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Placenta previa occurs when the placenta is lying low in your uterus and is either right next to or covering the cervix. In a normal pregnancy the placenta would be near the top of the uterus, well away from the cervix. During your early ultrasounds your doctor will look to see where the placenta is in your uterus. Placenta previa isn’t usually a problem early in pregnancy but can become a problem later in pregnancy causing bleeding and possibly premature birth.
During your mid-pregnancy ultrasound, usually done around 19 or 20 weeks, the doctor will determine where your placenta is lying. If your placenta is low in the uterus, right next to or covering the cervix, your doctor will need to monitor your pregnancy more closely. It is possible for the placenta to migrate into a more normal, higher, position later in the pregnancy so being diagnosed with placenta previa during your second trimester doesn’t necessarily mean you will still have placenta previa later in your pregnancy. The placenta itself does not move, but as your uterus continues to expand it may end up further away from your cervix. Only about 10% of women who are found to have placenta previa during their mid-pregnancy ultrasound still have it when they deliver their baby.
You will be scheduled for a follow up ultrasound so that your doctor can keep an eye on the location of your placenta, depending on if the placenta previa resolves itself or not you may have multiple ultrasounds throughout the remainder of your pregnancy. If placenta previa persists your doctor will likely prescribe pelvic rest and you’ll be advised to take it easy, being especially careful to avoid any activities that may provoke vaginal bleeding. Your doctor will monitor you for bleeding throughout the remainder of your pregnancy. If you do have bleeding or contractions you will be hospitalized so you can be monitored closely. With placenta previa you will not be able to deliver vaginally, which is why your doctor will want to keep an eye out for any signs of preterm labor.
Placenta previa can happen to any one, however, there are a few factors that increase your risk of placenta previa, they are:
- You are pregnant with multiples (twins or higher)
- You have previously had a c-section
- You have previously had uterine surgery (such as D&C or fibroid removal)
- You smoke
- You use cocaine
- You age and the number of kids you have had can also increase your risk
If you are diagnosed with placenta previa talk to your doctor about what that means for you, what you need to do to ensure a safe delivery, etc. As stated above, placenta previa found earlier in pregnancy often resolves later in pregnancy, however, it may persist so your doctor will monitor you closely throughout your pregnancy so they can ensure they are on top of any complications that may arise.
A new study conducted by Kaiser Permanente in California, and published in the American Journal of Obstetrics and Gynecology, shows a link between caffeine consumption and miscarriage risk. The study looked at over 1000 women, they were interviewed at an average of 10 weeks into their pregnancy. 16% of the women were found to have miscarried. Of those who miscarried, 60% of them had consumed up to 200mg of caffeine everyday, with another 15% saying they consumed more than 200mg of caffeine daily. By contrast only 25% of the women who miscarried had reported not consuming any caffeine.
Several studies have been conducted to determine the effect of caffeine on early pregnancy, however, previous research studies did not control for morning sickness (which often results in a reduced risk of miscarriage). In this particular study they did control for morning sickness and found an increased risk of miscarriage based on caffeine consumption even among those women who reported having morning sickness in early pregnancy.
Not a lot is known about why caffeine causes an increased risk of miscarriage, however, it is thought that since caffeine crosses the placenta is affects cell development and may even impact the blood flow from mom to baby.
Doctors have long cautioned women against consuming too much caffeine during pregnancy, but didn’t really know how much was too much. The results of the study seem to indicate that any amount of caffeine increases the risk of miscarriage, but that 200mg or more causes the greatest increased risk. 200mg of caffeine is equivalent to 2 cups of coffee, 4 caffeinated sodas, or 4 cups of tea.
I wasn’t a caffeine drinker before my pregnancy so it was easy for me not to consume any caffeine during my pregnancy. Women who rely on caffeine to get them going in the morning are likely to have a harder time staying away from or reducing the amount of caffeine they consume during pregnancy. A few things you can do to combat the exhaustion of the first trimester without turning to coffee are: get enough sleep (nap more, adjust your schedule so you can sleep more, etc), eat a healthy, balanced diet, and exercise.
Talk to your doctor about the results of this study and determine what you can do to reduce your own risk for miscarriage.
When I tested high on my glucose screening test several weeks ago I immediately started looking up information on the glucose tolerance test that I would have to have. What I found was that there really isn’t a whole lot of information out there about gestational diabetes and the glucose tests that are done to determine if a woman has gestational diabetes. Gestational diabetes is actually one of the most common pregnancy complications, occurring in about 4% of pregnancies.
Now that I have had and passed my glucose tolerance test (no gestational diabetes for me) I thought I would share some of the information I learned from my experience and what the tests were like for me. I have found that it is always better to have a little knowledge about what to expect than to go into a test blindly.
As with anything else you should always discuss your concerns, fears, and questions with your doctor. They know your situation and pregnancy best and can advise you on the specifics for you.
Glucose Screening Test: In a majority of cases your prenatal care provider will send you for a glucose screening test some time toward the end of your second trimester (this is the time when gestational diabetes most often begins). This may vary depending on your particular situation. I had my glucose screening test done at 25 weeks. This test does not require you to fast. You will go into either your doctor’s office, the hospital, or a lab (I had mine done at Quest Diagnostics). When you arrive you will be given a 50 gram serving of the glucose drink. You will be asked to drink this glucose drink and let the phlebotomist know when you have finished at which time a timer will be set for 60 minutes. You will have to sit around and wait, when 60 minutes has past your blood will be drawn. I had one small vile of blood taken from my test and from what I understand this is pretty typical. In my case the lab sent my results to my doctor’s office a few days later. What is considered a high result on the glucose screening test will depend on what gauge your doctor uses. Some doctors use 140mg/dl as the cut off while others use 130mg/dl. If your test results are higher than the cut off you will be sent in for a glucose tolerance test. The screening tells the doctor that you may be at risk for having gestational diabetes; however, it does not tell your doctor that you do indeed have gestational diabetes. The screening test, like many other screening tests, results in a lot of false positives, which is why you will be sent in for the more accurate glucose tolerance test for a definitive answer.
Glucose Tolerance Test: This test will be ordered if you test high on the glucose screening or if you have blood in your urine before the screening test was done. The glucose tolerance test is much more accurate and of course a much longer test. This test takes 3 hours in most cases and requires you to fast prior to going in for the test. You will be asked to fast for 8-12 hours prior to the test time (I was told 12 hours but I have seen information indicating that some women are told 8 hours). When you arrive for the test your blood will be immediately drawn (again about one small vile), this is your fasting test. You will then be given twice as much of the glucose drink as you were given at the screening test, 100 grams. Again, you will be asked to drink the glucose drink and a timer will be set when you have finished the drink, this time to go off at 1 hour intervals for the next 3 hours. At each hour your blood will be drawn, for a total of 4 including the fasting test.
Here is what is typically considered abnormal results on the glucose tolerance test (check with your doctor to see what they use)
- Fasting: 95mg/dl or higher
- 1 Hour: 180 mg/dl or higher
- 2 Hour: 155 mg/dl or higher
- 3 Hour: 140 mg/dl or higher
If you have abnormal an result (which is considered high on two or more of the blood draws) on this test then you will be diagnosed with gestational diabetes and your doctor will work out a treatment plan with you. Gestational diabetes is typically treated primarily with changes in diet and exercise. If this does not work then other options such as medication or insulin injections will be considered. You will be required to routinely test your blood sugar throughout the day to help monitor your condition. Women who have gestational diabetes typically have larger than average babies. Be sure to discuss any questions or concerns you have with your doctor.
One personal recommendation I can make is that you take a good book or something else to occupy yourself to both the screening test and the glucose tolerance test. It can seem like you are there a very long time, especially at the glucose tolerance test which is 3 hours or more and you haven’t eaten anything in over 12 hours.
You can read my previous article on gestational diabetes for more information on causes, treatment, and possible complications associated with gestational diabetes. You can also visit the American Diabetes Association website for more information as well.
During a pregnancy you will experience many symptoms ranging from morning sickness early on to swollen feet and ankles later in the pregnancy. Every pregnant woman worries about the health of her pregnancy and baby, always wondering what each little symptom she feels means. It is a good idea to talk to your doctor throughout your pregnancy to get an idea of what to expect and what to keep an eye out for. It is better to be equipped with knowledge in the event you experience a complication or problem during your pregnancy.
Here are a few signs that may indicate a problem and should not be ignored. If you experience any of these symptoms or others that you are concerned about you should immediately call your doctor.
- Your baby is not moving or is moving less frequently than normal
- Severe or persistent abdominal pain or cramping
- Vaginal bleeding or spotting
- An increase or change your vaginal discharge
- Pelvic pressure
- Pain or burning during urination, or a decrease in the amount of urine
- Severe or persistent vomiting, or any vomiting accompanied by a fever
- A fever above 100 degrees Fahrenheit
- Visual disturbances
- Persistent or severe headache
- Swelling of your face or hands, any sudden swelling of your feet, or rapid weight gain
- Persistent or severe leg cramps
- Fainting, frequent dizziness, or heart palpitations
- Difficulty breathing
- Chest pain
- Severe constipation accompanied by abdominal pain
- Diarrhea that lasts more than 24hrs
- Persistent and intense itchiness
As stated above these symptoms should not be ignored and you should call your doctor immediately if you experience any of them. You should also call your doctor any time you are concerned or unsure about something you are experiencing. It is always better to get checked out than to let something become a problem.
Here in the United States 1 out of every 10 babies is born premature, and that number is on the rise. A premature baby is one born at 37 weeks or earlier. A baby is considered full term when it is born after 37 weeks (even though a full pregnancy is actually 40 weeks long). Babies born before 37 weeks often need special care compared with those babies born after 37 weeks, and often have to stay in the hospital longer.
Babies born at or close to 37 weeks often have limited or no prematurity related problems, whereas babies born closer to 32 weeks (or earlier) often have prematurity related problems and require much more care.
So what causes a premature birth? There can be many causes of a premature birth, and sometimes the cause isn’t known at all, it just happens. A few of the more common causes of preterm birth include; placenta problems, a pregnancy of multiples, an infection in the mother, pregnancy complications, problems with the uterus or cervix, or drug and alcohol use during pregnancy.
If a baby is born premature it is often moved to a neonatal intensive care unit where it can be evaluated and then cared for based on its needs. The baby’s breathing and heart rate will be closely monitored, if it is not breathing well on its own it will likely be hooked up to a machine to help with its breathing. Premature babies often have trouble maintaining their body temperature and are put into special isolette beds that will help with body temperature control until they can do it on their own.
Each preemie is different and will require special care of varying degrees. Some babies will simply need to be monitored closely for a little while. Some babies will need to be hooked up to machines such as ventilators, feeding tubes, and IVs. Others will require surgery. Depending on how early your baby is born, what complications occur and whether or not your child has any birth defects will greatly impact on the type, degree and length of care needed.
Neonatal units are staffed with nurses and doctors that specialize in premature infant care. Be sure to ask questions and be involved in your baby’s care. Understanding what is happening, what is being done for your baby and why will help make it a lot easier to deal with. Hospitals often have psychologists that you can talk to about your feelings as well, which can be a big help too.
There are possible long term effects for preterm babies, such as physical and mental disabilities, blindness, hearing loss, brain damage and more. Talk to your baby’s neonatalogist to get the details of your child’s specific case and what to expect short term and long term.
Here are some helpful websites for more information on premature births.
(source: WebMD)