Month: April 2022

Pelvic girdle pain(PGP) and pregnancy

Posted on April 11, 2022   by   - Blog

Some women may experience pelvic pain during pregnancy. PGP or pelvic girdle pain also known as symphysis pubis dysfunction, SDP, usually affects 1 in 5 pregnant women. It will not affect the baby in any manner but can be painful for the mother when moving around. If the pain turns out to be severe, affecting day-to-day activities or your sleep, make sure to consult with your doctor. PGP is treatable, but it is better to diagnose it early so the treatment help relieves the pain before it can worsen and affect your emotional well being.

Symptoms of PGP

1)Experiencing pain

  • over pubic bone in the front along hips
  • deep in the pubic area between the vagina and anus
  • across lower back
  • spreading to the thighs

2)Grinding sensation in the pelvic area. The pain may worsen when doing the following –

  • walking
  • moving up or down the stairs
  • when you need to spread your legs to get out of a car
  • turning on bed
  • standing on one leg when getting dressed

Cause for pelvic pain during pregnancy

During pregnancy, the joints in the pelvic area may become stiff, misaligned or less stable. This may cause inflammation or pain. Certain other factors may contribute to it such as

  • history of pelvic girdle pain
  • injury to the pelvic area due to an accident
  • being overweight

Treatment for PGP

Physiotherapy – Exercise to strengthen lower body muscles and pelvic floor, improve your posture and help reduce the pain. Hands-on treatment will be given to the joints to get them in position.

  • Pelvic support belts may be provided
  • Medicines- which are safe to have during pregnancy can help reduce pain.

A few other essential points to keep in mind are

  • be active with the activities which are within pain limits
  • avoid activities that can increase the pain
  • wear flat shoes
  • when moving on the bed keep your knees together
  • sleep on the less painful side
  • when sleeping on your side use a pillow between your legs.
  • keep your knees close together when trying to move out of the car. A plastic sheet on your seating can help to turn on the seat.
  • sit down when getting dressed to avoid balancing on one leg
  • avoid breaststroke when swimming

Avoid following things when having PGP

  • Crossing legs
  • Bending down to lift or carry a toddler or baby on the hip
  • Carrying very heavy objects
  • Sitting on the floor
  • Sitting or standing for a very long duration

The doctor may also discuss finding position and range till which you can spread your legs for normal deliver. PGP usually reduces after delivery as the body and hormones start to settle back but if it lasts even after 6 weeks make sure to consult your doctor.

If you had a PGP, there is a greater chance of it repeating in your next pregnancy so make sure you are healthy and fit before the next pregnancy. Practicing exercises that strengthen the pelvic floor muscles can help reduce the chances of having it in the future.

For more details kindly contact us.

 

Cervical Stitch/Cervical Cerclage

Posted on April 11, 2022   by   - Blog

Cervical Cerclage

Towards the end of the third trimester when the body feels it is ready to deliver the child, the cervix starts to dilate(widen) so the baby can move out of the uterus through the vagina. But if this takes place early, due to the cervix being weak or other related problems it can result in premature birth or miscarriage. Cervical cerclage or cervical stitch is a procedure where the cervix is sewed if the doctor finds that the cervix is weak and there is a chance for premature delivery or miscarriage. It will be done at the hospital, and you may go home the same day.

Causes for Cervix to be weak

  • Had a cervical cerclage in an earlier pregnancy
  • Having a short cervix
  • A history of pregnancy loss in the second trimester
  • Abortions in the past

Ideally, it is done between the 12th and 14th week of pregnancy. If done at this time it is known as emergent cerclage. It can be done any time before 24 weeks and is rarely done in the later stages unless found necessary. The stitch is removed around 36-37 weeks.

When is cervical stitch not advised?

If you have an infection, having contractions or waters have already broken.

Cervical cerclage procedure

Before the procedure, an ultrasound will be taken to make sure the baby is fine and healthy. The doctor will also suggest tests to check for any infections. If found, a round of antibiotics must be taken and completed before the procedure.

During the procedure, local anesthesia is given to numb the pain. Surgery is usually done through the vagina. In some cases, when a vaginal cervical stitch has not worked or if it is not possible to do via the vagina, transabdominal cerclage is done. Progesterone shots may also be provided for additional help.

After the procedure, you may find vaginal bleeding for two days. You will have to visit your doctor every two weeks to make sure everything is fine. If the same procedure was followed in an earlier pregnancy, then you may need to stay in the hospital for some time.

Before delivery, the stitches will be removed. It is usually around 37 weeks or when you go to labor. If the stitches were done through a cut in the belly then the doctor will suggest a caesarean between 37 and 39 weeks.

There are a few risks associated with cervical cerclage such as vaginal bleeding, tear in the cervix, or infection. A cervical stitch will help to reduce the chances of having a miscarriage or premature birth, but it doesn’t mean we should not be careful. If you find anything different from usual, make sure to consult with your doctor.

 

Heavy bleeding after birth – Postpartum Hemorrhage

Posted on April 11, 2022   by   - Blog

Bleeding after Birth - PostPartum Hemorrhage

Bleeding from the vagina after giving birth is common (heavier than normal). It will reduce in the next few hours after delivery but will continue for a few more days and after which it will stop. In some cases, if the bleeding is very heavy and not stopping it is known as Postpartum hemorrhage. The chances of having it increase if you have had a history of it. PPH is identified when you lose

  • more than 500ml of blood after vaginal delivery
  • over 1000ml of blood after csec,

It is also identified by blood pressure measurement and taking red blood cell count (Hematocrit).

PPH may occur anytime between the first week to 12 weeks of having a baby. They are classified into two types –

  • Primary PPH, is when having blood loss within the first 24 hours after giving birth.
  • Secondary(late) PPH is when there is heavy bleeding after 24 hours after giving birth.

Once identified it must be treated immediately as severe loss of blood can cause a drop in blood pressure, which can result in shock or death.

Symptoms of PPH

  • Heavy Bleeding which doesn’t stop
  • Pain in vagina
  • Nausea
  • Drop-in blood pressure.
  • Feeling dizzy, weak, or having chills.

What are the causes or factors that increase the chances of having PPH?

This can be categorized into four.

1) Uterine atony – is when the uterus is enlarged or stretched due to multiple pregnancies. Usually, after delivery, the uterus contracts back to its size and during the process closes the placenta arteries which in turn reduces the uterine bleeding. But in this case, the uterus does not contract properly and hence the bleeding does not stop. There will be a slow and steady loss of blood.

Uterus contraction can also be affected by muscle fatigue caused due to prolonged labor or the use of certain medications during delivery. A full bladder also may interfere with uterus contraction.

2) Tear or damage to genital structures during delivery. It can be from incision during csec, tear during vaginal delivery, or from the instruments which were used to deliver the baby. The bleeding from the tear sometimes may occur at a concealed location and can go unnoticed for some time. It is later identified by severe pain accompanied by bright red vaginal bleeding.

3)Placenta fragment remains in the uterine cavity, ie during the delivery, the placenta hasn’t fully separated from the uterus. This affects the contraction of the uterus and results in uterine atony. The placenta needs to be passed completely within 30 to 60 minutes after delivery.

4) Issues that prevent blood clotting in the mother. It can be due to a genetic disorder like Von Willebrand Disease. Other causes can be placenta abruption and eclampsia.

Treatment for PPH(Postpartum Hemorrhage)

The treatment is determined based on the cause for bleeding

1)For Uterus Atony

  • Fundal Massage, massaging the fundal part will help the uterine wall to contract and harden
  • For a full bladder, a catheter will be used to empty the bladder if the mother is unable to urinate by herself.
  • medications may be provided to help the uterus contract.
  • if none of it works surgery will be advised.

2)For damage to any of the genital organs

Pressure needs to be applied at the site of bleeding or it must be repaired as soon as possible.

3)Retained Placenta –

Make sure the placenta has been delivered fully intact else remove any tissue that has been retained in the uterus. Surgery may be performed to remove the remains of the placenta.

4)If it is known that the patient will be at high risk for PPH an injection will be provided during labor to reduce blood loss. It also helps the placenta to separate from the womb.

5)The blood loss needs to be replaced, for this blood and blood products will be provided to prevent shock. IV fluids will also be administered.

6)Stepwise uterine devascularization, that is tying the blood vessels supplying uterus is done to control the bleeding and preserve the uterus.

7)Balloon tamponade is another technique performed to help control bleeding.

8)As a last resort, only if none of the treatments work(especially the last two methods mentioned) and the mother’s life is at risk hysterectomy may be necessary.

Postpartum hemorrhage can pose a serious risk to the life of the mother. However, detecting and treating the source of the bleeding as soon as possible helps in a full recovery.

For more details kindly contact us.