Some Basic
Pointers (Week 21)
Meconium
It refers to undigested debris from
swallowed amniotic fluid in the fetal
digestive system. Meconium is made
mostly of mucosal cells from the lining
of the baby's gastrointestinal tract.
It is bacteria-free and so it is sterile.
It is greenish black to light brown
in color that your baby passes from
its bowels before delivery, during
labor or after birth. Passage of meconium
into the amniotic fluid may be caused
by distress in the fetus. Meconium
during labor is a sign of fetal distress.
If a baby has had a bowel movement
before birth and meconium is present
in the amniotic fluid the fetus may
swallow the fluid or inhale it into
its lungs; baby could develop pneumonia
or pneumonitis from this action. For
this reason if meconium is seen at
delivery an attempt is made to remove
it from baby's mouth and throat with
a small suction tube.
Varicose veins
Varicose veins occur to some degree
during pregnancy; pregnancy, increased
age and pressure caused by standing
for long periods of time usually worsen
the condition. Varicose veins are
blood vessels engorged with blood.
They occur mostly in legs but can
also be found in the vulva and rectum.
The change in blood flow and the pressure
from the uterus make varices worse,
causing discomfort. They become move
obvious and painful as pregnancy advances.
With increasing weight and continuous
standing, the situation may worsen.
Symptoms vary; for some a blemish
or purple blue spot on the legs with
little or no discomfort, except at
the end of the day. Other women with
bulging veins will require elevation
in the evenings. Following pregnancy,
swelling should subside but they won't
disappear completely. Various methods
including laser treatment, surgery
can get rid of these veins. The procedure
is called vein stripping, which should
be done after and not during your
pregnancy. Following measures may
help keep veins from swelling much:
• Use medical support hose -
get your doctor to recommend you something
appropriate
• Wear clothing that does not
restrict circulation at the knee and
groin areas
• Spend as little time on your
fee as you can. Lie on your sides
or keep feet elevated when possible
- this enables veins to drain easily
• Wear flat shoes
• Don't cross your legs; this
cuts off circulation, and worsen the
problem
• High impact exercises such
as step aerobics or jogging can traumatize
the veins. Low impact exercises such
as biking, prenatal yoga may be a
better choice
Blood Clots in Legs
Swelling in your legs and feet is
common, especially when the day is
over. A serious complication is a
blood clot of the legs or groin. Symptoms
are swelling of the legs accompanied
by leg pain and redness or warmth
in the affected area. This problem
has many names including venous thrombosis,
thromboembolic disease and lower deep
vein thrombosis (DVT). It may happen
at other times as well but pregnancy
is a time when it is more rampant.
This is due to the weight of the uterus
and changes in the blood and its clotting
mechanisms. The decrease in blood
flow is called stasis. If you had
a clot before in your legs or anywhere
else, inform your doctor on this vital
information. There is a difference
between DVT and superficial thrombosis.
The latter is often at the surface
of the skin and can be felt on the
surface; it is treatable with a mild
pain reliever, elevation of leg, support
stockings and heat. If condition does
not improve DVT must be considered.
This is a more serious condition;
it requires diagnostic procedure and
treatment.
Symptoms can differ depending on the
location and severity. The onset can
be rapid with severe pain and swelling
of the leg and thigh. Inform your
doctor early on in pregnancy about
previous clots. The greatest danger
is pulmonary embolism in which the
clot breaks off and travels from the
legs to the lungs. It is a rare problem
and although it is serious it is preventable.
The leg may occasionally appear pale
and cool but the affected portion
is tender, hot and swollen. Often
the skin is red; squeezing the leg
or calf area is painful and walking
only aggravates the pain. One way
to tell if you have this problem is
to lie down and flex your toes toward
your knee. If you feel tenderness
at the back of the leg, then it is
an indication that you have this problem.
Check with your doctor if this occurs.
In the non-pregnant woman diagnosing
the problem can be done via an X-ray
accompanied by an injection with dye
into leg veins to detect the clots.
This test is not usually performed
on a pregnant woman because of exposure
to radiation and dye; ultrasound is
used instead. Treatment involved hospitalization
and heparin therapy, where heparin
a blood thinner is administered intravenously.
It can be taken in the form of a pill.
It is safe during pregnancy and is
not passed on to the baby.
Extra calcium must be taken if heparin
is given. Mother must be in bed with
the leg elevated and heat applied.
Mild pain reliever is given. Recovery
including hospitalization ranges from
7-10 days. Heparin is given after
this until delivery; following pregnancy
she may have to continue with the
therapy depending on the severity
of the clot. If a woman has clot problems
in one pregnancy, it is likely that
she will need therapy in subsequent
pregnancies. Heparin can be given
through daily self-administered injections
or in-dwelling IV catheter under doctor's
advice. There is an alternative treatment,
but that is not advisable as it passes
through the placenta and can be harmful
to the baby. This oral medication
can be given post pregnancy to prevent
blood clots for weeks to months depending
on the severity.
