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INVOLUNTARY LEAKAGE OF URINE IN WOMEN (INCONTINENCE) , NO NEED TO BE ASHAMED-GET TREATED

                    INVOLUNTARY LEAKAGE OF URINE IN WOMEN (INCONTINENCE)

                                     NO NEED TO BE ASHAMED-GET TREATED

 

Definition of Incontinence

It is leakage of urine which is involuntary causing social or hygienic problems and it is objectively demonstrable.

Stress urinary incontinence

– Also commonly known as SUI, (In this article SUI word may be synonymously used for leakage of urine)

-It is leakage of urine on pressure on abdomen like coughing straining for stool laughing etc. It is more commonly seen with advancing age

-SUI is not a disease, it is a symptom which can have many causes behind it. Most of the causes are curable and patient can be made dry and safe

-SUI is more common than diagnosed. Many women feel that SUI is normal and they don’t seek medical advice

-SUI is also seen associated with minor prolapse. The urinary symptoms are minor and they improve by pelvic floor exercises known as Kegel’s exercises

-In old post-menopausal women of age more than 60, prevalence of SUI is 15 to 20%

-Many a times post micturition dribble is confused with SUI. What happens in these cases is that after passing urine women get up too soon. The last part of residual urine dribbles and gets collected into vagina. when women get up, this urine leaks and gives rise to symptom of incontinence. Detailed history will give clinician an idea and this condition requires no treatment and only e patient education

-SUI is more common in women than men

-One in three women of more than 55 years of age have incontinence issues

-While 1 in 10 men of more than 55 years of age have incontinence issues

-More than 28 % women in their 30s experience loss of bladder control once a month

Types of incontinence

-Stress urinary incontinence

-It happens on coughing, laughing and lifting heavy weight. In this situation the abdominal pressure increases and urine leaks. The women will not get the sensation to pass urine, neither she will have the urge to pass urine. It happens even while sitting or standing normally. it is related to the weakness of pelvic floor and urinary sphincters

 

 -Urge urinary incontinence

-In this condition the woman will get a sensation to pass urine and when she goes she can’t reach the toilet,  and she will leak  even before sitting on commode.

-In this condition there is no rise in abdominal pressure, only the bladder contractions are at fault.

-Normally what happens, bladder relaxes when it is being filled with urine. When it is full the person will get the sensation. She will go to the toilet, then bladder contracts and woman will pass urine.

-In condition of urge incontinence, the bladder contracts during filling phase

 

-Overflow incontinence also known as hypotonic or paralyzed bladder

-In this condition either there is no sensation or less sensation during filling phase

-Bladder has no capacity to contract when full. It happens in neurogenic cases like

spinal injuries, CNS disturbances like stroke, multiple sclerosis, Parkinson’s disease, if the nerve supplying bladder is injured or damaged

-In this condition the bladder is always full, never empty and when it is reached its capacity of 600 ml it will leak the extra urine. This is overflow incontinence.

 -It is not necessary that patient will come to doctor with only one kind of incontinence whether urge or stress.

-Large number of patients with come with mixed incontinence some urge plus some stress incontinence

 

 -Continuous incontinence

-It is seen in cases of fistulas like vesico- vaginal fistula, urethro- vaginal fistula

 

Bladder functions are divided into two phases

Filling or storage phase

– In this phase, the sphincters are closed, bladder neck is closed, and it is accepting urine until it reaches 400- 500 ml

Emptying or voiding phase

In this phase bladder neck is open, sphincters are open, bladder is contracting.

 

                                                                                        Picture of bladder anatomy

Trigone– it is area of bladder between two ureteric orifices above & bladder neck below which is surrounded by internal and external sphincters and pelvic floor muscles.

Body of bladder is made of detrusor muscle which has two types of receptors.

  1. Parasympathetic receptors- helps in voiding – there are two varieties of receptors, Acetylcholine and Muscarinic receptors. Their function is to contract bladder and detrusor muscles, and they relax sphincters. This results in voiding of urine.
  2. Sympathetic receptors are of two kinds,

Alfa fibres in sphincters – Their job is contraction of sphincters

Beta fibres in bladder- their job is relaxation of bladder.

Their action results in filling of bladder.

 

Bladder filling and micturition cycle

-When sympathetic system is acting, parasympathetic is suppressed by our brain and bladder is in filling phase.

-When bladder is full signal passes to brain and brain stops suppressing parasympathetic. Now Parasympathetic becomes active and contraction of Detrusor muscles happens as well as relaxation of sphincters. This is voiding phase.

-Pelvic muscles and external sphincters are in our control. Even if detrusor is contracting and toilet is far away, woman can voluntarily contract the pelvic floor and control sphincters and not let the urine leak.

-When she has reached toilet and it is socially acceptable to pass urine then the pelvic floor muscles relax along with external sphincter and voiding happens.

-If bladder is unable to relax completely in filling phase it will hold only small amount of urine leading to frequency of urination along with urgency. If contractions are strong there will be urge incontinence.

-If bladder is not able to contract properly there will be, only partial emptying, now in next cycle bladder will take less time to refill, leading to complain of frequency. The residual urine in the bladder make get infected.

-The detailed history will tell what is the core problem.

Summary

-Urge incontinence– bladder muscle is contracting more than required. For overactive bladder-symptoms are frequency, urgency that are present both in day-time and night-time.

-Stress urinary incontinence– on increase of abdominal pressure during coughing or sneezing the urine leaks. This happens basically when sphincters are weak especially external sphincter. When pelvic floor muscles are weakened during childbirth all the pelvic organs sag down. In female urethra is small that is 4 cm. when woman coughs and sneezes, pelvic floor muscles do not support in closing the urethra. This will lead to stress urinary incontinence

-If woman is overweight it puts extra pressure on pelvic floor.

 

-In elderly people secretion of ADH- that is antidiuretic hormone from brain is reduced. that tend to produce more urine and especially in the night. lack of support from pelvic muscles and other co-morbid conditions like diabetes, Parkinson’s disease and CVA- cerebrovascular accidents add to difficulty

– Overconsumption of caffeine, alcohol, chocolates, citrus fruit juices may add to problem.

-Overflow incontinence- in neurological conditions like stroke, CVA

-When patient first presents to OPD, temporary causes of incontinence should be ruled out like-

-Infections which may present with frequency and urgency

– psychological causes

-Drugs like diuretics, NSAID’S (painkiller) which cause fluid retention and will lead to increased frequency in night as the blood supply to kidney is more at night and it will lead to diuresis which means increased formation of urine

– Anti Parkinson drugs, nasal decongestants, antidepressants, antipsychotics -they usually have anticholinergic component in them. This will lead to decreased bladder contraction which in turn will lead to retention of urine and later on mostly overflow incontinence

– BP medicines like Alpha adrenergic antagonist can cause urethral relaxation and SUI

 

Diagnosis

Diagnosis is by history and physical examination.

-Urine frequency of up to 7 times in a day is normal.  At times we find that patients are drinking lots of water maybe up to 4-5 litres per day and that is why they are passing lot of urine.

 

-History will also suggest whether woman gets urge and leaks before she reaches toilet or she is not feeling anything but when she laughs and coughs it leaks without any sensation.

-If we come across mixed variety, then we enquire what is troubling her more and treat her for that first.

– If there is burning or pain during passing of urine or there is fever, urine infection should be ruled out.

-If she is drinking lots of water it should be reduced to 2 litres per day.

-CVA/ Stroke/ Parkinson’s disease/ multiple sclerosis/ spine injuries should be ruled out.

 

Physical examination

 

-If bladder is found full, overflow incontinence should be ruled out

Bonney’s test -This test is done to assess if there is hyper-mobility of urethra.

Neurological examination– anal tone, anal sensation Is checked.

Bulbo-cavernous reflex on touching clitoris the anal sphincter will contract that means that sensory pathways are intact.

Voiding diary for overactive bladder (more than 2 times in night).

In this diary the time and amount of urination is noted every time with a measuring beaker. Home-stay for 24 hours is mandatory. Whatever is drunk is measured through glass.

This test will give idea about functional bladder capacity.

Ultrasound is done to check post void residue- hypotonic weak bladder will always be partially full and it will fill up early.

 

 Uroflowmetry

                                                                                 

-In this test woman passes urine in a commode and there is a transducer below which gives parameters like how much urine is passed, maximum flow rate in ml per second, average flow rate, time of voiding, whether she hesitates. In general voiding characteristics can be known.

 

Before starting anticholinergic drugs, it is very important to know that she is emptying bladder completely with good flow. Otherwise it will relax the already poorly contracting bladder and her post void residue will increase more.

 

 Urodynamics

 

                                                              

 

-Urodynamics is a general term to describe storage and voiding function of lower urinary tract.

-This study is done in sitting position.

-Two small tubes are passed in the bladder through urethra. One tube is used to fill the bladder at a desired rate of 10 to 30 ml per minute and the other tube is used to measure pressure inside bladder. – Normal saline is used. There is one more rectal catheter which measures intra-abdominal pressure.

-When should we do urodynamic study

-If persistent urinary tract symptoms like incontinence, retention, neurogenic bladder for overactive bladder are there.

– If despite presumed appropriate therapy patient still has symptoms like urgency, frequency, and SUI.

-If a surgery is being planned like TOT, Burch’s repair, pubo- vaginal sling, intravesical Botox injections.

-While performing this test privacy should be maintained, adequate antibiotic prophylaxis should be given, if there is UTI it should be treated first.

-During urodynamic studies the patient’s symptoms need to be replicated in real time.

-Before urodynamic studies an ultrasound is important to rule out vesico-ureteral reflux otherwise bladder will not get filled and much of saline will go into kidney.

-In case of mixed incontinence urodynamic study must be done before deciding type of surgery.

-If following symptoms are present like patient is not passing urine freely, post void volume is not less than 50 ml, stream is not good, that means patient is having voiding issues and likely to have bladder weakness. If TOT- tension free obturator sling surgery if done in this patient, her symptoms may worsen as she is already not passing urine well.

 

Mechanics of bladder filling

-The catheter inside bladder is used for measuring bladder pressure.

-Bladder is an intra -abdominal organ.

-When patient coughs intra-abdominal pressure rises as well as bladder pressure rises.

-Intravesical pressure/ bladder pressure is (Detrusor pressure + abdominal pressure)

-Detrusor pressure is (abdominal pressure – intravesical pressure)

– During filling phase Detrusor muscle is relaxed.

– During voiding- Detrusor contracts but abdominal muscle is relaxed and abdominal pressure does not increase.

 

Urge incontinence/ overactive bladder  

In this type of incontinence during filling phase of bladder itself, so many contractions of detrusor muscle happen

 

To demonstrate SUI

-Ask patient to cough, the abdominal pressure will increase, intravesical pressure also will increase, but the Detrusor muscle is not contacting.

 

Valsalva leak point pressure– helps in differentiating types of SUI.

-If leaking happens at pressure less than 20 CM of water that means sphincters are faulty. In this case Pubo- vaginal sling or tension sling is needed.

-If leak happens at 40 to 50 cm of water pressure that means sphincters are alright but there is urethral hypermobility and urethral support is bad and it does not get squeezed by pelvic floor muscles on rise of intra-abdominal pressure. TOT- Trans Obturator Tension free sling for treatment will be a good option.

 

Urinary incontinence surgery should be planned as per these guidelines

– High post void residue

– Voiding difficulties

– Overactive bladder

– SUI

 

-Prolapse of pelvic organs like uterus and SUI may occur together but they may not always be related. Prolapse surgery should be done on its own guidelines. If patient is having SUI along with prolapse, only prolapse surgery cannot be relied upon for cure of her symptoms.

 

-Burch’s colpo-suspension is a good option if only abdomen is opened for another surgery. It is very effective.

 

-50% of patients with SUI can be treated without surgery with the help of Kegel’s exercises if only compliance is maintained and biofeedback is used. 20 repetitions in all three positions that is lying down, sitting and standing with each contraction lasting 6 to 10 seconds. Do contractions in pairs.

 

Bladder training with the use of voiding diary, timed voiding is also used.

 

– intermittent self-catheterization can be used as a last resort every 3 hours

 

Botulinum injections– intravesical for overactive bladder which is not responding to anticholinergic drugs.

 

-At times in overactive bladder surgery is needed and intestinal conduit is put as a last resort.

 

-Drug therapy

-Solifenacin

– Oxybutynin

– Flavoxate

– Mirabegron

– Tolterodine

 

Contraindications to these drugs: –

– Narrow angle glaucoma

– Pregnancy

– Lactation

 

Side effects

– Constipation

– Dry mouth

 

With expert medical care most of women can lead a long, active and successful life.

 

 

 

 

 

EMERGENCY CONTRACEPTIVE PILL- Do’s & Don’ts

EMERGENCY CONTRACEPTIVE PILL- Do’s & Don’ts

WHATEVER THERE IS TO KNOW ABOUT IT

https://m.facebook.com/story.php?story_fbid=403179473596022&id=132666296798091

( This Facebook video contains live chat with Dr Himani Gupta about all these questions and answers )

Que1) What is Emergency Contraceptive Pill and what does it do?

Ans) Emergency Contraceptive Pill is supposed to prevent unintended pregnancy after unprotected intercourse or contraceptive failure.

Que2 ) How does Emergency Contraceptive Pill work ?

Ans) First- you should know the very basic of how a woman gets pregnant

-Every month, for a woman the menstrual period will last for 3-5 days

-Afterwards comes stage of folliculogenesis i.e. maturation of ova or egg till day 14-15

– Around middle of cycle there is release of ova from follicle of ovary.

-Meeting of ova and sperm happens in Fallopian tube with starting of life I.e. formation of embryo.

-Embryo travels through the Fallopian tube, comes to the uterine cavity, & gets attached to the endometrium i.e. the lining of the uterus known as implantation and life starts


Now- we will discuss, how Emergency Contraceptive Pill works-

– Emergency Contraceptive Pill will stop the egg from being released from the ovary (prevention of ovulation)

-If ovulation has already happened it will prevent sperm from attaching to the ova.

– It makes endometrium unsuitable for implantation.

What it can not do-

-If pregnancy is already established in the uterus i.e. implantation has happened, Emergency Contraceptive Pill cannot prevent it from growing neither can cause menses to come.

IMPORTANT MESSAGE- EMERGENCY CONTRACEPTIVE PILL IS NOT AN ABORTION PILL

-This notion that it will remove pregnancy is the most important reason for “perceived” failure of Emergency Contraceptive Pill

Que3) What are the circumstances in which Emergency Contraceptive Pill can be used?

                                              

Ans) Please note that Emergency Contraceptive Pill should be used as ‘BACK UP METHOD OF BIRTH CONTROL’ and ‘NOT A SUBSTITUTE OF REGULAR BIRTH CONTROL METHOD’

It can be used under following circumstances-

1)Male contraceptive failure- e. g. leakage/ tear / improper use of condom

2)Female forgot to take daily dose of regular oral contraceptive pill

3)Spontaneous / unnoticed expulsion of IUCD- Intra Uterine Contraceptive Device (Copper-T)

4) Unprotected sex- couple did not use any method to protect themselves

5) Forced sex – e.g. Rape

Que4) Is Emergency Contraceptive Pill safe to use?

Ans) Emergency Contraceptive Pill has approval from proper authorities, if taken for approved indications.

Que5) How effective is Emergency Contraceptive Pill?

                 

Ans) The effectiveness of Emergency Contraceptive Pill is

  • 95 % when taken within 12 hours
  • 85 % when taken within 25-48 hours
  • 58 % when taken within 49-72 hours

Que6) What are the side effects of Emergency Contraceptive Pill?

Ans) Common side effects are

  • Nausea, vomiting, headache
  • Lower abdominal pain and breast tenderness
  • Unexpected vaginal bleeding- this one is the most common side effect that brings woman to the OPD. It is expected to settle down by next menstrual cycle but at times requires medicinal support to control bleeding like- Antifibrinolytics, high doses of hormone – progesterone and Ormeloxifene.

WORD OF CAUTION– It is seen that many couples will use Emergency Contraceptive Pill, repeatedly, indiscriminately & without consulting Gynecologist or family doctor. These women may face severe side effects like intractable (Unstoppable) vaginal bleeding which proves very difficult to manage & control & is quite debilitating for the woman’s health.

Que7) If despite taking Emergency Contraceptive Pill – woman misses her menses, how can we know whether she is pregnant or not?

Ans) If woman misses her periods after taking Emergency Contraceptive Pill, she should do urine pregnancy test & Beta HCG test in blood to check if she has become pregnant.

Decision to continue with pregnancy or terminate can be taken after discussion with the Gynecologist.

Que8) if more than 72 hours have passed since unprotected sex, will Emergency Contraceptive Pill still work?

Ans) Emergency Contraceptive Pill is designed to work within certain time frame. If this is exceeded, you should consult your Gynecologist and consider option options.

Que9) Can Emergency Contraceptive Pill be used as regular birth control pill?

Ans) No woman should replace her regular birth control pill or OC Pill with Emergency Contraceptive Pill. Think about the irregular bleeding that happens after taking it. Also, protection rate is not 100 %. Regular birth control pills when taken as prescribed, on one hand provide 100 % protection & on top of that give extra benefit of regularization of cycles.

Que10) How often Emergency Contraceptive Pill can be used?

Ans) As the name suggests, it is for emergency only and THAT should arise only once in a while.

Couples should take care of themselves by using one of regular methods of contraception.

Que11) What are the points I should clearly understand before I take Emergency Contraceptive Pill?

Ans) Following points you should remember

  • Emergency Contraceptive Pill will not work for you if you are already pregnant
  • It should not be used as regular birth control method owing to its too many side effects & higher failure rates.
  • It doesn’t protect against HIV/ AIDS or any other STD (Sexually Transmitted Disease)

Que12) How is Emergency Contraceptive Pill different from abortion pill?

Ans) Both of them work in diametrically opposite way. Emergency Contraceptive Pill is designed so that it prevents the starting of pregnancy.

Whereas if pregnancy has already occurred then only abortion pills will work on it and aid in removing it.

Que13) Will Emergency Contraceptive Pill still be effective if several acts of unprotected intercourse have happened in a short duration of time?

Ans) We have already discussed the time span & effectiveness of EC. For several acts to happen, time span will naturally increase & hence the effectiveness will go down. Anyway, by indulging in several acts the very basic fundamental concept of ‘Emergency’ is forfeited. It can be used but with clear understanding & after consultation with a Gynecologist.

Que14) Can Emergency Contraceptive Pill be used during breast feeding period?

Ans) Emergency Contraceptive Pill does not have any significant milk decreasing effect. It can be used. However, again use of regular contraceptive method is advised.

Que15) Do I require a check up by doctor before taking Emergency Contraceptive Pill?

Ans) A normal healthy female can take EC on her own. However, it is always better to check with your Gynecologist as soon as & whenever possible.

 

STAY SAFE, STAY PROTECTED

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World


Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai


Ph  +91-7506027299

      +91- 9820193283 

Email-mygynaecworld@gmail.com


List of our attachment hospitals-

Om Navjeevan Hospital,Plot No.2, Sector-21. Kharghar, Navi Mumbai


Sanjeevan Hospital,Plot No. F/14, Opp. State Bank of Hyderabad,Sector-12, Kharghar,Navi Mumbai


Kharghar Medicity Hospital,Aum Sai CHS, Plot NO – C/23 Sector 7, Kharghar, Navi Mumbai


Motherhood Hospital,Utasav Chowk, Plot -No-5, Sector -7, Kharghar, Navi`Mumbai


Cloudnine Hospital, Palm Beach Galleria, Plot-no- 17,Sector- 19-D, Vashi, Navi Mumbai


People from following locations of Navi Mumbai and Raigad can approach us for Gynaecology related advise

-Kharghar,Kamothe,Kalamboli,Panvel,Road Pali,CBD Belapur,Seawoods,Nerul,Vashi, Sanpada, Juinagar, Khanda Colony, Taloja

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Early Cancerous Changes in Lower Genital Tract of Women- Update-24.2.19-Cell level changes

Early Cancerous Changes in Lower Genital Tract of Women- Update-24.2.19-Cell level changes

Hello friends,

As promised, we will continue our discussion on Preinvasive Lesions/Precancerous of The Lower Genital Tract of Women’.

-These lesions are a spectrum ranging from mildly cytoplasmic & nuclear (cell level) changes to severe dysplasia (severe derangement).

-There is no invasion (penetration) through basement membrane which would then characterize as invasive cancer.

Grading ( categorisation ) is done by measuring proportion of epithelium ( lining ) affected from basement membrane upwards.

– If it is affecting lower 1/3 rd, it is grade 1 or mild dysplasia.

-Involvement up to middle third is grade 2 or moderate dysplasia.

– Extension in to upper third is grade 3 or severe dysplasia.

– Full thickness involvement is known as carcinoma in situ.

– So, friends, in next update of this series will discuss in detail about some other aspect of this topic.

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283

 

Pelvic Mass in Women- Update-24.2.19,Causes in Prepubertal Girls,Benign & Malignant

Pelvic Mass in Women- Update-24.2.19,Causes in Prepubertal Girls,Benign & Malignant

Hello friends,

As promised, we will continue our discussion on Pelvic Mass and will discuss causes in pre-pubertal girls.

-The main reasons are functional cysts and benign i.e. non-cancerous lesions like germ cell tumors and mature cystic teratomas which are commonly known as Dermoid Cyst.

–  Cancerous or malignant tumors of ovary are very rare and account for only 1 percent.

-Causes for adolescent girls are pretty much same as pre-pubertal girls and in addition include Endometriosis and sequalae of pelvic inflammatory disease.

– In these age groups the diagnosis is a challenge as these masses present with non-specific signs and symptoms.

 Laparoscopic ovarian cystectomy is the preferred surgery if at all it Is required.

– So, friends, in next update of this series will discuss in detail about some other aspect of this topic.

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283

 

Changes During Menopause -Update-24.2.19-Hormonal Changes

Changes During Menopause -Update-24.2.19-Hormonal Changes

Hello friends,

As promised, we will continue our discussion on Changes During Menopause.

-Today we will discuss hormonal changes.

-During this time period the levels of FSH – ie Follicular Stimulating Hormone and LH ie Luteinizing Hormone increase and levels of hormones, Estrogen and Progesterone decrease.

-Impaired folliculogenesis & anovulation happens in ovaries.

-The existing follicles in the ovaries undergo accelerated rate of loss until eventually the supply of follicles is depleted.

-AMH ie Anti Mullerian Hormone is secreted by Granulosa cells of pre-antral ovarian follicles.

-Falling levels of AMH and rising levels of FSH are taken as marker of ovarian reserve during Menopausal transition.

– So friends , in next update of this series we will discuss in detail about some other aspect of this topic.

By

Dr Himani Gupta

Gynecologist & Obstetrician,Kharghar

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283

Main facilities- Normal delivery, Caesarean delivery,Medical abortion by abortion tablets, Pregnancy care

 

Techniques Used for Imaging in Gynecology-Update-24.2.19.Routes of Sonography-Trans-abdominal & Trans-vaginal

Techniques Used for Imaging in Gynecology-Update-24.2.19.Routes of Sonography-Trans-abdominal & Trans-vaginal

Hello friends,

As promised, we will continue our discussion on Techniques used for Imaging in Gynecology & will talk about different routes of sonography.

Trans-abdominal route of sonography provides global identification of all pelvic organs and their relationship to one another. A full bladder is usually necessary as it provides acoustic window, pushes the uterus upwards from behind the symphysis pubis and makes it more visible.

In Trans-vaginal sonography, the transducer is positioned in the vaginal fornices hence it is closer to the region of examination. Measuring endometrial thickness is easier this way. Urinary bladder is kept empty for the scan.

– So, friends, in next update of this series will discuss in detail about some other aspect of this topic.

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283

Gestational Trophoblastic Disease-a Strangely Abnormal Pregnancy,Update-24.2.19,Cancerous subset-GTN

Gestational Trophoblastic Disease-a Strangely Abnormal Pregnancy,Update-24.2.19,Cancerous subset-GTN

Hello friends,

As promised, we will continue our discussion and talk about Gestational Trophoblastic Neoplasia or GTN which is the malignant or cancerous subset of spectrum of Gestational Trophoblastic Diseases or GTD.

-GTN responds to chemotherapy and are routinely cured even in the presence of widespread metastases.

-In GTN, the chances for preservation of fertility and subsequent successful pregnancy are also good.

-Most commonly GTN develops from Molar pregnancy but may follow any kind of pregnancy.

– So, friends, in next update of this series will discuss in detail about some other aspect of this topic.

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283

Medical Investigations of Couple Seeking Fertility-Update-24.2.19-What is sub-fertility & when to investigate

Medical Investigations of Couple Seeking Fertility-Update-24.2.19-What is sub-fertility & when to investigate

Hello friends,

As promised, we will continue our discussion on evaluation of couple seeking fertility.

-Today we will seek deeper understanding of what is infertility and population dynamics.

-It is said that most couples are said to be subfertile as they will ultimately conceive if given enough time.

-The decision to start investigations in the couple depend on many factors like age of woman, for how long they have been married, ovulation status and so on.

– Generally, investigations are started if couple has failed to conceive in one year.

Fecundability, which by definition is ability of woman to conceive, is highly age related and declines with advancing age.

-Women in age group 35-40 years will require more frequent evaluation than younger woman.

– So, friends, in next update of this series will discuss in detail about some other aspect of this topic.

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283

Endometriosis-a Medical Dilemma in Women-Update-24.2.19-How it happens & spreads

Endometriosis-a Medical Dilemma in Women-Update-24.2.19-How it happens & spreads

Hello friends,

-As promised, we are back with more discussion on Endometriosis.

-Today, we will discuss several theories that propose cause of endometriosis.

Retrograde menstruation theory states that here is back flow of menstrual blood through Fallopian tubes into peritoneal cavity. These endometrial fragments get implanted there,survive,grow and give rise to endometrial lesions.

-Endometriosis also spreads through vascular or lymphatic channels to unusual locations like groin, perineum and retro-peritoneum.

-There is another theory of coelomic metaplasia which proposes that the lining of abdomen known as peritoneum is capable of turning into endometriotic lesions.

– So, friends, in next update of this series, we will discuss some more aspect of Endometriosis.

-Keep a watch on this space as next update will arrive soon

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283

Ectopic Pregnancy-a Devastating Outcome of Pregnancy,Update-24.2.19,Why it happens

Ectopic Pregnancy-a Devastating Outcome of Pregnancy,Update-24.2.19,Why it happens

Hello friends,

-As promised, we are back with more discussion on Ectopic pregnancy.

-Today, we will discuss various risk factors which are responsible for increased incidence of ectopic pregnancies.

-More people are suffering from sexually transmitted diseases which may lead to damage of the Fallopian tubes.

– This on one hand can cause infertility and on other hand ectopic pregnancy.

-If a surgery is done on Fallopian tube, either to correct its pathology or to reverse permanent family planning operation, it will leave the tube more prone for developing ectopic pregnancy.

– Women who become pregnant in later years of life or who require assisted reproductive techniques like IUI or IVF etc are at increased risk of developing ectopic pregnancy.

-Family planning methods like copper-T and permanent operation of female, when they fail, they lead to increased risk of ectopic pregnancy.

– So, friends, in next update of this series, we will discuss some more aspect of Ectopic Pregnancy.

-Keep a watch on this space as next update will arrive soon

By

Dr Himani Gupta

Gynaecologist & Obstetrician

Director-My Gynaec World

Official Head Quarter

Mother ‘n’ Care Clinic

Row House F 44/32

First Floor

Near Shivaji Chowk

Sector 12-Kharghar, Navi Mumbai

Ph  +91-7506027299

+91- 9820193283