Gynecology and Obstetrics Online Doctors Consultation — page 8

In PCOS there is delayed periods. You can wait for 45 days from your last period.

Please explain in detail .when did you have your last period? when did you had your last intercourse?

Hi kalai, Of course, Kalai. Here's a detailed **doctor-format case summary** including your obstetric history, current condition, lab interpretation, and recommendations: ### **Patient Case Summary** **Name:** Kalai **Age:** 29 **Sex:** Female **Location:** Bangalore **Gravida 2, Para 1 (G2P1)** --- ### **Presenting Concern:** Patient is currently pregnant (second pregnancy) and concerned about the risk of **rubella affecting the fetus**, as in the first pregnancy the child was born with **congenital cataract** and has **developmental delay** attributed to **Congenital Rubella Syndrome (CRS)**. --- ### **Obstetric History:** **G1:** - **Full-term delivery**, 2.5 years ago. - Infant diagnosed with **congenital cataract**, delayed developmental milestones (not walking yet). - Mother was presumed to have **primary rubella infection** during the first trimester based on clinical history. - No documented vaccination history prior to first pregnancy. **G2 (Current Pregnancy):** - Routine antenatal screening shows **Rubella IgG positive**. - No clinical symptoms of recent viral infection (fever, rash, arthralgia, lymphadenopathy) during this pregnancy. - No documentation of **Rubella IgM** in the current pregnancy yet (pending or not performed). - No history of contact with any rubella-infected individuals. - Pregnancy age and trimester: [Insert gestational age or trimester if known]. --- **Lab Investigation Summary:** - **Rubella IgG:** Positive → Indicates **past infection or vaccination-induced immunity** - **Rubella IgM:** [Insert Result if Available] → **If Negative:** Confirms **no recent/active infection** → **If Positive:** May suggest recent infection — requires **IgG avidity testing** to determine timing of infection. **Clinical Assessment:** - Based on the **Rubella IgG positive** status and **absence of symptoms**, it is **most likely that the patient is immune** to rubella due to past exposure (either from first infection or natural immunity). - **Risk of fetal rubella infection in current pregnancy is extremely low**, provided **IgM is negative**. - No additional symptoms to suggest current rubella reinfection. - However, given history of Congenital Rubella Syndrome in the first child, **close fetal monitoring is advised**. --- ### **Recommendations:** 1. **Confirm Rubella IgM status:** - If not yet done, perform **Rubella IgM test**. - If **IgM negative**: Patient is immune; fetus **not at risk**. - If **IgM positive**: Recommend **Rubella IgG avidity test** to assess timing of infection (low avidity = recent, high avidity = old infection). 2. **Fetal Monitoring:** - Serial ultrasounds: Monitor fetal growth and look for signs of congenital anomalies. - Targeted anomaly scan (Level II) at 18–20 weeks. - If any abnormal findings: Consider **fetal echocardiography** and **neurosonography**. - TORCH screening may be done as part of the antenatal panel if not already done. 3. **Genetic Counseling / MFM Referral:** - Referral to **Maternal-Fetal Medicine (MFM) specialist** is recommended due to history of CRS in previous child. - Can provide additional guidance and high-risk pregnancy management. 4. **Psychosocial Support:** - Reassure patient regarding the low likelihood of rubella affecting this pregnancy if immune. - Encourage regular antenatal visits and complete pregnancy monitoring. --- **Summary:** Kalai is a G2P1 woman with a past pregnancy affected by Congenital Rubella Syndrome. She is currently Rubella IgG positive, suggesting immunity. If IgM is negative, there is **no risk of rubella-related congenital defects** in this pregnancy. Continued monitoring is advised due to past obstetric history. --- If you provide your **Rubella IgM result** and **gestational age**, I can complete this summary for you with exact details. You're doing an excellent job being careful with this pregnancy, Kalai—keep following up with your doctor regularly, and don't hesitate to ask for specialized care when needed. Dr Shayeque Reza MD 9800280276

Though we don’t regularly advise medications for helping lactation but I believe breastfeeding is the first thing which connects mother to her infant. Now for non medical management part 1. Correct position and breastfeeding techniques https://www.researchgate.net/figure/Breastfeeding-techniques-and-Burping-Positions_fig1_364305561 2. It is advised to take no stress which means you should be calm everytime. 3. Keep trying even if no milk is being poured out from any breast 4. Trying emptying breast manually As far medication is involved Take 1. Tablet Domstal 10mg three times a day until optimal breast milk comes out from each breast 2. Lactogranules- put it in milk PS- Tablet Domstal can have a side effect- causing your neck to turn at one side. It is quite common side effect. In case you experience such side effect stop the medication and don’t panic it will become normal after sometime. Hope it solves your query Thank you

Though we don’t regularly advise medications for helping lactation but I believe breastfeeding is the first thing which connects mother to her infant. Now for non medical management part 1. Correct position and breastfeeding techniques https://www.researchgate.net/figure/Breastfeeding-techniques-and-Burping-Positions_fig1_364305561 2. It is advised to take no stress which means you should be calm everytime. 3. Keep trying even if no milk is being poured out from any breast 4. Trying emptying breast manually As far medication is involved Take 1. Tablet Domstal 10mg three times a day until optimal breast milk comes out from each breast 2. Lactogranules- put it in milk PS- Tablet Domstal can have a side effect- causing your neck to turn at one side. It is quite common side effect. In case you experience such side effect stop the medication and don’t panic it will become normal after sometime. Hope it solves your query Thank you

Do you have discharge?

Patient Name: Varshini Age: 24 years Date: 13/04/25 Chief Complaints: Diagnosis of PCOS (ovarian enlargement, irregular periods) Subclinical hypothyroidism No medication prescribed by previous doctor for PCOS Diagnosis Considerations: Polycystic Ovary Syndrome (PCOS) Subclinical Hypothyroidism Irregular menstrual cycles due to hormonal imbalance Blood Tests: Repeat Thyroid Function Tests (TSH, T3, T4) to monitor thyroid status and ensure proper management. Hormonal Profile: LH, FSH, estrogen, progesterone levels to check hormonal imbalance. Glucose and Insulin Levels: To check for insulin resistance, which is common in PCOS. *Follow with the reports for your treatment plan* Thank you Dr Shayeque Reza MD 9800280276

Hello Niti, This is a matter of concern . You need proper treatment and I am here to help you. Thank you for sharing your details, I understand this must be an emotionally and physically difficult journey. While I can’t give a definitive diagnosis without access to full clinical records, I can explain possible reasons for implantation failure in your case and suggest what might help next, in a format that mirrors a specialist’s note. Follow-Up Clinical Note – Recurrent Implantation Failure Evaluation Patient Name: [Niti Makkar] Age/Sex: 36/F Date: 12-04-2025 Chief Complaints: 2 failed IUI cycles at Rani Bagh clinic 2 failed IVF cycles at AIIMS No successful embryo implantation History of PCOD, low AMH, thyroid disorder, and endometriosis Probable Contributing Factors to Implantation Failure Low AMH (Anti-Mullerian Hormone): Indicates diminished ovarian reserve. Often leads to fewer eggs retrieved and lower-quality embryos. Endometriosis: Can cause inflammation and immune dysregulation in the uterus. Alters endometrial receptivity (uterus lining may not support implantation well). PCOD (Polycystic Ovarian Disease): Causes hormonal imbalance and poor egg quality. Associated with insulin resistance, which may affect implantation. Thyroid Disorders (especially hypothyroidism): Even mild imbalances in TSH can reduce chances of successful implantation. Target TSH before and during pregnancy: <2.5 mIU/L Uterine Environment: Endometriosis or prior surgeries may cause scarring or poor blood supply. Thin or non-receptive endometrial lining could be a cause. May need Doppler and hysteroscopy assessment. Immunological Factors / Genetic Compatibility: Abnormal NK cell activity or immune rejection. Embryo genetics (aneuploidy) or HLA compatibility issues. Recommended Next Steps Investigations: Endometrial Receptivity Assay (ERA Test) – to check the optimal implantation window. Hysteroscopy – to directly assess uterine cavity for adhesions, scarring, endometriotic lesions. Thrombophilia Profile – rule out clotting disorders affecting blood supply to embryo. Autoimmune panel – ANA, antiphospholipid antibodies, thyroid antibodies. Karyotyping (you and partner) – rule out chromosomal translocation. Treatment Considerations: Frozen Embryo Transfer (FET) – in a hormonally controlled cycle after correcting thyroid, lining, etc. Use of donor eggs – may be considered due to low AMH and repeated IVF failure (if egg quality is a concern). Endometrial scratch or PRP therapy – may improve implantation rates in some patients. Immunotherapy (under guidance) – low-dose steroids, intralipid infusions if immune factors suspected. Lifestyle optimization – insulin resistance control (Metformin), thyroid strict control, anti-inflammatory diet. * Please give me your valueable review. Dr Shayeque Reza MD 9800280276

provide more information and reports.

hello kanchan… please let me know any medication you are taking.