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Still have questions?

I plan to get pregnant soon. Do I need to see an obstetrician for an examination and what can I expect at this examination?

Yes, it is advisable to see an obstetrician prior to 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 gynaecological conditions such as endometriosis ( blood cysts ) or fibroids ( fibrous growths in the womb), both of which are common and can affect fertility. An ultrasound of the pelvis will also confirm the absence of any gynaecological condition. A PAP smear to exclude an early cancer of the neck of the womb will also be performed. having taken a history of your menstrual cycle, he can then advise you on the best time to conceive. he will also want to do some blood tests and if required refer you for genetic counselling.

What can I do to minimise the risk of birth defects in my baby prior to conceiving?

Women are not totally aware that the crucial period is 20 to 70 days after the first day of your last menses or one week before the missed menses until you are 44 days overdue. The fertilised egg is rapidly dividing and forming into an embryo well before the missed period. Hence, precautions should start well before your period has been missed and carried on into the first 12 weeks of the pregnancy. If you think you might be pregnant, avoid all X-rays, all medicines and herbs. You should stop drinking and smoking, do not apply creams with medication to your skin, do not perm or dye your hair and avoid hot baths and saunas. It is of course not possible to avoid the effects of all environmental factors: chemicals in the air, soil, water and food substances, infectious diseases. some of these may cause abnormalities in your baby.

I have a positive urine pregnancy test, But I do not feel many symptoms of pregnancy. Should I be worried?

In the first 4 weeks of pregnancy, most pregnant women will not feel much in the way of symptoms. By 5 weeks, you may start to feel more tired and frequent the toilet. You may start to lose your appetite and feel distended in the abdomen after eating. At about 10 weeks of pregnancy, the hormone human chorionic gonadotrophin (HCG) reaches its peak and that is when you will feel the most symptoms such as vomiting. In about 20% of pregnancies, however there are no symptoms at all except for a missed period. Having symptoms does suggest that the foetus is growing, but not having any symptoms does not mean that there is something wrong. This can be verified by an early ultrasound scan by your obstetrician.

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?

Assuming that your periods are regular prior to getting pregnant, the size of your water bag should correspond to your period of amenorrhoea. The possible causes in this case could 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 week. You should not be unduly worried as a single ultrasound scan will not distinguish between a blighted ovum and wrong dates. You should wait for a second ultrasound scan at least 2 weeks after your last one to see if the water bag has grown. If it has grown by 2 weeks then it was smaller because of wrong dates or delayed ovulation. the foetal heartbeat can be seen on the ultrasound scan from 6 to 7 weeks. If the heartbeat can be seen, you can be rest assured that your pregnancy has not undergone a miscarriage.

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

When you are pregnant, the physiological changes that take place cause swelling in the neck of neck of your womb and an increase in a clear watery vaginal discharge. this discharge coagulates as it passes down the vagina and turns into a white and sometimes powdery discharge. this discharge is called leucorrhoea and is normal. If you are excessively sensitive about the discharge, you may request treatment with an acid vaginal pessary. However if your discharge is yellow or green or if there is a smell or itching, you may have a fungal or bacterial infection. Have your obstetrician check you with a speculum.

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

To avoid putting on too much weight, you should avoid eating too much fried and oily food, fast foods, junk food and foods with empty calories such as cakes, chocolates and pastries. semi-cooked and raw food should also be avoided. Half-boiled and raw eggs, fish are not advisable. Semi-cooked food and half-boiled or raw eggs may result in food poisoning due to salmonella infection and this may do harm to your baby.

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?

There are three levels of ultrasound scanning. The first is a general scan including the number of foetuses, viability ( whether foetal heartbeat is seen), position of the foetus, placental position, the amount of fluid present, measurement of foetal age and the growth of the foetus and a general look at the structure of the baby. The second level is a more detailed look at the structure and form of the baby. the third level is a detailed scan of the structure including blood flow studies of the heart to exclude cardiac abnormalities. the majority of obstetricians who perform scans and scans which are performed in radiology clinics are level I to level II scans. Should a heart abnormality be suspected, a level III scan is usually requested. Screening all women with level III scans would not be practical and would be extremely expensive. There are also limitations on the accuracy of ultrasound scans, whether a level II or III scan is performed. the results are accurate to approximately 90%.

I have contracted Herpes Simplex Type II from my husband and am now 20 weeks pregnant. What is this and will this affect my baby?

Herpes Simplex Type II is sexually transmitted and is as common as one in ten adults in the US. It starts off as a primary infection with symptoms of itching and pain in the vulval area. there may be pain on passing urine. The infection is characterised by blister-like lesions on the vulval and perineal region. they break down to form ulcers which are quite painful. these subside after about 3 to 6 weeks. the virus may then remain dormant in the cells of the body. Reactivation may occur at any time but the symptoms are usually much less severe than the primary infection.

The virus may be passed through the placenta to the baby but it most commonly affects the baby during delivery especially as the baby passes through the cervix. Affected babies may have a generalised disease with lesions in the liver, brain and central nervous system, eyes, skin and mouth. it is almost always fatal. If you have had herpes, you should inform your obstetrician as this will affect the way in which you may be delivered. the safest method of delivery is by caesarean section. Even this may not prevent an infection if the caesarean section is done after the water bag of baby has ruptured.

What is the latest on the effect of sound on babies while still in the womb? Should I play music for my baby to hear?

The latest research suggests that the baby’s hearing is well developed by 14 weeks. Playing music to the baby has shown to increase the heart rate. A foetus also turns away from bright lights which suggests that learning begins before birth. Research has also shown that babies appear to recognise voices of parents and relatives whom they were exposed to prior to birth. It can be deduced that unborn babies are listening to you even before they are born. Thus it would be appropriate to start talking to your baby well before birth. The learning process begins well before your baby is born.

What is premature labour? What are the causes and how do I prevent this?

Pre-term labour or premature laboir is the onset of labour with contractions, effacement (thinning of the cervix or neck of the womb) and dilatation of the cervix before 37 weeks. It tends to affect those in the lower socio-economic group with insufficient nutrition and rest. Multiparous (those with more than one child) patients are also more at risk. Multiple pregnancies, chlamydia infection, bacterial vaginosis and group B streptococcal infection put the patient in a higher risk of pre-term labour. The onset is unpredictable and the management will depend on the gestation at which pre-term labour occurs. If you are at high risk, strenuous work should be avoided, abstinence from sex is prudent and regular visits to your obstetrician is a necessity. your obstetrician will probably put you on medication to stop the contractions.

Are there any signs that indicate that I will be going into labour soon?

The most frequent signs of impending labour are backache and tightenings several times a day. There may be occasional pains in the lower abdomen particularly at night. Other signs are frequent urination and the urge to defaecate. there may be a false labour prior to the actual labour. the baby may also have reduced foetal movements prior to your going into labour.

What is an epidural analgesia? How is it administered?

Epidural analgesia is the most effective form of pain relief and will provide adequate pain relief in 90% of cases. It is administered by an anaesthetist. He will carefully insert a catheter into the epidural space of the spinal canal. Through this catheter, a local anaesthetic is administered. It may be given either as a single dose or as a continuous infusion with the aid of a pump. Low doses and continuous infusions are the most common method of administration. You will also have a drip containing Hartman’s solution to ensure that your blood pressure does not fall. You will have to have your pulse, blood pressure and breathing monitored regularly and your baby will also need to have continuous foetal monitoring.

Is an episiotomy always necessary and under what circumstances will my obstetrician perform one?

An episiotomy is not a routine and in many cases can be avoided. A great deal will depend on your obstetrician and how often he performs episiotomies. An obstetrician who performs episiotomies for all deliveries is probably not practising good obstetrics. Your obstetrician will probably perform an episiotomy when he feels that the perineum is going to tear, when he performs an assisted delivery with either a forceps or vacuum or when there is foetal distress and he has to hasten the delivery.

I have inverted nipples. Can I breastfeed?

Yes you can breastfeed. You will have to use specially designed nipple shells and you will have to be extra patient. Stimulating the nipple prior to breastfeeding, holding the breast in the correct position and using pumps to draw the nipple out may help. Nipple shells are shells placed over the nipple. They have a hole in the base through which the nipple is encouraged to protrude from. Generally, nipple shields should not be used as they do not usually ensure adequate milk flow and may cause fungal infections.

What is the traditional belief on having cold baths after delivery?

It is believed that after delivery, the mother should not take cold baths for about a month as this will increase the chances of rheumatism in old age. Many women even in modern society still practise this old custom. However, this custom evolved from China where it is cold and winters are freezing. In tropical climates, this practise appears to be diminishing. Betel nut leaves, lemon grass and ginger are added to baths and they are said to reduce rheumatism.

I have been told to have an abnormal PAP smear. What does this mean and what needs to be done?

An abnormal PAP smear is one in which the cytologist who reads the smear finds that there are abnormal changes in the cells taken from the cervix or neck of the womb. This may be due to infection such as with the human papilloma virus (HPV) a sexually transmitted disorder. Further investigations will have to be conducted by your gynecologist such as a colposcopy ( where the cervix is examined with a high powered microscope) or a repeat PAP may be necessary after treatment with antibiotics. Should there be suspicion of a cancer, a colposcopy or a biopsy will be done to determine the severity of the condition.

What is endometriosis and can this affect my fertility?

Endometriosis is a condition in which the cells which normally line the cavity of the womb and are shed during menstruation, are found in other places such as the ovaries, the front or back of the womb, intestines etc. During menses, these cells will also bleed and can cause extensive damage to a woman’s reproductive organs. Blood cysts may develop around the womb and on the ovaries causing the adjacent structures such as the fallopian tubes and intestines to stick to the cysts. Fertility may be affected as the anatomy of the reproductive organs will be altered and damaged to a greater or lesser degree. Ovulation from the affected ovaries may also be prevented. The infertility that results is however correctable.

What is minimal invasive surgery ( MIS) and how is this performed?

You may have pelvic pathology which requires surgery and your gynecologist has suggested MIS. MIS has replaced open surgery in many gynaecological surgeries in the present day. Surgery is performed through two or three tiny incisions over the abdomen and using special instruments inserted through these incisions. A lazer or electrocautery is used to cauterise, remove lesions. MIS may be performed for removal of fibroids, endometriosis, hysterectomies, correction of prolapse and incontinence of urine. It is performed either as a day procedure or a very short hospital stay of 2 or 3 days. The advantages are less painful procedure, shorter hospital stay, quicker recovery and cost savings in certain cases. MIS is however highly surgeon dependent when one is considering the results and complication rates.