Health Issues

CONTRACEPTION

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 contraception. .

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 periods

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 breast-feeding.

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 hours.

Intrauterine devices

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

INFERTILITY

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 centers.

PREGNANCY

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.

Post delivery

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.