Risks for Preterm Births May Be Higher Among Overweight Mothers

July 28, 2010 — Risks for preterm births may be higher among overweight and obese mothers, according to the results of a systematic review and meta-analyses reported in the July 20 issue of the BMJ.

Compared with normal-weight women, very obese women were at 70% greater risk for induced preterm birth before 37 weeks and at 82% greater risk for early preterm birth (before 32 or 33 weeks).

"Overweight and obese women have increased risks of preterm birth and induced preterm birth and, after accounting for publication bias, appeared to have increased risks of preterm birth overall," the study authors write. "The beneficial effects of maternal overweight and obesity on low birth weight were greater in developing countries and disappeared after accounting for publication bias."

"Future research is needed to try to determine why overweight and obese women are at risk of preterm birth, and to determine effective methods of weight loss in women of childbearing age before pregnancy," the study authors conclude. " ...Clinicians need to be aware that overweight or obesity in women is not protective against having infants of low birth weight and should consider surveillance when indicated. Ideally, overweight or obese women should have prepregnancy counselling so that they are informed of their perinatal risks and can try to optimise their weight before pregnancy."

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Personal advices :

1) Achieve an ideal body weight before pregnant. The ideal body weight should be between BMI 20 to 24.

2) Control your weight gain during pregnancy. The ideal weight gain during pregnancy is between 10kg to 15kg.

Some Caffeine Is Okay During Pregnancy

By Genevra Pittman

NEW YORK (Reuters Health) Jul 21 - A cup of coffee a day during pregnancy probably won't increase a woman's risk of miscarriage or premature birth, The American College of Obstetricians and Gynecologists said today.

Until recently, studies have had conflicting findings about the effect of moderate caffeine consumption on pregnancy complications.

But, "I think it's time to comfortably say that it's okay to have a cup of coffee during pregnancy," Dr. William Barth, the chair of a College committee which reviewed the evidence, told Reuters Health.

In a statement published online today in Obstetrics & Gynecology, the College's Committee on Obstetric Practice said that 200 mg of caffeine a day, about the amount in a 12-ounce cup of coffee, doesn't significantly contribute to miscarriages or premature births. That definition of "moderate caffeine consumption" would also include drinking about four 8-ounce cups of tea or more than five 12-ounce cans of soda a day, or eating six or seven dark chocolate bars.

The committee said the evidence was not clear on whether consuming more than 200 mg of caffeine a day might increase pregnancy risks.

Anti Tetanus Injection

Dear Dr,

I am currently pregnancy at 7 months. I followed up my pregnancy in the government clinic and also in the private hospital. This week, the nurse in government clinic gave me an injection for Anti Tetanus and another injection will be given next month.

But my gynae doctor in the private hospital said the injection is not necessary. May I know what is the purpose for the injection?

C.L

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Hi, CL,

Tetanus (破伤风) is an infection of the wound, particularly the dirty wound. For example if your hand is cut by a sharp object, the doctor usually will clean the wound with antiseptic and then routinely they will give you an anti tetanus injection.

After delivery, you will have an episiotomy wound in your private part. The purpose of this injection is to reduce the possibility of the tetanus infection in your episiotomy wound.

About 50 years ago, there were not many hospitals available in the country. Many pregnant mothers had to deliver their baby at home by using the traditional midwifes service. These midwife carried a bag of scissors and knife to the house and conduct the delivery in a not cleaned and hygienic environment. Some of the scissors may contain bacterias because they were not cleaned and aseptic.

After delivery, many mothers developed wound infection in the episiotomy part and some of them complicated by serious tetanus infection.

As a result, all the pregnant ladies during that time need to receive anti Tetanus injection before the delivery to prevent wound infection.

However, this injection is not compulsory any more nowaday if you decide to deliver your baby in the hospital setting. The instruments in the hospital are properly cleaned and aseptic. Some of the instruments like needle, blade and suture are disposable. They are used once only before throwing away. So the risk of wound infection is very low.

This anti tetanus injection may cause fever, muscle pain and allergic reaction. For these reasons most of the private gynaecologist have stopped giving this injection.

However, the government clinic still continue to give the injection until today to every pregnant mothers, because some of them still prefer to deliver at home by the traditional midwifes, especially those stay in the rural kampung, Sabah, Sarawak and the Orang Asli.

So, CL, I agree with your gynae doctor that this injection is not important as far as you deliver your baby in the hospital setting.

Some news to share.

龙凤胎早夭　伤心外婆申诉：护士叫我

女儿自己生

二零一零年七月七日 下午五时四十三分

(槟城7日讯)一名伤心外婆带着失去龙凤双胞胎的女儿向郭庭恺申诉，声称其女儿在槟城医院早产时，护士只顾着聊天，把她女儿留在产房独自待产，还告诉她“是这样的，给她自己生啦！”

这名伤心外婆是55岁的黄秀菁，她周三早上带着刚失去一对5个月大龙凤胎的女儿沈咪咪（34岁）到玻璃池滑区州议员郭庭恺服务中心，在郭庭恺陪同下向媒体申诉其女儿的不幸遭遇，并对医护人员当时的态度不满。

沈咪咪表示，当她怀孕4个多月时，发现自己来红，并于上个月2日前往私人医院做检查。经过检查后，医生告诉她说其下体宽度太大，必须马上进行缝针手术，而手术后必须留院一段时间接受观察。

为了胎儿安全，她答应进行手术，并在私人医院住一周。由于私人医院医药费昂贵，她于上月9日向院方申请转至槟城中央医院。当天下午，她和母亲拿着医生的转院通知书，到中央医院柜台准备办理手续，才被告知必须到中央医院对面的妇产科医院做检查。

医护人员态度不友善

她和母亲不熟悉中央医院运作，想要问清楚时却遭一名医护人员无礼对待，以不友善口气告诉她说说，“因为怀孕不足5个月，她必须直接到妇产医院接受检查。”

当她和母亲到妇产医院办理入院手续后，当值护士表示要为她抽血检查，但她当时体质衰弱，被护士抽了2次血后即晕倒和出现抽搐情况。她休息一阵后，该名护士表示，之前被抽的血量不够，又向她抽2次血。

羊胎水破 当时怀胎5个月

在住院期间，她于19日发现来红和肚子痛，于是告诉病房当值医生，该名医生向主管医生请示后，向她表示她的睡姿错误，给她调整正确姿势。至于她肚子痛，医生说可能是尿道发炎。直到6月20日凌晨2时许，她突然羊胎水破，当值护士前后找来2个医生为她检查。不过，医生告诉她胎儿只有5个月大，即使出世后也会夭折，因此叫她要有心理准备。

女儿一人在产房

之后，医生帮她打了一支针后，便由护士推她到产房，留下她一人在产房里待产。当时，她知道一对儿女将会夭折而非常伤心，在产房内只有她一人，她觉得非常害怕，于是拨电通知母亲。黄秀菁接获女儿电话后，在凌晨4时许和丈夫抵达意愿，苦苦哀求后才获得院方通融让她进入产房陪伴女儿。当她进入产房后惊见只有女儿一人，便到病房外向正在聊天的护士查问：为什么没有医生或护士接生。岂知，一名护士告诉她说，“是这样的，给她自己生啦！”母亲听到这话后，无可奈何地在外陪着。

没人接生 独自产下2婴

沈咪咪说，当天凌晨5时50分，她独自在产房内产下第一个胎儿，36分钟后才产下第二个，这段时间内都没人跟她接生，当她生产完后，才有护士为她处理伤口，而其夭折的双胞胎儿也只是被护士马虎处理。

由于她当时流血不止，医生和护士用一把塑胶支撑钳撑开她下体，支撑钳突然断掉。当护士为她输血时，把针筒刺入她手臂后，才发现血包上的身份证号码有异，于是该名护士马上拔出针筒后，向其他护士查询。所幸，血包上的身份证号码只是书写错误，而不是拿错血包。

医生称须切除子宫保命

到中午，黄秀菁见女儿还未从产房出来，而且看到很多医生在产房内，便问一医生女儿情况。“当时医生说她下体流血未止，若情况没改善，须切除子宫保命。”

她担心女儿情况有变，致电女儿之前在私人医院主诊医生咨询，并在该医生建议下，向槟城医院申请转院回到私人医院接受治疗。她说，当时中央医院执勤医生以需要主管医生批准为理由，拒绝让其女儿转院，经过一段时间交涉后，她才成功为女儿转院。

当私人医院的医生为女儿检查后，告诉她女儿的情况良好，没有切除子宫的必要。对此，她不满当时中央医院的医生把女儿的实际情况“恶化”。黄秀菁和沈咪咪母女针对槟城医院医护人员的疏忽和恶劣态度表不满，并对政府医院服务失信心。沈咪咪透露，其8岁大儿子当时是在槟城妇产医院生产，但当时没这情况。

投诉医院无下文 郭庭恺促卫生部关注

玻璃池滑州议员郭庭恺表示会针对这起事件，修书向卫生部、卫生局、槟城医院等相关单位作出投诉。他说，他本身已接获不少关于中央医院的服务和医护人员恶劣态度的投诉，他也向院方和各相关单位作出反映，但都没下文，槟城医院总监更不曾给他任何回复。

他认为，卫生部应重视这些投诉，同时也对目前医院的体系制度进行改革和实行问责制。因为，过去有很多医院疏忽事件中，都没有人需要负责。他希望院方提升医护人员的服务态度和跟病人或家属说话的技巧。

看着婴儿衣 伤心妈妈红了眼眶

(槟岛西南区7日讯)伤心妈妈看着新生婴儿的衣服,不禁眼眶红了，她似在拼命眨眼忍住眼泪！

虽然沈咪咪还未为新生儿购买新衣服及用品，不过，他和母亲一早已收拾好长子黄俊彬（8岁）小时所穿过的衣服，准备在迎接第二个小生命时，让双胞胎穿。

有关的衣物包括了精巧可爱的鞋子、尿布等，还有一套俊彬之前从未穿过的新衣，由于婴儿衣服收藏已久，咪咪和母亲原本准备再过不久，就将有关衣服重新拿去清洗，岂料，衣服还没洗，孩子就这样没了，怎不教一家人伤心？

身子看起来还很虚弱的咪咪指出，长子的衣物和用品是在她怀胎7、8个月时才买。因此，她目前未想过这么早为新生儿添购衣物。

相关照片

■ 黄秀菁和沈咪咪母女在郭庭恺的陪同下，向媒体申诉她的悲惨遭遇。

■ 黄秀菁表示不满值班护士告诉她给女儿自己生。

■ 沈咪咪提及她一对夭折的双胞胎时数度流泪。

■ 望着这些暂时派不上场的婴儿用品，咪咪不禁悲从中来，眼眶泛红。

■ 如宝宝穿上这可爱的小鞋子，小脚丫显得更活泼可爱。

■ 这套崭新的婴儿衣物，是亲戚赠送大儿子，但从未拆开过，咪咪打算留给即将诞生的宝宝。

Placenta Previa (前置胎盘)

Hi Dr Jason,

thank you for creating a informative blog to share with all of us.

Im 16 weeks pregnant at the age of 34. this is my 2nd pregnancy after 4 years. My eldest daughter was a C-section baby due to low lying placenta.

I just wonder for this 2nd pregnancy, will I bear the same risk of this kind of complication?

thank you

best regards

Lim

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Diagram on the left : A normal placental location

Diagram on the right : Placenta previa where the cervix is fully covered by the placenta.

Hi, Lim,

Placenta previa is caused by abnormal placenta implantation into the lower part of the uterus where the cervix is completely or partially covered by the placenta tissue.

This situation is dangerous as the baby is unable to go through the birth channel due to the placenta obstruction at the cervix.

Sometimes, it may cause heavy bleeding during pregnancy and potentially risky to both the mother and baby.

The risk of recurrence of placenta previa in the subsequent pregnancy is around 20 percent.

It means you stand a high risk for this problem to happen again.

To make thing worse, a recurrent placenta previa with a previous caesarean delivery will significantly increase the risk of placenta accreta.

Placenta accreta is referred to a condition where the wall of uterus is infiltrated by the placenta tissue, particularly the wall around your surgical site in uterus.

The placenta issue may invade the uterine wall and as a result the placenta tissue is unable to separate from the uterus after delivery.

If this situation happens, it will cause heavy bleeding after delivery and sometimes the doctor need to remove the uterus in order to save life.

Your doctor should be able to determine the early placenta location after 3 months of pregnancy. If after seven months of pregnancy the location remained low lying, then the placenta previa is confirmed.

Dr Jason Ong