A family workout has many benefits. First of all, you have each other for accountability. When one person wants to slack off, their loving family members can help them see the light. Secondly, you have a buddy to push you to do your best. It is a friendly competition that can help you achieve fitness goals you never thought possible.

1. Backyard sports – it’s probably been a long time since you played a game of dodge ball or kick ball. Now’s your chance. Get the family together and start a game on the weekends. This type of stop and start movement gets the heart rate up and works the muscles. Other ideas include basketball game, softball game or volleyball.
2. Take a class together – for example, martial arts centers have programs from youth to adult. Each person can learn skills and then practise them together. Aerobics classes are another idea for a family exercise session. The guys in the family may not feel co-ordinated enough to do a step aerobics class but there’s always spinning, swimming or kickboxing classes to choose from at your local YMCA or the gym.
3. Enjoy nature – families feed off of each other. If one person can do it, the others want to try to do it also. Go for a family hike. Parks have some beautiful trails that range from easy to more challenging. Outfit your family with the proper gear and learn about nature together. Along the same lines as hiking is mountain climbing. There are trails here too. Help each other climb the rocks and take in some breathtaking views. Both activities work your heart, lungs and lower body. Even on a cool fall day you will feel the burn and the cleansing sweat of a good workout.
4. Do yard work – no one wants to choose outside work but if you do it together it can be fun and heart pumping. Take turns mowing a section of the yard. Pushing a lawnmower works the upper and lower body. Rake leaves in the fall. For more fun, jump into the big pile and then let everyone help rake them up again.
5. Play a video game – video games have become more athletic and virtual these days. The big talk is about the Wii game console. Using the Fit board or the regular games, your family will have plenty of laughs and even more exercise as they move to make the characters move in the games.

Who says family workouts have to be boring? Get together as a family and do something that you love to stay healthy.

Related posts:

1. Family Matters: How family interaction can affect your child!
2. Treating depression in children – Family therapy
3. Mommy and Me Yoga – Benefits for Life

What is a miscarriage?

It is the spontaneous loss of a pregnancy that occurs during the first 20 weeks of pregnancy, most commonly before 12 weeks. After 20 weeks the loss of the pregnancy is called a stillbirth. About 1 in 7 recognised pregnancies will miscarry and about 1 in 3 women will experience a miscarriage during their reproductive life. A miscarriage may occur so early in a pregnancy that a woman may have been unaware that she was pregnant. These miscarriages are often unreported. Sometimes a doctor or nurse may refer to a miscarriage as a “spontaneous abortion”. “Abortion” is the common medical term given to all pregnancies that end before 20 weeks (both miscarriages and terminations). Miscarriage can be a difficult and traumatic experience for some women. For others, it may happen so early that the pregnancy was undetected.

Why does miscarriage occur?

It is generally unknown what causes miscarriages. Basically, miscarriage occurs because the foetus did not develop properly, probably because of a chromosomal or other genetic abnormality. The pregnancy is not normal and miscarriage is nature’s way of taking care of the problem.

What are the risk factors for miscarriage?

The vast majority of miscarriages occur early. It is important to note that a woman’s actions do not cause miscarriage. It is simply a badluck chance event and there is nothing she can do to prevent it. However, miscarriage risk increases if the woman has certain risk factors that include:

· Age Increasing maternal age is associated with chance of miscarriage – 1 in 10 for women aged 20, 1 in 7 for women aged 30, 1 in 3 for women aged 40 and 1 in 2 for women aged 45.

· Alcohol, drugs and cigarettes – Alcohol of >2 drinks per day doubles risk of miscarriage. Smoking reduces supply of oxygen to the placenta (lifeline of foetus) increasing risk of miscarriage, ectopic pregnancy, oxygenstarved baby, underdeveloped baby and premature delivery.

· Some medications – speak with your doctor about certain risky medications

· Obesity – women who are obese (BMI > 30) are twice as likely to miscarry.

· Underlying medical conditions – eg. Uncontrolled diabetes, kidney or thyroid problem, tendency toward blood clotting, connective tissue disorders (eg. lupus).

· Previous pregnancy – the risk of miscarriage increases with the number of previous pregnancies.

· Abnormalities of uterus / cervix · Foetal chromosome abnormalities

What are the signs of a miscarriage?

Signs and symptoms of miscarriage may vary considerably and may include vaginal bleeding, abdominal cramps and pain, loss of pregnancy symptoms, and the passage of tissue. Any vaginal bleeding during pregnancy is called a threatened miscarriage. However 25% of women who go on to have a normal baby have experienced some vaginal bleeding during the pregnancy. With miscarriage, significant vaginal bleeding may be severe enough to require a blood transfusion. Pain may be as severe as giving birth.

Contact your doctor immediately if you have any of the following symptoms:
- vaginal bleeding and cramps shortly after a late period
- gradual bleeding causing pain or pressure in the lower abdomen
- sudden, severe pain in the lower abdomen or pain on opening your owels
- severe pain that does not feel like period pain
- dark bleeding which starts after the pain
- faintness, nausea, dizziness and vomiting

Types of miscarriage

· Threatened miscarriage – is a pregnancy complicated by vaginal bleeding with little or no pain. This often continues to be a normal pregnancy.

· Incomplete miscarriage – a failed pregnancy where the uterus may still contain pregnancy tissue. You may need a D&C (dilatation & curettage) or vacuum aspiration to remove the remaining tissue. This can be done at any GCA clinic or at a hospital.

· Complete miscarriage – is a failed pregnancy where the uterus has expelled all the pregnancy tissue without the need for any other medical or surgical treatment.

· Missed miscarriage – is a failed pregnancy but with no symptoms (no bleeding or pain). This may go undetected for some time or until pregnancy symptoms have gone away or the uterus fails to enlarge.

· Blighted ovum – no foetus development but the pregnancy sac is present.

· Ectopic pregnancy – pregnancy is growing on the Fallopian tube instead of the uterus. This is a serious medical condition and may require prompt medical attention to prevent lifethreatening bleeding if rupture of the tube occurs. 1 in 200 pregnancies are ectopic.

· Septic miscarriage – is a failed pregnancy complicated by an infection in the uterus.

· Recurrent miscarriage – 3 or more failed pregnancies in a row.

Investigating miscarriage

Ultrasound is the most important tool for diagnosing miscarriage. A vaginal ultrasound is valuable in assessing very early pregnancy because the vaginal probe is much closer to the uterus and the pregnancy may be seen more clearly. Other tests include pregnancy and progesterone blood hormone levels. Pregnancy hormone levels should double every 48 hours in a normally progressing pregnancy. If the levels are rising slowly or falling, a failed pregnancy is likely (or ectopic).

How is miscarriage treated?

Often miscarriages may occur naturally without the need for medical treatment. At other times, a dilatation & curettage (D&C or “curette”) may be required to remove the pregnancy tissue, therwise bleeding and pain may continue and infection may develop. Sometimes oral medication (misoprostol) may be an alternative to a surgical procedure for some women with a very early failed pregnancy. Antibiotics may be required if infection is present. Some women may require iron supplements, or more rarely, a blood transfusion if bleeding was significant.

What happens after a miscarriage?

You may experience light bleeding for up to 2 weeks (on & off). If the bleeding is heavy or persistent, you are passing clots, you have persistent abdominal pain, you have a foulsmelling vaginal discharge, you have a temperature >38 degrees, you are not feeling better, then you should contact your doctor, GCA clinic or hospital immediately.

What should I do if I think I am having a miscarriage?

· Ring your doctor, GCA clinic or hospital and describe your symptoms. If you are alone and things are happening fast, then dial 000 for an ambulance. Never drive yourself to hospital.

· Have a partner, relative or friend with you, if possible.

· Soak up blood with pads or towels. Keep a record of the number of pads you use each hour and how soaked they were.

· You may require a D&C so don’t eat or drink anything. Your stomach needs to be empty if you have an anaesthetic.

· Save any tissue you pass. It may be very helpful in excluding ectopic pregnancy as the cause of the bleeding.

· Remember that a doctor or nurse or anyone in a hospital cannot prevent miscarriage.

What is my chance of having another miscarriage?

Since most miscarriages happen by chance, one miscarriage only slightly lowers your chance of having a successful pregnancy the next time. However, 2% of women will have 2 miscarriages in a row and <1% of women will have 3 (recurrent miscarriage). This may happen out of chance but there may be some underlying reasons.

There may be repeated chromosomal abnormalities from one parent or the other. Blood clots may block the placenta. The shape of the uterus or cervix may not allow the foetus to develop properly or cause it to deliver early. Tests and treatments may be available for many of these problems. This may be emotionally traumatic and frustrating. Expert doctors (gynaecologists and geneticists), counselling and hospital clinics are available to deal with recurrent miscarriage.

How will I feel after a miscarriage?

Women who have had a miscarriage can experience a wide range of emotion – it may cause profound grief and depression that may be brief or long lasting. It is natural to feel loss, sadness, anger and even guilt, despite the fact that the end result is out of your hands. Expert counselling is available. Speak with your doctor or local hospital.

When can I get pregnant again?

You may conceive again even before the next period. The next period is expected in 46 weeks after a miscarriage. Some people may want to try again immediately, while others prefer to wait. There may be a slightly higher chance of miscarriage again if conception occurs before the first period, but remember that the next pregnancy is likely to proceed normally even if you have had previous miscarriages. All women planning pregnancy should be taking folic acid (best started at least 1 month prior to conception and continued for first 3 months of pregnancy), be immune to rubella and stop consumption of alcohol, cigarettes and other recreational drugs. It is also important to have a pap smear every 2 years, preferably done when you are not pregnant.

Related posts:

1. Facts About Miscarriage
2. Cramping During Pregnancy
3. Ectopic Pregnancy

This pamphlet is about late miscarriages between 14 and 20 weeks of pregnancy. It does not cover losses which happen after 20 weeks since most states define those as stillbirths. And it does not cover miscarriages that happen before 14 weeks though some of this information may be appropriate for a miscarriage before 14 weeks as well.

HOW OFTEN DOES THIS HAPPEN?

Up to 50 percent of all pregnancies may end in miscarriage; the actual numbers are unknown because many losses occur before a woman realizes she is pregnant. It is estimated that a quarter of all miscarriages are after 14 weeks. This means that there are over 600,000 reported miscarriages nation wide.

FINDING A REASON

Most families want to know the reason for their miscarriage, and after a late miscarriage, most hospitals offer some  investigations – although the investigation may not provide clear answers.  If a baby is miscarried after 14 weeks, it is usually developed enough for an autopsy to be preformed. An autopsy can, but does not always, provide a reason for the miscarriage. It can also confirm the baby’s gender. It can be difficult to be certain at delivery if a very tiny baby is a boy or a girl. Most parents find comfort is discovering their babies gender.

CAUSES OF LATE MISCARRIAGE

Chromosome Problems

Examples of chromosome problems are Down’s Syndrome, Edwards’ Syndrome, and Turner’s Syndrome. It is possible to test the babies chromosomes from samples taken from the placenta or umbilical cord.

Genetic Problems

Chromosomes carry our genes. Sometimes abnormal genes can cause fatal conditions. An example of a genetic problem is cystic fibrosis. Genetic problems are most likely to cause first trimester miscarriage.

Structural Problems

Examples of structural problems are spinal bifida and congenital heart defects. These problems may be identified during pregnancy on an ultrasound scan, but sometimes they are only discovered after the baby is born.

Anatomical Problems

One in 25 women has an abnormally shaped uterus (womb). In most cases this does not increase your risk of miscarriage.  Incompetent Cervix can cause a late miscarriage. Throughout pregnancy, the cervix (the neck to the uterus) should be tightly  closed. With Incompetent Cervix the cervix is weak and it may open as the baby grows.

Infection

Infections can cause late miscarriage, either by infecting the baby or by infecting the amniotic fluid. Infections can come  from many factors,some are from unknown causes though.

Antiphospholipid Syndrome (APS)

Antiphospholipid antibodies are formed in the body after many different illnesses. Anybody who has had a variety of illnesses may have antiphospholipid antibodies in their bloodstream without knowing it. If these antibodies are found in a woman who has had repeated miscarriages, this is known as antiphospholipid syndrome.

AFTER YOUR MISCARRIAGE

Your Baby

Many couples wonder what happens to their baby after their loss. What happens will depend on the stage at which your baby died and the policy at your hospital. The hospital staff should take time to explain to you what the hospital offers and should also give you written information.  You do not have to make a decision right away, nor does the decision have to be totally up to you. Discuss it with your  family and friends and take your time.

Your Body

Following your miscarriage you are likely to have some bleeding and possibly period-like pain, and this may continue for  several weeks. If the bleeding or pain increases or you have discharge that looks or smells offensive, or you are worried  about any other symptoms, call your doctor immediately. You should have your first period  approximately four weeks after your bleeding stops.  Your breasts may naturally produce milk. For many this is distressing and may even feel cruel. It is important not to stimulate your nipples or express milk from your breasts; this will only cause more milk production.  Wear a well-fitting supportive bra 24 hours a day for the first two weeks. For discomfort you can apply ice packs several times a day for 20 minutes at a time.

Your Mind

The “blues” are normal after a normal pregnancy and even more prevalent after a loss. This is totally normal and caused by  changes in your body. If the blues doesn’t get better with time or you are having harmful thoughts please contact your  doctor. There is support available online and through your hospital.

Related posts:

1. MISCARRIAGE
2. Cramping During Pregnancy
3. PRENATAL TESTING – OVERVIEW

There are limited data on the safety of antipsychotic drugs in pregnancy and breastfeeding. Reports of congenital abnormalities in the babies of women taking typical antipsychotics are uncommon, although chlorpromazine may cause symptoms in the neonate. No increased risk with atypical antipsychotics has yet emerged. If women can be managed with a low dose of a single antipsychotic drug the benefits of breastfeeding are likely to outweigh the risk of harmful effects.

The lifetime prevalence of schizophrenia is 0.5–1%. The peak incidence in women is during their childbearing years, but treatment can reduce fertility. The older antipsychotic drugs increase prolactin, resulting in significantly lower fertility rates than with the atypical antipsychotic drugs. The newer antipsychotics are also being used increasingly to treat other psychiatric disorders such as major depression and bipolar disorder. Many women with well-controlled psychiatric disease are therefore now able to contemplate pregnancy, but they have concerns about the effect of treatment on their offspring. Addressing these concerns is difficult because of a lack of data.

Typical antipsychotic drugs

Studies examining the use of the older antipsychotic drugs in pregnancy have not shown a significantly increased risk of birth defects above the baseline rate of 3% in the general population. There have been reports of two infants exposed to haloperidol with isolated limb defects, but they were also exposed to other drugs and thus there is no clear causal relationship with haloperidol. In contrast, there have been several larger studies which have not shown an increased risk of birth defects. Babies exposed to haloperidol and chlorpromazine in utero may show extrapyramidal abnormalities, similar to those seen in adults, for weeks after birth. Other suspected withdrawal symptoms following intrauterine exposure to chlorpromazine have included paralytic ileus, necrotising enterocolitis, fever, cyanotic spells and transient heart block.
Long-term follow-up studies of children have been reassuring. While these drugs probably still have their place in the treatment of acutely psychotic patients, they have largely been superseded by the atypical antipsychotics for long-term therapy.

Flupenthixol and the depot preparation zuclopenthixol are thioxanthene major tranquillisers. There are minimal human data apart from some case reports of normal outcomes following use in pregnancy. Like the older antipsychotic drugs they have been shown to affect fertility via dopamine and prolactin pathways.

Lactation

Chlorpromazine and haloperidol are excreted in human milk in small amounts. In one report, three breastfed infants exposed to haloperidol and chlorpromazine showed developmental regression which was not seen in infants exposed to trifluoperazine alone, suggesting that use of a single antipsychotic drug poses less of a risk to a breastfed infant. No adverse effects were reported in four infants exposed to flupenthixol via breast milk.

Atypical antipsychotic drugs

One study followed up over 150 cases of exposure to atypical antipsychotic drugs (olanzapine, risperidone, quetiapine and clozapine) in the first trimester of pregnancy. There were no differences in any of the pregnancy outcomes of interest, apart from low birth weight, which could not be explained by the study’s authors. The rate of malformations in the exposed group was no greater than in the control group.

Animal studies have not shown an increased risk of malformations with clozapine. Although human pregnancy data are relatively limited, there does not appear to be a significant increase in the incidence of birth defects or other adverse outcomes. There is one case report of a child with possible delayed speech acquisition following clozapine use during pregnancy and lactation. No other long-term neurodevelopmental follow-up data are available.

Concerns have been raised that olanzapine in particular tends to be associated with significant weight gain. During pregnancy this could be associated with an increased incidence of outcomes, including increased rates for birth defects such as neural tube defects and an increased risk of obstetric complications. Theoretical concerns about a relative folate deficiency have prompted some experts to suggest that women planning pregnancy while taking olanzapine should take 5 mg folate rather than the usual 0.5 mg to try and reduce the risk of neurodevelopmental disabilities.

Lactation

Limited information shows that maternal doses of olanzapine up to 20 mg/day produce low levels in milk and undetectable levels in breastfed infants. Generally, short-term adverse effects have not occurred, and sedation has not been reported. Limited long-term follow-up of infants exposed to olanzapine has been reassuring, particularly with monotherapy.

Conclusion

The potentially harmful effects of taking an antipsychotic drug in pregnancy have to be balanced against the harm of untreated psychotic illness. Data are limited, particularly for the atypical antipsychotic drugs, but there are no clear associations with specific congenital abnormalities.

The benefits of breastfeeding are likely to outweigh the potential harm of medication. Women who wish to breastfeed should be managed with a single antipsychotic drug if possible. All antipsychotic drugs are sedating and have relatively long halflives, so babies should be observed for lethargy, sedation and appropriate developmental milestones particularly if multiple antipsychotic drugs are used.

Note: A national register of antipsychotic medication in pregnancy has been developed. For information phone (03) 9076 6988 or email H.Gilbert@alfred.org.au

New drugs

Some of the views expressed in the following notes on newly approved products should be regarded as tentative, as there may have been little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. As a result of fuller experience, initial comments may need to be modified. The Committee is prepared to do this. Before new drugs are prescribed, the Committee believes it is important that full information is obtained either from the manufacturer’s approved product information, a drug information centre or some other appropriate source.

Abatacept

Orencia (Bristol-Myers Squibb)
vials containing 250 mg lyophilised powder
Approved indication: rheumatoid arthritis

The primary goal of treatment for rheumatoid arthritis is to preserve and restore physical function as well as modify the disease process and slow down the development of joint damage. In Australia, methotrexate is initially used to manage the disease. It is often given with other disease-modifying antirheumatic drugs (DMARDs) for moderate to severe disease. If these drugs are not effective or not tolerated, biological agents such as tumour necrosis factor (TNF) inhibitors may be considered.

Abatacept, a genetically-engineered protein, is a biological drug for rheumatoid arthritis which is designed to suppress T cell-mediated inflammatory reactions. It is made up of the extracellular part of the human cytotoxic lymphocyteassociated antigen (CTLA-4) linked to a fragment of human immunoglobulin G. Abatacept works by binding to two signal molecules (CD80 and CD86) on antigen-presenting cells, thereby preventing them from activating T cells.

Related posts:

1. Antiepileptic drugs in pregnancy and lactation
2. Taking Hydroxyzine during pregnancy and breastfeeding
3. Alcohol, drugs and pregnancy

Parents are prone to shrug off such transient depressive episodes because clinical depression seems to be too big a word to be used in the context of children. However, it is a fact that child depression does exist and the statistics indicate the makings of a nationwide phenomenon.

Teen depression is often confused with other conditions like anxiety, conduct and mood disorders. Moreover, teens tend to hide transient episodes from parents and often take to alcohol or self medicate with drugs. This makes it all the more difficult to diagnose the condition.

Adolescents who are low on self esteem, excessively self-critical or unable to come to terms with events in their lives are at a higher risk of developing depression. Teenage girls are at a higher risk and more prone to develop epression than teenage boys.

Clinical depression is a continuous state of low mood characterized by a pessimistic sense of inadequacy. It is also proven by a despondent lack of activity that lasts for at least three months. Depression can be caused due to hereditary or physical abnormalities within the brain. It is actually caused by a conflict – a conflict that goes on within the mind.

Outside of genetics and abnormalities in the brain structure, some of the causes of teen depression include:

* Family dysfunction – This is the most common cause behind child depression. Parents often fail to realize the affect that their behavior has on the psyche of the child. It has been observed that parents find it easy to label the child as a patient and are defensive about accepting the harm that they may have caused. Family dysfunction includes aspects of inadequate communication or independence conflicts between parents or between parents and the child.

* Stress at school – School has ceased to be an enjoyable experience in the current scene where competition is emphasized more than learning. Children who face stress at school are more prone to develop depression.

* Unrealistic parental expectations – Well meaning parents who are concerned about their children tend to push their children over the edge without realizing that each individual has his or her own intellectual limitations. Parents who place unrealistic expectations upon their children actually do more harm than good.

* Unresolved grief – Death, loss of a cherished relationship or a traumatic event exposes teens to a greater risk of depression.

* Emotional detachment – The adolescent mind is highly emotional and there is no guarantee of how a teenager will perceive his or her inabilities. Many times, inability to connect with others and an excessive fear of building new relationships may be the cause behind teen depression.

Depression, as it is, is difficult to diagnose. The condition becomes even more difficult to identify among teens. Parents should be well informed of the signs of depression and seek teen depression help from a consultant who is a specialist in teenage problems.

References:

http://www.teendepression.org/articles2.html

http://www.peaceandhealing.com/depression/teen.asp

http://www.kidzworld.com/article/4446-get-the-411-on-teen-depression

http://ezinearticles.com/?Depression—What-Really-Causes-It&id=282841

Related posts:

1. The Effects of Teen Depression
2. Parental Support Can Help in Prevention of Teen Suicide, Depression
3. Child Depression Symptoms