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I am 20 weeks pregnant. Recently, I had a terrible headache and the doctor told me that it was due to lack of magnesium in the blood. The headache disappeared after I took the magnesium tablets. Are there any food rich in magnesium that I can take? Magnesium is a “mineral” that is required for the brain cell to function properly. It helps relieve migraine and headache. The following foods are rich in magnesium. Dark green leafy vegetables such as spinach, Kai Lan and Chye Sim. Nuts and Seeds: It is estimated that half a cup of pumpkin seeds will provide almost the daily requirement of magnesium. Almonds, Brazil nuts, cashews, pine nuts, sunflower seeds and flaxseed are also rich in magnesium Legumes such as soybeans( one cup of which will provides nearly all the necessary magnesium for the day), edamame, black beans, kidney beans, white beans, chickpeas, black-eyed peas, and lentils Fruits: Avocado, bananas, strawberries, blackberries, grapefruit, and figs. Dark Chocolate and low-fat yogurt Fish such as Salmon and tuna

I am 50 years old with 2 grown up children. Recently my mammogram showed some microcalcifications. Though my family doctor assured me that the radiologist’s report indicated that they are non- cancerous, I am still very worried. What are microcalcifications? Any relationship with the calcium tablets I take? Calcium deposits or calcifications in the breast are quite common among women over the age of 50. They are often due to changes in the breast tissues from aging, injury (e.g. previous surgery), or inflammation. They are too small for you to feel but will show up on mammogram. They have no relation to the calcium you take in your diet or supplements. There are two types of calcifications 1. Macrocalcifications: These are large white dots and are oftentimes noncancerous. 2. Microcalcifications: These are fine, white specks which are usually noncancerous. But when they are irregular in size, shape, or tightly clustered, they may be a sign of breast cancer. If calcifications are suspicious, further tests may be done, including an ultrasound examination, a magnified and compression view of the mammograms or a breast biopsy. You should also do self-examination of your breasts regularly. If you notice a lump or changes in the skin or nipple, please consult your doctor right away.

I am 45 years old. I had an episode of heavy and prolonged periods recently. My gynaecologist suggested that I should have a dilatation and curettage (D&C) to find out the cause. This was done a week ago and the report showed “endometrial hyperplasia”. What is this condition? Could it lead to cancer? In a normal menstrual cycle, the lining of the womb (endometrium), changes cyclically in response to hormones secreted by the ovary. After menstruation, the endometrium is thin but soon it grows in thickness in response to the rising levels of the hormone, oestrogen, produced by the growing follicles of the ovary. In the middle of the cycle, an egg is released from the follicle (ovulation). The levels of another hormone called progesterone begin to increase. This hormone prepares the endometrium to receive and nourish a fertilized egg. If pregnancy does not occur, both oestrogen and progesterone levels fall causing a complete shedding of the endometrium .A new menstrual cycle then begins. Endometrial hyperplasia is a medical condition when the endometrium becomes too thick from an overgrowth of the cells. It is often caused by an imbalance of oestrogen and progesterone resulting in an excess of the former. The endometrium continues to grow in response to oestrogen. The overgrown cells may crowd together and may become abnormal. This condition, called hyperplasia, may lead to cancer in some women. Endometrial hyperplasia usually occurs in the following situations: During peri-menopause (menopausal transition) when ovulation occurs irregularly. After menopause, when ovulation stops and progesterone is no longer produced. Use of medications that act like oestrogen Long-term use of high doses of oestrogen after menopause Polycystic ovarian syndrome(PCOS) Obesity

Outside the operation theatre, he held my arms firmly and gave me a gentle hug. With a voice charged with emotion, he said” Doc, thank you for saving my wife and my baby. Thank you." He was full of joy and gratitude. Tears were rolling down his cheeks as he spoke. Barely an hour ago, his wife, M, 30 was admitted to the labour ward with severe abdominal pain and heavy vaginal bleeding. She was at the 38th week of her second pregnancy. When I examined her, the womb (uterus) was tense, hard and tender. Large clots were oozing out from the neck of the womb (cervix). Her blood pressure was raised at 150/95 mmHg. The baby’s heart rate was low at 110 beats minutes which suggested a lack of oxygen supply to it. I performed a Caesarean section right away. At the operation, there was a large amount of blood clot behind the placenta, which had peeled off prematurely from its bed. The baby was delivered quickly and cried well after resuscitation. M had a serious complication of pregnancy called placental abruption or detachment of the placenta before delivery. The placenta is a structure that connects the baby to the mother’s womb via the umbilical cord. It supplies oxygen and nutrients to the growing baby. If it is shed off from the wall of the uterus prematurely, both the mother and the baby can be in danger. This condition is not common occurring in 1 to 2 percent of all pregnancies. There are various factors that make placental abruption happen more easily. These include: · Past history of placental abruption · Previous caesarean section · Raised blood pressure during pregnancy · Maternal age over 35 years of age · Smoking · Too much amniotic fluid · Premature rupture of the membranes (water-bag breaks prematurely before labour) · A blow to the tummy, such as from a fall or car accident When placental abruption occurs, there will be varying amounts of bleeding from heavy with clots to slight with staining. But the amount can be deceptive. It does not always correspond to the degree of placental detachment. Blood could be trapped in the uterus by the placenta, resulting in little blood loss when the detachment is in fact, severe. Abdominal pain and/ or backache are often present. They can begin suddenly with a tender and tense uterus as in M’s case. In severe case of placental abruption, a delayed treatment may put the mother and the child in danger. The mother may go into shock from heavy blood loss. She may go into a life-threatening state when her blood is unable to clot. Her major organs such as kidneys and liver may fail. Maternal death happens with all these complications. For the baby, premature birth, fetal distress and stillbirth are known outcomes. Luckily, we managed to intervene early and delivered M and her baby in time. They were both discharged well three days after the Caesarean section.

My friend told me that the gender of the unborn baby can be predicted by observing its heart rates. If the baby’s heart rate is 140 beats per minute (bpm) and above, it is likely to be a girl. Is it true? The heart rate of the baby starts out at about 80-85bpm around the 5th week of pregnancy. It increases rapidly, reaching a peak of 170-200 bpm by the 9th week. It gradually decreases and becomes stable between 120 - 160 bpm from the15th week till delivery at term. One cannot predict the gender of the unborn baby from its heart rates. A study in1980 measured the fetal heart rate of 10,000 babies. It found no correlation between the baby's heart rate at any point throughout pregnancy and the gender .This was confirmed subsequently by another study in 2006.

I have been having menstrual cramps for the past 3 years and confirmed with a diagnosis of endometriosis by key-hole surgery recently. I am 30 years old and getting married next year. What can I do to ease this condition besides taking medications? Endometriosis is a protracted condition (refer the article “endometriosis “in “gynaecological conditions” in our website) with a very high chance of the disease recurring. There are quite a few ways that may help reducing the symptoms. 1. Maintain a healthy body weight. Endometriosis is a hormone dependent condition. It remains active in the reproductive age when the levels of female hormone – oestrogen - are high and regresses after menopause when the hormone levels are low. Maintaining a healthy weight will reduce the production of oestrogen by the fat cells. This can ease some of the symptoms of endometriosis such as pain and bleeding. 2. Reduce stress: Women with endometriosis are often found to have elevated levels of stress hormones. Reducing stress with exercise like walking, swimming, and yoga and focusing on emotional health such as meditation often lead to improved quality of life. 3. Take more Omega-3: Research has suggested that a diet high in omega-3 fatty acids will reduce the risk of having endometriosis. Food like salmon and flax seeds are rich sources of omega-3. 4. Eat Turmeric: Studies in experimental animals suggested that this spice has anti-inflammatory properties and slows down the growth of the endometrial implants in endometriosis. But more research is needed in human beings. 5. Avoid exposure to environmental toxins such as PCBs (Polychlorinated biphenyls) and BPA (Bisphenol A) found in plastic and packaging materials. 6. Alternative medicine: Acupuncture has been shown to relieve painful periods and pelvic pain.

HPV stands for Human Papilloma Virus. It is a very common virus and consists of a group of 200 types of related viruses. More than 40 HPV types can infect the genital areas of males and females. They are spread through intimate contact during vaginal, oral or anal sex. The infection is very common and nearly all sexually active men and women will get it at some point in their lives. It happens more often in those who have many sexual partners or in those who have sex with an infected partner. But a person with only one partner can also get HPV infection. Genital HPV types fall into two groups: 1. Low-risk HPVs, which cause skin warts on or around the genitals, anus, mouth, or throat. 2. High-risk HPVs, which can cause cancer of the cervix (neck of the womb) and other less common cancers —cancers of the vagina, vulva, anus, penis and throat. There are HPV vaccines available in preventing cancer of the cervix. (Refer HPV vaccines under Q&A in the website). But they do not protect against all HPV types of infection and will not prevent all cases of cervical cancer. You should continue to get screened regularly with smear test (Pap smear).

I am a first-time mum. My friend told me that I could have a glass of red wine occasionally after the first trimester. Will alcohol harm my baby? Yes. Alcohol can affect the growth and development of your baby by entering its bloodstream through the placenta.It has been associated the following conditions: Miscarriage Stillbirth Premature birth Intrauterine growth restriction (IUGR): a condition in which the unborn baby is smaller than it should be due to the malfunction of the placenta Slow development of baby’s brain Increased risk of the baby having illness , learning and behavioural disorders in infancy, childhood and as an adult Foetal Alcohol Syndrome: the most severe form of the alcohol-related conditions .Heavy drinking in pregnancy can cause facial deformities, heart defects and mental retardation as well as impaired emotional development, hyperactivity, poor attention span and poor short-term memory. If you want to avoid all possible alcohol-related risks, you should not take alcohol entirely during pregnancy

Sitting on the wheelchair with teary eyes and occasional sobs, she gazed patiently at her baby in the incubator at the neonatal intensive care unit (NICU). The baby weighing 1.2 Kg. looked no bigger than a kitten. It was thin and pale with loose, dry skin. It lay floppily with a number of tubes and wires attached to the monitoring machines. It cried feebly at times. M, 34 just had a Caesarean section(C-section) 2 days ago .This was her first pregnancy . It was apparently normal until at 28 weeks of gestation when the levels of the fluid surrounding the baby (amniotic fluid) were found to be low. The growth of the baby had slowed as well. The estimated weight of the baby was at the 10th percentile with the measurement of abdomen 2 weeks behind that of the head. The baby was diagnosed as having intrauterine growth restriction (IUGR) a condition in which the baby was small for the gestation. I asked M to come for frequent check-ups so that the baby’s growth can be monitored by ultrasound scans regularly. Her baby’s heart beats were also measured electronically by cardiotocograms (CTG) to ensure adequate oxygen supply. Steriod injections were also given to help improve the baby’s lung function. At the 33rd week of her pregnancy, CTG indicated that the oxygen supply to the baby was diminishing. The blood flow to the baby’s brain was reduced by Doppler flow studies. I discussed the gravity of the situation with M and her husband and decided that the baby should be delivered by C-section. The baby was born with a low Apgar score indicating its poor physical condition at birth. It was admitted to NICU in the incubator straight away for immediate medical care. Intrauterine growth restriction (IUGR) is a condition where the unborn baby does not grow at the normal, expected rate. The estimated weight of the baby is less than that of 90% of those with the same gestational age. It occurs in about 2 to 3 percent of all pregnancies and results from diminished supply of the nutrients and oxygen to the baby.Although some IUGR babies are small because of genetic factors, majority are due to other causes which include: Mother having : Pregnant for the first time or for the fifth time or more Under the age of 15 or over the age of 35 High blood pressure Chronic kidney diseases Diabetes Heart or respiratory diseases Anaemia Infection from viruses ,bacteria or parasites Alcohol, cigarette and drug abuse Reduced blood flow to the womb and placenta: Minor detachment of placenta before delivery Low lying placenta with bleeding Placental insufficiency Unborn baby having Infection Birth defects Genetic abnormality When IUGR is severe, the foetal oxygen supply is critically compromised. This may cause foetal death. In less severe case, the baby may have problems after birth. These include: Difficulty in breathing from inhalation of the first faeces(meconium) before or during delivery Low blood sugar Difficulty in maintaining the body temperature Low resistance to infection Increase in red blood cells resulting in abnormal clotting problems Developmental and learning disorders during childhood Management of IUGR depends on its onset and severity. Careful monitoring of the growth of the foetus using ultrasound and Doppler flow studies and optimal timing for delivery are important in achieving good outcome. It was quite an ordeal for M to watch her baby suffering in the incubator. Her face finally brightened up with smiles when it finally left the NICU after 2 weeks. When I saw her 6 weeks after the baby was born, it had put on a remarkable amount of weight and both mother and baby were doing well. “Doc, thanks for your timely intervention,” she said” thanks for letting me understand what motherhood really means.”I could see immense joy in her.

What is a chemical pregnancy? I think I might have one. I have been trying to conceive. My period was overdue for 4 days and the home pregnancy test was positive. I had a slight bleeding from the vagina the next day. I went to see my family doctor who repeated the urine test and it showed a negative result. What should I do? Do I need to clean up the womb? Will it have any impact on my future pregnancy? A. Soon after conception, the pregnancy hormone, human chorionic gonadotropin (hCG) is being produced by the fertilised egg (embryo). At about five weeks of pregnancy, the embryo is embedded in the uterus. A gestational “sac” can be seen on the ultrasound examination and the pregnancy is labelled as a “clinical” pregnancy. If the embryo, with measurable hCG, fails to grow and cannot be seen on ultrasound, it is known as a “chemical” pregnancy, a very early miscarriage. According to the American College of Obstetricians and Gynaecologists, it accounts for 50–75 percent of all miscarriages. If the woman is not expecting to become pregnant, she may not even know that she has miscarried; She may take it as a “delayed period” as menstrual bleeding often occurs around the same time. As chemical pregnancy happens very early after conception, it has very little effect if at all on your body. No treatment is needed. You can start trying to conceive after the next menstrual period. It would not have much impact on your future pregnancy unless it occurs repeatedly.

First, you have to produce the semen sample on the day of IUI by masturbation. After the semen is liquefied, it is centrifuged to separate the seminal fluid from the sperm. During this process, chemicals surrounding the sperm will be removed. This is to avoid severe adverse reactions in the uterus should they be inseminated. The sperm pellet is then suspended in a special fluid medium. In this way, most of the motile sperm will swim out of the pellet into the medium. They are then harvested for insemination. This procedure takes about 2 hours.

I am trying to conceive after having married for 3 years. I have been prescribed the ovulation drug, clomid. I would like to know how the medication work. Any side effects? Clomid or clomiphene citrate is the most commonly prescribed drug used to stimulate ovulation in women with infrequent or absent ovulation. It is also used empirically for treating women with unexplained infertility. Clomiphene is usually given on day 2 to day 5 of the menstrual cycle. It works by causing the pituitary gland (a small pea- size gland at the base of the brain) to secrete more FSH (follicular stimulating hormone). This hormone will stimulate the development of follicles (small sacs in the ovary) that contain the eggs. With good response, the egg will be released by ovulation from the mature follicle about a week to 10 days after clomiphene is taken. Clomiphene will bring about ovulation in about 80% of patients. To find out whether ovulation has occurred, doctor would rely on vaginal scan of the follicle, measurement of blood hormone levels, ovulation prediction kits, secretion from the cervix (neck of the womb) or the basal body temperature chart. Clomiphene is generally well tolerated. There are usually few side effects which are generally mild. Hot flashes occur in about 10% of women and typically disappear soon after treatment ends. Mood swings, breast tenderness, and nausea can happen. Severe headaches, blurred or double vision are rare but always reversible. Women who conceive with clomiphene have about 10% chance of having twins. Triplets are rare (<1%). Ovarian cysts, which can cause pelvic discomfort and a bloated feeling in the tummy, may form as a result of ovarian stimulation. This usually subsides with time. It is important to do an ultrasound to make sure that the ovarian cysts disappear before beginning another clomiphene treatment cycle.