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.

Ovarian cyst – laparoscopy is treatment of choice

Ovarian cysts are fluid-filled sacs or pockets in the ovary or on its surface. Women have two ovaries — each about the size and shape of an almond, 2-3cm in size— on each side of the uterus. Eggs, which develop and mature in the ovaries, are released in monthly cycles during the childbearing years.

Many women have ovarian cysts at some time. Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — can cause serious symptoms. To protect your health, get regular pelvic exams and know the symptoms that can signal a potentially serious problem.

Symptoms of ovarian cyst

Most cysts don’t cause symptoms and go away on their own spontaneously. However, a large ovarian cyst can cause:

  • Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst
  • Fullness or heaviness in your abdomen
  • Bloating

Complications of ovarian cyst

An ovarian cyst often causes no problems, but sometimes it can lead to complications.

  • Torsion: The stem of an ovary can become twisted if the cyst is growing on it. It can block the blood supply to the cyst and cause severe pain in the lower abdomen.
  • Burst cyst: If a cyst bursts, the patient will experience severe pain in the lower abdomen. If the cyst is infected, pain will be worse. There may also be bleeding. Symptoms may resemble those of appendicitis.
  • Cancer:less than 10 % of ovarian cysts can become malignant or cancerous.

Laparoscopy in ovarian cyst

A small incision will be made just below the navel. Next, a laparoscope will be inserted. This is a thin tube with a camera on the end. To allow the doctor to better view the organs, carbon dioxide gas will be pumped into the abdomen. The laparoscope will be used to locate the cyst. When it is found, 1 or 2 more incisions will be made. Surgical instruments will be inserted to remove the cyst. Tissue may be removed for testing. If cancer is found, both ovaries may need to be removed. After the cyst is removed, the instruments will be removed. The incision area will be closed with stitches or staples.

Immediately After Procedure

After the procedure, you will be given IV fluids and medications while recovering.

How Long Will It Take?

1-2 hours

Will It Hurt?

There will be pain after the surgery. You will be given pain medication.

Average Hospital Stay

You may stay overnight, or you may be able to leave the hospital the same day as your surgery.

Why Dr. Ruchi Tandon?

Dr. Ruchi Tandon is a trained laparoscopic Gynecological surgeon, practicing in best hospitals in South Delhi such as Max smart super speciality hospital, saket, Apollo Cradle Royale, Apollo Spectra Hospitals, Delhi. She has over 14 years of experience in the field of operative Gynecology and endoscopic procedures.

Why you should choose a specialized Laparoscopic Surgeon and Cosmetic Gynecologist?

Laparoscopy is a skilled profession that demands a high level of expertise and well-versed training. Gynecological Laparoscopy involves procedures such as

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy and Hysteroscopy for Infertility
  • Hysteroscopic Polypectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Gynecological expertise is of paramount importance in all of these procedures.

Reasons for gynecologic laparoscopy

Laparoscopy can be used for diagnosis, treatment, or both of them. A diagnostic procedure can sometimes very commonly turn into a treatment.

Some reasons for diagnostic laparoscopy are:

  • unexplained pelvic pain
  • unexplained infertility history of pelvic infection

Conditions that might be diagnosed using laparoscopy include:

  • Endometriosis
  • Uterine fibroids
  • Ovarian cysts or tumors
  • Ectopic pregnancy
  • Pelvic adhesions
  • Pelvic inflammatory disease

Some types of laparoscopic treatment include:

  • Hysterectomy or removal of the uterus
  • Removal of ovaries
  • removal of ovarian cysts
  • removal of fibroids
  • blocking blood flow to fibroids
  • adhesion removal
  • reversal of a contraceptive surgery called tubal ligation
  • Burch procedure for incontinence
  • vault suspension to treat a prolapsed uterus

Preparing for gynecologic laparoscopy

Preparation depends on the type of surgery. You may need imaging tests, or your doctor might order fasting or an enema.

Tell your doctor about any medication you take. This includes over-the-counter drugs and supplements. You may need to stop them before the procedure.

Ask a friend to come to pick you up after the surgery or schedule a car service. You will not be allowed to drive yourself.

Cosmetic Gynaecology

Cosmetic Gynaecology is one of the emerging areas of Gynecology and includes :

  • Non-surgical vaginal tightening
  • Surgical vaginoplasty
  • Hymenoplasty or restoration of virginity
  • Ovarian rejuvenation
  • Reversing menopause
  • Labiaplasty
  • Non-surgical treatments for painful intercourse

Dr. Ruchi Tandon, is a specialized gynecologist practicing in Greater Kailash, South Delhi with over 13 years of experience in operative laparoscopy, cosmetic Gynecology, and high-risk pregnancy cases.

What do you mean by Laparoscopy?

Laparoscopy also called as keyhole surgery, is a specialized kind of surgery, using very fine instruments and through small incisions (0.3-1.2 cm). Originally started in Germany, it has evolved rapidly over the last 3 decades, superseding convention surgery and ultimately is the preferred mode of operation for all types of Gynecological procedures and surgeries. The various advantages of Gynecological laparoscopic procedures include less hospitalization duration, quicker patient recovery, lesser scaring, overall less operative time reducing

complications.  

Procedures done by Laparoscopy /Hysteroscopy:

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy & Hysteroscopy for Infertility
  • Laparoscopic Adhesiolysis
  • Hysteroscopic Polypectomy
  • Hysteroscopic Myomectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Advantages of laparoscopic surgery:

  • Faster healing
  • Lesser scarring
  • Better recovery
  • Lesser hospital stay
  • Lesser intra operative complications

Complications of laparoscopy:

Same as of any other conventional open surgery.

The use of energy devices has risk of thermal injury to visceral organs, namely bowel injury and ureter injuries.

What all you need to know before your laparoscopy?

It is important to understand the benefits and risks of your procedure before undergoing any surgery.

In cases of difficulty, Laparoscopy may need to be converted into open laparotomy. Huge fibroids, adhesions and difficultly in visualisation can make laparoscopy a challenge for operating surgeon.

Laparoscopy Treatment:

Laparoscopy is being done in all the leading hospitals in South Delhi. Dr Ruchi Tandon has received extensive training in laparoscopy from best hospitals in Delhi and Mumbai, such as moolchand hospital, leelavati hospital. Dr Ruchi Tandon is one of the best gynecologists, based in greater Kailash and doing all sorts of daycare and operative laparoscopic procedures. Infertility surgeries, Myomectomy, hysterectomy, Hysteroscopy are some of the procedures to name a few.

She is doing these procedures at Max smart super specialty hospital, Saket, Apollo Cradle Royale and Apollo Spectra. In lieu of her experience and contribution to this field, she was conferred with the “best budding endoscopic surgeon “(National) award by the Economic Times at a grand event on 4th October, recently in Delhi.

Management of abnormal uterine bleeding

abnormal uterine bleeding

Abnormal uterine bleeding may be acute or chronic, and is defined as bleeding from the uterus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy. Acute AUB refers to an episode of heavy bleeding that is of sufficient quantity to require immediate intervention to prevent further blood loss. Acute AUB may occur spontaneously or in association with chronic AUB. Initial screening for an underlying disorder of hemostasis in patients with excessive menstrual bleeding should be structured by the medical history.

Basic workup of abnormal bleeding includes CBC (complete blood count), blood group, Thyroid function tests(TSH), UPT( Urine pregnancy test), coagulation parameters(PT,PTT,INR) and LFT( liver function test). Hormonal management is considered the first line of medical therapy for patients with acute AUB without suspected bleeding disorders.

Antifibrinolytic drugs, such as tranexamic acid, work by preventing fibrin degradation and are effective treatment for patients with recurrent AUB. Surgical options include dilation and curettage, endometrial ablation, uterine artery embolization, and hysterectomy.

The etiologies of acute AUB should be classified based on the PALM–COEIN system: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified.

Dr. Ruchi Tandon is a famous gynecologist who specializes in cases of AUB (Abnormal uterine bleeding).She has performed about 1000 hystroscopies and procedures related to AUB.

Endometriosis and its controversies

Endometriosis is defined as the presence of endometrial tissue at any area other than the normal situation; if it is seen in myometrial tissue it leads to a condition called as adenomyosis.

Endometriosis  commonly involves your ovaries, fallopian tubes and the tissue lining of pelvis. Rarely, endometrial tissue may spread beyond pelvic organs like intestines,liver and retroperitoneal spaces.

With endometriosis, displaced endometrial tissue continues to act as it normal tissue , it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped and bleeds monthly. When endometriosis involves the ovaries, cysts called endometriomas or chocolate cysts may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions ,abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain , sometimes severe —,especially during  periods. Fertility problems also may develop in younger females. Fortunately, effective treatments are available for both.

Symptoms

The primary symptom of endometriosis is pelvic pain associated with  menstrual period.

Common signs and symptoms of endometriosis may include:

  • Painful periods (dysmenorrhea).Pelvic pain and cramping may begin before  period and extend several days into the period.
  • Pain with intercourse.Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination. most likely to experience these symptoms during  
  • Excessive bleeding. occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
  • Endometriosis is first diagnosed in  women who are seeking treatment for infertility.
  • Other symptoms. may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during the menstrual periods.

The severity of  pain isn’t necessarily a reliable indicator of the extent of the condition.  Women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts or appendicitis. It may be confused with irritable bowel syndrome (IBS), a condition that causes alternate bouts of diarrhea, constipation and abdominal cramping.

When to see a doctor

See your doctor if you have signs and symptoms that may indicate endometriosis.

Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

Causes

Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation.In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Transformation of peritoneal cells.In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
  • Embryonic cell transformation.Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
  • Surgical scar implantation.After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
  • Endometrial cells transport.The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • Immune system disorder.It’s possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.

Risk factors

Several factors place you at greater risk of developing endometriosis, such as:

  • Never giving birth
  • Starting your period at an early age
  • Going through menopause at an older age
  • Short menstrual cycles — for instance, less than 27 days
  • Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
  • Low body mass index
  • Alcohol consumption
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Uterine abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.

Complications

Fertilization and implantation

Infertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.

Ovarian cancer

Ovarian cancer does occur at higher than expected rates in women with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it’s still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

Cervical cancer vaccination and awareness

Cervical cancer vaccination and awareness

Human papilloma virus also known as the cervical cancer virus or HPV accounts for upto 75% of all cervical cancers. Cervical cancer is the fifth most prevalent cancer and is caused by sexual transmission of HPV virus. The incidence is maximum in reproductive age group , namely between 30-40 years of age group and peaks by 50 years of age. India has a population of about 300 million women above the age group of 15 years. HPV 16 & 18 account for maximum number of cases of cervical cancer. HPV infection causes CIN1, CIN2,CIN3,CIS,invasive cancers.

The recent most vaccination programme in recommended in age groups 9-44 years and is preventive against 4 HPV’s i.e.HPV 6, 11,16,18. Prolonged use of contraceptives, increased parity, early age of sexual activity, multiple sex partners, tobacco smoking and co-infection with STD’s have been identified as established cofactors for cervical and precervical cancers. 70% of all adults are likely to be infected with at least one HPV type. Vast majority of the infections resolve spontaneously and only a few of the HPV infections progress to cancer.

The lifetime risk for genital HPV is 60–80% and genital warts is approximately 3-5%. Large scale screening programmes like pap smears are practically to implement in developing countries , hence cervical cancer screening should be carried out more effectively. The only effective way is to reach out to schools and encourage adolescent girls into cervical cancer vaccination.

Dr. Ruchi Tandon has visited numschools ands  and corporate organizations in Delhi -NCR to help the cervical cancer vaccination drive. She firmly believes that effective immunization can significantly help in reducing prevalence of cervical cancer.