Mother & Child Care Clinic

Hello, I am Dr. Yashica Gudesar I am a Gynecologist practicing in Dwarka since 17 years and I have a special interest in premarital and preconception counseling. Premarital counseling is very important think now days. Premarital counseling is a therapy that helps couple to prepare for marriage. In marriage, before getting married you should know each other well, you should know the relation, how to get in a relationship and how to complete a relationship and in the relationship what the problems you are facing. In India, we are getting married but we are not talking to each other. We are meeting each other we are talking to each other nut we are not talking about the further things which are involved during after the marriage like the contraception and planning about a baby so that is very important. We should decide early we should… when are we going to plan a baby because unplanned pregnancy are also not very good. We should always have a planned pregnancy and we should go for a preconception counseling. If you are going for a marriage, you should better go with your partner to a doctor and get yourself investigated. There are some test that need to be done like HIV, Hepatitis-B, DVRL some STD tests which is required to be rules out if you or your partner is suffering from an STD. because if any STD is there then post marriage you have some infection like honeymoon cystitis and pelvic Inflammatory diseases which might cause problem in initial months just after marriage. Better get yourself investigated and your partner investigated. The aim of premarital counseling is to prevent oneself from having unwanted pregnancies, to prevent oneself from infectious diseases, prevent from having an unsuccessful relation and to have a planned pregnancy. We should know what the fertile period is, what is the safe period and when is the time when there are high chances to get pregnant and what are the period when you are less chances of getting married. So and you should know completely about contraception. Contraception is very important because if you are planning to get married and into a relationship you should use contraception it’s depending on whether you are planning a baby or you not planning a baby. Just after marriage using a barrier method like a condom and oral contraceptive pills are the best methods to be used together just for 3 to 6 months till you decide which more of you are comfortable in. it is always better to discuss with your doctor. You should start planning 1 month, at least, one month prior to your marriage, because contraceptive pills oral contraceptive pills have effect starting one month if taken one month before. By failing to prepare, you preparing to fail. Thank you and if you want to further contact me you can video call me, you call on Lybrate or you can visit by website and the blog and we can have a discussion of premarital counseling. Thank you

People who have the Human Immunodeficiency Virus, commonly known as 'HIV', are known as HIV positive people. The virus is the agent of AIDS that is currently incurable. HIV is known to alter the human immune system and makes people much more susceptible and vulnerable to diseases and infections. Body fluids such as semen, blood, breast milk, vaginal fluids etc. of an infected individual contain the virus which can be passed from one person to another during blood-to-blood and/or sexual contact. HIV positive women may even pass on this virus to their children during pregnancy, delivery or by breastfeeding them. HIV is also transmitted during oral, anal or vaginal sex, by contaminated hypodermic needles and by blood transfusion. 
Mentioned below are a few issues that an HIV positive woman has to face apart from discrimination and stigma, fear of infecting their children or partners, violence and abandonment. 

1. Menstrual Disorders: Changes in menstrual cycles are frequently reported by HIV infected women. However, menstrual dysfunctions are due to varied reasons that aren't directly related to the disease. Although most of the HIV positive women suffer from amenorrhea i.e. the unusual absence of periods, it is not just due to HIV but also because of weight loss or immunosuppression.  

2. Contraception: It is very important that the contraception an HIV positive woman chooses not only acts as birth control but also to prevent the transmission of sexually transmitted diseases and HIV. Although condoms do not provide exceptional pregnancy prevention, they are excellent at preventing transmission of the HIV virus. Permanent sterilization is usually the most chosen contraceptive method for HIV serodiscordant couples.

3. Surgical Complications: HIV positive women are at a higher risk of undergoing gynecologic surgery. This is because they are more vulnerable to pelvic infectious disease that requires surgical intervention. There is also a greater risk of developing vulval cancer in HIV positive women. 

4. Fertility: There has been an increase in the number of seropositive women contemplating pregnancy and childbirth. Most couples resort to assisted reproduction to lower the risk of horizontal HIV transmission. Studies show that undergoing HIV treatment and having an undetectable viral load is helpful in preventing the transmission of HIV. It is important to consult a medical expert if you are unable to get pregnant after at least 6 months of trying. Fertility problems are more common in HIV positive women than HIV negative women. 

I am Dr Yashica Gudesar and I am a gynaecologist. I am in this profession since 17 years and I am working in Dwarka at my own private clinic. I am attached to Hospitals also. In this profession, I ahve come across many issues. The most common problem people are facing these days is a Pre conceptional Counselling which is very important and a younger generation is not aware of this.

What is Pre conceptional Counselling?

Pre conceptional counselling is educate the patient in a way that when she starts planning a pregnancy, it should be a planned pregnancy and she should have a healthy baby and a healthy pregnancy.

What is the aim of having a Pre conceptional counselling?

The patient should not be suffering from any existing disease which might not be diagnosed. Or if the patient is suffering from some disease then the baby should not be harmed. In case a patient is taking some drug, then the drug should be stopped or continued, should be confirmed before planning the pregnancy. So, the main aim is to ahve a healthy baby.

What a patient should do when they are coming for Pre conceptional counselling?

They should carry all the reports and they should give the proper history to the doctor about the previous health issues, any surgery or the medicines they are taking. They should discuss clearly about the drinkng and smoking habits

• In case a patient is planning for pregnancy, then they should take folic acid supplimentation. These suppliments prevent the neural tube defects.
• The alcohol consumption hsould be stopped.
• All medicines which are dangerous during the pregnancy should be stopped.
• The ideal time for Pre conceptional counselling should be taken 3-6 months before planning the pregnancy. But even if you have planned then 1 month is also a best time to go to a doctor.
• Start taking folic acid atleast 3 month before. This will prevent you from abortion

What Doctor might go for a Pre conceptional counseling?

• The doctor will take your BMI. If you are over weighted then they may ask you to reduce weight.
• There might be a questionair in all the history and all the examination of your body should be done.
• Infections should be ruled out.
• History of your vaccination should be taken. And the vaccination history is very important because you should go for measles, HPV which is for Cervical cancer and Rubella. This should be included in your Pre conceptional counselling. If any patient has not been vaccinated in childhood for Rubella then they should take the vaccination 3 months before they plan for pregnancy.

What you should do?

• You should take folic acid
• You should take Multi vitamins which includes B complex, Vit- D and Calcium
• If somebody's haemoglobin is less then they should take Iron.
• Any genetic disease in the family should be screened out before the planning for pregnancy.
• Thalassemia is one of the important disease which can be prevented
• Negative blood groups are important if the patient is hard and aborted earlier then it may give impact on the pregnancy.

So the main motive is to tell you that please do not undergo unplanned pregnancy. Take a Pre Conceptional counselling.

If you have any query, you can contact me through Lybrate or you can visit my clinic in Dwarka or you can aso take online appointments. If you need more information about the above discussed topic, you can read my blog as well.

Thank you.

Endometriosis is a condition where the endometrial tissue lining the womb, grows outside the urethral lining. This can cause severe pelvic pain and a host of other complications, if it is not treated on time. 

Here is everything you need to know about this ailment.

Symptoms:

Owing to the location of this tissue and its painful protrusion through the lining or walls of the womb, one of the earliest and most painful symptoms experienced may include severe cramps and pain during the menstrual cycle. Also, the patient will experience pain in the lower abdomen region about a week before the onset of the cycle. Heavy bleeding as well as infertility may be experienced in such cases too. Sexual intercourse will also give rise to pain in the region, while discomfort will be felt during the bowel movements. Pain in the lower back will also be experienced throughout the menstruation period. 

Stages: There are several stages of this disease and its progression, each of which will require a different form of treatment. These four stages usually depend on the location, size, depth and number of the endometrial implants within the body of the patient.

1. Minimal Stages: In this stage, usually there will be small wounds and lesions as well as shallow implants on the ovaries. Inflammation in the pelvic cavity can also be felt in this stage.
2. Mild Stage: In this stage, there will also be light lesions and shallow implants which will spread over the ovaries as well as the pelvic lining.
3. Moderate Stage: In this stage, the implants will dig deeper into the ovaries and the pelvic lining, which will result in the growth of even more lesions.
4. Severe Stage: As the name suggests, in this stage the patient will experience deep implants along with lesions in the bowels and the fallopian tubes.

Treatment:

Non-Medical Treatments

1. Eliminate nonorganic dairy products, beef, and chicken – because organic foods contain no added growth hormones. Increase nutrient-rich foods, especially cruciferous vegetables (broccoli cauliflower, Brussels sprouts, kale, cabbage, and bok choy), soy, cold-water fish (small fish when possible) and fiber.
2. Limit alcohol intake. Remember to eat protein at each meal and at each snack to keep the hormones more stable.
3. Maintain healthy levels of body fat to limit endogenous estrogen production.
4. Supplement with vitamins and minerals (especially calcium and magnesium) to make up for what is lacking in your daily food intake – pharmaceutical grade is the best.
5. Supplement with omega–3 essential fatty acids as a natural anti-inflammatory.

Medical Treatments

There are varied forms of this treatment including pain relief medication for minimal to mild stage patients. Also, hormonal therapy with the help of supplements may be prescribed. Hormonal contraceptives may also be used. In such cases, medication like Danazol, Medroxyprogesterone, 

Gonadotripin releasing hormone agonists, and other such elements may be prescribed. Conservative surgery and radical surgery may follow, depending on the severity of the condition. Laparoscopy is the preferred form of treatment in such cases. A hysterectomy can be conducted as a final resort where the surgeon will remove the cervix as well as the uterus of the patient. This will make pregnancy impossible for the patient, thereafter. To stem estrogen production, the ovaries will also be removed. 

One must discuss all risks and complications before going in for a certain form of treatment for this ailment. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

If you have been trying to get pregnant for a long period of time, but not succeeding, it is time for you to see a doctor immediately.
In case you have tried for pregnancy and not getting near it for a long duration, do not get disheartened and worried. There a lot of fertility techniques which have evolved over the time due to the advancement of medical technology.
If you have failed again and again, you should not wait anymore and visit a doctor. The doctor would help you locate the problem behind your failure and would provide you with other options of getting pregnant.

They are as follows:

Fertility drugs
They are the primary remedy for women who struggle to get naturally pregnant as they cannot perform ovulation.
Mimicking the body's own hormones, drugs such as Clomid work to trigger the ovaries into discharging eggs. This strategy prompts pregnancy accomplishment in a couple of months without further delay. Different drugs can, likewise, be utilized to control the menstrual cycle or thicken the womb's coating to set it up for pregnancy. Your doctor will prescribe you fertility drugs if you have an extremely irregular menstrual cycle and your ovulation is unusual, and you are not producing eggs. Sometimes, these drugs are given to women with pituitary failure.

Intrauterine insemination
In this process, a tube which contains sperms of best quality is inserted into the vagina of a woman into the uterus via the cervix. This process is carried out during the fertile-most period of the woman's menstrual cycle. It may be repeated for two or three days.
Your doctor may recommend this method in case you have unexplained infertility, or if you have problems in ovulating. If your partner is impotent or in case that you do not have a partner, this process can be undertaken.

In vitro fertilization (IVF)
This treatment includes the preparation of an egg outside your body. Eggs are accumulated from a woman's ovaries and are blended with sperm. The fertilization process happens in a leveled, flat shaped glass dish. The prepared egg or embryo is then put back into the uterus, which is called embryo transfer. A solitary treatment cycle can take anything between six weeks and two months and involves stages where you need regular injections and general ultrasound observing. This will be recommended by the doctor if you have unexplained fertility or when your fallopian tubes get blocked.
If you are struggling to get pregnant for a long time, you should not wait and consult a doctor, who would provide you with alternatives.

There are some commonest misconceptions about infertility, and these misconceptions should be eliminated as soon as possible so that the actual facts can be known. There are many online sites where you can find detailed information on the scientific explanations regarding infertility, and you can follow them.

List of myths and facts regarding infertility:

1.Myth: The menstrual cycle of a woman is for 28 days.
Fact: Normal cycle ranges between 21-36 days.

2.Myth: A woman can have pregnancy on the day one of menstrual cycle.
Fact: The released eggs remain viable for almost 12-14 hours, and a woman can get pregnant after an intercourse done two-days after ovulation and five-days before ovulation.

3.Myth: Infertility occurs due to stress.
Fact: Ovulation can surely get delayed due to hormone suppression, but infertility does not occur due to stress.

4.Myth: Sperms stay active for few hours.
Fact: Sperms stay alive at least for five days.

5.Myth: Men with a higher sexual-drive will have a normal sperm-count.
Fact: No relation is there in between fertility and virility. Sometimes, it has been found that men having a higher sex-drive do not produce sperms.

6.Myth: Women have to wait for three months to conceive after stopping the usage of contraceptive pills.
Fact: As soon as a woman stops pill usage, hormonal levels go back to normal condition, as a result of which ovulation begins immediately.

7.Myth: Only females have infertility troubles.
Fact: Both women and men suffer from infertility troubles as per the current scientific studies.

8.Myth: Ovulation occurs in a woman on the 14th day of menstrual cycle.
Fact: Ovulation can be calculated by counting 14 days backwards from the past menstrual cycle's last day.

9.Myth: Daily sex can increase conceiving chances.
Fact: During ovulation, having sex each day, especially in between 12-16th day of the cycle can be the best timing.

10.Myth: Fertility troubles occur at 35.
Fact: Peak fertility timing in a woman's life is 20, and this might continue until late 30s. Fertility troubles might even arrive at a younger age. With age, conception chances get declined, especially after 35. If you wish to discuss about any specific problem, you can consult a Gynaecologist.