by Dr Neelima Mantri | Jan 20, 2025 | Blog, Female Gynaecologist, Pregnancy Tips
Pregnancy is usually a thing that brings joy with it, but it comes with unexpected challenges. An example is the cervical insufficiency condition. It impacts a woman’s ability to carry a pregnancy to full term. It may be rare, but understanding it can ensure the best possible outcome for both mother and baby
What is Cervical Insufficiency?
It occurs when the cervix—the tissue connecting the uterus to the vagina—is weak or dilates too early in pregnancy. It usually occurs in the second trimester. It can be distinguished from preterm labour. Unlike preterm labour, which comes with contractions, cervical Insufficiency doesn’t show pain or any warning signs. It can lead to pregnancy loss or premature birth if not treated.
Causes of Cervical Insufficiency
There are many factors which contribute to this.
- Medical History: it could be a result of procedures like cervical biopsies, dilation and curettage (D&C), or even a traumatic childbirth experience for many women that can weaken cervical tissue.
- Factors from Birth: Some women may be born with abnormalities or genetic conditions, which makes them more likely to have cervix insufficiency.
- Hormonal Influences: Hormonal changes during pregnancy can soften and weaken cervical tissue, increasing the risk of early dilation.
Other risk factors are carrying multiple pregnancies, history of miscarriage, or uterine anomalies.
Symptoms of Cervical Insufficiency
Being able to differentiate between cervical Insufficiency and other pregnancy complications is important for much-needed early intervention. Cervical insufficiency often has no symptoms, which makes it harder to detect. However, there are some warning signs to watch for, including:
- Pelvic pressure or fullness.
- Vaginal spotting or changes in discharge.
- Early cervical dilation was noticed during routine exams.
Because these symptoms can be subtle or absent, regular prenatal checkups and open communication with your gynecologist and obstetrician, such as Dr Neelima Mantri, are essential.
The Diagnosis
Diagnosing cervical insufficiency typically involves:
- Medical History Evaluation: A review of past pregnancies, surgeries, or other risk factors is one.
- Physical Exams: Routine Pelvic exams to check for cervical changes.
- Ultrasound: Measuring cervical length can help assess the risk of insufficiency.
Detecting it early plays a major role in stopping complications.
Treatment Options
Cervical insufficiency treatment depends on how serious the condition is and what stage the pregnancy is at. Common options include:
- Cerclage: It is a surgical procedure. It involves stitching the cervix to keep it closed. Cerlage is often carried out between 12–14 weeks of pregnancy in high-risk cases or simply as an emergency measure if the cervix begins to dilate prematurely.
- Progesterone Therapy: Another way is therapy. Progesterone, a hormone essential for pregnancy, may be prescribed to help strengthen the cervix and reduce any inflammation.
- Restrictions: In some cases, doctors may recommend bed rest or minimal physical activity to reduce pressure on the cervix.
Pregnancy differs from person to person, so your doctors will work together based on your history to create a plan that works best for you.
Conclusion
Women can navigate this by understanding the causes, recognising the symptoms, and working closely with healthcare providers. If you or someone you know is at risk, encourage them to seek medical advice and consult the best obstetrician in Mumbai. Connect with Dr Neelima Mantri today.
by Dr Neelima Mantri | Jan 8, 2025 | Blog
Vanishing twin syndrome (VTS) occurs during pregnancy when one twin disappears in the uterus. This condition is usually experienced after it has been initially detected via ultrasound. It is a rare condition and is more prevalent in the first trimester.
For expectant parents, this experience is bittersweet because they are grieving the loss of one twin while celebrating the survival of the other. VTS is relatively common, especially with the use of early ultrasound technology. This article discusses the causes, symptoms, and how families can navigate this journey.
What is vanishing twin syndrome?
Vanishing twin syndrome occurs when a twin or multiple ones disappear in the womb. This is usually because of miscarriage early in the pregnancy. The surviving twin, the placenta, or the mother’s body, absorbs the remaining tissue from the vanished twin.
More cases of VTS have been detected than ever because of the advancement in ultrasound technology. In the past, such cases were not recognized. VTS is most commonly diagnosed during routine scans when multiple gestations are identified, but subsequent scans only show one fetus.
Causes of Vanishing Twin Syndrome
The loss of one twin is typically because of natural factors which no one can control. These are:
- Genetic abnormalities: Some vanished twins have chromosomal issues, which stop them from growing.
- Placental issues: Problems with the placenta, like insufficient blood flow or nutrients not getting to the fetus, can result in the loss of one twin.
- Maternal factors: How advanced in age the mother is, uterine abnormalities or even underlying health conditions of the mother can contribute to VTS. Research shows that this is more common among women who are older than 30.
VTS is rarely preventable and does not indicate a problem with the mother’s health or care.
Symptoms of Vanishing Twin Syndrome
The symptoms vary from person to person, but in most cases, there are no noticeable signs, and it is only discovered during a routine ultrasound. Commonly, some women may experience:
- Vaginal bleeding is often mistaken for a miscarriage.
- Cramp pain or pelvic discomfort.
- Back pain
Diagnosis and Treatment
An early scan may detect two gestational sacs, but subsequent scans may show only one fetus. There is no direct treatment for the vanished twin itself. The only thing that can be done is to monitor the surviving twin. Gynecologists and obstetricians in Mumbai focus on ensuring that the surviving twin develops and that the mother is monitored to prevent any further complications.
In most cases, the surviving twin continues to develop normally, and the pregnancy proceeds without any further complications. There may be the feeling that something could have been done right to prevent the incident from occurring, but it is noteworthy that the irregularities could stem from the vanished twin’s DNA
Conclusion
Vanishing twin syndrome is natural, and for the most part, it cannot be prevented. It may be emotionally challenging, but seeking support can help families go through the experience by focusing on the health of the surviving twin. For the mother’s health, connect with the best gynecologist Mumbai, Dr Neelima Mantri.
by Dr Neelima Mantri | Dec 26, 2024 | Blog, High Risk Pregnancy
Twin Anemia-Polycythemia Sequence (TAPS) is a serious complication that can occur in pregnancies involving monochorionic twins, that is, identical twins sharing a single placenta. It would have you looking for the best obstetrician in Mumbai. This article discusses the causes, symptoms, and treatment of TAPS.
What is the Twin Anemia-Polycythemia Sequence
This condition occurs when tiny blood vessel connections in the placenta cause blood to flow unevenly from one twin to the other. This then makes one twin (the donor) lose blood, leading to anemia, while the other twin (the recipient) ends up with too much blood and that makes their blood thicker than usual—a condition called polycythemia.
It is important to note that TAPS differs from another condition called Twin-to-Twin Transfusion Syndrome (TTTS). While TTTS is caused by larger blood vessel connections between the twins, which often leads to fluid imbalances in the amniotic sacs, smaller connections cause TAPS.
What Causes TAPS?
The primary cause of TAPS is the uneven flow between monochorionic twins. This is due to the tiny surface connections between the placenta’s arteries and veins, which cause blood to flow continuously from one twin to the other twin. Twin Anemia-Polycythemia Sequence can also be caused by a complication after a procedure called laser surgery, which is used to treat Twin-to-Twin Transfusion Syndrome.
The blood vessels are sealed using laser ablation to balance blood flow in the twins. However, the tiny blood connections may remain or develop and lead to TAPS. It is noteworthy that sometimes TAPS spontaneously develops, which shows how unpredictable monochorionic pregnancies are.
Symptoms of Twin Anemia-Polycythemia Sequence
TAPS develops gradually, so it may not show symptoms in the mother early on. However, the anemic twin(the donor) would have pale skin and low hemoglobin levels. The polycythemic twin (recipient) Wood would have a reddish or darker complexion because of thickened blood. In some cases, the placenta on the donor twin’s side may seem thickened, and the recipient twin’s liver may show bright white spots called starry sky.
The Treatment
The treatment depends on the stage of the pregnancy.
These treatments are done during the early stage of the pregnancy. The essence is to help keep both twins stable before delivery:
- Intrauterine Transfusion: For the twin with anemia, a direct blood Transfusion is given in the umbilical vein. This now helps restore hemoglobin levels to normal.
- Partial Exchange Transfusion: This is for the recipient twin who has thick blood. The procedure remixes a portion of the blood and replaces it with a fluid solution like saline or plasma. This would reduce blood viscosity and decrease clotting risk.
- Selective Fetoscopic Laser Surgery (SFL): For advanced cases of TAPS, this procedure is used to target the abnormal blood vessel connections in the shared placenta. A fetoscope (tiny camera) is inserted into the uterus, and a laser is used to seal the problematic vessels.
- Preterm Delivery: Where TAPS occurs towards the end of the pregnancy, the doctors may deliver the babies preterm. They would require intensive care if it comes to this.
Conclusion
The Twin Anemia-Polycythemia Sequence (TAPS) shows how complex monochorionic twin pregnancies can be. However, it shows that one must be vigilant and that timely care can do much good for the babies and the mother. Experienced professionals like Dr. Neelima Mantri have the knowledge and individualized care required for parents managing high-risk pregnancies.
by Dr Neelima Mantri | Dec 23, 2024 | News and Events
Dr. Neelima Mantri, widely recognized as one of the best Gynecologists and Obstetricians in Mumbai, showcased her expertise at the Annual National Conference, held in association with the Varanasi Obstetric and Gynecological Society.
During this prestigious event, Dr. Mantri delivered an insightful and impactful presentation that earned her the Best Paper Award from the Indian Association of Gynecological Endoscopists (IAGE).
Her dedication to advancing the field of gynecology and obstetrics, coupled with her innovative approaches, continues to set benchmarks in the medical community. This recognition reflects her unwavering commitment to improving women’s healthcare and her contributions to gynecological endoscopy.
by Dr Neelima Mantri | Dec 20, 2024 | Blog, Pregnancy Complications
Gestational Trophoblastic Disease refers to a group of rare and abnormal growths that develop during abnormal pregnancy. Though it is uncommon, understanding it is important. It is noteworthy that some GTDs are noncancerous while others are Malignant. This article discusses the types, causes, treatment, and symptoms of gestational trophoblastic disease
The Types of GTD
- Hydatidiform Mole (molar pregnancy): This is the most common form of GTD. It is usually the result of abnormal fertilization of eggs. It results in a mass of cysts. There are two types: partial mole and complete mole.
- Gestational Trophoblastic Neoplasia (GTN): This is a more serious form and can occur after a molar pregnancy. It includes several Malignant growths, such as Invasive moles (invade the uterine wall), Choriocarcinoma (spreads quickly to other parts), placental-site Trophoblastic tumor (forms at the placenta), and Epithelioid trophoblastic tumor (a rare and slow-growing tumor).
The Causes
Several factors contribute to increasing the risk of developing GTD.
- Abnormal fertilization: If an empty egg or multiple sperms fertilize the egg, it may lead to abnormal trophoblastic tissues.
- Maternal age: Women who are under age 20 or above 40 are at risk of developing GTD
- Previous Molar pregnancy: Having a history of molar pregnancy increases the risk of developing another one.
The Symptoms
The symptoms may vary and are dependent on the type and how severe. Common symptoms, however, include:
- Vaginally bleeding: Abnormal vaginal bleeding during pregnancy is one of the most common signs of GTD. It may be spotting or heavy bleeding, and the bleeding may be mistaken for a miscarriage.
- Severe Nausea and Vomiting: Most women with GTD would experience severe morning sickness. This is usually more serious than that of pregnancy nausea.
- Uterine Growth: GTD makes the uterus grow faster than expected fir the stage of pregnancy. This results from the abnormal growth of trophoblastic tissues and may be detected through a physical examination or ultrasound.
- High hCG level: Human Chorionic Gonadotropin(hCG)is a hormone produced during pregnancy. With GTD, the levels would be much higher. It can be confirmed through blood tests and is one major factor used to diagnose the condition
- Pre-eclampsia: Women with GTd may show signs of preeclampsia, like high blood pressure and protein in the urine in the first trimester.
The Treatment
Gestational Trophoblastic Disease treatment depends on the type, the stage it is at when diagnosed, and whether it is benign (not harmful) or Malignant. Treatment is to remove or destroy abnormal trophoblastic tissue, monitor for signs of recurrence, and preserve fertility whenever possible.
Specific treatment methods are:
- Suction Curettage: This is most suitable for molar pregnancy. Abnormal tissue is removed from the uterus using a gentle suction device.
- Chemotherapy: This is more suitable for invasive moles, choriocarcinoma, and other Malignant forms.
- Hysterectomy: This is the removal of the uterus. However, it is not favored by women who would still love to give birth.
- Radiation Therapy: In extremely rare cases, if it has spread to the brain or lungs, surgery isn’t possible, and radiation therapy would be suggested to help target the cancerous cells. This is, however, a thing of last resort where chemotherapy and surgery will not suffice.
Conclusion
Although rare, Gestational Trophoblastic Disease can have serious implications if not treated. However, with early detection, treatment, and follow-up, most women make a full recovery.
Knowing the symptoms and risks of GTD is crucial for ensuring that women seek timely medical attention, leading to better health outcomes and fertility prospects. To get the best female gynaecologist and laparoscopic surgeon in Mumbai, Connect with Dr Neelima Mantri.
