There are many known causes of infertility. Some are more absolute than others. For example, if a woman has blocked fallopian tubes, or a man has a very low sperm count or motility, then we know the cause of the couples infertility problem (or at least one of the causes). However, there are other fertility issues that are difficult to characterize as "the problem" - but we know that often they are at least factors contributing to the infertility.
What are the symptoms of endometriosis?
Pain is one of the most common symptoms of endometriosis. Usually the pain is in the abdomen, lower back, and pelvis. The amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small growths.
The days following the birth of your baby, which is called the postpartum period, is one of the most challenging times for moms and families. This time can be even more challenging for a mom who has undergone a cesarean delivery. After all deliveries, mom needs to take time to allow her body to rest and heal, which means no housework or running after other little ones. The maternal mortality rate is the highest in the postpartum period, so special attention needs to be given to taking care of mom. If you are a single mom or your partner has to return to work right away, try to set up a support team before the birth of your child for this postpartum period. This can be done with help from family, church members, new mom support groups or a postpartum doula.
Ultrasound scan is currently considered to be a safe, non-invasive, accurate and cost-effective investigation in the fetus. It has progressively become an indispensible obstetric tool and plays an important role in the care of every pregnant woman.
1. Diagnosis and confirmation of early pregnancy.
The gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured by about five and a half weeks. Ultrasound can also very importantly confirm the site of the pregnancy is within the cavity of the uterus.
2. Vaginal bleeding in early pregnancy.
The viability of the fetus can be documented in the presence of vaginal bleeding in early pregnancy. A visible heartbeat could be seen and detectable by pulsed doppler ultrasound by about 6 weeks and is usually clearly depictable by 7 weeks. If this is observed, the probability of a continued pregnancy is better than 95 percent. Missed abortions and blighted ovum will usually give typical pictures of a deformed gestational sac and absence of fetal poles or heart beat.
Fetal heart rate tends to vary with gestational age in the very early parts of pregnancy. Normal heart rate at 6 weeks is around 90-110 beats per minute (bpm) and at 9 weeks is 140-170 bpm. At 5-8 weeks a bradycardia (less than 90 bpm) is associated with a high risk of miscarriage.
Many women do not ovulate at around day 14, so findings after a single scan should always be interpreted with caution. The diagnosis of missed abortion is usually made by serial ultrasound scans demonstrating lack of gestational development. For example, if ultrasound scan demonstrates a 7mm embryo but cannot demonstrable a clearcut heartbeat, a missed abortion may be diagnosed. In such cases, it is reasonable to repeat the ultrasound scan in 7-10 days to avoid any error.
The timing of a positive pregnancy test may also be helpful in this regard to assess the possible dates of conception. A positive pregnancy test 3 weeks previously for example, would indicate a gestational age of at least 7 weeks. Such information would be useful against the interpretation of the scans. Please read the FAQs for more comments.
In the presence of first trimester bleeding, ultrasonography is also indispensible in the early diagnosis of ectopic pregnancies and molar pregnancies.
3. Determination of gestational age and assessment of fetal size.
Fetal body measurements reflect the gestational age of the fetus. This is particularly true in early gestation. In patients with uncertain last menstrual periods, such measurements must be made as early as possible in pregnancy to arrive at a correct dating for the patient. See FAQ. In the latter part of pregnancy measuring body parameters will allow assessment of the size and growth of the fetus and will greatly assist in the diagnosis and management of intrauterine growth retardation (IUGR).
The following measurements are usually made:
a) The Crown-rump length (CRL)
This measurement can be made between 7 to 13 weeks and gives very accurate estimation of the gestational age. Dating with the CRL can be within 3-4 days of the last menstrual period. (Table) An important point to note is that when the due date has been set by an accurately measured CRL, it should not be changed by a subsequent scan. For example, if another scan done 6 or 8 weeks later says that one should have a new due date which is further away, one should not normally change the date but should rather interpret the finding as that the baby is not growing at the expected rate.
b) The Biparietal diameter (BPD)
The diameter between the 2 sides of the head. This is measured after 13 weeks. It increases from about 2.4 cm at 13 weeks to about 9.5 cm at term. Different babies of the same weight can have different head size, therefore dating in the later part of pregnancy is generally considered unreliable. (Chart and further comments) Dating using the BPD should be done as early as is feasible.
c) The Femur length (FL)
Measures the longest bone in the body and reflects the longitudinal growth of the fetus. Its usefulness is similar to the BPD. It increases from about 1.5 cm at 14 weeks to about 7.8 cm at term. (Chart and further comments) Similar to the BPD, dating using the FL should be done as early as is feasible.
d) The Abdominal circumference (AC)
The single most important measurement to make in late pregnancy. It reflects more of fetal size and weight rather than age. Serial measurements are useful in monitoring growth of the fetus. (Chart and further comments) AC measurements should not be used for dating a fetus.
Other important measurements are discussed here.
The weight of the fetus at any gestation can also be estimated with great accuracy using polynomial equations containing the BPD, FL, and AC. computer softwares and lookup charts are readily available. For example, a BPD of 9.0 cm and an AC of 30.0 cm will give a weight estimate of 2.85 kg. (comments)
4. Diagnosis of fetal malformation.
Many structural abnormalities in the fetus can be reliably diagnosed by an ultrasound scan, and these can usually be made before 20 weeks. Common examples include hydrocephalus, anencephaly, myelomeningocoele, achondroplasia and other dwarfism, spina bifida, exomphalos, Gastroschisis, duodenal atresia and fetal hydrops. With more recent equipment, conditions such as cleft lips/ palate and congenital cardiac abnormalities are more readily diagnosed and at an earlier gestational age. (Also see the FAQ and Anomalies pages).
First trimester ultrasonic 'soft' markers for chromosomal abnormalities such as the absence of fetal nasal bone, an increased fetal nuchal translucency (the area at the back of the neck) are now in common use to enable detection of Down syndrome fetuses.
Read also: Soft Markers - A Guide for Professionals and Ultrasonographic "soft markers" of fetal chromosomal defects.
Ultrasound can also assist in other diagnostic procedures in prenatal diagnosis such as amniocentesis, chorionic villus sampling, cordocentesis (percutaneous umbilical blood sampling) and in fetal therapy.
5. Placental localization.
Ultrasonography has become indispensible in the localization of the site of the placenta and determining its lower edges, thus making a diagnosis or an exclusion of placenta previa. Other placental abnormalities in conditions such as diabetes, fetal hydrops, Rh isoimmunization and severe intrauterine growth retardation can also be assessed.
6. Multiple pregnancies.
In this situation, ultrasonography is invaluable in determining the number of fetuses, the chorionicity, fetal presentations, evidence of growth retardation and fetal anomaly, the presence of placenta previa, and any suggestion of twin-to-twin transfusion.
7. Hydramnios and Oligohydramnios.
Excessive or decreased amount of liquor (amniotic fluid) can be clearly depicted by ultrasound. Both of these conditions can have adverse effects on the fetus. In both these situations, careful ultrasound examination should be made to exclude intraulterine growth retardation and congenital malformation in the fetus such as intestinal atresia, hydrops fetalis or renal dysplasia. See also FAQ and comments.
8. Other areas.
Ultrasonography is of great value in other obstetric conditions such as:
a) confirmation of intrauterine death.
b) confirmation of fetal presentation in uncertain cases.
c) evaluating fetal movements, tone and breathing in the Biophysical Profile.
d) diagnosis of uterine and pelvic abnormalities during pregnancy e.g. fibromyomata and ovarian cyst.
It has been over 40 years since ultrasound was first used on pregnant women. Unlike X-rays, ionizing irradiation is not present and embryotoxic effects associated with such irradiation should not be relevant. The use of high intensity ultrasound is associated with the effects of "cavitation" and "heating" which can be present with prolonged insonation in laboratory situations.
Although certain harmful effects in cells are observed in a laboratory setting, abnormalities in embryos and offsprings of animals and humans have not been unequivocally demonstrated in the large amount of studies that have so far appeared in the medical literature purporting to the use of diagnostic ultrasound in the clinical setting. Apparent ill-effects such as low birthweight, speech and hearing problems, brain damage and non-right-handedness reported in small studies have not been confirmed or substantiated in larger studies from Europe. The complexity of some of the studies have made the observations difficult to interpret. Every now and then ill effects of ultrasound on the fetus appears as a news item in papers and magazines. Continuous vigilance is necessary particularly in areas of concern such as the use of pulsed Doppler in the first trimester.
The greatest risks arising from the use of ultrasound are the possible over- and under- diagnosis brought about by inadequately trained staff, often working in relative isolation and using poor equipment.
Going through the birth of your child is a wonderful and unique experience. No two deliveries are alike and there is no way to tell how your delivery is going to be. What we can tell you is the stages you will go through during this process and what you can generally expect. Childbirth can be broken into three stages:
First stage: Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm.
Second stage: Continues after the cervix is dilated to 10 cm until the delivery of your baby.
Third stage: Delivery of your placenta.
What are the symptoms of ovarian cysts?
Many women have ovarian cysts without having any symptoms. Sometimes, though, a cyst will cause these problems:
What is a laparoscopic myomectomy?
Fibroids that are attached to the outside of the uterus by a stalk (pedunculated myomas) are the easiest to remove laparoscopically. Many subserous myomas (close to the outer surface) can also be removed through the laparoscope.
Fibroids that are deep in the wall of the uterus, or submucous are most difficult to remove laparoscopically. Although there have been successful pregnancies after laparoscopic removal of deep or multiple myomas, the real question is whether or not the uterus can be repaired as well through the laparoscope as can be done through an abdominal myomectomy.
What are the advantages and disadvantages of laparoscopic myomectomy?
The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that several small incisions are used rather than one larger incision. It is important to understand that even a laparoscopic myomectomy is real surgery, and often requires several weeks of recovery. Another major factor in recovery time is motivation; I have found motivation can be just as important in recovery as the type of surgery.
One concern when there are multiple fibroids is of leaving smaller myomas behind. Often it is necessary to feel the uterus to find the smaller myomas; these likely would be left behind during a laparoscopic myomectomy. To summarize, I think laparoscopic myomectomy is best for pedunculated and superficial myomas. When there are deep myomas and a large number of myomas, I think that it is possible to repair the uterus better by doing an abdominal myomectomy.
A bit of editorializing...
One of my colleagues assisting me in a difficult laparoscopic surgery asked me when would I do a laparotomy (make a regular incision.) My answer was that I do the type of surgery that will obtain the best results. If I can obtain just as good results through the laparoscope I will do the procedure that way. But if I feel I can do a better job through a regular incision, then I will recommend that approach. When someone looks back years after surgery, the quality of surgery inside will be far more important than recovering 1 or 2 weeks earlier. Sometimes I will take a look through the laparoscope, and decide which way to approach the myomectomy at that time. What is an "abdominal myomectomy?
An abdominal myomectomy is the removal of fibroids through an incision in the abdomen. I usually can do this through a horizontal ("bikini") incision, even for large fibroids. There is no limit to the size or number of fibroids that can be removed. Abdominal myomectomy is done in a hospital, and women usually can go home within 48 hours of surgery. Photos below show an actual abdominal myomectomy.
Is there much blood loss with myomectomy?..
Usually there is little loss of blood when a myomectomy is done by a surgeon with extensive experience in the procedure. There are a number of ways to reduce blood loss. I use a laser to make the incision into the uterus, which seals blood vessels and reduces bleeding. Before the incision, medicines are injected into the uterus to shrink blood vessels. As a result, I find it unusual to lose an excess amount of blood during a myomectomy, even with large fibroids.There are a number of surgical techniques to reduce blood loss, so it is important to find a surgeon who is experienced in myomectomy.
What are the advantages and disadvantages of an abdominal myomectomy?
The ability to actually feel the uterus allows me to find fibroids deep inside the uterus that may not be visible just by looking. As you can see from the photos, being able to hold the uterus allows me to accurately repair the area from which large fibroids have been removed.
The disadvantage of an abdominal myomectomy is that it requires an incision, so recovery is somewhat longer than required if an incision is avoided. Fibroids that are on the inside of the uterus (submucous) can usually be removed with a resectoscope, without requiring any incision. Fibroids on the outside of the uterus (subserous) can sometimes be removed through a laparoscope, through several small incisions. I feel that this is often the method of choice for subserous or pedunculated (on a stalk) fibroids. If there are many fibroids or fibroids that are deep I can do a better job by doing an abdominal myomectomy. Most women feel that in the long run doing the best possible procedure to restore the health of the uterus is more important than recovering several weeks sooner.
How is an abdominal myomectomy done?
Here are photographs of an actual abdominal myomectomy.
Here is the abdomen before surgery. The uterus is the size of a 5 month pregnancy. It can be seen to protrude up to the belly button.
The uterus, which, is greatly enlarged by the fibroid, is lifted through the incision. A laser is being used to make an incision into the uterus so the fibroid can be removed.
The fibroid is being separated from the wall of the uterus (myometrium). It is very important to do this in the exact location between the fibroid and the myometrium in order to prevent excess bleeding.
This shows the fibroid almost completely free from the uterus. It is attached only at the base. The blood vessels at the base are being sealed with an electrosurgical device.
The uterus is being reconstructed by suturing the walls together with dissolving suture. This is being done in multiple layers to ensure a precise repair.
The last layer of sutures is placed, and the uterus is completely restored. A barrier to prevent adhesions will be placed before the uterus is replaced into the abdomen and the abdomen closed.
What is the recovery time for an abdominal myomectomy?
Recovery varies tremendously from person to person. Most women can return to work that does not require heavy lifting in 4 weeks. Many women can return in 2 weeks, and some women take 6 weeks.
What is a complete molar pregnancy?
Complete molar pregnancies have only placental parts (there is no baby), and form when the sperm fertilizes an empty egg. Because the egg is empty, no baby is formed. The placenta grows and produces the pregnancy hormone, hCG. Unfortunately, an ultrasound will show that there is no fetus, only a placenta.
What is a partial molar pregnancy?
What are the symptoms of a molar pregnancy?
How do I know if I have a molar pregnancy?
How is a molar pregnancy treated?
How will I feel emotionally after a molar pregnancy?
Although the removal of a molar pregnancy is not the termination of a developing child, it is still a loss. Even when an embryo is present, it does not have the opportunity to develop into a child. Most women discover that they are dealing with a molar pregnancy after the discovery and anticipation of being pregnant. Dreams, plans and hopes are cancelled all at once; it is still a significant loss.
Can I have another molar pregnancy?
What is laparoscopy used for in women ?
This procedure allows us to determine whether there are any defects such as scar tissue, endometriosis, fibroid tumors and other abnormalities of the uterus, fallopian tubes and ovaries.
If any defects are found then we can often be corrected with operative laparoscopy which involves placing instruments through ports in the scope and through additional, narrow (5 mm) ports which are usually inserted at the top of the pubic hair line in the lower abdomen.
Is it a big procedure? How much work would I miss?
In this country laparoscopy is usually done with general anesthesia (you go to sleep) although it can be done with local anesthesia and in many parts of the world local is the preferred technique.
The procedure usually takes between 20 minutes to 2 hours depending upon how much operative corrective work is required. A complicated case could take up to 4 hours or more.
What is the Complications
Complications associated with laparoscopy include the possibility of damage to other structures in the pelvis such as the bladder, ureter, bowel and blood vessels. Unexpected open surgery (larger incision) is always a possibility, but is very uncommon.
Any surgery can have an anesthesia-related complication or be associated with post-operative infection, such as a skin infection at an incision site.
Fortunately, all of these complications are very unusual when laparoscopy is expertly performed on young, healthy women.
What causes an ectopic pregnancy?
Ectopic pregnancies are caused by one or more of the following:
Who is at risk for having an ectopic pregnancy?
Women who are more at risk for having an ectopic pregnancy include the following:
What are the symptoms of an ectopic pregnancy?
The following symptoms may be used to help recognize a potential ectopic pregnancy:
It is important for you to seek emergency care if you are experiencing sharp pain or have bleeding.
How is an ectopic pregnancy diagnosed?
Ectopic pregnancies are diagnosed by your physician who will probably first perform a pelvic exam to locate pain, tenderness or a mass in the abdomen. Your physician will also use an ultrasound to determine whether the uterus contains a developing fetus.
The measurement of hCG levels is also important. An hCG level that is lower than what would be expected is one reason to suspect an ectopic pregnancy. Low levels of progesterone may also indicate that a pregnancy is abnormal.
Your physician may do a Culdocentesis, which is a procedure that involves inserting a needle into the space at the very top of the vagina, behind the uterus and in front of the rectum. The presence of blood in this area may indicate bleeding from a ruptured fallopian tube.
How is an ectopic pregnancy treated?
An ectopic pregnancy may be treated in any of the following ways:
What about my future?
Your hCG level will need to be rechecked on a regular basis until it reaches zero if you did not have your entire fallopian tube removed. An hCG level that remains high could indicate that the ectopic tissue was not entirely removed, which would require surgery or medical management with methotrexate.
The chances of having a successful pregnancy after an ectopic pregnancy may be lower than normal, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future.
Approximately 10% - 30% of pregnant women will experience Bacterial Vaginosis (BV) during their pregnancy. Bacterial Vaginosis is caused by an imbalance in the normal bacteria that exists in a woman’s vagina. It is not transmitted sexually, but is associated with having vaginal intercourse. You may or may not experience symptoms.
How do I know if I have Bacterial Vaginosis?
One of the symptoms of BV is a gray or whitish discharge that has a foul fishy odor. However some women do not experience any symptoms. Diagnosis is made through a pelvic exam. Vaginal discharge is tested through a wet mount (microscopic slide test), pH test (BV often causes a pH level of 4.5 or higher), KOH slide (microscopic slide test) or a whiff test (a mixture that causes a strong fishy odor).
What causes Bacterial Vaginosis?
Bacterial Vaginosis is an imbalance of bacteria which leads to an over growth of bacterial species. The cause has not clearly been identified. It is not transmitted sexually but it is associated with having vaginal sex and therefore may be listed under sexually transmitted diseases when you look it up.
How can Bacterial Vaginosis affect my pregnancy?
There is significant evidence that links Bacterial Vaginosis with preterm labor. There have been many recent studies that have been conducted to verify this information and find a method of prevention. Other studies have also shown a possible link to miscarriages, low birth weight and premature rupture of membranes.
If I am pregnant, will I be screened for Bacterial Vaginosis?
It is not necessary to screen non symptomatic pregnant women for BV. When obtaining your prenatal care, Bacterial Vaginosis is not routinely screened. It is important that you discuss any concerns you may have about BV with your health care provider.
What treatments are available for pregnant women with Bacterial Vaginosis?
Treatment is highly recommended to avoid any chance of preterm labor.
When you become pregnant you want to do everything you can to stay healthy. Unfortunately it is sometimes impossible to protect yourself from every illness out there. Chicken pox is a highly contagious viral infection that can be very serious. Fortunately there are ways to protect you and your baby if you are threatened by chicken pox.
What exactly is chicken pox?
Chicken pox is a viral infection also called varicella. It is accompanied by a rash, which appears as small reddish spots or pimples. A fever and body aches usually occur before the rash appears. Chicken pox is contracted during childhood in most cases although there are some instances when an adult is not immune and contracts chicken pox. About 95% of women in their childbearing years are immune to chicken pox.
Who is most at risk for getting chicken pox during pregnancy?
How will my baby be affected if I have chicken pox?
How your baby will be affected depends on where you are at in your pregnancy. According to the Organization for Teratology Information Service (OTIS):
Possible birth defects may be scars, eye problems, poor growth, small head size, delayed development, and/or mental retardation.
What can I do to protect my baby from chicken pox?
Can someone get chicken pox twice?
It is rare that a person will contract chicken pox twice, but those with immune problems are at an elevated risk of a second infection. There are also those cases when people think they had chicken pox when they were younger, when in fact it was just a rash or something else.
Cytomegalovirus (CMV) Infection
What is Cytomegalovirus (CMV)?
Cytomegalovirus (CMV) is a virus that can be transmitted to a developing child before birth. CMV infection is usually harmless and rarely causes illness. For most healthy persons who acquire CMV after birth there are few symptoms and no long-term health consequences. Once a person becomes infected, the virus remains alive, but usually dormant within that person’s body for life. There are two differnet types of infection: primary CMV and recurrent CMV infection. Primary infection can cause more serious problems in pregnancy than recurrent infection can.However, if a person's immune system is seriously weakened in any way, the virus can become active and cause CMV disease. For the majority of people who have CMV infection, it is not a serious problem.
What are the symptoms of CMV ?
Most children and adults who are infected with CMV do not develop symptoms whereas others may experience the following symptoms three to twelve weeks after exposure:
What are characteristics of CMV?
CMV is a member of the herpes virus group that is characterized by the ability to remain dormant within the body over a long period. Infectious CMV may be shed in bodily fluids (urine, saliva, blood, tears, semen, and breast milk) intermittently, without any detectable signs and without symptoms.
How common is CMV?
How is CMV spread?
Transmission of CMV occurs from person to person and is not associated with food, water, or animals. CMV is not highly contagious but has been shown to spread in households and among young children in day care centers. The infection is spread through close intimate contact with a person excreting the virus in their saliva, urine, breast milk or other bodily fluids.
How is CMV diagnosed?
Most CMV infections are rarely diagnosed because the virus usually produces few, if any, symptoms. However, people who have had CMV develop antibodies to the virus which remain in their body for the rest of their life. A blood sample can test for the CMV antibody followed by another blood sample within two weeks. The virus can also be cultured from specimens obtained from urine, throat swabs, and tissues samples. Laboratory tests to culture the virus is expensive and not widely available.
What is the treatment for CMV?
Maternal CMV infections may be treated with one of only two drugs that are used in in severe situations of CMV infection. There are no treatmens for prenatal or postnatal therapy of the infection. Vaccines for treatment are still in the research and developmental stages.
How can CMV be prevented?
Transmission of Cytomegalovirus is often preventable because it is most often transmitted through infected bodily fluids that come in contact with hands and then are absorbed through the nose or mouth of a susceptible person. People who interact with children should use safe hygiene practices including good hand washing and wearing gloves when changing diapers. Hand washing with soap and water is effective in preventing the spread of CMV.
How does CMV affect pregnancy?
The following potential problems can occur for infants who are infected from their mothers before (during pregnancy) birth:
When CMV is transmitted at the time of delivery from contact with genital secretions or later in infancy through breast milk, these infections usually result in few, if any, symptoms or complications.
What are some recommendations for pregnant women regarding CMV infection?
What are some recommendations for individuals who care for infants and children regarding CMV infection?
Most healthy people working with infants and children are not at risk from CMV infection. However, women of child-bearing age who previously have not been infected with CMV still have a potential risk for passing CMV to their babies in utero. CMV is commonly transmitted among young children. Since CMV is transmitted through contact with infected body fluids, including urine and saliva; child care providers (including day care workers, special education teachers, and therapists) should be educated about CMV infection and practice preventive measures. Susceptible non-pregnant women working with infants and children should not routinely be transferred to other work situations. Routine laboratory testing for the CMV antibody in female workers is not recommended, but can be performed to determine their immune status.
Incompetent Cervix : Weakened Cervix
During pregnancy, as the baby grows and gets heavier, it presses on the cervix. This pressure may cause the cervix to start to open before the baby is ready to be born. This condition is called incompetent cervix or weakened cervix and it may lead to a miscarriage or premature delivery. However, an incompetent cervix happens in only about 1 out of 100 pregnancies.
What causes an incompetent or weakened cervix?
A weakened cervix can be caused by one or more of the following conditions:
How will I know if I have an incompetent cervix?
Incompetent cervix is not routinely checked for during pregnancy and therefore is not usually diagnosed until after a second or third trimester miscarriage has occurred.
Women can be evaluated before pregnancy or in early pregnancy by ultrasound, if they have any of the factors that are potential causes of incompetent cervix. Diagnosis can be made by your physician though a pelvic exam or by an ultrasound. The ultrasound would be used to measure the cervical opening or the length of the cervix.
How often does an incompetent cervix happen?
An Incompetent or weakened cervix happens in about 1-2% of pregnancies. Almost 25% of babies miscarried in the second trimester are due to incompetent cervix.
What is the treatment for a weakened cervix?
The treatment for an incompetent or weakened cervix is a procedure that sews the cervix closed to reinforce the weak cervix. This procedure is called a cerclage and is usually performed between week 14-16 of pregnancy. These sutures will be removed between 36-38 weeks, to prevent any problems for when you go into labor. Removal of the cerclage does not result in spontaneous delivery of the baby. A woman would not be eligible for a cerclage if:
Possible complications of cervical cerclage include uterine rupture, maternal hemorrhage, bladder rupture, cervical laceration, preterm labor and premature rupture of the membranes. The likelihood of these risks are very minimal and most health care providers feel that a cerclage is a life saving procedure that is worth the possible risks involved.
The solid wastes (feces) of cats may contain a parasite called toxoplasma gondii that can cause toxoplasmosis, a rare but serious blood infection. Toxoplasmosis can also be contracted by eating infected, undercooked meat or by eating contaminated fruit or vegetables. If you have had cats for some time, you may have already been exposed to toxoplasmosis and developed immunity to it.
What are the symptoms of toxoplasmosis?
How common is toxoplasmosis?
Toxoplasmosis is most common in areas with warm, moist climates. More then 50% of the population in Central and Southern Europe, Africa, South America and Asia are infected with toxoplasmosis. Toxoplasmosis is common in France possibly due to the preference of minimally cooked and raw meat.
How will toxoplasmosis affect my pregnancy?
For women who are not immune to toxoplasmosis, exposure to this parasite just prior to or during pregnancy may cause the fetus to be infected.
According to the Organization of Teratology Information Services (OTIS),when the mother gets infected between weeks 10-24 , the risk for severe problems in the newborn is about 5-6%. Effects on the baby include: premature birth, low birth weight, fever, jaundice, abnormalities of the retina, mental retardation, abnormal head size, convulsions, and brain calcification.
During the 3rd trimester, a fetus has an increased risk of becoming infected, but the risk of damage to the fetus is decreased since most of the important development has already occurred.
How can I prevent toxoplasmosis?
How is toxoplasmosis diagnosed?
Most healthcare providers will routinely screen for toxoplasmosis immunity before pregnancy or during the first prenatal visit. A blood test can determine if you have been exposed. If toxoplasmosis is present during pregnancy, treatment with antibiotics will be given for several months to reduce the risk of severe damage to the baby. Cordocentesis is a test that can determine whether an infection has occurred during pregnancy.
Urinary Tract Infection During Pregnancy
A urinary tract infection (UTI), also called bladder infection, is a bacterial inflammation in the urinary tract. Pregnant women are at increased risk for UTI's starting in week 6 through week 24.
Why are UTI's more common during pregnancy?
UTI's are more common during pregnancy because of changes in the urinary tract. The uterus sits directly on top of the bladder. As the uterus grows, its increased weight can block the drainage of urine from the bladder, causing an infection.
What are the signs and symptoms of UTI's?
If you have a urinary tract infection, you may experience one or more of the following symptoms:
How will the UTI affect my baby?
If the UTI goes untreated, it may lead to a kidney infection. Kidney infections may cause early labor and low birth weight. If your doctor treats a urinary tract infection early and properly, the UTI will not cause harm to your baby.
How do I know if I have a UTI?
A urinalysis and a urine culture can detect a UTI throughout pregnancy.
How is a UTI treated?
UTI's can be safely treated with antibiotics during pregnancy. Urinary tract infections are most commonly treated by antibiotics. Doctors usually prescribe a 3-7 day course of antibiotics that is safe for you and the baby.
Call your doctor if you have fever, chills, lower stomach pains, nausea, vomiting, contractions, or if after taking medicine for three days, you still have a burning feeling when you urinate.
How can I prevent a UTI?
You may do everything right and still experience a urinary tract infection, but you can reduce the likelihood by doing the following:
Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Mild cases are treated with dietary changes, rest and antacids. More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line (IV). DO NOT take any medications to solve this problem without consulting your health care provider first.
Why is this happening to me?
Do not worry. Your body is not trying to reject the baby as some people used to think. The majority of pregnant women experience some type of morning sickness (70 - 80%) and about 1% of all pregnancies will experience extreme morning sickness called hyperemesis gravidarum. It is believed that nausea is caused by a rise in hormone levels, however the absolute cause is still unknown. Hyperemesis Gravidarum can not be prevented but you can take comfort in knowing that there are ways to manage it.
Distinguishing Between Morning Sickness and Hyperemesis Gravidarum:
Nausea sometimes accompanied by vomiting
Nausea accompanied by severe vomiting
Nausea that subsides at 12 weeks or soon after
Nausea that does not subside
Vomiting that does not cause severe dehydration
Vomiting that causes severe dehydration
Vomiting that allows you to keep some food down
Vomiting that does not allow you to keep any food down
Signs and Symptoms of Hyperemesis Gravidarum:
What are the Treatments for Hyperemesis Gravidarum?
In some cases hyperemesis gravidarum is so severe that hospitalization may be required. Hospital treatment may include some or all of the following:
All expecting mothers will be tested for gestational diabetes at some point during their pregnancy. Expecting mothers who are over the age of 35, over weight, or have a family history of diabetes may be tested earlier and more frequently.
What is gestational diabetes?
Gestational diabetes is a temporary form (in most cases) of diabetes in which the body does not produce adequate amounts of insulin to deal with sugar during pregnancy. It may also be called glucose intolerance or carbohydrate intolerance. Signs and symptoms can include:
Who gets gestational diabetes and why do I have to be tested?
Approximately 2-5 % of all expecting mothers will develop gestational diabetes with this number possibly increasing to 7-9 % in populations where mothers are more likely to have risk factors. The screening for this disease usually will take place sometime between your 24th and 28th week of pregnancy. Doctors test for gestational diabetes during this time because the placenta is producing large amounts of hormones that may cause insulin resistance. If the result comes back with elevated levels, further testing would be done to confirm a diagnosis of gestational diabetes.
What should I expect during my test?
During your prenatal visit your doctor will give you a sweet liquid (sweet does not necessarily mean good!) to drink one hour before your blood is drawn. It may cause you to feel a bit nauseous. The results will indicate if you are producing enough insulin or not.
If I have gestational diabetes how will I be treated?
The biggest part of treating gestational diabetes is controlling your blood sugar levels. There are things you and your doctor can do in order to control your levels and keep them at a safe and normal amount.:
Is there anything I should be afraid of?
If gestational diabetes is diagnosed and treated effectively, there is little risk of complications. If gestational diabetes is not treated, effects for mother and baby can include:
With proper care and treatment, women with gestational diabetes can have healthy babies and the diabetes should disappear after delivery.
It is important that you watch for any continuing signs that you may still be diabetic after giving birth. These symptoms include:
Testing may occur a few months after the delivery to make sure your blood sugar levels have returned back to normal.
The placenta normally attaches to the uterine wall, however there is a condition that occurs where the placenta attaches itself too deeply into the wall of the uterus. This condition is known as placenta accreta, placenta increta, or placenta percreta depending on the severity and deepness of the placenta attachment. Approximately 1 in 2,500 pregnancies experience placenta accreta, increta or percreta.
What is the difference between accreta, increta or percreta?
The difference between placenta accreta, increta or percreta is determined by the severity of the attachment of the placenta to the uterine wall.
Placenta Accreta occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle. Placenta accreta is the most common accounting for approximately 75% of all cases.
Placenta Increta occurs when the placenta attaches even deeper into the uterine wall and does penetrate into the uterine muscle. Placenta increta accounts for approximately 15% of all cases.
Placenta Percreta occurs when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder. Placenta percreta is the least common of the three conditions accounting for approximately 5% of all cases.
What causes placenta accreta?
The specific cause of placenta accreta is unknown, but it can be related to placenta previa and previous cesarean deliveries. Placenta accreta is present in 5% to 10% of women with placenta previa.
A cesarean delivery increases the possibility of a future placenta accreta, and the more cesareans, the greater the increase. Multiple cesareans were present in over 60% of placenta accreta cases.
What are the risks of placenta accreta to the baby?
Premature delivery and subsequent complications are the primary concerns for the baby. Bleeding during the third trimester may be a warning sign that placenta accreta exists, and when placenta accreta occurs it commonly results in a premature delivery. Your healthcare provider will examine your condition and use medication, bed rest and whatever else necessary to help continue the pregnancy towards full term.
What are the risks of placenta accreta to the mother?
The placenta usually has difficulty separating from the uterine wall. The primary concern for the mother is hemorrhaging during manual attempts to detach the placenta. Severe hemorrhaging can be life threatening. Other concerns involve damage to the uterus or other organs (percreta) during removal of the placenta. Hysterectomy is a common therapeutic intervention, but the results involve the loss of the uterus and the ability to conceive.
What is the treatment for placenta accreta?
There is nothing a woman can do to prevent placenta accreta, and there is little that can be done for treatment once placenta accreta has been diagnosed. If you have been diagnosed with placenta accreta your healthcare provider will monitor your pregnancy with the intent of scheduling a delivery and using a surgery that may spare the uterus. It is particularly important to discuss this surgery with your doctor if you desire to have additional children.
Unfortunately, placenta accreta may be severe enough that a hysterectomy may be needed. Again, it is important to discuss surgical options with your healthcare provider.
Placenta Previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix. The placenta may separate from the uterine wall as the cervix begins to dilate (open) during labor.
How common is placenta previa?
Placenta previa affects about 1 in 200 pregnant women in the third trimester of pregnancy.
Placenta previa is more common in women who have had one or more of the following:
What are the different types of placenta previa?
What are the symptoms of placenta previa?
Signs and symptoms of placenta previa vary, but the most common symptom is painless bleeding during the third trimester. Other reasons to suspect placenta previa would be:
What is the treatment for placenta previa?
Once diagnosed, placenta previa will usually require bed rest for the mother and frequent hospital visits. Depending on the gestational age, steroid shots may be given to help mature the baby's lungs. If the bleeding cannot be controlled, an immediate cesarean delivery is usually done regardless of the length of the pregnancy. Some marginal previas can be delivered vaginally, although complete or partial previas would require a cesarean delivery.
Most physicians recommend women who are experiencing placenta previa to:
What causes placenta previa?
The exact cause of placenta previa is unknown. However, the following can increase your risk:
Preeclampsia is a condition of high blood pressure during pregnancy. Your blood pressure goes up, you retain water, and protein is found in your urine. It is also called toxemia or pregnancy induced hypertension (PIH). The exact cause of preeclampsia is unknown.
Who is at risk for preeclampsia?
The following may increase the risk of developing preeclampsia:
What are the symptoms of preeclampsia?
Mild preeclampsia: high blood pressure, water retention, and protein in the urine.
Severe preeclampsia: headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency to bruise easily. Contact your doctor immediately if you experience blurred vision, severe headaches, abdominal pain, and/or urinating very infrequently .
How do I know if I have preeclampsia?
At each prenatal checkup your healthcare provider will check your blood pressure, urine levels, and may order blood tests which may show if you have preeclampsia.
Your physician may also perform other tests that include: checking kidney and blood-clotting functions; ultrasound scan to check your baby's growth; and Doppler scan to measure the efficiency of blood flow to the placenta.
How is preeclampsia treated?
Treatment depends on how close you are to your due date. If you are close to your due date, and the baby is developed enough, your health care provider will probably want to deliver your baby as soon as possible.
If you have mild preeclampsia and your baby has not reached full development, your doctor will probably recommend you do the following:
If you have severe preeclampsia, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely.
How does preeclampsia affect my baby?
Preeclampsia can prevent the placenta from getting enough blood. If the placenta doesn't get enough blood, your baby gets less oxygen and food. This can result in low birth weight.
Most women still can deliver a healthy baby if preeclampsia is detected early and treated with regular prenatal care.
How can I prevent preeclampsia:
Currently, there is no sure way to prevent preeclampsia. Some contributing factors to high blood pressure can be controlled and some can't. Follow your doctor's instruction about diet and exercise.
Near the end of the pushing stage, it may be apparent that mother and baby need a little extra help for a successful delivery. After ensuring anesthesia is working, your health care provider will gently apply forceps or minimal suction to the baby's head. As you push through the next contractions, your health care provider will gently bring the baby's head through the birth canal.
What are the instruments used in an assisted delivery?
We will use a vacuum extractor to help deliver the baby.
A vacuum extractor utilizes suction to turn the baby's head or pull the baby through the birth canal. Usually the suction cup has a controlled amount of suction, so just enough is used to help deliver the baby.
Why would an assisted delivery be necessary?
The following are common reasons your health care provider may suggest assisted delivery:
Your health care provider may suggest forceps if your baby is coming feet first or in a breech position
What should I watch for in my baby if the delivery is assisted?
The following are effects that may occur if your baby's delivery is assisted with forceps:
The following are effects that may occur if your baby is assisted with suction:
After a miscarriage, making the decision to try for another pregnancy can be difficult. It is natural to want to become pregnant again right away after going through the heartache of losing a baby. However, you should wait to attempt again until you are physically, as well as emotionally ready.
When can I attempt another pregnancy?
There is no perfect amount of time to wait before trying to conceive again, but many healthcare providers encourage woman to wait at least a few months to strengthen the chance of a healthy pregnancy. If a woman's body isn't ready to support a pregnancy by the time that she conceives again, she faces an increased risk of experiencing a repeat miscarriage. It takes time for the uterus to recover and for the endometrial lining to become strong and healthy again.
Medically, it is safe to conceive after two or three normal menstrual periods if tests or treatments for the cause of the miscarriage are not being done. Some physicians routinely recommend that couples wait six months to a year before attempting another pregnancy in order to come to terms with their loss, whereas other physicians feel there is no compelling reason to wait so long.
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What are the chances of having another miscarriage?
Many couples who experience a miscarriage worry that it will happen again. Fortunately, at least 85% of women who have had one loss will go on to have a successful pregnancy the next time, as will 75% of those who have experienced two or three losses.
When should a specialist be consulted before attempting to conceive again?
Your health care provider can refer you to the appropriate specialist in maternal-fetal medicine, genetics, or reproductive endocrinology who can help you have the best treatment to increase the chances of a healthy pregnancy. You may want to consider seeking help if you:
How do we decide when to try again?
Deciding when to try again is a decision only you as a couple can make. Another pregnancy won't replace the lost pregnancy but may help you by refocusing your attention. If there were medical complications with your miscarriage, make sure to discuss the plans to try again with your health care provider first.
How might we feel during the next pregnancy?
Your next pregnancy might not be as joyful as you would like because you've learned that life doesn't always go according to your plans. You can't say it's your first, but it is also difficult to say you are a parent. The following are recommendations to make this time a little easier:
Spontaneous abortion (SAB) or miscarriage is the term used for a pregnancy that ends on it's own, within the first 20 weeks of gestation. Often the medical name spontaneous abortion (SAB) gives many women a negative feeling, so throughout this information we will refer to any type of spontaneous abortion or pregnancy loss under 20 weeks as miscarriage.
Miscarriage is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists(ACOG). Studies reveal that anywhere from 10- 25% of all clinically recognized pregnancies will end in miscarriage. Estimations of chemical pregnancies or unrecognized pregnancies that are lost can be as high as 50-75%, but many of these are unknown since they often happen before a woman has missed a period or is aware she is pregnant.
Most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed on miscarriage, in the unfortunate event that you find yourself or someone you know faced with one.
There can be many confusing terms and moments that accompany a miscarriage. There are different types of miscarriage, different treatments for each and different statistics for what you chances are of having one. The following information gives a broad overview of some of the confusing parts of miscarriage. This information is to help equip you with knowledge so that you might not feel so alone or lost if you face a possible miscarriage situation. As with most complications with pregnancy, remember that the best person you can usually talk with and ask questions of, is your health care provider.
A threatened miscarriage or spontaneous abortion occurs in approximately 10% of pregnancies between 7 and 12 weeks of gestation. Symptoms include vaginal bleeding, abdominal cramps, and low back pain.
What are the benefits of Maternity Gymnastics?
Pregnant women who perform Maternity Gymnastics often find they have an easier birth. Strengthening these muscles during pregnancy can help you develop the ability to control your muscles during labor and delivery. Toning all of these muscles will also minimize two common problems during pregnancy: bladder leaks and hemorrhoids.
Maternity Gymnastics are also recommended after pregnancy to promote perineal healing, regain bladder control, and strengthen pelvic floor muscles. The best thing about Maternity Gymnastics is that they can be done anywhere, and no one knows you’re doing them.
Advantages of Maternity Gymnastics
How to do Maternity Gymnastics ?
1) To find the correct muscles, practice stopping the flow of urine when urinating.
2) Contract pelvic floor muscles for 10 seconds, then relax, repeating 10-20 times.
3) Breathe normally during the exercises and do this at least three times a day.
4) Try not to move your leg, buttock, or abdominal muscles during the exercises.
Ideas for when to do Maternity Gymnastics ?
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