tikosdear:
Good morning alemo50,it is so good to hv u here,pls I hv a Question,I had a scan the last time I went to the hospital,and the doctor said that I hv low laying placenta,from the scan,I was 31wks but from my lmp,I was 29wks and 2days.the Dr said that I will repeat the scan at 36wks,that most times it normally goes up,but that if it doesn't,that's means I hv to do CS. Is there anything that I can do to Mk it go up?and at what week will it be best to carry out the cs,if it does not go up? I am a first time Mum and I am a bit worried.thanks.
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Hi. Placenta previa is a condition in which the placenta is low in the womb, such that it can prevent the baby from passing through the birth canal. More worrisome is the fact that it can cause severe uncontrollable bleeding, but it would have been giving warning signs in form of small recurrent blessing episodes. It is therefore mandatory that every woman has a scan to localize the placenta.

Where the placenta is low-lying before the third trimester, the woman is reassured that more than three-quarter of such will migrate upward by the third trimester. However, during the upward migration the umbilical cord at the placenta attachment may remain low (vasa previa) with the risk that during labour it will tear and bleeding from the cord will be from the baby leading rapidly fetal death.

Therefore, the current evidence-based management of a placenta found to be low-lying before third trimester is as follows:

Step 1. The woman is warned that if she bleeds at any time, she should be admitted and remain in the hospital till delivery.
Step 2. If she does not bleed, she should present for a scan in the third trimester eg 36 weeks
Step 3. If it remains low at the third trimester scan, then it is called placenta previa.
This is then classified as 'minor' if the edge of the placenta is farther than 2cm away from the cervical os, or 'major' if it is within 2cm. The older classification into types I, II, III, and IV is obsolete. The classification into minor and major is based on the fact that vaginal delivery is allowed for minor cases provided there is no vasa previa, thereby avoiding unnecessary CS for most patients.
Step 4. Major placenta previa requires CS.
Step 5. If it is minor, a Doppler ultrasound scan is done to see if there is any vasa previa.
Step 6. Minor, and no vasa previa: Vaginal delivery is offered.
Step 7. Minor, with vasa previa: CS is indicated
Step 8. Where there is no placenta previa, and no vasa previa, Vaginal delivery is offered.

Now, for your own case, since you have not had a CS before, your management should be according to the above steps. For those who have have had a CS before, and now has placenta previa, an additional test of Doppler scan is still required to determine whether the placenta is 'morbidly adherent' onto the uterus, a condition called placenta acretta. In this condition, the placenta is attached to the previous CS scar, and so will not separate during the next CS, resulting in severe bleeding, and most of the time death. Therefore, such cases are best delivered by CS in a well-prepared centre by a highly experienced obstetrician, with blood transfusion facilities at hand.

I have gone into much details in answering your questions because whenever I hear of any woman dying during CS for placenta previa, it turns out that such women had a previous CS, complicated by placenta previa. Similarly, anytime I hear that a baby die when there was delivery of a woman who, though had no placenta previa but bled during first stage of labor, I ask if she ever had a low-lying placenta. If the answer was yes, I would say, she should have had a Doppler scan before delivery to rule out vasa previa.

So madam, your next step is to do a repeat scan with Doppler in the third trimester. Once you have done it, you can take a picture of the color Doppler and upload it here for further discussion if you do not mind.

Now some doctors would insist on CS for all types of placenta previa, whether minor or major. What you should do in such cases is to ask for the exact distance between the placenta and your internal os. If it is less than 2cm, don't worry. If more than 2cm, show him/her the literature stating that if there is no vasa previa you should not undergo CS as the risk of CS is higher than the risk of a placenta farther tan 2 cm away from the cervical os. While not being rude, you should let your health care providers know that it is your right to make an INFORMED DECISION BASED UPON BEST AVAILABLE EVIDENCE. Except for occasional instances, most women that I did Doppler scan for who had this experience were able to persuade their doctors to see reason with the available evidence and had successful vaginal delivery. CS has complications of its own also.

zaynie:
@ Alemo50, thank you for your grand gesture. May God reward you accordingly.


My question is, what causes oligohydramnious in foetus? I had it in my first pregnancy and when I registered for my second, the nurse made a correlation between it and the fact that my son has a heart murmur.
Is this true?
How can I prevent it from happening again?
I drank lots of water, i didnt observe any fluid leakage while pregnant too.

Thank you.

Hi. Thank you for your question. Oligohydramnios means shortage of amount of amniotic fluid around the baby. The cause is unknown in most cases, but like you rightly observed, it can be due to premature rupture of membranes (PROM), Fetal growth restriction (FGR), Congental malformations or dehydration. Since you were not leaking water, it was probably not due to PROM, although smalll leakages could escape notice. Since you drank enough water, it was probably not due to dehydration. That leaves us with FGR or Anomalies. Did ultrasound show that the baby was smaller than date to suggest FGR? The amniotic fluid is mainly the babies urine. So anomalies of the babies urinary system that is obstructing urine passage would also be seen on ultrasound.

Fortunately the recurrence rate of causes of oligohydramnios is low, hence you can look forward to a normal pregnancy outcome next time. But as the risk is still higher than for those who never had it, I will recommend that you do the following, which are NORMALLY done in developed countries, in your next pregnancy.

1) Any time you are planning to get pregnant, start using 5 mg of Folic acid, and continue it till you are 3 months pregnant. It reduces the risk of congenital anomalies.
2) Avoid Most medications as soon as you confirm that you are pregnant, if possible. Ideally, as you plan to get pregnant, if you are on any medication, let's know, and we can check the safety, to avoid any that can cause anomalies.
3) At 11-14 weeks, get screened for anomalies with first trimester ultrasound called NT (Nuchal translucency scan).
4) At 12-22 weeks, have a detailed anomaly scan by a fetal medics specialist, to include fetal echocardiogram (ultrasound of baby's heart), so that any anomalies can be dectected on time.
5) Always insist that your doctor/nurse tells you the measurement of your fundal height at each antenatal visit. It should not be less than your gestational age by more that 2, and it must grow by 1 cm every week. For example, if when your tummy was measured with the tape at 28weeks, it reads 26 weeks or above, then the baby is not small and there is no oligohydramnios. By 30 weeks, the measurement should be at least 30cm, which will show that the baby is growing (ie no FGR). If otherwise, insist that you be referred for Doppler scan to show that your baby is not having FGR. The thing about Doppler scan is that it measures umbilical blood flow from placenta to baby. And since the umbilical blood is the 'lifeline' of the baby, carrying everything the baby needs (food, oxygen) to it, and removing toxic wastes, if Doppler scan is normal, the baby will be okay for at least the next one week. As a matter of fact, Umbilcal artery Doppler is the Singular most important method of monitoring babies wellbeing now.

I hope this helps. If you have further questions, please do not hesitate to ask. By the way, how is your that your son doing?

modath:
@Alemo50,

Welcome, its great to have you.. God will bless you beyond your expectation for this kind gesture of yours... Thanks.

I'm going to take shameless advantage of your offer and ask a question that's been on my mind for a while;

What is the significant difference between a 37 and a 38 wk CS? From what I've read, some Drs push to 38wks because of breathing issues but some women go into labour at 36wks+ & deliver perfectly healthy babies.
I had an elective @ 37+1 and my baby was and is still doing very well, now I'm up for another one and another mum told me this present hospital will not do until 38wks unless there is fetal distress..

Kindly enlighten me/us as you are in the know. I'm 31wks now & I dont want to bring up the subject with the dr yet, till I'm in 36th week so they don't tag me ITK. Thx.

Hi. Most of what is done in medicine now is evidence based, meaning it must be backed with studies rather than just on what we doctors feel or think. CS used to be done at 37 weeks, because it was thought that the baby would have been matured (particularly the lungs) at that age, so why wait and risk having the baby die due to placental insufficiency as term progresses? But now that we have a way to predict placental function (using umbilical blood flow Doppler ultrasound), which can alert us to any danger as far away as one week, there is no longer any need for urgency. Now, not only is CS being carried out further, than 37 weeks it is now actually carried out at 39, yes 39 weeks, and not 38 weeks even. Please seen number 7 of this article http://pregnancy.about.com/od/cesareansection/a/safecesarean.htm . In Nigeria where there is still poor availability of Doppler scan using 4D ultrasound, 38 weeks appear to be a fair compromise. But if you are in Lagos, Benin or Portharcourt where there are fetal medicine practitioners doing Doppler scan, then elective CS should be done at 39 weeks and not 38 weeks, and DEFINITELY NOT 37 weeks. In developed countries, no doctor will do elective CS at less than 39 weeks. For further info, just google 'elective caesarean at 39 weeks.

marcjane:
hi mamas,pls put me in ur prayers.just woke @5am today and a sticky watery substance mixed with little blood,went for scan and was told threatened abortion,doc gave medications.scan said poor hearbeat@8weeks,Os closed.
Doc said arthemeter and panadol given to me by another doc might caused it.he said that i rescan in two weeks time.
I treated for malaria and typhoid b/f this occured.im scared.hope i dont miscarry.I'v not seen the blood till now.

Since the os (door of the womb) is closed, and there is fetal heartbeat, it is threatened miscarriage. The good news is that most will have good outcome. As a fetal medicine specialist (ie an Obstetrician and Gynecologist specializing in High Risk Pregnancy) I can reassure you that what matters is that there is a heartbeat. The fact that the scan said that the heartbeat is poor is of no consequence. Unless the heartbeat was studied by pulse wave Doppler, which I doubt. As long as you do not have pains, and the blood does not increase, the outcome is generally good. As for the arthemeter you took during embryo formation period, I will advise that you do a full 'Anomaly Scan' eg Nuchal Translucency at 11-13 weeks, and Detailed anatomical scan by 18-20 weeks, including fetal echocardiography. Don't worry about all theses high-sounding names I just mentioned. They are easily done on any 4D ultrasound machine by any fetal medicine specialist

marcjane:
just went to urinate now and saw blood spotting.

This condition is called antipartum haemorrhage (APH). The bleeding could be coming from the baby (Vasa previa), a low-lying placenta (Placenta previa), Premature placental separation (abruptio placenta) or lesions in your genital tract. Therefore you require a color Doppler ultrasound scan to find the cause.If I know your gestational age, I can offer more advice.

ritayoung:
Am. 40week+4days and labour has refuse to start , pls house iS there anything I can do to help start it? because my doc has fixed a date to induced me which am scared of,pls mamas I nid ur advice,am also a FTM tnx

You are post-date but not yet post-term. Date is 40 weeks + 0days. Term is 38weeks to 42weeks. So you still have 6 days before induction. You will most likely fall into labour before then. As long as your baby is fine, you need not worry. If your baby moves at least 10 times a day, then baby is fine. The reason for inducing women before they get to 42 weeks is because the placenta has started to age after 40 weeks, such that blood flow to the baby through the umbilical cord is now reduced. If your baby kicks up to 10 times a day, then there is enough umbilical blood flow. Alternatively, you can go for umbilical blood flow ultrasound scan, called Umbilical Artery Doppler, performed by a fetal medicine specialist. This costs around N7,500 and will tell you, among other things if the blood flow to your baby is ok to last it for the next one week. If you decide to do the scan, also insist on being told the likelihood of a successful induction, and a 4D baby picture which should come with the package. Best of luck

Hello all. I am a professor of Obstetrics and Gynaecology working in a University Teaching Hospital as an Obstetrician and Gynecologist. I am happy that Nigerian women are taking responsibilities for their health. I am willing to contribute by providing free Consultation online, so if you have specific questions, just ask me, and I will give you evidence-based advice. In the meantime I will be posting on what you should expect and do at each stage of your pregnancies here soonest. Cheers

Many thanks

Hi. A word of caution for those who plan to use Delaware County Memorial Hospital (DCMH): Expect more bills after paying the full maternity package. My wife delivered there after we had paid the so called self-pay maternity package of $7500 (6000 for delivery, 1500 fro antenatal care). After delivery we received a bill of around $3000 or so for anaesthesia. Then another bill for paediatrician. Today again, another one called physician bill. I don't know when the bills will stop coming: am I to expect nursing bill? JOHESU bill? Etc. I seriously regret using them now. Just for those who do not know. The funniest thing was that their financial person told me that after I had paid the full maternity package, all I needed to pay more is anaesthesia fee, which would just be a couple of a hundred dollars, but she was wrong. At any rate, it was her word against mine

nikkygal: debola23:

There is another hospital called Lankenau Medical Centre also in philly area. i know the hospital fees for uncomplicated womanly delivery is 1000$ and CS is 1300$. I am yet to contact a doctor to see what the doctors fees will be like but will do so once I get into the states.
Just thought I should share since I didn't see any info on people going to give birth around that area Philadelphia, PA. I wouldnt want to go back there because the relatives i have there are not so nice and I wouldnt like to go thru the same treatment especially now that I have a daughter who is very active. I preffer to stay on my own therefore I am looking for other options just have not made up my mind yet on which.
Thanks

Pls I will be going to Philly on Feb 04, so I will like to be in touch. Pls let's know what the physician fee will be for CS and other costs eg pediatrian, tests etc at the Lankenau Medical Centre.

Regarding POE, I emailed them also after emailing the US embassy in Nigeria, and their responses were similar, summarily: Refusal of entry is at the complete discretion of the officer, but at the minimum you should demonstrate financial capability and documentation with a US hospital.

Yvete:

Nasty comments like this is the reason why most people struggle with opening their doors to visitors from Nigeria. Some of you come with a competitive mindset. Who cares?? Never heard of Doctor's Hospital, Manhattan? FYI, that's where "envied" people go.

I think you are quoting out of context. The statement was made as part of a reason why someone refused a visa should not be severely depressed, as there are also reasons to be happy to be based in Nigeria. Therefore, it will be inappropriate of you to use that statement to justify why you or others close your doors to visitors from Nigeria. Even if you close your doors, you will realize that those to whom you have closed your doors will still survive one way or the other. They knock on your doors, not because they can't survive, but because they need support.

Moreover, it is true that some Nigerians based in US envy their counterparts in Nigeria in some areas, so you denying that is unfortunate. Painting a rosy picture of situations in US has cause many Nigerian youth to emigrate at all cost only to regret their decisions later. Coupled with the fact that those same people who painted the pictures then lock their doors in the face of those emigrants when they arrive in the US. So, whenever we give opinions, let's consider their effects on the lives of others.

Above all, let's continue to open our doors to our brothers in need, so that others can open their doors to us in need also. Cheers and God bless.

walemuse: Hi House,

Is anyone going to San Antonio, Texas? My wife is due in March and would be travelling to San Antonio via Houston next week. She would be staying with a family friend but we have made arrangement for an extended stay in case she does not like it with our friend. We have contacted the Christus Santa Rosa Hospital, and they confirmed that the cost of vaginal delivery is $2650. We are in contact with one of the physician (Dr. Karen Allshup) and the cost of maternity service at her practice is $2200, therefore we would be spending less than $5000 exclusive of any tests that may be required.

Wishing y'all a great 2014.

What of the cost of Caesarean section and VBAC please?

jyde2014:
Good morning all;
It's clearly stated on the refusal paper given to people that the decision cannot be appealed. However one can get an immigration lawyer to write to them giving detailed explanation and proofing to them that you have strong socio-economic ties to Nigeria.

Yeah, thanks for clarifying that. Immigration lawyer option is what I actually had in mind

[quote author=amynuch][/quote]
I think if a child does not want to be born in US we should respect its wishes. I have been to US and observed things carefully and have come to the conclusion that I will rather be in Nigeria than there. After all, to be rich in America is to have a beautiful house that you cannot afford to stay in because you have to be constantly out working in order to afford the house. Therefore my advice is that you APPEAL rather than go to Abuja, but while making every effort to get a USA visa you should just bear in mind that not getting the Visa may be best for your child if the visa is not granted eventually. Not to be proud, but anytime I visit USA my colleagues there envy me- I work half as much as they do, have a decent house, can visit America in summer, not much of anxiety etc.

bolanleife: y sister inlaw has found a cheaper option closer to her house for me @ Christus St Catherine Katy Hospital.....
At Uchetobi or any1 at Houston, just heard that Christus ST Catherine is not offering maternity services, can anyone confirm that?

It's on their website that the birthing centre is now closed

ori777:
Do you mind elaborating on the contents of the e-mail? And if you quoted your visa details, name etc? Or if it was just a general enquiry that isn't traceable to you? Thanks for your response.

Title: CHANGE OF VISA PLANS
Body: I obtained a B1/B2 visa for tourism purposes, but as events unfold, I realize I shall need to be assessing maternity services in the USA. I realize that this is covered by the Visa type, but as I did not originally state this in my Visa application, I wonder if the information can be updated in my records. Kind regards. Mrs Adarin Onirugbon

[quote author=ori777][/quote]
Hello,
Pls could you advise on what address you sent the mail to, the contents of the enquiry and if it was specific to you or if it was an anonymous enquiry.
I would appreciate your response.
Thanks.

Send the email to : LagosNIV@state.gov
Cheers

[quote author=ori777][/quote]

Send the email to LagosNIV@state.gov

LUBU16:

Thank you very much for this information I will look into it

The thing is at d visa interview I said I was going for vacation with a cousin who stays at phoenix Arizona naim dey fear me o as I was hoping to go in through phoenix

Or what do u pple think

You need to write the consular office in Lagos or Abuja and inform them of your change of plan. They will reply you that you should among other things have the financial wherewithal. You will then need to print out the mail and use it to prove at the point of entry that the embassy has been informed. This was what I did.

chiomy8: Hello guys,I just joined this forum & thought I should share my own experience.first everyone on this thread has being awesome,I got all the tips I wanted on dis thread,how to answer US visa questions & researched alot on d internet and everything paid off with serious 21 days fasting & dressed smartly,wit all smiles.God did it.I am currently in d US precisely California because of their lovely weather with my two kids.i wld b due in march,we flew via lufthansa in dec to avoid unnecessary port of entry wahala,stoped at Frankfurt then L.A,on arrival I bought this oversized winter jacket from balogun market in lagos,d officer at d point of entry didn't find out about my pregnancy and d kids helped to distract him a little,my luggages where not checked at all & I had loads of food stuffs,except palm oil. I have gotten a very affordable hospital here,dey accept test from nigeria and lots more.I rented an apartment as staying wit dis American relatives aint funny,especially wen u ve kids with u,but d number one killer of the whole thing is boredom,they all work so hard & dont ve time to really want to take u around unless dey re on their off days.above all every other thing is great.pls expectant mums avoid point of entries dat are known for harsh treatment.wishing everyone coming good luck & a happy new year.

Pls what is the name of the very affordable hospital, and how affordable? What kind of apartment did you rent (eg 2 bedrooms) and how much was the rent?

I am traveling to El Paso with my family of four (i.e. myself, my pregnant wife, and my two kids). However, when I wanted to book for intown suites, the website has allowance for 2 adults and only one kid. So what will happen to my other kid if I go ahead and book?