H1N1 influenza virus vaccination programs for pregnant women may have been controversial – but recent results are very reassuring.

The recent H1N1 Influenza pandemic across many parts of the World raised a great deal of concern particularly amongst

the pregnant population. Pregnant women form one of the most at risk groups in H1N1 influenza, showing increased

morbidity and mortality. Vaccination programs were put in place to provide H1N1 Influenza Virus vaccination to protect pregnant women during their antenatal care.

National campaigns to vaccinate at risk groups were met with major concerns because of uncertainty of the side

effects of the vaccine on the pregnant mother and unborn baby.

A lot of women did not heed the call to get vaccinated. Since the pandemic in 2009 a lot of efforts have gone into

gathering data about safety and outcomes following H1N1 vaccination during pregnancy.

Several studies have been published proving the efficacy and safety of the vaccines.

These studies have shown that among thousands of women, there was no increased risk to the mother or baby.

There were other unexpected advantages of H1N1 vaccination during pregnancy.

Read more here:

Objective  To describe a large study on pregnancy outcome after vaccination against H1N1 during the 2009/10 pandemic.

Setting  The Swedish Medical Birth Register was used for the analysis. Information on vaccination and pregnancy week

when vaccination was made was obtained from antenatal care documents.

Population  All women who gave birth during 2009 and 2010 in Sweden.

Outcome measures  Stillbirth, congenital malformations, preterm birth, low birthweight, small for gestational age.

A total of 18 612 vaccinated women having 18 844 infants were studied. The risk for stillbirth, preterm

birth and low birthweight was lower than in the comparison groups whereas the risk for small for gestational age and

a congenital malformation (after vaccination during the first trimester) did not differ from the comparison groups.

To read more follow this reference:

This Swedish study by Källén B, Olausson P. on the outcomes of H1n1 vaccination during pregnancy is the largest study

so far involving over 18,000 pregnant women who were vaccinated. The results confirmed earlier but smaller earlier

studies from Canada and elsewhere.

The study demonstrated benefits of vaccination other than protection against the H1n1 influenza virus. Women who were vaccinated had better pregnancy outcomes than those who did not get vaccinated. The was no clear explanation of the basis for the beneficial effect of the vaccine.

An intriguing question must arise as to whether unexplained fetal deaths in pregnancy are due to sub-clinical viral infections that may be less likely after H1n1 vaccination!

Those women who were vaccinated had bigger babies compared to non vaccinated women.

This study will go a long way to reassuring pregnant women who have been hesitant about vaccination against the influenza virus. The study also provides ammunition for health care providers as they go out to counsel women in their care about the importance of H1N1 vaccination during pregnancy.

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Prematurity remains an important clinical challenge across the globe.

Preterm labour prevention continues to exercise the minds of clinicians and researchers. Miscarriage in the second trimester is known to be preceded by changes on the cervix which can be identified by a vaginal ultrasound scan.

Pregnant women at risk of preterm labour due to a weak cervix, known as cervical incompetence, can be diagnosed by a careful history and a series of vaginal scans. These scans show a shortening cervix, and funnelling at the internal opening of the cervix.

Vaginal scan

Women showing features of cervical weakness are treated preventatively by inserting a cervical stitch at a level that strengthens the neck of the womb, and in most cases, preventing progression to a premature labour in late second trimester.

Frequently, the premature birth occurs after 18-22 weeks before the baby is viable. Therefore the key step is identifying women at risk of this preventable condition.

The recent paper published in the American Journal of Obstetrics and Gynecology compares the value of the stitch and the use of progesterone vaginal tablets.

Read more here:

Vaginal progesterone vs cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis
Objective

No randomized controlled trial has compared vaginal progesterone and cervical cerclage directly for the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous spontaneous preterm birth.

Four studies that evaluated vaginal progesterone vs placebo (158 patients) and 5 studies that evaluated cerclage vs no cerclage (504 patients) were included. Both interventions were associated with a statistically significant reduction in the risk of preterm birth at <32 weeks of gestation and composite perinatal morbidity and mortality compared with placebo/no cerclage.

Based on state-of-the-art methods for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous preterm birth.

Source: American Journal of Obstetrics & Gynecology abstract

Setting up a study comparing the use of the cervical stitch for the treatment of a weak cervix and progesterone is a difficult because of ethical dilemma.

Counselling would be paramount in the conduct of a randomised trial and I suspect there would be difficult recruitment issues.

The approach in the latest paper by Agustin Conde-Agudelo and colleagues, was to compare several studies run separately and adjust for differences. It is an acceptable methodology and has provided some answers.

The conclusion is that the use of the progesterone tablet is as effective in the prevention of second trimester premature labour as the cervical stitch, in women diagnosed with cervical incompetence by vaginal ultrasound. The choice between the two methods will have to be based on patient preferences, costs and expertise.

Of course if the conclusions of this study are confirmed by directly compared randomised study, the impact will be enormous. Progesterone treatment which has been shown to prevent premature labour from other causes would be a popular winner because it avoids surgery, which until now has been the mainstay of treatment for cervical incompetence.

Leave your comments here:

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A glass in Pregnancy – a NO NO

The latest report from Oxford research group confirms what has been a matter of intense debate that alcohol in pregnancy could be very harmful to the baby’s development.

There have been many studies before with similar conclusions, but these have been countered by the others that small amounts of alcohol in pregnancy is safe.

Even the Departments of health and NICE have not been explicit as to say “DO NOT Drink during pregnancy” in their advice regarding drinking during pregnancy.

For example advice from NICE states (2208, 2010):

Additional advice from the National Institute for Health and Clinical Excellence (NICE) advises women to avoid alcohol in the first three months in particular, because of the increased risk of miscarriage.

Advice from the Department of Health states:

“Pregnant women or women trying to conceive should avoid drinking alcohol. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk. Additional advice from the National Institute for Health and Clinical Excellence (NICE) advises women to avoid alcohol in the first three months in particular, because of the increased risk of miscarriage.”

Source: Department of Health Archives:

Advice from the Royal College of Obstetricians and Gynaecologists states (2006):

“When a woman drinks during pregnancy, the alcohol passes from her blood
stream through the placenta and into the baby’s blood stream.
● The safest approach in pregnancy is to choose not to drink at all.
● Small amounts of alcohol during pregnancy (not more than one to two units,
not more than once or twice a week) have not been shown to be harmful.”

Advice from the Royal college of Midwives is similar and based on same scienfitic reports.

It is not surprising then that women are confused and sometimes angry and frustrated.

The latest study clearly advises not to drink alcohol, if at all possible because the minimum safety levels are not known. Furthermore, the baby’s susceptibility to the effects of alcohol on the brain depends on the baby’s genetic predisposition. This is hard to know at in the antenatal period.

This is not the end of the debate unfortunately. A study will come out, soon or later, with the opposite advice, or cast doubt on what has been published in the last few days. This will not be bad, in terms of scientific discussion, but it is the publish which cannot take zigzagging information when it comes to the health of their unborn baby.

So Bumps Pregnancy Care Advice, based on the latest published evidence, is…To be safe, stay off alcohol during pregnancy. You will probably miss nothing in the process!

What are your views? Share with friends or follow us on Facebook.

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Walking in Pregnancy

…Then adopt a daily walking routine during your pregnancy

Some of the pointers to potential pregnancy problems include excessive pregnancy weight gain. This is why health

care professionals, midwives and obstetricians, watch weight gain during pregnancy keenly.

A woman who starts her pregnancy on the overweight or obese side, is likely to gain more during her pregnancy.

Women who gain more weight are likely to develop pregnancy related diabetes (gestational diabetes) and high

blood pressure.

Gaining health weight during pregnancy is therefore very desirable for all the good reasons.

A study by Cohen and colleagues, investigated what type of exercises helped women gain healthy weight during

pregnancy and their findings are very interesting.

Walking During pregnancy is beneficial – several studies have shown

Use of the Pregnancy Physical Activity Questionnaire (PPAQ) to Identify Behaviours Associated with Appropriate
Gestational Weight Gain During Pregnancy.

The Pregnancy Physical Activity Questionnaire (PPAQ) assesses physical activity practices of pregnant women. The

purpose of this study was to identify specific pregnancy practices that were associated with a healthy

gestational weight gain (GWG).  Our analysis supports daily walking as the preferred PA for achieving healthy rate GWG.

Source: A study by Cohen and colleagues

It is not just the risk of high blood pressure (pre-eclampsia) and diabetes that makes healthy weight gain in

pregnancy important. Obesity in pregnancy is associated with poor outcomes of pregnancy such as bleeding,

caesarean sections, clots in veins and interventions in general. Furthermore, babies born to mothers who are

obese in pregnancy are likely to be obese in adulthood and develop coronary heart disease.

As the study shows, women who are adopting walking as their preferred exercise during pregnancy remained within

a healthy weight gain range.

Therefore walking exercise during pregnancy is highly recommended; it is simple, refreshing and at minimal cost.

Have you found walking during pregnancy easy to do…share your experience here.

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3d Ultrasound scanning is finding more clinical applications in pregnancy.

A recent study from USA sought to assess how 2d ultrasound compared to 3D ultrasound in the assessment of

preterm birth based on the volume estimation of the baby’s adrenal gland.

The problem of preterm labour is a major clinical issue across the globe, because of the consequences of

prematurity on the baby and the health care service.

Fetal scan

Prematurity is associated with serious illness in the child, into adulthood with cerebral palsy and in

developing countries, high death rates particularly below 28 weeks. It is for this reason that efforts are

ongoing to find a method to predict and prevent preterm labour.

One method of predicting preterm labour is to use ultrasound to measure the adrenal gland volume. In this study,

3d ultrasound was compared to 2d scanning which is a more established method.

3d ultrasound for predicting preterm labour

Objective We aim to test the hypothesis that two-dimensional (2-D) fetal adrenal gland volume (AGV) measurements

offer similar volume estimates as volume calculations based on 3-D technique.

Fetal AGV was calculated using an ellipsoid formula derived from 2-D measurements

of the same blocks (0.523 × length × width × depth). Comparisons were performed by intraclass correlation

coefficient (ICC), coefficient of repeatability, and Bland-Altman method. The corrected AGV (cAGV; AGV/fetal

weight) was calculated for both methods and compared for prediction of preterm birth (PTB) within 7 days.

Conclusion 2-D volume estimation of fetal adrenal gland using ellipsoid formula cannot replace 3-D AGV

calculations for prediction of PTB.

Source: Click here for the abstract

3d ultrasound is not commonly seen as a clinical tool by most people. Together with 4D scans, 3d scans are

mostly thought of as a means of seeing the unborn baby in the womb; not really serious.

Over the last year more and more scientific papers have been published to show how significant the use of 3d

ultrasound technologies can enhance diagnostic tools currently available. For example 4d scanning is being

tested as a tool to assess the baby’s nervous system.  A well baby is expected to be seen as very active and

portraying features dependent on healthy brain system.

Although 3d scanning did not outperform the 2d scan in predicting premature labour, it was equally good.3d and

4d ultrasound scans are finding more clinical uses.

The post 3d Ultrasound For Premature Labour appeared first on Bumps 4D Scan.

Unnecessary caesarean sections due to third trimester pregnancy ultrasound

Caeasarean sections has become much safer these days, and some think, it is one reason that the rate of caesarean sections have gone up in all developed countries.

Maternal and fetal wellbeing, it is thought, would improve if enough cesareans were performed at the right time, without waiting for complications.

pregnancy ultrasound and c/sections

There is real concern that late pregnancy ultrasound scans are leading to unnecessary c/sections according to this recent publication. The authors investigated two groups of mothers in the last month of their pregnancy. They looked the likelihood of intervention by the obstetricians, by means of inductions, caesareans, and other procedures.

It appears, having an pregnancy ultrasound scan close to term, predisposed women to having a lot more interventions than the group that did not have ultrasound for weight estimation.

Both groups were similar in pregnancy characteristics.

To read more about this study go here:

The option to perform a safe cesarean delivery has dramatically reduced both neonatal and maternal morbidity and mortality over the past 100 years. There have been reductions in maternal mortality related to obstetric anesthesia even over the past 3 decades.1 Certainly, in the developing world, the capability to perform timely, safe cesareans would impact injury during childbirth to both mothers and babies. However, in the developed world it seems that our cesarean rate is too high–perhaps we have become cavalier about the indications for cesarean. Further, our medical-legal system puts enormous pressures on clinicians to guarantee safe passage for neonates that are neither feasible nor optimal for the bulk of our patients.

With these pressures, clinicians have an increasingly lower threshold to offer, recommend, and perform cesarean deliveries. The prevention of intrapartum hypoxic injury is a common indication for cesarean, despite the fact that our most commonly used tool for identifying such injury, intrapartum fetal monitoring, is limited and understudied. Another common indication is the cesarean performed for failure to progress in labor or for cephalopelvic disproportion in general. Such cesareans are even offered prior to the onset of labor, most commonly if the estimated fetal weight (EFW) is >5000 g in a woman without gestational diabetes to prevent shoulder dystocia. Unfortunately, our ability to accurately predict birthweight at this extreme value is poor, with a less than 50% positive predictive value for ≥5000 g, and our ability to predict shoulder dystocia is even worse. In a landmark study by Rouse et al,2 it was estimated that, utilizing a policy that offered elective cesarean to all women with an EFW >4500 g, the number of cesareans needed to prevent a brachial plexus injury would be 3695 with a cost of $8.7 million per injury prevented.

 

Comment on third trimester scans findings:

This study has thrown up very interesting questions.

Should we trust third trimester ultrasound to guide the clinicians in how to deliver women at risk of obstructed labour? Obviously not according to the results. Birth weights were similar in the two groups, and more importantly, outcomes were similar.

It has been known from earlier studies, that ultrasound scans are not accurate in fetal weight estimation, with wide margins of error. Therefore, one could conclude that ultrasound for estimation of the baby’s weight has undesirable consequences.

There are other factors at work in the practice of midwifery and obstetrics.

The fear of litigation is probably a factor in the escalating rates of caesarean sections. Claims for what is thought could have been prevented by performing a section running into millions.

Midwives are known for being less interventionists, and this fact is reflected in the findings of the study. They did not request as many scans as did the doctors. This simple fact, means women in the midwives group did not have as many intervention procedures as women in the doctors group. Telling isn’t?

One could advance an arguement that women in the midwiferly group are less likely to be obese, suffering blood pressure and other pregnancy complications.

The findings of this study though suggests that the differences were not the main explanations for the differences in ultrasound rates and c/sections.

In spite of the findings of this study, it will take a long while and many more studies to change the deeply ingrained culture of quick defensive caesarean sections in the developed countries’ obstetric units.

Now tell us what you think by leaving your comments here:

1. Do you think the findings of the study are exciting or worrying?
2.  Do you care if some women are delivered by caesarean without “a good reason”?
3. What do you think of doctors who seem to be using pregnancy ultrasound to decide for them on what to do?

The post Pregnancy Ultrasound for Weight Estimation: Questions Remain appeared first on Bumps 4D Scan.

A lot more mothers are opting to have 4d scans to see their baby in the womb…and get other benefits

The Pregnancy scan clinic, Bumps Care, has released the latest document, publicised here, as part of their new maternity blog; which is designed to assist pregnant women comprehend the features and benefits of 4d scans. This particular innovative review will be launched as an on-going attempt to help keep women up-to-date on motherhood tips along with dealing with a number of the different consequences caused by carrying a child and through early infancy periods.

4D Baby Scan – Face

The recent maternity review explains the actual procedure behind the 3d and 4d sonograms; the inventive type of scan specifically made to make it possible to appraise the growth and development of the baby during the pregnancy. This baby ultrasound is perfectly safe with regard to babies and was created to help expectant moms experience a better bond with the child as they get to see their 3d, live image of their unborn baby during a couple of vital phases of the being pregnant.

Pregnancy Scans – More than Just 4D Baby Scans

The Clinic has also reported fresh celeb influenced pregnant information that were triggered due to the highly advertised pregnancy associated with Snooki along with the newly released story that Adele may very well be expectant as well. The company thinks due to so much attention being put on a majority of these movie star pregnancies, more ladies will be keen to discover more about their own pregnancy and in what way stuff like 4d baby scan may also help them bond together with their unborn.

The most recent guide is currently available on this company web page and is also at this time being granted at zero cost for virtually any concerned person. This new article plus the Clinic’s added reports on the subject of pregnancy health care, created to help present expert tips about quality pregnancy health care ideas that will make any pregnancy less hazardous and more enjoyable for mother and baby in the womb.

Individuals who want more information about this kind of pregnancy scans go here

The post Modern 4d Scans Help Mothers Enjoy the Pregnancy appeared first on Bumps 4D Scan.

We get asked this question many times so we’ve prepared special page that explains what 4D scan is.

A 4D baby scan is a special type of scan increasingly performed to assess various aspects of the baby in the womb. Initially, about 10 years ago, 3D scanning emerged onto the market with bang, enabling mothers to see their baby in the womb. The 3D ultrasound technology applies the same ultrasound waves as the traditional 2 dimension scanning, but the machines computer composes the images into a one that provides 3 dimensions. This feature provides form, so that the image cast on the screen can be seen with depth to it.

On top of the ability to the see the images in 3 dimensions, you also see them in colour! This was revolutionary.

When you combine form and colour you get something special; and when you add motion to the combination you get a 4D scan. A 4D scan video provides the parents the chance to view into the womb, seeing their baby in form, colour and motion. An amazing experience.

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The problem was that at the beginning there were few clinical indications, and most of 3d and 4D scanning were driven by mothers’ popular demand. Now 4d scanning is a global service, available in most countries.

With time, 3d and 4D scanning has been adopted into clinical practice in many areas, not only in maternity care.

4D scan – What is the buzz all about?

What makes it different from other baby scans?

All types of baby scans, including 3D and 4D scans use the same basic ultrasound technology. However, 3D ultrasound scanning captures the images and constructs the image in 3 dimensions, renders the image to give it the realistic image seen on the scan monitor. The images seen on the monitor are in real time and are not fake! Indeed, there is a clinical use of 3d and 4d scans where an abnormality, for example an hare lip can be best seen in 3D.

Although some 3D baby pictures can be difficult to understand, they are usually better understood by the non-trained eye than the standard black and white 2D scans. Some providers of 4D scan services smooth out gaps to make the baby’s face artificially beautifu, smooth; because the images captures are not so good.

This kind of tinkering does spoil the pleasure of seeing the baby as is. We, at Bumps do not change the 3d baby images in any way. It is a matter of choice.

4D Scan – Important factors to a good experience

One of the key factors essential for an excellent 4D scan experience is the level of sonographer experience. If the experience of the sonographer is not high, you can expect less than optimum results. We analyse our results and have found that experience is highly correlated with client satisfaction.

Another important factor is the position of the baby during the scanning session. If the baby is hiding his or her face, sitting in an awkward position, getting a good image will be difficult. Oh, yes, a large layer of fat on the tummy makes matters a lot more difficult.

4D Baby Scans: The popular choice

4D Scans are popular amongst expectant mothers because they enable the mother and her family to see the baby while in the womb. This experience enhances bonding with the pregnant woman and her family. Moreover, the 4 ultrasound scans pose no threat to the baby. It is remarkable how the newborn’s face resembles the 3D scan image that was taken some weeks before birth.

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What you will see in a 4D Baby Scan

By this point a baby’s body parts are fully developed and the sonographer can take a clearer view of the baby inside the womb. If there are any fetal anomalies, they can also be recognised and discussed with the mother, however this is a small consideration that expectant mothers have when choosing to have a 4D baby scan. The majority of pregnant mothers have a 4D scan so that they can see their unborm baby.

4D Baby Scans: Managing pregnancy excitement and anxiety

Most couples get excited as pregnancy progresses and anticipate the coming of the baby. Thanks to 4D scanning technology, expectant mothers can connect and bond with their baby even before birth takes place.

The buzz about Bumps 4D Scans – What others are saying

“Our 4D scan experience at Bumps was so wonderful we cried with joy! When we first saw the image of our little one’s face, our hearts were filled with happy giggles. The staff were entirely friendly and excitable at Bumps, which encouraged the whole event. The price of the 4D baby scan included more than we needed of images that we will cherish for a lifetime!

I am so glad I did research to find the best place to have our 4D baby scan done.”

“Bumps had many locations to choose from, and the nearest 4D scan centre to our home. With our 4D images we also purchased the moving DVD of the ultrasound. I now show the DVD to everyone who visits and I watch it on my own all the time.

Thank you to everyone at the Bumps clinic for a unique and irreplaceable experience.”

Suzanne

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Embrace this special moment to bond with your baby while still inside the womb through our 3D Scans and 4D Scans.  Combining cutting-edge technology with a specialized and experienced team of medical professionals, your bumps 4D baby Scan is truly an opportunity you should not miss.

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