SERVICES

 

High risk pregnancy

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A pregnancy is considered high risk when a woman:

• Has a medical condition including genetic disease, chronic disease, chronic infection, brain disorder, heart problems or high blood pressure.

• Is underweight or overweight

• Is younger than 17 or older than 35

• Has had several miscarriages

• Has had preterm labor

• Has had gestational diabetes

• Has had preeclampsia

• Has had difficult births in the past

• Has an abnormality detected during the pregnancy

• Is having twins or triplets

 

Prepregnancy counselling

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General Issues in Preconception Care

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1. Nutritional considerations (intake of folic acid, healthy balanced diet, etc)

2. Reach and Maintain a Healthy Weight

3. Family genetic history

4. Medications

5. Psychiatric illness

6. Psychosocial factors

7. Environmental exposures

8. Substance use

9. Get Help for Violence

 

Infectious Disease Screening and Immunizations in Preconception Care

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Infectious disease

1. Chlamydia

2. Gonorrhea

3. Herpes simplex virus infection

4. Human immunodeficiency virus infection

5. Syphilis

6. Tuberculosis

 

Immunization

1. Hepatitis B

2. Influenza

3. Measles, mumps, rubella

4. Tetanus, diphtheria, pertussis

5. Varicella

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Gynae Laparoscopy

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An Overview

 

Laparoscopy (or key hole surgery) is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs. Laparoscopy is used to find problems such as cysts, adhesions, fibroids, and infection. Tissue samples can be taken for biopsy through the tube (laparoscope).

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In many cases laparoscopy can be done instead of open surgery that uses a larger incision in the belly. Laparoscopy can be less stressful and may have less problems and lower costs than laparotomy for minor surgeries. It can often be done without the need of staying overnight in the hospital.

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Laparoscopy is performed under general anaesthetic, so you'll be unconscious during the procedure and have no memory of it. You can often go home on the same day.

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Depending on the type of laparoscopic procedure being performed, you'll usually be asked not to eat or drink anything for 6-12 hours beforehand. If you're taking blood-thinning medication (anticoagulants), such as aspirin or warfarin, you may be asked to stop taking it a few days beforehand. This is to prevent excessive bleeding during the operation.

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If you smoke, you may be advised to stop during the lead-up to the operation. This is because smoking can delay healing after surgery and increase the risk of complications such as infection.

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During laparoscopy, the surgeon makes a small cut (incision) of around 1-1.5cm (0.4-0.6 inches), usually near your belly button.

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A tube is inserted through the incision, and carbon dioxide gas is pumped through the tube to inflate your tummy (abdomen). Inflating your abdomen allows the surgeon to see your organs more clearly and gives them more room to work. A laparoscope is then inserted through this tube. The laparoscope relays images to a television monitor in the operating theatre, giving the surgeon a clear view of the whole area.

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After the procedure, the carbon dioxide is let out of your abdomen, the incisions are closed using stitches or clips and a dressing is applied.

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Most people can leave hospital either on the day of the procedure or the following day. Before the procedure, you'll need to arrange for someone to drive you home because you'll be advised not to drive for at least 24 hours afterwards.

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For a few days after the procedure, you're likely to feel some pain and discomfort where the incisions were made, and you may also have a sore throat if a breathing tube was used. You'll be given painkilling medication to help ease the pain.

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Some of the gas used to inflate your abdomen can remain inside your abdomen after the procedure, which can cause:

• Bloating

• Cramps

• Shoulder pain, as the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder

 

These symptoms are nothing to worry about and should pass after a day or so, once your body has absorbed the remaining gas.

In the days or weeks after the procedure, you'll probably feel more tired than usual, as your body is using a lot of energy to heal itself. Taking regular naps may help.

The following Hystero Laparoscopic procedures can be in a gynaec patient:

1. Laparoscopic tubal ligation

2. Uterine fibroid treatment

3. Laparoscopic removal of uterus

4. Endometriosis

5. Abnormal vaginal bleeding

6. Recurrent miscarriages

7. Dysfunctional uterine bleeding

8. Postmenopausal bleeding

9. Urinary incontinence surgeries

10. Hysteroscopic surgeries

11. Cervical cancer surgery

 

Infertility Management

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Infertility means not being able to get pregnant after unprotected intercourse for 1 year in a woman under 35 years of age and for 6 months in a woman more than 35 years of age.

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Infertility can be due to problem in wife (30%), the husband (30%) and/or in both partnersor due to unknown causes in approximately 40% of cases.

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Infertility in men can be due to varicocele, low or absent sperm count, sperm damage or certain diseases. Risk factors for men’s infertility include alcohol and drug use, toxins, smoking, age, health problems, medicines, radiation, and chemotherapy.

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Risk factors for women’s infertility include ovulation problems, blocked Fallopian tubes (especially due to TB in our country), uterine problems, uterine fibroids, age, stress, poor diet, athletic training, and those risk factors listed for men.

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Aging decreases a woman’s fertility; after age 35 about 33% of couples have fertility problems; older women’s eggs are reduced in number, not as healthy and less likely to be released by the ovary – the woman is also more likely to have a miscarriage and other health problems. Women under 35 should try for a year and 6 months if 35 or older, to become pregnant before contacting their doctor if they have no health problems.

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Doctors asks the history of both partners and may run tests such as sperm studies, ovulation tests,ultrasound, hysterosalpingography, or laparoscopy to find out the cause of infertility.

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Infertility may be treated with medicine, surgery, artificial insemination, or assisted reproductive technology, based on the couples test results and other factors. There are multiple medicines that may be used to treat infertility in women.

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Intrauterine insemination is artificial insemination where a woman is injected with sperm into the uterus. ART (assisted reproductive technology) is when a woman’s eggs are removed, mixed with sperm to make embryos that are placed back in the woman’s womb; it’s successful in about 11% to 39%, depending on the woman’s age.

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There are several types of ART: in vitro fertilization and intracytoplasmic sperm injection.

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Surrogacy (the woman’s male partner sperm is used to fertilize another woman’s eggs and that other woman carries the fetus to term and the infant is then adopted ) is a way for some couples to have a baby. A Gestational carrier is a woman who has an embryo placed in her uterus, carries the fetus to term and gives the baby to the couple (or responsible persons) that produced the embryo.

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Laparoscopic treatment for infertility:

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Today laparoscopy has come as a boon for Infertility patients as it requires only 1 day hospital stay, early resumption of day to day activities, minimal blood loss and minimal adhesions make this procedure highly beneficial for the patients and also lead to higher pregnancy rate.

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During Laparoscopy for Infertility procedures that are easily done are:

• Lap Myomectomy - Removal of fibroids

• Resection of Endometriotic cysts and endometriotic implants

• Tubal Reconstruction is case of previous Laparoscopic Ligation also Known as Tubal Recanalization

• PCOD Drilling- for polycystic ovarian syndrome for patients who do not respond to medical management alone

• Lap Adhesiolysis especially in cases of tuberculosis

• Tubal Cannulation for Mucosal blocks in the tube

 

Hysteroscopy:

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Wherein the inner cavity of the uterus is examined by a hysteroscope and any abnormalities, if found are corrected. Following procedures can be done:

• Hysteroscopic Myomectomy: Wherein fibroids present inside the cavity of the uterus are removed at the same setting with special instruments like Resectoscope or HysteroscopicMorcellators.

• Hysteroscopic Polypectomy: Polyps are benign growths present inside the uterus which lead to infertility and irregular bleeding per vaginum. These growths are removed by Hysteroscopy.

• Septal Resection: Uterine septum is the presence of an abnormal wall within the cavity of the uterus which is resected(removed) at the time of Hysteroscopyso that infertility or miscarriage is prevented.

• HysteroscopicAdhesiolysis is for Ashermans syndrome: Sometimes small bands of tissue (Synechiae) present inside the cavity of the uterus are separated with special Hysteroscopic scissors.

• Hysteroscopic Tubal Cannulation.

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