Blog Topics

Induction of Labour

Credit to RANCOG

In most pregnancies, labour starts naturally between 37 and 42 weeks. When labour starts, a number of changes occur in your body:

  • your cervix (opening of your uterus / womb) will ‘ripen’ and become soft and open

  • you will experience strong, regular contractions that dilate (open) your cervix leading to the birth of your baby

  • the bag of membranes (‘waters’) around your baby may break

When labour starts on its own, it is called spontaneous labour.

A labour that is started with medical treatment is called ‘induced’ labour.

An induction of labour may be recommended when you or your baby will benefit from birth being brought on sooner rather than waiting for labour to start naturally.

The most common reasons for induction are:

  • you have a specific health concern, such as high blood pressure

  • your baby is overdue

  • there are concerns with your baby (less movements, low fluid, not growing well)

  • your waters have already broken but your contractions have not started naturally

 

What type of induction am I likely to have?

There are different ways to induce labour. To determine the best method of induction for you, your doctor or midwife will do a vaginal examination to check how ready your cervix is.

Based on this examination, they will recommend one of the following methods of induction:

  • a hormone called prostaglandin

  • balloon catheter

  • artificial rupture of membranes (ARM)

  • a hormone called syntocinon

The process of induction will vary for everyone. It may require one or a combination of these methods

Some women may have their membranes ruptured (‘waters broken’) but this may happen naturally. Some women may require syntocinon to stimulate contractions.

Membrane rupture

 

Methods of induction

Prostaglandins

Prostaglandin is a naturally occurring hormone that prepares your body for labour. A synthetic version has been developed to mimic your body’s natural hormone. This hormone is placed in your vagina either as a gel or pessary (like a tampon) that works to ripen your cervix. Once the prostaglandin has been inserted, your baby will be monitored and you will need to stay in hospital. Occasionally you may need more than one dose of prostaglandin. When the prostaglandin takes effect, your cervix will be soft and open and the next steps of your induction can start.

Balloon catheter

Prostaglandins are not suitable for all women, for example, if you have had a previous caesarean section or a reaction to prostaglandins in the past. Your doctor may therefore recommend a balloon catheter to ripen your cervix. This catheter is a thin tube which is placed inside your cervix and a small balloon inflated to place pressure on your cervix. This pressure should soften and open your cervix. This catheter will stay in place for several hours until either it falls out (indicating your cervix has opened) or until you are re-examined.

Artificial rupture of membranes (‘breaking your waters’)

If your waters have not broken, artificial rupture of membranes may be recommended. This is when your doctor or midwife puts a small hole in the bag of membranes or waters around your baby. This is done with a small instrument during a vaginal examination and can only occur once your cervix is open. Once your membranes have ruptured, contractions may start naturally, if not, a syntocinon infusion will be started.

Syntocinon

Syntocinon is a synthetic hormone that mimics your body’s natural hormone called Oxytocin. It is given through an intravenous infusion (drip) in your arm and stimulates contractions of the uterus. The infusion is slowly increased until you are having strong regular contractions. The infusion will continue until after your baby is born. Once syntocinon has started, your baby’s heart rate will be monitored throughout labour using a CTG machine. More information about monitoring your baby’s heart rate in labour can be found on the RANZCOG website under Patient Information.

Increased intervention

According to contemporary studies, induction of labour when performed appropriately does not increase the chances of obstetric interventions. However, it is always important to balance the risks and benefits of induction of labour carefully and discuss with your doctor or midwife.

 

Making your choice

When considering induction of labour, some women will choose a ‘wait and see’ approach to whether labour will start naturally. Others will choose induction.

Ask your doctor:

·      Why has an induction been recommended?

·      What are the potential risks with continuing your pregnancy until labour starts naturally?

·      What are the potential risks with having an induction of labour?

·      What are the procedures and care that are involved with an induction?

It is important that you are aware of the benefits and risks of both options so you can decide what is best for you and your baby.

 

What risks are involved with an induction of labour?

The induction may not work.

Occasionally, the process to ripen the cervix does not work, which means your cervix has not opened enough for the membranes to be ruptured. If this happens, your doctor will talk to you about your options. These may include, returning home until a later date, using a different method of induction, or you may require a caesarean section. Sometimes, after your membranes have ruptured, contractions may not start and labour does not become established. In this situation, your doctor will recommend a caesarean section.

Over-stimulation of the uterus.

One of the side effects of the synthetic hormones is they may cause the uterus to contract too much. This can sometimes cause stress to you and your baby. If this occurs, you may be given medicine to relax the uterus. If you have a hormone pessary, it will be removed.

 

DISCLAIMER: This document is intended to be used as a guide of general nature, having regard to general circumstances. The information presented should not be relied on as a substitute for medical advice, independent judgement or proper assessment by a doctor, with consideration of the particular circumstances of each case and individual needs. This document reflects information available at the time of its preparation, but its currency should be determined having regard to other available information. RANZCOG disclaims all liability to users of the information provided.

 

 

 

Can I drink decaffeinated coffee whilst pregnant?

Hi Everyone!  

Stefani here, Dr Suzana’s daughter and Practice Manager... So I have some great news for all of my fellow pregnant ladies and coffee lovers!

Once I found out that I was pregnant I was wondering how am I going to get through my day with only 200mg of caffeine!? (This was clearly before my nausea kicked in at 6 weeks all the way through to 18 weeks!)

So I started doing some research on the Nespresso website to determine how many milligrams of caffeine is in each of their pods, as I love my coffee strong!

When I came across the Nespresso FAQ’s it stated that it was safe for pregnant women to drink their decaffeinated pods.

Now this goes against every medical recommendation, as generally decaffeinated coffee is washed with chemicals and can cause an increased risk of miscarriage.

Naturally, I sent them an extensive email explaining why decaffeinated coffee is not safe for pregnant women to consume and how can they advise this!?

To my surprise they responded very quickly and informed me that in fact the Nespresso decaffeinated coffee beans are safe to consume whilst pregnant.

That response made me one happy pregnant lady… unfortunately shortly after I received that email my nausea kicked in and I couldn’t stand the smell or taste of coffee for a good few weeks and I questioned myself how did I ever like to drink this! Anyway, I am back to loving my coffee and occasionally have a Nespresso decaffeinated pod in addition to my strong latte.

Click here to learn more about caffeine limits during pregnancy.

 

To learn more about Nespresso’s decaffeinated coffee bean process keep reading below.

Nespresso’s response to my decaffeinated pods question:

“Decaffeination is an additional step before roasting and grinding. In general, there are several different processes of decaffeination. Some of them use chemical solvents and others use natural components: water or carbon dioxide, a natural constituent of air. We, at Nespresso use only those with natural components:

  • In the water decaffeination process, the raw coffee beans are moistened to make the bean texture porous. After that by circulating the moisture through the porous beans, the water removes the caffeine and some other water-soluble solids. The extract is then removed and filtered via active carbon where caffeine is separated from the other valuable coffee solids, which are then returned to the beans. The purified water will be re-used for subsequent decaffeination processes. The decaffeinated coffee is then dried after which the beans are ready for roasting.

  • In the carbon dioxide (CO2) method, the raw coffee beans are moistened and put into a vessel where it is pressurized with liquid carbon dioxide. Circulating through the coffee, the carbon dioxide selectively draws the caffeine out of the bean. The decaffeinated coffee is then dried after which the beans are ready for roasting. The method is also sometimes referred as “extraction with supercritical CO2”, referring to the physical state of CO2 (partly liquid , under pressure)

Both decaffeination methods use only natural ingredients for decaffeination and are completely safe for coffee drinkers. The processes respect the environment and the coffee bean’s true nature, allowing us to maintain the strength, variety and richness of its aromas for our consumers.
 

At Nespresso, we remove the caffeine without altering the coffee’s natural quality, using the smoothest most selective techniques, with no chemical solvents. Respecting the coffee bean’s true nature, our decaffeinated coffees are made exclusively from some of the world’s finest coffees and are free of any additives.

All caffeine intake has to be considered in assessing consumption habits. As per various scientific studies, an intake up to 400mg of caffeine from all sources per day for the normally healthy adult population and up to 200mg per day for pregnant women or breastfeeding women does not raise any safety concerns and has its place in a healthy and balanced diet.”

 

Thalassaemia

What is thalassaemia?

Thalassaemia is an inherited genetic disorder that affects the blood and causes lifelong anaemia.

People with thalassaemia do not produce enough healthy haemoglobin, which makes their blood cells small and pale. Haemoglobin is a protein found in red blood cells that carries oxygen from the lungs to the rest of the body.

People born with thalassaemia cannot move oxygen around the body properly. Depending on the type of thalassaemia they have, they may need regular blood transfusions to stay alive.

What causes thalassaemia?

Thalassaemia is caused when someone inherits gene mutations (‘spelling errors’ in the DNA in genes) from one or both parents. These gene mutations make the body lose red blood cells more quickly than normal and result in less haemoglobin.

There are different types of thalassaemia. The type someone has depends on which gene mutations they inherit.

Alpha thalassaemia: This is caused by a problem in 1 or more of 4 genes called alpha globin genes. People who inherit just 1 gene may not have any symptoms, but they can still pass the disorder onto their children. 2 genes cause mild symptoms, 3 genes (called Haemoglobin H disease) cause more severe symptoms, and babies who inherit 4 genes (called alpha thalassaemia major or hydrops fetalis) are usually very sick and do not live for long after they are born. Alpha thalassaemia more common in people of Southeast Asian, Southern Chinese, Middle Eastern, Indian, African or Mediterranean descent.

Beta thalassaemia: This is caused by mutations in 1 or 2 genes called beta globin genes. There are hundreds of possible mutations and symptoms depend on which mutation a person has. People with just 1 faulty gene usually have minimal symptoms but they can pass thalassaemia onto their children. People with 2 faulty genes (called thalassaemia major) often have life-threatening symptoms. Some people with 2 abnormal genes may still have milder symptoms and only need occasional blood transfusions. Beta thalassaemia usually affects people of Mediterranean, Asian or African descent.

How the thalassaemia trait inherited?

What are the symptoms of thalassaemia?

People with thalassaemia can:

  • feeel tired, weak, dizzy and short of breath

  • grow more slowly than usual as children

  • be pale or have yellow skin colouring (jaundice)

  • have dark urine

  • have a swollen belly

  • have slight deformity of their facial bones

If it’s not treated, thalassaemia can lead to heart failure and infections.

The symptoms can show up in babies and small children if the condition is severe, usually in the first 2 years of life..

How is thalassaemia diagnosed?

Some people find out they have thalassaemia because they are unwell. Their doctor talks to them, examines them and carries out blood tests. They may also have genetic tests.

Other people find out they have thalassaemia by chance, when a blood test done for other reasons shows something unusual.

There are times when doctors suggest a blood test to check for thalassaemia. This includes if:

  • you are planning to have a child

  • you have a relative with thalassaemia

  • you or your relatives have unexplained anaemia (low haemoglobin)

  • your family came from a region where thalassaemia is common

Unborn babies can also be tested for thalassaemia.

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How is thalassaemia treated?

If you have thalassaemia, you might or might not need any treatment. It depends on how severe your symptoms are.

People with severe thalassaemia may need blood transfusions every 3 to 4 weeks. People with less severe thalassaemia might need blood transfusions only occasionally, or not at all.

Blood transfusions can cause a build-up of iron in the body, which can lead to heart and liver damage. People with frequent blood transfusions can take a medicine that helps bring the iron back to a safe level (called iron chelation).

A few people have so serious a problem that they are advised to have a transplantation of stem cells or bone marrow from a healthy donor. This can help, but it has risks and is only rarely needed.

Living with thalassaemia

If you have thalassaemia, it is important to attend all your medical appointments and to have blood transfusions when you need them. You will need to prevent infections by washing your hands often and avoiding people with colds or the flu.

Take care of yourself by eating healthily.

What are the complications of thalassaemia?

People with thalassaemia can develop other problems including:

  • enlarged spleen

  • blood infections

  • bone problems such as deformities in the face or skull, or osteoporosis

  • damage to the heart, liver or hormonal system, caused by too much iron in the blood

Can thalassaemia be prevented?

When someone is diagnosed with thalassaemia, their close relatives (parents, children, brothers and sisters) may also be offered genetic testing to see if they have the gene mutation. It is a simple blood test that is free and can be done by your doctor.

You might want to know whether you carry the gene so you can make informed choices about having a baby in future. A child is only at risk of having thalassaemia if both parents are carriers. If both parents are carriers, there is a 1 in 4 chance their child will have thalassaemia. There is a 1 in 2 chance they will be a carrier.

If you carry the thalassaemia gene and are thinking of having a child, you and your partner may decide to:

  • have prenatal testing (a genetic test done during pregnancy) to see whether the child is affected

  • think about your options for having a child. For example, you may decide to have a child through IVF, and have genetic screening of the embryo before it is implanted

  • look out for symptoms of thalassaemia in your child

This Centre for Genetics Education fact sheet has more information about genetic screening in pregnancy for thalassaemia.

Resources and support

For information or support, contact:

Sources:

MAIN WEBSITE INFORMATION: https://www.healthdirect.gov.au/thalassaemia

Thalassaemia and Sickle Cell Society of Australia (Facsheets), Department of Health (Pregnancy Care Guidelines, Haemoglobin disorders), Lab Tests Online (Thalassaemia), Elsevier Patient Information (Thalassemia), Centre for Genetics Education (Thalassaemia)

Learn more here about the development and quality assurance of healthdirect content.

SUMMARY OF COVID VACCINE FOR PRE-PREGNANCY, PREGNANCY & BREASTFEEDING

Summary of Insta-Live on @lyzevansphysio held Sunday 25/07/2021

Prepared by Dr Lynn Townsend, MBBS BSc(Hons) FRANZCOG DDU

Background:

  • COVID-19 is a serious illness and can lead to death or long term illness.

  • The risks of the illness to pregnant women include the respiratory complications (like the

    general population) and pregnancy specific risks including miscarriage, abruption, abnormal

    clotting and pre-eclampsia, which are all increased compared to the usual pregnancy risks.

  • As of 23/07/2021, RANZCOG and ATAGI recognised those increased risks and changed the

    eligibility of pregnant women to 1b.

  • They have recommended mRNA vaccination in pregnancy. The only currently available

    mRNA vaccine at present is the Pfizer BioNTech vaccine, however from September the Moderna vaccine has been reported to be available in Australia.

    Historical background of mRNA technology:

  • mRNA technologies have developed since 1990 and the methods of producing mRNA technologies has improved dramatically since that time.

  • The technology has been used to develop vaccinations for infectious agents, cancer- vaccinations and immunomodulator therapies.

  • Many vaccinations have been developed using this technology but as yet have not been released to the public as there are already cheap effective alternatives, and scientific funding has always been difficult to obtain.

  • COVID-19 presented the world with a great challenge and the funding and scientific interest in this disease has meant that many laboratories were able to work on a COVID-specific vaccination, using the tools that they were already developing.

  • How do mRNA vaccines work?

  • All vaccinations rely on the premise that our natural immune system, mediated by B and T cells, recall “non-self” proteins and produce antibodies and cells to remove those proteins and neutralise them.

  • Older vaccines relied on using whole, inactivated cells or viral particles to expose to the immune system and then allow the immune system to remember how to neutralise that threat.

  • More contemporary vaccines rely on introducing protein fragments to the immune system and allowing the system to activate the neutralising and remembering “protocols”.

  • mRNA vaccines work by introducing tiny pieces of genetic code into the body. The cells that neutralise the code fragments are co-opted into producing the protein fragment which is then presented to the immune system and a response of neutralising and remembering is initiated.

  • The mRNA fragments are then completely destroyed and are no longer detectable after 48- 72 hours.

  • These fragments are unable to be incorporated into any genetic material within the body’s cells. The protein they produce are recognised as “non-self” and completely neutralised and remembered.

  • When a person is then exposed to “wild” COVID-19, the immune system swings into action and produces antibodies which neutralise the wild virus.

  • The COVID-19 vaccines, whilst helping to reduce the likelihood of disease have definitely reduced the likelihood of hospital or ICU admission.

Risk-Benefit matrix of Obstetric patients:

  • The initial mRNA vaccinations for COVID-19 were clearly demonstrated, using established Phase 1- 3 testing, to be safe and effective for non-pregnant people.

  • In some populations, the risk of COVID-19 at the end of 2020 and beginning of 2021 was very high, and pregnant women consented to getting vaccinated, understanding that the biological likelihood of adverse events was low and the potential benefit of the vaccine were high.

  • This occurred largely in the USA and Israel, but other countries such as Scotland also vaccinated their pregnant population.

  • After 6 months of active vaccination programs, we now have a population based database of large numbers of pregnant women having the vaccine.

o In the USA as of late July 2021, approximately 150000 pregnant women have been vaccinated, primarily with mRNA vaccines.

o We are uncertain how many actual pregnant women have been vaccinated worldwide, and we are uncertain which vaccine they received.

o It is highly likely that many more have been vaccinated in countries like China and Russia, using their locally developed vaccinations.

• In the literature, various analyses of outcomes have been published.


o The largest group was based in the USA and examined nearly 36000 women.

They found no increase in pregnancy and neonatal outcomes compared to the usual expected background rate of these conditions. This was published in a very high quality peer reviewed journal (NEJM) in June 2021.

o In Israel, nearly 7500 women were immunised and again, they found no increase in pregnancy complications and a significantly lower risk of infection in the vaccinated group. This was published also in a very high quality peer reviewed journal (JAMA) in July 2021.

o Lastly, in Scotland, almost 4000 pregnant women were immunised and they found similar outcomes. Their findings are still in press.

Pregnancy Specific Concerns:

  • No difference in all pregnancy outcomes

  • Good quality histological evidence of NO placental effects of the vaccine.

  • No mRNA crosses the placenta, only the maternally generated antibodies

  • There are detectable levels of maternal generated antibodies in cord blood which help to

    protect the baby in the first few weeks of life.

    Breastfeeding:

  • Maternally derived antibodies cross into the breastmilk and also protect the baby via passive

    immunisation.

  • No mRNA fragments are detectable in the breastmilk.

  • No need for “pump and dump”

    Fertility:

  • No interaction of the mRNA fragments with the female or male genitourinary system

  • No evidence of impact on fertility (IVF) treatments

  • Consequently, the current recommendation is that women should be vaccinated if eligible,

    during fertility treatments and should not delay becoming pregnant.

    Other key points:

  • All data is based on mRNA vaccines, so pregnant women should only consider Pfizer at present in Australia, not AZ

  • AZ still is an excellent, safe vaccine in appropriate groups after medical assessment.

  • “Long covid” is a post-viral illness that causes significant consequences with extreme fatigue

    and other prolonged symptoms that can significantly impact normal life activities. There is some evidence that even people with long covid benefit from vaccination as it can reduce the effects.

References:

How do mRNA vaccines work?

Pardi, N., Hogan, M.J., Porter, F.W. and Weissman, D., 2018. mRNA vaccines—a new era in

vaccinology. Nature reviews Drug discovery, 17(4), pp.261-279. USA Cohort study assessing pregnancy risk of vaccination

vaccine safety in pregnant persons. New England Journal of Medicine, 384(24), pp.2273-2282. Israeli Cohort study assessing pregnant risk of vaccination

Shimabukuro, T.T., Kim, S.Y., Myers, T.R., Moro, P.L., Oduyebo, T., Panagiotakopoulos, L., Marquez,

P.L., Olson, C.K., Liu, R., Chang, K.T. and Ellington, S.R., 2021. Preliminary findings of mRNA Covid-19

Goldshtein, I., Nevo, D., Steinberg, D.M., Rotem, R.S., Gorfine, M., Chodick, G. and Segal, Y., 2021.

Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant

Women. JAMA. And also:

Burd, I., Kino, T. and Segars, J., 2021. The Israeli study of Pfizer BNT162b2 vaccine in pregnancy:

considering maternal and neonatal benefits. The Journal of Clinical Investigation.

And also:

Bookstein Peretz, S., Regev, N., Novick, L., Nachshol, M., Goffer, E., Ben-David, A., Asraf, K.,

Doolman, R., Sapir, E., Regev Yochay, G. and Yinon, Y., 2021. Short-term outcome of pregnant

women vaccinated by BNT162b2 mRNA COVID-19 vaccine. Ultr

Vaccination and placentation

Shanes, E.D., Otero, S., Mithal, L.B., Mupanomunda, C.A., Miller, E.S. and Goldstein, J.A., 2021.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in pregnancy: measures

of immunity and placental histopathology. Obstetrics & Gynecology, pp.10-1097. Vaccination and ferility:

Safrai, M., Rottenstreich, A., Herzberg, S., Imbar, T., Reubinoff, B. and Ben-Meir, A., 2021. Stopping

the misinformation: BNT162b2 COVID-19 vaccine has no negative effect on women’s

fertility. medRxiv. And also:

Mattar, C.N., Koh, W., Seow, Y., Hoon, S., Venkatesh, A., Dashraath, P., Lim, L.M., Judith, O.N.G., Lee,

R.J., Johana, N. and Yeo, J.S., 2021. Addressing anti-syncytin antibody levels, and fertility and

breastfeeding concerns, following BNT162B2 COVID-19 mR

asound in Obstetrics & Gynecology.

NA vaccination. medRxiv.

Australian Government Decision Guide (an excellent reference)

https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-shared- decision-making-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregnancy-covid- 19-vaccination-shared-decision-making-guide-for-women-who-are-pregnant-breastfeeding-or- planning-pregna_0.pdf

Vaginal Discharge

Let’s talk vaginal discharge!

It is NORMAL and no woman should feel weird or ashamed about it!

So let’s get educated on what is normal discharge and what is abnormal discharge when you’re not pregnant and when you are pregnant.

FACT: The vagina is self-cleaning, and vaginal discharge plays an important role in keeping the vagina healthy (hence no need for anything more than water when you wash yourself, as soap can effect the pH balance and cause irritation).

The odour, colour and consistency may be different for all as it can range from clear to milky white-ish depending on the time in your menstrual cycle. For example, there is generally more discharge when you are ovulating, breastfeeding or sexually aroused. Abnormal vaginal discharge, however, is usually caused by an infection.

Vaginal discharge when you’re not pregnant

It's your body's way of cleaning and protecting the vagina. For instance, it's normal for discharge to increase with sexual arousal and ovulation. Exercise, use of birth control pills and emotional stress may also result in discharge.

Do not over clean yourself or use strongly scented soaps/gels, as you can end up with thrush.

Different types of discharge:

1. White – thick, white discharge is common at the beginning and end of your cycle

2. Clear & Stretchy – this is ‘fertile’ mucous and means you are ovulating.

3. Clear & Watery – This occurs at different times of your cycle and can be heavy after exercising.

4. Yellow or Green – this may indicate an infection, especially if it is thick or clumpy like cottage cheese or has a foul odour.

5. Brown – this may happen right after periods, and is just ‘cleaning out’ your vagina. Old blood looks brown.

6. Spotting blood/Brown – this may occur when you are ovulating/mid-cycle. Sometimes early in pregnancy you may have spotting or brownish discharge at the time your period would normally come.


If you have spotting at the time of your normal period rather than your usual amount of flow, and you have had sex without using birth control, you should check a pregnancy test.

If you have discharge and it is 4, 5 or 6 (reference above), and you have no idea why it is this colour or consistency, then it is important that you see a doctor (GP or Gynaecologist).

Pregnancy and vaginal discharge

If you have vaginal discharge whilst pregnant this is normal, as long as its clear/white. If you have blood (pinky/red/brown) discharge you must contact your doctor. Don’t stress! As this can also be normal and is common in many women during pregnancy, however you must always be checked by your doctor as it also could be an infection. Don’t wait until later on to see how it goes, call your doctor now!

Why am I getting more vaginal discharge since being pregnant?

In pregnancy, the layer of muscle in the vagina thickens, and cells lining the vagina multiply in response to an increase in the pregnancy hormone oestrogen. These changes prepare the vagina for childbirth. As a side effect, the extra cells mean that there is an increase in vaginal discharge, known as leucorrhoea. If you feel sore or itchy in the vaginal area and the discharge is anything other than cream or white, or it smells, your doctor will need to take a swab to rule out infection.

Some infections, such as thrush, cause an abnormal discharge. They are common in pregnancy and are easily treated. Over-the-counter creams and pessaries, inserted into the vagina, are the most effective treatment for thrush. They are not harmful in pregnancy and one pessary often clears the problem. Don't take oral medication for thrush. You can help prevent thrush by wearing loose cotton underwear, and some women find it helps to avoid perfumed soap or perfumed bath products.

Always consult your GP, Obstetrician, midwife or pharmacist before taking thrush medication.

You may also notice an increase in vaginal discharge that may happen several days before your labour begins, or potentially it’s the start of labour.

Remember pregnant or not if something doesn’t look or feel right and you’re unsure, always consult your doctor!!

Dr. Suzana’s pregnancy summary of what to expect when your expecting

This is a summary of the appointments that you will have with Dr. Suzana throughout your pregnancy.
Of course if you have any pregnancy related emergencies in between these set appointments you are welcome to call the rooms on 9419 8333 to see Dr. Suzana sooner than your next scheduled appointment.
As you are a private patient and she is your obstetrician.

Melbourne Obstetrician Melbourne Gynaecologist

Important Pre-pregnancy & Pregnancy Tests

Please take some time to read through the information in the links below.
These are very important tests to get an understanding of before you see Dr Suzana at your first appointment (pre-pregnancy & new pregnancies) so you can then ask her any questions you may have.

Genetic Carrier Screening

Reproductive Carrier Screening

Prenatal Screening for Chromosomal & Genetic Conditions

For more information about pre-pregnancy counselling, please click here.

For more information about pregnancy & what to expect when your expecting, please click here.

For more information about frequently asked pregnancy questions, please click here.

Placenta Praevia

The placenta develops at the same time as your baby and is attached to the lining of your uterus (womb) during pregnancy. It allows for oxygen and nutrients to pass from you to your baby as well as producing hormones that support your pregnancy.

Placenta praevia means the placenta has implanted at the bottom of the uterus, covering the cervix.

When a baby is ready to be born, the cervix (neck of the womb) dilates (opens) to allow the baby to move out of the uterus and into the vagina. When a woman has placenta praevia (the placenta has implanted at the bottom of the uterus, over the cervix or close by), the baby can’t be born vaginally. ‘Partial placenta praevia’ means the cervix is partly blocked, while ‘complete placenta praevia’ means the entire cervix is obstructed.

Some of the causes include scarring of the uterine lining (endometrium) and abnormalities of the placenta. Around one in every 200 pregnancies is affected.

Melbourne Obstetrician Melbourne Gynaecologist


Symptoms of Placenta Praevia

The most important symptom in placenta praevia is painless vaginal bleeding after 20 weeks. However, there are causes of vaginal bleeding other than placenta praevia. All bleeding during pregnancy should be reported to your doctor for prompt investigation and treatment.
 

Placenta Praevia Treatment

Placenta praevia is graded into 4 categories from minor to major. If you have grade 1 or 2 it may still be possible to have a vaginal birth, but grade 3 or 4 will require a caesarean section.

Any grade of placenta praevia will require you to live near or have easy access to the hospital in case you start bleeding. Heavy bleeding may mean you need to be admitted to hospital for the remainder of your pregnancy.

When you are in hospital, your blood will be taken to make sure an exact donor blood match is available in case you need a blood transfusion. You may also need to take iron tablets if you have anaemia (low blood haemoglobin level).

If you have bleeding during your pregnancy and have Rh negative blood, you will need an injection of Anti D so your baby is not affected by the bleeding.

Your baby may also be monitored with a cardiotocograph (CTG) to make sure they are not distressed. The CTG records your baby's heart rate and response to movements and contractions.

Being in hospital doesn't stop you from bleeding, but your baby can be delivered more quickly if needed. Your doctor or midwife will discuss any test results with you and what steps may be needed to ensure you and your baby's wellbeing.


Things to remember

  • During pregnancy, the placenta provides the growing baby with oxygen and nutrients from the mother’s bloodstream.

  • Placenta praevia means the placenta has implanted at the bottom of the uterus, over the cervix or close by, which means the baby can’t be born vaginally.

  • Treatment aims to ease the symptoms and prolong the pregnancy until at least 36 weeks.

What is shared care?

“Dr Suzanna is the best. I had issues with both my pregnancies, especially my second. Her professionalism and warm nature kept us calm, explaining everything to us at every step. I cannot recommend her highly enough.”
— Marjorie Absalom - Google Review

Dr. Suzana Kotevska is involved in the shared care system for all patients interested in this type of care during their pregnancy.

This is for patients who do not have private health insurance but still wish to be under the care of a specialist obstetrician (in this case Dr. Suzana Kotevska), and deliver in a public hospital.

Unfortunately with shared care Dr. Suzana will not be present at the birth of your baby, as she only delivers at Epworth Freemasons & St Vincent’s Private hospitals. Please read below for more information about who will be present at your delivery.

We understand that it can be expensive to go through the private system without private health insurance, and that is why Dr. Suzana is involved in shared care.

TO MAKE AN APPOINTMENT PLEASE CALL US ON 9419 8333 OR VISIT OUR ‘CONTACT US’ PAGE.

The benefit of shared care over complete public care:

Having the same specialist obstetrician look after you for all of your antenatal visits will allow you to develop a bond and a relationship with your doctor. All your queries, concerns, test results, ultrasounds etc. throughout your pregnancy will all be at the one clinic & one call away. What this means is that you won’t have to repeat your self to various midwives, junior or senior doctors within the public system and therefore sometimes resulting in different or conflicting advise from too many people and therefore confusing or worrying you.

Dr. Suzana doesn’t treat any of her patients differently and does her absolute best to ensure a smooth sailing pregnancy.

How shared care works:

Whilst seeing Dr Suzana for all your antenatal appointments you will also need to be booked into the public hospital that you will be having your baby at, as you will also have to attend certain appointments throughout your pregnancy there. Our receptionists will book you into the public hospital that you have chosen to deliver your baby at, once you have discussed this with Dr. Suzana at your appointment.

You will see Dr. Suzana for your very first appointment at 7-10 weeks, and at this appointment she will let you know when to come see her next and what tests, ultrasounds etc. you may need to do before that next appointment.

You will see Dr. Suzana for your antenatal appointments where you can speak to her about any concerns you may be having.

(Please go to ‘What To Expect When Expecting’ to learn more about each appointment; when they will be and what they will involve. Some of the steps may vary as you are delivering at a public hospital).

Luckily everyone in Australia with a Medicare number is entitled to free treatment as a public patient in a public hospital, paid for by Medicare. However, we do have to mention that the public system does rely on trainee doctors (interns, residents and registrars) who provide majority of the care whilst being supervised from specialists by phone or in person. Your care will be directed by whether that be by midwives, junior or senior doctors.

IMPORTANT NOTICE

If there are any emergencies after hours you will have to call 000 for an ambulance or go to the public hospital that you have been booked into.

Alternatively if it is a general query or concern you can call us during office hours Monday-Friday on 9419 8333 to book an appointment to see Dr Suzana at her office.

TO MAKE AN APPOINTMENT PLEASE CALL US ON 9419 8333 OR VISIT OUR ‘CONTACT US’ PAGE.

Endometriosis

The endometrium is the name for the cells that line your uterus (womb). These cells respond to the hormones released from the ovary.

Endometriosis is a common disease in which the tissue that is similar to the lining of the womb grows outside it in other parts of the body. 

When pregnancy doesn’t occur each month, the tissue comes away from the body with bleeding - this is known as a menstrual period.

Endometriosis occurs when these cells move to other parts of your body. Although they can move to almost any part of the body, most commonly endometriosis occurs in the pelvis.

Even though this tissue (the endometriosis) is outside the womb, it still responds to the messages from the ovary - it gets filled, and then when you have a period it bleeds.

Common symptoms include pelvic pain that puts life on hold around or during a woman’s period. It can damage fertility. Whilst endometriosis most often affects the reproductive organs it is frequently found in the bowel and bladder and has been found in muscle, joints, the lungs and the brain.

Endometriosis is:

  • Common - at least 1 in 10 women have endometriosis

  • Chronic - because endometriosis rarely goes away without treatment before menopause, the goals of treatment are to control the symptoms of endometriosis, not to cure it

  • Estrogen dependent - endometriosis is dependent on the hormone estrogen. Estrogen is produced by the ovary throughout the ‘reproductive years’; this means from the time you start having periods (puberty) to the time your ovaries shut down (menopause).

As long as you still have functioning ovaries you can still be affected by endometriosis. Once you go through menopause, your endometriosis will not be able to grow anymore.

Melbourne Obstetrician Melbourne Gynaecologist


Signs & symptoms of endometriosis:

The symptoms of endometriosis vary from one person to another.

Some women with endometriosis have no symptoms at all.

The 2 main symptoms that endometriosis causes are:

  1. Pain - the pain occurs in the places that the endometriosis has grown. It is mostly in the pelvis. It happens with your period (cyclical). For a lot of women the first pain they notice is with their periods. Some women with endometriosis also have pain with sex.

  2. Trouble getting pregnant (sub-fertility or infertility) - endometriosis can make it difficult to get pregnant. Because some women have no symptoms of endometriosis they might only get diagnosed once they start trying to get pregnant.

Other symptoms include:

  • Fatigue.

  • Pain that stops you on or around your period.

  • Pain on or around ovulation.

  • Pain during or after sex.

  • Pain with bowel movements.

  • Pain when you urinate.

  • Pain in your pelvic region, lower back or legs.

  • Having trouble holding on when you have a full bladder or having to go frequently.

  • Heavy bleeding or irregular bleeding.

What causes endometriosis?

The cause of endometriosis are not fully understood. Women with a mother or sister with endometriosis are more likely to get it.

How is endometriosis diagnosed?

Worsening painful periods is a symptom that may prompt your doctor to believe you have endometriosis. An ultrasound can sometimes help with the diagnosis. However the only way to know for sure is to undergo a laparoscopy.
This is a surgical procedure where your gynaecologist uses a small telescope inserted through your belly button to look at the organs on the inside of your pelvis. Your surgeon will take photos and often take samples of the endometriosis to confirm the disease.

How is endometriosis treated?

The treatment of endometriosis often involves both medication and surgery. 

Most women who have endometriosis will require both of these treatments at different stags of their lives.

The choice of treatments depends on how bad the pain is, where the pain is, and if you are trying to get pregnant.

  1. Medicines
    Pain relief medication like naproxen or ponstan

  2. Hormone-based treatments
    - The oral contraceptive pill - using the pill to stop ovulation, the levels of estrogen on the pelvis are reduced and this can help settle the activity of endometriosis.
    - Mirena - this small device is placed int he uterus and it releases a progesterone-like hormone. It has been shown to reduce the acitivy and pain of endometriosis over time for many women.
    - Other types of progesterone-like hormones - these medications can help settle the activity of endometriosis when used over time.
    - GnRG-agoniosts - some implants and sprays can switch off the release of reproductive hormones in women. However, this can can induce a state like menopause that women may find unpleasant. It is unusual to use such medications alone for more than a few months, as there can be long-term side effects.

  3. Surgery
    The surgery depends on the symptoms and location of the endometriosis.

  4. Complementary treatments (physiotherapy, psychology, etc.)
    Using other health professionals such as physiotherapists, acupuncturists, nutritionists and psychologists can be very helpful for women with endometriosis. You should always discuss these treatments with your doctor before commencing them, or if you are on any of these treatments and are having surgery, then it is also important to tell your doctor as some treatments can interfere with surgery.

There is not one type of treatment to suit all women that have endometriosis. Each treatment is specific to that woman and her symptoms and condition of the endometriosis. You should always be well informed and educated of the different types of treatments available to you, as well as the possible side-effects and complications. Keep in mind you may require more than just 1 type of treatment for your endometriosis.


For more information please seek independent medical assessment from a doctor. 
This is general advise only.

For more great info head to Endometriosis Australia website.

Skin & Hair Care During Pregnancy

Are you constantly confused about what is safe and what isn’t during pregnancy?
Well then have a read of the slides below to get a better understanding on what is & isn’t recommended during pregnancy.

Learn more about:

  • Vitamin A

  • Botox & fillers

  • Oils (essential oil, bio oil etc.)

  • Fake tan

  • Waxing & other hair removal products

  • Hair dye & Nail products/manicures

  • Protein Powders

A recent question that has come up a lot from our pregnancy patients (since beauty clinics reopened after our Melbourne COVID lockdown) is in regards to Laser hair removal during pregnancy.
Although laser hair removal is generally considered a safe procedure, doctors and dermatologists usually advise women to avoid the procedure because no studies have been done to prove that it's safe for mothers and babies. In the absence of research, doctors err on the side of caution.
Also note that laser hair removal is often less effective during pregnancy. Pregnancy hormones affect the pigmentation in your skin as well as the growth of hair follicles.



What’s an obstetrician?

“My husband and I are extremely grateful to Dr. Suzana for bringing our son to this world. Dr. Suzana is exceptional professional and amazing person. Throughout pregnancy and delivery, she showed so much care and professionalism, understanding and support. She visited us at the hospital for the check-ups and made us feel comfortable and reassuring. We felt like if Dr. Suzana was a member of our family or a close friend. We cannot recommend Dr. Suzana enough, she is simply the best!”
— Svitlana Kaiser - Google Review

An obstetrician is a doctor who specialises in pregnancy, childbirth, and a woman's reproductive system.

As an obstetrician Dr. Suzana has the skills to manage complex & high-risk pregnancies and births, and can perform interventions and caesareans. Dr. Suzana is also trained in women’s reproductive health (gynaecology).

Dr. Suzana’s responsibilities reflect that pregnancy and child birth is a natural and personal process in which the role of her as your obstetrician is to deliver expert advice and treatment in a caring professional manner to maximise the safety and well-being of mother and baby.

Dr. Suzana as the key health professional is responsible for the care of her pregnant patient and as such co-ordinates her care and acts as her advocate.

Dr. Suzana always treats her pregnancy patients with consideration and respect, seeking their cooperation and full understanding of medical issues may they arise. She takes an appropriate history and performs relevant clinical examinations, whilst handling all information in a private and confidential manner.

As a specialist obstetrician Dr. Suzana provides an accessible and appropriate level of information about, and explanation of:

- pregnancy, childbirth and the postpartum period

- advice offered, tests and treatment recommended, including any potential consequences of those recommendations and any possible alternative courses of action

- models of care and types of maternity service delivery so that a patient’s choice is well informed.

Dr. Suzana always provides the pregnant woman with the opportunity to participate in making decisions about her own care, and that of her baby before and after delivery. Dr. Suzana will discuss the possibility that a pregnant woman’s preferred management may not be possible in an emergency situation, and that planning for birth must be flexible and subject to modification if necessary, particularly in the event of complications. However Dr. Suzana also understands that the pregnant woman may choose to refuse treatment or investigations, and therefore the patient should be aware of the potential adverse consequences.

Dr. Suzana is readily accessible to both patients and colleagues when on duty or on call. As your private obstetrician Dr. Suzana ensures that any concerns or queries are responded to in a timely manner to ensure that our patients are put at ease immediately, and when it comes to emergency situations such as a pregnancy patients going into labor or other medical situation she will respond immediately when on duty or on call.

Dr. Suzana always goes above and beyond for each and every patient. She follows the guidelines and requirements set out by RANZCOG as she is a specialist accredited by the Royal Australian and New Zealand College of Obstetricians and Gynaecologist.

Sex & Relationships In Pregnancy

In a low risk pregnancy, sex is perfectly safe, although your levels of desire may fluctuate throughout pregnancy. Most women report that their interest in sex is the same of slightly reduced in the first trimester. In the second trimester, it varies from woman to woman and in the third trimester libido often falls.

SEX DURING PREGNANCY

During the first trimester, the hormonal changes that cause nausea, vomiting, and tiredness can naturally result in a reduced interest in sex. However, other pregnancy changes may increase your desire, such as an increased blood flow, which produces swelling in the clitoris and labia and extra vaginal secretions.
In the second trimester especially, vaginal lubrications and intensity of orgasm can increase, which may be accompanied by gentle contractions that harden the abdomen; these are normal and nothing to worry about. Many women find that their libido falls towards the end of their pregnancy as a bigger bump makes sex more awkward and uncomfortable, and they may also feel increasingly anxious about the birth.

HOW YOUR PARTNER FEELS

Partners have a range of feelings towards sex in pregnancy. While some find their partners new, fuller shape particularly sensuous, others feel apprehensive about sexy, fearing that they may harm the baby.
Some feel a combinations of these emotions. Unless there are concerns about the pregnancy, it’s generally thought that sex won’t cause harm, as your baby is well protected by the amniotic fluid and your uterus, and the mucus plug sealing the cervix protects against infection.

WHEN TO SEEK ADVISE

Some women experience vaginal bleeding after sex in pregnancy. This is most likely harmless and is often caused by the increased blood flow to the cervix in pregnancy, which can cause it to bleed on contact with your partners penis. If this is the cause, the bleeding should settle after the birth. However as there are other possible causes, report any bleeding to your doctor.
Apart from the size of your bump causing discomfort during sex, some women experience pain during sex towards the end of the pregnancy as the baby moves further into the pelvis; or they may find that the contractions that can accompany and orgasm become increasingly uncomfortable. These symptoms are u likely to be a cause for concern, but it’s worth mentioning them to your doctor for reassurance.
There are some circumstances in late pregnancy when intercourse may not be safe. This can be the case if you’ve had a previous premature labour or risk factors for premature labour, such a weak cervix, or if you have placenta paevia, or leakage of amniotic fluid which can mean your water shave broken.

If you have any concerns, don’t be afraid to ask your doctor for advise. Being able to enjoy sex in pregnancy can help your and your partner to feel close during this time of transition.
Indeed, psychologists have found that couples who enjoy sex in pregnancy are more tender towards each other and communicate better after birth.

Vaginal Birth After a Caesarean (VBAC)

Have you had a C-section? Are you thinking about how to give birth next time?

For many years it was assumed that once a woman had a C-section all future babies would also be delivered this way. However, this is not always the case. Whether you decide to have a Vaginal Birth After a Caesarean (VBAC) or a planned C-section in your future pregnancy, either option is usually safe but also has different risks and benefits involved.

Every woman’s preferences and risk profiles will be different.

It is extremely important to discuss your birth options with your obstetrician, to ensure that you are making the most informed choice. When considering your options your obstetrician will ask you about your medical history & your previous pregnancies (unless this is the same obstetrician as your previous pregnancies, then they will know your history).

Your obstetrician will want to know about:

-       The reason for your caesarean delivery & what happened – was it an emergency?

-       The type of cut that was made in your uterus

-       How you felt about your previous birth experience? (do you have any concerns?)

-       Whether your current pregnancy has been straightforward or have there been problems or any complications? (read our previous blog on Caesarean Sections to learn more).


Your obstetrician will always respect your right to be involved in the decision-making regarding the birth of your child, and your awareness of the risks and plans for future pregnancies.

It is important that your decision involves your partner and be made earlier on in your pregnancy and of course in consultation with your obstetrician. An agreed plan will then be documented in your pregnancy file.

What are the benefits & risks of VBAC?

Benefits of a successful VBAC include:

-       A vaginal birth; which may include an assisted birth

-       A higher chance of an uncomplicated normal birth in future pregnancies

-       When repeat elective C-section is chosen, there are risks associated with any major surgery, and all future births are likely to be by C-section. As the number of previous C-section deliveries increase, so does the risk of rare but serious complications

-       A shorter recovery & shorter stay in hospital

-       Less abdominal pain after birth

-       Some may have personal satisfaction in achieving a vaginal birth

-       Babies born vaginally have a lower risk of respiratory problems.

Risks for the mother & baby when attempting a VBAC:

-       There is a chance you will need an emergency C-section during labour, which has amplified risks of bleeding and infection compared to a planned C-section

-       Uterine scar rupture. This can result in serious problems for the baby (brain injury or even death) or for you (severe bleeding, including the small risk of hysterectomy)

-       The risk of your baby dying or being brain damaged in you chose a VBAC is very small (two in 1000 women). This is low however is it slightly higher than if oyu had a repeat C-section (one in 1000).

However, this needs to be weighed up against the risks and benefits of a planned C-section.

It can be challenging to explain and comprehend the risk of complications which occur rarely, but can have severe consequences if they occur.

When it’s not suitable for a VBAC

-      You have had three or more previous C-Section deliveries

-       Your uterus has ruptured previously

-       You have a high uterine incision

-       You have had a previous surgery to your uterus (removal of fibroids)

-       You have other pregnancy complications that require a C-section delivery

Factors affecting success of VBAC

Factors favouring success include:

-       Previous vaginal birth

-       Previous successful VBAC

-       Spontaneous onset of labour

-       Uncomplicated pregnancy without other risk factors

Factors making it less likely for a successful vaginal birth include:

-       You have never had a vaginal birth

-       Need to have your labour induced

-       Have had more than one previous C-section

-       Overweight with a BMI over 30 at booking

-       Have a complicated pregnancy

-       Have had sloe progress in a past labour

What happens if you don’t go into labour?

If you do not go into labour by 41 weeks your obstetrician will discuss various options with you. Induction of labour does remain an option for you however, this reduces the success rate of achieving VBAC and increases the rate of uterine rupture.

How will your care during labour be different if you have a VBAC?

There will be continuous monitoring of your baby’s heartbeat once you are in established labour. The progress of your labour will be closely monitored, and if you are not making good progress a repeat C-section will be advised. You will be involved throughout your labour with the planning of your care.

It is very important to think about all of your options very carefully. Your obstetrician is there to discuss any questions that you may have. Regardless of how your next baby is born vaginally or by C-section, she wants your experience to be safe, rewarding & satisfying for you and your family. And most importantly that you and your baby are healthy!

All About Caesarean Sections

A CAESAREAN SECTION MAY BE SUGGESTED IF THERE IS A POTENTIAL BENEFIT TO YOUR OWN OR YOUR BABY’S HEALTH, OR SOMETIMES BOTH.

A Caesarean section is the delivery of your baby by means of a cut in the abdomen. A Caesarean rate of around 10-15 % is thought to be reasonable, although in most western countries the rate has risen above 20%. almost a 3rd of all babies in Australia are now delivered by Caesarean.

TYPES OF CAESAREAN

Caesareans are either emergency or planned procedures. The doctor assesses urgency with a grading scheme. A Grade 1 Caesarean is one that is carried out if there is an immediate threat to the baby’s or mother’s life. A Grade 2 Caesarean is one where there is concern for the baby’s or mother’s wellbeing, but no immediate threat to life. A Grade 3 Caesarean is done when there is no immediate concern for the mother or the baby, perhaps because of a condition in the mother or baby. A Grade 4 Caesarean is an elective delivery planned to suit the woman and hospital.

CONSENT

The doctor will always get your consent prior to carrying out a Caesarean. She will tell you why the procedure is being proposed, and what its benefits and risks are. Ideally, you should have plenty of time to decide whether you want the operation or not, although with an emergency Caesarean, the time to think things over may be limited.

YOUR ANAESTHETIC

The anaesthetist will make sure that you have no pain during your operation, and will help you with pain control afterwards. Most women are awake during a Caesarean. An injection of medication into the spinal fluid in you back, called a spinal block, numbs any sensation of pain. Or, if you’ve been using an epidural for pain relief in labour, this can be used for the operation. After your anaesthetic has been given, the anaesthetist will check that it is working properly. Being awake usually means that your birthing partner can stay with you and it’s also a little safer for you and for your baby than a general anaesthetic. Very occasionally a general anaesthetic is needed.


THE OPERATION

Once the anaesthetist is happy that you’re pain free, your tummy will be cleaned with an antiseptic solution and sterile drapes will be placed over you, which also stop you and your partner seeing the operations.
During the operation, a long incision will be made on the tummy wall, across the bikini line, although occasionally an up-and-down cut below the belly button is done. Your bladder will be pushed down and the front of the uterus is opened so that the doctor can assess the baby. If your waters haven’t already broken, this will be done now before the baby and placenta are delivered. The surgeon will release the head from the pelvic brim and lift the baby out. Sometimes another member of the team needs to put pressure on the uterus to assist this. You’ll be able to see your baby when the cord has been cut, and once initial checks have been done on your baby, you or your partner should be able to hold your baby and have skin-to-skin contact while the operation is complete. You’ll have an injection of syntometrine to help deliver the placenta. To finish the Caesarean, the uterus will be closed up with one or two layers of stitches, the the tummy wall will be stitched in seperate layers.

RECOVERY

You will be encouraged by the midwives and obstetrician to get out of bed the following day, and by the day after this you may be well enough to do most things for yourself, with help.

POSSIBLE COMPLICATIONS

There are several common, but minor problems associated with Caesareans. These include bleeding during the operation, or a day or so later; needing a blood transfusion; or getting a minor infection in the bladder or in the wound. A major infection is far less common and having to have a second operation because of a life-threatening wound infection is rare.


MOST COMMON QUESTIONS AFTER CAESAREAN SECTION:

When can I drive?
6 weeks after a c-section is the recommended wait time before you can drive a car. It is important that you also speak with your car insurance to check what is stated in their T&C’s.

When can I exercise?
After a c-section you will need to wait until your 6 week check with your obstetrician before starting a strenuous program. Starting with low-impact exercises, such as walking and pilates.

When can I pick up my other child?
If your other children are 10kg + it is important that you avoid picking them up, as mentioned above in ‘When can I exercise’ you will need to wait a minimum of 6 weeks before being able to do any heavy lifting or strenuous work that can impact your abdominal muscles.

How do I take care of my Caesarean section wound?
(for all of Dr Suzana’s current pregnancy patients you can find this information in the USB we provide to you after your 10week appointment)

Your Caesarean incision may have been closed with staples which are usually removed within 3-7 days of delivery.
However the most common way that the incision is closed is with stitches, and are usually reabsorbable sutures, meaning they are absorbed by the body and do not need to be removed. Keep your wound clean and dry. Wear loose clothing and look for signs of infection (such as redness, pain, swelling of the wound or bad-smelling discharge). You will need to go see your obstetrician or midwife.
The incision will heal over the next few weeks. During this time, there may be mild cramping, light bleeding or vaginal discharge, as well as pain and numbness in the skin around the incision.
Most women will feel well by 6 weeks postpartum, but numbness around the incision and occasional aches and pains can last for several months.

Can I have a Vaginal Birth After a Caesarean (VBAC)?
ANSWER COMING IN OUR NEXT BLOG! 👉

Cytomegalovirus (CMV)

All the following information and much more is available at the CMV website. Please check it out!

What Is CMV?

Cytomegalovirus (CMV) is a common virus in the herpesvirus family. Fifty percent people have been infected by young adulthood and up to 85% by 40 years of age. Peaks of infection occur in children under 2 years age, and during adolescence.
Once a person becomes infected, the virus remains alive but usually inactive (dormant) within that person’s body for life. It is rare for a person to get symptoms after the initial infection unless their immune system is weakened by severe illness and treatments (e.g. for cancer). Reactivation can occur during pregnancy in women who have had infection previously, with a very small risk of transmission of CMV to the unborn baby.

Who Is At Risk?

If a woman is newly infected with CMV while pregnant, there is a risk that her unborn baby will also become infected (congenital CMV). Infected babies may, but not always, be born with a disability. The highest risk to the unborn baby occurs when a woman who has never had CMV before is infected with the virus for the first time during pregnancy (primary [first] CMV infection) and when infection occurs during the first half of the pregnancy.

Studies in Australia have shown that out of 1,000 live births, about 6 infants will have congenital CMV infection and 1-2 of those 6 infants (about 1 in 1000 infants overall) will have permanent disabilities of varying degree. These can include hearing loss, vision loss, small head size, cerebral palsy, developmental delay or intellectual disability, and in rare cases, death. Sometimes, the virus may reactivate while a woman is pregnant but reactivation does not usually cause problems to the woman or her unborn baby.

Transmission

Humans are the only source of CMV. The virus is found in urine, saliva, nasal mucous, breast milk, vaginal secretions and semen of infected people. The risk of transmission from children born with disability due to CMV infection is no greater than that from children who have CMV infection without symptoms. CMV is spread through:

  • Close contact with a person excreting the virus in their saliva, nasal mucous, urine or other body fluid

  • Handling children’s toys that have saliva or mucous on them, or handling contaminated items like dirty tissues or soiled nappies then touching the eyes, nose or mouth without first washing hands

  • From mother to her unborn child as a result of maternal infection during pregnancy

  • From mother to her unborn child as a result of virus reactivation during pregnancy

  • Breast milk of an infected woman who is breast feeding

  • Sexual contact.

Prevention

Pregnant women are recommended to take steps to reduce their risk of exposure to CMV and so reduce the risk of their developing baby becoming infected.

  • Wash hands often with soap and running water for at least 15 seconds and dry them thoroughly. This should be done especially after close contact with young children, changing nappies, blowing noses, feeding a young child, and handling children’s toys, dummies/soothers.

  • Do not share food, drinks, eating utensils or toothbrushes with young children.

  • Avoid contact with saliva when kissing a child.

  • Use simple detergent and water to clean toys, countertops and other surfaces that come into contact with children’s urine, mucous or saliva.

Child care workers who are pregnant or considering pregnancy should pay particular attention to good hand hygiene, especially after changing nappies or assisting with blowing noses or toileting.

Symptoms

Children and adults with healthy immune systems do not usually develop symptoms when infected, but may develop an illness similar to glandular fever with tiredness, sore throat, swollen glands and fever. People with a weakened immune system are more likely to develop symptoms.

Diagnosis

A person who has been infected with CMV will develop antibodies in their blood that indicate infection has occurred, either recently, or in the past. These antibodies stay in the body for the rest of that person’s life. Other tests, that detect the virus, are used to determine if a person has an active CMV infection.

Testing for CMV is not routinely recommended for all women during pregnancy or for newborn babies. CMV testing is currently recommended for pregnant women who develop an acute viral illness or when ultrasound reveals a foetal abnormality. However, pregnant women and women planning a pregnancy may wish to discuss CMV testing with their doctor, particularly if they work in high risk settings (e.g. in child care centres) or have very young children at home.

Infants born to mothers diagnosed with a primary CMV infection during pregnancy should be tested for congenital CMV infection. Babies who do not have a normal hearing screening test at birth (SWISH) can also be tested for congenital CMV, as hearing loss is the most common sign of congenital CMV. However, some infants with congenital CMV infection who appear healthy at birth develop hearing or vision loss over time; for this reason, babies known to be infected should have their hearing and vision assessed regularly.

Treatment

Currently, international research is being conducted about the best methods for treating CMV infection during pregnancy.

Pregnant women diagnosed with primary (first) CMV infection should be referred for specialist follow up and counselling in order to receive up to date information about the risks and benefits of the available treatments, which are currently experimental. Infants born with neurological disabilities due to CMV may benefit from early antiviral treatment; this should be discussed with a specialist paediatrician.

Most babies born with CMV infection grow up with normal health. Concerns about CMV infection can be discussed with a general practitioner or MotherSafe, a free telephone service that provides a comprehensive counselling service for women and their healthcare providers concerned about exposures during pregnancy and breastfeeding http://www.mothersafe.org.au/

To get involved join the STOP CMV Hand Campaign at https://www.cmv.org.au/stop-cmv-hand-photos/

*All this information is from the CMV website, all credit for this information goes to them.

Non-Invasive Perinatal Test (NIPT)

The Non-Invasive Perinatal Test (NIPT) is used to detect pregnancies that have an increased risk of a chromosome condition such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), Patau syndrome (trisomy 13), other rare trisomies and partial chromosome deletions and duplications.

These conditions are all related with intellectual disability and congenital malformations. The severity of intellectual disability and the risk of malformations vary with different disorders.

What is NIPT?

NIPT is an sophisticated screening test that includes an exact and accurate measure of the amount of fetal DNA in your blood before proceeding with the chromosome analysis. The NIPT uses cell-free Fetal DNA (cfDNA) located in the maternal blood to detect chromosome conditions found during pregnancy. cfDNA is released from the placenta into the maternal blood stream as part of the growth and development of the baby.

The NIPT screening is safe and poses no threat to the pregnancy as it uses a simple blood sample collected from the mother.

Melbourne Obstetrician Melbourne Gynaecologist

Accuracy 

The finding rate; this describes how good the test is at detecting a specific condition such as Down syndrome using the NIPT is >99%. What this means is that if your pregnancy is affected by Down syndrome, it will almost certainly be detected.
 

What happens if the NIPT is a high risk result?

A high risk result doesn’t necessarily mean that your pregnancy is definitely affected by a specific condition, what it means is that that may be an increased chance. When this happens a genetic counsellor will contact your obstetrician to discuss other testing options, such as diagnostic testing. Diagnostic testing will not give you a definitive yes or no answer, however it is the only way to verify the presence of a condition or assure you you’re your pregnancy will not be affected.

When can I do the test?

Screening can be done any time from 10 weeks of your pregnancy. Once the test has been undertaken it then takes 3-8 business days to receive the results. Your results are investigated by certified medical scientists who are trained specialists in prenatal screening and diagnosis. 

 

For more information please speak to Dr Suzana at your next appointment or visit:

https://www.sonicgenetics.com.au/nipt/patients/what-is-nipt/

https://www.vcgs.org.au/tests/perceptnipt

 

 

 

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Importance Of Your Pelvic Floor Muscles

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What do my pelvic floor muscles do? 

The pelvic floor is the base of the group of muscles referred to as your ‘core’. These muscles work with your tummy (deep abdominal) and deep back muscles and diaphragm to stabilise and support the spine. They also assist in controlling the pressure inside your abdomen to deal with the pushing force when you lift or strain, for example when you are exercising.

Pelvic floor muscles support the bladder, bowel and uterus in women (and the bladder and bowel in men).

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What causes my pelvic floor muscles to weaken? 

Pelvic floor problems can occur when the pelvic floor muscles are stretched, weakened or too tight. Some people have weak pelvic floor muscles from an early age, whilst others notice problems after certain life stages such as: 

·      Childbirth (predominantly resulting in the delivery of a large baby or prolonged pushing during delivery)

·      Being pregnant

·      Being overweight

·      Heavy lifting (e.g. at work or the gym)

·      Chronic cough or sneezing (asthma, heavy smokers & hayfever)

·      Changes in hormonal levels (menopause)

·      Constipation (excessive straining to empty your bowel)

·      A history of back pain

·      Growing older.

 

How do you strengthen your pelvic floor muscles?

Your pelvic floor muscles can be consciously controlled and therefore trained. Strengthening your pelvic floor muscles will help you to support your bladder and bowel. What this does in improve your bladder and bowel control and helps reduce the possibility of accidentally leaking from your bladder and bowel. With a regular strengthening exercise program your pelvic floor muscles will become stronger. This is very important for both women and men.

·      If you have mastered the art of contracting your pelvic floor muscles correctly, you can try holding the inward squeeze for longer (up to 10 seconds) before relaxing. Make sure you can breathe easily while you squeeze. If you can do this exercise, repeat it up to 10 times, but only as long as you can do it with perfect technique while breathing quietly and keeping everything above the belly button relaxed. This can be done more often during the day to improve control. If you need help identifying your pelvic floor muscles then visit the Pelvic Floor First website.

·      Pilates are another great way to strengthen your pelvic floor muscles as these muscles require slow exercises as well as fast exercises. Check out the Poise website for some great pilates workout examples. (Consult your physician if you have any questions or are hesitant whether or not pilates is ok and safe for you, especially if you are pregnant).

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How do I prevent damage to my pelvic floor muscles?

You need to avoid the following:

·      Straining with a bowel motion

·      Persistent heavy lifting

·      Repetitive coughing

·      Putting on too much weight.

Like all exercises, pelvic floor exercises are most effective when individually tailored and monitored. The exercises described are only a guide and may not help if done incorrectly or if the training is inappropriate.