Meticulous metabolic control of the diabetes and careful medical and obstetric management is required.
Gestational diabetes
This term refers to glucose intolerance that develops in the course of pregnancy and usually remits following delivery. The condition is typically asymptomatic. Women who have a previous history of gestational diabetes, older or overweight women, those with a history of large for gestational age babies and women from certain ethnic groups are at particular risk, but many cases occur in women who are not in any of these categories. For this reason some advocate screening of all pregnant women on the basis of random plasma glucose testing in each trimester and by oral glucose tolerance testing if the glucose concentration is, for example, 7 mmol/L or more. There is no consensus concerning the level of blood glucose which is harmful for the baby, and therefore no consensus concerning cut- off levels for screening and intervention.
Treatment is with diet in the first instance, but most patients require insulin cover during the pregnancy. Insulin does not cross the placenta. Many oral agents cross the placenta and are usually avoided because of the potential risk to the fetus.
Gestational diabetes has been associated with all the obstetric and neonatal problems described above for pre existing diabetes, except that there is no increase in the rate of congenital abnormalities. It is likely to recur in subsequent pregnancies. Gestational diabetes is often the harbinger of type 2 diabetes in later life. Not all diabetes presenting in pregnancy is gestational. True type 1 diabetes may develop, and swift diagnosis is essential to prevent the development of ketoacidosis. Hospital admission is required if the patient is symptomatic, or has ketonuria or a markedly elevated blood glucose level
Treatment of diabetes in pregnancy
The patient should perform daily home blood glucose profiles, recording blood tests before and 2 hours after meals. The renal threshold falls in pregnancy, and urine tests are therefore of little or no value. Insulin requirements rise progressively, and intensified insulin regimens are generally used. The aim is to maintain blood glucose and fructosamine (or HbA1c) levels as close to the normal
range as can be tolerated.
The patient is seen at intervals of 2 weeks or less at a clinic managed jointly by physician and obstetrician. Circum stances permitting, the aim should be outpatient management with a spontaneous vaginal delivery at term.
Retinopathy and nephropathy may deteriorate during pregnancy. Expert fundoscopy and urine testing for protein should be undertaken at booking, at 28 weeks and before delivery.
Obstetric problems associated with diabetes
Poorly controlled diabetes is associated with stillbirth, mechanical problems in the birth canal owing to fetal macrosomia (large baby), hydramnios (Excess water) and pre-eclampsia. Ketoacidosis in pregnancy carries a 50% fetal mortality, but maternal hypoglycaemia is relatively well tolerated.
Neonatal problems (Problems of new born) associated with diabetes
Maternal diabetes, especially when poorly controlled, is associated with fetal macrosomia. The infant of a diabetic mother is more susceptible to hyaline membrane disease (Respiratory distress following delivery) than non-diabetic infants of similar maturity. In addition, neonatal hypoglycaemia (Low blood sugar) may occur. The mechanism is as follows: maternal glucose crosses the placenta, but insulin does not; the fetal islets hyper secrete insulin to combat maternal hyperglycaemia, and a rebound to hypoglycaemic levels occurs when the umbilical cord is severed. These complications are due to hyperglycaemia in the third trimester. Poor glycaemic control around the time of conception carries an increased risk of major congenital malformations. When a pregnancy is planned, optimal metabolic control should be sought before conception.
Showing posts with label Pregnancy. Show all posts
Showing posts with label Pregnancy. Show all posts
Sunday, March 29, 2009
Thursday, March 19, 2009
To Do's for the Infertile Couples
In some couples, infertility may be the result of a complex medical problem. In others, it may be due to something easily correctable. These suggestions can help you create the best possible conditions for conception:
Both women and men should avoid getting sexually transmitted diseases, a cause of infertility. If either partner has symptoms of an STD, avoid having sex and see a doctor. Early treatment is important to prevent STDs from damaging the reproductive system.
You are most likely to conceive around 14 days before your next menstrual period is due to begin. If you have a 28-day cycle, this would be days 13-15 of your menstrual cycle (with day 1 being the first day of the last menstrual period). Mark the dates when pregnancy is most likely on a calendar and make time for sex without stress. There is no need for your partner to save up sperm by delaying intercourse before these times. Just try to have intercourse during the middle of your cycle.
Because sperm need to be kept cool, your partner should avoid tight clothing or underwear, long, hot baths; and especially soaks in hot tubs, whirlpools, or saunas.
During intercourse, all positions can produce pregnancy. After ejaculation, stay in bed for at least a half hour. Don't use any jellies, douches or creams because they can inhibit sperm. Some lubricants affect sperm as well.
Both you and your partner should avoid the use of any illicit (street) drugs. Some affect fertility, and others harm the fetus if conception occurs.
Stop smoking and limit your alcohol consumption, since these things may interfere with ovulation and sperm production. Some experts even suggest limiting caffeinated beverages, but less is known about the effects of caffeine.
Maintain a normal weight. Women who are either very overweight or underweight may have problems becoming pregnant.
Avoid exercising excessively, as too much exercise can interfere with ovulation.
Infertility may not be permanent. Many couples simply have reduced fertility and take longer to get pregnant.
First thing to do if failed to get pregnant:
If pregnancy has not occurred after a year of intercourse without birth control, you may wish to consult a doctor. Because fertility naturally declines with age, couples in their late thirties or forties may not want to wait this long to seek help.
Some couples are able to conceive almost immediately during the two to three months that it takes for the initial medical workup. Others need several months of diagnostic testing and treatment. About 30-40 percent of couples treated for infertility are able to conceive eventually.
Today, even the most difficult cases often can be treated successfully because of medical advances in the study and treatment of infertility during in the last 30 years. Your likelihood of getting pregnant depends on several factors: how long you've been trying to conceive, how old you are, and the exact cause of your infertility.
A variety of physicians may be able to help you find the cause of your infertility and treat it. Start with your obstetrician-gynecologist, who will perform the initial series of tests and further procedures if needed. Although men sometimes seek the assistance of urologists, some gynecologists can help them, too, as a part of treating the couple.
Some gynecologists have special interests or training in fertility issues and can coordinate most of the needed care themselves. Some have extra training in reproductive endocrinology, the study of how hormones affect fertility.
Both women and men should avoid getting sexually transmitted diseases, a cause of infertility. If either partner has symptoms of an STD, avoid having sex and see a doctor. Early treatment is important to prevent STDs from damaging the reproductive system.
You are most likely to conceive around 14 days before your next menstrual period is due to begin. If you have a 28-day cycle, this would be days 13-15 of your menstrual cycle (with day 1 being the first day of the last menstrual period). Mark the dates when pregnancy is most likely on a calendar and make time for sex without stress. There is no need for your partner to save up sperm by delaying intercourse before these times. Just try to have intercourse during the middle of your cycle.
Because sperm need to be kept cool, your partner should avoid tight clothing or underwear, long, hot baths; and especially soaks in hot tubs, whirlpools, or saunas.
During intercourse, all positions can produce pregnancy. After ejaculation, stay in bed for at least a half hour. Don't use any jellies, douches or creams because they can inhibit sperm. Some lubricants affect sperm as well.
Both you and your partner should avoid the use of any illicit (street) drugs. Some affect fertility, and others harm the fetus if conception occurs.
Stop smoking and limit your alcohol consumption, since these things may interfere with ovulation and sperm production. Some experts even suggest limiting caffeinated beverages, but less is known about the effects of caffeine.
Maintain a normal weight. Women who are either very overweight or underweight may have problems becoming pregnant.
Avoid exercising excessively, as too much exercise can interfere with ovulation.
Infertility may not be permanent. Many couples simply have reduced fertility and take longer to get pregnant.
First thing to do if failed to get pregnant:
If pregnancy has not occurred after a year of intercourse without birth control, you may wish to consult a doctor. Because fertility naturally declines with age, couples in their late thirties or forties may not want to wait this long to seek help.
Some couples are able to conceive almost immediately during the two to three months that it takes for the initial medical workup. Others need several months of diagnostic testing and treatment. About 30-40 percent of couples treated for infertility are able to conceive eventually.
Today, even the most difficult cases often can be treated successfully because of medical advances in the study and treatment of infertility during in the last 30 years. Your likelihood of getting pregnant depends on several factors: how long you've been trying to conceive, how old you are, and the exact cause of your infertility.
A variety of physicians may be able to help you find the cause of your infertility and treat it. Start with your obstetrician-gynecologist, who will perform the initial series of tests and further procedures if needed. Although men sometimes seek the assistance of urologists, some gynecologists can help them, too, as a part of treating the couple.
Some gynecologists have special interests or training in fertility issues and can coordinate most of the needed care themselves. Some have extra training in reproductive endocrinology, the study of how hormones affect fertility.
Wednesday, March 18, 2009
Female factors as a cause of infertility
Ovulation Factors as a Cause of Infertility
As women age, their ovaries and the immature eggs contained therein age as well. Unlike men who produce new sperm on a regular basis, women are born with all the eggs they'll ever have. Their eggs may become damaged from years of exposure to hazards such as chemicals or radiation.
Too little estrogen also can cause infertility. As a woman ages and nears menopause, the amount of estrogen produced drops gradually. With less estrogen, the ovaries may not produce an egg each month. The result is fewer babies as a woman ages. Another cause for low estrogen levels is too little body fat. Women who exercise too much or diet excessively— sometimes due to eating disorders—may not produce enough estrogen for ovulation to occur.
Other women with ovulatory problems have sufficient supplies of estrogen but lack other hormones, such as FSH, LH, and prolactin, that affect other aspects of the cycle.
Certain kinds of birth control continue to reduce ovulation even after they are no longer used. For example, some women who take birth control pills find that it takes them a few months to begin ovulat¬ing again once they've stopped taking the pill. After 2-3 years off the pill, however, their rates of ovulation are the same as for other women who use barrier contraception. Contraceptive implants that contain hormones offer a rapid return of fertility. On the other hand, contraceptive injections of hormones may sub¬stantially delay the return of fertility. It can take anywhere from 4 to more than 30 months for fertility to return.
Tubal and Peritoneal Factors as a cause of Infertility
Conditions affecting the fallopian tubes or the peritoneum sometimes cause infertility. The peritoneum is a strong sac that lines the inside of the abdomen. It forms a sort of bag that contains the digestive organs and runs alongside the fallopian tubes.
Scarring or blockage in the tubes may cause infertility. One of the most common causes of damaged tubes is infections. When STDs are untreated, they can worsen and move up the uterus into the tubes. This is pelvic inflammatory disease, a major cause of blocked tubes. Use of an intrauterine device increases the risk of infection, especially in young women with several sexual partners. Some researchers say that smoking cigarettes changes the lining of the fallopian tubes, inflaming them and making them less hospitable to conception.
When tubes are damaged, an ectopic pregnancy is more likely if conception occurs. In an ectopic pregnancy, the egg is fertilized as in a normal pregnancy but it does not implant in the uterus. Instead, often because the fallopian tubes are damaged, it implants in the tube or somewhere in the peritoneum and begins to grow there. Because it can burst the tube, ectopic pregnancy can be life threatening. If you have a history of pelvic infections, your chances of ectopic pregnancy are four times greater than normal.
Other problems include adhesions, in which nearby organs or tissues bind themselves together. An adhesion that causes another organ to pull on a fallopian tube may move the tube away from the ovary. This prevents the tube from catching the egg when it is released. Adhesions may be caused by infection, previous surgery on the pelvic organs, or endometriosis.
The role of endometriosis in infertility is the subject of great debate among doctors. In endometriosis, tissue like that lining the uterus moves to other places in the abdomen where it begins growing in response to hormones, just as the endometrium does. Such growth can cause pain and inflammation. Up to one-third of infertile women are found to have endometriosis. We do not know if this is just a coincidence or if the endometriosis helps cause the infertility. Severe or extensive endometriosis can cause adhesions. Severe disease is definitely thought to be linked to infertility.
Cervical and Uterine Factors as a cause of Infertility
The cervix is the narrow neck that forms the opening of the uterus to the vagina. It produces mucus that either helps or hinders the movement of sperm depending on where a woman is in her menstrual cycle. As a woman nears ovulation, mucus thins and becomes slippery and stretchy to help move the sperm through the cervix. The mucus looks much like raw egg white. If the mucus is thick or scanty instead, it is much more difficult for the sperm to move. High levels of nicotine have been found in the cervical mucus of women who smoke. Nicotine can be toxic to sperm.
Surgery on the cervix may also interfere with fertility. Some types of operations, such as conization (removing a wedge of tissue from the cervix), may result in scarring or little to no mucus production.
Other Factors of Uterus as cause of Infertility
The uterus may be affected by infections or adhesions. An infection of the lining of the uterus, endometritis, can be caused by STDs such as gonorrhea. Tuberculosis also can cause endometritis. Overgrowth of the uterine lining, called endometrial hyperplasia, or endometrial cancer can cause infertility as well.
If a woman has had the lining of her uterus scraped by D&C, or dilation and curettage after a pregnancy or for abnormal bleeding, the lining may not grow back properly. Adhesions may form, or the lining may be thin; either condition can contribute to infertility. The condition is known as Asherman’s Syndrome.
Growths in the uterus, such as fibroids, have been studied as possible causes of infertility. Although they may play a small role, if any in infertility, a doctor may remove them if no other cause for infertility is found.
An abnormally shaped uterus, such as one with a thin wall (septum) running down its middle, also known as septate uterus, can affect a woman's ability to have a child. Affected women are born with these defects that cause miscarriage (loss of the baby before it is ready to be born) rather than inability to conceive.
Antibodies against Sperm prevent Fertilization
Some women and men produce antibodies against sperm. When the immune system malfunctions, it sees the sperm as a foreign threat and produces anti¬bodies to fight them. The antibodies affect the ability of the sperm to move freely.
Unexplained Infertility
Sometimes a reason cannot be found for a couple's infertility. Even without knowing a cause, however, certain steps can be taken to increase the chance of conceiving. Some measures a couple can take them¬selves. Each month, approximately 3 percent of cou¬ples with unexplained infertility conceive on their own.
As women age, their ovaries and the immature eggs contained therein age as well. Unlike men who produce new sperm on a regular basis, women are born with all the eggs they'll ever have. Their eggs may become damaged from years of exposure to hazards such as chemicals or radiation.
Too little estrogen also can cause infertility. As a woman ages and nears menopause, the amount of estrogen produced drops gradually. With less estrogen, the ovaries may not produce an egg each month. The result is fewer babies as a woman ages. Another cause for low estrogen levels is too little body fat. Women who exercise too much or diet excessively— sometimes due to eating disorders—may not produce enough estrogen for ovulation to occur.
Other women with ovulatory problems have sufficient supplies of estrogen but lack other hormones, such as FSH, LH, and prolactin, that affect other aspects of the cycle.
Certain kinds of birth control continue to reduce ovulation even after they are no longer used. For example, some women who take birth control pills find that it takes them a few months to begin ovulat¬ing again once they've stopped taking the pill. After 2-3 years off the pill, however, their rates of ovulation are the same as for other women who use barrier contraception. Contraceptive implants that contain hormones offer a rapid return of fertility. On the other hand, contraceptive injections of hormones may sub¬stantially delay the return of fertility. It can take anywhere from 4 to more than 30 months for fertility to return.
Tubal and Peritoneal Factors as a cause of Infertility
Conditions affecting the fallopian tubes or the peritoneum sometimes cause infertility. The peritoneum is a strong sac that lines the inside of the abdomen. It forms a sort of bag that contains the digestive organs and runs alongside the fallopian tubes.
Scarring or blockage in the tubes may cause infertility. One of the most common causes of damaged tubes is infections. When STDs are untreated, they can worsen and move up the uterus into the tubes. This is pelvic inflammatory disease, a major cause of blocked tubes. Use of an intrauterine device increases the risk of infection, especially in young women with several sexual partners. Some researchers say that smoking cigarettes changes the lining of the fallopian tubes, inflaming them and making them less hospitable to conception.
When tubes are damaged, an ectopic pregnancy is more likely if conception occurs. In an ectopic pregnancy, the egg is fertilized as in a normal pregnancy but it does not implant in the uterus. Instead, often because the fallopian tubes are damaged, it implants in the tube or somewhere in the peritoneum and begins to grow there. Because it can burst the tube, ectopic pregnancy can be life threatening. If you have a history of pelvic infections, your chances of ectopic pregnancy are four times greater than normal.
Other problems include adhesions, in which nearby organs or tissues bind themselves together. An adhesion that causes another organ to pull on a fallopian tube may move the tube away from the ovary. This prevents the tube from catching the egg when it is released. Adhesions may be caused by infection, previous surgery on the pelvic organs, or endometriosis.
The role of endometriosis in infertility is the subject of great debate among doctors. In endometriosis, tissue like that lining the uterus moves to other places in the abdomen where it begins growing in response to hormones, just as the endometrium does. Such growth can cause pain and inflammation. Up to one-third of infertile women are found to have endometriosis. We do not know if this is just a coincidence or if the endometriosis helps cause the infertility. Severe or extensive endometriosis can cause adhesions. Severe disease is definitely thought to be linked to infertility.
Cervical and Uterine Factors as a cause of Infertility
The cervix is the narrow neck that forms the opening of the uterus to the vagina. It produces mucus that either helps or hinders the movement of sperm depending on where a woman is in her menstrual cycle. As a woman nears ovulation, mucus thins and becomes slippery and stretchy to help move the sperm through the cervix. The mucus looks much like raw egg white. If the mucus is thick or scanty instead, it is much more difficult for the sperm to move. High levels of nicotine have been found in the cervical mucus of women who smoke. Nicotine can be toxic to sperm.
Surgery on the cervix may also interfere with fertility. Some types of operations, such as conization (removing a wedge of tissue from the cervix), may result in scarring or little to no mucus production.
Other Factors of Uterus as cause of Infertility
The uterus may be affected by infections or adhesions. An infection of the lining of the uterus, endometritis, can be caused by STDs such as gonorrhea. Tuberculosis also can cause endometritis. Overgrowth of the uterine lining, called endometrial hyperplasia, or endometrial cancer can cause infertility as well.
If a woman has had the lining of her uterus scraped by D&C, or dilation and curettage after a pregnancy or for abnormal bleeding, the lining may not grow back properly. Adhesions may form, or the lining may be thin; either condition can contribute to infertility. The condition is known as Asherman’s Syndrome.
Growths in the uterus, such as fibroids, have been studied as possible causes of infertility. Although they may play a small role, if any in infertility, a doctor may remove them if no other cause for infertility is found.
An abnormally shaped uterus, such as one with a thin wall (septum) running down its middle, also known as septate uterus, can affect a woman's ability to have a child. Affected women are born with these defects that cause miscarriage (loss of the baby before it is ready to be born) rather than inability to conceive.
Antibodies against Sperm prevent Fertilization
Some women and men produce antibodies against sperm. When the immune system malfunctions, it sees the sperm as a foreign threat and produces anti¬bodies to fight them. The antibodies affect the ability of the sperm to move freely.
Unexplained Infertility
Sometimes a reason cannot be found for a couple's infertility. Even without knowing a cause, however, certain steps can be taken to increase the chance of conceiving. Some measures a couple can take them¬selves. Each month, approximately 3 percent of cou¬ples with unexplained infertility conceive on their own.
What is ovulation and how one gets pregnant?
To achieve pregnancy a series of complicated events occurs, which otherwise happens so simply! It is essential to know the normal process so that we can understand the reason; when there is difficulty of getting pregnant.
Ovulation and menstruation – What actually happens?
A woman is born with a lifetime supply of immature eggs in her ovaries. Each month, one matures and is released in a process called ovulation. Ovulation is an important part of the menstrual cycle. In a typical 28-day cycle, a woman's menstrual period begins on day 1. On day 14, ovulation occurs. On day 28, if the egg has not become fertilized, the menstrual cycle begins again with another period.
For ovulation to happen, different parts of the body must all work together. The brain and the ovaries both play roles in this coordination. The ovaries are the two almond-shaped glands sitting within reach of the fallopian tubes. Ovaries produce the eggs as well as the essential sex hormones needed for menstruation and pregnancy.
Just before ovulation, the hypothalamus and pituitary glands in the brain signal the body to start producing hormones. Follicle-stimulating hormone (FSH) prompts fluid-filled chambers in the ovary called follicles to begin growing. In each follicle a single ovum starts growing. Leutinizing hormone (LH) triggers the follicle to rupture when it is matured. In each cycle one ovum is usually released. Women ovulate about 14 days before their next menstrual period would be expected—day 14 on a 28-day cycle. Ovulation occurs within about a day after the surge in LH.
Both FSH and LH play additional roles in the menstrual cycle. They instruct the ovaries to produce estrogen and progesterone, hormones that help ovulation to occur and the uterus to prepare for pregnancy. The uterus is a hollow organ, shaped like a pear and only about three inches long in a non pregnant woman. Its lining, the endometrium, is richly supplied with blood vessels. The endometrium continually renews itself, building up in response to messages sent by estrogen and progesterone.
The Luteinizing Process The menstrual cycle consists of a complex series of events that interact to stimulate ovulation, prepare the uterine lining for a pregnancy, and cause the uterine lining to be shed if pregnancy does not occur. Two glands in the brain, the hypothalamus and the pituitary, send follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to the ovary just before ovulation to stimulate the development of a follicle and its release of an egg into a fallopian tube (ovulation). Follicles are the structures inside the ovary that produce the eggs to be fertilized and that release the hormone estrogen, which stimulates the lining of the uterus to thicken in preparation for pregnancy. After releasing the egg, the empty follicle, called the corpus-luteum, begins producing progesterone. This hormone continues to stimulate the uterine lining to grow and thicken. If the egg is not fertilized, a sudden drop in estrogen and progesterone triggers the uterus to shed its lining and menstruation begins. This marks the start of the next cycle
What actually happens when ovum is fertilized?
For fertilization to occur, healthy sperm must be deposited in a woman's vagina, preferably near the cervix, just about the time of ovulation. Each sperm is about 1/ 1000 inch long; its whip like tail swims up through the cervix, into the uterus, and into the fallopian tubes. Only one sperm is allowed fertilize an egg. Though millions of sperm may start their journey towards the solitary ovum, only a few hundred stay alive during the trip and one fortunate sperm ultimately fertilize the egg.
An egg, which is released during ovulation is usually picked up by the fallopian tube. Women have two fallopian tubes, each about 4 inches long. They are located just above the ovaries and have featherlike fingers called fimbria at their terminals near the ovaries. The fimbria and inner lining of the tubes are lined with cilia, which are like millions of active tiny hairs. These hairs shift the egg from the ovary inside the tubes by suction and cilliary action. An egg is fertilizable for only about 12-72 hours after its release.
The fallopian tubes have smooth tiny musculature throughout their lengths. In the middle, they help by contracting so that the sperm and egg move closer with each other and fertilization happens. At the end nearer the uterus, they are narrow to keep eggs from being released into the uterus too soon.
When sperm are present, they gather around the egg. They discharge enzymes from their heads to help make a hole in the egg to allow penetration. Once one sperm enters the egg, a chemical reaction ensues that pre¬vents other sperm from entering.
In the first half of a woman's menstrual cycle, estrogen makes the endometrial lining begin to thicken with a nutrient rich bedding in case pregnancy should occur. Progesterone then takes over. It is produced mainly in the second half of the cycle by a temporary organ called the corpus luteum. The corpus luteum is formed in the ovary from the follicle that released its egg. Progesterone causes the lining of the uterus to thicken even more. Estrogen and progesterone both play roles in ovulation as well.
If the egg is not fertilized, it dissolves and is absorbed by the body. Then hormone levels drop and the endometrium disintegrates without the hormonal nourishment. This shedding is the monthly menstrual period. The first day of a woman's period is the point at which her hormone levels are at their lowest.
How fertilized ovum is implanted in the uterus?
Inside the fertilized egg, cells begin to divide. If all goes well, the fertilized egg then journeys from the fallopian tube to the uterus where it implants itself in the spongy lining of the uterus. There it grows and develops into an embryo (weeks 2-8), then a fetus for the rest of the pregnancy, and 9 months later, a baby.
Numerous structural and hormonal factors play a part in fertility. What may look like the simplest of human activities—conceiving a baby—can become a miraculous chain of events, especially to a couple having problems getting pregnant.
Basic criteria of a fertile couple
Seven elements are essential to fertility:
1. A woman's ovaries must produce healthy eggs that are released regularly.
2. A man's testicles must be capable of producing healthy sperm that can reach the egg and then penetrate it.
3. During intercourse, the man's semen that contains his sperm has to be deposited at or at least close to the cervix. This puts the sperm in the best position to reach the egg.
4. There has to be a clear passage through the fallopian tube from the ovary to the uterus. This passage is used by both the egg moving down and the sperm moving up. Any obstruction in the fallopian tube interrupts the process of fertilization.
5. The man's sperm have to be able to move freely through the cervix. Any physical or chemical barrier can cause problems.
6. The ovum has 12 to 72 hours of life in which it can be fertilized. The sperm have up to 5 days in which they can fertilize an egg. Timing is critical.
7. Once the egg is fertilized, it has to find a suitable site for implantation in the lining of the uterus.
Ovulation and menstruation – What actually happens?
A woman is born with a lifetime supply of immature eggs in her ovaries. Each month, one matures and is released in a process called ovulation. Ovulation is an important part of the menstrual cycle. In a typical 28-day cycle, a woman's menstrual period begins on day 1. On day 14, ovulation occurs. On day 28, if the egg has not become fertilized, the menstrual cycle begins again with another period.
For ovulation to happen, different parts of the body must all work together. The brain and the ovaries both play roles in this coordination. The ovaries are the two almond-shaped glands sitting within reach of the fallopian tubes. Ovaries produce the eggs as well as the essential sex hormones needed for menstruation and pregnancy.
Just before ovulation, the hypothalamus and pituitary glands in the brain signal the body to start producing hormones. Follicle-stimulating hormone (FSH) prompts fluid-filled chambers in the ovary called follicles to begin growing. In each follicle a single ovum starts growing. Leutinizing hormone (LH) triggers the follicle to rupture when it is matured. In each cycle one ovum is usually released. Women ovulate about 14 days before their next menstrual period would be expected—day 14 on a 28-day cycle. Ovulation occurs within about a day after the surge in LH.
Both FSH and LH play additional roles in the menstrual cycle. They instruct the ovaries to produce estrogen and progesterone, hormones that help ovulation to occur and the uterus to prepare for pregnancy. The uterus is a hollow organ, shaped like a pear and only about three inches long in a non pregnant woman. Its lining, the endometrium, is richly supplied with blood vessels. The endometrium continually renews itself, building up in response to messages sent by estrogen and progesterone.
The Luteinizing Process The menstrual cycle consists of a complex series of events that interact to stimulate ovulation, prepare the uterine lining for a pregnancy, and cause the uterine lining to be shed if pregnancy does not occur. Two glands in the brain, the hypothalamus and the pituitary, send follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to the ovary just before ovulation to stimulate the development of a follicle and its release of an egg into a fallopian tube (ovulation). Follicles are the structures inside the ovary that produce the eggs to be fertilized and that release the hormone estrogen, which stimulates the lining of the uterus to thicken in preparation for pregnancy. After releasing the egg, the empty follicle, called the corpus-luteum, begins producing progesterone. This hormone continues to stimulate the uterine lining to grow and thicken. If the egg is not fertilized, a sudden drop in estrogen and progesterone triggers the uterus to shed its lining and menstruation begins. This marks the start of the next cycle
What actually happens when ovum is fertilized?
For fertilization to occur, healthy sperm must be deposited in a woman's vagina, preferably near the cervix, just about the time of ovulation. Each sperm is about 1/ 1000 inch long; its whip like tail swims up through the cervix, into the uterus, and into the fallopian tubes. Only one sperm is allowed fertilize an egg. Though millions of sperm may start their journey towards the solitary ovum, only a few hundred stay alive during the trip and one fortunate sperm ultimately fertilize the egg.
An egg, which is released during ovulation is usually picked up by the fallopian tube. Women have two fallopian tubes, each about 4 inches long. They are located just above the ovaries and have featherlike fingers called fimbria at their terminals near the ovaries. The fimbria and inner lining of the tubes are lined with cilia, which are like millions of active tiny hairs. These hairs shift the egg from the ovary inside the tubes by suction and cilliary action. An egg is fertilizable for only about 12-72 hours after its release.
The fallopian tubes have smooth tiny musculature throughout their lengths. In the middle, they help by contracting so that the sperm and egg move closer with each other and fertilization happens. At the end nearer the uterus, they are narrow to keep eggs from being released into the uterus too soon.
When sperm are present, they gather around the egg. They discharge enzymes from their heads to help make a hole in the egg to allow penetration. Once one sperm enters the egg, a chemical reaction ensues that pre¬vents other sperm from entering.
In the first half of a woman's menstrual cycle, estrogen makes the endometrial lining begin to thicken with a nutrient rich bedding in case pregnancy should occur. Progesterone then takes over. It is produced mainly in the second half of the cycle by a temporary organ called the corpus luteum. The corpus luteum is formed in the ovary from the follicle that released its egg. Progesterone causes the lining of the uterus to thicken even more. Estrogen and progesterone both play roles in ovulation as well.
If the egg is not fertilized, it dissolves and is absorbed by the body. Then hormone levels drop and the endometrium disintegrates without the hormonal nourishment. This shedding is the monthly menstrual period. The first day of a woman's period is the point at which her hormone levels are at their lowest.
How fertilized ovum is implanted in the uterus?
Inside the fertilized egg, cells begin to divide. If all goes well, the fertilized egg then journeys from the fallopian tube to the uterus where it implants itself in the spongy lining of the uterus. There it grows and develops into an embryo (weeks 2-8), then a fetus for the rest of the pregnancy, and 9 months later, a baby.
Numerous structural and hormonal factors play a part in fertility. What may look like the simplest of human activities—conceiving a baby—can become a miraculous chain of events, especially to a couple having problems getting pregnant.
Basic criteria of a fertile couple
Seven elements are essential to fertility:
1. A woman's ovaries must produce healthy eggs that are released regularly.
2. A man's testicles must be capable of producing healthy sperm that can reach the egg and then penetrate it.
3. During intercourse, the man's semen that contains his sperm has to be deposited at or at least close to the cervix. This puts the sperm in the best position to reach the egg.
4. There has to be a clear passage through the fallopian tube from the ovary to the uterus. This passage is used by both the egg moving down and the sperm moving up. Any obstruction in the fallopian tube interrupts the process of fertilization.
5. The man's sperm have to be able to move freely through the cervix. Any physical or chemical barrier can cause problems.
6. The ovum has 12 to 72 hours of life in which it can be fertilized. The sperm have up to 5 days in which they can fertilize an egg. Timing is critical.
7. Once the egg is fertilized, it has to find a suitable site for implantation in the lining of the uterus.
Wednesday, March 11, 2009
Vomiting in pregnancy - Morning sickness
Vomiting of Pregnancy , Morning Sickness & Hyperemesis Gravidarum (Pernicious Vomiting of Pregnancy)
Featured with nausea and vomiting either Morning or evening in pregnant women. Relentless vomiting severe enough to produce loss of weight, dehydration, starvation ketosis, hypochloremic alkalosis, and hypokalemia. Liver enzymes may be raised transiently. Seems to be associated with high or rising serum hCG ( Human chorionic gonadotrophin). More frequent and severe with multiple gestation (twins) or hydatidiform mole.
Nausea and vomiting start just following the first missed period and stop by the fifth month of pregnancy. Up to 75% of women complain of nausea and vomiting during their early part of pregnancy, and most of them complain nausea all through the day. This does not have any deleterious effects on the pregnancy and does not foretell or lead to any other complications.
Persistent, severe vomiting during pregnancy is a condition is known as hyperemesis gravidarum. This is really a disabling situation and requires hospitalization. Sometimes thyroid dysfunction is associated with hyperemesis gravidarum. Thyroid hormone profile should be done in such cases.
Treatment of morning sickness of pregnancy:
Reassurance and dietary recommendation solve the problem in the majority of women.Because of potential risk of teratogenicity, medications during the first half of pregnancy should be limited to those of vital importance to life and health. Antiemetics, antihistamines, and antispasmodics are in general needless and not useful much for nausea of pregnancy. Vitamin B6 (pyridoxine), 50–100 mg/day orally, is harmless and usually helpful in some patients.
Treatment of Hyperemesis Gravidarum
Hospitalization in a private room with nil or very restricted visitors solve the problem in many patients. If this fail to improve the situation, then nothing is given by mouth for 48 hours, and hydration and electrolyte balance is maintained by giving appropriate IV fluids and vitamin supplements as required. Hardly ever, total parenteral nutrition (TPN) may become needed. As soon as possible, she is shifted to a dry diet consisting of six small feedings daily plus clear liquids one hour after eating the solid food. Prochlorperazine rectal suppositories may be necessary sometimes.
Featured with nausea and vomiting either Morning or evening in pregnant women. Relentless vomiting severe enough to produce loss of weight, dehydration, starvation ketosis, hypochloremic alkalosis, and hypokalemia. Liver enzymes may be raised transiently. Seems to be associated with high or rising serum hCG ( Human chorionic gonadotrophin). More frequent and severe with multiple gestation (twins) or hydatidiform mole.
Nausea and vomiting start just following the first missed period and stop by the fifth month of pregnancy. Up to 75% of women complain of nausea and vomiting during their early part of pregnancy, and most of them complain nausea all through the day. This does not have any deleterious effects on the pregnancy and does not foretell or lead to any other complications.
Persistent, severe vomiting during pregnancy is a condition is known as hyperemesis gravidarum. This is really a disabling situation and requires hospitalization. Sometimes thyroid dysfunction is associated with hyperemesis gravidarum. Thyroid hormone profile should be done in such cases.
Treatment of morning sickness of pregnancy:
Reassurance and dietary recommendation solve the problem in the majority of women.Because of potential risk of teratogenicity, medications during the first half of pregnancy should be limited to those of vital importance to life and health. Antiemetics, antihistamines, and antispasmodics are in general needless and not useful much for nausea of pregnancy. Vitamin B6 (pyridoxine), 50–100 mg/day orally, is harmless and usually helpful in some patients.
Treatment of Hyperemesis Gravidarum
Hospitalization in a private room with nil or very restricted visitors solve the problem in many patients. If this fail to improve the situation, then nothing is given by mouth for 48 hours, and hydration and electrolyte balance is maintained by giving appropriate IV fluids and vitamin supplements as required. Hardly ever, total parenteral nutrition (TPN) may become needed. As soon as possible, she is shifted to a dry diet consisting of six small feedings daily plus clear liquids one hour after eating the solid food. Prochlorperazine rectal suppositories may be necessary sometimes.
Tuesday, March 10, 2009
Medications during pregnancy (Teratogenic drugs)
The safety of about one 50% of the medications used for the mother and embryo or fetus still remains unidentified. Most pregnant women (40%–90%) are exposed to either by prescription or, over the counter medications during pregnancy. These drugs include a assortment of chemicals, such as vitamins, minerals, antibiotics, laxatives, antiemetics, sedatives, antacids, diuretics, and antihistamines. Medications are very frequently consumed without a physician's prescriptions or, before pregnancy is diagnosed. In a small numbers of pregnant women, drugs are necessary to treat serious or life-threatening medical conditions, making it necessary to chalk out a clinical plan to treat the chronic disease and the acute physiology of pregnancy. Pharmacokinetics are drastically affected by pregnancy-associated physiologic changes (e.g., renal clearance, metabolism, blood volume, cardiac output), and dose regulations are frequently required to optimize the clinical results.
An unborn child may be harmed by drugs either through either teratogenic or fetal effects, depending on the timing of consumption. Teratogenic effects are conventionally considered to happen during the time of organogenesis (embryonic period), with susceptibility encompassing the second through eighth weeks after conception by embryonic age. Embryonic age is measured from the day of conception. Menstrual age is about 2 weeks more than embryonic age because menstrual age is calculated from the first day of the last menstrual period. A teratogen may result in a malformation in the unborn child when given during the period of organogenesis (embryonal period). The fetal period is counted from 9 weeks after conception to delivery. Fetal effects are changes in the structure or function of organ systems that are normally developed during organogenesis or organ systems that form at the time of the fetal period.
Medications those are known to cause harm to the unborn baby
High-dose vitamin A
Isotretinoin
Etretinate
Acitretin
Hormones
Androgens
Diethylstilbestrol
Danazol
Anticoagulants
Warfarin
Other coumarin anticoagulants
Antineoplastics
Aminopterin and methylaminopterin
Methotrexate
Busulfan
Cyclophosphamide
Anticonvulsants
Phenytoin and other hydantoins
Trimethadione and paramethadione
Valproic acid
Carbamazepine
Phenobarbital
Primidone
Trimethadione and paramethadione
Antibiotics
Fluconazole
Tetracycline
Other drugs
Angiotensin-converting enzyme inhibitors
Amiodarone
Aminopterin
Cocaine
Danazol
Lithium
Methimazole
Misoprostol
Methotrexate
Penicillamine
Quinine
Radioiodine
Thalidomide
Trimethoprim
An unborn child may be harmed by drugs either through either teratogenic or fetal effects, depending on the timing of consumption. Teratogenic effects are conventionally considered to happen during the time of organogenesis (embryonic period), with susceptibility encompassing the second through eighth weeks after conception by embryonic age. Embryonic age is measured from the day of conception. Menstrual age is about 2 weeks more than embryonic age because menstrual age is calculated from the first day of the last menstrual period. A teratogen may result in a malformation in the unborn child when given during the period of organogenesis (embryonal period). The fetal period is counted from 9 weeks after conception to delivery. Fetal effects are changes in the structure or function of organ systems that are normally developed during organogenesis or organ systems that form at the time of the fetal period.
Medications those are known to cause harm to the unborn baby
High-dose vitamin A
Isotretinoin
Etretinate
Acitretin
Hormones
Androgens
Diethylstilbestrol
Danazol
Anticoagulants
Warfarin
Other coumarin anticoagulants
Antineoplastics
Aminopterin and methylaminopterin
Methotrexate
Busulfan
Cyclophosphamide
Anticonvulsants
Phenytoin and other hydantoins
Trimethadione and paramethadione
Valproic acid
Carbamazepine
Phenobarbital
Primidone
Trimethadione and paramethadione
Antibiotics
Fluconazole
Tetracycline
Other drugs
Angiotensin-converting enzyme inhibitors
Amiodarone
Aminopterin
Cocaine
Danazol
Lithium
Methimazole
Misoprostol
Methotrexate
Penicillamine
Quinine
Radioiodine
Thalidomide
Trimethoprim
Saturday, December 13, 2008
Methods Of Contraception: Prevent Unwanted Pregnancies
There are many methods available to prevent unwanted pregnancy. Availability of so many methods means, till date there are no ideal contraceptive available! An ideal contraceptive should be 100% effective with no health hazards or side effects, completely reversible and should not hamper the sexual pleasure of the partners. Unfortunately none meet all the criteria so far.
However one should know the available methods, and use which is most suitable for him / her.
Broadly contraceptives can be divided into the following categories:
- Temporary Methods
- Non hormonal:
- Non hormonal:
- Safe period
- Withdrawal method ( Coitus interruptus)
- Condom
- Vaginal spermicide
- Female condoms and caps
- IUCD (Intra Uterine Contraceptive Device)
- Hormonal:
- Cyclical oestrogen progesterone combined oral contraceptive pill
- Progesterone only pills
- Hormonal implants
- Injectable hormonal contraceptives
- Hormonal subdermal implants
- Emergency Contraception
- Permanent Methods
- Vasectomy
- Tubectomy (Laparoscopic or Mini laparaotomy)
My following articles will describe in details the popular methods among the listed ones. Feel free to contact me in case of any doubt or question through comments or mail drbndhar@gmail.com
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