ehealthyland.com » Problems during pregnancy

Pregnancy: Twins or More

lorvent — Sat, 04 Feb 2012 03:41:16 +0000

Twins are two offspring resulting from the same pregnancy, usually born in close succession. They can be the same or different sex. Twins can either be monozygotic (MZ, colloquially “identical”) or dizygotic (DZ, colloquially “fraternal” or “non-identical”).

Is this topic for you?
This topic is for women who are pregnant with more than one baby. It focuses on the questions that are specific to multiple pregnancies. For information on what to expect during pregnancy, labor, and childbirth, see the topic Pregnancy.
What is a multiple pregnancy?

A multiple pregnancy means that a woman has two or more babies in her uterus. These babies can come from the same egg or from different eggs.
Babies that come from the same egg are called identical. This happens when one egg is fertilized by one sperm. The fertilized egg then splits into two or more embryos. Experts think that this happens by chance. It isn’t related to your age, race, or family history.
If the babies you’re carrying are identical, they:
• Are either all boys or all girls.
• All have the same blood type.
• Probably will have the same body type and the same color skin, hair, and eyes. But they won’t always look exactly the same. They also won’t have the same fingerprints.
Babies that come from different eggs are called fraternal. This happens when two or more eggs are fertilized by different sperm. Fraternal babies tend to run in families. This means that if anyone in your family has had fraternal babies, you’re more likely to have them too.
If the babies you’re carrying are fraternal, they:
• Can be both boys and girls.
• Can have different blood types.
• May look different from each other or may look the same, as some brothers and sisters do.
See a picture of identical and fraternal babies in the uterus.
What causes a multiple pregnancy?

If you take fertility drugs or have in vitro fertilization to help you get pregnant, you’re more likely to have a multiple pregnancy.
Fertility drugs help your body make several eggs at a time. This increases the chance that more than one of your eggs will be fertilized.
In vitro fertilization is the most common kind of assisted reproductive technology used to help women get pregnant. Several of your eggs are mixed with sperm in a lab. When the eggs are fertilized, they’re put back inside your uterus. The doctor puts in several fertilized eggs to increase your chances of having a baby. But this also makes a multiple pregnancy more likely.
You’re also more likely to have more than one baby at a time if:
• You’re age 35 or older.
• You’re of African descent.
• You’ve had fraternal babies before.
• Anyone on your mom’s side of the family has had fraternal babies.
• You’ve just stopped using birth control pills.
What are the risks of a multiple pregnancy?

Any pregnancy has risks. But the chance of having serious problems increases with each baby you carry at the same time.
If you’re pregnant with more than one baby, you’re more likely to:
• Develop a problem that causes your blood pressure to get too high (preeclampsia).
• Develop a type of diabetes that can occur while you’re pregnant (gestational diabetes).
• Deliver your babies too early. When babies are born too early, their organs haven’t had a chance to fully form. This can cause serious lung, brain, heart, and eye problems.
• Have a miscarriage. This means that you may lose one or more of your babies.
There is also a greater chance that one or more of your babies may be born with a disease that is caused by a bad gene or group of genes. If you or anyone in your family has had a child with a disease that is linked to a gene change, let your doctor know. There are tests that you can have between 10 and 20 weeks of your pregnancy that can tell if your babies are at risk for certain genetic disorders or birth defects.
Keep in mind that these problems may or may not happen to you. Every day, women who are pregnant with more than one baby have healthy pregnancies and have healthy babies.
How can you tell if you’re carrying more than one baby?

While you may feel like you’re carrying more than one baby, only your doctor can say for sure. He or she will do a fetal ultrasound to find out. This test can give your doctor a clear picture of how many babies are in your uterus and how well they’re doing.
If the test shows that you’re carrying more than one baby, you’ll need to have more ultrasounds during your pregnancy. Your doctor will use these tests to check for any signs of problems that your babies may have as they grow.
What type of treatment will you need?

If you’re pregnant with more than one baby, you’ll need to see your doctor more often than you would if you were having just one baby. This is because you and your babies have a greater chance of developing serious health problems.
Your doctor will do a physical exam at each visit. It’s important that you go to every appointment. Your doctor may also do a fetal ultrasound, check your blood pressure, and test your blood and urine for any signs of problems. Early treatment can help you and your babies stay healthy.
You’re having multiples. Now what?

The thought of having more than one baby may be scary, but it doesn’t have to be. There are some simple things you can do to keep you and your babies healthy.
The best thing you can do is take care of yourself. The healthier you are, the healthier your babies will be.
While you’re pregnant, be sure to:
• Go to every doctor’s appointment.
• Eat a healthy diet. Take in plenty of calories from foods rich in folic acid, iron, and calcium. These nutrients are essential for the healthy growth of your babies. Breads, cereals, meats, milk, cheeses, fruits, and vegetables are all good choices. If you’re not able to eat enough because of severe morning sickness, call your doctor.
• Don’t smoke, drink alcohol, or use illegal drugs.
• Avoid caffeine.
• Avoid using any medicines, vitamins, or herbs unless your doctor says it’s okay.
• Talk to your doctor about what activities are okay for you to do while you’re pregnant.
• Get a lot of rest.
After your babies are born, you may feel overwhelmed and tired. You may wonder how you’re going to do it all. This is normal. Most new moms feel this way at one time or another.
Here are some things you can do to ease the stress:
• Ask your family and friends for help.
• Rest as often as you can.
• Join a support group for moms with multiples. This is a great place to share your concerns and hear how other moms cope with the demands of raising multiples.
• If you feel sad or depressed for more than 2 weeks, call your doctor.

Repair of Choanal Atresia

lorvent — Wed, 07 Dec 2011 15:42:45 +0000

Surgery Overview

Choanal atresia (say “KOH-uh-nul uh-TREE-zhuh”) is blockage by bone or tissue of the nasal passages (choana) leading from the back of the nose to the throat. The condition—present at birth in about 1 in 7,000 babies—makes it impossible to breathe through the nose. Choanal atresia is diagnosed at birth when both passages are blocked. If only one passage is blocked, the diagnosis may be made later, usually after you notice that mucus drains from only one of your baby’s nostrils.
Repair involves surgery to reopen the nasal passages. Your baby may have a computed tomography (CT) scan, a form of X-ray, before the repair to help the doctor confirm the diagnosis and plan the surgery.
Your baby will receive general anesthesia for the operation. The surgeon can choose one of two approaches: inserting instruments through the nostrils (transnasal) or making an incision in the roof of the mouth (transpalatal). The doctor chooses the approach based on several factors, including the anatomy of the nasal passages. The surgeon may prefer to operate through the nose when thin tissue blocks the nasal passages, and through the roof of the mouth when thick bone blocks them.
In both approaches, the doctor stitches tubes called nasal stents into the passages to keep them open. After 6 or more weeks, the doctor removes the stents.
What to Expect After Surgery

After surgery, your baby should be able to breathe normally and will be able to breast-feed or bottle-feed. Newborns stay in the hospital for a few days; older children having surgery on one side may go home after a day or two. Health professionals will teach you how to suction your baby’s nasal passages at home to keep the stents open until they can be removed. They also will have you watch for complications (such as infection or bleeding) and will tell you when to call if a problem develops.
After the stents are removed, the doctor may use a thin, lighted instrument (endoscope) to look into the nose to make sure the airways are open.
Why It Is Done

The surgery opens nasal passages to allow the baby to breathe. A newborn can only breathe through the nose (except when crying) in the first weeks of life.
How Well It Works

Surgery cures the problem. Most children need only one operation, but in some cases, the procedure may be repeated if the nasal passages close again.
Risks

The main risk of surgery to repair choanal atresia is needing another surgery if the airway does not stay open.
In general, children have a small risk of infection or bleeding. Any surgery involving general anesthesia carries a small amount of risk. Call the doctor if your child has bleeding, a fever of 100.5° F (38.1° C) , pus coming from the nose, or you are unable to keep the stents clear so your child can breathe.
On rare occasions, injury to the nasal passages and skull may occur during surgery.
What to Think About
Surgery may be delayed until the child is 2 or 3 years old if only one nasal passage is blocked.
The transnasal technique requires less operating time than the transpalatal approach, but the risk of the nasal passages closing later may be higher.

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Pregnancy Complications

lorvent — Fri, 02 Dec 2011 15:41:52 +0000

Many women face some minor health problems and pregnancy complications, but there are some women who unfortunately get faced with more serious complications during pregnancy. When these pregnancy complications occur, usually a visit to your healthcare provider is required. It’s very important to report any unusual pregnancy symptoms to them, so you can get checked out. Below are some common pregnancy complications and unusual pregnancy symptoms, and how to treat them.

Anemia – Complications During Pregnancy

One of the common pregnancy complications, this occurs when there is an insufficient amount of blood cells circulating in the mother’s blood. At some point in their pregnancy, many woman experience this pregnancy complication. Mild cases of anemia during pregnancy shouldn’t harm your baby. There are two common types of anemia during pregnancy. The first, called dilutional anemia, is an increase of circulating blood sometimes up to 40-50% in order to sustain the growing baby. The second type of anemia during pregnancy is iron deficiency anemia, which is when a woman’s iron-level is insufficient and red blood cells aren’t being made in a great enough level.

Treatment for Anemia During Pregnancy
If you are suffering from iron deficiency anemia, then you should be taking an iron supplement which will help with this pregnancy complication. In addition, there are iron-rich foods that are helpful for these pregnancy complications, such as baked potatoes, red meat, kidney beans, spinach, fish, chicken and pork, which will also aid in the replenishment of iron levels in your pregnant body. If you are unable to absorb iron into your bloodstream, IV or injectable iron supplementation may be required. Folic acid or vitamin B12 may also be taken as well.

High Blood Pressure (Hypertension) During Pregnancy

Chronic hypertension is when a woman’s blood pressure is elevated before pregnancy. Pregnancy-induced hypertension, however, is when a woman’s blood pressure is elevated only during pregnancy. About 8% of pregnancies result in pregnancy-induced hypertension, and usually develops anytime after 20 weeks. Generally speaking, pregnancy-induced hypertension occurs close to a woman’s due date, and will resolve itself after delivery of the baby.

Pre-eclampsia – Complications During Pregnancy

Pre-eclampsia during pregnancy is a syndrome that occurs only in pregnancy, and is characterized by high blood pressure, protein in the urine, and an increased swelling in the legs and feet. About 6-8% of pregnant women experience this pregnancy complication, close to 90% of those are first-time mothers. Many women don’t know they are suffering from pre-eclampsia during their pregnancy, and are told by their healthcare provider after their blood pressure is taken. Some of the symptoms of pre-eclampsia during pregnancy are persistent headaches, flashing light, blurred vision and seeing spots, upper abdominal pain and sudden excessive lower leg swelling. Read more on pre-eclampsia during pregnancy.

Treatment for Pre-eclampsia During Pregnancy
Since the cause of pre-eclampsia during pregnancy is unknown, accurate treatment for it remains unproven. Most healthcare providers and doctors will agree that birth is typically the only cure. If a woman is close to her due date, and is suffering from pre-eclampsia during pregnancy, her delivery may become induced, as suffering from these pregnancy complications is serious.

Eclampsia – Complications During Pregnancy

Eclampsia during pregnancy is a very rare, but serious pregnancy complication in which it’s developed as a result of a pregnant woman having pre-eclampsia. The major symptoms of eclampsia are seizures and coma, so diagnosing pre-eclampsia during pregnancy can be vital.

Treatment for Eclampsia During Pregnancy
Eclampsia is considered a medical emergency, and can be treated by giving the pregnant mother oxygen and drugs in order to prevent any further seizures from occurring. In addition, urgent delivery of the baby is necessary in order to treat the pregnant mother properly.

Other Pregnancy Complications
Aside from anemia, hypertension, pre-eclampsia and eclampsia during pregnancy, there are other forms of pregnancy complications that a pregnant woman can experience. Uterine problems such as fibroids can occur. Fibroids are benign growths on the uterus and are more common in older woman than younger women. Bowel problems such as anal fissure, hemorrhoids and a few others can also occur. Digestive problems, infections, and joint issues are also types of pregnancy complications that can occur.

All in all, no matter what the pregnancy complication is, it should be reported to your healthcare physician, so that they may check you out and ensure that the pregnancy complications you are experiencing aren’t putting your pregnant body or you baby in any danger.

If Complications of pregnancy are health problems that occur during pregnancy. They can involve the mother’s health, the baby’s health, or both. Some women have health problems before they become pregnant that could lead to complications. Other problems arise during the pregnancy. Keep in mind that whether a complication is common or rare, there are ways to manage problems that come up during pregnancy.
Health Problems Before Pregnancy
If you have an ongoing health problem, make sure to talk to your doctor before pregnancy. Your doctor might want to change the way your health problem is managed. Some medicines used to treat health problems could be harmful if taken during pregnancy. At the same time, stopping medicines that you need could be more harmful then the risks posed should you become pregnant. Be assured that you are likely to have a normal, healthy baby when health problems are under control and you g
you have an ongoing health problem, make sure to talk to your doctor before pregnancy. Your doctor might want to change the way your health problem is managed. Some medicines used to treat health problems could be harmful if taken during pregnancy. At the same time, stopping medicines that you need could be more harmful then the risks posed should you become pregnant. Be assured that you are likely to have a normal, healthy baby when health problems are under control and you get good prenatal care.
Health Problems Before Pregnancy
Condition How it can affect pregnancy Where to learn more
Asthma
Poorly controlled asthma may increase risk of preeclampsia, poor weight gain in the fetus, preterm birth, cesarean birth, and other complications.
• Lung Diseases FAQ

Depression
Depression that persists during pregnancy can make it hard for a woman to care for herself and her unborn baby. Having depression before pregnancy also is a risk factor for postpartum depression.
• Depression FAQ
• Depression During and After Pregnancy FAQ

Diabetes
High blood glucose (sugar) levels during pregnancy can harm the fetus and worsen a woman’s long-term diabetes complications. Doctors advise getting diabetes under control at least 3 to 6 months before trying to conceive. • Diabetes FAQ

Eating disorders
Body image changes during pregnancy can cause eating disorders to worsen. Eating disorders are linked to many pregnancy complications, including birth defects and premature birth. Women with eating disorders also have higher rates of postpartum depression.
• Anorexia Nervosa FAQ
• Bulimia Nervosa FAQ

Epilepsy and other seizure disorders Seizures during pregnancy can harm the fetus, and increase the risk of miscarriage or stillbirth. But using medicine to control seizures might cause birth defects. For most pregnant women with epilepsy, using medicine poses less risk to their own health and the health of their babies than stopping medicine. • About Epilepsy

High blood pressure
Having chronic high blood pressure puts a pregnant woman and her baby at risk for problems. Women with high blood pressure have a higher risk of preeclampsia and placental abruption (when the placenta separates from the wall of the uterus). The likelihood of preterm birth and low birth weight also is higher. • National High Blood Pressure Education Program

HIV
HIV can be passed from a woman to her baby during pregnancy or delivery. Some HIV medicines can lower the chances of HIV being passed to the baby. But the effects of some medicines on the fetus are not clear or not known. Good prenatal care will help protect a woman’s baby from HIV and keep her healthy. • Women and HIV/AIDS

Migraine
Migraine symptoms tend to improve during pregnancy. Some women have no migraine attacks during pregnancy. Certain medicines commonly used to treat headaches should not be used during pregnancy. A woman who has severe headaches should speak to her doctor about ways to relieve symptoms safely. • Migraine FAQ

Overweight and Obesity
Recent studies suggest that the heavier a woman is before she becomes pregnant, the greater her risk of a range of pregnancy complications, including preeclampsia and preterm delivery. Overweight and obese women who lose weight before pregnancy are likely to have healthier pregnancies. • Overweight, Obesity, and Weight Loss FAQ

Sexually transmitted infections (STIs) Some STIs can cause early labor, a woman’s water to break too early, and infection in the uterus after birth. Some STIs also can be passed from a woman to her baby during pregnancy or delivery. Some ways STIs can harm the baby include: low birth weight, dangerous infections, brain damage, blindness, deafness, liver problems, or stillbirth.
• Sexually Transmitted Infections FAQ

Thyroid diseaseUncontrolled hyperthyroidism (overactive thyroid) can be dangerous to the mother and cause health problems such as heart failure and poor weight gain in the fetus. Uncontrolled hypothyroidism (underactive thyroid) also threatens the mother’s health and can lead to intellectual disabilities in the baby. • Graves’ Disease FAQ
• Hashimoto’s Thyroiditis FAQ

Uterine fibroids
Uterine fibroids are not uncommon, but few cause symptoms that require treatment. Uterine fibroids rarely cause miscarriage. Sometimes, fibroids can cause preterm or breech birth. Cesarean delivery may be needed if a fibroid blocks the birth canal. • Uterine Fibroids FAQ

Pregnancy Related Problems

Sometimes pregnancy problems arise — even in healthy women. Some prenatal tests done during pregnancy can help prevent these problems or spot them early. Use this chart to learn about some common pregnancy complications. Call your doctor if you have any of the symptoms on this chart. If a problem is found, make sure to follow your doctor’s advice about treatment. Doing so will boost your chances of having a safe delivery and a strong, healthy baby.
Health Problems During Pregnancy
Problem Symptoms Treatment
Anemia – Lower than normal number of healthy red blood cells • Feel tired or weak
• Look pale
• Feel faint
• Shortness of breath Treating the underlying cause of the anemia will help restore the number of healthy red blood cells. Women with pregnancy related anemia are helped by taking iron and folic acid supplements. Your doctor will check your iron levels throughout pregnancy to be sure anemia does not happen again.
Depression – Extreme sadness during pregnancy or after birth (postpartum) • Intense sadness
• Helplessness and irritability
• Appetite changes
• Thoughts of harming self or baby Women who are pregnant might be helped with one or a combination of treatment options, including:
• Therapy
• Support groups
• Medicines
A mother’s depression can affect her baby’s development, so getting treatment is important for both mother and baby.
Ectopic (ek-TOP-ihk) pregnancy – When a fertilized egg implants outside of the uterus, usually in the fallopian tube
• Abdominal pain
• Shoulder pain
• Vaginal bleeding
• Feeling dizzy or faint With ectopic pregnancy, the egg cannot develop. Drugs or surgery is used to remove the ectopic tissue so your organs are not damaged.
Fetal problems – Unborn baby has a health issue, such as poor growth or heart problems • Baby moving less
• Baby is smaller than normal for gestational age
• Fewer than 10 kicks per day after 26 weeks
• Some problems have no symptoms, but are found with prenatal tests Treatment depends on results of tests to monitor baby’s health. If a test suggests a problem, this does not always mean the baby is in trouble. It may only mean that the mother needs special care until the baby is delivered. This can include a wide variety of things, such as bed rest, depending on the mother’s condition. Sometimes, the baby has to be delivered early.
Gestational diabetes – Too high blood sugar levels during pregnancy • Usually, there are no symptoms. Sometimes, extreme thirst, hunger, or fatigue
• Screening test shows high blood sugar levels Most women with pregnancy related diabetes can control their blood sugar levels by a following a healthy meal plan from their doctor. Some women also need insulin to keep blood sugar levels under control. Doing so is important because poorly controlled diabetes increases the risk of:
• Preeclampsia
• Early delivery
• Cesearean birth
• Having a big baby, which can complicate delivery
• Baby born with low blood sugar, breathing problems, and jaundice

High blood pressure (pregnancy related) – High blood pressure that starts after 20 weeks of pregnancy and goes away after birth • High blood pressure without other signs and symptoms of preeclampsia
The health of the mother and baby are closely watched to make sure high blood pressure is not preeclampsia.
Hyperemesis gravidarum (HEYE-pur-EM-uh-suhss grav-uh-DAR-uhm) (HG) – Severe, persistent nausea and vomiting during pregnancy — more extreme than “morning sickness” • Nausea that does not go away
• Vomiting several times every day
• Weight loss
• Reduced appetite
• Dehydration
• Feeling faint or fainting Dry, bland foods and fluids is the first line of treatment. Sometimes, medicines are prescribed to help nausea. Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins. Usually, women with HG begin to feel better by the 20th week of pregnancy. But some women vomit and feel nauseated throughout all three trimesters.
Miscarriage – Pregnancy loss from natural causes before 20 weeks. As many as 20 percent of pregnancies end in miscarriage. Often, miscarriage occurs before a woman even knows she is pregnant Signs of a miscarriage can include:
• Vaginal spotting or bleeding*
• Cramping or abdominal pain
• Fluid or tissue passing from the vagina
*Spotting early in pregnancy doesn’t mean miscarriage is certain. Still, contact your doctor right away if you have any bleeding. In most cases, miscarriage cannot be prevented. Sometimes, a woman must undergo treatment to remove pregnancy tissue in the uterus. Counseling can help with emotional healing. See our section on Pregnancy Loss.

Placenta previa – Placenta covers part or entire opening of cervix inside of the uterus
• Painless vaginal bleeding during second or third trimester
• For some, no symptoms If diagnosed after the 20th week of pregnancy, but with no bleeding, a woman will need to cut back on her activity level and increase bed rest. If bleeding is heavy, hospitalization may be needed until mother and baby are stable. If the bleeding stops or is light, continued bed rest is resumed until baby is ready for delivery. If bleeding doesn’t stop or if preterm labor starts, baby will be delivered by cesarean.

Placental abruption – Placenta separates from uterine wall before delivery, which can mean the fetus doesn’t get enough oxygen. • Vaginal bleeding
• Cramping, abdominal pain, and uterine tenderness When the separation is minor, bed rest for a few days usually stops the bleeding. Moderate cases may require complete bed rest. Severe cases (when more than half of the placenta separates) can require immediate medical attention and early delivery of the baby.
Preeclampsia (pree-ee-CLAMP-see-uh) – A condition starting after 20 weeks of pregnancy that causes high blood pressure and problems with the kidneys and other organs. Also called toxemia. • High blood pressure
• Swelling of hands and face
• Too much protein in urine
• Stomach pain
• Blurred vision
• Dizziness
• Headaches The only cure is delivery, which may not be best for the baby. Labor will probably be induced if condition is mild and the woman is near term (37 to 40 weeks of pregnancy). If it is too early to deliver, the doctor will watch the health of the mother and her baby very closely. She may need medicines and bed rest at home or in the hospital to lower her blood pressure. Medicines also might be used to prevent the mother from having seizures.

Preterm labor – Going into labor before 37 weeks of pregnancy • Increased vaginal discharge
• Pelvic pressure and cramping
• Back pain radiating to the abdomen
• Contractions
Medicines can stop labor from progressing. Bed rest is often advised. Sometimes, a woman must deliver early. Giving birth before 37 weeks is called “preterm birth.”

Infections During Pregnancy

During pregnancy, your baby is protected from many illnesses, like the common cold or a passing stomach bug. But some infections can be harmful to your pregnancy, your baby, or both. This chart provides an overview of infections that can be harmful during pregnancy. Learn the symptoms and what you can do to keep healthy. Easy steps, such as hand washing, practicing safe sex, and avoiding certain foods, can help protect you from some infections.
Infections During Pregnancy
Infection Symptoms Prevention and treatment
Bacterial vaginosis (BV)
A vaginal infection that is caused by an overgrowth of bacteria normally found in the vagina.
BV has been linked to preterm birth and low-birth-weight babies.
• Grey or whitish discharge that has a foul, fishy odor
• Burning when passing urine or itching
• Some women have no symptoms How to prevent BV is unclear. BV is not passed through sexual contact, although it is linked with having a new or more than one sex partner.
Women with symptoms should be tested for BV.
Antibiotics are used to treat BV.
Cytomegalovirus (SEYE-toh-MEG-uh-loh VEYE-ruhss) (CMV)
A common virus that can cause disease in infants whose mothers are infected with CMV during pregnancy. CMV infection in infants can lead to hearing loss, vision loss, and other disabilities. • Mild illness that may include fever, sore throat, fatigue, and swollen glands
• Some women have no symptoms Good hygiene is the best way to keep from getting CMV.
No treatment is currently available. But studies are looking at antiviral drugs for use in infants. Work to create a CMV vaccine also is underway.
Group B strep (GBS)
Group B strep is a type of bacteria often found in the vagina and rectum of healthy women. One in 4 women has it. GBS usually is not harmful to you, but can be deadly to your baby if passed during childbirth. No symptoms You can keep from passing GBS to your baby by getting tested at 35 to 37 weeks. This simply involves swabbing the vagina and rectum and does not hurt.
If you have GBS, an antibiotic given to you during labor will protect your baby from infection. Make sure to tell the labor and delivery staff that you are a group B strep carrier when you check into the hospital.
Hepatitis B virus (HBV)
A viral infection that can be passed to baby during birth. Newborns that get infected have a 90 percent chance of developing lifelong infection. This can lead to liver damage and liver cancer. There may be no symptoms. Or symptoms can include:
• Nausea, vomiting, and diarrhea
• Dark urine and pale bowel movements
• Whites of eyes or skin looks yellow Lab tests can find out if the mother is a carrier of hepatitis B.
You can protect your baby for life from HBV with the hepatitis B vaccine, which is a series of 3 shots:
• First dose of hepatitis B vaccine plus HBIG shot given to baby at birth
• Second dose of hepatitis B vaccine given to baby at 1-2 months old
• Third dose of hepatitis B vaccine given to baby at 6 months old (but not before 24 weeks old)
Listeriosis (lih-steer-ee-OH-suhss)
An infection with the harmful bacteria called listeria. It is found in some refrigerated and ready-to-eat foods. Infection can cause early delivery or miscarriage.
• Fever, muscle aches, chills
• Sometimes diarrhea or nausea
• If progresses, severe headache and stiff neck Avoid foods that can harbor listeria.
Antibiotics are used to treat listeriosis.
Learn more from our Pregnancy Food Don’ts – Print-and-Go Guide (PDF file, 119 Kb).
Parvovirus B19 (fifth disease)
Most pregnant women who are infected with this virus do not have serious problems. But there is a small chance the virus can infect the fetus. This raises the risk of miscarriage during the first 20 weeks of pregnancy. Fifth disease can cause severe anemia in women who have red blood cell disorders like sickle-cell disease or immune system problems. • Low-grade fever
• Tiredness
• Rash on face, trunk, and limbs
• Painful and swollen joints No specific treatment, except for blood transfusions that might be needed for people who have problems with their immune systems or with red blood cell disorders. There is no vaccine to help prevent infection with this virus.
Sexually transmitted infection (STI)
An infection that is passed through sexual contact. Many STIs can be passed to the baby in the womb or during birth. Some effects include stillbirth, low birth weight, and life-threatening infections. STIs also can cause a woman’s water to break too early or preterm labor.
• Symptoms depend on the STI. Often, a woman has no symptoms, which is why screening for STIs during pregnancy is so important.
• For more information, see our Sexually Transmitted Infections Overview FAQ.
STIs can be prevented by practicing safe sex. A woman can keep from passing an STI to her baby by being screened early in pregnancy.
Treatments vary depending on the STI. Many STIs are treated easily with antibiotics.

Toxoplasmosis (TOK-soh-plaz-MOH-suhss)
This infection is caused by a parasite, which is found in cat feces, soil, and raw or undercooked meat. If passed to an unborn baby, the infection can cause hearing loss, blindness, or intellectual disabilities. Mild flu-like symptoms, or possibly no symptoms. You can lower your risk by:
• Washing hands with soap after touching soil or raw meat
• Washing produce before eating
• Cooking meat completely
• Washing cooking utensils with hot, soapy water
• Not cleaning cats’ litter boxes
Medicines are used to treat a pregnant woman and her unborn baby. Sometimes, the baby is treated with medicine after birth.
Urinary tract infection (UTI)
Bacterial infection in urinary tract. If untreated, it can spread to the kidneys, which can cause preterm labor.
• Pain or burning when urinating
• Frequent urination
• Pelvis, back, stomach, or side pain
• Shaking, chills, fever, sweats UTIs are treated with antibiotics.

Yeast infection
An infection caused by an overgrowth of bacteria normally found in the vagina. Yeast infections are more common during pregnancy than in other times of a woman’s life. They do not threaten the health of your baby. But they can be uncomfortable and difficult to treat in pregnancy. • Extreme itchiness in and around the vagina
• Burning, redness, and swelling of the vagina and the vulva
• Pain when passing urine or during sex
• A thick, white vaginal discharge that looks like cottage cheese and does not have a bad smell Vaginal creams and suppositories are used to treat yeast infection during pregnancy.

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chart with the common complications of prenatal period

Alcohol effects on fetus

lorvent — Wed, 07 Sep 2011 15:42:14 +0000

What effect does alcohol have on a fetus?

A woman who drinks alcohol while she is pregnant may harm her developing baby (fetus). Alcohol can pass from the mother’s blood into the baby’s blood. It can damage and affect the growth of the baby’s cells. Brain and spinal cord cells are most likely to have damage.
The term “fetal alcohol spectrum disorder” (FASD) describes the range of alcohol effects on a child. The problems range from mild to severe. Alcohol can cause a child to have physical or mental problems that may last all of his or her life.
The effects of alcohol can include:
• Odd facial features. A child may have a small head, flat face, and narrow eye openings. It may be hard to pick out one trait. But in general, a child’s head and face just don’t look right. This gets more obvious by age 2 or 3.
• Growth problems. Children who were exposed to alcohol before they were born may be smaller than other children of the same age.
• Learning and behavior problems.
• Birth defects. Problems can occur that involve parts of the body such as the eyes, ears, heart, bones, or urinary tract.
Heavy alcohol use during pregnancy can also lead to miscarriage, stillbirth, or a baby being born early.
How much alcohol is safe?

When a pregnant woman drinks alcohol, so does her baby. Heavy drinking (5 or more drinks on at least one occasion) during pregnancy can severely affect a developing baby. Studies do not yet show if it is safe for a pregnant woman to drink a small amount of alcohol. People react to alcohol in different ways, so no one can really say for sure how much alcohol (if any) is safe.
Although the risk is higher with heavy alcohol use, any amount of alcohol may affect your developing baby. You can prevent FASD by not drinking at all while you are pregnant. Many doctors suggest just that.
The effects that alcohol has on a developing baby depend on:
• How much, how often, and at what stage of pregnancy the mother drinks alcohol. The worst effects often are related to heavy alcohol use (5 or more drinks on at least one occasion).
• Whether the mother used other drugs, smoked, or had poor health for any reason while she was pregnant. In these cases, the child is more likely to have problems.
• Traits passed down through families. Some babies are more likely to be harmed by alcohol than others. It’s not clear why, but there may be a genetic link.
What can you do if you’re pregnant and have had alcohol?

Try to talk openly with your doctor if you have had alcohol while you’re pregnant. The earlier you tell your doctor, the better the chances for your child.
If your doctor knows to look for FASD-related problems while you’re pregnant, he or she can watch your baby’s health both before and after birth. And the doctor will know to do more tests, if needed, as your child grows.
If you think you might have a drinking problem, talk with your doctor, counselor, or other support person. Doing this can help you to see and address how alcohol may affect many parts of your life, including your pregnancy. For more information, see the Interactive Tool: Do You Have a Drinking Problem?
The child’s father as well as friends and family members all can help the pregnant woman avoid alcohol and seek help if needed.
When are alcohol effects on a fetus diagnosed?
Signs of FASD don’t always appear at birth. A doctor may be able to spot severe alcohol effects [fetal alcohol syndrome (FAS), fetal alcohol effects (FAE)]in the child at birth. But less severe effects, such as behavior or learning problems, may not be noticed until the child is in school.
Signs and Symptoms
If you adopted a child or consumed alcohol during pregnancy and are concerned that your child may have FAS, watch for characteristics of the syndrome, which include:
• low birth weight
• small head circumference
• failure to thrive
• developmental delay
• organ dysfunction
• facial abnormalities, including smaller eye openings, flattened cheekbones, and indistinct philtrum (an underdeveloped groove between the nose and the upper lip)
• epilepsy
• poor coordination/fine motor skills
• poor socialization skills, such as difficulty building and maintaining friendships and relating to groups
• lack of imagination or curiosity
• learning difficulties, including poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem-solving skills
• behavioral problems, including hyperactivity, inability to concentrate, social withdrawal, stubbornness, impulsiveness, and anxiety
Children with FAE display the same symptoms, but to a lesser degree.
Sometimes the doctor can find severe problems before the baby is born. If your doctor knows about your alcohol use, he or she can order a test (ultrasound) to look for signs of FAS in your baby, such as heart defects or growth delays. The cause of problems that are found during the test may not be clear. But the findings alert the doctor to any special care a baby may need after he or she is born.
Prevention Is the Key

FAS can be completely prevented by not drinking any alcohol during pregnancy.
What is the treatment for a child born with alcohol effects?

Caring for a child born with alcohol effects takes patience. Help for the child may include extra support in school, social skills training, job training, and counseling. Community services may be able to help your family with the costs of and emotions from raising your child.
Finding the problem early, even if the alcohol effects are mild, gives a child the best chance to reach his or her full potential in life. It may help prevent problems in school and mental health problems, such as substance abuse, depression, or anxiety.

Incoming search terms:

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effect of alcohol on unborn babies
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FASD features
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Toxoplasmosis

lorvent — Mon, 05 Sep 2011 03:41:19 +0000

What is toxoplasmosis?

Toxoplasmosis is a common infection found in birds, animals, and people.
For most people, it doesn’t cause serious health problems. But for a pregnant woman’s growing baby, it can cause brain damage and vision loss. Still, the chance of a pregnant woman getting the infection and passing it on to her baby is low.
If you’re pregnant or planning to have a baby and are worried that you may have toxoplasmosis, ask your doctor about getting tested. After you have had the infection, you can’t get it again or pass it on to your baby. You’re immune. Your body has learned how to fight it off. You don’t have to worry about passing the infection to your baby.
But if you aren’t immune, you’ll want to take special care while you’re pregnant. Avoid touching or eating anything that may be infected, such as infected meat and infected cat feces.
What causes toxoplasmosis?

A tiny germ called a parasite causes toxoplasmosis.
You can get the infection by:
• Eating infected meat that hasn’t been fully cooked or frozen.
• Changing an infected cat’s litter box. Cats infected with the parasite pass it on to others through their feces.
• Digging or gardening in sand or soil where an infected cat has left feces.
• Eating anything that has touched infected cat feces, including fruits and vegetables that haven’t been washed. You can also get the infection by eating food that has touched tables and counters your cat has walked on.
What are the symptoms?
If you get toxoplasmosis, you may feel like you have the flu, or you may not feel sick at all. Most people who get the infection don’t even know that they have it.
In healthy people, the infection often goes away on its own. But babies and people whose bodies don’t fight infection well need to take medicine to treat the infection and prevent serious health problems.
How is toxoplasmosis diagnosed?

A blood test can tell whether you have or have ever had toxoplasmosis. If you’re worried about getting the infection, ask your doctor about having the test.
If you get the infection while you’re pregnant, you’ll need to have your baby tested. Your doctor can take some fluid from the sac that surrounds your baby and check for the infection.
How is it treated?
If you get toxoplasmosis while you’re pregnant, you’ll take medicine that treats the infection. This medicine is called an antibiotic.
This medicine may:
• Keep your baby from getting the infection.
• Lower your baby’s chance of having serious health problems if he or she does get it.
Your baby has a better chance of being healthy at birth if you get treatment while you’re pregnant.
If your baby has the infection, he or she will also need to take antibiotics for a year after birth. This lowers the chance of having problems later on.
How can you prevent toxoplasmosis during pregnancy?

There are several things you can do to avoid getting toxoplasmosis:
• If you have a cat or are caring for one, ask someone to clean or empty the litter box while you’re pregnant. Wash tables and counters well if a cat may have walked on them. If you have to clean the cat’s litter box, wear gloves and a face mask. Be sure to wash your hands after you’re done.
• Eat only meat that has been fully cooked or frozen. Avoid dried meats, such as beef jerky.
• Avoid contact with cat feces in your garden. If you touch soil, be sure to wear gloves and wash your hands after you’re done.
• Wash fruits and vegetables before you eat them.
• Wash your hands and anything you use to prepare raw meat, chicken, fish, fruits, or vegetables.

Incoming search terms:

toxoplasmosis si Tomas

Rh Sensitization during Pregnancy

lorvent — Sun, 04 Sep 2011 15:44:16 +0000

What is Rh sensitization during pregnancy?

If you are Rh-negative, your red blood cells do not have a marker called Rh factor on them. Rh-positive blood does have this marker. If your blood mixes with Rh-positive blood, your immune system will react to the Rh factor by making antibodies to destroy it. This immune system response is called Rh sensitization.
What causes Rh sensitization during pregnancy?

Rh sensitization can occur during pregnancy if you are Rh-negative and pregnant with a baby (fetus) who has Rh-positive blood. In most cases, your blood will not mix with your baby’s blood until delivery. It takes a while to make antibodies that can affect the baby, so during your first pregnancy, the baby probably would not be affected.
But if you get pregnant again with an Rh-positive baby, the antibodies already in your blood could attack the baby’s red blood cells. This can cause the baby to have anemia, jaundice, or more serious problems. This is called Rh disease. The problems will tend to get worse with each Rh-positive pregnancy you have.
During your first pregnancy, your baby could be at risk for Rh disease if you were sensitized before or during pregnancy. This can happen if:
• You had a previous miscarriage, abortion, or ectopic pregnancy and you did not receive Rh immune globulin to prevent sensitization.
• You had a serious injury to your belly during pregnancy.
• You had a medical test such as an amniocentesis or chorionic villus sampling while you were pregnant, and you did not receive Rh immune globulin. These tests could let your blood and your baby’s blood mix.
Rh sensitization is one reason it’s important to see your doctor in the first trimester of pregnancy. It doesn’t cause any warning symptoms, and a blood test is the only way to know you have it or are at risk for it.
• If you are at risk, Rh sensitization can almost always be prevented.
• If you are already sensitized, treatment can help protect your baby.
Who gets Rh sensitization during pregnancy?
Rh sensitization during pregnancy can only happen if a woman has Rh-negative blood and only if her baby has Rh-positive blood.
• If the mother is Rh-negative and the father is Rh-positive, there is a good chance the baby will have Rh-positive blood. Rh sensitization can occur.
• If both parents have Rh-negative blood, the baby will have Rh-negative blood. Since the mother’s blood and the baby’s blood match, sensitization will not occur.
If you have Rh-negative blood, your doctor will probably treat you as though the baby’s blood is Rh-positive no matter what the father’s blood type is, just to be on the safe side.
How is Rh sensitization diagnosed?

All pregnant women get a blood test at their first prenatal visit during early pregnancy. This test will show if you have Rh-negative blood and if you are Rh-sensitized.
If you have Rh-negative blood but are not sensitized:
• The blood test may be repeated between 24 and 28 weeks of pregnancy. If the test still shows that you are not sensitized, you probably will not need another antibody test until delivery. (You might need to have the test again if you have an amniocentesis, if your pregnancy goes beyond 40 weeks, or if you have a problem such as placenta abruptio, which could cause bleeding in the uterus.)
• Your baby will have a blood test at birth. If the newborn has Rh-positive blood, you will have an antibody test to see if you were sensitized during late pregnancy or childbirth.
If you are Rh-sensitized, your doctor will watch your pregnancy carefully. You may have:
• Regular blood tests, to check the level of antibodies in your blood.
• Doppler ultrasound, to check blood flow to the baby’s brain. This can show anemia and how severe it is.
• Amniocentesis after 15 weeks, to check the baby’s blood type and Rh factor and to look for problems.
How is Rh sensitization prevented?

If you have Rh-negative blood but are not Rh-sensitized, your doctor will give you one or more shots of Rh immune globulin (such as RhoGAM). This prevents Rh sensitization in about 99 women out of 100 who use it.1
You may get a shot of Rh immune globulin:
• If you have a test such as an amniocentesis.
• Around week 28 of your pregnancy.
• After delivery if your newborn is Rh-positive.
The shots only work for a short time, so you will need to repeat this treatment each time you get pregnant. (To prevent sensitization in future pregnancies, Rh immune globulin is also given when an Rh-negative woman has a miscarriage, abortion, or ectopic pregnancy.)
The shots won’t work if you are already Rh-sensitized.
How is it treated?
If you are Rh-sensitized, you will have regular testing to see how your baby is doing. You may also need to see a doctor who specializes in high-risk pregnancies (a perinatologist).
Treatment of the baby is based on how severe the loss of red blood cells (anemia) is.
• If the baby’s anemia is mild, you will just have more testing than usual while you are pregnant. The baby may not need any special treatment after birth.
• If anemia is getting worse, it may be safest to deliver the baby early. After delivery, some babies need a blood transfusion or treatment for jaundice.
• For severe anemia, a baby can have a blood transfusion while still in the uterus. This can help keep the baby healthy until he or she is mature enough to be delivered. You will most likely have an early C-section, and the baby may need to have another blood transfusion right after birth.
In the past, Rh sensitization was often deadly for the baby. But improved testing and treatment mean that now most babies with Rh disease survive and do well after birth.
Cause
Rh sensitization can occur when a person with Rh-negative blood is exposed to Rh-positive blood. About 90% of women who become sensitized do so during childbirth, when their blood mixes with the Rh-positive blood of their fetus.1 Once exposed, a mother’s immune system produces antibodies against Rh-positive red blood cells. For more information about events and procedures that can put you at high risk for Rh sensitization, see the What Increases Your Risk section of this topic.
The minimum amount of blood mixing necessary to cause sensitization is not known. But many women become sensitized during pregnancy or childbirth after being exposed to as little as 0.1 mL of Rh-positive fetal blood.1 Fortunately, Rh sensitization can almost always be prevented with the Rh immune globulin injection.
When an Rh-negative person’s immune system is first exposed to Rh-positive blood, it takes several weeks to develop immunoglobulin M, or IgM, antibodies. IgM antibodies are too large to cross the placenta. So the Rh-positive fetus that first triggers maternal sensitization is usually not harmed.
A previously Rh-sensitized immune system rapidly reacts to Rh-positive blood, as during a second pregnancy with an Rh-positive fetus. Usually within hours of Rh-positive blood exposure, smaller immunoglobulin G, or IgG, antibodies are formed. IgG antibodies can cross the placenta and destroy fetal red blood cells. This causes Rh disease, which is dangerous for the fetus.
Some Rh-negative people never become sensitized, even after exposure to large amounts of Rh-positive blood. The reason for this is not known.
Symptoms

If you are already Rh-sensitized or become Rh-sensitized while pregnant, you will not have any unusual symptoms.
Fetal problems from Rh sensitization are detected with Doppler ultrasound testing and sometimes with amniocenteses. It is possible, however, that a fetus with severe Rh disease will move less frequently than it did earlier in the pregnancy.
Other conditions with symptoms similar to Rh sensitization include other blood type incompatibility problems and fetal infections.
What Happens
If you are Rh-negative
Unless you are given Rh immune globulin just before or after a high-risk event, such as miscarriage, amniocentesis, abortion, ectopic pregnancy, or childbirth, you have a chance of becoming sensitized to an Rh-positive fetus’s blood.
If you have been Rh-sensitized in the past
If you have been Rh-sensitized in the past, you must be closely monitored during any pregnancy with an Rh-positive partner because your fetus is more likely to have Rh-positive blood. In response to an Rh-positive fetus, your immune system may quickly develop IgG antibodies, which can cross the placenta and destroy fetal red blood cells. Each subsequent pregnancy with an Rh-positive fetus may produce more serious problems for the fetus. The resulting fetal disease (called Rh disease, hemolytic disease of the newborn, or erythroblastosis fetalis) can be mild to severe.
• Mild Rh disease involves limited destruction of fetal red blood cells, possibly resulting in mild fetal anemia. The fetus can usually be carried to term and requires no special treatment but may have problems with jaundice after birth. Mild Rh disease is more likely to develop in the first pregnancy after sensitization has occurred.
• Moderate Rh disease involves the destruction of larger numbers of fetal red blood cells. The fetus may develop an enlarged liver and may become moderately anemic. The fetus may need to be delivered before term and may require a blood transfusion before (while in the uterus) or after birth. A newborn with moderate Rh disease is watched closely for jaundice.
• Severe Rh disease (fetal hydrops) involves widespread destruction of fetal red blood cells. The fetus develops severe anemia, liver and spleen enlargement, increased bilirubin levels, and fluid retention (edema). The fetus may need one or more blood transfusions before birth. A fetus with severe Rh disease who survives the pregnancy may need a blood exchange. This procedure replaces most of the infant’s blood with donor blood (usually type O, Rh-negative).
• A history of pregnancy with Rh disease is a sign that you will need special treatment when you are pregnant with an Rh-positive fetus.
If you have been Rh-sensitized in the past, an Rh-negative fetus cannot trigger an immune reaction.
What Increases Your Risk
Rh sensitization can occur when a person with Rh-negative blood is exposed to Rh-positive blood. During pregnancy, an Rh-negative woman can become sensitized if she is carrying an Rh-positive fetus.
Factors that increase the risk of blood mixing and sensitization during pregnancy include:
• Delivery.
• Abdominal trauma, such as from a car accident.
• Abdominal surgery, such as a cesarean section.
• Placenta abruptio or placenta previa, both of which can cause placental bleeding.
• External cephalic version for a breech fetus.
• Obstetric procedures such as amniocentesis, fetal blood sampling, or chorionic villus sampling (CVS).
• Miscarriage (spontaneous abortion), ectopic pregnancy, or elective abortion (medical or surgical abortion) after 8 weeks of fetal age (when fetal blood cell production begins).
• Partial molar pregnancy involving fetal growth beyond 8 weeks.
Although rare, Rh sensitization has been known to occur after needle sharing between intravenous drug users. Transfusing Rh-positive blood in an Rh-negative person can also trigger sensitization. But this is extremely rare because blood is always tested prior to transfusion.
When To Call a Doctor

If you are already Rh-sensitized and are pregnant
Your pregnancy will be closely monitored. Discuss possible symptoms early in pregnancy with your health professional. Repeated diagnostic testing will be necessary to monitor the fetus.
Call your health professional immediately if you note a decrease in your fetus’s movement after 24 to 26 weeks of pregnancy.
If you are Rh-negative
Call your health professional immediately if you:
• Think you may have been pregnant and miscarried.
• Are pregnant and have had an accident that may have injured your abdomen.
Regular prenatal visits are essential. You will need an Rh immune globulin shot at 24 to 28 weeks and again after delivery if your baby has Rh-positive blood. This is the only way you can prevent Rh sensitization.
Watchful Waiting
Watchful waiting is not appropriate for Rh sensitization. It is important to keep all prenatal appointments so that your developing fetus can be closely monitored throughout your pregnancy.
Who To See
A woman who may have problems with Rh incompatibilitiy or sensitization can be treated by:
• A family medicine doctor, for mild fetal Rh disease.
• An obstetrician, for mild to moderate Rh disease.
• A perinatologist, for moderate to severe fetal Rh disease (hydrops).
If you test positive for Rh sensitization, your health care system or health professional may want you to be followed and treated by a perinatologist or an obstetrician who can easily call in a perinatologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests

If you are pregnant, you will have your first prenatal tests during your first trimester. At your first prenatal visit, every woman has her blood tested to see what her blood type is. If your blood is Rh-negative, it will also be tested for antibodies to Rh-positive blood. If you have antibodies, that means that you have been sensitized to Rh-positive blood. The antibodies can now kill Rh-positive red blood cells.
If you are Rh-negative and your partner is Rh-positive, your fetus is likely to be Rh-positive.
If you are pregnant or have miscarried, or if you have had an elective abortion, a partial molar pregnancy, or an ectopic pregnancy, you will need testing to see if you have been sensitized to Rh-positive blood.
If you are Rh-negative
All pregnant women have an indirect Coombs’ test during early pregnancy.
• At the first prenatal visit, your blood is tested to see if you have been previously sensitized to Rh-positive blood. If you are Rh-negative and test results show that you are not sensitized, a repeat test may be done between 24 and 28 weeks.
• If test results at 28 weeks show that you have not been sensitized, no additional tests for Rh-related problems are done until delivery (barring complications such as placenta abruptio). You will also have a shot of Rh immune globulin. This lowers your chances of being sensitized during the last weeks of your pregnancy.
• If your newborn is found to be Rh-positive, your blood will be screened again at delivery with an indirect Coombs’ test to see if you have been sensitized during late pregnancy or childbirth. If you have not been sensitized, you will have another shot of Rh immune globulin.
If you are sensitized to the Rh factor
If you are already Rh-sensitized or become sensitized while pregnant, close monitoring is important to determine whether your fetus is being harmed.
• If possible, the father will be tested to see if the fetus could be Rh-positive. If the father is Rh-negative, the fetus is Rh-negative and is not in danger. If the father is Rh-positive, amniocentesis will probably be used to learn the fetus’s blood type. In some medical centers, the mother’s blood can be tested to learn her fetus’s blood type. This is a new test that is not widely available.
• An indirect Coombs’ test is done periodically during your pregnancy to see if your Rh-positive antibody levels are increasing. This is the typical course of treatment for most sensitized women during pregnancy.
• Fetal Doppler ultrasound of blood flow in the brain shows fetal anemia and how bad it is. At a medical center with Doppler experts, this test can give you the same anemia information as amniocentesis, without the risks.
• Amniocentesis may be done:
o At or after 15 weeks to check amniotic fluid for signs of fetal problems.
o To learn the fetal blood type and Rh factor.
o On a repeated basis to check fetal anemia. This tells how much a fetus is being affected by sensitization.
• Fetal blood sampling (cordocentesis) may be done to directly assess your fetus’s health. This procedure is used on a limited basis, usually for monitoring known sensitization problems (as when a mother has had previous fetal deaths, or when other testing has shown signs of fetal distress).
• Electronic fetal heart monitoring (nonstress test) may be done in the third trimester to check your fetus’s condition. Unusual fetal heart rhythms detected during a nonstress test may be a sign that the fetus has anemia related to the sensitization.
• Fetal ultrasound testing can be used as a pregnancy progresses to detect sensitization problems, such as fetal fluid retention (a sign of severe Rh disease).
Early Detection
Early prenatal Rh blood typing and testing for Rh sensitization is necessary to ensure that every vulnerable fetus can be properly monitored and treated.
Treatment
If you are sensitized to the Rh factor
If your blood is Rh-negative and you have been sensitized to Rh-positive blood, you now have antibodies to Rh-positive blood. The antibodies kill Rh-positive red blood cells. If you become pregnant with an Rh-positive baby (fetus), the antibodies can destroy your fetus’s red blood cells. This can cause anemia.
If you are already Rh-sensitized and are pregnant, your treatment will focus on preventing or minimizing fetal harm and on avoiding early (preterm) delivery.
Treatment options depend on how well or poorly the fetus is doing.
• If testing shows that your fetus is Rh-positive but is only mildly affected by your Rh factor antibodies, you will be closely monitored until your pregnancy reaches term. Your fetus will be delivered early only if his or her condition worsens.
• If testing shows that your fetus is moderately affected by your Rh antibodies, your fetus’s condition will be closely monitored until his or her lungs are mature enough for a preterm delivery. A cesarean section may be used to deliver the baby quickly or to avoid the difficulty of inducing labor before term. A moderately affected newborn sometimes requires a blood transfusion immediately after birth.
• If testing shows that your fetus is severely affected by your Rh factor antibodies, a blood transfusion may be given before birth (intrauterine fetal blood transfusion). This can be done through the fetus’s abdomen or directly into the fetus’s umbilical cord. A preterm delivery is likely to be needed. Multiple blood transfusions are sometimes needed to keep a fetus healthy until the fetal lungs mature enough to function after birth. Often a cesarean section is done to deliver the baby quickly. A blood transfusion is sometimes needed immediately after birth.
Prevention
If you are Rh-negative and pregnant
If you are an Rh-negative woman and you have conceived with an Rh-negative partner, you are not at risk of Rh sensitization during pregnancy. (Most health professionals treat all Rh-negative pregnant women as though the father might be Rh-positive.)
If you are already sensitized to the Rh factor, your pregnancy will need to be closely monitored to prevent fetal harm. For more information on fetal and newborn treatment, see the Treatment Overview section of this topic.
If you are unsensitized Rh-negative, treatment focuses on preventing Rh sensitization during pregnancy and childbirth. Rh immune globulin (such as RhoGAM) is a highly effective treatment for preventing sensitization.
• To prevent sensitization from occurring late in the pregnancy or during delivery, you must have a shot of Rh immune globulin around week 28 of your pregnancy. This treatment prevents your immune system from making antibodies against your fetus’s Rh-positive red blood cells.
• Rh immune globulin injection is also necessary if you have had any vaginal bleeding or an obstetric procedure such as amniocentesis or external cephalic version.
• If your newborn is Rh-positive, you are given Rh immune globulin again within 72 hours of delivery. By preventing Rh sensitization from delivery, you are protecting your next Rh-positive fetus.
• If your newborn is Rh-negative, sensitization cannot happen, and no treatment is necessary.
Rh immune globulin is also necessary after a miscarriage, partial molar pregnancy, ectopic pregnancy, or abortion.
Home Treatment
There is no home treatment for Rh sensitization.
Medications
Use of Rh immune globulin is 99.8% effective in preventing Rh sensitization. Rh immune globulin contains Rh antibodies that have been purified from human donors. This treatment prevents an unsensitized Rh-negative mother from making antibodies against her fetus’s Rh-positive blood.
If an affected fetus younger than 34 weeks needs to be delivered, corticosteroid medicine (betamethasone or dexamethasone) may be given to the mother to speed fetal lung development before a premature birth.
Surgery
There is no surgical treatment for Rh sensitization during pregnancy.
Other Treatment
An intrauterine fetal blood transfusion is sometimes used to supply healthy blood to a fetus with severe hemolytic disease of the newborn (also called Rh disease or erythroblastosis fetalis).
A newborn blood transfusion or exchange transfusion is sometimes given to treat severe anemia or jaundice related to Rh disease.

high blood pressure and preeclampsia during pregnancy

lorvent — Sun, 04 Sep 2011 03:41:48 +0000

What are high blood pressure and preeclampsia?
Blood pressure is a measure of how hard your blood pushes against the walls of your arteries. If the force is too hard, you have high blood pressure (also called hypertension). When high blood pressure starts after 20 weeks of pregnancy, it may be a sign of a very serious problem called preeclampsia.
Blood pressure is shown as two numbers. The top number (systolic) is the pressure when the heart pumps blood. The bottom number (diastolic) is the pressure when the heart relaxes and fills with blood. Blood pressure is high if the top number is more than 140 millimeters of mercury (mm Hg), or if the bottom number is more than 90 mm Hg. For example, blood pressure of 150/85 (say “150 over 85″) or 140/95 is high. Or both numbers can be high, such as 150/95.
A woman may have high blood pressure before she gets pregnant. Or her blood pressure may start to go up during pregnancy.
If you have high blood pressure during pregnancy, you need to have checkups more often than women who do not have this problem. There is no way to know if you will get preeclampsia. This is one of the reasons that you are watched closely during your pregnancy.
High blood pressure and preeclampsia are related, but they have some differences.
High blood pressure

Normally, a woman’s blood pressure drops during her second trimester. Then it returns to normal by the end of the pregnancy. But in some women, blood pressure goes up very high in the second or third trimester. This is sometimes called gestational hypertension and can lead to preeclampsia. You will need to have your blood pressure checked often and you may need treatment. Usually, the problem goes away after the baby is born.
High blood pressure that started before pregnancy usually doesn’t go away after the baby is born.
A small rise in blood pressure may not be a problem. But your doctor will watch your pressure to make sure it does not get too high. The doctor also will check you for preeclampsia.
Very high blood pressure keeps your baby from getting enough blood and oxygen. This could limit your baby’s growth or cause the placenta to pull away too soon from the uterus. High blood pressure also could lead to stillbirth.
Preeclampsia

Preeclampsia is a pregnancy-related problem. The symptoms of preeclampsia include new high blood pressure after 20 weeks of pregnancy along with other problems, such as protein in your urine. Preeclampsia usually goes away after you give birth. In rare cases, blood pressure can stay high for up to 6 weeks after the birth.
Preeclampsia can be deadly for the mother and baby. It can keep the baby from getting enough blood and oxygen. It also can harm the mother’s liver, kidneys, and brain. Women with very bad preeclampsia can have dangerous seizures. This is called eclampsia.
What causes preeclampsia and high blood pressure during pregnancy?
Experts don’t know the exact cause of preeclampsia and high blood pressure during pregnancy. But they have some ideas about preeclampsia:
• Preeclampsia seems to start because the placenta doesn’t grow the usual network of blood vessels deep in the wall of the uterus. This leads to poor blood flow in the placenta.
• Preeclampsia may run in families. If your mother had preeclampsia while she was pregnant with you, you have a higher chance of getting it during pregnancy. You also have a higher chance of getting it if the mother of your baby’s father had preeclampsia.
• The mother’s immune system may react to the father’s sperm, the placenta, or the baby.
• Already having high blood pressure when you get pregnant raises your chance of getting preeclampsia.
• Problems that can lead to high blood pressure, such as obesity, polycystic ovary syndrome, and diabetes, could raise your risk of preeclampsia.
What are the symptoms?
. The severity of pre-eclampsia (High Blood Pressure in Pregnancy) is usually (but not always) related to the blood pressure level. You may have no symptoms at first, or if you have only mildly raised blood pressure and a small amount of leaked protein in your urine. The signs of preeclampsia are elevated blood pressure (hypertension) and the presence of excess protein in your urine (proteinuria) after 20 weeks of pregnancy. The excess protein is related to problems with your kidneys. Your doctor may identify these signs of preeclampsia at one of your regular prenatal visits.
High blood pressure and protein in urine are two main symptoms and signs of pre-eclamsia. Other signs and symptoms of preeclampsia — which can develop gradually or strike suddenly, often in the last few weeks of pregnancy — may include:
Proteinuria
Sudden Weight Gain
Headache
Nausea or Vomiting
Changes in Vision, blurred vision
Racing pulse, mental confusion, heightened anxiety, trouble catching your breath
Abdominal (tummy) stomach pain. The pain that occurs with pre-eclampsia (High Blood Pressure in Pregnancy) tends to be mainly in the upper part of the abdomen, just under the ribs.
Lower back pain
Hyperreflexia
Swelling or puffiness of your feet, face, or hands (oedema) is also a symptom of pre-eclampsia (High Blood Pressure in Pregnancy). However, this is common in normal pregnancy. Most women with this symptom do not have pre-eclampsia (High Blood Pressure in Pregnancy), but it can become worse in pre-eclampsia (High Blood Pressure in Pregnancy). Therefore, report any sudden worsening of swelling of the hands, face or feet promptly to your doctor or midwife.

Regular checks may be all that you need if pre-eclampsia (High Blood Pressure in Pregnancy) remains relatively mild. If pre-eclampsia (High Blood Pressure in Pregnancy) becomes worse, you are likely to be admitted to hospital. Tests may be done to check on your well-being, and that of your baby. For example, blood tests to check on the function of your liver and kidneys. Also, an ultrasound scan is usual to see how well your baby is growing.
How are high blood pressure and preeclampsia diagnosed?

High blood pressure and preeclampsia are usually found during a prenatal visit. This is one reason why it’s so important to go to all of your prenatal visits. You need to have your blood pressure checked often. During these visits, your blood pressure is measured with a blood pressure cuff. A sudden increase in blood pressure often is the first sign of a problem.
You also will have a urine test to look for protein, another sign of preeclampsia.
If you have high blood pressure, tell your doctor right away if you have a headache or belly pain. These signs of preeclampsia can occur before protein shows up in your urine.
How are they treated?

Your doctor may have you take medicine if he or she thinks your blood pressure is too high.
The only cure for preeclampsia is having the baby. You may get medicines to lower your blood pressure and to prevent seizures. You also may get medicine to help your baby’s lungs get ready for birth. Your doctor will try to deliver your baby when the baby has grown enough to be ready for birth. But sometimes a baby has to be delivered early to protect the health of the mother or the baby. If this happens, your baby will get special care for premature babies.
Do preeclampsia and high blood pressure lead to long-term high blood pressure?
If you have high blood pressure during pregnancy but had normal blood pressure before pregnancy, your pressure is likely to go back to normal after you have the baby. But if you had high blood pressure before pregnancy, you probably will still have it after you give birth.
Experts don’t think preeclampsia causes high blood pressure later in life. But women who get preeclampsia may have a higher-than-normal chance of getting high blood pressure after pregnancy or later in life.

placenta previa

lorvent — Fri, 02 Sep 2011 15:41:39 +0000

What is placenta previa?
If you have placenta previa, it means that your placenta is lying unusually low in your uterus, next to or covering your cervix. The placenta is the pancake-shaped organ — normally located near the top of the uterus — that supplies your baby with nutrients through the umbilical cord.

Placenta previa is not usually a problem early in pregnancy. But if it persists into later pregnancy, it can cause bleeding, which may require you to deliver early and can lead to other complications. If you have placenta previa when it’s time to deliver your baby, you’ll need to have a c-section.

If the placenta covers the cervix completely, it’s called a complete or total previa. If it’s right on the border of the cervix, it’s called a marginal previa. (You may also hear the term “partial previa,” which refers to a placenta that covers part of the cervical opening once the cervix starts to dilate.) If the edge of the placenta is within 2 centimeters of the cervix but not bordering it, it’s called a low-lying placenta. The location of your placenta will be checked during your midpregnancy ultrasound exam.

Causes
During pregnancy, the placenta moves as the uterus stretches and grows. In early pregnancy, a low-lying placenta is very common. But as the pregnancy progresses, the growing uterus should “pull” the placenta toward the top of the womb. By the third trimester, the placenta should be near the top of the uterus, leaving the opening of the cervix clear for the delivery.
Sometimes, though, the placenta remains in the lower portion of the uterus, partly or completely covering this opening. This is called a previa.
There are different forms of placenta previa:
• Marginal: The placenta is against the cervix but does not cover the opening.
• Partial: The placenta covers part of the cervical opening.
• Complete: The placenta completely covers the cervical opening.

Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have:
• Abnormally developed uterus
• Many previous pregnancies
• Multiple pregnancy (twins, triplets, etc.)
• Scarring of the uterine wall caused by previous pregnancies, cesareans, uterine surgery, or abortions
Women who smoke or have their children at an older age may also have an increased risk. Possible causes of placenta previa include:

• Abnormal formation of the placenta
• Abnormal uterus
• Large placenta
• Scarred lining of the uterus (endometrium)
Symptoms

The main symptom of placenta previa is sudden, painless vaginal bleeding that often occurs near the end of the second trimester or beginning of the third trimester. In some cases, there is severe bleeding, or hemorrhage. The bleeding may stop on its own but can start again days or weeks later.
There may be uterine cramping with the bleeding. Labor sometimes starts within several days after heavy vaginal bleeding. However, in some cases, bleeding may not occur until after labor starts.
See: Vaginal bleeding in pregnancy
Exams and Tests

Your health care provider can diagnose placenta previa with an ultrasound exam. Most cases of placenta previa are identified by routine ultrasound during pregnancy.
Treatment
Treatment depends on various factors:
• How much bleeding you had
• Whether the baby is developed enough to survive outside the uterus
• How much of the placenta is covering the cervix
• The position of the baby
• The number of previous births you have had
• Whether you are in labor
Many times the placenta moves away from the cervical opening before delivery.
If the placenta is near the cervix or is covering a portion of it, you may need to reduce activities and stay on bed rest. Your doctor will order pelvic rest, which means no intercourse, no tampons, and no douching. Nothing should be placed in the vagina.
If there is bleeding, however, you will most likely be admitted to a hospital for careful monitoring.
If you have lost a lot of blood, blood transfusions may be given. You may receive medicines to prevent premature labor and help the pregnancy continue to at least 36 weeks. Beyond 36 weeks, delivery of the baby may be the best treatment.
If your blood type is Rh-negative, you will be given anti-D immunoglobulin injections.
Your health care providers will carefully weigh your risk of ongoing bleeding against the risk of an early delivery for your baby.
Women with placenta previa most likely need to deliver the baby by cesarean section. This helps prevent death to the mother and baby. An emergency c-section may be done if the placenta actually covers the cervix and the bleeding is heavy or very life threatening.
Outlook (Prognosis)
Placenta previa is most often diagnosed before bleeding occurs. Careful monitoring of the mother and unborn baby can prevent many of the significant dangers.
The biggest risk is that severe bleeding will require your baby to be delivered early, before major organs, such as the lungs, have developed.
Most complications can be avoided by hospitalizing a mother who is having symptoms, and delivering by C-section.
Who’s most at risk for placenta previa?

Most women who develop placenta previa have no apparent risk factors. But if any of the following apply to you, you’re more likely to have this complication:

• You had placenta previa in a previous pregnancy.

• You’re pregnant with twins or higher-order multiples.

• You’ve had c-sections before. (The more c-sections you’ve had, the higher the risk.)

• You’ve had some other uterine surgery (such as a D&C or fibroid removal).

• You’re a cigarette smoker.

• You use cocaine.

Also, the more babies you’ve had and the older you are, the higher your risk.

Possible Complications
Risks to the mother include:
• Death
• Major bleeding (hemorrhage)
• Shock
There is also an increased risk for infection, blood clots, and necessary blood transfusions.
Prematurity (infant is less than 36 weeks gestation) causes most infant deaths in cases of placenta previa. The baby may lose blood if the placenta separates from the wall of the uterus during labor. The baby also can lose blood when the uterus is opened during a C-section delivery.
When to Contact a Medical Professional

Call your health care provider if you have bleeding from the vagina at any point in your pregnancy. Placenta previa can be dangerous to both you and your baby.
Prevention
This condition is not preventable.

Incoming search terms:

placenta previa marginal

Gestational diabetes

lorvent — Fri, 02 Sep 2011 03:42:18 +0000

What is gestational diabetes?

Gestational diabetes is diabetes that is found for the first time when a woman is pregnant.
Gestational (jes-TAY-shun-ul) diabetes is diabetes that is found for the first time when a woman is pregnant. Out of every 100 pregnant women in the United States, three to eight get gestational diabetes. Diabetes means that your blood glucose (also called blood sugar) is too high. Your body uses glucose for energy. But too much glucose in your blood can be harmful. When you are pregnant, too much glucose is not good for your baby.
This booklet is for women with gestational diabetes. If you have type 1 or type 2 diabetes and are considering pregnancy, call the National Diabetes Information Clearinghouse at 1–800–860–8747 for more information and consult your health care team before you get pregnant.
What causes gestational diabetes?

Changing hormones and weight gain are part of a healthy pregnancy. But both changes make it hard for your body to keep up with its need for a hormone called insulin. When that happens, your body doesn’t get the energy it needs from the food you eat.
What is my risk of gestational diabetes?
To learn your risk for gestational diabetes, check each item that applies to you. Talk with your doctor about your risk at your first prenatal visit.
o I have a parent, brother, or sister with diabetes.
o I am African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander.
o I am 25 years old or older.
o I am overweight.
o I have had gestational diabetes before, or I have given birth to at least one baby weighing more than 9 pounds.
o I have been told that I have “pre-diabetes,” a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes. Other names for it are “impaired glucose tolerance” and “impaired fasting glucose.”
If you checked any of these risk factors, ask your health care team about testing for gestational diabetes.
• You are at high risk if you are very overweight, have had gestational diabetes before, have a strong family history of diabetes, or have glucose in your urine.
• You are at average risk if you checked one or more of the risk factors.
• You are at low risk if you did not check any of the risk factors.
When will I be checked for gestational diabetes?
Your doctor will decide when you need to be checked for diabetes depending on your risk factors.
• If you are at high risk, your blood glucose level may be checked at your first prenatal visit. If your test results are normal, you will be checked again sometime between weeks 24 and 28 of your pregnancy.
• If you have an average risk for gestational diabetes, you will be tested sometime between weeks 24 and 28 of pregnancy.
• If you are at low risk, your doctor may decide that you do not need to be checked.
How is gestational diabetes diagnosed?

Your health care team will check your blood glucose level. Depending on your risk and your test results, you may have one or more of the following tests.
Fasting blood glucose or random blood glucose test

Your doctor may check your blood glucose level using a test called a fasting blood glucose test. Before this test, your doctor will ask you to fast, which means having nothing to eat or drink except water for at least 8 hours. Or your doctor may check your blood glucose at any time during the day. This is called a random blood glucose test.
These tests can find gestational diabetes in some women, but other tests are needed to be sure diabetes is not missed.

Your health care provider will check your blood glucose level to see if you have gestational diabetes.
Screening glucose challenge test

For this test, you will drink a sugary beverage and have your blood glucose level checked an hour later. This test can be done at any time of the day. If the results are above normal, you may need further tests.
Oral glucose tolerance test

If you have this test, your health care provider will give you special instructions to follow. For at least 3 days before the test, you should eat normally. Then you will fast for at least 8 hours before the test.
The health care team will check your blood glucose level before the test. Then you will drink a sugary beverage. The staff will check your blood glucose levels 1 hour, 2 hours, and 3 hours later. If your levels are above normal at least twice during the test, you have gestational diabetes.
Above-normal results for the oral glucose tolerance test*
Fasting 95 or higher
At 1 hour 180 or higher
At 2 hours 155 or higher
At 3 hours 140 or higher
Note: Some labs use other numbers for this test.
*These numbers are for a test using a drink with 100 grams of glucose.
How will gestational diabetes affect my baby?

Untreated or uncontrolled gestational diabetes can mean problems for your baby, such as
• being born very large and with extra fat; this can make delivery difficult and more dangerous for your baby
• low blood glucose right after birth
• breathing problems
If you have gestational diabetes, your health care team may recommend some extra tests to check on your baby, such as
• an ultrasound exam, to see how your baby is growing
• “kick counts” to check your baby’s activity (the time between the baby’s movements) or special “stress” tests
Working closely with your health care team will help you give birth to a healthy baby.
Both you and your baby are at increased risk for type 2 diabetes for the rest of your lives.
How will gestational diabetes affect me?

Often, women with gestational diabetes have no symptoms. However, gestational diabetes may
• increase your risk of high blood pressure during pregnancy
• increase your risk of a large baby and the need for cesarean section at delivery
The good news is your gestational diabetes will probably go away after your baby is born. However, you will be more likely to get type 2 diabetes later in your life. (See the information on how to lower your chances of getting type 2 diabetes.) You may also get gestational diabetes again if you get pregnant again.
Some women wonder whether breastfeeding is OK after they have had gestational diabetes. Breastfeeding is recommended for most babies, including those whose mothers had gestational diabetes.
Gestational diabetes is serious, even if you have no symptoms. Taking care of yourself helps keep your baby healthy.
How is gestational diabetes treated?
Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. You will learn how to control your blood glucose using

Using a meal plan will help keep your blood glucose in your target range.
• a meal plan
• physical activity
• insulin (if needed)
Meal Plan

You will talk with a dietitian or a diabetes educator who will design a meal plan to help you choose foods that are healthy for you and your baby. Using a meal plan will help keep your blood glucose in your target range. The plan will provide guidelines on which foods to eat, how much to eat, and when to eat. Choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.
You may be advised to
• limit sweets
• eat three small meals and one to three snacks every day
• be careful about when and how much carbohydrate-rich food you eat; your meal plan will tell you when to eat carbohydrates and how much to eat at each meal and snack
• include fiber in your meals in the form of fruits, vegetables, and whole-grain crackers, cereals, and bread
For more about meal planning, call the National Diabetes Information Clearinghouse for a copy of What I need to know about Eating and Diabetes.

Physical activity can help you reach your blood glucose targets.
Physical Activity

Physical activity, such as walking and swimming, can help you reach your blood glucose targets. Talk with your health care team about the type of activity that is best for you. If you are already active, tell your health care team what you do.
Insulin

Some women with gestational diabetes need insulin, in addition to a meal plan and physical activity, to reach their blood glucose targets. If necessary, your health care team will show you how to give yourself insulin. Insulin is not harmful for your baby. It cannot move from your bloodstream to the baby’s.
How will I know whether my blood glucose levels are on target?

Your health care team may ask you to use a small device called a blood glucose meter to check your levels on your own. You will learn

Each time you check your blood glucose, write down the results.
• how to use the meter
• how to prick your finger to obtain a drop of blood
• what your target range is
• when to check your blood glucose
You may be asked to check your blood glucose
• when you wake up
• just before meals
• 1 or 2 hours after breakfast
• 1 or 2 hours after lunch
• 1 or 2 hours after dinner
The following chart shows blood glucose targets for most women with gestational diabetes. Talk with your health care team about whether these targets are right for you.
Blood glucose targets for most women with gestational diabetes
On awakening not above 95
1 hour after a meal not above 140
2 hours after a meal not above 120
Each time you check your blood glucose, write down the results in a record book. Take the book with you when you visit your health care team. If your results are often out of range, your health care team will suggest ways you can reach your targets.

Will I need to do other tests on my own?
Your health care team may teach you how to test for ketones (KEE-tones) in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.
If your ketone levels are high, your health care providers may suggest that you change the type or amount of food you eat. Or you may need to change your meal times or snack times.
After I have my baby, how can I find out whether my diabetes is gone?
You will probably have a blood glucose test 6 to 12 weeks after your baby is born to see whether you still have diabetes. For most women, gestational diabetes goes away after pregnancy. You are, however, at risk of having gestational diabetes during future pregnancies or getting type 2 diabetes later.
How can I prevent or delay getting type 2 diabetes later in life?

After you have your baby, you can do a lot to prevent or delay type 2 diabetes.
You can do a lot to prevent or delay type 2 diabetes.
• Reach and maintain a reasonable weight. Even if you stay above your ideal weight, losing 5 to 7 percent of your body weight is enough to make a big difference. For example, if you weigh 200 pounds, losing 10 to 14 pounds can greatly reduce your chance of getting diabetes.
• Be physically active for 30 minutes most days. Walk, swim, exercise, or go dancing.
• Follow a healthy eating plan. Eat more grains, fruits, and vegetables. Cut down on fat and calories. A dietitian can help you design a meal plan.
Remind your health care team to check your blood glucose levels regularly. Women who have had gestational diabetes should continue to be tested for diabetes or pre-diabetes every 1 to 2 years. Diagnosing diabetes or pre-diabetes early can help prevent complications such as heart disease later.
Your child’s risk for type 2 diabetes may be lower if you breastfeed your baby and if your child maintains a healthy weight

Ectopic pregnancy

lorvent — Sun, 28 Aug 2011 03:44:29 +0000

Ectopic means “out of place.” In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes in more than 95% of ectopic pregnancies. This is why ectopic pregnancies are commonly called “tubal pregnancies.” The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies.
None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother’s life. A classical ectopic pregnancy does not develop into a live birth.
Alternative Names
Tubal pregnancy; cervical pregnancy; abdominal pregnancy
Signs and Symptoms
Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination.
The first warning signs of an ectopic pregnancy are often pain or vaginal bleeding. You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis and come and go or vary in intensity.
Any of the following additional symptoms can also suggest an ectopic pregnancy:
• vaginal spotting
• dizziness or fainting (caused by blood loss)
• low blood pressure (also caused by blood loss)
• lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy results from a fertilized egg’s inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube might have partially or entirely blocked it. Pelvic inflammatory disease (PID), which can be caused by gonorrhea or chlamydia, is a common cause of blockage of the fallopian tube.
Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg’s progress.
Diagnosis

If you arrive in the emergency department complaining of abdominal pain, you’ll likely be given a urine pregnancy test. Although these tests aren’t sophisticated, they are fast — and speed can be crucial in treating ectopic pregnancy.
If you already know you’re pregnant, or if the urine test comes back positive, you’ll probably be given a quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin (hCG), which is produced by the placenta and appears in the blood and urine as early as 8 to 10 days after conception. Its levels double every 2 days for the first several weeks of pregnancy, so if hCG levels are lower than expected for your stage of pregnancy, one possible explanation might be an ectopic pregnancy.
You’ll probably also get an ultrasound examination, which can show whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area. But the ultrasound might not be able to detect every ectopic pregnancy. The doctor may also give you a pelvic exam to locate the areas causing pain, to check for an enlarged, pregnant uterus, or to find any masses.
Even with the best equipment, it’s hard to see a pregnancy less than 5 weeks after the last menstrual period. If your doctor can’t diagnose ectopic pregnancy but can’t rule it out, he or she may ask you to return every 2 or 3 days to measure your hCG levels. If these levels don’t rise as quickly as they should, the doctor will continue to monitor you carefully until an ultrasound can show where the pregnancy is.
Options for Treatment

Treatment of an ectopic pregnancy varies, depending on how medically stable the woman is and the size and location of the pregnancy.
An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which stops the growth of the embryo.
If the pregnancy is further along, you’ll likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring a large incision across the pelvic area. This might still be necessary in cases of emergency or extensive internal injury.
However, the pregnancy may sometimes be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The image from the camera is shown on a screen in the operating room, allowing the surgeon to see what’s going on inside of your body without making large incisions. The ectopic pregnancy is then surgically removed and any damaged organs are repaired or removed.
Whatever your treatment, the doctor will want to see you regularly afterward to make sure your hCG levels return to zero. This may take several weeks. An elevated hCG could mean that some ectopic tissue was missed. This tissue may have to be removed using methotrexate or additional surgery.
What About Future Pregnancies?
Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of the damage that was done.
The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.
Who’s at Risk for an Ectopic Pregnancy?
While any woman can have an ectopic pregnancy, the risk is highest for women who are over 35 and have had:
• PID
• a previous ectopic pregnancy
• surgery on a fallopian tube
• infertility problems or medication to stimulate ovulation
Some birth control methods can also affect your risk of ectopic pregnancy. If you get pregnant while using progesterone-only oral contraceptives, progesterone intrauterine devices (IUDs), or the morning-after pill, you might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increases the risk of an ectopic pregnancy.
When to Call Your Doctor
If you believe you’re at risk for an ectopic pregnancy, meet with your doctor to discuss your options before you become pregnant. You can help protect yourself against a future ectopic pregnancy by not smoking and by always using condoms when you’re having sex but not trying to get pregnant. Condoms can protect against sexually transmitted infections (STDs) that can cause PID.
If you are pregnant and have any concerns about the pregnancy being ectopic, talk to your doctor — it’s important to make sure it’s detected early. You and your doctor might want to plan on checking your hormone levels or scheduling an early ultrasound to ensure that your pregnancy is developing normally.
Call your doctor immediately if you’re pregnant and experiencing any pain, bleeding, or other symptoms of ectopic pregnancy. When it comes to detecting an ectopic pregnancy, the sooner it is found, the better.
Prevention
Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. However, a tubal pregnancy (the most common type of ectopic pregnancy) may be prevented in some cases by avoiding conditions that might scar the fallopian tubes.
The following may reduce your risk:
• Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex without a condom, and getting sexually transmitted diseases (STDs)
• Early diagnosis and treatment of STDs
• Early diagnosis and treatment of salpingitis and PID