Tag Archives: Pregnancy and Birth

Molar Pregnancy

Definition:
A molar pregnancy is one condition in a range of problems known as trophoblastic disease, where a pregnancy doesn’t grow as it should. It’s sometimes called a hydatiform mole.

There are two different types of molar pregnancy, which differ in how they form and how they need to be treated.

In a normal pregnancy, genetic material from the mother and father combines to form new life. In a molar pregnancy, this process goes wrong. In a complete molar pregnancy, the maternal chromosomes are lost, either at conception or while the egg was forming in the ovary, and only genetic material from the father develops in the cells. In a partial molar pregnancy, there is a set of maternal chromosomes but also two sets of chromosomes from the father (ie, double the normal paternal genetic material).

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The genotype is typically 46,XX (diploid) due to subsequent mitosis of the fertilizing sperm, but can also be 46,XY (diploid).  In contrast, a partial mole occurs when an egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid) or 92,XXXY (quadraploid).

Complete molar pregnancies develop as a mass of rapidly growing cells but without a foetus – it cannot therefore develop into a baby.
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In a partial molar pregnancy, a foetus may start to develop but because of the imbalance in genetic material, it’s always abnormal and can’t survive beyond the first three months of pregnancy.

A molar pregnancy is often harmless, but if untreated can keep on growing and become invasive, spreading to the organs around it, or even further afield to the lungs, liver or brain. Very rarely, in two to three per cent of cases, it may become malignant. These cancerous types of trophoblastic disease are called choriocarcinoma and placental site trophoblast tumours.

Symptoms:
As the mole grows faster than a normal foetus would, the abdomen may become larger more quickly than would be expected for the dates of the pregnancy. The woman may experience abdominal pain, and also severe nausea and vomiting (hyperemesis).

Bleeding from the vagina is another common warning sign that things are not as they should be. Symptoms similar to pre-eclampsia – high blood pressure, protein in the urine, swelling of the feet and legs – may also occur in the first trimester or early in the second.

Most molar pregnancies are diagnosed at the first ultrasound scan, which shows a mass of cells without the presence of a foetus in a complete molar pregnancy or an abnormal non-viable foetus and placenta in a partial mole.

A woman with a hydatidiform mole often feels pregnant and has symptoms such as morning sickness, probably because the cells of the molar pregnancy produce the pregnancy hormone hCG (human chorionic gonadotrophin). This is also the hormone that is used in a pregnancy test, so she may have a positive result. Some women have no pregnancy symptoms (as with many normal pregnancies). — but most molar pregnancies cause specific signs and symptoms, including:

*Dark brown to bright red vaginal bleeding during the first trimester

*Severe nausea and vomiting

*Vaginal passage of grape-like cysts

*Rarely, pelvic pressure or pain

If you experience any signs or symptoms of a molar pregnancy, consult your health care provider. He or she may detect other signs of a molar pregnancy, such as:

*Rapid uterine growth — the uterus is too large for the stage of pregnancy

*High blood pressure

*Preeclampsia — a condition that causes high blood pressure and protein in the urine after 20 weeks of pregnancy

*Ovarian cysts

*Anemia

*Overactive thyroid (hyperthyroidism)

Causes:
A molar pregnancy is caused by an abnormally fertilized egg. Human cells normally contain 23 pairs of chromosomes. One chromosome in each pair comes from the father, the other from the mother. In a complete molar pregnancy, all of the fertilized egg’s chromosomes come from the father. Shortly after fertilization, the chromosomes from the mother’s egg are lost or inactivated and the father’s chromosomes are duplicated. The egg may have had an inactive nucleus or no nucleus.

In a partial or incomplete molar pregnancy, the mother’s chromosomes remain but the father provides two sets of chromosomes. As a result, the embryo has 69 chromosomes, instead of 46. This can happen when the father’s chromosomes are duplicated or if two sperm fertilize a single egg.

It remains unclear why a hydatidiform mole develops. However, there are a number of possible reasons, including defects in the egg, maternal nutritional deficiencies and uterine abnormalities. Women under 20 or over 40 are at higher risk.

Having a diet that’s low in protein, folic acid and carotene also increases the risk of a molar pregnancy. The number of times a women has been pregnant, however, doesn’t influence her risk.

Risk Factors:
Up to an estimated 1 in every 1,000 pregnancies is molar. Various factors are associated with molar pregnancy, including:

*Maternal age. A molar pregnancy is more likely for a woman older than age 35 or younger than age 20.

*Previous molar pregnancy. If you’ve had one molar pregnancy, you’re more likely to have another. The risk of a repeat molar pregnancy is 1 in 100.

*Some ethnic groups. Women of Southeast Asian descent appear to have a higher risk of molar pregnancy.

Diagnosis:
Molar pregnancies usually present with painless vaginal bleeding in the fourth to fifth month of pregnancy. The uterus may be larger than expected, or the ovaries may be enlarged. There may also be more vomiting than would be expected (hyperemesis). Sometimes there is an increase in blood pressure along with protein in the urine. Blood tests will show very high levels of human chorionic gonadotropin (hCG).

The diagnosis is strongly suggested by ultrasound (sonogram), but definitive diagnosis requires histopathological examination. On ultrasound, the mole resembles a bunch of grapes (“cluster of grapes” or “honeycombed uterus” or “snow-storm”). There is increased trophoblast proliferation and enlarging of the chorionic villi. Angiogenesis in the trophoblasts is impaired as well.

Sometimes symptoms of hyperthyroidism are seen, due to the extremely high levels of hCG, which can mimic the normal Thyroid-stimulating hormone (TSH).

Treatment :
Once it has been established that a woman is carrying a hydatidiform mole rather than a healthy foetus, suction evacuation is used to remove the pregnancy from the womb. This is curative in about four out of five molar pregnancies.

It’s then important to monitor the woman’s progress and repeatedly measure human chorionic gonadotropin (hCG) to be sure that everything settles back down to a normal, non-pregnancy level.

About 15 per cent of women who have had a complete molar pregnancy and 0.5 per cent of those with a partial molar pregnancy will require additional treatment, either because hCG levels hit a plateau or start to rise again, or because of persistent heavy vaginal bleeding.

Further treatment may involve the use of chemotherapy (usually methotrexate combined with folinic acid), especially if there’s any concern about invasive or malignant disease.

Complications:
After a molar pregnancy has been removed, molar tissue may remain and continue to grow. This is called persistent gestational trophoblastic disease (GTD). It occurs in about 10 percent of women after a molar pregnancy — usually after a complete mole rather than a partial mole. One sign of persistent GTD is an HCG level that remains high after the molar pregnancy has been removed. In some cases, an invasive mole penetrates deep into the middle layer of the uterine wall, which causes vaginal bleeding. Persistent GTD can nearly always be successfully treated, most often with chemotherapy. Another treatment option is removal of the uterus (hysterectomy).

Rarely, a cancerous form of GTD known as choriocarcinoma develops and spreads to other organs. Choriocarcinoma is usually successfully treated with multiple cancer drugs.

Prognosis:
More than 80% of hydatidiform moles are benign. The outcome after treatment is usually excellent. Close follow-up is essential. Highly effective means of contraception are recommended to avoid pregnancy for at least 6 to 12 months.

In 10 to 15% of cases, hydatidiform moles may develop into invasive moles. This condition is named persistent trophoblastic disease (PTD). The moles may intrude so far into the uterine wall that hemorrhage or other complications develop. It is for this reason that a post-operative full abdominal and chest x-ray will often be requested.

In 2 to 3% of cases, hydatidiform moles may develop into choriocarcinoma, which is a malignant, rapidly-growing, and metastatic (spreading) form of cancer. Despite these factors which normally indicate a poor prognosis, the rate of cure after treatment with chemotherapy is high.

Over 90% of women with malignant, non-spreading cancer are able to survive and retain their ability to conceive and bear children. In those with metastatic (spreading) cancer, remission remains at 75 to 85%, although their childbearing ability is usually lost.

Prevention:
Following successful treatment, most women can have children if they wish. However, it’s strongly recommended that a woman who has had a molar pregnancy doesn’t become pregnant again for 12 months. Although the likelihood is small, there’s a real risk of malignant disease developing and the increase in pregnancy hormones this would cause can’t be distinguished from those of a real pregnancy. Consequently, good contraception is required, as is regular monitoring by a hospital specialist.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/hydatidiformmole1.shtml
http://www.mayoclinic.com/health/molar-pregnancy/DS01155
http://en.wikipedia.org/wiki/Hydatidiform_mole

http://drugster.info/ail/pathography/375/

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Babies Eye Sight

Vision in a baby’s first few months
To start with, they can see a toy or face in front of them but anything much further away is a blur. Slowly, the distance that they can see clearly increases, until by about six months they can see across a room.

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Many tiny babies also have a squint (their eyes look in different directions), which usually gets better within a few months.

Faces are a good test
Most babies can recognise their parents by about two weeks and start to smile at about six weeks. In these early days, most babies are particularly fascinated by faces and will focus on one in front of them – following it with their gaze (they prefer familiar faces).

This gives you a chance to test your baby’s sight from the age of six weeks.

•Sit your baby on the lap of someone they’re comfortable with
•Crouch down so your face becomes level with your baby’s face and about an arm’s length away from them
•Your baby should fix his or her eyes on your face (rather than looking everywhere else)
•Keep looking at your baby but move your head around from one side to another
•Your baby should keep his or her eyes fixed on your gaze
Alternatively, use a toy moved in front of your baby. They should be able to follow a brightly coloured moving toy held about 20cm (8in) away from them by about six weeks.

It can be difficult to be certain
Small babies are easily distracted and it can be very difficult to test their sight with certainty, so any worries you have are best checked by a professional.

Small babies can seem to take longer than normal for their brain to register what their eyes are seeing, even though there’s no problem with their vision. This is more likely in premature babies. After a matter of weeks, their visual sense suddenly kicks in and the problem’s resolved.

Serious visual problems are rare at this age, especially if his eyes appear normal, but occasionally they do occur.

A parent’s instincts should never be ignored. If you’re worried, talk to your doctor.

You may click to see to learn more :

How a Baby’s Vision and Eyesight Develops

Vision Development in Babies

Developmental milestones: Sight

Source : BBC Health.

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Enhanced Alpha Fetoprotein Test (“Triple Screen”)

Definition:This is a  blood test that measures the levels of alpha-fetoprotein (AFP), a protein released by the fetal liver and found in the mother’s blood. AFP is sometimes called MSAFP (maternal serum AFP )  This blood test for pregnant women, also called a “triple screen,” checks the levels of protein and hormones being produced by the fetus. The levels of three different substances together can enable doctors to identify pregnancies that are at a higher risk for birth defects such as Down syndrome or neural tube defects (brain and spinal cord problems). If the blood test suggests problems, your doctor might recommend additional tests, such as amniocentesis or fetal ultrasound, to confirm the findings.
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The alpha-fetoprotein (AFP) test is available to women between their 15th and 20th week of pregnancy to screen for fetal abnormalities. This simple blood test measures the level of a protein called alpha-fetoprotein which is secreted by the liver of the fetus and enters the mother’s blood stream. Elevated levels of AFP may indicate an increased risk of neural tube defects such as spina bifida or anencephaly, while low levels suggest Down Syndrome or other chromosomal defects.

The AFP test does not determine the existence of these genetic disorders; it only predicts their likelihood. And while the AFP test is most often used to screen for these defects, it can also be used to identify abdominal wall defects, some renal and urinary tract abnormalities, Turner syndrome, low birth weight, and placental complications. An incorrectly-calculated gestational age and multiple fetuses can also cause abnormal AFP levels.


How do you prepare for the test?

* Before having this test done, you need to think carefully about what you would do with the results once you have them. The results of this blood test cannot show for sure whether you have either a healthy fetus or one with a problem; it can only suggest which patients might want to go ahead with further testing. Because amniocentesis (the test that is usually recommended after an abnormal triple screen) has a small risk of miscarriage, and because most people with an abnormal triple screen decide to go ahead with amniocentesis, this is an important decision. You should have this test done only if you think the information it offers would help you to make decisions about your pregnancy.

What happens when the test is performed?

* Your blood is drawn for this test sometime between your 15th and 20th weeks of pregnancy. The blood is tested for three protein and hormone levels: maternal serum alpha fetoprotein (MSAFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG). Your doctor needs to weigh you on the day you have your blood drawn and ask when your last period began or what your expected due date is. The analysis of the results will take into account your weight and stage of pregnancy to determine whether the levels are normal.

What risks are there from the test?

* There are no risks from this test itself, but there are some risks from tests that might be recommended if the test result comes back abnormal (see-> “Amniocentesis,” ). This test can be stressful for expectant parents. Several things can cause the test to come back as abnormal even when there are no real health problems. Confusing results can happen, for example, in twin pregnancies and when mistakes have been made in estimating the age of the pregnancy.

How long is it before the result of the test is known?
The test results are available to your doctor within two or three days.

For more information You may click to see:->

Health informations for pregnant women:
Pregnancy & Childbirth :
Integrated test during pregnancy:
Common Tests During Pregnancy:
Glossary:  From “abdomen” to “zygote,” here’s your guide to pregnancy terminology.
:
High-Risk Pregnancy :
Healthy & Safe Pregnancy
:

Resources:

https://www.health.harvard.edu/fhg/diagnostics/AFP/AFP.shtml?Submit=Know+More+About+This+Test%3F
http://www.parentingweekly.com/pregnancy/pregnancy_information/afp_test.htm

Pregnancy Exercise ‘Helps Baby’

Exercise during pregnancy can be good for the developing baby as well as for the mother, research suggests.
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Aerobic exercise during pregnancy ‘can benefit baby’

A team from the Kansas City University of Medicine and Biosciences suggest it is linked to better foetal heart health and nervous system development.

The findings from their pilot study of 26 women are being presented to the American Physiological Society’s conference in New York.

A UK expert said pregnant women should discuss exercise levels with their GP.

The researchers wanted to see if maternal exercise had cardiovascular benefits for the foetus.

They also wanted to see if foetuses whose mothers exercised had increased breathing movements compared to non-exercise exposed foetuses.

Foetal breathing is a “practice” movement where a baby developing in the womb gets ready to breathe after it is born.

It is also a sign of how well the respiratory system and central nervous system are developing.

Moderate exercise
The scientists used a non-invasive device to measure the magnetic fields produced by the electrical activity of maternal and foetal heart rates.
“Keep within your comfort zone so that you can still hold a conversation” Says Patrick O’Brien, Royal College of Obstetricians and Gynaecologists
It was also able to pick up foetal movements including breathing, body movements, hiccups and sucking.

The women studied were aged between 20 and 35 and were checked between the 36th and 38th weeks of pregnancy.

They were classed as exercisers if they did moderate intensity aerobic exercise such as moderate to vigorous walking, stationary bicycling and running for at least 30 minutes, three times per week. Most were doing more.

The researchers then compared them with pregnant women who did not exercise regularly.

Dr Linda May, who led the study, said: “Foetal breathing movement and the nervous system were more mature in babies exposed to exercise.”

She said further research was needed, both to look at more pregnancies and to evaluate the health of babies once they had been born.

But she said understanding more about how to improve the development babies’ nervous system could aid understanding of cot death.

“Some researchers think it has to do with something being wrong in the central nervous system, which affects respiration.

“Babies aren’t able to wake up and breath for themselves if they need to.”

She said this study had shown the babies of women who exercised had a more mature respiratory system, suggesting they would fare better after birth.

‘Do not overheat’
Dr May said it was safe for women to exercise while pregnant. But she said the team did not yet have evidence about what the minimum beneficial level of exercise in pregnancy was.

Patrick O’Brien, a consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists said the study was interesting and worth following up, although it was small.

He added: “This is an interesting finding and one which should encourage women to keep healthy when pregnant.

“Pregnant women should consult their midwives and doctors on the types of exercise they could do when pregnant and how much.”

Mr O’Brien said excessive exercise during pregnancy could be dangerous for the unborn baby if a woman becomes too hot or lets their heart rate go over 130 beats per minute.

But he said there was is no increased risk of miscarriage or premature labour linked to exercise.

He advised: “Keep within your comfort zone so that you can still hold a conversation.”

Sources: BBC NEWS:April 17,09

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Is Pre-Eclampsia Autoimmune ?

Researchers from University of Texas-Houston Medical School have revealed that pregnancy-induced high blood pressure or pre-eclampsia might be an autoimmune disease.
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In the study conducted using a mouse model, researchers injected the mice with pre-eclampsia with certain human autoantibodies that have been found in women with the disorder.

During the analysis, they team noticed that the mice showed multiple features of the disorder with dangerously high blood pressure, protein in the urine, and placental abnormalities,

The mice were then injected with a substance that blocks the activity of autoantibodies. This prevented the development of pre-eclampsia.

The team including Dr Yang Xia, Ph.D., and Rodney E. Kellems, Ph.D., Department of Biochemistry and Molecular Biology; and Susan M. Ramin, M.D., Department of Obstetrics, Gynecology and Reproductive Science hope that the new findings would help in improving diagnosis and treatment of pre-eclampsia.

Xia, the senior author, said that unlike antibodies that attack foreign substances and clear diseases from the body, autoantibodies attack their own cells and cause conditions in which a person’s immune system attacks the body’s own organs and tissues.

“This collaborative research is important because of its potential to lead to a possible cure of pre-eclampsia in pregnant women. Using the animal model we were able to prevent pre-eclampsia in pregnant mice,” Nature quoted Dr Susan Ramin, study co-author as saying.

“I don’t want to overstate the implications, but this is clearly a very exciting time for all of us involved in the research. We plan to focus our efforts in expanding this research to pregnant women,” she added.

Preterm births have serious implications on the infant’s heath. Infants are likely to die in the first month of life and those who survive face the risk of including learning disabilities, cerebral palsy, blindness, hearing loss, and other chronic conditions including asthma.

Sources: The Times Of India

 

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