Dr Suman Bijlani, Gynaecologist, Sonologist, Infertility Specialist, Obstetrician and Laparoscopic Surgeon, Mumbai.

Welcome, ladies, to the blog of Gyneguide, India’s only personalised gynaecological online consultation and live chat website!

This is a forum by women for women to exchange ideas and experiences about reproductive health and being a woman in today’s world.  My wish for you is “To be healthy and confident.” So feel free to express, share, learn, grow, and love.

Love you.


Dr Suman Bijlani,
Gyneguide – Helping women live better

The Rh Negative Pregnancy

My blood group is Rh negative. Will I be able to get pregnant?

Being Rh Negative does not affect your fertility. You can certainly become pregnant.

I am Rh negative. Will there be a problem if I marry a man with Rh positive blood group?

If you marry a man whose blood group is Rh positive, there are certain risks, but those are manageable.

Are there any problems that can happen during pregnancy due to my blood group?

If your husband is Rh positive, then your fetus (baby in womb) may be Rh positive. If your fetus is Rh positive, your body may form antibodies against your own fetus which may harm him/her. The chances of this happening are really small, though.

Why and how do antibodies form?

The Rh positive fetus has Rh antigen in his blood. During pregnancy, sometimes a small amount of fetal blood may ‘leak’ into the mother’s blood stream. This may lead to stimulation of the mother’s immune system which produces antibodies against the baby’s Rh antigen. These antibodies enter the baby’s circulation and destroy his red blood cells and cause anemia.

What precautions should I take so that my baby is safe?

Your obstetrician would test your husband’s blood group. If he is Rh negative, your pregnancy would not be at risk. However, if he is Rh positive, your doctor would test your blood for antibodies against the fetus, every 6-8 weeks. If the test remains negative (meaning no antibodies formed), it means that your baby is safe.

Do I need to take any treatment or injections to protect my baby?

The risk of forming antibodies is highest in the latter half of pregnancy. Your doctor would give you an injection (Inj Anti D) at 28 weeks of pregnancy to prevent formation of antibodies in the last trimester.

If at any time during pregnancy, you get bleeding per vaginum, you would need to take an additional shot of Inj Anti D to prevent antibody formation.

After delivery, the doctor would test your baby’s blood group. If your baby is Rh positive, you would need an additional shot of Inj Anti D to prevent formation of antibodies which may harm your baby in a future pregnancy.

How does Inj Anti D work?

Inj Anti D contains antibodies against the baby’s Rh antigen. When the mother is given this injection, these antibodies destroy the fetal blood, if any, which may have entered into the mother’s blood stream. Thus, the mother’s immune system does not produce antibodies against the fetus.

Do all women need to take that injection?

No. Only if your baby’s blood group is Rh positive, you need to take the injection within 24 hours, preferably as soon as possible.

What if during my pregnancy, at any point of time, my blood test shows positive for antibodies? What effects can that have on my baby?

If you develop antibodies against your baby at any point during pregnancy, your baby is at risk of developing anemia and jaundice inside the womb, which becomes progressively worse with time. Sometimes the anemia becomes so severe that the fetus develops heart enlargement and swelling all over the body.

After delivery, the baby may be born jaundiced or may develop jaundice within 24 hours.

What treatment can be given in such cases?

If antibodies develop during pregnancy, you would then need to get your fetal blood tested (by putting a needle into the baby’s umbilical cord-called cordocentesis) to diagnose how much he/she is affected. If the damage is severe, the doctor may need to deliver the baby urgently or do an ‘exchange transfusion’ within the womb if the fetus is very premature. Herein, the fetal blood is withdrawn and is replaced with fresh blood from a donor of O negative blood. By doing this, the mother’s antibodies are removed. However, this procedure may need to be repeated many times till the baby is safe to be delivered.

What if my baby develops anemia and jaundice after delivery?

If your baby develops jaundice and anemia after delivery, he/she would have to be admitted to intensive care unit and given ‘phototherapy’ to destroy bilirubin in the blood and ‘blood transfusions’ to treat anemia.

What are the chances of having problems in the next pregnancy?

If you have not had any complication in the present pregnancy and have taken Inj Anti D after delivery on time, the chances of developing complications in the next pregnancy are rare (less than 1%). However, all due precautions (as with the first pregnancy) would need to be taken.

I am an Rh positive woman. Can I marry a man who is Rh negative?

If a woman is Rh positive, there is no risk to the pregnancy. You may marry a man who is Rh positive or negative. Just make sure he has enough money J

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Cord blood banking

Cord blood banking:

What is cord blood banking?

Normally, at the time of delivery, the umbilical cord is cut off and discarded. The umbilical cord and cord blood are excellent store-houses of ‘stem cells’ which can be used to treat many diseases. Cord blood banking is a system of storage of umbilical cord and cord blood (in deep freeze) for future use so that it may be used to treat certain diseases in future.umbilical cord blood collection

What are ‘stem cells’ and how can they treat diseases?

The entire human body came from just one cell – the zygote or the fertilised ovum. This cell went on to differentiate into different specialized types of cells. For example, liver cells, skin or heart. Thus, this one single cell had the potential to create all types of cells of the human body.

Such a cell which can multiply and can be made to form any other cell is called a ‘stem cell’.Stem cell

Wow! That sounds like a sci-fi movie.

Yes, it is. The possibilities are immense. May be one day we will be able to form the entire human body, who knows!?

So, is this really happening today or are we just hoping that things would happen in future?

Stem cells from umbilical cord blood have being used in more than 30000 cases worldwide for the treatment of many diseases such as:

  • Various types of leukemia, myeloma and lymphoma (blood cancers)
  • Various blood diseases and disorders (thalassemia, sickle cell anemia)
  • Many metabolic, immune and genetic diseases

Stem cells are injected into the person who needs the transplant and they form the required type of blood cells.

In India, to date, about 32 transplants have taken place using umbilical cord blood, including 13 cases of thalassemia. The numbers are increasing fast.

What about forming new organs and tissues? Is this really happening?

The field of restoring damaged, lost or ageing tissues is known as regenerative medicine. Stem cells have been found to be able to regenerate damaged cells (heart muscle, joint cartilage, pancreatic cells which secrete insulin and damaged brain cells). One day soon, we should be able to treat heart disease, diabetes, stroke, Alzheimer’s disease and arthritis using stem cells. Research is progressing at an astounding pace in the field of stem cell technology.

List of possible diseases which may be treated by stem cells in the near future:

Nervous system:

  • Parkinsonism
  • Alzheimer’s Disease
  • Brain/spinal cord injury
  • Stroke
  • Cerebral Palsy

among others

Cardiovascular system:

  • Myocardial infarction
  • Congestive cardiac failure

among others

Fertility:

  • Premature ovarian failure
  • Azoospermia (absent sperms in the male)

Bone:

  • Osteoarthritis
  • Non-healing fractures
  • Bone and cartilage tumours
  • Tissue Injury

among others

Skin:

  • Non-healing ulcers/wounds
  • Burns
  • Anti-ageing?

Other major systemic diseases:

  • Type I diabetes
  • Type II diabetes (limited benefit)    
  • End stage renal disease
  • Cirrhosis of liver
  • Deafness, blindness
  • Missing teeth
  • Baldness

stem-cell-applications

What are the chances that, God forbid, my child might need stem cells? I would be spending a good amount of money, so I need to know whether this is all worth it.

Your child’s blood is stored for future use by himself/herself or any of your family members. So, you may be able to use his blood for his brother, sister or yourself. Being closely related genetically, you are likely to be able to utilise his/her cord blood in case of need.

As of today, the chances of needing cord blood for treatment would be about 1:2000.

But, year after year, with greater advances, the number of diseases being treated by stem cells is going on increasing. Besides, there is an increase worldwide in lifestyle diseases such as arthritis, diabetes mellitus, stroke, ischemic heart disease and cancer. Say, 20-30 years from now, cancers might be far commoner. Then stem cells would be the need of the hour.

How do I enrol myself for cord blood banking programme for my future baby? My wife is only 5 months pregnant.

There are various cord blood banking companies functioning in India today. You may get all the relevant information on the internet for the same. All you need to do is to contact a company’s representative and he/she would visit you to counsel you to understand the entire procedure of enrolment (including paperwork, terms and conditions, financial implications) as well as cord blood collection. The collection is done by their person in the hospital at the time of delivery and you need not worry about any of the logistics.

How do I select a good cord blood bank? What are the criteria to look for in a cord blood bank?

Let me list the criteria that you should be looking out for:

  • Credibility (years in the market – Indian and International, reputation and performance)
  • Accreditation (Indian and International)
  • Ask for hidden costs (for transportation/ multiplication of cells)
  • Costs (total cost and EMI facilities)
  • Insurance facilities for the baby in case transplant is required
  • Collaboration with major hospitals/ institutes if transplant is needed
  • Perks/sops (least important- look for main criteria instead)

Most companies draw out a contract of 21 years wherein you as parents, are guardians of your child’s cord blood. After 21 years, a new contract is drawn in the name of the child and the fees would be decided as per the then-existing charges for cord blood storage. Cord blood can be stored indefinitely!

Most companies store cord blood and cord tissue both. Storing cord tissue is very important as these cells would be needed for restoring damaged tissues. Hence, please opt for storage of both cord blood and tissues (may be at an additional cost).

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Ectopic Pregnancy

 

What is ectopic pregnancy?

A normal pregnancy grows inside the uterus. If the embryo implants outside the uterus, the pregnancy is known as ‘ectopic pregnancy’. The incidence of ectopic pregnancy is about 1-2% of all pregnancies.

Where exactly does an ectopic pregnancy occur outside the uterus?

The pregnancy may implant at any of the following sites:

          

    Inside the fallopian tube (tubal ectopic pregnancy)- commonest (98% cases) 

    Inside the ovary (ovarian ectopic pregnancy)Sites of ectopic pregnancy

        Inside the cervix (cervical ectopic pregnancy)

    Inside the abdominal cavity (abdominal ectopic pregnancy)

 

 

Since tubal pregnancy is by far the commonest type of ectopic pregnancy, the rest of the discussion will be limited to tubal ectopic pregnancy.

What happens if I have a tubal pregnancy? What happens to my baby? Will it be fine?

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Excessive vomiting in pregnancy

What exactly is Hyperemesis Gravidarum?

Hyperemesis gravidarum is a medical term for excessive vomiting during pregnancy, especially in the first trimester. It is an exaggerated form of morning sickness, to the extent that, you as a mother-to-be may experience significant weight loss and vomiting. You may be unable to eat, or even tolerate the smell or sight of food. You may throw up every time you eat anything at all. Prolonged periods of going without food or water cause acidity which worsens nausea and vomiting. This causes a vicious cycle and you may go for days without much food.

The condition is particularly distressing because of the severe retching and inability to eat, even though you may be very hungry!

 

How many women does it affect?

Most women (70-80%) experience varying degrees of nausea and vomiting in early pregnancy. Hyperemesis gravidarum affects about 1% pregnant women.

It is commoner if you have a multiple pregnancy (twins or triplets) and in a condition called vesicular mole (a type of abnormal pregnancy).

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Bleeding in early pregnancy- what to do

What exactly is a miscarriage?

Miscarriage means the spontaneous loss of embryo or foetus before 20 weeks of gestation or when the foetus is less than 500 g weight.

Pregnancy

 

How do I know whether I am having a miscarriage?

You may start bleeding … which may be fresh red blood, brown or black. It may be mild, moderate or heavy bleeding or just a stain on your panty.

Often the bleeding is accompanied by abdominal cramps and pain.

Many times, you may not feel any symptom at all and a routine ultrasound examination may bring bad news.

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