"So sometimes, it is not always possible for women to have only one cesarean or two cesarean. For some reasons people might plan a more prominent family, or there were problems in the first cesarean baby hasn't survived or we haven't need to do many cesareans generally everyone will ask is it safe to go for a second is it safe to go for a third is it safe to go for more like four can we still plan a more prominent family so the risks that can be involved can be very varied some women will have a lot of risks even with one cesarean. The second cesarean might be the most complicated, but the fourth or fifth cesarean is also not that complicated for some, and we can do it more safely. When can we say that women will have complications when we do cesarian? In the second cesarian, we can see that the structures that are pretty stuck inside the uterus are very scarred and thinned out. Then we will tell in that cesarian itself that it might not be very safe to go for a third or fourth one because when the scar is so thin, the subsequent pregnancy, the chance of the scar giving weight is very high. For some"

"So nowadays the videos are so much on so many people would have seen video of a cesarean section. But let me explain that seven layers is it's true like there are layers that you have to go through women's body to reach the baby. So what are those? Let me explain when we are taken to theater we clean and put the drapes so we use an antiseptic solution to clean the tummy and we use sterile drapes to cover the women or except the tummy where you have to open and we go just above the pubic bone. This stays a very nice neat scar but the size of the scar is almost to size of the head. So it's around 10 cm baby's head diameter is the measure for us. So around that much incision or the cut we have to make so we will do the cut just above the pubic bone which also called bikini line incision these days. So it's very cosmetic at the same time. This is how we have been used for over the years years before like 30-40 years. Before we used to do an up and down cut from naval till the pubic bone which is almost very very rare these days. There are still one or two indications that we do up and down but most of the time 99.9% of the time we are going bikine line. So what are the things that come under our way like. First thing is we'll make a cut on the skin and what is under the skin is the fat so we'll go through the fat fat is easy you just stretch it and it'll be fine and then there is layer which is white and ging and that is very strong it's called rectus sheath. It's like a sheath it's a ligament like structure and that is the most common thing that protect the tummy or the bowel contents not to come outside. So that is a strong one in our tummy that you have to go through it's called rectus sheet. So you have to cut most of the time and right under the sheet is the muscle it's called rectus muscle. There are two strong rectus muscles in our tummy when they are together the support is good so those you see people with six-pack and everything it is all those musles that's called rectus musles you don't have to cut that muscle in the middle. There are two musles side by side. So we go in the middle and just stretch it and we can enter inside inside the tummy it's like a balloon like structure like paper thin structure that walls off all the layers like a very thin cing film like structure we call it as peritoneum and inside that will be the intestines uterus bladder everything will be inside. So once we make a small cut in that cling film like structure called peritoneum. I can see the uterus but as soon as you see the uterus you cannot cut it because the bladder is like a fold in front of the uterus. So what we will do we will cut that ler also and separate the bladder away from the uterus then we make the cut on the uterus. So if you really count this is the seventh layer that's the uterus so once we cut the uterus then that's a bag of membranes and from there the baby comes out so these are seven steps"

"Some cesareans are planned cesarean section maybe because they had so many cesareans before or they were told to have a cesarean for some reason these are planned or also called elective cesarian section. So the other types or the most common types of cesareans that we do are an emergency cesareans means we don't plan that cesarian we go thinking that women will have a normal delivery something or other changes and then the cesarean will become necessary for them. So they are called emergency cesarian sections so we have so many categories of cesarian sections also. Depending on how soon we have to do a cesarian we have categories like category one is the the cesarean is must to save the life of mother or the baby and it is so emergency that you have to have the baby out within 20 minutes. These are called category one cesareans that is an extreme emergency and we do drills to make sure that you know it can happen and the whole team is ready to do so. This is only when you think if the previous cesarean section is trying for a normal delivery and we think that car has ruptured then the baby can die very quickly. So this is only many times that we think minutes matter we do this category of cesareans. Sometimes a cord is a cord around the baby can come down the position of the baby is not right it's not head down it's across then the chances of this cord coming down with water break is high. So these are the times that we have to do in a very very emergency situation we call it as category 1. What is Category 2? When cesarean is necessary but it is not an emergency that we have to do in you know 10 - 20 minutes but it has to be done within that hour when we think baby is a little distressed but not so much that we have like you know the baby's heartbeat is down and not picking up. But baby's heartbeat is going down each time it's not correcting we think there is a problem with the baby. So we need to be a little hening things but not to an extent that you know everything is dropped down without consent we are going in wheeling straight to theater we call it. So usually we just done within 1 to 2 hours of decision these are category two what are category three cesarians which is it has to be done but to. So the time of women and the team we can plan like see we are planned to do aan but you come in an emergency with pains. So it has to be done but it is not an emergency baby is fine mother is fine but we have to do in that day. So around 6 hours or 8 hours we can plan based on various other things when you have had food to eat, you can wait till you are safe to have anesthesia and then get this done, we call it as category three. Category four is when you plan a cesarean you give a date you come and vision then we call it as category four. So this is categories of cesarean and now we have seen planned and unplanned emergency and elective cesarean. These are types of cesarean sections"

"Prolapse doesn't always mean it is only the own that is dropping down that certainly is one part of various problems that we see with Prolapse. So what all can come down uterus or the womb can come down that is called uteovaginal prolapse when that is coming down the weight of the uterus also drags the bladder down when that happens we call it as cystocele. Cysto means it's like cyst like thing that is bladder is like a fluid filled structure. So we call it as cyos is when bladder comes down what is rectos is rectum that is a motion passage when it comes along the back of the uterus then we call it as rectocele and sometimes the bowel that is higher up can also come down. We name it as entrocoele and where the tube where you pass urine it is not the bladder but the tube where you pass urine it is called urethra. When that also comes down we call it urethrocele. These are the names of various types of prolapse what if uterus is removed for some reason or the other then the top of the vagina can also come down in that case we name it as vault prolapse vault is the top of the vagina that is stitched at the time of uterus removal. So that can also drop down when there is no support. So these are various types of prolapse now let us look into stages of prolapse there are various grades and stages that were come long way over the years to try and differentiate between various degrees or stages of prolapse. So we can tighter our treatment and explain our women that what stage the prolapse is and how are we going to do the management of that particular prolapse so the recent and the most accurate means that we follow is a pop Q system. That is a pelvic organ prolapse it's a very quantification test. Very specific it is not varied so when we have to compare different doctors examining different women or the same women examined by different doctors we can quantify it very accurately when we follow this staging system. Usually staging is such that when uterus drops down but we cannot see outside then we call it as stage one when thump is felt at the entrance of the vagina but not completely outside. We call it as stage two . When some lump is coming down the vagina and you can can see and feel between your legs then it is stage three and when the total length of the uterus is outside drops down we call it as stage four . So this is a rough staging calculation that we use but POP Q is a very specific quantitative system that we practice. Most of the urogynecologist will practice this system that's a method of documentation before and after we can compare"

"So what can we do to try and prevent a prolapse? Prolapse is known to happen in many women almost if you reach the age of 80 one in two women will have a prolapse. If you are 50 1 in 3 to one in four women will have a prolapse. It is so very common and it makes us think. So there is nothing for us to prevent not really we can do something to try and reduce our chance of having a prolapse or reduce the intensity of having symptoms. So what are those? First thing is our general health. So how are we maintaining our health? Are we overweight are we underweight are we having a lot of problem like you know you not doing any regular exercise and having problems with diabetes, trying to control our own medical problems will go a long way if someone has a trouble. Having constipation all their life there is a lot of strain on pelvic floor that can lead to prolapse so what we have to do is try and reduce the risk of constipation. Drink lot of water have fiber rich food or when it is required use a laxitive. So the amount of strain that we have on the pelvic floor is reduced this is over the years if you imagine if you have that strain that will increase your chance of prolapse. The second thing is someone with chronic cough problem they always have an allergy or cough which goes on for months and months then that also has a lot of pressure on the pelvic floor. So we have to try and get the treatment faster so the pressure on the pelv pelvic floor is reduced this is about our general health . So what you have to do specifically to the pelvic floor is by doing Kegel's exercises. These are also called pelvic floor exercise these are done when as if you have to suddenly stop yourself from passing urine or motion. So that squeeze of that pelvic floor. Doing this often will help you to prevent the prolapse or when the prolapse is in very early stage we can reduce the worsening of the prolapse. How do we have to do it? Squeeze the pelvic floor as if you are stopping to pass urine and motion. Do it a quick one squeeze and relax. Same things has to be repeated around 8 to 10 times at least three times in a day. So how do you have to remember? You don't have to stop doing anything to do an exercise. This Kegel's exercise can be done when you are actually doing something else like you're sitting and eating same time. Remember and concentrate on your pelvic floor and that is all you have to do so make sure that becomes a habit and that is how we can prevent a prolapse"

"Pelvic Organ Prolapse occurs when the uterus or womb of a woman drops down, leading to a feeling of numbness in the vagina. Women may suddenly feel that something is descending, causing discomfort while walking and a sensation of something between their legs. This can lead to friction and significant discomfort when sitting, and may even lead to issues with urination because the descending organ can put pressure on the bladder, making it difficult to empty completely. This can result in recurrent urinary tract infections, and can also cause difficulty with bowel movements. If a woman experiences discomfort, feels a lump in the vagina, has difficulty passing urine or bowel movements, or experiences unexpected bleeding after menopause, it's important to seek consultation from a gynaecologist"