Pregnancy/Maternity

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When a woman is expecting a baby, both mother and child need special care before, during and after birth. Pregnancy and maternity care are focused on ensuring that the mother and child are healthy. Reducing and risks during pregnancy and having a safe delivery.

Regular check-ups to identify and possible problems and recommendations about healthy lifestyle choice are an integral part of pregnancy and maternity care.

Maternity Journey:

Deciding to have a baby is one of the most important decisions in the life of a woman, as well as the family. There are many reasons why you will need the best doctors and medical care. An expectant mothers’ body is a whirlwind of hormon al and physical changes which requires careful monitoring and care at each stage, not forgetting the care and monitoring for the ‘little miracle’ rapidly growing inside.

Risk Factors

Pregnancy in itself puts the mother through stress due to the natural ch anges. However, some pregnancies maybe riskier than other. This is dependent on the mothers pre-existing health

• Pre- existing medical conditions, especially high blood pressure, diabetes, or autoimmune disorders, liver/ kidney diseases, infections, etc.

• Overweight and obesity increase the risk of complications during pregnancy and childbirth.

• Multiple pregnancies – twins or higher order pregnancies.

• Maternal age – lesser than 20 years or above 35 years poses risk to the mother.

• Previous bad obstetric history.

Signs & Symptoms:

Once you test positive for pregnancy, you require antenatal check-ups at regular intervals. These are necessary even if no problems are suspected. During these antenatal visits to your obstetrician, the doctor will monitor your health and your baby’s development, prescribe nutrition or supplements.

In addition to these routine antenatal visits, you should contact your doctor if you notice any of the following:

• Vaginal bleeding.

• Excessive nausea or vomiting.

• High fever.

• Vaginal discharge or itching.

• A burning sensation when passing urine.

• Severe pain in the leg or head.

• Flare up of existing conditions such as blood pressure, asthma or thyroid disorders.

Diagnosis:

During your antenatal check-ups, your obstetrician will check for any possible complications such as anaemia, gestational diabetes, high blood pressure, fetal health issues. Your doctor will conduct physical exams, and suggest blood tests or ultrasound exams, as necessary.

We offer 4 routine scans to every pregnant woman who consults us:

1. Early obstetric scan/dating scan :

This scan is done to know the single/multiple pregnancy, Gestational Age, Intrauterine /Ectopic Pregnancy, Subchorionic Hemorrhage

2. 11- 14 weeks scan (FTS) during the first trimester :

This is a critical period, marked by rapid changes for both you and your baby. These scans help doctors rule out Down syndrome, anencephaly, cleft lip, abnormal placenta function and other abnormalities in the fetus. These scans reveal the age of the baby and if there are multiple pregnancies. Meet your doctor to understand what to expect and what to be careful about.

You need to take extra care because the pregnancy is very fragile. Morning sickness is at its worst during the first trimester and sometimes there is loss of appetite accompanied by an aversion to certain smells or food. Your breasts will feel tender and swollen and as the pregnancy progresses you may feel out of breath sometimes as the baby pushes up into your lung space.

3. 18 – 22 weeks (Anomaly /level 2/target scan) during the second trimester.

These scans check the health and position of the placenta, liquor level and baby’s growth. This is the best period of pregnancy. For most women the symptoms of morning sickness go away and they are restored to their former energetic selves. Your nipples turn dark and you experience itching and stretch marks.

Regular visits to your doctor remain important during the second trimester. Share all your anxieties and apprehensions with your doctor so he may be ab le to assist you. Your doctor will monitor your baby’s heartbeat using Doppler ultrasound test.

4. 28 – 35 weeks (growth scan) during the third trimester.

The growth scan is done primarily to check the speed of growth, fetal heart rate and measurements that denote proper growth. This is a difficult time as you may experience back pain, leg cramps, heartburn, hemorrhoids, swollen ankles, warm body temperature, and tiredness. Consult your doctor if you have excessive ankle swelling.

You will feel your baby move and kick, it’s a great time of joy and exhilaration! Continue to visit your doctor regularly and learn how to smoothly manage the final stages of your pregnancy. At any time if you experience symptoms of severe abdominal pain, significant bleeding or extreme dizziness, call your doctor immediately.

Treatment Options:

• Your obstetrician may prescribe certain nutritional supplements for overall health. Or if you have a specific condition such as anaemia, you may be asked to take iron and folic acid supplements.

• If the baby’s development is not as expected, then you will be given special care, such as bed rest, or if necessary, an early delivery.

• Conditions such as gestational diabetes or high blood pressure will be controlled by medications.

• A few conditions, such as placenta previa, require bed rest.

• In case preeclampsia is diagnosed, hospitalisation may be necessary.

• In case the delivery happens before the full term, both mother and baby will need special care.

Premenstrual Syndrome

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What is premenstrual syndrome or PMS?

Premenstrual syndrome (PMS) is a combination of changes that many women experience about a week or two before their period. PMS symptoms include physical changes, such as acne, feeling bloated, and tiredness, as well as emotional or mood changes. PMS affects different women in different ways and may cause mild to severe discomfort. The symptoms usually disappear once the period starts.

Regular check-ups to identify and possible problems and recommendations about healthy lifestyle choice are an integral part of pregnancy and maternity care.

Possible Causes:

Most women notice some changes before their period starts. But for some, these changes cause discomfort and affect their daily life and routine. If you find pre - menstrual changes hard to deal with, you could see a doctor for your Premenstrual Syndrome (PMS).

PMS could be caused by the hormonal changes during your period. Fluctuations of a brain chemical called serotonin may also cause PMS.

Risk Factors:

Certain factors increase your risk of having PMS:

• A personal history or family history of depression or mood disorders.

• A family history of PMS.

• Smoking.

• Alcohol consumption.

• Any physical or emotional trauma you have suffered.

Signs & Symptoms:

The symptoms of PMS include physical as well as emotional or behavioural ones:

• Pain or bloating in the abdominal region.

• Constipation or diarrhoea.

• Sore breasts.

• Acne.

• Fatigue.

• Feeling irritable, anxious, depressed or over-sensitive to light or sound.

• Changes in sleep patterns.

• Food cravings, usually of sweets.

Diagnosis:

Your gynecologist will discuss your symptoms. PMS will be identified if you have more than one symptom and recurring. The timing of the symptoms will also help to establish whether they are related to PMS, as these typically disappear when your period starts. Your doctor may need to rule out other conditions that manifest in similar symptoms.

Treatment Options:

Your gynecologist may prescribe medications to reduce your PMS. Depending on your symptoms and diagnosis, these medications could include painkillers, antiinflammatory drugs, antidepressants or diuretics, which help you to shed excess fluid. In some cases, hormonal contraceptives may be prescribed , to stop ovulation and give relief from PMS.

Maternal Fetal Medicine

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What is maternal fetal medicine?

Maternal fetal medicine (MFM) is the special care of a pregnant mother an d baby before birth. Maternal fetal medicine specialists recommend screening tests to check that the baby and mother's health parameters are as they should be. If any irregularities are detected, they are treated. Maternal fetal medicine also includes the care of women who have high-risk pregnancies.

Possible Causes:

Maternal fetal medicine (MFM) refers to the care of the bab y inside the mother’s womb. A fetal medicine specialist recommends screening tests to rule out abnormalities which may be related to growth, genetics, high blood pressure etc. He assesses the environment in which the fetus is growing, diagnoses and manages irregularities related to the growth and structure of organs.

MFM specialists are trained to handle high-risk pregnancies. A high-risk pregnancy may be due to:

• Pre-existing health conditions of the mother, such as diabetes, hypertension, kidney disease, autoimmune diseases and infectious diseases.

• Placenta problems.

• Weakening of the cervix.

• Mother’s age over 35.

• Fetal problems such as heart defects or others.

• More than one fetus.

Risk Factors:

You may need a MFM specialist if:

• You are expecting more than one baby.

• You had any of these conditions before becoming pregnant – heart disease, high blood pressure, diabetes, autoimmune conditions, blood clotting disorder o r certain infections.

• You had complications during a previous pregnancy.

• You may also need an MFM specialist if any pregnancy or fetal problems are noticed.

Signs & Symptoms:

Some of the signs and symptoms that will need the attention of MFM specialists include:

• Amniotic fluid complications – too little or too much fluid in the sac around the fetus

• Vaginal bleeding.

• Placental complications.

• Any potential fetal abnormality suspected.

Diagnosis:

There are a number of tests used by MFM specialists to monitor the health of the mother and development of the fetus. Every pregnant woman is offered 3 routine scans:

• 11- 14 weeks scan (NT Scan +Double marker test)

• 18 – 22 weeks (Anomaly/level 2/target scan/TIFFA Scan + Quadruplet marker test)

• 28 – 35 weeks (growth scan)

These scans help doctors diagnose Down syndrome, abnormal placenta function and other abnormalities as early as 11-14 weeks in the fetus. It also estimates the age of the baby and if there are multiple pregnancies. The scans during the second trimester check the health and position of the placenta, liquor level and baby’s growth. In the third trimester the growth scan is done primarily to check the growth velocity, fetal heart rate and measurements that denote proper growth.

The other tests and scans include:

• Amniocentesis.

• Chorionic villus sampling (CVS).

• Fetal blood sampling and intrauterine transfusion.

• Fetal echocardiogram.

• Fetal magnetic resonance imaging (MRI)

• Genetic testing.

• Ultrasound and Doppler ultrasound.

Treatment Options:

Pregnancies with complex problems are usually handled by a multi-disciplinary team, made up of MFM specialists, as well as specialized fetal surgeons and experts in treating children with congenital conditions.

Treatment options depend on the nature of the complexity and may include treatment to be administered to the uterus as well as fetal surgeries or interventions.

Uterine Fibroids:

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What are uterine Fibroids?

Uterine fibroids are growths on the uterus that women in the childbearing age group sometimes get. These are not cancerous and do not increase the risk of getting uterine cancer. The fibroids vary in size and there may be one or multiple. Many women have uterine fibroids at some time in their lives, and may not know about them, as they do not always cause any symptoms.

Possible Causes:

Uterine fibroids are benign growths which may appear in your uterus, uterine wall, or on its surface. They are made up of muscle and connective tissue. Fibroids may grow as a single nodule or in clusters and may range in size from 1 mm to more than 20 cm in diameter.

The exact causes of fibroids are not known yet, but two factors probably contribute:

• Hormones: Oestrogen and progesterone seem to affect fibroid growth. When hormone production reduces, with menopause, fibroids usually shrink.

• Genetics: Research has found genetic differences between fibroids and normal cells in the uterus.

Risk Factors:

A number of factors increase the risk of developing uterine fibroids:

• Age: The risk of developing uterine fibroids is higher among women of childbearing age - generally between 30 and 40 years old.

• Obesity.

• Nulliparous Women i.e. women who have never conceived.

• Diet: Not eating enough green vegetables, fruit, or dairy products but eating excess of red meat.

Signs & Symptoms:

Some fibroids may not cause any symptoms and discomfort, so you may discover that you have them only due to a routine exam or ultrasound.

Sometimes fibroids cause symptoms, such as:

• Heavy and/or painful periods.

• Bleeding between periods – intermenstrual bleeding.

• Mass/Swelling felt per abdomen.

• Urinary symptoms like difficulty in passing urine.

• Painful intercourse.

• Miscarriages or infertility

Diagnosis:

Fibroids are often discovered when the gynaecologist conducts a pelvic exam, as the shape of the uterus may have changed. Your doctor will recommend other tests in order to get more information.

These tests could be:

• Ultrasound – to determine the number, size and location of fibroids.

• Blood tests – specially to rule out anaemia due to prolonged heavy blood loss.

• MRI.

Treatment Options:

You may not even know that you have uterine fibroids because they often don’t show any symptoms. Treatment plans are based on the number, size, and location of the fibroids, their symptoms, and your plans for future pregnancies.

• If your menstrual cycle is irregular or you experience heavy menstrual bleeding and pelvic pressure, your gynaecologist may put you on a course of medications.

• Other minimally invasive procedures such as laparoscopic myomectomy & hysteroscopic myomectomy are commonly practised.

• Traditional surgical procedures such as abdominal myomectomy or hysterectomy may be necessary in some cases.

• Hysterectomy ends your ability to bear children, so your doctor will discuss your fertility options before suggesting a treatment plan.

Medications usually don't eliminate fibroids but may shrink them. However, on discontinuation of hormonal therapy they may grow again.

Polycystic Ovarian Syndrome

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What is Polycystic Ovarian Syndrome or PCOS?

Polycystic ovarian syndrome or PCOS is a hormonal disorder that often afflicts women of reproductive age. This condition makes it difficult to conceive and causes periods to be irregular. Some women get acne or increased facial hair.

As PCOS increases the risk of other health problems, such as diabetes and high blood pressure, it is important to get the right advice. Women with PCOS can conceive with the right treatment.

Possible Causes:

PCOS is a hormonal disorder in women which leads to irregular periods, infertility and increased levels of androgen, the male hormone. Many patients with PCOS may suffer from obesity, obstructive sleep apnea, mood disorders, heart disease, high levels of insulin, and may develop insulin resistance.

While the exact PCOS causes aren’t known, some contributing factors that are suspected are:

• Excess insulin. If cells become resistant to the action of insulin, then blood sugar levels can rise, and the body might produce more insulin. This might increase the androgen levels, which disturbs ovulation.

• Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens.

• Heredity.

• Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

Risk Factors:

There are some factors that increase the risk of PCOS:

• Heredity – a familial predisposition.

• Stress may be both a symptom as well as a contributing factor to PCOS.

• Insulin resistance, which increases androgen levels.

• Overweight and obesity.

• Women with sleep apnoea may be at a higher risk.

Signs & Symptoms:

A PCOS symptoms checklist is:

• Irregular periods, usually delayed cycles followed by heavy and prolonged bleeding

• Polycystic ovaries which means ovaries might be enlarged and contain multiple follicles.The ovaries may develop cysts and fail to regularly release eggs.

• Excessive hair growth (male pattern), acne, hair loss on the scalp.

Diagnosis:

If your gynaecologist suspects PCOS, a pelvic exam to check for masses and growths would be conducted. Blood tests could be advised in order to check the levels of hormones. An ultrasound exam to check the ovaries and uterus may also be required.

Regular testing of blood pressure, sugar and cholesterol may also be necessary.

Treatment Options:

At CDR Hospital, PCOS treatment focusses on managing the specific concerns of the patient – whether infertility or acne or obesity.

• If you have PCOS and are overweight, losing weight and eating a healthy, balanced diet can reduce the symptoms.

• Symptoms like irregular periods, fertility problems or excessive body hair are treated with medications. If you are not able to conceive, then your gynaecologist will decide on further management after thorough evaluation of both partners.

• A simple surgical procedure called laparoscopic ovarian drilling (LOD) may be recommended which involves using heat or a la ser to destroy the tissue in the ovaries that's producing androgens, such as testosterone