First trimester in your first time pregnancy- what to expect

You have just gotten the big news!  You are pregnant! The feeling when you get confirmation from your Gynecologist doctor, is amazing! Having a child is the most precious, amazing and scariest thing ever!

Don’t worry though, I know it seems as if there is so much to do before the baby comes and there is, but relax, it’ll be okay and you’ll have help to get these things taken care of.  Here are some tips for you for first time pregnancy. These will help you get through your first time being pregnant with little worrying. Let’s face it, we’re women and we worry but don’t get so worked up, it will upset the baby. Good luck and congratulations.

Take Care of yourself during your pregnancy

The basic premise here is to be healthy and stay healthy for you and your baby.  Don’t smoke or be around second hand smoking or be around heavy smokers. You should not drink either.  You should sleep and rest as much as possible because you will NEED it! If you’re not, start taking prenatal vitamins, with folic acid.  When you buy these, always make sure they contain folic acid. It is vital to your pregnancy. Taking care of yourself will ensure that you have a healthy baby growing inside of you.  Your baby’s neural cord turns into the brain and spinal cord, developing in the 1st month you’re pregnant. Therefore, essential vitamins and minerals are very important from day one.

Exercise

If you don’t know this, it is very important that you exercise in some way to help with stress, weight control, help your circulation, keep your mood stable and you’ll sleep better if you exercise.  You should take a walk for at least 15-20 minutes each day. Swimming is a really good exercise when you are pregnant, especially if it’s summer time! Try to get at least 30 minutes of exercise a day.

Get to know more about your baby

Educate yourself and learn about what was going on with your body.  Learn the pains and what happens each week as your baby grows inside. If you read up on the baby, it will get you thinking about certain questions to ask your doctor.  Also, find out your family history, you’re going to need to know everything about everyone.

Keep track of your weight gains

During your pregnancy, it’s okay to gain weight, you’re eating for two, however, gaining too much weight can be unhealthy for you.  Also, you’ll have a hard time losing the weight if you gain too much. If you don’t gain enough weight, your baby’s birth weight and health could be in jeopardy.  This is what Gynecologist doctors recommend that you gain for your pregnancy:

  • Underweight: Gain 28-40 Pounds
  • Normal Weight: Gain 25-35 Pounds
  • OverWeight: Gain: 15-25 Pounds
  • Obese: Gain 11-20 Pounds

Eating Healthy will pay off! Trust me!

You definitely should drink about 8-10 glasses of water a day.  My doctor told me that I should eat about five or six well-balanced meals each day. When you eat, you need to make sure that you are eating foods that are folate-rich.  These foods include: cereals, lentils, oranges, orange juice and asparagus. Again, folic acid is extremely important in the development of your baby’s neural tube. Folic Acid also is vital for red blood cells to be created.  Natural sugars in bananas and apples can lift your energy levels, which is close to a cup of coffee.

Nausea with or without vomiting

Morning sickness or nausea, which can strike at any time of the day or night, is one of the classic symptoms of pregnancy. For some women, the queasiness begins as early as two weeks after conception. Nausea seems to stem at least in part from rapidly rising levels of estrogen, which causes the stomach to empty more slowly. Pregnant women also have a heightened sense of smell, so various odors – such as foods cooking, perfume or cigarette smoke – may cause waves of nausea in early pregnancy. There are some hints and tips to help combat the effects of morning sickness.

It’s important to take care of your baby, even before he or she is born. You can do this by living a healthy lifestyle and keeping doctor’s appointments while you’re pregnant. This is called prenatal care. You’re more likely to have a healthy birth if you maintain a healthy pregnancy.

Path to improved health

Schedule an appointment with your Gynecologist doctor as soon as you find out you’re pregnant. Your doctor will start by reviewing your medical history. He or she also will want to know about your symptoms. During this first appointment, urine and blood samples will be taken. (These will also be taken again on later visits.) Urine tests check for bacteria, high sugar levels (which can be a sign of diabetes), and high protein levels (which can be a sign for preeclampsia, a type of high blood pressure during pregnancy). Blood tests check for blood cell count, blood type, low iron levels (anemia) and infectious diseases (such as syphilis, HIV, and hepatitis).

The doctor also may do other tests at your first visit. These may vary based on your background and risk for problems. Tests can include:

  • A pelvic exam to check the size and shape of your uterus (womb).
  • An ultrasound to view your baby’s growth and position. An ultrasound uses sound waves to create an image of your baby on a video screen.

After your first visit, you will have a prenatal visit every 4 weeks. In months 7 and 8, you will have a visit every 2 weeks. In your last month of pregnancy, the visits will occur weekly until you deliver your baby. At each visit, the doctor will check your weight and blood pressure and test your urine. The doctor will listen to your baby’s heartbeat and measure the height of your uterus after the 20th week. You should always discuss any issues or concerns you have with your doctor.

Here are some other guidelines to follow during your pregnancy.

How much weight should I gain during pregnancy?

Talk to your doctor about this. It’s different for everyone, but most women should gain about 25 to 30 pounds. If you’re underweight when you get pregnant, you may need to gain more. If you are overweight, you may need to gain less.

What should I eat?

Eating a balanced diet is one of the best things you can do for yourself and your baby. Be careful of the following foods and drinks during pregnancy.

  • Raw meat, eggs and fish. Food that isn’t fully cooked can put you at risk for food poisoning. Don’t eat more than 2 or 3 servings of fish per week (including canned fish). Don’t eat shark, swordfish, king mackerel, or tilefish. These fish have high levels of mercury, which can harm your baby. If you eat tuna, make sure it’s light tuna. Don’t eat more than 6 ounces of albacore tuna and tuna steaks per week. It’s safe to have 12 ounces of canned light tuna per week.
  • Fruit and vegetables. Wash all produce before eating it. Keep cutting boards and dishes clean.
  • Eat 4 or more servings of dairy each day. This will give you enough calcium for you and your baby. Don’t drink unpasteurized milk or eat unpasteurized milk products. These may have bacteria that can cause infections. This includes soft cheeses such as Brie, feta, Camembert, and blue cheese, or Mexican-style cheeses, such as queso fresco.
  • Sugar substitutes. Some artificial sweeteners are okay in moderation. These include aspartame (brand names: Equal or NutraSweet) and sucralose (brand name: Splenda). However, if you have phenylketonuria (PKU), avoid aspartame.
  • Don’t drink more than 1 or 2 cups of coffee or other drinks with caffeine each day.

Can I take medicine?

Check with your doctor before taking any medicine. This includes prescriptions, pain relievers, and over-the-counter medicines. Some medicines can cause birth defects, especially if taken during the first 3 months of pregnancy.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi, with over 13 years of clinical experience. At present she is practicing in Max Smart super specialty hospital, Saket, Apollo cradle Royale, Nehru place and her clinic in Greater Kailash part 2, Delhi.

Living with a fibroid

What are uterine fibroids?

Fibroids are benign tumors made of smooth muscle cells and fibrous connective tissue. They develop in the uterus. It is estimated that 70-80% of women will develop fibroids in their lifetime—however, not everyone will develop symptoms or require treatment. The most important characteristic of fibroids is that they are not cancer, and they do not have the potential to become cancer. Because of that, it is reasonable for women without symptoms to opt for observation rather than treatment. Studies show us that fibroids grow at different rates, even in the same woman, and can range from the size of a pea to the size of a watermelon.

Who is at risk for uterine fibroids?

As women age their likelihood for developing fibroids increases. Studies have demonstrated that women with a family history are more likely to develop fibroids. Fibroids are also more common in African American women. Obesity has also been linked to an increase risk of fibroids. There are no foods or diets that are known to increase a woman’s risk of developing fibroids.

Symptoms

Some women never realize that they have fibroids because they have no symptoms. In other women, uterine fibroids are discovered either during a routine gynecologic exam or during prenatal care.

When symptoms of fibroids occur, they can include:

  • Pelvic pain or pressure
  • Heavy menstrual bleeding
  • Bleeding or spotting between menstrual periods
  • Unusually frequent urination
  • Abdominal swelling
  • Low back pain during intercourse or during menstrual periods
  • Fatigue or low energy from heavy periods and excessive bleeding
  • Infertility, if the fibroids are blocking the fallopian tubes
  • Constipation
  • Repeated miscarriages

Diagnosis

Usually, a woman doesn’t realize that she has a fibroid until her gynecologist feels it during a pelvic exam. If your gynecologist thinks you have a fibroid, several tests can confirm the diagnosis:

  • Pelvic ultrasound — In this radiology test, a wand-like instrument will be moved over your lower abdomen or may be inserted in your vagina to view the uterus and other pelvic organs more closely. The instrument produces sound waves that create an image of your pelvic organs.
  • Hysterosalpingogram— In this X-ray procedure, a dye is injected into your uterus and fallopian tubes to outline any irregularities.
  • Hysteroscopy— During this procedure, a narrow instrument that looks like a telescope is inserted through your vagina into your uterus. This lets the doctor look for abnormal growths inside your uterus.
  • Laparoscopy— In this procedure, a thin tube-like instrument called a laparoscope is inserted through a small incision in your belly so the doctor can look inside the abdomen.

Expected Duration

The number of fibroids, their size and how fast they grow varies among women. Female hormones encourage fibroids to grow, so they continue growing until menopause. Some fibroids shrink after menopause. However, larger fibroids may change little or become only slightly smaller in size. If a woman has had fibroids removed surgically, new fibroids can appear any time before she enters menopause.

Prevention

There are no proven measures you can take to prevent fibroids from developing. Studies show that athletic women seem to be less likely to develop fibroids than women who are obese or who don’t exercise.

Treatment

If fibroids are small and are not causing any symptoms, they do not need to be treated. Your gynecologist may do a pelvic examination every six months to a year to make sure that your fibroids are not growing rapidly. In some cases, medications can be prescribed to control any abnormal bleeding and temporarily shrink the fibroids.

Medications used to shrink fibroids, such as leuprolide (Lupron), create a temporary menopause by stopping the ovaries from making the female hormone estrogen. While estrogen levels drop and menstrual periods stop, menopausal hot flashes appear and fibroids stop growing and slowly shrink. This helps to stop blood loss from heavy, prolonged periods. However, when the medication is stopped periods return, hot flashes disappear and fibroids that have not been removed will start growing again. These medications usually are given by needle injection in a large muscle.

Fibroids may need to be removed if they cause significant symptoms or are large enough to interfere with fertility. Growths in your uterus also may need to be removed if it is difficult for your doctor to tell whether they are fibroids or cancer. There are several options for removing fibroids:

  • Myomectomy— This means cutting the fibroids from the uterine wall. Myomectomy allows a woman to keep her entire uterus in case she wants to have children. However, because this surgery can leave the uterine wall weakened, future babies may have to be delivered by Caesarean section. Surgery to remove fibroids sometimes can be done by laparoscopy, which is surgery through several small incisions in the lower abdomen. When fibroids are too large or too abundant to perform a laparoscopic procedure, then a traditional approach through a larger incision in the lower abdomen is preferred.
  • Hysteroscopic resection — In this procedure, a viewing instrument called a hysteroscope is inserted into the uterus through the vagina. Surgical instruments attached to the hysteroscope are used to remove fibroids growing inside the uterus. This procedure sometimes is done in combination with laparoscopy, depending on the number and location of the fibroids.
  • Uterine artery embolization — In this X-ray-guided procedure, material is injected into specific blood vessels to plug them and stop blood flow to a fibroid or fibroids. It is an option for a woman who may not be medically cleared for surgery or who does not plan to have more children, but prefers not to have her uterus removed.
  • Hysterectomy — In this procedure the uterus is removed including all fibroids within it. Though other options are available to treat or remove fibroids and the patient’s needs and goals must be fully considered, in some cases hysterectomy is the preferred treatment. This may include situations in which fibroids are too numerous, too large, or cause heavy prolonged bleeding and severe anemia. Some patients may prefer hysterectomy so they can be assured the fibroids will not grow back.

Dr.Ruchi Tandon is a Gynecologist with over 13 years of clinical experience in handling fibroids. At present, she is available at all leading South Delhi hospitals.

Painless delivery and water birthing – the things you should know

What is Painless Delivery?

Painless delivery refers to the use of an epidural injection which is given by an anaesthesiologist trained in epidural injection for pain relief during labour. It is injected in the lower of back, and a plastic tube is placed through which drugs are released around the spinal cord. It is mostly injected only once when you are in active labour which means you are having at least three contractions in 10 minutes.

Epidural doesn’t always provide 100% pain relief, but it substantially reduces pain and sensations in the lower half of the body, especially below umbilicus. In early labour, pain can be managed using natural methods like warm showers, massages, and exercises.

Is it safe to take Epidural?

According to the doctors, epidurals are safe for the mother and baby, and it also provides relief from exhaustion and irritability. It helps women to relax and refocus on labour, but like any medical intervention, it can also cause unwanted side effects.

Why should you avoid an Epidural?

Epidural has a numbing effect. You will not be able to walk around and be confined to your bed.

  • Your labour may be longer.
  • You may have difficulty urinating and need a catheter.
  • You may experience nausea and dizziness.
  • You may be at higher risk for a forceps or vacuum delivery.
  • It can fail to relieve the pain.

What are the Pros and Cons of Painless Delivery?
Pros

  • It helps a woman cope better with post-partum depression or exhaustion.
  • It relaxes the vaginal muscles and provides space for the baby to descend.
  • It decreases the blood pressure of the mother which is good because in natural labour, the mother has high BP and there are risks of the pressure reaching dangerously high levels and ending in a stroke.
  • It prevents damage that would otherwise occur to the pelvic muscles during a normal delivery.
    Cons
  • It can fail completely to relieve the pain sensation and can be cumbersome.
  • It could cause a backache, dizziness or shivering.
  • A decrease in the mother’s blood pressure can lead to a slowing down of heartbeat rate in the baby.
  • There is a risk of experiencing severe headaches because of the fluid of the spine leaking.
  • In some cases, there are chances of irretrievable damage to the nerves.In some studies, it was suggested that babies born in a painless delivery procedure could be a little slow and may face breastfeeding problems.

Should you choose a Painless Delivery?

It is suggested to a pregnant woman to prepare for normal delivery by building their stamina, practicing labour exercises and breathing techniques and selecting a birth partner. You can cope well with labour pain without an epidural with the right support.

Water delivery

Water birth is childbirth that occurs in water. Proponents believe water birth results in a more relaxed, less painful experience  Critics argue that the safety of water birth has not been scientifically proven and that a wide range of adverse neonatal outcomes have been documented, including increased mother or child infections and the possibility of infant drowning. A 2018 Cochrane database of water immersion in the first stages of labor found evidence of fewer epidural and few side effects but insufficient information regarding giving birth

A moderate to weak level of evidence indicates that water immersion during the first stage of childbirth reduces the pain of labor. A 2018 Cochrane review found that immersion during the first stage of childbirth reduces the use of epidurals, however there is no clear evidence on the benefits of water immersion for the second stage of labor or full water birth. There is no evidence of increased adverse effects for immersion during the first or second stages of labor. There is not strong evidence that a water birth reduces tearing or perineal trauma.

Water birth may offer perineal support for a birthing mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy.

Dr.Ruchi Tandon, is a trained obstetrician and Gynecologist, with over 13 years experience in painless deliveries. She is available at leading South Delhi hospitals like Max Smart superspeciality hospital, Apollo hospitals for pregnancy management.

Why choose Dr.Ruchi Tandon as your Gynecologist?

Let’s answer a more honest question first,

What should you look for in your Gynecologist?

Trust and comfort.

Once you have shortlisted a few doctors you would like to meet, schedule an appointment with them to help you decide which one to stick with.

Over the course of your nine months, you will form a bond with your gynecologist. Even if the relationship ends with the delivery, most mums remember the doctor who helped deliver their baby with fondness. You need to be able to trust your gynecologist to take the right decisions for you at short notice during birth and to give you the necessary information and advice to have a healthy pregnancy and baby.

This trust might grow as you progress in your pregnancy but you can already decide a lot in your first meeting. When you go for your first appointment, ask yourself the following questions:

  1. Does the gynecologist answer your questions willingly?
  2. Is she friendly and responsive?
  3. Do you feel comfortable asking her personal medical questions?
  4. Does she seem up-to-date in her knowledge?
  5. Is she listening to your concerns and answering accordingly?
  6. Is she gentle during her check up?
  7. Does she seem to care about your comfort?

If you don’t feel comfortable with this doctor at your first meeting, try another one.

Many women prefer female gynecologists. But keep an open mind: you may also find a male gynecologist who is understanding and helpful. Make your decision after you’ve had a chance to speak with several doctors.

There is a reason that a woman’s intuition is so revered, it is often right! So do your research, check background information and the practicalities of consulting a particular doctor, but in the end trust your gut.

Often family members have a common gynecologist because it is easier to see someone known, tried and tested than to look for a new doctor. Do not feel bad about wanting someone else if for some reason you are not comfortable with the gynecologists that your other family members have been happy with. It is about your health and your body so you have to be satisfied.

Difference Between a Gynecologist and Obstetrician

Technically, obstetricians and gynecologists are two separate specialties. Gynecologists are doctors or physicians who have specialized in women’s reproductive care. Obstetricians are the one delivering babies and providing pregnancy care. Now the two fields are largely interwoven and that is why in India, we have about 90% doctors who are a hybrid of the two, nicknamed as “ob-gyns” who would both take care of reproductive health problems while also delivering babies.
Happy pregnancy and happy womanhood!

Key points in helping you decide your Gynecologist

  1. Reference:You cannot visit every doctor in town to pick the right one for you. So you do the next best thing. Ask people! Ask family, friends, colleagues, your partner’s colleagues and neighbors for recommendations. Remember that you might not share your personality with these advisers, so what worked for them might not work for you. However, this step will definitely help you to narrow down your list. Or even create a list, if you have not already done so. You can also look online for feedback – but as usual, take them all with a pinch of salt.
  2. Reputation:Look for the doctor’s credentials. Start from the hospitals that the doctor has been with, and do take into consideration the educational degrees. More often than not, it is difficult for laymen to understand any acronym beyond MBBS and MD that follows the doctor’s name. However, once you have shortlisted the doctors, you could use credentials and number of years of experience as a selection criteria
  3. Specialization:Find out if your gynecologist is also an obstetrician (see the end of this article for details). If not, you would need an obstetrician at the time of your delivery. Also depending on your pregnancy, you might want to pick a gynecologist who is specialized in high-risk pregnancies. This option should be explored if you have an underlying medical problem, have had miscarriages before or if you are having multiples. For example, if you have been a patient of blood pressure or epilepsy, you will need to consider whether your doctor has handled patients with such conditions. In this reference, you will need to consider the hospital’s credibility as well
  4. Availability: How easy is to get an appointment with the doctor? What is the waiting period like? Unfortunately, better the doctor is, more busy he/she would be. In most cases, with good advanced planning, you can block the doctor’s calendar for your monthly check-ups. That said, here are few things you need to clarify:
  • Will the doctor be available on phone or SMS to answer your non-emergency queries?
  • How long do you need to wait to get a non-routine appointment?
  • How does he/she deal with emergency calls? How soon will he/she be able to meet or attend you?
  1. Time Spent: This is sometimes the most important criteria, especially for first-time parents-to-be. You need a gynecologist who is not rushing from one appointment to other without pausing. You need someone who is relaxed no matter how many more patients are waiting after you. You need someone patient enough to answer all your questions, no matter how minor it might sound

Dr.Ruchi Tandon, is a Gynecologist practicing in South Delhi for the last 13 years, she is available at leading hospitals including Max Smart super speciality hospital, saket, Apollo Spectra , kailash colony, Apollo cradle Royale , Nehru place , Delhi. She is well versed in the various subspecialties of Obstetrics and Gynecology. Trained laparoscopic surgeon and Cosmetic Gynecologist makes her an ideal choice. Her humbleness and approachable nature make her patient-friendly.

She is versed in cases of fibroids, pregnancy management, PCOD, endometriosis, menopause management, ovarian cyst, abnormal bleeding, recurrent UTI and PID.

Heavy period – how to manage it?

What is menorrhagia?

Menorrhagia is a heavy or prolonged menstrual bleeding. Many women have this type of abnormal uterine bleeding. It can be related to a number of conditions including problems with the uterus, hormone problems, or other rare conditions. While heavy bleeding can make it tough to take part in normal daily life at times, there are treatments to help.

What causes menorrhagia?

During your menstrual cycle, if an egg is not fertilized, the uterine lining breaks down, and bleeds. The egg and the uterine lining are then shed during your period.

Hormone problems or conditions that affect the uterus can result in heavy bleeding. Other diseases or bleeding disorders can also cause it.

Hormone problems include:

  • Imbalance of estrogen and progesterone or other hormones

Problems with the uterus include:

  • Fibroids (non cancerous)
  • Cancer
  • Pregnancy problems (such as a miscarriage or ectopic pregnancy)
  • Use of an intrauterine device (IUD)

Other conditions such as thyroid, kidney or liver disease, cancer or bleeding disorders can also cause heavy bleeding.

What are the symptoms of menorrhagia?

If you have to change your pad or tampon every 1 to 2 hours because it is soaked, or bleed longer than 7 days, see your doctor. Spotting or bleeding between periods is also a sign of a problem.

The symptoms of menorrhagia may look like other conditions or medical problems. Always consult your healthcare provider for a diagnosis.

How is menorrhagia diagnosed?

Your healthcare provider will ask you about your medical history and about your periods. You will also have a physical exam including a pelvic exam. You may be asked to keep track of your periods and how many pads or tampons you use for a few months if you haven’t already done so.

  • Blood tests. These check for anemia and test how fast your blood clots.
  • Pap test. For this test, cells are collected from the cervix and examined. It’s used to check for cancerous changes, infection, or inflammation.
  • Ultrasound. Using sound waves and a computer, your healthcare provider can check for fibroids or other problems inside the uterus.
  • Biopsy. Examining a tissue sample from the uterine lining can help your healthcare provider find cancer or other abnormal tissue.

Other tests include:

  • Hysteroscopy. Using a viewing instrument inserted through the vagina, your healthcare provider can see the cervix and the inside of the uterus.
  • Dilation and curettage (D&C).This procedure involves scraping and then examining the uterine cavity.

Treatment

Treatment of menorrhagia depends on the individual case.

Drug therapy includes:

  • Iron supplements to treat anemia
  • Tranexamic acid, or Lysteda, taken at the time of bleeding to help reduce blood loss
  • Oral contraceptives to regulate the menstrual cycle and decrease bleeding duration and quantity
  • Oral progesterone to treat hormonal imbalance and reduce bleeding
  • Hormonal IUD to thin the lining of the uterus, reducing bleeding and cramping

In women who have a bleeding disorder, such as von Willebrand’s disease or mild hemophilia, Desmopressin nasal spray, or Stimate can boost the levels of blood-clotting proteins.

Nonsteroidal anti-inflammatories, such as ibuprofen, or Advil, can be used to treat dysmenorrhea, or painful menstrual cramps, and they can help reduce blood loss. However, NSAIDS can also increase the risk of bleeding.

Surgical interventions

A number of surgical procedures are available to treat or relieve the symptoms of menorrhagia.

  • Dilation and curettage (D&C) is a surgical procedure for scraping the lining of the uterus
  • Uterine artery embolization treats fibroids, a cause of menorrhagia, by blocking arteries that feed them
  • Hysteroscopy involves inserting a camera into the uterus to evaluate the lining, assisting in the removal of fibroids, polyps, and the uterine lining.
  • Focused ultrasound ablation uses ultrasonic waves to kill fibroid tissue.
  • Myomectomy is a surgical intervention to remove uterine fibroids through several small abdominal incisions, an open abdominal incision, or through the vagina.
  • Endometrial ablation permanently destroys the lining of the uterus.
  • Endometrial resection uses an electrosurgical wire loop to remove the uterine lining.
  • Hysterectomy removes the uterus and cervix, and, sometimes, the ovaries.

The choice of intervention will take into account the cause and extent of the condition, the age and health of the patient, and their personal preference and expectations.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi and Greater Kailash.

PCOS in your 30’s, how it can affect you?

Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work.

The 3 main features of PCOS are:

  • Irregular periods – which means your ovaries do not regularly release eggs (anovulation)
  • excess androgen – high levels of “male” hormones in your body, which may cause physical signs such as excess facial or body hair
  • polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs (but despite the name, you do not actually have cysts if you have PCOS)

If you have at least 2 of these features, you may be diagnosed with PCOS.

What are polycystic ovaries?

Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size. 

The follicles are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place.

It’s difficult to know exactly how many women have PCOS, but it’s thought to be very common, affecting about 1 in every 5 women in the UK.

More than half of these women do not have any symptoms.

Symptoms of polycystic ovary syndrome (PCOS)

If you have symptoms of PCOS, they’ll usually become apparent during your late teens or early 20s.

They can include:

  • irregular periods or absent periods
  • difficulty getting pregnant as a result of irregular ovulation or failure to ovulate
  • The excessive hair growth or hirsutism – usually on the face, chest, back or buttocks
  • weight gain
  • thinning hair and hair loss from the head
  • oily skin or acne

PCOS is also associated with an increased risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS is unknown, but it often runs in families.

It’s related to abnormal hormone levels in the body, including high levels of insulin.

Insulin is a hormone that controls sugar levels in the body.

Many women with PCOS are resistant to the action of insulin in their bodies and produce higher levels of insulin to overcome this.

This contributes to the increased production and activity of hormones like testosterone.

Being overweight or obese also increases the amount of insulin your body produces.

What causes it?

Doctors don’t know exactly what causes PCOS. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally.

Genes, insulin resistance, and inflammation have all been linked to excess androgen production.

Genes

Studies show that PCOS runs in families.

It’s likely that many genes — not just one — contribute to the condition.

Insulin resistance

Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly.

Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy.

When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.

Obesity is a major cause of insulin resistance. Both obesity and insulin resistance can increase your risk for type 2 Diabetes.

Inflammation

Women with PCOS often have increased levels of inflammation in their bodies. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels.

How PCOS affects your body

Having higher-than-normal androgen levels can affect your fertility and other aspects of your health.

Infertility

To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. PCOS is one of the leading causes of infertility in women.

Metabolic syndrome

Up to 80 percent of women with PCOS are overweight or obese. Both obesity and PCOS increase your risk for high blood sugar, high BP, low HDL (“good”) cholesterol, and high LDL (“bad”) cholesterol.

Together, these factors are called metabolic syndrome, and they increase the risk for heart disease, diabetes, stroke.

Sleep apnea

This condition causes repeated pauses in breathing during the night, which interrupts sleep.

Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in obese women with PCOS than in those without PCOS.

Endometrial cancer

During ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up.

A thickened uterine lining can increase your risk for endometrial cancer. 

Depression

Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions. Many with PCOS end up experiencing depression and anxiety.

Dr.Ruch Tandon, the Gynecologist, specializes in PCOS and is available at leading hospitals in South Delhi

Urinary leakage in women, why does it happen?

What is stress incontinence?

Stress incontinence is the inability to control your urge to urinate in certain circumstances. It’s a serious and embarrassing disorder and can lead to social isolation. Any pressure placed on the abdomen and bladder can lead to the involuntary loss of urine.

It’s important to remember that the term “stress” is used in a strictly physical sense when describing stress incontinence. It refers to excessive pressure on the bladder and not emotional stress.

An overactive bladder is a separate condition. In some cases, both overactive bladder and stress incontinence can occur, which is called mixed incontinence. Your Gynecologist can do tests to determine which is causing your incontinence.

Anatomy of the bladder

Your bladder is supported by a varied system of muscles:

  • The sphincter encircles the urethra, the tube that carries urine outside of your body.
  • The detrusor is the muscle of the bladder wall, which allows it to expand.
  • The pelvic floor muscles help support the bladder and the urethra.

To hold urine inside your bladder without leakage, you need to be able to contract your sphincter. When your sphincter and pelvic muscles are weak, it’s more difficult to contract these muscles and the result is called as stress incontinence.

Stress incontinence symptoms

The main symptom of stress incontinence is the loss of bladder control during physical activity. You may experience a few drops of urine or a large, involuntary flow. This can happen while you are:

  • laughing
  • sneezing
  • coughing
  • jumping
  • exercising
  • doing heavy lifting
  • engaging in sexual intercourse

Sometimes even standing up from a seated or reclining position can put additional pressure on your bladder and cause a leakage. Stress incontinence is unique for every individual. You may not show symptoms every time you participate in an activity, and the same activities that cause leakage for you may not affect another person with stress incontinence.

Who suffers from stress incontinence?

Women are twice as likely as men to suffer from involuntary leakage. The most common causes of stress incontinence among women are pregnancy and childbirth, especially having multiple vaginal deliveries. During pregnancy and childbirth, the sphincter and pelvic muscles stretch out and are weakened.

Older age and conditions that cause a chronic cough can also cause stress incontinence. This condition can also be a side effect of pelvic surgery.

Some women only suffer from stress incontinence during the week before they get their period. Various studies explain that estrogen drops during this phase of the menstrual cycle, which can weaken the urethra. This is not common though.

Other risk factors for stress incontinence include:

  • smoking due to chronic cough
  • any other condition associated with chronic cough
  • excessive caffeine and alcohol use
  • obesity
  • constipation
  • long-term participation in high-impact activities

Treatment

Your Gynecologist may recommend a combination of treatment strategies to end or lessen the number of incontinence episodes. If an underlying cause or contributing factor, such as a urinary tract infection, is identified, you’ll also receive treatment for the condition.

Behavior therapies

Behavior therapies may help you eliminate or lessen episodes of stress incontinence. The treatments your doctor recommends may include:

  • Pelvic floor muscle exercises. Called Kegel exercises, these movements strengthen your pelvic floor muscles and urinary sphincter. Your doctor or a physical therapist can help you learn how to do them correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.

A technique called biofeedback can be used along with Kegel exercises to make them more effective. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.

  • Fluid consumption.Your doctor might recommend the amount and timing of fluids you consume during the day and evening. However, don’t limit what you drink so much that you become dehydrated.

Your Gynecologist may also suggest that you avoid caffeinated and alcoholic beverages because it’s believed that in some people these dietary irritants affect your bladder function. But, new research suggests that coffee and caffeine may not increase stress incontinence. If you find that using fluid schedules and avoiding dietary irritants significantly improves leakage, you’ll have to decide whether these changes are worth the improvement in leakage.

  • Healthy lifestyle changes.Quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve your symptoms.
  • Bladder training.Your doctor might recommend a schedule for toileting (bladder training) if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.

Medications

There are various approved medications to specifically treat stress incontinence.The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence.

Devices

Certain devices designed for women may help control stress incontinence, including:

  • Vaginal pessary. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your doctor or nurse. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed).

This is a good choice if you wish to avoid surgery. A pessary will require routine removal and cleaning. Pessaries are used mostly in people who also have pelvic organ prolapse.

Surgeries

Laparoscopic bladder neck repair, Kelly’s repair, sling operations,  burch colposuspensipn, TVT tape colposuspensipn are some of the surgical options.

Recently transvaginal RF LASER treatment is giving good results in stress and mixed incontinence.

Dr.Ruchi Tandon is a Gynecologist with 13 years experience in all cases of urinary leakage and urinary incontinence. She is practicing in leading hospitals in South Delhi.

What could possibly be the cause of your miscarriage and how to avoid it?

A miscarriage, also called a spontaneous abortion, is the spontaneous ending of a pregnancy. About 1/3 to 1/2 of all pregnancies end in miscarriage before a woman misses a menstrual period or even knows she is pregnant. About 10 to 20% of women who know they are pregnant will miscarry , mostly in the first three months.

A miscarriage is most likely to occur within the first 3 months of pregnancy, before 20 weeks gestation. Very few of miscarriages occur after 20 weeks’ gestation. These are termed late miscarriages.

What causes miscarriage?

About half of all miscarriages that occur in the first trimester are caused by chromosomal abnormalities, which might be hereditary or spontaneous , in the father’s sperm or the mother’s egg. Chromosomes are tiny structures inside the cells of the body that carry many genes, the basic units of heredity.

Genes determine all of a person’s physical attributes, such as sex, hair and eye color and blood type. Most chromosomal problems occur by chance and are not related to the mother’s or father’s health.

Miscarriages are also caused by a variety of unknown and known factors, such as:

  1. Infection
  2. Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents.
  3. Hormonal irregularities.
  4. Improper inplantation of fertilized egg in the uterine lining.
  5. Maternal age.
  6. Uterine abnormalities.
  7. Incompetent cervix. (The cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor.)
  8. Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs.
  9. Disorders of the immune system including lupus, an autoimmune disease.
  10. Severe kidney disease.
  11. Congenital heart disease.
  12. Diabetes that is not controlled.
  13. Thyroid disease.
  14. Radiation
  15. Certain medicines, such as the acne drug isotretinoin .
  16. Severe malnutrition.
  17. Infections

What are the symptoms of a miscarriage?

Symptoms of a miscarriage include:

If you are experiencing the symptoms listed above, contact your Gynecologist right away. She will tell you to come in to the office or go to the labor room.

How Is a Miscarriage Diagnosed and Treated?

Your Gynecologist will perform a pelvic exam, an ultrasound test and bloodwork to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilatation and curettage (D&C) procedure is performed. During this procedure, the cervix is dilated and any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to a D&C, certain medicines can be given to cause your body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery and whose condition is otherwise stable.

Blood work to determine the amount of a pregnancy hormone (hCG) is checked to monitor the progress of the miscarriage.

When the bleeding stops, usually you will be able to continue with your normal activities. If the cervix is dilated, you may be diagnosed with an incompetent cervix and a procedure to close the cervix (called cerclage) may be performed if the pregnancy is still viable. If your blood group is Rh negative, your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby as well as any of your future pregnancies.

Blood tests, genetic tests, or medication may be necessary if a woman has more than two miscarriages in a row (called recurrent miscarriage). Some diagnostic procedures used to evaluate the cause of repeated miscarriage include ultrasound, hysterosalpingogram (an X-ray of the uterus and fallopian tubes), and hysteroscopy (a test in which the doctor views the inside of the uterus with a thin, telescope-like device inserted through the vagina and cervix).

Can I Get Pregnant Following a Miscarriage?

Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.

If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your Gynecologist to perform diagnostic tests to determine the cause of the miscarriages.

Dr. Ruchi Tandon, is a Gynecologist with over 13 years experience in obstetrics and Gynecology, practicing in leading hospitals in South Delhi. She is approachable, experienced and highly competent in handling all types of pregnancies.

Endometrial polyp in your 40’s

Uterine or endometrial polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of ensdometrial polyps, also known as uterine polyps. These polyps are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer. They can range from few millimetres to few centimeters and can be endometrial, endocervical or cervical polyps depending on the origin of the tissue.

Symptoms

Signs and symptoms of uterine polyps include:

  • Irregular menstrual bleeding — for example, having continuous, unpredictable periods of variable length and heaviness
  • Bleeding between 2 menstrual periods
  • Excessively heavy menstrual periods
  • Vaginal bleeding after menopause
  • Infertility

Some women have only light bleeding or spotting; others are without symptoms.

Causes

Doctors don’t know exactly why women get uterine polyps, but it may be related to changes in hormone levels. Each month, your estrogen levels rise and fall, directing the lining of the uterus to thicken and then shed during your period. It’s an overgrowth of that uterine lining that makes a polyp.

Some things make you more likely to have polyps. One is age ,they’re more common in your 40s or 50s. That may be due to the changes in estrogen levels that happen right before and during your menopause.

Obesity, high blood pressure and taking the breast cancer drug tamoxifene can also raise your chances for uterine polyps.

Diagnosis

Transvaginal ultrasound

Hysteroscopy

Endometrial biopsy

Treatment modalities

Watch and wait

Medication :Some studies have shown polyps less than 5 mm can be treated with course of progesterones for upto 3 cycles, polys might regress or be she’d out in next  menstrual cycle.

Hysteroscopy:

Hysteroscopy had been accepted as the gold standard in diagnosis and treatment of all types of polyps. It is usually done as a daycare procedure and the obtained tissue is sent for histopathology diagnosis.

What to expect with hysteroscopic removal of endometrial polyp

Prior to surgery

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), Clopidogrel (Plavix), warfarin (Coumadin), and other blood thinners.
  • You will be scheduled to undergo the procedure after menstrual bleeding has ended and before ovulation (if you are still ovulating).
  • Ask your doctor which drugs you should still take on the day of the surgery.
  • Discuss any possible bleeding disorders or other medical conditions that you may have.
  • You will have blood samples taken in case you need a blood transfusion.
  • Do not smoke. This will help you to recover quicker.

On the Day of the Surgery

  • If you are to have general anesthesia, you will usually be asked not to drink or eat anything after midnight the night before the surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After Surgery

  • Most patients can go home the same day.
  • You may have increased cramping and vaginal bleeding for a day or two after the procedure.
  • You may experience gas pains for about a day or so due to gas administered during the procedure. This may extend into your upper abdomen and shoulder. Walking will help relieve this pressure.
  • This surgery has a quick recovery with most patients feeling much better within the first few days.

Recovery: what to expect in the next few weeks

  • Some women have some water discharge with some blood for a few weeks expect the flow to be heavy at first and then diminishing over time.
  • Most women feel better within the first week following surgery; however, do not lift, push or pull any heavy objects for a couple of weeks.
  • Do not resume sexual intercourse or douche until your doctor says it is OK.
  • Full recovery takes about two weeks to allow for internal healing.

Dr.Ruchi Tandon is a trained hysteroscopic surgeon with over 13 years of clinical experience. At present, she is providing her services in leading hospitals in South Delhi namely, Apollo Spectra, Apollo Cradle Royale and Max Smart super speciality hospital, Saket.

High Risk Pregnancy – How to manage it

Any pregnancy that poses a risk to the mother or baby, or is different from normal is considered as high-risk pregnancy.

What are the risk factors for high-risk pregnancies?

Sometimes a high-risk pregnancy is the result of a medical condition or disease present before pregnancy. In other cases, a medical condition that develops during pregnancy for either you or your baby causes a pregnancy to become high risk pregnancy.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age.Pregnancy risks are higher for mothers older than age 35 years.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using certain drugs can put a pregnancy at risk.
  • Medical history. A history of hypertension, diabetes, heart disorders, breathing problems such as poorly controlled asthma, infections, and blood-clotting disorders such as deep vein thrombosis can increase pregnancy risks.
  • Surgical history. A history of surgery on your uterus, including  C-sections, multiple abdominal surgeries or surgery for uterine tumors (fibroids), can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy can pose risks. Examples include an abnormal placenta position, bleeding during pregnancy, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh-positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher-order multiple fetuses.

What steps can you take to promote a healthy pregnancy?

Whether you know ahead of time that you’ll have a high-risk pregnancy or you simply want to do whatever you can to prevent a high-risk pregnancy, follow the instructions by your Gynecologist. For example:

  • Schedule a preconception appointment.If you’re thinking about becoming pregnant, consult your Gynecologist. She might counsel you to start taking a daily prenatal vitamin with folic acid and reach a healthy weight before you become pregnant. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy. Your health care provider might also discuss your risk of having a baby with a genetic condition.
  • Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby’s health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
  • Eat a healthy diet. During pregnancy, you’ll need more folic acid, protein, calcium and iron. A daily prenatal vitamin can help fill any gaps. Talk to your Gynecologist if you have special nutrition needs due to a health condition, such as diabetes.
  • Gain weight wisely. Gaining the right amount of weight can support your baby’s health — and make it easier to shed the extra pounds after delivery. Work with your Gynecologist to determine what’s right for you.
  • Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. Get your health care provider’s OK before you start — or stop — taking any medications or supplements.

Do you need special tests?

If you have a high-risk pregnancy, you might consider various tests or procedures in addition to routine prenatal screening tests. Depending on the circumstances, your Gynecologist might recommend:

  • Specialized or targeted ultrasound.This type of fetal ultrasound, an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus  targets a suspected problem, such as abnormal development.
  • During this procedure, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Typically done after week 14 of pregnancy, amniocentesis can identify certain genetic conditions, as well as neural tube defects — serious abnormalities of the brain or spinal cord.
  • Chorionic villus sampling (CVS).During this procedure, a sample of cells is removed from the placenta. Usually done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
  • Also known as percutaneous umbilical blood sampling, this is a diagnostic prenatal test in which a sample of the baby’s blood is removed from the umbilical cord for testing. The test can identify certain genetic disorders,  conditions and infections.
  • Ultrasound for cervical length. Your health care provider might use an ultrasound to measure the length of your cervix at prenatal appointments to determine if you are at risk of preterm labor.
  • Laboratory tests. Your health care provider will test your urine for urinary tract infections and screen you for infectious diseases such as HIV and syphilis.
  • Biophysical profile. 2This prenatal test is used to check on a baby’s well-being. It might involve only an ultrasound to evaluate fetal well-being or, depending on the results of the ultrasound, also fetal heart rate monitoring (nonstress test).

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. The decision to pursue prenatal testing is up to you and your partner. Discuss the risks and benefits with your Gynecologist.

Dr. Ruchi Tandon is a gynecologist specialising in high risk pregnancy, with over 14 years of clinical experience. She is currently associated with leading hospitals of South Delhi such as Max Smart Superspeciality Hospital, saket, Apollo Cradle Royale, Nehru Place and Apollo Spectra, Kailash Colony.