Wednesday, 3 August 2011

Ultrasound scanning and common problems

Why does my obstetrician perform an ultrasound scan through the vagina? Is this different from a scan over my abdomen?

A scan through the vagina is usually performed in the early pregnancy and particularly when the uterus is deep in the pelvis as with a retroverted uterus. It is purely technical to obtain a better image. If done through the abdomen, the bladder will ahve to be full and the view not as clear. The contents of the uterus, foetus, placenta are more easily seen. The cervix can be viewed and measured. This is important if cervical incompetence is suspected.

What is cervical incompetence and how is it diagnosed? How can this be treated?

Cervical incompetence is a condition where the cervix cannot hold the pregnancy. The cervix is the neck of the womb and if it is damaged eg by previous abortions or surgical procedures such as a cone biopsy, then it may slowly open during the pregnancy without much in the way of symptoms and a premature delivery results. This may also happen with multiple pregnancies. To diagnose the condition, a vaginal ultrasound scan is done at 12 , 16, 20 and 24 weeks. The normal length of the cervix is 3-5cms. If the cervix is <2.5cms, a premature delivery is likely. The diagnosis is best made as early as possible and preferably around 12 weeks. The treatment is the insertion of a stitch around the cervix. This will usually help hold the pregnancy until 38 weeks when it can be taken out and the delivery allowed to proceed.

Q  I am 12 weeks pregnant and have noticed an increase in the amount of vaginal discharge. Is this normal?

When you are pregnant, the physiological changes that take place cause swelling in the neck of the womb and an increase in clear watery discharge. This discharge coagulates as it passes down the vagina and turns into a white and sometimes powdery discharge called leucorrhoea. However, if the discharge is yellow, green, bloody or there is a smell or itch, you may have a fungal or bacterial infection and this will need treatment.

I am 12 weeks pregnant and have a thick, white, pasty discharge. It is causing a great deal of itch. What is this and do I need treatment?

You probably have moniliasis, a fungal infection that is very common in pregnancy. It occurs in about 20% pregnant women as is due to the excess moisture and alkalinity of the vagina. It may also occur after a course of antibiotics as the fungus is controlled by 'good' bacteria in the body. The antibiotics kills the 'good' bacteria and allows the fungus to multiply. Treatment is with vaginal pessaries or oral anti-fungals. If it is resistant to treatment or recurs, a blood test to exclude diabetes should be done.

I am 12 weeks pregnant and have noticed a greenish yellow discharge. What is this and what treatment should I receive?

Your obstetrician will want to examine you and perhaps take a swab from the vagina to be examined. If he sees small protozoa under the microscope then you have an infection called trichomoniasis. Treatment is with a 10 day course of metronidazole. Your husband should be treated as well as this is sexually transmitted. If there is a suspicion of having contracted a sexual disorder, your obstetrician can do a blood test to exclude other sexually transmitted disorders as trichomoniasis very often coexists with them.

Q I am 12 weeks pregnant and have been having this foul smelling discharge mixed with blood for the last one month. What is this due to?

The most common cause is a polyp on the neck of the womb. These fleshy growths grow from the inner portion of the neck of the womb. They are related to hormonal changes that take place during the pregnancy, and can sometimes be very large. They can be removed with a forceps without danger to the baby.

Q I am 12 weeks pregnant and get these sudden pains in the back of my thigh and buttocks. What is this due to and what can be done?

The pain is known as sciatic pain and is due to pressure on the nerve roots that supply the back of the thigh and buttocks. It is common in pregnancy due to the changes that take place in the intervertebral spaces during pregnancy and will usually disappear later. Your obstetrician may want to give you something to reduce the spasm that is associated with it and also vitamin B 12 which appears to help. Avoid using high heels and ensure that you maintain an erect posture.

Q I am 12 weeks pregnant.Is it safe to have sexual intercourse?

If your pregnancy is uncomplicated by bleeding pr premature rupture of membranes, low-lying placenta, it should be safe to resume sexual intercourse. Intercourse may continue until such time that it becomes uncomfortable which is usually in the last 2 months.There is no evidence that sexual intercourse is harmful to the baby.

What should my diet be at 12 weeks?

Your baby is now fully formed and is growing rapidly in size. You will want to increase your protein intake as these are the building blocks of the baby. You should take the equivalent of one steak per day. Your calorie intake will have to be increased by about 300 calories. You should ensure that you have sufficient calcium, iron and folic acid.

Are there any foods that I should avoid now that I am in my second trimestor?

To avoid putting on too much weight you should avoid eating too much fried and oily foods, fast foods and foods with 'empty' calories such as cakes , cookies, chocolates etc. Semi-ccoked and raw foods are not advisable as food poisoning can be harmful to your baby.

Is it true that I should avoid eating any shellfish and prawns during pregnancy?

There is no reason for you not to eat shellfish and prawns but make sure they are well cooked. Cockles that are not properly cooked can resullt in hepatitis A infection which can be harmful to your baby.

What excercises can I do in my 12th week and what excercises should I avoid?

The best form of excercise would be cardiovascular eg swimmong and walking. This would build up your stamina without putting too much strain on your joints. You should do some form of stretching and flexilbility excercises. Yoga would be the ideal as it will improve flexibilty, stamina, and tone the muscles. You should avoid straineous excercises such as jogging that would also put a greater starin on your joints. Ball games such as tennis, and golf should be avoided. Do an hour of walking a day or 20 minutes of swimming to build your stamina.

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