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Sunday, 29 April 2012

Repeat caesarean section or vaginal birth

In a recent large study from the University of Adelaide, it was found that risks to both baby and mother were significantly lower if a mother has an elective caesarean section after a previous caesarean section compared with a vaginal birth. The risks for serious complications and death for baby was 2.4% for attempted vaginal birth and 0.9% after elective caesaean section. The risks for serious complications and death for mother was also also significant eg the risk of life threatening bleeding was 2.3% after vaginal birth and 0.8% after elective caesaean section.
This is one more study that shows that the idict, "once a caesarean section always a caeasean section" may be the wiser choice.

Obesity in pregnancy

Most women know that smoking and drinking don't go with pregnancy and automatically will reduce or stop before getting pregnant. However few know that obesity and extreme underweight carry just as much risk if not more. Obesity may not be so common in the local context but I am increasingly seeing this as our foreign population in Singapore rises. Obesity is associated with hypertension, diabetes, beta streptococcal infection, large babies, premature labour, stilbirths, higher chance of caesarean section, greater risks than normal from caesarean section complications, postnatal depression. So counselling for those over and underweight should be part of the preconception consultation

Tuesday, 10 April 2012

Premature Labour

Although uncommon, there are certain factors that can bring about premature labour (defined as labour before 37 weeks gestation). The most common being a defect in hormonal production resulting in low or subnormal progesterone levels. A congenitally short cervix ( length 10-20mm) is also a factor and recent studies have shown that vaginal progesterone given throughout the pregnancy helps to delay the onset of labour. Other factors such as multiple pregnancy, multipara, inadequate nutrition, low lying placenta, medical conditions such as asthma, diabetes all predispose to premature labour. Those who have a threatened miscarriage in the early pregnancy are also at greater risk of premature labour and a case can be made for administering progesterone throughout the pregnancy in such cases