A hydrosalpinx is a blocked, dilated, fluid-filled fallopian tube usually caused by a previous tubal infection, for example sexually transmitted diseases such as chlamydia trachomatis and gonorrhea. The build-up of fluid is usually at the end of the tube nearest the ovary. Diagnosis of hydrosalpinx is usually made by a hysterosalpingogram (HSG), an x-ray procedure in which contrast dye is injected through the cervix into the uterine cavity to demonstrate the shape of the uterus and the patency (degree of openness) of the fallopian tubes. If the tubes are open, the liquid will spill out the ends of the tubes (Figure A). If the tubes are blocked, the liquid is trapped. Hydrosalpinx may also be diagnosed by laparoscopy, which is the insertion of a thin, telescope-like instrument called a laparoscope into the abdomen through an incision to visually inspect the tubes. They may also be visualized by ultrasound. Many patients with a hydrosalpinx have chronic or recurrent pelvic pain, while others are asymptomatic. Patients with a hydrosalpinx may experience repeated acute tubal infections, which cause fever and pain. If the fallopian tubes are completely blocked, pregnancy will not occur without the use of Assisted Reproductive Techniques. In milder cases, fertility may be restored by opening the tubes surgically. However, if the lining of the tubes is badly damaged, in vitro fertilization (IVF), which bypasses the tubes, is the treatment of choice. IVF is a form of assisted reproduction that involves stimulating the ovaries with hormones and surgically retrieving the eggs. The eggs are then combined with sperm in a laboratory dish. If the eggs fertilize and continue to divide, the resulting embryos are then transferred to the uterus where they hopefully implant in the endometrium (uterine lining) and develop into a viable pregnancy. Although IVF is considered to be the best fertility treatment for hydrosalpinx, the presence of a hydrosalpinx appears to reduce the success rates of IVF. Fluid within the hydrosalpinx appears to reduce embryo implantation rates and increase the risk of miscarriage. For these reasons, some physicians advise removing the tube (salpingectomy) or separating it from the uterus prior to undergoing IVF. article re-cited from: fertilityjourney.com

"Acupuncture can increase the chances of getting pregnant for women undergoing fertility treatment by 65%," according to The Guardian's news pages.The Times, The Daily Telegraph and BBC News covered the story and quoted Edward Ernst, a professor of complementary medicine, who cautioned that the effect might be due to a placebo effect caused by the women expecting acupuncture to work. He said that the expectation might cause them to relax which would improve pregnancy rates.The study behind this story is a systematic review which combined the results of "high quality" studies on acupuncture, rates of pregnancy and live birth in women undergoing in vitro fertilisation (IVF). Although the methods used by this study are robust, some possible biases cannot be ruled out. Studies that have negative results are less likely to be published and may therefore not have been included.When interpreting the 65% increase in pregnancy rates, it should be remembered that the differences in pregnancy rates were quite small. The results actually mean that in order to achieve one additional successful pregnancy, 10 women would need to be treated with acupuncture. The cost associated with lack of effect for the other nine women is something to be considered by individuals and health care providers.Finally, the study found that the additional benefit of acupuncture depended on how successful IVF was overall. Where pregnancy rates were high, acupuncture had little benefit.Where did the story come from? Dr Eric Manheimer, Grant Zhang, Laurence Udoff and colleagues from the University of Maryland School of Medicine, Georgetown University School of Medicine, Washington and the University of Amsterdam, Holland carried out the research.Funding was provided by the National Centre for Complimentary and Alternative Medicine of the US National Institutes of Health. The study was published in the peer-reviewed: British Medical Journal.What kind of scientific study was this? The study was a systematic review of randomised controlled trials that compared needle acupuncture given within one day of women receiving IVF with sham (fake) treatment or no treatment at all. The researchers searched for published literature in databases and conference proceedings for studies that compared acupuncture given within one day of IVF treatment versus sham acupuncture (or no treatment). They assessed the quality of 108 potentially relevant studies they found, and of these, included seven trials in their analysis.Only studies in which pregnancy had been confirmed (either by presence of gestational sac or heartbeat on ultrasound), ongoing pregnancy beyond 12 weeks gestation (confirmed through ultrasound), or a live birth, were included. The researchers also only included studies in which acupuncture needles were inserted into traditional meridian points (groups of points thought to have an effect upon a particular body part).The researchers used meta-analysis (a statistical technique) to pool the studies. They were particularly interested in the difference in rates of pregnancy between women who received acupuncture and those who did not.What were the results of the study? The seven studies that the researchers included in their analysis were all randomised controlled trials. In six of the studies, an acupuncture session was given just before the fertilised embryo was implanted back into the mother and another straight after. One trial involved acupuncture only after implantation. Two studies gave a third session during different phases of the process.The authors reported that IVF with acupuncture increased the odds of pregnancy by 65% (according to early evidence on ultrasound), increased the odds of ongoing pregnancy by 87% (according to ultrasound evidence of pregnancy at 12 weeks) and increased the odds of a live birth by 91% compared with IVF on its own.When the researchers only looked at the three studies that showed similar rates of pregnancy to women in the UK, they found that acupuncture did not increase rates of pregnancy with IVF.What interpretations did the researchers draw from these results? The researchers conclude that their results suggest that acupuncture given with embryo transfer, improves rates of pregnancy and live birth in women who are undergoing in vitro fertilisation.What does the NHS Knowledge Service make of this study? - In four of the seven studies that were included, the women knew which treatment they were receiving (while in the other three the comparison was sham acupuncture). The researchers say that the placebo effect (i.e. where believing in the effect of the treatment affects the outcome whether or not treatment is received) is unlikely to have had any effect in this study because the "outcomes are entirely objective (i.e. pregnancy and births)". However, as mentioned in some newspapers, other researchers have said that it is possible that if women expect the treatment to be helpful then they may be more relaxed and this in turn could affect pregnancy rates. - The researchers say that their findings are significant and clinically relevant, though they are "somewhat preliminary". They conclude by saying that the effectiveness of acupuncture depends on the previous rate of pregnancy in the population. They call for further research to investigate the relationship between the previous (baseline) rate of pregnancy and the effect of acupuncture. When they limited their analysis to studies that had the highest baseline rates of pregnancy, there was no significant effect of acupuncture on pregnancy success. The fact that the baseline rates of pregnancy varied across the studies is a weakness of the review. - The reviewers also say that publication bias may have affected their results, despite their best efforts to ensure this was not the case. They cannot rule out that there were small studies with negative results that have not been published and therefore not included. - The use of "odds ratios" to reflect the comparison is questionable. The authors themselves say that the odds ratio "significantly over-estimates the rate ratio" because the outcome of pregnancy is relatively frequent. A better reflection of the absolute benefit is to consider that these results mean that 10 women will need to be treated with acupuncture for there to be an extra successful pregnancy. In the other nine women, there would be no additional benefit. It is also worth noting that confirmed pregnancy rates were not very different between acupuncture and non-acupuncture groups in real terms (32% v. 27%). Presenting the results in these terms gives them a little more context.The results of this review suggest that acupuncture has a positive effect of pregnancy rates when given with IVF. An interpretation of the 65% benefit quoted by the papers must be considered in light of the fact that they represent relatively small absolute benefits considering that the rates of pregnancy in the non-acupuncture groups were high. Source: medicalnewstoday.com

Scientists claim that men who smoke, drink heavily or are exposed to pesticides while trying for a baby could harm generations of offspring.Researchers said animal studies showed abnormalities caused by environmental toxins were caused by genetic changes that were passed on through generations. Smoking, drinking alcohol and cocaine were found to cause chemical changes to semen Dr Cynthia Daniels of Rutgers University, said: "If I were a young man I would not drink heavily and I would not be smoking two packs of cigarettes per day while trying to conceive a child.""Studies have shown significant associations between male toxic exposures and increased rates of infertility, miscarriage, stillbirth and childhood health problems.""We need to open our eyes and look at the evidence. Sixty per cent of all birth defects have unknown sources. Why are we not examining such an obvious source of harm?" Dr Matthew Anway, of the University of Idaho, gave pregnant female rats daily injections of the pesticide vinclozolin during the period when the sex of embryos is determined. Male offspring had abnormalities including prostate and sperm development problems, and genetic changes that the researchers found were passed on through four generations when the males were mated with healthy females. Presenting his findings at the American Association for the Advancement of Science (ASSS) conference in Boston, he said: "In addition to the spermatogenic and prostate abnormalities, trans-generational effects on numerous disease states were observed, including tumour development and kidney disease." Dr Anway said the doses used in the experiments far exceeded the levels that humans could expect to be exposed to in the environment, but that the study was designed to demonstrate how toxins could lead to inheritable abnormalities. Dr Gladys Friedler, of the Boston University School of Medicine, said: "Both animal and epidemiological studies demonstrate that paternal exposure to a variety of potential toxins can adversely impact fetal development, produce a wide spectrum of deficits in offspring and be expressed in subsequent generations." source: medicalnewstoday.com

The aim of any IVF treatment is for the woman to become pregnant and to give birth to a healthy baby. In order to achieve greater success, some doctors implant more than one embryo into the womb of a woman during IVF. This practice often leads to multiple pregnancy and though commonly seen as desirable by parents, multiple pregnancy carries an increased risk of preterm birth, intrauterine growth restriction, and pre-eclampsia, thereby increasing maternal, perinatal and infant mortality. There is also a greater risk of long-term poor health for surviving babies, including the risk of cerebral palsy. In order to lower the multiple birth rate in IVF, the Human Fertilisation and Embryology Authority (HFEA), British Fertility Society (BFS) and Royal College of Obstetricians and Gynaecologists (RCOG) have all recommended single embryo transfer (SET). The catch of choosing SET for many parents has been that in the past, pregnancy rates have been lower per cycle (although they can increase the number of pregnancy attempts using embryo freezing). This is a particular problem if the number of cycles a woman can have is limited by funding.In a new study to be published by BJOG: An International Journal of Obstetrics and Gynaecology, scientists from the Assisted Conception Unit at Guy's and Saint Thomas' Hospital in London employed selective single blastocyst transfer during IVF. The technique they have developed resulted in an increase in the clinical pregnancy rate (CPR) and a significant fall in the multiple pregnancy rate (MPR). A blastocyst is a fertilised egg which has started to develop, ready for implantation. By waiting till the fifth day of cell division, doctors can better identify the embryos that have an improved possibility of implanting in the womb, thereby achieving higher successful pregnancy rates. The study took place between July 2004 and July 2007 and was divided into two groups. The first group (Jul 04 - Dec 05) were offered transfer of up to three embryos into the uterus, 2 - 3 days after insemination. The clinical pregnancy rate (CPR) was 27% and the multiple pregnancy rate (MPR) was 32%. In the second group (Jan 06 - Jun 07), doctors waited until day five to allow for further development of the embryos. One high quality blastocyst was transferred. The CPR per cycle for this group was 32% and the MPR was 17%.Using this transfer technique has the added benefit of producing surplus embryos which are suitable for cryopreservation, for parents who want to try for another baby at a later stage. This reduces the need for the woman to undergo ovarian stimulation again to retrieve her eggs for future use. Dr Yakoub Khalaf, who led the study, said "It is a myth that single embryo transfer lowers the success rate of pregnancy. If the right patients are selected for blastocyst transfer, success rates can be maintained and multiple pregnancy can be significantly reduced. "We believe firmly that a twin pregnancy is not an ideal outcome. People think it is two for the price of one, but the risks are real and we see the heartache time after time. I would encourage every IVF clinic to look at our results when treating their patients."Professor Philip Steer, BJOG editor-in-chief said, "Parents who are desperate to have a baby often willingly have two embryos transferred during IVF to increase their chances of pregnancy. This has resulted in the high numbers of twin births for mothers who go through IVF, with all the major increases in pregnancy and newborn problems that multiple pregnancy brings. "This new research has shown that the single embryo transfer of a good quality blastocyst during IVF treatment can not only increase a woman's chances of falling pregnant, but it also has the desired effect of decreasing the risk of a multiple birth. "The promising results of this study suggest that single embryo transfer can be the way forward for many women undergoing IVF. It is important that IVF units develop the skills to ensure that only the best blastocysts are used, and at the same time, women should be better educated about the high risks of multiple pregnancy. source : medicalnewstoday.com

By Claire We started ttc in Jan 2006. From the beginning we were unsure if we would have male factor issues, as dh had mumps orchitis when he was 16 years old, and as a result one of his testicles had been left much smaller. We saw his GP, and dh did a SA. The result was very poor/abnormal, and we had to wait for dh to be able to repeat the SA. During this time, he made lifestyle changes, and the 2nd result was much better. In June 2006, I discovered I was pg, but unfortunately started bleeding, and miscarried very shortly after. After the mc, my cycles became quite erratic. I was treated for cervical erosion at this time, and discussed my cycles/mc with my consultant. In Sept 2006, he did bloods, which showed I was not ovulating, at that time. He suggested starting clomid, to see if it would help regulate/ induce ovulation. My FSH and LH levels were fine. I started on 50 mg clomid in October 2006. Initially I had low cd 21 progesterone results, although my consultant said I was ovulating. I also had a short luteal phase of only 10-11 days at the most. I did 2 cycles at 50mg, 2 at 100mg, and one cycle at 150mg. Each time, my progesterone results were getting better. I began my 5th cycle of 150mg on 31st Jan 2007, and got my BFP on 28th Feb 2007! After a very straightforward pg, H was born at 36+5 weeks, on 15/10/07, weighing 6lb 2oz's We know our journey was much shorter and straightforward then many, and how lucky we are, but our journey took us through many emotions, with the worry over dh's SA, the mc, and taking clomid. Taking clomid did take its toll, and I thought it would work 1st time, and was very upset, and became increasingly so, with each cycle that it didn't work, so I hope this may bring hope to women who are going through having to take several courses of clomid.

20 weeks gestation 17 weeks gestation Your baby is anywhere from 4.4 to 4.8 inches by pregnancy week 17 and weighs almost 3 ½ ounces. He or she would fit nicely into the palm of your hand if you were able to hold them. At this stage, the baby should be able to start hearing things and should start to put on tiny layers of fat from this week on. Some women may notice the baby moving between 17 and 20 weeks, as it will become increasingly active. Between 18 and 19 weeks, the baby should measure between 5-7 inches and many abnormalities can now be picked up by ultrasound. An anomoly scan (major scan for detecting any defects) is usually carried out between 18 and 22 weeks. By 19-20 weeks the baby will start to produce meconium, the baby's first bowel movement,and the womb can be felt just below the belly button. The sex can almost certanly be determined by ultrasound at this point although it depends very much on the position of the baby! At this stage, the womb is rapidly growing and a woman may feel a little off balance and lighheaded. This is quite common and a pregnant mother should may sure she eats sensibly and drinks plenty of fluids.Rest is very important too, as is light excercise like walking By pregnancy 20 weeks the baby is now practicing breathing and swallowing regularly. Your baby continues to grow and fill out, with the head becoming slightly more proportional to the rest of the body.

Nutrition in pregnancy By Alana Juman Blincoe One of the most vital instances when a balanced diet and good nutrition are needed is when a women is about to become pregnant or is pregnant. It is well noted that women who have poor diets, have a greater tendency to give birth to babies who have a low birth weight. A baby born at fulwl term weighing less than 2.5kg is likely to suffer from illnesses and may have difficulty feeding ( There is also mounting evidence suggesting a mother’s diet can also have more far reaching effects for the fetus, leading to ill heath for a child in later life. It is therefore, of great importance that women about to conceive or who have conceived are educated about the necessary dietary requirements for optimum nutrition, both for themselves and their unborn child. Foods to eat n Based on information from the World Health Organisation, the government recommends we all eat at least five portions of fruit and vegetables per day. A variety of fruit and vegetables are best and different coloured fruit should be included to provide different combinations of vitamins, fibre and minerals. n Fibre sources can be found in wholegrain bread, rice, pasta and pulses. Large amounts of fibre during pregnancy can help to prevent constipation, n Starches (complex-carbohydrates) are foods like pasta, rice, potatoes and bread. n Two to three daily servings of protein are adequate. Foods include well-cooked eggs, lean meats, chicken and fish. Two servings of fish are recommended per week, including one of oily fish. Fish to eat in moderation are sardines, herring, mackerel, salmon and trout. This is due to mercury levels. If high they can harm a developing nervous system. Tinned tuna is not an oily fish, whereas fresh tuna is. Pulses like beans and lentils are good protein providers and a good source of iron. n For calcium at least two to three portions of dairy should be eaten, such as milk, yoghurt and cheese. Low-fat dairy products provide as much calcium as full-fat ones. For those who may suffer lactose intolerance, soya or sheep alternatives can replace those derived from cow’s milk. Pregnant women are advised to avoid goat’s milk or cheese, as it is unpasteurized. Foods to avoid: n The bacterium Listeria can cause miscarriage, stillbirth and severe illness in newborns. Avoid soft mould-ripened cheeses like Brie, all blue-veined cheese and Camembert. Cheddar, cottage cheese or other processed cheeses are fine. n Avoid meat or vegetable patés. Although tinned paté can be eaten. n Uncooked or under-heated ready meals should be avoided. n Organ meat, particularly liver or liver products (like paté) shouldn’t be eaten due to high levels of the retinal (animal) form of Vitamin A. Vitamin A is essential in pregnancy, but too much in the early stages is detrimental. Vitamin A or cod liver oil supplements should be avoided, including high-dose multi vitamins. n Avoid shark, marlin and swordfish. Shellfish can be eaten if cooked and part of a hot meal. n Daily caffeine limits are 300mg. High levels can cause low birth rate and miscarriage.(Klebanoff et al, 1999; Cnattingius et al 2000) Caffeine is in tea, coffee, soft drinks and chocolate. n The FSA (Food Standards Agency) advises pregnant women avoid drinking alcohol. n To prevent food poisoning such as salmonella, campylobacter and Escherichia coli 0157, always wash hands after handling raw meat. Only eat meat if thoroughly cooked; take specific care with minced meat and sausages. Store raw food separately from ready-to-eat foods; avoid raw shellfish, oysters and some sushi dishes. Don’t eat raw eggs or food containing raw or partially cooked eggs. n Biscuits and cakes should be cut down because of their high fat and sugar content British Journal of Midwifery, march 2006, Vol 14, No 3

Epidural anaesthesia is a type of anaesthetic used for childbirth, whether it be a vaginal or caesarean birth. It does not make the woman unconscious, but it stops her feeling any sensation in the lower body. This means there will not be any feeling in your abdomen (stomach), pelvis and legs. Epidural anaesthetic is a popular method of pain relief during labour and childbirth because you stay conscious throughout. The epidural is usually given once labour has started, before the cervix has started to dilate This video shows how its done- you can see the area being anaesthetised first

By Elaine I found out I had PCOS when I was about 17 - I had really irregular periods - they could be as far apart as 18 - 24 months apart ... anyway as soon as I got married in October 1997 we knew we wanted to have a family ... hadn't been using any protection for quite a while before we got married ... so I went to my GP who referred me to a consultant - I was booked in for a laparoscopy in March 98 which confirmed my PCOS and that everything else appeared to be ok - my DH also had the usual test done - I was prescribed 50mg of clomid in May 98 and amazingly got a BFP from my June cycle (2nd cycle) - by the time we were due to go back for my DH's result I was pregnant so there was no need to go back. My pregnancy went really smoothly and Callum was born at 38 weeks and was delivered naturally -- I needed a few stitches but apart from that everything went really easily ... if you need to know more about my actual labour let me know as I've assumed you want to know more about the ttc side of it. Shortly after Callum's first birthday in July 2000 we decided we'd try for another baby ... kinda expecting it to happen just as quickly again ... On one of our first visits back to the hospital my DH had to provide another SA and we found out that he had low motility sperm - it transpires that it was the same first time around but we very luckily got a BFP so never found out and didn't have to worry about it. Can't remember the exact number but it really was low and we were told that we should think of DS#1 as a miracle .. thanks!!! Over the next couple of years we had another 11 cycles of clomid - this time having to increase my dosage all the way up to 150mg but unfortunately never achieved a BFP - we also had one go at IUI but my DH's motility was so low that they decided not to offer any further IUIs. We were told that our only option would be to have ICSI and that we would not have another baby without going down this line. We were kinda shell shocked for a while but after about a year I went to see a new consultant (as we have moved house) he again reiterated much of what my previous consultant had said and commented that it was highly unlikely that we would get pregnant again without ICSI - we went away with a view to me losing some weight and coming back to see my consultant again in December to discuss ICSI in more depth ... I asked my consultant if there was any way I could find out if I did actually ovulate - although my periods were still very irregular I wanted to know if I did ever ovulate or not .. my consultant suggested that I contact my GP's surgery when I had my next period and went for day 21 bloods and then keep going weekly until i had another period - I had an appointment with my consultant at the beginning of September and the day of my appointment my GP surgery phoned to let me know that my bloods from the previous week showed that I had ovulated (whoopee!!!) anyway it turns out when I went to see my consultant I was actually pregnant but I didn't know it -- I commented to a few close friends that my boobs seemed to have grown and only because I knew I had ovulated I did a pregnancy test and nearly died (literally!!!) when it came up positive. I contacted my consultant who gave me an early scan a 7 weeks - he commented that I was the reason he never says "never" to anyone - he oftens says highly unlikely but not never. Coupled with my PCOS and my DH's low motility we have no idea how our little miracles got here - even when they got me to ovulate with clomid and then when I ovulated on my own my DH's motility was so low we were told our only options was ICSI. Gregor arrived at 40+2 after an induction - he was brow presentation and I ended up having to have an emergency c-section ..

Most of us will not have heard of Group B Streptococcus (Group B Strep or GBS), yet it is a common type of bacteria carried by about one third of us without us usually knowing. It is one of a number of bacteria that normally live in our bodies. Occasionally, however, GBS causes life threatening infections in 1 in every 1,000 babies born in the UK. Each year, 700 babies develop GBS infections (Septicaemia, Pneumonia, or Meningitis, 100 of these babies die, and 20 babies suffer long-term mental and/or physical handicaps, from mild learning disabilities to severe mental retardation, loss of sight, loss of hearing and lung damage. GBS is also a recognised cause of preterm delivery, maternal infections, stillbirths and late miscarriages. BUT GBS CAN BE TESTED FOR AND INFECTIONS PREVENTED IN MOST CASES. Medical research estimates that testing, offering intravenous antibiotics to known GBS carriers and women in premature labour would prevent 80-90% of GBS infections in newborn babies in the UK. Testing for GBS saves lives! HOW DO I KNOW IF I CARRY GBS? GBS does not make you feel unwell and there are no symptoms (there is no smelly discharge as some midwives claim). The only way to find out if you carry the GBS bacteria is to be tested for it. The GBS test sometimes used by the NHS (often called an HVS) is not reliable. It give a false negative result half the time (it says you don't carry GBS when you do!), although if you get a positive result from the HVS test this is accurate. A reliable Enriched Culture Method (ECM) test is available privately. This test is much more sensitive and has been specifically designed to detect GBS. But the ECM test has only been available in the UK since May 2003 so many health professionals may not yet know of it, particularly as GBS testing is not standard procedure. The test is simply a swab. There is only one laboratory in the UK that carries out the ECM test at this time, The Doctors Laboratory www.tdlplc.co.uk. You (or your health professional) can ask for a free GBS Screening Pack by calling 020 7460 4800 or e-mail them at gbs@tdlplc.co.uk. There is a £28.00 fee when you return the test for analysis (some health professionals may also charge you for specimen collection). The results take 3 working days and will be sent to your health professional. For more details of the ECM go to "How Can I Get an ECM Test" on the Group B Strep Support website www.gbss.org.uk (a national charity providing accurate and up-to-date information about GBS to families and health professionals. Because the swabs and the results are sent through the post, the test can be done anywhere in the country. The ECM test is best done between 35-37 weeks. This is because the GBS bacteria comes and goes in your body. Any earlier, you might test negative only to have the bacteria appear nearer your due date. Any later and you might give birth before the result is back! WHAT IF I TEST POSITIVE FOR GBS? A positive test for GBS means the GBS bacteria was present at the swab was taken - NOT that you or your baby will become ill. Roughly 230,000 babies are born each year to women who carry GBS and, of these, only 700 develop GBS infection. Carrying GBS is perfectly natural and normal - you just need to take precautions when giving birth. You should be offered intravenous antibiotics as soon as you go into labour or when your waters break, and then 4-hourly until delivery. A detailed leaflet "For Women Who Carry GBS" can be downloaded from The Group B Strep Support website for you to hand to your midwife and/or obstetrician. Oral antibiotics are NOT thought to be effective. A negative ECM test result means you do not need to be offered intravenous antibiotics. WHAT IF I CAN'T BE TESTED? Testing is not essential. If you have not managed to be tested (or the result is not available), or the less reliable NHS test has come back negative you should discuss with your midwife or obstetrician about your birth plan and being offered intravenous antibiotics if one or more risk factors is present. These risk factors are explained in the short "GBS & Pregnancy 2 page summary" and more detailed "GBS: The Facts" can be downloaded from The Group B Strep Support website for you to hand to your midwife and/or obstetrician. IF GBS IS SO RARE, WHY SHOULD I BE TESTED? Many midwives, doctors, and obstetricians will tell you there is no need to have a test for GBS as it is so rare. Serious GBS infections in newborns are very rare, but testing for GBS will make the chances of your baby being affected even more unlikely IF you find out you are a carrier BEFORE you give birth. Pregnant women are routinely tested for several rare conditions - HIV, syphilis, spina bifida, Hepatitis B. You are not being paranoid asking for a test - just taking precautions for the healthy delivery of your baby. Not testing for GBS currently contributes to 120 babies dying or being disabled each year. Around 90 of which might have fully recovered had their mothers been tested for GBS in late pregnancy and given intravenous antibiotics before birth. As there is a simple, cheap test (that doesnt cost the NHS a penny) that can prevent GBS infections why not take it? For more information on gbs, visit www.gbs.org.uk

From The Times Online: Imogen Edwards Jones wrote about her three-year struggle to become pregnant - a journey that has cost thousands of pounds and involved countless doctors, procedures and health scares. Her daughter, Allegra, was born and, here, Imogen's husband, Kenton Allen, describes the experience from the proud father's point of view I really do not know what all the fuss was about. The moment all 6lb 4oz of a rather grey and slimy Allegra Carmen Elizabeth Allen popped into view, three years of heartache vanished in an instant. All those years of failure suddenly seemed like one bad night out in Birmingham. All those worries about miscarriage or having a small baby or the 400 other obsessions I had been taught to fret about by medicine's finest minds vanished in a heartbeat. And not just any old heartbeat, but a brand new heartbeat from a brand new person. A person I had become convinced would turn out to be a male midget with a cleft palate and the promise of a career with Billy Smart's Circus. The relief was palpable. A family at last. After months of trying - Imogen, Kenton and their daughter Allegra On initial inspection, my daughter looked surprisingly normal. Especially for someone who has the unfortunate gene pool of Imogen and myself. Even the injustice of being referred to as "Less Attractive" for 18 months in these pages was immediately reduced to a silly self-obsession as I was handed Allegra. The midwife cried a bit. I cried buckets. Imogen cried out in pain. She is beautiful, as you can see from the photo. And the baby is pretty cute, too. It was, as they say, emotional. The journey to reach this magical moment began rather innocently about three years ago. We were not trying to start a family. We were not, however, trying to stop a family starting, relying on the Russian roulette school of birth control. I think we were secretly hoping, without ever saying it, that Imogen would become pregnant without us really trying. This did not work and slowly but surely, all our friends were suddenly discussing pushchair manufacturers and whether it is possible to put an unborn foetus down for Eton (it isn't, by the way). A quick trip to the local lady doctor later told us all we needed to know. Everything seemed fine in all departments. It was time to get serious. It was time for - drum roll, please - "baby sex". Apart from watching England play Germany in a World Cup semi-final, "baby sex" is probably the most stressful thing any man can go through. Baby sex is the point in a couple's relationship when they decide that nature is not taking its course speedily enough and they need to, quite literally, put their backs into making a baby. It is exhausting, humiliating and not much fun. I am a fit, young-ish man. My wife is as sexy as they come. The thought that after 12 hours at work I would come home and make passionate love to a beautiful women got me through many a difficult period in my early twenties. The reality of having to do it now was a nightmare. None of this seemed to be getting results, so it was time to turn to private medicine. I was obviously, it seemed, the problem and was dispatched for a sperm test. Forget climbing Everest in your trunks and flip-flops. Taking a sperm test is the biggest challenge to a man's masculinity: it makes you feel impossibly nervous and inadequate. Ultimately, it's the pressure to "deliver" the goods in a precise window of time (in my case, at 11.45 on a wet Tuesday morning) that gets to you. You feel like someone auditioning for a very low-budget adult film. Happily, according to the good folk at the Lister Hospital, I have "sperm like whitebait". With her husband in the clear, the focus turned on Imogen. First came the innocently named Clomid. If you have a partner who starts taking this fertility drug, my tip is to remove all sharp objects from the house and wear a cricket box at all times. Unfortunately, Clomid made no difference at all, so the gynaecologist suggested we try artificial insemination - which, until then, I thought was only appropriate for stud animals. After insemination, we had a tense two weeks in which I discovered we had spent, to date, about £1,000 on the baby game. A moderate hole in one's pocket for no return. But the crushing disappointment that follows an unsuccessful attempt leaves you with a bigger hole in your heart - a sad and lonely feeling that brings you closer to your wife than ever before while pushing you frighteningly far apart as the desperation of your situation looms larger. So, welcome, ladies, gentlemen, and my bank manager, to the wonderful world of IVF. From a male perspective, IVF is just about the weirdest thing you can legally do to your wife. I think I have now injected Imogen in the thigh and bottom well over 1,000 times on the road to a baby-shaped nirvana. I hope that if you are ever asked to inflict quite excruciating pain on your most loved one, you will also find that a bit of humour will help ease the pain and total hatred that your wife feels for you. As you gently ease a 6in needle into her buttocks for the 400th time, distracting her with your best material is a winner. It is always good to have something to chuckle about as you wipe the blood from your polished oak floorboards. Of course, the process of IVF is physically and emotionally painful and tremendously difficult for a woman. I used to have an enormous amount of respect for my wife. Having gone through IVF with her, this respect now knows no bounds. She is an incredibly brave and strong individual with huge reservoirs of strength. She puts me to shame. For both of us, the emotional fall-out from two failed attempts at IVF was devastating. We discovered that all our hopes and dreams had come to nothing. The process failed twice, in a very similar fashion. It was a normal Sunday afternoon, nine days after implantation of the eggs, and we were messing around at home. And then, from the bathroom, a low wail, followed by silence and the words, "It hasn't worked." Then tears, dread, guilt, hopelessness and a bill for six grand Some 11 months later, I am sitting in a delivery room at St Mary's Hospital, Paddington. Imogen is having contractions, my friend Theodora, the midwife, is checking for dilation and I am mopping Imogen's brow with a cool flannel (which I have, rather cleverly, I think, scented with lavender oil). And all because of one drunken night of passion. I firmly believe Imogen became pregnant because we relaxed for a month and got on with our lives and behaved like ourselves for a few weeks. Imogen is convinced it is because she spent a month drinking some foul-smelling herbs she got from a bloke in Oxfordshire. Either way, I do not care. We were about to have a baby. The birth was excellent fun and I would pay good money to do it all over again tomorrow. The fact that we did pay very good money, about £30,000, to get to this stage means that we will not be doing it all over again just yet. We were admitted to the hospital at about 6pm on May 28. Imogen had been having contractions for about 12 hours before. After a couple of hours, there was a lot of sweating and shouting and I distinctly remember the phrase, "Give me the bloody drugs now!" being uttered a couple of times. An epidural went in without a hitch and everything settled down nicely. So nicely that I was packed off home at midnight to get some sleep. I did not leave without having a bet with Theodora. I put £5 on a 5am arrival, just to make it a bit more exciting. She looked at me sagely and said. "Baby will arrive between 7 and 8am." I wasn't sure about her forecast and I hate losing a bet. I returned to the hospital at 4am to find all was peace and calm. And the peace and calm continued quite serenely until 6.30 - and then it was time for the big push. It is quite difficult for me fully to convey to you the beauty of this birth. After all the poking, probing, injections, and invasiveness that Imogen has gone through over the past three years, Allegra's arrival was more than a bit special. A totally natural delivery performed by Theodora, with me providing verbal encouragement, running commentary and that soothing flannel. No teams of doctors, no specialists with worried faces staring at growth charts. Just me, my wife and Theodora. At 7.25am precisely, our daughter joined us. A family at last. The aftermath of the birth was less than perfect. Imogen's placenta was stuck. All of a sudden, the tiny delivery room was crammed full of people looking slightly concerned. Imogen was whisked off to have her placenta removed in what she later described as "a James Herriot incident". She is fine now, but is not planning to go water-skiing for another couple of months. With Imogen in theatre, I was left completely on my own. We sat for almost two hours, my daughter and I. No nurses or doctors, just us, waiting for Mummy to come back safely. I was left holding the baby - our baby. She was smiling sweetly and seemed very tiny in my big fat ugly arms. I will never forget those few sweet hours. Allegra - or "the Passenger" as she was still known then - seemed perfect to me. Everyone who has subsequently poked and prodded her has pronounced her perfect, too, and she will remain perfect in our eyes, whatever journeys we go on together in the years ahead. So it seems there is such a thing as a happy ending. Even when you are only at the beginning.

A Water Birth Denied Deborah Byrne source: From MIDWIFERY MATTERS, Issue No.109, Summer 2006 For the purposes of confidentiality, names have been changed and no identifiable information has been given. During early shift on the birth centre, I welcomed a woman and her partner into our unit and introduced myself and my midwife mentor, Jenny. Lucy was expecting her second baby and had been experiencing regular uterine contractions for two hours with intact membranes. Lucy's contractions were regular, every five minutes lasting for approximately forty seconds. On palpation the contractions felt moderate to strong. Lucy's fundus was term, and the fetus was presenting in the left occipito anterior position with a cephalic, longitudinal lie. Lucy was a strong woman who was breathing through her contractions and mobilising. I asked Lucy and her partner Paul if they had a birth plan. Paul handed me a comprehensive plan which stated that Lucy wished to have an active birth with minimal intervention; they wanted to have intermittent fetal heart monitoring and no vaginal examinations. Lucy also stated very strongly that she wanted to birth her baby in the pool. I started to fill the birth pool as it can take fifty minutes for the pool to fill. I was excited by their birth plan and relished the opportunity to 'sit on my hands' and just be with them and support them through their birth experience. After an hour of mobilising and squatting on a birth ball, supported by Paul, Lucy wished to use the pool as her contractions became more intense. As the pool was ready she got in straight away and relaxed as she immersed herself in the warm water. The pool room was dark and quiet and Lucy commented on how relaxed she felt. During this time I realised that my shift was coming to an end and decided that I would stay until Lucy and Paul had their baby. The midwife taking over introduced herself as Catherine, and Jenny said goodbye. I had not worked with Catherine before but was optimistic that she would be as excited about Lucy and Paul's birth plan as I was. After Jenny had left Lucy began to experience expulsive contractions and external signs of fetal decent became apparent. To my surprise Catherine informed Lucy and Paul that she could not 'allow' them to birth in the pool as she had not been trained in water births. Catherine said that Lucy must get out of the pool to birth her baby and that she should do so straightaway. Catherine then stated in a paternalistic manner that she thought water births were dangerous and that she wanted Lucy out of the pool. Lucy complied with Catherine's request as she was frightened at not having a midwife who was confident with birth in water; it was at this point that Lucy's contractions stopped. Once dry, Lucy adopted a standing position and thankfully her contractions returned, I remained calm and guided Lucy to listen to her body and do what it was telling her. After two contractions the membranes ruptured spontaneously. Lucy then gave two huge roars. Daniel was born into his parents' hands. Physiological third stage was completed in ten minutes. Lucy's perineum was intact. Both Lucy and Paul had skin to skin contact with Daniel while both Catherine and I left the new family to bond. Lucy's labour and birth was wonderful and I feel very privileged to have witnessed it. I felt I had a bond with Lucy and Paul and went back to see them the next day and thanked them for allowing me to attend. Together we reflected on the birth and both Lucy and Paul were disappointed that they had not birthed Daniel in water. However, they both stated that they would want a midwife who was confident with water birth. Nevertheless, I remain angry with Catherine; I believe it was bad midwifery practice to order Lucy out of the birth pool at such an important phase in labour. I felt that Catherine should have enquired whether any other midwife was available to support Lucy during a water birth so she did not have to leave the pool. I feel disappointed in myself that I was not an advocate for Lucy and Paul, I feel that I should have stood up for them more, but thought it might aggravate the already tense atmosphere. I feel that as midwives we have to have up-to-date knowledge and skills so that we can offer holistic care to women. However, the aspect that concerned me most was the manner in which Catherine had spoken to Lucy and Paul, when she had stated that she thought water births were dangerous. This was said at a crucial time when Lucy needed encouragement and belief in her body's ability. It is also of concern that in a birth centre facilities are offered but can be withheld from women during labour owing to lack of knowledge or experience on the midwife's part. On the other hand, I also want to acknowledge the positive way in which Lucy and Paul prepared for their birth. Their birth plan was comprehensive and addressed all their needs. Lucy remained calm and adopted various positions while labouring and birthing. Paul was supportive and calm. To summarise this evaluation, I think this labour and birth experience was marred by lack of experience, knowledge and a belief in water birth on the part of the midwife. Water Birth According to Richmond (2003) during a water birth the newborn emerges into warm water, an environment that many feel is much closer to conditions in the womb than emerging into the air. Furthermore, water birth also has a positive influence on women during labour, an observation made by Burns (2004) in her systematic review of the effects of labour and birth in water. Burns concluded that there was a significant reduction in pharmacological pain relief when women laboured and birthed in water. A randomised controlled trial by Cammu et al (1994) had found that women were more relaxed while labouring in water. As the evidence suggests, labour and birth in water for some women can have a positive impact on their birth experience, it is disappointing when midwives are not 'trained' to 'do' waterbirths and the service cannot be offered to women (Burns 2002). According to Baston (2004) although the usual observations are made and recorded, managing the second stage in water is purely 'hands off'. These observations should be fetal heart auscultation, maternal pulse, maternal temperature and water temperature. Baston (2004) also states that water birth should only be conducted by experienced midwives. Nevertheless, as midwives we are expected to undertake evidence-based practice and the lack of knowledge or training in water birth restricts women's choices. Women are told they have choice, but in reality they are often denied some options. Furthermore, denying women the option of birthing in water is a waste of resources. Burns (2002) is concerned that NHS finances are wasted when pool rooms are established but used infrequently. According to Wickham (2003) water birth should be a compulsory component of the education of midwives and student midwives. Communication skills Women take their cue from midwives while in labour and so midwives should empower them; midwives need to feel empowered by their training and development. Communication skills are very important. According to Baston (2002) effective communication is fundamental to all aspects of midwifery care. Positive communication can empower and enhance a woman's experience of pregnancy, birth and life with a child (Baston 2002). In this case the communication skills demonstrated by Catherine were inexcusable, at no point was Lucy asked to vacate the pool, only ordered. Catherine's negative attitude towards Lucy's birth choice was an example of the culture of 'bullying' which exists in midwifery. Kirkham (2004) writes that bullying in midwifery stems from the culture of blame known to be widespread in the NHS. The culture of blame and bullying intimidates midwives; they start to doubt their skills (Robertson 2004). A paternalistic attitude develops towards women and care can then become institution centred and not woman centred. Catherine expressed her own fear and inexperience at a time when Lucy required empowerment and faith in her birth choices. Moreover, Robertson (2004) states that as birth is a social process, midwives need the opportunity to support women and each other, through mutual sharing and caring, recounting birth stories and talking through concerns and safe practice issues. Childbearing is a highly emotional time for most women and this can be reflected by how they interpret their birth experience and retell their birth stories (Stephens 2003). To conclude, to be a midwife is to be 'with woman'. In this scenario, although Lucy received care from a midwife, the midwife in question could not provide care for all of Lucy's requirements as she did not have the skills to support her. If we are to support women effectively as midwives we must recognise that lifelong learning will give us influence and strength. This strength can have a positive impact on the empowerment of women, midwives and the midwifery profession. REFERENCES Baston H (2002). 'Midwifery basics - communication', The Practising Midwife, 5, 10, 26-30. Burns E. (2004). 'Water: what are we afraid of?' The Practising Midwife, 7,10. Cammu H et al (1994). 'To bathe or not to bathe during the first stage of labour', Acta Obstetrica Gynecologia Scandinavia, 73, 468-70. Flint C (1986). Sensitive Midwifery, Chapter 11. 156-166, Heinemann Medical books, London. Gibbs G (1988.) Learning by Doing: A guide to teaching and learning methods, Further Education Unit. Oxford Polytechnic. Kirkham M (2004). 'Midwives: Praise and beyond', The Practising Midwife, 7, 4. Richmond H (2003). 'Theories surrounding waterbirth', The Practising Midwife, 6, 2. Robertson A. (2004). 'Changing Britain's birth culture', The Practising Midwife, 7, 4. Stephens A (2005). Leap of faith - From Direct Entry midwifery student to independent midwife. Midwifery Matters, 104, Spring 2005. Wickham S (2003). Waterdurals - Thinking outside the Box', The Practising Midwife, 6, 2.

Another normal vaginal delivery

The World Health Organisation, 1985 define normal birth as: Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition. The majority of fit and healthy women invariably expect to have a 'normal' birth. In an attempt to understand what will happen to them during birth they devour childbirth magazines, women's magazines, health education leaflets and any other material they can find. Believing that the experts know best they happily follow the doctors' and midwives' advice in the expectation that they will be safe in the hands of professionals, and their birth plans, if they have made them, will be respected. In 1997 AIMS raised the question of what is normal birth? So often women tell us of their traumatic birth experiences and state that they are not going to have a 'normal birth' next time - they want to have an epidural right away; or book an elective caesarean the next time. So often when they are told that they did not have a normal birth last time such women are amazed. Unfortunately, if the baby is born vaginally (without forceps or ventouse) the midwife invariably writes 'normal delivery' on the case notes. The women then presume that the high-technology interventive, obstetric delivery they endured was 'normal'. Common or usual it may be, but normal it certainly was not (Beech, 2003) Recent decades have seen a rapid expansion in the development and use of a range of practices designed to start, augment, accelerate, regulate or monitor the physiological process of labour, with the aim of improving outcomes for mothers and babies, and sometimes of rationalising work patterns in institutional birth. Often though this can lead to a ‘cascade of intervention’. An assessment of need and of what might be called "birthing potential" is the foundation of good decision making for birth, the beginning of all good care. What is known as the "risk approach" has dominated decisions about birth, its place, its type and the caregiver for decades now. The problem with many such systems is that they have resulted in a disproportionately high number of women being categorised as "at risk" are having unnecessary intervention at birth. So how can a care giver work with a woman during normal birth? WHO point out four aims of care to be considered: support of the woman, her partner and family during labour, at the moment of childbirth and in the period thereafter, observation of the labouring woman; monitoring of the fetal condition and of the condition of the infant after birth; assessment of risk factors; early detection of problems, performing minor interventions, if necessary, such as amniotomy and episiotomy; care of the infant after birth and referral to a higher level of care, if risk factors become apparent or complications develop that justify such referral. Care givers must bear in mind that in normal birth there should be a valid reason to interfere with the natural process. Beech, B (2002) What is Normal Birth? AIMS Journal, Winter 2002/3, Vol 13 No 4 [online] Available from: http://www.aims.org.uk/Journal/Vol13No4/whatIsNormalBirth.htm accessed 10/06/2007 WHO (1997) Care in normal birth: A practical guide [online] Available from: http://www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_Chapter1.en.html Accessed 11/06/2007

Asthma is a very common long-term condition that affects a persons airways and breathing. Approximately one adult in 13 is currently being treated for asthma in the UK (NHS, 2006). Asthma is an acute respiratory illness which is characterised by airway obstruction, airway inflammation and increased responsiveness to various stimuli including environmental irritants, viral respiratory infections, cold air and exercise. Asthma has been thought to be linked to an overactive immune system. In an asthma attack, the bronchi are irritable and have a tendancy to become swollen and inflamed, producing excess mucus that can block the smaller airways. (Swiet, 2002). The muscle in the walls of the airways contracts causing narrowing ( see appendix 1). Asthma attacks can vary in severity from mild breathlessness to respiratory failure. The main symptoms are wheezing, breathlessness, dry cough and a tightness in the chest. In a severe attack, breathing becomes increasingly difficult resulting in a low level of oxygen in the blood. Left untreated, such attacks can be fatal (Peters, 2004). Sometimes allergens such as pollen or dust also act as triggers to asthma. This condition can also be exacerbated by emotional stress which is quite common in pregnancy. During pregnancy, there are many changes in the Respiratory system that are controlled by hormonal and mechanical factors. Whilst the vital lung capacity remains the same (the maximum amount of air that can be moved from maximum inspiration to maximum expiration) during pregnancy, the total capacity is reduced due to the diaphragm rising with increasing gestation (Lavery, 1999). There is an increase in oxygen consumption which is associated with increased ventilation of up to 40%. This is achieved by increasing tidal volume from 500 to 700ml rather than an increase in respiratory rate Residual volume, the volume or air in the lungs which remains at the end of expiration (Swiet, 2002).Asthma affects approximately 4% of all women. About a third of women with asthma experience improvement while they are pregnant, about a third get worse, and about a third stay the same. De Swiet, 2002 suggests that despite changes in the respiratory system during pregnancy, it doesn’t seem to have a great effect on asthma , however the effect asthma has on pregnancy is different. Women with uncontrolled asthma are more likely to have complications during pregnancy. Their babies are more likely to be born pre-term, small or underweight at birth and to require longer hospitalisation after the birth. The more severe the asthma, the greater the risk to the fetus. In rare cases, the fetus can die from oxygen deprivation. Schatz (1992) suggests that asthmatic women are more likely to develop hyperemesis gravidarum, chronic hypertension and antepartum haemorrhage although the causes are unknown. Asthma most commonly exacerbates during the 24th to 36th week of gestation, whereas asthma rarely flares during the last 4 weeks of pregnancy and during labour and delivery. Within 3 months after delivery, almost 75% of women return to their pre-pregnancy status (Blaiss, 2004) >

Antepartum Haemorrhage This essay is designed to explore antepartum haemorrhage (APH), but as it is a wide topic area for discussion, the management will focus on haemorrhage due to placental abruption or abruptio placentae. The condition will briefly be defined, followed by a discussion of the predisposing factors. As there are many factors which contribute to APH, domestic violence as a pre-disposing factor will be elaborated upon. The term antepartum haemorrhage is applied to bleeding from the vagina occurring at any time from the 24th week of pregnancy and before the birth of the baby (Baskett, 1999) The largest identifiable cause of stillbirth (13.9%) between 2000-2002 were ante-partum haemorrhage (Cemach,2004) There are 3 main factors which cause APH: Haemorrhage from a normally situated placenta (placental abruption), haemorrhage from partial separation of a placenta abnormally situated in the lower uterine segment (placenta praevia) and haemorrhage from a lesion of the cervix or vagina such as an erosion, polyp or carcinoma (cancer). Other rare causes include uterine rupture (Basket, 1999) When part of the placenta detaches from the uterine wall, maternal blood escapes from the intervillous space. Sometimes the blood escapes past the membranes and through the cervix in what is called placental abruption with revealed haemorrhage as it is obvious to the eye. There may also be some abdominal discomfort if the placenta is in an anterior position. In severe cases it may cause fetal distress or death but in slight cases, the fetus is not affected (Ten Teachers, 1997).When there is placental abruption with no obvious bleeding, this is called a concealed haemorrhage. Symptoms can vary with the severity of the case. In extreme cases the woman may suffer from shock due to the amount of blood diffused into the uterus and painful uterine distension. The abdomen is hard and tender to touch, fetal parts cannot be felt and fetal heart cannot be heard (Ten Teachers, 1997). Gaufberg, 2006 suggests the causes of placental abruption to be: Maternal hypertension - Most common cause of abruption, occurring in approximately 44% of all cases, Maternal trauma (e.g., road traffic accidents and assaults) - Cigarette smoking, Alcohol consumption, Cocaine use, Short umbilical cord, Sudden decompression of the uterus (e.g., premature rupture of membranes, delivery of first twin), Retro placental bleeding from needle puncture (i.e., post amniocentesis), and advanced maternal age. Domestic violence is a predisposing factor widely recognised to possibly cause placental abruption. Domestic violence is reported by up to one in four women in Britain and represents a serious public health issue (refuge, 2006). The psychological and social consequences of domestic violence include alcohol and drug dependence, suicide attempts, depression, and post-traumatic stress disorder (Amaro et al 1990) Pregnancy may increase the risk of violence, and the pattern of assault may alter, with pregnant women being more likely to have multiple sites of injury and to be struck on the abdomen. These in turn have also been shown to increase the risk of abruption and placenta praevia (Boyle, 2002). Chan et a,1999 conducted a study which revealed that mothers over the age of 40 are more likely to suffer from antepartum haemorrhage but they did not elaborate on whether it was more likely to be due to placenta praevia or abruption. It was noted however that the incidence was higher in the primiparous older women than the multiparous. As well as the factors mentioned above, History of spontaneous miscarriage or induced abortion and previous caesarean section are factors which can contribute to placenta praevia All cases of APH should be admitted to hospital. In revealed haemorrhage with slight bleeding, when praevia has been excluded by ultrasound, Ten Teachers, 1999 suggests that the woman should be admitted to the antenatal ward for nothing more than rest and observation. In many cases no further bleeding occurs and the pregnancy continues to term. Ogueh et al 1998 analysed the need for hospitalisation in cases of antepartum haemorrhage with unknown origin and concluded that there was no need as is had no benefit in terms of gestation at birth, recurrent haemorrhage or fetal weight. The management of placental abruption is different from placenta praevia and treatment will depend on the extent of the abruption. When presented with a woman who is suffering from an antepartum haemorrhage, all health professionals involved with the mothers care should be prepared for a post partum haemorrhage. Blood should be taken for grouping, cross matching, full blood count and clotting studies. Kleiheur is usually performed in rhesus negative mothers to see if any fetal blood has crossed the placenta into the maternal circulation (Lindsay, 2004). If the bleeding is light to moderate, and the mother is not in immediate danger, then the course of action depends on the fetal heart rate (WHO, 2003). If it is normal or absent then membranes should be artificially ruptured but if the cervix is unfavourable, caesarean section should be performed. If the fetal heart is abnormal then either rapid vaginal delivery or caesarean section should be performed. When the abruption is severe, more than half the placenta will have separated and it becomes and obstetric emergency. Blood loss will usually exceed 1 litre and the mother will be very shocked (Linsay, 2004). There is also an increased risk of coagulation disorders. WHO, 2003 suggests that delivery of the baby should be made as soon as possible. They suggest delivery by vacuum extraction if the cervix is fully dilated or caesarean section if vaginal delivery is not imminent. Ergometrine 500mcg is given intravenously at delivery to control haemorrhage in the third stage of labour. It is usual to continue syntocinon infusion for some hours after delivery to maintain uterine contraction (Lindsay, 2004). If there are signs of shock then steps should be taken to conduct a blood transfusion if necessary. Throughout all diagnosis and treatment of APH, women and their families should be informed and all choices explained thoroughly. In conclusion, it can be seen that bleeding in pregnancy remains a major cause of maternal mortality. Midwives must therefore be familiar with the management of APH for whatever cause. The multidisciplinary team should be able to work together, responding to haemorrhage quickly and appropriately. Hospital guidelines should be kept up to date and in and area easily accessible to all relevant health care providers. Midwives should also be able to identify those women most at risk, referring them appropriately, also ensuring that the woman and her family are supported throughout. References Amaro H, Fried LE, Cabral H, Zucherman B. Violence during pregnancy and substance use. Am J Public Health 1990;80,575-9 Baskett T. (1999) Essential management of obstetric emergencies Clinical Press [Bristol] p 64-76 Boyle M, (2002) Emergencies Around Childbirth A Handbook for Midwives Radcliffe Publishing Ltd Cemach (2004) Stillbirth, neonatal and post neonatal mortality 2000-2002 England, Wales and Northern Ireland. Confidential Enquiry into Maternal and Child Health. [online] available from: www.cemach.org.uk/publications/2000-2002%20perinatal%20report.pdf. Accessed 10/12/2006 Chan B, Lao T (1999) Influence of parity on the obstetric performance of mothers aged 40 and above Human Reproduction [journal], Vol 14, No. 3, March 1999, pp. 833-837(5) Oxford University press Lindsay P (2004) bleeding in pregnancy in: Macdonald S, Henderson C, Mayes Midwifery, Balliere Tindall. London P772-73 Ogueh O, Johnson M.R. What is the value of hospitalisation in antepartum haemorrhage of uncertain origin? Journal of Obstetrics & Gynaecology, Volume 18, Number 2, 1 March 1998, pp. 120-122(3) Refuge (2006) Pregnancy and domestic violence [online] available from http://www.refuge.org.uk. Accessed 09/12/2006 Ten Teachers. (1997) Abnormal pregnancy in: Chamberlain G (ed) obstetrics Oxford University press WHO. (2003) Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors World Health Organisation [Geneva]

3rd stage, dlivery of placenta video

No one knows what triggers labour but there are assumptions that it begins by a hormonal response, probably to triggers which come from the baby's adrenal gland. Once this happensa womans uterus starts contracting. They may not even be felt at first and could go on for hours without the woman even realising. The first a woman may notice is a dull ache or period type pains in her low abdomen or back. These contractions may be start off irregular , possibly only occuring once every half an hour or so. Over time they will become closer together and more painful. Remember that not all births are the same. Your 'waters' could break before the contractions start or afterwards. And in some cases, not until the baby has been delivered. At the start of labour your cervix is barely open (dilated); over the next 5 to 15 hours or so it dilates completely. This can be seen in the simulated birth video under the 'birth' category. As the womb contracts, the baby is pushed downwards and almost reaches the end of the birth canal (vagina), with the head (usually) about to be born first. Breech delivery are still possible vaginally but can often be complicated requiring a lot of exertise. The idea of contractions is to dilate the cervix to around 10cms so that the baby's head can fit through. This process takes time hence the reason why some women say they were in labour for days. In factreallabour doesnt begin until the contractions are coming every 3-4 minutes, lasting 60 seconds and the woman is 3-4 cms dilated. Sometimes, contractions may slow down, or even stop. Sometimes it halps to move around or change position, to get the contractions going. The actual birth of the baby is called stage 2. It's usually a lot quicker than the first stage. It can be very quick – lasting just a few minutes – or take up to two hours, and sometimes much longer. Actively pushing takes a lot of effort and can be very draining. It begins when the cervix is fully dilated (10 cms), and when the woman feels a very strong urge to push downwards. . The first part of your baby to be born is the top of his head – this is known as 'crowning'. A couple more contractions and the head will emerge, usually facing towards your back. Your baby's shoulders and head will then turn sideways. The baby's body then emerges. The umbilical cord is usually clamped and then cut at this stage, the cord does not have to be cut by a health professional if the woman requests otherwise. Stage three is the delivery of the placenta, and it takes from 15 minutes to about half an hour. As the baby is born, syntometrine (a drug which helps with the separation of the placenta from the uterine wall) may be given as an injection, usually in the thigh or buttock. A physiological third stage is when no drugs are given to aid the separation of the placenta, a process which may take slightly longer. This means the uterus contracts by itself, and expels the placenta and membranes. The cord is clamped and then cut when it stops pulsating, after the placenta is delivered.

TESA video non surgical testicular sperm aspiration

Bleeding during pregnancy is relatively common, with around 1 in 10 women experiencing some bleeding. However, if you have bleeding at any stage during your pregnancy, you should call your midwife or GP immediately. It is not always caused by something serious, but it is very important to make sure. In early pregnancy, some womencomplain of light bleeding, called spotting, when the embryo plants itself into the lining of your womb. This is also sometimes known as implantation bleeding, and often happens around the time that your first period after conception would have been due. During the first three months of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy (when the embryo starts to grow inside your fallopian tubes instead of your womb). Later in pregnancy, bleeding can occur for different reasons. A cervical show happens when the plug of mucus from the cervix comes away as the body prepares for birth. Placental abruption may cause bleeding and is serious. This is when the placenta starts to come away from the wall of the womb. This can indicate an early delivery. Placenta praevia occurs when the placenta implants itself low in the womb, partially or totally covering the cervix. Vaginal bleeding in the later stages of pregnancy can also be a sign of a miscarriage. However, a miscarriage is very uncommon after the third month of pregnancy. To work out what is causing bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan, or blood tests to check your hormone levels

A nice clear video showing embryo deveoplment

I thought I would ad a little personal advice here! After having twins almost 6 months ago, I never thought that I would have them sleeping throughby 3 months. In fact the were born 6 weeks early and spent their first 3 weeks of life in hospital. When they cam home, thats when the nightmare at night began. I was up every hour, functioning on zero energy and extremely tearful. Over the weeks as they started to take more during a feed, I started googling on how to get a baby to sleep through. I saw tips about letting them cry it out, letting them get to 6 months first and all kinds of other ideas. I decided to do the routine thing. Bath at around 8 ish then bottle then bed. I would get them up around 10-11 to feed them again though. Remember that newborns NEED to feed every 4 hours (ish) and should not be expected to sleep through. When they can take about 6 ounces of milk in one go, then try! For me that was around 3 months of age, bearing in mind they were premature. I found that over the weeks they would wake up later and later. For example, one night, I would put them in bed at about 9 after a bath and feed, then feed them in their sleep at 11pm and find that they woke at 4.30 am for another feed. Sometimes earlier. But over the weeks, 4.30 became 5.30 and now they sleep from about 8 until 6.30 7.00 One thing about putting your baby down- if the baby is not tired, dont even bother, they will just scream and scream. After a few weeks of a routine, when they have naps through the day, they should start to get irritable in the evening and then its time to bath them and put them down. I got a musical cot toy so that they associated they sound with sleep time. Luckil for me it worked. DAmn you should have heared me 4 months ago!!!

Hmm not sure about this, maybe its just trying to promote the book but hey if you have unexplained fertility then maybe it may be worth taking some of the advice.

Diabetes is a condition in which the blood sugar level is high because there isn't enough insulin, or insulin isn't working properly. Insulin is a hormone that enables your body to break down sugar (glucose) in your blood to be used as energy. During pregnancy, various hormones block the usual action of insulin. This helps to make sure your growing baby gets enough glucose. Your body needs to produce more insulin to cope with these changes. Gestational diabetes develops when your body can't meet the extra insulin demands of the pregnancy. Gestational diabetes usually begins in the second half of pregnancy, and goes away after the baby is born. If it doesn't go away after the baby is born, it's possible that you already had diabetes and that it was picked up during your pregnancy. The other forms of diabetes, called type 1 and type 2 diabetes, are life-long conditions. Symptoms Gestational diabetes doesn't usually cause any symptoms. However, sometimes you may have symptoms of high blood sugar, such as: increased thirst needing to urinate frequently tiredness However, these are also common symptoms in normal pregnancy. Gestational diabetes isn't an immediate threat to your health. However, poorly controlled diabetes in pregnancy puts you at a higher risk of various problems. These include: a condition called pre-eclampsia, which causes high blood pressure premature labour having too much amniotic fluid You are also more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type 2 diabetes later in life. For your baby Having high blood sugar can cause your baby to grow larger, which can make delivery difficult. This can cause problems for both you and your baby. Sometimes a caesarean delivery is needed. You are more likely to have a caesarean delivery than women who don't have diabetes. Your baby may have low blood sugar (hypoglycaemia) after birth. This is because your baby makes extra insulin to respond to your high blood sugar levels. Shortly after birth, your baby may continue to make extra insulin causing his or her blood sugar level to be too low. If you had gestational diabetes, your newborn baby's blood sugar level will be checked regularly. Regular normal feeding, either breastfeeding or formula milk, may be enough to correct your baby's low blood sugar. But sometimes babies are given sugar (dextrose) solution through a drip (directly into a vein). Doctors will check your baby's blood sugar levels regularly. Your newborn baby is at risk of jaundice (yellowing of the skin and whites of the eyes). This isn't serious and usually fades without the need for medical treatment. There is an increased risk that your baby will be born with congenital problems, such as a heart defect. Sometimes, babies can be born with respiratory distress syndrome, in which the baby has problems breathing because his or her lungs have not matured normally. This usually clears up with time, although it may mean that the baby needs to be ventilated with a machine. There is also a slightly higher chance of stillbirth or death as a newborn, but this is rare as long as glucose levels in both you and your baby after birth are well controlled. There is an increased risk of the baby becoming obese as a child, although this may be due to the family's eating habits rather than any effect on the baby in the womb. Causes No-one knows why some women develop gestational diabetes and others don't, but you are more at risk if you: have a family history of gestational diabetes (ie mother, grandmother or sister had it) you have previously given birth to a large baby (weighing over 4.5kg/9lb 14) you have previously had a stillbirth are overweight or obese have polycystic ovary syndrome (PCOS) Diagnosis One way to diagnose gestational diabetes is with a glucose tolerance test, which needs to be carried out in the morning, after you have eaten nothing overnight. Your doctor will give you a solution of glucose to drink and take blood samples at different intervals to see how your body deals with the glucose over time. You will be offered a glucose tolerance test if you are at high risk of developing gestational diabetes (see Causes). There is enough evidence to support testing every pregnant woman to find out if she is at high risk of diabetes, so the National Institute for Health and Clinical Excellence (NICE) doesn't recommend routine screening. But some doctors and midwives test urine for sugar at antenatal visits and may offer a glucose tolerance test if they are concerned about diabetes. Treatment Your doctor will refer you to a specialist clinic where the doctors and nurses are experienced in looking after pregnant women with diabetes. You will need to have more frequent antenatal appointments than women without gestational diabetes. It's important that you control your blood sugar level if you have been diagnosed with gestational diabetes. This means regular testing of your blood sugar (glucose) levels, a carefully planned diet and keeping active. Your doctor at the specialist clinic will give you advice on how to test, how often to do it, and the blood sugar results that you are aiming for. You will probably need to do a test every day. Your doctor or a specialist dietician will give you advice about what to eat. A meal plan will probably consist of a variety of foods, including plenty of starchy foods such as wholemeal bread, pasta, rice and potatoes, and at least five portions of fruit and vegetables each day. Regular moderate intensity exercise, such as walking or cycling, can help reduce blood sugar levels and promote a sense of well being. At least 30 minutes of activity that gets you slightly breathless each day is recommended by the Department of Health. Medicines It's possible that your blood sugar levels will stay too high even if you make lifestyle changes. You may need daily injections of insulin if this happens. Your doctor or specialist nurse will teach you how to do this. It's possible to have too much insulin and this can cause low blood sugar (hypoglycaemia). Common symptoms of this are paleness, shaking, hunger and sweating. Your doctor or specialist nurse will explain how to recognise the symptoms of hypoglycaemia, and what to do if it happens. For example, keeping a sugary soft drink handy is a good idea. Occasionally, low blood sugar can cause you to lose consciousness, and you will need an injection if this happens. It's a good idea for your family and friends to know what to do if your blood sugar gets very low and you pass out. After your baby is born Your doctor or midwife will monitor the blood sugar levels of you and your baby after the birth. Diabetes UK recommend that it's best to breastfeed your baby within one hour of delivery.

What is induction of labour During pregnancy your baby is surrounded by a fluid filled membrane (sac) which offers protection whilst he or she is developing in the uterus (womb). The fluid inside the membrane is called amniotic fluid. In preparation for labour the cervix softens and shortens. This is sometimes referred to as "ripening of the cervix". Before or during labour the membranes rupture (break) releasing the fluid. This is often referred to as "your waters breaking". During labour the cervix dilates (widens) and the uterus contracts to push your baby out. In most pregnancies labour starts naturally between 37 and 42 weeks, leading to the birth of the baby. Induction of labour is a process designed to start labour artificially. When is induction recommended? When it is felt that your or your baby's health is likely to benefit, the midwife or doctor may offer and recommend induction of labour. On average about one in five labours are induced. There are a number of reasons why induction may be offered and recommended. For example if you have diabetes or pre-eclampsia (high blood pressure). If you are healthy and have had a trouble free pregnancy, induction of labour may be offered if: your pregnancy is more than 41 weeks your waters break before labour starts When induction of labour is being considered, your doctor or midwife should fully discuss your options with you before any decision is reached. This should include explaining the procedures and care that will be involved and whether there are any risks to you or your baby. If you have had a previous caesarean section or have had more than five babies this may affect whether induction is recommended. If your pregnancy is more than 41 weeks Even if you have had a healthy trouble free pregnancy, you should be offered induction of labour after 41 weeks because from this stage the risk of your baby developing health problems increases. An induction because you are overdue does not increase the chance of you needing a caesarean section. If you choose not to be induced at this stage then from 42 weeks you should be offered: Twice weekly checks of your baby's heartbeat using a piece of equipment called an electronic fetal heart rate monitor. A single ultrasound test to check the depth of amniotic fluid (or "waters") surrounding your baby. An ultrasound scan in early pregnancy (before 20 weeks) can help to determine your baby's due date more accurately. This reduces your chances of unnecessary induction. If your waters break before labour starts Sometimes a woman's waters break before labour starts. This happens in about one in twenty pregnancies and is known as prelabour rupture of the membranes (or PROM). When this happens, about nine out of ten women will go into labour naturally within twenty-four hours. The longer the time between PROM and the birth of the baby the higher the risk of infection to you or your baby. If you are more than 37 weeks pregnant and your waters have broken but you have not gone into labour you should be offered the choice of either: · Induction of labour OR · A "wait and see approach" to see if labour will start naturally As a wait and see approach carries a slight risk of infection, you will need to: check your temperature twice a day check for changes in the colour or odour of your amniotic fluid ("waters") check for any other signs of fever (e.g. shivers, flushing) If you have not gone into labour after, at most, four days induction is strongly recommended. If your waters break before you go into labour, your chances of having a caesarean section will not be increased by choosing either induction or "wait and see". How is labour induced (started)? There are a variety of methods that can be used to induce labour. You may be offered one or all of the methods described below depending on your individual circumstances. Membrane sweeping This has been shown to increase the chances of labour starting naturally within the next 48 hours and can reduce the need for other methods of induction of labour. Membrane sweeping involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. It can be carried out at home, at an outpatient appointment or in hospital. If you have agreed to induction of labour, you should be offered membrane sweeping before other methods are used. The procedure may cause some discomfort or bleeding, but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. Membrane sweeping is not recommended if your membranes have ruptured (waters broken). Using prostaglandins Prostaglandins are drugs that help to induce labour by encouraging the cervix to soften and shorten (ripen). This allows the cervix to open and contractions to start. Prostaglandins are normally given as a tablet or gel that is inserted into the vagina. This is usually done in hospital on an ante-natal ward. More than one dose may be needed to induce labour. Doses should only be given every six to eight hours. If your membranes have not yet ruptured (waters broken) prostaglandins are the recommended method of induction. This is the case whether this is your first pregnancy or not, and whether or not your cervix has ripened. Before giving prostaglandins your midwife or doctor should check your baby's heart beat. After being given prostaglandins you should lie down for at least thirty minutes. Once your contractions start your midwife or doctor should monitor your baby's heartbeat using a "CTG" or electronic fetal heart rate monitor. Once it is established that everything is okay, the CTG should be discontinued and you will be able to move around. For further information see the National Institute for Clinical Excellence information booklet "Monitoring your baby's heartbeat during labour" - 2001. There is no evidence to suggest that labour induced with prostaglandins is any more painful than labour that has started naturally. However prostaglandins sometimes cause vaginal soreness. Very occasionally prostaglandins can cause the uterus to contract too much which may affect the pattern of your baby's heartbeat. If this happens you should be asked to lie on your left side. You may be given other medication to help relax the uterus and any prostaglandin tablet or gel remaining in your vagina may be removed. Using Oxytocin Oxytocin is given in hospital in the delivery room (labour ward). This is a drug that encourages contractions. Oxytocin is given through a drip and enters the bloodstream through a tiny tube into a vein in the arm. Once contractions have begun, the rate of the drip can be adjusted so that your contractions occur regularly until your baby is born. If your membranes have ruptured (waters broken) prostaglandins and oxytocin are shown to be equally effective methods of inducing labour. This is the case whether this is your first pregnancy or not, and whether or not your cervix has ripened. Whilst being given the oxytocin the midwife or doctor should monitor your baby's heartbeat continuously. For further information see the National Institute for Clinical Excellence information booklet "Monitoring your baby's heartbeat during labour" - 2001. If your waters have not broken, a procedure called an amniotomy may be recommended. This is when your midwife or doctor makes a hole in your membrane to release (break) the waters. This procedure is done through your vagina and cervix using a small instrument. This will cause no harm to your baby, but the vaginal examination needed to perform this procedure may cause you some discomfort. Women who have oxytocin are more likely to have an epidural to help with pain. An epidural is a pain relief injection given into your back. Oxytocin is given by a drip and being attached to this will limit your ability to move around. Whilst it may be okay to stand up or sit down, it will not be possible to have a bath or move from room to room. Very occasionally oxytocin can cause the uterus to contract too much which may affect the pattern of your baby's heartbeat. If this happens you should be asked to lie on your left hand side and the drip will be turned down or off to lessen the contractions. Sometimes another drug will be given to counteract the oxytocin and lessen the contractions. If you have already had prostaglandins, oxytocin should not usually be given for at least six hours. Your doctor or midwife should fully discuss these options with you before any decision is reached. They should explain the procedures and care that will be involved and whether there are any risks to you or your baby. Further information For further information about induction of labour, and all other aspects of pregnancy and childbirth, talk to your midwife or doctor. Nice.org.uk Feb 2008

This video, whilst she is delivering naturally, note that the mother is flat on her back and given an episiotomy a little too hastiliy maybe...

Ovulation induction can be used for women who have been diagnosed with Hypothatic Pituitary failure or women with Polycystic ovary sysndrome and consequently may not be ovulating (Annovulatory). Monitoring the response to these drugs can be in the form of a blood or urine test (measuring Luteninizing Hormone). In some cases regular ultrasound scans may be offered. The aim of ovulation induction is to aid in the ovaries to produce a follicle and hopefully a mature egg. Ovulation induction may be offered in the form of the following drugs. Clomiphene or Clomid is a tablet that aids the ovaries to produce a follicle and in turn an egg. Clomid is administered on Day 2 of the menstrual cycle and continued for five days. Monitoring in the form of urinary LH testing kits or blood tests may be offered. Ideally, as recommended by the NICE guidelines, the first cycle of Clomid should be tracked and monitored to observe the individuals response to the drug. Clomid can be used in conjunction with follicular tracking to monitor the number of follicles as well as advising timed intercourse around ovulation. The couple will then be advised to start having sexual intercourse 3 times per week to optimise chances of conception.

unasissted surrogate mother birth video (water birth) I found this video absolutely amazing. Not only has the woman enabled a childless couple to become parents, but she had the strength and confidence to give birth unasissted at home. Wonderful

Fertilization failure in IVF is particularly common where there are grossly abnormal semen parameters or where the number of active spermatozoa is insufficient. Gamete micromanipulation is the only way to overcome this problem and offer assistance to couples who previously had to rely on the use of donor sperm. The ICSI procedure entails the deposition of a single sperm into the main body of the egg (cytoplasm) thus bypassing the outer layers of the egg (zona pellucida). The whole procedure is performed in the lab by the embryologists using special equipment, for egg and sperm manipulation, under the control of high-powered microscopes. This procedure is usually carried out in cases of severe male infertility (low number of active sperm or increased number of abnormal shape) For example men with azoospermia, and is also suggested in couples who have undergone multiple conventional IVF cycles with low fertilization rate. Finally, retrieval of low number of eggs, the existence of sperm with no acrosome unable to penetrate the egg and eggs with thick zona pellucida represent further indications for the performance of this procedure.

In-Vitro Fertilisation (IVF) is just one of several assisted conception techniques available to help people with fertility problems to have a baby. It involves an egg being surgically removed from the ovary and fertilised outside the body. The main IVF technique was developed in the 1970s. This involves giving the woman fertility drugs to stimulate egg production, and then surgically retrieving the eggs from the ovaries. She is then given hormones to prepare her uterus for pregnancy, while the eggs are fertilised with the sperm in a laboratory. The embryos are then implanted into the woman's uterus, and if all goes well, a normal pregnancy is achieved. There are several risks involved with assisted conception. The diagnostic and treatment procedures can involve discomfort, particularly for the woman undergoing IVF, who may experience side effects from the fertility drugs, and may find the egg retrieval uncomfortable. Ovarian hyper-stimulation syndrome (OHSS) is a rare but known side effect of IVF. It occurs when the fertility drugs given to stimulate egg production in the woman are so successful that the ovaries cannot cope with the increased number of eggs. A mild incidence can cause pain and bloating. If the overstimulation is severe, blood clots, kidney damage and twisting of the ovaries may occur, and monitoring in hospital will be required. OHSS can jeopardise the progress of the treatment cycle. Some assisted conception techniques carry an increased risk of ectopic pregnancy, where the fertilised egg implants in the fallopian tubes instead of the uterus. There is an increased chance of multiple gestation, that is, of producing twins or triplets, as the chances of IVF success are maximised by more than one embryo being put back into the womb. This has associated dangers, such as an increased risk of problems occurring during the pregnancy or labour, and of the babies being delivered prematurely. IVF procedures developed more recently include Intra-cytoplasmic Sperm Injection (ICSI). This helps those men for whom the standard IVF technique would fail, for example if their sperm are unable to penetrate the egg, to achieve pregnancy with their partner. nhs.gov.uk feb2008

fetus at 16 weeks of regnancy Your baby can smile! At 13-14 weeks the baby's muscles around the mouth have formed enough to enable a smile. The baby's liver has begun to secrete bile and the pancreas is producing insulin. The baby at 13 weeks will weigh between 13 and 20 grams. The placenta is fully functioning now and will have to produce hormones to sustain the pregnancy (progeterone) and its all systems go! Between 15 and 16 weeks The skin is very thin and you can see the blood vessels clearly underneath. The scalp hair pattern is developing while fine hair (called lanugo) covers the baby's body. The baby is approximately 12-14 cm (3.7 to 4.1 inches) and weighs about 50 grams by the end of week 15 By 13, morning sickness for some women may have begun to ease and they may even find their clothes getting a little tight although it will be a few more weeks before a prominent bump appears. At 16 weeks The top of the womb can be felt between the pubic bone and naval. A heartbeat can be detected through a midwifes pinnard or sonicaid, which is an electronic listening device