Posts Tagged ‘Birth’

Obstetric cholestasis during Pregnancy – Causes and Treatment

Cholestasis during pregnancy is a condition which affects the normal flow of bile in the gallbladder because of the large amount of pregnancy hormones. Cholestasis is more common in the last trimester of pregnancy when the hormones are at their peak, but this usually disappears within a few days after birth. Cholestasis means there is a reduction in the flow of bile through the bile ducts in the liver. Some bile then ‘leaks’ into the bloodstream, especially bile salts. They circulate in the bloodstream and can cause symptoms. Obstetric cholestasis is sometimes called intrahepatic cholestasis of pregnancy.

Causes:
Pregnancy hormones affect gallbladder function, resulting in slowing or stopping the flow of bile. The gallbladder produces bile in the liver, which is necessary in the breakdown of fats during digestion. When bile flow is stopped or slowed, it results in an accumulation of bile acids in the liver which can seep into the bloodstream. The exact cause is unclear. Hormonal and genetic factors may be responsible.

- Hormonal factors: Pregnancy causes an increase in the hormones estrogen and progestin. These may affect the liver in a way that slows down the bile that passes along the small bile ducts. Some pregnant women may be more sensitive to these effects of the hormone.
- Genetic factors: Obstetric cholestasis seems to run in some families (although it can skip several generations). One theory is that women who develop obstetric cholestasis may inherit a small problem with the way bile is made and passes through the bile ducts. It does not matter when one is not pregnant. However, the high level of hormones produced during pregnancy may ‘tip the balance due to a very low flow in the bile.

There may be some other environmental factors contributing to cholestasis. Within a week or so after birth, the symptoms disappear.

Treatment:
The goals of treating cholestasis during pregnancy are to relieve the itching. Some treatment options include:
- Topical anti-itch medications or with corticosteroids.
- Medications to reduce the concentration of bile acids such as ursodeoxycholic acid.
- The cold baths and cold water stop the flow of blood in the body by decreasing the temperature.
- Dexamethansone is a steroid that increases the maturity of the baby’s lungs.
- Vitamin K supplements are given to the mother before delivery and once the baby is born to prevent intracranial hemorrhage.
- Dandelion root and milk thistle are natural substances that are beneficial for the liver.
- Regular blood tests monitoring both the bile and serum liver function and informed about early delivery of the baby.

Ursodeoxycholic Acid
This is a naturally occurring bile acid and is used as a medicine. Strictly speaking, it is not licensed for pregnant women, but often prescribed. The logic is that taking this medication can help improve liver function and helps in reducing the level of bile acids in the blood. However, some doctors believe it helps, some small studies have found that it does not help. A current national standard of obstetric cholestasis states … “There is insufficient data to support the widespread use of ursodeoxycholic acid (UDCA) outside of clinical trials.”Therefore, treatment is being studied and can be used, but more research is needed to clarify whether it is useful or not.

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Spina bifida (“cleft spine”) – types, causes, symptoms, diagnosis, prevention and treatment

Spina bifida is a birth defect of the spine (backbone). Spine consists of spinal chord which is like a closed tube made up of nerves. Babies with spina bifida have an opening in the tube because it
has not completely closed. It happens during first month of pregnancy.
A spinal cord that’s damaged may not be able to do the important job of getting messages to and from the brain. These messages may not be able to get through if a person has spina bifida.

Different types of Spina Bifida
Every unborn baby’s spine is open when it first forms, but it normally closes by the 29th day following conception. In Spina Bifidas, the backbone never closes completely. There are four types of spina bifida:
- Occulta: In this, one or more vertebrae are malformed. The opening in the spine, is covered by a layer of skin.
- Closed neural tube defects: These are spinal defects in which the spinal cord is marked by a malformation of fat, bone, or membranes. It can cause incomplete paralysis with urinary and bowel dysfunction.
- Meningocele: The meninges protrude from the spinal opening, and the malformation may or may not be covered by a layer of skin.
- Myelomeningocele: The most severe condition and occurs when the spinal cord is exposed through the opening in the spine, resulting in partial or complete paralysis of the parts of the body below the spinal opening.

Causes of Spina bifida

- Folic acid deficiency.
- Genetics also seems to play a role.
- Spina bifida also can occur as part of a syndrome with other birth defects.

Symptoms of Spina Bifida

- Protrusion on the mid to lower back of the new born.
- Weakness of the hip, leg or feet of a newborn.
- Tuft of hair at the sacral area (back part of the pelvis) or dimpling of the sacrum.

Complications of Spina Bifida

Complications of spina bifida can range from minor physical problems to severe physical and mental disabilities. Severity is determined by the size and location of the malformation, whether or not skin covers it, whether or not spinal nerves protrude from it, and which spinal nerves are involved.
- Loss of sensation and paralysis, another neurological complication.
- A rare condition Chiari II malformation in which the brainstem and the cerebellum, or rear portion of the brain, protrude downward into the spinal canal or neck area. This condition can lead to compression of the spinal cord and cause a variety of symptoms including difficulties with feeding, swallowing, and breathing; choking; and arm stiffness.

Diagnosis of Spina Bifida

- A screening blood test, called an alphafetoprotein test (AFP), is done using the pregnant mother’s blood when she is about 15-17 weeks into the pregnancy.
- If the results are abnormal, a detailed (Level II) ultrasound is done which can show the presence of spina bifida.
- An amniocentesis (sampling of the amniotic fluid in the womb) may be done to recheck the AFP level or do other tests.

Prevention of Spina Bifida

- Folic acid can help prevent spina bifida before your baby is born.
- Women should realize that it is important that they consume the vitamin every day, whether they are planning a pregnancy or not.

Treatment of Spina Bifida

There is no cure for SB because the nerve tissue cannot be replaced or repaired.
- Treatment for the variety of effects of SB may include surgery, medication, and physiotherapy.
- The opening in the spine can be closed surgically either before or after birth, and this will reduce its effects on the body.

Cervical cancer and Pregnancy

Pregnancy and cervical cancer can be categorized under two categories for a better understanding. Cancer occurs in approximately one out of every 1,000 pregnancies. However, pregnancy itself does not cause cancer, and pregnant women are not more likely to get cancer than other women.
- Being pregnant when you are diagnosed.
- Pregnancy after treatment for cervical cancer.

If your cancer is a very early cancer, such as stage IA, then most doctors believe that it is safe to continue the pregnancy to term. Several weeks after delivery, a hysterectomy or a cone biopsy is recommended. If the cancer is stage IB, then you and your doctor must decide whether to continue the pregnancy.
There are several conditions which need to be met before a woman considers pregnancy. If all of these conditions are not met, then the risk is too great that the cancer could reoccur :
- The cancer cells must be confined to only the cervix.
- The cancer was less than 3 mm deep into the tissues of the cervix.
- The affected area was no larger than 10 mm across at any point.
- There is no sign of cancer in the blood vessels, lymphatic vessels or
lymph gland.
If the patient was treated with radiation therapy then most likely the patient is now infertile and pregnancy is not an option. Surgery, of course, removes the uterus which prevents pregnancies from forming.

However, there is a way in which a woman can get pregnant.
A woman who opted for a radical trachelectomy still has part of her cervix intact. It removes cancer cells but leaves enough of the cervix to support a pregnancy. The doctor will stitch around the opening to hold it closed. This procedure significantly increases the risk of miscarriages and premature births because the cervix often is unable to support the weight from the pregnancy. This procedure requires the baby to be born by Caesarean section.