Bed Wetting(Nocturnal Enuresis). What you need to know.


Many school-age children and even some teenagers suffer from nocturnal enuresis, which is described as nighttime bedwetting after the age of five. It is not a major health issue, and most children outgrow it. Even so, bedwetting can be distressing for both children and parents. Book your appointment with a child specialist in Greater Noida at Shivalik Hospital.

Nocturnal enuresis is classified into two types:

A child with primary enuresis has never had bladder control at night and has still wet the bed.

  • Secondary enuresis occurs when an infant has bladder control at night for at least 6 months but then lost it and wets the bed again.
  • Primary enuresis, on the other hand, is much more normal. A specialist should be consulted if a child or adolescent develops secondary enuresis. Bedwetting at this age may indicate a urinary tract infection or other health problems, neurological disorders (related to the brain), stress, or other issues.

What are some of the reasons for bedwetting?

Although the exact cause of bedwetting is unknown, it is thought to be due to a delay in development in at least one of the three areas mentioned below during the night:

  • Bladder: less bladder space at night
  • Kidney: at night, more urine is produced.
  • Brain: unable to wake up while sleeping

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Breast Cancer Detection and Treatment

Breast cancer is the most common cancer found in women. It is the second most common cause of death due to cancer in women.Breast cancer is rarely found in men. With increased awareness and early detection, cases of breast cancer have been coming down over the years. Consult the best gynecologist in Noida.

What is breast cancer?

It is the cancer of mammary glands. Cells of mammary glands proliferate abnormally to form a lump or tumour. If not treated it will travel to other parts of the body and proliferate at different sites; this is called as metastasis. The spread is common from one breast to another breast, to lymph nodes. Different types of breast cancer spread at different speed.

Symptoms of breast cancer:

At an early stage, no symptoms can be seen. First indication is a lump or mass in the breast, one can feel it with hands. Other symptoms may include:


  • Thickened or hard mass present in your breast
  •  Change in size or shape of breast
  • Change in size or shape of the nipples
  • Any form of discharge from nipples
  • Red patch around breast or nipples, any skin inflammation
  • Any growth in or near under arms
  • Peeling, flaking, or scaling of skin in any part of the breast.

What are the causes behind breast cancer?

Genetic and non-genetic factors play a role in the occurrence of breast cancer.

Genetic or inherited breast cancer: Breast cancer is inherited from mother or from maternal relatives. Women with familial history of breast cancer are at higher risk to develop breast cancer.

Nongenetic factors: It may include menstrual or reproductive history of a female, alcohol intake, body mass index, physical activity.

A woman taking birth control pills over the years, or on hormonal therapy for more than five years for the treatment of menopause, women with no pregnancy, girls who have started their menstruation cycle early, women with early menopause, and 50 plus age group of women are at higher risk of developing breast cancer.

Sedentary lifestyle and obesity are another risk factor for developing breast cancer. Women with more breast tissue are more prone to breast cancer. Alcohol consumption and abnormal dietary habits have been found to be causative factors in breast cancer. Consult the best gynecologist in Noida.

How to prevent breast cancer?

Keep your weight in control.

Follow a daily exercise routine.

Avoid consumption of alcohol.

Frequent screening of breast through mammography: women after 40 years of age should do mammograms annually.

Regular breast examination by yourself as well as from gynaecologist if you are genetically susceptible or in presence of any other predisposing factor.

Breastfeeding is the best way to control estrogen which is known to be a causative factor in breast cancer.

Types of breast cancers:

  • Ductal carcinoma in situ
  • Lobular carcinoma in situ
  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Medullary carcinoma
  • Mucinous carcinoma
  • Adenoid cystic carcinoma
  • Papillary carcinoma
  • Tubular carcinoma
  • Paget’s disease of the breast

Pregnancy associated breast cancer: Pregnancy associated breast cancer (PABC) is breast cancer occurring during pregnancy or within the first 1-2 years postpartum. Delay in diagnosis is common. Treatment is initiated during pregnancy. Surgery and chemotherapy are considered safe after the first trimester. Radiation, anti–HER-2, and endocrine therapy are considered after delivery due to adverse effects to the baby.

 Diagnosis breast cancer:

When a woman suspects any mass in breast, she should consult a doctor. Doctor will perform a physical examination of any abnormal tissue in the breast. Doctors will advise imaging tests to confirm the diagnosis.

Mammogram:It is a primary screening test for detection of breast cancer. If doctors suspect false images sometimes, other investigations are performed.

Ultrasound: Ultrasound will show the difference between a solid lump and a fluid filled cyst.

Magnetic resonance imaging (MRI): It helps by producing different images to get clearer pictures about tumours or abnormalities in the breast.

Biopsy: A piece of tissue is taken from the abnormal growth and sent to the laboratory for further testing. It confirms which type of breast cancer is developing. Type, size, and site of spread will determine treatment options.

Treatment of breast cancer:

Treatment of cancer can include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy.

There are several types of surgery depending on the size and location of the tumour. Breast cancer surgery is performed under general anaesthesia. A breathing tube is inserted into your nose and throat. Types of breast surgeries:

Lumpectomy: The tumour or lump is removed along with some of the normal tissue around it.

Mastectomy: The entire breast is removed during a modified radical mastectomy. The entire breast along with some of the lymph nodes inside the underarm and surrounding tissue are removed.

Radiation therapy: In this therapy radiation is used to kill the cancer cells or keep them from growing. External radiation therapy uses a beam machine outside the body that aims radiation at the cancer. Internal radiation therapy also known as brachytherapy uses a radioactive implant or different devices that gives off radiation inside your breast. Sometimes doctors advise radiation therapy after surgical removal of the tumour.

Chemotherapy:  After removal of the tumour, chemotherapy uses drugs to kill cancer cells. Chemotherapy is given to the whole body or sometimes only to the required area.

Hormone therapy: Another alternative treatment is hormonal therapy used after surgery to avoid recurrence of the cancer. Hormones are substances found naturally in the human body. Body uses Oestrogen mainly for the growth and development of the uterus, breast, and ovaries. However, tumour cells have receptors for the hormone oestrogen (ER-positive cancers) or progesterone (PR-positive cancers) which helps tumour cells grow and proliferate. Hormone therapy blocks oestrogen/ progesterone from binding to breast cancer cells so it cannot cause cancer cells to grow. Consult the best gynecologist in Noida.

Targeted therapy: Drugs in targeted therapy reach all parts of the body through bloodstream, so help in preventing growth at other areas of the body. The cells of breast cancer have a growth promoting protein HER-2. HER-2 positive breast cancer grows fast as compared to other breast cancer. Targeted drugs attack HER-2 and prevent the growth of cancer cells.

Immunotherapy: It is also known as Immuno oncology. Immunotherapy is self-induction of the body’s own immune cells to destroy cancer cells. Immunotherapy drugs are used in some forms of breast cancer to shrink the size of the tumour.

Chemotherapy, targeted therapy, and immunotherapy medications should be taken as per the prescription. These medications and radiation therapy have side effects; doctors should be consulted for new developed side effects. Long term follow-up and screening is required in breast-cancer survivors.

The good news is breast cancer is treatable when diagnosed early and patients can get back to normal life. To know more about breast cancer, book your appointment in Shivalik Hospital, Noida.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease is an umbrella term used for infection of the womb, ovaries, and fallopian tube. 90% of PID result from untreated sexually transmitted diseases (STDs) like chlamydia or gonorrhoea.

Bacteria travel from vagina to female reproductive organs and give rise to PID. Normally the cervix combats the spread of infection to other reproductive organs, but in STI, the cervix is infected and it is not able to keep the bacteria from reaching other organs. Other causes may include abortion, childbirth, treatments of pelvic region, or insertion of intrauterine devices (IUD). The risk of infection from placement of IUD is higher within a few weeks after insertion.Consult the best gynaecologist in Noida.


Pelvic inflammatory disease gives rise to mild symptoms in the majority of women, sometimes it leads to chronic pelvic pain. Most of the women do not experience any symptoms until they are trying to get pregnant.

  • Abdominal pain or tenderness– mild to severe different in different women
  • Unusual vaginal discharge or unpleasant odour
  • Nausea and vomiting
  • Painful intercourse
  • Spotting or abnormal uterine bleeding in between periods, after intercourse
  • Fever or fever accompanied by chills
  • Increase frequency of urination, painful urination.

When to see a gynaecologist?

  • Severe lower abdominal pain
  • Persistent nausea and vomiting
  • Fever of 101 F (38.3 C) and chills
  • Heavy vaginal discharge or foul odour

It is important to seek emergency medical attention if any of the symptoms occur. Sooner you will get the treatment, better the outcome and less complications of Phil week inflammatory disease.


Gynaecologist will diagnose PID through:

  • By asking for detailed medical history, general health, sexual activity And considering symptoms.
  • Pelvic examination of reproductive organs to check signs of infection.
  • Sample of vaginal culture of bacteria

Investigations for pelvic inflammatory disease may include blood test, urine test to determine urinary tract infection which may have same symptoms as PID, ultrasound of reproductive system to confirm the diagnosis.

Endometrial biopsy is recommended in some cases. In this test a small portion of lining of the uterus, endometrium is taken as a sample. It is tested in the laboratory.

Laparoscopy is used to closely observe female reproductive organs. A laparoscope is inserted through a small incision into a pelvic area to directly inspect the abnormalities.

Culdocentesis is a procedure rarely used but might help in some cases of PID. A needle inserted behind the vagina to aspirate the fluid for laboratory examination.Consult the best gynaecologist in Noida.

Treatment: Oral antibiotics are the treatment of choice to clear pelvic inflammatory disease. Ceftriaxone and doxycycline are effective in treating PID. Completing the dose of treatment is important, though all the symptoms have subsided. Sometimes patients may get relief before the infection wards off totally. Gynaecologist will plan follow up visits to check if treatment is working or not.

Some patients do not get any relief from oral antibiotics, they need hospital admission for I.V antibiotics administration. I.V administration of antibiotics required for Pregnant women, severe infection, and complications, to treat abscess in fallopian tubes or ovary.

Most of the patients do not require surgery. If there is recurrence of abscess and antibiotics are ineffective then the doctor may recommend surgery.

Antibiotics can cure PID completely on early diagnosis and treatment, but treatment cannot reverse the damage caused to reproductive organs.

Complications: Recurrent pelvic inflammatory disease leads to several complications such as:

  • Chronic pelvic pain
  • Ectopic pregnancy
  • Infertility issues

1 in 8 women face trouble in getting pregnant while suffering from PID. Bacteria from recurrent PID can lead to scarring of fallopian tubes. When an egg travels from ovary to fallopian tube for fertilisation, it can not meet sperms. Hence couples get trouble in conception or fertilisation may result in ectopic pregnancy.


  • If you are sexually active, always perform protected sex by using condoms or dental dams.
  • It is always advised to get tested for STIs like Chlamydia or gonorrhoea routinely if you have multiple partners or testing before having sex with new partner.
  • Do not ignore symptoms of PID. Talk to your gynaecologist about your symptoms or tell if you have unprotected sex.
  • Do not perform douching, it may push bacteria from vagina to other reproductive organs.Consult the best gynaecologist in Noida.


Does douching cause PID?

Douching can cause bacterial vaginosis by lowering the pH of Vagina, but there is no association found between douching and pelvic inflammatory disease.

Does my partner need treatment for pelvic inflammatory disease?

Yes, the male partner also needs to be treated to eradicate the infection completely. Otherwise, the infection may come back to you after being in contact.

When can I have sex, after having PID?

After finishing your PID treatment wait for one week and then resume sex with your partner. It may prevent the recurrence of infection.

To know more about Pelvic Inflammatory Diseases, book your appointment with Shivalik Hospital, Noida.

Best Gynaecologist in Noida serves superior gynaecological care for women

Gynaecology deals with the ailment related to female reproductive organs such as uterus, fallopian tubes, cervix, ovaries, and vagina. A gynaecologist is a doctor who treats disorders in females and may also treat related problems in the bowel, bladder, and urinary system as it is closely associated with female reproductive organs.

Gynaecologists provide a broad spectrum of women’s health care services ranging from unborn children, pregnant women as well as elderly women and diseases related to it. Shivalik hospital in Noida is a multispeciality hospital offering superlative healthcare and advanced treatment modalities in obstetrics and gynaecology.

Gynaecology services in Noida:

Pre-conception advice: Due to nuclear families, most of the couples do not get proper guidance before planning a family. Preconception advice is not just planning pregnancy but implementing a healthy lifestyle and adapting to balanced diet habits.

It gives a better idea to your gynaecologist about your family history and medical condition. It prepares the body and mind for change. It reduces complications in pregnancy and risks new-born. Your gynaecologist will guide you to conceive healthy.

Childbirth: Childbirth depends on myriads of factors, one of those is antenatal care. Vigilant and skilled team of gynaecologists in Shivalik hospital is operational to take care of high-risk pregnancy, normal deliveries, Caesarean section, as well as antenatal depression. Total care of pregnant women to provide guidance on nutrition, supplements, exercise routine aids in safe and normal delivery.

Normal delivery: Vaginal delivery is the safest and natural form of childbirth with less complications. Normal delivery has lots of benefits for mother and baby. No surgery and anaesthesia is required. Normal delivery renders faster recovery due to less chances of infection and blood loss.


In vaginal delivery, cortisone release helps in baby’s lung maturation and ensures normal breathing. It prevents the condition often observed in c-sections known as Transient tachypnoea of new-born. Baby can be immediately with the mother to feel her warmth that comforts the baby.

 Caesarean section:

1. Elective or planned caesarean section: It is planned by doctor and patients on the 38th to 39th week of pregnancy. Conditions for elective C-section

  • Cephalo-pelvic disproportion: CPD is present when the capacity of pelvis is inadequate to allow foetal head to pass through the birth canal. It can cause complications like fetal distress, head injury, uterine rupture etc.
  • Low lying placenta: Placenta is a vascular connecting structure between baby and mother. Normally placenta is present on top or side of uterus. In some conditions it is present at the lower level of the uterus. Placenta sometimes cover openings in the mother’s cervix called placenta previa. In such conditions the placenta can detach from the uterine wall and can cause immense bleeding.
  • Malposition of fetus: Normally the fetus is vertically aligned with head lying in lower position and legs are directed towards the chest of mother. In the transverse position the baby’s head on one side of the uterus and legs on the other side. It poses a risk of umbilical cord prolapse or fetal hand prolapse. Breech position is where the fetal head is directed towards the chest and legs towards the cervix. Complications may arise such as cord prolapse, reduced oxygen supply to baby.
  • Pelvic mass or tumour or fibroid
  • Serious infections like herpes infection
  •  Advanced carcinoma of cervix
  • Previous two C-sections and previous myomectomy
  • Mothers with moderate to severe heart disease cannot take stress from labour pain
  • Mothers with high blood pressure or diabetes
  • Twin pregnancy if the first baby is not in cephalic presentation.

 2. Emergency caesarean section: These are not planned before but depending on mother and baby’s condition, doctors opt for C-section for safety of mother and baby.

  • Fetal distress
  • Nonprogressive of labour
  • Complication during normal delivery like bleeding, convulsions etc.

For high-risk conditions like these C- section treatment is a safe choice for baby and mother.

Painless childbirth: Through the advent of medical science, painless childbirth is possible with the help of epidural anaesthesia. Epidural anaesthesia is the form of regional anaesthesia, administered in the lower back to a woman with active labour. It takes its effects within 10 to 15 minutes and a mother cannot feel pain during normal delivery. It is a boon for women with lower pain bearing capacity.

 Birth control: Different birth control options are available nowadays like Long-term contraception – intrauterine devices, copper Ts. and permanent contraception – tubectomy, vasectomy. Our gynaecologist offers the best counselling for family planning and helps you have a better future ahead. Short-term contraceptives are also available, but you must consult a gynaecologist for safer use.

 Gynaecological surgery: Different gynaecological and laparoscopic surgeries conducted with superior precision and using ultra-modern technology in Noida at affordable costs. Laparoscopic surgery for fibroids, cysts, endometriosis, pelvic inflammatory condition, adhesions, surgical wounds are conducted by a team of experts. Other services may include cystectomy (removal of cyst in the urinary bladder by removal of half or entire bladder), hysterectomy( removal of uterus), removal of ovaries, myomectomy ( removal of non-malignant fibroids from uterus), open abdominal surgeries.

Preventive and diagnostic treatment: Preventive health check-ups, Ultrasounds,post-menopausal care, breast cancer detection and treatment, treatment of sexually transmitted diseases, pelvic inflammatory diseases and other health related issues are taken care of by expert gynaecologists.


How to maintain the hygiene of vagina?

Gynaecologists do not recommend douching as it may penetrate high in vagina. It alters the normal pH of vagina and may lead to bacterial vaginosis. Vagina has self cleansing properties. Gentle soap and water is helpful for maintaining hygiene of vagina. Always wear cotton underwear and avoid tight clothing. Do not use sainted cosmetics in the vaginal area.

How to reduce pain from menstrual cramps?

Natural way to reduce cramps is using a heating pad on the stomach, and taking a warm bath. Exercising regularly and eating healthy also helps in decreasing cramps. Healthy lifestyle aids in hormonal regulation and symptoms of menstruation.

If you have any queries visit the best gynaecologist in Noida, Shivalik Hospital.

Depression in pregnancy

Pregnancy alters the mental and physical condition of women. Hormonal changes occur at every stage, which are responsible for the emotional state of women. It further leads to anxiety and depression in pregnancy.

In the majority of women, pregnancy is a happy phase of life. On the contrary 10 % of women feel sad all the time through weeks or even months. It is called antenatal depression and it is definitely not normal.

Depression during pregnancy can be harmful for both mother and baby, being stressed during pregnancy increases chances of postpartum depression. It also increases the risk of preterm delivery and low birth weight. Depression in pregnancy is treatable and Dr. Neena, best gynaecologist in Noida explains about how to resolve it.

What is antenatal depression?

Depression is a mental illness that affects your emotional condition. It makes you feel sad or anxious all the time. It affects the quality of life when it exists for a longer period of time. Pregnancy is a crucial time for mother and baby to be happy and healthy.

You are not alone! Pregnancy depression is common, and many women experience it. Undue stress or depression may lead to complications during pregnancy. It is important to treat antenatal depression at the right time by seeking medical attention.

Which factors increase the risk of depression during pregnancy?

Depression can be associated with the following factors:

Age: young women are more prone to depression during pregnancy

Support: Women who handled their pregnancy all alone are more likely to undergo depression. Having a family around, plays a great role in feeling supported. Women can discuss what’s going on in their mind with family members.

History of depression:Women with premenstrual dysphoric disorder are likely to develop depression during pregnancy.

Conflict: A marital conflict puts stress on the mother and that converts into anxiety and depression.

Fear: If a woman have experienced miscarriage, child loss then she probably can not come out of it and that constant fear leads to depression.

Hormonal imbalance: Surge of hormones alters the brain chemicals and causes depression and anxiety.

What are signs and symptoms of antenatal depression?

In pregnancy all women go through highs and lows. All pregnant women may feel sadness at some point of time, but it cannot always be depression. Many women who are suffering from depression does not understand it. If you notice any of the following symptoms, you should reach out to your gynaecologist:

  • Feeling sad all the time for weeks or months
  • having suicidal thoughts
  • Feeling negative, worthless, or guilty
  • Loss of interest in routine activities, eating
  • Having difficulty in sleeping, poor concentration or decision making

Women who have experienced depression in past life are at greater risk of developing depression during pregnancy. Ask yourself if you feel normal? From the last 2 weeks have you felt happiness in any activity?

Your health care provider will ask you some more questions, to confirm the diagnosis. Depression screening tests will give clear ideas about antenatal depression. Consult the best gynaecologist in Noida

What are the effects of depression on pregnancy?

Antenatal depression is not good for mother or baby. It may affect pregnancy in different ways:

Depression hamper your ability for self-care: Depression leads to loss of appetite, lack of sleep, poor concentration. It affects the overall quality of life. Due to depression, you may not be able to take care of yourself and baby, you might not follow medical recommendations. During pregnancy a healthy lifestyle and balance right is utmost important for proper growth and development of baby.

Placing you at greater risk of harmful substances:  To obtain relief from depression many people indulge in using tobacco, alcohol, or smoking. These habits have a bad impact on pregnancy.

It does not allow you to bond with your baby: From the womb, the baby can hear the mother’s voice. Pregnancy is a good time to bond to your little one, growing inside you. If a mother is depressed, it will affect the baby, babies can sense the emotion of the mother. It might be difficult for a depressed mother to take care of a fetus and connect with it properly.

What are treatment options for antenatal depression?

To come out of antenatal depression certain steps are necessary. Mental and physical health it’s important in pregnancy.

Set a routine: Plan your day, schedule diet and exercise routine. Following the routine will help you get back to normal. Try to do things that make you happy.

Stress management: Practice stress management techniques such as yoga, meditation will help you overcome your depression. Focus on self and baby care first. Distribute your workload. Talk about what you feel with your partner, family members or your gynaecologist.

Counselling: Do not struggle alone, If nothing works you can always opt for counselling. If you do not find family support, tell your concern to a counsellor.

Are antidepressants safe during pregnancy?

According to some studies, some antidepressant medicines are safe during pregnancy, considering short term effects on the baby. More studies are required to conclude about long term effects on the baby. Gynaecologists assess the individual risk and benefits before treatment.

To not know more about depression in pregnancy, book your appointment with the best gynaecologist in Noida, Shivalik hospital.

Painless Childbirth

Labour pain is experienced by every woman going through normal delivery. Labour pain is incapacitating. Women with a low pain threshold can not withstand the level of pain. It is associated with the risk of chronic pain, postpartum depression, post-traumatic stress disorder. Women have developed fear about normal delivery and they often opt for C- section.

Nowadays the concept of painless childbirth has emerged which is betwixt and between – neither labour pain nor C- section. Epidural anaesthesia is suggested by doctors by checking the health status of a mother and if there is no high-risk pregnancy. When active labour starts, anaesthesiologist introduces epidural injection which makes the delivery almost painless. Best gynaecologist in Noida Dr. Neena explains about painless childbirth in detail.

What is painless delivery?

Through the advent of medical science, painless childbirth is possible with the help of epidural anaesthesia. Epidural anaesthesia is the form of regional anaesthesia, administered in the lower back to a woman with active labour. It takes its effects within 10 to 15 minutes and a mother cannot feel pain during normal delivery. It is a boon for women with a lower pain threshold.

Mechanism of action of epidural anaesthesia: Contraction of muscles of the uterus and pressure on the cervix to push the baby out causes the labour pain. The labour pain begins on contraction of the uterus, and the cervix starts to open. The labour pain signals from the uterus reach the brain through the nerves of the backbone or spine. Epidural anaesthesia blocks these signals and causes numbness of the pelvic region. Though it does not provide 100 % pain relief, it significantly lowers the intensity of pain. Consult the best gynaecologist in Noida.

What is the procedure of epidural anaesthesia?

Lower back will be disinfected with an antiseptic solution to prevent infection. Anaesthesiologist will assist you to sit in the right position for effective epidural injection. While administering epidural injection, patients have to sit still with the back arched. A small needle is introduced between spinal bones and the space around spinal nerves. A catheter will be attached to the needle and placed in the lower part of the spinal cord. Needle will be removed then and the catheter will be tapped to avoid slipping from the place. Catheter will allow infusion of anaesthesia at regular intervals or continuous infusion as per requirement. It offers pain relief in abdominal, pelvic, genital areas.

What are the advantages of painless childbirth?

  • Painless childbirth is the midway between normal delivery and C- section. It offers the benefits of normal delivery to mother and baby by eliminating the labour pain.
  • Epidural anaesthesia is effective in lowering the numbers of C -section in India effectively.
  • Women with low pain bearing capacity and fear of labour pain are candidates for epidural delivery, if there is any mishap or emergency occur during the delivery, it is easy to perform C- section under epidural anaesthesia.
  • It helps in mitigating pain and aids in relaxation of mind. Mother can concentrate on childbirth instead of distractions and irritation from labour pain. Thereby lowers the risk of postpartum stress and depression.
  • It aids in descending movement of the baby by relaxing the pelvic and vaginal muscles.
  • Epidural anaesthesia aids in lowering blood pressure, it prevents shoot up of blood pressure during labour.

 What are side effects of painless childbirth?

  • Epidural anaesthesia is completely safe for mother and baby but there are some   side effects associated with it such as fever, breathing difficulties, nausea, dizziness, back pain, and shivering.
  • Migraine-like headaches are one of the side effects often experienced by new mothers. It is probably due to the leakage of anaesthesia in the spine.
  • Labour may take more time than usual due to epidural anaesthesia.
  • After delivery, mothers may have difficulties in passing urine, and a catheter can be used in such conditions.
  • Numbness of the entire lower body may take time to get normal. It may be difficult for you to walk on the same day.
  • Rarely, if the mother’s blood pressure gets lower, it may decrease the heart rate in the baby as well. It is an emergency and the baby needs to be taken out through C- section.


What are other forms of painless childbirth?

Other forms of painless childbirth are Entonox- delivery of nitrous oxide and oxygen through a breathing mask, and water birth. Consult the best gynaecologist in Noida.

 What are Contraindications for epidural anaesthesia?

  • A patient is taking blood thinners
  • Patient with low platelet count
  • Patient with a blood infection
  • Anaesthesiologist is not able to locate epidural space
  • If the woman’s cervix is not dilated at least by 4 cm
  • Patient with back infection
  • If the labour is so rapid and no time to induce anaesthesia.

What are Complications for epidural anaesthesia?

Complications of epidural anaesthesia are rarely observed such as skin infection at the site of insertion of catheter, slow breathing, seizures, nerve damage.

Painless childbirth using an epidural anaesthesia is beneficial for first time mothers for a positive natural birth. Gynaecologists always assess individual patient factors and recommend painless childbirth if convenient. To know more, book your appointment at Shivalik Hospital, Noida.

Importance and ways of breastfeeding by Paediatrician Dr. Ravi

Breastmilk is not just milk, but it is love, bonding and full of health benefits. Nothing as perfect as breastmilk for your baby. It keeps the right balance in terms of volume and composition from time to time as per babies need. It is essential for wholesome nutrition and healthy nutrition of babies.

Importance of breast milk:

For babies:

  • Breast milk is the source of immunoglobulins IgA, IgM, IgG, and secretory forms of IgM (SIgM) and IgA (SIgA). Breastmilk immediately secreted after childbirth is called Colostrum. It is thick and includes high amounts of SIgA, which protects a baby by forming a protective layer in their nose, throat, and throughout their digestive system. It also contains tissue repair factors.
  • It is a healthy start for babies, and it provides necessary nutrients in adequate amounts.
  • It is easily digested by babies, as the gut is not well developed. It does not cause diarrhoea or constipation which is common in new-born babies.
  • It protects against infection like ear infection and allergies by boosting the immunity. It prevents diabetes and cancer like diseases.
  • Babies who are breastfed have higher IQ and better mental development and emotional security.
  • Babies grow at a healthy weight and prevent obesity.

For mothers:

  • It helps in better healing of the body and prevents severe postpartum bleeding.
  • Without efforts mother come back to her pre pregnancy weight, by burning 500 extra calories per day
  • Breastfeeding mothers have stronger bones forever in life
  • It helps mother and baby to bond better and the baby can sense emotional security from breastfeeding.
  • Relaxation: At the time of every feeding there is release of hormone oxytocin, which is a happy hormone. Mother feels relaxed and calm.
  • Economical for most of the families:  Breastfeeding saves time and money as formula milk is an expensive and tedious process. Everyone cannot afford formula milk. Breast milk is available just by providing the right nutrition to the mother.
  • Women who have breastfed their babies are at lower risk of developing diabetes, osteoporosis, breast, ovarian and endometrial cancers in later life.

 Ways of breastfeeding: There are various positions of breastfeeding. You have to choose a comfortable position for you and your baby. Dr. Ravi, the best paediatrician in Noida has given guidance about breastfeeding positions.

The laid-back nursing position: It is also called as biological nursing hence effective from first feeding. It is helpful for new-born babies, mothers with small breasts, babies who have difficulty in latching, twins etc.

Position: Lean back on a bed or couch, take support of pillows to form a semi-reclined position. When you put your baby on your baby tummy, the baby’s head comes near your breast. You can guide your baby to breast. It can be used in both directions.

The cradle hold: It is a popular breastfeeding position but might be difficult for some women. After the baby has developed a proper latch, this position is comfortable for the baby.

Position: The side where you will be breastfeeding, hold your baby such that head rests in the bend of your elbow or the arm. Other hand will support the rest of the body.

Crossover hold: In this position the mother can easily observe the nipple and baby’s mouth. Mother has better control over the baby’s head, and she can guide it to form a good latch.

Position: If you are nursing on the right side, support the baby’s head with your left hand. Use another free hand, to cup your breast towards the baby’s mouth.

 Football hold or clutch hold: This position is helpful for feeding twins, women with Large breasts, women with C-section and can place the baby against the tummy, if a baby is small or premature.


Position: Hold your baby on one side, facing you, with the baby’s legs placed under your arm on the same side as the breast you’re nursing from.

Give support to the baby’s head with the same hand and use your other hand to cup your breast as you would for the crossover hold.

 Side-lying position: It is a simple but effective position, also helpful during night feeding.


Position: Baby and mother both sleep facing each other. Use your hand on the other side you are not lying on to cup your breast if required. Mother should observe the position, and there should not be excess bedding around that will suffocate the baby.

How to get a proper latch?

Rooting reflex allows a new-born baby to find your breast or bottle to begin feeding. Start gently tickling the baby’s lips with your nipple to stimulate the rooting reflex. Baby will turn back to your breast.

Do not stuff or force your nipple into a reluctant mouth, let the baby take initiative.

Assure that the baby’s mouth covers both the nipple and at least part of the areola.

Your baby’s breathing should be obstructed by your breast.

If you are not sure if the baby is getting milk, check the cheeks. You can see a rhythmic motion if the baby is sucking and swallowing.

If you want to unlatch your baby due to latching problems, re-latch or your baby is done feeding but not leaving breast, first press the breast near the mouth or by gently putting your finger into baby’s mouth. Consult the best paediatrician in Noida.

Avoid this position:

Mother hutched over the baby: Latching will hamper due to mother hutching over the baby. Instead keep back straight and bring your baby towards breast.

Baby’s body and head face in different directions: It will be uncomfortable for the baby to swallow.

Baby’s body is too far away from breast: Baby will try to develop a latch and pull your nipple.

All you need to know about tonsils

Tonsils are tissue pads situated on both sides of the back of the throat. Tonsils are lymph nodes that prevent the risk of infection by the mechanisms of filtration of germs and bacteria.

Tonsillitis is the swelling and inflammation of tonsils in which it becomes oval shaped lying at the back of the mouth. Children always suffer from tonsillitis. In infants, toddlers, and preschoolers tonsillitis occurs due to viral infection. Consult the best paediatrician in Noida.

What are symptoms of tonsillitis?

Normally, tonsils appear pink in colour and barely perceptible. In inflammation of the tonsils, it appears red, swollen and easily noticeable. There may be white layer covering the tonsils or yellow spots. It causes halitosis (bad breath) and fever.

Other symptoms are:

  • Difficulty in swallowing
  • Difficulty in drinking
  • Ear pain
  • Fever with chills
  • Severe Sore throat or persistent sore throat for more than 48 hours
  • Jaw tenderness
  • Throat pain
  • Change in voice
  • Headache
  • Due to severe infection and enlargement, tonsillitis leads to breathing difficulty.
  • In young babies it leads to loss of appetite, drooling of saliva, irritation.

Types of tonsillitis:

Acute tonsillitis: Acute tonsillitis is common and all children suffer from it at least once during childhood. It is considered acute when it subsides within or less than 10 days. Acute tonsillitis responds well to home remedies but sometimes require antibiotics under medical supervision. Consult the best paediatrician in Noida.

If symptoms persist more than 10 days or tonsillitis occur repeatedly, it is chronic or recurrent tonsillitis.

Chronic tonsillitis: Chronic tonsillitis symptoms are present for a longer period of time. It includes sore throat, halitosis (bad breath), tenderness of lymph nodes in the neck.

Over the period, dead cells, saliva, and food particles accumulate in the crevices of tonsillar tissue. The layer of debris gets hard and forms tonsil stones. Sometimes this debris gets dislodged on its own, but many a times it needs to be removed by Doctors.

In chronic tonsillectomy, the line of treatment is surgical removal of tonsils, called tonsillectomy.

Recurrent tonsillitis: Recurrent tonsillitis is characterised by repeated episodes of tonsillitis.

          Tonsillitis at least 5 to 7 times in a year

          Tonsillitis 5 or more times every year since last 2 years

          Tonsillitis 3 or more times every year since last 3 years

Recurrent tonsillitis occurs due to antibiotic resistant bacteria. These bacteria produce colonies in the crevices of tonsils called as biofilms and lead to repeated tonsil infection.

Genetic predominance can be seen in tonsilitis. In recurrent tonsillitis, low immune response can be found against streptococcus bacteria. It causes Strep throat and tonsillitis.

When to consult a Doctor?

Seek medical advice if you notice:

  • High fever up to 103°F (39.5°C)
  • Weakness of muscles
  • Stiffness in neck
  • Sore throat persistent after 2 days
  • Trouble in breathing due to excessive enlargement of tonsils

In some cases, tonsillitis gets better on their own, some cases may require other treatments. Consult the best paediatrician in Noida.

 Diagnosis of Tonsillitis: Diagnosis can be made with physical examination and history. Doctors may take a throat swab and send it to the pathology lab. Throat culture will be helpful in identifying the cause of tonsillitis.

To differentiate between viral and bacterial infection, doctors recommend complete blood count. From CBC doctors can determine mode of treatment.

 Treatment of Tonsillitis:

A mild case of tonsillitis doesn’t need treatment, it gets better with home treatment, especially viral infection.

In more severe cases of tonsillitis, treatment of choice is antibiotics or a tonsillectomy.

If a child gets dehydrated due to tonsillitis, doctors start intravenous fluids supplementation. Pain medicines are given to relieve the sore throat which helps in throat healing.

 Antibiotics: Bacterial infection of tonsils require antibiotics to fight the infection. Antibiotics may relieve symptoms faster and prevent complications of tonsillitis but also put on risk of developing antibiotic resistance. Another side effect is stomach upset.

Doctors prescribe penicillin for tonsillitis caused by group A streptococcus. If someone is allergic to penicillin, other antibiotics are available

Completing the full course of antibiotics, remains crucial to avoid resistant and further complications. Doctors take follow-up to check whether the medication was effective.

Tonsillectomy: Tonsillitis which does not respond to antibiotics, requires tonsillectomy. It is the surgical removal of tonsils. It is recommended in children with chronic or recurrent tonsillitis, complications of tonsillitis or where symptoms do not improve.

Repeated episodes of tonsillitis 5 to 7 times a year require surgery. It relieves breathing problems or trouble swallowing that can result from tonsillitis.

According to studies, tonsillectomy may reduce the number of throat infections in children during the first year after surgery, in adulthood they have greater risks of respiratory and infectious diseases.


Is tonsillitis contagious?

Yes, before 24 to 48 hours of showing symptoms, it is contagious. Without treatment, though you feel better it can pass the infection to others.

What are home remedies for tonsillitis?

  • Keep hydrated
  • Take proper rest
  • Warm saline gargles several times a day
  • Use throat lozenges
  • Consume popsicles or other frozen foods
  • Use a humidifier to moisten the air in the home
  • Consult the paediatrician before giving any medication to children.

To know more about tonsillitis, Consult Dr. Ravi, the best paediatrician in Noida.

Hepatitis A, B, C, D & E: Prevention and Treatments

According to WHO 325 million people worldwide are suffering from Hepatitis. Hepatitis is an inflammation of the liver. It mainly occurs due to viruses but also acquired by different modes of transmission. It leads to a variety of symptoms as well as serious health complications.

There are five main types of hepatitis, named from the virus strain due to which they occur –Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D & Hepatitis E. All of them leads to liver disease despite the difference in mode of transmission, severity of illness, regional spread, and ways to prevent it. Hepatitis B and C cause serious infection and can be fatal. It leads to liver cirrhosis, liver cancers and hepatitis related deaths. Consult the best paediatrician in Noida.

Symptoms of hepatitis: Symptoms may start appearing depending upon incubation period. Incubation is the time window from exposure to onset of symptoms. The incubation period is different for different strains.


Incubation Period

Hepatitis A

15 to 45 days

Hepatitis B

45 to 160 days

Hepatitis C

2 weeks to 6 months


Symptoms of viral hepatitis may include:

  • Loss of appetite
  • Nausea and vomiting
  • Fever
  • Abdominal pain
  • Generalised weakness
  • Sometimes patient may develop dark urine, light coloured stools, jaundice (yellowish discoloration of skin and conjunctiva of the eyes)

Most of the patients suffering from HIV, HBV and HCV do not show any symptoms.

For prevention of hepatitis, it is important to understand the mode of spread of Hepatitis infection through different strains. Consult the best paediatrician in Noida.

Hepatitis A: HAV infection causes acute viral hepatitis and never reaches chronic stage. It is contagious like other viral infections, could be spread from one person to another person especially in family members and close contacts. Due to lack of hygienic conditions, food and water contaminated with waste of HAV patients (faecal-oral route), oral secretions through kissing, in children in day-care centres or schools where proper sanitisation is not followed are some of the sources of transmission.

Hepatitis B: HBV infections can lead to chronic hepatitis and can transmit the infection to others till the time they are infected, that is from six months to decades. In HBV infected patients chronic infection leads to development of cirrhosis, liver failure or liver cancer.

Modes of transmission of HBV infection:

  • Hospital acquired through using infected needles, haemodialysis, from blood transfusion.
  • Through sexual contact
  • From mother to her new-born baby
  • In drug abusers it can be transmitted by using infected needles.
  • Through tattoo making, ear or nose piercing, using infected razors.

Hepatitis C: HCV infection is another chronic form and leads to liver cirrhosis, liver failure and liver cancer. The mode of transmission is through direct contact with body fluids through blood transfusions, sharing infected needles in drug abusers, sexual contacts. On an average 75 to 90% of transfusion associated infections are due to HCV.

Hepatitis D: HDV infection is a serious form of liver disease and also called delta hepatitis. It is always found in conjunction with Hepatitis B. HDV requires surface antigen to damage liver cells which is produced by HBV, hence HDV can not survive on its own. Mode of transmission is the same as that of HBV.  Combined HBV and HDV infections cause liver cirrhosis and rapid scarring of the liver, These infections are not easy to treat.

Hepatitis E: HEV infections are waterborne and same as HAV infection in terms of mode of transmission and disease. Due to poor hygiene HEV spreads through faecal-oral routes. It is most commonly seen in Asia.


Vaccines: Some forms of hepatitis can be prevented through vaccines. According to a study conducted by WHO estimated 4.5 million premature deaths could be prevented through proper education, vaccination, diagnosis, and medicines in low to middle income countries. So, immunisation against Hepatitis A and B is key to combat the infection.

Vaccination for Hepatitis starts at the age of 12 to 18 months and is given as 2 doses in children. In adults’ vaccination for hepatitis A and B is available in combined form.

Other ways of prevention:

In case of Hepatitis A and E:

  • Practice proper hand hygiene, wash your hands before and after eating. Wash your hands with soap and water after each toilet use.
  • Avoid eating and drinking from outside while you are traveling.
  • Always wash fruits and vegetables before eating or cooking.
  • Avoid eating raw and undercooked meat, sea food.
  • Always drink chlorinated and purified water.

Proper hygiene protocol should be followed in daycares and school going kids. To know more Consult the best paediatrician in Noida.

In case of Hepatitis B, C and D:

Do not share needles, razors, and toothbrushes.

Be aware while blood transfusion, take treatment where proper sanitation protocols are followed to stay away from hospital acquired infections.

Do not touch spilled blood.

Hepatitis B and C can be acquired through sexual intercourse or through kissing. It is important to have safe sex every time using condoms or other means of protection.


Hepatitis A and E: These two forms develop short periods of illness and do not require specific medication. If patients feel discomfort, experience diarrhoea or vomiting; doctors recommend proper hydration and nutrition.

Infection resolves on its own by plenty of rest, proper diet and hygiene and avoiding alcohol. Pregnant women with Hepatitis A or E require proper monitoring and medical care.

Hepatitis B: Hepatitis B with acute form does not require specific treatment whereas chronic form requires antiviral therapy. The treatment is continued for several months to years, so it is expensive. Chronic Hepatitis B requires periodic evaluation of patients to check response to treatment.

Vaccination is effective and safe against Hepatitis B. It is mandatory for new-born, medical and healthcare professionals. In new-born babies 3 doses of vaccine are given within 6 months of age.


 Hepatitis C: Antiviral therapy is used to treat acute and chronic forms of disease. Combination drug therapy is used to treat chronic infections. Patients need to be evaluated routinely to determine the suitable form of treatment. Patients with liver cirrhosis and scarring may require liver transplant.

Hepatitis D: There is no specific antiviral therapy for Hepatitis D. Vaccination for Hepatitis B is effective, as Hepatitis D always develops in patients with existing Hepatitis B.


Can I get Hepatitis B even after vaccination?

No. Hepatitis B vaccine is effective and good news is Hepatitis B is preventable through immunisation.

What is Fulminant hepatitis?

Fulminant hepatitis is resulted due to overuse or taking large doses of acetaminophen – an over-the-counter painkiller. It causes liver failure. It also can be a clinical symptom of severe liver function impairment which decreases liver synthesizing capacity and causes liver coma. It starts developing after eight weeks of hepatitis onset.

Are vaccines effective against all Hepatitis?

Vaccination is available only for Hepatitis A and B. Hepatitis B also provides immunisation against Hepatitis D as Hepatitis D can develop only in presence of Hepatitis B. Hepatitis C vaccine is available only in China.

To know more about Hepatitis in children, Consult the best paediatrician in Noida.

5 ways to keep your baby happy while you change his diaper!


Parenthood comprises new challenges every day. One of them is Diaper change. Do you wish that you would skip your turn?  Diaper change is a hard task during any time of the day, and during night it is even harder to calm down your crying baby and get some sleep. In public it is more embarrassing, but sometimes parents are left with no option. To know more consult the best paediatrician in Noida.

Do you know why babies cry during Diaper change? Let’s find out!

Babies hate diaper change; they get cranky and cry loudly. There could be a number of reasons that lead to fussy behaviour.

Wetness: As soon as they poop or pee, they feel cold which makes them unhappy. Most babies hate coldness associated with diaper change.

Hungry: If the baby is hungry while you change diapers, the baby can’t wait for feeding. Try changing diapers after feeding.

Confused:  New-born baby does not figure out what is going on, everything is new to them, as they understand the diaper changing routine, they will build some trust.

Change of turn: New-born babies easily get adapted to mother touch, sometimes while taking turns, they do not feel comfortable with change of touch.

Distractions: If parents change diapers in the middle of the play, they do not like it. Sometimes a new-born learns a new skill and wants to repeat it. While lying down on the back during diaper change, the baby can not perform newfound skills like sitting, rolling on the side, crawling etc.

Medical issue: Parents you need to cross check if it is associated with diaper change or any other medical issue such as colic etc. Consult the best paediatrician in Noida.

5 ways to keep your baby happy while you change diapers!

  • Keep it slow and connect with your baby: Do not force diaper changing on your baby to avoid a power struggle. Take a deep breath, be gentle, connect with your baby, go as per your baby’s mood. Slow down, take time to bond with him. If you repeat the same process, babies like the routine. If your baby understands, tell him, its diaper changing time.

  • Fun activity: Make it a funny activity, so that he can associate with it positively. Wear a funny cap, do some dance steps, and laugh aloud. If you show your panicked face, he will catch your emotion.

Hand over your baby a diaper, nappy rash cream, a special toy only reserved for diaper activity, make funny faces, in short use all your skills to keep him in a happy mood and without knowing how to change his diaper.

  • Special arrangements for diaper changing: Change diapers in warm rooms, babies do not like the cold. Make sure that nobody should be around whenever possible.

Hang a toy on the diaper changing table, change the diaper where the baby can observe a good view like a window or wallpaper containing a cartoon.

  • Narrate your actions: Communicating with your child is a great way to make him comfortable. Tell him “let’s get clean, you will feel better”. Let him hold a nappy cream, ask him for help “Pass me the cream.” “Now you are dry, and you can play.” Positive sentences have a positive impact on babies’ minds, and they also develop interest in activity.


  • Take help whenever possible: Ask your partner to help during diaper change. He will also get familiarised with the process and both can complete the task easily. Taking turns for changing diapers is a better arrangement. It will also build a bond between baby and daddy.

Using a good quality diaper is also one of ways to make diaper changing hassle free. If the diaper stays for long, the baby wouldn’t like it and he will not associate it positively.

Have a routine, change diapers in the morning, before night’s sleep, that will reduce your burden of getting up at midnight for diaper change.

To know more visit the best paediatrician in Noida.

How long does it take to recover from Dengue fever?

Dengue is a viral infection spread by mosquito bites. It is the fastest-growing mosquito-borne viral infection in the world. Aedes aegypti are the primary vectors of dengue and infected female mosquitoes are responsible for transmission. After incubation, an infected mosquito can spread the virus for the rest of her life.  

According to WHO, half of the world’s population is at risk of developing Dengue. There are four dengue viruses so there are chances of repeated infection. Second-time dengue infection is more dangerous and requires hospitalisation.

The breeding of these mosquitoes takes place in manmade containers like buckets of water, planters, and small containers with settled stored water. Book your appointment with the best paediatrician in Noida.

Symptoms: Symptoms of dengue starts appearing after four to six days of infection. Dengue can be difficult to differentiate from other infections like malaria, typhoid, influenza etc. Symptoms of Dengue are as follows:

  • Fever
  • Headache
  • Generalised body ache,
  • Pain behind eyes,
  • Skin rashes,
  • Muscle and joint pain,
  • Nausea and vomiting,
  • Mild bleeding etc.

 75% of dengue infections are asymptomatic, 20% have mild to moderate symptoms and 5% cases have severe dengue infection with fatal complications. Immuno-compromised persons and children are attacked by dengue.

Diagnosis: Your doctor will ask you about your recent travel history for areas with a high risk of Dengue. A blood test is performed to confirm dengue from other similar viral infections.

Treatment: Doctors will treat you as per your symptoms.  When a doctor confirms Dengue, patients should take as much rest as possible.

Acetaminophen or paracetamol is the drug of choice for the treatment of Dengue.

Drink plenty of water and fluids to stay hydrated. It is important to maintain electrolyte balance.

Take proper care and prevent worsening of symptoms. Severe dengue is a medical emergency. Symptoms of Dengue worsen rapidly within a few hours.

Severe dengue is seen in 1 in 20 people affected by it. It leads to fatal complications such as shock, internal bleeding, and death.

If a patient is infected a second time, he or she may develop severe dengue. Infants and pregnant women are at higher risk of severe symptoms. Book your appointment with the best paediatrician in Noida.

Warning signs of severe dengue: Warning signs can be seen in 24 to 48 hours after the fever is gone.

  •          Belly pain, tenderness
  •          Blood in vomiting or stool
  •          Bleeding nose or gums
  •          Vomiting at least 3 times in 24 hours
  •          Feeling tired, restless, or irritable

Reach out to your doctor, as it is an emergency condition.

Recovery time:

Dengue can be treated with proper treatment and a balanced diet. Recovery time depends on the patient, age, medical condition, symptoms etc. For example, if a patient has a haemorrhagic fever, he may take longer to recover.

The symptoms may start appearing after 4 to 7 from the mosquito bite however the infection remains from day one. The patient may take a time of 10-14 days to get rid of the infection from the body. Once the symptoms start showing, another week is needed for the infection to be flushed out through proper treatment and a balanced diet.

If in case the symptoms are detected late and treatment is not received on time, it may take the patient a little longer to recover. After the incubation period of 10-14 days, one has to go through another week of acute symptoms and then a few days of complete recovery. Book your appointment with the best paediatrician in Noida.

Hemorrhagic dengue fever time for recovery:

When dengue shows severe complications and develops hemorrhagic dengue fever, the symptoms and problems last for a longer time and take more days for recovery.  The symptoms of hemorrhagic fever, which is an emergency case of dengue, result in vascular permeability. It appears from the first week after you start noticing the signs of dengue fever.  The patient with haemorrhagic fever may need to be hospitalized and are usually closely monitored by specialists.

To know more about Dengue and its treatment visit Shivalik Hospital, Noida.