My name is Dr. Asha Khatri. I had passed MD in 1977 and obstetrics and gynecology from Pandit LNM Medical College, Raipur with gold medal and distinction. My special interests are infertility, high risk pregnancy, delivery and endoscopy. Today I am going to share with you some important topics related to obstetric which will help you in taking the proper decision. Premarital counseling is very important because so many conditions which you are not aware of can affect your obstetric outcome.
First you should know the HIV status of both the partners because if one is HIV positive the other can get the infection from the partner and if the mother is HIV positive then the baby can get infection from the mother during pregnancy. At the time of delivery, RH factor is decided by the type of protein on the red blood cells and it is also called NTJ. Most of the people have protein or RH Factor on the red blood cells and they are said to be RH positive and those they do not have the RH factor of protein on the cells are said to be RH negative. If RH negative mother carries an RH positive fetus during pregnancy, a small amount of leak or fetal blood cells takes place into the maternal circulation during pregnancy and at the time of delivery mother's body produces antibodies to fight the RH factor on the fetal red blood cells. These antibodies cross the placenta and reach the fetus and they destroy the fetal red cells and produce a condition called hemolytic disease of the newborn. In mild cases, the baby will develop the jaundice ; In moderate cases, it is the anemia of the newborn ; and in the sever cases the baby dies inside the uterus.
There is a way to prevent the formation of her body from forming antibodies rh- globulin containing RH. Antibodies should be injected into the Rh negative mother during pregnancy and just after delivery with readymade antibodies now available. The mother's body seems no need to make her own antibodies.
Thalassemia is a genetic blood disorder affecting the red blood cells it affects 7-8% of the Indian population. Some of the high risk communities are Sindhi Punjabi's lohanas Maymans and Bhanushalis.
Two main forms of thalassemia are:
- Thalassemia minor
- Thalassemia major.
Thalassemia Minor- People with thalassemia minor generally healthy, though they may suffer from mild anemia.
Thalassemia Major- Child with thalassemia major is born when both parents are carriers of thalassemia minor. Thalassemia major is a fatal blood disorder.
A regular transfusion is essential to enable proper growth and development of the child throughout the life. Proper planning and use of 100% sure and safe method of contraception should be used to avoid the unwanted pregnancy before marriage.
Now I am going to tell you about pre-pregnancy counseling. Antenatal care begins long before the patient becomes pregnant. All the patients should visit the gynecologist before pregnancy. Those patients who are at risk of medical and offset complications should visit to know when to become pregnant. Medical complications like diabetes, hypertension, thyroid, asthma, tuberculosis during pregnancy can cause genetic disorder. If patient has genetic disorder then they can choose not to become pregnant and may decide for adoption. Follic acid should be started three months before becoming pregnant to prevent the development of neural tube defects like spinal bifida and anencellaly.
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Love making is generally portrayed as a way to great pleasure. However, what most may not know is that intercouse can be painful, very painful, so much so that you at times don’t want it. In fact, an alarming 75% of women have had pain during sex at some point in their lives. There are physical and psychological components to this, both of which can be managed easily if identified. While some may be frank and talk about it, a lot of them go unspoken and therefore endure the pain in silence.
Painful intercourse, which is a major deterrent for a happy intimate life, has a lot to do with the mindset and emotions than actual physical or physiological problems. Fear of being hurt, performance anxiety, sexual inhibitions, past history of abuse, etc. are major contributors for painful intercourse.
Physical causes for the pain include temporary reasons like the ones listed below.
- Vaginal Infections: Fungal infections of the vagina and surrounding organs are very common and there could be sores or lesions, which can turn painful with sex.
- Vaginismus: Another common condition leading to painful sex, these are involuntary contractions, which often happens as a defense mechanism. The woman has the fear of being hurt and so these spasms happen.
- Gynaecological Issues: Ectopic pregnancy, ovarian cysts, menstrual disorders, endometriosis, cervical problems and vulvar injuries are other causes which can lead to painful intercourse.
With any of these, the remedy lies in acknowledging the problem.
If there are no physical issues, talking about the past, discussing her fears and anxiety can help. Many times, the expectations are often unspoken and there is a lot of uncertainty, fear and anxiety between the couple, especially with respect to intimacy. A frank talk can help ease both of them, and that can often help in reducing pain during sex. If required, counselling can be sought,so that she opens up. In most cases, one or two sittings with both couples and a counsellor can help find the problem and work out a lasting solution.
Lubrication is often another problem that leads to pain. When there is not sufficient mental stimulation, the chances of a dry vaginal mucosa are high. Artificial lubricants can be used to help with easy penetration and reducing the pain. Infections can be managed with antibiotics, often topical, unless it is very severe and requires systemic antibiotics. Women who have delivered babies should refrain from sex for complete healing, as it can be painful.
Menopause is another reason for painful sex and this is due to lower hormone level. Using hormones either topically or supplements like birth control pills can improve overall sexual urge and lead to painless sex.
Also known as tubal sterilization, tubectomy is a permanent method of contraception in women. It is a surgical procedure in which a portion of the fallopian tubes are blocked to prevent an egg that is released from the ovaries, from reaching the uterus. In case an egg is present in the uterus, it carries with it the risk of fertilization, thus, can lead to pregnancy. Sometimes the patient may change her decision and ask for a reversal of the process. However, it should also be kept in mind that the surgery is a complex one. The results are often not guaranteed.
- Tubectomy refers to cutting or blocking a small portion of the fallopian tubes that prevent the released eggs from reaching the uterus.
- The surgeon reaches to the fallopian tubes by cutting open a portion of the abdomen in case of an open surgery.
- Laparoscopic techniques are also available to conduct the surgery.
- The fallopian tubes are blocked by an artificial clip to prevent the passage of eggs.
Are there any risk factors involved?
- Tubectomy may create a number of health complications in the long run.
- Tubectomy is not advised for patients who have previously undergone abdominal surgeries.
- Major risks of injury such as perforation surrounding blood vessels, internal haemorrhage or a severely life-threatening situation such as ectopic pregnancy may occur later on. Ectopic pregnancy is when fertilization and implantation occur within the fallopian tube instead of the uterus.
- Tubectomy is even more challenging than vasectomy and has higher chance of giving rise to health complications.
Although the procedure is complex, it has a few advantages as well. Minimally-invasive surgeries help in quicker recoveries. It is almost 99% effective as a measure of birth control and thus provides a permanent solution. This surgery can even be done immediately after delivery. Sometimes, in rural areas, family welfare departments, government hospitals and primary health care centres offer free surgery and care to aid and educate about family planning.
What is Bacterial Vaginosis?
Bacterial Vaginosis is an infection that occurs in and around the female genitalia. It does not usually pose a major health threat and is a mild infection that can be controlled and cured with timely medical intervention. Although it is believed to be sexually transmitted, it can also affect women who are not sexually active.
In some cases, pelvic surgeries, which include caesarean, hysterectomy, abortion or other abdominal surgery, bacterial vaginosis can be contracted during the surgical procedure. This can further complicate the condition of the patient.
Bacterial Vaginosis is a common complaint among women who have physically reached the child bearing age and symptoms of this physical problem can become prominent at any time of the menstrual cycle.
Causes of Bacterial Vaginosis
Dirty, unwashed underwear
Multiple sexual partners
Change in the vaginal pH, causing the reduction in the protective acidic secretion that prevents the growth of other harmful bacteria
It can also arise from the placement of Intrauterine device (IUD), a contraceptive device placed to prevent the eggs released by the ovaries, from reaching the uterus.
Symptoms of Bacterial Vaginosis
The most common sign of bacterial vaginosis is a foul smelling vaginal discharge.
The discharge increases after sexual activities.
Discomfort during urination
In some rare cases, there is itching and dryness
In most cases, bacterial vaginosis does not reveal too many symptoms and does not even cause intense irritation.
Bacterial Vaginosis can be treated with antibiotics that are generally to be continued for a course of 7 days.
Symptoms and discomfort of bacterial vaginosis generally recede within 2-3 days. However, it is recommended that the medicine should not be stopped even after the symptoms disappear.
- Only in rare cases, certain antibiotics may lead to a vaginal yeast infection. In case of redness, inflammation, irritation and undesirable discharge, you must seek medical attention immediately.
Pregnancy is one of the most exciting and anxious phase in a woman’s life. There is definitely an information overload from all sources i.e. family, friends, medical team, books, Internet, etc., that is dumped on the mother-to-be. The idea is to prepare her for the delivery. What needs to be borne in mind though is that each delivery is unique and there are no two women who have had the exact same experience.
However, it is good for the mother to know what to expect so that she is mentally prepared and not totally caught unawares when the actual scenes unfold. The following are the sequence of events that she should be aware of and watch out for:
- With the due date nearing, she should keep a watch for the water breaking. This is passing of fluid surrounding the baby and is usually colorless and odorless. However, if it is green or brown, it is an indication that something might be wrong. Immediate medical help should be sought in that case.
- Along with water breaking, contractions is the next thing to watch out for. This is due to the tightening and releasing of the uterus, indicating that the baby has begun to descend down towards the cervix. If these last for up to a minute, occur every five minutes, and persist for up to an hour, it is a clear indication that it is delivery time and you must head to the hospital.
- Two sensations very prominent during delivery are pain and pressure. The pressure is from the baby passing down the birth canal. As the cervix and the vaginal canal expand to allow passage of the baby, there would be a great deal of pain and pressure. It is not just the mother, even the baby exerts significant pressure to come out of the womb during labor.
- The process of the baby getting out of the womb is what is medically termed as labor and has three distinct stages to it:
- The first stage has two parts to it i.e. an initial, gradual phase that may last for a few hours and a later, quicker phase. The rate of progress of delivery is steady.
- The second stage usually lasts for about two hours, during which the cervix is minimally dilated and pushing begins. This stage lasts until the baby is out of the womb.
- The third and the last stage is where the placenta is extracted and the umbilical cord is cut.
Some common problems you may expect include injury or tearing of the vagina or cervix, need for episiotomy, vomiting, passing of motion, anesthetic complications, etc. However, what would remain etched in the mother’s memory would be the first sight of the baby. In case you have a concern or query you can always consult an expert & get answers to your questions!
While you are too busy running a rat-race, chasing education, career, and everything extravagant and lavish, you might be slowly slipping away on your chances of parenting a baby. Find that strange and wayward? Well, your fertility might have already started taking a dip. The chances of conception drop down to less than 10% as a woman approaches the mid-thirties and a man, mid-forties. This is because increasing age takes a toll on the quality and the quantity of eggs produced. Chromosomal problems accompanied by risk of miscarriages tend to bring down pregnancy rates. So much so, that a child, born to older parents, might have higher risks of suffering from learning difficulties, psychological disorders and even autism. Not only age, but one’s innate lifestyle habits and practices can also be a few reasons behind infertility.
Age and Fertility: Women’s fertility starts to decline when women are in their early 30s (and the decline speeds up post-35). Men’s fertility starts to decline at 45 years of age. As well as declining fertility, there is an increased risk of pregnancy complications for older mothers and and with older fathers, an increased risk of the child having autism spectrum disorders, mental health disorders and learning difficulties.
Weight and Fertility: Obesity, owing to a sedentary lifestyle and an unhealthy diet, can cause and aggravate hormonal irregularities in both the genders. For men, these imbalances result in coital problems and dip in the sperm count, while for women, they pose threats such as miscarriages, risks of a still-born child and other pregnancy complications. Women who are obese and smoke are more than twice as likely as healthy weight women to have a baby with congenital heart disease.
The Appropriate Timing: If you fail to keep a track of the most fertile period of your menstrual cycle based on the days you ovulate, you might miss out on a good chance of getting pregnant. Pregnancy is technically possible during the five days before ovulation and the day of ovulation. The likelihood of actually becoming pregnant, though, is dramatically increased if you have intercourse in the three days leading up to and including ovulation.
Stress: In today’s times, some amount of stress is unavoidable. However, being subject to constantly high levels of stress on a daily basis ups the secretion of the stress hormone, ‘cortisol’; that eventually takes a toll on one’s libido, thus wreaking havoc on one’s chances and aspirations of parenting a child. Also, what too much stress does is that it mars personal relationships, thus further increasing one’s woes.
Pollutants: With rapid urbanization and unchecked industrialization, the world you live in was never more polluted than now. Such increased and consistent exposure to pollution makes one all the more vulnerable to infertility.
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 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:
- 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.
- 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.
- 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).
- 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.
- 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.
In case you have a concern or query you can always consult an expert & get answers to your questions!
My wife is pregnant but we do not want child right now, she think to take an abortion pill? Can it is safe? Its first time she is pregnant and she is 23 years old, Can abortion pills affect for pregnancy in future? Many couple surrounding us do not have any child after 3 to 10 years of marriage because of family planning .We are confused please give proper guidance.
Sometimes getting pregnant is not a very easy task and may end up taking a long time. But once you've decided to start a family of your own, it becomes harder to wait for it to happen. Here are 5 things you can do increase your chances of getting pregnant.
- Have missionary sex at least once every 2-3 days: The key is to have regular unprotected sex for over a year. The success rate for this is 84%. It is advised that you have sex every two to three days in every month of the year, and it's not necessary to stick to only those days for having sex when the woman is ovulating. Further, a spiced up sex life can increase your chances of the girl getting pregnant. As for the position, the missionary position works best as it helps the sperm on travelling through the cervix, which in any other position proves to be difficult. You can make the path of the sperm even easier by placing a cushion under the woman as it tilts the uterus, allowing the sperm to travel through more easily.
- Keeping track of the ovulation period: Even though regular sex throughout the month is advised, it is certainly more fruitful to know your cycle. You can only get pregnant when the sperm meets the egg, and the egg is only released around the 14th day in your cycle. This egg lives only for a day or two, so you have a limited window when you can actually get pregnant. Typically this window is approximately of 6 days, so it?s best to have sex in this period. But it's important not get obsessive and put too much pressure to have sex on these days as the stress can reduce sperm quality. So be mindful of it and still enjoy the activity rather than being obsessive. There are several free apps that you can download to help you track your cycle.
- Ensuring the sperm health: Cutting down on coffee, cigarettes and alcohol and maintaining an ideal weight as well as increasing the consumption of folic acid are necessary steps to ensure healthy and fertile sperm quality. Alcohol reduces sperm production, smoking causes low sperm count and slow-moving sperm, while being overweight can affect a man's libido and performance. The same goes for caffeine or drinks that contain a high amount of soda. Besides, prolonged exposure to heat on the testicular area should also be avoided to ensure that the man?s sperm is healthy. So avoid keeping laptops on your lap, saunas and jacuzzis, hot baths, steam rooms, long drives or wearing tight underwear.
- Try de-stressing: Psychological preparedness is as important as physical preparedness to maximise your chances of getting pregnant. These days couples lead very hectic and stressful lifestyles in which trying to get pregnant can only add to their stress levels. Increased stress lowers egg passage in women. Besides, trying too hard to get pregnant and the stress that it creates is the reason behind 30% of all infertility problems. In such cases, destressing by exercising, yoga, meditation or acupuncture is a good idea.
- Don't put off having a baby for too long: Women are at their peak fertile period in their early twenties, but these days many women opt for starting a family at a later age. Having a baby post the age of 30 can pose problems as fertility levels tend to drop. Post the age of 31 fertility in women drops by 3% per year and continues at the same rate till 35. After the age of 35 the rate of decline accelerates.
In case you have a concern or query you can always consult an expert & get answers to your questions!