Dr. Fakhra Masroor

M.B.B.S, DNB (Obs & Gyn), FIAOG

Consultant Gynaecologist and Laparoscopic Surgeon

Guidelines


Guidelines for obstetric care


  • Normal delivery can be accomplished provided all the criteria for normal delivery are favourable.
  • For the normal delivery size of the baby has to be average, good liquor amount, good foetal movement, at least 15 -20 times good foetal movement per day, and the most important is good passage, and spontaneous onset of labour with undue prolongation
  • OUR MAIN AIM IS SAFE DELIVERY OF THE BABY WITHOUT COMPROMISING THE LIFE OF MOTHER AND BABY.
  • BEST OUTCOME IS THROUGH GOOD ANTENATAL CARE.
  • Total duration for the antenatal period is 9 month and seven days.
  • Patients are properly evaluated by history and general examination.
  • Important medications are given and patients are advised for further consultation on due date.
  • First USG is done at 7 weeks for Foetal cardiac activity
  • In case of pain in lower abdomen, on / off bleeding or very risk pregnancy (after IVF, medical complication) early USG can be done by Transvaginal USG.
  • Next USG is done for Nuchal translucency at 12 wks that detects majority of the congenital anomaly problems.
  • Next USG is done at the 18 weeks for detailed congenital anomaly scan.
  • Next USG is done at 32 weeks to evaluate the baby growth and at the end at 38 -39 weeks to assess weight of the baby as well as liquor amount
  • Some of the baby who are not growing well, Doppler study is recommended which helps to decide the timing of the delivery.
  • Each case is not identical so as per profile of patients, such as height, weight, nutrition status as well as the high risk medical problems such as Hypertension, diabetes mellitus, hypothyroidism, heart disease, anaemia, symptoms of breathlessness and obstetrical condition such as position of baby and placenta, previous Caesarean Section, no living issue,
  • ALL THE MOTHERS ARE STRICTLY ADVISED TO COUNT FOETAL MOVEMENT EVERYDAY AND INFORM EARLIEST IF THERE IS LESS THAN 10 MOVEMENTS PER DAY.
  • Caesarean section can be planned (Elective or emergency CS).
  • Indication for emergency CS are very less liquor, foetal distress, placenta previa with bleeding per vagina, malpresentation such as breech or transverse lie.
  • Indication for elective CS – malpresentation, placenta previa, cephalopelvic disproportion, big baby.

PATIENT GUIDELINES FOR PCOS WITH OBESITY


  • PCOS is a very common problem for women and girl.
  • It can lead to obesity and obesity leads to PCOS.
  • PCOS is characterized by
  • Delayed period or no period for months
  • Increase in weight in most of them
  • Facial hair and acne in some of them
  • Not able to get pregnant because of no ovulation ang egg formation
  • Stress because of infertility, obesity and delayed cycle
  • Later on, medical problems like diabetes mellitus, increase in body fat, hypertension, heart disease, and cancer of uterus
  • 50% of PCOS women are overweight or obese.
  • Obesity leads to abnormal hormones which prevent egg formation.
  • More of male hormones are released, which leads to facial hair, acne and hair loss.
  • Medical management by medicine to regularise period, correct the hormone imbalance and attain fertility.
  • Medicine used are
  • Progesterone 0f short course for period
  • Oral contraceptive pills for young unmarried girl
  • Egg forming drug like letroz or injection of gonadotropins some time
  • Inositols or metformin to decrease the hormone imbalance
  • DURATION OF TREATMENT:
  • Not specified, can need for long duration of time
  • MAIN STAY OF TREATMENT:
  • Implementation of lifestyle changes, including weight loss and decrease in abdominal fat in obese patient

GUIDELINES FOR PATIENTS

  • Please contact Gynaecologist as soon your pregnancy test is positive, as we prescribe vitamins mainly folic acid for the baby’s nerve development.
  • Avoid heavy exertion, heavy lifting during pregnancy.
  • Avoid any type of infection especially urinary tract infection in pregnancy and high temperature as it is very damaging to the baby.
  • Eat nutritious diet especially good carbohydrates as Roti, Rice, banana.
  • Good protein as Daal, chana, non-vegetarian if you can take or paneer, soya bean. Avoid food of outside especially road side food.
  • Avoid constipation.
  • There should be at least 10 foetal movement count per day.
  • Please come at the follow date for check-up, if you miss for some reason then please, come in the next week.
  • Pl take prior appointment from clinic for convenience.
  • In case of any emergency please send me SMS/WhatsApp then call.
  • No advice will be given on WhatsApp and no comment on the report will be given on WhatsApp.