This is a liver condition in pregnancy which causes raised bile acids in your body. Bile acids are needed for digestion and absorption of fats and fat-soluble vitamins in the intestines.
The exact cause is not known, but some causes may include:
Your gynaecologist will need to take a detailed medical history and examine your skin to ensure that your itch is not related to other skin conditions e.g. eczema. You will need blood tests to check your liver function and bile acid levels – these may need to be repeated as your itch may start before your blood tests turn abnormal. Your liver function tests will need to be monitored weekly until delivery.
In some cases, you may need to be referred to a liver specialist to rule out other liver conditions.
Treatment may relieve symptoms but does not cure obstetric cholestasis – the only cure is to deliver your baby. Treatment options include:
If your liver function remains stable and there are other pregnancy concerns, you will be offered induction of labor from 37 weeks of pregnancy with the aim of a vaginal birth (unless there are other indications for C-section). Your labour will be monitored closely. Inducing labour from 37 weeks aims to balance the risks of prematurity and needing a C-section (due to early induction) versus the small increased risk of stillbirth.
You will need to repeat blood tests to check that your liver function has returned to normal at least 10 days after delivery, at your postnatal check with your gynaecologist.
Your gynaecologist will discuss appropriate birth control methods for you, as you will be advised to avoid estrogen-containing contraception.
You have a 45-90% chance of getting obstetric cholestasis this pregnancy – do inform your gynaecologist about your history as early as possible.
This is when your placenta is near to (<2cm away), or covers part of/all of the cervix (neck of womb). Although common in early pregnancy, in most cases the placenta moves up and away from the cervix as the pregnancy progresses and the uterus grows.
It is most commonly first diagnosed during your fetal anomaly scan at 20-22 weeks. If this is found, you will need a repeat ultrasound at 32 weeks to check your placental location. Both transabdominal and transvaginal scans may be needed to check the placenta location and its distance from the cervix. Only 1 in 200 women who had a placenta previa at their fetal anomaly scan will still have it at the end of their pregnancy.
For women with previous caesarean sections, the chance of their placenta moving up and away from the cervix as the pregnancy progresses is lower. A proportion of these women who may have placenta accreta. This is a condition where the placenta grows into, and is very stuck to, the muscle of the uterus. If your ultrasound scan shows features suspicious of placenta accreta, you may be asked to go for an MRI for further checks. Women with placenta accreta will need a caesarean delivery, have a higher chance of heavy bleeding after birth and injury to surrounding organs (e.g. bladder) during the operation and in some cases may require a life-saving hysterectomy (removal of the womb) to stop bleeding.
There is a risk of bleeding during your pregnancy due to your low-lying placenta/ placenta previa. This can range from light to heavy bleeding, and is usually painless. You will be asked to avoid sex, and to contact your gynaecologist and go to the Emergency Department in the event of any contractions, abdominal pain or vaginal bleeding. You are also at higher risk of more blood loss at the time of delivery – you should thus include sufficient iron in your diet to ensure you are not anaemic (low blood count).
You are also at a higher risk of premature delivery.
Due to the proximity to the cervix, women with low-lying placenta/ placenta previa will not be able to have normal vaginal deliveries and will need to be delivered through a caesarean section. This generally takes place from 37 weeks (depending on whether you have any history of bleeding earlier during your pregnancy), and you may need a course of steroid injections to help your baby’s lungs to mature.
GBS, or Group B streptococcus, is a bacteria that is commonly present in the vagina and rectum in many women. It is not harmful under normal circumstances but can occasionally cause serious infections for newborns delivered vaginally.
This is a vaginal swab that is taken from your lower vagina from 35 weeks of pregnancy onwards. It is sometimes done if you are in danger of premature birth.
Testing GBS positive does not mean your pregnancy becomes high risk. There may be a slightly increased risk of having a urinary tract infection or infection of the uterine lining after delivery; however this will not affect when or how you will deliver your baby.
Being GBS positive simply means that you should come to the hospital once you start having signs of labour and/or your waters break as you will need 4 hours of intravenous antibiotics before delivery to reduce the risk of your baby coming down with GBS infection. You will generally be offered an induction of labor if you are term and your waters have broken if you are GBS positive.
If you are scheduled for a caesarean section, you do not need additional treatment except for routine antibiotics required for a major operation.
If you receive adequate antibiotics, the risk of your baby developing GBS infection is low at 1 in 4000. He/she is at higher risk of getting GBS infection if he/she is born preterm, or if your waters have broken for more than 24 hours before delivery.
Majority (75%) of GBS infections occur as early onset; the rest occur as late onset.
Early onset GBS develops within the first week of life and includes:
Late onset GBS can develop from the first week to 3 months old and can cause meningitis, cerebral palsy, hearing loss or death.
Your baby’s neonatologist will monitor your baby to watch for any signs of GBS infection if he/she is at risk.
Umbilical cord blood is rich in blood stem cells. During your third stage of labour, after the umbilical cord is cut, a small sterile needle is used to draw out cord blood. This is then sent to the lab for processing. Collecting cord blood does not pose any risk to you or your baby.
These are immature cells that are mostly found in the bone marrow, which have the capability of growing into different types of blood cells. These are used for stem cell transplants which treat certain blood disorders and cancers.
Stem cell transplants need to be compatible and depends on both parents genes (meaning a parent and child is only half matched). Siblings can sometimes be compatible. For small families, that can be near impossible, hence the concept of cord blood banking.
This stores your child’s cord blood for your own use, like your personal bank account. Using your own blood stem cells may be preferable for certain diseases.
This stores cord blood from volunteer pregnant women at delivery in a public bank from which unrelated families can search for a compatible donor. Donating to a public cord blood bank means your child’s cord blood is publicly available and not for his/her personal use.
There is no right or wrong answer – you should discuss this with your partner and balance the information from both the public and private cord blood banks before making an informed choice.
This means that baby is lying head up, with his/her buttock or legs down towards the cervix (neck of womb). Although this is common in early pregnancy, most babies will turn head down (cephalic) by 36-37 weeks of pregnancy.
You have 2 main options:
1. External cephalic version (ECV)
This is generally a safe procedure that is performed from 36-37 weeks of pregnancy, and involves firm pressure on your abdomen to try and turn baby to head down position. It will be performed in the labour ward. You will be given medications to relax the uterus (this may cause your heart to beat faster temporarily). You may feel uncomfortable during the procedure, but should inform your gynaecologist if you feel pain. The procedure will take a few minutes. If it is unsuccessful, there may be one or two more attempts to try and turn your baby, if you are okay to continue with it. Your baby’s heartbeat will be monitored before and after the procedure. Success rate is 50%. There is 5% chance that your baby still turn back to breech even if ECV is successful.
ECV cannot be done for women whose water bag have broken, who have twins, recent vaginal bleeding, abnormal baby heartbeat or who need caesarean section for other reasons.
Pros: If successful, you will be able to attempt a normal vaginal delivery (hence avoiding a caesarean section).
Cons: 1 in 200 chance of needing an emergency caesarean section immediately after ECV due to bleeding or changes in your baby’s heartbeat. When you do go into labour, you have a slightly higher chance of needing an emergency caesarean section or assisted vaginal delivery (vacuum or forceps) compared to someone whose baby has always been in head down position.
2. Caesarean section
One may opt to go straight for caesarean section, e.g. not keen for ECV or in certain cases where ECV may be difficult e.g. multiple fibroids, high body mass index (BMI) etc.
In a very select group of women, vaginal breech delivery may be possible; however this is uncommonly done these days. A planned caesarean section is generally safe for your baby than a vaginal breech delivery (although it carries slightly more risk for you).
You have a higher chance of cord or limb prolapse if your water bag breaks. This means that the umbilical cord or baby’s foot/leg may drop out of your cervix first. If it is the cord, this is an emergency as baby’s oxygen supply can get cut off and he/she may end up with permanent brain damage, cerebral palsy or death. Cord prolapse generally does not happen if baby is head down as the head usually blocks other things from dropping out.If your baby is breech and you start having contractions and/or your waters break, you must contact your gynaecologist and go to the labour ward immediately.
Bleeding during pregnancy can range from spotting (small amount of pink, red, or brown blood on your underwear, or when you use the toilet) to full-on bleeding (like your periods, or even heavier). It can feel scary, and depending on when and how much the bleeding is, you may need to see your gynaecologist or go to the Emergency Department immediately.
25% of pregnant women experience spotting during the first 12 weeks of pregnancy. The reasons include:
Your doctor may need to do serial blood tests to check your pregnancy hormones (b-hcg). Most women with previous miscarriages will not have difficulties getting pregnant in future.
This may be caused by cervical irritation e.g. after sex, as during pregnancy there is increased blood supply to the cervix. This is common and usually not a cause for concern. Another reason could be a cervical polyp, which is a benign growth on the cervix – your doctor will do a cervical check to rule this out. If you are nearing your due date, it can be due to “show” – a sign that labour may be starting.
If bleeding is heavy, there are several things which need to be ruled out:
You should contact your doctor or go to Emergency Department immediately if you experience bleeding in the second/third trimester or other associated symptoms such as:
Depending on how far along you are in your pregnancy, your doctor may need to do blood tests, a vaginal examination, and/or an ultrasound scan to check on you and your baby.
If you have been diagnosed with a pregnancy loss, know that it is not your fault and that it is okay to ask for support during this difficult time. Grieving is normal. If you intend to get pregnant again, speak to your doctor on how long you should wait before trying for your next pregnancy and what you should be looking out for.
“Quickening”, or the start of feeling your baby movements happens around 18 weeks of pregnancy – if you are a first time mother, this may happen later at around 20 weeks; if this is not your first baby, you may start feeling them earlier.
This depends on how far along you are in your pregnancy. In the beginning you may feel some flutters or mistake them as your intestines rumbling. As your baby grows, you will start being able to distinguish kicks, elbowing and jabs – some can get painful if aimed at your ribs!
Babies have sleep-wake cycles. They sleep for 20-40 minutes (or longer sometimes) where they don’t move, then start moving when they are awake. Some babies are more active during the day, and some more so at night. You may not notice your baby movements if you are busy.
You should get used to your baby’s routine so that you are able to notice anything unusual.
Towards the end of your pregnancy, as there is less space in your uterus for your baby to move around, the type of movements you feel may change or become less forceful/dramatic.
You may start counting them from 32 weeks (earlier if your pregnancy is high risk). You should generally feel at least 10 movements within an hour. There are phone apps available to help you track them. If it is less than that, try drinking water, then lie down on your side with some music, talk to/nudge your baby and focus on counting his/her kicks. If you are still unable to feel your baby movements, contact your gynaecologist.
Kegel exercises are important in strengthening and maintaining your pelvic floor muscle tone. It is helpful in improving:
Kegel exercises should be started as early as possible – preferably when you get pregnant – and continued well into your menopausal years.
It is normal for you to take some time to learn which are the correct muscles and how to squeeze and relax sufficiently at first. Don’t worry and be patient!
The key is remembering to do your Kegel exercises daily. You can do them any time, in any place and in any position as nobody can tell that you are doing them! Don’t limit yourself to the sets above – if you can do it more often, do so.
If you have difficulty grasping the technique of Kegel’s exercises, speak with your gynaecologist who can refer you to a specialised physiotherapist.
As it is likely that your pelvic floor muscles have weakened, you may not see results until you have put in consistent efforts for at least 3 to 6 months. Remember – slow and steady wins the race!
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