With the cesarean section (C-section) rate in the U.S. approaching a staggering 32%, more women are faced with the often difficult decision of whether or not to attempt a vaginal delivery after C-section (VBAC). Of women who attempt VBAC, 30% will end up with another C-section during labor. The 70% of women who have a successful VBAC experience a quicker, less painful recovery and a lower complication rate for baby and mom. But there are risks of complications with VBAC, too. They are rare, but when they do happen they can be extreme. When a woman has a C-section, a cut is made in the lower part of her uterus to pull out the baby. The doctor then sews the uterine incision neatly back together, but it is always a bit weaker. With her next pregnancy, if a vaginal delivery is attempted, the pressure of labor contractions can cause the old uterine scar to break open 1% of the time. If this rare uterine rupture does happen, the mom risks hemorrhage and loss of her uterus. In extremely rare cases, oxygen can be cut off to the baby, leading to brain damage or death. If you have had one to two C-sections, ask yourself these questions as you consider your next delivery. How many kids do I want to have? A scheduled repeat C-section carries its own risks, including bladder injury, infection, and increased rates of NICU admission for the baby. A C-section is a major surgery, and the more of them you have, the higher your chances of complications. The complications related to a fourth C-section are somewhat higher than the third, and a fifth C-section carries extremely high risk. A pregnancy after four C-sections has a 10% chance of the placenta growing into the uterus (a condition called accreta), which is dangerous and usually results in a preterm delivery and a hysterectomy. If you’re thinking about having more than three children, you should strongly consider a VBAC. How important is a vaginal delivery to me? All births are beautiful miracles, but a VBAC delivery is almost triumphant. As the woman delivers, she finally gets to experience the birth that has been two pregnancies in the making. A lot of women have a strong desire to have a vaginal delivery. They feel this is an important life experience, and for them a 1% risk may seem worth it — others not so much. Have I had other vaginal deliveries? If you’ve had other vaginal deliveries before your C-section, your chance of successful VBAC is higher. Your risk of rupture is still there, but your chance for successful vaginal delivery is around 90%. Why did I have my first C-section? Is the reason for your first C-section something that can be changed? Was your first baby a breech 11-pounder, and this one is normal-sized and head down? If so, you might be a good candidate for VBAC. But if you were carrying a normal-sized baby last time, and you went into spontaneous labor and were unable to deliver vaginally, then it’s likely that the same thing could happen again. So, perhaps a repeat C-section might be a better option. There’s no “magic 8 ball of labor” that will tell us for sure if your VBAC will be successful. But if the reason for your first C-section is not present this time, than a vaginal delivery is more likely to be successful. Do my provider and hospital offer VBAC? If you plan to try for a VBAC, you need to make sure your hospital is equipped and your provider is on board. In order to improve the safety of VBACs, hospitals have to be ready at a moment’s notice to do an emergency C-section in case the uterus breaks. When a break happens, the placenta usually becomes detached from the uterus, meaning no oxygen for the baby. The obstetrician must get the baby out very quickly to prevent brain damage from lack of oxygen. If you live in a more rural area, you may need to travel to a more urban hospital in order to get a VBAC. In the end, each woman’s unique pregnancy history will determine whether VBAC is the right option for her. If you’re done having children with two, the chance of an easier recovery may not be worth the risk of rupture. But if you had a terrible experience with your first C-section and have a strong desire to experience natural child birth or want a larger family, then a 1% risk may seem minimal to you. Talk to your provider about your overall chance of a successful VBAC as you carefully weigh the risks and benefits. By Heather Rupe, DO
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(NAPSI)—Ovarian cancer, the eighth most commonly diagnosed and the fifth most common cause of cancer death for women in the UnitedStates, is sometimes called a “silent killer.” There is currently no reliable screening method to detect ovarian cancer and symptoms often go unnoticed. Early stages of ovarian cancer often present symptoms that are more commonly caused by other less serious conditions, such as abdominal pain, swelling or bloating, or pelvic pressure. As a result of late diagnosis, 75 percent of patients have ovarian cancer that has spread to nearby organs. The five-year survival rate for these ovarian cancer patients is less than 50 percent. “It is vitally important for women to understand that their risk of developing ovarian cancer and subsequent prognosis is influenced by several factors, including age, environmental and lifestyle factors, early stage of diagnosis, and family history,” said Sue Friedman, founder and Executive Director of Facing Our Risk of Cancer Empowered. “Additionally, the risk of developing ovarian cancer is increased in women with specific inherited genetic abnormalities. One of these risks is associated with BRCA 1 and BRCA 2 mutations.” Consider these facts and work with your doctor to understand your options for ovarian cancer treatment. Ovarian cancer facts and figures: • Approximately 22,000 U.S. women will be diagnosed with ovarian cancer in 2014. • Ovarian cancer is a disease in which cells in the ovaries grow out of control and form tumors, which are abnormal tissues that serve no function. • All women are at risk for ovarian cancer; however, roughly 90 percent of women who are diagnosed with ovarian cancer are older than 40. • The greatest number of ovarian cancers occur in women aged 60 years or older. • High-grade serous cancer is the most common and aggressive form of ovarian cancer. • Approximately 60-80 percent of ovarian cancer is of the serous subtype and as many as 95 percent of advanced ovarian cancers are of the serous subtype. • BRCA gene mutations can play a key role in serous ovarian cancer. In the general population, 1.4 percent of women will be diagnosed with ovarian cancer, while up to 40 percent of women with BRCA ½ mutations will be diagnosed with ovarian cancer in their lifetime. If you are living with ovarian cancer, be sure to talk to your doctor about all of your treatment options. And if someone you know has ovarian cancer or may be at risk, please visit www.myOCjourney.com, which is sponsored by AstraZeneca and designed to provide the support you need to live your best life as you fight ovarian cancer. this article comes from AstraZeneca Find out which common habits could make it harder to conceive By Leah Fessler, Women’s Health You know it takes a healthy woman (and man) to make a healthy baby. But sometimes, it can be way harder to conceive than you’d like–even if it’s the right time, with the right guy, and solid health. Turns out your fertility can be affected by many more factors than you might have thought. So, if you’re trying to get pregnant, or even if you can foresee a little you sometime in the future, it’s important to learn what (often easy!) lifestyle changes might be in stock. Ready to boost your baby-making potential? Here are 17 things that can mess with your fertility: Artificial Nighttime Light We know it’s bad to stare at smartphone or tablet screens at night, but these habits can mess with more than just your sleep cycle. According to research published in the journalFertility and Sterility, artificial nighttime light exposure can harm both your ability to conceive and fetal development if you’re already pregnant. Late-night light exposure can suppress melatonin production, the “sleep hormone,” that’s also produced in the reproductive tract and blocks eggs from damaging free radicals, particularly during ovulation. Insufficient melatonin production can also disrupt a developing fetus’ internal clock, resulting in long-term problems, researchers suggest. Junk Food If you’re not consuming the right nutrients (think monounsaturated fats, zinc, vitamin D, and B6), you could be disrupting your body’s regulation of critical reproductive hormones like progesterone, insulin, and testosterone. Pick up these 5 healthy foods on your next grocery trip to boost your body’s baby-making potential. Plus, make sure you’re eating a hefty and nutritious breakfast: Research published inClinical Science found that consuming about half of your daily calories in the a.m. could increase your fertility. Your Cholesterol AND His High cholesterol won’t just harm your heart–it can also negatively impact your ability to conceive, according to a recent study in the Journal of Endocrinology and Metabolism. Researchers found that high free cholesterol in women was associated with a longer time trying to get pregnant. But get this: When both male and female partners had high cholesterol, it was even harder to get pregnant, compared to couples with normal cholesterol levels. These results held true even after adjusting for age and BMI. So, if you and your guy are hopeful for a third member, make sureboth of you check those cholesterol levels stat. Stress If you’re having a hard time getting pregnant, a spa day or yoga class could certainly be in order; a study published this year in the journal Human Reproduction found that high stress levels are associated with an increased risk of infertility. Researchers found that women with high levels of alpha-amylase (a stress hormone associated with your sympathetic nerve system) had a 29 percent lower chance of pregnancy and were two times more at risk for infertility than women with low alpha-amylase levels. No time to zip off to your favorite beach resort? Thankfully, we’ve rounded up a ton of ways to relieve stress in just five minutes or less (hint: they include chocolate!). Poor Oral Health Those pearly whites boast benefits far beyond the perfect profile picture. A study in the Journal of Periodontologyfound that women who needed fertility treatments had higher levels of gum bleeding and inflammation than those who conceived naturally. “Several studies have indicated thata woman’s oral health may be related to her reproductive success,” says Susan Karabin, D.D.S., a spokesperson for the American Academy of Periodontology. So make sure to brush, floss, and make it to your exam every six months. Smoking Hopefully, an increased risk of lung and breast cancer has made you ditch this extremely unhealthy habit. If not, perhaps this will: The American Society for Reproductive Medicine (ASRM) estimates that smoking is linked to 13 percent of infertility cases. Plus, a study in Tobacco Control found that women who were exposed to secondhand smoke six or more hours a day as adults were 36 percent more likely to have trouble conceiving. Thankfully, your fertility level will return to normal in about a year, so if you’re trying to get pregnant (or just live a longer, healthier life), cut out the cigarettes—and tell your friends and family to do the same. Your Weight In case you need another reason to hit the gym (or scale down your fitness routine if it’s extremely intensive): “Being overweight is a huge issue if you’re trying to get pregnant,” according to ob-gyn Mary Jane Minkin, M.D., clinical professor at the Yale School of Medicine. That’s because an unhealthy weight can mess with your periods and ovulation. Additionally, The American Society for Reproductive Medicine estimates that 12 percent of infertility cases are because of weight-related issues. But being underweight can be equally harmful. “Losing a significant amount of weight or excessive exercise, particularly if your BMI drops below 18 or 19, can cause lack of ovulation in extreme cases and thus affect fertility,” says ob-gyn Alyssa Dweck, M.D., coauthor of V is for Vagina. Consider this a reminder of all the amazing benefits of maintaining a healthy weight that have nothing to do with how you look. Hormonal Imbalances We know the thyroid is key to metabolism regulation, but it can also affect your ability to conceive, says Dweck. “Thyroid abnormalities may very well lead to infertility because alterations in the thyroid hormone—whether one is hyper- or hypothyroid—interfere with ovulation. Thankfully, proper use of medications and other prescribed treatments can likely correct this,” says Dweck. Read more tofind out if you could have a thyroid disorder. Medications "There are certain medications, particularly certain antidepressants and mood stabilizers, that can affect your ability to conceive by making your body produce more prolactin, a hormone that interferes with ovulation," says Minkin. So if you’re thinking about getting pregnant, talk to an ob-gyn about what medications are safe or unsafe, what might affect your ability to conceive, and which ones you’re currently taking, says Minkin. That way you may be able to find an alternative that won’t interfere with getting pregnant. Your Age Oh, the biological clock; just mentioning it makes many of us totally anxious. While many women are postponing pregnancy until later in life–whether because of their career, relationship status, or hey, they just want to (we’re busy, people!)–it’s important to realize that fertility doesn’t last forever. “Fertility for women naturally starts to decline slowly after age 32,” says Dweck. “More notably after 35 and even more pronounced after 40. Women do not produce more eggs with age, but instead are born with a finite amount. Over time, the number and quality of eggs decrease.” That said, it’s definitely possible to conceive after age 35. If you’re still seeing no success after six months of trying (compared to a year, if you’re under 35), be sure to see an ob-gyn to discuss potential complications and treatments, suggests Minkin. Breastfeeding First things first: That old wives tale about breastfeeding making it impossible to get pregnant is totally false—it’s not birth control. However, it could make it harder to get pregnant. “If you are still breastfeeding one child while going for a second it can significantly impact fertility, as high secretion of prolactin, the hormone that you make when you lactate, can interfere with ovulation,” says Minkin. Your Cervical Mucus This fluid secreted by the cervix is crucial when it comes to baby making since it helps to protect the sperm as it travels through the female reproductive tract. (Weird right? Here arenine more things you didn’t know about sperm.) Cervical mucus abnormalities may cause infertility, usually if it’s too thick, says Dweck. But luckily, this is usually treated with medication or overcome with intrauterine insemination. Another reason to quit smoking: In women, tobacco changes the cervical mucus, thus making it harder for the sperm to reach the egg, says Dweck. Lubricants Yes, they can make the process way more fun (and comfortable), but some lubes can challenge conception. “Certain lubricants can actually impair fertility by affecting sperm,” says Dweck. “If you are having issues conceiving and feeling dry during intercourse, try a sperm-friendly lubricant such as Pre-Seed, available over the counter.” Uterine Polyps or Fibroids Uterine polyps are typically small, oval or round overgrowths of endometrial tissue that remain attached to the uterine wall, and uterine fibroids are basically the same, but are composed of muscular tissue. “These benign growths may actually cause infertility,” says Dweck. “Luckily, many issues with uterine polyps or fibroids are easily correctable with surgery.” Folic Acid Deficiency If there’s one vitamin you need to be taking when you’re trying to get pregnant (and if you foresee pregnancy in the future!), it’s folic acid. Your body uses this vital B-complex vitamin to create red blood cells, and it’s crucial for expecting mothers. So how much do you need? Minkin advises up to 400 micrograms of folic acid every day. The easiest (and most reliable) way to secure this intake is by taking a daily folic acid supplement (most have 400 mcg). You can also nosh on sunflower seeds, spinach, eggs and grains like pastas and cereals for a boost. Find out if you’re getting enough folic acid. Phthalates You might be much more familiar with this baby-making threat than you think: Phthalates are a group of synthetic chemicals used in plastics and some cosmetics. According to a study presented last year at the annual meeting of the European Society of Human Reproduction and Embryology, they might compromise your ability to conceive. Previous studies have shown phthalate exposure can mess with a man’s fertility, and this study found that women with the most phthalates in their systems were twice as likely to suffer from implantation failure after IVF procedures as women with the lowest level of phthalates. Learn more about how to minimize your phthalate exposure here. Chronic Health Conditions Certain health issues, like endometriosis and diabetes, can have a significant impact on your ability to get pregnant. Read more about endometriosis and your fertility, and check out what you need to know about gestational diabetes. If you're a mom-to-be bent on keeping up your workout routine, the trick is to consult your doctor, know your limit and have a plan for each trimester. “Pregnancy should not be a state of confinement,” said Raul Artal, chairman of the department of obstetrics, gynecology and women's health at Saint Louis University School of Medicine. “Healthy pregnant women should stay active, but take into account that their bodies change during pregnancy.” Artal, an author of the American College of Obstetricians and Gynecologists' guidelines on exercise during pregnancy, advises women to maintain their current level of training, whether it's biking, running or lifting. If you were squatting 125 pounds before donning maternity wear, then you can probably keep it up as elastic-waist pants take over your closet. You may have to lower the weight as the pregnancy progresses, however, if you start developing back pain. It's common for pregnant women to suffer from lordosis, a curvature of the spine that can cause lower back pain during strength training, Artal said. Proper technique is essential to prevent injury, especially at the tail-end of the pregnancy when your body will have a buildup in relaxin, a hormone that loosens ligaments for an easier delivery, said Michelle Mottola, director of the R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab at the University of Western Ontario. Joints might be prone to injury because of the higher hormone levels. So it's best to cut out any exercises that require rapid changes in direction or bouncing — no split jumps or burpees. And isometric exercise — the sorts of moves that require hold periods — is best left for post-pregnancy workouts. Stick to static moves such as squats, which are good for strengthening your abdominals and pelvic floor, the muscles and ligaments that support the womb, said Lisa Reed, a Washington-based trainer. She designs fitness and nutrition programs for each trimester of pregnancy and post-delivery. “The biggest thing with prenatal clients is strengthening the pelvic floor and abdominals,” Reed said. “Abdominals are going to be vital to car-rying the baby, to your posture and to the pushing stages of labor.” Reed also encourages clients in the third trimester to sit on the floor with a stability ball behind their back, pushing against the ball and taking deep breaths in and out. “As you exhale and push your lower back in, you are actually using your abs to exhale,” she said. “Pregnant women have to be really conscious of their breathing and remain hydrated throughout their workout.” By Danielle Douglas, Washington Post | August 24, 2014 DHA an omega 3 fatty acid is a structural component of brain , retina and other organs. It is available from maternal milk and fish oils. It has gained attention as a supplement for pregnancy improving babys attention and visual activity. article from: http://www.today.com/health/pregnant-women-should-eat-more-fish-fda-says-2D79784462 , by Stacey Naggiar Polycystic ovaries - when 12 or more peripheral follicular cysts are found in the ovaries on ultrasound.
All other symptoms including infertility, irregular or abnormal periods and obesity are related to these three main problems. Tests that your doctor may ask you to do: - An ultrasound - Blood tests that test the levels of the hormones testosterone, FSH, LH, prolactin etc. - Blood tests for sugar, especially two hours after breakfast. Link with infertility The first detection of PCOS is usually made when couples try to get pregnant but cannot conceive. The most common cause of infertility around the world is PCOS. When women are affected by PCOS they may not ovulate every month and there may be several months during which there is no ovulation. Therefore a couple may be trying to get pregnant for many months before they can actually get pregnant. This can be disheartening for many women. Having PCOS doesn't mean you can't get pregnant. It just means you might require a little more time than usual to get pregnant. In some cases certain treatments and lifestyle changes may be required. All women with PCOS can conceive by diet or exercise, medications like metformin or clomiphene citrate or ovulation induction with gonadotrophins. A minor surgical procedure known as laparoscopic ovarian diathermy may be required. The most important thing to remember is that having PCOS does not mean you will not be able to get pregnant. If you are diagnosed with PCOS, don't lose hope. Treatments or lifestyle changes can help you conceive. Treatment The first step after PCOS detection should be weight loss. All women diagnosed with PCOS are usually slightly overweight. Regular exercise and having a sugar restricted diet will help you lose weight and will improve symptoms of PCOS. PCOS is related to insulin and diabetes. This is why it is recommended that you avoid having very sweet foods. This is so important that many women with PCOS could conceive simply by losing weight. It is important to eat high GI foods like high GI rice (available under the brand name Purnava in most departmental stores and some pharmacies) and wholegrain flour. Include phytoestrogens in your diet. These are basically chemicals that act like oestrogen in the body. Though there is some controversy regarding whether these naturally occurring chemicals can help or not, a lot of women have reported positive results by simply increasing intake of phytoestrogens. Phytoestrogens are present in flax seeds (found in muesli), soya milk and tofu. These are normally not a part of our diets but this chemical is present in the highest amount in these foods. Other foods that contain it include peas, beans, cabbage, broccoli, bok choy, carrots, etc. Try increasing your intake of these foods and see if they help you. Your doctor may recommend birth control pills to make you have a regular cycle. You may also be asked to take ovulation inducing drugs which are basically hormones that help cause ovulation. Clomiphene and metformin are also prescribed to help you get pregnant. There are also many drugs prescribed to help you with acne and other symptoms. Precautions It is very difficult to predict who will get PCOS. There is no direct cause for it. However, emphasising on a balanced diet and a healthy lifestyle for young girls may be useful. The most valuable lesson you may give to your daughter would be to teach her the importance of exercise. This is more important for those who have PCOS in the family. The unhealthy nature of modern living -- including the toxins that we ingest with our food -- may be the reason for this sudden spike in PCOS cases. It is not possible to completely omit all the pesticides and preservatives from your life but it might benefit you if you try to restrict them as much as possible. from: http://www.thedailystar.net/polycystic-ovarian-syndrome-a-silent-misery-24626 |
Dr. Jaspal SachdevDr.Jaspal Singh Sachdev is the Resident Consultant and Head of Unit of Obstetrics and Gynaecology at Park City Medical Centre a Ramsay Sime Darby Hospital. Archives
December 2016
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