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Three Things You Must Do to Treat and Prevent UTI-Urinary Tract Infection

Three Things You Must Do to Treat and Prevent UTI-Urinary Tract Infection

The phrase urinary tract infection conjures up specters of pain, burning, fever, irritation and sometimes bleeding- a veritable nightmare for today’s multitasking woman. Catching and treating UTIs at the earliest (apart from avoiding them altogether!) are your best bet for avoiding long-drawn out health complications.

UTI

1) Get Pill-osophical
The quickest and most effective means of dealing with UTIs is to get medical treatment. A course of antibiotics is prescribed to stop the infection-causing bacteria in their (urinary) tracks and to prevent a relapse. Though effective, these antibiotics tend to have side effects like acidity ,metallic taste in mouth diarrhea, loss of appetite etc. Some people may be allergic to a particular drug and may develop rashes and itching. If you experience any of the above, seek medical assistance.

2 )Beat the Pain-demic
Wear non-restrictive and loose clothing that won’t put pressure on your abdomen. There are specific bladder analgesics (pain killer) tablets available.Ask your doctor to prescribe them to you.

3 )Paging Dr. Nature
Taking the antibiotic to kill the bacteria and increasing fluid intake to flush them out go hand in hand.  Fluid intake thus becomes very important. Drinking water, green tea, and cranberry juice will cleanse and rid the urinary tract of any bacterial remnants.
A U-Turn on UTIs
Many women especially college going and working ones, will experience recurrent urinary tract infection. Therefore, drink plenty of water, empty your bladder frequently, wash and wipe yourself after using the bathroom. You can ask your doctor to prescribe you pH balanced medicated feminine wash for regular use.

At times investigations of urine like routine microscopy, culture & sensitivity testing to know type of bacteria are done.

Checking blood for hemoglobin and sugar levels also is done.
Prevention is far better than any known cure. So stay hydrated, let it go, and allow your bladder to do its job!

Failed Copper-T and unwanted pregnancy

 

When ‘ Copper-T’ Fails And Results In Unwanted Pregnancy, What Should The Woman Do

Every birth control measure (Contraceptive method) has its own failure rates which results in pregnancy. Intra Uterine Devices- IUD,( IUCD- Intra Uterine Contraceptive Device) which is known as ‘ Copper –T’  in layman’s language also has its failures.

Presenting features of pregnancy with Copper-T in situ

-Woman will complain of missed periods
-Her pregnancy test will be positive
-Sonography will show presence of contraceptive device with pregnancy side by side

Fate of pregnancy with IUCD in situ ( IUCD-Intra Uterine Contraceptive Device )

If the woman conceives with IUCD still inside uterus, the pregnancy in question may have higher chances of complications like

Infection ( Chorioamnionitis )

The bag of membranes which surround the fetus become infected.  This is a serious medical condition as advance stages- Sepsis, may involve infection in blood . This wide spread infection may become life threatening

Management

Involves- termination of pregnancy as soon as possible along with adequate cover with antibiotics.

Abortion

-There are higher chances of abortions whether spontaneous or induced.
-Here we should understand the woman opted for an IUD as she did not want to become pregnant any more.
-There is a rule by Government  of India under MTP act (Medical Termination of Pregnancy ) , that says that pregnant woman can seek termination of pregnancy ( in layman’s language-abortion ) upto  20 weeks if the said pregnancy has occurred as a result of failure of contraceptive ( Birth Control ) measure

Preterm Birth

-Pregnancy with Copper –T in situ has a higher chance of preterm birth.
-Preterm birth has its own set of complications like low weight of neonate, requirement of NICU- Neonatal Intensive Care Unit, failure to thrive etc.

Ectopic Pregnancy

-If a woman conceives with ‘ Copper-T’ in situ, there are higher chances that the site of pregnancy will be abnormal.
-The normal site of implantation of pregnancy is inside the uterus.
-In ectopic pregnancy, the site of implantation can be Fallopian tubes (Tube like structure which is a passage between uterus and ovary), Ovaries etc.
-This pregnancy in abnormal location does not grow normally

Management

-Early diagnosis by sonography and surgical intervention to remove this abnormally located pregnancy is required in most of the cases

What can be done once pregnancy is diagnosed with Copper –T inside uterus

-If thread is visible, which may be the case in early pregnancy, the treating Gynaecologist will gently pull on the thread to attempt removal. Many a times it is successful.
-Assistance of Ultrasound may be sought to make the removal procedure safe and easy
-If thread is not visible- termination of pregnancy by D&E- Dilatation and Evacuation may be offered along with removal of Copper-T at the time of the procedure

 

 

 

 

 

 

 

 

 

 

 

 

 

Stillbirth-a devastating outcome of a pregnancy

Stillbirth- A Devastating Outcome of a Pregnancy

Pregnancy is a period of joy and expectation for any woman and her family.  It is a heart breaking situation for any Gynaecologist when the news has to be broken that the baby is no longer alive in the uterus or the mother has given birth to a dead child .

This is a complicated scientific topic. Gynaecologists who treat such cases require compilation of all their knowledge and experience to evaluate the woman, whether she is pregnant right now or if she comes with history of previous stillbirth and is planning to conceive in near future.

In this write up, first we will deal with the scientific definition of Stillbirth. It’s division into three categories- Early, Intermediate & late. Causes & risk factors of stillbirth. Evaluation of stillbirth and finally its management aspect

Terms used in this topic

Fetus means- the child developing inside uterus
Gestation age -refers to the duration of pregnancy in weeks
Fetal death/ fetal mortality -is the term used to describe unfavorable outcome of pregnancy irrespective of duration of pregnancy (gestation age)
Stillbirth- is the term generally used by laymen when death of fetus occurs late in pregnancy

Scientific Definition of fetal mortality- Sillbirth

 Fetal death means death, prior to complete expulsion or extraction from the mother of a product of human conception irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.

The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord or definitive movement of the voluntary muscles.

Fetal mortality is generally divided into three periods

-Early- less than 20 completed weeks of gestation (pregnancy)
-Intermediate- 20-27 weeks
-Late – 28 weeks or more

In due course of the discussion of this topic, many causes (Clinical Situations) of Stillbirth will be discussed. Some of them are responsible for fetal mortality in all three periods of gestation. At the same time, for any case of fetal death, many factors may be responsible.

Many clinical entities are a topic of discussions in themselves hence they will be presented in only simplified and concise manner

 Statistics of Stillbirth (Fetal Mortality)

83 % of stillbirths occur before the start of labor pains- Antepartum stillbirths

CAUSES OF STILLBIRTH (FETAL MORTALITY)

1)Placental Causes

-Placental abnormalities– mainly utero-placental insufficiency

Placenta is the structure which is attached to the uterus and supplies food and oxygen to the fetus through umbilical cord. It gets its supplies from the mother. Various factors lead to its insufficient working.

Calcified placenta1

-Placental abruption

In this clinical entity placenta gets detached from its attachment to uterus. This results in stoppage of blood supply to the fetus and fetal death occurs.

placental abruption

2)Umbilical cord causes

-Prolapse– During labor (Birthing Process ) when cervix (mouth of uterus) is dilating, at times the umbilical cord comes out of it before the fetal head is born . This leads to compression of cord between fetal head and maternal bones of pelvis. There is cessation of blood supply to the baby and fetal mortality occurs

cord prolapse

 

-Stricture – This is structural abnormality of umbilical cord in which shrinkage of cord occurs at some point & cessation of blood supply occurs.

cord stricture

-Thrombosis – Clotting of blood occurs in the blood vessels of umbilical cord & blood flow to baby is hampered

3) Fetal Causes

-Multifetal gestation

When lady is pregnant with more than one fetus. Commonly encountered situations are Twins- pregnancy with two fetus, Triplet-three fetus, Quadruplet-four fetus etc

multifetal gestation

Fetal Malformations 

There are certain genetic abnormalities which result in major structural abnormalities in the fetus. These abnormalities are incompatible (Non survivable) with life.

4)Maternal Causes

Hypertensive disorders –

-Pre Eclampsia – High BP which results as a complication of pregnancy
-Chronic Hypertension – When mother is suffering from high BP and she becomes pregnant

Diabetes in mother

-Diabetic Embryopathy– Fetus of a diabetic mother is more prone to have certain congenital structural malformations. Some of them are lethal
-Diabetic ketoacidosis– Diabetic mother can develop this metabolic dysfunction. Blood sugar levels are high and insulin levels are low. Maternal cells are unable to utilize this sugar. This is a life-threatening situation for both mother and baby.

5) Obstetrics complications

Preterm labor

If pregnant woman goes in labor and delivers prematurely before the fetus has reached term and is capable of surviving independently.

Preterm Prelabor Rupture Of Membranes-PPROM 

Amniotic membranes make up Amniotic sac which is a covering around growing fetus to keep it safe inside uterus. If these membranes get broken due to some reason, Amniotic fluid (Fluid around fetus) gets drained resulting into Umbilical cord getting compressed between walls of uterus and fetus. This results in cessation of Oxygen supply to the fetus and ultimately fetal demise.
rupture of membranes

Infections

There are certain infections involving fetus and placenta which will lead to fetal death.

RISK FACTORS FOR FETAL DEATH

Gynaecologists come to know about these risk factors either during examination or history taking. When one or more of these risk factors are present, vigilance on part of both patient and doctor is required.

Education
Maternal age– 35-39 years, more than 40 years
Smoking
Drug abuse
Obesity– BMI (Body Mass Index- weight of person vs height) 25-29.9, more than 30

ART- Artificial Reproductive Techniques- if pregnancy is the result of fertility treatment- example- IVF- In Vitro Fertilization, ICSI- Intra Cytoplasmic Sperm Injection etc

Previous history of adverse outcome

Preterm birth
Growth retarded baby
Stillbirth
Pre-Eclampsia
Placental abruption
Cholestasis (Jaundice) of pregnancy

EVALUATION OF STILLBIRTH

Why is it Necessary-Aims & Objectives

-It is beneficial for maternal psychological adaptation to a significant loss. She is grieving and may be thinking of herself as guilty.
-Risk of recurrence can be judged and appropriate counseling and therapy offered
-There are certain inherited ( genetic ) disorders and identification of these syndromes will provide useful information for other family members

How is it done

1)Evaluation of fetus
Appropriate consent of parents is required before carrying out many of these processes

History taking in detail of pregnancy events
Clinical examination at the time of birth-It is found that up to 35% of stillborns have major structural anomalies. Some have Dysmorphic features (Distorted facial structure). Some may have skeletal ( bone) abnormalities. Weight, head circumference and length of fetus is also measured.
Photograph taking from different angles
Fetogram-Full radiograph of fetus (X-Ray) of fetus

Examination of
Placenta along with its weight
Umbilical cord
Amniotic membranes

-Karyotyping
Karyotyping reveals chromosomal (genetic material) abnormalities in the fetus
Sample required-
-3 ml of fetal blood is drawn from Umbilical blood vessels or direct Cardiac (Heart ) puncture & is put in sterile heparinized container
If blood is not obtained, other fetal tissues that can be sent in either Ringer Lactate (RL) solution or special cytogenetic solution are-
-Placental block of dimension 1 X 1 cm to be taken from the site, below the cord insertion
-Umbilical cord segment – 1.5 cm long
-Internal fetal tissue sample- Costochondral junction (Soft tissue which binds rib with Sternum-Bone in the middle of the chest), Patella- Knee cap

Important:
-These samples are to be stored at room temperature
-A full fetal karyotype may not be possible in cases with prolonged fetal death (Maceration)
-Skin is no longer recommended as tissue sample
-Placement of sample within Formalin or alcohol will kill remaining viable cells and will prevent chromosomal testing

Stillborn’s autopsy-
 MRI– Magnetic Resonance Imaging
USG– Ultrasound

MANAGEMENT OF PSYCHOLOGICAL ASPECTS OF MOTHER

The event of stillbirth is traumatic for mother & her family. She is at increased risk of mental depression. Regular visit to the Gynecologist is advised.

MANAGEMENT OF SUBSEQUENT PREGNANCY AFTER STILLBIRTH

Preconceptional or initial prenatal visit

 Detailed medical and obstetrical history -There are certain risk factors which are modifiable like hypertension and diabetes. Pregnant woman may have it at the time of diagnosis of pregnancy or there may be a history that she had these conditions at the time of that pregnancy which resulted in stillbirth. Specific management protocols are in place for managing these conditions

-Evaluation and workup of previous stillbirth- Bad Obstetrics History (BOH)

-Determination of recurrence risk

Smoking cessation
Weight loss in obese women (preconceptional only)
Genetic counseling if family genetic condition exists
Thrombophilia (Increased tendency of blood to clot) work up – antiphospholipid antibodies, along with Lupus anticoagulant
-Support and reassurance

First Trimester- Weeks 1-12

Dating ultrasonography- to confirm live pregnancy and expected due date

First trimester screen (Double Marker )- Blood tests include-PAPP-A- Pregnancy Associated Plasma Protein -A &Beta HCG- Human Chorionic Gonadotrophin along with sonography  for specific fetal features. These are Nuchal Transluscency (NT) which is thickness of nape of neck in millimeters & Nasal Bone (NB) presence

Second Trimester-Weeks 13-28

Fetal ultrasonographic anatomic survey-2 D, 3 D, at 18-20 weeks of gestation

Maternal blood tests- Quadruple  or single marker alpha fetoprotein if first trimester screening is not done .These tests are risk estimation for genetic disorder

Third Trimester-Weeks 29-40

Ultrasonographic screening for fetal growth restriction after 28 weeks if there is history of previous low birth weight baby Fetal Kick counts monitoring-starting at 28 weeks

Delivery

-Delivery -at 39 weeks or earlier is recommended. It can be an induced labor or Caesarean delivery depending on the clinical assessment of mother and fetus at that time.

 

Cervical Insufficiency & Cerclage- A Reason For Mid Term Pregnancy Loss & It’s Treatment

Cervical Insufficiency & Cerclage- A Reason For Mid Term Pregnancy Loss & It’s Treatment

-Cervix is the lower part of the uterus which opens in the vagina.
-During the entire duration of 9 months of normal pregnancy it stays closed and when labour pains start it opens up and dilates and let the baby be born.
-You can say say that it is like a closed door .When fetus in uterus is increasing in size and weight , it is very important that this door stays closed else, baby will be born prematurely.
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Cervical insufficiency is a distinct clinical entity
It is characterized by painless cervical dilatation in second trimester of pregnancy ( 13-28 weeks of pregnancy ). It is also associated with decreased length of cervix- Short Cervix
Short_cerix
It results in prolapse (bulging out ) and ballooning of membranes around fetus (Amniotic Sac/Amniotic Membranes-these membranes make a sac around fetus and protect the pregnancy ) into vagina and ultimately expulsion of an immature fetus.
download

Unless effectively treated this sequence of events may get repeated in subsequent pregnancies.

Diagnosis
1) Ultrasonography- Inadequate Cervical length is an indicator along with funneling of cervix which is ballooning of membranes into the dilated internal os but with a closed external os.
2) Clinical internal examination by the Gynaecologist

Risk Factors
Previous cervical trauma caused by surgeries like
-D & C- Dilatation & Curettage
-Conization- Removal of a diseased tissue of cervix in manner of a cone
-Cauterization- Electric current application to cervical tissue for purpose burning the diseased tissue and stimulate generation of new and healthy tissue
-Amputation- Removal of protruding part of cervix
-Abnormal cervical development

Precautions before treatment of Cervical Incompetence
– Ultrasound is done to check for fetal well being.
-Sexual intercourse is prohibited one week before and after the surgery.

Contraindications to treatment
-Bleeding from vagina
-Uterine contractions and pain
-Rupture of bag of membranes- leaking of fluid

Treatment of Cervical Incompetence
Classic Cervical Incompetence is treated surgically with ‘Cerclage ‘ operation which reinforces a weak cervix by a purse string suture ( Stitching of mouth of uterus). The suture material used is strong, thick and non absorbent. These sutures will now provide strength to the cervix to stay closed even though the weight of the fetus will keep on increasing.
This procedure is done as prophylaxis ( prevention ).
At times ‘Rescue Cerclage’ is needed as patient presents with symptoms in emergency.
This suture is removed at a selected date when the pregnancy has attained a mature state and the newborn will be healthy.
At times the suture needs to be removed in emergency if the patient goes in labour prematurely.
Cervical_Cerclage

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When to do the Cervical Cerclage Surgery
-Most medical text books recommend surgery at 12-14 weeks of gestation- A sonography at this stage will rule out majority of congenital malformations ( Birth Defects )
-If there is previous loss of pregnancy, surgery should be done a couple of weeks prior to gestation age( pregnancy duration) at which the loss occurred.
– If pregnancy is at a later stage- there is risk that Cervical Cerclage operation might induce contractions of the uterus and in turn will lead to loss of pregnancy .

Success of Cerclage surgery
Many medical studies have been conducted and it is found out that the success of this surgery is unpredictable.

Many Gynaecologists will opt for alternative method of managing patients with cervical incompetence- like bed rest, abstinence, Progesterone hormone support , Tocolytics ( Uterine relaxants medicines)

After a thorough counselling of patient and relatives, a treatment option is chosen for that particular woman.The pros and cons of doing the surgery vs conservative approach is discussed.

Name of Cervical Cerclage Surgery
McDonald Cervical Cerclage ( Most commonly done surgery )

Procedure-How it is done
After giving anaesthesia , patient is put in lithotomy position ( Legs spread and supported, patients buttocks reaching the edge of the operation table )
1

It is a trans vaginal procedure
With the help of instruments ( Sim’s Speculum)- Cervix is exposed.
With the help of non traumatic instruments ( Sponge holder/ Ring forceps )- Cervix is held
Non-Traumatic needle ( Round body ) is used along with non absorbent , thick suture ( Thread ) and purse string sutures are placed as high as possible on Cervix.

ccp

Complications
Uterine contractions
Bleeding
Rupture of membranes
Infection

To summarize- Cervical Incompetence is one of the causes of recurrent pregnancy loss. Timely treatment may reduce further losses. It is very important that Gynaecologist and patient have a detailed conversation . Then only treatment protocol should be decided.

Hysteroscopic Myomectomy

Hysteroscopic Myomectomy -A Novel Approach to Removing Fibroids of Uterus

hysteroscopic-myoma-resection

In a case of uterine fibroids and in that too particularly intramural fibroids, alternative conservative surgeries are now available to suitable patients vs more radical operation of uterus removal- Hysterectomy

Dr Santosh Jaybhaye is an expert Gynaecologist of Kamothe, Panvel has performed this surgery of removing fibroids through Hysteroscopy. This surgery is an attempt to prevent surgery of removal of Uterus ( Hysterectomy ) in a patient who complains of irregular menstrual periods.
Admin- My Gynaec World
Dr Himani Gupta

Adverse Effects Of High BP on Pregnant Woman And The Newborn

Adverse Effects Of High BP on Pregnant Woman And The newborn

PIH

 

-High blood pressure –BP ( PIH- Pregnancy Induced Hypertension)s  affects  the health of both pregnant  mother and the unborn child adversely.

-Medical management like medicines, rest, hospitalization and regular visit to the Gynaecologist will  help in controlling PIH- pregnancy related high BP in most of the cases.

-This article will provide an insight into the complications that are associated with this clinical condition     which happen if medical advice is not followed and hypertension becomes uncontrolled.

-One needs to understand that in severe disease, unfortunately complications occur in spite of best and regular medical treatment of PIH- Pregnancy Induced Hypertension.

-Another pointer to understand is that in any one particular patient only one of the following or a  combination of the complications may be present.

The topic is written in easy language and terminology is such that the information provided will be useful to a large number of people. However medical terminology is inseparable part of this article. To make understanding simpler (  ) are used for medical terminology

 (A)  EFFECT ON PREGNANT LADY

The organs and systems get affected in many ways

 1) BRAIN

 Swelling of the brain( Cerebral edema)

Clinically the symptoms are

-Headache- which will not get OK by taking painkiller tablets

-Lethargy

-Confusion

-Blurred vision

In late stages

-Coma

-Fits(Eclampsia)- This is a dangerous clinical situation. It may be associated with significant brain injury and dysfunction.

Changes in brain at structural level include bleeding (Hemorrhage), Blockage of blood supply (Infarction), Decreased blood flow (Ischemia), shrinkage of blood vessels (Vasospasm)

These patients are prone to sudden increase in BP which may worsen their condition further

Investigations like CT Scan or MRI will show following features

-Swelling (Edema) of the brain

-Fluid channels of brain get blocked (Obliteration of central ventricles)

-Brain matter will come out( herniate)   through its coverings-life threatening (Transtentorial herniation)

2)EYES-VISUAL CHANGES AND BLINDNESS

Woman will complain of

-Seeing black spots before eyes (Scotomata)

-Seeing things as double (Diplopia)

Blindness– in most cases it will last for 4 hours to up to 8 days. It is reversible. The dysfunction occurs in brain where centre for vision lies.

In some cases partial or total blindness persists.

Eyeball changes

-Inner lining of eyeball gets disrupted (Retinal detachment)-one more reason of blindness

-Blood supply to eyeball is stopped  retinal artery occlusion)- causes permanent blindness

3) LIVER CHANGES

 -There may be bleeding inside the liver (Periportal haemorrhage)

-Blood may collect below its capsule( Subcapsular hematoma)

-There may be rupture of liver with dire consequences

Clinically patient presents as

-Pain in upper abdomen

Blood investigation for liver function will reveal raised liver enzymes ( SGOT,SGPT)

Liver complications are associated with higher death rate of pregnant woman (maternal mortality)

In rare cases liver transplantation only will save the life of the woman

HELLP syndrome is associated with liver disorders (Hepatocellular necrosis)

H (Hemolysis) EL ( Elevated Liver enzymes) ,LP (Low Platelets count)

Patient suffering from this complication will require intensive care and may have prolonged recovery time

4) KIDNEY CHANGES

 -Blood supply to the kidneys ( Renal perfusion ) and its filtration process , both are reduced

-Factors like  blood loss, redirection of the blood to more vital organs like brain, increased blood pressure leading to widespread contraction of blood vessels ( Vasospasm) are responsible for it.

-On microscopic level basic functional units of kidney like Glomeruli and Tubules are damaged.

Kidneys secrete many harmful substances of body through urine. Consequences of decreased kidney functions are many –

-Urine output is decreased

-Blood levels of Creatinine, Uric acid and Calcium rise

The accumulated toxic substances in blood will eventually affect the mental status of the patient and she will appear dull and lethargic

5) CHANGES IN BLOOD

Decreased platelet count (Thrombocytopenia-Platelet is a component of blood)

-The normal platelet count is 1.5-4-5 Lakh / ml.

-Platelets play a very important role in stopping the flow of blood at the site of injury or bleeding.

-During delivery or Caesarean section the amount of bleeding is more if platelet count is less and it puts the life of mother in danger.

-If serial monitoring of blood shows decreasing trend of platelet count, it becomes an indication for delivery

-After delivery recovery of platelets will take 2-5 days

Destruction of blood (Hemolysis)

 -In high BP pregnant  patients the lining of small blood vessels gets damaged.

-Platelets and fibrin (blood component) get deposited on these sites to seal these sites.

-Blood corpuscles get damaged while passing through these vessels.

-Destruction of blood will lead to fall in Hemoglobin level (Anemia)

-Microscopic slide examination of blood will show abnormal Red Blood Corpuscles (RBC) like (Schizocytosis,Spherocytosis,Reticulocytosis).

Blood clotting (Coagulation) changes

-There is widespread blood clotting and blood destruction happening at multi-organ level in these patients.

-As a result blood levels of clotting factors are deranged .

-The tests which are abnormal include- PT- Prothronbin Time, PTT-Partial Thromboplastin Time,Fibronectin, D-Dimers, Factor VIII, Fibrinogen etc

6) HEART AND CIRCULATORY SYSTEM (CARDIOVASCULAR) CHANGES ALONG WITH LUNGS (RESPIRATORY SYSTEM)

Heart is made up of two types of chambers

  • Contractile chambers to push blood out into the system-Ventricles –They are two in numbers, left and right
  • Receptive chambers to receive blood from the system- Atrium- They are also two in numbers, left and right

When BP is high the ventricles will need to work against more resistance. As a result their muscle mass increases (Ventricular hypertrophy). Their lumen gets diminished in size. The final result is that fluid accumulates in lungs( Pulmonary Edema)-leading to difficulty in breathing( Respiratory distress). It also results in accumulation of fluid in the body (Edema)

There are other factors too which will lead to accumulation of fluid in the lungs like injury to the lining of breathing units (Alveoli)

7) LUNGS CHANGES

There may be accumulation of fluid in lungs (Pulmonary edema)

Patient may have difficulty in breathing and at times may require ventilator support ( ARDS-Acute Respiratory Distress Syndrome)

B) EFFECT ON UNBORN CHILD ( FETUS )

Uterus-Placenta unit’s blood supply

(Utero-placental perfusion)

-Uterine artery is the main blood vessel supplying uterus and in turn to placenta and growing baby(fetus)

-In normal pregnancy the uterus and placenta allow uterine artery to supply extra blood to it for healthy growth of baby (fetus)

-In cases of high BP, both uterus and placenta will resist this extra supply, resulting in less blood available to baby (utero-placental insufficiency) which will lead to low birth weight of newborn (IUGR- Intra Uterine Growth Retardation)

-At times water around baby also becomes less (Oligohydramnios)

-This compromised placenta sometimes separates from its attachment to uterus prematurely, even when patient is not in labor (Abruptio Placentae). This will lead to bleeding (Ante Partum Hemorrhage) putting life of both mother and baby in danger (Maternal mortality and IUFD-Intra Uterine Fetal Death)

Preterm birth– at times it becomes necessary to deliver the pregnant woman even before her 9 months are not complete. This kind of decision is taken if all the medical management including tablets to control the BP, rest at home or even hospitalizations are failing to control the high BP of pregnancy (PIH-Pregnancy Induced Hypertension )

Note From Author:

Expert and timely medical care and patient’s compliance towards taking medicines and regular check up with prescribed investigations has improved the outlook  in most of the cases . In urban settings  where the facility for ICU- Intensive Care Unit,NICU-Neonatal Intensive Care Unit for the newborn and blood banks are available, both mother and child have a good outcome.

Rural areas which are yet to have these facilities have a scope for improvement towards ‘Healthy Mother-Healthy Child’ initiative

 

 

 

5 Reasons – Why Your Wife May Seem Cranky During Pregnancy and Why You Should Just Smile

5 Reasons – Why Your Wife May Seem Cranky During Pregnancy and Why You Should Just Smile

Care-pregnant-wife

The fact that you’re here means you have been through or are currently in a similar situation. During pregnancy, your partner will change, as I’m sure most of you have already noticed by now. Coming home from work and opening that main door has become a game of potluck, you do not know what’s on the other side of it. And I’m sure you have heard this from a lot of people but here it is- it’s not her fault, it’s the hormones!

Hormones are chemicals our glands secrete into our body that get to control things, all kinds of things. When a woman becomes pregnant, these hormones go into hyper drive to create the perfect environment for the baby. And while they are at it, they also cause the following changes-

 

  1. Nausea and vomiting
    This is the earliest symptom of pregnancy. Hormonal changes of pregnancy are again responsible for it. It usually subsides by the 4th month. At times it may be prolonged due to which women will require to take medicines for many months.
    Word to the Husband
    Remember the last time you had to take an antacid as you were having nausea and vomiting as a result of eating outside? Now imagine your wife having the same feeling for a period of 2-3 months.
  2. Pain
    ‘No pain, no gain.’  This age old saying is absolutely true for pregnancy. Whether delivery is normal or Cesarean some amount of pain will be experienced even with our newest medicines. She needs to undergo repeated blood tests, gynecological check ups, and has to get numerous vaccinations.
    Word to the Husband
    How many of us keep postponing health check ups, dental treatment for fear of pain?
  3. Change in Eating and Sleeping Habits
    When a woman gets married, she may enter a new realm of eating and cultural habits. What is eaten, the way it is cooked, eating time table, all may be entirely different from what she is used to since her birth. Add to that the increasing demands of pregnancy. She may experience craving for odd food items at times. Her sleeping habits may also change. Increasing abdominal girth makes it difficult for her to adopt a comfortable posture. Baby movements may keep her awake or wake her up frequently during sleep.
    All these things will overwhelm her.
    Word to the Husband
    You can start by acknowledging the fact that she still keeps smiling despite all these changes. Get her one meal per day of her choice. The way she has always liked and share it with her. Make sure you do whatever you can to get her comfortable when she wants to sleep.
  4. Weight gain
    As pregnancy advances she is bound to gain weight. Growing fetus, placenta, uterus and many other factors are responsible for this. During each doctor visit, first thing that will be asked of her ‘Have you gained weight?’ Healthy weight gain is necessary for a healthy pregnancy. Then again it comes with its own discomforts. Feeling of bloating, backache, swelling in legs, all are part of the package. Even after delivery, returning to pre-pregnancy weight may not be easily achievable for many women.
    Word to the Husband
    Empathy, sympathy and understanding will work for you. Accept the changes in her and help her do the same.

 

  1. Pregnancy Marks
    Pregnancy is going to leave its tell tale signs behind. Things like loss of hair will recover, pigmentation on face will also disappear with time and treatment. But stretch marks is the main concern. With our newer skin treatments it is possible that they appear less and can be made to go away to a certain extent. But even for a short period, her appearance and way of dressing may change.
    Word to the Husband
    Inner beauty and qualities of a person matter most in journey with your life partner. Tell her that she is the most beautiful woman that has walked in to your life at every opportunity that you get.

Put all this together & you’ve got someone who needs your help & support, however difficult it might be for you at times. So you’ll have to bite your lip, do a lot of agreeing & apologising, and keep telling yourself that she’s literally out of control. This is a hard time for her too. Things will get less confusing once you slowly learn to gauge her mood. Remember to always ask her what she needs.

Talk to her. Be with her. Support and love her.

 

3 Simple Ways to Avoid Unwanted Pregnancy

3 SIMPLE WAYS TO  AVOID UNWANTED PREGNANCY
Unwanted pregnancy

1) Use protection
-Prevention is always better than cure
-Indian social scenario is changing
-Pre- marital, extra-marital and living in relationships are on a rise.
-At times these relationships are casual and will lead to unwanted pregnancy
-At the end of it,  it is the female’s body which will bear the brunt of physical discomfort of abortion
-There are many myths in people’s minds regarding use of regular contraceptive methods like oral contraceptive pills, condoms or Copper -T
-Whether a couple is married or unmarried when these regular contraceptive methods are used, unwanted pregnancy can be avoided.
-A consultation with the Gynaecologist for check up and to understand their correct use is a must and will allay your anxieties and concerns

A word of caution here about Emergency Contraceptive Pill
-It is clear that these pills are for emergency situations
-Couples in steady relationship should adopt regular contraceptive method
-These emergency pills have very high content of hormones
-Using them can make your next menses irregular,  delayed and heavy
-They should be taken ONLY on advise of a Gynaecologist

2) Be alert – For early diagnosis of unwanted pregnancy
-As soon as you have missed your periods, check yourself for pregnancy
-Easiest method is to do a urine pregnancy test done at home in a kit easily available at Chemist.
-The instructions to do the tests are also clearly written on packet
-Advanced tests for diagnosis of pregnancy can be done on your Gynaecologist ‘s advice like a test in blood known as Serum Beta HCG and sonography

3) Timely treatment – See a Gynaecologist at earliest
-When we talk about unwanted pregnancy, it is clear that couple wants termination.
-Government of India has made guidelines to offer safe abortion to all who seek it, regardless of marital status
-There are two ways of undergoing abortion
A) Surgical D&C
-This is traditional way and will require a day time hospitalization.
-If done in Govt approved MTP ( Medical Termination of Pregnancy)  center,  it is safe
B) Abortion by pills
-If clinical situation is of early pregnancy and within the limit set by Govt of India,  oral abortion pills can be taken on advise of a Gynaecologist
-There are no risks of anesthesia and surgical instrumentation in this method and no hospitalization is required

6 Steps for Healthy Recovery after Hysterectomy

6 STEPS FOR HEALTHY RECOVERY AFTER HYSTERECTOMY
Hysterectomy

1) Eat healthy
– Simple wholesome home cooked food should be eaten .
– Avoid fried , spicy , fatty and outside food .
– Take plenty of oral liquids.

2) Rest at home
– Resting will lead to peace of body & mind .
-Operative area will heal faster

3) Take medicines on time
– Antibiotics will prevent infection
– Iron & vitamin tablets will improve your general well being

4)Go slow on work and exercise
-Work should be resumed gradually.
-Heavy work is to be avoided for at least six weeks
-Breathing exercises & Praanayam is good and wil improve oxygenation of blood.
-Walking can be started next and later on other exercises can be done

5)Delay having intercourse
-Intercourse can be resumed after six weeks.
-Visit to your gynecologist and check up to know if healing is complete is necessary

6) Visit your doctor on time
-Keep in touch with your doctor, consult and get yourself checked as per schedule.
-This will keep a tab on your recovery,  diagnose any complication at earliest for timely treatment.

Complications of D & C ( Dilatation & Curettage )

Complications of D & C ( Dilatation & Curettage )

-D & C is a very common gynaecological procedure to manage menstrual problems, to offer surgical abortion ( MTP- Medical termination of pregnancy ) & as a part of infertility work up -Every procedure has its inherent risks and complications-These complications can be minimized by using advanced technology like Hysteroscopy and Ultrasonud assisted procedures, use of good antibiotics and use of newer medications for cervical dilatation.
Complications

Pain
– Lower abdominal, menstrual like cramping is expected for a couple of days after procedure
– Normal pain killers are adequate to manage

Bleeding
-Vaginal bleeding to some extent is expected.
-If quantity is more or duration is prolonged it is abnormal
-Management requires ultrasound for diagnosis & repeat D & C

Infection
– May occur of uterus and other pelvic organs
-It presents as pain abdomen , fever and foul smelling discharge from vagina
-Management require course of antibiotics

 Injury to cervix
-Access to uterine cavity for the purpose of procedure is gained by dilatation of cervix ( mouth of uterus)
-This at times may lead to laceration (tearing ) and bleeding
– Management requires taking stitches on cervixs

Perforation
-It can occur with any instrument that is put inside uterus.
– Uterus, Bowel (Intestines and rectum), Urinary bladder, Blood Vessels are most commonly injured organs.
-There are more chances of injury if there has been a previous operation like Caesarean delivery, myomectomy ( operation for removal of fibroids) etc.
-Management depends on the organ involved, extent of injury and general condition of patient.
– Laparoscopy – (Key hole surgery) can be performed to diagnose the site of perforation as well as repair of damaged organ.
-Laparatomy – ( Open abdominal surgery ) is required in cases where extent of damage is more.
-Blood transfusion, Intervention by general surgeon , ICU care – all of them are rare but known clinical situations

 Adhesions
-Scar tissue developing inside uterus-known as Asherman’s syndrome
-Repeated D& C procedures may lead to this condition.
-The anterior and posterior walls of the uterus get stuck to each other.
-It will result in scanty or no menstruation subsequently
-Management requires- Hysteroscopy ( Looking inside cavity of uterus through instruments) and cutting of fibrous tissue.
– Further pregnancies may be complicated by miscarriage or ectopic pregnancy ( Pregnancy occurring at sites other than uterus) etc.

Anaesthesia complications 
Allergic reactions to medications