OBSTETRICS

BSc(Med) MBBS FRANZCOG MS (Gynae-Endoscopy) Robotic Surgeon

Dr. Surya Krishnan is an Obstetrician, Gynaecologist, Gynaecology Endoscopic Surgeon and Robotic Surgeon.

Overview

Our obstetric services include pre-pregnancy, pregnancy and post pregnancy care plans for both normal and high-risk pregnancies.

  • Pre-pregnancy assessment and counselling
  • Repeated early pregnancy loss (recurrent miscarriage)
  • Early pregnancy genetic counselling
  • Low-risk pregnancy with the expectation of normal birth
  • Pregnancy complicated with high blood pressure (pre-eclampsia), diabetes or other presentation
  • Women with pre-existing medical problems such as thyroid disease, autoimmune disorders, kidney disease or cardiac disease
  • Operative obstetrics, including caesarean section.

Please call our offices on (02) 9188 2863 to schedule an appointment.

This includes all surgeries performed on pregnant women for conditions associated with pregnancy, labour, or the puerperium (the short period after birth). It does not include surgery on the newborn infant.

First trimester

During the first 3 months of pregnancy, or the first trimester, there are many changes happening to you. As your body adjusts to the growing baby, you may experience nausea, fatigue, backaches, mood swings, and stress. Just remember that these things are normal during pregnancy. Most of these discomforts will go away as your pregnancy progresses, so try not to worry about them. Just as each woman is different, so is each pregnancy. When you are tired, get some rest. If you feel stressed, try to find a way to relax. Accept that your normal routine is changing.

Visiting Dr Krishnan is very important during these early stages. Dr Krishnan will perform several tests to check the health of both you and your baby. He will also be able to answer questions about any concerns or fears you might have, and he will tell you what you can do to make your pregnancy as easy as possible. You’ll need to know what types of exercises you can do, what you should eat for good nutrition, and what you might need to avoid during this time. Pay attention to what your body is telling you and listen to Dr Krishnan’s advice. This is an exciting time, and remember we are here to answer any questions you may have.


Second trimester

Most women find the second trimester of pregnancy to be easier than the first trimester. By the 26th week, your baby will weigh almost
2.5 pounds and be about 23cm long. With this growth comes the development of your baby’s features, including fingers, toes, eyelashes and eyebrows.

The second trimester of your pregnancy causes more noticeable changes to your body, relief to problems caused in the first trimester, new changes and more exciting experiences. Morning sickness, fatigue and many other things that might have bothered you during the first 3 months might disappear as your body adapts to the growing baby. Your abdomen will expand as you gain weight and the baby continues to grow. Before this trimester is over, you will feel your baby beginning to move. Most women feel movements before 22 completed weeks.

You should be gaining about 1-1.5 pounds per week during the second trimester. With this weight gain, you might notice that your posture has changed or that you are having backaches. Make sure to inform Dr Krishnan of any changes you might have noticed. During your visits, Dr Krishnan will be able to hear your baby’s heartbeat, see the baby’s development and determine the baby’s age. You might be given several kinds of tests at this time, including an ultrasound, which allows Dr Krishnan to see your baby and possibly even determine your baby’s sex. Other testing (amniocentesis, chorionic villus sampling and alpha-fetoprotein screening) includes ways to determine if the baby is healthy or if you are at risk for any complications and need to be more closely monitored. These tests help to determine the type of care you will be receiving for the rest of your pregnancy.


Third trimester

It might be hard to believe you are in your final trimester of pregnancy! This means in a few short months you will be holding your new baby in your arms. Your baby is still growing and moving, but now it has less room. You might not feel the kicks and movements as much as you did in the second trimester. You will also notice you may have to go to the bathroom more often or that you find it hard to breathe. This is because the baby is getting bigger and it is putting pressure on your organs. This is normal.

By the end of the trimester, you are likely to have gained about
25 to 30 pounds. About 7.5 pounds of that weight is your baby. Even before your baby is born it will be able to open and close his or her eyes and might even suck its thumb.

Your baby should also be moving into its birth position around this time, and your body will be preparing for the birth. Be sure to continue to visit Dr Krishnan and explore your options for labour and delivery.

Morning sickness is nausea or vomiting that usually occurs during the first trimester of pregnancy. Despite its name, you may feel nauseated or vomit at any time of day.

It is not understood why some women develop morning sickness, but certain factors such as hormones are involved. Women with high levels of pregnancy hormones tend to develop this condition and have it with subsequent pregnancies. More than half of pregnant women have morning sickness during the first trimester. It usually goes away by the second trimester.

When morning sickness is severe, it is called hyperemesis gravidarum.

NOTE: Please do not take any medications without notifying Dr Krishnan, as some medications cross the placental barrier and may cause undue effects on your growing baby.

These steps may help:

  • Eat snacks that are high in protein, don’t have rich or fatty foods
  • Avoid foods if the taste, smell or appearance is not suitable to you
  • Have frequent small snacks instead of full meals; being hungry can make it worse
  • Eat a nourishing snack before you go to bed at night
  • Increase intake of fluids such as water, fruit juice and clear soups, particularly if you are vomiting
  • Take it easy, especially in the mornings, as rushing about will make the nausea worse
  • Try and avoid time spent in the kitchen, as the smell of food can make you nauseous
  • Try to avoid eating while you are active, as movement often makes morning sickness worse
  • Try eating a biscuit or something light before you get out of bed in the morning
  • Seek medical help if needed

Moderate morning sickness may require:

  • Medication to reduce nausea and vomiting
  • Intravenous fluid treatment to relieve dehydration

Severe hyperemesis gravidarum may require:

  • Hospitalisation
  • Not eating or drinking anything, then slowly introducing food into your diet
  • Lab tests of blood and urine
  • Intravenous treatment to balance the electrolytes in your blood
  • Ultrasound examination of your pregnancy

We respect a woman’s right to choose the method of her delivery. If you desire a vaginal birth or an elective caesarean section, then Dr Krishnan will support you with either choice.

It is important to recognise the signs of labour so that you will know when you are experiencing the “real thing.” If this is your first baby, you will most likely experience lightening (the descent of the baby’s head into your pelvis) sooner than women who have already had other children. Typically, the signs of labour include uterine contractions, tightening of your stomach and cramps in your low back. About two thirds of women experience this tightening before their waters break. About one third will notice fluid leaking out first. If you are unsure about what is happening, contact us.

You may also be interested in taking childbirth preparation classes, which help guide new parents in the many decisions they will make before and during the birth process.

One of the things you may be most concerned with is the amount of pain you may experience during labour. Childbirth is different for all women, and no one can predict how much pain you will have.

During the labour process we will ask you if you need pain relief and help you to decide what option is the best for you. Your options may include:

  • a local or intravenous analgesic (pain relieving drug)
  • an epidural (injection which blocks pain in the lower part of your body)
  • a pudendal block (numbs the vulva, vagina and anus during the second stage of labour and during delivery)

Your baby is finally here! The joys and challenges of motherhood are about to begin. It is important to remember to take care of yourself, as well as your new baby. Caring for a new baby can be fun but it is also hard work.

You may be asking yourself, how much and how often should you feed your baby? What do you do when your baby is crying, or sick? How do you prevent accidents? These questions can be overwhelming at first, but you will quickly adjust. Remember to call us, your family and friends. We highly recommend contacting your local family health services and play groups.

As you decide whether or not to breastfeed, please reach out to Karen our midwife who can offer support.

If you are trying to lose some of your pregnancy weight, we encourage you to do it in a healthy way and consult your GP before you start any type of diet or exercise plan.

In addition to the physical changes to your body, you may feel despondent or even depressed. This can be a very normal phase following childbirth. 50%-75% of new mothers feel a little sad after giving birth. These feelings can range from very mild to serious, but there is help. Be aware of your feelings and continue to talk with your family, friends and Dr Krishnan. Sometimes this depression will go away on its own, but medication or therapy may be needed. ForWhen provide a national helpline, Monday – Friday. Contact number: 1300 242 322.

A healthy baby can benefit from breast milk, infant formula or a combination of the two. We do encourage breastfeeding for at least the first six months of life as it offers many benefits for both mother and baby. However, we also know it is a very personal choice and not every mother is able to feed her baby this way.

Breast milk contains carbohydrates, proteins, and fats essential for a baby’s health, as well as antibodies that help prevent infection and allergies. Breastfeeding can also help mothers bond with their baby and recover from pregnancy and delivery.

We encourage our expecting mothers to talk with our midwife Karen about breastfeeding, for although it is a natural thing to do, most need to learn how.

We also recommend women who breastfeed eat well-balanced, nutritious meals with generous portions of whole grain breads and cereals, fruits and vegetables, and dairy products with an abundance of calcium.


Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes is a form of diabetes that some women develop during the 24th – 28th week of their pregnancy. It usually disappears after the birth and does not mean that the baby will be born with diabetes.

If you are diagnosed, our treatment would usually involve monitoring your sugar levels and changing your diet, and in some cases, taking medicines including insulin.

Causes

When you are pregnant, your placenta produces hormones to help your baby grow. These hormones also block the action of insulin in your body. This is known as insulin resistance. In a normal pregnancy, your body will make 2-3 times more insulin if you are pregnant. If you already have insulin resistance, your body may not be able to cope with this extra need for insulin. This can lead to gestational diabetes.

Symptoms

Diabetes often has no symptoms, which is why all pregnant women are routinely tested.

If your blood glucose levels are very high, you might experience increased thirst and frequent urination.

Risk factors

Any pregnant woman can develop gestational diabetes, but risk factors that increase susceptibility include:

  • Being overweight
  • A family history of Type II diabetes
  • Women with hypertension (high blood pressure)
  • Being over the age of 35
  • Being diagnosed with diabetes in a previous pregnancy or had a large baby previously (8 pounds and over)

  • Have polycystic ovarian syndrome
  • Are taking some types of antipsychotic or steroid medicines


Course of illness

Although gestational diabetes usually goes away after the birth (when hormone levels return to normal), it still needs to be taken seriously.

  • The main concern is that it can increase the baby’s weight
  • If the baby becomes very large it may be necessary to have a caesarean or labour induced earlier
  • Women who develop gestational diabetes have about a 50% risk of developing Type II diabetes later in life
  • In severe cases, the baby may die in the utero

When gestational diabetes is well controlled, these risks are greatly reduced.



Routine tests

Pregnant women are routinely checked for gestational diabetes between the 24th and 28th weeks of their pregnancy. Women at increased risk are usually tested earlier.

The test used in Australia to screen for gestational diabetes is called the oral glucose tolerance test (OGTT). You need to fast for 10 hours (usually overnight, missing breakfast). You will have a blood test to check your baseline blood sugar level. Then you will be given a drink that contains 75g of glucose. Further blood tests are then performed after 1 and after 2 hours. You will be usually need to stay at the laboratory for the full duration of the test.

Managing gestational diabetes

Gestational diabetes needs careful monitoring for the remainder of your pregnancy. You will usually need to check and record your blood glucose several times a day. The most common times are straight after waking up, and either 1 or 2 hours after each main meal.

Other management can involve changing to a healthy eating plan, regular physical activity and medication.

We will conduct routine blood pressure and urine protein check-ups during your antenatal visit. We use these tests for the early detection of pre-eclampsia, also known as Pregnancy Induced Hypertension (PIH) or toxemia.

Pre-eclampsia is a serious medical condition that can occur after 20 weeks of pregnancy. It typically causes high blood pressure and can affect several of your body organs, including the liver, kidney and brain. If left untreated, it can lead to serious problems for you or your baby.

Pre-eclampsia is the most common serious medical disorder that can occur during pregnancy. Mild pre-eclampsia can occur in up to 1 in 10 pregnancies, and severe pre-eclampsia in up to 1 in 100 pregnancies. Early detection and treatment are important.


Risk factors

  • Pre-eclampsia with a previous pregnancy
  • History of high blood pressure
  • Existing diabetes
  • Autoimmune diseases such as lupus or APS (Antiphospholipid Syndrome)
  • Mental health conditions such as depression 
  • Assisted reproductive technology

Symptoms

Pre-eclampsia can be asymptomatic and may develop at any time after 20 weeks of pregnancy. Pre-eclampsia most commonly causes high blood pressure and protein in the urine.

Women with pre-eclampsia can have the following symptoms:

  • Swelling of hands, face and feet
  • Headaches that don’t disappear after taking medication
  • Visual disturbance, like spots or flashing
  • Upper abdominal pain, below the ribs
  • Dizziness
  • Nausea and vomiting

  • Heartburn


Complications for foetus

The placenta allows oxygen and nutrients to pass from the mother’s bloodstream to the baby, and waste products (such as carbon dioxide) to pass from the baby’s bloodstream to the mother. In pre-eclampsia, blood flow to the placenta is obstructed. In severe cases, the baby can be gradually starved of oxygen and nutrients, which may lead to:

  • Neonatal Asphyxia (low oxygen)
  • Neonatal Hypoglycemia (low glucose)
  • Intrauterine Growth Restriction (low birth weight)

Another serious complication of pre-eclampsia is abruption, which means the placenta separates from the uterine wall and the woman experiences vaginal bleeding and abdominal pain. This is a medical emergency.

Management

If your pre-eclampsia is mild or moderate, Dr Krishnan may recommend that you go to hospital for monitoring and start taking blood pressure medicines. You may also be prescribed treatment to prevent blood clots.

The only complete cure for pre-eclampsia is the birth of your baby. Dr Krishnan may recommend inducing labour early to help manage your pre-eclampsia.

Every pregnancy is unique, and Dr Krishnan will discuss with you what is best for you and your baby.

What is anaemia?

Anaemia is when you don’t have enough red blood cells or haemoglobin (the molecule in red blood cells that makes them red), which carry oxygen from the lungs around the body.

Causes

Causes can include:

  • If you are not eating enough foods that are rich in iron
  • If you are unable to absorb iron from the food you eat
  • If you experience blood loss; females are at increased risk of anaemia due to menstruation or heavy periods — 3 in 10 females of child-bearing age have anaemia
  • If you have certain inherited or bone marrow diseases, including thalassaemia
  • Some females develop iron-deficiency anaemia during pregnancy due to their increasing need for iron throughout the pregnancy

Symptoms

Signs or symptoms may include:

  • Fatigue or weakness
  • A fast heartbeat or heart palpitations
  • Dizziness, light-headedness or headaches
  • Shortness of breath, even when at rest

Diagnoses

A blood test called a full blood count is used to look at the amount of haemoglobin in your blood. Dr Krishnan may also refer you for a blood test to check your iron levels or other vitamin levels, to help identify the cause of the anaemia.

A blood film, where a pathologist looks at the size and shape of your red blood cells, can also help determine the underlying cause of your anaemia.

Course of anaemia

Patients with severe anaemia are more likely to delivery early and have small babies. Women with severe
anaemia may have symptoms such as weakness, fatigue, shortness of breath and headaches.

Birth is also associated with blood loss. Therefore, if you are anaemic, we may recommend taking iron for several months after delivery in order to help the body replace the lost blood cells and iron stores. Breastfeeding women may also need to take iron because iron is lost in breast milk.

As long as the anaemia is treated and corrected, there should be no problems.


Management

A well-balanced diet is always recommended, but iron and folate supplementation is indicated in pregnancy.