Infertility and it's treatment

Miscarriage Treatment Won't Harm Future Fertility: Study

HealthDay
By Robert Preidt

Most women give birth within five years, researchers find current treatments for women who've had an early miscarriage don't affect their long-term fertility, new research shows.

About 15 percent of pregnancies end in miscarriage in the first trimester. For decades, standard treatment was surgery to remove tissue remaining in the uterus, but now many women are offered expectant (watch and wait) and medical treatment as well, according to background information in the study.

Previous research found that infection rates are about the same for all three methods, but little information was available about their long-term effects on fertility.

The new British study, published online Oct. 9 in the BMJ, included 762 women who had received surgical, medical or expectant management for an early miscarriage. Asked about subsequent pregnancies and live births, 83.6 percent of the women reported a subsequent pregnancy and 82 percent had had a live birth.

Live birth within five years of miscarriage was reported by 78.7 percent of those who received medical treatment, 79 percent who received expectant management, and 81.7 percent of those who had had surgery, the researchers found.

Older women and those who experienced three or more miscarriages were much less likely to have a subsequent live birth, the study authors noted.

"Women can be reassured that long-term fertility concerns need not affect their choice of miscarriage management method," the researchers concluded.

SOURCE: BMJ, news release, Oct. 8, 2009

HealthDay
www.nlm.nih.gov

Bleeding During Pregnancy

Vaginal bleeding can occur frequently in the first trimester of pregnancy and may not be a sign of problems. But bleeding that occurs in the second and third trimester of pregnancy can often be a sign of a possible complication. Bleeding can be caused by a number of reasons.

Some basic things to know about bleeding are:

• If you are bleeding, you should always wear a pad or panty liner so that you can monitor how much you are bleeding and what type of bleeding you are experiencing.
• You should never wear a tampon or introduce anything else into the vaginal area such as douche or sexual intercourse if you are currently experiencing bleeding.
• If you are also experiencing any of the other symptoms mentioned below in connection with a possible complication, you should contact your health care provider immediately.

First Half of Pregnancy:

Miscarriage

Bleeding can be a sign of miscarriage but does not mean that miscarriage is imminent. Studies show that anywhere from 20-30% of women experience some degree of bleeding in early pregnancy. Approximately half of pregnant women who bleed do not have miscarriages. Approximately 15-20% of all pregnancies result in a miscarriage, and the majority occur during the first 12 weeks.

Signs of miscarriages include:

• Vaginal bleeding
• Cramping pain felt low in the stomach (stronger than menstrual cramps)
• Tissue passing through the vagina

Most miscarriages cannot be prevented. They are often the body's way of dealing with an unhealthy pregnancy that was not developing. A miscarriage does not mean that you cannot have a future healthy pregnancy or that you yourself are not healthy.

Ectopic Pregnancies

Ectopic pregnancies are pregnancies that implant somewhere outside the uterus. The fallopian tube accounts for the majority of ectopic pregnancies. Ectopic pregnancies are less common than miscarriages, occurring in 1 of 60 pregnancies.

Signs of Ectopic Pregnancies:

• Cramping pain felt low in the stomach (usually stronger than menstrual cramps)
• Sharp pain in the abdominal area
• Low levels of hCG
• Vaginal bleeding

Women are at a higher risk if they have had:

• An infection in the tubes
• A previous ectopic pregnancy
• Previous pelvic surgery

Molar Pregnancies

Molar pregnancies are a rare cause of early bleeding. Often referred to as a "mole", a molar pregnancy involves the growth of abnormal tissue instead of an embryo. It is also referred to as gestational trophoblastic disease (GTD).

Signs of a Molar Pregnancy:

• Vaginal bleeding
• Blood tests reveal unusually high hCG levels
• Absent fetal heart tones
• Grape-like clusters are seen in the uterus by an ultrasound

What are common reasons for bleeding in the first half of pregnancy?

Since bleeding that occurs in the first half of pregnancy is so common (20-30%), many wonder what the causes are besides some of the complications already mentioned. Bleeding can occur in early pregnancy due to the following factors, aside from the above mentioned complications:

• Implantation bleeding can occur anywhere from 6-12 days after possible conception. Every woman will experience implantation bleeding differently—some will lightly spot for a few hours, while others may have some light spotting for a couple of days.
• Some type of infection in the pelvic cavity or urinary tract may cause bleeding.
• After intercourse some women may bleed because the cervix is very tender and sensitive. You should discontinue intercourse until you have been seen by your doctor. This is to prevent any further irritation—having normal sexual intercourse does not cause a miscarriage.

Second Half of Pregnancy:

Common conditions of minor bleeding include an inflamed cervix or growths on the cervix. Late bleeding may pose a threat to the health of the woman or the fetus. Contact your health care provider if you experience any type of bleeding in the second or third trimester of your pregnancy.

Placenta Abruption

Vaginal bleeding may be caused by the placenta detaching from the uterine wall before or during labor. Only 1% of pregnant women have this problem, and it usually occurs during the last 12 weeks of pregnancy.

Signs of Placental Abruption:

• Bleeding
• Stomach pain

Women who are at higher risks for this condition include:

• Having already had children
• Are age 35 or older
• Have had abruption before
• Have sickle cell anemia
• High blood pressure
• Trauma or injuries to the stomach
• Cocaine use

Placenta Previa

Placenta previa occurs when the placenta lies low in the uterus partly or completely covering the cervix. It is serious and requires immediate care. It occurs in 1 in 200 pregnancies. Bleeding usually occurs without pain.

Women who are at higher risks for this condition include:

• Having already had children
• Previous cesarean birth
• Other surgery on the uterus
• Carrying twins or triplets

Preterm Labor

Vaginal bleeding may be a sign of labor. Up to a few weeks before labor begins, the mucus plug may pass. This is normally made up of a small amount of mucus and blood. If it occurs earlier, you could be entering preterm labor and should see your physician immediately.

Signs of Preterm Labor include these symptoms that occur before the 37th week of pregnancy:

• Vaginal discharge (watery, mucus, or bloody)
• Pelvic or lower abdominal pressure
• Low, dull backache
• Stomach cramps, with or without diarrhea
• Regular contractions or uterine tightening

www.americanpregnancy.org

Epidural, What you should know.

Once you are in active labour and are having regular, painful contractions, you can receive an epidural. An anesthesiologist is responsible for providing and overseeing this medication. He or she will explain the procedure to you and the types of epidurals available. The anesthesiologist will ask questions to ensure that there are no medical reasons you should not have an epidural, and will ask you about your concerns.

How an Epidural is Given

The epidural space surrounds the spinal cord. It is located using a special needle, which is passed between the bones of the spine, a few inches above the tailbone. The labour nurse will help you get into the best position, either lying on your side or sitting. It will take a few minutes to insert the epidural. After washing your lower back with antiseptic and freezing the skin, the needle will be inserted. A thin, flexible tube (the epidural catheter) will be passed through the needle, which is then removed. Local anesthetic ('freezing') will be injected through the tube, which is secured with tape. At this point, nothing hard or sharp will remain in your back.

The Effects of an Epidural

It takes between five and 30 minutes for the epidural to start working. During this early stage, you will feel warmth and tingling in the legs, followed by pain relief. As little medication as possible is used to relieve the pain, but some women will notice that their legs start to feel heavy.

The initial dose of freezing may last up to two hours. To prevent the pain from returning, medication is given continuously through the catheter. If the pain returns in spite of continuous medication, the dose can be increased. When it is time to push with the contractions, the dose of medication may be reduced or the medication may be stopped, as the numbness produced by the epidural can make it difficult to push.

Side Effects and Complications

An epidural is usually very safe for both mother and baby, but there are side effects and a small risk of complications, even when the best technique is followed. A possible drawback of an epidural is that it can slow down the labour process, which, in turn, can increase the need for forceps or even a cesarean section.

There are also a number of possible complications to be aware of:

Low blood pressure is the most common side effect of epidural anesthesia. You will be given fluids intravenously to prevent this complication. Your blood pressure will be monitored carefully. If your blood pressure does drop, you may be given IV fluids and medication to counteract the problem.

Shivering is not a serious side effect, but it is a common one. It usually occurs in the first hour after having an epidural and is associated with prolonged or advanced labour. An extra blanket may help!

Bladder control may be lost temporarily during labour, if you can't feel that your bladder is full. A urinary catheter may be needed.

If pain relief is inadequate even after the epidural, the catheter may have to be adjusted. Three percent of women experience no pain relief at all. If a woman who is having a cesarean section experiences inadequate pain relief she will be given nitrous oxide, or a local or general anesthesia.

Back pain after the birth is often attributed to the epidural, but is most often related to the labour and birth itself. However, a difficult epidural insertion may cause bruising between the bones of the spine, producing a lower back pain that usually lasts a few days.

An epidural may cause a headache if the needle goes deeper than the epidural space and causes the spinal fluid to leak. This headache is severe and, without treatment, it may last more than a week. Fortunately, an effective treatment, called a “blood patch,” is available. Your blood can be injected into the epidural space to relieve your headache. The risk of having this type of headache is approximately one in 200.

Nerve damage may cause prolonged numbness or partial weakness in one leg, which can last several weeks. It occurs after one out of every 2500 births. It is usually caused by pressure from the baby, on the nerves in the pelvis. However, it can, rarely, be caused by pressure from the epidural catheter on a nerve in the back. Tell your caregiver before you leave the hospital if your legs do not completely return to normal. In rare cases, permanent nerve damage can result in the area where the catheter was inserted.

Severe injury is rare. Severe drug reactions, such as convulsions, occur in one out of every 10,000 cases. Severe brain damage, coma, paralysis or death is even less common: about one case in 100,000. Note that the risk of severe injury or death due to an epidural is about the same as the risk of dying in a car ride.

www.womenshealthmatters.ca

Buying prenatal supplements

Should I take one?

Experts agree that the best way to make sure you and your baby get all the nutrients you need while you are pregnant is to eat a varied, well balanced diet. This should include fresh fruits and vegerables, whole grains, beans and fish. Foods such as refined sugars, processed foods, saturated fats, and other animal proteins should be limited.

However, in some circumstances it can be difficult to get all the nutrients you need through diet alone; if you are suffering badly with morning sickness, for example. In this case, your doctor or midwife may advise you to take a multivitamin supplement especially designed for pregnant women.

What should it contain?

There are no hard-and-fast rules as to what has to be in a multivitamin in order for it to be called a prenatal supplement, but a good supplement for pregnant woman generally contains more folic acid, iron and calcium than a general multivitamin. These three minerals are important for reasons explained below. Prenatal supplements don't contain retinol (the animal form of vitamin A), which can be harmful to unborn babies in large doses. They contain the plant-derived form of vitamin A (betacarotene), instead.

Folic acid
Folic acid is a B vitamin, which is also found in various foods, including beans, leafy greens and fortified breakfast cereals. Taking a 400 microgram (400mcg) folic acid supplement each day during the first 12 weeks of pregnancy (ideally starting at least one month before you start trying to conceive, preferably three months) can lower your risk of having a baby with a neural tube defect, such as spina bifida. Spina bifida is a serious congenital condition, which occurs when the tube around the central nervous system fails to close completely.

Studies show that women at high risk of having a baby with a neural tube defect (those who've had a baby with spina bifida before, for example, or women who take certain medicines for epilepsy) can lower their risk by 72 per cent if they take folic acid before and during pregnancy. These women also need to take a larger dose of folic acid each day (5 milligrams or 5mg). Talk to your doctor before you do this as you will need a prescription.

Iron
Iron is needed to make the extra blood required to support your growing baby. Your body is making so much extra blood when
you're pregnant that you need about 30 to 60 mg of iron every day; 15 to 45 mg more than the recommended daily allowance of 15 mg.

Calcium

Finally, a woman needs twice as much calcium when she's pregnant; 1,500 mg of calcium per day. Calcium is found in milk products, dark leafy vegetables, tofu, sardines and canned salmon.

Other nutrients

So, besides folic acid, iron and calcium, what else should a good
prenatal supplement contain? Look for one with vitamin C, vitamin D, B vitamins such as B6 and B12, potassium, zinc and vitamin E.

Find a supplement that provides 100 per cent of the recommended daily allowance of all the essential vitamins, and never take more than the recommended daily allowance (usually one multivitamin a day). Taking megadoses of certain vitamins can be harmful to you and your baby.

Strict vegeterians and women with medical conditions, such as diabetes, gestational diabetes or anemia should talk with their doctor or midwife about any special supplements they might need.

Where do I get them?

You can buy prenatal supplements at almost any pharmacy, or your doctor may prescribe them for you if there is a medical need. You can save money by buying a generic version instead of a branded name. Many doctors and midwives agree that these generic brands work just as well as other kinds.

Before buying prenatal supplements, make sure you've read the label and that you understand what each supplement contains.

www.babycenter.ca