Monthly Archives: May 2017
Ectopic Pregnancy
Ectopic or tubal pregnancy is a noteworthy pregnancy complication. Fortunately it is not common but should be identified and treated as soon as possible.
After fertilization, egg implants to the inside of the uterus. Ectopic pregnancy occurs when egg attaches itself outside of the uterus, most commonly in the fallopian tube(that’s where the term tubal pregnancy comes from). Embryo can not continue proper development outside of the uterus and if left untreated, can be life threatening or cause serious damage to the mother.
Symptoms
As ectopic pregnancy occurs in the beginning of the pregnancy it may happen that a female does not yet know about her condition. Therefore, it is also possible that there are no present symptoms. When the pregnancy test is positive and there are other early pregnancy signs too (sore breasts, nausea..), it is important to watch out for following symptoms:
- Vaginal spotting or bleeding – bleeding might vary from light to heavy. After getting a positive pregnancy test, beginning of red/brown bleeding or spotting should not be left inattentively. Ectopic pregnancy may also cause the fallopian tube rupture which may lead to severe bleeding. In this case doctor should be contacted immediately.
- Pelvic pain
- Abdominal pain – pelvic or abdominal pain might be of different intensity(mild, sharp,severe) and appear irregularly. Pain may be on the one side of the body.
- Shoulder or neck pain – ectopic pregnancy might cause internal bleeding. Blood will then gather under the diaphragm and irritate the nerves that go in the area.
- Weakness, dizziness
- Fainting
Causes and risk factors
In reality, it might be complicated to find out the cause of ectopic pregnancy. However, commonly, the problem is caused by the damaged fallopian tube that prevents egg from getting into the uterus, leaving it no other way but to implant outside of it. Common causes of blocked tube include:
- Pelvic infection and inflammation
- Scar tissue from previous surgery
- Abnormal growth that changes tube’s shape
Ectopic pregnancy might happen to anyone, however,there are several risk factors that might increase the chances. They include :
- Maternal age above 35
- Having experienced ectopic pregnancy before
- Pelvic inflammatory disease
- Previous pelvic surgeries
- Endometriosis
- Smoking
- Fertility drugs
Diagnosis and treatment
Ectopic pregnancy can be diagnosed through several methods :
- Pregnancy test to confirm the pregnancy
- Ultrasound – is used to check the location of the embryo, whether it is in the uterus or fallopian tube. Because an embryo can not continue proper development anywhere other than uterus, mother might have already miscarried before the exam. It is also possible than a female is on such an early stage of pregnancy that an embryo cannot yet be seen. Swollen fallopian tube or tissues left from the embryo will help to clarify the situation.
- HCG levels – HCG is is a hormone that is produced during pregnancy. Provided that the pregnancy is confirmed, HCG levels should not be lower than expected.
- Pelvic exam – will help to locate pain and check for tenderness in the abdomen.
If ectopic pregnancy is diagnosed, the treatment will vary according to the condition. Unfortunately, there is no way to transplant embryo in the uterus, so removing pregnancy tissues is the only way to support mother’s recovery. Remember that if the fallopian tube ruptures, it will cause severe bleeding and can lead to fatal consequences.
Treatment with Methotrexate
If ectopic pregnancy is identified on the early stage of pregnancy and there has been no damage to fallopian tube, the injection of methotrexate can be performed. It will stop cells from developing and allow the body to absorb remaining tissues instead.
Surgical Treatment
On later stages, medication might not be helpful and a small surgery will need to be performed. Laparoscope, a relatively thin instrument will be inserted through a very small incision in the abdomen. Remaining pregnancy tissues will be removed with the instrument. Surgery itself is called laparoscopy. According to the situation, fallopian tube might need to be removed during the laparoscopy.
When fallopian tube is already ruptured and a woman is experiencing heavy bleeding, emergency surgery will need to be done. It is called laparotomy and is performed through a larger incision.
Future Perspectives
Thinking about future pregnancy can be hard after a painful experience. Doctors may suggest to wait for 6 months approximately until the next try, however the duration may vary according to the treatment and the actual reason that caused the problem. If the fallopian tube was not removed, HCG levels should be checked regularly to see if the ectopic tissue was removed completely. If the results are 0, the recovery is progressing well and there is a good chance to have a successful pregnancy.
When the tubes are very damaged and a woman can not conceive naturally, remember that IVF treatment is a way to successful pregnancy and parenthood.
Implantation Bleeding
When trying to get pregnant, it may be devastating to notice bleeding on about the same day as next expected menstruation. However, bleeding might not at all be a regular period, but something that we call implantation bleeding – an early sign of pregnancy.
About Implantation Bleeding
Implantation bleeding usually starts about 10 days after egg is fertilized with sperm. Commonly, this happens just several days before woman expects her period. When the fertilized egg attaches itself in the uterus, it may disrupt tiny vessels. The disruption can cause bleeding, resulting in what we call implantation bleeding. The process itself is not abnormal, vice versa, about every third pregnant female experiences it.
It is not easy to tell a difference between menstruation and implantation bleeding. Discharge or spotting during implantation bleeding may be pink, red or brownish, accompanied with light cramping, headaches and mood swings. Not that much of a difference. In some cases, intuition may help because implantation bleeding might still look and feel different. For example :
- Implantation bleeding is usually of a lighter or simply a different color and makes the two cases distinguishable.
- If a woman experiences clotting during period, it will not be the case during implantation bleeding.
- Implantation bleeding will usually stop sooner than regular periods, especially for females who experience longer ones. The duration may last from several hours up to two days.
- And yes, sometimes it is impossible to tell a difference.
Implantation bleeding will terminate on it’s own and doesn’t need any kind of medical intervention. After the bleeding starts, it is the best practice to wait several days before doing the pregnancy test.
Are there complications?
Light bleeding is completely normal and sometimes may be just a little bit heavier because of a simple irritation after sexual intercourse or pelvic exam. Several infections may also contribute to bleeding, but it is still normal and will stop on its own.
However, if tests confirm that a female is pregnant and the bleeding is present, it is recommended to contact a doctor immediately (especially if bleeding has become heavy). Heavy bleeding early in pregnancy might indicate following issues :
- Ectopic pregnancy – a condition when an embryo implants outside the uterus instead of the inside.
- Molar pregnancy – genetic problem / error that occurs during fertilization, causing growth in the uterus but not the actual pregnancy.
- Miscarriage
Fertility Diet
Nobody doubts the importance of leading a healthy lifestyle. We all love toned and healthy bodies. Physical activities, hydration, well-balanced and healthy diet are things that benefit our lives mentally, medically and physically. Based on years of experience and researches, certain types of foods and lifestyle choices have been proven to influence fertility as well. Further we will focus on fertility diet – nutrients and meals that give a boost to reproductive system and support healthy pregnancy.
It is important to realize that diet choices influence fertility a long before actually trying to conceive – by the moment of pregnancy, it is essential to have a well prepared body. Remember that very low or very high body mass index (BMI) is often responsible for irregular menstruation, ovulation and a number of pregnancy complications.
Iron & Vitamin C
During menstruation, iron is leaving the body together with the red blood cells. For some females, periods are more heavy and they tend to lose more iron from the body. Iron deficiency is neither recommended for the baby, nor for the mother. It is really a hurdle to provide body with enough iron right before the pregnancy. For that reason, females should consider enriching their diet with iron- especially during menstruation.
It is recommended to avoid meals and beverages that may make periods heavier. Some examples are : alcoholic drinks, caffeine and spicy food.
Excessive amounts of caffeine can also be connected with conceiving difficulties. Remember that coffee is not the only beverage including caffeine. Tea and a number of soft drinks are too. However, it is okay to consume moderate amounts of them.
Foods rich in iron include:
- fish
- meat
- green vegetables
- beans
- tomatoes
- pumpkin beets
Vitamin C helps to absorb iron and provides body with essential nutrients. Tomatoes, broccoli, citruses and strawberry are examples of products rich with Vitamin C.
Protein sources and Vitamin B
Enriching fertility diet with proteins is important. However, as commonly believed, meat is not the only source of protein. Replacing meat with vegetable proteins is considered to be a good idea. They are lower in fats, can support ovulation and improve fertility.
Vegetables rich in protein include :
- nuts
- beans
- soybeans
- tofu
Vitamin B and folic acids can also aid ovulation. Folic acids, additionally can prevent fetal brain and spinal cord defects. Vitamin B may also aid the production of eggs. Future mothers may want to consider following products :
- spinach
- lettuce
- broccoli
- ssparagus
- eggs
- legumes
- whole grains
Fish
While fish is a good source to support fertility, regulate ovulation, improve egg quality, support baby’s brain and eye development, not all kinds of fish will do good.
Salmon, tuna (except some sorts), shrimps and catfish are rich in Omega-3 and should be included in fertility diet.
Taking fish oil supplements is also a reasonable option to consider, but it is better to choose one according to doctor’s recommendation.
Sushi, or any other forms of raw fish should be avoided. Fish that contain certain levels of metal – mercury, can also be harmful while trying to get pregnant. Types of fish that are high in mercury include :
- shark
- swordfish
- tilefish
- orange roughy
- ahi tuna
Hydration is crucial. Future mothers should maximize their water intake and keep alcohol consumption levels low. For women who love to consume dairy products, it is recommended to avoid low-fat dairies and substitute them with whole milk or full-fat yoghurt.
Similarly to females, future fathers should also control their health, weight and diet. Folic acid, vitamin C and zinc are good sources to support healthy sperm production. Alcoholic beverages, drugs and smoking should be avoided or completely limited.
The last, but not the least – remember to be physically active ! Some people may not want to go for a 5 km run or lift weights in the gym, however, they should definitely go for short, slow jogs or walks.
Low Amniotic Fluid
Amniotic fluid plays an important role during pregnancy; It supports baby’s growth and development. The levels of fluid could vary from low to high. This time, we will be focusing on low amniotic fluid, its meaning and possible outcomes.
What is amniotic fluid?
After conception, amniotic sac starts to form around the baby. Soon, the sac fills with the amniotic fluid. Before the second trimester of pregnancy, amniotic fluid is just a water that passes from mother’s circulatory system. Gradually with growth, baby starts to swallow amniotic fluid and excrete it as urine. Following this cycle, amniotic fluid finally becomes fetal urine and the levels of it depend a lot upon a baby.
Amniotic fluid is responsible for :
- Protecting baby from infections
- Protecting baby from trauma
- Supporting the development of muscles and limbs
- Supporting development of lungs
- Keeping baby’s oxygen supply sufficient
In certain situations and on certain stages of pregnancy, low amniotic fluid levels could represent a problem. The condition is also referred to as oligohydramnios when the amniotic fluid level is too low.
Low amniotic fluid – Oligohydramnios
If mother is leaking a fluid, experiences pregnancy complications, weights too small or doesn’t feel baby’s activity, doctors may become suspicious of oligohydramnios.
Amniotic fluid index is the way to measure fluid levels. Through ultrasound, sonographer will add up the measures from different sections of uterus and calculate the amniotic fluid index. Result should not be lower than 5 centimeters.
Causes
- Fetal problems – as already mentioned baby has an important role in maintaining the normal level of amniotic fluid. Baby, having problems with kidneys or urinary tract will not be able to produce enough urine, eventually leading to low amniotic fluid levels.
- Being past a due date (Post date pregnancy)
- Maternal problems, pregnancy complications – for example: preeclampsia, diabetes..
- Placenta not providing enough nutrients, oxygen or blood
- Leaky membranes – a small tear that allows the fluid to leak.
Usually, the level of amniotic fluid is the highest before the last trimester of pregnancy. As the due date approaches, the fluid will gradually decrease. Low amniotic fluid and oligohydramnios are most common during the last trimester of pregnancy or when mother is past her due date.
Because the amniotic fluid has a huge contribution in developing baby’s limbs and muscles, having low amniotic fluid levels in the first half of the gestation, could lead to more serious complications. They include damage to baby’s organs and unfortunately can also result in miscarriage or stillbirth.
If low amniotic fluid levels or oligohydramnios is present during the second half of the gestation, complications may include preterm labour, baby being too small, labour complications (and the need of c -section).
Baby’s health and amniotic fluid levels will be regularly controlled after the diagnose through ultrasounds and non-stress tests. When being close to the due date, delivery and induced labour is what the most of the doctors will recommend. Amnioinfusion is the procedure that raises the level of fluid with the help of catheter. The process helps to lower the chances of complicated labour and c-section.
As soon as pregnant women notice the leakage, they should immediately contact their healthcare providers. On the other hand, it is also crucial to attend prenatal checkups regularly and in case of surrogacy pregnancy, frequently ensure that the gestation is progressing as supposed.
Neonatal Herpes
When a pregnant female has genital herpes simplex virus (HSV2) which is active during the delivery, there is a chance of baby getting infected and born with neonatal herpes.
Neonatal herpes is a condition that can cause serious medical issues or even fatal consequences. Luckily, it is a very rare occurrence and the majority of females with genital herpes manage to deliver and raise healthy children.
The most important task is to timely identify whether the suspicion about baby being born with neonatal herpes is correct. After the delivery, symptoms commonly appear in between 1-3 weeks and in the majority of cases include skin vesicles (fluid filled sacs). Other signs of neonatal herpes include:
- respiratory issues
- fever
- malnutrition
- damaged and irritated skin, eye and oral areas.
What needs to be taken into consideration, is that mother’s genital herpes is not the only way to infect a baby. When a person with active oral herpes has physical contact with newborn, the infection can spread to the baby too. Physical contact, of course, includes kissing and even holding a baby after accidentally touching a cold sore on the mouth. In order to protect baby, it is important that people with HSV avoid close contact with him/her.
Neonatal herpes may be localized or disseminated. Localization means that the infection will affect skin, mouth and eyes. Disseminated type of infection may cause damage to organs, respiratory problems, hepatitis, unstable temperatures…
The infection may cause damage to provoke following complications :
- seizures
- mental retardation
- learning disabilities
- blindness
- death
Treatment
The course of treatment will vary according to the intensity of the issue. For example, if the infection is localized, the course of medication called acyclovir will normally be enough. When herpes is disseminated and is followed by a number of complications, acyclovir will need to be accompanied by special treatment, for example : control of seizures or temperature, supporting respiratory system of a baby and etc.
Localized neonatal herpes gives a solid opportunity to recover after a treatment. Disseminated, on the other hand, is unfortunately more severe condition and has a high morbidity and mortality rate. However, good news is that as already mentioned, neonatal herpes is relatively uncommon and females who discover HSV during pregnancy, do not need to terrified or worried.
Golf Ball Syndrome
On about 20th week of pregnancy, it is common to have a mid-pregnancy scan. During this procedure, ultrasound will reveal how baby’s organs(including heart), are developing. During the examination process, sonographer, (doctor performing the scan) may notice small bright spots on the baby’s heart. Because of their visual appearance, these white spots are referred to as gold balls and we would normally say that baby has a gold ball syndrome. Medical term for the spots is echogenic foci/focus.
Golf balls are found in up to 5% of fetuses. Their amount could vary from one to higher and are commonly located in the left ventricle of the heart. Usually their presence is not considered to be threatening : normally, they indicate neither fetal heart defect nor a heart dysfunction. Medically the process is explained as the mineralisation within a papillary muscle.
However, in some rare cases golf ball syndrome could be related to heart defect too. Additionally there has been identified a bond between golf balls and chromosomal abnormality, trisomy, causing the down syndrome. The suspicion about golf ball syndrome resulting in trisomy usually raises when mother has other medical problems and further fetal problems have been identified during the ultrasound.
Absence of other risk factors such as no medical issues and young maternal age, decrease the chance of a down syndrome significantly.
It is usually advised to perform an additional scan in about 3 weeks. First of all, because the golf ball syndrome has the tendency to disappear itself. If not, the detailed scan will reveal if there are any additional defects or whether the amniocentesis needs to be performed. When there is an uncertainty about harmlessness of golf balls, followed by certain pregnancy complications and risks, amniocentesis is a definite way to figure everything out.
During pregnancy, baby is surrounded by the sac of fluid, which is called amniotic fluid. Baby’s skin cells are shedded in the fluid and examination of this cells gives the opportunity to identify whether the baby has correct number of chromosomes. This medical procedure is called amniocentesis or chorionic villus sampling and is performed via passing a relatively thin needle through mother’s abdomen into the amniotic fluid. Amniocentesis is a very accurate representation of baby’s chromosome number and accordingly, gives a trustful impression whether baby could have a down syndrome.
Amniocentesis is not always recommended to perform and healthcare providers will only advise making the procedure when they have a reasonable suspicion about chromosomal abnormality.
Complications following the procedure could include bleeding, leakage of amniotic fluid, miscarriage or severe cramping. The complications are not common, however are worth to be taken into consideration.
In case of a surrogacy pregnancy, agency and clinics should simultaneously organize further scans in coordination with intended parents. Parents, on other hand, may like to be informed in advance about how much is the agency prepared for such occurrences and which procedures do they use to identify baby’s condition as clearly as possible.
Herpes and Surrogacy
While herpes and egg donation is not that much of a threatening combination, having a herpes simplex virus (HSV) during pregnancy (including surrogacy pregnancy) needs more attention and cautiousness.
When a pregnant female has genital herpes that is active during the delivery, the infection may be transmitted to a baby through the birth canal. When a baby is born with HSV, we would say that he/she has neonatal herpes. This condition is rare, but may result in serious and even fatal consequences for a baby.
Having Herpes Simplex Virus before pregnancy
When a female has chronic herpes simplex virus before pregnancy, the risk of transmitting it to the baby becomes minimal. First of all, situation is always easier to control when parents are aware of the condition in advance and accordingly, act as specified by their healthcare provider.
Immune system produces antibodies – proteins that fight viruses and bacterias. During pregnancy, antibodies protect baby too by transporting themselves to the baby via placenta. Virus may not be latent during the delivery and even if it is active in the birth canal, antibodies will fight for protecting the baby during the labour.
To further avoid complications and diminish the risks even more, it is recommended that mother controls the activeness of herpes regularly, especially before the labour. When HSV is active, despite the presence of antibodies, the safest action is to have a c-section.
Parents should still consider being attentive after the delivery and watch baby for the symptoms of HSV.
Getting infected during pregnancy
Risk of neonatal herpes increases significantly when a pregnant female gets infected during the pregnancy. The situation may get more serious, if the contraction with genital herpes occurs on the later stages of gestation. As opposed to the females who already have antibodies, newly infected mother does not have any of them. Their immune systems are not yet capable to fight the HSV.
When a woman gets infected on the last stage of pregnancy, delivering through a c-section will be the most sensible choice. With the help of medications, vaginal delivery may be possible if the virus is controlled and is obtained on the early stage of gestation.
While it is crucial to check on the infection regularly, it is even more important to consider and avoid the risk factors. If a sexual partner of a pregnant female has HSV it is recommended to have a protected intercourse when the infection is latent. During active period as well as last trimester, it is important to avoid having an itercourse.
For the sake of security, it is also recommended to have a partner tested on herpes. The symptoms might not be present and it is always a good idea to double check anything suspicious during the pregnancy.
Herpes and surrogacy
Before starting a surrogacy program, agencies should examine candidates on herpes and consider admitting only the healthy women. Additionally, surrogate mothers should be regularly checked on herpes during pregnancy too. Frequent checkups, of course, do not give a 100% guarantee that surrogate will not get infected. Agencies and parents should take into consideration that herpes may cause miscarriage and it is important to periodically check surrogate on various infections.
Treatment & best practices
Doctors will usually check the condition and activeness of herpes virus before the labour. In order to decrease risks of infecting a baby to minimum, doctors will advice to do a cesarean section when the virus is active in the birth canal.
Another tendency , that is becoming increasingly popular is to use the medication called acyclovir. While the medicine is not fully recommended during the pregnancy, according to the experience of hundreds of pregnant females as well as surrogacy agencies, acyclovir has not caused any kind of increased risks to a baby. Contrariwise, the medicine has prevented the outbreaks on the last stage of pregnancy. Normally, acyclovir is prescribed during the last month of gestation and decreases the need of c-section.
According to the state of herpes, period when it was identified or last active as well as course of the pregnancy, surrogacy agencies in cooperation with doctors, will decide whether it is reasonable to use acyclovir as a part of the treatment.
Placenta Previa and Pregnancy
Placenta previa is in the list of pregnancy complications. Future parents need to take into consideration that in case of noticing the symptoms, they should visit their healthcare provider immediately. In case of a surrogate pregnancy, intended parents and agencies should ensure that the surrogate attends prenatal checkups regularly and has the possibility/information to contact the clinic whenever she needs to.
About Placenta Previa
Placenta previa is the condition when placenta (organ connecting developing baby to the uterine wall) is lying in the lower part of the uterus, where it partially or completely covers the opening in cervix. In simple words, cervix is the passage located in the lower end of the uterus and connects it to the top of the vagina.
Normally, in most pregnancies, placenta attaches itself to the top of the uterus. During placenta previa, the reverse scenario occurs and placenta attaches to the lower part of the uterus.
According to the “portion” of covered cervix, it is possible to differentiate types of placenta previa :
- Complete/total previa – placenta covers the cervical opening completely
- Partial previa – placenta covers the portion of the cervical opening
- Marginal previa – placenta covers just the border of the cervix
Symptoms include the following :
- Bleeding without pain
Bleeding can range from light to heavy and can stop and return periodically. This is the main sign of placenta previa.
- Baby’s transverse position
- Contractions before time
The cause of placenta previa is not yet fully understood. However, the process could be explained as following : placenta, the organ that has to deliver nutrients and oxygen to the baby, will grow wherever the embryo attaches/implants itself in the uterus. If the location of the embryo is in the lower part, the placenta then may have to grow over the cervix- this is one possible explanation of why placenta previa occurs.
Additionally, there are some known risk factors that increase the chance of placenta previa, including :
- Multiple pregnancies when the placenta needs to be large
- Previous surgeries of the uterus
- Pregnancy not being the first one
- Age – when mother is older than 35
- Having experienced placenta previa during previous pregnancy(ies)
- Having cesarean sections (c-sections) before
Cesarean section stands for the delivery of a baby through a surgical procedure. It includes making an incision in mother’s abdomen and uterus and is used when a vaginal delivery puts mother and baby at risk.
- Leading unhealthy lifestyle (smoking and use of certain drugs, like cocaine)
The location of placenta is usually checked in the middle of gestation. It can be diagnosed with the ultrasound after a regular prenatal visit to a doctor. It is crucial to control the course of pregnancy frequently.
When the partial or marginal placenta previa is diagnosed early in the pregnancy, there is a small likelihood that the condition will still be present before the time of delivery. If placenta previa is diagnosed in the mid pregnancy there is no need to worry either because placenta is likely to change it’s place, as the uterus grows bigger before the delivery.
When mother is close to due date, the c-section will be performed immediately. If baby is still premature and the symptoms are not severe, it may be possible to wait and schedule the c-section delivery around 37th week of gestation. Because a placenta previa (especially total) blocks the baby’s way during the delivery, cesarian section is the most safe option to choose. Otherwise, blood vessels in the area can be seriously damaged.
Placenta previa requires bed rest. Physical activities and exercises may need to be limited for a certain period of time. However, in some cases, mother need to be hospitalized under the control of doctors in case heavy bleeding starts before the scheduled delivery date.
There exist possible complications to the condition that may include severe bleeding during or after labour. This kind of heavy bleeding may be life-threatening for the mother. If heavy vaginal bleeding cannot be controlled pregnant female should immediately seek for appointment in hospital or contact the emergency. The doctor might have to do the caesarian section independant from the stage of pregnancy. In this case, the baby will be born prematurely and need a special further treatment.
Parents should never forget that pregnancy is a very sensitive period and requires a lot of attention and care. A lot of threats are avoided and eliminated when found out on time.
