Pregnancy questions 101 - part 2

The excitement of finding out you’re expecting often causes soon-to-be-moms’ thoughts to centre around buying gorgeous baby outfits and strollers, and choosing colour schemes for the nursery, rather than asking their gynae questions. Obstetrician and gynaecologist Dr Philip Zinn answers some important questions that pregnant women should be asking.

Are there additional non-routine screening tests I can do, and are there any risks involved?
Additional blood tests are usually requested for women with a specific risk profile. These tests include:
•  A diabetes screening, which involves a glucose challenge test: a full glucose tolerance test that should be done in higher-risk women at 28 weeks of pregnancy (for those who are overweight, have a first degree relative who has type 2 diabetes, or who consistently have sugar in their urine (persistent glycosuria).
•  A kidney function test will be done if you have high blood pressure or protein in your urine.
•  A toxoplasma immunity test will be conducted if you live with cats, or if you’re a keen gardener, although precautions are usually adequate in protecting against toxoplasma infection.
•  Your thyroid can also be tested, as low levels could affect early foetal brain development.
•  Your iron levels should also be tested, although if your haemoglobin levels (which form part of the routine
screening tests) are normal, a routine iron supplement is usually sufficient.
•  You could also be tested for inherited diseases such as cystic fibrosis, sickle cell disease and thalassaemia.

“If you’re trying to conceive, the best approach is to have a preconceptual assessment done to assess certain risks, such as German measles (rubella) and chicken pox immunity, as vaccinations for these can only be given before conception,” says Dr Zinn.

Which situations should I consider an emergency?
•  Vaginal bleeding
•  A gush or recurring trickle of clear fluid from the vagina
•  Intermittent cramps, especially if they’re regular and get stronger and closer together
•  When experiencing constant or severe abdominal or lower back pain
•  Increasing cramping and diarrhoea – this can be a sign of an impending miscarriage or preterm labour
•  An obvious decrease in foetal movement during the third trimester
•  A sudden increase in swelling, especially in your face
•  A persistent headache, which doesn’t respond to paracetamol

I had an abortion previously. Will this affect my pregnancy?
A spontaneous abortion won’t affect a future pregnancy unless there’s a recurring cause. The majority of abortions are sporadic and don’t bring about the need for special tests, but if there are other medical conditions or if it’s happened many times, then testing may be necessary. This should be discussed before or very early on in pregnancy. An uncomplicated first trimester abortion procedure, which is performed safely, won’t affect a future pregnancy. A late abortion procedure could however influence the strength of the cervix in a future pregnancy. A serial ultrasound assessment of the cervix during pregnancy may give some warning of a weakened cervix.

Should I get genetic counselling?
If there’s a known or suspected familial condition that could jeopardise the health of the baby, counselling can be useful.
In many conditions, the genetic signatures are unknown and can’t be tested for in advance, but advice can be sought from your doctor or a clinical geneticist.

Couples who experience recurrent miscarriages can be tested for abnormal chromosomes, and if found, the risk of recurrence and diagnostic options can be discussed. Certain population groups have a higher incidence of congenital diseases such as cystic fibrosis, Tay-Sachs disease and thalassaemia, and genetic testing for gene carrier status is useful in these cases. 

I had a couple of drinks a few times before I knew I was pregnant. Could the alcohol have harmed my baby?
Clear evidence for the effect of low levels of alcohol in pregnancy has been lacking. We are aware that heavy drinking (five or more drinks in a session) around the time of conception increases the risk of miscarriage and foetal abnormalities. Some pregnant women may be more vulnerable to the effect of alcohol, and we know that alcohol crosses the placenta. The principle of avoiding or reducing alcohol intake to a minimum when planning a pregnancy is the best advice. Early diagnosis of pregnancy and avoiding alcohol from this time on is important.

Can being anaemic during pregnancy be dangerous for the baby?
Anaemia is caused by an iron deficiency, but supplementing during pregnancy is usually sufficient. Anaemia is identified through a haemoglobin test, routinely done at your first prenatal doctor’s visit, and may be repeated at a later stage of pregnancy.

A concern of anaemia is the reduced reserves available to the mother in circumstances of heavy blood loss. Even mild anaemia can cause excessive fatigue, shortness of breath and dizziness. When more severe, it can influence the foetal growth and has been associated with preterm labour. The baby gets preference for any circulating iron and oxygen in
Mom’s blood, so he’ll do better than Mom most of the time.

What will happen if I accidentally sleep on my stomach? Will my baby be okay?
Your baby is well protected in your uterus. We all move around regularly while we sleep, so don’t worry. Your body will tell
you when you need to move.

I sometimes have trouble breathing, even when I’m not exerting energy. Why does this happen, and does it mean my baby isn’t getting enough oxygen?
Provided you’re healthy and not anaemic, shortness of breath is common during pregnancy. The high progesterone levels
in your body as a result of the pregnancy make you feel as though you can’t breathe deeply enough. However, if you experience a significant change that worries you, get it checked, as it could even indicate a heart condition or anaemia. The
pressure of a growing tummy on your rib cage also influences your breathing during the later stages of pregnancy. Your baby is well-protected to ensure that he gets enough oxygen. If he’s moving around regularly, rest assured that all is well.

If my baby is lying breech, can he be turned and will I be able to give birth naturally?
A procedure called external cephalic version (ECV) is a recommended option for babies lying breech. This is best performed in the maternity ward with intravenous infusion of medication to relax the uterus. The baby is gently encouraged by the doctor’s hands on Mom’s tummy to roll forward or backwards into a head-down position. Done correctly, it’s not painful or rough.

The procedure may not work, and a C-section will be done if the baby’s in distress. Monitoring is done before and
after the procedure. Women who’ve had other pregnancy problems and previous uterine surgeries are excluded as possible candidates for this procedure. It’s a safe procedure when the guidelines are followed, and has been shown to reduce the rate of C-sections. ECV should only be done at full term (from 37 weeks). It is, however, no longer regarded as safe to have a vaginal birth when a baby is lying breech.

Is it true that I should avoid long car trips on bumpy roads?
A bumpy road isn’t dangerous during pregnancy, only uncomfortable. However, long car trips can cause blood clots to form in the deep veins of your legs (deep vein thrombosis) because you sit still for a long time. Foot exercises, thrombosis prevention stockings, staying hydrated, and regular stops along your journey can prevent this.

What is Group B Strep?
Group B Streptococcus (GBS) is a very common colonising bacterium of the colon and vagina. It’s present in about 20–30% of women and may come and go; it’s asymptomatic and is not an infection. It is however the most common cause of pneumonia in newborns and can lead to septicaemia and meningitis. During labour, the baby can breathe the bacteria in while moving down the birth canal. Some doctors screen for this bacteria at around 36 weeks gestation, but it’s not routine. GBS testing must include a swab sample from the lower vagina and rectum. You can ask your doctor for this test. Treatment requires an intravenous antibiotic during labour. 

Is it risky to have too many scans?
Research hasn’t identified any direct risks. The risk relates more to the false perception that all can be checked during a scan, which creates an unrealistic expectation of medical insight about the health of the baby. And as technology advances, ultrasound can see things that we can’t interpret, or we interpret incorrectly.

This can cause undue anxiety or an unnecessary intervention with its attendant hazards. Research has also shown value in ultrasound beyond the foetal assessment. There are experiential benefits including bonding (for Mom, Dad and other family members), reduced anxiety and a more informed public. Naturally, medical practitioners need to use technology with the appropriate caution and sensitivity to the as yet unknown risks.