Category Archives: gynaecologist

INDIA’S BEST GYNECOLOGIST

DR (PROF) SADHANA KALA, MS, FICOG

‘INDIA’S TOP 8 GYNECOLOGIST’
“at the top of the list is Dr Prof Sadhana Kala”
She is the only one from Delhi in the List

“View the list of best gynecologists in India, with their Review Rating, experience and Services offered. Dr (Prof) Sadhna Kala (Delhi) and Dr. Shobha Venkat (Bangalore) top the list because of their experience, review ratings and service quality.”

 

1. Best Gynecologists in India with Highest Review Ratings (published: 15 November 2017)https://www.elawoman.com/…/best-gynecologists-in-india-with…

 

2. Top 10 Best Gynecologists in India (published: Oct 25, 2017) http://essencz.com/piyalis…/top-10-best-gynecologists-india/

(At the World Congress of Gynecologist, Rio De Janerio, October 2018)

3. Top 10 Best Gynecologists in Delhi
http://essencz.com/piyalis…/top-10-best-gynecolaogist-delhi/

(At the World Congress of Gynecologist, Rio De Janerio, October 2018)

4. Best Gynecologists in Delhi NCR with Highest Ratings and Reviews
https://www.elawoman.com/…/best-gynecologist-in-delhi-ncr-w…

(Robotic Surgery Workshop, New York, 2016)

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CESAREAN VS VAGINAL DELIVERY

The birth of a child is supernatural spiritual event. – Lailah Gifty Akita,
A miracle is really the only way to describe motherhood and giving birth. – Jennie Flnch

SYNOPSIS

A baby may be delivered by a vaginal or a cesarean delivery. But in a given situation, one procedure may be safer for the mother and the baby than the other procedure.

Advantages of the vaginal delivery are that the mother feels it is natural, the recovery period is shorter and she can breastfeed earlier. Disadvantages are that it is a gruelling event and has a higher risk of urinary incontinence; and that the baby may be injured during delivery.

A cesarean may be required in certain situations such as low-lying placenta or breech baby. Mother has longer recovery period; and risk of excessive blood loss and bowel or bladder injury. Baby may have breathing problem and childhood ashthama and obesity.

A successful. VBAC (vaginal birth after a cesarean) is possible. However, there is a small risk of rupture of the uterus. Therefore, suitable doctor and hospital are required.

INTRODUCTION

Between cesarean and vaginal delivery, choose the one which has the least chance of causing injury or morbidity to the baby and the mother. Both procedures have risks. But in a given situation, risks in one procedure are greater than in the other. Aim is to minimize the risk.

For an informed discussion with the therapist, for choosing the optimum delivery method in a given situation, and for giving an informed consent, the expecting mother and her family need to know the pros and cons of the two methods of delivery.

This paper summarizes the pros and cons of the two methods for the mother and for the baby.

INCIDENCE

According to WHO, maternal and new-born deaths decrease as the cesarean rate rises up to 10-15% of the number of deliveries. Higher cesarean rate does not further reduce maternal or neonatal mortality. We may interpret that to mean that in 10-15% cases cesarean is called for; but in 85% of the cases, that is majority of the cases, vaginal delivery is possible. In a few other studies, the death rate continues to reduce till 19% of caesarean rate.

The average caesarean rate in India is 18%. However among the 20% richest population, the rate is 30%. In the United States caesarean rate is about 32% (2017). Clearly, among the rich, more caesareans are being done than are medically needed: rich women choose caesarean rather than vaginal delivery.

VAGINAL DELIVERY

A Mother finds vaginal delivery a more natural experience, feels she is giving birth the way nature intended her to. The other advantages are:

  • A shorter hospital stay (24 – 48 hours) and recovery time compared with a cesarean.
  • Avoid major surgery and its associated risks, such as severe bleeding, scarring, infections, reactions to anesthesia and longer-lasting pain.
  • Earlier contact with the new-born, hold her baby and begin breastfeeding sooner after she delivers
The disadvantages for the mother are;
  • Labor is a physically gruelling process and is hard work.\
  • A risk that the skin and tissues around the vagina can stretch and tear while the fetus moves through the birth canal. If stretching and tearing is severe, a woman may need stitches or this could cause weakness or injury to pelvic muscles that control her urine and bowel function.
  • Higher risk of bowel or urinary incontinence; more prone to leak urine when they cough, sneeze or laugh.
  • May experience lingering pain in the perineum, the area between her vagina and anus.
  • Increased risk of:
    o anxiety and stress during pregnancy
    o sexual problems post-delivery
    o increased risk of post partum depression
For the Baby the advantages are:
  • Muscles involved in birthing may squeeze out fluid in a new-born’s lungs, making breathing problems at birth less likely.
  • Good bacteria received as the new-born travels through the birth canal may boost its immune systems and protect its intestinal tracts.
  • For the Baby the disadvantage is that in long labor, or if the new-born is large, it may get injured during the birthing, resulting in a bruised scalp or a fractured collarbone.

CESAREAN

In certain medical situations, vaginal delivery may be too risky. Therefore a cesarean may be planned. Typical risky situations are:

  • Twins or other multiples
  • A very large baby in a mother with a small pelvis
  • Baby not in a heads-down position and efforts to turn the baby into this position before birth were unsuccessful.
  • Medical conditions such as diabetes or high blood pressure
  • An infection, such as HIV or genital herpes, that she could pass along to her baby during birth
  • Problems with the placenta during pregnancy

Sometimes an unplanned, or emergency cesarean, may become necessary because the health of the mother, the baby, or both, is in jeopardy. This may happen because of a problem during pregnancy; or after a woman has gone into labor: if labor is happening too slowly or if the baby is not getting enough oxygen (fetal distress).

Sometimes a mother may request for an elective cesarean because she wants to plan her delivery; or because she previously had a complicated vaginal delivery.

In certain situations cesarean is lifesaving. But opening up a woman’s abdomen and removing the baby from her uterus is a major surgery. The risks are:

• often leads to repeat C-sections in future pregnancies,
• longer hospital-stay, two to four days on average.
• longer recovery period, often at least two months; more pain and discomfort in the abdomen as the skin and nerves surrounding the surgical scar need time to heal.
• increased physical complaints such as pain or infection at the site of the incision and longer-lasting soreness.
• increased risk of:
o blood loss and a greater risk of infection, bowel or bladder injury or a blood clot forming during the operation.
o future pregnancy complications, such as placental abnormalities and uterine rupture, which is when the uterus tears along the scar line from a previous cesarean. The risk for placenta problems increases with every cesarean a woman undergoes.
o death during surgery: three time more likely in a cesarean than in a vaginal birth, due mostly to blood clots, infections and complications from anesthesia.
o miscarriage and stillbirth in pregnancy after cesarean.

Baby born by cesarean is at a higher risk of:

• stillbirth
• higher mortality rate than vaginal delivery baby
• more likely to be admitted to the NICU for breathing problems
• higher rate of childhood (up to the age of 12) asthama
• a greater risk of becoming obese as children and as adults (perhaps because women who are obese or have pregnancy-related diabetes are more likely to have a C-section)
• lesser immune system

VBAC

VBAC (vaginal birth after cesarean) is possible under certain conditions. But VBAC is not safe for every woman and can even be life threatening to her. Before attempting a trial of labor after cesarean (TOLAC), remember that the following are contraindications:

• obesity (body mass index 30 or higher; weight over 200 pounds)
• pre-eclampsia (high blood pressure during pregnancy)
• age (usually older than 35)
• previous caesarean was in the last 19 months
• fetus is very large
• the reason for the initial caesarean is recurrent (for example, very small maternal pelvic dimensions). In this case, TOLAC may be dangerous to both mother and baby.
• more than two previous caesareans
• scar is a vertical cut, that is, it goes from top to bottom (high risk it will rupture and harm the baby and the mother and will call for a cesarean)
• additional uterine scars, anomalies, or ruptures

If scar is low and a transverse cut, that is, goes from side to side, then TOLAC may be attempted.

According to ACOG (The American College of Obstetricians and Gynecologists):

• 3-4 out of 5, ie, 60-80% women can have successful VBAC
• transverse cut, risk of rupture, is 0.2 to 1.5%, ie 1 in 500
• VBAC is safer than repeat caesarean
• more than one previous caesarean does not pose any additional risk in VBAC
• genital herpes is acceptable, unless a visible lesion
• no evidence that a large baby requires cesarean. Squatting increases outlet of the pelvis by 10%

Rupture of the uterus is the principal risk of VBAC. The risk is small: less than 1% VBAAC result in rupture. But it is dangerous if it happens. Go for VBAC only if you are prepared to take that risk.

Also be sure to choose a best pregnancy doctor in south delhi and a hospital who can handle the rupture and do a cesarean if needed.

You may wish to attempt a VBAC because if it is successful, you will avoid the disadvantages of a Cesarean.

History

The second Mauryan Samrat (emperor) of India, Bindusara, was born c. 320 BCE by caesarean. His mother accidentally consumed poison and died when she was close to delivering him. Chanakya, his father Chandragupta’s teacher and adviser, cut open the belly of the queen and took out the baby Bindusara, thus saving the baby’s life.

That Julius Caesar was born by caesarean, hence the name caesarean for the procedure, is a myth. Though caesareans were performed in Roman times and Jewish woman are said to have survived such operation. But caesareans usually led to the death of the mother and were usually performed only when woman was dead or supposed to be beyond help. In Great Britain and Ireland, the caesarean-mortality rate in 1865 was 85%.

REFERENCES

1. Vaginal Birth vs. C-Section: Pros & Cons – Live Science
https://www.livescience.com › Health
2. Normal Delivery Vs Cesarean – Risks And Benefits – MomJunction
https://www.momjunction.com › Pregnancy › Giving Birth
3. Why You Don’t Want a C-Section | Fit Pregnancy and Baby
https://www.fitpregnancy.com › … › Why You Don’t Want a C-Section
4. Vaginal Birth After A C-Section (VBAC): Benefits & Risks – WebMD
https://www.webmd.com › Pregnancy › Reference
5. VBAC: Vaginal Birth after Cesarean – American Pregnancy Association
americanpregnancy.org › Labor and Birth

Ban On The Life-saving Drug Oxytocin: What It Means To Us

OXYTOCIN BAN

“Oxytocin is a very vital drug” – Dr Shivani Chaturvedi
“Too much risk for too little benefit?” – Dr (Prof) Sadhana Kala

India has banned formulation of oxytocin by private companies, and its sale by retail chemists, from 31 August 2018.

Dr (Prof) Sadhana Kala, Best gynaecologist, Laparoscopic surgeon and best Infertility specialist in Delhi, explained the reason for the ban to SheThePeople.TV. She said, “Oxytocin is misused in the dairy industry to make livestock release milk at a time convenient to the farmer. It is also used to increase the size of vegetables such as pumpkins, watermelons, brinjals, gourds and cucumbers. To prevent such misuse, the govt. has banned the formulation of oxytocin for domestic use by the private manufacturer. The ban is effective from 31 August 2018. For domestic use, oxytocin will be formulated only by KAPL – a public sector company – and supplied to registered hospitals and clinics. Oxytocin in any form or name will not be sold through retail chemist.”

Dr Kala, best Infertility doctor in Delhi, feels, “It is a good move by the govt. But the supply chain will have to be worked out. So that the hospitals and clinics get a regular and uninterrupted supply of oxytocin from KPCL.”

Dr (Prof) Sadhana Kala, Best Laparoscopic Surgeon in South Delhi, said to SheThePeople.TV, “Oxytocin has been widely used for active management of labour since 1969 to augment the insufficient uterine action when labour was slower than average; and to reduce the caesarean section rate. However, recent studies in the UK have shown that in more than two third of the cases oxytocin use was injudicious resulting in disciplinary action and litigation and malpractice settlement; that reduction in caesarean section rate was marginal; and labour was shorter by 1.3 hours. Oxytocin will continue to have a place in childbirth. But the question will remain whether such marginal benefits justify the risk of use of Oxytocin. Too much risk for too little benefit?”

NB:Oxytocin is the first choice drug to prevent bleeding in women after childbirth. – WHO; and is listed as a life-saving drug in the National List of Essential Medicines. – Dr (Prof) Sadhana Kala

PELVIC INFLAMATORY DISEASE (PID)

Every human being is the author of his own health or disease.
– Gautama Buddha

SYNOPSIS

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs. It is caused by many types of bacteria. If not treated, it can cause complications such as ectopic pregnancy and infertility. And How Best Laparoscopic Surgery in South Delhi can help you.

PID affects women in reproductive age. Peak incidence is in women of 15 to 24 years age. India is estimated to have at least one million episodes of PID each year.
Risk of PID increases with risky sexual practices: multiple sexual partners, sex with a person having PID, starting sex at a very young age and having sex without a condom.
PID often has no signs or symptoms. But a few of the symptoms that may appear are: pain in lower abdomen or pelvic pain, heavy or foul periods, bowl discomfort and pain in urination.

There is no single test to diagnose PID. It is diagnosed from symptoms and from gynaecological examination. Urine and blood tests, ultrasound, and laparoscopy may also be used. Because of absence of symptoms, and because the symptoms are similar to those of other diseases, PID diagnosis is often delayed. Woman’s recent sexual partners also need to be tested and treated.

A mixture of antibiotics is used for treatment and is successful in most cases. But a few cases may need laparoscopic or surgical intervention. Removal of intrauterine devices (IUDs) is not necessary.

Because of difficulty of diagnosis, and serious consequences of delayed treatment, empirical treatment may be initiated in at-risk women if symptoms of PID appear. Having regular medical care throughout lifetime maximizes the chances of early diagnosis and treatment of PID.

Improved education, routine screening, diagnosis, and empirical treatment of PID will reduce the incidence and prevalence of PID and its long-term sequelae.

INTRODUCTION

PID, if not treated, can cause ectopic pregnancy, infertility, chronic pelvic pain, cancer, peritonitis and tubo-ovarian abscess – the latter two can become life threatening.

In the US, more than one million women have PID, and more than 100,000 become infertile each year because of PID. In industrialized countries PID-incidence is 10 to 13 per 1,000 in women in 15 to 39 years age-group, with a peak incidence of about 20 per 1,000 women in 20 to 24 years age group. India is estimated to have more than one million PID episodes each year.

CAUSE

PID is an infection of the female reproductive organs – vagina, uterus, fallopian tubes, ovaries, and of womb lining (endometrium) and lining of the inside of the abdomen (peritoneum).

It is a bacterial infection. Many types of bacteria can cause it but in about one in four cases it is caused by sexually transmitted infection (STI) such as chlamydia or gonorrhoea. Sometimes normal, harmless, bacteria in the vagina get past the cervix and into the reproductive organs and cause PID. This can happen when the cervix is damaged after childbirth, miscarriage, abortion and inspection of the womb; or by an earlier PID.

In many cases, the cause of PID is unknown.

RISK FACTORS

Any woman can get PID. But the risk of getting it is increased by:
• Being sexually active and younger than 25 years age
• Having multiple sexual partners
• Having a new sexual partner
• Being in a sexual relationship with a person who has more than one sex partner
• Having a history of PID or STI
• Having sex without a condom
• Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms

Having an intrauterine device (IUD) does not increase the risk of PID. Potential risk, if any, is within the first three weeks after insertion.

SYMPTOMS

PID often has no signs or symptoms. But one or more of these symptoms may occur:

• Pain in lower abdomen
• Pelvic pain — especially during a pelvic exam
• Heavy or foul or painful periods with an unpleasant odor
• Unusual vaginal discharge, especially if it’s yellow or green
• Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
• Pain or bleeding during intercourse
• Fever, sometimes with chills
• Painful or difficult urination
• Bowel discomfort
• Nausea and vomiting

See your doctor if you experience any of the above symptoms.

Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with STI. If these signs and symptoms occur, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.

DIAGNOSIS

There is no single test to diagnose PID. It is diagnosed from symptoms and from gynecological examination.

Gynecologist in Delhi will talk about your medical and sexual history and do a pelvic examination to check for any tenderness and abnormal vaginal discharge. This examination may be discomforting, especially if you have PID.

Swabs may be taken from the inside of your vagina and cervix to look for bacterial infection and identify the bacteria responsible. A positive test for chlamydia or gonorrhoea supports the diagnosis of PID. Most women test negative but this does not rule out PID.
Other tests may, therefore, be required to look for signs of infection or inflammation, or to rule out other possible causes of your symptoms. These tests may include:

  •  A urine or blood test
  • A pregnancy test
  • An ultrasound scan, which is usually carried out using a probe passed through the vagina (transvaginal ultrasound)
  • In a few cases, especially the more severe cases, and where there may be other possible causes of the symptoms, such as appendicitis, laparoscopy may be used to look at the internal organs and, if necessary, take tissue samples to diagnose PID. Laparoscopy can also be useful in disproving cases wrongly labelled as chronic pelvic disease.
  • Recent sexual partners also need to be tested and treated to stop the infection recurring or being spread to others.

Diagnosis of PID can be missed or delayed because of absence of symptoms in the earliest, most curable stage. When symptoms do occur, they can be similar to symptoms of certain other diseases, such as appendicitis, food poisoning or food borne illness, ruptured ovarian cyst, diverticulitis, and ovarian torsion. Therefore have regular medical care throughout lifetime to maximize the chances of early diagnosis and treatment of PID.

TREATMENT

If diagnosed early, PID is treated with antibiotics for 10-14 days. A mixture of antibiotics to cover the most likely infections is given as tablets and injections. Complete the antibiotic course and avoid sexual intercourse during the treatment period to ensure the infection clears completely.

Antibiotics alone are successful in 34-75% of cases. Patients who do not improve in 72 hours are re-evaluated for laparoscopic or surgical intervention and for other possible diagnoses. Laparoscopy should be used if the diagnosis is in doubt. Laparoscopic pelvic lavage, abscess drainage, and adhesiolysis may be necessary. Laparoscopy gives direct visualization of internal organs and of the pelvis and obtaining of cultures for more accurate bacteriologic diagnosis. However, laparoscopy is not always available in acute PID; moreover, it is costly and requires general anesthesia.

If surgical treatment is required, attempt is to conserve reproductive potential with simple drainage, adhesiolysis, and copious irrigation or unilateral adnexectomy, if possible. Further surgical therapy is needed in 15-20% of cases so managed.

Most tubo-ovarian abscess (60-80%) resolve with antibiotic administration. Laparoscopy may be used to identify the loculations of pus requiring drainage. Unresolved abscesses may be drained by colpotomy, laparoscopy, or laparotomy. In patients with recurrent PID, dense pelvic adhesions may render surgery difficult.

Removal of intrauterine devices (IUDs) in acute PID cases is not necessary. But close clinical follow-up is mandatory if the IUD is left in place.

More research is needed to optimize PID diagnosis and treatment; and to improve patient and doctor’s compliance to guidelines.

COMPLICATIONS

Untreated PID may cause scar tissue, and collections of infected fluid (abscesses) in the fallopian tubes, which can damage the reproductive organs.

Other possible complications are:

• Ectopic pregnancy. The scar tissue prevents the fertilized egg from moving through the fallopian tube to implant in the uterus thus causing a tubal (ectopic) pregnancy that can cause massive, life-threatening bleeding and that may require emergency medical attention. PID is a major cause of ectopic pregnancy
Infertility. PID may damage the reproductive organs and cause infertility. Delaying the treatment, or frequent PID, dramatically increases the risk of infertility. In the US, 1 in 8 women with a history of PID has difficulty getting pregnant; and 15% of infertility cases are because of PID.
• Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that may last for months or years. Scarring in fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.
• Tubo-ovarian abscess. PID might cause an abscess — a collection of pus — to form in uterine tube and ovaries. If left untreated, this could develop into a life-threatening infection.

PREVENTION

To reduce the risk of PID:

• Practice safe sex. Use condoms every time you have sex, limit your number of partners, and ask about a potential partner’s sexual history.
• Talk to your doctor about contraception. Many forms of contraception do not protect against the development of PID. Using barrier methods, such as a condom, might help to reduce your risk. Even if you take birth control pills, it’s still important to use a condom every time you have sex to protect against STIs.
• Get tested. If you’re at risk of an STI, such as chlamydia, make an appointment with your doctor for testing. Set up a regular screening schedule with your doctor if needed. Early treatment of an STI gives you the best chance of avoiding PID.
• Request that your partner be tested. If you have PID or an STI, advise your partner to be tested and, if necessary, treated. This can prevent the spread of STIs and possible recurrence of PID.
• Don’t douche. Douching upsets the balance of bacteria in your vagina.

INCIDENCE

In a 1995 U.S. study, 8 percent of all women in their reproductive years were being treated for PID. The numbers have steadily reduced. In 2015, the annual visits for PID were down to about 90,000 a year.

Enough data on incidence of PID in India is not available. In one study about 11.55% of the study subjects were diagnosed with PID. In the industrialised world, the incidence is 1 to 2 per cent per year among sexually active women. On that basis, India will have about one million PID cases per year.

REDUCING THE INCIDENCE

Because of difficulty of diagnosis, and serious consequences of delayed treatment, it is recommended that empirical treatment should be initiated in at-risk women who have lower abdominal pain, adnexal tenderness, and cervical motion tenderness. That overtreatment be preferred to no or delayed treatment.

Women with PID should be counselled to abstain from sexual activity or use barrier protection strictly and appropriately until their symptoms and those of their partner have fully abated and they have completed their entire treatment regimen.

Improved education, routine screening, diagnosis, and empirical treatment of PID will reduce the incidence and prevalence of PID and its long-term sequelae. Education should concentrate on strategies to prevent PID and STIs, including reducing the number of sexual partners, avoiding unsafe sexual practices, and routinely using appropriate barrier protection. Adolescents, being at an increased risk for PID, should be advised to delay the onset of sexual intercourse until age 16 years or older.

AWAITING SURGERY? HOW TO CHOOSE THE SURGEON

Surgery outcome is better if the surgeon is female.
– BMJ, number 2 in the list of top medical journals of the world

“Patients have a right to know how good a surgeon is,”
– Dr. Fiona Godlee, editor in chief of the BMJ

Surgeon Rating

The US has websites that rate the surgeons. A patient can use these to choose the surgeon. Also, in May 2015, three major hospital systems in the US implemented the “Take the Volume Pledge” that prevents surgeons and hospitals from doing surgeries in which they have “low volume.” Surgical “volume” is the number of times a surgeon/hospital has done a specific surgical procedure in a defined time period.

India will not have surgeon-rating websites for many, many years to come. And surgeons/hospitals do not have any guidelines to prevent them from doing surgeries that they have little experience or currency of doing. How may the patient in India choose the surgeon?

Surgeon’s Experience

For over two decades researchers have acknowledged that the outcome of a surgery is related to the surgeon’s experience. This was confirmed by a recent Harvard University study that analysed surgical performance in 14 countries with a total of more than 17,000 surgeons and 35 different procedure types. Analysis of data on more than one million surgeries has shown that the more procedures a surgeons has performed, the better her patients’ outcome, at least until she hits a learning plateau. The plateau is reached after 25 to 750 procedures depending on the complexity of the surgery.

“Low Volume” surgeons’ patients have higher mortality, morbidity, intraoperative and postoperative complications, readmissions to hospital, and mortality within 30 days of surgery, as compared to “high volume” surgeons: for example, in pancreatic cancer surgery, annual death rates were nearly four times higher; in certain other surgeries, death rates were three times higher; in endocrine surgery, complication rates and reoperation rate were about two times higher; in gastric bypass surgery, risk of serious complications fell by 10 percent for every additional 10 cases per year the surgeon performed.

Choosing the Surgeon in India

In India, search engines like Google, Bing and Yahoo may be used to find a better surgeon. But Google is the best and the most widely used search engine. Let us say you are looking for a Gynaecologic laparoscopy surgeon in Delhi. Search “Best Gynae laparoscopic surgeon in Delhi.” Take the first ten names on the list and look at their average ‘rating’ and the number of persons who have given it. The higher the average ‘rating’ and the greater the number of persons giving it, the better: a surgeon with a rating of 5/5 given by 100 persons is likely to be better than the one with 4.7/5 rating given by 40 persons.

Next, look at the Google search pages. Page 1 is usually full of ads and sites of big hospitals and agencies like Practo, Lybrate, Quora and so on. You will find surgeons at page two onwards. Visit their website and check:

a. Their performance in medical school and later. Academic brilliance is often indicative of good professional competence.
b. Whether they have done specialised training and whether they have done it at a reputed, highly selective, institute. Specialisation is even more important than “volume.”
c. Whether they are keeping current with the latest technology by visiting Centres of Excellence in developed countries like the US, UK, Germany etc.
d. Browse her Blogs

Next, schedule a consultation with the selected surgeon. At the consultation ask the surgeon:

i. How many years’ experience she has in doing the specific surgical-procedure. A minimum of five years’ is preferred.
ii. How many total specific surgical-procedure she has done. Depending on the complexity of the procedure, minimum of 25 to 750 is suggested.
iii. How many specific-procedure she has done in the previous two years. For complex surgery, a minimum of 30 per year is suggested.

A good surgeon will not mind such questions and will not give incorrect information.

And finally, surgeon’s communication skills and trust-building ability are of singular importance.

Now ask yourself: “Was I comfortable talking? Did she answer my questions well? Did she ask good questions of me? Was she caring? Is she someone I can trust my life with?”

If possible, ask the surgeon’s other patients about their experience; and other doctors about surgeon’s expertise.

Before taking a final decision, seek a second opinion. In complex cases, about 1 in 5 second opinions are different from the initial treatment recommendation.

Conclusion

Every surgery has the potential for life-threatening complications. “Even in the best of circumstances, bad things can happen.” Occasional bad outcome are inevitable; but many surgical injuries are avoidable.

Minimize the probability of bad outcomes by choosing the right surgeon and the right hospital.

 

DAUGHTER OF UTTARAKHAND AWARD

DAUGHTER OF UTTARAKHAND AWARD

 

Dr Monika Pant (Vice President, BJP, Delhi) and Dr Rashmi Malhotra – my two nieces – accepted the Award for me since I was away; and Dr Monika read out my speech.

Extract from my acceptance speech at the Daughter of Uttarakhand Award;

“I’m an Uttarakhandi. But born in Lucknow, medical education and practice in Kanpur and in the US and in Delhi. My only connect to Uttarakhand was summer vacations in Nainital during my schooldays.

Then came the Uttarkashi earthquake, 1991. I spent a few weeks there to oversee the relief work undertaken by Swami Rama. That brought me face to face with the plight of the people in my home-state living in the villages perched on steep mountains.

I then founded Family Welfare Foundation of India to bring some medical care to the doorsteps of the villagers. The Foundation’s USP was that it neither sought nor accepted any donation from any one – individual, institution or govt.

In 1999, we became one of the few NGOs from India to be accredited by the United Nations (UN). Till date, we remain the only NGO in the UN system that does not accept donations from any one.

I also did bit of work for the setting-up of Swami Rama medical college, now HIHT University, at Rishikesh. I was a Professor in the college and trained the faculty in Minimally Invasive Surgery (MIS).

My work in Uttarakhand has been the best part of my life’s journey.”

26 April 2016

Laparoscopic & Robotic Gynec Surgeon

“I treat the patient, not the diagnosis”

Dr (Prof) Sadhana Kala
Laparoscopic & Robotic Gynec Surgeon
See:
www.drsadhanakala.com





FEMALE INFERTILITY TREATMENT

Fertility is God’s gift to women. And to men. But the gift is not equitable. A few have more of it, a few have less of it, and a few have none of it.

About 17% of couples have infertility. But with today’s technology, most of them can have a baby.

If a couple fails to conceive despite trying for 12 months, then it needs infertility treatment in Delhi. Since infertility can be in the man, or in the woman, both of them must be evaluated. In males, more than 90% of infertility is due to low sperm counts, poor sperm quality, or both. The remaining cases can be for several reasons: anatomical problems, hormonal imbalance, and genetic defects.

In females, infertility is mostly because of problems with ovulation or cervix, or damage to fallopian tubes or uterus, or abnormal cervical mucus. Also, as a woman ages, her fertility decreases.

DIAGNOSIS

Female infertility is a contributory factor in about half of all infertility cases; and the only factor in about one-third of all the cases. Most frequent causes of female infertility are:

• Ovulation problems • Damaged fallopian tubes or ovary • Cervix problem • Abnormal cervical mucus which prevents, or makes it difficult, for the sperm to reach the egg and to penetrate it • Age: as a woman ages, her fertility decreases.

Infertility specialist in Delhi diagnoses female fertility by physical, pelvic and breast examination, medical history and one or more tests such as:
• Urine or blood tests to check for infection, hormone problem and thyroid function • Ovarian reserve tests to determine the quality and quantity of eggs available for ovulation. • Cervical mucus and tissue test to check for ovulation. • Ultrasound to look at the uterus and ovaries’ abnormalities or problems. • Hysteroscopy to look for uterine abnormalities and growth inside the uterus. • Laparoscopy to see endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus and surrounding area. • Genetic tests to find if a genetic defect is causing infertility.

Depending on the cause, your age, and how long you have been infertile, one or more therapies may be needed to restore fertility.

TREATMENT

In India, 10-15 out of 100 couples (22-33 million couples) need Infertility treatment. And the number is increasing. Female infertility treatment may be medication or surgery or Assisted Reproductive Technologies (ART).

Medication:

• Antibiotics for infections.
• Hormones for hormone imbalance, endometriosis, or a short menstrual cycle.
• Medicine to stimulate ovulation.
• Supplements to enhance fertility.

Laparoscopic surgery to:

• Correct an abnormal uterine shape.
• Remove:
 Endometrial polyps and fibroids that misshape the uterine cavity.
 Pelvic or uterine adhesions.
 Blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.

ART

• Intra Uterine Insemination (IUI). In IUI, ovulation is monitored and millions of healthy sperms are placed inside the uterus at the time of ovulation.

• In Vitro Fertilization (IVF). In IVF, mature eggs are retrieved from the woman, fertilized with a man’s sperm in a dish in a lab, and the embryo is then transferred to womb. IVF cycle takes several weeks and requires frequent blood tests and hormone injections.

IUI is less physically demanding and a much shorter, and much cheaper (for three cycles, IUI, ₹ 10-15,000; IVF, ₹ 3-5 lakh) process than IVF; but IUI has a higher risk of multiple pregnancy.

Also, IUI success rate after three cycles is about 55%; for ART, it is 75-94%. For IUI, the rate dips sharply with woman’s age: dips to 3-14% for a woman of 45. For IVF the dip is hardly any.

For women in their late 30s and above, going directly for IVF may be a more cost-effective option.

But remember, ART is an art, not just science. Just as art depends on artist, so ART depends on the ARTist – the infertility specialist in Delhi. Just as the artist becomes more skilled with practice and experience, so does the ARTist, the doctor. So the right question to ask is not what the success rate of ART is; the right question to ask is what the success rate of the ARTist, the infertility doctor in Delhi, is.

Infertility is a complex disorder. Treatment demands significant financial, physical, psychological and time commitments. Be prepared for that.

Blog 02

Gynecologist in New Friends Colony for Treating Women Health Issues

Gynecology can be a very in-depth field and all women are advised to get routine and typical regular checkups to assure that their health is 100% and they are free of charge from disorders. A specialist of Gynecology really should often be professional and be sure ladies patients are always treated with respect, full esteem and kept comfortable. When a woman is fishy of issues with female organs she needs to right away look, aid and care from a Gynecologist in New Friends Colony.

Gynecological issues in women

When a lady is worried about finding herself pregnant, the most efficacious physician to talk with would be the Best Gynecologist in New Friends Colony. There isn’t anything worse for a woman than the fear of a disorder with her private organs; a Gynecologist in New Friends Colony can help diagnose if anything is present and the best way to proceed forward.

With the changing lifestyle practices, the numerous medical complications that can affect a woman keep increasing. Everywhere on the earth, the Governments are striving to provide the best healthcare facilities for women. Some of the common diseases and complications that women face in their lifetime include,

  • Hormonal imbalance
  • Infertility
  • Ovarian and Cervical cancer
  • Breast cancer

FEMALE GYNECOLOGIST IN DELHI

Gynecology was a field that was preponderantly filled with male doctors. As years went by, it was recognized that plenty of the patients did not feel much comfort with being treated by them. But in the recent times, there has been a substantial rise in the number of female gynecologists in the field. This condition does not connote that the male doctors are not pretty competent, but its roots from the fact that women feel a bit embarrassed, humiliated or held back when they want to ask a question related to their condition. This, in turn, forecloses them from telling the Gynecologist what problems they are suffering from, leading to a misdiagnosis on the part of the gynecologists. Dr. (Prof.) Sadhana Kala is a female Gynecologist in Delhi, New Friends Colony for women who are in need of a female doctor to assist them for their condition.

Blog 04

Preventive Care Tips by Gynecologist in Kalkaji Delhi

Gynecologist in Kalkaji Delhi has a dedicated unit for Gynecology and to treat disorders of the reproductive system. She will guide you right from the commencing when you have decided to be a mother through the whole period of pregnancy till the birth of the child and afterward. With highly experienced specialists as part of the gynecology, you can totally rely on her and be assured you’re in safe hands.

gynaecological issues in women

Because a woman’s health needs change with each stage of life, Best Gynecologist in Kalkaji, Delhi caters quality, feel for care from adolescence through climacteric.

From well-woman exams to treatment for self-gratification, overactive bladder, pelvic prolapse and many other disorders, you can count on the Dr. (Prof.) Sadhana Kala, Best Gynecologist in Delhi.

And when you are in a situation that’s troubling you, causing you discomfort, concern or embarrassment, you should not have to wait and bear. That’s why Dr. (Prof.) Sadhana Kala, Gynecologist in Kalkaji, makes appointments available quickly.

With Dr. (Prof.) Sadhana Kala, Gynecologist in Delhi, much of her attention is dedicated to the increasing medical needs of today’s women to cater the care possible at its best. She caters several Gynecological services through latest techniques and minimally invasive procedures.

With Dr. (Prof.) Sadhana Kala, Gynecologist in Kalkaji, she focuses on care of all women, from the cradle to climacteric, and she is one of the potent and powerful advocates for women’s health. As a highly qualified Gynecologist, she has an energy that is incomparable. She has a compassionate and deep esteem for variant morals, principals, and faiths, yet she works in a seamless way. She realizes that all women have different desires, and we customize the care accordingly.

Dr. (Prof.) Sadhana Kala, Gynecologist in South Delhi, specializes in preventive care and cure. She thinks beyond the patient’s immediate medical requirements by offering holistic and seamless unified care.  She caters comprehensive services under one roof.  As a Specialist, she covers multiple areas, including check-ups, Laparoscopy, Dysfunctional Uterine Bleeding, and Fibroids.

The services range from diagnosis to curing, aiding and even emotional and psychological support. You will feel the Warmth and Care of Dr. (Prof.) Sadhana Kala, Best Gynecologist in South Delhi, Exceptional Care for You and your Baby by her backed by modern, up to the minute equipment.