Bottle feeding your baby

This information is full of useful advice on how to bottle feed your baby, what you'll need to keep evrything perfectly clean and safe for your little one.

Breastfeeding is best for baby - is at all possible breastfeed for the first 6 months. You can find out more within our breastfeeding advisory card or from your midwife or health visitor.

What you may need

• Bottles (standard or wide neck).
• Appropriate teat flow for your baby.
• Bottle and teat brush.
• Expressed breast milk/formula milk powder (or ready-to-use cartons).
• Sterliser (steam, microwave or cold water).
• Milk powder dispenser.
• Bibs nd muslin cloths.
• You may require faster flowing teats and possibly different bottles e.g. anti-colic as your baby grows and develops.
• Bottle bag.

To Read More Click Here  Bottle Feeding your Baby

The skill of breastfeeding

Breast milk is the perfect food for your baby. It's available on demand, at the right temperature, and has many health benefits for you and your baby.

This information is full of useful advice on how to breastfeed your baby.

Be Prepared

• During pregnancy attend a local breastfeeding information class.
• Eat a healthy diet, and eat frequently - you need more calories during breastfeeding than pregnancy.
• Check your bra fits correctly and buy the correct maternity bras.
• Ask your midwife to help you position your baby correctly on the breast when you first start to feed. You should sit comfortably, with baby's tummy facing your tummy. You may need to use a pillow to support you and your baby.

To Read More Click Here  Breast Feeding your Baby

Toilet training is a major milestone for all children.

Dealing calmly with the transition fom nappies to using the toilet independently is vital to building your child's confidence.

What you may need

• Potties.
• Trainer pants (with super absorbent lining) x 4.
• Step-up stool so your child can reach the toilet or wsh basin.
• Toilet training seat or comfy trainer for the loo.
• Mattress protectors x 2
• Change bag with plenty of spare clothes, wipes and nappy sacks for wet clothing etc.
• Travel Potty.

To Read More Click Here  Toilet Training your Baby

“The God would have created eves with an abdominal zip, if He prefers caesarian to a normal delivery,” quipped Dr Gita Suresh from EVK Medical Centre, Chennai. She was answering to a query on "why caesarian", and the reply not just evoked laughter but also some thoughts and a healthy debate.

The venue was SNR Kalaiarangam, and the Sunday audience seemed to be more illuminated with the smiles of tiny tots and their moms. With the ambience of togetherness and happiness around, Women’s Centre was celebrating its 25th anniversary with an open forum on ‘women and wellness’.

“Infertility is a challenge that no one expects. Dealing with infertility and its treatment can be emotionally frustrating and exhausting. It can put a strain on even the best of relationships. But medicine has developed in such a way that it gives good reasons to be optimistic,” said Dr Mirudhubashini Govindrajan, clinical director of Women’s Centre.

Though the literacy rates have increased and people are more accessible about medicine, many are unaware of facts like infertility, its reasons and treatments available. A group of leading professionals from the Women’s Centre clinical team, headed by Dr Mirudhubashini, made themselves available to the women of Coimbatore through a free 2-hour open public session ‘Ask the gynaecologist’.

The first doubt from the audience was on 'fertility'. With all the specialists of Women Centre on dais, it was the infertility specialist Dr Lakshmi’s turn to answer.

“Infertility is the inability to become pregnant after one year of trying to conceive. Now a days, one of six couples suffer from infertility. Only 10 percent of the infertility is due to unknown causes,” she said.

“There are many causes for infertility which vary from women to men. Failed ovulation (the failure to develop and release egg due to some hormonal imbalance, stress, obesity etc), damaged or blocked fallopian tubes due to previous infection, surgery, tuberculosis etc, disorders of the uterus and problems around the uterus, age and other hormonal disorders can cause infertility in females while low or abnormal sperm count, stress, ill-health, hormonal problems, diabetes mellitus, smoking, tobacco and alcohol consumption can be the reasons in males.”

"Infertility can be treated. It can be sometimes cured with medications and not surgery, if known in the earlier stage," she added.

Meanwhile, a slip was passed on to the stage. Dr Suganya read it out, a question on sperm and embryo freezing. Dr Mirudhubashini explained on the situation that leads to sperm and embryo freezing and extend to which it can be kept frozen, said, “Well… often sperm is frozen when a man undergo some serious surgeries or treatments like chemotherapy, where there are chances of decrease in sperm count. Or it can happen when the husband may not be available at the time of sperm collection for test tube baby or in vitro fertilisation.”

“… And about the extend to which it can be kept frozen defers on conditions available. Anyway, embryos can be preserved for years.”
The next question was on in vitro fertilization and formation of embryos. Saranya, the embryologist was ready with her answer. “In vitro fertilization is a technology where human eggs, sperms and embryos are handled and grown outside the human body, in a very controlled environment with the optimum temperature needed. The embryo is then placed into the mother’s womb after a few days, to grow further into a baby,” she said. "It is this stage where the need for embryo freezing arises. If the implantation happens to be unsuccessful, then the embryos, collected and kept frozen, can be used."

Implantation unsuccessful?, came the next question.
Mirudhubashini now asks Dr Saradha to explain.
“Implantation is the term used for the process of keeping embryo back in uterus. If there is any further problem inside the uterus, which is causing a hindrance for the growth of the baby, then it is called implantation failure,” she explained. "The laboratory conditions are the most important aspect of implantation. The sperm, egg nor embryo should be kept in a temperature outside 37 degree, that it can cause abnormalities in them."

Dr Suresh and Dr Indrani Suresh from Mediscan, Chennai, had no hesitation answering a query from a mother on whether the doctors would support abortion in case of any abnormalities found. "Doctors are the advocates of the unborn. A doctor only has the right to save a life. He will never ask for an abortion unless the situation demands." On the future mental and physical sufferings of such babies, he quoted one of his experiences where a childless mother who conceived after treatment, was shocked to know that her baby was handicapped. Though abortion was suggested she said that if the baby can be kept alive at least for a few seconds after the birth her motherhood will be fulfilled. “…It depends on attitude. It’s a baby of our own that matter. All the rest comes after that for a childless couple,” he added.

“Today, women are less pain tolerant. They can’t tolerate the delivery pain, which was once considered the privilege and happiness of womanhood. Some working couples also 'plan pregnancy', some want delivery in ‘auspicious time' and good positioning of birth stars, and demand caesarian,” Dr Gita Arjun said.

Teenagers also took the opportunity to clear their doubts. The effect of uterus removal on physical fitness was raised from one of them. “Uterus removal has nothing to do with physical fitness. Since hormones are produced by ovary there is no chance for hormonal imbalance too," Dr Saradha explained.

The session continued with many more live questions and answers, but the most enlivening part of the session was the latter part. The children, whose reason for being in the earth was the Women’s Centre, filled this part with variety cultural programmes.

"Pitha rakshiti koumare
Bartho rakshiti youvane
Putro rakshiti vaardakye", says Manu.
Yes, there is a need for a woman to be cared for in all phases of her life _ especially when in labour. And it's to cater to her physical, emotional and mental needs that Coimbatore Women’s Centre has added new features that cater to the needs of mothers-to-be _ especially the 'birthing suite'. "The childbirth is a sweet memory that a mother should always cherish. It should not be turned into a thing that she should fight to forget. It is to be carried through out the life as now-a-days motherhood comes only once or twice in a lifetime for most of the women," says Dr. Mirudhubashini Govindarajan, clinical director of Women’s Centre.

"We try to take up women issues in a manner that is less addressed by other hospitals or organisations. We focus mainly on the comfort zone. that should be provided for a woman to have a pleasant delivery," she explains.

Childbirth being the most special occasion for the women, the mother-to-be should be taken care of and provided with all comforts around. It's to serve this purpose that the centre has added ‘birthing suite’ concept among its features.

"Birthing suite is more than a hotel room with all the facilities around. Rather than the physical amenities, the suite helps in backing the expecting mother with needed emotional support. The husband's access to the room at the time of delivery is also made possible. All the equipment needed for the delivery will be there in the suite hided so that it do not create an ambience of hospital. Usually, all the deliveries except the high risk cases will be held in the suite itself," said Jayaram Govindarajan, the administrator of the centre.

Childbirth being the most special occasion for the women, the mother-to-be should be taken care of and provided with all comforts around. It's to serve this purpose that the centre has added ‘birthing suite’ concept among its features.

The most special feature of the birthing suite is the ‘birthing bed’, which gives a comfortable birthing position for the mother-to-be and also the staff attending her. The main characteristics of the birthing bed includes its excellent design for the usage of it through out all the birthing phases, its low entrance height, stable construction, inclining of segments according to comfort ability and easy control of handles.

Stepping into 25th year of service, Women's Centre, located at Sri Ramakrishna Hospital, is a comprehensive women health care setup providing most complete solutions for all the health problems of women, from her puberty to menopause. It is unique in Coimbatore and the first of its kind to receive an ISO 9001:2000 award for its quality in service.

A well-catered team of 14 highly qualified full-time consultants, several visiting consultants, para-medical staff and a handful of other nursing staff enable Women’s Centre to be more passionate and responsible for the services. The consultants include professionals in infertility management, embryology, clinical obstetrics and gynaecology, andrology, laparoscopic (key hole), endoscopic and hysteroscopic surgeons, gynec-oncology, ultrasonology, adolescent care, pregnancy, newborn care and neonatology.

"We are an independent entity without much tie ups, for we concentrate more on quality, than spreading out the banner name. The key element of this type of organisation is the specialised consultants at the reach of our hands. It is not that to invite a visiting professional at their schedule, but it is to provide the medicare at the time, when the patient is in need of it," said Jayaram on the reason for not having more branches.

Women’s Centre, with a hand full of specialised doctors, round the clock are capable of giving individual attention to the patients. The infertility department, which needs more care while handling with eggs and sperms, outside the human body, to make sure that the couple bears their own child, it is important to have an individual attention.

The Centre is having an infertility laboratory with a completely sterile environment, which enables them to be more precise in IVF (In Vitro Fertilization) treatment.

"IVF is the last thing to choose for a childless couple. We are having many other phases of treating infertility, even without any surgery. IVF being the more critical phase is dealt with more precise. Highly qualified medical and technical personnel with years of hands on experiences add to the IVF facilities in the hospital," said Dr Lakshmi, specialised in treating infertility. Also three embryologists are there to offer their services round the clock.

Spreading more than 15,000 new smiles to the world, the centre has given many childless couples a reason for living. "I was childless for 17 years. I tried out many medicines, but of no use. Then I came to know about Women’s Centre from some of my villagers. I was suggested to do IVF. Now I am three months carrying, thanks to the doctors here," says Janaki (name changed) of Erode. Another childless couple, settled in Australia, came to Women’s Centre knowing about it from the successful story of their relative. Sairadha, childless for five years is now a mother-to-be with a four-month child giggling in her womb.

Apart from the health care services, the centre also stretches its hands to educational aspects. Classes are been conducted for the expecting and her relatives on various issues like the breast-feeding, obesity, a pre-note on the delivery pain, meditation etc. The shortage of well-trained personnel has made the centre to have a tie up with Bharatiar University to start a new course in Maternal and Child health for plus-two students. It also offers a Fellow of National Board (FNB), with students from various parts of the country enrolled after an all-India entrance test.

"The best feature of the centre is the emotional support they are providing. They understand us fully and only after that the doctors even start treatment. The way of approach helps to build confidence in patience," said Biji Alexander, who is preparing to be a mother after the IVF.

"Instead of bits and pieces here and there, we give a package for childbirth, starting from treatment till having a baby, at ultimate rate of affordability along with quality. In all means, Women’s Centre spreads an ambience of a second home for the mother-to-be," says Dr. Mirudhubashini with a confident smile.

When should i start solid foods?

Around six months of age, when the following milestones are achieved.

• Your baby sits with support and with good head control.
• Inserts toys or fingers into their mouth.
• Shows interest in food by leaning forward and opening their mouth when hungry.
• reaches for toys and grabs on to them accurately.

What foods should i start with?

• Start with a single ingredient, well cooked and mashed food. Rice or ragi kanji, fruits (mashed banana, cooked peeled apple or pear) or mashed vegetables (potato, carrot, green beans, sweet patato) or homemade vegetables soups like tomato soup.
• Do not add salt, sugar, masala or chilli powder.
• Make the food into a thin mixture. A small quantity of your own breast milk, formula milk, or water can be used to thin the mixture.

How do I start feeding the baby?

• Introduce the baby to one new food every few days, starting with just a few teaspoons full each day.
• Feed the baby with a teaspoon.
• Stir hot food, to help cool it evenly. Test the temperature yourself before feeding.
• Watch out for allergic reactions.
• Allow plenty of time to feed.
• If baby is not interested, try again later. Do not force feed the baby.
• Have the baby sit up, facing you while feeding. Use a high chair when possible.

What foods should I give my baby next?

If your baby is tolerating fruits and vegetables, you can try these foods

• Pureed or mashed noodles, idli, chapati, dosa, upma, bread or pasta.
• Cooked and mashed lentils or pulses (dhal or beans).
• Full fat curd, ghee, butter, pastuerised cheese or custard.
• Fully cooked mashed meat (mutton), fish, egg or chicken.

How do introduce foods that may cause allergies?

• Some food stuff like eggs, wheat, fish and shell fish may cause allergic reaction in some babies.
• Introduce these foods one at a time, closely watching for any allergic symptoms.
• Stop feeding if you notice any allergic reaction and discuss with your doctor.
• If the reaction appears severe or the baby has difficulty breathing go to a hospital immediately.
• Do not introduce peanuts, cashew nuts, badam, pista in younger children due to risk of allergy and choking. Consult with your doctor before introducing nuts or seeds.

Read More ...Solid Foods

Being considerably over weight can certainly have a negative effect on the chances of an individual conceiving. This is true for both men and women. The excess fat or adipose tissue itself can produce certain hormones and interfere with the normal levels of hormones. The regular hormone cycles can go haywire and contribute to infertility. Sometimes the obesity itself can be the result of hormonal problem such as thyroid dysfunction or polycystic overies.

Besides causing increased risk of heart disease, hypertension, and diabetes, obesity can also decrease the chances for regular ovulation. If one is significantly overweight, while your ovaries are trying to behave and cycle normally, the steady input of extra hormones the fat tissue will interfere.

Infertility treatment including test tube baby procedures are less likely to be successful if either the male or the female partner is considerably over weight.

The chances of becoming pregnant are 40% lower if their body mass index (BMI) is over 30.

The positive side is that weight loss, even as low as 5% can help to reverse the adverse effect

Menopause is neither a sudden nor a catastrophic event in a woman’s life. It is just an inevitable phase in her life when her hormonal cycles gradually come to a stop. This period of hormonal decline may last for several years before the actual cessation of menstrual period.

Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after the last menstrual period. It is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can sometimes disrupt sleep, sap energy and — at least indirectly — trigger feelings of sadness and loss. Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones.

First, menopause doesn't mean the end is near — you've still got as much as half your life to go. Second, menopause does not snuff out femininity and sexuality. In fact, many women find it liberating to stop worrying about pregnancy and periods.

Most important, even though menopause is not an illness, one shouldn't hesitate to get treatment if one is having severe symptoms. Many treatments are available, from lifestyle adjustments to hormone therapy.

The signs and symptoms of menopause often appear long before the final period. They include, Irregular periods, Decreased fertility, Vaginal dryness, Hot flashes Sleep disturbances, Mood swings, Increased abdominal fat, Thinning hair and Loss of breast fullness

It's important to see your doctor during the years leading up to menopause (perimenopause) and the years after menopause (postmenopause) for preventive health care as well as care of medical conditions after menopause. We will talk more about the causes and management in menopause in the coming issues.

Breast cancer is such an emotive disease, that, on discovering a breast related symptom, many women fear the worst. In fact, around 90% of these women will have benign pathology. The easiest way to reassure them is with a prompt and accurate diagnosis which lays the foundation for treatment.

When you go in to a doctor, as with any clinical problem, the process starts with the history and examination, followed by special investigations. After a discussion of the merits of the diagnostic modalities available, the conditions and their treatment will be described.

History

If the main symptom is of a lump, it is important to be able to tell your doctor how long it has been present, whether it has grown, if it is painful and whether it varies with the menstrual cycle.

The most common breast symptom is mastalgia. It is necessary to determine whether the pain truly originates in the breast or whether it is from elsewhere, eg. the esophagus or the heart. It is important to be able to tell the doctor the site, severity and duration of pain. Relationship to the menstrual cycle often provides a key to diagnosis. If this relationship is uncertain, a daily paid chart kept over a period of 2-3 months may help to confirm a link. Information to be concerned about as regards to nipple discharge includes the color of the discharge and whether it comes from one or both the nipples.

It is also important to tell your doctor if you are on the oral contraceptive pill or taking other hormonal agent. A history of current pregnancy or breast-feeding may be significant and if there is a family history of breast disease that could be important as well.

Examination

Self breast examination in the bath after each menstrual cycle is important. If any mass is felt, the following characteristics should be noted. Position, consistency and fixity (both deep and superficial) and specifically whether lump feels discrete or not. If you have a nipple discharge you should express a small quantity for analysis for Hb, cystology and culture examination of the axilllary and supraclavicular glands. Palpable lymph adenopathy increases suspicion of a breast carcinoma, but can also occur with an inflammatory process.

Investigation

Ultrasound and Mammography are the most frequently used methods of imaging. The aim of imaging is first, to provide a probable diagnosis and secondly to help exclude the presence of cancer, thereby reducing the need for more invasive interventions.

Palpable masses within the breast are breast imaged with ultrasound if you are under the age of 35. Over the age of 35, mammography and/or ultrasound will be performed. If clinically the lesion is suspicious of malignancy, a tissue diagnosis may also be obtained. The emergence of breast FNAC has produced a major change in the management of breast symptoms over the past decade, with a substantial reduction in the need for open biopsy. Results of FNAC can be generated within minutes, this allows planning of treatment and for those with benign disorders and also has the potential to assay your fears.

Glucose 6 Phosphate dehydrogenase enzyme is a red cell enzyme that prevents oxidative damage to red blood cells. Deficiency of this enzyme also known as G-6PD deficiency is inherited in an X linked recessive manner which means it is more commonly seen in male infants. When the deficient child or adult is exposed to certain drugs or infection they suffer from Red blood cell hemolysis and hemolytic jaundice which is self limited in most instances when the offending drug is promptly withdrawn but sometimes can be life threatening. In the newborn period it can result in severe jaundice that can lead to neurological damage, a condition called as kernicterus.

We are now offering newborn screening services to all neonates born at Women center which includes G-6PD screening. We have started to see babies with screen positive for G-6PD deficiency. If the screen is positive, the first step is to confirm it by doing a definitive quantitative assay for G-6PD deficiency.

Being a genetically inherited disorder it is lifelong and has no curative treatment. It is important to avoid drugs that can precipitate hemolysis if given to these patients and it is vital to inform doctors and other health care workers whom you meet the presence of this enzyme defect. For a list of drugs that should be avoided in those with G-6PD deficiency visit this link
G6PD

1. 35 weeks/2 kg/female baby delivered by elective LSCS because of ART (assisted reproductive technology) pregnancy kept by mother's side and maintaining blood sugars, had became suddenly pale with apnea and no audible heart sounds at 22 hours. Good response to resuscitation with ET IPPR (assisted ventilation) and cardiac massage and extubated to nasal O2 in 1 hour. Subsequently developed 3 episodes of tonic seizures and loaded with phenobarbital. Initial work up showed normal septic screen, normal CSF results, sugar, calcium, CT brain, EEG normal Na, K, Cl but with acidosis bicarb 9 and ABG(arterial blood gas) showing compensated metabolic acidosis, ammonia Normal but lactate elevated 5 fold. Repeat bicarb after bicarb correction for 24 hours still only 12.We kept the baby Nil by Mouth and took complete metabolic work up. The results from metabolic work up were surprisingly normal after which we started feeds and discharged the baby with advise on SIDS prevention and home monitoring, keeping the initial diagnosis as ALTE (apparent life threatening event). This is the first time I am seeing ALTE like picture in my neonatal practice of 15 years. If anyone has seen anything similar, please share with us.

2. 34 weeks primigravida mother, twin pregnancy booked somewhere else was referred to us for maternal jaundice of short onset (2 days). On arrival the CTG (cardiotachogram) of both the twins showed impending fetal demise with omnious pattern and hence emergency LSCS. Twins weighing 1.7 and 1.9 kg were born with only few audible heart beats but responded quite well to ET IPPR and shifted to NICU for ventilation. CXR was clear and both babies were extubated 8 - 10 hours later after caffeination. Quite surprisingly none of them developed any feature of HIE and were by mother's side by day 5.Mother's viral markers were negative and clinical diagnosis was acute fatty liver of pregnancy. Why the babies developed such severe fetal distress is unclear and also their surprisingly good outcome.

Endometrium is the lining of uterine cavity. In endometriosis, the endometrium is present outside the uterus. It mainly affects the ovaries, causing chocolate cysts of the ovary, pelvic, rubum, pevitonium etc. Following a caesarian section, the endometriosis may infiltrate into the bladder or anterior abdominal wall scar (scar endometriosis).

The exact reasons for endometriosis are not known.

Symptoms

• Progressive congestive dysmenorrhea – pain starts before the onset of periods and persists even after bleeding has stopped. Severe dysmenorrhea may limit the physical activities even.
• Dysparennia Endometriosis infiltrating into POD may cause this.
• Dyschesia pain during defecation
• Infertility – 15 to 20% of infertility patients will have endometriosis. Chocolate cysts of the ovary may compromise ovarian function. Pelvic adhesions will lead to altered tubo-ovarian relationship
• Pelvic pain

Menstrual irregularities may not be present.

Treatment

Depends on whether the patient wants to become pregnant or not.

Pain killers – for severe dysmenorrhea

Infertility - step by step management, trans-vaginal Ultrasound guided aspiration of chocolate cysts. Followed by infection of GnRHa. When the cyst varies in size, it can be removed through laparoscopy.

Adhesialysis – cauterization of endometriosis spots and restoration of tube ovarian anatomy can be done. Sometimes repeated aspiration of cysts will be required. Endometriosis has a chance of recurrence.

For those who have already had children – depending on the severity of endometriosis, surgery / medical treatment may be performed. Definitive treatment is surgery, i.e., TAH with BSO. The aim of medical treatment is to produce amenorrhea so that the exterpic endometrium will regime. Medical treatment could include of OC pills, progesterone tablets, injection, GNRHa injections, LNG IUCD.

Vaginal bleeding in pregnancy has many causes. Some are serious and some are not. Some causes result in bleeding early in pregnancy while others result in bleeding later. Slight bleeding often stops on its own. However, sometimes, bleeding may be of risk to you or your fetus. You should call your doctor or seek medical advice if bleeding occurs.

We will cover the following areas:

• The causes of bleeding
• Signs of problems
• What can be done

Many women with bleeding in pregnancy have minor conditions that need no treatment. At other times, bleeding can be a sign of a serious problem.

Early pregnancy

Many women have vaginal spotting or bleeding in the first 12 weeks of pregnancy. If you are bleeding in early pregnancy, your doctor may do a pelvic exam. A blood test may be done to measure human chorionic gonadotropin (hCG). It is a substance produced during pregnancy. You may have more than one of these tests because hCG levels increases as the pregnancy progresses. Ultrasound may be used to find the cause of the bleeding. Sometimes the cause is not found.

If you have bleeding during pregnancy, you may need special care. You have a higher chance of going into labor too early (preterm labor) or having an infant who is born too small.

Miscarriage

Bleeding doesn’t mean that miscarriage is certain, but it can occur. About half of the women who bleed do not have miscarriages. If there is a problem with the pregnancy, fetal death usually results in the passage of tissue, and the pregnancy ends.

Miscarriage can occur at any time during the first half of pregnancy. Most occur during the first 12 weeks.

Signs of miscarriage include:

• Vaginal bleeding
• Cramping pain felt low in the stomach (often stronger than menstrual cramps)
• Tissue passing through the vagina

Many women who have vaginal bleeding have little or no cramping. Sometimes the bleeding stop and pregnancy goes on. At other time the bleeding and cramping may become stronger. Then miscarriage occurs.

If you think you have passed fetal tissue, take it to the doctor’s office so it can be examined. If some tissue stays in the uterus, bleeding often continues. The tissue that remains may be removed by a procedure called dilation and curettage (D&C). The tissue also may be removed by a suctioning device. This is called suction curettage.

Most miscarriages cannot be prevented. They are often the body’s way of dealing with a pregnancy that was not normal. There is no proof that exercise or sex causes miscarriage. Having a miscarriage does not always mean that you can not have more children or that something is wrong with your health. If you have two or three miscarriages in a row, your doctor may suggest that some tests be done to look for a cause.

Ectopic Pregnancy

Another problem that may cause pain and bleeding in early pregnancy is ectopic pregnancy. If pregnancy occurs in a fallopian tube, it may burst. They may be internal bleeding also. Blood loss may cause weakness, fainting, or even shock. A ruptured ectopic pregnancy needs prompt treatment.

Ectopic pregnancies are much less common than miscarriages. They occur in about 1 in 60 pregnancies. Women are at a higher risk if they have had:

• An infection in the tubes (such as pelvic inflammatory disease)
• A previous ectopic pregnancy
• Previous tubal surgery

Molar pregnancy

A rare cause of early bleeding is molar pregnancy. It is also called gestational trophoblastic disease (GTD) or simply a “mole”. It is the growth of abnormal tissue instead of an embryo. A molar pregnancy may require treatment with suction curettage or with drugs.

Late Pregnancy

The causes of bleeding in the second half of pregnancy differ from those in early pregnancy. Common conditions that cause minor bleeding include an inflamed cervix or growths on the cervix.

Late bleeding may pose a threat to the health of the woman or the fetus. It may require treatment in a hospital. Heavy vaginal bleeding usually involves a problem with the placenta. The two most common causes of bleeding in late pregnancy are placental abruption and placenta previa. Preterm labor can also cause vaginal bleeding.

Placental Abruption

The placenta may detach from the uterine wall before of during labor. This may cause vaginal bleeding. Only 1% of pregnant women have this problem. It usually occurs during the last 12 weeks of pregnancy. Stomach pain often occurs, even if there is no obvious bleeding.

When the placenta becomes detached, the fetus may get less oxygen. This can pose a danger to the fetus.

Those at high risk include women who:

• Have already had children
• Are over 35
• Have had abruption before
• Have sickle cell anemia

Placental abruption has also been linked to:

• High blood pressure
• Blows or other injures to the stomach
• Smoking

Placenta Previa

When the placenta lies low in the uterus, it may partly or completely cover the cervix. This is called placenta previa. It may cause vaginal bleeding. Placenta previa is serious and requires prompt care.

Placenta previa occurs in 1 woman in 200. It is more common in women who have more than one child, who have had a cesarean birth or other surgery on the uterus, or who are carrying twins or triplets. Bleeding often occurs without pain.

Labor

Late in pregnancy, vaginal bleeding may be a sign of labor. A plug that covers the opening of the uterus during pregnancy is passed just before or at the start of labor. A small amount of mucus and blood is passed from the cervix. This is called “bloody show”. It is common. It is not a problem if it happens within a few weeks of your due date. If it happens earlier, you may be going into preterm labor. You should talk to your doctor right way.

Other signs of preterm labor include:

• Vaginal discharge
-Change type (watery, mucus, or bloody) -Increase in amount
• Pelvic or lower abdominal pressure
• Low, dull backache
• Stomach cramps, with or without diarrhea
• Regular contractions or uterine tightening

Taking Action

Call your doctor if you have bleeding in late pregnancy. You may need to be admitted to the hospital to find its cause. Ultrasound may be adviced. You may have to stay in the hospital for a few weeks. A blood transfusion may be required.

Conditions that cause bleeding in late pregnancy pose a risk to both mother and fetus. They may be serious enough to require early delivery of the baby, sometimes by cesarean birth.

Finally…

Many women with bleeding in pregnancy have minor conditions that need no treatment. At other times, bleeding can be a sign of a serious problem. Bleeding anytime in pregnancy-early or late-should be reported to your doctor. The health of you and your baby may depend on getting prompt treatment.

The length of a pregnancy is 40 weeks. In most pregnancies, labor starts between 37 and 42 weeks after a woman’s last menstrual period. When it begins before 37 weeks, it is considered preterm. Your baby can have problems if it is born too early. Serious illness or death can occur because the baby is not yet ready for life on his or her own.

In this posting we will explain the following areas:

• The warning signs or preterm labor
• How to detect it at an early stage
• Methods used to help prevent preterm labor.

What Is Preterm Labor?

Labor starts with regular contractions of the uterus. The cervix thins out (effaces) and opens up (dilates) so the baby can enter the birth canal. It is not known for certain what causes labor to start. Hormones produced by the woman, placenta, and fetus play a role. Changes in the uterus, which may be caused by these hormones, may cause labor to start.

There are many reasons for preterm labor. In most cases of preterm labor, however, the exact cause is not known.

Why should we be concerned ?

Preterm birth accounts for most newborn deaths. Growth and development in the last part of pregnancy are vital to the baby’s health. The earlier the baby is born, the greater the chance that he or she will have health problems. Preterm babies (also called premature babies or “preemies”) tend to grow more slowly than term babies. They also may have problems with their eyes, ears, breathing, and nervous system. Learning and behavioral problems are more common in children who were preterm babies.

Signs of Preterm Labor

If preterm labor is found early enough, delivery may be prevented or postponed in some cases. This will give your baby extra time to grow and mature. Even a few more days may mean a healthier baby. Some times the signs that preterm labor may be starting are fairly easy to detect.

• Change in type (watery, mucus, or bloody) of vaginal discharge
• Increase in amount of discharge
• Pelvic or lower abdominal pressure
• Constant, low, dull backache.
• Mild abdominal cramps, with or without diarrhea.
• Regular or frequent contractions or uterine tightening, often painless.
• Ruptured membranes (you water breaks with a gush, or sometimes even a trickle of fluid)

If you have any of these symptoms, don’t wait. Call your doctor’s office or go to the hospital right away.

Diagnosing Preterm Labor

It is common for women to have false labor, during the last part of pregnancy. These contractions may be painful and regular, but usually go away within an hour or so with rest. If you have contractions that occur 4 times every 20 minutes or if you have contractions 8 times an hour that last for more than an hour, call your doctor’s office or go to the hospital right away.

Preterm labor can be diagnosed only by finding changes in the cervix when you are having regular contractions. This means your doctor will have to examine you. To help diagnose preterm labor your doctor may use the following tests:

Fetal monitoring: These tests are used to record the heartbeat of the fetus and contractions of your uterus.

Ultrasonography: This exam may be used to measure the length of the cervix and estimate the size, age, and position of the fetus.

Fetal fibronectin: This test is used to measure the amount of a certain protein that helps predict the risk of preterm delivery.

You also may have a pelvic exam and tests to look for infections of the vagina or cervix.

Women at Risk

Preterm labor can occur without warning. Some women are at greater risk for preterm labor than others. Women who have little or no prenatal care and those who have had preterm labor before are at increased risk.

A number of other factors have been linked to preterm labor. For instance, too much amniotic fluid in the sac that surrounds the baby is a risk factor. Problems with the placenta or certain birth defects also increase the risk. Certain health factors also may be linked to an increased risk for preterm birth:

• Short cervical length as measured by ultrasound
• Increased amounts of the protein fetal fibronectin in vaginal discharge

If you are at risk for preterm labor or preterm delivery, you may be advised to take certain steps to help prevent preterm birth. These steps may involve:

• Changing your lifestyle
• Visiting your doctor more frequently
• Learning how to check your contractions.

If you are at risk for preterm labor, be sure to get early prenatal care. You may need to see your doctor more often for exams and tests. Smoking cigarettes and using certain illegal drugs, increase the risk of preterm birth. Women who have had a previous preterm delivery may be given progesterone, a hormone to help prevent another preterm delivery.

In many cases, women at risk for preterm labor do not have to take leave from their jobs. However, you may be advised to avoid heavy lifting or other hard or tiring tasks during pregnancy. Women at risk also may be advised to cut down on travel. Ask your doctor about these and other changes you may need to make in your daily routine.

If you have a history of preterm labor or have signs of preterm labor, you may wonder about having sex during pregnancy. Many women worry that the uterine contractions that often follow sex and orgasm will lead to preterm labor. Although in most cases the contractions stop, these are natural and real concerns that should be discussed with both your partner and your doctor. You may be advised to restrict sexual activity or to monitor yourself for contractions after sex.

Risk Factors for Preterm Labor

• You have warning signs of preterm labor.
• You have had preterm labor during this pregnancy.
• You had preterm labor or preterm birth in a previous pregnancy.
• You smoke cigarettes.
• You are carrying more than 1 baby.
• You have an abnormal cervix (due to surgery, for instance)
• You have an abnormal uterus.
• You have had abdominal surgery during this pregnancy.
• You have had an infection while pregnant.
• You have had bleeding in the second or third trimester of your pregnancy.
• You are underweight.
• You have had little or no prenatal care.
• You have a child with chromosomal disorders.

Half of the women who go into preterm labor have no known risk factors.

Monitoring for Contractions

After about 20 week of pregnancy, you should monitor yourself for signs of uterine activity or tightening. To monitor yourself, lie down on your side and gently feel the entire surface of your lower abdomen with your fingertips. You are feeling for a firm tightening over the surface or your uterus. In most cases, these feelings of tightening are not painful.

If you feel contractions, keep monitoring for an hour. Keep track of when each contractions starts and ends and the total number that occur in 1 hour. Having some uterine activity before 37 weeks of pregnancy is normal. If your contractions occur 4 times every 20 minutes or you have 8 contractions in an hour, you need to call doctor right away. You may be in preterm labor. You should contact your doctor or nurse each time you have 8 or more contractions per hour, unless you have been advised otherwise.

Changing Your Lifestyle

There may be lifestyle factors you can change during pregnancy to help decrease your risk of preterm labor.

• Get prenatal care
• Do not smoke or use illegal drugs

Treatment

Sometimes contractions can be stopped for at least 48 hours. Other times, the baby must be delivered. Your doctor may try to stop labor if:

• It is detected early enough
• You and your baby are not in danger from infection, bleeding, or other complications

You may be given medications called tocolytics that stop contractions. If it looks as though you may have the baby early, you may be given a medication called a corticosteroid. This substance crosses the placenta and helps the baby’s lungs mature and increased the baby’s chance to live.

Preterm Delivery

Sometimes preterm labor may be too far along to be stopped, or there may be reasons that the baby is better off being born, even if it is early.

These can include:

• Infection
• High blood pressure
• Bleeding
• Signs that the fetus may be having problems.

Many preterm babies are tiny and fragile. The baby may need special medical care to breathe, eat, keep warm, and treat any health problems that may arise. You or your baby may be moved to a different hospital that can provide this type of care. The care your baby needs depends on how early he or she is born. Preterm babies can have physical and mental disabilities that can be long-term, such as abdominal problems and problems with breathing. Babies born before 32 weeks of pregnancy are the most likely to have health problems.

Preterm babies may not be ready to live on their own. They may be cared for in a neonatal intensive care unit (NICU) for weeks and sometimes months. Preterm babies often are kept in an incubator to keep them warm. They are cared for by specially trained nurses and doctors. Today, with special NICU care, even very early, tiny babies have a chance of survival.

Finally ….

The exact causes of preterm labor are not known. However, there are things you can do to have a healthy pregnancy:

• Get regular prenatal care
• Eat healthy foods and do not skip meals.
• Lead a healthy lifestyle
• Be alert to signs of preterm labor.
• Follow your doctor’s advice.

PCOS is a condition in which a woman’s ovaries and in some cases the adrenal glands, produce more androgens (a type of hormone, similar to testosterone) than normal”. While all women produce some androgens, women with Polycystic Ovarian Syndrome have higher levels of these hormones, leading to increased hair growth, acne and irregular periods. PCOS affects 8 to 10% of women in their reproductive age group. It is a major cause of anovulation (ovary failing to release an egg) in persons with infertility.

Symptoms

• Chronic anovulation or irregular ovulation, hair growth, acne
• Hyperandrogenism (excessive production of androgens)
• Polycystic ovary detected by ultrasound

Besides causing infertility, it can cause a variety of diseases namely DUB (dysfunctional uterine bleeding), endometrial & breast cancer, hair growth and in the long run people who have PCOS could develop Diabetes or Hypertenstion.

Persons with PCOS may be obese (60 to 70%) anovulate, infertile and have hair growth. It is common in all age groups.

Treatment

a. Decrease in BMI (calculated in Wt. in kg/Ht in cm). Normal BMI is <25. Patient with high BMI should reduce their weight by diet restriction and high physical activity. Thus even a reduction of 6 to 7 kg can help to restore spontaneous menstruation with ovulation in few patients. It also decreases the dosage of drug used and enhances the response to drug.

b. Ovulation induction drug - to induce ovulation. This has to be taken only under the guidance of a Gynecologist. Indiscriminate use might lead to adverse side effect. So if there is no response to drugs in a 6 month period (ovulation but no pregnancy), the diagnosis should be renewed, instead of indiscriminate use.

Drugs include Clomephene citrate and Letroze. It leads to ovulation in 80% and pregnancy in 40% of patients within a 6 months period. A few drugs like Metformin may also be prescribed to normalize the insulin resistance seen in some people.

c. Gonadotrophins with or without Assisted Reproductive Technologies (ART)

With irregular cycles, the chance of ovulation and hence pregnancy is reduced. If you have irregular cycles and have problems with fertility then you should consult a Gynecologist soon.

Premenstrual Syndrome is a psychological and somatic disorder of unknown cause or etiology. PMS was traditionally thought to affect multifarious middle class articulate women in their late 30s and 40s, the symptoms beginning after childbirth and often following postnatal depression. However, this probably is due to the fact that this group of women reports their symptoms, whereas younger and less educated women experience equally severe symptoms but do not recognize them as such.

Only 5% of menstruating women are completely free from symptoms premenstrually and up to 95% of women experience at least one premenstrual symptom. In the majority, these are tolerated and there is no disruption with normal functioning. When symptoms interfere with normal life to produce social, family or occupational disruption, then a woman can be considered to have PMS.

Symptoms of PMS

The classical symptoms of PMS are irritability, aggression, depression, tension, bloatedness and breast pain. However there are many other symptoms like crying-bouts, decreased alertness, loss of confidence, social isolation, suicidal tendency, decreased libido, etc.

Diagnosis of PMS

There are no objective means of identifying or quantifying PMS and for practical purposes reliance is placed on history questionnaires and exclusion of other disorders. There are no specific blood tests for PMS. However blood tests may be useful to exclude other disorders.

Treatment

Currently treatment is offered in the absence of an etiological explanation and therefore is mostly empirical. The range of proposed treatment regimes for PMS are wide and varied. Some of them are as outlined below.

Non-pharmacological – Rest, isolation, psychotherapy, education, counseling, yoga, Self help Groups, diet, acupuncture, salt restriction and diet modification.

Hormonal – Oral contraceptives, Testosterone, Progesterone, Danazol, GnRh Analogues and mifipristone.

Non-hormonal – Diuretics, Vitamins Essential fatty acids, Tranquilizers, Antidepressants, Selective Serotomin Reuptake Inhibitors (SSRI)

Tubal factors account for 30% of cases of infertility. So assessing tubal patency is of foremost importance.

Causes of tubal dysfunction:

Pelvic inflammatory disease (PID)

Each episode of PID increases the risk of tubal block (12% after 1st episode, 24% after 2nd episode). PID is caused by sexually transmitted diseases (STD), Tuberculosis, following invasive genital procedures. While treatment for STD, the couple should be consulted and should undergo antibiotic treatment simultaneously to avoid recurrence. Women should consult the gynaecology if they have complaint of white fowl smelling discharge with fever or lower abdominal pain to avoid the squeals of PID.

Genital Tuberculosis

It is usually secondary to pulmonary tuberculosis and might present with menstrual irregularity of infertility. Because its prevalence in India, the diagnosis of tuberculosis should be kept in mind.

Previous ectopic pregnancy or tubal surgery

Endometriosis

Tests to assess Patency:

HSG (Hystero Salphingo Graphy)

This is performed from D6-D10 of the menstrual cycle (after the patient stops bleeding ). In this procedure, the uterine size, shape and the tubal patency is assessed by insulting a Radio Opaque Dye. It is done under X-ray (fluroscopy) guidance through the cervix. Appropriate aseptic precautions should be followed to prevent infection.

Sono Salphingo Graphy

The same procedure can be carried out during ultrasound examination but the sensitively and specificity is low.

Laparoscopy

This is the gold standard to assess the tubal patency because apart from tubal function; the presence of other pelvic factors like adhesion, endometriosis and tuberculosis or uterine malformation can be diagnosed and treated accordingly. It is done under general anesthesia, from D6-D10 of the menstrual cycle. A 1cm incision is made near the umbilicus and the telescope is introduced. The whole of peritonea cavity is magnified (X10) and visualized. The anatomy of the uterus/tubes and ovaries is analyzed in detail. The patency of the tube is assessed by instilling a dye, methylene blue, through the cervix. The spill from the peripheral end of the tube will confirm patency.

Preeclampsia occurs only during pregnancy and in the postpartum period. It affects both the mother and the unborn baby. Preeclampsia is usually silent and can advance rapidly, it shows up very unexpectedly during a routine blood pressure check and urine test. It is usually diagnosed by high blood pressure and the presence of protein in the urine. High blood pressure is a silent killer. Many signs and symptoms of preeclampsia are similar to other "normal" effects of pregnancy on your body. Often, women diagnosed with preeclampsia do not feel sick.

Symptoms include:

• Swelling
• Sudden weight gain
• Headaches and
• Changes in vision

However, some women who have rapidly advancing preeclampsia have very few symptoms.

Risk factors include:

• Previous history of preeclampsia
• Family history of preeclampsia (mother, grandmother, aunts, sisters)
• History of high blood pressure, diabetes or kidney disorders
• Body Mass Index greater than 30%
• Age over 40 or under 18
• Poly Cystic Ovarian Syndrome (PCOS)

Diagnosis and Management

Proper prenatal care is required to diagnose and manage preeclampsia. Preeclampsia, toxemia and Pregnancy Induced Hypertension are linked. Preeclampsia normally occurs in the middle to late stage of pregnancy, after 20 weeks of gestation. If it is detected and the baby is over 36 weeks then the baby is delivered and the mother is monitored before being sent home. In cases like this, if the baby is near term (after 36 weeks) the baby is induced, delivered and the mother watched and sent home as usual.

Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. Particularly after 20 weeks--do not miss your prenatal appointments. Like in any other pregnancy, eat healthy. A good prenatal diet full of vitamins, antioxidants, minerals and the basic food groups is essential. Cutting down on processed foods, refined sugars, and stopping coffee, tea, alcohol and any medication not prescribed by a physician is essential. We also advise you to consult your physician before taking any supplements, even herbal or if you have any questions related to preeclampsia.

Intrauterine insemination is also called artificial insemination, or IUI. The rational of Intra Uterine Insemination (IUI) is to reduce the effects of factors like cervical mucus, hostility and vaginal acidity that impede the progress of spermatozoa and to deposit a bolus concentrated, mobile, morphologically normal spermatozoa as close to the oocyte as possible.

An IUI procedure can be an effective treatment for some causes of infertility in women under about age 41. However, it is not effective for couples with:

• Tubal blockage or severe tubal damage
• Ovarian failure (menopause)
• Severe male factor infertility
• Advanced stages of endometriosis

For all other couples, before this is done, the couple should be fully evaluated including complete medical history, clinical examination and investigation for the presence of tubal damage or ovulatory disorder.

Counseling

The person or organization performing the procedure should at minimum counsel the patients on the process of ovulation induction, success rates, complications and the costs involved with the treatment options.

If a donor sperm is used then the couple should not only be assured that they will remain confidential but also should be informed of the means by which a donor is selected and screened.

Indications for insemination with the partners semen

• Ejaculatory failure – Impotence; spinal cord injury
• Mild male sub-fertility
• Cervical factor poor cervical mucus
• Immunological infertility
• Unexplained infertility
• Ovulatory dysfunction

Indications for using donor sperm

• Gross male subfertility – Azoospermia
• HIV infected male
• Genetic disease in male
• Severe rhesus incompatibility

Steps in the IUI

• Ovarian stimulation
• Monitoring follicular growth and endometrial development
• Timing of IUI
• Sperm preparation
• IUI with prepared sperm

Ovarian Stimulation

Done with clomiphene alone or clomiphene and gonadotropins. Super ovulation is used to increase the number of oocyte available with ovarian stimulation. The success rate is increased compared to natural cycles.

Timing of insemination

When the lead follicle reaches 18-20 mm, HCG is administered. Follicle ruptures 34 – 36 hrs after HCG and IUI is done at this time.

Sperm preparation

Is done using density gradient technique. The idea is to get a large number of morphologically normal motile spermatozoa in a small volume of culture media free from seminal plasma, leucocytes and bacteria. Insemination is carried out under aseptic conditions.

Success rate

The overall success rate per cycle is around 15%. Success rates depend on the cause for infertility. In patients with male factors success may be as high as 21%. The success depends on the age of both partners, duration of infertility and sperm parameters. The NICU fertility guidelines in UK advocate up to six cycles of IUI

Complications

Uterine contractions, intrauterine infection and anaphylaxis may occur rarely. Ovarian hyper stimulation syndrome or multiple pregnancies may also occur.

“Amma” (mother) - There is no word that is more nourishing to the ears of a woman. Motherhood is a rare opportunity gifted for a woman by nature. But there are so many unwanted tales and stories in the community to disgrace this gift of nature. Many mothers think Pregnancy is a horrible experience by believing these foolish tales.

There is no doubt that motherhood is not an easy task. There are a lot of problems for a woman while carrying the fetus in womb for 10 months such as facing many changes in lifestyle, food habits and body language. But delivery is a great experience for a woman.

We have in the past, elaborately analyzed problems in woman like Antenatal care, Hypertension, Downs Syndrome, Excessive bleeding during menstruation, Menopause, Cancer of Uterus, Diagnostic Laparoscopy, etc. Let us analyze what is infertility in the next few articles.

“Motherhood” – is an applauding word for a married woman. There are a lot of physical, mental, and spiritual problems for a woman who is not able to deliver a child. But by nature the failures can be attributed to women 40% of the time, men 40% of the time, to both 10% and other external factors for the remaining. The level of infertility is such that there are effects on fertilization in 1 out of every 6 married couples.

If a woman does not conceive within 1 year after marriage and if either of the couple is aged and she does not conceive within a year, they should approach a reputed hospital. They will conduct necessary tests to find out the reasons for failures. We will address in a later article on what to look for if you need to choose an infertility treatment center. There are many centers that have cropped up over the years but only a few are fully equipped.

Implantation anywhere else other than the uterus is Ectopic Pregnancy. The incidence rate is 1%, 95% of ectopic pregnancies involve the Fallopian tube. It can also be in the cervix, ovary or rarely even in the spleen, liver, etc.

Causes for increased incidence of Ectopic:

• Increased prevalence of sexually transmitted infection
• Tubal sterilization or tubal surgeries
• Increased abortions
• ART procedures

Risk factors for Ectopic Pregnancy:

High Risk

• Tubal corrective surgery
• Tubal sterilization
• Previous ectopic pregnancy
• Intrauterine device
• Documental tubal pathology

Moderate risk

• Infertility
• Previous genital infection
• Multiple partners

Those with previous pelvic or abdominal surgery or smokers have more risk of ectopic.

Natural history of tubal pregnancy:

Tubal abortion : All the products are extruded from the tube into peritorial cavity. Sometimes blood may collect within the tube or there may be slow trickling of blood into the abdomen.

Tubal rupture: Time of rupture depends on the site of implantation

Abdominal Pregnancy: If only the fetus is extruded at the time of rupture and placenta retains attachment to the tube and implants on surrounding structures

Heterotypic Ectopic Pregnancy : When tubal pregnancy is accompanied by consisting intrauterine gestation

Symptoms (After a period of amenorrhea)

• Severe lower abdominal pain
• Vasomutor disturbance synopse
• Vaginal bleeding – scanty dark brown

Diagnosis:

• USG TAC / TVS empty uterus with adnexal mass
• Severe Beta HCG

Treatment

Expectant Management – If patient is stable and Beta HCG values are falling.

Medical Management - If patient is stable; gestational age < 6 weeks and gestational sac < 3.5cm and Beta HCG is < 15000 miu. Success rate is 90% to 95%

Surgical Management – If patient is haemodynamically unstable laparotomy or laparoscopy. During surgery the tube may be removed (salphingectomy) or an incision put over the tube and products removed (salphingectomy).

Motherhood brings immense pleasure in every woman’s life. There are various physiological changes that occur in a woman during pregnancy. These physiological changes are essential for continuing pregnancy to term and for maternal and fetal wellbeing. One such important change is insensitivity of the blood vessels to pressor substances and vasodilatation which occurs at around 16-18 weeks of pregnancy. This change is essential for providing adequate blood supply to the growing fetus. On the contrary for reasons unclear, some women develop vasospasm instead of vasodilatation leading on to Gest. HT.

Although the consequences of gestational HT can’t be fully prevented, the maternal and fetal complication due to gest HT can be easily prevented or tackled with.

What is Gest. HT?

When the Blood Pressure in a pregnant woman is more than 140/90mmHg on two separate occasions, 6 hrs apart after 20 weeks of pregnancy, it is called as gest HT.

• When gestational HT is associated with protermuria (passing proteins in urine) it is called per-eclampsia .
• When gest HT is as with seizure it is called as eclampsia.

Incidence of Gest. HT is 5-10%

Risk Factor:

• Primigravida (woman pregnant for the first time)
• Pregnancy at ages < 18yrs > 35yrs.
• History of Gest.HT in previous pregnancy.
• Low socio-economic status.
• Multiple pregnancy
• Molar pregnancy
• Those with increased tendency for blood clotting (Thrombophilias)
• Obesity
• Smoking

How to diagnose high B.P?

Early diagnosis of gest HT is possible with regular antenatal check up

• B.P measurement during each antenatal visit
• Protermuria > 300mg/l in 24hrs or 1g/l in random sample

Do’s and Dont’s for a patient with Gest HT

• Regular antenatal check ups
• Regular intake of anti-hypertensive drugs as prescribed by the doctor
• Regular scans to assess fetal wellbeing

Danger signs

• Headache
• Blurring of vision
• Chest pain
• Swelling of the legs
• Vomiting
• ⇓fetal movements
• Pain abdomen and bleeding pelvic

If these signals are encountered, immediate medical consultation is required.

Complications of Gest HT

• Eclampsia
• Bleeding within the brain (Cerebral Haemorrhage)
• Heart failure
• Liver dysfunction
• Decreased platelets in blood (Thrombocytophilia)
• Abnormal blood coagulation (DIC)
• Kidney failure
• Intrauterine fetal death
• Placental separation before delivery (Abruption)
• Decreased fetal growth (IUGR)

Nutrition and rest in Gest. HT Patients

• Diet should be rich in green leafy vegetables and high in protein
• Avoid excessive salt intake
• Calcium, Vitamin C, E, Fish oil supplementation helps in gest .HTn.
• Adequate rest in left lateral position for 2 hours in the day and 8 hrs in the right is necessary to improve placental circulation.

Antenatal Care:

• Obstetric consultation as soon as pregnancy is confirmed or around 6-8 weeks (in patient with previous history of Gest HTn)
• EP Scan for FH documentation
• 20-24 weeks Target scan to r/o anomalies and for uterine artery dopler
• USG at regular intervals for fetal growth monitoring
• Delivery in institution

The Blood pressure usually returns to normal after delivery within 6 – 8 weeks. Thus Gest HT is a disease which can be properly managed with early diagnosis and regular follow up.

Every woman in her reproductive age group sheds some amount of blood during menstruation. If bleeding during menstruation is excessive, it curbs her physical activity and leads to many problems.

How does menstruation occur?

Every month, ovary produces many follicles out of which a dominant follicle grows under the influence of pituitary hormones and releases an oocyte. When there is follicular growth, hormones like estrogen and progesterone are produced which helps in building up the endometrium. At the end of the cycle, there is abrupt withdrawal of hormones and this makes the endometrium shed and this is revealed as menstruation.

Normal menstruation

Average duration 28-30 days
Sometimes as frequent as 21 days or as long as 35 days
Duration of flow 2-7days
Amount of Flow – 10 to 80 ml
If there is flow >7 days or excessive flow with passage of clots, we term it menorrhagea

Cause for excessive bleeding during menstruation:

• Around the time of puberty due to inadequate menstruation of hypothalomopitutary axis. The rhythm is set by 2 years.
• Fibroid uterus
• Endometrial hyperplasia or polyp
• Hormonal imbalance (DVB)
• Thyroid disorders
• Systematic disorders like hypertension, diabetesmellitus, overweight
• Pelvic inflammatory disease
• Uterine malignancy
• Vascular malformation
• Coagulation disorders

Sequel of excessive bleeding

• Generalized weakness
• Giddiness
• Anaemia

Investigations for excessive bleeding

• Haemoglobin to find the degree of anaemia
• Thyroid hormones
• Coagulation profile
• Check blood pressure, blood sugar
• Ultrasound to rule out anatomical problems

With these basic investigations, one might be able to find out a definitive cause and treat accordingly.

So excessive bleeding during menstruation is not a problem to be ignored but should be consulted with a Gynecologist for an appropriate remedy.

Antenatal care is the care of the women during pregnancy. The primary aim of antenatal care is to achieve at the end of the care, a healthy mother and a healthy baby. Ideally, this care should begin soon after conception and continue throughout the pregnancy.

In any couple planning to have a pregnancy the risks of the fetus are to be considered. This is important because 2% of the newborns have major malformations, about 1% has single gene disorders and nearly 1% will have mental subnormality. It is also observed that 60% of the abortuses have chromosomal anomalies, a gene disorder commonly known as Down’s syndrome. Prenatal care thus includes diagnosis and management of birth defects as well.

What is Down’s syndrome?

At the time of conception a baby inherits genetic information from its parents in the form of 46 chromosomes. 23 from mother and 23 from the father. In most cases of Down’s syndrome, a child gets extra chromosomes 21 for a total of 47 chromosomes instead of 46. It’s this extra genetic material that causes the physical features and developmental delays associated with Down’s syndrome. Your doctor or a genetic counselor can help you to sort through the pros and cons of each.

Screening and diagnostic tests:

Nuchal translucency test is an ultrasound performed between 11 and 14 weeks of pregnancy to detect any neural tube defects or fetal anomalies.

Blood tests such as karyotyping, triple screening tests could be performed to detect any fetal anomalies. Amniocentesis is one such diagnostic test to detect abnormalities in the genetic material inside the fetus’s cells. Prenatal tests such as chronic villi sampling, percutaneous umbilical blood sampling could also detect genetic abnormalities in a fetus.

If any of these tests show that the fetus has a birth defect, then doctor may recommend you to see a genetic counselor, who can determine how severe the problem is and help you decide whether or not to terminate the pregnancy, or help you make preparations to take care of the child with special needed.

Although some of the physical genetic limitations of Down’s syndrome cannot be overcome, education and proper care will improve the quality of life. The incidence of Down’s syndrome is estimated at one per 800 to one per 1000 births.

Seeking counseling, participation in a support group of other parents who have a child with particular disorder and relying on relatives and friends can help you cope. Physical, occupational and speech therapists and early childhood educators can work with your child to encourage and accelerate development.