Month: May 2022

Umbilical cord prolapse: Causes, Diagnosis and Management

Posted on May 17, 2022   by   - Blog

Umbilical Cord Prolapse - Dr.Shiva Harikrishnan

It is the umbilical cord that connects the baby to the placenta and supplies nutrients and oxygen to the baby. When this umbilical cord drops alongside(occult) or past the baby(overt) down the vagina before the baby has entered the birth canal for delivery, it is known as Umbilical Cord Prolapse. This may happen before or during delivery. In such a situation the prolapsed cord can get compressed between the baby’s body and pelvic bones resulting in the cutting off the oxygen supply to the baby which can cause stillbirth or other complications to the baby. Umbilical cord prolapse is usually not common but if it happens it will be an obstetric emergency.

Causes for umbilical cord prolapse

  • Preterm birth
  • Multiple gestation pregnancy (twins or more)
  • Breech position
  • Excessive amniotic fluid surrounding the baby(polyhydramnios)
  • Preterm rupture of membranes, i.e. the water breaks before 37 weeks.

Diagnosis 

  • The prolapsed cord can be seen during the medical examination.
  • The baby has an abnormal fetal heartbeat because the cord is stretched restricting the flow of blood to the baby.
  • It is likely you may feel the cord in your vagina

Umbilical cord prolapse management

In most cases, it requires immediate delivery of the baby, usually by c sec. Depending on the circumstance, vaginal delivery may also be considered. If at home, you will have to call emergency services as soon as possible. During the waiting period for delivery of the baby, the following steps may be taken

-you will be suggested to be in the knee to chest position to relieve the pressure on the cord. You will be asked to kneel with your face, knees, and chest touching the floor, with your hips raised.

-Someone from the team may insert two fingers using a gloved hand and apply upward pressure on the baby to help relieve pressure on the cord.

-the bladder may be filled with saline which can cause displacement of the uterus, hence reducing pressure on the cord.

The sooner the baby is delivered less risky it will be for the baby. However, longer the time it takes to diagnose and treat the issue, greater are the chances of complications to the baby, sometimes even leading to brain damage or death.

Umbilical prolapse can neither be prevented or predicted. But if the doctor has identified any chance for it to occur, especially after PROM, they will suggest getting admitted to the hospital.

For more details kindly contact us.

 

 

 

Ovarian Hyperstimulation Syndrome

Posted on May 17, 2022   by   - Blog

Ovarian Hyperstimulation Syndrome - Dr.Shiva

Ovarian Hyperstimulation Syndrome (OHSS) is a complication that usually occurs in women undergoing fertility treatment. As a part of the treatment, hormone medication is injected to stimulate the ovaries to generate more eggs than usual. But, in some cases, it causes blood vessels around the ovaries to leak fluid, which results in swelling of the ovaries and making it painful for the woman. This fluid may move to the abdomen. The treatment for OHSS is based on the severity of the issue.

Symptoms of Ovarian Hyperstimulation Syndrome

The symptoms usually start to occur a week after the usage of injections for stimulating ovulation. The symptoms may vary from mild to severe.

Mild Symptoms include –

  • Nausea and Vomiting
  • Thirst
  • Slight increase in weight or waist size.
  • Abdominal pain
  • Bloating

Severe Symptoms include –

  • Severe abdominal pain
  • A rapid increase in weight
  • Decrease in urination
  • Having problems with breathing
  • Blood clots
  • Large count of follicles

If you are undergoing fertility treatments and experiencing breathing problems or leg pain, make sure to contact your doctor as soon as possible.

 Factors that can increase the risk of having Ovarian Hyperstimulation Syndrome

  • PCOS -polycystic ovary syndrome
  • Age below 35
  • Being underweight
  • Having a high level of estrogen before injecting HCG
  • History of OHSS

 Complications related to OHSS

  • Fluid collection in chest and abdomen.
  • Dehydration
  • In severe cases kidney failure and increased abdominal pain.
  • Rupture of Cyst resulting in bleeding
  • Blood clots may develop. There are chances these clots may travel to the lungs or other organs making it life-threatening.
  • In rare cases death

 Diagnosis

Diagnosis for OHSS includes ultrasound, physical exam, x-ray or blood test. A standard pelvic scan may not be suggested as there are chances for cysts to burst under pressure.

 Management and Prevention of Ovarian Hyperstimulation Syndrome

  • Increase intake of water
  • Keep a track of your weight
  • Avoid strenuous physical exercise
  • If fluid has accumulated in the abdomen, it will be drained with a syringe.

Fertility plans are always set based on the patient’s health. If OHSS has been identified following steps may be adopted.

  • The medicines will be adjusted to the lowest dose required to stimulate the ovaries for ovulation.
  • Additional medications may be provided to reduce the risks associated with OHSS while at the same time not affecting the pregnancy.
  • The estrogen levels and follicle count levels will be constantly monitored, so that if they are at a higher level the HCG shots may be paused for a few days.
  • Alternatives for HCG shots may be used.

Getting pregnant can make OHSS worse. After taking all the aspects into consideration, the team may suggest to avoid sudden pregnancy. During this time they will freeze the eggs (embryo) and use it at a later stage after OHSS has reduced or cleared.

For more details, kindly contact us