Author Archives: Dr. Shraddha Galgali

Having a Caesarean section for a previous pregnancy does not automatically mean that every future baby must be delivered by C-section.

Some women who have had a previous Caesarean may be able to have a vaginal birth after Caesarean, commonly known as VBAC.

However, VBAC is not suitable for everyone. The decision depends on several factors related to your previous surgery, current pregnancy, medical history and the facilities available at the hospital.

If you are pregnant after a previous C-section and wondering whether a vaginal birth may be possible, understanding VBAC can help you have a more informed discussion with your obstetrician.

VBAC stands for Vaginal Birth After Cesarean.

When a woman who has previously had a C-section plans to attempt vaginal delivery, the process is often called a trial of labor after cesarean (TOLAC). If the trial is successful, the baby is delivered vaginally. If vaginal delivery is not possible or becomes unsafe, a repeat C-section may be required.

In some cases, yes.

However, there is no universal rule that every woman with one previous C-section can or cannot have a vaginal delivery.

Your doctor will consider several factors before recommending whether attempting VBAC is appropriate.

These may include:

• The reason for your previous C-section
• The type of incision made on your uterus
• Number of previous C-sections
• Your current pregnancy
• Position and size of the baby
• Placental location
• Other medical or pregnancy-related conditions
• Previous vaginal delivery, if any
• Availability of appropriate emergency obstetric care

The scar on the uterus is particularly important.

A low-transverse uterine incision is the most common type and generally carries the lowest risk of uterine rupture during a future trial of labor.

Other incision types, particularly certain high vertical or classical incisions, can carry a higher risk and may make VBAC inappropriate.

Importantly, the scar on your skin does not tell you what type of incision was made on your uterus. Your previous surgical records can provide this information.

When successful, VBAC can offer several benefits.

These may include:

• Avoiding another abdominal surgery
• Shorter recovery compared with C-section
• Lower risk of certain surgical complications
• Less blood loss in some circumstances
• Potentially fewer complications associated with multiple Caesarean deliveries in future pregnancies

A successful VBAC can also allow a woman to experience vaginal birth if that is important to her.

VBAC also has risks that need to be carefully discussed.

One of the most serious, although uncommon, complications is uterine rupture, where the previous uterine scar opens during labour. This can be dangerous for both mother and baby and requires immediate medical attention.

There is also a possibility that labour may not result in a vaginal delivery and an emergency C-section may become necessary.

This is why attempting VBAC should be planned in a setting where appropriate emergency care is available.

Every pregnancy is different. Factors that may influence the possibility of successful vaginal birth include:

• Previous Vaginal Delivery: A previous vaginal delivery can be an important factor when assessing VBAC prospects.
• Reason for Previous C-Section: The reason for the earlier C-section may also influence the current delivery plan.
• Type of Uterine Incision: The previous surgical records can help your obstetrician determine whether the uterine scar is appropriate for considering VBAC.
• Current Pregnancy: The baby’s position, estimated size, placental location and other pregnancy factors may influence the decision.
• Hospital Facilities: VBAC should be attempted in a hospital that can respond quickly if an emergency arises.

No.

Planning a VBAC means planning an attempt at vaginal birth, not guaranteeing the outcome.

Labour can progress differently than expected. If the health of the mother or baby becomes a concern, or if labour does not progress appropriately, a Caesarean delivery may become the safest option.

The priority should always be the safety of both mother and baby.

No. VBAC suitability must be assessed individually.

Some women may have medical or surgical factors that make attempting labour unsafe. Others may be reasonable candidates after detailed evaluation.

This is why it is important not to compare your pregnancy with a friend’s or relative’s experience. Your previous operation records and current pregnancy details matter.

If you have had a previous C-section, consider discussing these questions during your pregnancy consultation:

• What type of uterine incision did I have?
• Am I a suitable candidate for VBAC?
• What factors could affect my chances of vaginal birth?
• What are the risks in my particular case?
• Where should I plan my delivery?
• What happens if labour does not progress normally?
• Could an emergency C-section become necessary?

Shared decision-making between the woman and her obstetrician is an important part of choosing between TOLAC/VBAC and a planned repeat Caesarean.

If you are pregnant after a previous C-section, you do not necessarily need to make the delivery decision based on fear or assumptions.

Instead, start the discussion early, provide your previous medical and surgical records, attend regular prenatal appointments and understand the benefits and risks of your available options.

For personalised assessment and pregnancy guidance, Dr. Shraddha Galgali, Consultant Obstetrician & Gynecologist, can evaluate your medical history and current pregnancy and help you understand whether VBAC may be an option for you.

A previous C-section does not automatically rule out the possibility of a vaginal birth. For some women, VBAC may be a safe and appropriate option. For others, a repeat Caesarean may be the safer choice.

The right decision depends on your individual medical history, previous uterine incision, current pregnancy and the availability of appropriate medical care.

Rather than focusing only on whether a “normal delivery” is possible, the most important goal is to choose a safe and medically appropriate birth plan for both mother and baby.

Experiencing a miscarriage is emotionally and physically challenging. When pregnancy loss happens repeatedly, it can leave couples feeling anxious, confused, and hopeless. However, recurrent miscarriages are not the end of your journey to parenthood. With timely evaluation, proper diagnosis, and personalized treatment, many women go on to have healthy pregnancies. If you have had two or more consecutive pregnancy losses, it is important to consult an experienced obstetrician and gynecologist to identify the underlying cause and plan the right treatment.

Recurrent miscarriage, also known as Recurrent Pregnancy Loss (RPL), is generally defined as the loss of two or more consecutive pregnancies before 20 weeks of gestation. Although miscarriage is relatively common, recurrent miscarriages affect only a small percentage of couples. Identifying the cause early significantly improves the chances of a successful pregnancy.

Several medical conditions can contribute to repeated pregnancy loss.

Genetic abnormalities in the embryo are one of the most common causes of early miscarriage. Sometimes, one of the parents may carry a balanced chromosomal rearrangement that increases the risk.

Structural problems with the uterus can interfere with implantation or fetal growth.

These include:

• Uterine septum
• Fibroids inside the uterine cavity
• Uterine adhesions
• Congenital uterine abnormalities

Hormonal imbalance can affect implantation and pregnancy development.

Common conditions include:

• Thyroid disorders
• Uncontrolled diabetes
• PCOS (Polycystic Ovary Syndrome)
• Progesterone deficiency

Certain immune conditions may increase the risk of miscarriage, including:

• Antiphospholipid Syndrome (APS)
• Systemic Lupus Erythematosus (SLE)

Inherited or acquired clotting disorders may reduce blood flow to the developing placenta.

Lifestyle also plays an important role.

Risk factors include:

• Smoking
• Alcohol consumption
• Obesity
• Excessive caffeine intake
• Chronic stress
• Poor nutrition

Women above the age of 35 years have a higher risk of miscarriage due to age-related changes in egg quality.

You should seek specialist care if you have experienced:

• Two or more consecutive miscarriages
• Three or more pregnancy losses at any stage
• Pregnancy loss after detecting a fetal heartbeat
• Difficulty conceiving after repeated miscarriages
• A family history of recurrent miscarriage or genetic disorders
• Multiple failed IVF cycles
• Known medical conditions like thyroid disease, diabetes, or autoimmune disorders

Early evaluation can identify treatable conditions before your next pregnancy.

Your gynecologist may suggest a combination of investigations based on your medical history.

Blood Tests:

• Thyroid function tests
• Blood sugar levels
• Hormonal evaluation
• Antiphospholipid antibody testing
• Complete blood count
• Vitamin D and nutritional assessment (when indicated)

Genetic Testing:

• Karyotyping for both partners
• Testing of pregnancy tissue (in selected cases)

Imaging Studies:

• Pelvic ultrasound
• 3D ultrasound
• Sonohysterography
• Hysteroscopy
• MRI (only if required)

Additional Evaluation:

Depending on individual circumstances, clotting disorder screening or other specialized investigations may be recommended.

There is no single treatment for recurrent miscarriage. Management is individualized based on the underlying diagnosis.

Treatment options may include:

• Thyroid or diabetes management
• Progesterone support during early pregnancy (when appropriate)
• Blood-thinning medications for Antiphospholipid Syndrome
• Surgical correction of uterine abnormalities
• Lifestyle modifications
• Weight management
• Nutritional supplementation
• Genetic counseling
• Close monitoring during future pregnancies

A personalized care plan offers the best chance for a healthy pregnancy.

Yes. Many couples who experience recurrent miscarriages eventually achieve successful pregnancies with proper medical care. Advances in reproductive medicine allow specialists to diagnose and treat many underlying conditions effectively. Regular prenatal care, early pregnancy monitoring, and timely intervention can significantly improve outcomes.

While not every miscarriage can be prevented, these healthy habits may support pregnancy:

• Maintain a healthy body weight.
• Manage thyroid disorders and diabetes before conception.
• Stop smoking and avoid alcohol.
• Eat a balanced, nutrient-rich diet.
• Take folic acid before and during pregnancy.
• Exercise moderately as advised by your doctor.
• Attend regular prenatal check-ups.
• Seek medical advice before trying to conceive again.

Repeated pregnancy loss can take a significant emotional toll on both partners. Feelings of grief, anxiety, guilt, and fear are common. Along with medical treatment, emotional support from family, counseling, or support groups can make the journey easier. Remember, seeking help is a sign of strength, and you do not have to go through this alone.

If you have experienced two or more miscarriages, don’t wait for another pregnancy loss before seeking medical advice. Early evaluation can identify treatable causes and improve your chances of a healthy pregnancy. Consult Dr. Shraddha Galgali, Consultant Obstetrician & Gynecologist in Punawale, Pune, for comprehensive evaluation, personalized treatment, and compassionate care for recurrent pregnancy loss.

For many years, gynecological cancers were considered diseases that mainly affected older women. However, healthcare professionals are now seeing an increasing number of younger women being diagnosed with certain gynecological cancers, often in their 20s, 30s, and early 40s. While this trend does not mean that cancer has become common in young women, it highlights the importance of awareness, regular gynecological check-ups, HPV vaccination, and recognizing early warning signs.

The good news is that many gynecological cancers are highly treatable when detected early.

Gynecological cancers are cancers that develop in a woman’s reproductive organs.

These include:

• Cervical Cancer
• Ovarian Cancer
• Uterine (Endometrial) Cancer
• Vaginal Cancer
• Vulvar Cancer
• Fallopian Tube Cancer

Each type has different risk factors, symptoms, and treatment options.

Certain gynecological cancers, particularly cervical cancer, continue to affect younger women, especially where HPV vaccination and regular screening rates are low. In addition, lifestyle-related risk factors such as obesity are contributing to a rise in endometrial (uterine) cancer among younger women. Better awareness, improved diagnostic techniques, and earlier detection may also contribute to an apparent increase in diagnoses. Although ovarian and other gynecological cancers are still more common after menopause, they can occur in younger women as well.

Persistent infection with high-risk HPV strains is the leading cause of cervical cancer. Many HPV infections cause no symptoms and may persist for years before leading to precancerous changes. Fortunately, HPV vaccination and regular cervical screening can significantly reduce this risk.

Many women today choose to have children later due to education, career goals, or personal reasons. Delaying pregnancy may influence the risk of certain gynecological conditions, although the relationship with cancer varies depending on the cancer type and individual risk factors.

Obesity increases estrogen levels, which can raise the risk of endometrial (uterine) cancer. It is also associated with:

• PCOS
• Diabetes
• Metabolic syndrome
• Chronic inflammation

Maintaining a healthy weight is an important step in reducing risk.

Physical inactivity contributes to obesity and hormonal imbalance, both of which can affect long-term reproductive health. Regular exercise supports overall well-being and may lower the risk of several cancers.

Inherited genetic mutations, such as BRCA1 and BRCA2, significantly increase the risk of ovarian and certain other cancers. Women with a strong family history of breast or ovarian cancer should discuss genetic counseling with their healthcare provider.

Long-standing hormonal disturbances, including irregular ovulation seen in some women with PCOS, may increase the risk of endometrial cancer if left untreated. Timely diagnosis and appropriate treatment are important.

Advances in medical imaging, screening programs, and increased awareness mean that cancers are often detected earlier than in the past. This is a positive development because early-stage cancers are generally easier to treat.

Many gynecological cancers develop silently in their early stages.

Consult your gynecologist if you experience:

• Abnormal vaginal bleeding
• Bleeding after intercourse
• Bleeding after menopause
• Heavy or prolonged periods
• Persistent pelvic pain
• Pain during intercourse
• Persistent bloating
• Frequent urination
• Unexplained weight loss
• Loss of appetite
• Persistent vaginal discharge with an unusual smell or blood

Symptoms do not always indicate cancer, but they should always be evaluated.

You may have a higher risk if you have:

• Persistent HPV infection
• Family history of ovarian, breast, or uterine cancer
• BRCA gene mutation
• Obesity
• Diabetes
• PCOS with prolonged irregular periods
• Smoking
• Weak immune system
• History of abnormal Pap smear results

Although not every cancer can be prevented, healthy lifestyle choices and regular screening can lower your risk.

• Get the HPV Vaccine: HPV vaccination provides strong protection against the high-risk HPV types responsible for most cervical cancers. It is most effective before exposure to the virus but may still benefit eligible individuals based on age and medical advice.
• Attend Regular Cervical Screening: Routine cervical screening (such as Pap smear and, where appropriate, HPV testing) helps detect precancerous changes before they become cancer.
• Maintain a Healthy Weight: Regular exercise and a balanced diet support hormonal health and reduce the risk of obesity-related cancers.
• Don’t Ignore Persistent Symptoms: Any abnormal bleeding, pelvic pain, or unusual discharge should be assessed by a gynecologist promptly.
• Know Your Family History: If close relatives have had breast or ovarian cancer, discuss whether genetic counseling or earlier screening is appropriate.

Early diagnosis can:

• Improve treatment success
• Allow less extensive treatment in some cases
• Preserve fertility in selected women with early-stage disease
• Improve long-term survival and quality of life

Routine gynecological check-ups remain one of the best ways to protect your reproductive health.

Book an appointment if you experience:

• Bleeding between periods
• Bleeding after menopause
• Persistent pelvic pain
• Unexplained bloating lasting more than two weeks
• Pain during intercourse
• Recurrent abnormal vaginal discharge
• A strong family history of gynecological or breast cancers

Early evaluation can help identify whether symptoms are due to a benign condition or require further investigation.

While some gynecological cancers are being diagnosed more frequently in younger women, most cases are not caused by a single factor. Genetics, HPV infection, obesity, hormonal imbalance, and lifestyle all play important roles. The key message is simple: do not ignore persistent symptoms, keep up with recommended screenings, consider HPV vaccination if appropriate, and seek medical advice early. Early detection saves lives and offers the best chance for successful treatment.

If you have concerns about abnormal bleeding, pelvic pain, or your personal cancer risk, consult Dr. Shraddha Galgali, Consultant Obstetrician & Gynecologist in Punawale, Pune, for expert evaluation, preventive care, and personalized guidance.

Discovering that you have uterine fibroids can bring up a lot of questions. Are they dangerous? Will they affect my fertility? Do I need to get them removed? First, take a deep breath. Uterine fibroids are non-cancerous (benign) growths that develop in or around the wall of the uterus. They are incredibly common, affecting up to 70-80% of women by the time they reach age 50. In fact, many women have them and never even know it because they experience zero symptoms.

However, for some women, fibroids can cause severe pain, heavy bleeding, and fertility challenges. When lifestyle changes and medications fail to bring relief, surgery becomes a viable option.

If you are considering surgical options, a myomectomy is often the top choice—especially if you wish to preserve your fertility. Let’s dive into what a myomectomy is and exactly when it becomes necessary.

Unlike a hysterectomy (which removes the entire uterus), a myomectomy is a surgical procedure that removes only the fibroids, leaving your uterus intact. Because it preserves your reproductive organs, it is the preferred surgical option for women who plan to have children in the future or who simply wish to keep their uterus.

Depending on the size, number, and location of your fibroids, a myomectomy can be performed in three ways:

• Abdominal Myomectomy (Open Surgery): For very large or numerous fibroids.
• Laparoscopic or Robotic Myomectomy (Keyhole Surgery): A minimally invasive approach using small incisions, offering faster recovery and less pain.
• Hysteroscopic Myomectomy: Done through the vagina and cervix (no incisions) for fibroids growing inside the uterine cavity.

Your gynecologist will always look at your symptoms, your age, and your family planning goals before recommending surgery. Generally, a myomectomy is highly recommended in the following scenarios:

If your periods are so heavy that you are changing pads every hour, passing large blood clots, or bleeding for more than a week, it’s a major red flag. Severe blood loss often leads to chronic fatigue and anemia (low red blood cell count). If hormonal medications or non-surgical treatments fail to control the bleeding, removing the fibroids is the best way to restore your quality of life.

While many women with fibroids have perfectly healthy pregnancies, certain fibroids can get in the way.

• Submucosal fibroids (which grow into the uterine cavity) can alter the lining of the womb, making it difficult for a fertilized egg to implant.
• Large fibroids can block the fallopian tubes, preventing sperm from meeting the egg. If you have been struggling with unexplained infertility or have experienced recurrent miscarriages, a myomectomy can significantly improve your chances of conceiving and carrying a baby to term.

As fibroids grow, they take up valuable space in your pelvis. This can lead to a constant, dull ache in your lower abdomen, chronic lower back pain, or pain during intercourse. If the pain is affecting your daily routine and over-the-counter painkillers no longer help, surgical removal is necessary.

Large fibroids can weigh down on surrounding organs.

• If a fibroid presses against your bladder, you might feel the urge to urinate constantly or struggle to empty your bladder completely.
• If it presses against your bowel, it can cause chronic constipation, bloating, and abdominal distension (making your abdomen look prematurely pregnant).

While fibroids are benign, any growth that increases in size very quickly needs careful evaluation. If your doctor notices during routine ultrasounds that a fibroid is growing aggressively, they may recommend a myomectomy to remove it and biopsy the tissue, ensuring there are no complications.

The decision to undergo surgery is highly personal. If you are near menopause, your doctor might suggest waiting, as fibroids naturally shrink when estrogen levels drop after menopause. However, if you are in your reproductive years and fibroids are dictating your comfort, energy levels, or plans for a family, a myomectomy can be life-changing.

Every woman’s body and medical history are unique. If you suspect you have fibroids or have already been diagnosed and want to explore your surgical options—particularly minimally invasive laparoscopic myomectomy—it is crucial to consult an experienced gynecologist and advanced laparoscopic surgeon.

Don’t let chronic pain or heavy bleeding hold you back. Schedule a consultation today to discuss a personalized treatment plan tailored to your health and future goals.