Friday, September 30, 2011

Change of address

This post is to inform all my patients that I am shifting my residence cum clinic to

E 71,Arjun Marg,DLF Phase 1,Gurgaon,Haryana.The clinic shall be functional only in 2nd week of October.Inconvenience caused is regretted.http://maps.google.co.in/maps?hl=en&q=E71+Arjun+Marg+DLF+Phase+1+haryana&rlz=1W1ADFA_enIN436&gs_sm=e&gs_upl=8372l18233l3l18744l20l20l0l0l0l0l349l4515l0.6.9.4l20l0&bav=on.2,or.r_gc.r_pw.&biw=1280&bih=568&wrapid=tlif131735586413710&um=1&ie=UTF-8&sa=N&tab=wl

Friday, September 23, 2011

A brave girl with fibroid

More than three years back,a young Lady in her thirties visited me for some gynaecological problem.She had come from a not so small town of Utter Pradesh .She was quite stressed out,when she and her brother entred my chamber.

She was an unmarried and had been diagnosed with Fibroid uterus which was quite big in size .In fact it had engulfed the posterior wall of her uterus completely.There was an associated endometriotic cyst as well.Doctors had advised her a Hysterectomy .

She was heartbroken.she ,wished her uterus to be preserved.I examined her and told her that we can certainly try myomectomy ( removal of fibroid) but if she bleed heavily we might need a hysterecyomy.

Those were the days when I was more than happy doing the conventional open myomectomy and not the Laparoscopic one.When I opened her abdomen,it was all plastered(all the organs were stuck).I decided to carry on with myomectomy after separating the bad adhesion and removing the endometrioma.Slowly I managed to peel off the big posterior wall fibroid.In between our the then HOD Dr Veena Bhat peeped in my OT and she was convinced that I was trying to be foolhardy in preserving her uterus,Maybe she was right as what was left of posterior wall of uterus was just a very thin muscle layer.With great patience which isn't my virtue,I repaired the tattered edges of uterus.Some how I recreated an organ which looked like uterus.Dr Deepa Maheshwari who was assisting me was also concerned of a possible gangrene
Now the question was whether the uterus will heal or get gangrenous.God willing, it stayed in its place.She started getting her normal periods which weren't painful any longer.Ultrasound couple of month later suggested a normal size Uterus with normal sized endometrium.The young lady was very happy.She still keeps on sending me her good wishes all the time and I value it a lot.










But that was not the end of the story.I had suggested her to tell the complete thing to the person she would marry as uterus might not be so strong to take the brunt of pregnancy for nine months.She could have very well gone for a surrogacy.And with her uterus intact she felt good about her preserved femininity.

But unfortunately till I know last none of the boys she told her actual situation were willing to accept her.It is strange.We are OK to accept lies but it is very difficult for our males to take the honesty of the lady on face value and marry her.What if that girl had cheated and not told any of these males and would have created a story later on post marriage,which isn't very uncommon.

All said and done Females in India still remain a weaker sex.

Wednesday, September 21, 2011

Do you know someone with leaking bladder?

My Blog readers will get a general impression that I very often burst into 'when I was in Uk'.......I realize that I talk very often of you.You miss things which are good about a place when you are away from it.I was a very interested trainee,as any of my trainers including Mr Plemming and Mr Banfield or mr Klazinga or Miss Armstong or Dr Bolton would agree.
Of other subjects what interested me was Urogynaecology.If I had stayed in UK would have like to subspecalize in it.I miss it suddenly so much.
Urogynaecology is one area where the Ladies feel ashamed to share their problems.There are millions of females world over who have a leaking bladder ( be it on coughing or just overactive bladder which makes them rush to the nearest rest room every 10 minutes).
There are ladies with big prolapsing uterus and bladder and rectum.All of which compromises their quality of life badly.But then they are too embarrassed to share it with any one though the help is very near.
Surely if I get few patients of urogynaecology from this blog the money maker in me will surely be happy.But it isn't just the money maker,it is the urogynaecologist in me who has seen instant relief to such patients.Who has seen how after a successful treatment the life of such patient changes ,wishes to create more awareness regarding these conditions.
If any of the readers knows any lady of any socioeconomic group,please pass on my contact details to her.I would love to help them in which ever possible way I can,

 

Sunday, September 18, 2011

There is nothing like a best Gynaecologist!!

There is a website which due to some reason has given my name as best gynaecologist in Gurgaon.I am thankful to them.To be honest this website has encouraged many patients to meet me.
But honestly I believe that there can be a good Gynaecologist but there can never a best Gynaecologist.I will try to explain it by two personal examples.
A lady name Savita(Fake name to protect the identity of the patient) started coming to me for her antenatal visits.Her husband had done some research about my competence and used to come all the way from Delhi.Now this lady was a 35 +lady with a possible ongoing Diabetes of pregnancy which she wasn't willing to accept.Got a GTT done and doubts were confirmed.Refd her to the Diabetologist who put her on Insulin and diabetic diet.All for her good,but the Lady started getting depressed as she wasn't able to eat what she used to like.She was angry with me as well.My suggestions on healthy eating wasn't taken very kindly.Then I suggested a Induced delivery at 37 completed weeks as there is ample evidence of unexplained foetal deaths in Diabetic mothers.She wasn't ready as it would have meant delivery in Shharadh paksh.
   So what happened next.She wasn't happy with me.Preferred to go to some senior Gynaecologist from AIIMS.Anyways I wish her a safe delivery.but what I wish to highlight is that for whatever reasons they didn't find me good enough.

Now I will come to my second experience.Yesterday night I delivered a Lady vaginally.her first delivery was a Caesarean delivery for small pelvis at my hospital only,about 3 years back.She had heard that I deal with VBAC( vaginal birth after caesarean section).So she visited me in  her 28th week.Expressed her keen desire to have a vaginal delivery but not at my Hospital.It took a little explaining that Administrators never force us for a caesarean.

Today when I went for my morning rounds,she smiled and told me.......ask Dr Shalabh(my husband) to refer you as a gynaecologist if any one ever asks his opinion for the best gynaecologist.I was little confused.I asked her.......did Dr Shalabh refer you to me.She said,not you doc but to the gynaecologist to whom I went for my delivery first time who declared that I had small pelvis and gave me this scar.We had asked Dr Shalabh about the competence of the other doctor and he had said....she is very Good( So that speaks Volumes about Dr shalabh's professional behaviour of being a neutral doctor).She told me in end,Doc, all other prominent names had declined me a VBAC in this pregnancy.So for this lady I am the best gynaecologist.This lady surely made my day and I felt proud and happy.

So finally ,just wish to say the same doctor who isn't good enough for a couple for whom she made the diagnosis ,took care in her high risk pregnancy becomes the best for other couple.So may be it is better to be called just a good doctor rather than the best . 
What is HPV? Genital human papillomavirus (HPV)
 HPV is usually spread through sexual contact. Most HPV infections don’t cause any symptoms, and go away on their own like most of the viral infections.

HPV is the most common sexually transmitted virus in the world. More than half of sexually active men and women are infected with HPV at some time in their lives. cervical cancer in women is caused by HPV.HPV is also associated with several less common cancers, such as vaginal and vulvar cancers in women and other types of cancer in both men and women. It can also cause genital warts and warts in the throat.Cervical cancer is the 2nd leading cause of cancer deaths among women around the world
There is no cure for HPV infection, but some of the problems it causes can be treated. 

HPV vaccine 
HPV vaccine is important because protection from HPV vaccine is expected to be long-lasting. But vaccination is not a substitute for cervical cancer screening. Women should still get regular Pap tests. It can prevent most cases of cervical cancer ( approx 72 %) in females, if it is given before a person is exposed to the virus. n addition to preventing cervical cancer, it can also prevent vaginal and vulvar cancer in females, and genital warts in both males and females.
 Who should get this HPVvaccine and when?
Females: Routine Vaccination • HPV vaccine is recommended for females between 9 to 26 years. Why is HPV vaccine given to girls at this age? It is important for girls to get HPV vaccine before their fi rst sexual contact – because they won’t have been exposed to human papillomavirus. Once a girl or woman has been infected with the virus, the vaccine might not work as well or might not work at all. Females: Catch-Up Vaccination • The vaccine is also recommended for girls and womenupto 40 years of age but with suboptimal benefit. Males Males 9 through 26 years of age may get HPV vaccine to prevent genital warts. As with females, it is best to be vaccinated before the fi rst sexual contact.
HPV vaccine is given as a 3-dose series
1st Dose

Now

2nd Dose

1 to 2 months after Dose 1

3rd Dose

6 months after Dose 1

For further details you can visit
See
http://www.immunize.org/vis

Saturday, September 17, 2011

GBS(Group B streptococcus) Screening in pregnancy

Recently one of would be mom asked me about GBS screening.In past too couple of Ladies wished to know about GBS.Ii follow th British Protocol and will share with you soon.The American protocol calls for screening of all the pregnant Ladies.What follows is a direct cut,copy and paste from patient information leaflet of RCOG London.You can also visit http://www.rcog.org.uk/ for many other such important patient information leaflets.

Key Points

  • Group B streptococcus (GBS) is one of many bacteria that normally lives in our bodies, including in the vagina and rectum, and usually causes no harm.
  • About a quarter of pregnant women in the UK carry GBS in their vagina (this is called GBS carriage or colonisation with GBS).
  • GBS carriage is not routinely screened for during pregnancy in the UK.
  • GBS can be passed on from a mother to her baby. If this happens, it can occasionally cause severe illness in newborn babies. This is known as neonatal GBS.
  • Out of every 2000 newborn babies in the UK and Ireland, only one is diagnosed with neonatal GBS, but it can be very serious.
  • The risk of GBS being passed from a mother to a baby is highest during labour or at the time of the birth.
  • If GBS is found in your vagina when you are pregnant, or if you have had a baby with neonatal GBS, you may be offered antibiotics during your labour.
  • If your baby develops early onset neonatal GBS, he or she should be treated with antibiotics.
  • It is recommended that you breastfeed your new baby in the usual way. Breastfeeding has not been demonstrated to increase the risk of GBS and will protect your baby against other infections.

About this information

This information is intended for you if you are expecting a baby or planning to become pregnant. It tells you about:
  • Group B streptococcus (GBS) infection in babies in the first week after birth, otherwise known as early onset neonatal GBS infection, and referred to as ‘GBS’ throughout this information
  • why GBS can be dangerous for newborn babies
  • the most effective ways recommended in the UK for preventing GBS in newborn babies.
It aims to help you and your healthcare team make the best decisions about your care. It is not meant to replace advice from a doctor, midwife or nurse about your own situation.
This information does not tell you about:
  • why GBS causes symptoms in the newborn baby
  • late-onset GBS, which occurs after the first week of birth
  • the reason some women carry GBS in their vagina during pregnancy and others do not.
If you would like further information on these topics, please ask your healthcare professional.
  • Some of the recommendations here may not apply to you. This could be because of another illness you have, your general health, your wishes, or some or all of these things. If you think the treatment or care you get does not match what we describe here, talk about this with your doctor, midwife, nurse or another member of your healthcare team.

What is GBS?

GBS is part of the streptococcus family. It is a common bacterium (not a virus) which, like several others, normally lives in your body, including in the vagina and rectum (known as GBS carriage or colonisation). GBS usually causes no harm. However, if GBS is passed on from the mother to her baby around the time of the birth this can occasionally cause serious illness for the newborn baby.

What could it mean for my baby?

About a quarter of pregnant women in the UK carry GBS in their vagina. Many babies therefore come into contact with GBS during labour or during birth, and GBS will colonise some of them. The vast majority of babies are not harmed by contact with GBS at birth.
A small number of babies, however, develop GBS infection and may become seriously ill.
Most babies who are infected show symptoms within 12 hours of birth. They may be floppy and unresponsive and may not feed well. Other symptoms may include grunting, high or low temperature, fast or slow heart rates, fast or slow breathing rates, irritability, low blood pressure and low blood sugar.
Out of every 2000 newborn babies in the UK and Ireland, only one is diagnosed with GBS infection; this means that about 340 babies each year are diagnosed with earlyonset neonatal GBS. Around one baby dies out of every ten who are diagnosed. Although it is rare, GBS is the most common cause of life-threatening infection in babies during the first week after birth.
For a few babies who become ill but who have already had antibiotics, the doctors may suspect the illness is due to GBS infection although it is not possible to confirm this diagnosis (as the antibiotics will have already killed the bacterium).
If there seems to be a higher risk of your baby being infected with GBS or if you have had a previous baby with GBS infection, you should be offered antibiotics during labour to reduce the chances of your baby developing the infection. Babies who show signs of GBS infection need to be treated with antibiotics to get well.
It is safe to breastfeed your new baby. Breastfeeding has not been demonstrated to increase the risk of GBS infection, and it protects against many other infections.

Are there tests for GBS?

GBS carriage may sometimes be detected during pregnancy in the course of tests for other infections by taking a sample by swab (similar to a cotton bud) from your vagina and/or rectum.
As GBS can cause urine infection in pregnant women, GBS infection may also be detected by taking a mid-stream urine sample (MSU), which is then sent to a laboratory for analysis. Urine infection caused by GBS should be treated with antibiotics.
Currently the evidence suggests that screening all pregnant women routinely would not be beneficial overall. You can be tested privately for GBS but the RCOG does not recommend this because a positive test may possibly result in unnecessary and potentially harmful interventions. If a test is done, the most sensitive method of detection requires swabs from the vagina and rectum that are cultured in the laboratory in a special solution. It is important to be aware that a negative swab test does not guarantee that you are not a carrier of GBS.
If there is a concern that a baby has GBS infection after birth, you will be offered treatment for your baby and testing to confirm that GBS is the cause of the infection. This testing will involve taking a sample of blood, or a sample of fluid from the spinal cord. Routine testing for GBS is not necessary.

Why is there no national screening programme for GBS?

You will not be offered a test routinely for GBS carriage during pregnancy as there is no national screening programme for this in the UK. There is conflicting evidence, and differing views, about whether a national screening programme would be effective. Research is being carried out to provide a clearer picture.
The RCOG guideline Prevention of early onset neonatal Group B streptococcal disease has carefully considered the benefits and harms of screening for GBS carriage during pregnancy. It agreed that there is still no clear evidence to show that screening all pregnant women in the UK would be beneficial overall. One of the potential harms of screening for GBS carriage during pregnancy is that large numbers of women would be given antibiotics during labour. The possible risks of this are:
  • death or serious injury to a very few women from an allergic reaction (anaphylaxis) to the antibiotics
  • strains of bacteria becoming resistant to antibiotics.

What can help reduce the risk of GBS?

In some circumstances antibiotics can help to reduce the risk of a baby developing GBS and so you may be offered antibiotics during labour if:
  • GBS has been found in your urine in your current pregnancy
  • GBS has been found on swabs from your vagina and/or rectum which have been taken for another reason
  • you have previously had a baby with GBS infection
  • you are at higher risk of passing on GBS to your baby.This may be because:
    • you have a high temperature during labour
    • you go into labour prematurely (prior to 37 completed weeks of pregnancy)
    • you give birth more than 18 hours after your waters have broken.
Depending upon your particular circumstance, your healthcare professional will discuss the option of antibiotic treatment during labour.
Penicillin is normally given; if you are allergic to penicillin, you should be offered an appropriate alternative. If your doctor thinks you may have an infection but is not sure of the cause, you should be offered antibiotics that will treat a wide range of infections including GBS.

When antibiotics are not necessary

If you carry GBS in your vagina, you should not need antibiotic treatment:
  • if GBS was detected in your vagina in a previous pregnancy and the baby was not affected
  • during pregnancy, unless you have a symptomatic infection (for example, a urine infection) though you may require antibiotics in labour.
  • if you have a planned caesarean section before you go into labour and before your waters break.
The reason why antibiotics are not usually needed in these situations is that the risk of your baby becoming infected with GBS is so low and because antibiotics do not reduce your chances of carrying GBS at the time of the birth.

What will my treatment involve?

If you need antibiotics during your labour, it is best if you can start them as soon as possible after your labour starts. This will be given through a vein (intravenously). You should be offered further doses as necessary until the birth.
If you need intravenous antibiotics, it may not be possible to give birth at home or in some midwifery units. This may be a factor in your decision on where you will give birth.
If you need antibiotics during labour there may be concern about the risk of infection for your baby if for some reason you were not able to receive them, or if you delivered very soon after receiving them. The best approach in these circumstances is not clear. The options of monitoring the health of your baby, or of treating him or her with penicillin, should be discussed between you and the medical staff taking account of the potential risks and benefits of each approach.

What treatment is available for my baby?

Babies with any signs of GBS infection, for example, if the newborn baby is floppy and unresponsive and does not feed well, should be treated with antibiotics as soon as possible.
If you have had a previous baby with GBS, your healthcare team should either monitor the health of your newborn baby closely for at least 12 hours after birth, or treat him or her with penicillin until blood tests confirm whether or not GBS is present.
Babies who show no signs of GBS and who are well do not routinely receive antibiotics or tests for GBS.
More research is needed before we can be sure about the best way to identify and treat babies who were at ‘higher risk’ of GBS during labour and who appear healthy after birth. Your healthcare professional will keep you informed about the need to test and treat your baby for GBS after birth.

Are there any risks with antibiotics?

Some women have a specific allergy to antibiotics (see section Why is there no national screening programme for GBS?). Some women may experience temporary side effects such as diarrhoea or nausea. However, for most women antibiotics are safe. Your doctor or midwife should discuss the benefits and risks of taking antibiotics during labour for you as an individual.
It is thought that babies exposed to antibiotics very early in their lives may have a higher than normal risk of asthma and/or other allergies later in life.

What might happen without treatment?

If your doctor recommends that you take antibiotics because of risk factors such as a high temperature in labour, and you choose not to, your baby may be at higher risk of GBS infection.
If your baby has GBS infection and is not treated with antibiotics, he or she is likely to become seriously ill and may die.

Is there anything else I should know?

  • No screening test is entirely accurate. A screening test for GBS carriage could give a falsely negative result. In other words, a woman would be given a negative result when in fact she carried GBS in her vagina.
  • No treatment can be guaranteed to work all the time for everyone. Even with antibiotic treatment in labour, some babies still develop GBS infection.
  • You have the right to be fully informed about your health care and to make decisions about it. Your healthcare team should respect these decisions.

Sources and acknowledgements

This information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Prevention of early onset neonatal Group B streptococcal disease (which was published in November 2003 and is due to be reviewed in November 2006). This information will also be reviewed, and updated if necessary, once the guideline has been reviewed. The guideline contains a full list of the sources of evidence we have used.
Clinical guidelines are written to improve care for patients. They are drawn up by teams of medical professionals and consumers’ representatives, who look at the best research evidence available and make recommendations based on this evidence.
This information has been developed by the Patient Information Subgroup of the RCOG Guidelines and Audit Committee, with input from the Consumers’ Forum and the authors of the clinical guideline. It was reviewed by women attending clinics in Bristol, Liverpool and London. The final version is the responsibility of the RCOG Guidelines and Audit Committee.

Other organisations

These organisations offer support:
Group B Strep Support
PO Box 203
Haywards Heath
West Sussex RH16 1GF
Tel: +44 (0) 1444 416176
Email: info@gbss.org.uk
Website: http://www.gbss.org.uk/
The National Childbirth Trust
Alexandra House
Oldham Terrace
Acton
London W3 6NH
Tel: +44 (0) 870 7703236
Email: enquiries@national-childbirth-trust.co.uk
Website: http://www.nctpregnancyandbabycare.com/
© Royal College of Obstetricians and Gynaecologists 2006
The RCOG consents to the reproduction of this document providing full acknowledgement is made. The text of this publication may accordingly be used for printing with the addition of local information or as the basis for audiotapes or for translations into other languages. Information relating to clinical recommendations must not be changed.
Date published: 01/01/2007

Friday, September 16, 2011

Internet.......Use and abuse

If one logs in,Internet is full of blogs,comments and feed backs which are most uncomplimentary for the doctors.And few blogs like http://www.gurgaonwatch.com/ who try to give little balanced view are attacked by people claiming it to be supporting the doctors and are being compensated in lieu of that.My sincere thanks to you Vaibhav.Keep it up!!
What is the reason for such a negativity about us doctors?Are we really so bad or is it just that people who had a bad experience are more forthcoming in sharing their views online than people who had good experiences.
So being so vocal is not  being politically correct........when I express myself so openly.But can't help it.At the moment I am running short of time.Will get back to you in evening to share my experiences with some of my patients whom I would never like to have back as my patients.

PS : Today is 17th sept.And by now am feeling less agitated.Have decided not to go in great details about it.Just two examples........
One couple was so full of air throughout the pregnancy.Then they wished to know about stem cell banking which is costly in India but then it is optional and you don't need to feel guilty about it if you can't afford it.In his all seriousness,the husband said, doctor I will purchase a stem cell bank.I don't think in that case we need to go for it now.Needless to say that was their attitude throughout.They thought they had purchased the doctor,Nurse ,administrator etc by spending the Corporate Insurance money on a single room delivery.

Another one was a lady who ultimately left my care and I am so glad she did.I am sure for her I was a rude doctor,but actually I don't mind.There were many bizarre queries throughout.But the most interesting was as follows.She wished me to tell if massages were safe in Pregnancy.To which I said yes.then she sent me a long list of various types of massage : Swedish,thai,Balanese,some ambhigayanam massage which I had never heard of,keralite and few more exotic names which I had no clue of.now for God's sake I am a doctor.Not a masseur.

And ofcourse that control freak who wanted me to teach her husband to measure her progress in labour at home by doing an internal examination as he enjoyed the world cup matches.

And all of you thought................being doctor was easy!!

Thursday, September 15, 2011

Always Choose your Teacher (Guru) Carefully

Today I attended a workshop on Urogynaecology.There was a live demonstration of a surgery called TVTO.A fairly simple surgery ,done nicely by the surgeon who was performing it.There was a small audience of local gynaecologists and Urologists,quite a few well known names as well.Many questions were asked,many questions answered during the surgery,though very nicely done........with the amount of questions and answers this surgery generated it sounded like quite a complicated and very demanding procedure.If I was a beginner,I would have been little scared to perform this surgery .

Let me share with you how I did my first TVTO.It was my first OT with Mr Derek Klazinga at Glan Clwyd Hospital,Rhyl.I was a trainee.There were three TVTOs posted for the day.He performed the first one.Then he asked me ,have you done one before?I said ,''No".His next question was,do you wish to do the next one and I jumped and said 'yes'!!.There it was .He kept on explaining me the procedure and in 20 minutes the operation was done and over.Goes without saying that he let me perform the third one as well.He made the surgery look so simple.

I was a registrar in India in 2000.There was this one consultant ,who would shout so much during the laparoscopic surgeries that I would get nervous and used to think Laparoscopy as the most difficult surgery in the world.In fact I was sure in my mind that never would I be able to perform laparoscopic surgeries.I reached UK ,with the same mindset and explained it to my Consultant Mr Tivy Jones and Dr Chris Clark.They encouraged me by saying, Mona ,it is not so difficult.Just imagine putting a niddle inside the abdomen to drain ascitic fluid.It is as simple as that.And very soon I was performing laparoscopies.They made it so simple.

Then once I was performing a diagnostic laparoscopy.There were quite a few omental adhesions.I got nervous.Mr Banfield,asked to proceed with the adhesiolysis.And I said ,I have never done it before.'Mona,there is always a first time for everything,remember'.And there I was performing ,my first adhesiolysis.

I had registered for my level 1 laparoscopy training with prof B lynch.It was meant to be a hands on diagnostic laparoscopy.But guess what?When I put the scope in,it was a big size Ovarian cyst.And I muttered again,I have never done a cystectomy before.And he said quite compassionately,but I am sure you will perform many more in future.This is just the first one.And to my own amazement,I had performed the first Ovarian cystectomy.

All of them were great Gurus.I was blessed to have met some great teachers in my life who made me realize life wasn't as difficult as it seemed if your approach was correct. 

Monday, September 12, 2011

Episiotomy........to have it or not??

I follow RCOG (london) Guidelines to the core in my day to day practice.And it works well for me and my patients.But there is one area where I personally am not convinced about the guidelines due to the clinical experiences.
It is recommended not to give a routine episiotomy.In UK as well, I was called by the midwives to repair big bad tears which I always believed a timely episiotomy could have saved.
Now ,In India  as ladies are googling a lot and read these Biritish and American books on Pregnancy,they also wish the 'cut' to be minimized or avoided.I try to do so,but recently it ended in fourth degree tear of one of my patients.The dreaded Complete perineal tear.I feel really sorry for the lady.There wasn't any high risk factor.A very easy 'lift off' ventouse delivery for foetal bradycardia in 2nd stage.The lady is obese but that doesn't increase the risk of CPT.
Took her to OT for the anorectal repair and the perineal muscle repair and the repair of anal spincter.This is day 3 of the delivery.She is doing Ok.But with CPT one expects problems only later.......a fistula or anal incontinence.I have done a satisfactory job as the surgeon and I hope with little bit of luck  she won't have these complications.Atleast that is my sincere wish.
But again I am debating whether it is a good practice to give routine cut in all the first time pregnant ladies.May be that is what i will do in future.

Thursday, September 8, 2011

The Lady who had Dermoid in Pregnancy-Part 2

Sometime back I blogged about a Lady who I had operated upon for removing a big dermoid cyst while she was still pregnant.As ,at that point of time few of my friends were not sure whether I had done the correct thing by not terminating the Pregnancy,I promised you guys that I will update you about the outcome of this Pregnancy.
So 2 days back at 38 + weeks she was Induced for Labour as water surrounding the baby had decreased(moderate oligohydramnios,baby was mild IUGR,Umblical and Uterine artery showed higher than normal resistance and there were two tight loops of cord around the neck of the baby.She delivered a 2.5 kgs healthy male baby by ventouse delivery despite all the mentioned high risk factors and the  cord around the neck overhyped as and indication of caesarean section by Radiologists,gynaecologists and naturally patients alike.
That is not all.While she was pregnant her Downs Screening reports(double as well as quadruple) suggested her ,this Pregnancy to be a high risk for downs.She decided not to go for an amniocentesis as her astrologer told her that with a very strong Jupiter in her birth chart nothing will go wrong.That astrologer also had told her that it will be a vaginal delivery and it will be a male child.Amazing............
Planning to meet this amazing astrologer :)

Monday, September 5, 2011

Broadligament fibroid for TLH and Obturator fossa dissection

video video

Need an answer from you......

It is a common occurrence.I get call anytime in night.11pm,12 MN......Patients having Problems.Pregnancy with bleeding ,pain etc.So,how can I reassure you that your Pregnancy is safe?By getting you examined.And for that I advice all such Patients to come to the Hospital emergency to be examined by the Junior consultant gynaecologist on call.
The moment I ask them to go to the Hospital emergency...........Typical question is....In the night Doctor?Is it so urgent,but the pain or bleeding or any XYZ complain is not so bad.If I persist.......if you find it an emergency enough to give me a call so late in the night or so early in the morning I think it is an emergency enough to be examined and they are really reluctant.
This is a mystery for me.What actually are your expectations from me?I would appreciate if any one of you, who had such experience with me,could please let me know that what are your expectations when you give me an emergency call if you don't wish to come to hospital in the night?Knowing your expectations will help me  serve you better!!

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