Experts speak

Dr. Rajat Gupta, Senior Consultant, Cosmetic Surgeon Rosewalk Healthcare

The Mommy Makeover is a procedure designed especially for problems faced by women after Pregnancy and Breastfeeding. The surgical technique has found its way into mainstream media with it becoming the procedure of choice among Hollywood elite. Fortunately for mothers everywhere, there are many ways to address these changes and make yourself feel better about yourself. One such way is through mommy makeover surgery.

Mommy makeover surgery empowers you by helping you attain a contour body figure and a healthy, glowing skin effectively by the combination of surgical as well as a non-surgical procedure, including liposuction, tummy tuck, breast lift, facial rejuvenation, and additional skincare treatment.

A mother after 2 childbirths and breastfeeding routines, the patient faced issues of subcutaneous fat accumulation in the abdomen area, sagging abdominal skin, enlarged, loose and sagging breasts, deflated buttock area, and undesirable body shape. The patient also suffered back and neck pain and distorted posture due to enlarged breasts.

Dr Rajat Gupta, an experienced and board – certified surgeon with a track record of more than 800 Mommy Makeover procedures performed till date, carried out the procedure. 360O Liposuction, Abdominoplasty (Tummy Tuck), Reduction Mammaplasty (Breast Reduction), and Buttock Augmentation was recommended for the patient. She was examined for physical health, found in sound health conditions, and ready to receive the procedure. The patient was a non-smoking patient. She received 2 consultation sessions for a complete understanding of all the procedure inclusions. Each session lasted 45 minutes. The patient also checked the before and after images of previous surgery results performed by the surgeon. She found the results satisfactory and understood the procedure timeline, recovery timeline, and post-op care to be taken.

He started with the liposuction of the back followed by the liposuction of upper abdomen, the flank region called love handles, and the lower abdomen. This procedure is called 360 liposuction. It was performed to achieve harmonious results. To give a natural, hourglass shape, hi-definition liposuction was performed.

To remove the sagging and hanging skin, complete contouring of the abdomen, also known as Abdominoplasty or tummy tuck, was performed to give a highly aesthetic and natural-looking shape to the abdomen, along with an extremely shapely navel. During the tummy tuck, all the extra skin was removed, and the edges of the skin were sutured with the other edge of the skin. The skin was perfectly tightened on the abdomen area to remove all signs of sagging. The bikini incision was made to excise the extra skin tissue and was kept extremely low to keep it hidden inside the pelvic crease.

To achieve the hourglass shape, the divarication of the recti muscles was also corrected. The two muscles in the midriff, called recti, are usually joined in the midline, but after pregnancy, Mrs. Khatri(Name Changed) was facing divarication, which means the muscles had gone apart. Using his immense expertise, Dr. Gupta sutured the muscle layers together – one edge of the muscle to the other to bring them together. This helped in achieving a thinner waistline.

The fat removed from this zone was used to augment the lateral hips to provide a good elevation to the buttock area. This made the buttocks not wider but lifted and achieved the hourglass shape for the patient. The waist went in, and the buttocks slightly came out; thus, Mrs Khatri(Name Changed) received the desired hourglass shape.

For the breast reduction procedure, Dr Gupta performed liposuction to remove extra fat from the breasts. He then excised the excess amount of breast tissue and hanging skin and sutured it after lifting the breasts, giving them a natural, more youthful shape, proportionate to the rest of her body. The nipple and areola were also placed at an elevated position to give them a youthful appearance. This gave the patient an aesthetic-looking, fuller cleavage.

The aesthetics of the body and the shape have immensely improved. The results will improve over the next few weeks as the swelling and bruising settle down In all the abdominoplasty and body contouring procedures, the surgeon used MicroAire and VASER liposuction techniques. Other contouring devices were used to give the perfect natural-looking results as the patient desired. Tummy tuck combined with hi-def 360O lipo, breast reduction, and lateral raise of the buttocks combined together proved to be a highly successful procedure for Mrs. Khatri(Name changed), who was looking to regain the body shape she lost after multiple pregnancies.

Last few days have seen a drastic deterioration in Air Quality with Air Quality Index(AQI) going down and reaching very poor and sometimes hazardous levels.

Now this makes one think that we do know that Air Pollution is causing so many health issues especially Respiratory Issues in Children as well as Adults, then it must be having some effects on a growing foetus in the Pregnant Women’s Womb.

There have been studies which shows that exposure to environmental pollutants can lead to Adverse Pregnancy Outcomes.

It Increases the risks of spontaneous Abortions, Pre term Labour and when exposed in third trimester, might increase the risk ok Still Birth. Exposure to PM 2.5 and PM 10 as well as Carbon Monoxide and Cooking Smoke are the major Implicants of Pregnancy Loss due to Air Pollution.

Also, it is believed that the developing foetus is especially vulnerable to environmental toxins, such as Air Pollution. Studies also shows that air pollution can have a negative impact on Pregnancy outcomes such as Preterm Birth, Low Birth Weight, Intrauterine Growth Restriction as well as Congenital defects on Mother’s health as well.

Miscarriage which is typically defined as the loss of the foetus before 20 Weeks of Pregnancy, and still birth, which is typically defined as the death of foetus after 20 weeks of Pregnancy, are both the example of Pregnancy Loss. The most Serious Negative Pregnancy result is Miscarriages.

Magnetic Fields, Maternal Smoking and Ambient Cigarette Smoke have all been Linked to Negative Effects of Environmental Pollution on Spontaneous Abortion and Still Birth.

The disparities reflected by the child’s health indicators persist despite the significant improvements in children’s health that have been documented globally in recent decades, It is challenging to meet the Sustainable Development Goals because of the persistently low levels of health in socially vulnerable groups of the population (expressed in high rates of neonatal, infant, and under-five mortality, malnutrition, preterm birth, and low birth weight, among other adverse outcomes) (SDG).

The COVID-19 pandemic had a further impact on the situation as a whole, strengthening and highlighting the necessity of integrating social and health policies to address the complexity of children’s health issues.

In addition to being a significant contributor to neonatal morbidity and mortality, foetal growth restriction (FGR) also has long-term negative health consequences. In affluent nations where PM2.5 levels are generally low, a number of studies over the past ten years have shown that maternal exposure to ambient air pollution is a risk factor for aberrant foetal growth.

Article By: Dr. Payal Chaudhary, Senior Consultant, Obstretics and Gynaecologist, Madhukar Rainbow Children’s Hospital, Malviya Nagar

Article By: Dr Helai Gupta, Consultant, Obstretics and Gynaecologist, Rosewalk Healthcare

A UTI, or urinary tract infection, is an an infection of the urinary system. If limited to the urethra, that is the tube carrying urine outside, it’s called urethritis, and if it extends to the kidneys it’s called pyelonephritis.
In normal circumstances, urine is sterile and contains no bacteria. When bacteria from outside invades the urinary system, it causes infection and inflammation.

So how common is this infection?

Nearly 1 in every 5 women have had a UTI once in their life; it even affects men, children and the elderly! About 8-10 million people visit the doctor for UTIs yearly, and every 1 in 30 such infections can lead to a kidney infection.
If such infections keep , it can cause chronic kidney disease and high blood pressure.

So why do women get UTIs more frequently?

That’s because women have shorter urethras, the tube that carries urine out of the body. The opening of this urethra is also much closer to the anal opening in women where bacteria like E. Coli and Klebsiella are commonly found. Menstrual blood and vaginal discharge also provide a good medium for bacteria to grow.
Sometimes elderly people are unable to evacuate their bladder completely which can also lead to UTIs.

What causes a UTI?

The main culprit is usually bacteria called E. Coli but others can also cause a UTI.

What symptoms should you look out for?

UTIs most commonly present as abdominal pain and pain in the flanks, a sense of pressure in the lower abdomen, fever, bodyache and sometimes even chills. While urinating you may notice blood in your urine or foul smelling urine. An increase in the frequency of your urine and pain and burning while urinating could also indicate a UTI.

How do you diagnose a UTI?

Its important to visit a doctor if you experience these symptoms, so that they can confirm the diagnosis with a urine culture and analysis to find out which bacteria is responsible. Your doctor will also start you on the appropriate antibiotic and guide you on the dose and duration you need to take your meds for. Incomplete or empirical use of antibiotics can cause a recurrence and unnecessarily complicate the situation.

How can you prevent a UTI?

Fortunately with a few lifestyle changes you can prevent UTIs, these are:
1. Maintaining good personal hygiene and keeping the vulvovaginal area dry. Avoid washing after every act of urination, and wipe front to back with dry toilet paper.

2. Drinking plenty of fluids and avoiding sugary, or alcoholic drinks.

3. Try to urinate after sexual intercourse, and wash and dry after sexual intercourse as well.

4. Changing your birth control and menstrual products – for example, some diaphragms or even tampons and menstrual cups can cause a UTI if proper hygiene is not maintained.

5. Avoid spermicides, vaginal douching, strong soaps – these kill the normal vaginal flora that actually help fight off UTI causing , destroying your natural defence system.

6. Avoid tight fitting and synthetic underwear, switch to cotton underwear if possible so that sweat and moisture isn’t trapped.

All these simple switches will definitely reduce your chances of getting a UTI.

Article By: Dr Sudhir Kumar, Professor & HOD, Neurology Unit, Apollo Institute of Neurosciences, Hyderabad

Stroke is a serious neurological illness caused by blockage of blood supply to or bleeding into a part of brain, resulting in paralysis. It is the third leading cause of death and disability in the world, only behind heart attacks and cancer. One in six persons develop stroke in their lifetime and the prevalence of stroke increases to 1 in 4 people aged 40 or above. Every 20 seconds, one Indian suffers a stroke (or three persons every minute) and the numbers are alarmingly increasing due to changing lifestyle.

In Telangana including Hyderabad, the cases of stroke have spiraled since the COVID-19 pandemic. We have seen at least a 20% rise in cases of stroke in Hyderabad. COVID 19 infection increases the risk of stroke due to inflammation as well as hypercoagulable state (when blood clots easily in brain arteries). Covid vaccines also slightly increase the risk of strokes. Other causes contributing to a rise in stroke cases are anxiety & stress (which have increased since the pandemic), sleep deprivation (due to late office hours or engaging in late night parties) and alcohol abuse (Telangana holds the dubious distinction of being the second ranked state after Arunachal Pradesh in terms of alcohol consuming households).

Stroke prevalence is high in rural Telangana too. In a study conducted by Apollo hospital, Hyderabad in 2020 (published in Journal of Neurosciences in Rural Practice), the prevalence of stroke was found to be 27 per 10,000 population in Moinabad Mandal. Risk factors for stroke in rural Telangana were found to be smoking, alcohol consumption, high BP, high cholesterol, and central obesity.

Another feature noted in Telangana has been a higher incidence of stroke in younger population, mostly men aged 50 or less. Alcohol consumption and smoking have been found to be the causative factor of stroke in 70-80% of them. Post-Covid complications, unhealthy dietary habits and lack of exercise also contributed.

All is not gloomy when it comes to stroke in Telangana, there are silver linings too. People are now more aware of stroke symptoms and the fact that emergency treatment is needed for complete recovery. Compared to 5 years back, we are now doing double the number of stroke thrombolysis (clot buster therapy) and thrombectomy procedures (interventions to remove the clot from brain artery), which are time-bound treatments (effective in the first few hours after symptom onset). Availability of CT/MRI scan facilities and expert stroke care centers have also improved in Hyderabad and rest of Telangana.

We are now able to guide doctors in rural centers through TELESTROKE program (via Telemedicine) to administer advanced stroke treatments. Post-stroke care has also improved. People understand the benefits of rehabilitation and physiotherapy in stroke survivors, and this is reflected in the increased demand for rehabilitation beds in our hospital.

Also Read: Ultrasound scan can detect prostate cancer: Research

Mental health involves emotional, psychological & social wellbeing. It is all about how we think, feel, act, manage stress, relate to others & make healthy decisions childbirth is a profound psychological experience which can have a positive, empowering impact or a negative, traumatizing impact. Changing hormones during pregnancy can cause heightened emotions & one generally swings between being overjoyed to being stressed & overwhelmed. 1 in 5 women have mental health problem in pregnancy or after birth.

According to World Health Organisation, about 10% of pregnant women & 13% of new mothers experience a mental disorder, most common being depression. Poor maternal mental health can have long term implications on children’s health & may result in low birth weight babies & preterm delivery.
Babies exposed to stress hormones during pregnancy seem to show increased anxiety levels.

Women feel stressed thinking about pregnancy

• Labour pains, interventions or pregnancy complications
• Good parenting
• Changes in relationship
• Lack of support

Risk factors for Poor Mental Health during pregnancy are:
1. Pre-existing mental illness – Stopping medication for pre-existing mental disorder
2. Adverse life events
3. Difficult childhood memories
4. Family history of psychiatric illness
5. Substance abuse
6. Physical, emotional or sexual abuse
7. Exposure to domestic violence
8. Social adversity
9. Discrimination, stigma, racism
Ways to improve health during pregnancy are:
1. One has to prepare mind, body &soul
2. Positive affirmations help e.g. I’ll be strong, I’ll be brave, I’ve the power to deliver naturally
3. See pain as a friend, something useful which helps the baby to come out
4. Listen to positive, inspiring stories about childbirth
5. Talk therapy –Talk about your feelings to a friend, family member, doctor, therapist or support groups. Understand options & risk factors
6. Self-care: Listen to your body & mind and be aware of what you need
7. Sleep- 8 hours sleep is vital for being in happy emotional state
8. Diet- Eating healthy & natural foods promotes physical & mental health
9. Deep breathing exercises & relaxation techniques are helpful
10. Physical exercise improves mood & promotes good sleep
11. Reduce alcohol intake, stop smoking, treatment may include prescription medicine but one must consult the doctor before starting or stopping any medication.

Post-Partum Depression is a depressive illness which affects 10-15% of women within 1-2 months of childbirth.
One may experience various symptoms like:
1. Feeling low, tearful, unhappy & depressed
2. Irritability, Fatigue, sleeplessness with loss of appetite
3. Loss of interest in sex or unable to enjoy anything
4. Negative thinking
5. Feeling guilty
6. Loss of confidence
7. Anxiety about baby’s overall health. May present with racing pulse, breathlessness, sweating, thumping heart, may resent the baby also
8. Feeling hopeless & having suicidal thoughts
9. Hostility to new born & decreased emotional involvement
While 12-16% of women experience postpartum blues, post-natal psychological distress is also prevalent across cultures.
Most common factor was history of depression in antenatal period. Other contributory factors may be: Biological, psychological, obstetric, economic & cultural factors:
1. Biological- Poor physical health
2. Psychological- Depression, anxiety, past psychiatric history stressful life, child care stress, low self esteem
3. Obstetric- Previous abortion, loss of baby, unplanned pregnancy, absence of breast feeding
4. Unemployed, uneducated, domestic violence, lack of emotional support

Few tips that may help you to keep well & prevent depression
• Do make friends with other women who are pregnant or had a baby
• Do find someone to talk
• Do go to antenatal class
• Do make a well being plan
• Don’t try to be superwoman
• Don’t stop antidepressant medications during pregnancy without advice
Treatment involves medications but most women get better without medications within 3-6 months. 1 in 4 mothers may have postpartum depressions till 1 year of birth.
PND can affect one’s child development & behaviour & hence treatment is essential.

By Dr Lovelina Nadir
Gynaecologist and obstetrician
At rosewalk hospital
New Delhi

An unwanted pregnancy – alarm bells start sounding ! Panic buttons set and there is a need to immediately terminate the pregnancy .

Is there a right way to do this ?

The answer is yes .
Instead of hurrying to the nearest chemist shop and buying the kit over the counter , often with no instructions or half baked instructions of the pharmacist , which often leads to disastrous consequences it’s best to meet your gynaecologist . And why is that ?
Let’s go over the correct way of a medical abortion using pills .
The pregnancy must first be confirmed , initially with a urine pregnancy test or a serum B HCG test and then with an ultrasound . The ultrasound confirms an early pregnancy as also it’s location . Sometimes the pregnancy may be lodged in the tubes , called an ectopic pregnancy and at other times a molar pregnancy may be diagnosed ( grape like growths which develop in the uterus instead of an embryo ) In both cases if the abortion kit is used without supervision there may be life threatening risks . Medical abortion kits are recommended for intrauterine pregnancies upto 8 weeks , not more as there are higher chances of failure and heavy bleeding due to the procedure . That’s the reason an early pregnancy inside the uterus must be confirmed on ultrasound . Contraindications to use of medicine include asthma and severe respiratory disease , allergy to the medicine , adrenal disorders , long term corticosteroid use, porphyria, known blood thinning or anticoagulant therapy . This method is also undesirable for people who will not be able to understand or to follow instructions about use and risks and for those who can’t be in regular follow up with their gynaecologists or registered medical practitioners . So that’s a huge check list of people who are eligible or ineligible for the medical abortion kit .
Once you are eligible to use the medical abortion kit by a proper history , examination and ultrasound examination , you are counselled on how to take the medicine , the procedure , side effects and follow up . You are made to sign a consent form and asked to be in touch with your doctor in case there is the slightest problem during the course of this treatment which is somewhat long drawn and not always fool proof in terms of a complete abortion .

What to expect during the course of a medical abortion and what can go wrong ?
Once you are given the pills by specific protocols , you can expect to have severe cramping in the abdomen and heavy bleeding . This bleeding is initially heavier than a normal period and may be accompanied by fleshy pieces which are products of conception along with clots . This bleeding usually may become a little less in the following days but typically remains for 7-10 days or slightly longer . Other side effects of the medicine include headache , vomiting , diarrhoea , chills , fever , dizziness and lightheadedness .You are asked to get an ultrasound on day 10-14 of the procedure to see if the abortion is complete or if there are residual products of conception which may required to be removed by another medicine or a surgical aspiration or cleaning .

Now what can go wrong ?
There may be severe bleeding that is precipitated due to the abortion pills . If you soak more than one maxi pad completely in one hour for 2 successive hours it implies you are bleeding heavily . Moreover bleeding slightly more than normal may also be relatively heavy for a patient with low haemoglobin levels or anaemia . This heavy bleeding may be life threatening as it leads to hemorrhagic shock and may require to be stopped by a surgical evacuation and even blood transfusion in around 0.1 % of medical abortions . Imagine if you are sitting at home while this happens ; the events are horrific .
In case you’ve taken the medicines without ruling out an ectopic pregnancy , that could rupture leading to severe internal bleeding , shock and collapse . And in case any eventuality like this happens , who will be held responsible ? Certainly not the chemist who sold and prescribed the medicine because according to the MTP act , an abortion can only be done by a qualified gynaecologist or an experienced registered medical practitioner .
However this does not mean you will be in hospital for the entire course of a medical abortion . Your doctor will prescribe the medicine and you will be at home under her / his care and supervision just in case anything goes wrong . Also remember , though rare , medical abortions may lead to infertility due to infections of the genital tract ; hence proper screening , evaluation and follow up is of vital importance .

Unwanted pregnancies are definitely bothersome but remember contraception and prevention is the key . However should they happen always remember to take medical abortion kits in the right way and under supervision , equipped with all the knowledge ( not with Google or your peers) and with all the choices available .
Medical abortion kits used at home without medical supervision can indeed be disastrous and sometimes life threatening so choose to be safe and sensible . Talk to your doctor right away !

By
Dr Shelly singh
Gynaecologist and obstetrician
At rosewalk hospital
New Delhi