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Pregnancy/birth  Important tips

What are my chances of having a successful pregnancy

Answered by: Dr Geeta Chadha
Senior Consultant, Obstetrics & Gynaecology, Indraprastha Apollo Hospital, New Delhi

Q. My 21 years old wife underwent a D&C after miscarriage for partial vesicular mole. The doctor told us that it was a missed abortion as a result of partial vesicular mole. They took week by week blood test for beta HCG. First week result was 49,699 and last week’s result was 39.48. I am confused. Please explain. What are the chances of having a successful pregnancy?
A.  It is important to ensure that HCG levels come down to Zero. It is recommended that close follow up be done for a year after that in cases where pregnancy is urgently needed, then six months after the levels touch zero, but only with a go ahead of your doctor. And yes, chance of having a normal pregnancy next time is quite high.

Does my sperm analysis indicate that I can’t father a child?

Answered by: Dr Ranjith Ramasamy
Clinical Associate in Urology, New York-Presbyterian Hospital, Cornell University, USA

Q. I am a 30 years old man who underwent semen analysis, which showed: quantity - 2.5 ml, colour -greyish white, viscosity - thick, liquefaction time - 30 min, reaction - alkaline, sperm count-occasional motile sperm seen, pus cells - 2-3/HPF, RBC – nil and epithelial cells – nil. What does this report mean? Can I father a child?
A.  You have severe oligospermia (very few sperms) in semen analysis. Please repeat the semen analysis in a couple of weeks to see if it is the same. If it is, you need to be evaluated by an urologist. Most common identifiable cause of an abnormality in semen parameters is varicocoele (enlargement of testicular veins). Your doctor can do additional blood tests, scrotal ultrasound to determine other causes. Natural conception with such a low sperm count is possible, but rare. You can, however, become a father if the sperm is sufficient for artificial reproduction with IVF and your wife has no identifiable cause of infertility.

How can the complications in my pregnancy be treated?

Answered by: Dr Indira Hinduja
Consultant Gynaecologist & Obstetrician, KEM Hospital, Mumbai

Q. I am a 29 years old woman and LMP 8 months back. A single live foetus is seen in cephalic presentation in the ultrasound report. Foetal Maturity - L 32 weeks 3 days +/- 1 week, Approx Weight: 1770 gm +/- 258 gm, cardiac activity and foetal movements are normal. Foetal heart rate is 132 bmp, liquor amnii is adequate. AVI is 11.9, placenta is posterior and in upper segment grade I mature. NST is reactive. Bio-physical score is 10/10. Colour Doppler showed umbilical artery: PI=1.19, RI=0.69, S/D=3.2 (increased impedance), middle cerebral artery: PI=1.32, RI=0.70 S/D=3.3. The doctor says that S/D is high, and there is less blood flowing to the baby from umbilical cord. What could be the reason for this? What should we do for a full term delivery and a healthy baby?
A.  The Doppler ultrasound umbilical artery peak systolic and diastolic blood flow velocity ratio (umbilical S/D) is used in the monitoring of foetal safety. Many studies have come to the conclusion that increase of umbilical artery S/D ratio was associated with increased incidence of cord around the neck, moderate and severe hypertensive disorder of pregnancy, mode of delivery, foetal distress and IUGR. Doppler blood flow spectrum can be measured using 3 indices of umbilical artery flow S/D ratio may reflect resistance of the placenta and placenta microcirculation. Umbilical artery resistance can be studied by: 1) Pusatility Index (PI) (S – D /mean) - Peak systolic velocity – diastolic velocity ÷ time average max velocity (mean) 2) R.I. resistance index (S – D / S) (Peak systolic velocity – diastolic velocity – peak systolic velocity 3) S/D ratio – (peak systolic velocity / diastolic velocity) These three indices provide a semi quantitative method to assess the resistance of blood vessels to be monitored. Increased S/D ratio is associated with:- - Hypertensive disorders of pregnancy - Intra-uterine growth retardation (IUGR) - Cord around the neck - Fetal malformation - Abnormal amniotic fluid - Anaemia in the mother - Placental abruption - Placental previa Studies have reported foetuses with S/D ratio greater than 3.0 after 30 gestational weeks, to be at an increased risk of low birth weight. Management Early onset IUGR (before 32 weeks) - Classify IUGR by aetiology - Determine IUGR type - Treat maternal condition – improve nutrition, reduce stress - Evaluate growth scans and umbilical Doppler velocity every 3 weeks unless 36 weeks or severe oligohydramnios develops, consider hospitalization if AFI < 2.5 percentile with normal umbilical artery Doppler - Absent umbilical artery diastolic flow or reversed umbilical end diastolic flow (AEDF /REDF) - Determine IUGR type – symmetric vs. asymmetric Consider delivery of - Anhydramnios (no pockets of fluid that are clear of cord loop at 30 weeks gestation or beyond - Repetitive fetal heart decelerations - Lack of growth over 3 weeks period and mature lung studies - Abnormal UAD (AEDF or REDF) on umbilical artery Doppler Late onset IUGR (32 weeks or greater) - Classify IUGR - Determine IUGR type - Treat maternal condition, reduce stress - Encourage maternal rest in lateral positions - Growth scans and UAD every 3 weeks - Weekly BPP and NST Decision depends upon:- - Gestational age - Underlying aetiology - Probability of intact extra uterine survival - Level of expertise - Available technology Maternal Nutrition Weight gain in women with normal pre-pregnancy BMI – 11.29 kg to prevent growth restriction Energy needs: - 36 k cal / kg - Increase 10-15% over pre- pregnancy state - Protein additional 10-12 grams - Mineral calcium 1000grams - Iron – 30 mg - Vitamin folic acid – 30 mg, vitamin C-70mg, Vitamin A – 6000 IU Bed rest Results in decreased blood flow to periphery and increased blood flow to utero- placental circulation that improves foetal growth Maternal hyoperoxygenation therapy Aspirin ANP/IGF (atrial natriuretic peptides) / (insulin-like growth factors) Fetal Therapy i) Foetal nutritional supplementation ii) Mechanical therapy iii) Status of induction of pulmonary maturity

Does hip pain signify an ectopic pregnancy?

Answered by: Prof Mini Sood
Associate Professor, Department of Obstetrics & Gynaecology,University Technology Mara,Malaysia

Q. I am a 19 years old female into my sixth week of pregnancy. I am having sharp pains in my left side close to my hip. I also have a dull ache between pains and they increase when I am active. I think I can feel a hard lump and it feels to be about three centimetres in length. Could this be an ectopic pregnancy? I understand that the fallopian tubes are 1-3mm in width and I want to know how far they can stretch out during an ectopic.
A.  If the period is missed and pain is present, you need to have a vaginal scan to see any pregnancy inside or outside the uterus, also get a urine pregnancy test done. Most cases are diagnosed by these, but some may need a laparoscopy. If the pregnancy is in the tube, it may be ruptured or intact. Still but in the tube. In most cases surgery is the treatment- laparoscopy for the unruptured and open surgery in ruptured ones. If this is a precious baby, or conceived after problems, and you may want another try, sometimes medical treatment is done in unruptured ectopics for which you need get hospitalised.


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