What to expect when you're expecting (209 page)

Vomiting

Headaches

General malaise

Pain and tenderness in the upper right side of the abdomen

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.