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Here we are committed to serve patients & meet the challenges of complex medical situations & needs with competency, quality & safety.
Joint Knee Replacement
Knee joint replacement is a procedure that involves replacing an injured or ailing knee with an artificial joint, or prosthesis.
The prosthesis is made of metal alloys, plastics, and polymers. It mimics the function of a knee.
Purpose of a knee joint replacement –
Damage from arthritis is the most common reason for knee joint replacement. This includes both osteoarthritis and rheumatoid arthritis.
We as doctors usually only recommend knee replacement as the last resort or advanced treatment option. First-line treatment options include:
• weight loss
• physical therapy
• assistive devices, such as a cane or a knee brace
Joint Hip Replacement
Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint and replaces it with an artificial joint often made from metal and plastic components. It is usually done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier.
🔷 How do you know if you need a hip replacement?
If you have these symptoms, you should consider a hip replacement:
1. Severe hip pain that is not relieved by medication and that interferes with your work, sleep or everyday activity
2. Hip stiffness that restricts motion and makes it difficult to walk
🔷 What are the different types of hip replacement surgery?
The three major types of hip replacement are:
• total hip replacement (most common)
• partial hip replacement
• hip resurfacing
The most common type of hip replacement surgery is called a total hip replacement (also called total hip arthroplasty). In this surgery, worn-out or damaged sections of your hip are replaced with artificial implants. The socket is replaced with a durable plastic cup, which may or may not also include a titanium metal shell. Your femoral head will be removed and replaced with a ball made from ceramic or a metal alloy. The new ball is attached to a metal stem that is inserted into the top of your femur.
🔷 Two other types of hip replacement surgeries are each generally appropriate for patients of specific age groups and activity levels:
1. Partial hip replacement (also called hemiarthroplasty) involves replacing only one side of the hip joint – the femoral head – instead of both sides as in total hip replacement. This procedure is most commonly done in older patients who have fractured their hip.
2. Hip resurfacing of the femoral head and socket is most commonly done in younger, active patients.
Visit Dr. Gaurav Bhargava to get more information on hip replacement surgery and knee replacement surgery.
Obstetric Care For High Risk Patients
A pregnancy is considered high-risk when there are potential complications that could affect the mother, the baby, or both. High-risk pregnancies require management by a specialist to help ensure the best outcome for the mother and baby.
Vaginal delivery is safest for the fetus and the mother when the newborn is full-term at the gestational age of 37 to 42 weeks.
The labor leading to delivery of a full-term pregnancy is divided into three stages.
The first stage of labor is the longest stage of labor; it is the result of progressive and rhythmic uterine contraction which causes the cervix to dilate. The first stage of labor is divided into two sub-stages. The first sub-stage is known as the latent phase, which can last for several hours and starts from the cervical size of 0 cm to dilation of the cervix to 6 cm. The second sub-stage is known as the active phase, which includes the time from the end of the latent phase to the complete dilation of the cervix.
The second stage of labor includes the time from complete cervical dilation, which is the end of the first stage to delivery of the fetus. Duration of this phase is variable and can last from minutes to hours; however, the maximum amount of time that a woman can be in this phase of labor depends on the parity of the patient and whether the patient has an epidural catheter placed for anesthesia.
During this stage, three clinical parameters are important to be aware of, which include fetal presentation, fetal station, and fetal position. The fetal presentation is dictated by which fetal body part first passes through the birth canal; most commonly, this is the occiput or the vertex of the head.
The final stage of labor includes the time after the child is born to the delivery of the placenta. The duration of this phase is approximately 30 minutes; during this time, as the uterus contracts, the placenta separates from the endometrium. This process begins at the lower pole of the placenta, and progress is along with the adjacent sites of placental attachment.
The third stage of labor concludes once the placenta completely separates and is delivered.
Vaginal delivery is the preferred method for childbirth; and our expert Dr. Priyanka Bhargava is especially known for emphasizing on normal deliveries for her patients.
C - Section
A C-section, or cesarean section, is the surgical delivery of a baby through incisions in the abdomen and uterus. It’s typically only recommended in medically necessary cases, including in some high-risk pregnancies and when the baby is in the breech position and can’t be flipped around before labor begins.
A few factors that might necessitate a C-section include:
1. Certain medical conditions – You have a chronic condition like heart disease, diabetes, high blood pressure or kidney disease that makes vaginal delivery dangerously stressful to your body (and a cesarean birth is a safer option).
2. Infections – If you’re HIV-positive or have an active genital herpes infection, a scheduled C-section is necessary because both viruses can be transmitted to your baby during delivery.
3. Your baby’s health – An illness or a congenital condition might make the already tricky journey through the birth canal even more treacherous for your baby.
4. A large baby – Sometimes your baby is too large (a condition called macrosomia) to move safely, if at all, through the birth canal.
5. Your weight – Being extremely overweight or obese significantly increases your chance of needing a C-section delivery, partly because of the other risk factors that often accompany obesity (like gestational diabetes), and partly because obese women tend to have longer labors (which, in turn, ups your risk of ending up on the operating table).
6. Your age – While being older doesn’t guarantee a cesarean by any means, the odds of having one increase with age.
7. Breech position – When your baby is either feet-first or butt-first in a breech position and can’t be turned, we might decide that a C-section is necessary.
8. Multiples – The likelihood of the procedure increases with the number of babies you’re carrying.
9. Placental problems – If the placenta is partly or completely blocking the cervical opening (placenta previa) or has separated from the uterine wall (placental abruption), a C-section is likely safer for you and your baby.
10. Other complications – If you develop preeclampsia (pregnancy-induced high blood pressure) or eclampsia (a very rare progression of preeclampsia that affects the central nervous system, causing seizures) and treatment isn’t working, we might opt for a C-section to protect both of you.
11. A previous C-section – While having a first cesarean raises your risk of subsequent procedures, vaginal birth after c-section, or VBAC, is frequently successful and often recommended.
Vaginal Birth After C-Section (VBAC)
If you’ve already had a cesarean birth (also called c-section), you may be able to have your next baby vaginally. This is called a vaginal birth after cesarean (also called VBAC). Cesarean birth is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.
More than 6 to 8 out of 10 women (more than 60-80 percent) who try VBAC are successful in having their baby vaginally. Talk to the expert Dr. Priyanka Bhargava early in your pregnancy to find out if VBAC may be a good choice for you and your baby.
How do you know if having a VBAC is right for you?
Talk to the specialist Dr. Priyanka Bhargava if you’re thinking about having a VBAC. She can help you look at the risks and benefits. If your risks are low and your chances of having a successful VBAC are high, then you may decide that VBAC is right for you.
Your chances of having a successful VBAC are better if:
• You’ve had a vaginal birth before.
• You’ve had just one c-section in the past with a low transverse incision (also called a bikini cut).
• This means the cut was horizontal (side-to-side) and low on the uterus. This is the most common kind of c-section incision. It usually bleeds less than other incisions. It also makes a stronger scar on the uterus, which makes it less likely to tear.
• You and your baby are in good health during pregnancy.
• Your labor starts on its own just before or on your due date.
Your chances of having a successful VBAC are worse if:
• You have the same condition in this pregnancy that made your c-section necessary in a past pregnancy. For example, your baby has problems with his heart rate or is lying sideways in the womb.
• You’re past your due date or your labor is induced.
• You’re obese or you’ve gained excessive weight during pregnancy.
• You have high blood pressure, a condition known as Pre-eclampsia.
• There’s less than 18 months between your last pregnancy and your current pregnancy (called a short interpregnancy interval).
• Your baby is very large.
It’s not safe to have a VBAC if:
• You had a c-section in the past and your incision was not low transverse and instead was high vertical.
• You had a uterine rupture in a previous pregnancy. This is when the uterus (womb) tears during labor. It happens very rarely.
• You’ve had certain types of surgery on your uterus.
• You have certain health conditions or complications during pregnancy, like diabetes, heart disease, genital herpes or placenta previa, that make a c-section necessary.
What are the benefits of having a VBAC?
Having a VBAC has some benefits, including:
• There’s no need for surgery.
• Your recovery time is shorter than after having a c-section.
• There’s less blood loss.
• Your risk is lower for infection and other complications, like problems with the placenta called placenta previa and placent acreta.
• If you’re planning to have a lot of children, there’s less risk of complications from repeated surgeries, including scarring or injuries to the bowel or bladder.
What are the risks of having a VBAC?
VBAC can have some risks, even if both you and your baby are healthy during pregnancy. These risks include:
• Your labor doesn’t go well and you need a c-section anyway.
• Infection, injury and blood loss
• Your uterus ruptures (tears). This is rare, but it can be life-threatening.
Painless delivery can be achieved using a form of regional anaesthesia that provides pain relief during natural labour. Epidural anaesthesia is administered through an injection on the lower back of the mother. The drug takes about 10-15 minutes to take effect. This is a good option for women with a lower pain bearing capacity, who would otherwise opt for a C-section.
🔷 The advantages of Painless delivery –
1. Painless delivery gives women a chance at experiencing natural childbirth, with very little intervention. It has helped in bringing down the number of elective C-sections in India.
2. Women are given an option to take an epidural during labour if they feel they are not able to bear the pain, are exhausted from pushing or in case of any emergencies that may require an urgent C-section.
3. By alleviating pain, it allows the mother to focus on the delivery. It is an aid for relaxation and can prevent exhaustion and irritation experienced by most women during childbirth, thereby reducing the risk of developing post-partum complications.
4. It helps the baby descend easily by relaxing the pelvic and vaginal muscles.
5. It also helps in lowering the blood pressure of the mother, which otherwise can shoot up to dangerous levels during labour.