Appendicitis can happen at any time, even during pregnancy. Acute appendicitis is the most common condition requiring surgery during pregnancy.

Pregnancy can make diagnosis difficult because some symptoms can be typical in a normal pregnancy, such as nausea and vomiting. Pain in the lower abdomen on the right side may be credited to round-ligament pain or a urinary-tract infection. Diagnosis may be difficult because as the uterus grows, the appendix moves upward and outward, so tenderness and pain are located in a different place than normal.

Treatment of appendicitis is immediate surgery. This can be major abdominal surgery, with a 3-or 4-inch incision; it requires a few days in the hospital. Laparoscopy, with smaller incisions, is used in some situations, but laparoscopy may be harder to do during pregnancy because of the large uterus.

Rupture of a pregnant woman’s appendix occurs up to 3 times more often because acute appendicitis is not diagnosed soon enough. Most physicians believe it’s better to operate and remove a “normal” appendix than to risk infection of the abdominal cavity if an infected appendix bursts. Antibiotics are administered; many antibiotics are safe to use during pregnancy.

Sickle-Cell Disease

Sickle-cell disease is the most common hemoglobin disorder in the United States. About 8% of Black/African Americans carry the sickle-hemoglobin gene. However, it is also found in people of Arabic, Greek, Maltese, Italian, Sardinian, Turkish, Indian, Caribbean, Latin American and Middle-Eastern descent. In the United States, most cases of sickle-cell disease occur among Black/African Americans and Latino/Hispanics. About one in every 500 Black/African Americans has sickle-cell disease.

Sickle-cell disease is inherited. Normally, red blood cells are round and flexible, and flow easily through blood vessels. In sickle-cell disease, abnormal hemoglobin causes red blood cells to become stiff. Under the microscope, they may look like the C-shaped farm tool called a sickle.

Because they are stiffer, these red blood cells can get stuck in tiny blood vessels and cut off the blood supply to nearby tissues. This causes a great deal of pain (called sickle-cell pain episode or sickle-cell crisis) and may damage organs. These abnormal red blood cells die and break down more quickly than normal red blood cells, which results in anemia.

A person who inherits the sickle-cell gene from one parent and the normal type of that gene from the other parent is said to have sickle-cell trait. Carriers of the sickle-cell gene are usually as healthy as non-carriers. Sickle-cell trait cannot change to become sickle-cell disease.


Location of the appendix at various times during pregnancy.

When two people with sickle-cell trait have a child, there is a one-in-four chance their child may inherit two sickle-cell genes (one gene from each parent) and have the disorder. There is a two-in-four chance the child will have the trait. There is a one-in-four chance the child will have neither the trait nor the disease. These chances are the same in each pregnancy. If only one parent has the trait and the other doesn’t, there is no chance their children will have sickle-cell disease. However, there is a 50–50 chance of each child having the trait.

Tip for Week 22

Drink extra fluids (water is best) throughout pregnancy to help your body keep up with the increase in your blood volume. You’ll know you’re drinking enough fluid when your urine looks almost like clear water.

Sickle-cell disease can also affect biracial children. To what degree depends on the ethnic group of each parent and his or her genetic makeup. A union of a Caucasian and a Black/African American will not result in a child with sickle-cell disease because Caucasians are not carriers of the sickle-cell gene. However, the union of a Black/ African American and a person of Mediterranean or Latino/Hispanic descent could result in a child with sickle-cell disease if both parents carry the sickle-cell gene. In addition, if both parents are biracial, they could pass the disease to their children if each parent carries the gene. The risk of both biracial partners being carriers is lower, but the risk is still there and depends on each person’s genetic background and makeup.

Pregnancy and Sickle-Cell Disease. A woman with sickle-cell disease can have a safe pregnancy. However, if you have the disease, your chances are greater of having problems that can affect your health and your baby’s health.

During pregnancy, the disease may become more severe, and pain episodes may be more frequent. You will need early prenatal care and careful monitoring throughout pregnancy.

Until 1995, there was no effective treatment, other than blood transfusions, to prevent the sickling of the blood that causes a pain crisis. The medication, hydroxyurea, was found to reduce the number of pain episodes by about 50% in some severely affected adults. At this time, we do not recommend hydroxyurea for pregnant women. However, researchers continue to study new drug treatments to help reduce complications of the disease.

A blood test can reveal sickle-cell trait. There also are prenatal tests to find out if a baby will have the disease or carry the trait. Most children with sickle-cell disease are now identified through newborn screening tests.

Your healthcare provider will pay close attention to your sickle-cell disease during pregnancy. Work with your healthcare team to stay as healthy as possible.


Thalassemia, also called Cooley’s anemia, is not just one disease. It includes a number of different forms of anemia. The thalassemia trait is found all over the world but is most common in people from the Middle East, Greece, Italy, Georgia (the country, not the state), Armenia, Viet Nam, Laos, Thailand, Singapore, the Philippines, Cambodia, Malaysia, Burma, Indonesia, China, East India, Africa and Azerbaijan. It affects about 100,000 babies each year.

There are two main forms of the disease—alpha thalassemia and beta thalassemia. The type depends on which part of an oxygen-carrying protein (the hemoglobin) is lacking in red blood cells. Most individuals have a mild form of the disease. The effects of beta thalassemia can range from no effects to very severe.

Eating Dark Chocolate

Eating dark chocolate (at least 70% cocoa content) may be good for you. A daily dose of 30g of dark chocolate has been associated with lower blood pressure and a reduced risk of anemia. Chocolate also helps relax and dilate blood vessels to help lower blood pressure. Antioxidants found in dark chocolate may be healthy for you. Keep in mind the following when choosing dark chocolate.

•  Chocolate should be 70% or more cocoa.

•  Don’t eat more than 3 ounces a day.

•  Dark chocolate should replace other sweets.

A carrier of thalassemia has one normal gene and one thalassemia gene; this is called the thalassemia trait. Most carriers lead completely normal, healthy lives.

When two carriers have a child, there is a one-in-four chance their child will have a form of the disease. There is a two-in-four chance the child will be a carrier like its parents and a one-in-four chance the child will be completely free of the disease. These odds are the same for each pregnancy when both parents are carriers.

Various tests can determine whether a person has thalassemia or is a carrier. Chorionic villus sampling (CVS) and amniocentesis can detect thalassemia in a fetus. Early diagnosis is important so treatment can begin at birth to prevent as many complications as possible.

Having the thalassemia trait doesn’t usually cause health problems, although women with the trait may be more likely to develop anemia during pregnancy. Healthcare providers may treat this with folic-acid supplementation.

Most children born with thalassemia appear healthy at birth, but during the first or second year of life they develop problems. They grow slowly and often develop jaundice.

Treatment of thalassemia includes frequent blood transfusions and antibiotics. When children are treated with transfusions to keep their hemoglobin level near normal, many complications of thalassemia can be prevented. However, repeated blood transfusions may lead to a buildup of iron in the body. A drug called an iron chelator may be given to help rid the body of excess iron.

Certified Nurse-Midwives, Advance-Practice Nurses and Physician Assistants

In today’s obstetric-and-gynecology medical practices, you may find many types of highly qualified people helping to take care of you. These people—mostly women, but not all!—are on the forefront in guiding women through pregnancy to delivery. They may even help deliver their babies!

A certified nurse-midwife (CNM) is an advance-practice registered nurse (RN). He or she has received additional training delivering babies and providing prenatal and postpartum care to women. A CNM works closely with a doctor or team of doctors to address specifics about a particular pregnancy, and labor and delivery. Often a CNM delivers babies.

A certified midwife can provide many types of information to a pregnant woman, such as guidance with nutrition and exercise, ways to deal with pregnancy discomforts, tips for managing weight gain, dealing with various pregnancy problems and discussions of different methods of pain relief for labor and delivery. A CNM can also address issues of family planning and birth control and other gynecological care, including breast exams, Pap smears and other screenings. A CNM can prescribe medications; each state has their own specific requirements.

A nurse practitioner is also an advance-practice registered nurse (RN). He or she has received additional training providing prenatal and postpartum care to women. A nurse practitioner may work with a doctor or work independently to address specifics about a woman’s pregnancy, and labor and delivery.

A nurse practitioner can provide many types of information to a pregnant woman, such as guidance with nutrition and exercise, ways to deal with pregnancy discomforts, tips for managing weight gain, dealing with various pregnancy problems and discussions of different methods of pain relief for labor and delivery. He or she can also address issues of family planning and birth control and other gynecological care, including breast exams, Pap smears and other screenings. In some cases, a nurse practitioner may prescribe medications or provide pain relief during labor and delivery (as a certified registered nurse anesthetist [CRNA]).

A physician assistant (PA) is a qualified healthcare professional who may take care of you during pregnancy. He or she is licensed to practice medicine in association with a licensed doctor. In a normal, uncomplicated pregnancy, many or most of your prenatal visits may be with a PA, not the doctor. This may include labor and delivery. Most women find this is a good thing—often these healthcare providers have more time to spend with you answering questions and addressing your concerns.

A PA’s focus is to provide many health-care services traditionally done by a doctor. They care for people who have conditions (pregnancy is a condition they see women for), diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, perform some procedures, assist in surgery, write prescriptions and do physical exams. A PA is not a medical assistant, who performs administrative or simple clinical tasks.

We are fortunate to have these dedicated professionals working in OB/GYN practices and clinics. The care they provide is crucial to the medical community and makes quality medical care for women something every woman can look forward to.

7. Exercise for Week 22

Lie on your left side on the sofa, with your left knee bent. Bend your left arm, and place it under your head. Lower your right foot to the floor while keeping your leg straight. Hold for 10 seconds, then lift the straightened leg to a 45° angle; hold for 5 seconds. Do 5 complete repetitions with each leg. Helps ease sciatica; strengthens hips and upper buttocks muscles.


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