Pregnancy Tips: Will Exercise Make Giving Birth Easier?

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from "Great Expectations by Today's Parents magazine

I am 30 weeks pregnant and have not been exercising very much. I would like to start now as the antenatal class instructor says exercising will make the birth easier. What is the most appropriate exercise for me to start with in order to prepare me for labour?

Resuming your normal activities is recommended. The most appropriate exercises will be slow walking and swimming.

Source: Pregnancy Tips: Will Exercise Make Giving Birth Easier?

Pregnancy Tips: Water Breaking vs. Normal Leakage

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from "Great Expectations by Today's Parents magazine

How do you distinguish between water breaking and normal leakage?
Water breaking should not happen before pregnant women go into labour. It does not happen before labour (anytime before 37 weeks). You should consult a gynaecologist as soon as pre-term pre-labour rupture of membrane (pprom) happens. There is no normal leakage, only vaginal discharge.

Source: Pregnancy Tips: Water Breaking vs. Normal Leakage

Pregnancy Tips: Should I Worry About Yellowish Discharge From Breast?

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from "Great Expectations by Today's Parents magazine

I am now 32 weeks pregnant. A few days ago, after my shower, there was some yellowish discharge from my breast. Is this discharge from the nipples colostrum? How can I stop it from flowing out? Will I have enough colostrum to give my new baby when I deliver, if it continues?

During the last trimester, there will be a small amount of milky discharge from the nipples called colostrum. Do not squeeze or stimulate the nipples as it will usually stop on its own. Yes, you will have enough colostrum to give your baby when you deliver.

Source: Pregnancy Tips: Should I Worry About Yellowish Discharge From Breast?

Pregnancy Tips: What Is Dilatated Renal Pelvis?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from "Great Expectations" by Today's Parents magazine

I’VE JUST HAD MY 20-WEEK ANOMALY SCAN AND HAVE BEEN TOLD MY BABY HAS A DILATATED RENAL PELVIS. ALTHOUGH I’VE BEEN REASSURED THIS CONDITION WILL PROBABLY CORRECT ITSELF, I’M WORRIED.

Mild renal pelvic dilatation (swelling of the collecting system in the foetal kidney) occurs in 1 to 3 percent of pregnancies. It is more common in male foetuses. It is usually defined as an antero-posterior diameter of > 5 mm before 24 weeks and > 7 mm after 25 weeks.

Usually the condition will resolve on its own, but worsening renal pelvis dilatation may be due to some underlying problem in the urinary tract like obstruction, or certain abnormalities in formation of the kidney, for example, a duplex kidney or a multicystic kidney. If there is no family history of kidney disease, and there are no other abnormal findings on ultrasound, the outcome in the baby depends on whether the dilatation worsens as the pregnancy progresses.

If there are no other abnormal findings in addition to the dilatated renal pelvis, there is no need to check for chromosomal abnormalities in the foetus.

If the dilatation remains static or is less than 10mm, then an ultrasound scan of the urinary system will be done three to four days after birth. If this is normal, a follow up scan should be repeated one, six or 12 months later.

Unfortunately, the clinical significance of persistent neonatal renal pelvic dilatation is unknown as long-term follow up studies are not available. Even if the dilatation persists, the likelihood of serious urinary tract problems is very low.

If the dilatation is > 10 mm in a follow up ultrasound scan after 28 weeks gestation, your baby will be continued to be monitored closely after birth and other specialized tests of urinary tract function may be necessary.

Source: Pregnancy Tips: What Is Dilatated Renal Pelvis?

Pregnancy Tips: Can I Choose Natural Birth Even After C-Section?

GREAT EXPECTATIONS
By Dr Low Kah Tzay, Paediatrician | Mt. Elizabeth Hospital
reprinted with permission from "Great Expectations by Today's Parents magazine

I had a C-section during my first pregnancy due to bleeding at 32 weeks.
After a three-year gap, will there be any risk involved if I choose a natural birth for my second pregnancy?

The few studies available suggest that an interpregnancy interval shorter than 18 months and longer than 59 months are significantly associated with increased risk of adverse perinatal outcomes.

There is emerging evidence that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous Caesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa).

Hence, a three-year gap is an advantage.

The main risk in attempting a vaginal delivery after a Lower Segment Caesarean Section (also called VBAC, or Vaginal Birth After Caesarean Section) is an increased risk of uterine rupture (tearing open of the uterine wall) during the delivery.

The risk of rupture is 0.2 to 1.5 percent.

The rate of foetal death is low with both VBAC and C-section.

However, because the risk of foetal death increases with uterine rupture, foetal death occurs more frequently with VBAC than with repeat Caesarean delivery. Maternal death is rare with either type of delivery. VBAC is an acceptable option for women in the following situations:

* Does not have other conditions (as an example, placenta previa) that requires Caesarean delivery

* Has only one low transverse uterine incision from a past Caesarean delivery

* Has no other uterine scars (eg from a previous surgery for fi broid removal) and has never experienced a uterine rupture

* Does not have pelvic problems or abnormalities that prevent vaginal delivery

* The baby is in the proper position (head down)

In addition, VBAC should only be considered if facilities are available or an immediate Caesarean Section should it be necessary.

Dr. Low Kah Tzay is a paediatrician working at Mt Elizabeth Hospital. He specializes in the management of growth and development of children; such as feeding difficulties, language delay, sleep disorders, attention disorders, autistic spectral disorders and learning difficulties. His website: www.pediatricdoctor.net.

Source: Pregnancy Tips: Can I Choose Natural Birth Even After C-Section?

Pregnancy Tips: What Are Fibroids And How Do They Affect Conception?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from "Great Expectations" by Today's Parents magazine
I HAVE BEEN TRYING UNSUCCESSFULLY TO CONCEIVE FOR THE LAST SEVEN MONTHS. MY GYNAE DISCOVERED I HAVE FIBROIDS. WHAT SHOULD I DO AND HOW DOES THIS AFFECT MY CHANCES OF HAVING A CHILD?

Uterine Fibroids (myoma or leiomyoma) are very common – they are benign (noncancerous) growths of the uterine muscle. The size and location of the fibroids are important. The large majority of them are very small or located in an area of the uterus such that they will not have any impact on reproductive function.

There are three general locations for fibroids:

(1) Subserosal – on the outside surface of the uterus
(2) Intramural – within the muscular wall of the uterus, and
(3) Submucous – bulging into the uterine cavity.

The only type that will have any impact on reproductive function (unless it is very large) is the submucous type that is within the uterine cavity. These are much less common than the other two types of fibroids.

Because of their location inside the uterine cavity, submucous fibroids can cause infertility or miscarriages and may be removed hysteroscopically (a slim instrument inserted through the cervix into the uterus).

Other causes for infertility should be considered before treatment is initiated for subserosal or intramural fibroids which do not distort the uterine cavity.


Studies of infertile women with submucous fibroids distorting the endometrial cavity found significantly lower pregnancy and delivery rates, compared with infertile women without fibroids.

It is important to note that removal of submucous fibroids led to a significant increase in the pregnancy rate compared with the case in infertile women without fibroids.

Source: Pregnancy Tips: What Are Fibroids And How Do They Affect Conception?

Pregnancy Tips: Are Migraine Medications Harmful For Me?

GREAT EXPECTATIONS

By Dr Lai Fon Min

Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from "Great Expectations" by Today's Parents magazine
I AM EXPECTING MY FIRST CHILD AT THE AGE OF 32. I AM PRONE TO MIGRAINES BUT AM AFRAID TO USE ANY MEDICATION AS IT MAY HARM MY BABY. PLEASE ADVISE.
Migraine does not increase the risk for complications of pregnancy for the mother or the foetus.

Several studies have shown a tendency for migraine to improve with pregnancy. Between 60 and 70 percent of women either go into remission or improve significantly, mainly during the second and third trimesters.

Management of migraine during pregnancy should first focus on avoiding potential triggers; for example, stress, change in sleep pattern, bright lights or excessive computer use, irregular meals, smoking, alcohol and certain foods containing red wine or MSG.

Consideration should also be given to non-drug therapies.

If medication becomes necessary, paracetamol (Panadol) can be used safely. NSAIDs (aspirin, ibuprofen, naproxen) can be used as a second choice, but not for long periods of time, and they should be avoided during the last trimester.

A common antimigraine drug is ergot in combination with caffeine – Cafergot. Ergot is contraindicated in pregnancy.

For treatment of severe attacks of migraine, chlorpromazine, dimenhydrinate, and diphenhydramine and metoclopromide can be used to help with the nausea and vomiting in severe attacks; metoclopramide should be restricted to the third trimester.

In some refractory cases, steroids like dexamethasone or prednisone can be considered. Should prophylactic treatment become indicated, the beta-adrenergic receptor antagonists (e.g. propranolol) should be avoided.

Source: Pregnancy Tips: Are Migraine Medications Harmful For Me?

PREGNANCY TIPS: I Caught The Flu, Is It Bad For My Baby?

GREAT EXPECTATIONS

By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Camden Medical Centre
reprinted with permission from "Great Expectations" by Today's Parents magazine

I HAD A BAD FLU AND COUGH RECENTLY WITH A FEVER OF 38° C. I AM AFRAID IT MAY AFFECT MY BABY AS I AM THREE MONTHS PREGNANT. PLEASE ADVISE.

Influenza (commonly called “the flu”) is a common and contagious respiratory illness caused by influenza viruses. The flu can result in severe illness and life-threatening complications.

Influenza usually occurs in epidemics. What you are referring to as “flu” is more likely a “cold”.

Viral infections such as colds and flu are just as common when you’re pregnant as when you’re not, so many women end up worrying about whether a minor illness could harm their unborn child.

In general, there’s probably very little to worry about if it is short-lived and your baby is unlikely to suffer any ill-effects as a result. Because your immune system is affected during pregnancy, you may feel worse than usual.

Any severe or prolonged illness which causes you to be feverish and generally unwell may increase the risk of miscarriage. However, the “baseline” miscarriage rate in the first trimester may be as high as 20 percent, usually due to chromosomal abnormalities.

If your flu does not get better and you begin to cough up green/yellow sputum, experience shortness of breath, persistent chest pain, severe sore throat or a fever of 38 degrees, you should see a doctor. If you are less than 12 weeks pregnant, you should not take medication unless recommended by your doctor.

Source: PREGNANCY TIPS: I Caught The Flu, Is It Bad For My Baby?

Is Your Snoring A Health Risk? (Part 2/2)

Is Your Snoring A Health Risk? (Part 2/2)
When you stop breathing in your sleep it's time to see a doctor for sleep apnoea

By Verlaine S. Ramos | Reprinted with permission from Ezyhealth & Beauty magazine

Click here for previous chapter

Sleep apnoea

In some cases, snoring leads to sleep apnoea. In fact, snoring is the most common clinical symptom of sleep apnoea, says Dr Pang.

Sleep apnoea is when you stop breathing during sleep. The sleep apnoea that occurs among snorers is called obstructive sleep apnoea (OSA), wherein the throat is blocked while one is sleeping.

“Patients may complain of frequent awakenings with a choking and gasping sensation, nocturia (frequent passing of urine at night), or nightmares,” shares Dr Pang.

People suffering from OSA may also feel very tired and irritable during daytime because of the disturbed sleep. They may even find it difficult to stay awake even when doing important tasks like driving.

Snore less and sleep better

Health and lifestyle modifications are essential to reduce one’s snoring. If you are overweight for your height, it’s necessary to shed off the excess kilos. Most doctors will not consider treatment for snoring unless you are near the correct weight and will firstly advise you to lose weight.

If you drink alcohol, consider the amount you drink and the effect it has on your snoring. Try to avoid it for a while and note if it will reduce your snoring. Similarly, consider giving up on your smoking and see the benefits.

If you still experience snoring or sleep apnoea even after doing these measures, it’s time to pay your doctor (an ENT specialist or a respiratory physician) a visit.

This story cannot be reproduced, whether in part or in whole, without the permission of Ezyhealth.

Source: Is Your Snoring A Health Risk? (Part 2/2)

Is Your Snoring A Health Risk? (Part 1/2)

Is Your Snoring A Health Risk? (Part 1/2)
When you stop breathing in your sleep it's time to see a doctor for sleep apnoea

By Verlaine S. Ramos | Reprinted with permission from Ezyhealth & Beauty magazine

IT'S three in the morning and you toss and turn as you try to block off the irritating sound coming from your bed partner. Covering your ears with the pillow doesn’t seem to help, as his snoring becomes louder every minute. You just resign to the fact that you’ll wake up sluggish and puffy eyed again due to lack of sleep.

Snoring is a common problem and is deemed a nuisance. Unfortunately, the snorer is often oblivious to the nightly commotion; it’s always the bed partner who is kept awake night after night because of the dreadful noise.

What causes snoring?

According to Dr Kenny Pang, Director of Pacific Sleep Centre and President of the ASEAN Sleep Surgical Society, snoring is due to the excess vibration of the tissues in the mouth and oral cavity, which includes the soft palate, uvula, base of tongue and other soft tissues.

The noise occurs when there is an obstruction of the flow of air through the passage at the back of the mouth (airway) and nose.

Several factors increase the likelihood of a person to snore. These include:

• Being overweight – obese people frequently have a thick and fatty soft palate
• Geting older – snoring gets worse with age
• Gender – men are more likely to snore than women, but some women can also be snorers
• Family history – snoring may run in families, especially when you have similar facial structures (small jaw or shape of the throat)
• Drinking alcohol and smoking – alcohol relaxes the muscles of the throat and this causes the airway to collapse; smoking makes snoring worse
• Blocked nose – correcting the nasal abnormality may reduce the snoring
• Sleeping position – when lying on your back, your tongue tends to fall backwards and block the airway; hence, sleeping on your side reduces snoring
• In children – large tonsils and adenoids can cause severe snoring in kids, which may also require treatment

Click here for next chapter: What is sleep apnoea?

This story cannot be reproduced, whether in part or in whole, without the permission of Ezyhealth.

Source: Is Your Snoring A Health Risk? (Part 1/2)

Is Myopia In Kids Preventable? (Part 2/2)

Can You Prevent Myopia In Kids?
Parents guilty of passing on the myopia genes should not fret since they can still play a role in controlling their children’s myopia

By Jessie Kok | Reprinted with permission from Today’s Parents

Click here to read Part 1 of this story

Dr Gerard Chuah, senior eye surgeon at Total Eyecare Centre (Camden Medical Centre), and Dr Chew Wai Kwong, chief optometrist at Capitol Optical, answer frequently asked questions about myopia:


What exactly changes in the eyeball that causes myopia?
“Unlike normal children or adults, highly myopic people have elongated eyeballs which means the tissue at the back of their eyes is stretched,” says Chew. “Tissues like the retina, when highly stretched, become weaker and more vulnerable to retinal tear, resulting in higher risk of developing glaucoma and macular degeneration.”


Is it true that leaving the light on at night for babies may predispose them to myopia?
It is common for parents to leave a light on for babies while they sleep. While recent studies in America show that leaving a light on might lead to the development of myopia, more studies would need to be done to show conclusive evidence.


Are all cases of myopia irreverisble?
General cases of myopia are irreversible. However, another type of myopia – pseudomyopia – which occurs when there is excessive spasm of the focusing muscles in the eyes and more commonly seen in young children is reversible.


How is pseudomyopia treated?
When young children first visit an optometrist cycloplegic refraction is routinely done to eliminate pseudomyopia. Optometrists also rely on objective methods of retinoscopy and fogging to check on these cases.


How can eye drops assist in cases of myopia?
Currently, Atropine 1 percent eyedrops are used in some hospitals and clinics as a tool to address myopia progression. The Singapore National Eye Centre (SNEC) has ongoing studies to assess the role of the drops. There are promising preliminary results that show Atropine may help to retard the progression of myopia but more overseas and local studies are required for conclusive results.


Can certain types of food or supplements boost vision?
According to Dr Chuah, there is no conclusive evidence in studies that show consuming more vitamins and minerals can help to improve or control myopia, unless the child is severely malnourished. It is more important to get a child to relax her eye muscles by looking at faraway objects. “It’s got nothing to do with the colour of the object but more about letting the eye muscles rest after doing near-work,” he says.

Dr Chuah also highlights the efforts by the Ministry of Health in their myopia control programme that teaches students good eyecare habits such as taking breaks after 45 minutes of near-work and simple eye exercises.


A beneficiary of this programme is Kevan, who has successfully helped to control his children’s myopia. Now grown up and aged 11 and 13 respectively, Sarah and Sean have managed to control their myopia over the years through sporadic rests in between studying, and doing simple eye exercises as instructed by their father.


While Kevan does not expect complete recovery in his children, the improvement and control of his children’s myopia that gives him a sense of satisfaction.

“I know we cannot control hereditary symptoms,” he says. “But every parent can play a part when it comes to environmental factors to ensure the best management of childhood myopia.”

Source: Is Myopia In Kids Preventable? (Part 2/2)

Is Myopia In Kids Preventable? (Part 1/2)

Can You Prevent Myopia In Kids?
Parents guilty of passing on the myopia genes should not fret since they can play a role in controlling their children’s myopia

By Jessie Kok | Reprinted with permission from Today’s Parents

SARAH and Sean Ng were diagnosed with severe myopia by their optometrist at the age of four. The cute sight of the siblings in round, tortoise-shaped spectacles gradually turned into a source of concern for their parents, who noted the dangers their visually challenged children were facing.

“We took our children’s good vision for granted until Sarah’s optometrist told us about her severe myopia,” says Kevan Ng, the sibling’s father, who is himself short-sighted. “After a while, it became even more essential to childproof our home. Even telephone wires became hazardous with two little active blind moles around the house.”

Kevan’s case is not uncommon in Singapore. According to Capitol Optical, surveys done every three to five years show that the rate of children with myopia in Singapore is increasing. Myopia affects 25 percent of seven-year-olds, 50 percent of 12-year-olds and 80 percent of 18-year-olds on the island.

“Genetics cannot be controlled,” says Dr Gerard Chuah, Senior Eye Surgeon of Total Eyecare Centre at Camden Medical Centre, who notes the myopic risks in children are in proportion to genetics. “If one parent has myopia, the child would have a higher risk of myopia. If both parents are myopic, the risk becomes even higher for the child.”

Apart from genetic factors as in the Ng family’s case, Chew Wai Kwong, Professional Affairs Manager and Chief Optometrist at Capitol Optical, also believes that environmental factors play a part.

“Our gene pool and ethnic make up have not changed much in the past 40 years, and it is widely accepted now that the amount of time spent on near work and the computer, which now starts at a very young age, does have a direct influence on the development of myopia,” he says.

Parents guilty of passing on the myopia genes should not fret since they can play a role in controlling their children’s myopia.

But ignore the “looking at green objects” advice, since according to Dr Chuah, it serves no scientific purpose in controlling myopia. We look at the five most commonly asked questions posed to eyecare experts below.

Click here to read Part 2: Doctors answer FAQs on myopia

Source: Is Myopia In Kids Preventable? (Part 1/2)

Pregnancy Tips: Sex Before And After Pregnancy

GREAT EXPECTATIONS
By Dr Ann Tan, Consultant Obstetrician & Gynaecologist |
Women and Fetal Centre, a member of Pacific Healthcare Holdings

reprinted with permission from "Great Expectations by Today's Parents magazine

Until what stage of pregnancy can I still have sex?
Actually both sex and pregnancy are natural events and you can enjoy them concurrently so long as you do not experience any undue pain or bleeding. If you have any particular pregnancy problems of preterm labour/ incompetent cervix or multiple pregnancy, you should consult your obstetrician on the advisability of intercourse. The use of condoms may help to reduce the uterine reactivity by preventing semen from contact with the cervix.

How soon can I have sex after my baby is born?
There is no hard and fast rule and usually the woman is ready in four to six weeks post normal vaginal delivery and Caesarean section too! The vaginal wound is usually a little firm initially but should stretch out once activity is resumed while in the case of a Caesarean delivery, there should be no difference at all. For the latter, deep penetration may cause stretching of the Caesarean scar and that may initially be uncomfortable.

I am six months pregnant and find myself surprisingly more turned on than usual. Why is that?
The hormones of pregnancy are making you more curvy than before and it’s very natural that you might feel more sexy than ever before! Enjoy!

Source: Pregnancy Tips: Sex Before And After Pregnancy

Pregnancy Tips: Too Much Water in Water Bag

GREAT EXPECTATIONS
By Dr Low Kah Tzay, Paediatrician | Mt. Elizabeth Hospital
reprinted with permission from "Great Expectations by Today's Parents magazine

I’m due to have my second baby soon. My doctor says there is a lot of water in the water bag.

What does this mean?

It can be difficult to find out the cause of polyhydramnios (excessive fluid) and, sometimes, no cause can be found. Sometimes the extra fluid is due to a problem with the baby, or with the placenta or with you, the mother.

Possible causes include:

> Maternal diabetes, where your blood sugar levels are not well controlled. Your baby’s urine output increases and this in turn increases the volume of amniotic fluid

> Being pregnant with twins. There may be a particular problem if the babies are identical (monozygotic).

> Infections that affect your baby, such as rubella, cytomegalovirus,toxoplasmosis and syphilis, may be associated with polyhydramnios.

> A congenital problem with the baby occurs in about 20 per cent of polyhydramnios cases. There may be a blockage in the oesophagus (swallowing tube), meaning he cannot swallow the amniotic fluid and control the amount of it around him. It may also be a sign that the baby has a problem with his central nervous system, or with his heart or kidneys.

> Sometimes, polyhydramnios is associated with babies who have chromosomal abnormalities, such as Down’s or Edward syndrome

> In rare cases, the placenta may have developed a tumour or there may be a problem with the arteries in the umbilical cord resulting in polyhydramnios.

Most women with polyhydramnios go on to have healthy babies, particularly if the condition is mild. If you are not known to have diabetes, you will be given an oral glucose tolerance test (OGTT). If this is high, you may be referred to a diabetes specialist who can get your blood sugar levels down. This will reduce the amount of fluid.

Ultrasound scanning can help spot any problems with your baby. If a detailed scan shows nothing untoward, your baby is usually fine and the polyhydramnios is caused by something else.

There are other laboratory tests for investigating polyhydramnios if infection is suspected. You would be followed up at more frequent intervals as you are at higher risk of going into premature labour, cord prolapse when your water bag ruptures or the placenta starting to come away from the wall of the uterus (abruption placenta).

In mild cases of polyhydramnios, your doctor will advise you to rest or even start your maternity leave early. Even then, because your uterus is so swollen, you may go into labour prematurely.
Go to the hospital immediately if your waters break or you start having contractions.

Dr. Low Kah Tzay is a paediatrician working at Mt Elizabeth Hospital. He specializes in the management of growth and development of children; such as feeding difficulties, language delay, sleep disorders, attention disorders, autistic spectral disorders and learning diffi culties. His website is at www.pediatricdoctor.net.

Sources: Pregnancy Tips: Too Much Water in Water Bag

Pregnancy Tips: What is Low and Anterior Placenta?

GREAT EXPECTATIONS
By Dr Vanaja K, Consultant Obstetrician & Gynaecologist | National University Hospital
reprinted with permission from "Great Expectations by Today's Parents magazine

When I went for my scan, my gynae told me I have a low and anterior placenta. What is that and what implications does this have? Will it affect my baby adversely at all? Will I have any problems during labour and delivery?

Placenta is otherwise called after birth. After the delivery of the baby, the placenta will separate from the womb and will be delivered. It is important to know the exact location of the placenta in pregnancy. Usually it is located in the upper part of the womb and will not block the passage. The placenta can cover the neck of the womb in early pregnancy and as pregnancy advances, it will move away and not cause bleeding in pregnancy, so the mother can expect a normal delivery. For some it may continue to cover the neck of the womb in late pregnancy and can cause bleeding in pregnancy without any pain.

In medical terms it is called placenta praevia. In such cases, a Caesarean section will be the mode of delivery. The timing of delivery will be decided by the obstetrician based on the amount of bleeding, maturity of the baby, condition of the mother and baby. Bleeding in pregnancy will be considered a high risk case and some may need to stay in hospital for a few days before delivery. A lowlying placenta means the placenta is in the lower part of the womb. It is important to know whether it is blocking or not blocking the passage to warn about bleeding and the necessity for a Caesarean section. Bleeding will have effects on the mother and if it is heavy, it can affect the baby as well.

Source: Pregnancy Tips: What is Low and Anterior Placenta?

Are You A Walking Smell Bomb? (Part 1/2)

Sweat is actually odourless, so what you need to do is check on your hygiene

By Dr Shyneth Galapia | Reprinted with permission from Ezyhealth & Beauty magazine

AT SOME point in our lives, all of us have experienced being next to a person with body odour. It’s never a pleasant experience to sit next to a smelly classmate or be crammed on a train full of sweaty people.

More importantly, people with body odour may suffer from personal and social relationships. Feelings of embarrassment and decreased self-confidence are common.

SWEATING IT OUT
Sweating is the body’s biological way of regulating temperature, that’s why sweating is more profuse when it’s hot. Composed mainly of salt and water, sweat produces a cooling effect on the body as it evaporates from the skin.

Although about two to four million sweat glands are distributed on the skin, some body parts are more likely to sweat because they have more sweat glands.

According to Dr Chan Yuin Chew, a dermatologist at Gleneagles Medical Centre, “The palms, soles and underarms contain a lot of sweat glands.”

Sweat glands occurring over most parts of the body are called eccrine glands and they are responsible for producing the watery component of sweat.

Those found in hairy areas such as the scalp, armpits and groin are called apocrine glands. Bacterial breakdown of sweat produced from these glands is most likely to produce body odour because it contains protein, carbohydrate, ammonia and fats.

As these glands only mature during puberty, young children rarely develop body odour.

Several factors influence the way people sweat. Certain foods (spicy) and beverages (hot and those with alcohol or caffeine) can make you sweat.

Other factors that increase sweating include certain medical conditions (fever, hyperthyroidism, heart attack, tubeculosis, malaria) and medicines (morphine, anti-depressants).

“When one is excited or angry, there is increased sympathetic activity and one will notice that he or she will start sweating more profusely,” says Dr Eileen Tan, a dermatologist at the Eileen Tan Skin, Laser and Hair Transplant Clinic in Mount Elizabeth Medical Centre.

DECODING BODY ODOUR
Body odour is an unpleasant smell produced by a sweating and unhygienic person. Most of us would point to sweating or perspiration as the culprit, but it is not.

Sweat is actually odourless.

Dr Tan says, “Body odour is caused by a natural process involving sweat that occurs on the skin’s surface. However, if sweat is left on the skin for a long period of time, the bacteria that normally live there feed on it and break it down. This process releases chemicals that cause the unpleasant smell.”

READ NEXT CHAPTER: Your body odour checklist -- and how to fix it

The articles cannot be reproduced, whether in part or in whole, without the permission of Ezyhealth

Read more about hygiene and body odour.

Are You A Walking Smell Bomb? (Part 2/2)

How to detect and fix body odour

By Dr Shyneth Galapia | Reprinted with permission from Ezyhealth & Beauty magazine

Click here for Part 1

Body odour may also be influenced by poor hygiene, age (more common in adolescents, adults), gender (male) and diet. Dr Chan says, “Food like garlic, curry, strong spices and too much red meat can contribute to body odour.”

There’s a solution to whatever is causing body odour. Hygiene is of utmost importance. A little help from deodorants and antiperspirants are often enough to get rid of the offending odour.

Visit a dermatologist when these tricks fail to solve your odour troubles or if you suspect that a medical problem are is causing your body odour.

NECK
Odour trouble: Neck stench (accumulation of sweat)

How to fix:
- Apply absorbent agent such as baby powder
- Don’t allow sweat to dry; wipe it off right away

UNDERARMS
Odour trouble: Underarm stink (increased number of sweat glands, accumulation of sweat)

How to fix:
- Routinely apply deodorants or antiperspirants
- Get rid of underarm hair

CHEST/BACK
Odour trouble: Smelly torso (accumulation of sweat)

How to fix:
- Apply an absorbent agent such as baby powder
- Trim or get rid of chest hairs
- Wear cotton undergarments or use garment shields to help absorb the sweat. Lightweight clothing is also recommended
- Wipe off sweat right away

FEET
Odour trouble: Smelly feet (increased number of sweat glands, accumulation of sweat, fungal infection)

How to fix:
- Keep your feet clean and dry (don’t forget the spaces between your toes)
- Wear a clean pair of cotton socks everyday
- Use foot deodorants and antiperspirants
- Go barefoot when you can, to allow air to dry your feet
- Consult a dermatologist for fungal infection

GROIN/GENITALIA
Odour trouble: Malodorous groin (increased number of sweat glands; vaginal infections)

How to fix:
- Make sure to wash your private parts thoroughly each time you bathe
- Using a gentle feminine wash may help keep the area fresh
- Wear cotton undergarments to help absorb the sweat
- Consult a doctor for vaginal infections

HEAD
Odour trouble: Smelly hair and scalp (increased number of sweat glands, oil, dandruff, cigarette smoke, dust)

How to fix:
- Wash hair regularly
- Consult a dermatologist for dandruff and scalp disorders

GENERAL HYGIENE PRACTICES
- Bathe daily, even twice or thrice a day if you sweat profusely
- Wear clean, dry clothes. Bacteria strive in moist environment

Special thanks to Dr Chan Yuin Chew, Dermatologist, Dermatology Associates, Gleneagles Medical Centre and Dr Eileen Tan, Dermatologist, Eileen Tan Skin, Laser and Hair Transplant Clinic, Mount Elizabeth Medical Centre.

Sources
1. http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003218.htm
2. http://www.mayoclinic.com/health/sweating-and-body-odor/DS00305

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Find original article for Are You A Walking Smell Bomb? here.

Pregnancy Tips: Sex Before And After Pregnancy

GREAT EXPECTATIONS
By Dr Ann Tan, Consultant Obstetrician & Gynaecologist | Women and Fetal Centre, a member of Pacific Healthcare Holdings

Reprinted with permission from "Great Expectations by Today's Parents magazine

Until what stage of pregnancy can I still have sex?
Actually both sex and pregnancy are natural events and you can enjoy them concurrently so long as you do not experience any undue pain or bleeding. If you have any particular pregnancy problems of preterm labour/ incompetent cervix or multiple pregnancy, you should consult your obstetrician on the advisability of intercourse. The use of condoms may help to reduce the uterine reactivity by preventing semen from contact with the cervix.

How soon can I have sex after my baby is born?
There is no hard and fast rule and usually the woman is ready in four to six weeks post normal vaginal delivery and Caesarean section too! The vaginal wound is usually a little firm initially but should stretch out once activity is resumed while in the case of a Caesarean delivery, there should be no difference at all. For the latter, deep penetration may cause stretching of the Caesarean scar and that may initially be uncomfortable.

I am six months pregnant and find myself surprisingly more turned on than usual. Why is that?
The hormones of pregnancy are making you more curvy than before and it’s very natural that you might feel more sexy than ever before! Enjoy!

Source: Pregnancy Tips: Sex Before and After Pregnancy

Pregnancy Tips: What Are Fibroids and How Do They Affect Conception?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist | A Company for Women, Medical Centre
Reprinted with permission from "Great Expectations" by Today's Parents magazine

I HAVE BEEN TRYING UNSUCCESSFULLY TO CONCEIVE FOR THE LAST SEVEN MONTHS. MY GYNAE DISCOVERED I HAVE FIBROIDS. WHAT SHOULD I DO AND HOW DOES THIS AFFECT MY CHANCES OF HAVING A CHILD?

Uterine Fibroids (myoma or leiomyoma) are very common – they are benign (noncancerous) growths of the uterine muscle. The size and location of the fibroids are important. The large majority of them are very small or located in an area of the uterus such that they will not have any impact on reproductive function.

There are three general locations for fibroids:

(1) Subserosal – on the outside surface of the uterus
(2) Intramural – within the muscular wall of the uterus, and
(3) Submucous – bulging into the uterine cavity.

The only type that will have any impact on reproductive function (unless it is very large) is the submucous type that is within the uterine cavity. These are much less common than the other two types of fibroids.

Because of their location inside the uterine cavity, submucous fibroids can cause infertility or miscarriages and may be removed hysteroscopically (a slim instrument inserted through the cervix into the uterus).

Other causes for infertility should be considered before treatment is initiated for subserosal or intramural fibroids which do not distort the uterine cavity.

Studies of infertile women with submucous fibroids distorting the endometrial cavity found significantly lower pregnancy and delivery rates, compared with infertile women without fibroids.

It is important to note that removal of submucous fibroids led to a significant increase in the pregnancy rate compared with the case in infertile women without fibroids.

Source: Pregnancy Tips: What Are Firboids And How Do They Affect Conception?

Pregnancy Tips: Are Migraine Medications Harmful For Me?

GREAT EXPECTATIONS
By Dr Lai Fon Min
Consultant Obstetrician and Gynaecologist A Company for Women, Camden Medical Centre |
reprinted with permission from "Great Expectations" by Today's Parents magazine

I AM EXPECTING MY FIRST CHILD AT THE AGE OF 32. I AM PRONE TO MIGRAINES BUT AM AFRAID TO USE ANY MEDICATION AS IT MAY HARM MY BABY. PLEASE ADVISE.

Migraine does not increase the risk for complications of pregnancy for the mother or the foetus. Several studies have shown a tendency for migraine to improve with pregnancy. Between 60 and 70 percent of women either go into remission or improve significantly, mainly during the second and third trimesters. Management of migraine during pregnancy should first focus on avoiding potential triggers; for example, stress, change in sleep pattern, bright lights or excessive computer use, irregular meals, smoking, alcohol and certain foods containing red wine or MSG.

Consideration should also be given to non-drug therapies. If medication becomes necessary, paracetamol (Panadol) can be used safely. NSAIDs (aspirin, ibuprofen, naproxen) can be used as a second choice, but not for long periods of time, and they should be avoided during the last trimester. A common antimigraine drug is ergot in combination with caffeine – Cafergot. Ergot is contraindicated in pregnancy.

For treatment of severe attacks of migraine, chlorpromazine, dimenhydrinate, and diphenhydramine and metoclopromide can be used to help with the nausea and vomiting in severe attacks; metoclopramide should be restricted to the third trimester. In some refractory cases, steroids like dexamethasone or prednisone can be considered. Should prophylactic treatment become indicated, the beta-adrenergic receptor antagonists (e.g. propranolol) should be avoided.

Source: Pregnancy Tips: Are Migraine Medications Harmful For Me?