Dr Amit kyal - Obstetrician & Gynaecologist

Dr Amit kyal - Obstetrician & Gynaecologist WE CARE ABOUT YOUR HEALTH
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Dr Amit Kyal

20/11/2025

MOTIVE care bundle in PPH ( initial care )

The MOTIVE care bundle is an evidence-based clinical protocol designed to improve outcomes in postpartum hemorrhage (PPH) by promoting a standardized, timely, and team-based response in obstetric settings. It focuses on five major interventions, summarized by the acronym MOTIVE, and has been validated through major studies and guideline endorsements in recent years. Each letter represents a concrete, actionable step aimed at ensuring rapid hemorrhage control and minimizing maternal morbidity and mortality.

M - Massage ( Immediate uterine massage to stimulate contraction and control bleeding.)

O - Oxytocics ( Rapid administration of uterotonics (e.g., oxytocin or alternatives per local protocol).

T - Tranexamic acid ( Early use of tranexamic acid (TXA), preferably within 3 hours of PPH onset.)

I - IV fluids ( Prompt intravenous fluid resuscitation to maintain hemodynamic stability.)

V - Vital signs monitoring ( Continuous assessment and documentation of blood pressure, pulse, and respiratory rate.)

E - Examination ( Systematic assessment for retained tissue, trauma, or coagulopathy as the underlying cause.)

24/10/2025

1 SUMMARY OF FIGO RECOMMENDATIONS ON THE SCREENING, DIAGNOSIS, AND PREVENTION OF ANEMIA IN PREGNANCY ( OCTOBER, 2025 )

1.1 Screening and diagnosis of anemia in pregnancy

1)All pregnant women should be screened for anemia with a full blood count (FBC) at booking and again at 28 weeks (strong, low). In resource-limited settings, a hemoglobin concentration or hematocrit test can be used for screening

2)Anemia in pregnancy is diagnosed if the hemoglobin concentration is less than 11.0 g/dL in all trimesters of pregnancy and during the postpartum period

3)A hemoglobin concentration cutoff of less than 11 g/dL should be universally adopted in all settings and populations for the diagnosis of anemia in pregnancy

4)Anemia in pregnancy is classified based on severity as mild (10–10.9 g/dL), moderate (7.0–9.9 g/dL), and severe (

13/09/2025

Approaches for INSULIN REGIMEN IN PREGNANCY COMPLICATED BY HYPERGLYCEMIA

There are two main insulin regimens used in pregnancy:

1) Basal -bolus therapy
and
2) Split -dose (mixed) insulin regimens.

1)Basal-Bolus Insulin Regimen

The basal-bolus regimen mimics physiologic insulin secretion by providing both background (basal) insulin and mealtime (bolus) insulin coverage.

Components:
1. Basal insulin(long-acting): Controls fasting and between-meal glucose
- Options: Insulin detemir, NPH (isophane), or glargine
- Detemir /Detemir is preferred over NPH due to less hypoglycemia


2. Bolus insulin(rapid-acting): Covers mealtime carbohydrates
- Options: Insulin aspart, lispro, or glulisine
- Aspart and lispro are preferred with better safety profiles

Initiation Protocol:

1. Calculate total daily dose (TDD):
- 1st trimester: 0.7-0.8 units/kg actual body weight/day
- 2nd trimester: 0.8-1.0 units/kg/day
- 3rd trimester: 0.9-1.2 units/kg/day

2. Basal insulin:
- Start with 50% of TDD as basal insulin
- Typically given at bedtime (for NPH or detemir) or morning (for glargine)

3. Bolus insulin:
- Divide remaining 50% of TDD across 3 meals (typically breakfast, lunch, dinner)
- Initial doses: ~10-20% of TDD per meal, adjusted based on carbohydrate intake and pre-meal glucose

Titration:

- Basal insulin: Adjust based on fasting glucose targets (≤95 mg/dL)
- Bolus insulin: Adjust based on 1-hour postprandial (

12/05/2025

Approaches for INSULIN REGIMEN IN PREGNANCY COMPLICATED BY HYPERGLYCEMIA

There are two main insulin regimens used in pregnancy:

1) Basal -bolus therapy
and
2) Split -dose (mixed) insulin regimens.

1)Basal-Bolus Insulin Regimen

The basal-bolus regimen mimics physiologic insulin secretion by providing both background (basal) insulin and mealtime (bolus) insulin coverage.

Components:
1. Basal insulin(long-acting): Controls fasting and between-meal glucose
- Options: Insulin detemir, NPH (isophane), or glargine
- Detemir /Detemir is preferred over NPH due to less hypoglycemia


2. Bolus insulin(rapid-acting): Covers mealtime carbohydrates
- Options: Insulin aspart, lispro, or glulisine
- Aspart and lispro are preferred with better safety profiles

Initiation Protocol:

1. Calculate total daily dose (TDD):
- 1st trimester: 0.7-0.8 units/kg actual body weight/day
- 2nd trimester: 0.8-1.0 units/kg/day
- 3rd trimester: 0.9-1.2 units/kg/day

2. Basal insulin:
- Start with 50% of TDD as basal insulin
- Typically given at bedtime (for NPH or detemir) or morning (for glargine)

3. Bolus insulin:
- Divide remaining 50% of TDD across 3 meals (typically breakfast, lunch, dinner)
- Initial doses: ~10-20% of TDD per meal, adjusted based on carbohydrate intake and pre-meal glucose

Titration:

- Basal insulin: Adjust based on fasting glucose targets (≤95 mg/dL)
- Bolus insulin: Adjust based on 1-hour postprandial (

23/03/2025

Cervical cancer screening guidelines vary across different organizations and countries, reflecting differences in healthcare resources, disease prevalence, and population demographics. Below is a summary of the screening guidelines for cervical cancer from the American Cancer Society (ACS),U.S. Preventive Services Task Force (USPSTF),American College of Obstetricians and Gynecologists (ACOG) & World Health Organization (WHO)

1. American Cancer Society (ACS) - 2020 Guidelines
- Primary Screening Method:HPV testing alone (preferred) or co-testing (HPV + Pap smear).
- Age to Start Screening:25 years.
- Screening Intervals:
- HPV testing alone:Every 5 years (preferred).
- Co-testing (HPV + Pap smear):Every 5 years.
- Pap smear alone:Every 3 years (if HPV testing is not available).
- Age to Stop Screening:65 years (if adequate prior screening and no history of high-grade lesions).
- Special Populations:
- Individuals vaccinated against HPV should follow the same screening guidelines.
- Hysterectomy with removal of the cervix and no history of high-grade lesions: No screening needed.

2. U.S. Preventive Services Task Force (USPSTF) - 2018 Guidelines
- Primary Screening Method:HPV testing, Pap smear, or co-testing.
- Age to Start Screening:21 years
- Screening Intervals:
- 21–29 years:Pap smear every 3 years.
- 30–65 years:
- HPV testing alone every 5 years (preferred).
- Co-testing every 5 years.
- Pap smear alone every 3 years
- Age to Stop Screening:65 years (if adequate prior screening and no history of high-grade lesions)

3. American College of Obstetricians and Gynecologists (ACOG) - 2021 Guidelines
- Primary Screening Method:HPV testing, Pap smear, or co-testing.
- Age to Start Screening:21 years.
- Screening Intervals:
- 21–29 years:Pap smear every 3 years.
- 30–65 years:
- Co-testing every 5 years (preferred).
- Pap smear alone every 3 years.
- Age to Stop Screening:65 years (if adequate prior screening and no history of high-grade lesions).

4. World Health Organization (WHO) - 2021 Guidelines
- Primary Screening Method:HPV DNA testing (preferred).
- Age to Start Screening: 30 years
- Screening Intervals:
- HPV testing alone: Every 5–10 years.
- Visual Inspection with Acetic Acid (VIA): Every 3–5 years (in resource-limited settings).
- Age to Stop Screening: 50–65 years (depending on country-specific guidelines and resources).
- Special Populations:
- HIV-positive women: Start screening at age 25 and screen more frequently (every 3–5 years).

21/03/2025

The definitions of Sepsis-1, Sepsis-2,and Sepsis-3 reflect the evolution of our understanding of sepsis over time.
These definitions have been updated to improve diagnosis, treatment, and outcomes.

Sepsis-1 (1991)
- Definition:
- Sepsis was defined as systemic inflammatory response syndrome (SIRS) due to a suspected or confirmed infection.
- SIRS Criteria (at least 2 of the following):
1. Temperature > 38°C (100.4°F) or 90 beats per minute.
3. Respiratory rate >20 breaths per minute or PaCO₂ 12,000/mm³, 10% immature (band) forms.
- Limitations:
- The SIRS criteria were too broad and non-specific, leading to overdiagnosis of sepsis.
- Did not account for organ dysfunction, which is a key feature of sepsis.

Sepsis-2 (2001)
- Definition:
- Expanded on Sepsis-1 but retained the SIRS criteria.
- Introduced the concept of severe sepsis (sepsis with organ dysfunction) and septic shock (sepsis with hypotension unresponsive to fluid resuscitation).
- Severe Sepsis:Sepsis with at least one sign of organ dysfunction (e.g., hypotension, altered mental status, oliguria, etc.).
- Septic Shock: Sepsis with persistent hypotension despite adequate fluid resuscitation, requiring vasopressors to maintain blood pressure.
- Limitations:
- Still relied heavily on SIRS criteria, which remained non-specific.
- Did not fully capture the complexity of sepsis and its impact on organ function.

Sepsis-3 (2016)
- Definition:
- Sepsis is now defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Key Changes:
1. Focus on Organ Dysfunction:Measured by an increase in the Sequential Organ Failure Assessment (SOFA)score of **≥2 points**.
- SOFA evaluates dysfunction in six organ systems: respiratory, cardiovascular, hepatic, coagulation, renal, and neurological.
2. Septic Shock:Defined as sepsis with:
- Persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of ≥65 mmHg.
- Serum lactate level >2 mmol/L (>18 mg/dL) despite adequate fluid resuscitation.
- Simplified Screening Tool (qSOFA):
- For quick identification of patients at risk of sepsis outside the ICU:
1. Respiratory rate: ≥22 breaths/min.
2. Altered mental status
3. Systolic blood pressure : ≤100 mmHg.
- A score of **≥2** suggests a higher risk of poor outcomes.
- Advantages:
- Emphasizes organ dysfunction, which is more specific to sepsis.
- Better aligns with the pathophysiology of sepsis as a dysregulated host response.

16/03/2025





Pregnancy is a critical period that requires careful attention to the health and well-being of both the mother and the developing fetus. Following evidence-based guidelines can help ensure a safe and healthy pregnancy. Below are the **do’s and don’ts** as per general obstetric guidelines:

---
Do’s in Pregnancy

1. Prenatal Care
- Attend Regular Prenatal Visits:
- Schedule regular check-ups with your healthcare provider to monitor fetal growth, maternal health, and detect any complications early.
- Take Prenatal Vitamins:
- Folic acid (400–800 mcg/day) is essential to prevent neural tube defects. Iron, calcium, and vitamin D supplements may also be recommended.
- Get Vaccinations:
- Ensure vaccinations are up-to-date, including influenza (flu) and Tdap (tetanus, diphtheria, pertussis) vaccines during pregnancy.

2. Nutrition
- Eat a Balanced Diet:
- Include fruits, vegetables, whole grains, lean proteins, and dairy products.
- Increase caloric intake by ~300–500 kcal/day in the second and third trimesters.
- Stay Hydrated:
- Drink plenty of water (8–10 glasses/day).
- Consume Adequate Iron and Calcium:
- Iron supports increased blood volume, and calcium is essential for fetal bone development.

3. Exercise
- Engage in Moderate Physical Activity:
- Aim for 30 minutes of moderate exercise most days (e.g., walking, swimming, prenatal yoga).
- Exercise helps maintain a healthy weight, reduces stress, and improves circulation.

4. Lifestyle
- Get Adequate Sleep:
- Aim for 7–9 hours of sleep per night. Use pillows for support as the pregnancy progresses.
- Practice Good Hygiene:
- Wash hands frequently to prevent infections.
- Manage Stress:
- Practice relaxation techniques like deep breathing, meditation, or prenatal yoga.

5. Education and Preparation
- Attend Childbirth Classes:
- Learn about labor, delivery, and newborn care.
- Create a Birth Plan:
- Discuss your preferences for labor and delivery with your healthcare provider.

Don’ts in Pregnancy:

1. Avoid Harmful Substances
- No Smoking or Secondhand Smoke:
- Smoking increases the risk of preterm birth, low birth weight, and birth defects.
- No Alcohol:
- Alcohol can cause fetal alcohol spectrum disorders (FASDs), leading to developmental delays and birth defects.
- No Recreational Drugs:
- Illegal drugs (e.g., co***ne, ma*****na) can harm fetal development and increase the risk of complications.

2. Limit Caffeine
- Moderate Caffeine Intake:
- Limit caffeine to ≤200 mg/day (about one 12-ounce cup of coffee). Excessive caffeine may increase the risk of miscarriage or low birth weight.

3. Avoid Certain Foods
- Raw or Undercooked Meat, Eggs, and Fish:
- Risk of foodborne illnesses (e.g., toxoplasmosis, listeriosis).
- Unpasteurised Dairy Products:
- Risk of listeria infection.
- High-Mercury Fish
- Raw Sprouts/
- Risk of bacterial contamination.

4. Avoid Certain Medications
- Consult Your Doctor:
- Avoid over-the-counter or prescription medications without consulting your healthcare provider. Some medications (e.g., isotretinoin, ACE inhibitors) are harmful during pregnancy.

5. Avoid Excessive Heat
- No Hot Tubs or Saunas:
- High temperatures can increase the risk of neural tube defects and dehydration.
- Avoid Overheating During Exercise:
- Stay cool and hydrated during physical activity.

6. Avoid Heavy Lifting and Strenuous Activities:
- Limit Heavy Lifting:
- Heavy lifting or strenuous activities can increase the risk of injury or preterm labor.

7. Avoid Contact with Harmful Chemicals
- Limit Exposure to Toxins:
- Avoid exposure to pesticides, lead, and harmful chemicals (e.g., paint fumes, cleaning products).

Address

Regent Court, VIP Road, Deshbandhu Nagar, Baguihati
Kolkata
700059

Opening Hours

Monday 9am - 7pm
Tuesday 9am - 7pm
Wednesday 9am - 5pm
Thursday 9am - 6pm
Friday 9am - 6pm
Saturday 9am - 7pm
Sunday 12pm - 2pm

Telephone

+919339108591

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