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More About Special Care Pregnancies
Heart disease
In a normal pregnancy, significant changes occur in the cardiovascular system. These include:
- a An increase in heart output of almost 50 per cent.
- An increase in heart rate of up to 20 beats per minute.
- A lowering of blood pressure in early and mid-pregnancy, with a return to normal by late pregnancy.
These changes are quite normal but often lead to the discovery of an innocent heart murmur, which can be heard through a stethoscope because of the increased blood flow. Labour places an additional strain on the heart.
Management
Ideally, all women with heart disease should be given pre-conceptual counselling by a heart specialist to address the potential risks of any future pregnancy. They include, for example, women who received corrective heart surgery as children (for example, repair of a hole in the heart) and are now of child-bearing age, women who have problems with their heart valves, for example, narrowing of the aortic or mitral valves (aortic or mitral stenosis), and women with artificial heart valves.
If you become pregnant and have significant heart disease, your doctor wiil refer you to a specialist clinic where you can receive the best advice and the appropriate tests, for example, an echocardiogram (an ultrasound of your heart) or an ECG. Your condition will also be monitored regularly.
Thyroid disease
It is normal for the thyroid gland, which is situated at the front of the neck, to increase in size during pregnancy because of the increase in blood flow. However, the gland can cause problems if it is overactive (hyperthyroidism) or underactive (hypothyroidism). Uncommonly, thyroid disease is a cause of infertility.
| HIV Pregnant women are encouraged to have HIV screening. If a woman accepts screening, she is talked through the procedure and the possible consequences, and asked to give her consent. If the results of the test are positive, she will be offered counselling. The aim of treatment is to lower the chances of HIV infecting the baby. Giving the mother anti-retroviral drugs during the last few months of pregnancy reduces the risk of the baby acquiring the infection. HIV-positive pregnant women will normally be advised to have an elective caesarean section and to bottle- rather than breastfeed. All babies born to HIV-positive mothers start life with HIV antibodies, but this does not automatically mean that they are infected, as these are the mother's antibodies. The baby will be given a series of tests over the ensuing months to monitor the levels of the virus in the bloodstream.
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Management
If you have hyperthyroidism, your doctor will prescribe anti-thyroid : _.35, such as carbimazole and propylthiouracil. These can cross the placenta and cause fetal hypothyroidism, so the lowest possible doses of the drug must be used. Your paediatrician should be made aware of your condition so that he can check your baby once it is born. It is usually safe to breast-feed.
Hypothyroidism is treated with thyroxine, and very little crosses the placenta so your baby would not be at risk of side-effects.
Sickle-cell anaemia
Sickle-cell anaemia is a genetic disorder that mainly affects people of Afro-Caribbean origin, but also some people from the Mediterranean region, the Middle East and Asia. People with sickle-cell anaemia have abnormal haemoglobin that becomes distorted (sickle-shaped) under conditions of stress, blocking small blood vessels and causing severe pain and sickle-cell crises. The stress of pregnancy is sufficient to trigger a sickle-cell crisis.
In addition, pregnant women with sickle-cell anaemia have an increased risk of miscarriage, premature labour, stillbirth and preeclampsia, as well as DVT and PE, urinary tract infection and puerperal sepsis.The baby is also more likely to suffer from growth restriction and fetal distress.
Management
If you have sickle-cell anaemia, you should be referred to an antenatal clinic that is used to dealing with high-risk pregnancies, where there are obstetricians and haematologists at hand.
Cholestasis
Obstetric cholestasis (OC) is characterized by severe itching that normally affects the arms and legs, particularly the palms of the hands and soles of the feet, and the trunk. It develops during the last 3 months of pregnancy. Blood tests usually show abnormalities in liver function and an - cease in bile acids, but other causes of itching, such as hepatitis or gallstones, need to be excluded. In OC, the mother is at increased risk of bleeding after the delivery and the baby is more likely to be stillborn or suffer from fetal distress.
Management
If you are diagnosed as having OC, your baby should be monitored at 'e: Car intervals. You will be given vitamin K to reduce the chance of bleeding. You may also be given antihistamines to relieve the itching,although unsodeoxycholic acid, which reduces the level of bile acids circulating in the blood, is more effective. It is usually advisable to induce labour at 37-38 weeks. The likelihood of OC recurring in future pregnancies is about 90 per cent.
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Fetal Problems and surgery New surgical techniques mean that it is becoming possible to correct some abnormalities while the baby is still in the womb. Some techniques are available only in a few centres worldwide and may not be appropriate for all babies with the specified condition, depending on the severity of the case. spina bifida In this surgery, the tube around the spinal cord is closed to reduce further damage in cases where the fetus is not thought to be severely affected already. twin-twin transfusion syndrome (TTTS) Identical twins who share a placenta have a small but significant risk of developing TTTS. One twin receives more blood than the other because of abnormal blood vessels that connect across the placenta.Treatments include destroying these vessels with a laser and draining excess amniotic fluid. hernia of the diaphragm A weakness in the diaphragm allows the baby's intestines to move up into the chest and prevent the lungs from developing properly. A clip or balloon catheter is used to block the baby's airway, so that fluid can build up inside the lungs and help them to expand and grow more normally. heart valve problems Progressive narrowing of the valves in the fetal heart can be life-threatening and has recently been treated in the uterus. Using ultrasound to guide it, a tiny balloon is guided into the defective valve and then inflated.This enlarges the valve, allowing more blood to flow through it.
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