Oral Contraceptive Pills

The combined oral contraceptive pill (COCP), often referred to as the birth control pill or as “the pill”, is a type of birth control that is designed to be taken orally by women. It includes a combination of an oestrogen and progesterone.

Women take the pill by mouth to prevent pregnancy and it can be 99% effective if it’s taken correctly and continuously. However, the pill does not protect against sexually transmitted diseases, including HIV (the virus that causes AIDS).

What are the types of birth control pills?

Combination pills

Combination pills contain synthetic (man-made) forms of the hormones oestrogen and progestin. Most pills in each cycle are active, which means they contain hormones. The remaining pills are inactive, which means they don’t contain hormones. There are several types of combination pills like Monophasic pills(same dose of hormone in 1  cycle),Multiphasic pills(different levels of hormone in 1 cycle),extended pills(13 weeks cycle)

Progestin-only pills

Progestin-only pills contain progestin and no oestrogen. This type of pill is also called the mini pill. Progestin-only pills may be a good choice for women who can’t take oestrogen for health or other reasons.

Deciding on a type of birth control pill

Not every type of pill is a good fit for every woman. Talk to your doctor about which pill option would work best for you. Factors that can affect your choice include:

  •         your menstrual symptoms
  •         whether you are breastfeeding
  •         your cardiovascular health
  •         other chronic health conditions you may have
  •         other medications you may be taking

How do birth control pills work?

Combination pills work in two ways. First, they prevent your body from ovulating. This means that your ovaries won’t release an egg each month. Second, these pills cause your body to thicken your cervical mucus. This mucus is fluid around your cervix that helps sperm travel to your uterus so it can fertilize an egg. The thickened mucus helps prevent sperm from reaching the uterus.

Progestin-only pills also work in a few different ways. Mainly, they work by thickening your cervical mucus and by thinning your endometrium.

How do I use birth control pills?

You will receive a set of pills packaged in a thin strip. Pill packs containing regular birth control pills have either 21 or 28 pills.

Twenty-one-day pill packs contain 21 active pills.

Twenty-eight day pill packs contain 21 active pills and seven inactive (placebo) pills.

The pill packs are marked with the days of the week to remind you to take a pill every day. The seven inactive pills in the 28-day pill pack are added so that you are reminded to start a new pill pack after 28 days.

How Soon Do Birth Control Pills Work?

When taken as directed, birth control pills are usually effective the first month you begin taking them. To be safe, some doctors recommend the use of another form of birth control, such as condoms and foam, during the first month. After the first month, you can just rely on the pill for birth control.

What are the advantages?

  • Up to 99% effective
  • Easy to use
  • Doesn’t get in the way of sex
  • Lighter blood flow and lesser cramps.
  • As soon as you stop taking the pill, you can get pregnant
  • It reduces your risk of ovarian and endometrial (lining of the uterus) cancer by 50%
  • Some pills can help with pimples/acne, ectopic pregnancy, thinning of bones, anaemia associated with excessive blood loss during periods, and non-cancerous breast growths.

What are the disadvantages of birth control pills?

Birth control pills don’t protect against sexually transmitted infections. To make sure you’re protected against these infections, you need to use condoms in addition to your daily pill.

Also, you have to remember to take your pill every day. And you need to make sure you always have a new pack ready to go when you finish a pack. If you miss a pill or delay starting a new pack after finishing a cycle, your risk of pregnancy increases.

Are there any side effects?

Serious side effects are rare. Smokers have increased risk of stroke or heart disease.

Some pills can increase the risk of blood clots in the legs from 2 in 10,000 women per year to 6 times that rate.The risk of a blood clot from the pill is higher for certain women. This includes women who:

  •         are very overweight
  •         have high blood pressure
  •         are on bed rest for long periods

If any of these factors apply to you, talk with your doctor about the risks of using birth control pills.

We will discuss How to use Oral Contraceptive Pills in subsequent articles.

-Dr Prerna Gaur

Acknowledgements-

https://www.webmd.com/sex/birth-control/birth-control-pills#4

https://www.medicinenet.com/oral_contraceptives_birth_control_pills/article.htm

https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/

 

Fever in Pregnancy

It is a well-known fact that pregnancy is a state of low immunity. Fevers during pregnancy are not unusual.

It must be remembered that fever is only a symptom. Mild fevers that last only a short time usually are not a concern. If your temperature reaches 100 degrees F, consult your doctor.

It is advisable to keep an idea of the symptoms of few basic diseases causing fever. Reach out to your doctor if you have fever with any of the following signs –

Urinary Tract Infection(UTI) – in case of symptoms like high urge to urinate, sensation of burning while passing urine, cloudy urine or blood in it, pelvic pain, UTI must be suspected.

Common Cold – In situations when the infection persists beyond 2 weeks or if symptoms of common cold are getting worse, there is a high likelihood that the cause is much severe .Do not delay in such cases and immediately consult your doctor.

Influenza – if the fever is accompanied by chills, nausea, coughing, vomiting and body pains, then this might be influenza. Pregnant women are at higher risk of developing flu and can get seriously ill due to their suppressed immune system.

Gastrointestinal Virus – Besides fever, GI bug can cause vomiting and diarrhoea that may culminate in serious problems for pregnant mothers if not treated in time.

Important Do’s and Don’ts –

– A low fever in early pregnancy does not cause serious problem but having high fever is dangerous for baby. Therefore it is very important to get it in control as soon as possible.  Paracetamol is safe to be taken but not for more than 3 to 4 days without consulting the doctor..

– Even if fever subsides on its own or after taking paracetamol/acetaminophen, it’s always best to play it safe and see your doctor anyway

– Drink plenty of water and other cool beverages to prevent dehydration

– Take a tepid bath or shower or use a cool cloth on your head.

– If the fever is accompanied by vomiting or diarrhoea then Vital electrolytes lost through vomiting and diarrhoea, must be replenished.

– Consume balanced and healthy diet which contains fruits and vegetables. This healthy diet will supply you several antioxidant vitamins and minerals which helps in fighting infections

– Get plenty of rest when you have fever. Inactivity helps the body to stay cool and decreases falling and stumbling risk because of dizziness.

– If you are in your first trimester and have a fever higher than 102 degrees, be sure to seek treatment right away. This will help prevent short- and long-term complications for your developing baby

 

By,

Dr.Afroze Fatima

References

http://www.newkidscenter.com/Fever-During-Pregnancy.html

https://www.webmd.com/baby/tc/fever-during-pregnancy-topic-overview

https://www.healthline.com/health/pregnancy/could-fever-harm-my-baby#4

https://www.thebump.com/a/fever-during-pregnancy

https://www.whattoexpect.com/pregnancy/pregnancy-health/fever-during-pregnancy/

 

Postpartum depression

Being a new mother is a challenging phase as lots of adjustments are needed. Hence dealing with disruption of sleep wake cycle, responsibility of the baby, breastfeeding irregularities and recovery from the delivery is difficult. All these issues can lead to “Baby blues” or minor mood swings and irritability which generally disappears in a week or two post delivery without any treatment.

Postpartum depression is severe clinical depression after child birth.It can occur soon after delivery or within a year and requires treatment.

Causes of postpartum depression

Causes can be

  • Changes in body both before and after delivery
  • Changes in work and social relationships
  • Less time and freedom for leisure
  • Lack of sleep
  • Worrying about the ability to be a good mother
  • Inadequate support from the partner and family

What are the risk factors?

You may have a higher chance of developing postpartum depression, if you are

  • Under 20 years of age
  • Did not plan the pregnancy and have mixed feelings about it.
  • Had history of depression in the past or in the family
  • Have poor relationship with the partner, or a single parent
  • Financial and social issues
  • Currently drinks alcohol, smokes or takes illegal substances
  • Dealing with death, illness of a dear one

Symptoms of postpartum depression

Feelings of anxiety, restlessness, mood swings and tearfulness just after pregnancy is known as baby blues which mostly disappear in a week without treatment.

Postpartum depression may occur when the baby blues do not fade away or when signs of depression start 1 or more months after childbirth.

The symptoms of postpartum depression are the same as the symptoms of depression. Along with a sad or depressed mood, you may have some of the following symptoms:

  • Agitation or irritability
  • Changes in appetite
  • Feelings of worthlessness or guilt
  • Feeling like you are withdrawn or disconnected
  • Lack of pleasure or interest in most or all activities
  • Loss of concentration
  • Loss of energy
  • Problems in doing daily routine tasks
  • Significant anxiety
  • Thoughts of death or suicide
  • Troubled sleep

Also a mother with postpartum depression will be unable to take care of the baby and herself, will be afraid to be alone with the baby and may have negative feelings towards the baby.

Diagnosis

Diagnosis is made by the doctor on the basis of symptoms and history of your illness. If you feel you have any of the symptoms mentioned above, see your physician immediately.

Treatment

Treatment of postpartum depression includes medication and counselling. You may be advised appropriate medication which help in balancing certain brain chemicals linked to depression.

Counselling by a psychologist will help in dealing with the depression better. It helps in recognising negative feelings and handling them in a better way. So it is important to seek help of the psychiatrist as soon as the diagnosis is made.

If you’ve been diagnosed with postpartum depression, there are many things you can do to help yourself

  • Ask your partner, family, and friends for help with the baby’s needs and in the home.
  • DO NOT hide your feelings. Talk about them with your near ones.
  • DO NOT make any major life changes during pregnancy or right after giving birth.
  • DO NOT try to do too much, or to be perfect.
  • Make time to go out, visit friends, or spend time alone with your partner.
  • Rest as much as you can. Sleep when the baby is sleeping.
  • Talk with other mothers or join a support group.

Having good support of your family, partner and friends may help reduce the seriousness of the illness. Also timely diagnosis and treatment will help in quicker recovery. If you have any symptoms of depression as mentioned above, do not ignore it as just mood swings and seek medical help at the earliest.

-Dr Prerna Gaur

Acknowledgements

https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression

https://www.nhs.uk/conditions/post-natal-depression/symptoms/

https://www.medicalnewstoday.com/articles/237109.php

 

Premenstrual syndrome (PMS)

PMS is a condition that affects women’s physical and mental health which typically begin from 2-7 days before menstruation and usually disappears as soon as the periods start.
PMS is frustrating not only for the women but also for those around her.

Symptoms:

  • Breast tenderness
  • Acne
  • Sudden Mood swings
  • Irritability
  • Bloating of stomach
  • weight gain(temporary)
  • Swelling of fingers, toes and face.
  • Depression
  • Lethargy
  • headache
  • Back pain
  • Joint pain
  • Food cravings
  • Irritability, mood swings, crying spells 

No one knows what causes PMS, but hormonal changes trigger the symptoms.

Risk factors:

Women who are at an increased risk of suffering from PMS :

  • Have a family history of PMS
  • Lead a sedentary lifestyle
  • Take an unhealthy diet
  • Are below 30 years of age
  • Have more than two children
  • Suffer from high-stress levels


Some Dos and Don’t for to manage PMS

Do’s:

  • Have a diet high in carbohydrate and low in fat
  • Consume foods rich in vitamin B6 and vitamin E like fish,whole grains, and wheat germ as well as green leafy vegetables and fruits.
  • Take calcium- rich foods such as milk, paneer, curd, fenugreek, drumstick leaves and ragi
  • Finding relaxing activities that relieve tension, such as reading, watching a movie, going for a walk, or having a bath
  • Regular walking, cycling abdominal and pelvic exercises
  • Stretching and breathing exercises, such as yoga
  • Quit smoking, if you are a smoker

Don’t

  1. Take foods containing caffeine like coffee, tea and chocolate in excess.
  2.  Take refined carbohydrates, sugars and tobacco.
  3. Take foods which are oily, fried and spicy.
  4. Skip meals. Follow a regular meal schedule to maintain a more stable blood sugar level.
  5. Sleep too little
  6. Drink alcohol.

When to see a doctor:
You need to visit a doctor if any of your symptoms especially your mood swings, depression, or abdomen, joint and muscle pains are interfering with your day to day activities, or if they do not go away even after menstruation has stopped.

Treatment:

  • Many women experience relief from PMS symptoms through lifestyle changes alone.
  • Over-the-counter pain relievers such as ibuprofen, aspirin or naproxen may help
  • For more severe cases though, your doctor may prescribe medicines such  as..
  1. Antidepressants
  2. Nonsteroidal anti-inflammatory drugs
  3. Diuretics
  4. Hormonal contraceptives
  5. Oestrogen-only patches and implants.
    Prognosis:
    In most women, PMS symptoms begin to subside after age 35. They end at menopause.

Dr. Krishna priya.

https://www.everydayhealth.com/pms/pms-articles.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418247/

Emergency Contraceptives

In modern times, couples try to balance family and work hence unintended pregnancy is a concern in the event of unprotected intercouse. Unprotected intercourse occurs for multiple reasons which includes lapse in adherence to an ongoing method of contraception, a contraceptive mishap (such as condom breakage), lack of knowledge about contraceptive use and sexual assault.

Fortunately, several options are available for contraception that can be used after unprotected sex has already occurred; these methods, collectively referred to as emergency contraception,

Emergency contraceptives can prevent pregnancies upto 95% if taken with 5 days of unprotected intercourse.

Most common methods of emergency contraceptives are-

  1. Emergency contraceptive pills (ECPs)-These pills include the hormones like estrogens, progestins, or both and are advised to be taken at the earliest or within 72 hours.
  2. Copper-bearing intrauterine devices (IUDs)-These are inserted by a doctor up to 5 days after unprotected intercourse to prevent pregnancy.

Mode of action

  • Emergency contraceptive pills work by delaying release of egg and hence prevent ovulation.
  • IUD makes the uterus unfavourable by chemical changes for sperm and egg to meet and grow.
  • Emergency contraception cannot interrupt an established pregnancy or harm a developing embryo.

Advantages

Emergency contraception is a relatively safer form of backup birth control if your choice of contraceptive fails(like condom breakage,missed pills) or if you have unprotected sexual intercourse. It is used after intercourse but before pregnancy has occurred.

This pill does not affect future fertility.

Side effects

  • Side effects of emergency contraceptives are Nausea,vomiting,fatigue,headache,dizziness,breast tenderness and abdominal pain.
  • Side effects usually do not occur for more than a few days after treatment, and they generally resolve within 24 hours.

Points to keep in mind before choosing Emergency contraceptives

  • Emergency contraceptives should not be taken without prescription or bought over the counter.Only a registered medical practitioner after carefully assessing the situation can prescribe it.
  • There is no restriction of age and these can be prescribed to women of any age if need be. In minors, it can be prescribed after discussion with the guardian.
  • Frequent use of emergency contraceptive is not recommended as it can lead to complications. hence discuss with your gynecologist regarding use of a long term contraceptives.
  • It does not protect against sexually transmitted disease, so to avoid such a risk condom use is advised.
  • As the method is effective, most women get their next menstrual period at expected date, but in few cases there can be dysregulation of cycle or heavier bleeding.

According to WHO recommendations, every women who is at risk of unintended pregnancy should have the right to access emergency contraception. In India, after carefully assessing the health of the woman, a registered medical practitioner can prescribe emergency contraceptives.

Avoid buying emergency contraceptive pills over the counter without prescription.

Discuss with your physician/ gynecologist about the emergency contraception and the best option for you in case of an accidental intercourse.

-Dr Prerna Gaur

Acknowledgements-

https://www.webmd.com/sex/birth-control/emergency-contraception#1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216625/

https://www.emedicinehealth.com/emergency_contraception/article_em.htm#what_is_emergency_contraception

 

Effect of Losing Weight in treatment of PCOS and associated Obesity:

PCOS(Poly cystic ovarian syndrome) is the most common hormonal abnormality seen in women and also considered as the leading cause of infertility in their reproductive age. 50-60% of women with PCOS  are overweight or obese. Obesity  is strongly associated and is a common finding in PCOS ,aggravating many of its reproductive and metabolic features. The relationship between PCOS and obesity is complex, not well understood. The diagnostic criteria for PCOS is based on presence of 2 out of 3 features (Rotterdam criteria):

  1. Anovulation
  2. Polycystic ovary morphology
  3. Hyperandrogenism- clinical or biochemical

Does obesity cause PCOS?

Interesting part is that Obesity causes PCOS and vice versa.

Characteristics and features of PCOS:

Women with PCOS may have both reproductive and metabolic disturbances. In first part it causes increased androgen production, menstrual irregularity, hirsutism, and infertility. In second part , metabolic disturbances include defects in insulin action and β-cell function of pancreas causing glucose intolerance and eventual development of Type-2 Diabetes Mellitus. Other than Type-2 diabetes, PCOS is also associated to in causing dyslipidemia, hypertension, cardiovascular disease and endometrial cancer.  

PCOS and its Management:

Treatment of PCOS must focus both on  treating hyperandrogenism and anovulation and on reducing metabolic complications.

Treatment includes medical management and lifestyle intervention. Usage of Metformin based combination medications will help in balancing the metabolic issues like increasing sensitivity of tissues to insulin and also helps in regularizing menstrual cycles along with losing weight.

Losing weight is an Important strategy in treatment of PCOS:

The best approach to PCOS treatment is through lifestyle modification. So physical activity and taking low calorie diet plays an important role in restoring ovulation and decreasing infertility.

  1. Low caloric diet:Eat a high-fiber, low-sugar diet. Take more of fruits, vegetables, and whole grains. Avoid processed and fatty foods to keep blood glucose under control. Instead of taking 3 large meals take 4 to 6 small meals throughout the day
  2. Physical Activity: Along with the above diets, following a good exercise and making it upto 45 minutes per day helps in reducing weight and keeping insulin and other hormone levels under control & also increases insulin sensitivity and improves psychological issues that are present due to PCOS.

-Dr.Bhavani Sagar Surampally

 

Bleeding gums and oral care during pregnancy

Most of the pregnant women suffer from gum related problems, which may lead to bleeding from the gums when brushed or flossed.

Hormonal changes which take place during pregnancy, must be one of the cause for this condition which makes your gums more sensitive to the bacteria.

Other causes include smoking and diabetes, which can cause bleeding gums. Most of the pregnant women will think that this condition may affect their baby, but it is unlikely to be harmful for you or your baby if the cause is hormonal changes.

It’s very important to keep your teeth and gums as clean and healthy as possible while you’re pregnant. The best way to prevent or deal with gum problems is to practice good oral hygiene.
How to take care of your gums during pregnancy:

  1. At least one visit to a dentist during pregnancy is needed for checkup and cleaning.
  2. Brush your teeth twice daily with soft bristled brush and daily floss your teeth.
  3. If you are suffering from morning sickness then it is important to rinse your teeth and mouth after every episode of vomiting.
  4. Consider alcohol free mouthwash.
  5. Try gently massaging your gums using your index finger and thumb. Do not apply undue pressure and massage slowly.
  6. Smoking should be avoided as it makes the condition worse.
  7. It is always advised to follow a healthy diet during pregnancy including fruits, vegetables, whole grain products and dairy products such as cottage cheese, milk, etc., which are good for you and your baby.
  8. If diabetes during pregnancy is the cause then regular checkup of your sugar levels is needed. Try to avoid sugary foods too often.
  9. Reduce consumption of chocolate and other sugar-based snacks, as it can increase risk of your tooth decay.
  10. Consume optimum amount of water at least 2-3 liters a day, if you live in a hot and humid environment. Cut down on soda and other caffeine drinks.
  11. Avoid eating very tough foods, as chewing on them can cause you tooth fractures. Also, be wary of cold or caffeinated beverages as it can create sensitivity of teeth.
  12. It will subside after delivery if treated properly.
  13. If the problem still persists even after taking good precautions consulting your treating doctor is very important.

References:

https://www.babycenter.com/0_bleeding-gums-during-pregnancy_217.bc

http://americanpregnancy.org/naturally/treat-gum-disease-naturally-pregnancy/

https://www.nhs.uk/Conditions/pregnancy-and-baby/pages/teeth-and-gums-pregnant.aspx

-Dr. Y. Alekhya

Understanding the Medical Terminology used in Ultrasound Reports during Pregnancy

Confusion and apprehension in understanding medical terms of pregnancy used by your doctor and in test reports, scan reports are often seen in most of the pregnant women.

Here are a few terms often used in pregnancy which may help you in having a clearer idea on what the test, scan reports mean and your doctor says.

Terms from used in an ultrasound scan report during pregnancy:

  • LMP – Last Menstrual Period which is the first day of bleeding in last period.
  • EDD – Expected Date of Delivery is calculated according to LMP. Most accurate estimate of EDD is given by an ultrasound in 5-18 weeks of gestational age. Earlier an ultrasound is done, more accurate EDD can be estimated.
  • Gestational age – duration of pregnancy that is calculated from LMP.
  • Gestational sac – a large fluid filled sac like structure surrounding the embryo. It is usually the first component of pregnancy that can be visualized even before detecting an embryo on a transvaginal ultrasound scan as early as 5th week of pregnancy.
  • Fetus – baby in the womb from 9th week of pregnancy till delivery.
  • Fetal/embryonic pole – embryo which takes the shape of a curve with a head at one end and a tail like structure at the other end. A fetal pole usually starts getting detected from 5 ½ – 6 ½ weeks of pregnancy on an ultrasound scan.
  • Blighted ovum- a gestational sac without a fetal pole that may indicate a miscarriage.
  • CRL (Crown Rump Length) – length of the fetal pole from head to tail and of fetus in later weeks of pregnancy measured on an ultrasound scan.
  • Femoral Length (FL) – length of thigh bone of the baby.
  • BiParietal Diameter (BPD) – distance between sides of head of the baby.
  • Head Circumference (HC) – circumference of head of the baby.
  • Abdominal Circumference (AC) – circumference of abdomen of the baby.

FL, BPD, HC and AC values are computed to produce EFW (estimated weight of the baby) which helps in determining if the baby growing well according to the gestational age.

  • Fetal heart rate – heart rate of the baby according to an ultrasound scan.
  • Cephalic presentation – Head of the baby occupies the lower pole of the uterus, that is in the direction of legs of the mother.
  • Breech presentation – Limbs of the baby occupies the lower pole of the uterus, that is in the direction of legs of the mother.
  • Placenta – a disc shaped mass located on the back wall in the upper half of uterus from 10th week of pregnancy and produces progesterone hormone which prevents uterine contractions, maintaining healthy pregnancy and prevents miscarriage.
  • Low lying placenta – placenta that is situated in the lower half of uterus (normally situated in upper half of uterus).
  • Placenta previa – Low lying placenta that partially or completely covers the opening of cervix or womb at the end of pregnancy. This increases the risk of bleeding during pregnancy, miscarriage and the baby is usually delivered by cesarean section.
  • IUGR – IntraUterine Growth Restriction indicates the baby is small for gestational age.
  • AFI – Amniotic Fluid Index that is calculated based on levels of amniotic fluid in womb. Normal AFI is 8-18.

References:

http://americanpregnancy.org/while-pregnant/fetal-development/

http://americanpregnancy.org/pregnancy-complications/early-fetal-development/

https://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-weeks-4-5-6-7-8.aspx?tabname=pregnancy

https://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-weeks-37-38-39-40.aspx

https://www.nct.org.uk/pregnancy/low-lying-placenta

http://americanpregnancy.org/pregnancy-complications/placental-abruption/

http://americanpregnancy.org/pregnancy-complications/oligohydramnios/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492588/

http://americanpregnancy.org/labor-and-birth/mucus-plug/

https://dictionary.cambridge.org/dictionary/english/umbilical-cord

http://americanpregnancy.org/while-pregnant/calculating-conception-due-date/

Textbook of Obstetrics by D.C. Dutta.

 –   Dr. Divya Teja Pasupuleti

Vaccinations during Pregnancy

Vaccines help protect you and your baby against serious diseases. The simple concept of vaccinations in pregnancy is that vaccinated mothers pass on protective antibodies (infection-fighting molecules) to their babies before they are born. This provides some immunity against certain vaccine-preventable diseases during their first few months of life, when your baby is still too young to be vaccinated. Continue reading “Vaccinations during Pregnancy”

Baby kicks and movements during Pregnancy

One of the most exciting moments in your pregnancy is when you feel those first little flutters of your baby kicking. These tiny movements reassure you that your baby is developing and help you feel closer to the little life inside of you. Continue reading “Baby kicks and movements during Pregnancy”