“I hate the fact that my face is covered in spots now that I am pregnant. What happened to the radiant pregnancy ‘glow’ I was supposed to have? I was reassured that my skin would clear up eventually once the baby is born but nine months of this is pure agony, what can I do NOW?”

Skin changes during pregnancy

So what can you do if, pre-pregnancy, you had a shapely body and unblemished skin but are nowbombarded by a myriad of changes that prove to be too much to handle, such as acne breakouts or stretch marks? The most important thing is not to panic; help is on its way. As this chapter takes you through the various skin changes that occur during pregnancy, it will provide clear, concise and effective solutions and tips, ranging from practical advice to scientifically proven treatments that are safe for the pregnant woman.

Skin changes such as acne, itchiness and other kinds of skin blemishes are the inevitable outward signs of the transformations that take place in your body during pregnancy. These changes, which are caused by the hormonal ups and downs brought about by being pregnant, may be considered normal by some but not by others-a lot of pregnant mothers-to-be, especially those who are going through this experience for the first time, consider such changes to be abnormal or, using a more clinical term, ‘pathologic’. Some of these conditions may only be present during pregnancy but they can persist long after the baby has been delivered.

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The changes that occur in the pregnant patient’s body are caused by several factors. Many of these changes are the result of hormonal influence, some are caused by the growth of the fetus inside the uterus, and some are the result of the patient’s physical adaptation to the changes that are occurring. This lesson is closely related to anatomy and physiology.

CHANGES OF THE REPRODUCTIVE SYSTEM DURING PREGNANCY

Changes in the body during pregnancy are most obvious in the organs of the reproductive system.

a. Uterus.

(1) Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the uterus will have increased five times its normal size:

(a) In length from 6.5 to 32 cm.

(b) In depth from 2.5 to 22 cm.

(c) In width from 4 to 24 cm.

(d) In weight from 50 to 1000 grams.

(e) In thickness of the walls from 1 to 0.5 cm.

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Definition of ectopic: Pregnancy in which the fertilized egg or embryo implants on any tissue other than the endometrial lining of the uterus. 95% occur in the tube. 1.5% are abdominal, 0.5% are ovarian and 0.03% are cervical. The death rate is about 1 per 2000 ectopics in this country. About 40-50 women die each year from ectopic pregnancy in the U.S. There has been a large drop in the death/ectopic rate since 1970. In other words, it is much safer to have an ectopic than it was in 1970.

Risk factors for ectopic pregnancy

Pelvic inflammatory disease (PID)

Rate of ectopic pregnancy in women with previous known PID is increased 6-10 times higher than in women with no previous history of PID.

A published study of 745 women with one or more episodes of PID that attempted to conceive showed that 16% were infertile from tubal occlusion. Of those that conceived, 6.4% had ectopic pregnancies.

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What is a miscarriage?

It is the spontaneous loss of a pregnancy that occurs during the first 20 weeks of pregnancy, most commonly before 12 weeks. After 20 weeks the loss of the pregnancy is called a stillbirth. About 1 in 7 recognised pregnancies will miscarry and about 1 in 3 women will experience a miscarriage during their reproductive life. A miscarriage may occur so early in a pregnancy that a woman may have been unaware that she was pregnant. These miscarriages are often unreported. Sometimes a doctor or nurse may refer to a miscarriage as a “spontaneous abortion”. “Abortion” is the common medical term given to all pregnancies that end before 20 weeks (both miscarriages and terminations). Miscarriage can be a difficult and traumatic experience for some women. For others, it may happen so early that the pregnancy was undetected.

Why does miscarriage occur?

It is generally unknown what causes miscarriages. Basically, miscarriage occurs because the foetus did not develop properly, probably because of a chromosomal or other genetic abnormality. The pregnancy is not normal and miscarriage is nature’s way of taking care of the problem.

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Contributing Editor: Marcia L. Buck, Pharm.D.; Editorial Board: Kristi N. Hofer, Pharm.D.; Michelle W. McCarthy, Pharm.D.

Introduction

Supraventricular tachycardia (SVT) is the most common symptomatic arrhythmia of childhood, occurring in 1 in 250 to 1,000 children. In October 1989, adenosine was approved by the Food and Drug Administration (FDA) for the conversion of paroxysmal supraventricular tachycardia (SVT) to sinus rhythm. Even before approval by the FDA, adenosine was studied in the management of infants and children with SVT. Some of the initial studies were conducted at the University of Virginia by John DiMarco and colleagues, who were also involved in its development. Twenty years of accumulated experience have substantiated the efficacy of adenosine and revealed a relatively low incidence of serious adverse effects in patients who undergo treatment. This issue of Pediatric Pharmacotherapy will provide an overview of adenosine and provide recommendations for its use in infants and children with SVT.

Mechanism of Action

Adenosine is an endogenous purine nucleoside present in cells throughout the body. It is formed by breakdown of adenosine triphosphate (ATP) or 5-adenosylhomocysteine. While the multiple roles of endogenous adenosine are still being investigated, it is known to aid in maintaining the balance between oxygen delivery and demand by dilating the coronaries and slowing heart rate. These effects result from binding to adenosine A1 receptors in the sinoatrial (SA) node, the atrioventricular (AV) node, atrial myocytes, and coronaries.

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Losing a child is an unthinkable devastating event. Some families express the desire to know the facts on why this has happened. We have designed this pamphlet to give you general information about your loss, any further questions should be discussed with your nursing staff or doctors.

This pamphlet is about late miscarriages between 14 and 20 weeks of pregnancy. It does not cover losses which happen after 20 weeks since most states define those as stillbirths. And it does not cover miscarriages that happen before 14 weeks though some of this information may be appropriate for a miscarriage before 14 weeks as well.

HOW OFTEN DOES THIS HAPPEN?

Up to 50 percent of all pregnancies may end in miscarriage; the actual numbers are unknown because many losses occur before a woman realizes she is pregnant. It is estimated that a quarter of all miscarriages are after 14 weeks. This means that there are over 600,000 reported miscarriages nation wide.

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AMERICAN ACADEMY OF PEDIATRICS. Committee on Child Abuse and Neglect

ABSTRACT. In most cases, when a healthy infant younger than 1 year dies suddenly and unexpectedly, the cause is sudden infant death syndrome (SIDS). SIDS is more common than infanticide. Parents of SIDS victims typically are anxious to provide unlimited information to professionals involved in death investigation or research. They also want and deserve to be approached in a nonaccusatory manner. This statement provides professionals with information and guidelines to avoid distressing or stigmatizing families of SIDS victims while allowing accumulation of appropriate evidence in potential cases of death by infanticide.

Аpproximately 50 years ago, the medical community began a search to understand and prevent sudden infant death syndrome (SIDS). Almost simultaneously, medical professionals were awakened to the realities of child abuse.  Since then, public and professional awareness of SIDS and fatal child abuse during infancy have increased steadily. Recently, well-validated reports of child abuse and infanticide—perpetrated by suffocation and masqueraded as apparent lifethreatening events (ALTE) and/or SIDS—have appeared in the medical literature and in the lay press.  The differentiation between SIDS and fatal child abuse can be a critical diagnostic decision. Additional funding for research into the causes and prevention of SIDS and child abuse is needed.

SIDS: EPIDEMIOLOGY, PRESENTATION, AND RISK FACTORS

SIDS, also called crib or cot death, is the sudden death of an infant under 1 year of age that remains unexplained after thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history.  SIDS is the most common cause of death between 1 and 6 months of age. The incidence of SIDS peaks between 2 and 4 months of age. Approximately 90% of SIDS deaths occur before the age of 6 months.

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Produced by the Centre for Genetics Education.

Important points

• There are a number of different prenatal tests and procedures available to assess the development of the baby. Each has advantages, disadvantages and limitations

• There is no test that gives a 100% guarantee of a healthy baby. The tests give some information about the baby’s health. They do not find all potential health problems

• Counselling before a test is done, will help the woman decide which test, if any, is best for the woman and the baby

• Each prenatal test is done at a certain time during the pregnancy starting at 8-10 weeks and going through to 20 weeks and include:

– Prenatal screening tests that may identify a baby as being at an increased risk of having a particular problem. All pregnant women, regardless of their age or family health history, may choose to have one of these prenatal screening tests that include ultrasound; early pregnancy (first trimester) screening: nuchal translucency ultrasound with or without testing of the mother’s blood; second trimester screening: testing of the mother’s blood (maternal serum testing)

– Prenatal diagnostic tests that are used to see if the baby actually has a particular problem. Even if the test result is normal, however, the baby could still have some other problem. Prenatal diagnostic tests include ultrasound; chorionic villus sampling (CVS); amniocentesis; cordocentesis

– Preimplantation genetic diagnosis (PGD) is used to test the embryo created via in vitro fertilisation (IVF) therapy prior  to implantation

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Genital herpes is one of the most common sexually transmitted infections in the Canada. About 20-60% of sexually active men & women have the virus. Significant portions of those who are infected or vulnerable to infection are women of childbearing age with 2% to 4% acquiring the infection during pregnancy. Newborns acquire herpes through the birth process. There is a low risk of infection for babies born to mothers with recurrent HSV-2 infection, while there is a higher risk if the mother experiences primary infection during pregnancy, especially during the third trimester. Babies born to mothers with primary herpes infections are at up to 40-50% risk of infection even if the mother has no symptoms. Among newborns, HSV infection can be truly dangerous and can result in high morbidity and mortality. Infections are classified as skin/eye/mouth (SEM), central nervous system (CNS), or disseminated disease, according to the extent of the disease at presentation. A complicating factor in managing genital herpes in pregnant women (and their partners) to prevent transmission to their newborns is the often-invisible nature of the disease. New findings have shown that asymptomatic and unrecognized infections are much more common than clinical disease and initial infections are often without symptoms.

Knowledge and guidelines regarding the optimum management of infected pregnant women is continuing to evolve. Preventive strategies include cesarean delivery if active lesions or prodromal symptoms are present at term, serologic screening of pregnant women, and prophylactic antiviral therapy (for the woman and her partner) starting at 36 weeks.

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You have type 1 or type 2 diabetes and you are pregnant or hoping to get pregnant soon. You can learn what to do to have a healthy baby. You can also learn how to take care of yourself and your diabetes before, during, and after your pregnancy.

Pregnancy and new motherhood are times of great excitement, worry, and change for any woman. If you have diabetes and are pregnant, your pregnancy is automatically considered a high-risk pregnancy. Women carrying twins—or more—or who are beyond a certain age are also considered to have high-risk pregnancies. High risk doesn’t mean you’ll have problems. Instead, high risk means you need to pay special attention to your health and you may need to see specialized doctors. Millions of high-risk pregnancies produce perfectly healthy babies without the mom’s health being affected. Special care and attention are the keys.

Taking Care of Your Baby and Yourself

Keeping your blood glucose as close to normal as possible before you get pregnant and during your pregnancy is the most important thing you can do to stay healthy and have a healthy baby. Your health care team can help you learn how to use meal planning, physical activity, and medications to reach your blood glucose goals. Together, you’ll create a plan for taking care of yourself and your diabetes.

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