Obstetrics - Gynaecology

The Obstetrics and Gynaecology department offers modern and comprehensive care for women of all ages, including diagnostic and treatment services, in a caring environment. 

• Advanced maternity services for normal and high-risk pregnancies, postpartum and family planning services, infertility screening and treatments, and all endoscopic gynecological operations in addition to conventional gynecology surgeries and medical therapies. 
• Management of high-risk pregnancy by prenatal diagnostic testing like chorionic villus sampling, amniocentesis, fetal color Doppler and velocimetry studies.
• Cancer screening for perimenopausal women is done using colposcopy and pap smear and HPV – CO testing.
• First to perform laparoscopic ovarian transposition in Kerala.

We have performed three laparoscopic ovarian transpositions for ovarian conservation in young patients undergoing treatment for pelvic malignancies. One rare case of advanced first-trimester rudimentary horn pregnancy was managed successfully by laparoscopy. Tubal reconstructive surgeries were performed free of cost for eight 2004 tsunami victims out of which two were conceived and delivered soon after.

Cervical cancer screening by PAP smear and HPV DNA testing  

All patients are screened for cervical neoplasia by Pap smear collection. An Ayre's spatula is used to scrape cells from ectocervix and then a thin smear is prepared on a glass slide. The smear is immediately fixed and sent for cytologic analysis. Any abnormality of Pap smear is further evaluated with colposcopy. Colposcopy and colposcopy-guided biopsy Colposcopy is the procedure by which the cervix is visualized under magnification by using a colposcope. It is usually indicated once there are abnormal cells detected on Pap smear testing. It helps to identify the abnormal areas on the cervix and to direct the biopsy from those specific areas. 

LEEP Biopsy 

LEEP utilizes a thin wire loop to remove the cervical transformation zone through electrocautery. It allows samples to be collected for additional tissue analysis and treats the condition in the same sitting. 

Cryocauterization 

This is a simple and safe procedure to treat cervical erosion and does not require any anesthesia. A cryoprobe is first cooled by nitrous oxide and then touched to the abnormal cervical area. This freezes and kills the cells, resulting in the sloughing of the abnormal tissue. The patient is sent home the same day. 

Ultrasound-guided Procedures 

In addition to the routine pelvic and obstetric scan, various ultrasound-guided procedures are done on a routine basis. This includes sonohysterography and sonosalpingography, where saline is instilled in the uterine cavity and the fluid helps in outlining the intracavitary uterine pathology and also to establish tubal patency in infertile patients. Ultrasound-guided amniocentesis is done to procure a sample of amniotic fluid for metabolic and chromosomal analysis in patients who have bad obstetric history or inherited disorders. 

Pipelle Sampling 

Endometrial biopsy is taken by Pipelle device. It is a 2-mm slender plastic curette. It is introduced in the uterine cavity and a strip of endometrium is obtained for histopathology. This is a painless and quick procedure which has replaced the conventional D&C. Endometrial biopsy is used in the assessment of abnormal uterine bleeding in perimenopausal patients for the assessment of the endometrium during tamoxifen therapy and for the investigation of amenorrhea or infertility. In women, the combined use of pipelle sampling and ultrasound has a high detection rate for endometrial carcinoma.

Obstetric Services 

Ours is a tertiary care center, well equipped for handling all types of high-risk pregnancies and emergencies related to pregnancy and labor. We have the back up of a well-equipped NICU with all advanced life support systems. The services include: 

• Management of fetal abnormalities with close cooperation of departments of pediatric cardiology, pediatric surgery and neonatology. This includes fetuses with intrauterine growth restriction, those with salvageable structural anomalies such as congenital diaphragmatic hernia, PUJ obstruction, posterior urethral valve, congenital cardiac defects, duodenal atresia, etc.
• Evaluation and Management of recurrent miscarriages.
• Screening and management of preterm labor and PPROM.
• Management of critically ill obstetric patients - HELLP syndrome, APH, eclampsia, obstetric shock.
• Management of pregnancies complicated with maternal disorders like hypertension, diabetes, cardiac diseases, collagen vascular disorders, hematologic disorders, etc.
• Management of pregnancies associated with gynecologic conditions such as fibroids, ovarian tumors, prolapsed uterus, etc.

Labor Room - 24 Hour Service 

Services are available in the labor room with obstetricians and a team of well-trained staff 24/7. Intrapartum monitoring with electronic devices is routinely provided. All our gynecologists are well experienced in operative deliveries.

Antenatal Services for High-Risk Pregnancies 

Our antenatal clinic helps manage complicated pregnancies for women with hypertension, diabetes, multiple pregnancy and heart disease complicating pregnancy, intrauterine growth restriction (IUGR), pregnancy with renal and hepatic failure, etc. Intensive fetal monitoring facilities including cardiotocogram (CTG), obstetric ultrasonography, high resolution fetal echocardiography and color Doppler velocimetry provide essential diagnostic information for treatment of complicated cases. 

Gynecologic Services 

Our surgical team is performing all routine and complicated surgeries related to the female genital tract. Minimally invasive surgical procedures include: 

• Uterine surgeries - myomectomy, rudimentary horn excision, adenomyomectomy, total laparoscopic hysterectomy, laparoscopic assisted vaginal hysterectomy.
• Tubal surgeries - adhesiolysis, tubal surgeries for ectopic gestation, salpingectomy.
• Ovarian surgeries - follicular puncture, ovarian biopsy, cystectomy, 

adhesiolysis, ovariotomy. 

• Hysteroscopic procedures - septum resection, myomectomy, polypectomy, tubal cannulation.

Special Facilities 

• Disorders like primary amenorrhea, hirsutism, hyperprolactinemia, polycystic ovarian disease, premature menopause are dealt with by special coordination between the gynecologist and endocrinologist.
• Interventional radiological procedures such as uterine artery embolization available for the treatment of uterine fibroids.
• Gynopsychiatric consultation: Psychologic support for patients with gynecological ailments such as chronic pelvic pain, post-menopausal syndrome, infertility etc.

Adolescent Gynecology Clinic 

Menstrual problems, non-specific lower abdominal pain, anatomical and developmental abnormalities, genetic abnormalities, etc. are dealt with. 

Menopausal Clinic

Each patient undergoes a thorough mental and physical evaluation and assessment. If indicated, hormonal treatment to meet the patient's individual requirements is arranged. 

Infertility Clinic

The couple is evaluated for various male and female factors. Male factor evaluation is done in conjunction with urologists. Facilities for controlled ovarian stimulation with intrauterine insemination are currently available. Patients requiring further assisted reproductive techniques are referred to our Amrita Fertility Center in Ernakulam. 

Well Women Clinic

Special health care package is available for women in the perimenopausal age group. They are screened for cervical and breast malignancies by Pap smear testing and mammogram. Transvaginal ultrasound is done for endometrium and ovarian screening. Dexa scan is done for women at risk for osteoporosis. 

Family Welfare Clinic 

Postpartum clinic provides advice on contraception. We have facilities for insertion of intrauterine devices and laparoscopic sterilization. If indicated, Medical Termination of Pregnancy (MTP) services are also available. 

Cancer Screening Clinic 

Patients with abnormal pap smears are further screened by colposcopy and early lesions are treated by cryocauterization or Loop Electrode Excision Procedure (LEEP).

Phone: 0484 - 2854003, 0484 - 6684003 

Email: gynaecology@aims.amrita.edu