Monday, March 29, 2010

Breech Baby

Usually babies are head down by 32 weeks and hopefully 36 weeks. But if they remain breech or head up, then we have to decide what the best option for delivery is. If you have a normal uterine anatomy and your baby does not have any anomilies and your placenta is in a place that makes it safe to attempt to turn your baby, then we can schedule you for a time in labor and delivery and I will assist my OB backup physician in attempting to manually turn your baby. This is call an external version. We/he places our hands on your abdomen and try to somersault your baby into the right position. There is about a 3% risk of doing harm which would necessitate an emergency c/section. If all goes well, we monitor your baby for about 30-60 mins after and then send you home. We usually do these around 36-37 weeks when your baby is small enough to hopefully have success at turning, but old enough that survival outside the womb would be fine if you have to be delivered immediately. Your other options are to wait and see if the baby turns on its own, or you can try leaning down in the decline position on your elbows and knees a couple times a day for 5-10 mins and see if that helps your baby spontaneously move. If your baby doesn't turn and remains breech at the time of labor, you will likely need a c/section. If you think you are a good candidate to deliver a breech baby and you wish to try this, we send you to Dr. Silver at the University of Utah. I think he is one of the only OB's in Utah that will still attempt breech deliveries, as these are fairly dangerous. Otherwise we schedule you for a c/section. I have also had some patients go to acupuncturists and do acupuncture and they have had success. These acupuncturists claim to have an 80% success rate-which is pretty dang good if you think about it! Of course you check with your provider to make sure this is appropriate. If your uterus has a septal defect, or your baby has some other defect, or your amniotic fluid is low, it is best to leave things alone and have the c/section. You risk more damage to yourself or the baby to try to intervene, and let's face it, we want you to have a live healthy baby even if this means a longer recovery for you!

Vaginal Infections

I thought I'd post about something different than pregnancy stuff, although vaginal infections can occur during pregnancy. There are different types of vaginal infections with different symptoms and complications. I would say this is one of the primary things we see in the clinic on a typical day. To start with, let's talk about yeast infections. Most women will experience a yeast infection at least once in their lifetime, and likely more than that. Yeast is a natural pathogen that we all have a small amount of in our vaginas. However, it can multiply and grow when other good bacteria are killed off such as when you take antibiotics. It also thrives on sugar, so people with diabetes or who ingest too much sugar may be more prone to yeast infections. It is also present in people who are HIV positive-that is another story though. Symptoms of yeast are typically intense itching and burning. Sometimes women will notice a white, curdly discharge as well. Yeast is usually easily treated with medications some vaginal, some oral-dependent on your preference. You can also naturally treat this with eating yogurt that contains live acidophilus cultures or acidophilus tablets that can used vaginally or taken orally. And then avoid excessive sugar consumption!
The next vaginal infection we see, and probably the most common is bacterial vaginosis. This is usually caused by the bacteria "gardnerella." The most common symptom is foul odor-typically a fishy odor. There is usually runny clear to gray discharge. The odor is also ususally worse after intercourse. This one is somewhat worrisome during pregnancy as it can potentially cause the water to break early and increase infection risk from that to you and the baby. This in turn will lead to preterm delivery. This may not happen to all, but it does to some and therefore, I believe it is worth treating during pregnancy especially. This is easily treated with oral pills or vaginal gels. There are also some natural remedies available to such as garlic, but I'd prefer you come talk to me about those so I can tell you how to do it correctly:) I actually think some of the more natural treatments are better especially for recurrent bacterial vaginosis.
The other vaginal infections are usually sexually transmitted. Chlamydia is the most common and unfortunately, many women do not have symptoms. Therefore, unless you come in and ask to be screened, this can be missed for some time. Gonorrhea is another one, and you may have green discharge, or some burning, or you may have no symptoms at all. It is less common than chlamydia, but we do see it and it is very important for both of these infections to be treated. Which, luckily, those two are 100% curable. However, if it isn't detected for months or years, it can lead to infertility and chronic pelvic pain. So moral of this story is, don't be embarrassed, come in and be screened for everything and avoid problems down the road. We have seen it all before, and won't be surprised!
I forgot to mention warts and herpes...also sexually transmitted infections. Herpes causes blister like lesions on the outer and sometimes inner vagina. They are very painful. It is almost always pain that brings people with these lesions in to be checked. Unfortunately, there is no cure for herpes. You will have outbreaks throughout your life. We can somewhat control and suppress these outbreaks, but you will always have the virus and can spread the disease even when you don't have lesions. We can also treat some of the pain, but the disease remains.
Genital warts are also another nuisance. These are more common than herpes, but like herpes they are not really curable. We can apply an acid to them in the office or give you a prescription for a cream to help lessen or rid of you the present lesion (s), but the virus remains. You may still have outbreaks. The good thing is, these are not painful and do not usually cause a problem with vaginal delivery down the road (which herpes can). There is a vaccine however, that can prevent most strains of genital warts if you get the vaccine months prior to the exposure. The vaccine as some of you know is gardisil, and it also protects against some types of HPV that can cause cancer. Check with your provider if you think this may be something you are interested in.
Well, I think this mostly sums up vaginal infections.

Sunday, March 14, 2010

Diet, Exercise, Weight Gain

So, I get asked all the time "How much weight should I gain with pregnancy?" The answer is slightly different depending on your starting weight, so here goes. If you are a normal weight and BMI (body mass index) when you become pregnant, you should gain about 25-35 lbs. If you are overweight or obese meaning a BMI greater than 26, you should gain no more than 20 lbs. If you are underweight BMI less than about 21 you should gain about 28-40 lbs. Weight gain is something I believe is so important in growing a healthy baby. If you are not gaining enough weight, you risk a small for gestational age baby or a growth restricted baby. You also increase your risk of preterm birth (which although you may not care to be pregnant anymore, this is extremely dangerous for the baby). On the flip side of this, if you gain too much weight during pregnancy you risk a baby that is large for gestational age and the baby may have difficulty regulating blood sugars. Further a large baby (usually 9 + lbs is considered large) is at greater risk of birth trauma from shoulder dystocia (meaning we get the head delivered and the shoulders get stuck). This can result in Erb's palsy which causes the affected arm to be permanently numb (some are can be temporary) and can also result in death if we are unable to get the baby delivered rapidly. It also increases your risk of more severe vaginal and/or rectal lacerations :(
Okay, so now you know the risks, what can you do to prevent them? Try to eat healthy diet full of fresh vegetables, fruits, proteins, and complex carbohydrates. Try to avoid excess sugar, soda pop, and juices. Typically if you can include a small amount of protein with each meal, you will keep your blood sugars more stable and will not have rapid drops in sugar levels which make you crave more of the unhealthy sugars that contribute to some of the above problems. Protein is found in meats, fish, beans, nuts, peanut butter, tofu, yogurt, and cheese. I find if I tell patients that are feeling episodes of dizziness to include a small amount of protein with each meal, they tend to do better.
The other thing is exercise. Although I'm not a believer that you should be out running marathons or anything too strenuous, a little bit of exercise will help you maintain a normal weight gain with pregnancy and can help you be in shape for delivery. I would recommend walking, swimming, light aerobics, light weight lifting (no greater than about 10 lbs), yoga or pilates. Exercise also increases your brains natural endorphins such as serotonin and norepinephrine making you less depressed and moody.
Well, all of that being said, genetics do play a role in the size of your baby and some other conditions that you may not have total control of. So don't beat yourself up if you have a baby less than 6 lbs or over 9 lbs, you may not have been able to help it. I'm only suggesting ways to try and have the healthiest pregnancy and birth experience for you and your baby....
Good luck!

Preterm Labor

Hi everybody. Sorry I haven't posted for awhile. I just get busy with work, kids, etc. I've thought of some other topics though that might be worth writing about, so I'll hopefully get posting more regular again. I decided to start with I would do this one on preterm labor.
Many women will experience some signs of preterm labor during pregnancy, and I thought it would help to write some signs to help you decide between what is "false" labor from what is real. If you are having occasional contractions such as a few per day, this is usually nothing to worry about. However, if you feel that you are starting to have a pattern to the contractions such as 3 or more contractions per hour for more than hour you should be checked. Other signs of preterm labor include cramping (feeling like menstrual like cramps), pressure in the vagina or rectum, increase in vaginal discharge, leaking amniotic fluid, or backache, then you should be evaluated by your practitioner.
Typically, when patients present with signs of preterm labor, we run a test call a fetal fibronectin which we obtain from a vaginal swab. If this test is negative, there is a 99% chance you will not deliver for at least 2 weeks. Thus, this test is very indicative. However, if it is positive, you won't necessarily deliver early, but we will be more aggressive in our treatment to prevent preterm birth. Treatment is usually aimed at stopping contractions and thus slowing cervical dilation, and at buying more time for fetal maturity. We stop contractions with medications, and bed rest, as well as hydration. We also give you injections (steroids) to aid in fetal lung maturity in the event that your baby is born early. If you have had a history of preterm labor or preterm birth (preterm being less than 37 weeks gestation) we also may start you on progestone shots at about 17 weeks until 36 weeks. Although this doesn't always prevent preterm birth, there is some good evidence that it may delay it and allow more time for fetal maturity.
So, bottom line, make sure you tell me or your practitioner if you are noticing signs of preterm birth or if you have a history of preterm birth....hopefully we can have a better outcome than before!