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Nine Months : Common Concerns And Discomforts

Vaginal Discharge

In pregnancy: Vaginal discharge tends to increase in pregnancy and is quite similar to what you would expect before a period. This discharge which is mucus-like and clear is produced by the vagina due to the hormonal changes. It is nothing to worry about. However, if the discharge becomes coloured and foul smelling or is accompanied by itching, soreness and pain, you must consult your doctor or midwife to rule out vaginal infection. These infections are not serious and are easily treated with creams or pessaries.

What to do? Keep the vaginal area clean and wear cotton underwear which are absorbent.

You may feel comfortable wearing a panty liner if the discharge bothers you.



Varicose Veins

What are they? Swollen veins are called varicose veins and the most commonly affected veins are those of the calves and the thighs. These veins become painful and swollen. They are caused by hormonal changes and in later pregnancy, by the obstruction of the blood flow to the heart from lower legs as a result of the weight of the enlarging uterus. They are also known to be more common in mothers where this problem runs in the family.Varicose veins can also occur in the vulva and also in the rectum (haemorrhoids).

Symptoms:

* Aching legs

* Visible swelling of veins in calves and thighs

What to do?

* Avoid standing for long periods of time

* Avoid sitting cross-legged

* Try to sleep with your legs elevated than the rest of the body

* Practice foot exercises to improve circulation

* Sit with your feet elevated

* Wear support tights and put them on before you get up from the bed in the morning

Varicose veins generally disappear sometime after delivery but in certain cases, treatment may be required.

Vasa Praevia

The following information has been very kindly provided by a UK mother, Carol Prentice who suffered from this condition, has a healthy baby girl now and is a member of the International Vasa Previa Foundation (based in the US). For those of you looking for support for this condition, please visit www.vasaprevia.com

Cause: Vasa praevia occurs when fetal blood vessel(s) from the placenta or umbilical cord cross the entrance to the birth canal, beneath the baby. Vasa praevia can result in rapid foetal haemorrhage (occurs from the vessels tearing when the cervix dilates or membranes rupture) or lack of oxygen (if the vessels become pinched off as they are compressed between the baby and the walls of the birth canal). The aberrant vessels result from velamentous insertion of the cord, bilobed or succenturiate lobed placenta.

Symptoms: Vasa praevia can be asymptomatic but can also present with sudden onset of abnormally heavy or small amounts of painless vaginal bleeding in the second or third trimester of pregnancy. Source of blood should always be investigated to determine whether the blood is maternal or fetal. Incidence: Rarely reported, occurs in 1:2500 to 3000 births with a foetal mortality rate estimated to be as high as 95 percent if not diagnosed antepartum. Prognosis: When properly diagnosed antepartum, prognosis of survival is very good. The foetal mortality rate is very low when an elective C-section is performed after foetal lung maturity is adequate.

Ante partum Diagnosis: Changing current routine obstetrical ultrasound protocols to include checking the placental cord connection for velamentous cord insertion during all routine obstetrical ultrasounds is recommended (preferably with coluor Doppler). All suspected cases of velamentous cord insertion, placenta previa, low-lying placenta, multi-gestational pregnancies, and multi-lobed placentas need to be checked for vasa praevia with advanced ultrasound techniques, specifically level 2 ultrasound of the lower uterine segments and/or transvaginal color Doppler ultrasound. Vasa praevia can be detected during pregnancy as early as the 16th week with use of transvaginal sonography in combination with color Doppler.Infant death from vasa praevia is preventable if diagnosed antenatally.

Warning Signs: Vasa praevia might be present if any (or none) of the following conditions exist: low-lying placenta (may be caused by previous miscarriages followed by curreting of the uterus (D&C), or uterine operations, which causes scarring in the uterus), bilobed or succenturiate-lobed placentas, pregnancies resulting from in-vitro fertilization or multiple pregnancies.(5-6) Vasa previa bleeding is painless. Other OB or birthing bleeding complications are not necessarily painless..

Treatment: When diagnosed antepartum, treatment plans could include the following: use of tocolytes to stop all uterine activity; bedrest; no sexual intercourse, vaginal exams, lifting, heavy straining during bowel movements (use of stool softeners); hospitalization; foetal monitoring; regular ultrasounds to monitor progression of vasa praevia; determination of source of bleeding (either foetal or maternal); amniocentesis to access foetal lung maturity; steroid treatment to develop foetal lung maturity; and most importantly, elective cesarean delivery early enough to avoid an emergency but late enough to avoid complications of prematurity. When not diagnosed antepartum, aggressive resuscitation complete with blood transfusion for the infant if necessary must be planned for and/or expected.




               

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