Dr. Payal Chaudhary

Vaginal yeast infections are one of the commonest infections of the vulvovaginal region in women. As many as 75% of women will suffer a yeast infection once in their lifetime. It is caused by a fungus called Candida albicans.

Women who suffer from this infection present with curdy white discharge and intense itching in the vulval region. The vagina is lined by healthy bacteria which are called lactobacillus, the growth of these bacteria is facilitated by the hormone estrogen. Lactobacilli keep the pH of the vagina acidic and prevent the growth of pathogenic bacteria and fungus. Sometimes this delicate balance is disturbed by some predisposing factors.

Causes of Vaginal Yeast infections

There are many reasons you could get a yeast infection, including:

1. Hormonal changes of pregnancy, breastfeeding and menopause.
2.  Diabetes especially if not well-controlled leads to increased glucose in the cells of the lining of the vagina which as food for the yeast to grow.
3.  Sometimes yeast infections occur after an antibiotic course. Antibiotics kill the good bacteria, lactobacillus as well.
4.  People who use vaginal washes and sprays may also lead to a change in vaginal pH, triggering vaginal infection.
5.  Though a yeast infection is not considered a sexually transmitted infection, it can be passed from person to person through sexual contact.

Treatments for Vaginal Yeast Infections

Antifungal medications are the mainstay of treatment. Antifungal vaginal suppositories, creams, ointments, and sometimes oral antifungals are the best way to treat these infections. One should consult a gynaecologist for confirmation of diagnosis and to start the right treatment at the right time.

If you have diabetes or a weakened immune system, you may get yeast infections over and over again. It’s a condition called recurrent vulvovaginal candidiasis (RVVC). If you get yeast infections at least four times a year, your doctor may recommend that you take a weekly antifungal pill for 6 months to fight them.

Probiotic intake can help slow the growth of yeast in the vagina, thus lowering the risk of recurrent infection. Controlling sugar levels in the case of diabetics and losing weight if obese can also help keep these infections at bay. Avoiding using hygiene products like douches and wearing cotton breathable undergarments and trousers etc can help in preventing these infections.

An ectopic pregnancy is when a fertilized egg implants at any other site in the body except Uterus. Most commonly this phenomenon occurs in fallopian tubes in majority of the cases and rarely it may also happen in ovary or elsewhere in abdomen as well. Major risk in these cases is that of rupture of these thin fallopian tube as this pregnancy grows. A rupture can lead to major internal bleeding which is a life threatening emergency and requires surgery immediately.

One wonders, why an ectopic pregnancy would occur in the first place in some women. There are some risk factors which increase this risk. Majority of these risk factors are because of damage to the inner lining of fallopian tubes thus leading to poor movement of fertilized egg through fallopian tubes thus causing implantation of pregnancy in the tube itself. These risk factors are pelvic inflammatory disease, prior ectopic pregnancy, prior fallopian tube surgery, previous pelvic surgery, endometriosis etc. Some other risk factors are cigarette smoking, history of inability to conceive, use of assisted reproductive technology , such as IVF and sometimes older age.

An ectopic pregnancy may be completely silent till it ruptures and leads to massive internal bleeding which may present as sudden severe pain the abdomen, fainting, dizziness etc or may present as abnormal vaginal bleeding, low back pain or mild pain in abdomen or pelvis. A woman may experience either a missed period making her think she is pregnant or a period which is lighter in flow than her usual period. Urine pregnancy kit test may show faint positive. Diagnosis is made on an ultrasound along with a blood test called as beta hcg levels.

An ectopic pregnancy cannot move or be moved to the uterus, so it always requires treatment. There are two methods used to treat an ectopic pregnancy which depends on the stage at which it gets detected, medication till it has not ruptured and surgery for a ruptured or large unruptured ectopic pregnancy. Several weeks of follow-up are required with each treatment.

An obstetrician gynaecologist is the best person to take decision regarding the mode of treatment. A surgery when performed can either be performed laparoscopically or via an open surgery which would depend on factors like condition of the patient, skill of the surgeon etc. Surgery may require removal of damaged fallopian tube or removal of ectopic pregnancy contents after giving a small incision on the fallopian tube.

It should be kept in mind that once an ectopic pregnancy occurs, there is higher risk of ectopic pregnancy again. Thus whenever a pregnancy occurs in future, a woman with previous history of ectopic pregnancy must seek immediate consultation with her Obstetrician Gynaecologist and may be asked to get an early ultrasound with certain blood tests.

Dr. Payal Chaudhary
Senior Consultant
Obstetrics and Gynaecology
Rosewalk Healthcare by Rainbow Hospitals, New Delhi.

By, Dr. Payal Chaudhary, Senior Consultant, Obstetrics and Gynaecology, Rosewalk Healthcare

Thyroid gland is a small organ in the front of your neck that produces hormones that regulate your body’s metabolism and affect vital functions. The relationship between your thyroid health and fertility is an important and sometimes complex part of conception. Thyroid disorders refer to a group of disorders that cause dysregulated functioning of the thyroid gland, resulting in the overproduction (hyperthyroidism) or underproduction (hypothyroidism) of thyroid hormones, triiodothyronine (T3), and thyroxine (T4).

Thyroid disorders are known to affect a person’s body in a number of ways. A undiagnosed thyroid condition can sometimes hamper fertility of a man or woman. It can also cause problems during pregnancy. That is the reason that once a diagnosis of hyperthyroidism (excessive production of thyroid hormone and low TSH value) or hypothyroidism (low thyroid hormones in the blood stream and high TSH value) is made, if a person is planning on pregnancy he or she should seek treatment for the same. Once the over- or underactive thyroid is under control, however, there is no reason why you should not have a successful pregnancy and a healthy baby. Sometimes, the thyroid hormone values may be in the normal range but body may form auto antibodies against thyroid gland and that can also impact fertility.

Hyperthyroidism is condition of excess thyroid hormone production and the most common cause of an overactive thyroid is Graves’ disease. If it is untreated you may irregularity in your periods and the flow may be reduced too. This may lead to difficulty in conception. This happens due to abnormal TSH values hampering ovulation and implantation of the baby to the mother’s uterus lining. After treatment, if you are planning to get pregnant then you should get your thyroid function test done prior to embarking on trial for pregnancy. Fertility can actually return rapidly once thyroid is under control.

If you are pregnant and have (or have had) Graves’ disease it is important to tell your obstetrician about your medical history. Even if your thyroid function has returned to normal and even if you are now taking medication for an underactive thyroid(which can appear after a phase of overactive thyroid), you may still have Graves’ antibodies in your blood and these could affect you and your baby during or after your pregnancy. You should also inform your treating doctor that you are pregnant as soon as possible. Thyroid hormone levels need monitoring throughout pregnancy especially if you are on medication.

In men, hyperthyroidism can cause a marked reduction in sperm count, resulting in reduced fertility. The sperm count usually returns to normal once the thyroid condition has been treated. If treatment is started in the form of thyroid medication, it becomes safe to plan a pregnancy.

Certain changes made in day to day life can help in thyroid gland regulation. Dietary changes include avoiding processed food and artificial additives to the diet. Regular exercise also helps. There are some studies recently in literature, which also highlight the role of Vitamin D supplement especially if you are deficient and also adding Selenium rich foods to diet which includes fruits and nuts.

Last few days have seen a drastic deterioration in Air Quality with Air Quality Index(AQI) going down and reaching very poor and sometimes hazardous levels.

Now this makes one think that we do know that Air Pollution is causing so many health issues especially Respiratory Issues in Children as well as Adults, then it must be having some effects on a growing foetus in the Pregnant Women’s Womb.

There have been studies which shows that exposure to environmental pollutants can lead to Adverse Pregnancy Outcomes.

It Increases the risks of spontaneous Abortions, Pre term Labour and when exposed in third trimester, might increase the risk ok Still Birth. Exposure to PM 2.5 and PM 10 as well as Carbon Monoxide and Cooking Smoke are the major Implicants of Pregnancy Loss due to Air Pollution.

Also, it is believed that the developing foetus is especially vulnerable to environmental toxins, such as Air Pollution. Studies also shows that air pollution can have a negative impact on Pregnancy outcomes such as Preterm Birth, Low Birth Weight, Intrauterine Growth Restriction as well as Congenital defects on Mother’s health as well.

Miscarriage which is typically defined as the loss of the foetus before 20 Weeks of Pregnancy, and still birth, which is typically defined as the death of foetus after 20 weeks of Pregnancy, are both the example of Pregnancy Loss. The most Serious Negative Pregnancy result is Miscarriages.

Magnetic Fields, Maternal Smoking and Ambient Cigarette Smoke have all been Linked to Negative Effects of Environmental Pollution on Spontaneous Abortion and Still Birth.

The disparities reflected by the child’s health indicators persist despite the significant improvements in children’s health that have been documented globally in recent decades, It is challenging to meet the Sustainable Development Goals because of the persistently low levels of health in socially vulnerable groups of the population (expressed in high rates of neonatal, infant, and under-five mortality, malnutrition, preterm birth, and low birth weight, among other adverse outcomes) (SDG).

The COVID-19 pandemic had a further impact on the situation as a whole, strengthening and highlighting the necessity of integrating social and health policies to address the complexity of children’s health issues.

In addition to being a significant contributor to neonatal morbidity and mortality, foetal growth restriction (FGR) also has long-term negative health consequences. In affluent nations where PM2.5 levels are generally low, a number of studies over the past ten years have shown that maternal exposure to ambient air pollution is a risk factor for aberrant foetal growth.

Article By: Dr. Payal Chaudhary, Senior Consultant, Obstretics and Gynaecologist, Madhukar Rainbow Children’s Hospital, Malviya Nagar