Obstetrics – Gynecologist Surgery Indore

Pregnancy Care and management

Pregnancy care entails providing good care to expectant mothers before (prenatal care), during and after birth (postpartum care). It involves providing education and treatment for ensuring the healthy growth of the baby as well as the mother.

Antenatal care (prenatal care)

Aim- To have a healthy mother and healthy baby.

Prenatal care is an important part of a healthy pregnancy. Early and regular prenatal care mitigates the chances of uncertainties and complications during pregnancy. It leads to a safe and healthy delivery with a healthy mother and healthy baby.. Scheduling regular prenatal visits can help your doctor identify complications well in time. Moreover, it will help the moms-to-be to monitor their health. It is one of the best ways to ensure that your little one gets a healthy start. Prenatal care basically includes the intake of good nutrition and the adoption of healthy habits before and during pregnancy. Prenatal Care starts three months prior to conceiving. The healthy habits required to be followed during this period include:

• Restraining smoking and alcohol consumption
• Maintaining distance from all toxic substances at home and work.
• Consuming 400 to 500 micrograms of folic acid supplements on a regular basis

Antenatal Check ups

Pregnancy and giving birth to a baby are natural processes going on all the time all over the globe. Regular check ups are required to detect comorbidities like Gestational Diabetes, High Blood pressure, Thyroid disorders etc or complications early and treat them in time. Pregnancy is a very crucial period in the life of the expectant mother. Therefore, we assure you that you will be in the best hands during this Period. We will take care of all your issues to lend you the best experience

Once you visit your Gynecologist for the first visit your baseline weight, blood pressure, height etc will be recorded and your detailed examination and few basic tests will be ordered. After that your further visits will be scheduled as follows-

• Every month for first six months of pregnancy
• Every two weeks during the seventh and eighth months of pregnancy
• Every week for your ninth month of pregnancy
• Additionally, during these visits your doctor will assess your as well as your baby’s health by conducting checkups for the following:
• Weight and blood pressure
• Monitoring fetal heart rate and growth and wellbeing of fetus
• Conducting blood test for detecting HIV, anemia and Rh factor, blood sugar level etc
• Discussing special diet and exercise requirements.

Don’ts of Pregnancy-

• Avoid lifting heavy objects.
• Do not take any medicine without consulting your Doctor
• Avoid lifting heavy objects.
• Avoid smoking and Alcohol
• Avoid travelling especially in first three months and last months of pregnancy

High-Risk Pregnancy

For safe Motherhood identification of high risk pregnancies is very important. Following are the risk factors for high risk pregnancy.high-risk pregnancy is one of greater risk to the mother or her fetus than an uncomplicated pregnancy. Pregnancy places additional physical and emotional stress on a woman’s body. Health problems that occur before a woman becomes pregnant or during pregnancy may also increase the likelihood for a high-risk pregnancy.

High risk factors are-

• Recurrent Miscarriages
• diabetes
• negative Rh blood group
• Thyroid disorders
• bleeding in pregnancy
• high blood pressure
• Obesity
• Kidney disease
• Autoimmune diseases
• Pregnancy associated with HIV/AIDS
• preterm changes in the cervix
• poor fetal growth
• oligoamnios
• Elderly mother
• These conditions require extra care and treatment with specific delivery plan.

Detailed description of these specific conditions are given in separate pages.

Delivery

Here comes the moment you have been waiting for!! Giving birth to a child is a challenging process and sometimes becomes complicated.

Types of Delivery

Normal vaginal Delivery

Vaginal delivery is the birth of offspring or babies in humans through the vagina (also called the “birth canal”). It is the natural method of birth for all mammals.

It basically constitutes three stages of labor;

• the shortening and cervical dilatation or opening,
• gradual descent and birth of the baby and
• Delivery or expulsion of placenta.

Types of Vaginal Delivery:

A spontaneous vaginal delivery (SVD) occurs when a pregnant female goes into labor without the use of drugs or techniques to induce labor, and delivers her baby in the normal manner, without forceps, vacuum extraction, or a cesarean section.

An assisted vaginal delivery (AVD) or instrumental vaginal delivery occurs when a pregnant female goes into labor (with or without the use of drugs or techniques to induce labor), and requires the use of special instruments such as forceps or a vacuum extractor to deliver her baby vaginally.

An induced vaginal delivery is a delivery involving labor induction, where drugs or manual techniques are used to initiate the process of labor..

Painless Normal Vaginal Delivery

Painless delivery refers to the use of an epidural injection which is given by an anaesthesiologist for pain relief during labour. It is injected in the lower back, and a plastic tube is placed through which drugs are released around the spinal cord.

Cesarean Delivery

Cesarean delivery, also known as C-section delivery is a surgical procedure in which the infant is delivered by making an incision in the mother’s uterus and abdomen rather than by achieving the delivery through the vagina. The number of serious medical conditions such as abnormal fetus position, abnormal fetal heart rate, placental complications, and failure in the progression of labour may make the Cesarean delivery a necessary procedure to be conducted.

Finally

Pregnancy and child birth is the happiest moment in the life of every woman.Therefore, try staying healthy and happy as much as possible. Schedule timely check-ups, eat nutritious food and above all consult an expert health care professional to ensure well being of yourself and the baby.

Ectopic Pregnancy – An Overview

The condition of an ectopic pregnancy occurs when an embryo gets attached on the other places rather than inside the uterus. The embryo (fertilized egg) may be found attached to fallopian tubes, ovaries, peritonial cavity.  Majorly all of the ectopic pregnancies happen in the fallopian tube therefore are also referred to as tubal pregnancies. Ectopic pregnancy is an emergency medical condition because the fallopian tubes are not capable of holding growing embryos and require to be treated immediately.

Signs of Ectopic pregnancy

An ectopic pregnancy may not always show symptoms and may be identified during early ultrasound scan. Most commonly the symptoms for ectopic pregnancy tend to become visible during the 4 to12 weeks of pregnancy. The symptoms for an ectopic pregnancy may comprise of:

• Severe pain in lower belly, especially on one side.
• Vaginal bleeding or spotting.
• Missed period.
• Feeling of weakness, dizziness or fainting.
• Sharp pain in shoulder.

Contact your doctor immediately if you come across any of these symptoms and.encounter bleeding or sharp pain lasting more than a few minutes.

Diagnosis-

• Mainly by pelvic ultrasound scan or TVS
• Urine pregnancy test
• Serum Beta HCG done in blood

 Treatment of Ectopic Pregnancy

An ectopic pregnancy may be treated using any of the following methods-

Surgical treatment-Laparoscopy or Laparotomy using general anesthesia is usually done The procedure may either involve repairing or removing the affected fallopian tube

Medical treatment- Methotrexate injection is given. This medicine allows the body to kill and absorb the growing embryo.

Recovery after Ectopic Pregnancy

Ectopic pregnancy is a kind of early pregnancy loss and may make the person undergo grief and disappointment. During these stages the person may experience a mix of emotions. And these feelings may tend to last for several months. The condition of ectopic pregnancy may also affect your partner and relationship. It may lead to shattering of hopes and plans of family. Thus, the occurrence of these uncommon feelings require tender loving care and sometimes needs professional support from a psychologist or a Psychiatrist.

Thinking about conceiving again

Once you become stable physically and emotionally after this catastrophe, you can certainly try for another baby. However, it is advisable to wait for at least 3 months before trying to conceive again. Moreover, try investing enough time to achieve the best possible recovery.  If you have been treated using methotrexate it is ideally recommended to wait for at least three months, because becoming pregnant during this period may pose a risk to your baby’s health. Even after getting one fallopian tube removed a woman can easily become pregnant again if the other fallopian tube is normal and patent.. About 65 percent of women are believed to achieve successful pregnancy within the 18 months of ectopic pregnancy. One must report to the doctor as soon as one conceives as there are increased chances of ectopic pregnancy again.

Reasons for Ectopic Pregnancy-

• Commonest cause is Pelvic inflammatory disease (PID) – inflammation of the female reproductive system.
• Ongoing fertility treatments and fertility inducing medications
• Intrauterine device (IUD) or intrauterine system (IUS).
• Increasing maternal age, most likely between 35-44 years.

Overview

Recurrent miscarriage refers to the loss of three or more consecutive pregnancies. More than three consecutive miscarriages are considered to be a serious medical condition and require thorough physical examination and investigations.

Possible Causes

• chromosomal or genetic abnormalities
• imbalance in pregnancy hormones
• Cervical weakness or congenital uterine anomalies
• blood clotting disorders

Risk Factors

• Antiphospholipid syndrome (APS)
• Polycystic ovary syndrome
• Diabetes mellitus

Care after recurrent miscarriages

Following the recurrent miscarriages, your health professional will conduct certain investigations to know the cause. In 50 % no cause can be detected. However, early antenatal checkups and tender loving care during such circumstances can be of great help.s

What is an Ultrasound Scan?

An ultrasound scan or sonography is a type of imaging technique that uses high-frequency sound waves to look inside the structures and organs of the body. During pregnancy, doctors use these scans to monitor the development of a fetus.

Ultrasonography is done to know the growth and congenital anomalies in an unborn baby growing in the womb of a pregnant woman. Till today whatever research has been done shows that it is not harmful to the unborn baby. But it should not be done unnecessarily. Following types of sonography is done during pregnancy –

Early scan – between 7 to 9 weeks. Following things can be seen-

1. for dating the pregnancy

2. to know whether the Heartbeat has come or not

3. For multiple pregnancy

4. If there is ectopic Pregnancy ( sometimes pregnancy  may occur outside the uterus in fallopian tubes, ovary, peritoneal.)

Level 1 sonography or NT scan– Done between 11 to 13.6 weeks. This sonography is very important to know early congenital anomalies and down syndrome in Unborn baby. There are some specific features which may indicate the possibility of down syndrome. every women should get this sonography.

 level 2 sonography or target scan- This is a detailed sonography of the foetus done between 18 to 22 weeks. in this sonography most of the congenital anomalies can be detected along with the growth of an Unborn foetus.

Growth scan – This is done between 32-36 weeks to know the growth and the well being of the baby along with the amount of liquor amount, weight of the baby etc.

Sometimes in high risk cases like high blood pressure, diabetes, growth retardation serial growth scans are done to know the growth and timing of delivery.

Doppler- Study– This study is also done by sonography machine. In this study the blood vessels are evaluated. This study of blood vessels of Fetus play a very important role in high risk cases like high blood pressure, gestational diabetes, intrauterine growth retardation excetra to know the wellbeing of fetus and the timing of delivery.

Cardiotocography (CTG) – It measures your baby’s heart rate. At the same time it also monitors the contractions in the womb (uterus). CTG is used both before birth (antenatally) and during labour, to monitor the baby for any signs of distress. By looking at various different aspects of the baby’s heart rate, doctors and midwives can see how the baby is coping.

Breastfeeding

Breastfeeding is the best source of nutrition for your baby. It plays an important role in the development and well being of your newborn. For the first six months, your breast milk serves as a perfect nutrition for your baby.

Usually, you can start breastfeeding your baby immediately after birth. This helps your uterus to contract well and also help in early milk secretion The initial breast milk is referred to as colostrum which is thick and yellowish in color. It is full of proteins and antibodies which protects your baby from certain infections and is a good source of nutrition too

Benefits of Breastfeeding for the Baby-

1.Breast milk provides the ideal nutrition for infants.

2. It has a nearly perfect mix of vitamins, protein, and fat — everything your baby needs to grow.

3. it’s all provided in a form more easily digested than infant formula

4.Breast milk contains antibodies that help your baby fight off viruses and bacteria. Breastfeeding lowers your baby’s risk of having asthma or allergies.

5.Plus, babies who are breastfed exclusively for the first 6 months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea.

6.They also have fewer hospitalizations and visits to the doctor.

7.Breastfeeding has been linked to higher IQ scores in later childhood in some studies.

8.The physical closeness, skin-to-skin touching, and eye contact all help your baby bond with you and feel secure.

9.Breastfed infants are more likely to gain the right amount of weight as they grow rather than become overweight children.

 Breastfeeding Benefits for the Mother-

1.Breastfeeding burns extra calories, so it can help you lose pregnancy weight faster.

2.It releases the hormone oxytocin, which helps your uterus return to its pre-pregnancy size and may reduce uterine bleeding after birth.

3 Breastfeeding also lowers your risk of breast and ovarian cancer. It may lower your risk of osteoporosis, too.

Best positions to feed your baby-

 Cradle position- Rest the side of your baby’s head in the crook of your elbow with their whole body facing you. Position your baby’s belly against your body so they feel fully supported. Your other, “free” arm can wrap around to support your baby’s head and neck — or reach through your baby’s legs to support the lower back.

 Side-lying position– This position is great for night feedings in bed. Side-lying also works well when you’re recovering from an episiotomy, an incision to widen the vaginal opening during delivery. Use pillows under your head to get comfortable. Then snuggle close to your baby and use your free hand to lift your breast and nipple into your baby’s mouth. Once your baby is correctly “latched on,” support the head and neck with your free hand so there’s no twisting or straining to keep nursing.

 Cross-cradle hold–  Sit straight in a comfortable chair that has armrests. Hold your baby in the crook of your arm that’s opposite the breast you will use to feed them. Support their head with your hand. Bring your baby across your body so your tummies face each other. Use your other hand to cup your breast in a U-shaped hold. Bring your baby’s mouth to your breast and cradle them close, and don’t lean forward.

How often you should feed your baby

Newborns often want to feed every 2-3 hours. By 2 months, feeding every 3-4 hours is common, and by six months, most babies feed every 4-5 hours.

Post Delivery Care

The postpartum period basically begins after the birth of the baby and ends until the returning of the mother’s body to the pre-pregnant state. This period ideally lasts up to six to eight weeks after the delivery. Taking care during postpartum weeks is necessary to ensure a quick recovery. During this period the mother may encounter a number of emotional and physical changes while managing to take care of the newborn.

This healing period for mothers basically Involves following things-

Diet–  in case of normal delivery mother should be given energy drink in the form of milk, juices or coconut water immediately. Afterwards normal diet can be give. In case of c-section fluid are given after 6 hours of operation. After that depending upon mothers condition soft diet and full diet is started.

Rest & sleep– she requires adequate rest and sleep after delivery. Try to sleep when your newborn sleeps.

Care of breast before and after feeding– Nipple and areola should be cleaned before and after feed with cotton swab soaked in lukeworm water.

Bladder care–  Mother should be encouraged to pass urine after 2-3 hours and then 3 to 4 hourly in case of normal delivery. In case of c-section patient is cathaterized and cathatr is kept for 24 hours to 48 hours.

Bowel care– Avoid straining while passing stools. If costipated she should take stool softners or laxatives.

Care of vulva & episiotomy wound– After normal delivery or c-section Maxipads which can absorb more blood  should be used. and it should be changed at least twice a day or when soaked. Normally perineum or vulva should be cleaned with antiseptic twice a day.

If Episiotomy is given during delivery then wound should be washed with betadine lotion after passing urine or motion every time. episiotomy wound dressing is done with antiseptic ointment two times a day.

wound care after c- section– Most of the time nowadays internal stitches which gets dissolved are placed in the skin.Normally after cesarean section wound is dressed after 2 to 3 days and is kept open and antiseptic ointment can be applied once or twice a day and when the wound is kept open daily bath can be taken and after that antiseptic ointment can be applied.

Postnatal visits– In case of normal delivery a patient is usually discharged on the second or third day and called again after 5 days and then after 6 weeks. In case of cesarean section the patient is normally discharged on the third or fourth day and again called on the 9th day and then after 6 weeks. Contraceptive advice is also given during these visits.

Abortion

Ending pregnancy is indeed a tough decision. But if you think it is the best way forward, then at Dr. Hema Jajoo,s clinic you can get the required help and care. We offer a comprehensive range of abortion services under MTP act 1971 and PCPNDT act, india. According to this act. Abortion can be performed until 20 weeks of pregnancy.

Contraception

Birth control, also known as contraception, is designed to prevent pregnancy. Birth control methods may work in a number of different ways: Preventing sperm from getting to the egg. These methods can be Temporary or Permanent.

Temporary birth control methods-

Hormonal methods — Includes the pill, vaginal ring or a hormone patch. They mimic natural hormones in a woman’s body. They prevent ovulation and bring changes in the uterus and cervix so fertilization is much less likely to happen.

Barrier methods — Condoms, a diaphragm, sponge or cervical cap. The barriers stop sperm from reaching the egg.

Injectable methods — Progestin is injected every three months. Since the hormone dosage is less than other options, some patients prefer it. This method prevents conception similarly to other hormonal methods.

You may prefer a long-acting reversible contraceptive (LARC). These methods can last for three to 10 years. LARCs include:

Intrauterine devices — A T-shaped device is inserted into the uterus. The devices keep sperm from reaching the egg. There are two types of IUDs, hormonal and non-hormonal. Copper, non-hormone containing IUDs last approximately 3,5 or 10 years and hormone containing IUDSs last 5 years.

Hormonal implants — A match-stick sized plastic rod is implanted under the skin of the patient’s upper arm. The rod releases a special contraceptive hormone. This delivery system has hormonal results similar to hormonal and injectable methods.

Permanent Birth Control-

Dr Hema Jajoo can give you important information about your options for permanent birth control — also known as sterilization. This is of two types-

Tubal ligation — During this surgery, the clinician cuts, ties or seals your fallopian tubes. This blocks the egg’s path from your ovaries to the uterus. It also stops sperm from reaching the egg.

Vasectomy —A surgeon cuts, closes or blocks the vas deferens. This is the duct that carries sperm from the testes to the ejaculatory ducts. Once the duct is blocked, sperm can’t leave the testis. This procedure may not be fully effective for up to three months. Temporary birth control is used during the three months after the procedure.

Aim – To have a healthy mother & healthy baby in terms of physical, mental, intellectual, spiritual growth.

It is a science by itself and also a beautiful, easy and inexpensive way to improve intelligent, emotional and spiritual quotient of an unborn child by various means. It also includes keeping expectant mother happy and making her nine months journey joyful.

It is not a new concept in India, Indian people knew that behavior of parents and environment affects the growing child in the womb. That’s why our old grandmothers insisted that expecting mother should be kept happy and at the same time she should live with discipline, think positive thoughts, read good books, listen to good music and see good movies.

Our mythology tells story about Abhimanyu. He learnt how to enter into chakraviyu in the womb while Lord Krishna narrated the art of entering in to chakravyu to expecting subhadra. Another example is of Shivaji, the great warrior, his mother use to read and think about life stories of deshbhaktas, Ramayan, Geeta and Mahabharat when she was pregnant. Recently also, if you look into the life of famous tabla player Zakkir Hussain, his father Rakkatulla use to play tabla by his fingers on the womb of his pregnant wife.

It includes:

1. Pregnancy should be by choice and not by chance. The parent to be, couple must be prepared mentally, physically and economically to welcome an unborn child.
2. Every couple wants his would be born child with Intelligence (Buddhi), Valor (Shourya), Brilliance (Tejas), Strength (Shakti), good qualities (guna) like Love for Humanity and Nation, fearlessness, leadership, management skills, farsightedness, love for peace etc. Through garbha sanskar all this can be imparted to the unborn baby.
3. Developing baby in the womb is in the most educable stage of life. One can use various techniques to make this period most conducive to learning.
4. Baby starts listening from 4th month onwards.
5. Baby recognizes mother from her heart beat, voice, touch and smell.
6. Mother’s emotions affect the baby.
7. It is proved that baby is very close to father’s voice. So stories, mantra chanting and songs told by father makes a definite impact. Also baby recognizes father’s touch.

How Garbha Sanskar can be imparted—

1. Sat vichar– By inculcating positive thoughts and attitude towards life and pregnancy.
2. Keeping mother happy and joyful by husband and other family members.
3. Sat sahitya– reading good books about positive attitude in life, spiritual books like Ramayan, Bhagwad Geeta and Mahabharat and Puranas, and lives of deshbhaktas. Most important thing is to read thoughtfully and try to imbibe what is being read.
4. Music—Chanting of mantras and shlokas, listening to classical music and bhajans has a very  calming and elevating effect in the mind. It makes mother happy and joyful.
5. Prayers for all beings and for the unborn child.
6. Educating about the need of regular walk, yoga and exercise.
7. Visual aids like seeing good movies related to values, deshbhakti and spiritual masters.
8. Eating pure and nutritious food.
9. Wearing loose and comfortable cloths.
10. Thanks giving daily for giving the joy of becoming a mother.

Who can impart Garbha sanskar—

1. Actually it should start when ‘Parents to be’ couples starts planning for pregnancy by living a disciplined life and preparing themselves physically, mentally and economically.
2. Mother – As it is proved scientifically that mother and baby share experiences so whatever mother does has direct impact on the baby.
3. Father – baby understands father’s voice and touch. Father can talk, chant mantras or sing songs sitting near to mother and while doing so keep his hand on mother’s womb.
4. Grandparent – By story telling and giving advises that can be of great help.
5. Teacher – By listening lectures and discourses on values, good conduct and on our spirituality.
6. Society – Various functions and rituals performed in a community when mother is expecting.