Prenatal care is a type of preventative care with the goal of providing regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit both mother and child. During check-ups, women will receive medical information over maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins.

Recommendations on management and healthy lifestyle changes are also made during regular check-ups. The availability of routine prenatal care has played a part in reducing maternal death rates and miscarriages as well as birth defects, low birth weight, and other preventable health problems.

Prenatal care generally consists of:

• Monthly visits during the first two trimesters (from week 1–28)
• Fortnightly visits from 28th week to 36th week of pregnancy
• Weekly visits after 36th week until delivery (delivery at week 38–42)
• Assessment of parental needs and family dynamic

Physical examinations generally consist of:

• Collection of (mother’s) medical history
• Checking (mother’s) blood pressure
• (Mother’s) height and weight
• Pelvic exam
• Doppler fetal heart rate monitoring
• (Mother’s) blood and urine tests
• Discussion with caregiver

Ultrasound Obstetric ultrasounds are most commonly performed during the second trimester at approximately week 20. Ultrasounds are considered relatively safe and have been used for over 35 years for monitoring pregnancy. Among other things, ultrasounds are used to:

• Diagnose pregnancy
• Check for multiple fetuses
• Assess possible risks to the mother (e.g., miscarriage, blighted ovum, ectopic pregnancy, or a molar pregnancy condition)
• Check for fetal malformation (e.g., club foot, spina bifida, cleft palate, clenched fists)
• Determine if an intrauterine growth retardation condition exists
• Note the development of fetal body parts (e.g., heart, brain, liver, stomach, skull, other bones)
• Check the amniotic fluid and umbilical cord for possible problems
• Determine due date (based on measurements and relative developmental progress)

Generally an ultrasound is ordered whenever an abnormality is suspected or along a schedule similar to the following:

• 7 weeks — confirm pregnancy, ensure that it’s neither molar or ectopic, determine due date
• 13–14 weeks (some areas) — evaluate the possibility of Down Syndrome
• 18–20 weeks — see the expanded list above
• 34 weeks (some areas) — evaluate size, verify placental position.

• Minimal Access Technique
• Utilizing the Newest Technology
• Superior operator expertise
• Sound Technology
• Faster postoperative recovery
• Less pain
• Lose less blood
• Resume to normal activities more quickly

Symptomatic uterine fibroids can be treated by:

• Medication to control symptoms
• Medication aimed at shrinking tumours
• Ultrasound fibroid destruction
• Myomectomy or radio frequency ablation
• Hysterectomy
• Uterine artery embolization

There are three types of myomectomy:

• In a hysteroscopic myomectomy (also called transcervical resection), the fibroid can be removed by either the use of a resectoscope, an endoscopic instrument inserted through the vagina and cervix that can use high-frequency electrical energy to cut tissue, or a similar device.
• A laparoscopic myomectomy is done through a small incision near the navel. The physician uses a laparoscope and surgical instruments to remove the fibroids. Studies have suggested that laparoscopic myomectomy leads to lower morbidity rates and faster recovery than does laparotomic myomectomy.
• A laparotomic myomectomy (also known as an open or abdominal myomectomy) is the most invasive surgical procedure to remove fibroids. The physician makes an incision in the abdominal wall and removes the fibroids from the uterus.

Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity. In other words, menopause is the state in which the ovaries become unresponsive to gonadotropins with advancing age and their function declines resulting in an absence of menstrual function.

The characteristic symptom if menopause is ‘hot flush’ which begins usually as a pressure symptom in the head in most women.

Symptoms such as thinning of the membranes of the vulva, flattening of the vaginal epithelium, cervical atrophy, and also the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas are seen.

Following menopause there is a decline in collagenous bone matrix resulting in osteoporotic changes. Bone loss increases to 5% per year during menopause as a result of trabecular bone in sites such as the vertebral column and radius (colle’s fracture) being sensitive to lack of estrogen.

Symptoms such as breast atrophy, breast tenderness and swelling, decreased elasticity of the skin, and formication (itching, tingling, burning, pins, and needles, or sensation of ants crawling) can be distressing.
During the phase of menopause women experience a number of psychological symptoms like depression and/or anxiety, fatigue, irritability, memory loss and problems with concentration, mood disturbances, sleep disturbances, poor or light sleep, insomnia, and daytime sleepiness.

Sexual symptoms seen are dyspareunia or painful intercourse and decreased libido or desire to perform sexual intercouse.

The clinicians in our group are well versed with detecting these symptoms and treating them either medically or surgically.

Urogynecology involves the diagnosis and treatment of urinary incontinence and female pelvic floor disorders. Incontinence and pelvic floor problems are remarkably common but many women are reluctant to receive help because of the stigma associated with these conditions. Although countless women are bothered by a loss of bladder control, bowel symptoms, and pelvic discomfort they are often not aware that these problems have a name much less how common they really are. We are well experienced to tackle these problems and help women to lead a comfortable life.

Infertility is fundamentally the inability to conceive offspring. Infertility also refers to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, including some that medical intervention can treat.

Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following. If the sperm are of good quality and the mechanics of the woman’s reproductive structures are good (patent fallopian tubes, no adhesions or scarring), physicians may start by prescribing a course of ovarian stimulating medication. The physician or WHNP may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body.

If conservative medical treatments fail to achieve a full term pregnancy, the physician or WHNP may suggest the patient undergo in vitro fertilization (IVF). IVF and related techniques (ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART) techniques.
ART techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman’s reproductive tract, in a procedure called embryo transfer.
Other medical techniques are e.g. tuboplasty, assisted hatching, and Preimplantation genetic diagnosis.

Cervical cancer is cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on there are typically no symptoms. Later symptoms may include: abnormal vaginal bleeding, pelvic pain or pain during sex.

Human papillomavirus (HPV) infection appears to be involved in the development of more than 90% of cases. Other risk factors include: smoking, a weak immune system, birth control pills, starting sex at a young age and having many sexual partners, but these are less important. HPV vaccines protect against two high risk strains of this family of viruses and may prevent up to 65 to 75% of cervical cancers. As there still is a risk of cancer, guidelines recommend continuing regular Pap smears.

Early stage tumors are managed with hysterectomy (removal of the whole uterus including part of the vagina). The lymph nodes are removed as well. Alternatives include local surgical procedures such as a loop electrical excision procedure (LEEP) or cone biopsy.
Advanced stage tumors are treated with radiation therapy and cisplatin-based chemotherapy.