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Monday, 20 June 2011

Ectopic pregnancy

The incidence is low 1:700 and unless there is a history of pelvic infection causing some damage to the lining of the fallopian tubes, an ectopic pregnancy is not common. Ectopic pregnancy is a pregnancy that is outside the womb. It can be on any portion of the fallopian tube or even grow on the ovary. This abnormal location of the pregnancy means that it is not possible for the pregnancy to grow to full term and needs to be removed. The risks with an ectopic pregnancy are that as it grows in the tube, it will erode through the tube and rupture a blood vessel resulting in bleeding into the abdomen.

Thus the importance of an early check-up with the obstetrician as he will be able to diagnose an ectopic pregnancy before any serious mishap. Unfortunately an ectopic may be difficult to view on ultrasound scan but will be suspected if there is no pregnancy sac in the womb, and blood pregnancy hormone levels show a slow rise. Sometimes the sac can be seen in the tube and it will give the typical vivid appearance of surrounding blood vessels called the 'ring of fire'.

Diagnosis is by laparoscopy ( inserting a telescope through the belly button) and viewing the fallopian tubes. Treatment is either removing the pregnancy alone by cutting open the afected tube, or removing th entire tube if it is too badly damaged. The alternative is to use a cancer drug to try and dissolve the pregnancy.

Syphillis and pregnancy

Syphillis is a sexually transmitted disorder. With the rising incidence of sexually transmitted disorders especially in China, routine screening during pregnancy is important. Syphillis may have no symptoms especially in the early stages but the infection can cause sudden death of the foetus after 28 weeks. If it is not screened for and therefore missed would be a travesty as if detected, a single dose of penicillin antibiotic would avoid a stilbirth due to this sexually transmitted disorder.

Why you should sleep on your left side

A recent article  showed that sleeping on the back and right side predisposes to a higher incidence of sudden death of the foetus. Although further studies need to be done, it would be prudent to follow this rule especially if you are in your third trimestor. The incidence of stilbirth is not high and is less than 1: 10000. Very often it is attributed to a cord accident but in a large proportion no obvious cause is found. It may be that sleeping on the back and right could well be a cause. Pregnant women have always been told to sleep on the side and the reason is that there is a major vessel running parallel to the spine on the right and behind the womb. As the womb expands there will be increased pressure on this vessel. This blood vessel also supplies the foetus with oxygen and nutrition. The womb is naturally tilted to the right, thus it would make sense that sleeping on the right and back would increase the pressure on this vessel possibly reducing the oxygen to the foetus.
So always remember to sleep on the LEFT side!