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birth of babies with phocomelia (seal-like flippers in place of limbs) and other internal abnormalities and had to be withdrawn from the market.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/diarrhea-during-pregnancy-causes-dangers-treatment.htm http://www.phaa.com/diarrhea-during-pregnancy-causes-dangers-treatment.htm#comments Sat, 10 Jul 2010 20:52:26 +0000 Dr. Paul http://www.phaa.com/?p=318 Frequent bowel movements (more than three times a day) with passage of loose, watery, or unformed stools of more than 200 grams per day is known as diarrhea. It should be taken seriously in a pregnant woman, especially if it continues for more than two days. The causes may be varied but it is important to guard against the danger of dehydration, for which treatment should be initiated promptly.

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.

Swine flu is a highly contagious viral infection which produces flu-like symptoms such as fever, chills, sore throat, cough, headache and body aches. Although the entire population is at risk, certain groups of people are in more danger of contracting the disease as well as having more severe complications once they do get the disease.

Pregnant women fall under this high-risk group and complications as well as deaths have occurred, especially in the third trimester (last 3 months) of pregnancy. It could be that pregnant women are particularly at risk because their normal immune mechanism is suppressed during pregnancy, making them more vulnerable, and so more likely to get a severe form of the disease.

If you are pregnant and you suspect you have swine flu, or if you are suffering from any flu-like symptoms, you should immediately contact your  doctor or gynecologist and obstetrician and follow their advice closely. Starting early antiviral treatment for swine flu is the most reliable way of controlling the severity of the disease but you should first get your doctor’s approval for using it during pregnancy.

Because the swine flu poses a threat to pregnant women, they are considered as a priority for swine flu vaccination programs. Any misgivings about the side effects of antiviral medicines or vaccines should be set aside considering the seriousness of the disease that could occur in pregnant women, provided that you are being supervised by your doctor.

What are the Symptoms of Swine Flu?

You are likely to have flu-like symptoms such as fever, which may be accompanied by chills, headache, body aches, sore throat or cough. You may feel unusually tired, with loss of appetite and this should not be mistaken for symptoms associated with pregnancy.

Not all pregnant women who get the swine flu will have severe symptoms and complications but to be on the safe side, a consultation with your doctor is advisable. Even if the rapid flu test is done to confirm or rule out swine flu, the doctor may start you on medication even before the test results are available.

What are the Complications of Swine Flu?

• Pneumonia is the most serious complications that can develop and at times, breathing difficulties can lead to respiratory failure. Women who are HIV positive are at even greater risk.

• As well as being a danger to you, it may cause you to go into early labor and thus result in the delivery of a premature baby. Spontaneous abortion (miscarriage) is another possibility and if you experience any uterine or abdominal cramping or notice bleeding in pregnancy, then you should see a doctor immediately.

• Pre-existing conditions such as diabetes, asthma, COPD and heart problems may become worse.

• Severe dehydration may develop and some cases of swine flu infection report severe vomiting and diarrhea which can complicate the dehydration further.

• In pregnant women where death has occurred as a result of swine flu infection, delayed initiation of treatment with antiviral medicines has been cited as a cause.

Complications of Antiviral Medicines and Swine Flu Vaccines

Although certain side effects may occasionally occur with antiviral medicines and vaccines, you should remember that these are of less importance when compared to the complications that could develop if you are suffering from swine flu while you are pregnant. Early treatment with antiviral medicines can reduce the severity of the disease, prevent complications and even avoid death.

Nausea, vomiting, diarrhea and headache may occasionally occur as side effects of the antiviral drugs that are being used. More severe complications are breathing difficulties and wheezing, especially if you suffer from asthma or chronic obstructive pulmonary disease (COPD). Your doctor will decide on what type of antiviral is best for you, bearing your condition in mind.

Swine flu vaccination can be given at any stage of pregnancy and has there is no significant evidence of it being harmful for you or your baby. In fact, pregnant women have been included in the priority list for being vaccinated against swine flu as they are so vulnerable to the complications of it.

Prevention and Precautions

Vaccination against swine flu should be given to all pregnant women, whatever the stage of pregnancy, as a means of prevention.

If you are pregnant, you should take all precautions not to contract swine flu. Swine flu is spread from person to person by sneezing, coughing or touching surfaces infected with the virus. Basic precautions that can be taken to reduce chances of spreading or contracting the disease are

1. Staying away from people suffering from flu-like symptoms or those suffering with diagnosed swine flu.
2. Covering your nose and mouth with a tissue when coughing or sneezing and then disposing off the tissue immediately.
3. Washing hands regularly with soap and water or an alcohol based sanitizer.
4. Cleaning surfaces such as table tops and door handles regularly.
5. You can carry on with your daily activities such as going to work but take precautions to avoid contact with any infected person. If this is difficult, speak to your colleague who is unwell or your employer. Given you pregnant state, they will understand.
6. If a family member has been diagnosed with swine flu, you should keep away from that person as far as possible. It may be advisable to commence with antiviral medicines as a means of preventing the disease as close contact with a person in your home is almost unavoidable.

Prevention is always better than cure and this is the approach you should adopt so that you can continue with a safe pregnancy and deliver a healthy normal baby.

Vaginal bleeding in pregnancy is not always serious. Within the first few days after conceiving, you will experience a little spotting or light bleed. This is known as the implantation bleed and is perfectly normal. Apart from the implantation bleed, mild spotting and light bleeding in early pregnancy can occur with no danger to the mother or child. Some women even experience a light bleed at the time of their period although they are pregnant. However caution in early pregnancy is always advisable and if you are experiencing any vaginal bleeding, speak to your gynecologist.

Causes of Bleeding in Early Pregnancy

The most common cause of vaginal bleeding in early pregnancy is a spontaneous abortion or miscarriage. This may occur for a number of reasons and it is usually associated with abdominal pain. Every pregnant woman is at risk of a miscarriage, especially in the first 12 weeks as this is a very delicate stage in the pregnancy. If you have any of the risk factors associated with a spontaneous abortion, you should be even more weary of any sign of a vaginal bleed. These risk factors include a history of previous miscarriage(s), repeated fertility procedures, cigarette smoking, drug abuse or excessive alcohol consumption during pregnancy, adhesions and uterine fibroids.

Other causes of vaginal bleeding in early pregnancy include a ruptured ectopic pregnancy, which is very dangerous for the health of the mother. Bleeding in early pregnancy may also arise as a result of :

• Trauma – injury, fall, assault.
• Inflammation of the cervix (cervicitis).
• Inflammation of the vagina (vaginitis).
• Rupture of an ovarian cyst.

Other less common causes of vaginal bleeding in early pregnancy will be discussed with you by your gynecologist after he/she has excluded the most serious and common causes.

Warning Signs

Vaginal bleeding in early pregnancy is not uncommon. It should be investigated by your gynecologist or the attending doctor and in many cases, it is not serious. However if there are other signs and symptoms present, a case of vaginal bleeding in early pregnancy should be taken very seriously. These signs and symptoms include :

• Abdominal or pelvic pain with/without tenderness of the abdomen.
• Vaginal discharge that is yellow, brown or almost black or contains spots of blood, especially if there is a smelly vaginal odor.
• Dizziness, light headed feeling and/or fainting spells.
• Changes in blood pressure and or pulse.
• Fever.

Danger in Early Pregnancy

The main danger in early pregnancy is not taking any action when there are signs and symptoms present that should alert you to a possible problem. If you are feeling unwell in your early pregnancy, even if there is no signs or symptoms of any condition, rather consult with your gynecologist and put you mind at ease. While many of the signs and symptoms of pregnancy make a pregnant woman feel unwell, there are other possibilities that could be an indication of complications that could put both you and your baby at risk.