The Common Causes

• Small mass developed in the lining of womb or neck of womb (polyp)
  • Infection on neck of the womb
  • Harmless tumor known fibroid in the womb
  • Use of OC pill, a pill to prevent pregnancy
  • In 1-2 % it is usually seen in the centre of the cycle when egg is released
  • Women with copper T in the womb
  • Some medication which amplify bleeding
  • Cancer at the neck or mouth of womb.

Patient with underlined complaints need to have a diagnosis is made based on the history regarding her menses and associated complaints, current medication and any medical disorders. A comprehensive examination is necessary including pelvic examination to diagnose causes for the bleeding like polyp and infection. Pap smear sample is also taken by surface scarping of mouth of the womb with a wooden or plastic spatula and sent for microscopy. It is primarily a screening test which aids to identify suspicious changes in the womb neck. Additional tests are essential for verification if the Pap test is irregular. In western countries females undertake this test at regular intervals. In India it is suggested for female above 35 years of age even with no signs and in younger age with underlined symptoms or when there is a doubt on local pelvic examination.

Further investigation may be:

Ultrasound: Transvaginal ultrasound done through the vaginal which is the best for analysing the abnormalities in and around the womb. Like polyp and fibroid.

Hysteroscopy: Hysteroscope is a telescope like instrument which helps for direct visualization of inside womb and biopsy is also possible from suspicious parts. Polyp or fibroid can also be removed with hysteroscopy without any major operations. In several centers, it is made as a clinic procedure.

Colposcopy is made with a tool to enlarge the surface of the womb magnification of 15 40 times & colpomicroscope 100 150 times. It is for female with irregular smears & H/0 contact bleeding regardless of existence of negative smears lesion is not clinically identified colposcopic absorbed biopsy offers maximum dependability.

Management:

Management  depending on the cause :

• Hysteroscopic removal for Fibroid and polyp in the womb
• In case of bleeding due to OC pill or copper T – OC pill is stopped or copper T is removed.
• In case of infection of the mouth of the womb – Antibiotics based on orgasm. Trace and treat sexual partners.

Can be treated conservatively

If associated with white discharge and trouble symptoms persistent inspite of treatment then the lesion can be burnt with electrocautery or with a globe of ice

If coupled with white discharge and trouble, and also persistent symptoms in spite of treatment then the lesion can be burnt with electrocautery or with a globe of ice

When gynecological cancer is suspected, further investigation to be done urgently.

This is a new vaccine called GARDASIL, which has been introduced to prevent the development of cancer due to certain types of virus called Human Papilloma Virus (HPV). This is recommended between ages of 13 – 36 yrs. preferably it should be taken before the episode of 1st intercourse.

Dr B Ramesh
Altius Hospital
No. 6/63, 59th Cross, 4th Block, Rajajinagar,
Entrance (Opp.)to,  MEI Polytechnic, Bangalore -10.
Ph : 080 23151873. Mobile : 9844291777 email : endoram2006@yahoo.in
www.laparoscopicsurgeries.com

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 What is postpartum depression?

Postpartum depression, also known as postnatal depression, is a type of mood disorder that can affect women after they give birth. It is a relatively common condition, influencing between 10 and 15 percent of new mothers.

Pregnancy and childbirth can trigger chemical, social, and psychological changes in women that lead to postpartum depression. The phrase refers to a number of physical and emotional adjustments that many new mothers experience. Medication and counseling are both effective treatments for PPD.

Symptoms can include feeling sad or hopeless, mood swings, problems with sleep or appetite, feeling overwhelmed or anxious, and thoughts of harming oneself or the baby. If you are experiencing any of these symptoms after giving birth, it is important to seek help.

 Signs and Symptoms

Postpartum depression is difficult to detect. Following childbirth, many women experience these symptoms:

• Trouble sleeping
• Appetite changes
• Severe fatigue
• Lower libido
• Frequent mood changes

These symptoms, which can also be found in other types of major depression and aren’t typical following childbirth, include:

• Being uninterested in your baby or feeling like you’re not bonding with them
• Crying all the time, often for no reason
• Depressed mood
• Feelings of worthlessness, hopelessness, and helplessness
• Thoughts of death or suicide
• Thoughts of hurting someone else
• Trouble concentrating or making decisions
• Severe anger and crankiness
• Loss of pleasure

Untreated postpartum depression can be fatal for new moms and their children. If a new mother experiences the following symptoms, she should see a doctor:

• Symptoms persist beyond 2 weeks
• They can’t function normally
• They can’t cope with everyday situations
• They have thoughts of harming themselves or their baby
• They’re feeling extremely anxious, scared, and panicked most of the day

 Causes of Postpartum Depression

Despite the fact that there is no one specific reason for postpartum depression, these physical and emotional concerns can trigger it:

1. Hormones – The decrease in estrogen and progesterone after delivery may be a factor. Other thyroid hormones produced by your gland may plummet significantly, making you feel tired, sluggish, and sad.

2. Lack of sleep- When you’re sleep-deprived and overwhelmed, even little issues may become challenging to solve.

3. Anxiety- You may be concerned about being able to care for a newborn.

Self-image. These symptoms might affect your self-esteem, make you question your identity, or cause you to believe that you’ve lost control over your life.

Any of these issues can contribute to postpartum depression.

Types of Postpartum Depression

The three words used to describe the emotional swings that mothers may experience after childbirth are:

• Following childbirth, up to 70% of females are afflicted by the “baby blues.” You might have extreme mood swings, such as feeling delighted one minute and sad the next. You may shed tears for no apparent reason and feel irritable, disagreeable, restless, anxious, lonely, or depressed.
• The baby blues can range from a few hours to 1 to 2 weeks in duration. Baby blues seldom need treatment from a health care provider. Joining a group of new moms or speaking with other parents can help.
• Postpartum depression (PPD) is a type of sadness that can begin any day or even weeks after childbirth. PPD can strike anybody, not just the firstborn child, following the birth of a child. You might feel sad and miserable, as though you were experiencing the baby blues, but you’ll notice that they’re much more intense.

Postpartum Depression can make it difficult for you to complete the tasks that you need to do on a daily basis. You should see a health care professional, such as your OB/GYN or regular doctor, if your capacity to function is hampered. This doctor will screen you for depressive symptoms and devise a treatment strategy based on those factors.

If you do not get treatment for PPD, your symptoms can get worse. While PPD is a serious condition, it may be treated with medicine and counseling. Postpartum psychosis is a severe mental illness that can strike new moms. This sickness may manifest itself rapidly, with most cases occurring within the first three months after delivery. Women might lose touch with reality and hear voices (hearing things that aren’t real, such as a person talking) as well as delusions (believing strongly in things that are irrational).

Hallucinations (seeing things that aren’t there) are less prevalent. Other signs include insomnia (not being able to sleep), restlessness, and strange emotions and actions. Women who have postpartum depression require immediate therapy and almost always need medicine. Women are sometimes hospitalized because they are a danger to themselves or others.

How to prevent Postpartum Depression

If you have a history of depression, tell your doctor as soon as you find out you’re pregnant, or if you’re planning to become pregnant.

1. During pregnancy– Your doctor can keep an eye on you for symptoms. Support groups, counseling, and other therapies may all help with minor depression symptoms. Medications, even during pregnancy, may be used by your doctor.

2. After your baby is born- To look for symptoms of depression, your doctor may recommend an early postpartum check-up. The sooner you’re diagnosed, the sooner you can start treatment. If you have a history of postpartum depression, your doctor might prescribe therapy as soon as the baby is born.

 Treatment for Postpartum Depression

Postpartum depression is classified differently, depending on the nature of the symptoms and how severe they are. Antianxiety or antidepressant medicines, psychotherapy, and participation in a group for emotional support and education are all possible therapies.

In the case of postpartum psychosis, antipsychotics are frequently used to treat it. In many circumstances, hospitalization is required.

Don’t assume that you can’t take antidepressants, anxiety, or even psychotropic medications if you’re breastfeeding. Consult with your health care provider. Many women take medication while breastfeeding under the supervision of their doctors. This is a decision to be made between you and your doctor.

If you’re looking for expert and affordable medical care, visit Altius Hospitals or call +91 8882799799

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World Autism Day falls on 2^ND April every year. Autism is a part of a spectrum of few other neurodevelopmental disorders which include mainly Autism, Asperger’s disorder and Rett syndrome. The prevalence rate of autism spectrum disorder is around 8-10 per 10000 children, commonly seen in males and usually diagnosed around the 2^nd year of life, in severe cases even earlier. The exact cause though cannot be defined; however, genetics and heritability play a significant role.

Autism includes impairment of social communication and repetitive behaviour and can have associated delayed/ aberrant language development.  Around 30% of these children can also have intellectual disabilities. Asperger’s disorder, however, does not include language impairment criteria. Whereas, Rett syndrome is diagnosed when a female child shows normal development until 6 months of age and thereafter shows repetitive hand movements, decreasing language use, decreasing social engagement etc.

Children with autism might display insistence on having the same thing/activity, may be sensitive to some stimuli whereas, they might not respond to a certain stimulus like sound. They might show unstable moods and might cry, laugh, get irritated suddenly and at times for a prolonged duration. The child can also have poor attention and might be hyperactive, there can also be associated with ADHD. These children might display insomnia. They are also known to have special abilities like prodigious memories, calculation skills much better than the children of their age group.

A 2-year-old boy was brought by his parents to me with a history of speech delay, they had read about speech delay seen in autism and were worried about their son. However, upon detailed evaluation, there were no other clear features of Autism in the boy. We suspected a diagnosis of Speech Delay and advised the parents to encourage talking more to the child, involving grandparents and avoiding gadgets, within 6 months the child’s vocabulary improved significantly and no other signs of Autism were seen.

“A child with Autism should never be labelled as ‘Autistic child’. They are special and with the right therapy, they can show improvement. Also, if there is an associated intellectual disability, the child can be admitted to a special school wherein they can learn a curriculum designed according to the special child’s abilities and also do not feel overwhelmed with competition which can happen if they are admitted to other schools’”

Early diagnosis is essential for early intervention; hence parents, teachers and overall society need increased awareness about the pointers of autism. Management includes speech therapy, social skills training, cognitive behavioral therapy as per the age of the child. Mild autism might not be clearly evident, and might not interfere significantly with the daily routine. In severe cases, Science has developed several medications to manage agitation, mood swings, insomnia and hyperactivity which can improve the quality of life.

Dr. Shradha Shejekar

Visiting Consultant Psychiatrist

Altius Hospital, Bangalore

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