Proper Exercises During Pregnancy

Being pregnant does not mean that it is time for you to rest and relax throughout this period. While you do need rest and relaxation, you have to keep yourself active during pregnancy. Exercising is one of the best ways to keep healthy and fit.

Exercising not only helps in improving your strength and muscle tone but also to adapt to the changes that occur due to pregnancy. You can join classes or consult your doctor regarding the same. In case of any pregnancy related complications, it is better not to do exercises.


Benefits of exercising:


  • It will provide you strength and energy to keep yourself active
  • As it is normal to gain weight in pregnancy, exercising will help you carry this weight
  • It will help you during labour and childbirth, as it prepares you for the physical challenges associated with them
  • It will allow you to have proper sleep
  • It will help to deal with mood swings which is very common in pregnant women
  • It will help you to get back in shape after childbirth

Some exercises you can do during pregnancy:

  • Walking: Brisk walking is one of the best ways to remain fit and healthy during pregnancy. This is one of the safe cardio-vascular workouts possible without putting stress on your ankles and knees. If you can walk 30 minutes daily, five times a week, it is perfectly good for your health.
  • Swimming: One of the best exercises with little risk of injury, swimming is safe during pregnancy. Swimming lets your legs, arms, heart and lungs to work out. Moreover, it helps reduce swollen feet and backaches. But if you don’t know swimming, it is not the best time to start this exercise.
  • Yoga: Yoga during pregnancy helps you improve your posture, flexibility, muscle tone, blood circulation and to relax. It may help you in maintaining blood pressure, as well. You can even learn methods to stay calm and relaxed during labour.


  • Aerobics: Low impact aerobics can be done by pregnant women. It is better to join classes if you are planning to do aerobics during pregnancy. It will help you to strengthen your muscle tone as well as your heart and lungs.
  • Cycling: Cycling on stationary cycle is absolutely safe during pregnancy. This is the best way to strengthen your heart without putting much strain on your knees. Stationary cycles also reduce the risk of falling down.

Tips to follow while exercising:

  • Drink plenty of fluids and remain hydrated while exercising
  • Don’ t indulge in exercises that involve lying flat on the back or on the stomach
  • Avoid exercises that include heavy weights and straining
  • Don’t exercise to the point of exhaustion
  • Have healthy meals



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Infant Skin Care


The skin is the largest organ in the human body. Besides serving as a protective barrier, it has the function of thermoregulation, UV protection, protection from invasion of microbes and external antigens, repair and regeneration of wounds and synthesis of nutrients. It also has immunological  and sensory autonomic functions. We must remember that the skin of the neonate is not the miniature of the adult skin.

Differences between adult and term or preterm neonate skin

  1. The skin of the newborn is 20 to 30% thinner than the adult skin.
  2. Newborn skin is less hydrated and has reduced natural moisturization factor compared to adult.
  3. Ratio of body surface area to weight of a term neonate is up to 5 times that of an adult and that of preterm is 7 times than of an adult.
  4. Stratum corneum or the outermost layer of skin of a preterm baby is thinner than that of a term baby.
  5. At birth, the pH of newborn skin is slightly acidic whereas the adult skin has acidic pH from 5 to 5.5. Alkaline pH predisposes to diaper dermatitis and favours colonisation of Staphylococcus aureus and Candida albicans.


The skin of the newborn undergoes structural and functional modifications from the first few days of life up to almost the first year to adapt to the transition from the utero wet world to the extrauterine environment. The structural and functional immaturity of the skin of a preterm baby results in increased transepidermal water loss, susceptibility to mechanical trauma, microbial invasion and percutaneous absorption of toxins. In order to reduce the morbidity associated with immature skin barrier, optimum care for the skin of a newborn is essential.

 Cleansing and cleansers

Cleansing is a process of removing dirt, sebum, micro-organisms, exfoliated corneum cells from the skin surface by a complex interaction between the skin barrier, dirt, body secretions and a surfactant. Water is a good cleanser which removes the water soluble dirt but not the fat soluble particles.


Cleansers are surface active substances that emulsify the fat soluble particles and convert them into water soluble matter which can be washed off with water. Today a wide variety of soaps, special soaps and liquid cleansers are available in the market.

Cleansers are classified into three categories, namely true soaps, syndet bars and combars. Soaps are fatty acids derived from animal fat or vegetable fat processed with sodium or potassium hydroxide by saponification.

True soaps are composed of long chain fatty acid-alkali salts with a pH between 9 and 10. The high alkaline nature causes dissolution of lipids from the skin surface, disruption of acid mantle and stratum corneum barrier and raises the pH of the skin, Soap precipitates in hard water producing insoluble calcium or magnesium salts that prevent foam formation. Use of soap particularly in diseases of the skin may cause dryness and irritation of the skin resulting in redness and itching.

Special additives added to the soaps have resulted in the various subsets of soaps such as superfatted soaps, transparent soaps, medicated antibacterial soaps. Superfatted soaps contain increased oil and fat which help in minimizing the dryness of skin. Transparent soaps contain glycerine and sucrose. Antibacterial soaps contain antibacterial agents such as triclosan, triclocarban. These soaps reduce the skin biofilm bacterial count by blocking the lipid synthesis in the bacterial cell wall.

Syndets or synthetic detergents are synthetically derived organic quarternary ammonium compounds or polymerized or sulfonated fatty acids. They have a pH of 5.5 to 7. They are less likely to produce dryness and irritation of the skin.

Combars are composed of alkaline soaps to which surface active agents with a pH of 9 and 10 are added. They are milder cleansers than true soaps.

Other variants of cleansers

Soapless cleansers are lotions that are primarily composed of either glycerine or propylene glycol and cetyl/steryl alcohols and they can be wiped off without using water.

Liquid cleansers with appropriate blend of anionic, non-ionic and amphoteric surfactants are available. They are milder in nature and do not disrupt the skin barrier or acid mantle.

An ideal skin cleanser is one that is mild and has minimal interaction with skin and removes all unwanted materials from the skin. It should not affect the acid mantle of skin surface. It should be colourless and fragrance free and should not irritate the skin or eyes.



Shampoos that are available in the market are soapless and consists of a principal surfactant for detergent and foaming power, secondary surfactants to improve and condition the hair and additives to complete the formulation and special effects. Formaldehyde is the most common preservative used in shampoos and does not cause any side effects due to the short contact.

Baby shampoos should be ideally fragrance free and should not cause eye irritation. Medicated shampoos with ketoconazole, tar, zinc pyrithione, salicyclic acid are available for special hair conditions.


Vernix Caseosa


It is a naturally occurring complex, lipid rich substance coating the skin surface of the fetus. It is a chalky white material with shed epithelial cells, sebum and sometimes lanugo hair.

Preterm babies have very little vernix compared to the term babies and post term babies may not have vernix.

Vernix is highly beneficial. It is a natural cleanser and moisturizer with anti-infective, antioxidant and wound healing properties. It helps in the development of acid mantle and supports the normal bacterial colonization. WHO guidelines mention that vernix should not be removed at the time of birth.

Bathing the newborn


WHO guidelines mention that the initial bath for term newborn should be given 6 hours after birth. Any baby who is term and weighs more than 2.5 kgs could be given bath 6 hours after birth. In term IUGR babies only sponge bath is to be given until the baby’s weight crosses 2.5 kgs. There are some studies which have advocated bath after fall of the umbilical cord. Bathing makes the baby calmer and quieter than washing with cloth or sponge. The tactile stimulation that occurs during bathing provides a pleasurable experience for the baby and promotes the bonding between the baby and the parent or the caregiver.

How to give a bath:

  • Should be given in a warm room
  • Temperature of the bathwater should not exceed 37°C
  • Check the temperature of the water before placing the baby in the bath
  • If tub bath is given, the depth of the water should be 5cm up to the hip of the baby
  • Bathtubs may be a potential source of infection hence they must always be disinfected
  • Bath duration should not exceed 5 minutes in order to prevent overhydration of the skin which may lead to easy fragility of the skin and decrease threshold for injury

Routine bathing

Routine bathing of newborns and infants does not cause any harm. Daily baths are more preferable but during winter and in the hilly regions babies may be given bath twice or thrice in a week. 


Use of alkaline soaps during the neonatal period is to be avoided. If possible, liquid cleansers with acidic or neutral pH may be used which will not affect the skin barrier function or acid mantle. Syndets and mild soaps may be used in infants.

Care of the diaper area


Diaper area is exposed to excessive hydration, occlusion, friction and maceration. Faecal ureases catalyze the breakdown of urea to ammonia, which increases the pH of the skin surface. The pH increase will contribute to the activity of faecal enzymes, proteases, ureases and lipases which are highly irritant to the skin. Water and wet cloth are the gold standards for cleansing the nappy area. Mother should be advised to use only cloth napkins which should be changed frequently. It is important to keep the area dry. After defecation, moistened cloths or cotton balls soaked in lukewarm water can be used for cleaning the area. In case diapers are used, barrier creams containing zinc oxide and petrolatum based preparation could be used. Cloth napkins are to be washed with a mild detergent in warm water and dried in sunlight. Use of antiseptics to be avoided as a routine.

Care of the umbilical cord

Umbilicus should be kept dry and clean. Lukewarm water should be used for cleaning and cord should be kept exposed to air.

Care of the scalp

Cradle cap of the scalp is common in newborns. Mineral oil can be applied to the crusts and removed after two to three hours. Baby shampoos which are free from fragrance could be useful in removal of crusts and scales. The pH of the shampoos should be close to that of tears and should not cause irritation to the eyes.


Baby’s hair wash is to be given after the cord falls with a frequency of twice a week after that.

Use of baby powders


Mothers should be advised to smear the powder on the hands and then gently apply on the baby’s skin. Accidental inhalation of powders could happen if applied with puffs.

Care of the skin of preterm baby

Preterm babies have immature barrier function which results in increased transepidermal water loss, increased skin permeability, impaired thermoregulation, increased percutaneous absorption and susceptibility to trauma.

There is acceleration of permeability barrier maturation following birth hence within 2 to 3 weeks post-natally, babies develop competent barriers. But in preterm born at 22 to 25 weeks it takes 8 weeks to mature. In these preterm babies acid mantle develops over 2 to 8 weeks after birth. Gentle and minimal handling of the preterm babies is to be practiced. Hand hygiene measures are to be strictly followed by the mother or health care workers.

Sponge bath with water is to be given until the baby weighs 2.5 kgs after which regular bath is advised with mild cleanser. Micropore adhesives may be used to secure IV cannulas and while removing the adhesives use guaze piece soaked with warm water. Gentle application of emollients will help reduce the dryness and maintain the barrier function. Emollients also decrease the risk for invasive infections in preterms by preventing access to deeper tissues and the bloodstream through skin portals of entry.



Emollients are lipid containing substances that soften the skin and prevent transepidermal water loss. They help in restoration of skin barrier and thus retard further damage. Emollients contain hydrocarbon oils like petrolatum, mineral oils, paraffin and squalene. Fatty acids like lanolin acid, stearic acid and fatty alcohol like lanolin alcohol and cetyl alcohol are also used as emollients. Regular use of emollients is indicated in preterm babies. Emollients could be used in term babies with cleansers induced dryness.

Massage – Touch therapy

Touch is considered absolutely essential for growth and development of a neonate.

Lack of appropriate touch results in poor growth of the infant, delayed attachment to parent and psychological disturbances. Systematic application of touch is termed as massage. Massage promotes circulation, suppleness and relaxation of the different areas of the body and tones up the muscles. Massage results in promotion of mother-infant bonding.

Benefits of massage


  • Increases food absorption hormones such as insulin
  • Increased weight gain by increasing insulin and insulin like growth factor
  • Greater bone mineralisation and more optimal behavioural and motor responses
  • Babies become more active and alert

Oil massage

Oil massage is traditionally practiced in India. Oil enhances skin barrier function, acts as a source of warmth and nutrition and increases weight gain. Infants also showed less stress behaviour and lower cortisol levels following massage. Very low birth weight preterm neonates given oil massage showed better weight gain. Coconut oil, sunflower oil, mineral oil and synthetic oil are being used for massage. Mustard oil is recently been discouraged due to irritant and allergic contact dermatitis potential. Sunflower oil enhances the skin barrier function. Some studies have shown that olive oil can cause erythema and disruption of skin barrier function. During summer one has to avoid oil massage when baby has miliaria rubra. Oil massage should be given before bath during summer and after bath during winter.


Massage is ideally given by mother, father, grandparents or caregivers. It could be started after the 10th day of life in a well baby. Massage is to be given to babies when they are alert and active, preferably 1 to 2 hours after feed. Massage is to be done in a warm room. Mother or the caregiver has to cut their nails, and remove rings and watch. Strokes should be gentle and firm and not jerky. These gentle strokes should be given from head to foot. As the baby may not lie still, one should work with and not against the movements. Full body massage will take 15 minutes.


Comfortable signs of baby enjoying massage are happy vocal sounds like cooing, easy breathing pattern, bright-eyed look, ability to focus and take in surroundings comfortably and enjoying stretching, sucking, clasping own hands or feet.


ZIKA Virus


The Zika virus, a mosquito-transmitted disease, was first identified in the Zika Forest of Uganda in 1947 in the rhesus monkey. Eventually, it got transmitted to humans in 1952. This illness is transmitted by two species of mosquito — Aedes Albopictus and Aedes Aegypti. The Zika virus is similar to yellow fever, dengue, West Nile and Japanese Encephalitis viruses.


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Signs & Symptoms:

The time from incubation to exposure is not so clear but it lasts for 2-7 days.

  • The symptoms are a bit similar to dengue, usually causing mild illness which appears after some days of being bitten by an infected mosquito.
  • Mild fever, skin rashes, headache, muscle and joint pain, and pain behind the eyes may occur in an infected person.
  • Conjunctivitis, vomiting and malaise are some other symptoms of Zika virus.

 Modes of Transmission:


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  • Primarily, the Zika virus gets transmitted to humans through the bite of an infected Aedes mosquito, mainly Aedes Aegypti.
  • Unlike the Anopheles mosquito causing malaria which is active during night hours, the Aedes mosquito is extremely active during daytime; it can survive in both outdoor and indoor environment.
  • When a mosquito feeds on the blood of an infected person, it gets infected itself, transmitting the virus to other humans through bites.
  • Transmission through asymptomatic blood donors in whom RNA of Zika virus has been identified.
  • Possible transmission through sexual contact has also been reported.


A Zika virus infected person can be diagnosed through the following ways:

  • The presence of the Zika virus can be based on general symptoms such as mild fever, rash, conjunctivitis, pain, vomiting, uneasiness etc., Zika virus can be suspected through the patient’s place of living and history of travelling.
  • However, proper diagnosis is done by laboratory testing of blood, urine, saliva or other body fluids through the following tests:
  • PCR (Polymerase Chain Reaction) or by RT-PCR (Reverse-Transcription Polymerase Chain Reaction) for viral RNA
  • Serology Test


As the disease caused by Zika virus is usually mild, it does not require much medical attention. Those infected require proper rest, should drink plenty of fluids and take common medicines for fever and pain.

If the symptoms worsen, it is advisable to seek proper medical treatment. Currently, there is no vaccine or specific drugs available to fight the Zika virus.


To protect yourself from Zika virus, the following measures should help:

  • Avoiding mosquito bites is the best prevention.
  • Using insect repellent to kill mosquitoes.
  • Wearing light-coloured clothes that cover most parts of your body.
  • Sleeping under mosquito nets.
  • Covering water containers and emptying them from time to time

Microcephaly and Zika Virus:

Microcephaly is a neurodevelopmental disorder due to which babies are born with unusually small heads. The brains of these babies don’t develop properly during pregnancy or may stop growing in the first year of birth. Children infected with microcephaly experience problems like intellectual defects, developmental delays, hearing loss etc. It may also occur if a pregnant woman is malnourished, has diabetes or consumes alcohol.


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It is found that the rate of babies born with microcephaly in the virus-affected places is rising due to the possibility of pregnant women being infected by Zika virus.

Those travelling to infected areas should take all the preventive measures. Women planning to get pregnant or already pregnant and living in the affected areas should follow the measures strictly. Others should refrain from visiting these places so they don’t get infected.

Virus Affected Zone:

As per the update till 15 February, 2016, the Centers of Disease Control and Prevention (CDC) have warned about travel in the following areas with Zika virus transmission.

  • South and Central America: Brazil, Bolivia, Colombia, Mexico, Costa Rica, Paraguay, Panama, Venezuela Ecuador, El Salvador, French Guiana, Guyana, Guatemala, Honduras, Suriname and Nicaragua
  • Caribbean: Dominican Republic, Puerto Rico, Guadeloupe, Haiti, Jamaica, Barbados, Curacao, Saint Martin, Martinique and US Virgin Islands
  • Oceania: Samoa, American Samoa and Tonga
  • Africa: Cape Verde

Urinary Problems During Pregnancy

Many women experience some unpleasant conditions during pregnancy like urine infection, urinating more frequently, constipation, haemorrhoids etc.


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Urinary Tract Infection

Generally, urine infections are caused by bacteria from the skin, rectum or vagina which enters the urethra. There are different types of urinary tract infection, commonly known as UTI. Below are some of the urinary tract infections which occur during the time of pregnancy.


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Kidney Infection: Also known as pyelonephritis, kidney infection is one of the most serious complications during pregnancy period. Germs in the form of bacteria travel from the bladder up through the urethras which infect the kidneys. If not treated on time, the infection may spread on the bloodstream which becomes life-threatening at times.

Asymptomatic Bacteriuria: Sometimes, bacteria reach the urinary tract without showing any type of symptoms in pregnant women. This type of bacteria is known as asymptomatic bacteriuria. If such bacteria form in non-pregnant women then there is no problem at all. But in case of pregnant women, it needs to be treated. If asymptomatic bacteriuria is left untreated, it increases the risk of kidney infection. So, during your pregnancy, get your urine tested regularly. And if you are tested positive, you will be given oral antibiotics which are safe to consume during pregnancy period.
Cystitis or Bladder Infection: Cystitis or bladder infection is most common among women between the ages of twenty to fifty who are sexually active. In such case, bacteria form in the bladder where it multiplies which causes inflammation and other symptoms of bladder infection.


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Symptoms of urinary tract infection

In some cases, there are no symptoms of urinary tract infection. But during your first pre-natal examination, your doctor will test for asymptomatic urine infection. And if the below mentioned symptoms arise in your pregnancy period, consult your doctor.

  • Sudden and quick urge to pee, also known as urinary urgency
  • Burning sensation or pain while urinating
  • Bloody urine
  • Foul smelling urine
  • Feeling pain in the area of pubic bone

How to avoid urinary tract infection?

If you are a pregnant woman, you can minimise the chance of getting affected with urinary tract infection by taking the following measures.

  • Drink lots of water every day to keep hydrated
  • Empty your bladder fully when you urinate. And don’t stop your urge to pee as this may lead to urine infection
  • To prevent bacteria in the stool getting near the urethra, wipe yourself from front to back after the bowel movement
  • Always keep your genital area hygienic and clean by cleaning with water and mild soap
  • During your pregnancy avoid using sprays, powders and strong hygienic wash in the genital area as it can irritate your genitals and urethra. It makes a better place for the bacteria to breed
  • To eliminate genital bacteria, urinate before and after sex
  • You can drink cranberry juice during your pregnancy as it helps in reducing the level of bacteria and stops breeding in the urinary tract
  • Stay away from having chocolate and caffeine during your pregnancy as it can irritate the bladder

Treatment of urine infection during pregnancy

There are different types of antibiotic which help to stop urine infection during pregnancy. Usually seven days course is prescribed by the doctor to treat urine infection. The antibiotic given by the doctors during the time of pregnancy are safe to consume and doesn’t have any adverse effect. So, consult your doctor and get urine test done from time to time to keep a check on urinary tract infection and get treated accordingly.

For those infecting with cystitis can drink plenty of water and flush out the bladder time to time. But it is advisable to consult your doctor if such infection occurs. However, drinking lots of water helps you keep hydrated if you have fever during your pregnancy.

All You Wanted to Know About Pelvic Exercises During Pregnancy


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While pregnancy is physically demanding, exercise becomes necessary to cope with the physical as well as biological changes that affect specific areas such as muscles, joints, backbone and especially the pelvic floor. In this post, we are going to share how pelvic floor exercises during pregnancy are important since they not only help reduce pelvic pain but also ease the childbirth procedure.

Your takeaway from this blog post on pelvic floor exercises during pregnancy

  • Where are pelvic floor muscles located
  • How to locate pelvic floor muscles
  • Why is pelvic floor exercise so important
  • How does pregnancy affect pelvic floor
  • Benefits of pelvic floor exercises
  • Types of pelvic floor muscle exercises
  • What else you should know about pelvic floor exercises

Before we jump into the workout section, let’s have a quick intro on pelvic floor –


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 Where are pelvic floor muscles located?

As the name suggests, the pelvic floor muscles form the base of the pelvis.

Pelvic floor is a group of muscles, ligaments and sheet-like tissues that stretch from the front side to the back side i.e. base of your spine. These muscles are attached to the pelvis sides (the bones that we sit upon). They are also attached to the pubic bone and the coccyx i.e. tailbone. These muscles pass through the vagina, anus and urethra, as shown in the image.

What do pelvic floor muscles do?

  • They help in supporting the bladder, uterus and intestines.
  • They help in controlling bowel and bladder movement.
  • They help in sneezing, coughing and lifting heavy objects.
  • They support the spine and help during sex.

How to locate pelvic floor muscles?

Try to control your flow while urinating, and you can soon identify the muscles which help you stop the flow in the middle of urinating. However, it is not ideal to do this as an exercise as stopping the flow can affect your bladder.

Another way of identifying these muscles is by inserting two fingers into your vagina and try squeezing them. You will soon understand the mechanism.


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Why is pelvic floor exercise so important?

  • As already discussed above, the pelvic floor muscles support the uterus and help in bowel as well as bladder movement, so if the pelvic floor is weakened then the muscles become harder to be squeezed which affects urinating and bowel movement.
  • Weak pelvic muscles may also put you in an embarrassing situation as you may pee a little while coughing or sneezing. This further leads to a heavy dragging-like feeling because of improper bladder and womb movement.
  • Weak pelvic muscles also affect vaginal muscles.
  • Not only during pregnancy but pelvic muscles should be well maintained as post menopause hormonal changes worsen the abovementioned problems, thereby causing sagging of the uterus and bladder towards the walls of the vagina.

By regularly doing a few pelvic floor exercises, bladder weakness or prolapse symptoms are kept at bay, while reducing the pelvic pain during pregnancy and labour pain as well. 

How does pregnancy affect the pelvic floor?

The extra pounds that you put on following pregnancy exert pressure on your pelvic floor muscles, thereby leading to weakness that persists even after the childbirth. The pelvic floor tends to become weak as early as 12 weeks into your pregnancy.

As constipation is one of the common health problems for expecting moms, it can put more strain on your pelvic floor thus increasing the pelvic pain.

Benefits of doing pelvic floor exercises

  • They help in toning up the pelvic floor.
  • They help in reducing the risk of uterine/bladder prolapse.
  • They help during labour, while improving the recovery time.
  • They help in reducing post-partum discomforts such as perineal swelling and hemorrhoids.
  • They help in healing the area between anus and vagina i.e. perineum post-partum, by improving the blood circulation.
  • They help in reducing perineal tearing and the likelihood of episiotomy.
  • They help in the complete emptying of the bladder and bowel.
  • They help in maintaining the muscle tone of the vagina thereby easing the delivery process.
  • They help in preventing urinary leakage during pregnancy.

Types of pelvic floor exercises


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Since your pelvic floor muscles comprise two types of fibres — fast fibres that render strength and slow fibres that render stamina; we offer you two types of pelvic exercises during pregnancy for best results.

Short squeezes in pelvic floor exercise –

  1. Sit down comfortably by slightly stretching your knees. Stretch the muscles around the back passage just as you would do to stop your bowel movement.
  2. Now do the same thing at the front, as if you are squeezing your vagina to stop urinating.
  3. Make sure the squeezes are strongly executed in as much that you feel a definite ‘let go’.
  4. These types of short squeezes should not last for more than a few seconds.
  5. Try to do three sets per day in different positions.

Long squeezes in pelvic exercises during pregnancy

  1. Sit down in the same position as you had done for short squeezes and repeat the above step. The only difference is you need to hold it for a longer time i.e. a few extra seconds. But always remember to breathe normally.
  2. Make sure in the process you’re not constricting your buttock muscles. You can stress your lower abdominal muscles a bit but don’t squeeze out your anus.
  3. Take a break of few seconds before repeating the above step. However, you should stop immediately if you feel your muscles are tired.
  4. Try to find out how long you can hold on to the squeezing, say 4 seconds. This will help you do the long squeezes better.
  5. Now when you become comfortable with the 4-second long squeeze, try to increase it to say 10 seconds. You can gradually increase the counts with each workout.

Bonus points — What else you should know about pelvic floor exercises?

It is equally important to relax pelvic floor muscles as it is to tighten and squeeze them. It is especially important when the baby starts crowning its head during second stage of labour. The pelvic muscles need to be relaxed during this stage, so as to avoid episiotomy.

Make sure you drink a lot of fluid and that you urinate only when you feel your bladder is completely full. Since the frequency of urinating increases during pregnancy, do not try to hold on for too long as it affects the bladder.


What is Hysterosalpingogram ?

Hysterosalpingogram (HSG) is an X-ray test done to know about the patency of the fallopian tubes, which help in the transport of the egg and the fertilized embryo. It is usually done on 7th or 8th day of the menstrual cycle.


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Procedure and Instructions to be Followed for the Investigation

  1. In this test, a small amount of liquid (dye) is pushed into the uterus through a small instrument (speculum) placed in the vagina and an abdominal X-ray is taken. There can be period-like crampy pain during the procedure.
  1. To prevent pain, we advise Tab. Meftal spas to be taken with food, 1 hour before HSG and to continue it 8th hourly depending on the pain for the next two to three days.
  1. This test delineates the uterine cavity and the tubes. If the tubes are open, the dye flows out of the tubes and can be seen on the X-ray film.
  1. As this test involves pushing some liquid into the uterus, there can be a small risk of infection. In order to avoid this, we advise antibiotic Tab. Doxycycline 100 mg two times a day after food, starting from the day of HSG which has to be continued for a total of five days.
  1. Once HSG test is done, a gynaecology consultation (by appointment) with the report is advised.

Medical Ectopic Pregnancy

Ectopic pregnancy (EP) is a pregnancy situated outside the uterine cavity (normal location). Early diagnosis of EP is possible with the advent of high resolution ultrasound and judicious use of serum Beta hCG levels (blood test), which in turn allow medical management in most cases. The choice of treatment should be guided by eligibility criteria and patient’s choice after discussing risks and benefits. Methotrexate (MTX) is the drug used for medical management of EP, sometimes in combination with mifepristone.


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Prerequisites for Medical Management

  • Asymptomatic women with unruptured EP who are clinically stable, have normal baseline blood investigations (blood counts, liver and kidney function tests) and are willing for regular follow-up for 4-6 weeks, can be offered medical management.
  • High serum Beta hCG levels (> 3500 mIU / ml), ectopic mass size > 3.5 cm and / or presence of cardiac activity in EP are relative contra indications to medical management.
  • It should not be offered to those with significant bleeding into the abdomen or those with a coexisting viable intrauterine pregnancy.

Methotrexate Administration

Two protocols are currently used for medical treatment of EP : “Single Dose” MTX therapy at a dose of 50mg/m2 of body surface area and “Multidose” regimen consisting of 1mg / kg of MTX alternating with 0.1mg / kg of leucovorin for upto 4 doses of each agent. Both regimens are found to be effective.

  • MTX can be given on Out Patient basis and intramuscular administration is the preferred route.
  • Multidose regimen is preferred in women with high serum Beta hCG levels or those with presence of cardiac activity on ultrasound. In the single dose regimen, further doses of MTX may be repeated (upto a maximum of 3) if there is an inadequate response (<15% drop in serum Beta hCG).
  • In the single dose regimen, further doses of MTX may be repeated (upto a maximum of 3) if there is an inadequate response (<15% drop in serum Beta hCG).

Laparoscopy is indicated if :

  • Severe abdominal pain or signs suggestive of tubal rupture develop.
  • There is no satisfactory drop in serum Beta hCG levels even after 3 doses in the single dose regimen or 4 doses in multidose regimen.

Anti D:

Regardless of the method of treatment Anti D should be given to all Rh negative women who have an EP.

Patient Should Be Advised To

  • Avoid sexual intercourse until Beta hCG is <10 mIU / ml.
  • Avoid pregnancy for three months after MTX injection, due to the theoretical risk of birth defects with MTX.
  • Avoid sun exposure to limit risk of MTX dermatitis.
  • Avoid foods and vitamins containing folic acid.

Post Treatment Management

Beta hCG   Serial serum Beta hCG levels need to be checked on days 4 and 7 after MTX.

  • If there is >15% decrease between days 4 and 7, weekly follow up is advised until Beta hCG is <10 mIU / mL.
  • If <15% decrease is noted by day 7, 2nd dose of MTX is advised.
  • In multidose regimen, serum Beta hCG levels are checked every 48 hours till significant decrease is noted and weekly thereafter.

Ultrasound It is generally not repeated except to evaluate severe pain or suspected rupture or for patients with cardiac activity in the EP.

After completion of treatment, an ultrasound is advised to check for resolution of the EP which may take upto 3 months at times.


  • Overall success of medical management is 88 – 90%.
  • Around 14% of patients require a 2nd dose and less than 1% of women require more than 2 doses of MTX.

Side Effects

Drug related

Adverse reactions to MTX are usually mild and self-limited. Approximately 30% of patients in the single dose protocol will experience side effects, the most common are mouth ulcers and conjunctivitis.

Separation pain

Up to 75% of patients may complain of pain between days 2-7 after receiving the medication. This pain is usually mild and can be managed with paracetamol. Women with severe pain require further evaluation to rule out rupture of EP and the need for surgery.

Subsequent Reproductive Performance

  • There is no evidence of adverse effects of MTX treatment on future pregnancies.
  • Studies have shown a subsequent intra uterine pregnancy rate of 60-90%.
  • The incidence of recurrent EP is approximately 7-15%.
  • Women should be instructed to undergo an early ultrasound evaluation in subsequent pregnancies to confirm normal intrauterine location.

Cervical Cancer

Cervical Cancer CAN be avoided

The thought of cervical cancer is a particularly alarming one for all women, since no one knows exactly how it is caused. Many factors appear to be involved and not all of these will be present for every woman.


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Why have a Cervical Smear Test?

Cervix is the lowermost part of the uterus. If detected early, the majority of cervical cancer cases can be avoided and the disease can be halted. Unfortunately, during the early stages there are no signs to tell a woman that she may be at risk. One of the simple ways to detect it, is by having a cervical smear test (also called a PAP SMEAR). Once it is discovered, treatment to counteract can be initiated. The early warning signals can be detected, which if left untreated could lead to cancer.

What is a Cervical Smear Test?

A smear test is a very simple way of checking the health of the cervix. By looking at the smear, experts can confirm if the cervix is normal and healthy, or abnormal. Presence of abnormal cells suggests cancer may develop in the future.

When to have the Smear Test?

  • Women between the ages of 20 – 60 years should do the test every 3 years.
  • Women who have excess / recurrent attacks of vaginal discharge or bleeding after sexual intercourse should do the test, regardless of their age.
  • It should be done within 10 days of the onset of periods.
  • There should be no bleeding at the time of the test.

How is a Smear Test done?

The smear test is a simple out patient procedure where the gynaecologist scrapes some of the cells from the cervix (the neck of the uterus), and smears it on a glass slide and sends it to the lab for examination.

What happens after the Test?

It takes 3-4 days to get the results from the lab. If the smear test is normal, (as it is in a majority of cases), then it should be repeated after 3 years.

If the test discloses some “abnormalities”, this usually means that some changes have occurred in the cells, which, if left untreated, could develop into cancer after many years. Remember, most women who have had an abnormal smear test are successfully treated.

Once treatment is started, it will be necessary to repeat the test after some months. If the subsequent smear tests are normal, then the tests should be done every 3 years.

If, however, the subsequent smear tests are not normal and continue to show some abnormalities, then it will be necessary to investigate further.

One of the easiest and most accurate ways of studying the cervix and confirming the disease is by undergoing a Colposcopy.

Cervical Cancer


Colposcopy is an in-depth examination of the cervix, through a special microscope called a colposcope. A colposcope acts like a magnifying glass with a light and allows the doctor to have a closer look at the cervix.

What happens during Colposcopy?

A Colposcopy examination is an out patient procedure, just like the smear test. A solution is applied to the cervix, which will cause any problem areas to turn white. The cervix is then viewed through the colposcope, which is placed just outside the vagina. If there are any abnormal areas on the cervix, a tiny sample of tissue is taken (biopsy) and sent to the lab for further testing.

After Colposcopy

There is no need for an overnight stay in the hospital after a Colposcopy. As mentioned earlier, it is an out patient procedure. If some tissue is taken from your cervix, you may experience some mild cramping or light bleeding for a few days, which can be relieved by any anti-inflammatory medication. It is advisable to abstain from sexual intercourse for a few days after a biopsy.

he results of the biopsy will determine the course of action to be taken. Feel free to talk to your gynaecologist about the type of treatment, the duration, and the options available.

Cervical Cancer

STEM CELLS – Frequently Asked Questions

Q. What are stem cells?
A. Stem cells are the master cells of our body from which all the other 250 types of cells are formed. The umbilical cord blood mainly contains hematopoietic or blood cell forming stem cells i.e., stem cells that form Red Blood Cells, White Blood Cells and platelets.

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Q. In what conditions can stem cells be used?
A. As of now, stem cells have been used to treat almost 70 blood related diseases. Some of them are blood cancers like Leukemia and Myelo-proliferative disorders, Inherited Red Cell abnormality like Thalassemia, Immune-deficiency disorders and inherited metabolic disorders.

Q. What is the difference between Public Cord Blood Banking and Private Cord Blood Banking?
A. In public cord blood banking, there is no cost to the family concerned. The family donates their baby’s cord blood to the bank for future use by any Indian, subject to HLA compatibility or for research purposes. The cells belong to the bank and the family has no claims on the cells.

In private cord blood banking, the family pays a fee for storing their baby’s cord blood ONLY for their future use. The cells belong to the family.

Q. What is the rationale for public banking?
A. When the stem cells are donated, these cells can be made available to anyone across the world who is a perfect HLA match. Hence the likelihood of usage is much more, especially for Indians in any part of the globe as these HLA proteins are similar in people of the same ethnic origins.

Q. Does collecting cord blood affect the baby?
A. No. Cord blood is collected only after the birth of the baby and after clamping of the umbilical cord. The baby is in no way deprived of blood as the routine process of delivery is not interfered with in any way.

Q. Does the cord blood collection harm the mother?
A. No, it does not harm the mother in any way. It is a completely safe, harmless and painless procedure.

Q. Can all pregnant women donate cord blood?
A. Every healthy pregnant woman who has a normal pregnancy and a healthy foetus can opt to donate the cord blood of her baby.

Q. Will a blood sample be collected from the mother?
A. Yes, a sample from the mother will be collected at the time of onset of labour.

Q. What is HLA testing?
A. HLA or Human Leukocyte Antigen testing is the test for specific proteins that are present on the surface of the leukocyte (white blood cell). If stem cells from one individual have to be used for another person, the HLA types of the donor and recipient need to match.

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Q. How do I benefit from donating my baby’s cord blood?
A. Your cord blood donation will help the public cord blood bank to create a large inventory of tested stem cell units ready for transplant and thus increase the chances of finding a match. In the unforeseen event of any of your children needing a unit of stem cells for treatment of any haematological diseases, the public cord blood bank will make all efforts to find a best match available. In such an instance, you will only have to pay any additional testing charges and cost of transportation of the unit to the place of treatment.

Q. What are the chances that any one of us may need stem cells?
A. For a family to make use of the cells banked for itself, the likelihood varies from 1 in 400 to 1 in 200,000, as the usefulness is limited to the close family alone. Most of the childhood illnesses and cancers have a genetic basis and as the stem cells will carry signs of any genetic illness, the likelihood of the child using its own stored cells is also very remote.

Q. What happens if I donate to the public bank and then I need the stem cells myself?
A. If the cells you have donated are required for anyone else, the public bank shall issue these cells and keep you informed. If the cells are still with the bank, they will make them available to you at a concessional cost. This cost is for any additional testing and transport of the cells to the transplant site.

Q. What if there are twins?
A. Ideally, 70 ml or more cord blood is required to get adequate numbers of stem cells for transplant. In twin pregnancies, the volume of cord blood collected from each twin is appreciably less, as the weight of each twin is also less than an average weight of a newborn. Hence only in rare instances is cord blood collection in twin pregnancies encouraged.