Every pregnancy should be a wanted pregnancy
and therefore it should be a planned pregnancy.
It is imperative then to ensure use of a contraceptive
that suits the need of the couple. In present
times there is a wide range of options available
in the basket of contraceptives. There are temporary
methods i.e. reversible and permanent methods
i.e. irreversible. Permanent methods are used
when child bearing is no longer desired. Tubal
sterilization and vasectomy are the choices
available. Amongst the temporary methods the
choices vary on various factors. Barrier methods
such as male and female condoms are popular.
The male condom is widely promoted not only
to prevent pregnancy but also to prevent STD
and HIV. It is the single contraceptive that
serves this dual purpose. The combined oral
contraceptive pills (COCP) have been around
for decades and they have undergone numerous
developments. From standard dose pills we have
moved to the ultra low dose pills, which have
minimal or negligible side effects. The COCP
have many benefits over and above providing
They are Changes in menstrual cycle
(Decrease in pain
during periods, Decrease in quantity of bleeding,
regular cycle, decrease in iron loss in periods)
Benefits in the management of PCOS such as reduction
in acne and hirsutism, and regularization of
Prevention of malignancies
(Endometrial cancer, ovarian cancer, colorectal
cancer) Other benefits such as reduction in(Ovarian
cysts, pelvic inflammatory disease, ectopic
pregnancy, benign breast disease, acne) The
use of COCP has been clouded with many myths.
These myths can be addressed during a consultation
and we can help you to choose a pill appropriate
to your needs For women who cannot take estrogen
containing pills can use progesterone only pills.
They are particularly useful in women who are
Emergency contraceptive pills
Emergency contraceptive pills are not an alternative
to regular contraception but an emergency measure,
which can prevent an unwanted pregnancy if taken
within 72 hours of unprotected sex. They are
safe effective and available over the counter.
The common one available is marketed as two
tablets each containing 75 mcg of Levonorgestrel.
The first tablet is taken within 72 hrs of unprotected
intercourse and the second one is taken after
12 hours of the first tablet. Pill 72 is now
a single does tablet to be taken as soon as
possible after unprotected sex, but within 72
Intrauterine devices are ideal for spacing and
when long-term contraception is required. We
have the copper containing and the levonorgestrel
releasing intra-uterine system. They are easily
inserted in the out patient clinic and there
is no need of any anesthesia. They are effective
immediately from the time of insertion. They
are effective for as long as 5 to 10 years and
once removed, fertility returns at once. The
contraceptive vaginal ring and the contraceptive
patch are not yet available in the Indian market.
In present times couples have a wide array of
choices for contraceptives and one can always
find one to meet their needs. Abortion should
not be used as a method of contraception. However,
every method has a failure rate and if a pregnancy
does occur, and is not planned or wanted, seek
an appointment with Dr Shilpa as early as you
can because the earlier an abortion is done
, safer it is
UNWANTED PREGNANCY (ABORTION)
It is appropriately said that every child should
be a wanted child. Sometimes a pregnancy may
not be wanted. In this case one may seek an
abortion. Abortion is legal provided it is carried
out within the legal permits. An abortion can
be done only up to 20 weeks of pregnancy.
Under the terms of the abortion act, doctors
can agree to an abortion if they believe one
or more of the following:
1. Continuing with the pregnancy would involve
more risk to your physical or mental health
than terminating it.
2. Continuing with the pregnancy would involve
greater risk to your life than terminating it.
3. Any existing children of yours were likely
to suffer if the pregnancy continued.
4. There is a substantial risk that the child
would be deformed or seriously handicapped.
If one desires a termination of pregnancy then
one should seek an abortion as early as possible
as earlier it is done in the pregnancy safer
it is. The method of termination will depend
on the weeks of gestation.
When the pregnancy is
1. more than 7 weeks – abortion can be done
with just tablets. The tablets are safe effective
and have a success rate of more than 90 %. The
advantages are that the patient does not need
any admission, anesthetic, any instrumentation
of the uterus.
2. 7 – 12 weeks – then abortion is a simple
procedure. It is done under an anesthetic in
a day care center that is certified for abortion
services. The patient is able to go home in
a few hours.
3. 12 – 20 weeks – the procedure is a little
lengthy and one may need to stay overnight in
the hospital. If you wish to seek an abortion
or want further information then please feel
free to contact Dr SHILPA DODANI
Approximately 15 % of couples require assistance
with conceiving. The reasons for inability to
conceive spontaneously may be related to either
of the partners or may be unexplained. If a
couple has not been able to achieve a pregnancy
within one year then they are offered investigations
and further management. Basic tests include
hormonal profile, tubal patency and semen analysis.
Dr SHILPA DODANI offers the whole range of basic
management of infertility such as follicular
studies, ovulation induction, intrauterine insemination,
and donor insemination at clinic. Surgical procedures
such as ovarian drilling for polycystic ovaries,
removal of endometriomas, adhesiolysis, and
resection of the uterine septum can be easily
conducted at the centers visited by dr shilpa
dodani Invitro fertilization and embryo transfer
(IVF-ET) commonly called as test tube baby,
and other services such as ovum donation, sperm
banking, and surrogacy are offered in collaboration
with well established assisted reproduction
Pregnancy is one of the most precious times
in the life of a woman. Nine months and then
a bundle of joy is true happiness. This pleasure
needs to be nurtured very well. Signs and symptoms
of pregnancy. The commonest symptom is missing
of a period. Occasionally one may have spotting
at the time one would have expected the period.
The other common symptoms are nausea, vomiting,
shortness of breath, fatigue, and tiredness.On
examination the doctor may notice a enlarged
uterus which can be felt through the abdomen
only when more than 12 weeks of pregnancy.
Diagnosis of pregnancy
The pregnancy hormone is ß- HCG. This is easily
detected by a simple two minute home pregnancy
test. An ultrasound examination can confirm
the pregnancy. It will also give very valuable
information on the number of fetuses, location
of pregnancy, size of the sac and overall health
and viability of the pregnancy.
Common problems in pregnancy
Nausea, vomiting and heartburn are common problems.
One should avoid fried and spicy foods and maintain
good hydration. It is safe to take doxylamine,
and vitamin B -6 which are effective in preventing
and controlling the symptoms. Ondansetron has
also been used effectively. One may also have
loss of appetite and very peculiarly have complete
aversion to sight of some foods. Constipation
is also a common problem. It can lead to piles
and unnecessary blood loss during pregnancy.
Increasing fluid and fibre intake, and stool
softeners can help tide over the situation.
The three trimesters of pregnancy
The first trimester
This is from the time of conception to 12 weeks.
The commonest symptoms during this time are
nausea, vomiting, and heartburn. These can be
easily treated. The commonest problem during
this time is a miscarriage i.e. pregnancy loss.
This will present as abnormal vaginal bleeding
per vaginum and may be associated with pain.
It is diagnosed on ultrasound examination.
The second trimester
This lasts from 12 weeks to 28 weeks By this
time the nausea and vomiting subside. The risk
of miscarriage is reduced. Formation of the
major organs is completed by 20 weeks. After
that the fetus is increasing in size.
The third trimester
This lasts from the 28 weeks to 40 weeks. It
is at this time that many important medical
issues may surface. Anemia may worsen. One may
develop pregnancy induced high blood pressure
and gestational diabetes which have implications
on the health of both the mother and the fetus.
We provide exersice concultancy during pregnancy.
The patients are discharged within 24 – 48 hours
after vaginal delivery and in three days after
a cesarean section. Lactation is encouraged
as soon as the baby is delivered. Good care
of the breast and the episiotomy is advised.
Patients are advised to follow up for discussion
and implementation of contraception.
Routine checks in pregnancy
The first antenatal visit is recommended as
soon as the pregnancy is suspected or diagnosed.
The subsequent visits can be done as follows.
• Once a month up to 28 weeks.
• Twice a month up to 34 weeks
• Then once a week up to delivery This is only
an approximate schedule for a low risk uncomplicated
pregnancy. The schedule can change according
to the circumstances at that time.The commonly
advised tests are CBC, blood group, Thyroid
estimation, HIV, VDRL, HBsAg, sugar level estimation
and routine urine analysis. Various special
tests may be required depending on various medical
situations eg. Antiphospholipid antibody in
cases of recurrent miscarriage.Triple marker
is offered to all at 16 weeks. Obstetric ultrasound
examination is done at various stages- in first
trimester for dating, location of pregnancy
and to look for multiple pregnancies, in second
trimester for the study of anatomic defects,
and in the third trimester for growth. Additional
ultrasound and Doppler examination will be required
in special circumstances for eg Preterm labor
and abnormal bleeding in pregnancy. CBC and
sugar tolerance is repeated at 28 weeks. Common
supplements in pregnancy. Iron and calcium supplements
are commonly given to pregnant women. Folic
acid supplement is given even preconception
and continued into the first trimester. There
is enough scientific evidence to support its
use to prevent neural tube defects. Tetanus
toxoid is given, usually two doses one month
apart starting at 28 weeks. The role of Essential
fatty acids, Vitamin E, Lecithin and Arginine
are not yet convincing and therefore not recommended
as a routine. Dr SHILPA DODANI has a passion
for obstetrics i.e. care of women in pregnancy.
You can feel free to ask queries via email regarding
this important event in your life. She provides
quality compassionate care during pregnancy.