Barb's Daily Dose

Pregnancy Symptoms

It seems that every day someone is worried about whether they're pregnant and want to know if what they're feeling are pregnancy symptoms. Now that you can run to the drug store and buy a urine pregnancy test for under $25.00, that's probably a good first step if you've missed your period.  But even at that cost, many women don't want to spend the money and instead try to diagnose their own pregnancy symptoms themselves.

Pregancy After Miscarriage

In my practice, I care for many women who are pregnant.  It can be a magical time and I love, love, love seeing women for their first prenatal visit.  The best part of the 1st trimester ultrasound is that I can confirm the pregnancy and establish a firm due date.  Even though most pregnancies will be healthy and normal, there's always the chance that I won't see a beating heart or other indicators of a healthy, viable pregnancy.  I know that often the woman and her partner haven't slept the night before worrying about the 1st visit, and my blood pressure and heart rate are a bit elevated as I prepare also for the first ultrasound. 

Waiting for Home Pregnancy Test

I care for a lot of women who are trying to become pregnant and who are corssing their fingers, pacing in the bathroom and hoping that they'll see a plus sign on the drugstore urine pregnancy test.  They pee'd on the stick and now every second seems like hours as the test develops.  At first, they can't believe it, so they reach into the box and grab another test.  Is it real?  Is this really happening, they wonder.  I've had patients take 15 tests because they just couldn't believe their eyes.  They needed lots of confirmation.

Tilted Uterus and Miscarriage

I received this email the other day and thought I'd share it here because of the opportunity to correct some myths.

Dear Nurse Barb,

I had my first ultrasound at 8 weeks and got to see the heartbeat (150 beats per minute) and then I had my second appointment 2 weeks ago and got to hear the heartbeat on the doppler.  I had the NT ultrasound and blood work done on Wednesday.  They measured the fluid by neck and said everything looked good.  I will get the blood results back by mid-week. 

Pregancy After 40

Is it Safe for a Woman to Conceive After 40?

This question comes up all the time.  Depending on the woman's circumstances, if she is healthy, and without other medical problems, then the answer is Absolutely YES, a woman can safely conceive after 40.

The Risks

We've all heard that the risks of delivering a baby with a genetic disorder are increased after 40, but it's important to keep these "risks" in perspective and understand what it might mean for an individual woman.  Even at 40, the risk of delivering a baby with a genetic disorder are still quite small.

Help I Need to Know Exactly When I Conceived

Frequently Asked Questions

I recently found out that I was pregnant. The doctor said that I was 5 weeks and 3 days. My question is can you tell me about what day my conception occurred?

This is a question that comes up frequently and I wish that I could give you an exact answer about the date of conception. Many women need to know this information for a variety of important reasons.

The trouble is that even with very sophisticated technology like Ultrasounds that can give us a fairly accurate idea of how far along a woman is, these can be off by as much as 3-7 days in the first 12 weeks of pregnancy.

Amniocentesis

Many people have asked me why would a woman have an amniocentesis even if they wouldn't consider any option but continuing the pregnancy. This question has come up a lot recently. My position on whether families should have an amniocentesis is that this is another highly personal choice. There's no 1 right way or wrong way, my job is to provide information that they might not be aware of so that they can make a more informed choice.

Risks

1. The risk of miscarriage from Amnio is between 1:200 and 1:300. The risk is related to the skill of the doctor performing the procedure. So a perinatologist in a University setting with over 2000 procedures under their belt would have a lower rates of miscarriage compared to a OB/GYN in a smaller setting with less experience. Now, let's put that in perspective. The generally accepted risk of miscarriage in the 2nd trimester is the same, about 1:200 to 1:300.

Preparing for Medical Conditions
2. Many families choose to have an amnio, knowing that they would not terminate, as a way to be better prepared in case their child needs specialized care soon after the birth. Over half of babies born with Down Syndrome have significant heart defects that may require surgery soon after birth. Most have difficulty feeding, as well as a whole range of other challenges.

1st Trimester Testing Options

Though the vast majority of babies born each year are healthy and without any abnormality, there are many tests available that screen for genetic abnormalities and other birth defects. The most common serious genetic disorders are Down Syndrome and Trisomy 18.

Though women at any age can have a baby with Down Syndrome, the risk increases as women get older. For instance a 30 year old woman’s risk of having a baby with Down Syndrome is approximately 1 in 900, while a 35 year old’s risk is 1 in 300 and a 40 year old has a 1 in 100 risk.

Some tests to consider:

NT (nuchal translucency)—This ultrasound measures the baby’s neck (nuchal) fold thickness at 11 to 14 weeks to screen for Down Syndrome. This test by itself has a 60 to 80% accuracy.

Combined screening—Uses a blood test from the pregnant mom that measures pregnancy proteins and is done at 9 to 14 weeks. The results are then combined with the NT (nuchal translucency ultrasound) measurements to assess risk of Down Syndrome. The benefit of this test is that it's not invasive and therefore, there is no risk of miscarriage. These combined tests will detect about 85% of affected pregnancies.

Combined Integrated Screening – Also known as Stepwise Sequential Screening. This helps determine the risk of Down Syndrome by using the results from the Combined Screening done at 9 to 14 weeks combined with the Quad Marker test done at 15 to 20 weeks. This test screens for Down Syndrome, Trisomy 18 and spinal cord or neural tube defects (NTD). The accuracy is approximately 90 to 95% when all these tests are done together. Often families receive one set of results from the first test that can be worrisome and then have to wait for the second Quad Marker test results before finding out if the baby is okay. The benefit of this test is that it's not invasive and therefore, there is no risk of miscarriage. However, waiting for the results can be difficult.

Quad Marker Test - Also known as the AFP (Alpha-Feto-Protein) test, this is performed at 15 to 20 weeks. It is most accurate between 16 to 18 weeks. This test helps find babies with Down Syndrome, Trisomy 18 or a spinal cord or neural tube defect (NTD). About 70% of babies with these genetic disorders and about 90% with NTDs are found. If the test is positive, further testing with ultrasound and amniocentesis is advised. The benefit of this test is that it's not invasive and therefore, there is no risk of miscarriage.

Carrier testing for cystic fibrosis, Tay-Sachs, sickle cell – Or other serious inherited disorders. Pregnant women are tested to determine if they are carriers for any of these or other serious inherited disorders. If she is positive, the baby’s dad is tested. Carriers don’t show any signs of disease. Both parents must be carriers to have a chance of having an affected baby.

CVS (chorionic villus sampling)
This test for genetic defects is done at 10 to 12 weeks, and is often offered to women who are 35 or older. Guided by ultrasound, a small catheter is inserted through the abdomen or vagina to remove a very small amount of chorionic villi, which later develops into the placenta.

The cells are analyzed for genetic defects and the baby’s sex is determined. This does not test for spinal cord defects. CVS is 98 –99% accurate in detecting Down Syndrome and Trisomy 18. The miscarriage rate is approximately 1 in 200 to 1 in 300.

Amniocentesis

Often recommended for women 35 and older, this is performed between 16 to 20 weeks. This tests for Down Syndrome and Trisomy 18. Guided by an ultrasound, a needle is inserted into a pocket of amniotic fluid and some is withdrawn (the baby makes more). The needle does not touch the baby. The fluid has the baby’s cells, which are analyzed for genetic defects, and the sex is determined. The fluid is also tested for spinal cord defects. Amniocentesis has greater than 99% accuracy. The risk of miscarriage is between 1 in 200 and 1 in 300.