Services

Cesarean Section / C-sections

What is a c-section?

A c-section, or cesarean section, is the delivery of a baby through a surgical incision in the mother's abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In others, it's done in response to an unforeseen complication.

Why would I have a scheduled c-section?

Sometimes it's clear that a woman will need a c-section even before she goes into labor. For example, you may require a planned c-section if:

* You've had a previous cesarean with a "classical" vertical uterine incision (this is relatively rare) or more than one previous c-section. Both of these significantly increase the risk that your uterus will rupture during a vaginal delivery.

* If you've had only one previous c-section with a horizontal uterine incision, you may be a good candidate for a vaginal birth after cesarean, or VBAC. (Note that the type of scar on your belly may not match the one on your uterus.)

* You've had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).

* You're carrying more than one baby. (Some twins can be delivered vaginally, but most of the time higher-order multiples require a c-section.)

* Your baby is expected to be very large (a condition known as macrosomia). This is particularly true if you're diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.

* Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally).

* You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).

* You have an obstruction, such as a large fibroid, that would make a vaginal delivery difficult or impossible.

* The baby has a known malformation or abnormality that would make a vaginal birth risky, such as some cases of open neural tube defects.

* You're HIV-positive, and blood tests done near the end of pregnancy show that you have a high viral load.

Note that your caregiver will schedule your surgery for no earlier than 39 weeks -- unless there is a medical reason to do so – in order to make sure the baby is mature enough to be born healthy.

Why would I have an emergency c-section?

You may need to have an emergency c-section if problems arise that make continuing or inducing labor dangerous to you or your baby. These include the following:

* Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven't worked.

* Your baby's heart rate gives your practitioner cause for concern, and she decides that your baby can't withstand continued labor or induction.

* The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs to be delivered immediately because a prolapsed cord can cut off his oxygen supply.

* Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won't get enough oxygen unless he's delivered right away.

* You have a genital herpes outbreak when you go into labor or when your water breaks (whichever happens first). Delivering your baby by c-section will help him avoid infection.

What can I expect during recovery after a c-section?

The stitches used for your uterus will dissolve in the body. The final layer – the skin – may be closed with stitches or staples, which are usually removed three days to a week later (or your doctor may choose to use stitches that dissolve on their own). Closing your uterus and belly will take a lot longer than opening you up, usually about 30 minutes.

After the surgery is complete, you'll be wheeled into a recovery room, where you'll be closely monitored for a few hours. If your baby is fine, he'll be with you in the recovery room and you can finally hold him. You'll receive fluids through your IV until you can eat and drink.

If you plan to breastfeed, give it a try now. You may find nursing more comfortable if you and your newborn lie on your sides facing each other.

You can expect to stay in the hospital for about three days. Your doctor will talk with you about your pain medication. Most use a patient-controlled anesthesia, through your IV, followed by pain pills as necessary when you're able to eat and drink.

Gynecology Laproscopy

Over the past decade, advances in surgical techniques have rapidly changed women’s health care. Now, less invasive approaches to accomplish the same goals of more traditional surgeries have become available. Traditional methods of gynecologic surgery typically involve large abdominal or vaginal incisions. Hospital stays with these methods usually last for several days, and recovery could take one to several months.

The ability to miniaturize equipment and use cameras to see inside the body has led to the advanced technology used in minimally invasive surgery. During minimally invasive surgery, small, thin fiberoptic scopes and laparoscopic surgical instruments are introduced in to the body through a few small incisions – each measuring less than half an inch in length. The technology allows us to visualize in detail and delicately manipulate small organs, arteries, and veins, thus reducing tissue damage and blood loss. Surgery time, anesthesia time, blood loss, and infection rate are all significantly reduced. The result has been less painful procedures with shorter hospitalizations, faster recovery times, less tissue damage, as well as reduced healthcare costs. Patients typically go home a few hours after their surgery, and time away from work is usually one to two weeks.

Dr. Tanuka Das (Gupta) specializes in Gynecology Laproscopy. She is attached with organisations having state of the art facilities to render best of the services.

Abortion Care

It is appropriately said that every child should be a wanted child. Sometimes a pregnancy may not be wanted. In this case one may seek an abortion. Abortion is legal provided it is carried out within the legal permits. An abortion can be done only up to 20 weeks of pregnancy.

Under the terms of the abortion act, doctors can agree to an abortion if they believe one or more of the following:

1. Continuing with the pregnancy would involve more risk to your physical or mental health than terminating it.

2. Continuing with the pregnancy would involve greater risk to your life than terminating it.

3. Any existing children of yours were likely to suffer if the pregnancy continued.

4. There is a substantial risk that the child would be deformed or seriously handicapped.

If one desires a termination of pregnancy then one should seek an abortion as early as possible as earlier it is done in the pregnancy safer it is.

The method of termination will depend on the weeks of gestation.

When the pregnancy is :

1. < 7 weeks – abortion can be done with just tablets. The tablets are safe effective and have a success rate of more than 90 %. The advantages are that the patient does not need any admission, anesthetic, any instrumentation of the uterus.

2. 7 – 12 weeks – then abortion is a simple procedure. It is done under an anesthetic in a day care center that is certified for abortion services. The patient is able to go home in a few hours.

3. 12 – 20 weeks – the procedure is a little lengthy and one may need to stay overnight in the hospital.

If you wish to seek an abortion or want further information then please feel free to contact Dr. Tanuka Das (Gupta).

Disclaimer

Abortion Services in India is a website designed to provide information on the abortion services available in India.

The information on this website should not be treated as medical advice, diagnosis or treatment, and should not be taken as a substitute for medical advice from a qualified medical practitioner.

Pregnancy Care

Pregnancy is one of the most precious times in the life of a woman. Nine months and then a bundle of joy is true happiness. This pleasure needs to be nurtured very well. Signs and symptoms of pregnancy.

The most common symptom is missing of a period. Occasionally one may have spotting at the time one would have expected the period. The other common symptoms are nausea, vomiting, shortness of breath, fatigue, and tiredness.On examination the doctor may notice a enlarged uterus which can be felt through the abdomen only when more than 12 weeks of pregnancy.

Diagnosis of pregnancy

The pregnancy hormone is ß- HCG. This is easily detected by a simple two minute home pregnancy test. An ultrasound examination can confirm the pregnancy. It will also give very valuable information on the number of fetuses, location of pregnancy, size of the sac and overall health and viability of the pregnancy.

Common problems in pregnancy

Nausea, vomiting and heartburn are common problems. One should avoid fried and spicy foods and maintain good hydration. It is safe to take doxylamine, and vitamin B -6 which are effective in preventing and controlling the symptoms. Ondansetron has also been used effectively. One may also have loss of appetite and very peculiarly have complete aversion to sight of some foods.

Constipation is also a common problem. It can lead to piles and unnecessary blood loss during pregnancy. Increasing fluid and fibre intake, and stool softeners can help tide over the situation.

The three trimesters of pregnancy

The first trimester

This is from the time of conception to 12 weeks.

The commonest symptoms during this time are nausea, vomiting, and heartburn. These can be easily treated.

The commonest problem during this time is a miscarriage i.e. pregnancy loss. This will present as abnormal vaginal bleeding per vaginum and may be associated with pain. It is diagnosed on ultrasound examination.

The second trimester

This lasts from 12 weeks to 28 weeks

By this time the nausea and vomiting subside. The risk of miscarriage is reduced. Formation of the major organs is completed by 20 weeks. After that the fetus is increasing in size.

The third trimester

This lasts from the 28 weeks to 40 weeks. It is at this time that many important medical issues may surface. Anemia may worsen. One may develop pregnancy induced high blood pressure and gestational diabetes which have implications on the health of both the mother and the fetus.

It is during this time that one may go into preterm labor. There is risk of bleeding during this time mainly due to two causes i.e. abruption and placenta previa.

Labour

This may start any time after 37 weeks. In fact most women will deliver before the due date. Only a small percentage actually delivers on the due date and a few will go beyond the date.

The common symptoms of labor are

- Onset of labor pains i.e. contractions that gradually increase in amplitude and frequency.

- Passage of thick blood stained mucoid discharge.

- Breaking of the forewaters i.e. leaking of the liquor.

The common signs of labor are

- Confirmation of the above

- Dilatation of the neck of the womb i.e. cervix

- Descent of the presenting part of the fetus

First stage

This starts from the onset of labor to the time of full dilatation. The woman is admitted to the delivery suite. Monitoring of the labor process is done continuously to ensure that there is good progress. Cardiotocographic monitoring is routinely done to ensure wellbeing of the fetus.

Painless labor

In modern obstetrics there is no place for a painful labor. The timely use of epidural analgesia has made labor a memorable experience.

Second stage

This starts from full dilatation to the delivery of the fetus.

This stage is also very crucial as prolonged second stage can lead to instrumental and /or traumatic delivery for the mother, fistulas and asphyxia in the fetus.

Third stage

This stage starts at the delivery of the fetus and ends with the delivery of the placenta.

This is an important phase wherein sudden large amount of blood loss can occur due to various reasons. Active management of this phase is required as the blood loss can be prevented.

Post delivery

The patients are discharged within 24 – 48 hours after vaginal delivery and in three days after a cesarean section. Lactation is encouraged as soon as the baby is delivered.

Good care of the breast and the episiotomy is advised. Patients are advised to follow up for discussion and implementation of contraception.

Routine checks in pregnancy

The first antenatal visit is recommended as soon as the pregnancy is suspected or diagnosed. The subsequent visits can be done as follows.

• Once a month up to 28 weeks.

• Twice a month up to 34 weeks

• Then once a week up to delivery

This is only an approximate schedule for a low risk uncomplicated pregnancy. The schedule can change according to the circumstances at that time.The commonly advised tests are CBC, blood group, Thyroid estimation, HIV, VDRL, HBsAg, sugar level estimation and routine urine analysis. Various special tests may be required depending on various medical situations eg. Antiphospholipid antibody in cases of recurrent miscarriage.Triple marker is offered to all at 16 weeks. Obstetric ultrasound examination is done at various stages- in first trimester for dating, location of pregnancy and to look for multiple pregnancies, in second trimester for the study of anatomic defects, and in the third trimester for growth. Additional ultrasound and Doppler examination will be required in special circumstances for eg Preterm labor and abnormal bleeding in pregnancy.

CBC and sugar tolerance is repeated at 28 weeks.

Common supplements in pregnancy.

Iron and calcium supplements are commonly given to pregnant women. Folic acid supplement is given even preconception and continued into the first trimester. There is enough scientific evidence to support its use to prevent neural tube defects. Tetanus toxoid is given, usually two doses one month apart starting at 28 weeks. The role of Essential fatty acids, Vitamin E, Lecithin and Arginine are not yet convincing and therefore not recommended as a routine.

Dr. Tanuka Das (Gupta) has a passion for obstetrics i.e. care of women in pregnancy. You can feel free to ask queries regarding this important event in your life. She provides quality compassionate care during pregnancy.

Hysterectomy

Laparoscopic Hysterectomy utilizes the latest minimally invasive surgical techniques to remove the uterus through small (lcm) abdominal incisions. This procedure is indicated for heavy and irregular menstruation unresponsive to medical management, symptomatic fibroids, or pelvic pain from endometriosis/adenomosis or pelvic adhesive disease.

In the Laparoscopic Supracervical Hysterectomy, or LSH, the uterus is excised laparoscopically and removed, leaving a portion of the cervix behind. A special device called a morcellator is utilized to cut the uterine specimen into strips that are removed through a one-half inch diameter incision. The cervix is left in place to maintain sexual sensation and function. It also serves as prevention for future pelvic floor or vaginal apex prolapse. The procedure requires general anesthesia with a hospital stay, either as same-day surgery or overnight. There is usually less blood loss and less post-operative pain than traditional abdominal or vaginal hysterectomy. Recovery before returning to work is usually 10 days to 2 weeks.

Dr. Tanuka Das (Gupta) specializes in Gynecology Laproscopy. She is attached with organisations having state of the art facilities to render best of the services.

Hysteroscopy

Hysteroscopy is the use of a telescope-like instrument with a video camera to visually inspect the lining of the uterus (endometrium). It is commonly used to diagnose problems of the lining of the lining of the uterus including endometrial polyps, submucosal uterine fibroids, and uterine anomalies.

Operative hysteroscopy requires general or regional anesthesia and can be performed as an outpatient procedure.

Dr. Tanuka Das (Gupta) is attached with organisations having state of the art facilities to render best of the services.

Ovarian Cystectomy

The normal ovary by nature is a partially cystic structure. Most ovarian cysts develop as consequence of disordered ovulation in which the follicle fails to release the oocyte. The follicular cells continue to secrete fluid and expand the follicle, which over time can become cystic. Ovarian cysts are quite common and involve all age groups, occurring in both symptomatic and non-symptomatic females.

The ovaries are the female pelvic reproductive organs that house the ova and are also responsible for the production of sex hormones. They are paired organs located on either side of the uterus within the broad ligament below the uterine (fallopian) tubes. The ovary is within the ovarian fossa, a space that is bound by the external iliac vessels, obliterated umbilical artery, and the ureter. The ovaries are responsible for housing and releasing ova, or eggs, necessary for reproduction.

Indeed, ovarian cysts are one of the common gynecologic cause of hospital admissions. Most cysts spontaneously resolve while some will persist. The persistent ovarian cysts are most likely to be surgically managed. The standard surgical approach to presumptively benign ovarian cysts is the laparoscopic ovarian cystectomy.

Dr. Tanuka Das (Gupta) specializes in Gynecology Laproscopy. She is attached with organisations having state of the art facilities to render best of the services.

Endometrial Ablation

Endometrial ablation is a procedure that destroys (ablates) the uterine lining, or endometrium. This procedure is used to treat abnormal uterine bleeding. Sometimes a lighted viewing instrument (hysteroscope) is used to see inside the uterus.

Endometrial ablation can be done by:

* Laser beam (laser thermal ablation).

* Heat (thermal ablation), using:

* Radiofrequency.

* A balloon filled with saline solution that has been heated to 85°C (185°F) (thermal balloon ablation).

* Normal saline (heated free fluid).

* Electricity, using a resectoscope with a loop or rolling ball electrode.

* Freezing.

* Microwave.

The endometrium heals by scarring, which usually reduces or prevents uterine bleeding.

Endometrial ablation may be done in an outpatient facility or your doctor's clinic. The procedure can take up to about 45 minutes. The procedure may be done using a local or spinal anesthesia. And general anesthesia is sometimes used.

Infertility treatment

Fertility treatments can be grouped into three categories:

Medicines to improve fertility

These are sometimes used alone but can also be used in addition to assisted conception.

Surgical treatments

These may be used when a cause of the infertility is found that may be helped by an operation.

* Fallopian tube problems

* Endometriosis

* Polycystic ovary syndrome (PCOS)

* Fibroids

* Male infertility

Assisted conception

This includes several techniques such as:

Intrauterine insemination (IUI).

In vitro fertilisation (IVF).

Gamete intrafallopian transfer (GIFT).

Intracytoplasmic sperm injection (ICSI).

Dr. Tanuka Das (Gupta) offers the whole range of basic management of infertility. These services can be easily conducted at the centres visited by Dr. Tanuka Das (Gupta).

Evaluation of Infertility

Approximately 15 % of couples require assistance with conceiving. The reasons for inability to conceive spontaneously may be related to either of the partners or may be unexplained. If a couple has not been able to achieve a pregnancy within one year then they are offered investigations and further management.

Basic tests include hormonal profile, tubal patency and semen analysis. Dr. Tanuka Das (Gupta) offers the whole range of basic management of infertility such as follicular studies, ovulation induction, intrauterine insemination, and donor insemination.

Surgical procedures such as ovarian drilling for polycystic ovaries, removal of endometriomas, adhesiolysis, and resection of the uterine septum can be easily conducted at the centres visited by Dr. Tanuka Das (Gupta).

Invitro fertilization and embryo transfer (IVF-ET) commonly called as test tube baby, and other services such as ovum donation, sperm banking, and surrogacy are offered in collaboration with well established assisted reproduction centers.

Gynae Problems

There are many reasons why you might need to see a gynaecologist. It may be something as simple yet distressing as heavy periods or urinary incontinence or it may be something more complex such as having difficulty in conceiving or treating cancer. Whatever the problem, there is often a simple solution.

Below mentioned are some of the common gynae related problems:

* Abnormal Cervical Smears

* Bladder Problems

* Endometriosis

* Fertility Problems

* Gynaecological Cancer

* Heavy Periods/Menorrhagia

* Menopause

* Ovarian Cysts

* Pelvic Floor Problems

* Polycystic Ovary Syndrome

* Polyps

* Post Menopausal Bleeding

* Prolapse

* Vaginal Discharge

* Vulval Problems

Dr. Tanuka Das (Gupta) gives a patient ear to all your problems and is happy to answer all your queries so as to help provide each of her patients' an educating and informative treatment.

Teenage Counselling

The teenage years are a very special phase. Young girls are curious to understand their changing bodies. They have many questions and are seeking answers. These answers go a long way in building her confidence and a positive attitude towards the physical change that she will experience.

TEENAGE COUNSELLING

In our teenage counseling program, we conduct an informative counseling session in an open-friendly atmosphere. The young girl is informed about the normal body anatomy, physiology and the menstrual hygiene. Healthy habits regarding diet & exercise are promoted. Young girls have many misconceptions and myths regarding menstruation. Some of the common ones are questions like why one cannot go to the temple during periods and why should one not swim during periods? We address these whilst respecting the social/religious sentiments. Puberty & menarche are important milestones in a girl’s life. It is now the time to prepare her for womanhood. Sexual education is an important subject and needs to be handled well. Professional expertise is valuable in addition to the role of parents, teachers & peer educators. In our counseling sessions we provide information on various issues such as how one gets pregnant, how to prevent pregnancy, what are sexually transmitted infections, and safe sex.

TEENAGE HEALTHCARE:

Pain during periods is the most common reason for approaching a doctor and it can be very distressing. It may be severe enough to affect daily routine of the young girl. It is easily treated with simple analgesics, exercises & hot fomentation.

Acne, hirsutism, delayed or irregular periods, vaginal discharge, itching are some of the common problems for which a teenager may seek medical help.

Heavy prolonged periods are common during the first few years after menarche. Young girls occasionally become anemic due to heavy periods. Therefore it is vital to identify them. They may need not only haematinics but also hormonal medication to control the situation. It is not uncommon for the youth to indulge into sexual activity. It is imperative that they are well informed so that they can practice safe sex. Contrary to popular belief, providing information does not promote promiscuity. Teenage pregnancy is no longer uncommon. In such situation professional advice is given in a sensitive manner and confidentiality is respected. Legal Abortion is provided.

Youth of today are not uninformed but are misinformed. Dr. Tanuka Das (Gupta) aims to provide accurate scientific information and care in an unbiased, youth friendly atmosphere.