Posted on

Irregular periods in teenagers

Irregular periods are very common, especially in a girl’s first few years of getting her period.

What Are Regular Periods?

Most girls get their first period between the ages of 10 and 15, but some get it earlier and some later. The first period is known as menarche.

A girl’s monthly cycle is the number of days from the start of her period to the start of the next time she gets her period. You often hear this is a 28-day cycle. But 28 is just an average figure that doctors use. Cycle lengths vary — some are 24 days, some are 34 days. And a girl may notice that her cycles are different lengths each month — especially for the few years after she first starts getting her period.

Early in a girl’s cycle, her ovaries start preparing one egg. At the same time, the lining of the uterus becomes thick to prepare a nesting place for a fertilized egg in the event that the girl becomes pregnant.

About 2 weeks before a girl gets her period, the egg is released from the ovary (this is called ovulation). The egg travels through the fallopian tube into the uterus. If the egg isn’t fertilized by sperm, it starts to fall apart. Then the lining and egg leave a girl’s body as her period and the whole thing starts all over again — that’s why we use the word “cycle.” The first day a girl’s period comes is Day 1 of her cycle.

A girl’s body may not follow an exact schedule. It’s common, especially in the first 2 years after a girl starts getting her period, to skip periods or to have irregular periods. Illness, rapid weight change, or stress can also make things more unpredictable. That’s because the part of the brain that regulates periods is influenced by events like these. Going on a trip or having a major change in schedule can also make your period come at a different time than expected. All of this is perfectly normal.

It’s also normal for the number of days a girl has her period to vary. Sometimes a girl may bleed for 2 days, sometimes it may last a week. That’s because the level of hormones the body makes can be different from one cycle to the next, and this affects the amount and length of bleeding.

If My Period Is Irregular, How Do I Know When I Will Get It?

If your cycle is not regular, you’ll want to pay attention to the clues your body may give you that your period is coming soon. These may include:

• back cramps or stiffness
• heavier breasts or breast soreness
• headaches
• acne breakouts
• disturbed sleep patterns
• mood swings
• bloating
• loose stools

How Can I Be Prepared?

Keep some pads or tampons in your backpack or purse, just so you’ll have them handy in case your period comes when you’re not expecting it. You may even want to carry an extra pair of underwear.

What Causes Irregular Periods?

Most of the time, irregular periods are part of the normal changes that can happen when you’re a teen. As you get older, your cycle will probably settle into a recognizable pattern.

Sometimes, irregular periods can be caused by some medicines, exercising too much, having a very low or high body weight, or not eating enough calories.

Hormone imbalances can also cause irregular periods. For example, thyroid hormone levels that are too low or too high can cause problems with periods. Some girls have extra androgen, a hormone that can cause hair growth on the face, chin, chest, and abdomen. Extra androgen can also makes girls gain weight and have irregular periods.

Girls who are pregnant also will not get their periods.

Should I Worry About Irregular Periods?

Talk to your doctor if you have had sex and have missed a period because you could be pregnant. Also let the doctor know if:

• You were having regular periods that then become irregular.
• You stop getting your period.
• You have extra hair growth on the face, chin, chest, or abdomen.
• You start having periods that last longer than 7 days, are heavy, or are coming more often than every 21 days.
• Your period comes less often than every 45 days.
• You have severe cramping or abdominal pain.
• You have bleeding in between your periods.
• Your periods are irregular for 3 years or more.

The doctor may prescribe hormone pills or other medicines, or recommend lifestyle changes that can help you to have regular periods.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of clinical experience in handling all gynecological cases including irregular periods in teenage .

Posted on

Benign tumors or growth of the genitalia- vulva and vagina

Benign or malignant neoplasms of the vagina are uncommon. The frequency of benign lesions ranges from rare to very rare. Neoplasms that may develop in other locations within the genital tract may also be found in the vagina. Most vaginal tumors produce no symptoms until significant size is reached. Symptoms and signs may include a sensation of pressure, dyspareunia, obstruction of the vagina or urethra, or vaginal bleeding. However, most lesions will be detected during a routine exam in the asymptomatic patient. Vaginal neoplasms may be divided into cystic or solid lesions and a third category best described as related conditions. As is true for any neoplasm, biopsy provides a definitive diagnosis.

Gartner’s Duct Cyst

Gartner’s duct cysts develop as a result of incomplete regression of the mesonephric or wolffian duct during fetal development . In the male, these ducts form the epididymis. When present, these cysts may be multiple, and are located submucosally along the lateral aspects of the upper vagina. Histologic evaluation reveals nonsecretory, columnar epithelium. If these cysts are small, asymptomatic, and located in the lateral aspects of the upper vagina, no treatment is indicated. If the diagnosis is in question, or there is a history of antenatal exposure to synthetic hormones, adenosis of the vagina must be considered. The presence of mucosa, which stains normally with Lugol’s solution, helps to exclude the diagnosis of adenosis. Regardless of size, biopsies should be performed on symptomatic cysts or they should be excised. Larger cysts in the vaginal fornix may extend to the lateral aspects of the cervix and require excision in the operating room.

Paramesonephric Duct Cyst

In contrast to Gartner’s duct cysts, paramesonephric duct cysts are lined with secretory epithelium resembling endocervix or fallopian tube, suggesting müllerian origin. These cysts may be found anywhere in the vagina and frequently contain mucus. Vaginal adenosis is excluded by staining with Lugol’s solution. The diagnosis is established with an excisional biopsy if the cyst is large, symptomatic, or only recently identified.

Inclusion Cyst

Inclusion cysts of the vagina result from mucosa trapped in the submucosal area by surgical procedures such as episiotomy, colporrhaphy, or trauma including childbirth. As the cysts enlarge, symptoms may develop. These cysts are lined with squamous epithelium and contain keratin and squamous debris. Foreign-body reaction and inflammation surround the cyst. Treatment involves excision of the intact cyst and approximation of normal epithelium.

Endometriosis

Endometriosis in the vagina may develop at the site of a previous operation or as primary implants. Nodularity of the posterior vaginal fornix may represent endometriotic implants of the posterior cul-de-sac and may eventually erode or grow into the vaginal mucosa. When visualized colposcopically, these implants may appear dark blue or brown. If associated with fibrosis, the submucosal implants may appear white. Biopsy may yield chocolate-colored material representing old hemorrhage and dense fibrosis. Endometrial glands and stroma are usually identified histologically although the presence of both are not required to make the diagnosis. The diagnosis is made by biopsy unless endometriosis is identified in other parts of the pelvis. Small, symptomatic lesions are treated by excision or laser vaporization. Large lesions arising in the posterior cul-de-sac and extending into the posterior vaginal fornix may require laparotomy to accomplish excision. Preoperative therapy with gonadotropin releasing hormone analogs may greatly reduce the size of the implants, therefore, reducing the extent of excision or vaporization. We recommend outpatient mechanical bowel preparation prior to surgery. For the symptomatic patient who does not wish surgical excision of the lesion, gonadotropin releasing hormone analog therapy followed by suppression with oral contraceptives may be beneficial.

Leiomyoma

Vaginal leiomyomas or fibromyomas are rare lesions usually located in the anterior vaginal wall . Between 250 and 300 cases have been reported in the world literature. These lesions are benign smooth muscle neoplasms, usually solitary and in many cases asymptomatic. Histologically, they resemble leiomyoma of other origins. Proposed sites of origin include vaginal smooth muscle, local arterial musculature, or smooth muscle of the bladder or urethra. As is true of uterine leiomyomata, the vaginal lesions are estrogen dependent. Malignant conversion is extremely rare. When large, symptoms can include vaginal discharge or bleeding, dyspareunia, or urinary retention. The differential diagnosis of a midline anterior vaginal mass includes urethral diverticulum, fibroepithelial polyp, cystocele, Skene duct abscess, or vaginal malignancy. Therapy involves excision in the symptomatic patient. Recurrence is uncommon but reported.

Fibroepithelial Polyp

Fibroepithelial polyps of the vagina are uncommon and usually asymptomatic. In infants and young girls, sarcoma botryoides must be ruled out. Fibroepithelial polyps of the vagina are usually small and may be multiple. During pregnancy, these lesions may become enlarged, very edematous, and bizarre in appearance. Histologically, the polyps are composed of a squamous epithelial surface with a fibrovascular stalk and edematous stroma. Proposed etiologies include stromal proliferation or granulation tissue reaction as a result of local injury. Therapy involves excision of the polyp and stalk in the symptomatic patient or the patient with a large polyp.

Condyloma Acuminatum

Condyloma acuminatum represents the clinical manifestation of human papillomavirus infection.There are currently more than 120 human papillomavirus types identified. These lesions may be associated with condylomata of the cervix and vulva or appear only as vaginal lesions. Histologic evaluation confirms the diagnosis and rules out a dysplastic lesion. The microscopic description is similar to that for condyloma in other locations. Hybridization techniques to identify high-risk DNA type are currently of little help to the clinician in the face of obvious condyloma. Clinical management includes topical therapy with carefully applied bichloroacetic or trichloroacetic acid. For large or multiple lesions, excision, cauterization, laser vaporization, or loop electrical excision may be required. Cryotherapy may be helpful for small lesions; however, depth of thermal injury may be difficult to control. The entire genital tract should be evaluated and any obvious lesions treated simultaneously. Overly aggressive treatment, especially with laser or cautery may result in significant distortion and scarring of the vagina and should be avoided.

Urethral Caruncle

Urethral caruncles present as localized, red, friable lesions at the urethral meatus . They are generally seen in the postmenopausal woman and are thought to result from a localized area of prolapse of the urethral mucosa with secondary inflammatory changes. They can be confused with acute circumferential prolapse of the urethral mucosa, a condition usually seen in young girls. Urethral carcinoma must be excluded in patients with larger urethral caruncles. There may be pain, dysuria, and bleeding. Small asymptomatic urethral caruncles may not require any treatment. Larger or symptomatic lesions can be treated by topical application of estrogen. To establish the diagnosis, small biopsies may be performed under local anesthesia. Large or persistent lesions may require excision and reapproximation with fine absorbable suture.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including tumors of the vagina and vulva.

Posted on

Gynecology conditions and Gynecology consultation in COVID times for patients in South Delhi

The impact of the novel coronavirus disease 2019 (COVID-19) pandemic is catastrophic, with the cumulative number of confirmed worldwide cases reaching 1,610,909 by April 11, 2020. Despite the necessary reassignment of many healthcare resources to the care of patients with COVID-19, gynecologic patients must still receive a diagnosis and be treated. Therefore, guidelines for the safe management of these patients during the epidemic are needed to protect patients and the healthcare workforce.1 The Chinese Obstetricians and Gynecologists Association (COGA) organized experts from all provinces and autonomous regions in mainland China (Wuhan included) to contribute their experience in the diagnosis and treatment during the epidemic, aiming to distribute guidelines regarding the care of gynecologic patients during the COVID-19 outbreak in mainland China.

These guidelines were developed by the Department of Obstetrics and Gynecology at the Peking Union Medical College Hospital (PUMCH) and represent an effort to integrate infection control strategy and promote professionalism in medical practice. The guidelines represent collaboration with experts from 31 provinces over 2 weeks’ time. With the implementation of these guidelines, no nosocomial infections of COVID-19 have been identified at PUMCH. Given that it is not easy to anticipate when the epidemic will peak and the understanding of COVID-19 is still changing, parts of this consensus statement may become obsolete as knowledge about the epidemic evolves.

1. Outpatient

There should be triage for outpatients. Patients suspected of having COVID-19 should go to the fever clinic for further treatment. In principle, suspected cases, probable cases, or confirmed cases should not be allowed to seek medical advice in the outpatient gynecology clinic. Avoid having people gathering in the waiting area. One doctor or provider should treat 1 patient at a time in the consulting room, and the consulting room should be disinfected immediately after use. During the COVID-19 pandemic, we recommend online or remote consultation by telephone as much as practical, to minimize the risk of disease spread by close contact.

2. Operative patient

In emergency surgery with sufficient time available for screening, patients who are clinically stable should be asked the screening questions listed ,have their temperature assessed, and be checked for clinical symptoms to eliminate the possibility of COVID-19. If the possibility of a COVID-19 diagnosis cannot be completely ruled out, patients should go to the fever clinic for further screening . If the patient is clinically unstable or the patient’s condition is life-threatening, an emergency consultation with infection control experts may be useful. The decision may be made to treat the patient as a suspected case or even confirmed case .

In principle, it is recommended to reduce elective surgery during the epidemic. If the decision is made to perform elective surgery, the inquiry (screening questions) and triage protocol should be followed as for “time-limited” surgery.
Planning coordination throughout the hospital system, including the various surgical departments, anesthesia, and nursing services, is important in managing surgical services in the setting of a health emergency. Furthermore, adequacy of the blood supply must be considered when arranging operations. Autologous blood donation, acute normovolemic hemodilution, directed donation, and other methods can be considered as alternatives to allogenic blood transfusion.

3. Nonoperative inpatient

The triage protocol for a newly admitted patient is provided. Recommendations for ward management include the following: First, review the screening questions and take the temperature of patients, visitors, and accompanying persons; any patient with an elective admission or any nonpatient suspected of infection should be refused entry into the hospital.

Second, visiting rules can be modified according to local preference. It is recommended to prohibit visiting, and if visitors cannot be avoided, the number of visitors should be no more than 1. Visitors must be screened. Third, if a patient develops fever that cannot be explained by the primary disease (requires judgment by the attending doctor or professor), a consultation with infectious disease specialists is recommended. Fourth, if a patient is identified to have COVID-19, the patient should be transferred to a facility that can provide an airborne infection isolation room. At the same time, everyone who has had close contact with the patient should be isolated (This is a recommendation from our experience in mainland China. If there is a shortage of local medical staff, the strategy can be modified according to the actual situation.). Fifth, rooms should be reserved for emergency use for patients with infections during the outbreak (for emergency operations and for emergency isolations). Sixth, provide education for patients and close contacts.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions and is available in COVID free clinic.

Posted on

Dermoid cyst of the ovary

A dermoid cyst (also called as “mature teratoma”) is a sac-like growth that may be present at birth. It contains structures such as hair, fluid, teeth or skin glands that can be found on or in the skin. In some cases, especially when in the ovary, it also contains thyroid or brain tissue. Ovarian dermoid cysts, which not uncommonly are found in both ovaries, can develop in a woman during her reproductive years. The word “teratoma” is derived from Greek work “teraton” meaning monster. It was initially used by Virchow in 1863. The term “dermoid cyst” was coined by Leblanc in 1831.

Keywords: Bilateral ovaries, dermoid cyst, asymptomatic condition

Introduction

Mature cystic teratomas account for 10-20% of all ovarian neoplasms and are the most common neoplasm in patients of reproductive age group. Mature teratomas are usually benign, but in 0.1-0.2% of cases, it may undergo malignant transformation. They may remain asymptomatic or may present with acute abdomen due to torsion, infection, or rupture. Spontaneous rupture of the teratoma is rare and has been occasionally reported. Here we present a case of deroid cyst of ovary, which is bilateral and which is a rare presentation.

Discussion

Cystic teratomas make up approximately 15-25% of ovarian neoplasms. Almost 10-15% is bilateral. They are composed of well-differentiated derivatives of three germ layers-ectoderm, mesoderm and endoderm. Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary in women of reproductive age and are usually asymptomatic until they reach considerable size. Though they are common in reproductive age, but they can occur at any age including the post-menopausal woman. Most are 5-10 cm in diameter when diagnosed and on sectioning they usually contain thick sebaceous material, tangled hair and various dermal structures. One of the major complications seen in cystic teratomas is torsion, a partial or complete twisting of the ovarian suspensory pedicle causing severe pain, nausea and tissue necrosis. Malignant transformation is uncommon, occurring in approximately 0.1-0.2% of cases usually in older women. Ovarian teratomas have a predisposition to right lateral side.

Endometriosis co-existing with bilateral dermoid cysts of the ovaries is a rare occurrence although both benign conditions are said to be common in women in reproductive age group. This association has a clinical relevance because an endometriotic pathology can reveal a silent teratoma with bilateral ovarian localization.

In general, removing a dermoid cyst is not an emergency procedure. If a dermoid cyst ruptures, becomes inflamed, or causes pain or fever, a person should seek immediate medical advice. Treatment depends also upon the patients age. In younger woman, it may be possible to remove the dermoid cyst while still leaving behind normal ovary tissue for needed hormone benefits or future pregnancy. Autoimmune hemolytic anemia has been noted occasionally in patients with teratoma of the ovary, especially mature cystic teratoma.

Ovarian teratoma commonly has an indolent course and presents with abdominal pain due to complications such as torsion, hemorrhage, or infection. Spontaneous rupture of teratoma is rare due to its thick wall and it usually occurs in the peritoneal cavity. Rupture into a hollow viscus due to adhesions is extremely rare complication, which may present as perforation peritonitis.
Although ovarian teratomas are common day, we present this case because of its bilateral presentation, which is rare and the mode of treatment and the complications if not treated properly.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max e Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including dermoid cysts of ovary.

Posted on

Big and plenty of fibroids

Uterine fibroids are tumors that grow in a woman’s womb (uterus). These growths are typically not cancerous (benign)

Causes

Uterine fibroids are common. As many as one in five women may have fibroids during their childbearing years. Half of all women have fibroids by age 50.

Fibroids are rare in women under age 20. They are more common in African Americans than White, Hispanic, or Asian women.

No one knows exactly what causes fibroids. They are thought to be caused by:

• Hormones in the body
• Genes (may run in families)

Fibroids can be so tiny that you need a microscope to see them. They can also grow very large. They may fill the entire uterus and may weigh several pounds or kilograms. Although it is possible for just one fibroid to develop, most often there is more than one.

Fibroids can grow:

• In the muscle wall of the uterus (myometrial)
• Just under the surface of the uterine lining (submucosal)
• Just under the outside lining of the uterus (subserosal)
• On a long stalk on the outside the uterus or inside the uterus (pedunculated)

Symptoms

Common symptoms of uterine fibroids are:

• Bleeding between periods
• Heavy bleeding during your period, sometimes with blood clots
• Periods that may last longer than normal
• Needing to urinate more often
• Pelvic cramping or pain with periods
• Feeling fullness or pressure in your lower belly
• Pain during intercourse

Often, you can have fibroids and not have any symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause. A recent study also showed that some small fibroids shrink in premenopausal women.

Evaluating Uterine Fibroid Size for Removal

Women with large or symptom-producing fibroids may need to have an imaging study done to evaluate uterine fibroid size to determine whether it needs to be removed. The risk of not getting treatment is that fibroids sometimes grow to a size that often leads to significant symptoms, eventually requiring removal.

Larger fibroids or those that continue to grow may lead to complications.

• If submucosal fibroids are found on the inside of the uterus and are large enough to misshape the uterine lining, they should be removed to prevent reproductive problems. (iii)
• If fibroids are larger than a 12- to 14-week pregnancy (about the size of a large grapefruit), the risk of complications during surgery, such as injury to the ureter or bladder, increases. (i)
• Left untreated, very large fibroids can begin to degenerate or burst, even if they aren’t causing any symptoms. (i) Degeneration occurs when the growing fibroid outgrows its blood supply, causing the cells of the fibroid to die. This typically causes abrupt, severe pain and tenderness.
• When fibroids reach the size of a grapefruit (4 – 6 inches), there is a rare association with blood clots in the lungs, which can be deadly. (i)
• Rapidly growing large fibroids may be a sign of a rare cancerous form of fibroid, called a leiomyosarcoma. This type of tumor can’t be differentiated from a non-cancerous (benign) fibroid using ultrasound, MRI, or other imaging studies. However, this type of fibroid only occurs in less than 1percent of uterine fibroids, and these cancerous tumors are not believed to grow from a benign fibroid. (ii)

Treatment Options for Uterine Fibroids

There are several uterine fibroid treatment options:

• Uterine fibroid embolization (UFE) uses tiny particles about the size of sugar crystals that are injected into the blood vessels that lead to the uterus. The particles block the flow of blood to the fibroid, causing it to shrink and die. This minimally invasive procedure can be performed by an interventional radiologist on an outpatient basis. It doesn’t require open surgery and offers relief of symptoms with fewer risks, less pain, and a faster recovery compared to surgical procedures.
• Magnetic resonance imaging-guided (MRI) ultrasound surgery uses ultrasound waves to destroy fibroids. Waves are directed at the fibroids through the skin with the help of magnetic resonance imaging.
• Endometrial ablation destroys the lining of the uterus. This procedure is best for small fibroids that are less than 3 centimeters in diameter. (v)
• Hysterectomy is the surgical removal of the uterus. Because this surgery removes the fibroids along with the uterus, there is no chance of becoming pregnant after undergoing a hysterectomy.
• Myomectomy is another surgical option to remove all types of fibroids. There are three approaches to performing a myomectomy: hysteroscopy, laparotomy, and laparoscopy.

How large do uterine fibroids need to be before being surgically removed?

The normal uterine size is the size of a lemon or 8 cm. There isn’t a definitive size of a fibroid that would automatically mandate removal. Your healthcare provider will determine the symptoms that are causing the problem. Fibroids the size of a marble for instance, if located within the uterine cavity, may be associated with profound bleeding. Fibroids the size of a grapefruit or larger may cause you to experience pelvic pressure, as well as make you look pregnant and see increased abdominal growth that can make the abdomen enlarged.

It’s important for the healthcare provider and patient to discuss symptoms which might require surgical intervention.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including Fibroids. She is one of the best fibroids surgeon in south delhi.

Posted on

Antenatal care or pregnancy care in the COVID pandemic

The COVID-19 pandemic has everyone anxious and in fear. If you are pregnant, undoubtedly you have a lot of queries about whether coronavirus poses a threat to you and your baby. The answers are not crystal clear yet, due to the evolving nature of the disease. Knowledge from past epidemics due to similar respiratory illnesses help understand and manage viral infections during pregnancy. Here are the common queries among pregnant women answered.

What effect does coronavirus have on pregnant women?

Generally, pregnant women do not appear to be more risky than healthy adults to develop a more serious disease or any complications if affected by coronavirus. Mostly, they will only experience mild to moderate flu-like symptoms.

If you are pregnant and your flu-like symptoms are getting worse, it could mean that your chest infection is getting more severe, and you may require hospitalization. If you develop more severe symptoms or your recovery is getting delayed, contact a first response hospital near you immediately.

What effect will coronavirus have on my baby if I test positive for COVID-19?

As this is a very new virus, all the information and evidence is still not available to us. There is no evidence to suggest an increased risk of miscarriage if exposed to COVID-19. There is also no evidence of vertical transmission, which refers to the ability of the virus to pass to your unborn baby during pregnancy.
In a study of nine pregnant women in China who tested positive for COVID-19, all nine babies tested negative for the virus and were healthy overall. One pregnant lady in London tested positive for coronavirus and later her newborn also tested positive. However, it is unclear whether the baby contracted the viral infection in utero or shortly after birth. Expert opinion is that the baby is unlikely to be exposed during pregnancy, and it is unlikely for the baby to have any defects in development as a result. As of now, there isn’t any new evidence that says otherwise.

What are the effects of Coronavirus in the first trimester?

Pregnant women who were part of The Lancet study were all in their second or third trimesters. There is still no data on pregnant women who tested positive for the virus in their first trimester. Patients who may get infected with symptoms like high fever may increase the risk of birth defects, though there is no evidence for this yet.

Are pregnant women a vulnerable group for Coronavirus?

It is not yet known if pregnant women are more susceptible to be infected by COVID-19 when compared to the normal population. Despite this, pregnant women are advised to reduce social contact by social distancing. It is an established fact that in some women, pregnancy alters how the body fights some viral infections. Though evidence for coronavirus is still insufficient, it is for this reason that pregnant women are advised to be extra cautious during this pandemic.

Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?

Yes. The benefits of breastfeeding your infant far outweigh the risk of transmission of coronavirus through breastmilk. The main risk of breastfeeding is due to the close contact between you and your baby which can pose a risk of droplet infection that can spread to the baby while breathing. Discuss the risks and benefits with your treating doctor and family before you make a decision.

Here are some steps to follow to minimize the risk of transmission:

• Wash your hands before feeding or touching the baby, breast pump or bottles
• Try to avoid coughing or sneezing while you feed
• Wear a face mask while feeding, if available.
• If you are using a breast pump, follow instructions for cleaning and sterilizing properly.
• Consider asking one of your healthy family members to feed your baby if you are expressing milk.

Precautions for pregnant women against Coronavirus

Here are some actions you can take to prevent getting the disease during pregnancy:

• Wash your hands frequently. Hand hygiene can really protect you from exposure to COVID-19. You may hear this over and over but with good reason.
• Practice social distancing. Always maintain a distance of at least 2 metres or 6 feet from others when you are in a public place. Avoid contact with others as much as possible.
• Get your flu vaccination on time. Though the flu vaccine does not protect you from exposure to COVID-19, it does make you less susceptible to influenza, which can cause complications during pregnancy.
• Use a tissue when you cough or sneeze, throw the tissue in the dustbin. Wash your hands right after.
• Do not ignore any respiratory symptoms. If you develop a cough or any respiratory distress, do not hesitate to call your doctor. After taking a detailed history, your doctor will decide if you need to get tested for COVID-19.
• Go virtual. As much as possible, consider virtual consultations instead of prenatal visits to your gynecologist. Try to minimize or altogether avoid spending time in the doctors waiting room or in the hospital. However, some tests will require you to be there in person such as the ultrasound, blood tests and fetal testing.
• Work from home whenever possible.
• Stay safe. Symptoms such as high fever with or without continuous cough may indicate a possible coronavirus infection. Avoid coming in close contact with anyone showing these symptoms & take the time to look for support from your family and friends. Keep in touch via emails, messages or video chats. Consider taking up a new hobby or acquiring a new skill. Do things that make you happy and put your mind at ease such as taking a long shower, meditating or reading a book. Exercise as per your doctor’s advice and regularly do your Kegels and squats as recommended.

Do not stress too much if your due date is nearing, as hospitals have a system in place for safe deliveries and to ensure minimal risk of exposure for newborns.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of pregnancies. She is known for her bedside manners and etiquette towards pregnant women.

Posted on

Safe medical abortion in early pregnancy for unwanted pregnancy

Medical abortion, also known as non-surgical abortion, is one way to terminate an early pregnancy using medications. Medical abortion is provided by trained health care providers in private office settings, family planning clinics and hospitals.

A medical abortion can be performed from the time a woman suspects and confirms she is pregnant up until nine weeks from her last menstrual period. However, some insurance companies limit medical abortion to pregnancies of seven weeks or less.
In clinical practice, medical abortion is about 95 percent to 98 percent effective, causing a woman to completely pass the pregnancy without the use of surgery. In comparison, early surgical abortion is effective 98 percent of the time.

Medication abortion procedure

Medication abortion involves using the medications mifepristone and misoprostol instead of surgery to end a pregnancy. It can be done as soon as a pregnancy can be seen in an ultrasound. In India, medication abortion is performed up to five weeks of pregnancy.

A pregnancy needs high levels of the hormone progesterone to continue. Mifepristone works by blocking the action of progesterone to cause the pregnancy to stop progressing. Misoprostol causes the cervix to soften and the uterus to contract to allow the pregnancy to be expelled from the uterus.

The process and number of appointments for having a medication abortion varies depending on the type of clinic setting you attend, and whether certain tests you need (such as ultrasound and blood tests) are available on site or require separate appointments. A number of clinics are able to offer necessary tests and medication abortion in a single initial appointment.

The process of having a medication abortion generally involves the following steps:

• You will have a medical consultation with a Gynecologist and often a nurse as well, which involves a clinical assessment of medical and other relevant information, and arrangements for you to have an ultrasound and blood tests.
• You will be given information about the methods of abortion to help you to make an informed decision about the best method for you.
• If you decide to have a medication abortion, you will be asked to sign a consent form and will be given all the relevant information about what to expect, the steps you will need to take, and about pre- and post-abortion care.
• You will discuss what sort of pain relief, and any other appropriate medication you may require, and how to obtain it, in preparation for the abortion.
• If you have an intrauterine device, it will need to be removed before you take the first medication (mifepristone).
• You will take a tablet of mifepristone either at the clinic or at home and obtain the other appropriate medications.
• You will take a tablet of misoprostol 24 to 48 hours later. This softens the cervix and helps the uterus push out the pregnancy. This stage nearly always occurs at home. (If you need to travel after taking misoprostol and before the abortion is complete, it is recommended that you have a responsible adult who can drive you.)
• The abortion is usually completed some hours later, although it may take longer. You will usually need a day or two of rest or reduced activity.
• You will be encouraged to have telephone contact with the clinic you attended or another source of expert support in case you have any questions or concerns at any time during and after the procedure.

What to expect during and after a medication abortion

After taking the second medication abortion tablet at home, you may experience the following:

• nausea, vomiting, diarrhoea, dizziness, headache and fever
• pain – usually within half an hour and generally much stronger than period pain
• bleeding one to four hours later – heavier than a period and there may be large clots
• after two to six hours the bleeding usually settles to the level of your normal period
• bleeding is usually similar to a normal period for another three to seven days
• unpredictable, irregular or prolonged bleeding can last for up to four weeks after a medication abortion.

Note: The timing of the pain and bleeding is unpredictable. It occasionally starts before taking the second medication, but may take up to 24 hours to start.

Follow-up after a medication abortion

It is important to have a follow-up appointment to make sure the procedure is complete and the pregnancy has ended. Many doctors order a blood test to check that the pregnancy hormone level has dropped. You will be given an appointment for review in two weeks’ time.
Medication abortion does not work in around one percent of cases. Around two to five per cent of women will have some pregnancy tissue remaining in the uterus (womb) and will need further treatment such as additional tablets or a small surgical procedure to complete the abortion. Your Gynecologist will discuss this with you.

Advantages and disadvantages of medication abortion

Advantages of medication abortion include:

• For around 95 to 98 per cent of pregnancies up to five weeks, no further treatment is needed after taking the two doses of abortion medication.
• Unlike surgical abortion, medication abortion does not need to take place in a hospital or day surgery unit as it does not require a surgeon, anaesthetist or other medical staff to be present during the later stage of the procedure. This makes it a suitable alternative for those living in remote areas provided they have access to emergency care.
• It is a less clinical and non-surgical procedure, which some women may prefer.
• Some women feel it is a more natural process.
• It happens in a home environment.

Disadvantages of medication abortion include:

• Medication abortions are generally more time consuming than surgical abortions, and there may be more doctor visits and tests.
• In a small percentage of cases the medication needs to be repeated, and sometimes a surgical procedure is needed.
• Pain and bleeding generally last longer than following a surgical abortion.
• It is difficult to predict the time it will take for a medication abortion to complete – it may take longer than the expected four to eight hours, after taking the second medication.
• A separate appointment is needed if you would like an IUD inserted.
• Mifepristone is not suitable for some women.

Mifepristone may not be recommended for you if you:

• have certain medical conditions such as bleeding problems, adrenal failure or high blood pressure
• are taking long-term steroid or blood-thinning medication
• have had allergic reactions to medication containing mifepristone.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of abortions.

Posted on

Fibroids – Do’s and don’ts

What Are Fibroids?

Fibroids, or leiomyomata (myomas), are common noncancerous growths that usually occur in or on the muscle walls of the uterus. One cell divides repeatedly and grows into a firm, rubbery mass separate from the rest of the uterine wall. Almost half of women older than 50 have these growths. They’re more common in African American women than in Caucasian women. They can grow as a single mass or more often as a number of masses of different sizes.

What Causes Fibroids?

The cause isn’t clear. Several factors probably work together to produce fibroids. These factors may be hormones such as estrogen, genetics (runs in families), and environmental. Being overweight, never having had a child, and getting periods before age 10 also may have an effect. The fibroids usually, but not always, shrink after menopause (change of life).

What Are the Symptoms of Fibroids?

Most fibroids (30% to 50%) cause no symptoms. Problems, when they occur, are related to the size and location of the fibroids. Fibroids may grow to be quite large so that a woman may look pregnant and have symptoms of pregnancy: pressure in the pelvic area (lower belly), heaviness, and need to go to the bathroom often to urinate. Fibroids in the uterine wall or in the cavity of the uterus may cause bleeding between periods or heavier and more painful periods. Constipation, backache, pain during sex, and lower belly pains may occur. Rarely, fibroids cause sudden pain or bleeding.

How Are Fibroids Diagnosed?

The health care provider will do an examination of the pelvic area. Ultrasound or x-rays may be used but aren’t always needed for diagnosis. The doctor may do a special procedure (hysteroscopy) for women with bleeding symptoms. This simple procedure lets the doctor look into the uterus to find the cause of the bleeding or to plan or carry out therapy.

How Are Fibroids Treated?

Most fibroids need no treatment and only regular checks to be sure that they’re not growing too large or causing problems. Medicines including hormones and drugs that act against hormones can be tried. If fibroids continue to be a problem, hysterectomy (surgery to remove the uterus) is an option. Sometimes, fibroids alone may be surgically removed (myomectomy), which saves the uterus if children are wanted. Another newer method is uterine artery embolization. In this method, arteries to the uterus are blocked so they don’t feed the fibroids. Myolysis (electric current destroys fibroids and shrinks blood vessels feeding them) and cryomyolysis (liquid nitrogen is used instead of electric current) are other methods. However, fibroids can return and mean more surgery later. Newer medicines may shrink fibroids, but this change is only temporary.

DOs and DON’Ts in Managing Fibroids:

• DO get regular health care provider checkups.
• DO tell your health care provider your concerns and describe your symptoms.
• DON’T delay having children just because you have fibroids. They usually won’t get in the way of pregnancy. If you do need treatment for fibroids, some treatments can temporarily or permanently prevent you from becoming pregnant.
• DON’T worry about getting cancer from fibroids. Typical fibroids are not cancerous.

Surgery for uterine fibroids

• Medication to treat fibroid symptoms usually only works while you are taking it. Many women who have severe pain and heavy menstrual bleeding end up considering surgery as an option. There are a number of different types of surgical treatments, each with its own pros and cons.

• Surgery is done in the hope that it can permanently stop the symptoms of uterine fibroids. Some women do, in fact, experience long-term relief. But surgery always carries risks too. Whether or not surgery is an option – and, if so, what kind of surgery – will depend on how the woman feels about the different advantages and disadvantages. The size, number and location of the fibroids will also influence the choice of treatment. Not all types of surgery are suitable for women who still want to have children.

• Your doctor may recommend taking hormones such as GnRH analogues several weeks before having surgery. These kinds of artificial hormones are used to shrink the fibroids. Doctors can then make smaller cuts during surgery, allowing the womb (uterus) to recover more quickly. The drug ulipristal acetate is sometimes used for this purpose too.

• But removing individual fibroids isn’t a good idea if it might cause too much scarring in the womb, or if the risk of bleeding during or after surgery is too high. Plus, it isn’t always absolutely certain that the symptoms will improve after surgery. Hysterectomy (surgical removal of the womb) is then an option – or possibly another non-surgical treatment approach such as uterine artery embolization (UAE, sometimes also called uterine artery embolization, or UFE). Uterine artery embolization cuts off the blood supply to the fibroid.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years experience in handling all kinds of Gynecological conditions including Fibroids.

Posted on

Fibroids surgery -laparoscopy / key hole surgery versus open myomectomy

Uterine fibroids are noncancerous growths that grow in the wall of the uterus. When fibroids cause heavy bleeding or painful symptoms, and other treatments are ineffective, a doctor may recommend surgery.

Fibroids are common, but it is challenging for doctors to determine what percentage of people have them, as not everyone experiences symptoms. According to various estimates, fibroids may affect between 20% and 80% of the female population under the age of 50 years.

Although fibroids can sometimes grow to the size of a grapefruit or even larger, they are often very small. Many people with fibroids are unaware that they have them. People with asymptomatic fibroids do not require surgery or other treatments.

However, other people experience abdominal pain, pressure, bloating, pain during sex, frequent urination, and heavy or painful periods. These individuals may require surgery.

In this article, learn more about surgery for fibroids, including the types, risks, and what to expect.

There are several different surgical approaches to treating fibroids. The types of surgery that a person can have will depend on the location of the fibroid.

A doctor will usually recommend more conservative options, such as medication, before considering surgery.

In cases where medication and other treatments do not work, surgical options include the following:

Myomectomy

Myomectomy is a surgical procedure that removes fibroids. Depending on the location of these growths, a surgeon may also have to remove other tissue in the process. Surgeons offer different myomectomy techniques.

The traditional technique is quite invasive as it uses a relatively large cut. This incision may go from the bellybutton to the bikini line or run horizontally along the bikini line. Some surgeons also perform laparoscopic surgeries, which use smaller incisions but require more skill.

Although a myomectomy preserves the uterus, women who wish to become pregnant should speak to a doctor about the possible complications. Those with very large or deeply embedded fibroids may only be able to have cesarean deliveries after this procedure.

New fibroids may develop after a myomectomy, which means that it is not a permanent solution for everyone.

Radiofrequency ablation procedure

Radiofrequency ablation destroys fibroids using either an electric current, a laser, cold therapy, or ultrasound. It requires only a small incision.

However, it can cause dangerous pregnancy complications, such as scarring and infection, so doctors do not recommend it for those who are planning future pregnancies.

Radiofrequency ablation may be a good option for people considering a hysterectomy who want a less invasive procedure.

Endometrial ablation

Endometrial ablation does not remove fibroids, but it can help relieve heavy bleeding.

During endometrial ablation, a surgeon uses a range of techniques — which may include heat, electric current, freezing, lasers, or wire — to destroy the lining of the uterus. These techniques reduce or stop heavy bleeding.

This procedure is less invasive than some other surgical options. Sometimes, doctors can even perform it on an outpatient basis in their office.

This procedure may prevent women from being able to get pregnant in the future, so it is not a good option for those who would still like to have children.

Hysterectomy

A hysterectomy is a surgery to remove the uterus and, sometimes, the ovaries. A hysterectomy permanently eliminates uterine fibroids.

This procedure is not an option for anyone planning a future pregnancy, as it removes the womb. Some people opt to leave the ovaries in place so that they continue producing estrogen.

A surgeon may be able to perform a laparoscopic hysterectomy, which uses several small incisions and a tiny camera to help the surgeon see inside the abdomen. An open hysterectomy requires a large incision between the bellybutton and the bikini line.

Another option is a vaginal hysterectomy, which is the approach that most people prefer. In this procedure, a surgeon will remove the uterus through the vagina.

A vaginal hysterectomy may not be possible if the uterus or fibroid is too large to fit through the vagina.

Individuals who undergo an open hysterectomy may have a longer recovery time. Doctors usually recommend a hysterectomy only for those whose fibroids are very large or significantly interfere with their quality of life.
People who have other reproductive health issues, such as endometriosis, may find that a hysterectomy provides significant relief from fibroids and other symptoms.

Morcellation

Morcellation is a procedure that reduces the size of fibroids so that a surgeon can remove them through a tiny incision in the abdomen. A doctor may use morcellation during a myomectomy, hysterectomy, or other surgery.
However, the Food and Drug Administration (FDA) caution that morcellation carries significant risks.

While fibroids are not cancerous, uterine cancer is more common in people having fibroid surgery than experts previously thought.

It can also be difficult to tell the difference between a fibroid and a type of cancer that looks the same. According to the FDA, morcellation may inadvertently spread cancer that resembles a fibroid.

Benefits

The benefits of surgery depend on the type of surgery and can vary from person to person. For example, there is no chance that the fibroids will grow back after a hysterectomy. However, they may regrow following other procedures.

Some potential benefits include:

• reduced bleeding
• relief from pain or pressure
• removal of fibroids
• the potential that fibroids will either not grow as large or not regrow at all

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 13 years experience in handling all kinds of fibroids.

Posted on

Miscarriage or heavy bleeding in early pregnancy

What should you know about vaginal bleeding during pregnancy?

Vaginal bleeding or spotting during the first trimester of pregnancy is relatively common. Some amount of light bleeding or spotting during pregnancy occurs in about 20% of pregnancies, and most of these women go on to have a healthy pregnancy.

What is implantation bleeding?

Implantation bleeding is bleeding that occurs when the fertilized egg implants in the lining of the uterus. This happens around the time of the expected menstrual period. Implantation bleeding may occur before a woman realizes she is pregnant. What are the serious causes of vaginal bleeding in the first trimester of pregnancy?

What if I am pregnant and the bleeding severe?

Causes for severe bleeding during pregnancy include miscarriage, threatened miscarriage, and ectopic pregnancy. If you are pregnant and have vaginal bleeding, call 911 and go to the emergency department.

How much bleeding is normal during pregnancy?

Vaginal bleeding during the first three months of pregnancy is relatively common and usually is a cause of concern for the mother. Women wonder how much bleeding during early pregnancy is normal. While early bleeding may indicate the presence of a serious problem, this is frequently not the case. In fact, approximately 20% of pregnant women experience light bleeding or spotting during the first trimester of pregnancy. Most women go on to have uncomplicated pregnancies and ultimately deliver a healthy baby.

Spotting: Spotting usually refers to a few drops of blood that would not cover a pad or panty liner. Bleeding refers to blood flow that is heavy enough to require wearing a pad. If bleeding occurs during the first trimester, wear a panty liner or pad so that you are able to get an idea of the amount of bleeding that is occurring and can tell the health care professional. However, you should not use a tampon in the vagina or douche during pregnancy.

What other problems cause bleeding during early pregnancy (first trimester)?

Changes in the cervix: The normal hormone production during pregnancy can cause changes to the cervix, rendering it softer and more prone to bleeding. In addition, a cervical polyp (a benign overgrowth of tissue) may form, and this may bleed more easily during pregnancy. In both cases, spotting or light bleeding may be provoked following sexual intercourse or a pelvic examination.

Infection: A vaginal infection may cause spontaneous vaginal bleeding during pregnancy. The bleeding may be accompanied by abnormal vaginal discharge.

What causes heavy bleeding during early pregnancy (first trimester)?

Miscarriage

  • Bleeding, abdominal pain, and back pain are common signs of miscarriage.
  • An exam shows that the cervix is open.
  • Tissue may be extruded through the cervix and vagina.
  • A miscarriage occurs in an estimated 15% to 20% of pregnancies, usually during the first 12 weeks of gestation.
  • A genetic defect confined to the specific embryo in question represents the most common cause of miscarriage.
  • Few circumstances exist wherein a miscarriage in progress can be prevented.

Molar pregnancy

  • Molar pregnancy, also known as gestational trophoblastic disease or hydatidiform mole, is an abnormality of fertilization that results in the growth of abnormal tissue within the uterus.
  • Molar pregnancy is not a typical pregnancy, but the growth within the uterus leads to the typical symptoms of early pregnancy.
  • In a complete hydatiform mole, there is only abnormal tissue in the uterus (and no fetus).
  • In a so-called partial mole, there is abnormal tissue growth along with the presence of a fetus with severe birth defects.
  • The fetus is typically consumed by the abnormal growth of tissue in the uterus, and a molar pregnancy cannot result in a normal fetus or delivery.
  • Vaginal spotting or bleeding can be a symptom of molar pregnancy.
  • A sonogram or ultrasound is used to diagnose a molar pregnancy.

Ectopic pregnancy

  • Mild vaginal bleeding and increasing abdominal pain may indicate the presence of an ectopic pregnancy.
  • An ectopic pregnancy occurs in approximately 1 out of 60 pregnancies.
  • An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, where the blood supply is inadequate to sustain the growth of a normal pregnancy.
  • In the majority of cases of ectopic pregnancy, the embryo is located within one of the Fallopian tubes; this sometimes is referred to as a tubal pregnancy. As the pregnancy grows and the tube distends, abdominal pain becomes increasingly severe.
  • Sometimes these pregnancies can actually rupture the Fallopian tube, leading to significant blood loss.
  • In some cases, a blood transfusion and emergency surgery are needed for prompt resolution of this potentially life-threatening condition.

Threatened miscarriage

  • If a woman is bleeding during the first trimester of pregnancy, the possibility of a miscarriage must be ruled out.
  • Symptoms of a threatened miscarriage are bleeding and mild cramping, but the cervix stays closed and the fetus is still viable.
  • In many women, the bleeding stops and the pregnancy continues. For others, the bleeding continues, and they eventually have a miscarriage (i.e. spontaneous pregnancy loss).

Subchorionic hemorrhage

  • In this condition, blood collects between the gestational sac and the wall of the uterus.
  • At times, the intrauterine clot can be seen on ultrasound examination.
  • The body frequently reabsorbs these blood clots; however, occasionally there may be passage of old dark blood or even small clots from the vagina.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi, with over 14 years’ experience in handling all kinds of bleeding during pregnancy. She specializes in high risk pregnancy management and handling.