BABYssentials » The First 9

Hypertension – Part 3 – Preeclampsia

Saul — Thu, 29 Jul 2010 02:52:22 +0000

Previously, we have discussed high blood pressure that occurs to pregnant women prior to pregnancy known as pre-existing hypertension as well as hypertension that occurs as a result of pregnancy known as gestational hypertension. In this segment, we are going to discuss preeclampsia. Preeclampsia occurs when a woman has high blood pressure during pregnancy that has started to affect other organ systems in her body, more specifically her kidneys. When the high blood pressure starts to affect the kidneys, they do not perform their task of filtering protein out of the blood. The unfiltered protein then makes it way into the woman’s urine causing a situation called proteinuria. One cannot detect proteinuria with the naked eye. Additionally, one will not feel any symptoms of proteinuria. Using advanced tests, your doctor will be able to detect proteinuria. If a woman experiences both high blood pressure and proteinuria, they have what is known as preeclampsia.

Who is at risk for preeclampsia? Women who have had high blood pressure as well as those who have preeclampsia in the past are at risk of developing the condition. Additionally, individuals who are overweight and those who are either very young (teenagers) or very old for being pregnant (over 35) are also at risk. The blood pressure of those who fall into these categories will usually be monitored carefully by a doctor.

Preeclampsia can be very dangerous. Today, the only known cure of preeclampsia is to deliver the baby. If preeclampsia develops early in pregnancy the doctor may need to deliver the baby early in order to cure the disease. Occasionally one may be monitored carefully and may be admitted to the hospital to be put on bed rest. During this time, tests will be ordered to ensure that the baby is growing poperly. Doctors may also provide treatment for the elevated blood pressure.

Preeclampsia can lead to worse disorders if not treated appropriately. It can affect one’s liver and blood and some people can develop a condition known has Hellp syndrome which stands for H — hemolysis; EL — elevated liver enzymes; LP — low platelet count. When one displays symptoms of Hellp syndrome, it is a sign that preeclampsia has started to affect the liver and blood. Preeclampsia can also lead to seizures. If left untreated, preeclampsia can escalate to what is known as eclampsia which then begins to affect the brain. Because eclampsia it is such a serious disorder, it demands specialized care by a doctor and usually requires hospitalization and medication to both help prevent seizures and control the high blood pressure. During these situations, it is the goal to deliver the baby as quickly and as safely as possible. With proper care, most women and their babies will be fine.

Some common initial symptoms of preeclamsia include headaches, dizziness, nausea, blurry vision and pain in the abdomen (especially the upper right part). If you have any of these symptoms or feel that you are at risk for preeclampsia, definitely speak your doctor right away.

What Is Cervical Incompetence?

Saul — Fri, 23 Jul 2010 23:33:41 +0000

Cervical incompetence is a problem of pregnancy that is fortunately quite rare. When it happens, the symptoms usually occur during the second trimester of pregnancy. Cervical incompetence means that the cervix opens early and fails to maintain its strength. The cervix is the door to the uterus, and must remain closed throughout the pregnancy all the way until the end. When you are in labor, the door needs to open and allow the baby to be delivered. For this reason, it’s very important for the cervix to be “competent,” meaning that it needs to be able to do its job holding the baby in during the duration of the pregnancy until it’s supposed to open.

Who’s at risk of cervical incompetence? Primarily, women who have had procedures and surgeries performed her cervix such as conizations or LEEP Procedures, especially if she’s had more than one, are at higher risk of cervical incompetence. These surgeries may disrupt the tissue of the cervix, preventing it from staying closed. However, some women have cervical incompetence without any risk factors at all, especially women who have had cervical incompetence in prior pregnancies.

When a women is at risk for cervical incompetence, her doctor will take specific measures to diagnose the situation. The doctor will often times use his or her fingers to check to see if the cervix is dilating, or opening. Other times the doctor will use an ultrasound to check the length of the cervix and to determine if it is open.

If you do have cervical incompetence, what are the symptoms? The symptoms of cervical incompetence are, unfortunately, very subtle. Feelings of pressure and feeling as if you have to “push,” as if the baby’s coming out are symptoms that women may experience in the advanced stages. However, early on, when the cervix first starts to open, there may not be any symptoms at all except for possible subtle changes such as spotting or discharge.

How is cervical incompetence treated? If the doctor catches this problem before it becomes serious and before the cervix opens too much, the doctor may decide to do a procedure called a cerclage. A cerclage is a procedure where your doctor will place a stitch in the cervix in order to strengthen it and hold it closed until the end of pregnancy. The stitch is removed prior to delivery of the baby. Whether or not a cerclage is appropriate for you really depends on the specific details of your case, and must be discussed with your doctor.

Hypertension – Part 2 – Gestational

Saul — Fri, 23 Jul 2010 22:42:27 +0000

Today we’re going to talk about part two of our discussion about hypertensive disorders in pregnancy. In the last segment, we spoke about pregnant women that have hypertension prior to pregnancy. Now, we’re going to talk about gestational hypertension. Gestational hypertension is hypertension that is caused by pregnancy and is affects women who have had no prior history of hypertension prior to pregnancy.

Who is at risk for developing gestational hypertension? Typically, pregnant women who have had gestational hypertension in a prior pregnancy, had a strong family history of hypertension, are overweight, have diabetes and who are smokers are at a higher risk of developing gestational hypertension during pregnancy. Why is gestational hypertension such a big deal? High blood pressure in pregnancy can lead to more severe diseases and disorders such as preeclampsia which will be discussed in part 3 of hypertension. It’s very important to treat hypertension during pregnancy properly.

If you develop high blood pressure during your pregnancy, it may be treated in a number of different ways. Sometimes, bed rest may be required near the end of your pregnancy because bed rest may help keep the blood pressure under control. Occasionally, medication may be prescribed to control the blood pressure. However, as the pregnancy nears the end, delivery of the baby may be the best way to cure the problem. Of course, each case is different and different factors must be taken into account including the severity of the situation and the length of the pregnancy. Your doctor will probably want to perform special tests on the baby to make sure that the baby is growing properly, is healthy and is not at risk of developing any serious diseases. Remember, always consult your physician as every case is different.

A History of the Due Date And Its Future

Saul — Wed, 14 Jul 2010 02:38:51 +0000

So much mysticism and mythology surrounds the pregnancy due date. Much of the mysticism is held by physicians who hold on to the old ways of determining when a pregnant woman will deliver. Believe me, most physicians would love a way to determine the due date so we could plan our lives around the deliveries of our patients, but the truth is only 1-2% of women will actually deliver on their due date. So what determines a due date, and what is the difference between EDC (estimated date of confinement) and EDD (estimated date of delivery) and what the heck is Naegele’s Rule? This post will help show the origins of the due date and how we are currently using a system that is about 250 years old.

Franz Karl Naegele (1778-1851) was the German obstetrician who initially came up with the rule to determine a woman’s due date based on her last menstrual period (LMP). There are many ways to calculate Naegele’s Rule. I use the system where you take the LMP, add 7 days, and subtract three months. So if your LMP was April 1, 2009 then your due date would be January 8, 2010. You can impress your friends at parties with this maneuver. However, there are problems with Naegele’s Rule and many people have pointed out that this 250 year old method is no longer appropriate for our advanced age. What are some of the potential errors with calculating the EDC in this method?

Firstly, Naegele’s Rule assumes that you are having a regular period and that you ovulate on day 14 of your cycle. As a gynecologist, I can tell you that there are many women out there who have irregular cycles and may ovulate on day 20, 25, 12, 15….you get my point. This obviously would add potential error to the EDC determination and could alter the due date by days and even weeks.

There is another assumption that the routine pregnancy is 280 days based on our current calendar system. The problem with this determination is that there are many months that contain 30 days or 31 days. And what happens in a leap year, or if you are not pregnant over the shorter month of February? A movement currently exists that is trying to state that the number should be 288 days and that we are inducing women that have premature babies.

A study performed in 1990 stated that the proper method for determining a due date was to take the LMP, count back three months and add fifteen days for a primiparous (first pregnancy) woman or 10 days for a multiparous (subsequent births) woman. This was published in the journal Obstetrics and Gynecology. There are many that argue that this method of calculating the EDC is as archaic as the term EDC itself. Lending to the agrarian societies from whence it came, the EDC literally came from the fact that a woman was confined to her bed for the last part of her pregnancy to prevent preterm labor. While we still prescribe bedrest today as a possible therapy for preterm labor, it does seem odd that the medical establishment uses terminology from the 1700’s.

The due date is as individual as the pregnant mother. While the EDC is currently calculated by Naegele’s Rule, this does seem a bit archaic and inefficient; especially if we are using this dating method to determine inductions and postdatism. Other methods to determine due dates have been proposed with increased accuracy, but they require a woman to measure body temperatures and be more involved in her own self-care. Many reading this article are very involved with birth and feel as though self-care is very important, but there are many women out there that simply choose not to be observant of their own cycle.

So what do we “do” with the “due?” Today, it seems that we will keep the current system in place while continuing to back it up with ultrasounds which are accurate within 5 days if performed in the first trimester. Approximately 3% of so-called term births (occurring after 37 weeks) are completed with fetal lung immaturity and this could be because the baby may have been born between 35-37 weeks and not the completed term. Are we too involved in the birthing process? Are there better ways to determine the pregnant due date or should we not worry about the date and just let man/woman be born in his own time. The latin word natura gives rise to the word natural and means “to be born.” Maybe we should just let nature take its course.

This article was written by Shawn A. Tassone, M.D. author of “Hands Off My Belly! The Pregnant Woman’s Guide to Surviving Myths, Mothers, and Moods” – Mom’s Choice Gold Recipient and Arizona Book Publisher’s Glyph Award Winner. For more information about Dr. Tassone and his book, please visit http://www.handsoffmybellyguide.com.

Hands Off My Belly! The Pregnant Woman’s Survival Guide to Myths, Mothers, and Moods is for sale on Amazon and Barnes and Noble and at most brick and mortar stores.

Depression, Medication and Pregnancy

Saul — Wed, 14 Jul 2010 01:48:52 +0000

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Among the many medical disorders that can affect women who get pregnant, depression is one of the most common. About 10 – 20% of women will have episodes of depression throughout their lives; depression during the time of pregnancy is no exception. Many are being treated with medications or other types of therapies for depression. The following question is very common: What do I do about my depression? How do I treat it? Do I have to stop my medicine? Do I have to change my medicine?

During pregnancy when one is depressed, one needs to consider the risks of taking medications. Although they are very, very rare, some antidepressant medications have been known to cause risks associated with pregnancy, However, they do exist. Some of these risks can occur to the baby after the baby has been born forcing the baby to withdrawal from the medicine. Additionally some medications may cause some effects on the baby’s development, specifically lung development.

Ultimately, if you are on anti-depressants, it is really important to speak with your doctor about the risks that apply. Because there is a very remote chance of something affecting the baby due to anti-depressants, the smart choice is to sometimes continue taking the medicine as the risks to the mother with sever depression may outweigh the potential harm to the baby. Again, these are things that need to be discussed with your doctor before you decide to stop, start or switch medicines.

Its is also important to remember that any woman who’s depressed during pregnancy is at higher risk of developing postpartum depression.