| Q: |
I've been told I'm “high risk” because of my blood pressure. What does this mean?
| | A: |
Blood pressure is monitored in pregnancy since raised blood pressure can be a sign of preeclampsia.
At each prenatal visit, your doctor or midwife will record your blood
pressure and assess your risk of preeclampsia based on the blood
pressure reading, your medical history, and family medical history.
Factors that may increase your risk of complications include:
High blood pressure.
Preeclampsia or raised blood pressure in previous pregnancies, or having a mother or sister who had preeclampsia.
Being over 35 years old and this being your first pregnancy.
Being significantly over- or underweight.
Having a multiple pregnancy.
If your midwife thinks
you are “high risk,” she will discuss a plan of care for your
pregnancy. Many women who are assessed as high risk have pregnancies
that progress without complications, but they are monitored a little
more closely.
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| Q: |
I've been told that because of my diabetes I have to go see a specialist—why is this?
| | A: |
Whether you develop diabetes in pregnancy (known as gestational
diabetes), or have preexisting diabetes, you will require special care
with support from a diabetic health-care team. This is because diabetes
poses risks in pregnancy if there is poor control of blood glucose
levels. In the mother, these include hypertension (high blood pressure),
thrombosis (blood clots), preeclampsia, diabetic kidney disease, and
diabetic retinopathy, a condition that affects the retina in the eye.
For the baby, there is an increased risk of congenital abnormalities and
growth may be too fast or too slow. It is important that your care
takes into account any other complications you may already have from
diabetes.
The key to a
healthy pregnancy and baby when you have diabetes is good blood glucose
control since your insulin requirements will change throughout
pregnancy. Controlling blood glucose levels reduces the risk of birth
defects and stillbirth, or a larger than expected baby, which can
present problems during birth. If you have gestational diabetes, you
will need to adapt your diet to include more complex carbohydrates and
fiber and reduce fats and sugar; you may also need insulin injections to
help control blood sugar levels. If you require insulin, then your care
will be managed by a physician.
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| Q: |
I have epilepsy—will I need special care in pregnancy?
| | A: |
Ideally, women with epilepsy should discuss their situation with
their doctor prior to conception. Epilepsy and the medication used to
control it do carry some risks in pregnancy, but there are ways to
minimize these. Some epileptic drugs are thought to be more harmful to a
developing baby than others, so your doctor may wish to change your
medication before you become pregnant. Although most women taking
epilepsy medication have healthy babies, taking any type of epilepsy
medication increases the risk of birth defects, so you will probably be
offered more frequent ultrasounds. The goal is to control your seizures
on the minimum dose. The medicine also restricts your body's absorption
of folic acid, which reduces the risk of an unborn baby developing
neural tube defects such as spina bifida, so your doctor will probably
discuss taking a higher dose of folic acid. Once your baby is born, you
will generally be advised to breast-feed if at all possible, since any
risk to the baby from the medicine is outweighed by the many health
benefits of breast milk.
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| Q: |
I'm 28 weeks and have been having contractions. Will my baby come early?
| | A: |
From early pregnancy, the uterus “practices” contracting in
preparation for labor. A mother is usually unaware of these practice
contractions, known as “Braxton Hicks,” until later in pregnancy, when
they can be felt as a hardening of the “belly.” each contraction lasts
from a few seconds to a few minutes before the uterus relaxes and
becomes soft again. These contractions are painless (although they can
feel uncomfortable!), follow no regular pattern, and having them does
not necessarily mean that your baby will be born early. However, if you
experience painful contractions—described as being like strong
“period-type” pains—and they seem to increase in strength and frequency,
contact your doctor or hospital since you could be going into preterm
labor. You should also seek medical advice if you leak any fluid or
blood from the vagina.
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| Q: |
My last baby was premature—is this likely to happen again?
| | A: |
Having one premature baby, born before 37 weeks of pregnancy,
means that you have about a 15 percent chance of having a second preterm
birth, although this also depends on why you had a premature birth
originally. Reasons why babies are born prematurely include:
Infection in the mother.
Early rupture of the membranes (“water breaking”).
Multiple pregnancy.
Weak, shortened cervix (neck of the womb).
Unusual shaped womb, for example, a bicornuate uterus (heart-shaped womb).
A medical condition in the baby, for example, if the baby is not growing as expected, which means that labor has to be induced early.
A medical condition in the mother, such as preeclampsia, which also means that labor has to be induced early.
Although most of the
causes of premature birth cannot be prevented, there are steps you can
take to reduce the risk of premature labor. These include not smoking,
avoiding being under- or overweight, and avoiding extreme stress. In
addition, it is essential that you attend all your prenatal appointments
so that the well-being of both you and your baby is constantly
assessed. You should discuss whether there was an obvious reason for
your last baby being premature, and if there are any specific
preventative measures you can take to help avoid a reoccurrence this
time around.
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| Q: |
I'm expecting triplets. Will I be treated as “high risk”?
| | A: |
Yes, you will be classified as having a high-risk pregnancy since
all the usual risks are increased for women with twins and multiple
pregnancies. This is partly because hormone levels are higher when there
is more than one baby, and partly because it is hard work for your body
to carry and nourish three little lives! There will be an increased
risk of miscarriage; severe pregnancy sickness (hyperemesis gravidarum);
raised blood pressure/preeclampsia; anemia (iron deficiency); diabetes;
and premature and/or low birth weight babies. There is also an
increased, although small, risk that one or more of the babies will die
during the pregnancy. With triplets, you will almost certainly need to
give birth by cesarean section. Although considered a very safe
operation, this is still major surgery and carries the associated risks.
You can expect your
obstetrician to plan specialized prenatal care with you and you will
probably have more frequent checkups and scans. If you attend all your
appointments and care for your health, it is likely that you will have
three healthy babies at the end of your pregnancy. For more information
about multiple pregnancy and details of local support groups, contact
the march of dimes or your local neonatal intensive care unit (NICU).
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| Q: |
I have lupus—how will this alter my care during pregnancy?
| | A: |
Lupus is an autoimmune disease that causes inflammation in the
bone joints, blood, kidneys, and skin and sufferers often find that
symptoms flare up due to certain triggers. The condition is more common
in women than men, especially women of childbearing age. Some women find
that pregnancy aggravates lupus, causing a flare-up, probably due to
the hormonal changes that occur, while others find that pregnancy eases
the symptoms. As lupus can affect an unborn baby, increasing the risk of
stillbirth, miscarriage, premature labor, and slow growth, your
pregnancy will be monitored very closely, especially when checking your
blood pressure and urine.
However, the likelihood
is that you will have a completely healthy pregnancy resulting in a
healthy baby. You can contact the lupus foundation (www.lupus.org) for support and information.
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| Q: |
I've had a few small bleeds during pregnancy—will my baby be OK?
| | A: |
Bleeding in early pregnancy is not uncommon. Usually, the reason
is unknown, but there is a theory that although the hormones of the
menstrual cycle are suppressed, variations in the cycle continue. This
could explain why some women have light “spotting” around the time a
period would be due. If the bleeding is light, and not accompanied by
abdominal cramping or pain, then it is unlikely that there is anything
wrong.
Bleeding after early
pregnancy can be due to a cervical ectropian, when the surface of the
cervix becomes “raw.” this results from hormonal changes and is not
harmful to the baby. Sexual intercourse can aggravate a cervical
ectropian, stimulating bleeding.
Bleeding in late
pregnancy may be more serious as it can be due to the placenta
partially, or totally, detaching from the wall of the uterus, known as
placental abruption, or to a low-lying placenta, known as placenta praevia.
If you have a
mucus discharge tinged with blood in late pregnancy, this may be a
“show,” when the plug of mucus sealing the cervix comes away. This is
normal and can indicate that labor isn't far away.
It is important that you
seek advice for any type of bleeding at any stage of pregnancy, since
serious causes for bleeding must always be ruled out.
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| Q: |
We know our baby has Down syndrome. How can we best prepare ourselves?
| | A: |
On a practical level, you can prepare in much the same way as
every parent, thinking about your preferences for labor, attending
prenatal classes, and planning for the new arrival. Knowing in advance
that your baby is going to be born with a condition gives you time to
adjust and find out as much as possible about what to expect. You may
want to tell family and friends too, to give them time to prepare. Ask
your health-care provider for details of local support groups and
contact the national Down syndrome society (www.ndss.org) for more information.
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| Q: |
I had an emergency cesarean last time. Now the doctor says I'll have a trial of labor, what is this?
| | A: |
This means labor after a cesarean section. Another term is VBAC
(Vaginal Birth After Cesarean Section). Until relatively recently, most
doctors advised women who had had a cesarean to have a planned cesarean
for the next baby to avoid uterine rupture, where the cesarean scar
tears in pregnancy or labor. Although serious, this is rare and it is
now thought to be preferable for both the mother and baby to have a
natural vaginal delivery if possible. In some cases, a referral to
another hospital will be necessary to accommodate a mother's wish to
have a trial of labor after a previous cesarean birth. Only women with a
transverse uterine scar are appropriate candidates for a VBAC.
Your chances of
having a successful labor depend partly on why you had a cesarean
section. If it was because the baby was breech or you had a low-lying
placenta, your chances of a natural labor this time are higher. If it
was due to complications in labor, such as slow cervical dilatation,
then the problem may recur. Overall, about half of women have natural
deliveries after a cesarean.
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| Q: |
My friend had placental abruption. Is this serious?
| | A: |
Placental abruption means that the placenta has started to come
away from the wall of the uterus before the pregnancy has reached full
term. This is a potentially serious condition that may mean the baby
needs to be delivered as soon as possible by cesarean section. If there
is persistent pain in the abdomen during pregnancy, which may be
accompanied by fresh, bright red, bleeding and/or a change in the baby's
movements, then medical help should be sought immediately.
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| Q: |
I have had three miscarriages—will my prenatal care be different because of this?
| | A: |
While one or even two miscarriages are relatively common, three
is less so. If you have had recurrent miscarriages, you may wish to take
advantage of genetic counseling and early prenatal care. You may be
advised to take low-dose aspirin if there is evidence that you have a
blood-clotting condition called antiphospholipid syndrome (aPL). A
vaginal scan may also be offered to check if you have a “weak cervix,”
where the cervix is unable to support the growing baby. If a weak cervix
is diagnosed, you may be given a stitch during pregnancy to hold the
cervix shut. There is some evidence that taking the hormones
progesterone or human chorionic gonadotrophin in early pregnancy can
reduce the risk of miscarriage.
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| Q: |
My baby is very small for her dates—can anything be done about this?
| | A: |
From 25 weeks, your midwife will measure and palpate your belly
to estimate the fetal size. If she thinks you are “small for dates” she
may refer you for an ultrasound for a more accurate assessment of the
baby's size and of the efficiency of the placenta. You may be offered a
repeat scan in a week or so to measure growth over time. If babies do
not grow as they should, this is called intrauterine growth restriction
(IUGR). This can be due to a problem with the baby or the placenta,
affecting the amount of oxygen and nutrients reaching the baby.
Preeclampsia can cause IUGR, as can smoking, drinking alcohol, and using
recreational drugs. If your baby is very small and the rate of growth
drops off considerably, it may be necessary to deliver the baby early.
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| Q: |
My friend had hyperemisis gravidarum in her pregnancy—can you tell me more about this?
| | A: |
Hyperemesis gravidarum (HG) is severe pregnancy nausea and
vomiting, a debilitating condition affecting around one percent of
women. The woman is unable to keep down food or fluids without vomiting
and becomes clinically dehydrated. This can begin at around week 6 of
pregnancy and may last until 16–20 weeks (although some women suffer
throughout pregnancy).
Sufferers may
need hospital treatment with intravenous fluids and medications to
control the vomiting may be given, but their success varies. No one is
sure what causes the condition, but it is thought that high levels of
the hormone HCG, fluctuations in thyroid levels, and changes in liver
function may all be involved. Sometimes the condition runs in families.
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Prescribed bed rest When you may need to rest in pregnancy
Toward the end of
pregnancy, there are some circumstances when you may need to be
admitted to the hospital for bed rest and monitoring.
If you have contractions, but your water hasn't broken; you may also be given a drug to slow contractions. If
you develop preeclampsia in pregnancy you may have to stay in the
hospital and measures will be taken to reduce your blood pressure. If you have placental abruption, you will be monitored in the hospital and early delivery may be needed.
Obstetric cholestasis A rare liver condition in pregnancy that causes intense itching
Cholestasis is
a condition in which bile does not flow freely down the bile ducts in
the liver, causing bile to leak into the bloodstream.
This condition poses serious risks for both the mother and the baby,
and so it is important that it is diagnosed with a blood test and
managed as soon as possible. Medication will be given to relieve the
itching and improve the liver function. The goal of the medication is to
stabilize the condition until it is safe for the baby to be delivered.
Usually labor is induced between 35 and 38 weeks of pregnancy.
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