Preeclampsia Causes, Treatment and Prevention

Who is at risk for preeclampsia?

• A first-time mom
• Previous experience with gestational hypertension or preeclampsia
• Women whose sisters and mothers had preeclampsia
• Women carrying multiple babies
• Women younger than 20 years and older than age 40
• Women who had high blood pressure or kidney disease prior to pregnancy
• Women who are obese or have a BMI of 30 or greater

What are the symptoms?

Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, or it may have a sudden onset. Monitoring your blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least four hours apart — is abnormal.

Mild preeclampsia: high blood pressure, water retention, and protein in the urine.

Severe preeclampsia: headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency to bruise easily.

Other signs and symptoms of preeclampsia may include:

• Excess protein in your urine (proteinuria) or additional signs of kidney problems
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Upper abdominal pain, usually under your ribs on the right side
• Nausea or vomiting
• Decreased urine output
• Decreased levels of platelets in your blood (thrombocytopenia)
• Impaired liver function
• Shortness of breath, caused by fluid in your lungs

Contact your doctor immediately if you experience blurred vision, severe headaches, abdominal pain, and/or urinating very infrequently.

How do I know if I have preeclampsia?

At each prenatal checkup, it’s important that your healthcare provider checks your blood pressure because an early symptom of preeclampsia is a rise in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater, documented on two occasions, at least four hours apart is abnormal.

Your physician may also perform other tests that include: checking your urine levels, kidney and blood-clotting functions; an ultrasound scan to check your baby’s growth; and Doppler scan to measure the efficiency of blood flow to the placenta.

What is the treatment?

Treatment depends on how close you are to your due date. If you are close to your due date, and the baby is developed enough, your health care provider will probably want to deliver your baby as soon as possible.

If you have a mild case and your baby has not reached full development, your doctor will probably recommend you do the following:

• Rest, lying on your left side to take the weight of the baby off your major blood vessels.
• Increase prenatal checkups.
• Consume less salt
• Drink at least 8 glasses of water a day
• Change your diet to include more protein

If you have a severe case, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely, along with possibly bed rest, dietary changes, and supplements.

How can preeclampsia affect the mother?

If preeclampsia is not treated quickly and properly, it can lead to serious complications for the mother such as liver or renal failure and future cardiovascular issues.

It may also lead to the following life-threatening conditions:

• Eclampsia– This is a severe form of preeclampsia that leads to seizures in the mother.
• HELLP Syndrome (hemolysis, elevated liver enzymes, and low platelet count)- This is a condition usually occurring late in pregnancy that affects the breakdown of red blood cells, how the blood clots, and liver function for the pregnant woman.

How does preeclampsia affect my baby?

Preeclampsia can prevent the placenta from getting enough blood. If the placenta doesn’t get enough blood, your baby gets less oxygen and food. This can result in low birth weight. Most women still can deliver a healthy baby if preeclampsia is detected early and treated with regular prenatal care.

How can I prevent preeclampsia:

The exact cause of preeclampsia is not known. It’s thought to be improper functioning of the placenta including insufficient blood flow to the placenta. Other factors that may increase risk include: high fat and poor nutrition; immune function disorders; genetic issues or a family history.

Currently, there is no sure way to prevent preeclampsia. Some contributing factors to high blood pressure can be controlled and some can’t. Follow your doctor’s instruction about diet and exercise.

• Use little or no added salt in your meals
• Drink 6-8 glasses of water a day
• Avoid fried foods and junk food
• Get enough rest
• Exercise regularly
• Elevate your feet several times during the day
• Avoid drinking alcohol
• Avoid beverages containing caffeine
• Your doctor may suggest you take the prescribed medicine and additional supplements

What are the Causes of Preeclampsia?

According to the Mayo Clinic, the exact cause of preeclampsia involves several factors. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta.

In women with preeclampsia, these blood vessels don’t seem to develop or function properly. They’re narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them.

Causes of this abnormal development may include:

• Insufficient blood flow to the uterus
• Damage to the blood vessels
• A problem with the immune system
• Certain genes

Want to Know More?

• High Blood Pressure During Pregnancy
• Understanding a High Risk Pregnancy

Compiled using information from the following sources:

1. Medscape; Hypertension and Pregnancy

2. Preeclampsia Foundation

3. Mayo Clinic

The post Preeclampsia appeared first on American Pregnancy Association.

Can Babies Get EBV?

In healthy infants and adults, there is often no apparent infection from the first introduction to EBV. Teenagers and young adults, as well as patients with lower functioning immune systems (people with AIDS and other immune diseases), may see more significant symptoms and may develop infectious mononucleosis (“mono”).

Though EBV is not the only virus that can cause infectious mononucleosis, it is the most common cause. In teens and young adults, 1 in 4 infections with EBV will result in a mononucleosis infection.
EBV can also cause many other diseases and conditions, including but not limited to:

• Viral meningitis
• Encephalitis
• Transverse myelitis
• Optic neuritis
• Paralysis of facial muscles or on one side of the body
• Acute Cerebellar Ataxia
• Guillain-Barre syndrome
• Pancreatitis
• Myocarditis
• Pneumonia
• Lung disease
• Lymphocytosis
• Weakened immune system

To find out more about these other possible illnesses, visit the CDC’s website here. If you are concerned about any symptoms that you are having, please call your doctor right away.

How is it spread?

The virus is spread mainly through saliva but can spread through all bodily fluids. “Mono,” or infectious mononucleosis, is a common infection that can result from EBV and among teenagers is often called the “kissing disease” due to its ease of transmission in saliva.

What are the symptoms of an EBV infection?

Symptoms of an EBV infection may include:

• Fever
• Sore throat
• Exhaustion
• Skin rash
• Swollen neck lymph nodes
• Enlarged liver and spleen

These symptoms should only last as long as any other common illness, typically no longer than 1-2 weeks. Occasionally, fatigue may last longer.
Remember that many children and healthy adults will not experience any symptoms, or the symptoms may seem like a normal childhood illness or the common cold. Those who are most susceptible to having these symptoms are those with compromised or low-functioning immune systems (persons with HIV/AIDS, some pregnant women, teenagers, and maybe even more so someone with teen pregnancy.).

What are the symptoms of infectious mononucleosis?

The symptoms of infectious mononucleosis are similar to EBV but are more severe. They may include:

• Fever
• Extreme exhaustion
• Sore throat
• Skin Rash
• Headaches
• Body aches
• Swollen neck & armpit lymph nodes
• Swollen liver and/or spleen

You may shake these symptoms in 1-2 weeks, but occasionally it can take more time to get back to your normal level of energy (a few weeks to 6 months). If your symptoms persist six or more months past diagnosis, you may be diagnosed with rare chronic active EBV infection. You should contact your doctor if your symptoms don’t subside after two weeks, and especially after six months.
Keep in mind that though EBV is the most common cause of infectious mononucleosis, it is not the only possible cause. Other causal factors include cytomegalovirus (CMV), toxoplasmosis, hepatitis A/B/C, HIV, rubella (measles), or adenovirus.

How is EBV diagnosed?

Since EBV’s symptoms are similar to many other minor illnesses, the best way to determine EBV infection is a blood test for antibodies specific to EBV. If these antibodies are present, it indicates the presence of EBV.

I have infectious mononucleosis; how do I know if it is from EBV?

Infectious mononucleosis is typically diagnosed from symptoms alone; however, sometimes it is necessary to determine the cause. In this case, testing with the following results may indicate EBV infection:

• Abnormal white blood cells
• A higher number of white blood cells than normal
• Fewer neutrophils
• Fewer platelets
• Proteins/enzymes indicative of an atypical liver function

What is the treatment for EBV infection?

Since it is a virus, there are not many options for treatment other than to reduce the symptoms. Pain killers and fever reducers such as ibuprofen or acetaminophen can reduce any body aches and control fever. Rest and proper hydration (water, electrolyte drinks) are useful approaches to managing the symptoms.
For pregnant women, acetaminophen can be taken to reduce fever and treat body aches – avoid ibuprofen.

If I get infectious mononucleosis from EBV, is there a different treatment?

The answer depends on the severity of your sickness. Infectious mononucleosis will need to be monitored by your doctor and the same above measures taken to reduce the symptoms, as well as an extended resting period. If the infection negatively affects your organs (specifically the spleen and/or liver), your doctor may take steps to treat these as well. Because infectious mononucleosis can cause an enlarged spleen, do not participate in contact sports to avoid rupturing the spleen.

How can I avoid contracting or transmitting EBV and/or infectious mononucleosis?

Since the virus can pass in saliva and other bodily fluids, avoid kissing and sharing drinks, food, toothbrushes; also avoid anal, vaginal, or oral intercourse with someone you know has EBV, or if you have EBV.

EBV and Infectious Mononucleosis During Pregnancy

Is treatment the same if I am pregnant and have EBV or infectious mononucleosis?

Typically, yes, the treatment will be the same. Acetaminophen should be used instead of ibuprofen to reduce fever and body/headaches. Rest and hydration are crucial, especially during pregnancy, since the developing fetus depends on having a hydrated and well-rested mother.

The biggest concerns would be (1) keeping any organ infection or damage to a minimum, and (2) ensuring that the mother’s temperature does not rise too high or stay high for too long. This is because the developing baby is more sensitive to temperature than the mother’s body is. High temperatures have the potential to cause miscarriage (first half of pregnancy), birth defects (first trimester), and/or preterm delivery (if fever is associated with infection of an organ).

Can Babies Get Mono?

Research since the 1980s has shown different answers to this question. Some studies show that there is no correlation between EBV reactivation during pregnancy and congenital disabilities or early delivery/low birth weight. More recently, one study demonstrated a link between significant EBV reactivation and early delivery and low birth weight. Another found a relationship between maternal depressive symptoms around week 32 and late EBV activation before delivery.

More research is needed on EBV activation and its effects on pregnancy and the fetus. Nearly all studies agree that EBV reactivation is not associated with fetal death. If we take high fever out of the equation, it is possible that EBV activation or infection during pregnancy could be related to early delivery and low birth weight.

Will the virus be passed to my baby?

Some studies reported infection with EBV of a newborn born to a mother with EBV, though the percentage was small. There is no clear indication of whether the virus is passed in utero or during delivery. Talk to your healthcare provider about any interventions he or she thinks is necessary to prevent transmission.

The good news is that, even if EBV is transmitted from you to your baby, EBV in infancy and childhood is typically asymptomatic, with few children seeing episodes of infection. Additionally, most people will have EBV by the time they are 35 years of age, the so chances are that your baby would someday contract EBV anyways.

Is it safe to breastfeed my baby if I have EBV and he/she does not?

Data shows that EBV can be present in breast milk, but there are no studies as of yet that determine if this results in transmission to the infant.

The best course of action is to speak with your doctor about your EBV status and how that affects your pregnancy and your baby after delivery.

Want to Know More?

• Sexually Transmitted Diseases (STDs) and Pregnancy
• How to Stay Health While Pregnant During  Pandemic

Compiled using information from the following sources:

1. CDC: About EBV: https://www.cdc.gov/epstein-barr/about-ebv.html

2. CDC: About Mononucleosi: https://www.cdc.gov/epstein-barr/about-mono.html

3. CDC: For Healthcare Providers: https://www.cdc.gov/epstein-barr/hcp.html

4. Mayo Clinic: Mononucleosis and Epstein-Barr: What’s the connection?

5. Mayo Clinic: Mononucleosis: Diagnosis & Treatment.

6. Mayo Clinic: Mononucleosis: Can it recur?

7. Persistent Epstein-Barr Virus infection and pregnancy. J Infect Dis. Jun 1983.

8. Epstein-Barr Virus infection in pregnancy — a prospective controlled study. Reprod Toxicol. 25 Aug 2008. 10.1016/j.reprotox.2008.04.004

9. Infectious mononucleosis during gestation: report of three women and their infants studied prospectively. Pediatr Infect Dis. Jul 1984.

https://www.ncbi.nlm.nih.gov/pubmed/6473132

10. Epstein-Barr Virus infections in pregnancy: a prospective study. J Pediatr. Mar 1984.

11. Epstein-Barr Virus infection during pregnancy and the risk of adverse pregnancy outcome. BJOG. 22 Sep 2005. doi: 10.1111/j.1471-0528.2005.00764.x

12. Maternal depressive symptoms related to Epstein-Barr virus reactivation in late pregnancy. Scientific Reports. 31 Oct 2013. doi: 10.1038/srep03096

https://www.nature.com/articles/srep03096

13. Recommendations for breastfeeding during maternal infections. J. Pediatr. (Rio J.) Nov 2004. https://dx.doi.org/10.1590/S0021-75572004000700010

14. Study of mother-to-child Epstein-Barr virus transmission by means of nested PCRs. J Virol. Oct 1996.

15. Epstein-Barr virus (EBV) infection in infancy. J Clin Virol. Apr 2001.

16. Livestrong: Effects of High Temperature on Pregnancy.

The post Mono and Pregnancy appeared first on American Pregnancy Association.

Some basic things to know about bleeding:

• If you are bleeding, you should always wear a pad or panty liner, so that you can monitor how much you are bleeding and what type of bleeding you are experiencing.
• You should never wear a tampon or introduce anything else into the vaginal area, such as douche or sexual intercourse if you are currently experiencing bleeding.
• If you are also experiencing any of the other symptoms mentioned below in connection with a possible complication, you should contact your health care provider immediately.

First Half of Pregnancy:

Miscarriage: Bleeding can be a sign of miscarriage, but does not mean that miscarriage is imminent. Studies show that anywhere from 20-30% of women experience some degree of bleeding in early pregnancy. Approximately half of the pregnant women who bleed do not have miscarriages. Approximately 15-20% of all pregnancies result in a miscarriage, and the majority occur during the first 12 weeks.
Signs of Miscarriage include:

• Vaginal bleeding
• Cramping pain felt low in the stomach (stronger than menstrual cramps)
• Tissue passing through the vagina

Most miscarriages cannot be prevented. They are often the body’s way of dealing with an unhealthy pregnancy that was not developing. A miscarriage does not mean that you cannot have a future healthy pregnancy or that you yourself are not healthy.

Ectopic Pregnancies:

Ectopic pregnancies are pregnancies that implant somewhere outside the uterus. The fallopian tube accounts for the majority of ectopic pregnancies. Ectopic pregnancies are less common than miscarriages, occurring in 1 of 60 pregnancies.
Signs of Ectopic Pregnancies:

• Cramping pain felt low in the stomach (usually stronger than menstrual cramps)
• Sharp pain in the abdominal area
• Low levels of hCG
• Vaginal bleeding

Women are at a higher risk if they have had:

• An infection in the tubes
• A previous ectopic pregnancy
• Previous pelvic surgery

Molar Pregnancies:

Molar pregnancies are a rare cause of early bleeding. Often referred to as a “mole”, a molar pregnancy involves the growth of abnormal tissue instead of an embryo. It is also referred to as gestational trophoblastic disease (GTD).
Signs of a Molar Pregnancy:

• Vaginal bleeding
• Blood tests reveal unusually high hCG levels
• Absent fetal heart tones
• Grape-like clusters are seen in the uterus by an ultrasound

What are the common reasons for bleeding in the first half of pregnancy?

Since bleeding that occurs in the first half of pregnancy is so common, many wonder what the causes are besides some of the complications already mentioned.
Bleeding can occur in early pregnancy due to the following factors:

• Implantation bleeding can occur anywhere from 6-12 days after possible conception. Every woman will experience implantation bleeding differently—some will lightly spot for a few hours, while others may have some light spotting for a couple of days.
• Some type of infection in the pelvic cavity or urinary tract may cause bleeding.
• After intercourse, some women may bleed, because the cervix is very tender and sensitive. You should discontinue intercourse until you have been seen by your doctor. This is to prevent any further irritation—having normal sexual intercourse does not cause a miscarriage.

Second Half of Pregnancy:

Common conditions of minor bleeding include an inflamed cervix or growths on the cervix. Late bleeding may pose a threat to the health of the woman or the fetus. Contact your health care provider if you experience any type of bleeding in the second or third trimester of your pregnancy.

Placental Abruption:
Vaginal bleeding may be caused by the placenta detaching from the uterine wall before or during labor. Only 1% of pregnant women have this problem, and it usually occurs during the last 12 weeks of pregnancy.
Signs of Placental Abruption:

• Bleeding
• Stomach pain

Women who are at higher risks for this condition include:

• Having already had children
• Are age 35 or older
• Have had abruption before
• Have sickle cell anemia
• High blood pressure
• Trauma or injuries to the stomach
• Cocaine use

Placenta Previa:
Placenta previa occurs when the placenta lies low in the uterus partly or completely covering the cervix. It is serious and requires immediate care. It occurs in 1 in 200 pregnancies. Bleeding usually occurs without pain.
Women who are at higher risks for this condition include:

• Having already had children
• Previous cesarean birth
• Other surgery on the uterus
• Carrying twins or triplets

Preterm Labor:
Vaginal bleeding may be a sign of labor. Up to a few weeks, before labor begins, the mucus plug may pass. This is normally made up of a small amount of mucus and blood. If it occurs earlier, you could be entering preterm labor and should see your physician immediately.
Signs of Preterm Labor include these symptoms that occur before the 37th week of pregnancy:

• Vaginal discharge (watery, mucus, or bloody)
• Pelvic or lower abdominal pressure
• Low, dull backache
• Stomach cramps, with or without diarrhea
• Regular contractions or uterine tightening

The post Bleeding During Pregnancy appeared first on American Pregnancy Association.

In addition to screening for these abnormalities, a portion of the test (known as the nuchal translucency) can assist in identifying other significant fetal abnormalities, such as cardiac disorders.  The screening test does not detect neural tube defects.

What is a first trimester screening test?

It is very important to remember what a screening test is before getting one performed. This will help alleviate some of the anxiety that can accompany test results. Screening tests do not look only at results from the blood test.  They compare a number of different factors (including age, ethnicity, results from blood tests, etc…) and then estimate what a person’s chances are of having an abnormality.

These tests DO NOT diagnose a problem; they only signal further testing should be done.

How is the first-trimester screen performed?

The blood screen involves drawing blood from the mother, which takes about 5 to 10 minutes. The blood sample is then sent to the laboratory for testing. The ultrasound is performed by an ultrasound specialist or perinatologist and takes between 20 and 40 minutes. The results are evaluated within a week of the testing.

What are the risks and side effects to the mother or baby?

Except for the discomfort of drawing blood, there are no known risks or side effects associated with the First Trimester screen. There is a 5% false-positive rate for the test. Parents should be aware of the possibility of receiving abnormal results and then finding, after further testing, the baby is normal.

Why you might consider this test

One advantage to having First Trimester Screening is that you will have information about your risk for Down syndrome and trisomy 18 earlier in the pregnancy than you would with the standard Maternal Serum Screening. While both First Trimester and Maternal Serum Screening can test for Down syndrome and trisomy 18, Maternal Serum Screening can also test for neural tube defects.

When is the first-trimester screen performed?

The First Trimester Screen is performed between the 11th and 13th week of pregnancy. Because the test is performed so early, it is often used to determine whether a mother should consider undergoing an early (first-trimester) diagnostic test, such as chorionic villus sampling, or second-trimester amniocentesis.

What does the first-trimester screen look for?

In babies who are at an increased risk for chromosomal abnormalities, increased fluid is often found in the nuchal translucency. Abnormally high or low hCG and PAPP-A levels are also often found. The first-trimester screen combines the results from these three measurements (nuchal translucency, hCG, and PAPP-A) with maternal age risk factors and determines an overall risk factor for chromosomal abnormalities.

What do the results mean?

It is important to remember the first-trimester screen is a screening test and not a diagnostic test. This test only notes a mother is at risk of carrying a baby with a genetic disorder. Many women who experience an abnormal test discover later the test proved false.

You will not be given specific quantitative values for the separate parts of the First Trimester screen. Instead, you will be told whether your results are “normal or abnormal”, and you will be given a risk level by your genetic counselor. The counselor will give you your risk factor for chromosomal abnormalities based on the test results (for example 1/250, 1/1300).

Abnormal test results warrant additional testing for making a diagnosis.  Your genetic counselor will discuss the results with you and assist you in deciding about diagnostic tests, such as CVS or amniocentesis. These invasive procedures should be discussed thoroughly with your healthcare provider and between you and your partner. Additional counseling may prove helpful.

What are the reasons for further testing?

First Trimester Screening will help find about 84 percent, or 5 out of every 6, babies with Down syndrome, and about 80 percent, or 4 out of every 5, babies with trisomy 18.

• Down syndrome, also called trisomy 21, is caused by an extra chromosome in the developing baby. It causes mental retardation and serious heart problems. One baby out of every 600 is born with Down syndrome. Although having a baby with Down syndrome occurs more often to women who are older, it can happen at any age.
• Trisomy 18 is caused by an extra chromosome in the developing baby. Few babies with trisomy 18 survive to birth. One baby in every 6,000 is born with trisomy 18. Trisomy 18 causes mental retardation, heart defects, very poor growth, and other problems.

Performing further testing allows you to confirm a diagnosis and then provides you with certain opportunities:

• Pursue potential interventions that may exist (i.e. fetal surgery for spina bifida)
• Begin planning for a child with special needs
• Start addressing anticipated lifestyle changes
• Identify support groups and resources
• Make a decision about carrying the child to term

Some individuals or couples may elect not to pursue testing or additional testing for various reasons:

• They are comfortable with the results no matter what the outcome
• Because of personal, moral, or religious reasons, making a decision about carrying the child to term is not an option
• Some parents choose not to allow any testing that poses any risk of harming the developing baby
• It is important to discuss the risks and benefits of testing thoroughly with your healthcare provider. Your healthcare provider will help you evaluate if the benefits from the results could outweigh any risks from the procedure.

Want to Know More?

• Quad Screen
• Triple Screen
• Pregnancy Nutrition
• Pregnancy Vitamins & Nutrients

Compiled using information from the following sources:

1. Dartmouth-Hitchcock Obstetrics
2. New England Journal of Medicine, Volume 349, Number 15, October 2003, First-Trimester Screening for Trisomies21 and 18
3. National Down Syndrome Society
4. Nemours Foundation

The post First-Trimester Screening appeared first on American Pregnancy Association.

The Centers for Disease Control and Prevention (CDC) is helping healthcare facilities that provide obstetric care, labor and delivery, recovery and inpatient postpartum care for pregnant patients with confirmed coronavirus or suspected of having the virus prepare for your labor and delivery. Here’s what you need to know:

When you have COVID-19 and it’s time to give birth

• Notify the hospital that it’s time for you to come in. Give them plenty of notice so they have the time they need to prepare for your arrival. This may include identifying the most appropriate room for labor and delivery; ensuring infection prevention/control supplies and personal protection equipment (PPE) are ready; and alerting your healthcare team about infection control requirements.
• If you need to be transported to the hospital by ambulance or other emergency medical services, alert the company (and 911 if you call them) so they can use good infection control and other protections. They will also remind the emergency room/maternity ward that you have or are suspected of having COVID-19.

If I have COVID-19, can I pass it to my baby during pregnancy or delivery?

According to a few reports, some newborns have tested positive for COVID-19. But that doesn’t necessarily mean they picked it up from their mothers in the womb. The most common way to get COVID-19 is through respiratory droplets that a sick person coughs or sneezes. Experts believe it’s more likely that infected babies picked it up through droplets after birth from their mother or a caregiver.

What to expect during delivery

There’s no evidence that women with COVID-19 shouldn’t deliver vaginally. But delivery might be different from what you expected.

One group of experts suggests that if the mother has COVID-19, it might be helpful to leave the vernix — a white, waxy coating on newborns’ skin — on for 24 hours after birth. The coating contains antimicrobial substances that could protect against infection.

During Hospitalization

The American College of Obstetricians and Gynecologists recommends that babies born to women who have the coronavirus be isolated and monitored for symptoms.

• You will likely be placed in a single-person room with a dedicated bathroom. The door should remain closed.
• Your healthcare team will employ the CDC’s standard and advanced precautions for infection prevention and control. This may include asking you to wear a face mask to prevent transmission to others, including your infant. The team will wear respirators or face masks, gowns, gloves and eye protection (PPE). These protection items should be put on before entering your room and after leaving your room.
• Healthcare teams caring for infants born to mothers with confirmed COVID-19 will exercise the same cautions and procedures.
• Visitors will be restricted and encouraged to use alternatives such as video-call apps on cell phones or tablets. If visitation must occur, the hospital may require visits to be scheduled and controlled, plus:
  • Visitors will be screened for fever and respiratory symptoms. Also for underlying illness putting them at higher risk for COVID-19) and ability to comply with precautions.
  • Facilities may provide instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of personal protection equipment while in the patient’s room.

• Visitors should not be present during specimen collection procedures.
• Visitors will be allowed to only visit the patient room. They should not go to other locations in the facility.

Mother/Baby Contact

According to the CDC, the virus that causes COVID-19 is thought to spread mainly by close contact with an infected person through respiratory droplets. Whether a pregnant woman with COVID-19 can transmit the virus that causes COVID-19 to her fetus by other routes of vertical transmission (before, during, or after delivery) is still unknown.

However, in limited recent case series of infants born to mothers with COVID-19, none of the infants have tested positive for the virus that causes COVID-19. Additionally, the virus was not detected in samples of amniotic fluid or breast milk.

There’s no evidence that the virus itself can lead to birth defects, miscarriage, or any other problems. But a fever in early pregnancy, from COVID-19 or any other cause, can raise the chances of birth defects. And severe lung illnesses late in your pregnancy can make you more likely to deliver your baby prematurely. Some babies born to women who had coronavirus were born preterm. But it’s not clear whether the virus was to blame.

Because it is unknown if a pregnant woman with COVID-19 can transmit the virus to her baby before, during or after delivery, the hospital will likely take extra precautions to avoid any potential complications. These may include

• • Temporarily separating (e.g., separate rooms) mothers who have or are suspected of having COVID-19 from her baby until the mother’s symptoms clear.
  • The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team.
  • A separate isolation room should be available for the infant while they remain a PUI (person under investigation). Healthcare facilities could limit visitors, with the exception of a healthy parent or caregiver. Visitors will be instructed to wear gown, gloves, face mask, and eye protection (PPE). If another healthy family or staff member is present to provide care (e.g., diapering, bathing) and feeding for the newborn, they should use gowns, gloves, face masks, and eye protection.
  • The decision to discontinue temporary separation of the mother from her baby will likely be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. The decision should take into account disease severity, illness signs and symptoms, and results of laboratory testing for the virus that causes COVID-19.
  • If it’s necessary that the newborn stay with his/her ill mother in the same hospital room, the hospital will take measures to reduce exposure of the newborn to the virus that causes COVID-19:
    • Physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn at least 6 feet away from the ill mother.
    • If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed COVID-19 or is a PUI should put on a face mask and practice good hand hygiene before each feeding or other close contact with her newborn. The face mask should remain in place during contact with the newborn.

Breastfeeding with COVID-19

• During temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver.
• If a mother and newborn do room-in and the mother wishes to feed at the breast, she should put on a face mask and practice hand hygiene before each feeding.

All information is from the Centers for Disease Control and Prevention.

The post Can I Give Birth Safely if I have Coronavirus? appeared first on American Pregnancy Association.

Ectopic Pregnancy Symptoms

Although you may experience typical signs and symptoms of pregnancy, and a pregnancy test result may be positive, an ectopic pregnancy can’t continue as normal. The following symptoms may be used to help recognize a potential ectopic pregnancy:

• Sharp or stabbing pain that may come and go and vary in intensity. (The pain may be in the pelvis, abdomen, or even the shoulder and neck due to blood from a ruptured ectopic pregnancy pooling under the diaphragm).
• Vaginal bleeding, heavier or lighter than your normal period
• Gastrointestinal symptoms
• Weakness, dizziness, or fainting

It is important to contact your doctor immediately if you are experiencing sharp pain that lasts more than a few minutes or if you have bleeding.

What are the Causes?

• An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked.
• Scar tissue from a previous infection or a surgical procedure on the tube may also impede the egg’s movement.
• Previous surgery in the pelvic area or on the tubes can cause adhesions.
• Abnormal growths or a birth defect can result in an abnormality in the tube’s shape.

Who is at risk for Having an Ectopic Pregnancy?

• Maternal age of 35-44 years
• Previous ectopic pregnancy
• Previous pelvic or abdominal surgery
• Pelvic Inflammatory Disease (PID)
• Several induced abortions
• Conceiving after having a tubal ligation or while an IUD is in place
• Smoking
• Endometriosis
• Undergoing fertility treatments or are using fertility medications

How is it Diagnosed?

Ectopic pregnancies are diagnosed by your physician, who will probably first perform a pelvic exam to locate pain, tenderness, or a mass in the abdomen. Your physician will also use an ultrasound to determine whether the uterus contains a developing fetus. The measurement of hCG levels is also important. An hCG level that is lower than expected is one reason to suspect an ectopic pregnancy.

Your doctor may also test your progesterone levels because low levels could be a sign of an ectopic pregnancy. In addition, your physician may do a culdocentesis, which is a procedure that involves inserting a needle into the very top of the vagina, behind the uterus and in front of the rectum. The presence of blood in this area may indicate bleeding from a ruptured fallopian tube.

What are the Treatments?

• Methotrexate may be given, which allows the body to absorb the pregnancy tissue and may save the fallopian tube, depending on how far the pregnancy has progressed.
• If the tube has become stretched or has ruptured and started bleeding, part or all of it may have to be removed. In this case, bleeding needs to be stopped promptly, and emergency surgery is necessary.
• Laparoscopic surgery under general anesthesia may be performed. This procedure involves a surgeon using a laparoscope to remove the ectopic pregnancy and repair or remove the affected fallopian tube. If the ectopic pregnancy cannot be removed by a laparoscopically, another surgical procedure called a laparotomy may be done.

What About My Future Pregnancies?

Your hCG level will need to be re-checked on a regular basis until it reaches zero if you did not have your entire fallopian tube removed.  An hCG level that remains high could indicate that the ectopic tissue was not entirely removed, which would require surgery or medical management with methotrexate.

The chances of having a successful pregnancy after an ectopic pregnancy may be reduced, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future.

Want to Know More?

• How to Get Pregnant
• What You Need to Know About Infertility
• 7 Discomforts of Pregnancy

Compiled using information from the following sources:
MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 21]. Pregnancy Loss; [updated 2006 Feb 22; reviewed 2006 Feb 7; cited 2006 Feb 22]. Available from: https://www.nlm.nih.gov/medlineplus/pregnancyloss.html
Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 10.
MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 21]. Ectopic Pregnancy; [updated 2010 Feb 21;] Available from https://www.nlm.nih.gov/medlineplus/ency/article/000895.htm

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What causes fetal arrhythmia?

Fetal arrhythmia has been linked to a number of possible causes. In some cases, healthcare providers may not be able to pinpoint the source, especially if the abnormal rhythm is transient.

It is possible that high levels of caffeine consumption may cause heartbeat irregularities, but currently, only case studies have been performed. It is suggested that pregnant women limit their caffeine intake to 200mL of caffeine a day–roughly the amount found in one cup of coffee.

Also, arrhythmia may, at some point in development, be normal. During the second trimester, the baby’s heart may begin to beat irregularly as the electrical pathways of the heart mature. This is natural, and not a cause for alarm unless the irregularity lasts for a considerable period of time.

Some arrhythmias may indicate a structural abnormality of the heart, in which case your healthcare provider will run further tests and take any appropriate action necessary. If the baby’s heart rate is consistently high, your doctor may prescribe you medication that is passed through the placenta to the baby to help regulate the heartbeat.

Should I be concerned about arrhythmia?

The causes of arrhythmia are still relatively unknown. However, based on the information that doctors do have, it appears that most arrhythmias are not life-threatening to you or your baby and will resolve themselves.

In the unusual circumstance that the arrhythmia is more severe, the baby may be born with a heart irregularity that is managed throughout his or her life. There is a remote chance that fetal death may occur while in the womb or during delivery.

Next Steps

Your health care provider’s first step will be to monitor the heart rate and well-being of your baby. However, there may be questions about the condition that warrants further investigation. In these rare cases, your healthcare provider may refer you to a fetal cardiologist for further evaluation.

Want to Know More?

• Most Common Pregnancy Complications
• Understanding a High-risk Pregnancy

Compiled using information from the following sources:

1. DiLeo, G. (2002). The anxious parent’s Guide to Pregnancy (p. 108). New York City: Contemporary Books.

2. Fetal Arrhythmia/Dysrhythmia. (n.d.). Retrieved August 15, 2014.

3. Stephenson, E. (2010, March 19). Heart Rhythm Problems (Arrhythmias).

4. Srinivasan, S. & Strasburger, J., Overview of Fetal Arrhythmias.

5. Weber, R., Stambach, D., & Jaeggi, E. (2011, January 8). Diagnosis and management of common fetal arrhythmias.

6. Zaidi, A., & Ro, P. (n.d.). Treatment of Fetal and Neonatal Arrhythmias.

The post Fetal Arrhythmia appeared first on American Pregnancy Association.

Second-Hand Smoke and Pregnancy

Second-hand smoke is characterized as the product released into the environment whenever someone who is smoking exhales. It can also come from the end of tobacco-containing smoking products. There are approximately 4,000 chemicals present in second-hand smoke, many of which have been determined to be related to cancer.  If you are exposed to second-hand smoke during pregnancy, both you and your baby are put at risk.

Some of the health conditions associated with being exposed to second-hand smoke are a miscarriage, low birth weight, early birth, learning or behavioral deficiencies in your child, and Sudden Infant Death Syndrome (SIDS). SIDS is a disorder where an infant dies unexpectedly while they are sleeping. This condition is somewhat of a mystery as autopsies and medical examinations do not pinpoint a cause of death, and infants seem healthy before they die.

In order to reduce the risks associated with cigarettes and cigars, it is best to avoid smoke and smoking entirely.

Third-Hand Smoke and Pregnancy

Pregnant women can be exposed to this type of smoke without even realizing it. Third-hand smoke is the residue left behind by cigarettes on furniture, in rugs, in paint, etc.  Third-hand smoke can stick around for months or years. If a place smells like smoke, even if no one is currently smoking, it is a safe bet there is tobacco residue there.

Toxins can enter your bloodstream when you either touch something containing the residue or breathe in some of the residues. When the toxins make their way into your blood, they are then shared with your baby. One study performed at the Los Angeles Research Institute determined that third-hand smoke residue has a detrimental effect on prenatal lung development. This can cause respiratory problems later in life.

If you and your partner are trying to get pregnant, are pregnant, or have recently had a child, it is best to minimize the amount of third-hand smoke in your home. You should stop smoking entirely if you are trying to conceive.

Make sure your partner smokes outdoors and does not enter the house wearing the outer clothing they have smoked in. For example, encourage your partner to wear a coat or sweatshirt when smoking and remove it before coming indoors. In addition, after being exposed to cigarettes, it is important you and your partner washes your hands before touching your baby.

What About Once Your Baby is Born?

It is important your baby has limited exposure to second-hand smoke even once he/she is born. Babies in contact with second-hand smoke are more likely to develop SIDS. In addition, children exposed to second-hand smoke experience negative effects on their immune system.

They are more likely to have ear infections, colds, respiratory ailments, and teeth problems. Third-hand smoke is likely to be as harmful as second-hand smoke to your infant, so it is important to keep your child away from areas that contain third-hand smoke residue.

Compiled using information from the following sources:

1. The Dangers of Secondhand Smoke.

https://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Secondhand-Smoke.aspx

2. Peterson, Tara & Mittal, Manoj K. (2011).  Apparently Life-Threatening Event and Sudden Infant Death Syndrome in Florin, Todd A. & Ludwig, Stephen (Eds.), Aronson, Paul L. & Werner, Heidi C. (Assoc. Eds.), Netter’s Pediatrics (69). Philadelphia, PA: Elsevier Saunders.

3. Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed). (2011, April 19). ‘Thirdhand smoke’ poses danger to unborn babies’ lungs, study finds. ScienceDaily.

https://www.sciencedaily.com/releases/2011/04/110419101231.htm

4. Mitchell, Teresa J.  (2011, Nov. 1).  Third-Hand Smoke Affects Your Baby.

(2011, May). Smoking During Pregnancy. Retrieved from: https://americanpregnancy.org/pregnancy-health/smoking-during-pregnancy/

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What causes hip pain during pregnancy?

During pregnancy, your body releases hormones that allow connective tissue to relax and soften. As a result of this, the joints and ligaments between the bones in your pelvis will begin to loosen. Increasing flexibility in these bones is imperative for allowing the baby to move through your body during labor. Lower back pain, as well as, changes in posture and a heavier uterus may contribute to the soreness you feel.

Other causes of pain in your hips include increased pressure on the sciatic nerve. The two sciatic nerves in your body run from the lower back to the feet. When an enlarged uterus puts pressure on the nerves, you can experience pain, numbness, or a tingling sensation in the buttocks, hips, and thighs. 

This problem is referred to as sciatica. As you get closer to your due date, your baby will change its position in your uterus. This will likely reduce the discomfort you are feeling. Sciatica is usually normal during pregnancy, but you should still inform your doctor if you experience it, as there are other less common, but serious, causes of sciatica.

Another possible cause of hip pain during the second trimester is round ligament pain. Round ligament pain is characterized by sharp pains in the abdomen, hip, and groin area. The pain may intensify with rapid movements or changes in position. For more information on round ligament pain, please review this article on round ligament pain during pregnancy.

How can you alleviate hip pain during pregnancy?

Practicing exercises that strengthen both the back muscles, as well as, your abdominal muscles will likely reduce hip pain. One exercise that may provide relief is elevating your hips above chest level while lying on your back for a couple of minutes. Taking a warm bath or applying warm compresses to the sore area can reduce pain. In addition, a massage may ease soreness.

As you get closer to your delivery date, make sure to sleep on your side and keep your legs and knees bent. Using pillows to support your abdomen and upper leg can alleviate uncomfortableness while sleeping. If lying on your side worsens your hip pain, place a pillow or blanket at the small of your back and sleep leaning against it. This will reduce pressure on the hip you are sleeping on.

When should you call your doctor?

If your hip pain is accompanied by pressure or soreness in the pelvic area that radiates towards the thighs before the 37th week of pregnancy, it is important to seek out your health care provider. This can be a sign of preterm labor.
Along with pelvic pressure, other indications of preterm labor are:

• Abdominal cramping and discomfort, particularly in the lower abdomen
• Lower backache that extends to the front and sides of your body, without relief, when you change positions
• Unexpected contractions that occur approximately every ten minutes
• Discharge from your vagina that is clear, pink, or brown in color

Want to Know More?

• 7 Discomforts of Pregnancy
• Nighttime Ice Cream – the official pregnancy ice cream is formulated to be easy to digest

Compiled using information from the following sources:

1. Katz, Vern L. (2003).  Prenatal Care in Scott, James R., Gibbs, Ronald S., Karlan, Beth Y., & Haney, Arthur F. (Eds.), Danforth’s Obstetrics and Gynecology, 9^th edition (18).  Philadelphia, PA: Lippincott Williams & Wilkins.

2. The Third Trimester: 28 to 40 weeks and beyond in Johnson, Robert V. (Ed.), Mayo Clinic Complete Book of Pregnancy & Baby’s First Year (176-7).  New York, NY: William Morrow and Company, Inc.

3. Common concerns and questions of pregnancy in Harms, Roger W. (Ed.), Mayo Clinic Guide to a Healthy Pregnancy (455-76). New York, NY: HarperCollins Publishers Inc.

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Usually your Rh factor blood type isn’t an issue. But during pregnancy, being Rh-negative can be a problem if your baby is Rh-positive. If your blood and your baby’s blood mix, your body will start to make antibodies that can damage your baby’s red blood cells. This could cause your baby to develop anemia and other problems.

Each person’s blood is one of four major types: A, B, AB, or O. Blood types are determined by the types of antigens on the blood cells. Antigens are proteins on the surface of blood cells that can cause a response from the immune system. The Rh factor is a type of protein on the surface of red blood cells. Most people who have the Rh factor are Rh-positive and those who do not are Rh-negative.

How do I know if I am Rh negative or Rh positive?

As part of your prenatal care, you will have blood tests to find out your blood type. If your blood lacks the Rh antigen, it is called Rh-negative. If it has the antigen, it is called Rh-positive. When the mother is Rh-negative and the father is Rh-positive, the fetus can inherit the Rh factor from the father. This makes the fetus Rh-positive too.

Problems can arise when the fetus’s blood has the Rh factor and the mother’s blood does not. You may develop antibodies to an Rh-positive baby. If a small amount of the baby’s blood mixes with your blood, which often happens, your body may respond as if it were allergic to the baby. Your body may make antibodies to the Rh antigens in the baby’s blood. This means you have become sensitized and your antibodies can cross the placenta and attack your baby’s blood.

They break down the fetus’s red blood cells and produce anemia (a condition that happens when the blood has a low number of red blood cells). This condition is called hemolytic disease or hemolytic anemia. It can become severe enough to cause serious illness, brain damage, or even death in the fetus or newborn. Sensitization can occur any time the fetus’s blood mixes with the mother’s blood.

It can occur if an Rh-negative woman has had:

• A miscarriage
• An induced abortion or menstrual extraction
• An ectopic pregnancy
• Chorionic villus sampling
• A blood transfusion

How can problems be prevented?

• A blood test can provide you with your blood type and Rh factor.
• Antibody screen is another blood test that can show if an Rh-negative woman has developed antibodies to Rh-positive blood.
• An injection of Rh immunoglobulin (RhIg), a blood product that can prevent sensitization of an Rh-negative mother.

RhIg is used during pregnancy and after delivery:

• If a woman with Rh-negative blood has not been sensitized, her doctor may suggest she receive RhIg around the 28th week of pregnancy to prevent sensitization for the rest of pregnancy.
• If the baby is born with Rh-positive blood, the mother should be given another dose of RhIg to prevent her from making antibodies to the Rh-positive cells she may have received from their baby before and during delivery.
• The treatment of RhIg is only good for the pregnancy in which it is given. Each pregnancy and delivery of an Rh-positive child requires repeat doses of RhIg.
• Rh-negative women should also receive treatment after any miscarriage, ectopic pregnancy, or induced abortion to prevent any chance of the woman developing antibodies that would attack a future Rh-positive baby.

What are some other reasons RhIg may be given?

• If and when amniocentesis is conducted, fetal Rh-positive red blood cells can mix with a mother’s Rh-negative blood. This would cause her to produce antibodies, therefore making it necessary for RhIg to be given.

A Rh-negative mother may receive RhIg after birth, even if she decides to have her fallopian tubes tied and cut to prevent future pregnancies for the following reasons:

1. The woman may decide later to try to have the sterilization reversed.
2. There is a slight chance the sterilization may fail to prevent pregnancy.
3. In case there is a need for a blood transfusion in the future, the treatment will prevent her from developing antibodies.

What happens if antibodies develop?

Once a woman develops antibodies, RhIg treatment does not help. A mother who is Rh sensitized will be checked during her pregnancy to see if the fetus is developing the condition. The baby may be delivered on time, followed by a blood transfusion for the baby that will replace the diseased blood cells with healthy blood. For more severe cases, the baby may be delivered early or given transfusions while in the mother’s uterus.

How common is the Rh-negative factor?

• More than 85% of people are Rh-positive.
• The Rh factor does not affect a person’s general health.
• Problems can occur during pregnancy when the baby’s blood has the Rh factor and the mother’s blood does not, however it can be prevented in most cases with the medication called immunoglobulin (RhIg).

Compiled using information from the following sources:

1. Mayo Clinic Complete Book of Pregnancy & Babys First Year. Johnson, Robert V., M.D., et al, Ch. 11.

2. Danforths Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 18.

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