There are essentially four types of major
blood groups in humans – A, B, AB and O. The Rhesus factor
is a substance in blood by which human blood may be divided by its
presence into (Rh +ve) or (Rh -ve) groups. The final identification
of a blood group is thus O +ve, B –ve etc.
There is some misconception that the same blood group in both partners
may be detrimental. This is not true. The actual problem may occur
when the mother is Rh –ve and the husband is Rh +ve irrespective
of their ABO grouping.
The baby of such a union could be Rh –ve or Rh +ve. For an
Rh –ve baby there will be no problems and no precautions need
to be taken. For an Rh +ve baby on the other hand complications
of varying severity may take place.
Reasons
Mixing of some blood of the baby and mother occurs throughout every
pregnancy but more so at the time of delivery. The mixing of Rh
+ve blood (from the baby) in a Rh -ve mother causes the mother to
build up some negative factors (antibodies) in her blood over time
against the Rh +ve blood cells. These negative factors may then
cross over to the baby through the placenta (afterbirth) and destroy
the blood cells of the baby. Usually the first pregnancy is spared,
as a few months are needed for the negative factors to be built
in the mother’s body. In the subsequent pregnancies Rh +ve
babies are likely to be affected by the antibodies of the mother.
Symptoms
Tests may be done to estimate the amount of negative
factors in the mothers’ blood. (Indirect Coombs’ test).
This gives us an idea of the chances the baby may be affected. If
the chances of the baby being affected are high – serial tests
of amniotic fluid or blood directly from the baby in the womb are
done. If the condition is mild, early delivery and treatment of
the baby is done after birth. If severe, blood transfusions for
the baby need to be carried out in the womb. These procedures are
done in selected places by specialists and carry a high complication
rate.
Precautions
Injections are given both during pregnancy and soon after delivery
to prevent an Rh –ve mother carrying an Rh +ve baby from developing
the negative factors. The same injection needs to be given after
a miscarriage to neutralize the mixing of blood which occurs in
those cases.
General Treatment
Treatment as explained above essentially depends
on the severity of the condition. For severely affected babies,
the chance of dying is high. Precautions include early identification
of the high-risk pregnancies by checking blood groups with Rh factor
for all pregnant women.
The term is used to describe jaundice like
condition seen during pregnancy, usually in the last few months.
Reason
Cholestasis occurs due to the stagnation of bile in the gall bladder
due to the action of hormones that are increased during pregnancy.
The bile acids are not cleared adequately and the levels increase
in the blood.
Symptoms
Itching all over the body, yellowing of
the eyes, yellowish colored urine and pale stools are features
of obstetric cholestasis.
Precautions
There are no ways of preventing the condition.
It occurs more in the first pregnancy. An ultrasound is necessary
to exclude stones in the gall bladder.
Treatment
Lotions applied over the areas of itching
and anti histaminics help to relieve the itching. Careful supervision
of the remaining pregnancy needs to be done, as complications
of the baby are known to be associated with this condition. The
baby needs to be given vitamin K injections soon after delivery.
The term is used to describe the delivery of a
dead baby or a baby who shows no signs of life after delivery.
Reasons
Though this could be due to both maternal and fetal
(baby in the womb) causes, in up to 50% of cases no cause may
be found. The maternal causes include diabetes and hypertension
while fetal causes are growth restriction, congenital anomalies,
cord accidents and distress (oxygen shortage) during or before
the process of delivery. Stillbirths may occur secondary to a
separating placenta or compression of the cord. (attaching baby
to the placenta).
Symptoms
Inability of the mother to feel the baby kicks
for a prolonged duration of time is the first hint that something
may be wrong. On examination, the baby heartbeat is not heard.
An ultrasound examination gives the final diagnosis.
Precautions
Some stillbirths cannot be prevented. Frequent
check ups during the pregnancy period and diligent monitoring
during the delivery process may help to prevent other stillbirths.
General Treatment
Delivery needs to be hastened after a stillbirth.
Medicines to open the neck of the womb and make it contract are
administered. Contrary to the popular belief, a delay in delivery
of a dead baby by a few days does not usually cause any harm to
the mother.
In this condition, blood vessels of the afterbirth (placenta)
traverse through the membranes and occupy a position below the
presenting part of the baby (usually head).
Reasons
There is no particular reason for this condition
but identification by ultrasonography is helpful to avert a catastrophe.
Symptoms
In Vasa praevia, the blood comes directly
from the baby and if not recognized early, the chances of the
baby dying in the womb are very high. Bleeding starts as soon
as the membranes rupture (breaking of waters). On gentle internal
examination, pulsating vessels may be felt. The baby heart rate
as recorded from the mother’s tummy shows signs of distress.
Precautions
Ultrasonography and Color Doppler studies can diagnose the condition.
Internal examinations need to be avoided as they can lead to sudden
heavy bleeding.
Treatment
Prompt recognition of the condition and
delivery by cesarean section is the key and gives optimal results
for the baby.
A fistula is a connection within the body between
two hollow organs – birth passage (vagina) and stool passage
(rectum), birth passage (vagina) and urinary bladder etc.
When the fistula occurs as a result of a complication during the
process of delivery it is called an obstetric fistula.
Reasons
A fistula between the vagina and urinary bladder
may occur in cases of prolonged labor. This happens when the baby’s
head gets stuck at the opening of the womb for a long time. A
fistula between the vagina and the rectum may occur during the
process of delivery when a cut near the opening of the birth passage
gets extended.
Symptoms
A fistula with the urinary bladder causes continuous
dribbling of urine through the vagina. This is associated with
recurrent urinary tract infections and the continuous stench of
urine. A fistula involving the rectum causes passing of stools,
gas or foul smelling discharge through the vagina.
Precautions
Knowing the causes, appropriate obstetric management
can prevent the occurrence of a fistula. In most cases the delivery
is unsupervised or being performed by an inexperienced medical
person.
Treatment
In almost all cases, the treatment is by surgery, which is usually
done from the passage below.
This is a condition describing decreased water
in the womb surrounding the baby.
Reasons
This could happen in a post-dated pregnancy i.e.
when the expected date of delivery has been crossed. Leakage of
fluid (PPROM) may also be responsible. It may also be seen along
with anomalies of the baby especially involving the kidneys. Sometimes
however no cause is found.
Symptoms
On clinical examination the height of the womb appears to be less
than what is expected for that stage of pregnancy. A definite
diagnosis is made on ultrasonography during which major anomalies
of the baby are also ruled out.
Precautions
Regular check ups with the doctor during pregnancy
help in early detection of the condition.
Treatment
Essentially depends on the reason for oligohydramnios. If pregnancy
is prolonged, delivery needs to be planned. If the baby is severely
deformed, pregnancy should be terminated. If there is leakage
of fluid, early delivery or methods of fluid replacement need
to be sought. If no cause is found, hydration therapy (drinking
a lot of water) and amnioinfusion (injecting saline from outside)
may be attempted. Frequent sonography examinations need to be
done as a part of the follow up.
This encompasses a list of physical and
mental discomfort experienced by a woman for a few days usually
prior to her periods. In almost all the cases the problems subside
with the onset of periods.
Reasons
It is usually seen in women between the
age group 20 to 40 years. Though the exact reason is not known,
many believe that fluctuations in hormone levels are most likely
to be responsible in susceptible women.
Symptoms
Symptoms include bloating, irritability,
breast tenderness and a general feeling of unwell. Often the symptoms
trouble women for a few months before subsiding on their own.
They can recur from time to time.
Precautions
There are no ways of preventing the condition
but treatment is indicated in women where the discomfort is severe
enough to hamper normal activity.
General Treatment
Vitamin supplements and evening primrose
oil are able to relieve symptoms in mild cases. For severe cases
– hormones or other group of drugs may be necessary.
This term refers to an infection of the fallopian tubes. Fallopian
tubes are conduits on each side connecting the uterus (womb) and
the ovaries (egg sac).
Reasons
The infection is often a sexually transmitted
one, coming from an infected partner. Alternately tuberculosis
may be a cause. Occasionally, these infections are seen after
abortions or similar operations (D &C) from the birth passage.
Symptoms
In acute cases there is severe pain in the
lower tummy, which may be associated with fever and nausea. In
chronic cases, the pain may be long standing, increasing during
periods. She may come to the doctor with infertility (the inability
to bear a child). Sometimes there may be no problems at all and
the diagnosis is made during a laparoscopy. Salpingitis is seen frequently in women
having multiple sexual partners. The usual age group is between
20 and 40 yrs.
Precautions
To prevent salpingitis – one needs
to avoid intercourse with infected partners. The use of condoms
by either the male or the female can help to reduce the incidence
of this disease. Early diagnosis and treatment can help to prevent
long-term complications. Three episodes of the disease can cause
infertility in 50% of cases.
General Treatment
Treatment involves the use of antibiotics
often for long durations. In severe cases medicines may need to
be given by the intravenous route (directly in blood) for which
patients require to be hospitalized. Often the damage done to
the tubes by repeated infections is permanent and treatment does
not reverse the damage.
This is an infection of the birth passage (vagina)
and the neck of the womb (cervix).
It is caused by a parasite, which is usually transmitted by intercourse
with an infected partner.
Symptoms
Symptoms may include vaginal soreness, itching
and a thick yellowish discharge.
Precautions
The disease is usually seen in the 15 – 30
year age group. It may be prevented by avoiding multiple or infected
sexual partners. Barrier contraception in the form of condoms
help to minimize the risk of transmission.
General Treatment
Testing the discharge for the parasites helps in
the diagnosis. However, sometimes antibiotics are empirically
administered. Usually problems settle in 1 – 2 weeks of
starting treatment.
Cancer refers to an abnormal growth, which may
involve any part of the body. When the inner lining of the womb
(uterus) is involved, the term uterine cancer is used.
Reasons
Though any woman can be affected, the condition
is more commonly seen in obese and diabetic women. It is usually
seen above 50 years of age, though rarely younger women may be
affected.
Symptoms
Any irregular bleeding after the age of 40 needs
evaluation. The bleeding may occur after the periods have stopped
altogether (usually > 50 yrs) or in between two periods. Lower
tummy pain or heaviness is uncommon.
Precautions
There are no ways of prevention of uterine cancer
but early detection often leads to complete cure. Care needs to
be taken for women on hormones after menopause.
General Treatment
Treatment is always by an operation where the uterus
along with the tubes and ovaries are removed. In advanced cases
however chemotherapy and radiotherapy may also be needed.
These are benign tumors arising from the womb (uterus).
These fibroids are seen in 25 – 30 % of women after the
age of 40 years.
Reasons Symptoms
Often these tumors are incidentally detected on
an ultrasound and do not produce any symptoms at all. Pain and
bleeding during menstruation, lower tummy heaviness, problems
during passing urine are other problems caused by the tumors.
If the bleeding is very heavy – tiredness, lethargy and
increased fatigability may be present due to anemia.
Precautions
Fibroids may occur in any age group but are most
frequently seen between 30 to 50 years.
General Treatment
Treatment depends on the size and symptoms. Fibroids,
which are large enough to be felt on the tummy, need to be removed
surgically. If smaller in size and causing no problems they can
be ignored. Surgery may involve removing just the tumor or the
entire uterus. Removal of the entire womb (uterus) is considered
when women have completed their child bearing or when they wish
to preserve the uterus. For women who are unmarried or do not
have any children – the tumors are removed only. The operation
may be done by the usual cut on the lower tummy or by the laparoscopic
(key hole surgery) route. Fibroids have a propensity to recur
and many may be present at the same time.
When the supports of the uterus (womb) become lax,
the uterus tends to come down through the birth passage and protrude
out during strenuous activity. In advanced cases it may be hanging
outside while walking or standing up. Often part of the urinary
bladder or rectum can also hang out with the uterus.
Reasons
Prolapse usually occurs due to the damage of the
birth passage, which is incurred during the final stages of a
normal delivery. Lack of hormones after menopause may worsen the
process. Sometimes inherited defects in the muscles of the birth
passage could be responsible.
Symptoms
Women with uterine prolapse usually complain of
soreness and discomfort near the birth passage with the sensation
of a mass coming down. The problem becomes more apparent while
straining at stools. For chronic cases, ulcers may be present
leading to a foul smelling discharge. Occasionally, there may
be problems in passing urine with a feeling of obstruction. Prolapse
is usually seen after the age of 50 years, though some degree
may be seen soon after a normal delivery. Rarely, in young women
due to inherited defects in the muscles, the same disease may
be seen in early twenties.
Precautions
Prevention includes exercises of the muscles of
the birth passage before and after a delivery. The use of hormones
after menopause may be useful in some cases.
General Treatment
There is no medical treatment for uterine prolapse. Though exercises
may be of benefit in mild cases, surgery is most often required.
Surgery may be conservative where the lax supports are hitched
up by an operation from the tummy above or the birth passage below.
Radical surgery is appropriate for older women who have completed
their family and involves removal of the uterus with correction
of the deformity.
This term refers to cancer occurring from the birth
passage.
It is a rare form of cancer in women (1-2% of cancers) and presents
usually after menopause.
Reasons
It could be due to chronic irritation due to uterine prolapse
or a forgotten pessary.
Previous cancer from the mouth of the womb (cervix) or hysterectomy
done in the past for cancer may be responsible.
Symptoms
Foul smelling discharge from the birth passage and bleeding on
and off are the usual symptoms. Rarely pain may be present.
Precautions
Early treatment for uterine prolapse or any bleeding
after menopause need sot be evaluated. Women known to have cancer
in adjoining areas or having received treatment for the same in
the past are susceptible.
General Treatment
Surgery can be done in early stages. Radiotherapy
is the mainstay of treatment.. Survival rates of treatment depend
on how early the disease is recognized.
This is a fungal infection involving the
birth passage and is one of the most common abnormal causes of
white discharge.
Reasons
It is very common and may be seen due to
poor hygiene, overuse of antibiotics, uncontrolled diabetes and
a variety of medical diseases.
Symptoms
White discharge is usually seen with varying
degrees of soreness, discomfort and itching near or in the birth
passage (vagina). There may be redness, burning and ulceration
in the region as well. This is a disease that can be seen at any
age group.
Precautions
Maintaining personal hygiene is the key.
Frequent changing of sanitary napkins during periods and keeping
the area dry is the key. Checking for diabetes and other immunodeficiency
diseases need to be done.
General Treatment
Treatment is often single dose antifungal
medicines and both sexual partners need to be treated for long-term
relief. Sometimes creams or pessaries may be prescribed to apply
locally. In recurrent cases treatment may be for be a prolonged
period.
The term is used to describe infection affecting
the birth passage (vagina).
Reasons
The organisms causing infection may be acquired
by the sexual route. Alternately, proximity to the urinary and
bowel passages, make the vagina susceptible to infection. Often
fungal infection or candidiasis is the cause.
Symptoms
Itching near the vagina, soreness and a
discharge are the most common complaints. The discharge may be
thick and foul smelling.
Precautions
Maintaining genital hygiene is important.
Avoiding intercourse with infected partners or use condoms.
General Treatment
Treatment depends on the organism, which
may be identified. Appropriate antibiotics need to be used for
all sexual contacts to prevent recurrence.
