2026 is not about noise or speed.

It’s about clarity, intention, and growth.

Not every quiet path is empty.

Some are full of meaning, purpose, and wisdom.

This year, I am choosing: Peace over pressure,

Light over constant visibility,

Patience over rushing outcomes,

Health over burnout,

Family over endless obligations,

Depth over numbers.

And a calm, grounded mind over chaos.

I’m learning that growth doesn’t always announce itself.

Sometimes, it happens quietly 

in boundaries, in consistency,

in choosing what truly matters.

Trusting the process,

placing my steps in God’s hands,

and moving forward with faith and gratitude.

Quietly becoming myself.

With purpose. With grace. With faith.

Happy New Year 2026 ✨🦋

#DrRababCares

 Threatened Miscarriage

Causes & Clinical Guideline

🩺 Threatened miscarriage is defined as vaginal bleeding before 20 weeks of gestation with:

🔒 Closed cervical os

🫄 Intrauterine pregnancy

❤️ Fetal cardiac activity present

➡️ The pregnancy is at risk but still viable at the time of assessment.

🔍 Important Causes

🩸 Subchorionic hematoma

🌱 Implantation bleeding

🧬 Hormonal instability (progesterone deficiency)

🔬 Cervical causes (ectropion, polyp, infection)

💑 Intercourse-related bleeding

❓ Idiopathic (no identifiable cause – very common)

⚠️ In many cases, no single cause is found.

📝 Clinical Assessment (Guideline-Based)

History

📅 Gestational age

🩸 Amount & duration of bleeding

😣 Associated pain

🔁 Previous pregnancy losses

🧪 Rh status

Examination

🩺 Vital signs & hemodynamic stability

🤲 Abdominal examination

🔍 Speculum examination:

• Source of bleeding
• Cervix closed
• Exclude cervical pathology

🔎 Investigations

🖥️ Ultrasound (key investigation)

Intrauterine pregnancy

❤️ Fetal cardiac activity

📏 Gestational age

🩸 Subchorionic hematoma (if present)

🧫 Laboratory tests (if indicated)

Blood group & Rh

Hb if bleeding is moderate–heavy

β-hCG only in very early or uncertain viability.

💊 Management

Management is mainly expectant with close follow-up.

🤍 Reassurance & counseling

🛌 Relative rest (❌ strict bed rest not recommended)

🚫 Avoid intercourse temporarily

💊 Analgesia if needed (paracetamol)

Progesterone

🌸 Vaginal progesterone may be considered

Especially with:

🔁 Previous miscarriage

🩸 Ongoing bleeding

🧬 Suspected luteal phase deficiency

Anti-D

💉 Indicated for all Rh-negative women with bleeding

🚫 Not Recommended

❌ Routine antibiotics

❌ Tocolytics

❌ Strict bed rest

❌ Unnecessary medications

🔄 Follow-Up

📆 Repeat ultrasound in 7–14 days

🚨 Immediate review if:

• Heavy bleeding
• Severe abdominal pain
• Fever
• Dizziness or syncope

🌟 Key Message

Threatened miscarriage does NOT mean inevitable miscarriage.

❤️ Presence of fetal cardiac activity is a strong reassuring prognostic sign.

#DrRababCares 

#ThreatenedMiscarriage

#EarlyPregnancy

#FirstTrimesterBleeding

#PregnancyCare

#MaternalHealth

#EvidenceBasedMedicine

 📌 Postpartum Health – Evidence-Based Guideline Overview

🔹 1. Timing of Postpartum Care

First contact: within 3 weeks after delivery

Comprehensive visit: by 6–12 weeks postpartum

(ACOG recommends postpartum care as an ongoing process, not a single visit)

🔹 2. Physical Recovery Assessment

✔ Uterine involution

✔ Lochia pattern (amount, color, odor)

✔ Perineal or cesarean wound healing

✔ Breast & lactation assessment

✔ Pelvic floor symptoms (pain, incontinence, prolapse)

🔹 3. Postpartum Hemorrhage & Anemia

Ask about:

Excessive bleeding

Dizziness, fatigue

Check:

Hb if symptomatic or high-risk

Treat anemia early to improve recovery & mental health.

🔹 4. Mental Health Screening (Mandatory)

🧠 Screen for:

Postpartum blues

Postpartum depression

Anxiety & PTSD

📌 Use validated tools (e.g. EPDS)

📌 Early referral saves lives

🔹 5. Blood Pressure & Medical Conditions

Monitor BP (especially after:

Pre-eclampsia

Gestational hypertension)

Follow-up:

Diabetes

Thyroid disorders

Chronic illnesses

🔹 6. Contraception Counseling

Discuss before 6 weeks

Options depend on:

Breastfeeding status

Medical conditions

Emphasize birth spacing

🔹 7. Sexual Health & Intimacy

Address:

Dyspareunia

Vaginal dryness

Libido changes

Normalize concerns — silence delays healing

🔹 8. Red Flags – When to Seek Help Urgently

🚨 Heavy bleeding

🚨 Fever

🚨 Severe headache or visual changes

🚨 Chest pain or breathlessness

🚨 Severe sadness or harmful thoughts

🔹 9. Patient-Centered Postpartum Care

Postpartum care should be:

Continuous

Individualized

Physical + emotional

Supportive, not dismissive

#DrRababCares 

#PostpartumHealth #PostnatalCare #MaternalHealth #WomenHealth #OBGYN #PostpartumRecovery #MentalHealthMatters #PatientCenteredCare

 ✨ Behind the story…

Yesterday, we talked about thrombocytopenia in pregnancy —

numbers, guidelines, thresholds, and decisions.

Today, I want to talk about what those numbers really mean in real life.

Because behind every “routine” cesarean section,

there can be a quiet story no one sees.

A mother whose platelets were slowly dropping.

Weeks of careful monitoring.

Daily questions in the doctor’s mind:

Observe… or intervene? Wait… or act?

No panic.

No dramatic alarms.

Just vigilance.

Because postpartum bleeding doesn’t always come crashing through the door.

Sometimes, it whispers.

A uterus that tightens… then relaxes.

Blood that collects silently.

Signs that only show themselves if you’re truly watching.

In those moments, medicine is not about heroics.

It’s about being prepared before the crisis exists.

✔ Blood ready

✔ Platelets available

✔ Team aligned

✔ Decisions made calmly, minute by minute

This was not a dramatic emergency.

And that’s exactly why it mattered.

Because the most dangerous situations are often the quiet ones.

The ones that tempt us to relax too early.

The ones that remind us that stability is not a guarantee — it’s something we protect.

Thankfully, this story ended well.

A stable mother.

A safe outcome.

A reminder of why preparation saves lives.

Every birth deserves respect.

Every mother deserves safety.

And every “routine” case deserves our full attention.

💛

Dr Rabab Cares

#DrRababCares

#ThrombocytopeniaInPregnancy

#MaternalCare

#PostpartumHemorrhage

#CesareanSection

#WomenHealth

#SafeMotherhood

 🔴 Low Platelets in Pregnancy

What every pregnant woman should know?

Low platelets during pregnancy is a common finding — but not every low number is dangerous, and not every case needs treatment.

🔍 What are platelets?

Platelets help blood clot and prevent excessive bleeding.

Normal platelet count is usually 150,000–450,000.

🤰 Why do platelets drop during pregnancy?

1️⃣ Gestational Thrombocytopenia (Most common – 70–80%)

✔️ Appears in late pregnancy

✔️ Mild drop (usually >70,000)

✔️ No symptoms

✔️ No treatment needed

✔️ Resolves after delivery

2️⃣ Immune Thrombocytopenia (ITP)

✔️ Platelets may drop below 70,000

✔️ May occur earlier in pregnancy

✔️ Sometimes needs treatment (steroids or IVIG)

3️⃣ Preeclampsia / HELLP syndrome

✔️ Associated with high blood pressure

✔️ Liver enzymes abnormal

✔️ Requires urgent management

🩺 When do we treat low platelets?

👉 Not based on the number alone

Treatment is considered if:

• Platelets <70,000
• Active bleeding
• Rapid drop in count
• Planned surgery or delivery requiring safe levels

💊 Treatment options (according to guidelines)

✔️ Corticosteroids

Used mainly in ITP, not gestational thrombocytopenia.

✔️ IVIG (Intravenous Immunoglobulin)

Used when:

Steroids fail

Rapid platelet rise is needed before delivery

✔️ Platelet transfusion

Reserved for:

Surgery

Active bleeding

Severe thrombocytopenia

🧠 Delivery & anesthesia considerations

Vaginal delivery is safe if platelets ≥ 50,000

Cesarean section usually requires ≥ 50–80,000

Regional anesthesia decisions are made case-by-case

💛 Key message

🔹 Most cases of low platelets in pregnancy are benign

🔹 Proper diagnosis matters more than panic

🔹 Management should always follow evidence-based guidelines

🔹 With close monitoring, outcomes are usually excellent.

Dr Rabab Cares

Because reassurance is sometimes the most important treatment 🌸

#DrRababCares

#ForestParkHospital 

#PregnancyCare

#HighRiskPregnancy

#PlateletsInPregnancy

#MaternalHealth

Despite clear guidelines, anemia in pregnancy is still frequently mismanaged, leading to avoidable maternal and fetal risks.

❌ Common mistakes we still see:

🔴 1. Treating the number, not the cause

Starting iron without confirming iron deficiency

→ Overlooking hemoglobinopathies, B12 or folate deficiency.

🔴 2. Delaying treatment because anemia is “mild”

Mild anemia can progress rapidly if ignored — especially in late pregnancy.

🔴 3. Poor follow-up after starting oral iron

No repeat hemoglobin check

→ No way to assess response or compliance.

🔴 4. Persisting with oral iron despite failure

No Hb rise after 2–4 weeks

→ IV iron should be considered, not delayed.

🔴 5. Using blood transfusion too early

Transfusion is not treatment for iron deficiency in stable patients.

🔴 6. Ignoring anemia before planned delivery

Low Hb + cesarean section = higher transfusion risk.

🔴 7. Stopping treatment once Hb improves

Replenishing iron stores is as important as correcting Hb.

Key Take-Home Message

Anemia in pregnancy is preventable, detectable, and treatable —

but only when managed correctly and early.

📌 Following evidence-based protocols protects both mother and baby.

💬 Which mistake do you see most often in practice?

#DrRababCares 

#ForestParkHospital 

#AnemiaInPregnancy

#ClinicalPractice

#Obstetrics

#EvidenceBasedMedicine

 Anemia in Pregnancy: 

When Do We Use IV Iron?

Oral iron is the first-line treatment for iron deficiency anemia in pregnancy.

However, not all women respond adequately — and delays can increase maternal and fetal risks.

According to international guidelines (including World Health Organization and major obstetric societies):

IV iron is recommended when:

🔴 Moderate to severe anemia

Hemoglobin < 9 g/dL, especially in the 2nd or 3rd trimester

🔴 Poor response to oral iron

Hb fails to rise by ~1 g/dL after 2–4 weeks of compliant oral therapy

🔴 Intolerance or non-compliance

• Severe gastrointestinal side effects
• Inability to tolerate oral iron

🔴 Late pregnancy

When rapid correction is needed before delivery

🔴 High-risk situations

• Previous postpartum hemorrhage
• Planned cesarean section with low Hb

Why IV iron?

✔️ Faster hemoglobin correction

✔️ Better replenishment of iron stores

✔️ Reduced need for blood transfusion

✔️ Improved maternal well-being before delivery

📌 Modern IV iron preparations are safe, effective, and well tolerated when properly indicated.

Clinical Pearl

Blood transfusion should not be the first option for stable pregnant women with anemia.

Correcting iron deficiency early is safer — and smarter.

💬 Do you routinely reassess Hb after starting oral iron?

#DrRababCares 

#FORESTPARKHOSPITAL 

#AnemiaInPregnancy

#IVIron

#EvidenceBasedPractice

#MaternalCare

Anemia during pregnancy is one of the most common medical conditions worldwide, yet it is often underestimated.

According to World Health Organization guidelines:

🔹 Anemia in pregnancy is defined as:

Hemoglobin < 11 g/dL in the 1st & 3rd trimester

Hemoglobin < 10.5 g/dL in the 2nd trimester

Why does anemia matter?

🔴 Effects on the mother:

Fatigue and reduced physical capacity

Palpitations, dizziness

Increased risk of postpartum hemorrhage

Poor tolerance to blood loss during delivery

Delayed postnatal recovery

🔴 Effects on the fetus:

Low birth weight

Preterm delivery

Reduced neonatal iron stores

In severe cases: intrauterine growth restriction (IUGR)

🔴 Effects on labor & delivery:

Higher risk of blood transfusion

Increased maternal morbidity

Slower post-delivery recovery

Key Guideline Messages

✔️ Not all anemia is dangerous — severity matters

✔️ Iron deficiency is the most common cause

✔️ Early screening and treatment significantly improve outcomes

✔️ Management should be individualized (oral iron, IV iron, or further evaluation if no response)

📌 Routine hemoglobin testing is recommended during pregnancy, and treatment should never be delayed if anemia is detected.

Clinical Reminder

Anemia is not just a lab value.

It is a modifiable risk factor that directly affects pregnancy safety.

💬 When was your last hemoglobin check?

Hashtags

#DrRababCares 

#ForestParkHospital 

#AnemiaInPregnancy

#MaternalHealth

#EvidenceBasedMedicine

#HealthyPregnancy

Guideline-Based Facts You Should Know

Cervical length measurement is not a routine screening test for all pregnant women, but it is a crucial tool in selected cases to assess the risk of preterm birth.

🔍 Who SHOULD have cervical length assessment?

According to ACOG, SMFM, and RCOG guidelines, cervical length measurement is recommended for women with:

• A history of spontaneous preterm birth

• Second-trimester pregnancy losses

• Symptoms of threatened preterm labor

• Multiple pregnancy (twins or more)

• Previous cervical surgery (LEEP, cone biopsy)

• Uterine anomalies

• An incidentally discovered short cervix on ultrasound

⏱️ When is the BEST time to measure cervical length?

• 16–24 weeks of gestation

• This is the window where cervical length has the highest predictive value

• Routine measurement after 24 weeks is not recommended for screening

📍 How should it be measured?

✔ Transvaginal ultrasound is the gold standard

❌ Transabdominal ultrasound is not reliable for accurate cervical assessment

⚠️ What is considered a “short cervix”?

• Cervical length <25 mm before 24 weeks

→ Associated with increased risk of preterm birth

🩺 Why does this measurement matter?

Because it can change management, including: 

• Vaginal progesterone

• Cervical cerclage (in selected high-risk cases)

• Increased surveillance and timely intervention

🔑 Key Guideline Message

✔ Cervical length screening should be risk-based, not universal

✔ Proper timing and technique are essential

✔ Early identification can significantly reduce preterm birth risk

Dr Rabab Cares 🤍

#DrRababCares 

#PretermBirth

#CervicalLength

#HighRiskPregnancy

#AntenatalCare

#MaternalHealth

#ForestParkHospital

This is one of the most common concerns women have — and the short answer is:

No, an IUD does NOT cause infections by itself.

🔬 What do guidelines say?

According to WHO, CDC, and ACOG guidelines:

Modern IUDs (copper or hormonal) do not increase the long-term risk of pelvic infections.

The only slightly increased risk of infection is during the first 20 days after insertion, and this is related to pre-existing infection, not the IUD itself.

⚠️ When can infections happen?

An infection may occur if:

• A woman already has an untreated STI (like chlamydia or gonorrhea) at the time of insertion
• Poor aseptic technique is used during insertion (rare in clinical settings)
• New exposure to STIs after insertion (IUD does not protect against STIs)

👉 The IUD does not create bacteria, and it does not “store infection” inside the uterus.

🩺 Do we need routine antibiotics before insertion?

No.

Guidelines do not recommend routine antibiotics before IUD insertion.

What is recommended:

Proper history taking

STI screening only for women at high risk

Safe, sterile insertion technique

🚨 When should a woman seek medical advice?

After IUD insertion, seek care if there is:

Persistent lower abdominal pain

Fever

Foul-smelling vaginal discharge

Pain during intercourse

These symptoms are not normal and should be evaluated — whether or not an IUD is present.

🌸 The bottom line

✔️ IUDs are safe, effective, and long-acting contraceptive methods

✔️ They do not cause infections

✔️ Good counseling and proper insertion make them even safer

Fear should never replace facts.

💙 Dr Rabab Cares

If you have symptoms or concerns, don’t remove the IUD on your own — get proper evaluation first.

#DrRababCares

#FamilyPlanning

#IUDFacts

#WomenHealth

#ReproductiveHealth

#FORESTPARKHOSPITAL

Pregnancy is often described as a “happy time”, but for many women, it can also be emotionally overwhelming.

Feeling low during pregnancy is not weakness — it is a medical condition that deserves attention and care.

🔹 What is Prenatal Depression?

Prenatal (antenatal) depression is depression that occurs during pregnancy. According to WHO and ACOG guidelines, it affects up to 10–20% of pregnant women worldwide.

🔹 Common Symptoms:

• Persistent sadness or crying spells  

• Loss of interest or pleasure  

• Excessive anxiety or constant worry  

• Sleep disturbances (insomnia or sleeping too much)  

• Appetite changes  

• Feeling hopeless, guilty, or overwhelmed  

• Difficulty bonding with the pregnancy  

🔹 Why Is It Important Not to Ignore?

Untreated prenatal depression may increase the risk of:

• Poor antenatal care attendance  

• Preterm birth or low birth weight  

• Postpartum depression  

• Difficulty bonding with the baby  

🔹 Who Is More at Risk?

• Previous history of depression or anxiety  

• Unplanned or high-risk pregnancy  

• Limited social or family support  

• Financial or relationship stress  

• Pregnancy complications  

🔹 What Do Current Guidelines Recommend?

✔ Routine screening during pregnancy using validated tools (e.g. EPDS, PHQ-9)  

✔ Early psychological support and counseling  

✔ Lifestyle support: sleep, nutrition, social support  

✔ Medication ONLY when clearly indicated and prescribed by a specialist  

✔ A multidisciplinary approach involving OB-GYN and mental health professionals  

🔹 The Most Important Message:

You are not alone.

Help is available.

Asking for support is a sign of strength, not failure.

If you’re pregnant and struggling emotionally, please speak to your healthcare provider.

Your mental health matters — for you and for your baby. 🤍

#DrRababCares

#PrenatalDepression

#MaternalMentalHealth

#AntenatalCare

#WomenHealth

#MentalHealthInPregnancy

#ForestParkHospital

 Vaccinations During Pregnancy 🤰💉

A Complete Guide for Pregnant Women in Zambia 🇿🇲

Vaccination during pregnancy is a key part of antenatal care.

It protects both the mother and the baby and helps prevent serious, life-threatening infections.

🇿🇲 Vaccination Protocol During Pregnancy in Zambia

Zambia follows WHO / EPI-based guidelines, focusing on early protection, especially against maternal and neonatal tetanus.

1️⃣ Tetanus (TT / Td) – MOST IMPORTANT

🔹 Which vaccine?

TT or Td

(Tdap is not routinely available in the public sector)

🔹 When?

✔ If the woman is NOT adequately vaccinated or her history is unknown:

First dose (TT1): at the first antenatal visit (ANY trimester)

Second dose (TT2): at least 4 weeks later

➡️ These two doses protect both the mother and the newborn in the current pregnancy.

✔ If the woman received ≥2 doses in previous pregnancies:

One booster dose during pregnancy is usually sufficient

🔔 Important note:

Although some international guidelines mention 27–36 weeks (mainly when Tdap is used),

👉 In Zambia, tetanus vaccination should NOT be delayed. Early vaccination is recommended.

2️⃣ Influenza (Flu Vaccine)

🗓 When?

Any trimester, once available

✅ Why?

• Pregnancy increases the risk of severe flu
• Reduces complications such as pneumonia and hospitalization
• Protects the newborn after birth

3️⃣ COVID-19 Vaccine

🗓 When?

Any trimester (including booster doses if indicated)

✅ Why?

Reduces risk of severe illness, ICU admission, and preterm birth

Safe for both mother and baby

4️⃣ Hepatitis B Vaccine

🗓 When?

If not previously vaccinated or if the mother is at higher risk

💉 Schedule:

0 – 1 – 6 months (can be started during pregnancy)

✅ Why?

Prevents maternal infection

Reduces mother-to-child transmission

❌ Vaccines NOT Given During Pregnancy

(Live vaccines)

🚫 Measles, Mumps, Rubella (MMR)

🚫 Varicella (Chickenpox)

➡️ These should be given before pregnancy or after delivery

🟢 Key Take-Home Messages

✔ Vaccines in pregnancy are safe and evidence-based

✔ They protect two lives at the same time

✔ In Zambia, early tetanus vaccination is essential

✔ Always follow individual medical advice during antenatal visits

📌 Every pregnancy is unique. Discuss your vaccination plan with your healthcare provider.

#DrRababCares

#ForestParkHospital

#ZambiaHealth

#PregnancyCare

#AntenatalCare

#MaternalHealth

#PregnancyVaccines

#HealthyMomHealthyBaby

 When Do We REALLY Need Pregnancy Support (Progesterone) Medications? 

“Pregnancy stabilizers” or progesterone supplements are widely used — but medically, they are NOT needed for every pregnancy.

📌 According to international guidelines (ACOG, RCOG, ESHRE):

✅ Progesterone IS recommended in specific situations only:

1️⃣ Threatened miscarriage

• Vaginal bleeding in early pregnancy

• With a confirmed intrauterine pregnancy

• Especially in women with a history of previous miscarriage

2️⃣ Recurrent pregnancy loss

• Women with ≥2–3 previous miscarriages

• Progesterone may improve live birth rates in selected cases

3️⃣ Assisted reproduction (IVF / ICSI)

• Luteal phase support is standard of care

• Progesterone is essential until placental hormone production is established

4️⃣ Proven luteal phase deficiency

• Diagnosed clinically, not routinely screened

• Selected cases only

⚠️ Progesterone is NOT routinely needed for:

• Every early pregnancy

• Mild cramps without bleeding

• Normal pregnancies with no risk factors

• “Just in case” use without medical indication

🧠 Important medical facts:

• Most miscarriages are caused by chromosomal abnormalities — progesterone cannot prevent these.

• Overuse of medications does NOT guarantee pregnancy continuation.

• Treatment should be evidence-based, not fear-based.

🩺 Practical guidance:

• Ultrasound confirmation of an intrauterine pregnancy is essential

• Dosage, route (oral, vaginal, injection), and duration must be individualized

• Follow-up is more important than medication alone

✨ Key message:

Progesterone can be life-saving in the RIGHT patient — but unnecessary in many others.

Correct diagnosis and personalized care always come first.

Dr Rabab Cares 🤍

#DrRababCares 

#ForestParkHospital 

#PregnancyCare

#Progesterone

#ThreatenedMiscarriage

#RecurrentMiscarriage

#EvidenceBasedMedicine

#PregnancyEducation

📌 According to recent medical guidelines (WHO & ACOG):

✅ Physically:

Ovulation can occur as early as 2–4 weeks after a miscarriage.

There is NO medical evidence that waiting several months improves pregnancy outcomes in uncomplicated cases.

Studies show that women who conceive within the first 6 months after a miscarriage do NOT have higher risks of:

• Recurrent miscarriage

• Preterm birth

• Pregnancy complications

In fact, some studies suggest equal or even better outcomes.

⚠️ When waiting is recommended:

• If there was heavy bleeding or infection

• After a molar pregnancy

• After surgical complications

• If the miscarriage was due to an underlying medical condition that needs treatment

• If the woman is not emotionally ready

🩺 Practical medical advice:

• Wait until bleeding has completely stopped

• At least one normal menstrual cycle is helpful for accurate pregnancy dating (but not mandatory)

• Start folic acid before trying again

• Ensure medical follow-up if the miscarriage was recurrent or complicated

💙 Emotional readiness matters:

Healing is not only physical. Grief, anxiety, and fear are normal after miscarriage. There is no “right time” — only the time that feels right for the woman and her family.

✨ Key message:

Pregnancy after miscarriage is often safe once the body has recovered, but timing should always be individualized.

Dr Rabab Cares 🤍

#DrRababCares 

#ForestParkHospital 

#PregnancyAfterMiscarriage

#MiscarriageCare

#WomensHealth

#MaternalHealth

#PregnancyEducation

 PreTerm Premature Rupture Of Membranes 

Today, I walked with a mother through one of the most painful and complex journeys in obstetrics 

a pregnancy affected by long-standing PPROM (preterm premature rupture of membranes).

For weeks, she lived with uncertainty, leaking amniotic fluid day after day, hoping her baby would somehow stay safe. 

But PPROM at very early gestations often carries risks far greater than any mother should bear alone: 

infection, severe bleeding, and life-threatening complications.

When the body can no longer protect the pregnancy, the mother’s safety becomes the priority

not because her baby is any less loved, 

but because her life matters, 

her health matters, 

and her family still needs her.

I want every woman to understand something deeply:

• PPROM is NOT your fault.  

• Early pregnancy loss is NOT a punishment.  

• And choosing to protect your own life is an act of courage, not guilt.

As doctors, we do not simply “manage a case.”  

We hold space for a mother’s grief, her fear, her guilt, her hope… 

and we guide her through a decision no woman ever imagines having to make.

Behind every ultrasound.  

Behind every diagnosis.  

Behind every emergency…  

there is a woman with a story, a dream, and a heart trying to survive the impossible.

To the mothers who have experienced PPROM, miscarriage, or recurrent losses:  

• Your body is not failing you.  
• Your motherhood is not defined by a single outcome.  
• And your grief is real, valid, and deserving of compassion.
• Healing takes time.  
• And no woman should walk that journey alone.

Dr Rabab Cares 🌿🤍

#DrRababCares 

#ForestParkHospital 

#PPROM #PregnancyLossAwareness  #EarlyPregnancyLoss 

#BecauseMothersMatter #YouAreNotAlone #HealingJourney #MedicalSupport

 Are Repeated Caesarean Sections Safe? 

Many women wonder whether having more than one Caesarean section is safe.

 The medical answer is:

✅ YES — repeated C-sections can be performed safely,

⚠️ BUT the risks do increase with each additional surgery.

🔹 What we know from medical studies:

Most women can safely have 2 or even 3 C-sections with good maternal and fetal outcomes, especially when:

• They receive proper antenatal care

• The surgery is done in a well-equipped hospital

• The team is experienced in high-risk obstetrics

⚠️ However, with each repeat C-section, the following risks become higher:

• Increased blood loss and postpartum hemorrhage  

• Placenta previa (low-lying placenta)

• Placenta accreta spectrum (placenta abnormally attached to the uterus)

• Dense pelvic and abdominal adhesions

• Injury to nearby organs such as the bladder or bowel

• Longer operative time and slower recovery

• Higher chance of blood transfusion

• Increased risk of hysterectomy in very complicated cases (rare but serious)

🧠 Important medical facts:

• There is NO universal “safe maximum number” of C-sections for all women.

• Risk depends on:

  – Number of previous C-sections  

  – Type of uterine scar  

  – Presence of previous complications  

  – Placental location in the current pregnancy  

  – General maternal health  

👩‍⚕️ Planning is the key to safety:

Women with multiple previous C-sections should have:

• Early ultrasound for placental location

• Regular antenatal follow-up

• Delivery planned in a hospital with surgical, blood bank, and ICU facilities

• A clearly documented surgical history

✨ Final medical message:

Repeated Caesarean delivery can be safe, but it is never “routine.”

Each pregnancy must be carefully assessed individually to minimize risks and ensure the safest outcome for both mother and baby.

Dr Rabab Cares 🤍

#DrRababCares 

#ForestParkHospital 

#CesareanSection

#RepeatCS

#HighRiskPregnancy

#SafeDelivery

#MaternalHealth

 When Should We Do a 4D Ultrasound? 🤍

4D ultrasound is an advanced imaging technique that allows real-time visualization of the baby’s movements, facial expressions, and some structural details. It is mainly an ADDITIONAL tool to routine medical ultrasounds—not a replacement for them.

✅ The BEST time to perform a 4D ultrasound is:

Between 26 and 32 weeks of pregnancy

Why this period?

• The baby has developed clear facial features

• There is still adequate amniotic fluid for proper imaging

• The baby is not yet too large or crowded

• Movements and expressions can be seen clearly

🟢 Earlier than 26 weeks:

• Facial features are still immature

• Images may not be very clear

🟠 After 32–34 weeks:

• The baby becomes larger

• Less space and reduced fluid may affect image quality

• Facial views may be partially hidden

⚕️ MEDICAL NOTE (Guidelines-based):

The most important ultrasound for fetal anomaly detection remains the **detailed anomaly scan at 18–22 weeks (2D ultrasound)**.

4D ultrasound is mainly used for:

• Enhanced visualization of fetal face and movements

• Certain suspected facial or limb anomalies

• Parental reassurance and bonding

🚫 4D ultrasound is NOT a screening tool for birth defects by itself.

It does NOT replace:

• Routine growth scans

• Doppler studies

• Anomaly scan

• Medical obstetric ultrasound follow-up

💡 Safety message:

Ultrasound is considered safe when used for medical indications and by trained professionals. Unnecessary prolonged exposure should be avoided.

✨ Technology is amazing — but correct medical timing is what truly matters.

Dr Rabab Cares 🤍

#DrRababCares 

#ForestParkHospital 

#4DUltrasound

#PregnancyScan

#PrenatalCare

#FetalUltrasound

#MaternalHealth

#PregnancyEducation

 Normal Pregnancy Pain vs. Warning Signs:

 Know the Difference 🤍

During pregnancy, many physical changes occur, and some degree of discomfort is completely normal. However, certain types of pain or symptoms should NEVER be ignored.

✅ Common NORMAL pregnancy pains include:

• Mild lower abdominal cramps due to uterine stretching

• Lower back pain and pelvic discomfort

• Round ligament pain with sudden movements

• Mild, irregular uterine tightening (Braxton Hicks)

• Bloating, gas, and constipation-related discomfort

These are usually mild, temporary, and improve with rest or change of position.

⚠️ DANGER SIGNS that require IMMEDIATE medical attention:

• Vaginal bleeding at any stage of pregnancy

• Severe, persistent, or sudden abdominal pain

• Regular painful contractions before 37 weeks

• Decreased or absent fetal movements

• Severe headache with blurred vision or flashing lights

• Sudden swelling of face, hands, or legs

• Shortness of breath, chest pain, fainting

• High fever, persistent vomiting, or signs of infection

• Leakage of fluid from the vagina (PROM)

🚨 These symptoms may indicate serious complications such as:

Placental problems, preterm labor, pre-eclampsia, infection, or fetal distress.

💡 Medical guideline message:

Every pregnancy is unique. What is “normal” for one woman may be dangerous for another. Trust your instincts and always seek medical care if something feels wrong.

✨ Early medical intervention saves both mother and baby lives.

#DrRababCares 

#PregnancyCare

#MaternalHealth

#WarningSignsInPregnancy

#SafePregnancy

#PrenatalCare

#HighRiskPregnancy

 Intimacy During Pregnancy: What Do Medical Guidelines Say? 🤍

Intimacy during pregnancy is one of the most common concerns for couples.

 According to international medical guidelines, sexual activity is generally safe in uncomplicated pregnancies.

✅ When is intimacy considered safe?

• Normal, low-risk pregnancy

• No vaginal bleeding

• No placenta previa

• No history of recurrent miscarriage

• No signs of preterm labor

• Intact membranes (no leaking of waters)

✅ Possible benefits:

• Reduced stress and anxiety

• Better emotional bonding between partners

• Improved sleep and mood

• Supporting a healthy marital relationship

🟢 By trimester:

• First trimester: Safe if there is no bleeding or pain.

• Second trimester: Usually the most comfortable period.

• Third trimester: Still safe in low-risk pregnancies, with gentle, comfortable positions.

⚠️ When should intimacy be avoided or restricted?

It is NOT recommended in the following situations:

• Vaginal bleeding of unknown cause

• Placenta previa

• Threatened miscarriage

• History of preterm labor

• Short/weak cervix or cervical incompetence

• After cervical cerclage

• Premature rupture of membranes (PROM)

• Active genital infections

⚠️ Call your doctor urgently if, after intercourse, you notice:

• Continuous bleeding

• Severe abdominal pain

• Leakage of fluid

• Regular uterine contractions

💡 Each pregnancy is unique.

What is safe for one woman may not be safe for another. Always follow your doctor’s advice — not social media myths.

✨ Your safety, comfort, and peace of mind always come first.

#DrRababCares

#PregnancyEducation

#CoupleHealth

#PrenatalCare

#PregnancyMyths

#ForestParkHospital

 Family Planning Series – Week 10

Natural & Fertility Awareness Methods  

These methods depend on understanding the woman’s natural fertility cycle and avoiding unprotected intercourse during the fertile window.

🔹 Types of Natural Methods:

1️⃣ Calendar (Rhythm) Method  

Based on calculating fertile days according to previous cycles.

2️⃣ Cervical Mucus Method  

Monitoring the changes in vaginal discharge to identify ovulation.

3️⃣ Basal Body Temperature Method  

Daily temperature measurement to detect ovulation after it occurs.

4️⃣ Symptothermal Method  

A combination of temperature + mucus + cycle tracking.

5️⃣ Withdrawal (Coitus Interruptus)  

The male partner withdraws before ejaculation (least reliable).

✅ Advantages:  

- No hormones.  

- No medical intervention.  

- Acceptable for couples who prefer natural methods.  

- Free of cost.

⚠️ Disadvantages:  

- Requires high discipline and daily tracking.  

- Higher failure rate compared to hormonal and long-acting methods.  

- Easily affected by stress, illness, irregular cycles.  

- Does NOT protect from STIs or HIV.

📖 Effectiveness:  

Typical use failure rate ranges from 15–25% per year .

💡 Key Message:  

Natural methods can work for motivated, well-informed couples — but they are not the most reliable options for pregnancy prevention.

#DrRababCares 

#FamilyPlanning #NaturalMethods #FertilityAwareness #ReproductiveHealth #WomensHealth #ForestParkHospital

 🩺 HSG Test (Hysterosalpingography) – What You Need to Know

HSG is a special X-ray test using contrast dye to evaluate:

✅ The shape of the uterine cavity

✅ The patency of the fallopian tubes

✅ Possible tubal blockage

✅ Some uterine abnormalities or adhesions

It is one of the most important investigations in infertility work-up.

🕒 When is HSG done?

After menstruation and before ovulation

Usually between day 7–10 of the menstrual cycle

🧪 How is the procedure done?

A contrast dye is injected through the cervix

X-ray images are taken while the dye fills the uterus and tubes

The whole procedure takes only a few minutes

Mild cramping similar to menstrual pain is common and temporary.

✅ What can HSG diagnose?

• Tubal blockage
• Intrauterine adhesions
• Congenital uterine anomalies
• Sometimes it has a therapeutic effect by flushing mild tubal blockages

⚠️ Important notes:

• Should not be done during pregnancy
• A painkiller is recommended 30 minutes before the test
• Occasionally, antibiotics are prescribed after the procedure

🌸 Reassurance:

HSG is a simple, safe, and quick procedure. Accurate diagnosis can save precious time in the journey of infertility management.

#DrRababCares 

#HSG 

#InfertilityWorkup

 #WomenHealth #FertilityCare 

 #ForestParkHospital

 🩺 Antenatal Care (ANC): Your First Line of Protection in Pregnancy

Pregnancy is not just about waiting for delivery —

it is about protecting two lives from the very beginning 🤍

Regular antenatal care is the most effective way to prevent maternal and fetal complications.

✅ According to WHO & International Guidelines:

🔹 First ANC visit:

As early as 6–8 weeks of pregnancy

🔹 Minimum recommended visits:

✅ 8 visits OR MORE during pregnancy

1 in the first trimester

2 in the second trimester

5 in the third trimester

⚠️ High-risk pregnancies require MORE frequent visits

(According to the medical condition and doctor’s plan)

✅ Who is considered High-Risk?

High blood pressure

Diabetes (pre-gestational or gestational)

History of pre-eclampsia or PPH

Multiple pregnancy (twins)

Previous C-section

Anemia

Advanced maternal age

Medical diseases (asthma, heart disease, thyroid, etc.)

➡️ These women need closer and more frequent follow-up to prevent complications.

✅ What must be done during ANC visits?

🩸 Blood tests

Hemoglobin (anemia screening)

Blood group & Rh factor

HIV, Syphilis, Hepatitis B

Blood sugar (Gestational Diabetes screening)

🧪 Urine tests

Protein (pre-eclampsia detection)

Urinary tract infection screening

🩻 Ultrasound scans

Dating scan (first trimester)

Anomaly scan (18–22 weeks)

Growth & wellbeing scans (third trimester)

💉 Vaccinations

Tetanus / Tdap

As per national protocol

💊 Supplements

Folic acid

Iron

Calcium

Vitamin D (if needed)

⚠️ Danger signs that MUST NOT be ignored:

• Severe headache
• Blurred vision
• Swelling of face or hands
• Vaginal bleeding
• Reduced fetal movements
• Persistent vomiting
• Severe abdominal pain

➡️ Any of these require urgent medical attention immediately.

🌸 Why regular ANC saves lives:

• Early detection of pre-eclampsia
• Prevention of post-partum hemorrhage
• Control of gestational diabetes
• Prevention of preterm birth
• Better planning for safe delivery
• Improved neonatal outcomes

📌 Most maternal and fetal complications are preventable with proper follow-up.

👩‍⚕️ Antenatal care is not optional. It is life-saving.

Even if you feel well — complications may be silent.

#DrRababCares

#AntenatalCare

#HighRiskPregnancy

#MaternalHealth

#WomenHealthMatters

#ForestParkHospital

 World AIDS Day | Pregnancy & HIV — What Every Mother Should Know

Being pregnant while living with HIV is not the end of the story.

With today’s medical care, more than 98% of babies can be born HIV-negative if proper guidelines are followed.

Here is what truly saves lives 👇

✅ Key Guidelines for HIV-positive Pregnant Women:

🔹 Early HIV testing for every pregnant woman at the first ANC visit.

🔹 Immediate start of ART (antiretroviral therapy) once HIV is detected — regardless of CD4 count.

🔹 Strict daily medication adherence — missing doses increases the risk of transmission.

🔹 Regular viral load monitoring during pregnancy to ensure viral suppression.

🔹 Safe mode of delivery based on viral load and obstetric indications.

🔹 ARV prophylaxis for the newborn immediately after birth.

🔹 Safe infant feeding counselling according to national guidelines.

🔹 Continuous follow-up for both mother and baby after delivery.

With these simple but powerful steps:

➡️ Mother stays healthy

➡️ Baby stays HIV-negative

➡️ Family stays safe

To every pregnant woman living with HIV: You are not dangerous.

You are not weak.

You are a mother protecting her baby with courage and treatment.

Fear does not protect babies — science does.

Silence does not save lives — early testing does.

Stigma does not heal — treatment does.

On this World AIDS Day, we choose

 🩷 Knowledge over fear

🩷 Care over judgment

🩷 Treatment over stigma

Every pregnancy matters.

Every baby deserves a healthy beginning.

#DrRababCares

#WorldAIDSDay

#HIVInPregnancy

#PMTCT

#SafeMotherhood

#ANC

#ForestParkHospital

#EndHIVStigma

#WomenHealthMatters

 Honored to contribute to the ZAGO Scientific Congress with two presentations focused on preventing avoidable maternal deaths in low-resource settings:

🔹 The Role of Obstetric Ultrasound in Reducing Preventable Maternal Deaths in Zambia

🔹 Innovative Low-Cost Interventions for Managing Postpartum Hemorrhage to Reduce Preventable Maternal Deaths in Zambia

Grateful for the thoughtful engagement, rich discussions, and the opportunity to share practical, real-world solutions that can be implemented immediately on the ground.

My sincere thanks to the ZAGO organizing committee, the esteemed chairpersons, and all colleagues for an inspiring scientific atmosphere and meaningful exchange.

Together, we continue to work toward safer motherhood and better outcomes for every woman.

#DrRababCares 

#ZAGO2025 #MaternalHealth #PostpartumHemorrhage #ObstetricUltrasound #PreventableMaternalDeaths #WomenHealth #GlobalHealth #ForestParkHospital