DAKSH CLINIC

Hi,

I am Dr. Puja Sharma, Gynaecologist, Delhi. Today I will talk about diabetes in pregnancy. As you all know that diabetes is a very common disease. There is the hormone in our body by the name of insulin which regulates blood sugar. So, what happens in pregnancy? Changes in insulin lead to changes in blood sugar. For a lady who is already diabetic and has conceived or a lady who has been diagnosed as the diabetic first time in the pregnancy, in both these condition, the change in insulin sensitivity causes a high risk both to the mother and baby. It has been generally acknowledged that tight glycemic control means good blood sugar control during pregnancy can reduce these complications to a large extent.

Now let me first begin with diabetes before pregnancy. So, in a lady who is diabetic before pregnancy and she is planning to get pregnant, what all things she should think? 3 things she should remember what medicines is she taking, what is her blood sugar level before conception and the third important thing is blood pressure. She should get her blood sugar level done before a month planning for pregnancy. 2nd category is those girls who have had a history of diabetes in a previous pregnancy. There are 30-50% chances of getting diabetes in 2nd pregnancy. They should be cautious. They should get their blood sugar done before a month planning for pregnancy. They should get their HbA1C done. 3rd category is gestational diabetes mellitus. When you go for a pregnancy check, diabetes is one of the tests which you have to get done.

Gestational diabetes has some consequences on both mother and child. What can happen to a mother? Mother can have high blood pressure because of diabetes, an increase in the water around the baby. She can have difficulty in delivery and more chances for landing in c-section. Other complications like retinopathy, the effect on kidneys. Coming to the baby, gestational diabetes is a higher risk for the baby. There are chances of death or abortion. There are chances of many malformations in the baby like any deformity. High blood sugar can cause a deformity in the baby. Baby can be larger than normal babies. Baby's weight can be more than 3.5 kgs.

How do we diagnose diabetes in pregnancy? As I told you certain tests are required. If they are negative then we repeat the tests after 24-28 weeks again. If any of the tests comes positive then you are subjected to frequent tests and blood sugar monitory. How do we manage diabetes? We try to manage the patient on medical nutrition therapy and exercise. We give a proper diet plan to the patient and exercise schedule of 30 mins per day. Diet is given as per your height, weight, and BMI. After 2 weeks again blood sugar test repeated. If with all precautions, blood sugar is still not under the control then we put the lady either on insulin or oral medications. Coming to the mode of delivery. Diabetic mother usually requires early intervention. We have to take a decision for the delivery before 40 weeks of pregnancy. 2nd is the mode of delivery either vaginal or c-section. There are certainly more chances of c-section in diabetic women.

After delivery the glycemic control is important. Even after the delivery, we need to check the lady for diabetes test after 6 weeks. This is to see whether she is diabetic or she was diabetic only during pregnancy. Even when the lady develops diabetes, they have more chances of diabetes in later life. Diabetes in pregnancy is a high-risk pregnancy but it can be well managed by proper glycemic control. Certain tips for a diet to be taken like carbs increase the blood sugar level-so it should be taken in the split meals. Rather taking 3 big meals, you can take 6 small meals. Fried foods have to be restricted. Protein intake has to be neutral. Eat complex carbs like jawar, bajra, raagi, oats, salads. So, I wish you a very healthy pregnancy. And if there are any signs of diabetes in pregnancy if you are facing then consult your gynecologist.

Thank You.

Hi,

I am Dr. Puja Sharma, Gynaecologist. Today I will discuss a very common problem i.e. fibroid uterus. If you are at a reproductive age group then you must know about this. What are fibroids? What can happen if they are left untreated? What are the diagnostic techniques and finally the treatment? This is the most common tumors happens in the muscles of the uterus. This is the most common benign tumors. Benign means are non-cancerous. Who can have them or what are the risk factors? It is most commonly seen in women who had a family history of fibroids, who are nulliparous, who have early menarche or late menopause and obesity? These are the few risk factors. What are the symptoms? How can a lady think that she is having fibroids?

The fibroids mostly present with menstrual disturbances like abnormal uterine bleeding, mostly in the form of excessive and frequent uterine bleeding. It can also present as lower back pain, pelvic pain, pain during passing stools, pain during urination. Some fibroids can also cause infertility. We need to give certain extra precautions during pregnancy and after pregnancy. How can we diagnose them? In some cases, fibroids can be found while doing an ultrasound or pelvic examination otherwise for diagnosing it we need to a transvaginal ultrasound. However, in some cases, transabdominal ultrasound or MRI can be needed in rare cases. In most of the cases, it can be done through ultrasonography only. Now, coming to the treatment. Treatment depends upon the symptoms. Management of fibroid should be tailored according to the size of the fibroid, location of the fibroid, patient's age and desire for fertility. Now a lady who is having multiple small fibroids, in such cases, no treatments are required, if the lady is around in the premenopausal group or lady is about to have menopause in a few years, no treatment is required. If the lady desirous of fertility and having big fibroids then we can offer her myomectomy which means the removal of just fibroid, not the uterus.

If the lady has completed her family and still desires to remain the uterus and she is having fibroids which can be removed then also we can do myomectomy. But this does not mean that fibroid cannot recur. It can. Now the lady who is having multiple fibroids and completed their family, in such case, the main treatment is hysterectomy which means complete removal of the uterus. And this surgery should be done with the minimal invasive possible. So, nowadays it can be done by laparoscopy, ultrasonic energy, open surgery. I would like to mention if you are in the reproductive age group and you are not having a menstrual complaint, back pain, then please seek medical advice. At least meet your Dr and get yourself examined. So, your problem can be detected and treated early.

Thank You!