Dr. Hafeez

Fetal Alcohol Syndrome – what are the risks?

Post author By Dr. Hafeez
Post date February 7, 2021

Fetal alcohol syndrome

Fetal Alcohol Syndrome

A woman who drinks alcohol during the pregnancy period can give birth to a baby with Fetal Alcohol Syndrome Disorder, commonly known as FASD. FASD is a collective term which includes a range of disorders. Hence, these disorders can cause growth problems and brain damage in the baby.

Types of FASDs:

Some common types of FASDs are:

Fetal alcohol syndrome (FAS)
Alcohol-related birth defects
Alcohol-related neurological disorders
Partial fetal alcohol syndrome
Neurobehavioral disorders related to prenatal exposure to alcohol

However, among all these disorders, fetal alcohol syndrome is the most severe form of the condition. Babies suffering from this condition experience problems with their memory, vision, attention span, hearing, communication, and learning abilities. Hence, the problems may differ from child to child, but the defects are eternal.

Causes of fetal alcohol syndrome:

When a woman drinks alcohol during pregnancy, some of that alcohol passes to the fetus by way of the placenta. The developing fetus cannot process alcohol in the same way as an adult. Furthermore, alcohol is present in a more concentrated form in the fetus, which prevents the absorption of oxygen and nutrients by the vital organs. Unfortunately, the damage is done in the initial few weeks of pregnancy, when a mother might not yet know that she is expecting a baby. The risk enhances when the woman is a heavy drinker. According to research, alcohol consumption is most harmful during the first 3 months after conception. However, the American Academy of Pediatrics reveals that alcohol intake can cause damage to the fetus at any time during the conception period.

Fetal alcohol syndrome symptoms:

Fetal alcohol syndrome covers a large number of problems. Thus, there are several possible symptoms of this disorder. Since the severity of symptoms varies from individual to individual, some babies experience them to a far greater degree than others. Hence, the signs and symptoms of fetal alcohol syndrome may include a mixture of physical defects, cognitive or intellectual disabilities, and problems in following a normal work routine.

Defects of the central nervous system:

Problems with the central nervous system and brain may involve:

Poor balance and coordination
Hyperactivity and jitteriness
Low judgment power
Difficulty in solving a problem with reasoning
A problem in identifying the consequences of choices
Mood swings
Poor memory
Learning problems, delayed development, and poor intellectual abilities
Problems with processing information and attention

Physical defects:

Physical problems in a fetal alcohol syndrome baby may include:

Deformities of fingers, limbs, and joints
Poor physical growth and development before and after birth
Hearing problems
Difficulty with vision
Small brain size and head circumference
Distinctive facial features, including an exceptionally thin upper lip, small eyes, upturned short nose, and smooth skin between the upper lip and nose

Behavioral and social problems:

Defects in functioning, interacting, and coping with others may involve:

Poor social skills
Troubles in school
Difficulty in getting along with others
Problems switching from one task to another
Difficulty in staying on a task
Problems planning and working towards a goal
Trouble with controlling behaviors and impulses
Problems adapting to change

Risk factors of fetal alcohol syndrome:

Thus, the more alcohol you consume during pregnancy, the higher the chance of problems appearing in your child. Hence, there is no safe limit on alcohol intake during the conception period. You may put your baby at risk even when you don’t know you’re expecting a baby. So avoid alcohol if:

You are pregnant
You are trying to conceive
You think you might be expecting a baby

Diagnosis of fetal alcohol syndrome:

To avoid the severe outcomes of fetal alcohol syndrome (FAS), its early detection is very important. Hence, consult your specialist if you think that your baby might have FAS. Also, inform your health professional if you drank during pregnancy. Moreover, a physical examination of your baby may show a heart murmur (abnormal heart sounds) or other cardiac problems. Thus, as your baby grows the signs which confirm its diagnosis are:

Low growth rate
Abnormal facial features
Small head size
Poor language acquisition

Treatments for fetal alcohol syndrome:

While fetal alcohol syndrome (FAS) is not curable, but there are treatments for a few of its symptoms. Thus, the earlier the detection, the more progress that can be made. Depending on the signs and symptoms a fetal alcohol syndrome baby exhibits, they may need several doctor visits. However, social services and special education can also help the young child in learning how to talk, such as speech therapies.

At home:

Children suffering from FAS will benefit from a loving and stable home environment. They are more sensitive to disruptions in routine life as compared to a normal child. Thus, children with FAS are more expected to develop problems due to substance abuse and violence in later life if they are exposed to violence and abuse at home. However, these children do well when they get simple rules to follow, a routine, and rewards for positive behavior.

Medication:

Although no medicine can completely reverse FAS, some medicines can address the symptoms of this disorder. For example, some drugs can manage energy levels, depression, and the inability to focus. Some of these medicines are:

Stimulants:

Stimulants can be used to treat some FAS symptoms, including trouble in paying concentration, low impulse control, hyperactivity, and other behavioral issues.

Neuroleptics:

This type of medication can improve neurological problems such as anxiety, aggression, and some behavioral problems.

Antidepressants:

Fetal alcohol syndrome majorly affects the central nervous system of your child. Thus, these medicines can help in treating brain issues, including loss of concentration, school disruption, mood swings, aggression, irritability, negativity, and anti-social behaviors.

Anti-anxiety drugs:

Anxiety is common in FAS children. Hence, this medication can improve anxiety symptoms. Drugs can affect each child differently. However, one medicine may work better for one child, but not for another. Thus, to identify the accurate treatment, your doctor may use different drugs and doses. It is therefore vital to consult with your child’s doctor to discover the best treatment strategy for your baby.

Nutritional interventions:

Research suggests that nutritional factors influence the damage caused by alcohol in the developing fetus. However, it is expected that postnatal nutrition can also influence the behavioral and physical outcomes in children with FASD.

Prenatal nutritional interventions:

Studies show that women who drink alcohol during pregnancy have several nutritional deficiencies as compared to the control group. For example, in one study, May and colleagues examined the nutritional status of mothers who gave birth to babies with FASD compared with mothers who gave birth to babies without FASD. The results revealed that mothers of fetal alcohol syndrome babies were deficient in several nutrients such as choline, vitamin B6, A, C, E, and D, minerals including zinc, calcium, and iron, and omega 3 fatty acids. Hence, the deficiency of these nutrients can cause the abnormal development of the baby and exacerbate the damaging effect of alcohol. However, the research found that women consuming alcohol and also taking micronutrient supplements had a lower risk of FASD in babies than women who did not take supplements. These supplements can also reduce the oxidative stress caused by alcohol in the fetus. Thus, it is recommended to take supplements of vitamin E, C, and omega 3 fatty acids, which reduces the risk of FASD in newborns.

Postnatal nutritional interventions:

Nutritional status has a strong association with the development of cognitive abilities in your baby throughout their childhood. Hence, studies found that children suffering from FASD do not consume an adequate amount of calories, omega 3 fatty acids, choline, and vitamin D. However, these nutrients can attenuate the harmful effects of alcohol on both behavioral and brain development. In one study, the supplementation of choline in the diet of FASD children showed positive outcomes in brain development. It is thus recommended that FASD children should consume an adequate amount of these nutrients, which improves their mental development and functioning.

Exercise interventions:

Physical activity has several health benefits on behavior and brain outcomes. Research found that exercise can improve learning abilities and memory by elevating circulating proteins, which encourages brain performance such as brain-derived neurotrophic factor (BDNF). Moreover, research also found that running can enhance intellectual and learning abilities in rodents who were exposed to alcohol at prenatal state.

Counseling:

You can also improve the symptoms of fetal alcohol syndrome in children by using behavioral training. For example, friendship training can teach your child how to learn social skills, talk, and interact with their fellows. On the other hand, executive function training can also play a promising role in improving skills including self-control, understanding effect and cause, and reasoning. Some important educational and behavioral therapies are:

Good buddies is an effective children friendship training program which improves social skills in FASD child. Through this training, your child learns how to deal with teasing, slipping into a group, and appropriate sharing. This strategy involves sessions for the child and parents for 12 weeks.
Families Moving Forward (FMF) program provides support to the families who deal with challenging FASD behaviors. Moreover, it is the most effective strategy for a child suffering from severe behavioral problems. The duration of the program is between 6 to 11 months and involves almost 16 sessions. Services are offered by specialized trainers and mental health providers.

Moreover, a child with FASD also needs academic help. For example, a math teacher can help your child in improving their learning abilities.

Parent training:

Parental training is also important; you can learn about the disabilities of your child and how to interact with and care for your baby. Hence, siblings and parents can help FASD children in solving the social issue through support groups and talk therapy. Here are some simple parenting tips which can be useful:

Pay attention to your child’s talents and strength
Accept the limitations of your kid
Use simple examples and language
Give a reward for every positive behavior
Use music, hands-on activities, and visual aids to help your child learn
Remember, most of your child’s challenging behavior is due to brain problems instead of willful misbehavior

Alternative approaches:

In every medical condition, disability, and injury, there are several untested strategies which are endorsed by using informal networks. Thus, these strategies are known as alternative techniques. Before applying these interventions, first consult your health professional and check it out sensibly. Thus, your child’s doctor can offer guidance about the benefits and risks of these treatments. Some of these effective alternative approaches are:

Therapy of creative art
Yoga
Acupressure and acupuncture
Energy healing, massage, and Reiki (palm healing technique, which promotes physical or emotional healing)
Biofeedback (body-mind technique used to gain control over involuntary functions of the body, including blood flow, heart rate, blood pressure, and skin temperature)
Homeopathy, herbal, and vitamin supplements
Visual imagery and relaxation therapies
Auditory training

Positive factors:

Studies reveal that there are positive factors which help in reducing the secondary effects of fetal alcohol syndrome in children. Some of these positive factors are:

Early diagnosis. Children who are detected at an early stage can be given appropriate social services and educational classes, which helps in solving their social and behavioral issues.
FASD children must get a stable, nurturing, and loving home environment, which helps in preventing secondary behavioral issues such as unemployment, incomplete education, and criminal acts.
FASD children should never be exposed to violence.
Involve your child in social services and educational classes.

In the bottom line:

Hence, to prevent fetal alcohol syndrome disorder it is recommended to avoid alcohol intake during pregnancy. Moreover, this disorder is incurable, but you can manage its symptoms through multiple interventions.

References:

May, P. A. et al. Dietary intake, nutrition, and fetal alcohol spectrum disorders in the Western Cape Province of South Africa. 46, 31-39 (2014).
Nyaradi, A., Li, J., Hickling, S., Foster, J. & Oddy, W. H. J. F. i. h. n. The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. 7, 97 (2013).
Chambers, C. et al. 2MATERNAL ALCOHOL CONSUMPTION DURING PREGNANCY, NUTRITIONAL STATUS, AND IMPACT ON INFANT OUTCOMES. 48 (2013).
Warren, K. R., Hewitt, B. G., Thomas, J. D. J. A. R. & Health. Fetal alcohol spectrum disorders: research challenges and opportunities. 34, 4 (2011).
Voss, M. W., Vivar, C., Kramer, A. F. & van Praag, H. J. T. i. c. s. Bridging animal and human models of exercise-induced brain plasticity. 17, 525-544 (2013).
Fetal Alcohol Syndrome, <https://www.mayoclinic.org/diseases-conditions/fetal-alcohol-syndrome/diagnosis-treatment/drc-20352907>
Fetal Alcohol Syndrome, <https://www.healthline.com/health/fetal-alcohol-syndrome>
Center for Disease Control and Prevention, Fetal Alcohol Spectrum Disorders FASD,

Common illnesses

What is Baby Fever?

Post author By Dr. Hafeez
Post date February 7, 2021

baby fever, what is baby fever, How To Take Baby's Temperature

Baby Fever

It might be confusing when your baby has a fever for the first time. Furthermore, a baby fever is definitely something to worry about if your kid is only a few weeks old, the fever is persistent, or both. Babies need unique treatment along with specific medicines to get healthy again.

But did you know that a baby fever is also a sign of a healthy immune system? However, this doesn’t mean that you don’t need to worry about it.

There are several types of fevers in babies. Thus, it is important to identify the cause and undergo treatment for the same.

Let’s find out everything you need to know about baby fever.

What is baby fever?

Baby fever can be defined as an increase in the body temperature of your infant. It is also a sign that the body is fighting with an illness, but it cannot be ignored and left as it is. If your baby is only a few weeks old and the fever is chronic, you must reach out to a doctor. You cannot predict the cause of a fever by just temperature alone. It could be just because of cold or infection, but it could also be an indication of something serious.

The normal body temperature of a baby lies within the 36.5°C to 38°C range. If the body temperature is more than the normal range, this can be called a fever. However, a high temperature doesn’t necessarily indicate that your kid has a serious disease, as it is the body’s natural way of dealing with illnesses and germs. Remember, the fever may come on gradually over days, but it can be quicker in some cases.

What are the symptoms of baby fever?

There are several indications of baby fever. Most are easily noticed and none should be ignored. You must confirm the symptoms if you get the slightest hint that your baby has a fever. Common symptoms of infants with a fever are listed below:

An abnormal rise in the body temperature of the baby. This can be easily noticed by a casual touch on the forehead.
A decrease in appetite.
A sudden rise or fall in the amount of time spent sleeping.
If your baby gets irritated and cries a lot, this is a strong sign of a fever.
Chills, shivering, and sometimes sweating accompany a fever.

How can you identify the fever?

You can easily identify a baby fever by taking the temperature of a baby. A light touch to the forehead with the hand will give you an idea of temperature. However, you can confirm the fever using a thermometer.

It is important to know the type of fever your baby has. This will prevent your baby from developing any kind of serious illness. The identification of a fever isn’t a difficult process because of common and noticeable indications. However, if the baby appears normal and the thermometer shows an abnormal reading, you must go for a checkup.

However, the magnitude of the temperature will not determine how sick your baby is. In some cases, a viral infection can lead to a very high body temperature. Sometimes a baby fever is identified by the breathing process of the baby. Infants usually breath faster if they have a fever; you should contact the doctor if your child has an increased heart or breathing rate.

How to take baby’s temperature?

There are three significant spots to measure baby fever using a thermometer. It is recommended to always use a digital thermometer as they provide better and accurate results. Using a mercury thermometer can be risky. In the case of newborn babies, only a digital one should be used.

Ear thermometers, called tympanic, require an accurate placement to get reading. Skin strips are not recommended for babies. Now let’s read about three main places on the body to take the temperature.

On the forehead: The temporal artery thermometer is the new method used to measure temperature. It is recommended for newborn babies as it is more comfortable as compared to the rectal thermometer. It uses the blood flowing through the temporal artery on the forehead.
In the rectum: It is recommended to measure the temperature in the rectum. This is best for a baby up to three years of age. The baby’s internal temperature can be taken accurately using this method. Be very careful while using the rectal thermometer, as it can pass along germs.
In the armpit: You can use this method to initially confirm the temperature. This is also known as an auxiliary measurement. Once you have confirmed the fever, you can use a rectal or other thermometer.

What causes baby fever?

There are several reasons for baby fever. Keep in mind that a fever is not an illness, but usually an indication of some other situation. A few reasons that cause fevers include:

Infection: Infants usually get fevers from viral infections. The body gets stronger and fights against diseases by developing a fever. The high temperature kills germs and helps the body withstand risky infections.
Immunization: Babies have to get many vaccines and may develop a fever because of that. However, it isn’t obvious whether the fever is because of infection or fear.
Overdressing: Kids can also develop fevers when they are overdressed in a hot environment. When babies are dressed heavily, especially in hot temperatures outside, this can cause a fever.
Teething: Babies develop fevers when they began to grow teeth. Teething can lead to a small rise in body temperature. However, the baby must still be taken to the doctor in such a situation.
Skin injury: A very unique but unusual justification for a baby fever is skin injury. The fever is not because of the injury, but because of an infection from the injury.
Weather: Really hot weather can cause fevers in babies. Unlike adults, babies can not regulate their body temperature very well. This, hot weather is also a possible reason for a baby fever.
Dehydration: When a baby is unable to fulfill their required fluid intake, it can lead to a rise in body temperature. If this is not treated at the early stages, dehydration can occur. Eventually, this will lead to several serious diseases.

What can you do when your baby has a fever?

You must make your baby comfortable before treating the fever. You also should keep an eye on the symptoms. Here are some things you can do if your baby has a fever:

You must keep track of their health on daily basis. Babies that stay happy and comfortable require less treatment.
Make sure that your baby stays hydrated. Giving the baby more fluids can boost the process. You can ask your doctor for a special drink, if needed. However, water is the best drink for babies; fevers lead to dehydration.
Proper rest is necessary for an infant with a fever. This doesn’t mean that your baby must be in bed all day, but a baby should not feel tired if there’s a fever.
If your baby is too uncomfortable, you can ask the doctor for medicine. Baby fever reducers can be effective in easing pain. Without a doctor’s prescription, don’t give your baby any type of medicine. The dosage depends directly upon the weight of your baby.
Never wake up a baby who is sleeping as it can make the situation worse. You must not wake your baby to give them medicine or anything else. Sleep is important to reduce the temperature.
You must use lightweight blankets and sheets to cover the baby. Also, don’t dress up the baby too heavily. Overdressing can increase the temperature instead of decreasing it.
The surroundings of the baby must be kept normal. It should be neither too cold nor too hot. A normal temperature will keep the baby comfortable.
For some babies, bathing in lukewarm water is effective. However, this is a temporary solution. Some people use a sponge in the process, but this is not the right approach. Some babies can feel irritation from the sponge, which will make the baby extremely uneasy.

When to see a doctor?

If you notice any of the signs listed below, you must call your doctor immediately:

If your infant has a temperature above 38°C and is less than three months in age, this fever could be an indication of something serious.
If your infant is older than three months and the body temperature is above 39°C.
If there’s something in particular along with fever, like a sore throat or earache.
Any sign of dehydration can be very risky accompanied by fever; it can lead to other health issues including less urination and increased laziness.
Vomiting and diarrhea are persistent.
If the temperature had not decreased after 24 hours.

Is a fever always dangerous?

A fever can be really dangerous when it is persistent and accompanied by other factors mentioned earlier. A persistent fever can cause dehydration and other health issues. It is very difficult to take care of babies in such situations. Infants become incredibly uncomfortable and sometimes a simple fever leads to serious problems like seizures.

There is no need for medicine if the baby is not feeling uneasy. The fever should just go away with time and young babies get healthy in just 24 hours. However, a fever can be dangerous if your child of fewer than 3 months has a fever.

The fever is not a serious issue if your baby shows any of these signs:

Willing to play more
No change in skin color
Still smiling
Eating and drinking well

It could be an emergency if your baby is having one of these signs:

Bluish lips, nails, and/or tongue
Sudden laziness
Continuous crying
Difficulty breathing
Rashes or purple skin
Increased irritation
Drooling

Don’t worry about a fever. Just take good care of your baby and make sure to provide them with comfort and care. Normally, a fever in young babies is just because of colds and infections.

What else to know?

You need to be prepared for some of the questions that the doctor is going to ask. This will help you to explain the situation in a better way. It will also give your doctor a better idea if you answer everything well. This is important because you are going to answer on the behalf of your baby. Doctors will ask you several questions to prescribe the best treatment for baby fever. Some of the questions are:

Baby’s symptoms: The very first question you have to answer is the symptoms of your baby. This is why you are suggested to keep an eye on the symptoms and note them down. You must be concerned about even the tiniest change in your baby’s behavior.
Home remedies: Your doctor might ask about the home remedies that you have tried to lower their body temperature. It is advised to make a list of your efforts. Also, note everything you gave your baby to eat. It would be great if you can note the exact time and make a proper list.
Baby’s medical history: You will be asked if your baby has any allergies or other diseases. This is because a fever can be a symptom of the development of a previous disease. Doctors will also ask about immunization and any present chronic condition your baby has. In some cases, they can also ask about pregnancy and birth details.
Habits and exposures: One of the most common questions that doctors ask. They will also ask about any change in the feeding habits of the baby. The number of times your infant urinates may also be asked.

Final Words

Baby fever is a common thing and you don’t need to worry about it too much. It is generally a sign of a good immune system; baby fever indicates that the body is fighting with some kind of illness. There are some really common and noticeable symptoms of fever. Once you notice any of them, you must visit a doctor. Usually babies don’t require any medicine, only a good and comfortable sleep. You have already read things you can do yourself to make your baby comfortable and cheerful again. Just make sure that your baby is happy and enjoying whatever home remedy you are using. Getting a check up is also recommended, as doctors can easily identify any growing disease.

Common illnesses

What is colic in babies?

Post author By Dr. Hafeez
Post date February 7, 2021

What is colic in babies

What is colic in babies? What are the symptoms? Lets start out with a mini-diagnosis:

Does your infant cry for several hours at a time and resist your every effort to soothe their tears? If so, they might be suffering from colic.

What is colic in babies anyway?

Colic is not a disorder or disease; it is a condition where your baby cries without any reason for more than 3 hours per day, more than 3 times per week, and for more than 3 weeks. Hence, infants suffering from this condition are commonly known as colic babies. While the situation is a bit of mystery, health professionals agree on a few things:

Colic usually starts at almost 2 weeks of age if your baby is full-term, or possibly later if the baby is pre-term
It commonly goes away on its own in three to four months
Colic can occur regardless of your infant’s age, sex, birth order, or whether they are bottle-feed or breast-feed
An infant suffering from colic grows in the same way as those who do not

What are colic symptoms?

How do you know your baby is colicky? Infants often show some symptoms and signs at the same time every day, especially in the evening. Some of these are:

Colic follows the “rule of three”: your baby cries for three hours a day, three times a week, and for consecutive three weeks.
Your baby cries more in the later afternoon and evening.
Your infant seems to be crying without any reason, such as no hunger, no dirty diaper, no sickness, and no tiredness.
While crying, your baby closes their eyes, opens their mouth wider, holds their breath, and furrows their brow.
Your baby has more bowel activity and may spit up or pass gas.
Your baby’s sleeping and eating patterns are disturbed due to crying. For example, a baby may anxiously seek a nipple only to reject it when sucking has just began.

Cause of colic in babies:

However, there is no exact cause of colic in babies. Studies reveal that colic has no genetic relation to anything that happens during childbirth or pregnancy. It’s also not anyone’s fault.

Moreover, here are some theories regarding the possible causes of colic in babies:

Overstimulation of the senses:

Newborn babies have a built-in mechanism for tuning out sounds and sights around them, allowing them to eat and sleep without being disturbed by the environment. However, this mechanism usually ends at the end of the first month, which makes your baby more sensitive to the stimuli of the surrounding environment. Thus, with so many new sensations, your baby becomes overwhelmed and cries to release stress.

Immature digestive system:

It is difficult for an infant to digest food with their brand new gastrointestinal tract. Hence, food sometimes passes quickly and does not break down completely. This condition results in the formation of gas, which causes pain in the infant’s intestine. This situation results in crying.

Sensitivity or food allergy:

Some doctors believe that colic for babies is due to an allergy to the cow’s milk protein casein, which is present in infant formulas. It might also be due to the reaction of a specific food present in the mother’s diet for a breastfed baby. Either way, a food sensitivity or allergy can cause tummy pain in the baby, which results in colicky behavior.

Exposure to tobacco:

Research has found that women who smoke during or after pregnancy are more likely to have colic in babies. However, secondhand smoking also contributes to colicky behavior. It is thus recommended to abstain from tobacco use during pregnancy and the lactation period to avoid these health and behavior issues in infants.

Infant acid reflux:

Studies show that infant GERD (gastroesophageal reflux) may trigger episodes of colic behavior in infants. However, GERD in infants is due to the overdevelopment of the lower esophageal sphincter, which prevents the backflow of stomach acid into the esophagus. Thus, in this condition stomach acid comes into the throat of the baby, which causes irritation and pain. Hence, common symptoms of GERD in infants include poor eating, spitting up, and irritability after and during feeding.

How does colic differ from normal crying?

There is a clear difference between normal crying and colic crying. Doctors agree that colic crying is more intense, louder, and higher in pitch as compared to normal crying, sometimes like screaming. Hence, colic babies are usually inconsolable and cry throughout the day.

Diagnosis of colic:

There is no specific test to detect colic in babies. Hence, a doctor will do a physical examination and focus on the following things to diagnose colic:

Skin tone of your baby
Energy level
Bodyweight
Breathing
Body temperature

Colic remedies for babies:

Moreover, in addition to exhaustion and frustration, you may feel guilty and inadequate when all your efforts to calm your fussy baby end in vain. Do not worry: there are some simple, easy ways to reduce the effect of colic in your baby and offer a soothing effect.

If there is suspected overstimulation of senses in baby:

Respond:

Crying is the only way by which an infant can communicate with you. Hence, it is recommended to respond promptly to your infant’s cries. Studies found that a quick response to your baby’s cries will decrease their crying in the long-run.

Excise excitement:

Limit visitors and avoid exposing your newborn to new experiences in this stimulating surrounding, particularly in the evening and late afternoon. Clearly notice how your infant responds to new stimuli and try to avoid those which offend them.

Create calm:

Create a peaceful environment for your baby which makes them relax and reduce colicky behavior. Sing or speak in a soothing voice, dim the lights, and keep all distractions and noise to a minimum.

If there is a suspected gastrointestinal problem:

Apply light pressure on infant’s tummy:

Research found that some colicky babies feel relief when you apply pressure to their tummy, as the feeling of touch is soothing for both child and parent. You may try the ‘colic carry’ or place them face-down in your lap while gently patting or rubbing their back, which should help them calm.

Try burping your infant:

If your infant’s inconsolable, fussy behavior is due to gas, then burping might offer relief from pain. Hence, make sure you are effectively burping your kid.

Use anti-gas drops:

Research reveals that reducing gas can decrease crying and discomfort in a colicky baby. You should therefore ask your pediatrician for anti-gas drops made with simethicone, which is effective in breaking down the gas bubble and reducing colic symptoms in the baby.

Consider probiotics:

Probiotic drops can also help in relieving tummy pain in colic babies. Probiotic bacteria naturally grow in the intestine of the infant and maintain gut health. However, the research is limited, so consult your doctor about probiotic drops.

Ask about switching formulas:

If your baby is on formula, try formulas which do not contain cow milk. Studies have found that infants feeding on whey hydrolyzed formula show improve colicky symptoms. However, make sure to consult your doctor before switching formula.

Watch what you eat:

If your baby is getting breastfed, then focus on what you eat. Try to eliminate all those foods from your diet which create tummy problems for your baby, such as acidic citrus fruits, gas-producing cruciferous vegetables (cauliflower, cabbage), and all allergens (soy, peanut, eggs, fish, dairy, and nuts).

Other calming remedies for colic in babies:

Swaddle:

Toss the blanket in your dryer. When it’s nice and warm, wrap your little one in it. This combination of warmth and security should help your baby calm and relax.

Get close to your baby:

Carrying or cuddling your infant not only gives them a feeling of protection and pleasure, but also help you in understating their needs. If you’re worried that too much holding can spoil your baby or make them clingy, don’t worry and put these fears aside. You are not spoiling your new one, so hold and cuddle them, which offers a soothing effect.

Try white noise:

White noises can also help in making your baby calm. The “hum” of the dryer and vacuum cleaner might create comfort for colic babies as it reminds them of their mother’s womb. Hence, these white voices can help your newborn fall asleep faster.

Play soothing music:

Studies have found that some crying babies respond to a lullaby, soft classical music, and quiet singing. Other babies like to enjoy the sounds of nature or the whir of a fan. The repeated sounds of “ahh” and “shh” can also help in drying the tears of your baby.

Get in motion:

You may also try swinging. Little ones feel comfortable with gentle movements, as they feel like they are present in the womb.

Get out of the house:

Sometimes just changing to an outdoor location magically changes the mood of your baby. Thus, put your baby in a carrier or stroller and go for a walk in the park. You can also strap them into the car seat for a drive.

Offer a pacifier:

Studies reveal that colicky babies want to eat all the time. This is because sucking offers a soothing effect, not because they’re hungry. Thus, if adequate feedings do not satisfy your baby, a pacifier might help.

In the bottom line:

Colic is no specific disease, so by following these simple, easy, and home-based remedies you can cope with colicky behavior in your baby. However, always consult your pediatrician before trying any type of herbal remedy or new formula.

References:

What to expect. Colic in Babies: Signs, Causes, and Tips for Parents, <https://www.whattoexpect.com/first-year/health-and-safety/what-is-colic/> (2020, November 20,).
Colic in Babies, <https://www.webmd.com/parenting/baby/what-is-colic#1>
Gelfand, A. A. in Seminars in pediatric neurology. 79-82 (Elsevier).
Illingworth, R. ‘Three Months’ Colic’. journal of archives od disease in childhood 29, 165 (1954).
Campbell, J. Dietary treatment of infant colic: a double-blind study. Journal JR Coll Gen Pract 39, 11-14 (1989).

Contractions

What are Braxton Hicks Contractions?

Post author By Dr. Hafeez
Post date September 15, 2020

braxton hicks contractions; when do braxton hicks contractions start; what do braxton hicks contractions feel like

Braxton Hicks contractions are irregular and infrequent relaxation and contraction of muscles of the uterus, also known as false labor pains. These contracts usually start after 6 weeks of pregnancy but does not cause significant pain due to their low intensity and frequency. In some pregnant women, these contractions become much more disturbing and discomforting during the second trimester of pregnancy. However, almost all pregnant women have these contractions during the third trimester of pregnancy.

Braxton Hicks contractions are the physiological process by which the body prepares itself for labor, but they do not specify the time or beginning of labor. These contractions are not an abnormal part of pregnancy. In most cases, they do not cause pain. Pregnant women just feel mild irritation and discomfort similar to that seen during menstrual periods. [i]

Physiology of Braxton Hicks Contractions:

Braxton Hicks contractions play a role in preparing the uterine muscles for the birth process by toning these muscles. That is why they are also known as practice for labor. They also help in the softening of the cervix. These sporadic contractions may increase the blood flow towards the placenta. Oxygenated blood fills the intervillous spaces of the uterus, where pressure is relatively low. Braxton Hicks contractions aid the blood to flow towards the chorionic plate so that oxygenated blood could enter fetal circulation. [ii]

What do Braxton Hicks contractions feel like?

Braxton Hicks contractions begin as a tightening of uterine muscles in the upper portion of the uterus and then spreads in the downward direction. Some women describe these contractions as tightening of the abdomen that is periodic and infrequent. Many women describe these contractions similar to the menstrual cramps. They cause hardening and odd bending or distortion of the abdomen. These contractions feel more intense and frequent as you reach closer to your delivery date.

These contractions are usually more intense and uncomfortable for women with second pregnancy as compared to the women who have become pregnant for the first time. But in some cases, first-time pregnant women may start to feel discomfort during the second trimester of pregnancy.

Read also our article What do contractions feel like

When do Braxton Hicks contractions start?

Braxton Hicks contractions may start early in the pregnancy, but you would not be able to notice them before the 20^th week of pregnancy. These contractions become more obvious after 26 weeks of pregnancy until the end of pregnancy. [iii]

Braxton Hicks Contractions vs. True Labor:

They are different from true labor pains because they are do not increase in duration, intensity, or frequency, which are suggestive signs of labor. These false labor contractions are infrequent, with uneven frequency and duration, and do not follow any pattern or rhythm. They do not cause pain and usually disappear after an interval and then reappear in the future. At the end of pregnancy, these contractions become more intense, and their frequency of occurrence increases, so women start to think that she has labor pains. At that time, they differ from labor pain in such a way that they do not cause dilation of the cervix and do not result in the delivery of the fetus.

Here we are going to compare Braxton Hicks contractions and True Labor:

They usually do not cause pain, while true labor is painful.
Braxton Hicks contractions have an irregular pattern of occurrence, while true labor occurs at regular intervals.
They are confined to your belly or some specific area while true labor starts in the back and spread around the belly towards the midline.
They reduce or stop when you change your positions or activity level. A woman can sleep during Braxton Hicks contraction. True labor aggravates with a change in position.
These contractions last within a short time that is 30 seconds to 2 minutes, while true labor lasts between 30 to 90 seconds and prolongs with time.
Braxton Hicks contractions don’t get close together over time, while true labor gets closer together and stronger with time.
Braxton Hicks contractions are weaker, and they lessen or disappear with time, while true labor gets intense with time. [iv]

Causes or Triggers:

Braxton Hicks contractions usually occur due to periodic tightening and relaxing of muscle fibers of the uterus. Exact phenomena of occurrence of Braxton Hicks contractions is not known. But some aggravating factors or triggers have been identified that include:

Overexertion or hyperactive woman during pregnancy: Moderate exercise such as walking, yoga, or swimming is a good way to remain fit and healthy during pregnancy. A hard or intense workout can cause Braxton Hicks contractions. If you feel cramping or tightening during exercise, discontinue and take some rest to avoid Braxton Hicks contractions.
Sexual intercourse: Having orgasm during pregnancy may cause a tightening of the belly that may predispose to Braxton Hicks contractions.
Distention of bladder due to the fullness
Dehydration: When muscles are dehydrated, they start to cramp up, and this also includes the uterus. Severe dehydration may lead to preterm labor due to excessive contractions of the uterus. Drinking a lot of water during pregnancy is a good way to prevent these problems.
Urinary tract infections: Pain or discomfort due to UTI can predispose to Braxton Hicks contractions. Consult your doctor if you have a burning sensation during urination.

According to some studies and clinical trials, these triggers have one thing in common that is they cause potential stress to the fetus and increase the demand for blood and oxygen to the placenta for fetal requirements. [v]

Why should you be aware of Signs of Early Labor?

To deal with Braxton Hicks contractions and differentiate between the Braxton Hicks contractions and true labor, you should know about the signs of early labor while you are reaching close to the expected delivery date. Early signs of labor include:

Pain in the pelvis and lower back that wrap the whole abdomen
Brownish mucous or watery discharge
Increase in frequency and urgency of urination
Loosening of stools

If you are observing these signs along with regular and frequent contractions, you are possibly in labor. It is not necessary to meet your doctor or midwife immediately. You can tell them about the symptoms that you are observing and ask them about how long does it take to reach true labor contractions.

At the end of pregnancy, Braxton Hicks contractions are so confusing that a mother having many pregnancies in the past may not be able to identify whether it is true labor or false labor. The most convenient way to avoid confusion and stay calm is to keep yourself in close contact with the doctor or midwife. [vi]

Read also the article Signs Of Labor-How To Know The Signs Of Birth

Should I call my doctor or midwife?

In case of mild discomfort during the second trimester and early third trimester, you do not need to call the doctor or midwife because these obviously are Braxton Hicks contractions. However, if you feel pressure and pain in addition to discomfort in the lower back, pelvis, and abdomen, you may be having early signs of labor. Such signs before 37 weeks of pregnancy may be considered a sign of premature labor, which needs immediate consultation with the doctor or midwife.
If you have completed the full term, then you may wait according to the schedule arranged by your midwife or doctor. In case of strong contractions with 5 minutes gap, you should immediately go to the hospital.
At any time during the course of pregnancy, you should consult the midwife or doctor if you have the following conditions or symptoms:
Vaginal bleeding
Constant pain in your abdomen
If you observe that your baby’s movements have diminished or stopped
Feeling very sick
In case of any doubt, do not hesitate to call your midwife or doctor for advice [vii]

How to Get Relieved from Braxton Hicks Contractions?

If Braxton Hicks contractions are causing irritation or discomfort, you can take the following measures:

Change your position or activity level, take a walk, or take rest if you are active
Drink a cup of herbal tea or a glass of water
Eat something
Take a warm water bath for half an hour
Attain mental relaxation by breathing deeply, or perform relaxation exercises [viii]

[i] Hill, W. C., & Lambertz, E. L. (1990). Let’s get rid of the term “Braxton Hicks contractions”. Obstetrics and gynecology, 75(4), 709–710.

[ii] Raines DA, Cooper DB. Braxton Hicks Contractions. [Updated 2020 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470546/

[iii] Lockwood, C. J., & Dudenhausen, J. W. (1993). New approaches to the prediction of preterm delivery. Journal of perinatal medicine, 21(6), 441–452. https://doi.org/10.1515/jpme.1993.21.6.441

[iv] False Labor & Pregnancy. Cleveland Clinic. (2020). Retrieved 10 September 2020, from https://my.clevelandclinic.org/health/articles/9686-true-vs-false-labor.

[v] Raines, D. A., & Cooper, D. B. (2020). Braxton Hicks Contractions. In StatPearls. StatPearls Publishing.

[vi] Signs that labour has begun. nhs.uk. (2020). Retrieved 10 September 2020, from https://www.nhs.uk/conditions/pregnancy-and-baby/labour-signs-what-happens/.

[vii] MacKinnon, K., & McIntyre, M. (2006). From Braxton Hicks to preterm labour: the constitution of risk in pregnancy. The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres, 38(2), 56–72.

[viii] Braxton Hicks Contractions | American Pregnancy Association. American Pregnancy Association. (2020). Retrieved 10 September 2020, from https://americanpregnancy.org/labor-and-birth/braxton-hicks-762.

Contractions

What do contractions feel like

Post author By Dr. Hafeez
Post date September 5, 2020

what do contractions feel like

What are contractions anyway?

Contractions are tightening of uterine muscle fibers that occurs briefly and intermittently throughout pregnancy, and more regularly and forcefully during active labor. A contraction normally happens when the muscles of your uterus tighten up like a fist and then relax and eventually helps push your baby out. When you’re in true labor, your contractions last about 30 to 70 seconds and come about 5 to 10 minutes apart. They’re so strong that you can’t walk or talk during them.

So, what do contractions feel like

Typically, real labor contractions feel like a pain or pressure that starts in the back and moves to the front of your lower abdomen. Unlike the ebb and flow of Braxton Hicks, true labor contractions feel steadily more intense over time. During true labor contractions your belly will tighten and feel very hard. Some moms-to-be liken these contractions to menstrual cramps.

That being said, it’s difficult to predict or describe what real labor contractions will feel like for you. This is partly because everyone’s experience of pain is different. For you, early contractions may feel quite painless or mild, or they may feel very strong and intense. The pain you feel can also differ from one pregnancy to the next, so if you’ve been in labor before you might experience something quite different this time around.

Real contractions happen when your body releases a hormone called oxytocin, which stimulates your uterus to contract. They’re a signal that your body is in labor: For many women, real contractions start at around the 40th week of pregnancy however, Real contractions that begin before the 37th week can be classified as premature.

Real contractions tighten the top part of your uterus to push your baby downward into the birth canal in preparation for delivery. They also thin your cervix to help your baby get through. The feeling of a true contraction has been described as a wave. The pain starts low, rises until it peaks, and finally ebbs away.

If you touch your abdomen, it feels hard during a contraction. You can tell that you’re in true labor when the contractions are evenly spaced (for example, five minutes apart), and the time between them gets shorter and shorter (three minutes apart, then two minutes, then one). Real contractions also get more intense and painful over time.

Some signs of real contractions include;

You may see a clump of pinkish or bloody mucus when you use the bathroom.
You may feel like the baby has “dropped” lower in your belly.
You may experience fluid leaking from your vagina. This is a sign that your “water” (a bag of fluid called the amniotic sac) has broken. Intensify with activity, rather than ease up, and aren’t relieved by a change in position.
Become progressively more frequent, intense and generally (but not always) more regular. The contractions usually last about 30 to 70 seconds each — and although each one won’t necessarily be more painful or longer than the last, the intensity builds up as labor progresses. Likewise, the frequency doesn’t always increase in regular, even intervals, but it does increase.
May be accompanied by an upset stomach, cramps or diarrhea.
May be accompanied by a rupture of your membranes (commonly referred to as your “water breaking“). However, this only happens in about 15 percent of labors; it’s more likely that your membranes will rupture spontaneously during labor or will be ruptured artificially by your practitioner.

How to time real contractions

Once you start experiencing contractions, timing them can help indicate how your labor is progressing. Having this information can also help your healthcare provider assess how far along you are, and whether it’s time to head into the hospital or birthing center.

Timing your contractions can also help you figure out whether you are actually in labor, or simply experiencing Braxton Hicks “practice” contractions.

Here’s how to time your contractions:

Make a note of the time when your first contraction starts (“time” on the table).
Write down how long the contraction lasts (“duration”)
Then mark the length of time from the start of the contraction to the start of the next one (“frequency”)
Keep noting these times for at least an hour to see if there is a pattern, and to see if the contractions are getting closer together.

Here’s an example of what timing your contractions would look like:

BRAXTON-HICKS CONTRACTIONS (aka False Labor).

Braxton-Hicks contractions are sometimes called “false labor” because they give you the false sensation that you are having real contractions. Although they can thin the cervix (the opening of the uterus) as real contractions do, Braxton-Hicks contractions won’t ultimately lead to delivery.

Braxton-Hicks contractions typically start in your third trimester of pregnancy. They’ll arrive from time to time, often in the afternoon or evening and especially after you’ve had an active day. You won’t notice any real pattern, but Braxton-Hicks contractions may come more often the closer you get to your due date.

False labor contractions are also irregular, don’t increase in severity or frequency and usually stop if you change positions. They may also be accompanied by other false labor signs. When a Braxton-Hicks contraction hits, you’ll feel a tightening in your abdomen. It’s not usually painful, but it can be.

Signs you’re having Braxton-Hicks contractions include:

contractions that come and go
contractions that don’t get stronger or closer together
contractions that go away when you change position or empty your bladder

How can you tell the difference?

This chart can help you tell whether you’re in real labor or just “practicing”:

	Braxton-Hicks contractions	Real contractions
When do they start?	As early as the second trimester, but more often in the third trimester	After your 37th week of pregnancy (if they come earlier, this can be a sign of preterm labor)
How often do they come?	From time to time, in no regular pattern	At regular intervals, getting closer and closer together in time
How long do they last?	From less than 30 seconds to 2 minutes	From 30 to 70 seconds
How do they feel?	Like a tightening or squeezing, but not usually painful	Like a tightening or cramping that comes in waves, starting in the back and moving to the front, getting more intense and painful over time.

WHEN TO CALL YOUR PRACTITIONER ABOUT CONTRACTIONS.

Your practitioner has likely told you when to call if you think you’re in labor (a good rule of thumb: when contractions are five to seven minutes apart). If you’re not sure if you’re in real labor but the contractions are coming pretty regularly, pick up the phone anyway. Just don’t wait for perfectly even intervals, which may never come.

Concerned it’s the middle of the night? Don’t feel guilty about waking your doctor — people who deliver babies for a living get plenty of 3 a.m. phone calls and are used to them.

And don’t be embarrassed if it’s a false alarm — you won’t be the first (or last) expecting mom to misjudge her labor signs. Besides, it’s always best to err on the side of caution.

Your practitioner will want you to answer a few questions, not only to provide information, but also to hear the tone of your voice. As you talk through the contraction, he or she will probably be able to tell whether it’s the real thing — so don’t try to cover up the pain in the name of good phone manners.

Your provider will use all the information to decide whether you should head to the hospital or birthing center, or whether you should stay home a little longer where you may feel more comfortable and relaxed during the early stages of labor.

WHEN TO HEAD TO THE HOSPITAL IMMEDIATELY.

Be sure to call your practitioner right away and if you can’t get through, head for the hospital in the following instances:

Your contractions are increasingly strong but you haven’t yet reached 37 weeks; you may be experiencing preterm labor
Your water breaks, with or without other signs of labor
Your water breaks and it has a greenish-brown tint
You feel the umbilical cord slip into your cervix or vaginal canal, which could be cord prolapse

It’s perfectly natural to feel anxious about contractions and labor as your due date approaches. Talking to your healthcare provider or your doula about any worries you have can help put your mind at ease.

Birth, and the hours after

Signs Of Labor-How To Know The Signs Of Birth

Post author By Dr. Hafeez
Post date August 19, 2020

signs of labor the signs of labor signs of labor early signs of labor near signs for labor approaching

Is this a sign of labor, or is it just a false pain? Is my delivery near? What are the signs of birth?

These may be the questions regarding early signs of labor that are frequently arising in your mind if you are approaching the end of pregnancy. The tough and rough period of gestation is almost over, but how do you know that the final day is approaching?

It’s natural to have mixed feelings of fear and excitement, especially if it’s your first baby. It’s hard to predict what you’ll feel first, because every pregnancy is unique. However, there are some common signs pregnant moms feel near the birth of their baby.

What is Labor?

The process of giving birth is called labor.

Usually, it starts from pre-labor signs of birth and contractions, then ends with the baby coming to the world.

The pre-labor signs start about a month before the final day.

It’s hard to pinpoint the exact time of labor, but the following signs will help you with the ringing “alarm bell”.

Pre-Labor – Weeks to Days Before Labor

Pre-labor is the predecessor of early labor.

These are the indications that the body is preparing to give birth.

It can start between 37 to 40 weeks or even a little late.

The following are the features of this period.

The Lightening – The Baby “Drops”

The baby starts preparing to “exit” and descends to the pelvis.

This is also known as pelvic pressure. Your belly bulge will drop from the mid-abdomen to the lower abdomen.

The pressure on your lungs is released, so now you can breathe more easily.

If it’s your first baby, this condition can develop 2 to 3 weeks earlier. In subsequent childbirths, this process initiates just before the actual labor.

It is usually the baby’s head that first enters the pelvis, but it may be feet depending upon the position of the baby.

Increased Urination

The previous stress on the diaphragm is released so you experience easy breathing, but now the pressure is on the bladder and intestines.

You may need to go to the bathroom frequently. You can also feel urine leaking while coughing or sneezing.

You’ll end up going to the bathroom multiple times at night, so it’s best to have some soft lighting for the sake of safety.

Pre-Labor Diarrhea

With the increase in pressure in the lower abdomen and a more relaxed rectum due to hormonal changes, you can experience “pre-labor diarrhea”.

This is normal as you near labor. Your healthcare provider will educate you on how to deal with this situation.

The most important thing is to remain hydrated during this period. Make sure you take plenty of water, juices, and other liquids as advised by your doctor.

Dilation and Thinning of the Cervix

The cervix is the bottleneck-shaped opening of the uterus into the vagina, via which the baby is delivered. It is approximately 4 cm in length. It modifies itself for labor in two steps.

Dilation

Dilation is defined as the opening of the cervix prior labor. This sign of labor occurs at a slow pace in pre-labor and rapidly in actual labor.

Your healthcare provider will measure it on each visit. Each individual shows a different level of dilation.

Effacement, also known as Cervical Ripening

During the entire pregnancy, the cervix remains tightened and closed so no foreign particle can enter. It is further blocked by a mucus plug at the opening.

Near the time of labor, the cervix starts shrinking and shortening, known as effacement. You may feel mild pain when this happens.

Vaginal Discharge – Bloody Show

With the loss of the mucus plug due to dilation and effacement, it can come out in a piece or pieces stained (or not!) in blood.

This dislodgment of the mucus plug is often followed by the production of thick clear or pinkish discharge.

This event is known as a bloody show and is an impending sign of birth.

Pain and Cramps in the Lower Back

As you approach your due date, you will start feeling pain and cramps in the lower back and groin region.

This sign of labor happens because your muscles and joints loosen and adapt for the upcoming event. It starts weeks before the expected date.

Energy Level Extremities

There are two possibilities for energy. You either feel super excited with the urge to organize everything (known as nesting), or you’re extremely tired.

Nesting: You wake up in the morning and suddenly have a strong and compelling desire to organize everything. This pre-labor sign is known as nesting.

This appears as energy bursts and urges every mom differently. Some may start organizing the closet or washing all the new baby clothes. Others may start cleaning and painting the house. Every individual displays nesting differently. It is totally fine as long as you don’t over-exert yourself.

On the contrary, some mothers feel the opposite. They feel super lazy and tired. This might be because of frequent bathroom visits, a lack of sleep, and an enlarged belly size. This, again, is natural and fine too.

Fewer “Kicks” – Decreased Movements

Near the end of pregnancy, less movement is felt by mothers. No one knows why this happens.

One hypothesis suggests that the baby is saving energy for the big day. If you feel almost no movements, you must immediately contact your doctor.

Early Labor – Days to Hours before Birth

Contractions

You may start feeling contractions weeks before the actual labor, but these may be false labor pains called Braxton Hicks Contractions.

True labor pains are due to the periodic contraction and relaxation of the uterus. It may feel like extreme period pain.

There are several differences between true and false pains, summarized in the table below.

Features	True Labor Pains	False Labor Pains (Braxton Hicks Contraction)
1. Time of onset	Day/hours before birth	Weeks before birth
2. Contraction Interval	Regular	Irregular
3. Intensity	Increases	Remains Same
4. Location of Contraction	Start from back towards front	Usually at lower abdomen
5. Duration	4 to 6 min –shortens to 30 to 60 seconds	Irregular- doesn’t shorten
6. Baby Position	Baby starts descending	Doesn’t change location
7. Cervical Dilation	Present	Absent

Water Ball Leakage

One of the final signs of birth is leakage of the water ball, but only 15 % of mother experience this.

Water ball leakage is the rupture of the amniotic sac, a fluid-filled membrane in which the baby lives for the entire time of pregnancy. It trickles slowly as an odorless and colorless fluid.

Sometimes, you may confuse it with urine. If it is a yellowish color with the smell of ammonia, it is urine. If it is odorless or sweet in smell, it is amniotic fluid.

Breakage of the water ball is a sign that you have either already started experiencing labor pains or are going to experience them in between 12 to 24 hours. Your body keeps producing this fluid until the baby is delivered.

If your water ball has leaked, it’s time to call your doctor or visit the hospital.

Preterm Labor – Warning Signs

Preterm or Premature labor is described as when you start feeling all or some of the above signs of birth before your due date.

Labor is labeled as preterm if it starts three weeks before the expected date.

Doctors never wish to deliver a baby early. The more time in the womb, the better. There are many treatments to delay an early induction of labor.

What are the Signs of Premature Labor?

The following are signs of preterm labor:

Early Regular Contractions
Fluid leakage
Nausea, vomiting, and diarrhea
Pain in the back
Vaginal bleeding

Who is at Risk?

The following features increase the risk of preterm labor:

Smokers
Alcohol consumption
Overweight/underweight
Babies with birth defects
Test tube babies
A small gap between consecutive pregnancies
Twins or multiple babies
Health problems like diabetes, hypertension, preeclampsia, clotting disorders, and infections

When to Contact the Doctor

The Pre-Labor period starts from weeks or even months before birth. You may start feeling all or some of the above-mentioned signs of birth. You can pre-inform your healthcare provider about the symptoms you have started experiencing.

If it’s your first pregnancy, it’s sometimes difficult to identify the subsequent events, so don’t hesitate to contact your midwife or doctor when in doubt.

The period of early labor starts a few hours or days before the birth. This is the most important time to remain in contact with your doctor. A few important factors to be considered in this period are;

Water leakage and the start of the true contractions is the most important event. It means that you are probably hours away from giving birth.
If your pregnancy is labeled as high-risk, you should be more cautious. For example, if you are diabetic, hypertensive, or have other underlying health problems.
Strength & duration of contractions. If the intensity of the contraction is increasing with a shortening duration, it’s usually one of the final signs.
Common Myths about Signs of Labor

There are several myths and misconceptions regarding signs of birth that confuse moms – especially for a first pregnancy.

You might have already heard a few of them:

Your water will leak like a flood: As shown in various movies, this is one of the most common myths. First of all, it doesn’t break in all pregnancies and, if it does, it leaks slowly and gives you plenty of time to call your doctor. You don’t need to panic, but you shouldn’t delay informing your healthcare provider.
The C-Section is less painful than vaginal birth: Again, this is the misconception that unfortunately exists.

The truth is there is nothing like a natural vaginal birth. Yes, you bear the pain instantly, but you resume your normal routine life just days after a standard vaginal delivery.

Postoperative issues in C-Section

You’ll be unable to resume your normal routine for some weeks. Wound infection, scarring, and more time required between pregnancies are a few other disadvantages.

A full moon means more babies are born: Another myth is that more babies are born when the moon is full. In reality, there is no scientific evidence available on this fact.
An epidural will enhance chances of C-Section: An epidural is a type of anesthesia that makes your normal vaginal delivery pain free. It doesn’t slow down the labor process and there is no evidence-based relation available about this myth.
If you have twins or multiples, a C-Section is a must: This is dependent on the advice of your gynecologist, but twins or multiple babies can be delivered via normal vaginal delivery.
The doctor will be there for the entire time of labor: The paramedical staff, midwives, and nurses are well trained to handle and communicate the situation with your doctor. Your doctor will keep visiting at intervals and will remain in contact with the staff. As the final time approaches, your doctor will be there. There is no need for a doctor’s presence all the time, but if they are there, then great!

Take-Home Message

Pregnancy is a very tiring process, physically and emotionally. It’s totally fine if you feel exhausted at some points.

Make sure that you follow these key points.

Get educated about pregnancy and labor. The more you know, the less you’ll be surprised. This will, in turn, reduce your anxiety – especially if it’s your first time.
Don’t panic if you experience signs of birth. Relax and follow the instructions that your healthcare provider has given.
Always have someone responsible in contact with you towards the end of a pregnancy. You can go into labor at any time. If you’re living alone, this becomes even more important.

Complications and symptoms

How Long does Morning Sickness last? Morning Sickness Symptoms

Post author By Dr. Hafeez
Post date August 2, 2020

morning sickness morning sickness remedies how long does morning sickness last remedies for morning sickness morning sickness relief morning sickness symptoms help with morning sickness morning sickness help what helps morning sickness what causes morning sickness

What is Morning sickness

Morning sickness is a complaint that usually occurs during pregnancy and includes symptoms such as vomiting and nausea. It does not necessarily occur in the morning, but at any time of the day or night. It is most common in pregnancy during the first trimester but, in a few cases, it may occur during the whole pregnancy period. It is usually the first sign a woman observes at the start of pregnancy, distressing more than 80% of women during their pregnancy period. Women taking hormone replacement therapy or hormonal contraceptives may also experience morning sickness.

Morning sickness can be relieved by home remedies such as sipping ginger ale, over-the-counter medications, and taking healthy snacks throughout the day. In rare cases, morning sickness takes a much more serious form known as hyperemesis gravidarum. In hyperemesis gravidarum, vomiting and nausea result in severe dehydration and weight loss, which may be more than 5 percent of the weight of the woman before the start of pregnancy. If it reaches emergency level, hyperemesis gravidarum may require hospitalization during pregnancy to receive intravenous fluids to combat dehydration, medications, and sometimes a feeding tube[1].

Morning sickness is an uncomfortable and irritating condition, but it poses no health risk to the mother or fetus. It is a physiological process of pregnancy and some researches have proven that it is a sign of a normal and healthy pregnancy.

Some studies show that pregnancies in which morning sickness occurs have less risk of stillbirths and miscarriages[2].

What causes morning sickness?

The common cause of morning sickness in pregnancy is a change in the levels of hormones in the body. The most common hormones include progesterone, estrogen, and human chorionic gonadotropin (hCG). Other causes may include changes in blood sugar levels and sense of smell.

Estrogen levels increase by approximately one hundred percent in pregnant women as compared to non-pregnant women. However, there is no evidence of a difference in the levels of estrogen circulating in pregnant women who have morning sickness and those who do not have morning sickness. Additionally, one of the main roles of increased progesterone levels during pregnancy is to relax the muscles of the uterus to prevent preterm labor and early childbirth. An increase in progesterone levels may also relax the muscles in the stomach and bowel, causing more acid secretion from the stomach cells and acid reflux. HCG is produced by the developing embryo and placenta at different stages of pregnancy. Some experts propose that morning sickness has an association with HCG.

Hypoglycemia, caused by increased transport of glucose from the mother’s body to the fetus via the placenta, may cause decreased energy levels. A decrease in energy levels can also cause nausea and vomiting in pregnancy. Pregnancy may cause an increase in sensitivity to odors that may overstimulate normal nausea stimulus[3].

Causes of Morning Sickness Other Than Pregnancy:

Insomnia and fatigue may disturb sleep patterns and change the neuroendocrine response, resulting in vomiting and nausea.
If a person sleeps for more than 12 hours without having a meal before sleep, low levels of glucose in the body can make you feel weak, nauseous, and dizzy upon waking.
Any health condition that causes increased acidity in the stomach or acid reflux to the esophagus may cause symptoms similar to morning sickness.
Sinus congestion puts pressure on the inner part of the ear, causing dizziness, nausea, vomiting, and stomach upset.
When post-nasal drip drains mucus from the sinuses to the throat and stomach, it can cause symptoms similar to morning sickness[4].
Due to emotional disturbances like anxiety, stress, and excitement, you may feel nausea.
Vomiting and nausea in the morning can be caused by excessive alcohol consumption the previous night. Alcohol can also cause hypoglycemia and dehydration.
Morning sickness may be caused by a food allergy or intolerance. Overeating can also cause nausea and vomiting.
A stomach disorder known as gastroparesis may also result in nausea. It is a condition in which the muscles in the wall of the stomach become weak, obstructing the transport of food to the intestines.
Morning sickness may occur in the case of gallstones. These are formed due to high cholesterol levels which accumulate and harden in the bile ducts to form stones. It attaches gallbladder to the intestine via tubes that can cause pain and nausea[5].
Vomiting and nausea are side effects of many medications that include opioids, antibiotics, and some other drugs. Drugs used in chemotherapy also stimulate the part of your brain that controls nausea and vomiting. Occasionally, such medications disturb the cells in the lining of the intestine and stomach and may result in vomiting and nausea[6].

Symptoms of Morning Sickness:

Symptoms of morning sickness typically include vomiting and nausea, commonly during the early months of pregnancy. In some cases, symptoms of morning sickness may become severe and may also be associated with other symptoms, including:

Severe nausea, vomiting, or both
Decreased urinary output with dark-colored urine
Dizziness or fainting while standing up
Unable to keep liquids down
Palpitations
Vomiting blood

Usually, symptoms of morning sickness improve after twelve weeks of pregnancy, but in some cases may persist for the whole duration of the pregnancy[7]

How long does morning sickness last?

Morning sickness starts in the 6^th week of pregnancy and lasts until about the 12^th week. Symptoms of morning sickness are at a peak between 8 to 10 weeks. According to many studies, almost 50 percent of pregnant women feel free from morning sickness at about the 14^th week of pregnancy or at the beginning of the second trimester. The same studies also revealed that 90 percent of pregnant women had settled morning sickness by 22 weeks. Additionally, pregnant women who experience nausea and vomiting during the eighth week have a decreased risk of miscarriage by about 50 percent.

Morning sickness is not restricted to the morning only; it may also occur throughout the whole day or night. Only two percent of pregnant women feel morning sickness only in the morning. However, if you went to sleep hungry, there is an increased risk of vomiting and nausea in the morning after waking up. Some health professionals have changed the name of morning sickness and now call it NVP, or nausea and vomiting during pregnancy[8].

If morning sickness does not last a typical amount of time or symptoms become severe, it may be a complication of morning sickness known as hyperemesis gravidarum. This usually occurs in about 0.5 to 2 percent of pregnancies. This condition is the second most common reason for hospitalization in pregnant women. Most cases of hyperemesis gravidarum recover at the 20^th week of pregnancy, but 22 percent of cases resolve after the termination of pregnancy.

Women who suffer from hyperemesis gravidarum once have increased risk in future pregnancies. Other risk factors include:

Family history of hyperemesis gravidarum
Pregnancy at a younger age
At first pregnancy, the risk is more
Twin or multiple pregnancies
Obese women[9]

How to Diagnose Morning Sickness

If you have symptoms of morning sickness, your physician may ask for some investigations to confirm the diagnosis. In the case of pregnant women, the doctor may order some tests to rule out any maternal or fetal disorder. All the investigation that may be required include:

Urine Tests
Urine tests help to determine dehydration, normal amounts of specific hormones that are secreted in urine during pregnancy, and creatinine levels.
Blood Tests
Blood chemistry tests include a complete blood count and comprehensive metabolic panel (Chem-20). These tests will check out the electrolytes in the blood, malnourishment, dehydration, deficiency of certain vitamins, and anemia[10].
Ultrasound
Ultrasound is used to investigate the normal growth and development of your baby with the help of images produced by sound waves.

What are the best remedies for morning sickness?

Morning sickness can be relieved with lifestyle measures and home remedies. Medical treatment is also available for treating morning sickness.

Lifestyle and Home Remedies:

Food items that are low in fat and high in protein can help to prevent or treat symptoms of morning sickness. Pregnant women should avoid eating spicy, fatty, and greasy foods. Eat foods that are easy to digest and do not harm the digestive tract. Food items such as rice, bananas, applesauce, and toast are high in energy and easy to digest. Foods containing ginger, such as ginger lollipops and other salty foods, can also prevent nausea.[11]
Eat a piece of dry toast or a few soda crackers after waking up in the morning. Eat small meals with plenty of snack foods throughout the day. Larger meals are not helpful during pregnancy because they cause acidity and nausea. The empty stomach worsens the symptoms of morning sickness; that is why frequent snacking is preferred during pregnancy.
High fluid intake can help in pregnant women with mild or severe morning sickness and in pregnant women with dehydration as a complication of morning sickness. Sipping ginger ale and water are good for reducing symptoms. During pregnancy, more than six cups of non-caffeinated fluids are helpful.
Avoid smells and foods that increase symptoms of morning illness. Certain smells and foods trigger nausea in pregnant women.
Keep the windows or doors open at home or the workplace for fresh air. Go outdoors for a walk in the morning or evening.
Prenatal vitamins are essential during pregnancy. If a woman feels nauseous or queasy, she should take vitamins with a snack or at night before going to bed. If these measures do not help to prevent the symptoms, ask your doctor for other ways to fulfill your dietary needs.
Use mouthwash and properly clean your mouth after vomiting. The acid produced in the stomach can be damaging to the teeth. Baking soda mixed in water is a good choice because it neutralizes the acid and protects the enamel of your teeth[12].

Alternative medicine

Several alternative remedies can help protect you against morning sickness, including:

Wristbands are available without prescriptions and may prove helpful to women with morning sickness due to their acupressure properties.
Acupuncture is another way to treat morning sickness in some pregnant women. In this procedure, a trained practitioner uses needles that are inserted into the skin – or deeper – and provide relief from symptoms of morning sickness.
Herbal ginger supplements help to lessen nausea and vomiting in some women. Most research proposes that ginger is safe for consumption during pregnancy, but according to some studies, ginger may affect fetal sex hormones.
In some women, morning sickness can be relieved by hypnosis. Aromatherapy can also help some women deal with morning sickness[13].

Medical Treatment:

In mild cases, medical treatment is not required. However, in case of severe symptoms or extreme discomfort, your doctor may prescribe B-6 supplements (pyridoxine), ginger, and over-the-counter medications such as doxylamine. Anti-nausea drugs such as ondansetron and promethazine are safe to use during pregnancy and commonly prescribed by the doctors.

Diclegis is an FDA-approved medication for use in pregnancy. One clinical study determined that Diclegis relieved nausea completely in more than 40 percent of pregnant women with morning sickness. Another trial concluded that about 70 percent of women showed improvements in morning sickness symptom[14].

In moderate or severe vomiting and nausea, dehydration may occur causing the loss of electrolytes such as potassium and sodium. In such cases, oral or intravenous fluids, along with prescription drugs, may have a significant role in relieving the symptoms.

Your doctor will ask about how many times you have vomited, the frequency of nausea, whether you have consumed extra fluids, and whether you have practiced home remedies. Your doctor will recommend medications for symptoms of morning sickness that are safe in pregnancy.

Also, consult your physician before taking any supplement or over-the-counter medications during pregnancy. If you have hyperemesis gravidarum, you may need emergency treatment or hospitalization. Treatment involves intravenous fluids and anti-nausea medications[15].

Best Foods for Dealing With Morning Sickness

Every pregnant woman has different reactions to different foods. But when it comes to the health and safety of the fetus as well as the mother, there are a few things you need to remember when consuming food that will not only ensure good health but also keep your morning sickness at bay.

Go for easy to digest foods
When feeling sick, look for light foods such as avocado, ripe bananas, applesauce and toasts.
Drink fluids
Try nutritious fluids such as herbal teas, almond milk, soups, smoothies and lemon water. These are light and fulfilling drinks that will help with upset stomach, heartburn and other symptoms of morning sickness.
Include some ginger in your diet
Ginger is an amazing thing for reducing nausea and vomiting. You can consume it grated, with tea, like ginger ale or even as ginger candies.
Peppermint and citrus can help
Peppermint and citrus are two magical foods that are scientifically proven to help soothe heartburn, upset stomach and improve digestion. Besides adding them to your tea or smoothie, try peppermint and citrus candies or even sniff a lemon if you like.

Besides changing your diet, you also need to change your routine. Keep a track of the following things during your mealtime:

Never stay empty stomach as it can increase acidity and develop nausea and heartburn.
Avoid sleeping on an empty stomach. This doesn’t mean you munch on heavy foods. Try light snacks and as discussed earlier- easy to digest foods.
Always keep a small bag of snacks with you.
Let go of foods that trigger nausea.
Stick to smaller portions and more 5 to 6 meals a day.

Do You Need to Consult a Doctor for Your Morning Sickness?

Generally, morning sickness is a part and parcel of pregnancy. It’s not considered a serious situation that needs medical attention. However, you must contact your healthcare provider if the following situations occur:

You are losing weight.
You are vomiting blood.
You vomit more than 3 times a day.
It’s impossible to eat or drink.
You are experiencing extreme fatigue.

References:

[1] Lee, N. M., & Saha, S. (2011). Nausea and vomiting of pregnancy. Gastroenterology clinics of North America, 40

(2), 309–vii. https://doi.org/10.1016/j.gtc.2011.03.009

[2] Bustos, M., Venkataramanan, R., & Caritis, S. (2017). Nausea and vomiting of pregnancy – What’s new?. Autonomic neuroscience : basic & clinical, 202, 62–72. https://doi.org/10.1016/j.autneu.2016.05.002

[3] Gadsby, R., Barnie-Adshead, A. M., & Jagger, C. (1993). A prospective study of nausea and vomiting during pregnancy. The British journal of general practice : the journal of the Royal College of General Practitioners, 43(371), 245–248.

[4] Singh, P., Yoon, S. S., & Kuo, B. (2016). Nausea: a review of pathophysiology and therapeutics. Therapeutic advances in gastroenterology, 9(1), 98–112. https://doi.org/10.1177/1756283X15618131

[5] Frese, T., Klauss, S., Herrmann, K., & Sandholzer, H. (2011). Nausea and vomiting as the reasons for encounter in general practice. Journal of clinical medicine research, 3(1), 23–29. https://doi.org/10.4021/jocmr410w

[6] Mosa, A., Hossain, A. M., Lavoie, B. J., & Yoo, I. (2020). Patient-Related Risk Factors for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review. Frontiers in pharmacology, 11, 329. https://doi.org/10.3389/fphar.2020.00329

[7] Chan, R. L., Olshan, A. F., Savitz, D. A., Herring, A. H., Daniels, J. L., Peterson, H. B., & Martin, S. L. (2011). Maternal influences on nausea and vomiting in early pregnancy. Maternal and child health journal, 15(1), 122–127. https://doi.org/10.1007/s10995-009-0548-0

[8] Chan, R. L., Olshan, A. F., Savitz, D. A., Herring, A. H., Daniels, J. L., Peterson, H. B., & Martin, S. L. (2010). Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion. Human reproduction (Oxford, England), 25(11), 2907–2912. https://doi.org/10.1093/humrep/deq260

[9] McCarthy, F. P., Lutomski, J. E., & Greene, R. A. (2014). Hyperemesis gravidarum: current perspectives. International journal of women’s health, 6, 719–725. https://doi.org/10.2147/IJWH.S37685

[10] Teasdale, S., & Morton, A. (2018). Changes in biochemical tests in pregnancy and their clinical significance. Obstetric medicine, 11(4), 160–170. https://doi.org/10.1177/1753495X18766170

[11] Viljoen, E., Visser, J., Koen, N., & Musekiwa, A. (2014). A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutrition journal, 13, 20. https://doi.org/10.1186/1475-2891-13-20

[12] Matthews, A., Dowswell, T., Haas, D. M., Doyle, M., & O’Mathúna, D. P. (2010). Interventions for nausea and vomiting in early pregnancy. The Cochrane database of systematic reviews, (9), CD007575. https://doi.org/10.1002/14651858.CD007575.pub2

[13] Khorasani, F., Aryan, H., Sobhi, A., Aryan, R., Abavi-Sani, A., & Ghazanfarpour, M. et al. (2019). A systematic review of the efficacy of alternative medicine in the treatment of nausea and vomiting of pregnancy. Journal Of Obstetrics And Gynaecology, 40(1), 10-19. https://doi.org/10.1080/01443615.2019.1587392

[14] Einarson, A., Maltepe, C., Boskovic, R., & Koren, G. (2007). Treatment of nausea and vomiting in pregnancy: an updated algorithm. Canadian family physician Medecin de famille canadien, 53(12), 2109–2111.

[15] Ebrahimi, N., Maltepe, C., & Einarson, A. (2010). Optimal management of nausea and vomiting of pregnancy. International journal of women’s health, 2, 241–248. https://doi.org/10.2147/ijwh.s6794

Tags How long does morning sickness last, Morning Sickness

Complications and symptoms

Molar Pregnancy: A rare complication of pregnancy

Post author By Dr. Hafeez
Post date August 1, 2020

Molar pregnancy, molar pregnancy symptoms; molar pregnancy partial; molar pregnancy in ultrasound

Pregnancy is a life-changing event for every woman. As joyful as the entire journey is, there are various complications and doubts throughout the 9 months. During these months, a woman goes through a lot of physical and emotional turmoil. Any complication during pregnancy is not only dangerous for the child, but also for the mother. One such case is a molar pregnancy. In this article we will cover: can you detect molar pregnancy in ultrasound? What are molar pregnancy symptoms.

Usually, there are two types of complications in pregnancy; non-molar and molar.

Non-molar complications include Placental Site Trophoblastic Tumor (PSTT) and choriocarcinoma.
Molar complications includes complete and partial molar pregnancy.[1]

What is Molar Pregnancy?

Molar Pregnancy, also called Hydatidiform Mole or HM, is a very rare complication of pregnancy. A typical hydatidiform mole is a voluminous mass or swollen, sometimes cystically dilated, chorionic villi, appearing grossly as grapelike structures.

In this complication, which is more properly known as Gestational Trophoblastic Disease (GTD), the trophoblast cells (which normally develop in the placenta) grow abnormally.[1]

Unfortunately, this complication leads to the termination of pregnancy because the fetus is unable to form properly. Instead of a healthily forming fetus, there is a lump of cells that grow in the womb. In a normal pregnancy, the fertilized ovum grows into a fetus with clearly defined cell segregation and maturation. In a molar pregnancy, a tumor-like mass resembling a mole or lump of cells is produced. The accumulation of cells that form a mole-like mass – and the failure to properly develop the placenta – leads to an insufficient supply of oxygenated blood and nourishment.[1]

Types of Molar Pregnancy

Complete Molar Pregnancy

In a complete mole, there is no fetal part at all. Instead, there is a mole of abnormal cells that grow abnormally in the uterus.[1]

The levels of the Beta Human Chorionic Gonadotropin hormone is extremely elevated.[1]

Moreover, the two types of trophoblasts in the placenta, called syncytiotrophoblast and cytotrophoblast, are equally proliferated. [1]

A complete molar pregnancy occurs in 2% of all pregnant women. [1]

Partial Molar Pregnancy

As compared to complete moral pregnancy, there is the presence of a fetal part in partial molar pregnancy. However, the fetus is abnormal and is unable to survive, thus leading to termination of pregnancy. [1]

The level of Beta Human Chorionic Gonadotropin is elevated, but not as high as in complete molar pregnancy. [1]

The syncytiotrophoblast and cytotrophoblast cells that are present in the placenta undergo partial and complete proliferation. [1]

There is nearly nil occurrence of partial molar pregnancy among pregnant women. [1]

A complete mole is more dangerous than a partial mole because it has the tendency to convert into choriocarcinoma. [1]

This disease has proven to be quite dangerous . It often leads to cancerous conditions which aggravate with time if adequate treatment is not acquired. [1]

Molar Pregnancy in Ultrasound

In ultrasound, high-frequency sound waves are directed towards the abdominal and pelvic region.

Radiology allows ultrasound tests to detect molar pregnancy as early as nine weeks. When the high-frequency sound waves echo, they produce specific patterns upon imaging.

In case of complete molar pregnancy

Ultrasound scans may reveal an intrauterine mass with cystic spaces associated with the absence of fetal content and amniotic fluid. Moreover, there is a thick cystic placenta that fills the uterus, due to which the uterus appears quite enlarged. Crystal-like structures show the presence of ovarian cysts. [2]

Usually, it is difficult to diagnose molar pregnancy by relying on imaging in the first trimester. This is because the results resemble a normal pregnancy or empty gestational sac. Therefore, less than 50% of cases of molar pregnancy are detected in the first trimester. In ultrasound imaging, theca lutein cysts are quite clearly visible. [2]

The characteristic feature of an ultrasound scan is the snowstorm or bunch of grape appearance. [2]

A color Doppler scan reveals high velocity with a low impedance flow. [2]

In case of partial molar pregnancy

Ultrasound scans can reveal growth-restricted fetuses and low amniotic fluid. There is the presence of fetal and placental content; the fetus is well-developed but the growth is retarded. It presents the fetus dead or alive with hydrophobic degeneration. The placenta is quite thick and large in proportion to the uterine cavity due to cystic-like appearance. The cystic spaces in the placenta are not always present.

Moreover, the ultrasound scan reveals a gestational sac or amniotic cavity which may be empty or may contain amorphous small fetal content. It is surrounded by a thick outline of placental echoes which intermixes with cystic spaces.

A color Doppler scan shows high velocity with low impedance flow. [3]

What are the symptoms of Molar Pregnancy? [4]

In the beginning, everything appears normal. As the pregnancy progresses, symptoms begin to appear in the first trimester. These include:

Vaginal bleeding. This varies in color; from dark brown to bright red, the discharge can appear in any shade.
There is often a brownish watery discharge instead of proper vaginal bleeding.
In a normal pregnancy, there is nausea and vomiting; in molar pregnancy, the intensity of morning sickness worsens. Thus, the intensity of nausea and vomiting increases and can happen at any time during the day.
Sudden severe abdominal pain caused by internal bleeding.
Grape-like cysts usually discharge through the vagina.
Immense pelvic pain or pressure.
The height of fundus is extraordinarily large in the first trimester which indicates abnormality.
Sometimes the uterine growth varies between too much and too little.
High blood pressure.
Proteinuria occurs, which is the presence of protein in the urine after 20 weeks of pregnancy. Proteinuria coupled with high blood pressure is called Pre-eclampsia.
Ovarian cysts on the ultrasound.
Usually, upon running regular CBC, there is a decrease in red blood cells (RBCs). This condition is called anemia.
Thyroid gland overworks, causing intense symptoms of hyperthyroidism.
Ultrasound shows no fetal movement or heartbeat; a dead or abnormal fetus.
βhCG level,

Most of the symptoms are also observed in normal pregnancy and therefore do not bother the soon-to-be-mother. However, some characteristic symptoms indicate abnormality. Ultrasound tests can confirm the condition of molar pregnancy.

What are the causes of Molar Pregnancy?

The occurrence of molar pregnancy is beyond the control of a woman. It does not happen due to intake or any physical or biological action.

The cause lies solely in genetics.

The two types of molar pregnancy have different patterns of gene involvement. To understand how a flaw in gene mixing causes this, it is necessary to understand the normal process.

In human beings, there are 23 pairs of chromosomes. When a sperm fuses with an ovum, one pair – from both male and female, which are XX and XY respectively – combine.

In a molar pregnancy, the ovum is empty. There are no chromosomes in it. When one sperm fuses with the ovum, it undergoes duplication and the resulting chromosomal number becomes 46 XX or 46YY. The initial chromosomal content after fertilization duplicates, producing abnormal genetic products. In this case, the zygote is homozygous diploid. However, when two sperms fuse an empty ovum, it also undergoes duplication forming 46 XX or 46 XY. [1]

In this case, the zygote is heterozygous diploid. [1]

In a partial molar pregnancy, two normal sperms fuse with one normal ovum. The genetic makeup is 69 XXY, 69 XYY, or 69 XXX. This is due to two sets of chromosomes from the father and one set of chromosomes from mother. [1]

As a result, the zygote is triploid. [1]

What are the risk factors? [5]

Although the occurrence is quite rare, in 1 out of 1000 pregnancies, it is necessary to understand the risk factors. For instance, the most common risk factors are:

Maternal age

In pregnancy, the age of the mother is the most critical and important aspect. The risk of developing a molar pregnancy is higher for women who are older than 45. The risk is equally high when the mother is younger than 20. Therefore, it is necessary to keep age in mind when planning a pregnancy.

Thus, pregnancy in teenage and middle age is the most restricted age for pregnancy.

Previous history

All those women who have had a molar pregnancy before are likely to develop it again. Repetition occurs in 1 out of every 100 women. If a woman has had more than one molar pregnancy, then her chances to develop another are around 1 in 5.

Blood group

Women with blood groups A and AB are at a slightly higher risk of developing molar pregnancy.

Ethnicity

Among all ethnicities, Asian women are most at risk of developing molar pregnancy. As compared to women of other ethnicities, the risk is twice.

Infertility issues

There are numerous women who have difficulty conceiving. This is due to underlying issues concerned with fertility which have a huge impact on the conception. In conclusion, such women often end up with a molar pregnancy.

How to prevent Molar Pregnancy? [6]

A molar pregnancy can only be prevented if you are familiar with the age group which is at highest risk. It is best not to plan pregnancy in teenagers and during middle age, thus avoiding the chance to develop one.

Moreover, if you have had a molar pregnancy before, it is best to wait for 6 to 12 months before another pregnancy. The risk of developing another is 1 in 80 women.

Other than these two preventions, there is nothing else that can be done. Developing a molar pregnancy is not under a woman’s control.

Due to the interference of non-modifiable and uncontrollable factors, a molar pregnancy can’t be prevented.

How is it treated? [7]

It is necessary to understand that such a pregnancy cannot continue since the problem lies at the genetic level. There are some treatment options that must be employed to prevent any fatal complications.

Dilation and Curettage (D&C)

In this technique, shortened as D&C, the abnormal molar tissue is removed from the uterus.

This treatment plan is conducted under the effect of anesthesia. A doctor inserts a speculum into the vagina of a woman to observe the cervix. Next, the doctor dilates the cervix. With the help of a vacuum, the device removes the molar tissue from the uterus.

HCG monitoring

The removal of molar tissue from the uterus does not allow the woman’s body to plan pregnancy again. There is a slight possibility that a small part of molar tissue is still present in the uterus; that tissue basically produces the HCG hormone. A doctor measures the HCG level until it drops to normal. If the level of HCG fails to become normal, then there is a need for additional treatment.

For 6 to 12 months, the HCG levels are continuously under observation.

Hysterectomy

A molar pregnancy can convert into Gestational Trophoblastic Neoplasia (GTN). In case of GTN or no desire for future pregnancies, it is better to remove the uterus.

References

Kumar, V., Abbas, A. K., & Aster, J. C. (2018). Chapter 19: Female Genital System and Breast. In Robbins Basic Pathology (10th ed.). Pennsylvania: Elsevier.
Radswiki. (n.d.). Complete hydatidiform mole: Radiology Reference Article. Retrieved June 26, 2020, from https://radiopaedia.org/articles/complete-hydatidiform-mole?lang=us
Radswiki. (n.d.). Complete hydatidiform mole: Radiology Reference Article. Retrieved June 26, 2020, from https://radiopaedia.org/articles/complete-hydatidiform-mole?lang=us
Molar pregnancy. (2017, December 14). Retrieved June 26, 2020, from https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175
Gestational Trophoblastic Disease – Risk Factors. (2019, August 01). Retrieved June 26, 2020, from https://www.cancer.net/cancer-types/gestational-trophoblastic-disease/risk-factors
Molar Pregnancy Prevention. (n.d.). Retrieved June 26, 2020, from https://my.clevelandclinic.org/health/diseases/17889-molar-pregnancy/prevention
Molar pregnancy. (2017, December 14). Retrieved June 26, 2020, from https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/diagnosis-treatment/drc-20375180

Chickenpox - All you need to know

Can you get chickenpox with vaccine?

Post author By Dr. Hafeez
Post date June 18, 2020

chickenpox with vaccine

The chickenpox vaccine is essential for getting yourself immunized against the virus. However, here the question arises: can you get chickenpox with vaccine? Unfortunately, you can still get chickenpox even after the vaccination.

There’s no specific rule which says that getting the chickenpox vaccination won’t make you prone to the viral infection. If an individual becomes immunized against chickenpox after getting the vaccine, there’s still a chance that they can get the virus. It’s possible to be exposed to the virus through the droplets expelled by a person infected with chickenpox when they cough or sneeze. However, someone who has become immune to the chickenpox virus after previously suffering with it will not be able to be infected by the acute form.

Symptoms

The symptoms in an immunized individual will be mild. Mild symptoms include a low-grade or no fever and only a few blisters. The blisters appear on the limbs or hairline of the person, while the macular rash can also appear on the neck, chest, abdomen, and scalp. Very few erythematous lesions can also occur on the buccal cavity. If chickenpox appears in those who have been vaccinated, it subsides within 10 to 14 days because of their strong immunity. Thus, the treatment of these patients is considered conservative.

Read about Chickenpox symptoms, and 4 things you can do to help

Treatment

In the conservative management patients with chickenpox, calamine solution is applied on the skin where the macular rash is present. Moreover, antihistamine drugs such as are given to patients. These drugs help to prevent the symptoms of allergies.

If we talk about the statistics, there is only a 2-3% chance of getting the chickenpox virus after being vaccinated against it. That means that 95-97% of people do not get the virus after being vaccinated.

Now a new question arises: why do people who get vaccinated develop milder symptoms or none at all? This happens when the vaccine of varicella is injected into the individual’s body. As a result, the body produces a reaction against it. This reaction is called an antigen-antibody reaction. Antibodies are produced in the body and make the body immune to this virus.

Read about Chickenpox and shingels – whats the difference?

At what age should your baby get a chickenpox vaccine?

Your baby should get shot of the chickenpox vaccine between the ages of 12 to 15 months. This vaccine is called the varicella vaccine and helps to prevent the serious complications of chickenpox disease.

These complications include bacterial infections, hepatitis, encephalitis, or pneumonia. The chickenpox disease is also called varicella. It involves a diffuse rash caused by the varicella-zoster virus. Therefore, it’s best that your baby get the chickenpox vaccine on time in order to develop their immunity.

After receiving the varicella vaccine around the age of 12 months, your baby becomes immunized within three months. Still, if your baby is unable to get the vaccine against chickenpox at the right age, no worries! It’s still possible to get the shot at the age of 13. When a child receives the vaccine at this age, they will develop immunity within four weeks.

Why is receiving the varicella shot necessary?

A person who hasn’t been vaccinated against chickenpox will become easily prone to the exanthem. Even if they recover, it doesn’t mean that the virus goes away.

The virus remains in the dorsal ganglionic cells. These cells are also called sensory ganglions. When the unimmunized child reaches late adulthood, the virus present in the ganglionic cells may reactivate.

After reactivating, this virus can attack the body more severely. For example, it may develop exanthem over the dermatomes. This appears as a rash. The rash seems like tiny vesicles and appears all over the body, including all the extremities, trunk and back, face, hairline, sides, etc.

An unimmunized child may develop a fever of 104 °F. They may also develop the other complications of the chickenpox. On the contrary, a child who has had the varicella immunization at the right time will not be prone to chickenpox and, if they do develop chickenpox, will have milder symptoms. Furthermore, while these symptoms subside of their own within a short period, you should still be careful with your child’s health. Make sure you know the right schedule for getting your child immunized against chickenpox.

Vaccination Booster

When you take your child to get vaccinated, your doctor may advise you to come again for another shot at a specific time. This is the vaccination booster. The vaccination booster is an extra shot of the immunity antigen given after the very first shot of the vaccine. The vaccination booster shot is given to increase the level of immunity of a person against the specific antigen.

Different types of vaccinations have different timings for administration. One of such booster doses of vaccination is varicella-zoster. This vaccine, when combined with its booster dose, is more than 95% effective in preventing the disease. The vaccination is given in two doses at 0.5 ml. The schedule for the booster dose depends upon two conditions:

If the child has received the first dose of vaccination at the age of 12 months to 15 months, the second booster dose is given when the child is 4 to 6 years old.
If the first dose of vaccination is received by an adolescent at the age of 13 years, the booster dose is given after an interval of 4 to 6 weeks.

As we know that the child receives a single shot of vaccine equal to 0.5ml, this means that when a child receives the booster dose of vaccine, they end with a total 1 ml of the varicella vaccine. However, why are vaccination booster doses given? And why is there an interval between the 1st dose and the booster shot?

Why boost the vaccine?

To answer this, it’s important to understand the concept of vaccinations. Vaccines contains a weak version of the virus which is inserted into the body. This mean the virus is detected and our bodies form antibodies to fight against it. When the first shot is given, immunity starts to develop inside a person’s body.

The development of immunity, however, takes time. For example, it takes nearly three months for the antibodies against varicella to create immunity. Moreover, immunity may not develop completely inside a person’s body; that’s the reason for the booster shot.

Chickenpox vaccination duration

Chickenpox is a disease that can easily affect your child if they aren’t immunized. This can lead to the development of the following symptoms:

High-grade fever
Macular rash
Itching
In severe cases, complications such as bacterial infections, pneumonia, and protracted vomiting.
In severe cases, the virus also affects the visceral organs of an individual.

On the other hand, the child or adult who receives the vaccination at the right time remains protected against this viral disease. Moreover, if they do become infects, the symptoms of the disease appear to be very mild.

Next, how long does it take to develop immunity against this viral infection? The answer to this question is simple; almost 3 months are required to develop immunity for a child.

Similarly, if an adult gets the vaccination at the age of 13, they will develop immunity within a period of 4 to 5 weeks.

When you get your child immunized, one question always arises: for how long does the chickenpox vaccination remains effective? When someone gets immunized against the varicella virus, they will remain immunized for a period of 10 to 20 years.

During this period, there is almost a 95% chance that they will not get chickenpox. Plus, even if they do become infected, they will not develop severe symptoms.. Moreover, the recovery phase will be faster than the developmental phase and the virus will subside within a few days.

To get your immunity against the virus for 10 to 20 years, it is necessary to receive both shots of the vaccine. These include the primary shot and the booster dose. If you haven’t received the chickenpox vaccination, you can become prone to the disease.

What side effects or risks are there?

The chickenpox vaccine is also termed as a varicella vaccine. This vaccine is necessary for the prevention of the varicella infection. However, there are a few side effects or risks associated with it which will be discussed below.

Side effects associated with the chickenpox vaccine:

Minor injection site reactions
The appearance of a varicelliform rash
Other associated side effects
Allergic reaction

Minor injection site reactions:

The chickenpox vaccine is given in the deltoid (shoulder) muscle. As a result, a site reaction occurs in two cases: either as a reaction of the skin to the needle or as a result of an allergic reaction to the drug injected.

Reactions include redness, swelling, and itching at the site of injection. Bruises can also form at the injection site. These types of reactions occur in almost 20 % of vaccines.

The appearance of varicelliform rash:

After getting the vaccination, 3-5% of people experience a simple rash at the injection site. The 3-6 % of people are those who develop the varicelliform rash outside the injection site. This rash appears as a mass of small blisters and is painful for the patient.

Other associated side effects:

Fever
Cough
Heaviness in the chest
Convulsions or body tremors
A feeling of weakness/ fatigue
Upset stomach

Allergic reaction:

An allergic reaction can also occur in response to the chickenpox vaccine. The signs and symptoms of an allergic reaction include:

Dizzy feeling
Increased palpitations
Swelling of body parts such as lips, face, or hands, etc.
Shortness of breath
Urticaria

Risks of varicella vaccine:

Before the administration of the varicella vaccine, you should also be aware of the risks. If you meet the conditions given below, please consult your healthcare practitioner before injecting the vaccine.

Do not inject vaccine if you have developed a severe allergic reaction after previous doses
The chickenpox vaccine is not suitable for those children who have immunodeficiency
The chickenpox vaccine should not be injected in pregnant females
Premature babies are also at risk of the chickenpox vaccine

Common illnesses

Hemangioma – Strawberry Birthmark – Should you fear it?

Post author By Dr. Hafeez
Post date May 27, 2020

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What is Hemangioma – Strawberry birthmark?

Hemangiomas, or strawberry birthmarks, are commonly seen in children, occurring in approximately 5-10% of 1-year-old infants. These marks are reddish, which is the result of blood vessel collection under the skin.

Despite being called strawberry birthmarks, hemangiomas do not necessarily appear at birth, as some children may not experience them until weeks after birth.

Typically, hemangiomas are small in size, but in some cases, they may grow very large, which naturally is quite worrisome for the parents.

However, you should know that these birthmarks are benign in nature, meaning you have no reason to worry, but it is still recommended by the American Academy of Pediatrics (AAP) to contact your baby’s pediatrician as soon as you notice strawberry-like structures on your child’s skin.

In this article, we will provide you with a comprehensive guide on how to identify infantile hemangiomas (I Hs), their causes, diagnosis, and available treatment options.

How to identify hemangioma

To identify strawberry birthmarks, you need to be familiar with where it might appear, as well as the types of hemangiomas there is.

As mentioned earlier, these benign tumors can appear anywhere in the body, with a special predilection towards certain areas, including:

Face
Neck
Scalp
Torso
Back

When you notice a reddish area on your child’s skin, try to focus on the lesion; if you see superficial blood vessels accumulated together, it is probably a hemangioma.

Note that I said “probably” because of the resemblance of this lesion with several other dermatological conditions, such as port-wine stain.

Depending on the connection of hemangiomas with other tissues, we have three types:

Superficial hemangiomas
A superficial hemangioma is mostly composed of blood vessels near the outer layer of the skin (i.e. epidermis), which gives it a bright, red color and a relative elevation over the skin. In other words, if you touch the lesion, you will feel as if it’s a bump.
Deep hemangiomas
Deep hemangiomas are spread into the deeper layers of the skin, including the adipose and muscular tissue. Typically, these tumors appear blue or purple, and they are also known as cavernous hemangiomas.
Combined hemangiomas
If the strawberry birthmark does not qualify the two definitions above, it might the combined type.

What causes hemangioma on a baby?

The exact causes of infantile hemangiomas are not yet identified; however, experts pinpointed common risk factors that may lead to this condition.

These include:

Caucasian children
While this risk factor is commonly cited, evidence shows that it’s related to an increased in preterm labor incidence in white females, which is a documented risk factor for hemangiomas.
Regardless of the underlying mechanism, infantile hemangiomas are more prevalent in white females compared to other races, especially Africans who have the lowest incidence of this condition.
Female gender
Several studies confirmed that the female gender of the newborn increases the risk of developing infantile hemangiomas; however, scientists are not completely sure about the mechanism that leads to this finding.
Advanced maternal age
Advanced maternal age predisposes newborns to a variety of conditions, including chromosomal abnormalities (e.g., down syndrome), maternal diseases (e.g., preeclampsia), and birth complications (e.g., postpartum hemorrhage).
In a 2007 prospective study, researchers analyzed the risk factors of infantile hemangiomas and found that advanced maternal age (over 40 years old) may augment the prevalence of this condition.
Preeclampsia
Preeclampsia is a common medical condition that occurs during pregnancy and is characterized by elevated blood pressure in the pregnant mom.
In a 2017 study, researchers confirmed the link between preeclampsia and hemangiomas, concluding that “Early-onset pre-eclampsia is associated with increased risk of hemangioma at birth, but detection bias due to longer hospital stays and closer follow-up may be part of the reason.”
Prematurity
Premature newborns are at higher risk of developing cardiovascular and respiratory problems, which is explained by the immature organ systems that are not ready for the outside environment.
While many reputable sources linked infantine hemangiomas to premature birth, JAMA dermatology went one step further and analyzed the characteristics of hemangiomas in term and preterm babies.
The prospective study found that the number of hemangiomas in preterm newborns surpass those observed in term babies. Additionally, the female to male ratio decreases, which means that males are as likely to develop hemangiomas as females.
Twin births
Multiple pregnancy is a prenatal maternal risk factor for preeclampsia, placenta previa, and gestational diabetes. All of which increase the risk of hemangiomas in infants.
The biological mechanism is quite complex and involves the over-secretion of vascular endothelial growth factors (VEGFs) that induce blood vessel formation and expansion in the skin, resulting in full-blown hemangiomas.
Taking fertility medications
Fertility medications’ mechanism of action involves the modification of estrogen and progesterone concentration in the blood, which is thought to activate certain metabolic pathways that induce blood vessel expansion, and eventually hemangiomas.
Genetics
Despite the absence of any evidence that suggests the involvement of genetics in hemangiomas, experts believe that the difference in prevalence between races can only be explained by genetic predisposition.

How to diagnose hemangioma

In most cases, the diagnosis of hemangiomas is straightforward.

When you suspect this condition and visit the pediatrician, he/she will take a look at the lesion during the physical examination to analyze its color, size, and depth.

If the doctor suspects that the strawberry birthmark extends into deeper layers of the skin, further testing might be warranted.

The most commonly ordered tests include CT scan, MRI, or a biopsy to study the cellular architecture of the tumor.

Finally, if the tumor is large enough and/or extending into deeper tissues, the doctor might recommend surgical excision, which requires brief hospitalization in a specialized surgical center.

How to treat hemangioma in babies?

The treatment options for hemangiomas are numerous due to how diverse these tumors are.

For instance, the doctor must take into account, the size, location, and invasiveness of the tumor, as well as the rate of growth before choosing the appropriate treatment approach.

Regardless of these considerations, here are the most commonly used treatments for hemangiomas:

Therapeutic abstinence (doing nothing)

While this might seem counterintuitive, small hemangiomas often resolve without leaving scars, especially in areas covered by clothes. For this reason, the physician might choose to closely observe the tumor without any therapeutic intervention to make sure no complications are developing.
If the tumor starts to grow in size or invade surrounding tissues, it might be time to consider other treatment options.
Beta-Blockers
Beta-blockers are a class of medication used to treat blood hypertension, hyperthyroidism, and migraines. Since 2008, these drugs have become the number one prescribed treatment for hemangiomas. In infants who are 5 weeks of age or older, the FDA approved oral propranolol to treat IH.
Generally speaking, the treatment lasts for 6 months taking the drug twice a day. Additionally, your pediatrician might prescribe timolol (topical form) to apply on the site of hemangioma, which is a preferred choice for small tumors.
Both drugs proved their efficacy in slowing down the progression of hemangiomas and reducing the risk of complications.
Corticosteroids
Before approving beta-blockers as a treatment of IH by the FDA, corticosteroids were the gold standard therapy.
Physicians prescribe these drugs as monthly injections or topical use on the site of the hemangioma. However, due to the heavy side effect profile, most clinicians today favor propranolol, leaving cortisones to rare situations such as beta-blocker intolerance.
Phototherapy
Phototherapy, or laser therapy, uses high-intensity beams of light to heal ulcerated hemangiomas. The mechanism of action involves the destruction and vasoconstriction (shrinking) of superficial vessels to stop the bleeding and ulcerations.
Physicians may order laser therapy to treat all different types of IH, especially those located in the airways, risking to compromise the child’s normal breathing.
Surgical ablation
The vast majority of IH do not require surgical interventions, but in some cases, the damage is too extensive to control with noninvasive treatments.
For instance, if the hemangioma damages the surrounding tissues, threat vital functions (e.g. breathing), or cause recurrent hemorrhages (bleeding), removing the tumor becomes inevitable.
This procedure requires general anesthesia and may lead to important scarring, which is one of the most important factors that physicians take into consideration when doing the benefit/risk analysis of the surgery.
Conclusion

Hemangioma in babies, or strawberry birthmark, are benign tumors that often cause great concern to parents, especially those who have never heard of this condition.

The pathophysiology and causes of this condition are poorly understood, but researchers are constantly conducting studies and clinical trials to better comprehend the underlying mechanism, as well as potential treatment approaches for hemangiomas.

Hopefully, you found this article helpful and informative, but if you still have any questions, feel free to ask in the comment section below.

The baby inside

Fetal development stages

Alcohol and smoking

Connect with your unborn

Your body and health

Complications and symptoms

Contractions

Life as pregnant

Stress

How to sleep when pregnant

Tools and ressources

Healthy habits during and after pregnany - FREE EBOOK

Your babys health

Baby Massage: Benefits and Techniques Backed by Science

Babies and Chemicals

Food and Breastfeeding

Common illnesses

Your babys life

Wonder Weeks e-mail program

Potty training

Development

Games your baby will love

Safety

Emotions

Teething

Your life with a baby

How to Make Bath time Fun for Babies

Family and the baby

Connect with your baby

Birth, and the first hours after

Tools and ressources

Your babys safety - FREE EBOOK

Encourage you baby to be active - FREE EBOOK

Parent Coaching

Family

Familylife

Nutrition and cooking

Your toddlers life

Games and toys

Learning

Behaviour

Parenting

The highly sensitive child

Communicate with your child by decoding the situation

Parents stress

Positive parenting

Parent Coaching

Tools and ressources

Your babys safety - FREE EBOOK

Encourage you baby to be active - FREE EBOOK

Parent Coaching

Recipes for babies

Dinners for babies

Side dishes and spreads

Porridge

Fruit purees and salats

Nutrition and cooking

Recipes for baby

Nutrition glossary

Healthy food for babies

Milk and other beverages

10 important Food Safety tips

Organic food for baby - should or should not?

Minerals and your baby

Vitamins for your baby

Family meals - 6 ways to make them work

Baby Led Weaning

Baby-Led Weaning (BLW) - When and How to Start

Table of Contents

Fetal Alcohol Syndrome

Types of FASDs:

Causes of fetal alcohol syndrome:

Fetal alcohol syndrome symptoms:

Defects of the central nervous system:

Physical defects:

Behavioral and social problems:

Risk factors of fetal alcohol syndrome:

Diagnosis of fetal alcohol syndrome:

Treatments for fetal alcohol syndrome:

At home: