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Ovarian Cysts and Pregnancy
A cyst, in general, is a fluid-filled sac that forms in some of the organs of the body. An ovarian cyst is similarly one such fluid filled pocket that grows in one or both of the ovaries. Ovarian cysts can occur in a significant number of women at some point without affecting their health or ability to conceive. They develop and resolve on their own. However, some types of cysts cause infertility or troubling symptoms when they rupture or grow too much in size.
What Is An Ovarian Cyst?
Ovaries are two almond-sized structures in the female reproductive system, which are responsible for the production of eggs. During the menstruation cycle, the ovaries release one egg every month in a process called ovulation. During each cycle, several egg-containing follicles, inside the ovary, ripen as they get filled with nourishing fluids that envelop each egg. The largest follicle, then, bursts to release the egg. Sometimes, the egg continues to develop but the process isn’t complete, and the follicle remains as a cyst in the ovary for some time before disappearing. Most of the time, ovarian cysts are harmless and present little or no discomfort, some, however, can rupture causing internal bleeding. In rare cases, the cysts develop into cancer.
Types of Ovarian Cysts
There are different types of ovarian cysts that can be classified as either functional cysts or pathological cysts.
Functional Cysts:
Functional cysts occur due to the natural processes during the menstrual cycle and are very common. They affect women who have an active menstrual cycle and haven’t had a menopause. They are often benign (non-cancerous) and harmless and disappear on their own in a few months without treatment. In rare cases, they may cause symptoms such as pelvic pain.
Functional cysts occur mainly in two types:
Follicular Cysts: These are the most commonly occurring type of cysts in women and develop in either of the following ways:
The follicle develops in the ovary but the egg is not released, and it continues to grow.
The follicle bursts after ripening to release the egg but stays filled with fluid
Follicular cysts are usually small, but some may grow to sizes up to 5 or 6 cm across. They usually disappear on their own in a few months without treatment.
Luteal Cysts: They form when the follicle which has burst to release an egg remains as a shell (corpus luteum). Sometimes, the shell reseals and may get filled up with fluid or blood. Luteal cysts can grow up to 6cm in size and take a few months to go away. In some cases, they can burst and release blood in the abdomen which can be painful and dangerous.
Pathological Cysts:
Pathological cysts are caused by abnormal growth of cells and aren’t related to the menstrual cycle. They can develop in all women before or after menopause. These cysts can develop from the cells that make up the outer part of the ovary or from the cells used to create eggs. Pathological cysts can grow large and block blood supply to the ovaries or even burst. They are rarely cancerous and are removed surgically when they are.
Pathological cysts are classified as:
Dermoid Cysts: These cysts, also called teratomas, form from embryonic cells and can contain tissues within them such as skin, hair or teeth. They are mostly benign.
Cystadenomas: They form on the surface of the ovary and are filled with watery or mucous-like fluids.
Endometriomas: These cysts grow due to a condition called endometriosis where uterine endometrial cells grow outside the uterus. Some of this tissue can attach to the ovary and form a growth.
Symptoms
In most women, ovarian cysts do not cause any noticeable symptoms. In some, however, when the cysts grow to a large size and are blocking the blood supply or pressing on surrounding organs or are leaking blood, there can be clear symptoms such as:
Change in the menstrual cycle where the periods are irregular, heavier or lighter
Need to urinate frequently
Feeling excessively tired
Difficult or pain when emptying the bowels
Feeling bloated, full or suffer indigestion
Inability to conceive
Diagnosis of Ovarian Cysts
Ovarian cysts can be found during a pelvic exam. Depending on the nature of the cysts and their type, the doctor will recommend different tests to determine the cyst type. Some of the tests include:
Pregnancy Test: A positive on this test suggests that you have a corpus luteum cyst.
Pelvic Ultrasound: An ultrasound transducer that sends and receives high-frequency sound signals is used to create an image of the uterus. The scans give insight into the location, type and contents of the cyst.
CA 125 Blood Test: Cysts that are partly solid are at high risk of being cancerous. The test looks for a protein called cancer antigen 125 which shows up in elevated levels in women with ovarian cancer.
Does Ovarian Cyst Affect Your Chance of Getting Pregnant?
Most of the ovarian cysts do not lead to infertility. However, there are two types that make it difficult to get pregnant.
Polycystic Ovarian Syndrome (PCOS): The condition leads to the formation of multiple small cysts in the ovaries and interferes with ovulation by making it rare or irregular. PCOS leads to irregular menstrual periods and hormonal imbalance. It is also the most common type of cyst that leads to infertility.
Endometriosis: These types of cysts can block the fallopian tubes or damage the ovaries causing infertility.
Risks of Ovarian Cyst while Pregnant
Can ovarian cyst affect pregnancy? Yes and no. The risks associated depend on the type and size of the cyst during pregnancy. Ovarian cysts that grow to large sizes take up space and apply pressure on the urinary bladder, or the cysts burst and pour its contents into the abdominal cavity. In some cases, the cyst pedicle gets twisted, and the blood supply is cut off. Such a cyst might die and elevate the risk of severe peritonitis which is an inflammation of the lining of the abdominal cavity that is dangerous to both the mother and the child.
Ruptured Or Twisted Cyst In Pregnancy
Ovarian Torsion:
When cysts grow to large sizes, they cause the ovaries to move out of place. Sometimes the forces due to displacement can cause the ovary to get twisted in a condition called ovarian torsion. It can decrease or cut off blood flow to the ovaries and cause symptoms such as severe pelvic pain, nausea and vomiting.
Rupture:
Cysts that contain blood and fluids can rupture when they overgrow and cause internal bleeding and severe pain. The larger the cyst, the greater its chance of rupturing. Vigorous activities and exercises that affect the pelvis can cause a large cyst to rupture.
Treatment
The treatment of ovarian cysts depends on the risk it poses and the discomfort felt by the woman during pregnancy. Watchful waiting is the first approach when a cyst is discovered in an ultrasound scan. With follow up scans, it is possible to tell if the cyst has resolved on its own or is growing in size, posing a risk.
If the cyst grows large enough to cause pain or other risks such as a rupture, it may be surgically taken out. A keyhole surgery or laparoscopy is normally done in early pregnancy. If the cyst is large or develops late in pregnancy, it will be removed through a cut in the tummy (laparotomy).
Removing ovarian cyst during pregnancy is done in two ways:
Operation After 20 Weeks: A troublesome cyst will need to be removed surgically but only after 20 weeks of the pregnancy. A surgery to remove it before 20 weeks increases the chances of a miscarriage, and therefore, is avoided.
Operation At Any Stage: Sometimes a large cyst could develop on a stem from an ovary causing it to twist (Ovarian torsion). This could damage the ovary and make the woman very sick. In such cases, doctors operate immediately, no matter what stage the pregnancy is in.
Preventive Measures
There is no way to prevent ovarian cysts from forming. However, regular pelvic exams can ensure they can be detected as early as possible. Changes in the menstrual cycles and unusual symptoms that persist for many cycles are, usually, an indicator and should be reported to the doctor.
When Should You Call the Doctor?
Ovarian cyst and pregnancy can co-exist as long as the cyst is benign and monitored on a regular basis to check if there are indications of trouble on the horizon. If you feel a sudden abdominal pain accompanied by vomiting and fever, it’s time to call the doctor. Some of the other symptoms can include cold and clammy skin along with weakness and lightheadedness. These are signs of an emergency and should not be ignored.
Having an ovarian cyst is not always a cause for worry, chances are that the cyst you have is benign and will resolve on its own in months. It is important, however, to get it examined on a regular basis to be on the safer side.
Also read: Irregular Periods After Pregnancy: Should You Worry? Read more
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(Not so) Milky Mommy! - My Lactation Story, Struggles and Success
Hello Mommies,
Breastfeeding is no rosy or beautiful feeling, well it wasn't for me at least. I have struggled a lot with lactation, even today at times (3-month baby). It hurts, yes I did know, but nobody told me the challenges I had to face and the intensity, not even my mother. It was normally painful and everything was fine until my girl needed some formula to get jaundice out. Yes, it was a successful effort but she would not take my milk at all later. There were at least 6 lactation nurses who pinched my nipples hard to get the milk out, just to lure my baby into drinking directly. We tried different positions, used cut syringes to suck the milk out when the pinching didn’t help, used breast pumps and what not. And we failed, each time the result was painful blood clotted nipples which with a blow of air would hurt. Yes, I did cry because of the excruciating pain and because I was a lactation failure. I knew how much my little one needed my milk for her growth. I didn’t want to express and feed her as I knew it was short term, soon I would start producing milk. Thankfully, with the nurses who would just not give up, my girl started to breastfeed again and well. When I told my lactation consultant regarding the breastfeeding, she was ecstatic and teary-eyed looking at my little one gaining 200 g every week. It wasn’t just because of my struggle that she was overwhelmed; it was also because I had an easier option of formula which I was adamant not to put my baby on.
Then, later on, I had a bad engorgement, caught a fever and at least for a month, I cried every time I breastfed my baby. Not an improper latch but my wound would just not heal.
So much pain and struggle but at the end when she is growing well, I beam with such pride and know it was all worth it. So, ladies, I’m sorry to say this but please don’t give up, no matter what. Even if your doctor says so, listen to your motherly heart and give your 100%. I have heard mothers say the baby just wouldn’t suck or latch. I feel you mommies but every time I would lose hope I used to remember what my doc told me. She said, " Have you seen how new born calves run to their mothers, latch and feed?
Human babies are no less, it’s just that they can’t walk. I don’t believe in babies not wanting to suck or latch. Hold her as close to you as you can, feed her and I assure you, you will struggle unlatching her."
For you and your baby’s health, please breastfeed, mommies. It is all worth it, every verified medicine you take to increase your milk is all worth it. Give your little one kangaroo mother care regularly and you will see the big difference. Hope I was of help.
Happy Breastfeeding! Happy Parenting!
Happy mothers, healthy babies!
Disclaimer: The views, opinions and positions (including content in any form) expressed within this post are those of the author alone. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The responsibility for intellectual property rights of this content rests with the author and any liability with regards to infringement of intellectual property rights remains with him/her. Read more
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Surgical Abortion - Types, Procedure and Risks
It is the right of every woman to have children by choice. When abortion seems to be the right choice or is medically required, here is all you may want to know about surgical abortions - types, procedures and risks, in a simplified manner.
What is a Surgical Abortion?
The foetus or fertilized egg is lodged and attaches itself to the uterine lining. An abortion is said to be done when the foetus is vaginally evacuated through a surgical procedure. This procedure is based on the age of the foetus and other factors. For example, an ectopic pregnancy cannot be terminated this way.
It is always wise to educate yourself, speak to your doctor and then decide on a surgical abortion. The answers below are not meant to replace the doctor’s advice.
Preparation for Surgical Abortion
Surgical abortion process and procedures depend on the age of the foetus and whether any factors negate the abortion. Though the procedure is surgical, you should be well advised and mentally prepared to terminate the unwanted pregnancy. Given below are some pointers to help you through an abortion.
Ensure that you confirm your appointment and have an attendant accompany you.
Ensure that you do not eat anything for at least 3 hours prior to the procedure.
Ensure that you carry an ID card, health insurance and payment for the abortion and antibiotics prescribed.
Ensure that you have the contact details of your regular doctor and an emergency number to be called, written down.
Ensure that you carry all medical reports.
Ensure that you carry fresh underwear, sanitary pads etc.
You can also keep in mind how long does a surgical abortion take in order to plan your day or ask for support from any trusted friend or family member.
Pain Management Available During the Process
Is surgical abortion painful? Yes, it will be. However, various pain management methods are available to make the process less painful. You can receive local anaesthesia which will numb your cervix but keep you awake. Doctors may also give you oral pain relief medication like ibuprofen or mild sedatives to keep you relaxed. You can also discuss with your doctor the possibility of opting for a stronger sedative that can be administered through an IV.
Anaesthetic Choices You May Avail
Though you may have a choice of anaesthetics, the doctor’s decision is final! Based on a medical evaluation of your case, one of the following methods may be used.
General anaesthesia
A lighter mild anaesthetic gas
A local cervical anaesthetic also called the spinal tap
Intravenous sedation with local anaesthesia
Some of the factors that help the doctor decide on the right anaesthetic procedure are:
Allergies and health conditions like asthma, epilepsy, anaemia, etc.
Observing a fast and completion of bowel evacuation
Age of the foetus
Your weight and stress levels will determine how you cope with the surgery
Any previous complications in surgery and gynaecological procedures
Types of Surgical Abortion Procedures
The surgery and procedures used depend on the age of the foetus. The procedures that happen in Indian hospitals are:
First trimester- Medicational abortion, Vacuum Aspiration or Dilation and extraction D&E
Second trimester- Dilation and extraction D&E, Dilation and Curettage D&C
1. Aspiration
Surgical abortion at 12 weeks is performed using the suction and aspiration method. The process is also called suction curettage, suction-aspiration or vacuum aspiration. This is the method used between 6 and 16 weeks. The procedure takes about 10 to 15 minutes.
How is it performed?
You will be given pain relief medication or sedation.
A speculum used to open your vagina as you lie back with your feet in the stirrups.
Your cervix is numbed with a local anaesthesia.
A surgical tool called tenaculum is used to dilate your cervix and facilitate the insertion of absorption rods.
After the cervix dilates enough, a plastic tube with a suction device called a cannula is inserted into your uterus. The placenta and the foetus are suctioned out by this.
A few hours of stay at the clinic may be required for recovery. During this period, you will also be given antibiotics to prevent any infection.
Risks and Side-Effects of Suction Aspiration
Dizziness
Cramping
Nausea
Sweating
Severe bleeding for long durations
Perforation of the uterus
Cervical damage
Blood clots
The last four side-effects are rare and the procedure is deemed safe 97% of the time.
2. Dilation and Evacuation (D&E)
After a gestational time of 16 weeks, the surgical abortion procedure of dilation and evacuation, or D&E, is used. The procedure takes about 15 to 30 minutes.
How is it performed?
A synthetic dilator is inserted into your vagina, 24 hours prior to the procedure.
On the day of the procedure, the cervix is numbed with medication.
A tenaculum is used to hold the cervix and the uterus in place.
Cone shaped rods are inserted to dilate the cervix further.
A cannula or a plastic tube with a suction device is used to take the foetal tissue out.
Using a surgical instrument called a curette, any residues on the lining are scraped off.
Forceps may be used in case larger pieces are to be removed.
Suctioning is performed in the end to ensure the complete removal of the tissue.
Risks and Side-Effects of Dilation and Evacuation
Nausea
Cramping
Bleeding
Blood clots
Perforation of the uterus
Damage to the uterine lining
Cervical damage
Infection
What Happens after the Abortion?
After any surgery, a period of recovery is always present. Antibiotics are prescribed and should be taken to prevent infections and manage any surgical abortion side-effects. Normally, a follow-up after a week is recommended. No special care may be required. However, general precautions for two weeks after the procedure are
Shower instead of taking a bath.
Avoid sexual intercourse and insertion of any foreign objects into the vagina.
Use clean sanitary pads and avoid tampons.
Avoid going swimming and exposure to urinary tract infections.
How to Care for Yourself After Surgical Termination of Pregnancy?
It is normal to have some bleeding and abdominal cramps following the abortion process and the surgical abortion recovery period may vary for women. Regular pain relief (except aspirin) can alleviate the pain and sanitary pads can be used to manage bleeding. Complications are rare if you follow the instructions and are on medications.
During this time avoid the following to prevent the risk of infection:
Sexual intercourse
Being submerged in water (swimming or taking baths)
Heavy exercises
Use of tampons
Contact your doctor or head to the hospital if:
You develop an infection
You notice heavy bleeding
You develop a fever
You have severe cramping or tummy pain
A postoperative check-up for side effects, one or two weeks after your procedure is a must.
The abortion process is a dilemma and is always undertaken after due deliberation and counselling. It is painful both mentally and physically, and hence, managed with painkillers and anaesthetics. In case of any complications or side effects like a fever, cramps, heavy bleeding, etc., immediately get in touch with your doctor or head to the nearest hospital.
Also Read:
After Abortion Care
Period after Abortion Read more
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Puja Kumari has added a new answer
Guardian of 0 children
3 hours ago
Q. #asktheexpert My baby is 4months old he is having fever after vaccination . how many days would the fever remain? can I give him medicine
Puja Kumari
Trying To Conceive
2 hours ago
A. vomiting ka kya karan ho sakta
Dr Ghouse has added a new answer
Guardian of 0 children
2 hours ago
Q. #asktheexpert
Can we have sex during pregnancy and is it safe?
Dr Ghouse
Paediatrician
2 hours ago
A. okay no problem if you don't have any risk factors ko. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
Dr Ghouse has added a new answer
Trying To Conceive
2 hours ago
Q. Dr meri baby 12 month running hai uska weight 6 kg hai uska growth nahi ho pa Raha hai to kya kare or over active hai
Dr Ghouse
Paediatrician
2 hours ago
A. ok see c. if the baby is not having proper height and weight it means that baby is having failure to thrive baby needs investigations like TSH and other related test to find out the reason
Dr Sameer awadhiya has added a new answer
Guardian of 0 children
2 hours ago
Q. mere twins baby hai boy nd girl one month 8 days when I check eye and ear which month
Dr Sameer awadhiya
Paediatrician
2 hours ago
A. For the query asked needs consultation with doctor for proper guidance so it is better that the doctor will guide you the correct way .
Online consultation can also be taken jjand the expert will give you the proper answer .
Ankita Mehta has added a new answer
Guardian of 0 children
40 mins ago
Q. is white discharge in 8th month normal?
Ankita Mehta
Mom of a 8 yr 7 m old girl
39 mins ago
A. hi
yes
but if it is too thick or clear like water,if there other symptoms like itching, irritation, redness,foul smell from vagina, please visit your gynecologist
Rashmi has added a new answer
Guardian of 0 children
26 mins ago
Q. My son is 5 months old is suffering from cough..what to do?
Rashmi
Mom of a 9 yr 7 m old girl
25 mins ago
A. Kindly consult your paediatrician they will examine the child and accordingly they can help you with the best medicine that you can offer to the child as of now and don’t give any medicine without taking an advice from your paediatrician please
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