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.

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