What are the signs and symptoms? Spotting or bleeding may be a sign, often beginning in the first trimester. But many subchorionic bleeds are detected during a routine ultrasound, without there being any noticeable signs or symptoms. Spotting or bleeding may be a sign, often beginning in the first trimester. But many subchorionic bleeds are detected during a routine ultrasound, without there being any noticeable signs or symptoms.

You'll Want to Know ...

Asubchorionic bleed does not affect the baby, and since you'll be checked with ultrasounds until the hematoma corrects itself, you'll get reassurance each time you see your baby's heartbeat (and that will be more often than most expectant parents get!).

What can you and your practitioner do? If you have spotting or bleeding, call your practitioner; an ultrasound may be ordered to see whether there is indeed a subchorionic bleed, how large it is, and where it's located. If you have spotting or bleeding, call your practitioner; an ultrasound may be ordered to see whether there is indeed a subchorionic bleed, how large it is, and where it's located.

Hyperemesis Gravidarum What is it? Hyperemesis gravidarum is the medical term for severe pregnancy nausea and vomiting that is continuous and debilitating (not to be confused with typical morning sickness, even a pretty bad case). Hyperemesis usually starts to lift between weeks 12 and 16, but some cases can continue throughout pregnancy. Hyperemesis gravidarum is the medical term for severe pregnancy nausea and vomiting that is continuous and debilitating (not to be confused with typical morning sickness, even a pretty bad case). Hyperemesis usually starts to lift between weeks 12 and 16, but some cases can continue throughout pregnancy.

Hyperemesis gravidarum can lead to weight loss, malnutrition, and dehydration if it's left untreated. Treatment of severe hyperemesis often requires hospitalization-mostly for the administration of IV fluids and antinausea drugs, which can effectively safeguard your well-being and your baby's.

How common is it? Hyperemesis gravidarum occurs in about 1 in 200 pregnancies. This pregnancy complication is more common in first-time mothers, in young mothers, in obese women, in women carrying multiple fetuses, and in women who've had it in a previous pregnancy. Extreme emotional stress can also increase your risk, as can endocrine imbalances and vitamin B deficiencies. Hyperemesis gravidarum occurs in about 1 in 200 pregnancies. This pregnancy complication is more common in first-time mothers, in young mothers, in obese women, in women carrying multiple fetuses, and in women who've had it in a previous pregnancy. Extreme emotional stress can also increase your risk, as can endocrine imbalances and vitamin B deficiencies.

What are the signs and symptoms? The symptoms of hyperemesis gravidarum include: The symptoms of hyperemesis gravidarum include: [image] Very frequent and severe nausea and vomiting Very frequent and severe nausea and vomiting[image] The inability to keep any food or even liquid down The inability to keep any food or even liquid down[image] Signs of dehydration, such as infrequent urination or dark yellow urine Signs of dehydration, such as infrequent urination or dark yellow urine[image] Weight loss of more than 5 percent Weight loss of more than 5 percent[image] Blood in the vomit Blood in the vomit What can you and your practitioner do? If your symptoms are relatively mild, you can first try some of the natural remedies used to fight morning sickness, including ginger, acupuncture, and acupressure wristbands (see If your symptoms are relatively mild, you can first try some of the natural remedies used to fight morning sickness, including ginger, acupuncture, and acupressure wristbands (see page 130 page 130). If those don't do the trick, ask your practitioner about medications that can help (a combination of vitamin B6 and Unisom Sleep Tabs is often prescribed for tough morning sickness cases). But if you're vomiting continually and/or losing significant amounts of weight, your practitioner will assess your need for intravenous fluids and/or hospitalization, and possibly prescribe some sort of antiemetic (antinausea) drug. Once you're able to keep food down again, it may help to tweak your diet to eliminate fatty and spicy foods, which are more likely to cause nausea, as well as to avoid any smells or tastes that tend to set you off. In addition, try to graze on many small high-carb and high-protein meals throughout the day, and be sure your fluid intake is adequate (keeping an eye on your urinary output is the best way to assess that; dark scant urine is a sign you're not getting, or keeping down, enough fluids). and Unisom Sleep Tabs is often prescribed for tough morning sickness cases). But if you're vomiting continually and/or losing significant amounts of weight, your practitioner will assess your need for intravenous fluids and/or hospitalization, and possibly prescribe some sort of antiemetic (antinausea) drug. Once you're able to keep food down again, it may help to tweak your diet to eliminate fatty and spicy foods, which are more likely to cause nausea, as well as to avoid any smells or tastes that tend to set you off. In addition, try to graze on many small high-carb and high-protein meals throughout the day, and be sure your fluid intake is adequate (keeping an eye on your urinary output is the best way to assess that; dark scant urine is a sign you're not getting, or keeping down, enough fluids).

You'll Want to Know ...

As miserable as hyperemesis gravidarum makes you feel, it's unlikely to affect your baby. Most studies show no health or developmental differences between infants of women who experience hyperemesis gravidarum and those who don't.

Gestational Diabetes What is it? Gestational diabetes (GD)-a form of diabetes that appears only during pregnancy-occurs when the body does not produce adequate amounts of insulin (the hormone that lets the body turn blood sugar into energy) to regulate blood sugar effectively. GD usually begins between weeks 24 and 28 of pregnancy (which explains why a glucose screening test is routine at around 28 weeks). GD almost always goes away after delivery, but if you've had it, you'll be checked postpartum to make sure it's gone. Gestational diabetes (GD)-a form of diabetes that appears only during pregnancy-occurs when the body does not produce adequate amounts of insulin (the hormone that lets the body turn blood sugar into energy) to regulate blood sugar effectively. GD usually begins between weeks 24 and 28 of pregnancy (which explains why a glucose screening test is routine at around 28 weeks). GD almost always goes away after delivery, but if you've had it, you'll be checked postpartum to make sure it's gone.

Diabetes, both the kind that begins in pregnancy and the kind that started before conception, is not harmful to either the fetus or the mother if it is well controlled. But if excessive sugar is allowed to circulate in a mother's blood and thus to enter the fetal circulation through the placenta, the potential problems for both mother and baby are serious. Women who have uncontrolled GD are more likely to have a too-large baby, which can complicate delivery. They are also at risk for developing preeclampsia (pregnancy-induced hypertension). Uncontrolled diabetes could also lead to potential problems for the baby after birth, such as jaundice, breathing difficulties, and low blood sugar levels. Later in life, he or she may be at an increased risk for obesity and type 2 diabetes.

How common is it? GD is fairly common, affecting 4 to 8 percent of expectant women. Because it's more common among obese women, rates of GD are rising along with rising obesity rates in the United States. Older moms-to-be are more likely to develop GD, as are women with a family history of diabetes or GD. Native Americans, Latin Americans, and African Americans are also at somewhat greater risk for GD. GD is fairly common, affecting 4 to 8 percent of expectant women. Because it's more common among obese women, rates of GD are rising along with rising obesity rates in the United States. Older moms-to-be are more likely to develop GD, as are women with a family history of diabetes or GD. Native Americans, Latin Americans, and African Americans are also at somewhat greater risk for GD.

What are the signs and symptoms? Most women with GD have no symptoms, though a few may experience: Most women with GD have no symptoms, though a few may experience: [image] Unusual thirst Unusual thirst[image] Frequent and very copious urination (as distinguished from the also frequent but usually light urination of early pregnancy) Frequent and very copious urination (as distinguished from the also frequent but usually light urination of early pregnancy)[image] Fatigue (which may be difficult to differentiate from pregnancy fatigue) Fatigue (which may be difficult to differentiate from pregnancy fatigue)[image] Sugar in the urine (detected at a routine practitioner visit) Sugar in the urine (detected at a routine practitioner visit) What can you and your practitioner do? Around your 28th week, you'll be given a glucose screening test (see Around your 28th week, you'll be given a glucose screening test (see page 297 page 297) and, if necessary, a more elaborate three-hour glucose tolerance test. If these tests show you have GD, your practitioner will likely put you on a special diet (similar to the Pregnancy Diet) and suggest exercises to keep your GD under control. You may also need to check your glucose levels at home using a glucose meter or strips. If diet and exercise alone aren't enough to control your blood sugar level (they usually are), you may need supplementary insulin. The insulin can be given in shots, but the oral drug glyburide is being used more and more often as an alternative treatment for GD. Fortunately, virtually all of the potential risks associated with diabetes in pregnancy can be eliminated through the careful control of blood sugar levels achieved by good self- and medical care. For more on diabetes control, see page 519 page 519.

You'll Want to Know ...

There's little reason for concern if your GD is well controlled. Your pregnancy will progress normally and your baby shouldn't be affected.

Can it be prevented? Keeping an eye on your weight gain (both before and during pregnancy) can help prevent GD. So, too, can good diet habits (eating plenty of fruits and vegetables, and whole grains, keeping refined sugar intake down, and making sure you're getting enough folic acid) and regular exercise (research shows that obese women who exercise cut their risk of developing GD by half). Continuing these preventive steps after the baby's born also significantly reduces the risk of diabetes occurring later in life. Keeping an eye on your weight gain (both before and during pregnancy) can help prevent GD. So, too, can good diet habits (eating plenty of fruits and vegetables, and whole grains, keeping refined sugar intake down, and making sure you're getting enough folic acid) and regular exercise (research shows that obese women who exercise cut their risk of developing GD by half). Continuing these preventive steps after the baby's born also significantly reduces the risk of diabetes occurring later in life.

Keep in mind, too, that having GD during pregnancy puts you at greater risk of developing type 2 diabetes after pregnancy. Keeping your diet healthy, staying at a normal weight, and, even more important, continuing to exercise after the baby is born (and beyond) significantly cuts that risk.

Preeclampsia What is it? Preeclampsia (also known as pregnancy-induced hypertension or toxemia) is a disorder that generally develops late in pregnancy (after week 20) and is characterized by a sudden onset of high blood pressure, excessive swelling (edema), and protein in the urine. Preeclampsia (also known as pregnancy-induced hypertension or toxemia) is a disorder that generally develops late in pregnancy (after week 20) and is characterized by a sudden onset of high blood pressure, excessive swelling (edema), and protein in the urine.

If preeclampsia goes untreated, it could progress to eclampsia, a much more serious condition involving seizures (see page 562 page 562). Unmanaged preeclampsia can also cause a number of other pregnancy complications, such as premature delivery or intrauterine growth restriction.

How common is it? About 8 percent of pregnant women are diagnosed with preeclampsia. Women carrying multiple fetuses, women over 40, and women with high blood pressure or diabetes are at greater risk of developing preeclampsia. If you're diagnosed with preeclampsia in one of your pregnancies, you have a 1 in 3 chance of developing the condition in future pregnancies. That risk is higher if you are diagnosed with preeclampsia in your first pregnancy or if you develop preeclampsia early in any pregnancy. About 8 percent of pregnant women are diagnosed with preeclampsia. Women carrying multiple fetuses, women over 40, and women with high blood pressure or diabetes are at greater risk of developing preeclampsia. If you're diagnosed with preeclampsia in one of your pregnancies, you have a 1 in 3 chance of developing the condition in future pregnancies. That risk is higher if you are diagnosed with preeclampsia in your first pregnancy or if you develop preeclampsia early in any pregnancy.

What are the signs and symptoms? Symptoms of preeclampsia can include any or all of the following: Symptoms of preeclampsia can include any or all of the following: [image] Severe swelling of hands and face Severe swelling of hands and face[image] Swelling of the ankles that doesn't go away after 12 hours of rest Swelling of the ankles that doesn't go away after 12 hours of rest[image] Sudden excessive weight gain unrelated to eating Sudden excessive weight gain unrelated to eating[image] Headaches that don't respond to over-the-counter pain relievers Headaches that don't respond to over-the-counter pain relievers[image] Pain in the upper abdomen Pain in the upper abdomen[image] Blurred or double vision Blurred or double vision[image] A rise in blood pressure (to 140/90 or more in a woman who has never before had high blood pressure) A rise in blood pressure (to 140/90 or more in a woman who has never before had high blood pressure)[image] Protein in the urine Protein in the urine[image] Rapid heartbeat Rapid heartbeat[image] Scant urine output Scant urine output[image] Abnormal kidney function Abnormal kidney function[image] Exaggerated reflex reactions Exaggerated reflex reactions

The Reasons Behind Preeclampsia No one knows for sure what causes preeclampsia, though there are a number of theories: [image] A genetic link. Researchers hypothesize that the genetic makeup of the fetus could be one of the factors that predisposes a pregnancy to preeclampsia. So, if your mother or your spouse's mother had preeclampsia during their pregnancies with either of you, you are somewhat more likely to have preeclampsia during your pregnancies. A genetic link. Researchers hypothesize that the genetic makeup of the fetus could be one of the factors that predisposes a pregnancy to preeclampsia. So, if your mother or your spouse's mother had preeclampsia during their pregnancies with either of you, you are somewhat more likely to have preeclampsia during your pregnancies.[image] A blood vessel defect. It has been suggested that this defect causes the blood vessels in some women to constrict during pregnancy instead of widen (as usually happens). As a result of this vessel defect, theorize researchers, there is a drop in the blood supply to organs like the kidney and liver, leading to preeclampsia. The fact that women who experience preeclampsia during pregnancy are at an increased risk later in life of having some sort of cardiovascular condition also seems to indicate that the condition may be the result of a predisposition in some women to high blood pressure. A blood vessel defect. It has been suggested that this defect causes the blood vessels in some women to constrict during pregnancy instead of widen (as usually happens). As a result of this vessel defect, theorize researchers, there is a drop in the blood supply to organs like the kidney and liver, leading to preeclampsia. The fact that women who experience preeclampsia during pregnancy are at an increased risk later in life of having some sort of cardiovascular condition also seems to indicate that the condition may be the result of a predisposition in some women to high blood pressure.[image] Gum disease. Pregnant women with severe gum disease are more than twice as likely to also have preeclampsia compared to women with healthy gums. Experts theorize that the infection causing the periodontal disease may travel to the placenta or produce chemicals that can cause preeclampsia. Still, it is not known if periodontal disease causes preeclampsia or if it is just associated with it. Gum disease. Pregnant women with severe gum disease are more than twice as likely to also have preeclampsia compared to women with healthy gums. Experts theorize that the infection causing the periodontal disease may travel to the placenta or produce chemicals that can cause preeclampsia. Still, it is not known if periodontal disease causes preeclampsia or if it is just associated with it.[image] An immune response to a foreign intruder: the baby. This theory implies that the woman's body becomes "allergic" to the baby and placenta. This "allergy" causes a reaction in the mother's body that can damage her blood and blood vessels. The more similar the father's and mother's genetic markers, the more likely this immune response will occur. An immune response to a foreign intruder: the baby. This theory implies that the woman's body becomes "allergic" to the baby and placenta. This "allergy" causes a reaction in the mother's body that can damage her blood and blood vessels. The more similar the father's and mother's genetic markers, the more likely this immune response will occur.

What can you and your practitioner do? Regular prenatal care is the best way to catch preeclampsia in its early stages (your practitioner might be tipped off by protein in your urine and a rise in your blood pressure, or the symptoms just listed). Being alert to any such symptoms (and alerting your practitioner if you notice them) also helps, particularly if you had a history of hypertension before pregnancy. Regular prenatal care is the best way to catch preeclampsia in its early stages (your practitioner might be tipped off by protein in your urine and a rise in your blood pressure, or the symptoms just listed). Being alert to any such symptoms (and alerting your practitioner if you notice them) also helps, particularly if you had a history of hypertension before pregnancy.

If you're diagnosed with preeclampsia, your treatment will probably include bed rest at home and careful blood pressure and fetal monitoring (though more pronounced cases may require hospital bed rest). With severe preeclampsia, the treatment is usually more aggressive and includes delivery within three days of diagnosis. Intravenous magnesium sulfate is begun promptly because it almost always prevents progression to eclampsia.

Though treatments are available to control preeclampsia for short periods of time, there is no cure except for delivery of your baby, which will likely be recommended as soon as the baby is physically mature enough or after medications are given to speed lung maturity. The good news is that 97 percent of women with preeclampsia recover completely, with a speedy return to normal blood pressure, after delivery.

On the research horizon: Scientists are developing simple blood and urine tests that can predict which moms-to-be are likely to develop this complication. They've found that women who eventually develop preeclampsia show high levels of a substance called soluble FH-1 in the blood and urine. Another substance called endoglin may also prove to predict the condition. Ideally, the research will lead to much earlier detection of preeclampsia.

Can it be prevented? Research has suggested that for women at risk for preeclampsia, aspirin or other anticlotting drugs during pregnancy may reduce the risk, though the benefits of this medically induced therapy need to be weighed against its theoretical risks. Some research has suggested that good nutrition, which ensures adequate intakes of antioxidants, magnesium, vitamins (especially D), and minerals, may reduce the risk of preeclampsia, as may proper dental care. Research has suggested that for women at risk for preeclampsia, aspirin or other anticlotting drugs during pregnancy may reduce the risk, though the benefits of this medically induced therapy need to be weighed against its theoretical risks. Some research has suggested that good nutrition, which ensures adequate intakes of antioxidants, magnesium, vitamins (especially D), and minerals, may reduce the risk of preeclampsia, as may proper dental care.

You'll Want to Know ...

Fortunately, in women who are receiving regular medical care, preeclampsia is almost invariably caught early on and managed successfully. With appropriate and prompt medical care, a woman with preeclampsia near term has virtually the same excellent chance of having a positive pregnancy outcome as a woman with normal blood pressure.

HELLP Syndrome What is it? HELLP syndrome is a combination of conditions that can affect a pregnant woman, either by itself or in conjunction with preeclampsia, almost always in the last trimester. The acronym stands for hemolysis (H), in which red blood cells are destroyed too soon, causing a low red-cell count; elevated liver enzymes (EL), which indicates that the liver is functioning poorly and is unable to process toxins in the body efficiently; and low platelet count (LP), which makes it difficult for the blood to form clots. HELLP syndrome is a combination of conditions that can affect a pregnant woman, either by itself or in conjunction with preeclampsia, almost always in the last trimester. The acronym stands for hemolysis (H), in which red blood cells are destroyed too soon, causing a low red-cell count; elevated liver enzymes (EL), which indicates that the liver is functioning poorly and is unable to process toxins in the body efficiently; and low platelet count (LP), which makes it difficult for the blood to form clots.

When HELLP develops, it can threaten both a mother's life and that of her baby. Women who aren't diagnosed and treated quickly run about a 1 in 4 chance of suffering serious complications, primarily in the form of extensive liver damage or stroke.

How common is it? HELLP syndrome occurs in fewer than 1 in 10 preeclamptic or eclamptic pregnancies and fewer than 1 in 500 pregnancies. HELLP syndrome occurs in fewer than 1 in 10 preeclamptic or eclamptic pregnancies and fewer than 1 in 500 pregnancies.

Women who develop preeclampsia or eclampsia are at risk, as are women who have had HELLP in a previous pregnancy.

What are the signs and symptoms? The symptoms of HELLP are very vague, consisting of (in the third trimester): The symptoms of HELLP are very vague, consisting of (in the third trimester): [image] Nausea Nausea[image] Vomiting Vomiting[image] Headaches Headaches[image] General malaise General malaise[image] Pain and tenderness in the upper right side of the abdomen Pain and tenderness in the upper right side of the abdomen[image] Viral-type illness symptoms Viral-type illness symptoms Blood tests reveal a low platelet count, elevated liver enzymes, and hemolysis (the breakdown of red blood cells). Liver function rapidly deteriorates in women with HELLP, so treatment is critical.

What can you and your practitioner do? The only effective treatment for HELLP syndrome is delivery of your baby, so the best thing you can do is be aware of the symptoms of the condition (especially if you already have or are at risk for preeclampsia) and call your practitioner immediately if you develop any. If you have HELLP, you might also be given steroids (to treat the condition and help mature the baby's lungs) and magnesium sulfate (to prevent seizures). The only effective treatment for HELLP syndrome is delivery of your baby, so the best thing you can do is be aware of the symptoms of the condition (especially if you already have or are at risk for preeclampsia) and call your practitioner immediately if you develop any. If you have HELLP, you might also be given steroids (to treat the condition and help mature the baby's lungs) and magnesium sulfate (to prevent seizures).

Can it be prevented? Because a woman who has had HELLP in a previous pregnancy is likely to have it again, close monitoring is necessary in any subsequent pregnancy. Unfortunately, nothing can be done to prevent the condition. Because a woman who has had HELLP in a previous pregnancy is likely to have it again, close monitoring is necessary in any subsequent pregnancy. Unfortunately, nothing can be done to prevent the condition.

Intrauterine Growth Restriction What is it? Intrauterine growth restriction (IUGR) is a term used for a baby who is smaller than normal during pregnancy. A diagnosis of IUGR is given if your baby's weight is below the 10th percentile for his or her gestational age. IUGR can occur if the health of the placenta or its blood supply is impaired or if the mother's nutrition, health, or lifestyle prevents the healthy growth of her fetus. Intrauterine growth restriction (IUGR) is a term used for a baby who is smaller than normal during pregnancy. A diagnosis of IUGR is given if your baby's weight is below the 10th percentile for his or her gestational age. IUGR can occur if the health of the placenta or its blood supply is impaired or if the mother's nutrition, health, or lifestyle prevents the healthy growth of her fetus.

How common is it? IUGR occurs in about 10 percent of all pregnancies. It's more common in first pregnancies, in fifth and subsequent ones, in women who are under age 17 or over age 35, in those who had a previous low-birthweight baby, as well as in those who have placental problems or uterine abnormalities. Carrying multiples is also a risk factor, but that's probably due more to the crowded conditions (it's hard to fit more than one 7-pounder in a single womb) than to problems with the placenta. Having been small at birth yourself also puts you at an increased risk of having a small baby, and the risk is also higher if the baby's father was born small. IUGR occurs in about 10 percent of all pregnancies. It's more common in first pregnancies, in fifth and subsequent ones, in women who are under age 17 or over age 35, in those who had a previous low-birthweight baby, as well as in those who have placental problems or uterine abnormalities. Carrying multiples is also a risk factor, but that's probably due more to the crowded conditions (it's hard to fit more than one 7-pounder in a single womb) than to problems with the placenta. Having been small at birth yourself also puts you at an increased risk of having a small baby, and the risk is also higher if the baby's father was born small.

You'll Want to Know ...

A mom who has already had a low-birthweight baby has only a modestly increased risk of having another one-and, to her advantage, statistics show that each subsequent baby is actually likely to be a bit heavier than the preceding one. If you had an IUGR baby the first time around, paying attention to all the possible contributing factors can reduce the risk this time around.

What are the signs and symptoms? Surprisingly, carrying small is not usually a tip-off to IUGR. In fact, there are rarely any obvious outward signs that the baby isn't growing as he or she should be. Instead, IUGR is usually detected during a routine prenatal exam when the practitioner measures the fundal height-the distance from your pubic bone to the top of your uterus-and finds that it's measuring too small for the baby's gestational age. An ultrasound can also detect a baby whose growth is slower than expected for his or her gestational age. Surprisingly, carrying small is not usually a tip-off to IUGR. In fact, there are rarely any obvious outward signs that the baby isn't growing as he or she should be. Instead, IUGR is usually detected during a routine prenatal exam when the practitioner measures the fundal height-the distance from your pubic bone to the top of your uterus-and finds that it's measuring too small for the baby's gestational age. An ultrasound can also detect a baby whose growth is slower than expected for his or her gestational age.

What can you and your practitioner do? One of the best predictors of a baby's good health is birthweight, so having IUGR can present some health problems for the newborn, including having difficulty maintaining a normal body temperature or fighting infection. That's why it's so important to diagnose the problem early and try to boost baby's chances of a healthy bottom line at birth. A variety of approaches may be tried, depending on the suspected cause, including bed rest, intravenous feedings if necessary, and medications to improve placental blood flow or to correct a diagnosed problem that may be contributing to the IUGR. If the intrauterine environment is poor and can't be improved, and the fetal lungs are known to be mature, prompt delivery-which allows baby to start living under healthier conditions-is usually the best way to go. One of the best predictors of a baby's good health is birthweight, so having IUGR can present some health problems for the newborn, including having difficulty maintaining a normal body temperature or fighting infection. That's why it's so important to diagnose the problem early and try to boost baby's chances of a healthy bottom line at birth. A variety of approaches may be tried, depending on the suspected cause, including bed rest, intravenous feedings if necessary, and medications to improve placental blood flow or to correct a diagnosed problem that may be contributing to the IUGR. If the intrauterine environment is poor and can't be improved, and the fetal lungs are known to be mature, prompt delivery-which allows baby to start living under healthier conditions-is usually the best way to go.

Can it be prevented? Optimum nutrition and the elimination of risk factors can greatly improve the chances for normal fetal growth and a normal birthweight. Controlling certain maternal risk factors (such as chronic high blood pressure, smoking, drinking alcohol, or using recreational drugs) that contribute to poor fetal growth can help prevent IUGR. Good prenatal care can also minimize the risks, as can excellent diet, proper weight gain within recommended guidelines, as well as minimizing physical and excessive psychological stress (including chronic lack of rest). Happily, even when prevention and treatment are unsuccessful and a baby is born smaller than normal, the chances that he or she will do well are increasingly good, thanks to the many advances in neonatal (newborn) care. Optimum nutrition and the elimination of risk factors can greatly improve the chances for normal fetal growth and a normal birthweight. Controlling certain maternal risk factors (such as chronic high blood pressure, smoking, drinking alcohol, or using recreational drugs) that contribute to poor fetal growth can help prevent IUGR. Good prenatal care can also minimize the risks, as can excellent diet, proper weight gain within recommended guidelines, as well as minimizing physical and excessive psychological stress (including chronic lack of rest). Happily, even when prevention and treatment are unsuccessful and a baby is born smaller than normal, the chances that he or she will do well are increasingly good, thanks to the many advances in neonatal (newborn) care.

You'll Want to Know ...

More than 90 percent of babies who are born small for date do fine, catching up with their bigger birth buddies in the first couple of years of life.

Placenta Previa What is it? The definition of placenta previa is a placenta that partially or completely covers the opening of the cervix. In early pregnancy, a low-lying placenta is fairly common but as pregnancy progresses and the uterus grows, the placenta usually moves upward and away from the cervix. If it doesn't move up and partially covers or touches the cervix, it's called partial previa. If it completely covers the cervix, it's called total or complete previa. Either can physically block your baby's passage into the birth canal, making a vaginal delivery impossible. It can also trigger bleeding late in pregnancy and at delivery. The closer to the cervix the placenta is situated, the greater the possibility of bleeding. The definition of placenta previa is a placenta that partially or completely covers the opening of the cervix. In early pregnancy, a low-lying placenta is fairly common but as pregnancy progresses and the uterus grows, the placenta usually moves upward and away from the cervix. If it doesn't move up and partially covers or touches the cervix, it's called partial previa. If it completely covers the cervix, it's called total or complete previa. Either can physically block your baby's passage into the birth canal, making a vaginal delivery impossible. It can also trigger bleeding late in pregnancy and at delivery. The closer to the cervix the placenta is situated, the greater the possibility of bleeding.

How common is it? Placenta previa occurs in 1 out of every 200 deliveries. It is more likely to occur in women over the age of 30 than in women under the age of 20, and it is also more common in women who have had at least one other pregnancy or any kind of uterine surgery (such as a previous C-section or a D and C following miscarriage). Smoking or carrying multiple fetuses also increases the risks. Placenta previa occurs in 1 out of every 200 deliveries. It is more likely to occur in women over the age of 30 than in women under the age of 20, and it is also more common in women who have had at least one other pregnancy or any kind of uterine surgery (such as a previous C-section or a D and C following miscarriage). Smoking or carrying multiple fetuses also increases the risks.

What are the signs and symptoms? Placenta previa is most often discovered not on the basis of symptoms but during a routine second-trimester ultrasound (though there isn't even the potential for problems with a previa until the third trimester). Sometimes the condition announces itself in the third trimester (occasionally earlier) with bright-red bleeding. Typically, bleeding is the only symptom. There's usually no pain involved. Placenta previa is most often discovered not on the basis of symptoms but during a routine second-trimester ultrasound (though there isn't even the potential for problems with a previa until the third trimester). Sometimes the condition announces itself in the third trimester (occasionally earlier) with bright-red bleeding. Typically, bleeding is the only symptom. There's usually no pain involved.

What can you and your practitioner do? Nothing needs to be done (and you don't have to give your low-lying placenta a second thought) until the third trimester, by which point most early cases of placenta previa have corrected themselves. Even later on, there is no treatment necessary if you've been diagnosed with previa but aren't experiencing any bleeding (you'll just need to be alert to any bleeding or to signs of premature labor, which is more common with placenta previa). If you're experiencing bleeding related to a diagnosed previa, your practitioner will likely put you on bed rest, pelvic rest (no sex), and will monitor you closely. If premature labor seems imminent, you may receive steroid shots to mature your baby's lungs more rapidly. Even if the condition hasn't presented your pregnancy with any problems at all (you haven't had any bleeding and you've carried to term), your baby will still be delivered via C-section. Nothing needs to be done (and you don't have to give your low-lying placenta a second thought) until the third trimester, by which point most early cases of placenta previa have corrected themselves. Even later on, there is no treatment necessary if you've been diagnosed with previa but aren't experiencing any bleeding (you'll just need to be alert to any bleeding or to signs of premature labor, which is more common with placenta previa). If you're experiencing bleeding related to a diagnosed previa, your practitioner will likely put you on bed rest, pelvic rest (no sex), and will monitor you closely. If premature labor seems imminent, you may receive steroid shots to mature your baby's lungs more rapidly. Even if the condition hasn't presented your pregnancy with any problems at all (you haven't had any bleeding and you've carried to term), your baby will still be delivered via C-section.

Placenta Previa Here, the placenta completely covers the mouth of the uterus, making a safe vaginal delivery impossible.

You'll Want to Know ...

Placenta previa is considered to be the most common cause of bleeding in the latter part of pregnancy. Most previas are found early and managed well, with the baby delivered successfully by a cesarean (about 75 percent of cases are delivered by C-section before labor starts).

Placental Abruption What is it? Placental abruption (also called abruptio placenta) is the early separation of the placenta (the baby's support system) from the uterine wall during pregnancy, rather than after delivery. If the separation is slight, there is usually little danger to the mother or baby as long as treatment is prompt and proper precautions are taken. If the abruption is more severe, however, the risk to the baby is considerably higher. That's because a placenta's complete detachment from the uterine wall means the baby is no longer getting oxygen or nutrition. Placental abruption (also called abruptio placenta) is the early separation of the placenta (the baby's support system) from the uterine wall during pregnancy, rather than after delivery. If the separation is slight, there is usually little danger to the mother or baby as long as treatment is prompt and proper precautions are taken. If the abruption is more severe, however, the risk to the baby is considerably higher. That's because a placenta's complete detachment from the uterine wall means the baby is no longer getting oxygen or nutrition.

How common is it? It occurs in less than 1 percent of pregnancies, almost always in the second half of the pregnancy and most often in the third trimester. Placental abruption can happen to anyone, but it occurs more commonly in women who are carrying multiples, who have had a previous abruption, who smoke or use cocaine, or who have gestational diabetes, a predisposition to clotting, preeclampsia, or other high blood pressure conditions of pregnancy. A short umbilical cord or trauma due to an accident is occasionally the cause of an abruption. It occurs in less than 1 percent of pregnancies, almost always in the second half of the pregnancy and most often in the third trimester. Placental abruption can happen to anyone, but it occurs more commonly in women who are carrying multiples, who have had a previous abruption, who smoke or use cocaine, or who have gestational diabetes, a predisposition to clotting, preeclampsia, or other high blood pressure conditions of pregnancy. A short umbilical cord or trauma due to an accident is occasionally the cause of an abruption.

What are the signs and symptoms? The symptoms of placental abruption depend on the severity of the detachment, but will usually include: The symptoms of placental abruption depend on the severity of the detachment, but will usually include: [image] Bleeding (that could be light to heavy, with or without clots) Bleeding (that could be light to heavy, with or without clots)[image] Abdominal cramping or achiness Abdominal cramping or achiness[image] Uterine tenderness Uterine tenderness[image] Pain in the back or abdomen Pain in the back or abdomen What can you and your practitioner do? Let your practitioner know immediately if you have abdominal pain accompanied by bleeding in the second half of your pregnancy. A diagnosis is usually made using patient history, physical exam, and observation of uterine contractions and the fetal response to them. Ultrasound may be helpful, but only about 25 percent of abruptions can actually be seen on ultrasound. If it's been determined that your placenta has separated slightly from the uterine wall but has not completely detached, and if your baby's vital signs stay regular, you'll probably be put on bed rest. If the bleeding continues, you may require intravenous fluids. Your practitioner may also administer steroids to speed up your baby's lung maturation in case you need to deliver early. If the abruption is significant or if it continues to progress, the only way to treat it is to deliver the baby, most often by C-section. Let your practitioner know immediately if you have abdominal pain accompanied by bleeding in the second half of your pregnancy. A diagnosis is usually made using patient history, physical exam, and observation of uterine contractions and the fetal response to them. Ultrasound may be helpful, but only about 25 percent of abruptions can actually be seen on ultrasound. If it's been determined that your placenta has separated slightly from the uterine wall but has not completely detached, and if your baby's vital signs stay regular, you'll probably be put on bed rest. If the bleeding continues, you may require intravenous fluids. Your practitioner may also administer steroids to speed up your baby's lung maturation in case you need to deliver early. If the abruption is significant or if it continues to progress, the only way to treat it is to deliver the baby, most often by C-section.

Chorioamnionitis What is it? Chorioamnionitis is a bacterial infection of the amniotic membranes and fluid that surround and protect your baby. It's caused by common bacteria such as E. coli or by group B strep (which you'll be tested for around week 36 of your pregnancy). The infection is believed to be a major cause of preterm premature rupture of the membranes (PPROM) as well as of premature delivery. Chorioamnionitis is a bacterial infection of the amniotic membranes and fluid that surround and protect your baby. It's caused by common bacteria such as E. coli or by group B strep (which you'll be tested for around week 36 of your pregnancy). The infection is believed to be a major cause of preterm premature rupture of the membranes (PPROM) as well as of premature delivery.

How common is it? Chorioamnionitis occurs in 1 to 2 percent of pregnancies. Women who experience premature rupture of the membranes are at increased risk for chorioamnionitis because bacteria from the vagina can seep into the amniotic sac after it has ruptured. Women who've had the infection during their first pregnancy are more likely to have it again in a subsequent pregnancy. Chorioamnionitis occurs in 1 to 2 percent of pregnancies. Women who experience premature rupture of the membranes are at increased risk for chorioamnionitis because bacteria from the vagina can seep into the amniotic sac after it has ruptured. Women who've had the infection during their first pregnancy are more likely to have it again in a subsequent pregnancy.

What are the signs and symptoms? Diagnosis of chorioamnionitis is complicated by the fact that no simple test can confirm the presence of infection. The symptoms of chorioamnionitis can include: Diagnosis of chorioamnionitis is complicated by the fact that no simple test can confirm the presence of infection. The symptoms of chorioamnionitis can include: [image] Fever Fever[image] Tender, painful uterus Tender, painful uterus[image] Increased heart rate in both you and your baby Increased heart rate in both you and your baby[image] Leaking, foul-smelling amniotic fluid (if membranes have already ruptured) Leaking, foul-smelling amniotic fluid (if membranes have already ruptured)[image] Unpleasant-smelling vaginal discharge (if membranes are intact) Unpleasant-smelling vaginal discharge (if membranes are intact)[image] Increased white blood count (a sign the body is fighting an infection) Increased white blood count (a sign the body is fighting an infection) What can you and your practitioner do? Be sure to call your practitioner if you notice any leaking of amniotic fluid, no matter how small, or if you notice a foul-smelling discharge or any other of the symptoms listed above. If you are diagnosed with chorioamnionitis, you will likely be prescribed antibiotics to wipe out the bacteria, and be delivered immediately. You and your baby will also be given antibiotics after delivery to make sure no further infections develop. Be sure to call your practitioner if you notice any leaking of amniotic fluid, no matter how small, or if you notice a foul-smelling discharge or any other of the symptoms listed above. If you are diagnosed with chorioamnionitis, you will likely be prescribed antibiotics to wipe out the bacteria, and be delivered immediately. You and your baby will also be given antibiotics after delivery to make sure no further infections develop.

You'll Want to Know ...

Rapid diagnosis and treatment of chorioamnionitis greatly reduces the risks to both mother and baby.

Oligohydramnios What is it? Oligohydramnios is a condition in which there is not enough amniotic fluid surrounding and cushioning the baby. It usually develops in the latter part of the third trimester, though it could show up earlier in pregnancy. Though the majority of women diagnosed with oligohydramnios will have a completely normal pregnancy, there is a slight risk of umbilical cord constriction if there's too little fluid for your baby to float around in. Often, the condition is simply the result of a fluid leak or puncture in the amniotic sac (one you wouldn't necessarily notice). Less commonly, a low level of amniotic fluid can suggest a problem in the baby, such as poor fetal growth or a kidney or urinary tract condition. Oligohydramnios is a condition in which there is not enough amniotic fluid surrounding and cushioning the baby. It usually develops in the latter part of the third trimester, though it could show up earlier in pregnancy. Though the majority of women diagnosed with oligohydramnios will have a completely normal pregnancy, there is a slight risk of umbilical cord constriction if there's too little fluid for your baby to float around in. Often, the condition is simply the result of a fluid leak or puncture in the amniotic sac (one you wouldn't necessarily notice). Less commonly, a low level of amniotic fluid can suggest a problem in the baby, such as poor fetal growth or a kidney or urinary tract condition.

How common is it? Four to 8 percent of pregnant women are diagnosed with oligohydramnios during their pregnancy, but among overdue women (those two weeks past their due dates), the number rises to 12 percent. Women with a post-term pregnancy are most likely to have oligohydramnios, as are those who have premature rupture of membranes. Four to 8 percent of pregnant women are diagnosed with oligohydramnios during their pregnancy, but among overdue women (those two weeks past their due dates), the number rises to 12 percent. Women with a post-term pregnancy are most likely to have oligohydramnios, as are those who have premature rupture of membranes.

What are the signs and symptoms? There are no symptoms in the mother, but signs that would point to the condition are a uterus that measures smaller than it should and a decreased amount of amniotic fluid, detected via ultrasound. There might also be a noticeable decrease of fetal activity and sudden drops in the fetal heart rate in some cases. There are no symptoms in the mother, but signs that would point to the condition are a uterus that measures smaller than it should and a decreased amount of amniotic fluid, detected via ultrasound. There might also be a noticeable decrease of fetal activity and sudden drops in the fetal heart rate in some cases.

What can you and your practitioner do? If you're diagnosed with oligohydramnios, you'll need to get a lot of rest and drink plenty of water. The amount of amniotic fluid will be closely monitored. If at any point oligohydramnios endangers the well-being of your baby, your practitioner may suggest amnioinfusion (in which fluid levels are augmented with sterile saline) or may opt for an early delivery. If you're diagnosed with oligohydramnios, you'll need to get a lot of rest and drink plenty of water. The amount of amniotic fluid will be closely monitored. If at any point oligohydramnios endangers the well-being of your baby, your practitioner may suggest amnioinfusion (in which fluid levels are augmented with sterile saline) or may opt for an early delivery.

Hydramnios What is it? Too much amniotic fluid surrounding the fetus causes the condition known as hydramnios (also called polyhydramnios). Most cases of hydramnios are mild and transient, simply the result of a temporary change in the normal balance of the amniotic fluid production, with any extra fluid likely to be reabsorbed without any treatment. Too much amniotic fluid surrounding the fetus causes the condition known as hydramnios (also called polyhydramnios). Most cases of hydramnios are mild and transient, simply the result of a temporary change in the normal balance of the amniotic fluid production, with any extra fluid likely to be reabsorbed without any treatment.

But when fluid accumulation is severe (which is rare), it may signal a problem with the baby, such as a central nervous system or gastrointestinal defect, or an inability to swallow (babies typically swallow amniotic fluid). Too much amniotic fluid can put your pregnancy at risk for premature rupture of membranes, preterm labor, placental abruption, breech presentation, or umbilical cord prolapse.

How common is it? Hydramnios occurs in 3 to 4 percent of all pregnancies. It is more likely to occur when there are multiple fetuses and can be related to untreated diabetes in the mother. Hydramnios occurs in 3 to 4 percent of all pregnancies. It is more likely to occur when there are multiple fetuses and can be related to untreated diabetes in the mother.

What are the signs and symptoms? More often than not, there are no symptoms at all with hydramnios, though some women may notice: More often than not, there are no symptoms at all with hydramnios, though some women may notice: [image] Difficulty feeling fetal movements (because there's too much of a cushion) Difficulty feeling fetal movements (because there's too much of a cushion)[image] Unusually rapid growth of the uterus Unusually rapid growth of the uterus[image] Discomfort in the abdomen Discomfort in the abdomen[image] Indigestion Indigestion[image] Swelling in the legs Swelling in the legs[image] Breathlessness Breathlessness[image] Possibly, uterine contractions Possibly, uterine contractions Hydramnios is usually detected during a prenatal exam, when your fundal height-the distance from your pubic bone to the top of your uterus-measures larger than normal, or during an ultrasound that measures the amount of fluid in the amniotic sac.

What can you and your practitioner do? Unless the fluid accumulation is fairly severe, there's absolutely nothing you need to do except to keep your appointments with your practitioner, who will continue to monitor your condition. If the accumulation is more severe, your practitioner may suggest you undergo a procedure called therapeutic amniocentesis, during which fluid is withdrawn from the amniotic sac to reduce the amount. Since hydramnios puts you at increased risk for cord prolapse, call your practitioner right away if your water breaks on its own before labor. Unless the fluid accumulation is fairly severe, there's absolutely nothing you need to do except to keep your appointments with your practitioner, who will continue to monitor your condition. If the accumulation is more severe, your practitioner may suggest you undergo a procedure called therapeutic amniocentesis, during which fluid is withdrawn from the amniotic sac to reduce the amount. Since hydramnios puts you at increased risk for cord prolapse, call your practitioner right away if your water breaks on its own before labor.

Preterm Premature Rupture of the Membranes (PPROM) What is it? PPROM refers to the rupture of the membranes (or "bag of waters") that cradle the fetus in the uterus, before 37 weeks (in other words, before term, when the baby is still premature). The major risk of PPROM is a premature birth; other risks include infection of the amniotic fluid and prolapse or compression of the umbilical cord. (Premature rupture of the membranes, or PROM, that isn't preterm-that is, it takes place after 37 weeks, but before labor begins-is discussed on PPROM refers to the rupture of the membranes (or "bag of waters") that cradle the fetus in the uterus, before 37 weeks (in other words, before term, when the baby is still premature). The major risk of PPROM is a premature birth; other risks include infection of the amniotic fluid and prolapse or compression of the umbilical cord. (Premature rupture of the membranes, or PROM, that isn't preterm-that is, it takes place after 37 weeks, but before labor begins-is discussed on page 363 page 363.) How common is it? Preterm premature rupture of membranes occurs in fewer than 3 percent of pregnancies. Women most at risk are those who smoke during pregnancy, have certain STDs, have chronic vaginal bleeding or placental abruption, have had a previous early membrane rupture, have bacterial vaginosis (BV), or who are carrying multiples. Preterm premature rupture of membranes occurs in fewer than 3 percent of pregnancies. Women most at risk are those who smoke during pregnancy, have certain STDs, have chronic vaginal bleeding or placental abruption, have had a previous early membrane rupture, have bacterial vaginosis (BV), or who are carrying multiples.

What are the signs and symptoms? The symptoms are leaking or gushing of fluid from the vagina. The way to tell whether you're leaking amniotic fluid and not urine is by taking the sniff test: If it smells like ammonia, it's probably urine. If it has a somewhat sweet smell, it's probably amniotic fluid (unless it's infected; then the fluid will be more foul smelling). If you have any doubts about what you're leaking, call your practitioner to be on the safe side. The symptoms are leaking or gushing of fluid from the vagina. The way to tell whether you're leaking amniotic fluid and not urine is by taking the sniff test: If it smells like ammonia, it's probably urine. If it has a somewhat sweet smell, it's probably amniotic fluid (unless it's infected; then the fluid will be more foul smelling). If you have any doubts about what you're leaking, call your practitioner to be on the safe side.

What can you and your practitioner do? If your membranes have ruptured after 34 weeks, you'll likely be induced and your baby delivered. If it's too soon for your baby to be delivered safely, chances are you'll be put on in-hospital bed rest and be given antibiotics to ward off infection, as well as steroids to mature your baby's lungs as quickly as possible for a safer early delivery. If contractions begin and the baby is believed to be too immature for delivery, medication may be given to try to stop them. If your membranes have ruptured after 34 weeks, you'll likely be induced and your baby delivered. If it's too soon for your baby to be delivered safely, chances are you'll be put on in-hospital bed rest and be given antibiotics to ward off infection, as well as steroids to mature your baby's lungs as quickly as possible for a safer early delivery. If contractions begin and the baby is believed to be too immature for delivery, medication may be given to try to stop them.

You'll Want to Know ...

With prompt and appropriate diagnosis and management of PPROM, both mother and baby should be fine, though if the birth is premature, there may be a long stay in the neonatal intensive care unit for baby.

Rarely, the break in the membranes heals and the leakage of amniotic fluid stops on its own. If that happens, you'll be allowed to go home and resume your normal routine while remaining on the alert for signs of further leakage.

Can it be prevented? Vaginal infections, particularly BV, can lead to PPROM; therefore, watching out for and treating these infections may be effective in preventing some cases of PPROM. Vaginal infections, particularly BV, can lead to PPROM; therefore, watching out for and treating these infections may be effective in preventing some cases of PPROM.

Preterm or Premature Labor What is it? Labor that kicks in after week 20 but before the end of week 37 of pregnancy is considered to be preterm labor. Labor that kicks in after week 20 but before the end of week 37 of pregnancy is considered to be preterm labor.