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    Pregnancy and Childbirth

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    Pregnancy and childbirth is an important phase of a women’s life where she requires care, support and maximum attention to her health. At Sakra, we have a team of highly experienced doctors to ensure the well-being of the mother and the little one in every way. Our services include several aspects of pregnancy and childbirth including Natural childbirth, Painless labour, Instrumental deliveries, Caesarean section, High-risk pregnancy care and delivery, and Fetal Medicine.

    Natural childbirth

    Natural childbirth is a way of giving birth to a child where the mother selects not to use drugs in order to speed up the labor or decrease pain.    

    Pain relief during labor 

    During labor, pregnant women are offered inhalation of gas - Entonox (mixture of N2O and oxygen in 1:1 ratio) or an epidural analgesia in the epidural space near the spinal cord. This is an advanced pain management technique used during delivery which reduces the pain perception by almost 85% .

    Instrumental deliveries

    During delivery when baby needs aid to be born, an instrument is attached to the head of the baby to assist in delivery. It is also known as assisted birth or operative vaginal birth. The instruments used for assisting birth are forceps and ventouse.

    The forcep has a handle at one end, and the other end has two curves which cradle the baby's head. The ventouse has a cup (made of silicon plastic) to be attached on the baby’s head and a handle to pull on is attached to the suction device to create vacuum. 

    Caesarean section

    Caesarean section is a surgery carried out under epidural/spinal anaesthesia where the baby is delivered by making an incision on women's abdomen and uterus. This can be planned or an emergency procedure.  The emergency procedures can be related to  the condition of the mother or baby or labour as a dynamic process. 

    It normally takes 30 to 45 minutes. C-section is comparatively safer for mother and baby. However, it is major surgery and carries risks. It also takes longer time to recover from a C-section than from vaginal birth. After healing, the incision might leave a scar in the wall of the uterus. This could cause problems with an endeavored vaginal birth later. However, in more than  half of the women who have had a C-section can give vaginal birth later.

    High-risk pregnancy care and delivery

    Frequently a pregnancy is categorized as high risk because of the problems that arise from the pregnancy itself and which have little to do with the mother's health or because of the pre-existing medical conditions of the mother. A high-risk pregnancy may pose challenges before, during or after delivery. If a women has a high-risk pregnancy, women, and her baby may need special care throughout her pregnancy. This includes:

    • Advanced maternal age
    • Premature labor
    • Multiple pregnancies
    • Medical conditions 
    • Pregnancy complications
    • Fetal problems
    • Chronic conditions
    • Placenta previa

    This high-risk pregnancy can be treated by a trained and expert obstetrician who can provide a safer delivery with an optimal  outcome for pregnant women and her newborn.

    Fetal Medicine    

    Fetal medicine is a division of medicine which includes the evaluation of fetal growth and well-being, the upkeep of fetal health and the diagnosis of fetal abnormalities and sicknesses. Nowadays, diagnosis for pregnant women has improved which helps to detect problems of the fetus much before birth. Thus, the fetus is progressively becoming an independent individual, and fetal medicine is the specialty that addresses this “unborn patient”. Obstetricians, neonatologists,  maternal-fetal medicine specialists, pediatric surgical specialists, pediatric cardiologists, and geneticists are various specialists who are involved in fetal medicine. Fetal medicine is divided into two branches:

    • Fetal treatment –  It is a therapy performed on an ill fetus with the aim of attaining fetal well-being  through medical and surgical procedures.
    • Prenatal diagnosis – In this division, the abnormal condition of the fetus is detected. Ultrasound is the most common test used for this diagnosis.

    Fetal medicine helps detect and treat the fetal abnormalities in the womb of the mother which helps in delivering a healthy baby.

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    Testimonials

    Tanisha Kumari shares her experience of her mother's treatment at Sakra Hospital

    I am Tanisha Kumari writing you this note on the day of my mother's discharge. Who was very afraid of

    Read More

    I heartily thank Dr.Prabha for taking care of my wife with successful delivery

    We were travelling from HAL to Atibele(Govt Hospital) for the delivery because one of the family members is the in-house

    Read More

    Pregnancy Journey with Sakra World Hospital

    Tejaswini and her husband shares their complete pregnancy journey at Sakra World Hospital under the capable hands of Dr. Prabha

    Read More

    Precise assessment and rapid response during emergency, saved us

    Our sincere thanks to Dr. Prabha Ramakrishna and team for the safe delivery of our baby at Sakra. Her precise

    Read More

    All the doctors +Support Staffs are super friendly+ Knowledgeable

    We were referred by my sis in law, who is a Doctor and associated with Bloom IVF in Haryana and

    Read More

    Really like to thank Dr.Sapna,Dr.Nandita And Dr.Pritima for the wonderful treatment

    I am very happy to share my experience with IVF sakra. Would really like to thank Dr.Sapna,Dr.Nandita And Dr.Pritima for

    Read More

    We are very happy with the service, support and encouragement of the whole staff

    We are very happy with the service, support and encouragement of the whole staff. Very special thanks to Dr.Pritimala who

    Read More

    We did IVF with Sakra Hospital. And finally we got good news, Thanks to everyone

    We are very thankful to Dr.Sapna & her supportive team. We had 3 IVF failures so we were very depressed

    Read More

    My pregnancy and delivery experience has been awesome

    I believe that these 9 months are very precious and one always wants them the best as anything can go

    Treatment: Pregnancy Care and Delivery

    Name: Ms. Goldie Srivastava

    Location: Bangalore

    Read More

    Thank you Dr Prabha We are pleased with your professional service.

    I am glad to know Dr. Prabha and would like to share my experience. I know Dr. Prabha since mid

    Treatment: Pregnancy Care

    Name: Chaitra B.V

    Location: Bangalore

    Read More

    Excellent- Many thanks. Dr. Prabha you are a true professional

    Excellent- Many thanks. Dr. Prabha you are a professional and you understand your patient so well. Being a father and

    Read More
    ‹ ›

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    I am Tanisha Kumari writing you this note on the day of my mother's discharge. Who was very afraid of losing her confidence of getting well. But now she became so lively and happy.

    So, thank you so much for your excellent care. Especially Dr. Shanthala Thuppanna, Dr. Shreelekha and Praisy thank you for answering every question and giving emotional support. Thank you for keeping us in your thought before, during and after hospitalization.

    Obviously, these can not be done without supporting staff and nurses. I am exceeding satisfied with your professionalism and commitment to excellent nursing care. In nursing staff a heart full thanks to sister Dolma (not sure if I’m writing the name correctly) but she was a night staff on 23rd and 24th May.

    The cleanness, medical service and nursing care feel so good to no longer be confined to the sick bed. My mother who is here for 4 days ( 23rd - 27th) felt at home throughout the whole recovery process. It's just a home away from home.

    Thank You all,

    Yours Truly Admirer

    Tanisha Kumari.

    (Attendant of/on behalf of UHID: 526948)

    We were travelling from HAL to Atibele(Govt Hospital) for the delivery because one of the family members is the in-house staff there. But during the travel, her water broke. So we had to rush her to the nearest hospital. We were around Bellandur so we chose to come to Sakra. As we are from a lower economic class we were not sure if we were able to afford it. But to our surprise when we came here we received a very warm response. Dr Prabha and her team were really nice and accommodating. 
    If my wife and child had not received the medical care immediately, then it could have been life-threatening consequences. Sakra was very kind to waive off the entire hospital charges, So our initial anxiety of paying huge money is gone and we thank the management for the initial gesture and support.

    All the caregivers/staff/doctors have a great blessing towards my family.

    Thank you so much

    Tejaswini and her husband shares their complete pregnancy journey at Sakra World Hospital under the capable hands of Dr. Prabha and Dr. Shalini. Watch the video to know more! About Department of Obstetrics and Gynaecology: The Department of Obstetrics and Gynaecology at Sakra World Hospital provides complete care that goes beyond the needs of a woman, to ensure a healthy life for them. The Department provides a wide range of services including complete obstetrical care, management of high risk pregnancies, painless deliveries, infertility management, contraception an

    Our sincere thanks to Dr. Prabha Ramakrishna and team for the safe delivery of our baby at Sakra. Her precise assessment and rapid response during emergency saved us. She is very dedicated toward her work and her patient friendly interactions gave us lot of confidence. Over the course of time she has become like a family doctor to us.  Regards.

    Patient Name: Mrs. Sireesha Katuri (Patient underwent C-section, High-risk Pregnancy Case)

    Testimonials By: Mr. Dastagiri Babu. N

     

     

     

     

     

     

    Dr. Prabha Ramakrishna
    Senior Consultant in Obstetrics and Gynaecology

    Book Appointment With Dr. Prabha Ramakrishna,Obstetrician

     

    Dr. Shanthala Thuppanna
    Senior Consultant - Gynecological Laparoscopy

    Book Appointment With Dr. Shanthala Thuppanna,Gynaecologic Oncologist,Gynaecologist

     

    Dr. Chitra Sreenivasa Murthy
    Senior Consultant - Obstetrics and Gynaecology

    Book Appointment With Dr. Chitra Sreenivasa Murthy,Obstetrician & Gynaecologist

     

    Dr. Anupama Rani V
    Associate Consultant - OBG

    Book Appointment With Dr. Anupama Rani V,Obstetrician & Gynaecologist

     

    Dr. Shilpa Kava
    Associate Consultant – OBG & GYN

    Book Appointment With Dr. Shilpa Kava,OBG

     

    Dr. Vani Ayyasamy
    Attending Consultant (OBG & GYN)

    Book Appointment With Dr. Vani Ayyasamy,Gynaecologist

     

    Dr. Chaitra Gowda
    Attending Consultant - OBG

    Book Appointment With Dr. Chaitra Gowda K N,Consultant Obstetrician and Gynecologist

    We were referred by my sis in law, who is a Doctor and associated with Bloom IVF in Haryana and its turned out to be blessing for us. Bloom IVF Bangalore is one of the best facilities I have visited in INDIA plus Abroad. All the doctors +Support Staffs super friendly+ Knowlagable.They Maid our journey to pregnancy from infertility very smooth and easy. I would specifically like to mention everyone here Dr.Pritimala,Dr.Sapna,Dr.Anubha and sister chinnamma for the brilliant job here.

    I am very happy to share my experience with IVF sakra. Would really like to thank Dr.Sapna,Dr.Nandita And Dr.Pritima for the wonderful treatment, Sister chinnu had been very supportive & friendly, Thanks to Dr.Anubha and Miss.Dipika for the support as wel.Thanks once again.

    We are very happy with the service, support and encouragement of the whole staff. Very special thanks to Dr.Pritimala who patiently treated and explained to us throughout about the procedure. Thanks to Dr.Anubha  who gave us constant support & chinnu sister who gave us injection without pain and always with a smile.

    We are very thankful to Dr.Sapna & her supportive team. We had 3 IVF failures so we were very depressed & then Dr.Sapna gave us courage and Support.so we did IVF with Sakra Hospital. And finally we got good news, Thanks to everyone.

    I believe that these 9 months are very precious and one always wants them the best as anything can go wrong at any point. So it is very helpful at this time to have good support, especially on the healthcare front especially from the doctors. Certainly, one has multiple options to select from, to go to any kind of facilities available in the city and we are happy we chose Sakra World Hospital for our baby’s arrival. The reason was very simple - I had really good feedback for the facility as well as the doctor and our experience was also amazing when we visited the hospital for the first time. When we met Dr Chitra we were pretty confident from the first consultation itself that we are in the right hands. Theses 9 months are definitely not easy and it has almost been a roller coaster with so many ups and downs and mostly downs. We used to panic and would get depressed at times and that is when the immense support from the doctor and her team made us feel most comfortable. So our overall experience has been very good as we have always got all the care, attention and proper treatment at all time.

    “My experience has been awesome. The services have been very nice, everyone from the housekeeping to the nursing staff has been very kind and helpful. The doctors are amazing and give a lot of confidence and have a very positive attitude, Dr Anju Namashivaya from Fetal Medicine has always given wonderful advice during all the scans and even if there were any ups and downs she would handle the situation so well and would never let us panic. Dr Chitra certainly is an amazing doctor and even 5 minutes with her can make you feel so much at ease and she gives support at every step throughout the pregnancy. We feel really grateful that we chose to deliver at Sakra World Hospital.”  Ms Goldie Srivastava

    I am glad to know Dr. Prabha and would like to share my experience. I know Dr. Prabha since mid of 2015 when I first went to her for a check-up she was polite, took time to explain us things and gave us the moral support throughout my pregnancy period, she always addressed our concerns patiently, be it when we visited her in person or through messages and emails, she has always responded to my messages and emails.

    I would like to thank Dr.Prabha and her team at Sakra. the nursing staff are very Polite and humble, We are pleased with your professional service.

    "At Sakra, the 'Women and child care department', has set the bar very high in patient care and the treatment."

     

    Thank you Dr. Prabha. All the best!!

     

    Excellent- Many thanks. Dr. Prabha you are a professional and you understand your patient so well. Being a father and husband, I was nervous but you were exceptionally brilliant with easing the tension and making the process so smooth. Many thanks to you. Sister Divya and Sister Annie "YOU ARE A STAR". Thank you for taking very good care of my wife and son. I will always remember your care and affection. Most importantly, your professionalism towards your "Call of Duty." My sincere thanks to you both. God bless you two.

    Husband of Sylvia Chakhi
     

    Pregnancy During Covid-19 Crisis: A Guideline For Expecting Mothers

    Pregnancy is probably one of the most sensitive times in a woman’s life. The global Coronavirus outbreak that comes with loads of anxiety, fear and life like never before has made pregnant mothers even more worried. They are confused and not certain about what they should do and they should not. They have ample confusion and queries about whether the deadly virus can pose a threat to their newborns in the womb, what precautions they must take to remain safe from Covid-19 during the gestation and immediately after the delivery or how they keep their mental health fit during and post-pregnancy. Here is all a pregnant mum must know about the impact of a pandemic on the health of the mother and the new-born and the various ways both can remain healthy during the crisis time. 

    How Covid-19 can affect pregnancy?

    There is no evidence that reveals carrying a baby makes a woman more prone to contracting Coronavirus compared to other healthy adults without any co-morbidities. In case a pregnant woman tests positive for Covid-19, she may not be at a greater risk of developing severe complications as well. However, during pregnancy, the efficiency of one's immune system may decrease and that is why a pregnant woman must be more careful particularly at the present situation and follow the norms of social distancing and self-quarantine.

    A pregnant woman may experience flu-like symptoms - mild to moderate, like most others. However, if the flu-like symptoms worsen in a pregnant woman or there is a delay in recovery, it may indicate the severity of the chest infection and that may require immediate hospitalization. 

    Although Covid-19 is a new and evolving virus and not adequate evidence is available at present, it is not confirmed yet that Coronavirus may increase the risk of a miscarriage. Also, vertical transmission meaning direct transmission of the virus from the mother to the unborn baby has not been substantiated till now. A recently conducted Lancet study on women in their third trimester has shown that the risk of vertical transmission of Covid-19 is low and there is no evidence of foetal malformations due to maternal infection with Covid-19. 

    Tips for pregnant women to remain safe from Coronavirus during pregnancy

    Pregnancy is a critical time, especially the first trimester. Tackling Coronavirus during pregnancy certainly needs extra caution. These suggestions may result in a smooth pregnancy during the Covid-19 time.

    • Be aware of the infection: It is essential for a would-be-mum to know about the virus - particularly its symptoms so that she can take immediate steps and visit a doctor in case they experience any. She must know the mode of transmission as well so that she can take necessary precautions to prevent contraction.

    • Do not violate the prevention guidelines: It is wise to follow the social distancing guidelines set up by the government. Pregnant women must not visit crowded areas, wear a mask while going out in case of an emergency, know to use a mask appropriately and not touch the back and the front side of a mask must follow respiratory, hand hygiene and social distancing diligently.

    • Maintain your regular check-ups: Skipping regular check-ups during pregnancy is not at all recommended. However, during the Coronavirus crisis, it is wise to opt for tele-consultancy/ online consultancy and get the routine check-ups done on time. ICMR has advised the mandatory visits to the hospital for pregnant women in 3rd, 5th, 7th and 9th months as they also involve other tests such as fetal scans and vaccines.

    • Avoid touching face, eyes and nose: Despite washing hands thoroughly it is wise to not touch face, eyes and nose repeatedly as it may turn out to be harmful to the baby and the mother. 

    • Sleep well: It is essential to get adequate sleep during pregnancy. Good sleep helps in enhancing body immunity and keeps one energetic. Sleep is particularly necessary for the baby in the womb. 

    • Eat well: Due to decreased immunity during pregnancy, it is important to get a balanced and nutritional diet. The appropriate diet amps up the body's ability to fight against diseases. 

    Coronavirus and breastfeeding - Things to keep in mind 

    In case a new mum is tested positive for Covid-19, she can breastfeed her newborn. The reason, breastfeeding a child is far more beneficial compared to the risk of transmission of the virus through breast milk. However, there may be a risk of droplet infection due to close contact between the mother and the child during breastfeeding and the virus can spread to the baby while breaking. The following tips may help a Coronavirus positive new mum breastfeed her newborn without the fear of transmitting the virus.

    1. Wash hands before feeding or touching the baby, breast pump or bottles

    2. Try to avoid coughing or sneezing while feeding. Wearing a mask while feeding may help. 

    3. While using a breast pump, follow instructions for cleaning and sterilizing properly.

    4. Consider asking one of your healthy family members to feed your baby if you are expressing milk. 

     Following the doctor’s advice and working on mental health can make pregnancy, delivery and post-partum hassle-free and without worries during this crisis. 

    Coronavirus and pregnancy: Keeping the mental health intact 

    Social distancing and the complete lockdown have disrupted our lives to a large extent. Life will not be the same post lockdown as well. Social distancing may result in monotony, stress, anxiety and depression among the pregnant and the new mothers. Here are things that can help them keep their mental health fit.

    • Do not panic: There is no need to panic and get scared about the Covid-19 outbreak. Take the required precautions and let go of panic and stress. 

    • Stay away from news and fake content on social media: It is wise to not watch news related to Coronavirus continuously. Also, stay away from rumours related to the virus. 

    • Keep in virtual touch with family: It is always good to remain among family and close friends during pregnancy as it keeps an expecting mother happy and stress-free. During the lockdown remain in touch with your family members online, do video calls and chat with them. 

    • Remain physically and mentally active at home: Do exercises at home, sign in for online yoga and meditation classes, cook healthy food, try new recipes, engross in creative art, watch happy movies, listen to good music and de-stress. Keep away from smoking and drinking.

    The Surprising Link Between Oral Health and Pregnancy

    Can Oral Health Have an Effect on Pregnancy?

    Recent research indicates a link between gum disease and childbirth complications. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small.

    More studies are needed to confirm the exact correlation between gum disease during pregnancy and labor complications, but it appears that gum disease may trigger increased levels of biological compounds that induce labor. Data also suggests that when periodontal disease worsens during pregnancy, there's a higher risk of having a premature baby.

    What Can I Do to Ensure I Have a Healthy Pregnancy?

    Pregnancy and dental care are important for a healthy baby. Pregnant women and women who plan on getting pregnant should visit their dentist for a checkup and to treat any dental problems before conceiving.

    Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce pregnancy dental problems.


    What Oral Problems Might Develop During My Pregnancy?

    Many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums.

    Pregnancy gingivitis occurs due to increased levels of hormones that influence the way gums to react to the irritants in plaque.

    Keeping your teeth clean, especially near the gum line, will help dramatically reduce or even prevent gingivitis during pregnancy. 

    What Can I Expect When I Visit My Dentist During My Pregnancy?

    First, be sure to let your dentist know you're pregnant when you schedule your appointment. It's best to schedule your dental visit during the fourth to sixth month of your pregnancy. Avoid seeing a dentist during the first three months of pregnancy, are thought to be of greatest importance in your child's development and the stress of a dental visit may be detrimental to the foetus.

    Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless necessary. 

    During the last trimester, prolonged sitting in a dental chair can become uncomfortable and a dental examination may be infeasible.

    If you need to schedule an emergency visit, let the dentist know about your pregnancy before you arrive. Discuss any relevant medical history, stress factors, past miscarriages and medications you are taking as these can influence your dental care plan and outcomes.

    Avoiding A Toothache During Pregnancy

    It is recommended by dental specialists that women see a dentist before they plan a pregnancy. This way, the office can do a thorough checkup and cleaning, as well as treat any existing dental problems. Of course, you can also consult a dentist while pregnant.

    When you experience a toothache or gum problems during pregnancy, see a dentist as soon as possible for treatment. Dental health issues can adversely affect your pregnancy and early intervention is important for both mother and child.

    Avoiding Tooth Decay

    Cavities are formed when the bacteria in your mouth use the sugars and carbohydrates present in food to produce acid, which dissolves the enamel on your teeth. 

    Pregnant women are at increased risk for developing tooth decay due to a number of reasons: unhealthy food cravings, decrease in brushing and flossing and vomiting as a result of morning sickness can intensify the amount of acid in the oral cavity.

    To prevent tooth decay, brush your teeth twice a day, using a soft brush and appropriate toothpaste. Keep sugary snacks to a minimum. Rinse your mouth with water when you aren't able to brush, and floss once a day. 

    It's fairly common for an expecting mother to complain about bleeding gums when brushing or flossing. Hormonal changes that come along with pregnancy can cause inflammation, sometimes called pregnancy gingivitis. To keep this condition from developing into more serious gum disease, intensify your dental care routine by using an antibacterial mouthwash and seeing your dentist for more frequent cleanings.

    Look Out for Gum Disease

    Some pregnant women experience a raw-looking swelling of gum tissue called a "pregnancy tumor" grows between the teeth. These growths bleed easily and may be caused by excessive plaque. Consult a dentist if you suspect you have a pregnancy tumor, even though they are usually benign.

    Another uncommon complication of pregnancy is loose teeth. This can develop due to hormones affecting the ligaments that hold the teeth in place.

    Pregnancy dental care is an important part of your general health and the health of your baby. This is why, for a safe and healthy pregnancy, dentists and obstetricians encourage women to make their oral health a priority.

    Oral hygiene maintenance during pregnancy

    Unless it's a dental emergency, plan your dental visits throughout the entire pregnancy. Start by scheduling an appointment prior to becoming pregnant. That way, any necessary procedures can occur before you become pregnant. 

    The first trimester isn't ideal for dental treatments as the fetus is in the initial stages of development. Instead, schedule non-emergency visits for the second trimester or early in the third trimester.

    There a few experiences in a woman's life as special as being pregnant. Seeing a dentist while pregnant is often overlooked but it is important that you don't forget to maintain good oral health. That includes teeth cleaning while pregnant. 

    Brush at least twice each day with good toothpaste and don't forget to floss, as it complements brushing by removing food particles that stick in places a brush can't reach. Taking care of your mouth ahead of time will allow you to focus on the joyful arrival of your child.

    Management of High Risk Pregnancy

    How can high-risk pregnancies be managed?

    For all women who are diagnosed with a high-risk pregnancy, treatment options vary depending on the risk factors specific to the pregnancy and the woman’s medical history.

    High Blood Pressure

    It is important to regulate blood pressure during pregnancy which can be done by making some changes in the high blood pressure medication. Certain diet and lifestyle changes may also be recommended to keep the blood pressure under control.

    Gestational Diabetes

    Gestational diabetes, or developing diabetes during pregnancy, increases the risk of pregnancy complications. Often times the woman is diabetes only during pregnancy and is normal after the delivery. Many women having gestational diabetes have healthy pregnancies and healthy infants provided they follow a recommended diet and treatment plan. Some important points to be considered by a woman diagnosed with gestational diabetes include:

    1. Regular monitoring of blood sugar level and maintaining control. A woman diagnosed with gestational diabetes must regularly track her blood sugar levels by testing several times a day.

    2. Eating a healthy diet. A low carbohydrate diet with meals spread throughout the day helps to keep blood sugar under control. As diet plans may vary for each individual’s needs, one must always follow a diet as recommended by a dietician and the doctor.

    3. Maintaining a healthy weight. The amount of weight gain that is healthy for a woman will depend on how much she weighed before pregnancy. It is important to track both overall weight gain and the weekly rate of weight gain.

    4. Maintaining a daily record of diet, exercise, and glucose level. A woman with gestational diabetes should write down her blood sugar numbers, physical activity, and everything she eats and drinks in a daily record book.

    Some women with gestational diabetes will also need to take medicine, such as an oral hypoglycemic tablet or insulin to help manage their diabetes.

    HIV Treatment

    HIV infection can be passed from a mother to her fetus as well as during childbirth and breastfeeding, but treatment can prevent transmission.

    What steps can be taken to promote a healthy pregnancy?

    Staying healthy is probably the first step that one needs to do to lower the risk of having a difficult pregnancy. With the increasing incidence of high risk pregnancies in the current times, it is highly recommended to follow a healthy lifestyle and also consider a pre conception evaluation by a health care providers to ensure fitness for a pregnancy.

    Even during the pregnancy, there are steps that can be taken to reduce the risk of certain problems:

    1. Taking at least 400 micrograms of folic acid (a type of vitamin B) every day before and during pregnancy.

    2. Getting proper immunizations.

    3.  Maintaining a healthy weight; eating a good diet; getting regular physical exercise.

    4.  Smoking, alcohol, or drug use should be strictly avoided.

    5.  Prenatal care appointments early during pregnancy and visiting a health provider for regularly scheduled appointments throughout the pregnancy should be given prime importance.

    Management of High-Risk Pregnancies at Sakra World Hospital 

    Sakra World Hospital being a multidisciplinary hospital has a highly qualified and experienced team of specialists from all departments. Our high-risk obstetrics team offers a well-coordinated comprehensive continuum of care for the management of complicated pregnancies throughout pregnancy, childbirth, and beyond to protect both the mother and the baby.

    Being a tertiary care hospital, multidisciplinary team involvement is built in to give the best outcome. Experts in neonatology, critical care, endocrinology, rheumatology, cardiology, neurology, nephrology, gastroenterology, urology, interventional radiology, transfusion medicine, laboratory medicine are all available round the clock.

    Sakra Advantages – All under one roof:

        1. Exclusive labor and delivery rooms specially designed to create a living and safe setting during childbirth.
        2. Options for painless labor using analgesic and breathing techniques
        3. Ultra-modern operation theatres dedicated to obstetrics
        4. Day assessment unit
        5. Early pregnancy assessment 
        6. High dependency unit 
        7. Intensive care unit
        8. Neonatal ICU
        9. Round the clock blood bank services
        10. Laboratory medicine 
        11. Interventional radiology

    High Risk Pregnancy

    What is a High Risk Pregnancy?

    A high risk pregnancy is the one in which some conditions puts the mother or the developing fetus or both at higher than normal risk of developing complications during or after the pregnancy and birth. Such women and their babies need close monitoring and care throughout the pregnancy. It is essential to understand what causes a high risk pregnancy and to manage it properly at the right time. 

    What are the factors that increase the chances of a High Risk Pregnancy?

    Pre-existing conditions/factors that can increase the chances of a High Risk Pregnancy include:

        1. Heart disease
        2. High blood pressure
        3. Kidney problems 
        4. Diabetes
        5. Thyroid disorders
        6. Epilepsy
        7. Respiratory disorders like asthma
        8. Autoimmune diseases (like SLE, Rheumatoid arthritis, APLA)
        9. Blood disorders (anemia, thalassemia, sickle cell disease, ITP, etc.)
        9. Underlying mental health conditions 
        10. Family history of high risk pregnancies, or genetic conditions
        11. Problematic past pregnancies
        12. Including previous adverse pregnancy outcome, repeated pregnancy losses, preterm labor
        13. Habits like – smoking, drinking alcohol, using illegal drugs
        14. Being overweight or underweight
        15. Maternal age over 35 years

    Pregnancy complications - Various complications that develop during pregnancy pose risks, such as problems with the uterus, cervix or placenta. 

    Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization — a potentially serious condition that can occur when the mother’s blood group is Rh negative and the baby's blood group is Rh positive.

    Other conditions/factors that can develop during pregnancy include:

        1. Preeclampsia (high blood pressure during pregnancy that can affect the mom-to-be’s liver, kidneys and brain)
        2. Gestational diabetes (diabetes that develops during pregnancy)
        3. Preterm labor (labor that starts before 37 weeks)
        4. Placenta praevia (placenta lying unusually low in the uterus so that it may be covering the cervix, which can cause excessive bleeding during delivery)
        5. Pregnancy with more than one baby (multiple pregnancies)

    What else you must know about high-risk pregnancy?

    Consult your health care provider about how to manage any medical conditions you might have during your pregnancy and how your health might affect labor and delivery. Ask your health care provider to discuss specific signs or symptoms to look out for, such as:

        1. Vaginal bleeding
        2. Persistent headaches
        3. Pain or cramping in the lower abdomen
        4. Watery vaginal discharge — in a gush or a trickle
        5. Regular or frequent contractions — a tightening sensation in the abdomen
        6. Decreased fetal activity
        7. Pain or burning with urination
        8. Changes in vision, including blurred vision

    Also, find out which signs or symptoms should prompt you to contact your health care provider and when to seek emergency care.

    A high-risk pregnancy might have ups and downs. Do your best to stay positive as you take steps to promote a healthy pregnancy.

    How is a High risk pregnancy diagnosed?

    A high risk pregnancy can be detected at an early stage in the pregnancy with a complete medical history of the mother, a thorough medical examination supported by certain investigations. Continuous monitoring of physical health and personal habits help a health care provider in identifying any risks/problems that develop during pregnancy. 

    Once a diagnosis has been made, the woman with a high-risk pregnancy should receive specialized care from a team of health care providers adept in managing high risk pregnancies throughout the pregnancy to ensure that she carries the fetus or fetuses to term.

    Get Closer to Your Baby’s Life Inside the Womb

    Fetal medicine and its role in pregnancy

    Fetal medicine is a specialty that provides a holistic approach towards fetal care and works in sync with Obstetrics and Gynecology to ensure a safe and healthy delivery. All kinds of specialized diagnostic and fetal screening tests necessary for monitoring the developing fetus are performed to ensure timely prenatal diagnosis and thus improved prognosis before and after birth. 

    What to expect at your Appointment with a Fetal Medicine specialist?

    Before your appointment 

        1. You should always try and go assisted by a family member for the appointment. It is also suggested to avoid taking small children along. 
        2. For Early Pregnancy Scan -  you need to have a full bladder, but not so full that you are uncomfortable
        3. For all other pregnancy scans: you do not need to have a full bladder for the scan.
        4. Always carry your maternity notes, scan reports, and prescriptions with you.

    At your appointment:

    During the Scan

        1. You will have to lie on your back in the scan room with your tummy uncovered.
        2. The lights in the room will be dim for a clear view of the screen.
        3. A gel will be spread on your tummy so that a hand-held probe can be easily moved backwards and forwards over it.  The probe sends sound waves through your tummy.  The sound waves bounce back off the      baby and are translated into an image on the screen.

    After your scan

        1. The results will be explained to you and a scan report with details of the examination will be released in a few minutes.
        2. Your next scan will be scheduled accordingly.                     

    What is the need of different ultrasound scans during pregnancy?

    There are several reasons why it is essential to take different ultrasound scans for women between 11 to 14 weeks of pregnancy.

        1. To see the baby’s heart beating
        2. Check whether there is just one baby
        3. Confirm how many weeks pregnant you are by measuring the baby
        4. Check for any major abnormalities
        5. To do screening for Down’s Syndrome 

    What are the different types of Scans?

    Early pregnancy scan (5 to 11 weeks) 

     This scan is done to locate the pregnancy, check the baby’s heart beat and diagnose multiple pregnancies.

    Nuchal translucency scan (11 to 13 weeks + 6 days) 

    This scan is done to assess the risk of chromosomal problems and rule out fetal anomalies in the baby.

    Early Anomaly Scan (16 to 17 weeks)

    Routine Anomaly scan (18 to 20 weeks) 

    This scan helps to assess the baby’s growth, basic echocardiography, rule out anomalies, and check the placenta.

    Fetal Echo (18 to 24 weeks) 

    Fetal echo is a complete study of the baby’s heart.

    Growth scans (24 weeks onwards)

    These scans can be done according to the need any time after 24 weeks and are mainly done to assess baby’s growth, the amniotic fluid around the baby and to assess the blood supply to the baby (Doppler study).

    What are the tests done under fetal medicine?

    SCREENING BLOOD TESTS

        1. Double marker (10 to 13 weeks + 6 days)
        2. NIPT (Non Invasive Prenatal Testing) (10 weeks onwards)
        3. Quadruple test (16 to 21 weeks)

    DIAGNOSTIC TESTS

    CVS (11 to 14 weeks)

    CVS is a test carried out during pregnancy, which involves removing tissue from the placenta to detect chromosomal abnormalities such as Down syndrome and some other genetic conditions, such as sickle cell disease or thalassemia major, if your doctor has asked for you to be tested for these.

    Amniocentesis (15 weeks onwards)

    Amniocentesis is a test carried out during pregnancy which involves using a fine needle to remove a small amount of the amniotic fluid around your unborn baby. Amniocentesis is used to detect chromosomal abnormalities such as Down syndrome. It can also detect certain other genetic conditions, and fetal infections. 

    OTHERS

        1. Amnio Drainage/ Reduction 
        2. FBS (2nd Trimester onwards)

    How to breastfeed?

    Women have been breastfeeding since the beginning of time, but it cannot be stated that every woman is always prepared to breastfeed. Every woman who experiences childbirth for the first time is completely new to breastfeeding as well. Nursing can be a little tough in the beginning, but with patience, effort, guidance and lots of support, both the mother and the baby can get a hold of it.

    It is always good to try and learn breastfeeding in the hospital as soon as possible and be get guidance from a nurse or a lactation consultant. Though a newborn knows instinctively how to suck, getting his lips and your nipple in the right position (called "the latch") may take some time to settle. Minor adjustments might be required as the nipple may slip out of baby's mouth, or the baby may not know, or may cry, or may just be too sleepy from the birth process.

    The mother should not get discouraged due to the small challenges that might come in the beginning. These can be dealt with the help of nurses and lactation consultants or an older women in the family and can develop an understanding and get comfortable with the whole process. Also even if does not get right for several hours (or a whole day), the baby will not starve. 

    Since feeds can take anything from five to 40 minutes, the mother should always be seated in a comfortable position for breastfeeding. It is important to have calm and comfortable surroundings especially in the early days of breastfeeding until one gets accustomed to it. 

    The baby should be held in a position that is comfortable for the baby as well as the mother to avoid any pain in the arm or the back. Cushions and pillows can be used to give support to the baby or the mother's hand and back. Every mother and baby is unique and will have their own breastfeeding style.

    It the latching or the sucking hurts, the suction can be interrupted by inserting the little finger in the corner of the baby's mouth between the baby's gums and the nipple. Once the baby latches on properly, the feeding can resume.

    Always let the baby feed fully from just one breast rather than alternating between both breasts, which can lead to the baby getting more of watery foremilk, but not enough of the fat-enriched hindmilk. This can lead to a fussy baby who wants to breastfeed often.

    If the baby still feels hungry after feeding on the first breast, the second can be offered. But always remember to burp before restarting the feed. And after every complete feed.

    Some Breastfeeding positions

    What are the common problems that one can face in breastfeeding?

    Some women adjust to breastfeeding easily while many new mothers find it hard to get used to it. A new mother’s breasts have never been subjected to the jaws of a hungry newborn before, so for most moms, it hurts in the beginning. In the first six weeks, as mother’s milk supply adjusts and the baby learns how to breastfeed, and the mother may suffer from some of the following problems:

    1. Engorgement - overfull breasts

    2. Mastitis – an infection in the breasts due to bacteria that enter the breast and multiply in the milk duct causing pain and inflammation.

    3. Cracked, bleeding or sore nipples                                                     

    Breastfeeding takes patience and practice. The mother should never lose hope and whenever faced with a problem should always seek help or advice. 

    What is the right time and the right process to stop breastfeeding?

    According to World Health Organization it is recommend that babies are given only breast milk for their first six months. This is called exclusive breastfeeding. It is also said that women should carry on breastfeeding even after their babies have started on solid food, until the end of the first year and beyond if they wish. 

    Doctors advise breastfeeding exclusively for about six months. After which the baby can be supplemented with semi-solid diet while continuing to breastfeed, until the baby stops taking breast milk completely. Some mothers choose to stop breastfeeding (this is known as weaning) when the baby starts eating a wide variety of food.

    Breastfeeding is not a choice. It is a responsibility

    It is an act that not only helps you feed your baby but one that builds a special bond between you and your baby.

    What are the benefits of breastfeeding for the baby?

    It is the best source of nutrition for the baby as it contains all the essential vitamins, fats and proteins that are important for the baby’s growth, and are made available in a form that is easily digestible for the baby. Breast milk contains antibodies that boost immunity and helps your baby fight off various viral and bacterial infections.  It also protects the baby against many allergies and is known to significantly reduce the child’s risks towards cancers. It lowers your baby's risk of having asthma or allergies along with other common infections.

    Breast feeding is also known to significantly reduce the incidence of stomach infections, lower respiratory infections, ear infection and meningitis in children. It also prevents children from a lot of diseases that develop later in life, like – type 1 and 2 diabetes, high cholesterol and inflammatory bowel diseases and conditions like obesity as well.

    How does breastfeeding benefit the mother?

    Breastfeeding is not only beneficial for the baby but also has many benefits for the mother. Apart from building the emotional bond between the mother and the baby, breastfeeding is very healthy for the mother as well. It even fastens the mother’s recovery from childbirth. The hormone oxytocin, released during breastfeeding, acts to return the uterus to its regular size more quickly and can reduce postpartum bleeding. 

    It is also seen that women who breastfeed, experience reduced rates of breast and ovarian cancer later in life. Breastfeeding can also reduce the future risk of developing type 2 diabetes, rheumatoid arthritis, and cardiovascular disease, including high blood pressure and high cholesterol, in women. It can also help protect you against ovarian cancer and weak bones (osteoporosis) later in life. 

    Exclusive breastfeeding also acts as natural form of contraception as it delays the return of the mother’s normal menstrual period, thus increasing the time between pregnancies. 

    What is the essential diet and nutrition requirement of a breastfeeding mother?

    It is important to have a good nutritional diet for a lactating mother for the following reasons:

        1. For sufficient production of breast milk  
        2. For providing adequate nutrients to the infant
        3. To meet the mother’s daily needs

    The nutritional requirements of a breastfeeding mother are similar to those of a pregnant woman. It is recommended to continue eating just as they were eating during the pregnancy. However, breastfeeding mothers need a little more amount of calories. The lactation period demands an additional 500kcal in diet. Lactating mothers should also take a diet rich in proteins, vitamins, iron and calcium. 

    High proteins products like – cereals, pulses, whole grains, dry fruits, eggs and chicken, are good for the mother and thus provide the necessary protein supplement to the baby.

    Lactating mother should abstain from consumption of alcohol and aerated drinks as well. Healthier options like fresh fruit juices, tender coconut water and lime juice can be consumed to stay hydrated. Staying hydrated is very essential as it ensures regular supply of milk. It is advised to consume minimum 8 glasses of water a day, and try to drink one glass before every feed. 

    Women can also continue the supplement of iron and calcium advised to them during pregnancy, until 3 months post-delivery.

    Oatmeal, is also a good option for lactating mothers, as it is helps reduce cholesterol and regulate blood pressure. It's also seen to increase the milk supply and is a good nutritional diet for lactating mothers.

    Blossoming on wheels!

    0n 14th Feb 2017, while Sakra World Hospital was launching its new comprehensive maternity program – Birth and Blossom, one of their trained nursing staff was doing a miraculous emergency delivery in an ambulance. It was around 3 PM when patient - Ms. Smita (name changed) called the emergency of Sakra World Hospital complaining of pain abdomen and vomiting. An ambulance was immediately sent to the address with a nurse on board to assist the patient. As soon as they reached and examined the lady it was found that she being full term pregnant, was in labor and needed to be transferred to the hospital immediately. It was barely 10 months since they had left for the hospital when the nurse observed that the baby was crowning and she might deliver before they reached the hospital. Assessing the situation the nurse (Madhu Kumar) took the courageous decision to stop the ambulance and deliver the baby with the best possible resources available. He updated the hospital immediately and another ambulance with a doctor and some more essential supplies was immediately dispatched from the hospital. Meanwhile with constant telephonic support from the team at hospital and with the help of the husband and mother in law, Madhu prepared to deliver the baby in the ambulance. He performed the entire procedure with immense courage and confidence, and considering the situation he did a commendable job using every resource in the most efficient way possible. At the end of 45 minutes when the ambulances arrived at the hospital the baby and the mother were safely moved in and admitted at Sakra World Hospital. 

    Silent Epidemic: Osteoporosis has affected 200 million women worldwide

    Osteoporosis is estimated to affect 200 million women worldwide - approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90.Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Overall, 61% of osteoporotic fractures occur in women, with a female-to-male ratio of 1.6. Nearly 75% of hip, spine and distal forearm fractures occur among patients 65 years old or over. A 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures, and similarly, a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture. In India: Expert groups peg the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013.In a study among Indian women aged 30-60 years from low income groups, BMD at all the skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52%) and osteoporosis (29%) thought to be due to inadequate nutrition. It is projected that more than about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050.

    As osteoporosis has no obvious symptoms. Traditional X-rays can’t measure bone density, but they can identify spine fractures. Bone mineral density (BMD) has to be measured by more specialised techniques. A number of different types of BMD tests are available, but the most commonly used is DXA (dual-energy X-ray absorptiometry), capable of detecting quite small percentages of bone loss. It is used to measure spine and hip bone density, and can also measure bone density of the whole skeleton. While most limb fractures (such as at the wrist or hip) are obvious, spinal fractures can be more difficult to diagnose. This is because they might be painless, or if there is pain, a person may not know it is caused by a fracture due to the many different causes of back pain.  More obvious signs of spinal fractures are:

    • Loss of height

    • Development of a curved upper back (sometimes called a Dowager's Hump)

    Since there are usually no outward signs of osteoporosis developing, doctors will often recommend diagnostic testing depending on your age and if you have other risk factors for the disease.

    Prevention: Calcium and vitamin D supplementation reduces rates of bone loss and also fracture rates in older male and female adults, and the elderly. Ensure a nutritious diet and adequate calcium intake, Avoid under-nutrition, particularly the effects of severe weight-loss diets and eating disorders, Maintain an adequate supply of vitamin D, Participate in regular weight-bearing activity, Avoid smoking and second-hand smoking, Avoid heavy drinking.

    We in Sakra have started an “Osteoporosis Clinic” the first of its kind in Bangalore to tackle this silent epidemic on Monday, Wednesday and Friday afternoons under guidance of our Endocrinologist Prof.Dr.C.V.Harinarayan.

    Dr. C.V. Harinarayan
    Director - Diabetes & Endocrinology
    M.D. (Int. Med), D.M. (Endocrinology) (AIIMS) F.A.M.S., F.R.C.P.(Glasgow), F.R.C.P.(Edindurgh), F.R.C.P.(Lond), F.A.C.E.(USA)

     

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