Fetal Monitors

Bond Mejeh asked:


Thyroid disease affects different aspects of pregnancy and postpartum health for the mother and the newborn child. There have been varied and contradicting practices with regards to thyroid disease and pregnancy. As a result a group of endocrinologists came together to publish a journal containing clinical guidelines for the management of thyroid problems during pregnancy and during the postpartum period. The creation of this group came about over a two-year period and their findings were published in the Journal of Endocrinology and Metabolism, the August of 2007 issue. This journal represents the methods and practices of endocrinologists all over the world.

Some of the main components of that journal are being discussed below. The points bear crucial implications for women who are diagnosed with thyroid disease during their pregnancy or even at the postpartum stage. Some of the information also has a bearing on women who develop thyroid disease before they get pregnant.

Hypothyroidism & Pregnancy

The condition of hypothyroidism in a mother or an unborn child can cause serious health problems on the unborn baby. If a woman is aware of her condition as properly diagnosed hypothyroidism, she should reconsider trying to get pregnant or avoid maternal hypothyroidism altogether.

If a woman should develop hypothyroidism prior to her pregnancy and it has been properly diagnosed by a doctor or endocrinologist, her thyroid medication will need to be adjusted so that the thyroid stimulating hormone (TSH) level goes no higher than 2.5 prior to entering pregnancy.

A woman diagnosed as hypothyroid during her pregnancy should undergo treatment immediately. The goal is to restore her thyroid levels back to normal as soon as possible. Upon entering the first trimester, her thyroid-stimulating hormone (TSH) level should be held at less than 2.5. Upon entering the second and third trimester, her thyroid-stimulating hormone (TSH) should be maintained at less than 3.0. Thyroid function tests need to be reviewed and re-evaluated within 30 to 40 days after the initial diagnosis.

When a pregnant woman reaches week four to six, her thyroid medication dosage will almost always need to be increased. It is possible that her dosage will increase by anywhere from thirty to fifty percent.

Some women have a thyroid auto-immunity as in cases where she has been previously examined and found to be positive for thyroid antibodies. Woman who have an auto-immunity and who possess normal thyroid stimulating hormone (TSH) levels in early stages of pregnancy can still be at risk of becoming hypothyroid at any point in the pregnancy. It is recommended that she be monitored regularly throughout the pregnancy for elevated thyroid stimulating hormone (TSH).

If a woman is diagnosed with subclinical hypothyroidism which involves a thyroid stimulating hormone (TSH) level above normal with normal free T4 levels, her condition can lead to a negative health outcome for her and her unborn child. Immediate treatment of the mother can help to ensure a healthier pregnancy and birth outcome. However, treatment has not been proven to guarantee long-term neurological development of the baby. In spite of this, experts believe that the possible benefits of treatment still outweigh any possible risks if the mother went without treatment. The consensus is that treatment is recommended even in women with subclinical hypothyroidism.

Once childbirth has occurred, most women who have been diagnosed with hypothyroidism will need to have their medication dosage reduced.

Hyperthyroidism & Pregnancy

It has been found that hyperthyroidism can be brought on by Graves’ disease. Transient hyperthyroidism can also trigger hyperemesis gravidarum, which is a condition of pregnancy that causes severe morning sickness. The diagnosis involves determining whether a woman has a goiter, tests positive for thyroid antibodies or both.

If a pregnant woman’s hyperthyroidism is triggered by Graves’ disease or nodules are found in the gland, she should begin treatment for hyperthyroidism immediately. Generally, pregnant women are given anti-thyroid medication as part of treatment especially when initially diagnosed.

The most common antithyroid medication given usually during the first trimester is propylthiouracil. Propylthiouracil is generally the drug of choice because methimazole contains has a slightly higher risk of birth defects. Methimazole is used, but it is only prescribed if propylthiouracil is not available or if a woman is experiencing complications with it.

There are situations where surgery may be the only recommended method for treatment instead of drugs. They are:

If there is a severe negative reaction to anti-thyroid drugs. If a woman requires an extremely high dosage to control her hyperthyroidism. Uncontrolled hyperthyroidism remains despite treatment.

If the above cases are evident, surgery is recommended usually during the second trimester. The second trimester for this operation poses less risk to the unborn child and danger to the pregnancy.

Treating subclinical or mild hyperthyroidism has not been shown to improve or better the outcome of pregnancy. Therefore, treating subclinical or mild hyperthyroidism is not because of the potential negative effects on the unborn child.

Note: Radioactive iodine should never be administered to any woman who is or may be pregnant.

Antibodies, Graves’ Disease and Newborns

There are two antibodies in a mother that can cross the placenta and affect the unborn child’s thyroid gland. They are called TSH receptor-stimulating or TSH receptor-binding antibodies. If a woman is diagnosed positive for any of these antibodies while pregnant, her child can be born with hyperthyroidism. It is very important that these antibodies be measured in both women who have Graves’ disease or who have given birth previously to newborn children who developed Graves’ disease. It may be necessary to treat the mother with anti-thyroid drugs in order to reduce any risk to the newborn child.

If a woman has elevated TSH receptor-stimulating or TSH receptor-binding antibodies and is treated with anti-thyroid drugs, a doctor should conduct a fetal ultrasound evaluation. This scan will search for any evidence of dysfunction in the thyroid gland of the still developing baby. Such would include finding any evidence of slow growth and enlargement in the baby’s thyroid.

If a new mother has been diagnosed with Graves’ disease, her newborn child should still be evaluated after birth for any dysfunction in its thyroid gland.

Pregnancy with Severe Morning Sickness and Hyperthyroidism

Hyperemesis gravidarum is severe morning sickness that may also include dehydrations and significant weight loss. All pregnant women diagnosed with hyperemesis gravidarum should have their thyroid gland examined for any dysfunction.

If a woman is diagnosed with overt hyperthyroidism due to Graves’ disease and gestational hyperthyroidism with substantially elevated thyroid hormone levels treatment may be required.

Thyroid Nodules, Thyroid Cancer & Pregnancy

A fine-needle aspiration (FNA) biopsy evaluation is recommended for pregnant women with thyroid nodules measuring larger than 1 cm in size.

Once a pregnant woman is diagnosed with malignancy or cancerous thyroid nodules and they are such nodules are found during the first or second trimester, surgery should be recommended in the second trimester.

Note: Well-differentiated thyroid cancers grow at a much slower rate. If the evaluation or biopsy shows the cancer to be papillary or follicular without any evidence of advanced disease, a woman may be able to choose having the surgery after childbirth.

A pregnant woman previously diagnosed with thyroid cancer or a woman (as in the above case) diagnosed with a well-differentiated thyroid cancer opting to have surgery after her child is born can still receive treatment that can help to suppress thyroid stimulating hormone (TSH). Though her thyroid stimulating hormone (TSH) level may be suppressed, it would still be detectable. The desirable situation is to have free T4 or total T4 levels remain within the normal range for the pregnancy.

Note: Radioactive iodine should never be administered to women who are breastfeeding.

Women who are receiving therapeutic doses of radioactive iodine should wait a minimum of six months and up to a year before becoming pregnant. This will ensure stability of thyroid function and that the cancer is in remission.

Postpartum Thyroid Problems After Pregnancy

A thyroid evaluation should be conducted three to six months after a woman has given birth if she has already tested positive for thyroid peroxidase antibodies.

In women with type 1 diabetes, postpartum thyroiditis is three times more likely to occur. That being the case, woman with type 1 diabetes should have thyroid evaluation three months and six months after childbirth.

Women who already have a history of postpartum thyroiditis have a significantly increased risk of developing hypothyroidism within five to ten years after a postpartum thyroiditis episode. Any women that fall into this group should have their thyroid checked and evaluated annually.

Screening for Thyroid Dysfunction During Pregnancy

In particular, women who face a higher risk of thyroid disease should be screened and evaluated. It is recommended that these evaluations occur in women who are having an infertility evaluation.

It is also recommend that women who fall into the at-risk groups below be evaluated.

developed a goiter have a history of hyperthyroid or hypothyroid disease have a history of post-partum thyroiditis, or thyroid lobectomy have tested positive for thyroid antibodies have symptoms or clinical signs such as anemia or elevated cholesterol that might suggest possible hypothyroidism or hyperthyroidism have type 1 (auto-immune) diabetes and/or other autoimmune disorders have had radiation to the head or neck area during medical treatment have a history of miscarriage or preterm delivery

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Michael Bauch asked:


View from the Jury Box

By Michael Bauch

During jury selection for a medical malpractice case tried in New York State Supreme Court (Queens division), I asked a lot of questions—in hopes that this would disqualify me from consideration.

I had heard that lawyers usually don’t like potential jurors who ask “too many” questions. Questions might cause them to reveal something they would prefer not to or cause other jurors to start asking questions. To my surprise, I was chosen to be on the jury. As I would find out later, I was selected because I asked so many questions.

My two previous jury experiences had been on criminal cases, which, understandably, created a more serious, weighty atmosphere for jurors. However, the entire process in the Caputo civil case (jury selection, accessibility of the judge and attorneys, and, to a surprising extent, the trial itself) seemed to encourage a spirit of open, even friendly, inquiry into the important issues.

New York State residents are permitted to postpone reporting for jury service up to three times before the law requires them to report. I had already used all three of my postponements and was fairly certain that I would end up on a jury this time. Considering the reputation of medical malpractice cases as examples of “jackpot justice,” and my skeptical views about trial lawyers, I expected to see the civil justice system at its worst.

Trial lawyers are often associated with words like ambulance-chaser, shark, and predator—and those middle-of-the-night TV commercials that urge us to sue someone. In response, the American Trial Lawyers Association embarked on an ambitious image improvement campaign. In 2006, it changed its name to the American Association for Justice. And it dropped the term trial lawyer altogether, replacing it with civil practice attorney.

“Med-mal” is a prime example of how the reputation of civil practice lawyers has deteriorated. They are often blamed for causing juries to wrongly side against doctors on the question of medical negligence and to award more in damages than justice requires. But this reputation may be a bad rap.

“Doctors & Juries,” a 2007 article in the Michigan Law Review reported that “Although juries are widely believed to be biased against physicians, patients lose twice as many medical malpractice verdicts as they win.” The article compared studies of cases that resulted in jury verdicts and evaluations of the same facts by one or more physicians. The analytical methods of the studies differed, but the comparisons showed surprising similarities: plaintiffs won about 10 to 20 percent of the cases with weak evidence of negligence and 50 percent of the cases with strong evidence.

Marc J. Citrin is a prime example of why the reputation of trial lawyers may be undeserved. Citrin is a senior partner with the New York firm of Shaub, Ahmuty, Citrin & Spratt, which specializes in professional liability defense and hospital and health care law.

When my turn came to be interviewed for the Caputo v. Doctors Wallace and Stern and Long Island Jewish Medical Center jury, I was astonished that Citrin, the defense lawyer in this case, encouraged me to ask all the questions I could think of—and continued to talk with me after the jury interviews ended. I appreciated that he took my concerns seriously and answered to the best of his ability. When he didn’t have a good answer or didn’t know the answer, he said so.

In complex matters like medical malpractice, Citrin tries to find jurors who will be able to follow the arguments and decide the case with their heads rather than their hearts. In selecting this jury, Citrin looked for working people. “They know how to assume responsibility. I also want educated people because they ask a lot of questions,” he says.

Defending doctors accused of malpractice is one of Citrin’s specialties. “I like defending doctors. They try to do the right things for the right reasons,” he says. “I have a deep-seated belief in the position that I am advocating. “I try to be open and honest with juries and provide all of the information necessary for them to reach the conclusion that I want them to reach.”

Toni Ann Caputo sued her obstetrician, Dr. Frances Stern, a senior attending physician at Long Island Jewish Medical Center (LIJ), and the hospital’s labor and delivery staff, alleging that they had deviated from accepted medical practice in the management of her labor and delivery. (Dr. Wallace was separated from the case before trial because she had had minimal contact with Caputo.) The suit alleged negligence because Stern and LIJ staff did not perform an emergency Cesarean section delivery in response to what the plaintiffs said was severe fetal distress.

Her lawyer, John Langell, at the time with New York City medical malpractice firm Fitzgerald & Fitzgerald, argued that the baby was in severe distress due to repeated “variable decelerations” shown on the fetal heart monitor. Variable decelerations are temporary decreases in a baby’s heart rate caused when the baby presses on the umbilical cord. Langell said that the cord compression caused “hypoxia”—deprivation of oxygen to the brain—resulting in brain damage and permanent developmental delays. Caputo sought monetary compensation of $1 million on the baby’s behalf.

Nicholas, born with the umbilical cord wrapped twice around his neck, not breathing or moving, had turned pale blue. The Apgar scale, used by doctors to evaluate a newborn baby’s general condition, was 2 (out of a possible 10) at one minute after birth, and 3 at five minutes. Intervention by members of the hospital’s Neonatal Intensive Care Unit (NICU) brought steady improvement to Nicholas’s vital signs. They stabilized his Apgar at 8 (normal). Mother and baby were routinely discharged from the hospital two days later without further incident.

After the plaintiffs completed their case, Citrin began his defense of Stern and LIJ. He dealt first with whether Stern had deviated from accepted medical practice in managing Caputo’s labor and delivery. Citrin called other OB/GYN physicans, who testified that, based on the fetal heart monitor strip, Stern made a medically acceptable decision to permit Caputo’s labor to proceed and her to give birth naturally.

Citrin later addressed an issue that I had asked about during jury selection. In court, witnesses and Nicholas’s medical records confirmed my conjecture that at no time in the child’s life before age five (his age at the time of the trial), had he ever been given any kind of diagnostic tests that might have revealed brain damage sustained at birth or later. Although this is neither illegal nor abusive, this simple fact made Caputo seem neglectful of her son’s interests.

Caputo testified that, when Nicholas was about two years old, she began to notice that he might be delayed in achieving normal developmental milestones in a few areas. She was working and carried adequate health insurance for herself and Nicholas, but she never had him tested—no CAT scans, MRIs, or EEGs had ever been taken. The law firm representing the Caputos sent Nicholas for an EEG in preparation for this trial and ordered competency tests to show the extent of Nicholas’s developmental deficits. He now attends a special education program at a New York City public school.

Whatever these tests showed, there were no earlier baseline data to compare them against. For me, that was the deciding point, and Citrin had framed it very clearly for the jury. Once our deliberations began, we quickly agreed overall that the plaintiffs hadn’t convinced us, especially regarding negligence. We awarded no monetary compensation.

We worried about the impact that our verdict might have on Nicholas, who came into court briefly during the trial. He was a physically healthy child with long, curly hair and a pleasant manner. He waved and smiled at the jury members. As a father of three, I could not help but feel compassion for Nicholas and his mother. All of the jurors felt the same way: we were concerned about what the future might hold for them.

However, we were told after the trial by the presiding judge, New York State Supreme Court Justice Roger N. Rosengarten, that to reach a mutually acceptable financial settlement, Citrin had offered Langell what is known as a “high/low agreement.” In a high/low agreement, the low figure sets a minimum amount that a plaintiff is assured of receiving. The high figure is the maximum amount the plaintiff stands to gain, regardless of what a jury decides. In effect, this agreement puts the financial outcome of a civil trial beyond the jury’s control. Why did Citrin believe it was necessary to offer the high/low?

“If we lost and had to pay compensation, all or most of Dr. Stern’s personal assets, including her house, could have been taken away from her. LIJ was not subject to the high/low, so she would have been the only one held financially liable. I wanted to protect Dr. Stern’s personal assets.”

It’s easy to understand why Langell accepted the offer: “We might have gone home empty-handed. I could not let that happen if there was an alternative,” Langell said after the close of the trial. Caputo, who had originally sought a million dollars, accepted $600,000 under the agreement. Neither she nor Langell agreed to be interviewed for this article despite repeated requests.

“Caputo was the type of case where the facts could have supported either side,” Justice Rosengarten says. A verdict had the potential for plaintiffs to go home with nothing or for defendants to pay a much larger amount in compensation than they expected. Mr. Citrin’s offer of the high-low served the interests of both sides. I’m glad that they were able to reach an agreement.”

Medical malpractice remains a politically sensitive issue. There are some indications that the Barack Obama presidency might create a very different arena for deciding medical malpractice cases. Obama coauthored an article in 2006 with Hillary Clinton for the New England Journal of Medicine, titled “Making Patient Safety the Centerpiece of Medical Liability Reform.” The article recommended an alternative dispute resolution mechanism, which could radically change or eliminate the current litigation-based civil tort system.

Obama and Clinton favored a nonbinding process by which physicians could confidentially accept responsibility for medical errors in exchange for an offer of “fair compensation” and the patient’s promise not to sue. However, if the result is nonbinding, the parties could still try their case in a civil court. Predictably, opinion is divided—some legal experts see the change as necessary because the current system has become too expensive and time-consuming. Civil practice lawyers and judges are generally against it: they believe that it would be anti-democratic to deny plaintiffs their day in court.

 



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Dawn Pirrie asked:


are giving birth at home, pre-labour will shift imperceptibly into full labour, without changes in location or attendants.

You will remain in familiar surroundings with no need to travel while in labour.

Once notified your midwife will come to your house and stay with you throughout.

You will be free to move around and take up any position that feels comfortable.

You will be encouraged to take your own time during labour.

Your membranes normally will be left to rupture spontaneously.

You will be encouraged to seek relief from pain without drugs although if you require pain medication such as pethidine it can be available if arranged with the midwife in advance.

Your midwife will try hard to help you retain an intact perineum thus avoiding an episiotomy.

Your partner and family can be an integral part of the birth.

You will have your baby with you at all times.

After the birth you will be free to celebrate as you choose.

During the early stages of labour, you will probably find it is more comfortable if you move mound. Many women feel a burst of energy and some get an overwhelming urge to clean the kitchen sort out a cupboard. This is an expression of nesting and is a subconscious urge to prepare for the imminent birth. Use this time to arrange your birthing room, gathering sheets and newspapers and getting ready all the things you, your midwife and the baby will need. Ones labour has become established, you or your partner should phone the midwife if she isn’t already on her way, as well as any other people who you want to be present.

Throughout labour your midwife will be with you continuously and she will monitor the baby s heartbeat every five minutes with a sonicaid. She and your partner! will encourage you and help you into the most comfortable positions; some pain relief (usually gas and oxygen) will be available if you need it.

As the baby is being born you will probably find it helpful to squat. Your partner may “catch” the baby before putting him to your breast and your baby may breastfeed immediately. The cord will be clamped and cut once it has stopped pulsating, your baby will be quickly checked over, and the midwife will help you deliver the placenta. The baby will be given a thorough examination and weighed in a spring scale. You will be cleaned up and, if necessary, sutured. Then you will be ready to enjoy your new family member and celebrate together.

THE ADVANTAGES

There are certain advantages to having your baby at home, such as being in familiar surroundings with all the privacy you require. Your partner can play an integral part in the birth and your other children may also be present. You will have the major say in your labour, avoiding routine medical intervention. You don`t have to perform according to preconceived medical ideas of what is normal. You will have the same midwife throughout and you will not be separated from your baby or your partner afterwards. You will avoid the risk of cross-infection from medical staff and other mothers.

THE DISADVANTAGES

Rest assured that the vast majority of home births proceed without a hitch. However, if something does go seriously wrong, you will have to go into hospital. Your midwife will always accompany you. There are three main problems that can occur - your baby may have problems being born; he may have difficulties breathing at birth (although this is often due to pain-killing drugs - one risk that does not usually occur at home); and you may have a retained placenta. Not all of these problems are emergency situations. Most breathing difficulties can usually be eased by clearing the airways, giving oxygen and massage. All midwives carry oxygen just in case.

YOUR BABY’S EXPERIENCE

Your baby will benefit from the relaxed atmosphere at home and will have exactly the same care from your midwife as if he’d been born in hospital.

Your baby’s heart rate will be monitored by a fetal stethoscope or a hand-held sonicaid.

He will emerge into the skilled hands of the midwife, or be caught by your birth partner.

Once breathing, he will be given to you immediately after his birth and may suckle spontaneously.

His umbilical cord will be clamped, and cut once it has stopped pulsating.

The skin-to-skin contact he experiences as you give him a welcoming cuddle may help his breathing. He will be weighed and examined by the midwife; but there will be no hurry to clean him up.

Birth at home.

Your baby’s birth will be a private celebration as he is born into the intimate environment of his family. The absence of bright lights and noise will allow you to greet your baby calmly and gently. If you have other children they can get to know this new member of the family immediately and you can have them present at the moment of birth if you wish.

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Jamess Bogdan asked:


src=”http://www.loss-weight-diet.org/wp-content/uploads/2009/10/high-blood-pressure-300×225.jpg” alt=”high blood pressure” title=”high blood pressure” />What is High Blood Pressure?

Blood pressure is the force of blood against the artery walls. It is often written or stated as two numbers. The first or top number represents the pressure when the heart contracts. This is called systolic pressure. The second or bottom number represents the pressure when the heart rests between beats. This is called diastolic pressure.

Blood pressure is traditionally measured with a device called a sphygmomanometer. It measures blood pressure in millimeters of mercury (mmHg). An inflatable cuff is wrapped around the arm and is inflated to squeeze the blood vessels in the arm. The health care provider uses a stethoscope to listen to the pulse as the pressure is released in order to determine the systolic and diastolic pressure. Some blood pressure testing devices are now electronic and provide digital readouts of the blood pressure measurement and pulse rate.

Blood pressure normally rises and falls throughout the day. When it consistently stays too high for too long, it is called hypertension. The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure notes these levels for defining normal and high blood pressure in adults:

High blood pressure or hypertension for adults is defined as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher. Normal blood pressure is a systolic blood pressure of less than 120 mmHg and a diastolic blood pressure of less than 80 mmHg. Prehypertension is defined as a systolic blood pressure of 120–139 mmHg or a diastolic blood pressure of 80–89 mmHg. Persons with prehypertension are at increased risk to progress to hypertension.

If the systolic and diastolic blood pressure levels are in different categories, blood pressure status is defined according to the higher category. For example, a person with a high systolic pressure but a normal diastolic pressure will be considered to have high blood pressure (sometimes referred to as systolic hypertension). A person with a high diastolic pressure but a normal systolic pressure will be considered to have high blood pressure also (sometimes referred to as diastolic hypertension).

High blood pressure for adults will usually be measured on at least two different doctor visits before a diagnosis of high blood pressure is made.

For children, high blood pressure is determined by comparing the child’s blood pressure with the distribution of blood pressure for children of similar sex, age and height. A child whose blood pressure is greater than or equal to 95% of children of similar sex, age, and height (at or above the 95th percentile) would be considered to have high blood pressure. Prehypertension in children is classified as a blood pressure of 120/80 mmHg or higher but below the 95th percentile. A diagnosis of high blood pressure should be based on blood pressure readings on at least three different visits. The correct–size blood pressure cuff must be used.

More importantly, high blood pressure can be prevented or controlled through lifestyle changes and with medications when needed.

Types of High Blood Pressure

Essential hypertension—in most cases, high blood pressure does not have a specific treatable cause. This form is called essential hypertension.

Secondary hypertension—in a few cases, the cause of hypertension is some other underlying condition. This is called secondary hypertension. This may be due to kidney disorders, congenital abnormalities, or other conditions. Blood pressure usually returns to normal when the problem is corrected.

Pregnancy–related hypertension—existing high blood pressure can predispose some women to develop problems when they become pregnant. This is called pre-existing chronic hypertension. Also, some women first develop hypertension when they are pregnant. There are several types of this pregnancy–induced hypertension, sometimes called gestational hypertension. Either type of high blood pressure can harm the mother’s kidneys and other organs, and it can cause low birth weight and early delivery. Preeclampsia is a serious condition of pregnancy and is related to increased blood pressure and protein in the mother’s urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother’s kidney, liver, and brain. When preeclampsia progresses and seizures develop, the condition is known as eclampsia—the second leading cause of maternal death in the United States. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth. Most women who develop signs of preeclampsia are closely monitored to lessen or to avoid related problems. Treatment is focused on reducing water retention and lowering blood pressure to normal limits.

Treatment of High Blood Pressure

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Curious In California asked:


I had to be monitored 3-5 times a week during my first pregnancy because I had a high risk pregnancy. I am not pregnant with my 2nd baby and I know I’ll have to have simular monitoring. What is a good, reliable, accurate brand of fetal monitors that can be purchased for home use? I’ve seen many on many different sites, but how do I know what is a good brand, what is really accurate without breaking the bank? I know they can range from $30-$600 and I really don’t want to spend more than $200

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KC asked:


I just ordered a fetal heart monitor and I had a couple of questions for the ladies that are also using one.

I bought the gel that goes with it, but do you have to use that?

I’m be about 26 weeks when it gets here and I was wondering if anyone knew where I should be aiming it? Like underneath my belly button and to the side or above my belly button.
Was it easy to distinguish between your heartbeat and the baby’s?

I just figured that I’d save myself a bunch of worrying by getting one. I just hope it’s as good as I hear.
Thanks for the answers. I am so excited to get it and put my mind as ease.

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Arnaldo Velez asked:


Smoking during pregnancy is the most important modifiable risk factor associated with adverse pregnancy outcomes. It is associated with 5 percent of infant deaths, 10 of preterm births, and 30 percent of small for gestational age infants.

In addition, smoking and secondhand smoke exposure increases the risk of infertility, placental abruption, preterm premature rupture of membranes (PPROM), and placenta previa.

Despite the known harmful effects of smoking on the health of mothers and their children, it is estimated that 22 percent of American women of reproductive age smoke cigarettes. Overall estimates of smoking rates during pregnancy vary based on the method of data collection; the Pregnancy Risk Assessment Monitoring System (PRAMS) survey reported a prevalence of 14 percent in 2005 in the United States. When analyzed by state, the prevalence of smoking anytime during pregnancy ranged from 6 percent in Utah to 36 percent in West Virginia. The exact prevalence of smoking during pregnancy is difficult to discern, not only because of incomplete records, but also because most studies rely on self-reported smoking behavior and are therefore subject to underreporting.

Impaired fetal oxygen delivery is the best-studied cause of adverse outcome in pregnant women who smoke. Pathologic evaluations of the placentas of smokers have shown structural changes, including a reduction in the fraction of capillary volume and increased thickness of the villous membrane when compared to nonsmokers. Both of these factors may contribute to abnormal gas exchange within the placenta. Exposure to cigarette smoke also acutely decreases intervillous perfusion, possibly via nicotine-induced vasospasm. Another problem is that carbon monoxide exposure from smoking causes the formation of carboxyhemoglobin, which has multiple effects on systemic and fetal oxygen delivery.

Smoking may also result in direct damage to fetal genetic material. One study compared the chromosomal instability of amniocytes from smokers and non-smokers, and noted an increased incidence of structural chromosomal abnormalities among women who smoked regularly. Most of these abnormalities were the result of deletions or translocations, and many were localized to the 11q23 region, which is also associated with several hematologic malignancies.

Other possible mechanisms responsible for adverse fetal outcomes in mothers who smoke include direct toxicity of the more than 2500 substances found in cigarettes, such as ammonia, polycyclic aromatic hydrocarbons, hydrogen cyanide, vinyl chloride, nitrogen oxide, and carbon monoxide. In addition, there are over 4000 chemicals in mainstream tobacco smoke, which is drawn through the tobacco column and exits through the mouthpiece during puffing. The number of compounds emitted in tobacco smoke may actually exceed 100,000.

Animal models suggest that nicotine can directly impair lung development due to interaction with nicotinic acetylcholine receptors (nAChR). Prenatal nicotine exposure also can blunt the cardiorespiratory response to postnatal hypoxemia in sheep. Similarly, term human infants with significant cotinine levels at delivery are limited in their ability to maximize and vary their heart rate during the first four hours of life.

Finally, exposure to nicotine results in sympathetic activation leading to acceleration of fetal heart rate and a reduction in fetal breathing movement. While the consequences of these changes are not well understood, both of these parameters are used as indicators of fetal well-being.

The negative impact of cigarette smoking on fetal health is well established. Cigarette smoking has been associated with numerous adverse outcomes, including spontaneous pregnancy loss, placental abruption, PPROM, placenta previa, preterm labor and delivery, low birth weight (LBW), and ectopic pregnancy. While the pathophysiology is not completely understood, as discussed above, several possible mechanisms related to impaired gas exchange, direct toxicity, and sympathetic activation have been proposed.

Although smoking cessation during pregnancy is of maximal benefit if it occurs early in the first trimester, quitting at any time during pregnancy can have some beneficial effects. For women unable to quit smoking, reducing the number of cigarettes smoked still has maternal and fetal benefits.



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Katie D asked:


Has anyone bought and used the BebeSounds fetal heart monitor? I bought one when I entered my third trimester, but I have yet to find his heart beat with the stupid thing! I was just wondering if anyone else has used it and had success with it, or if everyone else got jipped like I did. If you were able to use it, what did you do that I am apparently not doing? I am following all the instructions given with it, and I even put it where the doctor normally finds his heart beat, but I hear NOTHING. Just curious…

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Due On Jan 23 2010~ Baby #1 asked:


has anyone used one of those websites to rent a fetal heart doppler? if so what was your experience with them and what company did you use?

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Daniels’s Mommy 9/10/09 asked:


I’ve been reading a lot of birthing stories lately and notice a lot of them request that there is no fetal monitoring. Is there a reason so many people don’t want it? This will be my first baby so I haven’t been through labor yet, is there something I don’t know about fetal monitoring devices? are they bad or something? Why do so many people request to not have one?
I know what fetal monitoring is and I always thought it was important which is why I thought it was odd that so many people were against it. It was also an option on the birth plan to not use it unless there was an emergency which I found odd because I thought they used them all the time. Just wondered if there was a valid reason people didn’t want the monitoring?

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