Preterm Labor in #Pregnancy

 Posted by Chantel Martiromo,  Article By Kyle J. Norton

Preterm labor is defined as a premature labor between 20 - 37 weeks of gestation before full term. According to the statistic, 1 in 8 babies is born premature and 12% of all pregnancies are ended in preterm pregnancy, causing life longed health problem to some and one of the leading cause of infant death.

Signs and symptoms
1. Uterus Contraction
Pregnant women who are experience frequent uterus contraction for 5 minutes or more are at risk of preterm pregnancy.
2. Vagina discharge
It may be result of leaking fluid and bleeding from the womb.
3. Pain during urination
It can be caused by bladder or urinary track infection cause of preterm labor.
4. Intense pelvic pressure and low, dull backache
Symptoms of normal term labor.
5. Abnormal cramps and pain
It is not a usual sign of pregnancy.
6. Etc.
Causes and risk factors
1. Previous history
Women who have a previous incidence of preterm labor are at higher risk of preterm pregnancy again.

2. Pregnancy with multiple babies
According to the article of "Multiple birth" posted in the enote, the article indicated that Babies born from multiple-birth pregnancies are more likely to result in premature birth than those from single pregnancies. 51% of twins and 91% of triplets are born preterm, compared to 9.4% in singletons.

3. Uterine and Cervical structure abnormalities
Certain reproductive structure abnormalities can increase the risk of preterm labor, including
a duplicated or septate cervix, T-shaped uterus, etc.

4. Infection
Certain infections including bacterial vaginosis, bladder, urinary track, kidney infection can increase the risk of preterm labor and give birth early. According to the study of "Periodontal infection and preterm birth, Results of a prospective study by MARJORIE K. JEFFCOAT, D.M.D., NICO C. GEURS, D.M.D., MICHAEL S. REDDY, D.M.D., D.M.SC., SUZANNE P. CLIVER, B.S., ROBERT L. GOLDENBERG, M.D. and JOHN C. HAUTH, M.D., researchers found that Patients with severe or generalized periodontal disease had adjusted odds ratios (95 percent CI) of 4.45 (2.16–9.18) for preterm delivery (that is, before 37 weeks gestational age). The adjusted odds ratio increased with increasing prematurity to 5.28 (2.05–13.60) before 35 weeks’ gestational age and to 7.07 (1.70–27.4) before 32 weeks’ gestational age.

5. Chronic illness
Certain chronic illness such as high blood pressure, kidney disease and diabetes may increase the risk of preterm labor.

6. Maternal α-fetorrprotein levels in second trimester
Abnormally high plasma levels of α-fetoprotein in early pregnancy increases risk of preterm labor. According to the study of "PREDICTING THE RISK OF PRETERM LABOR BY SECOND TRIMESTER MEASUREMENT OF MATERNAL α-FETOPROTEIN LEVELS AND A RISK FACTOR SCORING SYSTEM" by FATEMEH DAVARI TANHA,* M.D., FARIBA SARDARI, M.D.,ZAHRA EFTEKHAR, M.D., MAHBOD KAVEH, M.D., AND NARGESSIZADY MOOD, M.D., researchers found that the combination of measurement of maternal serum AFP in the second trimester associated with a risk factor scoring system provides a more accurate indicator of the risk of preterm delivery and therefore may be of use in targeting prevention strategies.

7. Socio-economical and obstetric effects
Biopsychosocial risk factors for preterm birth and postpartum emotional well-being: a case–control study on Turkish women without chronic illnesses by Ilkay Gungor, Umran Oskay,Nezihe Kizilkaya Beji, researchers found that many of the socio-economical and obstetric causes of preterm births were similar to other countries with higher preterm birth rates. Preterm births were associated with lower social support along with more anxiety and depressive symptoms in early postpartum.

8. Overweight before pregnancy
Women who are overweight or obese are at great risk of giving birth to a preterm baby compared with normal weight women. According to the study of "Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and metaanalyses" by Sarah D McDonald, associate professor, Zhen Han, associate professor, Sohail Mulla, student, Joseph
Beyene,researchers found that Overweight or obese women have increased risks of preterm birth before 32 weeks and induced preterm birth before 37 weeks, and, accounting for publication bias, preterm birth before 37 weeks overall.

9. Underweight, smoking, uterine bleeding, blood pressure abnormalities and Inadequate Rate of Weight Gain
In a study of "Maternal Underweight Status and Inadequate Rate of Weight Gain During the Third Trimester of Pregnancy Increases the Risk of Preterm Delivery" by ANNA MARIA SIEGA-RIZ,*3 LINDA S. ADAIR* AND CALVIN J. HOBELf, researchers found that Women who delivered preterm were significantly lower in prepregnancy weight and as a result had a lower mean prepregnant BMI than women who delivered term (Table 2). In addition, mothers of preterm infants were less frequently married, more likely to smoke, to be African-Americans and had more occurrences of uterine bleeding and blood pressure abnormalities (chronic hypertension and/or pregnancy-induced hypertension) than mothers of term infants.
Researchers also found that Women who delivered preterm gained the same
amount of weight in the first trimester and had a similar rate of weight gain in the second trimester as women who delivered term (refer to Table 2). However, differences in rate of weight gain were seen in the third trimester. Women who delivered term gained, on average, 30 g more per week than women who delivered preterm. The weight gain curves for term vs. the types of preterm deliveries, preterm labor and preterm PROM are shown in Figure 1. Regression lines fitted to the data illustrate the similarities in the rate of weight gain among all three groups.

10. Singleton pregnancies after IVF-ET/GIFT
According to the study of "Increased risk of preterm birth in singleton pregnancies resulting from in vitro fertilization-embryo transfer or gamete intrafallopian transfer: a meta-analysis" by McGovern PG, Llorens AJ, Skurnick JH, Weiss G, Goldsmith LT., researchers found that The risk of preterm birth in singleton pregnancies resulting from IVF-ET/GIFT is twice that of natural conceived pregnancies.

11. Short time between pregnancies
Women who are pregnant again less than 6-9 months after giving birth are at higher risk of the preterm pregnancy. In a study of "Effect of the Interval between Pregnancies on Perinatal Outcomes" by Bao-Ping Zhu, M.D., Robert T. Rolfs, M.D., M.P.H., Barry E. Nangle, Ph.D., and John M. Horan, M.D., M.P.H. researchers suggested that the optimal interpregnancy interval for preventing adverse perinatal outcomes is 18 to 23 months.

12. Alcohol
Alcohol abuse increases the risk of preterm labor. According to the article of "Alcohol Use and Premature Birth" in 2006 Teresa Kellerman, the author wrote that Increased awareness about the risk of alcohol use during pregnancy can prevent many cases of premature birth, as well as the serious effects associated with Fetal Alcohol Spectrum Disorders.

13. Lack of prenatal care Lack of prenatal care increases the rate of recurrent preterm delivery and health care costs when compared to university hospital-based prenatal care by Serdar Ural MD, Cary Cox, Karin Blakemore MD, Eva Pressman MD and Jessica Bienstock MD, researchers concluded that Inner-city patients with a history of PTD who received even minimal prenatal care in a university HS clinic had a significantly lower incidence of recurrent PTD than those who had no prenatal care. Prenatal care also lowers total health care costs in women with a history of PTD. The coordinated multidisciplinary aspect of care provided at academic centers may have a positive impact on the problem of PTD.

14. Other causes, include
a. Poor nutrients
b. Physical and drug abuse
c. Etc.

Diagnosis
If you are experience certain symptoms of preterm pregnancy, after recording the family history and physical exam, your may perform
1. Speculum examination of the cervix Speculum Exam of the cervix is an examination of the cervix and vaginal walls to find out how much the cervix has opened and thinned, and any leaking fluid with the use of a sterile speculum.

2. Endovaginal cervical sonography
Endovaginal cervical sonography is a type of ultrasound used to examine the pelvic organs with an aim is to determine the length of the cervix in a preterm pregnancy if she is experience certain symptoms of preterm labor. According to the study of Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. by Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy GA 3rd, Miodovnik M, Langer O, Sibai B, McNellis D; National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network., researchers found that cervical length assessed by endovaginal sonography between 16 weeks' and 18 weeks 6 days' gestation, augmented by serial evaluations, predicts spontaneous preterm birth before 35 weeks' gestation in high-risk women.

3. Fibronectin test
Fibronectin test is performed by a specimen collected from the patient using a vaginal swab, it is a protein produced by the fetus is an excellent biological marker to determine the risk of preterm labor. The positive test is an indication of preterm pregnancy.

4. Transabdominal sonography
The test is to examine the length of the cervix to determine the risk of preterm labor.
In a study of "Comparison of transvaginal and transabdominal sonography in the detection of early pregnancy and its complications.", by Jain KA, Hamper UM, Sanders RC. researchers found that all six missed abortions were detected by endovaginal sonography, but only three were diagnosed on transabdominal sonograms. Our findings show that endovaginal sonography is more sensitive than transabdominal sonography in the detection of early pregnancy and its complications.

5. Etc.

Prevention
A. How to do
1. Healthy diet
Unhealthy diet can cause nutrients deficiency of which can increase the risk of preterm labor.
2. Quit smoking
Women who smoke during pregnancy are at higher risk of preterm pregnancy than non smoke women.
3. No excessive drinking
Excessive drinking not only increases the risk of preterm labor but also promotes Fetal Alcohol Spectrum Disorders.
4. Prenatal care
Increased risk of preterm labor for women who are pregnant without adequate prenatal care.
5. Avoid over or underweight Pregnant
Women who are under or overweight before pregnancy are associated with higher risk of preterm pregnancy.
6. Avoid infection
Avoid infection caused by bacteria, virus and sexual transmitting diseases by practice safe sex and eating healthy to enhance immune function.
7. Reduce stress
By meditation, yoga to keep you relax.
8. Etc.

B. Diet
Healthy diet and life style with moderate exercise should be beneficiary to provide an optimal health and reduce the risk of preterm labor
C.1. The American Pregnancy Association recommends alterations to your diet, including
1. Protein
Protein in your foods positively affects the growth of fetal tissue, including the brain. It also helps your breast and uterine tissue to grow during pregnancy,
a. 75 to 100 grams of protein per day as it can be divided into 2-3 servings of meat (1 serving = approximately 3 ounces/ size of a deck of cards) from chicken lean beef, lamb, pork, nut and tofu (1 serving = approximately ⅓ cup), etc.
b. 2-3 servings of legumes (1 serving = approximately ½ cup) such as red and white kidney beans,black beans, navy beans etc..

2. Calcium Daily requirement of calcium is around 1000 milligrams during pregnancy. Calcium helps your body regulate fluids, and it helps build your baby’s bones and tooth buds, such as milk (1 serving = 1 cup), eggs (1 serving = 1 large egg), yogurt (1 serving = 1cup),pasteurized cheese (1 serving = approximately 1.5 ounces/ or 4 playing dice stacked together), tofu (1 serving = ½ cup), etc.

3. Iron
In combination with sodium, potassium, and water, iron helps increase your blood volume and prevent anemia. A daily intake of 27 milligrams is ideal during pregnancy.
a. 2-3 servings of green leafy vegetables (1 serving = approximately 1 cup)such as collard turnip, spinach, lettuce, etc.
b. 3 servings of whole grains (1 serving = approximately. ½ cup or one slice), such as bread, cornmeal, cereal, oatmeal, etc.

4. Folate/Folic Acid
Folic acid plays a key role in reducing the risk of neural tube defects, including spina bifida. Experts recommend 600 to 800 micrograms (.6 to .8 milligrams) daily.
a. 2 servings of dark green leafy vegetables (1 serving = approximately 1 cup), such as collard, turnip, spinach, lettuce. etc.
b. 2-3 servings of fruit (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc.

5. Vitamin C
Fruits and vegetables rich in Vitamin C will help with wound healing, tooth and bone development, and promotes metabolic processes. Experts recommend at least 85 milligrams per day. 3 servings of fruit or vegetables (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc. (Source)

6. Etc. for more healthy foods please visit 100+ Healthy Foods Classification

C. Antioxidants
Intake of antioxidants should be beneficial for anyone to prevent the disease at the beginning, including pregnant women. For more information of the effects of antioxidants to cancers and diseases.

D. Etc.

Treatments
The aim of most treatments have been directed toward the inhibition of myometrial contractions by delay delivery long enough to allow certain treatments and to transfer the mother and fetus to an appropriate hospital.
A. In general approaches
Treatment of preterm labor are depended totally in the types of symptoms of which a woman is experiencing. In many case, closely managing such as below are beneficial, depending to the diagnosis.
1. Empty your bladder
2. Lie down tilted towards your left side may slow down or stop signs and symptoms
3. Avoid lying flat on your back to prevent the increased uterine contractions to increase
4. Drink several glasses of water to reduce the risk of dehydration cause of contractions
5. Monitor the time of between contractions for one hour every day
6. Etc.

Remember that premature labor does not always result in premature delivery. Some women experience the symptoms of premature labor, sometimes put on bed rest until the pregnancy progresses further.

B. Medication
B.1. Tocolytics
Tocolytics also known as anti-contraction medications are the types of medication used to suppress premature labor for women who are experience the symptoms of preterm labor with an aims to buy time for the administration of certain medication to accelerate fetal lung maturity, including beta-mimetics (terbutaline), magnesium sulfate,
calcium channel blockers (for example, nifedipine), non-steroidal anti-inflammatory drugs, NSAIDs (indomethacin), etc..

B.2. Progesterone

Progesterone 17-hydroxyprogesterone caproate, can help to reduce the risk of preterm birth in women with recurrent preterm birth by 40–55%as it relaxes the uterine musculature, maintains cervical length, and has anti-inflammatory effect. In a study of " Polymorphisms in folate metabolizing genes and risk for spontaneous preterm and small-for-gestational age birth." by Engel SM, Olshan AF, Siega-Riz AM, Savitz DA, Chanock SJ., researchers concluded that our results suggest the possibility of a direct or indirect role for the SHMT1(1420)T variant in spontaneous preterm or SGA births.

B.3. Antibiotics and Preterm Labor, including Premature Rupture of Fetal Membranes

In case of preterm labor is a result of infection than antibiotic is given through IV injection. In a study of "Can antibiotics prevent preterm birth--the pro and con debate." by Lamont RF., researcher found that Antibiotics used prophylactically for the prevention of preterm birth are more likely to be successful if: they are used in women with abnormal genital tract flora (rather than other risk factors for preterm birth, e.g. low BMI, twins, generic previous preterm birth); they are used early in pregnancy prior to infection (tissue penetration/inflammation and tissue damage); they are used in women with the greatest degree of abnormal genital tract flora; and if they are used in women with a predisposition to mount a damaging inflammatory response to infection.

B.4. Cervical cerclage

In case of preterm labor is as a result of cervix shortens, cervical cerclage is benefial by placing a suture around the cervix that can prevent further shortening and widening. But cccording to the study of "Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data." by Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM., researchers found that Cerclage does not prevent preterm birth in all women with short cervical length on transvaginal ultrasonography. In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior preterm birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. In contrast, in twins, cerclage was associated with a significantly higher incidence of preterm birth.

B.5. Antenatal Corticosteroids
In order to prevent the damage as a result of immature lungs which are not yet producing their own surfactant of preterm baby, medcation of Antenatal Corticosteroids such as Betamethasone, dexamethasone, etc., is beneficial to stimulate the production of surfactant in the lungs of the fetus.

B.6. Etc.


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Group B Streptococcal Infection in Pregnancy

Posted by Chantel Martiromo,  Article By Kyle J. Norton


Group B Streptococcal Infection, also known as Strep B and group B Strep, genus Streptococcus of the phylum Firmicutes found in the flora of the gut and genital tract of 20-40% women, is defined as a serious illness of bacteria infection. In pregnancy, the diseases is deadly as it can cause fatal to the fetus. In US, the disease causes approximately 1,600 early-onset cases and 80 deaths of newborn annually.

I. For the Mother
A. Symptoms
Most women who are infected by GBS have no symptoms, but in serious cases, it causes symptoms of
1. Urinary tract infection
2. Fever
3. Seizures
4. limpness or stiffness,
5. Heart palpitation and blood pressure abnormalities,
6. Vaginal infection
As a result of the bacteria infection
7. Sepsis
If the bacteria have entered the blood stream
8. Others include
Skin and soft-tissue infection, bone, lung joint infection, etc, depending to the onset of the infection.

B. Causes
1. Random spreading
Most people came to contact the bacteria are at risk of GBS infection but without showing any symptoms. That may the reason that 20% to 40% of pregnant women have the bacteria without knowing.
2. Existence
According to some study, some people can have the bacteria in their body throughout their entire life, while others only harbor the bacteria for a limited period of time.
3. Etc.

C. Diagnosis
Since there is no side effect in healthy women, there is no diagnosis required for general population, unless the women are pregnant. Once you are pregnant, in the 35- 37 weeks of gestation, it is recommended to the test of Vagina and Rectum are swabbed. Vagina and Rectum are swabbed is recommended by the The Centers for Disease Control and Prevention (CDC). The result of the test is usually reported within 24 -48 hours, due to the risk of infection to the newborn, women who are suspected of the diseases are given antibiotic through IV.

C. Prevention
Although there is no sure way to prevent the diseases from transmitting to the newborn, healthy diet and moderate exercise should be beneficiary to provide an optimal health and reduce the risk of the GBS.
C.1. The American Pregnancy Association recommends alterations to your diet, including
1. Protein
Protein in your foods positively affects the growth of fetal tissue, including the brain. It also helps your breast and uterine tissue to grow during pregnancy,
a. 75 to 100 grams of protein per day as it can be divided into 2-3 servings of meat (1 serving = approximately 3 ounces/ size of a deck of cards) from chicken lean beef, lamb, pork, nut and tofu (1 serving = approximately ⅓ cup), etc.
b. 2-3 servings of legumes (1 serving = approximately ½ cup) such as red and white kidney beans,black beans, navy beans etc..

2. Calcium Daily requirement of calcium is around 1000 milligrams during pregnancy. Calcium helps your body regulate fluids, and it helps build your baby’s bones and tooth buds, such as milk (1 serving = 1 cup), eggs (1 serving = 1 large egg), yogurt (1 serving = 1cup),pasteurized cheese (1 serving = approximately 1.5 ounces/ or 4 playing dice stacked together), tofu (1 serving = ½ cup), etc.

3. Iron
In combination with sodium, potassium, and water, iron helps increase your blood volume and prevent anemia. A daily intake of 27 milligrams is ideal during pregnancy.
a. 2-3 servings of green leafy vegetables (1 serving = approximately 1 cup)such as collard turnip, spinach, lettuce, etc.
b. 3 servings of whole grains (1 serving = approximately. ½ cup or one slice), such as bread, cornmeal, cereal, oatmeal, etc.

4. Folate/Folic Acid
Folic acid plays a key role in reducing the risk of neural tube defects, including spina bifida. Experts recommend 600 to 800 micrograms (.6 to .8 milligrams) daily.
a. 2 servings of dark green leafy vegetables (1 serving = approximately 1 cup), such as collard, turnip, spinach, lettuce. etc.
b. 2-3 servings of fruit (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc.

5. Vitamin C
Fruits and vegetables rich in Vitamin C will help with wound healing, tooth and bone development, and promotes metabolic processes. Experts recommend at least 85 milligrams per day. 3 servings of fruit or vegetables (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc. (Source)

6. Etc. for more healthy foods please visit 100+ Healthy Foods Classification

C.2. Antioxidants
Since GBS can cause serious effects as a result of weakened immune system. Intake of antioxidants should be beneficial for anyone to prevent the disease at the beginning, including pregnant women. For more information of the effects of antioxidants to cancers and diseases.

D. Treatments
There is no treatment but antibiotic to protect the newborns, unless the mother is serious sick as a result of the infection.

II. For the newborns (Early onset of the GBS)
A. Causes and risk factors of having a newborn with early onset of GBS
1. If a woman is test positive in the 37 weeks of gestation
2. Fever during delivery, if tested BBS positive
3. Women who had previous incidence of the disease
4. Rupture of membrane 18 hours or more before delivery
5. Risk of the baby with early onset increases 2000% if left untreated
6. Rupture of membrane before 37 weeks
7. Fever during delivery
8. Etc.

B. Diagnosis to prevent the onset of the diseases to the baby 1. In the 35- 37 weeks of gestation.
All pregnant women are needed to have a Vagina and Rectum swabbed, because of the bacteria come and go status and approximately 25% of pregnant women are infected with the diseases, Vagina and Rectum swabbed is recommended by the The Centers for Disease Control and Prevention (CDC). The result of the test is usually reported within 24 -48 hours, women who are suspected of the diseases are given antibiotic.
2. Blood or spinal fluid test of the newborn
If a mother is infected with GBS, the new born is usually tested to make sure the baby is not infected by the disease with the test of the blood or spinal fluid.

C. Prevention of having giving birth of a bay with the early onset GBS
Antibiotics
Women who are tested positive of GBS and whose membranes are ruptured more than 18 hours accompanied with fever are given antibiotics through the vein (IV) during labor to prevent the early-onset group B strep disease to the baby, but not Late-Onset Disease.
According to the study of " Duration of intrapartum prophylaxis and concentration of penicillin G in fetal serum at delivery." by Barber EL, Zhao G, Buhimschi IA, Illuzzi JL., researchers found that Short durations of prophylaxis achieved levels significantly above the MIC, suggesting a benefit even in precipitous labors. The designation of infants exposed to fewer than 4 hours of prophylaxis as particularly at risk for GBS sepsis may be pharmacokinetically inaccurate.

2. Planned Cesarean Delivery
According to the article of "Prevention of Perinatal Group B Streptococcal Disease" by Stephanie Schrag, D. Phil., Rachel Gorwitz, M.D.,Kristi Fultz-Butts, M.P.H. and Anne Schuchat, M.D., researchers found that although a risk does exist for transmission of GBS from a colonized mother to her infant during a planned cesarean delivery performed before onset of labor in a woman with intact amniotic membranes, it is extremely low, based on a retrospective study at a single hospital (99) and a review of CDC active,.... Patients expected to undergo planned cesarean deliveries should nonetheless still undergo routine vaginal and rectal screening for GBS at 35--37 weeks because onset of labor or rupture of membranes may occur before the planned cesarean delivery.

3. Etc.

III. For the newborns (Later onset of GBS in newborns)
( It may happen but rarely, as all newborns are test (blood or spinal fluid test) for the diseases, as soon as they are born)
Baby born with GBS infection mother, may be OK at birth, but may develop the disease in the first week to 3 months after birth
A. Symptoms as a result of infection effects
1. Fever
2. Difficulty feeding
3. Irritability
4. Difficulty breathing
5. Gastrointestinal and kidney problems
6. Heart and blood pressure instability
7. Sepsis, pneumonia and meningitis depending to the infected organs.
8. Etc.

B. Diagnosis
The aim of the diagnosis is to find out where is the infection located and treat accordingly to the onset of the disease
1. Blood clotting tests
It is the test to measure the the clotting tendency of blood, the time it takes blood to clot.

2. Blood gases
The test is to measure the levels of oxygen and carbon dioxide in the blood to determine how well your lungs are working and if oxygen therapy is required or not.

3. Complete blood count
It is the test to measures 3 Types of Cells in Blood, Abnormally high or low counts may indicate the presence of many forms of disease.

4. CSF culture
It is a test to determine if a newborn has exhibited the symptoms of meningitis.

5. Urine culture
The aim of the test is to determine the existence of the bacteria in urinary tract.

6. X-ray of the chest
It is to determine if the diseases has infected the lung.

7. Etc.

C. Treatments
1. Antibiotics given through a vein
Group B strep infections in newborns and older babies are treated with antibiotics (e.g., penicillin or ampicillin) given through a vein (IV). If the baby is severe illness, other medication and therapies in addition to antibiotics may be needed.

2. Oxygen therapy
If the diagnosis indicated that the abnormality of levels of oxygen and carbon dioxide.

3. Medication
Medication will be used to treat the later onset of the GBS in the newborn according to the diagnosis, including
a. Fluids given through a vein
It may be result of rapid fluid loss or blood loss due to hypovolemic shock
b. Medicines to reverse shock
Shock is generally a result of inadequate levels of oxygen in the blood, medication is given depended to the diagnosis
c. Medicines to treat blood clotting problems, such as blood thinner, medication forantithrombin deficiencies, etc. depending to the diagnosis.
d. Etc.

4. Etc.

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Rh Negative Disease in Pregnancy

Posted by Chantel Martiromo,  Article By Kyle J. Norton 

Rh Negative Disease is a hemolytic disease of a newborn (HDN), as a result of a conception of Rh- mother and Rh+ positive father, leading to a Rh+ pregnancy, causing destruction of blood cells in a fetus. The disease ranges from mild to severe. In most case, it could lead to fatal in the past and complications of the baby but could not affect the mother's health.

Causes
Rh Negative is caused by no protein found on the surface of red blood cells. While most of population have a genetic RH+, a woman with RH- is at risk of fetus complications if she becomes pregnant.

Diagnosis and test
1. Blood test
a. Flow cytometry
Type of optical analysis and separation of cells and metaphase chromosomes by light scattering and fluorescence to confirm the passing and volume of fetal blood into the maternal circulation.
Flow cytometry is used very comomlt in the diagnosis of blood disorder, including blood cancer.
In a study of "Detection of Trace Amounts of Fetal RhD-Positive Red Cells with Flow Cytometry after Multiple Rh-Negative Intrauterine Transfusions and RhD-Gene Determination with PCRR." by Lynena, T.J. Leglera, J.H. Maasa, A. Surenb, R. Osmersb, B. Behringc, W. Schroeterc, M. Koehlera, researchers found that Polymerase chain reaction (PCR) analyses showed the presence of RhD-gene sequences in both cases. Therefore, FC and PCR seem to be suitable methods for the diagnosis and the monitoring in cases of imminent hemolytic disease due to anti-D alloimmunization. With further transfusions, both children developed well after delivery.

b. Coombs test
The test is to determine the IgG antibodies that have passed through the placenta that can lead to hemolytic disease of the fetus.

c. Full blood count
It is a test of information of in a patient's blood, including red blond cells, white blood cells, and platelets.

d. Etc.

2. Bilirubin
The test is to check for the levels of bilirubin excreted in bile and urine, the elevation of levels of bilirubin is an indication of certain diseases.

e. Etc.

3. Ultrasound
Pelvic ultrasound is an image test by using high frequency sound waves to generate the the image which will be sent to your doctor to examine for any abnormality in the pelvic. It is often used in managing the progress of the fetus in the RH- pregnant mother.

Prevention, treatment and management
A. Prevention
Most Rh negative disease can be prevented by treating the mother during pregnancy or within 72 hours after childbirth. Please make sure you and your partner understand that you must talk to your doctor even before having a baby. If you are women with RH- and married to a men with RH+. If you are unsure, please have a blood test.

B. Treatment
The diseases had been deadly in the past, but today, it is treatable.
Rho(D) Immune Globulin
Rho(D) Immune Globulin is a type of medicine of anti-RhD used in a RH negative diseases of a newborn by binding to fetal Rh D positive red blood cells to prevent the complication caused by Rh- mother. The medicine is given by intramuscular injection. Some researchers suggested that Rho (D) Immune Globulin should to be given all RH- women at the 28 weeks of pregnancy.
According to the guidance of "The clinical effectiveness and cost effectiveness of routine anti-D prophylaxis for RhD-negative women in pregnancy." posted at the national institute for health and clinical excellent suggested that Routine antenatal anti-D prophylaxis is recommended as a treatment option for all pregnant women who are RhD negative and who are not known to be 'sensitised'.
2. Risks and side effects
a. Allergic reactions to skin such as skin rash, itching, etc.
b. Breathing difficulty
c. Swelling of the face, lips, or tongue
d. Fever
e. Chest pain
f. Yellow color of skin
g. Etc.
If the symptoms persist, please talk t0 your doctor.

C. Management
C.1. During pregnancy
1. Ultrasound
Pelvic ultrasound is an image test by using high frequency sound waves to generate the the image which will be sent to your doctor to examine for any abnormality in the pelvic. It is often used in managing the progress of the fetus after treatment of Rho(D) Immune Globulin in the RH- pregnant mother.

2. Intrauterine blood transfusion
Intrauterine blood transfusion may be necessary for the fetus by blood transfusion into fetal umbilical vein or into fetal abdomen.

3. Analysis of maternal anti-RhD antibodies
It is necessary to measure the levels anti-RhD antibodies, increasing levels of anti-RhD antibodies must be treated quickly.

4. Etc.

C.2. Soon after child birth
1. Phototherapy for the newborn
Most children born with Rh Negative Disease have a levels of bilirubin of more than 85 umol/l (5 mg/dL), a indication of jaundice.
2. Exchange transfusion
If necessary, by removing the newborn's red blood cells or platelets and replace them with transfused blood products.

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Postpartum Thyroid Disease

Posted by Chantel Martiromo,  Article By Kyle J. Norton

Postpartum thyroid disease is defined as a condition of women who deliver babies have postpartum thyroiditis, with hyperthyroidism, hypothyroidism, or both, within one year after delivery as the thyroid pland has become abnormal in production of thyroid hormones. If you need more information abount postpartum depression, please follow the link. Due to hornomal change expected after giving birth, most postpartum thyroid diseases are overlook by your doctor. It is for your own benefit, if you are experiencing symptoms of thyroidism, you should see your doctor. According to statistic, approximately 10 percent of women may suffer thyroid disease after childbirth.
In most cases, postpartum thyroid disease (transient thyroidism) may be temporary, as it will disappear after a short period of time

The Thyroid Hormone SolutionEssential Guide To Recovering Natural Thyroid Health.
By Louise O'Connor, Naturopath & Thyroid Expert.
Postpartum depression and postpartum thyroid disease
According to the study of Postpartum thyroid disease is not associated with postpartum depression by American thyroid association, study of 641 women with no thyroid disease. They were evaluated at the time of delivery and 1, 3, 6, 9, and 12 months after delivery, researchers found that 56 women (11 percent) had postpartum thyroid disease. Sixty-one women (10 percent) had a high score on the Beck Depression Inventory. Eleven (2 percent) were confirmed by a psychiatrist to have postpartum depression and 50 (8 percent) had lesser psychological disturbances (depressive disorder, anxiety). Researchers concluded that Women with postpartum thyroid disease do not have an increased risk of depression.

Most common types of Postartum thyroid diseases
1. Hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones.
2. Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones.
You will be direct to the article of hyperthyroidism in pregnancy and hypothyroidism in pregnancy. because of the similar of the subjects.

Please disreagrd the sections of "The importance to have hyperthyroidism under controlled in pregnancy" and "The importance to have hypothyroidism under controlled in pregnancy"

Please note
A. Hyperthoyrouidism
1. If your are not breast feeding with hyperthyroidism after child birth
a. Radioactive form of iodine may be used as it is the most effective treatment to cure hyperthyroidism as as a result of killing thyroid cells which have absorbed the radioctive iodine. Please note that the cells in the thyroid gland are the only cells in our body with the ability to absorb iodine, therefore the radioactive iodine will not damage other cells in the body.
b. Risks and side effects
b.1. Causing hypothyroidism as a result of radioactive iodine has killed more of the thyroid cells than expected
b.2. Mild case of hyoerthyroidism as a result od radioactive iodine has killed less thyroid cells as expect.
This risk can be disovled if the righ amount is used
b.3 Nausea
b.4. Swollen salivary glands
b.5. Mentallic taste.
As the glands have absorbed some of the radioactive iodine.
b.6. Etc.

Precautions: Following radioactive iodine therapy, you will need to take certain precautions to prevent radiation exposure to others, specially to elder and baby. As you doctors will give you a precised details.

2. If you are breast feeding your baby
1. You may consider stop it while you are in hyperthyroid treatment with radioactive iodine. Your doctor will tell you the time that is necessary for the radioactive iodine completely withdrawn from your body, before you can proceed with breast feeding your baby again.
2. If you choose not to stop, then the treatments will be the same with either medication or surgery.

B. Hypothyroidism
A Woman who is hypothyroid and on thyroid hormone replacement, with the follow up of thyroid hormone measurment to make sure that her thyroid hormone in the aceptable can be breast feeding her baby, because the amounts of medication cross over cause no harm to the baby health.
According to the article of "Breastfeeding and Thyroid Disease, Questions and Answers Can You Nurse Your Baby When Hypothyroid, Taking Thyroid Drugs Like Synthroid, or With Hyperthyroidism or Graves' Disease and Taking Antithyroid Drugs Like Tapazole or PTU" by Mary Shomon, the author wrote
" ....I (Mary Shomon) was not becoming engorged in between nursings, and after more visits to the lactation consultants and doula, the theory was that I didn't have a sufficient enough milk supply, and Julia didn't have a very strong sucking reflex. After trying many methods of increasing milk supply recommended by the various resources I called on -- everything from herbs like fenugreek, a nursing vacation, and nursing every 2 hours -- Julia continued to lose weight. At the three-week point, the pediatrician insisted that I add supplemental formula for Julia. Julia immediate began gaining weight.
Insuffient milk production by the mother may be a problem with postpartum hypothyroidism.
I will direct you to me previous article "Tips to help your New Born to Gain Weight - The Easy Way, if you are breastfeeding and have hypothyroidism" with a slight change to the tittle.

Chinese Secrets to Fatty Liver and Obesity Reversal
A fabulous E book with Research based & Scientifically proven Efficacy To Treat Fatty Liver Diseases & Achieve Optimal Health & Loose Weight

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Pregnancy - Gestational Diabetes

Posted by Chantel Martiromo,  Article By Kyle J. Norton

Gestational Diabetes is defined as a condition of high blood glucose of a pregnant women who is experience such diseases or symptoms only during pregnancy as a result of hormonal change, but return to normal blood sugar after giving birth. Gestational diabetes is considered as an indication of type II diabetes. It affects approximately 3% of pregnant women.

Symptoms
Symptoms is similar to those with diabetes, including
1. Frequent thirst
As a result of high concentration of glucose in the blood
2. Infections
Women who have gestation diabetes prone to have frequent infection, it may be result of high levels of glucose in the urine that cause bacteria invasion.
3. Nausea and vomiting
Nausea and vomiting is associated to early pregnancy, but in some cases, it can be a symptoms of gestational diabetes.
4. Fatigue
Fatigue may be a result of high blood sugar cause of inability of the body in sugar metabolism.
5. Increased urination
It is caused by the affect high blood sugar in the function of the kidney, instead of over growth of the uterus putting pressure to the bladder.
6. Blurred vision
Blurred vision can be caused by accumulation of fluid in the retina of your eye.
7. Weight loss
Women who are losing weight during pregnancy can be caused high blood sugar in the blood.
8. Etc.


Causes and risks factor
1. Insulin resistant
Insulin resistant may be caused by the body normal reaction if the body to secure glucose supply to the growing fetus.
According to the article "Gestational Diabetes: Detection, Management, and Implication" by Darcy Barry Carr, MD, and Steven Gabbe, MD, the authors wrote that The mechanism of insulin resistance is likely a postreceptor defect, since normal insulin binding by insulin-sensitive cells has been demonstrated.16 The pancreas releases 1.5–2.5 times more insulin in order to respond to the resultant increase in insulin resistance.17 Patients with normal pancreatic function are able to meet these demands. Patients with borderline pancreatic function have difficulty increasing insulin secretion and consequently produce inadequate levels of insulin. GDM results when there is delayed or insufficient insulin secretion in the presence of increasing peripheral resistance.

2. Placental hormones
Some researchers suggested that gestation diabetes in pregnancy may be caused by placental hormone as a result of increased fat deposits during pregnancy.

3. According to study of " Gestational diabetes mellitus by Thomas A. Buchanan and Anny H. Xiang, researchers found that
a. Autoimmune diabetes and GDM
Type 1 diabetes results from autoimmune destruction of pancreatic β cells....A small minority (less than 10% in most studies) of women with GDM have the same markers present in their circulation. Although detailed physiological studies of these women are lacking, they most likely have inadequate insulin secretion resulting from autoimmune damage to and destruction of pancreatic β cells. They appear to have evolving type 1 diabetes.
b. Monogenic diabetes and GDM
Monogenic diabetes mellitus has been identified outside of pregnancy in 2 general forms. Some patients have mutations in autosomes (autosomal dominant inheritance pattern, commonly referred to as maturity-onset diabetes of the young [MODY].... Mutations that cause several subtypes of MODY have been found in women with GDM.
c. Insulin resistance, β cell dysfunction, and GDM
The majority of women with GDM appear to have β cell dysfunction that occurs on a background of chronic insulin resistance.

4. Family history
Women who have a previous record of the incidence are at higher risk of Gestational diabetes.

5. Age
Women who are pregnant at age of 30 and older are at higher risk of the incidence.

6. Obesity
Obesity is a major risk of gestational diabetes or especially when developing rapidly after pregnancy.

7. History of an unexplained miscarriage or stillbirth
Nevertheless, on the assumption that repeated unexplained abortions might be a prediabetic
or latent diabetic phenomenon, Williams,24 Gilbert14 and Hoet25 have performed glucose
tolerance tests in the mothers, and frequently found them to be abnormal, according to the article of PREDIABETES A Synthesis By W. P. U. JACKSON, M.A., M.D., M.R.C.P., D.C.H..

8. History of giving birth to over weight baby (9 Lbs or more)
Women who have had a previous history of giving birth to one or more over weight baby are at higher risk of developing gestation diabetes, according to the article of"PREDIABETES A Synthesis" By W. P. U. JACKSON, M.A., M.D., M.R.C.P., D.C.H.
9. Hydramnios
Birth defect is a very frequent concomitant of the diabetic pregnancy. Its incidence in prediabetes has not yet been elucidated., according to the article of " PREDIABETES" A Synthesis By W. P. U. JACKSON, M.A., M.D., M.R.C.P., D.C.H.

8. Glycosuria
The excretion of glucose into the urine as a result of the kidneys are unable to reclaim all of the filtered glucose back into the bloodstream may be a sign of gestational diabetes.

9. Toxaemia
Women who are pregnancy of pre-eclampsia or eclampsia are at high risk of gestational diabetes due to presence of bacterial toxins in the blood.

10. Etc

Diagnosis and test
Women who have some of above symptom or at high risk, are recommended to have blood glucose test between 24-28 weeks of pregnancy.
1. A fasting glucose blood test
There is requirement of the test but you can not eat for a period of 10 hours but no more than 16 hours. If you blood glucose levels are in the normal range, no further test are required. If you blood glucose levels are higher than normal range, here are some additional tests. 2. Oral Glucose Tolerance Blood Test
Preparation same as the above test, but in this test, your blood glucose is tested when you arrive at the clinic, test again at one hour after drinking a sugary beverage. If your blood glucose level is above normal range, you are be diagnosed with gestational diabetes.

3. If you are diagnosed with gestation diabetes, then there are more tests to ensure a healthy pregnancy, including ultrasound (general health of the baby), fetal movement records (movement of the baby every 2 hours), fetal monitoring ( heart beat of the baby). etc.


Preventions
1. Lose weight
Obesity is one of the major factor which contribute to diabetes and gestational diabetes, you make sure that you lose weight before you want to get pregnant.
2. Age
Since age is associated to the risk of gestational diabetes, getting pregnant before the age of 30 will avoid any complication, including gestation diabetes.
3. Eating and living healthy
Eating healthy and living healthy such as quick smoke and drinking can provide you with optimal health for a healthy conception and delivery.
Please read 100+ Healthy Foods Classification
4. Moderate exercise
Moderate exercise enhances conception while rigid exercise reduces it
5. Reduce stress
Stress is proven to be a big factor in contributing to gestational diabetes, taking yoga or meditation class will be beneficial for relaxation.
6. Etc.

Complication of untreated gestation diabetes
Although it is rarely happened in the western world but in some underdevelopment countries, untreated gestational diabetes can cause below complication if left untreated
1. Dead of the fetus
According to the "PREDIABETES A Synthesis" By W. P. U. JACKSON, M.A., M.D., M.R.C.P., D.C.H, the authors wrote that Malins has observed an interesting relationship between the diabetogenic effect of pregnancy in the mother with established diabetes and the survival of the infant. He found that the foetus was less likely to survive in those cases where the mother needed a considerable increase in insulin dosage during pregnancy, and particularly where this higher insulin.

2. Develop respiratory distress syndrome
As we mentioned above.

3. Hypoglycemia
It is a result of over production of the baby pancreas to counter the high blood glucose during pregnancy.

4. Over size baby
As a result of high levels of glucose in the mother blood

5. Jaundice
As a result of the immature of the baby in breakdowning of red blood cells, causing bilirubin build up that leads to yellowish skin color and the white parts of the eye.

6. Etc.

Treatments
A. In conventional medicine
A.1. Diet
Depending to the diagnosis and meeting with gestation diabetes nutritional specialist or dietitian, you may be given a specific plan to keep your blood glucose within the normal range. Here is some guide line, from the article of "Nutrition Basics For Women with Gestational Diabetes" posted in diabetesmommy online magazine. (Source)
1. Eat and drink at least 4 servings of dairy products and calcium-rich foods a day to help ensure that you are getting 1200 mg. of calcium in your daily diet. Sources of calcium include dairy products, some nuts, green vegetables and foods and beverages fortified with calcium, such as calcium-fortified, unsweetened ready-to-eat cereals.
2. Eat at least three servings of iron-rich foods per day to ensure you are getting 30 mg. of iron in your daily diet. Sources of iron include enriched grain products (rice); lean meat, poultry and fish; eggs and leafy green vegetables.
3. Choose at least one source of Vitamin C every day. Sources of Vitamin C include oranges, grapefruits, strawberries, honeydew, broccoli, cauliflower, brussel sprouts, green peppers, tomatoes and mustard greens.
4. Choose at least one source of folic acid every day. Sources include dark green leafy vegetables, veal, fortified grain products, legumes (lima beans, black beans, black-eyed peas and chickpeas) and fruits.
5. Choose at least one source of Vitamin A every other day. Sources rich in Vitamin A include carrots, pumpkins, sweet potatoes, spinach, water squash, turnip greens, beet greens, apricots and cantaloupe.
6. Avoid alcoholic beverages during pregnancy. Alcohol has been linked to premature delivery and low birth weight babies. If you think you may have a problem with alcohol use, please talk to your health care provider so he or she can help protect you and your baby.
7. Limit caffeine to no more than 300 mg. per day (two 8-ounce cups of coffee, three 8-ounce cups of tea or three 12-ounce glasses of caffeinated soda). Remember, chocolate contains caffeine -- the amount of caffeine in a chocolate bar is equal to 1/4 cup of coffee.
8. DO NOT DIET or try to lose weight during pregnancy -- both you and your baby need the proper nutrients in order to be healthy. Ask your health care provider how much weight you should gain during pregnancy. A woman of average weight before pregnancy can expect to gain 25 to 35 pounds during pregnancy. You may need to gain more or less weight, depending on what your health care provider recommends.
9. Eat a variety of foods to get all the nutrients you need. The Food Guide Pyramid on the next page provides an example of the number of servings you should eat from each food group every day.
10. The use of non-nutritive or artificial sweeteners approved by the Food and Drug Administration is acceptable during pregnancy. These FDA-approved sweeteners include aspartame and acesulfame-K. The use of saccharin is strongly discouraged during pregnancy because it can cross the placenta and may remain in fetal tissues. Talk with your health care provider about how much non-nutritive sweetener is acceptable during pregnancy.

Foods to Choose to Lower Blood Sugar
Breads and Grains 6-11 servings/day	Fruits and Vegetables 2-4 servings/day	Dairy 4 servings/day
1 slice of bread 1/2 bagel or English muffin 1 plain rice cake 6 crackers (such as matzo, bread sticks, rye crisps, saltines) 3 graham crackers 3/4 cup ready-to-eat cereal 1/2 cup pasta or rice 1/2 cup corn Small plain baked potato 1 small pancake 1 6-inch tortilla	1 piece of fresh fruit 1 melon wedge 1/2 cup chopped, cooked, frozen or unsweetened canned fruits 3-5 or more vegetable servings/day 1/2 cup cooked or canned vegetables 1 cup chopped, uncooked or frozen vegetables	1 cup low-fat milk 1 cup soy milk 1 cup low-fat unsweetened yogurt 1 1/2 ounces of cheese 1/2 cup low-fat cottage cheese
Meat, Fish, Poultry 2-3 servings/day	Fats and Oils In limited amounts (approximately 5-8 tsp/day)	Sweets and Snacks In limited amounts
2 ounces cooked lean meat, fish or poultry 2 ounces of cheese 2 eggs or the equivalent in egg substitutes 1 cup cooked dried beans or peas 2 tbsp peanut butter 1/4 cup tofu (bean curd)	Vegetable oil (olive, canola or peanut oils) Tub margarine Fat-free or low-fat salad dressing	Peanut butter and crackers Cheese and crackers Vanilla wafers Plain popcorn, pretzels "Free" foods Raw vegetables Diet soda Sugar-free gelatin Sugar-free syrup Low-sugar jelly Sugar-free candy and gum Unsweetened popsicles

At you are following the diet, you will have to record your blood glucose in the morning when you wake, before and after each meal, depending to the recommendation of the dietitian. ( It is frustrate, if you hate blood and needle punctuation)

A.2. Insulin
If diet can not lower the blood glucose after 1 week or 2, insulin injection once or twice daily, with adjustments may be necessary to lower the blood glucose after meal to prevent nay unwanted pregnant complication, depending to the blood diagnosis.



B. Herbal medicine
Please consult with your doctor or related field specialist before applying
1. Astragalus
Research suggests that the herb astragalus may help to prevent and treat gestational diabetes. In a study of "Clinical evaluation of the antioxidant activity of astragalus in women with gestational diabetes", (Article in Chinese) by Liang HY, Hou F, Ding YL, Zhang WN, Huang XH, Zhang BY, Liu Y., researchers found that astragalus can effectively control blood glucose, reduce the free radicals, and promote the antioxidative activity, and may play a role in the prevention and treatment of gestational diabetes.

2. Cinnamon
According to the study of Cinnamon, Glucose Tolerance and Diabetes Nutrient Requirements and Functions Laboratory (NRFL) of the Beltsville Human Nutrition Research Center (BHNRC) , researchers indicated that the results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.

3. Garlic (Allium Sativum)
Garlic have been used by herbalists over thousand of years in treating diabetes. In a study of "Antidiabetic effects of S-allyl cysteine sulphoxide isolated from garlic Allium sativum Linn." by

Sheela CG, Augusti KT., researchers found that Garlic (Allium Sativum) increased significantly liver and intestinal HMG CoA reductase activity and liver hexokinase activity.

4. Ginkgo Biloba
Ginkgo biloba has also been used in the traditional Chinese medicine practice for the treatment of diabetes. In a study of Ginkgo Biloba Extract and the Insulin Resistance Syndrome,

by Principal Investigator: G B Kudolo, Affiliation: University of Texas Health Science Center

Country: USA, researcher found that (The results of this study) when taken together should provide very important information on balancing the risk of accelerating pancreatic beta-cell dysfunction, with its beneficial effects on delaying the onset of cognitive function. The results of this study should also provide valuable information for designing new therapeutic strategies for the treatment of diseases in the insulin resistance syndrome.

5. Fenugreek and other herbs
In a study of "Complementary and alternative medicine for the treatment of type 2 diabetes.", byNahas R, Moher M., researchers concluded that Chromium, and possibly gymnema, appears to improve glycemic control. Fibre, green tea, and fenugreek have other benefits but there is little evidence that they substantially improve glycemic control. Further research on bitter melon and cinnamon is warranted. There is no complementary and alternative medicine research addressing microvascular or macrovascular clinical outcomes.

6. Etc.

C. Traditional Chinese medicine
Please consult with your doctor or related field specialist before applying Qi Wei Bai Zhu San (Chniese herbal formula)
C.1. Ingredients
1. Ren Shen (Ginseng Root) 6 g
Main uses; Strongly tonifies Original Qi, Tonifies the Lungs and Spleen, Promotes generation of Body Fluids, Calms thirst,...
2. Fu Ling (Poria) 10 g
Mian uses; Eliminates Water, Strengthens the Spleen, Calms the Mind,....
3. Bai Zhu (White Atractylodes) 10 g
Main uses; Tonifies Qi, Strengthens the Spleen, Dries Dampness, Stops sweating, Prevents miscarriage,...
4. Gan Cao (Licorice Root) 12 g
Mian uses; Tonifies the Spleen, Benefits the Qi, Moistens the Lungs, Regulates the nature of other herbs,...
5. Mu Xiang (Costus Root) 6 g
Main uses; Moves Qi, Regulates the Middle, Calms pain,...
6. Ge Gen (Kudzuvine Root) 15 g
Mian uses; Raises Yang, Clears Heat, Promotes generation of Body Fluids,...
7. Huo Xiang (Agastache) 10 g
Maim uses; Transforms Dampness, Disperses Summer-Heat, Stops vomiting,..

C.2. Clinical study
According to the article of Clinical Studies on Gestational Diabetes Mellitus with Formula of Qi Wei Bai Zhu San Posted on June 16, 2010 by China Papers, researcher found that
1. Treatment group (is better) than in the control group, but glycemic control to significantly reduce the time the normal range;
2. Two groups of Chinese (medicine) history treatment; symptoms the observation group of Chinese medical symptoms of improved obviously superior to the controls
3. Treatment group (is better) than control group women, the morbidity can be reduced
4. Treatment group (is better) than the control group to better regulate blood lipid
5. Treatment group (is better) than in the control group to control blood gluose fluctuations and maintain long-term steady state plasma glucose
6. Groups can all reduce the 2-hour postprandial blood glucose, but the treatment group (is) more effective.
7. Two groups can reduce the class blood sugar, and lower blood sugar. The effect of the same class
Researchers concluded that Qi Wei Bai Zhu San is good at strengthening spleen. By application of strengthening spleen and personal diet guide can effectively reduce blood glucose, reduce lipid and maternal complications.It clinically has good effect for pregnant women of weakness of spleen and stomach type…


Chinese Secrets to Fatty Liver and Obesity Reversal
A fabulous E book with Research based & Scientifically proven Efficacy To Treat Fatty Liver Diseases & Achieve Optimal Health & Loose Weight

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Pregnancy and Low Birth Weight

Posted by Chantel Martiromo,  Article By Kyle J. Norton


Low birth weight is a condition of a baby who was born below the weight of gestational age due to several reasons, including, the baby was born too soon, were small for gestational age, the poor health of the mother, nutritional deficiency, certain diseases, etc. According to the statistic of the World health organization, globally, more than 20 million infants were born with low birth weight.

The consequences of low birth baby (Symptoms)
Some LBW babies can have life-long health problems as well as the risk of dying in the first year of life. Most common diseases of low birth weight baby include
1. Respiratory distress syndrome (RDS)
As the lung is a last organ to develop of the fetus during 40 weeks of pregnancy, respiratory problem is a very common for baby who was born with low weight. Babies who were born before the week of 34 are at risk of lacking surfactant to keep the small air sacs in the lungs from collapsing. The introduction of additional oxygen is very helpful to keep the baby lung to expand, but according to the antioxidant theory, it can also induce the chain of oxidation, causing vary health problem to the baby, if the additional oxygen has to be used it for a prolonged period of time, as the baby has weakened immune system to defend it due to low birth weight.

2. Intraventricular hemorrhages (IVH) (bleeding in the brain
Bleeding can occurs within the first days of life in the brain of some very low-birthweight. According to the article of "Treatment reduces brain hemorrhages in very low birthweight babies" posted in the National Institue of neorological institutes, "between 20 to 40 percent of very low birthweight infants have intracranial hemorrhages, putting them at very high risk for major neurodevelopmental problems" and "Very low-birthweight babies who are treated with indomethacin within 6-12 hours after birth have a lower incidence and reduced severity of brain hemorrhage, a frequent and often debilitating complication of such births".

3. Patent ductus arteriosus (PDA)
PDA is a heart problem that is common in premature babies. It is defined as a condition of a congenital disorder in the heart with persistent opening between two major blood vessels leading from the heart.
According to the study of Patent ductus arteriosus in infants of low birth weight.
D R Smith, D H Cook, T Izukawa, P M Olley, P R Swyer, and R D Rowe, researchers found that In 48 patients whose heart failure could not be controlled by other medical therapy indomethacin was given, and in 20 (42%) it was judged successful. Surgical ligation of the ductus was performed at a median age of 30 days in 33 infants who either failed to respond to indomethacin or in whom its use was contraindicated; there were no intraoperative deaths, but 11 (33%) of the infants died 4 days to 6 months after the operation.

3. Necrotizing enterocolitis (NEC)
Necrotizing enterocolitis (NEC) is defined as a condition of premature death of cells of portions of the bowel tissue after 2-3 weeks of birth, causing feeding intolerance, increased gastric residuals, abdominal distension, bloody stools, etc.. Treatments of babies with NEC include supportive care antibiotics and in some case, clostomy may be necesesary depending to the disgnosis.

4. Retinopathy of prematurity (ROP)
Retinopathy of prematurity (ROP) is defined as acondition of a blinding eye disease of premature babies and very low birth weight infants born before 32 weeks of pregnancy as a result of an abnormal growth of blood vessels in the eye. According to the strudy of Retinopathy of "Prematurity in Extremely Low Birth Weight Infants" by C. Gregory Keith, Lex W. Doyle, researchers found that the increase in the survival rate of ELBW infants is not always accompanied by an increase in the rate of severe ROP or blindness, at least for ELBW infants born in some large level-3 centers. In most cases, the disease can heal themselves with little or no vision loss. In severe cases, laser therapy or cryotherapy is necessary to destroy the peripheral areas of the retina but it may cause some vision loss. In latest stage of ROP, Scleral buckle and vitrectomy may be necessaery depending to retcam screening.

5. Psychological effects
According to the study of "Psychiatric symptoms in low birth weight adolescents, assessed by screening questionnaires." by Indredavik MS, Vik T, Heyerdahl S, Kulseng S, Brubakk AM., researchers found that very low birth weight(VLBW) adolescents are at risk of developing psychiatric symptoms, and reduced social and academic skills by the age of 14. Term SGA adolescents may have discrete emotional, behavioural and attention deficit symptoms. ASEBA and SDQ provide a useful supplement to psychiatric interview.

6. Later in the baby life
In a study of Emotional, behavioral, social, and academic outcomes in adolescents born with very low birth weight. by Dahl LB, Kaaresen PI, Tunby J, Handegård BH, Kvernmo S, Rønning JA., researchers found that From parents' point of view, significant proportions of very low birth weight adolescents experience more emotional and behavioral problems and less competence than normative adolescents. In contrast, very low birth weight adolescents state less problems and similar or higher competence than normative adolescents. Very low birth weight adolescent girls report more emotional and behavioral problems compared with their parents than very low birth weight adolescent boys do. Externalizing problems in very low birth weight adolescent girls are often not recognized by parents. To better understand these seemingly paradoxical findings and to develop adequate intervention programs, there is a need for prospective longitudinal studies.

7. Short stature
In a study of "Low birth weight--additional important factor of diagnosis in children with short stature". [Article in Polish] by Majcher A, Pyrżak B, Bielecka-Jasiocha J, Witkowska-Sędek E., researchers found that
a. Low birth weight is diagnosed in every sixth child with short stature in the Clinic of Endocrinology.
b. Children born on time with low birth weight should be diagnosed early towards congenital genetic disorders and development defects.

8. Metabolic syndrome and ischemic heart disease.
Baby who was born low birth weight is at higher risk of heart diseases and diabetes as a result of inflammatory processes in adulthood. According to the study of "Low birth weight and markers of inflammation and endothelial activation in adulthood", The ARIC study by Lucia C. Pellanda, Bruce B. Duncan, Alvaro Vigo, Kathryn Rose, Aaron R. Folsom, Thomas P. Erlinger, researchers found that LBW predicted greater inflammation and endothelial activation, as indicated by the higher score of blood markers, consistent with the hypothesis that early life events may result in a hyper-responsive innate immune system. Such a pro-inflammatory tendency could help explain the association of low birth weight with elements of the metabolic syndrome and ischemic heart disease.

9. Etc.

Causes
1. Mother’s poor nutrition
According to the World health organization, Once pregnant, the mother’s nutrition and diet,
lifestyle, such as alcohol, tobacco or drug abusehave greatly affected the weight of the fetus. In most cases, it is caused by long-term maternal malnutrition,

2. sexual tramitting diseases during pregnancy
Certain sexual tramitting diseases can increase the risk of low birth weight of the newborn, including syphilis
2.1. Infectious diseases HIV
It is an disease caused by the human immunodeficiency virus (HIV) which can severe damaging the immune system that can lead to infection and inflammation as a result of weakened immune system in fighting against foreign invasion. Symptoms include acute infection, fever, swollen lymph nodes,etc. Your baby may be infected by the virus as a result of sharing blood supply with you or you can transmit the disease during childbirth.

2.2.Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacteria Treponema pallidum. The disease is developed into your stages with no symptom in the first stage, rash in the palm, soles of the feet,, etc. in the second stage. In the latent (hidden) stage of syphilis, no symptoms, the disease is hidden but it can be transmitted through sexual activity. In the final stage, is also known as Tertiary Syphilis, the infectious person may experience symptoms of Heart, Eyes, Brain , Nervous system, etc. damages. According to the statistics, more than 6000 cases of syphilis are reported in the United States alone each year. It is a concern that you may transmit the disease to your baby during child birth.

2.3. Etc.

3. Low income family
Women who are low income earner may be suceptible to low birth weight baby as a result of nutritional deficiency according to the World health Organization.

4. Birth defects
Certain genetic birth defects may be result in low birth weight baby, including
a. Chromosomal abnormalities The diseases can be caused by genetic passing through from the parent or an error in cell division. Chromosomal abnormalities can be divided into two basic groups, numerical and structural anomalies.

b. Single gene defects
It is a result of single gene defect out of 40-60,000 genes presented in the human body leading to the leads to alternation of the DNA code as a result of an defect amino acid sequence in the proteins.

c. X-Chromosome abnormality
Women who carry the mutated genes of the X chromosome have 50% risk in giving birth to a X-link related birth defects. Types of disorder is depended to the degrees of expression of the mutation. In X chromosome abnormality, men are affected and women are carriers.

d. Multifactorial problems
It is a type of genes mutation involved many factors, including the environment in the causation of birth defection, including cleft lip or cleft palate, neural tube defects, etc.

e. Teratogenic problems
It is type of mutation gene abnormality caused by exposure to certain chemicals, radiation, alcohol, heavy chemicals, certain medication, etc.

f. Etc.

5. Chronic health problems
Certain chronic illness such as anemia, high blood pressure, diabetes, and heart, lung and kidney if left untreated or uncotrolled can affect the weight of the baby, including low birth weight due to nutritional deficiency.

6. Inadequate maternal weight gain
Women who don’t gain enough or gain too much weight during pregnancy increase their risk of having a low-birthweight baby (2, 6). According to the study of "Maternal prepregnant body mass index and weight gain related to low birth weight in South Carolina" Posted in the free library by Farlex researchers found that Eight percent of the very low birth weight (VLBW)rate in South Carolina can be attributed to inadequate weight gain in pregnancy. Approximately 19% of the state's VLBW rate can be attributed to either underweight or overweight BMI at conception.

7. Certain exposures and smoking
a. Expose to indoor air pollution, can increase the risk of low birth weight bady.
b.Women who smoke during pregnancy smoke are twice as likely to give birth to low-birth weight infants.
According to the study of "Air pollution combustion emissions: characterization of causative agents and mechanisms associated with cancer, reproductive, and cardiovascular effects." by Lewtas J., researchers found that Long-term epidemiologic studies have reported an increased risk of all causes of mortality, cardiopulmonary mortality, and lung cancer mortality associated with increasing exposures to air pollution. Adverse reproductive effects (e.g., risk for low birth weight) have also recently been reported in Eastern Europe and North America. Although there is substantial evidence that PAH or substituted PAH may be causative agents in cancer and reproductive effects, an increasing number of studies investigating cardiopulmonary and cardiovascular effects are investigating these and other potential causative agents from air pollution combustion sources.

8. Etc.

Diagnosis
If you have previous low weight birth, if you feel the baby is not growth large enough, please consult with your doctor. Since there is no symptom to identify the abnormality, follow-up exams are necessary including ultrasound.

Prevention
A. How to avoid
1. If you have previous low birth weight baby, it is imporant that you make sure your are at the optimal health and all chronic illness are under controlled before you get pregnant again to lower the risk of low birth weight incidence. Believe or not, the rate of 2 consecutive low birth weight baby is very low in a healthy woman.

2. Stop smoking
Women who smoking during pregnancy are at twice as risk to give birth of a low eight baby that non smoking women.

3. 17 alpha-hydroxyprogesterone caproate (17P).
In some case, when it is absolutely necessary, injection P17 may be given, depending to the diagnosis. Acording to the study reported in the New England Journal of Medicine (N Engl J Med 2003; 348:2379-85), showed that 17P treatment reduced preterm birth by 34 percent in women pregnant with a single baby who had a previous preterm delivery.

4. Balancing diet
For more information of healthy diet, please visit 100+ Healthy Foods Classification
The American Pregnancy Association recommends alterations to your diet, including
4.1. Protein
Protein in your foods positively affects the growth of fetal tissue, including the brain. It also helps your breast and uterine tissue to grow during pregnancy,
a. 75 to 100 grams of protein per day as it can be divided into 2-3 servings of meat (1 serving = approximately 3 ounces/ size of a deck of cards) from chicken lean beef, lamb, pork, nut and tofu (1 serving = approximately ⅓ cup), etc.
b. 2-3 servings of legumes (1 serving = approximately ½ cup) such as red and white kidney beans,black beans, navy beans etc..

4.2. Calcium
Daily requirement of calcium is around 1000 milligrams during pregnancy. Calcium helps your body regulate fluids, and it helps build your baby’s bones and tooth buds, such as milk (1 serving = 1 cup), eggs (1 serving = 1 large egg), yogurt (1 serving = 1cup),pasteurized cheese (1 serving = approximately 1.5 ounces/ or 4 playing dice stacked together), tofu (1 serving = ½ cup), etc.

4.3. Iron
In combination with sodium, potassium, and water, iron helps increase your blood volume and prevent anemia. A daily intake of 27 milligrams is ideal during pregnancy.
a. 2-3 servings of green leafy vegetables (1 serving = approximately 1 cup)such as collard turnip, spinach, lettuce, etc.
b. 3 servings of whole grains (1 serving = approximately. ½ cup or one slice), such as bread, cornmeal, cereal, oatmeal, etc.

4.4. Folate/Folic Acid
Folic acid plays a key role in reducing the risk of neural tube defects, including spina bifida. Experts recommend 600 to 800 micrograms (.6 to .8 milligrams) daily.
a. 2 servings of dark green leafy vegetables (1 serving = approximately 1 cup), such as collard, turnip, spinach, lettuce. etc.
b. 2-3 servings of fruit (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc.

4.5. Vitamin C
Fruits and vegetables rich in Vitamin C will help with wound healing, tooth and bone development, and promotes metabolic processes. Experts recommend at least 85 milligrams per day. 3 servings of fruit or vegetables (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc. (Source)

4.6. Etc.

Treatment
A. In conventional medicine
Since there is no specific treatment or prevention, closely monitors the growth of the fetus with nutritional modification and making sure all chronic illness are under controlled and the baby is catching up with growth in the 18 and 24 months.

B. Herbs
Please do not use these herbs until you have consult with your herbal medicine practitioner 1. Chamomile flowers
Chamomile flowers, the dried flower heads of the herb Matricaria recutita is effectively used in herbal medicine to get rid of nauseating feeling, a common symptoms during pregnancy, as well as inducing sleep.

2. Yellow dock
Yellow Dock has been used extensively as herb to cleanse or purify the blood, thus preventing jaundice in newly born baby. Since it contains high amount of vitamin C and iron, it ensures the pregnant women and baby getting enough oxygen for a healthy pregnancy.

3. Ginger root
In a study of Complementary therapies for nausea and vomiting in early pregnancy, researcher concluded that nausea and vomiting are uncomfortable and sometimes debilitating symptoms encountered in early pregnancy. Many of the more conventional remedies offer only partial to negligible relief. Some pregnant women also express scepticism regarding the safety of the more traditionally prescribed pharmacological agents used to combat morning sickness. Vitamin B6, ginger root and acupressure are three complementary modalities that may help alleviate these self-limiting discomforts. Ginger is admired world wide for its anti-inflammatory and anti- bacterial properties. Thus, it works amazingly on morning sickness.

4. Echinacea
Echinacea, a genus of herbaceous flowering plants in the daisy family, Asteraceae has been used traditionally to treat or prevent colds, flu, and other infections by enhancing the immune system. In a study of pregnancy outcome following gestational exposure to echinacea: a prospective controlled study by Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G. researchers found that gestational use of echinacea during organogenesis is not associated with an increased risk for major malformations.

5. Red Raspberry leaf
Red Raspberry leaf has been used in herbal medicine as herbal tonic for pregnancy by tonifying the uterus, preventing miscarriage and decreasing constipation due to containing many minerals and vitamins, including vitamin C, calcium and an alkaloid uterus tonifier called fragrine.

6. Nettles
Nettles are species of flowering plants of the genus Urtica in the family Urticaceae contained Vitamins A, C, D and K, calcium, potassium, phosphorous, iron and sulphur of which are necessary for providing nutrients a healthy mother and her baby. The herb has been used in herbal medicine to stop excessive bleeding (vitamin K), prevent hemorrhoids, ease leg cramps and other spasms, nourish and protect the mother and unborn.

7. Etc.
C. Traditional Chinese medicine
Please do not use these herbs until you have consult with your traditional Chinese medicine practitioner Dang Gui Shao Yao San is one the recommended formula because it is extensively used in China and Japan and has been monitored in many large-scale clinical trials with pregnant women. The formula was first recommended for use during pregnancy in the Jin Gui Yao Lue, and has been used regularly for the past 1,800 years. In animal studies researchers found that Dang Gui Shao Yao San showed no teratogenic effects (tendency to cause birth defects). The formula has been used to treat female infertility, morning sickness, anemia during pregnancy, and to prevent miscarriage and approved by the Japanese Ministry of Health. The formula used to avoid miscarriage or to treat a variety of pregnancy disorders, but it is also employed as a blood tonic and treatment for mental distress associated with blood deficiency. It includes peony, Chinese angelica root, cnidium, atractylodes, hoelen and alisma.

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