Q: How common is the situation?
It is a very common condition. Although it is called commonly as “Morning Sickness”, it can occur at any time of the day. It is usually not harmful to the fetus, but it can have a serious effect on your life, including your ability to work or do your normal daily activities.

Q: When does it start?
Usually starts before 9 weeks of pregnancy. For most women subsides by 14 weeks. For some, it may last several weeks or months. For few, it may last throughout the entire pregnancy.

Q: What is Hyperemesis Gravidarum?
Most severe form of nausea vomiting in pregnancy. It occurs up to 3% of pregnancies. The condition is diagnosed when a woman has lost 5% of her pre-pregnancy body weight and complications of dehydration. The mother should be admitted at the hospital and managed to restore body fluids.

Q: What are the risk factors?
Multifoetal pregnancy[ Twin, Triplet, Quadruplet, etc.] Past pregnancy with nausea and vomiting Mother or sister had severe nausea and vomiting in pregnancy History of motion sickness or migraines

Q: What are the medical conditions which can be associate with nausea & vomiting in pregnancy?
Ulcer Food-related illness Thyroid disease Gall bladder disease

Q: Can nausea & vomiting affect my baby?
Usually does not harm your or baby’s health. If it is severe it can have an effect on your fluid balance and baby weight.

Q: How can you feel better?
Take a multivitamin.
Try eating dry toast or crackers in the morning before you get out of bed to avoid moving around in an empty stomach. Drink fluids often. Avoid smells that bother you. Eat small frequent meals instead of three large meals. Try bland foods. BRATT diet – Banana, Rice, Apple, Toast, Tea. Eat Ginger – Ginger tea, Freshly cut ginger pieces.

Q: What is the Medical treatment?
Lifestyle and diet modifications
Vit B6 + Doxylamine – To be taken alone or in combination 30 minutes before each meal. Once to thrice daily.
Antiemetic drugs – If not controlled by Vit B6, Doxylamine antiemetic drugs can be used to prevent vomiting. Many antiemetic drugs can be used safely in pregnancy.

Q: How to treat severe nausea and vomiting?
Hospitalization. Liver Function Tests. Urine for ketone bodies. Serum Electrolytes. IV fluids, IV antiemetics. Further management depending upon your condition.

Q: What are the groups of food we eat?

 

• Grains: Rice, Wheat, Maida, Bread, Muri, Chire etc
• Fruits: Fruits freshly cut or Fruit Juice which are 100% fruit juice. 
• Vegetables: Vegetables can be raw or cooked or 100% vegetable Juice like Carrot, Beetroot, etc.
• Protein foods: Protein foods include red meat, chicken, fish, seafood, beans and peas, eggs, daal, soyabean. 
• Processed Food Products: Soy products, Nuts, and Seeds.
• Dairy: Milk and products made from milk, such as butter, ghee, cheese, yogurt (dahi), ice cream, chocolates, etc

 

Q: Are oils and fats part of healthy eating?

Although they are not a food group, oils and fats do give you important nutrients. During pregnancy, the fats that you eat provide energy and help build many fetal organs and the placenta. Most of the fats and oils in your diet should come from plant sources. Limit solid fats, such as those from animal sources. Solid fats also can be found in processed foods.

 

Q: Why are vitamins and minerals important in my diet?

Vitamins and minerals play important roles in all of your body functions. During pregnancy, you need more folic acid and iron than a woman who is not pregnant.

 

Q: How can I get the extra amounts of vitamins and minerals I need during pregnancy?

Taking a prenatal vitamin supplement can ensure that you are getting these extra amounts. A well-rounded diet should supply all of the other vitamins and minerals you need during pregnancy.

 

Q: What is folic acid and how much do I need daily? 

Folic acid, also known as folate, is a B vitamin that is important for pregnant women. Before pregnancy and during pregnancy, you need 400 micrograms of folic acid daily to help prevent major birth defects of the fetal brain and spine called neural tube defects. 

Current dietary guidelines recommend that pregnant women get at least 600 micrograms of folic acid daily from all sources. It may be hard to get the recommended amount of folic acid from food alone.

For this reason, all pregnant women and all women who may become pregnant should take a daily vitamin supplement that contains folic acid. 

 

Q: Why is iron important during pregnancy and how much do I need daily?

Iron is used by your body to make a substance in red blood cells that carries oxygen to your organs and tissues. During pregnancy, you need extra iron—about double the amount that a non-pregnant woman needs. This extra iron helps your body make more blood to supply oxygen to your fetus. 

The daily recommended dose of iron during pregnancy is 27 mg, which is found in most prenatal vitamin supplements. You also can eat iron-rich foods, including lean red meat, chicken, fish, dried beans and peas, iron-fortified cereals.

Iron also can be absorbed more easily if iron-rich foods are eaten with vitamin C-rich foods, such as citrus fruits and tomatoes.

 

Q: Why is calcium important during pregnancy and how much do I need daily?

Calcium is used to build your baby's bones and teeth. All women, including pregnant women, aged 19 years and older should get 1,000 mg of calcium daily; those aged 14–18 years should get 1,300 mg daily. Milk and other dairy products are the best sources of calcium. If you have trouble digesting milk products, you can get calcium from other sources, such as dark green leafy vegetables or a calcium supplement.

 

Q: Why is vitamin D important during pregnancy and how much do I need daily?

Vitamin D works with calcium to help the baby’s bones and teeth develop. It also is essential for healthy skin and eyesight. All women, including those who are pregnant, need 600 international units of vitamin D a day. Good sources are milk fortified with vitamin D. Exposure to sunlight also converts a chemical in the skin to vitamin D.

 

Q: How much weight should I gain during pregnancy?

The amount of weight gain that is recommended depends on your health and your body mass index before you were pregnant. If you were a normal weight before pregnancy, you should gain between 25 pounds and 35 pounds during pregnancy. If you were underweight before pregnancy, you should gain more weight than a woman who was a normal weight before pregnancy. If you were overweight or obese before pregnancy, you should gain less weight.

 

Q: Can being overweight or obese affect my pregnancy?

Overweight and obese women are at an increased risk of several pregnancy problems. These problems include gestational diabetes, high blood pressure, preeclampsia, preterm birth, and cesarean delivery.

Babies of overweight and obese women also are at greater risk of certain problems, such as birth defects, macrosomia with a possible birth injury, and childhood obesity.

 

Q: Can caffeine in my diet affect my pregnancy?

Although there have been many studies on whether caffeine increases the risk of miscarriage, the results are unclear. Most experts state that consuming fewer than 200 mg of caffeine (one 12-ounce cup of coffee) a day during pregnancy is safe.

Please do not take soft drinks most of which contains caffeine. You may take lassi, coconut water/ Daab water.

 

Q: What are the benefits of including fish and shellfish in my diet during pregnancy?

Omega-3 fatty acids are a type of fat found naturally in many kinds of fish. They may be important factors in your baby’s brain development both before and after birth. To get the most benefits from omega-3 fatty acids, women should eat at least two servings of fish or shellfish (about 8–12 ounces) per week before getting pregnant, while pregnant, and while breastfeeding.

 

Q: What should I know about eating fish during pregnancy?

Some types of fish have higher levels of a metal called mercury than others. Mercury has been linked to birth defects. To limit your exposure to mercury, follow a few simple guidelines. Choose fish and shellfish such as shrimp, salmon, catfish, and pollock. Do not eat shark, swordfish, king mackerel, marin, orange roughy, or tilefish. Limit white (albacore) tuna to 6 ounces a week. You also should check advisories about fish caught in local waters.

 

Q: How can food poisoning affect my pregnancy?

Food poisoning in a pregnant woman can cause serious problems for both her and her growing baby.

Vomiting and diarrhea can cause your body to lose too much water and can disrupt your body’s chemical balance. To prevent food poisoning, follow these general guidelines:

 

Q: What is listeriosis and how can it affect my pregnancy?

Listeriosis is a type of food-borne illness caused by bacteria. Pregnant women are 13 times more likely to get listeriosis than the general population. Listeriosis can cause mild, 􀂧u-like

symptoms such as fever muscle aches and diarrhea but it also may not cause any symptoms

Wash food. Rinse all raw produce thoroughly under running tap water before eating, cutting, or cooking.

Keep your kitchen clean. Wash your hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.

Avoid all raw and undercooked seafood, eggs, and meat. Do not eat sushi made with raw 􀂦sh (cooked sushi is safe). Food such as beef, pork, or poultry should be cooked to a safe

internal temperature.

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symptoms such as fever, muscle aches, and diarrhea, but it also may not cause any symptoms.

Listeriosis can lead to miscarriage, stillbirth, and premature delivery. Antibiotics can be given to treat the infection and to protect your fetus. To help prevent listeriosis, avoid eating the following foods during pregnancy:

 

Glossary

Antibiotics: Drugs that treat certain types of infections.

Body Mass Index: A number calculated from height and weight that is used to determine whether a person is underweight, normal weight, overweight, or obese.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the woman’s abdomen and uterus.

Fetus: The stage of prenatal development starts 8 weeks after fertilization and lasts until the end of pregnancy.

Gestational Diabetes: Diabetes that arises during pregnancy.

Macrosomia: A condition in which a fetus is estimated to weigh between 9 pounds and 10 pounds.

Miscarriage: Loss of a pregnancy that occurs before 20 weeks of pregnancy.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

• Unpasteurized milk and foods made with unpasteurized milk
• Hot dogs, luncheon meats, and cold cuts unless they are heated until steaming hot just before serving
• Refrigerated pate and meat spreads
• Refrigerated smoked seafood
• Raw and undercooked seafood, eggs, and meat

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Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury, such as an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, _uid in the lungs, or a severe headache or changes in vision.

Preterm: Born before 37 weeks of pregnancy.

Trimester: Any of the three 3-month periods into which pregnancy is divided.

If you have further questions, contact your obstetrician-gynecologist.

This information is designed as an educational aid to patients and sets forth current

information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. 

 

Q: What is a normal menstrual cycle?

The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts up to 8 days.

 

Q: When is bleeding abnormal?

Bleeding in any of the following situations is considered abnormal uterine bleeding:

 

• Bleeding or spotting between periods
• Bleeding or spotting after sex
• Heavy bleeding during your period
• Menstrual cycles that are longer than 38 days or shorter than 24 days
• “Irregular” periods in which cycle length varies by more than 7–9 days
• Bleeding after menopause

 

Q: What are the causes of Abnormal Uterine Bleeding?

• Problems with ovulation
• Fibroids and polyps
• A condition in which the endometrium grows into the wall of the uterus
• Bleeding disorders
• Problems linked to some birth control methods, such as an intrauterine device (IUD) or birth control pills
• Miscarriage
• Ectopic pregnancy
• Certain types of cancer, such as cancer of the uterus

 

Q: At what ages is abnormal bleeding more common? 

Abnormal bleeding can occur at any age. However, at certain times in a woman’s life, it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9–14 years).

During perimenopause (beginning in the mid– 40s), the number of days between periods may change. It also is normal to skip periods or for

bleeding to get lighter or heavier during perimenopause.

 

Q: How is abnormal bleeding diagnosed?

Your doctor will ask about your health history and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You also can use a smartphone app designed to track menstrual cycles. You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted infections (STIs).

 

Q: What tests may be needed to diagnose abnormal bleeding?

• Based on your symptoms and your age, other tests may be needed. Some of these tests can be done
• Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
• Hysteroscopy—A thin, lighted scope is inserted through the vagina and the opening of the cervix. It allows your doctor to see the inside of the uterus.
• Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope.
• Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the inside of the uterus.
• Magnetic resonance imaging (MRI)—An MRI exam uses a strong magnetic field and sound waves to create images of the internal organs.
• Computed tomography (CT)—This X-ray procedure shows internal organs and structures.

 

Q: What medications are used to help control abnormal bleeding?

Medications often are tried first to treat irregular or heavy menstrual bleeding. The medications that may be used include the following:

 

• Hormonal birth control methods—Combined Oral Contraceptives. These hormones can lighten menstrual flow. They also help make periods more regular.

• Gonadotropin-releasing hormone (GnRH) agonists—These drugs can stop the menstrual cycle and reduce the size of

• Tranexamic acid—This medication treats heavy menstrual bleeding.

• Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps.

• Antibiotics—If you have an infection, you may be given an antibiotic.
• Special medications—If you have a bleeding disorder, your treatment may include medication to help your blood clot.

 

Q: What types of surgery are performed to treat abnormal bleeding?

 

If medication does not reduce your bleeding, a surgical procedure may be needed. There are different types of surgery depending on your condition, your age, and whether you want to have more children.

 

Endometrial ablation (TCRE) destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, is greatly increased. If you have this procedure, you will need to use birth control until after menopause.

 

Uterine artery embolization is a procedure used to treat fibroids This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow.

 

Another treatment, myomectomy, removes the fibroids but not the uterus.

 

Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed. Hysterectomy also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.

 

Q: How common is male infertility?

A: Findings show that male infertility is just as common as female infertility. Overall, one-third of infertility cases are caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors.

 

Q: What are the symptoms of male infertility?

A: Some signs include an inability to ejaculate or a small volume of seminal fluid being released upon ejaculation. Red or pink semen can indicate blood is present. Pain, swelling or a lump in the testicular or genital area can also indicate a health issue. If a man has experienced blunt force trauma to the genitals or undergone cancer treatment, it is best to seek a medical evaluation prior to trying to conceive.

 

Q: What are the causes of male infertility?

A: The causes of male infertility can vary from a wide spectrum of diagnoses. Causes of male infertility include:

 

• Varicocele - The presence of swollen or dilated veins surrounding the testicles, commonly present in the left testicle, causing damage to sperm. Approximately 15 out of 100 men are diagnosed with a varicocele.
• Sperm Flow Blockage - Different conditions can cause a blockage in sperm flow, and these can commonly be corrected with minor surgery. Blockages can cause sperm count to be extremely low or not present at all.
• Hormonal Problems - Hormonal issues, sometimes caused by excess weight, can decrease or halt sperm production.
• Genetic Abnormalities: Missing, extra, broken, or misshapen chromosomes, sperm DNA fragmentation or damaged individual genes on the Y chromosome can impact male fertility.
• Infection: Prostate or epididymis infections can have a significant impact on male fertility.
• Oxidative Stress: Reactive oxygen or oxidants in the semen can damage the sperm cell membrane and DNA.
• Medication & Treatment Side Effects: Certain medications or medical treatments can interfere with sperm production.

 

Q: How is male fertility diagnosed?

A: After taking a complete medical history and undergoing a physical examination, a semen analysis is completed to measure the quantity and quality of semen. Additional tests, including diagnostic and genetic testing, may be necessary based on preliminary findings. An ultrasound may be used to detect a varicocele or sperm tract abnormality.

 

Q: How is the health of semen evaluated?

A: The health of semen can only be evaluated properly by an andrologist through a semen analysis. The health of semen is evaluated by three main factors: motility, morphology, and count. Motility refers to the ability of sperm to move effectively. At least 40% should be moving forward rapidly, with at least 50% swimming forward, even if the movement is sluggish. Morphology pertains to the shape of sperm, with a normal-sized head and tail being ideal. At least 14% of sperm should be of normal shape. Sperm count refers to the amount of sperm present in seminal fluid. The concentration of sperm should be at least 15 million per milliliter, with a total volume of semen of at least 2 milliliters. It is normal for up to 25% of semen to be dead. The goal is to see at least 75% of sperm alive.

 

Q: When it comes to sperm count, what is a “normal” range?

A: The normal range for the number of sperm per milliliter spans from 15 million to 100 million. Sperm counts below 10 million are considered poor while a sperm count of 15 million or more may be fine if motility and morphology are normal. A complete lack of sperm occurs in about 10-15% of men who are infertile.

 

Q: What can a man do to boost fertility?

A: Semen health can rapidly improve by maintaining a healthy BMI, eating a healthy diet, exercising regularly, drinking in moderation, and taking vitamin supplements. Taking a daily multivitamin can boost sperm health: Zinc increases sperm count and function, Folic Acid can reduce sperm abnormalities, Vitamin C boosts sperm motility, and Vitamin D assists in healthy sperm development and libido. An additional Coenzyme Q10 supplement of 200 mg per day can improve sperm count and motility.

 

Q: What common factors hurt male fertility?

A: Excess weight can cause hormone imbalances, which can decrease sperm quality. Smoking cigarettes and marijuana can also damage sperm quality, as can drinking excessively. Contrary to popular belief, hot tubs, cell phones, and laptops do not cause male fertility, but excess heat around the genitals doesn’t help. This includes cycling for several hours at a time. If you and your partner use lubrication, be sure to use Pre-Seed lubricant or an oil-based lubricant since water-based lubricants (Astroglide, K-Y Jelly) can inhibit sperm movement by 60-100% within 60 minutes of intercourse.

 

Q: Are there genetic or aging issues that hurt male fertility? Does family history matter?

A: A study published in the journal Nature found that paternal fertility decreases with age. The study found a link between paternal age and an increased risk of autism and schizophrenia. Other genetic abnormalities involving abnormal chromosomes, sperm DNA fragmentation, or inherited diseases may affect male fertility and require further evaluation.

 

Q: What is a common fertility treatment protocol for a man with infertility?

A: Treatment can range depending upon the diagnosis. Low sperm count can be treated by placing semen through a sperm wash and completing an Intrauterine Insemination (IUI). Should IUI not result in pregnancy, In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) provides a high chance of success. A lack of sperm due to anatomical abnormalities such as retrograde ejaculation may be corrected surgically. If ejaculation is not possible, sperm can be aspirated from the testes and used in IVF. Donor sperm is available for those who have undergone cancer treatment and no longer have viable sperm.