Pelvic Girdle Pain
Is a pregnancy discomfort that causes severe pain, instability and limitation of movement at the pelvic joints. Pelvic girdle pain (PGP) is the major term for all pelvic pain, including pubic pain which is also called symphysis pubis dysfunction (SPD). PGP includes pain anywhere from the lumbar spine/abdomen down to the thigh, either at the front or back. The pain may vary from a mild ache to severe pain which restricts daily activities. Causes of the pelvic pain includes the uneven movement of joints in pelvis, changes to the way your muscles work to support you pelvic girdle joints, and one pelvic joint not working properly causing knock-on pain in the other joints of your pelvis. The levels and area of pain can fluctuate from woman to woman. The pain might be a general throb or it might shoot into your rear end or down the back of your legs.
Symptoms include feeling the pain in lower back, symphysis pubis joint, sacroiliac joints, groin, front and the back of thigh, back of your lower leg, pelvic floor and around perineum or around the hips. The pain is frequently aggravated by exercises, lying on the back and turning over in bed. Moving your legs particularly when seated or resting can hurt, going out of the car or turning over in bed can be painful too etc. Having intercourse can be agonizing, contingent upon the positions one gets into. PGP is experienced more during evenings, especially on the off chance that you had a busy active day. It mainly occurs during the first three months of pregnancy and sometimes shortly before delivery. It is caused by postural changes, growing baby, and unstable pelvic joints under the influence of pregnancy hormones. Treatments include physiotherapy, exercises, and pain-relief tablets.
It is a weakening of heart muscle that begins during final month/s of pregnancy all the way to about five months after delivery, it may result in heart failure. It is a rare condition and causes a decreased flow in the pumping of blood through the heart. Heart pumps upto 50% more blood during pregnancy as there is a need to transfer oxygen and vital nutrients to the baby. Doctors believe that the extra pumping of blood combined with other risk factors which put a strain on heart contribute to this disorder.
The patient complains of fatigue, breathlessness, increase night time urination, swollen ankles, dilation of neck veins and low blood pressure. Smoking, drinking alcohol, having multiple pregnancies, myocarditis, improper diet and previous family history can increase the risk of peripartum cardiomyopathy. It can be life threatening if untreated. Prevention includes healthy life style and a balanced diet. The medication to control the symptoms include beta-blockers (drugs that reduce blood pressure and improve blood flow by blocking the adrenaline hormone), digitalis (drugs that strengthen the heart to improve pumping and circulation), and diuretics (drugs that lower blood pressure by removing excess water and salt from the body).
A Low-salt diet is recommended to manage the blood pressure of women with this condition. Women must avoid drinking alcohol and smoking tobacco as it worsens the symptoms. Perpartum Cardimyopathy can affect the pregnant woman’s health for the rest of the life as the heart damage is irreversible. According to a research study,the outlook for women diagnosed with peripartum cardiomyopathy is good for those whose hearts return to normal size after delivery. This happens for between 30-50 percent of women. In all cases, 4 percent of patients require a heart transplant, and 9 percent die as a result of the heart transplant procedure.
It is the tearing of the tissue area between the vagina and anus. It is a commonly encountered problem during delivery or childbirth About 85% of the women undergo perineal tearing. Perineal tears are of varying degree. They can be superficial and may extend to second or third degree which can cause severe damage. Tears are more likely to develop if its a first vaginal delivery, assisted delivery, head of baby is big; baby was in abnormal position before delivery and woman pushed for a long time. There are no potential risks of perineal tear and can be prevented with little care. Stitches are required where the tear is longer than 2 cm after which it should be properly taken care of. The site of stitches takes time to heal and the patient has to deal with the pain and tenderness which usually lasts up to 10 days.
The tear is most likely to hurt for a few weeks and the patient has to take care not to apply any pressure on the stitches. Proper hygiene routine should be followed to promote healing and prevent any sort of infection from spreading by gently cleaning the area with warm water. It is important to pat dry the area and not rub. Constantly touching the area should also be avoided. The stitches are most likely to be absorbed on their own. If the perineum becomes red, has an odour or is swollen then the patient should contact the practitioner. Kegel exercises and perineal massages can be performed a month before the delivery to help the vaginal muscles better able to stretch over the baby’s head. After the delivery Kegel exercise should be continued to stimulated circulation, decrease risk of incontinence and help the tear heal faster.
Piles happen when the blood vessels of the anus become inflamed and hang out after or during defecation. Piles affect about one out of ten women in their last trimester. Piles may also develop during labour. The risk increases in pregnant women because the hormone progesterone causes relaxation and expansion of walls of the anus this makes it easier for the vessels to protrude out. The weight of the baby also adds more pressure on the veins. Increased blood flow during pregnancy and constipation are also contributing factors. Some of the symptoms associated with piles are itching, soreness and inflammation around the anus. Rectal bleeding and mucous discharge after defecation. Moreover, there’s an urgency to defecate. Several steps can be taken to avoid getting piles. These include:
1. Staying hydrated, plenty of fluid intake is not just necessary for prevention of piles but for other pregnancy related complications as well.
2. Fibre rich diet also serves the same purpose and eases bowel movements. Fibres can be taken in the form of bread, brown rice and vegetables.
3. Exercise should be made an essential part of your routine.
4. Avoid sleeping on your back to minimize pressure on the rectal area.
5. Don’t apply too much pressure while defecating, take breaks.
6. Maintain good hygiene
Piles are extremely painful. To alleviate its symptoms, application of a cold pack on the affected area is beneficial. Use lubricants and oils to gently push the piles back into the rectum. Use a pillow to avoid discomfort when sitting, use moist wipes and pat the area clean instead of wiping it, talk to your doctor about the condition. This condition generally doesn’t pose a risk to the baby and tends to resolve with a few days post delivery.
During the first couple of years of a baby’s life, the skull bones are not properly fused together so that the brain can develop and grow. Therefore during birth, positional changes might occur resulting in a pointed or too long head which returns back to its proportional position. In certain cases, when a baby sleeps on a particular side or due to neck muscles of that side, the head becomes flat on that side resulting in plagiocephaly. It does not have any serious medical complications. The head can return to its normal shape before complete fusion of the bones.
It is a serious condition in which placenta partially or completely separates from the uterus before the baby is born. This condition can deprive the baby of nutrients and oxygen thus potentially life threatening to both mother and the baby. The risk of growth problems in the baby is increased, Occurrence is about one in 150 pregnancies. It usually occurs during last three months of pregnancy but can occur any time after 20 weeks. Causes of placental abruption includes smoking, using cocaine, having preeclampsia or hypertension, abnormalities in uterus, and having multiple pregnancies. The patient experiences vaginal bleeding, dizziness and headaches.
Treatment completely depends on the internal condition of the separation, location of the separation, and the age of the pregnancy. Partial separation or a complete separation can occur during pregnancy, causing varying degrees of impacts and thus treated accordingly. Bed rest and close monitoring is prescribed if the pregnancy is not mature that is in the case of partial separation. However, transfusions and other emergency treatments may be recommended in other cases. Delivery (vaginal delivery if the fetus is stable) is the safest option in the case of complete separation. If the mother or baby is in distress then the caesarean delivery is necessary. There is no treatment that can impede the placenta from dethatching and there is no way of reattaching it. Pre-mature birth or low birth weight might result from any kind of placental abruption.
Placenta previa is a condition where the placenta develops in an abnormally low position close to the cervix. Due to this the placenta can sometimes completely or partially cover the cervix. This can create complications such as delivering the baby early or death of the mother if bleeding doesnt stop during delivery. A caesarean birth is also likely due to these complications. The placenta previa can occur during third trimester of pregnancy affecting 1 out of 200 women throughout the world. It is found to be more common in those women who have
1. Twins or triplets
2. More than one child
3. Birth by caesarean
4. Surgery on uterus
There are different types of placenta previa:
1. Complete which means that the placenta covers the cervix completely and is more likely to stay this way.
2. Partial means portion of cervix is covered by placenta.
3. Marginal is when it is on the border of the cervix.
The type of placenta previa can be confirmed between 16-20th week of the pregnancy or later. As the pregnancy progresses the placenta can either grow away from the cervix (and may not be a problem at all) or close to the cervix or may not change its position at all. There are various signs and symptoms to detect placenta previa such as painless vaginal bleeding, premature contraction, and transverse position of the baby or uterus being larger than gestational age. For women who are experiencing placenta previa it is recommended that they avoid intercourse, frequently visit hospital, avoid pelvic exams and reduce travelling. If the mother experiences vaginal bleeding that doesn’t stop, then regardless of the pregnancy period, a caesarean delivery is required,
Is the feeling of depression and anxiety after giving birth. It mostly occurs in females but sometimes males can also experience this condition. The exact cause of this problem is not known but genetic, environmental and emotional factors do influence the depression up to a certain degree. The symptoms may show up after one or two weeks of post birth and may include feeling extreme sadness, anxiety, helplessness, crying all the time, mood swings, loss of interest in any activity, loss of appetite, difficulty falling asleep, difficulty in making decisions, avoiding friends and family and feeling exhausted all the time.
Physical and emotion changes play a role in postpartum depression. After childbirth there is a dramatic hormonal change in the woman’s body as estrogens, progesterone and hormones produced by thyroid glands considerably decrease which causes feeling tired and depressed. Whereas emotional changes may occur if the mother is having problems caring for the new born baby, feeling less attractive due to body changes in pregnancy, struggling with life balance and being sleep deprived. PPD becomes dangerous when the person starts having suicidal thoughts and thinks about harming oneself or the baby.
There are alternative therapies (non medical interventions) that can be used to help heal the mother e.g herbal remedies. PPD can also be treated with antidepressants or psychotherapy. Recovery and treatment time is different for every patient but it usually ranges from 6 months. In some cases it lasts longer and becomes chronic depression. To promote recovery resting, setting realistic expectations, exercising, accepting help from family and friends, connecting with other new mothers, not isolating oneself, adopting healthy lifestyle and taking out time for healthy activities is recommended. Do read our blog article on postal depression for more advice and guidance
Post-traumatic Stress Disorder
It is a condition that develops in some people that have experienced a shocking, scary or dangerous event. These events may include warfare, traffic collisions, sexual assault, a threat to person life, death of a loved one or it may be because of an unwanted pregnancy. After trauma every normal human being experience range of reaction and those who cannot recover from initial symptoms naturally are diagnosed with PTSD.
Symptoms include dreams or feelings related to events, disturbing thoughts, mental or physical distress to trauma-related problems, attempts to avoid trauma-related situations, alterations in how a person thinks and feels, and an increase in the fight or flight response. These symptoms usually begin to show within 3 months or 12 months after the incident. Even though young children are less expected to show distress but instead may express their memories through play. Those with this disorder are at a higher risk of suicide. There are two types of PTSD chronic which is ongoing and acute which is short-term. Symptoms that last more than a month and interfere with personal relationships of the person are considered to be PTSD. An adult must experience the following for a month to be diagnosed with PTSD:
1. One avoidance symptom: staying away from places, avoiding feeling/thoughts.
2. One re-experiencing symptom: flashback of the past trauma, bad dreams, bad thoughts.
3. Two cognition and mood symptom: trouble remembering, negative thoughts.
4. Two reactivity and arousal symptom: difficulty sleeping, feeling tense
There are two most common treatments for PTSD:
1. Antidepressants: these medications may help control the emotions of anger, sadness, anxiety and feeling numb. FDA approved medicine Prazosin can help reduce sleeping problems and nightmares.
2. Psychotherapy: Also known as talk therapy can occur along with taking antidepressants. This includes talking with mental health professional one on one or in a group of people. The time frame of psychotherapy is usually 6-12 weeks or more according to the patient.
Pneumonia is a disease that affects the respiratory system,. Babies and young children get pneumonia from a virus known as RSV while infants can catch pneumonia via GBS bacteria. Cough and fever are two of pneumonia’s main indications. Other indicators can include weakness, vomiting, diarrhoea, loss of appetite, headache, and trouble breathing. Pneumonia can strike anytime, but it usually shows up in winter and spring, often after a cold or other upper respiratory infection. Treatment of bacterial type is through antibiotics while the viral type can be alleviated by rest and fluids. Infants have laborious breathing and discoloration of skin to due to lack of oxygen. PPH is diagnosed using ultrasonography techniques.
Pneumothorax in Newborns
Pneumothorax refers to accumulation of gas or fluid in the chest cavity. In infants, the small air sacs in the lungs may burst leading to a leakage of gases and fluids out of the lungs. This condition is more prevalent in babies with Respiratory Distress Syndrome, Meconium Aspiration Syndrome or other respiratory disorders. Babies have difficulty in breathing, discolouration of skin appears due to decreased oxygen supply and restlessness. Pneumothorax can be identified via chest X-Ray.
Delivery of the foetus more than 3 weeks before the due date is referred to as premature birth. As a result the baby has less time to develop in the womb potentially leading to some medical complications. Premature babies usually have a small body with a large disproportionate head, sharper features due to less fat storage, underdeveloped respiratory system and a lower body temperature.
Neonates are vulnerable to toxic environmental and chemical agents. Such exposures may be accidental, error in both drug dosage and route of administration, or improper baby care. In addition, the newborn infant may show signs of hostile response to a variety of chemicals that are given to the mother and cross the uterus barrier, thereby affecting the fetus before or during both labor and delivery. The clinical signs and indications of poisoning are not always directly recognized
Postmaturity results when the baby is born after 42 weeks gestation. This is most likely due to a miscalculated due date or when a mother has had a previous post-mature pregnancy. Postmature babies have a risk of being underweight or overweight with a lower blood glucose level due to the utilisation of glucose stores. Delivery/labour Risks increase as the baby may be larger than expected.
Polycythemia in Newborn
An abnormally higher number of Red Blood Cells (RBC) this might be due to postmaturity, low oxygen level in fetus while in the uterus or due to maternal diabetes. A higher RBC counts makes the blood thick and slow. Newborns usually don’t show symptoms but when visible, these are characterised by sluggishness, lethargy and inability to feed properly. Newborn are kept hydrated to overcome effects of Polycythemia.
Towards their due date pregnant women often present with high blood pressure and proteins in their urine. This life-threatening condition, called preeclampsia, can have serious repercussions for the both the baby and the mother. A lot of small blood vessels clamp down in the kidneys, liver, and brain. The blood vessels also constrict which might lead to a leakage of blood out of the vessels due to increased pressure, resulting in accumulation of fluid outside the vessels. Also, lesser blood flow to the placenta leads to the diminished development of baby due to lack of nutrients and oxygen. It has also been hypothesized that preeclampsia could be due to an imbalance of prostaglandins. The following signs and symptoms are experienced by the patients:
1. Swelling in feet, legs, and hands
3. Pain below the ribs
5. Shortness of breath
6. Tendency to bruise easily
If left untreated, it may lead to:
1. Low birth weight of the baby
2. Preterm delivery
3. Learning and hearing disabilities in baby
5. Seizures (called eclampsia in this condition)
6. Kidney and liver failure
7. Loss of vision
Poor nutrition and obesity are reported to be causes of preeclampsia. Women who conceive for the first time and are above the age of 40 have a greater risk. Diabetes, genetics and being pregnant with twins or triplets are risk factors as well. If preeclampsia is mild, doctors advise hospitalization of the patient and regular monitoring of blood pressure. Medicines are prescribed to lower the B.P. Steroid injections are given to help the development of baby’s organs faster. In case of severe preeclampsia, delivery of the baby is the only treatment of choice either through the vagina, if the mother is 36 weeks pregnant, or by C-section. Generally, the prognosis of preeclampsia is good and it takes up to 3 weeks for the symptoms to subside after delivery.