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Placenta Previa: All You Need To Know

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There’s so much to discover while expecting your little one; from your baby bump to the placenta and even your baby’s milestones. In fact, as you progress on this journey, you’d realize that every pregnancy is unique.

In this article, you’d discover everything you need to know about an important medical condition, called placenta previa, which affects the placenta during pregnancy.

Table of contents

What is Placenta Previa?

Placenta previa is a medical condition that occurs in a pregnant woman when the placenta blocks the cervix (opening into the birth canal), thereby obstructing the path that the baby should come out from.

In normal conditions, the placenta is attached to the top of the uterus. This way, it can serve as a safe passageway of substances to and from the baby. However, in placenta previa the placenta covers the cervix, causing serious bleeding from the vagina.

Placenta Previa types

Placenta Previa Symptoms

The most common symptom of placenta previa is bleeding.

In fact, 5 in 10 women with placenta previa experience light to heavy bleeding at some point. Medical experts agree that any bleeding during pregnancy may be associated with problems with the placenta. Whenever this bleeding occurs in the second trimester of pregnancy, it may be a symptom of placenta previa.

placenta previa

In most cases, the bleeding is painless, and it can be light, or heavy.

Some women also complain of tightness or cramps due to increased contractions or pressure on their backs while managing placenta previa.

What Are The Types of Placenta Previa?

Depending on the location of the placenta, placenta previa is grouped into:

  • Complete: This occurs when the placenta completely covers the cervix. When this happens, every part of the cervical opening is blocked or covered by the placenta
  • Partial: In this instance, the placenta only partially covers the cervix. That is, only a part of the cervix is covered by the placenta.
  • Marginal: This occurs when the placenta is located adjacent to the cervix, but not completely covering it. In fact, scans show that the placenta lies adjacent to the cervical opening

Risk Factors for Placenta Previa

Some of the factors that predispose a woman to placenta previa are:

  • Maternal age greater than 35 years
  • Multiple gestation
  • Cigarette smoking or use of cocaine
  • Number of previous deliveries
  • A previous history of any of the following:
    • C-section delivery
    • Placenta previa
    • Any surgical procedure involving the uterus

What Causes Placenta Previa?

In most cases, the factors that predispose a woman to placenta previa are either uterine or placental.

The Uterine Factors

With the uterine factors, there’s an underlying abnormality in the uterus. This causes scarring in the upper parts of the uterus, making it quite ‘uncomfortable’ for the placenta to be situated there.

These factors include:

  • Previous C-section.
  • Instrumentation of the uterine cavity (like D&C procedures for induced abortions or miscarriages).
  • Any previous surgical process involving the uterus.

The Placental Factors

In this instance, the causal factors make the placenta increase in size to compensate for reduced function. When this happens, a larger placenta increases the risk of developing placenta previa during pregnancy.

Some of these placental factors include:

  • Multiple gestation (i.e. pregnant with more than one baby at a time).
  • Living at high altitudes (the oxygen available at high altitude is low, hence, the placenta does more work delivering oxygen to the fetus).
  • Smoking

Diagnosing Placenta Previa

Thankfully, this condition is diagnosed easily during an ultrasound scan. Most times, this occurs during your routine antenatal clinic visit or doctor’s appointment.

How to diagnose placenta previa

In other cases, medical experts can make a diagnosis of placenta previa whenever a woman complains of any of the symptoms mentioned in this article.

During your antenatal clinic, your doctor would use an ultrasound machine to observe your little one (and the placenta). With this, he/she can see the exact location of your placenta and determine if you have placenta previa.

In women who are experiencing the symptoms of placenta previa like bleeding, it is really important to conduct an ultrasound scan before a physical examination to prevent further bleeding.

How To Treat Placenta Previa

There is no drug that cures placenta previa. However, the condition is managed with proper medical care.

In most cases, the goal of treatment or management is to limit bleeding in order to help you get closer to your due date safely. To achieve this, your doctor may prescribe drugs that prevent premature labor. With these drugs, the contractions that cause bleeding are greatly reduced.

placenta previa

To further reduce the symptoms, you may also get a corticosteroid prescription which helps your baby develop faster, even if he/she is not up to term. Eventually, your doctor would schedule a C-section when your baby is safe enough to join you in this world.

However, if the bleeding is heavy and incessant, an emergency C-section would be scheduled even if the baby is not up to term.

Furthermore, the treatment option for placenta previa depends on:

1. The Volume of Blood Loss.

If the bleeding is light, you’d be placed on bed rest and restricted from sex during this period and heavy exercise. However, if the bleeding is heavy, you may be given a blood transfusion to make up for the blood loss.

2. Your Expected Delivery Date

The closer you are to your due date, the better. This is because your baby will have a greater chance of survival, even if you have to undergo an emergency C-section.

3. The Position of The Placenta & The Baby

During pregnancy, positions are really important.

The position of the placenta and your baby would determine the method of treatment because your doctors would consider the best possible option for your and your little one before making any decision.

Complications of placenta previa

Sadly, placenta previa may become worse as the pregnancy progresses. In fact, it may result in life-threatening conditions for the mother and the baby.

Placenta previa complications for the mother

In some cases, placenta previa may present with other placental or umbilical cord conditions. This can eventually cause growth retardation or breech presentation of the baby.

Placenta previa bleeding also increases the risk for preterm premature rupture of membranes (PPROM), which can lead to premature labor.

In other instances, placenta previa may cause placenta accreta; a condition that occurs when the placenta grows too deeply into the uterus. When this happens, it becomes very difficult to separate the placenta from the uterus during delivery.

Sadly, placenta accreta is life-threatening and may require surgical removal of the uterus (hysterectomy) during a C-section.

Placenta previa complications for the baby

In babies, placenta previa may cause any of the following conditions that lead to premature birth:

  • Low birth weight: resulting from reduce nutrient supply.
  • Fetal breathing problems: due to reduced oxygen supply.
  • Birth Injuries like Cerebral Palsy.

Conclusion

Finally, it is important to remember that attending regular ante-natal clinics would help your doctor identify any of the symptoms or possible causes of placenta previa.

Also, if you notice any of the symptoms mentioned in this post, please contact your doctor ASAP.

We are here for you, Mama.

References

Shobeiri, F., Jenabi, E., Karami, M., and Karimi, S. (2017). Determinants of placenta previa: a case-control study. Biomedical Research and Therapy, 4(06), 1411-1419. Accessed on 25th September, 2021 from https://doi.org/10.15419/bmrat.v4i06.182

Rao J , Fan D , Zhou Z, Luo X, Ma H , Wan Y, Shen X, Lin D , Zhang H, Liu Y and Liu Z (2021). Maternal and Neonatal Outcomes of Placenta Previa with and without Coverage of a Uterine Scar: A Retrospective Cohort Study in a Tertiary Hospital. International Journal of Women’s Health. Volume 2021:13 Pages 671—681. Accessed on 25th September, 2021 from https://doi.org/10.2147/IJWH.S310097

Jing L, Wei G, Mengfan S and Yanyan H (2018). Effect of site of placentation on pregnancy outcomes in patients with placenta previa. PLOS ONE 13(7): e0200252. Accessed on 25th September, 2021 from https://doi.org/10.1371/journal.pone.0200252

Singleton Pregnancy: All You Need To Know

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Each pregnancy is unique for every woman; from the symptoms to the duration, and even the number of growing babies. Although it is less common, it is possible to have more than one baby growing in your uterus at the same time. In this article, we’d walk you through the commoner alternative; a singleton pregnancy.  

Read on to learn more.

Table of contents

What’s A Singleton Pregnancy?

In plain terms, a singleton pregnancy means being pregnant with only one baby at a time. It is the direct opposite of a multiple pregnancy, which occurs when a woman is expecting more than one baby in the same pregnancy.

A woman with a singleton pregnancy

Are Singleton Pregnancies More Common?

Yes.

Medical studies show that singleton pregnancies are more common than multiple pregnancies. In fact, the American Pregnancy Association postulates that there are only about 32.6 multiples per 1,000 births per year in the United States.

This means that you’re 96.74% more likely to have a singleton pregnancy.

However, it is important to remember that any of the following factors can increase the possibility of having a multiple pregnancy:

  • Age
  • Genes
  • Fertility Treatments

Antenatal Care for Singleton Pregnancies

Proper antenatal care is an important part of pregnancy, even for singleton pregnancies.

This is a form of essential healthcare with the ultimate aim of ensuring a healthy pregnancy, labor, and delivery for both mother and child.

Regular antenatal clinics would help your doctor monitor your pregnancy, identify potential complications, and guide you to a healthy delivery.

A singleton pregnancy doctor with nylon gloves

During your singleton pregnancy, your antenatal care may include:

  • Routine Blood Tests: to check for anemia, HIV, blood type, genotype, hormonal fluctuations and other blood-related factors during pregnancy.
  • Blood Pressure Checks: This is very important to reduce the possibility of high blood pressure or preeclampsia during pregnancy.
  • Ultrasound Scans: to monitor your baby’s growth and heart rate
  • Weight Measurement
  • Dietary Advice

Your doctor may even recommend special breastfeeding or baby care classes that would teach you how to breastfeed and care for your little one effectively.

Postpartum Care for Singleton Pregnancies

Although most of the hype is usually about antenatal care and staying healthy in all the stages of pregnancy, postpartum care is also very important.

In most cases the postpartum period lasts for about 6 to 8 weeks, starting from the day your little one is born.

During this period, most women undergo a lot of physical and emotional changes as they learn to care for the newborn.

Proper postpartum care after a singleton pregnancy includes:

1. Proper Rest

Rest is super important for all new moms. With the right amount of rest, your body gets all it needs to return to its pre-pregnancy state. Getting enough rest also helps to keep your skin firm and healthy after pregnancy.

After a singleton pregnancy, you can get enough rest by:

  • Sleeping when your baby sleeps
  • Reducing your caffeine intake
  • Eating well
  • Receiving help from friends and family

2. Healthy Diets

A healthy diet is very important for every new mom.

In addition to providing your little one with all he/she needs for a healthy life, a healthy diet would strengthen you and help your body heal faster.

As you recover from the rigors of pregnancy, you can follow a diet that is rich in:

  • Fluids
  • Vegetables
  • Fruits
  • Protein
  • Healthy Fat

3. Proper Vaginal Care

Vaginal care is another essential part of postpartum care after a singleton pregnancy. If you’re experiencing any form of vaginal soreness, urination problems, vaginal discharge, or postpartum cramps, please visit your doctor for a proper diagnosis and treatment.

Differences between Singleton and Multiple Pregnancies

1. A Smaller Bump

Although most moms-to-be may not notice this, one of the major differences between a singleton and twin pregnancy is the size of your baby bump.

Some experts agree that a singleton baby bump may be about 20% smaller than a multiple pregnancy belly. Thankfully, a lighter (or smaller) baby bump is less stressful for the uterus and mother.

2. Reduced Fatigue

Here’s the fact: more babies come with increased demands on your body and mind.

Although fatigue is one of the earliest signs of pregnancy, women with singleton pregnancies usually don’t have to deal with as much fatigue as moms with multiples.

This may be a function of hormonal fluctuations, increased urination, and sleep interruptions during pregnancy.

To reduce the severity of fatigue during pregnancy, you can:

  • Drink less caffeine
  • Eat healthy
  • Move your bedtime earlier

3. Reduced HcG Levels

Human Chorionic Gonadotropin (hCG) is an important pregnancy hormone which forms the basis of pregnancy tests. In fact, home pregnancy test kits are specially designed to detect this hormone in your urine to confirm pregnancy.

If you’re trying to conceive or undergoing fertility treatment, your doctor may conduct some blood tests to establish your average hCG level. After this, he/she will continue to monitor your numbers for any drastic changes.

In 2018, a research study showed that women pregnant with singletons may have lower hCG baseline levels than those pregnant with multiples.

4. Single Heartbeat

With a fetal doppler, it is possible to hear your baby’s heartbeat as early as the 8th or 9th week of pregnancy.

A singleton pregnancy due date calculator

In a multiple pregnancy, the doctor may detect a second heartbeat and schedule an ultrasound scan to get a clearer picture. However, this is not the case with a singleton pregnancy.

5. Reduced Weight Gain

Weight gain is a common concern for most moms-to-be.

A singleton pregnancy reduce weight gain

Although this difference may not become obvious till the later stages of pregnancy, women with singleton pregnancies usually don’t add as much weight as those with multiple pregnancies.

In addition to the changes listed above, studies show that women with singleton pregnancies tend to get to term and have vaginal deliveries a lot more than those with multiple pregnancies.

Conclusion

Every pregnancy, whether singleton or multiple, is an exciting and unique process. Although it comes with some changes and risks, it is important to focus on your health and seek proper antenatal care during pregnancy.

It is also essential to note that the early signs of pregnancy may not confirm whether or not you have a singleton, however, proper prenatal tests can.

If you have any concerns or worries about your pregnancy, please contact your healthcare provider.

We are always here to help you.

References

Stages of Pregnancy and Prenatal Development

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You may have heard the popular saying: ‘Life occurs in stages’. Well, this is true; even for your pregnancy and your baby. For most women, pregnancy is an exciting time marked by preparation, purchases, and changes. The fact is: your baby experiences a lot of prenatal changes as he/she prepares to meet you for the first time. This article contains info about the stages of pregnancy and prenatal development.

In this article, we’d talk about the changes that come with prenatal development; the stages, duration, major events, and results.

Read on to learn more!

Table of contents:

What Is Prenatal Development?

In plain terms, prenatal development refers to the growth process that your baby experiences before he/she is born. Prenatal development spans from conception (the fertilization of an egg by a sperm) to the birth of your precious one.

stages of pregnancy

Generally, it refers to the process of life development from a single cell to an embryo and eventually, a fetus. Like every other life event, prenatal development occurs in stages.

As usual, we’re here to supply all the info you need.

What Are The Stages of Pregnancy and Prenatal Development?

Averagely, it takes about 40 weeks for a baby to fully mature. This begins from conception to delivery. Just like pregnancy, prenatal development occurs in three major stages. These stages are:

  • Germinal Stage
  • Embryonic Stage
  • Fetal Stage

At the completion of all three stages of development, your baby should be ready to join you in this world. Furthermore, prenatal development is also organized into three (1st, 2nd & 3rd) trimesters, which do not correspond with the three stages.

Next, we’d discuss each stage of prenatal development; the major events, duration, and how it relates to trimesters of pregnancy.

stages of pregnancy

1. The Germinal Stage (2 Weeks)

As we mentioned earlier, prenatal development begins at conception when the female egg (oocyte) is fertilized by a mature male sperm. The germinal stage of prenatal development begins at conception and lasts for about two weeks, just after implantation occurs.

At the beginning of the germinal stage, your baby is just a tiny, one-cell zygote formed by the fusion of your egg and a mature sperm. Once the major events of this stage are completed, the zygote becomes an embryo and the next stage of development begins:

The major events of the germinal stage include:

  • Sex Determination: This occurs at the point of fertilization when parental DNA combines to constitute a brand new DNA set that is your baby’s.
  • Cell Division (Mitosis): In the first week of the germinal stage, the zygote rapidly divides into multiple cells that serve as the foundation for cellular development even after birth.
  • Attachment (Implantation): As cell division progresses, the zygote travels down your fallopian tubes and attaches (implants) to the uterine lining where it eventually embeds.

2. The Embryonic Stage (6 Weeks)

The embryonic stage begins at implantation (in the second week) and extends to the 8th week of pregnancy. During implantation, your body begins to produce and secrete pregnancy hormones. It is at this point that you’d probably have a positive pregnancy test result. read our other article on positive signs of embryo transfer

Upon implantation, pregnancy hormones are secreted, blood vessels grow, the placenta is formed and the zygote becomes an embryo.

The major events of the embryonic stage include:

  • Formation of The Three Cell Layers: These cell layers are the Ectoderm (outer layer), Mesoderm (middle layer) and Endoderm (inner layer). As prenatal development proceeds, these cell layers differentiate into the various tissues and organs in your baby’s body.
  • Commencement of Systemic Development: In the embryonic period, your baby’s brain, heart, blood vessels, spinal cord, and digestive system would begin to develop from their precursor cells.
  • Limb Development: Who doesn’t like those cute, sturdy legs babies have? Well, we do too. As the body system develops, the embryo also begins to grow hands, feet, and digits.
  • Commencement of Organic Development: At this stage, major organs like the eyes, nose, kidneys, and lungs also begin to develop in rapid succession.

Want to know the best part?

When the embryonic stage of prenatal development ends, all essential internal and external structures have been formed. In addition, your little one is now referred to as a fetus.

3. The Fetal Stage (32 Weeks)

No doubt, this is the most dramatic stage of prenatal development. In the fetal stage, your baby undergoes rapid changes in size, shape, features, and mental ability. At the beginning of this period; the fetus, which is about the size of a kidney bean, begins to assume the form of an actual human baby.

induced labor

The fetal stage is also the longest stage of prenatal development. This is because the growing fetus undergoes more changes at this point than anywhere else in prenatal life.

The major events of the fetal stage include:

  • Physical Growth: At the beginning of the fetal stage, your baby weighs only about 3 grams. By the time he/she is ready to come into your arms at birth, he or she may weigh up to 3.2 kilograms. Therefore, the fetal stage is also called the period of major physical development.
  • Fetal Movements Begin: A very important feature of the fetal stage is the commencement of fetal movement. As an expectant mom, this is when you begin to feel the ‘kicks’.
  • Development of Physical Features: At this point, important physical features like nails, eyebrows, and eyelashes are formed.
  • Breathing Movements Begin: Although the lungs do not become fully functional until your baby takes his/her first breath at birth, breathing movements begin in the fetal stage.
  • Full Organ Function: At the end of this developmental stage, all organs and systems are expected to be fully functional for life outside the womb.

At the end of the fetal stage of prenatal development, your child is ready to be born and come into your loving arms.

Stages of Pregnancy

As we mentioned earlier, pregnancy occurs in three distinct stages. This include:

  • First Trimester (0-13 Weeks)
  • Second Trimester (12-26 Weeks)
  • Third Trimester (26-40 Weeks)

First Trimester (0-13 Weeks)

This stage of pregnancy doubles as the most crucial stage of prenatal development. As we mentioned above, this trimester matches with the Germinal and Embryonic stages of prenatal growth. For most women, this stage comes with a variety of pregnancy symptoms like nausea, tiredness, breast tenderness, and frequent urination.

Second Trimester (13-26 Weeks)

This stage of pregnancy is widely regarded as the easiest part of the entire journey. This is because most women no longer feel those weird pregnancy symptoms. However, this trimester may come with new feelings of abdominal cramps, back pain, and constipation.

Third Trimester (26-40 Weeks)

Now, here’s the final stretch of the entire pregnancy journey. In this period, your uterus would grow to almost double its pre-pregnancy size. As a result, it is really important to attend your antenatal clinics and stay on a healthy diet and exercise routine.

Problems in Prenatal Development

Sadly, there is no perfect process. Problems may arise at any point in prenatal life. Thankfully, medical science has made great strides in prenatal diagnosis and maternal care to reduce the risk and impact of these problems.

Generally, problems of prenatal development are called congenital anomalies. These anomalies may result from genetic, infectious, nutritional, or environmental factors.

Congenital Anomalies

Congenital anomalies are ‘birth defects’.

These are unusual or unexpected problems that can occur at any of the three stages of prenatal development and result in physical malformations that affect different parts of a child’s body after birth. In other instances, congenital anomalies may cause developmental delays which prevent a child from achieving expected growth milestones.

Common examples of congenital anomalies include:

  • Down Syndrome: This genetic problem occurs when there’s an extra chromosome in a baby’s DNA set. Children with Down Syndrome often have intellectual disability, flat nasal bridges, a single palmar crease, as well as other distinct features.
  • Heart Defects: This refers to any problem in the prenatal development of the heart. Some examples of common heart defects are Ventricular Septal Defect, Tetralogy of Fallot and Patent Ductus Arteriosus.
  • Neural Tube Defects (NTDs): These are birth defects of the brain, spine, or spinal cord. Most times, these defects occur even before the mother realizes that she is pregnant. Two of the most common types of NTDs are Spinal Bifida and Anencephaly.

Thankfully, advances in medical science have made it possible to identify and manage these congenital anomalies. However, prevention is always better (and easier) than treatment.

You can prevent congenital anomalies by:

  • Attending regular antenatal clinics
  • Sticking to your antenatal medication religiously
  • Maintaining a healthy lifestyle
  • Following a healthy diet that’s rich in folic acid

With these tips, we are confident that you and your little one would be healthy, strong, and happy always.

Bottom Line

In conclusion, the three stages of prenatal development are unique but equally important. As you expect your little one(s), it is also important to take care of yourself. Remember to attend your clinics, eat right, exercise often, and rest well.

You and your baby are going to be just fine, Mama!

REFERENCES

Our Motivation

“The prospect of making a difference in people’s lives has always given me a thrill. Call it a God complex, I call it a vocation.”  

open table discusson

Photo Credit: Tolu the Midwife

The Edie and Amy Company was founded in 2017 by Dr. Ijeoma Ejekam Idaresit, to help mums navigate the challenges they face after childbirth and during breastfeeding. While receiving antenatal care as a new mother, she realized that neither her professional training nor the way information and tools were passed across were enough to prepare her for the challenges she faced on her own pregnancy, childbirth, and breastfeeding journey. 

Inspired to address this gap, Dr. Ijeoma Ejekam Idaresit established Edie and Amy, a maternal focused online media and product organization. Edie and Amy Co. provides information and products for mums and mums-to-be on getting pregnant, early signs of pregnancy, what to expect during pregnancy, childbirth and early childhood development for parents and expecting mothers, with a strong focus on the mother’s well-being.

With a Masters’ degree in public health specialized in Health Systems Strengthening, a well-known dedication to the consistent delivery of quality, and driven by the desire to help mothers, Dr. Ijeoma grew the company to become a trusted source of accurate health information presented in a relatable and interesting format, reaching over 12,000 mothers monthly through this website and other social media platforms. 

edie and amy representatives

Photo Credit: Dr. Onyedikachi Ekwerike, PSNAfrica Founder

In addition, Edie and Amy executes public health initiatives in partnership with NGOs, faith-based organizations and government agencies to provide support and mother care products in local communities. 

Dr. Ijeoma Idaresit was passionate about providing much-needed mental health support to mothers. She actively promoted this cause as the Conference Director of the Postpartum Support Network Africa (PSNAfrica). Kind, hardworking, supportive, selfless, caring, a loving mother and wife, and a firm believer that if anything was worth doing, it was worth doing excellently; these are the things that best describe her. 

The Edie and Amy company is dedicated to continuing the legacy, vision and passion of Dr Ijeoma Idaresit and her children Edidiong and Risachi. 

Second Month of Pregnancy

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Pregnancy is new ground for most women and can even be scary without the right information at your fingertips to guide you through. So, breaking down the period of pregnancy into nine months, we would go through all the changes we can expect to see in you and the baby. We would also see the best care tips for you and the baby.

Size of pregnancy of two monthsbaby
At this point, the baby is as big as one of these seeds.

What’s going with the baby?

By now, the baby’s neural tube is fully formed. Your baby’s face is also slowly being formed. The baby’s fingers and toes would have slowly started forming. By the end of the 2nd month, your baby would be called a foetus by the doctors and would be the same size as an agbalumo seed. So, sadly, there is still no baby bump to show off.

What should I expect to see physically?

In the second month of pregnancy, you might have nausea (or feeling like you want to vomit), popularly known as early morning sickness. Be warned though, this nausea can be all day round. While it is commoner in the first trimester of pregnancy, if it persists, you can use vitamin B6 tablets and ration your meals into small quantities. You might also have a heightened sense of smell, which would trigger nausea and the early morning sickness. You might be feeling constipated. This is also normal as your body starts to adjust to the demands of pregnancy.

As your hormonal levels fluctuate, you might also have some mood swings and breakouts of pimples. These are perfectly normal, but please consult with your doctor before using any drugs. You might be easily fatigued as your body uses up energy in preparing for the baby’s growth. Please talk to your doctor to get a diet that is optimum for you and the baby.
You might also feel like urinating more often. This is as a result of the HCG hormone directing more blood flow to the uterus to aid the baby’s growth. As the uterus grows in size, it would increasingly put pressure on the bladder and cause more urination. You might also have some pain or tenderness in your breasts. This is as a result of your body preparing for the breastfeeding phase by causing the growth of the milk ducts.

How do I take care of myself during the second month of pregnancy?

You should be preparing for your first antenatal visit to the doctor. If the early morning sickness persists, please book a visit to the physician for the next line of action.

References

Cleveland Clinic; 2/06/2020; https://my.clevelandclinic.org/health/articles/7247-fetal-development-stages-of-grow

The Bump; 2/6/2020; www.thebump.com/pregnancy-week-by-week/

Managing Postpartum Hypertension

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High blood pressure is quite normal during pregnancy. In fact, it’s the most common medical problem in pregnancy. Sometimes, this rise in blood pressure remains after childbirth, causing postpartum hypertension.

Immediately after childbirth, blood pressure drops but may tend to rise again in the first five days after delivery. In addition, women with normal blood pressures during pregnancy may also experience brief hypertension in the early days of motherhood.

What is Postpartum Hypertension?

Postpartum hypertension occurs when blood pressure values of 140/90mmHg and above are observed on more than two occasions within a four-hour window after childbirth.

Severe hypertension is defined as a systolic blood pressure of 160 mmHg or more and/or diastolic blood pressure of 110 mmHg or more on 2 or more occasions repeated within a short period of time (minutes).

Causes of Postpartum Hypertension

There is no specific cause of hypertension after pregnancy. But the following may put a woman at risk of having postpartum hypertension:

  1. High blood pressure during pregnancy : A woman is at risk of postpartum hypertension if she had high blood pressure during pregnancy. High blood pressure before pregnancy also puts a woman at risk of developing hypertension after childbirth.
  2. Pre-eclampsia: A condition characterized by high blood pressure and the presence of 3proteins in the urine during pregnancy.
  3. Obesity: Obese women are at a higher risk of developing postpartum hypertension.
  4. Birth of multiples also puts a woman at risk for postpartum hypertension.
  5. Diabetes: Having diabetes increases your chances of developing hypertension after childbirth.

What Are The Symptoms?

  1. High blood pressure of 140/90 mmHg or more
  2. Proteinuria (excess protein in urine)
  3. Decreased volume and frequency of urination
  4. Severe headache
  5. Pain in the upper abdomen (usually beneath the ribs on the right side)

Management of Postpartum Hypertension

A wider variety of antihypertensive agents are available for managing hypertension after childbirth compared with the antenatal period. This is because the effect of a baby’s presence on his/her mother’s system ends at birth.

Whenever a new mum has a personal or family history of hypertension, reduced levels of blood potassium, and other related conditions, her doctors would have to monitor her blood pressure closely.

The best kind of antihypertensive drug to use after childbirth is one that will:

  • Effectively control blood pressure.
  • Cause minimal side effects.
  • Have no negative effect on babies with breastfeeding mothers.

The following are antihypertensive drugs with no known adverse effects on babies receiving breast milk:

  • Labetalol and Atenolol

Both are beta-blockers. Asthmatic women and mothers with a history of heart problems should avoid this drug.

Treatment

Atenolol requires only a single dose per day, putting it at an advantage over others since it increases compliance in women who find multiple doses difficult.

  • Nifedipine

This is a Calcium channel blocker that functions by reducing the diameter of blood vessels. In addition, it doesn’t really seep into breast milk.

With a doctor’s approval, Nifedipine can initially be prescribed at a dose of 10–20 mg twice daily. However, once control is established, the daily dose can be converted to 30-60mg.

Other anti-hypertensive drugs include:

  • Enalapril
  • Captopril
  • Metoprolol

The first-line agent is Atenolol in combination with Nifedipine. Nevertheless, if the mother wishes to breastfeed her baby, diuretics are usually avoided because of the increased thirst it causes. Because of the risk of postnatal depression, sedation, and postural hypotension, Methyldopa should be avoided after childbirth.

In Conclusion

Early detection and management of postpartum hypertension is essential to prevent further complications. In addition to this, hypertensive mothers should follow the doctor’s prescription and advice religiously.

Finally, you should avoid over-the-counter drugs at all times.

REFERENCES

CAN I HAVE A VAGINAL BIRTH AFTER C-SECTION? HOW?

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Ngozi dreaded the possibility of another C-section. Although the last one was successful, she desperately wanted a vaginal birth this time. In addition, she considered one surgery to be more than enough.

There are two major means of giving birth in today’s world. The more common one is the vaginal birth. This involves the mother pushing out the baby from the uterus through the vagina.

The Caesarean method (C/S) involves the doctor making a cut in the belly and uterus and the baby is delivered via this means. Under certain conditions, the doctor may recommend you having a C/S instead of a vaginal birth.

Quite a number of women, like Ngozi, prefer a vaginal birth for their next pregnancy after Caesarean Section (VBAC). Thankfully, this is acheivable.

According to a study done in the United States, seven out of ten women who opted for a vaginal delivery after a C/S had successful deliveries.

As usual, we’re here to guide you and supply all the relevant info you need on this journey.

What is VBAC?

VBAC stands for Vaginal Birth After Caesarean. It is a term that connotes having a vaginal birth (delivery) after a previous delivery through a Caesarean section.

VBAC is not right for everyone though. Some factors put some women at risk of some complications if they go for VBAC. The first step in the VBAC process is a meeting with your doctor to determine the possibility of it working out.

Things To Consider Before Opting For A VBAC

1. The Incision

This refers to the type of incision (cut) made on your uterus (womb) during the previous C-section. It is important to note that this incision differs from the one made on your skin during the procedure.

The direction of cut made on your uterus largely determines the possibility of a VBAC. If you had a transverse incision (a side-to-side cut) across the lower, thinner part of your womb, you’re more likely to have a successful VBAC.

2. Number of Previous C-sections

This follows a simple rule; The more C-sections you’ve had, the lower the chances of a successful VBAC.

3. Health Factors

Sometimes, medical tests reveal that a vaginal birth may be risky for you and your baby. Examples include whether you are obese, have pre-eclampsia. As a result, your doctor may insist on another C-section.

4. Number of Developing Babies

Here’s another simple rule; The more the babies, the more the push.

Delivering multiple babies can cause an obvious strain, making the vaginal birth process more difficult. Therefore, a woman carrying multiple pregnancies following a C-section birth may have to undergo another C-section.

5. Your Baby’s Weight

The larger your baby, the least likely a VBAC will be successful and thus it may not be offered.

What Are The Benefits Of VBAC?

1. No surgery.

This is definitely a big relief to most women. A vaginal birth after C-section simply means that no cut will be made on your body.

2. Shorter Recovery Time.

In clear terms, the recovery process for a vaginal birth is shorter than what is required after a C-section. This affords you more time to spend with your little one and loved ones.

3. Lower risk of infection.

With vaginal delivery, you’re at a lower risk of contracting any infection.

4. Minimal blood loss.

Thankfully, blood loss in a vaginal delivery is minimal compared to a C-section.

What Are The Risks?

  1. Uterine Rupture: During the process of labour after a previous C-section birth, the womb faces a small risk of tear. This arises as a result of unhealed cuts or high-risk incisions. However, this is a rare occurrence.
  2. A Possible Return To C-section: During a vaginal birth, unplanned situations may force your doctors to fall back to a C-section in order to preserve both lives (You & Your Baby).

How Can You Prepare for a VBAC?

First things first! Consult with your doctor at the first antenatal visit after the previous C-section to know if a VBAC is possible.

Ensure that your doctor has your complete medical history. This will enable your doctor make the best decision in your interest. You will only be allowed to go into spontaneous labour. Your health team will be on standby for an emergency Caesarean section. They will monitor your progress in labour carefully, no medication to make the womb contract or induce labour will be given for safety reasons. If your doctors are not happy about your progress an emergency Caesarean section will be provided.

Treatment

Above all, it is safer to register with a hospital that is known for handling emergency C-sections.

Conclusion

Yes, having a vaginal birth after a C-section is possible. In addition, the chances of a successful VBAC increases when labour starts without any induction on your due date or before it.

Nonetheless, you need to take every necessary precaution to ensure that everything goes well. Finally, ensure your doctor has all of your previous medical history and whatever is going on with you currently.

REFERENCES
  • March of Dimes (2015). Vaginal Birth After Caesarean. Accessed on 25th August, 2020 from https://www.marchofdimes.org/pregnancy/vaginal-birth-after-cesarean.aspx
  • Mayo Clinic Staff (2020). Vaginal Birth After Caesarean (VBAC). Accessed on 25th August, 2020 from https://www.mayoclinic.org/tests-procedures/vbac/about/pac-20395249
  • The American College of Obstetricians and Gynaecologists (ACOG) (2017). Vaginal Birth After Caesarean Delivery. Accessed on 25th August, 2020 from https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/vaginal-birth-after-cesarean-delivery

Cervical Cerclage

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It’s another day and you catch yourself looking at the calendar again, counting down the few weeks left to meet your little bundle of joy. Although this pregnancy is just 7 months old, you still worry if it would be like the others; perhaps this one would also arrive too early.
Hopefully, it would be different this time. Especially when you remember all the precautionary measures you have put in place.
These measures are based on medical advice from your last antenatal clinic appointment. Actually, the doctor suggested a cervical cerclage.

From that moment, although the doctor did her best to explain, you still wonder if it would be enough to save your child.

What Is a Cervical Cerclage?

Cervical cerclage refers to a couple of procedures done to keep your cervix closed before delivery.
It is also called a “cervical stitch”.

The cervix is the funnel-shaped lower part of your womb. It opens during childbirth to allow your baby free passage out of the womb and into the world. However, opening of the cervix too early could lead to premature labor. Therefore, cervical cerclage is done to help support the cervix during pregnancy, keeping it closed until childbirth or at least the baby is mature enough to thrive outside the womb.

Source: Shutterstock

Why Is It Done?

The cervix is closed, long, and firm in the absence of pregnancy.

During pregnancy, it gradually softens, shortens, and expands as your body prepares to ease your baby into the world.
In some cases, the cervix begins to efface (stretch and thin out) and open too early. This usually occurs in women with a short or weak cervix. It can lead to premature childbirth or in some severe cases, a miscarriage.

Cerclage
Shutterstock/ Medical Art

You may need a cervical cerclage if :

  • You have a short or weak cervix that starts to open in the second trimester (before 24 weeks of pregnancy).
  • There’s a history of miscarriage with painless dilation of the cervix in the second trimester.
  • You had a cervical cerclage in your previous pregnancy.
  • The previous pregnancy ended in a preterm delivery (before 34 weeks of pregnancy).

This procedure is usually done between 12 to 14 weeks of pregnancy. However, a doctor may recommend a cervical cerclage as late as the 24th week. Anything after this would be too risky.

A cervical cerclage cannot always be recommended as a quick fix for everyone at risk of premature delivery.

It is discouraged in cases where active vaginal bleeding, preterm labor, and an intrauterine infection are present. Your doctor is also less likely to recommend this procedure if you are pregnant with twins or more.

How Effective Is Cervical Cerclage?

Research suggests that a cervical cerclage helps reduce the risk of premature delivery. However, this is greatly affected by some factors such as the timing and degree of cervical change before the cerclage.

What To Expect

  • Before The Procedure; An ultrasound image of your womb would be taken to check the health of your baby. Also, a swab of your cervical mucus may also be taken to rule out any infections.
An ultrasound scan should be done before and after a cervical cerclage
  • During the Procedure; A cervical cerclage is usually done through the vagina (transvaginal) or less commonly, through the belly (transabdominal). You would be given medicine to numb the pain before the doctor begins. This could be a pain-numbing injection in your back (such as an epidural) or something to sedate you. You may also fall asleep depending on what kind of medicine is given.
  • After The Procedure; You may experience some symptoms immediately after the procedure such as;
    • Mild Spotting
    • Mild Cramping
    • Increased Vaginal Discharge (colourless and odourless)

Spotting, cramping, and vaginal discharge after a cerclage are all normal. If you notice any increase, please inform your doctor. Avoid any unnecessary physical activity for about 2-3 days after the procedure and just give yourself time to relax. Sometimes you may be asked to abstain from sexual intercourse as well.

  • Before Delivery; Your cervical cerclage stitches have to be removed before childbirth as the cervix is the only non-surgical passageway for your baby. Your doctor would recommend this when childbirth is around the corner, usually around 37 weeks of pregnancy. It might be required sooner if you go into labor.

Your stitches may be left in before childbirth if you are having a C-section. You may also decide to keep it in for a longer period, but this should be discussed with your doctor as it may make it difficult for you to get pregnant.

Listen to your body..

In the end, the goal is for you to have a safe delivery and give birth to a healthy child. Therefore, it is essential to inform your doctor in time of any changes you may notice, seek and heed their medical advice as regards your pregnancy, to the ultimate benefit of you and your baby.

References
  • Zarei, M., Zahedifard, T., & Nori, R. (2018). Successful treatment with home care during the second half of a twin pregnancy complicated by a short cervix: A case report. Biomedical Research and Therapy, 5(02), 2045-2049. https://doi.org/10.15419/bmrat.v5i02.419.
  • Nivin Todd 2020, Cervical Cerclage and Your Pregnancy; What You Need to Know, WebMD, Viewed on June 3, 2020,

Are Epidurals Really Painful?

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Cynthia’s threshold for pain was really low. As a child, she avoided any form of rough play that could result in painful injuries. Eventually, the inevitable call of puberty and menstrual cramps came along, and she had to rely on minor analgesics (paracetamol and others) to deal with the pain every month. When pregnancy came, she couldn’t get her mind off the possibility of extreme pain during childbirth. During one of her antenatal clinics, she explained this fear to the attentive doctor, who prescribed an epidural as a means to block out the pain.

Some women get bad headaches with pre eclampsia
Source: Shutterstock
Your Antenatal Clinics Are Very Important
Source: Pexels

What Exactly Is An Epidural?

The word ‘epidural’ means ‘near the spinal cord.’

It refers to an injection that is administered close to the spinal cord with the aim of preventing pain. These injections usually contain steroids or pain relief medication.

It is a common pain relief method during labor.

Source: Pexels

Epidurals create a certain degree of numbness from your belly button to the upper parts of your legs. This enables you to stay awake and active all through the delivery process. They allow you to watch your little one come into the world while causing you minimal pain.

How Is It Done?

In cases where an epidural is necessary, the doctor will insert a needle and a tiny tube (catheter) into the lower section of your back. After insertion, the needle would be removed while the tube would remain in place to serve as a delivery channel for the medication.

Source: Shutterstock

 

When Does It Begin?

An epidural can begin at any point during labor.

Some women prefer it at the beginning while others would rather wait till the end. Actually, the choice is yours to make (in consultation with your doctor)

Is It Really Painful?

Not really.

Just before the procedure, the doctor will numb the region where the medication is to be administered. In most cases, this action may result in a quick burning sensation at the selected site.

However, this is very helpful because it prevents you from feeling any pain as a result of the epidural injection. Although, most people tend to feel a little pressure when the needle is inserted.

What Are The Advantages?

  • They reduce pain during labour
  • You can continue to receive pain relief medications via an epidural for as long as you require
  • The amount of medication delivered through an epidural can be regulated as necessary
  • It aids relaxation, thereby speeding up the first stage of labour in most women.

Is Your Child At Risk After An Epidural?

The quantity of medication that reaches a baby from an epidural is really small. Therefore, there is little or no risk to your little one after having one.

Additionally, studies show no evidence of a birth defect caused by an epidural. 

Is There Any Side Effect?

Generally, epidurals are very safe.

Most Epidurals Are Used To Reduce Pain
Source: Pexels

In most cases, there is a very low risk of complications as a result of epidural. However, as it is with all drugs, there are potential side effects.

These include:

  • Decreased Blood Pressure (hypotension). The doctor will be on the lookout for this and be on hand to carry out measures or give medications to prevent or counter this effect.
  • Headache
  • Sore Back

If you experience any of these symptoms after an epidural, please consult your doctor for proper care. Learn more about the causes of back pain after childbirth.

One More Thing

It is a really good idea to share all concerns with your doctor before delivery day. Don’t be afraid to seek out help or ask for medications to deal with pain in this period.

Epidurals are safe, easy, and advisable in most cases.

Source: Shutterstock

You Are Not Alone.

REFERENCES
  • Salynn Boyles, 2003. Epidural Injections for Childbirth Rising https://www.webmd.com/baby/news/2030122/epidural-injections-for-childbirth-rising.
  • Epidurals. https://www.asahq.org/whensecondscount/pain-management/techniques/epidural/
  • Shutterstock
  • Pexels.com

HIV IN PREGNANCY: WHAT YOU NEED TO KNOW

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HIV…the feared Human Immunodeficiency Virus. In Nigeria, it is associated with so much stigma and fear because most people consider a positive diagnosis to be a death sentence. For women living with HIV in pregnancy, the stakes are even higher due to their relationship with their unborn child.

You can protect your unborn child from HIV by taking your medication, preactising safe sex and registering early for antenatal care.

However, contrary to popular opinion, a diagnosis of HIV does not automatically mean a woman cannot get pregnant. If you are HIV positive and you plan on having children, here are a few things you need to know about HIV and pregnancy.

What Should I Do Before Getting Pregnant?

Discuss with your doctor early on if you plan to get pregnant. He/she would inform you about the effects of HIV on pregnancy. Your doctor will also guide you on how to best prepare for a healthy pregnancy.

Everyone diagnosed with HIV needs to take their medicines and keep up with their check-ups to remain healthy. This is especially important if you plan to get pregnant. Doing this way before your pregnancy will lower the risk of passing the virus to your baby.

Worried about infecting your partner? There is no need to be!

If your partner is HIV negative, there are still ways you can get pregnant that will greatly reduce the risk of your partner getting infected. These are part of the things you need to discuss with your doctor.

I Am HIV Positive , Can I Transmit It To My Baby?

Yes, it is very possible to transmit HIV to your baby. This can happen during pregnancy, childbirth or breastfeeding. Therefore, necessary precautions need to be taken throughout your pregnancy and birth to prevent this from occurring.

The single most important factor in spreading the virus to your baby is your viral load. This is more or less the volume of the HIV detectable in your bloodstream.

I Don’t Have HIV. Why Should I Get Tested During Pregnancy?

Pregnant or not, everybody needs to know their HIV status at regular intervals.

Even if you have never been confirmed positive for the HIV virus, you still need to get tested for HIV if you are pregnant. This is because it is possible to have the virus and not know.

In such a case, early detection will not only protect your baby from also getting an infection, but will also improve your overall health.

What Should I Do If My Partner Is The One With HIV?

Women are more likely to get an HIV infection through vaginal sex than men.

This means that if your male partner is the one with the infection, you have a higher risk of getting HIV while trying to get pregnant. However, it is still possible to get pregnant without getting infected as long as the necessary precautions are taken.

The first thing to do is to talk to your doctor about your options. You may be recommended to be on HIV medicine that would help protect you and your baby from HIV. Your doctor may also suggest you use donor sperm or assisted reproductive technology to get pregnant. However, keep in mind that these options are more expensive.

I Am Already Pregnant. Will My Baby Have HIV?

As a person living with HIV, contact your doctor immediately you get miss a period and have a positive pregnancy test. This would help him/her direct you on the right path to a safe and healthy pregnancy.

We want you to know that you having HIV does not automatically mean your child would have HIV. With recent advances in medicine, it is now possible to lower the risk of mother-child transmission to almost zero!

How Can I Protect My Baby From Getting Infected?

If you have HIV, you can take these steps to reduce the risk of passing it to your baby:

  1. Inform your doctor you want to get pregnant. This is the only way to get professional guidance on how to have a healthy pregnancy and baby.
  2. Get prenatal/antenatal care, and take it seriously. This is the only way your doctor can closely monitor you to ensure you and your baby are fine. It is advisable to choose a hospital or doctor that is specialized or experienced in caring for babies exposed to HIV.
  3. Start HIV treatment. Your doctor would most likely put you on antiretroviral drugs to reduce the risk of you infecting your baby. If you were on medication before pregnancy your meds may be modified slightly to ones that are safe for pregnancy. With HIV treatments, come some side effects that may be especially challenging during pregnancy. Still, you have to take your drugs. Discuss with your doctor about whatever side effects you may experience and how to best manage them.
  4. Stay the course: You will have tests done at regular intervals to monitor your viral load and make sure you and your baby are healthy. Please don’t skip them and if you do try and make arrangements to make up.
  5. Breastfeeding: Breastmilk has so many benefits for your baby. It provides immunity and more. However, a few precautions need to be taken. The virus can be transferred to your baby through breast milk; even if you are on medication. Recommendations vary based on where you live, your financial situation etc. In some countries, formula feeding is recommended. While in others where the risk of not breastfeeding (eg. diarrhoeal diseases, malnutrition) outweigh the benefits, it is recommended that you give your child breastmilk. Please speak to your doctor about your options.
  6. Do not mix feeds: If you are planning on formula feeding, stick to that. Please do not mix breastmilk and formula. Irritations from formula feeding can compromise your baby’s gut and leave them vulnerable to any virus in your milk.

How Will My Care During Pregnancy And Delivery Be Different?

During pregnancy, your doctor would most likely put you on HIV medication. This would reduce the risk of you transferring HIV to your child. You may also need to visit the hospitals more often as your doctor will need to monitor you closely.

It is important to discuss your delivery options with your doctor as soon as possible. Your doctor may recommend either a C-section or a vaginal delivery. A C-section is usually recommended for an HIV positive mother that has had no prenatal care nor been on any anti-HIV medication.

What Happens To My Baby After Birth?

Your baby should be given some anti- HIV medication immediately they are born or within 12 hours of birth. This which will be continued. They will then be tested at birth, 2 weeks old, 4 weeks, 6 weeks and so onto monitor their status when the antibodies to HIV would have cleared from their system.

Your doctor will inform you on whatever follow-up tests your baby would need and when they need to be carried out. Discuss with your doctor about whether your baby would need to start HIV treatment immediately. Most doctors will prescribe antiretroviral drugs for your baby for the first 4 weeks after birth to prevent your baby from getting HIV.

What Happens To Me After Birth?

Your doctor may decide to stop or change your anti-HIV drugs after birth. However, do not alter your regimen without approval from your doctor as this could lead to problems.

You would also need to continue with your medical care through routine medical checkups, family planning services, mental health services and HIV specialty care.

Consult with your doctor about which of these services you may need and how to access them.

If you choose not to breastfeed, please inform your doctor so they can prescribe medication to help stop your breastmilk flow and prevent complications such as mastitis, abscesses or discomfort from breast engorgement.

Should I Be Worried?

In today’s world, living with HIV is no longer a death sentence.

People who are diagnosed with an infection do go on to live healthy, normal lives with the option of giving birth to healthy HIV-free babies! So even if you or your partner is HIV positive, there is absolutely no need to worry. Given the current COVID- 19 pandemic please read through the current guidance for pregnant women.

Speak to your doctor, follow all advice given and take your medications and keep up with your screening tests. We assure you that you and your baby would be fine.

Learn about malaria in pregnancy/
REFERENCES