January 30, 2012
What Every Pregnant Woman Should Know About Genetics
www.nurture-or-nature.com
The story regarding Republican presidential candidate Rick Santorum’s daughter, brings the subject of genetics into the forefront. Santorum’s 3-year-old daughter, Bella, has Trisomy 18, which is an abnormal disorder where some cells do not contain 2 complete sets of 23 chromosomes. It is almost always fatal and most affected babies die at birth or shortly thereafter. Bella, by some schools of thought, might be considered a miracle.
The diagnosis of a genetic disorder such as Trisomy 18, usually begins with either a screening blood test such as quad screen, or a routine ultrasound after 17 to 18 weeks. The technician or physician might note a fetus that has a clenched fist or unusual feet called Rockerbottom feet. These signs are called the Edward’s syndrome. Other ultrasound findings that suggest genetic abnormalities include polyhydramnios or excessive amniotic fluid, a “double-bubble” sign indicating a condition called duodenal atresia that is associated with Down syndrome as well as heart problems. Also, most fetuses with Down syndrome also have congenital heart problems.
If a suspicious finding is detected on an ultrasound, the technician should report it to your physician immediately for further evaluation and consultation. These consultations should include a referral to a geneticist. The geneticist will take a complete family history from both you and the father of your baby and might suggest obtaining an amniocentesis procedure to obtain fetal cells for confirmation of the disorder. All amniocentesis procedures require written consent because there is a 1 percent risk of rupturing the membranes during the procedure. There are 2 schools of thought regarding genetic screening: one school says why bother? There’s nothing that can be done. The other says it is good to know in advance so that the mother can make critical decisions regarding the continuation of the pregnancy.
Genetic counselors can identify other potential problems such as hemophilia and color blindness which are called x-linked disorders. These conditions are carried on the genes of females but only expressed or affected by males.
Genetics is an evolving field that continues to play an important role in obstetrics and pediatrics. All pregnant women should be encouraged to fully utilize their services as needed.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
January 25, 2012
Worried About 1st Trimester Pain? Here’s What You Should Do!
During the first 12 weeks of pregnancy, some women experience pain or discomfort. The most common reasons are urinary tract infections and stretching of the abdominal wall muscles, particularly as you approach week 12. Sometimes women will experience implantation pain around week 6. This occurs when the fertilized egg travels from the fallopian tube and implants into the uterine lining. These types of pain are common and nothing to be concerned about. However, on rare occasion, other types of pain demand immediate attention.
Any pain associated with bleeding and cramping warrants an immediate phone call or visit to your healthcare provider. This combination of symptoms may indicate a significant problem, including pregnancy loss. Your provider will examine you to determine the following:
- The baby is alive. This will be checked with an ultrasound and measurement of the hormonal levels of the pregnancy.
- The pregnancy is in the right place, inside your uterus, and not inside the fallopian tube (known as an ectopic pregnancy). An ectopic pregnancy, although rare, is a medical emergency because the baby is in an abnormal place. As the baby grows, the fallopian tube could rupture, causing severe bleeding and shock, among other problems.
Any pain associated with a temperature of 100°F or higher needs to be evaluated further to make certain that you don’t have an appendicitis or an infection in the kidneys (aka pyelonephritis).
The signs of appendicitis are
- Dull pain near the navel or the upper portion of the abdomen that becomes sharp as it moves to the lower right portion of the abdomen
- Loss of appetite
- Nausea or vomiting or both soon after abdominal pain begins
- Inability to pass gass
- Temperature of 99°F to 102°F
The signs of pyelonephritis are
- Back, side, and groin pain with a fever of greater than 101°F
- Frequent urination that is painful and/or burning urination, especially at night
- Blood and/or pus in the urine
Should you experience any of the signs or symptoms discussed above, please contact your provider immediately or go to the hospital for further evaluation. These are potentially life-threatening conditions that require immediate attention.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do!
Excerpt from The Smart Mother’s Guide to a Better Pregnancy.
January 23, 2012
When Is Nausea in Pregnancy Not Normal?
Although morning sickness is the most common cause of nausea and vomiting during pregnancy, other diagnoses must also be considered, particularly if you lose more than 3 pounds within a one-week period and are retching day and night.
Hyperemesis gravidarum (HD) is a severe form of nausea and votiting affect 3 percent of pregnant women and is associated with severe dehydration, electrolyte imbalance and weight loss. Your provider should consider this diagnosis if
- You have lost more than 10 pounds in a two-week period and have relentless vomiting.
- Large ketones, substances the body makes when it is not receiving enough calories, are found in the urine. This can be documented with a dipstick urine test.
The treatment of HD includes hospitalization with IV fluids (with vitamins added) until the patient is against able to tolerate food.
Gallstones develop when cholesterol and other substances in the bile form crystals that become hard stones in the gallbladder. The female hormone estrogen can cause this condition during pregnancy. The symptoms of gallbladder disease in pregnancy include the following:
- Severe nausea and vomiting associated with pain in the upper right portion of the abdomen or pain that radiates to the back or shoulder blade.
- Jaundice (yellowing) of the skin and eyes, dark urine, and light-colored stools. These symptoms are associated with gallstones that have blocked the common bile duct.
A diagnosis of gallbladder disease can be made using an ultrasound. Depending upon the symptoms and the number and location of the stones, treatment can range from prescribing a bland diet to surgically removing the entire gallbladder.
A molar pregnancy is a rare condition occurring in approximately one in a thousand pregnancies. It is an abnormality of the placenta that’s very rare and occurs when a sperm fertilizes an empty egg. Sometimes it may be associated with severe nausea and vomiting. The two types of molar pregnancy are complete and partial. In a complete mole, there is no baby, just a placenta. In a partial molar pregnancy, there is a baby that has an abnormal number of chromosomes and usually dies. Sometimes this condition is also associated with cancer. You don’t need to be concerned about this condition unless you have vaginal bleeding with the passage of grapelike clots. This condition is confirmed by an ultrasound.
Between 50 to 90 percent of women have some form of nausea during pregnancy that is normal. However, should you experience any of the symptoms that are mentioned above; please see your provider immediately.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
This is an excerpt from The Smart Mother’s Guide to a Better Pregnancy
January 18, 2012
5 Questions Every Pregnant Woman Should Ask Before Being Induced
Although most women will spontaneously develop labor by their due date, there are exceptions to the rule. Some women may have to be delivered earlier because of complications such as high blood pressure, pre-eclampsia, diabetes, poor fetal growth or low amniotic fluid. Other women may have to be induced because they have exceeded their due date by one to two weeks. Why are inductions of labor necessary? When the conditions within the uterus or a medical condition pose a threat to either the baby or the mother, the baby must be delivered. While most labor inductions are successful, there are some questions that pregnant moms need to ask in order to increase their chances of having favorable outcomes.
- Is my cervix favorable? The softer the cervix, the greater the chances are of having a successful vaginal delivery. If the cervix is not “favorable” or soft, medicine will be necessary to make the cervix softer, usually in the form of suppositories.
- How long will the induction take? This is a legitimate question because the longer the induction takes to occur, the greater the risk of developing complications such as infections. Most inductions of labor and delivery occur within 48 hours of admission. First-time moms dilate 1.2 centimeters per hour while moms who have had previous children dilate at 1.5 centimeters per hour. It can take up to 20 for a 1st time mom and 14 hours for a mom with previous children to develop active labor (meaning she is dilated 4 centimeters) but thereafter she should deliver within the next 12 hours. A 3-day induction of labor is a red flag that there might be potential problems that could compromise the health of the unborn baby or mom.
- If you are being induced, break your water but are not having contractions, ask your provider whether he or she will give you antibiotics to prevent infections. The longer your membranes are ruptured, the greater the risk of developing an infection.
- A multiple-day induction of labor involves many providers and nurses who will be changing shifts. Sometimes things or information gets lost in the transition. Ask who the lead person or team leader is regarding your care and make sure everyone is on the same page regarding your information. Try to obtain this information, BEFORE you are admitted to the hospital.
- Trust your instincts. If things appear complicated during your labor, ask for a maternal fetal medicine consult. These are high risk OB doctors who specialize in managing complications.
Most of the medical malpractice cases that I have reviewed as an expert have involved the issues discussed above. To be forewarned is to be forearmed.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what do to.
January 16, 2012
A Former Preemie Gets a Well-Deserved Break
There are stories that make you cheer and Samantha Garvey’s is one of them. Her light is just beginning to shine but I’m certain in a few more years its intensity will become much brighter. She entered the world prematurely, raring to begin her human experience. At only 2 pounds and 14 ounces at birth, we might have easily have lost her. In her 17 brief years, she has had her share of adversity. Her mother’s automobile accident caused injuries that left her unemployed for almost 8 months. Her father’s income as a taxi driver was not enough to sustain them. The eviction from their rented home on New Year’s Eve came at the most inopportune time. Her father moved the family into a hotel temporarily but they eventually ended up in a homeless shelter, something that has happened more than once during Samantha’s childhood. Samantha immersed herself in school and for the past 2 years, was involved in a research project in marine biology. Ironically, her research project involved looking at the response of mussels when they are in the midst of adversity. What did Samantha discover? The greater the danger encountered by the mussels, the thicker their shells became. A lesson we can all apply to life.
Samantha submitted her research project to the national Intel science competition and made the competitive semi-finals. She is now one of 300 students nationwide who have a chance of winning the top prize of $100,000. And it gets even better. The county social service department found a home for Samantha’s family at a subsidized rent and a private corporation is donating furniture. Hopefully, she will also hear good news from Brown and Yale Universities where she has submitted her applications for freshman admission.
When Olga and Leo Garvey bought their 2 pound 14 ounce daughter into the world, they gave us a gift. Let Samantha’s resilience and determination be an inspiration to us all, especially to parents of premature babies. Somewhere on the other side of the rainbow, the angels are smiling, and we are too. Congratulations, Samantha. I’m sure we’ll hear about you again in the near future.
January 11, 2012
Boy or Girl? You Might Find Out Sooner Than You Think!
Photo from www.pregnancy.about.com
Okay future moms and dads, your dream is about to come true. The National Institute of Health has recently published an article that indicated the sex of a fetus might be able to be determined as early as the first trimester, even a few days after conception based on a blood test. That’s right, a blood test. No more invasive procedures such as an amniocentesis where a needle is inserted into the abdomen to withdraw fluid from around the baby. In the future, there will be no more chorionic villus sampling where a small sample is taken from the early placenta using a needle and inserted into the abdomen or through the cervix. Both of these procedures have a small risk (1 to 2%) of causing miscarriages and are used to detect genetic disorders. The fetal sex determination is just an added benefit.
Research in South Korea on more than 200 women was done during the first trimester by taking blood samples and testing them for 2 specific enzymes called DYS14 and GDPH. The ratio of both of these enzymes can predict whether a woman is having a boy or a girl. This will certainly take tremendous pressure off a healthcare provider who is usually bombarded with requests to have an ultrasound for fetal sex determination. Oh the challenges I had during my years in practice was trying to convince pregnant moms that an ultrasound for fetal sex determination was not a legitimate medical reason and most insurance companies simply would not pay for them. While it’s true that the sex of the fetus is determined at conception, the external genitalia (male and female parts) are not visible until approximately 18 weeks although sometimes it is seen earlier, depending on the position of the baby and the accuracy of the ultrasound.
According to the researchers, more research will be required before this test hits the market but it’s comforting to know that help is on the way. There will come a day when you’ll be able to take a pregnancy and then find out what you’re having the same day or shortly thereafter. Isn’t that exciting?
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
January 9, 2012
A Call to Action: Why All Pregnant Women Deserve “Beyonce-Care”
Celebrity is an interesting phenomenon.
On a hot summer night in 1990, my chief resident (who was also my BFF) and I were on call at Harlem Hospital. We were informed that a “guest” was coming to interview us. Hot, sweaty and looking haggard rather than glamorous, we wanted to choke our director when Spike Lee walked through the door with film crew in tow. Lee was there to film the infamous movie, “Mo Better Blues.” We introduced him to our staff, he hung out with us all night and a patient allowed him to witness her delivery. Lee, dressed in paper scrubs, stared in awe as most people do when witness the miracle of birth. He graciously sent the patient a dozen roses the next day. I’m sure it’s not a coincidence that one of the main character’s in the movie was named Clarke, which just happened to be the name of one of our favorites nurses on duty that night. Denzel Washington was coming the next night but I was scheduled to go on vacation and someone else got the pleasure of meeting him. But here’s where the hypocrisy begins. When it came time to film the actual delivery for the movie, our residency director (who hadn’t delivered a baby in over 20 years) pulled rank and hijacked the part. To his credit, Spike Lee paid for the patient’s delivery.
On January 7, 2012, Lenox Hill Hospital in New York City, shut down its entire 4th floor, prohibited employees from using cell phones and security cameras were taped. “Ingrid Jackson,” aka Beyonce Knowles Carter was having a baby. All hands were on deck and the hospital functioned at its highest level of proficiency. Unfortunately, the same day that Blue Ivy Carter entered the world, 2 women died of maternal complications. Many more had abruptions, premature labor, shoulder dystocias and stillbirths. $1.3 million dollars bought quality care for Beyonce, something that should really be experienced by all.
While I’m ecstatic about the arrival of Blue Ivy Carter, especially since her father and I were once residents of the humble Marcy Projects; my prayer is that Lenox Hill Hospital will take their windfall profit of $1.3 million dollars and put it to good use. How about donating ultrasounds, maternal fetal consultations and (OMG), a couple of free deliveries for uninsured pregnant women? And I’m sure they won’t boot Beyonce out of the hospital one day after her C. Section.
The birth of Blue Ivy Carter, while joyful, is yet another glaring example of separate and unequal health care treatment. Congratulations Jay and B. As you bask in the glow of your daughter’s safe arrival, please take time to remember those who may not be as fortunate.
January 4, 2012
Why Every Pregnant Woman Needs a Hero
For years I struggled to define what I was doing as a physician regarding patient care. I finally figured it out. I was attempting to improve birth outcomes. An outcome is another way of saying end result and for most pregnant women the desired result is a healthy baby. There is an erroneous assumption that all pregnant women will have healthy babies. Unfortunately, this is not always true. Out of the 4 million babies born each year, according to the National Center for Health Statistics, 1.3 million babies require special care after they’re born. About 6 percent of newborns or 200,000 babies per year require life-saving intensive care that could have occurred before, during or after their births. What happens at the time of birth potentially depends on how much homework (aka due diligence) was done prior to going to the first prenatal appointment.
My goal for 2012 is to encourage women to become significantly more proactive regarding their healthcare, especially if they’re pregnant. Background checks of hospitals, clinics and healthcare providers should be done on a routine basis prior to making an initial appointment. Obstetrics is a specialty of the unexpected. A “normal” pregnancy could become “abnormal” in a matter of minutes in the labor room. Unwanted conditions such as diabetes, high blood pressure and premature labor rear their ugly heads. Can your healthcare provider handle these problems appropriately?
The untimely death of Hip Hop artist “Heavy D” aka Dwight Arrington Myers is a teachable moment in prevention. An autopsy confirmed that Myers had died from a blood clot to his lungs, also known as a pulmonary embolism. Myers had a previous history of obesity and heart problems. He was returning from England which is an extremely long flight. Sitting for greater than 2 hours increases the risk of developing blood clots in the legs. I wonder if anyone had advised him to stand every 2 hours for 15 minutes as a precaution. This advice also applies to pregnant women.
The story of Flight 1549, aka the “Miracle on the Hudson” is inspiring. The pilot, Captain Skully Sullenberger miraculously landed a plane in the Hudson River after the plane’s engine had been compromised by low-flying birds. His skill and proficiency saved 150 lives. Can your healthcare provider and hospital handle the unexpected? I certainly hope so.
The Smart Mother’s Guide to a Better Pregnancy was written to help pregnant women improve birth outcomes. There will also be future webinars to assist as well.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
