Nausea-and-Vomiting.jpg
02/Mar/2020

During the first trimester of pregnancy, many women experience the bouts of nausea and vomiting commonly described as morning sickness. It usually begins around the 6th week of pregnancy, peaks around week 9, and in 95% of women it disappears by the 12th week of pregnancy, but can continue up to 16 to 18 weeks as well. rarely this concern can go up to delivery. Although unpleasant, morning sickness is considered a normal part of a healthy pregnancy.

Though it is commonly called morning sickness it is not confined to only the morning hours and can happen during any part of the day.

It is just a physical reaction of the body to the high level of circulating pregnancy related hormones.

“Hyperemesis gravidarum” is the term used to describe a more severe condition. Hyperemesis may cause you to vomit multiple times throughout the day, lose weight, be unable to consume food and liquids, and typically requires evaluation in the hospital and treatment with intravenous fluids and medication(s).

Women who are more likely to develop nausea and vomiting of pregnancy include those who:

  • developed these symptoms in a previous pregnancy,
  • experience nausea and vomiting while taking estrogen (for example, in birth control pills)
  • or have menstrual migraines,
  • have a history of gastrointestinal problems (ie, reflux, ulcers),
  • have twins, triplets, or other multiples,
  • have a molar pregnancy (a type of abnormal placenta and pregnancy)

 

Treatment:

Of mild to moderate vomiting where one is not dehydrated, is mainly dietary and lifestyle change:

  • Dietary intervention, we encourage multiple small feeds of your choice that are high in protein or carbohydrates and low in fat.
  • Remember your taste buds don’t like your routine tastes but will be comfortable with slight variations in taste. Eg. Ginger – powdered ginger or ginger tea may help to relieve nausea and vomiting in some women.
  • Distract yourself while having food so that your concentration is not on your food plate.
  • Try eating before or as soon as you feel hungry to avoid an empty stomach.
  • Treatment may not totally eliminate your nausea and vomiting.
  • The goal is to make symptoms tolerable so that you can eat and drink enough to keep you hydrated and not losing much weight.
  • Smelling fresh lemon, mint, or orange or using an oil diffuser with these scents may also be useful, just remember to keep changing the scents often.
  • Avoid triggers— one of the most important treatments for pregnancy-related nausea and vomiting is to avoid odors, tastes, and other activities that trigger nausea.
  • Eliminating food triggers, like spicy foods, helps some women.
  • Brushing teeth after eating may help prevent symptoms so that lingering taste of food can prevent trigger of nausea.

 

If you are unable to hold down food or liquids, you may get dehydrated and need to be treated with intravenous (iv) fluids. This may be done in your doctor or nurse’s office or in the hospital, depending upon the severity of your vomiting. For a short time, you may be advised not to eat or drink anything, to allow the gut to rest. You can slowly begin to eat and drink again as you begin to feel better, usually within 24 to 48 hours. Antiemetics drugs to prevent vomiting, are prescribed in severe cases not responding to the above, even steroids for a short term may be prescribed.

Most women with pregnancy-related nausea and vomiting recover completely without any complications. Women with mild to moderate vomiting often gain less weight during early pregnancy. This is rarely a concern for the baby unless the mother was very underweight before pregnancy.

In women with severe nausea and vomiting (hyperemesis gravidarum) who are hospitalized multiple times and who do not gain weight normally during pregnancy, then there is a small risk that the baby might be underweight or small.

Women who have hyperemesis gravidarum are at 15-20% risk of recurrence in future pregnancies.


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02/Mar/2020

Many women have diabetes during pregnancy, why?

GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy

It includes the situation where it is diagnosed for the first time in the current pregnancy even if the glucose intolerance was preexistent or begun concomitantly with the pregnancy.

Gestational diabetes mellitus (GDM) has become one of the most common medical complications of pregnancy. It can have significant health implications for both the mother and child.

Maternal carbohydrate metabolism is where it starts to change during pregnancy. As pregnancy advances insulin resistance increases due to placental hormones. If there is inadequate secretion of insulin in response to increased bloodsugar, then one develops GDM.

The first screening for GDM starts at the first booking visit. This is done by checking fasting blood glucose or timed glucose level measurement and again rechecking once more at 24–28 weeks of gestation, usually with a 75gm OGTT. This protocol of monitoring is for pregnant women with low risk. The protocol for Patients with High risk of developing GDM in the current pregnancy, is to screen them twice, both in the booking visit and later at 24-28 weeks of pregnancy with the 75gm GTT.

  • High risk women are those who have a BMI of greater than 30 kg/m2.
  • H/O of GDM in previous pregnancies or fetal macrosomia.
  • family history of diabetes mellitus.
  • glucose detected on urine dipstick testing (2+ or above on one occasion, or 1+ on two or more occasions).

 

Management:

Management of GDM is by using a multidisciplinary approach involving a team comprising of an obstetrician, endocrinologist and dietician. Most of the patients are initially started on and controlled through diet changes, but as pregnancy advances if the insulin resistance increases some may require pharmacologic therapy with tablets or insulin injections to prevent complications.

What are the implications on the fetus and new born, before and after birth?

GDM if uncontrolled can adversely affect the intrauterine development of fetus at each trimester.

In the first trimester, Spontaneous miscarriages and major congenital anomalies may be induced.This is usually so if the diabetes is overt.

During the second and third trimesters, Fetal macrosomia (abnormal Increased fetal growth in size) sudden intrauterine demise, may occur if  sugars are uncontrolled.

Postbirth there is increased chance of neonatal hypoglycaemia, jaundice and polycythaemia in the baby.

 

Long-term medical considerations of GDM:

GDM disappears in 95 % of women post-delivery. But are the risk of developing diabetes at the rate of 20% to 60% in future and increased risk of developing GDM in subsequent pregnancies.

75 gm GTT (2step) should be performed at least 6 weeks after delivery if both glucose levels and GTT are normal post-partum, lifestyle modification and Thereafter, annual glucose and HbA1C testing can detect deteriorating glycemic control and predict the onset of Type 2 DM.

All patients with prior GDM should seriously consider lifestyle modifications, good physical activity and diet modifications that will lessen insulin resistance and prevent or at least delay the age of onset of DM in future.

If GTT is impaired intense lifestyle modification and  regular monitoring of blood glucose levels 3-6monthly is advised.

If overt diabetic status is diagnosed during pregnancy then DM protocol of management to be followed.

GDM carries a small but potentially important longer-term risk of obesity and glucose intolerance in children too.

Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity.

 


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02/Mar/2020

Heavy menstrual bleeding which is medically referred to as MENORRHAGIA is used to describe a menstrual bleed that is increased in duration or quantity.

i.e. if it continues for more than 7 days, or less than that, but associated with passage of large clots or need to change pads or tampons that are completely soaked at least once in every 1 or 2 hours or overflow even after the usage of extra-large size sanitary pads.

When you realize you are going through this problem it is advisable to consult a gynecologist to investigate the probable cause and get treated because long standing neglected heavy periods can lead to…..

ANAEMIA and its complications namely

  1. extreme fatigue
  2. breathlessness and
  3. preventing one from doing day to day work.

So what are the probable causes that leads to menorrhagia….

1) HORMONAL IMBALANCE….the most common cause when there is an imbalance in the normal cycle of female hormones namely estrogen and progesterone. In such situations the menstrual cycle is delayed and followed by heavy or prolonged bleeding.

This pattern is common during the first one year following menarche (attaining periods for the first time). This is because of the immaturity of the hormonal axis.

This also happens with people who have polycystic ovaries or increased levels of the hormone Prolactin(milk secreting hormone) or deficiency of thyroid hormone or are just overweight!

2) Endometrial polyps: a non cancerous excessive growth of the lining of uterus

3) Fibroid s: non cancerous growths from the wall of the uterus

4) Adenomyosis: the  tissue that lines the uterus is seen in the muscle layer of the uterus.

5) Intrauterine contraceptive device

6) Medical bleeding disorders (rarely)

7) Unhealthy pregnancy that is miscarrying, especially when one is not aware of being pregnant, can also present as menorrhagia.

8) Cancer of the lining of uterus or the cervix can present as heavy vaginal bleeding especially if the woman is postmenopausal.

9) Rarely blood thinners given for various medical conditions.

 

Diagnosis and investigations

  • Includes your gynecologist speaking to you to understand the problem,
  • examining you and taking a pap smear
  • A basic pelvic scan
  • A hormonal work up including thyroid profile
  • complete blood count.

 

Treatment

Depends on the cause of heavy bleeding.

Iron supplements are given if your hemoglobin is less than normal.

If cases of hormonal imbalance, management starts with weight loss if obese, then non hormonal treatment are tried with Tranexmic acid

If it fails, hormones in the form of oral tablets or injectables or as an intrauterine device (called Mirena) is used.

Endometrial polyp is surgically removed by hysteroscopic polypectomy.

Adenomyosis is treated majorly with hormones.

Fibroids in the uterus can be treated with hormone modulating medications or surgical removal of the offending fibroid or the uterus itself.


Gestational-hypertension.jpg
02/Mar/2020

  • Gestational hypertension high blood pressure(BP) that develops after week 20 in pregnancy and goes away after delivery.
  • Preeclampsia –  gestational hypertension can lead to this severe condition after week 20 of pregnancy.  Protein appears in the urine in addition to high BP

 

During my pregnancy am I at risk for developing gestational hypertension?

The following moms may be at an increased risk of developing gestational hypertension during their pregnancy

  • First-time moms
  • Women whose sisters and mothers had pregnancy induced hypertension(PIH)
  • Women carrying twins or triplets or more
  • Women younger than age 20 or older than age 40
  • Women who had high blood pressure or kidney disease prior to pregnancy

 

How will my pregnancy be managed?

If you have mild hypertension and your baby is not fully developed, your doctor will probably recommend the following:

  • Rest, lying on your left side to take the weight of the baby off your major blood vessels.
  • Increase prenatal checkups.
  • Consume less salt.

If you have severe hypertension, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely.

 

How does gestational hypertension affect my baby?

Placenta supplies oxygen and nutrients to the baby from the mother. in gestational hypertension the blood vessels of the placenta start to constrict so the baby gets less oxygen and food and it affects its growth. This results in reduced intrauterine growth and low birth weight babies. This is not the case in every women with gestational hypertension. If adequately controlled and it is mild gestational hypertension, then the pregnant mom delivers a healthy normal baby.

If your hypertension is severe, it can lead to a condition known as preeclmapsia, which can have much more serious affects on mom and baby.

 

How does my health get affected in gestational hypertension?

Especially if your bp is uncontrolled or severe it can affect your

  • Kidneys leading to medical renal disease
  • Cause convulsions called eclampsia
  • Retinal haemorrhage in the eyes
  • Liver dysfunction
  • Blood clotting mechanism can be altered leading to failure of clotting of blood (the HELLP syndrome)
  • Lungs filling up with fluids called pulmonary edema causing breathlessness

 

How can I prevent gestational hypertension:

Currently, there is no sure way to prevent this condition. Some contributing factors to high blood pressure can be controlled, while others cannot. Some ways you can help prevent gestational hypertension is by

  • Get enough rest.
  • exercise regularly.
  • avoid drinking alcohol.
  • avoid beverages containing caffeine.
  • Your doctor may suggest you take prescribed medicines if there is an indication that you are at risk for developing gestational hypertension in the current pregnancy.

 


Forties-Conceive_.jpg
22/Feb/2020

The natural age limits of fertility in both women and men have become more apparent with the recent trend toward delaying childbearing.

Research indicates that among nulliparous women, the percentage experiencing infertility increases markedly with age, from 7%–9% among those aged 15–34 years to 25% among those aged 35–39 years and 30% among those aged 40–44 years.

the risk of infertility rises with age in women, because the eggs produced are of lower quality and their reproductive physiology shows signs of deterioration. Impaired ovulatory function, endometriosis, uterine leiomyomata and tubal disease are common causes.

The management of infertility ranges from counseling and advice to medications and surgery. The most common medical services received by women in the reproductive age facing infertility problems are clinical examination and reproductive advice (29%), testing of her and the male partner (27%) and ovulation medications (20%). Less commonly services utilized were intrauterine insemination (IUI) (7%), surgery or treatment for blocked tubes (3%) and assisted reproductive technology (ART) (3%).

Treatments for infertility can carry significant health risks to the mother and child. For example, a very rare but serious risk of using drugs for ovulation induction is ovarian hyperstimulation syndrome (OHSS), which is characterized by enlargement of the ovary and an accumulation of fluid in the abdomen. OHSS is usually self-limiting, resolving spontaneously within several days, though the most severe cases may require hospitalization and intensive care. In addition, some (but not all) research suggests that infertility treatments may be associated with an increased risk of gynecologic or breast cancer.

Infertility treatments have increased the rate of twin and higher-order multiple births, which put both mother and the unborn babies at higher risk of adverse outcomes. Though medical management of infertility is successful for many couples, some may need higher level treatment that has its own risks and costs involved. 



German-measles-RUBELLA.jpg
22/Feb/2020

Are you and your partner Planning for a pregnancy…

Check if you are protected from German measles ‘RUBELLA’ ?

Rubella, commonly referred to as GERMAN MEASLES is a viral infection. When it affects a person, it causes flu like symptoms which includes fever, sore throat, swelling of glands and rashes. But not all people infected with the virus go through the above symptoms. Some do not develop the symptoms but can still transmit the infection to others.

How does the transmission of virus occur?

Transmission of the viral infection is through airborne droplets. The rashes develop 2 weeks after acquiring the virus. The disease is infective from 1 week prior to appearance of rash and extends up to 4 days after appearance of rash which may be mild and pass unnoticed.

What damage does the rubella virus cause to the unborn baby?

Contracting the virus during the first 3-4 months of pregnancy (when the mother does not have immunity against the virus), can cause CONGENITAL RUBELLA SYNDROME in 9 out of 10 babies in this situation.

What is congenital rubella syndrome?

This is a group of serious conditions that can occur separately or together in the child where there can be  damage to brain, eyes, ears or the heart.

How do you know whether you  are protected?

If you have had Rubella vaccination or 2 MMR vaccinations 3 months apart then most likely you are protected. But nevertheless it is wise to check for rubella immunity status through blood Rubella IgG test prior to planning for pregnancy more so if you are not sure of your vaccination status.

If you are Rubella IgG is positive, it indicates that you have immunity against the virus and you can start planning for the pregnancy.

What if Rubella IgG is negative?

If it is negative then you have get vaccinated with Rubella vaccine and thereafter to plan for pregnancy after 3 months.

What happens if I conceive immediately after the vaccination?

To conceive at least a month after vaccination is preferable but there is no evidence that the vaccine causes congenital rubella syndrome to the unborn fetus.

If diagnosed as not being immune to Rubella during pregnancy…what precautions to take?

If you are not immune to Rubella and pregnant avoid contact with persons especially children with flu like symptoms and rashes.

You cannot take the vaccine during pregnancy. You can take the  vaccine immediately after delivery before you leave the hospital.

Baby is not at risk while you take the vaccine during breastfeeding.

So unless you are confident about your rubella immunisation status it is advisable to check your immunity prior to planning for pregnancy.


OBSTETRIC-CHOLESTASIS.jpg
14/Feb/2020

  1. Obstetric cholestasis (OC), also called intrahepatic cholestasis of pregnancy (ICP), is a potentially serious liver disorder that can develop in pregnancy. Normally, bile salts flow from your liver to your gut to help you digest food. In obstetric cholestasis, the bile salts don’t flow properly and build up in your body instead.

    Cure: There’s no cure for OC, but it clears up once you’ve had your baby.

    Hereditary: It seems to run in families, although it can occur even if there is no family history. It is also more common in women of Indian and Pakistani origin. If you have had OC in a previous pregnancy, you’re more likely to develop it again in a subsequent pregnancy.

    Risk: There is risk of premature birth or stillbirth. Because of the link with stillbirth, you may be offered induction of labour or a caesarean section after 37 weeks of pregnancy.

    Symptoms:
    • Severe itching all over your body, usually without a rash & most commonly in last 4 months of pregnancy. Some women get severe rash, for some it is unbearable or non-stop.
    • Other symptoms include dark urine, jaundice (yellowing of the skin and whites of the eyes) and pale bowel movements (poo).Treatment:

    OC is diagnosed by liver function tests (LFTs). Once diagnosed, you will have regular LFTs until your baby is born, so that your doctor can monitor your condition. If your LFTs are normal and you continue to have severe itching, the LFTs may be repeated every week or two to keep an eye on them.

    Creams, such as calamine lotion, are safe to use in pregnancy and can provide some relief from itching. There are some medications that can reduce bile salts and ease itching, but it’s not known whether they are safe to take in pregnancy.

    Because OC can affect your absorption of vitamin K, which is important for healthy blood clotting you may need to take vitamin K supplement.


preconception.jpg
14/Feb/2020

Preconception counseling In Bangalore

Caring for your health before you become pregnant will help you learn about any risk factors and treat any medical problems before you conceive.This helps you make healthy choices for you and your baby.

During the preconception counseling you will be questioned regarding your medical and surgical history,family and genetic history,previous obstetric history and lifestyle habits. A basic physical examination,weight and BP check is done.

Blood test to check rubella virus immunity done.

Based on the assessment, lifestyle modification,to avoid any medications that can be harmful to baby and appropriate counseling if any required given to ensure a healthy pregnancy and baby. Folic acid is advised to be taken from at-least 2 months prior to pregnancy .If not immune to rubella, vaccination advised.


PROLACTIN.jpg
03/Sep/2015

Prolactin is the hormone that produces milk through mammary glands during lactation. Gland secreting prolactin is situated in the brain.

Physiological increase of prolactin hormone levels occur during pregnancy and lactation.
In the non-physiological state an abnormal increase in the prolactin hormone manifests by the following symptoms

  • Milk secretion from breasts
  • Absence of menstrual flow
  • Decreased menstrual flow
  • Headache or blurring of vision associated with above-mentioned symptoms.

Pathological increase can be due to

  • Hypothyroidism
  • Polycystic ovaries
  • Drug induced
  • Prolactin secreting tumor

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An experienced gynecologist for normal delivery in Bangalore and she is a member of Bangalore Society of Obstetrics & Gynecological and FOGSI.

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