What are Teratogenic Substances?

Any substance which can cause developmental malformations in the embryo is known as a teratogen. These may include prescription and over-the counter (OTC) drugs, herbal medicines and supplements, tobacco, alcohol, as well as illegal drugs.

Perhaps the most publicized teratogenic drug known is Thalidomide, which was prescribed and used extensively in the late 50’s and early 60’s for morning sickness in pregnancy. It resulted in the birth of babies with phocomelia (seal-like flippers in place of limbs) and other internal abnormalities and had to be withdrawn from the market.

How Drugs Affect the Fetus?

Drugs reach the fetus through the placenta, in the same way that oxygen and nutrients are delivered to the baby in the mother’s uterus. Depending upon the drug taken, the amount, duration, and stage of pregnancy, it can produce varying effects. Drugs can damage the fetus (resulting in abortion), cause developmental abnormalities (producing birth defects), and result in stillbirth.

A baby is most likely to be born with birth defects if exposed to the harmful effects of drugs during the time when the organs are developing, usually between the third and eighth week of fertilization. This means that sometimes, in very early pregnancy, the fetus may be exposed to harmful substances without a woman being aware that she is pregnant. Drugs taken after this period, although less likely to cause severe birth defects, may contribute to problems with growth and function of normally developed body parts.

Pregnancy Drug Categories

According to the degree of risk to the fetus when used in pregnancy, drugs are classified into categories by the Food and Drug Administration (FDA).

• Category A
• These drugs are considered absolutely safe for the fetus, as proved by well-designed studies and reputable clinical trials. This category includes prenatal vitamins and folic acid.

• Category B
• Animal studies show no harmful effects but results of human studies are inconclusive or animal studies show harmful effects but not so in human studies. This includes amoxicillin (antibiotic), ondansetron (for nausea), insulin (for diabetes).

• Category C
• Human and animal studies are inconclusive or animal studies show harm to the animal fetus. No data on the effect on the human fetus. This includes fluconazole (for yeast infection), sertraline and fluoxetine (for depression).

• Category D
• These drugs may cause risk to human fetus but may sometimes be considered for the treatment of life-threatening or severe conditions where the risks are outweighed by the beneficial effects. This includes phenytoin (for epilepsy) and some cancer drugs (chemotherapy).

• Category X
• Risks to the fetus cannot be outweighed by any possible benefit. This includes isotretinoin (for acne), thalidomide (for leprosy and certain types of cancer drugs.

Vaccines in Pregnancy

Vaccines made of live virus, such as rubella (German measles) and varicella (chicken pox) cannot be given to pregnant women because of their teratogenic effects. However, vaccines for cholera, typhoid, hepatitis A and B, tetanus, diphtheria, plague, and rabies may be given if considered necessary.

Tobacco, Alcohol and Narcotics

The harmful effects of tobacco and alcohol on the growing fetus are many, as are illegal drugs when used during pregnancy. This is discussed further under the dangers of cigarette smoking in pregnancy and dangers of alcohol consumption during pregnancy.

Causes of Poylcystic Ovary Syndrome (PCOS)

The exact cause of PCOS is not known but a hormonal imbalance is the basic problem encountered in a woman suffering from this disease. This can lead to anovulation (lack of ovulation) or irregular ovulation, scanty or irregular periods, and cysts within the ovaries.

Infertility resulting from ovulation problems can occur due to :

• Abnormally high levels of androgen (male hormone).
• Low follicle-stimulating hormone (FSH).
• Insulin resistance.

Falling Pregnant with PCOS

Infertility is a common problem in women with PCOS but pregnancy is still a possibility and women should not lose hope. Many women with PCOS do not know they have this condition until they undergo investigations for infertility. There are various treatment options for infertility and this must be with a gynecologist. Failure of one therapeutic measure to achieve the desired result does not mean that a woman will not fall pregnant.

Fertility medications such as clomiphene citrate or gonadotropin injections may help to stimulate ovulation and increase chances of pregnancy. Clomiphene citrate can achieve ovulation in a large number of cases and can result in a successful pregnancy within a few months. However, one of the main side effects of this drug is having a multiple pregnancy. If positive results are not achieved within 6 months, gonadotropin injections to stimulate the ovaries may be tried.

Other options

• An alternative to ovarian stimulation is ovarian drilling or laparoscopic ovarian diathermy (LOD). Small holes are drilled into the ovary by means of a hot diathermy probe or laser.
• Drugs used to treat diabetes, such as metformin, may help to increase the response to fertility drugs.
• IVF may be tried to achieve pregnancy.
• Losing excess weight with lifestyle changes such as diet and exercise may be helpful.

Causes of Endometriosis

Just as with PCOS, the cause of endometriosis is not clearly understood. Tissues from the endometrial lining of the uterus get implanted in some site other than the uterus, such as the fallopian tubes, ovaries, bladder, abdomen or other abnormal sites and give rise to various symptoms.

Although a many women with endometriosis have no problems with conceiving, the chances of endometriosis causing infertility are relatively high. Infertility may be caused by anatomic factors such as adhesions and scarring caused by endometrial tissues in the pelvis, or hormonal factors which hinder ovulation, fertilization or implantation of the fertilized ovum. Pain during intercourse caused by endometriosis may restrict the act and be a factor in reducing chances of pregnancy.

Falling Pregnant with Endometriosis

Women with mild or moderate endometriosis have a fairly good chance of conceiving, even without any specific treatment. Infertility is more likely to occur in women who have severe endometriosis.

There are various treatment options available for endometriosis which may increase chances of conception. Surgical treatment often gives better results than hormonal or other medical treatments when the aim of treatment is to achieve pregnancy. Assisted reproduction techniques such as intrauterine insemination or in-vitro fertilization (IVF) may provide better results when combined with surgical treatment. Surgery aims to remove any endometrial tissue or adhesions, as well as repair any damage done to organs. Laparoscopic surgery is the method of choice in most cases.

]]> http://www.phaa.com/chances-of-pregnancy-with-pcos-and-endometriosis.htm/feed 0 http://www.phaa.com/changes-in-periods-after-childbirth-breastfeeding.htm http://www.phaa.com/changes-in-periods-after-childbirth-breastfeeding.htm#comments Wed, 14 Jul 2010 23:28:30 +0000 Dr. Paul http://www.phaa.com/?p=323 After delivery, most women are curious and concerned about when they will get their periods, if it will be any different from menstruation before childbirth, or whether there will be any changes in their periods if they are breastfeeding. A lot of changes take place in a woman’s body following pregnancy, childbirth and during lactation, but these changes are by no means the same in every woman.

Bloody Discharge after Childbirth

The blood stained vaginal discharge continuing after delivery is mistaken by some women as menstruation. This discharge is known as “lochia” and consists of blood mixed with mucus and endometrial tissue lining the uterus. The lochia will gradually diminish in amount in a week or two but may continue for up to 6 weeks after delivery.

Changes in Periods after Childbirth and Breastfeeding

Periods may become unpredictable after birth of your baby. You cannot know for sure when you will get your first period after childbirth – it may be within 6 to 8 weeks of delivery or as late as after 6 months or more. It is normal to find the menstrual cycle becoming irregular and the bleeding heavier than before. The cycles may be of shorter or longer duration and you may even skip a period. The length of the period can be longer or shorter too.

Menstruation may become painful (dysmenorrhea) even though you may not have had such complaints previously, or they may be accompanied by symptoms of premenstrual syndrome (PMS) such as swelling of the body, nausea, dizziness or emotional changes a few days before periods. Always differentiate between abdominal pain and menstrual pain when pregnant or after giving birth – refer to Abdominal Pain and Menstrual Cramps.

The single most important factor determining how soon after childbirth a woman will get her periods is whether she is breastfeeding or not. Usually, a woman who is breastfeeding her baby exclusively without any supplementary feeding will not get her periods as long as she is breastfeeding. This rule is not absolute and you can get your periods even while breastfeeding. However, it is most likely that you will get your periods within 6 months after stopping breastfeeding.

If you are breastfeeding your baby intermittently with bottle-feeding, you may get your periods 3 to 4 months after childbirth, which may initially start as spotting. As you can see, there is no hard and fast rule.

Causes of Changed Periods

Hormonal changes in the body following childbirth and breastfeeding are mainly responsible for the changes in the  period occurring around this time. During breastfeeding, the pituitary gland secretes the hormone prolactin which helps in the secretion of breast milk and also suppresses ovulation, which is the reason why lactation is a natural means of contraception (though by no means a fool-proof one). Prolactin also suppresses estrogen, resulting in lactational amenorrhea (cessation of periods during breastfeeding), or it may cause irregular periods.

It should not be assumed that a woman cannot get pregnant if she has not had a period after childbirth. It is possible for a woman to ovulate even without menstruation. As a rule, it is safer to use some form of contraception once you start your periods after childbirth.

Causes of Diarrhea During Pregnancy

As in the non-pregnant state, diarrhea may occur in pregnant women due to the following reasons :

• Viral infections – most cases of diarrhea are caused by viral infections, such as rotavirus, norovirus, or adenovirus. The symptoms are generally mild and usually settle on their own.

• Bacterial infections – more serious types of diarrhea are caused by bacterial infections or food poisoning caused by contaminated food or water. Bacterial infection may be caused by Campylobacter, Salmonella, Shigella or Escherichia coli (E. coli).

• Parasitic infections – diarrhea may be caused by Giardia lamblia, Entameba histolytica, or Cryptosporidium which enter the digestive system through contaminated food or drinks.

• Food intolerances such as lactose intolerance or gluten intolerance.

• Exacerbation of inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis.

• Reaction to medicines such as antibiotics and antacids.

• Irritable bowel syndrome.

Diarrhea during pregnancy could also occur due to the following causes :

• Diarrhea during late pregnancy could be an indication that labor is about to ensue.

• Regular laxative intake to treat constipation in pregnancy (often due to iron supplements).

• Hormonal changes associated with pregnancy could affect the gastrointestinal system and cause diarrhea in some women.

• Dietary changes in a pregnant woman, such as intake of more fruits and vegetables and other high fiber diet.

• Unusual cravings and eating indigestible foods and other unusual substances (pica) during pregnancy.

• Excessive water intake may change the stool consistency in some women.

Dangers of Diarrhea During Pregnancy

While most cases of diarrhea do resolve on their own, diarrhea during pregnancy should not be taken lightly if it persists beyond two days or if there are other associated symptoms such as fever, vomiting, abdominal cramping or signs of dehydration (excessive thirst, dryness of mouth, dry skin or decreased urine output). Persistent and severe diarrhea may lead to :

• Dehydration – when there is excessive loss of fluid and electrolytes from the body, either due to severe diarrhea alone, or diarrhea and vomiting together, dehydration can occur. Dehydration may become a cause for concern for the health of the fetus.
• Weight loss.
• Malnutrition.
• Miscarriage.
• Pre-term labor.

Treatment of Diarrhea During Pregnancy

In most cases, the diarrhea resolves on its own without any specific treatment. Preventing and treating dehydration is essential.

• Plenty of fluids should be given by orally. Oral rehydration solutions (ORS) may be given but caffeine, alcohol and dairy products are to be avoided.

• Intravenous fluids may need to be given in case of severe diarrhea, especially if there is associated vomiting which cannot be controlled.

• The BRAT diet involves returning to solid foods by consuming mashed bananas, rice, grated or stewed apples or apple sauce and toast. If these foods are well tolerated without any vomiting, a bland diet should be commenced immediately containing mixed vegetables, meat and fiber. Yogurt should be used with caution as secondary lactose intolerance may arise after some instances of gastroenteritis.

• Medicines should be used with caution in pregnancy. Use of anti-diarrheals is controversial but if necessary, loperamide may be used safely even in the first trimester of pregnancy. Drugs containing diphenoxylate with atropine, and bismuth subsalicylate are not recommended in pregnancy.

• Treatment of the underlying cause is essential.

• Probiotics containing Saccharomyces boulardii and Lactobacillus casei may be helpful in restoring the normal intestinal flora. Live culture yogurt should be avoided for the reasons mention above.

Normal Vaginal Discharge in Pregnancy

Early Pregnancy Discharge

In early pregnancy, vaginal discharge may increase due to the rise of hormones such as estrogen and as a result of greater blood flow to the vagina. The discharge that is normally seen during pregnancy consists of vaginal and cervical secretions, dead skin cells and bacteria naturally found in the vagina. This thin, white discharge with little or no odor is not a cause for concern. In fact, it may be one of the earliest signs of pregnancy and does not need any treatment. If copious, you may need to wear a sanitary pad to make you feel more comfortable.

Late Pregnancy Discharge

Towards the end of pregnancy, a slow trickle or a gush of fluid discharged from the vagina may be caused by amniotic fluid discharge or breaking of water. Sometimes, a thick mucus discharge tinged with blood is seen just before delivery of the baby. This is known as “show”, which is a sign that delivery is imminent.

Abnormal Vaginal Discharge in Pregnancy

Vaginal Infection Discharge

Vaginal discharge may be a sign of vaginal infection, such as bacterial vaginosis, vaginal fungal or yeast infection, trichomonal vaginitis, or sexually transmitted diseases (STD’s).

• A thin, white or grey discharge with a typical fishy odor, along with vaginal itching and burning may indicate bacterial vaginosis. It is not a sexually transmitted infection.
• A thick, white, curdy or cottage cheese type of discharge, usually odorless, with intense vaginal itching may point to a vaginal yeast infection (vaginal candidiasis). The infection is usually not transmitted sexually.
• A yellowish-green or grey, thin, frothy, fishy smelling discharge with vaginal itching and burning is most likely to be a Trichomonas vaginalis infection, which is a sexually transmitted infection. A yellowish vaginal discharge with vaginal itching and burning urination can be a symptom of other sexually transmitted diseases such as chlamydia and gonorrhea.

Miscarriage and Ectopic Pregnancy Discharge

Slight blood-stained discharge or spotting during pregnancy may be normal in some women, but it could be a more ominous sign indicating a threatened abortion or a miscarriage in early months of pregnancy and should always be brought to your doctor’s notice. Bleeding from the vagina in the first trimester of pregnancy, especially if there is severe abdominal pain, fever or dizziness, may be a sign of miscarriage or ectopic pregnancy.

Placenta Previa and Abruptio Placentae

Discharge of blood from the vagina in latter half of pregnancy could be a dangerous sign which needs immediate medical attention. It may be due to placenta previa (a low-lying placenta which partially or completely covers the cervical os – opening to the birth canal) or abruptio placentae (the placenta breaks away from the uterus before delivery of the baby).

A pregnancy can be a stressful time for any mother, especially so for first time mothers, and the presence of any vaginal discharge should be investigated. Even if it appears to be a normal discharge, the confirmation from a medical professional can be comforting and reduce any unwarranted stress on the mother.

Risk Factors for Air Travel during Pregnancy

Although air travel during pregnancy can be quite uneventful and not a threat to the continuation of a healthy pregnancy, certain factors need to be kept in mind before you make any travel plans. You should always consult with your doctor before you undertake any travel, even if there is no obvious risk. Some of the risk factors for traveling when pregnant include :

1. Twin pregnancy or other multiples.
2. Severe anemia.
3. Gestational diabetes.
4. Hypertension (high blood pressure).
5. Pre-eclampsia.
6. Heart problems.
7. Clotting disorders.
8. Vaginal bleeding or spotting. Refer to Bleeding in Pregnancy.
9. Placental abnormalities.
10. Preterm birth in previous pregnancies.
11. Risk of preterm birth in this pregnancy.
12. A valuable pregnancy such as after a number of miscarriages.

Best Time for Air Travel during Pregnancy

Most doctors agree that the best time for air travel for a pregnant woman is during the second trimester. This is the time when you are most comfortable with your body, there is least chance of a miscarriage or preterm delivery and the misery of morning sickness is hopefully behind you.

Different airlines have different rules regarding the safety of allowing a pregnant woman on board after a certain month of pregnancy. While some allow air travel till the eighth month and even later, if so recommended by the doctor, others restrict travel from the seventh month onwards. It would be sensible to be aware of the rules before booking your tickets for a particular airline.

Considerations for Air Travel during Pregnancy

A few points, if kept in mind, can make your journey more comfortable.

1. If possible, avoid journeys with a very long travel time.
2. To avoid dehydration, drink plenty of fluids like water and juice during the flight.
3. Move your feet and ankles while seated and try to get up and walk every hour at least, to prevent the very real risk of deep vein thrombosis (DVT).

Worries Regarding Air Travel

• High altitude cosmic radiations – this should not be a cause for concern unless you are a very frequent flier like a flight attendant or pilot.
• Decreased air pressure – most commercial flights have pressurized cabins, hence there is no real risk for a pregnant woman.
• Airport screening machines – metal detectors pose no real threat to you or your baby since they only use a low-frequency electromagnetic field. No x-rays are involved here.

Another form of screening (backscatter x-ray system) which is increasingly being used in some airports uses a very low level of x-rays, which are said to be practically harmless. However, if you have any concerns about this, you should ask for a physical “pat-down” search in its place.

If you are going on a long vacation, do not forget to calculate your stage of pregnancy on your return flight.

All pregnant women should be routinely screened for gestational diabetes between 24 and 28 weeks of pregnancy. If you fall in the high-risk category for developing diabetes during pregnancy, you will need to be tested for diabetes as soon as you become pregnant and later again at 24 to 28 weeks.

An oral glucose tolerance test involves drinking 50g of glucose solution and your blood sugar is tested after one hour. If screening is positive, you will need to take another glucose tolerance test. This will be done after you have been advised to take an unlimited carbohydrate diet for 3 days, overnight fasting, and resting for 30 minutes before the test.

Risk Factors

You may be more likely to develop gestational diabetes if you have one or more of these risk factors.

1. Over 25 years.
2. Obese.
3. Family history of diabetes.
4. Had gestational diabetes in previous pregnancies.
5. Had a ‘big’ baby in your previous pregnancy.
6. Have previously given birth to a stillborn baby.
7. Fall under certain ethnic groups such as Native American, African American, Asian or Hispanic.

Complications of Diabetes in Pregnancy

Although many pregnant women with gestational diabetes do not have any complications, other cases of gestational diabetes may result in serious complications for both mother and child.

Risk to the Baby

• Increased risk of miscarriage.
• Enhanced rates of congenital malformations (birth defects).
• Large baby, with additional risk of birth injuries, obstructed labor or Cesarean section.
• Pre-term delivery, resulting in a premature baby.
• Respiratory (breathing) difficulties.
• Congestive heart failure.
• Low birth weight.
• Jaundice in the newborn.
• Child can develop hypoglycemia soon after birth.
• Increased risk of stillbirth.
• Greater chance of the baby developing diabetes in later life.
• Risk of obesity as the child grows.

Risks to the Mother

• Risk of developing gestational diabetes in future pregnancies.
• Chances of developing diabetes in later life.
• Birth canal injuries and obstructed labor due to big baby.
• More likely to have a Cesarean section.
• Polyhydramnios (excessive amniotic fluid).
• May increase risk of developing pre-eclampsia.
• Frequent UTI.

Treatment and Management of Diabetes in Pregnancy

Blood sugar control is very important during pregnancy to avoid complications for you and your baby.

1. Regular blood sugar monitoring (including home glucose monitoring before each meal) is absolutely necessary throughout pregnancy.
2. Diet and exercise.
3. Controlling hypertension and obesity.
4. Insulin injections – if diet and exercise does not reduce the blood sugar level adequately.
5. Avoiding hypoglycemia if on insulin – taking meals on time and in the right quantity.
6. Oral hypoglycemic drugs are not used as they can pass through the placenta and may harm the baby.
7. Ultrasonography to monitor fetal growth and well-being.
8. Regular antenatal checkups.

Women with pregestational diabetes have much to gain if they can maintain a normal blood glucose level before, at the time of conception and during pregnancy. They should pre-plan their pregnancy. Avoiding smoking from the time the pregnancy (Cigarette Smoking in Pregnancy) is planned and folic acid supplements from 3 months before conception can help reduce some of the risks during pregnancy.

Lifestyle alterations can delay or prevent risk of developing diabetes in the future.

Women with established diabetes prior to pregnancy need regular monitoring of their blood sugar levels from the time pregnancy is planned – both for conceiving (Causes of Infertility) and maintaining a healthy pregnancy. If you previously had a normal blood sugar level but have developed diabetes during your pregnancy, you are suffering from a condition known as gestational diabetes. It is very possible that your blood sugar will return to normal after delivery of your baby, but there will remain a chance that you will develop diabetes in subsequent pregnancies or later in life.

A part of the pre-pregnancy health screening, you doctor will consider all these factors.

Types of Diabetes in Pregnancy

Diabetes in pregnancy may be of two types :

• Pregestational diabetes where a woman was suffering from diabetes even before she became pregnant. Good control of blood sugar levels prior to conception reduces the risks to mother and baby.

• Gestational diabetes where diabetes was detected for the first time during pregnancy.

Both forms of pregnancy diabetes can be either type 1 or type 2 diabetes.

In type 1 diabetes, there is absolute lack or deficiency of insulin (which is needed to control blood sugar levels) while in type 2 diabetes there is reduced effectiveness of insulin. Type 1 diabetes can be treated by diet and insulin injections – oral hypoglycemics (drugs for lowering blood sugar levels) are of no use here.

Type 2 diabetes can be treated by diet, oral drugs and/or insulin. However, during pregnancy, only diet and insulin are the forms of treatment since the safety of oral drugs in pregnancy is still not proven.

Causes Gestational Diabetes

As the baby grows within the uterus, the nutritional demands on the mother are greater. This is necessary for the baby’s development and nutrients reach the baby from the mother’s blood through the placenta. During pregnancy a number of hormonal changes occur in the body. In the course of supplying adequate glucose to the baby, certain hormones restrict the action of insulin so that the mother does not develop hypoglycemia (low blood sugar).

As a result, more than the usual amount of insulin has to be secreted by the pancreas to be able to keep the blood sugar within the normal range. If the body is unable to cope with this situation, gestational diabetes develops.

Symptoms of Gestational Diabetes

Most women do not have any symptoms of gestational diabetes, or even if they do, they are generally mild and may be confused with normal symptoms of pregnancy. This may include :

1. Increased thirst.
2. Frequent urination.
3. Fatigue.
4. Weakness.
5. Nausea and vomiting.
6. Weight loss, even with increased appetite.
7. Vaginal infections, including an exacerbation of thrush.
8. Urinary tract infections (UTI).

Often diabetes is detected only after a routine blood sugar test during pregnancy. It is for this reason that antenatal care should include screening for gestational diabetes between 24 and 28 weeks of pregnancy.

Alternatively you can discuss your concerns with your gynecologist and obstetrician who will direct you to appropriate reading material and videos on the labor process.

Signs of Labor

The question that most women want to ask is “How will I know when labor is starting?” That is indeed a very important question but it is often very difficult to differentiate between ‘true’ and ‘false’ labor pain.

The basic point you need to remember is that if the pain is coming regularly, increasing in intensity with each contraction, and the gap between pains is gradually becoming less, then chances are that you are going into labor.

On the other hand, ‘false’ labor pain causes contractions that come irregularly, do not increase in intensity, and are often relieved upon walking or lying down.

The other signs of labor, in addition to true labor pains are :

1. Membrane rupture – which may come as a gush of fluid from the vagina or as a slow trickle.
2. Low back pain.
3. A red-tinged mucus discharge from the vagina – known as “show”.

Stages of Labor

The labor process is divided into 3 parts.

First Stage of Labor

This is the time from onset of regular contractions (onset of labor) till the cervix is fully dilated (10cm). At this point the cervix is said to be fully effaced – there is no rim of cervix felt around the head.

This is usually the longest stage of labor and can take from 8 to 12 hours if this is your first pregnancy, or 6 to 8 hours in subsequent pregnancies. Although it may be difficult to pinpoint exactly when labor started, as a rule, contractions occurring every 2 to 3 minutes and lasting for 30 to 45 seconds signify that the labor process has started and delivery is imminent.

Second Stage of Labor

This is the time from full dilatation of the cervix to birth of the baby. This can take from a few minutes to 2 hours, and will usually take between 45 minutes to 2 hours if this is your first childbirth, or may take only 15 to 45 minutes in subsequent deliveries.

With each contraction you get an urge to push (you should push during contractions and rest in between) until the baby is finally out. The umbilical cord is clamped and cut after delivery of the baby.

Third Stage of Labor

This is the time taken from birth of the baby till delivery of the placenta. After delivery of the baby, the uterus contracts so that the placenta separates out from it and can be removed. You might have chills and trembling at this stage.

Sometimes, the hour following delivery of the placenta is referred to as the “fourth stage of labor” and is important because this is the time when there is maximum chance of severe bleeding (postpartum hemorrhage). Women with certain risk factor

You may choose to have a natural birth without any drugs or you may want to go for something to help you relieve the pain during childbirth. Your doctor will be the best person to advise you regarding your medication options. Normally IV (intravenous) or epidural medications are given for pain relief.

During delivery, the position of your baby is very important. Normally the baby comes out head first but at other times the buttocks or feet may be the first to come out (breech delivery) or the face or shoulder may be the presenting part.

You may need an episiotomy (a surgical incision given in the area between the vagina and anus to help easy delivery of the baby) or a forceps delivery. A Cesarean section may need to be done in certain situations, where the baby cannot come out through the vagina, or in case of some life-threatening condition to save you or the baby.

It is important to note that if you do discover one sided breast swelling, with or without any palpable lumps, it is advisable to consult with your doctor or gynecologist first before you jump to any conclusions or decide to ignore it. The reality is that both breasts are not exactly the same size or shape, but it is usually such a subtle difference that it cannot be easily noticed.

Causes of Breast Swelling on One Side

Young girls often find that one of their breasts is slightly larger than the other. This is a normal finding and should not be a cause for concern. Women on contraceptive pills or hormone replacement therapy (HRT) may also have slight breast enlargement, usually on both sides (bilateral), but sometimes it may be only on one side (unilateral). These are two of the most common causes of noticeable one-sided breast enlargement.

Other possible causes of one-sided breast swelling may include :

Infection

Mastitis which is breast infection is common in women who are breastfeeding. It can cause swelling of the breast on one side.

A breast abscess is a collection of pus which forms within the breast as a result of infection. It usually occurs in a woman who is breastfeeding.

Cellulitis or inflammation of the skin as a result of an infection can cause swelling of the breast.

Trauma/Injury

Any injury to the breast may cause a swelling due to collection of blood within the breast. A firm irregular mass due to fat necrosis may follow trauma.

Fibrocystic Breast Disease

Fibrocystic disease of the breast (fibroadenosis)  may occur in one or both breasts. It is usually seen during the child bearing years and is common in pre-menopausal women. The lumps may be painful but there is no fear of them becoming cancerous.

Fibroadenoma

A fibroadenoma is also called a “breast mouse” because it is felt as a smooth swelling which is quite mobile within the breast. It usually occurs in young women, causing a painless swelling in the breast and is usually not pre-cancerous.

Cysts

Cysts are little sacs filled with fluid. A cyst may cause swelling of the breast which sometimes becomes painful just before the onset of periods.

Milk cysts may form due to pockets of milk collection within the breast during lactation. These can become infected and form a breast abscess at a later stage.

Cancer

Breast cancer continues to rise globally and a regular mammogram and routine breast examinations are advisable. A biopsy of a lump will assist with the final diagnosis.

Lipoma

A breast lipoma is a lump formed by collection of fatty tissue within the breast.

Lymphatic Obstruction

Lymphatic obstruction is the blockage in lymph flow within the breast and this may be due to a tumor, infection, injury or surgery and can cause a unilateral breast swelling.

Infants, New Born Babies

Breast lumps are sometimes seen in newborn babies and this is formed by the action of the of the maternal hormones. These usually disappear in due course, without any treatment, as the estrogen level falls.

Implants

Toughened silicone implants or scar tissue after breast augmentation surgery  may be felt as pseudolumps in the breast.