Pregnancy Lounge

Tag: treatment

  • Preterm Labor Treatment

    Depending on how far along you are in your pregnancy, your doctor or midwife may not attempt to stop your preterm labor. If you aren’t close to term, one of the first things that may be done is re-hydration. You may be given fluids and possibly an IV. Preterm contractions can many times be directly related to dehydration. If your contractions stop after re-hydration, you will more than likely be discharged with orders to increase your fluid intake and follow up with a visit with your doctor or midwife, without any medications. If you are thought to be in labor preterm (before the 37th week of pregnancy), you may be given antibiotics to prevent (or treat) possible infection, especially if your membranes have ruptured.

    If re-hydrating you doesn’t stop contractions, then you will most likely be given medication. There are typically two types of medications given to women who are having preterm labor. The first type helps to slow down or stop labor contractions if given early enough (they are called “tocolytics”) .The second type helps the baby’s lungs mature before birth (“corticosteroid” medications).

    Tocolytic medications often used include terbutaline (or brethine), ritodrine, nifedipine, magnesium sulfate, or indomethacine. Each of these medications work in a different way, but the goal is to minimize the strength and number of contractions which may cause the cervix to dilate and efface. They may be given in an injection, by IV, under the skin or in the form of a pill. Your doctor or midwife may prescribe your medication to be administered by a ‘pump’, which delivers a small amount automatically through a device similar to that used by insulin dependent diabetics, while you stay in the hospital. Tocolytic medications are not as successful later in labor, if your membranes have broken, or if your cervix is already dilated beyond 2 centimeters. Tocolytics are not used if you have chorioamnionitis (an infection in the membranes around the baby), bleeding, abruptio placenta, severe preeclampsia or eclampsia, cardiac disease or other severe medical illnesses.

    Like other drugs, these medications are associated with side effects for you, as well as your baby. Before choosing a medication, you and your doctor or midwife must weigh the risks and benefits of each. Possible side effects of some of these drugs include (but are not limited to): drowsiness, dizziness, headaches, muscle weakness, irregular or fast heartbeat, nausea, vomiting, nervousness, restlessness, insomnia, shaking, shortness of breath, hyperglycemia (high blood sugar) and hypokalemia (low blood potassium), double vision, fluid in the lungs, fever, hallucinations and heart attack. Possible side effects for the baby include: fast heart rate, high or low blood sugar after birth, loss of muscle tone, slow breathing, drowsiness, enlarged heart, jaundice and bleeding within the brain or heart. You and your baby should be monitored very closely while taking any of these medications.

    By delaying preterm labor with tocolytic medications, doctors and midwives can use other medications to help speed up the baby’s lung development and improve the baby’s chance of survival. Corticosteroid (or steroid) medications are given, particularly if delivery appears to be inevitable. Betamethasone (also called celestone) or dexamethasone are given by injection into muscle tissue.

    Sometimes, if an incompetent cervix has been diagnosed, a cervical cerclage may be done. This is a procedure where the cervical opening is stitched to keep it closed. Early cerclage placement has a significantly higher success rate than those performed after effacement and dilation have occurred. Bedrest (either at home or in the hospital) may be recommended, with varying levels of activity (from limited to none). It is important for you to discuss with your doctor or midwife what range of activity you may participate in when bedrest is prescribed.

    Back to Labor Stages

  • Diagnosis and Treatment of Infertility

    Most couples are advised to wait until they have been trying to conceive for at least a year, before seeking medical help, with the exception of couples over 35. Those that are over 35 or those that have reason to believe there may be a fertility problem should not wait a year before consulting a doctor.

    Infertility testing and treatment can be difficult and expensive. Before starting infertility testing, it’s best for couples to discuss how far they would be willing to go with testing and treatment. Only have testing for conditions that they are willing and financially able to have treated would help them move on to other options such as adoption.

    Diagnosis of infertility may take the use of a special doctor called an infertility specialist or a reproductive endocrinologist. Infertility is diagnosed after an infertility workup, which includes a physical exam of both partners to determine their general state of health. Many times, laboratory tests are conducted and sometimes both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no obvious cause can be determined at that point, like improperly timed intercourse or absence of ovulation, more specific tests may be recommended.

    Depending on the test results of those tests, different treatments can be suggested. About 90% of infertility cases are treated with medication or surgery. Various fertility drugs may be used for women with ovulation problems. It’s important for couples to talk with their doctor about the drug to be used, so they understand the drug’s benefits and side effects. An x-ray of the fallopian tubes and uterus may be done after dye is injected, to show if the tubes are open and to show the shape of the uterus. An exam of the tubes and other female organs for disease may be done, using an instrument called a laparoscope to see inside the abdomen. If needed, surgery can be done to repair damage to a woman’s ovaries, fallopian tubes, or uterus.

    For a man, testing usually begins with a semen analysis, which looks at the number, shape, and movement of his sperm. Because semen is rather variable in quality, the test may be repeated. Sometimes other kinds of tests, such as hormone tests, are done.

    Depending upon the degree of abnormality, the treatment may range from relatively simple artificial insemination of the woman with the man’s semen (AIH), through conventional in-vitro fertilization and embryo transfer (IVF-ET), to the latest techniques of assisted fertilization by microinjection (ICSI). In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm count, in vitro fertilization (IVF) is an option. In IVF, eggs are removed from the ovary and mixed with sperm outside the body in a culture dish. After about 2 days, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women’s uterus.

    Infertility and Women
    Infertility and Men