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Category: Obstetrical Concerns

Zika Virus and Pregnancy

 

You’ve probably heard about the Zika virus in the news, and hopefully you know of the CDC recommended travel warning for pregnant women, or those women trying to become pregnant; avoid non-essential travel to areas with the Zika virus.

The Zika virus has been associated with the development of a birth defect called microcephaly, as well as miscarriage.  Microcephaly is a condition of small head and brain development, and can be associated with seizures, eye abnormalities, hearing loss, and other problems in growth and neurologic development.

 

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10 Tips to Help Improve Nausea in Pregnancy

 

Nausea in pregnancy is very common, affecting more than 50% of pregnant women.  Though commonly called ‘Morning Sickness’, the symptoms can occur at any time of the day.  Nausea of pregnancy usually improves by 14-16 weeks, but can continue throughout the pregnancy for some women.  Nausea in pregnancy is usually not harmful to your developing baby, but may become more problematic when associated with consistent vomiting and weight loss.

The cause of Nausea in Pregnancy is not well understood.  It may be caused by the elevated hormone levels of pregnancy and their effect on slowing overall gut motility.  The GI tract is normally constantly moving food and stomach acid from the stomach, though the GI tract.  The effect of slower gut motility can result in a feeling a nausea after eating a large (your standard sized) meal, where food isn’t moving out of the stomach at the same rate.  With slower gut motility, stomach acids aren’t moving out of the area at a normal rate either, potentially also causing a feeling nausea when we go 3-4 hours without eating.

 

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Can we Reduce the Rate of Cesarean Section Births?

 

Whether common knowledge or not, the Cesarean Section birth rate in the U.S. hovers around 31%. meaning that 1 of 3 babies in our country are born by Cesarean Section.  In the last 2 decades, the rate of Cesarean Section births has continued to rise, even for first-time mothers.  According to our national organization, ACOG, the most common reason for Cesarean Section birth among first-time mothers is abnormal progess in labor.  The rate of Cesarean Section birth among first-time mothers varies throughout the country, raising their concern for the re-evaluation and standardization of the definitions of 'normal labor progress' among practicing Obstetricians in our country.

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Severe Flu Season Predicted for 2014-1015

 

The flu season is definitely among us, with January being the peak season for influenza outbreaks.  The CDC has predicted a more severe 2014-2015 flu season this year, with 91% of influenza infections thus far being due to the H3N2 virus.  Unfortunately, because of the guesswork involved in manufacturer’s development of the upcoming year’s vaccine strains, this year’s flu vaccine has only a 48% match to the H3N2 viral strain.  Nonetheless, flu illness does appear to be less severe in those having received the vaccine.  Of particularly grave significance, is the prevention of the flu in pregnant women.  Pregnancy infers particularly high risks for the development of severe illness in mothers to be.  Pregnancy related changes in our immune systems make pregnant women at higher risk for developing severe complications of the flu, such as pneumonia, respiratory distress and even death.  In the 2009 pandemic of the H1N1 influenza virus, 5% of deaths occurred in pregnant women, though pregnant women accounted for only 1% of the U.S. population.  The CDC and ACOG strongly advise pregnant women to receive the flu vaccine, noting its safety in all trimesters of pregnancy.

If you’re pregnant, be sure to get your flu vaccine.  The most common symptoms of the flu are fever, cough, nasal congestion, sore throat, headache, shortness of breath and muscle aches.  Be sure to contact your health care provider if you’re experiencing any symptoms of the flu.

http://www.medpagetoday.com/InfectiousDisease/URItheFlu/48940

Suzanne Hall, MD  Ob/Gyn (@drsuzyyhall)

Eastside Gynecology Obstetrics, PC

Macomb, Roseville, Grosse Pointe, Rochester, MI

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Pertussis Recommendations in Pregnancy

 

New cases of ‘Whooping ‘ cough/Pertussis infections are on the rise in the US.  The CDC reports 48,000 new Pertussis infections in 2012, the highest number since 1955.  Pertussis infections can result in serious illness, especially for the newborn, where the condition can be life-threatening.

 

The CDC and ACOG recommend the Tdap vaccine (tetanus/diphtheria/pertussis) in pregnancy.  The vaccine is considered safe in all trimesters of pregnancy, though recommended at 27-36 weeks gestation.  Receiving the vaccine during pregnancy improves the chances of your baby receiving ‘passive’ immunity from the infection.  If the vaccine was not received during the pregnancy, vaccination in the immediate postpartum time period is the next recommendation.  Close contact and the baby’s caregivers should also be vaccinated.  Pregnant women should be re-vaccinated with each pregnancy.

 

https://www.acog.org/About_ACOG/ACOG_Departments/Immunization/~/media/Departments/Immunization/Tdap%20Vaccine%20Mailing/Tear%20pad%20FAQTDAP.pdf

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Common Reasons why a Cesarean Section may be recommended in Labor

Cesarean Section Delivery isn’t Failure…It’s ‘Plan B’

 

If I had a nickel for the many times I’ve heard a laboring patient say, “I really don’t want a Cesarean Section!”  In addressing their labor concerns, often times I try re-clarifying with them what they really mean in saying “I don’t want a Cesarean Section”.  I believe what most of our patients really mean is:

“I’m really ‘hoping’ for a vaginal birth”…

“If I had a preference for delivery, it would be vaginally, rather than by Cesarean Section”…

However…

“If circumstances arise for which a Cesarean Section would be better for the health and safety of my baby, I’d definitely agree to Cesarean Section delivery”…

 


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Home Birth...Safe??

In our society today, women have a choice as to where to deliver their babies.  Though home births have been on the slow increase (with some ‘popularization’ by certain celebrity backing,) we should be careful not to ‘over-glamourize’ the concept of home birth.  Before considering the option of home birth, it’s vitally important for us to understand the risks of delivering a baby at home, even when those desires for home birth are based on concerns for a more private, comfortable, or ‘natural’ birthing experience.

 

Though the risk of neonatal death from a home birthing experience is (overall) considered low, findings from a new Cornell University study on home births show us that the risk of neonatal death is nearly 4X higher for babies delivered at home than those delivered in a hospital setting.  According to lead author Dr. Amos Grunebaum,  a professor of clinical obstetrics and gynecology at Cornell University's Weill Cornell Medical College,  the predominant reason why “Home birth is more dangerous”, is that births occurring at home don't have the advantage of a hospital delivery, where immediate critical care is available for the baby if a complication arises.  "There's insufficient equipment and personnel available [in the home] to address complications," Grunebaum says. Woman should know these risks before considering a home birth.

 


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Monitoring your Baby in Labor: What is Electronic Fetal Monitoring?

 

In the process of labor your baby’s normal fetal heart rate patterns assure us of the well-being of the baby, and it’s tolerance of the process of labor.  During labor, the baby’s heart rate is monitored most commonly by a device called the Electronic Fetal Monitor.  Many of you may be familiar with the device with the 2 Velcro straps wrapped across your belly.  One of the circular sensors of the monitor laid across your abdomen picks up the fetal heart rate, while the other sensor measures the frequency of your contractions.

 

While we don’t intend for labor to be a ‘stressful’ condition for you or your baby, the reality is that the arduous process of labor can be a stress to both of you.  While in labor, we monitor our Moms with vital signs, oxygen status, often IV hydration, and pain management when requested. Monitoring of the baby’s status during labor happens by our interpretation of the baby’s fetal heart rate patterns, using the Electronic Fetal Monitor.  The monitor uses Doppler ultrasound wave forms (no radiation exposure) to record the fetal heart rate pattern, and is considered completely safe, posing no risk to your baby.

 

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Understanding the negative stigma of Genital Herpes...It's the Newborn who's at greatest risk

 

Understandably, for many persons, a new diagnosis of genital herpes may lead to feelings of shock, shame, guilt or embarrassment. Often times, patients are unaware of how common this virus is among the general population.  Some studies have shown up to 1 in 5 of sexually active people have been infected with the Herpes virus, whether they’re aware of it or not.

 

Genital herpes is a treatable condition.  Aside from being sexually transmitted, much of the negative stigma around this infection seems to come from the fact that you don’t ‘get rid of’ it, and that recurrences can happen.  Herpes is a viral infection (like HPV,) and though the symptoms (a cold sore in the case of oral herpes, or a genital sore in the case of genital herpes) can be treated, the virus itself remains present in our blood stream indefinitely. Even in its dormant state (no symptoms present,) the virus remains detectable by blood test, and can lead to partner-to-partner spread of infection (from asymptomatic shedding of the virus) when no detectable ‘sore’ is present.  Gonorrhea and chlamydia, different from the Herpes virus and HPV, are bacteria or bacterial-like infections that are cured with treatment, with no detectable bacteria remaining after adequate therapy (unless the individual is ‘re-infected’.)

 

Though a diagnosis of genital herpes can be an embarrassing nuisance, it’s actually a newborn baby who’s at the most serious risks from a genital herpes infection.  A newborn baby infected with genital herpes is at risk for multi-organ infection, that can be fatal if left untreated.  If you are pregnant, with a known history of genital herpes, it’s important to let your healthcare providers know that information.  Certain measures (anti-viral medications in the last month of your pregnancy, and performing a Cesarean section if active lesions are present at the time of labor) should be taken, to decrease the risk of spread of infection to your newborn baby.

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What does 'Natural Birth' mean to You?

 

A natural birthing experience is desired by many expecting mothers…But what does ‘Natural Birth’ really mean?  For some women it means a vaginal birth with little or no medical interventions, for some it means a vaginal birth without pain medications (or without an epidural), for others it may mean any accomplished vaginal birth, and not a cesarean section.

 

Nearly a third of babies in this country are delivered by cesarean section. The more recent adoption of early skin-to-skin contact and intraoperative breastfeeding, not only benefit maternal-infant bonding, but also benefits the baby in terms of earlier success with breastfeeding.  It simulates a more ‘natural birthing’ experience, preventing the feeling of ‘disconnect’ for the parents of cesarean section babies, while separated from their baby in the operating suite.

 

As a practicing Ob/Gyn, I hold no strict or definite definition of ‘Natural Birth’.  I allow the patient to decide and define whatever ‘Natural Birth’ means to them.

 

 

Suzanne Hall, MD (@drsuzyyhall)

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"Is breastfeeding really better for my baby?"...The Benefits of Breastfeeding for the Infant

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Expecting and new mothers are faced with many decisions in preparation for the care of their newborn baby, the decision to breastfeed, being among one of the most important ones.  We’ve all heard the advice of family and friends that “breastfeeding is better for the baby”, but how true do we really know this to be?

The fact is, it is true.  Medical research has shown human breast milk, over formula feeding, to benefit the infant in several ways.  Some of those benefits include, improvement in gastrointestinal functioning, improvement in immune defenses, thereby reducing the occurrences of several acute illnesses, and enhancing the maternal-infant bonding, possibly reducing infant stress.  Because of the proven health benefits to infants, many national health organizations have recommended exclusively breastfeeding infants for the first 6 months of life (i.e., Academy of Pediatrics, the American Congress of Obstetricians and Gynecologist, The World Health Organization.)



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Feeling Your Baby Move...For the first time!

 

An exciting time for expecting parents is the first sensation of fetal movement, medically termed ‘quickening’.  Though fetal movement can be seen by ultrasound as early as the first trimester, the perceived, physical sensation of fetal movement generally occurs by around the 20th week of the pregnancy.  This sensation of fetal movement may vary among women, and among different pregnancies.  Some first-time moms may not perceive this movement until up to 22nd-24th week of pregnancy, while others may recognize the sensation of movement as early as 16-18 weeks.

This sensation of early fetal movement has been described as feeling like the fluttering of a butterfly, a tickling, or a light tap.  The differences in the timing of your perception of fetal movement may be based fetal/placental location, or the anatomy of your abdominal wall.  Initially, it may be hard to distinguish these movements from a feeling of gas or a hunger pang.  But once you recognize the sensation as fetal movement, you’ll most likely be reassured and happy with your baby’s activity!

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Have you considered seeing a Certified Nurse-Midwife for your pregnancy/delivery?

What is a Certified Nurse-Midwife?

More and more women in the US are choosing a certified nurse-midwife (CNM) for their pregnancy, birth, postpartum, and well-woman care. Certified Nurse Midwives are licensed health care providers educated in nursing and midwifery. They have master’s degrees in nursing, certified by the American Midwifery Certification Board, and are licensed to practice midwifery in the state of Michigan. National statistics show that in 2009 CNMs attended 11.9% of vaginal births, an all time-high. This trend has been discussed in newspapers such as the New York Times and in movies such as The Business of Being Born. As a leader and innovator in women’s health care, Eastside Gynecology and Obstetrics has committed to bring midwifery services to their clients, the only practice that does so in the area.

 

The midwives at Eastside Gyn/OB provide personalized, individualized care. We nurture each mother and her family with sensitive, holistic care. Our clients love that they get to know the person who will be taking care of them for their birth. We also have a commitment to promoting physiologic labor and birth, believing that labor works best when allowed to begin in its own time and progress at its own pace. At the same time, we are trained to recognize those situations where intervention is warranted and have the benefit of a close and supportive working relationship with the physicians in the practice when referral or consultation is needed.  As midwives, we aspire for you to have the birth experience that you desire. We promote mother-infant bonding immediately after birth, delayed cord clamping, breastfeeding, and childbirth classes such as hypnobirthing. We also desire for each birth to be a family experience for all who wish to be involved.

 


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Hypertension (High Blood Pressure) in Pregnancy

Did you know that up to 10-15% of pregnancies are affected by hypertension? About 5% of those cases are in women previously known to have hypertension (termed ‘chronic hypertension’), prior to pregnancy.  Another 5-8%, develop hypertension within the pregnancy (termed ‘gestational hypertension’ or ‘pregnancy-induced hypertension’.)

 

Hypertensive disorders are characterized by blood pressures consistently ranging 140/90 or greater.  Women with chronic hypertension (existing before pregnancy, or diagnosed before 20 weeks of gestation) may require blood pressure medications to control their blood pressure, even throughout the pregnancy.  Those medications should be reviewed with your healthcare provider, to assess their safety in pregnancy, even before conception.

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Choosing Pregnancy at Later Ages in Life... What my Medical Training Didn't Teach Me

If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them.   With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’.  I counsel women on their risks nearly every day.

I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation.  I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age.  I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...

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Suzanne Hall, MD  (@drsuzyyhall)

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Causes of Miscarriages

Today we are going to discuss miscarriages.  Miscarriages happens in 1-2 out of every 10 pregnancies.  The majority of them will happen in the first 12 weeks of pregnancy. When you lose more than 2-3 in a row, it may be called recurrent miscarriage.  There are multiple reasons that can cause miscarriages.  Unfortunately, more than half of them are unknown.

Some of the known causes are chromosomal or genetic issues, medical conditions in the mother, and problems with the mom's uterus.  By far the most common is chromosomal issues. This accounts for more than 50-60% of the losses.  Some other causes are maternal medical conditions such as autoimmune disease like Lupus, uncontrolled high blood pressure, heavy smoking, clotting disorder and uncontrolled diabetes.  In addition, some women's uteri may have formed abnormally at birth. This is called uterine anomaly. This can also contribute to miscarriages as well.

For those of you that have experienced a miscarriage, there is no better way of describing it other than that it "sucks".  It is a lost of life. You'll feel sad just as if you would if you had loss someone.  In a way you did.

However, what I try to tell my patients is this. Know that the majority of the losses are from a chromosomal issue that is out of your control. So don't beat yourself up. Don't think back and say "maybe I shouldn't have done that, drank that, or taking that medicine".  There will be a natural feeling of guilt. But that's ok. Your human.  But understand that the majority of the times it's NOT YOUR FAULT.  This is very important to understand.

The good news is that even if you had 2 or 3 miscarriages, the chances of you having a healthy baby is still very high.  With the advances in medicine, we can correct uterine anomalies and treat the mom's medical conditions, and hopefully, help you achieve a healthy baby.

Until next time...


docbchen

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Miscarriage

Today we are going to discuss miscarriages.  Miscarriages happens in 1-2 out of every 10 pregnancies.  The majority of them will happen in the first 12 weeks of pregnancy. When you lose more than 2-3 in a row, it may be called recurrent miscarriage.  There are multiple reasons that can cause miscarriages.  Unfortunately, more than half of them are unknown.

Some of the known causes are chromosomal or genetic issues, medical conditions in the mother, and problems with the mom's uterus.  By far the most common is chromosomal issues. This accounts for more than 50-60% of the losses.  Some other causes are maternal medical conditions such as autoimmune disease like Lupus, uncontrolled high blood pressure, heavy smoking, clotting disorder and uncontrolled diabetes.  In addition, some women's uteri may have formed abnormally at birth. This is called uterine anomaly. This can also contribute to miscarriages as well.

For those of you that have experienced a miscarriage, there is no better way of describing it other than that it "sucks".  It is a lost of life. You'll feel sad just as if you would if you had loss someone.  In a way you did.

However, what I try to tell my patients is this. Know that the majority of the losses are from a chromosomal issue that is out of your control. So don't beat yourself up. Don't think back and say "maybe I shouldn't have done that, drank that, or taking that medicine".  There will be a natural feeling of guilt. But that's ok. Your human.  But understand that the majority of the times it's NOT YOUR FAULT.  This is very important to understand.

The good news is that even if you had 2 or 3 miscarriages, the chances of you having a healthy baby is still very high.  With the advances in medicine, we can correct uterine anomalies and treat the mom's medical conditions, and hopefully, help you achieve a healthy baby.

Until next time...

docbchen

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What To Expect In The First Trimester

So what should you expect in the first trimester of pregnancy?  For many of you, this is a very exciting time.  Especially if you’re a first time mom.  There is A LOT happening in your body both hormonally and physically.  Some will experience emotional swings because of the hormone surges.  So husbands, please be understanding.


From a physical standpoint, it is not uncommon to feel menstrual type cramps because everything is growing and being stretched.  This type of pain is typically cramping and sharp shooting in nature.  This is because there are ligaments that are attached to your uterus.  The easiest way to describe them is that they are like rubber bands that attach to your uterus.  So as you grow, they stretch.  And sometimes, if they stretch too much, they’ll spasm and you’ll experience a sudden sharp shooting pain.  This pain can feel like someone is jabbing you from the vagina up (doesn’t that sound good), and sometimes it’ll feel like a shooting vaginal pain down wards or across your lower abdomin.  These typically don’t last long, but it can be quite uncomfortable.  This is completely normal.  It does not mean you are trying to have a miscarriage.  It’s normal growth.  However, most Ob/Gyn’s will order an ultrasound to make sure everything is ok.


The other thing that can happen early on is nausea and vomiting.  This is normal because of the hormonal changes that is occurring.  It typically peaks between 8-10 weeks for most women, but some will continue beyond the 12th week.  There are a wide range of treatment including vitamins, pressure point stimulator, and medicine that can help.  Please talk to your health care provider if your experiencing severe nausea or vomiting.


The first trimester can also be a time of anxiousness.  This is true for anyone that has had a miscarriage.  Most miscarriage will happen in the first trimester, and the majority of these are related to chromosomal abnormalities.  While there are certain behavors that may increase the risk of miscarriage such as smoking and high caffeine intake, the majority of miscarriages are uncontrollable.  Symptoms of miscarrage are usually severe recurrent cramping that doesn’t ease up and vaginal bleeding.  If you have these symptoms, please notify your health care provider.


Hope this quick synopsis helped answer some of your questions.  Good luck!

docbchen


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