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The woman, who becomes pregnant for the first time experiences a completely new change in her life. Her body is also new to this challenging situation. Her abdominal cavity which was normally filled with intestines now starts to be occupied with an evolving uterus. The evolving uterus exerts a pressure on abdominal organs and intestine, this causes reflex of food from the stomach to oesophagus and cause heartburn or burning sensation in abdomen. Hormonal and lifestyle changes in pregnancy cause gastric upsets, for example, hyperacidity, nausea, vomiting and heartburn. In order to treat pregnancy-related heartburn or constant burning sensation in abdomen certain things can be done. First of all, avoid fatty, and spicy food. Spicy food tends to damage the protective mucosal covering of the stomach. So the acid burns the inner cavity of the stomach which causes the feeling of burning sensation inside the abdomen. Because the baby is also present in the abdomen, it exerts a positive ...

Pain Relief in Labor: Birth is a difficult process but it brings immense joy and happiness to the woman which compensate for the pain to a degree of extent. Birth can be extremely painful especially in primigravida (first pregnancy). Many women have watched birth scenes in TV and movies and think that Labor is an extremely difficult and painful process. It is true but it is a natural process and nature has empowered women to pass through the process of Labor. Pain can be relieved in Labor to a considerable extent. A doctor will give you and explain several choices and it is up to mother what type of analgesia (pain relief method) she wants to use. Here, you may learn about all the pain relief methods in Labor and then you may discuss them with your doctor and choose the best according to your wishes. Let us discuss all the methods briefly. Different Methods Used to Relieve Pain in Labor: 1. Non-Pharmacological or General Method: One-to-one care in Labor from a midwife, doc...

Hyperthyroidism is a condition in which thyroid gland starts to secrete an increased amount of thyroxine in the blood. This, in turn, produces several effects in the body, including, palpitations, weight loss, increased appetite, heat intolerance, sleeplessness, generalized weakness and abortions. There are various causes that are responsible for this increased production of thyroxine by the thyroid gland. We will not go into this detail in this article but have explained it in a separate article, the link of which is stated below. Thyroid Diseases, an overview Hyperthyroidism in pregnancy should be treated, because it may result in fetal abnormalities. The thyroid hormone T3 and T4 crosses the placenta in small amounts. The amount of diffusion across the placenta decreases with the age of the pregnancy. But still, it may cross in significant amounts. The thyrotropin-releasing hormone and thyroid stimulating immunoglobulins (which are responsible for maternal hyperthyroidism) and be...

What are the chances of pregnancy after having unprotected sex? This question comes in every woman mind who has had unprotected sex. Pregnancy depends on many factors. Unprotected sex is one of the basic factors on which occurrence of a successful pregnancy depends. But the failure of condoms and the rate of pregnancy after protected sex is 2 %. It means 2 of 100 women who have had protected sex (condom protected) may result in pregnancy. It means that protected sex is not 100% preventive. On the other hand unprotected sex does not always result in pregnancy. There are various factors which are necessary  in order to get pregnant Some of the important factors are stated below: 1. Age of women: Sexual intercourse before puberty and after menopause won’t result in pregnancy. 2. Ovulation: Pregnancy won’t occur if the woman hasn’t released an egg. A Woman who has a menstrual cycle of 28 days, ovulates (release an egg) on 14th day of the menstrual cycle (the day when bleeding...

Note: This article is written for healthcare providers, please do not follow the treatment given in this article without the supervision of a qualified healthcare provider, as it may be associated with serious health-related adverse effects, may result in temporary or permanent disability.  Termination of an unwanted early pregnancy or abortion with the help of medicines is possible. Termination of early pregnancy or abortion with the help of medicine is found to be successful in most of the cases of unwanted pregnancies. But induced medical abortion is not considered ethical rather it is considered as sinful act according to various religious beliefs and literature. It is strongly recommended that do not use these abortion methods without the supervision of a qualified medical practitioner. There are various methods of termination of early pregnancy and abortion with the help of medicine. We will talk about three methods here. Medicines Used for termination of early pregnancy ...

Every healthy woman experience monthly bleeding. This monthly cycle is called the menstrual cycle. The duration of the menstrual cycle varies woman to woman but the average duration of the menstrual cycle is 28 days. In this article, we will consider a woman having a menstrual cycle of 28 days. After every 28 days, a woman starts bleeding vaginally. The duration of this bleeding also varies from 3 – 7 days. If the bleeding stops in one or two days or continue more than 7 days than it could n’t be menstrual bleeding and other causes of vaginal bleeding must be excluded and you should see a doctor to have a proper physical and vaginal examination. There is another medical term called “implantation bleeding”. This bleeding occurs at the start of pregnancy and indicates attachment of embryo to the wall of uterus. Actually embryo embed itself in the wall of uterus and encroaches the uterine wall. During this encroachment the uterine vessels rupture and appear as vaginal bleeding. This blee...

I have got a period can I still be pregnant? This is another question that has been asked to us several times. You may read our previous topic related to it “ chances of pregnancy after having unprotected sex ”. If you have had unprotected sex and after a few days you have noticed vaginal bleeding then there is a possibility that you may have got one of the following things. 1. Normal Menstrual bleeding 2. Implantation bleeding. 3. Dysfunctional uterine bleeding 4. Bleeding from the lower genital tract. 5. Bleeding from urethra instead of vagina. Normal Menstrual Bleeding: If you had read the article “ chances of pregnancy after having unprotected sex ” then now you know that not every unprotected sex result in pregnancy due to various factors. So there is a possibility that the bleeding is menstrual. Implantation Bleeding. This is something that every woman should know. Many women confuse implantation bleeding with menstrual bleeding and think that they are not pregnant ...

Watery Vaginal Discharge after Pelvic/Cervical Surgery/Operation (Ureter Ligation During Radical Hysterectomy): Today My paying guest came to me and said her aunt has some problem. I took her history and she said, patient has under gone Pelvic surgery a month ago for some pelvic cancer.  Operative notes were saying “radical hysterectomy performed, Cervix was barrel shaped and removed, uterus and ovaries are removed. Uterine artery ligated, Lymph nodes were normal in size shape and consistency. Specimen is sent for lab examination. Then i read the specimen examination report, it said, “Stage II Cervical Cancer”. I didn’t find any other abnormality in lab reports except slightly raised serum creatinine and urea Then i saw Intravenous Urogram where i clearly noticed dilated pelvis of right kidney, left kidney was normal and bladder was normal in size shape and contour no filling defect seen. Then i asked about her current symptoms, she said that she has fever, pain in right...

The breast secrets Colostrum for the first few days after delivery, which is yellow in colour and thicker than milk. Although it is in a small amount, but is enough for a normal baby and is exactly what a baby needs for the first few days. It contains more antibodies and more WBC than the Later milk. It gives the first immunization to protect the baby from bacteria and viruses. It is rich in growth factor which stimulates a baby immature intestine to develop. The growth factors prepare the baby intestine to digest and absorb milk and to prevent the absorption of undigested protein. Colostrum is laxative and helps the baby to pass meconium. this help to prevent jaundice. So the communities avoiding colostrum need to be educated regarding these benefits

Ovarian Cysts Management of Adnexal Mass Adnexal masses may be found as the result of a patient complaint or an incidental finding on an exam or an imaging study (ultrasound, computed tomography [CT], magnetic resonance imaging [MRI]). The etiology can be determined through consideration of the patient’s age, history, exam, ultrasound findings, and possibly tumor markers. The presence of ovarian cysts is more worrisome in peripubescent girls and post-menopausal women, as they are more likely to be malignant in these age groups. Other causes of adnexal enlargement on examination, besides ovarian lesions, include ectopic pregnancy and pelvic abscess. Management of Painful Ovarian Cysts Unilateral pelvic exam in the luteal half of the cycle is a common problem among menstruating women and is often due to a hemorrhagic luteal cyst. The diagnosis can be confirmed by pelvic ultrasound, which should reveal a complex cyst. Repeating the ultrasound after the next cycle (preferably in th...

Uterine Inversion: Uterine inversion either partial or complete is a serious but rare obstetric complication. In this condition the fundus of the uterus extend to, or through the cervix and it may come out of the vagina. It usually occurs in third stage of labour. This is a life-threatening condition and require prompt diagnosis and definitive treatment. Very rarely it may occur in non pregnant patients and in these patients it is usually associated with prolapsing uterine fibroids. Although it may occur in association with other tumors. Classification Of Uterine Inversion: First Degree Inversion: The inverted fundus extend to, but not through the cervix.   Second Degree Inversion: The inverted fundus extend through the cervix but remain inside the vagina Third Degree Inversion: The inverted Fundus extend outside the vagina. Total Inversion The vagina and uterus both are inverted. Causes  and Risk Factors Of Uterine Inversion: Uterine inversion ...

Uterine Rupture: Uterine Rupture during pregnancy and labor is a rare occurrence that frequently results in life-threatening maternal and fetal compromise whereas uterine scar dehiscence is a more common event that seldom results in maternal or fetal complications. Uterine Scar Dehiscence: By definition uterine scar dehiscence constitute a separation of a pre-existing uterine scar without disruption of overlying visceral peritoneum and doesn’t bleed significantly from the edges. In addition, the fetus, placenta and umbilical cord must be present inside the uterine cavity. Signs and Symptoms: Continuous abdominal pain. Vaginal bleeding Uterine contraction ceases Fetal heart rate (FHR) becomes abnormal. Management of Uterine Rupture: If the uterine rupture is suspected, laparotomy should be done as soon as possible. see also: Uterine inversion Primary post partum hemorrhage. Complications Of Third Stage of labour

Placenta Adherens - Placenta Acreta, Increta, and Percreta: In these conditions whole or part of the placenta is adherent to the uterine wall due to an invasion of myometrium with chorionic villi which make expulsion of placenta out of the uterus difficult. Adherent Placenta or Placenta Adherens Placenta adherens is a condition in which placenta remains attached to the uterine wall for an abnormally long time following birth. Causes Of Adherent Placenta: 1. Uterine Contraction is necessary for placental separation. any deficiency or incoordination of uterine contraction may make placenta difficult to separate. 2. Uterine anomalies: An abnormally shaped uterus can prevent the placenta from being expelled. 3. Hormonal Causes: During childbirth, the hormone oxytocin is released into the blood. Oxytocin is a potent hormone which induces powerful uterine contraction which helps in placental separation as well. If for some reason, adrenaline is released into the blood (adrenaline is a h...

Complications Of the Third Stage Of Labour Third Stage Of Labour: In the first two stages of labor, the baby is delivered completely. The third stage of labor extends from delivery of the baby to the delivery of the placenta and this stage lasts for 15-30 minutes. Normally placenta is delivered within 30 (max) minutes of delivery of the baby. Complications Of the Third Stage Of Labour: 1. Retained Placenta Trapped Placenta: The placenta detaches from the uterus but becomes trapped due to the cervix closing. Partial Accreta:   The placenta grows into and becomes deeply attached to the uterus. This prevents detachment. Placenta Adherens:   The muscular layer of the uterus fails to contract and placenta remain attached to the uterus. 2. Primary Post Partum Hemorrhage 3. Uterine Inversion 4. Uterine Rupture General Management: 1. Stop the bleeding by massaging the uterus to cause it to contract or by bimanual compression. 2. Uterine contraction is maintained by ergometrin ...

You must read the following related articles too; 1.  Indirect Hyperbilirubinemia and jaundice in neonates causes symptoms and treatment (click here) 2. Phototherapy to reduce neonatal bilirubin level and jaundice. (click here) 3. When should exchange transfusions be given? (click here) Pharmacological or Drug Therapy for neonatal jaundice. •Antibiotics if septicemia present. •Adequate feeding. •Prevent Rh-isoimmunization in the mother by giving Rh0(D) immune globulin(Rhogam) injection within 2 hours of Rh-positive infants. •Phenobarbitone •Metallo porphyrins •A 500mg/kg dose of i.v immunoglobulin given to the infant as soon as the diagnosis is established. 

Exchange transfusion is performed if intensive phototherapy (what is phototherapy click here)  has failed to reduce bilirubin levels to a safe range and if the risk of kernicterus exceeds the risk of the procedure or the infant has signs of kernicterus. Potential complications from exchange transfusion are not trivial and include acidosis, electrolyte abnormalities, hypoglycemia, thrombocytopenia, volume overload, arrhythmias, NEC, infection, graft vs host disease, and death. This widely accepted treatment is repeated if necessary to keep indirect bilirubin levels in a safe range. •Various factors may affect the decision to perform an exchange transfusion in an individual patient. The appearance of clinical signs suggesting kernicterus is an  indication for exchange transfusion at any level of serum bilirubin. A healthy full-term infant with physiologic or breast milk jaundice may tolerate a concentration slightly  higher than 25 mg/dL with no apparent ill effect, whe...

Phototherapy To Reduce Bilirubin Level In Neonate-Mechanism and Effects: The ancient people knew this effect. Even in the rural area of Pakistan and other countries, the mothers keep their baby in sun for several minutes because they know that this sun energy imparts some beneficial effects on their baby. Now we are going to learn how solar energy helps a neonate. Every newborn baby has 11 million RBCs per millilitre (normal adult level is 5 million RBCs/mm cube) These RBCs also have a shorter lifespan. After birth, the neonate is exposed to environmental oxygen. So the extra RBCs undergo destruction and within few weeks RBCs level reduces to lower level. The increased destruction of RBCs leads to the excessive formation of bilirubin. Which imparts a yellow colour to the baby's skin which is known as neonatal jaundice. ( read this article to have a clear idea about neonatal jaundice - Indirect hyperbilirubinemia in the neonate, causes, signs and symptoms and treatment ) ...