Tuesday, July 14, 2009

Reply to 夏娃

夏娃 said...

I'm a 26 yr old 18weeks pregie with 20 years asthma record. Average asthma attack was 1-2 a year until my recent pregnancy caused twice emergency nabuliser due to accute attack. Under the control of ventolin inhaler and having problem of morning sickness till today,gastric,tonsilitis,sinusitis,unstoped nose bleed yet cauterization not helping,low hb 10.4 on iron supplement. Soft tissue of my last back joint is out of alignment due to car accident 3 years ago. Can I take epidural? Need your advise on whether can I undergone natural birth as my asthma wasn't so under control recently.


It is very unfortunate to know that your pregnancy is complicated by multiple underlying medical conditions.

To make the thing worse, most of the problems you listed will get worse as your pregnancy progresses. They will get better only after the delivery.

Let us write down the list of medical problems you have:

1) Childhood asthma which was worsening during your pregnancy.

2) Recurrent sinusitis, tonsilitis and rhinitis.

3) Gastritis

4) Prolonged morning sickness till 18 weeks pregnancy

5) ? spine injury due to car accident

6) Low hemoglobin ( anaemia )

7) Mental stress due to uncertainty in your chance of normal delivery.

Airway allergy:

The first and second problems are related to airway allergy. You are born with strong genetic history of allergy. I believe some of your family members have the similar problem as it is an inheritance problem.

Your asthma was worsening recently because during the pregnancy period, some of the products from your baby may circulate in your blood stream. FYI, 50% of your baby genetic products are contributed by your husband. Your body unable to accept the presence of your husband genetic products in your body and hence resulting in allergic reaction in the airway.

To make thing worse, your baby is growing in size daily. Your tummy will keep on increasing in size and compressing the lung function. A mild asthma attack after 7 months can become a serious problem due to lung compression by the baby.

If ventolin inhalation is not helpful, you can start steroid inhalation to control the attack. Generally, steroid inhalation in pregnancy is safe.

Since there is a chance that your baby may inherit the allergy problem from you, I strongly encourage you to give breast feeding for your baby. Breast milk reduces the allergic rection to your baby compared with cow milk. Alternatively, choose a hypoallergic milk formulation.

You still can go for normal delivery. The doctor can offer you some prevention measures before you enter the labour room, such as ventolin nebuliser and high flow oxygen. Caesarean section that requires general anaesthesia sometimes can cause severe asthmatic attack due to the anaesthetic gas. Therefore, Caesarean section is NOT SAFER than normal delivery in this situation.

Prolonged Morning Sickness.

Morning sickness usually will not last longer than 16 weeks ( 4 months). It is unfortunate your problem drag on for so long.

Maybe you need to check your thyroid function to exclude hyperthyroid.

Your gastritis maybe related to prolonged morning sickness due to frequent empty stomach.

Try small but frequent meals. Avoid oily diet and foods that leave behind a strong smell in your mouth.

Spine Injury

It is important to know the level of the injury. If you have fully recovered from the injury, to give epidural is not a problem. Epidural is NOT ASSOCIATED with back pain, although general public always think so......

Otherwise, you can consider other options of pain relieve during the labour, such as Entonox, Pethidine injection and breathing exercise.

Low Hemoglobin

Your hemoglobin level of 10.4 g% is not too bad. It is just borderline. Normally we accept more than 11g% as normal.

However, during pregnancy because of water retention, the blood can be diluted due to increased in water component.

As far as the level is more than 10 g%, it is considerd acceptable.

Since you are only 18 weeks pregnant, you still have plenty of time to increase the Hb level. You can take more protein diet and iron supplement.

If you are very keen for normal delivery and you fulfil the conditions for normal delivery, why not.....go ahead and try it....


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