Wednesday, October 29, 2008

CRINONE 8% Progesterone Gel



I would like to share about my baby's journey from the womb to birth. My baby girl is almost 2 months old. However, I did experience twice miscarried in a row before that.

I am a person who is quite easy to get pregnant. However, keeping the early pragnancy is difficult. My first miscarried happen when the pregnancy was 2 months, and the second one was about one month and a half. Each miscarried was always started with a little blood discharge, then heavy bleeding.

Me and my husband were very very sad since we still have no baby yet at that time. Finally, I check with a doctor in Singapore and she told us straight away that my problem is lack of progesterone hormone in my womb.

On my third pregnancy, I was in Los Angeles at that time, and I also experience a little discharge from my vagina. Then my friend took me to her doctor, and the doctor suspect the same thing, lack of progesterone.

Finally, after carrying some blood test, the doctor prescribe me with CRINONE, 8% NATURAL PROGESTERONE GEL. I have to use it every night for 40 days. From my research, the CRINONE is the most expensive progesterone support. One tube is $23. This is quite heavy for me since I am an international patient that is not covered in US health service.

From my experience of using Crinone, my baby can pass the first trisemester successfully, developed a strong placenta and miracle cord. Actually I was a bit worry about the side effect of the medicine. However, I pray to GOD to protect my baby and let her grow healthy.

Month by month passed, and finally my baby was born. She is almost two months old, healthy, and I pray for her always.

I would be very happy to answer any question regarding to my experience using Crinone.
Cheers

Boosting Breast Milk with Katuk Leaf




I would like to share about this kind of leaf called "Katuk" leaf (Sauropus androgynus).

I live in Indonesia. My baby is almost two months old. From the one of my baby born, my friends and parents told me to eat "katuk" leaf. They said that this leaf will boost my breast milk a lot. My doctor also prescribe me some supplement called LactaMum. However, it seems that katuk leaf is more effective for me.

I attach the picture below. That's katuk leaf. I am not sure how to buy/find in US or other countries. They way how it is cook, just like cooking spinach. Water, salt, some young corn, then the leaves. It's just like spinach soup. Instead, this leaf is smaller and darker green.

Well, its been proven to boost my breast milk a lot. Just in the morning when I pump my breast, I can collect 200 ml.






Tuesday, October 28, 2008

Morning Sickness Tips

There is no magic pill that will instantly cure you from a bout of morning sickness. As with anything else, what works for one person might not work for another. Also, since your body and hormones are constantly changing during pregnancy, don't be surprised if what worked one week doesn't have the same affect on your morning sickness the next. But don't give up hope - there are many things you can take and do for morning sickness nausea!


Home Remedies and Cures for Morning Sickness

Many pregnant moms want to know "what can I take for morning sickness nausea?" The following are real-life remedies and cures for morning sickness that worked with real women during their pregnancies.
  1. Make yourself eat, especially if your last meal or snack was over two hours ago. Two of the biggest culprits of the queasy stomach and nauseas morning sickness symptoms are low blood sugar and a stomach filled with acid. Eat bland foods - crackers and dry toast for instance, or acid-neutralizing dairy foods like milk, yogurt and ice cream. Many women report near-miraculous recovery once there is something in their stomach.
  2. Pay attention to your cravings. Many pregnant women have complained of severe morning sickness, but when they ate what they craved - which they were sure would worsen their symptoms (a hamburger, taco, or pizza, or Pop Tarts for instance), the nausea went away.
  3. Get out in the fresh air. Take a walk, or simply go outside, sit on a bench, and breath in non-stale air. Caution, this may not work in areas where there is a high level of exhaust fumes or cigarette smoke (or other smells that can trigger nausea), high humidity, or high temperatures. However, if it's nice (or even cold) outside, having a breath of air helps clear the nausea.
  4. Stay hydrated!
    There is no understating the importance of staying hydrated and drinking enough water while you are pregnant. If water makes you gag (some women have an aversion to the chlorine and/or minerals found in tap water), the following tricks:
    Make a blender smoothie using ice and fruit or milk (or yogurt) and fruit. You can add some nuts or whey powder to get some additional protein in your diet, too!
  5. Try adding a splash or slice of lemon or lime to very cold water with ice.
    Have a cup of ginger or mint tea. Stay away from caffeinated teas, and be careful of herbal teas - there are some herbal teas that are fine when you're not pregnant, but may cause problems during your baby's development. Check with your care provider before venturing beyond mint and ginger herbal teas.
  6. Suck on ice chips. One of my co-workers couldn't stand drinking water, but she was able to eat ice chips all day long. Not just a little ice - she went through eight six-ounce cups of ice a day!
    Non-caffeinated carbonated beverages - such as 7-UP, organic
  7. Ginger Ale, and Sprite, to name a few - bring great relief nausea relief to many people, pregnant or not. Stay away from the diet versions of these drinks; artificial sweeteners can increase nausea, and aren't healthy for your baby's development.
    If possible, try lying down in a dark, cool room with your eyes closed (the building I worked in had some great rooms in the basement for this type of break). A damp towel draped across your forehead provides additional relief. Sometimes the absence of visual distractions and bright lights helps to calm morning sickness symptoms.
  8. Better yet, take a nap. Sometimes stress and being over-tired can trigger morning sickness, and a quick nap takes care of the situation. You're pregnant - you are building a baby, and you cannot do everything you use to do before you became pregnant. Sometimes women - especially moms - forget that and over-extend themselves, the results of which can be fatigue and the feelings of morning sickness.
  9. One of the most popular morning sickness cures is ginger root.
    Try Ginger in many forms - candied ginger, ginger ale, raw ginger (either on its own or in a glass of cold water or hot tea), and for some moms, pickled ginger, can help ease the symptoms of morning sickness. As with any supplement, be wary of taking ginger capsules until you speak with your care provider regarding safe dosages of ginger in your pregnancy diet.
  10. Don't forget to try the remedies that work for you when you suffer from motion sickness or have the stomach flu, either as an adult or the comforting remedies from childhood. What worked then will most likely work now to give you morning sickness relief.
  11. Pay attention to what happens during your day, and note when you experience your morning sickness. Your morning sickness could follow the Danish you have every morning at 10. Many moms didn't make the correlation between their usual routines and morning sickness. One of the number one culprits of this is taking prenatal vitamins and iron supplements on an empty stomach or too early in the day. If you find that your prenatal vitamins bring on bouts of morning sickness no matter when you take them, ask your care provider about prenatals with lower amounts of iron.
  12. Other moms have found morning sickness relief by changing their brand of soap, shampoo, or perfume while they were pregnant, or asking their spouse to stop smoking or change colognes.
    Over-the-Counter Morning Sickness Relief
  13. There are different types of pregnancy-relief drops, pops, and chewing gum that offer relief for Moms. We offer Preggie Pops and Drops in our store, mainly because so many customers and friends have said, "you need to sell these - they really, really work!" Preggie Pops, and similar products, are an all-natural remedy for morning sickness made specifically for women searching for a drug-free relief from pregnancy and morning sickness.
  14. There is also an acupressure band you can purchase, which is a soft cotton wristband for motion sickness that's available in drugstores. The band has a plastic button that pushes against an acupressure point on the underside of your wrist. It's a simple, inexpensive method that has given many people relief from seasickness and morning sickness.
  15. A step up from the acupressure band - at a cost of roughly $75 and available by prescription - is a band that, instead of acting as acupressure, stimulates the underside of your wrist with a mild electric current. This works well for some pregnant moms.
  16. While widely available, do not take over-the-counter antacids or other stomach soothers without first talking to your care provider. Maalox may have worked wonders for your friend's cousin's sister, but it may not be safe for you and your baby during your pregnancy.
    Vitamin Supplements and Prescriptions as Morning Sickness Remedies
    Many women have found morning sickness relief in taking Vitamin B6. Check with your provider before taking this - or any other supplement. Your care provider will know the recommended and SAFE dosage for you and your baby (which may be different than that of your friend or sister!)
  17. If you have a constant battle with morning sickness, talk to your doctor about a prenatal anti-nausea medication. There are several available that can be prescribed that won't harm the development of your baby. Read our The Risks of Morning Sickness article for signs of severe morning sickness that you should report to your doctor.
  18. Remember - your body is changing every day in response to your pregnancy. Just because a cure didn't work in the first few weeks doesn't mean that you shouldn't try it again in the second or third trimester. Also, while some morning sickness remedies seem to be acts of miraculous healings, others may lessen symptoms to aid in your comfort. The only true cure for morning sickness in pregnancy is to have that baby - but we'd like you to be as comfortable as possible between now and then!

Changes in Your Baby

During your pregnancy, you will see many changes in your body. However, the most incredible changes are occurring in your developing baby. In 9 short months, your baby grows from a few small cells into a fully grown, fully developed little being that can live on its own outside of your body. For 9 months, your body has protected, nourished and nurtured the baby as it has grown to maturity, ready to begin its life. And although you won't be able to see much more than an enlarging abdomen, incredible things are happening inside your body.

This chapter attempts to give you an idea of some of the fascinating things that occur as your baby grows and develops. After reading it, you may agree with me that the growth of your baby is truly a miracle.


Your Baby's Due Date


Two Ways to Figure the Due Date

Most women don't know the exact date their baby was conceived, but they usually know the day their last menstrual period began. The doctor subtracts 2 weeks from the date of the last period as an estimate of when conception occurred. Your estimated due date is 38 weeks after the date of conception (40 weeks after the first day of your last period).


There is a second way to determine your due date. Add 7 days to the date of the beginning of your last menstrual period, then subtract 3 months. This gives you the approximate date of delivery. For example, if your last period began on January 20, your estimated due date is October 27.


Gestational Age and Fertilization Age

Gestational age, also called menstrual age, dates a pregnancy from the first day of the last menstrual period. It is 2 weeks longer than the fertilization age.

Fertilization age, also called ovulatory age, is 2 weeks shorter than gestational age and dates from the actual date of conception. This is the actual age of the fetus.


Baby Development During Pregnancy

Your baby grows and changes from a small group of cells to a fully developed baby ready to begin life. The designation between "embryo" and "fetus" is somewhat arbitrary. During the first 8 weeks of development (10 weeks of gestation), the developing baby is called an embryo. From 8 weeks of development until delivery, it is called a fetus. The great changes your baby goes through to become a fully developed baby are easier to follow if we look at them in each trimester.


Trimesters

The length of your pregnancy is divided into three trimesters, each about 13 weeks long.


First trimester development. The first trimester represents the greatest change for any developing fetus. In the first 13 weeks of development, your baby grows from a collection of cells the size of the head of a pin to a fetus the size of a softball. Organs begin developing, and your baby begins to look more like a baby.

Very few, if any, structures in the fetus are formed after the 12th week of pregnancy. This means your baby forms all of its major organ systems by the end of the first trimester. These structures continue to grow and to develop until your baby is born.


Second trimester development. At the beginning of the second trimester (14th week), your baby weighs less than 1 ounce (28g) and is only about 4 inches (10cm) long.


Third trimester development. Your baby weighs about 1-1/2 pounds (0.7kg) at the beginning of the third trimester (27th week), and its crown-to-rump length is under 9 inches (22cm). {Crown-to-rump length is the measurement from the top of the baby's head [crown] to the buttocks of the baby [rump].) When it is delivered, your baby will weigh close to 7-1/2 pounds (3.4kg) and be about 21 inches (53cm) long.


Baby's Size and Weight

Birthweight varies greatly from baby to baby. However, the average weight of a baby at term is 7 to 7-1/2 pounds (3.3 to 3.4kg).


Ultrasound is the test of choice to estimate fetal weight. A formula has been established to help estimate fetal weight using this technology. Several measurements are taken, including the diameter of the baby's head, circumference of the baby's abdomen and length of the femur (thighbone) of the baby's leg. Occasionally other fetal measurements are taken. A drawback of using ultrasound for estimating fetal weight is that estimates may vary as much as half a pound (225g) in either direction. However, the accuracy of predicting fetal weight with ultrasound continues to improve.


The size of the fetus's head surprises many of my patients. When you are 13 weeks pregnant, your baby's head takes up about half the crown-to-rump length (measurement from top of the head to the baby's buttocks). In 2 months, when you are 21 weeks pregnant, the head will be about one-third of the fetal body. At birth, your baby's head will be one-fourth the size of its body.


Your Baby's Heart


Your baby's heart starts beating very early. By the 6th week of pregnancy (age of fetus is 4 weeks), the heart tubes fuse and contractions of the heart begin. This can be seen on ultrasound.

Occasionally you may listen to your baby's heartbeat at the doctor's office and hear it skip a beat. An irregular heartbeat is called an arrhythmia. Arrhythmias in a fetus are not unusual, so don't be overly concerned. The equipment could be faulty or there may be some other problem transmitting the sound.

Arrhythmias are not usually serious in a baby before birth; many disappear after the baby is born. If an arrhythmia is discovered before labor and delivery, you may require fetal heart-rate monitoring during pregnancy. When an arrhythmia is discovered during labor, it may be decided to have a pediatrician present when the baby is born.


Your Baby in the Womb

Some patients are startled when they see an ultrasound of their baby and it appears that the baby has its mouth open. In addition to turning over and moving their hands and feet, babies do open and close their mouths in the womb. The fetus may also suck its thumb or finger.


Digestive System Develops

By 21 weeks, the fetal digestive system has developed enough to allow the fetus to swallow amniotic fluid. The fetus absorbs much of the water in the swallowed fluid. Hydrochloric acid and adult digestive enzymes are present in small amounts in the fetal digestive system at 21 weeks.

Researchers believe swallowing amniotic fluid may help growth and development of the fetal digestive system. It may also condition the digestive system to function after birth. By the time a baby is born, he or she may swallow large amounts of amniotic fluid, as much as 17 ounces (500ml) of amniotic fluid in a 24-hour period.


Eyes Open

Your baby can open its eyes inside the uterus. Eyelids cover the eyes and are fused or connected around 11 to 12 weeks. They remain fused until about 27 to 28 weeks, when they open.


Hearing Begins

A baby can hear inside the womb, before it is born. Life inside the womb may be like living near a busy freeway. The developing baby hears a constant background of digestive noises and the maternal heartbeat. The mother-to-be's voice is also heard, although the fetus may not hear higher-pitched tones. There is evidence that by the third trimester the fetus responds to sounds it hears. Researchers have noted fetal heart-rate increases in response to tones it hears through the mother's abdomen. Newborns have been found to prefer their mother's voice to a stranger's, which suggests they recognize the mother's voice. They have also been found to prefer their mother's native language, and they respond strongly to a recording of an intrauterine heartbeat.

Nutrition and Exercise

Eating healthfully, exercising and controlling your weight during pregnancy go a long way toward giving your baby a healthy start in life. The foods you eat help your baby develop and grow. By eating healthfully, you will provide your baby with the nutrients it needs to build its bones and organs. Exercising during pregnancy keeps you in good shape and ready to do the work of labor and delivery. Controlling your weight (not gaining too much weight but gaining enough) makes sure your developing baby is getting the nutrients it needs. One study showed 95% of the women who had good-to-excellent diets delivered babies in good-to-excellent health. Only 8% of those women who ate poor diets (lots of junk food) had babies in good-to-excellent health. One of your main goals in pregnancy is to give birth to the healthiest baby you can. Your nutrition during pregnancy has a great effect on your baby's health. Exercise and weight control add to your overall health and thus to the health of your baby.

Some women get the false idea they can eat all they want during pregnancy. Don't fall into this trap! You don't want to gain more weight than your doctor recommends during pregnancy—it can make you uncomfortable and it is harder for you to lose the extra pounds after your baby is born. Increase the number of calories you consume now you're pregnant. Most experts agree a normal-weight pregnant woman needs to increase her caloric intake by 300 to 800 calories a day. These extra calories are important for tissue growth in you and your baby. Your baby uses the energy from your calories to create and to store protein, fat and carbohydrates, and to provide energy for its own body processes. Expect some weight gain during your pregnancy—it's natural and normal. Eat a variety of foods every day to supply you with the nutrients you need. You'll want to eat dairy products, protein foods, fruits and vegetables, and breads and cereals.


Cravings During Pregnancy

For many women, cravings during pregnancy are normal. Cravings for particular foods during pregnancy can be both good and bad. If you crave foods that are nutritious and healthy, eat them in moderate amounts. If you crave foods that are high in sugar and fat, and loaded with empty calories, be very careful about eating them. No one knows why some women develop cravings during pregnancy, especially cravings for foods they might not normally eat. But many believe it is because of the hormonal and emotional changes that occur during pregnancy. It's not uncommon during pregnancy to be nauseated by foods you love to eat normally. The hormones of pregnancy have a significant impact on the gastrointestinal tract, which can affect your reaction to certain foods.

Artificial Sweeteners

Aspartame and saccharin are the two most widely used artificial sweeteners. Recently there has been controversy over the safety of aspartame. I advise you to substitute foods that do not contain the sweeteners for products you usually use because currently we just don't know about its safety for pregnant women and their developing babies. Also, aspartame is a source of phenylalanine in the diet. Pregnant women who suffer from phenylketonuria must follow a low-phenylalanine diet or their babies may be born mentally retarded and suffer from delayed development. Saccharin is not used as much today as in the past, but it is still found in many foods, beverages and other substances. The Center for Science in the Public Interest reports saccharin is not safe for use during pregnancy. Without further evidence, it is probably better to avoid using this product while you're pregnant.

A Healthy Eating Plan During Pregnancy

It's a good idea to eat a variety of foods throughout your pregnancy. Below is a list of daily servings from six food groups.
  • Dairy products—4 to 5 servings a day
  • Vegetables—at least 4 servings a day
  • Fruits—2 to 4 servings a day
  • Protein sources—3 to 4 servings a day
  • Carbohydrates (breads, cereal, pasta and rice)—6 to 11 servings a day
  • Fats/flavorings—3 to 5 servings a day
  • Dairy Products

Drinking During Pregnancy

Drink 6 to 8 glasses (64 ounces; 1.9 liters) of liquid every day. Water is the best choice. I advise all my patients to drink plenty of water every day. Some patients tell me they don't like drinking so much water, but it really is important during pregnancy. Water is necessary for your body to process nutrients, develop new cells and sustain blood volume. You will probably feel better if you drink more fluid than you normally do. Your blood volume increases during pregnancy; drinking extra fluids helps you keep up with this change. Drinking water throughout the day can help you in other ways too. Many women who suffer from headaches, uterine cramping and various other problems during pregnancy find increasing their fluid intake helps resolve some of their symptoms. It also helps avoid bladder infections. Drink 6 to 8 glasses (64 ounces; 1.9 liters) of liquid every day. Water is the best choice. When your urine is light-yellow to clear, you're getting enough water. Dark-yellow urine is a sign you need to add more fluid to your diet.


Drinking Coffee During Pregnancy

Drinking as few as 4 cups of coffee a day (800mg of caffeine) by a pregnant woman has been associated with decreased birthweight and a smaller head size in newborns. Although an exact "toxic" amount for caffeine has not been determined, it makes sense to limit your caffeine intake. Caffeine is found in many beverages and foods, including coffee, tea, cola drinks and chocolate. Some medications, such as cough medicines and headache medicines, also contain a lot of caffeine. It's important to read labels. Caffeine is a central-nervous-system stimulant. There are no known benefits for you or your unborn fetus from caffeine. Caffeine can also affect calcium metabolism in both you and your baby. Limit your caffeine intake during pregnancy and if you breast-feed. Read labels on foods, beverages and over-the-counter medications to find out about caffeine content. Eliminate as much caffeine from your diet as possible. Some medications, such as cough medicines and headache medicines, contain a lot of caffeine. It's important to read labels.


Vitamins and Minerals in Pregnancy

As I said before, it's very important to take your prenatal vitamin throughout pregnancy. Prenatal vitamins contain the recommended daily amounts of vitamins and minerals you need during pregnancy. They are taken to ensure your health and your baby's health. However, they aren't a substitute for food or a good diet. The main difference between prenatal vitamins and multivitamins is that prenatal vitamins also contain iron and folic-acid supplements.
The only mineral that needs to be supplemented during pregnancy is iron. The average woman's diet seldom contains enough iron to meet the increased demands of pregnancy. Blood volume increases by 50% in a normal pregnancy, and iron is an important part of blood production in your body.


Iron
You may be advised to take iron supplements during pregnancy. Prenatal vitamins contain some iron but you may need to take extra iron. Your healthcare provider will test you for anemia early in your pregnancy. If he or she determines you need an iron supplement, you must take it for your health and your baby's health. Most prenatal vitamins contain 60mg of elemental iron. Some women worry that taking iron may cause constipation. Constipation can be a side effect. Work with your doctor to find the correct amount of iron to help lessen side effects.


Fluoride
The use of fluoride and fluoride supplementation during pregnancy is controversial. Some researchers believe fluoride supplementation during pregnancy results in improved teeth in your child, but not everyone agrees. However, no harm to the baby has been shown from fluoride supplementation in a pregnant woman. Some prenatal vitamins contain fluoride.


Sodium
Sodium is a chemical that works to maintain the proper amount of fluid in your body. During pregnancy, it can also affect your baby's system. Sodium is found in salty foods (such as potato chips and dill pickles) and in processed foods, from soups to meats. You need some sodium; you just don't need too much. Read food labels to discover just how much you're getting! During pregnancy, keep your consumption of sodium under 3g (3000mg) a day. Too much sodium causes water retention, swelling and high blood pressure. Any of these can be a problem for you. It's difficult to avoid something unless you know where to find it. With sodium, that can be tricky. It's in the salt shaker and in salty-tasting foods, such as pretzels, chips and salted nuts. (Table salt is about half sodium.) You may be surprised by the amount of sodium present in foods that don't taste salty. Sodium is found in canned and processed products, fast foods, cereals, desserts and even soft drinks and some medications! See the chart opposite for a listing of the sodium content in a variety of foods.

Medications and Treatments

One of the most important pieces of advice during pregnancy is to be extremely careful about any medications you use. By "medications," I mean prescriptions your doctor may write for you and over-the-counter preparations, vitamins, minerals and herbs. Any of these substances may affect a developing baby. What may seem like only a little to you could pass through the placenta to your developing fetus.



If possible, discuss the medications you must take for medical conditions before you get pregnant. If you were unable to do this, discuss all medications (prescription and over-the-counter) you take on a regular basis at your first visit. Dosages may need to be adjusted, or you may have to stop taking a particular substance. However, never stop taking any medication you need for a chronic problem without consulting your doctor first! Some medication cannot and should not be stopped during pregnancy. Talk to your doctor before making any decisions about medication use.
Various medications you take affect the developing baby.


Be extremely careful about any medications you use—not only prescriptions your doctor may write for you, but also over-the-counter preparations, vitamins, minerals and herbs. Any of these substances may affect a developing baby.


Vitamin Usage during Pregnancy


Prenatal Vitamins
It's very important to take your prenatal vitamins for your entire pregnancy. Sometimes late in pregnancy a woman stops taking them—she gets tired of taking them or she decides they aren't necessary. The vitamins and iron in prenatal vitamins are essential to your baby's well-being, so take them until your baby is born.


Folic Acid
Most women don't need to take extra folic acid during pregnancy if they follow a good diet and take prenatal vitamins as directed. Folic acid is found naturally in green leafy vegetables. Prenatal vitamins have 0.8 to 1 mg of folic acid in each pill, which should be sufficient for a normal pregnancy.
Studies indicate a woman who has had a baby with a neural-tube defect, such as spina bifida, may be able to reduce her chances of having another baby with the same problem if she takes extra folic acid before pregnancy and throughout early pregnancy.


As of 1998, many products have been enhanced with folic acid. These foods include staples, such as some bread products, rice, cereals, noodles, farina and commeal. Read labels.
Prescription and Nonprescription Medications during PregnancyPrescription MedicationsDiscuss all medications (prescription and over-the-counter) you take on a regular basis at your first prenatal visit. This is an extremely important part of your prenatal care. You may need to have your dosage adjusted, you may have to stop taking a particular substance, or certain conditions may require additional medication


Thyroid medication. It's important to continue taking your thyroid medication throughout your pregnancy. Be sure your doctor knows what you take. Thyroid hormone is made in the thyroid gland. This hormone affects your entire body and is important in your metabolism. Thyroid hormone is also important in your ability to get pregnant. Don't stop taking or change your dose of thyroid hormone without talking with your doctor. Thyroxin (medication for low thyroid or hypothyroid) is safe to take during pregnancy.
Propylthiouracil (high-thyroid or hyperthyroid medication) passes to the baby; you will probably be given the lowest amount possible during your pregnancy.


Lupus medication. The medication used to treat lupus is steroids; the primary steroid given is prednisone. Many studies have been done on the safety of prednisone during pregnancy, and it has been found to be safe.


Prozac™. Studies indicate Prozac is safe for use during pregnancy.


Skin medication. Accutane® (retinoic acid isotretinoin) is a common treatment for acne. However, pregnant women must nor take it! There is a higher frequency of miscarriage and malformation of the fetus if a woman takes Accutane during the first trimester of pregnancy.
Tetracycline, also commonly used to treat acne, should not be taken during pregnancy because it can cause discoloration of your baby's permanent teeth later in life. (For that reason, tetracycline must not be prescribed for any child under age 8.)


Any type of medication you use can get into your bloodstream and could be passed to your baby. Retin-A, which some women use on their skin, should be avoided during pregnancy because we do not know its effects on the fetus at this time.


Nonprescription or Over-the-Counter Medications
Although they do not require a prescription, over-the-counter (OTC) medications should be taken with care during pregnancy. Many OTCs contain aspirin, caffeine or phenacetin—all should be avoided during pregnancy. Limit your use of cough syrups, which may contain as much as 25% alcohol.
Be careful with medications containing ibuprofen, such as Advil®, Motrin® and Rufen®. Avoid newer medicines, such as Aleve® and Orudis®, until we know more about them and their safety in pregnancy. Read package labels and ask your doctor or pharmacist before taking anything.
Any type of medication you use can get into your bloodstream and could be passed to your baby.
Safe nonprescription preparations. OTC medications that are safe include acetaminophen (Tylenol), some antacids (Amphojel, Gelusil, Maalox, milk of magnesia), throat lozenges (Sucrets®), some decongestants (Sudafed®) and some cough medicines (Robitussin®).
Aspirin. Almost any medication you take when you are pregnant passes to your baby or has some effect on your pregnancy. Discuss aspirin use with your doctor.


Can Birth-control Methods Affect Pregnancy?
Some women who discover they are pregnant have been practicing birth control. They worry about the effect birth-control pills, lUDs and spermicide may have on their pregnancy.


Birth-Control Pills
If you get pregnant while taking birth-control pills, stop taking the pills, and notify your doctor. Any method of contraception can fail; the chance of failure with birth-control pills is between 1 and 3%. There is a small increase in problems for the fetus if you take birth-control pills while you're pregnant. It is not cause for great alarm, but discuss it with your doctor.


IUDs
If you become pregnant while using an lUD, notify your doctor immediately. You will need to discuss whether the lUD should be removed. Most doctors usually attempt to remove the lUD, if possible. The risk for miscarriage is higher if your lUD is left in place. The risk for ectopic pregnancy is also higher if you get pregnant with an lUD.


Spermicides
Spermicides have not been shown to be harmful to a developing fetus. Some women who discover they are pregnant have been practicing birth control.


Immunizations and Vaccinations in Pregnancy
Be careful about immunizations and vaccinations during pregnancy. Some immunizations may harm the developing fetus and should not be received by a pregnant woman. The risk of exposure to various diseases is an important consideration. Not all vaccines harm the fetus. That's why it is so important to discuss this concern with your doctor.
Sometimes immunization is needed. Once your doctor determines you have been exposed to a disease, or exposure is possible, he or she will weigh the risk of the disease against the potential harmful effects of the immunization. There are vaccines you should never receive if you are pregnant. Avoid vaccinations for measles, mumps and rubella (MMR), poliomyelitis and yellow fever. You should receive primary vaccine against polio only if your risk of exposure is high; for example, if you are traveling to a high-risk area.
Few vaccines are considered safe for a pregnant woman. The only vaccines generally regarded as safe during pregnancy are tetanus, diphtheria and rabies. Others may be safe, but we are unsure about them at this time, so avoid them.
If you are unsure if you might need a vaccine and are pregnant, talk to your healthcare provider. If you don't think you are pregnant, it would still be wise to have a pregnancy test and to be using reliable contraception before receiving a vaccine.

Signs and Symptoms of an Ectopic Pregnancy

In normal pregnancies, a fertilized egg becomes attached to the wall of uterus. In some cases, the egg attaches outside of the uterus, usually in the fallopian tube. This is called an ectopic pregnancy. Ectopic pregnancies are fairly common, happening in one out of every sixty pregnancies. Unfortunately, ectopic pregnancies must be terminated as the tubes are not able to support the growth of a baby.

Ectopic pregnancies are generally caused by some sort of abnormality in the fallopian tube. A tube can become partially or completely blocked if there has been a previous infection. Adhesions or scar tissue caused by previous surgeries can also cause damage to the tubes. Some women are born with tubes that are not normal. Sometimes there is no apparent cause for the ectopic pregnancy to occur. Women who have had abdominal surgery, pelvic inflammatory disease, or multiple abortions are more likely to develop an ectopic pregnancy. There is also a greater risk for women who are in their late thirties or older at the time of their pregnancy. Women who have had one ectopic pregnancy are at greater risk for having a second.

Most women do not know their pregnancy is ectopic until they start to have symptoms. Ectopic pregnancies will cause a woman to have a positive pregnancy test. If a doctor is monitoring the level of hCG, the pregnancy hormone, an ectopic pregnancy might be diagnosed because of lower than normal hCG levels. Generally, a woman will start having symptoms as the pregnancy develops that will indicate that an ectopic pregnancy is occurring. The most common symptom is sharp pain in the pelvic area, stomach, shoulders or neck. The pain can be quite intense, but it will often come and go. Nausea and vomiting are common. Women suffering from an ectopic pregnancy can experience vaginal bleeding which can be quite heavy. They might faint, or complain of being weak or dizzy.

The earlier an ectopic pregnancy is diagnosed, the better. A doctor will diagnose an ectopic pregnancy by monitoring hCG levels, performing an ultrasound to see if anything can be seen in the uterus, and by performing a pelvic exam. A procedure called a culdocentesis might be performed to check for the presence of blood behind the uterus which might indicate an ectopic pregnancy.

Once a pregnancy has been determined to be ectopic, it is impossible to save. The focus will be on saving the fallopian tubes and minimizing damage. If the pregnancy is not too far along, doctors will administer methotrexate. It is used to encourage the body to absorb the tissue from the pregnancy. However, if there is significant bleeding or the fallopian tube has become damaged, surgery will be performed. The patient will undergo laparoscopic surgery, or may need a laparoscopy. The surgeon will remove the pregnancy and attempt to save the fallopian tube. If it is too damaged, he will remove the tube during the surgery. The level of hCG will be monitored to ensure that all of the pregnancy tissue was removed.

Losing a pregnancy because it was ectopic can be very difficult emotionally for a woman. Counselling might be appropriate to help her deal with her loss. Friends and family members should understand that it can be devastating for a woman to lose a pregnancy in this manner and should be supportive. Having an ectopic pregnancy does not mean that a woman can not have a successful pregnancy in the future. After the patient has recovered, her doctor can discuss possible options for another pregnancy. Many women go on become pregnant and carry a baby to term without complications.

Food to avoid During Pregnancy

During pregnancy, it’s important to get a nutritionally balanced diet for the benefit of you and your baby. However, there are certain foods you should avoid during pregnancy as they carry a risk of damaging your heath, or that of your unborn child. If one of your favourite treats is listed below, then you’re better off going without during your pregnancy, despite any cravings you might have!

Soft cheese and blue veined cheese

(E.G. Camembert, Brie, Stilton, Feta)
These types of cheese may be delicious, but they can contain listeria, a bacterium found in unpasteurised food and in soil and can cause the infection listeriosis which can be fatal to your unborn baby (and has been linked to Meningitis). Stick to hard cheeses such as Cheddar and Red Leicester – cottage cheese and spreads such as Primula are also safe as they are usually pasteurised.


Cold deli meat

Cold meat bought from the deli has been known to contain listeria – If you do eat deli meat, make sure to heat it up until it is steaming – the listeria bacterium dies at temperatures above 75 degrees Celcius

Smoked fish

‘Kippered’ or ‘Smoked’ fish can contain listeria, so avoid these!

Deep sea fish

(E.G. Tuna, Marlin, Shark, Swordfish, King Mackerel, some fish used in Sushi)
Fish which live in deep sea contain high levels of Mercury, which are usually not damaging to grown humans, but in your unborn baby can cause brain damage leading to developmental issues such as late walking or talking. Canned tuna contains much less mercury than fresh tuna, but even so it is recommended not to eat more than 3-4 medium sized (140g) cans of tuna a week.


Shellfish

Raw shellfish such as mussels, oysters and cockles can contain bacteria, and even cooking these does not prevent algae-related infections linked to red tides. Avoid if possible.

Raw meat

This includes rare steaks, Sushi, uncooked seafood such as shellfish and any meat that is undercooked. Meat that is not properly cooked can contain coliform bacteria, toxoplasmosis and salmonella which can cause food poisoning and can be dangerous for your baby. It’s never fun having food poisoning anyway, so make sure to order well done, and if your BBQ’s are usually a culinary gamble then avoid!
Raw egg

Foods that contain raw egg include home-made ice cream, mayonnaise, Caesar salad dressing, Unpasteurised Egg nog, Hollandaise sauce and home-made custard, as well as runny eggs! Raw egg can contain salmonella which causes severe food poisoning, so look for products that contain pasteurised ingredients as these are safe. Eggs should be cooked until the white AND yolk are solid.

Certain fresh-water fish

There are industrial pollutants called polychlorinated biphenyls (PCBs) which, in contaminated areas, can be found in freshwater fish such as salmon, pike and trout. Eating lots of fish contaminated with PCBs when pregnant has been linked with decreased attention, memory and IQ in children. If you eat these types of fish, be aware of the risks and try and keep intake to a minimum in case of pollution.

Liver

Liver is very high in Vitamin A, which is an essential vitamin but in high doses can cause birth defects. Minimise the amount you consume during pregnancy to avoid issues.

Raw sprouts

There have been cases of an outbreak of salmonella from eating raw sprouts, so make sure these are cooked properly. Who eats sprouts raw anyway?

Unwashed raw vegetables

Raw vegetables are really good for you and your baby, so eat plenty of them! However, make sure they are washed well to remove any contamination with toxoplasmosis which can be found in the soil.

Green sprouting potatoes

Potatoes which have started to sprout and go green contain toxins known as alpha-solanine and alpha-chaconine – which are linked to spina bifida and other developmental issues. It’s no use just cutting off the green bits, just chuck the whole lot away!

Peanuts

Eating peanuts during pregnancy can increase the risk that your child will have an allergy to these, which as we all have heard can be fatal. Other nuts such as cashews, almonds and hazelnuts are fine to eat, and very good for you, so just avoid the peanut butter while you have a bump!

Caffeine

Studies are inconclusive, but there is a certain amount of evidence to suggest that large amounts of caffeine intake may be linked to miscarriages. Avoid taking more than 300mg of caffeine a day (3 cups of coffee or 6 cups of tea). Caffeine can also be found in Cola, chocolate and energy drinks. It’s also a diuretic (helps eliminate fluids from the body) so ensure you drink plenty of water during pregnancy. If you can’t give up your coffee addiction, then at least try and avoid drinking too much during your first trimester, when risk of miscarriage is greatest.

Alcohol

There is no level of alcohol intake which is known to be safe during pregnancy, so there is no excuse to drink alcohol at all during pregnancy (or breastfeeding). Alcohol can cause Fetal Alcohol Syndrome or other developmental disorders, and regardless of your craving for a glass of wine or beer is not safe for your little one!

In addition, it’s important that any reheated food you eat is piping hot right through, to make sure any nasty bugs are killed in the food!

Coping with Morning Sickness

It’s a well-known fact that morning sickness is extremely common within the first three months of pregnancy. Contrary to its name, “morning” sickness can occur at any time of day, and can even last for the entire duration of the pregnancy.

Massive hormone levels are the cause for the nausea, and although distressing, it is unlikely to cause damage to your baby.Getting up too quickly can bring on morning sickness, so if you have a partner with you, ask them to bring you a drink and biscuit in bed before you get up. This will help to steady you before you start your day.

Strong flavours and smells can often be a trigger for sickness during pregnancy, so it may be a good idea to avoid these if you begin to experience this. Coffee, alcohol, cola, chocolate, sugary and fatty foods are all known to cause nausea or upset pregnant bellies. Ask your partner / family to help you avoid these by keeping a good stock of “safe” foods in your fridge – things which can be prepared quickly or eaten cold, or which do not have a lingering smell or taste.

Due to the possible risks to the baby, conventional medicine is often avoided when treating morning sickness, resulting in a greater number of women seeking alternative therapies to help them cope with this difficult time.If you are looking to try another way, then the following methods may be of use to you:


Acupressure
Applying pressure to certain points on your body in order to give pain relief, is referred to as Acupressure. Used for over 3000 years, the principles of acupressure are the same as those of acupuncture, but instead of penetrating the body with needles, prolonged pressure is applied. The pressure point which is thought to help alleviate morning sickness, is located in the middle of the inside of your fore-arm, around two to three finger-widths up from the crease of your wrist. The point sits between two tendons which can be found by slightly clenching your wrist. Once you have found this point, you need to apply vibrating pressure for 20 seconds, then relax. This can be repeated.

Chinese Medicine
Personalised prescriptions can often be made up by a herbalist at a Chinese medicine shop, so it’s well-worth a visit. This applies to almost any ailment, and appeals to many who do not wish to take chemical treatments.

Ginger
Ginger is well-known for its ability to reduce nausea. Many women find that tea made from fresh ginger root first thing in the morning is a great help. Making ginger tea is really simple; here’s how - Add one teaspoon of root ginger to a cup of boiling water. Steep for 10 minutes, then strain. Add honey to sweeten it if you like, then drink whilst still warm. You can even try adding ginger to a main meal such as a stir fry, or if you don’t like the taste of ginger, you can buy ginger capsules from your local health shop which will also have the same effect.

Fruit Juice
Both apple and pineapple juices are both believed to reduce nausea, so why not keep a glass of juice next to your bed at night-time?
If you find it hard to keep solid foods down, why not try making your own fruit and vegetable juices or smoothies? It is paramount that you don’t become dehydrated, so always try to keep taking liquids in, especially when you have been sick.
Of course the most important thing for you and your baby, is to follow your own natural instincts. If your body tells you that you really shouldn’t be drinking orange juice in the mornings, then listen to it! Remember that no two pregnancies are the same, and that if you begin to become concerned about your morning sickness, speak to your doctor or nurse and they will be able to offer advice.

Pregnancy Tests


Pregnancy is an important time to pay attention to your health. One way you and your doctor will keep an eye on you is to perform various tests during your pregnancy. Some tests tell your doctor about your health. Other tests tell the doctor certain things about your baby. Most tests are routine—every pregnant woman has them.

A few tests are done if your doctor thinks he or she could learn more about your health or your baby's health from them. Your first test will probably be a pregnancy test. You can do this yourself at home, or take care of it in your doctor's office. Home pregnancy test kits are very accurate. Once you know you're pregnant, a lot of tests will be done at your first or second visit with your doctor.

These tests tell your doctor how healthy you are at this time and whether he or she needs to caution you about things to avoid or to watch out for. Some tests are repeated during pregnancy, if necessary. Because tests during pregnancy are important, cooperate with your doctor about having them. Keep your appointments for tests, and always check with your doctor's office about test results.

Working before Pregnancy


Hazards
Many workplace exposures, such as to X-rays and chemicals, could be harmful during pregnancy. Find out if this could be a problem for you during pregnancy by discussing it with your doctor before you get pregnant. If you wait to ask until after you find out you're pregnant, you may have already exposed your developing fetus to various dangers during the early and most important weeks of development.

Standing on the Job
Studies have shown that women who stand for a long time each day have smaller babies. If you have had premature deliveries or an incompetent cervix in the past, or if your job requires that you stand a lot, discuss the situation with your healthcare provider. You may need to modify your job.

Healthcare Insurance—Are You Covered?
Not every insurance plan includes maternity coverage. Some have a waiting period to pay for surgery or for having a baby. Some may not cover your doctor or the hospital you want. Find out about these things before trying to get pregnant. Having a baby costs a lot; know what your coverage is ahead of time. Planning ahead may save you money and save you the trouble of changing doctors or hospitals.

Your Prepregnancy Health

If you are in good health before and during your pregnancy, you'll do a lot to ensure the good health ofyour baby. But in many cases, you can have a successful pregnancy even if you have a chronic health problem. Many women with health problems have successful pregnancies and healthy babies.

It is very important for you to discuss your particular situation with your doctor before becoming pregnant. Follow his or her instructions carefully. Below are short discussions about some common health problems a pregnant woman may have.

Diabetes

A lot of progress has been made regarding diabetes and the pregnant woman. However, diabetes can have serious effects during pregnancy. Risks to you and your baby can be decreased with good control of blood sugar during pregnancy. Discuss your concerns with your physician before you try to conceive. The longer your diabetes is under control before you become pregnant, the better—but most doctors recommend having your condition under control at least 2 or 3 months before pregnancy begins. This helps lower the risk of miscarriage or of fetal development being affected. Most problems for diabetic women occur during the first trimester—the first 13 weeks of pregnancy. However, problems can occur throughout pregnancy, which is why it's important to have your diabetes under good control before you conceive. A woman's insulin requirement often increases in the last 13 weeks of pregnancy.

Heart Problems

Some heart problems may be serious during pregnancy and require special care. Other heart problems may affect your health so adversely that your physician will advise against pregnancy. This serious question must be discussed with your heart specialist and your obstetrician before you get pregnant.

Anemia

If you have been anemic in the past, your doctor can easily check you for anemia now. When you're pregnant, great demands are made on your body's iron supplies for the baby. Many women start taking vitamins or iron before getting pregnant. Because you have had a problem in the past, discuss this with your doctor before pregnancy.

Thyroid Condition

If you take medication for a thyroid condition, don't make any changes without first consulting your physician. Medication for thyroid problems is very important during pregnancy.

X-rays and Other Tests

If you have a condition, such as a back problem, that requires X-rays, CT-scans or MRI tests, complete them while you are still using contraception, before you consider conceiving. A good time to schedule these tests is right after the end of your period, so you know you're not pregnant.

Vaccinations

If you have recently received a vaccination, discuss the matter with your doctor before you try to become pregnant. Some vaccinations are safe during pregnancy. Others, such as the vaccination against rubella, are not. Most physicians believe it's wise to continue contraception for at least 3 months after receiving any type of vaccination.

Medications

If you commonly take medications for various problems, it's best to be cautious with your use of these substances while you are preparing for pregnancy and while you are trying to conceive. Follow the guidelines below for safe use. Ask your doctor if the medications you are taking are safe to use during pregnancy. Take all prescription medications as prescribed. Don't use old medications for current problems. Be careful with over-the-counter medications. Many contain caffeine, alcohol and other additives. Never use anyone else's medication for your medical problem. Notify your doctor immediately if you are using medication and believe you might be pregnant.

Exercise before Pregnancy

Exercise is good for you, whether or not you are pregnant. It's an important part of a healthy pregnancy, too. Develop a good exercise program before getting pregnant to help you feel better, control weight and increase stamina. Exercise can also help make labor and delivery easier.

To find and maintain a good exercise program, choose exercise you enjoy and can do in any type of weather. A great deal of information on various types of exercise programs is available from your local hospital, your healthcare provider and health clubs. The American College of Obstetricians and Gynecologists (ACOG) has tapes available on exercise during and after pregnancy. Ask your healthcare provider for ordering information.

If you love to exercise, that's great! But don't overdo it while you are pregnant. General guidelines for exercise before and during pregnancy include those listed below. Before starting a new program, consult your doctor about past medical problems and past pregnancy complications.

  • Start exercising before you get pregnant
  • Exercise on a regular basis
  • Start gradually, and increase as you build strength
  • Wear comfortable clothing
  • Avoid contact sports or risky exercise, such as water-skiing or horseback riding. Allow plenty of time for warming up and cooling down
  • Check your pulse every 10 to 15 minutes during exercise
  • Don't let your pulse exceed 140 beats a minute
  • Once you're pregnant, be careful when changing positions
  • After the fourth month of pregnancy, don't lie flat on your back when exercising. This decreases blood flow to your baby
  • Stop exercising and consult your doctor if you have any bleeding, loss of fluid from the vagina, shortness of breath, dizziness, abdominal pain or other serious problems

Nutrition before Pregnancy


Many of my patients who are considering pregnancy tell me they love hamburgers, French fries and other junk foods, and they hate to give them up. They wonder if their eating habits will affect their pregnancy. The answer is yes. Avoid junk food. Eat fresh, nutritious foods, including lots of fruits and vegetables. Prepare them simply, with little added fat.

Start Eating Well Now

It is best for you and your baby if you develop good eating habits before you get pregnant. Eat nutritiously for all 12 months of pregnancy. By the time many women know they're pregnant, they are 7 or 8 weeks into the pregnancy—or more! These early weeks of pregnancy are important in the development of your baby. That's why it's important to be prepared and to start eating right before you are pregnant.

About Weight

Pregnancy is not the time to start a new diet or to try to lose weight. Dieting can cause temporary deficiencies in vitamins and minerals that are important to your developing baby. Ask your healthcare provider about a good eating plan before getting pregnant, and make necessary changes before pregnancy.

Changes during Pregnancy

Your body goes through incredible changes during pregnancy! Your breasts enlarge, and the number of milk ducts to produce breast milk increases. Your organs are crowded by your enlarging uterus, which may cause more-frequent urination, heartburn or indigestion. Your legs, feet and hands may swell. Your hair and skin often undergo changes.

How Pregnancy Occurs

During your menstrual cycle, your body prepares for the possibility of pregnancy. An egg is released from one of your ovaries, and changes take place in the lining of your uterus to provide an environment for the development of a fertilized egg. If fertilization does not take place, the enriched lining is discarded through the menstrual flow.
Fertilization is believed to occur in the middle part of the Fallopian tube, not inside the uterus. Sperm travel through the uterine cavity and out into the tube to meet the egg that comes from the ovary. After fertilization, the fertilized egg begins to divide and to grow. Within 3 to 7 days, it travels down the Fallopian tube into the uterus and attaches to the wall of the uterus. The developing baby is now called an embryo. (After 8 weeks it is called a fetus.)
By about day 12, the amniotic sac begins to form around the developing embryo. The sac contains fluid in which the baby can move around easily. Amniotic fluid also cushions the fetus against injury and regulates temperature.

Your Current Contraception Methods

Most doctors recommend staying off the Pill for two or three normal menstrual cycles before trying to get pregnant. Use some other form of contraception, such as the barrier method (condom), until you want to get pregnant.
The best and easiest time to remove an intrauterine device (IUD) is during your period. Wait for a couple of normal cycles after your IUD is removed before trying to conceive. Use a barrier contraceptive during the waiting time.
If you use the Norplant® implant for birth control, wait at least two or three menstrual cycles after it is removed before trying to get pregnant. The Depo-provera® injection works for 3 months. Advised to have at least two normal periods before you attempt a pregnancy.

When to See Your Doctor

If possible, see your doctor before you get pregnant. A visit before pregnancy clears up questions about medications you are taking. You can have a Pap smear and any other tests your healthcare provider decides are necessary. With your healthcare provider, you can evaluate your current weight and set a target weight gain for your pregnancy. You will know you're in good health before getting pregnant; if you're not, you can make plans to get into the best shape you can before you get pregnant.

Your doctor may order a range of tests, including:
  • Pap smear
  • Rh-factor test
  • Blood typing
  • Rubella titers
  • Mammogram, if you are 35 or older

If you know you have other specific or chronic medical problems, such as diabetes, have these checked. If you have been exposed to hepatitis or AIDS, tests should be done for these.

Top 10 Early Pregnancy Symptoms

The only sure-fire way of testing if you are pregnant is to get a home pregnancy test and find out for sure! However, there are a group of symptoms which can indicate that you're pregnant which some women experience really early in pregnancy - so take a look through the following list and if you recognise your symptoms then get a test to find out for sure!



Headaches


Increased headaches can be caused by all those hormones flowing around your body. They can also make you moody and agitated.Other possible causes - Dehydration, impending period or a wide range of other reasons.

Tiredness/Fatigue
Many pregnant women feel exhausted in the first few weeks of pregnancy, and the cause is unknown although it may be to do with large amounts of hormones flowing around your body preparing it for carrying a child!Other possible causes - General exhaustion or illness can cause tiredness

Abdominal bloating
Those hormones again! You may notice that your clothes fit more snugly than normal and you feel bloatedOther possible causes - Period being due

Swollen or Tender breasts
Your breasts can become tender or swollen from as little as 1-2 weeks after conception!Other possible causes - A due period or birth control pills can cause sore, tender breasts.

Nausea and sickness
Morning sickness usually arrives at 2-8 weeks for the majority of unlucky mums, this may be short lived, or for some continue through pregnancyOther possible causes - Food poisoning and other illnesses, or stress.

Frequent urination
Need to go to the bathroom all the time? From about 6 weeks, many women find that they need to urinate more frequently. This is caused by increased liquid being stored by your body, and therefore the liver processing more urine.Other possible causes - Urinary tract infection, diabetes or drinking lots of fluids!

Implantation Bleeding
6-12 days after conception, the embryo implants itself in the wall of your uterus, and this can cause spotting or cramps.Other possible causes - Actual period, or infection

Food cravings
You might not be longing for ice-cream with chillies or a nice lump of coal, but craving for certain foods is a common pregnancy symptom, which can begin very early in pregnancyOther possible causes - Lack of certain nutrients, bad diet.

Nipples (areola) becoming larger and darker
Many women's areola become darker and larger during pregnancy, this is completely natural!Other possible causes - Hormonal imbalance unrelated to pregnancy

Missed period
This is the most obvious sign of pregnancy. Although many women bleed during pregnancy, it is normally lighter and briefer than a normal periodOther possible causes - Stress, excessive weight loss/gain, birth control pills

Preparing for Pregnancy


Planning your pregnancy before you get pregnant helps ensure that your baby gets the best start in life that you can possibly give him or her. For that reason, many physicians and other healthcare workers are now considering pregnancy a 12-month term. The actual length of a pregnancy (growth from a fertilized egg into a normal-size baby) is 9 months. But now we know the few months before you get pregnant can be as important as the 9 months in which the fetus develops inside of you.

With good preparation on your part, you can give your baby the best start toward a healthy life. The months that you plan for your pregnancy give you time to prepare your body and make any necessary lifestyle changes. You can eat nutritiously, cut out alcohol and tobacco use, begin an exercise program, get your weight under control and talk to your doctor about any other medical concerns you have.

You can do many things to prepare for pregnancy
  • Exercise regularly.
  • Find out if medications you take regularly can be decreased or discontinued.
  • Ask your physician if they are safe to take during pregnancy.
  • Get your weight under control. Pregnancy is not the time to lose weight.
  • If you need X-rays or medical tests, get them done before trying to get pregnant.
  • It's a good time to control or to eliminate tobacco, alcohol or drug use.
  • Decide who will deliver your baby.
  • Check on your insurance coverage for pregnancy.

Obstetric Ultrasound Scans

What are Obstetric Ultrasound Scans?

Obstetric Ultrasound is the use of ultrasound scans in pregnancy. Since its introduction in the late 1950’s ultrasonography has become a very useful diagnostic tool in Obstetrics. Currently used equipments are known as real-time scanners, with which a continous picture of the moving fetus can be depicted on a monitor screen. Very high frequency sound waves of between 3.5 to 7.0 megahertz (i.e. 3.5 to 7 million cycles per second) are generally used for this purpose.

They are emitted from a transducer which is placed in contact with the maternal abdomen, and is moved to "look at" (likened to a light shined from a torch) any particular content of the uterus. Repetitive arrays of ultrasound beams scan the fetus in thin slices and are reflected back onto the same transducer.
The information obtained from different reflections are recomposed back into a picture on the monitor screen (a sonogram, or ultrasonogram). Movements such as fetal heart beat and malformations in the feus can be assessed and measurements can be made accurately on the images displayed on the screen. Such measurements form the cornerstone in the assessment of gestational age, size and growth in the fetus.

A full bladder is often required for the procedure when abdominal scanning is done in early pregnency. There may be some discomfort from pressure on the full bladder. The conducting gel is non-staining but may feel slightly cold and wet. There is no sensation at all from the ultrasound waves.


Why and when is Ultrasound used in Pregnancy?


Ultrasound scan is currently considered to be a safe, non-invasive, accurate and cost-effective investigation in the fetus. It has progressively become an indispensible obstetric tool and plays an important role in the care of every pregnant woman.

The main use of ultrasonography are in the following areas:
1. Diagnosis and confirmation of early pregnancy.
The gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured by about five and a half weeks. Ultrasound can also very importantly confirm the site of the pregnancy is within the cavity of the uterus.

2. Vaginal bleeding in early pregnancy.
The viability of the fetus can be documented in the presence of vaginal bleeding in early pregnancy. A visible heartbeat could be seen and detectable by pulsed doppler ultrasound by about 6 weeks and is usually clearly depictable by 7 weeks. If this is observed, the probability of a continued pregnancy is better than 95 percent. Missed abortions and blighted ovum will usually give typical pictures of a deformed gestational sac and absence of fetal poles or heart beat.

Fetal heart rate tends to vary with gestational age in the very early parts of pregnancy. Normal heart rate at 6 weeks is around 90-110 beats per minute (bpm) and at 9 weeks is 140-170 bpm. At 5-8 weeks a bradycardia (less than 90 bpm) is associated with a high risk of miscarriage.
Many women do not ovulate at around day 14, so findings after a single scan should always be interpreted with caution. The diagnosis of missed abortion is usually made by serial ultrasound scans demonstrating lack of gestational development. For example, if ultrasound scan demonstrates a 7mm embryo but cannot demonstrable a clearcut heartbeat, a missed abortion may be diagnosed. In such cases, it is reasonable to repeat the ultrasound scan in 7-10 days to avoid any error.
The timing of a positive pregnancy test may also be helpful in this regard to assess the possible dates of conception. A positive pregnancy test 3 weeks previously for example, would indicate a gestational age of at least 7 weeks. Such information would be useful against the interpretation of the scans. Please read the FAQs for more comments.
In the presence of first trimester bleeding, ultrasonography is also indispensible in the early diagnosis of ectopic pregnancies and molar pregnancies.

3. Determination of gestational age and assessment of fetal size.
Fetal body measurements reflect the gestational age of the fetus. This is particularly true in early gestation. In patients with uncertain last menstrual periods, such measurements must be made as early as possible in pregnancy to arrive at a correct dating for the patient. See FAQ. In the latter part of pregnancy measuring body parameters will allow assessment of the size and growth of the fetus and will greatly assist in the diagnosis and management of intrauterine growth retardation (IUGR).

The following measurements are usually made:
  • The Crown-rump length (CRL) - This measurement can be made between 7 to 13 weeks and gives very accurate estimation of the gestational age. Dating with the CRL can be within 3-4 days of the last menstrual period. (Table) An important point to note is that when the due date has been set by an accurately measured CRL, it should not be changed by a subsequent scan. For example, if another scan done 6 or 8 weeks later says that one should have a new due date which is further away, one should not normally change the date but should rather interpret the finding as that the baby is not growing at the expected rate.

  • The Biparietal diameter (BPD) - The diameter between the 2 sides of the head. This is measured after 13 weeks. It increases from about 2.4 cm at 13 weeks to about 9.5 cm at term. Different babies of the same weight can have different head size, therefore dating in the later part of pregnancy is generally considered unreliable. (Chart and further comments) Dating using the BPD should be done as early as is feasible.

  • The Femur length (FL) - Measures the longest bone in the body and reflects the longitudinal growth of the fetus. Its usefulness is similar to the BPD. It increases from about 1.5 cm at 14 weeks to about 7.8 cm at term. (Chart and further comments) Similar to the BPD, dating using the FL should be done as early as is feasible.

  • The Abdominal circumference (AC) - The single most important measurement to make in late pregnancy. It reflects more of fetal size and weight rather than age. Serial measurements are useful in monitoring growth of the fetus. (Chart and further comments) AC measurements should not be used for dating a fetus.

  • Other important measurements are discussed here.
    The weight of the fetus at any gestation can also be estimated with great accuracy using polynomial equations containing the BPD, FL, and AC. computer softwares and lookup charts are readily available. For example, a BPD of 9.0 cm and an AC of 30.0 cm will give a weight estimate of 2.85 kg. (comments)

4. Diagnosis of fetal malformation.
Many structural abnormalities in the fetus can be reliably diagnosed by an ultrasound scan, and these can usually be made before 20 weeks. Common examples include hydrocephalus, anencephaly, myelomeningocoele, achondroplasia and other dwarfism, spina bifida, exomphalos, Gastroschisis, duodenal atresia and fetal hydrops. With more recent equipment, conditions such as cleft lips/ palate and congenital cardiac abnormalities are more readily diagnosed and at an earlier gestational age.

First trimester ultrasonic 'soft' markers for chromosomal abnormalities such as the absence of fetal nasal bone, an increased fetal nuchal translucency (the area at the back of the neck) are now in common use to enable detection of Down syndrome fetuses. Ultrasound can also assist in other diagnostic procedures in prenatal diagnosis such as amniocentesis, chorionic villus sampling, cordocentesis (percutaneous umbilical blood sampling) and in fetal therapy.

5. Placental localization.
Ultrasonography has become indispensible in the localization of the site of the placenta and determining its lower edges, thus making a diagnosis or an exclusion of placenta previa. Other placental abnormalities in conditions such as diabetes, fetal hydrops, Rh isoimmunization and severe intrauterine growth retardation can also be assessed.


6. Multiple pregnancies.
In this situation, ultrasonography is invaluable in determining the number of fetuses, the chorionicity, fetal presentations, evidence of growth retardation and fetal anomaly, the presence of placenta previa, and any suggestion of twin-to-twin transfusion.


7. Hydramnios and Oligohydramnios.
Excessive or decreased amount of liquor (amniotic fluid) can be clearly depicted by ultrasound. Both of these conditions can have adverse effects on the fetus. In both these situations, careful ultrasound examination should be made to exclude intraulterine growth retardation and congenital malformation in the fetus such as intestinal atresia, hydrops fetalis or renal dysplasia. See also FAQ and comments.


8. Other areas.
Ultrasonography is of great value in other obstetric conditions such as:
a) confirmation of intrauterine death. b) confirmation of fetal presentation in uncertain cases.c) evaluating fetal movements, tone and breathing in the Biophysical Profile.d) diagnosis of uterine and pelvic abnormalities during pregnancy e.g. fibromyomata and ovarian cyst.

Transvaginal Scans

With specially designed probes, ultrasound scanning can be done with the probe placed in the vagina of the patient. This method usually provides better images (and therefore more information) in patients who are obese and/ or in the early stages of pregnancy. The better images are the result of the scanhead's closer proximity to the uterus and the higher frequency used in the transducer array resulting in higher resolving power. Fetal cardiac pulsation can be clearly observed as early as 6 weeks of gestation. Vaginal scans are also becoming indispensible in the early diagnosis of ectopic pregnancies. An increasing number of fetal abnormalities are also being diagnosed in the first trimester using the vaginal scan. Transvaginal scans are also useful in the second trimester in the diagnosis of congenital anomalies. Read one of my presentations at OBGYN.net-Ultrasound.

Doppler Ultrasound

The doppler shift principle has been used for a long time in fetal heart rate detectors. Further developments in doppler ultrasound technology in recent years have enabled a great expansion in its application in Obstetrics, particularly in the area of assessing and monitoring the well-being of the fetus, its progression in the face of intrauterine growth restriction, and the diagnosis of cardiac malformations.Doppler ultrasound is presently most widely employed in the detection of fetal cardiac pulsations and pulsations in the various fetal blood vessels. The "Doptone" fetal pulse detector is a commonly used handheld device to detect fetal heartbeat using the same doppler principle.

Blood flow characteristics in the fetal blood vessels can be assessed with Doppler 'flow velocity waveforms'. Diminished flow, particularly in the diastolic phase of a pulse cycle is associated with compromise in the fetus. Various ratios of the systolic to diastolic flow are used as a measure of this compromise. The blood vessels commonly interrogated include the umbilical artery, the aorta, the middle cerebral arteries, the uterine arcuate arteries, and the inferior vena cava. The use of color flow mapping can clearly depict the flow of blood in fetal blood vessels in a realtime scan, the direction of the flow being represented by different colors. Color doppler is particularly indispensible in the diagnosis of fetal cardiac and blood vessel defects, and in the assessment of the hemodynamic responses to fetal hypoxia and anemia.

A more recent development is the Power Doppler (Doppler angiography). It uses amplitude information from doppler signals rather than flow velocity information to visualize slow flow in smaller blood vessels. A color perfusion-like display of a particular organ such as the placenta overlapping on the 2-D image can be very nicely depicted. Doppler examinations can be performed abdominally and via the transvaginal route. The power emitted by a doppler device is greater than that used in a conventional 2-D scan. Its use in early pregnancy is therefore cautioned. Doppler facilities are generally an integral part of modern ultrasound scanners. They merely would need to be switched on to function. One does not need to 'go' to another machine for the doppler investigations.

3-D and 4-D Ultrasound

3-D ultrasound can furnish us with a 3 dimensional image of what we are scanning. The transducer takes a series of images, thin slices, of the subject, and the computer processes these images and presents them as a 3 dimensional image. Using computer controls, the operator can obtain views that might not be available using ordinary 2-D ultrasound scan. 3-dimensional ultrasound is quickly moving out of the research and development stages and is now widely employed in a clinical setting. It too, is very much in the News. Faster and more advanced commercial models are coming into the market. The scans requires special probes and software to accumulate and render the images, and the rendering time has been reduced from minutes to fractions of a seconds. A good 3-D image is often very impressive to the parents. Further 2-D scans may be extracted from 3-D blocks of scanned information. Volumetric measurements are more accurate and both doctors and parents can better appreciate a certain abnormality or the absence of a certain abnormality in a 3-D scan than a 2-D one and there is the possibility of increasing psychological bonding between the parents and the baby.

An increasing volume of literature is accumulating on the usefulness of 3-D scans and the diagnosis of congenital anomalies could receive revived attention. Present evidence has already suggested that smaller defects such as spina bifida, cleft lips/palate, and polydactyl may be more lucidly demonstrated. Other more subtle features such as low-set ears, facial dysmorphia or clubbing of feet can be better assessed, leading to more effective diagnosis of chromosomal abnormalities. The study of fetal cardiac malformations is also receiving attention. The ability to obtain a good 3-D picture is nevertheless still very much dependent on operator skill, the amount of liquor (amniotic fluid) around the fetus, its position and the degree of maternal obesity, so that a good image is not always readily obtainable.

More recently, 4-D or dynamic 3-D scanners are in the market and the attraction of being able to look at the face and movements of your baby before birth was also enthusiastically reported in parenting and health magazines. This is thought to have an important catalytic effect for mothers to bond to their babies before birth. What are known as 're-assurance scans' and the rather misnamed 'entertainment scans' have quickly become popular.

Most experts do not consider that 3-D and 4-D ultrasound will be a mandatory evolution of our conventional 2-D scans, rather it is an additional piece of tool like doppler ultrasound. Most diagnosis will still be made with the 2-D scans. 3-D ultrasound appears to have great potential in research and in the study of fetal embryology. Whether 3-D ultrasound will provide unique information or merely supplemental information to the conventional 2-D scans will remain to be seen.
Click here for some good sample images courtesy of Dr. Bernard Benoit. Visit the GE 4D site for more pictures and information. Dr. Najeeb Layyous's 3-D and 4-D website also has many more pictures and clips. Read also the FAQ page.

The Schedule

There is no hard and fast rule as to the number of scans a woman should have during her pregnancy. A scan is ordered when an abnormality is suspected on clinical grounds. Otherwise a scan is generally booked at about 7 weeks to confirm pregnancy, exclude ectopic or molar pregnancies, confirm cardiac pulsation and measure the crown-rump length for dating.A second scan is performed at 18 to 20 weeks mainly to look for congenital malformations, when the fetus is large enough for an accurate survey of the fetal anatomy. multiple pregnancies can be firmly diagnosed and dates and growth can also be assessed. Placental position is also determined. Further scans may be necessary if abnormalities are suspected.

Many centers are now performing an earlier screening scan at around 11-14 weeks to measure the fetal nuchal translucency and to evaluate the fetal nasal bone (and more recently, to detect tricuspid regurgitation) to aid in the diagnosis of Down Syndrome. Some centers will do blood test biochemical screening at the same visit. Further scans may sometimes be done at around 32 weeks or later to evaluate fetal size (to estimate the fetal weight) and assess fetal growth. Or to follow up on possible abnormalities seen at an earlier scan. Placental position is further verified. The most common reason for having more scans in the later part of pregnancy is fetal growth retardation. Doppler scans may also be necessary in that situation.

The total number of scans will vary depending on whether a previous scan has detected certain abnormalities that require follow-up assessment. What is often referred to as a Level II scan merely indicates a "targeted" examination where it is done when an indication is present or when an abnormality is suspected in a previous examination. In fact professional bodies such as the American Institute of Ultrasound in Medicine does not endorse or encourage the use of these terms. A more "thorough" examination is usually done at an a perinatal center or specialised clinic where more expertise and better equipments may be present.

One should not dwell too much on the definitions or guidelines for a level II ultrasound scan. The prenatal sonologist should always try very hard to look for and assess any abnormality that may be present in the fetus. It is not very meaningful to be talking about level III or even level IV scans.
That a pregnancy should be scanned at 18 to 20 weeks as a rule is gradually becoming a matter of routine practice. Please go to the FAQ page and News page for other discussions. A rather thorough discussion paper on Ultrasound screening in pregnancy can be found here. Read also the RCOG's paper on routine screening in pregnancy.

What about Safety?

It has been over 40 years since ultrasound was first used on pregnant women. Unlike X-rays, ionizing irradiation is not present and embryotoxic effects associated with such irradiation should not be relevant. The use of high intensity ultrasound is associated with the effects of "cavitation" and "heating" which can be present with prolonged insonation in laboratory situations. Although certain harmful effects in cells are observed in a laboratory setting, abnormalities in embryos and offsprings of animals and humans have not been unequivocally demonstrated in the large amount of studies that have so far appeared in the medical literature purporting to the use of diagnostic ultrasound in the clinical setting. Apparent ill-effects such as low birthweight, speech and hearing problems, brain damage and non-right-handedness reported in small studies have not been confirmed or substantiated in larger studies from Europe. The complexity of some of the studies have made the observations difficult to interpret. Every now and then ill effects of ultrasound on the fetus appears as a news item in papers and magazines. Continuous vigilance is necessary particularly in areas of concern such as the use of pulsed Doppler in the first trimester. The greatest risks arising from the use of ultrasound are the possible over- and under- diagnosis brought about by inadequately trained staff, often working in relative isolation and using poor equipment.

 

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