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Blood Incompatibilities

smart review online — Sat, 17 Oct 2009 13:24:25 +0000

Blood Incompatibilities

Erythroblastosis Fetalis (EBF)

EBF is the result of blood incompatibility between the mother and her fetus. Understanding how the negative and positive blood incompatibility occurs can be confusing, but here goes.

When the mom’s blood type is negative and the baby’s father’s type is positive, the baby has a 50/ 50 chance of being positive too. Being positive is what causes the problem between mom and baby. The mother’s body normally views the baby as a friendly, harmless parasite. In the Rh negative mom whose baby is Rh positive, the mother’s body views the fetal blood cells as dangerous intruders and takes action. Mom becomes sensitized and develops antibodies (weapons) to destroy the red blood cells in the baby. As the red blood cells are being destroyed, the baby becomes anemic. More problems develop as the baby tries compensating for the anemia. In severe cases, the fetal heart and liver can fail from trying to keep up, although with current treatment 70 percent of even severely affected babies survive.

A Stitch in Time

Prevention is always the best approach to any problem. This is no exception. Once the mother is sensitized, the sensitivity is lifelong and irreversible. It doesn’t help to lock the barn door after the horse has escaped.

Blood typing, Rh determination, and antibody screening are routinely done at the first prenatal visit. All Rh negative mothers have the antibody screen repeated a t 28 weeks of pregnancy. If there are no antibodies to indicate she’s sensitized, a prophylactic injection of Rh Immune Globulin (RhIG) should be given. After delivery, if the baby’s blood type is positive, another injection of RhIG is given within 72 hours, locking the barn door to sensitization. Even if you’re having a tubal ligation, you need RhIG because occasionally tubal ligation fails, or at a later time you might want your tubes reconnected.

Other Indications for RhIG

Spontaneous abortion (miscarriage) occurring more than 6 weeks after the last menstrual period.

Induced abortion

Ectopic pregnancy

After amniocentesis

There’s always great optimism that EBF will be wiped out in our lifetimes. Do your part; there are always inadvertent slipups. If any of the above situations occur, remind your doctor to order the RhIG injection. Don’t assume you don’t need it – you do.

ABO Incompatibility

Occasionally, blood incompatibility can result when mom has type O and baby has either AB, A, or B type blood. Only 2 percent of births are affected by ABO incompatibility. This type of EBF is different from the Rh-problem. ABO isn’t as serious and doesn’t become more severe with each pregnancy. The baby doesn’t die before birth, and the sophisticated technology, such as amniocentesis and ultrasound, isn’t necessary. Preterm delivery isn’t necessary. ABO incompatibility is more a pediatric disease than an obstetrical one and can usually be treated with little difficulty after the baby is born.

The Overdue Blues-Postdates Pregnancy

You’re now 2 weeks past your due date and officially considered postdates by your doctor. You’re afraid to be seen in public because you’re tired of people asking “Haven’t you had that baby yet?” You stop answering the phone because your mother calls every 3 hours to ask “Is anything happening?” You’ve stopped speaking to your husband, your doctor, and the rest of the world. You don’t want to be pregnant anymore. You want your doctor to do something! You may be miserable, but your doctor isn’t having any fun either. She has to worry about your “aging” placenta providing enough oxygen and nutrients to your baby. Your doctor has to weigh many factors in order to make the appropriate decision in your particular case. If your actual due date is really uncertain, add more gray hairs.

The state of your cervix is usually the critical factor in whether or not labor can be induced. With an unripe cervix, some doctors prefer to leave Mother Nature alone if the fetal well-being tests are reassuring, the baby is growing appropriately, and there’s an adequate amount of amniotic fluid. Some obstetricians start fetal testing at 41 weeks.

The more unripe the cervix, the less chance of a successful induction of labor. There are no guarantees the oxytocin will work. In some cases with an unripe cervix, doctors try the serial induction technique: The first day is spent just trying to ripen the cervix, another day is spent “priming” the uterus, and on the third day efforts are made to establish true labor sometimes it works, sometimes not.

If your cervix is ripe and ready to go, most doctors feel comfortable inducing labor. Everybody can breathe a sigh of relief. If you and your doctor opt for inducing labor, skip to the induction section-your prayers have been answered.

Twins

smart review online — Sat, 17 Oct 2009 13:21:38 +0000

Twins

Pass The Smelling Salts!

The possibility of more than one baby lurks somewhere in the dark recesses of every pregnant woman’s mind. Twins occur once in every 100 pregnancies. The thought may delight some and provoke horror in others.

Head Start

Before ultrasound, as many as 30 percent of twin pregnancies were surprises. The smelling salts weren’t needed until delivery. Early diagnosis of the twin pregnancy is critically important; plans must be made. In the first or early second trimester, an ultrasound exam can eliminate surprises. You can see two babies in there-no guessing. For the duration of your pregnancy and definitely after, you’ll need to make adjustments in your life-style.

Double Trouble

Twins may double your fun after birth, but there are potential problems during pregnancy that your doctor will want to anticipate and avoid. The twin pregnancy is high-risk. Careful attention to detail and planning help ensure a happy landing for your double duo. Listing some of the potential problems for you isn’t done to scare you but to give you a good idea why you need skilled care during your pregnancy.

Potential Problems for Twin Pregnancy

Significantly higher infant mortality rates than single pregnancies.

Low birth weights.

Preterm labor. Twins deliver on the average about 3 weeks early.

Discordant growth-intrauterine sibling rivalry. One twin receives more nourishment from the placenta, and the other one is “underfed.” “The placenta always liked you better” kind of thing.

Preeclampsia.

Maternal anemia.

Placental problems such as premature separation and placenta previa.

Complicated labor. If one twin is breech, a cesarean birth is often done.

Now you know why many obstetricians have gray hair. Guiding your twin pregnancy to a successful, uneventful completion is a real challenge for both you and your doctor. There are five important things you can do for yourself:

At about 28 to 32 weeks, your doctor may ask you to quit work and spend a fair amount of time lying on your side to increase placental blood flow. T his also helps the babies gain weight.

Learn the signs of pre term labor. Pay attention to what your body is telling you.

Don’t hesitate to call the doctor or the office nurse if you think you’re having contractions.

Eat a well-balanced diet with adequate calories.

Take your vitamins, the ones with the iron and folic acid.

Your doctor will perform several ultrasound exams during pregnancy to follow the growth patterns of both babies-remember the sibling rivalry. Nonstress testing might be added weekly at 32 weeks, if it’s indicated, to evaluate how well the babies are doing.

Delivery may add a few more gray hairs to your obstetrician’s head. He’ll want you to deliver in a hospital with equipment and personnel trained to care for you during labor and your babies at birth. Talk to your doctor about your options. If preterm labor strikes, a perinatal center is usually your best bet. It’s less anxiety-provoking if you plan ahead for all possible situations. Have a game plan. You’ve had enough surprises.

Preterm Labor

smart review online — Sat, 17 Oct 2009 13:17:49 +0000

Preterm Labor

Six to eight percent of all babies born arrive before 37 weeks’ gestation. These small numbers, however, account for 75 percent of all the neonatal deaths – a significant statistic. It costs as much to care for 5 preterm babies as it does 150 pregnant women. Everyone agrees that prevention is the best approach since Mother Nature provides the best incubator. But this is easier said than done.

An Obstetrical Stew

It’s extremely difficult to prevent something when you aren’t sure of the exact cause, as in 50 to 60 percent of preterm labors. The current strategy is to identify – in advance those women most at risk for preterm labor. A look at a risk-assessment guide reveals an obstetrical stew of social, physical, and pregnancy factors that contribute to preterm labor. The following is a sample list.

Major factors for preterm labor:
Previous preterm labor
Multiple pregnancy (twins or more)
Abdominal surgery during pregnancy
Two second-trimester abortions
Cervix less than 1 cm long
Cervix dilated more than 1 cm
DES daughter
Cone biopsy of cervix
Incompetent cervix
Irritable uterus
Polyhydramnios (excessive amniotic fluid)
Uterine anomaly (double uterus)

Minor factors for preterm labor:
Bleeding after 12 weeks
One abortion in the second trimester
Three or more first-trimester elective abortions
Febrile (fever) illness
Pyelonephritis (kidney infection)
More than 10 cigarettes per day

Prevention

The earlier preterm labor is diagnosed, the sooner treatment can begin. Once the cervix has started to dilate, it’s difficult to stop the progress of labor for very long. Intensive education of women in the high-risk group is one method being used to prevent preterm labor. The women are shown how to assess themselves for signs of preterm labor. The education is reinforced by frequent telephone contact with nurses who provide support and information.

Ambulatory home monitoring is an investigational technique that may help identify pre term labor. The woman wears a uterine contraction monitor several times a day. The recorded contractions are transmitted by phone to a central unit where doctors or nurses evaluate the strip. Some feel that the home monitoring system is effective, but others feel that education and self-assessment by the pregnant woman combined with frequent nurse contact work as well and are also less expensive. Time will tell.

What’s Cooking: Symptoms

Symptoms of preterm labor are often very subtle; they may go unrecognized until the cervix has dilated. You can suspect preterm labor if you have:

An increase in your usual clear, mucous, vaginal discharge

Noticeable tightening of your uterus, every 10 minutes or less

Backache different from the type you usually have

Feeling of pressure in your pelvis

Urinary tract infections are a common cause of pre term labor symptoms. Call your doctor if you have one or “more symptoms (frequency and burning on urination). It’s easier to check it out than to deal with a preterm baby in the neonatal intensive care unit (NICU) for a month or two.

Treatment-Your Interventions

If you experience uterine contractions before 37 weeks of your pregnancy, lie on your left side and drink a quart of water. The combination of rest and fluids often quiets the irritable uterus. Call your doctor and tell her how often your contractions are occurring and what you’re doing to quiet your uterus.

Treatment- Your Doctor’s

If contractions continue in spite of your interventions, hospitalization is required to observe and treat preterm labor. Half the women treated will respond to bedrest on the left side and an IV to increase their fluid level (hydration). The fetal monitor documents the uterine activity and ensures that the baby is doing well. If after an hour or two the contractions are getting closer and/or the cervix is changing, the decision to try to stop labor has to be made. Labor usually won’t be stopped if:

You’re 35 weeks or more pregnant

The baby’s lungs are mature

You’re 4 or more centimeters dilated

Your bag of water has ruptured

Contraindications to suppressing labor include fetal distress, poorly controlled diabetes, severe preeclampsia, intrauterine infection, and bleeding.

Several drugs are used to stop labor if you’re between 26 and 35 weeks pregnant. They buy time to allow the baby’s lungs to mature. The more your cervix is dilated, the less time you can buy. The decision to use the drugs rests with you and your doctor.

If you’re less than 34 weeks pregnant and your hospital doesn’t have an NICU, you’ll probably be transferred to a hospital that can provide the expert care your baby needs. This is in the best interests of your baby. If the receiving hospital has a highly trained transport team, you may be allowed to deliver in your hospital. After delivery, your baby is then transferred.

The Crisis

The delivery of a preterm baby precipitates a major emotional and financial crisis. Important developmental tasks have been interrupted. You’re plunged into motherhood before you’re emotionally ready-you have no time to savor the anticipation. You have to work through the formidable emotions of disappointment and guilt. Disappointment is painful and acute-you didn’t have your fantasy-perfect birth experience. Instead of a picture-perfect, full term baby, your preemie is skinny, red, wrinkled, and frighteningly fragile looking.

Disappointment is minor compared to the guilt you feel. You’re convinced somehow that you’re responsible for your baby being born early. Emotionally, you have a lot of grieving to complete. You find yourself stumbling through the grieving process with stops along the way. Anger follows shock and can be directed outwardly to those around you or inwardly expressed as depression. Anger comes from fear. Communicate your feelings and fears to each other, your doctor, and the nurses caring for you and your baby.

Then, there’s your baby. Instead of euphoria, there’s fear for the fate of your very little new one. You’re expected to begin the attaching, loving process when there may be no guarantees she’ll survive. You may try to protect yourself, after all you’ve been through, by delaying the attachment process. You wonder if you’ll have to say goodbye before you really have the chance to say hello. The situation can seem overwhelming. What do you do now?

Coping

You and your husband need as much love and support as your new baby does. This isn’t a time to tough it out alone. Gather around you all the emotional support you can. Use the hospital social worker, chaplain, or other professional to help you work through that difficult but necessary grieving and adjustment process.

The development of the NICU has had a tremendous impact on the survival rates for the very pre term baby. Babies as young as 28 weeks, in the hands of a neonatologist and highly trained nurses, have very good survival rates.

The personnel in the NICU know the value of having you touch, spend time with, and nurture your baby right from the start. Liberal visiting hours provide the opportunity to hold and cuddle your baby. You can still develop that important attachment. It won’t take long before you no longer notice the tubes and machines. You only have eyes for your “little one” as he grows into that regular-sized baby you expected.

Preeclampsia

smart review online — Sat, 17 Oct 2009 13:12:53 +0000

Preeclampsia

Facts and Fallacies

Preeclampsia has probably been around for as long as women have been getting pregnant. It’s also known as toxemia, pregnancy -induced hypertension, or EPH gestosis. Preeclampsia is the most misunderstood and myth-ridden disease in pregnancy. Let’s clear up some of the more common myths with some facts.

Preeclampsia isn’t related to obesity or excessive weight gain during pregnancy.

It isn’t caused by salt (sodium chloride). Women with preeclampsia actually have normal sodium levels. Salt restriction isn’t recommended.

The condition isn’t cured or alleviated by taking water pills (diuretics) for the swelling.

Preeclampsia isn’t caused by a diseased placenta, poisons, or toxins in the body. The term “toxemia” is still used, but it isn’t an accurate one to describe the disease.

It isn’t prevented by vitamin therapy or high-protein or other special diets. There’s no known prevention.

Preeclampsia is one of the most studied diseases in pregnancy. In spite of all the research, we still don’t know what causes the disease or how to prevent it T he only cure at this time is to deliver the baby.

The Computer Goes Kaput

Preeclampsia usually occurs during a first pregnancy. Five percent of pregnancies develop preeclampsia. In addition to the first-time mother, women with diabetes, chronic hypertension, and multiple pregnancies are at risk for developing the disease. Preeclampsia seems to result from a number of interacting factors that affect the response of the mother’s immune system. Her immunological system may short-circuit because of poor nutrition plus exposure to placental hormones for the first time. Genetic factors may play a part… some unknown incompatibility between mom and dad. Who knows for sure? The body’s immunological computer, because of some unknown variable, doesn’t “program” the body’s response to the pregnancy in a normal way and preeclampsia results.

Software Snafu-What Goes Wrong

Preeclampsia has important effects on you and your baby. Your vascular system, which holds and carries blood throughout your body, changes in shape with this disease. Instead of being straight hollow tubes with unrestricted blood flow, your vessels look more like sausages. Some areas are very narrow and others very wide. The increased pressure inside the blood vessels forces fluid out into the tissues, to relieve the pressure. Your blood becomes thicker without the fluid. Your blood pressure (BP) rises because of the areas of constriction in the vessels. The changes in the vessels produce the three symptoms used to diagnose preeclampsia: edema (swelling), hypertension (increased blood pressure), and protein in the urine.

The blood flow to the baby is decreased due to the decrease in fluid volume inside your vessels and the increase in blood pressure. These “short rations” produce a small baby whose physical growth potential isn’t reached. Intrauterine growth retardation (IUGR) is the term used to describe the condition.

Signs and Symptoms

Preeclampsia is similar to a computer virus. It’s present long before you realize something is wrong. The disease makes its appearance some time after the twentieth week of pregnancy. The first sign is usually a weight gain of more than 2 pounds in I week. Generalized swelling (edema) appears next. It’s normal to have swelling of the feet and ankles, but it isn’t normal for the face and hands to swell. Pay attention if you can’t get your rings off and your face seems fuller than usual.

After the swelling, your blood pressure starts rising. A BP of 140/ 90 is abnormal in pregnancy. You can still have preeclampsia even if your blood pressure doesn’t reach that level. If the top number of your BP rises 30 points above your early or prepregnancy BP and the bottom number rises 15 points, it’s still possible to have preeclampsia. For example, if your first trimester pressure was 90/60 and now you consistently register 120/75, you need to be evaluated, particularly if you have swelling also. With mild preeclampsia, you may not have protein in your urine.

Downtime-Treatment

Since delivery is the only cure for preeclampsia, your doctor tries to slow the progress of the disease until your baby’s lungs are mature enough for safe delivery. There are no advantages to waiting if it isn’t necessary – the disease doesn’t get better with time.

Preeclampsia is classified as mild or severe. Each category is managed differently. With mild preeclampsia, you may have generalized swelling and your BP is elevated but under 160/ 110. You probably have no protein in your urine. You feel fine, which is misleading. With this disease, you can rapidly progress from the mild to the severe form in a matter of hours. It’s very unpredictable. Listen to what your doctor tells you and cooperate fully. Your doctor may let you stay at home instead of hospitalizing you if you have mild preeclampsia. Your doctor’s instructions usually include lots of rest while lying on your side. This position helps the edema fluid be reabsorbed back into your vessels. Your blood pressure usually decreases, and your baby benefits from the extra blood flow. You can enjoy catching up on your favorite soap or reading a romantic novel for the third time. Strict bed rest usually isn’t necessary, but cooking, cleaning, shopping, and bouncing babies around are off limits. If you try to continue your normal activities, your preeclampsia will only get worse and you’ll end up in the hospital.

Besides rest, your doctor will have you take your BP several times a day. Check your BP in the same arm in the same position each time for consistency in the readings. She may also have you check your urine for protein with a dipstick.

Your trips out of the house will be short. You can go to the doctor’s office or hospital to have stress or nonstress testing to monitor how the baby is handling the effects of the preeclampsia. You may have blood tests done weekly to monitor the progress of the disease. Ultrasound exams may be done to reassure everyone your baby is growing on schedule. If you aren’t getting better despite the decreased activity, hospitalization may be necessary.

With severe preeclampsia, your BP will be 160/ 110 or higher on two or more checks 5 minutes apart after resting. Your urine will show 2+ or more protein. You probably won’t feel well. You may have what you think is heartburn and a headache. The treatment is hospitalization. The decision to deliver your baby will depend on what your doctor decides is the best course of action for both you and your baby.

With severe preeclampsia, your doctor is worried about convulsions. She’ll give you magnesium sulfate, the drug used to prevent seizures, usually administered intravenously. When the drug is first administered, you may develop a stuffy nose, headache, and feel very flushed. These common side effects subside within a short period of time.

Your doctor will discuss the available options and help you understand the best course of action for both you and your baby. Remember, with delivery comes the cure. Preeclampsia has no long-term effects, you get well, and everything returns to normal. You’re soon feeling better and getting acquainted with your newborn baby.

Herpes

smart review online — Sat, 17 Oct 2009 13:09:02 +0000

Herpes

Not So Simplex

Herpes simplex used to be just a plain old “cold sore.” In the 1980s it became the dread virus that threw a wet blanket on the fires of the sexual revolution. The herpes hysteria grew because medicine had neither prevention nor cure. Even the admonition “Hey, let’s be careful out there!” didn’t help. The herpes hysteria has diminished because of the more serious threat of AIDS.

The herpes virus is the Greta Garbo of sexually transmitted diseases elusive and mysterious. The true incidence of herpes isn’t known since it’s not reported to public health agencies. Even trying to confirm whether or not you have herpes can be maddening. Let me count the ways.

Blood Test

A blood test only proves exposure to the virus, not whether you’ve had herpes. Most adults will have a positive test that only shows a universal exposure to the virus.

Cultures

The only way to prove the diagnosis of herpes is to use a swab and dab the suspected area and have the specimen tested to see what grows (culture). Problems arise with false positives (the test says you have it but you don’t) because of other viral infections. False negative culture (virus present but doesn’t grow) occurs even if you have lesions but they aren’t “shedding” at the time. It’s also possible to contract the virus and not have it show up as an infection for years. No one knows for sure what triggers the infection. Some marriages have met an untimely and unnecessary end over who gave what to whom. Remember, a clinical diagnosis, where the doctor just looks at the lesion and says “Yep, you’ve got it,” is subject to error. Cultures must be done to be certain.

Contracting herpes creates havoc with both your body and psyche. Common feelings are shame and guilt. You may feel like a sexual leper. Your pregnancy will probably dredge up those old feelings you thought you had worked through, especially the guilt. Now you have your baby and the possible consequences to consider. The facts should reassure you and allow you to enjoy your pregnancy without the gloom and doom.

Just the Facts

One percent of pregnancies are complicated by herpes. The risks to pregnancy differ between the primary infection (your first) and any recurrence. In early pregnancy with a primary infection, there’s a greater risk for miscarriage but not birth deformities. Herpes generally isn’t an indication for terminating pregnancy. In the last 6 weeks of pregnancy, there’s an increased risk for preterm labor and infecting the baby after birth. Recurrences of herpes during pregnancy don’t offer any risk to the baby; very rarely does the virus cross the placenta to the baby. The number of babies who actually become infected with herpes after birth is very small, 1 in 4000 or 5000. Unfortunately, those babies who acquire herpes have a mortality rate of 40 percent. Two-thirds of those who survive have serious neurological problems or eye damage. To help ensure your peace of mind, here are a few simple guidelines to follow:

If you’ve already been proven as having herpes, no cultures are needed during pregnancy.

If you haven’t previously had herpes and you discover lesions (sores), you need to be cultured while the virus is still “shedding.” The best time to do a culture is when you feel the tingling or burning right before the outbreak and the first or second day after the outbreak. Make an appointment with your doctor and show him exactly where your suspected lesion is.

During outbreaks, be sure not to spread the lesions to other parts of your body. Soap and water are good disinfectants. Corn starch on the sores and drying them with your hair dryer work as well as anything.

There’s but one cardinal rule: The baby and the virus shouldn’t meet. If lesions are present when you go into labor, you’ll most likely have a cesarean.

If no lesions are detected at the time of labor, you’ll have a vaginal birth.

Delivery Management

When lesions are present at delivery, a cesarean birth is done to try to prevent transmission of the virus to the baby, but there are no guarantees. When there are active lesions and the membranes are ruptured, the role of cesarean is unclear. Some doctors won’t do a cesarean if the water has been broken for more than 4 hours because they feel that the infection has had ample time to travel upward into the uterus. Other doctors prefer to do a cesarean regardless of the length of time the membranes have been ruptured. It’s a tough decision because no one knows for sure which is the best approach.

The Good News

Even if you deliver with active lesions, remember that more than 90 percent of babies don’t become infected. Most babies appear to be protected from infection by the mother’s antibodies.

After delivery, even if you have lesions, the only precaution you need to observe is good hand-washing. Isolation procedures or a private room aren’t necessary. The nursery may insist you room with your baby, depending on their policy. You can breast-feed if you wish.

Complications in Pregnancy

smart review online — Sat, 17 Oct 2009 13:04:54 +0000

Complications in Pregnancy

Rain on Your Parade

For the majority of women, pregnancy is a normal and physiologically uneventful process. You count on breezing through pregnancy with no problems, looking and feeling great. When complications arise, you’re forced to make adjustments in your idyllic pregnancy plan. It is not an easy adjustment for most women. Your self-esteem suffers. Disappointment and anger are common emotions as you struggle to deal with the unexpected events. You add anxiety and fear for you and your baby to the witch’s brew of unknowns facing you. You need expert care, added emotional support, and accurate information to cope effectively with the changes.

When you understand the basics, your anxiety decreases. When you’re calm, you’re better able to hear and understand what your doctor communicates to you. You’ll find that you can cope and maintain some control over the unanticipated events which altered your pregnancy plans. You don’t have to junk your original blueprint for your pregnancy; you just have to do some remodeling. For example, you can still enjoy and revel in the normal aspects of your pregnancy. You can feel the baby move, take childbirth classes, and shop for baby furniture. You’ll still experience those “normal” aches and pains of pregnancy along with every other pregnant woman. Only part of your pregnancy is complicated, not all of it!

Gestational Diabetes

Approximately 1 to 4 percent of pregnant women develop the condition known as gestational diabetes. What happens?

Pooped Pancreas

During the second trimester, the hormones of pregnancy are in full force. These hormones inhibit the effectiveness of insulin in the body. The pancreas, which produces insulin, has to work harder to produce more insulin to keep up with the increased demand. Most women are able to meet the increased demand; for those who can’t, a temporary state of diabetes results when the demand is greater than the supply of insulin.

Banking on Your Body

In the diabetic state, your body can’t effectively transact the business of converting the food you eat into energy. The food you eat can be considered energy checks that you deposit in your body bank. Insulin acts as the bank teller who converts your checks into available energy. Simple sugar is like cash for immediate energy; fat is stored as savings for emergencies; other sugar is stored as an easy access checking account. Insulin is the key to the system running efficiently and keeping you in funds. Without insulin, your assets are frozen. Your deposits don’t make it into your accounts, and you don’t have access to what’s already there. Your blood develops high levels of sugar but isn’t able to use it. It’s similar to having $1 million in a safety deposit box but not having the key to open it.

Good News

Unlike the type of diabetes that requires insulin; gestational diabetes is a temporary condition. After delivery, when the pregnancy hormones are gone, your body returns to its regular metabolism. Also, your baby doesn’t run the increased risk of developing congenital anomalies since gestational diabetes doesn’t develop until the second trimester. Let’s discuss some potential problems that do need to be anticipated.

Fit or Fat

The higher blood sugar levels you experience with gestational diabetes present some problems (or you and your baby. Your baby’s prime fuel is sugar. By 12 weeks she’s making her own insulin to handle the sugar you give her. Your blood sugar crosses the placenta very easily. When you have excess amounts in your bloodstream, it gravitates to the baby. Uncontrolled blood sugar levels that are chronically elevated pose big risks for your baby.

The chronically elevated blood sugar levels force-feed the baby; excessive weight and size result. The more your baby weighs the more potential problems for both of you during labor and delivery. For example, you may have no problem delivering an 8pound baby, but at 9 to 10 pounds there isn’t enough room. Birth injury to you and the baby is a possibility. Your chances for a cesarean birth increase. Jaundice and low blood sugar (hypoglycemia) are also common complications for the baby when blood sugar is uncontrolled during pregnancy. Detection and management of the condition are crucial for a successful pregnancy.

Detection and Treatment

The American College of Obstetrics and Gynecology (ACOG) recommends screening all pregnant women 30 and over and those who have risk factors for diabetes. Many experts believe that all pregnant women need screening at 24 to 28 weeks of pregnancy. Screening includes either ingesting a 50gram sugar drink or eating a meal high in carbohydrates. A blood sample is taken 1 to 2 hours later. Some doctors have sugar meters in their office and offer this test to their patients; it’s worth doing. These days, with early detection and appropriate management, many potential problems can be avoided.

Treatment of gestational diabetes is fairly simple. Your doctor will prescribe a diet from the American Diabetic Association (ADA). The diet controls your blood sugar, keeping it within safe levels. Most pregnant women are able to maintain their blood sugar with just the diet. It’s important to follow the diet if you want to avoid the problems discussed earlier. A reasonable exercise program also helps control blood sugar. If your blood sugar can’t be controlled with diet and exercise alone, insulin will be prescribed also. Remember, this metabolic condition is only a temporary one; with just a little extra effort on your part, you can assure that your baby will be healthy.

After Delivery

Half the women who develop gestational diabetes during pregnancy are at increased risk for diabetes in later life. So even if your metabolism returns to normal after delivery, you need follow-up. Developing diabetes in later life is associated with a family history of the disease, obesity, lack of exercise, and inappropriate diet. After pregnancy, resolve to continue the good eating habits you learned from your ADA diet, and continue exercising to lose unhealthy pounds. It will pay off in the future.

Insulin-Required Diabetes

For those of you who are diabetics and regularly use insulin, there’s also good news. The outcomes for women with diabetes and their babies is the best it has ever been. With well-controlled sugar levels during pregnancy, you can expect and have a healthy baby!

Management of insulin-required diabetes in pregnancy has become more efficient, less costly, and less disrupting to your life-style than it used to be. Monitoring sugar levels at home gives you more control and the consistent feedback you need to keep your blood sugar levels consistently within safe limits.

To assure the best outcome possible for your planned baby, see your internist, obstetrician, or perinatologist before you get pregnant. Achieving the best control possible before conception lowers the risks for congenital anomalies. By the time you realize you’re pregnant, it may be too late since the anomalies occur in the first trimester. Get an early start on prevention.

When to Call the Doctor

smart review online — Sat, 17 Oct 2009 12:14:19 +0000

When to Call the Doctor

Two kinds of women drive doctors crazy: those who call for every little twinge and those who wouldn’t call if they were staked to an ant hill because “I didn’t want to bother you.” Here are some hints to help you avoid falling into these two categories.

Any Vaginal Bleeding

Vaginal bleeding doesn’t automatically mean disaster, but the source of the bleeding needs to be investigated. Panic usually follows if you’re on the toilet when you discover the bleeding because even a few drops will look like gallons as soon as they hit the water. Wipe with toilet paper and make note of the color-bright red or more reddish-brown? Did the bleeding start after some activity, such as intercourse or moving furniture? Is it associated with cramping or localized pain anywhere? Your doctor will ask you these questions and how much blood you think you lost. Just remember the difference between bleeding and hemorrhaging: If blood isn’t running down your leg and filling up your shoe, you’re not hemorrhaging. Keep calm and call your doctor.

Swelling of Face and Fingers-Generalized Swelling

Swelling of feet and ankles is common in pregnancy, so it’s no cause for alarm. Swelling of face and fingers along with feet and ankles may be a sign of preeclampsia (toxemia) and needs some follow-up with your doctor.

Severe or Continuous Headache

Headache that is severe or continuous is another possible sign of preeclampsia. Dimness or blurring of vision may accompany this type of headache. Migraine headaches also have these symptoms.

Abdominal Pain

Aches and pains are so common in pregnancy that you sometimes need help in deciding if your abdominal pain is something to be concerned about. Before calling your doctor, think about what kind of pain you’re having. Where is it? What does it feel like? Do you have any other symptoms besides abdominal pain, such as bleeding? Have you noticed an increase in your vaginal discharge? Does the pain come and go, or is it constant? It may just be the old round ligament pain again, but call your doctor and check it out.

Persistent Vomiting

You need help with this one so you won’t become too dehydrated and upset your body’s chemical balance. Don’t wait until you’re dried out that your tongue looks like the sands of the Sahara. Call your doctor.

Chills or Fever

This could be old garden variety f1u that no one can do much about, BUT, it could also be a kidney infection, which is serious. If your temperature is over 101 degrees, call your doctor. If you have a fever lower than 101 degrees but pain in the area of your kidneys and/ or frequency and burning on urination, call your doctor; you may have a kidney infection.

The garden variety flu with temperatures below 101 degrees with no other symptoms usually resolves itself within 24 hours. Try Tylenol and fluids. If your symptoms don’t resolve within 24 hours or you’re concerned, call your doctor.

Painful Urination

Most women don’t have to be encouraged to call the doctor for this one. You feel like your bladder is going to burst, but all you can manage are a few drops that feel like razor blades. A bladder infection, besides being painful, is a common cause of preterm labor symptoms and needs to be treated because you can’ t cure it yourself.

Accidental Injury

Generally, the baby is well protected from blunt trauma to the abdomen in early and middle pregnancy by the cushioning effect of the amniotic fluid. In late pregnancy, injury to the baby is more likely to occur when the head is fixed in the pelvis and amniotic fluid is normally decreased.

Seven percent of women experience some type of injury during pregnancy. The vast majority of these accidents don’t harm the baby. Occasionally, injury to the abdomen can seriously decrease oxygen to the baby. Premature separation of the placenta from the uterine wall and high stress levels associated with an auto accident or other trauma are thought to be contributing factors.

If you have an accident, and your abdomen receives a blow, call your doctor. Some reassuring tests can be done in the hospital. In addition to examining you, the medical staff can evaluate the baby. A contraction stress test and fetal monitor can detect signs of fetal distress. The Kleihauer-Betke blood test is done to detect fetal bleeding. The tests may take 2 or 3 hours to complete, but you’ll have some peace of mind to go with your bruises.

An ounce of prevention: Wear your three point seat belt restraint. The lap belt should be positioned on your thighs. Seat belts significantly decrease injury to both mom and baby.

Social Drugs in Pregnancy

smart review online — Fri, 16 Oct 2009 14:32:50 +0000

Social Drugs in Pregnancy

Demon Rum

Alcohol doesn’t discriminate between mother and baby. It’s an equal opportunity drug that easily crosses through the placenta to the baby. If you become tipsy, your baby won’t pass a sobriety test. You wouldn’t dream f giving your newborn a martini, so don’t give your unborn baby one either.

The detrimental effects of alcohol on the developing fetus have been known for centuries. Carthage and Sparta passed laws to prevent newlyweds from drinking so they wouldn’t produce defective children. Thus, it’s not hot news that alcohol can cause problems for babies.

The exact amount of alcohol it takes to produce adverse effects on babies is unknown, but consuming 3 ounces or more per day puts your baby in the high-risk category for Fetal Alcohol Syndrome (FAS) and Intrauterine Growth Retardation (IUGR). Low birth weight and stillbirths increase when pregnant women consume more than 1.6 ounces of absolute alcohol per day. The highest risk for problems is associated with beer, rather than wine or liquor, despite beer’s lower absolute alcohol content. The reason is unknown. The risks are lower, but not zero, if you consume 1 ounce or less of alcohol per day, which is the equivalent to either 24 ounces of beer, 8 ounces of table wine, or 2 mixed drinks. No safe levels of alcohol consumption have been established for pregnancy. It’s a little like playing Russian roulette-you’ve no way of knowing you’re in trouble until it’s too late. The only safe course is to abstain during pregnancy.

No-No Nicotine

The dangers of smoking are well known. Because 20 to 30 percent of women of childbearing age smoke, let’s concentrate on the effects of smoking on your baby. Smoking causes your blood vessels to constrict, decreasing the blood flow carrying nutrients and oxygen to the baby, who won’t get full rations throughout pregnancy. Smoking inhibits your ability to metabolize certain important vitamins and minerals. If you aren’t absorbing those nutrients, neither is the baby.

Here’s a fact that may appeal to your womanly vanity. Vitamin C builds and maintains vital tissue and cells. Smoking prevents proper absorption for both you and your baby. The result to you is . . . wrinkles! The lack of vitamin C robs the skin of elasticity. Show me a woman who looks younger than her age, and I’ll show you a nonsmoker. The reverse is also true. Calcium is an important requirement in pregnancy. The baby needs lots of it, and so do you. Smoking prevents calcium absorption. Calcium is drained from your bones to supply the baby, leaving you with softening of the bones-osteoporosis in later life. It’s no coincidence that women under 65 who develop osteoporosis are overwhelmingly smokers.

Back to the baby. Smoking mothers produce a higher incidence of preterm births, miscarriages, stillbirths, congenital defects, and low birth weight babies. Smoking contributes to 20 to 40 percent of low birth weight infants. If you smoke 20 cigarettes or more a day, your baby will weigh approximately 1/2 pound less. Fifteen to forty-five percent of unfavorable pregnancy outcomes are attributed to smoking. And the effects don’t end at birth: Children of smoking parents continue to show a decrease in their lung function as they grow older.

As with any other drug, the effects are dose-related: more smoking, more problems. Give the kid a break! If you can at least cut down during the last trimester, your baby will be healthier. He can gain more weight, and all those growing brain cells he’ll need to become the next Einstein will get some extra nourishment. Should you decide to quit, the most effective way is cold turkey. Just stop. Your body is addicted to the nicotine, and trying to cut down just prolongs the agony of withdrawal. There are a number of self-help groups in the community dedicated to helping you quit-try one.

Popular Pot

Marijuana originated in central Asia about 5000 years ago. The Chinese used it as a remedy for various ills, but it never caught on with the party crowd there. In England during the 1800s, marijuana was considered a wonder drug that cured all. The Muslims used it for intoxication and to cure everything from asthma to dandruff and piles. George Washington grew pot on his farm… but don’t look for an expose in the National Enquirer. George wasn’t a closet playboy. He didn’t smoke the stuff; he made ropes out of it.

There’s the potential to become complacent about marijuana since cocaine seems so much more dangerous. Pot continues to be a very popular “recreational” drug; some say its use is epidemic. The effects of marijuana on pregnancy are still not clear. Some studies have associated marijuana use with smaller babies and a fivefold increase to deliver a baby with FAS features. Animal studies show a greater incidence of miscarriages, decrease in birth weight, stillbirth, and neonatal deaths. More information on humans is needed. Meanwhile, it’s safer to get high on meditation or exercise, especially while you’re pregnant.

Coke Catastrophe

Maternal use of cocaine during pregnancy is resulted at an alarming rate. The consequences are serious for both mother and baby. Placental abruption (premature separation of the placenta from the uterine wall) can occur because of the dramatic constriction of blood vessels with cocaine use. The mother can hemorrhage, endangering her life and her unborn baby’s. Cocaine increases the risk of preterm delivery and delivery of a baby small for gestational age. There’s also increasing concern about neurologic problems resulting from intrauterine exposure to cocaine that may have lifelong implications. These babies have emotional and physical disabilities they may never be able to overcome. If that isn’t enough, babies born to mothers who use cocaine undergo painful withdrawal from the drug in the first days of life, which isn’t exactly a loving welcome to the world.

If you use cocaine, you need help. Contact anyone of the several organizations available to help with cocaine problems and take advantage of their service. Do it before you become pregnant. Do it for you and your baby.

Stimulants (Coffee, Tea, Cola)

Caffeine, the socially acceptable “upper” for most of us, stimulates the central nervous system. Many people need one cup of coffee in the morning to get their heart started, and one to wake up. Drinking caffeine during pregnancy is generally safe, but drinking more than five or six cups of coffee per day (600 milligrams of caffeine) is associated with low birth weigh t babies and stillbirths. Caffeine is found in a variety of medications as well as tea and cola.

Be on the safe side and limit your caffeine intake to less than 400 milligrams per day. Caffeine is excreted less efficiently during pregnancy, and insomnia can result with even small amounts. If you have trouble sleeping, eliminate caffeine and see if it helps.

Over-the-Counter Drugs in Pregnancy

smart review online — Fri, 16 Oct 2009 14:30:41 +0000

Over-the-Counter Drugs in Pregnancy

OTC drugs are the ones you prescribe for yourself. Sixty-five percent of pregnant women medicate themselves for various ailments. A sound rule to follow is to avoid all medications for the relief of minor aches and pains in the first trimester. Only take medications ordered by your doctor and follow the directions to the letter. Here’s a review of some common OTC drugs used during pregnancy.

Aspirin

Aspirin is the most commonly used drug in pregnancy. It’s a great drug but not the best one for the pregnant woman. In excessively high doses, aspirin can cause congenital defects. Aspirin also alters the body’s clotting mechanism in both mom and baby, which is why it’s not recommended during pregnancy, particularly in the last trimester.

Acetaminophen

Acetaminophen is the generic name for products such as Tylenol, Datril, and Tempra, which have a safe track record in pregnancy. It has the same ability as aspirin to ease those aches and pains and to lower temperatures. In small doses, acetaminophen can be used safely during pregnancy.

Vitamins

Everyone agrees the pregnant woman needs extra iron, but what about vitamins? Physicians almost routinely prescribe vitamins during pregnancy. The experts in the field say vitamin supplementation isn’t necessary; the benefits are unproven. But ask the experts if they prescribe vitamins in their practice: They do.

Vitamins aren’t an acceptable substitute for a balanced diet. If you take a vitamin supplement, keep it simple. You don’t need to spend a fortune on prenatal supplements. One-a-day multiple vitamins will suffice. Megavitamin therapy during pregnancy is very risky. The fat-soluble vitamins A, D, E, and K can accumulate in the body and produce toxic effects. Birth defects and other problems have been related to excessive vitamin intake. For example, vitamin C in high doses taken regularly during pregnancy can lead to scurvy in the newborn baby after birth. The baby is used to the high levels of vitamin C, and when the supply is decreased after birth, the baby gets scurvy. When it comes to vitamins in pregnancy, “A little dab will do ya.”

Antacids

Heartburn can be a problem during pregnancy. Avoid drugs with high sodium content such as Bromo Seltzer, Alka Seltzer, or Fizrin. Two of these products also contain aspirin and caffeine. Baking soda isn’t a good idea either because it’s just more salt in your system. There are two acceptable remedies: TUMS and Amphojel. TUMS contain 500 grams calcium carbonate per tablet. You can alleviate your heartburn and supply some of your daily calcium requirements. Some doctors recommend TUMS instead of calcium pills if you don’t drink milk. Don’t overdo the calcium, or you may become constipated; three tablets per day is sufficient. Amphojel gives effective relief from heartburn but causes even more constipation than TUMS. Use both these drugs moderately. A word of forewarning: Antacids can be like nasal sprays. When they wear off, the heartburn can be even worse than before. Avoid all other antacids on the market while pregnant.

For an eye-opening guide to medications, read The Medicine Show by Consumer Reports, which gives the real scoop about the effectiveness, dangers, and expense of all those drugs you learn about in the media. It’s an education that could save you a lot of money.

Risky Rays

X-rays aren’t drugs, but many pregnant women are exposed to them during pregnancy, often inadvertently when x-rays are taken before the mother-to be even knows she’s pregnant. Current medical opinion feels that there’s no increased risk of abnormalities in these cases. Diagnostic x-ray studies (upper and lower intestinal series, kidney studies) generally should be avoided during pregnancy, but if they’re done, there’s no great reason to worry about the baby being abnormal.

Drugs in Pregnancy

smart review online — Fri, 16 Oct 2009 14:28:48 +0000

Drugs in Pregnancy

The Right Stuff

We have prescription drugs, over-the-counter (OTC) drugs, and the ever popular social/recreational drugs. There’s something for everyone. Pregnancy provides the opportunity for many women to examine their particular pattern of drug use.

Everyone wants a healthy baby with all the designated parts in the proper places. Pregnant womeI1 worry about birth defects and try to do everything possible to avoid harmful substances that might harm their developing baby. There’s much confusion and anxiety about what causes birth defects and the role that drugs play. When a miscarriage or abnormality in the baby occurs, the normal reaction is to look for a place to lay the blame. But it’s not that simple most of the time.

Pregnancy normally carries a 2 to 4 percent risk for abnormalities, and only 2 to 3 percent have a known cause. Drugs are implicated in approximately 6 percent of birth defects.

The Porous Placenta

There’s no placental barrier as previously thought. The placenta functions more like a sieve. Picture the strainer you use to drain spaghetti and you get the idea: Only the largest of particles can’t drain through the porous membrane.

Whether a drug affects a developing fetus depends on the drug, the particular period of pregnancy, how much is taken, how often, and so on. Some drugs can be dangerous at any time during pregnancy, not just during the first 12 weeks. The baby’s genetic susceptibility can also play a part. For lack of a better explanation, fate seems to be the only explanation as to why some babies have problems while most don’t. At least right now we don’t have all the answers. Avoiding all drugs during pregnancy is ideal but not always practical. Following are commonsense guidelines to drug use during pregnancy.

Prescription Drugs

Most people believe in the magic of medicine. We want quick cures and rely on pills, potions, and powders to cure what ails us. For every symptom there must be a pill to alleviate the misery. Suffering isn’t our strong suit.

Half of all pregnant women use at least one prescription drug during pregnancy. Antibiotics are frequently prescribed during pregnancy because infections have more potential to cause harm than an antibiotic. Ampicillin and penicillin are safe to take during pregnancy; there are others.

There are two antibiotics to avoid during pregnancy. Tetracycline will stain the developing baby’s teeth. Sulfa medications given near the time of delivery may cause the baby’s skin to become yellowed (jaundiced) in the first days of life. Your doctor has to weigh the benefits and risks of prescribing medications for you. For example, the risk of preterm labor from a urinary tract infection is higher than taking the medication. If you have the miseries from the flu or a cold, you don’t need medication; you can take to your bed and wait it out.

A Final Word

In truth, not enough information about drugs and their exact effects on pregnancy is available… a lot of unknowns out there. Don’t devote a major amount of time worrying about what you took during the first trimester when you didn’t know you were pregnant. If you took an aspirin or had a glass of wine, don’t spend the rest of your pregnancy walking on eggshells and worrying because you could make yourself crazy thinking about all the possibilities. The fact is, the vast majority of babies are healthy.

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