Services

Our obstetrical services include pre-pregnancy, pregnancy and post-pregnancy care plans for both normal and high-risk pregnancies.

Obstetrics Services Include:

  • Pre-pregnancy assessment and counseling
  • Repeated early pregnancy loss (Recurrent miscarriage)
  • Early pregnancy genetic counseling
  • Low risk pregnancy with the expectation of normal uncomplicated birth
  • Pregnancy beyond 35 years of age
  • High risk pregnancy care; including multiple pregnancies, pre-eclampsia, or diabetes
  • Women with pre-existing medical problems, such as thyroid disease, autoimmune disorders, kidney disease, cardiac disease
  • Operative obstetrics, cesarean section

Morning Sickness

Morning sickness is nausea or vomiting that usually occurs during the first trimester of pregnancy. Despite its name, you may feel nauseated or vomit at any time of day.

It is not understood why some women develop morning sickness, but certain factors such as hormones are involved. Women with high levels of pregnancy hormones tend to develop this condition and have it with subsequent pregnancies. More than half of pregnant women have morning sickness during the first trimester. It usually goes away by the second trimester.

When morning sickness is severe, it is called hyperemesis gravidarum.

NOTE:

Please do not take any medications without notifying our doctors, as some medications cross the placental barrier and may cause undue effects on the growing baby.

These steps may help:

  • Eat snacks that are high in protein, don’t have rich, fatty foods
  • Avoid foods if their taste, smell or appearance is not suitable to you
  • Having frequent small snacks instead of full meals; being hungry can make it worse
  • Eat a nourishing snack before you go to bed at night
  • Increase intake of fluids such as water, fruit juice, clear soups particularly if you are vomiting
  • Take it easy, especially in the mornings, as rushing about will make the nausea worse
  • Try and avoid time spent in kitchen, as the smell of food can make you nauseous
  • Try to avoid eating while you are active as movement often makes morning sickness worse
  • Try eating a biscuit or something light before you get out of bed in the morning
  • Seek medical help, before it can get worse

Moderate morning sickness may require:

  • Medication to reduce nausea and vomiting
  • Intravenous fluid treatment to relieve dehydration

Our doctors will explain the side effects and risks of any medication prescribe.

Severe hyperemesis gravidarum may require:

  • Hospitalization
  • Not eating or drinking anything, then slowly introducing food into your diet
  • Lab tests of blood and urine
  • Intravenous treatment to balance the electrolytes in your blood
  • Ultrasound examination of the pregnancy

Pregnancy

First Trimester

During the first 3 months of pregnancy or the first trimester, there are many changes happening to you. As your body adjusts to the growing baby, you may experience nausea, fatigue, backaches, mood swings, and stress. Just remember that these things are normal during pregnancy. Most of these discomforts will go away as your pregnancy progresses, so try not to worry about them. Just as each woman is different, so is each pregnancy. When you are tired, get some rest. If you feel stressed, try to find a way to relax. Accept that your normal routine is changing.

Visiting your doctor is very important during these early stages. Your doctor will perform several tests to check the health of both you and your baby. He/she will also be able to answer questions about any concerns or fears you might have, and he will tell you what you can do to make your pregnancy as easy as possible. You’ll need to know what types of exercises you can do, what you should eat for good nutrition, and what you might need to avoid during this time. Pay attention to what your body is telling you and listen to your doctor’s advice. This is an exciting time, and it is important to understand what you should expect during your pregnancy.

Second trimester

Most women find the 2nd trimester of pregnancy to be easier than the 1st trimester. By the 26th week, your baby will weigh almost 2 1/2 pounds and be about 9 inches long. With this growth comes the development of your baby’s features, including fingers, toes, eyelashes and eyebrows.

Morning sickness, fatigue, and many other things that might have bothered you during the first 3 months might disappear as your body adapts to the growing baby. Your abdomen will expand as you gain weight and the baby continues to grow. Before this trimester is over, you will feel your baby beginning to move. Most women feel movements before 22 completed weeks.

You should be gaining about 1/2 to 1 pound per week during the 2nd trimester. With this weight gain, you might notice that your posture has changed or that you are having backaches. During your visits your doctor will be able to hear your baby’s heartbeat, see the baby’s development and determine the baby’s age. You might be given several kinds of tests at this time, including ultrasound, which allows the doctor to see your baby and possibly even determine your baby’s sex. Other testing (amniocentesis, chorionic villus sampling, alpha-fetoprotein screening) includes ways to determine if the baby is healthy or if you are at risk for any complications and need to be more closely monitored. These tests help to determine the type of care you will be receiving for the rest of your pregnancy.

Third Trimester

Your baby is still growing and moving, but now it has less room. You might not feel the kicks and movements as much as you did in the 2nd trimester. You will also notice that you may have to go to the bathroom more often or that you find it hard to breathe. This is because the baby is getting bigger and it is putting pressure on your organs. Don’t worry, your baby is fine and these problems will subside once you give birth.

Labor

Our doctors respect a woman’s right to choose the method of her delivery. If you wish to aim for a vaginal birth then he will support you fully in this choice. Similarly, if you choose to have an elective Caesarean Section he will support you fully in this choice.

It is important to recognize the signs of labor so that you will know when you are experiencing the “real thing.” If this is your first baby, you will most likely experience lightening (the descent of the baby’s head into your pelvis) sooner than women who have already had other children. Typically, the signs of labor include uterine contractions, tightening of your stomach, and cramps in your low back. About two-thirds of women experience these tightening before their waters break. About one-third will notice fluid leaking out first. If you are unsure about what is happening, contact your doctor’s office.

You may also be interested in taking childbirth preparation classes, which teach coping methods for labor and delivery, and helps guide new parents in the many decisions they will make before and during the birth process. One of the things you may be most concerned with is the amount of pain you may experience during labor. Childbirth is different for all women, and no one can predict how much pain you will have. During the labor process, our doctors and nurses will ask you if you need pain relief, and will help you decide what option is the best for you. Your options may include a local or intravenous analgesic (pain relieving drug), an epidural (injection which blocks pain in the lower part of your body), or a pudenda block (numbs the vulva, vagina and anus during the second stage of labor and during delivery).

Post Partum

Your baby is finally here! The joys and challenges of motherhood are about to begin. It is important to remember to take care of yourself as well as your new baby. Caring for a new baby can be fun but it is also hard work. How much and how often you should feed the baby? What do you do when the baby is crying, or sick? How do you prevent accidents? These questions can be overwhelming at first, but you will quickly adjust. A new baby needs constant care, but you will be skilled at taking care of your child in no time. There are people out there, including your family, friends, doctor, and support groups, which will help you get through it. You are not alone.

You have experienced nine months of changes in your body. Those changes will continue in the next couple of months as you decide whether or not to breastfeed and as your body starts to recover from having the baby. It is important to take care of yourself during this time. Make sure to rest when you can and don’t try to do too much.

In addition to the physical changes to your body, you may feel depressed. This can be a very normal phase following childbirth. Fifty to 75% of new mothers feel a little sad or depressed after giving birth. These feelings can range from very mild to serious, but there is help. Be aware of your feelings and continue to talk with your family, friends, and your Doctor. Sometimes this depression will go away on its own, but medication or therapy may be needed. Both can help you feel better and get back to enjoying your new baby.

Breast Feeding

Breast-feeding offers many benefits for both mother and baby. 
A healthy baby can benefit from breast milk, infant formula or a combination of the two. Breast milk is extremely nutritious and contains carbohydrates, proteins, and fats essential for a baby’s health. Breast feeding, apart from helping babies get proper nutrition and can help mothers recover from pregnancy and delivery.

Breast feeding can

  • Promote a “bond” between mother and baby.
  • It is natural and specially made for your baby
  • There are lots of things in breast milk that are good for your baby, but are not found in formula milk.
  • It is safe for your baby, and easily digested.
  • It contains all the minerals and nutrients that your baby needs for the first six months of life. Together with other foods, it is very good for the next six months or more as well.
  • It is always ready when your baby needs it.
  • Breast milk also contains antibodies that help prevent infections and allergies. Your baby will be less likely to get infections, allergies and many other diseases.
  • Breast fed babies have less chance of obesity.
  • It helps you and your baby feel close to each other.
  • Breast-feeding releases hormones, which cause the uterus to shrink after delivery and also decreases bleeding. It helps your body return to normal more quickly after the birth
  • Mothers who breast-feed typically have an easier time losing weight after pregnancy.
  • It does not cost anything and does not take time to prepare.

Expecting mothers planning to nurse should discuss breast-feeding with a doctor, nurse, or certified lactation consultant before giving birth. Although breastfeeding is a natural thing to do, most of us need to learn how.
If a mother does decide to breast-feed her children, she should understand that breast-feeding is a major responsibility that requires her to maintain excellent nutrition and health. Women who breast-feed should eat well-balanced, nutritious meals. Generous portions of whole grain breads and cereals, fruits and vegetables, and dairy products with an abundance of calcium are recommended. It will take time for both of you to learn this new skill of breastfeeding. The nurses in the hospital will help you and your baby start breastfeeding.

Breast feeding and Coffee

Most physicians agree that it is safe for breast-feeding mothers to consume small amounts of caffeine (equivalent to one to two cups of coffee per day), though larger amounts of caffeine may interfere with a baby’s sleep or cause him or her to become fussy.

Breast feeding and Alcohol

Breast-feeding mothers should avoid alcohol because it can be passed through the breast milk to the baby. An occasional drink (no more than four ounces of alcohol) is probably safe.

Associated Conditions

Gestational diabetes

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes is a form of diabetes that some women develop during the 24th – 28th week of their pregnancy. It usually disappears after the birth, and does not mean that the baby will be born with diabetes.

Diabetes Mellitus is a condition when the pancreas (the organ responsible for producing insulin) is either unable to make insulin, or the insulin is unable to work effectively. The function of insulin is to keep the glucose levels within normal limits. With inadequate insulin, glucose builds up in the blood leading to high blood glucose levels causing health problems.

Causes

The definite cause of Gestational diabetes is not known, but it is assumed that as pregnancy progresses, the mother’s energy needs increase. Also, placental hormones that help the baby grow and develop, block the action of the mother’s insulin. This is called insulin resistance. The pregnant woman needs extra insulin so the glucose can get from the blood into the cells where it is used for energy. If the body is unable to meet this requirement, then diabetes develops. When the pregnancy is over and the insulin needs return to normal, the diabetes usually disappears.

Women who develop gestational diabetes have a greater risk of developing Type II diabetes later on.

Symptoms

Diabetes often has no symptoms, which is why all pregnant women are routinely tested.

If symptoms occur, they may include:

  • Unusual thirst
  • Excessive hunger
  • Excessive urination
  • Frequent infections
  • High blood pressure

Risk factors

Any pregnant woman can develop gestational diabetes, but risk factors that increase susceptibility include:

  • Being overweight
  • A family history of diabetes
  • Women with hypertension (high blood pressure)
  • Being over the age of 30 years (everyone’s tendency to develop diabetes increases with age)
  • Previous babies were large at birth (8 pounds and over)

Tell your doctor:

  • If you have had gestational diabetes in a previous pregnancy
  • If you have a family history of gestational diabetes or diabetes
  • If you have given birth to a baby weighing 8 pounds or over

Course of Illness

Although gestational diabetes usually goes away after the birth (when hormone levels return to normal), it still needs to be taken seriously.

  • The main concern is that it can increase the baby’s weight, and have other health effects on the unborn baby.
  • If the baby becomes very large it may be necessary for the woman to have a Caesarean delivery.
  • Women who develop gestational diabetes have about a 50% risk of developing Type II diabetes later on.
  • Type II Diabetes, which is increasingly common in people over the age of 40, is a chronic disease, which has to be carefully managed with healthy eating and regular physical activity. Sometimes long-term medication is also needed. If Type II diabetes isn’t controlled it can cause serious health problems including heart and kidney disease, and eye problems.

Routine tests

Pregnant women are routinely checked for gestational diabetes between the 24th and 28th weeks of their pregnancy. Women at increased risk are usually tested earlier. The glucose challenge test involves taking a glucose drink, waiting for one hour and then having a blood test. If your glucose level is high, you will have additional glucose tolerance test to confirm the diagnosis. This involves fasting from the night before the test, drinking a stronger glucose solution, and being blood tested each hour for 3 hours.
Managing gestational diabetes

A woman with gestational diabetes needs careful monitoring for the remainder of her pregnancy.
Management is mainly aimed at changing to a healthy eating plan, physical activity, monitoring blood glucose levels. Specific management strategies include:

  • Eating regular meals. Hospital dietitians can advise on which foods to eat and which foods to avoid, and how often to eat
  • Regular exercise to help reduce insulin resistance
  • Dietary modifications, such as switching to a low fat, high fiber diet with plenty of fresh foods
  • No alcohol or cigarettes
  • Regular blood tests performed at home to check glucose levels
  • Some women may need to take medications, these may include tablets to insulin injections

Pregnancy and Blood Pressure

Routine blood pressure and urine protein check up during antenatal care is for the early detection of a condition known as pre-eclampsia, also known as Pregnancy Induced Hypertension PIH or toxemia.

Pre-eclampsia is a serious pregnancy disorder of pregnancy characterized by high maternal blood pressure, protein in the urine and severe fluid retention. It is a fairly common complication of .

There is no cure for the condition, except delivery of the baby.

Risk Factors

  • First pregnancy or a new partner
  • Family History
  • Diabetes Mellitus
  • Multiple pregnancy
  • Obesity
  • Extremes of maternal age
  • Preexisting Hypertension
  • Hydatidiform mole (A relatively rare mass or tumor that can form within the uterus at the beginning of a pregnancy)
  • Hydrops Fetalis (Rh Disease)

The mother’s blood pressure usually returns to normal as soon as the baby is delivered.

Signs & Symptoms

Pre-eclampsia can be asymptomatic, and may develop at any time after 20 weeks of pregnancy but commonly develops during the later stages of pregnancy.

Pre-eclampsia most commonly causes high blood pressure and protein in the urine. Some advanced symptoms include

  • Hand and face swelling
  • Headache
  • Visual disturbance
  • Upper abdominal pain
  • Dizziness
  • Nausea & Vomiting

Complications for fetus

The placenta in uterus is a special organ that allows oxygen and nutrients to pass from the mother’s bloodstream to the baby, and waste products (such as carbon dioxide) to pass from the baby’s bloodstream to the mother. In pre-eclampsia, blood flow to the placenta is obstructed. In severe cases, the baby can be gradually starved of oxygen and nutrients, which may affect its growth. All these lead to

  • Neonatal Asphyxia (low oxygen)
  • Neonatal Hypoglycemia (Low glucose)
  • Intrauterine Growth Restriction (Low birth weight)

This growth restriction threatens the life of the baby and it may be necessary to deliver the baby prematurely. Another serious complication of pre-eclampsia is abruption, which means the placenta separates from the uterine wall and the woman experiences vaginal bleeding and abdominal pain. This is a medical emergency.

Management

Since Pre-eclampsia can be asymptomatic, regular antenatal check up is advised. Bed rest, in early stages may control the situation; sometimes medication is needed to control blood pressure. But if the signs of toxemia and poor fetal growth persist, it will often be necessary to induce labor and deliver the baby early.

Pregnancy and Anemia Pressure

What is anemia?

Anemia is decrease in red blood cells in blood, which can lead to a lack of oxygen-carrying ability and causing unusual tiredness. The deficiency occurs either through the reduced production or an increased loss of red blood cells. Red blood cells are produced in the Bone marrow, and their average life expectancy is about 120 days.

To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anemia will develop.

Causes

  • Poor intake of iron in diet. Iron is needed to make red blood cells. When women loose blood, they also loose iron. This happens in pregnancy due to the fact that the woman must supply iron to both herself and her baby. Iron is replaced by vitamin supplements or in the diet.
  • Folic acid deficiency. Folic acid is a Vitamin B, which is needed to produce red blood cells.
  • Chronic illness
  • Blood Loss from bleeding hemorrhoids or gastrointestinal bleeding
  • Even if iron and folic acid intake are sufficient, a pregnant woman may become anemic because pregnancy alters the digestive process. The unborn child consumes some of the iron orfolic acid normally available to the mother’s body.

Signs & Symptoms

The symptoms such as tiredness and general weakness will be similar to those of any other type of anemia. In severe cases, the woman will be short of breath even at rest.

If the anemia is prolonged, other signs of iron-deficiency anemia may develop such as a smooth shiny tongue and tenderness of the skin at the corners of the mouth. However, these advanced signs are rare.

Diagnoses

Routine blood tests during antenatal care shows low hemoglobin concentration as well as the characteristic small, pale red blood cells under the microscope (in the case of iron deficiency anemia).

The diagnosis of iron deficiency anemia can be confirmed by measuring the amount of storage iron as well as the levels of iron binding proteins in the blood. The diagnosis of folate deficiency is confirmed by estimating the red blood cell folate levels.

Course of anemia

Patients with severe anemia are more likely to delivery early and have small babies. Women with severe anemia may have symptoms such as weakness, fatigue, shortness of breath and headaches.

Birth is also associated with blood loss. Therefore, if a woman is anemic, she should take iron for several months after delivery in order to help the body replace the lost blood cells and iron stores. Breast-feeding women may also need to take iron because iron is lost in breast milk.

As long as the anemia is treated and corrected, there should be no problems.

Management

A well-balanced diet is always recommended but iron and folate supplementation is indicated in pregnancy.

When the anemia is caused by lack of iron, it is treated with iron supplements, preferably ferrous sulfate tablets. These supplements should not be taken more than twice daily, since the side effects of iron are increased in doses of more than two daily. The side effects are stomach upsets and constipation, which are problematic in pregnancy.

If the anemia is due to folic acid deficiency, it is treated with folic acid supplements.

Laparoscopy

Laparoscopy also called minimally invasive surgery or keyhole surgery is commonly performed gynecology procedure to diagnose and treat some abdominal and pelvic conditions. Laparoscopy is direct visualization of the abdominal cavity, ovaries, outside of the tubes and uterus by using a laparoscope. The laparoscope is a long thin instrument with a light source at its tip, to light up the inside of the abdomen or pelvis. Fiber optic fibers carry images from a lens, at the tip of the laparoscope, to a video monitor, which the surgeon and other theatre staff can view in real time.