Pregnancy
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Gestational Diabetes and Labour Induction: Why It Matters
During pregnancy, certain hormones wreak havoc and do not allow your body to use insulin to keep your blood sugar levels under control. Insulin is what helps convert sugar to energy, and sometimes, pregnancy does not allow this to happen, which leads to high blood sugar levels. This, unfortunately, leads to gestational diabetes. Gestational Diabetes among pregnant women means that labour has to be induced around 39-40 weeks of gestation, failing which it could have adverse impacts on the unborn baby and the mother. Gestational diabetes and induction of labour is a complicated situation in the case of pregnancy. Find out more information about the same and how to induce labour as one of the methods to ensure no neonatal complications.
Is Induction of Labour Necessary When You Have Gestational Diabetes?
Some women have symptoms of GD, whereas others don’t. Some can also fix it just by managing diet and some exercise, whereas others need shots of insulin. A lot of healthcare providers recommend around 39–40 weeks for inducing childbirth. The WHO recommends not before 41 weeks, if gestational diabetes is the only medical condition; although this is backed up by weak evidence (1). Guidelines for GD according to the American Congress of Obstetricians and Gynaecologists recommend induced labour not before 39 weeks of gestation with controlled gestational diabetes (2).
Each case is treated individually based on the patient’s medical analysis and requirements. For many women, if diabetes develops during pregnancy, they can most likely have labour deliveries. However, inducing labour becomes important when diabetes is not controlled to maintain the health and safety of both the baby and the mother.
The NHS suggests that if your blood sugar level is under control and there seems to be no concern or pregnancy complication about you or your baby’s health, it is best to wait for labour to start naturally. However, if you have not given birth by 40 weeks and six days, you’ll most probably be suggested labour induction or a caesarean section. Early delivery is usually recommended when there are maternal and fetal health concerns or the blood sugar has not been in control (3).
Why Is Labour Induction Important in the Case of Gestational Diabetes?
What used to be a relatively rare condition is now becoming more and more common. Having GD can negatively impact the health of both the mother and the unborn child, but it does not affect the way you give birth. You can still give birth vaginally and can also have an uncomplicated delivery. Here are some reasons why inducing labour is a good option.
1. Stillbirth
One of the main reasons for inducing childbirth in women who have GD is to prevent stillbirth. The chances of stillbirth increase significantly after the 40-week benchmark for women with GD. Therefore, sometimes, labour is induced, usually before 39 weeks, to make sure the mother and the child are safe (4).
2. Larger Than a Normal Baby
Women with GD usually have babies that are slightly larger, which is termed as macrosomia. The extra sugar crosses paths with the placenta and makes your baby fatter due to the storage of insulin. Inducing labour would be important because babies can weigh up to 4.5 kg sometimes.
3. Other Complications
Macrosomia or a large baby can lead to other complications as well, including damage to the tailbone, blood loss, tearing, etc. Inducing childbirth can help avoid these complications.
4. Preeclampsia
Preeclampsia is a condition which is characterised by high blood pressure and the presence of protein in the urine during pregnancy. This can lead to complications such as preterm labour, abruptions or even seizures that can prove to be fatal for mother and child (5). A study showed that induction of labor for women with mild preeclampsia between 34–37 weeks helped reduce the risk of the outcome by a little bit.
5. Mother-Baby Health
During childbirth, the most critical part is to keep the mother and baby as safe as possible. GD occurs in a lot of women nowadays, and scientists say that the number might go up. Monitor your blood sugar levels continuously, and if induction is required, ensure you are well-informed about it.
How Will You be Induced?
There are multiple ways to induce labour, but if you have to go through it, you should understand it completely, including all the benefits and risks involved. Each way of inducing childbirth has its pros and cons. You should make sure to talk to your doctor in depth and understand which method is best suited for you after a thorough medical analysis. Here are some ways in which you can be induced.
A common question is, “Will I be induced if I have Gestational Diabetes?” The answer is yes because that is a safer option for you and your baby. Gestational diabetes can lead to a lot of complications, so it is better to induce labour than try natural methods.
Artificial Rupture of Membrane of ARM, where an amnihook is inserted to pierce the water bag surrounding your baby to help the baby crown. Many women opt for this option.
Oxytocin is another method to induce labour wherein synthetic oxytocin is inserted via an IV drip. This will engage your hormones and trigger your system into labour. Some childbirths are induced at 38 weeks due to gestational diabetes, which is earlier than what the WHO recommends.
A low-risk option is a Foley Balloon catheter, which is placed in the vagina and inflated in the hope that the baby’s head will help encourage dilation. Since there are no drugs involved, this is a low-risk way to induce labour.
Prostaglandin gel is used to encourage contractions. The doctor will insert the gel to soften and dilate the cervix. Although it is a synthetic hormone, it is useful for inducing labour.
FAQs
1. Can you have a natural delivery with gestational diabetes?
Yes, it is possible to have a natural delivery for women with gestational diabetes with the implementation of some precautions, including close monitoring of the mother and the baby, controlling the blood sugar levels of the mother throughout labour and delivery, monitoring the position of the baby for a smooth delivery, and having an assisted birth. Gestational diabetes may impact maternal and fetal health, but it doesn’t prevent a natural vaginal birth (6).
2. Does gestational diabetes always mean early delivery?
Being pregnant with gestational diabetes does not always mean that you’ll deliver early. As each pregnancy is unique, he decision to deliver early or wait till the term depends upon various factors, especially the health of the mother and the baby. Since the ultimate goal of managing gestational diabetes is delivering the baby safely and healthily without compromising on the maternal health and minimal medical invasions, doctors will assess each situation accordingly and make a decision for the well-being of the mother and the baby.
3. Can early delivery be avoided if a pregnant woman has gestational diabetes?
The best a mother can do to prevent delivering early with gestational diabetes is by keeping her blood sugar levels under strict check. Women can consult their doctors for personalised care and a tailored meal plan during their pregnancy to help maintain stable blood sugar levels. For instance, this can be done by monitoring blood sugar levels regularly, eating a healthy diet that includes foods with a low glycemic index, exercising regularly and moderately, taking doctor-prescribed glucose-lowering medications or insulin on time (7).
4. What are the chances of a normal delivery with gestational diabetes?
Yes, there are food chances of having a vaginal delivery with gestational diabetes with a few precautions and essential things in check. Doctors will make sure that your diabetes is well-controlled and you are under no other pregnant complications that could be hindering a normal delivery.
5. Is it safe to have an assisted home birth in pregnancy with gestational diabetes?
Women with gestational diabetes require high-level care. Thus, having a home birth with gestational diabetes can be very dangerous for both the mother and the baby. Health experts do not recommend home birth for pregnant women with gestational diabetes due to the lack of necessary facilities for the monitoring of the mother and the baby, and the chances of life-threatening complications post-delivery (8).
Although natural childbirth is the best way to go, sometimes circumstances are unpredictable. In those situations, one should not worry and find a solution instead. If your condition can be managed, you should ideally have a normal birth. However, GD can be controlled as well, so don’t worry, follow your doctor’s advice and you will have a safe delivery for you and your baby. GD can be prevented by following a healthy diet and lifestyle. Regular check-ups can also be helpful in keeping your blood sugar levels in a safe range. Make an informed decision after consulting your doctor, and all the best!
References/Resources:
1. WHO – WHO recommendations for Induction of labour
2. American Family Physician – ACOG Releases Guideline on Gestational Diabetes
3. NHS – Gestational Diabetes
4. PubMed Central – The Risk of Stillbirth and Infant Death Stratified by Gestational Age in Women with Gestational Diabetes
5. PubMed Central – Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors
6. Gale Onefile – Maternal and fetal outcome in gestational diabetes mellitus
7. PubMed Central – Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus
8. Wiley Online Library – Infant Death Following Home Birth: A Case Report of Fatal Neonatal Hypoglycemia*
Also Read:
Is Vomiting While Labour Beneficial
Induce Labour Using Acupuncture
Timing Contractions While Labour
Foods That Induce Labor Quickly
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Birthing Ball – Benefits, Exercises and Uses
If you are wondering about effective ways of exercising and dealing with labour, you would be glad to know that birthing balls are a boon for a mother-to-be. You may have seen these giant inflated balls in the gym, in your yoga class, or during one of the antenatal visits at your doctor’s clinic. A birthing ball is not only effective during the birthing process, but these vinyl balls may also help you sail through your pregnancy. In this article, we will discuss how you can use a maternity exercise ball efficiently and derive maximum benefits from it. Let’s begin with understanding what a birthing ball is and what its benefits are.
What Is a Birthing Ball?
A birthing ball or a birth ball is a kind of an exercise ball that can be used during pregnancy, labour, and even after birth. These rubber balls can be used in many ways, including during pregnancy and later (1).
When to Start Using Birthing Ball?
You can begin using a birthing ball as early as the first trimester, but many women find it most helpful during the second and third trimesters. As you approach the later stages, especially from 32 weeks onwards, a birthing ball can help prepare your body for labour by encouraging the baby to move into the optimal position for birth and relieving pelvic pressure.
Benefits of Using a Birthing Ball
A pregnancy ball has many benefits and may help you in several ways during pregnancy. Here are some of them (2):
It helps ease your back pain and thus makes mobility easier during pregnancy.
It helps increase blood flow to your pelvic region (uterus and placenta).
It helps in reducing spinal pressure.
It helps in giving counter-pressure to your thighs and perineum.
It helps in providing excellent support to your ankles and knees.
It helps you to be in an upright position and thus works efficiently with gravity for your baby’s descent.
It helps in opening the pelvic muscles.
Some women may feel dizzy while using a birthing ball. If you feel any dizziness, refrain from using it.
Let’s get to know a little more about birthing balls.
Difference Between a Birthing Ball and a Gym Ball
Gym ball and pregnancy can go well together when the ball is used gently for comfort, posture support, and light movement. A birthing ball and a gym ball are more or less the same. Both these balls are made of an anti-burst material, which means they wouldn’t burst at one go on being punctured but deflate slowly. These balls should be kept from sharp objects, direct heat or rough surfaces. The only features that differentiate a birthing ball from a gym ball are:
Gym balls are comparatively smaller than birthing balls.
Most birthing balls come with an anti-slip finish.
Some birthing balls are round, while some are in the shape of a peanut to allow using it while lying in bed.
Which Birth Ball Should You Buy?
You should buy a birth ball according to your height, which means if you sit on the ball, your feet should touch the floor comfortably. We shall talk a little more in detail about the size of the ball shortly. When you select one, you can opt for one with an anti-slip finish and anti-burst features. Also, make sure you buy a ball that can take your weight. A birth ball meeting these criteria is a good purchase to ease pregnancy, labour, and childbirth.
Maternity ball covers are also readily available. If the store owner offers one, consider buying it for the reasons below.
Why Do You Need to Buy a Birthing Ball Cover?
You need to buy a birthing ball cover because of the following reasons:
The cover makes it easier to carry the ball from one place to another.
The cover helps to keep the ball clean.
The cover helps to manage the ball effectively.
The cover makes the ball feel soft against the skin.
The cover makes the ball look pretty, and you can keep changing the covers for a new look if you get bored with it.
How to Choose the Size of the Pregnancy Ball?
As mentioned earlier, your appropriate ball size can be determined based on your height. The following table will also help you ascertain the right size of the birthing ball for you (3):
Your height
Recommended Ball size
Less than 5 feet 4 inches
55 centimetres
5 feet 4 inches to 5 feet 10 inches
65 centimetres
5 feet 10 inches or taller
75 centimetres
It is recommended that you buy a high-quality birthing ball or one from a renowned brand. Most balls are pressure-tested and can easily support weights up to 300 kilograms.
It is a good idea to buy a pump along with your birthing ball, as most balls do not come with one. It is common for the ball to lose air when used regularly. With a pump, you may fill the air as and when needed.
The next question many expectant mothers have is how to use the birthing ball. Well, most of the time, you buy a birthing ball only after an expert advises you to. The expert would also guide you through and teach you the best and the safest ways to use the ball. Nonetheless, here are some ways to be prepared to use the ball for the first time.
How to Use a Birthing Ball for the First Time?
If you are using maternity or birthing ball for the first time, the following tips may prove to be useful for you (4):
Place the ball on a rug or a carpet rather than placing it on the floor. You can be barefoot or use anti-skid shoes. You may ask someone to help you to sit while supporting the ball from behind.
Balance your body by placing your feet firmly on the ground and keeping them apart (almost 60-70 centimetres).
Place your hands on your knees to get comfortable as you sit on the ball. Rock sideways or back and forth. Once you secure your position, bounce gently.
If you do not feel confident with the bouncing or rocking movement, you may place a chair close to you and use it as support.
If you wish to use the ball for exercise, make sure there is ample space in the room to place it. You should keep your movements slow and steady and stop when you feel uncomfortable.
You already know that the birthing ball can be used at any stage of pregnancy and after childbirth if an expert advises it. But what are its uses? Let’s find out!
Uses of Birthing Ball
You can use your birthing ball during pregnancy, labour, and after childbirth. Read on to learn its uses.
1. During Pregnancy
During pregnancy, a birthing ball can strengthen the pelvis, the lower back and the leg muscles. If exercising is not always possible, you can comfortably sit or relax on the ball rather than using a chair, couch or sofa. A gentle rocking exercise will prepare you well for childbirth, too. You may move back and forth or sideways. In the later months of pregnancy, you may also use the birthing ball to change your baby’s position. In case your baby is in a posterior position, the forward-leaning and upright positions may help your baby change position (5).
2. During Labour
Similarly, the birthing ball can come in handy during labour, too. You may lean on the ball for support or sit on it, rocking front or sideways as you experience the contractions. The curve of the birthing ball provides good support and puts gentle pressure on the engorged vagina during labour. The ball also provides good mobile support, especially to the upper body. Having said that, it is very important that you are comfortable using a birthing ball before using it for labour (6).
3. After Childbirth
After childbirth, a birthing ball can be useful for sitting as it provides a comfortable shape and feel to sit on as compared to sitting on a hard surface due to the soreness that remains for a few days after childbirth. Once you get the hang of the ball and can balance your weight, breastfeeding your baby can be very convenient and comfortable, too. You may even rock and soothe your crying baby while sitting on the ball. It is perfect for exercising and helps you tone up and lose pregnancy fat. It can be used for sitting, even in the office. When your child grows, you may help your baby stand, walk or scoot with your birthing ball.
We mentioned exercising using the birthing ball in the article above a couple of times. But swaying and rocking are not the only exercises that can be done on it. Read on for more ways to exercise on the birthing ball.
Exercises to Do With a Birthing Ball
A birthing ball is extremely beneficial for exercising in pregnancy. You may also use birthing ball exercises to induce labour. Following are some of the exercises that you may do with your birthing ball:
1. The Bouncing Exercise
Bouncing gently on a birthing ball helps in strengthening your legs and your balancing ability. You can perform this birth ball exercise to induce labour.
2. The Pelvic Tilt Exercise
Place your birth ball against the wall and sit with your back touching the ball. By pulling your tummy in a little, gently curve your lower back and push it towards the ball. This is a good way to strengthening your lower back and uterus.
3. The Hula Hoop Exercise
You need to sit firmly on the ball with your hands resting on your hips. You should make large circular movements with your hips, just like hula hoop dancers do. This is a great exercise for your pelvic floor and your thighs.
4. The Resting Child’s Pose
You will be required to kneel on the ground with the ball held in front with both your hands. Then, slowly roll the ball forward and bend as much as possible using the ball as the support. This pose strengthens the lower back, the arms, the shins, and the calf muscles.
5. Ball Lift
This is a great exercise to tone your arms and stretch the spine. Stand with your feet apart, holding the ball in both your hands. Stretch your hands and slowly lift the ball over your head. Then, slowly lower your hands and bring the ball in front. Do this a couple of times, ensuring your back is straight and your feet are firm on the ground.
Note:- If you want to practice these exercises, you must first learn them from a specialist and make sure you do them under supervision. Ask your husband or caregivers to support you while you do them.
If you are concerned about using a birthing ball, you must consult a specialist who can help you. Here are some more tips that will be useful when using a birthing ball.
Tips to Use a Birthing Ball Safely
Following are some tips on how to use pregnancy ball or labour ball safely:
It is important to choose a ball with a non-bursting feature. This feature ensures that the ball does not burst suddenly.
Make sure to buy the right ball size for you (according to your height).
Always move carefully on the ball.
Buy a ball that has a non-slippery or anti-skid surface.
Place your hands on the ball to keep it steady before sitting.
Keep a safe distance between your feet so you do not go off balance or slip.
It is better to sit barefoot on the ball or wear good anti-skid footwear to avoid slipping.
Never hold your breath sitting on the ball. Inhale through your nose and exhale through your mouth.
It is recommended that you use the birthing ball under supervision for the first few times before you get a good handle on it.
FAQs
1. Is using a birthing ball safe for all pregnant women?
Generally, using a birthing ball is safe for most women. Still, it’s always best to consult your doctor, especially if you have any specific conditions like pelvic pain or are at risk of preterm labour.
2. How can I use a birthing ball to improve my posture during pregnancy?
Sitting on a birthing ball instead of a regular chair encourages you to maintain a more upright posture. It helps engage your core muscles, improves balance, and reduces slouching, which can lead to back discomfort.
3. Can a birthing ball help with swelling in the legs and feet during pregnancy?
Using a birthing ball to do gentle exercises like rocking or rotating your hips can improve blood circulation, which may help reduce swelling in the legs and feet.
4. How often can I use a fit ball for pregnancy?
A birthing ball can be used daily for short sessions, whether for sitting, stretching, or light movement. Some people replace their chair with a birthing ball for part of the day to maintain active sitting and reduce stiffness.
5. Is a yoga ball for pregnancy the same as a birthing ball?
A yoga ball and birthing ball are very similar. Both are large, anti-burst exercise balls, though birthing balls may be slightly thicker and sized specifically for pregnancy and labour use.
6. Can an exercise ball for pregnant women be used after birth?
Yes, a birthing ball can be helpful postpartum for comfortable sitting, supporting gentle core exercises, and easing back tension. Its soft, flexible surface can make sitting more comfortable during recovery.
7. Is a Swiss ball the same as a physio ball, and can it be used during pregnancy?
A Swiss ball and a physio ball are essentially the same type of large, anti-burst exercise ball. During pregnancy, both can be used for gentle stretching, posture support, and light mobility exercises, making them versatile tools for comfort and stability.
A birthing ball is a great way of staying fit during pregnancy. It can ease your labour woes and has ample benefits even after your baby is born. However, it is recommended to master the technique of using a birthing ball before using it for labour. Be always cautious while using a birthing ball to avoid accidents or mishaps. The best way to do that is to have someone with you to support you or the ball every time you use it.
Also Read:
Water Birth Delivery
Best Positions to Try During Labour and Delivery
Tips on How to Prepare for Labour & Childbirth
Using Peanut Ball for Labour And Delivery
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Everything You Need to Know About Postnatal Exercise
Congratulations! After nine months of anticipation and preparation, you’re finally a new mom. At this point, you’re probably beaming with excitement — but don’t push yourself trying to get back into the normal swing of things just yet. Regaining your strength and normal physique is going to take some time and patience, but it does come with a ton of benefits.
Getting regular exercise after giving birth not only gives you a helpful boost of energy and less stress, but it also equips you with better health to perform your new mum duties. However, don’t forget to take it easy on your body and keep in mind that there are some precautions to take to ensure you stay safe.
Wait for Your Six-week Postnatal Check-up Before Breaking in a Sweat Again
Generally, you should wait until your six-week postnatal checkup to see if you’re clear to start exercising again. You don’t want complications such as postpartum depression or haemorrhages to get in the way. It might also take longer if you had a caesarean birth, as your body will need more time to recover. It will also depend on your fitness habits and how conditioned your body is prior to the birth of your baby.
Start Slowly
Of course, there’s no pressure to hit the gym again just yet. Getting back into shape could mean something as simple as taking the stairs instead of the elevator, or walking to your neighbourhood shop instead of driving your car. When your postnatal bleeding has stopped, you can consider exercises such as swimming, whichBody Soul identifies as one of the safest exercises to do even during pregnancy. Not only is swimming easy on your joints, but it also improves circulation and alleviates swelling as you immerse yourself in water. And, as previously discussed here on First Cry Parenting, don’t ever forget to warm up properly.
Your Core Won’t Feel the Same
A study published on Manual Therapy found that majority of women go through diastasis recti, which is the separation of your left and right abdominal muscles at the end of pregnancy. It often comes with feelings of vulnerability and a disconnect from one’s center. Unfortunately, up to 39% of those women still experience its symptoms even after six months postpartum. One of them is R&B singer Ciara, who took to Instagram after her pregnancy to reveal her struggle. In a post, the hopeful artist wrote, “I have diastasis rectifrom both of my pregnancies, so I have to work extra hard to regain my core strength. Determined. Let’s Go Mammas!” This is completely normal, and it is recommended to see a physical therapist or trainer who specializes in postpartum training.
Invest in New Sportswear
I know you’re eager to put on your favorite athleisure wear again, but you might need to buy new sports bras for extra support. This reduces the risk of back pain, bad upper body posture, and stretch marks. Pretty Me also emphasizes the need for the right shoes, especially since your feet have most likely swollen up since pregnancy. Consider the kind of workout for the clothing support you need. This is important so as to avoid injuries.
Be Prepared to Experience New Kinds of Pain
Relaxin is the hormone that helps loosen joints for labour, but it can remain in your system for up to 12 months after your baby’s birth, causing you to be less stable when moving around. As such, you’ll need to focus on balancing or stability exercises to get you back on track.
Another newfound pain can take the form of postpartum depression. Even Kate Middleton isn’t exempt from this issue, which affects millions of mothers worldwide. After her pregnancy, the Duchess opened up about her mental health problems where she felt a lack of confidence. Of course, this can make you demotivated to get fit, but exercising can actually be a good way to boost your mood and confidence. Just don’t fall prey to unrealistic expectations, and go at your own pace.
Don’t Forget Proper Nutrition
You know how they say that fitness has more to do with your diet than exercise? The same still holds true for postpartum health. Remember that you just spent the last nine months growing a baby inside of you, so you are going to need all the nutrients you can get. Mind Body Green suggests eating nutrient-dense foods to replenish your body, which is also one of the best things you can do for yourself in the first six months and beyond. Hydrate often, and look to add supplements into your diet.
Disclaimer: The views, opinions and positions (including content in any form) expressed within this post are those of the author alone. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The responsibility for intellectual property rights of this content rests with the author and any liability with regards to infringement of intellectual property rights remains with him/her.
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Itchy Feet During Pregnancy – Causes, Symptoms and Treatment
Many women go through the discomfort of experiencing itching all over their bodies during pregnancy, while some face this irritating sensation more localized, specifically on certain body parts like their feet, hands, belly, or chest. It’s a common issue, with most cases of itching being nothing more than an annoying nuisance. However, in some instances, severe itching can go beyond mere irritation, leading to significant sleep loss or, in more concerning scenarios, it can be an indicator of a critical medical problem that requires immediate attention. This makes it crucial for expecting mothers to be well-informed about the potential implications of itchy feet while pregnant, including the underlying causes, recognizable symptoms, and the variety of treatment options available to alleviate the discomfort.
Why Do Women Have Itchy Feet During Pregnancy?
Many grumbles and grievances stem during pregnancy, ranging from vomiting and nausea to something unusual, such as itchy feet and legs. Yes, it is a fact that some pregnant ladies may experience itching, particularly on their feet. Though it is not a serious concern, one must agree that continuous itching is quite annoying. There are various reasons why pregnancy could lead to itchy feet, ranging from increased sweat production hormonal changes to skin issues, for example, psoriasis. This is not a serious problem, but itching can be very uncomfortable, and the last thing you need to feel during pregnancy is uncomfortable.
In some cases, itchy feet during pregnancy can also be due to a condition known as cholestasis or acholia of pregnancy. In cholestasis or acholia, the pregnancy hormones induce liver dysfunction, resulting in a build-up of bile in the bloodstream and liver. As a result, this build-up leads to itching in specific parts, such as the hands or feet. If pregnant ladies experience acholia or cholestasis, this condition should ideally be treated medically. If not treated medically, the condition may even affect the unborn baby.
What Causes Itchy Feet When Pregnant?
Pregnant ladies may experience foot itching due to several reasons. Intense foot itching could be related to other symptoms that depend on the root cause. Also, some pregnant ladies may experience isolated itching of feet, while few may experience itching all over the body, including the belly and hands. While a few others may experience severe feet itching with slight itching in other parts of their body.
Following are a few of the common causes of itchy feet during pregnancy:
1. Hormonal and Immune System Changes
Changes in the hormones and immune system during pregnancy can lead to skin irritations. Specific immune system functions could suppress or increase the baby’s development and growth, and such immunity changes can make some women susceptible to certain skin conditions during pregnancy.
2. Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of Pregnancy (ICP), also known as Obstetric cholestasis (OC), happens due to irregular bile movement from the liver to the gut during pregnancy (1). The bile salts below the skin cause severe itching without rashes in the feet and hands and slight itching in other areas. Some of the other symptoms are jaundice which is the yellowing of the whites of the skin and eyes, and stomach pain on the right side. The diagnosis can be confirmed by getting a blood test done.
3. Peripheral Neuropathy
Peripheral neuropathy damages the nerves outside the central nervous system (spinal cord and brain), which results in numbness, tingling, pain, and itching in the feet and hands (2). Lower extremity (feet) neuropathy is quite common during pregnancy due to nerve compression from the developing uterus. However, it must be noted that this kind of damage reverses after the baby is born.
4. Psoriasis
Psoriasis can lead to painful plaques on the feet and itching in the feet and other bodies during pregnancy. Ladies who have psoriasis before their pregnancy may have remission or a flare-up once they get pregnant. However, some women may also find that their symptoms improve during pregnancy.
5. Dry skin
Dry skin is a common cause of itchy feet, especially in climatic conditions that are extremely dry. Swimming in chlorinated water and frequent washing of feet can also lead to dry skin. Dry skin can also be caused by dermatitis or eczema, resulting from environmental and genetic factors. Some pregnant ladies may experience itchy feet due to dyshidrotic eczema – a type of eczema that appears on the feet’s sides and soles (3).
6. Allergic Reactions
Allergic reactions can lead to itchy feet in some pregnant women once exposed to certain triggers, and such triggers can vary in each scenario.
Signs and Symptoms of Itchy Feet During Pregnancy
Severe itching is the key symptom of cholestasis of pregnancy without any rash. The itching frequently gets worse at night and may cause a lack of sleep. The itching mostly begins during the third trimester of pregnancy but may also begin earlier, and it may worsen as the due date comes near. After the delivery, however, the itching usually disappears within a few days. So, be patient, and you need not google the keywords itchy swollen feet pregnancy.
Changes to one’s skin may also come along with the itchy sensation. Some signs and symptoms of itchy feet during pregnancy are (4):
Cracked, open areas
Dry, scale-like plaques
Blisters
Rash
Swelling
Itching
Redness
White spots
Yellowing of the skin and whites of the eyes (jaundice)
Nausea
Loss of appetite
Can Itching of Feet in Pregnancy Be Serious?
The complication of itchy feet during pregnancy is usually not a very serious condition. However, suppose itching happens in the feet and hands during the third trimester of pregnancy and is accompanied by uncommon symptoms such as vomiting, nausea, loss of appetite, and fatigue. In that case, this may be more than just a skin issue. One very common problem of itchy feet during pregnancy could be cholestasis—a disorder that weakens digestive fluid from the liver. This is usually accompanied by the lightening of the color of the stool and the darkening of urine color. Extra bile in the blood could harm your baby and increase the risk of premature birth or inhaling their stool (meconium) during delivery, leading to breathing problems.
Also, cholestasis may lead to poor absorption of vitamins A, D, E, and K (fat-soluble vitamins), which can resolve once the child is born. However, cholestasis can also lead to dangerous complications, with a high risk of repetition in a woman’s future pregnancies.
How Are Itchy Feet Treated in Pregnancy?
For common causes of itchy feet during pregnancy, various treatments can be tried to relieve the continuous itching.
1. Cold packs
Cool washcloths, cold footbaths, or ice packs draped in towels also should be applied to a woman’s feet to soothe the itchy skin. Do not apply the ice for more than 10 to 15 minutes.
2. New socks
Socks that are loose-fitting and made of natural, breathable fibers (like wool or even cotton) can keep feet from becoming itchy and sweaty.
3. Massage
A foot massage can also do wonders for the itching of feet as it helps distract the nerves and reduce the itching. However, one needs to gently massage the feet and avoid the acupressure points on the feet and around the ankles since certain spots can lead to uterine contractions.
4. Moisturizers
Simple, odorless moisturizers, such as shea butter, cocoa butter, or colloidal oatmeal can help calm itchy feet. However, one should check with the doctor before using topical medications, such as a lotion with diphenhydramine (Benadryl) or calamine lotion, as these may be dangerous during pregnancy.
5. Medications
Suppose early pregnancy itchy feet are caused by psoriasis or eczema. In that case, it is recommended to check with the doctor before using any medications as they may not be safe to use during pregnancy, and your doctor can help you find safer substitutes. One favored treatment for psoriasis during pregnancy is ultraviolet B phototherapy.
Home Remedies for Itchy Feet During Pregnancy
There are various home remedies for ways to relieve itchy feet during pregnancy. A few of them are (5):
Use a Cold Compress: Take an ice pack and place it on your feet for a few minutes.
Use Juniper Berry Lotion: Blend some sweet almond oil, olive oil, or any other oil, a little beeswax, a few juniper berries, and some ground cloves. Apply this mixture on your feet for some relief from itching of feet.
Use a Paste Made Out of Gram Flour: Make a mixture of gram flour, oil, and water to make a smooth paste. Apply this paste on the affected area for 15 minutes and then wash off.
Use Calamine Lotion: Apply some calamine lotion to the affected area and leave it overnight. This should help with the itching.
Use Coconut Oil: Take some extra virgin coconut oil and massage the affected area with this oil. Coconut oil can seep through the skin and reach the dry skin cells.
Use Aloe Vera: Collect some aloe vera gel from aloe vera leaves and apply this gel to the affected area. The aloe vera plant is well known to offer health benefits and help with various skin conditions.
Tips to Keep Feet Healthy During Pregnancy
The extra weight of carrying a baby can lead to various foot-related conditions in pregnant ladies. One of the common problems in pregnant women is itchy, swollen, and painful feet resulting from excess fluids. Following are a few tips to keep feet healthy during pregnancy:
Reduce the time spent walking barefooted.
Orthotics can offer extra support for the feet and enable the distribution of weight uniformly.
Wear shoes with good support and offer good blood circulation to the feet.
Keep feet elevated if you experience swelling and keep massaging the feet.
Do some light and frequent exercise, such as walking, to enable blood circulation in the feet.
How to Know If You Got Cholestasis of Pregnancy?
Severe itching is the prime symptom of cholestasis of pregnancy, and any rashes do not accompany this itching. Pregnant women usually feel itchy on the soles of their feet or the palms of their hands. However, some women feel itchy everywhere, and the itching typically worsens at night (6). A doctor is the best person to diagnose cholestasis of pregnancy with a blood test and a physical examination. These tests also let the doctor know how the liver is functioning.
When to See a Doctor?
Itchy feet during pregnancy at night can be treated at home with a few changes in your lifestyle changes, the application of topical moisturizers, and creams. However, one must visit a doctor if:
The itching worsens or does not improve with any treatments
One has peripheral artery disease or diabetic neuropathy symptoms
Home remedies show no improvement
You experience right-sided abdominal pain
You notice grey or pale stools
FAQs
1. Are there any preventive measures to avoid itchy feet during pregnancy?
While it may not be possible to prevent feet itching in pregnancy entirely, several strategies can help minimize discomfort. Regular moisturization with products specifically formulated for sensitive or pregnancy-affected skin can maintain skin hydration and elasticity. Avoiding hot water and using mild, fragrance-free soaps can also reduce skin irritation. Staying hydrated and maintaining a healthy diet rich in vitamins and minerals supports overall skin health, potentially reducing the risk of developing itchy feet during pregnancy.
2. Is it normal for the itching to worsen at night?
Many pregnant women report that itching, including itchy feet, tends to worsen at night. This can be due to a combination of factors such as increased skin temperature from being under blankets, decreased distraction from daytime activities, and the natural circadian rhythms of certain skin functions. While it’s a common occurrence, persistent or severe nighttime itching should not be ignored, as it could indicate underlying issues that might require medical attention.
3. Are there any specific skincare products pregnant women should avoid to prevent itchy feet?
Pregnant women should be cautious about the skincare products they use, especially on areas like the feet, which may become more sensitive during pregnancy. Products containing harsh chemicals, fragrances, and certain essential oils may exacerbate skin irritation and dryness, leading to increased itchiness. It’s advisable to use mild, hypoallergenic, and fragrance-free moisturizers and soaps. Before trying any new product, it might also be beneficial to patch-test a small area of skin or consult with a healthcare provider to ensure its safety during pregnancy.
This was all about itchy feet and pregnancy. Pregnancy is a wonderful and also bumpy ride. With all the anticipation and excitement, there may be some side effects along the way. However, most of these side effects can be easily treated at home, and one need not get stressed with the whole experience.
References/Resources:
1. Intrahepatic cholestasis of pregnancy: What is it?; NCT; https://www.nct.org.uk/pregnancy/worries-and-discomforts/pregnancy-related-conditions/intrahepatic-cholestasis-pregnancy-what-it
2. Klein. A; Peripheral nerve disease in pregnancy (Clinical Obstetrics and Gynecology); National Library of Medicine; https://pubmed.ncbi.nlm.nih.gov/23563878/; June 2013
3. Weatherhead. S, Robson. S, Reynolds. N; Eczema in pregnancy (BMJ); National Library of Medicine; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925231/; July 2007
4. Cholestasis of pregnancy; Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/symptoms-causes/syc-20363257
5. Be Cautious of Feet Itching Symptoms; Medicover Hospitals; https://www.medicoverhospitals.in/symptoms/feet-itching
6. Itching during pregnancy; Pregnancy, Birth & Baby; https://www.pregnancybirthbaby.org.au/itching-during-pregnancy
7. Pillarisetty. L, Sharma. A; Pregnancy Intrahepatic Cholestasis; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK551503/
Also Read:
Hives (Urticaria) when Pregnant
Stomach Itching in Pregnancy
Vaginal Itching while Pregnant
Irritable Uterus during Pregnancy
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Biophysical Profile: Purpose, Procedure, and Risks
With advancements in medical technologies, it is now easier to perform tests that determine your baby’s health in the womb. The biophysical profile is a medical procedure that is performed to assess your baby’s growth and health when it is in the womb; it helps explicitly in checking whether the baby in the womb is getting enough oxygen or not. Biophysical profiling is done to check the general well-being of the baby in case of high-risk pregnancies. It is a non-invasive and painless procedure that is globally accepted to track a baby’s health (1).
What Is a Biophysical Profile?
A biophysical profile (BPP) is a combination of a biophysical profile ultrasound evaluation and a non-stress test (NST) (2). It is advised only if the gynaecologist sees a potential risk or complication in the pregnancy. It is done after 28 weeks of pregnancy. It shows the baby’s heart rate, breathing, movements, tone, and the level of the amniotic fluid present. Following are some of the attributes that are checked during a biophysical profile (3):
Foetal Breathing: It shows how your baby’s chest moves as he breathes.
Foetal Heart Rate: It indicates the number of heartbeats per minute.
Foetal Movement: It records the number of movements your baby makes in 30 minutes, but sometimes, if the baby is asleep, it takes longer than 30 minutes.
Foetal Tone: It shows the ability of the baby to flex and extend an arm or leg, measured by counting quick and jerky movements.
The Volume of Amniotic Fluid: The amount of amniotic fluid surrounding your baby.
Who Should Opt for a BPP Test? When Should It Be Done?
It is usually performed if it is a high-risk pregnancy, overshot due date, twins, or maternal high blood pressure or heart disease. It is also done in unstable pregnancies or with progressive foetus deterioration. Here are some other reasons for getting a biophysical profile test (4):
You are a diabetic and on medication.
You are experiencing other medical conditions which might affect your pregnancy.
You are experiencing gestational hypertension.
Your baby is showing weak growth and appears smaller.
Your baby is not very active.
Your levels of amniotic fluid are not appropriate. It is either more or less than the normal range.
You’ve crossed the due date, and the doctor wants to understand how the baby is pulling along.
You have a history of losing a baby during the third trimester of pregnancy for unknown reasons, and the doctor wants to double-check this time to ensure everything is fine to avoid the chances of a repeated miscarriage.
You or the baby has a condition that requires monitoring.
Although it is done during the third trimester, it is purely the doctor’s call to do the BPP test or not.
Procedure
There are two parts to a BPP. One of the tests is a non-stress test (NST), and the other is an ultrasound evaluation. These tests are usually done with a full bladder; the mother is asked to drink a few glasses of juice or water (6-7 glasses). This helps in pushing the intestines out of the way to get a clearer picture of the baby. In full-term pregnancies, it might be needed on a full bladder, as the baby itself pushes the intestines out of the way.
For an NST, you must lie on your left side. It involves one belt strapped to the abdomen of the mother to measure the fetal heart rate and another belt to measure the contractions. These parameters are measured for 20-30 minutes. If the baby is not moving or is asleep, a buzzer is used to wake up the baby, and then the ultrasound is done by a skilled and qualified technician supervised by a perinatologist. This ultrasound might take about an hour. It is used to observe the body movements of the baby, flexing the arms and legs, also referred to as muscle tone, the baby’s capability to move its chest muscles and diaphragm for breathing, and the quantity of the amniotic fluid. The ultrasound test is similar to the obstetrical ultrasound, which is performed during pregnancy.
How Long Does It Takes?
A biophysical scan or a biophysical test in pregnancy requires two noninvasive tests, including fetal monitoring and an ultrasound. The average duration of a BPP ultrasound may take about 30 minutes to an hour to complete (5).
Risks and Side Effects
This procedure has no potential side effects since it is non-invasive, but the only concern is the prolonged exposure to ultrasound. The mother’s anxiety might cause some deviations in the parameters, especially while doing the non-stress test. Hence, you are advised to stay relaxed for the entire duration of the procedure.
What Does a Biophysical Profile Test Result Mean?
A BPP in pregnancy has five specific foetal parameters that are studied and “scored” during the procedure:
Biophysical Attribute
Normal
Abnormal
Breathing
1 breathing episode within 30 minutes
No breathing episodes within 30 minutes
Movement
2 or more limb movements within 30 minutes
(active continuous movements are considered as one single movement)
Less than 2 limb movements within 30 minutes
Muscle Tone
1 or more episodes of active extension/flexion of limbs, and so on (for example, opening and closing a hand is considered as one tone)
Slow extension/flexion of limbs, partially open fetal hand, and so on
Heart Rate
2 or more episodes of reactive heart rate acceleration within 20 minutes
1 or more episodes of unreactive heart rate acceleration
Amniotic Fluid
1 or more adequate pockets of fluid
Either no pockets or inadequate pockets of fluid
Every movement tested in the BPP is a result of efferent signals that originate in different central nervous system (CNS) centres. It matures at various gestational ages. The total score is used by your doctor to determine the health of the baby.
The BPP profile ultrasound technician (sonographer) assigns a score of 0 – 2 for each parameter. A score of 8 to 10 is considered normal and good; anything less than that is a cause for concern. If the score is 6, then the BPP scan needs to be repeated within 24 hours. If the score is 4 or less, it is considered abnormal; there might be a need to deliver the baby immediately (6). Sometimes, even if the scores are fine, the amniotic fluid levels might need monitoring. Depending on the stage of the pregnancy, delivery might be advised.
An abnormal pattern can be noticed in the umbilical cord blood flow followed by reduced FHR (foetal heart rate) and the loss of breathing. The movements of the foetus and tone are the last parameters that show abnormalities. If the abnormalities are closer to term, then immediate delivery is done. However, if it is far away from the term, then the comprehensive management of the baby’s health is planned out. This might include weekly or fortnightly testing.
A modified biophysical profile is a combination of the Non-Stress Test and the evaluation of the amniotic fluid levels. It is a more efficient version of the biophysical profile. If the amniotic fluid levels are lower, it indicates that the baby is not making enough urine or that the placenta might not be functioning properly. If either the NST or Amniotic Fluid Volume (AFV) is abnormal, then the complete BPP is performed along with a contract stress test (CST).
A study titled “The antenatal measurement of foetal urine production” mentions that “two mechanisms help to explain the relationship between decreased AFV and perinatal morbidity and mortality. Decreased fluid may reflect uteroplacental insufficiency, especially in growth-retarded and postdate foetuses.”
The bpp scan cost is not very high. However, it varies from hospital to hospital. Speak to the radiologist before consenting to the procedure.
A biophysical profile is a standard tool that helps the doctor monitor the baby and possibly prevent fetal distress. It is a tool for providing antenatal fetal surveillance. The false negatives in BPP are very low (0.77 mortality per 1000 babies), and hence, it’s a reliable procedure. When the test results indicate a risk to the growing fetus, the physicians can take measures to intervene and avoid progressive metabolic acidosis, which can result in death.
Please note that even if the BPP results are normal and accurate, they reveal the baby’s current situation and do not predict the outcome of a pregnancy (7).
FAQs
1. Why do I need a biophysical test?
A biophysical profile test is recommended when a doctor senses a health concern with the unborn baby. It could be done if there is a fetal growth problem, decreased movement of the baby, or the pregnancy goes beyond 42 weeks. Please note that a biophysical profile does not always mean anything is wrong with the baby. Your doctor may recommend one for other routine checks (2).
2. How can pregnant women prepare for a BPP test?
The biophysical profile in pregnancy is non-invasive and does not require any preparation from the patient’s side. Your doctor may suggest you eating before the test as some babies get active once the mother has eaten (5).
3. How often is the BPP test done during pregnancy?
The frequency of the biophysical scoring ultrasound is decided by the consulting doctor. It could also be recommended in the last trimester if the requirement feels so to the doctor. Communicate with your doctor for the follow-ups if necessary.
4. Can I get the results of the BPP test immediately?
In some cases, you may get the results right after the test is finished.
The BPP testing process may induce anxiety in many expecting moms. To ease your anxiety and fears, communicate with your doctor well and discuss any doubt or pressing question that arises. Prenatal care and tests are essential to rooting any complications and ensuring a healthy and smooth pregnancy.
References/Resources:
1. Mannin. F. A; Biophysical profile test for antepartum fetal assessment; UpToDate; https://www.uptodate.com/contents/biophysical-profile-test-for-antepartum-fetal-assessment
2. Biophysical Profile; Stanford Medicine; https://www.stanfordchildrens.org/en/topic/default?id=biophysical-profile-90-P02438
3. Biophysical Profile; Cleveland Clinic; https://my.clevelandclinic.org/health/diagnostics/21013-biophysical-profile
4. Biophysical Profile (BPP) Test; University of Michigan Health; https://www.uofmhealth.org/health-library/tw9854#tw9856
5. Biophysical Profile: BPP Ultrasound and Nonstress Test; Johns Hopkins Medicine; https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/biophysical-profile-bpp-ultrasound-and-nonstress-test
6. Biophysical Profile (BPP); Children’s Hospital of Philadelphia; https://www.chop.edu/conditions-diseases/biophysical-profile-bpp
7. Oyelese. Y, Vintzileos. A. M; The Uses and Limitations of the Fetal Biophysical Profile; Clinics in Perinatology; https://www.sciencedirect.com/science/article/abs/pii/S0095510810001387?via%3Dihub; March 2011
Also Read:
Foetal Echocardiography
GCT & GTT Tests during Pregnancy
Rh Factor and Antibody Screening
Common Trimester-wise Tests during Pregnancy
A Guide To Non-Invasive Prenatal Testing (NIPT)
Read more
NT (Nuchal Translucency) Scan in Pregnancy – Importance & Procedure
Congenital disorders or defects are defined as disorders or defects that babies are born with, or in simpler words – birth disorders or defects. Most of the time, congenital disorders cannot be treated. However, it definitely helps to know before the birth of your baby if he is going to have any congenital disorder. Pregnancy ultrasounds help ensure the appropriate growth and development of the baby. One such scan/test is the Nuchal Translucency (NT) Scan, which helps doctors diagnose if the baby is at risk of developing Down’s Syndrome. NT Scan in pregnancy is a promising technology for detecting potential abnormalities in an unborn baby. If your doctor suspects any unusual readings on your ultrasound, they may recommend Nuchal Translucency scanning. Read on to learn more about the Nuchal Translucency scan.
What Is Nuchal Translucency (NT) Scan?
The Nuchal Translucency (NT) Scan is a prenatal screening. It allows us to primarily determine if the baby runs a risk factor of being born with Down’s Syndrome (1). Down’s Syndrome is a congenital defect wherein a baby is born with three copies of chromosome number 21 (instead of the normal 2 copies) (2).
Along with this, the NT scan is also able to detect if your baby is at risk of having few other congenital defects like other chromosomal abnormalities (particularly in chromosome number 13 and 18), and heart problems.
Please Note :- The NT scan is only a ‘screening’ test. It cannot identify with 100% accuracy whether or not your baby will be born with Down’s Syndrome. It will only identify the degree of ‘risk’. In other words, the NT scan gives a probability of your baby developing Down’s Syndrome. Based on the results of the scan (which will be explained further in this article) your gynaecologist may advise you to take a ‘diagnostic’ test, which will tell you with certainty whether or not your baby will develop Down’s Syndrome.
Let’s now take a look at Nuchal Translucency a little more in-depth and also understand how the scan is done. We are aiming to answer all the questions you could possibly have about this topic. But, in case you have some more questions, you must speak to your gynaecologist immediately.
What Is Nuchal Translucency?
Nuchal translucency is the sonographic appearance of the degree of translucency of the fluid that builds up at the back of your baby’s neck (or the ‘nape’ of the neck) during his normal growth within the womb (3) (4). The fluid build-up is a normal process; however, the composition of this fluid, especially its thickness and translucency, is affected by chromosomal abnormalities, such as the one responsible for Down’s Syndrome.
Importance of Nuchal Translucency Scan
The NT test during pregnancy helps assess the probability of some chromosomal conditions but does not provide a diagnosis or treatment. It estimates the risk of (5):
Down Syndrome (Trisomy 21): Caused by extra genetic material on chromosome 21, leading to distinct features, learning challenges, and possible congenital heart issues.
Edward’s Syndrome (Trisomy 18): It is a rare genetic disorder that can cause severe organ abnormalities and developmental delays and also lead to a shortened life expectancy (6).
Patau Syndrome (Trisomy 13): Similar in severity to Edward’s Syndrome, this condition results from an extra copy of chromosome 13, potentially causing structural defects, intellectual disabilities, and organ complications.
Beyond genetic risk assessment, the NT scan also checks fetal heart health and development, offering more insights into the baby’s overall well-being.
How Is the Nuchal Translucency (NT) Ultrasound Scan Carried Out?
An NT scan is nothing but sonography. It can be performed as a Transabdominal or Transvaginal Ultrasound. It is important to note that to measure the NT, the fetal crown-rump length should be between 45 mm and 84 mm (7).
1. Transabdominal Ultrasound
Here are the steps carried out for a transabdominal ultrasound.
The sonographer applies some gel all over the lower abdomen.
The images of the foetus are obtained using an ultrasound probe.
If the results of this ultrasound are not satisfactory enough for your sonographer to build a report, you may be requested to go for a transvaginal ultrasound.
Your sonographer will let you know how much water you must drink before the ultrasound.
2. Transvaginal Ultrasound
While a transvaginal ultrasound may sound more ‘invasive’, it is a safe procedure to carry out the nuchal translucency test. Here’s what is done during a transvaginal ultrasound.
A thin ultrasound probe, about 2 cm thick, with a disposable, protective sheath, is coated with an ultrasound gel.
It is then inserted in the vagina to obtain images of the baby.
While this method may provide better results, you can consult your doctor if you are uncomfortable about it.
Who Performs the Nuchal Translucency (NT) Scan?
The nuchal translucency scan is an ultrasound which is performed by a qualified sonography technician. It would be best to ask your gynaecologist for trusted recommendations of a good technician. You cannot rely on just a technician or an assistant to perform the test.
When Is the Nuchal Translucency (NT) Screening Done?
The NT scan is typically performed between the 11th and the 13th week of your pregnancy (8). This is because your baby’s neck is still transparent during these weeks. After the 13th week (sometimes, 13 weeks and 6 days), the clear space at the back of the foetus’ neck can disappear, thus making it difficult to diagnose any congenital defects. Thus, first-trimester nuchal translucency screening is recommended.
Is the Nuchal Translucency (NT) Screening Risky for the Baby?
The NT scan is a non-invasive method. No blood sample is required to perform this test, no needles are inserted in any part of your body, nor are you subjected to any kind of radiation. The NT scan is thus a very safe procedure. It does not adversely affect you or your baby in any way.
The only concerns pregnant women may have about an NT screening are psychological – anxiety, nervousness, and fear about the procedure. However, you must realise that an NT scan is only going to help you be better prepared to take care of your baby when he comes into this world. Stay positive, and talk to your gynaecologist and sonographer about the scan to get answers to any questions you may have.
During a scan, the sonographer will take measurements of the nuchal translucency. He would then compare them with the nuchal translucency measurement chart, which we shall talk about in the next part of the article.
Nuchal Translucency Measurement Chart
In normal foetuses, the thickness of the nuchal translucency measures about 2 mm on average. Other measurement values indicate the following.
Foetuses with 1.3 mm nuchal translucency thickness on average are at low risk of Down’s Syndrome.
The normal range of nuchal translucency thickness is up to 2.5 mm on average. However, nine out of ten babies with nuchal translucency thickness up to 3.5 mm will be normal and will NOT suffer from Down’s Syndrome. Such values for nuchal translucency thickness are typically observed in foetuses between 45 and 85 mm in length.
If the nuchal translucency thickness is up to or more than 6 mm on average, the foetus is at high risk of Down’s Syndrome (1).
You must bear in mind that It is difficult to pin a definite ‘cut-off’ value for the thickness of the nuchal translucency. A lot depends on the size of the foetus, the age of the mother, and some more factors. Many a time, a foetus with Down’s Syndrome also produces more nuchal fluid. Therefore, it might not be possible to determine the risk factor accurately in certain cases.
This is why doctors may look for another indicative sign, which is the development of the nasal bone. It has been indicated that the absence of a nasal bone suggests a high risk of Down’s Syndrome, too. Let’s now dive deep into how accurate a nuchal translucency test can be.
How Accurate Is the Nuchal Translucency Test
As previously explained, the pregnancy nuchal translucency scan only predicts how likely you are to give birth to a baby with Down’s Syndrome. It is not a diagnostic test but merely a screening. If you consider the nuchal translucency measurement figures discussed above, you will realise that the nuchal translucency scan is not highly accurate.
If your baby is at risk of developing Down’s Syndrome according to the nuchal translucency scan, you may be advised to undertake a diagnostic test, which is a blood test that confirms whether your baby will be affected or not.
The diagnostic test involves the measurement of levels of two hormones – Human Chronic Gonadotropin (hCG) and Pregnancy Associated Plasma Protein A (PAPP-A). A normal foetus produces and releases these two hormones in the mother’s bloodstream. The NT scan on its own is about 70 to 75% accurate; however, combined with a blood test, its accuracy can increase up to 90%.
Who Should Go for a Nuchal Translucency Screening?
Mothers who have previously given birth to a baby with Down’s Syndrome are at a higher risk of doing so a second time. It is highly advisable for such women to undertake a nuchal translucency scan. Also, the risk factor for Down’s Syndrome increases with maternal age. While 1 in 1500 babies born to women in their 20s develops Down’s Syndrome, the chances increase for women in their 40s. 1 in 100 women in their early 40s may give birth to a baby with Down’s Syndrome, while 1 in 50 women in their mid-40s may give birth to a baby with Down’s Syndrome. Mothers are advised to go for the nuchal translucency screening accordingly.
Why Should You Have a Nuchal Translucency Ultrasound?
As a mother, it is understandable that you would be wary of getting any ‘tests’ done to ensure your baby is healthy. At the same time, any test you are advised to take will get you feeling concerned about your baby’s and your own safety. Yet the question remains: why should you get a nuchal translucency ultrasound done?
The nuchal translucency scan can help detect several other things:
Risk of Patau Syndrome (a congenital defect where the baby is born with three copies of chromosome number 13 instead of the normal two copies).
Risk of Edward’s Syndrome (a congenital defect where the baby is born with three copies of chromosome number 18 instead of the normal two copies).
Risk of physical conditions like congenital heart problems.
The NT scan can thus better equip you in terms of knowledge to make your choice about whether you want to continue your pregnancy or not or how you can prepare yourself to take care of your child.
FAQs
1. What is assessed during a nuchal translucency scan?
During an NT scan, doctors assess fetal heartbeat, nuchal translucency measurement, blood flow to the fetal heart, nasal bone analysis, and maternal hormone levels.
2. Is an NT scan painful?
No, an NT scan is a painless and non-invasive scan that does not pose any risk to the fetus or the mother.
3. Is an NT scan mandatory?
No, an NT scan is not compulsory but parents’ choice. However, it can be way of a reassuring self and helping with the preliminary information about the pregnancy.
NOTE:- The Medical Termination of Pregnancy Act, 1971, allows a woman to medically terminate her pregnancy (i.e. have an abortion) up to the 20th week of pregnancy, provided that continuing the pregnancy might prove fatal to her or the baby or if there is considerable risk of the baby being born with physical and/or mental handicap that will prevent it from having a quality life. It is strongly advised that you seek legal counselling and guidance before taking any step.
In most cases, it will not be required of the mother to take such a drastic decision as nature has its own way of taking care of the situation. About 50% of foetuses that have Down’s Syndrome do not complete a full term and are spontaneously naturally aborted. Hence, the chances of you giving birth to a baby with Down’s Syndrome are much smaller than the chances of such a foetus completing a full term in the first place.
However, should your pregnancy continue successfully and you give birth to a baby with Down’s Syndrome, prenatal screening tests for Down’s Syndrome can actually help you better prepare yourself for the upbringing of such a baby. Management of Down’s Syndrome can be quite challenging, especially for parents who have no prior experience of dealing with such a baby, and it always helps to be informed beforehand.
References/Resources:
1. Nuchal translucency scan; Pregnancy, Birth and Baby; https://www.pregnancybirthbaby.org.au/nuchal-translucency-scan
2. About Down Syndrome; NDSS; https://ndss.org/about
3. Raised Nuchal Translucency (NT) in pregnancy; Northern Lincolnshire and Goole NHS Foundation Trust; https://www.nlg.nhs.uk/resources/raised-nuchal-translucency-nt-in-pregnancy/
4. Sharifzadeh. M, Adibi. A, et al.; Normal reference range of fetal nuchal translucency thickness in pregnant women in the first trimester, one center study; J Res Med Sci.; PubMed Central; https://pmc.ncbi.nlm.nih.gov/articles/PMC4746871/; October 2015
5. Nuchal Translucency; Cleveland Clinic; https://my.clevelandclinic.org/health/diagnostics/23333-nuchal-translucency
6. Trisomy 13 and Trisomy 18 in Children; Stanford Medicine; https://www.stanfordchildrens.org/en/topic/default?id=trisomy-13-and-trisomy-18-in-children-90-P02419
7. Nuchal translucency; NHS England; https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/nuchal-translucency/
8. First Trimester Screening, Nuchal Translucency and NIPT; Johns Hopkins Medicine; https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/first-trimester-screening-nuchal-translucency-and-nipt
Also Read:
CT Scan in Pregnancy
Anomaly Scan in Pregnancy
Dating Scan during Pregnancy
Doppler Ultrasound Scan when Pregnant
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Bleeding Gums During Pregnancy: Causes, Treatment & Prevention
Weight gain, sudden cravings for food, and a constant need to visit the washroom are some of the symptoms of pregnancy that are often spoken about. However, certain other symptoms are not talked about much. Bleeding gums during pregnancy is one of those pregnancy symptoms. While it may seem like a minor issue, bleeding gums can be an early sign of the hormonal changes taking place in the body during pregnancy. About half of the pregnant women have red swollen and tender gums that bleed, especially when brushed. Understanding why it happens and how to manage it can help expectant mothers maintain good oral health throughout their pregnancy. Read on to learn the details of this sign of pregnancy.
Are Bleeding Gums Normal in Pregnant Women?
Your body goes through significant changes during pregnancy, including hormonal fluctuations and a growing belly. If you are pregnant with bleeding gums, it is important to know that this is a common condition experienced by many expectant mothers (1). Bleeding gums during pregnancy are usually a mild form of gum disease. While it is generally not a major cause for concern, taking preventive measures and seeking guidance from your gynaecologist and dentist can help maintain good oral health throughout pregnancy.
Causes of Bleeding Gums in Pregnancy
Your pregnancy hormones affect almost every tissue in your body, including your gums. However, this isn’t the only reason for those swollen, red, painful gums. Below are some of the reasons why you could be suffering from this:
Bleeding gums are common due to the hormonal changes that the body undergoes (2).
During pregnancy, the increase in progesterone makes it hard for the body to fight plaque bacteria, causing the gums to bleed.
Moreover, a pregnant woman also faces swollen gums due to 30 to 50 percent increase in blood supply (3).
Calcium deficiency and consumption of sugary food weaken the teeth and cause toothache (4).
Signs and Symptoms of Gum Disease During Pregnancy
Not just bleeding, gum disease in pregnancy could be noted through the following symptoms (5):
Red or swollen gums
Tender Gums
Sensitive teeth
Loose teeth
Difficulty in chewing
Persistent bad breath
Receding gums (gums pulling away from the teeth)
Complications of Blood From Gums During Pregnancy
Though swollen, tender gums are common during pregnancy, periodontitis with inflamed and bleeding gums needs utmost care and immediate attention (6). A canker sore or a recurrent aphthous ulcer can develop around gums. These are round red bumps that might become annoying because of the size. The lumps can grow big and cause infection when they rupture.
Can Gum Bleeding or Gum Disease in Pregnancy Cause Harm to Your Baby?
Bleeding gums are unlikely to harm the growing baby. Some studies suggest that severe gum disease can cause pre-term labour, low birth weight, and preeclampsia, but there is no proven relation between gum disease and its effects on birth or the health of the baby.
Treatment for Sore and Bleeding Gums in Pregnancy
Maintaining good oral health is the key to mitigating bleeding gums. Here are some of the treatment methods for bloody gums during pregnancy:
1. Prescription Mouth Rinse
Apart from following a proper brushing routine, rinsing the mouth can also help in keeping the acid and bacteria away. Be sure to choose a mouth rinse that is alcohol-free as alcohol content usually leads to dry mouth (7). Mouthwash can be used easily throughout the day. Consult the dentist to find out the best-suited mouthwash.
2. Prescribed Oral Antibiotics
Normally, a dentist can prescribe antibiotics to treat bleeding gums, but pregnant women need to be careful as it could affect their pregnancy. Therefore, antibiotics are the last resort for pregnant women and should never be prescribed without written consent from the gynaecologist.
Antibiotics kill bacteria and reduce plaque in the mouth by checking the gum disease, thus allowing the gums to heal. Dentists prescribe antibiotics in the form of capsules or pills. They can also be directly applied as a gel on the gums or used as a mouthwash. Be sure to loop in your gynaecologist to ensure the dentist prescribes medicines that do not affect the pregnancy.
3. Surgery
Surgery to treat bleeding gums is avoided during pregnancy unless there is an emergency, which is a rare occurrence. In case there is a pregnancy tumour, it is removed completely along with the complete elimination of the residual lesions and the plaque and calculus deposits, and also the factors that cause these accumulations.
Common Antibiotics Suggested By the Practitioner
Although any medication during pregnancy should be approved and prescribed by a dentist and your gynaecologist, these are some of the conventional antibiotics that dentists prescribe in case of gum disease and pregnancy.
It is, however, best to consult your doctor before taking any of these (8).
Amoxicillin
Ampicillin
Clindamycin
Erythromycin
Penicillin
Nitrofurantoin
How to Prevent Bleeding Gums While Pregnant?
As they say, prevention is always better than cure. Therefore, practising good oral hygiene is the key to avoid pregnancy related oral issues. Below are some steps you must take and integrate it into your daily routine (9):
Brush your teeth at least two times a day once in the morning and other before going to bed.
Electric toothbrushes with rotating heads are effective in removing the plaque. Give up smoking in case you smoke.
For diabetics, it is important to keep your sugar level in check. Rinse your mouth daily with a good mouthwash.
Home Remedies for Swollen and Bleeding Gums During Pregnancy
Nature has the entire cure that we need. Here are some home remedies to treat the bleeding gums at home:
1. Green Tea Remedy
Drinking green tea helps in reducing swollen gums and prevents the building of plaque and bacteria (10).
2. Olive Oil
Mixing olive oil in salads will strengthen the teeth and limit plaque formation. It has anti-bacterial properties (11).
3. Honey
Even though honey is sweet, it has natural anti-bacterial qualities. It also has the necessary minerals to strengthen the gums (12).
4. Clove Oil
Clove oil is known to keep the gums and teeth healthy. It is also an antiseptic. You can rub clove oil on the gums or chew on a clove (13).
5. Aloe Vera
It has soothing qualities and can ease the pain or decrease the inflammation. It can be availed in various forms such as toothpaste, mouthwash, or gel (14).
6. Baking Soda
It helps to neutralise the acids in the mouth that can eventually lead to cavities. It can be directly sprinkled on the toothbrush or mixed with toothpaste.
7. Sage Tea
Like green tea, this too has antimicrobial and antibacterial properties. Boil the leaves for 2-3 minutes and then strain the water. Use the water to rinse the mouth.
8. Tea Tree Oil
Rinsing the mouth with a mixture of tea tree oil and water can kill harmful microorganisms and provide instant relief to inflamed gums.
What Dental Treatment Should You Avoid?
You must make sure that your dentist has your necessary pregnancy details as medications and dental x-rays can cause issues for the fetus. The Department of Health advises that amalgam fillings shouldn’t be removed during pregnancy.
When Should You Call the Dentist for Gum Bleeding During Pregnancy?
In addition to keeping the dentist informed of your dental conditions, call the dentist immediately if you have a severe toothache, painful bleeding gums, persistent bad breath, loose teeth, growth in your mouth, or receding gums.
FAQs
1. Is it common to have bleeding gums in the 3rd trimester?
Yes, bleeding gums in the 3rd trimester are fairly common. Hormonal changes continue throughout pregnancy, and increased blood volume can make the gums more sensitive and likely to bleed. Proper oral care can help manage symptoms during this stage.
2. How long do bleeding gums last during pregnancy?
The duration varies from person to person. Some women experience bleeding gums only during the first trimester, while others may notice symptoms throughout pregnancy. In most cases, gum health improves after delivery when hormone levels stabilise.
3. Should I change my toothbrush if my gums bleed during pregnancy?
Using a soft-bristled toothbrush is generally recommended if your gums are sensitive or bleeding. A soft brush can effectively clean your teeth while reducing irritation to the gum tissues (2).
Bleeding gums during pregnancy is a common condition that can be kept in check. Oral healthcare is very important to maintain during pregnancy. Visit your dentist regularly and keep the dentist and the gynaecologist informed of any abnormalities that might be noted.
Also Read:
Dentist while Pregnant
Tooth Pain during Pregnancy
Teeth Whitening in Pregnancy
Mouth Ulcers During Pregnancy
Remedies for Tooth Pain and Bleeding Gums during Pregnancy
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Complications in the First Trimester of Pregnancy
It is often said that pregnancy is one of the most beautiful phases in a woman’s life. It involves pampering, indulgence, and immense support from one’s partner and family. Most pregnancies progress smoothly and without complications. However, understanding the possible complications of first trimester pregnancy is essential for every expectant mother. During the early stages of pregnancy, women undergo several tests, ultrasounds, and physical examinations so that doctors can rule out any complications or address concerns promptly.
An expectant mother is more susceptible to certain risks as the body undergoes tremendous changes to accommodate new life. Certain parts of the immune system become more active, while others are naturally suppressed to support these changes. Here is a look at some common early pregnancy problems and solutions every expecting mother should know about.
Pregnancy Complications in the First Trimester
There is a significant change in hormonal activity during the first trimester. This change is essential but brings with it complications like fatigue or nausea. While these are low risk and are more bothersome than dangerous, there are a few serious pregnancy problems in first trimester that you should be aware of. We have mentioned them below:
1. Miscarriage
It is unfortunate that about 10-15 per cent of pregnancies conclude in a miscarriage. Of these, it is reported that around 80% happen during the first trimester. Miscarriage during early pregnancy can be caused by infections, chromosomal abnormalities, clotting disorders, or anatomic problems with the uterus. Eating a balanced diet, appropriate exercise, avoiding alcohol and cigarettes should help sustain your pregnancy (1).
2. Ectopic Pregnancy
An ectopic pregnancy happens when a fertilised egg gets implanted outside the uterus. One in 50 of all pregnancies could be an ectopic one. Most ectopic pregnancies occur in the fallopian tube and may cause the tube to rupture. This can be fatal as it causes internal bleeding (2).
3. Constipation and Diarrhoea
Stomach problems during pregnancy first trimester are not uncommon. Usually, women experience mild to severe constipation due to changes in diet and incorporation of iron-rich foods. This may sometimes cause haemorrhoids and bloody stools (3). Diarrhoea that lasts more than 3-4 days should be reported to the doctor, or it could lead to dehydration and weakness. Continue to have a balanced diet and drink copious amounts of water. In rare cases, diarrhoea can be a result of food poisoning. It should be treated immediately if it doesn’t resolve within 24 hours (4).
4. Multiple and Twin Pregnancy Complications
30% of mums carrying twins or multiple foetuses are known to have vaginal bleeding. Twin pregnancy complications in the first trimester include vanishing twin, where one baby is lost to a miscarriage during the pregnancy. The embryo that is lost is usually reabsorbed into the uterine lining without any noticeable symptoms to the expectant mother (5). Up to 30 per cent of multiple pregnancies face the vanishing twin syndrome. It is detected because the mother has usually had early scans that showed dual embryos.
5. Vaginal Discharges or Itching
Vaginal discharge is a regularity in a woman’s life. Nothing is alarming about a little vaginal discharge unless it has an odour or is coloured yellowish. Additionally, if there is itching or redness, it could indicate an infection. A more serious concern is if the itching indicates an STD that could be transmitted to the baby (6).
6. Painful Urination
A urinary tract infection is a bane in every woman’s life. During pregnancy, a woman becomes highly susceptible to Urinary Tract Infection. The changes that pregnancy causes to the urinary tract makes it very easy for a pregnant woman to contract a UTI. Additionally, the pressure from the uterus prevents the bladder from completely draining and this causes infection. If you leave a UTI untreated, it can lead to kidney infection or early labour (7).
7. Difficulty Breathing
Increased levels of progesterone during the first trimester contribute to shortness of breath. Working slowly, sitting up straight, and sleeping on propped up pillows might help with easing breathing problems during the first trimester of pregnancy. Once you’re past the first trimester, the shortness of breath usually occurs around the third trimester when your uterus pushes up against the diaphragm and lungs, making it difficult to take a deep breath. If wheezing, palpitations, or coughing accompany shortness of breath, then you should let your doctor know immediately. They may be able to tell the difference between plain shortness of breath and other complications.
8. Spotting or Vaginal Bleeding
Implantation bleeding is common in pregnancy and is nothing to get alarmed about (8). There are, however, other reasons like cervical polyps that can lead to spotting and bleeding (9). Rupture of a tubal pregnancy, as in the case of an ectopic pregnancy, can also cause a fatal bleed.
9. Calf Pain & Headache
Calf pains during the first trimester are not very common. Hormonal changes combined with exhaustion can be credited with this. But pain on one side alone could be an indicator of a travelling blood clot. Pregnancy increases the chances of developing clots. A clot in the head could cause severe headaches. Clots that form in leg veins are known as Deep Vein Thrombosis. Staying active and improving blood circulation reduces the chances of blood clots and cramps (10).
10. Nausea & Vomiting
Morning sickness is the most common affliction that affects a pregnant woman during her first trimester. It affects different women differently. For some people, it could be extreme, and it increases the risk of dehydration. Some women cannot hold down anything that they eat. It may lead to reduced nutrition for the mother and foetus. Doctors may recommend some medication to regulate nausea and prevent dehydration in extreme cases (4).
11. Fatigue & Insomnia
Pregnant women, during the first trimester, experience a massive slump in the quality of sleep. Pregnancy sleep problems in the first trimester could be attributed to the fatigue and extreme exhaustion that women feel throughout the day. It could also be attributed to heartburn and bathroom breaks at night.
12. Temperature Above 101°F
A fever that crosses 101°F could be a sign of an underlying infection. This could invariably affect the foetus, and it should be checked. Fever accompanied by rash or joint pain could be parvovirus or Toxoplasma (11). There is also a minor chance that it could indicate cytomegalovirus which is a reason for congenital deafness (12). The chances of risk to the infant occur when a pregnant woman has recurrent CMV infection.
13. Swelling
After 20 weeks of pregnancy, swelling is considered to be normal in most women. This is caused by a change in blood volume and blood flow, allowing fluids to be trapped in the tissues around the extremities. But swelling in the first trimester, especially in the face and hands could be an indicator of preeclampsia (13). Always consult your doctor if in doubt about such things.
FAQs
1. How can women reduce the risk of early pregnancy problems?
Women can lower the risk of complications by eating a balanced diet, staying hydrated, taking prenatal vitamins, avoiding smoking and alcohol, managing stress, and attending regular prenatal checkups. Early medical guidance plays a key role in ensuring a healthy pregnancy for both mother and baby.
2. What are the signs of an unhealthy pregnancy in the first trimester?
Certain symptoms such as severe abdominal pain, persistent vomiting, high fever, heavy bleeding, dizziness, or sudden loss of pregnancy symptoms may indicate a problem during early pregnancy. While some discomfort is normal, any unusual or severe symptom should be discussed with a doctor immediately.
Pregnant women might face any number of discomforts ranging from slight dizziness to mild pelvic pain. Once past the 12 weeks mark, discomforts like nausea and vomiting will reduce or completely stop. Expectant mothers will now be asked to get scans and tests done in each trimester to rule out any other complication like Down’s syndrome in the foetus, preeclampsia, placenta previa, gestational diabetes, high blood pressure, or low amniotic fluid.
Bear in mind that although we have listed one too many 1st trimester pregnancy problems that mothers-to-be should watch out for, pregnancy is one of the most naturally beautiful phases in a woman’s life. There are many positives about being pregnant like hearing baby’s first heartbeat, feeling that first movement, the first kick, the glow and radiance of being pregnant, and the arrival of those tiny fingers and toes after 10 months. So, be watchful and heed any medical advice from your doctor but remember to relax and enjoy these months before your entire life becomes about your tiny tot.
Also Read:
Common Second Trimester Complications
Uterine Prolapse During Pregnancy
List of Pregnancy Problems and Their Solutions
Pregnancy Complications Every Woman Should Know
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Twin-to-twin Transfusion Syndrome – Stages, Causes, and Symptoms
TTTS (twin-to-twin transfusion syndrome) is an uncommon and dangerous illness that can develop during pregnancy. When identical twins share a placenta, the TTTS occurs (monochorionic). Abnormal blood vessels connections happen in the placenta. They allow for unequal blood flow between the fetuses – one of the twins, referred to as the donor, gets dehydrated, while the receiver, the other twin, gets excessive blood pressure. The recipient excretes an excessive amount of urine, overfilling the amniotic sac.
What Is Twin-to-twin Transfusion Syndrome (TTTS)?
The twin-to-twin transfusion syndrome (TTTS) is a disorder in which the fetuses share a placenta but are in two different amniotic sacs (monochorionic-diamniotic or “mono-di”). How common is twin to twin transfusion syndrome? It occurs in 10-15% of identical twin pregnancies. The placenta ordinarily maintains intricate blood flow networks that regulate blood flow via each fetus’ umbilical cord.
In TTTS, however, these networks have aberrant connections, disrupting the usual balance and resulting in low blood flow to one twin (donor) and excessive blood flow to the other (recipient). As a result, the donor twin suffers from low blood pressure, slow growth, and low amniotic fluid levels (oligohydramnios). On the other hand, the receiver twin develops normally, but the increased blood supply generates high blood pressure, which causes heart strain and high amounts of amniotic fluid (polyhydramnios).
If left untreated, TTTS can cause severe prematurity and substantial damage to the heart, brain, kidneys, and other organs in either twin. It can be lethal for one or both twins in the worst-case scenario.
Stages of Twin-to-twin Transfusion Syndrome
TTTS diagnosis is a staging method utilized to classify the condition’s severity. This technique, known as the Quintero staging system, aids in determining if an intervention is required and which treatment option(s) are most suited. Here is an explanation of the stages of twin to twin transfusion syndrome:
1. Stage 1
In the twin-to-twin transfusion syndrome stage 1, the ultrasound indicates an amniotic fluid imbalance surrounding the twins, but the donor twin’s bladder is still visible. The presence of the bladder suggests that the donor baby is receiving enough nutrients and fluid from the blood to make pee.
2. Stage 2
The 2nd stage is when the ultrasound reveals an amniotic fluid imbalance around the twins, but the donor twin’s bladder is not evident. This discovery suggests that the bladder is empty, indicating that the infant has finished producing pee.
3. Stage 3
In addition to the symptoms of Stages 1 and 2, in the twin to twin transfusion syndrome stage 3, the ultrasound reveals substantial irregularities in the flow of blood within the twins’ umbilical cords.
4. Stage 4
In addition to the symptoms of Stages I-III, the recipient twin exhibits evidence of cardiac failure (hydrops fetalis or extra fluid within the baby).
Causes of Twin-to-twin Transfusion Syndrome
During pregnancy, the placenta is an extremely busy organ that gives oxygen and nourishment to the baby. It develops alongside the newborns. Sometimes, the normal flow of blood in the placenta’s arteries adopts an aberrant pattern for unknown reasons. When two pregnant infants share a placenta, blood circulation can become imbalanced, with one baby receiving too much blood through the umbilical cord and the other receiving too little. This imbalance is what causes TTTS.
Symptoms of Twin-to-twin Transfusion Syndrome
Twins experiencing TTTS exhibit varying symptoms depending on whether they are donors or receivers:
1. Donor
Donor TTTS twins receive less placental blood and lose blood to the other twin. Donor twins are smaller than donor twins both before and after birth. They are pale and anemic, have lower fetal pee flow, and have smaller bladders than typical. If the twins have two amniotic sacs, the donor twin will have less amniotic fluid than the other twin (oligohydramnios).
2. Recipient
Recipient twins get an abnormally large amount of blood from the placenta and the other twin. These infants are bigger and have an abundance of amniotic fluid (polyhydramnios). Because these infants have so much blood in their bodies, their circulatory systems may become overburdened, resulting in cardiac difficulties.
Long-term Effects of Twin-to-twin Transfusion Syndrome
Twin-twin transfusion syndrome frequently results in preterm delivery. To avoid the risk factors of TTTS, Babies in this situation require care in a neonatal critical care unit.
The vast majority of newborns who are successfully treated for twin-twin transfusion syndrome go on to enjoy normal, healthy lives. Some people, however, encounter minor problems, such as anemia. This is a simple problem to solve. Brain damage and heart failure are more significant issues. If local experts are unavailable, Cincinnati Children’s specialists can assist by providing long-term, professional care for these children.
How Is Twin-to-twin Transfusion Syndrome Diagnosed?
Ultrasound confirms the diagnosis of twin to twin transfusion syndrome. When ultrasound pictures demonstrate that one child has an excess amniotic fluid and the other has much less, the problem is obvious. Blood-flow abnormalities in the umbilical cord may also be discovered. Furthermore, the mother’s uterus may grow more quickly than usual during pregnancy.
Because TTTS can progress quickly, women bearing twins who share a placenta should have regular ultrasounds to assess amniotic fluid quantities. Ultrasounds are typically conducted every two weeks, beginning at 16 weeks. During the third trimester, the frequency of ultrasounds rises.
How to Manage Twin-to-twin Transfusion Syndrome When Pregnant?
A maternal-fetal medicine specialist should monitor TTTS to identify if the stage is advancing. Progression may happen quickly, in a few days. To prevent twin to twin transfusion, some alternatives are:
1. Amnioreduction
This treatment drains extra fluid from the bigger twin, lowering amniotic pressure and lowering the risk of premature labor. Typically, fetoscopic laser photocoagulation is used.
2. Photocoagulation Using a Fetoscopic Laser
At roughly 16-26 weeks of gestation, surgeons utilize a laser to block the blood arteries that communicate between the two babies in cases with TTTS Stage 2 or higher. The surgeon inserts a pencil-tip-sized fiber-optic scope into the mother’s uterus and scans the whole placenta to detect the crossing blood vessels. Once all of these are mapped, a small laser fiber is implanted, and laser energy is used to block blood flow between the twins. Separating the blood flow of the twins is analogous to functionally separating the placenta, enabling each twin to grow independently.
3. Ultrasound Observation Using Frequent Ultrasounds
Although stage 1 instances may not necessitate intervention, it is critical to regularly monitor the twins’ growth to rule out advancement to stage 2 or beyond.
Treatment of Twin-to-twin Transfusion Syndrome
The stage of illness determines the appropriate treatment for TTTS. In most cases of TTTS (stages 1-4) that arise before 28 weeks, we advocate laser surgery since it tackles the underlying source of the disease – aberrant placental connections. If heart strain has not yet formed or the TTTS has evolved slowly after 26 weeks, a trial of observation with follow-up ultrasounds may be possible in the earliest stage I patients.
A fetal echocardiogram, sometimes known as a “fetal echo,” is a specialist ultrasound of the fetal heart that assesses cardiac strain. The fetal echo allows us to predict which individuals with stage 1 TTTS are likely to proceed to advanced stages of the illness during an observation period. Observation is not advised in these situations.
TTTS Treatment Before Birth
The key to treating twin to twin transfusion syndrome is early detection and management. The optimum treatment choice for your infants will be determined by the stage of the TTTS and the gestational age of your babies at the time of diagnosis. There are several possibilities available, including the following:
Amnioreduction: This is a technique that is performed to reduce extra fluid from the recipient twin’s amniotic sac. The operation is similar to amniocentesis in that the clinician guides a long, extremely tiny needle into the uterus to retrieve the fluid using “real-time” ultrasound pictures. This method may be recommended for Stage 1 TTTS or when TTTS is discovered later in pregnancy when fetoscopic laser photocoagulation (see below) is no longer a possibility.
Expectant Management: This entails close ultrasonography monitoring throughout the pregnancy. For most Stage 1 TTTS, we now prescribe expectant management.
Fetoscopic Laser Photocoagulation: A laser is used in this minimally invasive surgery to ablate (close) blood vessels that contribute to the infants’ aberrant blood flow (Figures 3-5). Many studies have shown that this treatment for twin-to-twin transfusion syndrome is the most beneficial for newborns with advanced TTTS.
Delivery: If TTTS is detected later in the pregnancy, having the infants delivered may be the best decision.
TTTS Treatment After Birth
If severe TTTS starts or worsens after 26 weeks of gestation, it is typically better to deliver early when the infants can survive outside the womb. The condition is automatically ended after they are born (since the twins are no longer attached). However, the consequences of the disease may not subside immediately. In most cases, they are best treated in the neonatal critical care unit shortly after delivery.
Even if the condition heals on its own (as it does in roughly 60% of early-stage TTTS patients) or if laser surgery is performed, most physicians still prefer to deliver the babies a few weeks before full term (at 36 to 37 weeks) to minimize future difficulties. Even after endoscopic laser surgery, a Cesarean section is not required unless obstetrical complications are prevalent in twin pregnancy.
TTTS is an uncommon condition that, when appropriately handled, leads to a successful pregnancy for most patients. Because of the illness’s low prevalence and peculiar physiology, most pregnant parents are ignorant of disease progression and prognosis. Now that you know more about it, stay vigilant and cooperate with your doctor to treat the condition properly.
Also Read:
Parasitic Twins
Fraternal Twins Facts
Vanishing Twin Syndrome
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Fenugreek (Methi) Seeds For Pregnant Women – Benefits & Side Effects
Fenugreek is a herb that is native to Asia and the Mediterranean region. Fenugreek seeds are used for cooking and medicinal purposes. They have a strong flavour, and when consumed in raw form, they taste bitter. But they offer various health benefits that people eat. Fenugreek seeds are consumed to treat digestive and respiratory issues and to strengthen the digestive system. These seeds are also known to treat menstrual problems and induce labour. But can you consume fenugreek leaves and seeds during pregnancy? What are its benefits, and how do you include fenugreek in your pregnancy diet? We will explore the answers to all these questions related to fenugreek and pregnancy in the article below.
Is It Safe to Consume Fenugreek(Methi) During Pregnancy?
Consuming fenugreek while pregnant is considered safe for women as long as it is consumed in moderate quantities. However, excessive intake could potentially result in premature uterine contractions. If taken just before delivery, fenugreek might cause a unique maple syrup-scented body odour in the newborn, although no lasting effects have been observed.
Nutritional Profile of Fenugreek Seeds
Following is the nutrient value of 100 g of fenugreek seeds:
Nutrient
Amount
Protein
23 g
Calories
323kcal
Carbohydrates
58.35g
Fiber
24.6g
Calcium
176mg
Benefits of Consuming Fenugreek Seeds During Pregnancy
Fenugreek is rich in anti-inflammatory properties and it offers essential minerals and vitamins that are required during pregnancy.
Here are some of the benefits of consuming fenugreek seeds during pregnancy.
Consuming fenugreek seeds during pregnancy acts as a natural combatant for gestational diabetes.
Breast enlargement is a common occurrence during pregnancy that causes breast tenderness and can be painful. However, consuming fenugreek seeds can help alleviate pain. Soak a few seeds overnight in water, strain the liquid in the morning and drink.
Fenugreek has been shown to relieve the pain associated with labour and it also helps lessen the duration of the contractions.
Consuming fenugreek during pregnancy can also help stabilise sugar levels.
Fenugreek is a natural fortifier for the immune system as well as a system cleanser. Eating fenugreek can help combat heart disease, lung disorder, influenza, and various allergies.
Side Effects of Consuming Fenugreek Seeds During Pregnancy
While consuming fenugreek can be beneficial for your health during pregnancy, it can pose certain risks to your health too. Some of the side effects that may arise on the consumption of fenugreek during pregnancy are stated below.
Fenugreek seeds are known to induce contractions, hence they can be consumed during labour. But you must avoid eating them before the 37th week as it could result in premature labour.
Consuming fenugreek seeds can cause bloating, gas, diarrhoea, and nausea.
Some people are naturally allergic to fenugreek. If you are one of them then you might experience reactions like swelling, nasal congestion, and wheezing.
Consumption of fenugreek seeds in excess amounts can lead to birth defects in the baby.
Consuming fenugreek seeds just before labour may cause the baby to have unusual body odour. However, this odour does not have any long-term effects on the baby’s health.
How Much Fenugreek Seeds Should You Eat During Pregnancy?
There are numerous ways in which fenugreek can help your body when you are pregnant, but you must include them in your diet in small quantities. Fenugreek seeds, when consumed in moderation can boost your immune system greatly. It can help prevent allergies and keep you healthy. It is also a great ingredient to help boost your metabolic rate. Here is how you can include them in your diet.
You can soak a teaspoon of the seeds in a glass of water overnight, then strain and drink the water in the morning. Alternatively, you can incorporate the same amount in your meals. Another option is to swallow the seeds with water as is. The effect of the seeds will be slower in this case. You must also remember that you can use fenugreek leaves in your diet. A fistful of clean leaves a day is the daily recommended amount you can consume. However, it is recommended that fenugreek seeds and leaves should be consumed in small quantities.
Tips to Include Fenugreek in Your Pregnancy Diet
Here are some ways in which you can include fenugreek or fenugreek seeds in your pregnancy diet.
While preparing food, particularly Indian food, be sure to add half a teaspoon of this spice in the tadka. This way your food becomes more flavourful while also giving you the benefits.
You can make curry with fenugreek leaves or methi. However, don’t make the food spicy. You can add some jaggery to tone down the bitterness.
Use the leaves along with spinach or lettuce to make a serving of salad every day. This will keep your stomach light and refreshed.
Soak a handful of fenugreek seeds in some water overnight, swallow the seeds, and drink the water for a hydrating and nutritionally rich start to the day.
Blend a handful of strawberries, chia seeds, honey, yoghurt, and fenugreek seeds for a power smoothie to help keep you energized throughout the day.
Soak the seeds in water overnight and use the water as a base for a soup the next day. Powder the soaked seeds and the powder to the broth, add veggies, meat, and seasoning and let it simmer. This can be a light dinner with an extremely high nutritional value.
Powder some fenugreek seeds and add the powder to a glass of watermelon juice. Squeeze some lime into it to make a mocktail that is tasty and energizing.
Mix flax seeds, fenugreek seeds, coriander powder, and turmeric in a glass of warm milk and drink. This can provide relief from a sore throat and cold.
Grate some ginger and garlic, mix it with a couple of teaspoons of water, put it on a simmer and mix till it reaches a paste-like consistency, add fenugreek seeds, chives, rosemary and thyme to create a unique barbeque marinade for meat or fish.
FAQs
1. Is It Safe to Drink Fenugreek Tea While Pregnant?
Yes, it is safe to consume tea made of fenugreek in pregnancy as it boosts lactation.
2. Does Fenugreek Interact With Prenatal Vitamins?
No, there is no proof that methi during pregnancy interacts with prenatal vitamins.
3. Can Fenugreek Lead to Miscarriage?
Excess consumption of fenugreek, especially during the third trimester, can sometimes lead to miscarriage.
Eating fenugreek during pregnancy first trimester, second trimester and third trimester can be beneficial for your health but it can even lead to certain complications, especially if you eat them before the 37th week of your pregnancy. Consuming the seeds or leaves in small quantities can strengthen your immune system and help prevent allergies, but you should consult your doctor before adding fenugreek seeds or leaves to your diet. If your doctor gives a go-ahead, you can add it to your diet but you must watch out for any signs of allergy. In case of an allergic reaction, contact your doctor right away. Consult a dietician for a better idea of how much fenugreek you may require on a regular basis and what nutritional requirements your body has in particular.
References/Resources:
1. Effect of Fenugreek on Milk Production; classic.clinicaltrials.gov; https://classic.clinicaltrials.gov/ct2/show/NCT00851591
2. Herbs and Pregnancy; americanpregnancy.org; https://americanpregnancy.org/healthy-pregnancy/is-it-safe/herbs-and-pregnancy/
3. Spices, fenugreek seed; fdc.nal.usda.gov; https://fdc.nal.usda.gov/fdc-app.html#/food-details/171324/nutrients
4. What to eat before, during and after pregnancy; UNICEF; https://www.unicef.org/rosa/stories/what-eat-during-and-after-pregnancy
5. Lisha J. John, Nisha Shantakumari; Herbal Medicines Use During Pregnancy: A Review from the Middle East; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561638/
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Sesame Seeds in Pregnancy
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