Thursday, 27 October 2016

Failure of 'Copper-T' Resulting in Unwanted Pregnancy


Failure of 'Copper-T' Resulting in Unwanted Pregnancy

Every birth control measure (Contraceptive method) has its own failure rates which results in pregnancy. Intra Uterine Devices- IUD,( IUCD- Intra Uterine Contraceptive Device) which is known as ‘ Copper –T’  in layman’s language also has its failures.

                                                           

Presenting features of pregnancy with Copper-T in situ
-Woman will complain of missed periods
-Her pregnancy test will be positive
-Sonography will show presence of contraceptive device with pregnancy side by side

Fate of pregnancy with IUCD in situ ( IUCD-Intra Uterine Contraceptive Device )
-If the woman conceives with IUCD still inside uterus, the pregnancy in question may have higher chances of complications.
Infection ( Chorioamnionitis ) – The bag of membranes which surround the fetus become infected.  This is a serious medical condition as advance stage which is known as Sepsis, may involve infection in blood . This wide spread infection may become life threatening
Management
Involves- termination of pregnancy as soon as possible along with adequate cover with antibiotics.

Abortion
-There are higher chances of abortions whether spontaneous or induced. Here we should understand the woman opted for an IUD as she did not want to become pregnant any more.
-There is a rule by Government  of India under MTP act (Medical Termination of Pregnancy ) , that says that pregnant woman can seek termination of pregnancy ( in layman’s language-abortion ) upto  20 weeks if the said pregnancy has occurred as a result of failure of contraceptive ( Birth Control ) measure

Preterm Birth
Pregnancy with Copper –T in situ has a higher chance of preterm birth. Preterm birth has its own set of complications like low weight of neonate, requirement of NICU- Neonatal Intensive Care Unit, failure to thrive etc.

Ectopic Pregnancy
-If a woman conceives with ‘ Copper-T’ in situ, there are higher chances that the site of pregnancy will be abnormal.
-The normal site of implantation of pregnancy is inside the uterus.
-In ectopic pregnancy, the site of implantation can be Fallopian tubes (Tube like structure which is a passage between uterus and ovary), Ovaries etc.
-This pregnancy in abnormal location does not grow normally

                                                      


Management

-Early diagnosis by sonography and surgical intervention to remove this abnormally located pregnancy is required in most of the cases

What can be done once pregnancy is diagnosed with Copper –T inside uterus
-If thread is visible, which may be the case in early pregnancy, the treating Gynaecologist will gently pull on the thread to attempt removal. Many a times it is successful.
-Assistance of Ultrasound may be sought to make the removal procedure safe and easy.
If thread is not visible- termination of pregnancy by D&E- Dilatation and Evacuation may be offered along with the removal of Copper-T at the time of the procedure

By
My Gynaec World
We are committed to spread awareness about health and wellness
To know more log onto our website
www.mygynaecworld.com


Official Head Quarter
Mother ‘n’ Care Clinic
Shri Row House-F 44/30
Near Shivaji Chowk
Sector 12-Kharghar, Navi Mumbai

Ph +91-7506027299
      +91- 9820193283
Email-mygynaecworld@gmail.com














Doctor,my Copper -T is lost,I am worried. What should I do?


Doctor,my Copper -T is lost,I am worried. What should I do?

There are many effective contraceptive ( Birth Control ) methods available for women. Placement of a small device in the uterus is ons such method.Intra Uterine Contraceptive Device-IUCD,Intra Uterine Device-IUD are the medical terminology used for this method of birth control. In common man's language the device is popularly know as' Copper-T'
In this article term 'Copper-T ' is used synonymously for IUCD/IUD

What is Copper-T

                                             

-Cooper –T is a small T shaped device which is placed inside the uterus for the purpose of birth control (Contraception )
-The device once placed will be effective for 3, 5 or 10 years depending upon the type of device.
-The Copper –T is placed inside the uterus but the thread attached to it extends through mouth of uterus (Cervix ) into vagina.
-Checking of thread is done periodically to make sure that the device is in its place.

-Using a 'Copper-T ' is a very popular and safe method of birth control.
-Each method of contraception has its own complications and faliure rates.
-The complications that we are going to discuss in this article are very rare.

Precautions Taken After Insertion Of Copper-T And Likely Complications
-After putting the Copper-T, the woman is called after one month, once her next menses is over.
-The Gynaecologist examines the woman and checks the thread
-At times the Gynaecologist will find that the thread is missing.
-Now, this situation can arise even in the first month after insertion or later on during the life span of Copper-T as cited earlier.
                                                  


How To Safeguard Against Losing Copper-T
-Woman should come for first check up as advised by her Gynaecologist in a month after putting of Copper-T
 -Subsequently a gynaec check up is suggested at 6 monthly intervals.
-Woman is also taught to palpate the thread herself.
-She is supposed to repeat this procedure every month. She should contact her Gynaecologist immediately if she finds that the thread is missing.
                                                    


What Could Have Happened To Copper-T If The Thread Is Found Missing
There are few possibilities-

1) Copper- T is expelled
It may happen that the Copper –T got expelled and the woman did not notice its expulsion.
Diagnosis of this condition is by exclusion
Sonography and X-ray of abdomen and pelvis is done. If both these tests come out normal and no Copper-T is found, the diagnosis of expelled Copper-T is made.

-Woman may come to the Gynaecologist in a pregnant state. Management of pregnancy depends on woman’s wish to either continue or discontinue with the pregnancy.

2) The Copper-T is malpositioned
-In this situation, the Copper-T stays inside the uterus but the thread has curled up inside the uterus.
-One more possibility is that the thread became loose & came out but the Copper-T stayed inside.
 Diagnosis is by Ultrasound.
Management
-Copper-T is removed by a special instrument called ‘IUCD retrieval hook’. This procedure is done under anesthesia in operation theater.
-At times removal by Hysteroscopy becomes necessary.
                                                       
         

 3) Perforation of wall of uterus by Copper-T

                                                      

-In this case patient may present with pain in abdomen and bleeding from vagina.
Diagnosis
Ultrasound (Sonography ), X-Ray  of abdomen, CT-Scan or MRI is done to diagnose this condition.

                                                              


Complications of perforation
-Bleeding
- Formation of adhesions among intra abdominal organs. For example the intestines may stick together.
-Perforation of abdominal organs. For example intestines or urinary bladder may get perforated by IUD
-Formation of abnormal tracks between two organs (Fistulas ) .
Management
Patient will require retrieval of Copper-T either by laparoscope or an open operation on abdomen will be required.

                                                       



By
My Gynaec World
We are committed to spread awareness about health and wellness
To know more log onto our website
www.mygynaecworld.com

Official Head Quarter
Mother ‘n’ Care Clinic
Shri Row House-F 44/30
Near Shivaji Chowk
Sector 12-Kharghar, Navi Mumbai

Ph +91-7506027299
      +91- 9820193283
Email-mygynaecworld@gmail.com

Sunday, 16 October 2016

Oligohydramnios-Water Around Fetus Decreases During Pregnancy-How It Badly Effects Health Of Baby


                             

Oligohydramnios-Water Around Fetus Decreases During Pregnancy-How It Badly  Effects  Health Of Baby

What is amniotic fluid
-Amniotic fluid is the fluid around fetus (Unborn baby in uterus)in which it swims during the course of the pregnancy. This is approximately 98% water.
-In a term pregnancy, total volume of fluid is around 2800 ml

Definition of Oligohydramnios
Abnormally decreased volume of amniotic fluid is called ‘Oligohydramnios”
Anhydramnios
No measurable pocket of amniotic fluid around baby

Source of amniotic fluid
Amniotic fluid is a secretion of fluid from various sources. The main sources are listed below
-Membranes and placenta surrounding baby
-Fetal skin
-Fetal urine production
-Fetal lung fluid

Importance of amniotic fluid
Amniotic fluid serves several roles during pregnancy
-It allows the fetus to have movements in the uterus. This helps in development of muscles and bones of the baby
-Fetus keeps on swallowing this fluid. This helps in development of intestines of the baby.
-It gives space so that fetal lungs can expand. This will help in development of lungs of baby and baby will breathe normally when born
-Fetus draws its blood supply, oxygen and nutrition from umbilical cord. Adequate amniotic fluid is necessary for its free movement and continuous supply.

What are trimesters of pregnancy
-The total duration of pregnancy that is 40 weeks is calculated as 9 months plus one week. Calculation is started from first day of last menses.
These 40 weeks are divided into three groups
-First trimester- include first 12 weeks
-Second trimester- weeks 13 -28
-Third trimester-29- 40weeks

Diagnosis of oligohydramnios
-Diagnosis is done by doing sonography ( Ultrasound) .Overall quantity of fluid is estimated .
-Colour Doppler studies of umbilical artery will tell if fetus is receiving enough blood supply.
-NST- Non Stress Test- a tracing of fetal heart rate pattern is a good indicator of baby’s well being

When does it happen
Early onset
When oligohydramnios is detected in early second trimester .

1) By 18 weeks of pregnancy fetal kidneys are the main source of amniotic fluid. Those fetal abnormalities which will result in decreased fetal urine production as the kidneys are not properly formed or there is obstruction in passage of urine will give rise to oligohydramnios. A few major genitor-urinary abnormalities are
-Renal agenesis (non formation of kidneys )
-Multicystic dysplastic kidney ( Kidneys are malformed and have multiple fluid filled structures in it)
-Polycystic kidneys ( Kidneys have multiple cysts)
-Bladder outlet obstruction ( urine is forming normally but can’t come out of bladder  as the outlet has obstruction)
-Posterior urethral valves ( urethra is the tube like structure which will let the urine come out of bladder- if there are valves preventing the urination-oligohydramnios develops)
-Urethral atresia- urethra is not completely formed

2) Rupture of bag of membranes which is around the fetus.  This will clinically present as watery discharge from vaginal. There may be bleeding too. Later on patient may complain of pain in lower abdomen which is associated with uterine contractions.

Mid pregnancy onset
When decrease in amniotic fluid happens in late second trimester or early third trimester.
In these times , oligohydramnios is associated with
-Suboptimal fetal growth- IUGR ( Intra Uterine Growth Retardation )
-Placental abnormality-Placenta is not working at its optimal level and blood supply in it is less.
-Pregnancy induced hypertension ( High BP ) clinically known as PIH

                                       
Post term pregnancy onset
When the pregnant woman has crossed the due date, oligohydramnios may set in
It is usually because of suboptimal functioning of placental surfaces.

Medicines responsible
Some medicines if taken in pregnancy for a long time will lead to development of oligohydramnios
All medications in pregnancy should be taken on advice of expert gynaecologist

Prognosis (outcome) of oligohydramnios
If pregnancy is complicated by oligohydramnios-the baby will suffer many abnormalities

Potter’s syndrome- it is a combination of three features
1) Limb contractures- hands and legs may have abnormal shape
2) Compressed face- face looks abnormal
3) Death of fetus  from pulmonary hypoplasia- the lungs are underdeveloped and do not support the life of baby

Many other adverse fetal effects are also associated with oligohydramnios
-Fetal malformations
-Stillbirth- a dead baby is born
-Preterm birth
-Increased chances of Cesarean delivery
-Low birth weight of the newborn which will require care in NICU- Neonatal Intensive Care Unit
-Neonatal death- baby expires soon after being born
- Meconium aspiration- baby passes stool even before it is born. This fecal matter/ stool (Meconium) is ingested by the baby and chokes up the respiratory tract, hence leading to difficulty in breathing after being born.

Management of oligohydramnios
-Management of oligohydramnios requires close fetal monitoring by available diagnostic modalities like sonography and NST
-Medicinal support to increase the blood flow to uterus and baby and to help the fetus gain weight. These medicines have limited effectiveness.
-Timely delivery of the baby as soon as the maturity of the baby is achieved.


My Gynaec World and its team of expert Gynaecologists and Neonatologists along with support of well equipped diagnostic centers and hospitals are doing their best to provide complete care to all pregnant women

People from following locations of Navi Mumbai can approach us for Gynaecology related advise

-Kharghar,Kamothe,Kalamboli,Panvel,Road Pali,CBD Belapur,Seawoods,Nerul,Vashi,  Sanpada, Juinagar, Khanda Colony, Taloja

To know more log on to our website-www.mygynaecworld.com
By
Dr Himani Gupta
Gynaecologiost
Ph +91-7506027299
      +91- 9820193283
Email-mygynaecworld@gmail.com
Web- www.mygynaecworld.com
Mother ‘n’ Care Clinic
Shri Row House-F 44/30
Near Shivaji Chowk
Sector 12-Kharghar, Navi Mumbai

Friday, 7 October 2016

High Blood Pressure ( BP ) In Pregnancy And How It Badly Affects The Health Of Pregnant Mother And Child

High Blood Pressure ( BP ) In Pregnancy And How It Badly Affects The Health Of Pregnant Mother And Child

                                                         
   
-High blood pressure –BP ( PIH- Pregnancy Induced Hypertension)s  affects  the health of both pregnant  mother and the unborn child adversely.
-Medical management like medicines, rest, hospitalization and regular visit to the Gynaecologist will  help in controlling PIH- pregnancy related high BP in most of the cases.
-This article will provide an insight into the complications that are associated with this clinical condition     which happen if medical advice is not followed and hypertension becomes uncontrolled.
-One needs to understand that in severe disease, unfortunately complications occur in spite of best and  regular medical treatment of PIH- Pregnancy Induced Hypertension.
-Another pointer to understand is that in any one particular patient only one of the following or a  combination of the complications may be present.

The topic is written in easy language and terminology is such that the information provided will be useful to a large number of people. However medical terminology is inseparable part of this article. To make understanding simpler (  ) are used for medical terminology

(A)  EFFECT ON PREGNANT LADY

The organs and systems get affected in many ways

1) BRAIN

Swelling of the brain( Cerebral edema)
 Clinically the symptoms are
-Headache- which will not get OK by taking painkiller tablets
-Lethargy
-Confusion
-Blurred vision

In late stages
-Coma
-Fits(Eclampsia)- This is a dangerous clinical situation. It may be associated with significant brain injury and dysfunction.

Changes in brain at structural level include bleeding (Hemorrhage), Blockage of blood supply (Infarction), Decreased blood flow (Ischemia), shrinkage of blood vessels (Vasospasm)

These patients are prone to sudden increase in BP which may worsen their condition further

Investigations like CT Scan or MRI will show following features
-Swelling (Edema) of the brain
-Fluid channels of brain get blocked (Obliteration of central ventricles)
-Brain matter will come out( herniate)   through its coverings-life threatening (Transtentorial herniation)

2)EYES-VISUAL CHANGES AND BLINDNESS

Woman will complain of
-Seeing black spots before eyes (Scotomata)
-Seeing things as double (Diplopia)
-Blindness- in most cases it will last for 4 hours to up to 8 days. It is reversible. The dysfunction occurs in brain where centre for vision lies.
In some cases partial or total blindness persists.

Eyeball changes
-Inner lining of eyeball gets disrupted (Retinal detachment)-one more reason of blindness
-Blood supply to eyeball is stopped  retinal artery occlusion)- causes permanent blindness


3) LIVER CHANGES

-There may be bleeding inside the liver (Periportal haemorrhage)
-Blood may collect below its capsule( Subcapsular hematoma)
-There may be rupture of liver with dire consequences

Clinically patient presents as
-Pain in upper abdomen

Blood investigation for liver function will reveal raised liver enzymes ( SGOT,SGPT)

Liver complications are associated with higher death rate of pregnant woman (maternal mortality)

 In rare cases liver transplantation only will save the life of the woman

HELLP syndrome is associated with liver disorders (Hepatocellular necrosis)
H (Hemolysis) EL ( Elevated Liver enzymes) ,LP (Low Platelets count)
Patient suffering from this complication will require intensive care and may have prolonged recovery time

4) KIDNEY CHANGES

-Blood supply to the kidneys ( Renal perfusion ) and its filtration process , both are reduced

-Factors like  blood loss, redirection of the blood to more vital organs like brain, increased blood pressure leading to widespread contraction of blood vessels ( Vasospasm) are responsible for it.

-On microscopic level basic functional units of kidney like Glomeruli and Tubules are damaged.

Kidneys secrete many harmful substances of body through urine. Consequences of decreased kidney functions are many –
-Urine output is decreased
-Blood levels of Creatinine, Uric acid and Calcium rise

The accumulated toxic substances in blood will eventually affect the mental status of the patient and she will appear dull and lethargic


5) CHANGES IN BLOOD

Decreased platelet count (Thrombocytopenia-Platelet is a component of blood)
-The normal platelet count is 1.5-4-5 Lakh / ml.
-Platelets play a very important role in stopping the flow of blood at the site of injury or bleeding.
-During delivery or Caesarean section the amount of bleeding is more if platelet count is less and it puts the life of mother in danger.
-If serial monitoring of blood shows decreasing trend of platelet count, it becomes an indication for delivery
-After delivery recovery of platelets will take 2-5 days

Destruction of blood (Hemolysis)

-In high BP pregnant  patients the lining of small blood vessels gets damaged.
-Platelets and fibrin (blood component) get deposited on these sites to seal these sites.
-Blood corpuscles get damaged while passing through these vessels.
-Destruction of blood will lead to fall in Hemoglobin level (Anemia)
-Microscopic slide examination of blood will show abnormal Red Blood Corpuscles (RBC) like (Schizocytosis,Spherocytosis,Reticulocytosis).

Blood clotting (Coagulation) changes

-There is widespread blood clotting and blood destruction happening at multi-organ level in these patients.
-As a result blood levels of clotting factors are deranged .
-The tests which are abnormal include- PT- Prothronbin Time, PTT-Partial Thromboplastin Time,Fibronectin, D-Dimers, Factor VIII, Fibrinogen etc


6) HEART AND CIRCULATORY SYSTEM (CARDIOVASCULAR) CHANGES ALONG WITH LUNGS (RESPIRATORY SYSTEM)

Heart is made up of two types of chambers
1-      Contractile chambers to push blood out into the system-Ventricles –They are two in numbers, left and right
2-      Receptive chambers to receive blood from the system- Atrium- They are also two in numbers, left and right

When BP is high the ventricles will need to work against more resistance. As a result their muscle mass increases (Ventricular hypertrophy). Their lumen gets diminished in size. The final result is that fluid accumulates in lungs( Pulmonary Edema)-leading to difficulty in breathing( Respiratory distress). It also results in accumulation of fluid in the body (Edema)

There are other factors too which will lead to accumulation of fluid in the lungs like injury to the lining of breathing units (Alveoli)

7) LUNGS CHANGES

There may be accumulation of fluid in lungs (Pulmonary edema)
Patient may have difficulty in breathing and at times may require ventilator support ( ARDS-Acute Respiratory Distress Syndrome)

B) EFFECT ON UNBORN CHILD ( FETUS )

Uterus-Placenta unit’s blood supply
(Utero-placental perfusion)
-Uterine artery is the main blood vessel supplying uterus and in turn to placenta and growing baby(fetus)
-In normal pregnancy the uterus and placenta allow uterine artery to supply extra blood to it for healthy growth of baby (fetus)
-In cases of high BP, both uterus and placenta will resist this extra supply, resulting in less blood available to baby (utero-placental insufficiency) which will lead to low birth weight of newborn (IUGR- Intra Uterine Growth Retardation)
-At times water around baby also becomes less (Oligohydramnios)
-This compromised placenta sometimes separates from its attachment to uterus prematurely, even when patient is not in labor (Abruptio Placentae). This will lead to bleeding (Ante Partum Hemorrhage) putting life of both mother and baby in danger (Maternal mortality and IUFD-Intra Uterine Fetal Death)
-Preterm birth- at times it becomes necessary to deliver the pregnant woman even before her 9 months are not complete. This kind of decision is taken if all the medical management including tablets to control the BP, rest at home or even hospitalizations are failing to control the high BP of pregnancy (PIH-Pregnancy Induced Hypertension )
 
Note from Author

Expert and timely medical care and patient’s compliance towards taking medicines and regular check up with prescribed investigations has improved the outlook  in most of the cases . In urban settings  where the facility for ICU- Intensive Care Unit,NICU-Neonatal Intensive Care Unit for the newborn and blood banks are available, both mother and child have a good outcome.
Rural areas which are yet to have these facilities have a scope for improvement towards ‘Healthy Mother-Healthy Child’ initiative


My Gynaecology World has an expert team of doctors including experienced Gynaecologists, up-to date Physicians and Intensivists , Peadiatricians and Neonatologists which are backed by state of the art attached hospitals having ICU ( Intensive Care Unit ) and NICU (Neonatal Intensive Care Unit ) along with Blood Bank facilities

Watch our video on YouTube for further insight
https://www.youtube.com/watch?v=e-5hJolwhd0

 People from following locations of Navi Mumbai can approach us for Gynaecology related advise

-Kharghar,Kamothe,Kalamboli,Panvel,Road Pali,CBD Belapur,Seawoods,Nerul,Vashi,  Sanpada, Juinagar, Khanda Colony, Taloja

To know more log on to our website-www.mygynaecworld.com
By
Dr Himani Gupta
Gynaecologiost
Ph +91-7506027299
      +91- 9820193283
Email-mygynaecworld@gmail.com
Web- www.mygynaecworld.com
Mother ‘n’ Care Clinic
Shri Row House-F 44/30
Near Shivaji Chowk
Sector 12-Kharghar, Navi Mumbai