Month: December 2022

C-sections, when are they needed and why?

Posted on December 16, 2022   by   - Blog

Cesarean or C-section

Cesarean or C-section is when a baby is delivered via surgery by making an incision in the abdomen and uterus.

When is C-section necessary?

Some C-sections are planned, and some become necessary due to complications during labor. Listing some of the reasons for performing a caesarean-

  • Fetal distress- If the team identifies a change in the baby’s heartbeat, the baby will have to be delivered as soon as possible as the baby may not be getting enough oxygen.
  • Prolonged labor – where the mother has been in labor for 20 hours (14 hours for having delivered before) or more and not much progress has been seen.
  • Baby is in a breech position, that is the feet or buttocks have entered the birth canal, or in a traverse position where the baby’s shoulder or side comes first. The baby must be head down first for a vaginal delivery else it can get complicated.
  • The mother is carrying more than one baby
  • Birth defect in baby – in such a case c-sec will be suggested to avoid further complications.
  • Prolapsed umbilical cord – where the cord slips through the birth canal before or along with the baby. This will compress the cord restricting the blood flow to the baby.
  • Had a previous C-section.
  • Serious health concerns for the mother such as gestational diabetes, high blood pressure, or heart disease. A vaginal delivery will also be avoided if the mother has genital herpes, HIV, or any infections that may be transferred to the baby during vaginal delivery.
  • Baby has an unusually big head (due to any underlying issue) or the mother has a small pelvis(also known as CPD – cephalopelvic disproportion).
  • In cases of Placenta previa or placenta abruption.

Risks of having a C-section

To mother – Blood loss, reaction to anaesthesia, though rare injuries to bowel or bladder, increased risk for future pregnancies like placenta accreta and uterus tearing along the scar line, blood clots, infections, longer recovery period.

How to prepare for Cesarean?

If you are having a planned C-sec the doctor will suggest talking with an anesthesiologist. Even if you have planned for a vaginal birth last minute complications may make it necessary to have a c-sec. Blood tests will be taken. The blood type will be recorded so that they are prepared in the unlikely event that a blood transfusion is required.

How is Cesarean performed?

Your abdomen will be cleared before the surgery, a catheter will be placed to keep your bladder empty. IV fluid will be administered through your vein in the arm.

The anaesthesia given is usually regional where only the lower part of the body becomes numb, and you will be awake during the surgery. Anaesthesia may be given as a spinal block or an epidural. In some cases, you will be given general anaesthesia and you will not be awake during the surgery.

After the lower part of the body has been made the incision will be made in the abdomen and uterus to take the baby from the uterus. After this, your uterus will be stitched using dissolving stitches and the abdomen incision is closed using sutures.

Types of incision for C-section

  • Abdominal incision- It is usually done horizontally just above the pubic area. In some cases, it may be a vertical incision starting from below the navel to just above the pubic area.
  • Uterine incision – Here also the incision is usually horizontal across the lower part of the uterus. In some cases, it may differ based on the complication or position of the baby.

You may leave the hospital after three to four days if the doctor finds you fine for discharge. Once home drink lots of water, avoid sex for around 6 weeks, take pain medications as prescribed, and avoid doing strenuous work for some time. Do consult with your doctor if the pain is not reducing, having a high fever, discharge from an incision, blood clots, or vaginal discharge with a foul smell.

A vaginal delivery is the safest method of delivery, but doctors may suggest a caesarean if there is a complication or if it is the best option for the life of the mother and baby.

 

Uterine Rupture

Posted on December 16, 2022   by   - Blog

Uterine Rupture - Causes, Symptoms, Treatment, Prevention

Uterine rupture is a serious childbirth complication where the uterus walls(all three layers – endometrium, myometrium, and perimetrium) tear apart causing the baby to slip into the peritoneal cavity(abdomen). It is seen in women who previously had a caesarean or have uterine scars caused by other surgeries in the uterus. The tear occurs at the location where the surgery was previously performed. Though serious, it is rare and occurs only in 1% of pregnant women.

If the baby slips out of the uterus into the abdomen it can suffer from suffocation and the mother will undergo excessive bleeding. Both these issues must be treated immediately else it can be fatal to both mother and baby.

Other risk factors that can cause uterine rupture are –

  • External trauma to the uterus.
  • Abnormalities of the uterus.

Symptoms of having uterine rupture

Some of the warning signs are

  • Excessive bleeding
  • Pain at the previous site of uterine scar
  • Sudden uterine pain
  • Slower contractions
  • Low blood pressure
  • Fetal distress
  • Chest pain caused by the collection of blood in the peritoneum.
  • Shock in mother

Causes

During labor, as the uterus contracts with building pressure to push the baby out of the uterus into the birth canal, the pressure can cause the uterus to tear at the previous delivery scar.

Risks of having uterine rupture

In the mother, the main risk is blood loss but, in most cases, it can be treated, reducing the chance of fatal bleeding. The risk to the baby is major as once the uterine rupture has occurred the doctors need to deliver the baby as soon as possible because if the baby is not taken out within 10 to 40 mins, varying on the range /intensity of the situation, the baby may die due to lack of oxygen.

Diagnosis

It can officially be diagnosed only during the surgery. But immediate action is required if the medical team suspects symptoms to be that of uterine rupture. Delay in time for action increases the risks to the mother’s and baby’s life.

Treatment

Immediate delivery of the baby and treatment for blood loss in the mother must be performed simultaneously. Women may need blood transfusions. The baby will be pulled out from the mother as soon as possible via surgery and will be provided critical care.

The earlier the issue is diagnosed, the greater the chance of survival. But do not worry as the chances of being fatal for the mother is only 1% and 6% in babies.

Prevention

If the pregnant woman has had surgery on the uterus previously the only way to prevent it is to opt for a caesarean. It doesn’t mean that vaginal birth is not possible but the type of incision made on the uterus and the period since when the surgery was performed is also taken into consideration for making a decision. But do discuss all the options available with your doctor and take a decision that you believe is best for the mother and baby.

For more details kindly contact us.

Ectopic Pregnancy

Posted on December 16, 2022   by   - Blog

Ectopic Pregnancy - Dr.Shiva Harikrishnan

A fertilized egg normally attaches itself to the womb’s inner lining. Ectopic pregnancy is when a fertilized egg implants itself outside the main cavity of the uterus. It usually affects one out of every 100 pregnancies.

The eggs are carried from the ovaries to the uterus through the fallopian tubes during ovulation. But if the fertilized egg gets implanted in the tube instead of being inside the uterus it is known as tubal pregnancy (or fallopian tube pregnancy), the most common type of ectopic pregnancy. Other areas where ectopic pregnancy can occur include the interstitial (cornual pregnancy), ovary, or cervix which is the lower part of the uterus. Heterotopic pregnancy refers to multiple pregnancies in which one fertilized egg is found implanted inside the uterus and the other outside. This is a rare type of ectopic pregnancy.

A fertilized egg will not be able to survive in such a type of pregnancies and must be treated as soon as possible as it can be life-threatening.

Causes for ectopic pregnancy

The most common type, that is tubal pregnancy occurs when the egg gets stuck in the fallopian tube instead of moving to the uterus due to inflammation or an issue with the tube such as a scar. Hormonal imbalance is another cause.

Symptoms

Symptoms can start as early as the start of the second month to the end of the third month (between the 4th to 12th week) of pregnancy but most of the early symptoms are like that of normal pregnancy such as missing your period, nausea, and breast tenderness.

Early warning symptoms include –

  • Vaginal bleeding
  • Pain in the shoulder tip – the pain starts where the shoulder ends and the arm begins.
  • Lower abdomen pain
  • Frequent urge to poop.

As the fertilized egg starts to grow, the symptoms become more prominent. However, if you experience any of the below listed symptoms, you should take them seriously and seek medical attention as soon as possible-

  • Severe pain in the abdominal or pelvic area
  • Feeling dizzy
  • Pale look
  • Feeling sick

These symptoms indicate that the fallopian tubes may have ruptured. Immediate surgery will be necessary to repair the tube.

Diagnosis for ectopic pregnancy

An ectopic pregnancy can be detected only during a scan. A combination of ultrasound and blood tests will be done to diagnose ectopic pregnancy. A transvaginal ultrasound will help to correctly identify the location of the pregnancy.

Risk factors

Some factors can increase the chances of having an ectopic pregnancy

  • Previous history
  • Infections such as gonorrhea that can cause inflammation in the tube
  • Smoking
  • Previous surgery on the fallopian tube
  • Fertility treatment

Treatment

An ectopic pregnancy cannot survive and has to be removed as soon as possible because if it grows and ruptures it can cause life threatening bleeding. Treatment methods include –

  • Providing medicine that will stop the pregnancy from growing and dissolves the cell already present.
  • Surgery – a keyhole(laparoscopic) surgery will be performed to remove the fertilized egg.

Prevention

Ectopic pregnancy cannot be prevented but surely one can try to decrease the risk by:

  • Not smoking
  • Using a condom when not trying to get pregnant, to prevent transmission of sexually transmitted infections

For more details kindly contact us.

Ovulation and the right time to conceive

Posted on December 16, 2022   by   - Blog

Ovulation -right time to concieve

Ovulation is the time when an egg is released by the ovary, it travels through the fallopian tube and remains there for 12 to 24 hours where it gets fertilized in the presence of a sperm. If you are trying to get pregnant, you need to keep track of your ovulation because you can get pregnant only if you have intercourse during the five days before or on the day it happens.

When does ovulation occur?

It typically occurs 14 days prior to the start of the next menstrual cycle. This is applicable for those who have a 28-day menstrual cycle but in most situations, the cycle length may vary slightly. In such cases, it is best to maintain a menstrual calendar to keep track of your ovulation date.

Symptoms of ovulation or how can you identify that you are ovulating?

  • Vaginal secretion – before ovulation starts the vaginal secretions will be wet and clear. The sperm can also easily travel in the presence of this mucus. After ovulation, these secretions decrease and become thicker.
  • Increase in body temperature – the body temperature increases during ovulation which can be detected using a thermometer.
  • Ovulation kit – Before you start ovulating, your hormone levels rise. This kit can detect the presence of these hormones in your urine. If it shows a positive sign, chances are you will be ovulating within the next two days.

Other signs include tenderness of breasts, slight cramping, or bloating along with the earlier-mentioned symptoms.

When is the best time to conceive?

When the sperm is already present in the fallopian tube when the egg is released, i.e. during ovulation, the chances of getting pregnant are best. In the right conditions, the sperm can survive within the female reproductive system for about five days after sexual intercourse. Hence it is best to have intercourse starting from 3 to 5 days before the day of ovulation to that day to increase the chances of getting pregnant. This duration is also known as the fertile window, which is the time frame during which you can get pregnant. Beyond the fertile window, the chances of getting pregnant are almost nil as an egg cannot be fertilized after that to create an embryo.

How to identify if you are pregnant after ovulation?

The earliest symptoms can start 4 days past ovulation (also known as DPO). But the symptoms can also exist even if you are not pregnant. So do not consider these signs as sure signs of pregnancy. Some of them are –

  • slight cramps (but it can also be the start of menstrual bleeding)
  • spotting – caused by implantation bleeding, but this occurs only around 6 to 12 days after ovulation
  • tender breasts
  • nausea

An accurate method to identify if you are pregnant is to take a pregnancy test after ensuring you have missed your periods (if you are having regular periods). Else wait till 3 weeks after ovulation (if you have irregular periods). But for the right confirmation, you will need to consult with the doctor as pregnancy kits may display,

– negative, if the tests were taken early

– false positive, which occurs rarely, if there may be some underlying issue other than pregnancy like menopause, an issue with the ovaries, or when having medications containing hormone HCG.

For more details, kindly consult with us.