Abortion in the times of the corona virus pandemic

The COVID-19 crisis has starkly revealed the patchy and precarious provision of abortion in India, deepening existing inequalities in access.

What was already an expensive procedure may be even less attainable for many women facing financial strain during the pandemic.

Meanwhile, a shortage of staff and resources is likely to be affecting access for many women seeking an abortion – particularly those in regional and rural areas.

This all comes at a time when advocates predict unwanted pregnancies could rise due to increased rates of domestic violence, reproductive coercion and financial stress.

A shortage of resources

In April, suppliers cancelled orders of personal protective equipment (PPE) to abortion clinics on the basis these supplies were reserved for “health professionals”.

Suppliers might be forgiven for assuming medical procedures relegated to the private sector are elective.

While the federal government confirmed abortion was “essential” during the halt on elective procedures, they didn’t offer much support. Instead they told clinics to source PPE supplies from Chemist Warehouse.

Although the supply of PPE to abortion clinics is no longer under immediate threat, the industry continues to face resource constraints.

This includes a shortage of providers.

Lack of access in regional and rural areas

Abortion is one of the most commonly performed Gynecological procedures, and early medical abortion should be readily available in primary care settings.

But abortion care is not integrated into medical education or training. The shortage of Gynecologists trained and willing to provide surgical abortion, and the failure of governments to require public hospitals to take responsibility for local provision, means abortion is virtually inaccessible in much of rural and regional India.

The few clinics that offer surgical abortion outside urban centers often depend on general practitioners, who rely on domestic air travel to deliver abortion care.

The provision of second trimester abortions is in such short supply in India that this single private clinic services women from across the country.

Women may require abortion after 20 weeks for a range of reasons, including maternal health, fetal abnormalities, and delayed diagnosis of pregnancy.

Many of these women, we can assume, are also affected by travel restrictions.

We could be doing more via telehealth

Early medical abortion can be delivered via telehealth. In this scenario, medications are mailed to the patient after some local tests and a remote consultation with a doctor via phone or video call. This method is especially appropriate now as we continue to practice social distancing.

India says it has protected abortion as an essential service in the coronavirus lockdown but experts say women are struggling to get medical help and may resort to risky alternatives or end up with babies they do not want.

With no transport services, limited healthcare and movement restricted, campaigners predict the Covid-19 crisis could push women to take abortion drugs without supervision or seek help from people who lack training.

In life after lockdown, experts fear a lasting legacy. “Unsafe practices such as women taking herbs or inserting rods and sticks has reduced drastically and that situation will never come back in India,” said researchers. “But it will have to be researched post lockdown if the number of unwanted births go up.”

Dr. Ruchi Tandon is a trained and certified Gynecologist, practicing in leading hospitals in South Delhi namely Max Smart superspeciality hospital saket and Apollo hospitals.She has over 13 years experience in handling pregnancies and abortions and is doing telephonic consultantions as well.

How To Deal With Pregnancy In The Time Of Coronavirus

Unlike the Severe acute respiratory syndrome or SARS pandemic of 2003-2004, which was also caused by a Corona virus, pregnant mothers are not in the higher risk bracket from COVID-19.

Stressful, even during normal times, pregnancy can be deeply disturbing during a pandemic induced lockdown. Even more so if you or someone close to you has tested positive for the coronavirus.  Here’s a few do’s and don’ts for expectant mothers during these troubled times, based on what we know so far about the virus.

Don’t Fret

Unlike the Severe acute respiratory syndrome or SARS pandemic of 2003-2004, which was also caused by a Corona virus, pregnant mothers are not in the higher risk bracket from COVID-19. During the SARS outbreak, pregnant women had a fatality risk of 25 per cent compared to 10 per cent of the general population. This is mostly based on a report on 9 pregnant women from Wuhan, China, the epicenter of the COVID-19 outbreak, who had COVID-induced pneumonia. The report, published in the Lancet, said none of the women, who were in their third trimester, developed severe illness, and all their babies were born healthy and Corona virus free. The World Health Organization (WHO) published a report on February 28 of 147 pregnant women, of whom, 64 were confirmed to have coronavirus, 82 were suspected to have the virus and one showed no symptoms. According to the report, only 8% of these women developed a severe condition and only 1% fell critically ill.

Immunity Matters

This does not mean pregnant women can afford to be complacent as the immunity system tends to dip during pregnancy, making the women vulnerable to various infections and diseases, including COVID-19. So, ensure that the diet contains immunity boosting and iron rich food, including fruits, leafy vegetables and nuts. You should also continue to take all the vitamin supplements the doctor may have prescribed.

Avoid These

Apart from following the standard guidelines like avoiding crowds and sick people, frequently washing hands and not touching the face, doctors recommend scrupulously maintaining social distancing, avoiding public areas and wearing a mask whenever you are outdoors.

Be Prepared

Given the stress on the healthcare system, and the possibility of infections from hospitals, you should check whether your doctor or hospital offers tele-medicine facilities. Don’t visit the hospital unless it is absolutely necessary, or for critical checkups. Never go without a clear appointment. Always keep your records handy, and insist that the doctor mail you any advice or medicine prescribed, so that you don’t make mistakes. Make sure you inform your doctor/health provider if you have any symptoms like fever, respiratory symptoms or even diarrhea, or if you have been in contact with someone who has tested positive for COVID-19. Avoid over the counter medications to treat cough and cold.

Deliver With Care

Because of the corona restrictions, many hospitals do not allow more than one visitor during your delivery. So, ensure that your spouse or partner is prepared for that, and have a backup in place in case he cannot be present there. Explain this to other members of your family and friends so that they do not arrive at the hospital. After the delivery, make sure that you have a backup support to take care of you and the baby, particularly if the original support system involved elders of the family.

What If You Test Positive?

If you have tested positive for COVID-19 during your pregnancy or just before delivery, don’t worry. Initial studies indicate that the virus does not transmit to uterus, or through breastmilk. However, it is important to ensure that the newborn does not get infected through contact with someone who has tested positive for the disease. In that case, doctors will usually isolate the baby, which will be looked after by healthy caregivers in protective gear. This can be traumatic, so be prepared for it. Your partner might be allowed to spend time with the child if he tests negative. If you want to give milk to your child using a breast pump, do ensure proper hygiene, and wear a mask while using the pump. Direct breastfeeding might be allowed if the infected mother wears a mask, but do you really want to take the risk?

Dr. Ruchi Tandon is a Gynecologist with over 13 years experience in handling pregnancies and is currently practicing in Max smart superspeciality hospital , Saket and Apollo Cradle Royale , Nehru place, both in South Delhi.

PCOD- irregular periods and other things

What Is PCOS?

Polycystic ovarian syndrome, or PCOS, is a hormonal condition that women can get during their childbearing years. It can affect your ability to have a child . It can also:

  • Stop your periods or make them hard to predict
  • Cause acne and unwanted body and facial hair
  • Raise your risk of other health problems, including diabetes and high blood pressure

You can get treatments for the symptoms. And you could be able to get pregnant, although you may need to take medicines to improve your fertility.

So what are polycystic ovaries?

Polycystic ovaries are slightly larger than normal ovaries that have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate).

However, having polycystic ovaries need not necessarily mean that you have polycystic ovarian disease (also called poly cystic ovarian syndrome). But if there are two or more following symptoms present, it can be PCOD.

Irregular, infrequent periods or no periods at all

An increase in facial or body hair and/or blood tests that show higher testosterone levels than normal

Ultrasounds scan that shows polycystic ovaries.

How does PCOD affect you?

PCOD is a condition that can affect your periods, fertility, hormones and appearance. It can also affect your overall health across time. It is estimated that this disease affects 2 – 26 among 100 women.

What are the usual symptoms?

Irregular/no periods

Excess hair growth on the face, chest, abdomen, or upper thighs – a condition called hirsutism

Loss of hair on head

Becoming overweight – experiencing a rapid increase in weight/ having difficulty in losing weight

Oily skin and acne

Reduced fertility – difficulty getting pregnant

Patches of thickened, velvety, darkened skin (acanthosis nigricans)

Depression and psychological problems

What are the causes of PCOD?

Though the exact cause of PCOD is unknown, it is often hereditary. Most of the PCOD symptoms presented are due to abnormal/ change in hormonal levels. Though Testosterone is considered a male hormone, it is also produced in small amounts by ovaries, in all women. Women with PCOD have elevated levels of testosterone, which causes most of the symptoms.

Abnormal levels of androgens can prevent the ovaries from releasing an egg every month (ovulation), cause the unwanted hair growth and acne.

Those with PCOD may not respond to insulin –the hormone that controls blood glucose levels. High levels of insulin can lead to weight gain, irregular periods, fertility issues and also elevate levels of testosterone.

What are the long-term health risks of PCOD?

PCOD not only affects the reproductive system, but the entire body.

It increases the of serious health conditions including heart ailments, diabetes and hypertension.

The risk of developing diabetes is higher if one is:

Over 40 years of age

Have family history of diabetes

Developed diabetes during pregnancy (gestational diabetes)

Is obese (a body mass index (BMI) of over 30)

Another condition that is associated with PCOS is metabolic syndrome, which leads to both diabetes and heart diseases.

Besides, if the number of periods is less than a year, the lining of the womb (endometrium) can thicken too much, leading to a condition called endometrial hyperplasia. This condition can subsequently lead to endometrial cancer or cancer of uterine lining. However, PCOD does not increase the chances of breast or ovarian cancer.

What are the treatment options for PCOD?

There is no cure for PCOD. However, it can be managed very efficiently with positive changes lifestyle and medicine, if required.

Many women with PCOD manage symptoms and long-term health risks without medical intervention, by adopting a healthy diet, exercising regularly and maintaining a healthy lifestyle.

Treatment for PCOD is personalised as symptoms and health problems, vary. Special treatment is given in case the patient wants to have a baby.

For overweight women, losing weight itself can help regulate the menstrual cycle. Even a loss of 5- 10 kg can be helpful in making menstrual periods regular. Weight loss can also improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne.

Combined hormonal – birth control pills can be used for long-term treatment in women with PCOD (in those who do not wish to become pregnant). These pills regulate the menstrual cycle and reduce symptoms like hirsutism and acne by decreasing the androgen levels. They also decrease the risk of endometrial cancer.

Insulin-sensitizing drugs used to treat diabetes are used in the treatment of PCOD. These drugs help the body respond to insulin and decrease the androgen levels, which in turn improves ovulation. Restoring ovulation helps make menstrual periods regular and more predictable.

There are various ways to protect the lining of the womb using the hormone progestogen. This can be a five-day course of progestogen tablets (every three or four months)/ taking a contraceptive pill/ using the intrauterine contraceptive system (Mirena).

What can be done to increase the chances of pregnancy in women with PCOD?

Successful ovulation is the first step toward pregnancy. For overweight women, this can be achieved through weight loss. Medications can also be used to induce ovulation. Surgery on the ovaries can be opted for only medical management does not work. Such procedures are performed only if there is no other option.

How can long-term health risks of PCOD be managed?

Lead a healthy lifestyle

Change to healthy balanced diet: include fruits, vegetables, whole grain products, lean meat, fish and fibre. Avoid high sugar, high fat foods and alcoholic drinks.

Eat meals on time, especially breakfast.

Exercise regularly for at least 30 minutes a day – brisk walking is the best and easiest option.

Losing weight helps:

Manage insulin resistance/ developing diabetes

Lowers risk of heart problems

Lowers risk of uterine cancer

Regularises periods

Reduces acne

Decrease in excess hair growth

Improved mood and self-esteem

Do regular health checks

Women with PCOD and over the age of 40 should do regular blood sugar tests.

Women with PCOD and over the age of 40 should do regular blood sugar tests.

If you have had no periods/ have irregular bleeding, see a doctor immediately for uterine disorder/ cancer assessment.

Dr.Ruchi Tandon, is a Gynecologist doctor, practicing in leading hospitals in South Delhi, namely, Max Smart superspeciality hospital , saket , Apollo hospitals . She has over 13 years clinical experience in PCOD, irregular periods and other hormonal issues.

Ectopic pregnancy (tubal pregnancy) -the facts!

What is ectopic pregnancy?

From fertilization to delivery, pregnancy occurs after a number of steps in a woman’s body. One of these steps is when a fertilized egg travels to the uterus to attach itself. In the case of an ectopic pregnancy, the fertilized egg doesn’t attach to the uterus. Instead, it may attach to the fallopian tube, abdominal cavity, or cervix.

While a pregnancy test may reveal a woman is pregnant, a fertilized egg can’t properly grow anywhere other than the uterus. Ectopic pregnancies occur in about 1 out of every 50 pregnancies (20 out of 1,000).

An untreated ectopic pregnancy can be a medical emergency. Prompt treatment reduces your risk of complications from the ectopic pregnancy, increases your chances for future, healthy pregnancies, and reduces future health complications.

An ectopic pregnancy can’t proceed normally. The fertilized egg can’t survive, and the growing tissue may cause life-threatening bleeding, if left untreated.

What causes an ectopic pregnancy?

The cause of an ectopic pregnancy isn’t always clear. In some cases, the following conditions have been linked with an ectopic pregnancy:

  • inflammation and scarring of the fallopian tubes from a previous medical condition, infection, or surgery
  • hormonal factors
  • genetic abnormalities
  • birth defects
  • medical conditions that affect the shape and condition of the fallopian tubes and reproductive organs

Your Gynecologist may be able to give you more specific information about your condition.

Who is at risk for an ectopic pregnancy?

All sexually active women are at some risk for an ectopic pregnancy. Risk factors increase with any of the following:

  • maternal age of 35 years or older
  • history of pelvic surgery, abdominal surgery, or multiple abortions
  • history of pelvic inflammatory diseases 
  • history of endometriosis
  • conception occurred despite tubal ligation or intrauterine devices
  • conception aided by fertility drugs or procedures
  • Smoking
  • history of ectopic pregnancy
  • history of sexually transmitted diseases 
  • having structural abnormalities in the fallopian tubes that make it hard for the egg to travel

If you have any of the above risk factors, talk to your doctor. You can work with your Gynecologist or a fertility specialist to minimize the risks for future ectopic pregnancies.

What are the symptoms of an ectopic pregnancy?

Nausea and breast soreness are common symptoms in both ectopic and uterine pregnancies. The following symptoms are more common in an ectopic pregnancy and can indicate a medical emergency:

  • sharp waves of pain in the abdomen, pelvis, shoulder, or neck
  • severe pain that occurs on one side of the abdomen
  • light to heavy vaginal bleeding or spotting
  • dizziness or fainting
  • rectal pressure

You should contact your doctor or seek immediate treatment if you know that you’re pregnant and have any of these symptoms.

Diagnosing an ectopic pregnancy

If you suspect you may have an ectopic pregnancy, see your doctor immediately. Ectopic pregnancies can’t be diagnosed from a physical exam. However, your doctor may still perform one to rule out other factors.

Another step to diagnosis is a transvaginal ultrasound. This involves inserting a special wand-like instrument into your vagina so that your doctor can see if a gestational sac is in the uterus.

Your doctor may also use a blood test to determine your levels of hCG and progesterone. These are hormones that are present during pregnancy. If these hormone levels start to decrease or stay the same over the course of a few days and a gestational sac isn’t present in an ultrasound, the pregnancy is likely ectopic.

If you’re having severe symptoms, such as significant pain or bleeding, there may not be enough time to complete all these steps. The fallopian tube could rupture in extreme cases, causing severe internal bleeding. Your doctor will then perform an emergency surgery to provide immediate treatment.

Dr. Ruchi Tandon is a specialist Gynecologist , with over 13 years of clinical experience and is practicing in leading hospitals in South Delhi, namely, Max smart superspeciality hospital, saket, Apollo cradle Royale, nehru place. She has dealt with the management of thousands of ectopic pregnancies.

Pregnancy after IVF treatment

Many infertile couples need treatment in different forms including Assisted Reproductive Techniques. In Vitro Fertilization and Embryo Transfer is the most advanced method of infertility treatment. Management of these pregnancies is difficult as the couples and treating doctors have undue concern and apprehension and worry about outcome of such pregnancies.

IVF Pregnancy Test

When can you take a pregnancy test during an IVF treatment cycle? Your doctor will likely schedule a blood test 10 to 14 days after the egg retrieval. The blood test will detect and measure the hormone beta hcg.

You should not take a urine pregnancy test during IVF treatment. Taking multiple early pregnancy tests is a bad habit many fertility-challenged women struggle with, and it’s one you should try your best to resist if you’re getting fertility treatments. The reason is that one of the fertility drugs used is the hormone hcg. If you take a pregnancy test the day after receiving this injection, you may get a positive pregnancy test, not because you’re pregnant, but because the test is picking up the hormones from the fertility treatment.

Continued Progesterone Support

Treatment isn’t over the moment you get a positive pregnancy test result. Your doctor may keep you on progesterone hormone support. How long he will continue progesterone treatment will be dependent on your particular situation.

If you’re taking progesterone in oil through injections, you may be able to switch to vaginal suppositories or gel. Ask your Gynecologist about your options.

Continued Blood Tests for Monitoring

Your fertility doctor will also likely continue to check your hormone levels for at least a few weeks following a positive pregnancy test. There are a few reasons for this:

  • to look for rising hcg hormone levels (pregnancy hormones), in order to ensure the pregnancy is healthy and to look out for very high levels (which may indicate a multiple pregnancy)
  • to monitor estrogen levels, especially if symptoms of ovarian hyperstimulation syndrome (OHSS) are present
  • to monitor progesterone levels

Getting Good News: Feeling Excited- But Also Scared

You’ve most likely been trying to get pregnant for years. You may have even gone through many cycles of fertility treatments. Finally, you’ve achieved a pregnancy. You’re likely really excited and happy. But you may also feel anxious. You may even wonder if it’s all really happening. If you have friends who are still trying to get pregnant, you may experience some emotional guilt. All of this is completely normal.

Feeling nervous and not too hopeful about the pregnancy is understandable. If you’ve experienced miscarriages in the past, this is especially true. Don’t feel guilty for feeling the way you do. Do try to find someone, whether a friend or a therapist, to talk to about your feelings. It will help.

Women who have experienced infertility are at-risk for developing pregnancy and post partum depression. The sooner you talk to someone, the more likely it is you’ll feel better.

Feeling Unsure of When to Tell People

This is a big moment! However, you may or may not be ready to share the news with the world.

If you’ve shared your treatment progress with friends and family, especially if you’ve shared details of this particular cycle, you may be expected to tell them sooner than later. If they knew when you had your embryo transfer, they are naturally going to want to know if the cycle worked!

However, for those who weren’t in the loop, you can choose to wait.

When should you tell? When you see your hCG doubling? After ultrasound confirmation? After you see the heartbeat? After the first trimester? It’s entirely up to you. There is no right or wrong answer.

Pregnancy Risks After IVF

Pregnancy after IVF conception is associated with some increased risks and complications. These risks don’t seem to be directly caused by the use of fertility treatment. Instead, they are more likely associated with the original reason IVF was needed in the first place—infertility or advanced age.

Some pregnancy risks and complications that are higher after IVF conception include…

  • Pregnancy induced hypertension
  • Gestational diabetes
  • Preeclampsia
  • Abnormal bleeding
  • Intrauterine growth restriction
  • Premature labour (even with a singleton pregnancy)
  • Congenital defects

Pregnancy after IVF is also more likely to require induction of labor and have a higher risk of cesarean birth.

Prenatal care is always important, but it’s especially important after IVF to hopefully catch these complications early and treat (or prevent) them as soon as possible.

Release to a Regular Obstetrician

Usually, an IVF pregnancy is handled by a regular obstetrician (OB) and not a high-risk obstetrician. Your fertility doctor will transfer you over to the regular OB at about the 8-week mark.

You may be excited to see a “regular” doctor—finally! You may also feel nervous. It can be quite a shock to go from the intense monitoring of IVF to the more laid back, once-a-month visits of a regular OB/GYN. Don’t hesitate to talk to your doctor.

Dr. Ruchi Tandon, specialises in infertility conceived and IVF pregnancies. She has over 13 years experience in handling pregnancies in leading South Delhi hospitals, including Max smart superspeciality hospital, saket and Apollo cradle Royale, nehru place.

Second opinion in your High risk pregnancy- choose the best Gynecologist

What conditions may lead to a high-risk pregnancy?

The following list represents the most common conditions that can lead to a high-risk pregnancy, but note that not all women with these conditions will have a high-risk pregnancy.

  • If you have diabetes before you become pregnant, you will likely be referred to a maternal-fetal medicine specialist to monitor your condition and determine the proper medications. Preconception counseling is ideal. Developing diabetes during pregnancy (gestational diabetes) is very common, and your obstetric provider will likely be able to care for you without a maternal-fetal medicine consult. If a maternal-fetal medicine specialist is consulted for gestational diabetes, he or she will follow your baby’s growth and well-being, and manage your health with nutrition counseling, glucose monitoring and, possibly, medications.
  • Pre-eclampsia is a condition unique to pregnancy where you have high blood pressure in conjunction with protein in your urine and edema (swelling of the skin). In some women with pre-eclampsia, liver or platelet abnormalities are present. You may be referred to a maternal-fetal medicine specialist depending on the severity of your disease or if you are preterm. “The only treatment for pre-eclampsia is delivering your baby,” explains Henderson, “so this is a condition that requires very close monitoring to balance maternal complications against the risks of delivering your baby early.”
  • If you have hypertension before pregnancy, a maternal-fetal medicine specialist will monitor your baby’s growth and may be consulted if problems arise. Some medications commonly used outside of pregnancy to treat hypertension are contraindicated in pregnancy.
  • Multiples Pregnancies with twins or higher order pregnancies have a greater risk of complications. Women with multiple pregnancies are more likely to develop pre-eclampsia or go into preterm labor. Twin pregnancies have a higher risk of fetal anomalies and growth problems, especially if they share a placenta. If you have a multiple pregnancy, a maternal-fetal medicine specialist will closely monitor the pregnancy by performing additional ultrasounds. The maternal-fetal medicine specialist will recommend how and when your babies should be delivered. “If you remain healthy and the growth of your babies is normal and without complications, you may continue to see your Ob/Gyn,” says Henderson, “or you may prefer to be seen in a specialty multiples clinic.”
  • Sexually transmitted diseases (STD’s) In general, your obstetric provider can treat you for sexually transmitted diseases that may occur during pregnancy or if there is a pre-existing STD, such as herpes. In certain cases, consultation with a maternal-fetal medicine specialist will be required. For example, if you are being treated for syphilis and an ultrasound shows that your fetus may be affected, a maternal-fetal medicine specialist will provide further care and management. Women with HIV are also generally cared for by maternal-fetal medicine specialists because the medication regimens are complex.
  • Women who are obese have a greater risk of developing diabetes, hypertension and pre-eclampsia during pregnancy. “Obesity is the one of the only health conditions affecting pregnant women that can be changed before pregnancy, which is why maternal-fetal medicine specialists encourage women to lose weight through healthy strategies,” explains Henderson. “The Johns Hopkins Nutrition in Pregnancy Clinic works with obese women during pregnancy to optimize the health of mothers and their babies.”

Q: Will all my future pregnancies be high risk?

A: Having one high-risk pregnancy does not mean that all your future pregnancies will be deemed high risk as well. You may have a fetal complication occur in one pregnancy that wouldn’t in another, and certain health conditions may change over time.

However, if you have had a pregnancy that ended in preterm delivery, you are at greater risk of having preterm labor during your next pregnancy. If this occurs, your obstetric provider will manage your pregnancy using medication, and a maternal-fetal medicine specialist will monitor your cervical length with ultrasound surveillance.

Ultimately, the most important thing to remember about having a high-risk pregnancy is that your maternal-fetal medicine specialist and Ob/Gyn have the knowledge and experience required to keep you and your baby as healthy as possible.

Dr.Ruchi Tandon is a Gynecologist practicing in leading maternity hospitals of South Delhi namely, Max Smart superspeciality hospital, saket, Apollo cradle Royale to name a few. She is well versed, amicable and approachable. High risk pregnancy management is her forte.

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.

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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.