Call : +91-9650645300, 8800306999
E-Mail : info@sanrampathlab.in

Akash Hospital

Akash Hospital was established in the year 2011 providing the best services available in gynecological treatments. Under the guidance of Dr. Shalini Sharma, MBBS, DNB, Akash Hospital deals with expertise in the area of High risk pregnancy and Labor management. Thus, Akash Management comes as a boon to hundreds and thousands of mothers-to-be.We take up all gynecology based problems and provide services to patients to adults and adolescents with the help of the state of the art technology. We have a huge expertise in providing pediatric gynecologic care.

Following are the services we offer:-

  • Antenatal Care
  • High Risk Pregnancy
  • Conventional Gynecology
  • Adolescent Problems
  • Menopausal Problems
  • M.T.P.
  • Family Planning

 

Teen Times

The teenage years are a very special phase. Young girls are curious to understand their changing bodies. They have many questions and are seeking answers. These answers go a long way in building her confidence and a positive attitude towards the physical change that she will experience.

Teenage counseling

In our teenage counseling program, we conduct an informative counseling session in an open-friendly atmosphere. The young girl is informed about the normal body anatomy, physiology and the menstrual hygiene. Healthy habits regarding diet & exercise are promoted. Young girls have many misconceptions and myths regarding menstruation. Some of the common ones are questions like why one cannot go to the temple during periods and why should one not swim during periods? We address these whilst respecting the social/religious sentiments. Puberty & menarche are important milestones in a girl’s life. It is now the time to prepare her for womanhood. Sexual education is important subject and needs to be handled well. Professional expertise is valuable in addition to the role of parents, teachers & peer educators. In our counseling sessions we provide information on various issues such as how one gets pregnant, how to prevent pregnancy, what are sexually transmitted infections, and safe sex.

Teenage Healthcare

Pain during periods is the commonest reason for approaching a doctor and it can be very distressing. It may be severe enough to affect daily routine of the young girl. It is easily treated with simple analgesics, exercises & hot fomentation.
Acne, hirsutism, delayed or irregular periods, vaginal discharge, itching are some of the common problems for which a teenager may seek medical help.

Heavy prolonged periods are common during the first few years after menarche. Young girls occasionally become anemic due to heavy periods. Therefore it is vital to identify them. They may need not only haematinics but also hormonal medication to control the situation.
It is not uncommon for the youth to indulge into sexual activity. It is imperative that they are well informed so that they can practice safe sex. Contrary to popular belief, providing information does not promote promiscuity. Teenage pregnancy is no longer uncommon. In such situation professional advice is given in a sensitive manner and confidentiality is respected. Legal Abortion is provided.
Youth of today are not uninformed but are misinformed. We aim to provide accurate scientific information and care in an unbiased, youth friendly atmosphere.

UNWANTED PREGNANCY (ABORTION)

It is appropriately said that every child should be a wanted child. Sometimes a pregnancy may not be wanted. In this case one may seek an abortion. Abortion is legal provided it is carried out within the legal permits. An abortion can be done only up to 20 weeks of pregnancy.

Under the terms of the abortion act, doctors can agree to an abortion if they believe one or more of the following:
1. Continuing with the pregnancy would involve more risk to your physical or mental health than terminating it.
2. Continuing with the pregnancy would involve greater risk to your life than terminating it.
3. Any existing children of yours were likely to suffer if the pregnancy continued.
4. There is a substantial risk that the child would be deformed or seriously handicapped.
If one desires a termination of pregnancy then one should seek an abortion as early as possible as earlier it is done in the pregnancy safer it is.
The method of termination will depend on the weeks of gestation.

When the pregnancy is
1. < 7 weeks – abortion can be done with just tablets. The tablets are safe effective and have a success rate of more than 90 %. The advantages are that the patient does not need any admission, anesthetic, any instrumentation of the uterus.
2. 7 – 12 weeks – then abortion is a simple procedure. It is done under an anesthetic in a day care center that is certified for abortion services. The patient is able to go home in a few hours.
3. 12 – 20 weeks – the procedure is a little lengthy and one may need to stay overnight in the hospital.
If you wish to seek an abortion or want further information then please feel free to contact Dr Shalini Sharma

CONTRACEPTION

Every pregnancy should be a wanted pregnancy and therefore it should be a planned pregnancy. It is imperative then to ensure use of a contraceptive that suits the need of the couple. In present times there is a wide range of options available in the basket of contraceptives. There are temporary methods i.e. reversible and permanent methods i.e. irreversible. Permanent methods are used when child bearing is no longer desired. Tubal sterilization and vasectomy are the choices available.
Amongst the temporary methods the choices vary on various factors. Barrier methods such as male and female condoms are popular. The male condom is widely promoted not only to prevent pregnancy but also to prevent STD and HIV. It is the single contraceptive that serves this dual purpose.The combined oral contraceptive pills (COCP) have been around for decades and they have undergone numerous developments. From standard dose pills we have moved to the ultra low dose pills, which have minimal or negligible side effects. The COCP have many benefits over and above providing contraception.
They are Changes in menstrual cycle
(Decrease in pain during periods, Decrease in quantity of bleeding, regular cycle, decrease in iron loss in periods)
Benefits in the management of PCOS such as reduction in acne and hirsutism, and regularization of periodsPrevention of malignancies
(Endometrial cancer, ovarian cancer, colorectal cancer)
Other benefits such as reduction in(Ovarian cysts, pelvic inflammatory disease, ectopic pregnancy, benign breast disease, acne)
The use of COCP has been clouded with many myths. These myths can be addressed during a consultation and we can help you to choose a pill appropriate to your needs For women who cannot take estrogen containing pills can use progesterone only pills. They are particularly useful in women who are breast-feeding.Injectable contraceptives are effective methods requiring an injection only once in three months or two months depending on the preparation used. They are appropriate when long-term contraception is required.

Emergency contraceptive pills are not an alternative to regular contraception but an emergency measure, which can prevent an unwanted pregnancy if taken within 72 hours of unprotected sex. They are safe effective and available over the counter. The common one available is marketed as two tablets each containing 75 mcg of Levonorgestrel. The first tablet is taken within 72 hrs of unprotected intercourse and the second one is taken after 12 hours of the first tablet. Pill 72 is now a single does tablet to be taken as soon as possible after unprotected sex, but within 72 hours.

Intrauterine devices are ideal for spacing and when long-term contraception is required. We have the copper containing and the levonorgestrel releasing intra-uterine system. They are easily inserted in the out patient clinic and there is no need of any anesthesia. They are effective immediately from the time of insertion. They are effective for as long as 5 to 10 years and once removed, fertility returns at once.
The contraceptive vaginal ring and the contraceptive patch are not yet available in the Indian market.

In present times couples have a wide array of choices for contraceptives and one can always find one to meet their needs. Abortion should not be used as a method of contraception. However, every method has a failure rate and if a pregnancy does occur, and is not planned or wanted, seek an appointment with Dr Shalini Sharma as early as you can because the earlier an abortion is done , safer it is.

GYNAE INFECTION

Infection can affect the external genitalia, the lower tract i.e. vagina or the upper organs i.e. cervix,uterus, tubes and ovaries. Infections can be viral, fungal, bacterial, and parasitic. There can be mixed infections too.
Women will normally present with vaginal discharge, fever nausea, vomiting and pain in the lower abdomen, either singly or in various combinations. Infections can occur in all age groups and is particularly common in teenagers, young adults and the geriatric population. Sexual history, presence of important medical conditions such as diabetes and HIV, and pregnancy play an important role in the course of the infection and its management.
Diagnosis can be a challenge as many conditions in the lower abdomen will present with similar symptoms e.g. appendicitis. Various tests such as smear, culture, blood test, ultrasound of lower abdomen, and occasionally laparoscopy is done in the diagnosis and the management of these infections. Treatment will depend on the organism involved and the degree of spread. Prompt diagnosis and appropriate treatment is the key in preventing long term complications such as chronic pelvic pain, blocked tubes, inability to conceive and ectopic pregnancy.

GYNAE CANCERS

The gynecological cancers are cancers in the cervix, womb, ovaries, vagina and vulva. Of these the cancers of cervix, womb and ovaries are relatively common. Each of these cancers is different in its risk factors, screening options, presentation, and response to treatment and survival rates.
The common symptoms are abnormal vaginal bleeding, pain in lower abdomen, back ache, bloating, loss of appetite and change in urinary and bowel habits. None of these are characteristic of any particular cancer and can happen even in benign conditions.Screening tests can enable us to detect the disease even before it happens. Screening for cervical cancer by pap smear is extremely effective and enables us to detect changes in the cervix that are precancerous. Effective treatment can be given even before the cancer happens.Unfortunately there is no reliable, practical and effective means of screening for all the other gynecological cancers. Uterine cancers present with vaginal bleeding early and therefore are diagnosed in early stages where treatment can be very effective. Ovarian cancers many times present quite late. Treatment then depends on the stage of the disease.
The treatment for all cancers depends on the type of cancer and how far it has spread. Common treatment modalities are surgery, chemotherapy, and/or radiation. Most patients may need various combinations of these modalities. Surgery involves removal of the cancerous mass, commonly the organs involved, the lymph nodes and sometimes adjacent organs that may be involved. Chemotherapy involves the use of radiation involves the use of high-energy rays (just like X-rays) that kill the cancer cells, or stop them from growing.Therefore patients need multi-disciplinary approach, highly qualified, and experienced team of experts for the appropriate management to achieve the best results. Dr Shalini Sharma is an expert gynecologist attached to a hospital where the whole team and infrastructure is available for the best treatment.

COMMON GYNAE PROBLEMS

The field of women’s health has always been a matter of concern. Women need care not only in pregnancy and childbirth but in all phases of life i.e. womb to tomb. It is important to have a holistic and comprehensive approach. Advances in technology, and innovations have made it possible to provide good prevention strategies, early diagnosis, appropriate and timely treatment.
In this section I have discussed some common gynecological health problems that affect women in various different stages of life. We aim to provide overall wellbeing of the women with the highest quality care in a compassionate manner using latest technology and leading edge evidence-based treatment.

PCOS

PCOS is an endocrine and metabolic disorder. It is considered in any woman with acne, hirsutism, menstrual irregularity, or obesity.
Patients with PCOS, have anovulation, i.e. they may not produce a follicle cyclically. They may therefore present with primary amenorrhea (i.e. no periods at all), too few periods (oligomenorrhea) or secondary amenorrhea i.e. absence of periods for six months or more. Some may also have excessive, frequent and irregular bleeding (dysfunctional uterine bleeding).
Resistance to insulin, and increase in insulin levels is an important factor in PCOS. Obesity is present in approximately one-half of patients with PCOS. The waist:hip ratio may be greater than 0.85.
The cause of PCOS is unknown, but there is a possibility that PCOS may be a complex genetic disorder in which the genetic factor interacts with various environmental factors and causes imbalance in the hormones.
The diagnosis of PCOS is based upon clinical and biochemical criteria. It is suspected in cases of adolescents with hirsutism, acne, menstrual irregularity, or obesity. The diagnosis is further confirmed if excess anogen is demonstrated by laboratory testing. Anogen panel consists of plasma total testosterone, free testosterone, and another anogens such as DHEA sulfate. Plasma-free testosterone is the single most sensitive test for the detection of anaogen excess. DHEA sulfate is the main marker of anogens that come from aenals. Cortisol and thyroid function tests are indicated in obese patients to exclude other causes of obesity.Pelvic ultrasound shows the features of a polycystic ovary. i.e. multiple(more than 10) small follicles with increased stroma.
A baseline lipid panel and a glucose tolerance test are important as PCOS is related to insulin resistance. The fasting glucose concentration is poor predictor of the two-hour level in PCOS. Two-hour blood glucose greater than 140 mg/dL indicates insulin resistance and this is important from the treatment point of view.
The treatment of PCOS is based upon the symptoms. The choice of treatment will depend on the individual patient’s symptoms and goals.
Reduction in weight by diet and exercise is essential first step.
Menstrual irregularity should be treated in patients with PCOS because chronic anovulation is associated with increased risk of developing endometrial hyperplasia and carcinoma.Combined Oral contraceptive pills (COCP) therapy usually is the first-line treatment for women with menstrual irregularity. They regularize the cycles very effectively and also normalize anogen levels.
Cosmetic treatment of abnormal and excessive hair growth is offered to patients. It is safe and effective but does not correct the underlying problems. Therefore they all offer only temporary relief. The usual methods are depilation (e.g. shaving, hair removing creams), epilation (eg, plucking, waxing), destruction of the dermal papilla (eg, electrolysis or laser therapy.Treatment with COCP brings about significant improvement in acne and arrests progression of hirsutism.Antian are sometimes prescribed in combination with COCP in severe hirsutism. Insulin-lowering agents such as metformin, thiazolidinediones and D-chiro-inositol are used to correct the insulin resistance. This improves ovulation and hormonal profile in patients with PCOS.

Patients with PCOS who desire child bearing and do not conceive naturally may require ovulation and assisted reproductive techniques to help them conceive.

Above all patients with PCOS require a boost to their confidence as they may have serious emotional issues with their hair growth, acne and obesity. Dr Shalini Sharma provides good counseling and motivation beside the medical approach to these patients to meet their goals.

FIBROIDS

Fibroids are one of the commonest benign i.e. non cancerous tumors of the uterus.They are whorls of smooth muscle tissue that can be very variable in size (few millimeters to more than 20 cms), in position (sub mucous, intramural, or sub serous), and in number (one or two to multiples of ten). Fibroids usually grow during the reproductive years and they tend to shrink after menopause.Fibroids are very variable in presentation. They may not cause any symptoms. They may cause symptoms on the basis of their location, size, and number.
Fibroids may cause very heavy bleeding during periods and sometimes even before and after the periods. They may be associated with very painful periods. Sometimes they may be implicated in infertility. If they are large enough to give pressure symptoms then one can have frequency of urine and / or constipation. If they are large enough then they may present as a mass felt by the women through her lower abdomen.
Fibroids can be diagnosed on clinical examination of the pelvis. They can be further confirmed by ultrasonography. MRI can be done in special situations.
Treatment of fibroids will depend on various factors such as :
– Symptoms that are present
– Age of the patient
– Location of fibroids
– Desire for child bearing
If they are not causing any problems then they may not need any intervention. If they are causing problems then fibroids may be removed. They can be removed through the uterus if they are bulging into the cavity. They may be removed by an incision in the abdomen and the uterus. Alternatively they can be removed through minimally invasive surgery (key hole surgery). In some situations the doctor may suggest removal of the uterus, for eg perimenopausal patients with a large fibroid.
There are a few modern advances in the management of fibroids such as putting a plug in the blood vessel that supplies the fibroid. This option is not yet widely available.If you have a fibroid then you must do a consultation to decide if it needs any intervention and if yes then seek the best management option. Dr Shalini Sharma provides the full range of options for management of fibroid.

ENDOMETRIOSIS

Endometriosis is a condition where cells of the lining of the uterus (the endometrium) are found in places outside the uterine cavity. The uterus is made of three layers and the innermost layer that lines the cavity is called the endometrium. In some women the cells of the endometrium may be found in the pelvis and around the uterus, ovaries and fallopian tubes. Endometriosis can happen to any women in the reproductive years i.e. 15 to 45 years of age.
Women who have endometriosis may complain of pain in the lower abdomen and pelvic region, pain during or after sex (dyspareunia), painful and/or heavy periods (dysmenorrhoea) and, sometimes difficulty in getting pregnant (infertility). These symptoms may affect the quality of her life significantly. The pain during sex/periods and the chronic pain may be very distressing. It is also possible that the woman has endometriosis but may have no symptoms at all.
We still do not know why endometriosis occurs but there are various theories that explain the pathology. The most commonly accepted theory is that, during a period, small amount of menstrual blood flows from the uterus into the pelvic area via the fallopian tubes. This is called ‘retrograde menstruation’. This tissue then implants inside the pelvis. During the cycle it responds to the hormones (estrogen and progesterone) just as the uterine lining does.
This tissue will also grow in response to the hormones and then break down and bleed in the same way as the normal lining. This bleeding inside the pelvis remains inside and then causes inflammation, pain and finally leads to adhesions. Endometriosis on the ovaries can lead to cysts i.e. collection of dark brown chocolate colored fluid in and around the ovary. These are called endometriomas. Occasionally endometriosis may occur on the bowel and bladder or deep within the muscle wall of the uterus (adenomyosis) and in scars especially the caesarean.
Diagnosis is difficult as there is no definitive symptom. And there is no definitive test. The same set of symptoms may happen even in other conditions such as pelvic infections.
Sonography can be done but it has its limitations. It may show the presence of cysts if any. But it may not necessarily tell the nature of cysts. Small endometriotic spots will not be seen on sonography.
Laparoscopy is the only way to get a definite diagnosis. I.e. we look inside the abdomen with a camera. This procedure is an operative procedure and has to be done under anesthesia. If endometriosis is found on laparoscopy we will do therapeutic procedures at the same time; such as burning of the spots, cutting of adhesions and removal of chocolate cysts. Normally before proceeding to laparoscopy one would have already tried painkillers and hormonal medication (Combined oral contraceptives, the LNG – IUS GnRH agonists). Some of these may be used even after the laparoscopy once the diagnosis is clear. Women who have difficulty in conceiving may require assisted reproductive techniques to conceive. Finally some women may even require removing the uterus tubes and ovaries if the pain is very distressing. If you have any of the following either singly or in combination – pain in lower abdomen , especially during periods which starts before the period and continues after the cycle , pain during sex irregular cycles, are not able to conceive then make an appointment to see Dr Shalini Sharma . Do not allow the pain of endometriosis to cripple your life.

PERIOD PROBLEMS AFTER 40

Bleeding problems in women are common especially above 40 years. In a woman having abnormal and/or heavy vaginal bleeding, there are two possibilities.
1. There is a cause for the bleeding such as Thyroid disorders, Fibroid Uterus, adenomyosis etc.
2. There is no obvious cause & the bleeding is due to hormonal variations. This is called as Dysfunctional Uterine Bleeding (DUB)
The commonest investigations, which are carried out, are CBC, Thyroid profile and Sonography of pelvis. Sonography will identify a bulky uterus, fibroids, adenomyosis and give information on the thickness of the lining of the womb.
In some cases a Hysteroscopy and Dilatation & Curettage (D&C) is required. This is a day care procedure, which is done for both diagnosis & treatment. Hysteroscopy involves looking inside the womb with a telescope and is particularly useful to identify polyps. D&C involves scraping of the lining of the womb. The lining is then sent for Histopathological Testing. Outcome of the reports then enable us to plan the treatment.
Various forms of medication are used in management of DUB.
1. Non-hormonal – These are usually taken during the menses and help to reduce the amount of blood loss from the uterus.
2. Hormonal – Progestogens and combined oral contraceptive pills are used commonly in women to manage DUB.
The above forms of medical treatments are effective but the benefit may not last for very long. In such situations the patient will require alternative treatment. In present times modern modalities are available. Those are simple, safe, effective and are day care procedures that do not require even one night stay in the hospital.LNG-IUS (Levonorgestrel Intrauterine system)
This is a T shaped intra uterine system that is loaded with Levonorgestrel. It releases 20 micrograms of Levonorgestrel daily in the uterine cavity thereby leading to decidualization followed by atrophy of the endometrium. It has a life of 5 years and cost about Rs 8000/- It is used very effectively in the management of DUB. It is inserted at the time of a diagnostic hysteroscopy and curettage. The entire procedure is done under general anesthesia, takes about less than half an hour and the patient is able to go home on the same day. This procedure can avoid hysterectomy in 70-80% cases of DUB. An important pre-requisite is that the endometrial cavity should be uniform. An added advsntage of LNG-IUS is that it is an effective contraceptive and the menstrual blood loss reduces considerably.
Thermal Balloon Ablation (TBA).
This is a silicone catheter that is connected to a central heating unit. The balloon is inserted into the uterine cavity, inflated to a presuure of 160 – 180 and then heated to a temperature of 87 dergrees centigrade fro 8 minutes. It leads to thermal ablation of the endometrium. The procedure can be done under Intravenus sedation and local anesthesia or general anesthesia. The operation time is approximately 30 minutes and patient is able to go home on the same day. A success rate of 90% over three years and a long term success rate of 80% have been reported. The randomized control trials comparing LNG-IUS and TBA have reported similar results for both procedures. The only tumbling block in providing this state of the art technology for the treatment of DUB is the formidable cost of the balloon. But one can definitely offset it against the cost of the three day hospital stay and loss of working days when recuperating from major surgery.
Trans cervical resection of the endometrium.
This is electrosurgical resection of the endometrium with a loop under hysteroscopic vision. This procedure too is day care but under certain circumstances can require one night stay in the hospital. It is done under general anesthesia. the procedure has a longer learning curve. It is an acceptable treatment for DUB with a long term success of 80%.
Hysterectomy
is still the last answer for DUB, and one of the commonest surgeries performed by the gynecologist. Breakthrough advances have taken place in vessel sealing i.e. hemostatic devices that are used during laparoscopic surgery. The optics have also improved systematically over the years. Therefore it may not be too long before hysterectomy is done laparoscopically and patient is discharged on the same day.
Conventional hysterectomy (vaginal & abdominal) involves minimum hospital stay of two nights and three days, average is three nights and four days. It is still a popular and acceptable method, which is widely offered by most gynecologists.
Conclusion
In modern times women need not be with DUB and need not have a radical hysterectomy. The scientific and judicial use of modern technology i.e. LNG-IUS, TBA and minimally invasive surgery can bring relief to millions of women with DUB; and this can be done in just one afternoon.

AGING GRACEFULLY

Menopause is an important milestone in the lives of the women. The changes that happen after menopause are not only due to menopause but also related to aging.
At menopause the follicles in the ovary are depleted and there is a decline in the hormone levels. This hormone deprivation can lead to changes in the target organs and sometimes these changes will translate into symptoms.
Hot flashes are very typical symptoms of menopause. They occur mainly in the night and last for 2 to 5 years. They usually resolve spontaneously.
They can be very distressing and lead to disturbed sleep. This then causes fatigue irritability and a whole range of psychosomatic symptoms.
Vaginal dryness is also a common problem; this can lead to dry and painful sex and sometimes-vaginal infections due to change in vaginal pH and flora.
Urinary frequency and urgency also occur due to similar reasons and can lead to embarrassing moments.
Hormone deprivation also has long-term implications. It causes bone loss and eventually leads to osteoporosis. The alterations in the lipid profile can lead to increase in the risk of cardiovascular disease.
At the time of perimenopause it is advisable that one should evaluate one’s own health. The aim here is to improve ones quality of life. The other objectives are to identify the risks factors and silent diseases if any.
It is the time that one would address the alterable risk factors such as diet, smoking, alcohol, etc. A complete health check up includes detailed history and examination followed by screening tests.
Screening test routinely advised by the gynecologists would include Complete Hemogram, Sugars Levels, Liver, Renal And Lipid Profile, thyroid function tests, Pap smear test and urine test.
The radiological tests include Ultrasound of the abdomen and pelvis, Mammography and dexa scanning.
After a complete assessment the doctor will advice life style modifications, drugs (prescription and non-prescription) and sometimes even alternative medicine methods.
Estrogen and Progesterone replacement therapy needs special mention as the last decade has seen a lot of research and a shift in attitude due to the scientific evidence that has emerged from the research. Estrogen alone or Estrogen Progesterone replacement both are still useful for the management of the menopausal symptoms. They are prescribed in the lowest possible dose and for the shortest possible duration in women who do not have any contraindication.
They are not prescribed for primary or secondary prevention and treatment of chronic diseases such as osteoporosis and cardiovascular diseases.
Phytoestrogens are popular but the evidence regarding their efficacy and safety is not yet conclusive. Therefore they have to be taken with caution.
Fore more information on management of menopause please feel free to contact Dr Shalini Sharma
Key Hole Surgery
Endoscopic surgery is commonly known as key Hole surgery In Gynecology key hole surgery includes laparoscopic and hysteroscopic surgery.
Advances in technology and optics, availability of designer equipment has changed the mode of surgical management of common gynecological problems.
Keyhole surgery allows very small scars less pain, less duration of hospital stay, and faster recovery.
Common applications in gynecology
Hysterectomy i.e. removal of the uterus is one of the commonest surgeries performed in gynecology. It may be removed through the vagina and in some cases through the abdomen. But in present times a substantial number of abdominal cases are done through the laparoscope.
Fibroids, adhesions, endometriotic cysts and ovarian cysts are also by and large tackled with the laparoscope.
Common applications in Infertility
Endoscopic surgery has revolutionized the management of various conditions that affect fertility. The most significant results have been seen in the areas of Polycystic Ovarian Syndrome (PCOS,) Hydrosalpinges, Endometriosis and Uterine anomalies.
PCOS is one of the most common cause of anovulatory infertility. The current lines of treatment for PCOS are weight loss, insulin sensitizing agents, ovulation induction drugs and assisted reproductive techniques. In certain cases there is a benefit from laparoscopic ovarian drilling. The cycles become regular and acne and hirsutism improves The pregnancy rate and delivery rate also improves significantly.
Tubal disease is also an important factor in female infertility. Patients with hydrosalpinx have a decreased clinical pregnancy rate and an increased miscarriage rate. The presence of hydrosalpinx has a deleterious effect on the outcome of IVF-ET.
Operative laparoscoic excision of hydrosalpinges is very effective in the treatment of hydrosalpinges and improves the pregnancy rate after IVF-ET.
Endometriosis is the presence of endometrium like tissue outside the uterine cavity. It is an important cause of infertility. Laparoscopy is used for diagnosis of endometriosis. Laparoscopic treatment is very effective in relieving pelvic pain, in dealing with endometriomas and adhesions. Laparoscopic management can lead to improvement in fertility and pregnancy rate.
Uterine Malformations albeit rare do occur and can cause infertility and recurrent pregnancy loss. Acquired uterine anomalies (submucous myomas and polyps) can also result in infertility. Hysteroscopy meets with both the diagnostic and therapeutic needs. Hysteroscopic surgery is now the treatment of choice over abdominal procedures because of various benefits – reduced morbidity, decreased costs, hospital stay, no scar on abdomen, improved reproductive performance, and shorter interval to conception after operation and avoids caesarean section. Septum in the uterus is the commonest anomaly and hysteroscopic resection, which is done in few minutes of operating time, gives very good success.
Dr Shalini Sharma has access to state of the art equipment and an experienced team at the hospitals that she visits. This enables her to offer keyhole surgery to her patients.

PREGNANCY CARE

Pregnancy is one of the most precious times in the life of a woman. Nine months and then a bundle of joy is true happiness. This pleasure needs to be nurtured very well. Signs and symptoms of pregnancy.
The commonest symptom is missing of a period. Occasionally one may have spotting at the time one would have expected the period.
The other common symptoms are nausea, vomiting, shortness of breath, fatigue, and tiredness.On examination the doctor may notice a enlarged uterus which can be felt through the abdomen only when more than 12 weeks of pregnancy.
Diagnosis of pregnancy
The pregnancy hormone is ß- HCG. This is easily detected by a simple two minute home pregnancy test. An ultrasound examination can confirm the pregnancy. It will also give very valuable information on the number of fetuses, location of pregnancy, size of the sac and overall health and viability of the pregnancy.
Common problems in pregnancy
Nausea, vomiting and heartburn are common problems. One should avoid fried and spicy foods and maintain good hydration. It is safe to take doxylamine, and vitamin B -6 which are effective in preventing and controlling the symptoms. Ondansetron has also been used effectively. One may also have loss of appetite and very peculiarly have complete aversion to sight of some foods.
Constipation is also a common problem. It can lead to piles and unnecessary blood loss during pregnancy. Increasing fluid and fibre intake, and stool softeners can help tide over the situation.
The three trimesters of pregnancy
The first trimester
This is from the time of conception to 12 weeks.
The commonest symptoms during this time are nausea, vomiting, and heartburn. These can be easily treated.
The commonest problem during this time is a miscarriage i.e. pregnancy loss. This will present as abnormal vaginal bleeding per vaginum and may be associated with pain. It is diagnosed on ultrasound examination.
The second trimester
This lasts from 12 weeks to 28 weeks
By this time the nausea and vomiting subside. The risk of miscarriage is reduced. Formation of the major organs is completed by 20 weeks. After that the fetus is increasing in size.
The third trimester
This lasts from the 28 weeks to 40 weeks. It is at this time that many important medical issues may surface. Anemia may worsen. One may develop pregnancy induced high blood pressure and gestational diabetes which have implications on the health of both the mother and the fetus.
It is during this time that one may go into preterm labor. There is risk of bleeding during this time mainly due to two causes i.e. abruption and placenta previa.
Labour
This may start any time after 37 weeks. In fact most women will deliver before the due date. Only a small percentage actually delivers on the due date and a few will go beyond the date.
The common symptoms of labor are
– Onset of labor pains i.e. contractions that gradually increase in amplitude and frequency.
– Passage of thick blood stained mucoid discharge.
– Breaking of the forewaters i.e. leaking of the liquor.
The common signs of labor are
– Confirmation of the above
– Dilatation of the neck of the womb i.e. cervix
– Descent of the presenting part of the fetus
First stage
This starts from the onset of labor to the time of full dilatation. The woman is admitted to the delivery suite. Monitoring of the labor process is done continuously to ensure that there is good progress. Cardiotocographic monitoring is routinely done to ensure wellbeing of the fetus.
Painless labor
In modern obstetrics there is no place for a painful labor. The timely use of epidural analgesia has made labor a memorable experience.
Second stage
This starts from full dilatation to the delivery of the fetus.
This stage is also very crucial as prolonged second stage can lead to instrumental and /or traumatic delivery for the mother, fistulas and asphyxia in the fetus.
Third stage
This stage starts at the delivery of the fetus and ends with the delivery of the placenta.
This is an important phase wherein sudden large amount of blood loss can occur due to various reasons. Active management of this phase is required as the blood loss can be prevented.
Post delivery
The patients are discharged within 24 – 48 hours after vaginal delivery and in three days after a cesarean section. Lactation is encouraged as soon as the baby is delivered.
Good care of the breast and the episiotomy is advised. Patients are advised to follow up for discussion and implementation of contraception.
Routine checks in pregnancy
The first antenatal visit is recommended as soon as the pregnancy is suspected or diagnosed. The subsequent visits can be done as follows.
• Once a month up to 28 weeks.
• Twice a month up to 34 weeks
• Then once a week up to delivery
This is only an approximate schedule for a low risk uncomplicated pregnancy. The schedule can change according to the circumstances at that time.The commonly advised tests are CBC, blood group, Thyroid estimation, HIV, VDRL, HBsAg, sugar level estimation and routine urine analysis. Various special tests may be required depending on various medical situations eg. Antiphospholipid antibody in cases of recurrent miscarriage.Triple marker is offered to all at 16 weeks. Obstetric ultrasound examination is done at various stages- in first trimester for dating, location of pregnancy and to look for multiple pregnancies, in second trimester for the study of anatomic defects, and in the third trimester for growth. Additional ultrasound and Doppler examination will be required in special circumstances for eg Preterm labor and abnormal bleeding in pregnancy.
CBC and sugar tolerance is repeated at 28 weeks. Common supplements in pregnancy.
Iron and calcium supplements are commonly given to pregnant women. Folic acid supplement is given even preconception and continued into the first trimester. There is enough scientific evidence to support its use to prevent neural tube defects. Tetanus toxoid is given, usually two doses one month apart starting at 28 weeks. The role of Essential fatty acids, Vitamin E, Lecithin and Arginine are not yet convincing and therefore not recommended as a routine.
Dr Shalini Sharma has a passion for obstetrics i.e. care of women in pregnancy. You can feel free to ask queries via email regarding this important event in your life. She provides quality compassionate care during pregnancy.
TRYING TO GET PREGNANT
Approximately 15 % of couples require assistance with conceiving. The reasons for inability to conceive spontaneously may be related to either of the partners or may be unexplained. If a couple has not been able to achieve a pregnancy within one year then they are offered investigations and further management.
Basic tests include hormonal profile, tubal patency and semen analysis.
Dr Shalini Sharma offers the whole range of basic management of infertility such as follicular studies, ovulation induction, intrauterine insemination, and donor insemination.
Surgical procedures such as ovarian drilling for polycystic ovaries, removal of endometriomas, adhesiolysis, and resection of the uterine septum can be easily conducted at the centers visited by Dr Shalini Sharma
Invitro fertilization and embryo transfer (IVF-ET) commonly called as test tube baby, and other services such as ovum donation, sperm banking, and surrogacy are offered in collaboration with well established assisted reproduction centers.

BREAST ISSUES

Breast health deserves special attention. Breast development occurs in various phases in a woman’s life. Some of the common problems that women report with are breast pain, breast lumps, infections and inflammations in the breast and nipple problems like discharge.

The lactation period is an important phase where breast care is very important. Breast engorgement, inflammation and abscess formation and cracked nipples are common unless proper breast feeding principles are followed. Dr. Shalini Sharma gives detailed counseling during and after pregnancy on correct principles of breast feeding.

Breast cancer is one of the commonest cancers affecting women. Various factors influence the risk of breast cancer – such as age, family history, genetic factors, exposure to various hormones and many more. It is important to remember that a fair number of women who get breast cancer may not have an identifiable risk factor.

Self examination, a yearly check with a doctor, and regular mammograms can go a long way in detecting the breast cancer in early stages. Multidisciplinary approach is required for the successful management of the breast cancer.

Dr. Shalini Sharma provides good quality compassionate care for women. We can teach you self examination, provide a clinician assessment and advise regarding mammography where ever required.