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Your 40-week Journey : What's a High-risk Pregnancy? Complications in pregnancy (part 1)

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- How to have natural miscarriage
- Foods That Cause Miscarriage
- Signs Proving You Have Boy Pregnancy
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.

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.

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.
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.
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.

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).

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.

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.

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.
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.

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.
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.
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.
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.

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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