Perinatal Diagnostic Center also welcomes your questions.
Common medical terms, diagnosis and procedures:
Advanced Maternal Age (AMA)
Women who are 35 years or older at the time of delivery may have health problems such as hypertension, diabetes or heart disease which may affect the baby. Also, these mothers may be more at risk for certain genetic conditions such as Down syndrome in the baby. Additional testing during pregnancy may be advised.
A c-section is a surgical procedure that involves making an incision in your abdomen and uterus through which your baby is delivered. In certain circumstances, a c-section is scheduled in advance; in others, it's done when an unforeseen complication arises.
Situations that usually warrant a c-section:
- Cord prolapse (when the umbilical cord falls into the vagina)
- Bleeding from the placenta
- Abnormal pelvic structure , for example as a result of a serious injury.
- Shoulder presentation of the baby .
- Serious maternal health problems (e.g., infection, diabetes, heart disease, high blood pressure, etc.) when labor would not be safe for either mother or baby.
- Dystocia (difficult childbirth), which includes labor that fails to progress, prolonged labor, and CPD (cephalopelvic disproportion) when the baby is too large to pass safely through the mother's pelvis.
- Breech presentation (buttocks or feet first).
- Fetal distress. The baby may show signs of distress such as slowing of heart rate or acid in the blood before vaginal delivery can be completed quickly.
There are three main types of diabetes, including:
Type 1 Diabetes -- An estimated 5 percent to 10 percent of those with diabetes have type 1 diabetes. It is considered an autoimmune disease, meaning that the body's own immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no insulin, and therefore need to take insulin everyday. Although the condition can appear at any age, onset of type 1 diabetes is most common in children and young adults, which is why it was previously called juvenile diabetes.
Type 2 Diabetes -- Accounting for 90 percent to 95 percent of those with diabetes, type 2 diabetes is the most common form of the condition. It usually is diagnosed in adults over the age of 40 and 80 percent of those with type 2 diabetes are overweight. However, because of the increase of obesity in our society, type 2 diabetes is being diagnosed at younger ages and is now frequently seen in children. Initially in type 2 diabetes, insulin is produced, but the insulin cannot function properly, which leads to a condition called insulin resistance. Eventually most people with type 2 diabetes suffer from both insulin resistance and decreased insulin production.
Gestational Diabetes -- Gestational diabetes develops during pregnancy . It occurs more often in African Americans, Native Americans, Latinos and people with a family history of diabetes. Typically, it disappears after delivery, although the condition is associated with an increased risk of developing diabetes later in life.
If you think that you have diabetes, visit your doctor immediately for a definite diagnosis. Common symptoms include the following:
- Frequent urination
- Excessive thirst
- Unexplained weight loss
- Extreme hunger
- Sudden vision changes
- Tingling or numbness in the hands or feet
- Feeling very tired much of the time
- Very dry skin
- Sores that are slow to heal
- More infections than usual
It is important to note that some people may only experience a few symptoms that are listed above. An estimated 50 percent of people with type 2 diabetes do not experience any symptoms and therefore do not know they have the disease.
Fetal echocardiography is an ultrasound test performed during pregnancy to evaluate the heart of the unborn baby.
Echocardiography assesses the heart's structures and function. A small probe called a transducer is placed on the mother's abdomen and sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed in certain locations and at certain angles, the ultrasonic sound waves move through the mother's and baby's skin and other body tissues to the baby's heart tissues, where the waves bounce (or "echo") off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer interprets the echoes into an image of the heart walls and valves.
Fetal echocardiography can help detect fetal heart abnormalities before birth, allowing for faster medical or surgical intervention once the baby is born. This improves the chance of survival after delivery for babies with serious heart defects.
Hypertension during pregnancy is a potentially serious side effect of pregnancy that must be addressed immediately. Hypertension or high blood pressure during pregnancy affects roughly one of every six pregnant women. While for some hypertension during pregnancy is easily resolved, for others hypertension can result in a high risk pregnancy, with increased risk for premature labor, delivery and maternal complications. Certain complications are associated with high blood pressure during pregnancy. These include a condition called pre-eclampsia or eclampsia. This condition also known as toxemia of pregnancy is typically associated with additional symptoms including:
- Severe headaches.
- Spots before the eyes or blurry vision.
- Stomach pain in the upper quadrant of the abdomen.
- Swelling, including excessive swelling resulting in rapid weight gain.
- Decreased fetal movement or fetal distress.
In most cases the only cure for hypertension during pregnancy is delivery. Some babies will be delivered early to protect their health and that of the mother.
Hyperthyroidism occurs when the thyroid produces excess thyroid hormone. The thyroid gland is located in the neck and produces several hormones, which control metabolism, or the way cells use energy. Hyperthyroidism is a common disorder affecting over two million Americans, most of whom are women.
The most common cause of the condition is Graves' disease, which accounts for 85 percent of cases. Hyperthyroidism also can result from nodular goiter, a condition in which an inflammation of the thyroid occurs due to viral infections or other causes, ingestion of excessive amounts of thyroid hormone, and ingestion of excessive iodine.
Initially, many patients do not experience any symptoms and therefore do not get diagnosed with hyperthyroidism until it is more advanced. In older people, some or all of the typical symptoms of hyperthyroidism may be absent, and the patient may just lose weight or become depressed. Typical symptoms of the condition include:
- Nervousness and irritability
- Increased resting heart rate, which causes heart palpitations
- Heat intolerance and increased sweating
- Weight loss with increase in appetite
- Frequent bowel movements
- Thyroid enlargement causing a lump in the neck
- Pretibial myxdemia, which causes a thick redness on the front of legs and typically occurs with Graves' disease
- Thin, delicate skin and irregular fingernail and hair growth
- Menstrual disturbance, such as decreased flow
- Mental disturbances
- Sleep disturbances, including insomnia
- Changes in vision, eye irritation or exophthalmos, which is a protrusion of the eyes that typically occurs with Graves' disease
Hypothyroidism occurs when the thyroid gland fails to produce enough thyroid hormone. Without enough thyroid hormone, the body becomes tired and run down. Every organ system slows, including the brain, which affects concentration; the gut, causing constipation; and metabolism -- the rate at which the body burns energy -- resulting in weight gain. Although there are many different causes of hypothyroidism, the resulting effect on the body is the same.
The most common cause of hypothyroidism is Hashimoto's thyroiditis, a disease in which the body's immune system attacks the thyroid gland. Failure of the pituitary gland to secrete a hormone to stimulate the thyroid gland, called secondary hypothyroidism, is a less common cause of hypothyroidism. Other causes include congenital defects, surgical removal of the thyroid gland, irradiation of the gland and inflammatory conditions.
The condition is more common in women and people over the age of 50. Other risk factors include thyroid surgery and exposure of the neck to X-ray or radiation treatments. With proper treatment, patients with hypothyroidism can regain full control of their lives and completely eliminate symptoms.
The symptoms of hypothyroidism depend on the amount of decrease in thyroid hormone and the duration of time in which the decrease has been present. Most patients experience mild symptoms, which are often confused with other problems. Symptoms may include:
- Joint or muscle stiffness
- Decreased hearing
- Weight gain
- Dry skin
- Sensitivity to cold
- Coarseness or loss of hair
- Goiter, or an enlarged thyroid causing a lump in the neck
- Memory and mental impairment
- Irregular or heavy menstruation
- Slowed heart rate
- Decreased libido
Multiple Pregnancy ( Twins, Triplets and Beyond)
A multiple gestation is a pregnancy in which a woman is carrying two or more babies In the past two decades, the number of multiple births in the United States has jumped dramatically. Between 1980 and 2000, the number of twin births has increased 74 percent, and the number of higher order multiple (triplets or more) has increased fivefold, according to the National Center for Health Statistics. Today, about 3 percent of babies in this country are born in sets of two, three or more, and about 95 percent of these multiple births are twins.
The rising number of multiple gestations is a concern because women who are expecting more than one baby are at increased risk of certain pregnancy complications, including preterm delivery (before 37 completed weeks of pregnancy). Babies who are born preterm are at risk of serious health problems during the newborn period, as well as lasting disabilities and death.
Some of the complications associated with multiple gestations can be minimized or prevented when they are diagnosed early. Although previous generations often were surprised by the delivery of twins (or other multiple), today most parents to-be learn the news fairly early. An ultrasound examination can detect more than 95 percent of multiple by the beginning of the second trimester. (Sometimes a seemingly normal twin gestation that is identified very early is later found to have only one fetus. These so-called “vanishing twin” events are not well understood.)
An abnormal result on the triple or quadruple screen—blood tests done around the 16th week of pregnancy to identify babies at increased risk of certain birth defects—also alerts a health care provider to the possibility of multiples, as does hearing more than one fetal heartbeat during a routine examination. A provider also may suspect that a woman is carrying more than one baby if she puts on weight more rapidly than anticipated in the first trimester, her uterus is larger than expected or if she has severe pregnancy-related nausea and vomiting (morning sickness). Some women also may notice more fetal movement than in a previous singleton pregnancy. Whenever a multiple gestation is suspected, the health care provider will most likely recommend an ultrasound examination to find out for sure.
Nutrition during Pregnancy
You don't have to give up all the foods you love when you're pregnant. You just need to eat smart and make sure that most of your choices are healthy ones. You only need 300 extra calories per day to support your baby's growth and development.
Vitamins and minerals help your body use the energy provided by foods for both yourself and your baby. They also help repair and maintain cells and tissues.
You can get most of the vitamins and minerals you need from a healthy diet. Because it may be hard to get enough iron, folic acid and calcium from food, many women take a prenatal vitamin every day.
Take your prenatal vitamin every day. Take vitamins as directed. Read the label and talk to your health care provider.
Do not take additional vitamins and minerals unless your health care provider says that you should. Large amounts of vitamins and minerals, especially vitamin A, can be harmful. Do not take more that 5,000 IU (international units) of vitamin A per day.
Choose a diet that includes a variety of healthy, nutritious foods. What are some good choices? Fruits, vegetables, whole-grain breads and pastas, milk products, and low-fat protein sources such as lean red meat, beans, tofu, poultry and some fish.
If you have trouble digesting lactose (the natural sugar found in milk), lactose-reduced milk products and calcium-fortified orange juice can help you get enough calcium.
For a healthy woman with “normal” pre-pregnancy weight, a 25-35 pound weight gain is expected. If you are under-weight, you should gain
28-40 pounds, and if you are over-weight, 15-25 pounds. Your provider will help determine if your weight gain is adequate to provide for your growing fetus.
Sexual relations: Intercourse is acceptable in a normal, healthy pregnancy. It should be avoided in instances when abortion or pre-term labor threatens a pregnancy.
Smoking: Smoking should be avoided during the duration of the pregnancy. Women who smoke during pregnancy have smaller babies, and have an increased risk of spontaneous abortion, pre-term delivery, and fetal death.
Over the Counter Medications: Any drug has the potential to be harmful to the pregnancy. However, there are many medications for common ailments that are safe during pregnancy. For example, Tylenol is safe for headaches (avoid aspirin or ibuprofen unless recommended by your doctor), Robitussin and other selected cough medications are safe, as well as medications for diarrhea, constipation, nausea and vomiting. Check with your doctor before taking any medication . Also, let your doctor know of any medications (prescription and over the counter) that your are taking.
Illicit Drugs: L ong term use of drugs during pregnancy is harmful to the fetus. The fetus may exhibit distress in the womb, low birth weight, and/or serious compromise as the consequence of drug withdrawal soon after birth.
Douching: Douching should be avoided during the pregnancy.
Exercise: Mild exercise is good for a pregnant woman and will not harm the pregnancy. If you did not have a vigorous exercise regimen before the pregnancy, do not start one now. Always talk with your provider before initiating an exercise regimen. In general, walking, swimming, and jogging are good forms of exercise. You should limit aerobic exercise to 20 minutes. Avoid exercising in hot weather, and drink plenty of fluids. After the fourth month, do not exercise lying flat on your back.
Travel: Travel by healthy, pregnant women has no harmful effect on the pregnancy. When traveling, prolong sitting or immobilization should be avoided. Every 2 hours, the pregnant woman should walk around to increase the circulation in her legs. Travel should be avoided within the last few weeks of pregnancy, in the event a complication develops and you are away from your doctor.
Conditions that should be reported to your doctor
There are certain conditions or symptoms that should be reported to your doctor immediately. These symptoms may be a warning sign of serious illnesses that may occur during pregnancy. The following is a list of some of these symptoms:
- Vaginal bleeding or spotting
- Abdominal pain
- Painful urination
- Severe or continuous headache
- Fever or chills
- Blurry vision or dimness
- Fluid leaking from the vagina
- Decreased fetal movement
- Foul or irritating vaginal discharge
- Persistent nausea or vomiting