Dr Anjali Kumar is a renowned obstetrician & gynecologist as well as a trained advanced robotic surgeon with over 33 years of experience in her field. She is counted amongst some of the most experienced obstetricians, gynaecologists, and robotic surgeons in Delhi NCR.
She even has the unique distinction of having a technique named after her (the ‘Kumar’s Technique’ – ‘Reverse Uterine Closure Technique’). It is used for suturing the very thin lower uterine segment in previous LSCS patients. This technique was presented, published and accepted at the apex national and international conferences – AICOG 2015 and FIGO -Vancouver 2015.
She specialises in performing advanced gynaecological endoscopic and robotic procedures including operative laparoscopy and hysteroscopy and is known for her successful treatments of patients, both in the country as well as abroad.
Dr Kumar also initiated the concept of “Natural Childbirth Oriented Pregnancy Care” in and around NCR. She was the first one to start patient educational programs and labour preparation antenatal classes for expectant couples in Gurgaon. She has developed patient strategies and labour protocols to increase normal delivery rates and decrease caesarean/ instrumental deliveries. She routinely encourages and focuses on VBACs (vaginal births after caesarean) cases.
She is also seen on various television talk shows. She also features numerous columns on gynaecology related issues in leading newspapers, magazines and web portals. Her book “I am Blessed” has touched countless expectant couples all around. She is also the founder of an educative digital platform on woman’s health called “ MAITRI “
MAITRI is also part of prestigious WHO FIDES group, a group of verified healthcare information provider.
What causes painful periods and how can you reduce the pain?
Did you know the medical term for menstrual cramps is “Dysmenorrhea”? Almost every woman can vouch to have experienced menstrual cramps severe enough to need medication. In reality, periods may be a permanent part of our lives, the severe pain associated with periods, on the other hand, need not be. The lack of awareness added to the social stigma associated with menstruation contributes to millions of women suffering silently from period pain. In this article, Dr Anjali Kumar, reputed obstetrician and gynaecologist in Delhi NCR talks about painful periods, its possible causes and preventive measures.
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Before we understand why periods can cause extreme pain in some women, let us understand what happens in the body during this process.
Every month, the female body prepares itself for pregnancy by building up the uterine lining. When the matured egg released by the ovaries every month is not fertilised, the body starts shedding this excess uterine lining resulting in “periods”. In order to push out the excess lining from the vagina, the uterine muscles contract and relax. This may result in severe muscle cramps for some women, and be barely noticeable in others.
Period pain need not be limited to the abdomen, it can also manifest as pain in the back, legs, thighs etc. It can also cause nausea, vomiting and diarrhoea.
Did you know that there are two different types of period pain? Doctors classify dysmenorrhoea (period pain) into two main categories:
Primary dysmenorrhoea is pain that is mainly caused by the uterine muscle contractions. It is more common in women under the age of 30 years and women who experience heavy periods.
Secondary dysmenorrhoea is pain that is caused by factors other than muscle contractions. It can be due to benign growths in the uterus such as fibroids. It can also be due to conditions such as endometriosis.
As highlighted above, period pain develops majorly due to muscle contractions in the uterus. These contractions are triggered by hormone-like substances called prostaglandins. Higher levels of prostaglandins are associated with more severe menstrual cramps. They can be caused by:
Endometriosis: A condition where the endometrial lining (lining of the uterus) grows outside the uterus, usually on the fallopian tubes, ovaries etc.
Uterine fibroids: Uterine fibroids are benign (non-cancerous) growths in the wall of the uterus
Adenomyosis: Adenomyosis is a painful condition where the uterine lining grows into the muscular wall of the uterus
Pelvic inflammatory disease: PID is an infection of one or more of the upper reproductive organs such as the uterus, ovaries or fallopian tubes. It can spread through sexual intercourse.
Cervical stenosis: Is a condition where the cervical opening is too small causing issues in regular menstrual flow. This results in a painful increase in pressure inside the uterus.
Painful periods can also be the result of several other underlying conditions. Your gynaecologist can help in identifying the root cause of the pain for a more effective treatment plan.
Also, read: Answers to Some Common Questions about Endometriosis
It is still unclear why some women have extremely painful periods while some experience no discomfort at all. Some of the risk factors of painful periods are:
If you experience extremely severe pain every month that impacts your daily life, your doctor can recommend any of the following treatment options:
This is the first line of defence against painful periods. Over the counter pain medications can be used to manage mild to moderate period pain. If required, your gynaecologist may also prescribe stronger pain killers.
In some cases, gynaecologists might recommend the use of hormonal birth control to prevent ovulation and reduce the severity of period pains. They should be used only if recommended. These medications also have several side effects, so make sure you are aware of them before you start taking them.
If your period pains are caused due to conditions such as endometriosis, your gynaecologist might recommend a surgery to treat the underlying condition. In some cases, hysterectomy (surgically removing the uterus) might also be done. However, this is the last resort.
If you believe that your pain is not severe enough to warrant a trip to the hospital, the following tips can help you relive some of the pain at home itself.
Apply a hot water bag or warm compress to your lower abdomen and back. You can even take a long hot water bath. This will help in relaxing your uterine muscles, giving you much needed relief from the pain.
While the dull ache in our muscles during our periods can make exercising tougher, physical activity is a proven solution for period cramps. Light exercise such as walking has been shown to reduce the intensity of period pains in some women. Yoga also has several exercises which are designed to relax the uterine muscles and reduce period pain.
Drink a lot of water and keep yourself hydrated during your periods for a smoother and less painful cycle.
While there is insufficient evidence to show the link between period cramps and diet, eating a balanced diet rich in vitamins and fibre such as lean meat, fresh fruit, green vegetables and whole grains, has shown to have a positive impact on our menstrual health.
Even today, there is a lot of stigma around menstruation and periods. There have also been several initiatives that started to address the problems caused by period pains such as corporates recognising “period leaves” every month. However, there is a long way to go in increasing awareness about menstrual cramps and pain. To know more about how to have a pain-free and smooth menstrual cycle, you can consult Dr Anjali Kumar at the CK Birla Hospital, Gurgaon.
Book an appointment with Dr Anjali Kumar.
Also, read: Lifestyle and diet tips for PMS
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Vaginal birth after caesarean (VBAC) | 5 things you should know
Earlier women who delivered via a cesarean section had no other option other than opting for a cesarean section for all subsequent pregnancies. Today, VBAC or vaginal birth after caesarean offers an alternate birthing process for women. In this article, Dr Anjali Kumar, top obstetrician and gynaecologist in Delhi NCR talks about 5 things everyone thinking of VBAC should know.
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Before opting for VBAC, you need to assess if it is the right option for you. Some risks can make it an unviable birthing option. There are several factors that decide if you are an ideal candidate for VBAC. These include:
The three types of uterine incisions used for C-sections are low transverse, low vertical and classical uterine incisions. VBAC is usually done only on women with low transverse or low vertical uterine incisions. A high vertical incision or classical incision is associated with a higher risk of uterine rupture.
Uterine rupture is a rare but severe complication that can occur in pregnancy. It causes the uterus to tear which can allow the fetus to slip into the abdominal cavity. Women with uterine scars due to previous caesarean sections are at a higher risk of developing this complication. If you have a history of uterine rupture, you would not be considered an ideal candidate for VBAC.
If you have undergone any surgical procedures on your uterus in the past such as fibroid removal, you would not be considered for VBAC. Previous surgeries can cause uterine scarring which is not ideal for VBAC.
VBAC is not recommended for women who have had more than two C-sections previously.
VBAC is not recommended for women who have undergone a C-section delivery less than 18 months prior.
If you have any other underlying condition such as placental problems or multiple births, which can complicate your pregnancy or labour, you would not be recommended a VBAC.
Other factors such as being overweight, breech presentation of the baby, size of the baby etc can also result in VBAC being ruled out. Discuss your suitability for VBAC at length with your obstetrician early on in your pregnancy so you can start preparing for your labour.
Read: Caesarean section delivery – What to expect
While you may be keen to explore the option of vaginal birth after caesarean (VBAC), the fact is that not all hospitals or doctors offer this birthing option. While complications arising from VBAC are rare, hospitals and doctors need to be prepared to perform an emergy C-section during TOLAC (Trial of labour after cesarean). Constant fetal and maternal monitoring is also essential during this process. Hence, if the hospital or doctor is not experienced in handling difficult labour, they may not offer VBAC as a birthing option. Deciding to switch your hospital and doctor later in the pregnancy can be tough. Hence, choose your hospital and doctor after exploring these options carefully, early on in your pregnancy.
In the past few years, there has been a sharp increase in the popularity of VBAC. Many expectant mothers wish to explore this birthing option due to the number of benefits associated with it. Lower recovery time, lower risk of infection from the surgery, shorter hospital stay and lesser pain are some of the advantages of VBAC for the mother. Even for the baby, passing through the birth canal helps squeeze the fluid from his/her lungs as well as transfers good bacteria, providing him/her valuable immunity after birth.
A lesser-known fact about caesarean section is that it is not ideal for women wishing to give birth more than 3 times. As repeated cesareans can cause several complications and uterine scarring. Each consecutive c-section poses a greater risk than the previous one. In such a scenario, talk to your doctor about your birthing options.
Like any other medical procedure, VBAC also has several risks associated with it. This is one of the major reasons why it is not ideal for everyone, nor is it offered by all medical institutions and doctors. Complications arising from VBAC are rare, also because the candidate for VBAC is screened thoroughly to minimise their risk factor.
During a VBAC, there is a small chance that the previous uterine scar breaks open. This occurs in less than 1% of all VBAC deliveries. In such a case, an emergency hysterectomy might have to be performed. There is also a chance that the VBAC attempts have to be abandoned midway due to maternal or fetal health. Emergency C-sections is performed in such a scenario.
If you have assessed your suitability for VBAC, start preparing for it early on. Speak to your doctor at length about steps you can take to have a healthier pregnancy and reduce the risk of developing pregnancy complications. Ensure that your hospital is equipped to handle complications during childbirth and also has a good NICU. Speaking to other women who have also undergone VBAC can help you manage your expectations and be better prepared.
For more information about prenatal care and birthing options, you can consult Dr Anjali Kumar at the CK Birla Hospital.
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Rh factor and how it impacts your pregnancy
Your blood type is either positive or negative. This indicates the presence or absence of a protein called Rh (rhesus) protein in your blood. Checking for blood type is the possibly the most preliminary test done when you are pregnant.
The Rh factor is passed through genes. Which means the foetus will either have a positive or negative blood type depending on the parents’ blood type. If the expectant mother is Rh negative and her foetus is Rh negative, it results in a complication called Rh incompatibility.
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If you are Rh-negative and any amount of Rh-positive blood mixes with yours, your body treats the presence of the Rh protein as an intruder. It then creates antibodies (anti-Rh antibodies) to destroy the Rh-positive protein. These antibodies can then cross the placenta and attack the foetus’s blood cells causing serious health risks for the foetus or new-born which can also prove to be fatal.
Don’t be too alarmed if you discover that your pregnancy has Rh incompatibility. As long as it is detected early in the pregnancy, your doctor would monitor the condition and provide treatment to minimise risk.
In fact, in most cases, your blood doesn’t mix with your baby’s blood during pregnancy. Risk of contact increases during labour and delivery as well as during amniocentesis, bleeding during pregnancy, move the foetus during breech presentation or abdominal trauma during pregnancy.
If you are Rh negative, you would have to undergo an antibody screen during your first trimester. This test detects the presence of anti-Rh antibodies. If it isn’t present, you would be given a dose of Rh immune globulin, so as to prevent your body from producing anti-Rh antibodies during your pregnancy. If your baby is born Rh positive, you might be given another dose of the same medication after delivery, which isn’t required if your baby is Rh negative.
If Rh antibodies crosses the placenta and enters the foetal blood stream, it can result in Rh diseases such as life-threatening anaemia; a condition in which the foetal red blood cells are destroyed faster than they are produced. If the antibody screen detects the presence of Rh antibodies then you are said to be Rh sensitised. In this case, the only course forward is to monitor foetal health and manage the condition. This is done by giving the baby blood transfusions through the umbilical cord during the pregnancy or immediately after delivery as required. For some cases, the doctor might also decide to deliver the baby before full term.
Rh sensitisation can occur in the event of miscarriage, ectopic pregnancy and induced abortion. This can case complications in subsequent pregnancies in case of Rh incompatibility. If you have undergone any of the above events and are not Rh sensitised, your doctor might advise you to take a dose of Rh immunoglobulin to prevent complications in subsequent pregnancies.
First things first, do not panic. Understand the condition clearly by discussing it at length with your doctor. Maintain regular prenatal visits to monitor the condition. Today, with improvements in testing and treatment has significantly improved the prognosis of Rh incompatibility. This is evident as now, most babies with Rh disease survive and lead healthy normal lives. Relax and focus on maintaining a healthy pregnancy by making good lifestyle choices.
Ques: Is Rh incompatibility a problem if I am Rh positive?
If you are Rh positive, it does not cause Rh sensitisation. This is because the absence of Rh protein in the foetal blood stream won’t stimulate the production of Rh antibodies.
Ques: Can being Rh negative result in miscarriage?
Being Rh negative can result in Rh incompatibility if the foetus has Rh positive blood type. With early detection and proper treatment, the condition can be managed. Regular prenatal visits can help in managing this condition and preventing it from complicating.
