The nine months of your life are crucial; it launches a new episode of your life. Therefore you must act seriously enough to cut down on unhealthy food habits. Most importantly you must make yourself aware of the different disorders that might occur. If precautions are not taken at the proper time, these can lead to complications and even unfortunate miscarriages. Say No to Alcohol and Drugs Consumption of alcohol during this period of nine months is risky. Alcohol is said to cause several birth defects. You must be aware of the different medicines you take; for certain antibiotics can have adverse effects on your body and especially on the developing fetus. You must stop smoking cigarettes and relying on drugs for temporary satisfaction. These can terminate pregnancy and also lead to birth defects. Common Disorders Disorders that are likely to occur during your pregnancy are anemia, thomboembolic disease and several urinary tract infections. The common symptom of these disorders is high fever. Fever might seem to be a less harmful term but for a pregnant woman it might pose as a serious threat. If you feel feverish during the first trimester, act spontaneously. This is because fever as high as 103°F not only enhances the chances of miscarriages but may also affect the fetuses developing brain and spinal cord. Fever at the advanced stages of your pregnancy may cause irregular labor pain. German measles, viral infections like mumps, jaundice, chicken pox, protozoan infections and bacterial infections in the vagina may have dire effects on the fetus. On the other hand, thomboembolic disease of blood clotting may cause fateful injuries at the time of the birth of your child. Anemia is a common problem in pregnant women. Anemia may make the mother to be extremely tired, gasping for breath at times. It can also make her feel light-headed. It is therefore advisable, that you keep in touch with your doctor, and go for check up regularly for the safety of your child and of course for yourself. Aaron Nimocks is a frequent blogger at Pregnancy Hut and has written a guide on 17 weeks pregnant and 18 weeks pregnant. Article Source: http://EzineArticles.com/?expert=Aaron_Nimocks

Amniotic fluid embolism (AFE) is a rare obstetric emergency in which it is postulated that amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, causing cardiorespiratory collapse. In 1941, Steiner and Luschbaugh described AFE for the first time after they found fetal debris in the pulmonary circulation of women who died during labor. Current data from the National Amniotic Fluid Embolus Registry suggest that the process is more similar to anaphylaxis than to embolism, and the term anaphylactoid syndrome of pregnancy has been suggested because fetal tissue or amniotic fluid components are not universally found in women who present with signs and symptoms attributable to AFE.1 The diagnosis of AFE has traditionally been made at autopsy when fetal squamous cells are found in the maternal pulmonary circulation; however, fetal squamous cells are commonly found in the circulation of laboring patients who do not develop the syndrome. In a patient who is critically ill, a sample obtained by aspiration of the distal port of a pulmonary artery catheter that contains fetal squamous cells is considered suggestive of but not diagnostic of AFE syndrome.2 The diagnosis is essentially one of exclusion based on clinical presentation. Other causes of hemodynamic instability should not be neglected. Pathophysiology The pathophysiology of AFE is poorly understood. Based on the original description, it was theorized that amniotic fluid and fetal cells enter the maternal circulation, possibly triggering an anaphylactic reaction to fetal antigens. However, fetal material is not always found in the maternal circulation in patients with AFE, and material of fetal origin is often found in women who do not develop AFE. Benson et al3 tested 2 hypotheses concerning the pathophysiology of AFE: (1) Clinical symptoms result from mast cell degranulation with the release of histamine and tryptase, or (2) Clinical symptoms result from activation of the complement pathway. Nine women with AFE were compared with 22 women with normal labors. Serum from patients with AFE was collected within 14 hours of symptom onset and frozen. Urine was collected within 12-24 hours after symptom onset. Control patients had complement levels measured on admission, during labor, and the day after delivery. Six of the 9 women with AFE died, and all 9 required blood transfusions for disseminated intravascular coagulation (DIC). Seven women had no evidence of mast cell degranulation (ie, either urinary histamine or serum tryptase). Compared with postpartum control patients, complement levels in the AFE group were severely depressed. C3 in the AFE group was 44 compared with 117.2 in the postpartum group. C4 was 10.7 in the AFE group versus 29.4 in the postpartum group. These differences were statistically significant. This suggests that complement activation may play an important role in the pathophysiology of AFE. Farrar and Gherman4 reported the case of a 40-year-old multipara in active labor with acute onset of facial erythema, seizures, hypoxia, cardiac arrest, DIC, and ultimately death. Fetal squames and fibrin thrombi were found in the pulmonary tree at autopsy. Blood drawn 2 hours after symptom onset had a serum tryptase level of 4.7 ng/mL (normal <1 ng/mL). A case reported by Marcus et al5, in which AFE developed after a spontaneous rupture of membranes, demonstrated no increase in mast cells or degranulation in lung tissue as shown by Giemsa staining. Serum tryptase levels were 11.4 ng/mL (normal <11.4 ng/mL). The initiating event is poorly understood. However, usually during labor or other procedure, amniotic fluid and debris, or some as yet unidentified substance, enters the maternal circulation; this may trigger a massive anaphylactic reaction, activation of the complement cascade, or both. Progression usually occurs in 2 phases. In phase I, pulmonary artery vasospasm with pulmonary hypertension and elevated right ventricular pressure cause hypoxia. Hypoxia causes myocardial capillary damage and pulmonary capillary damage, left heart failure, and acute respiratory distress syndrome. Women who survive these events may enter phase II. This is a hemorrhagic phase characterized by massive hemorrhage with uterine atony and DIC; however, fatal consumptive coagulopathy may be the initial presentation. source: emedicine.com

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When you've been struggling for some time to get pregnant, and you believe you've tried everything, then you must begin to eliminate every potential mistake you might be making - no matter how small or trivial it may seem. Some of these small changes can produce incredible results, especially when enough of these small changes are made together. And there's no better place to start making these small changes than with your diet. You are what you eat, after all! One of the foods you can eliminate from your diet right now to immediately give a boost to your fertility levels are peas. Many women and men eat peas regularly, and since they're generally a very healthy vegetable that's not surprising. But the truth is that peas are incredibly damaging to fertility levels. This isn't something that's always been known, and it's not something that's common knowledge - that's why so many of us make the mistake of eating them while we try to conceive. It was actually an accident that led to the discovery about peas. And believe it or not, the discovery was made in Tibet. Scientists noticed that Tibet had one of the slowest-growing population rates on Earth. And these same scientists began to suspect that peas may be to blame. That's because the pea is a staple food in Tibet, and is consumed in large amounts. Researchers around the world began to study this theory, and not long after they discovered a natural chemical in peas with strong anti-fertility effects. But even the researchers couldn't believe just how strong an effect this chemical was having. When they gave this chemical to women in capsules the pregnancy rate dropped by an incredible 60 percent almost overnight. The effect was so immediate and so strong that many Asian countries began extracting the chemical from peas and using it as a contraceptive. It even affected men. Because when men took the chemical their sperm counts plummeted by a massive 50 percent. Despite these shocking discoveries, it's taken some time for the ideas to reach the western world. But slowly we're beginning to realise how deadly peas can be to our chances of becoming pregnant. This is largely thanks to some studies carried out recently in the United States that confirmed what the researchers had been trying to tell us for years - that peas have the potential to completely prevent conception, and should therefore be avoided entirely until after your baby is born. Ellie Lewis is a professional writer/researcher whose specialty is helping couples beat infertility. She's also the creator of "You Can Get Pregnant," the highly-acclaimed video guide on how to get pregnant quickly, safely, and naturally. If you'd like to maximize you fertility and guarantee yourself the best chance of getting pregnant then claim your free access to the "Get Pregnant Now" video course by visiting Ellie's site http://www.YouCanGetPregnant.com Article Source: http://EzineArticles.com/?expert=Ellie_Lewis

Key points Once you have had chickenpox you cannot catch it a second time. This is known as being immune to it. Most UK adults are immune to chickenpox. Chickenpox is very rare in pregnant women in the UK. Although it affects very few babies in the womb, it can be very serious for them and/or their mother. If you are not immune to chickenpox, or you are not sure whether you are immune, while you are pregnant do all you can to avoid coming into contact with people who may have it. If you have chickenpox, avoid contact with other pregnant women and new babies until at least five days after the rash appears, or until all the blisters have crusted over. About this information This information is aimed at you if you are pregnant or are thinking of becoming pregnant. It tells you: what chickenpox is; why it is important for you to avoid contact with chickenpox while you are pregnant; about the most effective treatments available in the UK for you and your baby if you come into contact with chickenpox while you are pregnant. It aims to help you and your health care team to make the best decisions about your care. It is not meant to replace advice from a doctor or nurse about your own situation. It does not look at how to deal with chickenpox in small children. Some of the recommendations here may not apply to you; this could be because of some other illness you have, your general health, your wishes, or some or all of these things. If you think the treatment or care you get does not match what we describe here, talk about it with your doctor or with someone else in your health care team. Return to top What is chickenpox? Chickenpox is a very infectious illness and is caused by a herpes virus called Herpes zoster. The medical name for chickenpox is varicella. Most people in the UK get chickenpox in childhood and are immune to it after that. Being immune means you cannot catch it again. A small number of adults, however, are not immune. If you catch chickenpox as an adult it can be more serious. If you are pregnant there may be risks for your baby, too. You usually catch chickenpox by being in the same room as an infected person for at least 15 minutes, or being face to face with them for at least five minutes. You can have chickenpox for ten days to three weeks before any symptoms appear: the first signs are a fever and feeling unwell an itchy rash of watery blisters will appear after a few days the blisters will burst, form a crust and finally heal over. You can pass chickenpox on to other people from up to two days before the rash appears until all the blisters have crusted over. After you have had chickenpox the virus stays in your body and can become active again later. This time it causes shingles. Shingles appears as a patch of itchy blisters which dry out and crust over after a few days. It can be painful. If you have never had chickenpox you can catch it if you come into close contact with the fluid from the blisters of someone with shingles. Return to top What should I do if I come into contact with chickenpox? If you have already had chickenpox, you are immune and there is nothing to worry about. You do not need to do anything. If you have never had chickenpox, or you are not sure whether you have had it: See your GP as soon as possible. They can give you a blood test to find out if you are immune (eight or nine out of every ten women in the UK turn out to be immune and have nothing to worry about). If you develop a rash, contact your GP immediately If you catch chickenpox: Tell your doctor immediately. Tell your doctor if you get breathing problems or any new symptoms. Avoid contact with other pregnant women and new babies until at least five days after the rash appears or until all the blisters have crusted over. What could chickenpox mean for my baby? If you have already had chickenpox, your baby will have the benefit of your immunity during the pregnancy and for the first seven days after it is born. You have nothing to worry about. If you get chickenpox in the first three months of your pregnancy this does not seem to increase the risk of a miscarriage. Only a very small number of pregnant women (about three in every thousand) catch chickenpox in the UK. An even smaller number of babies are affected in the womb. The risks to an unborn baby depend on when its mother catches chickenpox. If she catches it: … up to the 20th week of pregnancy – the baby may be infected. In just 1 to 2 of every 100 cases the baby gets shingles later in the pregnancy; this can cause damage to the eyes, legs, arms, brain, bladder or bowel. If a baby is infected, an ultrasound scan may show up some of the problems if it is done at 16-20 weeks or five weeks after the mother has caught the virus. The baby’s eyes should usually be tested shortly after it is born. … between the 20th and 36th week – the baby will have no problems in the womb. The virus will stay in its body, however, and may show up as shingles in the first few years of its life. It will be no worse than for any other child. … after the 36th week and between one and four weeks before birth – the baby may get chickenpox in the womb. … and the baby is born within seven days of the mother’s rash appearing – the baby may get severe chickenpox; some babies may die as a result. The birth may be more risky for a mother and her baby if she develops the rash of chickenpox within seven days of the birth. If you get shingles while you are pregnant it is usually mild and there is no risk for you or your baby. Return to top How can my baby be treated? Two anti-viral drugs are available to treat chickenpox. Varicella-zoster immune globulin (VZIG) strengthens the immune system for a short time. It is made from human blood, given by donors. It does not necessarily prevent chickenpox developing but it may make the attack less serious. It is used before any symptoms appear; it does not work afterwards. Aciclovir may reduce fever and symptoms if it is started within 24 hours of the rash developing. There is not enough evidence to show whether it can prevent serious complications for mother or baby. If you get chickenpox within five days of giving birth, or if you show symptoms within two days, your newborn baby will be given VZIG. This will not necessarily stop it getting chickenpox, but it should reduce symptoms and the risk of complications. Your baby will be checked for signs of chickenpox for about another two weeks. If your baby is born with chickenpox it will usually be given aciclovir by injection; this should help to support the baby’s immune system and make the rash heal more quickly. If your baby comes into contact with chickenpox within the first seven days after the birth it will be protected by any immunity you have. If you are not immune, or if you have given birth early, your baby will usually be given VZIG. What could chickenpox mean for me? Although chickenpox is very rare in pregnant women in the UK it can be very serious. You can get complications such as pneumonia. Very occasionally women can die from complications, but such deaths are very rare now (nine were reported in the eleven years from 1985 to 1996). You are at greater risk of complications if you catch chickenpox when you are pregnant if: you smoke; or you have a lung disease such as bronchitis or emphysema; or you are taking steroids or have done so in the last three months; or you are in the second half of your pregnancy. If any of these apply to you, and you are not immune and you think you have been in contact with chickenpox, see your GP immediately. You may have to spend some time in hospital. You cannot be vaccinated against chickenpox in the UK. If you are not immune to chickenpox, or you are not sure whether you are immune, try to avoid coming into contact with people who may have it. Adults from tropical or subtropical areas are less likely to have had chickenpox in childhood. If you have moved to the UK you have a greater risk of catching chickenpox than women who have grown up here. Return to top What treatment can I get? Your GP should send you to hospital if you catch chickenpox and develop any of the following: Chest and breathing problems Headache, drowsiness, vomiting or feeling sick Bleeding A bleeding rash A dense rash If you are not immune to chickenpox you can be treated with VZIG, usually by injection, up to ten days after you come into contact with chickenpox. If you take VZIG more than ten days after you come into contact with chickenpox it will not prevent it from developing, but your symptoms should be milder and last less time than usual. It is not yet clear whether taking VZIG will prevent your unborn baby from catching the chickenpox virus. One study of 97 pregnant women who had chickenpox and were given VZIG showed that all their unborn babies stayed free of the infection. In another case, however, a baby developed complications in the womb even though the mother was given VZIG. Aciclovir can reduce your fever and symptoms if you develop a rash and you are seen within 24 hours of it appearing. It is not usually prescribed for chickenpox if you are less than 20 weeks pregnant. You will usually be given aciclovir by mouth. Aciclovir is no use for chickenpox if you take it more than 24 hours after the rash appears, so it is important to get to your GP quickly. Once you have given birth you are no longer considered to be at serious risk if you come into contact with chickenpox, but if you are not immune your doctor may give you aciclovir. If you develop the rash, try not to scratch. Take extra care with hygiene to prevent your skin getting infected or turning septic; your GP can tell you more about how to do this. Return to top Are there any risks in treatments? If you take aciclovir after the 20th week of your pregnancy it does not seem to harm your unborn baby. Your doctor can tell you more about the risks of VZIG as a human blood product. Is there anything else I should know? Hospitals and GP surgeries take all reasonable steps to avoid contact between pregnant women and staff with chickenpox. No treatment can be guaranteed to work all the time for everyone. You have the right to be fully informed about your health care and to share in making decisions about it. Your health care team should respect and take your wishes into account.

Key Points Chorionic villus sampling is known as CVS. CVS is a procedure in which a tiny sample of tissue is removed from the placenta, or afterbirth, either by passing a fine needle through the mother's abdomen (transabdominal) or by passing a fine tube or forceps through the cervix (transcervical). CVS is usually offered to women who have an increased chance of having a baby with a disorder. It is not usually offered on a routine basis. CVS is also used to detect whether or not a baby has a chromosomal disorder, such as Down syndrome. The safest time to have CVS is after 10 weeks of pregnancy. Although CVS is usually done before 14 weeks of pregnancy, it can be done later than this. About 2 in every 100 women (or 2%) who have a CVS from 11 to 13 weeks of pregnancy under ultrasound guidance miscarry as a result of the procedure. An alternative procedure, amniocentesis, has a lower risk of miscarriage and is usually offered later in pregnancy. RCOG information about amniocentesis can be found here. If a disorder is diagnosed, then you should be given information and the opportunity to discuss this with a specialist. You will be asked to sign a consent form before having CVS. About this information This information is intended for you if you are pregnant and you have an increased chance of the baby having a disorder. You may have already been offered CVS. The information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Amniocentesis and Chorionic Villus Sampling (published in January 2005). To find out more about the guideline, see the Sources and acknowledgements section. This information tells you about CVS and what you need to know if you are considering whether or not to have this procedure during pregnancy. This information aims to help you and your healthcare team make the best decisions about your care. It is not meant to replace discussions with an obstetrician, midwife or genetic counsellor about your situation. This information does not tell you about: amniocentesis – see RCOG patient information ‘Amniocentesis: what you need to know' If you would like further information about this topic, then please ask your healthcare professional. Some of the recommendations here may not apply to you. This could be because of some other illness you have, your general health, or some or all of these things. If you think the treatment or care you get does not match what we describe here, talk about this with your obstetrician, midwife or genetic counsellor. What is CVS? CVS is a diagnostic procedure carried out during pregnancy. It is most commonly used to check the baby's chromosomes for specific disorders such as Edward syndrome , or Down syndrome and a few specific genetic disorders . return to top When and how is CVS performed? CVS is performed after 10 weeks. Before the procedure, gel is applied over your abdomen. You are scanned to check the positions of both the baby and the placenta (afterbirth). CVS involves taking a tiny piece of the developing placenta, where it is attached to the womb. The placenta contains tissue that is genetically identical to the baby. CVS may be performed in two ways (see below). The obstetrician doing the procedure will choose the method that he or she thinks is more appropriate for you. This will depend upon the position of the placenta. Through the abdomen (transabdominal) A transabdominal CVS may be performed from 13 weeks onwards. For this, you might get some local anaesthetic to numb the area. Your skin is then cleaned in the area where the needle will be inserted. Transabdominal CVS Using an ultrasound probe to guide the direction, a needle is pushed through the abdomen and the wall of the womb into the placenta. A small amount of placental tissue is sucked up into a syringe by moving the needle in and out of your abdomen. The needle is then taken out and the baby is checked on ultrasound. Through the cervix (transcervical) Transcervical CVS is usually performed between 11 and 13 weeks. A speculum is inserted into your vagina. The vagina and cervix are cleaned. Using ultrasound guidance, fine forceps or a small tube is passed through the cervix to the placenta. A small amount of placental tissue is removed, using either forceps or a fine suction catheter. Transcervical CVS The baby is checked on ultrasound after this. After each procedure, the placental tissue, which contains some of the baby's cells, is sent to the laboratory for testing (see section on ‘What are the laboratory tests?'). If your blood group is Rh (sometimes called rhesus) negative, you will be recommended an injection of anti-D immunoglobulin after the procedure to prevent you from developing antibodies against the baby's blood cells. You can find more information about this in Guidance on the routine use of anti-D prophylaxis for RhD negative women: information for patients , by the National Institute for Health and Clinical Excellence (NICE). Is CVS painful? Most women say that having CVS, either transabdominal or transcervical, is uncomfortable rather than painful, a bit like a period pain. Some women say the transcervical method is like having a cervical smear taken. Women also say they feel anxious. After the procedure you should rest, if you wish to, for the remainder of the day. You may notice some ‘spotting' of blood and cramping for a few hours afterwards. This is normal. If you experience any unusual symptoms immediately after the test, such as feeling shivery (as if you have flu), fluid loss, bleeding or contractions, then you should seek advice immediately. return to top What are the risks? Every pregnancy carries a risk of miscarriage. CVS may sometimes cause a miscarriage due to injury or infection in the womb. The additional overall risk of miscarriage from CVS is approximately 2%. In other words, about 2 in every 100 women who have CVS under ultrasound guidance after 10 weeks will miscarry. Your healthcare professional will discuss the risk at your hospital. It is possible that the risk of miscarriage following transabdominal CVS may be less than transcervical CVS. More research is needed to confirm this. There is a small risk, less than 1 in 1000 women who have CVS, that the procedure will cause a serious infection. Infection can be caused by the needle puncturing the bowel, or skin contamination, but neither of these should happen if standard practices for CVS are followed. Infection can also be caused if the needle is contaminated by the ultrasound gel or the ultrasound probe. These risks can be reduced by standard procedures to reduce infection, for example, by using sterile gel. Clinicians who do CVS often, rather than occasionally, seem to be slightly better at getting enough placental tissue during the procedure, and may also have a lower risk of miscarriage. The Royal College of Obstetricians and Gynaecologists recommends that to maintain their skills, clinicians doing CVS should do at least 10 each year. Who should consider CVS? Women may consider CVS if they: have had a previous pregnancy affected with a disorder have one or more relatives affected with a genetic disorder themselves or their partner are at greater risk of having a child with a genetic disorder, such as cystic fibrosis, thalassaemia or sickle cell disease have received a result from a scan which shows certain features, such as increased fluid at the back of the baby's neck (nuchal translucency) indicating the baby may have a disorder such as Down syndrome have an increased risk of a chromosomal disorder because they are over a certain age (typically 35 years) want to know for certain whether the baby has a disorder. return to top What are the laboratory tests? There are two types of laboratory tests which can be used to look at the baby's chromosomes. These are: a full karyotype which checks all the baby's chromosomes. Results from this test are usually ready in two to three weeks a rapid test which checks for specific chromosomes. The disorders that can be detected by the rapid test include Down syndrome (known as ‘trisomy 21' caused by an additional chromosome 21), Edward syndrome (known as ‘trisomy 18' caused by an additional chromosome 18) and Patau syndrome (known as ‘trisomy 13' caused by an additional chromosome 13) and if requested sex chromosome disorders. Results from this test are usually ready after three working days. There may be a charge for this test. The unit where you had your CVS will make arrangements with you as to how you will receive your results. How reliable are the laboratory tests? The laboratory tests use different techniques to analyse the baby's chromosomes. With the full karyotype test there is a small chance, about 1 in 100, that it will not give a clear result. This could be because the sample was analysed and the test gave an uncertain result. Problems with the rapid test are that some samples may not be suitable for the test and that, even if it does not find a problem, the full karyotype may show an abnormality when that result becomes available about two weeks later. For most women the laboratory test will give a definite ‘yes' or ‘no' answer. The result will let you know, one way or the other, whether the baby has the disorder the test was looking for. If the test gives an uncertain result, it may be necessary for you to have another diagnostic procedure, known as amniocentesis (further information about Amniocentesis can be found at here). return to top What will the results tell me? The laboratory tests which look at the baby's chromosomes are able to detect a range of disorders, but not all. Most women who have CVS will have a ‘normal' result, in other words, their baby will be born without the disorder(s) that the test was looking for. Some women will be informed that the baby has the disorder the test was looking for. Very occasionally women have CVS to detect Down syndrome and another disorder is detected by the test. A very few women will have a ‘normal' result and yet in spite of this, they will have a baby born with the disorder tested for, or another chromosomal or genetic condition. A normal result does not exclude every disorder. What are my choices if the results are abnormal? If the results are abnormal, these will be discussed fully with you. For the majority of disorders, there is no treatment or cure. You will need to consider what is best for you and the baby. This might be to: continue with the pregnancy and use the information you have gained to help prepare for the birth and aftercare of your baby end this pregnancy. It is helpful to talk through all the options with your doctor or midwife before you make a decision about having CVS. You should be able to talk through your options with a paediatrician and consultant geneticist or genetic nurse counsellor. Some women who made an informed decision to end their pregnancy want to talk with a counsellor afterwards about their experience. return to top Making a decision about CVS Making a decision about having a diagnostic procedure during pregnancy, such as CVS, can be difficult. You may be making this decision alone or with your partner. To help make the decision which is best for you, your healthcare professional should discuss the following information with you: the types of laboratory tests available and what the results will tell you the reliability of the laboratory test(s) the risk having an uncertain result and being offered a repeat procedure the risk of miscarriage from CVS (both transabdominal and transcervical) including the risk in your own unit at this time how long the results will take how you will get the results your options if the baby is found to have a disorder. You may want to know more about the disorder or disorders which can be detected by CVS. You may also want to know more about what is involved in ending a pregnancy and how you may feel afterwards. You might want to find out as soon as possible about a disorder because you are fairly certain that, if the results are abnormal, you would end this pregnancy. In this instance, you may decide that CVS is the best option for you. Amniocentesis as an alternative to CVS If you are uncertain what you would do if the baby has a disorder, but want to know anyway, then you may consider having a procedure later on in pregnancy. This procedure is known as amniocentesis (further information on Amniocentesis can be found at www.rcog.org.uk). Amniocentesis is a diagnostic procedure which is done after 15 weeks of pregnancy. About 1 in a 100 (or 1%) women who have an amniocentesis, under ultrasound guidance, from this time will miscarry as a result of the procedure. What is the difference between CVS and amniocentesis? CVS Amniocentesis What does it involve? Taking a small amount of placenta under ultrasound guidance. Taking a small amount of amniotic fluid that surrounds the baby in the womb under ultrasound guidance. When is the safest time to have the procedure? After 10 weeks of pregnancy. Transcervical CVS is usually done at 11-13 weeks, transabdominal after 13 weeks. Normally after 15 weeks of pregnancy. What is the risk of miscarriage? About 2 in 100 (2%) women will miscarry as a result of the procedure. About 1 in a 100 (1%) women will miscarry as a result of the procedure. What is involved in ending the pregnancy? At this stage, this involves a n small operation to empty your womb. Ending a pregnancy later on may involve going into labour. In making a decision about CVS, or amniocentesis, it is important that you have enough time and that you feel supported in your final decision. You should be given time to talk through your options and be able to request any further information. The final decision is yours. Only you can weigh up how much you want early information about a disorder against the slight risk that the procedure may lead to miscarrying a baby who may, or may not, have a disorder. If you decide to have CVS, then you will be asked to sign a consent form before the procedure is carried out. return to top Is there anything else I should know? If you are are HIV positive and you decide to have CVS, this might increase the risk of passing HIV on to your baby. You may be offered treatment with HAART (highly active antiretroviral therapy), if you are not already taking it. This reduces the risk of the HIV virus infecting the baby. If you carry hepatitis B or hepatitis C viruses , there is in theory a possibility that CVS might increase the risk that you pass this onto your baby. There is not enough information to be sure about whether this risk is real or not. If you would like to know more about amniocentesis, see ‘Amniocentesis: what you need to know' (RCOG website address). Your health professional should give you full information about amniocentesis. You have the right to be fully informed about your health care and to share in making decisions about it. Your healthcare team should respect and take your wishes into account.

Key points Cord blood is the baby's blood that remains in the placenta and umbilical cord after birth. Cord blood contains stem cells. Blood stem cells from cord blood can be used for transplants for children and young adults. This is known as a cord blood or stem cell transplant. A cord blood transplant can treat many blood diseases, immune diseases and metabolic diseases. It is not yet known if stem cells from cord blood can be used to treat other conditions. Stem cells from cord blood can be collected and stored for future use. Cord blood is not usually collected as a routine. Cord blood must be collected safely and in a way that minimises contamination and infection. It is best if a trained technician who is not involved in the care of a woman or her baby collects cord blood. There are two types of cord blood bank: private (commercial) banks public banks. Private banks are generally for-profit organisations which store cord blood for possible future use by an individual's own family for a fee. Each hospital should have its own policy on private banking and make this policy available to prospective parents. A public bank, such as the NHS cord blood bank, stores donated cord blood for use by patients anywhere in the world who need a transplant. A public bank may also store cord blood for families with a known genetic or other disease. The Royal College of Obstetricians and Gynaecologists (RCOG) supports public banking and donation to the NHS cord blood bank. The RCOG remains unconvinced about the benefit of storing cord blood with a private bank for families who have no known medical reason to do so. About this information This information is for you if you are deciding whether to use a private (commercial) cord blood bank. It is based on the Royal College of Obstetricians and Gynaecologists (RCOG) Scientific Advisory Committee (SAC) Opinion Paper on Umbilical Cord Blood Banking published in 2006.This Statement is due for revision in 2008. This information aims to help you and your healthcare team make the best decisions for you and your family. It is not meant to replace specific advice from a doctor, or midwife, about your own individual situation. Some of the information here may not apply to you. Your doctor, midwife, or another member of your healthcare team will discuss any further issues with you. What is cord blood? Cord blood is the baby's blood that remains in the placenta and cord after birth. After the baby is born, the blood in the placenta and cord is no longer needed and is usually disposed of carefully. Cord blood contains many different types of cells including very small numbers of a particular type of cell, known as stem cells. These cells are the building blocks of all the other cells in the body. Different parts of the body are made up of different types of cells: the heart is made up of heart cells, the liver is made up of liver cells, blood is made up of blood cells, and so on. Stem cells can grow into these different kinds of cells in the body. Why is cord blood useful? Cord blood is currently used in the treatment of: blood related disorders, such as leukaemia, sickle cell anaemia and thalassaemia (also known as haemoglobinopathies) some immune system disorders metabolic storage disorders, such as Hurler syndrome (an inherited condition caused by an enzyme deficiency). Some scientists have claimed that cord blood could potentially be used to cure diseases such as Alzheimer's disease, Parkinson's disease and conditions such as diabetes. They also claim that cord blood could be used to treat diseases affecting the brain, heart and spine. Other scientists argue that there is not enough evidence to back up these claims. It may be that in the future more diseases will be treated with cord blood. At present, however, much more research is needed. return to top How is cord blood used? Blood stem cells are stem cells that grow into new blood. A cord blood transplant uses blood stem cells to replace diseased cells with healthy new cells and rebuild an individual's blood and immune system. For the transplant to be a success, the new cells must match the individual's own cells as closely as possible. There have been over 6000 successful cord blood transplants (between relatives and non-relatives) worldwide. Cord blood transplants can be used as an alternative to bone marrow transplants to treat some disorders. This has mainly been successful in treating young patients for leukaemia. The advantages of a cord blood transplant, compared with a bone marrow transplant, are that: there are fewer complications with a cord blood transplant. it is easier to find a match from stem cells than from bone marrow. This, in turn, leads to increased access to transplantation, particularly for patients from ethnic minorities. cord blood can be frozen and stored for years so it is more readily available. there are fewer delays with a cord blood transplant. Delays are inevitable in the case of bone marrow transplants because of the need to search registers, contact would-be donors and the bone marrow retrieval procedure itself. The disadvantages are that: a cord blood transplant may not be possible. There may not be enough cells from one cord for a transplant, especially to an adult. for some blood conditions, such as certain leukaemias, a transplant using a child's own blood may be harmful. This is because the stored stem cells may contain the same abnormality and risks that caused the child to become ill in the first place. In this case, a donation from another source would be better. What is cord blood banking? Cord blood banking is when cord blood is collected and stored for treating a disease or illness. Types of cord blood bank Public banks If you give birth in one of three hospitals in the south east of England, you can donate cord blood to a public bank such as the NHS cord blood bank. There is also a small NHS public bank in Belfast in Northern Ireland (see section ‘Is there anything else I should know?”). Donation is voluntary and collection and storage is free of charge. A public bank stores cord blood for use by anyone anywhere in the world, thus ensuring fair access for all patients requiring stem cell transplantation. It is an alternative to a volunteer bone marrow donor registry. The RCOG supports public banking and donation to the NHS cord blood bank. If there is a known genetic condition in your family or you already have a child with leukaemia or blood related disorder, your clinician may recommend that you consider banking your baby's cord blood. Your clinician may be able to arrange for cord blood to be collected and stored in the NHS cord blood bank for future use by your family. You should also discuss this with the doctor looking after the person in your family who is ill. return to top Private (commercial) banks People can store cord blood with a private bank in the hope that, in the future, cord stem cells may be useful, should a member of their own family develop a disease treatable by stem cell therapy. The chances of your child ever needing to use his or her own cord blood are extremely small, so there is no guarantee that the cord blood will ever be needed. Nevertheless, you may feel this is worthwhile, like an insurance policy. There is a fee for collection and long-term storage of up to £1,500. Depending on circumstances, some private banks may store cord blood free of charge for certain families where there is a known genetic condition. If you have not banked with a private bank and your child develops a blood related disorder, immune system disorder or metabolic storage disorder in the future, then you still have other options. These are: cord blood from a public bank in the UK or internationally. use of other sources of therapy such as bone marrow transplants. There is worldwide collaboration with international bone marrow registries to find suitable matches for patients who require a bone marrow transplant. treatment from a sibling who matches a family member who can give bone marrow. Full written information on the private banking policy at your hospital should be given to you at your antenatal booking appointment. This information may not be given routinely, so you may need to ask if you would like to find out more. The RCOG remains unconvinced about the benefit of storing cord blood with a private bank for families who have no known medical reason to do so. How is cord blood collected safely? Cord blood must be collected safely. It is important that: a trained technician who is not involved in your or your baby's care collects the cord blood. It is important that neither your obstetrician nor your midwife should be distracted from looking after you and your baby during and immediately after childbirth. there should be no alteration in your ‘usual management' of labour, such as the delivery of the placenta or clamping of the cord. Some evidence indicates that immediate cord clamping may be harmful to babies. However, delaying cord clamping can prevent a successful cord blood collection. cord blood should be collected after the placenta has been delivered in a clean environment using methods and facilities, which meet the required regulations including the EU Tissue and Cells Directive. Cord blood collection may not be advisable or possible if: the baby is premature you have a multiple pregnancy the cord around the neck needs to be cut early to deliver the baby you are delivered by emergency caesarean section you are being prescribed certain medication you or the father of the baby have tested positive for a transmissible infection(s). return to top Making an informed decision If you are considering private banking you should discuss this with your doctor or midwife. You may wish to consider the following points: Not all hospitals allow collection by private banks. You should ask about the private banking policy at your hospital during your antenatal booking appointment. Once you have made a decision about banking, you should let your doctor or midwife know. You may find that your midwife or obstetrician has been advised by their professional organisation not to collect blood for a private bank. There are a number of uncertainties surrounding cord blood storage. For instance, who owns the cord blood legally? What are your rights if the facility storing the cord blood breaks down and the cord blood becomes unusable? Private banks are run by private companies. If you decide to bank through a private company, you will enter into a contract between yourself and the company. It is your responsibility to check that you are happy with all the terms and conditions of the contract. Some private companies make additional charges to screen for bacterial diseases. Since April 2006 all UK cord blood banks come under the EU Directive on Tissue Cells 2004/23/EC and are required to be licensed by the Human Tissue Authority (HTA). Cord blood should be collected and banked in accordance with this. If you choose to use a private bank, it is your responsibility to check that the private bank is approved and follows correct procedures. Some questions to ask are as follows: Is the bank accredited/licensed for storage of cord blood? If it is a UK bank, has it been licensed by the Human Tissue Authority (HTA)? Does the bank follow proper collection procedures? What happens if no stem cells are collected? Does the bank follow best practice testing regimens? Does the bank follow best practice sample storage? Where is the cord blood stored? Is the transportation to the storage facility checked to ensure the blood is kept appropriately? When is the stored cord blood no longer useful? What happens to the cord blood when it is no longer needed? Who is responsible for screening the blood to ensure that HIV/hepatitis- positive cord blood is stored separately? Could my child or any of my children use the cord blood, if I am not around? What will happen to my cord blood, if the bank is no longer functioning in the future? Useful additional information A Parent's Guide to Cord Blood Banks www.parentsguidecordblood.com The Society of Obstetrician and Gynaecologists of Canada Patient information leaflet. http://www.sogc.org/health/pdf/cord-bloodfinal_e.pdf The Anthony Nolan Trust is a charity which recruits and registers bone marrow donors. http://www.anthonynolan.org.uk/ Is there anything else I should know? The Commercial company advertising itself as the UK Cord Blood Bank http://cordbloodbank.com/uk/about.php is not the same as the NHS Cord Blood Bank. The hospitals that routinely collect cord blood for storage in a public bank are Northwick Park Hospital in Middlesex, Barnet Hospital in Hertfordshire, the Luton and Dunstable Hospital NHS Trust in Luton and the Mater Hospital Trust in Belfast. source rcog.org.uk

Key points A miscarriage is the early loss of a pregnancy. Recurrent miscarriage is when this happens three or more times. Around 1 woman in every 100 has recurrent miscarriages. Most couples who have had recurrent miscarriages still have a good chance of a successful birth in future. If you have had recurrent miscarriages, you may be offered blood tests and/or a pelvic ultrasound scan to try to identify the reason for them. In spite of careful investigations, it is often not possible to find the reason for recurrent miscarriages. Your doctors will not be able to tell you for sure what will happen if you become pregnant again. About this information This information is for women and couples who have had three or more miscarriages. It is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline The Management of Recurrent Miscarriage (last revised in May 2003). It tells you: what we know about the reasons for recurrent miscarriages about recommendations the guideline makes on the most effective ways of investigating and treating women who have recurrent miscarriages. It aims to help you and your healthcare team make the best decisions about your care. It is not meant to replace advice from a doctor or midwife about your own situation. It does not look at reasons or treatment for single miscarriages. Some of the recommendations here may not apply to you; this could be because of some other illness you have, your general health, your wishes, or some or all of these things. If you think the treatment or care you get does not match what we describe here, talk about it with your doctor or with someone else in your healthcare team. What is recurrent miscarriage? A miscarriage is when you lose a pregnancy at some point in the first 23 weeks. When this happens three or more times doctors call this recurrent miscarriage. For women and their partners it is a very distressing problem. Around one woman in every 100 has recurrent miscarriages. This is about three times more than you would expect to happen just by chance, so it seems that for some women there must be a specific reason for their losses. For others, however, no underlying problem can be identified; their repeated miscarriages may be due to chance alone. Why does it happen? Often, in spite of careful investigations, the reasons for recurrent miscarriages cannot be found. However, if you and your partner feel able to keep trying, you still have a good chance of a successful birth in future. There are a number of things which may play a part in recurrent miscarriage. It is a complicated problem and more research is still needed. Your age and past pregnancies The older you are, the greater your risk of having a miscarriage. The more miscarriages you have had already, the more likely you will be to have another one. Genetic factors For around three to five in every 100 women who have recurrent miscarriages, they or their partner have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although such abnormalities may cause no problem for you or your partner, they may sometimes cause problems if passed on to your baby. Abnormalities in the embryo An embryo is a fertilised egg . An abnormality in the embryo is the most common reason for single miscarriages. However, the more miscarriages you have, the less likely this is to be the cause of them. Autoimmune factors Antibodies are substances produced in our blood in order to fight off infections. Around 15 in every 100 women who have had recurrent miscarriages have particular antibodies, called antiphospholipid antibodies (aPL), in their blood; fewer than two in every 100 women with normal pregnancies have aPL antibodies. Some people produce antibodies that react against the body's own tissues; this is known as an autoimmune response and it is what happens to women who have aPL antibodies. If you have aPL antibodies and a history of recurrent miscarriage, your chances of a successful pregnancy may be only one in ten. Womb structure It is not clear how far major irregularities in the structure of your womb can affect the risk of recurrent miscarriages. Estimates of the number of women with recurrent miscarriage who also have these irregularities range from two out of 100 to as many as 37 out of 100. Women who have serious anatomical abnormalities and do not have treatment for them seem to be more likely to miscarry or give birth early. Minor variations in the structure of your womb do not cause miscarriages. Weak cervix In some women the entrance of the womb (the cervix) opens too early in the pregnancy and causes a miscarriage in the third to sixth month. This is known as having a weak (or ‘incompetent') cervix. It is overestimated as a cause of miscarriage because there is no really reliable test for it outside of pregnancy. Polycystic ovaries If you have polycystic ovaries your ovaries are slightly larger than normal ovaries and produce more small follicles than normal. This may be linked to an imbalance of hormones. Just under half of women with recurrent early miscarriages have polycystic ovaries; this is about twice the number of women in the general population. Having polycystic ovaries is not a direct cause of recurrent miscarriage and it does not mean that you are at any greater risk of further miscarriages. We are not sure what the link is. Many women with polycystic ovaries and recurrent miscarriage have high levels of a hormone called luteinising hormone (LH) in their blood. Reducing the level of LH before pregnancy, however, does not improve your chances of a successful birth. Hyperprolactinaemia Prolactin is a hormone which prepares a pregnant woman's breasts to produce milk. When a woman produces too much prolactin, this is known as hyperprolactinaemia. It is not yet clear whether this condition plays a role in recurrent miscarriage because the evidence is conflicting. Infections If a serious infection gets into your bloodstream it may lead to a miscarriage. If you get a vaginal infection called bacterial vaginosis early in your pregnancy, it may increase the risk of having a miscarriage around the fourth to sixth month or of giving birth early. It is not clear, though, whether infections cause recurrent miscarriage; for this to happen, the bacteria or virus would need to be able to survive in your system without causing enough symptoms to be noticed. This rules out illnesses like measles, herpes, listeria, toxoplasmosis and cytomegalovirus (so you do not need to be tested for them if you have recurrent miscarriages). Blood conditions Certain inherited conditions mean that your blood may be more likely to clot than is usual. These conditions are known as thrombophilia. They do not, though, mean that a serious blood clot will inevitably develop. Although thrombophilia has been thought to play some part in miscarriage, we do not yet know enough about how or why that is. Alloimmune reaction Some people have suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory. Diabetes and thyroid problems Diabetes or thyroid disorders can be factors in single miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control . What can be done? Supportive antenatal care Women who have supportive care from the beginning of a pregnancy have a better chance of a successful birth. There is some evidence that attending an early pregnancy clinic (if there is one in your area) can reduce the risk of further miscarriages. Screening for abnormalities in the structure of your womb You should be offered a pelvic ultrasound scan to check for and assess any abnormalities in the structure of your womb, so that they can be treated if necessary. Another method of screening using hysterosalpingography (an X-ray of the fallopian tubes using fluid injected through the entrance of the womb) has no advantages over pelvic ultrasound and causes more discomfort, so it is not usually necessary. Screening for genetic problems You and your partner should be offered a blood test to check for chromosome abnormalities; the test is known as karyotyping. If either or both of you turn out to have an abnormality you should be offered the chance to see a specialist called a clinical geneticist. They will tell you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counselling. It can help you decide what you want to do for the future. If it seems likely that other members of your family could be affected by the same problem, they too may be offered genetic counselling. Screening for abnormalities in the embryo If you have a history of recurrent miscarriage and you lose your next baby, your doctors may suggest checking for abnormalities in the embryo or the placenta afterwards. They will do this by checking the chromosomes of the embryo through karyotyping, although it is not always possible to get a result. They may also examine the placenta through a microscope. The results of these tests may help them to identify and discuss with you your possible choices and treatment. Screening for vaginal infection If you have had miscarriages in the fourth to sixth month of pregnancy or if you have a history of going into labour prematurely, you may be offered tests (and treatment if necessary) for an infection known as bacterial vaginosis (BV). If you have BV, treatment with antibiotics may help to reduce the risks of losing your baby or of premature birth. There is not enough evidence to be sure that it makes any difference to the chances of a baby surviving. Treatment for aPL antibodies There is some evidence that if you have aPL antibodies and a history of recurrent miscarriages, treatment with low-dose aspirin tablets and low-dose heparin injections in the early part of your pregnancy may improve your chances of a live birth up to about seven in ten (compared to around four in ten if you take aspirin alone and just one in ten if you have no treatment). Even with treatment, you will have a risk of extra problems during pregnancy (including pre-eclampsia, restriction in the baby's growth and premature birth). You should be carefully monitored so that you can be offered appropriate treatment for any problems that arise. Steroids (certain sorts of natural or synthetic hormones) have been used to treat aPL antibodies in recurrent miscarriage, but they do not seem to improve the chances of a successful delivery and they carry significant risks for you and your baby, compared with aspirin and heparin. Treatment for thrombophilia Although you may have a higher risk of miscarriage if you have an inherited tendency to blood clotting (thrombophilia), you may still have a healthy and successful pregnancy. At present there is no test available to identify whether you will miscarry if you have thrombophilia. You may, though, be offered treatment to reduce the risk of a blood clot. Tests and treatment for a weak cervix If you have a weak cervix, a vaginal ultrasound scan during your pregnancy may indicate whether you are likely to miscarry. If you have a weak cervix you may be offered an operation to put a stitch in your cervix, to make sure it stays closed. It is usually done through the vagina, but occasionally it may be done through a ‘bikini line' cut in your abdomen, just above the line of the pubic hair. Although having a cervical stitch after the third month of pregnancy slightly lowers your risk of giving birth early, it has not been proved to improve the chances of your baby surviving. Because all operations involve some risk, your doctors should only suggest it if you and your baby are likely to benefit. They should discuss the risks and benefits with you. Hormone treatment It has been suggested that taking progesterone or human chorionic gonadotrophin hormones early in pregnancy could help prevent a miscarriage. There is not yet enough evidence to prove whether this works. Immunotherapy Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and it may carry serious risks (including transfusion reaction, allergic shock and hepatitis). What could it mean for me in future? Your doctors will not be able to tell you for sure what will happen if you become pregnant again. However, even if they have not found a definite reason for your miscarriages, you still have a good chance (three out of four) of a healthy birth. return to top Is there anything else I should know? You have the right to be fully informed about your health care and to share in making decisions about it. Your healthcare team should respect and take your wishes into account. No treatment can be guaranteed to work all the time for everyone. source: rcog.org.uk

Key points If you are HIV positive you should be offered specialist care and regular health checks during your pregnancy. If you are HIV positive you can pass the virus on to your baby: through the placenta while you are pregnant during the birth through your breast milk. You can greatly reduce the risk of passing on HIV to your baby if you avoid breastfeeding. Having anti-retroviral treatment during your pregnancy also reduces this risk. It may help your own health as well. You may also reduce this risk if you choose to have a planned caesarean section. You may also be offered medication at the time of your delivery to help to reduce this risk. To reduce the risk of your newborn baby developing HIV, he or she should usually be given medication for four to six weeks after birth. About this information This information is intended to help you if you have been diagnosed with HIV and you are pregnant or planning to have a baby. It is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline HIV in pregnancy (published in April 2004) and explains the recommendations the guideline contains. This information tells you: what it can mean for you and your baby if you have HIV. what the guideline says about the most effective ways of: treating you during your pregnancy and labour protecting your baby from HIV in the womb, during the birth and in the first weeks of its life. This information aims to help you and your healthcare team make the best decisions about your care. It is not meant to replace advice from a doctor or midwife about your own situation. It does not tell you about treatments for women with HIV who are not pregnant, about what you can do to avoid HIV infection before you are pregnant or about the continuing care you can expect after you have had your baby. This information was correct at the time of writing (January 2005) but this is a rapidly changing area of knowledge. Some of the recommendations here may not apply to you. This could be because of some other illness you have, your general health, your wishes, or some or all of these things. If you think the treatment or care you get does not match what we describe here, talk about it with your doctor or with someone else in your healthcare team. return to top About HIV HIV is short for human immunodeficiency virus. This virus prevents the body's immune system from working properly and makes it hard to fight off infections. HIV can be passed from one person to another through body fluids. These are: blood semen vaginal fluids breast milk. If you have the HIV virus, this is sometimes known as being HIV positive. The drugs that are used to treat people with HIV work by blocking the action of the virus. Because HIV is what is known as a retrovirus, these drugs are known as anti-retroviral drugs. They seem to work best when three or more types are used together. This combination is known as highly active anti-retroviral therapy (HAART for short). What could it mean for my baby? You can pass HIV on to your baby: through the placenta while you are pregnant during the birth through your breast milk. You can reduce the risk of this if you: avoid breastfeeding and choose other ways of feeding your baby (by using formula milk, for example) have treatment with anti-retroviral drugs choose to have a caesarean section ( an operation to deliver the baby by cutting through the wall of your abdomen and womb). You will greatly reduce the risk of passing on HIV to your baby if you avoid breastfeeding. Getting appropriate anti-retroviral treatment also reduces the risk. This may be of benefit to your own health as well. return to top What extra antenatal care can I expect? The RCOG recommends that all women should be offered a test for HIV early in pregnancy. If you are HIV positive you should be offered specialist care and regular health checks. Your doctors will usually offer you anti-retroviral drugs during your pregnancy and at the birth, if you are not taking them already. This is to help prevent you passing the HIV virus on to your baby and to stop any HIV symptoms you have from getting worse. You should be cared for and advised by a team of specialists that includes: a doctor who specialises in HIV an obstetrician (a doctor who specialises in the care of pregnant women) a midwife a paediatrician (a doctor who specialises in children's health) other specialists if you need them. Screening tests If you have a sexually transmitted or vaginal infection that has not been diagnosed and treated, it may: infect your baby affect your pregnancy and increase the risk of passing on HIV to your baby. You should therefore be offered tests for vaginal and sexually transmitted infections as soon as possible in your pregnancy. The tests will usually be repeated around the 28th week of your pregnancy. You should be offered treatment if you need it. You should be offered other screening tests, such as those for Down syndrome and/or scans for abnormalities in the baby, in the same way as women who do not have HIV. We do not know for sure whether having amniocentesis (which means putting a needle through your abdomen and womb to take a sample of the fluid around the baby) increases the risk of passing on HIV to your baby. In theory, it is possible. If you need to have amniocentesis, or any other similar test which involves piercing the sac that lines your womb and protects the baby, you may be offered treatment with HAART (highly active anti-retroviral therapy) if you are not already taking it. This reduces the risk of the HIV virus infecting your baby. Anti-retroviral treatment In consultation with other members of your antenatal healthcare team, your HIV specialist will recommend those drugs he or she considers best for you. The specialist will also recommend when you should start and stop taking them. He or she will usually offer you anti-retroviral drugs for the birth, whatever method of delivery you choose. If you are not already taking anti-retrovirals If you do not need HIV treatment for yourself you should still be offered treatment to stop you passing on the virus to your baby. This treatment may be either an anti-retroviral drug called zidovudine or a combination of anti-retroviral drugs (HAART). Your doctor will usually recommend you start the treatment around the 28th to 32nd week of your pregnancy and continue until the baby is born. If you are already taking HAART (highly active anti-retroviral therapy) If you are already taking HAART your doctors will usually recommend that you continue with it. They may change the drug combination after the 13 th week of your pregnancy if blood tests show it is no longer working well enough. If you have advanced HIV If you need HIV treatment for yourself you should be offered HAART, usually starting around the 13 th week of your pregnancy. This treatment will usually be continued after the birth. If you are diagnosed late in pregnancy If you are diagnosed with HIV late in your pregnancy, or during labour, you should usually be offered treatment with HAART, including zidovudine, during and after your labour. The HAART treatment should continue until blood tests show whether the virus is active in your system. Your doctors may adjust your treatment after that. What is the best way to give birth? If you are not taking HAART, you can reduce the risk of passing on HIV to your baby by having a planned caesarean. If you are already taking HAART, this reduces the risk of HIV for your baby. A planned caesarean may further reduce this risk. We need to do more research about the effects of planned caesarean for mothers and babies in terms of HIV transmission. To help you to decide what kind of delivery to have, your doctors should discuss with you the specific risks and benefits, for you and your baby, of the methods you are considering. You should be offered a planned caesarean section, usually in the 38th week of your pregnancy, if: you are taking zidovudine alone; or you are not taking HAART; or if the HIV virus can be detected in your blood. If you wish to have a vaginal birth, your doctors should respect your views. They will also take account of the circumstances of any previous pregnancies and the levels of the HIV virus in your blood in deciding what method of delivery to recommend. Whatever method you choose, a sample of your blood should be taken at the time of the birth to check the amount of the virus in your system. What happens if I have a planned caesarean section? You should be offered antibiotics to reduce the risk of other infections. If you have not been taking HAART, or if the HIV virus can be detected in your blood, you should be offered an infusion of zidovudine, beginning four hours before your caesarean. The infusion delivers the drug at a steady rate through a drip (by means of a needle inserted into a vein in your hand or arm). It should continue until your baby is born and the umbilical cord has been clamped. What happens if I have a planned vaginal birth? You should be offered HAART treatment throughout your labour. Your doctor may also recommend that you should be offered a zidovudine drip (see previous section). If so, the drip will start when you go into labour and finish once your baby is born and the umbilical cord has been clamped. The earlier in labour that your waters break, the higher the risk is of passing on the HIV virus to your baby. Your healthcare team should therefore delay breaking your waters for as long as possible. They should also avoid putting electrodes on the baby's scalp to monitor its heartbeat and avoid taking blood samples from the baby before it is born. What treatment will my baby need after birth? Your baby's umbilical cord should be clamped as soon as possible after the birth. The baby should be bathed immediately after the birth. After the birth, your baby should usually be given anti-retroviral drugs by mouth until he or she is between four and six weeks of age. What is the best way to feed my baby? You can greatly reduce the risk of passing on HIV to your baby if you do not breastfeed and do not use your own expressed breast milk. This is the single most important means of reducing the risk to your baby. If you are HIV positive, it is safer to use an alternative, such as formula milk. return to top Is anti-retroviral treatment safe? Anti-retroviral drugs, including zidovudine, are generally safe, but they can sometimes have side effects including: stomach and digestive problems liver problems rashes diabetes fatigue (extreme tiredness) high temperature breathlessness. Some of these side effects are similar to symptoms of pre-eclampsia ( a condition that can occur in the second half of pregnancy) and of cholestasis (a liver disorder). Although pre-eclampsia is usually mild, it can cause serious problems for you and your baby if it is not detected and treated. Some evidence suggests pre-eclampsia may be more common in women who take HAART. Zidovudine may reduce the levels of iron in your blood (this is called being anaemic) for a short time. Because some side effects are similar to signs of other conditions, it is important to tell your doctor or midwife straight away if you experience any unusual symptoms while you are pregnant. If you show any signs of pre-eclampsia or cholestasis an HIV specialist should see you as soon as possible. Always ask your doctor or midwife if you are worried about anything. What if I don't have anti-retroviral treatment? If you do not have anti-retroviral treatment there is a much greater risk that you will pass on the HIV virus to your baby. Fewer than two women in every 100 who have appropriate treatment pass the virus on to their baby . Around 25 in every 100 HIV positive women pass on HIV if they have no anti-retroviral treatment. Will anyone else be told about my HIV status? All the people in your healthcare team need to be aware that you are HIV positive, so that they can provide the best care possible for you and your baby. If you have not yet told your sexual partner that you are HIV positive, your healthcare team will encourage you to do so, in order to reduce the risk of passing on the HIV virus. Members of your healthcare team should not tell anyone about your HIV status, without your permission. They should respect your right to confidentiality and use care and sensitivity in all situations where information about you could be disclosed to your partner or relatives. The only exception to this is when your healthcare team thinks that, by not telling a sexual contact that you are HIV positive, you are putting that person's life at serious risk. In these circumstances, the General Medical Council says that health professionals may tell a sexual contact about a woman's HIV status. Your healthcare team must discuss this with you first. They must weigh up any risks involved for you (such as violence and/or abuse) before they decide what to do. If they decide to reveal your HIV status to a sexual contact, they must be able to show why they think this is necessary. Is there anything else I should know? If you are thinking of having a baby and you or your partner, or both of you, are HIV positive, you should be offered pre-pregnancy counselling. If one of you is HIV positive and you are thinking of having a baby, you may wish to consider artificial insemination, IVF, sperm washing or other kinds of assisted conception. These help reduce the risks of passing on HIV. No treatment can be guaranteed to work all the time for everyone. You have the right to be fully informed about your health care and to share in making decisions about it. Your health care team should respect and take your wishes into account. The National Study of HIV in Pregnancy and Childhood monitors how many mothers pass on HIV to their baby. Doctors report all cases of women with HIV who are pregnant. These reports do not include women's or babies' names, so you cannot be individually identified. This study provides up-to-date information about treatment in pregnancy and can help us to improve care for women and their babies.

Key points Genital herpes is an infection of the area in or around the vagina, the vulva (the lips around the opening of the vagina) and anus. It is caused by the herpes simplex virus. If you catch herpes, you may notice painful sores in the affected area but you may not notice any symptoms at all. The virus stays in your body and can become active repeatedly. There is a very small risk that you could pass on the infection to your baby during birth. This risk is very low if you first get genital herpes before you are pregnant but much higher if it first develops around the time of labour. If a mother passes on herpes to her baby at birth the infection is known as neonatal herpes. Although it can be very serious, neonatal herpes is rare in the UK and treatment for affected babies is available. If you get genital herpes for the first time while you are pregnant, you may be offered a drug called aciclovir to reduce your symptoms. You should be offered a caesarean section if you develop genital herpes for the first time in the last six weeks of your pregnancy. Most women who have genital herpes give birth to healthy babies. About this information This information is intended to help you if you are pregnant and you have been told you have genital herpes. It is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Genital Herpes In Pregnancy (published in March 2002). It tells you: what it means for you and your baby if you have genital herpes while you are pregnant about the most effective recommended treatments available in the UK for pregnant women affected by genital herpes what you can do to reduce the risk of passing the infection on to your baby. This information aims to help you and your healthcare team make the best decisions about your care. It tells you about the recommendations the RCOG guideline makes. It is not meant to replace advice from a doctor, midwife or nurse about your own situation. It does not tell you about treatments for nonpregnant women with genital herpes or about treatments for babies with neonatal herpes. Some of the recommendations here may not apply to you. This could be because of some other illness you have, your general health, your wishes, or some or all of these things. If you think the treatment or care you get does not match what we describe here, talk about it with your doctor, midwife, nurse or someone else in your healthcare team. return to top What is genital herpes? Genital herpes is an infection of the area in or around the vagina, the vulva (the lips around the opening of the vagina) and anus. It is caused by a virus called herpes simplex. Herpes may cause sores on the mouth and nose (cold sores), on the genitals (the penis in men, the vulva and vagina in women) and anal area, or on the eyes, fingers and hands. There are two types of the virus. They are known as herpes simplex 1 and 2. Herpes can be passed from one person to another: through skin-to-skin contact with a herpes simplex sore by having vaginal, oral or anal sex or sharing sex toys with someone who has an outbreak of genital herpes by having oral sex with someone who has a cold sore at the time of birth by a mother to her baby. When you catch genital herpes for the first time you may notice painful sores or watery blisters in your pubic hair, vagina, vulva or anus. You may have pain when you urinate. You may feel as though you have flu - feverish, unwell and very tired. Genital herpes sores may appear in or around the vagina, the vulva (the area including the labia (outer and inner lips) and the opening to the vagina) or the anus Once you catch herpes, the virus stays in your body and can become active repeatedly. A warning sign of an outbreak may be a tingling feeling in the area that is affected. You may not realise you have genital herpes. You can carry and pass on the infection without showing any symptoms. You are most likely to pass the virus on to someone else when, or just before, symptoms appear. The sores or blisters are extremely infectious. However, you can also pass on herpes to someone else even if you have no noticeable symptoms. What could genital herpes mean for my baby? Because genital herpes affects the area in or around the vagina, it is possible (but not common) for a woman who has the infection to pass it on to her baby when she gives birth. If a baby catches herpes at birth this is known as neonatal herpes . Neonatal herpes can cause infections in the baby's skin, eyes or mouth and may damage the brain or other organs. The baby may become seriously ill or even die. Treatment with medication may help prevent or reduce lasting damage to the baby's health. Although neonatal herpes can be serious, it is very rare in the UK – it affects only one or two out of every 100,000 newborn babies. Most women who have genital herpes give birth to healthy babies. Your unborn baby is usually protected by your own immunity. This means that you pass on to your baby a resistance to any infections you have had before, or with which you have been in contact. Babies usually keep this protection for up to three months after they are born. If you first get genital herpes before you become pregnant and you have no outbreak during your pregnancy or labour, you are very unlikely to pass the virus on to your baby. If you have had herpes before and it is active again when you go into labour, the risk to your baby is still very low. If you catch genital herpes for the first time late in your pregnancy your immune system has no time to develop and pass on your immunity. This means that there is a higher risk of passing on herpes to your baby. Around 40 out of every 100 women who have a vaginal birth at the time of a first infection pass on the virus to their babies. There is most risk of this happening if the baby is born four hours or more after your waters break. How can I reduce the risk to my baby? At your first antenatal appointment, your midwife may ask you whether you or your partner has ever had genital herpes. You should tell the midwife if you know that either or both of you have had it. If your partner has herpes but you do not, or if you are unsure whether you have it, you may reduce the risk of getting it yourself by avoiding sexual intercourse or oral sex whenever he has an outbreak. As people with genital herpes can pass on the infection even when they show no symptoms, you may want to consider using condoms throughout your pregnancy. You will not be offered tests for genital herpes as a matter of routine while you are pregnant. Because neonatal herpes is very rare in the UK, routine screening tests are not an effective way of preventing it . Avoid skin-to-skin contact between your newborn baby and anyone with an active herpes infection (including a cold sore on the mouth or herpetic whitlow, a herpes infection at the edge of a fingernail). What treatment will I be offered? If your doctor or midwife thinks you have caught genital herpes for the first time while you are pregnant, they should refer you to a genitourinary specialist. This specialist can offer you appropriate testing, treatment and support. They will also check you have no other sexually transmitted infections. If you first get genital herpes when you are pregnant, you may be offered a five-day course of tablets that contain an antiviral drug called aciclovir. Aciclovir may reduce the length and severity of your symptoms. If you first get genital herpes towards the end of your pregnancy, you should be offered aciclovir every day for the last four weeks of your pregnancy. This may stop the herpes from returning when you are due to give birth. You may be offered aciclovir if you have a repeat outbreak of genital herpes while you are pregnant, especially in the last three months of your pregnancy. We still need to find out more about how effective aciclovir is for women who develop herpes before a pregnancy. Are there any risks in treatments? There is no evidence of any risks to your unborn baby if you take aciclovir while you are pregnant. Most women experience no side effects. Will I need a caesarean? If you get a first infection of genital herpes in the first six months of your pregnancy, you do not need to have a caesarean. If you get genital herpes for the first time in the last six weeks of your pregnancy, your doctors will offer you a planned caesarean section. If you develop genital herpes for the first time as you are about to give birth or go into labour, your doctors will recommend that you have a caesarean section. This reduces the risk of passing on herpes to your baby during the birth. If you first caught herpes before you got pregnant and you have an outbreak around the time of your labour, you may not need to have a caesarean. The risks for you in having a caesarean may be greater than the risk of your baby being infected. Your midwife and doctors should discuss this with you. Is there anything else I should know? No treatment can be guaranteed to work all the time for everyone. You have the right to be fully informed about your health care and to share in making decisions about it. Your health care team should respect and take account of your wishes. Rcog.org.uk

High Risk Pregnancy Maybe you have experienced miscarriages or perhaps it is your age, but for some reason you are in the high risk pregnancy category. And instead of realising that you are a completely unique individual, it might seem that books and your gynecologist/doctors keep referring to your pregnancy as high risk. Hearing this over and over can take away from the miracle and magic of your pregnancy and also introduces an element of concern that you really don't need. But instead of allowing high risk pregnancy to be a weight on your shoulders, you can choose to hear it in another way entirely. High Risk Can Work To Your Advantage For Pregnancy Success If you are more mature or have experienced challenges in your fertility you are high risk for sure... There is a high risk that you will really appreciate fully this pregnancy and prioritise it your life. There is a high risk that you are ready to receive this wonderful baby in your life. And, there is a high risk that you are now able to embrace fully the gift of parenthood. Supporting Your Pregnancy You can make a list of the wonderful experiences of which you are at risk precisely because of your age, experience etc.! So next time somebody refers to yours as a 'high risk pregnancy', nod to yourself and think 'Yes, there is a very high risk that I am going to experience more joy, love and magic in pregnancy, birth and parenting than I ever thought possible'. Deirdre Morris would like to invite you to visit http://www.magicalbeginningsforbaby.com for a Free Gift sample of her Pregnancy Workbook which supports you in inspired fertility, pregnancy and birth. Article Source: http://EzineArticles.com/?expert=Deirdre_Morris

How will I know if my waters have broken? You may notice a ‘gush’ of fluid or you may feel damp. The fluid (known as amniotic fluid) is a clear or pinkish colour. It may be slightly blood stained. The amount of fluid you lose may vary from a trickle to a gush. This usually happens once labour has started. If it happens between 24 weeks and 37 weeks, it means that your waters have broken earlier than normal. Two out of every 100 women (2%) experience this during pregnancy. Breaking of the waters is also known as rupture of the membranes. If your waters break early, it is also referred to as preterm prelabour rupture of membranes. What should I do? If you think that you are leaking fluid from the vagina, it is advisable to wear a sanitary pad (not a tampon) and monitor the colour and smell of the fluid, as well as how much is leaking. Sometimes the leaking fluid is urine. Leaking urine can be normal during pregnancy. Leaking amniotic fluid smells different from the smell of urine. If you think the fluid is amniotic fluid, contact your local hospital. What happens at the hospital? You will have a careful check-up which may include: a discussion with your doctor or midwife about whether you have experienced this in a previous pregnancy (if it has happened before, it is more likely to happen again) a vaginal inspection. Your doctor or midwife will use a speculum to look at your cervix (entrance to the uterus) and see if the leaking fluid is amniotic fluid. Your doctor will also be able to see if the cervix is changing in preparation for labour a specific test of the fluid to help decide if the waters have broken. These tests are not 100% accurate an ultrasound scan to see the amount of fluid around the baby a check of the baby’s heartbeat. If your waters have not broken, you may be able to go home. If only a very small amount of amniotic fluid leaks at first, it is not always easy to confirm that your waters have broken. If you continue to leak fluid at home, you should return to the hospital for a further check-up. If the check-up shows that your waters have broken, you may be advised about: admission into hospital regular monitoring of the baby regular monitoring for signs of labour regular tests and monitoring for infection including having your temperature and pulse taken a blood test a vaginal swab (the results of your swab may indicate the presence of a common vaginal infection called group B streptococcus or GBS (see RCOG Patient Information Preventing Group B streptococcus – information for you). Return to top What caused it? For most women, the reason their waters have broken early is not known. The baby is surrounded by fluid within a bag of membranes. The vagina is not sterile and always contains healthy bacteria. There is a link between waters breaking and the growth of certain types of bacteria in the vagina. These bacteria produce enzymes that can weaken the membranes and cause the waters to break too soon and fluid to leak out. It is unlikely that: anything you did caused your waters to break early anything could have been done to prevent this from happening. What could this mean for me and for my baby? Spontaneous vaginal delivery (preterm birth) Most women go into labour spontaneously within 24 to 48 hours of their waters breaking. However, the chance of this happening is increased when infection is present. Infection The membranes form a protective barrier around the baby and after these have broken, there is a risk of bacteria and infection getting into the uterus (womb). When infection gets into the uterus it is known as chorioamnionitis and this can trigger a preterm birth. The symptoms of infection may include a raised temperature, an unusual vaginal discharge with an unpleasant smell, a fast pulse rate and/or abdominal (uterine) pain. Your baby’s heart rate may be faster than normal. Once you have an infection, your baby may need to be born soon to prevent a more serious infection. Lung development The amniotic fluid which surrounds the baby is needed for the baby’s lungs to develop. If the waters break very early, there may not be enough fluid for your baby’s lungs to develop normally. Prematurity If your baby is likely to be born early, you should be given full information about what this might mean for your baby’s health and development. Premature babies (born before 37 weeks) can have an increased risk of health problems, particularly with breathing, feeding and infection. Babies born before 34 weeks tend to have a higher risk of severe breathing problems, which may require intensive support. Problems are even more severe when a baby is born before 28 weeks of pregnancy. Those premature babies with a problem will be cared for in hospital. In some cases the hospital might move you and/or your baby to a special care baby unit in a different hospital to give your baby more specialist care. Return to top What if my waters have broken before 24 weeks? If your waters have broken before 23 to 24 weeks of pregnancy and you give birth, sadly, it is unlikely that your baby will survive. Babies who do survive are likely to have serious health problems. The possible treatment and outcomes for your baby will be discussed with you by an experienced paediatrician (a doctor specialising in the care of babies and children). What treatment can I have? There is no treatment that can replace the fluid or repair the hole in the membranes of the amniotic sac. The baby’s kidneys will continue to produce amniotic fluid even if the waters are broken. You may leak fluid for the rest of the pregnancy. The purpose of treatment is to monitor for signs of infection and help get ready for birth. You may be offered: a course of antibiotics to treat and/or lower the risks of infection and the associated problems. These antibiotics will not harm your baby steroid injections (corticosteroids) to help the baby’s lungs mature for breathing medication (tocolysis) to stop contractions and reduce the risk of the baby being born too early. Tocolysis is not routinely given. It is used if you need to be transferred to a hospital where there is a cot on a neonatal intensive care unit. It may also be used if more time is needed for the steroids to work. When can I go home? If your waters have broken, you may be advised that you need to stay in hospital until the baby is born. However, going home may be an option if you can return to the hospital easily. You will need to check for signs of infection at home. What should I do at home? Your doctor will have a full discussion about the signs of infection to watch for. It is very important that you: check that your temperature is normal twice daily (a normal temperature is 37.0 degrees Celsius or less) check the colour of the fluid does not change (see below). You should wear a sanitary pad rather than a tampon avoid vaginal intercourse. You will be asked to come to the hospital at least once a week for a check-up. This may involve: a blood test to measure white cell count (white cells fight infection and increase if infection is developing) a vaginal swab to see if any unhealthy bacteria are present monitoring the baby’s heart rate depending on your hospital, an ultrasound scan to look at the amount of amniotic fluid around the baby and the blood flow to the baby (Doppler scan). Return to top When should I call for help? Contact your doctor and/or return to the hospital immediately if you experience any of the following: raised temperature (more than 37ºC) if you are worried that the baby is not moving as normal flu-like symptoms (feeling hot and shivery and achy) vaginal bleeding if the leaking fluid becomes greenish or smelly abdominal pain contractions. What are my options for giving birth? Your doctors should discuss your options for giving birth. Continuing with the pregnancy may increase the risk of infection (chorioamnionitis). However, it reduces the risk of problems relating to a premature baby. Depending on your situation, your choices may include: continued monitoring of you and the baby until you give birth naturally being induced at between 34 and 37 weeks of pregnancy. You will be given pessaries (vaginal tablets) or a drip to start your labour. Being induced increases your chance of needing a caesarean section. A glossary of all medical terms is available. Sources and acknowledgements This information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Preterm Prelabour Rupture of Membranes(published by the RCOG in November 2006). This information will also be reviewed, and updated if necessary, once the guideline has been reviewed. The guideline contains a full list of the sources of evidence we have used. You can find it online here. Clinical guidelines are intended to improve care for patients. They are drawn up by teams of medical professionals and consumer representatives who look at the best research evidence available and then make recommendations based on this evidence. This information has been developed by the Patient Information Subgroup of the RCOG Guidelines and Audit Committee, with input from the Consumers’ Forum and the authors of the clinical guideline. It was reviewed prior to publication by women attending clinics in London, Dublin and Brighton. The final version is the responsibility of the Guidelines and Audit Committee of the RCOG. The RCOG consents to the reproduction of this document provided that full acknowledgement is made. A final note The Royal College of Obstetricians and Gynaecologists produces patient information for the public. This is based on guidelines which present recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment plan must be made by the doctor or other attendant in the light of the clinical data presented and the diagnostic and treatment options available. The RCOG consents to the reproduction of this document provided that full acknowledgement is made. Royal College of Obstetricians and Gynaecologists 2008