GURGAON, GYNECOLOGIST,OBSTETRICIAN, GYNAE, DOCTOR, IN, NEAR, SOHNA ROAD, GYNAECOLOGIST, TREATMENT

Mirena (Hormonal Contraceptive) : How does it Act ?

2012-03-26T00:37:00.000-07:00

Mirena acts by

Supplements the endometrial action of progestins to foreign body reaction
Endometrium becomes decidualized, with atrophy of glands
Inhibition of implantation
Inhibition of sperm capacitation and survival

The Ovarian functions are NOT disturbed; the cycles remain ovulatory in 85 percent of patients, regardless of bleeding pattern.

Few Shortcomings of Mirena include; irregular bleeding and scanty menses. Amenorrhoea may occur in up to 50 % of patients.

Mirena: Intra-uterine Contraceptive Device (IUCD)

2012-03-26T00:22:00.001-07:00

Mirena is a longer acting hormone releasing device. It has a T shaped polyethylene frame with a steroid reservoir, containing Levonorgesterol.
This device mainly acts by releasing levonorgesterol into the uterine cavity, and effects are due to local progesterone action. It can produce contraceptive action for up to 5 years.
Pearl Index after 5 years is 0.09/ 100 women year.
Health Benefits of Mirena

Reduction of blood loss
Reduction of pain and dysmenorrhoea in Endometriosis, and fibroids.
Do not influence lactation, or foetal growth
Prevention and treatment of Endometrial hyperplasia

Corticosteroids for Premature Birth & Premature babies

2012-03-19T11:49:00.000-07:00

Corticosteroids have been used for many years in women who are thought to have a high chance of having their baby early. Premature babies (born before 37 weeks) have an increased risk of health problems, particularly with breathing, feeding and infection. These problems tend to be more severe the earlier the baby is born.

A single course of corticosteroids has been shown to help with a baby’s development and therefore will increase the chance of your baby surviving, once born. It also lessens the chance of your baby having serious complications after birth such as breathing problems due to the lungs not being fully developed, bleeding into the brain, serious infection or bowel inflammation.

Risks to the baby, if mother is overweight during Pregnancy

2012-03-19T11:47:00.000-07:00

If you have a BMI of 30 or above before pregnancy or in early pregnancy, this can affect the way the baby develops in the uterus (womb). Neural tube defects (problems with the development of the baby’s brain and spine) are uncommon. Overall around 1 in 1000 babies are born with neural tube defects in the UK but if your BMI is over 40, your risk is three times that of a woman with a BMI below 30.
Miscarriage - the overall risk of a miscarriage under 12 weeks is 1 in 5 (20%), but if you have a BMI over 30, your risk increases to 1 in 4 (25%).
You are more likely to have a baby weighing more than 4kg (8lb and 14 ounces). If your BMI is over 30, your risk is doubled from 7 in 100 (7%) to 14 in 100 (14%) compared to women with a BMI of between 20 and 30.
Stillbirth - the overall risk of stillbirth in the UK is 1 in 200 (0.5%), but if you have a BMI over 30, your risk is doubled to 1 in 100 (1%).
If you are overweight, your baby will have an increased risk of obesity and diabetes in later life.

Gynaecological Cancer screening

2012-03-19T04:04:00.000-07:00

Post menopausal bleeding of any severeity requires URGENT screening. You may be harbouring a malignancy.
Ultrasound and Endometrial aspiration , may be required.

Overweight in pregnancy: Check your BMI

2012-03-18T11:44:00.000-07:00

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. The higher your BMI, the higher the risks.

Risks include-
Thrombosis
Gestational Diabetes
Pre-eclampsia & Hypertension

Indications of performing Chorionic villus sampling, or Amniocentesis

2012-03-18T11:41:00.001-07:00

have had a high risk screening test for Down syndrome
have had a previous pregnancy affected with a genetic disorder
or your partner have one or more relatives affected with a genetic disorder, which means you are at greater risk of having a child with a genetic disorder, such as cystic fibrosis, thalassaemia or sickle cell disease
have received a result from a scan which shows certain abnormal ultrasound features, such as fluid collection at the back of the baby's neck (nuchal translucency), or a congenital heart defect which indicates the baby may have a disorder such as Down syndrome. This may be suspected on a scan at 18-22 weeks
want to know for certain whether your baby has a genetic disorder or not.

Chorionic Villus Sampling & Amniocentesis in Pregnancy

2012-03-17T11:39:00.001-07:00

Chorionic Villus Sampling and amniocentesis are tests carried out during pregnancy, to check your baby for disorders such as Down syndrome and, where appropriate, rarer specific inherited disorders. Amniocentesis is also occasionally done to test for other disorders in pregnancy such as fetal infection.

In CVS a small sample of the placenta (afterbirth) is taken for testing, whereas in amniocentesis a small amount of amniotic fluid - the water around your baby inside your uterus (womb) - is taken for testing.

CVS is performed most commonly between 11 and 13 weeks. Amniocentesis is performed after 15 weeks.

Non prescription management of Peri-menopausal Syndrome

2012-03-17T11:36:00.000-07:00

Regular aerobic exercise such as running and swimming. You should avoid infrequent, high impact exercise as this may make your symptoms worse.
Low intensity exercise such as yoga may help hot flushes and general well being.
Reducing your intake of caffeine/caffeinated drinks and alcohol can help to reduce hot flushes and night sweats.

Maternal smoking linked to higher incidence of congenital heart defects in offsprings

2012-01-29T08:22:00.000-08:00

Maternal cigarette smoking in the first trimester was associated with a 20 to 70 percent greater likelihood that a baby would be born with certain types of congenital heart defects, according to a study by the Centers for Disease Control and Prevention. Congenital heart defects are the most common type of birth defects, contributing to approximately 30 percent of infant deaths from birth defects annually.
read more....
http://www.cdc.gov/media/releases/2011/p0228_smokingpregnancy.html?source=govdelivery

Polycystic Ovarian Syndrome

2012-01-28T08:21:00.000-08:00

Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production. High serum concentrations of androgenic hormones, such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S), may be encountered in these patients.
PCOS is also associated with peripheral insulin resistance and hyperinsulinemia, and obesity amplifies the degree of both abnormalities.
Patients with PCOS may present with various clinical features.
Menstrual abnormalities/ Hyperandrogenism/ Infertility/ Obesity/ Diabetes mellitus/ Sleep apnea/ Metabolic syndrome
Treatment:
Diet and exercise: In patients with PCOS who are obese, endocrine-metabolic parameters markedly improve after 4-12 weeks of dietary restriction.
Metformin: This antidiabetic drug improves insulin resistance and decreases hyperinsulinemia in patients with PCOS
Patients with PCOS who are infertile but desire pregnancy should be referred to a reproductive endocrinologist for further evaluation and management of infertility.

Intrauterine Contraceptive Devices IUCD or IUD

2012-01-16T05:00:00.000-08:00

An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed. However, an IUD should only be removed by a medical professional.

Hormonal and copper IUDs work in different ways. With a copper IUD, a small amount of copper is released into the uterus. This type of IUD does not affect ovulation or the menstrual cycle. Copper IUDs prevent sperm from being able to go into the egg by immobilizing the sperm on the way to the fallopian tubes. If an egg does become fertilized, implantation on the wall of the uterus is prevented because copper changes the lining of the uterus.

With hormonal IUDs, a small amount of progestin or a similar hormone is released into the uterus. These hormones thicken cervical mucus and make it difficult for sperm to enter the cervix. Hormonal IUDs also slow down the growth of the uterine lining, making it inhospitable for fertilized eggs.

Before an IUD is placed, a physical examination is important to make sure that the reproductive organs are normal and that no infections are present.

An IUD can be placed during an office visit and remains in place until a medical professional removes it. It can be inserted at any phase of the menstrual cycle, but the best time is right after the menstrual period because this is when the cervix is softest and when women are least likely to be pregnant.

Once the IUD is placed, women can return to normal activities such as sex, exercise, and swimming as soon as they are comfortable. Strenuous physical activity does not affect the position of the IUD.

Ref : MEDSCAPE

Emergency Contraception Pill or "Morning after" pill

2012-01-15T05:22:00.000-08:00

Emergency contraception (birth control after sexual intercourse) is the use of a drug or device to prevent pregnancy after unprotected sexual intercourse. Emergency contraceptive pills are sometimes called the “morning-after pill,” but they are usually effective if taken within 72 hours of unprotected sexual intercourse.

Emergency contraceptive measures can be taken within the first 72 hours after unprotected sexual intercourse to reduce the possibility of pregnancy. A woman is most likely to become pregnant if sexual intercourse occurs in the few days before or after ovulation (release of an egg from the ovary). Emergency contraceptives should not be used as a contraceptive method in women who are sexually active or planning to become sexually active. They are not as effective as any ongoing contraceptive method.

Emergency contraception pills contain high doses of the same hormones that are in birth control pills. The high dose of hormones is short lived. Cases of deep vein thrombosis (blood clotting) have been reported in women using the emergency method. These pills are not designed to terminate an existing pregnancy.

Emergency contraception pills should only be taken with expert opinion. Cases of Uterine rupture have been reported in patients with inadvertent use.

Ref: Medscape

Abruptio Placentae : Bleeding in Pregnancy

2012-01-14T22:49:00.000-08:00

Abruptio placentae, also called premature separation of the placenta, is a serious complication of pregnancy. The placenta separates away from the inner wall of the uterus before delivery. Untreated abruption can harm both mother and baby. It can mean compromised oxygen and nutrients for the baby and heavy bleeding in the mother. It’s a medical emergency.

Risk factors include hypertension, trauma, and multiple pregnancies. Abnormalities of pregnancy called chorioamnionitis and polyhydramnios are also risk factors. Others are age (younger than 20 and older than
35), preeclampsia, diabetes, smoking, use of cocaine, and alcohol consumption.

The main symptoms are uterine bleeding, abnormal uterine contractions, and fetal distress . Contractions are painful and obvious. Weakness, low blood pressure, fast heart rate, abdominal pain, and back pain may occur. Grade 1 abruption includes mild bleeding from the vagina and uterine contractions, stable vital signs, and stable fetal heart rate. Grade 2 means moderate bleeding, abnormal contractions, low blood pressure, distressed fetus, and abnormal coagulation profile. Grade 3 is worst. It involves severe bleeding and contractions, very low blood pressure, fetal death, and very poor coagulation profile.

Treatment :Stabilization of the mother is done first. Intravenous fluids are given to maintain blood pressure and keep the urine flow steady. An emergency cesarean section and blood transfusions may be needed. For almost full-term babies and mild abruption, vaginal delivery may be possible.

Ovarian Cyst

2011-12-07T09:15:00.000-08:00

Dr Deepika Tiwari, Consultant Obstetrician & Gynaecologist
Sohna Road, Gurgaon Ph: 09911821669
Ovarian cysts are fluid-filled sacs within or on the surface of an ovary. Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months. Ovarian cysts — especially those that have ruptured — sometimes produce serious symptoms.

The symptoms of ovarian cysts, if present, may include:

Menstrual irregularities
Pelvic pain — a constant or intermittent dull ache that may radiate to your lower back and thighs
Pelvic pain shortly before your period begins or just before it ends
Pelvic pain during intercourse (dyspareunia)
Pain during bowel movements or pressure on your bowels
Nausea, vomiting or breast tenderness similar to that experienced during pregnancy
Fullness or heaviness in your abdomen
Pressure on your rectum or bladder that causes a need to urinate more frequently or difficulty emptying your bladder completely.

Infrequent complications associated with ovarian cysts include:

Ovarian torsion. Cysts that become large may cause the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion.
Rupture. A cyst that ruptures may cause severe pain and lead to internal bleeding.

To identify the type of cyst, your doctor may perform the following procedures:

Pregnancy test

Pelvic ultrasound

Laparoscopy

CA 125 blood test

The treatment depends upon the type/ stage of the cyst; or the presence of complications.

Female Infertility : Causes & Treatment

2011-12-07T09:05:00.000-08:00

Dr Deepika Tiwari; Consultant Obstetrician & Gynaecologist
Ph: 9911821669Generally, infertility results from female infertility factors about one-third of the time and male infertility factors about one-third of the time. In the rest, the cause is either unknown or a combination of male and female factors.

When to see a doctor
If you're in your early 30s or younger, most doctors recommend trying to get pregnant for at least a year before having any testing or treatment.

If you're age 30 to 35, discuss your concerns with your doctor after six months of trying.

If you're over 35 or have a history of irregular or painful periods, pelvic inflammatory disease (PID), repeated miscarriages, prior cancer treatment or endometriosis, your doctor may want to begin testing or treatment right away.

1. Ovulation disorders account for infertility in 25 percent of infertile couples

Abnormal FSH and LH secretion, Polycystic ovary syndrome (PCOS), Luteal phase defect, Premature ovarian failure, Premature ovarian failure.

2. Damage to fallopian tubes (tubal infertility)

3. Endometriosis

4. Cervical narrowing or blockage

5. Uterine causes

6. Unexplained infertility

Treatments can either attempt to restore fertility — by means of medication or surgery — or assist in reproduction with sophisticated techniques.

Fertility restoration: Stimulating ovulation with fertility drugs
Fertility drugs, which regulate or induce ovulation, are the main treatment for women who are infertile due to ovulation disorders. In general, they work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation.

Reproductive assistance: In vitro fertilization
This effective technique involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and transferring the embryos in the uterus three to five days after fertilization. In vitro fertilization (IVF) often is recommended when both fallopian tubes are blocked. It's also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor infertility, male infertility and ovulation disorders.

Anemia among Pregnant Women in India

2011-12-07T09:00:00.000-08:00

Dr Deepika Tiwari, Consultant Obstetrician & Gynaecologist, Sohna Road, Gurgaon 9911821669

According to WHO, the prevalence of Anaemia in pregnancy in south East Asia is around

56%. In India incidence of anaemia pregnancy has been noted as high as 40-80%.

Maternal risk due to Anemia : Poor weight gain. Pre term labours, Pregnancy Induced

Hypertension , placenta previa, eclampsia, premature rupture of membrane (PROM) Postnatal

sepsis, sub involution, embolism etc.

Risk to Foetus and Newborn : Complications include Prematurity, low birth weight, poor

Apgar score, fetal distress, neonatal distress requiring prolonged resuscitation, and neonatal anemia due to poor reserve. Infants with anemia have higher prevalence of failure to thrive, poorer intellectual developmental milestones, and higher rates of morbidities and neonatal mortalities than infants without anemia.

Studies carried out in India and elsewhere have shown that iron deficiency is the major cause of anaemia followed by folate deficiency. In recent years, the contribution of B12 deficiency has been highlighted.

Anaemia and iron deficiency in the mother are not associated with significant degree of anaemia in the children during neonatal period. However, iron stores in these neonates are low, iron content in breast milk in anaemic women is low and because of these factors substantial proportion of infants become anaemic by six months.

Unless effective screening of pregnant women is done for detection of anemic status, substantial
reduction in maternal mortality and morbidity may not be lowered.

Ref : Indian J Med Res;