H1N1 and pregnancy

Recently, H1N1, also known as "swine flu" has gained a high magnitude of media attention. With all of the information and attention that H1N1 has attained, it is only natural that people of all ages are interested in knowing the implications of "catching" this virus.

Pregnant women are no different. In fact, women in the third trimester of pregnancy (women that are greater than 28 weeks or 7 months pregnant) bear a disproportionate burden of disease. Women in the third trimester are more likely than their non pregnant counterparts to suffer respiratory compromise when contracting H1N1 (and the flu in general prior to H1N1). This is thought to be due to the effect of the growing uterus and decreased lung capacity in the third trimester. Put another way, in the third trimester, the baby begins to take up so much space that lungs become less spacious and therefore put pregnant women at a higher risk to have complications compared to someone that is earlier on in their pregnancy when the lung volume is greater.

Symptoms of the flu include Fever AND/or cough with or without sputum and sore throat at a minimum. Other symptoms that may or may not be present include body aches, difficulty breathing, runny nose, nausea, vomiting, or diarrhea. It is important to remember the top symptoms which are Fever with a cough or sore throat. If you have diarrhea for one day or are nauseated one time, it DOES NOT mean you have H1N1. Normal ailments of pregnancy will continue, so it is important not to be overly paranoid.

Treatment for H1N1 exists. It is most affective when starting treatment within the first 48 hours of symptoms. The medication helps to prevent the virus from multiply and spreading to more cells within the human body, therefore helping symptoms to resolves faster. Some women with severe symptoms may require hospitalization, which will be determined by the health care provider. Telephone followup is another way in which health care providers may choice to follow patients once treatment begins to ensure that symptoms aren't worsening, while providing minimal exposure to others.

Though the virus is spread through droplets (meaning by air) when someone coughs or sneezes, it is important to practice proper hand washing as well. When you sneeze, try and use your arm to cover your sneeze or cough rather than your hand, thus decreasing the spread of germs in general. It is recommended STRONGLY that pregnant women receive the flu vaccine. This year's standard flu vaccine does not include protection from H1N1 due to the fact that it was manufactured prior to emergence of H1N1.

Each year, epidimiologists look at current flu strains predict which strains will be prevelant for the following year, thus flu vaccines are made approximately a year in advance. When the epidiemiologist get it right, there are lower rates of flu in suceptiable populations receiving the flu vaccine. When they are wrong, or a new strain develops outside of the flu season, suceptible populations are at greater risk of contracting some form of the flu. It is important, however, to still receive that standard flu vaccine if you are pregnant even if you do not receive the H1N1 vaccine. The "regular" flu is responsible for more than 30,000 deaths yearly and pregnant women are at greater risk for serious complications.

As always, if you have questions or concerns, make sure to contact a health care provider near you! :)

The Children of Hurley Medical Center need your help!!!!

Let's face it. Michigan is probably among the most economically deprived states in the country. If you had to pick a city that has been harder hit by the economic downfall, look no further than Flint.

As you might remember, Michael Moore has described the economic downturn in Flint several times in his documentaries. This is mainly due to Michigan's dependence on the once bustling (now collapsing car industry).

I know, I know. Cry me a river right? Well before you get all bah-humbug and only think about yourself, I am BEGGING you to take 2 minutes out of your day to create an email account and vote for Hurley Medical Center to receive a new game room courtesy of the Children's Miracle Network. All you have to do is visit the Children's Miracle Network Website by clicking HERE or for those of you who do not trust links simply type in the following address: http://xbox.childrensmiraclenetwork.org/

It will ask you to create an account. All you need is a valid email address. You may vote 10 times every day. PLEASE REGISTER ALL OF YOU EMAIL ADDRESSES AND VOTE FOR HURLEY MEDICAL CENTER. When you log in, select Michigan as the state and Hurley Medical Center will pop up! You can vote daily until October 16th! Please do so!

The children of Flint thank you!

Urinary Tract Infections

Ever had the following symptoms? Burning with urination, the feeling that you have urinate more often, with lower abdominal pain (*and are NOT pregnant)? If so, then you were probably diagnosed with a urinary tract infection (UTI).

Many women have had the unfortunate experience of this burning, unpleasant sensation. The UTI is far more common in women as compared to males. This is due to the variations between the female and male anatomy. The urethra (which is where urine exits the body), is located closer to the rectum (and vagina, which yes, we hopefully all know men do not have a vagina). Also, the urethra is located at a shorter distance from the bladder when compared with males. Given this information, it is not surprise that UTI occur more commonly among the female sex.

Interestingly, many women note the onset of UTI with changes in sexual partner or with marked increases in sexual activity. "Honeymoon cystitis" describes a bladder infection that many brides notice upon returning from their honeymoons. Many myths to decrease sexually related UTIs include whiping from front to back (which is also a myth regarding the prevention of UTIs in general) and voiding/urinating immediately after intercourse. Unfortuantely, various studies have shown that these methods do not decrease the risk of UTIs.

Another popular remedy, the consumption of cranberry juice to prevent UTIs, also has yielded mixed results. It is unsure as to whether drinking cranberry juice definitevly treats UTIs, however, there isn't strong evidence to say that it is ineffective.

Some women also experience recurrent bladder infections. This is generally defined as 2 or more UTIs in 6 months or 3 or more episodes in 12 months. Therefore, if a person experiences a bladder infection once a year, they would not meet the criteria for recurrent UTIs though they experience them often. Women with recurrent UTIs may have additional tests performed, such as a urine culture to make sure that the antibiotics are directed against the right bug/bacteria. Once the organism/bug is identified, antibiotic therapy can be directed toward the patient's specific circumstances.

For example, if the patient is experiencing recurent UTIs that are associated with intercourse, one option is to provide the patient with medication to take immediately following sex. This has been shown to decrease the rates of recurrent bladder infections associated with intercourse. If the patient is unable to pinpoint any factors that are associated with her UTIs, low dose amounts of antibiotics can be taken for a period of 6-12 months. After this time passes, the health care provider will instruct their patient if it is appropriate to discontinue therapy and see how the patient responds.

Most women experience an improvement of symptoms within 48 of begining medication for their UTI. If symptoms have not improved, or if they have worsened patients are usually instructed to inform their health care proider for futher evaluation.

Overview of the Prenatal visit!!!

The Prenatal visit

After taking “the test” and finding out you are indeed pregnant, it’s time to select an obstetrician, certified nurse midwife, or family practitioner to care for you and your growing baby. Ideally, one should select a care provider prior to becoming pregnant. However, the majority of women begin the selection process after the fact. This article serves as an outline of things to expect during each trimester. While many practitioners have their own style, at a minimum, you should encounter the following during your pregnancy journey.

The first visit
Whether the initial visit occurs during the first, second, or third trimester, you can expect a series of initial questions to aid your provider in getting to know you and your expectations for the pregnancy. Expect questioning regarding the date of your last menstrual period, physical health, social habits (drinking, smoking, drug use), medication use, etc. In addition, a general physical exam will occur. If it has been more than a year since your last pap smear, expect to receive one during this visit.
Many providers will also perform a cervical exam. This involves placing two fingers into the vagina until the cervix can be felt and assess how “open” or dilated it is. Eventually your cervix will reach 10cm (or maximal dilation) and it will be time to push, but hopefully this will not occur before 37 weeks! Finally a series of lab work will occur, including testing for sexually transmitted infections and blood work to determine blood type, etc. Finally, the health care provider will make arrangements for you to receive an initial ultrasound to confirm the “due date.” Seems like a lot? Don’t worry, the following visits aren’t as intense J

First and second trimester routine visits
During the first two trimesters, women can expect to visit their healthcare provider at 3-4 week intervals. At every visit, women can expect questions regarding contractions, vaginal bleeding, and whether or not the baby is moving regularly. Fundal height is also measured. This involves placing a tape measure on the abdomen (belly) and measuring how long the uterus is. At 20 weeks, the top of the uterus is within a few centimeters of the belly button. The fundal height helps to assess whether or not baby is growing appropriately.
In addition to the routine visits, many women will receive a second ultrasound between 18-22 weeks to determine if baby’s organs are forming appropriately along with discovering baby’s gender. If everything checks out OK, the majority of women will not receive another ultrasound during the pregnancy.

Third trimester
The third trimester is a time of excitement because the finish line is in sight. The routine prenatal questions and fundal height assessments continue and the time between visits decreases. Additional testing occurs to assess for gestational diabetes (pregnancy induced high blood sugar). This occurs between 24-28 weeks. It involves drinking an orange colored solution and having blood drawn an hour later. Your healthcare provider will notify you of the results and if additional testing will occur. At 36 weeks, testing occurs to determine the presence of a vaginal bacterium called Group B Strep. This is done by placing a cotton swab in the vagina and the rectum to collect a sample which is sent to the lab. If the sample contains Group B Strep, it is necessary to receive antibiotics during labor to prevent baby from catching an infection during birth. In addition to this test, many healthcare providers repeat testing for gonorrhea and chlamydia. The prenatal visits will continue until it’s time for baby to be delivered! Pregnancy is an exciting time. Make sure to enjoy it (even the aches and pains)!

© CGees 2009

Round Ligament Pain

Round Ligament Pain

With advancing gestational age (meaning the length of time that a woman is pregnant since conception) aches and pains often become more common. The first trimester is often plagued with nausea, morning sickness, and at times, severe nausea and vomiting. The second trimester tends to be the best for many patients especially since the nausea is often resolving, the initial pregnancy fatigue is subsiding, and you can now enjoy shopping for your cute little maternity clothing.

The third trimester has it sets of benefits and annoyances. Now that you can show off your belly like the movie stars, your ever expanding uterus could be causing more discomfort, especially in the groin and pelvic region. For some women, it might feel as though every time they move, climb stairs, lift their leg, or sit a certain way a sharp pain will follow. In the OBGYN community, this pain is known as round ligament pain. There are many ligaments that help to hold your uterus in place during the non-pregnant state. As your baby grows, the uterus must increase in size to hold your bundle of joy. In order for your uterus to stretch, your ligaments and your pelvis must change shape as well. This can cause sharp pains during movement due to spasm of your ligaments. Patients most frequently report the pain occurring in their right groin, but it could occur on both sides.

This pain is different from contraction pain. During a contraction, patients frequently report feeling their baby “ball up” or “curl up” inside of them, along with a tightening feeling over their abdomen. During a contraction, it is also possible to feel your belly (which is your uterus) becoming hard.

Unfortunately, there is not much that can be offered as a treatment for round ligament pain (and no, we will NOT deliver you at 33 weeks because you have groin pain). However, comfort measures such as a heating pad or warm towel can help. Also, try gradually sitting or avoiding sudden movements. That will also help decrease spasms during movement. As always, if your pain feels unusual to you or is worrisome, make an appointment to see your OBGYN, nurse midwife, or family practitioner to further answer your questions in detail.

© 2009 CGees