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Obstetrics & Gynaecology

Frequently Asked Questions

After an intercourse when your periods are delayed by more than 7 days, there are chances that you may be pregnant. Urine test and blood test will further confirm the pregnancy.
Ultrasound will confirm the pregnancy only after 6 weeks provided the periods are regular. Fetal cardiac heart beat can be recorded only at that time.
It could be a missed abortion. Immediately consult your Gynaecologist for further help.
When the baby is grossly abnormal or not compatible with life, it fails to grow and the body throws it out. This is called missed abortion.
That pregnancy has to be medically terminated because the baby will not grow in future.
Consult a doctor. If baby is fine, injection, Medications and rest will be advised. Further evaluation will be done 15 days later
The severity of vomiting during the first trimester of pregnancy varies from patient to patient. It is better to take plenty of fruits and fruit juices. If it doesn’t subside then take Vit B6 tabs or an antiemetic after consulting with your doctor.
Increasing size of uterus with the baby growing inside puts pressure on the stomach and intestine causing narrowing of sphincter through which the food passes. Secretions are also increased and food stays for a longer time in the stomach. Some time regurgitation / bleching occurs, which leads to acidity.
You can climb the stairs carefully. Long distance traveling should be avoided.
Yes. You can sit down. Routine work can be done.
All fruits and Vegetables can be taken. Anything particularly allergic to an individual to be avoided.
You can take a mild laxative like Isapgol. Take plenty of water (2 full glasses) in the morning before tea or coffee. Walking mild exercises will help.
It is better to avoid in the initial months because it can cause vomiting, you may not tolerate oily and greasy foods. Similarly in the last month again you may have discomfort in the abdomen. So it is better to avoid non-veg food and heavy eating.
One and half of two litres of liquids should be taken. This should include fruit juices, water and tender coconuts.
No it is not advisable. Sleep disturbance may be because of frequent urination and increased size of the baby. Please consult your doctor for further advise.
Urinary infection soon after marriage is very common. Its called Honeymoon Pyelitis. The treatment is drinking plenty of water and tender coconut. Check the urine for infection and take the necessary antibiotics after consulting your doctor.
Personal hygiene is very important during pregnancy for the couple. The private parts should be cleaned properly. Any infection should be treated by the doctor.
Regular walking and raising the legs in the bed while sleeping will relieve the pain in legs. Avoid standing for long durations. If pain persists consult your doctor.
It is natural to have stretch marks and darkening of the skin during pregnancy. To avoid this you may apply Vitamin E oil right from the beginning of pregnancy.
1st scan-at 10-12 weeks-early pregnancy scan. 2nd scan-at 22-24 weeks-to rule out major abnormalities. 3rd scan-at 36 weeks-to see the maturity of the baby and fluid volume.
Only in the 4th and 9th month, 2 injections are required.
To rule out Anaemia, Diabetes, high BP, Thyroid problems, venereal diseases and to know the blood group as well as Rh typing.
Intercourse can be continued as usual. If there is no contraindication like spotting or precious baby (successful pregnancy after lot of missed abortions)
Fibroid is a non-cancerous growth arising from the muscle wall of the womb. It is one of the most common gynecological conditions and is estimated to be present in about 20 - 30 per cent of the women.
Depending on the size and location of the fibroids, there may or may not be any symptoms. But fibroids can cause the following symptoms:
  • Heavy bleeding or painful periods
  • Bleeding in between periods
  • Feeling “full” in the lower abdomen - sometimes called “pelvic pressure”
  • Urinating often (results from a fibroid pressing on the bladder)
  • Lower back pain
  • Difficulty to conceive and repeated miscarriages
The treatment depends on the women’s age, desire for further childbearing, the size of the fibroids, her symptoms and their severity. If a woman has uterine fibroids, but has no symptoms, she may not need any treatment. However a regular check up is required to see if the fibroids have grown. Fibroids are hormone dependant and hence usually decrease in size after menopause. If the fibroid gives rise to mild symptoms of pain, your doctor may suggest pain-relievers. Certain hormonal medications can reduce the bleeding during menses. Other drugs like GnRh-analogues can be used temporarily for symptom relief or to reduce the size of the fibroid before surgery. Mirena coil can be used in some cases to reduce the bleeding during menses. Those fibroids that are giving rise to severe symptoms, are big, or growing in size need to be treated surgically. Surgery involves either removing the fibroids (myomectomy) or the entire womb (hysterectomy). Both of the procedures can be performed by the laparoscopic approach as well as by the conventional open surgery depending on the size of the fibroid, its location, the doctors’ experience and training. Certain other treatments are now being tried. These involve cutting off the blood supply of the fibroids uterine artery embolization which can be performed under X-ray guidance.

Patient Information
Laparoscopy

Introduction

Nowadays, it is possible to look inside the abdomen and even perform surgery inside the human body without making a large cut or incision on the abdomen. With technological advancement and innovation, many of our traditional surgeries can be safely performed under this “minimally invasive” technique. Under the field of gynaecology, the 2 main types of surgery are: Laparoscopy and Hysteroscopy.

Laparoscopy

Laparoscopy is a procedure to look inside of the abdomen and pelvis using a laparoscope. This helps to see the ovaries, outside of the tubes and uterus and other organs inside the abdomen. The laparoscope is a special telescope to which a light source and camera is attached. It is about as thick as a pen and about 12 cm long.

Laparoscopy is commonly used to :

  • find the cause of symptoms such as abdominal pain, pelvic pain
  • as part of investigation of infertility.

  • In addition to simply looking inside, a doctor can use fine instruments to perform surgery inside the abdomen. This laparoscopic surgery is also called 'key-hole surgery' or 'minimal invasive surgery' and maybe used to treat cysts, endometriosis, fibroids, perform hysterectomy and even pelvic floor reconstruction. In general, compared to traditional surgery, with laparoscopic surgery there is usually :

  • less pain following the procedure
  • a shorter hospital stay
  • a quicker recovery
  • a much smaller scar

  • Prior to Surgery

    You will require to fast for at least 6 hours before the surgery. You will be given instructions regarding the time from when you should begin fasting and when to come in to the hospital.

    Bowel Preparation

    Your surgeon will instruct you regarding the bowel preparation if required. This will entail drinking a purgative the evening before surgery and taking light (eg soup) diet the night before surgery. Usually this will lead to you having diarrhea. While unpleasant, this procedure minimizes the risk of surgical complications from bowel injury during your surgery.

    In the Operating Theatre

    The anesthesiologist will place five adhesive tabs on your chest to monitor your heart rate. An intravenous drip will be set to help give you the required medication and fluids during surgery. The anesthetist will then give you a mask to breathe into and will administer some medication that will make you go off to sleep. The surgeons will make a small about 1-1.5 cm cut inside your navel and through this, the laparoscope will be introduced. Carbon dioxide gas (CO2) will be put into the abdomen through a special instrument inserted into the navel. This gas helps to distend the abdomen, making it easier for the surgeon to see the internal organs during laparoscopy. The gas will be removed at the end of the procedure. Two or three small ½ cm cuts will be made on the lower abdomen to put in the other instruments to be able to perform the surgery. At the end of the surgery, these will be repaired using dissolvable material.

    After Surgery

    After surgery, you will wake up in the Recovery Room. You will be transferred to the ward from the Recovery Room about one hour after surgery.
    You will be having an intravenous drip running after the operation till you are able to tolerate feeds. Injectable medication will be given for pain or nausea. You can tell your nurse if you are uncomfortable and need more pain relief. You may experience a sore throat. This is caused by irritation from a tube placed through your throat into the windpipe (trachea) during anesthesia. It usually lasts for just a few days and can sometimes be helped by throat lozenges. You may have a tube draining urine after the operation and your surgeon will decide when it is to be removed. If there is no tube draining urine, you can ask for a bedpan to empty your bladder. Your surgeon will decide when you will be allowed to go back home. This maybe 4 - 6 hours after surgery at the earliest.

    Gas Pains

    You may have some pain in your shoulder tip. This is caused by the gas which had been pumped inside irritating the diaphragm which has the same nerve supply as the shoulder tip. This pain passes off in a couple of days.
    Recovery after a laparoscopic procedure is very rapid. There is no need for bed rest and most patients are able to resume full activities within a few days to a week after laparoscopy.

    Possible complications of Laparoscopy :

    There may be some minor bleeding or bruising around the skin incisions.
    Post operative infections or allergic reactions to medications used may occur as well. Occasionally retention of urine, or clot formation in the legs may occur.

    Possible serious complications which may occur include the following :

  • Accidental damage to structures inside the abdomen such as the intestines, urinary bladder, ureters (tubes that bring urine from the kidneys to the urinary bladder), uterus (womb) or certain blood vessels. This is rare and happens in about 3 - 4 per 1000 procedures but if it occurs, a cut on the abdomen may be needed to correct the damage.
  • Excessive bleeding and the formation of hematomas (blood collections) of the abdominal wall near the incisions. This may occasionally require blood transfusion
  • As with any operation, there is a small risk of complications of anaesthesia. Certain conditions like previous abdominal surgery, presence of adhesions, severe endometriosis, pelvic infections, obesity, or excessive thinness may increase the risk of these complications. If complications occur, the hospital stay will be prolonged.

  • The risk of death during laparoscopy is very rare - about 3 - 8 per 100,000 and is less than the risk of death during pregnancy.



    Information to assist you in managing some of the common discomforts of pregnancy.
    Bleeding and swollen gums

    Regular dental check ups and use a soft toothbrush regularly during pregnancy.

    Nausea and Vomiting

    Small frequent meals of carbohydrates
    Rest
    Vitamin B6.
    Ginger tea*

    Heartburn

    Avoid fatty and spicy foods, bending and lying flat after meals.
    Avoid coffee and chocolate.
    Sleep propped up with extra pillows.
    Consult your doctor if it doesn't subside.

    Constipation

    Increase fluid and fibre intake (good source of fibre include wholemeal bread, wholegrain cereals, fruit and vegetables). Regular exercises
    Do not use liquid paraffin or other lubricants as a laxative during pregnancy as they can inhibit the absorption of fat-soluble vitamins.
    Consult your doctor if it is very severe

    Haemorrhoids

    Effective prevention and treatment of constipation will aid in reducing the occurrence and severity of haemorrhoids. Rest and elevate the legs above the hips. Ice packs to the anal area may also help. Women should be reassured that most cases resolve shortly after birth. Mild, local anaesthetic creams may be of some help.

    Generalised Itching

    It is common in pregnancy. Calamine lotion may help along with a mild antihistamine.

    Backache

    Occurs in up to 75% of pregnant women, due to altered posture and the effect of hormonal influences, softening/loosening of ligaments.
    Sit on chairs with good back support, avoid heavy lifting. Wear low-heeled shoes and have adequate rest in bed.
    Roll onto your side before trying to sit up, as this reduces lower back strain.
    Massage of the lower back with the heel of the hand in a circular motion may also alleviate symptoms. Hot fomentation and local analgesic gels will be of help.

    Cramps

    Occur mainly at night and cause is not clearly understood. There has been no evidence to support the use of calcium supplements except for a placebo effect.
    Relief of night cramps may also be aided by massaging the calves before going to bed and by elevating the foot of the bed by 20-25cm.

    Carpal Tunnel Syndrome (Wrist Pain)

    Caused by compression of the median nerve in the wrist usually during the latter part of pregnancy. Some help may be found from the application of a light-weight splint from a physiotherapist. This should be worn particularly at night to support the wrist.

    Symphysis pubis pain (Pubic bone pain)

    Caused by swelling within the joint, separation of the pubic bone. Usual onset is late in the latter part of pregnancy and frequently comes on gradually. Symptoms include pain in the public bone and groin and may radiate to the lower back and inner thighs. May affect walking and weight-bearing. Referral to a physiotherapist is recommended.

    Insomnia (Difficulty in sleeping)

    Often experienced during late pregnancy. You can change your sleeping positions and use supporting pillows.

    Varicose veins and leg oedema

    Support stockings appears to be the most effective relief for varicosities during pregnancy. Correct size is essential. Ask for guidance from your doctor. Elevation and ankle exercises also will be of help.