Tuesday, 24 October 2017

CARE OF PREGNANT WOMEN-EPISODE 2-SOCIETY WEB TV-HEALTH IS WEALTH

CARE OF PREGNANT WOMEN-EPISODE 2-SOCIETY WEB TV-HEALTH IS WEALTH

https://www.youtube.com/watch?v=2v5ZDD8qu4o

Participants:

Dr Himani Gupta
Gynaecologist
Clinic Mother 'n' Care
Kharghar, Navi Mumbai
Ph- 7506027299 , 9820193283

Dr Rekha Anand
Gynaecologist
New Life Clinic
Kharghar, Navi Mumbai
 Ph: 9869052171

CARE OF PREGNANT WOMEN-EPISODE 1-SOCIETY WEB TV-HEALTH IS WEALTH

CARE OF PREGNANT WOMEN-EPISODE 1-SOCIETY WEB TV-HEALTH IS WEALTH

https://www.youtube.com/watch?v=qrVtUVIfJEk

Participants:

Dr Himani Gupta
Gynaecologist
Clinic Mother 'n' Care
Kharghar, Navi Mumbai
Ph- 7506027299 , 9820193283

Dr Rekha Anand
Gynaecologist
New Life Clinic
Kharghar, Navi Mumbai
 Ph: 9869052171


Wednesday, 16 August 2017

PCOS (Poly Cystic Ovarian Syndrome) -Role Play-Symptoms,Precautions & Management

PCOS (Poly Cystic Ovarian Syndrome) -Role Play-Symptoms,Precautions & Management

Characters
Dr Deepa Kala- Gynaecologist from Nerul, Navi Mumbai- Playing part of Consulting Gynaecologist
Mrs Shanti Chalwadi- Clinical Assistant- Playing part of Teenager Patient
Dr Himani Gupta- Gynaecologist from Kharghar,Navi Mumbai- Playing part of Mother of Patient

web- www.mygynaecworld.com

YouTube Video
https://www.youtube.com/watch?v=m4Q4wJxC8MU

My Gynaec World gives permission for following script to be used for educational purpose ( Non Monetary)  as role play worldwide by anyone


..............................................................................................................................................................


माँ -नमस्ते डॉक्टर साहब

डॉक्टर -नमस्ते ,बोलिये

माँ - डॉक्टर साहब अपनी बेटी को आपको दिखाने आयी  हूँ इसका menses time पर नहीं आता। पंद्रह दिन ऊपर हो गए हैं इस बार। पिछले छः महीने से ऐसा ही चालू है। पंद्रह बीस दिन नहीं तो कभी कभी तो एक महीना भी ऊपर हो जाता है और flow भी ठीक नहीं है,बहुत ही कम  होता है। 

डॉक्टर- आपकी उम्र क्या है और आप क्या करते हो 

लड़की - nineteen years और मैं कॉलेज में जाती हूँ 

डॉक्टर -आपकी file देखी है मैंने। आपकी उम्र के हिसाब से आपका वज़न बहुत ज़्यादा है।  क्या आप exercise करते हो। इसका खाना पीना ठीक है क्या ?

माँ - कहाँ डॉक्टर साहब। यह तो कुछ खाती ही नहीं। बस classes ,tuition इसमें ही दिन  चला जाता है।  exercise करने का उसे time ही नहीं है। हर वक़्त थकी हुई रहती है। 

लड़की - मैं बाहर खा लेती हूँ जब मुझे भूख लगती है 

डॉक्टर -आप क्या खाते हो,वडा पाव ,pizza ,burger ,यही ना। 

लड़की -हाँ 

डॉक्टर -(माँ से) -आप please बाहर जाइये , मुझे इनको check करना है। 
(माँ उठकर जाती है )

डॉक्टर -क्या आप physically intimate हैं किसी के साथ 

लड़की -नहीं डॉक्टर साहब , ऐसा कुछ नहीं है। 

डॉक्टर - आप अंदर सकती हैं ( मा अंदर जाती है ). इनके कुछ blood test जैसे कि CBC , blood sugars और thyroid hormone की जाँच  और एक पेट की sonography करके देखनी पड़ेगी। इसके बाद ही  treatment शुरू कर सकते हैं। 

माँ -क्या हम ऐसा कर सकते हैं की पहले दवाई देके देख लें ,अगर आराम नहीं पड़ा तो टेस्ट करवा लेंगे। इसकी तो उम्र भी इतनी कम है।  ऐसे में thyroid होता है क्या ?
डॉक्टर -आपकी बेटी के symptoms से hormonal disturbance होने के chances लगते हैं। सबसे common disorder -PCOS या polycystic ovarian syndrome  है। Thyroid हॉर्मोन का कम या ज़्यादा होना इस उम्र में भी देखा जाता है। और उसकी वजह से भी menses आगे पीछे होते हैं। सही diagnosis के बाद ही दवाइयाँ शुरू करनी चाहियें। खाने का पौष्टिक और संतुलित होना बहुत ज़रूरी है। बाहर का खाना कम  से कम  खायें।वज़न को control में रखना है। उसके लिए exercise करना बहुत ज़रूरी है। 

माँ -कुछ साल बाद जब इसकी  शादी और फॅमिली का समय आयेगा तब क्या इसे परेशानी होगी ?

डॉक्टर -PCOS के treatment के लिए आजकल बहुत अच्छी दवाइयाँ available हैं, जिसमें hormones और non hormones दोनों ही शामिल हैं। अगर बाद में कुछ परेशानी आयी भी तब भी इलाज आसान है। 


PCOS is a disorder of hormonal imbalance and a very common cause of menstrual irregularities.Its management depends on patient's age, marital status and clinical profile. With changes in lifestyle and increasing stress, this disorder is seen to be rising. If any of the woman of your family is having these symptoms , you should consult a Gynaecologist.


By
Admin- Dr Himani Gupta
Gynaecologist & Obstetrician
Kharghar,Navi Mumbai

Head Office-My Gynaec World
Clinic -Mother 'n' Care
Shree Row House- F44/30, Sector-12, Kharghar
Navi Mumbai
Ph- +91-7506027299











Tuesday, 15 August 2017

EFFECTIVE COMMUNICATION-DR S NEELKANTHAN

EFFECTIVE COMMUNICATION-DR S NEELKANTHAN

EFFECTIVE COMMUNICATION-DR S NEELKANTHAN



Impact Diagnostic Center ,Kharghar and My Gynaec World organized a lecture for doctors and clinical staff on ‘Effective Communication’ on 12.8.17. It was taken by Dr S Neelkanthan who is a renowned clinical psychologist and corporate trainer of international fame. Salient points that got covered were
1) Gap between intention and impact on our stake holders 
2) Identifying and bridging communication gap
3) Communication for patient's delight 
The program was very successful with good number of people participating in it
By Admin- Dr Himani Gupta
Gynaecologist from Kharghar,Navi Mumbai
Ph- +91-7506027299


Friday, 11 August 2017

PRADHANMANTRI SURAKSHIT MATRUTVA ABHIYAAN-9.8.17

PRADHANMANTRI SURAKSHIT MATRUTVA ABHIYAAN-9.8.17


Hon. Prime Minister has started this social initiative.
On 9th of every month a specialty Gynaecology OPD is conducted by private practitioners at Urban Health Care Center.
The aims and objectives of this is to screen high risk pregnant women of poor socio-economic strata and provide them with quality health care to bring down maternal mortality.
One such clinic was conducted at Turbhe UHP by NMOGS- Navi Mumbai Obstetrics & Gynaecological Society .
Dr Himani Gupta participated in this month's camp.
This initiative is one more example of doctors working selflessly for the betterment of health of society.


By
Admin
Dr Himani Gupta
Gynaecologist & Obstetrician
My Gynaec World
www.mygynaecworld.com
Ph-7506027299

Wednesday, 26 July 2017

Kharghar Doctors' Association organised free health check up for children of Greenfingers School,Kharghar

Kharghar Doctors' Association organised free health check up for children of Greenfingers School, Kharghar,Navi mumbai




KDA- Kharghar Doctors' Association conducted a free health check up camp for all the children of Greenfingers School, Kharghar, Navi Mumbai from 20.7.17-26.7.17

Doctors are a community who work selflessly for the benefits of society


By Admin
My Gynaec World
Dr Himani Gupta
Gynaecologist from Kharghar, Navi Mumbai
web- www.mygynaecworld.com
Ph- +91-7506027299







FREE SCHOOL BOOKS DISTRIBUTION -DHAMOLE VILLAGE,KHARGHAR,NAVI MUMBAI

FREE SCHOOL BOOKS DISTRIBUTION -DHAMOLE VILLAGE,KHARGHAR,NAVI MUMBAI




A free school books distribution for underprivileged children of Dhamole Village, Golf course, Kharghar, Navi Mumbai, was organized by Dr Vaibhav Bhadane on 23.7.17.  
This is a one of the kind gesture by health care providers for the benefit of society 


By
Admin
Dr Himani Gupta
Gynaecologist from Kharghar, Navi Mumbai
web- www.mygynaecworld.com
Ph-+91-7506027299




Monday, 19 June 2017

Monsoon Fever


MONSOON FEVER






My Gynaec World and its team of associated doctors continuously make efforts to spread awareness about common relevant topics among doctors and patients. In association with Impact Pathology & Diagnostic Center ,Kharghar, at its conference hall, a lecture on Monsoon Fever for practicing doctors of the Kharghar,Navi Mumbai was conducted by eminent physician Dr Mahesh Padsalge. There were beneficial insights on how to diagnose the cause of fever ( Dengue, Malaria,Viral hepatitis,Leptospirosis), its OPD management, medicinal aspect and when to transfer the patient to hospital if warning signs appear. Dr B N Gorad, Director of Impact group has taken this initiative to have such seminars and lectures conducted on regular basis.

By
Dr Himani Gupta
Gynaecologist from Kharghar, Navi Mumbai
Director- My Gynaec World
web-  mygynaecworld.com
Ph- 7506027299


Friday, 26 May 2017

STILLBIRTH-A DEVASTATING OUTCOME OF A PREGNANCY



STILLBIRTH-A DEVASTATING OUTCOME OF A PREGNANCY


Pregnancy is a period of joy and expectation for any woman and her family.  It is a heart breaking situation for any Gynaecologist when the news has to be broken that the baby is no longer alive in the uterus or the mother has given birth to a dead child .

This is a complicated scientific topic. Gynaecologists who treat such cases require compilation of all their knowledge and experience to evaluate the woman, whether she is pregnant right now or if she comes with history of previous stillbirth and is planning to conceive in near future.

In this write up, first we will deal with the scientific definition of Stillbirth. It’s division into three categories- Early, Intermediate & late. Causes & risk factors of stillbirth. Evaluation of stillbirth and finally its management aspect

Terms used in this topic
Fetus means- the child developing inside uterus
Gestation age -refers to the duration of pregnancy in weeks
Fetal death/ fetal mortality -is the term used to describe unfavorable outcome of pregnancy irrespective of duration of pregnancy (gestation age)
Stillbirth- is the term generally used by laymen when death of fetus occurs late in pregnancy


 Scientific Definition of fetal mortality- Sillbirth

Fetal death means death, prior to complete expulsion or extraction from the mother of a product of human conception irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.
The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord or definitive movement of the voluntary muscles.

Fetal mortality is generally divided into three periods
-Early- less than 20 completed weeks of gestation (pregnancy)
-Intermediate- 20-27 weeks
-Late – 28 weeks or more 

In due course of the discussion of this topic, many causes (Clinical Situations) of Stillbirth will be discussed. Some of them are responsible for fetal mortality in all three periods of gestation. At the same time, for any case of fetal death, many factors may be responsible.
Many clinical entities are a topic of discussions in themselves hence they will be presented in only simplified and concise manner


83 % of stillbirths occur before the start of labor pains- Antepartum stillbirths

CAUSES OF STILLBIRTH (FETAL MORTALITY)

1)Placental Causes

-Placental abnormalities- mainly utero-placental insufficiency
Placenta is the structure which is attached to the uterus and supplies food and oxygen to the fetus through umbilical cord. It gets its supplies from the mother. Various factors lead to its insufficient working.

                                                              


-Placental abruption 
In this clinical entity placenta gets detached from its attachment to uterus. This results in stoppage of blood supply to the fetus and fetal death occurs.

                                               



2)Umbilical cord causes
  
-Prolapse- During labor (Birthing Process ) when cervix (mouth of uterus) is dilating, at times the umbilical cord comes out of it before the fetal head is born . This leads to compression of cord between fetal head and maternal bones of pelvis. There is cessation of blood supply to the baby and fetal mortality occurs
                                           
                                                 
   
-Stricture – This is structural abnormality of umbilical cord in which shrinkage of cord occurs at some point & cessation of blood supply occurs.

                                                 

-Thrombosis – Clotting of blood occurs in the blood vessels of umbilical cord & blood flow to baby is hampered

3) Fetal Causes

-Multifetal gestation 
When lady is pregnant with more than one fetus. Commonly encountered situations are Twins- 2 fetus, Triplet-3 fetus, Quadruplet-4 fetus etc

                                             



Fetal Malformations 
There are certain genetic abnormalities which result in major structural abnormalities in the fetus. These abnormalities are incompatible with life.

4)Maternal Causes

Hypertensive disorders
-Pre Eclampsia - High BP which results as a complication of pregnancy
-Chronic Hypertension – When mother is suffering from high BP and she becomes pregnant

Diabetes in mother
-Diabetic Embryopathy- Fetus of a diabetic mother is more prone to have certain congenital structural malformations. Some of them are lethal
-Diabetic ketoacidosis- Diabetic mother can develop this metabolic dysfunction. Blood sugar levels are high and insulin levels are low. Maternal cells are unable to utilize this sugar. This is a life-threatening situation for both mother and baby.

5) Obstetrics complications

Preterm labor
If pregnant woman goes in labor and delivers prematurely before the fetus has reached term and is capable of surviving independently.

Preterm Prelabor Rupture Of Membranes-PPROM- 
Amniotic membranes make up Amniotic sac which is a covering around growing fetus to keep it safe inside uterus. If these membranes get broken due to some reason, Amniotic fluid (Fluid around fetus) gets drained resulting into Umbilical cord getting compressed between walls of uterus and fetus. This results in cessation of Oxygen supply to the fetus and ultimately fetal demise.

                               

Infections
There are certain infections involving fetus and placenta which will lead to fetal death.


RISK FACTORS FOR FETAL DEATH

Gynaecologists come to know about these risk factors either during examination or history taking. When one or more of these risk factors are present, vigilance on part of both patient and doctor is required.
-Education
-Maternal age- 35-39 years, more than 40 years
-Smoking
-Drug abuse
-Obesity- BMI (Body Mass Index- weight of person vs height) 25-29.9, more than 30
-ART- Artificial Reproductive Techniques- if pregnancy is the result of fertility treatment- example- IVF- In Vitro Fertilization, ICSI- Intra Cytoplasmic Sperm Injection etc
-Previous history of adverse outcome
  Preterm birth
  Growth retarded baby
  Stillbirth
  Pre-Eclampsia
  Placental abruption
  Cholestasis (Jaundice) of pregnancy



EVALUATION OF STILLBIRTH

Why is it Necessary-Aims & Objectives
-It is beneficial for maternal psychological adaptation to a significant loss. She is grieving and may be thinking of herself as guilty.
-Risk of recurrence can be judged and appropriate counseling and therapy offered
-There are certain inherited ( genetic ) disorders and identification of these syndromes will provide useful information for other family members

How is it done

1)Evaluation of fetus
Appropriate consent of parents is required before carrying out many of these processes

-History taking in detail of pregnancy events

-Clinical examination at the time of birth-It is found that up to 35% of stillborns have major structural anomalies. Some have Dysmorphic features (Distorted facial structure). Some may have skeletal ( bone) abnormalities. Weight, head circumference and length of fetus is also measured.

-Photograph taking from different angles

-Fetogram-Full radiograph of fetus (X-Ray) of fetus

-Examination of
  Placenta along with its weight
  Umbilical cord
  Amniotic membranes

-Karyotyping
Karyotyping reveals chromosomal (genetic material) abnormalities in the fetus
Sample required-
-3 ml of fetal blood is drawn from Umbilical blood vessels or direct Cardiac (Heart ) puncture & is put in sterile heparinized container

If blood is not obtained, other fetal tissues that can be sent in either Ringer Lactate (RL) solution or special cytogenetic solution are-
-Placental block of dimension 1 X 1 cm to be taken from the site, below the cord insertion
-Umbilical cord segment – 1.5 cm long
-Internal fetal tissue sample- Costochondral junction (Soft tissue which binds rib with Sternum-Bone in the middle of the chest), Patella- Knee cap

Important:
-These samples are to be stored at room temperature
-A full fetal karyotype may not be possible in cases with prolonged fetal death (Maceration)
-Skin is no longer recommended as tissue sample
-Placement of sample within Formalin or alcohol will kill remaining viable cells and will prevent chromosomal testing

Stillborn's autopsy-

MRI- Magnetic Resonance Imaging

USG- Ultrasound


MANAGEMENT OF PSYCHOLOGICAL ASPECTS OF MOTHER

The event of stillbirth is traumatic for mother & her family. She is at increased risk of mental depression. Regular visit to the Gynecologist is advised.



MANAGEMENT OF SUBSEQUENT PREGNANCY AFTER STILLBIRTH



Preconceptional or initial prenatal visit

-Detailed medical and obstetrical history -There are certain risk factors which are modifiable like hypertension and diabetes. Pregnant woman may have it at the time of diagnosis of pregnancy or there may be a history that she had these conditions at the time of that pregnancy which resulted in stillbirth. Specific management protocols are in place for managing these conditions
-Evaluation and workup of previous stillbirth- Bad Obstetrics History (BOH)
-Determination of recurrence risk
-Smoking cessation
-Weight loss in obese women (preconceptional only)
-Genetic counseling if family genetic condition exists
-Thrombophilia (Increased tendency of blood to clot) work up – antiphospholipid antibodies, along with Lupus anticoagulant
-Support and reassurance

First Trimester- Weeks 1-12
Dating ultrasonography- to confirm live pregnancy and expected due date
First trimester screen (Double Marker )- Blood tests include-PAPP-A- Pregnancy Associated Plasma Protein -A &Beta HCG- Human Chorionic Gonadotrophin along with sonography  for specific fetal features. These are Nuchal Transluscency (NT) which is thickness of nape of neck in millimeters & Nasal Bone (NB) presence

Second Trimester-Weeks 13-28
Fetal ultrasonographic anatomic survey-2 D, 3 D, at 18-20 weeks of gestation
Maternal blood tests- Quadruple  or single marker alpha fetoprotein if first trimester screening is not done .These tests are risk estimation for genetic disorder

Third Trimester-Weeks 29-40
Ultrasonographic screening for fetal growth restriction after 28 weeks if there is history of previous low birth weight baby
Fetal Kick counts monitoring-starting at 28 weeks
Delivery
-Delivery -at 39 weeks or earlier is recommended. It can be an induced labor or Caesarean delivery depending on the clinical assessment of mother and fetus at that time.


By ;
Dr Himani Gupta
Gynaecologist & Obstetrician
Director-My Gynaec World
Web-  www.mygynaecworld.com

Official head quarter
Clinic Mother 'n' Care
F 44/30
Shree Row House
Sector- 12, Kharghar, Navi Mumbai. Maharashtra
Ph-7506027299
     -9820193283

Monday, 10 April 2017

Cervical Insufficiency & Cerclage- A Reason For Mid Term Pregnancy Loss & It's Treatment

Cervical Insufficiency & Cerclage- A Reason For Mid Term Pregnancy Loss & It's Treatment

-Cervix is the lower part of  the uterus which opens in the vagina.
-During the entire duration of 9 months of normal  pregnancy it stays closed and when labour pains start it opens up and dilates and let the baby be born.
-You can say say that it is like a closed door .When fetus in uterus is increasing in size and weight , it is very important that this door stays closed else, baby will be born prematurely.
                                         




Cervical insufficiency is a distinct clinical entity
It is characterized by painless cervical dilatation in second trimester of pregnancy ( 13-28 weeks of pregnancy ). It is also associated with decreased length of cervix- Short Cervix

                                                 

It results in prolapse (bulging out ) and ballooning of membranes around fetus (Amniotic Sac/Amniotic Membranes-these membranes make a sac around fetus and protect the pregnancy ) into vagina and ultimately expulsion of an immature fetus.

                                                           

Unless effectively treated this sequence of events may get repeated in subsequent pregnancies.

Diagnosis
1) Ultrasonography- Inadequate Cervical length is an indicator along with funneling of cervix which is ballooning of membranes into the dilated internal os but with a closed external os.
2) Clinical internal examination by the Gynaecologist
                                                     
Risk Factors
Previous cervical trauma caused by surgeries like
-D & C- Dilatation & Curettage
-Conization- Removal of a diseased tissue of cervix in manner of a cone
-Cauterization- Electric current application to cervical tissue for purpose burning the diseased tissue and stimulate generation of new and healthy tissue
-Amputation- Removal of protruding part of cervix
-Abnormal cervical development

Precautions before treatment of Cervical Incompetence
- Ultrasound is done to check for fetal well being.
-Sexual intercourse is prohibited one week before and after the surgery.

Contraindications to treatment
-Bleeding from vagina
-Uterine contractions and pain
-Rupture of bag of membranes- leaking of fluid

Treatment of Cervical Incompetence
Classic Cervical Incompetence is treated surgically with 'Cerclage ' operation which reinforces a weak cervix by a purse string suture ( Stitching of mouth of uterus). The suture material used is strong, thick and non absorbent. These sutures will now provide strength to the cervix to stay closed even though the weight of the fetus will keep on increasing.
This procedure is done as prophylaxis ( prevention ).
At times 'Rescue Cerclage'  is needed as patient presents with symptoms in emergency.
This suture is removed at a selected date when the pregnancy has attained a mature state and the newborn will be healthy.
At times the suture needs to be removed in emergency if the patient goes in labour prematurely.
                                                               
                                         

                                                       

When to do the Cervical Cerclage Surgery
-Most medical text books recommend surgery at 12-14 weeks of gestation- A sonography at this stage will rule out majority of congenital malformations ( Birth Defects )
-If there is previous loss of pregnancy, surgery should be done a couple of weeks prior  to gestation age( pregnancy duration) at which the loss occurred.
- If pregnancy is at a later stage- there is risk that Cervical Cerclage operation might induce contractions of the uterus and in turn will lead to loss of pregnancy .
                                                             
Success of Cerclage surgery
Many medical studies have been conducted and it is  found out that the success of this surgery is unpredictable.

Many Gynaecologists will opt for alternative method of managing patients with cervical incompetence- like bed rest, abstinence, Progesterone hormone support , Tocolytics ( Uterine relaxants medicines)

After a thorough counselling of patient and relatives, a treatment option is chosen for that particular woman.The pros and cons of doing the surgery vs conservative approach is discussed.

Name of Cervical Cerclage Surgery
McDonald Cervical Cerclage ( Most commonly done surgery )

Procedure-How it is done
After giving anaesthesia , patient is put in lithotomy position ( Legs spread and supported, patients buttocks reaching the edge of the operation table )


It is a trans vaginal procedure
With the help of instruments ( Sim's Speculum)- Cervix is exposed.
With the help of non traumatic instruments ( Sponge holder/ Ring forceps )- Cervix is held
Non-Traumatic needle ( Round body ) is used along with non absorbent , thick suture ( Thread ) and purse string sutures are placed as high as possible on Cervix.

                                                             
 

Complications
Uterine contractions
Bleeding
Rupture of membranes
Infection

To summarize- Cervical Incompetence  is one of the causes of recurrent pregnancy loss. Timely treatment may reduce further losses. It is very important that Gynaecologist and patient have a detailed conversation . Then only treatment protocol should be decided.

For more information log on to our website- www.mygynaecworld.com

Dr Himani Gupta
Admin
My Gynaec World