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: Sex Before And After Pregnancy

GREAT EXPECTATIONS
By Dr Ann Tan, Consultant Obstetrician & Gynaecologist |
Women and Fetal Centre, a member of Pacific Healthcare Holdings

reprinted with permission from “Great Expectations by Today’s Parents magazine

Until what stage of pregnancy can I still have sex?
Actually both sex and pregnancy are natural events and you can enjoy them concurrently so long as you do not experience any undue pain or bleeding. If you have any particular pregnancy problems of preterm labour/ incompetent cervix or multiple pregnancy, you should consult your obstetrician on the advisability of intercourse. The use of condoms may help to reduce the uterine reactivity by preventing semen from contact with the cervix.

How soon can I have sex after my baby is born?
There is no hard and fast rule and usually the woman is ready in four to six weeks post normal vaginal delivery and Caesarean section too! The vaginal wound is usually a little firm initially but should stretch out once activity is resumed while in the case of a Caesarean delivery, there should be no difference at all. For the latter, deep penetration may cause stretching of the Caesarean scar and that may initially be uncomfortable.

I am six months pregnant and find myself surprisingly more turned on than usual. Why is that?
The hormones of pregnancy are making you more curvy than before and it’s very natural that you might feel more sexy than ever before! Enjoy!

Source: Pregnancy Tips: Sex Before And After Pregnancy

Pregnancy Tips: Too Much Water in Water Bag

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

I’m due to have my second baby soon. My doctor says there is a lot of water in the water bag.

What does this mean?

It can be difficult to find out the cause of polyhydramnios (excessive fluid) and, sometimes, no cause can be found. Sometimes the extra fluid is due to a problem with the baby, or with the placenta or with you, the mother.

Possible causes include:

> Maternal diabetes, where your blood sugar levels are not well controlled. Your baby’s urine output increases and this in turn increases the volume of amniotic fluid

> Being pregnant with twins. There may be a particular problem if the babies are identical (monozygotic).

> Infections that affect your baby, such as rubella, cytomegalovirus, toxoplasmosis and syphilis, may be associated with polyhydramnios.

> A congenital problem with the baby occurs in about 20 per cent of polyhydramnios cases. There may be a blockage in the esophagus (swallowing tube), meaning he cannot swallow the amniotic fluid and control the amount of it around him. It may also be a sign that the baby has a problem with his central nervous system, or with his heart or kidneys.

> Sometimes, polyhydramnios is associated with babies who have chromosomal abnormalities, such as Down’s or Edward syndrome

> In rare cases, the placenta may have developed a tumour or there may be a problem with the arteries in the umbilical cord resulting in polyhydramnios.

Most women with polyhydramnios go on to have healthy babies, particularly if the condition is mild. If you are not known to have diabetes, you will be given an oral glucose tolerance test (OGTT). If this is high, you may be referred to a diabetes specialist who can get your blood sugar levels down. This will reduce the amount of fluid.

Ultrasound scanning can help spot any problems with your baby. If a detailed scan shows nothing untoward, your baby is usually fine and the polyhydramnios is caused by something else.

There are other laboratory tests for investigating polyhydramnios if infection is suspected. You would be followed up at more frequent intervals as you are at higher risk of going into premature labour, cord prolapse when your water bag ruptures or the placenta starting to come away from the wall of the uterus (abruption placenta).

In mild cases of polyhydramnios, your doctor will advise you to rest or even start your maternity leave early. Even then, because your uterus is so swollen, you may go into labour prematurely.
Go to the hospital immediately if your waters break or you start having contractions.

Dr. Low Kah Tzay is a pediatrician 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 is at www.pediatricdoctor.net.

Sources: Pregnancy Tips: Too Much Water in Water Bag

Pregnancy Tips: What is Low and Anterior Placenta?

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

When I went for my scan, my gynae told me I have a low and anterior placenta. What is that and what implications does this have? Will it affect my baby adversely at all? Will I have any problems during labour and delivery?

Placenta is otherwise called after birth. After the delivery of the baby, the placenta will separate from the womb and will be delivered. It is important to know the exact location of the placenta in pregnancy. Usually it is located in the upper part of the womb and will not block the passage. The placenta can cover the neck of the womb in early pregnancy and as pregnancy advances, it will move away and not cause bleeding in pregnancy, so the mother can expect a normal delivery. For some it may continue to cover the neck of the womb in late pregnancy and can cause bleeding in pregnancy without any pain.

In medical terms it is called placenta praevia. In such cases, a Caesarean section will be the mode of delivery. The timing of delivery will be decided by the obstetrician based on the amount of bleeding, maturity of the baby, condition of the mother and baby. Bleeding in pregnancy will be considered a high risk case and some may need to stay in hospital for a few days before delivery. A lowlying placenta means the placenta is in the lower part of the womb. It is important to know whether it is blocking or not blocking the passage to warn about bleeding and the necessity for a Caesarean section. Bleeding will have effects on the mother and if it is heavy, it can affect the baby as well.

Source: Pregnancy Tips: What is Low and Anterior Placenta?

Pregnancy Tips: Sex Before And After Pregnancy

GREAT EXPECTATIONS
By Dr Ann Tan, Consultant Obstetrician & Gynaecologist | Women and Fetal Centre, a member of Pacific Healthcare Holdings

Reprinted with permission from “Great Expectations by Today’s Parents magazine

Until what stage of pregnancy can I still have sex?
Actually both sex and pregnancy are natural events and you can enjoy them concurrently so long as you do not experience any undue pain or bleeding. If you have any particular pregnancy problems of preterm labour/ incompetent cervix or multiple pregnancy, you should consult your obstetrician on the advisability of intercourse. The use of condoms may help to reduce the uterine reactivity by preventing semen from contact with the cervix.

How soon can I have sex after my baby is born?
There is no hard and fast rule and usually the woman is ready in four to six weeks post normal vaginal delivery and Caesarean section too! The vaginal wound is usually a little firm initially but should stretch out once activity is resumed while in the case of a Caesarean delivery, there should be no difference at all. For the latter, deep penetration may cause stretching of the Caesarean scar and that may initially be uncomfortable.

I am six months pregnant and find myself surprisingly more turned on than usual. Why is that?
The hormones of pregnancy are making you more curvy than before and it’s very natural that you might feel more sexy than ever before! Enjoy!

Source: Pregnancy Tips: Sex Before and After Pregnancy