Dr Pallavi's Clinic

Hi friends, I am Dr Shakuntala Kumar I am practising obstetrician and gynaecologist at New Life Hospital Delhi and Fortis Hospital Shalimar Bagh. Today we will be discussing ovary commonly encountered problem name Polycystic Ovarian Syndrome. Are you suffering from problems like hair fall, excess facial and body hair, very-very oily skin along with acne, frequently encountered menstrual abnormalities or problems in periods of difficulty in becoming pregnant, chances are you may be suffering from the Polycystic ovarian syndrome. A polycystic ovarian syndrome is because of a hormonal imbalance namely the female hormones like estrogen and progestogen imbalance between the excess of male hormones happening in these women. These women also have insulin resistance in their body, leading to several other disorders like high blood pressure, diabetes and high cholesterol levels in their body. Friends because of a Polycystic ovarian syndrome is at the interplay of hormonal disbalance compounded with environmental factors, like the lifestyle of the person because of this there is a development of multiple eggs in the ovary rather than formation of one single egg. These small-small eggs coming up in the ovary do not allow a dominant egg to form because of which there is an ovulation or non-development of eggs. This is the main reason why these women face difficulty in conceiving and are facing several hormonal imbalances.

Now let us talk about the diagnosis of a polycystic ovarian syndrome, so friends just an ultrasound finding of multiple cysts in the ovary of these women is not the sole criteria. We have certain criteria because of which we diagnose Polycystic ovarian syndrome a woman will be having normal ovaries but suffering from PCOS, on the other hand, she may be having polycystic ovaries but she is in a normal lady. So the diagnosis depends on certain clinical and investigational and certain ultrasound findings of the women. Which is not one single criteria of polycystic ovaries coming up in the ultrasound. Coming to the treatment part of these women that treatment depends on the problem that is these women are facing but in the root cause of these problems lays the obesity part of these women. So the most important part of the treatment is weight loss and lifestyle management, so please listen to your doctor, when she is saying and requesting you to lose weight. That is possible through a healthy lifestyle, a healthy diet and workout plans. Secondly, if this woman is suffering from menstrual irregularities we will correct that by improving her lifestyle and by giving her certain drugs, if she is suffering from acne or excess body hair we will be giving certain drugs to tackle that, if she is suffering from anovulation or by that I mean difficulty in conceiving or becoming pregnant, we will be giving certain drugs to induce ovulation, this may require the intake of tablets or sometimes intake of certain injections. So friends polycystic ovarian syndrome is no longer an enigma, it can very much cure. The only thing that is required is you helping your doctor curing it by managing a very healthy lifestyle and through the drug that we prescribed you taking them diligently. Thank you very much.

Hello, I am Dr Pallavi Vasal consultant Obstetrics and gynaecologist. Today I will be talking about abnormal uterine bleeding so, abnormal uterine bleeding is bleeding anywhere from the genital tract which is unusual. It can occur as in the form of spotting or bleeding before the periods or in between periods, after sex or it can be longer than a normal period, heavier than normal or if the bleeding is happening after menopause. If we divide the causes of abnormal uterine bleeding if we see young girls who have it as they started with the menstrual period. It usually because of trauma and any foreign body, irritation of the genital tract or an urine tract infection, but we have to be very careful about this sexual abuse, in young girls if it is happening, In adolescence during the teenage it can be during the first few years of the after the attaining the menstrual cycles it can happen in the first few years. This is because of the hormonal changes, which are happening in the girl’s body. But in that case, also we need to rule out any kind of pregnancy, infection any bleeding disorders or any other medical illness. In the reproductive age, group pregnancy has to be ruled of first because that is the most common cause of the abnormal bleeding in the reproductive age group. Then it can be because of the abnormal gain in weight or sudden loss in weight, intake off or any hormones or in use of any contraceptive intrauterine contraceptive virus, in pre-menopause that is between the age of 40 to 50 years of age, it can be because of the Ovulatory dysfunction that means there they are changes in the hormones when the periods are about to end because of that the hormones they are dysregulated that lead to abnormal bleeding. It can be because of fibroid in the womb or it can be because of the increased thickness of the lining of the womb or the growth of the endometrial polyp. So pregnancy precancerous or the cancers of the cervic, so any kind of cancers this also needs to be taken care off. And in the postmenopause, so in the postmenopause it is very important to see if a lady has started bleeding again after attaining the menopause, this leads to being because we need to rule out cancer because it is very scary and if it is diagnosed at a very early stage it can be treated very nicely. The another most common cause in menopause age group is atrophic days, thinning of the lining of the vagina and the womb sometimes that leads to irregular bleeding or growth of polyp for fibroid or infection in the uterus that can also lead to abnormal bleeding in women who are menopause. Now the symptoms as we discussed the symptoms are like bleeding or spotting in between the periods, the periods are less than 26 days more than 35 days heavy bleeding or prolonged bleeding during the periods. As we go ahead you need to go to a gynaecologist get a general checkup done along with the abdominal examination and the internal examination and then usually ultrasound is very much required in these cases to rule out anything which can be treated by surgery or the treatment can be with the medicines. Now a couple of blood test like CBC, the complete blood count, the hormonal profile, the infection screen, the pregnancy test all these needs to be done. The treatment is based on the cause, if there is no significant pathology identified then hormonal correction is required and this is done with hormonal therapy, which can be oral, injectable or in the form of intrauterine contraceptive device or if there is a particular cause like fibroid or polyp, then that needs to be removed through the surgery. In menopause age group we advise endometrial biopsy even if there is nothing but significant in the ultrasound because we need to rule out cancer in a patient who has attained menopause but still are having periods. So the important things I would say is too young girls especially avoid taking an excess of hormones or you should maintain a healthy weight and healthy lifestyle and there is very much there is a very high intake of I pills and adolescent that should be avoided because they have screwed up your periods and leads to irregular bleeding. For further queries, you can talk to me or connect me through Lybrate.

Hello, everyone, I am Dr Pallavi Vasal consultant of Obstetrics and Gynaecologist. Today I am discussing about pregnancy after the age of 35 years which is becoming fairly common nowadays and as the carrier orientation is increasing more and more women are conceiving after the age of 35. So, major concerns which arise after the age of 35 whether you are going to have a healthy baby or not and whether the pregnancy is going to be a smooth one or not. So what happens naturally is the egg production peeks at the age of 24 to 26 years and during this time the production of eggs is of very good quality but as the age increases there is a decline in the quality of the eggs as well as quantity of the eggs which are being produced in a female body. So there are issues which might arise because of it so what happens if we go for the risks in cases of the baby so what happens if the risk of down syndrome which is a congenital malformation rich is very closely link with the age of mother if the risk is one in 2000 at the age of 20years it increases to one in 350 at the age of 35 and further one in 100 at the age of 40years. So, with the increasing age of mother, there are chances of having a baby with Down syndrome. But nowadays we have excellent test and wonderful results we can expect with the levels of testing which are available nowadays like we go for double marker, quadruple marker even there is a test which is called Non-invasive prenatal test so that we can filter the baby cells from the mother cells and study than in detail whether the baby is having any abnormality or not.

All these are screening test and if needed further we can go for the confirmatory test like amniocentesis and coronary vessel tissue sample. Another thing with age is the doubt of having sugar during pregnancy, the problem with blood pressure developing during pregnancy but all these things come in to pregnancy only if you have the previous health has not been very good or if you have being diabetic or if you have already being hypertensive, then they put in a major issue otherwise they don’t. So if you have a good health before pregnancy so there are high chances that you will have a healthy pregnancy even after the age of 35 years beyond this if you have any doubt you can consult me or you can consult me through Lybrate and you can book an appointment through Lybrate.

Hello everyone, I am DR. Pallavi Vasal, consultant of Obstetrics and Gynaecologist, working at Gurgaon. Today I will be discussing Tuberculosis in pregnancy. The class of patients which we deal with and the surrounding around is, we always think that tuberculosis is not that common in our class but it is not so. India has the largest number of cases of tuberculosis cases in the whole world, around 1 in 600. The incidence of tuberculosis in India is around 1 in 600 and in our country tuberculosis is still very prevalent. It is transmitted through respiratory droplets, though it is very important that you be very careful about your surroundings. Now during pregnancy, we are particularly discussing tuberculosis in pregnancy because during pregnancy your immunity comes down and because of this, you become most acceptable to any kind of infection and usually we catch an infection from the surrounding. So you need to be very careful about the workers you are hiring like your maid, your driver, your gardener, you need to screen them before you hire them because they are the ones who might be carrying tuberculosis. And if you screen them it will be helpful for you also and for them also. Untreated tuberculosis is the greater risk to the mother and the baby then does the drug have. So it is very important to screen and treat tuberculosis timely and quickly as soon as it is diagnosed. Most commonly the bacteria it affects the lungs otherwise it can affect the all the organs of the body. Now, when usually the symptoms of tuberculosis are like evening rise of temperature, loss of appetite, you don’t feel hungry, despite being pregnant you start losing weight, crowning cough lasting for more than 3 weeks, generalised tiredness, breathlessness and nausea. What happens in pregnancy is the physiological changes which happen in pregnancy makes the diagnosis of tuberculosis during pregnancy a bit tricky. So it is usually based on your history then your sputum which is coming out that is examined at least 2 times and chest X-Ray can even be done in the pregnancy if you are in a high-risk category with the abdominal shielding so that the baby is unharmed. Now there is another test called tuberculosis PCR which is tested in your sputum, culture can also be sent. And there is one more test called GeneXpert which also tells us about the resistance of the tuberculosis bacteria.

The treatment of tuberculosis depends upon the intensity and the severity of the disease. It can vary from 6 months to 9 months depending upon your condition. Usually, most of the drugs can be safely taken during pregnancy even in the first trimester, except a couple of drugs like streptomycin which is not advisable to take in the first trimester of pregnancy. In India the incidents of drug-resistant tuberculosis are also increasing, so once you are tested positive you need to take a complete treatment otherwise there are high chances of relapse and you developing a multi-drug resistant TB, which is very difficult to treat. Once you diagnose with TB, it takes 2 to 3 weeks after the starting of the treatment for you to become non- infectious. Till that time you have to keep your hygiene very good and keep wearing a mask if you are having lung TB, wash your hands repeatedly, eat healthy food and get a lot of fresh air, so that in general your health remains very good. Now be regular with your visits to the gynaecologist and with the physician for the treatment of tuberculosis and for the treatment of pregnancy as well. As pregnancy advances, if the TB is treated properly, it doesn’t cause much risk but there are chances of early labour, premature delivery and rarely the baby might also carry a form of TB which is known as congenital TB. But all these can be very well presented with the drug treatment if it is taken very timely and very efficient. So if you have any doubts regarding any of these issues then we can further. We can make an appointment through Lybrate or we can fix an appointment.