Multiple Pregnancy

Multiple pregnancy is when there are more than one embryo getting attached to uterine lining and developing into multiple foetuses. This can be twins, triplets, quadruplets or higher order pregnancies. The incidence of twins is gone up from 18.9/1000 live births in 1980 to 32.1/1000 live births.

How multiple pregnancy happens?

One baby growing in the womb (uterus) on its own is called a singleton pregnancy. By far the most common type of multiple pregnancy is a twin pregnancy when there are two babies. Having three babies in the same pregnancy is known as triplets and having four is known as quadruplets. It is very rare to have more than four. Multiple pregnancy happens because two to three eggs get fertilized with two to three sperms or when one fertilised egg make two to three instead of one embryo.

Let us understand about TWINS as this is the commonest of all multiple pregnancies. Also, it is important to understand that the placenta is crucial to the pregnancy – it is the place where your body ‘meets’ your baby directly to pass across the nutrients your baby needs to grow. When an egg is fertilized it starts dividing till it convert itself into a zygote. If split occurs in early stage of cell division identical twins are formed. This cell division continues until it converts into a ball of cells and starts implanting itself in the lining of womb and becomes an embryo. The cells will form distinct areas like central group forms the baby and outer lining form the amniotic sac.

Types of twins:

  • Dichorionic diamniotic (DCDA): Two placenta and two amniotic sacs.
  • Mono chorionic diamniotic (MCDA): One placenta and two sacs.
  • Mono chorionic mono amniotic (MCMA): One placenta and one sac

Causes of multiple pregnancy:

  • Maternal age: women more than 35 are more prone to conceive multiple.
  • Fertility medication: These drugs stimulate ovaries to produce multiple eggs
  • Family history: History of multiple gestation in the family makes one prone for the same.
  • Had a history of twin in the past.

Risks to foetuses

  • premature birth
  • low birth weight
  • Twin to twin transfusion
  • Discordant growth
  • Miscarriages

RISKS TO MOTHER

  • Gestational diabetes
  • Preeclampsia or hypertension
  • Severe hyperemesis

Management

  • Foetal reduction: this is termination of one or more foetuses after the NT USG . Proper understanding of the procedure from parental side is very important. Risk of abortion needs special attention.
  • More frequent visits to obstetrician
  • Cervical encircalage / stitch: It’s role in preventing miscarriage is doubtful
  • Vaginal progesterone: this is known to help keep cervical integrity
  • Dietician advice to help prevent GDM
  • Ecosprin can be advised for prevention of preeclampsia
  • More frequent scans to understand the growth pattern.
  • Intervention by foetal Medicine expert if required
  • Vigilant postnatal care as the chances of post-natal depression is high
  • Avoid alcohol, smoking as advised with any singleton pregnancy.
  • Steroid injection: these injections are given to mother to help the maturity of foetal lungs, by doing this we can avoid/ decrease the stay of babies in NICU

Mode and time of delivery

Chances of Normal Vaginal Delivery is high under following conditions:

  • The babies are growing properly
  • Position of babies in the womb normal and conducive for normal delivery

LSCS would be a method of choice for:

  • MCMA twins
  • Pprom: water break/ leaking prematurely before term
  • Unfavourable position
  • CPD wherein the birth passage is narrow
  • Second twin after vaginal birth of first baby, if vaginal delivery not possible due to abnormal lie and position of baby, decreasing heart rate, placental abruption

As per guidelines the ideal time of delivery is around 38 weeks, any time before is 32 weeks has high risks for babies

Special attention

Genetic screening: Please talk to your obstetrician and opt for amniocentesis if indicated, double/quadruple marker, CVS and NIPT screening methods are not conclusive

Bed rest: not indicated

Eat for three: not required, should get consultation with dietician

Breastfeeding: no issues and both the babies can be fed properly

ENJOY YOUR PREGNANCY AND FEEL FREE TO ASK FOR HELP FROM FAMILY AND FRIENDS DURING PREGNANCY AND POST YOUR DELIVERY AS MULTIPLE PREGNANCY IS A VERY DEMANDING CONDITION PHYSICALLY AND MENTALLY.

By,
Dr. Suhasini Inamdar

 

My Gynaec – The Essential App For Expecting And New Moms

Motherhood Hospitals is a comprehensive woman and child care hospital committed to providing a gamut of services to women, newborns and paediatrics. Our multidisciplinary team provides comprehensive and personalised care, including obstetrics, gynaecology, neonatology, paediatrics, fetal medicine, radiology and speciality outpatient clinics. Situated in chief areas of Bangalore such as Indiranagar, Sarjapur Road and Hebbal, Motherhood hospitals ensure the safest and most hygienic services for mums and hence, must be on the top of every mum’s list of healthcare centres. Their hospitals comprise teams of highly qualified gynaecologists and paediatricians, making them Tiny steps top choice in terms of a recommendation for you.

Here, weŸ??re reviewing one of the newest features Motherhood has added to reach out to mums in need – My Gynaec: Motherhood. It is an app designed keeping in mind the convenience of every mum who indulges in the childbirth frenzy. It is inclusive of everything a mom-to-be can possibly run for – from appointments with doctors to reminders for medicines.

The app is simple to understand and access, with explicit features related to pregnancy and womenŸ??s health. All it requires you to do in order to access it is sign up using your personal details, which then leads you to a dashboard of categories you can choose to explore. These categories revolve around the matters of pregnancy and women health and care, further leading you into the world of motherhood.

They allow you to keep a tab on not only your doctorŸ??s appointment, but also let you calculate the following:

  1. Due date (using LMP- last menstrual period)
  2. Ovulation cycle
  3. Menstrual cycle
  4. BabyŸ??s growth status
  5. Menopause
  6. Condition of your breasts during and after pregnancy

With features such as a well-built alarm and calendar system, you can now keep a check on all of the above things. You can also collect all your special pregnancy memories through features such as the pregnancy milestone, which allows you to capture every single milestone you cover during pregnancy with dates, personal descriptions and pictures.

What actually makes this app so efficient is the connectivity it provides you with the world around you. In the case of emergencies, it allows you to be in touch with both your hubby and gynaecologist. With features such as Emergency calls, you can now make sure your husband is the first person to know in case youŸ??ve faced any emergency, including your labour. Here, your husband will be receiving notifications about your appointments, due date and the stages of your babyŸ??s growth.

Overall, the app is built to make your life easier during pregnancy. In case you feel the need to contribute to the app or suggest changes in it, you can always choose the feedback option from the home screen dashboard. In our opinion, it is a must on your phone.

My Gynaec is available both on iOS and Android. It is only a click away from installation. We suggest you get this app on your phone right now!

Take care!

Article Source Credits : TinyStep

World Hepatitis Day

28th July is recognized as World Hepatitis Day; and today we would help you understand the common causes and Effect of Hepatitis in Pregnancy.

Hepatitis is an infection and inflammation of the liver caused by a virus. Jaundice during pregnancy is mainly caused by Hepatitis.

Normally, being pregnant will not hasten the disease process or make it worse, unless a woman has hepatitis E.

Most of the times pregnant women are completely unaware that they have been infected with a hepatitis virus. Usually this is because any symptoms of the illness may only be felt or at times there are no symptoms at all. Good antenatal care and blood screening are important during pregnancy, to avoid and cure it at an early stage.

The common types of Hepatitis are:

Hepatitis A :

Hepatitis A is transmitted by the oral-fecal route, such as from contaminated water or diapers. The main treatment is rest and a nutritious diet, and usually the woman will recover within a month or two. If a newborn is exposed, the infection is usually mild and they will have a lifelong immunity to the disease. If a pregnant woman gets exposed, she will be given immune gamma globulin (IG) to help protect her from getting the disease. It is always recommended to the pregnant ladies who plans a travel to get immunized.

Hepatitis B:

Hepatitis B is one of the most highly transmitted forms of hepatitis from mother to child around the world. Usually, the disease is passed on during delivery with exposure to the blood and fluids during the birthing process.

When the infant is born, the newborn will receive hepatitis B immune globulin at birth, and should be vaccinated with a hepatitis B vaccine at one week, one month, and six months after birth.

Hepatitis C:

Hepatitis C occurs if a person is exposed through transfusions, contaminated needles, or injected drug use. Mostly women become pregnant during the years between 20 and 40, which is also the age group in which the incidence of hepatitis C, hence screening for hepatitis C before and during pregnancy is done. The risk of a pregnant woman passing the hepatitis C virus to her unborn child is generally low and has been related to the levels of quantitative RNA levels in the motherŸ??s blood.

Hepatitis E:

Hepatitis E is a rare and sporadic viral infection of the liver. Its risk of transmission is highest in regions where there are low standards of sanitation. It is transmitted via the fecal-oral route through contaminated water. When this illness affects pregnant women, they may experience a more severe form of illness, which may possibly lead to acute liver failure.

1. What are the signs of hepatitis during pregnancy?

Common signs of Hepatitis are:

  • Nausea and vomiting
  • Loss of appetite
  • Fever
  • Abdominal pain
  • Yellowing of the skin and the whites of the eyes.

The problem is, depending on the type of virus, symptoms might not show up for months after infection, or you may have no symptoms at all.

2. How can we analyses that a person is infected with hepatitis during pregnancy?

Blood Test can indicate the presence of hepatitis. There are blood tests which can also show the liver condition.

3. How will hepatitis affect the unborn baby?

The baby would be fine throughout the pregnancy. Some risk factors involve only during the time of birth. ThatŸ??s why all pregnant women are tested for hepatitis B. If the test shows the mother has been infected, doctor will take steps to minimize the baby’s chances of infection.

 

Dr. Sireesha Reddy

Obstetrics & Gynaecology

PCOS and Pregnancy

Polycystic ovary syndrome is a complex, commonest endocrine metabolic condition in the reproductive years of a woman. There is no single attributing factor. It is multifactorial.

Its impact on pregnancy is not elucidated entirely. Women with recurrent pregnancy loss, subfertility, obesity causing concerns are associated with PCOS.Spontaneous miscarriage is seen in almost 40% of patients in early pregnancy. Recurrent pregnancy loss and subfertility could be related due to increased secretion of LH hormone causing concerns with egg maturity and uterine lining receptivity. Pregnancy induced insulin resistance due to other pregnancy hormones puts patients at risk to develop Gestational diabetes, pregnancy induced hypertension.

In women who have been on insulin sensitizers like Metformin before pregnancy to decrease insulin resistance and in obese women , continuing them on Metformin after conception have been associated with less pregnancy losses, hence recommended to continue till 12 weeks of pregnancy. There is no additional risk of abnormalities by continuing Metformin.

Lifestyle modifications including diet and exercise will help women with PCOS contemplating pregnancy reduces the above mentioned risk

Dr. Madhushree Vijayakumar

Consultant OBGYN

Food For A Healthy Mind & Pregnancy

Every day, pregnant and nursing women have to make important dietary decisions by consuming healthy meals that include essential nutrients such as folic acid, calcium and pre-natal vitamins. Omega-3 fatty acids, which are long-chain polyunsaturated essential fatty acids, are also crucial for the mother’s health and also for the overall development of a healthy baby.

Research indicates that one of the most essential Omega-3 fatty acids is DHA (docosahexaenoic acid), which is critical for the development and functioning of the brain, the eyes and the central nervous system. Since Omega-3 fatty acids are not generated by the human body, pregnant and lactating women must obtain it either through diet or supplements. Babies rely on their mothers to get the much-needed DHA.

The Benefits

The European Food Safety Authority Scientific Panel recommends that pregnant and nursing women should consume 350 to 450 mg of DHA every day. Research suggests that DHA helps pregnant women by reducing the risk of pre-term birth and postpartum depression. According to a recent study in The American Journal of Clinical Nutrition, taking DHA helps optimal pregnancy outcomes. By ingesting supplements during the last half of pregnancy, women have longer gestation cycles, bigger babies, and fewer preterm births.

DHA also benefits the baby. Research shows that it results in an increase in brain weight and a child’s IQ, better hand-eye coordination. Babies get DHA from breastmilk, where it is found naturally. Infant formulas are now being supplemented with DHA.

Research indicates that preterm infants born without the benefit of DHA in last trimester of the pregnancy did not perform well on cognitive mental tests. Low levels of DHA in children have been linked to an increased risk of Attention Deficit Hyperactivity Disorder (ADHD), vision problems and depression.

In India, there is a low level of importance given to DHA during pregnancy and lactation. DHA intake in India among pregnant women is 10 times lesser than the intake among mothers in developed countries.

There are different dietary sources of DHA such as:

  • Algae: Certain microalgae are natural sources of DHA. A natural vegetarian source of DHA can now be produced from microalgae, and is currently available in dietary supplements, fortified foods, and a number of infant formulas.
  • Fatty fishes such as anchovies, salmon, herring, mackerel, tuna and halibut
  • Organ meat such as liver
  • Fish oil
  • Poultry and egg yolks
  • Breast milk

Of the above, significant amounts of DHA are found in animal organs and fatty fish, which is a challenge for Indias huge vegetarian population. Non-vegetarians have the highest DHA levels. Not only that, pregnant women are usually advised to limit consumption of fish due to concerns over toxins such as mercury.

A common misconception that many have come across is the use of flaxseed and walnuts in the belief that these foods are a rich source of DHA. That is not true. Flaxseeds and flaxseed oil contain a particular omega-3 fat called ALA (alpha-linolenic acid), a precursor of DHA. While the body can convert small amounts of ALA into DHA, it is not sufficient. According to World Health Organisation, marine oil supplements are often recommended to pregnant women to fulfil their Omega-3 requirements as they contain fatty acids DHA and EPA, which are the precursors of prostaglandins. Marine oils are usually promoted as a treatment for hypertension among pregnant women and non-pregnant adults.

Preeclamsia & Prematurity

Preeclampsia and Prematurity Insights on Managing Challenges in Pregnancy- Motherhood Hospital India

Pre – Eclampsia is a serious health problem affecting 5-8% of pregnancy worldwide

(8-10)% of pregnant women in India gets affected by it.

40% indicated or medically induced prematurity is caused by pre – Eclampsia and eclampsia in order to save life of mother and baby as delivery is the final option for this disease of placental origin.

Main indications of premature delivery are

Fetal:

  • Fetal disease
  • Intrauterine growth restriction
  • Oligo hydramnios
  • Placental abruption
  • Abnormal blood to fetus or abnormal doppler study

Maternal indications :

  • Recurrent eclampsia
  • HELLP syndrome
  • D/C
  • Liver hematoma
  • Renal failure
  • Hypertensive encephalopathy
  • Pulmonary edema

Can pre-elcampsia, eclampsia and prematurity can be prevented?

Primary prevention:

To prevent disease from happening

  • Avoid smoking and alcohol (It reduces disease by 30 – 40 %)
  • Maintain healthy weight
  • Avoid late marriage and late pregnancy
  • Diet rich in antioxidant such as Vit C, Vit E,Magnesium,. Zinc and calcium if positive family history of hypertension pre-eclampsia and eclampsia
  • Medication
  • Role of low dose of ecospirin is still no confirmed

SECONDARY PREVENTION

  • Medicines as such as Nifedipine, Labetalol, Hydralazsine
  • Sodium nitro prusside sodium

Tertiary Prevention to avoid recurrence by Magnesium sulphate

The main culprit of Pre-Eclampsia and eclampsia is placenta, which provides nourishment for baby.

There is no 100% effective screening method to prevent it. So, final outcome depends on experienced and dedicated obstetrician for early diagnosis organized antenatal care and family decision of delivery

Authored By : Dr Deepmala

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

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.

 

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.