What impact could a low lying placenta have on your pregnancy
Author: development
Fibroids in Pregnancy
The impact of Fibroids in pregnancy and how this may
Pregnancy Induced Hypertension
High blood pressure is also called hypertension. Measuring your blood pressure at your first antenatal visit and throughout pregnancy is recommended for all pregnant women.
***Key Points***
In pregnancy it can develop because of the pregnancy or you may already have high blood pressure before you became pregnant.
It may occur after 20 weeks gestation and be a one-off event, or be part of a more complex condition such as preeclampsia.
Treatment includes rest, monitoring your blood pressure and the your baby’s growth and wellbeing. If your blood pressure doesn’t settle then you may need to start on medication or your baby may need to be born early.
***Key Points***
***Monitoring your blood pressure***
Your blood pressure is monitored throughout your pregnancy at each antenatal visit. Pregnancy induced hypertension [PIH] is usually diagnosed after 20 week’s gestation, it is usually a blood pressure greater than 140 over 90. However this should be assessed on an individual basis by your midwife or doctor.
It can also be a sign of a more serious condition called pre-eclampsia.
There may be a higher chance of you developing high blood pressure during pregnancy if you have had pre-eclampsia before, you are aged over 40, have another illness such as diabetes, you are pregnant with twins or you have a high body mass index [BMI].
***Monitoring your blood pressure***
***High blood pressure***
PIH is one of a few types of high blood pressure, the others are: chronic hypertension (when you had high blood pressure before the pregnancy); and pre-eclampsia (a serious condition that can affect other organs in the body).
If you experience headaches, blurred vision, seeing spots, swelling in your legs, feet, face and hands, and pain in your upper abdomen it is advised that you seek medical advice as soon as possible.
It is suggested that you maintain a nutritious diet and exercise to maintain a healthy weight and if you smoke to give up smoking. If there are concerns about your blood pressure your care provider may suggest a medication to help manage it.***High blood pressure***
During your antenatal visits the midwife of doctor will monitor your blood pressure. High blood pressure may impact on the function of your placenta and its ability to provide your baby with oxygenated blood and nutrients.
Resources
Health Direct – pre-eclampsia or pregnancy induced hypertension [PIH]
Underlying Medical Conditions
If you have an existing medical condition you should consult with your specialist about planning for pregnancy.
Your medical condition may impact on your pregnancy, labour and birth and postnatal experience, your specialist team will collaborate with your maternity care team in order to provide you with the most appropriate care.
***Key Points***
Some women experience medical conditions that may have an impact on their pregnancy care choices.
These may include: asthma [or respiratory disease], diabetes, cardiac disease, epilepsy, problems due to previous injury including car accidents or birth, high blood pressure or previous surgery [this list is not inclusive of every medical condition that may impact on your pregnancy, birth and postnatal period].
Most importantly your specialist and maternity care providers collaborate in order to provide you with the most appropriate care to your needs.
In the majority of cases your pregnancy will be considered high risk as you will need more careful monitoring of your health and your baby’s.
Some symptoms may get worse due to the pregnancy and you may need changes to your medication or your treatment options may change.
***Key Points***
***Asthma***
If you have asthma before pregnancy it should not cause any problems if you manage it well. Most asthma medications are safe during pregnancy and it is usually better for you and your baby to take the medication rather than have your symptoms get worse if you don’t take medication. It is advisable to talk with your treating doctor about medications and pregnancy. For about one third of women their asthma will not change during pregnancy, for another one third their asthma will improve and for the other third they will notice their asthma getting worse during pregnancy. There is a chance that women with very bad asthma may develop high blood pressure or pre-eclampsia during pregnancy. If your asthma is not managed well there is a chance that your baby may be born early or have a low birth weight.
***Asthma***
***Diabetes***
Diabetes – it is important to manage your diabetes well if you are planning pregnancy or just found out you are pregnant. You will have a specialist team caring for you to help manage your diabetes and to carefully monitor your pregnancy. Keeping your blood sugars stable during pregnancy is important for the health of you and your baby.
There is a chance that you could develop eye or kidney problems during the pregnancy if your sugars are not well maintained. You also have a higher chance of developing pre-eclampsia which is a serious complication of pregnancy that may also affect your baby and cause a pre-term birth.
Your baby may have a higher chance of being born with some complications including – weighing more than average, being stillborn or having an abnormality, or developing diabetes later in life. Your doctor may recommend an induction of labour due to the effects of the diabetes on you and your baby. Both you and your baby will be monitored after the birth to check your sugar levels.
***Diabetes***
***Cardiac disease***
Cardiac disease – if you have pre-existing cardiac disease it is recommended that you speak with your treating doctor about your plans to get pregnant. Pregnancy increases your blood volume by about 30%-50% and during labour and birth increased pressure is placed on the heart and blood flow through the body.
Due to these added pressures, if you have cardiac disease it is recommended that you have an assessment by a cardiologist as part of your pregnancy care planning. You might develop high blood pressure during the pregnancy or if you have an epidural it might cause low blood pressure, throughout pregnancy, labour and birth there are constant changes to your blood pressure, heart rate and cardiac output.
This means that you may not have had problems before pregnancy but pregnancy may cause you to experience exacerbated symptoms.
***Cardiac disease***
***Epilepsy***
Epilepsy – as with other pre-existing conditions, careful management of your epilepsy you’re your specialist care team is important. Your medications may need to be changed or modified, aiming for the lowest dose to prevent seizures. About 95% of women with epilepsy have a successful pregnancy.
A detailed ultrasound is recommended at 18-20 weeks to specifically assess the heart, kidneys and presence neural tube defects. You will be more closely monitored during your pregnancy and labour and birth. The importance of rest and good quality sleep is particularly important during pregnancy.
Your baby will be more closely monitored after the birth, breastfeeding is encouraged but make sure you talk to your doctor or midwife about the type of medicine you are taking.
When you are home it is suggested that you feed your baby sitting on the floor, bath your baby when someone else is around, try not to carry your baby around too much and have an automatic brake on your pram.
***Epilepsy***
***High blood pressure***
High blood pressure – also known as chronic hypertension [also if high blood pressure was found before 20 weeks of pregnancy it will be called chronic hypertension] usually a blood pressure reading of more than or equal to 140/90 [140 over 90].
You may already be receiving treatment for your high blood pressure and will be taking medication to manage it. Your doctor or midwife will encourage a healthy life-style, including eating healthy, nutritious food, participating in regular exercise, maintaining a healthy weight and if you smoke to try to give up.
You will be more closely monitored during pregnancy and labour for signs that you may be developing pre-eclampsia. There is a higher chance of developing complications such as a placental abruption, pre-eclampsia, pre-term birth, low birth weight, perinatal death and gestational diabetes.
***High blood pressure***
***Pre-existing injury***
Pre-existing injury/surgery – you may have had an accident, injury or surgery that may impact on your choices during pregnancy or labour and birth. Things such as injury or surgery to the pelvis or spine may influence options for birth or pain relief during labour, or may affect your ability to be mobile during labour.
Breast surgery may influence your choices regarding feeding your baby. It is important to talk to your doctor about how this might affect your choices during pregnancy, labour and birth and the postnatal period.
***Pre-existing injury***
Resources
Department of Health WA – pre-existing conditions that can affect pregnancy
Family Education – managing pre-existing illness in pregnancy
Health Direct – Asthma and pregnancy
Diabetes Australia – pregnancy
Heart Foundation – heart disease and pregnancy
SA Health – guidelines epilepsy and pregnancy management
RACGP – epilepsy and pregnancy
Epilepsy Foundation – pregnancy planning
Department of Health – blood pressure
Multiple Births
When you are pregnant with more than one baby – either twins, triplets or more, it is referred to as a multiple birth.
This occurs in about 2-3% of pregnancies across Australia and about 98% of that number are twins.
***Key Points***
- Your pregnancy is considered higher risk if you are pregnant with twins or triplets, however your pregnancy and birth can still be a positive experience.
- Most women with multiple pregnancies will ahve a healthy pregnancy and will give birth to healthy babies, however women pregnant with twins or triplets or more are more likely to experience pregnancy complications such as anaemia, bleeding, high blood pressure or premature labour.
- They occur 2-3 more time more frequently in twin pregnancies and higher in triplet pregnancies.
- Gather information, resources and support to navigate through this experience. This is an exciting time for you and your family and work towards a positive birth experience and early parenthood.
***Key Points***
***Discovering its more than one!***
The confirmation that you are expecting twins or triplets can be a shock and you may feel an array of emotions form excitement to overwhelm.
Twins or triplets are confirmed on ultrasound and your health professional wil be able to twll you how many baby’s, how many placenta’s and how many amniotic sacs there are at around 10-12 weeks gestation.
If you are pregnant with twins, your care provider will want to find out what type of twins you are having. Twins are either fraternal, which means two eggs have been fertilised by two sperm or they can be identical, which is when one fertilised egg splits and forms two babies. Identical twins may each have their own placenta, share a placenta and be separated by the inner membrane or they share a placenta and are not separated by an inner membrane.
If the babies are sharing a placenta it means that they are also sharing the supply of oxygenated blood and removal of deoxygenated blood and waste products. If the supply is not equal between the two babies some complications may occur. Which is why twin pregnancies need to be more closely monitored.
Triplets, or more babies are usually a combination of twins and a single baby. Most commonly they are identical twins with one other baby, but can be fraternal. These pregnancies are more complex than others so will need more frequent monitoring and specialist care.
***Discovering its more than one!***
***Your antenatal care***
If you’re pregnant with twins, triplets or more, then you’ll need a higher level of care to monitor you and your babies’ progress.
That means more appointments and tests during your pregnancy. The usual tests include ultrasound, blood, urine tests. When you are carrying multiples, you will most likely have more ultrasounds than a singleton pregnancy to monitor the growth of your babies.
Expecting twins or triplets increases your chance that your placenta may not work as well as we expect. This can affect your babies’ growth and wellbeing during pregnancy. This may mean one or both of your baby’s is smaller than expected and will be closely monitoried throughout pregnancy.
Giving birth prematurely (before 37 weeks) is more common if you have a multiple pregnancy and can either be because you go into labour early or because your healthcare team recommend that the babies are born early due to concern about your baby’s.
Depending on how early they have been born, they might need to spend time in the Special care nursery or neonatal intensive care unit. Wherever possible your babies will be kept together however depending on their individual needs they may need to be cared for separately.
You may feel more unwell during pregnancy with twins or other multiples, there is a higher chance that you may develop diabetes or high blood pressure.
It is important to care for yourself during pregnancy, but especially when you are pregnant with more than one baby
- Eat nutritional foods and drink plenty of water
- Stay active with gentle exercise
- Pelvic floor exercises are essential
- Look after your emotional wellbeing
***Your antenatal care***
***Birthing options***
Your care giver will talk to you about your wishes for the birth. You Midwife and Doctor will start to discuss your birth plan from around 24 weeks pregnant. There are a number of options that impact the decisions regarding your birth as to whether you plan for a vaginal birth or caesrean section.
This will include the position in which you babies are lying, how well they are growing and your personal preference about birth.
Both vaginal birth of twins and caesarean section have risks and benefits depending on your individual circumstances. you Midwife and doctor will discuss these options with you to enable you to make an informed decision.
***Birthing options***
***Prepare for Parenting***
Having twins or triplets will be challenging but oh so rewarding!
- Join your local Australian Multiple Birth Association group
- Seek out local breastfeeding support in pregnancy
- Don’t go it alone – seeks and accept help!
***Prepare for Parenting***
Resources
Australia’s Mothers and Babies – mothers who have multiple births and their babies
Better Health Channel – twins and multiple births
Pregnancy after 40
Most women over 40 have a healthy pregnancy and healthy baby. However you will be offered increased monitoring during pregnancy as there are some added risks to consider.
***Key Points***
The most common terms used to describe a woman who is pregnant over 40 years are ‘advanced maternal age’, “late or older’ pregnancy. We have elected to use the term ‘pregnant over 40’ instead.
You may have conceived naturally at around 40, 1 in 10 women are likely to be able to, or you may have achieved pregnancy using reproductive technologies, either way congratulations…there is lots to look forward to!
When you are pregnant in your 40s your antenatal care will be much the same as someone younger. However, research suggests that women pregnant over 40 are at a higher risk than younger groups of developing some pregnancy complications.
However there are some things that may occur more commonly in older mothers such as: miscarriage, gestational diabetes, high blood pressure, placenta praevia and premature labour.
There may be an increased chance of miscarriage, your baby having chromosomal changes and interventions such as caesarean section. You will likely be offered more tests and your pregnancy may be more closely monitored.
***Key Points***
***Antenatal care and screening***
Many women pregnant over 40 are in excellent health and most will have a healthy pregnancy and a healthy baby. Your Midwife or Doctor will discuss with you your previous health and any pre-existing illnesses and as with any pregnancy you will be offered regular antenatal visits to monitor the health of you and your baby.
However, research suggests that women pregnant over 40 are at a higher risk than younger groups of developing pregnancy complications.
Your care provider may offer tests for genetic conditions such as Down syndrome, as older mothers have a higher chance of conceiving a baby with Down syndrome , around one in 100 at 40 years of age, and by age 44 the chance of having a baby with Down syndrome is one in 30.
These are tests you can have but none are compulsory – they are a personal choice.
You may be offered screening tests which indicate there is a higher chance your baby may have a condition. The non-invasive prenatal screening test (known as NIPT) is the most accurate screening test for chromosomal changes and involves a blood test after 10 weeks of pregnancy. The results are usually available in 3-5 days, the test costs around $450 AUD and is not covered by Medicare or health insurance.
If a screening test shows you have a higher chance of having a baby with chromosomal changes you may be offered diagnostic testing which can give you a definite answer. A diagnostic test may be chorionic villus sampling (CVS) which is done after 11 weeks of pregnancy. The risk of miscarriage after this procedure is thought to be around 1 in 100 pregnancies. Or if after 15 weeks of pregnancy you may be offered an amniocentisis to confirm whether or not your baby has chromosomal changes or a genetic condition. The risk of miscarriage after amniocentisis is around 1 in 200 pregnancies.
Both procedures are completed by a doctor using ultrasound to guide the insertion of a very fine needle to remove a sample of amniotic fluid [in the amniocentisis] or placenta [in the CVS]. The sample will be sent away for testing and your doctor will give you the results in a couple of days or up to a week or two. Ask your doctor about your individual situation. Each procedure may only take a few minutes and you will feel minimal discomfort afterwards. If the test shows that your baby has a condition you may be offered genetic counselling to discuss your options.
Good antenatal care is essential. There is a an increased risk of placenta praevia, high blood pressure, gestational diabetes and premature labour, therefore your pregnancy and wellbeing will be monitored closely. You nay be offered further ultrasounds to monitor your baby’s growth and wellbeing and the functioning of the placenta.
***Antenatal care and screening***
***Planning for labour***
Your Midwife or Doctor may suggest increased monitoring once you reach 38 weeks pregnant. They may suggest extra ultrasounds or monitoring by listening to your baby’s heart rate over a period of time. While the overall risk for stillbirth is still very low there is a slight increase for women pregnant over 40. The risk of stillbirth at 39-40 weeks is 1 in 1000 pregnancies under 35 years of age and about 2 in 1000 pregnancies for women over 40.
Therefore your Midwife or Doctor may discuss with you the risks and benefits of an induction of labour as you approach 40 weeks. An induction of labour is when labour is started artificially using medications and by breaking the waters surrounding your baby encouraging the uterus to contract.
When discussing an induction of labour your should have a clear understanding of how the benefits of inducing labour outweigh the risks of waiting for labour to begin on its own.
Your Midwife or Doctor will help you understand the risks for your own pregnancy. Different people will make different choices based on their own preferences and values. Remember the choice is yours.
***Planning for labour***
As with pregnancy at any time, surround yourself with a good support network before, during and after the birth.
Resources
https://www.ontariomidwives.ca/pregnancy-and-birth-after-age-40
Resources for Recurrent Miscarriages
Whee to see help when you are experiencing recurrent misscariages
eg. pink elephant, RANZCOG
Early Miscarriage
A miscarriage is the loss of the baby before 20 weeks gestation, most often this occurrs before 12 weeks.
***Key Points***
Miscarriage brings with it an array of emotions. Your grief reaction is individual to you and impacted by so many factors, such as how long it took you to become pregnant or wether this is your third or fourth miscarriage or your first pregnancy.
If you are here because you have experienced a pregnancy loss, we are so very sorry and the heartbreak you are experiencing.
It is not often until you start to talk to other women about their experience that you realise how common it is.
About one in five of all pregnancies end in miscarriage.
Sharing your experience, talking to other women about your loss can help you to process these emotions.
***Key Points***
***Experiencing a miscarriage***
You might experience cramping, strong period pain and bleeding which might indicate you are having a miscarriage. For some women, they don’t know it has happened, there are no signs or symptoms. You may have no idea anything is wrong until you go for a routine scan that shows your baby has no heart beat.
If you think you are having a miscarriage you should go to your local doctor or hospital.
You cannot prevent a miscarriage from happening and may not ever find out the reason. Often a miscarriage happens when the baby has not developed properly – there may be a chromosomal problem, issues with blood clotting, immunity problems, medical conditions or physical problems that may impact the growing baby – ask your care provider about your unique situation.
Remember to use sanitary pads not tampons during a miscarriage.
***Experiencing a miscarriage***
***Treatment for a miscarriage***
What is the treatment for a miscarriage?
If an ultrasound has confirmed that the pregnancy has ended in general there are a number of options open to you
- Wait to miscarry naturally
- Elect to have a dilation and curettage – sometimes known as a D&C
- Take a tablet to induce a miscarriage
For some women, it’s not until they start bleeding that they know anything has happened to their baby, and you may have a complete miscarriage straight away
Talk to your doctor or specialist about the most appropriate way to progress for your individual situation and make a decision together that you are happy with.
Your risk for miscarriage increases as you get older, if you smoke, if you drink alcohol or have a history of having recurrent miscarriages.
***Treatment for a miscarriage***
***Causes of a miscarriage***
What are the causes of a miscarriage? – I am trying to find answers
It is important to know that in around 50% of cases a medical explanation for our pregnancy loss with not be found. This can be reassuring for some but disappointing for others.
Be reassured that usually after you have had a miscarriage you can go on to have a successful pregnancy next time.
***Causes of a miscarriage***
***The emotions of pregnancy loss***
The emotions of a pregnancy loss
The loss of a baby can affect you and your partner and it may take time for the grief to subside. You will also be experiencing the physical and hormonal changes of the loss of a pregnancy. The support of your family and friends can be comforting at this time.
Be kind to yourself. The aftermath of a pregnancy loss can be a very sad and often feel a very lonely time. Allow yourself time, care for yourself physically and accept practical support from friends and family.
In Australia, women who experience miscarriage, and their partners, will soon be entitled to two days of paid bereavement leave as landmark legislation was put to the federal parliament on 24th June 2021
***The emotions of pregnancy loss***
***Support services***
For support you can contact SANDS 24 hour phone support 1300 308 307,
Pink Elephants Support network
REFERENCES
Pregnancy Birth Baby – miscarriage
Better Health Channel – miscarriage
Raising Children Network – miscarriage
***Support services***
References
Pregnancy Birth Baby – miscarriage
Better Health Channel – miscarriage
Bleeding in Early Pregnancy
Bleeding in early pregnancy is common. Research tells us between 20-40% of women will experience bleeding before 12 weeks.
***Key Points***
Many of these pregnancies will continue on and result in the birth of a baby. About one third to one half will result in miscarriage.
It is a very distressing symptom for you as you seek reassurance about the wellbeing of your baby and the continuation of your pregnancy. Contact your care provider or local hospital if you experience bleeding early in pregnancy
***Key Points***
***Bleeding during pregnancy***
For many women they will continue the pregnancy, others may not know what caused the bleeding. The bleeding may also be a sign of miscarriage or ectopic pregnancy.
You should seek advice and assessment from a health care provider or, if the bleeding is heavy you should call and ambulance or go to your local hospital emergency department.
They will need to estimate the amount of blood you have lost so it is important to put a pad on, and if the bleeding is heavy keep the soiled pads in a plastic bag and take them in with you. They will also measure your blood pressure, temperature, pulse, check your urine and your blood group.
They may use an ultrasound to view the baby and they may take blood from you to check your pregnancy hormone levels. You might be monitored in hospital for a while or you may be able to go home after you have been checked.
***Bleeding during pregnancy***
REFERENCES
Pregnancy Birth Baby – bleeding during pregnancy
Better Health Channel – bleeding problems
RACGP – early pregnancy bleeding
The Women’s – bleeding in early pregnancy
Department of Health WA – pain or bleeding in early pregnancy
Ectopic Pregnancy
During early pregnancy, when a fertilised egg implants itself outside of the uterus it is called an ectopic pregnancy. It is estimated that this happens in about 1 in 100 pregnancies. It most often occurs before 14 weeks of pregnancy. There is no possibility that the baby will survive outside of the uterus.
***Key Points***
- Outcomes are improved if you seek antenatal care early in pregnancy
- Seek medical assistance in early pregnancy if you experience abdominal pain.
- Call an ambulance immediately if you experience sudden, sharp, intense abdominal pain.
***Key Points***
***Signs and symptoms***
Some women don’t know it has happened, for others they will experience abdominal pain and bleeding. Always seek medical assistance if you experience either.
The ectopic pregnancy can be potentially serious for the mother who is at increased risk of severe bleeding. The most common spot for the fertilised egg to implant is the fallopian tube, as it grows the fallopian tube cannot accommodate the growing embryo and may rupture, causing significant pain and bleeding.
Some women may not even know they are pregnant, they may experience pain and bleeding which may indicate an ectopic pregnancy. Some may think they are pregnant but the embryo cannot be seen in the uterus during an ultrasound scan.
***Signs and symptoms***
***Treatment***
Medication may be offered via an intramuscular injection in your arm to dissolve the embryo or surgery may be required to remove the embryo and treat any bleeding.
If the ectopic pregnancy has ruptured you will experience sudden, sharp, intense abdominal pain. Looking pale and feeling dizzy or fainting. Feeling very unwell. If this happens you must call an ambulance urgently. This could be life threatening if left untreated
***Treatment***
References
UpToDate – Ectopic pregnancy – clinical manifestations and diagnosis
Department of Health Western Australia – ectopic pregnancy
