High Risk Pregnancy

Gestational Diabetes Mellitus (GDM)

We advise OGTT (Oral Glucose Tolerance Test) to each Indian woman in pregnancy, using 75 gram glucose, as per International guidelines, to detect GDM (Gestational Diabetes Mellitus)

In this case, the first OGTT at 10 weeks was normal but OGTT at 24 weeks indicated GDM

Sugar level was controlled with diet, oral medicines with regular check up for blood sugar

Serial ultrasound scan done to check for fetal growth

Delivery done at term, giving steroid injection for lung maturity of the baby

Both mother and baby healthy

After delivery, sugar level came to normal

IVF Pregnancy, Less Movement of the baby, Emergency C Section

Married for 10 years with MALE INFERTILITY

Tried IUI 10 times and IVF 2 times

1st IVF ended in miscarriageSuccessful pregnancy after 2nd IVF

Careful observation done throughout pregnancy with ultrasound monitoring.

An episode of NO FETAL MOVEMENT (FM) at 32 weeks resolved spontaneously with CTG, Doppler scan and perception of FM subsequently.

Delivery was planned at 37 weeks

At 35 weeks, again felt NO FM. CTG was suspicious (as shown in the picture)

We URGENTLY (Midnight) consulted Paediatrician and Anaesthetist and conducted Emergency C-section at 1 AM.

The baby weighing 3.2 Kg was healthy and the mother went home in healthy condition.

Timely decision and watchful observation can save life

Amniocentesis, Growth restriction, Hypothyroid, Repeated Miscarriage

Patient presented to us after first Miscarriage (No heart beat found)

While she was under our care, 2nd pregnancy also ended up in miscarriage

Before further investigations could be taken, she conceived for the 3rd time

After long discussion about merits and demerits, she opted for “EMPIRICAL THERAPY” (medicines with unproven benefits)

After confirmation of heart beat, Empirical therapy* was startedL-Thyroxine was supplemented for subclinical hypothyroidism

Quad Test showed high risk of Down Syndrome, for which AMNIOCENTESIS was advised and the result came as NORMAL

Serial Growth Scans detected FETAL GROWTH RESTRICTION (Inadequate Growth of the baby)

Baby was in BREECH (upside down)Steroid injection was given for lung-maturity of the baby

Healthy Male baby born by C-section at 36 weeks

Bicornuate Uterus, Triplet, Premature Baby, Repeated Miscarriage

35 years old lady with INFERTILITY and 5 REPEATED MISCARRIAGES (3 at 12 weeks, 2 at 18 weeks).

Bicornuate uterus was seen in ultrasound and confirmed by hysteroscopy-laparoscopy.

She was offered operative correction, which she refused.

After explaining risks, she opted for ovulation induction.

After 2nd cycle, she conceived but surprisingly it was TRIPLET (2 in left horn, 1 in right horn).

At 26 weeks, she developed preterm labour and 2 babies were delivered vaginally.

Surprisingly, the 3rd baby in Right horn continued till 35 weeks, when emergency C-section was done because of she had ruptured membranes (PROM).

The 3rd baby was healthy and went home smoothly.

Pic taken during C-section with her kind permission.

Fibroid in Pregnancy, Growth Restriction

24 years old lady from Burdwan, 3 years infertility

All fertility factors normal except MULTIPLE FIBROIDS in UTERUS.

She was advised operation (to remove fibroids) which she refused

Fortunately she conceived naturally within 2 months

Fibroids increased in size in pregnancy but no other problems

From 26 weeks, we suspected INADEQUATE GROWTH of the BABY (by putting hands over abdomen)

Was advised ultrasound scan regularly (Growth scan with colour Doppler) which revealed growth restricted baby

Decided to deliver the baby at 37 weeks after giving steroid injection to promote lung-maturity of the baby

At CS, fibroids were seen and left undisturbed

Baby’s weight 1.8 Kg, cried at birth, was sent to SCBU

Baby had low blood sugar (Hypoglycaemia), well managed at NICU and went home safe

Gestational Diabetes (GDM), Big Baby



This case was diagnosed with GDM at 1st Visit by OGTT

Blood sugar was not controlled with diet and oral medicines,

     so after consulting Diabetologist- Insulin was started

Renal and Retinal Check up was done for the mother

Mother developed high blood pressure (PRE-ECLAMPSIA) which was managed by medicines, monitoring and blood tests regularly

Baby was monitored by Combined test (11-13 weeks), Anomaly Scan (18-20 weeks), Fetal Echocardiography (20-22 weeks) and serial Growth Scans (ultrasound) from 28 weeks as we suspected large baby (MACROSOMIA)

Delivery was done at 37 weeks

Baby weighed 3.9 Kg, suffered from low blood sugar (HYPOGLYCAEMIA) which was well managed at NICU

Baby went home in healthy condition

Mother’s blood sugar came down to normal, soon after delivery

No Fetal Movement, Emergency C Section, Infertility-Pregnancy, Obesity, Hypothyroid


This couple from Barasat, started Infertility Treatment at 2012, after having tried for 1 year

All Fertility Factors of both were normal

They tried Ovulation Induction and IUI several times, which FAILED

They consulted DIFFERENT PLACES, still NO LUCK

They ended their treatment at 2014, feeling FRUSTRATED

In a fine morning in 2016, the woman found herself PREGNANT

It was HIGH RISK PREGNANCY because of OVERWEIGHT and HYPOTHYROIDISM. Proper care was provided, including serial ultrasound scans

AT 32 weeks, she felt NO FETAL MOVEMENT (FM). We took it seriously and offered CTG and Doppler scan, both of which came normal and she felt FM and so was discharged

At 35 weeks she again felt persistent no FM. This time CTG was SUSPICIOUS. Decision for URGENT DELIVERY was taken.

Baby was delivered healthy, CRIED at birth, did NOT require NICU (though we kept it READY)

Placenta Praevia, Emergency C Section, Premature baby, PCOS-Infertility

Couple from Howrah with 7 years long Infertility

It was because of PCOS leading to NO Ovulation. All other factors were normal

Ovulation Induction 8 cycles FAILED and then they opted for IUI

Conceived after 1st CYCLE of IUI SUCCESSFULLY

Pregnancy was HIGH RISK, because of PLACENTA PRAEVIA (Placenta was lying in the lower part of the uterus)

She had several episodes of bleeding throughout pregnancy and needed hospitalization several times, with advice of iron tablets, rest, observation, regular ultrasound and Haemoglobin check up

At 34 weeks, she presented with severe bleeding. Her Haemoglobin was 6 g/dl

To save the life of both, we decided for EMERGENCY C-Section and URGENT arrangement of BLOOD

She needed 3 units of BLOOD TRANSFUSION during and after delivery

Both mother and baby went home within 3 days despite the HIGH RISK FACTORS

Picture of the HAPPY COUPLE at the 4th birthday of their PRECIOUS BABY, when they visited our clinic as a gesture of gratitude

Pic taken with their kind permission

Twin, Premature Babies, Bleeding, IUI

Couple with MALE FACTOR INFERTILITY with SPERM COUNT only 5 million/ml, tested on several occasions

Female factors were all normal

Was advised IVF-ICSI, which they could not afford

IUI with Donor sperms was NOT acceptable to them

After repeated COUNSELING about the HIGH RISK of FAILURE, they opted for “TRIAL” of IUI using HUSBAND’s SPERMS

To our UTTER SURPRISE, she conceived after 1st IUI and it was TWIN PREGNANCY!!!

As Twin is HIGH RISK PREGNANCY, she was thoroughly MONIOTORED throughout

She developed PREMATURE LABOUR at 35 weeks and delivered a MALE and a FEMALE baby, weighing 1.9 Kg and 1.7 Kg respectively

As her haemoglobin was 8 g/dl before delivery and she was at HIGH RISK of BLEEDING, she was transfused one unit of BLOOD at delivery

Thalassaemia Carrier, Repeated Miscarriage

Mother having history of 2 REPEATED MISCARRIAGES, both at 8 weeks

NO CAUSE was identified for the REPEATED MISCARRIAGE

After explanation, she opted for NO EMPIRICAL THERAPY (that means, she refused trying some medicines, which are commonly used to ‘prevent’ miscarriage, but effectiveness is questionable)

She is a known THALASSAEMIA CARRIER with Anaemia

Throughout pregnancy her haemoglobin was carefully monitored and was kept 9.5 g/dl before delivery

She delivered healthy baby at 38 weeks

Though she was at risk of bleeding during delivery, she did NOT require BLOOD TRANSFUSION

Bleeding in Pregnancy, Normal Delivery, Repeated Miscarriage

REPEATED MISCARRIAGE at 1st Trimester, followed by SECONDARY INFERTILITY (Inability to conceive)

Despite thorough Investigations, NO CAUSE was identified for INFERTILITY and REPEATED MISCARRIAGES

Conceived naturally with their patience, faith and perseverance in DIFFICULT TIMES

NO ADDITIONAL MEDICINE was used, except those used in normal pregnancy

Only ‘treatment’ provided was TENDER LOVING CARE (Counselling, Support and Emotional Boosting when one feels FRUSTRATED)

Pregnancy was complicated by off and on bleeding but everything was fine eventually

Normal Vaginal Delivery of a healthy male baby at term

Old Age, Empirical Treatment, Repeated Miscarriage

39 years old lady came with 2 REPEATED MISCARRIAGES (No heart beat of the baby was detected)

NO CAUSE was identified for the REPEATED MISCARRIAGE

After explanation of limited role of treatment options, she opted for EMPIRICAL THERAPY (that means, she agreed to try some medicines, which are commonly used to ‘prevent’ miscarriage, but effectiveness is questionable)

This included progesterone, aspirin and low molecular weight heparin injection

Unfortunately she miscarried 3rd time under our care (initially heart beat was seen but lost subsequently)She kept TRUST on us and conceived 4th time!!!

This time pregnancy continued till term and she delivered a healthy baby

Twin, IVF, Severe Preeclampsia, Premature Babies

38 years old with UNEXPLAINED INFERTILITY of 8 long years

Conceived after 1st cycle of IVF with TWIN PREGNANCY

SEVERELY ANAEMIC (Haemoglobin 7 g/dl before delivery) because of fibroid and piles. Could not tolerate iron tablets

Developed SEVERE PRE-ECLAMPSIA with BP 180/110 mm Hg despite 3 MEDICINES and heavy PROTEIN LOSS in URINE. LIVER and KIDNEY function started to get deranged

Steroid injection was given to promote lung maturity

This HIGH RISK PREGNANCY was discussed with neonatologist and C-section was done at 31 weeks

MALE and FEMALE babies weighing 1100 gram and 900 gram, respectively, were delivered and sent to NICU and finally went home

After delivery mother’s BP was uncontrolled, so was sent to ICU to give MAGNESIUM SULPHATE injection to prevent convulsion and stroke (ECLAMPSIA)

Mother was discharged within 4 days in HEALTHY CONDITION and her BP, liver and kidney became normal within 6 weeks • •

Growth restriction, Severe Hypothyroidism, Thalassaemia Carrier

Mother severely HYPOTHYROID (TSH >100 mU/L), was on L-Thyroxin 150 µg/day around delivery

She is a known case of THALASSAEMIA MINOR (Diagnosed in pregnancy) with severe anaemia (Hb <7 g/dl)

The baby was NOT GROWING WELL inside the uterus, because of FGR (Fetal Growth restriction)

Blood pressure was normal but there was PROTEINURIA (Loss of Protein in Urine). So liver and kidney functions were tested and found normal

Presented to us at 36 weeks 5 days

After giving steroid Injection, we decided to deliver at 37 weeks with NICU Back up and arranging BLOOD

On the day of admission, she felt LESS FETAL MOVEMENT, so prompt CTG was done, which was suspicious, so decided to expedite the delivery

Male Baby, weighing 2 Kg was born, cried at birth, NICU was not required

Both mother and baby went home within 3 days in good health

PCOS, Gestational Diabetes Mellitus (GDM), Large Baby

Patient of PCOS (polycystic ovary syndrome) Having INFERTILITY

In pregnancy, she was diagnosed to have HYPOTHYROIDISM, which was managed with medicines and regular monitoring

Initial blood sugar testing (with 75 gram OGTT- Oral glucose Tolerance Test) was normal but became abnormal at 28 weeks, was diagnosed with GESTATIONAL DIABETES MELLITUS (GDM), controlled with oral medicines and diet

Regular ultrasound was done, which revealed LARGE  BABY (excessive growth)

Admitted at 32 weeks with ABDOMINAL PAIN and was diagnosed to have LIVER DISEASE

At 36 weeks, she BROKE WATER and was admitted.

     Steroid injection was given to promote lung maturity of the baby

She was in ADVANCED LABOUR. We discussed the plan with them and they opted for C-section (as large baby may get injured during vaginal delivery)

C-section was difficult but the mother was fine and blood sugar became normal after delivery, without medicines

Healthy Male Baby weighing 3.2 Kg was delivered, did not require NICU admission and his blood sugar was monitored

Both mother and baby went home within 3 days in good health

IUI Pregnancy, Hypothyroidism

Patient of PCOS (polycystic ovary syndrome) Having INFERTILITY

SPERM PARAMETERS mildly abnormal (abnormal motility)


     (No heart beat seen in USG) due to Chromosomal abnormality of the baby (TRIPLOIDY)

Next time, OPTED FOR IUI, after explaining the success rate

Did not want TUBAL PATENCY TEST (HSG/ HyCoSy) before IUI

Conceived after 1st IUI

Detected with Hypothyroidism, which was managed with medicines and regular monitoring

Successful Pregnancy Outcome

Asthma, O negative Blood Group, Gestational Diabetes Mellitus (GDM)

Patient known ASTHMATIC, controlled on inhaler (as and when required)

In pregnancy, she was found to be HYPOTHYROID, which  was managed with medicines and regular monitoring

Diagnosed by OGTT (75 gram Oral Glucose Tolerance test),  in 1st visit, with to have GESTATIONAL DIABETES MELLITUS  (GDM), controlled with oral medicines, diet, regular monitoring

Blood group “O NEGATIVE”, monitored with ICT (Indirect Coomb’s Test) and 2 doses of Anti-D injection (28, 34 weeks)

Presented at 34 weeks with NO FETAL MOVEMENT, which resolved with reassurance after a normal CTG

PLANNED DELIVERY was decided at 37 weeks with NICU Back up, after giving STEROID INJECTION for lung maturity

Healthy Male Baby was delivered, cried at birth, did not require NICU

Mother’s blood sugar become NORMAL after delivery, without need of medicines

Mother was given Anti-D injection after delivery, as baby’s blood group was POSITIVE (To prevent damage to next pregnancy)

Both mother and baby went home within 3 days in good health

Gestational Diabetes Mellitus (GDM), Obesity, PCOS

Patient with PCOS (Polycystic Ovary Syndrome) with Obesity

Before pregnancy, she was found to be Sub-clinically HYPOTHYROID, which was managed with medicines and regular monitoring

Diagnosed by OGTT (75 gram Oral Glucose Tolerance test), in 1st visit, with to have GESTATIONAL DIABETES MELLITUS  (GDM), which was NOT adequately controlled with diet and was offered Insulin

She refused Insulin, so was advised oral medicines, which controlled blood sugar

PLANNED DELIVERY was decided at 37 weeks with NICU Back up, after giving STEROID INJECTION for lung maturity

Healthy Female Baby was delivered, cried at birth, did not require NICU

Mother’s blood sugar become NORMAL after delivery, without need of medicines

Both mother and baby went home within 3 days in good health

Diabetes, Hypothyroid, Multiple Surgeries, Liver Disease, Hypothyroidism, Thalassaemia Minor, Emergency Delivery

36 years old mother presented in her 2nd pregnancy

She was having DIABETES, that required very high dose of INSULIN and was managed consulting Endocrinologist, checking HbA1C, regular sugar monitoring, kidney and retinal check up, Fetal Echocardiography with Growth Scan (Regular USG)

She was a known case of HYPOTHYROIDISM, that was controlled with medicines and regular check up

She is THALASSAEMIA MINOR with severe ANAEMIA, not responding to oral iron, requiring IRON INJECTION

She had several operations (Gall Bladder, Appendics, INTESTINAL OBSTRUCTION), all putting her at SURGICAL RISK during delivery

In her 1st pregnancy, water broke at 35 weeks, for which C-section was done, resulting in MASSIVE BLEEDING. All these put her at RISK OF RECURRENCE during delivery

She developed severe ITCHING and we diagnosed liver disease after blood test (OBSTETRIC CHOLESTASIS), which was controlled by medicines and regular monitoring

At 28 weeks, she presented with NO FETAL MOVEMENT, which resolved after admission, with normal CTG but USG showed ABNORMAL BLOOD FLOW to the baby

Considering all risks, we planned delivery at 36 weeks

At 34+ weeks, she was admitted with headache and breathlessness, which were managed with medicines and consulting cardiologist. ECG, BP, Echo, urine tests all were normal

STEROID INJECTION was given to promote ling maturity of the baby with blood sugar monitoring (As Steroids increase sugar level)

Suddenly she felt NO FETAL MOVEMENT (On admission), so we decided to deliver her URGENTLY at MIDNIGHT, arranging blood, ICU and NICU Back up

Baby was healthy, cried at birth, did not require NICU

Mother was also fine, without much bleeding, was kept at ICU for Observation for few hours. She did not need Insulin after delivery

Both are fine at 3 months visit

Urinary Tract Infection (UTI) in Pregnancy, Infertility

Everything is POSSIBLE in Fertility Treatment

Couple with Infertility because of  PCOS and problems in Ovulation

Advised Tubal patency tests (HyCoSy) which showed both the Fallopian TUBES were BLOCKED

We discussed with them 2 options 1)Directly IVF 2)Laparoscopy-Hysteroscopy- to confirm/ refute actual block   and to make attempt to open it (“Proximal cannulation”). If that failed, she would  require IVF

They opted for IVF. We started preparing them for it. Before the actual stimulation, pregnancy test was done and surprisingly, it was POSITIVE.

TVS and β-hCG blood test were done to make sure that it was NOT “ectopic pregnancy” (which is a possibility in actual tubal block)

This spontaneous pregnancy was complicated by repeated urinary tract infections (UTI) for which she was put on antibiotics throughout (UTI can affect the growth of the baby)

Healthy baby was delivered at term

Message- Finding a “Bad” result” is NOT the end of the world • •

Advanced Age, Breech, Emergency Delivery, PCOS, Hypothyroidism

35 years old lady with INFERTILITY because of PCOS with Hirsutism (excessive body hair growth) and HYPOTHYROID (taking L-Thyroxine)

Ovulation Induction failed, planning for IVF but conceived spontaneously

From 28 weeks, we suspected INADEQUATE GROWTH of the baby (by putting hand over patients’ abdomen)

Was advised serial ultrasound scans (Growth Scan with Colour Doppler) which revealed GROWTH RESTRICTED BABY

Decided to deliver the baby at 37 weeks, in NICU set up after giving STEROIDS to promote lung maturity of the baby

The baby was in BREECH (Upside Down, with buttock-first instead of usual head-first position)

At 36+ weeks, she suddenly went into PRETERM LABOUR with RUPTURED MEMBRANES and so we decided for EMERGENCY C-Section

Baby’s birth weight was 2.2 Kg, CRIED at birth, 2 loops of cord around neck, was in BREECH, did NOT require NICU admission

Both mother and baby was discharged within 3 days after delivery

B Negative Blood Group, Cholestasis, Growth Restriction, Thalassaemia Carrier, Infertility


All investigations NORMAL except subclinical HYPOTHYROIDISM (On L-Thyroxine before and throughout the Pregnancy)

We diagnosed her having Thalassaemia MinorConceived at 1st cycle of Ovulation Induction (Clomiphene 100 + FSH 75x 2 doses)

B NEGATIVE blood group. So, has been monitored throughout the pregnancy by Indirect Coomb’s Test (ICT) in blood and Anti-D given antenatally

Haemoglobin was checked thoroughly and higher dose of iron given

Developed itching in pregnancy, Liver Function Test (LFT) was abnormal and was diagnosed as “Obstetric Cholestasis”, for which medicines were given and LFT repeated regularly

Growth Scan was advised from 28 weeks

36 weeks scan showed Inadequate Growth of the baby (Fetal Growth Restriction- FGR)

Decision for delivery was taken, giving Steroid Injection for lung maturity of the baby

At 37 weeks, C-section was done in NICU set up, keeping blood in hands for the mother

The couple is now enjoying their parenthood after the struggle

Severe Hypothyroidism in Pregnancy, PCOS

Many people have so many MYTHS, MISCONEPTION and SUPERSTITION associated with PREGNANCY

PCOS lady with spontaneous conception, was on Metformin before pregnancy, which  was continued throughout the pregnancy

SEVERE HYPOTHYROIDISM with TSH >10 and  was controlled only with 175 mcg of  L-Thyroxine daily, after consultation with Endocrinologist

Some people DISCOURAGED her to CONTINUE pregnancy at such uncontrolled TSHWe gave her support and she kept faith on us

Pregnancy was uncomplicated with healthy baby delivered at 38 weeks

Both mother and baby healthy

It’s important to keep trust on the Science, rather than hear-say

Obesity, Hypothyroidism, PCOS, High Blood Pressure

PCOS conceived spontaneously

Subclinical Hypothyroidism, was on L-Thyroxine before and therapy throughout the pregnancy

BP was raised, controlled with medicines

Mother was advised low molecular weight heparin injection after delivery because of obesityBoth mother and baby healthy

Obstetric Cholestasis, Gestational Diabetes

2nd pregnancy, previous one c-section

OGTT done using 75 gram glucose as per International guidelines. 1st OGTT at 12 weeks was normal. 2nd OGTT at 24 weeks revealed GDM (Gestational Diabetes Mellitus)

Sugar level was controlled with diet, oral medicines and finally Insulin, after consulting Diabetologist and dietician- with regular check up for blood sugar

Subclinical Hypothyroidism, was on L-Thyroxine    therapy throughout the pregnancy

Liver function altered with itching (Obstetric Cholestasis)

Serial ultrasound scan done to check for fetal growth

Delivery done at term, giving steroid injection for lung maturity of the baby

Both mother and baby healthy

After delivery, sugar level came to normal

Thalassaemia Minor, Growth Restriction, Obstetric Cholestasis, Hypothyroidism

PCOS, Spontaneous Conception, was on Metformin before and throughout the pregnancy

Thalassaemia Minor, diagnosed, before pregnancy when she came to us

Developed Itching in Pregnancy with abnormal liver function test (Obstetric Cholestasis)

Subclinical Hypothyroidism, was on L-Thyroxine therapy before and throughout the pregnancy

Haemoglobin was low despite high dose iron supplementation

Fetal Growth restriction (FGR) was diagnosed by serial ultrasound scan

Considering such high risk factors, decision to delivery by C-section was taken at 37 weeks, giving steroid injection for baby’s lung maturity, in NICU set up

Both mother and baby healthy

IUI, Triplet, Placenta Praevia, Premature Babies, GDM, Breech, Growth Restriction, Liver Disease, Anaemia

•It’s the perseverance, trust, Confidence and strong Positive Attitude that gave the results.

Couple with 3 years of Infertility.

•Woman having PCOS and the man having some Sexual Dysfunction.

•After discussion of merits and demerits, opted for IUI.

1st IUI cycle FAILED but the woman’s positive attitude persisted and so she camefor 2nd cycle in next month.

•This time urine test was POSITIVE for pregnancy and surprisingly it was TRIPLET baby (2 baby in one sac and another one in separate sac)

•It was VERY HIGH RISK PREGNANCY and so, we offered her SELECTIVE FETAL REDUCTION (converting Triplet to Twin by“killing” the mostly affected baby).

•But we had to respect her choices, as she said “High risk DOES NOT ALWAYS MEAN THAT I WILL HAVE ALL THESE PROBLEMS”.

Pregnancy was complicated by moderate intermittent BLEEDING, Gestational DIABETES (GDM), Obstetric Cholestasis (Abnormal LIVER function), Severe ANAEMIA, LOW LYING Placenta and Inadequate GROWTH of 2 babies.

•She was thoroughly monitored by frequent check up, regular blood tests, 2 weekly ultrasound.

We decided to deliver her at 32weeks after arranging a JOINT MEETING with neonatologist, fetal Medicine specialist and the patient and her husband.

•STEROID injection was given to promote LUNG MATURITY of the BABIES.

•This time also, they held strong positive response, even after explaining the risks and costs.

Suddenly, at 27 weeks her WATER was BROKEN and was hospitalized and decision for delivery was taken after giving ANTIBIOTICS and ARRANGING BLOOD.

All 3 babies cried at birth, weighing1 Kg(Male), 700 gram (Male) and 650 gram (FEMALE).

•Fortunately, the post-operative period was uneventful and she was discharged on 4th day after transfusing 1 unit BLOOD.

•All the babies were promptly shifted to NICU. With proper ventilator support, they gradually improved, started feeding and were discharged one after another.

Now they all have gained proper weight, feeding well.

Previous Baby Died Before Delivery, Thalassaemia Minor, Hypothyroidism

•The Best New Year Gift for this Couple.
They came to us one year ago. Three months prior to that, the lady lost her first pregnancy, because the baby died inside the uterus at 30-week of pregnancy. We provided them TLC (Tender Loving Care).
We explained them that we need to do some tests to find out the cause of fetal death (IUFD- Intrauterine Fetal Death). If any cause would be found, we could take some corrective measures in next pregnancy. However, in 50% cases, no cause of IUFD could be found despite extensive investigations but in that case the chance of recurrence is very rare and we can provide some “Empirical Treatment” (can try some medicines but their effectiveness is questionable, however they are not harmful). Here all investigation reports were normal. We discovered she is beta thalassemia minor (but husband’s test is normal) and hypothyroid (controlled with medicine). 
We asked them to try naturally for 3 months. She conceived soon. We again discussed the merits and demerits of “Empirical Treatment” and they agreed. So, we started Low Dose Aspirin and Low Molecular Weight Heparin Inection. We performed all routine tests like Combined Test, Anomaly Scan, OGTT (Oral Glucose Tolerance Test) etc. These were all normal. As per International Recommendation, we advised serial Growth Scan with Colour Doppler to see baby’s growth and blood flow in different organs. These were normal.
We discussed with them the merits and demerits of Delivery at 37 weeks. They agreed to proceed. The mother was given Steroid Injection to promote the Lung Maturity of the baby.
As per their request, the delivery was done on 1st January 2019 at 7 AM (date and time were decided by the woman). The healthy baby boy was born, cried at birth and was handed to the mother. The mother is also healthy. Today, they are going back home.
Thus, the lady left home for hospitalization in 2018 (31 December) and she is returning home in 2019 with her New Year Gift.
Photo uploaded with her kind Permission

Severe Preeclampsia, Chronic Hypertension, Premature Delivery at Emergency

•PS- Published with kind permission from the patient.
She was referred to us by our Colleague from Chandannagar, as she required delivery at NICU Set Up.
Young lady had Hypertension (high Blood Pressure- BP) diagnosed before pregnancy (“Chronic Hypertension”) but she was not taking medicines properly. She did not visit the Gynaecologist before pregnancy.
She visited the Gynaecologist at 16 week of pregnancy for the first time. The doctor did all the tests (blood, urine, Ultrasound) that are needed in a pregnant woman with high BP and started medicines to lower BP. The diagnosis of Preeclampsia (PE) was made.
Initially everything went well. Baby’s growth was also satisfactory. But from 34 weeks BP started to rise and could not be controlled even with 2 medicines within 2 weeks. So, the doctor, in right manner, gave her Steroid Injection (to promote lung maturity of the baby) and sent the lady to us for urgent delivery in NICU set up, as the baby was premature (36 week).
We examined the lady, checked all previous records, and tested blood for some tests, continued medicines to lower BP and informed our team. Our expert Neonatologist and Anaesthetists (Dr Arun Senapati, Dr Chandan Pal) agreed to deliver the baby at night (11 PM) as EMERGENCY, after explanation of high risk for mother and baby. We booked beds in ICU for the mother and in NICU for the baby.
Delivery was done by Caesarean Section. There was increased bleeding which was managed by injection. 
The baby had breathing troubles, so was sent to SCBU. Baby was taken care of by our expert Neonatologist Dr Lokesh Pande and then shifted to the ward after 2 days. However, NICU was not needed.
However, mother’s BP was still uncontrolled. So we administered Injection Magnesium Sulphate to reduce the risk of Eclampsia. (Eclampsia carries high risk of maternal mortality). Antihypertensive was added and Medicine Specialist was consulted. However, there was no other symptoms for severe Preeclampsia. 
Now mother and baby both are discharged in stable condition.

Hypothyroid, PCOS- Pregnancy

•They came to us with inability to conceive. They tried many medicines and even IUI. We found all tests normal except PCOS (Polycystic Ovary Syndrome). 
We gave them time to decide. They returned after a year and requested Ovulation Induction (Medicines to help the eggs grow). We advised medicines and TVS Follicular Scan (to see if eggs were growing after taking the medicine). There was no result after 2 months. But in the 3rd month, they conceived.
Pregnancy was largely uneventful. All tests were normal. She was Hypothyroid, but it was well controlled with medicine. 
Finally both the mother and baby are healthy.

Growth Restriction, Hypothyroid, Infertility-Conception

•They came to us in December 2017 with Inability to conceive. The woman had PCOS. The man had mild problems in Sperm Motility. All other reports were normal.
The woman had Hypothyroidism, which was well controlled with Medicine.
They agreed to try Ovulation Induction (medicines to help the eggs grow) for 2-3 months. We performed TVS Follicular Scan to see if eggs were growing after taking the medicines. Fortunately they conceived after 1st month of taking the medicine.
Pregnancy was largely uncomplicated. All the reports were normal, like Combined Test, Anomaly scsn etc.
As she was at risk of FGR (Fetal Growth Restriction) or IUGR (Intrauterine Growth Restriction), we advised them Growth scan with Colour Doppler from 28 week. The result at 28 and 32 week were normal. However, the report at 36 week shower FGR with abnormal blood flow to the baby.
FGR carries the risk to the baby before birth (sudden death) and also after birth (low blood sugar, breathing problems, feeding troubles, infection, jaundice, NICU admission etc). So we decide to deliver the baby at NICU set up, after giving Steroids injection to the mother (for lung maturity of the baby).
Delivery was done. Mother has no problem. We advised her Low Molecular Weight to reduce her risk of Thrombosis (as she is overweight).
The baby was initially alright but subsequently his blood sugar fell down and he could not take milk properly. So he was admitted to NICU, but after everything was controlled, he had been sent to the mother.
Now mother and baby both are doing fine.

Obesity, Hypothyroid, PCOS-Pregnancy, Amniocentesis, Growth Restriction

•They came to us in May 2017 for the first time with difficulty in conceiving. All the reports were normal except that the lady had irregular cycles for PCOS, because of which she did not have “OVULATION” (eggs were not growing and getting ruptured).
Additionally she was suffering from hypothyroidism, for which L Thyroxine supplementation was started.
She was also overweight. So we advised Weight Reduction.
Finally they agreed to have “OVULATION INDUCTION” (OI) with oral tablet Letrozole. In the first month, we monitored her with TVS Follicular scan to confirm if Letrozole was able to start Ovulation. When it was confirmed, we advised them to try this medicine at home for another 2 months. At the end of 2 months she felt frustrated as there was no pregnancy. But in next month she got the good news.
However, it was HIGH RISK PREGNANCY, because of PCOS, Hypothyroidism and Obesity. We performed screening for GDM (Gestational Diabetes Mellitus) using 75 gram glucose for OGTT (Oral Glucose Tolerance Test), because she was at risk of GDM. However, it was normal.
She was at risk of Preeclampsia (high Blood Pressure and loss of Protein in urine), so we advised low dose ASPIRIN tablet with regular blood pressure monitoring. It was also normal.
Thyroid was well controlled with medicine.
The First Trimester Test (Combined Test) showed high risk for Down Syndrome (Chromosomal Abnormality and Mentally Challenged child). So we advised Amniocentesis (collecting fluid from mother’s uterus, around the baby, which is Amniotic Fluid) to confirm the suspicion, after explaining all risks and benefits. Amniocentesis was done and the result was NORMAL. 
The Anomaly Scan was normal. Because of Obesity, she was at risk of IUGR (Intrauterine Growth Restriction), restricted growth of the baby. So we advised Regular Growth Scan , which revealed IUGR. However baby’s blood flow was normal.
So we gave her Steroid Injection to promote lung development of the baby and decided to deliver at 37 werk at NICU Set Up.
The delivery was done. Both mother and baby are healthy now. Because of weight, we advised her injection Low Molecular Weight Heparin (LMWH) to reduce the risk of blood clotting (Thrombosis).
We are grateful to them for keeping faith on us throughout their struggle.

Pregnancy at advanced age, Overweight, Hypertension, Gall Bladder Stone

•Successful result in High Risk Pregnancy is possible if proper care is provided.
This lady is 37 year-old in her 1st Pregnancy. She conceived naturally and came to us after getting pregnant. Pregnancy at age more than 35 years, can carry high risk for mother (high BP, diabetes, clotting of blood- Thrombosis, Bleeding and even life risk) and for baby (miscarriage, birth defects, sudden death, i adequate growth, delivery before time etc).
Before pregnancy, she was on medicines for high Blood Pressure (HYPERTENSION). However, during pregnancy, her BP was well controlled, albeit on higher side, but did NOT need any medicine to lower BP. However, we evaluated her fully to find out the cause of Hypertension, by Cardiology Consultation, ECG, Echocardiography, Urine test for Protein and regular blood tests. She was advised to check her BP at home regularly.
She is overweight. It carries the risk for mother (high BP, diabetes, Thrombosis, delivery problems and life risk) and baby (Miscarriage, birth defect, sudden death, inadequate growth, excessive growth and low birthweight)
Having previous Hypertension, advanced age and increased weight, she was at risk of Preeclampsia (a Life threatening disease in pregnancy with high BP and loss of protein in urine, which can harm baby and can damage mother’s heart, lungs, kidneys, liver, brain etc). So as per International Guidelines, we started Tablet ASPIRIN at low dose to reduce the risk of Preeclampsia.
We performed all investigations performed in all pregnant women. These include blood tests for complete blood count, blood sugar (after taking 75 gram glucose), blood group, Thalassemia screening, Thyroid, HIV, Hepatitis B and Hepatitis C etc, and also Urine for routine tests and culture. Combined test was done at 12 weeks to determine the risks of abnormalities in the baby and Anomaly scan was done at 20 weeks to determine if all organs of the baby were well developed. Additionally, as she was at risk of inadequate growth of the baby, Serial Growth Scan with Colour Doppler was performed from 28 weeks, regularly.
However, she required Hospital Admission two times on Emergency basis (one episode at night and another during Puja) for headache, vomiting, breathing problems, problem in vision and pain in upper abdomen. We take these problems SERIOUSLY, because these may indicate SEVERE PREECLAMPSIA (that may be life threatening). Some tests were done after admission. Fortunately all reportss were normal, except liver function test was abnormal (enzymes elevated) and a small (5 mm) stone was noted inside the Gall Bladder. However, these problems subsided with medicines.
Considering all risk factors, we decided to deliver her at 37 weeks in NICU set up. She was given injection Steroid to improve the lung maturity of the baby. She could not tolerate iron tablets in pregnancy, so haemoglobin was slightly low. However, she did not receive any blood transfusion. Now mother and baby both are healthy.

IUI, Triplet to Twin

•They came to us in May 2017 with inability to conceive for 2 years. They did some tests outside and these were normal. We carried out rest of the tests and all were normal. So it was “UNEXPLAINED INFERTILITY”.
After discussing the merits and demerits of different treatment options, they agreed to try medicines for 3 months. We gave Tablet Clomiphene Citrate (CC) for 3 months and performed TVS follicular scan in 1st month to confirm that CC was working (eggs were growing with CC).
Unfortunately they did not conceive within 3 months. They wanted to proceed for IUI (Intra-Uterine Insemination) for 3 to 4 times after discussion of the pros and cons. IUI was done using CC and Injection. In the 1st cycle, 3 follicles were growing.
We gave them 2 options- (1) proceeding for IUI , that carries the risk of multiple pregnancy (Twin, Triplet), or (2) cancelling the IUI that time. They were eager to conceive, so they opted for option (1).
IUI was done and they conceived after the 1st IUI. But as expected, it was TRIPLET pregnancy. Again we discussed 2 options- (1) to continue as Triplet that carries higher risk to mother and babies, or (2) to convert Triplet into Twin by “damaging” one baby, called “SELECTIVE FETAL REDUCTION”, that carries small risk of losing all the 3 babies. They decided for the 2nd option. Fetal Reduction was done around 14 weeks, after NT scan by an Expert Fetal Medicine Specialist. The procedure was uneventful.
The rest of the pregnancy was uncomplicated, except she continued Thyroid medicine for Hypothyroidism. However, she required extra visits and more frequent scans to see if all the babies were OK. 
Finally, decision for delivery was taken after Steroid Injection for promoting Lung Maturity if the babies. Delivery was done by Caesarean Section as both babies were in Breech (Upside down, head up, bottom below) in NICU set up. As per their request, her husband was allowed to stay inside the Operation Theatre at the time of Delivery.
Both babies cried at birth, one male and one female weighing 2.3 and 2.1 Kg respectively. None of them required NICU Admission. Mother is also healthy.
We are grateful to this couple for keeping faith on us throughout their journey from the beginning till delivery.
PS- Picture taken with kind permission from the Mother.

Gestational Diabetes, PCOS, Infertility

•The young couple visited to us in July 2017 with Infertility. The lady had PCOS (Polycystic Ovary Syndrome). She tried Letrozole tablets for Ovulation Induction outside, before coming to us but did not respond to that medicine.
The man had mild problem in sperm motility. The rest of the tests were normal.
So, after discussion with us, they planned for 3 cycles of Ovulation Induction with oral medicine , Clomiphene Citrate (CC). TVS follicular scan was done in the 1st month, that diagnosed ovulation (thus she was responding to CC).
Finally, she conceived within 3 months of treatment with oral medicine. They kept their faith on us throughout the journey in pregnancy. Like other pregnant woman, all routine tests were done including Combined Test in 1st Trimester and Anomaly scan.
Indian women are at risk of GDM (Gestational Diabetes Mellitus), especially those with PCOS. Therefore, following International Recommendation, we perform OGTT (Oral Glucose Tolerance Test) using 75 gram glucose in early pregnancy for ALL women.
In this lady, the value of OGTT was higher and so we diagnosed GDM. The disease was controlled with diet and medicine. Blood test for HbA1c, Retinal check up, kidney function test, Echocardiography of the baby and Growth scan were all done along with regular monitoring of blood sugar.
Steroid Injection was given to the mother to promote lung maturity of the baby. Delivery was done at 38 weeks. Baby is healthy, weighing 2.78 kg. Mother is also doing well and blood sugar is now normal.
Thus PCOS needs proper care before and during pregnancy.

Gestational Diabetes Mellitus (GDM), PCOS, IUI-Pregnancy

•You have to have faith on yourselves.
This couple came to us in early 2017. The woman was having PCOS (Polycystic Ovary Syndrome).
After reviewing all reports we advised Ovulation Induction (OI) with different medicines and injections. However all failed to give pregnancy.
We are thankful to this couple as they bore with us when we had problems with TVS monitoring (machine disturbance, change of place and emergency problem from our part).
Finally they decided for 2 cycles of IUI, failing which they would go for IVF.
IUI 1st cycle done at December 2017 but it failed. They did not give up. They opted for 2bd cycle IUI in January 2018 and it becomes positive.
Like before, they kept trust on us throughout the pregnancy. The woman developed Gestational Diabetes Mellitus (GDM) which was controlled with medicine and dietary restrictions. GDM was diagnosed according to DIPSI Guidelines using 75 gram glucose tolerance test. Retinal check up, kidney function test, HbA1c testing, Regular monitoring of blood sugar, Echocardiography of the baby and Growth scan were all done, apart from routinely advised first trimester screening and Anomaly Scan.
After discussion with them, decision for delivery was taken. Steroid injection was given for lung maturity of the baby. Delivery was done at 38 weeks at NICU Set up. Healthy baby cried at birth, weighing 2.74 Kg and did not require NICU Admission.
The family is ready to welcome their new member with great pride.

Thalassaemia Carrier, Gestational Diabetes

•Successful outcome after diagnosis of Thalassemia Minor and Gestational Diabetes Mellitus (GDM) in 1st Pregnancy.
The mother came to us for the first time at around 16 weeks of pregnancy.
Ideally screening for Chromosomal Abnormalities of the baby should be done by 11-13 weeks by COMBINED TEST. However, that test was not done here. So we advised Quadruple Test to look for Chromosomal Abnormalities. It turned out to be normal.
Ideally Thalassemia Screening should be done before planning pregnancy. In this case we did it around 17 weeks and surprisingly it cane out as Thalassemia Minor (CARRIER). So the couple was in stress. However, husband’s blood test came as normal. So no further intervention was needed.
Indian Women are at higher risk of developing GDM. So screening fir GDM should be done with 75 gram oral glucose tolerance test (OGTT) at first booking and again at 24 weeks. Undiagnosed and untreated GDM can cause sudden death if the baby before delivery and also problems after birth. Mother is at high risk if developing Diabetes in later life. In this case we could perform the test only around 24 weeks. The diagnosis of GDM was done. Simple dietary measures and oral medicine were sufficient to control the sugar.
Finally delivery was done and both mother and baby are doing well.
Thus, you need proper screening in each Pregnancy as per the Latest Guidelines.

Challenging Caesarean Section

•Pregnancy is sometimes very much unpredictable.
This woman conceived spontaneously while she was abroad. She came to us last week with ultrasound report showing Fetal Growth Restriction (FGR). We planned for delivery by 37 weeks.
Yesterday (11.06.2018) she presented as EMERGENCY with labour pain at 6 PM. We decided to proceed for Emergency Caesarean Section at 9 PM. It was at 35 weeks.
As per our protocol, husband was allowed inside the theatre during C Section. Baby was delivered, with reduced water (liquor).

The delivery was EXTREMELY DIFFICULT for abnormally shaped uterus.
The stitching of the uterus was far more DIFFICULT. It took unusually longer time to complete the operation.
The posterior area of uterus showed SEVERE ENDOMETRIOSIS that started to bleed profusely and was managed by different techniques. 
The relationship between two Fallopian tubes and the ovaries were extremely distorted and even we could not understand where the tubes were actually.
Usually these patients need IVF for conception.
But it is beyond our knowledge how did she conceive spontaneously.
Finally mother and baby are doing well.
Thus pregnancy is an enigma. We don’t know why the couples with all factors normal, fail to conceive. On the other hand couples with very bad results conceive without any treatment.

Amniocentesis, Growth restricted Baby, Hypothyroid, Thalassaemia carrier, OHSS, PCOS-Pregnancy

•Published with kind written consent from the patient.

Infertility and High Risk Pregnancy gi hand in hand.

She is having PCOS, in 1st cycle with 100 mg Clomiphene Citrate (CC), she had OHSS (Ovarian Hyperstimulation Syndrome- where ovaries respond in unusual excessive manner to the medicines given for increasing the chance of rupture of the eggs). That cycle was cancelled and they were asked to abstain from sexual intercourse.

Next cycle she was given 50 mg CC. This time again she had OHSS. We offered her conversion to IVF but she could not afford.
Surprisingly she conceived and it was single tone pregnancy (we were apprehensive that there may be twin or triplet).
She is beta thalassaemia carrier (but husband normal), so she had severe Anaemia in pregnancy.
She is hypothyroid and was on replacement with L Thyroxine throughout the pregnancy.
First trimester screening (combined test) showed High Risk for Down Syndrome, so Amniocentesis was done and fortunately the report came as normal.
By 28 weeks she developed intense itching all over the body, and after blood test, was diagnosed to have Obstetric Cholestasis.
Serial Growth Scan revealed FGR (Fetal Growth Restriction).
Steroid was given to promote lung maturity of the baby and delivery was done at 36 weeks with NICU backup , keeping one unit of blood in hand.
Baby boy weighing 2 kg was delivered and cried at birth, did not require NICU.
One unit blood was transfused.
Finally we see her smiling face. •

Fibroid in Pregnancy, Infertility, Gestational Diabetes Mellitus (GDM), Growth Restricted Baby, Hypothyroid

•Fibroid always DOES NOT NEED REMOVAL.
Patient presented with Infertility because of PCOS in 2016. We advised weight reduction and offered investigation.
All tests were normal except polycystic ovaries and multiple FIBROIDS in uterus.
We advised her try for natural conception first.
She could not come for follow up because of personal and career commitment..
However, all of a sudden she visited to us in 2017 with positive pregnancy test.
Her Fibroids increased in size tremendously causing severe pain (relieved by frequent use of injection and advice for hospitalization).
Additionally, her vaby did not grow well (FETAL GROWTH RESTRICTION- FGR) for which serial ultrasound monitoring was done.
Baby was also in BREECH (upside down, buttock first and head higher).
After testing for OGTT with 75 gram glucose, she was found to have GDM (Gestational Diabetes Mellitus) which was controlled with oral medicines and diet.
She was also hypothyroid taking medicine.
Considering all high risk we planned for C section at 36 weeks with consent that she might need MYOMECTOMY (Fibroid Removal) during C Section and blood in hand. Steroid was given to promote lung maturity of the baby.
However, we managed to deliver the baby without disturbing the Fibroids. Blood was NOT transfused. 
A very cute female baby weighing 2 Kg was delivered and sent to SCBU for initial breathing troubles. However she was alright within 24 hours and was sent to ward with mother.
Both are healthy with mother’s blood sugar being normal after delivery.
PS- Taken with kind permission from the patient.

Obesity, Repeated Miscarriage, Infertility

•Infertility with Recurrent Miscarriage

Patient presented to us with previous 2 early miscarriage (no heart beat seen) followed by secondary Infertility.
All investigations were normal (hormones, ultrasound, tubes, semen). Regarding Miscarriage- karyotype, Anti Phospho lipid antibody, 3D ultrasound all were normal.
She was obese with hypothyroid.
As a treatment of “UNEXPLAINED INFERTILITY” she received several cycles.
The Recurrent Miscarriage was also UNEXPLAINED.
We discussed with her next treatment plan. She tried to wait and fortunately conceived within 3 months SPONTANEOUSLY.
Regarding UNEXPLAINED REPEATED MISCARRIAGE, we discussed with her treatment options and their limitations and lack of GUARUNTEE that these treatment are 100% effective. She opted for these treatment as a last resort. We repeatedly explained that all these treatment may fail and without medicine successful outcome can happen.
1. Hydroxyprogesterone caproate inj (500) twice weekly till 20 weeks
2. Natural micronized progesterone gel once daily till 30 weeks
3. Inj hCG (5000) twice weekly till 12 weeks
4. Inj Enoxaparin (40) daily till delivery
5. Inj IgG once in 3 weeks till 18 weeks
6. Tab dydrogesterone 20 mg/day till 20 weeks
7. Aspirin 75 mg/day till one week before delivery.
We planned for delivery at 37 weeks. But suddenly she went into labour and the liquor was MECONIUM STAINED (baby passed stool and was distressed before delivery). So decision for Emergency C Section was taken.
She delivered a healthy Male Baby last night.
A mother’s smile with her baby in her lap is just DIVINE.


Obesity, fetal Growth restriction, Gestational Diabetes Mellitus (GDM)

•Obese lady has been diagnosed with GDM (GESTATIONAL DIABETES MELLITUS) by OGTT (with 75 gram glucose) done in early pregnancy as per International Recommendation.
Sugar was controlled with oral tablet (Metformin), regular sugar check , dietary restrictions and consultation with Endocrinologist.
Serial GROWTH SCAN with COLOUR DOPPLER Was advised, every 2 weeks, which detected Inadequate Growth of the baby, FGR (FETAL GROWTH RESTRICTION).
As the growth was slow over last 3 scans , we discussed with the woman, about the need of early delivery.
Steroid injection was given to promote lung maturity. As steroids increase blood sugar level, she was put on Sliding scale of Insulin. 
C section was done at 36 weeks at NICU set up. Healthy baby cried at birth, weighing 2.4 kg. He was kept in SCBU for 24 hours for observation, then sent to the mother.
Mother’s blood sugar became normal after delivery without need of medicine. She was put on Enoxaparin Injection for prevention of thrombosis.

IUGR (Intrauterine Growth Restriction), Thalassaemia Minor

•Thalassaemia Screening should be done before pregnancy or in early pregnancy to prevent the thalassaemia in the baby.

•She came in her first pregnancy

•We tested and found that she was thalassaemia carrier •Husband’s blood test was normal

•She had anaemia in pregnancy and required blood transfusion after delivery

•Serial Growth Scan revealed IUGR. Steroid Injection was given to promote the lung maturity of the baby.

•Delivery was done at 37 weeks in NICU set up

•Healthy baby cried at birth

•Both mother and baby were discharged at stable condition

Hypothyroidism in Pregnancy

•Testing for Thyroid (TSH) should be done in early pregnancy

•If TSH is more than 2.5 IU/ml, it should be suppressed with L-Thyroxine

•She came to us in first pregnancy

•L-Thyroxine Supplementation was done and TSH was well controlled

•Delivery was done at 37 weeks

•Baby had low blood sugar (Hypoglycaemia) after delivery, which was managed in SCBU •Finally both mother and baby are doing well

ITP in Pregnancy, No Blood Transfusion

•She came to us in first pregnancy

•Before pregnancy she was absolutely healthy

•In pregnancy blood test revealed that she had ITP (Immune Thrombocytopaenic Purpura), that is the low platelet count but the cause remained unknown

•However, she did not have single episode of bleeding in pregnancy

•After discussion with Haematologist she was advised oral steroid and injection IgG to improve the platelet count

•No platelet transfusion was needed

•Blood sugar and BP monitoring were done to see if there was any side effect of steroid therapy

•Caesarean Section was done at 37 weeks. Mother did not require any platelet or blood transfusion

•Baby  had low platelet count after delivery, which was well managed by the paediatrician

•Now mother and baby both are healthy

Thyroid Disorder in Pregnancy

•Testing for Thyroid (TSH) should be done in early pregnancy

•If TSH is more than 2.5 IU/ml, it should be suppressed with L-Thyroxine

•She came to us in first pregnancy

•L-Thyroxine Supplementation was done and TSH was well controlled

•Delivery was done at 38 weeks

•Finally both mother and baby are doing well •

Gestational Diabetes Mellitus (GDM), Obstetric Cholestasis

•In her first pregnancy she had abnormal results in OGTT (Oral Glucose Tolerance test). So we diagnosed GDM

•GDM was well controlled with diet, oral medicine with regular monitoring

•At 34 weeks, she developed itching in whole body. Liver Function Test (LFT) revealed Obstetric Cholestasis, which is a potentially life-threatening condition for the baby

•Steroid injection was given to the mother to promote the lung maturity of the baby.

•Delivery was done at 37 weeks

•Mother’s blood sugar was well controlled after delivery •Now both mother and baby are doing well

Obesity, Hypothyroidism, Negative Blood Group, Infertility

•They were trying for pregnancy for two years. They tried ovulation induction with oral medicines for several cycles

•We found all investigations normal, except PCOS

•We gave them ovulation induction with injectables. These failed. She was planning for IUI. In the meantime she conceived naturally.

•Her blood group was negative, so serial blood test for ICT (Indirect Coombs Test) was done to see if baby was affected or not. ICT was normal

•Thyroid problem was well controlled with medicines

•Delivery was done successfully. Baby is doing well

•Mother was advised heparin injection after delivery to prevent thrombosis (as she was overweight)

Twin, Preterm Delivery at 28 weeks, Infertility

•Their first pregnancy ended in miscarriage after a trauma

•Then they could not conceive but all reports were normal

•She conceived spontaneously with twin

•At 28 weeks, she went into preterm labour and delivered the babies

•Unfortunately one baby dies because of infection

•The other baby was taken care in NICU

•Now both the mother and baby are doing well •

Breech, Gestational Diabetes Mellitus (GDM)



This case was diagnosed with GDM at 1st Visit by OGTT

Blood sugar was controlled with diet and oral medicines

Baby was monitored by Combined test (11-13 weeks), Anomaly Scan (18-20 weeks), Fetal Echocardiography (20-22 weeks)

Baby was in BREECH (Upside Down- head high, buttock below)

Developed preterm labour at 36 weeks, so C-section was done

Baby, weighing 3.1 Kg went home in healthy condition

Mother’s blood sugar came down to normal, soon after delivery

Successful Delivery in Diabetes in Pregnancy

This lady came to us in her 4th pregnancy. All previous pregnancies were uncomplicated and there were normal delivery. Her age is 36 years. We performed OGTT and diagnosed GDM. It was well controlled with diet and oral medicines. All tests like Combined test, Anomaly Scan, Fetal Echocardiography, Growth Scan were done. Steroid was given. But as the baby’s weight was larger, delivery was done by Caesarean Section at NICU set up. Baby’s birth weight 3.6 kg, but did not require NICU. Now mother and baby both are healthy.

Uploaded with kind permission

PCOS, Hypothyroid, Infertility-Conception

The couple came to us with PCOS. They wanted OI. We started Letrozole. In the first cycle TVS confirmed Ovulation. They conceived after 3rd month. She was hypothyroid, which was controlled with medicine. Age delivered the baby at 37 weeks

Successful Pregnancy at high age, GDM, Infertility

Image may contain: 1 person, baby and closeup

Self Insemination can give successful pregnancy in Sexual Dysfunction.
PS- Uploaded with kind permission.
The couple came to us in June 2017 with Non-Consummation of Marriage. The husband’s age was 43, wife’s age was 38. The man had Erectile Dysfunction (ED).
After initial examinations and investigations, no apparent cause for the ED was found. We tried all possible medicines at the highest possible doses but unfortunately, nothing worked for him. Finally, we advised Penile Doppler (to see blood flow in the Penis by ultrasound, after Papaverine Injection into the Penis). It showed abnormal blood flow to the penis. So, only options remaining were vascular surgery or Vacuum Erection Device (VED).
The couple decided to think for pregnancy first, as the lady was already 38 years old. We performed initial investigations like Semen Analysis, AMH, Rubella and Thalassemia screening. All were normal
We explained the possible complications of Pregnancy for the mother and baby because of the age. They agreed to take the risks.

They wanted to proceed for IUI (Intrauterine Insemination). We explained, IUI is a medical procedure, so if they wish a d feel comfortable, they can try Self Vaginal Insemination for 2 to 3 months. If this failed, IUI could be considered.
We explained them how to do Self Insemination. The lady was asked to detect the timing of Ovulation (Release of eggs) by Urine test, done at home, using LH kit. The husband was asked to collect his semen in a sterile container and put it inside the vagina by dropper. All these were done at home by themselves. No medicines, apart from Folic Acid was advised. This is, because, we believe in the least possible number of investigations, the least possible use of medicines and the least possible medical interventions.

They returned after 2 months with POSITIVE Pregnancy Test. Because of the age, it was High Risk Pregnancy. We performed all the routine tests like Combined Test, Anomaly Scan etc.
South Asian Women are at risk of GDM (Gestational Diabetes Mellitus). GDM carries high risk of DEATH of the baby, before birth. It should be detected by a test called OGTT (using 75 gram Glucose), NOT by Ordinary Fasting Sugar or PP Sugar. Here the initial OGTT was normal. But OGTT at 28 weeks was abnormal. So, she developed GDM, which was well controlled with diet and oral medicine only (Without Insulin).
Because if her age, first pregnancy and being overweight; the baby was at risk of developing IUGR (Intrauterine Growth Restriction)- the inadequate growth of the baby. It should be detected by Serial Growth Scan and Colour Doppler. We performed this and detected IUGR at 34 weeks, along with decreased Liquor (water around the baby). IUGR babies are at risk of serious complications before and after birth. So, we gave her Steroid Injection (to promote lung maturity of the baby) and decided for delivery at 37 weeks at NICU set up.
Delivery was done by Caesarean Section. Both mother and baby are healthy now.
1. Sexual Dysfunction is common but Pregnancy is Possible.
2. Self Insemination can give pregnancy without any Medical Intervention.
3. Higher age does not always need any treatment to achieve pregnancy.
4. Pregnancy at high age is High Risk Pregnancy and needs proper care.
5. Screening for GDM should be done by OGTT twice in pregnancy.
6. IUGR should be diagnosed by growth scan.
7. Delivery should be done in NICU Set Up.