Obstetrics

  • Obstetrics Recurrent pregnancy losses

    Miscarriage of a pregnancy is a physically and emotionally challenging ordeal. When pregnancy loss is repetitive, these feelings are magnified. While the risk of miscarriage increases with increasing maternal age, overall approximately 13% of all recognized first pregnancies miscarry. The risk of a second consecutive miscarriage is only slightly increased to 17%. However, the risk of miscarriage after two consecutive pregnancy losses rises to 35 to 40% and continues to rise with each subsequent miscarriage. It is estimated that between 2 to 5% of couples desiring pregnancy will suffer from recurrent pregnancy loss

  • High risk pregnancy

    Pregnancy can be a stressful time, especially if there's a complication. Our Doctor may help you in continuation of high-risk pregnancy.

    Our program offers consultations and second opinions to you and your obstetrician. Our goal is to answer questions, explain conditions, provide testing, and help you and your baby from conception to delivery. Our prenatal care is extensive.

    Our team is experienced to handle virtually any high-risk pregnancy problem, including:

    • diabetes
    • heart disease
    • kidney disease
    • high blood pressure
    • cancer in pregnancy
    • Rh blood factor problems
    • history of pre-term birth
    • genetic disease in the mother or family
    • quadruplets and other multiple
    • births birth defects identified before birth
  • Diabetes in pregnancy

    Diabetes is the most common medical complication of pregnancy, affecting 2 to 3% of all pregnancies. Ten percent of cases are women who have diabetes before pregnancy, and for these women, the risk of birth defects is four times greater than in women who get diabetes during pregnancy.

    The most common birth defects resulting from a diabetic woman becoming pregnant are problems with the structure of the baby's heart, spine or kidneys. These outcomes are especially true if the mother has high blood sugars prior to conceiving. Women with pre-pregnancy diabetes are also at higher risk of out-of-control diabetes during pregnancy, which can lead to an increased risk of stillbirth.

    Careful management of diabetes before conception is critical. Women who have normal blood sugars before and when they conceive experience lower risks for birth defects. The risk can even be lowered to near the level of a non-diabetic woman.

    Ninety percent of the cases involving diabetes during pregnancy are classified as gestational diabetes. This is diabetes that is diagnosed or recognized during a pregnancy. Since it develops after the baby's organs are formed, the risk of birth defects does not increase. Women with gestational diabetes, however, do experience greater incidences of excessive baby growth before birth. This can lead to delivery problems or the need for a cesarean section. Controlling sugars during pregnancy can lower the risk.

  • Hypertension in pregnancy

    Chronic hypertension in pregnancy is associated with increased rates of adverse maternal and fetal outcomes both acute and long term. These adverse outcomes are particularly seen in women with uncontrolled severe hypertension, in those with target organ damage, and in those who are noncompliant with prenatal visits. In addition, adverse outcomes are substantially increased in women who develop superimposed preeclampsia or abruptio placentae. Women with chronic hypertension should be evaluated either before conception or at time of first prenatal visit. Depending on this evaluation, they can be divided into categories of either "high risk" or "low risk" chronic hypertension. High-risk women should receive aggressive antihypertensive therapy and frequent evaluations of maternal and fetal well-being, and doctors should recommend lifestyle changes. In addition, these women are at increased risk for postpartum complications such as pulmonary edema, renal failure, and hypertensive encephalopathy for which they should receive aggressive control of blood pressure as well as close monitoring.

    In women with low-risk (essential uncomplicated) chronic hypertension, there is uncertainty regarding the benefits or risks of antihypertensive therapy. In our experience, the majority of these women will have good pregnancy outcomes without the use of antihypertensive medications. Antihypertensive agents are recommended and are widely used in these women despite absent evidence of either benefits or harm from this therapy.

  • IUGR

    The term intrauterine growth restriction (IUGR) is the most common generic term that is used to describe the fetus with a birthweight at or below the 10th percentile for gestational age and sex. This term is often erroneously used as synonymous of small for gestational age (SGA). The IUGR fetus is a fetus that does not reach his potential of growth; whereas the SGA fetus is a fetus who reaches his potential of growth. In other words, a fetus who has a potential of growth at the 50th percentile but because of maternal, fetal, or placental disorders occurring alone or in combination, becomes growth restricted (birthweight <10th percentile) is a IUGR fetus and he is at risk for adverse perinatal outcome. A fetus with a potential of growth at the 7th percentile who reaches his potential of growth (7th percentile) is not a IUGR fetus but a SGA fetus. He is a normal small fetus and he is not at risk for adverse perinatal outcome.

  • Preterm delivery
  • Post term pregnancy

    Last menstrual period is the best physiological land mark to assess the gestational period in pregnancy. However, a few women are sure of their dates and often cause anxiety when they come with postdatism. A post-term pregnancy is the one which extends beyond 42 weeks or 294 days from the first day of the last menstrual period.

    Post-dated pregnancy always poses a high risk, as there is a possibility of foetal distress and death due to progressive foetal hypoxia following plancental insuffiency as a result of its agening. This is however a rare complication as usually there is enough reserve. Although it appears desirable for the pregnancy to be terminated before such a problem arises, it is not always possible to do so as there is a significant number of patients where obstetric dates are not well substantiated; further, when pregnancy reaches 42 weeks, there are patients with a cervix unfavorable for induction and in whom induction results in a high caesarean section rate.

  • Placenta pravia

    Placenta praevia (also known as low lying placenta) is a complication of pregnancy, when the placenta is in the lower segment of the uterus and covers part or all of the cervix. Between three and six of every 1000 pregnant women have this problem. Bleeding may be a symptom of the condition. As the lower part of the uterus stretches in the second half of pregnancy, the placenta may become detached, causing severe bleeding. The baby cannot be born vaginally if the placenta is totally obstructing the opening from the womb.

    Uncontrolled bleeding (haemorrhage) is life-threatening for both mother and baby, although this is rare. If the bleeding doesn't stop, or if the mother goes into premature labour, the baby will need to be delivered by caesarean section even if the date on which he was due isn't for quite a few weeks.

    Placenta praevia can be divided into four types, of which the first two are the most common:

    • The placenta is positioned low in the womb, but the baby can still be born vaginally.
    • The lower edge of the placenta touches the opening of your cervix, but does not cover it, so the baby can be born vaginally.
    • The placenta partially covers the opening of your cervix. The baby will need to be born by caesarean section.
    • The placenta completely covers the opening of your cervix. The baby will need to be born by caesarean section.

    If you have an ultrasound scan in early pregnancy and the placenta seems to be near, or even covering the cervix, don't be too alarmed. It almost certainly is not placenta praevia. As your baby grows, your expanding uterus naturally pulls the placenta away from your cervix. Even if the placenta is still low-lying at your 20-week scan, it may well not present a problem once you are full-term

  • Twins pregnancy

    Obviously, carrying and delivering two babies at once is more of a feat than just producing one, but the fact remains that pregnancy and birth are physiological states, not symptoms of a disease process. Statistically, it is true that there’s an increased likelihood of problems with twins. However, not all complications of single pregnancies occur more frequently in a twin pregnancy, so don’t worry. How twin pregnancies happen Identical twins.

    One egg splits after fertilization into two separate cells – each one of these growing into a baby (usually sharing the same placenta). Having developed from the same cell, they are always the same sex and look alike. Non-identical or fraternal twins. Two eggs are fertilized by two different sperm at the same time, (each baby having its own placenta). They can be different sexes and probably will not look any more alike than any brother or sister. Your chance of having twins Twin pregnancies are passed down through the female and are more likely to occur if there are already non-identical twins in the family.

  • Elder mother

    According to figures from the Human Fertility and Embryology Authority (HFEA) is evident that there is an increase in the rates of women attaining motherhood at a later age. Based on statistics it was seen that in 1992, just one baby was born to a mother aged 50 or over. But in 2002, 24 babies were born to women in that age group after IVF treatment. Though rules by the NHS say that IVF should not be done to women over 39 there is no legal IVF age limit. Recently Dr Patricia Rashbrook, of Lewes, East Sussex, became Britain's oldest mother at the age of 63. She underwent IVF treatment from an Italian fertility doctor Severino Antinori. The HFEA shows that there is an increase both in the number of women seeking IVF and the number of babies born after IVF.

    FAQ

    Q.1.   I am 25 years old and married for 3 years. I have just missed my period by one week and was excited about my pregnancy but my doctor says that I have an ectopic pregnancy and I must get it operated and removed. Are there no alternatives? Kasturi

    Ans:  An ectopic pregnancy is one where the pregnancy gets stuck in the tube or ovary rather than in the womb (uterus). This is diagnosed clinically or on sonography. It is a dangerous condition as the tube can burst and there can be severe bleeding inside the pelvis, therefore treatment has to be done urgently. This can be treated either with special injections of drugs such methotrexate or by key hole surgery (laparoscopic surgery) where the tube can be removed or only the pregnancy is removed and the tube is saved if it looks healthy.