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A Short Cervix May Equal a Short Pregnancy

Thursday, October 18th, 2012

Taking care of yourself during pregnancy, has always been a trusted form of prevention for preterm births, so avoiding habits such as smoking and overeating are recommended. Sometimes, even women who stay healthy deliver preterm with no reasonable explanation. However, studies show that there could be a very obvious and physical predictor as to whether or not you will deliver your baby preterm.

Although controversial, there have been new recommendations that the cervix should be measured (transvaginally) in the midtrimester of every pregnancy in order to assess the possibility of a preterm birth. Critics of universal screening have cited a concern that facilities for transvaginal ultrasound screening are not widely enough available. There also is concern about the potential misuse or overuse of technology, and concern that many women will undergo treatment unnecessarily.

A recent review was published by one of the investigators of the study promoting the use of a hormone gel (progesterone) intravaginally to treat such shortened cervices. This investigator was also a paid consultant for the company who manufactured the progesterone gel and therefore, had a serious conflict of interest in her recommendations. Nevertheless, there is mounting evidence that a cervical length measuring between 10-20 mm places the pregnancy at increased risk for early delivery. It has long been known that women with a shorter cervix are more likely to give birth preterm. However, the best management approach eluded clinicians until several studies demonstrated that women who had a history of preterm birth fared better when they were given weekly injections of progesterone (17a-OH progesterone caproate). In patients without a history of preterm birth, the treatment was not given; that is, until recent studies demonstrated shortened cervices, identified at midterm, had better outcomes when the patient was treated with a progesterone gel intravaginally.

Preterm labor, defined as birth before 37-weeks of pregnancy. Cervical insufficiency results when the cervix dilates (without labor contractions) leading to a preterm birth. Shortened cervices are more likely to have cervical insufficiency. With that said, ACOG (American College of Obstetricians and Gynecologists), a governing body for OB/GYNs) fell short of mandating routine transvaginal cervical length screening in women without prior preterm birth.

When you become pregnant, it will be up to your physician or midwife to request a midtrimester ultrasound, which looks at the cervix as well as the fetus for anomalies. If your cervix is abnormally short, you and your physician can be prepared for preterm labor and intravaginal progesterone can be offered. Another form of management also sounds good in the form of a cervical cerclage, or a stitching of the cervix to prevent labor before the 37th week. However, this plan of management remains controversial with several studies showing no improvement in outcomes for preterm fetuses. Also, the downside of a cervical cerclage is rupture of membranes and infection, which may ultimately lead to hysterectomy. With a shortened cervix, patients may be advised to take bed rest in your last trimester to prevent any unnecessary pressure on the birth canal.

A short cervix is probably not a feature you’ve ever included in a physical description of yourself, but when you become pregnant, it could become the difference between a preterm infant and a baby that has grown to term.

– Yvonne S. Thornton, M. D., M. P. H.

Source:

Alfirevic Z, Owen J, Carreras Moratonas E, Sharp AN, Szychowski JM, Goya M. Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with history of preterm birth and a sonographic short cervix. Ultrasound Obstet Gynecol. 2012 Sep 18. doi: 10.1002/uog.12300. [Epub ahead of print]

Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate.Szychowski JM, Berghella V, Owen J, Hankins G, Iams JD, Sheffield JS, Perez-Delboy A, Wing DA, Guzman ER; for the Vaginal Ultrasound Trial Consortium.J Matern Fetal Neonatal Med. 2012 Aug 24.

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Tags: Pregnancy, short cervix, women's health

Why Pregnancy Will Leave You Breathless

Thursday, October 11th, 2012

Especially if you were fit before your pregnancy, losing your breath when performing simple tasks seems like a reasonable cause for concern. Running a half marathon before you became pregnant was easier than going up a flight stairs with your baby bump because you become winded at the third step. While losing your breath can be frightening at times, it is actually a common side effect of pregnancy. Many women experience it, and unless you’re really having trouble breathing and there are other side effects, you don’t need to rush to the doctor. There are a few harmless reasons you might be losing your breath.

You might experience breathlessness even in your first few weeks of pregnancy. While this seems outrageous because you have very few other symptoms, it’s actually because your body is sending more oxygen to the fetus. The hormone progesterone is doing its job and increasing your lung capacity so that you can take in more oxygen. That extra oxygen is then sent down to assist in the development of your baby. So, you might feel like you’re not getting enough because your body and breathing patterns are not adjusted to this newly added space in your lungs.

Later in your pregnancy, your growing uterus will more likely cause your breathlessness. Your baby bump will begin to push up against the surrounding organs, including your lungs. You might feel like you can’t get a full breath in because, frankly, you can’t. Most women experience this most at 31 weeks and later when the uterus begins pushing against the diaphragm.

If you start feeling short of breath during your pregnancy, your first instinct will be to panic. Instead, you should relax, as panicking will only make it harder to breathe. Stop what you’re doing and breathe slowly and deeply, and soon you’ll catch your breath. You should also try improving your posture so that your lungs can easily reach full capacity. If you find it difficult to breathe through the night and upon waking up, try sleeping in an upright position, as it could be a sign that you sleep in a way that restricts the lungs. Amazingly, you might notice that your breath returns to normal in your last few weeks of pregnancy because your baby will drop down to the birth canal. Breathe deeply and start getting ready, because you’ll be a mom in no time.

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: breathing problems, Pregnancy, women's health

Drink Up Ladies!

Thursday, October 4th, 2012

If you were lost on a desert island, you would probably die from dehydration before you died of starvation. This is surprising for many people, since we all know how hungry we can get when we accidentally skip even one or two meals. The symptoms of dehydration are harder to pinpoint, but it’s extremely important that you get enough water every day. If hydration is so vital to our wellbeing on a regular basis, imagine the importance of it during pregnancy.

Women who are pregnant should be diligent in staying hydrated for the duration of their gestation. It is easier to become dehydrated when you are pregnant. For one thing, you are probably experiencing more nausea and vomiting than you ever have. Morning sickness is common, and every time you lose your lunch, you could become seriously dehydrated. The worst part is that you won’t have the desire to drink fluids after you’re sick, so the problem is not always remedied.

I recommend to my patients that they should drink, at least, two quarts of pure water per day. Not soda, not tea, not coffee, but good old-fashioned water. In the summer months, that amount should increase by a quart in order to compensate for the increase in perspiration and insensible loss. With the recommended quart of skimmed milk per day, I really don’t understand why there is a need for any more fluids in the form of soft drinks, etc. Becoming dehydrated during your pregnancy, even temporarily, puts your baby at risk for serious complications. When a pregnant women is dehydrated, that fluid restriction is thought to decrease the production of amniotic fluid in your womb. Particularly, in the second or third trimesters, dehydration can lead to premature labor because it triggers the same hormone that causes uterine contractions (oxytocin), not to mention the typical pains of dehydration such as headaches and muscle cramping.

The best way to prevent dehydration during your pregnancy is to drink more than enough water and stay out of the extreme heat and direct sunlight. If you experience symptoms such as dark urine, infrequent urination, headaches, dry mouth, chapped lips, and dry skin, contact your doctor immediately. It might be too late for water to solve the problem, and hospitalization might be required.

In a perfect world, we could all relax during our pregnancy and focus only on our health. Unfortunately, we are all busy people and our daily lives are often full of other concerns. If you find it difficult to keep track of how much water you’re drinking, consider keeping a log to make sure you’re always getting enough. Dehydration can be serious, so make sure avoiding it becomes one of your top priorities.

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: dehydration, Pregnancy, women's health

Ditch the Itch——Are You at Risk for Obstetric Cholestasis?

Monday, October 1st, 2012

There are many reasons why you might feel itchy during your pregnancy. You might start to itch around your midsection because your skin is stretched. You also might itch because of your prenatal vitamins. The hormones released during gestation also make your skin more sensitive, so even something as simple as your perfume or fabric choices might have you scratching incessantly. However, if you’re experiencing severe, generalized itching (pruritus) all over your body (especially the soles of your feet) that won’t go away, it’s time to talk to your doctor. It could be a sign of a serious condition known as obstetric cholestasis.

Obstetric cholestasis (OC) or intrahepatic cholestasis of pregnancy is a disorder that affects the liver and develops during pregnancy. Ten percent of the affected women will develop jaundice. Essentially, it is caused by a buildup of bile salts that are supposed to be flowing to and from your liver in the digestion of food. You’re at a higher risk of OC if it runs in your family. So, if your mom had OC while she was pregnant with you, there’s a good chance you’ll get it, too. It is also more common in women in Pakistan, Sweden and Chile. Unfortunately, there is no cure for OC. Itching usually resolves within a few days of delivery, and subsequent liver problems are uncommon — although cholestasis is likely to recur with other pregnancies. Because the liver is involved and the liver is responsible for clotting factors, blood tests to check your clotting factors are done throughout the pregnancy and you may need to take Vitamin K supplements, depending on the test results. Although the condition may seem to be just a nuisance and annoying to the mother, it can lead to stillbirth. So, it is a very serious condition. Because most fetal surveillance studies, such as electronic antepartum fetal testing (nonstress test) are very poor at predicting stillbirth in this disorder, doctors recommend that women with OC with elevated bile salts need to have their labor induced at 37 weeks (after fetal lung maturity has been established) to make sure the baby makes it out healthy and happy.

If your physician determines that the cause of your itching is in fact OC, you’ll need to get regular tests to make sure your liver is functioning properly. For some women, the itching is unbearable, so you should talk with your physician if the itchiness is interfering with your daily activities. A medication, known as Actigall (ursodeoxycholic acid ) helps regulate cholesterol by reducing the rate at which the intestine absorbs cholesterol and consequently is effective in alleviating the itching. Aveeno^®oatmeal baths, topical steroid creams and other steroids have been used with some success. . You should also try to scratch your skin as infrequently as possible, as open cuts from scratches could become infected. Although, when you’ve got the pregnancy itch, not scratching is obviously easier said than done!

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: itching, obstetric cholestasis, Pregnancy, women's health

Prepare for Pregnancy After-Pains

Thursday, September 27th, 2012

You already know about the pains associated with pregnancy. The discomfort you feel in the months leading up to your due date don’t end once you give birth though. This is where many women are caught off guard when they learn that a week or two of healing after their delivery doesn’t leave them completely pain free.

When you consider the dramatic shift your body has experienced throughout your pregnancy, it shouldn’t be too surprising that it will take it awhile to get back to normal. Your weight isn’t the only thing that will take a while to reset though. After all that tightness, stretching, and pulling, your muscles, ligaments, and skin have been through a lot, and that will make them sore for some time. As these areas adjust, so too will your uterus, as it contracts back up into its original size and location. This process can take up to six weeks, and during that time (especially during breast feeding), you may feel after-pains from this movement. Urinating regularly can help relieve some of this discomfort. If you received any stitches, these will obviously be a bother and will take time to heal. Your swollen breasts will also be sore, and the nipples will probably get even more painful as they adjust to your child’s frequent feeding schedule. Your entire body will need to rebalance, and the if you had back pain from carrying the baby the last few months of pregnancy, it may take a couple more to ease the discomfort . Getting in shape will help speed this along, but don’t push yourself too much. You’re allowed some time to recuperate.

If you’ve already discovered these lasting pains and are trying to find ways to endure, there are a few pain relieving strategies you can try. Sitz baths, ice packs, wash bottles, and massages are supportive measures for postpartum pain. However, a new mom should not deprive herself of effective pain medication, such as extra-strength Tylenol, ibuprofen or prescription pain medications given by her doctor, even if she is breastfeeding. If you’re in very intense pain though, speak with your physician to make sure there isn’t a more serious issue. They may have advice for other safe pain relieving methods too. Otherwise, welcome to the joy and pain of parenthood!

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: after-pains, pain relief, Pregnancy, women's health

What Does Your Baby Bump Tell You about Gender?

Monday, September 17th, 2012

We’ve all heard a few old wives’ tales concerning the prediction of gender in a developing fetus. Some say that the position of your belly is an indicator of the gender. If your belly is protruding on the lower side, then it’s a boy, and if it has settled fairly high, then it’s probably a girl. If only it were this easy to tell. Unfortunately, it is not this easy, and now there is proof. When I was pregnant with my two children, I was carrying “high” both times and yet, I have a son and a daughter. If looking at a pregnant woman’s belly forecasts the gender, then we could do away with prenatal studies.

Some people rely on the lunar calendar and still others have come up with the curious baking soda test. While these supposed gender predictors might be fun and grandma might claim to be absolutely sure of their accuracy, these and the location of your belly simply have no correlation with the gender of your baby. Researchers in Australia who had been testing various methods for gender prediction decided to take on the baby bump test. Their test would try to correlate the position of the placenta with gender prediction. Using ultrasound to identify and record the location of the placenta, they observed 277 pregnant women. They found that the rate of males and females born was almost 50-50 and that there seemed to be no connection between the location of the placenta, and gender. Instead, they found that the assessment of the baby’s genital tubercle at 12-14 weeks as a prediction technique was much more useful, with an accuracy rate of more than 85%. This is the tiny little nub that starts to protrude as your baby develops. Doctors have found that the angle of this nub can tell them a great deal about the resulting genitalia.

Although it may be tempting to quote this study to grandma, it is a sad commentary on our culture when we seem to have an insatiable need to identify gender. There really shouldn’t be any need to identify the gender if we are going to treat little girls the same as little boys. But, we don’t. This obsession with trying to identify gender (often leading to feticide in many countries) only underscores the lingering sex discrimination that still exists in the 21^st century. What difference does it make whether the growing fetus is a boy or a girl——unless they are going to be treated differently? When someone asks, “Is it a boy or a girl?” They are knowingly or unknowingly perpetuating the idea that one gender is better or worse than the other. We should be asking, “Is the baby healthy?”

The next time people try to tell you that your belly looks like it’s holding a boy or girl, you can simply smile and nod and let them have their fun. Instead, rely on your doctor and hope you have a healthy baby. Even better, leave it up to fate and wait for the surprise.

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: gender, Pregnancy, women's health

Prepare for Pregnancy After-Pains

Thursday, September 13th, 2012

If you’ve already discovered these lasting pains and are trying to find ways to endure, there are a few pain relieving strategies you can try. Sitz baths, ice packs, wash bottles, and massages [http://www.webmd.com/parenting/baby/news/20041103/pain-after-childbirth-common-often-untreated] are supportive measures for postpartum pain. However, a new mom should not deprive herself of effective pain medication, such as extra-strength Tylenol, ibuprofen or prescription pain medications given by her doctor, even if she is breastfeeding. If you’re in very intense pain though, speak with your physician to make sure there isn’t a more serious issue. They may have advice for other safe pain relieving methods too. Otherwise, welcome to the joy and pain of parenthood!

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: after-pains, pain relief, Pregnancy, women's health

How Safe is Your Acne Medication?

Monday, September 10th, 2012

It seems that every teen goes through skin issues because of all those hormones. However, many women suffer from acne far into adulthood. This has them using a variety of treatments to keep their skin looking nice. Unfortunately, one acne medication has dangerous side effects, including birth defects.

If you are pregnant, breastfeeding, or planning to become pregnant in the next year, you will need to avoid medications, including acne treatments, that could be unsafe for your baby. One brand in particular, commonly known as Accutane, can cause birth defects like cleft palate, heart defects, hydrocephaly, and microcephaly. There have been warnings issued, but many women are unclear as to whether or not their medication is dangerous or not. Take the time to check the ingredients and warning label on your acne medication boxes and bottles. You’ve likely been using it for years, so you might not have thought to check these areas once you became pregnant. Don’t just look for Accutane when weeding out your products though. The drug is also found under the name Isotretinoin. If you see either of those words on the label, you’ll need to replace it with a safer brand. These particular ingredients are normally found in pills for treating nodular acne, so there are many other safe alternatives.

Getting a handle on skin care can be frustrating, but clear skin is not worth the price your child and your family will pay if you have a baby born with defects, some of which are life threatening. As soon as you think you might want to become pregnant, take a look through all of the products you put on and in your body, because very soon, you’ll be sharing it with a very delicate new life.

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: Accutane, acne, birth defects, isotretinoin, Pregnancy, skin care, women's health

Chocolate is the Caffeine of Choice for Moms to Be

Thursday, August 30th, 2012

When you get pregnant, you want to do everything you can to ensure the safety of your developing baby. For this reason, most moms cut out foods, drinks, and chemicals that might have adverse effects on their baby. Caffeine is just one thing they often give up, which means no more tall daily lattes or espressos. Although high levels of caffeine can be dangerous, small amounts are fine, and one study found that the levels of caffeine found in chocolate are safe for moms and their unborn babies.

Many experts agree that moms should avoid taking in any more than 200 mg of caffeine per day. This allows for a small cup of coffee, but most women still choose to avoid it altogether, which is probably a good idea, unless you need it as a stimulant for bowel regularity. You never know how much caffeine a particular brew of coffee might hold, and it’s always better to be safe than sorry. When pregnancy has you craving something sweet though, you might forget that chocolate too contains caffeine.

Fetal heart rate reactivity is a medical term that describes how reactive the baby’s heart rate is when it is moving around in utero. With fetal movement, the fetal heart rate accelerates about 15 beats per minute and is a sign of fetal well-being. Fetal reactivity assessment is used as a surveillance tool when we are worried about the baby in a Mom who may have hypertension or diabetes (known as a nonstress test or NST). The more “reactive” the fetal heart rate is, the better. A study published in the Journal of Maternal-Fetal and Neonatal Medicine determined that eating chocolate can make the fetal heart rate more reactive . This increased heart rate did not appear to be from the caffeine in chocolate, but rather from the theobromine, which dilates blood vessels and decreases blood pressure. In order to make up for this physiologic change, your heart and also your baby’s heart have to pick up the pace in order to maintain adequate blood circulation, resulting in a more reactive fetal heart rate pattern, which is a good thing.

However, as with any chemical, food or supplement that alters your body function, it should be taken in moderation. In other words, don’t go overboard, but don’t feel the need to pass up on a “chocolate moment” to satisfy those cravings once in a while either.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Pregnancy, Women's health news, Your newborn baby | No Responses »
Tags: caffeine, chocolate, Pregnancy, women's health

Don’t Rush Your Delivery

Monday, August 27th, 2012

While being pregnant is a blessing, how you feel while pregnant is hardly ever comfortable or convenient. As your delivery date approaches, this will become even more true. That doesn’t mean it’s a good idea to rush your delivery though. In fact, rushing your delivery could lead to serious problems that would make life after your pregnancy even more inconvenient. Let me clarify the definition of a full-term pregnancy. A full-term pregnancy is between 38 weeks, 0 days and 42 weeks, 6 days. Yes, four weeks! Mother Nature gives the baby four weeks to make up its mind to exit the padded “condo”. With that said, recent neonatal literature (http://journals.lww.com/greenjournal/Abstract/2011/11000/Neonatal_Outcomes_After_Implementation_of.12.aspx) has concluded that babies who are delivered before the 39^th week of gestation are significantly at risk for neurological deficits and respiratory problems.

Unfortunately, we have become a society of convenience. Consequently, there has been an increase in the number of births by early induction of labor lately. While it’s true that if there is medical reason to induce labor early, it can be a necessity, that does not mean it is safe or recommended for everyone. In some cases, couples decide that they would like their baby to be born on a special date for future birthdays. For others, it is because a father might be leaving for a while and would otherwise miss the birth of his child. In still other cases, doctors actually recommend early induction simply because they are hoping to have the holiday off or don’t want to be called away from their vacation should delivery come later than the expected due date. A study by the Agency for Healthcare Research and Quality concerning the results of elective induction once again confirm the dangers involved. Inducing labor before your baby is ready, can cause serious problems that could harm his or her physical and mental development. Those developmental issues could affect them for the rest of their life. Also, babies born too early often have to stay in the hospital longer and sometimes must spend that time in intensive care. The March of Dimes has supported this study and is now strongly opposing early elective delivery before 39 weeks.

Although you and your doctor might be itching to get that baby out and into the world, that is no reason to induce labor. If it becomes medically necessary to do so, then it can be done safely, but the risks are still increased. If your doctor urges you to induce labor without a medical reason, seek a second opinion. If it’s just your impatience pulling you in that direction, be patient. You’ll have plenty of time with your little one soon enough, and by waiting for your baby’s natural delivery date, the time you get with them will be of a much better quality.

– Yvonne S. Thornton, M. D., M. P. H.

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Tags: early delivery, inducing labor, Pregnancy, women's health