How to have twin babies

how to have twin babies

Many couples want to conceive hope to have twin babies. They have many reasons such as ensuring that their children have a close sibling through childhood, or just wanting a large family. Multiple births occur in about 3 percent of all pregnancies in the US annually. Experts say that there are some steps women can do to increase their chance of having twins. There are some factors that play role in possibility of having twins: diet, ethnicity, genetics, and lifestyle. Here are some guidelines about how to have twin babies.

• Take fertility drugs. They stimulate the ovaries to support more than one ovarian follicle each months towards maturity. The result is that more than one egg is released.
• If you come from a family where no identical twins are common, then your family history and genetic endowment means that you've got a greater possibility of having them yourself. But identical twins can happen in any family.
• Women who have previously had a baby have a higher chance of conceiving multiple pregnancies.
• Ethnicity: be of American/African heritage. Women from these ethnic background have a distinctly higher rate of twin pregnancies.
• The more times you conceive, the greater the chances of conceiving more than one baby.
• Try to conceive straight after you have stopped taking the pill because the body is going through a hormonal readjustment phase.
• For you who already have a set of twins, your chance of having twins again is higher.
• Good news for taller women! They tend to conceive more twins!
• Taking a folic acid supplement one month before conceiving.
• Talk to your doctor. Assisted reproduction technology will help you get twin babies.

Source: Huggies, Wikipedia

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Anti phospholipid antibodies and infertility

Infertility is the inability to conceive and have offspring. More specific, infertility is also defined as the failure to conceive after a year of regular intercourse without contraception. Evidence is emerging that inability to conceive or recurrent miscarriage in a healthy patient can provide an early clue of an adverse health condition.

anti phospholipid antibodies and infertility

Investigation to disclose the causes of reproductive failure can therefore assist with an earlier management strategies, so it can provide a long term benefit for women and restore their natural fertility. There are many causes of infertility, one of them is thrombophilia. How thrombophilia causes infertility remains unknown and poorly understood. After excluding other physical or anatomical causes such as fibroids, uterine scar tissue, congenital abnormalities, and polyps, assessment of medical history of the patient is an important next step.

Thrombophilias are disorders of blood coagulation that increase the likelihood of inappropriate clotting. It can be a concern during pregnancy because in pregnancy, blood tends to clot easily. Thrombophilia can be both congenital or acquired. The most common form of acquired thrombophilia is antiphospholipid syndrome (APS). In APS, there are antibodies against phospholipids in association with either vascular thrombosis or recurrent misscariage.

Laboratory test
For women with medical history of recurrent miscarriages, they are recommended to be screened for antiphospholipid antibodies. The most significant antibodies (immunoglobulin) involved in APS are lupus anticoagulant, anticardiolipin (ACA), and anti beta 2 glycoprotein 1 & 2.

Treatment
There are two options. First is oral antiplatelet (aspirin) and the second is UFH (unfractionated heparin). Combination of both therapies may reduce pregnancy loss in APS-positive cases by as much a 54% compared to aspirin alone.

Thrombophilia and contraception
Estrogen-containing medications can increase the risk of venous thromboembolism including deep vein thrombosis (DVT). So don't hesitate to contact your doctor to choose the best contraception for you.

How to avoid blood clot?
Control your weight, do not be overweight. Keep a healthy diet, avoid saturated fats. Keep your cholesterol level low. Stop smoking. Lower your blood pressure. Controll your glucose level (if you are diabetician). No more than 14 units of alcohol per week.

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How to conceive quickly

how to conceive quickly

Many people see to be very easy to get pregnant, as easy as dreaming it. But for other couples, it feels so long, because what we are waiting for is uncertainty. As we know, ages plays a big role. A research said that approximately one third of women ages 35-39 and half of women more than 40 have trouble getting pregnant (infertility = inability to conceive for 12 months). For men, age starts to be a fertility factor in the late 30s. One study found that in men ages 35-40, the percentage who don't conceive is about 18-28%.

There are many factors: controllable and uncontrollable. What parts of fertility we can control? What do many studies say about how your environment and lifestyle habbits play a role in the complex process of baby making?

DIET

One of the biggest research to examine the role of diet in fertility was done by the researchers of Harvard University in 2007. After observing 18,000 women and their dietary, the researchers found a pattern of eating that seemed to boost baby-making potential. Women with few risk of infertility ate fewer sugars and trans fat, more fiber and iron, more proteins from veggies instead of animals, and more high-fat dairy products than low-fat ones. These patterns are independent of age.

SMOKING

Smoking lowers a woman's chance of getting pregnant both naturally and when using fertility treatments like invitro fertilization (IVF). How about passive smokers? Studies said that women who were exposed to second-hand smoke as children have been shown to have a harder time getting and staying pregnant (with 68% higher chance of miscarriage or difficulty to conceive). So for you who are smoking, quitting smoking before trying isn’t just a good idea for your own healthy pregnancy, it helps ensure that, down the line, your baby will have a healthy pregnancy too. And for men, do not smoke since smoking has been shown to lower healthy sperm counts.

BODY WEIGHT

Body weight influences the reproductive cycle. An excess or deficit of fat cells seems to upset the delicate cascade of chemical events that are needed to make a baby. Being obese can exacerbate polycystic ovary syndrome (PCOS). But even for women who ovulate, weight has been shown to play into fertility. There’s a strong association between having a BMI over 30 or under 20 and delayed conception. One research found that for every BMI interval over 29, chances of pregnancy went down by five percent. Roughly one in four U.S. women of childbearing age is obese.

ENVIRONMENTAL CHEMICALS

A handful of chemicals are suspect when it comes to getting pregnant – for example, phthalates (used in plastics, food packaging, toys, and more), pesticides, bisphenol A (BPA), air pollutants, as well as polychlorinated biphenyls (PCBs). Last year, for example, a study of Chinese factory workers found that those with higher levels of BPA exposure had lower semen quality. PCBs, which were banned decades ago but still linger in the environment, seem to clearly affect sperm motility and damage sperm DNA.

It’s not a bad idea to find ways to limit exposure to the dubious chemicals (buy organic “dirty dozen” fruits and veggies, use BPA-free products when possible, consider not living near a highway, eat less processed and packaged food, check your cosmetics with the Environmental Working Group’s database, and so forth).

But there are a few reasons not to head for full-blown panic over chemicals in the environment. For one, it’s very hard for scientists to accurately pinpoint how and in what quantity one particular chemical affects something like sperm health because controlled studies are near impossible. Consider also that we bump into hundreds of environmental chemicals every day through no choice of our own – to a large extent it’s all out of our control.

LAST BUT NOT LEAST: KNOW YOURS, BUT NO OVERTHINK

It’s tempting with information like this to go overboard, especially when something as precious as your fertility is seemingly at stake. That said, just as with age and fertility statistics, lifestyle and fertility stats are just that – averages and trends across large samples of women. Plenty of moms get pregnant without a hitch on a steady diet of hamburgers, just as plenty who have impeccable diet and exercise habits struggle with infertility. Your best plan for getting pregnant? Stay informed, but don’t make yourself crazy with the details.

Source: BabyHopes

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Thalassemia How To Test

Thalassemia is an inherited blood disorder in which the body makes an abnormal form of hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen. This disorders result in increased destruction of red blood cells, which leads to anemia.

thalassemia how to test

Thalassemia Causes

Hemoglobin consists of two proteins: alpha globin and beta globin. Thalassemia occurs when there is a defect in a gene that control production of those globins.

Genetically, thalassemia is classified into two main types:

1. Alpha thalassemia: when a gene or genes related to the alpha globin protein are missing or mutated.
2. Beta thalassemia: when similar gene defects influence the production of beta globin protein.

Clinically, thalassemia is classified into:

1. Major thalassemia: A person with major thalassemia must inherit the defective gene from both parents.
2. Minor thalassemia: occurs if a person receive the defective gene from only one of his parents, so he becomes a thalassemia carrier. Person with minor thalassemia has minimal symptoms or mostly symptomless.

Risk factor of thalassemia

1. Certain ethnicity: Chinese, Asian, Mediteranian, and Afro-American.
2. Family history of thalassemia.

Thalassemia symptoms

• Alpha thalassemia is the most severe kind of thalassemia. It can cause stillbirth (death of unborn baby, usually during late stages of pregnancy or while delivering)
• Children born with major thalassemia may be normal at birth, but they will develop anemia in their first year of life.
• Symptoms of thalassemia-related anemia:
• Fatigue
• Growth failure, failure to thrieve
• Bone deformities in the face
• Jaundice 
• People with minor form of beta and alpha thalassemia have no symptoms, but microscopically, it can be identified.

thalassemia how to test

Thalassemia how to test

• Peripheral blood test (complete blood count) and peripheral blood film
• Low level of hemoglobin
• Low level of red blood cells
• Pale red blood cells
• Various size and shape of red blood cells.
• Serum iron test
• Hemoglobin electrophoresis: to detect abnormal form of hemoglobin molecule.
• DNA analysis : it is a definitive way to diagnose thalassemia and also thalassemia carrier.
• Prenatal testing. It can be done before the baby is born. The goals are to rule out thalassemia and to determine how severe the thalassemia is. There are 2 kinds of tests in fetuses:
• Amniocentesis: it can be done in week 16 of pregnancy by taking sample of fluid that surrounds the fetus.
• Chorionic villous sampling: it is usually done in week 11. The sample is a tiny piece of placenta.
• Premarital testing. 
• If both of bride and groom have minor thalassemia (carriers), they should consult to a doctor before planning a pregnancy. Remember that thalassemia is a preventable disease!
• Assisted reproductive technology. It helps couples with thalassemia carrier to have a normal baby. This procedure involves retrieving mature eggs from a woman and then fertilizing them with a selected man's sperm in a laboratory. After that, the embryos are tested if there is any gene defect. Only those without defective genes are implanted in the woman.

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Symptoms Of Hypertension In Pregnancy

symptoms of hypertension in pregnancy

Hypertension in pregnancy, whether it happens before or after conception, should be managed properly, since hypertension can harm the baby because of decreased blood flow to the placenta. Besides that, pregnant women with hypertension tend to deliver prematurely.

Risk factors
Pregnant women are at a high risk of hypertension during pregnancy if:

• Medical history of chronic hypertension
• Previous pregnancy with hypertension
• Age: under 20, or more than 35.
• Family history of hypertension during pregnancy
• Medical history of diabetes, cardiovascular disease
• Heavy smoker, alcoholic, drug abuser
• Medical history of kidney disease
• Medical history of auto immune disease such as SLE, rheumatoid arthritis
• Being underweight or overweight before pregnancy 

There are different kinds of hypertension in pregnancy:

• Gestational hypertension. If hypertension occurs after week 20. After delivery, the blood pressure will back to normal.
• Chronic hypertension. If hypertension occurs before pregnancy, or during pregnancy but before week 20. After delivery, it will last more than 12 weeks.
• Preeclampsia. It is a life threatening condition that is characterized by hypertension and protein in the urine after week 20 of pregnancy. 

Symptoms of hypertension in pregnancy

• Prolonged headache
• Blurred vision
• Ringing in the ears
• Upper abdominal pain (just like dyspepsia), usually on the right side
• Abnormal weight gain (more than 2.3 kg per week)
• Increased vomiting
• Swelling in the face and hands
• Numbness in extremities
• Decreased fetal movement
• Persistent vaginal bleeding

Treatment of hypertension in pregnancy

If you experience the symptoms above, please be aware of preeclampsia. Go to your obstetrician to take some blood and urine tests, and sonography to know about the fetal well being. The doctor will give you antihypertension drugs that should be taken regularly. At home, you should check the blood pressure periodically. Hospitalization is also needed in certain condition.

Sources:

• American Pregnancy Association
• Mayo Clinic

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Down Syndrome Symptoms in Pregnancy

down syndrome symptoms in pregnancy

According to National Center for Biotechnology Information, the definition of Down syndrome is a genetic condition in which a person has  47 chromosomes, instead of the usual 46. Mostly, Down syndrome happens when there is an excess copy of chromosome number 21, that called as Trisomy 21. This disorder has many impacts on the body and brain developmental.

Down syndrome symptoms

The symptoms of Down syndrome is very variable, and can be mild or severe. Children with Down syndrome have a recognized characteristic appearance, such as: smaller had with abnormal shape, the inner cornea may be rounded not pointed. Another Down syndrome symptoms are: decreased muscle tone at birth, flat nose, small ears, small mouth, separated joints between skull bones, short hands, short fingers, and white spots on the central eye called Brushfield spots. Children with Down syndrome have a slower physical, social, and mental development. They tend to have impulsive behavior and poor judgment.

Down syndrome symptoms in pregnancy

Diagnosis of Down syndrome can be made through 2 ways: directly after birth as described above or while pregnancy. Nowadays, technology is very helpful for us to improve methods of fetal abnormalities early detection. How to diagnose Down syndrome will be described below:

• Obtaining fetal tissue samples through amniocentesis and chorionic villi sampling (CVS). They are better to be done in 10-12 weeks of pregnancy.
• USG findings: fetus with Down syndrome sometime (not always) show some characteristics signs on USG, such as: decreased femur length, increased skin behind the neck, and choroid plexus cysts.
• Maternal serum testings. These tests are better to be done in 15-18 weeks of pregnancy.
• Alpha fetoprotein. The level will decrease in mother with Down syndrome fetus.
• Estriol. It is also decreased in the Down syndrome pregnancy.
• HCG (human chorionic gonadotropin). It is increased in the Down syndrome pregnancy.
• Inhibin A. It is also increased.
• PAPP-A (pregnancy associated plasma protein A). In the first trimester, low level of PAPP-A is found in Down syndrome pregnancy.

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Treatment Of Migraine During Pregnancy

treatment of migraine during pregnancy

Migraine may be the  common disease that affects people around the world. People with migraine experience headache (from mild, moderate, and severe), nausea, vomiting, and sometimes photophobia (hypersensitivity with light). The causes of migraine is definitely uncertain. The role of hormones makes migraine more frequently happen in women, especially between ages 20-45. According to National Center for Biotechnology Information, a beneficial effect of migraine during pregnancy, mainly in the last 2 trimesters, has been observed in 55 to 90% of women who are pregnant, irrespective of their migraine type. In fact, there is a higher percentage of women with menstrual migraine find that their condition becomes worse when they are pregnant. Migraine during pregnancy however may appear only in the first time of pregnancy. The effect of migraine during pregnancy which becomes worse after birth delivery is because the high and stable estrogen levels during pregnancy and the rapid fall off after pregnancy. 

Treatment of migraine during pregnancy

1. Non pharmacological therapy. It is better for you to try such as: relaxation, smooth massage, aromatherapy, sleep, ice packs, before you start taking drugs that probably have more side effects to the fetus.
2. Pharmacological treatment of migraine during pregnancy  
• Acetaminophen (paracetamol) 1000 mg used as rectal suppository is highly recommended for acute migraine.
• Ibuprofen and aspirin are second line drugs. They are avoided to take in the third trimester.
• Triptans (sumatriptan, naratriptan, zolmitriptan) are probably safe but we have lack of data that support them. Please review the last part below.
• Metoclopramide is recommended to treat disturbed nausea, and safe to use in the second and third trimester.
• Ergotamine tartrate is contraindicated for pregnant women.
• Betablockers (propanolol, metoprolol) can be used as prophylactic drugs but they are less indicated for pregnant women.

Correlation of NSAIDs drugs during pregnancy and the risk of spontaneous abortion

All types of non aspirin NSAIDs are proven to increase the risk of spontaneous abortion. Please avoid using NSAIDs to treat migraine while you are pregnant or actively trying to get pregnant. The better choice to treat migraine and headache during pregnancy is acetaminophen.

Correlation of Triptan during pregnancy and the risk of adverse pregnancy outcomes and major congenital disorders

Based on FDA, triptans includes in Category C during pregnancy and there are no increased risk shown in fetal abnormalities. The use of triptans during the first trimester is NOT proven to increase the risk of congenital malformation, but triptans that are used in the last trimester of pregnancy was found to be associated with a mild increase of bleeding during labor and atonic uterus.

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Ovarian Cyst Symptoms During Pregnancy

Ovarian Cyst Symptoms During Pregnancy

There are usually no specific ovarian cysts symptoms during pregnancy. The case are rarely found, based on epidemiology, pregnant women are rarely found with ovarian cancer, one of more than 1,000 women suffering from ovarian cyst during pregnancy. These cysts are usually harmless. Gynaecologysts classify ovarian cysts as cancerous and non-cancereous by using ultrasound  (USG) methods. But this method can not ensure the level of malignancy of ovarian cysts.

Enlarged ovarian cysts cause complications in pregnancy. Ovarian cyst symptoms during pregnancy happen when cyst rupture can lead to pain. This pain can be eliminated by certain pain killer for pregnant women, but the underlying process must be treated well.

Treatment of ovarian cysts larger than 6 cm is surgery. Surgery generally does not interfere with pregnancy or the baby but the operation should be avoided when ongoing pregnancy. Surgical removal of ovarian cysts is better in the second trimester of pregnancy to avoid complications.

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