Our dedication to expectant mothers begins at the very start of life itself. Led by our team of friendly and experienced consultants in the areas of Obstetrics & Gynaecology and Paediatrics, the maternity services team at KL Women Specialist is committed in providing safe and quality care to all patients.
Our highly skilled and experienced nurses are specially trained in neonatal care, midwifery and lactation to provide optimum care for your newborn lovely baby.
ULTRASOUND SCANNING IN OBSTETRICS & GYNAECOLOGY (DETAILED AND 4D SCAN)
With our recently acquired state of the art 4D ultrasound equipment, we are able to make the best assessment and diagnosis of all obstetrical assessments as well as gynecological diagnoses. This equipment provides unique information in the treatment and diagnosis of obstetrical and gynecological concerns.
Obstetric Ultrasound
Obstetric ultrasound uses sound waves to produce pictures of a baby (embryo or fetus) within a pregnant woman, as well as the mother’s uterus and ovaries. It does not use ionizing radiation, has no known harmful effects, and is the preferred method for monitoring pregnant women and their unborn babies. A Doppler ultrasound study – a technique that evaluates blood flow in the umbilical cord, fetus or placenta – may be part of this exam.
This procedure requires no special preparation. Since only your lower abdominal area needs to be exposed for this exam, you may want to wear a loose-fitting, two-piece outfit. Leave jewelry at home.
Gynaecology Ultrasound
The examination can be performed by transabdominal ultrasonography, generally with a full bladder which acts as an acoustic window to achieve better visualization of pelvis organs, or by transvaginal ultrasonography with a specifically designed vaginal transducer. Transvaginal imaging utilizes a higher frequency imaging, which gives better resolution of the ovaries, uterus and endometrium (the fallopian tubes are generally not seen unless distended), but is limited to depth of image penetration, whereas larger lesions reaching into the abdomen are better seen transabdominally. Having a full bladder for the transabdominal portion of the exam is helpful because sound travels through fluid with less attenuation to better visualize the uterus and ovaries which lies posteriorly to the bladder. The procedure is by definition invasive when performed transvaginally. Scans are performed by health care professionals called sonographers, or gynecologists trained in ultrasound.
How is the procedure performed?
For most ultrasound exams, you will be positioned lying face-up on an examination table that can be tilted or moved. Patients may be turned to either side to improve the quality of the images.After you are positioned on the examination table, the radiologist (a physician specifically trained to supervise and interpret radiology examinations) or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.
There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.
Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry quickly. The ultrasound gel does not usually stain or discolor clothing.
Sometimes the radiologist determines that a transvaginal scan needs to be performed. This technique often provides improved, more detailed images of the uterus and ovaries. This method of scanning is especially useful in early pregnancy.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician, or to the physician or other healthcare provider who requested the exam. Usually, the referring physician or health care provider will share the results with you. In some cases, the radiologist may discuss results with you at the conclusion of your examination.
Follow-up examinations may be necessary. Your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if a finding is stable or changed over time.
GYNAECOLOGY
A Pelvic ultrasound scan is the most effective imaging modality used to examine the uterus and ovaries. It is may also be used during pregnancy to monitor the health and development of the embryo or fetus. In males, a pelvic ultrasound usually focuses on the bladder and prostate gland. There are two methods of performing pelvic ultrasound; Supra-pubic (through a full bladder) and transvaginal (via the vagina). For Supra-pubic ultrasound you will need a full bladder for the scan and will be advised on how much water to drink and how long before the examination. For transvaginal ultrasound, no preparation is required.
Dysmenorrhea
Dysmenorrhea refers to painful menstruation. The pain can be severe enough to affect day-to-day activities.
- Primary Dysmenorrhea is the most common type of painful menstruation. This occurs where there is no underlying problems of the uterus or pelvis. It often occurs in teenagers and in women in their 20s.
- Symptoms:
- Pain usually begins few hours before or just with the onset of menstruation.
- The pain usually lasts for a few hours and may extend for the entire day.
- Painful contractions in the lower abdomen , which may radiate to the back and medial aspect of thighs.
- Secondary Dysmenorrhea occurs in association with underlying pelvic or uterus disease. Conditions that cause secondary dysmenorrhea include:
- Endometrosis
- Adenomyosis (endometrical cells which is lining of uterus are formed within the muscle of the uterus)
- Pelvic Inflammatory Disease
- Cervical Stenosis (narrowing of the opening to the uterus)
- Fibroids
Symptoms:
- Pain usually starts shortly before or at the beginning of the menstrual period
- Pain in the lower abdomen during menstruation
- Pain may be felt in the hips, lower back or thighs
- Nausea
- Diarrhea
- Headache
- Fatique
Fibroids
Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumours become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign or non-cancerous.
Symptoms:
- Heavy menstrual bleeding between or during the period that includes blood clots
- Irregular bleeding
- Painful sexual intercourse
- Lower abdominal or pelvic pain
- Abdominal enlargement
Endometriosis
Endometriosis refer to a condition where the lining of the uterus (endometrium) is present in abnormal sites such as the muscle layer of the uterus, ovaries, fallopian tubes and occasionally beyond the pelvis.
Symptoms:
- Painful periods
- Painful sexual intercourse
- Excessive vaginal bleeding during and in between periods
Pelvic Inflammatory disease (PID)
PID affects the genital tract. It is a spectrum of infection and inflammation of the upper tract organs, typically involving the uterus, fallopian tubes, pelvic peritoneum, and surrounding structures.
Symptoms:
- Lower abdominal and pelvic pain
- Fever
- Lethargy and headache
- Irregular and excessive vaginal bleeding
- Painful sexual intercourse
- Abnormal vaginal discharge
Leucorrhea
Physiologic leucorrhoea occurs during puberty, ovulation and around the date of menstrual cycle, mostly caused by estrogen imbalance.
Inflammatory leucorrhoea is a result from inflammation or congestion of vaginal mucosa. A gynaecologist must be consulted once the discharge turns yellowish or has an odour as that is a sign of diseases in progress.
Parasitic leucorrhoea is caused by parasitic bacteria. Common symptoms of parasitic leucorrhoea are burning sensation, itching as well as frothy, thick, white or yellow discharge.
Vaginitis
Vaginitis refers to inflammation of the vagina that can result in discharge, itching and pain, Vaginitis may be due to infections or non-infectious causes, which could be caused by bacteria, fungus, or parasitic organisms known as Trichomonas Vaginalis. Reduced estrogen levels after menopause and some skin disorders can also cause vaginitis.
- Trichomonas vaginitis is caused by the organism, Trichomonas vaginalis.Symptoms:
- Itching around the vagina
- Painful urination
- Increased frequency of urination
- Frothy, thin, greenish-yellow discharge with a foul odour
- Candida vaginitis is caused by the organism Candida albicans.Symptoms:
- Thick, white vaginal discharge that appears curd-like and in flakes, often adherent to the vaginal wall
- Severely intense vulvovaginal itching
- Painful sexual intercourse
- Trichomonas vaginitis is caused by the organism, Trichomonas vaginalis.Symptoms:
POLYCYSTIC OVARIAN SYNDROME PCOS
First described by Stein Leventhal in 1935, PCOS is a problem in which a woman’s hormones are out of balance. It is a syndrome-collection of signs and symptons, therefore the clinical presentations can be highly variable. Some of the clinical syndromes include:
- Irregular menses
- Hyperandrogenism
- Insulin Resistance and Obesity
- Infertility
- Long term consequences
It can cause problems with your periods and make it difficult to get pregnant. If it isn’t treated, over time it can lead to serious health problems, such as diabetes and heart disease.
Causes
The exact cause of PCOS isn’t known. Factors that might play a role include:
- Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.
- Low-grade inflammation. This term is used to describe white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
- Heredity. Research suggests that certain genes might be linked to PCOS.
- Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.
Complications
Complications of PCOS can include:
-Infertility
-Gestational diabetes or pregnancy-induced high blood pressure
-Miscarriage or premature birth
-Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver
-Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
-Type 2 diabetes or prediabetes
-Sleep apnea
-Depression, anxiety and eating disorders
-Abnormal uterine bleeding
-Cancer of the uterine lining (endometrial cancer)
Obesity is associated with PCOS and can worsen complications of the disorder.Diagnosis
There’s no test to definitively diagnose PCOS. Your doctor is likely to start with a discussion of your medical history, including your menstrual periods and weight changes. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne.
Your doctor might then recommend:
- A pelvic exam. The doctor visually and manually inspects your reproductive organs for masses, growths or other abnormalities.
- Blood tests. Your blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS. You might have additional blood testing to measure glucose tolerance and fasting cholesterol and triglyceride levels.
- An ultrasound. Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits sound waves that are translated into images on a computer screen.
If you have a diagnosis of PCOS, your doctor might recommend additional tests for complications. Those tests can include:
- Periodic checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
- Screening for depression and anxiety
- Screening for obstructive sleep apnea
Treatment
PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.Lifestyle changes
Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5 percent of your body weight — might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS, and can help with infertility.
Medications
To regulate your menstrual cycle, your doctor might recommend:
- Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
- Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn’t improve androgen levels and won’t prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.
To help you ovulate, your doctor might recommend:
- Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
- Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
- Metformin (Glucophage, Fortamet, others). This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don’t become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
- Gonadotropins. These hormone medications are given by injection.
To reduce excessive hair growth, your doctor might recommend:
- Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
- Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defect, so effective contraception is required while taking this medication. It isn’t recommended if you’re pregnant or planning to become pregnant.
- Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
- Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.
POLYCYSTIC OVARIAN SYNDROME PCOS
First described by Stein Leventhal in 1935, PCOS is a problem in which a woman’s hormones are out of balance. It is a syndrome-collection of signs and symptons, therefore the clinical presentations can be highly variable. Some of the clinical syndromes include:
- Irregular menses
- Hyperandrogenism
- Insulin Resistance and Obesity
- Infertility
- Long term consequences
It can cause problems with your periods and make it difficult to get pregnant. If it isn’t treated, over time it can lead to serious health problems, such as diabetes and heart disease.
ULTRASOUNDS SCAN IN PREGNANCY
Ultrasound has been used in obstetrics for more than thirty years. Evidence suggests there are no harmful effects on the human fetus. Most importantly, the ultrasound baby scan should only be used when there is an indication and that the fetus should be exposed to a pregnancy scan for the shortest duration of time as possible.
Early Pregnancy scan
(6-10 weeks gestation)Nuchal Thickness scan
(11-14 weeks gestation)Detailed Anomaly Scan
(18-23 weeks gestation)Fetal Growth and Health scan
(26 weeks gestation onwards)Doppler assessment of fetal vessels may be needed if there is cause for concern regarding fetal growth and well-being.
Newer technology with 3D/4D baby scans allow accurate visualisation of the fetal face and fetal spine.
The following tests and services are available at our centre.
