Thursday, September 20, 2012

Atrophic Vaginitis

Atrophic vaginitis is caused by a decrease in Estrogen hormone levels. Estrogen levels normally drop after menopause, leading to the condition more frequently presenting in women over 45 years of age.

Other cause of Atrophic vaginitis may be
  • Medications or hormones used to decrease estrogen levels in women, as part of the treatment for breast cancer, endometriosis, fibroids, or infertility
  • Radiation treatment to the pelvic area or chemotherapy
  • Severe stress, depression, or rigorous exercise
Atrophic vaginitis may occur in younger women who have had surgery to remove their ovaries. Some women develop the condition immediately after childbirth or while breastfeeding, since estrogen levels are lower at these times.

Clinical Presentation

Burning on urination,  bleeding after intercourse, Painful sexual intercourse causing a loss in sexual interest, Slight vaginal discharge, Vaginal soreness, including itching or burning sensations

Prescription estrogen is very effective in treating atrophic vaginitis. It is available as a cream, tablet, suppository,  all of which are placed directly into the vagina. These medicines deliver estrogen directly to the vaginal area.

For any queries, pl visit our gynecologist

Monday, September 17, 2012

Fibroid Treatment in Gurgaon

Fibroids are benign tumors occuring in the Uterus. They are rare before the age of 20 years.

Depending upon the location, Uterine fibroids may present as

Bleeding between periods
Frequency of Urination
Pelvic cramping or painful periods
Heavy menstrual bleeding (menorrhagia)
Menstrual periods that may last longer than normal
Sensation of fullness or pressure in lower abdomen

Fibroids are often described by their location in the uterus:

Myometrial -- in the muscle wall of the uterus
Submucosal -- just under the surface of the uterine lining
Subserosal -- just under the outside covering of the uterus
Pendunculated -- occurring on a long stalk on the outside of the uterus or inside the cavity of the uterus

Surgery and procedures used to treat fibroids include:

1. Hysteroscopic resection of fibroids: Women who have fibroids growing inside the uterine cavity may need this outpatient procedure to remove the fibroid tumors.
2. Uterine artery embolization: This procedure stops the blood supply to the fibroid, causing it to die and shrink. This procedure is done by an interventional radiologist, in consultation with Gynecologist.
3. Myomectomy: This surgery removes the fibroids. It is often the chosen treatment for women who want to have children, because it usually can preserve fertility.
For any queries, pl contact our Gynecologist

Thursday, August 16, 2012

ECTOPIC PREGNANCY

An ectopic pregnancy typically occurs in one of the fallopian tubes. This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or cervix.
Abdominal or pelvic pain and light vaginal bleeding are often the first warning signs of an ectopic pregnancy.
The risk of having an ectopic pregnancy increase, if you have a history of ectopic pregnancy, or infection of fallopian tubes in the past.

Ruptured Ectopic pregnancy is an emergency situation, and may lead to excessive bleeding and shock.
Early diagnosis is important; Ultrasonography is the test of choice. 

Saturday, August 4, 2012

EXCESSIVE MENSTRUAL BLEEDING / MENORRHAGIA

Menorrhagia is defined as menstruation at regular cycle intervals but with excessive flow and duration. Clinically, menorrhagia is defined as total blood loss exceeding 80 mL per cycle or menses lasting longer than 7 days.


  • Young patients, from menarche to the late-teen years, most commonly have anovulatory bleeding due to the immaturity of their hypothalamic-pituitary axis.





  • Women aged 25-50 years may have organic or structural abnormalities. Uterine Fibroids or polyps are frequent  findings.





  • Postmenopausal women with any uterine bleeding should receive an immediate workup for endometrial cancer.



  • Pregnancy should  be excluded before further testing or medications are advised.
    Other differential diagnoses must be kept in mind while assessing a patient with menorrhagia.

    Investigations : Pelvic ultrasound is the best noninvasive imaging study to assess uterine shape, size, and contour; endometrial thickness; and adnexal areas.

    Successful treatment of chronic menorrhagia is highly dependent on a thorough understanding of the exact etiology. Treatment must be individualized based on the cause of bleeding.

    For any queries, pl contact Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669

    Saturday, July 28, 2012

    PAP Smear : What you MUST know to prevent Cervical Cancer


     
     
    Cancer of the cervix  is the  most common genital cancer among women worldwide. The best way to detect cervical cancer is by having regular Pap smears.  A Pap smear is a microscopic examination of cells taken from the uterine cervix.
     
    A Pap smear can detect certain viral infections such as human papillomavirus (HPV), that is known to cause cervical cancer.

    Risks factors for cancer of the cervix include  the following:
    Cervical cancer screening by PAP smear is now recommended every 3 years starting at age 21. Screening may be carried out every 5 years for women over age 30 if a Pap smear and HPV test are performed.

    Women over age 65 or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests.

    A negative or normal test finding means that the cervix looks healthy. All the cells are of a healthy size and shape.
    A positive or abnormal test finding means that there is something unusual  in the sample. The test found cells of a different size and shape.

    An abnormal Pap smear result does not always indicate cancer. Cells sometimes appear abnormal but are not cancerous. The woman will have to return to the doctor for follow-up care.
              A check-up with a doctor is necessary.
    A vaccine is now available to prevent HPV infection,

    For any further queries, pl contact your gynecologist

    Thursday, July 19, 2012

    AIR TRAVEL DURING PREGNANCY

    Dr Deepika Tiwari, Gynecologist, Gurgaon www.gurgaongynae.inhttp://www.drdeepikatiwari.blogspot.com/http://www.gurgaongynecologist.webs.com/


    Pregnant women & those contemplating pregnancy need special consideration because of specific nature of the potential health hazards of long distance flights.These include exposure to cosmic radiation, reduced arterial oxygen pressure, immobilization & unforseen medical & obstetrical emergencies encountered during flight.

    More radiation shielding is provided by atmospheric air at lower altitudes.The dose received from cosmic radiation is usually lower during short haul flight since long haul flight are usually flown at higher altitudes.
    The changes in heart rate & BP which are associated with decreased partial oxygen pressure may affect women with compromised pregnancies.

    Increased risk of venous thrombosis may occur due to prolonged immobilization from cramped seats, which is called Economy class syndrome.

    ADVICE

    1.  Pregnant women  should use their seat belts continuously while seated.
    2. Long distance flights are not recommended for women upto  36 wks gestation with singleton pregnancy & 32 wks with multiple pregnancies.
    3. Travellers should be updated on routine immunizations including TT,Diptheria, Influenza, & other immunization  based on  geographic  risk

    4. Travel is not  recommended at any time during pregnancy for women who have medical /obstetrical prblems that could result in emergencies

    NOTE : Always consult your gynaecologist, whenever you are planning for air travel.

    Friday, July 13, 2012

    Smoking in Pregnancy



    Dr Deepika Tiwari, Gynecologist, Gurgaon 
    www.gurgaongynae.in
    http://www.drdeepikatiwari.blogspot.com/
    http://www.deepikatiwari.com/


    If you smoke and you are pregnant, or planning to become pregnant, you are strongly advised to stop smoking.
    Smoking when you are pregnant increases the risk of: miscarriage; slowing the growth of the baby leading to a low birthweight; premature labour leading to the baby being premature (prem); stillbirth.
    Even after the birth, children of smoking parents have an increased risk of developing chest infections, asthma, glue ear, and sudden infant death syndrome (cot death).

    You and your baby will get most benefit, and the risks will be most reduced, if you stop before you become pregnant. Planning to become pregnant is a good incentive to stop smoking for many women, and is often a good time to persuade partners to give up too.

    Thursday, July 12, 2012

    Painful Periods in Women


    Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
    www.gurgaongynae.in
    http://www.drdeepikatiwari.blogspot.com/
    http://www.gurgaongynecologist.webs.com/



    Painful periods are common in teenagers and young adults.
    Primary dysmenorrhoea is the most common type of painful periods. This is where there is no underlying problem of the womb (uterus) or pelvis. It often occurs in teenagers and women in their 20s.
    Secondary dysmenorrhoea is pain caused by a problem of the womb or pelvis. This is less common, and is more likely to occur in women in their 30s and 40s.

    The main symptom is crampy pain in your lower abdomen.

    The following may indicate secondary dysmenorrhoea:
    It is important to differentiate between the primary and secondary dysmenorrhoea; the treatment depends on the underlying cause. Supportive care and Anti-Inflammatory medication help control the severeity of symptoms.

    Breast Feeding of Newborn

     Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
    www.gurgaongynae.in
    http://www.drdeepikatiwari.blogspot.com/
    http://www.deepikatiwari.com/

     

    Breast milk is the best nutrition for babies. The World Health Organization recommends that babies are fed only breast milk for their first six months, and that breast-feeding then be continued as part of a mixed diet until the age of two years. A vitamin D supplement is recommended for all breast-feeding women and for breast-fed babies.
    On average, breast-fed babies have fewer infections in their early life. The main reason for this is that antibodies are passed in the breast milk from mother to baby. Antibodies are proteins that help to fight infection. Breast-fed babies have less diarrhoea and vomiting, and fewer chest and ear infections, compared with babies who are not breast-fed. Breast-feeding enhances the bonding process between baby and mother.
    There is now good evidence from research studies that, on average, the following health problems in later life are less common in those who had been breast-fed compared with those who had not: obesity and overweight; high blood pressure; high cholesterol level; eczema; type 2 diabetes; leukaemia; asthma. ref

    It is recommended to start breast feeding as soon as practical after the baby birth. Colostrum is an important source of antibodies for the newborn. Some women have difficulty in initiating breast feeding. Such issues can be easily treated with supportive care , and some counselling by the gynecologist.



    Wednesday, July 11, 2012

    Hypothyroidism in Pregnancy

    cold intolerance,
    slow heart rate(Bradycardia) ,
    delayed relaxation of tendon reflexes,
    excessive menses (in non pregnant ) 
    The most common cause of hypothyroidism is autoimmune.
    Hypothyroidism is diagnosed with reduced free T4 concentration with increased TSH levels.
    Most serious consequence of hypothyroidism in pregnancy is Myxedema Coma which is a medical emergency. Neuropsychiatric development is delayed in offsprings born to hypothyroid mothers . However correction of maternal hypothyroidism in first 12 wks of pregnancy might improve outcome.
    Cretinism (deaf mutism, spastic motor disorders & hypothyroidism ) is distinct & severe form of brain damage caused by severe maternal iodine deficiency .
    Patients with hypothyroidism should be counselled to delay pregnancy until maintenance level of T4 is achieved.
    Hypothyroid in pregnancy requires treatment with thyroxine with thyroid function tests repeated every 3 months ( however they should be repeated every 4-6 wks if dosage changes are to be made).

    Sunday, July 1, 2012

    Pregnancy with Diabetes


    It is estimated that 3- 5 % of pregnancies are complicated by Diabetes mellitus.With increasing prevalence of Diabetes in young women, it is important to understand  the common symptoms that a pregnant lady may suffer, to diagnose it early.


    Some important features to be understood…
    *Gestational Diabetes refers to the condition where in high blood glucose levels are monitored for the first time during pregnancy.
    *Diabetes diagnosed before pregnancy may be insulin dependent (IDDM), or non- insulin dependent (NIDDM).
    * During pregnancy, there is a physiological increase in insulin resistance, to satisfy the nutritional demands of foetus.
    * High levels of maternal blood glucose levels, may lead to high levels of glucose in foetal blood.
    * Patients who are already diagnosed with Diabetes, before getting pregnant, may develop high blood pressure during pregnancy, and increased susceptibility to infection; may increase the likelihood of caesarean section; large baby size (Macrosomia); shoulder dystocia etc.
    *Increased risk of congenital abnormalities in the foetus, miscarriage, still birth, premature delivery.
    Intensive control  of glucose levels around the time of conception, can reduce the incidence of congenital abnormalities. In non diabetic subjects fasting glucose should be 70mg/dl- 126mg/dl .Diabetic subjects tend to have higher post prandial  & sustained minor elevations of glucose,

    WHEN TO CONSULT A DOCTOR

    A higher fasting, postprandial sugar levels

    An abnormal glucose challenge test

    An abnormal Glycosylated Hemoglobin

    Repeated infections especially urinary infections

    Polyhydraminos (increased liquor )

    H/o previous stillbirths, large babies, premature delivery, traumatic delivery

    For any queries, pl consult your doctor

    Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
    www.gurgaongynae.in
    http://www.drdeepikatiwari.blogspot.com/
    http://www.gurgaongynecologist.webs.com/

    Monday, March 26, 2012

    Mirena (Hormonal Contraceptive) : How does it Act ?

     Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
    www.gurgaongynae.in
    http://www.drdeepikatiwari.blogspot.com/
    http://www.gurgaongynecologist.webs.com/

    Mirena acts by
    • Supplements the endometrial action of progestins to foreign body reaction
    • Endometrium becomes decidualized, with atrophy of glands
    • Inhibition of implantation
    • Inhibition of sperm capacitation and survival
    The Ovarian functions are NOT disturbed; the cycles remain ovulatory in 85 percent of patients, regardless of bleeding pattern.

    Few Shortcomings of Mirena include; irregular bleeding and scanty menses. Amenorrhoea may occur in up to 50 % of patients.

    Mirena: Intra-uterine Contraceptive Device (IUCD)


    Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
    www.gurgaongynae.in
    http://www.drdeepikatiwari.blogspot.com/
    http://www.gurgaongynecologist.webs.com/

    Mirena is a longer acting hormone releasing device. It has a T shaped polyethylene frame with a steroid reservoir, containing Levonorgesterol.
    This device mainly acts by releasing levonorgesterol into the uterine cavity, and effects are due to local progesterone action. It can produce contraceptive action for up to 5 years.
    Pearl Index after 5 years is 0.09/ 100 women year.
    Health Benefits of Mirena
    • Reduction of blood loss
    • Reduction of pain and dysmenorrhoea in Endometriosis, and fibroids.
    • Do not influence lactation, or foetal growth
    • Prevention and treatment of Endometrial hyperplasia

      read more in next article...

      Monday, March 19, 2012

      Corticosteroids for Premature Birth & Premature babies


      Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
      www.gurgaongynae.in
      http://www.drdeepikatiwari.blogspot.com/
      http://www.gurgaongynecologist.webs.com/

      Corticosteroids have been used for many years in women who are thought to have a high chance of having their baby early. Premature babies (born before 37 weeks) have an increased risk of health problems, particularly with breathing, feeding and infection. These problems tend to be more severe the earlier the baby is born.
      A single course of corticosteroids has been shown to help with a baby’s development and therefore will increase the chance of your baby surviving, once born. It also lessens the chance of your baby having serious complications after birth such as breathing problems due to the lungs not being fully developed, bleeding into the brain, serious infection or bowel inflammation.

      Risks to the baby, if mother is overweight during Pregnancy

      • If you have a BMI of 30 or above before pregnancy or in early pregnancy, this can affect the way the baby develops in the uterus (womb). Neural tube defects (problems with the development of the baby’s brain and spine) are uncommon. Overall around 1 in 1000 babies are born with neural tube defects in the UK but if your BMI is over 40, your risk is three times that of a woman with a BMI below 30.
      • Miscarriage - the overall risk of a miscarriage under 12 weeks is 1 in 5 (20%), but if you have a BMI over 30, your risk increases to 1 in 4 (25%).
      • You are more likely to have a baby weighing more than 4kg (8lb and 14 ounces). If your BMI is over 30, your risk is doubled from 7 in 100 (7%) to 14 in 100 (14%) compared to women with a BMI of between 20 and 30.
      • Stillbirth - the overall risk of stillbirth in the UK is 1 in 200 (0.5%), but if you have a BMI over 30, your risk is doubled to 1 in 100 (1%).
      • If you are overweight, your baby will have an increased risk of obesity and diabetes in later life.

      Gynaecological Cancer screening

      Post menopausal bleeding of any severeity requires URGENT screening. You may be harbouring a malignancy.
      Ultrasound and Endometrial aspiration , may be required. 

      Sunday, March 18, 2012

      Overweight in pregnancy: Check your BMI


      Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
      www.gurgaongynae.in
      http://www.drdeepikatiwari.blogspot.com/
      http://www.gurgaongynecologist.webs.com/

      Being overweight (BMI > 25) increases the risk of complications for pregnant women and their babies. With increasing BMI, the additional risks become gradually more likely, the risks being much higher for women with a BMI of 40 or above. The higher your BMI, the higher the risks.

      Risks include-
      Thrombosis
      Gestational Diabetes
      Pre-eclampsia & Hypertension

      Indications of performing Chorionic villus sampling, or Amniocentesis


      • have had a high risk screening test for Down syndrome
      • have had a previous pregnancy affected with a genetic disorder
      • or your partner have one or more relatives affected with a genetic disorder, which means you are at greater risk of having a child with a genetic disorder, such as cystic fibrosis, thalassaemia or sickle cell disease
      • have received a result from a scan which shows certain abnormal ultrasound features, such as fluid collection at the back of the baby's neck (nuchal translucency), or a congenital heart defect which indicates the baby may have a disorder such as Down syndrome. This may be suspected on a scan at 18-22 weeks
      • want to know for certain whether your baby has a genetic disorder or not.

      Saturday, March 17, 2012

      Chorionic Villus Sampling & Amniocentesis in Pregnancy

      Chorionic Villus Sampling and amniocentesis are tests carried out during pregnancy, to check your baby for disorders such as Down syndrome and, where appropriate, rarer specific inherited disorders. Amniocentesis is also occasionally done to test for other disorders in pregnancy such as fetal infection.

      In CVS a small sample of the placenta (afterbirth) is taken for testing, whereas in amniocentesis a small amount of amniotic fluid - the water around your baby inside your uterus (womb) - is taken for testing.

      CVS is performed most commonly between 11 and 13 weeks. Amniocentesis is performed after 15 weeks.

      Non prescription management of Peri-menopausal Syndrome

      • Regular aerobic exercise such as running and swimming. You should avoid infrequent, high impact exercise as this may make your symptoms worse. 
      • Low intensity exercise such as yoga may help hot flushes and general well being. 
      •  Reducing your intake of caffeine/caffeinated drinks and alcohol can help to reduce hot flushes and night sweats.

      Sunday, January 29, 2012

      Maternal smoking linked to higher incidence of congenital heart defects in offsprings


      Maternal cigarette smoking in the first trimester was associated with a 20 to 70 percent greater likelihood that a baby would be born with certain types of congenital heart defects, according to a study by the Centers for Disease Control and Prevention. Congenital heart defects are the most common type of birth defects, contributing to approximately 30 percent of infant deaths from birth defects annually.
      read more....
      http://www.cdc.gov/media/releases/2011/p0228_smokingpregnancy.html?source=govdelivery

      Saturday, January 28, 2012

      Polycystic Ovarian Syndrome

      Dr Deepika Tiwari, Gynecologist, Gurgaon

      Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production. High serum concentrations of androgenic hormones, such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S), may be encountered in these patients.
      PCOS is also associated with peripheral insulin resistance and hyperinsulinemia, and obesity amplifies the degree of both abnormalities.
      Patients with PCOS may present with various clinical features.
      Menstrual abnormalities/ Hyperandrogenism/ Infertility/ Obesity/ Diabetes mellitus/ Sleep apnea/ Metabolic syndrome
      Treatment:
      Diet and exercise: In patients with PCOS who are obese, endocrine-metabolic parameters markedly improve after 4-12 weeks of dietary restriction. 
      Metformin: This antidiabetic drug improves insulin resistance and decreases hyperinsulinemia in patients with PCOS
      Patients with PCOS who are infertile but desire pregnancy should be referred to a reproductive endocrinologist for further evaluation and management of infertility.

      Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
      www.gurgaongynae.in
      http://www.drdeepikatiwari.blogspot.com/
      http://www.gurgaongynecologist.webs.com/

      Monday, January 16, 2012

      Intrauterine Contraceptive Devices IUCD or IUD

       An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed. However, an IUD should only be removed by a medical professional.




      Dr Deepika Tiwari, Gynecologist, Gurgaon 
      www.gurgaongynae.in
      http://www.drdeepikatiwari.blogspot.com/
      http://www.gurgaongynecologist.webs.com/www.deepikatiwari.com

      Sunday, January 15, 2012

      Emergency Contraception Pill or "Morning after" pill

       Emergency contraception (birth control after sexual intercourse) is the use of a drug or device to prevent pregnancy after unprotected sexual intercourse. Emergency contraceptive pills are sometimes called the “morning-after pill,” but they are usually effective if taken within 72 hours of unprotected sexual intercourse.  

      Emergency contraceptive measures can be taken within the first 72 hours after unprotected sexual intercourse to reduce the possibility of pregnancy. A woman is most likely to become pregnant if sexual intercourse occurs in the few days before or after ovulation (release of an egg from the ovary). Emergency contraceptives should not be used as a contraceptive method in women who are sexually active or planning to become sexually active. They are not as effective as any ongoing contraceptive method.


      Emergency contraception pills contain high doses of the same hormones that are in birth control pills. The high dose of hormones is short lived. Cases of deep vein thrombosis (blood clotting) have been reported in women using the emergency method. These pills are not designed to terminate an existing pregnancy.


      Emergency contraception pills should only be taken with expert opinion. Cases of Uterine rupture have been reported in patients with inadvertent use.


      Ref: Medscape
      Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
      www.gurgaongynae.in
      http://www.drdeepikatiwari.blogspot.com/
      http://www.gurgaongynecologist.webs.com/

      Saturday, January 14, 2012

      Abruptio Placentae : Bleeding in Pregnancy

      Dr Deepika Tiwari, Gynecologist, Gurgaon
      Abruptio placentae, also called premature separation of the  placenta, is a serious complication of pregnancy. The placenta separates away from the inner wall of the uterus before delivery. Untreated abruption can harm both mother and baby. It can mean compromised oxygen and nutrients for the baby and heavy bleeding in the mother.  It’s a medical emergency.

      Risk factors include hypertension, trauma, and multiple pregnancies. Abnormalities of pregnancy called chorioamnionitis and polyhydramnios are also risk factors. Others are age (younger than 20 and older than
      35), preeclampsia, diabetes, smoking, use of cocaine, and alcohol consumption.


      The main symptoms are uterine bleeding, abnormal uterine contractions, and fetal distress . Contractions are painful and obvious. Weakness, low blood pressure, fast heart rate, abdominal pain, and back pain may occur. Grade 1 abruption includes mild bleeding from the vagina and uterine contractions, stable vital signs, and stable fetal heart rate. Grade 2 means moderate bleeding, abnormal contractions, low blood pressure, distressed fetus, and abnormal coagulation profile. Grade 3 is worst. It involves severe bleeding and contractions, very low blood pressure, fetal death, and very poor coagulation profile.


      Treatment :Stabilization of the mother is done first. Intravenous fluids  are given to maintain blood pressure and keep the urine flow steady. An emergency cesarean section and blood transfusions may be needed. For almost full-term babies and mild abruption, vaginal delivery may be possible.



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