Changes in human body during pregnancy

Human body undergoes enormous changes during pregnancy. It affects the body from head to toes. It is amazing how the body accommodates the baby so smoothly.

1) There is a new growth spurt in hair, glow on the face and bleeding gums because of increased estrogen in the blood.

2) Increased pigmentation on face ,neck , nipples and abdomen due to increase in melanin . This pigmentation is also known as melasma or chloasma or PREGNANCY MASK.

3) Water retention leading to puffiness of face , swelling of fingers and toes . Swelling around sciatic nerve causes pain in lower back and thigh . Contact lens users feel difficulty in their usage.

4) There is marked increase in the size of breasts as they need to get ready for nursing the baby.

5) Dryness of skin and breakage of collagen leading to stretch marks.

6) Constipation because of progesterone ,the hormone of pregnancy ,it is known to make the bowel sluggish.

7) Joints and ligaments loosen around pelvis and other places because of pregnancy hormones specially RELAXIN, this helps for accommodating baby and delivery. Loosening also results in back pain, change in gait WADDLING.

8) Increase in body temperature, heart rate and breathlessness due to increase in metabolic rate and increased cardiac output.

9) Increase in stagnation of venous blood flow leads to hemorrhoids or piles, varicose veins.

10) Acne worsens as the hormonal shift makes skin very oily.

By,

Dr. Suhasini Inamdar

Hernia in Pregnancy By Dr. Sangeeta Gomes

Dr. Sangeeta Maternal guidance on hernia in pregnancy - Motherhood Hospital India

Hernia is a hole or gap in the abdominal muscle wall that causes either intestine or fatty tissue to protrude through.

Areas of Hernia: Abdomen, Groin, Incisional sites.

Hernia types:

  • Umbilical or belly button: Umbilical Hernia is the most common of Hernias in pregnancy. It is the site where umbilical cord is attached when child is born. There is a small opening in this area and an increased pressure can stretch it open. It appears in pregnancy and disappears after delivery.
  • Inguinal hernia/Femoral hernia: These are seen in the groin area.
  • Incisional hernia: It develops in the operation site, and is usually seen in vertical scar on abdomen.

Hernia normally occurs after 18-20 weeks of pregnancy and around 2% of women get Hernia during or after their pregnancy. Approximately 0.02% of women require surgery.

2 per 1000 women with transverse incision and 10 to 30% women with vertical incision can get hernia.

Hernia in pregnancy does not require immediate attention, unless it becomes painful. If painful and left untreated can lead to serious and life-threatening complications like obstruction and intestinal gangrene.

Babies may not get affected by mothers Hernia.10-30% of infants have umbilical hernia after birth which usually closes by 1 year and 2% remain which may require surgery.

Predisposing factors:

  • Women having muscle weakness from birth.
  • Aggregating factors like chronic cough, constipation, asthma and obesity
  • Big baby, twins, polyhydramnios can also stretch muscle making them thin and weak, and tear them due to pressure of growing baby in uterus.
  • Heavy weight lifting.
  • Fluid in the abdomen.
  • Tumor in the abdomen raising intra-abdominal pressure.

Signs and symptoms of Hernia:

Many women have no symptoms. Some can see or feel a bulge while lying down, standing or coughing, in the inguinal or belly button area. Some have dull aching pain while laughing talking, coughing and sneezing. Some may find difficult to walk if they become bigger. If symptoms like pain, fever, nausea are there, they should meet the doctor immediately.

Diagnostic tests:

  • By physical examination on inspection and palpation feeling the gap in the hernia site and reducing the contents back into the abdomen.
  • By cough impulse one can feel the touch of the intestine gurgling in the hernia site.
  • Ultrasound examination of abdomen and pelvis can show the site, size, shape and contents of the gap. Higher test like CT scan also be done.

Treatment of hernia:

Once detected treat with good physical support at the site of a hernia to prevent the further discomfort. Hernia support band, compression therapy groin bands etc to be used under DoctorŸ??s supervision. While sleeping take off the hernia support band. Keep pillow between or under knees for support.

ItŸ??s not recommended to have surgery during pregnancy unless its posing risk to the mother and baby. If due to some complication, surgery has to be done, plan it in second trimester of pregnancy. This carries a risk of preterm delivery.

For Pregnancy with Hernia, Caesarian section is not mandatory, they can deliver normally. Caesarian section is done only if obstetrics reasons are there. After delivery allow the body to recover fully which can be from 3 to 6 months. Then surgery can be done, if Hernia persists.

Tips for Prevention:

  • Go for pre-conception counseling which includes general and physical examination to rule out Hernia.
  • Minimize excess physical activity like lifting heavy weight.
  • Yoga and muscle strengthening exercises under guidance
  • Maintain healthy body weight
  • Maintain balance diet, avoid constipation.
  • Avoid lifting or carrying children in arm.
  • Avoid smoking, and avoid pushing hard during bowel movement or passing urine.

Types of surgery:

  • Open method
  • Laparoscopic method

In both the methods hernia gap is repaired using a mesh.

By,
Dr.Sangeeta Gomes

Multiple Pregnancy

Multiple pregnancy is when there are more than one embryo getting attached to uterine lining and developing into multiple foetuses. This can be twins, triplets, quadruplets or higher order pregnancies. The incidence of twins is gone up from 18.9/1000 live births in 1980 to 32.1/1000 live births.

How multiple pregnancy happens?

One baby growing in the womb (uterus) on its own is called a singleton pregnancy. By far the most common type of multiple pregnancy is a twin pregnancy when there are two babies. Having three babies in the same pregnancy is known as triplets and having four is known as quadruplets. It is very rare to have more than four. Multiple pregnancy happens because two to three eggs get fertilized with two to three sperms or when one fertilised egg make two to three instead of one embryo.

Let us understand about TWINS as this is the commonest of all multiple pregnancies. Also, it is important to understand that the placenta is crucial to the pregnancy – it is the place where your body ‘meets’ your baby directly to pass across the nutrients your baby needs to grow. When an egg is fertilized it starts dividing till it convert itself into a zygote. If split occurs in early stage of cell division identical twins are formed. This cell division continues until it converts into a ball of cells and starts implanting itself in the lining of womb and becomes an embryo. The cells will form distinct areas like central group forms the baby and outer lining form the amniotic sac.

Types of twins:

  • Dichorionic diamniotic (DCDA): Two placenta and two amniotic sacs.
  • Mono chorionic diamniotic (MCDA): One placenta and two sacs.
  • Mono chorionic mono amniotic (MCMA): One placenta and one sac

Causes of multiple pregnancy:

  • Maternal age: women more than 35 are more prone to conceive multiple.
  • Fertility medication: These drugs stimulate ovaries to produce multiple eggs
  • Family history: History of multiple gestation in the family makes one prone for the same.
  • Had a history of twin in the past.

Risks to foetuses

  • premature birth
  • low birth weight
  • Twin to twin transfusion
  • Discordant growth
  • Miscarriages

RISKS TO MOTHER

  • Gestational diabetes
  • Preeclampsia or hypertension
  • Severe hyperemesis

Management

  • Foetal reduction: this is termination of one or more foetuses after the NT USG . Proper understanding of the procedure from parental side is very important. Risk of abortion needs special attention.
  • More frequent visits to obstetrician
  • Cervical encircalage / stitch: It’s role in preventing miscarriage is doubtful
  • Vaginal progesterone: this is known to help keep cervical integrity
  • Dietician advice to help prevent GDM
  • Ecosprin can be advised for prevention of preeclampsia
  • More frequent scans to understand the growth pattern.
  • Intervention by foetal Medicine expert if required
  • Vigilant postnatal care as the chances of post-natal depression is high
  • Avoid alcohol, smoking as advised with any singleton pregnancy.
  • Steroid injection: these injections are given to mother to help the maturity of foetal lungs, by doing this we can avoid/ decrease the stay of babies in NICU

Mode and time of delivery

Chances of Normal Vaginal Delivery is high under following conditions:

  • The babies are growing properly
  • Position of babies in the womb normal and conducive for normal delivery

LSCS would be a method of choice for:

  • MCMA twins
  • Pprom: water break/ leaking prematurely before term
  • Unfavourable position
  • CPD wherein the birth passage is narrow
  • Second twin after vaginal birth of first baby, if vaginal delivery not possible due to abnormal lie and position of baby, decreasing heart rate, placental abruption

As per guidelines the ideal time of delivery is around 38 weeks, any time before is 32 weeks has high risks for babies

Special attention

Genetic screening: Please talk to your obstetrician and opt for amniocentesis if indicated, double/quadruple marker, CVS and NIPT screening methods are not conclusive

Bed rest: not indicated

Eat for three: not required, should get consultation with dietician

Breastfeeding: no issues and both the babies can be fed properly

ENJOY YOUR PREGNANCY AND FEEL FREE TO ASK FOR HELP FROM FAMILY AND FRIENDS DURING PREGNANCY AND POST YOUR DELIVERY AS MULTIPLE PREGNANCY IS A VERY DEMANDING CONDITION PHYSICALLY AND MENTALLY.

By,
Dr. Suhasini Inamdar

 

ECTOPIC PREGNANCY

By Dr. Suhasini Inamdhar

An ectopic pregnancy is an early pregnancy that occurs outside of the normal location (uterine lining) for a developing pregnancy. The vast majority of ectopic pregnancies are so-called tubal pregnancies and occur in the Fallopian tube. An ectopic pregnancy occurs in about one in 1%-2% of all pregnancies.

These other places can be:

1) Fallopian tubes
2) Ovaries
3) Cervix
4) Cornua of uterus
5) Abdominal Cavity

The major health risk of ectopic pregnancy is rupture leading to internal bleeding. Before the 19th century, the mortality rate (death rate) from ectopic pregnancies exceeded 50%. Statistics suggest that with current advances in early detection, the mortality rate has improved to less than five in 10,000. The survival rate from ectopic pregnancies is improving even though the incidence of ectopic pregnancies is also increasing. The major reason for a poor outcome is failure to seek early medical attention. Ectopic pregnancy remains the leading cause of pregnancy-related death in the first trimester of pregnancy.

Causes of Ectopic pregnancy:
1)LAZY EMBRYO

The embryo does not travel till the cavity of uterus, but gets attached in the ovary, tube or cornua of uterus .
2) PELVIC INFLAMMATORY DISEASE (PID) : infection because of :

1) chlamydia,
2) bacteria
3) acute appendicitis
4) recurrent D & C/ MTP
5) pelvic surgery

inflammation of the pelvis sets in and the fallopian tubes get damaged, form adhesions, get partially /completely blocked and impede the movement of embryo. This makes embryo to get settled in the tube.

3) ENDOMETRIOSIS
Here the anatomy of Fallopian Tubes and Pelvis gets distorted and tubes do not function to the full potential.

4) TUBAL LIGATION OR REVERSAL OF THE SAME
Family planning procedure where the tubes are tied sometimes fails and this can lead to partial blockage of tubes.
5) IUCD
It is sometimes the cause of genital tract infection and can lead to damaged tubes.

6) PREVIOUS ECTOPIC PREGNANCY

7) EMERGENCY CONTRACEPTIVE PILL
Here the egg is already fertilised and it’s movement is hampered because of change in the hormonal miluea
8) PROGESTERONE ONLY PILL (MINI PILL)
Here the mucus membrane of tubes gets altered and the motility of tube also is affected
9)CIGARETTE SMOKING
It is known to increase the level of protein PROKR1 in the fallopian tube and this protein is known to help in implantation of embryo.
Please remember: ectopic pregnancy is not your fault and it just happens, one needs to be vigilant and aware.

By,
Suhasini Inamdar

My Gynaec – The Essential App For Expecting And New Moms

Motherhood Hospitals is a comprehensive woman and child care hospital committed to providing a gamut of services to women, newborns and paediatrics. Our multidisciplinary team provides comprehensive and personalised care, including obstetrics, gynaecology, neonatology, paediatrics, fetal medicine, radiology and speciality outpatient clinics. Situated in chief areas of Bangalore such as Indiranagar, Sarjapur Road and Hebbal, Motherhood hospitals ensure the safest and most hygienic services for mums and hence, must be on the top of every mum’s list of healthcare centres. Their hospitals comprise teams of highly qualified gynaecologists and paediatricians, making them Tiny steps top choice in terms of a recommendation for you.

Here, weŸ??re reviewing one of the newest features Motherhood has added to reach out to mums in need – My Gynaec: Motherhood. It is an app designed keeping in mind the convenience of every mum who indulges in the childbirth frenzy. It is inclusive of everything a mom-to-be can possibly run for – from appointments with doctors to reminders for medicines.

The app is simple to understand and access, with explicit features related to pregnancy and womenŸ??s health. All it requires you to do in order to access it is sign up using your personal details, which then leads you to a dashboard of categories you can choose to explore. These categories revolve around the matters of pregnancy and women health and care, further leading you into the world of motherhood.

They allow you to keep a tab on not only your doctorŸ??s appointment, but also let you calculate the following:

  1. Due date (using LMP- last menstrual period)
  2. Ovulation cycle
  3. Menstrual cycle
  4. BabyŸ??s growth status
  5. Menopause
  6. Condition of your breasts during and after pregnancy

With features such as a well-built alarm and calendar system, you can now keep a check on all of the above things. You can also collect all your special pregnancy memories through features such as the pregnancy milestone, which allows you to capture every single milestone you cover during pregnancy with dates, personal descriptions and pictures.

What actually makes this app so efficient is the connectivity it provides you with the world around you. In the case of emergencies, it allows you to be in touch with both your hubby and gynaecologist. With features such as Emergency calls, you can now make sure your husband is the first person to know in case youŸ??ve faced any emergency, including your labour. Here, your husband will be receiving notifications about your appointments, due date and the stages of your babyŸ??s growth.

Overall, the app is built to make your life easier during pregnancy. In case you feel the need to contribute to the app or suggest changes in it, you can always choose the feedback option from the home screen dashboard. In our opinion, it is a must on your phone.

My Gynaec is available both on iOS and Android. It is only a click away from installation. We suggest you get this app on your phone right now!

Take care!

Article Source Credits : TinyStep

Dr. Asha Hiremath Critical Case 2

Dr. Asha:Expert Insights on Critical Cases - Motherhood Hospital India

38- year elderly lady Mrs. Pallavi with BOH- Bad Obstetric history of recurrent pregnancy loss. She previously had 3 spontaneous abortions all within 1-2 months of early pregnancy.

Her first child was her fourth pregnancy which was a complicated case of APLA positive pregnancy, (Antiphospholipid Syndrome). This is an auto immune disorder, considered as high-risk obstetrics patients. She was evaluated sonographic, monitoring & medication was initiated & completed her term pregnancy, she was asked to be delivered by LSCS with a 3.4 kg healthy baby girl.

2 years later she conceived again and in spite of all critical & high risk past history, with supersize anticoagulation therapy, proper counselling & intense monitoring she successfully delivered her second child 3kg health girl child.

 

Dr. Asha Hiremath

Obstetrics & Gynaecology

Dr. Asha Hiremath Critical Case 1

28-year-old Dr. Meena dentist by profession, diagnosed pregnancy for the first time. She had to undergo treatment for primary infertility which was successful & was diagnosed with twin pregnancy.

She was extremely happy when her pregnancy was confirmed but unfortunately, she complained of pain in abdomen on & off. She was diagnosed with a fibroid (lump in uterus) about 9.8 Cms subserosal fibroid. In order to protect her pregnancy, we had to manage her with Dolo 650mg to control pain & any other treatment modality could affect her pregnancy. She was managed safely until 39 weeks & was delivered by LSCS healthy girl baby of 2.56kg and 2.93 Kgs boy baby born.

Dengue and Malaria Beware of the Fever During Pregnancy

Monsoon is the season where everyone starts enjoying their life. This season gets the child out in you. Many wants to play in the rain water, get drenched in the rain and the list goes on. Yes, enjoying is one part of monsoon. But getting ready to fall sick is another aspect which everyone needs to be careful during this season.

Dengue, Malaria, Chikungunya, Swine flu are common in the monsoon season. In the last 2 -3 years, there is a sudden spurt in the dengue cases everywhere. Most of the time hospitals will be completely filled with dengue patients and they turn away the patients because of the unavailability of the beds. But fever like dengue, malaria and swine flu could be dangerous during pregnancy if the care is not taken properly.

Dengue infection in pregnancy carries the risk of haemorrhage for both the mother and the new-born. Also there is a serious risk of premature birth and fetal death. In the case of infection developing close to the delivery time, there is a risk of vertical transmission.

Similarly malaria and swine flu during pregnancy can lead to miscarriage, congenital infections etc. Malaria can also cause anaemia in pregnant women and may result in convulsion, kidney failure. So it is important to monitor for dengue, malariaand swine flu during pregnancy.

Measures to be taken to avoid dengue, malaria and swine flu

  • Don’t travel to areas where dengue, malaria are prevalent
  • Keep your surroundings clean. Close the window in the morning and evening to avoid mosquitos entering the house
  • Wear protective cloths like long pants, long sleeve dresses
  • Use bed nets, preferably treated with an insecticide to prevent mosquito bite.

Simple treatments which a pregnant women can follow during dengue, malaria and

  • Drink plenty of fluids like water, fresh juice, coconut water. This will help to prevent dehydration.
  • Avoid taking medicines like aspirin for fever. This may lead to bleeding and other complication
  • Antipyretics helps to manage fever and body pain.
  • Meet the physician as early as possible.

World Hepatitis Day

28th July is recognized as World Hepatitis Day; and today we would help you understand the common causes and Effect of Hepatitis in Pregnancy.

Hepatitis is an infection and inflammation of the liver caused by a virus. Jaundice during pregnancy is mainly caused by Hepatitis.

Normally, being pregnant will not hasten the disease process or make it worse, unless a woman has hepatitis E.

Most of the times pregnant women are completely unaware that they have been infected with a hepatitis virus. Usually this is because any symptoms of the illness may only be felt or at times there are no symptoms at all. Good antenatal care and blood screening are important during pregnancy, to avoid and cure it at an early stage.

The common types of Hepatitis are:

Hepatitis A :

Hepatitis A is transmitted by the oral-fecal route, such as from contaminated water or diapers. The main treatment is rest and a nutritious diet, and usually the woman will recover within a month or two. If a newborn is exposed, the infection is usually mild and they will have a lifelong immunity to the disease. If a pregnant woman gets exposed, she will be given immune gamma globulin (IG) to help protect her from getting the disease. It is always recommended to the pregnant ladies who plans a travel to get immunized.

Hepatitis B:

Hepatitis B is one of the most highly transmitted forms of hepatitis from mother to child around the world. Usually, the disease is passed on during delivery with exposure to the blood and fluids during the birthing process.

When the infant is born, the newborn will receive hepatitis B immune globulin at birth, and should be vaccinated with a hepatitis B vaccine at one week, one month, and six months after birth.

Hepatitis C:

Hepatitis C occurs if a person is exposed through transfusions, contaminated needles, or injected drug use. Mostly women become pregnant during the years between 20 and 40, which is also the age group in which the incidence of hepatitis C, hence screening for hepatitis C before and during pregnancy is done. The risk of a pregnant woman passing the hepatitis C virus to her unborn child is generally low and has been related to the levels of quantitative RNA levels in the motherŸ??s blood.

Hepatitis E:

Hepatitis E is a rare and sporadic viral infection of the liver. Its risk of transmission is highest in regions where there are low standards of sanitation. It is transmitted via the fecal-oral route through contaminated water. When this illness affects pregnant women, they may experience a more severe form of illness, which may possibly lead to acute liver failure.

1. What are the signs of hepatitis during pregnancy?

Common signs of Hepatitis are:

  • Nausea and vomiting
  • Loss of appetite
  • Fever
  • Abdominal pain
  • Yellowing of the skin and the whites of the eyes.

The problem is, depending on the type of virus, symptoms might not show up for months after infection, or you may have no symptoms at all.

2. How can we analyses that a person is infected with hepatitis during pregnancy?

Blood Test can indicate the presence of hepatitis. There are blood tests which can also show the liver condition.

3. How will hepatitis affect the unborn baby?

The baby would be fine throughout the pregnancy. Some risk factors involve only during the time of birth. ThatŸ??s why all pregnant women are tested for hepatitis B. If the test shows the mother has been infected, doctor will take steps to minimize the baby’s chances of infection.

 

Dr. Sireesha Reddy

Obstetrics & Gynaecology

PCOS and Pregnancy

Polycystic ovary syndrome is a complex, commonest endocrine metabolic condition in the reproductive years of a woman. There is no single attributing factor. It is multifactorial.

Its impact on pregnancy is not elucidated entirely. Women with recurrent pregnancy loss, subfertility, obesity causing concerns are associated with PCOS.Spontaneous miscarriage is seen in almost 40% of patients in early pregnancy. Recurrent pregnancy loss and subfertility could be related due to increased secretion of LH hormone causing concerns with egg maturity and uterine lining receptivity. Pregnancy induced insulin resistance due to other pregnancy hormones puts patients at risk to develop Gestational diabetes, pregnancy induced hypertension.

In women who have been on insulin sensitizers like Metformin before pregnancy to decrease insulin resistance and in obese women , continuing them on Metformin after conception have been associated with less pregnancy losses, hence recommended to continue till 12 weeks of pregnancy. There is no additional risk of abnormalities by continuing Metformin.

Lifestyle modifications including diet and exercise will help women with PCOS contemplating pregnancy reduces the above mentioned risk

Dr. Madhushree Vijayakumar

Consultant OBGYN