Normal Delivery Hospital in Ahmedabad, C Section Delivery

Normal Delivery and C-Section

A goal to be pursued constantly during There are a few conditions in which the safety of the mother and baby lies in a quick operative delivery by caesarean section. Distress of the baby or mother, alterations in the fetal heart rate pattern, abnormal CTG, passage of meconium i.e green coloured stool of the baby, non progress of labour or arrest of labour would warrant an operative delivery by caesarean section. We have two fully equipped operation theaters for such obstetric emergencies The caesarean delivery almost universally performed is the LSCS (Lower segment caesarean section), in which a transverse incision through the lower uterine segment is made. For this, the abdominal incision of choice is the Pfannenstiel incision. It is a slightly curvilinear incision at the level of the pubic hairline , extended somewhat beyond the borders of the rectus muscles. It is cosmetically sound scar with good post operative recovery. The most common indications for caesarean delivery.

Repeat Caesarean
Dystocia or failure to progress in labour
Cephalo-pelvic disproportion
Breech presentation
Fetal distress
Placenta praevia

With advanced techniques, the recovery period of caesarean section is now only two to three days with near to normalcy within three days. Cosmetically superior scar and stitching with sub-cuticular method gives minimal scarring and is very well accepted by most women

Pain Less delivery (Epidural Analgesia)

When uterine contractions and cervical dilatation cause discomfort, pain relief with epidural analgesia is a viable option. It can be accomplished by injecting a suitable local anaesthetic agent in to the epidural or peridural space. This space is a potential area that contains areolar tissue, fat, lymphatics and the internal venous plexus, which becomes engorged during pregnancy so that it appreciably reduces the volume of the space. The portal of entry for obstetric analgesia is through either a lumbar intervertebral space for lumbar epidural analgesia (more commonly used), or through the sacral hiatus and sacral canal, for caudal epidural analgesia. An indwelling plastic catheter is inserted hence more than one injection can be repeated at intervals for pain relief. The lady must be in active labour and cervix must be atleast 3-4cms open.

The procedure of epidural catheterization is done by one of our team of qualified anaesthetists. After an informed consent, patient is hydrated well with Ringer Lactate solution and continuous monitoring of maternal heart rate and blood pressure is required. With the lady in lateral decubitus or sitting position, epidural space is identified with a loss of resistance technique and epidural catheter is threaded 3cms in to the epidural space. A combination of bupivacaine (0.25% to 0.5%) and fentanyl (according to weight of patient) may be used. The effect of epidural analgesia on labour (on the negative side) may include longer labours and increased incidence of chorioamnionitis, vacuum or caesarean delivery. Most of the times, epidural analgesia is a relatively safe procedure causing significant pain relief to the laboring woman.

Normal Vaginal Birth and Low Risk Vacuum

Most women are extremely anxious prior to their due date about vaginal delivery, whether they will be able to take labour pains or not, or whether they will require a caesarean section. Should you require a caesarean section, we have fully equipped and modern operation theaters for the same and an expert anaesthesia team for any type of obstetric emergency. We give the couple full opportunity to discuss their birthing plan with our obstetric team in the last weeks of pregnancy. Should you be scared of labour pains or find them unbearable, the option of epidural analgesia is open for the lady in labour, after the doctor has examined and assessed her clinically and finds it suitable for her.

Normal Vaginal Birth

On admission in the birthing suite the obstetrician will subject the patient to a cardiotocograph of the baby and an internal examination to assess which stage of labour she is in. On an average, active stage of labour would last for 6-8 hours before the birth of the baby. The treating doctors may have to do several internal checkups in order to assess the progress of labour. For women who are not able to bear the labour pains, the option of epidural analgesia remains open, provided the doctor feels it is suitable at that stage of labour. Deep breathing exercises and minimal ambulation is allowed in the labour suite. Oxytocin drip may be required to augment labour pains. In order to aid the second stage of labour, vacuum cup may be applied to the baby’s head or rarely an outlet forceps. A fully qualified paediatric team always attends to any delivery in our hospital. You may require stitches in the vagina(episiotomy) if the perineum is too tight, it is done under local anaesthesia

LOW RISK VACUUM

Vacuum extractor is a suction device for the fetal scalp to facilitate delivery of fetal head. In Europe, it is referred to as VENTOUSE (from French, literally, soft cup). The prerequisites for vacuum application are

vertex presentation with engaged head (preferably zero station and lower)
Completely dilated cervix with ruptured membranes
There should be no disproportion between size of fetal head and maternal pelvis Relative contraindications for vacuum delivery include face or nonvertex presentations, extreme prematurity, fetal coagulopathies, fetal macrosomia Complications with well selected cases are very few and rare e.g., scalp lacerations and cephalhaematomas. In general, it is a safe and effective technique to facilitate delivery of fetal head and shorten the second stage of labour.

High Risk Delivery

The high risk pregnant patient can come with bad obstetric history or with a well recognized medical complication. The majority of high risk pregnant patients are women who in the course of otherwise normal pregnancies, develop unexpected severe complications which require difficult management decisions with occasionally compromised fetal or maternal outcome.

Reasons of ‘High Risk Pregnancy’

Those that require invasive procedures for fetal diagnosis and therapy e.g. Rh iso-immunization, non immune fetal hydrops, fetal congenital heart blocks.
Those with severe medical complications affecting the mother such as diabetes, cardiac disease grade 3 and 4, sickle cell disease, SLE.
Those with recurrent poor obstetrical outcome such as habitual abortion, recurrent still birth, recurrent PROM, recurrent preterm labour.

Maternal Fetal Medicine

We provide pre-conception counseling, genetic counseling, prenatal diagnosis including comprehensive and targeted ultrasounds, first trimester screening, chorionic villus sampling, amniocentesis, among others. Our expert faculty consists of highly trained maternal-fetal medicine specialists with extensive experience in the management of the most complex maternal and fetal disorders. Pregnant women suffering from serious medical disorders such as epilepsy, preeclampsia, chronic hypertension, renal disease, heart disease, diabetes are cared for routinely in our center. We also have extensive clinical experience in the management of preterm labor, cervical insufficiency and preterm premature rupture of membranes.

Advances in Maternal Fetal Medicine

Today’s state of the art ultrasound machines are equipped with 3 D and 4 D ultrasound technology. The introduction of this technology enabled physicians to add a new dimension to gynaecological and obstetrical ultrasound imaging. 4-D Ultrasound System takes 3-D images of the fetus and adds another dimension: time, resulting in a true-to-life image. Conditions like cleft lip/palate, cysts, scoliosis, hand anomalies, skeletal malformations, spinal bifida and heart defects can be clearly seen.

Electronic Fetal Monitoring System

A goal to be pursued constantly during labour is preservation of fetal well-being by early detection and relief of fetal distress. Fetal monitoring includes surveillance of fetal heart and uterine activity by an electronic device in which the ‘Ultrasound Doppler Principle’ is used. The transducer is placed on the maternal abdomen at a site where fetal heart action is best detected. A coupling gel may be applied because air conducts ultrasound poorly. These signals are edited electronically before fetal heart rate data are printed onto a bedside monitor tracing paper. The average fetal heart rate in the third trimester ranges between 120 to 160 beats per minute. Bradycardia comprises a baseline fetal heart rate under 120 beats per minute that lasts 15 minutes or longer and severe bradycardia is less than 80 beats per minute for three minutes or longer. Tachycardia is mild if baseline fetal heart rate is between 161 and 180 beats per minute and severe if more than 180 bpm. Decelerations are decrease in fetal heart rate below baseline rate. They may be early, when there is a drop in heart rate with uterine contractions as is related with cervical dilatation(and can be considered physiological) . Compression of fetal head produces variable decelerations (or due to umbilical cord occlusion). The late deceleration is a symmetrical decrease in fetal heart rate beginning at or after the peak of the contraction and returning to baseline only after the contraction has ended. Late decelerations are uniform in shape and typically begin 30 seconds or more after the onset of contractions Hence, the CTG (cardio-toco-graph) is an important aid to the obstetrician for deciding fetal distress of the woman in labour so that timely action (and delivery by C-Section) can be done to safely deliver a healthy, uncompromised baby. At our center we have Electronic Fetal Monitoring System

Cord Blood Stem Cell Preservation

What are stem cells and why are they transplanted?

All of the blood cells in your body start out as young (immature) cells called hematopoietic stem cells. (Hematopoietic means blood-forming.) Even though they may be called “stem cells” for short, these cells are not the same as stem cells from embryos that are studied in cloning and other types of research. Here, we will use “stem cells” to mean hematopoietic stem cells. Stem cells mostly live in the bone marrow (the spongy center of certain bones), where they divide to make new blood cells. Once blood cells are mature they leave the bone marrow and enter the bloodstream. A small number of stem cells also get into the bloodstream. These are called peripheral blood stem cells. Stem cell transplants are used to restore the stem cells when the bone marrow has been destroyed by disease, chemotherapy (chemo), or radiation. Depending on the source of the stem cells, this procedure may be called a bone marrow transplant, a peripheral blood stem cell transplant, or a cord blood transplant. We will give you more detail on each of these later. Any of these types may be called a hematopoietic stem cell transplant. The first successful bone marrow transplant was done in 1968. It was not until nearly 20 years later that stem cells taken from circulating (peripheral) blood were transplanted with success. More recently, doctors have begun using cord blood from the placenta and umbilical cords of newborn babies as another source of stem cells.

What makes stem cells so important?

Stem cells make the 3 main types of blood cells: red blood cells, white blood cells, and platelets. We need all of these types of blood cells to keep us alive. And in order for these blood cells to do their jobs, you need to have enough of each type in your blood.

When do people need stem cell transplants?

Stem cell transplants are used to replace bone marrow that has been destroyed by disease, chemo, or radiation. In some diseases, like leukemia, aplastic anemia, certain inherited blood diseases, and some diseases of the immune system

Sources of stem cells for transplant

There are 3 possible sources of stem cells to use for transplants: bone marrow, the bloodstream (peripheral blood), and umbilical cord blood from newborns. Although bone

Bone marrow

Bone marrow is the spongy tissue in the center of bones. Its main job is to make blood cells that circulate in your body and immune cells that fight infection. Bone marrow was the first source used for stem cell transplants because it has a rich supply of stem cells.

Peripheral blood

Normally, few stem cells are found in the blood. But giving hormone-like substances called growth factors to stem cell donors a few days before the harvest causes their stem cells to grow faster and move from the bone marrow into the blood. Bone marrow was the first source used for stem cell transplants because it has a rich supply of stem cells.

Umbilical cord blood

A large number of stem cells are normally found in the blood of newborn babies. After birth, the blood that is left behind in the placenta and umbilical cord (known as cord blood) can be taken and stored for later use in a stem cell transplant. The cord blood is frozen until needed. Stem cells can be preserved for life time, but as of now, we store it for 21 years as per universal guidelines. These stem cells are stored at a temperature of -196 degrees Celsius in vapor phase of liquid Nitrogen. Bone marrow was the first source used for stem cell transplants because it has a rich supply of stem cells.

Pricing Structure

The total cost of stem cell preservation for 21 years is Rs 75,000. It involves a flexibility of paying the full amount in installments.

Post Natal Care

As soon as pt is shifted to indoor patient department after normal delivery or caesarean section she is immediately attended by a medical officer & trained staff nurse. They check the vitals of both mother & newborn baby, which in mother is pulse, B.P, Bleeding & wound site & in baby, resp rate, skin colour any discharge from mouth or umbilicus. Then doctor on duty will educate & encourage pt for taking care of herself & baby. She is encouraged to take healthy nourishing diet which is provided by hospital, plus ingestion of lots of liquids orally. she is taught & initially assisted by trained staff nurse for giving breast feeding to baby which is very important in first few hours of life. Then vaccination is also given in our hospital within 24-48 hrs (if baby is full term &/or of good weight) by a senior pediatrician. On discharge patient is given full instruction about importance of continuing breastfeeding as long as possible, caring of wound , necessity of continuing supplements of iron & calcium for minimum upto 3 to 4 months & detailed advise regarding methods of contraception (to avoid immediate pregnancy) and postnatal exercise to get back the pre pregnant state as early as possible. we at our center are doing caesarean section scar closer by sub cutaneous stich , so that hospital stay get minimized to 3 days, leaves no scar on abdomen ,cosmetically good & post operative recovery is fast.