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Illnesses and Conditions of Pregnancy

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How do you tell if a condition of pregnancy is actually a risk for pregnancy, for labor or for birth or after? If you are given a diagnosis of a condition, is it an illness that needs treatment? A condition that needs watchful attention? Or is it a statement of what is currently happening with your pregnancy? It’s hard to thread through this type of information.

And what if a doctor doesn’t actually give you a diagnosis but instead says that you are “low normal” or “high normal”? What does all of this mean and how do you figure it out?

A diagnosis is often just giving a name to a set of things that are happening to a mother and/or her baby.  Sometimes, this is a list of symptoms that equal a diagnosis, sometimes, it’s a response diagnosis to a particular set of tests and the given results.

If you are given a test, there is a range of what we call “normal”. Normal is what the average population, the average mother, should fall into if she is given the test at the same time every other mother is given it. It’s an average. For some mothers, however, their normal may be a bit lower or a bit higher than other mothers. A personal normal is not always in the same range as average normal. A good example is due dates. While we know that due dates are an average, almost every mother out there is going to have her baby before or after her due date. It’s a guess based on averages of when mothers will go into labor.

So what is the problem with a range of normal? Some moms are not going to fall in that range and they will be treated as if they have a medical condition or that something needs to be done.

What is “real” and what is “borderline”?  Keep in mind BORDERLINE is not a reason for over-medicalization of birth. If you are low normal, watchful behavior on the part of your care provider is called for but that is not an automatic indication that interference is needed. You and your care provider should both share your concerns, do research on possibilities, symptoms and what to watch for, then make decisions on when action is indicated or necessary.

Common Tests During Infertility, Pregnancy and Childbirth

Is induction reasonable or is it not?

Is a cesarean reasonable?

Induction

Sweeping Membranes

PROM/AROM/SROM

Low Placenta vs. Placenta Previa and other placenta problems

Fecal and Urinary Incontince (actually a condition of postpartum)

Gestational Diabetes

Incompetent Cervix and Preterm Labor

Irritable Uterus

Pregnancy Induced Hypertension (PIH)

Post-Dates or “Late” babies:

Here is a good overview of postdates: http://www.mdlinx.com/obstetrics-gynecology/newsl-article.cfm/3751506/ZZ6566495150134827269204/?news_id=1189&newsdt=092111&subspec_id=102

Prolonged pregnancy
Obstetrics, Gynaecology & Reproductive Medicine, 09/15/2011

Simpson PD et al. – The alternative approach of expectant management with serial fetal surveillance, whilst awaiting the onset of spontaneous labour, has been advocated. The optimal method and timing of such fetal surveillance have not yet been established, but current NICE guidelines suggest twice–weekly cardiotocography and ultrasound estimation of maximum amniotic pool depth from 42 weeks gestation. Resources and maternal wishes must be considered when managing a prolonged pregnancy.

  • Prolonged pregnancy is defined as a pregnancy lasting more than 294 days (i.e. 42 weeks’ gestation).
  • Measurement of the crown-rump length during a first trimester ultrasound is a reliable method of estimating gestation and is relied upon to define prolonged pregnancy.
  • Prolonged pregnancy is recognised as a high-risk problem but the aetiology remains unknown.
  • It is associated with increased adverse outcome for both the mother and the fetus.
  • Perinatal morbidity and mortality are significantly increased and, for that reason, most obstetric units offer routine induction of labour between 41 and 42 weeks of gestation to minimise the adverse perinatal risks.
  • However, there is no clear evidence about the optimum time to deliver.

 

Breech:

Breech is a condition of pregnancy, not an illness. Some babies, rather than being head down in the birth canal, are head up, near the ribcage. As mothers get closer to term and even beyond term, babies can and do turn to face head-down but some babies, for whatever reason (there is no evidence that it’s a lack of room) never decide to turn.

Conditions of the Baby:

Shoulder dystocia:

A Comparison of Obstetric Maneuvers for the Acute Management of Shoulder Dystocia
Obstetrics and Gynecology, 05/24/2011

Hoffman MK et al. – Delivery of the posterior shoulder should be considered following the McRoberts maneuver and suprapubic pressure in the management of shoulder dystocia. The need for additional maneuvers was associated with higher rates of neonatal injury.

Methods

  • Using an electronic database encompassing 206,969 deliveries, all women with a vertex fetus beyond 34 0/7 weeks of gestation who incurred a shoulder dystocia during the process of delivery were identified.
  • Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded.
  • Medical records of all cases were reviewed by trained abstractors.
  • Cases involving neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, or hypoxic–ischemic encephalopathy or intrapartum neonatal death attributed to the shoulder dystocia) were compared with those without injury.

 

Results

  • Among 132,098 women who delivered a term cephalic liveborn fetus vaginally, 2,018 incurred a shoulder dystocia (1.5%), and 101 (5.2%) of these incurred a neonatal injury.
  • Delivery of the posterior shoulder was associated with the highest rate of delivery when compared with other maneuvers (84.4% compared with 24.3–72.0% for other maneuvers; P<.005 to P<.001) and similar rates of neonatal injury (8.4% compared with 6.1–14.0%; P=.23 to P=.7).
  • The total number of maneuvers performed significantly correlated with the rate of neonatal injury (P<.001).

Low AFI

Obesity in Pregnancy:

Plus-Size Pregnancy Index

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