September 17, 2012
You have been which might be considered fluid for the past two days. You call your provider, who advises you to go to the hospital for further evaluation. Upon your arrival at the hospital, the nurse does something called a nitrogen test. Nitrogen is a substance that turns blue when exposed to amniotic fluid, mucus or blood. Your nitrogen test proves negative. Should you be discharged home? Yes or No.
The answer is no, you should not be discharged home. You first need to have an ultrasound to make certain you have adequate fluid. You could have legitimately been leaking fluid for several days and now have no fluid. Without fluid, an infection called chorioamnionitis could easily develop. Or if your fluid is extremely low (also known as oligohydramnios), you might need to be delivered.
Did you learn something? Well here’s another quiz also taken from the book:
You have had a dull headache all day. For the past two weeks you have received nonstress tests because you complained of decreased fetal movement. You had a two-hour wait before a bed became available in the triage unit. The nurse takes your vital signs, and your blood pressure is 140/90. After twenty-five minutes, your nonstress test is reactive, the triage unit is becoming busy, and the nurse calls your physician with a report of your NST results but omits your blood pressure result and complaint of a headache. However, she does advise your physician that the labor is busy and they need your bed. Your physician’s midwife is on call and sends you home. Is this correct?
No. Although the nurse was correct to report a reactive nonstress test, she did not mention your elevated blood pressure or your complaint of a headache. In this clinical situation, other tests would be necessary to make certain that you are not developing pre-eclampsia.
In pregnancy, the unexpected things, if not managed properly could get you in trouble. Sadly, many healthcare providers do not discuss potential problems with patients until they are smack in the midst of a crisis.
Want to be prepared? Then order a copy of The Smart Mother’s Guide at www.smartmothersguide.com. Remember a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
September 12, 2012
There are few times that I become gravely concerned about the way medicine is practiced and this is one of them. A recent medical study in the Journal of Hypertension reported some startling facts: pregnant women are receiving blood pressure medication that might be harmful to their babies.
When physicians decide to specialize in obstetrics, we know exactly what we’re getting into. We have two patients, both mother and unborn baby and we don’t want either to die. Each year 4 million babies are born in the U.S. and between 6 to 8% of their mothers will have high blood pressure. Why are physicians and healthcare providers concerned about high blood pressure? Because if untreated, it can cause a stroke leading to death.
During pregnancy, a patient can have there are 3 types of high blood pressure: (1) chronic hypertension that occurs before 20 weeks, (2) gestational hypertension that occurs after 20 weeks but is not associated with protein in the urine and (3) pre-eclampsia that occurs after 20 weeks and is associated with protein in the urine. Pre-eclampsia, if untreated can lead to seizures (also known as eclampsia) and strokes. It is one of the most common reasons for death as a result of pregnancy. The treatment for pre-eclampsia is the delivery of a baby because the placenta is causing a problem. If the patient’s blood pressure is extremely high and life-threatening, medicine is also given to prevent the woman from having a stroke until she is delivered.
On the other hand, chronic hypertension is treated with medication during pregnancy to prevent strokes from occurring. But what type of medicine? The FDA classifies medicines in 5 categories from “A” to “X” to describe how they will affect the unborn baby. Category A poses no harm to the baby and Category X should never be given because it has been proven to cause birth defects. The blood pressure medication Lisinopril is a category X medication. It should never, never be taken during pregnancy.
Pregnant moms please read those labels and ask questions before taking medication. A healthy pregnancy doesn’t just happen. It takes a smart mom who knows what to do.
July 9, 2012
Amber Scott is a very lucky woman. She was 38 weeks pregnant and had complained about a headache all day which was mistakenly thought to be a migraine. It wasn’t. More than likely it was pre-eclampsia and somehow the diagnosis was missed. Amber’s husband told her to lie down and presumably left the house. He attempted to contact her throughout the day and when he arrived home, he found her unresponsive with one eye open and the other closed. She was moaning and had vomited. When she arrived at the hospital, an emergency c-section was performed and Amber’s baby was saved. It was determined that Amber had a blood clot to her brain which was removed surgically as well as part of her skull in order to avoid damaging her brain. Amber was in a semi coma with a guarded prognosis but miraculously, she had progressed enough to see her baby 6 weeks after the delivery.
Amber is able to move her right side but will require many months of rehabilitation. Some women are not so lucky. A pregnant woman that has complaints of a severe headache needs immediate attention. If she’s in her third trimester, it should be assumed that she has preeclampsia until proven otherwise, especially if the headache doesn’t go away after taking analgesics. Headaches are usually the first sign of high blood pressure in a pregnant woman and should not be ignored. Complaints of headaches associated with blurry vision, abdominal pain, swollen hands or feet and “spots” in front of their eyes needs to be addressed immediately even if it means going to the hospital first before calling your midwife or physician.
The definitive treatment for preeclampsia is the delivery of the baby because it is the placenta that is thought to contribute to the rising blood pressure. If the blood pressure becomes too high, a woman may have a seizure, also known as eclampsia and suffer a stroke that could be potentially fatal.
Headaches during pregnancy should never be ignored or assumed to be a migraine and requires an immediate blood pressure checks. Taking this precaution might inevitably save your life.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
August 3, 2011
According to CDC, there has been a 54 percent increase in the number of pregnant women who’ve had strokes in 1995 to 1996 and in 2005 to 2006. While this may surprise some researchers, it certainly would not surprise clinicians who take care of pregnant women who have risk factors such as obesity, chronic hypertension or a lack of prenatal care. Ten percent of strokes occur in the first trimester, 40 percent during the second trimester and more than fifty percent occur during the post partum period and after the patient has been discharged home. Hypertension was the cause of one-third of stroke victims during pregnancy and fifty percent in the post partum period. Hypertension accounted for one-third of stroke cases during pregnancy and fifty percent in the post partum period. Many stroke cases might be prevented if blood pressure problems were treated appropriately during pregnancy.
Pregnant women who have high blood pressure during the first trimester are treated with medication and are classification as having chronic hypertension. The problem occurs when patients begin their prenatal care late and have high blood or when a diagnosis of pre-eclampsia is missed. Pre-eclampsia is a clinical condition that includes high blood pressure, protein in the urine and swelling of the hands, face, ankle or feet. Should patients be treated with medication or should their babies be delivered? The diagnosis may not be straight forward. The patient’s blood pressure could be high but there’s no protein in the urine. Or the patient may have high blood pressure that returns to normal with bed rest. Or the patient is only 26 or 27 weeks but has high blood pressure and a diagnosis of pre-eclampsia but the practitioner is hesitant to deliver the baby based on its prematurity. Or the patient is hospitalized for high blood pressure and then the blood pressure returns to “normal” so the healthcare provider inadvertently sends the patient home. Or the patient had high blood pressure, delivered a baby, is sent home and then has a seizure and ultimately a stroke.
What should a pregnant mom do to prevent a stroke? If you have blood pressure problems during your pregnancy, insistent on obtaining a consultation from a high-risk obstetrician (aka maternal fetal medicine specialist) even if you think your present obstetrician or midwife is managing your prenatal care appropriately. A second opinion never hurts and in some cases, it can save a life. Two heads are always better than one.
February 22, 2010
Patients do not come in neat little packages with straight forward pregnancies nor are their complications obvious. Some pregnancies are complicated not only by health issues but social issues as well. Take Karen* for example. She was considered mentally “slow”. Her parents gave her up at the age of eight and she subsequently grew up in group homes.
Karen had an innocence that made everyone want to protect her and I was at the top of the list. She had a friend name Shirley* who was also pregnant and they eventually became roommates. I was not Shirley’s physician, but I wish I had been. Both Karen and Shirley made plans for the birth of their babies and assumed they would grow up together.
Two weeks before Shirley’s due date, she began bleeding bright red blood but was hesitant to go to the hospital. When she finally arrived, her baby was dead from a premature separation of the placenta; a condition known as placental abruption. Shirley most likely had pre-eclampsia, a disease that sometimes goes unrecognized.
The day before Karen’s due date, her blood pressure became elevated, there was protein in her urine and her feet were swollen. I referred her to the hospital with a diagnosis of pre-eclampsia. Karen brought home a healthy baby. Shirley left the hospital with empty arms.
Here are three important things every pregnant mom needs to know about pre-eclampsia:
- If you are over 20 weeks pregnant and your feet are swollen someone needs to check your blood pressure
- If your blood pressure is “normal” but you have protein in the urine, the urine needs to be sent for a 24-hour specimen AND you need to be given the results
- If there is more than 300 gram of protein in the urine, you may have pre-eclampsia and a decision needs to be made whether your baby should be delivered
Sometimes the diagnosis of pre-eclampsia is missed because a patient doesn’t have the usual presentation of extremely high blood pressure. Karen was Caucasian; Shirley was African American. Both had the same illness that ended with very different outcomes.
If Shirley ever becomes pregnant again, I’d be honored to be her physician. Every pregnancy deserves to have a happy ending.
*Names have been changed
September 7, 2009
Did you know that nearly seven babies will die before their first birthday for every thousand who are born in the U.S. and the rate for African American, Hispanic and Native American women, are even higher? Premature births occurring before thirty-seven weeks and low-weight babies, weighing less than five pounds account for the highest number of deaths in the U.S.
In recognition of September as the National Infant Mortality Awareness Month, I’d like to share some SMART tips to pregnant women:
S = Seek prenatal care early. Problems in pregnancy cannot be fixed at the last minute. Tests for genetic problems can only be detected in the early first and second trimesters. A first trimester ultrasound is also the MOST accurate in terms of a due date.
M = Mention all high-risk factors such as family history of diabetes, high blood pressure or bleeding. Do not omit information such as smoking or “recreational” drugs. It will come back to haunt you.
A= Ask to have your cervix measured during your ultrasound if there is a previous history of premature contractions or delivery. A cervical length of 2.5 centimeters or less is a risk factor for preterm labor.
R= Research your hospital and prospective physician or midwife carefully. Is the physician or midwife skilled in managing high-risk conditions? Will they continue to see you even if you lose your insurance? Has the hospital had any recent outbreaks of antibiotic-resistant – infections in the newborn nursery? Is there 24-hour anesthesia?
T= Test for potential problems such as Gestational Diabetes, Sickle Cell Trait or sexually transmitted infections.
The U.S. is one of the most industrialized countries in the world, yet we rank below Cuba and Taiwan, with respect to our national infant mortality rate. The health of a nation is judged by its national infant mortality rate. We can do better. We must do better. The health of our future generation is depending on it.
May 9, 2009
In celebration of Mother’s Day, I’d like to share a few pearls from my book, The Smart Mother’s Guide® to a Better Pregnancy. Those who orbit my universe know how impassioned I am about babies. Crazy would probably be a better term. I cringe when a newborn is admitted to the NICU because someone wasn’t paying attention.
The path to a successful delivery becomes much straighter when everyone marches in the same direction. Knowing how to sidestep some of the imperfections of our hospital systems will greatly improve your chances of having a successful delivery.
Please take my Smart Mother’s Guide Quiz© and see how you do:
You are thirty-five weeks pregnant and were admitted to the hospital by your physician for suspected pre-eclampsia or high blood pressure. You were also evaluated by the maternal-fetal medicine specialist, who recommends inducing your labor in the morning after he has obtained your lab results. The next morning your physician’s partner is on call. He examines you and states that he is going to discharge you home because your blood pressure has improved. Is the physician correct?
The maternal-fetal medicine specialist had ordered lab tests and had recommended an induction of labor. You should request that the on-call physician discuss your case with the maternal-fetal medicine specialist before discharging you since there is a difference of opinion regarding your care. The specialist wanted to induce you for a reason. Sending you home would place both you and your baby in harm’s way.
For more helpful tips regarding pregnancy and delivery, please pick up a copy of the Smart Mother’s Guide® to a Better Pregnancy available at all book stores and Amazon.com.
A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.