Gynecology Archives - Dr Deborjyoti Pal

• Early mobility is preferred. It decreases the chances of urinary retention, constipation, blood clots in legs and also drainage of post delivery unnecessary materials from the uterus
• Discharge from hospital (if no complications) should be within 2 days in a case of vaginal delivery & within 4 days in case of cesarean delivery.
• Mother should food according to her choice in adequate amounts. It should contain adequate amounts of proteins, carbohydrates, fats, vitamins and micronutrients. Can take advice from nutritionists if needed. Breast feeding mothers need higher caloric intake in their food (500 calories extra than non breast feeding women).
• Adequate sleep is needed. So any problems leading to less sleep for the new mother should be dealt with promptly.
• Constipation after delivery should be treated with food having high leafy vegetable content, lots of oral water intake (3 lit/day) and if needed laxatives can be used.
• Mother should try and pass urine as early as possible after a vaginal delivery. If passing urine becomes a problem due to pain in stitches or less bladder tone then an urinary catheter is inserted to evacuate urine. The catheter can be kept inserted into the bladder till bladder tone returns. In case of cesarean delivery same principle to be followed after removing urinary catheter inserted during the operation.
• Post vaginal delivery the vaginal and perineal stitch area should be kept clean & dry. Area should be washed with soap & water after every act of urination & defecation. Wiped with dry clean cloth. For initial 2 weeks an antibiotic ointment can be used to apply on perineal wound.

• Breast care

• Wear a nursing bra that fits well but is not too tight or restrictive, but actually supports the breasts well. Avoid underwired bra.
• Take daily bath. Wash breast with normal water only. Do not use soap as it causes cracked nipples by removing the protective coating on nipple and areola, derived from natural secretions of glands around the nipples.
• Nipple should be washed with water and cotton before & after each feed and kept dry between feeds.
• Change nursing pads if they become soiled or wet.

• Rooming-in

Hospital practice where mothers and normal babies stay together in the same room, all day from after delivery. This is to be practiced as it creates the much needed bonding between the baby and the mother. Helps in early initiation and sustenance of breast feeding. Also helps in making the mother conversant with the babies everyday habits and behaviour helping the mother to better raise their children.

• Vaccines

• Rubella vaccine if not given before pregnancy & mother in non immune to rubella virus.
• In Rh (-)ve mothers with Rh(+)ve babies Anti-D immunoglobulin injection has to be given within 72 hours of delivery.
• TDaP vaccine if missed in pregnancy.

Here I have tried to focus in brief about important aspects of normal post delivery care for mothers. This is certainly not an exhaustive discussion but any other queries can be dealt with adequately by your gynecologist or baby doctor if needed. You can also mail your queries to deborjyotipalqueries@outlook.com.

• WHAT IS USG?

USG or Ultrasonography is a very commonly used investigation in pregnancy. The basic mechanism is that sound waves are emitted by the usg probe placed on the abdomen or inside the vagina, which gets reflected back to the probe from the various structures of the baby and around it, to then be converted into an image on the usg machine screen.

Many patients fear that there are harmful rays in usg that may harm the fetus. But there are no such rays in usg, I can assure you all of that.

• PURPOSE: usg done at specific times during the pregnancy period to get information about how the pregnancy is developing, detect the possible presence of developmental defects both at structural and genetic levels & predict the development of certain harmful conditions in the developing baby, so that actions can be taken to prevent those harmful conditions from developing.

• TIMINGS & PURPOSE OF EACH USG:

• 6-8 weeks—Known as the ‘DATING SCAN’. It accurately gives the age of the fetus. Moreover, it detects for the first time the presence of a heartbeat in the baby. Importantly it also detects the number of developing babies and the exact location of the pregnancy. (Pregnancy developing in any location other than inside the uterus is known as ECTOPIC pregnancy & is very dangerous for the mother, sometimes leading to death if not detected early enough or not treated properly)

• 11-14 weeks—‘NT SCAN’. Simply speaking, the length of a translucent area at the back of the baby’s neck is measured. Also, the presence of nasal bone is looked for. Certain blood tests are done with maternal blood. All these data along with the maternal age at conception is taken into consideration for calculating the probability of the presence of certain chromosomal disorders and structural defects in the developing baby. Reported as ‘HIGH RISK’ or ‘LOW RISK’. High-risk mothers are evaluated more for coming to a definitive diagnosis.

Also, the location of the developing placenta (the organ that is responsible for supplying all nutrition and oxygen to the baby) is noted in this scan. Location is important as the placenta develops in the lower part, close to the lower opening of the uterus is a major concern, as it can result in repeated minor/major bleeding episodes in pregnancy, which keeps the gynecologist on his/her toes.

Read USG In Pregnancy Part 2 Here

In my 3 part blog on this topic, I have elaborated on ultrasonography in various phases of pregnancy and each of their importance. To know more on this topic you can mail me at deborjyotipalqueries@outlook.com.

You can also book appointments with me by calling on 9830047058/8017815356 OR you can go to the appointments section on www.deborjyotipal.com.

DEFINITION—

Acute and sudden development of inability to pass urine on one’s own will.
Sometimes it is accompanied by lower abdominal pain due to overdistension of the urinary bladder with huge amounts of stored urine if the inability persists for an appreciable amount of time.
Acute urinary retention occurs in approx. 4 to 5 pregnant women out of every 1000. In some studies, its occurrence is as low as 1 in 3000 pregnancies.

TIME OF OCCURRENCE—

Mostly occurs between the 10th to 16th week of pregnancy.

CAUSES—

• Most commonly there is dysfunction of urethral sphincter relaxation.
• Woman aged 35 or more during pregnancy.
• Previous abortion.
• Endometriosis.
• Recurrent history of pelvic infection.
• Women born with deformities of the uterus.
• Fibroid uterus.
• Abnormal shape of the pelvis.
• Urinary tract infection.

SYMPTOMS OF ACUTE URINARY RETENTION—

• Distress in passing urine with decreased flow requiring more effort.
• Stop starting flow during passing urine.
• Non-passage of urine causing bladder distension and pain in the lower belly.

CONSEQUENCES-

In advanced cases bladder rupture, hydronephrosis, Acute renal failure, and spontaneous abortion.

WHAT TO DO REGARDING ACUTE URINARY RETENTION IN PREGNANCY—

Early recognition of these symptoms and information passage to your gynecologist as early as possible is a must, to avoid severe consequences. Hospitalization and continuous catheter placement inside the bladder might be necessary for 48 hours. If managed properly and on time severe complications can be easily avoided. Post-discharge from the hospital, you might be prescribed certain exercises, which need to be done without fail.

To know more about this and seek help you can book an appointment with me by calling on 9830047058/8017815356 OR you can go to the appointments section on www.deborjyotipal.com.