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?

Pregnancy Tips: What Is Implantation Bleeding?

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

WHAT IS IMPLANTATION BLEEDING AND WHAT ARE THE SYMPTOMS?
Implantation bleeding occurs when an egg has been fertilised and implants into the lining of the uterus. Up to a third of women report some bleeding or spotting around the time of implantation.

It is typically small in amount, and not a “heavy” bleed. Implantation happens about a week (range 6-12 days) after ovulation. It may be accompanied by cramping or backache.

Implantation will appear before you expect your period and some may mistake it for spotting before their period begins.

Because there is typically so little and it is before you would expect your period it would be normal to think you are just getting ready to start your period.

However, if you think there is a chance you could have conceived in that cycle, please do a urine pregnancy test.

Source: Pregnancy Tips: What Is Implantation Bleeding?

Pregnancy Tips: What Is Dilated 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 DILATED 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 fetuses. 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 dilated renal pelvis, there is no need to check for chromosomal abnormalities in the fetus.

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 Dilated Renal Pelvis?