Category Archives: Pregnancy & Child birth

Complications In Pregnancy

Pre-eclampsia, eclampsia or toxemia of pregnancy
Definition:
Pre-eclampsia or preeclampsia (PE) is a disorder of pregnancy characterized by high blood pressure and a large amount of protein in the urine. The disorder usually occurs in the third trimester of pregnancy and gets worse over time. In severe disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. PE increases the risk of poor outcomes for both the mother and the baby. If left untreated, it may result in seizures at which point it is known as eclampsia.

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Toxemia of pregnancy is a severe condition that sometimes occurs in the latter weeks of pregnancy. It is characterized by high blood pressure; swelling of the hands, feet, and face; and an excessive amount of protein in the urine. If the condition is allowed to worsen, the mother may experience convulsions and coma, and the baby may be stillborn.
The term toxemia is actually a misnomer from the days when it was thought that the condition was caused by toxic (poisonous) substances in the blood. The illness is more accurately called preeclampsia before the convulsive stage and eclampsia afterward.

Preeclampsia affects between 2–8% of pregnancies worldwide. Hypertensive disorders of pregnancy are one of the most common causes of death due to pregnancy. They resulted in 29,000 deaths in 2013 – down from 37,000 deaths in 1990. Preeclampsia usually occurs after 32 weeks; however, if it occurs earlier it is associated with worse outcomes. Women who have had PE are at increased risk of heart disease later in life. The word eclampsia is from the Greek term for lightning. The first known description of the condition was by Hippocrates in the 5th century BCE

Symptoms:
Swelling (especially in the hands and face) was originally considered an important sign for a diagnosis of preeclampsia. However, because swelling is a common occurrence in pregnancy, its utility as a distinguishing factor in preeclampsia is not great. Pitting edema (unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a health care provider.

In general, none of the signs of preeclampsia are specific, and even convulsions in pregnancy are more likely to have causes other than eclampsia in modern practice. Further, a symptom such as epigastric pain may be misinterpreted as heartburn. Diagnosis, therefore, depends on finding a coincidence of several preeclamptic features, the final proof being their regression after delivery.

The symptoms of toxemia of pregnancy (which may lead to death if not treated) are divided into three stages, each progressively more serious:
Mild preeclampsia symptoms include edema (puffiness under the skin due to fluid accumulation in the body tissues, often noted around the ankles), mild elevation of blood pressure, and the presence of small amounts of protein in the urine.

Severe preeclampsia symptoms include extreme edema, extreme elevation of blood pressure, the presence of large amounts of protein in the urine, headache, dizziness, double vision, nausea, vomiting, and severe pain in the right upper portion of the abdomen.
Eclampsia symptoms include convulsions and coma.

Risk Factors:
Known risk factors for preeclampsia include:

*Nulliparity (never given birth)
*Older age, and diabetes mellitus
*Kidney disease
*Chronic hypertension
*Prior history of preeclampsia
*Family history of preeclampsia
*Advanced maternal age (>35 years)
*Obesity
*Antiphospholipid antibody syndrome
*Multiple gestation
*Having donated a kidney.
*Having sub-clinical hypothyroidism or thyroid antibodies

It is also more frequent in a women’s first pregnancy and if she is carrying twins. The underlying mechanism involves abnormal formation of blood vessels in the placenta amongst other factors. Most cases are diagnosed before delivery. Rarely, preeclampsia may begin in the period after delivery. While historically both high blood pressure and protein in the urine were required to make the diagnosis, some definitions also include those with hypertension and any associated organ dysfunction. Blood pressure is defined as high when it is greater than 140 mmHg systolic or 90 mmHg diastolic at two separate times, more than four hours apart in a women after twenty weeks of pregnancy. PE is routinely screened for during prenatal care.
Causes:
There is no definitive known cause of preeclampsia, though it is likely related to a number of factors. Some of these factors include:

*Abnormal placentation (formation and development of the placenta)
*Immunologic factors
*Prior or existing maternal pathology – preeclampsia is seen more at a higher incidence in individuals with preexisting hypertension, obesity, antiphospholipid antibody syndrome, and those with history of preeclampsia
*Dietary factors, e.g. calcium supplementation in areas where dietary calcium intake is low has been shown to reduce the risk of preeclampsia.
*Environmental factors, e.g. air pollution
*Those with long term high blood pressure have a risk 7 to 8 times higher than those without.

Physiologically, research has linked preeclampsia to the following physiologic changes: alterations in the interaction between the maternal immune response and the placenta, placental injury, endothelial cell injury, altered vascular reactivity, oxidative stress, imbalance among vasoactive substances, decreased intravascular volume, and disseminated intravascular coagulation.

While the exact cause of preeclampsia remains unclear, there is strong evidence that a major cause predisposing a susceptible woman to preeclampsia is an abnormally implanted placenta. This abnormally implanted placenta is thought to result in poor uterine and placental perfusion, yielding a state of hypoxia and increased oxidative stress and the release of anti-angiogenic proteins into the maternal plasma along with inflammatory mediators. A major consequence of this sequence of events is generalized endothelial dysfunction. The abnormal implantation is thought to stem from the maternal immune system’s response to the placenta and refers to evidence suggesting a lack of established immunological tolerance in pregnancy. Endothelial dysfunction results in hypertension and many of the other symptoms and complications associated with preclampsia.

One theory proposes that certain dietary deficiencies may be the cause of some cases. Also, there is the possibility that some forms of preeclampsia and eclampsia are the result of deficiency of blood flow in the uterus.

Diagnosis:
Pre-eclampsia is diagnosed when a pregnant woman develops:

*Blood pressure >_ 140 mm Hg systolic or  >_  90 mm Hg diastolic on two separate readings taken at least four to six hours apart after 20 weeks gestation in an individual with previously normal blood pressure.
*In a woman with essential hypertension beginning before 20 weeks gestational age, the diagnostic criteria are: an increase in systolic blood pressure (SBP) of   >_ 30mmHg or an increase in diastolic blood pressure (DBP) of   >_15mmHg.
*Proteinuria  >_ 0.3 grams (300 mg) or more of protein in a 24-hour urine sample or a SPOT urinary protein to creatinine ratio  >_ 0.3 or a urine dipstick reading of 1+ or greater (dipstick reading should only be used if other quantitative methods are not available)

Suspicion for preeclampsia should be maintained in any pregnancy complicated by elevated blood pressure, even in the absence of proteinuria. Ten percent of individuals with other signs and symptoms of preeclampsia and 20% of individuals diagnosed with eclampsia show no evidence of proteinuria. In the absence of proteinuria, the presence of new-onset hypertension (elevated blood pressure) and the new onset of one or more of the following is suggestive of the diagnosis of preeclampsia:

*Evidence of kidney dysfunction (oliguria, elevated creatinine levels)
*Impaired liver function (impaired liver function tests)
*Thrombocytopenia (platelet count <100,000/microliter)
*Pulmonary edema
*Ankle edema pitting type
*Cerebral or visual disturbances
*Preeclampsia is a progressive disorder and these signs of organ dysfunction are indicative of severe preeclampsia. A systolic blood pressure ?160 or diastolic blood pressure ?110 and/or proteinuria >5g in a 24-hour period is also indicative of severe preeclampsia. Clinically, individuals with severe preeclampsia may also present epigastric/right upper quadrant abdominal pain, headaches, and vomiting. Severe preeclampsia is a significant risk factor for intrauterine fetal death.

Of note, a rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is still considered important to note, but is not considered diagnostic.

Predictive tests:
There have been many assessments of tests aimed at predicting preeclampsia, though no single biomarker is likely to be sufficiently predictive of the disorder. Predictive tests that have been assessed include those related to placental perfusion, vascular resistance, kidney dysfunction, endothelial dysfunction, and oxidative stress. Examples of notable tests include:

*Doppler ultrasonography of the uterine arteries to investigate for signs of inadequate placental perfusion. This test has a high negative predictive value among those individuals with a history of prior preeclampsia.
*Elevations in serum uric acid (hyperuricemia) is used by some to “define” preeclampsia,[14] though it has been found to be a poor predictor of the disorder. Elevated levels in the blood (hyperuricemia) are likely due to reduced uric acid clearance secondary to impaired kidney function.
*Angiogenic proteins such as vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) and anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1) have shown promise for potential clinical use in diagnosing preeclampsia, though evidence is sufficient to recommend a clinical use for these markers.
*Recent studies have shown that looking for podocytes, specialized cells of the kidney, in the urine has the potential to aid in the prediction of preeclampsia. Studies have demonstrated that finding podocytes in the urine may serve as an early marker of and diagnostic test for preeclampsia. Research is ongoing.

Differential diagnosis:
Pre-eclampsia can mimic and be confused with many other diseases, including chronic hypertension, chronic renal disease, primary seizure disorders, gallbladder and pancreatic disease, immune or thrombotic thrombocytopenic purpura, antiphospholipid syndrome and hemolytic-uremic syndrome. It must be considered a possibility in any pregnant woman beyond 20 weeks of gestation. It is particularly difficult to diagnose when preexisting disease such as hypertension is present. Women with acute fatty liver of pregnancy may also present with elevated blood pressure and protein in the urine, but differs by the extent of liver damage. Other disorders that can cause high blood pressure include thyrotoxicosis, pheochromocytoma, and drug misuse
Treatment:
Preeclampsia and eclampsia cannot be completely cured until the pregnancy is over. Until that time, treatment includes the control of high blood pressure and the intravenous administration of drugs to prevent convulsions. Drugs may also be given to stimulate the production of urine. In some severe cases, early delivery of the baby is needed to ensure the survival of the mother.

Prevention:
Recommendations for prevention include: aspirin in those at high risk, calcium supplementation in areas with low intake, and treatment of prior hypertension with medications. In those with PE delivery of the fetus and placenta is an effective treatment. When delivery becomes recommended depends on how severe the PE and how far along in pregnancy a person is. Blood pressure medication, such as labetalol and methyldopa, may be used to improve the mother’s condition before delivery. Magnesium sulfate may be used to prevent eclampsia in those with severe disease. Bedrest and salt intake have not been found to be useful for either treatment or prevention.

Diet:
Protein or calorie supplementation have no effect on preeclampsia rates, and dietary protein restriction does not appear to increase preeclampsia rates. Further, there is no evidence that changing salt intake has an effect.

Supplementation with antioxidants such as vitamin C and E has no effect on preeclampsia incidence, nor does supplementation with vitamin D. Therefore, supplementation with vitamins C, E, and D is not recommended for reducing the risk of pre-eclampsia.

Calcium supplementation of at least 1 gram per day is recommended during pregnancy as it prevents preeclampsia where dietary calcium intake is low, especially for those at high risk. Low selenium status is associated with higher incidence of preeclampsia.

Aspirin:
Taking aspirin is associated with a 1% to 5% reduction in preeclampsia and a 1% to 5% reduction in premature births in women at high risk. The WHO recommends low-dose aspirin for the prevention of preeclampsia in women at high risk and recommend it be started before 20 weeks of pregnancy. The United States Preventive Services Task Force recommends a low-dose regimen for women at high risk beginning in the 12th week.

Physical activity:
There is insufficient evidence to recommend either exercise or strict bedrest as preventative measures of pre-eclampsia.

Smoking cessation:
In low-risk pregnancies the association between cigarette smoking and a reduced risk of preeclampsia has been consistent and reproducible across epidemiologic studies. High-risk pregnancies (those with pregestational diabetes, chronic hypertension, history of preeclampsia in a previous pregnancy, or multifetal gestation) showed no significant protective effect. The reason for this discrepancy is not definitively known; research supports speculation that the underlying pathology increases the risk of preeclampsia to such a degree that any measurable reduction of risk due to smoking is masked. However, the damaging effects of smoking on overall health and pregnancy outcomes outweighs the benefits in decreasing the incidence of preeclampsia. It is recommended that smoking be stopped prior to, during and after pregnancy

Restriction of salt in the diet may help reduce swelling, it does not prevent the onset of high blood pressure or the appearance of protein in the urine. During prenatal visits, the doctor routinely checks the woman’s weight, blood pressure, and urine. If toxemia is detected early, complications may be reduced.

Resources:

http://health.howstuffworks.com/pregnancy-and-parenting/pregnancy/complications/a-guide-to-pregnancy-complications-ga13.htm

http://en.wikipedia.org/wiki/Pre-eclampsia

Mums Always Think Mother Knows Best

Mothers-to-be think their own mothers know better than the medical profession when it comes to health advice, researchers say.

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Pregnant women are bombarded with diffenent advices

A University of London team talked to women who gave birth in the 1970s, 1980s and the 2000s.

Modern women were more likely to take a mixture of advice – but were still more likely to follow family wisdom.

One baby charity said family tips were useful, but medical advice should be sought if mothers-to-be had worries.

The researchers talked about pregnancy and childbirth advice to seven women who gave birth in the 1970s and 12 of their daughters who had babies in the 2000s.

They then also analysed interviews on the same topic which had been carried out with 24 women in the 1980s.

The 1970s women were most likely to take advice from family members.

But researchers found that women who had babies between 2000 and 2010 had to evaluate a wide range of information from doctors, midwives, books, magazines and, latterly, the internet – as well as that from their families.

In these women, it tended to be family advice that won out – particularly if a mother-to-be was dealing with a specific symptom.

One woman, Hetty, from the 2000s generation, said she had tried to stop drinking tea because she had read on the internet that caffeine could cause miscarriages in the first few weeks of pregnancy.

But she then added she had taken her grandmother’s advice that tea could help relieve morning sickness.

“She just used to stay in bed and have a cup of tea. And that did help actually.”

‘Strike a balance’

Professor Paula Nicolson from Royal Holloway, University of London, who led the study, said: “When it comes to the crunch – if women feel sick for example – they will take their mother’s or their grandmother’s advice.

“They wouldn’t necessarily recognise how important it was to them, but it would override the science.”

She added: “Taking all the guidelines too seriously leads to anxieties. Lack of self-confidence also can lead to worry about ‘doing the wrong thing’ which is potentially more harmful than taking the odd glass of wine or eating soft cheese.”

Jane Brewin, chief executive of baby charity Tommy’s, said women had to “strike a balance” about what advice they took.

“It’s only natural to want to talk about the significant changes that happen to a woman’s body and how she feels; mums and close friends often have first-hand experience and tips that are helpful.

“However we always stress that if any mum-to-be is worried about anything during their pregnancy they should seek medical advice without delay.”

Source:
BBC NEWS:May 14. 2010

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Baby Development & Care from Birth to Three Months

It is very difficult to know  what a newborn baby is capable of. In the early days and weeks after birth, to the naked eye, not much. Eating, crying, sleeping, and pooping seem to take up the majority of her day, with a few moments of alertness thrown in for good measure. But recent research has shown that she’s doing a lot more than that. “Even in the first minutes of life, babies are a wonder,” says Naomi Steiner, MD, a developmental and behavioral pediatrician at Tufts-New England Medical Center, in Boston. “The newborn has a superactive brain and is primed to learn.”
CLICK & SEE….>..….(1)….……....(2)
Recent research, much of which relies on high-tech advances in intrauterine photography and brain imaging, now offers empirical proof of what parents have known all along: Babies are smart. What’s more, each baby is born with a unique personality that becomes readily apparent within the first few weeks of life. “Babies come into the world as themselves,” says Dr. Steiner. “It’s our job to get to know them.”

Baby’s Ability

Even though your baby can’t care for herself, what she is capable of at birth may surprise you. She’s born with 70 innate reflexes designed to help her thrive, some of which are truly remarkable. “Reflexes like the tonic neck reflex — in which your baby turns his head to one side, straightens one arm, and holds the other out — are critical to labor and delivery, helping your baby squirm around during the birth process, stimulating the uterus to keep contracting,” says Dr. Brazelton. In essence, he’s helping your labor progress.

Other reflexes are less subtle to a new parent. If left on his mother’s abdomen in a dim, quiet room after birth, a healthy newborn “will rest for about 30 minutes and will gaze at his mother’s face on and off,” reports Marshall Klaus, MD, who wrote the first textbook on neonatology and has coauthored a number of popular books for new parents, including Your Amazing Newborn (Perseus). Then he’ll begin smacking his lips and moving toward the breast completely unaided, using a powerful stepping reflex and bobbing his head up and down to gather momentum. Once at the breast, a newborn will open his mouth wide and place his lips on the areola, latching on all by himself for his first feeding. From that point on, these inborn responses will affect your newborn’s every move. The rooting reflex, for example, helps your baby seek nourishment. However, seemingly random, reflexive movements may be more intentional than we first thought. “When in a quiet, alert state, and in communication with a caregiver, some babies will reach out to try and touch something,” says Dr. Klaus.

Normal newborns at birth apparently have the underlying potential to reach for things, he explains, but their strong neck muscles are linked to their arms, so that a slight neck movement moves the arms as well. This connection protects the baby’s head from suddenly dropping forward or backward.

Baby’s Thinking

It depends upon how you define thought; of course, a newborn can’t share ideas. But some researchers believe that babies do put concepts together (albeit on a primitive level), evidenced by the fact that they remember and recognize their mother’s voice from birth, and express and respond to emotions before and immediately after birth. One could argue that memory and emotion are inextricably linked to thought. “A baby’s brain grows very differently depending on what sorts of experiences the baby has both in utero and after birth,” says Wendy Anne McCarty, PhD, the founding chair and faculty of the Prenatal and Perinatal Psychology Program at the Santa Barbara Graduate Institute, in California. “During gestation, birth, and early infant stages, we learn intensely and are exquisitely sensitive to our environment and relationships. From the beginning of life, we’re building memories.” Other experts say that a baby’s brain is too undeveloped to do more than orchestrate vital body functions. One fact remains clear: Newborns learn every day and apply that knowledge to their growing repertoire of skills. So can a newborn really think? Watch your baby, and judge for yourself!

Yopu may find the following:-In the first three months, your baby will learn to raise his or her head, smile, kick, move both arms and legs, roll over and make babbling noises. You will also learn to distinguish your baby’s cries, which will help you determine what your baby wants from you. Baby may also learn to wake up less as his or her stomach grows bigger and takes more in at a feeding.

Dr. Klaus discovered that newborns instinctively reach out until about 3 weeks of age, when this ability apparently disappears until about 3 months of age. This coincides with the time it takes your baby to start learning how to integrate his senses and gain control over his muscles. This is a prime example of how your baby’s need to learn so much, so quickly, means he must set aside some tasks while focusing on other, more important ones, such as regulating his sleep-wake cycles and figuring out how to focus his brand-new eyes on all the new sights around him.

So why do all these useful survival instincts seem to disappear so early — some as early as the 2-month mark? A baby spends the first few months of his life reacting to the world around him. But once he starts to understand where he ends and the world begins, which is partly a matter of brainpower, and partly a matter of practice, some behaviors that were once reflexive become active, as gradually baby learns that he can make things happen on his own and affect his environment. And, says Dr. Brazelton, “Just watching a baby learn is enough to give you hope for the human race.”

Baby’s Senses and Sensibility:-
Touch:
Your newborn’s skin is his largest and most highly developed sensory organ. At birth, your baby can respond to variations in temperature, texture, pressure, and pain. Your newborn’s lips and hands have the largest number of touch receptors, which may account for why newborns enjoy sucking on their fingers.

Smell:
By the 28th week of pregnancy, your baby can use her nose. One piece of evidence: Newborns placed between a breast pad from their mother and one from another woman most often turn toward the one with the alluring Mom-smell.

Taste:
In your womb, your baby gets a sampling of flavors as he swallows amniotic fluid. Studies have shown that fetal swallowing increases with sweet tastes and decreases with bitter or sour tastes.

Hearing:
Although your baby’s middle ear is still somewhat immature at birth, as are the sound processing centers of his brain, your newborn can hear you and will prefer human speech over any other sounds, especially if the voice is yours.

Vision:
By the time you actually meet your baby, her eyes are capable of excellent vision; however, her brain is still too immature to distinguish between different shades of color. By the time your baby is 3 months old, she will want to look at the world around her. She’ll prefer bright colors or sharp contrasts, and her favorite thing to look at will be faces.

Resources:

http://www.parents.com/baby/care/newborn/your-baby-from-birth-to-3-months/?page=5

http://www.thebabydepartment.com/babycare/baby-development.aspx

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In Vitro Fertilization (IVF)

Definition:
In vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy. The first “test tube baby”, Louise Brown, was born in 1978.

……Oocyte granulosa cells……….naked egg

In vitro fertilization (IVF) is a procedure in which eggs (ova) from a woman’s ovary are removed. They are fertilized with sperm in a laboratory procedure, and then the fertilized egg (embryo) is returned to the woman’s uterus.

ivf1_large..ivf2_large..ivf3_large

The term in vitro, from the [Latin] root meaning within the glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, test tube babies, refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However, in vitro fertilisation is usually performed in the shallower containers called Petri dishes. (Petri-dishes may also be made of plastic resins.) However, the IVF method of Autologous Endometrial Coculture is actually performed on organic material, but is yet called in vitro. This is used when parents are having infertility problems or they want to have multiple births.

IVF has been used successfully since 1978, when the first child to be conceived by this method was born in England. Over the past 20 years, thousands of couples have used this method of ART or similar procedures to conceive.

Other types of assisted reproductive technologies might be used to achieve pregnancy. A procedure called intracytoplasmic sperm injection (ICSI) uses a manipulation technique that must be performed using a microscope to inject a single sperm into each egg. The fertilized eggs can then be returned to the uterus as in IVF. In gamete intrafallopian tube transfer (GIFT) the eggs and sperm are mixed in a narrow tube and then deposited in the fallopian tube, where fertilization normally takes place. Another variation on IVF is zygote intrafallopian tube transfer (ZIFT). As in IVF, the fertilization of the eggs occurs in a laboratory dish. And, similar to GIFT, the embryos are placed in the fallopian tube (rather than the uterus as with IVF).

Purpose
IVF is one of several assisted reproductive techniques (ART) used to help infertile couples to conceive a child. If after one year of having sexual intercourse without the use of birth control a woman is unable to get pregnant, infertility is suspected. Some of the reasons for infertility are damaged or blocked fallopian tubes, hormonal imbalance, or endometriosis in the woman. In the man, low sperm count or poor quality sperm can cause infertility.

IVF is one of several possible methods to increase the chances for an infertile couple to become pregnant. Its use depends on the reason for infertility. IVF may be an option if there is a blockage in the fallopian tube or endometriosis in the woman, or low sperm count or poor quality sperm in the man. There are other possible treatments for these conditions, such as surgery for blocked tubes or endometriosis, which may be attempted before IVF.

IVF will not work for a woman who is incapable of ovulating or with a man who is not able to produce at least a few healthy sperm.

Diagnosis/Preparation

Once a woman is determined to be a good candidate for in vitro fertilization, she will generally be given fertility drugs to stimulate ovulation and the development of multiple eggs. These drugs may include gonadotropin-releasing hormone agonists (GnRHa), Pergonal, Clomid, or human chorionic gonadotropin (hcg). The maturation of the eggs is then monitored with ultrasound tests and frequent blood tests. If enough eggs mature, a physician will perform the procedure to remove them. The woman may be given a sedative prior to the procedure. A local anesthetic agent may also be used to reduce discomfort during the procedure.

The screening procedures and treatments for infertility can become a long, expensive, and, sometimes, disappointing process. Each IVF attempt takes at least an entire menstrual cycle and can cost $5,000–10,000, which may or may not be covered by health insurance. The anxiety of dealing with infertility can challenge both individuals and their relationship. The added stress and expense of multiple clinic visits, testing, treatments, and surgical procedures can become overwhelming. Couples may want to receive counseling and support through the process.

Aftercare
After the IVF procedure is performed, the woman can resume normal activities. A pregnancy test can be done approximately 12–14 days after the procedure to determine if it was successful.

Risks Factors and Complications
The risks associated with in vitro fertilization include the possibility of multiple pregnancy (since several embryos may be implanted) and ectopic pregnancy (an embryo that implants in the fallopian tube or in the abdominal cavity outside the uterus). There is a slight risk of ovarian rupture, bleeding, infections, and complications of anesthesia. If the procedure is successful and pregnancy.

……………IVF

Forin vitrofertilization, hormones are administered to the patient, and then eggs are harvested from her ovaries (A). The eggs are fertilized by sperm donated by the father (B). Once the cells begin to divide, one or more embryos are placed into the woman’s uterus to develop (C). (Illustration by GGS Inc.)

is achieved, the pregnancy carries the same risks as any pregnancy achieved without assisted technology.

The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g., England) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of < 2500 g.[6] However recent evidence suggest that singleton offspring after IVF is at higher risk for lower birth weight for unknown reasons.

Another risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome.

If the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early to examine that male offspring is at higher risk for sperm abnormalities.

Birth defects
The issue of birth defects has been a controversial topic in IVF. Many studies do not show a significant increase after use of IVF, and some studies suggest higher rates for ICSI, whereas others do not support this finding. In 2008, an analysis of the data of the National Birth Defects Study in the US found that certain birth defects were significantly more common in infants conceived with IVF, notably septal heart defects, cleft lip with or without cleft palate, esophageal atresia, and anorectal atresia; the mechanism of causality is unclear.[8]

Japan’s government prohibited the use of in vitro fertilisation procedures for couples in which both partners are infected with HIV. Despite the fact that the ethics committees previously allowed the Ogikubo Hospital, located in Tokyo, to use in vitro fertilisation for couples with HIV, the Health, Labour and Welfare Ministry of Japan decided to block the practice. Hideji Hanabusa, the vice president of the Ogikubo Hospital, states that together with his colleagues, he managed to develop a method through which scientists are able to remove the AIDS virus from sperm.

Normal Results:
Success rates vary widely among clinics and among physicians performing the procedure. A couple has about a 10% chance of becoming pregnant each time the procedure is performed. Therefore, the procedure may have to be repeated more than once to achieve pregnancy.

Abnormal results include ectopic or multiple pregnancy that may abort spontaneously or that may require termination if the health of the mother is at risk.

Morbidity and Mortality Rates:
The most common cause of morbidity is ecotopic pregnancy. Pain is associated with most components of the procedure. Mortality as a result of IVF is extremely rare.

Alternatives
Other types of assisted reproductive technologies might be used to achieve pregnancy. A procedure called intracytoplasmic sperm injection (ICSI) utilizes a manipulation technique that must be performed using a microscope to inject a single sperm into each egg. The fertilized eggs can then be returned to the uterus, as in IVF. In gamete intrafallopian tube transfer (GIFT), the eggs and sperm are mixed in a narrow tube, and then deposited in the fallopian tube, where fertilization normally takes place. Another variation on IVF is zygote intrafallopian tube transfer (ZIFT). As in IVF, the fertilization of the eggs occurs in a laboratory dish. And, similar to GIFT, the embryos are placed in the fallopian tube, rather than in the uterus as with IVF

You may click to see->

Intrauterine Insemination (IUI)

Manbir  Online

Digitable Builder

Three-parent embryo formed in lab

Resources:

http://en.wikipedia.org/wiki/In_vitro_fertilisation

http://www.answers.com/topic/in-vitro-fertilisation

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Have Chocolate to Cut Eclampsia Risk in Pregnancy

Watching a pregnant woman in convulsions is one of most frightening sights. Yet, it happens in one in 1,000 pregnancies in India and is a well-known complication of pregnancy known as eclampsia or toxemia of pregnancy. The early warning signs of eclampsia are elevated blood pressure, protein in the urine and swelling of the arms and feet — a state called pre-eclampsia.

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And this occurs in nearly one in 25 pregnant women. One of the major reasons to make regular visits to the doctor during pregnancy is to have the blood pressure and urine checked, especially in the third trimester, to make sure these complications do not occur.

Scientists are unclear as to the causes of pre-eclampsia or eclampsia but they suspect that placental chemicals cause constriction of the small arteries of the mother’s body. The constriction of vessels causes blood pressure elevation, fits, and damage to the kidneys. Nearly 5% of mothers who develop eclampsia die from the complications.

The treatment for eclampsia are magnesium sulfate and valium, but the treatment for pre-eclampsia are few: bed-rest and in severe cases, an early delivery of the baby. For years, scientists have been searching for ways to prevent pre-eclampsia; however, to date there have been no good therapies.

A recent study from Yale University conducted by Elizabeth Triche and published in the journal Epidemiology found a simple and rather pleasant way to decrease the risk of pre-eclampsia in pregnant women. Triche studied nearly 2,000 pregnant women and recorded their chocolate intake during the first and third trimester of pregnancy and their blood chocolate levels at pregnancy (chemical in chocolate called theobromine).

Her findings were remarkable. In the first trimester, the women who had greater than five servings of chocolate per week had a 19% lower incidence of pre-eclampsia than the women who had less than one serving of chocolate. For the third trimester, the mothers who ate more chocolate had a 40% lower incidence of pre-eclampsia. Also, mothers who had high levels of theobromine, the chocolate ingredient, had a 70% lower incidence of pre-eclampsia.

Though the sample size of this study was not sufficient to make some of these findings statistically significant, and one study is not enough to prove a cause-effect relationship, the trends were impressive.

Chocolate, especially dark chocolate, is known to have over 600 beneficial compounds especially related to cardiovascular health. Given that few preventive measures exist for pre-eclampsia — it’s nice to know that one chocolate bar per day can make a huge difference for the mother and the baby. All medicine isn’t bitter!

You may click to see:->

Chocolate may reduce pregnancy complications

Eating chocolate during pregnancy can help prevent pre-eclampsia in babies

Could eating chocolate save your baby’s life?

Sources: The Times Of India

Pregnancy Timeline

Weeks 1-4
Fertilisation occurs and a ball of quickly multiplying cells embeds itself in the lining of the uterus.CLICK & SEE
In the UK pregnancy is calculated from the first day of the woman’s last period so for as much as three weeks of this first month she might not be actually pregnant. When fertilisation does occur the tiny mass of cells called a blastocyst at this stage embeds itself in the lining of the womb which is already thickening to support it.

Week 5
The mass of cells is developing fast and becomes an embryo. For many women the first sign of pregnancy is a missed period.
Shopbought tests are considered largely reliable so the mother-to-be does not have to have her pregnancy confirmed by her GP. If a first test is negative a second one a few days later may prove positive as hormone levels in the urine rise.....CLICK & SEE

Week 6
The embryo officially becomes a foetus. It is about the size of a baked bean and its spine and nervous system begin to form.
The foetus already has its own blood system and may be a different blood group from its mother. Blood vessels are forming in what will become the umbilical cord and tiny buds which will become limbs appear.

Week 7

The baby’s heart is beginning to develop. Morning sickness and other side effects of early pregnancy may take hold.
Around this time many women find they experience the side-effects of early pregnancy including needing to urinate more often nausea and vomiting and feeling a bit weepy and irritable. All medication including supplements need to be carefully checked as the foetus is undergoing vital development in the first 12 weeks. If the woman has not told her GP or community midwife she is pregnant yet now is a good time to do so.

Week 8

It is quite common to have a first scan at this stage if the woman has had a previous miscarriage or bleeding.
An early scan is often done through the vagina and is used to check the pregnancy is not ectopic. It should show up the baby´s heartbeat. The nervous system is also developing rapidly especially the brain. The head gets bigger and eyes form under the skin of the face. The foetus’ limbs are growing and look more like arms and legs. All internal organs are developing and becoming more complex.

Week 9
The foetus is about 5cm long with its head tucked onto its chest. It has most its major organs and eyes and ears are developing.

Week 10
A scan at 10-13 weeks is recommended to pin down the date of the pregnancy.

Week 11
The umbilical cord is fully formed providing nourishment and removing waste products. The foetus looks fully human now.

Week 12
By this week the threat of miscarriage is much reduced. Many women announce their pregnancy to friends and colleagues.
The foetus is growing in length much more quickly by now it is about eight cm long and weighs about 60 grams. The placenta is now wellformed though it’s not yet doing its full job it takes over fully in week 14. The mother is likely to have her first scan this week.

Week 13
The womans uterus is becoming larger and is starting to rise out of the pelvis. The foetus can move its head quite easily.

Week 14

Third of the way through. The average pregnancy lasts 266 days or 280 days from the first day of last period.

Week 15
Screening for Downs syndrome is offered about now. A simple blood test is carried out first then further tests may be offered.
On the basis of the blood test results the woman may opt for a Chorionic Villus sample or an amniocentesis which would diagnose Down’s syndrome or other chromosomal abnormalities. However these diagnostic tests have a small risk of subsequent miscarriage. An alternative to blood tests is a nuchal translucency scan a new scan offered by some larger hospitals. But again an amniocentisis would be required for firm diagnosis.

Week 16
The foetus now has toe and finger nails eyebrows and eyelashes. It is also covered with downy hair.
The hair that will cover the baby until the last week or so of pregnancy – called lanugo – starts to form. This hair is very fine more like down and it probably serves as some form of insulation and protection for the skin.

Week 17
The foetus can hear noises from the outside world. By this stage the mother is visibly pregnant and the uterus is rising.

Week 18
By this stage the foetus is moving around a lot – probably enough to be felt.

Week 19
The foetus is now about 15-20cm long and weighs about 300g. Milk teeth have formed in the gums.

week 20
Half way through pregnancy now. Almost all mothers are offered a routine scan. The foetus develops a waxy coating called vernix.
The scan can show the foetus in fine detail and often reveal if the baby is a boy or a girl. However not all hospitals offer to tell parents the sex of the child – and not all parents want to know.

Week 21
The mother may feel short of breath as her uterus pushes against her diaphragm leaving less space for the lungs.
The mother may be offered another ultrasound scan around this time. The scan can check the baby’s spine internal organs and growth are normal.

Week 22
Senses develop: taste buds have started to form on the tongue and the foetus starts to feel touch.

Week 23
The skeleton continues to develop and bones that form the skull begin to harden – but not fully.

Week 24
Antenatal checkup and scan to check the baby´s position. A baby born this early does sometimes survive.
A baby born at 24 weeks may possibly survive but it would have severe breathing difficulties as its lungs would not be strong enough to cope. It would also be very thin lightweight and susceptible to infections.

week 25

All organs are now in place and the rest of the pregnancy is for growth. Preeclampsia is a risk from here onwards.
This potentially fatal condition causes high blood pressure protein in the urine and swelling caused by fluid retention. The causes are unclear but research suggests it may be linked to an immune reaction to the foetus or the placenta. If the condition is serious women may be advised to take drugs to lower their blood pressure and in some cases an early caesarean or induction may be performed. Serious complications of pregnancy

Week 26
The foetus skin is gradually becoming more opaque than transparent.

Week 27
The foetus measures about 34cm and weighs about 800g.

Week 28
Routine checkup to test for preeclampsia. Women with Rhesus negative blood will also be tested for antibodies.
If the mother has Rh negative blood but the baby is Rh positive she can develop antibodies to her baby’s blood during labour. This is not a problem in the first birth but can affect subsequent pregnancies and result in stillbirth. Fortunately treatment is simple and effective. BBC Health: Ask the doctor – Rhesus disease

Week 29
Some women develop restless leg syndrome in their third trimester.
This is sensations such as crawling tingling or even cramps and burning inside the foot or leg – often in the evening and at night disturbing sleep and making the mother feel she needs to get up and walk around. No-one knows what causes this harmless but irritating condition.

Week 30
Braxton Hicks contractions may begin around now. They are practice contractions which dont usually hurt.
These are irregular, painless contractions which feel like a squeezing sensation near the top of the uterus. If contractions become painful or occur four times an hour or more, the woman should call a doctor as she may be in early labour.

Week 31
The foetus can see now and tell light from dark. The mother´s breasts start to produce colostrum about now
This high calorie milk is produced by the mother to feed the baby for the first few days after birth before normal milk starts.

Week 32
Another antenatal appointment. The foetus is about 42cm and weighs 2.2kg. A baby born now has a good chance of survival.

Week 33
From now the baby should become settled in a head downwards position. A midwife can help to move it if necessary.

Week 34
The mother may find it more difficult to eat full meals as the expanded uterus presses on her stomach.

Week 35
If the mother has been told she may need a planned caesarean, now is a good time to discuss it further.


Week 36

The baby’s head may engage in the pelvis any time now.

Week 37
The baby’s lungs are practically mature now and it can survive unaided. The final weeks in the womb are to put on weight.

Week 38
Babies born from this week onward are not considered early.

Week 39
Another ante-natal appointment. The mother has reached her full size and weight by now.

Week 40
In theory the baby should be born this week. The mother’s cervix prepares for the birth by softening.

Week 41
First babies are often up to a week late but if there are signs of distress to mother or child the birth will be induced.

CLICK TO SEE ALSO:->

PRE-NATAL
Minor complications
Serious complications

DURING LABOUR
Pain relief
Complications of labour

POST-NATAL
Breast vs bottle

RELATED INTERNET LINKS:
Childbirth.org
Family Planning Association 

Sources: BBC NEWS

Getting Back In Shape After Childbirth

Following the birth of a child, a new mother is often overwhelmed by the tasks of parenthood. Besides adjusting to her new lifestyle, the mother must turn her attention to her own body. Hormonal changes during pregnancy and the growth of the fetus in the uterus have tremendous effects on the mother’s body. The pelvic floor, which is a group of muscles which support the abdominal organs, is often weakened and stretched during pregnancy and childbirth. To restore strength to these muscles a woman must perform a series of exercises..…CLICK & SEE

During the nine months of pregnancy, the woman’s body continues to change and evolve to meet the needs of the unborn baby. However, within weeks after the baby is born, the mother can take steps to enhance the healing in her body. With proper exercise, a new mother can speed her recovery time and simultaneously feel better about herself.

A Post Partum Exercise Regimen

Strengthening of the abdominal and pelvic floor muscles represent the foundation of a post-partum exercise program. During childbirth, the abdominal muscles are often stretched and the pelvic floor muscles traumatized. Although the uterus will return to normal size within six weeks, specific strengthening exercises are required to restore the tone to the abdominal muscles.

Specifically, patients need to practice a series of four exercises designed to promote the strength of the affected muscles. First, identify the pelvic floor muscles by partially emptying the bladder and stopping the urine flow. This exercise promotes the strength of the pelvic floor muscle. Secondly, while laying supine, flatten the stomach and hold for five seconds. (Don’t forget to keep breathing). The third recommended exercise is called the “straight curl up.” To perform this exercise, the woman should lay on the ground with her feet flat on the floor. Then, she should reach forward toward the knees, lifting her shoulders off the floor. During each motion, the woman should pause and slowly return to the starting position. Finally, the diagonal curl up will boost the strength of the abdominal muscles. To perform this exercise, the woman should again rest on the back with the knees flexed and the feet flat. Then, to complete the exercise, the woman must diagonally reach across her body with her right hand extending toward her left knee. Then slowly return to the starting position and resume the exercise, only this time reaching her left hand to her right knee. The performance of these exercises will allow the new mother to restore healthy and strong muscles.

click to see the pictures

Restoring Back Strength

As a mother gets back on her feet following delivery, moderate exercise is important. Experts often recommend walking (and pushing a stroller) because it restores back strength and posture. During pregnancy and childbirth, the muscles of the back tend to shorten, leading to a rotated pelvis. Physical therapists call this forward rotation a lordosis, “sway-back” position.

To correct this condition after pregnancy, a woman can perform several other exercises. The first exercise referred to as a “bridge,” requires the woman to rest on the back with her knees bent and feet flat. Then, she must gently lift her hips toward the ceiling. A second exercise designed to improve posture center on pelvic tilting. In this exercise, the woman must rest on her back and contract the abdominal muscles while simultaneously flattening the arch of the back into the floor. This exercise will strengthen the abdomen and reduce the possibility of the “sway back” position. Finally, women who just gave birth to a baby must guard against awkward lifting positions that can cause back complications. The mother must instead remember the proper lifting techniques of bending at the knees and keeping the head and chest high. By practicing these and other post partum exercises, women can maintain their health and enjoy their new bundle of joy.

Yoga Exercises under the guidance of some expart is the best way to rejuvenile yourself and mentain good health,mind and soul all along.

Source:Therapy Services Associates