AIR TRAVEL DURING PREGNANCY

Dr Deepika Tiwari, Gynecologist, Gurgaon www.gurgaongynae.inhttp://www.drdeepikatiwari.blogspot.com/http://www.gurgaongynecologist.webs.com/

Pregnant women & those contemplating pregnancy need special consideration because of specific nature of the potential health hazards of long distance flights.These include exposure to cosmic radiation, reduced arterial oxygen pressure, immobilization & unforseen medical & obstetrical emergencies encountered during flight.

More radiation shielding is provided by atmospheric air at lower altitudes.The dose received from cosmic radiation is usually lower during short haul flight since long haul flight are usually flown at higher altitudes.

The changes in heart rate & BP which are associated with decreased partial oxygen pressure may affect women with compromised pregnancies.

Increased risk of venous thrombosis may occur due to prolonged immobilization from cramped seats, which is called Economy class syndrome.

ADVICE

1.  Pregnant women  should use their seat belts continuously while seated.

2. Long distance flights are not recommended for women upto  36 wks gestation with singleton pregnancy & 32 wks with multiple pregnancies.

3. Travellers should be updated on routine immunizations including TT,Diptheria, Influenza, & other immunization  based on  geographic  risk

4. Travel is not  recommended at any time during pregnancy for women who have medical /obstetrical prblems that could result in emergencies

NOTE : Always consult your gynaecologist, whenever you are planning for air travel.

Painful Periods in Women

Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/



Painful periods are common in teenagers and young adults.
Primary dysmenorrhoea is the most common type of painful periods. This is where there is no underlying problem of the womb (uterus) or pelvis. It often occurs in teenagers and women in their 20s.
Secondary dysmenorrhoea is pain caused by a problem of the womb or pelvis. This is less common, and is more likely to occur in women in their 30s and 40s.

The main symptom is crampy pain in your lower abdomen.

• May spread to your lower back, or to the top of your legs.
• Usually starts as the bleeding starts, but it may start up to a day before.
• Usually lasts 12-24 hours, but lasts 2-3 days in some cases.
• Can vary with each period. Some periods are worse than others.
• Tends to become less severe as you get older, or after having a baby.

The following may indicate secondary dysmenorrhoea:

• If you have a change in your usual pattern of pain. For example, if your periods become more painful than they used to be, or the pain lasts longer than it used to. In some women with secondary dysmenorrhoea the pain starts several days before the period begins, and lasts all the way through the period
• Other symptoms may include.
• Irregular periods.
• Bleeding between periods.
• Pains between periods.
• The bleeding becomes heavier than previously.
• Vaginal discharge.
• Pain during sex.

It is important to differentiate between the primary and secondary dysmenorrhoea; the treatment depends on the underlying cause. Supportive care and Anti-Inflammatory medication help control the severeity of symptoms.

Breast Feeding of Newborn

 Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.deepikatiwari.com/

 

Breast milk is the best nutrition for babies. The World Health Organization recommends that babies are fed only breast milk for their first six months, and that breast-feeding then be continued as part of a mixed diet until the age of two years. A vitamin D supplement is recommended for all breast-feeding women and for breast-fed babies.
On average, breast-fed babies have fewer infections in their early life. The main reason for this is that antibodies are passed in the breast milk from mother to baby. Antibodies are proteins that help to fight infection. Breast-fed babies have less diarrhoea and vomiting, and fewer chest and ear infections, compared with babies who are not breast-fed. Breast-feeding enhances the bonding process between baby and mother.
There is now good evidence from research studies that, on average, the following health problems in later life are less common in those who had been breast-fed compared with those who had not: obesity and overweight; high blood pressure; high cholesterol level; eczema; type 2 diabetes; leukaemia; asthma. ref

It is recommended to start breast feeding as soon as practical after the baby birth. Colostrum is an important source of antibodies for the newborn. Some women have difficulty in initiating breast feeding. Such issues can be easily treated with supportive care , and some counselling by the gynecologist.

Hypothyroidism in Pregnancy

Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/
Hypothyroidism affects 1% of pregnant patients. Defining symptoms of hypothyroidism include;

cold intolerance,

slow heart rate(Bradycardia) ,

delayed relaxation of tendon reflexes,
excessive menses (in non pregnant ) 

The most common cause of hypothyroidism is autoimmune.

Hypothyroidism is diagnosed with reduced free T4 concentration with increased TSH levels.

Most serious consequence of hypothyroidism in pregnancy is Myxedema Coma which is a medical emergency. Neuropsychiatric development is delayed in offsprings born to hypothyroid mothers . However correction of maternal hypothyroidism in first 12 wks of pregnancy might improve outcome.

Cretinism (deaf mutism, spastic motor disorders & hypothyroidism ) is distinct & severe form of brain damage caused by severe maternal iodine deficiency .

Patients with hypothyroidism should be counselled to delay pregnancy until maintenance level of T4 is achieved.

Hypothyroid in pregnancy requires treatment with thyroxine with thyroid function tests repeated every 3 months ( however they should be repeated every 4-6 wks if dosage changes are to be made).

Pregnancy with Diabetes

It is estimated that 3- 5 % of pregnancies are complicated by Diabetes mellitus.With increasing prevalence of Diabetes in young women, it is important to understand  the common symptoms that a pregnant lady may suffer, to diagnose it early.

Some important features to be understood…

*Gestational Diabetes refers to the condition where in high blood glucose levels are monitored for the first time during pregnancy.

*Diabetes diagnosed before pregnancy may be insulin dependent (IDDM), or non- insulin dependent (NIDDM).

* During pregnancy, there is a physiological increase in insulin resistance, to satisfy the nutritional demands of foetus.

* High levels of maternal blood glucose levels, may lead to high levels of glucose in foetal blood.

* Patients who are already diagnosed with Diabetes, before getting pregnant, may develop high blood pressure during pregnancy, and increased susceptibility to infection; may increase the likelihood of caesarean section; large baby size (Macrosomia); shoulder dystocia etc.

*Increased risk of congenital abnormalities in the foetus, miscarriage, still birth, premature delivery.

Intensive control  of glucose levels around the time of conception, can reduce the incidence of congenital abnormalities. In non diabetic subjects fasting glucose should be 70mg/dl- 126mg/dl .Diabetic subjects tend to have higher post prandial  & sustained minor elevations of glucose,

WHEN TO CONSULT A DOCTOR

A higher fasting, postprandial sugar levels

An abnormal glucose challenge test

An abnormal Glycosylated Hemoglobin

Repeated infections especially urinary infections

Polyhydraminos (increased liquor )

H/o previous stillbirths, large babies, premature delivery, traumatic delivery

For any queries, pl consult your doctor

Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/

Polycystic Ovarian Syndrome

Dr Deepika Tiwari, Gynecologist, Gurgaon

Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production. High serum concentrations of androgenic hormones, such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S), may be encountered in these patients.
PCOS is also associated with peripheral insulin resistance and hyperinsulinemia, and obesity amplifies the degree of both abnormalities.
Patients with PCOS may present with various clinical features.
Menstrual abnormalities/ Hyperandrogenism/ Infertility/ Obesity/ Diabetes mellitus/ Sleep apnea/ Metabolic syndrome
Treatment:
Diet and exercise: In patients with PCOS who are obese, endocrine-metabolic parameters markedly improve after 4-12 weeks of dietary restriction. 
Metformin: This antidiabetic drug improves insulin resistance and decreases hyperinsulinemia in patients with PCOS
Patients with PCOS who are infertile but desire pregnancy should be referred to a reproductive endocrinologist for further evaluation and management of infertility.

Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/

Intrauterine Contraceptive Devices IUCD or IUD

 An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed. However, an IUD should only be removed by a medical professional.

Hormonal and copper IUDs work in different ways. With a copper IUD, a small amount of copper is released into the uterus. This type of IUD does not affect ovulation or the menstrual cycle. Copper IUDs prevent sperm from being able to go into the egg by immobilizing the sperm on the way to the fallopian tubes. If an egg does become fertilized, implantation on the wall of the uterus is prevented because copper changes the lining of the uterus.

With hormonal IUDs, a small amount of progestin or a similar hormone is released into the uterus. These hormones thicken cervical mucus and make it difficult for sperm to enter the cervix. Hormonal IUDs also slow down the growth of the uterine lining, making it inhospitable for fertilized eggs.

Before an IUD is placed, a physical examination is important to make sure that the reproductive organs are normal and that no infections are present.

An IUD can be placed during an office visit and remains in place until a medical professional removes it. It can be inserted at any phase of the menstrual cycle, but the best time is right after the menstrual period because this is when the cervix is softest and when women are least likely to be pregnant.

Once the IUD is placed, women can return to normal activities such as sex, exercise, and swimming as soon as they are comfortable. Strenuous physical activity does not affect the position of the IUD.

Ref : MEDSCAPE

Dr Deepika Tiwari, Gynecologist, Gurgaon 
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/www.deepikatiwari.com

Emergency Contraception Pill or "Morning after" pill

 Emergency contraception (birth control after sexual intercourse) is the use of a drug or device to prevent pregnancy after unprotected sexual intercourse. Emergency contraceptive pills are sometimes called the “morning-after pill,” but they are usually effective if taken within 72 hours of unprotected sexual intercourse.  

Emergency contraceptive measures can be taken within the first 72 hours after unprotected sexual intercourse to reduce the possibility of pregnancy. A woman is most likely to become pregnant if sexual intercourse occurs in the few days before or after ovulation (release of an egg from the ovary). Emergency contraceptives should not be used as a contraceptive method in women who are sexually active or planning to become sexually active. They are not as effective as any ongoing contraceptive method.


Emergency contraception pills contain high doses of the same hormones that are in birth control pills. The high dose of hormones is short lived. Cases of deep vein thrombosis (blood clotting) have been reported in women using the emergency method. These pills are not designed to terminate an existing pregnancy.


Emergency contraception pills should only be taken with expert opinion. Cases of Uterine rupture have been reported in patients with inadvertent use.


Ref: Medscape
Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/

Female Infertility : Causes & Treatment

  Generally, infertility results from female infertility factors about one-third of the time and male infertility factors about one-third of the time. In the rest, the cause is either unknown or a combination of male and female factors.

When to see a doctor
If you're in your early 30s or younger, most doctors recommend trying to get pregnant for at least a year before having any testing or treatment.

If you're age 30 to 35, discuss your concerns with your doctor after six months of trying.

If you're over 35 or have a history of irregular or painful periods, pelvic inflammatory disease (PID), repeated miscarriages, prior cancer treatment or endometriosis, your doctor may want to begin testing or treatment right away.

1. Ovulation disorders account for infertility in 25 percent of infertile couples

Abnormal FSH and LH secretion, Polycystic ovary syndrome (PCOS), Luteal phase defect, Premature ovarian failure, Premature ovarian failure.

2. Damage to fallopian tubes (tubal infertility)

3. Endometriosis

4. Cervical narrowing or blockage

5. Uterine causes

6. Unexplained infertility

Treatments can either attempt to restore fertility — by means of medication or surgery — or assist in reproduction with sophisticated techniques.

Fertility restoration: Stimulating ovulation with fertility drugs
Fertility drugs, which regulate or induce ovulation, are the main treatment for women who are infertile due to ovulation disorders. In general, they work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation.

Reproductive assistance: In vitro fertilization
This effective technique involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and transferring the embryos in the uterus three to five days after fertilization. In vitro fertilization (IVF) often is recommended when both fallopian tubes are blocked. It's also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor infertility, male infertility and ovulation disorders.

Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/