- Good Health Before Pregnancy: Preconceptual Care
- Reducing Your Risk of Birth Defects
- Preconception Carrier Screening
Counselling for Third Trimester Issues and Considerations
- Car Safety for You and Your Baby
- Air travel in pregnancy
- Cord Blood Banking
- Early Preterm Birth
- Group B Streptococcus and Pregnancy
- If Your Baby is Breech
- What to Expect After Your Due Date
The average heart rate of the foetus lies between 110 and 160 beats per minute, which can vary up to 5-25 beats per minute. The heart rate may vary as the foetus responds to the uterine conditions, but an abnormal pattern may indicate problems such as the lack of oxygen supplied to the foetus.
The process of normal child birth is categorized into 3 stages of labour:
First stage: This stage commences with dilation and thinning of your cervix to allow the baby to reach the end of the birth canal. This stage is usually the longest part of the labour and is further divided into early labour and active labour.
- Early labour: In early labour your cervix may dilate and you may experience mild to moderate contractions lasting for 30 to 90 seconds. A thick, stringy, blood-tinged liquid may discharge through the vagina. The duration of early labour is unpredictable, but can be longer for a first delivery and shorter for subsequent deliveries.
- Active labour: During active labour your cervix dilates more rapidly and the contractions are stronger, closer together and may last longer. The transition phase is considered as the last part of active labour.
Second stage: This stage is the birth of your baby and usually lasts from a few minutes up to several hours depending on the position of the mother and the baby. During this stage your cervix is fully dilated, uterine contractions become more frequent and you feel a strong urge to push. With each contraction you may be encouraged to push to speed up the process. You may be asked to withhold some pushes to help prevent tears in the vaginal tissues. After your baby’s head emerges the airway will be cleared and the umbilical cord is clamped and cut. The rest of the baby’s body is delivered soon after the head.
Third stage: During this stage the placenta, an organ connecting the uterine wall and the foetus, is expelled. Gentle uterine massage may help to release the placenta. The placenta should be intact and any remaining parts within the uterus should be removed to prevent bleeding and infection.
Complications: The complications of the birthing process include:
Weak contractions: Weak contractions can make the mother exhausted and can cause foetal distress. Foetal distress occurs when there is lack of oxygen. Improper or weak contractions may be caused by rigid or oedematous cervix.
Passage obstruction: Difficult labour may occur when the birth passage is obstructed by tumours, cysts, fractures, and physiological changes such as degenerative joint disease.
Abnormal presentation of the foetus: Abnormal position of the foetus could be either upside down or breech (buttocks down) position. In face presentation the baby’s face is leading with the neck in extension. In shoulder presentation, the shoulder, arm or trunk may present first and this type of presentation is more common in multiple pregnancies.
Forceps delivery: In this type of delivery forceps are used to grasp the foetal head. Use of improper forceps technique can result in injury to the foetus.
Caesarean Section: It is a surgical procedure of delivering a baby though an incision in the lower abdomen. Caesarean section is indicated in foetal distress, maternal (mother) distress, abnormal position of the foetus, and narrow birth passage.
When the baby is ready to come out, your cervix (opening of the womb) thins out and begins to widen (dilate) to about 10 cm. Contractions help the baby to move down the birth canal. This is described as intense pain and pressure that increases during the course of the delivery, and is generally feared by many women.
To aid in a pain-free delivery, many turn to a regional anaesthesia called epidural to block the pain. Apart from this, many others opt for caesarean section surgery, where the baby is surgically removed (under anaesthesia) through an incision made on the abdomen Here, you would not have to push at all. However, pain medications may be associated with certain side effects such as nausea and drop in your blood pressure, while surgery may lead to potential complications such as excessive bleeding, infection, longer recovery and breathing problems in your child.
On the contrary, some women opt for a natural birth, and avoid pain relievers to numb labour pains and choose a normal vaginal delivery. Medical interventions such as epistomy (surgical incision made between the vagina and anus to facilitate child birth) or foetal monitoring are also avoided. Labour pains are important indicators, as each contraction acts as a guide for the progression of labour and encourages the movement of your baby down the birth canal. Without pain, labour is more likely to slow down and become less effective. As labour proceeds and pain increases, the body produces endorphins, natural pain killers, which will help you, continue with the birthing process.
The early mild labour pains have to be borne by the patient Epidural analgesia is given only when labour is well set and the cervix or the opening of the uterus is at least 3-4 cm. This requires close monitoring by a team of Gynaecologist and Anaesthetist. Drug is introduced at regular intervals depending on the requirement and intensity of the pain. This procedure is SAFE for both the baby and the mother.
A Caesarean section is often performed when a vaginal delivery would put the baby’s or mother’s life or health at risk. Some are also performed upon request without a medical reason to do so, which is not recommended. Planned caesarean sections also known as elective caesarean sections should not be scheduled before 39 weeks gestational age unless there is a medical reason to do so.
Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy for either mom or baby causes a pregnancy to become high risk.
Specific factors that might contribute to a high-risk pregnancy include:
- Advanced maternal age. Pregnancy risks are higher for mothers age 35 and older.
- Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
- Medical history. A prior C-section, low birth weight baby or preterm birth — birth before 37 weeks of pregnancy — might increase the risk in subsequent pregnancies. Other risk factors include a family history of genetic conditions, a history of pregnancy loss or the death of a baby shortly after birth.
- Underlying conditions. Chronic conditions — such as diabetes, high blood pressure and epilepsy — increase pregnancy risks. A blood condition, such as anemia, an infection or an underlying mental health condition also can increase pregnancy risks.
- Pregnancy complications. Various complications that develop during pregnancy pose risks, such as problems with the uterus, cervix or placenta. Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh positive.
- Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order multiples.
- You had a problem in a past pregnancy, such as:
- Preterm labor.
- Preeclampsia or seizures (eclampsia).
- Having a baby with a genetic problem, such as Down syndrome.
A diet consisting of the right balance of carbohydrates, proteins, fats, minerals, vitamins and water constitutes a healthy diet. Some important nutrients to be included into your diet are:
Folic acid: Folic acid prevents neural tube defects in the early stages of a developing foetus. Getting the recommended amount of folic acid alone from food may be difficult; hence, it is necessary to include folic acid supplements before and during your pregnancy.
Calcium and Vitamin D: A growing baby has high demands for calcium and vitamin D as bones and teeth develop. You can take in calcium through food or as supplements during pregnancy. Foods with high sources of calcium, such as milk, milk products and broccoli, should be included in your regular diet. Vitamin D can be obtained from milk fortified with vitamin D and from exposure to sunlight.
Iron: During pregnancy,your body produces more blood to carry oxygen to the growing foetus; hence, the quantity of iron required for this transfer of oxygen, needs to beincreased. You should include iron-rich food such as fish, poultry, lean red meat, prunes and dried beans into your diet. Including vitamin C rich foods, such as tomatoes and citrus fruits, helps in faster absorption of iron in the body.
Fish: Fish is a rich source of omega-3 fatty acids and an important nutrient for the development of your baby’s brain, before and after birth. Fatty fish like salmon is a good source of Vitamin D and sardines are rich in calcium. However, fish with high concentrations of mercury, such as shark and swordfish, should be limited or avoided during pregnancy as mercury is responsible for causing birth defects and damaging the baby’s nervous system.
Consumption of alcohol and caffeine should be avoided during pregnancy. Other foods to be avoided include:
- Unpasteurised milk, cheese and juices
- Raw eggs and foods that have raw eggs, such as Caesar salad
- Uncooked seafood and meat
- Processed meat products
Doctors generally do not suggest a vegetarian diet while pregnant, but if you are a vegan or vegetarian, you can continue with the same foods. Your doctor may suggest protein, vitamin B12 and vitamin D supplements if you do not consume meat, eggs, milk products and seafood.
- Maintain a healthy well-balanced diet by eating nutritious food, which contributes to your baby’s growth and development. Your doctor may also suggest nutritional supplements or preparations containing calcium, iron, and folic acid. Folic acid prevents problems in your child’s brain and spinal cord, and is usually recommended before you become pregnant.
- Regular exercises may be beneficial as they may relieve discomforts during pregnancy. Walking and swimming are most preferred and recommended. However, you must consult your doctor before taking up these exercises and ensure that they are not overdone.
- Drink plenty of water to prevent dehydration.
- Get enough sleep during your pregnancy. Sleep on your left side as it prevents your baby’s weight from applying pressure to the large blood vessels that carry blood to your heart, feet and legs.
The below are some things to avoid during pregnancy.
- Avoid cigarettes, abusive drugs and alcohol as they are harmful for you as well as your baby.
- Avoid excessive intake of caffeinated products such as coffee as they increase your risk of miscarriage.
- Avoid cleaning cat litter boxes and eating raw or undercooked meat as they may cause toxoplasmosis, an infection that leads to chances of foetal eye and brain damage, poor growth and premature birth.
- Know when to go to the hospital.
- Be pre-registered at the hospital where you plan to give birth.
- Have your preferences for labour and delivery.
- Know day and night phone numbers for your health care provider’s office and the labour and delivery unit.
- Have transportation to the hospital.
- Know where to go when you get to the hospital (including the after-hours entrance).
- Have arrangements made if you plan to donate your cord blood.
Supplies You’ll Need for Your Newborn
- Infant car seat as required by law
- Breastfeeding supplies, such as a nursing bra and pads
- Diapers, diaper pins, and diaper pail
- Changing table, cotton balls, wash cloths, mild soap, diaper rash ointment, hair brush, and thermometer
- Infant sleepers, T-shirts, and receiving blankets
- Sweater and a cap for your baby
- Crib sheets and blankets; your baby does not need a pillow
- Waterproof pads for crib or lap
Crib, cradle, or bassinet
- Ovulation induction
- Intra-uterine insemination
- Donor Insemination
- Fertility Enhancing Laparoscopic Surgeries
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- Menstrual Disorders
- Vaginal Discharge
- Pelvic Infections
- Fibroid Uterus
- Ovarian Cysts
- Polycystic Ovarian syndrome
- Chronic Pelvic Pain
- Vulval Disorders
- Uterine Prolapse
- Genital Warts
- Sexually Transmitted Disease
- Post-menopausal Bleeding
- Endometrial Polyp
Laparoscopic surgery is done through one or more small incisions (keyholes), using small tubes and tiny video cameras and surgical instruments.
Our team of Advanced Laparoscopy has invented a new technique of Scarless Stitchless Laparoscopic surgery which is the latest in Minimally Invasive Gynaecology which has highest cosmetic value and hence called as Cosmetic Laparoscopy. Other than cosmesis this technique causes least pain, minimal blood loss and no incidence of hernia.
COMMON LAPAROSCOPIC PROCEDURES
1. Total Laparoscopic hysterectomy: hysterectomy specifically implies removal of the uterus only.
2. Laparoscopic Myomectomy: removal of benign fibroid tumors (myomas) laparoscopically. Fibroids are very common benign muscle tumors. They are often associated with abnormal bleeding, dysmenorrhea, abortion, infertility or, if large, pressure-like symptoms.
3. Laparoscopic Ovarian Cystectomy: the goal of this procedure is to remove a benign ovarian cyst and preserve the normal ovarian tissue.
4. Laparoscopic Oophorectomy: removing one or both of the ovaries laparoscopically.
5. Laparoscopic Removal of Endometriosis: full surgical excision or destruction of any endometriosis implants.
6. Laparoscopic Procedures for Pelvic Organ Prolapse: uterosacral ligament plication. Laparoscopic presacralcolpopexy.
7. Laparoscopic Radical Hysterectomy: Alongwith uterus surrounding tissues are also removed for proper clearance of cancerous tissue.This surgeryis done for cervical cancer cases
8. Laparoscopic Pelvic Lymph Node Dissection: The Lymph nodes which are the first sites for spread of cancer are removed to check the stage of cancer.
9. Laparoscopic Salpingectomy for Ectopic Pregnancy
10. Laparoscopic surgery for ovarian torsion: Ovarian torsion occurs in enlarged ovary and most commonly in cases of ovarian dermoid cyst. This is an emergency and if not operated and tetwisted this can jeopardise the ovary.
11. Laparoscopic Cervical Cerclage: In cases of cervical incompetence when the vaginal cervical cerclage has failed in the previous pregnancy, Laparoscopic cervical cerclage is indicated. We prefer to do this surgery in the interpregnancy period.
12. Laparoscopic Tuboplasty: In Cases of infertility with tubal pathology, block and adhesions, tuboplasty opens the fallopian tube and restores the anatomy.
Women commonly develop urinary leakage after delivering their children. Symptoms are often unpleasant with leakage, frequent need for pads, hygiene issues, and embarrassment. In the past, treatment of urinary incontinence required significant operations with long recuperation. Hence, many women suffered with their urinary incontinence symptoms rather than seeking a cure. A new procedure, called a mid-urethral sling, now offers great results with urinary leakage corrected in most women with a minor procedure and rapid recovery. Finally, women no longer need to suffer with unpleasant urinary incontinence symptoms.
Urinary leakage is caused by changing in the bladder’s position due to the stress on the pelvic structures of delivering an infant. Due to the process of childbirth, the bladder tends to drop down further into the pelvis and as the bladder drops, urinary control worsens. The most common symptoms of urine loss related to poor support is leakage with coughing, sneezing, laughing or any activity that increases pressure within the abdomen.
Women who have urine leakage should definitely be seen by their gynaecologist for evaluation. A routine gynaecologic evaluation can often help determine whether urine loss is due to poor support. Other Common Genitourinary problems are Pelvic organ prolapse, Pelvic support problems, Urinary tract infections, stress urinary incontinence.