A third of all stillbirths are due to smallness of babies ( a condition called IUGR). The mainstay of management is Doppler Ultrasound. Two-thirds of small babies cannot be detected by tummy examination by Doctors/nurses in the clinic. Therefore, for the sake our unborn babies, do Doppler screening for fetal wellbeing in your third trimester of pregnancy

http://www.layyous.com/en/ultrasound-scan/the-clinical-advantages-of-3d-and-4d-ultrasound/2-118

See above link for a comprehensive clinical benefits of 4D Ultrasound

4D ultrasound allows the pregnant woman to see her baby's overall body so that if there is any abnormality, it can be detected on time and the woman can see for herself. Gone are the days when an ultrasound scan will say one thing and the woman or the doctor is not convinced

corrall:

Oga Alemo, thanks a bunch for your inputs here, the only problem I have is that this your medical terms no be here o, can some of this things be explained in small small English?

I will try my best, my sister, to explain am for small small english. Everything wey I dey say, i fit summarise am say, the most important thing to do to know if your baby is going to be okay is to measure the blood wey de flow to the baby through the umbilical cord. The name of the test na 'umbilical artery doppler'. Experiment don show wetin i dey talk. 'see Umbilical artery Doppler was shown to have 100% specificity for predicting foetal outcome, See http://www.ncbi.nlm.nih.gov/pubmed/23457860 .' If na the only thing wey person do for pregnancy be that, our picking go dey survive more because once we know say blood no dey flow to our baby again, we go quickly deliver the baby. I pray say wetin i want to say next no go cause my fellow doctors to vex with me, but the truth be say, nine out of ten of our doctors no dey tell pregnant women wetin I just talk about doppler so (from one study wey we do for one conference). The reason wey dem de give be se they no know when the test go reach Naija. But the test don dey Naija. Na the awareness me I just dey spread. Once pregnant mothers start to dey demand for some tests, e go make us doctors to read the latest thing wey de happen. I wish all of us luck

BEST WAY TO KNOW IF YOUR BABY IS FINE
Umbilical artery Doppler was shown to have 100% specificity for predicting foetal outcome, See http://www.ncbi.nlm.nih.gov/pubmed/23457860 . What this means is that once the Doppler scan of your babies umbilical artery shows that blood is flowing to your baby, it means that in all of such cases the baby will be okay.
So, if your baby is not kicking fine, or you have any illness that you think might have affected your baby, or the doctor/nurse says your baby is not growing well etc, go straight for umbilical artery doppler ultrasound.

MGeey:
Hello mamas. Please my EDD was on May 31st. i have been having lots of discharge for the past 2 days but this morning, i saw a tinge of blood (show). I went to the hospital and a midwife examined me and said she's only been able to put in a finger. she asked me to come back in the evening as i will have contractions then, she asked me to exercise. i trekked from that hospital till half way home (long journey) and all through I was having contractions. Got home n relaxed n d contractions stopped until I started exercising again but now I'm not having it anymore but the discharge is much and I feel like I'm leaking water.

what should I do biko I'm so frustrated. My laps are paining me because of previous exercise and I'm limping because of the way d baby is lying.

Madam. It is important that you go back tomorrow so that they can look and confirm whether your water has broken or not. If it has, then labour must start (either on its own or with medication) within 24 hours to avoid infections from germs migrating upward into the womb.

The signs that labour has started are: 1) Contactions becomes regular, occurring every 10minutes or less, and becoming more painful, 2) show, which is the bloodstained mucus that you described, 3) opening cervix (entrance to womb) which can only be assessed by the the nurse doing it on two occasions 4 hours apart, to see if it is opening more, rather than doing it only once, since some people have open cervix already and if not done twice one cannot know if the opening is increasing. 4) seeing water.

So what you should do is avoid all these exercises and go back tomorrow, ask that they check if you are draining water, and let that same nurse check your cervix again to see if the opening has increased. Also post here the exact time of all your contractions for the next one hour, so that I can tell you whether it fits into tha pattern of true labour.

Thanks

Alemo50:
And promotes maternal-fetal bonding

Further isuog.org

mytestimony:

About 7 weeks.

I think you should just do a high definition scan to find the cause

And promotes maternal-fetal bonding

mytestimony:
Plenty tins happening here o. Will go bk nd read just dt I hv an urgent question. Is it okay to take Amoxil in very early pregnancy?
Also what cld b d reason for severe abdominal pain in early pregnancy. Is it normal. Pain dst wont stop. Esp at night. Os it ok to take ibuprofen in very early pregnancy. Mk una come ans abeg

How early in pregnancy are we talking about? Embryo becomes a fetus at 8 weeks, so can you be more specific? For any pain in early pregnancy, first thing is to exclude ectopic pregnancy

4D scans and Dopplers are extremely safe in pregnancy

mumsgirl27:
Alemo50:
Good Morning and thanks for the been here, Please am 29wks and 2day pregnant, and I don't feel my baby kick strongly like people says, sometimes through out a day, the baby might kick once or not at all, my hospital do scan at every ANC visit (which is every 2wks) and from the scan my baby is doing good, please what can I do to make the baby kick more. Am getting more scared by the day.Thanks

The problem with reduced fetal movement is that before a baby dies in the womb, it first shows that sign. But many babies are okay but just are not very active or are just sleeping. The challenge is to know which is which. If you read no. 8 and 9 of this article http://www.wwl.nhs.uk/Library/FOI/Requests/2012_2013/October_2012/1398_GuidelineObs21_Antenatal_Fetal_Monitoring.pdf you will see that only Doppler ultrasound of umbilical blood flow can tell you. If blood flow to the baby is normal, nothing bad can happen to that baby for the next two weeks. That is what is meant by Doppler having a high negative predictive value, ie when Doppler says no problem, that means no problem. So the way to get reassured is to undergo Umbilical artery Doppler scan. If it's normal, then you don't have to worry for two weeks. If the baby is active after that, you don't have to repeat it.

VictoriaOb:
@Alemo50
Please advise me on this Doppler scan. My baby was noticed to be having this IUGR thing, and I read that the best way to monitor the baby is by umbilical artery doppler. How does this help?

Babies growth depends entirely on the amount of blood flowing through the umbilical artery from the placenta to the baby. Since the babies organs are not yet fully functional, everything it needs to keep it alive is supplied by the placenta. So if a baby is not growing well (IUGR) you need to use Doppler ultrasound scan to assess the degree of umbilical blood flow. Once the blood flow has reduced to a critical point, then the baby must be delivered.

The Services of Sonologists to assist our fetal medicine specialists in carrying out ultrasound scan is required. BSc Radiology, Human Anatomy or Human Physiology, Med Lab Science are desirable qualifications. Necessary training would be offered.

To apply, send CV to: oborovo@yahoo.com.

Yawning baby on 4D Scan

everfaithfulGod:
Alemo50 thanks for your support here.
Pls I need your opinion on this. I ave been having bossom fluid leakages since i was 12wks. Experienced this anytime i dont wear bra and especialy wen i just finish hot food,it wil be gushing out like no man business. I am 19wks now and its getting worse.I wash bed spread everyday. I am not comfortable with this at all. Ive done 3 scan since 12 wks til nw and my baby is doing fine. How can i stop the leakage pls? kindly help.

Hyperlactation do occur in pregnancy and its not a disease. But in order to avoid the inconveniences, you may try shield and other measures here at http://www.babycenter.com/0_hyperlactation-overabundant-milk-supply_8488.bc which is also applicable in pregnancy

@goldmine
Scan frequency for twins is very different from that for singletons. For singletons, only 3 scans are needed, which are: 1) the first trimester (11-14 weeks scan) for dating, Nuchal Translucency, gross anomalies and uterine artery Doppler to categorise the pregnancy as high or low risks, 2) the mid-trimester (18-20) weeks for detailed anomaly scan, Doppler, and placental localization, and 3) Third trimester growth scan to determine percentile of weight and umbilical blood flow Doppler.

For twins, additional scans are required. First, at the 11-14 weeks, the chorionicity of the placenta must be determined. This will tell us if the twins are sharing the same placenta. If they are (ie mono chorionic) they are at the risk of developing a complication called Twin-to-twin Transfusion Syndrome ((TTTS) between 16-24 weeks. This is a condition where one baby draws blood from the other. In order to detect TTTS, if the 11-14 scans show mono chorionic twins, then scans are done at 16, 18, 20, 22 and 24 weeks (ie evey 2 weeks till 24 weeks). But if the babies are dichorionic, scan are done only every four weeks because in twins one cannot use fundal height to estimate fetal growth, but must rely on serial growth scans, as poor growth in one fetus can be masked by normal growth in the second, in which case fundal height measurement will be inaccurate. Also because the tummy in twins is bigger than normal, fundal height measurement is useless to determine fetal growth restriction (IUGR). Every woman with twins are encouraged to read this article on ultrasound schedule for twins: http://www.babycentre.co.uk/x1014523/what-scans-will-i-have-if-im-expecting-twins

Regarding your pains, you are probably correct about the symphysis pain. Symphyseal diastasis can be measures on 4D scan and will appear as increased gaping on standing. If it is, then I can post the various measures to take for you, which you can preview at http://www.babycentre.co.uk/a546492/pelvic-pain-spd

Immaangel:
Pls what will I use to dry up a wound cos its over a month I have a knife cut on my leg somehow inbetween two toes and it has refused to heal, d worst part of it is that it hurts like hell and I always get hit by something in my environment on d same sport. Pls prescribe a drug I can use to dry it up and heal faster. Thanks

If a wound has not healed for over a month it might be a pointer to an underlying illness, particularly diabetes. So please test your urine for sugar. Do you urinate excessively or get thirsty too often? Any weight loss?

beckytunde:

alemo50 weldone sir.thanks and God bless u

all will be well with us all

Amen and thanks

Mtm5313:
Pls My Pcv Is 26 And My Edd Is This Month(june). What Can I Use To Boost It.Thanks

First, any identifiable cause? Eg did you bleed? Are you a sickler, did you just recover from malaria? Or any illness with fever? Have you been eating well? If any of the above is present, it needs to be addressed. In the meantime start oral iron preparations plus folic acid plus vitamin C eg ferrotone with Vit C. That will increase PCV by 3% in 7-10 days. Luckily you should be able to achieve 30% before delivery

goldmine:


Sir, i'm curious. What exactly are the conditions that can be assessed? Also,where in Lagos can I get this service and at what cost? Thanks in advance.

The conditions that can be assessed are:
1. Exact picture of the baby in colour and video like one shown here. You can have the videos recorded on flash drive to play for families. It promotes bonding as you see the baby open its mouth, suck thumb, grin, and other behaviors you never thought babies engage in. No woman ever forgets the experience, and the pictures and videos are there for life
2. Sex from 3 months
3. Any abnormality in the baby
4. Doppler of mother and baby to know if enough blood is getting to the baby. If enough blood is getting to the baby (ie if the Doppler of umbilical artery is normal), that baby cannot die in the womb in the next one week. So Doppler is the main test of fetal wellbeing worldwide now. So, whenever the doctor says that IUGR is suspected, that is poor fetal growth, then Umbilical artery Doppler must be done so that unnecessary CS is avoided
5. Prediction of outcomes of pregnancy. Eg MCA Doppler if woman is Rhesus negative, Uterine artery Doppler to know if the woman will develop Hypertension in pregnancy, so that low dose aspirin can be started to prevent it
6. Nuchal translucency to detect if baby has chromosomal anomaly eg Down syndrome
7. Infertility scan, such as sonoHSG to replace X-Ray HSG, Follicular monitoring etc

Essentially it performs all the required scan to ensure that the woman sees and interpret the findings herself

Where it can be done in Lagos: OMVIAL 4D Ultrasound Centre, 9 Fadeyi Street, Off Awolowo Way, By Ikeja Bus stop, Ikeja. Cost #5,000. If Doppler is required, then it's #7,500. Tel: 08036166396, 09099745678

VictoriaOb:


Alemo50. Thank you for your gesture. My doctor says that my baby is small, and so that I will need c-section. I am now at 35weeks. He said my height of fundus is 31cm. And I did a scan which says that my baby is 32weeks. I am distressed. Please advise me

Cesarean section for small baby is never allowed in our practice unless the following 7 questions are answered in the affirmative.
1. Is the gestational age known? You cannot say a baby is small for date if the date is not certain. And you cannot say the date is certain if there is no early (ie before 26 wks) scan report to support it. LMP is unreliable in 40% of the time.
2. Was the measurement of the uterus valid? The measurement should be repeated, preferably by another doctor before saying that the uterus is small for date.
3. Has the ultrasound confirmed that the small size uterus is due to small baby? The estimated fetal weight MUST be less than 10th percentile in the ultrasound report before you can say ‘small for gestational age’ (SGA) fetus.
4. Is the SGA fetus small because it is not growing (IUGR – intrauterine growth restriction) and not because the baby just happen to have a small physique (constitutionally small baby). This is confirmed on Doppler of umbilical artery. It is reduced umbilical blood flow that causes IUGR. If the umbilical blood flow is normal, then the baby is small because of small stature and not because of IUGR, and you do not do a CS for a baby because it happens to just have a small stature.
5. If the umbilical artery Doppler is reduced but not absent, and a diagnosis of IUGR, has been made, has a growth scan demonstrated restricted growth? At least two weeks interval scans should be done to demonstrates that the baby is not growing. if during the two weeks the baby has grown at a rate that is consistent with a normal baby, then the diagnosis of IUGR should be reversed.
6. Is the IUGR severe? If it is not severe, then vaginal delivery with close monitoring is the best option. However, if non-stress test shows that the baby cannot withstand the stress of labour, then Caesarean section would be the best option.
7. If CS has been deemed the best option, has fetal lung maturity been promoted?

So you see that by the time these criteria are applied, you will discover that many of such CS for so called small baby, up to 70%, are actually unnecessary. The World Health Organisation has been screaming regarding the astronomically high rate of CS being performed these days. You can see that there are at least 7 stages at which CS for small babies could be unnecessary. At the stage 1 above, a woman could have given a wrong LMP eg if she had implantation bleeding and taught that that was her LMP, or the calculation of the EGA from LMP was errorneous, and this happens all the time in a busy clinic. Another error in level 1 is if the woman did not do an early scan, and the result of a late scan is being used. Scan in the third trimester can be wrong to up to 3 weeks, and by the time you add the allowance of 2 weeks that is normally allowed for HOF, you are getting a difference of 5 weeks, which would alarm most doctors.

At level 2, you will be amazed how measurement errors occur so frequently in the clinic. To understand what I am saying, the next time you are in the antenatal clinic, after your height of fundus has been measured, get another nurse to measure it again, and you will see what I am saying.

The third error is in the ultrasound estimation of weight. Again, error as much as 500g will occur even when a fetal medicine specialist was the one that performed the scan. So reliance is on Umbilical artery Doppler. And so on and so forth.

The current trend is to use 4D ultrasound in assessing babies conditions. If you have any question about this technology, please feel free to ask me. I am a fetal medicine specialist (ie an obstetrician and Gynecologist who specializes in advanced care for the unborn baby)

tchiwinnie:
wow, long tym network no gree me comment since. Plenty oldies come surface, julieni, maran 1983, phunielomo, byvan03(u just dey change moniker ba), lyndaryoce, smokeydrinkey, chifreke.I hail all of una o. Na only Donatee wey no come.
@ my chief Alemo50, respect sir! God bless u.
@marcjane, pls try to relax.Observe strict bedrest biko.

Thanks

helovesme:
Alemo50

I have been battling with carpal tunnel syndrome on my left wrist. It started while I was around 20weeks preggers.

I have used everything - from deep heat to robb to aboniki. No relief. I even went as far as placing hot water bottle on the wrist all night - no relief instead I ended up with red inflamed skin.

Tired of all my DIY, I saw a GP. She said only solution was painkillers (something stronger than pcm and codeine) but I declined as I'm trying to avoid as much as possible taking any meds.

I went to another GP. He suggested I wear a splint on my wrist. Now, the splint provides very little relief, I hate wearing it at work and it makes sleeping uncomfortable at night.

Any solution please?

Hello. The thing about carpal tunnel syndrome in pregnancy is that different measures work for different people. Let me direct you to this site where you can try all the measures, and see if any works for you. http://brochures.mater.org.au/Home/Brochures/Mater-Mothers-Hospital/Pregnancy-Carpal-tunnel-syndrome

Fortunately, it resolves after delivery as fluid accumulation in the body resolves.

zaynie:
Thanks @ Alemo50.

My son is doing great. He shows no physiological symptoms due to the heart murmur. His cardiologist insists that we bring him for observations every 3months or at anytime he has cough or any other illness.

Thank God

marcjane:
@alemo50,this is the scan and im still loosing blood.

If you are still losing blood, you should do the Doppler scan to know what you should do. You cannot afford to wait for the two weeks

marcjane:
Thanks for the explaination.just saw the blood spotting for the 2nd time last night and in d midnight

t turned brownish colour,this usually occur during
urinating.
This morning it turned reddish and then brownish again.scan 8wks4d but i know is more than that cos my LMP was march 18.
doc gave me DUPHASTON dydrogestrone,MAXIRON and other medicine with no name.i do hv light pain and cramps.
pls where can dat ultrascan be done,i stay in surulere.Thanks
p.

OMVIAL 4D Ultrasound Centre, 9 Fadeyi Street, off Obafemi Awolowo Way, Near Ikeja Bus Stop at Ikeja. 08036166396. Best of luck

HARMYMY:
Alemo 50 good morning and thanks for the gesture.
Am FTM 35wks pregnant and I have issue with having sex, even b4 I took in . my husband find it difficult to penetrate me due to he don't like seeing me in pain because I used to cry any time he makes attempt to sleep with me. Am worry if I can have virginal delivery or book for CS

Hi HARMYMY. Your complaint is referred to as vaginismus. It is involuntary contraction of the pelvic muscles during an attempt at intercourse. Because of the high level of hormones during pregnancy, all your muscles would yield to allow for passage of the baby, so you can have a successful vaginal delivery

cutiereborn:
Happy sunday to all mamas in the house, both vigilante & pushing.
You are most welcome to the thread @ Alemo50.
Please o, can anyone tell me if this is normal... Yesterday DH was giving me some all round massage and concentrated on the boobs, and both brought out liquid almost like squriting (don't know if I got the spelling correct). DH has been afriad to touch that area since and na dat side dey make me dey in d mood wella before the do (covers face). We do the do often, though am 6months gone by this week.
Sorry for the long story.
@proudmum, I trust u r doing fine. Let us know please.

Hi. Great to have you mention this. Most women are too shy to ask questions from us doctors at the clinic about intimate matters, and most doctors are embarrassed to bring up the issues. So, anything to encourage our women to air their concerns is most welcome. Now to answer your question, if you are not hurt by it, no medically genuine reason to withhold from it.