Myomectomy

What is Myomectomy and why is it performed?

Myomectomy is a surgical procedure conducted to remove fibroids in the uterus, also known as leiomyomas. These noncancerous growths are common and can occur at any age, but they aretypically seen during a woman’s childbearing years. The goal of this procedure is to remove symptomatic uterine fibroids and reconstruct the affected areas. The entire uterus is not removed unlike during a hysterectomy, which means that fertility is preserved and patients can bear children. Myomectomy helps improve symptoms of uterine fibroids, such as pelvic pressure, heavy or irregular menstrual bleeding, and frequent urination. This procedure is recommended to patients who plan on bearing children and need to eliminate uterine fibroids that may be affecting their fertility. There are three methods to Myomectomy: Abdominal Myomectomy: The uterine fibroids are removed through an incision in the lower belly. This is the most invasive method of the three. It involves general anaesthesia and a long recovery time. Patients have to stay at the hospital for two or three days. The incision will leave a visible scar. Laparoscopy Myomectomy: The fibroids are removed through small incisions using a laparoscope. This is minimally invasive and does not need a long recovery time. If the fibroids are too large, the surgeon will conduct an abdominal myomectomy. An overnight stay at the hospital may be necessary. Hysteroscopic Myomectomy: A special scope is inserted into the uterus through the vagina and cervix and wire loop is used to remove the fibroids. This is also a minimally invasive procedure and the patient does not need to stay at the hospital for recovery.

Are there any risks or complications?

As with all surgical procedures, myomectomy has its share of risks and complications. Some of them are:

• Excessive bleeding
• Infection
• Perforation of the uterus
• Damage to neighbouring organs
• Scar tissue that can cause fertility problems
• Development of new fibroids which may need another procedure for removal

What does recovery involve?

There will be some pain and discomfort following a myomectomy procedure. The doctor will prescribe some painkillers to make recovery more comfortable. The patient may experience some spotting that can last between a few days to weeks. The type of myomectomy procedure will dictate the recovery period. Patients are advised to refrain from lifting heavy objects or performing strenuous exercise until the incisions are completely healed. It is also recommended to wait up to six weeks for patients to have sex or become pregnant.

Medical Abortion

Medical termination of pregnancy or medical abortion is a procedure where medication is used to end a pregnancy. It is the safest and most effective when the woman is in the first trimester of pregnancy. This procedure does not need surgery or other techniques and can be performed in a clinic or at home under a doctor’s supervision.

Why is it done?

The reasons behind choosing the medical termination of a pregnancy are usually highly personal. In most cases, women prefer to have an abortion to end an unwanted pregnancy. It is also a recommended treatment if the person has suffered an early miscarriage. Medical abortions are sometimes the suitable option if the expectant mother has a medical condition that can adversely affect her or the baby’s health. A medical abortion is treated as a last resort. Doctors will conduct several tests to determine if the pregnancy may be dangerous for the mother or child.

Who is eligible for medical abortion?

Before choosing to undergo a medical termination, patients are requested to be completely certain about their decision as reversing the effects can be dangerous. Medical abortions are suitable for women who want to end an unwanted pregnancy as long as they are in their first trimester. If the patient has suffered a miscarriage, a medical abortion is conducted to remove foetal and placental tissue. Medical abortion is not suitable for:

• Women who have been pregnant for over nine weeks
• Suspected cases of ectopic pregnancies
• Individuals who have an intrauterine device (IUD) in their system
• Individuals who have certain health conditions such as bleeding disorders, heart diseases, lung diseases, seizure disorder or certain genetic diseases
• Women who are on blood thinners or long-term steroids
• People who cannot make follow-up visits to their doctors or do not have access to emergency medical treatment

What are the side effects of a medical abortion?

Medical abortions are known to cause cramping and bleeding for up to two weeks, so patients are advised to speak to their doctors about possible side effects. Some common ones are:

• Nausea
• Vomiting
• Dizziness
• Headaches
• Diarrhoea
• Hot flashes

Get in touch with our specialised team of doctors for answers to your gynaecological queries.

Hysterectomy – Understand the Procedure

What is Hysterectomy?

A hysterectomy is a procedure where the uterus is surgically removed. This procedure is performed to treat various conditions that cause chronic pain, infection or cancer. There are many reasons why women undergo hysterectomies and the extent of the procedure depends on these reasons. In most cases, hysterectomy involves the removal of the entire uterus. The fallopian tubes and ovaries may also be removed. Once a woman has undergone a hysterectomy, she will no long have menstrual periods and cannot bear children. There are many types of hysterectomy. The most important and frequently recommended ones are: Partial hysterectomy: Only a portion of the uterus is removed and the cervix is left intact Total hysterectomy: The entire uterus and cervix is removed Hysterectomy and salpingo-oophorectomy: The entire uterus is removed along with one or both of the fallopian tubes and ovaries

Why is a Hysterectomy necessary?

This procedure is performed to help treat a number of gynaecological issues, such as:

• Chronic pelvic pain
• Pelvic inflammatory disease - infection of the female reproductive organs
• Uterine, cervical or ovarian cancer
• Uncontrollable vaginal bleeding
• Uterine fibroids
• Uterine prolapse - protrusion of the uterus from the vagina through the cervix
• Endometriosis - condition where the uterine inner lining grows on the outside of the uterine cavity, leading to bleeding and pain
• Adenomyosis - condition where the uterine inner lining grows into the uterine muscles

How is a Hysterectomy performed?

There are different methods to a hysterectomy procedure and the doctor will determine the most suitable one depending on the patient’s condition and medical history. Abdominal hysterectomy: The uterus is removed through a large horizontal or vertical incision in the abdominal area. There are chances of visible scarring. Vaginal hysterectomy: The uterus is removed through a small incision made inside the vagina. There will be no visible scars. Laparoscopic hysterectomy: A laparoscope is used to view the inside of the abdomen and remove the uterus. Few small incisions are made instead of a single large one. A hysterectomy is a permanent sterilisation procedure. It may also induce sudden menopausal symptoms that can be difficult to cope with. If you may want to become pregnant later, speak to your doctor regarding alternatives and options.

Dilation and Curettage

What is D&C?

Dilation and curettage or D&C is a medical procedure conducted to extract tissue from inside the uterus. It is performed to diagnose and treat certain uterine conditions or to remove the uterine lining following an abortion or miscarriage. During this procedure, doctors use medication or small instruments to dilate or open the cervix, the narrow lower part of the uterus. A surgical instrument known as a curette is then used to extract uterine tissue.

Why is D&C done?

The doctor might recommend undergoing D&C to collect endometrial sampling in cases such as:

• Abnormal uterine bleeding
• Presence of abnormal endometrial cells during routine tests
• Bleeding after menopause
• Symptoms of endometrial hyperplasia, polyps or uterine cancer

D&C is also a routine procedure to remove the contents of the uterus. These cases include:

• Clearing out tissues that have remained inside the uterus following an abortion or miscarriage to prevent heavy bleeding or infection
• Removal of a molar pregnancy where a tumour forms inside the uterus instead of a foetus
• Removal of uterine or cervical polyps

Doctors also perform D&C along with other gynaecological procedures such as hysteroscopy, where a slim tube with a camera is inserted into the uterus to identify any problems or take biopsy samples.

How is a D&C performed?

Before D&C can be performed, the doctor will administer anaesthesia. The patient is made to lie on their back with their heels resting in stirrup supports. An instrument called a speculum is inserted into the vagina through which dilation rods are inserted to open up the cervix. The rods are removed after adequate dilation has been achieved and a spoon-shaped instrument is inserted. This instrument has a suction device or a sharp edge which is used to scrape the uterine wall for tissue removal. After the extraction, the speculum is removed and the patient is sent to the recovery room for observation. Some patients experience light bleeding, spotting or cramping following a D&C procedure.

Ovarian Preserve Fertility

What is Cystectomy?

Cystectomy, also known as ovarian cyst removal, is a surgical procedure to remove fluid-filled sacs known as cysts from the ovaries. An ovarian cyst is a follicle in the ovaries that is larger than 2 centimetres that usually develops due to disordered ovulation where the follicle fails to release the egg. These follicles expand due to fluid secretion and become cystic over time. Persistent cysts that are bigger than 4 centimetres often have to be removed surgically. They rarely present any signs or symptoms, but these cysts can cause abnormal bleeding and pain. Cystectomy can help remove cysts and preserve fertility, but there are chances of new masses or cysts to re-form over time. This risk can be eliminated only by surgically removing the ovaries in a procedure known as oophorectomy.

Why is a Cystectomy performed?

Before a cystectomy, the doctor will confirm the presence of ovarian cysts using an ultrasound. The procedure is often performed to remove ovarian cysts and rule out possibilities of ovarian cancer. There are other purposes for a cystectomy procedure, such as:

• Removal of abnormal masses in the ovaries
• Removal of abnormally solid cysts that do not contain fluid
• Removal of a cyst that has not responded to non-surgical treatment methods
• Removal of symptomatic cysts that cause pain or abnormal bleeding
• Removal of ovarian cysts in patients who are pre-menstrual, postmenopausal or using birth control pills

How is a Cystectomy performed?

Depending on the size of the mass or cyst, there are two methods that can be followed during a cystectomy. In case of small-sized, benign cysts, a laparoscopic technique is most suitable. A small incision is made near the navel and carbon dioxide gas in introduced into the abdominal cavity to expand the area. The laparoscope is introduced and specialised surgical tools are used to remove the cyst. In case of large cysts that show signs of being cancerous, the surgeon may perform a procedure known as laparotomy. During this procedure, large incisions are made in the abdominal area that allow the surgeon to remove the cyst as well as affected ovaries, fallopian tubes, uterus, fatty tissue and surrounding lymph nodes. Talk to our experienced gynaecologists today for details on risk factors and treatment of ovarian cysts.

High-Risk Pregnancy Care

What is a high-risk pregnancy?

Pregnancy is a beautiful experience, but it can be a nightmare for some women. A high-risk pregnancy, as the name suggests, is a pregnancy that contains one or more risks that can threaten the life of the mother, the baby or both. While your pregnancy may seem safe at the beginning, complications and risks may arise over time. It is not difficult to ensure your pregnancy is safe. Regular prenatal care can help you maintain a healthy pregnancy and welcome your baby into this world without serious problems.

What can lead to a high-risk pregnancy?

There are several factors that can cause a woman to develop a high-risk pregnancy. Some of them are:

• Existing health issues like diabetes and high blood pressure
• Teenagers and women over the age of 35 have shown to be more susceptible to high-risk pregnancies
• A mother carrying multiple foetuses will be at a higher risk of developing complications
• Being obese or overweight can increase your chances of developing conditions like gestational diabetes, neural tube defects, preeclampsia, and stillbirth. Infants can also develop heart problems due to obese mothers
• Being underweight can lead to complications such as premature birth and a malnourished baby
• Women who have had issues with previous pregnancies can develop complicated pregnancies in the future
• Smoking, drinking alcohol and taking drugs can lead to problems during pregnancy and severely affect the baby’s development

How to prevent a high-risk pregnancy?

The best way to maintain a healthy pregnancy is to diligently follow your doctor’s instructions. Regular prenatal care, a healthy diet, and basic exercises can help you keep complications at bay. Keep away from stressful situations, risky foods, and unhealthy habits during your pregnancy.

Treat Ectopic Pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy can be described as a complicated pregnancy where the fertilized egg is fixed in the fallopian tubes, ovaries or cervix. Based on the area of the implantation, ectopic pregnancies are known as tubal or cervical pregnancies. Ectopic pregnancies are highly dangerous because they are located in other areas besides the uterus. As the foetus develops, it could result in damaging the organ around it. This leads to serious complications and can threaten the mother’s life.

What are the signs and symptoms of an ectopic pregnancy?

Ectopic pregnancies can sometimes appear as normal pregnancies, which is why diagnosis is tricky. The most common signs of an ectopic pregnancy include nausea, vomiting, missed periods, fatigue, frequent urination, and abdominal cramps. Here are some more serious symptoms associated with an ectopic pregnancy:

• Vaginal bleeding
• Severe pelvic pain
• Fainting or dizziness resulting from blood loss
• Lower back pain
• Low blood pressure

What are the causes of an ectopic pregnancy?

It has been difficult for doctors to ascertain the exact causes of an ectopic pregnancy, but there are certain conditions that can increase your chances.

• Hormonal factors/ IUCD
• Birth defects
• Genetic abnormalities
• Scarring or damage to the fallopian tubes caused by an earlier medical condition
• Scarring caused by previous surgery
• Diseases like chlamydia or gonorrhoea that cause inflammation of the fallopian tubes
• Endometriosis

How can an ectopic pregnancy be treated?

The location and size of the fertilized egg helps determine how the ectopic pregnancy can be treated. If the ectopic pregnancy is in its early stages, it can be treated with medication such as methotrexate. If the pregnancy is over a few months, it will have to be terminated and removed via surgery. Doctors today are able to use less-invasive procedures like laparoscopy to removed ectopic tissue that results in minimal scarring and lesser recovery time.

Delivery – Natural and C-Section

Childbirth is a beautiful and life-changing experience. Mothers can give birth through two types of delivery - natural and C-section.

What is natural delivery?

Natural childbirth or vaginal birth is the process of welcoming a child with little to no medical involvement. This means that little to no pain relievers will be administered. Instead, mothers resort to controlled breathing and relaxation techniques during the delivery. Many mothers prefer this process because it is allowing nature to take its course. Most mothers choose natural childbirth when they are confident that there are no problems surrounding the pregnancy and baby. A doctor will be present to guide her through the process.

What is a C-Section?

A Caesarean section or C-section is a surgical childbirth procedure where the baby is delivered from the mother’s womb by making incisions in the Lower abdomen. C-sections are recommended to mothers whose pregnancies may have seen some complications, it may be obstetrical conditions. They are also performed if the baby’s health is at risk. During a C-section, the mother is given general or epidural anaesthesia to help make the procedure as painless as possible. C-sections are safe and allow the mother a faster recovery time.

When should you choose a C-Section?

While most mothers prefer a natural childbirth, there are times when a C-section is the better choice. Your doctor will schedule a C-section if:

• A vaginal delivery is risky to both mother & baby, especially if you have a specific medical condition
• You have faced certain complications during your pregnancy(HT,DM)
• The baby is in the wrong position within the uterus or preterm, IUGR/ twins in wrong position
• The baby is showing signs of birth defects
• There are complications with the placenta

Consult with your obstetrician or family doctor on which childbirth procedure is more suitable for you.

Stomach Cancer

Understanding stomach cancer

Stomach cancer is the uncontrolled growth of mucosal cells found in the stomach lining. It is commonly caused by mutation within the cells’ DNA which causes them to grow and multiply rapidly. These cancer cells accumulate and develop into a tumour which sometimes invades neighbouring tissues and organs. Cancer cells can also spread throughout the body. Risk factors that increase your chances of developing stomach cancer include:

• Obesity
• Smoking
• History of chronic untreated Gastroesophageal Reflux Disease (GERD)
• Diet high in smoked or salty foods
• Low-fibre diet
• Chronic Helicobacter pylori (H. pylori) infection
• Long-term stomach inflammation
• Polyps
• Family history

Do you need surgery to treat stomach cancer?

While chemotherapy and radiation are often used in treating cancers, surgery is the main treatment. People who have early-stage stomach cancer can undergo a less-invasive procedure where an endoscope fitted with specialised surgical tools that are used to remove cancerous tissue is inserted into the affected area. The tools are used to remove cancerous tissue. For more progressive cases, a more traditional surgery technique is used. This involves making an incision along the patient’s abdomen which gives the surgeon access to the affected area. The cancerous portion is removed along with surrounding tissue and lymph nodes. The incision is closed and the patient is sent to post-operative care.

What does stomach cancer surgery involve?

The aim of stomach cancer surgery, whether traditional or minimally invasive, is to cure the local disease or at least arrest its metastasis. To treat stomach cancer, two techniques are commonly used. Partial/distal/subtotal gastrectomy: This involves the removal of part of the distal stomach along with the surrounding fatty tissue and lymph nodes. This is done if the cancer is in the distal part of the stomach. The remaining stomach is connected to the intestines to achieve smooth passage of food and water. Total gastrectomy: This involves removing the entire stomach and its surrounding fatty tissue and lymph nodes. The patient’s oesophagus is connected to the intestines. Talk to your oncologist today for more details on stomach cancer and its treatment.