Best Maternity Hospital in India

"What is prolapse? Anything getting weakened and sagging. So what is uterine prolapse? See, the uterus is very well supported by a network of muscles and ligaments in our body, so it is held up in its place. What happens with repeated trauma of these muscles and these ligaments is that they are not able to hold and you know give that kind of support to the uterus. In those cases, the uterus will gradually start slipping, and with further slipping, there will be a time when it will begin to protrude out of the vagina, and this is called prolapse. And when we talk about the stages of prolapse it is this which is what we are staging then it is like it is sagging it is lowered down in the vagina the patient can feel it but it is not seen outside the vagina. So that's a stage one prolapse when it is at the introitus. It can be easily seen when you go to the doctor for an examination can be very easily seen. So that's a stage two prolapse. Stage three is when it comes out of the vagina that's a stage three prolapse and the final stage that's stage four that's called procedentia. Precedential is when the whole of the uterus is out of the vagina. So what are the risk factors who would more likely get prolapse in their life so those who have a history of vaginal deliveries especially traumatic vaginal deliveries, prolonged labor, or maybe attended by you know untrained dais or there was a delivery of a large baby and it was a difficult birth. So those are the patients or there have been some pelvic surgeries and there is some trauma to those ligaments and muscles so those are the patients. Then anything that increases the intraabdominal pressure say a chronic cough may be due to asthma COPD any lung conditions or chronic constipation. So anything that increases abdomen pressure would again push the uterus down. Then the obese patients are the people who are at risk for getting prolapsed"

"We have to understand what is preeclampsia. Preeclampsia is a condition in pregnancy wherein the mother develops high blood pressure, and it usually develops after 20 weeks of pregnancy. So, around 5 months of pregnancy, this also leads to albumin leakage in the urine. So will there be proteinuria, and how will it be diagnosed? When you have high BP readings, you go to your antenatal visits. Your doctor checks your BP, and it is 140 systolic and 90 diastolic millimetres of mercury. Then, your doctor would ask you to wait until we again take your BP. If your BP is consistently this high or higher, then we do tell you that you are developing pregnancy-induced high hypertension, and we check your urine by a dipstick method for albumin if this also is positive for protein then we do a quantitative test and send a 24 hours urine sample for a quantification of protein leak in urine. So with high BP with protein leak, albuminuria is called preeclampsia, and the effects it would have on your baby starting from the baby can have growth restriction because the blood supply to the baby is restricted, and the baby can have prematurity. Baby can land up with the emergency C-section due to some Doppler changes on our ultrasound because once the baby's growth is restricted. Once the liqor around the baby becomes less, so then we start following you Doppler scans and then once we realize that baby is no more growing inside it is safe to deliver the baby. But sometimes, there's an emergency scenario in which the mother presents to us with bleeding abruption. In that case, they also have to do an emergency cesarean and deliver the baby. In that case, the mother and baby both are at risk, and the prematurity also increases the nursery state for the baby. It also has its maternal complications as well the mother can have end organ damage. The kidneys can get affected, the liver can get affected. So we need thorough maternal fetal surveillance whenever a lady is diagnosed with a preeclampsia condition. Mother is also at risk for a seizure-like activity, which is called eclampsia. If the BP goes uncontrolled a regular check of blood pressure a urine kidney, liver profile, blood test and an ultrasound monitoring of the baby's growth, the blood flows. They are very important whenever you have preeclampsia in your pregnancy"

"So ectopic and fertility are definitely closely related because why did one have an ectopic in the first place? So probably there was some altered tubal motility, and probably there was some disturbance in the tubo-ovarian relationship. So the way our uterus fallopian tubes and ovaries are aligned it is meant that at the ovulation time the ovary should release the egg the fallopian tube should grab that egg and it should be conveyed to the sperm should come the fertilization should occur and then the embryo should come and implanted in the uterus. The fertilization always takes place in the tube. But when there is altered motility the cilia of the tube is Disturbed in those cases only patient would land up with an ectopic . So if somebody had an ectopic we always tell you that you have a risk for ectopic. So whenever you perceive next the moment you miss your period do a UPT come to us and we should rule out a ectopic. So definitely there is an element of subfertility. Subfertility means a reduced fertility. In patients with a history of ectopic pregnancy and if somebody had a medical management of ectopic like she received methotrexate. So how soon can she plan for another pregnancy? Let me tell you methotreate is a teratogenic drug. So minimum period is 3 months after one injection of methotraxate minimum 3 months one should avoid conception, one should take folic acid supplements. And if somebody had a surgery so again 3 months would be a time for complete pelvic recovery, complete recovery of the general health and patient should take supplements to build up on the lost blood, on the lost nutrition. So it can be easily said that 3 months is a good enough time after which you can plan pregnancy. And if somehow the both the tubes are damaged or you have a doubt that one side I had an ectopic, the other tube on ultrasound there is a suspicion that whether it's healthy or not, one can also go for tubal evaluation before planning pregnancy procedures like HSG or SSG can be used"

"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"