Vaginal Birth after Caesarean Section

Posted on April 8, 2009 by Doctor

Having a baby when you have had a Caesarean before

You have had a previous Caesarean section. This leaflet aims to give you information on your birth options in this pregnancy.

What are the chances of having a vaginal birth?

Many women who have had a Caesarean section can safely have a vaginal birth in a subsequent labour. This is known as Vaginal Birth after Caesarean section (VBAC). As long as there are no reasons not to, you will be offered and encouraged to try for a vaginal delivery. The evidence suggests that this is advantageous for you and has no significant adverse effect on your baby. Studies have shown that of those women who chose vaginal birth after Caesarean section, between 60 – 83% would be successful.

What are the risks of attempting a vaginal birth?

A mother who has had a previous Caesarean has a small risk of the womb (uterus) rupturing. This happens because the scar on the uterus tears open during the strain of labour; the risk of this happening is around 1 in 300 (0.35%). If your labour is induced the risk of scar rupture is higher at up to 2 – 3% (depending on the method used). However, you are more likely to need a Caesarean section for reasons other than scar rupture, e.g. the baby becoming distressed during labour or not making good progress.It is because of this small risk of scar rupture that you are advised to have your baby in hospital, with monitoring of your baby’s heart and facilities to perform an immediate repeat Caesarean if needed. If scar rupture occurs in the hospital setting the chances for you and your baby are excellent.The progress of your labour will be closely watched and if you are not making good progress a repeat Caesarean will be advised. You will be able to have an epidural during labour, if you wish.If you give birth vaginally you will have an even better chance of future vaginal births, avoiding the risks of a repeat Caesarean.

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Genital Herpes during Pregnancy

Posted on April 7, 2009 by Doctor

Having a herpes infection during pregnancy can cause any pregnant woman anxiety. Will your baby be born with the infection? What kind of complications occurs to an infant with herpes? And is there anything you can do to prevent your baby from being infected?

What is Herpes?
Herpes is a viral infection that is spread through direct contact with herpes sores. There are two types of herpes virus: Herpes Simplex Virus 1 (HSV-1) and Herpes Simplex Virus 2 (HSV-2). HSV-1 has traditionally been associated with causing oral herpes. This type of herpes is marked by cold sores around the mouth area. HSV-2 is the main cause of genital herpes and is spread through vaginal and anal sex. However, HSV-1 can also be transmitted through oral sex, causing a genital herpes infection. There is no cure for herpes.

Genital Herpes Symptoms
The most common herpes symptoms are herpes bumps or lesions. These blister-like sores can appear around the anus, on the penis, on the thighs or buttocks, or in and around the vaginal area. These sores may be accompanied by pain, muscle aches, headaches and fever. Because many women develop vaginal herpes, that is, herpes sores in the vagina, female herpes symptoms can also include vaginal discharge. Unfortunately, this can lead to a misdiagnosis of a yeast infection or pelvic inflammatory disease instead of recognizing the symptoms of herpes for what they really are. Sometimes, boils are confused with a herpes infection. If you have boils, they will be much larger than herpes blisters. Seek appropriate boil treatment.

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Choosing Gynecologist

Posted on April 5, 2009 by Doctor

Many women feel awkward and even a bit frightened when they see their gynecologist for a routine check up. This level of anxiety can be compounded when there’s a serious medical problem requiring continuing visits. For this reason, women are often selective in who they choose as their gynecologist.

One of the decisions a woman must make in selecting a gynecologist is whether to choose a male or female doctor. When making this decision, it’s important to understand the advantages of choosing a male or female gynecologist. There is no doubt that there are highly competent and caring gynecologists of both sexes, so it will be important to consider the individual and their background over sex. What are the advantages of choosing a female gynecologist over a male gynecologist?

Women doctors tend to spend more time with their patients.

You may have a variety of questions and concerns when you visit your gynecologist. You need a gynecologist who’s willing to take the time to answer your questions. Several studies have shown that, women doctors tend to spend more time with patients when compared to their male counterparts. Again, you’ll want to consider the individual physician since this doesn’t hold true in every case.

Women doctors may have more natural empathy for gynecological problems.

Women physicians have the same reproductive organs that you do and often experience the same problems as their patients. This may give her unique insight and empathy into what you’re experiencing. It can be reassuring to know someone understands what you’re going through.

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Contraceptives and Breastfeeding

Posted on April 3, 2009 by Doctor

If you’ve had a baby recently, congratulations! This can be an exciting time for both you and your baby as you get to know one another. You may also be ready to get back to leading a normal family life and want to take measures to prevent pregnancy. If you’re breastfeeding, what type of contraceptive should you use while nursing? Is it safe to use contraception while breast feeding?

The good news is if you’re breastfeeding, it’s unlikely you’ll become pregnant during the first six weeks after delivery. In fact, pregnancy is unlikely to occur during the first six months of breastfeeding as long as you’re breastfeeding consistently and haven’t had return of your monthly periods. Unfortunately, even though it’s unlikely, it’s not foolproof which is why contraception during breastfeeding is still important.

Most medical experts advise against using birth control pills that contain estrogen during the first six weeks of breastfeeding. This is because the hormones in estrogen containing birth control pills could potentially affect brain development and may alter the flow of milk from the breast. After the first six weeks, it’s generally considered safe to use a birth control pill while nursing, although only progesterone based pills should be used, not pills containing estrogen. These progesterone only pills are sometimes known as “mini-pills” and are considered safe contraception while breastfeeding by most experts, particularly after the first six weeks have passed. This form of contraception is considered to be ninety-eight percent effective.

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Birth Control Pill and Cancer

Posted on April 2, 2009 by Doctor

You’ve probably heard about an association between the use of oral contraceptives and cancer risk. Some studies conducted several years ago showed a possible weak association between use of the birth control pill and breast cancer. What’s the latest word about the role oral contraceptives play in increasing cancer risk?

It should come as considerable reassurance to women on oral contraceptives that a study carried out in the U.K involving 46,000 women who were followed over a period of thirty-six years showed no increased risk of breast cancer even with longer term use of oral contraceptives for eight years or greater. The results of this study were published in the February 2008 issue of the Journal of Family Practice.

This study showed that short term users of oral contraceptives (less than eight years) actually had a twelve percent lower risk of developing any type of cancer than did non-users. The association between oral contraceptives and cancer showed the greatest risk reduction for cancers of the colon, ovaries, and uterus.

Results were quite different with longer term use birth control pills and cancer risk. According to results of the same study published in the Journal of Family Practice, women who used oral contraceptives for eight years or more had a twenty-two percent greater risk of contracting any type of cancer when compared to non-users. The exceptions were ovarian cancer which showed a risk reduction with longer term use and breast cancer which showed no association between use of the oral contraceptives and cancer risk.

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How To Lose That Baby Fat Once And For All!

Posted on March 24, 2009 by Doctor

Your pregnancy weight may have taken nine months to put on, but it seems to be taking much longer than that to take off. While other new moms seem to snap right back to the pre-pregnancy form, you can’t seem to lose much weight. Along with the complete exhaustion of taking care of a baby, your poor body image is not helping your mental and emotional state. To make matters worse, you may have been side-tracked by your realistic weight loss plan by the lure of a fad diet that guaranteed quick results. Whether you have ten or twenty pounds or more to lose, the good news is that you can lose that extra unwanted weight. While it may seem like your motivation and willpower are zapped, you do have what it takes to lose weight. After all, if you can get through the grueling pain of labor and childbirth, you can certainly get your body back in shape!

Get Real! Think back to when you were pregnant and were noticing the different shapes of all the pregnant bellies. Some moms seemed to carry a bowling ball under their shirts while others plumped out nicely in all the right spots. Still others got bigger everywhere. The truth of the matter is that no two bodies are alike. So while you may envy those very few number of moms who can squeeze into their tight jeans a few weeks after childbirth, check your envy at the door. You are not that woman. In fact, most women are not that woman. The vast majority of women have to work very hard at getting their weight back to being even within eye-shot of their pre-pregnancy weight.

And once you lose your baby weight, your body still may not look the same. The fact of the matter is that you may never fit into those old tight-fitting jeans again, even when you reach that  magic number on the scale. So set your expectations accordingly and avoid the disappointment that is bound to ensue. Your body has gone through a tremendous adjustment in order to bring your little miracle into the world, so be content with your baby and the “new” you.

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Mastitis while pregnant

Posted on March 21, 2009 by Doctor

By: K. Karl

Mastitis affects about 20% of nursing mothers. On a rare occasion mastitis can occur while the mother is still pregnant. The routine cures for mastitis does not apply to a pregnant woman. Left alone, mastitis in a pregnant woman can lead to serious complications.

Mastitis is normally caused by a blocked lactation duct. This duct does not completely empty when the baby nurses which causes the mother’s milk to back up. Since the milk is high in sugar, bacteria love it and flourish.

Nursing mothers with mastitis are put on antibiotics. They are told to encourage frequent feedings for the infant in order to keep the lactation duct clear. This situation is impossible for the woman who is still pregnant. It is not recommended to use a breast pump to clear the duct because that type of breast stimulation can cause premature uterine contractions.

The following is a true story of a woman who developed mastitis while she was pregnant. The story includes mastitis treatments while pregnant, nursing, and weaning. The treatments lasted over eight months.

The first sign that Samantha had that there was a problem was eight weeks before her due date. She had a small red lump on one side of her breast. It hurt to touch it. Samantha’s obstetrician recommended a breast doctor since he was unfamiliar with this problem during pregnancy.

The breast doctor was also unfamiliar with this problem but she needed to know what type of bacteria was causing the infection. She aspirated the lump with the smallest needle possible in order to send the fluid to the lab.

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Cesarean Birth for Medical Reasons

Posted on March 16, 2009 by Doctor

Cesarean section (c-section) is delivery of a baby by surgery. An incision (cut) is made in the mother’s belly and uterus (womb). According to the National Center for Health Statistics, 1 in 3 babies in the United States is delivered by cesarean section.

C-section can be a lifesaving operation when either you or your baby face certain problems before or during labor and delivery. Many women who deliver surgically do not expect it. Most cesarean sections go well for both the mother and the baby.

Some health care experts believe that many c-sections are medically unnecessary. A cesarean section is major surgery and should be done only when the health of the mother or baby is at risk.

What you can do:
Learn about cesarean section well before your due date so you will be prepared if you need to be. Talk to your health care provider about c-section.

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Fetal Hydantoin Syndrome. A Case of Prenatal Diagnosis of Fetal Hydantoin Syndrome By Ultrasound

Posted on March 10, 2009 by Doctor

Thomaz Rafael Gollop and Ivan Salzo

Abstract

Fetal hydantoin syndrome (FHS) is a set of disruptions occasionally present in fetuses exposed in utero to phenytoin or other anticonvulsants. Administration of phenytoin in early pregnancy may impair proper psychomotor performance expected for children’s development. Several combined phenotypic markers delineate the syndrome, but the presence of single clinical signs is more common. There is controversy about the etiology of FHS. Associated disruptions may be related to a deficiency in a detoxifying enzyme (epoxide hydrolase), vascular problems, and/or factors not yet known. Genetic causes are believed to influence susceptibility to the drug. This text reports an unusual pattern of malformations detected in an ultrasound scan (gastroschisis, sacral meningomyelocele, and absence of the right lower limb) and in the anatomopathological study (left-side gastroschisis, sacral meningomyelocele, scoliosis, left clubfoot, absence of the right lower limb, and pectus carinatum) of a fetus whose mother took phenytoin. These defects may have been provoked by exposure to the drug during embryogenesis. In view of similar malformations observed in cases of prenatal exposure to cocaine, a recognized vasoconstrictor, it is suggested that vascular disruptions of hemodynamic origin constituted the event leading to some of the anomalies caused in the developing embryo. A complication of the chorionic villus sampling procedure, used for cytogenetic analysis, is another possibility.

Introduction

Phenytoin (Dilantin), the new denomination for diphenylhydantoin, is an efficient hydantoin anticonvulsant. Phenytoin is presumed to disrupt normal development of some fetuses when administered during pregnancy. In the 60′s, effects attributed to this medication were grouped into a somewhat recognizable pattern of anomalies (Briggs et al., 1994): fetal hydantoin syndrome (FHS). Classical indicators of FHS were classified by Hanson (1986) into three distinct sets:

1) abnormalities of pre- and post-natal growth – this set includes microcephaly;

2) delay in development, and impaired psycho-motor performance – cases of mental retardation are common;

3) dysmorphic craniofacial features and limb anomalies.

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Acne in pregnancy

Posted on March 7, 2009 by Doctor

During pregnancy, acne can both clear and get worse. In early pregnancy, acne often gets a bit worse but as pregnancy progresses, acne can often improve, possibly because of increased levels of oestrogen.

Treatment in pregnancy

Topical treatments that can be used in pregnancy include:
* Benzoyl peroxide
* Azelaic acid

Benzoyl peroxide

Benzoyl peroxide is a commonly used topical treatment for mild acne. It is safe for adults and children, and can be used in pregnancy.

Benzoyl peroxide has the following properties:

* Antiseptic i.e. it reduces the number of skin surface bacteria (but it does not cause bacterial resistance and in fact can reduce bacterial resistance if this has arisen from antibiotic therapy). It also reduces the  number of yeasts on the skin surface.
* Oxidizing agent – this makes it keratolytic and comedolytic i.e. it reduces the number of comedones.
* Anti-inflammatory action.

Benzoyl peroxide is available as cream, gel, lotion and wash at concentrations of 2.5 %, 5 % and 10 %. It may
be combined with other topical or oral therapy. It is especially valuable in combination with topical or oral antibiotics as it may reduce the growth of antibiotic-resistant bacteria.

In New Zealand, products containing benzoyl peroxide are available without prescription. They include:

* Benoxyl™ 5%, 10% Lotion
* Benzac™ AC2.5%, 5%, 10% Gel; Wash 5%
* Brevoxyl™ 4% Cream
* Oxy™ 5 5% lotion, Oxy™ 10 10% Lotion
* PanOxyl™ 2.5%, 5%, 10% Gel, PanOxyl™ AQ 2.5%, 5%, 10% Gel

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