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6 Things To Remember If You Are Planning To Become Pregnant

6 Things To Remember If You Are Planning To Become Pregnant

A couple looking for pregnancy visits a gynaecologist. Here are the pointers to prepare them about what they may expect during this visit.
pregnant woman
Medical history– couple will be asked about the any existing or past illnesses . If they are on any regular medication. Specific questions will be asked about presence of diabetes and epilepsy.
Similar questions will be asked about the family and if there are any genetic disorders running in the family
Social history –With growing urbanisation, nuclear families are becoming a norm. There is loss of support in terms of someone taking care of you, whether it is cooking or doing house chores. Inquiry is also done about substance abuse, alcohol consumption and smoking.
Obstetrics ( previous pregnancies ) history of woman is asked

-A general medical examination is done.
-A note of nutritional deficiencies is made

Obesity as well as extreme underweight- both these clinical conditions are commonly encountered and may come in way of achieving pregnancy normally

Exercising regularly is important to keep fit. At the same time you should not exhaust yourself. Augment heat dissipation by wearing light clothes and fluid replacement.

A few routine and at times special tests are done
-HIV-to rule out infection
-HbsAg-to rule out infection
-VDRL-to rule out infection
-HCV- to rule out infection
-Hb Electrophoresis-to know about abnormal haemoglobin and Thalassemia
-Chromosomal microarray analysis-in cases of previous pregnancy loss
-Thyroid tests- T3, T4, TSH
-Pap’s Smear

A few vaccines are recommended
-Influenza vaccine
-Rubella- a blood investigation will tell if the woman is susceptible.Those who are yet unimmunized, vaccination is done
-Varicella- Chicken pox- if not contracted previously, vaccine is given

Oligohydramnios-Water Around Fetus Decreases During Pregnancy-How It Badly Effects Health Of Baby

Oligohydramnios-Water Around Fetus Decreases During Pregnancy-How It Badly  Effects  Health Of Baby


What is amniotic fluid
-Amniotic fluid is the fluid around fetus (Unborn baby in uterus)in which it swims during the course of the pregnancy. This is approximately 98% water.
-In a term pregnancy, total volume of fluid is around 2800 ml

Definition of Oligohydramnios
Abnormally decreased volume of amniotic fluid is called ‘Oligohydramnios”

No measurable pocket of amniotic fluid around baby

Source of amniotic fluid
Amniotic fluid is a secretion of fluid from various sources. The main sources are listed below
-Membranes and placenta surrounding baby
-Fetal skin
-Fetal urine production
-Fetal lung fluid

Importance of amniotic fluid
Amniotic fluid serves several roles during pregnancy
-It allows the fetus to have movements in the uterus. This helps in development of muscles and bones of the baby
-Fetus keeps on swallowing this fluid. This helps in development of intestines of the baby.
-It gives space so that fetal lungs can expand. This will help in development of lungs of baby and baby will breathe normally when born
-Fetus draws its blood supply, oxygen and nutrition from umbilical cord. Adequate amniotic fluid is necessary for its free movement and continuous supply.

What are trimesters of pregnancy
-The total duration of pregnancy that is 40 weeks is calculated as 9 months plus one week. Calculation is started from first day of last menses.
These 40 weeks are divided into three groups
-First trimester- include first 12 weeks
-Second trimester- weeks 13 -28
-Third trimester-29- 40weeks

Diagnosis of oligohydramnios
-Diagnosis is done by doing sonography ( Ultrasound) .Overall quantity of fluid is estimated .
-Colour Doppler studies of umbilical artery will tell if fetus is receiving enough blood supply.
-NST- Non Stress Test- a tracing of fetal heart rate pattern is a good indicator of baby’s well being

When does it happen
Early onset

When oligohydramnios is detected in early second trimester .

1) By 18 weeks of pregnancy fetal kidneys are the main source of amniotic fluid. Those fetal abnormalities which will result in decreased fetal urine production as the kidneys are not properly formed or there is obstruction in passage of urine will give rise to oligohydramnios. A few major genitor-urinary abnormalities are
-Renal agenesis (non formation of kidneys )
-Multicystic dysplastic kidney ( Kidneys are malformed and have multiple fluid filled structures in it)
-Polycystic kidneys ( Kidneys have multiple cysts)
-Bladder outlet obstruction ( urine is forming normally but can’t come out of bladder  as the outlet has obstruction)

-Posterior urethral valves ( urethra is the tube like structure which will let the urine come out of bladder- if there are valves preventing the urination-oligohydramnios develops)
-Urethral atresia- urethra is not completely formed

2) Rupture of bag of membranes which is around the fetus.  This will clinically present as watery discharge from vaginal. There may be bleeding too. Later on patient may complain of pain in lower abdomen which is associated with uterine contractions.

Mid pregnancy onset
When decrease in amniotic fluid happens in late second trimester or early third trimester.
In these times , oligohydramnios is associated with
-Suboptimal fetal growth- IUGR ( Intra Uterine Growth Retardation )
-Placental abnormality-Placenta is not working at its optimal level and blood supply in it is less.
-Pregnancy induced hypertension ( High BP ) clinically known as PIH

Post term pregnancy onset
When the pregnant woman has crossed the due date, oligohydramnios may set in
It is usually because of suboptimal functioning of placental surfaces.

Medicines responsible
Some medicines if taken in pregnancy for a long time will lead to development of oligohydramnios
All medications in pregnancy should be taken on advice of expert gynaecologist

Prognosis (outcome) of oligohydramnios
If pregnancy is complicated by oligohydramnios-the baby will suffer many abnormalities

Potter’s syndrome– it is a combination of three features
1) Limb contractures- hands and legs may have abnormal shape
2) Compressed face- face looks abnormal
3) Death of fetus  from pulmonary hypoplasia- the lungs are underdeveloped and do not support the life of baby

Many other adverse fetal effects are also associated with oligohydramnios
-Fetal malformations
-Stillbirth- a dead baby is born
-Preterm birth
-Increased chances of Cesarean delivery
-Low birth weight of the newborn which will require care in NICU- Neonatal Intensive Care Unit
-Neonatal death- baby expires soon after being born
– Meconium aspiration- baby passes stool even before it is born. This fecal matter/ stool (Meconium) is ingested by the baby and chokes up the respiratory tract, hence leading to difficulty in breathing after being born.

Management of oligohydramnios
-Management of oligohydramnios requires close fetal monitoring by available diagnostic modalities like sonography and NST
-Medicinal support to increase the blood flow to uterus and baby and to help the fetus gain weight. These medicines have limited effectiveness.
-Timely delivery of the baby as soon as the maturity of the baby is achieved.

Three Things You Must Do to Treat and Prevent UTI-Urinary Tract Infection

Three Things You Must Do to Treat and Prevent UTI-Urinary Tract Infection

The phrase urinary tract infection conjures up specters of pain, burning, fever, irritation and sometimes bleeding- a veritable nightmare for today’s multitasking woman. Catching and treating UTIs at the earliest (apart from avoiding them altogether!) are your best bet for avoiding long-drawn out health complications.


1) Get Pill-osophical
The quickest and most effective means of dealing with UTIs is to get medical treatment. A course of antibiotics is prescribed to stop the infection-causing bacteria in their (urinary) tracks and to prevent a relapse. Though effective, these antibiotics tend to have side effects like acidity ,metallic taste in mouth diarrhea, loss of appetite etc. Some people may be allergic to a particular drug and may develop rashes and itching. If you experience any of the above, seek medical assistance.

2 )Beat the Pain-demic
Wear non-restrictive and loose clothing that won’t put pressure on your abdomen. There are specific bladder analgesics (pain killer) tablets available.Ask your doctor to prescribe them to you.

3 )Paging Dr. Nature
Taking the antibiotic to kill the bacteria and increasing fluid intake to flush them out go hand in hand.  Fluid intake thus becomes very important. Drinking water, green tea, and cranberry juice will cleanse and rid the urinary tract of any bacterial remnants.
A U-Turn on UTIs
Many women especially college going and working ones, will experience recurrent urinary tract infection. Therefore, drink plenty of water, empty your bladder frequently, wash and wipe yourself after using the bathroom. You can ask your doctor to prescribe you pH balanced medicated feminine wash for regular use.

At times investigations of urine like routine microscopy, culture & sensitivity testing to know type of bacteria are done.

Checking blood for hemoglobin and sugar levels also is done.
Prevention is far better than any known cure. So stay hydrated, let it go, and allow your bladder to do its job!

Failed Copper-T and unwanted pregnancy


When ‘ Copper-T’ Fails And Results In Unwanted Pregnancy, What Should The Woman Do

Every birth control measure (Contraceptive method) has its own failure rates which results in pregnancy. Intra Uterine Devices- IUD,( IUCD- Intra Uterine Contraceptive Device) which is known as ‘ Copper –T’  in layman’s language also has its failures.

Presenting features of pregnancy with Copper-T in situ

-Woman will complain of missed periods
-Her pregnancy test will be positive
-Sonography will show presence of contraceptive device with pregnancy side by side

Fate of pregnancy with IUCD in situ ( IUCD-Intra Uterine Contraceptive Device )

If the woman conceives with IUCD still inside uterus, the pregnancy in question may have higher chances of complications like

Infection ( Chorioamnionitis )

The bag of membranes which surround the fetus become infected.  This is a serious medical condition as advance stages- Sepsis, may involve infection in blood . This wide spread infection may become life threatening


Involves- termination of pregnancy as soon as possible along with adequate cover with antibiotics.


-There are higher chances of abortions whether spontaneous or induced.
-Here we should understand the woman opted for an IUD as she did not want to become pregnant any more.
-There is a rule by Government  of India under MTP act (Medical Termination of Pregnancy ) , that says that pregnant woman can seek termination of pregnancy ( in layman’s language-abortion ) upto  20 weeks if the said pregnancy has occurred as a result of failure of contraceptive ( Birth Control ) measure

Preterm Birth

-Pregnancy with Copper –T in situ has a higher chance of preterm birth.
-Preterm birth has its own set of complications like low weight of neonate, requirement of NICU- Neonatal Intensive Care Unit, failure to thrive etc.

Ectopic Pregnancy

-If a woman conceives with ‘ Copper-T’ in situ, there are higher chances that the site of pregnancy will be abnormal.
-The normal site of implantation of pregnancy is inside the uterus.
-In ectopic pregnancy, the site of implantation can be Fallopian tubes (Tube like structure which is a passage between uterus and ovary), Ovaries etc.
-This pregnancy in abnormal location does not grow normally


-Early diagnosis by sonography and surgical intervention to remove this abnormally located pregnancy is required in most of the cases

What can be done once pregnancy is diagnosed with Copper –T inside uterus

-If thread is visible, which may be the case in early pregnancy, the treating Gynaecologist will gently pull on the thread to attempt removal. Many a times it is successful.
-Assistance of Ultrasound may be sought to make the removal procedure safe and easy
-If thread is not visible- termination of pregnancy by D&E- Dilatation and Evacuation may be offered along with removal of Copper-T at the time of the procedure














Missing Thread Of Copper-T – Where Has It Gone & What Should The Woman Do

Missing Thread Of Copper-T , Where Has It Gone & What Should The Woman Do

There are many effective contraceptive ( Birth Control ) methods available for women. Placement of a small device in the uterus is ons such method.Intra Uterine Contraceptive Device-IUCD,Intra Uterine Device-IUD are the medical terminology used for this method of birth control. In common man’s language the device is popularly know as’ Copper-T

In this article term ‘Copper-T ‘ is used synonymously for IUCD/IUD

What is Copper-T


-Cooper –T is a small T shaped device which is placed inside the uterus for the purpose of birth control (Contraception )
-The device once placed will be effective for 3, 5 or 10 years depending upon the type of device.
-The Copper –T is placed inside the uterus but the thread attached to it extends through mouth of uterus (Cervix ) into vagina.
-Checking of thread is done periodically to make sure that the device is in its place.

-Using a ‘Copper-T ‘ is a very popular and safe method of birth control.
-Each method of contraception has its own complications and faliure rates.
-The complications that we are going to discuss in this article are very rare.

Precautions Taken After Insertion Of Copper-T And Likely Complications

-After putting the Copper-T, the woman is called after one month, once her next menses is over.
-The Gynaecologist examines the woman and checks the thread
-At times the Gynaecologist will find that the thread is missing.
-Now, this situation can arise even in the first month after insertion or later on during the life span of Copper-T as cited earlier.


How To Safeguard Against Losing Copper-T

-Woman should come for first check up as advised by her Gynaecologist in a month after putting of Copper-T
-Subsequently a gynaec check up is suggested at 6 monthly intervals.
-Woman is also taught to palpate the thread herself.
-She is supposed to repeat this procedure every month. She should contact her Gynaecologist immediately if she finds that the thread is missing.
cut 7

What Could Have Happened To Copper-T If The Thread Is Found Missing

There are few possibilities-

1) Copper- T is expelled

It may happen that the Copper –T got expelled and the woman did not notice its expulsion.
Diagnosis of this condition is by exclusion

Sonography and X-ray of abdomen and pelvis is done. If both these tests come out normal and no Copper-T is found, the diagnosis of expelled Copper-T is made.

-Woman may come to the Gynaecologist in a pregnant state. Management of pregnancy depends on woman’s wish to either continue or discontinue with the pregnancy.

2) The Copper-T is malpositioned

-In this situation, the Copper-T stays inside the uterus but the thread has curled up inside the uterus.
-One more possibility is that the thread became loose & came out but the Copper-T stayed inside.
 Diagnosis is by Ultrasound.



-Copper-T is removed by a special instrument called ‘IUCD retrieval hook’. This procedure is done under anesthesia in operation theater.
-At times removal by Hysteroscopy becomes necessary.

3) Perforation of wall of uterus by Copper-T

-In this case patient may present with pain in abdomen and bleeding from vagina.


Ultrasound (Sonography ), X-Ray  of abdomen, CT-Scan or MRI is done to diagnose this condition.


Complications of perforation

– Formation of adhesions among intra abdominal organs. For example the intestines may stick together.
-Perforation of abdominal organs. For example intestines or urinary bladder may get perforated by IUD
-Formation of abnormal tracks between two organs (Fistulas ) .


Patient will require retrieval of Copper-T either by laparoscope or an open operation on abdomen will be required.


5 Tips to Solve the Problem of Irregular Periods


1) Exercise and diet
-Regular physical exercise in the form of walking, jogging, yoga, dancing, cycling Is a must
-Regularisation of eating habits,  avoiding junk food and too much eating of outside food should be done
-Don’t skip breakfast
-Three square meals with dinner by 8 pm
-Two small in between healthy snacks on salads sprouts or nuts should be done
-Drink plenty of oral liquids
-Exercise & diet have a value as they will keep your body fit and weight under control

2)Healthy lifestyle
-Early to bed and early to rise was the ‘Mantram’ given by our elders.It still holds true
-Your body is the only place where you live. Take utmost care of it.
-Meditating for some time daily will calm your mind and will maintain positive outlook
-It is a scientific fact that stress causes hormonal imbalance
-Avoid unwanted factors in life, be it alcohol,smoke or excessive social media

3)Hormones check
-Most common cause of irreglar menses is hormonal imbalance
-Disorders of thyroid and prolactin hormones is commonly seen
-Diagnosis of these canditions can easily done in blood tests & subsequently medicines can be started
-PCOS(PCOD)- Poly Cystic Ovarian Syndrome- is another hormonal imbalnce disorder, which is now on a rise.Its diagnosis also depends on some specialized hormonal tests

-Sonography tells us the structure of uterus and ovaries
-Abnormalities can be detected and appropriate treatment offered
-In cases of PCOS, at times hormonal tests in blood come normal, but when we do sonography of ovaries, we come to know that PCOS is a likely diagnosis

-Taking prescribed medications on time is a must
-It may include hormonal or non-hormonal tablets
-Treatment may last uptoa period of 3-6 months
-Afterwards it is stopped
-Many a times normalization of menses occurs & no further treatment is required
-At times we also see cases where woman will experience recurrence of symptoms. These women will require repeat course of medicines

Stillbirth-a devastating outcome of a pregnancy

Stillbirth- A Devastating Outcome of a Pregnancy

Pregnancy is a period of joy and expectation for any woman and her family.  It is a heart breaking situation for any Gynaecologist when the news has to be broken that the baby is no longer alive in the uterus or the mother has given birth to a dead child .

This is a complicated scientific topic. Gynaecologists who treat such cases require compilation of all their knowledge and experience to evaluate the woman, whether she is pregnant right now or if she comes with history of previous stillbirth and is planning to conceive in near future.

In this write up, first we will deal with the scientific definition of Stillbirth. It’s division into three categories- Early, Intermediate & late. Causes & risk factors of stillbirth. Evaluation of stillbirth and finally its management aspect

Terms used in this topic

Fetus means- the child developing inside uterus
Gestation age -refers to the duration of pregnancy in weeks
Fetal death/ fetal mortality -is the term used to describe unfavorable outcome of pregnancy irrespective of duration of pregnancy (gestation age)
Stillbirth- is the term generally used by laymen when death of fetus occurs late in pregnancy

Scientific Definition of fetal mortality- Sillbirth

 Fetal death means death, prior to complete expulsion or extraction from the mother of a product of human conception irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.

The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord or definitive movement of the voluntary muscles.

Fetal mortality is generally divided into three periods

-Early- less than 20 completed weeks of gestation (pregnancy)
-Intermediate- 20-27 weeks
-Late – 28 weeks or more

In due course of the discussion of this topic, many causes (Clinical Situations) of Stillbirth will be discussed. Some of them are responsible for fetal mortality in all three periods of gestation. At the same time, for any case of fetal death, many factors may be responsible.

Many clinical entities are a topic of discussions in themselves hence they will be presented in only simplified and concise manner

 Statistics of Stillbirth (Fetal Mortality)

83 % of stillbirths occur before the start of labor pains- Antepartum stillbirths


1)Placental Causes

-Placental abnormalities– mainly utero-placental insufficiency

Placenta is the structure which is attached to the uterus and supplies food and oxygen to the fetus through umbilical cord. It gets its supplies from the mother. Various factors lead to its insufficient working.

Calcified placenta1

-Placental abruption

In this clinical entity placenta gets detached from its attachment to uterus. This results in stoppage of blood supply to the fetus and fetal death occurs.

placental abruption

2)Umbilical cord causes

-Prolapse– During labor (Birthing Process ) when cervix (mouth of uterus) is dilating, at times the umbilical cord comes out of it before the fetal head is born . This leads to compression of cord between fetal head and maternal bones of pelvis. There is cessation of blood supply to the baby and fetal mortality occurs

cord prolapse


-Stricture – This is structural abnormality of umbilical cord in which shrinkage of cord occurs at some point & cessation of blood supply occurs.

cord stricture

-Thrombosis – Clotting of blood occurs in the blood vessels of umbilical cord & blood flow to baby is hampered

3) Fetal Causes

-Multifetal gestation

When lady is pregnant with more than one fetus. Commonly encountered situations are Twins- pregnancy with two fetus, Triplet-three fetus, Quadruplet-four fetus etc

multifetal gestation

Fetal Malformations 

There are certain genetic abnormalities which result in major structural abnormalities in the fetus. These abnormalities are incompatible (Non survivable) with life.

4)Maternal Causes

Hypertensive disorders –

-Pre Eclampsia – High BP which results as a complication of pregnancy
-Chronic Hypertension – When mother is suffering from high BP and she becomes pregnant

Diabetes in mother

-Diabetic Embryopathy– Fetus of a diabetic mother is more prone to have certain congenital structural malformations. Some of them are lethal
-Diabetic ketoacidosis– Diabetic mother can develop this metabolic dysfunction. Blood sugar levels are high and insulin levels are low. Maternal cells are unable to utilize this sugar. This is a life-threatening situation for both mother and baby.

5) Obstetrics complications

Preterm labor

If pregnant woman goes in labor and delivers prematurely before the fetus has reached term and is capable of surviving independently.

Preterm Prelabor Rupture Of Membranes-PPROM 

Amniotic membranes make up Amniotic sac which is a covering around growing fetus to keep it safe inside uterus. If these membranes get broken due to some reason, Amniotic fluid (Fluid around fetus) gets drained resulting into Umbilical cord getting compressed between walls of uterus and fetus. This results in cessation of Oxygen supply to the fetus and ultimately fetal demise.
rupture of membranes


There are certain infections involving fetus and placenta which will lead to fetal death.


Gynaecologists come to know about these risk factors either during examination or history taking. When one or more of these risk factors are present, vigilance on part of both patient and doctor is required.

Maternal age– 35-39 years, more than 40 years
Drug abuse
Obesity– BMI (Body Mass Index- weight of person vs height) 25-29.9, more than 30

ART- Artificial Reproductive Techniques- if pregnancy is the result of fertility treatment- example- IVF- In Vitro Fertilization, ICSI- Intra Cytoplasmic Sperm Injection etc

Previous history of adverse outcome

Preterm birth
Growth retarded baby
Placental abruption
Cholestasis (Jaundice) of pregnancy


Why is it Necessary-Aims & Objectives

-It is beneficial for maternal psychological adaptation to a significant loss. She is grieving and may be thinking of herself as guilty.
-Risk of recurrence can be judged and appropriate counseling and therapy offered
-There are certain inherited ( genetic ) disorders and identification of these syndromes will provide useful information for other family members

How is it done

1)Evaluation of fetus
Appropriate consent of parents is required before carrying out many of these processes

History taking in detail of pregnancy events
Clinical examination at the time of birth-It is found that up to 35% of stillborns have major structural anomalies. Some have Dysmorphic features (Distorted facial structure). Some may have skeletal ( bone) abnormalities. Weight, head circumference and length of fetus is also measured.
Photograph taking from different angles
Fetogram-Full radiograph of fetus (X-Ray) of fetus

Examination of
Placenta along with its weight
Umbilical cord
Amniotic membranes

Karyotyping reveals chromosomal (genetic material) abnormalities in the fetus
Sample required-
-3 ml of fetal blood is drawn from Umbilical blood vessels or direct Cardiac (Heart ) puncture & is put in sterile heparinized container
If blood is not obtained, other fetal tissues that can be sent in either Ringer Lactate (RL) solution or special cytogenetic solution are-
-Placental block of dimension 1 X 1 cm to be taken from the site, below the cord insertion
-Umbilical cord segment – 1.5 cm long
-Internal fetal tissue sample- Costochondral junction (Soft tissue which binds rib with Sternum-Bone in the middle of the chest), Patella- Knee cap

-These samples are to be stored at room temperature
-A full fetal karyotype may not be possible in cases with prolonged fetal death (Maceration)
-Skin is no longer recommended as tissue sample
-Placement of sample within Formalin or alcohol will kill remaining viable cells and will prevent chromosomal testing

Stillborn’s autopsy-
 MRI– Magnetic Resonance Imaging
USG– Ultrasound


The event of stillbirth is traumatic for mother & her family. She is at increased risk of mental depression. Regular visit to the Gynecologist is advised.


Preconceptional or initial prenatal visit

 Detailed medical and obstetrical history -There are certain risk factors which are modifiable like hypertension and diabetes. Pregnant woman may have it at the time of diagnosis of pregnancy or there may be a history that she had these conditions at the time of that pregnancy which resulted in stillbirth. Specific management protocols are in place for managing these conditions

-Evaluation and workup of previous stillbirth- Bad Obstetrics History (BOH)

-Determination of recurrence risk

Smoking cessation
Weight loss in obese women (preconceptional only)
Genetic counseling if family genetic condition exists
Thrombophilia (Increased tendency of blood to clot) work up – antiphospholipid antibodies, along with Lupus anticoagulant
-Support and reassurance

First Trimester- Weeks 1-12

Dating ultrasonography- to confirm live pregnancy and expected due date

First trimester screen (Double Marker )- Blood tests include-PAPP-A- Pregnancy Associated Plasma Protein -A &Beta HCG- Human Chorionic Gonadotrophin along with sonography  for specific fetal features. These are Nuchal Transluscency (NT) which is thickness of nape of neck in millimeters & Nasal Bone (NB) presence

Second Trimester-Weeks 13-28

Fetal ultrasonographic anatomic survey-2 D, 3 D, at 18-20 weeks of gestation

Maternal blood tests- Quadruple  or single marker alpha fetoprotein if first trimester screening is not done .These tests are risk estimation for genetic disorder

Third Trimester-Weeks 29-40

Ultrasonographic screening for fetal growth restriction after 28 weeks if there is history of previous low birth weight baby Fetal Kick counts monitoring-starting at 28 weeks


-Delivery -at 39 weeks or earlier is recommended. It can be an induced labor or Caesarean delivery depending on the clinical assessment of mother and fetus at that time.


Cervical Insufficiency & Cerclage- A Reason For Mid Term Pregnancy Loss & It’s Treatment

Cervical Insufficiency & Cerclage- A Reason For Mid Term Pregnancy Loss & It’s Treatment

-Cervix is the lower part of the uterus which opens in the vagina.
-During the entire duration of 9 months of normal pregnancy it stays closed and when labour pains start it opens up and dilates and let the baby be born.
-You can say say that it is like a closed door .When fetus in uterus is increasing in size and weight , it is very important that this door stays closed else, baby will be born prematurely.
Cervical insufficiency is a distinct clinical entity
It is characterized by painless cervical dilatation in second trimester of pregnancy ( 13-28 weeks of pregnancy ). It is also associated with decreased length of cervix- Short Cervix
It results in prolapse (bulging out ) and ballooning of membranes around fetus (Amniotic Sac/Amniotic Membranes-these membranes make a sac around fetus and protect the pregnancy ) into vagina and ultimately expulsion of an immature fetus.

Unless effectively treated this sequence of events may get repeated in subsequent pregnancies.

1) Ultrasonography- Inadequate Cervical length is an indicator along with funneling of cervix which is ballooning of membranes into the dilated internal os but with a closed external os.
2) Clinical internal examination by the Gynaecologist

Risk Factors
Previous cervical trauma caused by surgeries like
-D & C- Dilatation & Curettage
-Conization- Removal of a diseased tissue of cervix in manner of a cone
-Cauterization- Electric current application to cervical tissue for purpose burning the diseased tissue and stimulate generation of new and healthy tissue
-Amputation- Removal of protruding part of cervix
-Abnormal cervical development

Precautions before treatment of Cervical Incompetence
– Ultrasound is done to check for fetal well being.
-Sexual intercourse is prohibited one week before and after the surgery.

Contraindications to treatment
-Bleeding from vagina
-Uterine contractions and pain
-Rupture of bag of membranes- leaking of fluid

Treatment of Cervical Incompetence
Classic Cervical Incompetence is treated surgically with ‘Cerclage ‘ operation which reinforces a weak cervix by a purse string suture ( Stitching of mouth of uterus). The suture material used is strong, thick and non absorbent. These sutures will now provide strength to the cervix to stay closed even though the weight of the fetus will keep on increasing.
This procedure is done as prophylaxis ( prevention ).
At times ‘Rescue Cerclage’ is needed as patient presents with symptoms in emergency.
This suture is removed at a selected date when the pregnancy has attained a mature state and the newborn will be healthy.
At times the suture needs to be removed in emergency if the patient goes in labour prematurely.


When to do the Cervical Cerclage Surgery
-Most medical text books recommend surgery at 12-14 weeks of gestation- A sonography at this stage will rule out majority of congenital malformations ( Birth Defects )
-If there is previous loss of pregnancy, surgery should be done a couple of weeks prior to gestation age( pregnancy duration) at which the loss occurred.
– If pregnancy is at a later stage- there is risk that Cervical Cerclage operation might induce contractions of the uterus and in turn will lead to loss of pregnancy .

Success of Cerclage surgery
Many medical studies have been conducted and it is found out that the success of this surgery is unpredictable.

Many Gynaecologists will opt for alternative method of managing patients with cervical incompetence- like bed rest, abstinence, Progesterone hormone support , Tocolytics ( Uterine relaxants medicines)

After a thorough counselling of patient and relatives, a treatment option is chosen for that particular woman.The pros and cons of doing the surgery vs conservative approach is discussed.

Name of Cervical Cerclage Surgery
McDonald Cervical Cerclage ( Most commonly done surgery )

Procedure-How it is done
After giving anaesthesia , patient is put in lithotomy position ( Legs spread and supported, patients buttocks reaching the edge of the operation table )

It is a trans vaginal procedure
With the help of instruments ( Sim’s Speculum)- Cervix is exposed.
With the help of non traumatic instruments ( Sponge holder/ Ring forceps )- Cervix is held
Non-Traumatic needle ( Round body ) is used along with non absorbent , thick suture ( Thread ) and purse string sutures are placed as high as possible on Cervix.


Uterine contractions
Rupture of membranes

To summarize- Cervical Incompetence is one of the causes of recurrent pregnancy loss. Timely treatment may reduce further losses. It is very important that Gynaecologist and patient have a detailed conversation . Then only treatment protocol should be decided.

Hysteroscopic Myomectomy

Hysteroscopic Myomectomy -A Novel Approach to Removing Fibroids of Uterus


In a case of uterine fibroids and in that too particularly intramural fibroids, alternative conservative surgeries are now available to suitable patients vs more radical operation of uterus removal- Hysterectomy

Dr Santosh Jaybhaye is an expert Gynaecologist of Kamothe, Panvel has performed this surgery of removing fibroids through Hysteroscopy. This surgery is an attempt to prevent surgery of removal of Uterus ( Hysterectomy ) in a patient who complains of irregular menstrual periods.
Admin- My Gynaec World
Dr Himani Gupta

Adverse Effects Of High BP on Pregnant Woman And The Newborn

Adverse Effects Of High BP on Pregnant Woman And The newborn



-High blood pressure –BP ( PIH- Pregnancy Induced Hypertension)s  affects  the health of both pregnant  mother and the unborn child adversely.

-Medical management like medicines, rest, hospitalization and regular visit to the Gynaecologist will  help in controlling PIH- pregnancy related high BP in most of the cases.

-This article will provide an insight into the complications that are associated with this clinical condition     which happen if medical advice is not followed and hypertension becomes uncontrolled.

-One needs to understand that in severe disease, unfortunately complications occur in spite of best and regular medical treatment of PIH- Pregnancy Induced Hypertension.

-Another pointer to understand is that in any one particular patient only one of the following or a  combination of the complications may be present.

The topic is written in easy language and terminology is such that the information provided will be useful to a large number of people. However medical terminology is inseparable part of this article. To make understanding simpler (  ) are used for medical terminology


The organs and systems get affected in many ways


 Swelling of the brain( Cerebral edema)

Clinically the symptoms are

-Headache- which will not get OK by taking painkiller tablets



-Blurred vision

In late stages


-Fits(Eclampsia)- This is a dangerous clinical situation. It may be associated with significant brain injury and dysfunction.

Changes in brain at structural level include bleeding (Hemorrhage), Blockage of blood supply (Infarction), Decreased blood flow (Ischemia), shrinkage of blood vessels (Vasospasm)

These patients are prone to sudden increase in BP which may worsen their condition further

Investigations like CT Scan or MRI will show following features

-Swelling (Edema) of the brain

-Fluid channels of brain get blocked (Obliteration of central ventricles)

-Brain matter will come out( herniate)   through its coverings-life threatening (Transtentorial herniation)


Woman will complain of

-Seeing black spots before eyes (Scotomata)

-Seeing things as double (Diplopia)

Blindness– in most cases it will last for 4 hours to up to 8 days. It is reversible. The dysfunction occurs in brain where centre for vision lies.

In some cases partial or total blindness persists.

Eyeball changes

-Inner lining of eyeball gets disrupted (Retinal detachment)-one more reason of blindness

-Blood supply to eyeball is stopped  retinal artery occlusion)- causes permanent blindness


 -There may be bleeding inside the liver (Periportal haemorrhage)

-Blood may collect below its capsule( Subcapsular hematoma)

-There may be rupture of liver with dire consequences

Clinically patient presents as

-Pain in upper abdomen

Blood investigation for liver function will reveal raised liver enzymes ( SGOT,SGPT)

Liver complications are associated with higher death rate of pregnant woman (maternal mortality)

In rare cases liver transplantation only will save the life of the woman

HELLP syndrome is associated with liver disorders (Hepatocellular necrosis)

H (Hemolysis) EL ( Elevated Liver enzymes) ,LP (Low Platelets count)

Patient suffering from this complication will require intensive care and may have prolonged recovery time


 -Blood supply to the kidneys ( Renal perfusion ) and its filtration process , both are reduced

-Factors like  blood loss, redirection of the blood to more vital organs like brain, increased blood pressure leading to widespread contraction of blood vessels ( Vasospasm) are responsible for it.

-On microscopic level basic functional units of kidney like Glomeruli and Tubules are damaged.

Kidneys secrete many harmful substances of body through urine. Consequences of decreased kidney functions are many –

-Urine output is decreased

-Blood levels of Creatinine, Uric acid and Calcium rise

The accumulated toxic substances in blood will eventually affect the mental status of the patient and she will appear dull and lethargic


Decreased platelet count (Thrombocytopenia-Platelet is a component of blood)

-The normal platelet count is 1.5-4-5 Lakh / ml.

-Platelets play a very important role in stopping the flow of blood at the site of injury or bleeding.

-During delivery or Caesarean section the amount of bleeding is more if platelet count is less and it puts the life of mother in danger.

-If serial monitoring of blood shows decreasing trend of platelet count, it becomes an indication for delivery

-After delivery recovery of platelets will take 2-5 days

Destruction of blood (Hemolysis)

 -In high BP pregnant  patients the lining of small blood vessels gets damaged.

-Platelets and fibrin (blood component) get deposited on these sites to seal these sites.

-Blood corpuscles get damaged while passing through these vessels.

-Destruction of blood will lead to fall in Hemoglobin level (Anemia)

-Microscopic slide examination of blood will show abnormal Red Blood Corpuscles (RBC) like (Schizocytosis,Spherocytosis,Reticulocytosis).

Blood clotting (Coagulation) changes

-There is widespread blood clotting and blood destruction happening at multi-organ level in these patients.

-As a result blood levels of clotting factors are deranged .

-The tests which are abnormal include- PT- Prothronbin Time, PTT-Partial Thromboplastin Time,Fibronectin, D-Dimers, Factor VIII, Fibrinogen etc


Heart is made up of two types of chambers

  • Contractile chambers to push blood out into the system-Ventricles –They are two in numbers, left and right
  • Receptive chambers to receive blood from the system- Atrium- They are also two in numbers, left and right

When BP is high the ventricles will need to work against more resistance. As a result their muscle mass increases (Ventricular hypertrophy). Their lumen gets diminished in size. The final result is that fluid accumulates in lungs( Pulmonary Edema)-leading to difficulty in breathing( Respiratory distress). It also results in accumulation of fluid in the body (Edema)

There are other factors too which will lead to accumulation of fluid in the lungs like injury to the lining of breathing units (Alveoli)


There may be accumulation of fluid in lungs (Pulmonary edema)

Patient may have difficulty in breathing and at times may require ventilator support ( ARDS-Acute Respiratory Distress Syndrome)


Uterus-Placenta unit’s blood supply

(Utero-placental perfusion)

-Uterine artery is the main blood vessel supplying uterus and in turn to placenta and growing baby(fetus)

-In normal pregnancy the uterus and placenta allow uterine artery to supply extra blood to it for healthy growth of baby (fetus)

-In cases of high BP, both uterus and placenta will resist this extra supply, resulting in less blood available to baby (utero-placental insufficiency) which will lead to low birth weight of newborn (IUGR- Intra Uterine Growth Retardation)

-At times water around baby also becomes less (Oligohydramnios)

-This compromised placenta sometimes separates from its attachment to uterus prematurely, even when patient is not in labor (Abruptio Placentae). This will lead to bleeding (Ante Partum Hemorrhage) putting life of both mother and baby in danger (Maternal mortality and IUFD-Intra Uterine Fetal Death)

Preterm birth– at times it becomes necessary to deliver the pregnant woman even before her 9 months are not complete. This kind of decision is taken if all the medical management including tablets to control the BP, rest at home or even hospitalizations are failing to control the high BP of pregnancy (PIH-Pregnancy Induced Hypertension )

Note From Author:

Expert and timely medical care and patient’s compliance towards taking medicines and regular check up with prescribed investigations has improved the outlook  in most of the cases . In urban settings  where the facility for ICU- Intensive Care Unit,NICU-Neonatal Intensive Care Unit for the newborn and blood banks are available, both mother and child have a good outcome.

Rural areas which are yet to have these facilities have a scope for improvement towards ‘Healthy Mother-Healthy Child’ initiative