Breech presentation refers to a baby being positioned with it’s bottom pointed down. This is the opposite of the normal “head-down” position (cephalic presentation). Breech presentation can make labor and delivery more complicated, so it’s important for expectant mothers to be informed about this condition and its management. Breech presentation is more common in early stages of pregnancy. However, by 28 weeks, only about 20% are breach & this decreases to 3-4% at term (37-40 weeks). In most cases, a breech presentation does not necessarily indicate a problem. However, if the baby remains in a breech position closer to your due date, your healthcare provider will discuss options. This may include attempts to turn the baby or planning for a cesarean delivery.
What can be done to turn a breech baby? If your baby is in a breech position, your healthcare provider may discuss options to help turn your baby to a head-down position before delivery, including:
External Cephalic Version (ECV): This is a procedure where a healthcare provider applies gentle pressure on your abdomen to try and turn the baby to a head-down position. It is usually done after 37 weeks of pregnancy and will require inpatient monitering for any complications. ECV is not always successful and may not be an option. A consultation with a provider who performs ECV is needed prior to performing to determine if you’re an appropriate candidate. Positional Techniques: In some cases, your doctor may recommend specific exercises or positions, like spending time on hands and knees or using pelvic tilts, to encourage the baby to turn. These exercises may be suggested before attempting ECV or if ECV is not an option. Resources such as www.SpinningBabies.com are available for reference. Chiropractor: Certain chiropractors are certified in “Websters Technique” which is a specific chiropractic adjustment that focuses on correcting alignment which would aid in the baby turning head-down.
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Cystic Fibrosis/Carrier Screening Blood test is accurate for screening a woman for carrying the gene for cystic fibrosis, a rarer serious respiratory and digestive disease. If the woman is positive, the father of the baby will be screened to assess the risk of a child having cystic fibrosis. This would never have to be repeated in subsequent pregnancies because it’s screening the mother, not the fetus. MaterniT 21 Plus - performed after 10 weeks Blood test that determines the risk of 3 fetal Trisomies by measuring the amount of fetal chromosomes in maternal blood. It screens for Trisomy 21 (Down’s), Trisomy 18 (Edward’s) and Trisomy 13 (Patau’s syndrome). There is an option to determine the sex of the baby. It’s 99% accurate. An AFP can be done after 15 weeks as well. Ultra-screen (or Nuchal Translucency) Ultrasound performed between 11 weeks+3 days and 13 weeks+6 days Blood Test (finger stick) between 10-13 weeks A combination of an ultrasound and maternal blood test. It determines the same 3 Trisomies as the Harmony screen, but not the sex of the baby. It may also detect several other rare chromosomal abnormalities. There is a 91% detection rate. An AFP would be done after 15 weeks as well. AFP (Alpha Fetoprotein) - performed between 15 and 21 weeks. Maternal blood test to detect factors that may indicate neural tube defects (NTD’s) such as spina bifida or anencephaly. It is done in addition to Harmony, Ultrascreen or CVS because those do not screen for NTD’s. This is screening only, and has a higher false positive rate (75% accurate). Quad Screen - performed between 15 and 21 weeks Maternal blood test includes the AFP test as well as screening for Down’s Syndrome. There is a higher false positive rate similar to AFP. Amniocentesis - performed after 16 weeks A test of amniotic fluid (the fluid that surrounds the baby in the sac) done by inserting a needle (with ultrasound guidance) into the uterus and removing some of the fluid for genetic analysis. This is 100% accurate for numerous genetic abnormalities as well as the sex of the baby. It’s a more invasive procedure with a slight risk of miscarriage or infection (0.5%). This test is performed at an OB specialists office. Chorionic villus Sampling (CVS) - performed between 10 and 13 weeks Chorionic villi are found in the placenta and carry the same genetic material as the baby. It tests for certain genetic disorders, as well as chromosomal abnormalities such as Down’s syndrome (similar results as amniocentesis, but done much earlier). Sampling is done by inserting a thin, flexible catheter through the cervix into the placenta. Risk for miscarriage is approximately 1/100. Risks also include infection, leaking amniotic fluid and rare limb deformities. An AFP can also be performed. This test is performed at an OB specialists office.
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The package insert has specific instructions regarding missing a dose. In general, if you miss one dose, take it as soon as you remember or with the next dose. If you miss three or more pills in a month you should use a back up form of contraception
Headache Nausea Breast tenderness Breakthrough bleeding Typically side effects are minor & resolve after several months of use.Combined pills are safe for most women; however they are linked to a small increase in the development in blood clots, heart attack and stroke. You may not be a good candidate if you have the following risk factors: 35 years or older with risk factors Smoke cigarettes or use other nicotine containing products Have high blood pressure or high cholesterol History of blood clots, or blood clotting disorders Have migraines with aura Have certain liver or gallbladder disease Have a history of breast cancer Risks can also increase for blood clots while on combined oral contraceptive especially after surgery or during long period of travel.
Make “periods” more regular, lighter & shorter. Reduction in menstrual cramps. Decrease risk of uterine, ovarian & colon cancer. Improve acne and unwanted hair growth. Treat disorders of heavy mentrual bleeding/pain, such as endometriosis & fibroids. Reduce frequency of migranes associated with mentration
How Do I Use It? Birth control pills are designed to be taken everyday, at the same time eac day. The pill pack typically will contain two types of pills - hormonal pills along with non-hormonal pills, also known as placebo pills. Some packages don’t include a placebo, nothing is taken those days. It is expected to get withdrawel bleeding, or a “period”, while taking the placebo pills. Your provider may instruct you to take the hormonal pills in a method more tailored to your specifi needs including extended cyclevuse (84 days of hormonal pills) or continuous dosing (365 days of hormonal pills.) How Does It Work? Estrogen and progestin work together to stop the ovaries from releasing an egg each month, known as ovulation. They also thicken the cervical mucus, making it harder for sperm to reach a potential egg, and thin the lining of the uterus.
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An echogenic intracardiac focus (or EIF) is seen on ultrasound and appears as a small or bright spot in the baby’s heart. This is typically thought to represent a tiny deposit of calcium in the muscle of the heart. An EIF does not affect the way the heart functions or its development. It is not a birth defect. An ultrasound finding of an EIF is typically considered a normal variant and it occurs in 3-5% of normal pregnancies. An EIF does not actually go away, but it may be harder to see as the pregnancy progresses. As the heart grows, the bright spot remains the same and becomes harder to see. There is no reason to repeat ultrasounds to moniter an EIF. There is no reason to inform the pediatrician at birth about this finding. There is a very weak association with certain chromosomal abnormalities, specifically Down Syndrome (Trisomy 21). When EIF is seen on ultrasound there is a slightly increased risk for Down Syndrome compared to fetuses that do not have this finding. However, other factors are a lot more important including other ultrasound findings and the results of screening tests. There are several additional tests that can be performed for screening. A maternal blood sample can be used to assess risk for Down Syndrome. Amniocentesis is the only diagnostic test.
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Echogenic bowel refers to an ultrasound finding where loops of fetal bowel (intestines) appear bright. When echogenic bowel is the only unusual finding on ultrasound, the infant typically doesn’t have any problems. Most fetuses identified with echogenic bowel are normal. There are a number of causes of echogenic bowel. Most frequently there is no underlying cause identified and no concerns with the infant. However, echogenic bowel can be associated with cystic fibrosis, cytomegalovirus infection, bowel obstruction, trisomy 21, intrauterine growth restriction, or the fetus swallowing blood after an intra-amniotic bleed among other things. Echogenic bowel is seen in less than 1% of pregnancies and in the vast majority of cases is of no consequence. There are several additional tests that can be performed for screening. A maternal blood sample can be used to assess risk for Down Syndrome. A consultation can be made with a high-risk obstetrician (Perinatologist or Maternal Fetal Medicine Specialist) for further ultrasound evaluation.
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Taking daily aspirin has been shown to reduce the risk of preeclampsia, a serious complication of pregnancy and the post-partum period. You have been identified as someone at increased risk of developing preeclampsia. Your MomDoc provider recommends you start taking low dose aspirin between 12-16 weeks of your pregnancy. This is typically two 81 mg tablets taken daily at bedtime. In some cases one tablet may be recommended. You should continue until delivery unless directed otherwise.
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Often women don’t get enough Vitamin E or an essential fatty acid called linoleic acid. Therefore, we recommend: - Vitamin E - 800 units per day - Evening Primrose Oil - 3 grams per day in divided doses (found in health food stores) - Decreasing or eliminating caffeine - Flax seed Women often have breast pain as their hormones begin to surge prior to their menstruated period. To control these hormonal swings can be difficult. Some women may be placed on low dose birth control pills if the pain is severe. Post-menopausal women on estrogen replacement therapy may need to lower their dose or stop it entirely if there pain is severe. In addition, a small amount of estrogen is made in the fatty tissues of everyone’s body and reducing weight can often help decrease the amount of estrogen and breast pain. Very rarely, in cases of severe pain associated with excess hormones, Danazol (an anti-estrogen) can be considered to lower hormone levels. Many women start having breast pain in the 10-15 years prior to menopause, and this may represent pre-menopausal hormone fluctuations. The breasts are held onto the chest wall by Cooper’s Ligaments within the breast. Stretching of these ligaments can cause breast pain. Studies have shown that the majority of women have poor fitting bras. A firm, supportive & well-fitting bra is crucial to some women to relieve the pain that is related to stretching of the support structures of the breast. For patients with severe pain, an intercostal nerve block can provide relief, as can steroid injections. These would be performed by a pain management physician. Some patients need a mild prescription pain reliever such as Celebrex. However, for most women, Tylenol, Motrin or Advil will suffice.
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What causes Pregnancy loss? A pregnancy loss is almost never caused by something you did. Past abortions, sex, exercise, mild falls, spicy foods, and most medications do not cause an early pregnancy loss. There is a higher chance of pregnancy loss with older age, some chronic illnesses, some infections, changes in the uterus, and severe injury although one of the most common reasons for pregnancy loss is genetics. When a pregnancy starts, cells divide fast to make an embryo, and sometimes errors occur. Your body notices this, and the pregnancy may stop growing. Most types of pregnancy loss don’t affect your chances of having a normal pregnancy in the future. If you have more than 2 pregnancy losses in a row, you may be at a greater risk of future pregnancy loss. You should talk with your clinician about this. What will I see & feel when I have a Pregnancy loss? You may or may not have symptoms. If symptoms occur, you may have spotting/bleeding from the vagina, cramps/abdominal pain, back pressure and you may pass small or large clots. These symptoms may be minor or severe. They may last a few days or weeks. Contact your clinician for a visit as soon as you notice bleeding, cramping, and/or pain. These symptoms can be part of a normal pregnancy, but it is a good idea to have more tests done. If you have very heavy bleeding and soak through more than 2 maxi pads per hour for 2 hours in a row, or a fever above 101°F, go to the emergency room. What happens during a Pregnancy loss? During a pregnancy loss, the pregnancy leaves the uterus through the cervix and the vagina. An ultrasound image of the uterus may assist in finding out what is going on. If a pregnancy loss has started, it is not possible to stop your body from continuing to pass the pregnancy tissue. If the pregnancy tissue does not pass on its own, or if you would prefer to help your body pass the tissue more quickly, you have options. Your clinician can give you a medication that you can take at home to help pass the tissue or you can have a procedure in the hospital to remove the pregnancy tissue. After a Pregnancy loss: Pregnancy loss can be hard. It is okay to give yourself time to heal and check in with your emotions. There is no right or wrong way to feel, and there is no “normal” amount of time that you will need to recover. Your period should return in 4 - 8 weeks. If you haven’t had a period within 12 weeks you should make an appointment. Speak with your clinician to learn how to prevent another pregnancy until you are ready, or about becoming pregnant again. If you have a hard time going back to normal activities, speak with your clinician so that you can get the support you need.
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Hormonal IUD’s are effective right away if it is inserted within 7 days of the start of your menstrual period. If it is inserted at any other time, avoid vaginal sex or use a backup birth control method (condom) for the next 7 days. Copper IUD’s are effective right away. Hormonal or Copper IUD’s do not protect you against STI’s, including HIV.
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Copper IUD - increased menstrual pain & bleeding, bleeding between periods, especially in the first few months of use. Pain & heavy bleeding usually decrease within 1 year of use. Hormonal IUD - spotting & irregular bleeding, especially in the first 3 to 6 months of use; headaches; nausea; depression; and breast tenderness.
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It does not interfere with sex. It can be inserted right after a miscarriage or childbirth and is safe to use while breastfeeding. If you wish to get pregnant or want to stop using the IUD for any reason, simply have it removed by a health care professional. Few medical conditions prevent its use. You do not need to have had children to use it. The hormonal IUD helps decrease menstrual pain and heavy menstrual bleeding. It may also stop menstrual bleeding completely. The IUD is a very highly effective method compared to other methods. The copper IUD is the most effected form of emergency contraception if it is inserted within 5 days of having unprotected sex. The copper IUD has no effect on your natural hormones
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​What Is It? The intrauterine device (IUD) is a small, T-shaped plastic device that is inserted into and left inside the uterus. Hormonal IUDs release a small amount of a hormone called progestin into the uterus. Different brands are approved for up to 3 to 8 years of use. The copper IUD releases a small amount of copper into the uterus. It is approved for up to 10 years of use
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