Melomed Articles


30 January 2020 - Dr. Matshidiso Agnes Tisane

Obstetrics


Preconception Counselling
The road to a safe, happy and healthy pregnancy begins long before you have a positive result on a pregnancy test. Preconception counselling is a visit with your gynaecologist where you discuss many aspects of pregnancy and plan for a healthy pregnancy.

Preconception care should be an integral part of primary care for women of reproductive age, especially those who are planning a family in the near future. 

We recommend that you schedule a preconception appointment at least three months before trying to fall pregnant. 

The doctor will conduct a physical exam to check the heart, lungs, breasts, thyroid, blood pressure and abdomen. She will also record your weight and perform a pelvic exam. 

She will also discuss the following with you: 

Your family history: You and your partners family history can provide great insight into any genetic disorders or conditions that may be passed on to your child. Understanding your medical past can help your Dr Tisane treat you and your child in the future.  

Your general medical history: It is essential that we see the whole picture of your health before pregnancy. During your appointment, Dr Tisane will want to discuss surgeries, hospitalisations or transfusions you may have had in the past. She will also ask you about any pre-existing medical conditions, allergies and medications you may currently be taking. 

Your OB/GYN history: Your past gynaecological may have a direct impact on your ability to conceive and carry to full term. Some STDs and vaginal infections may affect a woman's ability to conceive. We may do cervical cultures or blood tests to make sure there are no infections that could cause issues during conception or pregnancy.

Based on the results of the tests, we may make several suggestions after your appointment. These could be a mix of lifestyle and healthcare changes, including losing weight, quitting smoking or drinking, taking particular vitamins, updating your immunisations and avoiding certain medications that could be harmful to the baby. 

Antenatal care
Pregnancy is an exciting time for an expectant woman. While pregnancy is a happy time, you need to make sure that your baby is healthy during your pregnancy. This is where antenatal care comes in. Antenatal care is the healthcare and support you receive while you're pregnant. This ensures you and your unborn baby are healthy throughout your pregnancy.

Dr Tisane offers antenatal care to pregnant women not only for the journey of pregnancy but also for the birth of their baby. During your first antenatal appointment, Dr Tisane will confirm your pregnancy and discuss your gynaecological history.  

We recommend coming for your first appointment between 7 - 10 weeks of pregnancy. During this appointment, Dr Tisane will perform a dating scan, take your medical and gynaecological history, discuss birth choices and answer any questions that you may have. Following this, Dr Tisane will see you approximately 4-6 weekly until 28 weeks, followed by fortnightly visits until 36 weeks, and finally weekly until your baby is born. 

Dr Tisane performs the following screenings:
  • Pregnancy diagnosis: A physical examination, laboratory evaluation, and ultrasound is used to confirm the pregnancy
  • First-trimester screen: An ultrasound between 8 and 12 weeks of your pregnancy to check on your pregnancy health and your babys development in the first trimester.
  • Second-trimester screening: Taking between 15 and 20 weeks of pregnancy, these may include blood tests to provide information about the risk of having a baby with certain genetic conditions or birth defects.
  • Maternal risk profile assessment: a blood test combined with an ultrasound to determine the chance of an unborn child having Down syndrome, Edward syndrome or a neural tube defect

  • Dr Tisane will also prioritise any physical symptoms that may be plaguing you during your pregnancy such as morning sickness, fatigue, weight gain and anxiety. She will also offer advice on healthy eating and lifestyle changes. 

    She does her utmost to make you feel comfortable enough to ask any questions you may have about your pregnancy. For example, you can ask her advice on physical pregnancy symptoms and the birth itself. You may also want to ask questions about caring for your baby after birth.

    Birthing services
    The birth of a baby is undeniably one of life's most special occasions and Dr Tisane, strives to make your birthing experience an unforgettable one. She is here to support you with your care every step of your exciting journey to parenthood - during pregnancy, your delivery, and after your baby's birth.

    We know that although the prospect of becoming a parent is exciting, it could nevertheless also be a time of uncertainty and anxiety as you prepare for the birth of your baby and the new responsibilities that come with it.   

    We encourage expectant parents to participate fully in developing a birthing plan that suits their needs: from the type of birth, to who should support the expectant mother during delivery and what type of accommodation you'd prefer. 

    She will help you come up with a birthing plan that outlines your ideal birth and may need to be adjusted as the actual situation unfolds.

    Talk with your partner and decide who you want in the birthing room. Some couples feel that this is a private time and prefer not to have others present. A birth plan may include other considerations like pain relief during labour and delivery positions. 

    Whether you prefer a natural vaginal delivery or a caesarean section, she will be able to advise you on what may be best for your baby as well as what to expect from each choice.

    At Melomed Tokai, we strive to create a tranquil and supportive environment in our maternity units, with nursing staff on hand to guide and assist you. Our modern facilities incorporate various accommodation options to suit our patients' specific needs, including private en-suite rooms and semi-private rooms.


    Post-delivery care
    Dr Tisane has a special interest in Maternal care. As a qualified Ob-gyn, she cares for women both during and after their pregnancies. 

    Six weeks after giving birth, you will need to come in for an ob-gyn exam called a postnatal check-up. While giving birth may be a normal and natural process, some women experience a few health challenges, and its important that they are examined and treated promptly. The baby also needs to be checked to make sure that he/she is growing healthily. 

    The consequences of skipping your postnatal appointment can be serious: it can lead to incomplete healing, an unwanted pregnancy, an overlooked infection, undiagnosed postnatal depression and other health concerns. Taking the time to keep this appointment is vital and can pay off in many ways, both physically and emotionally.

    A postnatal check-up for a new mother includes:

  • Checking your general health
  • Checking your incision (If you had a tear during vaginal delivery)
  • Checking your mental and emotional well-being
  • Examining your uterus, ovaries, and cervix
  • Examining your breasts for any abnormalities 

  • During your appointment, Dr Tisane will also ask if:

  • Youre feeling sad or anxious
  • Youre having trouble holding in your pee 
  • Having sex is painful

  • Dr Tisane also offers contraceptive advice and child spacing services for new mothers. Child spacing refers to the practice of waiting between pregnancies to conceive again. A woman's body needs to rest for a while after pregnancy. We recommend that you wait at least 18 months before trying to conceive again, in order to maintain the optimal health for yourself and your children.

    Gynaecology
    Adolescent gynaecology

    Adolescent gynaecology deals with the reproductive health problems in adolescents, including sexual health, and the initial diagnosis and assessment of rare gynaecological conditions. Adolescence is a time of emotional and physical change; therefore, gynaecological and sexual health problems are common. Going through puberty can particularly be a challenging time for teens and pre-teens. 

    Although you may feel nervous about your first visit to the gynaecologist, Dr Tisane will provide you with a safe space when you can be open and honest. You're also welcome to bring along a relative or friend for support, or simply come alone if you'd prefer. 

    Dr Tisane has a passion for treating adolescents, and she is able to skillfully diagnose, manage and treat a range of issues that can affect women under the age of 18. 

    We recommend that girls first see a gynaecologist when theyre between the ages of 13 and 15. At this age, gynaecologists will perform a regular health exam and talk to them about their bodys development. 

    While all teenage girls should see a gynaecologist, it is especially important to have an examination if you have been sexually active (or is planning to be) or has problems with her period.

    After your initial visit, your appointments with your gynaecologist will be focused on preventing unplanned pregnancies and sexually transmitted diseases/infections (STD/STI) through contraceptive counselling, managing unruly menstruation cycles and any recurrent yeast infections or urinary tract infections. 

    You will also have the opportunity to discuss any abnormal menstruation concerns such as painful menstrual cramping that isnt relieved by analgesic tablets, extremely heavy bleeding, periods that last longer than seven days, nausea or vomiting and premenstrual syndrome (PMS).

    Some common issues that adolescents face:

  • Puberty problems
  • Early/late onset of periods and/or breast development
  • Period problems
  • Heavy bleeding
  • Sexual development disorders
  • Abnormal development of the vagina or uterus 


  • Infertility and miscarriages workup and consultation
    As an ob-gyn, Dr Tisane investigates the causes of infertility and recurrent miscarriages. 

    Infertility is when a couple cannot conceive after having regular unprotected sex. We recommend that you seek the help of a gynaecologist if conception hasn't occurred within 12 months. However, infertility evaluation may be started sooner in patients who are older than 35 or have medical risk factors for infertility. 

    Causes of infertility include polycystic ovarian syndrome, uterine abnormalities, tubal obstruction, cervical issues, or problems with ovulation. In general, a lack of ovulation is the biggest cause of infertility in women. In men, abnormal sperm production or function are some of the leading causes of infertility. In other cases, couples simply struggle with how to time intercourse with ovulation.

    Recurrent miscarriages appear to be a natural process to protect a woman from a pregnancy that is abnormal. Most losses are due to a chromosomal abnormality of the embryo. However, a variety of other factors can contribute to continued failure to carry a pregnancy. In some cases, genetic factors can prevent an embryo from developing normally. In other cases, conditions affecting the uterus, metabolic causes, environmental factors, infections, hormonal disorders, and possibly clotting disorders can affect a woman's ability to carry a pregnancy.

    If you and your partner are having trouble conceiving or have experienced multiple miscarriages, then a visit to a gynaecologist is generally the first step in your journey to becoming parents, 

    Dr Tisane will conduct tests and provide advice on increasing your chances of conceiving and carrying a baby to full term. These tests include:

  • Taking your medical history-you will be asked questions about your menstrual period, abnormal bleeding or discharge from the vagina, pelvic pain, and disorders that can affect reproduction such as thyroid disease
  • Conducting a physical examination to help direct the evaluation
  • Serum progesterone level measurements- these monitor ovulation on the 21st day of a womans monthly cycle. 
  • Imaging procedures such as hysterosalpingography are used to view the inside of the fallopian tubes and uterus
  • Hysteroscopy for intra uterine abnormality such as bands or fibriods
  • Laparoscopy is recommended for patients with a history of endometriosis, pelvic infections, or ectopic pregnancy

  • Possible treatments include: 

  • Medication to induce ovulation: recommended for woman with anovulation (when ovulation doesn't take place)
  • Medication for related health issues such as diabetes, thyroid dysfunction, or high prolactin levels
  • Injectable hormones
  • Surgery for blocked fallopian tubes, problems in the uterus and fibroids
  • Intrauterine insemination (IUI): sperm is placed into the uterus
  • at the time of ovulation
  • In Vitro Fertilization (IVF): this procedure combines the egg and sperm in a laboratory 
  • Examining lifestyle factors such as diet and exercise

  • Contact Dr Tisane's office if you are experiencing any infertility issues or recurrent miscarriages for work up and referral where necessary.

    Abnormal uterine bleeding
    Abnormal uterine bleeding is when you bleed in between your monthly periods, you bleed for too long, or you have an extremely heavy flow. A normal menstrual flow typically lasts approximately five to seven days and occurs every 21 to 35 days. A period that lasts longer than this may be cause for concern. 

    The signs of abnormal uterine bleeding could vary. Some signs that your bleeding could be abnormal include:

  • Menorrhagia (heavy menstrual bleeding)
  • Unusually long periods (seven days or longer)
  • Inconsistent menstrual cycles
  • Bleeding at unusual times (e.g. between periods, after sex, during menopause)

  • A hormonal imbalance is a common cause of abnormal bleeding. This is seen mainly in teenagers, pregnant women, or women approaching menopause. For women who have reached menopause, any bleeding should be considered abnormal and should be investigated. 
    Fibroids, which are small or large growths in the uterus, can also cause irregular bleeding. In rare cases, infection of the cervix, a thyroid problem, or cancer of the uterus can cause abnormal bleeding. 

    Dr Tisane will perform several tests when diagnosing abnormal uterine bleeding. These tests may include:
  • A pregnancy test if you are not experiencing menopause
  • Blood tests to check your blood count and check for blood clots
  • A thyroid test
  • Checking hormone levels
  • A pelvic ultrasound
  • A hysteroscopic exam of your uterus to check for fibroids, polyps or signs of cancer
  • A biopsy of the endometrium - recommended for women who older than 35 years of age, or have risk factors for cancer.

  • Treatment options will depend on your diagnosis, severity, and health history. Treatment choices also depend on age, the desire to preserve fertility and the cause of the abnormal bleeding. 

    Treatment options include:
  • Medication: birth control pills, progestins, nonsteroidal anti-inflammatory drugs, tranexamic acid (Lysteda), and the levonorgestrel intrauterine system (IUD/Mirena).
  • Surgery: There are surgical options available for abnormal bleeding. However, these procedures can result in the loss of fertility, so they need to be considered carefully. 
  • Endometrial ablation
  • Endometrial resection
  • Dilation and curettage (D&C)
  • Myomectomy
  • Hysterectomy
  • Treatments for menstrual cramps and PMS

  • Contraception advice and prescription
    Your choice of birth control depends on various factors, including your general health, your gynaecological health, how often you have intercourse, and whether or not you want children. 
    As a qualified ob-gyn, Dr Tisane will sit down with you and carefully discuss the pros and cons of each method to help you decide what option will best suit your needs. 

    Dr Tisane provides a wide variety of contraceptive methods, including:
    Birth control pills
    There are two types of birth control pills:

    Progestin-only pills: these contain only progestin and exclude estrogen. These pills must be taken within the same 3 hours every day to prevent pregnancy.

    Combination pills: These contain two hormones: estrogen and progestin. Take one pill every day to prevent pregnancy. It is not necessary to take your combination pill at the same time every day.

    IUCD (Mirena, copper T) insertion & removal
    This device is inserted into the uterus (womb) to prevent pregnancy. There are many types of IUCDs, and they come in different shapes and sizes. Commonly used types are IUCDs containing copper.

    Sterilisation
    A permanent method of birth control. In this procedure, the fallopian tubes are closed off, preventing the egg from moving down the fallopian tube and keeping the sperm from reaching the egg.

    Injections 
    The injection releases progestogen into your bloodstream to prevent pregnancy.

    Nuva Rings
    These are flexible, transparent plastic ring thats inserted into the vagina. You wear NuvaRing for three weeks, and then remove it allowing menstruation to occur and then insert a new ring after a week.

    If you're new to contraceptives or simply want to change your existing method, contact Dr Tisane. She will be able to guide you towards the method that is best suited to your reproductive needs. 

    General gynaecology
    A women's health journey can be quite complex, which is why it is essential to have a check-up once a year to look after your gynaecological health. Through expert guidance and compassionate care, Dr Tisane strives to find that perfect balance to make your journey as easy and stress-free as possible.    

    Dr Tisane provides you with the highest quality and most compassionate gynaecological healthcare through all stages of your life. 

    Many women believe that gynaecological check-ups are not a necessity, but they are one of the most effective ways for women to receive preventive health screening and education that is specific to women. Regular screenings are important to detect harmful conditions such as cervical cancer, breast cancer and the human papillomavirus (HPV) in their early stages. 
    Dr Tisane is highly experienced and passionate about treating the gynaecological needs of all women from adolescents to older women. 

    We recommend that you start visiting a gynaecologist when you start becoming sexually active, or you're age 21 or over. You should also make an appointment with an ob-gyn If you notice any unusual symptoms such as irregular periods, a lack of periods or unusual discharges, then you should 

    Dr Tisane offers a wide range of healthcare services, including:

  • A general check-up: This may include taking your full medical history, checking your blood pressure, conducting a urine test, ultrasounds and a pelvic exam. 
  • Gynae ultrasound: they play an important role in the evaluation of gynaecological problems and can help provide a diagnosis and exclude possible causes for pelvic pain.
  • Chronic pelvic pain diagnosis: this usually involves a pelvic exam, ultrasounds and lab tests
  • Cervical cancer screening: This includes a pap smear and an HPV (human papillomavirus) test
  • Genital tract diseases screening: Dr Tisane will test for Vaginal Infection, Candidiasis, Trichomoniasis, Cervical Polyp and Cervical Erosion. 
  • Hysteroscopy: a thin tube is inserted into the vagina to examine the cervix and inside of the uterus. It is mainly used to diagnose abnormal bleeding problems. 
  • Breast exams: Dr Tisane examines your breasts for any lumps or abnormalities.
  • Sexual Health: Dr Tisane will test for HIV/AIDS and other Sexually Transmitted Diseases (STDs) and provide treatment if necessary. 
  • Hormonal problems: Dr Tisane treats hormonal conditions such as PCOS-related hormonal imbalance and irregular testosterone levels and hormonal issues after menopause. 

  • Dr Tisane understands that patients may be uncomfortable about these private and sensitive health issues. The thought of seeing a doctor, especially for the first time, and discussing intimate issues may cause anxiety for some women. Dr Tisane is an ob-gyn specialist that goes out of her way to make you feel at ease. 


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