MOOD SWINGS IN PREGNANCY

Why am I like this? Why have I become lot more forgetful? Can I go through this pregnancy for next 9 months? Will I be a good mother? I donŸ??t think my husband understands me anymore These are the few questions which run through a to- be-momŸ??s thoughts. Pregnancy is a roller-coaster ride with huge excitement. As soon as a woman realizes she is pregnant, she is anxious with also many questions in her mind. Surge of pregnancy hormones, sleep deprivation, nausea, lack of appetite, anxiousness can cause overwhelming response with her mood. Telling her that its common to have mood swings, alleviating her fears about pregnancy concerns, making her understand that these changes are not permanent could help her go through the pregnancy well. Hydration, having small frequent meals, good sleep, talking it though to family and friends, gentle exercise, making time for some activities with friends and family should help het to cope up with the mood swings in a positive way. If anxiety or feeling low symptoms worsen she should seek help with her doctor. – Madhushree Motherhood, Hebbal

Myths and Facts about Pregnancy by Jasmine

  • Myths and facts about pregnancy
    1. A pregnant mother should be eating for two.
    2. Saffron will make the babyŸ??s complexion fairer.
    3. Pregnant women should avoid fish.
    4. Craving for spicy foods means you are having a boy, and craving for sweet foods indicate a girl.
    5. Pregnant women can catch a flu with cold and sour food items.
    6. Papaya and pineapple can cause abortion or miscarriages.
    7. The food you crave or eat more during pregnancy are going to be babyŸ??s favorites.
    1. There is no evidence to show that you need to eat for two. Eating a healthy, balance diet is important.
    2. There is no evidence to support this belief.
    3. Fish that contain high levels of mercury should be avoided. E.g. Shark, Sword Fish, King Mackerel and Tile Fish. Mercury consumed during pregnancy has been linked to developmental delays and brain damage.
    4. Research shows that cravings have nothing to do with determining the sex of a baby.
    5. These foods are loaded with vitamin (citrus fruits) especially vitamin C. ItŸ??s an important vitamin for iron absorption. Curd and butter milk provide probiotics which keep the mothers get healthy and help in digestion along with providing good immunity.
    6. These fruits in their raw form contain certain enzymes, which if consumed in large quantities, can cause uterine contractions.
    7. No real evidence for this but some studies have shown that food choices you made during pregnancy may shape babyŸ??s food preference.

By
Jasmine, Nutritionist, Sarjapur Road

DIET IN PREGNANT WOMEN IN FIRST TRIMESTER

A healthy pregnancy with expert advice on pregnancy diet first trimester - Motherhood Hospital India

The months of trying and fretting over conception are finally over and you can now feel part of that magical world of new parents:

Once you are pregnant, it is rather important you eat the right type of food, in right quantity, and right intervals, to ensure a healthy mother and a healthy foetus. A balanced diet, containing low carbs, high proteins, necessary vitamins, minerals, micro nutrients and antioxidants along with fats in moderate amounts is what very pregnant mother should look forward to.

Even though your doctor might have prescribed folic acid pills/supplement you still need to include folate rich foods in your diet. Foods rich in folate include enriched white rice, cooked lentils / cooked spinach, chick peas, oranges, broccoli & eggs.

Vitamin B6 is important during the first trimester as it can inhibit nausea and vomiting. Rather than taking medicines include vitamin B6 rich foods like whole grains/walnuts/bananas jowar in your pregnancy diet.

If you can digest it, milk is a wonderful source of protein, vitamins, calcium, water, healthy fats and fortified vitamin D, Dairy products like curds and yogurt can add variety to your meal.

Fruits are rich in vitamins, antioxidant, fibre and water content. They are a perfect recipe for healthy pregnancy.

Iodine rich diet like eggs, cow’s milk ,strawberry ,walnuts to ensure proper mental development of the foetus

Tips for a healthy pregnancy:

  • Aim for 5-6 meals per day
  • Eat when you are hungry & stop when your full
  • Select fruits & Vegetables from different colours of the rainbow,
  • Aim to eat all recommended groups.

VAGINAL DISCHARGE IN PREGNANCY IS IT A SIGN OF HIGH RISK PREGNANCY

PREGNANCY can be as confusing as it is elating and itŸ??s not always easy to tell which changes are normal and which are cause of concern .one such change is vaginal discharge; which can vary in consistency or thickness frequency and amount during pregnancy.

Not many women are aware that a certain amount of discharge during pregnancy is normal. It may vary time to time. It is important to monitor consistency and colour to prevent any risk to the pregnant mother and growing foetus. Early intervention and getting the specialized prenatal care for the same increases your chance of a healthy pregnancy.

What causes changes to the vaginal discharge:

As cervix and vagina softens with the ongoing pregnancy, the discharge increase in pregnancy. The babyŸ??s head may press against the cervix and often lead to increased discharge.

When is the discharge a cause to worry in pregnancy:

Lots of thin clear discharge could be amniotic fluid leak calls for an immediate visit with your clinical practitioner.

Discharge is tinged with blood and youŸ??re not yet 37 weeks then call your doctor immediately.

It smells strange and suggests infection you need to see your gynaecologist immediately.

 

Infections To Look Out For During Pregnancy

Expectant mothers are more susceptible to various viral, bacterial and other types of infections compared to regular people. Being aware and taking precautions is significant in ensuring the health of mother and baby

Pregnant women are at increased risk of acquiring infections because of the lower immunity levels.According to Dr Teena Thomas, Consultant Obstetrician and Gynaecologist at Motherhood Hospitals, it is common for pregnant women to catch infections as their immunity is generally low. Ÿ??Urinary tract Infections and conditions such as bacterial vaginosis are quite common but with the right advice and medical treatment, these types of problems during pregnancy can to resolved,Ÿ? says Dr Thomas.

At Motherhood Hospitals, doctors strive to ensure that all expectant mothers get the best quality care and assistance. All the necessary diagnostic tests are carried out for early detection of any infection and timely treatment is given for the same.

There are different types of infections that might affect women in pregnancy. These can be categorised into Ÿ??

VIRAL INFECTIONS

  1. Chicken Pox Ÿ?? This infection is rarely seen in pregnant women, as most people get chicken pox in childhood and because of this become naturally immune to the virus. But in women who have never been affected, there are chances of getting it during pregnancy. If affected by the chicken pox (varicella) virus, pregnant women are at risk of contracting pneumonia. It can be dangerous for the newborn if the virus affects the expectant mother at the end of the 1st trimester or very close to the delivery. In the first trimester, there is a one per cent chance of the baby developing a serious condition called Varicella syndrome, a rare condition in infants that results in low birth weight and certain developmental/brain abnormalities and hence may require terminations. If the mother is diagnosed with chicken pox very near to the delivery time, then there is a risk of the baby also getting infected.

Ÿ??If the non-immune expectant mother is infected nearing delivery. She can be administered the varicella zoster immunoglobin as soon as possible to minimise the effect of the infection. The infected newborn should also be administered the same immunoglobin and effective treatment for the ailment needs to be given by a team of specialists.We have had mothers with chicken pox coming in to the hospital and with timely care and treatment both baby and mother came out of danger,Ÿ? said Dr Thomas.

  1. Cytomegalovirus (CMV) Ÿ?? It is a common virus, belonging to the Herpes virus family and many people get infected by it at some point in their lives. But it rarely causes any symptoms. While CMV infection is quite rare, it can be a cause of concern in pregnancy, as 1-4 in 100 babies can get infected by the virus through their mothers. It may cause flu-like symptoms in the pregnant woman. Most infected babies donŸ??t have any problems but some may have congenital abnormalities including hearing loss, visual impairment and so on. The virus can be detected with a blood test and treated accordingly.
  1. Hepatitis B (HBV) Ÿ?? This virus is highly infectious and can be blood borne or sexually transmitted. It can cause liver problems later in life. Pregnant women who are infected by the virus can pass it on to the foetus. So babies at risk should be immunised at birth with HBV vaccine as this is 90-95 per cent effective in preventing the disease.

Ÿ??We screen expectant mothers for HBV as part of the antenatal care and if found positive, appropriate treatment is given,Ÿ? adds Dr Thomas.

  1. Hepatitis C Ÿ?? This virus is also passed on through the blood or sexually transmitted. If the mother passes on the infection to the newborn, medical assessment needs to be done and care is provided.
  2. Herpes Ÿ?? This viral infection can be of different kinds, most commonly oral herpes and genital herpes. Primary genital herpes is diagnosed by actively present blisters and ulcers in the vaginal area particularly dangerous for the baby and it can be passed on during a vaginal delivery. Normally, doctors advise a Caesarean section delivery to prevent transmission.
  3. HIV Ÿ?? A test for the virus is offered as part of antenatal care to all mothers. An HIV positive pregnant woman can pass on the infection to her baby. Ÿ??But constant monitoring and active treatment from 28 weeks of pregnancy, apart from an elective C-section can bring down the risk of transmission. Late booking patientŸ??s treatments can also be commenced at 36 weeks in labour.After birth also the baby is monitored for some time to rule out transmission,Ÿ? says Dr Thomas.
  4. Parvovirus Ÿ?? This is rare type of virus but if there is primary infection during pregnancy, the expectant mother might have mild rash and fever. Some complications of Parvovirus include miscarriage or the fetal anaemia. There is a test to diagnose the infection and can be treated with medications and requires fetal monitoring.
  5. Rubella Ÿ?? It is a contagious infection caused by the Rubella virus which causes fever, rashes, sore throat and swollen glands. In India, rubella infection is very rare as it is part of the standard immunisation plan. But Primary Rubella affects the mother in the first half of pregnancy it can lead to serious complications in the baby including blindness and mental retardation. In the later part of the pregnancy, it can result in pre-term labour.

Ÿ??We had a young mother who was diagnosed with Rubella at 28 weeks of pregnancy through a test. She was monitored carefully by the hospital and all necessary care was taken. She went into preterm labour and birth and the baby weighed only 1.1 kg. But with good care in the NICU, the baby went home healthy,Ÿ? recalls Dr Thomas.

PARASITIC

Toxoplasmosis Ÿ?? This is the most common parasitic infection seen during pregnancy and is caused by the parasite Toxoplasma gondii, found in cat faces. If the pregnant mother comes in contact with the parasite, by handling cat litter or eating raw contaminated food, there is a risk of passing it on to the foetus. The infection is dangerous in pregnancy as it can cause stillbirth, miscarriage and congenital abnormalities in the baby. Such infections can be easily prevented by taking necessary precautions but if the pregnant woman is found to be infected, antibiotic medications are administered till delivery.

BACTERIAL

Urinary tract infection (UTI) Ÿ?? The most common infection in pregnancy, it is an infection of the urinary tract caused by bacteria which causes burning sensation, fever and chills.Most women are checked for UTIs during antenatal screening and treated accordingly, Asymptomatic bacteria (without symptoms) also needs to be treated. It can cause complications such as low birth weight and preterm labour .

Bacterial Vaginosis (BV) Ÿ?? This is an infection caused by overgrowth of hormonal commensal bacteria of the vagina and is typically characterised by fishy odour in the vaginal discharge. BV in pregnancy can lead to complications such as preterm labour, miscarriage and premature rupture of the membrane and hence requires prompt treatment with Antibiotics.

Group B Streptococci Ÿ?? This is a bacterial infection that is mostly asymptomatic but in some pregnancies, it can cause serious complications in the baby. It results in preterm labour and premature rupture of membrane.

All the three bacterial infections can be treated successfully with antibiotics.

Sexually Transmitted Diseases (STDs) Ÿ?? There are a few common sexually transmitted diseases such as Gonorrhoea and Chlamydia that when present in a pregnant woman can cause problems. Complications include preterm labour, miscarriage & new-born infections. STDs should be diagnosed and detected early and treated with medications.

HOW TO PREVENT INFECTIONS

Sometimes a little bit of care and sound advice from the gynaecologist can go a long way in preventing harmful infections during pregnancy.

According to the Centers for Disease Control and Prevention, simple measures can prevent infection. These include Ÿ??

  1. Washing your hands often especially after touching raw food and meat, using the bathroom, playing with children, touching dirt and soil
  2. Avoid eating uncooked food and raw and processed meat.
  3. Drink lots of water to prevent UTIs. (around 2.5 l/ day)
  4. Stay away from animal droppings and cat litter.
  5. Get checked for infections such as HIV, STDs and Hepatitis B
  6. Make sure to get vaccinations
  7. Healthy diet and lifestyle remains till date the key to prevent it.

Content Credits: Dr Teena Thomas (Obstetrics & Gynaecology)

Antenatal Ultrasound Scan

( KNOWING AND BONDING WITH YOUR BABY AT EVERY STAGE)

Ultrasound scan use sound waves to image your baby. The scans are completely painless and have no known side effects.

For most of the expectant mothers its very exciting to see their baby in the womb

Depending on the stage of pregnancy your doctor will offer you scan accordingly.

The scan can provide information that may mean you have to make further important decisions.

The first scan is called the dating scan or the viability scan. The purpose of this scan is:

  • Check your babies heart beat
  • Estimate the date of delivery based on the babies measurements
  • Say whether you are pregnant with one or more babies.
  • Detect where the embryo is implanted, inside the womb or outside( ectopic, usually in the fallopian tube)
  • To find out the cause of bleeding in case if you have

The next scan is usually prescribed at 11 weeks to 13 weeks of gestation .

  • This scan is usually called NT( Nuchal translucency) scan. This scan is performed to asses your baby’s risk for downs syndrome
  • To confirm the site of placental implantation
  • To asses the cervical length

The third scan offered to all women is called the anomaly scan, usually takes place between 18 to 22 week of pregnancy.

  • This scan checks for structural abnormalities of the baby
  • To examine the baby to see if all the organs are normal
  • Asses the amount of amniotic fluid
  • A Doppler scan also can be performed to study the blood flow to the baby and within the baby

An interval growth scan or a fetal well being scan can be performed in the last trimester :

  • To measure your baby’s growth rate and amniotic fluid
  • Check the baby’s weight
  • Presentation of the baby

Some are offered more number of scans depending on their health and their pregnancy

It is an opportunity for fathers also to bond with the baby.

Content Credits: Dr Elizabeth Jacob( Radiology)

Morning Sickness -don’t fear! By Dr. Beena Jeysingh

It is an uncomfortable feeling of just nausea or nausea with vomiting experienced in the early
weeks of pregnancy due to hormones. About 50 percent of pregnant women experience it.
Usually starts around 6weeks of pregnancy and disappears by end of 3months though rarely can
stay until end of pregnancy. Report to obstetrician if excess vomitting, less or dark color urine,
blood in vomitus. Management is by intake of frequent small feeds and in severe cases
medications to reduce vomiting.

By

Dr.Beena Jeysingh

Travel during pregnancy by Dr.Beena Jeysingh

You can still enjoy a holiday or travel for professional reasons during pregnancy. But, yes there will be some restrictions and precautions that you need to take & maintain.

The best time to travel is the middle of your pregnancy between 14 and 28 weeks. Most of the emergencies happen in the 1st and 3rd trimester & it would be difficult to move around once youŸ??re pregnant for 28 weeks and over.

When you’re travelling by air, domestic airlines normally do not allow women who are pregnant above 36 weeks while international flights itŸ??s after 28weeks. But itŸ??s always best you confirm with your airlines . You may also require a“fit to fly” medical certificate from your treating obstetrician prior to flying. Make sure to book an aisle seat if possible, so that itŸ??s easy to get up and stretch your legs.

Important Things To Keep In Mind While Travelling

  • Hydrate yourself adequately.
  • Avoid carbonated drinks during and before your flight.
  • If you are prone to nausea or vomiting get prescription for anti-vomiting drugs from your obstetrician.
  • Keep moving your legs and rotating the ankles frequently.
  • During a road trip (car or train), limit travel to 6 hours per day with breaks during travel to stretch your legs.
  • For a cruise ship be sure to carry your medications to handle sea-sickness.
  • Wear comfortable clothes.
  • Take advice on health insurance and any vaccinations if required.
  • Carry a dictionary of the local language spoken if it is a language not known to you.

Happy & Safe Travels

By Dr.Beena Jeysingh

Recurrent Pregnancy Loss by Dr. Sireesha Reddy

Recurrent Pregnancy Loss

Spontaneous pregnancy loss is a surprisingly common occurrence. Whereas approximately 15% of all clinically recognized pregnancies result in spontaneous loss, there are many more pregnancies that fail prior to being clinically recognized. Only 30% of all conceptions result in a live birth

Spontaneous pregnancy loss can be physically and emotionally taxing for couples, especially when faced with recurrent losses. Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period. Based on the incidence of sporadic pregnancy loss, epidemiologic studies have revealed that 1% to 2% of women experience recurrent pregnancy loss.

CAUSES

Genetic Etiology

Approximately 2% to 4% of RPL is associated with a parental balanced structural chromosome rearrangement, most commonly balanced reciprocal or Robertsonian translocations.

Anatomical Abnormalities

Anatomic abnormalities account for 10% to 15% of cases of RPL and are generally thought to cause miscarriage by interrupting the vasculature of the lining of womb, prompting abnormal and inadequate placentation. Thus, those abnormalities that might interrupt the vascular supply of the lining of womb are thought to be potential causes of RPL. These include congenital uterine anomalies, intrauterine adhesions, and uterine fibroids or polyps.

The uterine septum is the congenital uterine anomaly most closely linked to RPL, with as much as a 76% risk of spontaneous pregnancy loss among affected patients. Other M?ªllerian anomalies, including unicornuate, didelphic, and bicornuate uteri have been associated with smaller increases in the risk for RPL.

The presence of intrauterine adhesions, sometimes associated with Asherman syndrome, may significantly impact placentation and result in early pregnancy loss. Intramural fibroids larger than 5 cm, as well as submucosal fibroids of any size, can cause RPL.

Infectious Causes

Certain infections, including Listeria monocytogenes, Toxoplasma gondii, rubella, herpes simplex virus (HSV), measles, cytomegalovirus, and coxsackieviruses, are known or suspected to play a role in sporadic spontaneous pregnancy loss. However, the role of infectious agents in recurrent loss is less clear. The most pertinent risk for RPL secondary to infection is chronic infection in an immunocompromised patient.

Endocrine Causes

Luteal phase defect (LPD), polycystic ovarian syndrome (PCOS), diabetes mellitus, thyroid disease, and hyper prolactinemia are among the endocrinologic disorders implicated in approximately 17% to 20% of RPL.

Poorly controlled type 1 diabetes mellitus is also associated with an increased risk of spontaneous abortion. Evaluation of endocrine disorders should include measurement of the thyroid-stimulating hormone (TSH) level. Other testing that might be indicated based on the patientŸ??s presentation include insulin resistance testing, ovarian reserve testing, serum prolactin in the presence of irregular menses, antithyroid antibody testing. Therapy with insulin-sensitizing agents for the treatment of RPL that occurs in the presence of PCOS has recently gained popularity.

Thrombotic Etiologies

Both inherited and combined inherited/acquired thrombophilias are common, with more than 15% of the white population carrying an inherited thrombophilic mutation.

The potential association between RPL and heritable thrombophilias is based on the theory that impaired placental development and function secondary to venous and/or arterial thrombosis could lead to miscarriage. Evidence that the transfer of nutrition from the maternal blood to the fetal tissues depends on uterine blood flow, and thus may be affected by thrombotic events occurring there, suggests a role for thrombophilias in pregnancy losses regardless of gestational age.

Appropriate therapy for heritable or acquired thrombophilias should be initiated once the disorder is diagnosed. Therapy is disorder specific and includes

(1) Supplemental folic acid for those patients with hyperhomocysteinemia

(2) Prophylactic anticoagulation in cases of isolated defects with no personal or family history of thrombotic complications

(3) Therapeutic anticoagulation in cases of combined thrombophilic defects.

Environmental Etiologies

Because of its propensity to result in feelings of responsibility and guilt, patients are often particularly concerned about the possibility that environmental exposures may have caused their pregnancy losses.

Three particular exposures-smoking, alcohol, and caffeine-have gained particular attention, and merit special consideration given their widespread use and modifiable nature. Although maternal alcoholism (or frequent consumption of intoxicating amounts of alcohol) is consistently associated with higher rates of spontaneous pregnancy loss, a connection with more moderate ingestion remains tenuous. Studies linking moderate alcohol intake with pregnancy loss have shown an increase in risk when more than 3 drinks per week are consumed during the first trimester or more than 5 drinks per week are consumed throughout pregnancy. It seems logical that cigarette smoking could increase the risk of spontaneous abortion based on the ingestion of nicotine, a strong vasoconstrictor that is known to reduce uterine and placental blood flow. However, the link between smoking and pregnancy loss remains controversial, as some, but not all, studies have found an association. Although still not undisputed, there appears some evidence that caffeine, even in amounts as low as 3 to 5 cups of coffee per day, may increase the risk of spontaneous pregnancy loss with a dose-dependent response. The association of caffeine, alcohol, and nicotine intake with recurrent pregnancy loss is even weaker than their associations with sporadic loss.

Prognosis

Although the diagnosis of RPL can be quite devastating, it can be helpful for the physician and patient to keep in mind the relatively high likelihood that the next pregnancy will be successful. A particular individualŸ??s prognosis will depend on both the underlying cause for pregnancy losses and the number of prior losses. Correction of endocrine disorders, APA, and anatomic anomalies enjoy the highest success rates, approximately 60% to 90%. Patients with a cytogenetic basis for loss experience a wide range of success (20%Ÿ??80%) that depends on the type of abnormality present. Overall, the prognosis for RPL is encouraging. Even with the diagnosis of RPL and as many as 4 to 5 prior losses, a patient is more likely to carry her next pregnancy to term than to have another loss.

By

Dr. Sireesha Reddy | Know your doctor

Ectopic pregnancy By Dr. Beena Jeysingh

Normally the fertilized egg implants and grows into a baby inside the uterus. Rarely can it implant outside the uterus when it is called Ectopic pregnancy. The commonest site is fallopian tubes and is called Tubal pregnancy. Other sites can be ovary and cervix.
Presenting symptoms can be missing of periods, light vaginal bleeding, lower abdominal pain or giddiness.
Diagnosis is either through ultrasound or monitoring pregnancy hormone levels [b-hcG] in correlation with clinical symptoms.
Early diagnosis and management is important as it can cause heavy internal bleeding. Depending on the condition of patient and stage of ectopic pregnancy the management could be medical or surgical. Laparoscopy is the preferred surgical approach until the patientŸ??s condition does not permit when open method is opted.

By
Dr. Beena Jeysingh | Know your doctor https://www.motherhoodindia.com/dr-beena-jeysingh-2/