Normal & High Risk Pregnancy
The Services / Treatments provided in pregnancy are
- Antenatal Care
- Painless delivery and scarless caesarean births
- Obstetrical emergencies like High Risk and complicated pregnancy, Ectopic pregnancy, Prolapsed cord, Pre-eclampsia, Placental abruption, Uterine rupture can occur during obstructed labour and endangered foetal and maternal life.
- Medical disorders with pregnancy like Diabetes, Jaundice, Thyroid disorders, severe anaemia, kidney disease, dengue fever, cardiac disease etc.
- Labour Care like continuous foetal monitoring and interventional techniques.
- Comfort techniques and preparation exercises.
- Pregnancy, labour and postpartum care.
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Neonatal and Post Natal care under the expert care of child specialist.
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Prenatal care: This includes routine office visits with physical exams and routine lab tests and specialized tests like Complete blood count (CBC), Blood type, General antibody screen Rh incompatibility, Hepatitis B surface antigen, HIV screen etc. Along with dietary advice, physical activity and counselling is done for problems.
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Normal vaginal delivery: It is the natural way of birth through the vaginal canal. It is the default method of delivery of the baby for all women unless there is a contraindication. We encourage women to experience a normal vaginal delivery because it has many advantages, like less pain after the delivery, quicker recovery and less hospital stay. Also most mothers have a sense of accomplishment after a normal delivery. All women get counseling about labor and its stages and are educated so that they know what to expect when the time comes.
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Caesarean Section: Caesarean section is the delivery method of the baby through a surgical incision in the mother’s abdomen and uterus. A C-section is often performed in circumstances that would put the fetus or the mother at risk. When there is a known contraindication for vaginal delivery then the C- section can be scheduled for approx. 38 weeks. Usually, it is performed under spinal anaesthesia so that the mother can be awake and experience the birth of her baby. Caesarean section has been optimized over the years and complications from this type of surgery have been significantly decreased. An incision is performed (approx. 12cm long) bellow the “bikini” line and a low transverse incision is done on the uterus in order for the baby to be delivered. All the layers are meticulously re-approximated and the patient is transferred to the recovery room. The duration of the procedure is about 30-40 min. C- section is a safe alternative method of delivery when the vaginal approach is not feasible or when there is a risk for the baby or the mother.
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Induction of Labor: Induction of labor is an artificial start of the labor process through medical or other intervention in order achieve a normal vaginal birth. Induction of labor is performed when prolongation of the pregnancy is considered risky for the mother or the fetus. It is not always successful (i.e. lead to vaginal birth) as this depends on many factors, like the softness or opening of the cervix, shape of bony structure of pelvis, the parity of the mother and others.
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Episiotomy: Sometimes the obstetrician might need to make a cut in the area between the vagina and the anus (perineum) during the last stages of labour. This is called episiotomy and makes the opening of the vagina wider in order to facilitate the delivery and avoid uncontrolled rupture of the area. Local anaesthesia is given before an episiotomy is performed so that the patient will not feel any pain, then after the delivery the episiotomy is repaired. The pain during recovery from the episiotomy usually dissipates within the following 2-4 weeks. Only 1% of the women continue to experience pain that interferes with their day to day activities and quality of life.
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Cord clamping: Instead of immediate clamping and cutting of the umbilical cord, it seems that delayed cord clamping has significant benefits. Improving transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion and lower incidence of necrotizing enterocolitis and interventricular haemorrhage. There are tough situations that delayed cord clamping cannot be performed like when immediate infant resuscitation is needed or maternal haemorrhage occurs.
Ten tips for a healthy pregnancy
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Tip 1: Eat five to six well balanced meals a day. Due to hormonal changes in the body pregnant women cannot eat heavy meals, therefore splitting the food into small portions. Eat well – balanced diet, paying attention to the recommendation of the food pyramid. Drink more milk, foods that substitute for milk. Drink 8-10 glasses of liquid per day. Eat a little extra protein. Take several servings of fresh fruits and vegetables every day. Vegetable and fresh fruit juice also will help to reduce the oxidative stress.
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Tip 2: Take iron, calcium, folic acid, vitamins and minerals. Whole grains, green leafy, other vegetables and nuts are good. Take a prenatal vitamin each day as directed by obstetrician.
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Tip 3: Drink plenty of liquids, at least eight to ten glasses a day. If mouth and lips are dry, drink more liquids. This tip for healthy pregnancy is useful to help overcome constipation, digestion problems and to reduce oxidative stress.
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Tip 4: Stay active. Practice yoga, meditation or deep breathing exercises. Try 30 minutes of exercise at a moderate pace on most days. Walk in cool, shaded areas or indoor in order to prevent overheating.
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Tip 5: Try to minimize the stress in life during pregnancy. Stress management techniques such as slow deep breathing and relaxing various muscle groups will help pregnant woman when she feels she is under stress.
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Tip 6: Avoid substances that are dangerous for the pregnancy and the baby. Don’t take any medicines, even over the counter medications during pregnancy. Avoid caffeine intake and artificial colouring agents and sodas.
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Tip 7: Get plenty of rest. Get adequate sleep atleast eight hours in the night. If there are sleep disturbances during the night, try to take naps during the day.
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Tip 8: Wear comfortable, non restricting shoes and put feet up several times a day to prevent fatigue and swelling of feet, legs and ankles.
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Tip 9: Visit the doctor atleast once in a month after getting pregnant initially. There on from 2nd and 3rd trimester, make it a point to visit the doctor upon advice (say once in 15 days or week). Never neglect a doctor’s appointment. Take necessary medication and injections (immunizations) as suggested by health care provider.
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Tip 10: Message to the pregnant women. Enjoy this special time in life! Your partner, your family and friends can help make the most of this wonderful transition. Have confidence in your body’s ability to grow, nourish, and give birth to this baby.
Post Pregnancy Weight Loss
It is recommend that healthy weight loss is about 0.5 to 0.75 kg per week. To lose one pound (appr. half kg) per week, you need to create a deficit of 500 calories per day (either through diet or exercise) with a proper post pregnancy weight loss plan with the guidance of dietician. Crash diets is not recommended at all.
Breast feed
Yes, breast feeding is great not just for your baby, but also for you to lose weight! It provides essential nutrients for the baby, and since its providing it from the mother’s body, it increases your calorie expenditure, thus helping weight loss!
High Risk Pregnancy
A pregnancy is characterized High Risk when it carries an increased risk for maternal and/or fetal health problems. Common conditions that make a pregnancy high risk is Hypertension, Diabetes, obesity, multiple gestations, advance maternal age etc. Women with high risk pregnancies should receive care at more frequent visits, sometimes from a special team of health providers and have more frequent fetal well-being tests. Usually HR pregnancies are followed more closely after 28 weeks and have more restrictions in order to carry their infant closer to term.
BPP (Biophysical Profile)
BPP (Biophysical Profile) is a test performed with an ultrasound machine and measures your baby’s movement, muscle tone, breathing movements and amniotic fluid. This test is designed to detect fetal stress. A perfect score means that the baby is having a good time in the uterus. Sometimes BPP is combined with NST.
Recurrent Pregnancy Loss
What is recurrent pregnancy loss?
Recurrent pregnancy loss is said to occur when woman has two or more miscarriages. After three repeated miscarriages, a thorough physical exam and testing are recommended.
What are the common cause of miscarriage?
Most miscarriages can occur randomly when an embryo receives an abnormal number of chromosomes during fertilization. This type of genetic problem happens by chance and there is no medical condition that causes it. However, it becomes more common when the age of woman is more than Thirty Five years.
What are the various reasons for having recurrent pregnancy loss?
The various reasons can be as under
- Genetic Causes: In a small number of couples who have repeated miscarriages, one partner has a chromosome in which a piece is transferred to another chromosome. This is called a translocation. People who have a translocation usually do not have any physical signs or symptoms, but some of their eggs or sperm will have abnormal chromosomes. If an embryo gets too much or too little genetic material, it often leads to a miscarriage.
- Congenital Anatomical Problems with reproductive organs: Certain congenital problems of the uterus are linked to repeated miscarriages. Although there are many such disorders, one of the most common that has been associated with miscarriage is a septate uterus. In this condition, the uterus is partially divided into two sections by a wall of tissue.
- Asherman syndrome, in which adhesions and scarring form in the uterus, may be associated with repeated miscarriages that often occur before a woman even knows she is pregnant. Fibroids and polyps, which are benign (noncancer) growths of the uterus, also may play a role in recurrent pregnancy loss.
- Medical Problems: Women who have certain medical conditions may have an increased risk of repeated miscarriages like
- Antiphospholipid syndrome (APS) is an autoimmune disorder in which a person’s immune system mistakenly makes antibodies to certain substances involved in normal blood clotting. APS is associated with repeated miscarriages and fetal deaths.
- Diabetes mellitus. In this disease, high levels of a sugar called glucose are present in the blood. Women with diabetes, especially those in whom the disease is poorly controlled, have an increased risk of pregnancy loss.
- Women with a condition called polycystic ovary syndrome also have an increased risk of miscarriage.
- Thyroid Disorders: Undiagnosed thyroid disease is one such problem linked to miscarriage in some studies. Given that the symptoms of thyroid disease are often less than obvious, many women with recurrent miscarriages might have an untreated thyroid condition.
- Hyperprolactinemia may lead to recurrent miscarriages
Investigations:
Detailed Clinical history, A complete physical exam, including a pelvic exam, blood tests may be done. Testing may be done to help detect genetic causes of repeated miscarriages. Imaging tests may be considered to find out if a uterine problem is causing repeated miscarriages.
Treatment:
If a specific cause of repeated miscarriages can be identified as under
- Genetic abnormality: Doctor may suggest a treatment is given according to that issue in case of a chromosome translocation, genetic counselling may be recommended. Results of genetic testing can help clarify your options. In vitro fertilization with special genetic testing called preimplantation genetic diagnosis may be done to select unaffected embryos.
- Anatomical defects of reproductive organs: Corrective surgery may be able to increase the chances for a successful pregnancy. For example, a septum in the uterus can be removed.
- For antiphospholipid syndrome: Use of a medication that prevents blood clots, such as heparin, sometimes combined with low-dose aspirin, may be prescribed throughout pregnancy and for a few weeks afterward. This treatment can increase the rates of successful pregnancy in women with this condition.
- Treatment of medical disorders like Diabetes, Thyroid Disorders and genital infection etc.
