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Bringing a new life to an existence is one of the most precious moments of any parent’s life. At KIMS Cuddles, we strive to make those precious moments of a mother even more memorable and cherishing through our services.

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The world class gynecologists at KIMS Cuddles, diagnose and understand your health issues and work towards curing them. Our doctors are dedicated to provide personalized care for w...

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At our gynecology hospital in Hyderabad, our experts help you manage the spacing between the birth of your child by contraceptive methods. We provide confidential, low-cost, preven...

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Laparoscopy involves making small incisions on the abdomen or the pelvis of a person to diagnose conditions. We have experts in treating gynecologic cancers, hysterectomy, endometr...

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Doctor Videos


Dr. Vasundara Cheepurupalli, Colposcopy, Gynaecology Services, Hysteroscopy, Laparoscopy Procedures, Obstetrics, PCOD Specialty centre, Woman Health Services


Dr. Vasundara Cheepurupalli, Colposcopy, Gynaecology Services, Hysteroscopy, Laparoscopy Procedures, Menopause clinic, Obstetrics, PCOD Specialty centre, Urogynecology Services, Woman Health Services


Managing Re-current Vaginal Discharges

Dr. Vasundara Cheepurupalli, Gynaecology Services, Maternity services, Obstetrics, Woman Health Services


Dr. G. Nikila Reddy, Gynaecology Services, Hi-Risk Pregnancy, Maternity services, Obstetrics, Painless Delivery, Postnatal care, Pregnancy Nutrition, VBAC, Woman Health Services


Dr. M. Madhavi, Fitness & Care, Gynaecology Services, Hysteroscopy, Laparoscopy Procedures, Maternity services, Menopause clinic, Obstetrics, PCOD Specialty centre, Urogynecology Services, Woman Health Services


Dr. Vasundara Cheepurupalli, 9 Months Full Term Care, Antenatal Care, Colposcopy, Fertility Services, Fitness & Care, Gynaecology Services, Hi-Risk Pregnancy, Laparoscopy Procedures, Maternity services, Obstetrics, Painless Delivery, PCOD Specialty centre, VBAC, Woman Health Services


Dr. Vasundara Cheepurupalli, Fitness & Care, Gynaecology Services, Laparoscopy Procedures, Menopause clinic, Obstetrics, Urogynecology Services, Woman Health Services


Dr. Vasundara Cheepurupalli, 9 Months Full Term Care, Antenatal Care, Fertility Services, Fitness & Care, Gynaecology Services, Hi-Risk Pregnancy, Maternity services, Obstetrics, Painless Delivery, Preconception, Pregnancy Nutrition, VBAC, Woman Health Services


Dr. Vasundara Cheepurupalli, 9 Months Full Term Care, Fertility Services, Fitness & Care, Gynaecology Services, Hi-Risk Pregnancy, Lactation, Lactation Support Services, Maternity services, Obstetrics, Painless Delivery, Postnatal care, Preconception, Pregnancy Nutrition, VBAC, Woman Health Services


Dr. Vasundara Cheepurupalli, 9 Months Full Term Care, Antenatal Care, Fertility Services, Fitness & Care, Gynaecology Services, Hi-Risk Pregnancy, Maternity services, Obstetrics, Painless Delivery, Pregnancy Nutrition, VBAC, Woman Health Services

Health Blogs

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10 November, 2023

5 best ways to avoid premature labour

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The average length of a human gestation is 280 days or 40 weeks. The gestation period is usually counted from the first day of woman’s last menstrual period. It’s good and healthier for babies not to be born before they’re due. If the labour starts before 37 weeks of pregnancy, then it is usually called as premature labour. In this case, the baby is not fully grown and is not entirely ready to come into the outside world.In premature labour, the mother is unable to carry her baby for the full 9-month term. There are a number of reasons behind the preterm labour, including traumas, accidents and unpredictable diseases. Although the reasons are not clear, here are the common and best advisable ways to avoid premature labour.Learn what you can do to prevent early labour!  See your health care provider early and regularly during your pregnancy. Prenatal care is designed over the years to minimise the risk and complications of pregnancy. A good health care provider can ensure and plan your pregnancy. Attend all prenatal appointments with your doctor and have all the screening tests to check your health and your baby’s health. Understand the common problems of the pregnancy and check the root causes in case of complications. Understanding the root causes will help you and your doctor plan better labour for you.  Stay away from smoke, drink, or illegal usage of drugs. Protect your baby’s health and well being by staying away from smoke, drink or usage of drugs. Indirect exposure or passive exposure will also cause tremendous issues. Get help to quit for your or your family members around you, if needed. Always remember tobacco and alcohol will cause harm to your pregnancy! Stay or get to a healthy weight during pregnancy. Overweight and underweight women have a higher chance of giving premature birth. Work with your doctor and understand the weight demands during pregnancy. Try to achieve a healthy weight based on what your doctor suggests. Don’t get discouraged; even a small change in your weight may lower the chance of giving birth to a preterm baby. Always keep your weight on check.  Track your chronic diseases and take care of them  Inform your health care provider in case of any chronic disease such as diabetes, blood pressure or gastritis. They have to be kept well controlled before, during and after pregnancy. However, if any of the chronic conditions worsen during pregnancy, the chances for premature labour are higher. Thus, tracking and taking care of such chronic diseases is highly important.  Practice a healthy diet and regular yoga Taking care of your body and mind during pregnancy plays a vital role in the health of the baby. Eat a variety of foods and drink lots of water to maintain the balance of vitamins, proteins and minerals in your body. Do regular exercise or yoga to boost your metabolism and contain the stress levels.  Preterm pregnancies cant always be prevented. But following a healthy routine will definitely lower the chances of premature births. Studies suggest that women who get routine prenatal care are more likely to have a healthier pregnancy and baby.    *Information shared here is for general purpose. Please take doctors’ advice before taking any decision.

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20 November, 2021

5 easy ways to reduce stress during pregnancy

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No matter how happy you are about your pregnancy, stress during the pregnancy phase is unavoidable. Most of the time, it is because of the hormones that play around. But there are a lot of other factors that account to stress. Managing stress during pregnancy is an efficient way to enjoy your pregnancy period.  Knowing the changes and accepting them happening to your body will help you best during this phase. However, know more efficient ways to reduce stress during pregnancy.  Here are the 5 easy ways to reduce stress during pregnancy.  Eat well and sleep well must be a routine  Nothing can replace the best benefits of proper food and sound sleep. Ensure that you follow a balanced diet with all the necessary supplements that your body needs and take enough rest. A night of proper sleep will make your day brighter and keep you comparatively in a cheerful mood. Rest when you are tired. Do not overdo during pregnancy. A perfect routine for food and sleep will ease up your hormones.  Surround yourself with positive energy. Talk to your friends and family. Pregnancy can put you through a lot of thoughts. It will make you think about the least possible negativity. Well, these are the instincts of the mother to safeguard her child. So it is no wonder that you get all such thoughts. However, do not put them all to yourself. Talk them out with your best buddies and family. Let them know your concerns and allow them to soothe you down.  Exercise must be your normal  We are not talking about heavy workouts and impulsive training. It is all about simple meditation and gentle exercise. Mild exercise during pregnancy will lower cortisol levels; the stress hormone is partly responsible for your stress. Thus, regular exercise will help you stay fit and help you check your stress levels during pregnancy.  You can choose simple exercises like walking, swimming, low paced stationary bike etc. Learn more about safe cardio exercises that you can consider during pregnancy here.  Take time out for yourself You might feel upset over small things. It is normal to be so during pregnancy. Do not feel wrong about such instances. Instead, when you feel low or feeling upset over something, take some time out for yourself to calm you down. Pick your favourite activity that you love to do and spend enough time with it. Try it for yourself! Taking a break can do significant wonders for your mental health, especially during pregnancy! Do not skip your doctor appointments  Visiting your doctor regularly for prenatal appointments will make you feel at ease. Knowing your condition and baby’s condition will help you better understand the situation. At times, a simple talk with your doctor can help you calm down. Regular appointments will also help you check for the complications of pregnancy. An excellent way to check your mental health and ease you as well!  Remember, it is perfectly alright to worry about your unborn baby. Whether the baby is healthy or growing out well inside. But, do not let these thoughts overcome the joy of your pregnancy. Follow the above-mentioned suggestions to reduce your stress during pregnancy and enjoy the blissful moments of your life!!  *Information shared here is for general purpose. Please take doctors’ advice before taking any decision. 

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25 October, 2021

Pelvic Pain

Authored By: Dr. K. Shilpi Reddy

Pelvic Pain Pelvic pain is pain in the lower part of the abdomen and pelvis. It can stem from multiple causes. Pelvic pain arises from the conditions associated with reproductive, urinary or digestive systems, or from muscles and ligaments in the pelvis. Pelvic pain can be due to irritation of nerves in the pelvis. Chronic pelvic pain is constant or intermittent pelvic pain for six months or more. Pelvic pain may spread to lower back, buttocks or thighs. Pelvic pain can also be situational, such as while using the bathroom or have sex. Causes More than one condition can lead to Pelvic pain. Common causes of acute pelvic pain Ovarian cyst– it is fluid-filled bubble arising from an ovary and causes pelvic pain when it ruptures or becomes twisted Acute pelvic inflammatory disease– a bacterial infection of the reproductive organs, which often follows a chlamydia or gonorrhoea infection and needs immediate treatment with Antibiotics. Ectopic Pregnancy (or other pregnancy-related conditions) Miscarriage or intrauterine fetal death Menstrual cramps (dysmenorrhea) Mittelschmerz (ovulation pain) Appendicitis – a painful swelling of the appendix which usually causes pain on the lower right-hand side of your abdomen Peritonitis– inflammation of the peritoneum; it causes sudden abdominal pain that gradually becomes more severe and requires emergency treatment Urinary tract infection – it will cause pain or a burning sensation while urination Kidney stones Constipation or bowel spasm – this could be due to changes in diet, medication, irritable bowel syndrome or, in rare cases, a bowel obstruction Less common causes include: Pelvic abscess –it is collection of pus in between pelvic organs requiring urgent treatment Endometriosis – a condition where bits of endometrium is found outside the uterus, such as on the ovaries, leading to painful periods Uterine fibroids Long-term pelvic pain If pelvic pain persist for 6 months or more that is either intermittent or continuous, it’s known as chronic pelvic pain. The most common causes of chronic pelvic pain are: Endometriosis Chronic pelvic inflammatory disease – a bacterial infection of female reproductive organs which often follows a chlamydia or gonorrhoea infection and needs immediate treatment with antibiotics Irritable bowel syndrome – a common condition of the digestive system that can cause cramps, bloating, diarrhoea and constipation Conditions involving the muscles, joints, and ligaments in the pelvis, lower back, or hips. Less common causes of chronic pelvic pain are: Recurrent ovarian cysts  Recurrent urinary tract infection Lower back pain Prolapse of the uterus– where the uterus slips down along with other organs from its normal position and usually causes a “dragging” pain Adenomyosis – endometriosis that affects the muscle of the uterus, causing painful, heavy periods Fibroids – tumours(non-cancerous) of the uterus, fibroids can be painful if they twist, but uncomplicated fibroids aren’t usually painful Chronic interstitial cystitis – chronic inflammation of the bladder Inflammatory bowel disease (IBD) –It includes ulcerative colitis and Crohn’s disease, which affect the gut Hernia  Trapped or damaged nerves in the pelvic area  Uterine cancer Cervical cancer Vulvodynia Symptoms Worsening of menstrual cramps Menstrual pain Vaginal bleeding, spotting or discharge Painful or difficult urination Constipation or diarrhoea Bloating or gas Blood seen with a bowel movement Blood in urine Pain during intercourse Fever or chills Pain in the hip area Pain in the groin area Diagnosis To begin with, your doctor will do a complete examination to look for problems with your reproductive system. The doctor will need complete information about past and present health and symptoms. You might need to undergo some tests, such as: Blood and urine tests for signs of infection. A pregnancy test. Tests for sexually transmitted infections (STIs)– vaginal culture Emotional issues can be a big part in chronic pain. Inform your doctor about any depression or stress that is adding to your problem. Your Doctor will need to know about any past or current sexual or physical abuse. It can be tough to talk about these things, but all this information is needed to provide right treatment. If initial tests don’t suggest anything significant, then you might have to go for other tests that show pictures of the organs in your belly. These may include: Abdominal and pelvic X-rays. Diagnostic laparoscopy Hysteroscopy (procedure to examine the uterus). Stool guaiac test- tests microscopic blood in stool sample Lower endoscopy such as colonoscopy or sigmoidoscopy Ultrasound  CT scan of the abdomen and pelvis Finding the cause of pelvic pain can take long time. You should keep record about the type of pain you have, timings and any precipitating factors. Treatment Once your condition is diagnosed- you will be treated for that problem. Some common treatments include: Birth control pills or hormone treatment for problems related to your periods. Surgery for removal of a growth, cyst, or tumor. Medical management- such as an antibiotic for infection or medicine for irritable bowel syndrome. If you are not diagnosed foe the condition causing pelvic pain-you can be offered treatment to help you manage the pain. Best results are seen from a combination of treatments such as: Pain relievers called NSAIDs, like ibuprofen or naproxen. Tricyclic antidepressant medicine or anticonvulsants, which can help with pain and with depression. Cognitive-behavioural therapy or biofeedback, to help you change the way you think about or react to pain. Counselling, to give you emotional support and reduce stress. Physical therapy to help you relax your muscles, improve your posture, and be more active. Pain relievers that are injected (local anaesthetic) into specific areas to help with pain. You may need to try many treatments before you find the ones that help you the most. If the things you’re using aren’t working well, ask your doctor what else you can try. Taking an active role in your treatment may help you feel more hopeful.

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21 October, 2021

Post Menopausal Bleeding

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What is post-menopausal bleeding? When the monthly periods stop for 12 months we call it menopause.  Any bleeding that happens after that is called post-menopausal bleeding.  Is it normal to have bleeding after menopause? It is never normal to have bleeding after menopause. Even if it is spotting, or slight smearing of blood on pad or happened only once or no pain it is still not normal and you should not ignore.  Is it cancer?  All women who have post-menopausal bleeding will not have cancer.  Only less than 10% women might have cancer. Rest of 90% might have simple reasons for bleeding.  What can be the reasons for the post-menopausal bleeding? Most common reason will be dryness of vagina also known as atrophy.  Other reasons might include small growths or polyps, infection of cervix or vagina, or use of hormone replacement pills. Less commonly there can be cancer of uterus or cervix or vagina.  What should I do when I notice post-menopausal bleeding?  Whenever you notice post-menopausal bleeding make an appointment with your doctor as soon as possible instead of postponing or observing for repetition.  What will happen at doctor’s visit?  When you visit the doctor will complaints of post-menopausal bleeding the doctor will take history of all your medical problems and check you which might involve internal check. If you are due for Pap smear or never had that done before Pap smear will be done which is twisting of soft brush at cervix – that is mouth of the uterus.  You will be advised ultrasound scan to check for any growths inside the uterus or abnormal thickness of uterine lining and also to rule out ovarian cysts.  You will be advised to have a biopsy of the lining of the uterus if it is looking thick. It is generally done in the outpatient department itself and you will not need anesthesia. It is well tolerated and a simple procedure. You might experience some crampy pain while biopsy is being taken.  The reports will be available in a week and you will be called to discuss the reports.  If biopsy is not tolerated or insufficient or if you are taking a pill for breast cancer you will need a camera test called hysteroscopy. A small camera is passed inside the uterus to check the lining. It can be done as outpatient or in operation theatre under anaesthesia. Even if you need anaesthesia it is a small procedure and you will be discharged on same day of the procedure.  What are the treatment options?  If biopsy and all examination reports are normal you will be reassured and no follow up will be needed unless the problem repeats. If there is uterine cancer identified you will need surgery to remove the uterus and ovaries. Remember the uterine cancers are detected early so there is very good cure possible. If vaginal dryness is the cause – you will be given hormone cream to help. If any infections identified you will be suggested appropriate antibiotics. If small polyps are the reason the polyps can be removed and sent for biopsy. If lining is thick but no cancer within then progesterone pills or coil will be suggested. Overall the treatment depends on the cause of the postmenopausal bleeding. 

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03 October, 2021

Pelvic Organ Prolapse

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What you need to know about pelvic organ prolapse? What is pelvic organ prolapse?  Uterus (womb), bladder & rectum (back passage) are the organs present within a woman’s pelvis. They are normally held in their place by ligaments and muscles called pelvic floor. If these support structures are weakened there will be bulge of organs from their natural position into the vagina. When this happens it is known as pelvic organ prolapse. Is it common to have prolapse?  It is very common especially in older women. As many women don’t go to doctor or talk about it, it might be difficult to know exactly the proportion of women who can have this problem. It is estimated that at least 50% of women over 50 years of age will have symptoms with pelvic organ prolapse. Why does pelvic organ prolapse happen?  Being Pregnant and giving birth are most common reasons for weakening of pelvic floor. More births the woman had, more difficult births, more bigger babies, more likely is the chance of you having the prolapse. After menopause it is common. Being overweight, constipation, persistent cough, and prolonged heavy lifting can also increase the chance of having the prolapse. Sometimes there is hereditary tendencies too. What symptoms will be there if I have a prolapse?  Sometimes there might not be any problem at all and we will know only when examination is done. Most of the times, it is the sensation of lump coming down is the symptom. Backache, heaviness or dragging discomfort in the vagina can be there.If bladder is also prolapsed – You may experience need to pass urine frequently, incomplete emptying, frequent urine infections. If bowel is also prolapsed – You can have constipation or incomplete bowel emptying. Some women might have to push the lump back to be able to empty bladder or bowel. Sex might be uncomfortable and lack of sensation during intercourse can be distressing. Will I need tests?  Prolapse is usually diagnosed by performing a vaginal examination. Your doctor will insert a speculum (a metal or plastic instrument used to separate the walls of Vagina) to assess the prolapse and to determine exactly which organs are prolapsing. Urine test will be done to check for infection. If you have leakage of urine special tests like Urodynamics will also be done. What are the treatment options?  If mild prolapse and no symptoms, you might choose to take wait and see option, however losing weight if you are overweight, reducing cough, avoiding constipation, avoiding heavy lifting can help to reduce worsening of the problem. Kegels or pelvic floor exercises will help to strengthen the pelvic floor muscles.If you are unable to do these exercises you will be referred to a physiotherapist to guide you doing the right way. Vaginal hormone might be recommended. Other options include pessaries or surgery. Pessary – Is a good way of supporting the prolapse. If you don’t wish the surgery or if surgery is too risky for you due to any medical condition you will be given this option. Pessary is made of plastic or silicone. There are many varieties and sizes of pessaries available. Your doctor will advise the right one for you. Most commonly used pessaries are ring pessaries. Fitting the right size pessaries can sometimes take more than one attempt. They have to be changed frequently. You have to report to your doctor if you experience any irritation or bleeding. Surgery – Choosing surgery will depend on severity of your symptoms, effect on quality of life and if other options are not helpful. There will be some risks with any operation especially if you are overweight or have any medical problems. The usual surgery that is done is removal of uterus and pelvic floor repair. Lifting up the uterus or vagina to a bone of your spine or a ligament within your pelvis are also available especially if prolapse is recurrent. Closing off the vagina will be considered only if many surgeries are unsuccessful or you are in very poor medical health. How successful is the surgery? In 75% of women surgery is successful. However in 25% of women, prolapse can come back and might require further surgery at a later date.

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24 September, 2021

Bacterial Vaginosis

Authored By: Dr. K. Shilpi Reddy

Bacterial vaginosis is a vaginal infection caused by bacteria. It is the most common cause of abnormal vaginal discharge that happens in reproductive-age women. It can cause a “fishy” odor and vaginal irritation in some women. Others may not have any symptoms. SYMPTOMS Most of the females with bacterial vaginosis will not have any symptoms but when they have, it includes- Burning feeling while micturation Fishy smell mostly after sex Itching Thin white, gray, or green discharge RISK FACTORS It is rarely seen in females who are not sexually active. It most commonly affects- Pregnancy Unprotected Intercourse Have an intrauterine device (IUD) Have multiple sex partners Have a new sex partner Have a female sex partner Use douches Smoking Perfumed bubble baths, vaginal deodorants, and few scented soaps Washing underwear with strong detergent CAUSES BV is due to an imbalance of natural vaginal bacterial flora. Why this happens is not clear. The role of bacteria Bacteria is present allover our bodies, but some are beneficial while others are harmful. These bacteria become infectious when number of harmful bacteria increases. The vagina is house for mostly “good” bacteria and some harmful bacteria. BV occurs when the harmful bacteria outgrows the good bacteria in number. A vagina should contain bacteria called lactobacilli. These bacteria produce lactic acid, making the vagina slightly acidic. This prevents growth of other bacteria. Acidity of vagina decreases if levels of lactobacilli decreases leading to growth of other bacteria’s. However, exact relationship of these harmful bacteria with BV is not known. COMPLICATIONS Bacterial vaginosis doesn’t generally cause complications. Sometimes, having bacterial vaginosis may lead to: During pregnancy– In pregnant women, bacterial vaginosis is linked to loss of pregnancy, early rupture of amniotic membranes, Chorioamnionitis, premature deliveries and low birth weight babies due to preterm labours. After Delivery-Postpartum Endometritis, an irritation or inflammation of uterine lining. Sexually transmitted infections– Bacterial vaginosis makes women more susceptible to sexually transmitted infections, like HIV, herpes simplex virus, chlamydia or gonorrhea. If you have HIV, bacterial vaginosis increases the chances of passing on the virus to your partner. Infection risk after gynecologic surgery- such as hysterectomy or dilation and curettage (D&C). Pelvic inflammatory disease (PID) – Bacterial vaginosis can sometimes cause an infection of the uterus and the fallopian tubes therefore the risk of infertility increases. Studies have shown that success rate of IVF decreases in BV. PREVENTION Minimize vaginal irritation- by using mild or nonscented soaps and tampons or pads. Don’t douche- douching disrupts the vaginal balance and may increase your risk of vaginal infection.  Avoid Sexually transmitted diseases- Use a male latex condom, limit your number of sex partners. Always wipe from front to back instead of back to front after using the bathroom. Wear cotton or cotton-lined underwear. Bacteria thrive in moist environments. Cotton helps wick away moisture. DIAGNOSIS The doctor will: Ask about your medical history- about previous STIs, etc. Do an overall physical exam Do a pelvic exam- for signs of infection, condition of pelvic organs Take a sample of discharge from your vagina to look for  bacteria Test your vaginal pH. A vaginal pH of 4.5 or higher is associated with bacterial vaginosis. TREATMENT Often it remains asymptomatic, but women with signs and symptoms should take treatment to avoid complications. Often antibiotics (metronidazole, clindamycin, tinidazole) are required to treat BV. This could be a tablet or a cream or gel you put into your vagina. Most females need to take treatments for 5 to 7 days. Finish full course of medicines, even if the symptoms go away. Incomplete medications course can lead to recurrence. Since BV can be spread through sex, so it is advisable to avoid sexual contact till treatment is finished. Female sexual partners should see their doctor to find out if they need treatment. IUDs users with BV can opt for other forms of contraception. To treat bacterial vaginosis, following medicaions can be prescribed: Metronidazole- This is given as oral forms mostly. Metronidazole is also be given as a topical gel to insert into the vagina. It is the most commonly used antibiotic. It is preferred over other antibiotics if the woman is breastfeeding or pregnant. Clindamycin -This medicine is available as a cream that you insert into your vagina. Clindamycin creams are known to weaken latex condoms- so take adequate precautions for atleast 3 days after stopping the treatment. Tinidazole-This medication is taken orally. Tinidazole reacts with alcohol, so avoid alcohol during treatment and for at least three days after completing treatment. Secnidazole -This is an antibiotic you take orally in one dose.  Generally it is not necessary to treat an infected woman’s male sexual partner, but it can spread among female sexual partners, so female partners should be tested and treated accordingly. It’s especially important for pregnant women with symptoms to be treated to decrease the risk of premature labour. RECURRENCE Around one-third of women whose symptoms disappear with treatment will have a recurrence within 3 months, and half will have a recurrence within 6 months. If more than three episodes occur within 12 months, the doctor may prescribe a vaginal metronidazole gel to use twice a week for 3 to 6 months. While current research shows there may be some benefit to probiotic therapy, more research is needed on the subject.

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21 September, 2021

Bleeding in Pregnancy

Authored By: Dr. K. Shilpi Reddy

Bleeding during pregnancy is relatively common, but it can be a dangerous sign. Visit your doctor even if its spotting or it stops. What causes bleeding early in pregnancy? Having sex- mostly due to pregnancy changes in cervix An infection Smoking Implantation Bleeding- When a fertilized egg (embryo) attaches to the lining of the uterus (womb) and begins to grow. Usually occur 10-14days after conception. It is harmless. Invasive testing like Amniocentesis and Chorionic villus sampling- done to check genetic abnormalities. Hormone changes. Medical conditions- Bleeding disorders Changes in your cervix. Occasionally bleeding or spotting in the first trimester can be due to a serious problem, like: Miscarriage- loss of pregnancy before 20weeks. Almost all women who miscarry have bleeding or spotting before the miscarriage. Bleeding can be along with pain abdomen. Ectopic pregnancy-fertilized egg implants outside uterine cavity and begins to grow.  Molar pregnancy- it is growth of abnormal tissue in the uterus, instead of a baby. Molar pregnancy is rare. What causes bleeding in the Second and Third Trimesters? Abnormal bleeding in late pregnancy is considered more serious because it can lead to severe complications to mother or baby.  Placenta previa-the placenta is located in lower uterine segment, partially or completely covers the internal OS. Placenta previa is not very common in the late third trimester, occurs in one in 200 pregnancies. It leads to painless bleeding. Placental abruption- In about 1% of pregnancies, the placenta separates its attachment on the uterus before or during labour. Placental abruption is very dangerous for the mother and baby both. It is often associated with severe abdominal pain, severe bleeding from the vagina, tender uterus, and backache. Uterine rupture-In rare cases, a scar from a previous C-section or uterine surgery can tear open during pregnancy. Uterine rupture can be life-threatening, and requires an emergency C-section. It can present with pain and tenderness in the abdomen. Vasa previa- In rare circumstances, baby’s blood vessels in the umbilical cord or placenta lies just above the opening to the birth canal. It can be fatal for the baby because the blood vessels can tear anytime, causing the baby to bleed severely and lose oxygen. It might be associated with abnormal fetal heart rate and excessive bleeding. Premature labor- Vaginal bleeding late in pregnancy can be due to your body getting ready to deliver. Preterm labour is when labour starts before 37th week of pregnancy. Other symptoms of preterm labor include contractions, vaginal discharge, abdominal pressure, and lower backache. Other causes of bleeding in late pregnancy are: Sex Internal examination by your doctor. SHOW- Mucus plug which was inside cervix during pregnancy comes out, as the cervix is getting ready for labour to start. It can happen anytime from few days before contractions start or during labour itself. Injury to the cervix or vagina Polyps- usually painless bleeding  Cancer What should you do if you have bleeding or spotting during pregnancy? Seeking medical attention immediately is must in case of- Heavy bleeding Bleeding with pain or cramping Dizziness and bleeding Pain in your belly or pelvis Passing some tissue with blood Keep a record of amount of bleeding, if it gets heavier or lighter, and number of pads you are using.  Check the color of the blood.  Your provider may want to know. Bleeding can be brown, dark or bright red. Do not use a tampon, douche or have sex during bleeding. Inform your Doctor if you are Rh Negative. Diagnosis To find out the cause of bleeding, you will need to have a detailed vaginal or pelvic examination, an ultrasound scan or hormonal levels through blood tests. Your doctor will inquire about other symptoms, like as abdominal cramp, dizziness and pain. Sometimes it might not be possible to find out what caused the bleeding. How are bleeding and spotting treated? Treatment depends on cause of the bleeding.  Rest is very important part of treatment during bleeding. Take time off from work and take rest for a little while. Don’t have sex, douche or use tampons. If your symptoms are not severe and you are preterm-you’ll be monitored and can be kept in hospital for observation. Severe Symptoms and term gestation can mandate delivery.

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18 September, 2021

Uterine Polyps

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What are uterine polyps? Uterine polyps or endometrial polyps are the growths that happen with in the lining of the uterus (womb- where in the baby grows in pregnancy). The polyps can be attached to the lining of the uterus by a thin stalk or thick broad base. They are usually no cancerous although sometimes we have to rule out precancerous or cancerous changes in them. Polyps can sometimes cause irregular bleeding or problems with fertility  Who can have uterine polyps? Uterine polyps are more likely to develop in women of 40-50 years age. They can also happen after menopause but rare in women under 20 years Women who are overweight or obese or those with high Blood pressure or those who use tamoxifen (medicine used in treatment of breast cancer) are more likely to develop uterine polyps. What are the reasons & why some women develop uterine polyps? The exact reasons are unknown Hormonal changes especially retrograde plays a role in causing the lining of the uterus to get thickened and thereby causing polyps. What symptoms can women have when they have uterine polyps? Women might experience heavy menstrual bleeding, irregular or unscheduled bleeding, spotting or bleeding in between periods, fertility problems. Most of the time polyps might not cause any problems and are detected at scans done for various other reasons. What tests are done to know if there is uterine polyp or not? After taking details of your symptoms and thorough clinical examination your doctor might ask for ultrasound scan. Pelvic ultrasound done from vagina is used to detect uterine polyps. As ultrasound uses only sound waves it is safe. Sometimes it is challenging to detect some polyps especially if lining is thicker or irregular. Saline can be passed through vagina into the uterus and scan done to get clear view of inside of the uterus. This is called saline sonogram or sonohysterogram. Sometimes biopsy done for lining if uterus can detect polyps. However polyps can be missed at biopsy. Hysteroscopy is considered to be good standard test to detect and treat uterine polyps. A small camera is passed through vagina and cervix into the uterus and fluid is used to distend the uterine cavity. Direct visualisation of lining of uterus is possible through this test. Major advantage is removal of polyps can be done at same time as the test. What treatment options are available for uterine polyps? Not all polyps need removal especially if women don’t have symptoms. However if irregularities of bleeding or polyps that are suspicious of cancer or precancerous or in women with history of miscarriages or fertility problems and in women polyps are noted after menopause removal is suggested. Medications – hormones like progesterone can be used for temporary treatment. Hysteroscopy and polyp removal is generally the treatment of choice. It enables not only the diagnosis but also ensures complete removal of polyp under vision thereby reducing the regrow of the polyp. Some polyps might reoccur despite complete removal. Just doing curettage without using the cope is not ideal. Additional surgeries might be required if polyps are precancerous or cancerous or recurrent. Can we prevent formation of uterine polyps? There is no way to prevent formation of polyps. However by reducing obesity and controlling high blood pressure we can prevent polyps indirectly. Those who are on tamoxifen medicine for breast cancer will need regular gynaecology check up to detect early. In some premenopausal women who have recurrent polyps and those who have completed family LNG -IUS (progesterone hormone containing coil) has shown to reduce the recurrence.

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18 September, 2021

Vaginal Fistulas

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What is a fistula? A fistula is an abnormal connection or channel or passage way connecting one internal organ to the other or to outside of the body. Where all can fistula form? Fistulas can form between anal passage and skin (back passage to surface of skin) called perinatal fistula. Bladder to bowel called enterovesical or colovesical fistula  Bowel to vagina – recto education or enterovesical fistula  Bowel to skin – enterocutaneous fistula  Bowel to bowel – enteroenteric or enterocolic fistula Bladder to vagina – vesicovaginal fistula  What is vesico-vagina fistula? Vesico-vaginal fistula is an abnormal connection between the bladder and vagina. When you have this fistula urine will constantly leak from vagina as vagina is not drained to hold urine like bladder. What are the symptoms of fistula?  Vaginal fistulas does not cause pain but it can cause some problems that will need medical care for example if there is vesico vaginal fistula- due to constant leak of Irvine genital area may get infected or sore. You can even experience pain during sexual intercourse. Sometimes fever, pain in the tummy, loose motions, weight loss, nausea and vomiting can happen. Most of the time quality of life is affected due to embarrassment of leaking that can lead to lot of psychological problems  What are the reasons & why some women develop fistula? Most often child birth is the reason especially if very prolonged labour and difficult delivery. Other reasons or causes include abdominal surgeries like caesarean or hysterectomies. Cancers- cervical or colon cancers  Radiation treatment  Bowel disease like crowns or diverticulitis  Infections after episiotomy or deep perineal tears at child birth Traumatic injury like after a road traffic accident  How do I know if I have a fistula? If you have any of the above said symptoms your doctor will do internal examination and can also perform some tests. Due test where your bladder will be filled with a floured s ok union and a tampon is placed in the vagina. If you have a fistula dye will leak into the vagina and tampon will be coloured.  Sometimes X- rays, camera tests like cystoscope or sigmoidoscope, CT scan of MRI will be used to diagnose fistulas.  What treatments are available for fistulas? Some fistulas may heal on their own especially if it is very small.  A small tube or catheter is passed into your bladder so that urine is drained constantly allowing fistula to heal. Sometimes special hours or plugs can be used to seal or fill the fistula.  Antibiotics might be used to treat infect caused by fistula.  Many people might need surgery. The type of surgery depends on the type of fistula, where it is located and the size of the fistula.  It could be done laparoscopic (key hole) or Abdominal (through a cut in your tummy) or through vagina. Special patches can be seen over the fistula of tissues from another place be used to close the fistula especially if fistula is between back passage and vagina.  What will happen if I don’t get treated for fistulas? Vaginal or urinary tract infections can keep coming back  Hygiene problems  Stool or gas can leak through vagina and anus Pus can collect called access  Fistulas can sometimes comeback despite treatment. Women who have crowns disease are especially at high risk of this recurrence.

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22 August, 2021

Obesity and Pregnancy

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WHAT IS OBESITY? Obesity is when your BMI is 30 or higher. To calculate your body mass index, divide your weight in kilograms by your height in meters squared. BMI Weight status Below 18.5 Underweight 18.5-24.9 Normal 25.0-29.9 Overweight 30.0 and higher Obesity EFFECTS OF OBESITY ON MY ABILITY OF GETTING PREGNANT? High BMI can reduce fertility by inhibiting normal ovulation. Even with regular ovulation, high BMI can reduce fertility significantly. Research has shown that higher the BMI higher are the chances of IVF failure. HOW MUCH WEIGHT SHOULD I GAIN DURING PREGNANCY? Pre-pregnancy weight and BMI helps in determining how much weight you need to gain during pregnancy. Single pregnancy – For BMI of 30 or higher and with one baby, the recommended weight gain is about 5 to 9 kilograms. Multiple pregnancy – For BMI of 30 or higher and with twins or multiples, the recommended weight gain is about 11 to 19 kilograms. For a BMI of 40 or higher, gaining less than the recommended amount or losing weight during pregnancy might lower the risk of a C-section or having a baby significantly larger than average. However, this might also increase the risk of having a small for gestational age baby. HOW OBESITY WILL EFFECT ME DURING PREGNANCY? Obesity during pregnancy lead to risk of several serious health problems: Gestational hypertension – High blood pressure during the second half of pregnancy is called gestational hypertension. It can lead to serious complications. Preeclampsia – Preeclampsia is a serious form of gestational hypertension that usually happens in the second half of pregnancy or soon after childbirth. This can lead to Kidney or Liver Failure. Rarely it can lead to, seizures, heart attack, and stroke can happen. It can also lead to problems with the placenta and growth problems for the fetus. Gestational diabetes – High levels of blood sugar during pregnancy increase the risk of having a very large baby. This also increases the chance of caesarean birth. Gestational diabetes puts you at a higher risk of diabetes mellitus in the future. So do their children. Obstructive sleep apnea – Sleep apnea is when a person stops breathing for short periods during sleep. During pregnancy, sleep apnea can lead to fatigue and increase the risk of high blood pressure, preeclampsia, and heart and lung disorders. HOW OBESITY WILL EFFECT MY BABY? Obesity increases the risk of: Birth defects – Babies might born with birth defects, such as heart defects and neural tube defects (NTDs) Problems with diagnostic tests – having too much body fat can make it difficult to see the baby’s anatomy on an ultrasound exam. Monitoring of baby’s heart rate during labor more difficult. Macrosomia – Baby is larger than normal leading to increased risk of injury during birth. The Baby’s shoulder can get stuck after the head is delivered as they are bigger. Macrosomia also increases the risk of caesarean birth. Babies  with too much body fat are at a greater risk of obesity. Preterm birth – Problems with a woman’s obesity are such as preeclampsia, may lead to a preterm birth for maternal safety. Preterm babies have an increased risk of short-term and long-term health problems. Stillbirth – The higher the BMI, the greater the risk of stillbirth. WHAT CAN BE DONE BEFORE PLANING PREGNANCY?  Before pregnancy, get a preconception check-up. Losing weight by exercises and diet before pregnancy is good for both you and your baby. Weight loss can improve your fertility. Bariatric surgery can be considered for people who are very obese or who have major health problems due to obesity. If you have weight loss surgery, you should delay getting pregnant for 1-2 years after surgery, when you will have the most rapid weight loss. HOW TO PLAN A SAFE PREGNANCY? During pregnancy, these precautions can help keep you and your baby healthy: Get early and regular prenatal care. Prenatal care are check-ups during pregnancy. Go to every prenatal care check-up, even if there are no complications. Your Doctor gives you prenatal tests, like a glucose screening test for diabetes and ultrasound for baby’s growth and development.   Talk to your doctor about how much weight to gain during pregnancy.   Eat healthy foods. Talk to a Dietician to help you plan your meals. It can help you make a healthy eating plan depending on your age, weight, height and physical activity. Don’t diet. Severe forms of dieting can reduce the nutrients your baby needs to grow and develop.  Do something active every day- activities that are safe for you like walking every day. Begin with 5min and gradually increase up to 30min walk every day. Swimming is a good form of exercise for pregnant women. The water supports your weight leading to less likelihood of injuries and muscle strain.  HOW DOES OBESITY AFFECT LABOUR AND DELIVERY? Obese women have prolong labors than women of normal weight. It can be harder to monitor the baby during the process of labor. So, obesity during pregnancy increases the chances of having a caesarean birth. In case of caesarean birth is needed, the risks of infection, bleeding, and other complications increases for a woman who is obese than for a woman of normal weight.

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