Gestational Diabetes Mellitus (GDM) is the diabetes that occurs during pregnancy and usually disappears after delivery.As gestational diabetes can harm mother and unborn baby,it is important to manage it. GDM appears in the second half of pregnancy ,in 24 -28 weeks.So it is necessary to conduct a screening for blood glucose around this period.

Causes 

Testing for GDM

All women are screened for gestational diabetes at their 24 to 28 week routine check up. Women who are at higher risk may be tested more often. You are at higher risk of developing gestational diabetes if you:

• are overweight
• over the age of 25 years
• a family history of type 2 diabetes
• come from some Asian backgrounds
• have had gestational diabetes before
• have previously had polycystic ovary syndrome
• have had a large baby before

Glucose tolerance test
Tests include the glucose challenge test and the oral glucose tolerance test (OGTT).‘Glucose tolerance test’ is the diagnostic test used to find out if you have gestational diabetes. It requires fasting for 10 hours (generally overnight). A blood test is taken, followed by a 75g glucose drink and further blood tests at one and two hours later. You will be required to remain at the laboratory for the two-hour duration of the test. If the results of the glucose challenge test show high blood glucose, you will return for an OGTT test to confirm the diagnosis of gestational diabetes.
A diagnosis of gestational diabetes doesn’t mean that you had diabetes before you conceived, or that you will have diabetes after giving birth.
If you are diagnosed with GDM,you will need to consult diabetologist also in addition to your gynaecologist.

Mangement,Treatment and Prevention

Managing gestational diabetes includes following a healthy eating plan and being physically active. If your eating plan and physical activity aren’t enough to keep your blood glucose in your target range, you may need insulin.
You can lower your chance of getting gestational diabetes by losing extra weight before you get pregnant if you are overweight. Being physically active before and during pregnancy also may help prevent gestational diabetes.
If you had gestational diabetes, you are more likely to develop type 2 diabetes. Your child is more likely to become obese or develop type 2 diabetes. You may be able to lower your and your child’s chances of developing these problems by reaching a healthy weight, making healthy food choices, and being physically active.

For any queries regarding the procedure and treatment facilities,email us at query@gtsmeditour.com .

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Maternal-fetal medicine (MFM) is a specilaity of Gynecology and Obstetrics which specializes in health of pregnant women foetus.The department provides specialized care of the mother and fetus in complicated, high-risk pregnancies.The speciality is also called perinatology.

Reasons to visit MFM

Sometimes it is the pregnant women who needs care for unexpected problems that develop during pregnancy such as early labor, bleeding, or high blood pressure.  In other cases, it is the baby who faces the non-routine. If birth defects or growth problems are found in the foetus, treatment can be started  before birth by providing monitoring, blood transfusions, or surgery to support babies with the best possible care until they are ready for delivery.

Reasons why you may see an MFM physician:

• Pregnant women of advanced maternal age (35 years or older) at the expected time of delivery.
• Pregnant women who have had an abnormal first trimester screening result (for down syndrome and/or Trisomy 18) or an abnormal second trimester quad screen result (for Down Syndrome, Trisomy 18 and/or spina bifida)
• Pregnant women who have had a positive carrier test results for genetic conditions such as cystic fibrosis and sickle cell disease
• Pregnant women experiencing complications such as bleeding, preterm labor, hypertension, diabetes and others
• Pregnant women with a multifetal gestation (twins, triplets, quadruplets)
• Pregnant women using medications, alcohol or other drugs which could be harmful to the unborn baby
• Pregnant women who have an abnormality discovered by ultrasound
• Couples who are pregnant or considering pregnancy who have a family history of birth defects, mental retardation or genetic conditions
• Couples with unexplained infertility, recurrent miscarriages or fetal loss.
• Problems with a previous pregnancy, such as multiple previous miscarriages, premature birth, low birth weight baby, Rh sensitization, prior cesarean delivery or a desire for Trial of Labor after cesarean (TOLAC), prior stillbirth or early neonatal demise
• Cervical insufficiency, also known as incompetent cervix
• Intrauterine growth restriction (IUGR)
• Pre-pregnancy diabetes and gestational diabetes
• Chronic high blood pressure in addition to gestational hypertension, preeclampsia or eclampsia
• Maternal heart disease such as repaired congenital heart malformation or coronary artery disease
• Kidney disease such as chronic renal failure, nephropathy, kidney stones or lupus nephritis
• Placenta abnormalities such as placenta previa (covering the cervix) or placental abruption (premature separation of the placenta)
• Premature labor threatening to result in early delivery
• Hyperemesis gravidarum (excessive nausea and vomiting during pregnancy)
• Infections that could threaten a pregnancy, such as HIV/AIDS, STDs (sexually transmitted diseases), bacterial vaginosis (BV), cytomegalovirus (CMV), hepatitis B virus (HBV), hepatitis A virus (HAV), listerisosis, parvovirus BI9 infection (also know as Fifth’s disease), toxoplasmosis and urinary tract infections
• Complication from thyroid diseases (Graves disease, Hashimoto’s disease, hypothyroid)
• Complication from liver diseases (intrahepatic cholestasis of pregnancy, hepatitis, acute fatty liver of pregnancy
• Thrombophilias or clotting disorders, such as Factor V Leiden mutation, prothrombin gene mutation, antithrombin III deficiency, protein S and protein C deficiencies
• Autoimmune diseases, such as systemic lupus erythematosus
• Reproductive abnormalities, such as double uterus
• Umbilical cord abnormalities, such as vasa previa, nuchal cord, umbilical cord cysts or knots
• Rh disease and other cases of alloimmunization
• Managing pre-existing conditions that require medications, such as seizure disorders, cancer, interstitial cystitis, Crohn’s disease or ulcerative colitis,
• Management of wide range of obstetrical emergencies, such as maternal hemorrhage

Prenatal Diagnostics

Some fetal problems may be identified during pregnancy through tests.Prenatal diagnosis assists couples in making informed decisions regarding the management of their pregnancy.Genetic counseling assesses the risk of passing an inheritable disease or birth defect to your baby.

Screening tests such as 1st Trimester Screening and Multiple Marker Screening (or Quad Test) provide information regarding the relative risk of having a baby with either a genetic (chromosomal) abnormality such as Down syndrome or a structural anomaly such as spina bifida.

• 1st trimester screening for fetal chromosomal abnormalities is done between about 11 weeks and 13 weeks 6 days of pregnancy. It combines two modalities, ultrasound and a maternal blood specimen. It provides information about a woman’s risk for having a child with Down syndrome  and Edwards or Patau’s syndrome
• Multiple Marker Screening or Quad Test assesses the child’s risk for having a chromosomal abnormality or neural tube defect (spina bifida or anencephaly).  It is a screening test, not diagnostic. Performed between the 16th and 20th weeks of pregnancy, a sample of the mother’s blood is drawn to help adjust a pregnant woman’s age-related risk.

• Diagnostic tests used to identify conditions are amniocentesis, chorionic villus sampling (CVS), targeted sonogram examination and percutaneous umbilical blood sampling (PUBS).
  • Amniocentesis is a technique to obtain amniotic fluid containing fetal cells from the “bag of waters” to analyze the cells for the number of chromosomes. It does require inserting a needle into the “bag of waters” to obtain the fluid containing the cells. It is usually done between 15 and 20 weeks of pregnancy for this purpose.
  • CVS is a procedure to obtain a sample of the placenta to detect fetal chromosomal abnormalities. The test is used when information about the chromosomes of the fetus is desired earlier in pregnancy, since it is done between 10 and 13 weeks of pregnancy. This test involves inserting a needle into the developing placenta to obtain the sample.
  • High resolution ultrasonography, including 3-D ultrasonography when indicated, helps identify fetal abnormalities.
  • Percutaneous umbilical blood sampling (PUBS) detects chromosomal abnormalities and blood abnormalities (fetal hemolytic disease) and may be used to diagnose fetal infection (toxoplasmosis or rubella), abnormal fetal platelet count and Rh incompatibility (alloimmunization). It is rarely needed now but when necessary it typically is done later in pregnancy, at 20 weeks of pregnancy and beyond.
• Maternal blood tests can determine a woman’s status regarding the Rh factor, immunity to rubella (German measles), Parvo virus, toxoplasmosis and chickenpox.

Treatments

Cervical cerclage is a surgical procedure performed when the cervix cannot hold a pregnancy inside the womb against the forces of gravity.  A stitch is placed to help the developing baby remain inside the uterus as long as possible or until 37-38 weeks of pregnancy. The procedure is often used if the mother has a history of second-trimester miscarriages without labor, a damaged cervix, a previous cone biopsy or LEEP procedure, or an inherited uterine anomaly.There are currently no treatments for fetal chromosomal abnormalities. When the condition is known before birth, full preparations can be made for the arrival of a child who will have special needs.Alloimmunized pregnancy, either from the Rh factor or other red blood cell factors, may require intrauterine transfusion of blood to the fetus to treat or prevent serious fetal low blood count.

 

Emma Wren Gibson, frozen as an embryo in 1992, was born in 2017, more than 25 years later.Frozen embryo transfer is one of the procedures in invitro fertilisation(IVF).IVF is one assistive reproductive technology(ART) used to establish pregnancy.It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm in the laboratory. This fertilized egg  known as an embryo can then be frozen for storage or transferred to a woman’s uterus. Emmas’s is the longest an embryo is known to have been frozen before being born as baby.

 

ART procedures and IVF

IVF is used in women experiencing difficulty to conceive.This may include male or female genetic defects,abnormal sperm production in male,ovulation problems in female among many.Major ARTs are In vitro fertilization (IVF),Intracystoplasmic sperm injection (ICSI),Gamete intrafallopian Transfer (GIFT),Zygote Intrafallopian Transfer (ZIFT) and Tubal Embryo Transfer (TET).Most of these techniques relies on embryo transfer.
In Vitro Fertilisation involves uniting the ovum with the spermatozoon in vitro in order to obtain fertilised embryos for transfer to the mother’s uterus.First step to IVF is ovarian stimulation.Ovarian stimulation consists of the administration of daily injections which cause the ovaries, instead of producing a single ovum which is what they do naturally each month, to produce more oocytes so that a larger number of embryos can be obtained.
Multiple eggs are desired because some eggs will not develop or fertilize after retrieval.Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.The male is asked to produce a sample of sperm, which is prepared for combining with the eggs.In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization.The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos.If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

Frozen Embryo Transfer

A frozen embryo transfer (FET) is a cycle where a frozen embryo from an earlier cycle is thawed and transferred back into a woman’s uterus. This means that woman has an egg or embryo ready  for assistive reproduction procedure.She does not have to undergo a cycle of hormone stimulation and egg collection. Frozen embryo cycles can be undertaken on natural cycles  or ovulation stimulation.
As mentioned earlier, during an IVF cycles more than one embryo may be created.But it is recommended to transfer only one and freeze others. This is due to the serious risks associated with multiple pregnancies if more than one embryo is transferred at a time.Once the embryo transfer has been made,remaining good quality embryos are vitrified so that they can be used in a later IVF cycles.
Embryo freezing gives you more chances for a pregnancy . If pregnancy is not achieved  from the first transfer , we can transfer a frozen embryo during a frozen embryo transfer cycle.
This cuts down on the amount of time that is needed for each ART cycle. The quality of eggs deteriorates with age, leading to the possibility of having a more difficult time conceiving. The more quality of eggs, the better the chance that they will be of high enough quality to result in pregnancy. FET offers the patient the chance to use more quality possible eggs as this is vitrified during earlier ovulation cycles.

Fertility Preservation

The biggest benefit of FET is fertility preservation.There can be cases where some have a serious illness such as cancer that will potentially risk damage to your eggs or sperm from chemotherapy, radiotherapy or other treatments, including surgery.This can affect the fertility in future. FET can also help those people who are not in a position to have a babies right now but would want later and also those who would like the opportunity to start a family beyond the age at which fertility naturally declines.
Fertility preservation options for women include egg freezing, embryo freezing and ovarian tissue freezing.

Embryo freezing is used when there is partner or donor .Frozen embryos can be stored for many years.

Egg freezing is a method of storing a woman’s unfertilised eggs. To obtain eggs for freezing, a woman would usually have hormonal stimulation for 10 – 12 days. Frozen eggs may be stored for many years without significant deterioration. When the woman is ready to use her eggs, they are warmed, and then fertilised with sperm.

Ovarian tissue freezing involves removing a small piece of ovarian tissue from one ovary, cutting it into tiny slices and then freezing it. Later, when you are ready to try to conceive, the ovarian tissue slices are grafted back into your pelvis. Around nine months later, the grafted ovarian tissue can start to produce reproductive hormones and follicular development. Pregnancy may be achieved either with ovarian stimulation and IVF, or perhaps even naturally. Moaza Al Matrooshi was born with a serious blood disorder.By the age of nine ,she needed chemotherapy treatment for the disorder. She is  the first to give birth after having her fertility restored using ovarian tissue frozen before the onset of puberty.She delivered a healthy baby boy.

 For any queries regarding  treatment facilities,email us at query@gtsmeditour.com 

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When it comes to delivery,cesarean section is often frowned upon.People shaming c-section says it is not ‘real birth’.They argue that it is an easy way out and you did not experience pain and the baby did not come out of you and on and on.Alas,vaginal birth is not the only thing a mother does for her baby.If  C-section babies are not really born,they would still be in their ‘trimesters’!!Let us see the details of c-section mode of delivery here to accept and appreciate it.

What is c-section

Cesarean section delivery is the surgical delivery of the baby by making incisions in the abdomen and uterus of the mother.Emergency c-section is performed when the labour has already begun but complications crop up.Health care team decides immediately that it is the safest option.Emergency c-section can be life saving for both mother and the baby.
When the mode of delivery is already chosen to be c-section before one goes into labour,then it is called planned or elective c-section.In most cases, c-sections are done for the safety of the child.Vaginal delivery poses danger when baby is lying in difficult position for labour or there are problems with the placenta such as a low lying placenta.

Reasons for planned Cesarean Section 

There are several reasons why cesarean sections may be planned prior to the labour or at the beginning of labour. As mentioned earlier,most of the reasons attribute to the safety of the baby and/or the mother.

Placenta Previa
This is where the placenta is near of covering the cervix. This blocks the pathway for a vaginal birth or would present a bleeding risk during labor.

Certain Fetal Positions
Your baby’s position in the uterus may mean that a vaginal birth is not possible, nor safe for them to be born. This can include: Transverse Lie, some breech positions, etc.

Higher Order Multiples
With every baby that you have in the uterus the risk of a cesarean birth increases. While there are births of twins and triplets vaginally, the more babies, the less likely a vaginal birth will be possible. This is many times due to odd positions in the uterus.

Genital herpes
If you have herpes occurring late in pregnancy and you have an active lesion on your genitals, you may be encouraged to have a cesarean rather than delivery vaginally. This is to prevent transmission to your baby.

Pre-eclampsia
You have pregnancy-related high blood pressure

Certain Fetal Conditions
Your baby isn’t getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately

Other conditions
Your labour isn’t progressing or there’s excessive vaginal bleeding,diseases that may make vaginal birth difficult like pulmonary or coronary disease of the mother,HIV positive with a high viral load at time of birth.Previous invasive uterine surgery, including a previous classical cesarean incision

Some mothers may choose planned c-section if they feel they cant cope with the pain involved in a vaginal birth especially if they had had a difficult vaginal delivery with their last baby.Also for some mothers,it may have caused severe postpartum depression.You never know what she goes through physically and emotionally.So ,there is no reason in shaming mothers going ahead with elective c-section.

C section Sugery

Most caesareans are carried out under spinal or epidural anaesthetic. Both types of anaesthetic are given as an injection in your spine that numbs the lower part of your body. This mean you’ll be awake.You will either lie on your side or sit leaning forward, curving your back, while the anaesthetist inserts a very fine needle into your spine.Occasionally a general anaesthetic, where you’re asleep, may be used, particularly if the baby needs to be delivered more quickly.This means you will be asleep for the operation

Before the procedure:You will be given

• fluids through a needle in your arm (a drip), to stop you getting dehydrated and to reduce the risk of low blood pressure during the operation
• anti-sickness medicine to stop you feeling or being sick
• a small tube (catheter) into your bladder to drain urine – this will stay in place for at least 12 hours and until you feel able to walk to the toilet.

During the procedure:

• a screen is placed across your body so that what’s being done is not seen.
• a cut about 10-20cm long will usually be made across your lower tummy and womb so your baby can be delivered.you may feel some tugging and pulling during the procedure
•  Baby is then lifted out.

The whole operation normally takes about 40-50 minutes.

After the procedure:

• regular checks to make sure the anaesthetic is wearing off , your breathing, heart rate, blood pressure, wound dressing and pain relief for the first few hours
• regular checks on the amount of vaginal bleeding
• a catheter to drain urine from your bladder
• compression stockings to reduce your risk of blood clots
• a needle in your arm (drip) to give you fluids until you’re eating and drinking again

Recovery

C section is a major surgery meaning it risks associated with it like any other surgery.Moms are at greater risk during c section than vaginal birth.Recovery takes more time than normal delivery. Most women experience some discomfort for the first few days after a caesarean, and for some women the pain can last several weeks.The wound in your tummy will eventually form a scar.Regular pain killers are advised to control pain and bleeding.Once the anaesthetic has worn off, you’ll be able to stand up and do short walks.It’s important to move around soon after your c-section to reduce the risk of blood clot.

Benefits far outweigh any disadvanatges.No reasons for shaming mothers!

For any queries regarding  treatment facilities,email us at query@gtsmeditour.com 

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Endometriosis a painful condition caused when tissues that line the uterus grow outside of uterus.The tissues that make up the lining of the uterus is called endometrium.Women with endometriosis have tissues similar to endometrium  on other organs of the body. Endometriosis usually occurs usually on other reproductive organs inside the pelvis or in the abdominal cavity and affects women of childbearing age.

 

Understanding the condition

In a regular menstrual cycle,if fertilization has not happened , hormonal changes signal the uterus to prepare to shed its lining.The endometrial tissues build up and egg along with the uterine lining is shed in form menstrual bleeding.Whereas in patients with endometriosis,the misplaced endometrial tissues  also respond to the hormonal signals and by building up and breaking down just like the endometrium does, resulting in small bleeding inside of the pelvis.Unlike the cells in the uterus that leave the body , this blood has no way to escape.This leads to inflammation, swelling and scarring of the normal tissue surrounding the endometriosis implants.
Mostly,the endometrial tissues grow on ovaries, Fallopian tubes, bowel and outer walls of the uterus.But it can appear anywhere in the body.Though very rarely,it is found to develop on kidney, bladder and lungs. Endometriosis can be located on and even within an ovary, causing fibrous cysts called endometriomas. Blood become embedded in the normal ovarian tissue  surrounded by endometrioma.

Causes

Several ideas have been proposed to explain what causes the tissues on uterine lining to grow on other parts of the body.One idea explains endometriosis by retrograde menstruation.It is a sort of reverse menstruation in which the period blood and tissues travel out of the uterus  through Fallopian tubes to the abdominal cavity where it attaches and grows.But this idea fail to explain the occurrence of endometriosis at strange locations like thumb and knee.It is better explained by another theory that suggests that some cells outside uterus can transform into endometrial cells.  Another possible explanation is that the cells from the lining of the uterus travel  and implant via blood vessels or lymphatic system to reach other organs similar to how cancer cells spread. Also, endometriosis can spread as a result of direct transplantation during a cesarean section where in endometriosis cells attach to the abdominal incision and endometriosis is formed in the scar.

Symptoms

Symptoms of endometriosis vary in different women. Some women experience mild symptoms, but others can have moderate to severe symptoms. The severity of your pain is not the indicator of stage of the condition. Mild form of the disease may cause agonizing pain. It’s also possible to have a severe form but very little discomfort.For some,it is asymptomatic.

Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:

• painful periods especially excessive menstrual cramps or irregular periods
• pelvic pain before and during menstruation
• infertility
• heavy menstrual bleeding or spotting between periods
• Painful urination or  blood in the pee during menstrual period
• uncomfortable bowel movements
• pain after sexual intercourse
• lower back pain that may occur at any time during your menstrual cycle
• feeling sick, constipation, diarrhoea
• Nausea and fatigue

Endometriosis and Pain,infertility

Due to the misplaced cells,the woman with endometriosis have bleeding from tissues outside the uterus as well during menstrual period.When blood comes into contact with other organs especially in the abdomen, it causes inflammation and irritation, creating pain. Also,the scar tissue developed from the endometriosis contribute to the pain.
Endometriosis seems to impair fertility  by causing distortion of the fallopian tubes making it incapable of picking up the egg after ovulation and by creating inflammation that can adversely affect the function of the ovary, egg, fallopian tubes or uterus.
Statistics show that  20 – 40% of women with infertility have endometriosis and this points to how much of a factor endometriosis is in infertility!

Diagnosis

Since endometriosis manifests itself in many ways and shares symptoms with other conditions, diagnosis can be difficult and often delayed. The condition is in most case diagnosed ,when the patient tries to evaluate infertility and  pelvic pain in one another reason.The only definitive way to diagnose endometriosis is by laparoscopy.Laparoscopy is a minor surgical procedure in which a laparoscope, a thin tube with a camera at the end, is inserted into the abdomen through a small incision. Laparoscopy helps to determine the location, extent and size of the endometrial growths.

Treatment

Treatment options available to women with endometriosis are:

• Surgery
  As a treatment for endometriosis, surgery can be used to alleviate pain by removing the endometriosis, dividing adhesions or removing cysts.
  Conservative surgery: This aims to remove or destroy the deposits of endometriosis and is usually done via a laparoscopy (keyhole surgery). This is also used to diagnose the disease and can be used to improve fertility.  Although surgery can provide relief from symptoms, they can recur in time.
  Radical surgery: This refers to a hysterectomy or oophorectomy: Hysterectomy is the removal of the womb,  with or without removing the ovaries. If the ovaries are left in place then the chance of endometriosis returning is increased. Oopherectomy is the removal of the ovaries, either one or both.When both ovaries are removed, a woman will experience an instant and irreversible menopause.
  These procedures may be decided after taking many factors into consideration.
• Hormone treatment
  These are treatments that are used to act on the endometriosis and stop its growth. They either put the woman into a pseudo-pregnancy or pseudo-menopause because during pregnancy the endometrium is thin and also inactive. Both states are reversed when the patient stops taking the hormones. In addition, testosterone derivatives are occasionally used to mimic the male hormonal state.All of these have a contraceptive effect, so are not used if the patient is trying to become pregnant.
• Pain relief
  Pain medication avoids the use of hormones so it does not prevent the growth of endometriosis.When taken appropriately, pain medication can be extremely effective. Either painkillers, or drugs that modify the way the body handles pain, can be used.

Some complementary therapies may be beneficial in controlling the symptoms of endometriosis.These include acupuncture,homeopathy,yoga etc.

The course of treatment depends on several factors.The approach will depend on how severe the disease is and when you expect to become pregnant.Endometriosis is a debilitating and challenging condition. Fortunately, there are treatments available which can alleviate the symptoms and condition.

 For any queries regarding the procedure and treatment facilities,email us at query@gtsmeditour.com .

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