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

 

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

Skin and hair care in monsoon by Dr Arun Kumar

Natural immune resistance in the body is decreased during monsoon. Apart from common infections like flu, common cold, dysentery asthma, skin problems like the allergic rash, atopic dermatitis, dry skin eczema, fungal infections, acne, prickly heat are common. Dry scalp, dandruff, itchy scalp, hair fall are common too.

Damp and humid weather in monsoon, attracts more microbes and fungi, resulting in skin rashes to ringworm etc. The season tends to infect the air, atmosphere surroundings, foods, and drinks. While skin changes during pregnancy are common, your skin and hair are also affected from the harsh treatment of the moist humid rainy weather.

Skin care in monsoon:

  • Drink lots of water, 2-3 liters per day, water consumption hydrates your body and flushes out all the unwanted toxins.
    • Use a soap free cleanser for washing your face, wash gently 2-3 times a day.
    • Mild organic face scrubs twice a week.
    • Dap dry the face, body, towel usage roughens the skin.
    • Alcohol-free toner to maintain PH balance.
    • The humidity leads to dry skin, use a nourishing moisturizer to keep your skin soft supple and healthy.
    • Use a water based moisturizer for oily skin.
    • Use a reliable sunscreen with a good SPF, it may be cloudy but that doesn’t stop sun’s UV rays causing skin damage.
    • The homemade facial pack is preferred.
    • Waterproof light makeups are the better choice.
    • Prevent the lip cracking moisturizing lip balm with SPF.
    • Apply moisturizer twice a day for the entire body.
    • Facial and bleaching should be avoided or at least limited as it makes the skin rough.

Hair care in Monsoon

  • Monsoon is the time of humidity which creates itchiness on the scalp. It is recommended to have a warm coconut oil massage which will help to get rid of itchiness. If there is dandruff in the scalp, massage with neem oil.
    • Mild anti dandruff shampoo diluted 1:1 ratio in water weekly once or twice to clean the scalp.
    • Prevent the hair from getting drenched in rain, but if does happen it is best to shampoo the hair as soon as possible and then dry them.
    • Monsoon season demands a conditioner after a mild gentle shampoo.
    • Hair coloring must be avoided during the rainy season.
    • Natural herbal products are better than heavy chemical shampoos in rains as they help to maintain the shine and natural look of the hair.
    • Try the hairstyles that are more natural in look than elaborate ones.
    • Avoid blow dryers and try to dry hair with a towel to retain the moisture.

Some do’s and don’ts to tackle fungal infection

DO’s

  • Regular bathing, body cleaning is the must..
  • Before wearing clothes, drying out the folds area to prevent excess moisture wearing loose fitting clothes.
  • Laundering clothes of an infected person in hot water and washing with the antiseptic agent.
  • Drying clothes in sunlight for at least 2 hours wearing clothes after ironing them and placing them separately.
  • Washing your hands with anti-septic and water frequently. Keeping hair, nails and scalp clean.
  • Wearing well ventilated shoes with cotton socks not sharing comb and other utilities with other family members.

DONT S

  • Occasional bathing using towel used by other members of the family wearing clothes immediately after bath washing personal clothes with family members clothes.
  • Wearing clothes dried under the fan and without ironing them, wearing tight jeans, leggings, sharing comb and other utilities with family members.
  • Scratching on lesions and not washing hands, keeping hair, nails, and scalp filthy walking barefoot in public places.

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

Endometriosis – Everything You Need To Know

Many women learn to normalise pain they experience during their period and not to talk about out loud.We’re encouraging women and teenagers to break a taboo and talk about their menstrual health.Endometriosis (pronounced en- doh mee tree oh sis) affects more than just the physical body and can have a profound emotional impact on women and girls living with the condition. Don’t be afraid to ask your partner, friends or family for their support when you feel upset or confused. Endometriosis can affect all women and girls of a childbearing age, regardless of race o Endometriosis r ethnicity.

Women Health & Nutrition

A balanced diet is a cornerstone of health for Women. Nutrient-rich foods provide energy for women’s busy lives and help to prevent disease. Eating right as follows:

  • At least three servings of whole grains such as whole-grain bread, rice, roti, paratha etc can be taken.
  • Three servings of low-fat or fat-free dairy products including milk, buttermilk, yogurt or cheese, ragi, soya, almond milk etc
  • Five servings of protein such as lean meat, chicken, fish, eggs, beans or peas and nuts.
  • Three cups of fruits Ÿ?? fresh without added sugar.
  • Three cups of colorful vegetables Ÿ?? fresh without added salt / cooked.

Iron is one of the keys to good health and energy levels in women. Iron-rich food sources include red meat, chicken, fish, kale, spinach, green leafy vegetables, beans, lentils and fortified breads and cereals. Plant-based sources of iron are more easily absorbed by your body when eaten with vitamin C-rich foods. So the wise choice is to add tomatoes to lentil soup or add a pinch of lemon juice in your salads and cooking.

When women reach childbearing age, they need to eat good amount of folic acid to decrease risk of birth defects. The requirement is at least 400 micrograms of folic acid a day. Diet which contains folic acids such as Citrus fruits, leafy greens, beans and peas naturally contain folate. There are many folic acid fortified foods such as cereals, rice and breads can be used.

For healthy bones and teeth, women need to eat a variety of calcium-rich foods every day. Calcium keeps bones strong and prevents osteoporosis, a bone disease in which the bones become weak and break easily. Some calcium-rich foods include low-fat or fat-free milk, yogurt and cheese, sardines, tofu (if made with calcium sulfate) and calcium-fortified foods including juices and cereals.

To keep weight in check at any age, women should avoid a lot of excess calories from added sugars, fat and alcohol. Limit regular soft drinks, sugar-sweetened beverages, candy, baked goods and fried foods. Opt for low-fat dairy and meat products instead of their full-fat counterparts. Eat fewer foods that are high in saturated fat Ÿ?? the kind found in fatty meats, sausages, cheese and full-fat dairy products, baked goods and pizza.

Since women typically have less muscle, more fat and are smaller than men, you need fewer calories to maintain a healthy body weight and activity level. Moderately active women need 1,800 calories a day.

Exercise is an important part of a woman’s health. Regular daily activity helps with weight control, muscle strength and stress management.

Endometriosis & It’s Effect On Fertility

The most common complication of endometriosis is infertility and couples often find out about the problem when they take up tests to check fertility status. The relationship between endometriosis and infertility has been the topic of much debate. Research has shown that infertile women are six to eight times more likely to have endometriosis than fertile women. Some of the explanations given for decreased fertility in women suffering from this disorder include distorted pelvic anatomy, endocrine and ovulatory abnormalities, altered peritoneal and tubal function, altered hormonal and cell-mediated functions in the endometrium.

Based on common observations during laparoscopy, it has been found that the cysts and adhesions caused by the disease can lead to changes in anatomy of the pelvic organs. This impairs the fertilization process and in turn affects the release of eggs, thus leading to infertility.

Many women with mild to moderate endometriosis are able to conceive and carry a pregnancy to term. Doctors may advise women with endometriosis not to delay having children as the condition is likely to get worse over time. Interestingly the symptoms of endometriosis, especially pain, seem to disappear in women who are pregnant or breastfeeding.

Myths and Facts about Pregnancy by Jasmine

  • Myths and facts about pregnancy
    1. A pregnant mother should be eating for two.
    2. Saffron will make the babyŸ??s complexion fairer.
    3. Pregnant women should avoid fish.
    4. Craving for spicy foods means you are having a boy, and craving for sweet foods indicate a girl.
    5. Pregnant women can catch a flu with cold and sour food items.
    6. Papaya and pineapple can cause abortion or miscarriages.
    7. The food you crave or eat more during pregnancy are going to be babyŸ??s favorites.
    1. There is no evidence to show that you need to eat for two. Eating a healthy, balance diet is important.
    2. There is no evidence to support this belief.
    3. Fish that contain high levels of mercury should be avoided. E.g. Shark, Sword Fish, King Mackerel and Tile Fish. Mercury consumed during pregnancy has been linked to developmental delays and brain damage.
    4. Research shows that cravings have nothing to do with determining the sex of a baby.
    5. These foods are loaded with vitamin (citrus fruits) especially vitamin C. ItŸ??s an important vitamin for iron absorption. Curd and butter milk provide probiotics which keep the mothers get healthy and help in digestion along with providing good immunity.
    6. These fruits in their raw form contain certain enzymes, which if consumed in large quantities, can cause uterine contractions.
    7. No real evidence for this but some studies have shown that food choices you made during pregnancy may shape babyŸ??s food preference.

By
Jasmine, Nutritionist, Sarjapur Road