June 27, 2012
Pregnancy Shouldn’t be a Deadly Affair: Critical Advice That Could Save Your Life
Dr. Linda Burke Galloway advises pregnant women about warning signs of dangerous affairs.
June 18, 2012
Why Pregnant Women Need to Know About MRSA
Photo credit: Public Health Image Library (PHIL)
A few years ago, a 20-something year old pregnant woman presented to her physician with complaints of a skin bump that was red and painful. She was told it was a spider bit and given antibiotics. The patient ultimately went in labor but required an emergency cesarean which went well without any complications. Four days later she developed skin lesions and 3 months later she expired after a very stormy hospital course. What did she die of? MRSA, which stands for Methicillin Resistant Staph Aureus.
Staph Aureus (Staph) is a bacteria that can be found on the skin and doesn’t usually cause problems as long as there are no breaks or cuts in the skin. However, if there are cuts and Staph gains entry into the skin, an infection can develop that if often not serious. However, Staph has a very dangerous form that is resistant to the medications that will normally treat it. The resistant form of Staph can cause havoc if unrecognized which can lead to several complications including death. In fact, 20% of people who have (MRSA) dies from this infection because the diagnosis is made too late. One of the most common complaints patients have when there is a MRSA infection is a bump or red lesion on the skin that is misdiagnosed as a spider bite. How do you avoid the misdiagnosis? By knowing who is at risk and what to look for.
MRSA tends to be found in places where there are many people living close to each other such as nursing homes, but of late, several cases are also associated with
- People who are either in a prison or an athletic facility.
- Athletes who share towels or razors
People who either work in prisons or visit relatives or friends incarcerated should always wash their hands after a visit.
If you are given a diagnosis of a “spider bite,” request that it be cultured, meaning a Q-tip is used to take a sample from the bump. Sometimes people can have the infection without having any symptoms. This is known as being a “carrier.” Again, if you are given the diagnosis of having a spider bite, ask that a culture be obtained from inside of your nose to make certain you don’t have MRSA.
MRSA can be treated appropriately with the right antibiotics. Medicines that are associated with Penicillin such as Amoxicillin and cephaplosporins will not work.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
May 30, 2012
Why is Preeclampsia Misdiagnosed?
Preeclampsia is a pregnancy condition that involves high blood pressure, swelling and protein in the urine. Risk factors for developing preeclampsia include:
- 1st Pregnancy
- Age; young teens and women over 35 are at greater risk
- Obesity
- History of diabetes
- History of hypertension
- Family history (mother, sister, aunt) of preeclampsia
The typical preeclamptic patient has a blood pressure of 140/90 or greater with protein in the urine and swollen ankles in the late 3rd trimester. She may often complain about a headache. This patient is fairly straightforward, but what happens if these symptoms present in a patient who is only 31 weeks? Or 27 weeks? Some healthcare providers will try to “buy time” and “treat the patient with bed rest or blood pressure meds” and she ends up having a seizure or a stroke. The only treatment for preeclampsia is delivery of the baby because it is the placenta that’s causing the problem. There’s something in the placenta that causes the blood vessels to squeeze and increase the blood pressure. Once the placenta is delivered, the blood pressure usually comes down but a woman can have preeclampsia and the risk of having a seizure for 96 hours after birth.
A patient may have a blood pressure of 120/80 with a measurement of 3+ protein in the urine. Her normal blood pressure is usually 90/60 and she has gained 5 pounds in one week. Yet her physician or midwife thinks this is normal. It’s not. They have been lulled into a false sense of security because her blood pressure is 120/80 and not 140/90. This patient should have her blood pressure repeated 2 more times within a 6 hour period and if it remains high, the diagnosis of preeclampsia is made. She should also have her urine collected for 24 hours to determine if there’s significant protein.
Why is preeclampsia often misdiagnosed? Because healthcare providers view the abnormal signs of pregnancy as “normal” variants. They’re not. A headache that doesn’t go away, a sudden increase in weight gain, swollen feet or ankles needs further evaluation as well as significant protein in the urine. If you think you have preeclampsia but your healthcare provider disagrees, by all means, call your insurance company and request a second opinion.
Remember, a healthy pregnancy doesn’t just happen it takes a smart mother who knows what to do.
April 9, 2012
Introducing Guest Blogger Melis Ann: What Pregnant Moms Need to Know About Neonatal Intensive Care Units
Today I’d like to introduce our guest blogger, Melis Ann, who has written a thought-provoking and highly informative article about Neonatal Intensive Care Units and the importance of selecting the right hospital. Melis Ann is a mom and a social scientist who loves to do research to find out the how and why. Her website is http://melisann.hubpages.com
Welcome, Melissa.
During pregnancy, there are many decisions to make. The most important decision is where to have your baby. Hospitals have different levels of qualifications to deal with life-threatening circumstances that newborn babies may face. Many infants are born premature and need help to survive in a Neonatal Intensive Care Unit (NICU). Many other babies, including full-term babies, are unexpectedly affected by breathing difficulties, heart defects and other birth defects and need emergency care. Understanding what to look for in a hospital, the neonatal nurses, and the NICU will give expectant parents the ability to make an informed decision. See the article at the following link.
March 26, 2012
Blind and Without Feet: The Tragedy and Triumph of a Former Pregnant Woman
Self Magazine’s article about Carol is one of tragedy and triumph. Carol never dreamed she would have a problem during her pregnancy. Yet, her feet, ring finger, sight and part of her left arm are gone. Like most pregnant women, her previous two pregnancies were uneventful (albeit nine months apart) and this one appeared to be as well. However the pain that awoke her in the middle of the night was the beginning of a cascade of events that would change her life forever. At first she thought she had a urinary tract infection or perhaps it was a kidney stone. Carol was a medical assistant by training and her husband Scott, a dentist, so she was familiar with medical problems and procedures. She went to the emergency room and was kept overnight. Nothing appeared unusual.
Twelve days later, she awoke feeling weak and aching all over. She had a temperature of 102, called her OB physician and was instructed to take Tylenol.® The fever rose to 103 despite cold baths and other holistic measures that family members provided. She developed premature contractions and presented to the labor room doubled over in pain. She also had diarrhea. While the nurses prepared her room, she was given pain meds and then relaxed. Scott turned away from Carol momentarily to call her mother and when he turned back the nurse and doctor announced that Carol’s blood pressure had dropped dramatically as well as the baby’s heart beat. An emergency C/Section saved the baby’s life, however, Carol’s was in limbo. Unbeknownst to Scott, the medical staff was fighting for Carol’s life because she was septic. Sepsis is a very aggressive infection that takes over the body and produces horrific effects and it usually caused by bacteria called Group A Streptococcus.
The road to recovery was long and painful. Carol remained in the hospital 97 days after her daughter’s birth. Three years later she remains blind, walks with artificial feet but is surrounded by the love of friends and family. I share this story to empower pregnant women to become more alert about their pregnancy. What are the lessons learned?
- Any fever should never be ignored and if it is 100 or higher, a face-to-face evaluation with a medical provider is necessary.
- The advice of taking Tylenol for a fever of 102 without a medical visit was unconscionable.
- Never leave a hospital without receiving a diagnosis. Carol thought she had a urinary tract infection during the first hospital admission. Did she have a urine culture and if so, what did it show?
Carol Carol says “Every day is good because I’m here.” I couldn’t agree with her more.
February 27, 2012
New Ways to Deal With an Old Problem for Pregnant Women
One of the greatest challenges in obstetrics is treating and preventing preterm labor that has an annual cost of 26 billion per year and is the most common reason for birth defects. In past 10 years, measuring length of the cervix has been used a tool to determine whether the patient is high-risk for early labor and delivery. A cervical measurement by an ultrasound of approximately 2.5 centimeters or 1 inch is highly suggestive of impending early labor. However, because there have been many false positive results, it is not recommended for use as a screening test for all pregnant women; only those who have had a history of a previous premature birth.
The quest for finding a tool to predict preterm labor continues and a joint medical study out of the Universities of Maryland and Yale may be onto something according to the American Journal of Obstetrics and Gynecology. They attempted to determine if there are other ways to identify babies that are at risk for early delivery and used an ultrasound to measure fetal adrenal glands. Preliminary results show great promise. The measurement of fetal adrenals was proven to be a predictor of preterm labor. What are the adrenal glands? They sit on top of the kidneys and are responsible for the “fight or flight” responses that the body needs when it is stressed. It speeds up the heart, increases blood pressure and the rate of breathing. An enlargement of the fetal adrenal gland volume with the use of a 2-dimensional ultrasound can identify women who are at risk for having a preterm birth within 7 days. So, for example, if a woman complains of back pain or early contractions, an ultrasound measurement of the fetal adrenals would predict whether she is at risk for developing preterm labor within the next 7 days. Armed with this information, obstetricians and clinicians can give the appropriate treatment in an attempt to prevent early labor. Although this is not the present standard of care it is certainly something to look forward to in the near future.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
February 6, 2012
Should You Have Your Baby At Home?
Home birth, a controversial subject in the world of maternity will gain even greater controversy based on the recent death of 36 year old Carol Lovell, an Australian home birth advocate who collapsed and died after the birth of her second daughter. Lovell was rushed to the hospital after she developed symptoms of heart failure during labor and ultimately died.
Despite warnings from the American College of Obstetricians and Gynecologists (ACOG), homebirths in the U.S. has increased by 29% from 2004 to 2009, according to Bloomberg Business Week. Caucasian women over 35 with previous children are more likely to have homebirths and over 60 percent of them are attended by midwives, 5 percent by physicians and 33 percent by “others.” Admittedly, twenty years ago, the thought of having a homebirth seemed farfetched. However, when patients lost their freedom of choice regarding hospital selections based on managed care restrictions and healthcare became more focused on profit as opposed to quality healthcare, the landscape changed dramatically.
Women opt to give birth at home for a multitude of reasons. Some want minimum interventions such as the I.V., meds and fetal monitoring. Others prefer to deliver in the comfort of their home based on its familiarity and then of course, there’s the issue of cost. It is much cheaper to deliver a baby at home rather than in a birth center or hospital. But here’s the dilemma: obstetrics is a specialty of the unexpected and a low risk pregnancy can transform into a high risk condition abruptly with little warning. Unfortunately, when a complication occurs during homebirth, the babies will die 2 to 3 times faster than if they were born in the hospital. Why? Because of the advantage of life-saving neonatal technology that is used in most hospitals. If a mother has a difficult birth in a hospital, the pediatricians and neonatal specialists are in the delivery room at the time of birth. The baby is whisked away to the neonatal intensive care unit where life-saving procedures are performed. A home birth does not offer this advantage.
Although ACOG does not support homebirth, they make the following recommendations:
- Have standard prenatal care, including Group B Strep screening
- Work with a certified midwife, certified nurse midwife or physician that practices in an integrated or regulated health system
- Be able to obtain professional consultations from obstetricians or specialists quickly
- Have a plan for safe and quick transportation to a nearby hospital in the event of an emergency
- Be a low risk patient
- Do not have a home birth if you are beyond 42 weeks
It is also time for ACOG to meet these women halfway. We know that the numbers of homebirths are steadily increasing. ACOG needs to devise new methods and innovations of improving patient safety. Homebirths are here to stay, whether we like it or not.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
January 30, 2012
What Every Pregnant Woman Should Know About Genetics
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.
