🧠The Rhythm of the Menstrual Cycle 

In the rush of modern life, we often overlook the natural rhythms that quietly guide our bodies.

The menstrual cycle is often reduced to “just a period.”

But in reality, it is a carefully orchestrated dialogue between the brain and the ovaries  led by FSH and LH, shaped by estrogen and progesterone, and expressed through the uterus.

🤔Each phase has intention.

Each hormonal shift has meaning.

Ovulation is not random.

Bleeding is not meaningless.

😥Even PMS is not “just moodiness.”

Hormonal changes influence energy, focus, sleep, appetite, emotional sensitivity, and resilience.

The cycle affects the whole woman  not just her reproductive organs.

🤐And yet, in many cultures, it remains something whispered about.

Minimized.

Sometimes even dismissed.

But the menstrual cycle is often called the “fifth vital sign” for a reason.

Irregularity may reflect stress.

Pain may reflect inflammation.

Absence may signal deeper endocrine imbalance.

When we listen to the cycle, we listen to the body’s intelligence.

🤗As we enter the stillness of the weekend, let’s shift the narrative 

from inconvenience

to insight

from stigma

to understanding.

Because women deserve not only care 

but awareness, respect, and informed support.

💭 What is one thing about your cycle that you wish had been explained to you earlier in life?

 Dr Rabab Cares

#DrRababCares 

#WomenHealth

 #MenstrualHealth 

#HormonalBalance 

 #WomenEmpowerment

 🤗Final Perspective: Beyond the Diagnosis

Hypertensive disorders of pregnancy are not defined by fear.

They are defined by physiology, risk assessment, and clinical judgment.

👍Throughout this series, we discussed: 

• Risk factors and placental dysfunction

• The role of uterine artery Doppler

• When to monitor and when to intervene

• Timing of delivery

The central message remains consistent:

Pregnancy is dynamic.

Risk evolves.

Management requires continuous reassessment  not static labels.

💥Gestational hypertension and preeclampsia are not managed by one number, one test, or one decision.

💥They are managed through:

• Structured surveillance

• Timely escalation

• Context-based decisions

• And individualized care

👁Most pregnancies remain safe.

Good outcomes are not accidental  they are the result of systematic follow-up and clinical preparedness.

Medicine does not promise certainty.

It provides structured protection.

Dr Rabab Cares

#DrRababCares 

#HypertensiveDisordersOfPregnancy

#GestationalHypertension

#Preeclampsia

#HighRiskPregnancy

#MaternalFetalMedicine

#AntenatalCare

 💥Timing of Delivery in Gestational Hypertension How Decisions Are Made

In gestational hypertension,

the question is rarely if delivery will happen 

but when.

Timing of delivery is a balance between:

 • Maternal safety

• Fetal maturity

• Disease stability over time

There is no single gestational age that fits all cases.

🔹 When expectant management is appropriate

Delivery is usually deferred when: 

• Blood pressure remains in the mild to moderate range

• There are no symptoms of preeclampsia

• Laboratory results are normal

• Fetal growth and wellbeing are reassuring.

In these cases, continued pregnancy under close surveillance is safe and appropriate.

🔹 When delivery should be considered earlier

Delivery is indicated or strongly considered when: 

• Blood pressure becomes severe or difficult to control

• Features of preeclampsia develop

• Maternal symptoms appear

• Laboratory abnormalities emerge

• Fetal growth restriction or compromise is detected.

At this point, prolonging pregnancy may increase risk

without meaningful fetal benefit.

🔹 Gestational age matters

Management at:

 • 28 weeks

is very different from

• 37 weeks

As pregnancy advances,

the threshold for intervention becomes lower,

and the balance increasingly favors delivery.

🎯 Key principle:

In gestational hypertension,

delivery is not a failure of care 

it is often the definitive treatment.

Good timing is not based on blood pressure alone,

but on trend, context, and maternal–fetal assessment.

Dr Rabab Cares

#DrRababCares 

#GestationalHypertension

#TimingOfDelivery

#HypertensionInPregnancy

#HighRiskPregnancy

#MaternalFetalMedicine

#AntenatalCare

 ✨ When Fibroid  Location Matters More Than Size

Not all fibroids behave the same.

And not all pregnancy losses are chromosomal.

This was a 12-week pregnancy.

The baby was well.

No obvious fetal abnormalities.

But there was a large fundal fibroid about 12–13 cm.

And the placenta was located directly beneath it.

Over time, the fibroid underwent extensive degeneration and necrosis.

One month later… the pregnancy ended in a missed miscarriage.

💥What can we learn from this?

Most fibroids in pregnancy are harmless.

But when:

• The fibroid is large

• Located at the fundus

• Shares the same implantation site as the placenta

• And undergoes significant degeneration

The uteroplacental environment may be compromised.

Not always dramatically.

Sometimes gradually.

Sometimes silently.

Chronic vascular stress.

Mechanical distortion.

Inflammatory mediators from necrotic tissue.

All can affect placental perfusion.

Yesterday, we performed a myomectomy after about 8 weeks of that miscarriage. 

Not because fibroids always cause miscarriage.

But because in this specific case, anatomy mattered.

And preparation for a safer future pregnancy matters even more.

Medicine teaches us humility.

Sometimes it’s not about doing more.

It’s about understanding better.

Dr Rabab Cares 🤍

#DrRababCares 

#UterineFibroids

 #PregnancyCare 

#PlacentalHealth 

#Myomectomy

 💥Why Preeclampsia Can Still Happen Despite Doing Everything Right?

One of the hardest truths in obstetrics

is that preeclampsia can still occur even when everything is done correctly.

Some women:

• Start antenatal care early

• Take low-dose aspirin on time

• Use calcium supplements

• Control blood pressure carefully

• Attend all follow-up visits

And yet, preeclampsia still develops  sometimes early and severe.

This is not failure.

And it is not negligence.

In many cases, preeclampsia is driven by early placental and vascular pathology that begins very early in pregnancy —sometimes before preventive strategies can fully change the course.

What medicine can do:

✔️ Reduce risk

✔️ Delay progression

✔️ Improve outcomes

What medicine cannot always do:

❌ Fully override certain biological

 mechanisms in every pregnancy

Understanding this matters because it:

 • Removes blame from the woman

• Sets realistic expectations

• Emphasizes the need for early, specialized care

• Replaces false reassurance with honest vigilance

Preeclampsia is not always preventable.

But it is always deserving of respect, close monitoring, and timely decisions.

Dr Rabab Cares

#DrRababCares 

#Preeclampsia

#HighRiskPregnancy

#MaternalHealth

#MaternalFetalMedicin

 Medicine is not just about diagnoses and protocols

In obstetrics, every decision carries a story, a family, and a future.

Some days are joyful, some are heavy, and many are quietly exhausting.

Behind every ultrasound, every delivery, and every long night on call,

there is a responsibility we carry with humility and care.

I’m grateful for the trust women place in us during the most vulnerable moments of their lives.

This work reminds me daily that being a doctor is not about perfection 

it’s about presence, honesty, and doing your best, even when outcomes are beyond your control.

Dr Rabab Mustafa

Obstetrics & Gynecology | Medical Director

#DrRababCares 

#Obstetrics

#WomensHealth

#MaternalCare

#DoctorLife

#HealthcareWithHeart

 ⏳Uterine Artery Doppler and Preeclampsia: What Is the Link?

Preeclampsia is primarily a placental disease.

Its roots begin early long before blood pressure rises or symptoms appear.

Uterine artery Doppler helps us assess how well the placenta is forming and functioning during early pregnancy.

🔹 What is the connection?

In normal pregnancy, uterine arteries gradually adapt to allow low-resistance blood flow to the placenta.

In pregnancies that later develop preeclampsia, this adaptation may be incomplete or abnormal, leading to: 

• Increased resistance to uteroplacental blood flow

• Reduced placental perfusion

• Placental ischemia and dysfunction

These changes can be detected by uterine artery Doppler.

🔹 What abnormal Doppler findings suggest:

✔️ Higher risk of early-onset preeclampsia

✔️ Increased risk of placental insufficiency

✔️ Association with fetal growth restriction

✔️ Need for closer antenatal surveillance

Findings such as high resistance indices or persistent diastolic notching reflect impaired placentation  a key mechanism in preeclampsia.

🔹 What Doppler cannot guarantee:

❌ A normal Doppler does not rule out preeclampsia

❌ An abnormal Doppler does not mean preeclampsia is inevitable

❌ It cannot predict exact timing or severity

🔹 Why timing matters:

Uterine artery Doppler is most informative when performed in the first and early second trimester, when placental development is still ongoing.

Later in pregnancy, its value is limited for prediction, but may still support overall clinical assessment.

🎯 Key message:

Uterine artery Doppler does not diagnose preeclampsia.

It helps us understand risk early, before clinical disease appears.

It is a tool for risk stratification, not reassurance

and it works best when combined with clinical judgment and continuous follow-up.

Dr Rabab Cares

#DrRababCares 

#UterineArteryDoppler

#Preeclampsia

#HighRiskPregnancy

#AntenatalCare

#MaternalFetalMedicine