Pregnancy Tips: Will Exercise Make Giving Birth Easier?

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from “Great Expectations by Today’s Parents magazine

I am 30 weeks pregnant and have not been exercising very much. I would like to start now as the antenatal class instructor says exercising will make the birth easier. What is the most appropriate exercise for me to start with in order to prepare me for labour?

Resuming your normal activities is recommended. The most appropriate exercises will be slow walking and swimming.

Source: Pregnancy Tips: Will Exercise Make Giving Birth Easier?

Pregnancy Tips: Water Breaking vs. Normal Leakage

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from “Great Expectations by Today’s Parents magazine

How do you distinguish between water breaking and normal leakage?
Water breaking should not happen before pregnant women go into labour. It does not happen before labour (anytime before 37 weeks). You should consult a gynaecologist as soon as pre-term pre-labour rupture of membrane (pprom) happens. There is no normal leakage, only vaginal discharge.

Source: Pregnancy Tips: Water Breaking vs. Normal Leakage

Pregnancy Tips: Should I Worry About Yellowish Discharge From Breast?

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from “Great Expectations by Today’s Parents magazine

I am now 32 weeks pregnant. A few days ago, after my shower, there was some yellowish discharge from my breast. Is this discharge from the nipples colostrum? How can I stop it from flowing out? Will I have enough colostrum to give my new baby when I deliver, if it continues?

During the last trimester, there will be a small amount of milky discharge from the nipples called colostrum. Do not squeeze or stimulate the nipples as it will usually stop on its own. Yes, you will have enough colostrum to give your baby when you deliver.

Source: Pregnancy Tips: Should I Worry About Yellowish Discharge From Breast?

Pregnancy Tips: What Is Dilatated Renal Pelvis?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from “Great Expectations” by Today’s Parents magazine

I’VE JUST HAD MY 20-WEEK ANOMALY SCAN AND HAVE BEEN TOLD MY BABY HAS A DILATATED RENAL PELVIS. ALTHOUGH I’VE BEEN REASSURED THIS CONDITION WILL PROBABLY CORRECT ITSELF, I’M WORRIED.

Mild renal pelvic dilatation (swelling of the collecting system in the foetal kidney) occurs in 1 to 3 percent of pregnancies. It is more common in male foetuses. It is usually defined as an antero-posterior diameter of > 5 mm before 24 weeks and > 7 mm after 25 weeks.

Usually the condition will resolve on its own, but worsening renal pelvis dilatation may be due to some underlying problem in the urinary tract like obstruction, or certain abnormalities in formation of the kidney, for example, a duplex kidney or a multicystic kidney. If there is no family history of kidney disease, and there are no other abnormal findings on ultrasound, the outcome in the baby depends on whether the dilatation worsens as the pregnancy progresses.

If there are no other abnormal findings in addition to the dilatated renal pelvis, there is no need to check for chromosomal abnormalities in the foetus.

If the dilatation remains static or is less than 10mm, then an ultrasound scan of the urinary system will be done three to four days after birth. If this is normal, a follow up scan should be repeated one, six or 12 months later.

Unfortunately, the clinical significance of persistent neonatal renal pelvic dilatation is unknown as long-term follow up studies are not available. Even if the dilatation persists, the likelihood of serious urinary tract problems is very low.

If the dilatation is > 10 mm in a follow up ultrasound scan after 28 weeks gestation, your baby will be continued to be monitored closely after birth and other specialized tests of urinary tract function may be necessary.

Source: Pregnancy Tips: What Is Dilatated Renal Pelvis?

Pregnancy Tips: Can I Choose Natural Birth Even After C-Section?

GREAT EXPECTATIONS
By Dr Low Kah Tzay, Paediatrician | Mt. Elizabeth Hospital
reprinted with permission from “Great Expectations by Today’s Parents magazine

I had a C-section during my first pregnancy due to bleeding at 32 weeks.
After a three-year gap, will there be any risk involved if I choose a natural birth for my second pregnancy?

The few studies available suggest that an interpregnancy interval shorter than 18 months and longer than 59 months are significantly associated with increased risk of adverse perinatal outcomes.

There is emerging evidence that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous Caesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa).

Hence, a three-year gap is an advantage.

The main risk in attempting a vaginal delivery after a Lower Segment Caesarean Section (also called VBAC, or Vaginal Birth After Caesarean Section) is an increased risk of uterine rupture (tearing open of the uterine wall) during the delivery.

The risk of rupture is 0.2 to 1.5 percent.

The rate of foetal death is low with both VBAC and C-section.

However, because the risk of foetal death increases with uterine rupture, foetal death occurs more frequently with VBAC than with repeat Caesarean delivery. Maternal death is rare with either type of delivery. VBAC is an acceptable option for women in the following situations:

* Does not have other conditions (as an example, placenta previa) that requires Caesarean delivery

* Has only one low transverse uterine incision from a past Caesarean delivery

* Has no other uterine scars (eg from a previous surgery for fi broid removal) and has never experienced a uterine rupture

* Does not have pelvic problems or abnormalities that prevent vaginal delivery

* The baby is in the proper position (head down)

In addition, VBAC should only be considered if facilities are available or an immediate Caesarean Section should it be necessary.

Dr. Low Kah Tzay is a paediatrician working at Mt Elizabeth Hospital. He specializes in the management of growth and development of children; such as feeding difficulties, language delay, sleep disorders, attention disorders, autistic spectral disorders and learning difficulties. His website: www.pediatricdoctor.net.

Source: Pregnancy Tips: Can I Choose Natural Birth Even After C-Section?

Pregnancy Tips: What Are Fibroids And How Do They Affect Conception?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from “Great Expectations” by Today’s Parents magazine
I HAVE BEEN TRYING UNSUCCESSFULLY TO CONCEIVE FOR THE LAST SEVEN MONTHS. MY GYNAE DISCOVERED I HAVE FIBROIDS. WHAT SHOULD I DO AND HOW DOES THIS AFFECT MY CHANCES OF HAVING A CHILD?

Uterine Fibroids (myoma or leiomyoma) are very common – they are benign (noncancerous) growths of the uterine muscle. The size and location of the fibroids are important. The large majority of them are very small or located in an area of the uterus such that they will not have any impact on reproductive function.

There are three general locations for fibroids:

(1) Subserosal – on the outside surface of the uterus
(2) Intramural – within the muscular wall of the uterus, and
(3) Submucous – bulging into the uterine cavity.

The only type that will have any impact on reproductive function (unless it is very large) is the submucous type that is within the uterine cavity. These are much less common than the other two types of fibroids.

Because of their location inside the uterine cavity, submucous fibroids can cause infertility or miscarriages and may be removed hysteroscopically (a slim instrument inserted through the cervix into the uterus).

Other causes for infertility should be considered before treatment is initiated for subserosal or intramural fibroids which do not distort the uterine cavity.

Studies of infertile women with submucous fibroids distorting the endometrial cavity found significantly lower pregnancy and delivery rates, compared with infertile women without fibroids.

It is important to note that removal of submucous fibroids led to a significant increase in the pregnancy rate compared with the case in infertile women without fibroids.

Source: Pregnancy Tips: What Are Fibroids And How Do They Affect Conception?

Pregnancy Tips: Are Migraine Medications Harmful For Me?

GREAT EXPECTATIONS

By Dr Lai Fon Min

Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from “Great Expectations” by Today’s Parents magazine
I AM EXPECTING MY FIRST CHILD AT THE AGE OF 32. I AM PRONE TO MIGRAINES BUT AM AFRAID TO USE ANY MEDICATION AS IT MAY HARM MY BABY. PLEASE ADVISE.
Migraine does not increase the risk for complications of pregnancy for the mother or the foetus.

Several studies have shown a tendency for migraine to improve with pregnancy. Between 60 and 70 percent of women either go into remission or improve significantly, mainly during the second and third trimesters.

Management of migraine during pregnancy should first focus on avoiding potential triggers; for example, stress, change in sleep pattern, bright lights or excessive computer use, irregular meals, smoking, alcohol and certain foods containing red wine or MSG.

Consideration should also be given to non-drug therapies.

If medication becomes necessary, paracetamol (Panadol) can be used safely. NSAIDs (aspirin, ibuprofen, naproxen) can be used as a second choice, but not for long periods of time, and they should be avoided during the last trimester.

A common antimigraine drug is ergot in combination with caffeine – Cafergot. Ergot is contraindicated in pregnancy.

For treatment of severe attacks of migraine, chlorpromazine, dimenhydrinate, and diphenhydramine and metoclopromide can be used to help with the nausea and vomiting in severe attacks; metoclopramide should be restricted to the third trimester.

In some refractory cases, steroids like dexamethasone or prednisone can be considered. Should prophylactic treatment become indicated, the beta-adrenergic receptor antagonists (e.g. propranolol) should be avoided.

Source: Pregnancy Tips: Are Migraine Medications Harmful For Me?

PREGNANCY TIPS: I Caught The Flu, Is It Bad For My Baby?

GREAT EXPECTATIONS

By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from “Great Expectations” by Today’s Parents magazine

I HAD A BAD FLU AND COUGH RECENTLY WITH A FEVER OF 38° C. I AM AFRAID IT MAY AFFECT MY BABY AS I AM THREE MONTHS PREGNANT. PLEASE ADVISE.

Influenza (commonly called “the flu”) is a common and contagious respiratory illness caused by influenza viruses. The flu can result in severe illness and life-threatening complications.

Influenza usually occurs in epidemics. What you are referring to as “flu” is more likely a “cold”.

Viral infections such as colds and flu are just as common when you’re pregnant as when you’re not, so many women end up worrying about whether a minor illness could harm their unborn child.

In general, there’s probably very little to worry about if it is short-lived and your baby is unlikely to suffer any ill-effects as a result. Because your immune system is affected during pregnancy, you may feel worse than usual.

Any severe or prolonged illness which causes you to be feverish and generally unwell may increase the risk of miscarriage. However, the “baseline” miscarriage rate in the first trimester may be as high as 20 percent, usually due to chromosomal abnormalities.

If your flu does not get better and you begin to cough up green/yellow sputum, experience shortness of breath, persistent chest pain, severe sore throat or a fever of 38 degrees, you should see a doctor. If you are less than 12 weeks pregnant, you should not take medication unless recommended by your doctor.

Source: PREGNANCY TIPS: I Caught The Flu, Is It Bad For My Baby?

Is Myopia In Kids Preventable? (Part 2/2)

Can You Prevent Myopia In Kids?
Parents guilty of passing on the myopia genes should not fret since they can still play a role in controlling their children’s myopia

By Jessie Kok | Reprinted with permission from Today’s Parents

Click here to read Part 1 of this story

Dr Gerard Chuah, senior eye surgeon at Total Eyecare Centre (Camden Medical Centre), and Dr Chew Wai Kwong, chief optometrist at Capitol Optical, answer frequently asked questions about myopia:

What exactly changes in the eyeball that causes myopia?
“Unlike normal children or adults, highly myopic people have elongated eyeballs which means the tissue at the back of their eyes is stretched,” says Chew. “Tissues like the retina, when highly stretched, become weaker and more vulnerable to retinal tear, resulting in higher risk of developing glaucoma and macular degeneration.”

Is it true that leaving the light on at night for babies may predispose them to myopia?
It is common for parents to leave a light on for babies while they sleep. While recent studies in America show that leaving a light on might lead to the development of myopia, more studies would need to be done to show conclusive evidence.

Are all cases of myopia irreverisble?
General cases of myopia are irreversible. However, another type of myopia – pseudomyopia – which occurs when there is excessive spasm of the focusing muscles in the eyes and more commonly seen in young children is reversible.

How is pseudomyopia treated?
When young children first visit an optometrist cycloplegic refraction is routinely done to eliminate pseudomyopia. Optometrists also rely on objective methods of retinoscopy and fogging to check on these cases.

How can eye drops assist in cases of myopia?
Currently, Atropine 1 percent eyedrops are used in some hospitals and clinics as a tool to address myopia progression. The Singapore National Eye Centre (SNEC) has ongoing studies to assess the role of the drops. There are promising preliminary results that show Atropine may help to retard the progression of myopia but more overseas and local studies are required for conclusive results.

Can certain types of food or supplements boost vision?
According to Dr Chuah, there is no conclusive evidence in studies that show consuming more vitamins and minerals can help to improve or control myopia, unless the child is severely malnourished. It is more important to get a child to relax her eye muscles by looking at faraway objects. “It’s got nothing to do with the colour of the object but more about letting the eye muscles rest after doing near-work,” he says.

Dr Chuah also highlights the efforts by the Ministry of Health in their myopia control programme that teaches students good eyecare habits such as taking breaks after 45 minutes of near-work and simple eye exercises.

A beneficiary of this programme is Kevan, who has successfully helped to control his children’s myopia. Now grown up and aged 11 and 13 respectively, Sarah and Sean have managed to control their myopia over the years through sporadic rests in between studying, and doing simple eye exercises as instructed by their father.

While Kevan does not expect complete recovery in his children, the improvement and control of his children’s myopia that gives him a sense of satisfaction.

“I know we cannot control hereditary symptoms,” he says. “But every parent can play a part when it comes to environmental factors to ensure the best management of childhood myopia.”

Source: Is Myopia In Kids Preventable? (Part 2/2)

Is Myopia In Kids Preventable? (Part 1/2)

Can You Prevent Myopia In Kids? Parents guilty of passing on the myopia genes should not fret since they can play a role in controlling their children’s myopia

By Jessie Kok | Reprinted with permission from Today’s Parents

SARAH and Sean Ng were diagnosed with severe myopia by their optometrist at the age of four. The cute sight of the siblings in round, tortoise-shaped spectacles gradually turned into a source of concern for their parents, who noted the dangers their visually challenged children were facing.

“We took our children’s good vision for granted until Sarah’s optometrist told us about her severe myopia,” says Kevan Ng, the sibling’s father, who is himself short-sighted. “After a while, it became even more essential to childproof our home. Even telephone wires became hazardous with two little active blind moles around the house.”

Kevan’s case is not uncommon in Singapore. According to Capitol Optical, surveys done every three to five years show that the rate of children with myopia in Singapore is increasing. Myopia affects 25 percent of seven-year-olds, 50 percent of 12-year-olds and 80 percent of 18-year-olds on the island.

“Genetics cannot be controlled,” says Dr Gerard Chuah, Senior Eye Surgeon of Total Eyecare Centre at Camden Medical Centre, who notes the myopic risks in children are in proportion to genetics. “If one parent has myopia, the child would have a higher risk of myopia. If both parents are myopic, the risk becomes even higher for the child.”

Apart from genetic factors as in the Ng family’s case, Chew Wai Kwong, Professional Affairs Manager and Chief Optometrist at Capitol Optical, also believes that environmental factors play a part.

“Our gene pool and ethnic make up have not changed much in the past 40 years, and it is widely accepted now that the amount of time spent on near work and the computer, which now starts at a very young age, does have a direct influence on the development of myopia,” he says.

Parents guilty of passing on the myopia genes should not fret since they can play a role in controlling their children’s myopia.

But ignore the “looking at green objects” advice, since according to Dr Chuah, it serves no scientific purpose in controlling myopia. We look at the five most commonly asked questions posed to eyecare experts below.

Click here to read Part 2: Doctors answer FAQs on myopia

Source: Is Myopia In Kids Preventable? (Part 1/2)