Dr. Bhagyashree Deshmukh

Pregnancy is considered to be one of the most challenging and important phases in the life of a woman.

Pregnancy Complications are health problems that occur during pregnancy. They can involve the mother’s health, the baby’s health, or both. Some women have health problems before they become pregnant that could lead to complications. Other problems arise during the pregnancy. Keep in mind that whether a complication is common or rare, there are ways to manage problems that come up during pregnancy.

Some complications that might occur during pregnancy are discussed below:

1. Severe Nausea and Vomiting: It is common for nausea and vomiting to occur during a pregnancy. In order to avoid this condition, one should consume several small meals throughout the day and completely avoid spicy and fatty foods.
2. A persistent abdominal pain, severe headache, swelling and visual disturbances during the third trimester: This can be a fatal condition and often is a sign of high blood preeclampsia (pregnancy complication involving high blood pressure as well as damage to another organ system). It can be diagnosed early using good prenatal care which essentially comprises of frequent check-ups with the doctor and all the necessary treatment during pregnancy.
3. Flu Symptoms: It is recommended that flu vaccine should be administered to pregnant women as they usually tend to develop the disease during their pregnancy.
4. Gestational Diabetes: Gestational diabetes can increase the chance of a larger baby at birth and create delivery complications, increase your risk for high blood pressure and cause the baby to have blood sugar problems after birth. If you are diagnosed, it’s important to consult your gynecologist to control your blood sugar level, which can often be done through diet and exercise.
5. Baby’s activity level significantly declines: Sometimes, the activity of a previously active baby might decline. This can be felt by reducing the number of the kicks by the baby. The doctor has specific equipment that aids in identifying and resolving the problem.
6. Bleeding: Heavy bleeding accompanied by abdominal pain and menstrual-type cramps during the first trimester might indicate an ectopic pregnancy (embryo is implanted outside one’s uterus) or a miscarriage while occurrence in the third semester indicates placental abruption (characterized by the placenta separating from the womb’s walls). Any form of bleeding warrants the immediate attention of the doctor. Steps to avoid bleeding include bed rest, avoiding heavy work, and keeping yourself hydrated.

A Healthy Pregnancy-

The best way to ensure a healthy pregnancy is to focus on the things you can control and don’t obsess about what could happen. Take good care of yourself and your developing baby and talk with your healthcare provider when you have concerns.

Menstruation is the monthly discharge of blood from the vagina, which lasts for about 5 to 6 days. It is the shedding of the inner lining of the uterus, when pregnancy does not occur after the release of egg from the ovary. Menstrual periods are generally often accompanied by painful cramps in the lower abdomen, heavy bleeding, weakness, water retention, irritability and malaise.

What is Menorrhagia?

Very heavy or prolonged periods are medically termed as menorrhagia. It is abnormally heavy bleeding if there is a requirement to change sanitary napkins or tampons several times within a very short span of time. Passing large blood clots, night time bleeding, bleeding for over 7 -8 days, are other symptoms that one might be suffering from menorrhagia.

Common Causes Behind It

1. Menorrhagia is mostly a cause of hormonal imbalance, particularly in the levels of estrogens and progesterone.

2. Fibroids, cysts or polyps in the organs of the reproductive system, which includes the uterus, ovaries or fallopian tubes.

3. History of miscarriage or failed pregnancies.

4. Use of contraceptives

How can you treat heavy bleeding during menses

1. Change of diet: You must include more minerals, iron, magnesium and calcium in your diet. Your diet must comprise a lot of green vegetables, fresh fruits and dairy products.

2. Some non steroidal anti inflammatory drugs such as ibuprofen may be prescribed to reduce the blood loss.

3. Certain hormonal therapies to regulate the hormonal imbalances and menstrual irregularities.

4. Home remedies such as intake of certain herbs, ginger and coriander seeds help to control heavy bleeding.

5. Increasing magnesium intake to balance out levels of oestrogen.

6. It is best to stick to natural remedies, as it generally does not create complications in other bodily functions.

If the bleeding cannot be controlled even after a change of diet and home remedies, you must visit the gynaecologist as soon as possible. Heavy bleeding is a serious problem, especially if accompanied by dizziness, fluctuations in the blood pressure, nausea and weight loss. Severe cramps and constant bleeding can hinder daily routine, therefore, the earlier you receive medical attention, the quicker you will get relief.

Menstruation is a barometer of a women's health. Any changes in the menstrual pattern of a woman could be a harbinger of serious underlying disease and should not be overlooked. However adolescent girls are a special case where menstrual pattern is variable and much different from Adult women. It is very common for teenaged girls who have recently started menstruating to have irregular periods. This period pattern is wrongly classified as 'period problems". At the same time one needs to understand that some of the real problems like period pain in young girls are often overlooked as "normal" when they could be associated with serious medical disorders.

Although menstrual disorders are fairly common in most young women, it may have an underlying cause which can be indicative of a serious issue. Therefore, it is recommended for young women to consult a gynecologist if any difficulties arise.

Symptoms Of Menstrual Disorders (Severe)

1. Excessive abdominal pain
2. Excessive vaginal pain
3. Missed / irregular periods
4. Painful periods

The severe symptoms are usually accompanied by mild symptoms such as:

1. Irritability
2. Weight loss
3. Vomiting
4. Headaches/back pain
5. Fatigue
6. Insomnia
7. Diarrhea

PCOS and Menstrual Disorders

Polycystic Ovarian Syndrome is a common reason for women to experience irregular menstrual periods. PCOS occurs when there is an excess of male hormones (androgens) in the body which hinder the production and release of eggs in the ovaries, resulting in menstruation problems. Symptoms of PCOS are acne, hair loss and weight gain. Women with PCOS are 80% more likely to suffer from fertility issues later in life. Along with that, PCOS can result in high cholesterol and high blood pressure. One serious concern for women with PCOS is resistance to insulin which leads to diabetes.

Diet and menstrual disorders

Poor diet can also lead to menstrual complications. An extremely high fiber diet can result in less frequent ovulations and therefore irregular periods. A diet which is too low in fats and fatty acid can also result in abnormal menstrual patterns.

Stress and PCOS

Young women are often prone to immense stress. Stress is one of the primary reasons for delayed periods. Stress can cause minor complications in the hypothalamus which may have consequences in the levels of hormones in the body.

The presence of ovarian cysts in the vagina may be a cause for irregular or painful periods. Endometriosis can cause heavy bleeding and extreme pain.

A girl’s first period or Menarche marks her transition from a ‘girl’ to a ‘woman’. Most girls have their first period between the ages of 11 to 13 depending on their genetic structure, body weight, nutrition and maturity of the hypothalamic-pituitary-ovarian axis. Periods are usually irregular in the first two years and gradually settle into a pattern. Along with the duration of the periods, there may also be fluctuation in the amount of blood being lost. Puberty menorrhagia can be described as excessive vaginal bleeding during menstruation. This can occur up to the age of 19 years.

One of the characteristic symptoms of menorrhagia during puberty is having to change tampons or sanitary napkins every 2-3 hours. Periods that last more than 7 days can also be a sign of this condition. While the average amount of blood lost during menstruation is 30ml, adolescents suffering from this condition can lose up to 80ml of blood. Other symptoms include acne, pale skin, the growth of excessive facial or body hair and palpitations of the abdomen. These indicate an imbalance of hormones within the body.

In most cases, this condition is caused by anovulatory cycles. This can be described as a menstrual cycle in which an egg is not released by the ovaries. Anovulatory cycles may be triggered by sudden changes in hormone levels, drastic weight loss or weight gain, stress, extreme levels of exercising and an imbalanced diet. The use of hormonal contraceptives and infections may also cause excessive menstrual bleeding. Less common causes of this condition include endocrine disorders, systemic illnesses and structural lesions such as cervical polyps or fibroids.

While menorrhagia is common during puberty, if it continues for over three months, you must consult a doctor. Depending on the factors triggering this condition it can be treated with hormonal or non-hormonal medication or even a combination of the two. Treatment for this condition must be tailored to each patient while keeping in mind her age, family medical history and co-existing medical conditions. Hormonal treatment for excessive menstrual bleeding can take the form of oral contraceptives or progesterone tablets. Non-hormonal forms of treating this condition include iron supplements and medication to reduce blood flow. You should also eat more food that is rich in iron and vitamins while reducing intake of proteins and spicy foods. Home remedies for this condition include drinking a tea made with coriander seeds or adding cinnamon to your usual cup of tea.

Epithelial Ovarian Cancer is a condition in which malignant tumor emerges from the tissue lining in the outer surface of the ovary. Epithelial tumors are usually benign, but this form of malignancy has been found to be the most common type of ovarian cancer. Moreover, it cannot be diagnosed until in its advanced stage. Medical research shows that factors such as multiple pregnancies, delayed childbirth and early menarche seem to raise the risk of ovarian cancer, while dietary and environmental factors also play a significant role in it.

Symptoms
1. A majority of the patients have been observed to have extensive intra-abdominal growth.
2. They may experience discomfort or swelling of the abdominal region.
3. The feeling of being bloated, lack of appetite, unnatural weight alteration, dyspepsia, malaise, and urinary problems are frequently reported symptoms.
4. Patients also experience constipation and other gastrointestinal problems.

Treatment
The first step towards treatment of ovarian cancer is to diagnose the condition. A thorough pelvic examination (consisting of an examination of the vagina, uterus, ovaries, fallopian tubes, and cervix) will help to pin point any abnormality of the ovary. If the doctor notes nodularity, firmness or lack of tenderness during the examination, these can be taken as symptoms of malignancy of epithelial ovarian tumors. Ultrasound examination of the abdominal region will also help to locate abnormality in the tissues on the outer surface of the ovary. The next logical step towards treatment is getting a biopsy. During this procedure potentially malignant cells are removed and then diagnosed by a pathologist to conclude if the cells are cancerous or not. The process of removal is known as laparotomy.

Apart from a handful of stage one patients, most women with epithelial ovarian cancer receive chemotherapy. The standard treatment for this type of ovarian cancer is the surgical elimination of tumor. This includes total abdominal hysterectomy, a surgery in which the uterus and cervix is removed through an incision in the abdomen. Post surgical treatment consists of taxane-platinum chemotherapy. Patients with minimal residual cancer undergo external radiation therapy or intraperitoneal chemotherapy (radioactive liquid is channelled into the abdomen with the help of a catheter).

A lot of research has been done in this field and a variety of clinical trials are available for a patient, if he/she wishes to be a part of it. Leading methods are immunotherapy and targeted therapy are also available. Immunotherapy uses the immune system of the patient to battle cancer. Bodily substances or substances created in the lab are used to restore and boost the body’s natural defence mechanisms against cancer. Targeted therapy, on the other hand, uses substances to identify the cancer and attack the malignant cells without jeopardizing non-cancerous cells.

Are you experiencing swelling, bump and lesions in your vaginal area? These might be an indication of female vaginal sores. They may be itchy, quite painful, are usually tender and may also produce discharge. The sores usually develop because of skin disorders. Most cases of genital sores are symptoms of some kind sexually transmitted infection (STI). 

Diagnosis of female genital sores
A physical examination is undertaken for finding out the exact cause of genital sores and swelling in women. A pelvic test may also be carried out and you will be required to provide your doctor with your medical history reports. Blood tests, including blood work and a culture of the sore are also used for diagnosis. A culture is referred to as the method of taking a sample from your genital sore and testing it for the detection of bacteria. An ideal treatment method is suggested by your doctor after proper diagnosis. 

Self Care 
Based on the symptoms you experience and observe, you can cure vaginal sores by using simple self-care methods before consulting a doctor. A sitz bath is effective for getting relief from pain and discomfort. You can prepare a sitz bath at home by filling your bathtub with warm water and adding a saline solution or baking soda to the water in the bathtub. The water should be up to your hips when you get into the bathtub. You may even purchase a small basin meant for a sitz bath, which is available at all drug stores. 

Treatment
There are various ways of treating vaginal sores and the exact treatment depends on the cause of the sores. Here is a list of the most common treatment methods:

1. Use certain oral and topical medicines for treating the sores and getting relief from pain.
2. Try other medicines which include pain relievers, antibiotics, corticosteroids, antiviral medications, and certain anti-itch medicines for treating vaginal sores. 
3. Some forms of genital sores do not require treatment, but you can get rid of them if they are bothering you. A noncancerous cyst is such a type of sore.  
4. The long term outlook for vaginal sores depends on the cause. Sores accompanied by swelling occur due to chronic skin conditions, which are likely to affect you again in the future. You should get an existing STI treated for avoiding the recurrence of vaginal sores. 
5. The best way to keep away from vaginal sores is to have safe sex using protection, such as condoms. This will prevent the infection from being transmitted to your sexual partners. You must not hide the fact that you are having vaginal sores to avoid harassment, and should always open up and seek proper treatment.

Like many systems within the human body, the reproductive system is also a self maintaining one and performs many complex functions on its own. The female reproductive system is one such system and within it, the vagina is an especially good example. It is a self contained system wherein, the balance of the vaginal bacteria is maintained for proper health.

Douching
Douching is a process that involves the cleaning out or washing of an internal cavity of a body, such as the anus or the vagina with the help of water and special nozzles. Vaginal douching has become prevalent among women, mostly due to aggressive marketing campaigns which claim that it helps to keep the vagina clean. It is estimated that in developed nations, one in four women perform douching regularly.

Is it any good?
Vaginal douching has been reviled by most medical professionals around the world. The consensus is that not only does vaginal douching have no benefits; it may also be harmful for your vagina in general. The vagina is an ecosystem wherein multiple types of organisms thrive, including bacteria and fungi. These organisms keep each other in check and maintain the health of the organ. These organisms help maintain the pH Levels (the alkaline to acidic radio) within the vagina. Douching may actually disrupt the balance and cause harm by destroying one type of micro-organisms and letting the other proliferate, thus causing infections and other problems.

Problems caused by vaginal douching
Douches, especially the ones found in the market, contain elements such as iodine, baking soda, vinegar and other chemicals that can make the delicate vaginal balance go haywire. Some of the disorders that can be caused by it are mentioned as follows:

1. Yeast infections: This is due to the proliferation of the fungi known as ‘candida’ within the vagina. This fungus is present within the vagina, but douching can reduce the bacteria that counteract it, resulting in rapid growth. This is one of the most common infections of the vagina.
2. Bacterial vaginosis: Similar to how yeast infections occur, in this case, harmful bacteria proliferate within the vagina. This is also a common vaginal infection and douching has been deemed as one of the leading causes for it.
3. Pelvic inflammatory diseases: Douching pushes the bacteria of the vaginal canal into the cervix and the uterus, resulting in infections such as PID or pelvic inflammatory diseases (an infection in the reproductive organ in females).
4. Pregnancy related problems: A myth has been floating around that if a woman performs douching after sexual intercourse, it will wash away the sperm and hence prevent her from getting pregnant. In fact, the reverse is true. Douching can often push the sperm up into the uterus causing pregnancy. Not only that, pregnancies caused in such a manner have higher chances of bearing complications such as ectopic pregnancies (a condition wherein the fertilized egg gets implanted outside one’s uterus), birth defects, etc.
5. Irritation and vaginal dryness: Douching at the very least will result in the vagina turning dry as the natural mechanisms are disrupted. This results in irritation and itching.

Babies can enter this world in one of two ways: Pregnant women can have either a vaginal birth or a surgical delivery by Caesarean section, but the ultimate goal is to safely give birth to a healthy baby.

A C-section, or Caesarean section is a surgical procedure to remove baby through an incision in the mother’s abdomen and then a second incision in the uterus.

A C-section may be a necessity in certain situations, such as delivering a very large baby in a mother with a small pelvis, or if the baby is not in a heads-down position and efforts to turn the baby before a woman gives birth have been unsuccessful.

Sometimes the decision by an obstetrician to perform a C-section is unplanned, and it is done for emergency reasons because the health of the mother, the baby, or both of them is in jeopardy. This may occur because of a problem during pregnancy or after a woman has gone into labor, such as if labor is happening too slowly or if the baby is not getting enough oxygen.

Some C-sections are considered elective, meaning they are requested by the mother for non-medical reasons before she goes into labor. A woman may choose to have a C-section if she wants to plan when she delivers or if she previously had a complicated vaginal delivery.

Reasons for a C-section may include-

1. Health problems in the mother
2. The mother carrying more than one baby
3. The size or position of the baby
4. The baby’s health is in danger
5. Labor is not moving along as it should

The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. It can raise the risk of having difficulties with future pregnancies. Some women may have problems attempting a vaginal birth later. Still, many women are able to have a vaginal birth after cesarean (VBAC).

How You Might Feel-

You won’t feel any pain during the C-section, although you may feel sensations like pulling and pressure. Most women are awake and simply numbed from the waist down using regional anesthesia during a C-section.

That way, they are awake to see and hear their baby being born. A curtain will be over your abdomen during the surgery, but you may be able to take a peek as your baby is being delivered from your belly.

However, women who need to have an emergency C-section occasionally require general anesthesia, so they’re unconscious during the delivery and won’t remember anything or feel any pain.

Recovering from a C-section-

After a C-section, a woman may spend two to four days in the hospital, but it may take her up to six weeks to feel more like herself again.

Her abdomen will feel sore from the surgery and the skin and nerves in this area will need time to heal. Women will be given narcotic pain medications to take the edge off any post-surgery pain, and most women use them for about two weeks afterward.

A woman may also experience bleeding for about four to six weeks after a surgical birth. She is also advised to not have sex for a few weeks after her C-section and to also avoid strenuous activities, such as lifting heavy objects.