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SERVICES WE PROVIDE

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.

Diagnosis Of Pre-Existing Diseases

Pre-existing diseases are not directly related to the pregnancy but can cause risk during the pregnancy. We have state of the art facilities for diagnosing and treating them....

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Post-Natal Care

A few percentage of kids are born pre-term or pre-matured i.e. before the 37 weeks of gestational age. We have a skilled team which takes care of you and your baby after you give b...

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Pregnancy Care

Our obstetric experts take care of the mother and baby during the pregnancy throughout the trimesters to ensure a healthy delivery. We won’t let you forget any of your check-up and...

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Doctors

photo of Dr. Vasundara Cheepurupalli

Dr. Vasundara Cheepurupalli

Senior Consultant Gynaecologist, Robotic and Laparoscopic Surgeon, Cosmetic Gynaecologist and Obstetrician

photo of Dr. G. Usha Ravi

Dr. G. Usha Ravi

Consultant Obstetrician & Gynaecologist

photo of Dr. M. Madhavi

Dr. M. Madhavi

Consultant Obstetrician, Gynaecologist, Laparoscopic Surgeon & Infertility Specialist

photo of Dr. G. Nikila Reddy

Dr. G. Nikila Reddy

Consultant Obstetrician, Gynaecologist & Laparoscopic Surgeon

photo of Dr. Srujana Siddhani

Dr. Srujana Siddhani

Consultant Obstetrician, Gynaecologist & Laparoscopic Surgeon

photo of Dr. Sindhura Vaddamani

Dr. Sindhura Vaddamani

Consultant Obstetrician & Gynaecologist, Specialist in High-Risk Obstetrics & Maternal Medicine

Patient Testimonials


Mrs. Priyanka Kumari


Patient Testimonial: Successful #NormalDelivery under Dr. Vasundara Cheepurupalli at KIMS Cuddles


Mrs. Kalyani


Mrs. G. Kavitha


Mrs. Neha Begum


Mrs. Usha Rani


Mrs. Naga Vijaya Teja Mani


Mrs. Priyank Kumari


Mrs. C. Mounika


Mrs. Satya Kumari

Doctor Videos


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


Dr. Sindhura Vaddamani, 9 Months Full Term Care, Antenatal Care, Gynaecology Services, Hi-Risk Pregnancy, Maternity services, Obstetrics, Painless Delivery, Pregnancy Nutrition, VBAC, Woman Health Services


Dr. G. Nikila Reddy, Ms. Pooja Marathe, Fitness & Care, Obstetrics, Pregnancy Nutrition, Woman Health Services


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

Health Blogs

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28 August, 2024

Preparing for Pregnancy

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A Guide for Expectant MothersPreconception Checkups: The First StepBefore you embark on the journey of pregnancy, it's crucial to ensure your body is ready. Scheduling a preconception checkup with your healthcare provider is the first step. During this session, your doctor will go over your medical history, current health status and any medications you may be taking. This checkup is an opportunity to identify and manage any health issues that could affect your pregnancy.Key Tests and ScreeningsYour preconception checkup may include:Blood tests can determine anemia, blood type, and immunity to infections such as rubella and chickenpox.Screening for sexually transmitted infections (STIs).Assessing your vaccination status and updating any necessary vaccines.A discussion on managing chronic conditions such as diabetes or hypertension.Nutrition Tips for Expectant MothersNutrition is extremely important in preparing your body for pregnancy. A well balanced diet contains critical nutrients that promote fetal and mother health.Key NutrientsFolic Acid: Critical for preventing neural tube abnormalities. Aim for at least 400 micrograms per day from fortified meals or supplements.Iron: Promotes increased blood volume and avoids anemia. Include iron-rich foods like lean meats, spinach and legumes.Calcium: Essential for fetal bone development. Consume dairy products, leafy greens and fortified plant based milks.Omega-3 Fatty Acids: Is essential for brain and eye development. Include fatty fish, such as salmon, walnuts and flaxseeds.HydrationMaintain hydration by drinking lots of water throughout the day. Proper hydration improves overall health and helps alleviate typical pregnancy symptoms such as constipation and exhaustion.Exercise Recommendations for Expectant MothersRegular exercise activity can help boost your overall health, lift your spirits, and prepare your body for the demands of pregnancy and labor. Exercise can also lower the risk of gestational diabetes, preeclampsia and excess weight gain.Safe ExercisesWalking: A easy and effective technique to stay active without overworking your body.Swimming: Provides a full body workout while being gentle on the joints.Prenatal Yoga: Enhances flexibility, reduces stress and promotes relaxation.Strength Training: Helps build muscle endurance. Use light weights and avoid heavy lifting.Exercise TipsConsult Your Doctor: Before beginning any fitness plan, speak with your doctor, especially if you have any pre-existing health concerns. Listen to Your Body: Avoid high-impact or contact sports. Stop exercising if you have any pain, dizziness or shortness of breath.Stay Hydrated: Drink water before, during and after exercise to stay hydrated.Final ThoughtsPreparing for pregnancy involves a holistic approach that includes medical checkups, proper nutrition and regular exercise. By following these steps, you can increase your chances of having a healthy pregnancy and an easy transition into parenthood. Remember that every woman's body is unique, so speak with healthcare professionals to create a strategy that meets your specific needs.Begin this lovely journey with confidence and care, knowing that you're doing everything you can to give your future kid the greatest possible start.

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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

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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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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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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08 July, 2021

Understanding Urinary Incontinence

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Urinary incontinence is the involuntary loss of urine. Urinary incontinence may be a temporary condition that results from an underlying medical condition.The severity ranges from occasionally leaking urine when you cough or sneeze to having an intense urge to urinate that you don’t get to a toilet in time. Though it occurs more frequently as people get older, urinary incontinence isn’t an inevitable consequence of aging. SYMPTOMS Based on symptoms there are following types of incontinence- Stress incontinence. Urine leaks when when there is pressure on bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Urge incontinence. It is a sudden, intense urge to urinate leading to involuntary loss of urine. It can be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes. Overflow incontinence. Its frequent or constant dribbling of urine due to incomplete emptying of bladder. Functional incontinence. A physical or mental impairment leads to inability to reach toilet in time.  Mixed incontinence. Presence of more than one type of urinary incontinence. CAUSES Urinary incontinence isn’t a disease, it’s a symptom. It can be caused by routine habits, underlying medical conditions or physical problems. Temporary urinary incontinence Certain drinks, foods and medications acts as diuretics -They include: Alcohol Caffeine Carbonated drinks and sparkling water Artificial sweeteners Chocolate Chili peppers Foods high in spice, sugar or acid especially citrus fruits Heart and blood pressure medications, sedatives, and muscle relaxants Large doses of vitamin C Urinary incontinence may also be caused by medical condition those can be treated easily such as: Urinary tract infection. Infections irritates urinary bladder, leading to strong urges to urinate, and occasionally incontinence. Constipation. The rectum is located near the bladder and shares similar nerve supply. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency. Persistent urinary incontinence Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including: Pregnancy. Hormonal changes induced by pregnancy and the increased weight of the fetus can lead to stress incontinence. Childbirth. Muscles supporting bladder and bladder nerves gets damaged in the process of vaginal birth. Changes with age. Aging of the bladder muscle leads to decrease in storage capacity of bladder. Also, frequency of involuntary bladder contractions increases as you get older. Menopause. After menopause deficiency of estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence. Hysterectomy. In women, the supporting muscles and ligaments are same for bladder and uterus. Any surgery that involves a woman’s reproductive system, may damage the supporting pelvic floor muscles, which can lead to incontinence. Obstruction. A tumor  along urinary tract blocks the normal flow of urine, leading to overflow incontinence. Urinary stones or stone-like masses that form in the bladder — sometimes cause urine leakage. Neurological disorders. Parkinson’s disease, Multiple sclerosis, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence. DIAGNOSIS Thorough history and physical examination. Simple maneuver like coughing can demonstrate incontinence. Urinalysis- is done to look for signs of infection, traces of blood or other abnormalities in urine. Bladder diary. For several days a record has to be maintained mentioning how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes. Post-void residual measurement.  If further information is needed tests, such as urodynamic testing and pelvic ultrasound might be recommended . These tests are usually recommeded prior to surgery. TREATMENT Specific treatment for urinary incontinence will be determined based on: Your age, overall health and medical history Type of incontinence and extent of the disease Your tolerance for specific medications, procedures or therapies Expectations for the course of the disease Treatment may include: Behavioral therapies: Bladder training: Trains people to resist the urge to void and gradually increase the intervals between voiding. Toileting assistance: Uses routine or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking. Diet modifications: Removing bladder irritants, such as caffeine, alcohol and citrus fruits from diet. Pelvic muscle rehabilitation (to improve pelvic muscle functioning) Kegel exercises: can improve, and even prevent, urinary incontinence. Biofeedback: Used with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles. Vaginal weight training: Small weights are held within the vagina which leads to strenghtening the vaginal muscles. Pelvic floor electrical stimulation: Mild electrical pulses are given to pelvic floor muscles which stimulate muscle contractions. Medication : Anticholinergic medications Vaginal estrogen Pessary (is worn inside the vagina to prevent leakage) Office procedure Botox injections into bladder Urethral bulking agents Peripheral nerve stimulation Surgery  Slings (can be synthetic or natural tissue) Bladder suspension Peripheral nerve stimulation

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08 July, 2021

Yoga In Pregnancy

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Prenatal yoga is a form of gentle yoga that is designed according to the growing needs of a pregnant body during all three trimesters. The focus is on poses that keep you safe while practicing movement, stretching, deep breathing, and mental centering. The American college of Obstetricians and Gynaecologists say that modified or prenatal yoga is one of the safest forms of exercise during pregnancy with correct guidance.. They also recommend combining a yoga practice with other types of activity such as swimming, walking or stationary cycling. Are there any health benefits? Yoga during pregnancy is beneficial, especially for addressing the physical, emotional, and mental aspects of this critical time. Keeps the body active. Prenatal yoga builds mobility,flexibility and strength, which helps in supporting and maintaining a healthy body during pregnancy. Stabilizes your mood. Yoga is known for its ability to help reduce stree and manage symptoms of anxiety. Helps with mental centering. Help you to develop awareness of yourself, your body, and your baby. Reduces overall symptom burden of pregnancy. Pregnancy can put a lot of added pressure on your lower back, and your body which leads to pain in areas such as the lower back.Prenatal Yoga helps in reducing these pains and improving the stride and gait during walking. Focuses on pelvic floor muscles. Prenatal yoga classes often emphasize strengthening the pelvic floor muscles, which helps in childbirth. Encourages breathing exercises. Prenatal yoga helps to use breathing as a tool when we encounter stress in our lives, and learning to breathe through new feelings and sensations helps you lessen anxiety and concern during pregnancy. Prepares the body for childbirth. Helps to open up hips and keep correct postural alignment, which helps with labor and delivery. Increased well-being in young pregnant women. Encourages community support. Prenatal yoga class is an excellent place to connect with other expecting moms that can help support you during pregnancy and beyond. When To Start? First Trimester– If you are doing Yoga prior to pregnancy, then it can be continued. Second Trimester-Avoid Yoga poses which require lyng flat on abdomen or back. As Balance is a problem during second trimester, consider using props like- yoga pillows, straps, blocks, etc. Third Trimester-Avoid balancing poses. Focus on breathing and relaxation techniques as it will help in relieving physical and emotional challenges of third trimester. When to Avoid? Medical conditions like Heart disease, lung disorder. High BP History of miscarriages If you have high hisk of Preterm Labor Multi fetal gestation Placenta previa/low lying placenta What can be done? Cat/cow stretch Standing back bend Warrior on a chair Standing Warrior Cobbler’s or tailor’s pose Squatting Side-lying position Hip Rotations What can not be done? Revolved side angle pose. Full wheel pose. Bridge pose. Bow pose. Cobra pose. Locust pose. Full camel pose. Upward facing dog. Precautions To Be Followed Talk to your prenatal care provider. Always check with your doctor if you are fit to do yoga and rule out any contraindications. Take general precautions. Follow general precautions of exercises- stay hydrated before and after exercises. Take it easy. Focus on breathing during yoga sessions. Iif you are already an expert in yoga, be ready to make some modifications considering your pregnancy. Any pain or discomfort requires to make an adjustment or ask your instructor to recommend an alternative position. Hold poses only for as long as you’re comfortable and don’t push yourself to the point of pain or exhaustion. Be aware of body changes. Your joints will relax and loosen up during pregnancy, so change positions slowly and carefully. Your changing body can affect your balance, so go slow. Take proper safety measures especially during third trimester, consider using a wall or chair for support. Avoid lying on your back, especially after the first trimester as it can put pressure on your inferior vena cava and reduce blood flow to your uterus. Skip headstands and shoulder stands. Don’t hold poses for a long time. Skip positions that require extreme stretching of the abdominal muscles. Avoid doing yoga in hot, humid conditions.

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