Health Guide

Multiple Pregnancy Week by Week

There are two distinct camps in the multiple pregnancy debate, is it better to have or to have not?

To many in the general population, multiple pregnancy resulting from infertility treatment sounds like a wonderful outcome, the "instant family" after years of involuntary childlessness. This is reinforced by magazine articles and television programmes in which readers and viewers are invited to marvel at the rows of beds, shoes, school lunches etc., in families coping with raising triplets, quads, quintuplets or more.

As an IVF embryologist, I fell into this category. After the couple had a positive pregnancy test it was not common to hear any more about them. In the absence of any further information, it was normal to assume that things were running smoothly, and that the worst the parents would have to cope with, would be a few sleepless nights after the children were born. But over the past ten or so years, I have come to understand exactly what a multiple pregnancy means to the family.


The pregnancy
I became pregnant when I was 27 years old. I had just lost a blighted ovum pregnancy and then conceived naturally in the subsequent cycle. This second pregnancy was a quadruplet implantation, with one embryo lost at 5 weeks' gestation (although this was not accompanied by any bleeding). The ultrasound examination showed tissue in the uterus, although evidence of a fetal heart was not conclusive.

7 weeks
A second ultrasound examination at 7 weeks gestation showed 3 fetal hearts, with two quite close together. Another ultrasound examination at 10 weeks gestation showed three separate sacs, although one was much larger than the other two.

16 weeks
At 16 weeks gestation, biophysical profiles of all the fetuses were made by ultrasound examination and showed that two of the fetuses were developing normally, while the third was smaller.

20 weeks
At 20 weeks gestation, I developed pregnancy induced hypertension and was placed on bed rest. There was an unequal distribution of amniotic fluid in the fetal sacs - one had a very high volume of fluid, while the others had very low volumes. This made it impossible to treat the condition medically, since treatment to increase or decrease the fluid volumes would cause problems for the others.

24 weeks
At 24 weeks gestation, I was spilling protein in my urine, my kidneys weren't functioning properly so I was accumulating fluid, and I had extremely high blood pressure. I was admitted to hospital because the doctors were concerned about premature labour. After a couple of days, my condition had stabilised, but there were still very unequal amounts of amniotic fluid. The only way to even up the amount of fluid was to physically remove some from the large sac. This was done trans-abdominally using an amniocentesis needle attached to a 60 ml syringe. A total of 1.3 litres of fluid was removed, 60 ml at a time (quite a painful procedure because the layers of tissue were moving relative to one another as the amount of fluid decreased, but the needle was left in place all the time to reduce the risk to the baby).

26 weeks
At 26 weeks gestation, another ultrasound biophysical profile of the babies was ordered. The third triplet showed an abnormal blood flow that could have been due to a heart defect and we had to face the possibility that she might not survive. Because of the uncertain outcome, we were asked to decide whether to continue the pregnancy or to deliver at 26 weeks to allow her to be operated on. There was no evidence that we could improve her prognosis by surgery (since nobody knew exactly what, if anything, was wrong), and we felt that the risk to the other babies' health was too great when there was such an uncertain outcome. We decided to continue with the pregnancy.

27 weeks
By 27 weeks gestation, my blood pressure was controlled, my kidneys were working again and I had lost the fluid that had accumulated in my tissues. The fetuses were growing well. I "saw" them most days during the routine ultrasound, and had started referring to them by name. The medical team was pleased with our progress, and foresaw no problems.

28 weeks
At 28 weeks gestation, the Monday morning ultrasound showed that the third triplet's heart had stopped beating. Because of the fused placenta, the babies had to be delivered by emergency Caesarean - since they were now at risk.

The delivery
There were 14 people in the delivery room (hardly an intimate and moving experience!). Baby 1 (Caitlin) weighed 1100g and had to be resuscitated, Baby 2 (Rebecca) was stillborn. She weighed 800g. Baby 3 (Sara) weighed 890g and was doing reasonably well. All of the babies were taken away immediately.

Our first joint parental decision was to allow Sara and Caitlin to be given lung surfactant - fortunately the decision to end the drug trials had been made 2 hours earlier!

Rebecca
The following morning, I had to make my first sole parental decision I had to sign the autopsy release form for Rebecca. The enormity of trying to come to terms with the loss of a child as well as having to understand the challenges faced by the surviving babies, at the same time I was recovering from surgery, is too painful and too hard to describe.

In that first week, we had to arrange for Rebecca's funeral while at the same time I had to start expressing breast milk for Caitlin and Sara. It was a week of sharp contrasts, pain and cofusion, instead of joy and happiness at the birth of three healthy babies.

Caitlin & Sara
During that week, Caitlin had to be given another drug to close the hole in her heart. The surfactant treatment worked very well and both Sara and Caitlin were breathing on their own (ie they didn't need ventilators) within a couple of days, although they still required oxygen treatment. In the following week, Sara was doing very well, and there was talk of moving her out of the intensive care unit. Meanwhile, part of Caitlin's gut had died due to lack of oxygen. This is a life-threatening condition. In other cases it requires surgery to remove the dead portion of the bowel. Rebecca's funeral was held that week. Caitlin recovered and did not require surgery. Her health improved quite quickly, and she was moved into the intermediate part of the intensive care unit.

Meanwhile, Sara had contracted viral pneumonia and her lung had collapsed. She had to be put back on the ventilator. On the same day, I was allowed to hold Caitlin for the first time. She was so small that her head rested in the crook of my elbow and her feet were at the end of my palm. Caitlin continued to do well and was moved to the special care nursery just to grow. She learned to suck and I could breastfeed her. She still had some lung damage and needed extra oxygen.

Sara
Sara was still very ill and her lung damage was worsening. The drugs she was on caused her a lot more damage and in the end, every system was affected. She was being given 100% oxygen but her levels were below 80% (they should be 85-95%). She stayed this way for weeks, until finally she crashed. Her oxygen levels were down to 28% and nothing was helping her. She was still in a humidicrib, and I still hadn't held her. I made a scene in the intensive care unit about how they couldn't let her die because they hadn't let me hold her. I was escorted out of the NICU. The following day, Sara was still alive but her oxygen levels were still extremely low, around 36%. The staff had decided that it couldn't hurt for me to hold her.

Everyone in the NICU knew what was happening and people came running from everywhere with tissues when they put Sara in my arms. As I held Sara, the oxygen saturation monitor alarmed. It was reading 96%. Sara improved slowly, but her oxygen saturation levels stayed relatively low (around 70%) for the next few weeks. The doctors didn't expect her to improve, and couldn't give us a prognosis - although they told us that nobody who had been that sick had ever survived. That week, the nurses put Caitlin and Sara together and took photographs. They thought it might be the only chance we would have to see them together.

Coping with critically ill children
Finally, after 10 weeks, Caitlin was to be released from hospital. The day before Caitlin was to come home, the medical staff called us in for a conference. They told us that Sara was gravely ill, that they had evidence that she had sustained brain damage. They said that she was constantly in pain and that she would never have a good day in her life. They then asked us to support their suggestion that they withdraw care and allow her to die. This was too hard to face, and we asked for their personal rather than professional advice. We decided to put off the decision for another week.

During that week, Sara was treated with high doses of steroids, and she improved dramatically. Caitlin had come home on schedule, and she still needed oxygen. The day that Caitlin came off oxygen supplementation was the same day that Sara came off the ventilator. Sara had to stay in hospital for another 2 months, and she started to grow, although her lung damage was extreme. She was discharged from hospital when she was 5 months old. She was home for 2 days before she had to be rushed back to hospital with breathing difficulties. She ended up staying in hospital for 3 months, and she had surgery (after she got to 5.5 lbs) to stop her from vomiting constantly. A gastrostomy tube was also inserted through her stomach wall so that she could be tube fed when she was too sick to manage eating

When she was discharged from hospital this time, we had to give her nebulised drugs every 3 hours, followed by chest physiotherapy. The treatment that had kept her alive had taken away all the hairs in her lungs, so she couldn't get rid of the mucus on her own. She also had to be fed small amounts of high calorie formula via her g-tube every 3 hours, and she couldn't have been fed less than an hour before chest physio. She also had to be given drugs every three hours around the clock and she was fed via her g-tube overnight while she slept.

We had to be very organised about Sara's care and we devised lots of systems to make sure that she was given the right drugs and treatment at the right time. For example, when Sara was in bed at night she had her oxygen tubing as well as a feed line going into her stomach. This meant that she had two lengths of tubing running through her bed and there was a risk that she could get them tangled around her throat. We ended up putting both tubes inside her sleeper pyjamas and bringing them out at her foot, because then she would have to do somersaults to get the tubes around her neck.

Another problem was that she had to have drugs given to her in her g-tube at 8am, 11am, 2pm, 5pm, 8pm, 11pm, 2am and 5am. Some of these drugs were quite dangerous so we had to make sure that we weren't going to make a mistake in the middle of the night by giving the wrong dose or giving it at the wrong time, since she didn't get the same drugs at each time. Of a night, I'd give Sara her 10:30pm Ventolin etc., then chest physiotherapy, then put her back to bed and hook her up to the overnight feeding bag. There was a peristaltic pump which passed the formula into her stomach at a fixed rate. When the bag was empty, the pump would alarm - we set the flow rate so that the alarm would go off at 5am, so that I could get up, switch it off, give Sara her 5am drugs and then go back to bed. We had to work it so that I did the 11pm and 5am shift and my husband did the 2am shift, so that he could have 2 stretches of good sleep, since he was the one earning the money of a day.

The guilt and despair involved with having critically ill children is extreme, and certainly outweighs any perceived advantage of just having to have one pregnancy to complete a family.

Meanwhile, Caitlin was doing very well and we had to try to give her as normal a childhood as possible. This level of care continued for 2 years, with Sara in and out of hospital due to lung problems. At 2 years and 3 months, Sara was well enough to be weaned off supplementary oxygen and most of her drugs. She was unable to walk, and had developed an oral aversion, meaning that she didn't like eating. We then had another 2 years of intensive therapy (physiotherapy, occupational therapy, speech therapy) to teach her how to walk, how to move food around in her mouth, and to give her a sense of herself. The breakthrough with her eating was chocolate. She surprised us all by eating an Easter egg. It took her until she was 6 years old before she was confident in chewing and moving food around in her mouth. The girls continued to grow and Sara started to outgrow all of her problems.

Now we have two 10-year olds. They are both generally healthy and intelligent children. However, it took five years of virtually 24 hour nursing and caring to get us here. From my family's experiences, I could not recommend multiple pregnancy to anyone. The guilt and despair involved with having critically ill children is extreme, and certainly outweighs any perceived advantage of just having to have one pregnancy to complete a family. Finally, I would just like to say that we begrudge nothing that we have had to do but please remember my family's trials and hurdles when thinking about the 'rightness' of the "instant family" that multiple pregnancy brings.

| Posted in » Pregnancy  

What is Cleft Lip

Cleft Lip

What is other name :
Hare lip.


Introduction :
One or two off centre splits in the upper lip that may involve the palate (roof of the mouth).


Types :
Can vary from a barely noticeable notch in the upper lip, to a complete wide split of the upper lip and full length of the palate.

Cause :
From four to seven weeks after conception in the womb, each of us has a double cleft lip; and from the fifth to twelfth weeks, each of us has a cleft palate. For virtually everyone, these clefts of the lip and palate close naturally before we are born. Closure does not occur naturally in late pregnancy or after birth.


Incidence :
In about one person in 800, the clefts in the lip and palate do not close naturally before birth.


Investigations :
Sophisticated x-rays and CT scans of the face and skull will be undertaken before any surgical repair to accurately gauge the extent of the problem.


Screening :
May sometimes be detected late in pregnancy by an ultrasound scan of the foetus.


Treatment :
These children need special medical, dental and speech therapy treatment, especially during their early development. The aims of the team of specialists treating these people are threefold. Firstly, and most importantly, to ensure that the developing child has good speech through to adult life. Secondly, to enhance facial attractiveness; and thirdly, to produce the best possible jaw function and dental bite. The reason for good speech having the highest priority during treatment is that no matter how facially attractive a person may be, if that person cannot speak clearly and well, his/her social and personal development will be severely restricted. Directly related to good speech is good hearing. Most children with a cleft palate need careful monitoring to ensure their hearing is adequate. It is important that these children maintain good general health, and particularly to avoid infections or surgery to their tonsils and adenoids. Surgical repair of the cleft lip is normally done between two and six months after birth. Infants with a double cleft lip must have special dental treatment to reshape their upper jaw prior to surgical repair of the lip. The dental treatment starts immediately after birth, and requires a high degree of cooperation from the parents. This period is very emotional and demanding for the parents, but becomes most rewarding after the lip repair is done. The palate repair is normally done at about one year of age, and this is the critical operation for the child's speech. Most children with a cleft palate have an upper jaw which does not grow is well as the lower jaw, thus special dental and orthodontic care is necessary until the child has finished growing, to ensure the jaws and teeth develop in the correct relationship to each other. The vital periods for correct specialist care are when the adult teeth appear at seven or eight years, and during the rapid growth stage between 11 and 13 years. The ability to bite, chew and smile effectively are essential for both comfort and appearance. An attractive face and clear speech are added benefits of good care.


Outcome :
Modern surgery now makes it possible to correct poor speech in people who have a cleft palate, no matter how old they are. Older patients who have a poor bite because of a too small or too large upper or lower jaw can also be helped by this surgical technique. Cleft palate and lip are no longer the gross social stigmas of earlier years.


Further information:
Parents and children can benefit from the assistance offered by support groups such as Cleft-Pals that exist in most capital cities.

| Posted in » baby, Pictures of Cleft Lip, Pregnancy  

Birth Control Complications

Although the contraceptive pill is very safe, there are some women who should not use it. Those who have had blood clots, severe liver disease, strokes or bad migraines must not take the pill. Heavy smokers, obese women and those with diabetes must be observed closely, and probably should not use the pill after 35 years of age. Medroxyprogesterone injections are generally very safe, and by far the most reliable of the reversible forms of contraception, but problems can include headaches, abnormal vaginal bleeding, and the contraceptive effect lasting far longer than desired.

The complications of a tubal ligation are few, the main ones being bleeding and infection. The operation is safe and effective, and it is extremely rare for pregnancy to occur afterwards. The woman's menstrual cycle is not affected in any way, but if the contraceptive pill is ceased after the operation, her periods may become heavier and uncomfortable due to the loss of control offered by the pill. This sometimes leads to the misconception that hysterectomies are needed after a tube tie. After a vasectomy there may be some bruising and discomfort of the scrotum for a few days after the operation, but other complications are rare. Not all women are suited to the use of IUDs. Only about 40% of women still have them in place a year after insertion. Sometimes they can fall out, they may cause heavy and painful periods, or rarely they can cause infections of the uterus resulting in permanent infertility. During insertion, it very rarely may penetrate the uterus to cause serious peritonitis. The devices seem to have fewer side effects in women who have had a pregnancy, but there are smaller devices available for women who have had no children.

| Posted in » Pregnancy, Womens Health  

The Intrauterine Device - Birth Control

The intrauterine device -
The intrauterine device is a piece of plastic shaped like a7, T or S, that may be covered by a thin coil of copper wire. It is inserted by a doctor through the vagina and cervix to sit inside the uterus (womb). The intrauterine device acts by irritating the lining of the womb (uterus), and preventing the development of the pregnancy. The insertion of the device is done very simply by your own doctor, and takes only a few minutes. It is usually quite pain free. Through a speculum (a collapsible metal tube) a doctor will examine the entrance to the womb (the cervix) and check the shape and size of the uterus. Then, while holding the cervix carefully with a special pair of forceps, the IUD is slowly pushed through the cervix canal into the uterus. It is only 3mm. in diameter when inserted, but once inside the uterus it springs open to its "7", "T" or "S" shape and is held in position by the arms of the device pushing on the uterine walls. It is normal to insert the intrauterine device immediately after a menstrual period, but may be inserted at other times if the woman wants immediate protection Once in place, the woman is not aware of its presence. After each period she should feel for the fine thread which will normally hang into the vagina. This is used to remove the intrauterine device at a later time. The device can remain in place for two or three years before its needs to be changed, but a doctor should check it every year, when you should also have a routine Pap smear test. The intrauterine device has one great advantage - you cannot forget to take it or use it. Once in place it can be relied upon to give 97% protection against pregnancy. When you want to become pregnant, or no longer require contraception, the device is easily removed. Your doctor will merely pull on the short thread left outside the uterus (but inside the vagina), and the intrauterine device will fold up on itself, enabling it to be gently withdrawn.

| Posted in » Pregnancy, Womens Health  

Contraceptive pill - Birth Control

Contraceptive pill -
The oral contraceptive pill is the safest and most effective form of reversible contraception. There are many different dosage forms and strengths, so that most women can find one that meets their needs. The main types are the constant dose two hormone pill, the two or three phase two hormone pill (hormone doses vary during month), and the one hormone mini-pill (see Medication Table). The pill has several positive benefits besides almost perfect prevention of pregnancy. It regulates irregular periods, reduces menstrual pain and premenstrual tension, may increase the size of the breasts, reduces the severity of acne in some women, and libido (the desire for sex) is often increased. It even reduces the incidence of some types of cancer.

Two different hormones control the menstrual cycle. At the time of ovulation, the levels of one hormone drops, and the other rises, triggering the egg's release from the ovary. When the hormones revert to their previous level two weeks later, the lining of the womb is no longer able to survive and breaks away, giving the woman a period. The pill maintains a more constant hormone level, and thus prevents the release of the egg. With the triphasic pills, the level of both hormones rises at the normal time of ovulation, and then drops slightly thereafter to give a more natural hormonal cycle to the woman, while still preventing the release of an egg. When the pill is stopped (or the sugar pills started) at the end of the month, the sudden drop in hormone levels cause a period to start.If taken correctly, the pill is very effective as a contraceptive. But missing a pill, or suffering from diarrhoea or vomiting can have a very pregnant result. Some antibiotics can also interfere with the pil. A few women do have unwanted side effects from the contraceptive pill. These can include headaches, break through bleeding, nausea, breast tenderness, increased appetite and mood changes. If these problems occur, they can be assessed by a doctor, and a pill containing a different balance of hormones can be prescribed.

There is no need these days to take a break from the pill every year or so. This may have been the case in earlier years, but is no longer necessary. The effects of the pill are readily reversible. If you decide to become pregnant, you could find yourself in that state in as little as two weeks after ceasing it, with no adverse effects on the mother or child.

| Posted in » Pregnancy, Womens Health  

Vasectomy - Birth Control

Vasectomy
Most men are very anxious about a vasectomy, as they are not sure what happens and are concerned that it may affect their libido or masculinity. This is not so. Sperm are produced by the testes throughout adult life at a relatively constant rate. The sperm enter a complex network of small tubules which unite to form the sperm tube (vas deferens). The sperm pass along this tube to a storage sac (the seminal vescicle) in the groin where they await the next ejaculation. The walls of the sperm storage sac secrete a fluid which nourishes the sperm, and along with an exudate from the prostate gland, forms 95% of the semen passed by the man during intercourse. When he ejaculates, the sperm and supporting fluid (called semen when combined) pass down the sperm tube to its junction with the urethra, and then along this tube to the outside of the penis. In the operation, a local anaesthetic numbs the side of the scrotum, and through a small incision, the doctor cuts, burns and ties the sperm tube (vas deferens) so no further sperm can pass along it from the testes. This may be done in the doctor's rooms, or as a day patient in a private hospital.

The procedure is very simple and brief, and no pain is felt.The man is not immediately sterile after the operation. Because sperm are stored in the sac above where the tube is tied, this must be emptied by about a dozen ejaculations over the next few weeks. It is normal to have a test done about six weeks after the operation to check that no sperm are getting through or remaining in storage. The couple can stop their other contraceptive measures after this test is confirmed. The male hormones which establish and maintain masculinity are also produced in the testicles. These are no affected in any way by the operation as they enter the blood stream directly from the testes and continue to function normally. The man's ejaculation is not affected either, as the fluid from the sperm storage sac is passed as normal.

2. Preventing the release of the egg (ovum) from the ovary.

| Posted in » Mens Health, Pregnancy, Womens Health  

Tubal ligation - Birth Control

Tubal ligation

A tubal ligation can be done by an open procedure or laparoscopy. In the open operation the surgeon (usually a gynaecologist) makes a horizontal cut about 7cm. long just above the pubic bone to gain access to the fallopian tubes and then ties or clamps them. The scar should be below the line of all but the briefest of bikinis. The commoner and simpler operation is a laparoscopy. Two small cuts are made in the abdomen, one in the belly button and one low down on one side. Each is 1cm. long. Through these small cuts, long stainless-steel tubes are placed. The surgeon looks through one, and operates with very long, fine instruments through the other.

The Fallopian tubes are closed with metal clips and electrically burnt in this procedure, which takes only 15 minutes under a general or local anaesthetic in a hospital or clinic. Laparoscopy can also be done through a cut in the top of the vagina, which avoids any scars, but is technically more difficult and sex must be avoided for several weeks. Only an overnight stay is required in hospital with these procedures. With laparoscopy there is only minor lower abdominal discomfort for a few days, and normal work can be resumed after a week. Recovery is a little slower with the open operation.If the circumstances are appropriate, and if arranged with theobstetrician beforehand, tubal ligation can be performed at the same time as a Caesarean section.

| Posted in » Pregnancy, Womens Health  

Sterilisation - Birth Control

Sterilisation

Tying the fallopian tubes in a woman or the vas deferens in a man to give permanent infertility. A couple may decide that their family is complete, and that under no circumstances do they want more children. This must be a decision of the couple, and not the individual woman, as the ability to have children is a joint property, not an individual one. Once the decision has been made, a further decision to choose between a male vasectomy or female tubal ligation (tube tie) is necessary. Because both these operations are designed to be permanent, even the most extenuating circumstances, including the death of a child or marriage break-up, must be taken into consideration. Some individuals do succeed in having micro-surgical repair of their vas deferens or fallopian tube, but the success rate is only about 65%, and it is not a factor that should be considered when contemplating sterilisation.

| Posted in » Pregnancy, Womens Health  

Periodic Abstinence - Birth Control

Periodic abstinence


Natural family planning is really a form of periodic abstinence from sex, or not having sex at those times of the month when a woman is fertile. The trick is knowing just what are the safe and not so safe times. Obviously, it is essential for both sexual partners in this situation to cooperate fully in the contraceptive process. The man must be as aware of the woman's cycle as she is herself. For this reason alone, this method of contraception does not suit all couples. There are many different ways of calculating the fertile time of the month. The most common is a simple mathematical calculation, as a woman usually ovulates 14 days before her next period starts. If the woman has a regular cycle, there is no problem, but if her cycle varies significantly, other clues to ovulation must be observed. Changes in body temperature can give a guide to ovulation, as the temperature first dips, then rises about half a degree centigrade at the time of ovulation. Changes in vaginal secretions also occur just before ovulation, and these can be noted on a glass slide. Breast tenderness and lower abdominal pain may be other relevant signs in some women.

The Billing's method of contraception is a combination of the above factors. Because sperm can live for a number of days in the woman after ejaculation, and because the woman is fertile for two or three days after ovulation every month, sex must be avoided for six to eight days during every cycle. The failure rate of this method can vary widely, and depends a great deal on the couple's commitment to follow the rules strictly, and the woman's own ability to note her own bodily changes. The percentage of women falling pregnant in one year while using natural family planning as varied from 5% to 25% in different clinical studies. Natural family planning can be used in combination with other forms of contraception, such as condoms, spermicidal foam or diaphragms, which are used at the time of the month when pregnancy may occur. No couple should undertake this form of contraception without consulting a doctor who understands, and is prepared to teach, natural family planning.

Contraception: Periodic Abstinence

| Posted in » Pregnancy, Womens Health  

Help with Constipation

Constipation

Other names :
Bound up.


Introduction :
Difficulty in passing firm faecal motions.


Types :
What are considered to be normal bowel habits varies dramatically from one person to another. Some consider it normal to pass a motion three times a day, others once a week. Provided there are no symptoms or complications, neither of these extremes requires treatment.


Cause :
There is no doubt that the most common causes of constipation are poor diet and poor toiletry habits. The excess intake of junk foods with little or no fibre and excess sugars, leaves nothing for the lower bowel to work on, and constipation results. The repeated postponement of nature's call can lead to excessive distension of the lower gut, and dry hard stools. Once the gut becomes distended, the urge is reduced, and the problem becomes self perpetuating. Other causes of constipation vary from dehydration, inactivity (invalids in bed for long periods), pregnancy and the side effects of many medications (eg: codeine), to diseases as diverse as an underactive thyroid gland, gut tumours, psychiatric conditions and diabetes.


Incidence:
Everyone suffers from this problem at some time, but some more so than others. The incidence gradually increases with age and is far more common in the elderly than the young. To get some idea of how common the problem is in the community, just check a chemist's shelves. There are scores of treatments available for the management of constipation.


Revention :
Once the constipation is relieved, preventing its recurrence is important. The best time to go to the toilet is after a large meal, because there is a reflex (the gastro-colic reflex) that stimulates the large bowel after the stomach is filled. Setting aside the time after the main meal of the day on a regular basis can often improve personal habits, and prevent considerable discomfort.


Investigations :
In severe cases, special x-rays of the lower gut, or a colonoscopy (passing a flexible tube through the anus into the gut) may be performed.


Course :
To be medically significant, constipation must cause discomfort in theabdomen, pain around the anus, bleeding, tears (both pronunciations of the word are appropriate), piles or some other problem.


Treatment :
The best way to deal with the problem is to change the diet. This involves avoiding white bread, pastries, biscuits, sweets and chocolates. Fibre containing foods such as cereals, vegetables, fruit and plenty of fluids should be taken. If dietary measures are not successful, fibre supplements may be used. These are available in tablet, liquid and granule form. Laxatives are the next step, but these should be used cautiously, particularly in children, as dependence can rapidly develop. Thesemedications vary in effectiveness and strength, but the weakest one to work is the best one to use. Paraffin, other oils, senna and cascara should be tried first. As a last resort, enemas may be used to clear out the lower gut, but once again, these should be used as infrequently as possible.


Complications:
Chronic constipation should not be ignored, but must be assessed by a doctor to ensure that there is no serious underlying cause. If a cause is found, that is treated; if no cause is found, the constipation itself is relieved.

Related Sites:

What I need to know about Constipation

| Posted in » Pregnancy, Women's Health  

Child Birth - Forceps and ventouse delivery

If a baby is slow in coming through the birth canal, or becomes stuck, it is necessary to ensure that the baby is delivered as quickly as possible, often within a few seconds. In these situations forceps or a vacuum device (ventouse) may be attached to the baby’s head. Forceps may also be used to protect a delicate skull in premature babies, or assist the birth of the head when the baby is breach (bottom first). Forceps cannot crush or damage a baby’s skull as they have a lock on them that prevents them from closing too far. They come in different sizes and shapes to suit both mother and child. The two arms of the forceps are slid separately around the baby’s head, and are then locked into position on the outside. Once in position, the baby’s head can be turned to a more favourable position, and easily slid out of the birth canal (vagina). A ventouse is a suction cap that fits onto the baby’s scalp and applies traction to the head as the mother pushes. The doctor cannot pull too hard because the vacuum seal will break if s/he does so. This form of intervention is far more uncomfortable for the mother than the baby, as the baby is being removed from a trapped position into the outside world. Additional pain relief or anaesthetics are usually given to the mother during the procedure.

| Posted in » Pregnancy  

Caesarean section

About one in five babies are now delivered in this manner. There are obvious situations where a Caesarean section is the only choice for the obstetrician. These include a baby that is presenting side on instead of head first, a placenta that is over the birth canal, a severely ill mother, a distressed infant that may not survive the rigours of the passage through the birth canal, and the woman who has been labouring for many hours with no success. Caesarean sections may also be performed if the mother has had a previous operative birth, if she is very small, if previous children have had birth injuries or required forceps delivery, for a baby presenting bottom first, if the baby is very premature or delicate, in multiple pregnancies where the two or more babies may become entangled and a host of other combinations and permutations of circumstances that cannot be imagined in advance. The decision to undertake the operation is often difficult, but it will always have to be up to the judgment and clinical acumen of the obstetrician, in consultation with the mother if possible, to make the final decision.

The operation is extremely safe to both mother and child. A light anaesthetic is given to the mother, and the baby is usually delivered within five minutes. The anaesthetic is then deepened while the longer and more complex task of repairing the womb and abdominal muscles is undertaken. In many cases, the scar of a Caesarean can be low and horizontal, below the bikini line, to avoid any disfigurement. The latest innovation is epidural anaesthesia, where a needle is placed in the middle of the mother’s back, and through this an anaesthetic is introduced. The woman is feels nothing below the waist, and althoughsedated, is quite awake and able to participate in the birth of her baby, seeing it only seconds after it is delivered by the surgeon. Most doctors and hospitals allow husbands to be present during these deliveries. Recovery from a Caesarean is slower than for normal child birth, butmost women leave hospital witin ten days. It does not affect breast feeding, the chances of future pregnancies or increase the risk ofmiscarriage.

| Posted in » Pregnancy  

Stages of Child Birth

Child Birth

| Posted in » Pregnancy  

Pregnancy Related Carpal Tunnel Syndrome

Introduction :
Numbness, tingling and pain in the hand caused by compression of nerves in the wrist.


Cause :
Most readers will have heard of RSI (repetition strain injury) which has been one of the "in" diseases in recent years. Carpal tunnel syndromeis one of several different conditions of the joints, bones, tendons and muscles that may cause RSI. Your wrist is made up of eight small bones, which are arranged into two lines of four bones each. These bones are all joined together by ligaments. These wrist bones are further arranged into an arch, with the open part of the arch on the palm side of the wrist. This arch is maintained by a band of ligament that runs across the open part of the arch, forming a half circle shaped tunnel, the carpal tunnel. Through this tunnel run the arteries, veins, nerves, muscles and tendons that supply and move the hand. It is thus a very crowded area. If you use your wrist a great deal (as in typing or playing the piano), the tendons running through this narrow tunnel may become strained and inflamed. They then swell, and this causes increasing pressure in the carpal tunnel, which cannot expand because it is made of solid bone and ligaments. The slow collapse of the bony arch with old age and rheumatoid arthritis, results in the same problem. Pregnancy is a very common cause of the syndrome, due to the retention of fluid, and slight swelling of all tissues that occurs. Some women find the syndrome flares just before a period with their premenstrual tension, for the same reason.


Incidence:
Typists, truck drivers, musicians, pregnant women and the elderly. Theseare the groups of people who are most likely to develop this distressing condition.


Prevention :
Strapping or splinting the wrist during repetitive use may prevent the problem from occurring.


Investigations :
Once the condition is suspected, x-rays of the wrist, and studies to measure the rate of nerve conduction in the area, are performed to confirm the diagnosis. In obvious cases, the tests may be unnecessary.


Course :
The most vulnerable structures in the carpal tunnel are the nerves, and pressure on these causes the burning pain, tingling, numbness and weakness of the hand that are characteristic of this syndrome. The symptoms are often worse after sleeping with the wrists flexed, while reading a newspaper, or gripping a steering wheel.


Treatment :
Treatment depends upon the severity and cause. In pregnancy, when the problem will probably settle after the birth, splinting of the wrist and rest are often all that is necessary. In other cases, if splinting does not work, nonsteroidal anti-inflammatory tablets (see Medication Table), fluid removing medication (diuretics - see Medication Table), and injections of steroids into the wrist may be tried. Many cases progress and require surgery to release the pressure on the nerves inside the carpal tunnel. This is a very simple operation, done under local or general anaesthetic, and the patient is left with a small scar across the wrist on the palm side. Only one day in hospital is necessary. Urgent surgery is sometimes required with severe cases during pregnancy. Obviously, the sooner the problem is treated, the less likely it is that long term problems will develop. Treatment should be sought at the first sign of discomfort in the hand or wrist, not when the pain becomes unbearable.


Complications:
Rarely, in untreated cases, permanent numbness or weakness may occur in the hand.


Outcome :
The vast majority of cases recover completely with appropriate treatment.

Carpal tunnel syndrome during pregnancy

| Posted in » Pregnancy  

Baby's first feeding

Baby's first feeding routine
A flexible routine is required. No two babies are the same and a baby will not necessarily conform to a mothers' schedule or indeed to the anticipated four hourly pattern.

• Baby should feed often and be comfortable at the breast.
• Feeding times vary in the first few weeks at between six to eight times in a twenty four hour period.
• Leaking milk can occur between feeds triggered by emotions or hearing baby's cry. Breast pads will protect clothes.
• Feeding is best done in a comfortable position to avoid backache and baby dragging on the breast. Sit upright with back support, or lean slightly forward with breasts falling slightly towards baby. Stack pillows, if necessary, to ensure baby is level with breast.
• Baby should "latch" onto a good mouthful of breast tissue. Sucking on the end of the nipple can be painful and will cause tender nipples.
• Feeding should be a pleasurable bonding experience for both mother and baby.

| Posted in » Pregnancy  

Breastfeeding Newborn

Why is breastfeeding considered the preferable method for feeding a newborn?

• Breast milk is a complex and living fluid and discoveries continue to be made about its unique properties.

• Provides all the nutrients in the ideal form
• Contains antibodies that protect babies from infections
• Is free from germs
• Protects against some diseases of later childhood and adult life
• Bonds mothers and babies and makes them both feel warm and secure
• Reduces the risk of allergies
• Is convenient and economical
• Lessens the chance of diarrhoea which is more common in artificially fed babies
• Alters daily and even during a feed to suit baby's changing needs

• thick and creamy yellow in colour
• rich in special properties protective properties

• The breasts become fuller due to the increased milk supply and swollen breast tissue
• Engorgement, an uncomfortable feeling of tenderness and fullness, can occur if the milk comes in quickly. This usually disappears as baby's feeding matches the mother's milk supply.

Breastfeeding Newborn: Introduction

| Posted in » Pregnancy