MI Heart & Women's Health Care Clinic and Diagnostic Centre

Intrauterine growth restriction is a condition where the foetus is smaller than it should be according to its age because it is not growing at a normal rate inside the uterus. This puts the baby at risk for several dangerous conditions during pregnancy, delivery and post-birth. Some of these are low weight at birth, caesarian delivery, decreased oxygen levels, low blood sugar, low resistance power, breathing problems and low body temperature. IUGR can lead to stillbirth in extreme conditions and to long-term growth problems too. This is the main reason why prenatal birth monitoring is very important.

Causes
IUGR can occur in expecting mothers who have a problem with the placenta. We already know that placenta is the cord of life that joins the mother with the foetus. It provides oxygen and food to the developing baby inside the womb. Apart from this, IUGR can occur if the mother has:

1. Diabetes
2. Hypertension
3. Heart disease
4. Rubella or syphilis infections
5. Kidney or lung disease
6. Malnutrition or anaemia
7. Twins and triplets also increase the risk for IUGR

The main symptom of IUGR is a small baby for its age in the womb. It may look small and sickly and the placenta is dry and shrivelled.

Management
Dealing with IUGR depends on many factors. Usually, doctors go for a slew of tests to see how the infant is doing. A detailed sonogram is usually performed to look for foetal anomalies. Tests like a urine sample, ultrasound, platelet count and liver function test are also administered to the mother. The mother is put on bed rest to improve blood flow to the foetus and antenatal steroids are prescribed to promote foetal lung maturity. General management also includes treatment of maternal disease like high BP and cessation of substance abuse or alcohol.

For management of IUGR, daily blood pressure measurements, foetal movement profiles, serial ultrasound examinations are important to determine the severity and progression of IUGR. If the situation becomes critical, labour is induced and the baby is delivered by caesarian section.

IUGR can’t be cured and can only be managed so it’s best to prevent it in the first place by keeping all of your prenatal appointments. You must be aware of your baby's movements. If your baby is not moving much or stops suddenly, you should rush to your doctor. You must also not take any medicine without consulting your doctor during pregnancy. Eat healthy and rest fully to have a risk free birth and last, but not the least, stay away from drugs, alcohol and smoke, even second hand, for the health of your baby.

Although the cause of over 60% of birth defects are not known, there are things that you can do to help ensure optimal health for your baby.

There are a number of things you can do to increase the probability of having a healthy pregnancy and a healthy baby. Some are more challenging than others because they may require that you break bad habits, but it is worth your effort.

Here are a variety of tips you can use to prevent birth defects as you contemplate starting or adding to your family:

1. The first and foremost tip is maintaining preconception health; eating well balanced and nutritional meals, and taking a multivitamin daily that includes the recommended 400 mcg of folic acid.
2. If you are sexually active and pregnancy is a possibility, make sure you take a multivitamin daily, which includes the recommended 400 mcg of folic acid and other essential B vitamins.
3. Avoid all activities that could potentially lead to birth defects, including alcohol, tobacco, illicit drugs, and caffeine.
4. Seek an annual gynecological and wellness exam.
5. Obtain genetic counseling and birth defect screening, particularly if you have any family history of birth defects or if you are 35 years of age or older. If you wish to discuss about any specific problem, you can consult a Gynaecologist

In case you have a concern or query you can always consult an expert & get answers to your questions!

To keep the vagina healthy and clean, a pale white, odourless fluid is discharged from the vagina. However, in cases where there is an infection in the vagina, this discharge may change in terms of both colour and odour. This condition is known as leucorrhoea and can affect women of different ages. There are two types of leucorrhoea:

Physiologic changes
In such cases, the discharge is caused by a fluctuation in hormonal levels. It usually affects girls going through puberty, women in the state of sexual excitement or in the first trimester of pregnancy and newborn baby girls.

Inflammatory or pathological
This type of leucorrhoea may be triggered by a number of conditions including vaginal yeast infections, cervicitis and trichomonal vaginitis. Some of the symptoms of this infection are:

• Abdominal cramps and pain in the lumbar region and calves
• Fatigue
• Headaches
• Constipation
• Itching

In case you have a concern or query you can always consult an expert & get answers to your questions!

There are several medical conditions that can adversely impact the vulva in females. There can be infections ranging from mild to high as per the skin condition. The vulva is also at the risk of developing cancer in some cases. It is advisable to see your doctor, whenever you find any bleeding, rash or lump in the vulva. Your doctor will be in a position to tell whether you need immediate treatment or not. Your symptoms will help him to determine the cause behind the changes.

What is the vulva?
Vulva forms the outer (external) sex organs of a woman. It is made up of two pairs of muscular 'lips'. The outer pair is called the labia majora. The outer pair is covered in pubic hair. The inner pair is called the labia minora. The inner pair is thinner and is very delicate and sensitive. You will find two openings in between these lips. These lips lead to uterus and urethra separately. There is a tiny organ called clitoris that lies just in front of the vulva.

What are the symptoms linked to vulva related diseases?
The symptoms will depend obviously on the underlying condition. Ranging from pain, itching, and finding a lump, you may notice several kinds of symptoms. All these changes are related to the appearance of the vulva. The symptoms decide the gravity of the situation. It is advisable to not wait and take prompt medical help in case of lumps in the vulva. A doctor will be able to tell what has happened to tell you by means of physical examination first. Later, you might have to take tests like internal swab test. A swab is nothing, but a small ball of cotton attached to a thin stick. It will be rubbed inside vulva to collect samples for testing. The doctor may also go for a biopsy to confirm the presence of carcinogenic cells in the vulva lump.

What type of infections can affect vulva?
Vulva can be affected by infections that are caused by germs such as bacteria, viruses and fungi. You may be affected due to the following infections:
1. Thrush: It is a common infection in women. It leads to a whitish discharge. It makes the vulva red and very itchy. It can be treated with anti fungal creams.
2. Genital herpes infection: It is a sexually-transmitted infection and spreads by skin-to-skin contact. Many people who are infected might not have symptoms. But they are carriers and can pass on to a healthy person. There is an occurrence of mild soreness or blisters.
3. Genital warts: It is caused by viral infection due to close sexual contact.
4. Other infections: You vulva can be affected by scabies and pubic lice.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Hello, I am Dr Rakhi Gupta I am an Obstetrician & Gynaecology practising in New Delhi. Today we are going to discuss our common topic that is laparoscopy and hysteroscopy. As we are commonly heard laparoscopy and hysteroscopy have a big role these days in gynae management. They can be diagnostic as well as the therapeutic that which we can use them as a part of a diagnostic tool or in order to treat any problem. Laparoscopy and hysteroscopy generally are done together or they may be done separately as per the requirement. They can be done as an office cystoscopy or it can be done under sedation or under general anaesthesia if combined with laparoscopy. So the purpose of diagnosis is visualisation of the abdominal contents via the laparoscopy, we can look over the lower organs that are the uterus, the tubes, the ovaries, the pouches which are adjacent to the uterus, the health of the rectal area as well as a bladder and in case of any disease it can be corrected such as we can manage difference cysts, different myomas operatively. Hysteroscopy is a direct visualisation of the uterine cavity by the means of a laparoscope, so it can show the health of the vagina, the cervix, the uterus and the kind of endometrial. It can be also used for resection of myomas, the fibroids, any septa, any abnormal polyp or removal of any misplaced copper-T inside the uterus. It is a very common procedure, very safe and in case of any issues you should always discuss a doctor for this option, which is a quick procedure and also it has an early recovery and an early discharge from the hospital. The person returns back to work at a very minimum time. Thank you, in case of any consultation or any query regarding this please contact me through Lybrate.

Hello, I am Dr Rakhi Gupta I am a senior consultant Obstetrics & Gynaecology. Today we are here to discuss a very common female problem that is regarding the discharge per vagina or the vaginal discharge. Often the ladies have this complaint, it is a very common symptom apart from bleeding, itching and so many other things. So the common myths regarding vaginal discharge, vaginal discharge is a normal occurring and it is usually odourless, colourless and it varies time to time during different phases of the cycle. We have to worry in certain cases only, in case the vaginal discharge becomes copious that is it is staining the undergarments or it is yellowish in colour or it is blood mixed or it is malodorous. In such cases, we are supposed to discuss and consult a doctor. What are the causes of vaginal discharge, the causes of vaginal discharge vary, first of all, it is a normal discharge, secondly it may be infectious, the infections related to this are related to fungal infections, bacterial infections then protozoal infection so on? So the treatment varies according to this sometime it is given on the basic type of discharge, sometimes a cultural sensitivity has done and the treatment is antifungals, antimicrobials or antiprotozoal. Again the discharge may be indication of something serious occurring in the body, they may be discharged which may occur, post sexual which is blood mixed or it may be foul smelling, copious purulent discharge which may show of some kind of puss kind of infection in the body such as severe infection of the uterus or any cancer developing within. In any of these such cases, we should always seek help immediately before the disease progress do not treatable. However the discharge is very and they need immediate intention, so in case of any problem we are there to help you out, you can consult me on Lybrate in such cases.

A fibroid tumour is made up of muscle cells that have escaped and come together to create a knot or a mass in the uterus. These tumours can occur due to a family history, and are usually known to occur for women patients nearing menopause. One of the most common symptoms is unusually heavy menstrual cycles. Let us walk you through the rest of the details.

*  Types: Fibroid tumours can be of three types, mainly depending on the location. While submucosal fibroids can be found just under the lining of the uterus, intramural fibroids can be found between the muscles that lie on the walls of the uterus. Finally, the third type - subserol fibroids - go beyond the uterine wall to enter the pelvic cavity. 

*  Symptoms: Usually, there are no symptoms of these kinds of fibroids. There may be heavy bleeding during the monthly menstrual cycle, as well as swelling and pain in the abdomen. Also, prolonged bleeding is common when these kinds of tumours are present in the body. 

*  Cause: Fibroid tumours are mostly caused due to an overgrowth of the cells beyond the muscular walls that line the uterus. In such cases, the growth is further fuelled by hormones like estrogen and progesterone. These hormones are usually at their highest level in the body, during the child bearing years of a woman. During menopause, these tumours are known to shrink before they eventually vanish. It is very rare to find malignancy in such tumours. 

*  Risk: Are you at risk? Well, that depends on your age, family medical history, weight and in some cases, even the ethnicity. These tumours are mostly found in women who are between the age of 30 to 40 years and continues through menopause. Obesity is also a major reason that gives rise to this condition. Further, women of colour are known to develop this more easily while a family history can also increase your chances of the same.

*  Tests and Diagnosis: A pelvic exam and an ultrasound as well as a history of your menstrual cycle will help the doctor in determining whether or not you are suffering from this condition.

*  Treatment: Non steroid anti inflammatory drugs can help in bringing down the swelling and pain, especially in cases where there is heavy menstrual bleeding. Birth control pills and patches with hormones can also help in such cases. Further, progesterone shots and iron supplements may be prescribed. Very severe cases may require surgery for removal with a myomectomy.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Vitamin D and pregnancy hand in hand go together. Expecting mothers need ensure they get the recommended amounts of Vitamin D during pregnancy for the healthy development of the baby as well as their own well-being. 

Vitamin D is a fat-soluble vitamin obtained mostly from consuming fortified milk or juice, fish oils, and dietary supplements. It also is produced in the skin by exposure to sunlight. Vitamin D which is ingested or produced in the skin must undergo hydroxylation in the liver and kidney to promote absorption of calcium from the gut to enable normal bone mineralization and growth. Severe maternal Vitamin D deficiency has been associated with congenital rickets and disordered skeletal homeostasis coupled with fractures in the new-born during pregnancy.  Vitamin D is necessary for the metabolism and absorption of phosphorus and calcium. Many studies are finding a connection between low serum vitamin D levels and an increased risk of certain types of autoimmune disease, cancers, insulin resistance, neurological disease and cardiovascular disease.

Latest studies have shown that Vitamin D deficiency is common during pregnancy especially among women residing in northern latitudes, living in cold climates or wear sun and winter protective clothing and ethnic minorities, especially those with darker skin. As the Vitamin D level of new-born is largely dependent on maternal Vitamin D status, the infants of mothers with vitamin D deficiency are also at risk of Vitamin D deficiency. Inadequate vitamin D can lead to abnormal bone growth, fractures, or rickets in new-borns.  Deficiency of vitamin D leads to a higher risk of pregnancy complications like gestational diabetes, premature birth and low birth weight.

The symptoms of a vitamin D deficiency include aching muscles, bone pain, and softened bones leading to fractures. Fish liver oil, fatty fish, and eggs are excellent food source for Vitamin D. It is difficult to get sufficient vitamin D from food, which makes it necessary to have Vitamin D supplements. Since the skin uses the sun's rays to produce vitamin D, limited sun exposure is recommended. Exposure to the sun's ultraviolet rays intensifies the pigment changes causing skin darkening in pregnant women. Thus, most doctors endorse that pregnant women protect themselves from the sun and get their vitamin D from supplements. The average prenatal vitamin contains 400 IU of vitamin D, which makes it imperative that additional supplements should be taken. The significant compounds for human development are D2 and D3. The best way to really ensure adequate vitamin D is through simple supplementation. Ergocalciferol is the vegetarian form of vitamin D whereas cholecalciferol is the animal-sourced form, derived from fish liver oil or lanolin from sheep.

Causes, diagnosis and treatment of Polycystic Ovaries

Hello. I'm Dr. Rakhi Gupta. I'm practicing as a Senior Consultant Gynecologist in Savita Bihar, New Delhi. So today we are here to discuss one of the most important problem such as Polycystic Ovaries.

Polycystic Ovaries as you would have heard is very common these days, especially in the reproducive age groups. The girls between the age of 15-45 often are having this problem and they present as menstrual irregularities, lots of acne on the face, then increase in weight, hair loss from the scalp, excess hair gain from the body. These kind of problems are usually a manifestation of abnormal lifestyle. We must say that it is not a disease but it is a lifestyle pattern. And improper diet, improper exercise and so many other environmental factors that are effective such as radiation, pesticides etc maybe affecting them.

So basically the investigations done in such cases are in the form of ultrasonography and blood test related to hormones such as prolactin, testosterone, insulin and blood sugar levels. The treatment is in the form of weight reduction, exercise, increased physical activities and certain medications that contain the insulin level, the testosterone levels. At times because of infertility, they may be requiring ovulation induction medicines. So the treatment varies as per the symptons and most of the things are under control.

Since this is a problem that is involved in more than 20% of the girls in India it needs an urgent attention and immediate treatment. In case of any query you can contact me through the Lybrate or directly at my clinic. Thank you so much.

Vulvovaginal candidiasis refers to the infection of the vagina, accompanied by itching in the vulva. It is caused by a particular strand of yeast known as candida albicans.
There are several reasons which contribute to the onset of vulvovaginal candidiasis, some of them are:

1. Pregnancy
Pregnancy is a time when the body of a woman undergoes a plethora of changes. With the upsurge of certain hormones, this is also the most potent time when they tend to suffer from vulvovaginal candidiasis.

2. Higher dose of estrogen
Estrogen is responsible for maturing the vagina as well as provides glycogen which facilitates the growth of candida albicans. Subsequently, older and younger women, who are less prone to estrogen disorder, suffer the least from vulvovaginal candidiasis.

3. Uncontrolled diabetes
Those women who suffer from uncontrolled diabetes for a long period of time are more susceptible to vulvovaginal candidiasis. Although the accurate reason is yet to be known, according to research, the presence of excessive glucose in the blood triggers the production of yeast in the vulva and the vagina.

4. Weak immune system
A strong immune system is a boon which only few people enjoy. Consequently, the very reverse, a weak immune system is extremely fatal, one that invites several complications; vulvovaginal candidiasis being one of them.

5. Stress
Excessive stress and exhaustion may also be considered as a probable reason that causes imbalance in your system.

6. Hormone replacement therapy
Estrogen is commonly held as a possible culprit that causes vulvovaginal candidiasis. Therefore in those hormonal replacement therapies, where estrogen is artificially administered into the body significantly increases the risk of an impending vulvovaginal candidiasis.

In spite of its frequent occurrences, it is possible to treat this infection. Some of the ways by which it can be done are-

1. Anti-fungal cream
Those creams which negate the growth of fungus are, for obvious reasons considered as the most preferred choice to combat vulvovaginal candidiasis. There are plenty of anti-fungal creams available in the market, which can be misleading, therefore you must choose wisely.

2. Diflucan
This medication works wonders in treating vulvovaginal candidiasis. This must be orally administered under the doctor's supervision to enjoy the results. If you wish to discuss about any specific problem, you can consult a gynaecologist.