and consistency. You should make observations at a place and time convenient to you,and make the habit of writing it down.It will be even better if you can plot it on a chart. The peak mucus day and vaginal sensations should be carefully recorded.

Safe time for intercourse:

Intercourse can be done during menstruation and also during the dry days .You should abstain yourself from having intercourse as soon as the 1st sign of mucus appears in the pre ovulatory phase and also during the wet days in the ovulatory days and for 3 days after the peak mucus day.Beginning with the 4th day after your mucus discharge abates you can have unprotected intercourse till next menstruation.

Draw back of this method

Not suitable for those with abnormal vaginal discharge.
Uncomfortable as few of you finds touching their own vagina awkward.

4.Symptothermal Method

This is the best method when it comes to pin pointing the fertile period . as it does so with greater precision and reliability. It takes into account the results of BBT,cervical mucus changes(Billing Method) and of other menifestations of the fertile period such as Mid cycle pain,mid cycle light vaginal bleeding/spotting,and breast tenderness. These observations are noted in a symtothermal chart(If i am able to upload the chart you will be able to see it along with my blog.But i am unable to upload any pictures.Plz bare with me and teach me if you can.) The practice of intercourse is same as Billing Method.

Advantage of Natural Family planning Methods

As the name implies its natural so no harm from any kind of chemicals,hormones
Your natural menstruation is not affected.
The best part---There is no cost its free,just need a little planning and understanding.
It may actually improve your marital harmony as it involves the man"s co operation.
Its morally and culturally acceptable in any society where other methods of contraception are not acceptable.
Once you learn it properly NFP does not need any follow up or supply of contraceptives.
NFP can be used both for avoiding pregnancy or achieve it when desired.

Disadvantages

You need proper training by an expert atleast for initial 3 months.
commitment,motivation and co operation of both partners are essential.
It could be bothersome for you as you need to manage those records and charts daily.
The worst part -- effectiveness is less than that of some modern contraceptives.

Who can not use NFP

If you have very irregular cycles with cycles shorter than 21 days.
During adolescence , pre menopause and lactation
If you have had cervical surgery such as cautery,conisation or amputation
If you have vaginal infection ( till you get cured of it )
If you have sexually transmited disorder((STD) or Pelvic inflammatory disorder(PID) in the last 3 months.
If you had abortion recently.
If your husband is not so co operative
If you practice casual sex.

2.Lactational Amenorrhea Method:

Its based on the fact that when you have delivered the baby and is exclusively breast feeding him you are most likely to be infertile atleast till your baby is 6 months old.Exclusive breast feeding means feeding in day as well as night time with no food supplement of any sort.

The anti fertility effect of lactation depend mostly upon the frequency and distribution of nursing episodes throughout the day and night and also the time the baby spends sucking the breast.You will remain infertile for a longer period if you breast feed your baby more at night.

Who can not use LAM

When your baby is 6 months old or more.
If you for any reason can not exclusively breastfeed your baby.
You start having menstruation( bleeding for at least 2 days following 8 weeks after child birth)
If you are having some medicines such as mood altering drugs,reserpine,antimetabolites,cortisone,radioactive drugs,cyclosporine and anti coagulant.
If you have viral hepatitis.
If you have HIV/AIDS

3.Withdrawal Method

Its basically means discharge of semen outside vagina at the end of intercourse.It need great motivation and self control of your partner.

4.Minor Methods

These methods are neither practical nor advisable. I will just mention the names as part of history.These are

Abstinence---where you don"t have sex at all
Vaginal Douching--where people use to flush their vagina with all kind of fluid after intercourse.
Masturbation
Abnormal sex acts

These minor methods should not be practiced as they are impractical other than abstinence.I hope i have given you a fair idea rather than confusing regarding what you can do your self to prevent being pregnant. plz let me know if it had helped you till than practice safe sex.

Diet in pregnancy

2011-03-09T07:11:00.000-08:00

OK now you are pregnant........you are full of anxiety....what should you do what should you eat ??? that is the next big question..... well its time now to say bye bye to those junk foods and say hello to healthy food ,at least for the sake of your baby...although i have said like that i am pretty much sure that you are a healthy foodie....

now we all know what we should eat right ? everybody is conscious now a days about what type of food they should eat...if you surf the net you would probably get a load of web site which will give you the precise calorie amount the exact daily dose of carbohydrate,the percentage of fats in your diet and blah blah blah.......the point is what more can i say...probably nothing. So i decided that instead of giving you the exact amount of curbs , fats and proteins in your diet , i would rather try and give you some practical advises.

The need of your body changes as you advance through your pregnancy, as your baby grows so does your appetite.As long as you are gaining in your weight the food you are taking is probably sufficient, provided

you have a normal pregnancy
You don't have Diabetes/hypertension(high blood pressure).
you are not obese
you don't literally live on junk foo

   Presuming you have none,and presuming you know that healthy food does not mean junk food , i will take our discussion further and try to give you a fair scenario of your dietary picture  Initially when you begin your journey through the first few months you are usually much bugged by morning sickness. some even has tendency to vomit at the site or smell of food , and its quite natural that you loose few kgs initially(1 to 2 kgs).

In 1st Trimester (initial 3 months )

   If you are bothered by morning sickness try to space your meal . take small quantities and take frequently. its also seen that in this period you might experience some amount of appetite loss. so you probably would not be able to tale large feeds. when you decrease the quantity of your food and increase the frequency ...
you will be able to take the same amount you used to take before .do not to take food force fully.it will do more harm than good. try to bring variations in your food. if one does not click , probably the other will do. Well of-course you should definitely avoid oily or fatty foods or foods with much spices as it will lead to more acid secretion in your stomach and you will end up having either gastritis or more morning sickness or the worst both.do not be bugged by the fact that if you are having 3 to 4 episodes of vomiting a day or if you are eating 2/3rd the amount of what you used to take before.initially your babies need is very less . it will get what it needs to get from you.Once you come in terms with your new hormones in your body, your appetite and weight both will run uphill.so cheer up.

try to take small tit bits whenever you can
avoid food which seems to increase your morning sickness
take lots of water or fruit juice ,keep yourself well hydrate

As you cross your 1st trimester
Now is the time to eat

Normally by now you would have left your loss of appetite , morning sickness etc etc behind.this is the time where your appetite will grow , and so also your baby. Most of my patient says they feel hungry all the time. so i advise them eat whenever you feel like you need to eat. But keep in mind not to over stuff your self at the same time.
Once you start growing your tummy , their is a condition called "gastroesophageal reflux", this might bother you . The cause is that your growing uterus will give pressure on your stomach , and it becomes more prone to reflux food into your esophagus (the passage which takes food from your mouth to stomach) . So many of you will experience burning sensation in your chest or slight pain or discomfort in the mid section of your chest.To avoid this there are few simple tips which you can do.

Avoid taking large meal , instead try taking small meals at frequent interval.
Avoid taking very rich food.(oily/spicy)
avoid lying down soon after having meal
Try taking a large pillow which will support not only your head but your shoulder too,which will raise your chest level from that of your stomach.
Try sleeping on your right side as stomach empties on right side( after you complete 7 months you should lie more often on your left side to facilitate blood flow)

What are the foods that you should take ?
Foods which are tasty and also nutritious and above all which are easily digestible.The foods which should be included in your list are

Milk and milk products: try the pasturized milk as boiling destroys almost all vitamins in milk
fish,meat and poultry : always cook properly , if possible in pressure cooker
lots of green vegetables :High in fibre so keeps your bowel clean , also rich in minerals.You Can take it raw (as in salad)or cooked .do not forget to wash vegetables properly in running water
seasonal fruits: if possible take fresh fruit instead of canned or processed fruit.
cereals and pulses
Lots of fluid to keep yourself well hydrated and to avoid urinary tract infection which is so common in initial 3 months of pregnancy.

Vitamin supplements in pregnancy

There is a particular vitamin which your doctor will prescribe in the initial 3 months .Its called Folic acid. its particularly useful certain specific developmental bieth defect such as open neral tube defect.Its very important for you to take this vitamin regularly.Actually you should start taking this medicine even before you are pregnant at least 2 months prior to becoming pregnant . The dose is 4 mg /day.If you have any previous baby with such birth defect the dose should be 5mg/day.

Later as you advance you will be given Iron and Calcium supplements according to your need to replenish your physiological anemia and to safe gourd your bone against too much density loss. Also at times you might be given Vit B complex according to your need.

Foods/Habits to avoid

Stop smoking if you are a smoker. There is nothing like bringing it down slowly.Its harmful and stop it outright.You are strong enough to be able to stop it right now
Give up alcohol as lots of studies has shown that it might give rise to attention deficit or learning problems or worst few developmental defects to your baby.
Fish containing high level of mercury such as studies has suggested it causes damage to developing nervous system of your baby.Few fishes i would like to specially mention are Shark,sword fish and .marlin.You should also restrict intake of Tuna to less than 4 medium can per week.
Limit the intake of caffeine as it has been found it gives rise to higher incidence of miscarriage and low birth weight.
Limit intake of food or vitamin supplement which are rich in Vit A such as liver and liver products,Vit A supplemenst,Cod liver oil supplements.
Do not take raw meat,fish or unpasteurized milk as you might get infected with listera . listeriosis might lead to miscarriage,still birth or it might infect the newborn also.

One thing i would like to mention is during pregnancy its very important that you do not starve , as you might have attacks of hypoglycemia.so always keep something in your bag such as biscuits,cookies or dry fruits and pop in some whenever you feel hungry at the odd time or place till you find something proper to eat.So i think by now i have given you enough information regarding your diet. You should gain at least 10 to 12 kgs throughout your pregnancy.mostly this weight gain happens from 4th month onwards.so instead of counting your calories and percentage of different foods in your diet stick to your basic diet but increase the quantity according to your demand.take the vitamin supplements advised by your doc and i dont see why you should not have a healthy pregnancy and a healthy baby...so stay healthy eat healthy and stay well....

Heterotopic pregnancy

2011-03-04T10:21:00.000-08:00

   Today i did a laparotomy ( any operation for which you need to open up the abdomen is termed laparotomy ) the indication is .........yes you are right (no prize for guessing )....Heterotypic pregnancy...........

   Heterotypic pregnancy is actually a twin pregnancy , one inside uterus and the other being outside uterus...most commonest site being the tubes. it is actually a very rare condition........if you want the statistic its 1 in 30,000.........pretty rare huh.....thank god for it being rare.......but as always we being the spoil sport are making it happen more often . as we are trying to gift babies to infertile couples we are also increasing its incidence. it can be as common as 1 in 900 in case of ovulation induction.

   in my patient though it was nothing of that sort.she had an abnormality of the uterus.....she had bicornuate uterus....if i am successful it putting a picture in this blog than you can see that a normal uterus has a single cavity.but in this particular patient she had two cavities in her uterus. she had a normal pregnancy in her right uterine cornu and a left sided ectopic pregnancy. she also has a child of 3 years which she had delivered normally.

   this type of condition is particularly confusing with ruptured corpus luteal cyst of pregnancy (about which i will discuss some other time ). it can only be differentiated properly by Histopathological examination of the dissected tissue.

   to diagnose it ...a high degree of suspicion is necessary .the lady usually presents with a short period of amenorrhea , followed by symptoms of ectopic pregnancy......such as bleeding vaginally severe pain abdomen as the ectopic pregnancy ruptures and fainting as severe intra abdominal bleeding ensues. the bleeding can be very severe at times so as to endanger ones life.the uterine pregnancy usually does not give rise to any problem but most of the time ends as missed abortion.

   one diagnostic tool which comes in handy is ultrasonography as it can visualize both pregnancies properly(in case of my patient both the pregnancies was alive even when the tubes had ruptured . the placenta got hold of near by organs and was feeding from them)

   regarding management of this condition its nothing but laparotomy . the ectopic pregnancy has to be removed and bleeding has to be stopped.

   pregnancy is the most natural phenomenon that can happen to a lady...but when there is deviation the result can be devastating. the only way to diagnose it before catastrophe strikes is to do an ultrasonography before you miss the second period.

   i think i have written enough on heterotypic pregnancy....till i blog again stay well and be healthy.

post partum depression

2011-03-04T06:35:00.000-08:00

Post partum depression is a highly under reported condition that affects many women across the world. Who have undergone childbirth. post refers to after and partum refers to a latin word that means birth. “during the 1st week after childbirth,many women(upto 85%)experiences a brief period of mood symptoms and anxiety mostly due to exertion,loss of sleep. about 10 to 15% of women however experiences more significant mood symptoms in the post partum period , called post partum depression.

Signs and symptoms: Post natal depression is by far the most widely discussed perinatal mood disorder. Defining as arising in or persisting into, the first postnatal year.it presents similarly to depression at other times. while most mothers suffer from being is emotionally low after childbirth. Extended periods of depression should be looked into.The depression can begin at any time between delivery and six months or even a year. In more severe forms the women may express suicidal thoughts.It is usually characterized by

low mood,
tearfulness,
emotional lability,
fatigue,
excessive anxiety,
attachment difficulties and
withdrawal from social events

. Main reasons: Although the precise cause of post partum depression is unclear many scientifical studies point that it is linked to the hormonal fluctuation that a woman experiences after childbirth. number one is

.blame it on your hormones: During pregnancy the levels of female hormones estrogen and progesterone increase upto 10 folds.within the 1st 48 hours after delivery this hormone level decline dramatically. Research suggest a connection between rapidly declining hormone levels and the appearencec of symptoms of PPD.other hormones such as prolactin (levels of which are lower at the time of delivery but begin to raise sharply in the 1st week following delivery) and changes in blood levels of cortisol and aldosterone have also been implicated in PPD.

Why does postnatal depression matter ?

Its effects on mother

1. psychiatric illness was the most common cause of indirect deaths and the largest cause of maternal deaths overall in the last CEMACH report(why mothers die 2000—2002)

2. it is reasonable to speculate that a tremendous amount of damage was also present in families where the woman did not die,but made a failed attempt at suicide.

3. although symptoms of depression may remit spontaneously,or respond to counselling ,about 1/3 rd of women will remain depressed and need further treatment.

4. untreated depression may contribute to the development of a chronic refractory mood disorder in the mother, a potentially negative influence on the marital relationship with the possibility of contributing to raised rates of separation in couples. This will also have a negative impact on the baby or othe siblings.

5. difficulties are often concealed.this may be due to cultural attitudes to mental health problems.women fear the label and what they perceive as the stigma:they are afraid that they will be seen as a bad mother and the baby will be taken away. The disease process itself makes people feel isolated and not want to relate to anyone including health professionals.

Impact on the child

This is one area of research in which there is good evidence that postnatal depression particularly if moderate or severe can have long lasting negative effects on any children in the family,with new infant being particularly at risk. There appear to be both short and long term effect.

Short term

1. Infants are often reported as being of more difficult temperament by their mothers(although this may be because the mothers are themselves not coping well and giving poor feedback emotionally to the children,who then behave in a more difficult fashion in order to gain attention.

2. less sensitive mother-infant interactions are seen,leading to insecure attachment pattern

3. one study has even reported PPD to be a risk factor of sudden death syndrome(SIDS)

Long term

1. A number of researchers have found adverse effects persisting for sometime,and this effect appears to be more marked for boys.

2. Sinclair and murray found PPD to be associated with significantly raised levels of child disturbance at the age of 5 years ,specially in boys.

3. another group of researchers has been following a cohort of 149 women recruited at 3 months post partum. 132 of their chidren was followed upto the age of 11 years.children of women depressed at 3 months were found to have significantly lower IQ scores, more attention problems and difficulties in mathematical reasoning and were more likely to have special educational needs. Boys were more severely affected than girls.

4. finally a meta analysis conducted by Beck concluded that post partum depression had a small but significant effect on children’s cognitive and emotional development.for all these reasons identification and active treatment of women experiencing post natal depression is important.

Management :

Treating it right: “ the 1st step is medical evaluation by a physician or psychiatrist to rule out presence of other illnesses”. counselling and psychotherapy can help women identify factors that may be causing depression. Counselling along with participation in a support group is recommended.however care should be exercised before putting breast feeding mothers on medication.the most commonly used treatments for depression are antidepressants ,psychotherapy or a combination of two.which of these is the right treatment for an individual depends on the nature and severity of the case.

back ache in pregnancy

2011-03-02T09:12:00.000-08:00

Oops my back hurts…..how many of us have used these words in our life ? Probably many times….well it hurts and worries you most , specially when you are pregnant. Coz many a times you can not pop those pain killers like you used to do before.

Regardless of whether you are pregnant or not the lifetime incidence of low backache ranges from 50 to 70%.All the structures of the lower spine and pelvis i.e. the muscles ,ligaments, joints,intervertebral discs and nerve root can cause back ache.

As if that was not enough, back ache is very common during pregnancy. You will be surprised to know that 50 to 80% of pregnant ladies will admit to the fact that they have some degrees of back pain while they are pregnant. Of which a very few reported it to their doc. The pain may be associated with certain activities only, or it may be so severe that you would have restricted mobility.( I hope I have not scared you ).

Back pain usually starts to bother you between 5th to 7th month(i.e.20 to 28 weeks of pregnancy). But if you have had back pain before , it might come even earlier.

There are two commonest types of back pain

• Lumbar

• Sacral/pelvic

Lumbar

This pain usually occurs over your lower lumbar vertebra but may be associated with radiation pain into your legs too.It is usually aggrevated by maintenance of the same position for a prolonged period of time, be it sitting or standing for a long time.

Sacral/pelvic pain

This pain is about four times common than the lumbar pain.Usually you will have this pain way lower down over your sacrum. It could be on one side or could be symmetrical.It may also radiate down to your pubis infront and down to your buttocks into the back of the thighs. I am sorry to say , but the pain is not relieved by short period of rest. The pain get worst if you roll over in bed or raise up from seat or climb stairs.

Cause of Backache: The causes of back pain are myriad and fortunately rare in pregnancy. Infact many of these causes are likely to affect fertility and result in difficulties in conceiving. But never the less I have prepared an exhaustive list of causes of backpain. It will be difficult to explain each and every disease separately but I will try to explain in my subsequent blogs.

Mechanical

• Muscle pain

• Prolapse of itravertebral disc

• Spondylolisthesis

• Lumbar spondylosis

• Fibromyalgia

• Osteoarthritis

• Spinal Stenosis

Traumatic

• Fracture of vertebra

• Soft tissue injury

• Foreign body migration including shot pellets and sharpnels

Inflammatory

• Rheumatoid arthritis

• Ankylosing Spondylitis

• Reiter’s Syndrome

• Psoraitic Arthritis

Infective

• Osteomyelitis

• Tuberculosis

Metabolic

• Osteomalacia

• Paget’s disease of bone

• Osteoporosis and vertebral collapse

Tumours

• Primary of bone : Benign or malignant

• Secondary of bone

• Multiple Myeloma

Haematological

• Sickle cell disease

Referred from other organs

• Gastric Ulcer

• Duodenal ulcer

• Gallbladder disease

• Pancreatitis

• Renal :Infections,stones,or tumours

Vascular

• Aneurysm

                   Majority of pregnancy related back pain is caused by a combination of hormonal effects on joint laxity,postural changes and a change in the centre of gravity.

                  There is also evidence to suggest that ladies who are overweight or who smokes cigarettes have a higher chance of developing back pain in pregnancy. So girls beware of those puffs you take when you are pregnant. and undertaking physical activity and maintaining fitness before pregnancy reduces the risk of backache during pregnancy. so girls its another reason why you should hit the gym. most pregnancy related back pain tends to resolve quickly in the postpartum(this is the period after you deliver the baby till 6 weeks). But 1/3rd of sufferers will continue to have back pain for 4 weeks after delivery and 1/6th will continue to have till 9weeks after delivery.

                   Thankfully in the majority of cases the cause of pregnancy with back pain is mechanical. However few ladies may trace the pain to her pre pregnancy days also. Most mechanical back pain are sudden in onset after lifting or straining, but in contrast to that pregnancy related back pain tends to be more of a gradual onset.

Management

          What and how you should get yourself relieved of backache when you are pregnant mostly depends on the below mentioned points provided you don’t have any evidence of prolapsed itervertebral disc.

• Avoidance of aggrevating factors

• Wearing shoes with low heel or no heel( I personally advise this)

• Bed rest in a firm bed

• Analgesia but not NSAID( non steroidal anti inflammatory drugs)

• Exercise to strengthen the back….such as swimming

            I hope I have not bored you enough… but coming to think of it don’t go for the long list of causes I have illustrated. Being a doc I cant help but provide you with the entire scenario.but probably and mostly you will never have a severe backache in your pregnancy. So just maintain a healthy life style,avoid.smoking keep your back straight ,remain active and enjoy life……..

morning sickness

2011-02-19T04:10:00.000-08:00

lets face it girls......although it is the time to rejoice that u r actually pregnant but it is also the time to get bombarded with lots of advises starting from ur mom to the sales woman at the mall. But coming to think of it don't u think its soooo cool to get a lot of attention that showers on u ?

uhem ok lets come to the point...well i thought since pregnancy is the universal truth let me give u to be moms few piece of advise regarding few problems that frequently bothers u . well number 1 on ur list is MORNING SICKNESS. now everyone of u know what that is ...right . its that u puke .....ugh how disgusting . well never mind its usually harmless , and plz don't even think that u will have it only in morning...it can happen at any time...

Now why do we have it........thats the million dollar question ...the answer is THE CAUSE IS NON SPECIFIC. how convenient as some of u will say...whenever u cant figure out the cause..they will blurt that answer....well let me tell u till now medical science have failed to specify the exact cause...some blame it on the pregnancy hormone the HCG...and some blame it on...ahem ...plz excuse me for saying this ...ur psyche.

Now since we dont know what causes it ...let me tell u some tips how to avoid it ...

whenever u are awake don't jump out of bed right away. try to turn to ur sides few times then get up and sit for a while then slowly hang ur feet and then get up
take a dry cracker which has less fat in it .
keep ur self properly hydrated.
do not take solid and liquid food at the same time
try to think of something else
even a new perfume or breathing fresh air sometime is helpful.

well thats for today girls...i think u should definitely get benefited if u follow these tips.... but if ur vomiting does not stop using these simple measures go meet ur gynaec right away...she will give u some simple medicine which are totally safe for ur baby and u which will surely stop ur morning sickness.....till next time take care....Enjoy ur pregnancy.....

2010-06-09T04:48:00.000-07:00

Hello to you all..........lately i have been thinkng..what can i do help my fellow people in distrees.......as being a gynaecologist i have to deal with so many querries........but still i feel our people are sometimes ashamed to ask some particular questions regarding there health and well fare.........i choose this media to try to answer all ur querries regarding health issues......as i m new in this field..my writing and my presentations may be a bit rusty............but i would like to polish my writing in future..........