Your Pregnancy

Ectopic pregnancy is one of the abnormal outcomes of pregnancy in 2% of pregnant woman and is defined as implantation of a fertilized egg outside the endometrial cavity. It remains a major cause of maternal morbidity and mortality when left untreated and accounts for as much as 9% of maternal death in this country. Quantitative measurements of the beta subunit of human chorionic gonadotropin (ß-hCG) and transvaginal ultrasonography have improved the accuracy of diagnosis and allow earlier detection of ectopic pregnancies.

History of the Procedure:

In modern medicine the ability to diagnose and treat ectopic pregnancies has significantly improved, thereby reducing the maternal risks. Recently Laparoscopy has revolutionized the way of dealing with the ectopic pregnancy says Prof. R.K. Mishra the recipient of Global Laparoscopic Trainer award of 2008 and Director of Laparoscopy Hospital, New Delhi.

Approximately 97.7% of all ectopic pregnancies occur in the fallopian tubes, and the others in the ovary, abdomen, or cervix. The ampullary pregnancy is the most common site of implantation (80%), followed by the isthmus (11%), fimbria (4%), cornua (2%), and interstitia (3%). Approximately 85% of ectopic pregnancies occur in multigravid women. In the United States, rates are nearly twice as high for women of other races compared with white women.

Aetiology:

Common risk factors for ectopic pregnancy include tubal damage, smoking, and altered motility in the fallopian tube. Bad smoking habits in the new generation women is a risk factor in about one third of ectopic pregnancies and may contribute to decreased tubal motility by damage to the ciliated cells in the fallopian tubes. Altered tubal motility can also occur as the result of oral contraceptive. Progesterone only oral contraceptive and progesterone intrauterine devices have been associated with increased risk of an ectopic pregnancy.

Clinical Symptoms:

Ectopic pregnancy can be diagnosed by typical triad which includes bleeding and abdominal pain and a positive pregnancy test result. The clinical presentation can therefore be confusing, since symptoms overlap with miscarriage. One third of women have no clinical signs and 9% have no symptoms of ectopic pregnancy. As a result, almost half of cases are not diagnosed at the first prenatal visit by their gynecologists.

On physical examination signs include lower abdominal tenderness with or without rebound and pelvic tenderness usually much worse on the affected side. Gynaecologists can find abdominal rigidity, involuntary guarding, and severe tenderness as well as evidence of hypovolemic shock with tachycardia, should alert the clinician to a surgical emergency; this may occur in up to 20% of cases. On per vaginal examination, the uterus may be slightly enlarged and soft, and uterine or cervical motion tenderness may suggest peritoneal inflammation.

Indications for surgery in ectopic pregnancy include women with the following criteria:

· Not suitable candidate for medical therapy

· Failed medical therapy

· Heterotopic pregnancy with a viable intrauterine pregnancy

• Hemodynamically unstable and need immediate treatment

Medical therapy:

While methotrexate has remained the most effective and popular drug used in medical therapy for an ectopic pregnancy, other protocols have been used, such as potassium chloride, hyperosmolar glucose, RU 486, and prostaglandins.

Surgical therapy:

Surgical therapy may be open laparotomy or via the laparoscopy. According to Prof. R. K. Mishra all ectopic pregnancies requiring surgery should be treated laparoscopically. Risk factors for converting laparoscopy to laparotomy should be considered and include multiple prior surgeries, pelvic adhesions, skill of the surgeon and surgical staff, availability of the equipment, and condition of the patient. If the ectopic pregnancy is at the fimbria, then fimbrial evacuation is feasible, in the absence of indications for salpingectomy. Partial salpingectomy may be indicated if the pregnancy is in the mid portion of the tube, none of the indications for salpingectomy is present, and the patient may be a candidate for later tubal reanastomosis.

Laparoscopy Technique:

Desiccate the tube between the uterus and the ectopic pregnancy using bipolar cautery and compress and desiccate the tuboovarian artery, while preserving the uteroovarian artery and ligament. Cut along the desiccated path, closer to the specimen, leaving a pedicle for hemostasis. Infiltration of the mesosalpinx with vasopressin (20 IU in 50 mL of isotonic sodium chloride solution [ie, normal saline or NS]; some authors use only 10 IU in 50 mL of NS) to get transient ischemia and to avoid bleeding. Needle electrode, is used to make a 1- to 2-cm incision on the antimesenteric side of the tube.  Aquadissector, under pressure can be used to dissects and dislodges the ectopic pregnancy and clots.

Ovarian cysts and pregnancy occurring together can cause many women to feel extremely alarmed. It is worth remembering that cysts are common during pregnancy. Many pregnant women just have to come in terms with it and learn to live with both – ovarian cysts and pregnancy. It is difficult to feel relaxed when a woman is faced with pregnancy and ovarian cysts simultaneously. But a feeling of tension and stress, originating from worrying about it, will only do more harm than good for the expecting mother and the unborn child. As such it is advisable to stop worrying and seek treatment promptly. Pregnancy in itself is a demanding situation and the presence of ovarian cysts only makes it more complicated. The need of the hour for a pregnant woman with ovarian cysts, therefore, is to expedite recovery by understanding the nature of the cysts and seeking proper treatment.

Complications of ovarian cysts

Ovarian cysts occurring during pregnancy can be either of benign or malignant. Benign cysts pose minimal threat during pregnancy and are often ignored. On the other hand, malignant ovarian cysts carry a lot of risk and pose a grave threat in the pregnancy stage. The first step, therefore, is to correctly determine the actual nature of the cysts that you have. It is mainly on the basis of the nature of the cysts, and the extent and severity of the condition, that the treatment plan will be determined. Although some cysts often get cured without any medical or surgical intervention, most other types need a proper treatment plan. It is critical to monitor the ovarian cysts carefully to avoid possible complications like ovarian cysts rupture during pregnancy. In spite of regular monitoring, complications can arise suddenly. Even if you have been diagnosed with benign cysts, take extra care during pregnancy and stay safe.

Let’s face it, ovarian cysts and pregnancy are a potentially dangerous combination. It requires urgent medical attention and should not be ignored. Ovarian cysts have been known to be responsible for complications in pregnancy, including miscarriages. Larger cysts give rise to even bigger and more serious problems. Consult with your doctor and initiate the best form of treatment without delay. This will ensure that you have a healthy and trouble-free pregnancy. There are many excellent treatment options available today.

Treatment

Ovarian cysts during pregnancy need a different course of treatment than during normal times. Some of the drugs and medication used during normal times may be considered dangerous for the unborn child. The pregnant patient is therefore strongly advised to refrain from buying over the counter drugs, especially painkillers. Some of the other conventional options may also not be available. The state of pregnancy will preclude many of the usual measures adopted by conventional medical treatment. Ovarian cysts surgery is such impossibility during this time. Hence, it is always advisable to look at alternative natural forms of treatment that can help cure ovarian cysts during pregnancy, without the usual hazards of conventional mainstream treatment. One of the best means to address the problem is by taking recourse to the holistic approach. Due to its intrinsic safe nature, holistic approach can prove to be extremely beneficial in treating ovarian cysts while posing no threat to the pregnancy. Other advantages include:

• Holistic approach is one of the safest and most benign modes of treatment that a pregnant woman can adopt. It can be started during any phase of pregnancy and the patient can always rest assured knowing that it will pose no danger for her or the unborn child.

• Holistic approach addresses the problem at the grass root level and this ensures that the problem does not recur again in the future. This is where holistic approach scores over conventional medical treatment which aims to cure only the symptoms without eradicating the root of the problem. This leaves the patient vulnerable for future attacks and there is always a risk that the condition will appear again later. Holistic approach not only provides relief from ovarian cysts during pregnancy. It goes much further than that and actually roots out the problem for good.

• Holistic approach makes extensive use of natural techniques that are very efficient and incredibly effective, yet mild and benign for the human body. This marks a sharp departure from the aggressive techniques and harsh medication used in conventional forms of treatment. The multidimensional nature of holistic approach lets it explore many different avenues of treatment, instead of remaining stuck with one dogma. This ensures a roaring success eventually.

• Further complications that may arise during pregnancy are effectively avoided by adopting the holistic approach. Ovarian cysts may rupture and lead to rapid deterioration of the condition. Holistic approach helps one overcome these threats by keeping the condition under control and preventing it from developing complications. This ultimately ensures a safe and uneventful pregnancy even if a woman has ovarian cysts.

Holistic approach also helps at an emotional level and can help relieve stress and anxiety that are usually experienced by most women during pregnancy. The holistic practitioner often acts as a counselor who can help put your fears to rest, relieve your tension, lower your stress levels and clear your doubts. You will be amazed to find a whole new degree of confidence and vigor that will enable you to enjoy your pregnancy while getting your ovarian cysts cured simultaneously.

Your chosen holistic practitioner will advise you on the best course of action to treat your specific case of ovarian cysts and pregnancy. Don’t delay if you are pregnant and you know to have ovarian cysts? Start a treatment today to avoid further risks and head for complete recovery quickly.

Heartburn in pregnancy is caused by a muscular weakness. The muscle involved is the lower esophageal sphincter (LES), a ring of muscle between your stomach and esophagus. The LES is designed to relax when you swallow food so that the food can enter the stomach. Once the food is in the stomach, the LES is to tighten, keeping food and stomach acids from flowing back into your esophagus. If the LES always worked properly, no one would ever suffer heartburn in pregnancy.

Like many other parts of the body, however, the LES is affected by pregnancy. Heartburn in pregnancy is a frequent complaint.

Common Question about Heartburn in Pregnancy

When does heartburn start in pregnancy? How soon in pregnancy do you get heartburn? When should I expect heartburn in pregnancy? The question varies, but the answer is always the same. Heartburn in pregnancy usually begins around the fifth month. From that point forward, it may come and go until you give birth.

How do you treat heartburn in pregnancy?

Pregnancy Heartburn Treatment

Pregnancy heartburn treatment begins with an understanding of the relationship between heartburn and pregnancy. Why is it that at this time when you are so happy to be expecting, you suddenly have heartburn?

With pregnancy, the placenta produces progesterone, a hormone that relaxes the uterus’ smooth muscles. It relaxes some other muscles, too, one of which can be the LES separating the esophagus and stomach. As progesterone relaxes the LES, it fails to close and/or remain tightly closed. This allows acids to flow back into the esophagus, causing heartburn. Progesterone also affects the contractions of the esophagus, slowing the wavelike action. This, too, contributes to heartburn in pregnancy.

As your pregnancy progresses and your baby grows, your abdominal cavity will become crowded. The limited space will be taken up increasingly by the growing, moving infant. This puts pressure on the stomach, which in turn pressures the LES to open. Heartburn can quickly result as stomach acids are pushed into the esophagus.

Steps of Pregnancy Heartburn Treatment

Your healthcare provider will warn you not to take medications that might harm the baby. There are steps you can take, however, to treat heartburn in pregnancy.

1. Watch your weight gain. Ask your physician how much you should reasonably gain, and be careful to keep your weight to that limit. Excess weight will place more pressure on the LES and increase heartburn.

2. Avoid tight clothing, especially around your waist and abdomen. Tight clothing also contributes to pressure on the LES muscle ring.

3. When bending, bend at the knees rather than at the waist. Bending at the waist is a common cause of heartburn in pregnancy.

4. Eat several small meals during the day in place of three larger meals. Eat slowly and chew your food well.

5. Have your last meal or snack at least two to three hours before bedtime. Allowing food to digest before you lie down can reduce heartburn.

6. Although you will want to drink eight to ten glasses of water daily, you should Avoid drinking large amounts of liquid during meals. Try to remember that a distended stomach will pressure the LES and cause heartburn.

7. Ward off potential heartburn by chewing gum after eating. The chewing action can help release air bubbles that contribute to heartburn and the gum stimulates the production of saliva, which can help neutralize acid.

CAUTION: The author is not a professional physician, and offers this information about heartburn in pregnancy for educational purposes only. Please seek advice from your health care provider.

During pregnancy, the hormones in the body undergo changes. That may cause acne during the early pregnancy. In later period acne often clears. Since you have to use every medication very carefully during pregnancy, let us find out about what cannot be used.

Some of the medications that are to be avoided during pregnancy are: Vitamin A derivatives, Tetracyclin Antibiotics, Hormones and Salicylic acid preparations.

Vitamin A Derivatives:

Molecule such as Isotretinoin that is very potent for acne treatment must be totally avoided during, before, and after pregnancy. It may produce birth defects in the fetus and should never be taken during pregnancy. Other vitamin A topical molecules such as tretinoin, tazarotene, etc. carry warnings about their use during pregnancy and while breast-feeding. They should also be avoided. Retinoids are becoming very popular and some cosmetics contain retinoids. Please use any skin care product only after consulting your doctor.

Tetracycline group of antibiotics:

Tetracycline and its derivatives such as doxycycline may affect the bone growth and discolor teeth of the fetus, and the breast-fed child. Avoid use of any antibiotic without consulting your doctor.

Hormone Therapy For Acne:

Female hormones are widely used to treat acne. Flutamide and Spironolactone may be passed to the fetus and cause birth defects. Estrogens and other anti androgens should not be used during pregnancy. It is yet not known if these hormones are passed to the breast-feeding child. They should therefore be avoided during breast-feeding. As a cautionary measure, during pregnancy and while breast-feeding use every medication only after consulting your doctor.

This article is only for informative purposes. This article is not intended to be a medical advise and it is not a substitute for professional medical advice. Please consult your doctor for your medical concerns. Please follow any tip given in this article only after consulting your doctor. The author is not liable for any outcome or damage resulting from information obtained from this article.