Your due date is coming up and it is time to get ready – when and what should you be packing in your hospital bag? We have come out with a hospital bag checklist below.
*only applicable in Singapore
It is not compulsory to bring everything on this list but it never hurts to be prepared! Having your hospital bag packed and settled can go a long way in calming those pre-delivery jitters.
Swelling is otherwise known as “oedema”, which usually peaks in the third trimester as the pregnancy belly grows to its biggest. You may notice this when you start experiencing difficulty fitting into your usual shoes or having a mark where your ring usually sits. Don’t worry when that happens – you are not alone!
Swelling in pregnancy occurs because your total body water volume increases during pregnancy and as the day progresses, you will find the extra water gathering in the lowest parts of your body. In other words, it is normal for you to notice that the swelling is worst towards the end of the day.
Another reason why swelling in pregnancy happens due to pressure from your heavy womb resulting in changes in your blood flow in your legs – this can cause you to have oedema in your legs.
“Normal” swelling in pregnancy typically occurs in your hands, legs and feet. It is common and it sucks, but should not cause you too much discomfort or hinder you in your usual daily activities.
There are 2 dangerous conditions in pregnancy that can be associated with “excessive swelling” – they are pre-eclampsia and deep vein thrombosis.
Pre-eclampsia is a condition where there is pregnancy-induced high blood pressure, most commonly in the third trimester, which is associated with loss of protein in the urine (proteinuria). This results in oedema which can occur in the hands, legs, feet or even face. Associated symptoms to look out for include headaches, blurring of vision and pain in the gastric region. If you think you may be having pre- deep vein thrombosis eclampsia, it is important to alert your ObGyn as soon as possible. This is because pre-eclampsia is a dangerous condition that can progress to eclampsia, where you may experience seizures.
Deep vein thrombosis (DVT) refers to the formation of a blood clot in the deep veins of your leg. Pregnant women are more prone to developing DVT due to increased viscosity of their blood. Symptoms suggestive of DVT include sudden leg swelling, warmth, redness and/or pain – and these usually affects one leg only. The danger of DVT is a potentially fatal condition called pulmonary embolism, where part of the blood clot in your leg can break off and travel to your lungs. If you suspect you may be having a DVT, you must inform your ObGyn immediately for further evaluation.
There are many ways you can try to reduce the discomfort associated with pregnancy swelling.
Here are some of the Dos:
Elevate your legs and feet above your heart – do this whenever you can; getting a stool or footrest to prop your legs up when you are seated can help. Similarly, when you’re sleeping, do use a pillow or two to elevate your legs.
Wear compression stockings – these improve the circulation in your legs and relieve swelling.
Go for comfortable footwear – toss your high heels and opt for supportive footwear.
Keep well hydrated – to flush out excessive sodium from your system.
Keep active – regular movements like walks and gentle exercise can help reduce swelling.
Here are some of the Don’ts:
Avoid standing for long periods of time – try instead to take frequent breaks to rest and elevate your legs.
Avoid excessive salt intake – watch the sodium intake in your diet as it can worsen your swelling
Above all, don’t worry too much. You will be back to your (non-swollen) state some time after you deliver your baby!
Congratulations you are having twins (or maybe even more)! All’s good – right? Here’s what you need to know about having twins or multiple pregnancies.
Dichorionic diamniotic (DCDA) twins occur when 2 eggs are fertilised or if 1 fertilised egg splits soon after fertilisation. This means that each baby has his/her own placenta and water bag. This situation happens in all non-identical twins, and a third of identical twins.
Monochorionic diamniotic (MCDA) twins occur when 1 fertilised egg splits later. This means that each baby has their own water bag but share a placenta. This situation happens in two-thirds of identical twins.
If the fertilised egg splits even later, this means that each baby share the same water bag and placenta. This is known as monochorionic monoamniotic (MCMA) twins, and happens in 1 in 100 identical twins.
What kind of triplets you have depend on whether they are sharing placenta or water bag.
Although most women with multiple pregnancies go on to have healthy babies, as the old saying goes – double the trouble! These are the possible problems:
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Yes, you can still opt for Down syndrome screening. The results for first trimester Down syndrome screening will be different for non-identical twins but the same for identical twins. Non-invasive prenatal testing (NIPT) will be more accurate for identical twins but less so for non-identical twins.
If your screen test results return high risk and you opt for invasive diagnostic tests, it may be more technically challenging.
You will need to be vigilant and contact your gynaecologist earlier if you develop any issues (see above). You should take your folic acid and prenatal supplements regularly, particularly iron.
You will need to be seen more frequently and have more checks by your gynaecologist. For dichorionic twins (who have their own placenta), ultrasound scans need to be done every 4 weeks. For monochorionic pregnancies (who share a placenta), ultrasound scans need to be done every 2 weeks from 16 weeks (due to the risk of TTTS) until delivery. Monitoring may need to be closer if complications are detected.
You have an increased risk of going into preterm labour. If you don’t and there are no other issues with your pregnancies, you will be offered either induction of labour or C-section (this depends on several factors which your gynaecologist will discuss with you):
Stretch marks commonly appear on your abdomen, upper thighs, buttock and breasts during pregnancy. Exactly when and where they appear varies between women. After childbirth, they may fade but will unlikely disappear completely. They occur due to your skin stretching and becoming thin as your pregnancy progresses but do not affect your health or your baby.
Here are some tips to help with stretch marks:
| Recommended pregnancy weight gain (single baby) | Recommended pregnancy weight gain (twins and above) |
| 13 – 18kg | Discuss with dietician |
| 11 – 16kg | 17 – 24.5kg |
| 7 – 11kg | 14 – 23kg |
| 5 – 9kg | 11 – 19kg |
A stillbirth is when baby dies after 24 weeks of pregnancy. 1 in 200 births are stillborn.
In majority of cases, there is no cause found. Some causes include:
This is diagnosed on an ultrasound scan, where the baby’s heart is confirmed to have stopped beating. There may still be feelings of baby movement even though a stillbirth has been diagnosed as this is related to baby shifting in the amniotic fluid.
Doing tests may not be able to pinpoint a cause most of the time. If a cause is found, there may or may not be things you can do in subsequent pregnancies to reduce the chance of this happening again.
Tests are optional and you can discuss with your partner/family as to which ones you would like done. Tests that your gynaecologist may recommend include:
This depends on your health situation, pregnancy and personal preference. You will be able to discuss this with your gynaecologist. Your choices include:
This means waiting for labour to start naturally. If you have signs of infection, pre-eclampsia, placenta abruption, blood clotting abnormalities or your waters have leaked, this is not recommended. It is also not recommended to delay labour for too long as you may develop complications in the meantime. Your baby’s appearance may also deteriorate.
This involves putting tablets into your vagina to induce contractions with the aim of a vaginal delivery. You may experience bleeding and breaking of water bag during this process. You will be asked to push when you are fully dilated.
Vaginal birth is recommended for most women (even if you have had a C-section before) because there are fewer risks compared to C-section to both you (in terms of surgical complications and physical recovery) and your future pregnancies. Although the thought of it can be distressing, you will be supported throughout this process and pain relief options will be available.
Whether to see your baby immediately after birth, a little while after birth, or not at all is entirely your choice. There is no right or wrong answer, and you should discuss this with your partner and family members and do what feels right to you. Whatever you choose, you will be supported by your gynaecologist and midwife. If you wish to have mementos e.g. hand/footprints, this can be arranged.
You may be given medications to stop your breast milk from coming in. You will also be offered additional emotional support to help you through this process.
You will have bleeding and pain for the next few days which should settle in a few weeks. You may still experience breast milk coming in – apply ice packs and wear tight-fitting bras to help with this. You will be given a follow-up appointment with your gynaecologist for a check, and a review of your tests (if performed).
Having a stillbirth is one of the most difficult things that a mother can experience. Do allow yourself time to grieve and seek support from your partner, family members and friends. If you find difficulty in coping, do speak with your gynaecologist who will be able to arrange for counselling sessions. Support groups can be a great source of comfort.
You can try for your next pregnancy as soon as you and your partner are physically and emotionally ready. Choose a reliable birth control method if you do not wish to get pregnant. Let your gynaecologist know early of your stillbirth history. Preconception care is important. Depending on the cause (if any was found), there may need to be adjustments in your pregnancy care.
At every stage of pregnancy, there is a weight and size estimation of the fetus from 1 to 100th centile (1 being the smallest and 100 being the biggest). If your baby measures at or below the 10th centile on ultrasound scan, that means that you have a small baby.
There are 2 possibilities: baby is meant to be small (but healthy), or there is an issue causing growth restriction where baby cannot grow to his/her full potential (intrauterine growth restriction). In some cases, an exact cause cannot be found and your baby may need some investigations after birth.
If you baby is meant to be small (but healthy), there is no issues with your pregnancy.
If your baby is growth restricted, there is an increased risk of stillbirth (baby’s heartbeat stopping suddenly) or not doing well after birth. This increases your chance of needing a premature delivery. The earlier in pregnancy your baby is diagnosed to be small, and the smaller he/she is on ultrasound, the poorer the outlook is. Babies who are noted to be small earlier in pregnancy tend to have a higher chance of being affected by infection or genetic problems.
You will require additional ultrasound scans and antenatal visits with your gynaecologist for close monitoring.
If your baby is meant to small (but healthy), you will be able to carry your baby to term.
If your baby is growth restricted, the timing and method of delivery will depend on a few factors including:
Every case needs to be individualised and your gynaecologist will advise you on this.
If your pregnancy has no other issues, you may be able to have a normal vaginal birth. You will need close monitoring throughout the process, as baby (being small) has a higher chance of having an abnormal heart trace during labour requiring an emergency C-section.
If your baby’s growth is severely restricted, there is abnormal blood flow/ low amniotic fluid level on ultrasound scan, or if your baby’s heart trace is abnormal, he/she may not be able to tolerate the stress of natural labour and your gynaecologist may recommend a C-section. Your baby will need to be checked by the neonatologist on birth.
That depends on the cause of your small baby previously. If the cause is modifiable e.g. better control of medical problems, stop smoking – these should be done immediately. For example, if you had pre-eclampsia in your previous pregnancy that resulted in a small baby, your gynaecologist will be able to start you on aspirin early in this pregnancy.
Certain factors that are non-modifiable cannot be helped – however, your gynaecologist will be able to arrange for additional ultrasound scans to monitor the growth of your baby closely.
What does having a short cervix mean?
Your cervix refers to the neck of your womb. During your pregnancy, it is supposed to remain long, firm and closed. As your pregnancy reaches term, your cervix prepares for labour by softening, shortening and opening up (dilating).
Having a short cervix earlier on in your pregnancy means that you have a risk of late miscarriages as well as preterm labour and birth. Premature babies can have problems with their brains, lungs, hearts, eyes and other organs. They can also have long-term health issues including intellectual and development delays.
What are the risk factors of a short cervix?
You may be at a higher risk of having a short cervix if you had previous surgery to your cervix e.g. removal of part of your cervix in a cone biopsy. However, most women with a short cervix do not have symptoms. Your gynaecologist may suspect this if you:
If you experience lower abdominal cramps, pelvic pressure or bleeding during your pregnancy, contact your gynaecologist immediately.
How is a short cervix diagnosed?
It is diagnosed via a transvaginal ultrasound, where the length of your cervix is measured. If it is <25mm, it is considered short. This is not routinely done and is usually performed in your second trimester only if you have risk factors.
What is the treatment for a short cervix?
This is a stitch that is put around the cervix to keep it closed, and is done before 24 weeks of pregnancy. This operation is performed vaginally under general anaesthesia. This stitch can be removed outpatient once your pregnancy reaches term.
This can come in the form of injections or vaginal tablets. They help reduce the risk of you going into preterm labour, and will need to be continued until your pregnancy reach term.
If your cervix is not too short and you are not too far away from being term, your gynaecologist may simply advise you to rest, avoid strenuous exercise and sex, and return for close monitoring.
Does having a short cervix affect my health outside of pregnancy?
No, having a short cervix does not have implications of your health if you are not pregnant.
Preterm premature rupture of membranes refer to the breaking of your water bag before 37 weeks of pregnancy.
In many cases, the cause cannot be found. Some risk factors include:
Not everyone will experience a “pop”, but you will feel fluid continuously trickling out of your vagina which is beyond your control (unlike urine). You may wet your underwear or clothes. If you think you may be having PPROM, contact your gynaecologist immediately.
Your gynaecologist will need to take a detailed history and perform a vaginal examination to confirm the presence of fluid in your vagina, as well as cervical dilation. A test e.g. Actim PROM or amnicator may need to be done to confirm that the fluid in your vagina is coming from your water bag. Your temperature, blood pressure and pulse will be taken. Vaginal swabs, urine samples and blood tests need to be taken to check for infection. An ultrasound scan will be done to check your baby’s position and amniotic fluid level. An electronic monitor (cardiotocography/CTG) will be used to monitor your baby’s well-being by checking his/her heartbeat and the frequency of your contractions (if any).
You will need to be hospitalised. Depending on how many weeks pregnant you are, you may require:
If you and your baby are well and your investigations return fine, you will be allowed to continue with your pregnancy with close monitoring. Labour will need to be expedited if either you or your baby start showing signs of infection or distress – this may come in the form of induction of labour or caesarean section, depending on the urgency.
You do have an increased risk of having PPROM and premature labour in your subsequent pregnancies, but there are things that can be done to reduce this risk – do speak with your gynaecologist for advice.
Preterm or premature labour refers to going into labour before 37 weeks of pregnancy. This can result in preterm or premature births. Premature babies can have problems with their brains, lungs, hearts, eyes and other organs. They can also have long-term health issues including intellectual and development delays.
In some cases, an exact cause cannot be found. Risk factors of preterm labour include:
These may include:
If you experience any of the above or think you may be going into preterm labour, contact your gynaecologist immediately.
Your gynaecologist will need to take a detailed history and perform a vaginal examination to check for cervical dilation. Vaginal swabs may need to be taken e.g. Actim Partus to check for the possibility of going into preterm labour in the next 48 hours. Both vaginal swabs and urine samples will be taken to screen for infections. Your baby’s position (head up or down) will be checked. An electronic monitor (cardiotocography/CTG) will be used to monitor your baby’s well-being by checking his/her heartbeat and the frequency of your contractions.
You will need to be hospitalised. Depending on how many weeks pregnant you are, you may require:
If your preterm labour continues despite treatment and you are deemed at high risk of having a preterm birth, your gynaecologist will discuss the appropriate mode of delivery with you (vaginal delivery versus caesarean section). If your preterm labour is successfully treated and your contractions subside, you may be allowed to go home with close outpatient clinic visits.
You do have an increased risk of having premature labour and birth in your subsequent pregnancies, but there are things that can be done to reduce this risk – do speak with your gynaecologist for advice.
This is a serious condition where the placenta prematurely separates from the uterus. It occurs more commonly in the third trimester. It can be potentially life-threatening as it can cut off the blood supply and oxygen to the baby and result in heavy bleeding for the mother.
In many cases, the cause cannot be found. Some risk factors include:
Symptoms can occur suddenly (acute), or slowly over time (chronic).
If you think you may be having placental abruption, contact your gynaecologist immediately.
Placenta abruption is an emergency due to potential life-threatening effects on both mother and child.
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Baby
Depending on the situation, you may require:
You do have an increased risk of having placenta abruption in your subsequent pregnancies – if there was a known cause e.g. smoking or hypertension, you should control these to reduce your risk. Do speak with your gynaecologist for advice.
Photo credit: Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
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