Tag-Archive for ◊ Pregnancy ◊

Author:
• Friday, July 23rd, 2010

Pregnant women need no longer give up their morning cup of coffee. A research review by The American College of Obstetricians and Gynecologists had found that moderate caffeine consmption probably won’t increase the risk of a miscarriage or premature
birth.

Until recently, studies have had conflicting findings about the effect of moderate caffeine consumption on pregnancy complications but a College committee has reviewed the evidence.

“I think it’s time to comfortably say that it’s OK to have a cup of coffee during pregnancy,” Dr. William Barth, the chair of the College committee, told Reuters Health. The College’s Committee on Obstetric Practice said that 200 milligrams of caffeine a day — about the amount in a 12-ounce cup of coffee — doesn’t significantly contribute to miscarriages or premature births.

That definition of “moderate caffeine consumption” would also include drinking about four 8-ounce cups of tea or more than five 12-ounce cans of soda a day, or eating six or seven dark chocolate bars. The committee said the evidence was not clear on whether consuming more than 200 mg of caffeine a day might increase pregnancy risks.

The group considered two recent studies, each of which followed more than 1,000 pregnant women. One study, led by Dr. David Savitz of The Mount Sinai Medical Center in New York, found no increased rate of miscarriage for women who consumed low, moderate, or high levels of caffeine at different points in their pregnancy.

In the other, Dr. De-Kun Li and his colleagues at Kaiser Permanente’s Division of Research in Oakland found a higher risk of miscarriage in women who consumed more than 200 mg of caffeine per day, but no extra risk at lower levels. The committee also pointed to two other studies that found that a mother’s moderate caffeine intake did not make it any more likely she would deliver a baby prematurely.

Research has shown that caffeine is able to cross the placenta, which led to worries that it could cause miscarriage or premature birth. In the United States, about 16 percent of all pregnancies end in miscarriage and about 12 percent of babies are born prematurely.

Barth said previous studies were mixed and unclear about the link between caffeine and pregnancy risks. It was the new findings from large groups of women that allowed the committee to feel confident that moderate caffeine intake was safe.

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Author:
• Thursday, January 07th, 2010

Risk Factors

Alcohol

  • Alcohol is teratogenic
  • An occasional drink during pregnancy carries no known risk
  • Fetal alcohol syndrome (FAS) may occur with chronic exposure to alcohol in the later stages of pregnancy. Features  may include :
    • Growth retardation
    • Central nervous disfunction :
      • Microcephaly
      • Mental retardation
      • Abnormal neurobehaviour (hyperactivity disorder)
  • Facial anomalies :
    • Small palpebral  fissures
    • Indistinct / Absent philtrum
    • Epichantic folds
    • Flattened nasal bridge
    • Short length of nose
    • Thin upper lip
    • Low set, unparallel ears
    • Retarded midfacial development

Tobacco

  • The leading preventable cause of low birth weight
  • Smoking is associated with decreased birth weight and increased prematurity
  • There is a positive association between sudden infant death syndrome and smoking
  • Use of nicotine patch is controversial

Marijuana

  • No evidence of significant teratogenesis in humans
  • Metabolites detected in urine of users for days to weeks
  • Commonly used by multiple substance abusers; thus. Its presence in urine may identify patients at high risk for being current users of substances as well

Cocaine

  • Pregnancy does not increase one’s suspectibility to cocaine’s toxin effects
  • Complication of pregnancy :
    • Spontaneous abortion and fetal death in utero
    • Preterm labor and delivery
    • Meconium stained amniotic fluid
    • Teratogenic effects of cocaine :
      • Growth retardation
      • Microcephaly
      • Neurobehavioral abnormalities ; impairment in orientation and motor function

Opiates

Heroin

  • Three to sevenfold increase in incidence of stillbirth, fetal growth retardation, prematurity, and neonatal mortalitiy
  • Signs of infant withdrawal occur 24 to 72 hours after birth
  • Treatment with methadone improves pregnancy outcome

Newborn infants born to narcotic addicts are at risk for severe, potentially fatal narcotic withdrawal syndrome, characterized by :

  • High pitched cry
  • Poor feeding
  • Hypertonicity or tremors
  • Irritability
  • Sneezing
  • Sweating
  • Vomiting
  • Seizures

Hallucinogens

  • No evidence that lysergic acid diethylamide or other hallucinogens cause chromosal damage or other deleterious effects on human pregnancy
  • There have been no studies on the potential long term effects on neonatal neurodevelopment

Amphetamines

Crystal methamphetamine, a potent iv stimulant has been associated with :

Decreased fetal head circumference

  • Placental abruption
  • Intrauterine growth retardation
  • Fetal death in utero
Author:
• Tuesday, January 05th, 2010

History

The majority of women have amenorrhea from the last menstrual period until after the birth of their baby.

Symptoms

Although not specific to pregnancy, these symptoms may alert the patient to the fact that she is pregnant :

  • Breast enlargement and tenderness from about 6 weeks gestational age.
  • Areolar enlargement and increased pigmentation after 6 weeks gestational age.
  • Colustrum secretion may begin after 16 weeks gestational age.
  • Nausea with or without vomiting, from about the date of the missed period.
  • Urinary frequency, nocturia, and bladder irritability due to increased bladder circulation and pressure from the enlarging uterus.

Signs

Some clinical signs can be noted, but may difficult to quantify :

  • Breast enlargement, tension, and venous distention
  • Bimanual examination reveals a soft, cystic, globular uterus with enlargement consistent with the duration of pregnancy.
  • Chadwick’s sign : Bluish discoloration of vagina and cervix, due to congestion of pelvic vasculature.

Pregnancy Testing

How ?

The beta subunit of human chorionic gonadotropin (hCG) is detected in maternal serum or urine.

  • hCG is a glycoprotein produced by the developing placenta shortly after implantation.
  • A monoclonal antibody to the hCG antigen is utilized.

When ?

  • Blood levels become detectably elevated 8 to 10 days after fertilization ( 3 to 3.5 weeks after the LMP ).
  • hCG rises in a geometric fashion during T1, producing diferent ranges for each weeks of gestation.

Fetal Heart Tones

The electronic Doppler device can detect fetal heart tones as early as 8 weeks gestational age

Ultrasonic scanning

When ?

  • To confirm an intrauterine pregnancy.
  • To confirm the presence of a fetal heartbeat in a patient with a history of miscarriage.
  • To diagnose multiple pregnancy.
  • To estimate gestational age.
  • To screen for fetal structural anomalies.