tag:blogger.com,1999:blog-32019097629090634712024-03-13T22:38:33.545+08:00Nine Months and CountingAll your pregnancy questions answered...Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-3201909762909063471.post-14141622528720092862015-06-09T13:06:00.000+08:002015-06-09T13:15:34.050+08:0016 to 20 weeks. Visits to your obstetrician<div dir="ltr" style="text-align: left;" trbidi="on">
Q<b><u> I am now 16 weeks pregnant. what should I expect at my obstetrician?</u></b><br />
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Your baby will be fully formed, much larger and fingers and toes can be seen. The sex of the baby can be determined. He may want to do a blood test (triple test) for down's syndrome if the oscar test was not done earlier in the pregnancy.<br />
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Q <b><u>What is a triple test?</u></b><br />
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This is a blood test to determine your risk of down's syndrome and other chromosome defects, detect spina bifida or other neural tube defects. The test measures 3 hormones and together with the mother's age and weeks of gestation, a risk factor is determined. A factor more than 1:250 would be positive. There are however false positives and negatives in this screen and it is not infallible. A positive test would indicate a need for an amniocentesis.<br />
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Q <b><u> I have been told that I need an amniocentesis. How is this procedure done and what are the risks?</u></b><br />
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Approximately 15 mls of the babies waterbag fluid is extracted under local anaesthesia. This is usually done under ultrasound scan guidance. The fluid will contain the foetal cells from shed skin. These cells are harvested and examined . The procedure is relatively painless and takes about 20 minutes. The cell culture takes about 2 weeks and therefor the test should be done well before 20 weeks. It is a safe procedure with a less than 1% risk of complications. The main risk is that of miscarriage.<br />
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Q <b><u>My obstetrician advised me to have an amniocentesis at 16 weeks rather than a chorionic villus biopsy at 9 weeks. Why is this so?</u></b><br />
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Chorionic villus biopsy is a procedure in which a biopsy is taken from the placenta under ultrasound guidance. The material is then undergoes DNA analysis to determine gene disorders. The risk of miscarriage is higher than amniocentesis, the results often inconsistent and a UK study has shown increased foetal abnormalities resulting from the procedure.<br />
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Q <b><u>Both my husband and I are thalassaemia carriers. What tests should I do to determine if my baby is normal?</u></b><br />
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If both your husband and you are carriers, then you have a 1:4 chance of having a thalassaemia major child. This is fatal in childhood. This can be excluded by means of foetal blood sampling. the foetal cord is identified under ultrasound scan and a needle inserted to aspirate a small amount of cord blood and the blood then undergoes DNA analysis.<br />
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Q <b><u>What is a foetal-DNA test and when should it be done?</u></b><br />
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This test may be done as early as 9 weeks. It tests the baby's DNA that passes into the mother's bloodstream. It is a very accurate test almost 99% and looks to replacing amniocentesis as the test of choice. It is non invasive and therefore does not carry the risks that are associated with an amniocentesis. This test is referred to as the Harmony test or Panorama test.<br />
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Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-30413370750874309042015-06-09T12:47:00.004+08:002015-06-09T12:47:48.414+08:00Common Problems You May Encounter 16 - 20 Weeks<div dir="ltr" style="text-align: left;" trbidi="on">
Q <u><b> I am now 16 weeks pregnant and have low back pain. Is this common and what can I do to prevent this? </b></u><br />
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Although backache is more common in the last trimester, it may occur at any time in the pregnancy. The physiological changes in pregnancy result in a relaxation of the ligaments and muscles that support the joints. The increasing weight of the pregnancy means that there is extra strain on these ligaments. Avoid using high heels, and always keep an upright posture. Your centre of gravity when standing should be slightly behind. This way your back muscles will not need to work so hard to hold up the extra weight in front.<br />
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Q <b><u>I am 16 weeks pregnant and feel persistently breathless. Why is this so?</u></b><br />
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Breathlessness is common and by 16 weeks 25% of women will feel so. This is due to the effect of the pregnancy hormone progesterone on the breathing muscles. You should of course have yourself checked for lung or heart problems such as asthma, bronchitis, valve prolapse of the heart etc all of which may cause you to be breathless.<br />
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Q <u><b> I have been having frequent headaches. Is this normal and what can I take?</b></u><br />
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Headaches in pregnancy are common. It is often due to the increased circulation in the brain. Tension headaches and migraine are also more common. Should the headache be mild, simple painkillers may suffice. However should the headaches be persistent or severe, then brain blood vessel malformations and hypertension needs to be ruled out by your doctor.<br />
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Q <b><u>I was standing at the bus stop when I suddenly felt feint. Is this normal and what can I do to prevent this?</u></b><br />
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Feeling giddy and feint is very common and is due to the haemodynamic changes of the body during the early stages of pregnancy. There is a fall in the normal blood pressure of pregnant women which only returns to its normal level at about 28 weeks. Avoid standing in a queue for too long, getting up too fast from a sitting or sleeping position. Should you encounter this problem, raise your arms above your head and the blood from the arms will go to your head. When you feel better sit down and slowly put your head between your legs. You will feel less of this problem when you are in your third trimester.<br />
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Q <b><u> I am 16 weeks pregnant and have noticed that my ankles are swelling. Is it normal to swell so early in pregnancy?</u></b><br />
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In the early pregnancy swelling is due to the increased hormone oestrogen. This causes the blood vessels to be more permeable and water seeps out through them to surrounding tissues especially the ankles due to gravity. It affects about 1:3 pregnancies. It is considered as normal. However watch your salt intake as this may also cause more water retention and eventually high blood pressure. Swollen ankles early in pregnancy may also indicate impending pre-eclampsia, a condition that occurs in first pregnancies. have your blood pressure monitored regularly that it is not increasing. Avoid standing for long periods and raise your legs at night when sleeping.<br />
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Q <b><u> I have been having frequent leg cramps. How can I avoid these?</u></b><br />
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Leg cramps may be due to several factors. It may be due to a deficiency of certain minerals such as calcium, magnesium, or sodium. The more common reason is due to pooling of blood in the legs as a result of too much standing during the day and poor circulation. Your doctor may want to do your blood mineral levels and replace them with supplements. To reduce poor circulation, you may want to have your husband massage your calfs before sleeping and also sleep with your legs raised on two pillows.<br />
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Q <b><u> I have been having frequent palpitations. Is this normal and what needs to be done?</u></b><br />
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A fast heartbeat that lasts one or two hours is considered normal in pregnancy. It is related to the changes in the circulation of blood. However if it persists and lasts longer and more frequent than that, you should check with your doctor to exclude any problem with the heart. Irregular and fast heartbeats require urgent assessment by your doctor and perhaps a referral to a cardiologist to exclude certain conduction defects of the heart.<br />
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Q <b><u> I am always leaking urine when I cough, sneeze or run after a bus. Is this normal?</u></b><br />
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About 60% of pregnant women will develop stress incontinence, a condition in which the normal structures of the bladder outlet which prevents leakage are altered due to the hormonal changes taking place. You should be rest assured that it is normal and will improve after delivery. However, if your delivery is difficult or assisted with either a forceps or vacuum, there is a chance that these tissues will be weakened and the stress incontinence may persist after pregnancy. Kegel excercises during the pregnancy and after may help. This problem does not usually arise in those having caesarean section delivery.<br />
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Q <u><b>Why can't I get a good sleep at night?</b></u><br />
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It is common in pregnancy to have poor and broken sleep. You do not need to worry that it will affect your baby if you have insufficient sleep. However do try to rest more during the day if the sleep at night is broken. You may have a problem with having to get up due to more frequent urination, cramps, backache, an uncomfortable large uterus, or due to anxiety. Dreams seem to be more common in pregnancy perhaps due to the hormonal changes. It is not advisable to take sleeping tablets. Instead try taking a leisurely walk in the evening followed by a hot cup of milo or any beverage. Avoid all caffeine after 3 o'clock, spicy food for dinner, television, and bright lights in your bedroom.<br />
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Q <b><u> I have a pain in the outer portion of my thigh when I walk but gets better when lying down. Is this normal?</u></b><br />
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During pregnancy the swollen ligaments of the groin may press on a nerve called the lateral cutaneous nerve which supplies the outer portion of the thigh and skin. There will be pain and numbness. Rest assured that this is temporary and will disappear after delivery.<br />
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Q <b><u> I have numbness and pain in my fingers when I wake up in the morning. What is this due to and how can I relieve this?</u></b><br />
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The numbness and pain is due swelling and compression of the nerve known as the median nerve which runs under the ligament of the wrist. There may be tingling , numbness or pain in one or both hands. It is known as carpal tunnel syndrome. This is usually a temporary problem in pregnancy and will resolve after delivery. It may be mild in which case no treatment is required. If it is distressing medication to reduce water retention may be prescribed. Surgery is not usually required for this condition in pregnancy.<br />
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Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-16532404065870467912012-01-02T17:31:00.000+08:002015-06-09T12:50:52.189+08:0016 to 20 weeks of pregnancy - visits to your obstetrician and prentatal tests<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>I am now 16 weeks pregnant. What should I expect at my obstetricians?</u></b><br />
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He may want to do an ultrasound scan. You will see that the baby is now much larger, starting to move its arms and legs. Fingers and toes will be visible and in some instances may be seen to be sucking its fingers and toes!. the sex of the baby can be determined with accuracy at this stage. A triple blood test may be done if the oscar test was missed earlier.<br />
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Q <b><u>What is a triple test and why do I need to have this?</u></b><br />
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This is done to determine if you are high risk of developing a Down's Syndrome baby ( baby with an extra chromosome resulting in mental retardation). It will also tell us the risk of defects of the spine. It is usually performed if the Oscar test has been missed. It measures 3 hormones present in the mother's blood and correlating this with her age and stage of pregnancy, a risk factor can be determined. This screen is not however as accurate as the Oscar test and like most tests will have false positives and negatives. A positive test would indicate the need for an amniocentesis ( tapping the fluid in the baby's water bag). A positive test for spinal defects can be correlated with a detailed foetal abnormality scan at 20 weeks.<br />
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Q <b><u>I have been told that I need an amniocentesis. How is this procedure carried out and is it risky?</u></b><br />
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Approximately 15 mls of the baby's water bag is aspirated under ultrasound scan guidance. The ultrasound scan will determine the best site to insert the needle. The needle is inserted with or without local anaesthetic and the needle is watched on the ultrasound scan so that the chance of hurting the baby and its cord are minimised. It is a relatively painless procedure. The fluid contains the baby's skin cells shed from the baby. The cells are grown in the laboratory and the cells examined. It takes about 2 weeks for the karyotyping, but for an extra cost a PCR may be done and results obtained in 3 days. However it is still advisable to have a full karyotype. <br />
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The procedure carries a risk of less than 1%. The main risks are of miscarriage following leakage of the baby's water bag, injury to the baby. The majority will have no complications.<br />
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Q <b><u>My obstetrician advised me to undergo amniocentesis at 16 weeks rather than a chorionic villus biopsy at 9 weeks. Why is this so?</u></b><br />
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Chorionic villus biopsy (CVB) is a procedure in which a biopsy is taken from the foetal placenta at about 9 weeks gestation.The specimen undergoes a DNA analysis to determine certain genetic disorders. The procedure carries a higher risk of miscarriage than amniocentesis. There are also inconsistencies in the results and maternal contamination of villus samples have led to to errors in gene analysis. More importantly, studies in the UK have shown abnormalities in foetuses born to women who have had this procedure performed.<br />
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Q <b><u>Both my husband and I are thalassaemia carriers. What tests should I do to determine if my baby is normal?</u></b><br />
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If both you and your husband are carriers, you have a 1 in 4 chance of having a baby with thalassaemia major, a condition which is almost always fatal in childhood. This can be diagnosed by foetal cord blood sampling at 16 weeks. The foetal cord is identified under ultrasound scan and a needle inserted to aspirate a small amount of blood which undergoes DNA analysis. <br />
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Q<b><u> I have been told that I should have a detailed scan of my baby at 20 weeks. Why is this necessary</u></b>?<br />
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The aim of every obstetrician is to have as low a perinatal mortality and morbidity rate as possible ie low death rate and low foetal complication. About 20% of perinatal mortality is due to congenital abnormalities. One of the important tools to diagnose congenital abnormalities is the ultrasound scan. The majority of abnormalities are best seen at about 20 weeks. Some abnormalities detected may be so severe as to warrant a decision to have an abortion. Other less severe abnormalities detected can prepare the patient, paediatrician for further treatment at the time of birth.<br />
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Q <b><u>How accurate is an ultrasound scan in excluding foetal abnormalities? Can I assume that my baby is normal since my ultrasound scan did not show up any abnormalities?</u></b><br />
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There are 3 levels of ultrasound scanning. The first is a general scan. This scan determines the number of foetus, position of the foetus and placenta, amount of fluid, measurement of the gestational age and growth of the foetus, a general look at the structure of the foetus. The second level would look at a more detailed structure and form of the foetus while the third level includes blood flow studies to exclude cardiac abnormalities. Most obstetricians with sufficient experience would do level 2 scans. The level of accuracy will depend on the experience of the obstetrician performing. An experienced obstetrician should obtain an accuracy of about 80%.<br />
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Q <b><u>What structural abnormalities may not be picked up by ultrasound scanning?</u></b><br />
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Small abnormalities are difficult to pick up. Very pften the fingers of the hand are clenched making it difficult to view all of them. Small holes in the heart, the way the major vessels enter and leave the heart are difficult to view, positional deformities of the legs and feet. The accuracy will depend greatly on the position of the baby at the time of scanning, the amount of abdominal fat in the mother, the position of the placenta and amount of fluid.<br />
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Q <b><u>Is a 3 D and 4 D scan of value?</u></b><br />
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3D and 4D (3D in motion) scans have become almost standard in todays context. With advances in ultrasound machine technology, not only 2D but 3D clarity have improved tremendously. A 3D and 4D scan will complement the 2D scan. It shows the baby in a form more readily identifiable to most patients. If abnormalities are detected at 2D, the 3D and 4D will help confirm or refute the diagnosis. Another great advantage of the 4D is mother/ father and baby bonding which can start now before the baby is born!</div>
Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-4883581416900120032011-08-03T10:05:00.000+08:002015-06-09T12:57:17.817+08:00Ultrasound scanning and common problems<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>Why does my obstetrician perform an ultrasound scan through the vagina? Is this different from a scan over my abdomen?</u></b><br />
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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.<br />
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Q <b><u>What is cervical incompetence and how is it diagnosed? How can this be treated?</u></b><br />
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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.<br />
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Q<b><u> I am 12 weeks pregnant and have noticed an increase in the amount of vaginal discharge. Is this normal?</u></b><br />
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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.<br />
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Q <b><u> 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?</u></b><br />
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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.<br />
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Q <b><u>I am 12 weeks pregnant and have noticed a greenish yellow discharge. What is this and what treatment should I receive?</u></b><br />
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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.</div>
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Q <b><u>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</u></b>?</div>
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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.</div>
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Q <b><u>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?</u></b></div>
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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.</div>
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Q<b><u> I am 12 weeks pregnant.Is it safe to have sexual intercourse?</u></b></div>
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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.</div>
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Q <b><u>What should my diet be at 12 weeks?</u></b></div>
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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.</div>
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Q <b><u>Are there any foods that I should avoid now that I am in my second trimestor?</u></b></div>
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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.</div>
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Q <b><u>Is it true that I should avoid eating any shellfish and prawns during pregnancy?</u></b></div>
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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.</div>
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Q <b><u>What excercises can I do in my 12th week and what excercises should I avoid?</u></b></div>
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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.</div>
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Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-28080838689595577262011-07-07T11:42:00.000+08:002015-06-09T12:58:44.457+08:0012 to 16 weeks. Visits to your obstetrician<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u> I am 12 weeks pregnant. What can I expect at my visit to my obstetrician?</u></b><br />
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He may want to do an ultrasound scan. Your baby is now fully formed and is about 10 cms long. This is an important scan as he will probably want to determine if there is visible structural abnormalities, presence or abscence of nasal bone, nuchal fold thickness, and whether there is more than one foetus. Both height and weight, blood pressure and urine tested for sugar, blood and protein.<br />
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Q <b><u>What is nuchal fold thickness (NT) and why is it done?</u></b><br />
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Between 11 and 14 weeks the foetus will show fluid behind the nape of the neck. This is from the developing lymphatic system. The measurement is taken with the foetus lying on its back. It has been found that a thick fold may indicate a chromosomal abnormality and the greater the NT the greater the likelihood of an abnormality such as Down's Syndrome. Generally a NT of >2.5 cms would be taken as being abnormal. <br />
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Q <b><u>Why is it necessary to determine the presence of the nasal bone?</u></b><br />
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The nasal bone is absent in Down's Syndrome and many other chromosome abnormalities. A nasal bone measurement can be taken between 14 and 20 weeks. A measurement greater than 4.6mm would be considered as normal, while a measurement of less than 3.5mm would likely be a Down's. The ratio of the diameter of the head (BPD) to the nasal bone should by less than 8 and if > 10 is suggestive of Down's Syndrome.<br />
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Q<b><u> What is the Oscar Test?</u></b><br />
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This is a prenatal screen for Down's syndrome and other chromosome abnormalities. It measures the risk of having a Down's baby. It it is a combination of the nuchal fold thickness, and 2 blood parameters, free beta HCG and PAPP-A. The accuracy of the test is over 90%, however with any screen there are both false positives and negatives.The test is done from 11 to 14 weeks. If the test is positive, your obstetrician will advise you to have an amniocentesis (tapping of the baby's water bag to obstain foetal cells for culture and examination)<br />
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Q <b><u>What is the triple test and how does it differ from the oscar test?</u></b><br />
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The triple test is done at 15 weeks and above. It is also a prenatal screen for Down's syndrome and measures the 3 factors in the blood, alpha feto protein, free beta HCG and unconjugated estriol. The accuracy is over 80% and like the oscar test has both false positives and negatives. As with the oscar test, if positive, your obstetrician will advise an amniocentesis.</div>
Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-76576029400300865692011-06-17T11:06:00.001+08:002015-06-09T13:00:32.956+08:00Other concerns in early pregnancy<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>What are stretch marks and are they preventable?</u></b><br />
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Stretch marks are caused by the undue stretching of the collagen fibres in the skin that has been altered by the pregnancy hormones. They may occur on the abdomen, thighs, breasts. Alot depends on your skin type which is genetically determined. Some have more stretchable skin and do not get stretch marks while others may even get severe stretch marks all over. To avoid them, try not to put on too much weight, and avoid rapid weight gain. The bigger the baby the more likely you are to get stretch marks. They are generally unavoidable otherwise, and applying stretch mark creams are unhelpful. Stretch marks will lighten and turn to a silvery colour after birth. <br />
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Q <b><u> I have developed brown patches on my face during this pregnancy, and a dark line down the middle of my abdomen. Is this normal?</u></b><br />
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The brown patches are known as melasma, and the line, linear nigra. They are the result of an increase in the pigment hormone melanin. Generally they will lighten and disappear several months after delivery. There are medications such as triluma to apply to remove them, but are not advisable to use during pregnancy.<br />
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Q <b><u> I have been told that I have a retroverted or tilted womb. I am now 8 weeks pregnant. Will this in any way have an effect on my pregnancy?</u></b><br />
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About 10% of women are born with a tilted womb. Although there are some reports of a higher risk of miscarriage it does not appear to affect the outcome of the pregnancy. The uterus will usually correct itself and assume the normal anteverted position at about 16 weeks. A retroverted womb may cause some backache, constipation and difficulty in passing urine. If severe, can result in urinary retention and the need for catheterisation. The neck of the bladder may be stretched by the enlarging womb that eventually it is so narrow that urinary retention results. If persistent, admission to hospital may be necessary and an indwelling tube in the bladder inserted.<br />
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Q <b><u>I am in my 10th week of pregnancy and have found that I am having difficulty in passing urine. What is this due to?</u></b><br />
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If your obstetrician has told you that you have a tilted womb at your earlier examination, then that ios the cause of the difficulty in passing urine. The stretching and narrowing of the bladder outlet that is positioned over the uterus results in retention of urine. In the beginning there may be difficulty in passing urine and this may eventually lead to complete urinary retention. The treatment is admission to hospital and insertion of an indwelling catheter. The problem usually improves as the pregnancy advance s towards 16 weeks and the uterus rises out of the pelvis.</div>
Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-70635537022540455652011-06-17T10:23:00.002+08:002015-06-09T13:01:04.995+08:00Excercises in early pregnancy<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u> What excercises can I do in the early pregnancy?</u></b><br />
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If you have been doing some form of aerobic excercise before pregnancy it is alright to carry on, however do not overstrain and do it in moderation. Do not start vigorous excercise for the first time otherwise. Jogging and ball games should be avoided. Your joints and ligaments are more susceptible to damage during pregnancy. Jogging will divert precious oxygen and blood from the growing baby. Always start slow with warming up excercises and stretch well after your excercise. Swimming, cycling on a stationary cycle and walking are the ideal forms of aerobic excercises.<br />
<br />
Q <b><u>Can I do yoga?</u></b><br />
<br />
Yes but with limitation. Taking it as a form of stretching and toning excercise would be best. The muscles to tone would be the back, abdominal and calf muscles as these are the ones that would be worked most during your pregnancy. When lying on your back do not do this for long periods ie more than 5 minutes as this may cause a drop in your blood pressure and also reduce the blood flow to the baby. When getting up from the flow do so slowly as there may be a sudden fall in blood pressure.</div>
Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-69017630474968224822011-06-14T16:21:00.000+08:002015-06-09T13:03:26.283+08:00Nutrition and Diet<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>What are the nutritional requirements during pregnancy?</u></b><br />
<br />
Your requirements will change over the pregnancy. It should be a healthy one with more fibre, less sugar, salt and fat. Quality rather than quantity should be the aim. Definitely dont eat for two! Freshly prepared foods are preferable to canned foods which contain preservatives. Organic would be the ideal. Avoid fried and salty meals, cut down on snacks such as cookies, pastries, ice cream. Your diet should be balanced with a fair amount of protein, carbohydrates, fat. Your sources of protein are fish, meat, poultry, nuts, beans.<br />
<br />
As pregnancy advances, increase the protein intake and replace refined carbohydrates with complex ones such as wholemeal bread and brown rice which will provide you with energy but not cause sudden surges of glucose in your body. Vegetables such as brocolli, spinach, will provide you with folic acid, while fruits, tomatoes vitamin C which will protect against infections and build strong bones, teeth and gums. Vitamin A found in eggs, dairy, fish oils and vegetables are necessary for healthy skin, hair, nails and vision. Vitamin B found in meat, fish, eggs, cheese are necessary for brain and nervous system development. Vitamin D in fish, milk, eggs and cheese build bones. Vitamin E in cereals, vegetable oils maintain healthy red blood cells. Calcium in cheese and dairy for bones and teeth. Your calorie intake should gradually be increased from 2000 cal/day to 2400 cal/day in the third trimestor.<br />
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Q <b><u>What is my ideal weight gain during pregnancy?</u></b><br />
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You should aim for an average weight gain of about 12 to 15 kg throughout the pregnancy. A staedy weight gain of about 0.25 to 0.45 kg /week will ensure a favourable outcome. The weight gain may not be even. In the first trimestor you may not gain so much but don not be worried as your baby will be drawing from the reserves that you have built up before you were pregnant. From 12 to 20 weeks you should gain about 2 kg and between 20 and 40 weeks, 20kg.<br />
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Q <b><u> I weigh only 39kg and am pregnant. I have been on a diet. Will this affect my baby?</u></b><br />
<br />
At a weight of only 39 kg you are underweight by about 10-15 kg. It has been shown that starting a pregnancy with a low weight predisposes you to an approximately threefold increase in the risk of having a low birth weight baby. Definitely do not diet during pregnancy. Your weight gain should also depend on whether your build and how active you are. Intake should be between 1800 to 3000 cal/day.<br />
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Q <b><u> I am overweight and am pregnant. Should I diet?</u></b><br />
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Although obesity predisposes to hypertension, diabetes and more complications in pregnancy, it is not nutritionally advisable to diet. A negative calorie balance will result in the body utilising th eprotein necessary for foetal growth and development. Calorie restriction will result in in fat being broken down and the ketosis that results can be detrimental to the baby.<br />
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Q <b><u>I am obse and am planning to get pregnant. Should I diet?</u></b><br />
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You should try to reduce to as near as possible to normal weight for your height. Obesity in pregnancy carries inceased risk of complications such as medical problems, hypertension, diabetes, bigger baby and more difficult delivery, reduced mobility. Caesarean section in an obese patient carries higher anaesthetic risks and more difficult healing of the operative wound.<br />
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Q<b><u> I am a vegetarian. Will this affect my pregnancy?</u></b><br />
<br />
A vegetarian diet not taken to the extreme can be nutritionally adequate. The amount and quality of protein would be of importance. You will need at least 30 gms/day of protein in the form of milk, eggs, cheese, soya and beans.<br />
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Q <b><u>My obstetrician has told me that I do not need supplements during pregnancy. Will my diet be sufficient in providing adequate vitamins and minerals?</u></b><br />
<br />
If you start off pregnancy well nourished and with adequate stores and you follow the recommended increased requirements of calories, calcium, folic acid, and iron in your food then supplements may not be necessary. However in many asian and japanese diets intake of iron and calcium is inadequate. This is typically high in carbohydrate but low in protein which may lead to a state of deficiency in the later part of the pregnancy. Supplements are therefore highly recommended in the asian context.<br />
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Q <b><u>What are the exact requirements during pregnancy?</u></b><br />
<br />
The daily allowance of nutrients is only a guide. There is insufficient physiological information on the needs of women during pregnancy. As a rule the total calorie intake should be about 2300cal/day, more if you are heavier and active and less if you are small and less active. Protein should be 30-70 gm/day, calcium 1200cal/day, vitaminA 600u, vitamin D 400u, thiamin 1.5mg, nicotinic acid 15mg, ascorbic acid 50mg and folic acid 1 mg.<br />
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Q <b><u> Do I need supplements of vitamin A and D</u></b><br />
<br />
With a normal western diet the requirements are duly met. In some asian diets where dairy products are not readily consumed there may be insufficient vitamin A and D. As a result calcium may not be be easily absorbed. Supplementary vitamin D is then necessary. It should be cautioned that vitamin A and D in excess of the daily requirements may cause foetal abnormalities.<br />
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Q <b><u>I have been taking Royal Jelly supplements. Can I continue this during pregnancy.</u></b><br />
<br />
The actual nutritional and mineral value of royal jelly is unsubstantial. It however is high in sugar content. There is no harm in taking royal jelly but not in large amounts. It should also be cautioned that royal jelly may cause allergic and asthmatic reactions.<br />
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Q<b><u> Can I take birds nest during pregnancy. Will it be beneficial to my pregnancy?</u></b><br />
<br />
Birds nest is birds saliva which contains little then a small amount ofprotein. It therefore has not much nutritional value. It is however safe to take but should not be taken with too much rock sugar.<br />
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Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-62416266250557028422011-06-14T11:16:00.000+08:002015-06-09T13:03:59.644+08:00The early pregnancy. Ultrasound scanning<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>Is ultrasound scanning harmful to my baby?</u></b><br />
<br />
Ultrasound scanning has been used to study the foetus for many years. It emplys sound waves which are beyond the hearing range of humans. Studies have shown that at the frequency used, scanning is harmless and provides beneficial information about the foetus and its wellbeing. To date no adverse effects have been noted since the introduction of ultrasound scanning in the 1950's.<br />
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Q <b><u>What is the purpose of an ultrasound scan? How often will my obstetrician perform a scan during my pregnancy?</u></b><br />
<br />
Ultrasound scan will confirm the diagnosis of an early pregnancy by the finding of a gestational sac in the womb. The age of the foetus can be determined. This is particularly important when the periods are not regular. It will also indicate if the foetus is growing well, whether the foetus is structurally normal, the position and lie of the foetus. The recommended number is three, once in the early pregnancy, another at 11-14 weeks for the nuchal fold thickness, and the third at 20-24 weeks when a structural abnormality scan is performed. If the pregnancy is a high risk one, then serial scans should be done. Some obstetricians perform ultrasound scans at every visit and this is is also acceptable.<br />
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Q <b><u>What is a 3D ultrasound scan and how does this differ from a 2D?</u></b><br />
<br />
The conventional scan is a 2D scan. A 3D scan is volumetric and will show the foetus as a 3D picture. The features and external structures can be easily viewed with a 3D from 12 weeks onwards. The 3D scan is complementary to the 2D in function but may be more meaningful to you as 2D pictures are more difficult for you to visualise or comprehend.<br />
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Q <b><u> What is a 4D and how does it differ from 3D?</u></b><br />
<br />
4D scan is actually a 3D view but in motion. The foetus is viewed in the womb together with its motions in 3D. Sometimes the foetus can be seen sucking its fingers, yawning, swollowing the amniotic fluid, or blinking. 4D allows bonding and can be very meaningful to a mother to see her baby doing things in her womb!</div>
Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-52711796858984139622011-06-07T11:34:00.000+08:002015-06-09T13:05:09.901+08:00Common problems in early pregnancy<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u> I am in my early pregnancy and have been vomiting many times a day. What can I do?</u></b><br />
<br />
Most pregnant women will have some degree of vomiting from 6 weeks. It can vary from mild to severe. Certain factors may bring it aggravate it such as noisy, crowded places, where the smell of cooking is strong,, bumpy bus and car rides. Small frequent meals instead of bug meals should be taken, after eating if possible lie down. Sucking ice cubes or dry biscuits may help. Ant-vomiting pills may be taken and are safe. Should your vomiting become severe, then admission to hospital for rehydration and treatment will become necessary. Severe dehydration can affect the foetus and should be avoided. Dehydration is present if you lose weight and urination is reduced in frequency and amount passed. Your obstetrician will asess you and decide if admission is necessary.<br />
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Q <u><b>My obstetrician says that I am suffering from hyperemesis gravidarum. What is this and what needs to be done?</b></u><br />
<br />
This is a medical condition in which the vomiting is of a severe nature. It occurs in about 3:1000 pregnancies. There is dehydration, imbalance of elecrolytes, sodium and potassium, possible liver damage and is a danger to both mother and child. It may occur due to abnormally high pregnancy hormones due to multiple pregnancies . Your obstetrician will want to admit you. Rehydration and replacement of electrolytes are instituted, and the condition will rapidly improve. Liver function will also improve over time.<br />
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Q <u><b>What is heartburn? How can I avoid heartburn in pregnancy?</b></u><br />
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This is an uncomfortable sensation in the chest due to gastric juices being pushed up into the lower portion of the windpipe. This occurs as the muscle between the stomach and chest relaxes due to pregnancy. It tends to occur at night when lying down. Eating small frequent non-oily and spicy foods and sleeping in the upright posture will help. Antacids to neutralise the acid may also be taken.<br />
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Q <b><u>I am experiencing backache even though I am only 10 weeks pregnant. Is this normal?</u></b><br />
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The backache in early pregnancy may be related to a womb that is tilted backwards. The enlarging womb will put pressure on your spine. You may get some relief by sleeping on your side or tummy. The backache should get better once you reach 16 weeks as the enlarging womb rises out of the pelvis and starts to grow forwards.<br />
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Q <b><u> I suffer from gastritis. What can I take for it?</u></b><br />
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During pregnancy there will be an increase of gastric juices and acid. You should avoid all spicy foods. Have small frequent meals and avoid any foods that are acidic eg oranges. Antacids initially may be taken. If this does not relieve the discomfort, your obstetrician may give you something stronger such as cimetidine. This does not have any adverse effect on the pregnancy.<br />
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Q <b><u> I suffered from constipation prior to pregnancy. However my constipation has worsenedn ow that I am pregnant. Is this normal?</u></b><br />
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During pregnancy, there is a slowing of intestinal movements due to the effect of hormones. This may give you a feeling of of distension and constipation. You should drink at least 6 glasses of water a day, eat fruits and vegetables and high fibre foods. If it is still a problem you can ask your obstetrician for laxatives but you should avoid using them too frquently.<br />
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Q <b><u> I am in my early pregnancy and find that I am always breathless and tired. Is this normal?</u></b><br />
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The hormones in pregnancy will affect your breathing and chest muscles. This causes breathlessness and tiredness which increases as the pregnancy advances and the hormones rise. It is important however that you have yourself checked for any heart or lung problems. The symptoms will generally improve after 16 weeks gestation.<br />
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Q <u><b>I have noticed that I have frequent nose bleeds. Is this normal?</b></u><br />
<br />
Nose and gum bleeds are common and are caused by an increase in the total body blood circulation. Of course you should have yourself checked for anything serious such as hypertension, nasal polyps or other growths in the nose if the bleeding is frequent and persistent. It is also good to have your dentist do a check and cleaning during your pregnancy.<br />
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Q <u><b> I have been having pain in my teeth. Is this normal and should I see a dentist?</b></u><br />
<br />
Pain in the teeth is common during pregnancyand not something to be alarmed about. It is not due to vitamin deficiency. Your dentist will check for cavities. Cavities that have been enlarging during pregnancy may be due to insufficient calcium intake. Hence it is imporatnt that you get at least 1600mg calcium perday from supplements and food.<br />
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Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-82150801608079259802011-06-07T10:15:00.000+08:002015-06-09T13:06:30.084+08:00The early pregnancy. Infections and foetal abnormalities.<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>What is toxoplasmosis. Is it harmful?</u></b><br />
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This is a parasitic infection acquired through contact with cats. They are a contaminant of raw food. Avoid contact with cats faeces, consuming uncooked or semi-cooked food. If you have a cat it is best to avoid allowing the cat to sleep on your bed. Also do a blood test for toxoplasma antibodies. Infection during the early pregnancy can cause abnormalities in 18% cases. Such as small brain, excess water in brain, mental retardation.<br />
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Q <b><u> I have come into contact with the chicken pox virus. will this affect my my pregnancy?</u></b><br />
<br />
If you have had chicken pox before then it is less likely that you will get it a second time. The virus can only be potentially harmful if you contract the virus. Contact with the virus will not affect your pregnancy. The most common abnormalities occur when contracting the virus in the first trimestor. These include growth and mental retardation, abnormalities of the limbs and skin scarring.<br />
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Q <b><u>Will rubella infection affect my pregnancy?</u></b><br />
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German measles or rubella results in abnormalities in 20% infections. The virus may cross the placenta and cause serious abnormalities such as mental retardation, cataracts, deafness, heart defects.<br />
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Q <b><u>I am 6 weeks pregnant and have come into contact with a person with rubella. Will this affect my baby?</u></b><br />
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You should see your obstetrician right away. Blood tests will determine if you have immunity to rubella. He may want to give you passive immunisation with immunoglobulin. This injection may have to be repeated a few days later and if the blood tests show that after 3 weeks from contact you have not contracted rubella then you are safe!<br />
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Q <b><u> I have recently had a rubella vaccination and am now pregnant 2 months after the injection. will this affect my baby?</u></b><br />
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The advice that is normally given is that you should not get pregnant within 3 months of the vaccination. However from reports so far it now appears that there are no adverse effects on the pregnancy.<br />
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Q <b><u> I am now 6 weeks pregnant. Can I be vaccinated against the the chicken pox virus? Can I be vaccinated against flu?</u></b><br />
<br />
Generally live virus vaccination should not be done during pregnancy but if inadvertent vaccination has occured, you should not be alarmed as there are no reported effects on the pregnancy. It is recommended that you be vaccinated against flu virus during the flu season or if it is endemic. The effects of flu during pregnancy can be more serious then if you are not pregnant.<br />
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Q <b><u>can herpes simplex type I and II infections cause abnormalities?</u></b><br />
<br />
If it is the primary infection, herpes simplex can cause microcephaly ( reduced brain size), hydrocephalus ( enlarged head filled with excess water in the brain) and patent ductus ( an important blood vessel to the heart that does not close at birth). Transmission of the herpes virus is low during pregnancy but is more likely to occur during vaginal delivery.<br />
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Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-60173057376268460462011-06-02T11:11:00.000+08:002011-06-02T11:11:28.536+08:00The early pregnancy. Environmental factors and foetal abnormalities<div dir="ltr" style="text-align: left;" trbidi="on">Q Why is smoking in pregnancy bad?<br />
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The chance of a normal pregnancy outcome is reduced as complications are increased by the reduction in blood flow caused by nicotine to the foetus. Miscarriages, growth retardation, decreased birth weight, intra-uterine death and prematurity are some of the complications.<br />
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Q There are several smokers in my workplace. Will inhalation of cigarette smoke affect my baby. It has been shown that in fact inhalation of secondary smoke is even more potent to your foetus and may cause all the complications of smoking. It is important to try and avoid this as far as possible.<br />
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Q Is consuming alcohol harmful during pregnancy?<br />
<br />
The effect of alcohol depends on the amount you drink. Generally you should not exceed a glass of wine a week. Heavy drinking (>6 glasses) can cause foetal alcohol syndrome in as many as 50% pregnancies. This is characterised by low birth weight, a small head, abnormal features of the face and head, mental retardation and abnormal coordination with delayed physical and mental ability.<br />
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Q I have been taking high doses of vitamins before getting pregnant. Can this affect my pregnancy?<br />
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High doses of vitamin A and D appear to cause an increased incidence of miscarriages and foetal abnormalities of the face, head, heart, retardation of behaviour and central nervous system. Care should be taken when taking vitamins and only those advised by your obstetrician. Accutane, a derivative of vitamin D often used in the treatment of acne can also cause abnormalities.<br />
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Q I had a chest xray and then discovered I was pregnant. will this harm my baby?<br />
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Xrays used for diagnosis are safe as the amount of radiation is extremely low. A chest xray delivers < 5 rads to you of which only a small amount will go to the baby. If a lead shield is used, the amount is negligible. Doses of >50 rads are required to possibly cause foetal malformations such as mental retardation, cataracts, small brain, blood cancer.<br />
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Q Will a sauna or hotbaths affect my pregnancy?<br />
<br />
High temperatures may cause foetal abnormalities. It is best to avoid both especially in the first 16 weeks of pregnancy when the central nervous system of the baby is developing. Exposure to high temperatures has been shown to cause neural tube defects of the spine. The risk however is low. Neural tube defects can be diagnosed by an alpha foeto-protein blood test and a 2/3D scan of the foetal spine.<br />
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Q Will contact with petrochemicals affect my pregnancy?<br />
<br />
Breathing vapours or skin contact with certain chemical solvents such as polychlorinated biphenyls may cause abnormalities such as growth retardation and skin pigmentation.<br />
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Q What medications can affect my pregnancy?<br />
<br />
As a general rule you should avoid any medication in the first trimestor unless necessary. There are certain medications which are definitely harmful whentaken. The US Food and Drug Aministration in 1980 came out with the categorisation for use of drugs in pregnancy:<br />
Category A: Adequately controlled studies on humans have shown no risk. Vitamins not exceeding the recommended daily allowance are under this category.<br />
Category B: No evidence of risk in humans. Either animal studies show risk but human findings do not or if no adequate human studies have been done, animal studies are negative with regards to antihistamines, certain antibiotics with antifungals such as chlorpheniramine, penicillins, cephalosporins, sulphonamides, metronidazole, erythromycin, clindamycin, nystatin, prednisolone, insulin, vaccines such as hepatitis B, tetanus.<br />
Category C: Risk cannot be ruled out as human studies are lacking. However, potentail benefits may justify the risk of use. This includes aspirin, betamethasone, codeine, dexamethasone, gentamycin, heparin, methyldopa, diazepam.<br />
Category D: Positive evidence of risk to the foetus but potential benefits may outweigh the risks. This includes medroxyprogesterone, phenobarbitol, phenytoin, streptomycin, tetracycline, quinine.<br />
Category X: Disallowed in pregnancy as studies have shown foetal risk outweighs all possible benefits. This includes clomiphene, oestrogen, ethanol, isotretinoin, live vaccines such as measles, mumps, smallpox and oral contraceptives.<br />
<br />
Q What antibiotics can I take and what cannot I take during pregnancy?<br />
<br />
The majority of antibiotics are safe. Penicillins are widely prescribed and are safe during pregnancy. Tetracyclines can cause permanent staining of teeth, streptomycin, 8th nerve damage and hearing loss in 15% of infants.<br />
<br />
Q My GP has given me some cough mixture and anti-flu maedines. They they safe to take?<br />
<br />
Cough mixtures should not be consumed for long periods. They are generally safe but if your cough is protracted ie more than 2 weeks, you should have yourself tested for mycoplasma chest infection or pneumonia rather than simply continuing with the cough mixture. High fever can be potentially harmful and should be contained below 38 degrees F.<br />
<br />
Q I am epileptic and suffer from frequent fits. I am on anticonvulsants. what effect do these drugs have on my pregnancy?<br />
<br />
Specific patterns of abnormalities have been observed with different anti-convulsants. Dilantin can cause a syndrome characterised by abnormalities of the face, skull, limbs, heart and mental retardation. About 40% of exposed foetuss will have this abnormality. Tegretol also causes similar abnormalities. Trimethadone and paramethadone used in the treatment of minor convusions (petit mal convulsions) cause abnormalities in 85% exposed foetuss and should not be used.<br />
<br />
Q I have been taking sleeping tablets, valium. will this affect my pregnancy?<br />
<br />
the reporst are conflicting but there are reported cases of foetal abnormalities, and evidence that valium does cross the placental barrier to the foetus. Certain major tranquilisers such as lithium have been proven to cause abnormalities.<br />
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Q I was taking oral contraceptives when I discovered that I was pregnant. Will this affect my pregnancy?<br />
<br />
Reported abnormalities include congenital heart defects, nervous system defects, limb and sex organ abnormalities. Sex organ abnormalities are usually seen with the higher dose oral contraceptives. the low dose contraceptives that are normally used today do not appear to have any effect on the foetus.<br />
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Q I have been using the intrauterine contracetive device (IUCD) and discovered I am pregnant. What do I do?<br />
<br />
You should go to see your obstetricians who will do certain tests to exclude an ectopic pregnancy. An IUCD increases the risk of ectopic pregnancies. An ultrasound scan will detremine if the pregnancy is healthy. If there is no bleeding and the pregnancy healthy, the IUCD can be removed and the baby delivered as normal. If there has been bleeding or the IUCD thread cannot be seen on vaginal examination, then the IUCD is left inside and can be removed during the delivery of the placenta. There are no consistent reports of adverse effects of the IUCD on the foetus. It is very safe to proceed wuth the pregnancy.<br />
<br />
Q I work with computers throughout the day. Will this harm my pregnancy?<br />
<br />
Although there have been various reports of miscarriages with exposure to low electromagnetic waves, recent studies by the RCOG have shown that they do not increase the incidence of miscarriages or prematurity. and that it is safe to ahve prolonges exposure to computers.<br />
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</div>Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-6939068066184940212011-06-02T09:47:00.000+08:002011-06-02T09:47:41.521+08:00The early pregnancy. Visits to your obstetrician / miscarriages<div dir="ltr" style="text-align: left;" trbidi="on">Q I am now pregnant. When should I see an obstetrician and what should I expect at this visit?<br />
<br />
You should arrange for your first visit between 6 and 8 weeks. this is the best time unless you have a problem before this. He will want to do an ultrasound scan to confirm the pregnancy and to get an expected date of delivery (EDD). At 6 weeks it is possible to determine the presence of a heartbeat and exclude a pregnancy that is not in the womb but the tubes (ectopic pregnancy). He will take a full obstetric and gynaecological history, ask you about the regularity of your periods and past contraceptive use. Your height and weight are measured, your pulse and blood pressure taken, and urine examined for sugar, protein and signs of infection. In the early stage a transvaginal rather than an abdominal ultrasound scan would give a clearer picture. A PAP smear may be done depending on the obstetrician. (some do this after the delivery as it may cause bleeding).<br />
<br />
Q I have a positive pregnancy test, but do not feel any symptoms. Should I be worried?<br />
<br />
In the first 4 weeks, most will not feel any symptoms. At 5 weeks, you may feel some tiredness and frequency of urine. Distension and loss of apetite, giddiness and abdominal pulling sensations are common. At 8-10 weeks, the hormone levels are at its peak and you may feel the most symptoms such as nausea and vomiting. In 20% pregnancies there are relatively no symptoms. Having symptoms is a good sign that the pregnancy is likely to be alright. However if there are no symptoms, you should not be unduly worried. An ultrasound scan by your obstetrician will determine if the foetus is alright.<br />
<br />
Q I am 6 weeks pregnant and have found out through an ultrasound scan that my baby's water bag is smaller than expected. Should I be unduly worried?<br />
<br />
Assuming that your periods are regular, the size of the water bag should correspond to your period of amenorrhoea. the possible causes could be be wrong dates given, delayed ovulation or a blighted ovum (foetus that has not been growing). If your periods are irregular, then you may have conceived later and the foetus is actually smaller than 6 weeks. You should not be unduly worried as a single ultrasound scan will not distinguish between a blighted ovum and wrong dates. You should have a repeat ultrasound 2 weeks later to see if the foetus has grown. An ultrasound scan at 7 weeks will also pick up the foetal heartbeat and if present will rule out a blighted ovum.<br />
<br />
Q I have been for my first visit to my obstetrician. he has told me that he is not able to see the baby's water bag. Should I be worried?<br />
<br />
In the early stages of pregnancy, it may not be possible to see the pregnancy sac. factors such as position of the womb, obesity, sophistication of the scanner will determine if a 4 week pregnancy can be seen. At 5 weeks, he should be able to see the pregnancy sac, if not it raises the possibility of an ectopic pregnancy. He may want to do serial hormone levels and ultrasound scans to rule out this possibility.<br />
<br />
Q I have been told that my baby has not been growing. Why is this and what is the cause?<br />
<br />
If serial ultrasounds show a slow growth or abscence of a heartbeat then your pregnancy has undergone a miscarriage. This is termed a blighted ovum or missed abortion. It is due to an improperly formed foetus. As the hormone levels will rise slower or decrease, there may not be much in the way of pregnancy symptoms. Bleding may or may not be present. Very often the diahnosis is made even before bleeding occurs on ultrasound scan. The typical features would be an irregular shaped pregnancy sac, abscence of heartbeat and low or falling hormone levels. Your obstetrician will then perform an evacuation of the uterus. This should be done as soon as possible as any delay can result in infection or bleeding disorders.<br />
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Q I am 7 weeks pregnant. I have noticed some bleeding. What is this due to and what should I do?<br />
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You are probably having a threatened miscarriage. Bleeding due to a threatened miscarriage is as common as 1:5 pregnancies. You should stop all physical activity and seek your obstetrician. He will want to do a vaginal examination as the bleeding may also be from a growth in the cervix. An ultrasound scan will determine the viability of the foetus. If the heartbeat is present then there is a good chance that with bed rest and hormonal support, the pregnancy will be an ongoing one. Bed rest for up to 4 days after the bleeding stops is important. If the bleeding is heavy and especially if there are cramps, your obstetrician may decide to admit you to hospital for rest.<br />
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Q I am 7 weeks pregnant and have been having heavy bleeding with cramps. What will my obstetrician do?<br />
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Your obstetrician will want to determine whether a miscarriage has occured. Ultrasound scan will show an absent pregnancy sac or some products of conception if this is so. An evacuation to clean up the womb may be deemed necessary.<br />
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Q I have had 3 first trimestor miscarriages. I am planning for a 4th pregnancy. What are the likely causes of recurrent miscarriages and what can be done?<br />
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There are various causes, including genetic abnormalities, hormonal problems, infections, excessive smoking or drinking, medical problems and anti-phospholipid antibody syndrome (APA). A blood test to screen for diabetes, systemic lupus erythematosis (SLE), APA, infections such as rubella, toxoplasmosis, cytomegalovirus and genetic karyotyping for both you and your husband will be done, including a hormone profile.<br />
The treatment will depend on the cause. If a due to a lack of the pregnancy hormone, progesterone, treatment with utrogestan (micronised progesterone) together with human chorionic gonadotrophin injections has been shown to improve outcome greatly. If APA positive, treatment is with a combination of low dose aspirin and heparin.This is to reduce the clot formation in the placenta that impairs the blood supply to the foetus. The combination gives a success rate of 75%.<br />
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</div>Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-89535376709086488662011-05-28T11:19:00.000+08:002015-06-09T15:00:33.093+08:00The early pregnancy (Antenatal): Signs and symptoms<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>What are the early symptoms of pregnancy as I suspect I may be pregnant?</u></b><br />
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A feeling of constant tiredness, giddiness, painful breasts, pulling sensations in the lower tummy, frequent urination and a bloatedness may be present before 6 weeks. From then nausea and vomiting may present as mild to severe as the hormone levels in the body rise to a peak. About 80% women will have some degree of nausea and vomiting.<br />
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Q <b><u>Are there other signs to suggest that I am pregnant?</u></b><br />
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Your temperature may rise and remain higher than normal, the area around your nipple will become more pigmented and there may be little bumps called Montgomery's tubercles. Pressing the breasts may cause a nipple discharge of colostrum from 16 weeks.<br />
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Q <b><u>How can I confirm my pregnancy?</u></b><br />
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Your body releases a hormone called human chorionic gonadotrophin (HCG) and this can be detected in the urine at low levels (50mIU.ml) with standard pregnancy test kits. It is possible that the test may even be positive 2-3 days before you miss a period. Blood HCG levels are even more sensitive and can be done if there is doubt from the urine test or if there is a doubt about the health of the pregnancy. Pelvic ultrasound scan will show a small gestational sac as early as 5-6 weeks, appearing as a tear drop shaped shadow at the top of the uterus.<br />
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Q <b><u>How is my expected date of delivery (EDD) calculated? I know the exact day that I conceived. Will this help in the calculation of my EDD?</u></b><br />
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Your EDD is calculated as 40 weeks from the first day of your last period (LMP), not from the day of conception which would be 14 days later for a 28 day cycle. If your periods are irregular than calculation from your LMP would not be accurate. Your obstetrician will then do an ultrasound scan to determine your EDD based on the length of the foetus and the gestational sac. Ultrasound scan for dating is accurate to within 4 days if done in the first trimestor (up to 12 weeks).<br />
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Q <b><u>What is a full term pregnancy and when is the baby considered mature for delivery?</u></b><br />
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A full term pregnancy is 40 weeks plus or minus 2 weeks. The baby's lungs are mature after 37 weeks. Most baby's will deliver between 37 and 40 weeks but a small percentage will go beyond 40 weeks. Labour before 37 weeks is considered as premature.<br />
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Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0tag:blogger.com,1999:blog-3201909762909063471.post-77428199049607658792011-05-27T16:38:00.001+08:002015-06-09T14:59:49.648+08:00Before pregnancy (Prenatal): Preparing yourself for pregnancy<div dir="ltr" style="text-align: left;" trbidi="on">
Q <b><u>I am preparing to start a family. What are the things I need to know before I see my obstetrician?</u></b><br />
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You will want to know if you have had your vaccinations for rubella, hepatitis A and B, and flu. A family history of inherited disorders should be sought both on yours and your husband's side such as mental retardation, thalassaemia (an inherited blood disorder), down's syndrome or any chromosomal disorder. Past illnesses and operations should be noted and any treatment or medications for present illnesses recorded. Allergies to drugs should be known. You should also convery past gynaecological problems to your obstetrician.<br />
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Q <b><u>I plan to get pregnant soon. Do I need to see an obstetrician for an examination and what can i</u></b><br />
<b><u>I expect at this examination?</u></b><br />
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Yes, it is advisable to see an obstetrician prior to your conceiving. He will want to take a medical, gynaecological and family history, perform a general examination including taking your blood pressure and testing your urine for sugar. He will also want to perform a gynaecological examination to exclude conditions such as endometriosis (blood cysts) or fibroids, both of which are common in women and can affect fertility. A pelvic ultrasound scan will detect these conditions. Having taken a history of your menstrual cycle he can then advise you on the best time to conceive. He will want to do certain blood tests and if necessary genetic counselling.<br />
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Q <b><u>Does my husband need to have a medical check-up prior to my conceiving?</u></b><br />
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If your husband has a history of a genetic disorder, fathered a child with a birth defect, previously contracted a sexually transmitted disorder, had mumps or tuberculous infection (both of which can cause damage to the testicles and infertility) he should then go for a check-up.<br />
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Q <u><b>How soon and how should I prepare myself for my pregnancy?</b></u><br />
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You should start preparing as early as 3 months before getting pregnant. Try and determine when you are ovulating. If your periods are regular, ovulation is 2 weeks before your next period. If your periods vary by a few days, an ovulation (LH) kit from the pharmacy can help you determine your date of ovulation. You should take a folic acid 5mg/day to prevent miscarriages and abnormalities. A general multivitamin and a well balanced diet should be consumed. Avoid high doses of multivitamins A and D as they can cause foetal abnormalities. If you smoke or drink, you should try to reduce or cut it out totally. If you are diabetic or hypertensive you will need to see your doctor to have these well controlled before pregnancy. Excercise moderately and if fit you can continue through into your pregnancy. Avoid gaining excessive weight or dieting, contact with chemicals, taking long distance flights during the months that you are trying to conceive.<br />
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Q<b><u> I have been on oral contraceptives and now want to start a family. Do I have to wait after stopping before trying for a pregnancy?</u></b><br />
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If you have been on the OC for some time, it may take several months for your ovaries to start functioning properly. Once the periods become regular you have started ovulating and there is no reason not to start right away. There are no adverse effects on your pregnancy.<br />
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Q <b><u>What foods should I consume in preparation for my pregnancy?</u></b><br />
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You will want to eat a healthy, sensible diet. If it is possible, go with organic food as much as possible. Eat lots of food rich in vitamins and fibre. Do eat fresh foods, vegetables and fruits. Avoid foods high in preservatives or unrefined carbohydrates. Oily fish and lean meats are best.<br />
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Q <b><u>Do I need to do any excercise prior to conceiving?</u></b><br />
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Pregnancy is a stress on the body. For you to enjoy your pregnancy you should try to keep yourself fit. Start by doing excercises such as walking half an hour a day, swimming and cycling twice aweek. Your excercises may be carried on into your pregnancy. keep your muscles toned and joints supple with stretching excercises or yoga. Toning excercises should be aimed at your abdominal muscles, lower back and calf muscles. Avoid jogging or running.<br />
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Q <b><u>Why do I need to keep myself fit before my pregnancy?</u></b><br />
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Excercise benefits are prevention of backache and improvement of posture and as a result less pain during the nine months of pregnancy. If you are fit and healthy, you are more likely to enjoy your pregnancy and suffer less from pain and depression. It may also help with recovery after your delivery. Start early and gradual rather than vigorous and late in the pregnancy.<br />
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Q <b><u>What can I do to minimise the risk of birth defects in my baby?</u></b><br />
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You may not be aware but the the crucial period is the two weeks before you miss your period and discover that you are pregnant. During this time, you should avoid having any xrays, going on long distance flights (exposure to cosmic rays), all medicines, chemicals (especially petrochemicals), make-up eg lipstick (contains pthalates). You should stop consumption of all alcohol, smoking, perming or dying your hair, hot tubs or saunas. Of course it is not possible to avoid all contaminants but minimise them as much as possible.<br />
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Q <u><b>Do I need genetic counselling before conceiving?</b></u><br />
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You should be counselled if 1. you or your spouse has a birth defect or genetic disorder, 2. you or your spouse has a child or close relative with a birth defect, mental retardation or any genetic disorder, 3. you or your spouse is a carrier of a genetic disorder such as thalassaemia, 4. you are above 35 years, 5. have had 3 or more miscarriages or stilborn foetus.<br />
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Q<b><u> What is the best age to start having a baby? </u></b><br />
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Your most fertile years are in your 20's and you are less likely to run into complications. In your 30's, fertility begins to decrease and the pregnancy risks start to rise such as miscarriages, abnormalities, medical problems- hypertension, diabetes, difficult deliveries. All these rise dramatically after the age of 40. The earlier the better.<br />
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Q <u><b>How long will it take for me to get pregnant?</b></u><br />
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If you have regular cycles and having sexual intercourse at the right time, it would take you on average 3 months of trying to get pregnant. The chance of pregnancy each cycle is approximately 30%. If you have tried without success for more than 6 months, then you should consult you gynaecologist to see if there is anything wrong. If after a year of trying there is almost certainly something wrong and both you and your spouse will need to see a gynaecologist.<br />
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Q<b><u> What blood tests should I do prior to conceiving?</u></b><br />
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A hormone profile will indicate whether you are fertile, other tests would be tests for sexually transmitted disorders, a full blood count and electrophoresis for thalassaemia (an inherited blood disorder), and a hepatitis A,B and C screen.</div>
Dr. Gordon Lim http://www.blogger.com/profile/08628657462979786556noreply@blogger.com0