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Monday, 28 September 2015

External Cephalic Version (ECV)

In a normal pregnancy, the baby settles in a cephalic (head down) position by the last few weeks of pregnancy, ready for delivery ^[1]. But sometimes, the baby may remain in a feet-down position (breech baby) ^[2] even as your labor starts, often requiring a c-section. In such cases, the External cephalic version or ECV may come useful, letting you consider a natural delivery ^[3].

What is and external cephalic version (ECV)

An external cephalic version or ECV is a medical procedure for turning your baby into a proper head-down position from a breech or transverse presentation by applying pressure on a certain point in your belly ^[4].

ECV procedure: Turning a breech baby

The main purpose of attempting an ECV is to give the mother a chance to have a natural vaginal birth. Before an ECV, you may be given some tocolytic medication (labor repressants) to relax the uterine muscles and prevent contractions during the procedure ^[4]. The doctor then places his hands on your abdomen, one above the place where the baby’s head is and another below his buttocks and pushes the baby to make him rotate ^[5]. In some cases, it may need more than one attempt to successfully turn the baby. You may be offered a local anesthesia, especially if ECV is attempted multiple times.

External Cephalic Version

Your baby’s position, as well as his heart rate is closely monitored at all time ^[6] so the process can be stopped the moment there is the smallest sign of fetal distress (such as his heart rate dropping suddenly) ^[5]. Due to this reason, an ECV is always performed at a hospital where the doctor may monitor the baby easily using methods and equipments like ultrasound, and an emergency c-section may be arranged in case of a possible threat to the mother or the baby ^[7]. The amniotic fluid level is also measured prior to the procedure while Rh-negative women are given an Rh immune globulin injection to avoid complications ^[8].

When is an ECV attempted

No specific gestational age has been set as ideal for attempting an ECV. Although, studies have shown it to reduce the chances of a breech presentation at birth when performed before term (weeks 33-36), it is usually performed in or after week 37 ^{[7, 9]} as your baby may still have time to turn on his own before that ^[10]. It is associated with a considerable success rate when performed in up to 42 weeks ^[11].

Women with their first pregnancy are usually offered an ECV at or after the 36th week while those with a second or subsequent pregnancy may have the procedure after week 37 ^[11].

Does an external cephalic version hurt

Most women describe the process as uncomfortable to moderately painful, but bearable due to its short duration ^[18]. About 5% of women undergoing ECV have reported severe pain during the attempt ^[11]. Analgesic medication may be necessary to carry on the process in some cases. The version may be stopped if the mother experiences excessive pain as it might indicate some complications ^[14]. It has been found that a successful ECV causes less pain than an unsuccessful one ^[19].

When is external cephalic version avoided

Your doctor may check your medical history and examine your baby to see if a cephalic version should be contraindicated. Common factors to avoid it include:

Having a suspected placental complication, such as a previa or an abruption, in this pregnancy or history of one in a previous pregnancy

Severe high blood pressure or preeclampsia ^[12]

Having experienced any vaginal bleeding within the past week ^[13]

Having an abnormally shaped uterus (e.g. a bicornuate uterus) ^[14]

Low levels of amniotic fluid or any other complication associated with the fluid or sac, such as ruptured membranes

Tocolytic medications contraindicated for the mother due to some heart disorder or some other health condition ^[5]

History of a cesarean section or needing a c-section in current pregnancy due to some other complications ^[15]

Carrying twins

Ultrasound or some other test detecting any sign of fetal distress (e.g. irregular heart rate) ^[16]

Suspecting some fetal growth restriction or anomaly ^[18]

Are there any risks of an external cephalic version (ECV)

Studies show ECV to be possibly safe, being associated with a small chance of some serious complications.

Maternal complications

It rarely leads to any complications, but in any case, the following complications should be considered before opting for the procedure:

Placental abruption ^[20]

Your waters breaking early (premature rupture of membranes) ^[21]

Uterine rupture (rare) ^[22]

Beginning of labor (in about 1% of the cases) ^[15]

Women who opt for an ECV have a higher chance of requiring a cesarean delivery than those with a spontaneously occurring cephalic presentation (study). Due to this reason, it is usually preferable to wait for as long as possible to give the baby a chance to turn into position on his own before attempting a version ^[23].

Fetal complications

Multiple studies have shown no increase in the risk of intrauterine fetal death within 24 hours of successfully turning a breech baby. The fetal heart rate is monitored immediately after the procedure to check for any abnormalities. There are usually no complications, but EVC may sometimes lead to:

Changes in the fetal heartbeat detected on the monitor ^[24]

The umbilical cord getting squeezed, reducing the oxygen and blood flow to the fetus ^[5] (increasing the risk of birth defects and problems such as brain damage)

Nuchal cord ^[29]

Fetomaternal hemorrhage (fetal blood cells getting into the mother’s blood-stream) ^[25]

An emergency c-section is necessary in around 0.50% of all ECV attempts, commonly because of signs of fetal distress or placental bleeding ^{[8, 13]}.

External cephalic version success rate

It is successful in over 50% of cases ^[26] in reducing the chances of a vaginal breech delivery as well as a c-section (study review), with the exact success rates depending on the medical history of the mother as well as the health of the baby ^[13]. About 90% of transverse babies have been turned successfully using this method ^[8].

C-section is one of the principle causative factors for various maternal complications after childbirth. So, ECV also contributes to reducing the risk of such problems ^[4]. However, even after a successful attempt, your baby may turn back into a breech position (in less than 5% cases ^[27]), requiring a cesarean birth ^[6]. Your doctor may also schedule a second attempt if possible.

Factors contributing to a better chance of success

Having had a baby before ^[26]

The baby being situated high up in the uterus and not engaged in the pelvis ^[6]

Having proper amniotic fluid levels around the baby

Having a posterior placenta (located at the posterior side of the uterus) ^[16]

The mother having proper BMI and body weight

A complete breech presentation of the baby

Routine use of tocolytics has also been shown by studies to increase the success rate of ECV when performed at term. Epidural anesthesia has been shown to contribute to a better chance of success as well (study).

When to call the doctor

Talk to your doctor to understand the care and restrictions necessary following the procedure. Watch out for the following warning signs after an ECV:

Any vaginal bleeding ^[21]

Increased fluid leakage

Reduced fetal movement ^[6]

Abdominal pain or contractions

Oral temperature being over 102°F ^[14]

External cephalic version ICD-9 code

The ICD-9-CM code used for referring to ECV is 73.91 ^[28].

References +

http://www.nct.org.uk/birth/baby-positions-birth

http://www.babycentre.co.uk/a158/breech-birth

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/breech-birth.aspx#close

http://emedicine.medscape.com/article/1848353-overview

http://www.webmd.com/baby/external-cephalic-version-version-for-breech-position

http://www.babycentre.co.uk/x2063/can-my-breech-baby-be-turned-safely

http://apps.who.int/rhl/pregnancy_childbirth/childbirth/breech/cd000083_leder_com/en/

http://www.babycenter.com/0_breech-birth_158.bc?showAll=true

http://www.babycenter.com.my/x2063/are-there-any-safe-and-proven-methods-to-turn-a-breech-baby

http://www.whattoexpect.com/pregnancy/breech-baby/

https://www.rcog.org.uk/globalassets/documents/guidelines/gt20aexternalcephalicversion.pdf

http://www.kemh.health.wa.gov.au/development/manuals/OG_guidelines/sectionb/2/b2.10.2.pdf

https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/turning-a-breech-baby-in-the-womb-external-cephalic-version.pdf

http://www.sw.org/HealthLibrary?page=External%20Cephalic%20Version

http://www.newcastle-hospitals.org.uk/services/maternity-unit_treatment-and-medication_external-cephalic-version.aspx

http://evidencebasedbirth.com/what-is-the-evidence-for-using-an-external-cephalic-version-to-turn-a-breech-baby/

http://www.aafp.org/afp/1998/0901/p731.html

http://www.uhcw.nhs.uk/clientfiles/File/ECV_163_Mar_2013.pdf

http://www.ncbi.nlm.nih.gov/pubmed/16026399

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/placental_abruption

https://www.ottawahospital.on.ca/wps/wcm/connect/612592804f7cbd779d4cdf62660efeb4/P325+English+Jan+2011.pdf?MOD=AJPERES

http://addisonob-gyn.org/ECV.pdf

http://www.nct.org.uk/birth/breech-birth

http://www.acog.org/Patients/FAQs/If-Your-Baby-Is-Breech

http://www.ncbi.nlm.nih.gov/pubmed/18591311

http://www.uptodate.com/contents/external-cephalic-version

http://patient.info/doctor/breech-presentations

http://icd9cm.chrisendres.com/index.php?srchtype=procssrchtext=73.91Submit=Searchaction=search

http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?AccessionNumber=12006008180

External Cephalic Version (ECV)

Postpartum Depression In Men

It is erroneously believed that postpartum depression or PPD can only occur in new mothers. But, the truth is that it can also affect new dads, usually within the first year of having a baby ^[1]. Feeling depressed for a few days after your little bundle of joy comes into this world does not mean you love your baby any less. It often results from the additional responsibilities you face a parent.

What causes male postpartum depression?

Like PPD in women, it is almost impossible to pinpoint the exact factors responsible for postpartum depression in new fathers. Possible causes and risk factors include:

Having a partner suffering from PPD

Inability to bond with the baby or getting used to the idea of being a father

Sleep deprivation due to caring for the baby, especially if you have a colicky baby who tends to cry all the time ^[2]

Going through a difficult financial situation or having a stressful job

Becoming parent at a young age ^[3]

Having a stressful relationship with your partner or any other family member ^[2]

Researches show that women are not the only ones to experience lowering hormone levels after childbirth. The testosterone levels in the fathers go down as well while the estrogen and prolactin levels go up, leading to symptoms of depression ^[4]

History of a stressful event in the recent past

Unplanned pregnancy and baby

What are the symptoms of postpartum depression in men?

Feeling down all the time

Losing interest in activities you used to enjoy

Insomnia (inability to sleep) or hypersomnia (excessive sleepiness) ^[5]

Fatigue

Difficulty concentrating on anything ^[6]

Changes in weight and appetite

Anger, irritability and frustration

Isolation from friends and family

Physical symptoms like digestion problems and headache

Unexplained crying spells ^[4]

Inability to make any decision

Feeling of worthlessness

Feeling resentful towards the baby which also makes you feel guilty ^[4]

Thoughts of hurting yourself

Working constantly (to take the mind off of the depressive thoughts)^[5]

Postpartum depression treatment in men

The psychotherapy procedures used for managing PPD in men are the same as those used for treating women. Talk to your mental health care provider to find out what treatment measure your respond best to ^[3]. Antidepressants may also be necessary for managing severe depressive symptoms in some rare cases ^[2]. The depression management measures used by women (e.g. getting lots of sleep and following a healthy diet) are recommended for men as well ^[6]. Talking to other dads about how to be a good parent to your child can help you to better deal with the situation ^[3]. Alternative therapies like exercise, yoga, massage therapy and acupuncture ^[7] can also prove helpful.

Does postpartum depression in the father affect the baby?

You may not know it yet, but you are as important for your baby as the mother. Dads affected by postpartum depression are less likely to spend time with the baby, play with them and read to them. This may have a negative impact on the character development of the baby as well as the father-child relationship ^[6]. According to researches, untreated PPD in fathers can be associated with poorer behavioral, emotional and social outcomes in kids, especially in boys, when they reach 3 years of age ^[8].

Long Term Prognosis for Postpartum Depression in Men

Proper support and therapy can cure the condition within a few months ^[9]. But, leaving the condition untreated can lead to permanent depression, resulting in long-term ill consequences on the whole family ^[6]

Postpartum Depression Incidence in Men

Studies show about 14% of new fathers in the United States to get PPD shortly (often within 6 weeks) after their babies are born. The statistics goes up to 25% within 3-6 months after birth ^[4].

References +

Postpartum Depression In Men

Baby Weight Gain

A baby’s weight after birth plays a pivotal role in his physical and mental development. Factors determining his birth weight include his gender, race of origin, the nutrition he received in his mother’s womb, his health at the time of birth and maternal health during pregnancy ^[1].

Average baby weight at birth

Full-term newborns (born at 38 to 40 weeks) usually weigh between 6 pounds (2.75 kg) and 9 pounds (4 kg) ^[1].

Newborn baby weight

During his stay at the hospital, a newborn’s weight is constantly monitored. It is essential for parents to make sure that their babies have about five to seven wet and three to four dirty diapers a day, as this indicates that he is getting the nutrition needed, which is pivotal in his weight gain.

Newborn weight loss

Newborns lose a certain percentage of their birth weight in the initial 5 to 7 days. Formula fed babies as well as breastfed infants shed 5% and 7% to 10% of their weight respectively ^[1,2]. The prime reason for this is the loss of the excess fluid they are born with ^[3]. Losing of birth weight in a newborn is not at all a matter of concern if they are passing urine and stool normally, until they lose more than 10% of the weight they had at birth ^[30].

How much weight should your newborn gain

After gaining back their lost birth weight in 10 to 14 days ^[4,27], most healthy newborns put on about half to one ounce of weight per day during the first month ^[29].

However, it may take more than three weeks to recover the lost pounds for babies who have undergone a significant reduction in weight post-birth ^[1], are sick or suffering from breastfeeding jaundice ^[23].

How fast do babies gain weight

If your baby is in good health, he should be gaining one to two pounds per month until the fifth or sixth month, after which he should have doubled his weight at birth ^[30,31]. By their first birthday, most of them weigh three times than what they were at birth ^[26].

Growth spurt: Infant weight gain

Growth spurt is a part of your baby’s developmental phase when he starts gaining weight at a faster rate than before ^[8]. It primarily occurs at 2 weeks, 3 weeks, 6 weeks, 3 months, 6 months and 9 months ^{[8, 9]}, lasting for a day or two in babies up to around three months and about a week in older ones ^[8]. During a growth spurt, your baby will feed for a longer time when nursed or remain hungry even after his bottle milk gets over ^{[8, 9]}.

Baby weight gain chart: Month by month

The chart given below is based on the growth standards devised by the World Health Organization (WHO), giving you an insight into how much your breastfed baby weighs in the first year of his life ^{[10, 11]}.

Weight gain: Breastfed vs. Formula fed

It has been observed that formula-feds weigh more than breastfeeding infants, once they reach three to four months of age when both are almost twice their weight at birth ^[1]. This disparity in weight remains till their second birthday, after which the gap begins to bridge ^[5,7]. Studies have shown that by the time they reach their first birthday, nursing babies are thinner in comparison to formula-feds ^[6].

Why do breastfed babies gain less weight than formula-feds

The feeding pattern of nursing babies may be the probable cause of their slow weight gain throughout the first year of their life. Breastfed babies stop feeding on their own once they are full, whereas formula-feds are often made to finish off their bottle, thus getting a higher intake of food. Moreover, the protein composition of formula milk, different from breast milk, is believed to bring a change in the metabolism of the body ^[5].

Low birth weight in babies

Babies born full term may have a low birth weight due to certain genetic reasons. Other responsible factors might include being born to a teen mother or to parents with smaller body stature ^[28]. It can also occur in multiple pregnancies as the growing space in the uterus is shared by the babies ^[19]. Those with any congenital medical condition may also weigh less than normal at birth ^[28].

Premature baby weight

According to the World Health Organization (WHO), neonates delivered prior to 37 weeks are categorized as premature babies ^[12]. Taking into count their gestational age, they may have low birth weight (less than 5.51 pounds)^[19], very low birth weight (less than 3.30 pounds) ^[25]or extremely low birth weight (less than 3.30 pounds) ^[24]. Preterms born as early as 24 weeks may gain about .011 pounds (5 grams) a day while slightly bigger babies will experience an increase of approximately 0.44 pounds in their daily weight ^[13].

Babies not gaining weight

Your baby may not be gaining weight if he is not getting the required nutrition, having difficulty in digestion, not being able to get sufficient amount of breast or bottle milk because of some problem in his jaw, or even because of a serious medical condition ^[16]. It is advisable to monitor your baby’s weight on a regular basis to keep a check on his growth rate.

Failure to thrive

If the above-mentioned concerns persist for a prolonged period, your baby may grow at a slower rate in comparison to children of his age and gender ^[18] or lose weight at a faster pace, with the possibility of developing the problem of “failure to thrive” ^{[16, 17]}.

How to help your baby gain weight

Nursing your baby well is an important factor, influencing his weight gain. If you feel that your nursing baby is cranky or fussy even after latching onto your breasts for a longer time, speak to your pediatrician about the same as it might indicate that the amount of milk he is getting is not sufficient.

Introduce solids at the correct time as well as try giving him a nutritious diet of mashed or pureed fruits, vegetables, beans, egg yolks, boneless fish and other healthy foods to help him gain proper weight ^[20,22].

If your baby is old enough to eat finger foods, stay with him at mealtimes to make sure that he eats well rather than just nibbling at the contents on his plate.

Breastfed premature babies may be given a supplement known as human milk fortifier mixed in their feeds to help them cope up with additional requirements of protein, vitamins, calorie, calcium and iron ^[21].

Preemies who are formula fed may require Vitamin A, Vitamin C, Vitamin D and folic acid supplements ^[21].

References +

Baby Weight Gain

Postpartum Weight Loss

Putting on those extra pounds during pregnancy is considered normal, even necessary, for the growth of your baby. Although the level of weight gain varies depending on your pre-pregnancy body weight and BMI ^[1], all women are eager to lose whatever weight they may have put on during these nine months as soon as possible once the baby is born. However, there are a few things to consider before you go on a weight loss regime.

How much weight do you lose after giving birth

Most mothers expect to go back to their pre-pregnancy weight right after birth, but your baby alone does not account for the increased weight ^[2]. However, with your baby having an average birth weight of 7-9 pounds, along with about 1 pound of the placenta, and few more pounds of amniotic fluid and blood, most women find themselves around 10-12 pounds lighter after delivery ^[3].

Losing weight after pregnancy: Your post-baby body

The nature and rate of weight loss after childbirth varies from one woman to another, often depending on their lifestyle, activity levels, diet habits as well as metabolism ^[4]. Many new mothers are surprised to see that they look almost as pregnant as before, with a bulging belly, even after their baby is born. There are other factors responsible for this post-delivery body apart from the extra fat stored over these nine months, including excess fluids and an expanded uterus that needs time to come back to its previous, non-pregnant state.

Within a week, your body will start losing the fluids in the form of urine and perspiration. So, the symptoms of frequent urination ^[5], hot flashes and night sweats ^[6] are still going to be with you for a little longer.

The body after having a cesarean section or complicated birth

Women having had a c-section may need a little more time to regain their old fitness, as apart from pregnancy, they also need to recover from a major surgery ^[7]. It is common to experience some swelling throughout the body due to the IV fluids administered during a c-sections delivery. This fluid is excreted from the body through urination and sweating along with the water weight ^[8].

When can you start dieting post pregnancy

The whole process of pregnancy and childbirth takes a toll on your body, and it needs time to recover. So, it is not advisable to start any vigorous exercise routine or weight loss diet until the first postpartum checkup, about 6 weeks after delivery ^[9]. Breastfeeding mothers should not consider dieting for losing weight at least for 2 months after their baby’s arrival, as a low calorie diet around this time may interfere with the quality and amount of breast milk ^[4].

How to lose weight after having a baby

Post pregnancy diet

As mentioned above, going on a fad diet is never recommended to fight those extra post-baby calories ^[10]. Your diet may not be the same as the previous nine months when you were eating to provide all the necessary nutrients for your baby’s growth. For example, your recommended calorie intake will not be as high as it was while carrying ^[11]. However, even now what you eat will have an effect on your nursing baby through the production and quality of breast milk ^[12]. Consult your doctor before deciding to follow any diet plan to make sure that you get all the necessary nutrients while shedding the unwanted fats. Here are a few things to keep in mind:

Opting for high fiber foods, whole grains, monounsaturated fats, fresh fruits, and vegetables as these make you feel full for longer, preventing you from eating too frequently while providing all the necessary nutrients.

Avoiding skipping meals as this only harms your body by keeping you from getting the required vitamins and minerals without actually aiding in weight loss.

Eating smaller portions during a meal as this can help in long-term weight maintenance by preventing overeating.

Including plenty of calcium-rich foods, like leafy green vegetables and low-fat dairy products to make sure your baby gets enough calcium without you suffering too much bone loss ^[13].

Avoiding packaged fruit juices and sodas, opting for water whenever you feel thirsty

Post-pregnancy workout

Earlier, new mothers were asked to wait for at least one and a half to two months before starting any exercise. However, at present experts consider it safe for a woman who has had a vaginal birth with no complications to start on a workout routine as soon as she feels well enough ^[14].

Whenever your doctor says it is safe to start, begin with light activities ^[9], like taking your baby out in his stroller, or taking a swim ^[15]. Later, you can gradually move on to running, yoga and gym sessions.

Weight loss after c-section

Although regular exercise and a healthy diet are the best way to shed those extra pounds in those with a cesarean ^[16], it is usually advised to wait for two months or longer ^{[7, 17]} before starting heavy physical activities.

Things to keep in mind while exercising after pregnancy

Walking is the safest and one of the most effective exercises for postpartum women. You can start with just a gentle, short walk, gradually increasing the time length over the weeks. Carrying your baby in a baby carrier may be a good idea as the extra weight can be beneficial for faster weight loss ^[18].

Make sure never to exhaust yourself by pushing too far, your body still needs time to regain its pre-pregnancy energy ^[19].

Exercising with your baby is a good option as it can benefit the both of you. But, it is advisable to practice the moves first with a rolled bed sheet or a doll to make sure there is no risk of dropping your baby in the process ^[20].

You can consult your doctor regarding the safety of using weight loss aid products like support girdle belts and post-baby support corsets that may help you get a toned belly faster. But, these products are not meant to replace a healthy diet or a workout schedule.

How long does it take to lose the baby weight

Normal weight women, whose weight gain over the pregnancy is within the recommended limits of 25 pounds to 35 pounds, may get back to their pre-pregnancy weight within 2-3 months from the time they start maintaining a proper diet and exercise routine ^[21]. On the other hand, if you were overweight or obese before conception or if you gained more than what your doctor recommended, you might need up to a year (or longer) to lose the baby fat ^[22]. However, it does not mean you need to stress yourself to maintain this timeline. Just like every pregnancy is different, so is the rate at which your body can get rid of the baby weight.

Average weight loss after pregnancy

Experts recommend shedding your baby weight gradually with the ideal weight to lose per week being around 1 to 2 pounds for women who are breastfeeding ^[22]. Even those formula-feeding their babies should maintain the same weight loss routine as their body needs the same amount of time to recover ^[23]. Losing too much weight within too short a period might mean that you are losing muscles instead of fat ^[24].

How does breastfeeding help to get in shape after baby

Your body burns up to 500 calories a day for producing breast milk, so you are a step closer to losing that extra weight every day as you nurse your baby ^[25]. Breastfeeding can also help you to get a flatter belly by stimulating the release of certain hormones that accelerates the shrinking of your uterus ^[19].

Women with gestational diabetes are more at risk of developing diabetes after their baby is born. Losing the baby weight with lifestyle changes soon after delivery may considerably lower the risk by improving glucose metabolism ^[26].

References +

Postpartum Weight Loss

Amniocentesis

What is amniocentesis?

Amniocentesis (also referred to as amnio, amniotic fluid test or AFT) is a prenatal testing procedure with significant accuracy. It involves collecting an amniotic fluid sample from the uterus and testing it in the laboratory for certain fetal abnormalities and genetic conditions. ^[1]

Who should have amniocentesis?

Women over 35 years old (babies born to older women are more at risk of developing genetic conditions like Down syndrome) ^[2]

Women with a history of a neural tube defect (a condition affecting the brain and spinal cord) or any chromosomal condition in a previous pregnancy ^[13]

Women with positive results from prenatal screening tests such as a blood test or noninvasive prenatal testing ^[3]

Women who have a family history of any genetic condition like cystic fibrosis, sickle cell disease and Down syndrome ^[4]

Why is amniocentesis performed?

For detecting hereditary conditions like spina bifida ^[5], Down syndrome and fragile X syndrome

For assessing the lung maturity of the baby if an early delivery is required due to some pregnancy complication

For detecting intrauterine infections

For finding out whether the baby has any life threatening conditions like Edward’s syndrome (Trisomy 18), Patau syndrome (Trisomy 13) and Tay-Sachs disease

For assessing the health of the baby in case the mother has a blood sensitization, like Rh sensitization (a serious condition that occurs when the mother has a different blood type than the baby). But at present, obstetricians often use a Doppler ultrasound instead of AFT for detecting such conditions.

For determining the gender of the baby ^[6]

For decreasing the amniotic fluid volume within the uterus (rarely in cases of polyhydramnios)

When is amniocentesis performed?

AFT is usually performed during the second trimester, particularly between the 15th and 20th weeks of pregnancy ^[7]. It may also be performed during the later stages of pregnancy (third trimester), especially before a pre-term delivery or a c-section birth.

Guidelines to prepare for amniocentesis

Drinking lots of water may be recommended prior to the ultrasound as a full bladder helps to produce better results

One may be advised not use Aspirin pills for five days before the amnio procedure ^[8]

One may be asked to avoid heparin and Lovanox for 24 hours before the procedure

What is the procedure of amniocentesis?

The step by step procedure includes performing an ultrasound to ascertain the positions of the baby, the placenta and the amniotic fluid pockets, then disinfecting the mother’s belly area with an antibacterial solution to prevent infecting the fluid while collecting the sample ^[7]. Next, the diagnostician collects around one ounce of amniotic fluid using a thin needle while monitoring the path of the needle on ultrasound. The ultrasound also helps to make sure that the baby’s heartbeat is normal after collecting the fluid sample. It is then sent to a clinical laboratory for karyotyping ^[18] – a process used for examining the chromosomes in the cells within the sample.

Amniocentesis Tests

Does amniocentesis hurt?

It is not a painful process as most women feel only a sharp pinch, along with a lot pressure, when the needle goes through the uterus. Some women can barely feel it when the needle is run through the abdominal skin, but may feel a sharp pain when the needle goes through the uterus (it does not last for more than a few seconds).

Does amniocentesis need any aftercare?

Doctors recommend 24-hour bed rest following the test

Following a healthy diet containing fresh fruits, vegetables and dairy products

Drinking ample amounts of fluid

Practicing relaxations techniques as the stress and anxiety associated with the test may be harmful for the baby ^[9]

How long does it take to get the amniocentesis results?

Depending on the purpose of the test, the results are available:

Within 10 days (when checking fetal abnormalities like neural tube defects and protein levels in the fluid)

Up to 2 weeks (when checking for any genetic conditions in the baby)

Having a FISH (fluorescent in situ hybridization) test along with an amnio helps to get the results within a couple of days instead of weeks. It has a significant accuracy rate in predicting chromosomal abnormalities in the baby. ^[14]

Are there any side effects of amniocentesis in the mother?

It is a fairly safe screening procedure that often does not cause any side effects; however, some women may experience:

Mild to moderate cramping that continues for a few hours after the fluid sample is collected

Soreness and irritation around the spot where the needle was inserted (usually lasts for a couple of days) ^[10]

Continuous vaginal wetness due to leakage of amniotic fluid

Moderate to severe headache (rare)

What are the risks of amniocentesis for the baby?

Amniotic Fluid Leakage: Occurs after the test, often stopping on its own without causing any serious complications. However, in some cases, chronic fluid leakage may lead to orthopedic complications for the baby. ^[11]

Needle Injury: The baby may get injured by the needle if it moves a leg or an arm into its path. However, serious injuries of this kind are rare.

Rh sensitization: In some rare instances, the test leads the blood cells of the baby to enter the bloodstream of the mother ^[11]. This may cause various complications if the mother has Rh negative blood (in such cases, the mother is given Rh immunoglobulin following the test to prevent her body from generating antibodies against the baby’s blood cells).

Uterine Infection (rare)

Infection transmission: If the mother is affected by an infectious disease, like toxoplasmosis, hepatitis C or HIV, the infection may be transferred to the baby during the examination.

Scarring: Sometimes, the baby may be born with a small depressed scar resulting from an amnio test performed during mid-trimester. ^[12]

What are the odds of a miscarriage following an amniocentesis?

The risk of miscarriage associated with the test ranges from 1 in 300 to 1 in 500 ^[11]. According to researchers, having amniocentesis before the 15th week of pregnancy increases the danger of a miscarriage. The chances of miscarriage are somewhat higher in women carrying twins or triplets.

What are the limitations of amniocentesis?

An AFT can rule out only certain chromosomal and genetic disorders in the baby. It cannot detect conditions like autism, non-specific mental retardation, cleft lip and various heart defects ^[6]. So, having a negative test result does not guarantee that one will have a normal baby.

Although amnio produces accurate results, it is sometimes difficult to interpret them. Such cases may call for additional chromosome testing. ^[17]

Amniocentesis Vs Chorionic Villus Sampling

Chorionic villus sampling (CVS) is another prenatal screening test that helps with the diagnosis of chromosomal abnormalities in the fetus. Although, the basic purpose of both amnio and chronic villus sampling is to detect chromosomal or genetic abnormalities in the baby, their procedures are completely different. CVS involves collecting cell sample from the tiny finger-like projections called chorionic villi, located on the placenta ^[15]. The sample is then sent to a lab for genetic analysis.

One of the main advantages of amnio over CVS is that the former can detect neural tube defects (spina bifida) as well as chromosomal defects in the baby ^[15] while the latter cannot. On the other hand, CVS has the advantage over amnio as it can be performed during the first trimester (typically between the 11th and 12th week), which enables parents to know whether their baby has any serious birth defects at an earlier stage.

Are there any alternatives to amniocentesis?

There is a new non-invasive fetal DNA test that can be used instead of amnio ^[16]. This cell-free blood test produces accurate results while there is no risk of miscarriage. In this test, a blood sample is collected from the mother to examine the DNA of the baby for any abnormalities.

How much does an amniocentesis test cost?

Its cost may vary from one country to another, ranging from $1,000 to $1,500.

References +

http://www.babycenter.com/0_amniocentesis_327.bc

http://www.mayoclinic.com/health/amniocentesis/MY00155/DSECTION=why-its-done

http://www.babycentre.co.uk/a327/amniocentesis

http://www.drugs.com/cg/amniocentesis.html

http://www.mayoclinic.com/health/amniocentesis/MY00155

http://www.webmd.com/baby/guide/amniocentesis

http://www.marchofdimes.com/pregnancy/amniocentesis.aspx

http://www.cpmc.org/learning/documents/amnio-ws.html#How Do I Prepare for an Amniocentesis?

http://www.drugs.com/cg/amniocentesis-discharge-care.html

http://americanpregnancy.org/prenataltesting/amniocentesis.html

http://www.mayoclinic.com/health/amniocentesis/MY00155/DSECTION=risks

http://www.ncbi.nlm.nih.gov/pubmed/6486849

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Amniocentesis

http://www.cyh.com/healthtopics/healthtopicdetails.aspx?p=438np=459id=2765#11

http://www.babycenter.com/0_chorionic-villus-sampling-cvs_328.bc

http://onmommysmind.net/an-alternative-to-amniocentesis/

http://www.sogi.net.au/mintdigital.net/SOGI.aspx?XmlNode=/Services/Prenatal+testing/Amniocentesis

http://www.virtualmedicalcentre.com/health-investigation/amniocentesis/42

Amniocentesis

Sunday, 27 September 2015

Chest Pain during Pregnancy

Experiencing chest pain with or without a little shortness of breath is reasonably common during pregnancy, along with all the other aches and pains occurring in this period ^[1]. However, it is necessary to let your doctor know about the problem as it might indicate serious conditions or pregnancy complications.

Is chest pain an early sign of pregnancy?

Chest pain is not counted among the common early symptoms as it can occur anytime during pregnancy due to various causes. However, in some women it can come with the other symptoms like nausea and stomach pain.

Causes of chest pain in pregnancy

Apart from the rising hormone level, which is often to blame for most pregnancy complaints, certain other factors may also lead to the symptom:

Gas and indigestion: It is quite common for gas to get trapped in the chest area, leading to indigestion and sometimes a dull chest pain during pregnancy. It often gets worse with the beginning of the third trimester (around the 27th week) ^[2], but can occur in the first and second trimesters as well.

Heartburn and acid reflux: Acid reflux is a common pregnancy symptom in which the stomach acids pass through the lower esophageal sphincter (the valve usually preventing food and stomach acids from escaping the stomach) into the chest, often leading to pain and discomfort that might worsen after eating ^[3].

Stress and anxiety: Apart from leading to muscle tension, headache and backache, severe stress is a common causative factor behind chest pain as well ^[4].

Asthma and breathing difficulty: Women with a history of asthma or bronchitis are more likely to experience the symptoms of shortness of breath along with pain or tightness in the chest while pregnant ^[1].

Breast changes: Your breasts start changing and preparing for breastfeeding right from the time of pregnancy, often causing breathlessness and chest pain.

Pressure from the growing uterus: As the uterus continues to grow, it starts applying pressure on the adjacent areas, including the diaphragm and chest, often leading to pain and discomfort ^[5]. This type of pain tends to be worse in twin pregnancies as the uterus needs more space to grow.

Cough and cold: These are one of the most common causes of mild to moderate chest pain ^[1] along with a sore throat.

More serious causes

Serious causes for chest pain in pregnant women may include deep vein thrombosis, coronary heart diseases, heart attack and an ectopic pregnancy ^[6]. Recent studies show that the symptoms of congenital cardiac disorders such as heart murmur are becoming more common among pregnant women ^[1]. According to experts, the recent advancements in the medical field might be a key factor behind this as it is allowing more women with congenital heart abnormalities to survive and reach childbearing age. Another responsible factor may be that nowadays, most women do not plan on conceiving before reaching late twenties and being over 28-30 years of age heightens the risks of many cardiac complications.

Differential diagnosis for chest pain during pregnancy

Severe chest ache may indicate any of the following conditions ^[7]:

Gastroesophageal reflux disease (GERD)

Coronary ischemia

Pericarditis (Inflammation of the pericardium)

Pleurisy or pleuritis (inflammatory disease involving the pleura of the lungs)

Pneumonia

Progesterone induced muscle and ligament laxity

Pulmonary Embolism

How to relieve chest pain while pregnant

Consult your health care provider regarding the severity and possible treatment options for the pain. Managing the pain with useful lifestyle changes and natural remedies is advisable as most medicines are not recommended for pregnant women.

Tips for pain management

These tips can help keep the pain under control unless you have an underlying condition:

Sitting and standing straight as a bad posture can prevent your lung from getting enough oxygen ^[8]

Taking lots of rest

Using a cushion to keep the upper body propped up when lying down

Sleeping on your left to prevent the growing uterus from putting extra pressure on the major organs and blood vessels ^[5]

Avoiding lying down right after having a meal

Eating multiple small meals instead of three large ones (helps prevent acid reflux, heartburn, GERD etc)

Taking your prenatal vitamins and including plenty of vitamin, calcium, iron and magnesium rich foods in your diet

Practicing stress relieve techniques like yoga ^[1]

Avoiding alcohol, caffeine, greasy, spicy foods and fast foods (as these often flare up gas and heartburn)

Home remedies

Indigestion and heartburn are the most common causes of pain and discomfort in the chest. The following home treatments can help ease the pain by fighting these problems:

Drinking ginger and chamomile tea once or twice a day

Slippery elm is another natural remedy considered safe in pregnancy ^[9]

Drinking a glass of warm milk along with a tablespoon honey

Eating some almonds as their rich calcium content can help with digestion ^[10]

Having a cup of coconut water as it is one of the most effective natural acid neutralizers

Adding 2 teaspoons of caraway seeds in some boiling water, letting it steep for 10-12 minutes before straining the liquid and drinking it (use sweeteners if preferable) ^[11]

Apple cider vinegar, as it helps to curb the production of stomach acids

Treatment with medication

Chest pain resulting from serious diseases and complications often call for medical treatment ^[1]. Your doctor can diagnose the problem and prescribe medications for a healthy pregnancy. Apart from the serious causes mentioned above, pleuritic chest pain, severe breathing difficulty or asthma ^[12], digestive disorders and cardiovascular diseases may also require medication.

When to worry about chest pain during pregnancy

Chest pain accompanied by severe breathing difficulty, rapid pulse ^[13], fever, dizziness, shortness of breath, sweating [1], fatigue, persistent vomiting and numbness in your arms

Stabbing pain in the left side of the chest (might indicate serious cardiac disorders like a heart attack) ^[5]

Pain that radiates from the chest area into your ribs, arms and jaws

Severe pain in the right side of your chest (might indicate viral infections, gallbladder disorders and liver diseases) ^[14]

Sudden sharp pain in the chest area, along with swelling in one or both legs (might indicate a blood clotting disorder) ^[15]

Sharp pain centered at the middle part of your chest that comes and goes, lasting just a few minutes at a time (might indicate a heart attack) ^[16]

Chest pain that worsens when breathing deeply (might indicate Pericarditis) ^[17]

Burning pain in the upper chest area (often during or after meals) that tends to worsen while bending over (can be just heartburn, but might indicate serious conditions like hiatal hernia) ^[18]

Stabbing pain and palpitations after exercise or running

Pain with deep breathing, coughing or sneezing (might indicate pleuritis) ^[2]

Pain with movement of shoulders and arms along with the chest wall being tender to tough (might indicate a musculoskeletal problem) ^[19]

Severe chest pain occurring while lying down at night (might indicate coronary heart disorders)

Chest pain ICD-9 and ICD-10 codes

The ICD-9 code for this symptom is 786.5 ^[20] while its ICD-10 code is R07 ^[21].

References +

Chest Pain during Pregnancy

Leg Cramps during Pregnancy

Leg cramps are involuntary muscle contractions affecting the calves, feet and sometimes the upper leg. The painful sensation is quite normal during pregnancy, often occurring at night ^[1]. Although most common during the third trimester ^[2], you may experience occasional cramps early in the first and second trimesters as well.

What causes leg cramps in pregnancy?

The exact causes leading to this symptom are still unclear as it may result from a number of factors. The strenuous job of bearing all the extra baby weight might be the cause behind leg cramps towards late pregnancy ^[3]. The growing uterus puts direct pressure on the main vein in your legs. The rising progesterone level, affecting your leg muscle tone, is often the principal factor responsible for the problem in early pregnancy. Other possible risk factors include:

Lack of nutrients like calcium and magnesium

Dehydration in pregnancy ^[4]

A past leg injury

Changes in blood circulation from your legs to your heart due to the growing uterus ^[5]

Carrying twins

Why are pregnancy leg cramps more common at night?

Most women complain of intense cramping at night that wakes them up even from a deep sleep. It is quite difficult to pinpoint any specific factor behind such severe cramps at night. Extreme fatigue and high body fluid levels are believed to be responsible for these nighttime leg cramps ^[6].

How to prevent leg cramps in pregnancy?

Avoiding standing for extended periods of time

Avoiding sitting or standing for long periods, keeping your legs crossed ^[5]

Drinking lots of fluids to stay hydrated

Rotating the ankles and wiggling the toes while sitting down

Stretching the calf muscles several times throughout the day, especially before going to bed ^[1]

Going for a short walk every day or following a light prenatal exercise routine ^[2]

Wearing comfortable shoes with proper ankle and heel support

Avoiding sleeping positions that leave the toes pointing downward

Following a diet containing plenty of calcium, potassium and magnesium rich foods such as leafy vegetables, bananas and dairy products ^[4]

Nutrition deficiency causes a number of pain and complications while pregnant. You need extra nutrition during pregnancy for the wellbeing of your baby as well as your own. So, magnesium and vitamin B supplements may be recommended for preventing cramping; however, experts are still not sure about their effectiveness ^[1].

Pregnancy leg cramps treatment

Applying a hot compress or a heating pad (consult your doctor before opting for heat treatment) ^[7]

Standing on a cold surface or getting an ice massage to relieve the muscles ^[6]

Gently massaging the calves

Lying down on your bed with a few pillows under your legs to keep them elevated

Wearing supportive stockings ^[8]

Walking around in your room for some time to flex the leg muscles ^[5]

Taking a warm bath can ease the pain by relaxing the muscles ^[1]

According to some, sleeping with a bar of soap under your feet helps to avert the pain. But, there is no scientific proof for this home remedy.

Stretching exercise for leg cramp relief

Doing some pregnancy-safe stretching exercises whenever you feel your leg muscles cramping can help to get rid of the pain. Straighten both your legs, keeping the heels in contact with the floor. Then, gently bend the toes back toward the shins as far as you can. Hold in this position for about 10 seconds before releasing the pressure. It might hurt a bit in the beginning, but will gradually lessen the pain by easing the muscle spasm ^[5].

Medical Treatment

Drugs and medicines like quinine (tonic water) are not recommended for treating the symptom in pregnant women ^[9]. Some recommend taking acetaminophen for relieving severe pain ^[4]. But, it is advisable to avoid taking any medicines during this time to keep your baby safe.

When to call the doctor?

Constant muscle cramping that refuses to go away with exercise or any of the above remedies

Leg cramps accompanied by symptoms like swelling, tenderness and redness in the legs (might indicate blood clotting disorders) ^[3]

Persistent leg cramps during the last months of pregnancy (might be a sign of labor) ^[10]

Leg cramps with ankle and foot swelling (might indicate varicose vein)

Cramping accompanied by symptoms like extreme headache and diarrhea

ICD-9 and ICD-10 Codes for Leg Cramps

The ICD-9 code used for indicating cramp is 729.82 ^[11], while its ICD-10 code is R25.2 ^[12].

References +

Leg Cramps during Pregnancy

Abdominal Pain or Cramps during Pregnancy

Is it normal to have abdominal pain or cramps during pregnancy?

Having occasional mild to moderate abdominal pain is normal throughout pregnancy ^[1]. The pain is often more severe in women carrying twins than in single pregnancies. Severe pain with or without certain other symptoms may indicate a number of serious complications ^[2].

Are abdominal pain and cramping early signs of pregnancy?

Menstrual-like abdominal cramps that come and go are one of the earliest symptoms of pregnancy ^[3], often occurring even before you notice the missed period and a home pregnancy test shows positive results. It is generally accompanied by other symptoms like spotting (implantation bleeding) fatigue, breast tenderness, nausea and constipation ^[4] in the first months.

Why is lower right abdominal pain more common during pregnancy?

With the growth of the embryo, the uterus begins to tilt towards the right, causing the ligaments to stretch or contract. This often leads to lower right abdominal pain and cramping ^[5].

What causes upper/lower abdominal pain in pregnancy?

Common harmless causes

The embryo implanting itself to the uterus wall (constant low period-like pain in the upper abdomen, lasting for about a day) ^[1]

Indigestion, gas, bloating and constipation occurring as a result of the hormonal changes ^[6]

The growing uterus putting excessive pressure on the intestine, bladder, muscles and ligaments (the uterus pulling on the ligaments often cause pain around the bellybutton)

Exercising while pregnant, putting additional pressure on the muscles and ligaments ^[2]

The cramping may become more noticeable due to rapid movements such as standing up suddenly, coughing or sneezing

Round ligament pain, mainly occurring during the second and third trimester (caused by the extra stress on certain ligaments due to holding the growing uterus in suspension within your abdomen) ^[6]

Having a history of c-section delivery

Braxton Hicks contractions or false contractions

Pelvic girdle pain

Having intercourse

Serious causes

Ectopic pregnancy (especially during the first three months), a complication in which the embryo gets implanted outside the uterus

Miscarriage

Premature labor ^[7]

Placental Abruption

Preeclampsia or HELLP syndrome ^[8]

Chorioamnionitis

Acute fatty liver of pregnancy (life threatening complication usually occurring later in pregnancy) ^[9]

Acute polyhydramnios

Uterine fibroids ^[23]

Yeast infection ^[25]

Non-pregnancy related causes

A viral stomach infection ^[10], food poisoning or allergies

Kidney and urinary tract infections ^[10]

Appendicitis

Gallstones ^[6]

Inflammatory bowel syndrome

Gastroesophageal reflux disease (GERD) ^[22]

Pelvic inflammatory disease

Hernia

Lactose intolerance

How to prevent lower abdominal pain while pregnant?

Drinking lots of fluid to stay hydrated ^[11]

Getting plenty of rest

Doing regular stretching exercise to keep the abdominal muscles strong and toned for avoiding conditions like round ligament pain (avoid exercises that require you to lie on your back for over a few minutes in the first trimester as they may be harm your baby by reducing the blood supply) ^[12]

Practicing relaxation techniques such as deep breathing

Avoiding lifting heavy objects or climbing stairs quickly (especially during the second and third trimesters) ^[13]

How to relieve pregnancy abdominal pain?

Taking a warm bath ^[14]

Lying down on the opposite side of the pain

Massage therapy by a licensed practitioner

If the symptom is resulting from round ligament pain, reducing the amount of daily activities and avoiding the sitting, standing and lying positions that trigger the pain can help manage it ^[15]

For sudden pain, bending forward to the point of pain relief and then relaxing the muscles again (this helps to reduce the tension of the muscles and tissues) ^[11]

Home remedies such as lemon juice and ginger may help with fast pain-relief (make sure to consult your doctor before using these natural remedies)

Walking or changing positions (helps to relieve pain caused by gas) ^[21]

When to call the doctor?

Severe pain that wakes you up at night

Sharp lower abdominal pain in early pregnancy accompanied by vaginal bleeding or passing blood clots and tissues (might indicate miscarriage or ectopic pregnancy) ^[16]

One sided abdominal pain ^[24]

Constant pain with or without bleeding (especially during the first trimester) ^[2]

Pain accompanied by fever or chills ^[5]

Pain along with the symptoms of faintness or lightheadedness

Intense pain in the upper abdominal area along with headache, nausea and vision disturbances, especially during the third trimester (might indicate preeclampsia) ^[17]

Abdominal cramps accompanied by a burning sensation while urinating (might indicate urinary tract infection)

Pain accompanied by lower back pain and diarrhea ^[18]

Menstrual-like cramping accompanied by over 5 contractions within an hour before the 37th week of pregnancy (might be a sign of premature labor) ^[7]

ICD-9 and ICD-10 Codes

The ICD-9 code used for indicating abdominal pain is 789.0 ^[19] while its ICD-10 code is R10 ^[20].

References +

Abdominal Pain or Cramps during Pregnancy