Obstetrics And Gynaecology

Unless you have been identified with any complications, it is perfectly safe to travel during pregnancy. Most women find the second trimester the most ideal time to travel as you are done with the morning sickness of the first trimester and won’t get as easily tired as one does in their third trimester. Indian airline carriers allow women to travel up to 32 weeks of their pregnancy. 

In a normal pregnancy, you can be expected to come in for a check up on the following days:

• 4 weeks to 28 weeks: 1 visit/month
• 28 weeks to 36 weeks: 1 visit/2 weeks
• 36 weeks to 40 weeks: 1 visit/week

If it is a high-risk pregnancy such as twins, advanced age of women or a complicated pregnancy, your doctor may want to see you more often depending on your condition.  

A pregnant woman needs more folic acid, calcium, iron & protein than a non-pregnant woman. Hence pre-natal vitamins, which contain an ideal amount is prescribed to every expecting woman. Leafy vegetables, whole grains, dairy products, fruits and lean meats should make up 80 % of the diet. There can be cravings for salty and sugary food in pregnancy but one should try to eat as healthily as possible to avoid gaining excess weight. 
Your body will undergo a multitude of changes as you go through your pregnancy. The most obvious change is your abdomen. It will start looking globular by 12 weeks, an ovoid shape by 28 weeks and turns spherical beyond 36 weeks. The change in the shape of your abdomen is accompanied by slight discomfort, gastric reflux and stretch marks over the next 9 months. The breasts become larger and the areola becomes darker as the pregnancy advances. Your skin may undergo changes such as stretch marks on your buttocks, thighs and abdomen in the second half of pregnancy. Hyperpigmentation of the umbilicus, nipples, abdominal midline & face may be seen due to the hormonal changes in pregnancy. Spider veins and reddening of the palms is commonly seen due to hyperdynamic circulation. Sometimes, there is change in growth rate and texture of nails and hair. Feet and ankles swell during pregnancy due to the increased fluid carried by the body. Leg cramps may occur due to the excessive fluid, shortage of calcium and phosphorus and fluctuation of hormones. A healthy weight gain in pregnancy is 11 kg– 1 kg in the first trimester, 5kg in the second trimester and 5kg in the third trimester. Anything between 11- 17 kgs is taken as a normal weight gain of pregnancy. There is an increase in your body temperature which will get back to normal by the 16th week. Due to increased ligament laxity, many women suffer from back pain during their pregnancy. 
Placenta previa is a sudden onset of painless, recurrent bleeding which is apparently causeless. In 5% of the cases, it occurs during labour especially for first time moms. In 1/3rd of the cases, there are ‘warning’ hemorrhages that hint towards placenta previa.
While it is not common for Placenta Previa to be painful, some women may experience cramping. 
There is no way to prevent Placenta Previa. However, there are different ways to make sure you have a safe pregnancy:
• Adequate antenatal care will help in a safe pregnancy which includes correction of anemia
• ‘Warning’ hemorrhages should not be ignored
• Increased fetal monitoring especially if there is history of bleeding
• Bed rest as much as possible
• Keep a look out for signs of pre-term labour
• An increased protein intake in your diet is recommended 
The objectives of treatment of pre-eclampsia are to stabilize the increased blood pressure and prevent eclampsia. Depending on your healthcare provider, you may be asked to be admittedbased on your health status. If you are showing signs toward the end your pregnancy, then delivery is the best course of action for the health of the baby and mother. However, if the delivery is too risky to the health of the baby, your doctor may prescribe absolute bed rest, anti-hypertensives, anti-convulsants and corticosteroids(These may also be given prior to delivery to help develop the baby’s lungs)
Pre-eclampsia is the sudden development of high blood pressure (up to 140/90 mmHg) with or without protein in the urine, after 20th week of your pregnancy. It is a serious complication that leads to a difficult pregnancy, eventually leading to induction labor ahead of the due date. 
While there is no measure that can completely stop pre-eclampsia from developing, there are certain things you can do to decrease the risks.
• Be regular in your antenatal visits to your doctor. Keep a track of your blood pressure in a diary as a way of monitoring your health status especially after your 20th week of gestation.
• Take your blood pressure and weight regularly to see any spikes.
• Maintain a low-salt diet and make sure your calcium intake is adequate. 
If untreated, pre-eclampsia can progress further into eclampsia, a condition in which a pregnant woman goes through convulsions and may fall into a coma, due to brain injury. The increased blood pressure can damage the kidneys & the liver. There is a risk of developing pulmonary edema & cause blood clots which may become fatal. Timely intervention in pre-eclampsia is the key for the best outcome of both mother and child.

Ovarian Hypofunction is the reduced function of the ovaries that include decreased production of hormones.

Most of the time the cause of Ovarian Hypofunction is unknown; however, they are a few contributing factors:
• Infections such as tuberculosis & gonorrhea which damage the ovarian follicles, thus reducing their number
• Autoimmune disorders such as Addison’s disease & thyroiditis
• Chemotherapy & Radiotherapy may lead to depletion of ovarian follicles
• Genetic conditions such as chromosome abnormalities can result in hypofunction

The most common complication of Ovarian Hypofunction is infertility. Other complications include increased risk of ovarian cancer & osteoporosis. There is a psychological component often ignored that needs to addressed and treated.
Pelvic Inflammatory Disease(PID) is one of the most common gynecological problems in the world. While the exact number cannot be determined due to unreliable diagnosis from clinical signs and symptoms, it is credited for 3 – 10% of all gynecology related hospital admission in India.
Once findings and tests confirm PID, your doctor will prescribe you antibiotics. If the PID has progressed to form an abscess, you may need surgery. 
Pelvic Inflammation causes scaring and adhesion of Pelvic tissues leading to tubal blockage and in turn infertility. Pelvic Tuberclosis perse is a major cause of infertility in India.
Yes, insurance should cover the treatment. Infertility till date is not covered by insurance.
Placenta Previa and Pre-eclampsia need bed rest, thus leading to a decreased quality of life. Barring any complications, Ovarian Hypofunction and Pelvic Inflammation, while may lead to discomfort, mood swings and mild pain, should not affect your daily routine significantly.
There is a risk of post-partum hemorrhage in pre-eclampsia up to 6 weeks post-delivery thus follow ups are necessary. Placenta Previa may cause post-partum hemorrhage thus needs to be monitored. If there is an abscess formation in PID, post-surgery follow ups will be suggested by your doctor.

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