Dr. Manish Kaushal

Thyroid, Breast, Endocrine & Cancer Surgeon

Dr. Manila Kaushal

Obstetrician, Gynecologist & Laparoscopic Surgeon

Book an appointment

You can book an appointment as soon as you know that you're pregnant. It's best to consult as early as possible.

At first visit, you will be given information about:

  Folic acid and vitamin D supplements

  Nutrition, diet and food hygiene

  Lifestyle factors that may affect your health or the health of your baby, such as smoking, recreational drug use and drinking alcohol We will advice you antenatal screening tests like Hemoglobin, Blood group and Rh status, CBC, syphilis, hepatitis B, HIV, rubella, Hb Electrophoresis and testing for thyroid disease. These tests will be discussed with you and you can choose whether you have them or not.

We may do a ultrasound for confirming number location and viability of embryo.

We will also do a general health check-

  a check to make sure your heart, lungs and blood pressure are okay

  a urine test, to make sure your kidneys are healthy and check for signs of infection

  a Pap smear test

  a Breast check.

Please inform us if

  You've had any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth.

  You're being treated for a chronic disease, such as diabetes or high blood pressure.

  You or anyone in your family have previously had a baby with an abnormality.

  There's a family history of an inherited disease.

Your next appointment should happen when you are 11-14 weeks pregnant. This is called the first antenatal visit or booking visit.

We will finalize your due date of delivery. If you have a regular menstrual cycle and you know the date your last period started this can be used to work out when your baby is due. Your due date is calculated by adding 40 weeks (280 days) to the first day of your last menstrual cycle. An ultrasound scan will give you a more accurate date for the birth of your baby.

Between 11-13 weeks gestation you will be offered sonography and blood test(Double Marker) which detects Down's syndrome, Trisomy 18 and neural tube defects.

What is Down Syndrome Screening Test?

Every woman has a chance of giving birth to a baby with Down's syndrome. The chance increases with your age. So even before you're pregnant, you will have a certain risk level, based on your age (background risk).

Down syndrome is a genetic disorder that occurs very early in your pregnancy when your baby is first forming. While most people have 23 pairs of chromosomes, people with Down syndrome have an extra copy of chromosome 21.

There are 2 types of screening tests that are available that tell you if your baby might be at risk of having Down syndrome.

First trimester combined screening

To calculate your overall risk, we advice NT scan(11-!3weeks 6 days) and blood test known as biochemical screening(9-12 weeks). At the ultrasound scan appointment, the sonographer measures the thickness of the nuchal translucency (a pocket of fluid) at the back of your baby's neck.

The blood test measures the levels of two different hormones that when combined with NT will give your own risk of having such baby.Further diagnostic tests can then be done to confirm the results.

Screening for Birth Defects by Ultrasound (Anomaly Scan at 18-20 weeks) Between 26-28 weeks gestation screening for diabetes and anemia in pregnancy will be performed. Just before your expected date of delivery will get your CBC and urine routine test done.

How frequent should I see doctor during my pregnancy?

You will be seen every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks and then weekly until you deliver. Some patient may be seen more frequent if problems arise during their pregnancy.

At 36 weeks, we give

  Information about breast-feeding.

  Information to prepare her for labour and birth (birth plan, pain relief options, how to recognise the onset of active labour).

  Information about care of the new baby and preparations needed.

  Information about routine procedures such as newborn screening and vitamin K prophylaxis.

  Advice about postnatal self-care, along with information about postnatal depression and "baby blues".

How many ultrasounds will be performed?

In early regnancy transvaginal ultrasound will be performed at around 8 weeks to confirm viability, number and location of pregnancy. Second ultrasound is NT scan between 11 to 14 weeks. We call it as early anomaly scan and it will also confirm your due date.  I recommend an anomaly ultrasound between 18-20 weeks. We could  offer a growth scan or Dopplers after 28 weeks if on examination there is some worry regarding Additional ultrasounds are performed for other medical needs.

What about childbirth classes?

Classes are scheduledfrom time to time. You may call to schedule your classes.

Vaccination in pregnancy:

We advice one shot of Td vac at 16 -18 weeks, Influenza vaccine at 25 weeks and single shot of Tdap(Combined vaccine for tetanus, diptheria and whooping cough) at 28 weeks.


  Regular uterine contractions every 3-5 minutes for 1 hour.

  Vaginal Bleeding. Spotting vaginally after an exam is normal. If any bleeding heavier than spotting go to the hospital.

  Rupture of membranes.

  Decrease fetal movement.

What is Cesarean-Section Delivery

A cesarean section, also called a c-section, is a surgical procedure performed when a vaginal delivery is not possible or safe, or when the health of the mother or the baby is at risk. During this procedure, the baby is delivered through surgical incisions made in the abdomen and the uterus. We give a transverse bikni incision on your skin and dissolving stiches  are used to make it cosmetic. A cesarean delivery might be planned advance if a medical reason calls for it, or it might be unplanned and take place during your labor if certain problems arise.

These days, having a caesarean section is becoming more and more common. Many of us face an overflow of information on the subject (from friends, family) that can leave us wondering whether we can go ahead with a normal delivery. If you've decided you are going to try for a normal delivery, there is a lot to look forward to. There are many reasons why this is a good birth choice for both you and baby.

What is painless delivery?

We call it as epidural analgesia. Pain is the reason to have epidural and whenever your pain is significant you can request for an epidural. Epidural is not necessary for you to have delivery, but it can be beneficial in reducing the pain of labour.

Epidural is a small injection placed in your lower back, through which a  small tube (the size of a twine) is put into your back near the nerves carrying pain from the uterus. fine tube (epidural catheter). Drugs can be injected through this tube to relieve the pain of labour. These drugs are local anaesthetics which cause numbing of the nerves and pain sensation without affecting the ability to move. These drugs are also very safe for the baby. With an epidural in place, you may feel the contractions, but they will not be painful. All the same, you will feel some pressure symptoms and some tightness with contractions. It is given by anesthetist who is trained in doing so. The anaesthesiologist and your nurse will check that the epidural is working well throughout.

All women in labor who need pain relief can have an epidural, except those on blood thinning drugs or abnormal blood tests.

Occassionally, epidural may not work as well as we would like it to. If this happens, the anaesthesiologist will help by giving extra doses or changing your position or the catheter position. If it still does not work, the procedure has to be repeated (by placing the epidural catheter again).

Complications due to Epidural Injection

  Epidural can cause a drop in your blood pressure. To decrease this risk, you will be given fluids through an intravenous line.

  Some women may have itching which disappears when the epidural is stopped. Medication can be given to relieve the sensation.

  An epidural may prolong the second stage of labour and reduce the urge to bear down. Occasionally this may result in you having an instrumental delivery.

  One in 100 women may develop severe headache after an epidural. It is called post dural puncture headache and can be treated.

  About one in 2000 mothers gets a feeling of tingling or pins and needles down one leg after having a baby. Such problems are more likely to result from childbirth itself than from an epidural.

  A small number of women may experience numbness or heaviness in the legs. It usually wears off once the epidural is discontinued. The risk of any permanent damage is extremely low.

  Backache is common during pregnancy and often continues afterwards when you are looking after your baby. There is now good evidence that epidurals do not cause long-term backache, though you may feel soreness at the site of the injection for a few days.

  Just like surgery is never done without anaesthesia, so also techniques are available to manage labour pain.

Receiving pain relief in labour is not a pre-requisite for delivery! It is dependant on your tolerance level and the choice you want to make

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