Search for tag: "preeclampsia"

Dr. Miller: When should your birth be induced? We're going to talk about that next on Scope Radio.

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Dr. Miller: Hi, I'm here with Howard Sharp, he is a professor of obstetrics and genecology at the University of Utah. Howard, what does it mean when a woman is induced?

Howard: We're talking about labor induction. That would be starting a patient into labor artificially. Most women will eventually go into labor, in fact if you wait long enough, over 90% are just to go on their own. But in the last several decades we have gotten into a habit of starting patients. Sometimes we start them electively and sometimes we start them because it's indicated, there's a problem, maybe there's high blood pressure or preeclampsia.

Dr. Miller: So, one would be to start to do the induction because of a health reason or to prevent a medical outcome.

Howard: Yes. That will be called a medically indicated induction. But there are a lot of elective inductions that have gone on.

Dr. Miller: Are there more elective or medical inductions now in this country?

Howard: That's a good question. It probably varies from site to site. We don't have as many elective inductions here at The University of Utah, but we do do them and we do them very carefully with a lot of counseling.

Dr. Miller: I think one of the concerns you may have had was that there is perhaps more inductions than may be there need to be?

Howard: I think so. It's interesting if you look at the... for example the C-Section rate back in the '60s, it was about 5% of women were getting C-Sections. Last year it was about 33%. So, something happened on the way to the 2000s. I think maybe there is a little bit of medic-legal worry, certainly inductions became a little but more popular, we had access to Oxytocin.

Dr. Miller: That's one of the hormones that induces the labor.

Howard: Exactly.

Dr. Miller: Starts labor.

Howard: A lot of things have kind of changed plus babies are getting bigger. Sometimes baby's just a little bit bigger than the pelvis. But I think that a lot of the reasons for the increased caesarean section rate is unnecessary. That's what we're really trying to focus on getting that lower.

Dr. Miller: Is it fair for a woman to say that she doesn't want to be electively induced? Is that part of the conversation?

Howard: Yes. In fact ideally, I think most of us would agree that if a woman can go in labor on her own that is ideal and that is really what we prefer.

Dr. Miller: Why is there disagreement in the medical community perhaps about this issue of elective induction? It doesn't sound like there's much of a disagreement about induction to prevent illness or medical complications, but it sounds like there may be some disagreements over elective inductions.

Howard: Yes, there is some disagreement. I think in terms of elective inductions there are some issues and that is, there is a convenience factor that it's sometimes more convenient for the physicians, sometimes it's more convenient for the patients, their families. And so we kind of have to weigh that against the risk of having a caesarean delivery.

I think most people, if you thought your risk of having a caesarean delivery was higher because you are doing an elective induction, most people would say, "Well okay, hold off a little bit." Having said that, it doesn't mean that all elective inductions are bad. If you have an appropriate patient there really isn't much of an increased caesarean delivery rate.

Dr. Miller: If a woman has a failed induction, is that a possibility?

Howard: Yes.

Dr. Miller: How often does that happen, where you're induced but yet you don't end with a full term labor?

Howard: That is more common in a first time mom. The first time around, we really encourage patients not to be induced until it becomes medically indicated. That would be if there was a medical problem or if they had reached a point in their gestational age, whether that's 41, 42 weeks there is going to be a higher risk of still birth. Or at some point if the percentage is not working as well, there is a little bit higher risk of getting a caesarean delivery as you wait too long.

Dr. Miller: It sounds like medical inductions need to listen to the advice of your obstetrician and elective inductions certainly a more of a problem in first time moms, probably to be avoided electively. In general, discuss the use of elective inductions in second term or more term labors with your physician.

Howard: I think it really does require a conversation. For example if it's their second or third baby and they've had a very favorable vaginal birth with their first or second and their cervix is ready by that, we actually have scores that kind of grade how ready the cervix is. As long as they're at least 39 weeks, that is a reasonable thing to discuss. One of the problems has been inducing before the baby is ready. We get in a little bit of trouble here in the United States doing elective inductions before 39 weeks and babies ended up in the newborn intensive care unit which is a terrible outcome. A lot of things to consider and it's just worth having a discussion.

Dr. Miller: Do you think that discussions should occur early during the visits to the obstetrician's office well before time of delivery?

Howard: I do. I think once you kind of get close to delivery, some people are a little tired of pregnancy. I'm a guy, so obvious I've never done this but

Dr. Miller: I think as you look, you are. I get that.

Howard:

but I can only imagine it's uncomfortable. If someone is kind of expecting to be induced or if that's what they've had and then you're telling them otherwise, that's a little bit tough to take.

Dr. Miller: In your practice or your colleagues practice, do you generally bring this up from your standpoint in your discussion with your patients early on? You generally are sort of not looking to do elective inductions if possible.

Howard: Right. We usually try to bring it up at least before during the early third trimester.

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Dr. Kirtly Parker Jones: Preeclampsia or toxemia of pregnancy. What is that? For all of you Downton Abbey fans, it's what killed Lady Sybil Crawley at the end of her first and only pregnancy, and you all got to see it misdiagnosed and untreated on TV. What is preeclampsia? Who gets it? How can we prevent it? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care and this is The Scope about preeclampsia.

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Dr. Kirtly Parker Jones: Toxemia is such an old fashioned term but it refers to a common condition of pregnancy, associated with high blood pressure, kidney problems, and possible seizures called eclampsia. The term toxemia came from the fact we didn't know what caused it but thought it was some sort of pregnancy toxin, and we knew it was cured by delivery. Preeclampsia is the condition before it gets to the stage of seizures. Today on The Scope we're going to talk about how it's diagnosed, who gets it, and some very recent recommendations, just this week, about how we might prevent it.
So toxemia, preeclampsia, pregnancy induced hypertension, these are all terms used for a condition in the pregnancy that causes high blood pressure and kidney problems and swelling that can progress to seizures, stroke and organ failure. It happens in about 5 to 10% of pregnancies, or about 1 in 15, so it's common and it's treated by delivery and resolves within several weeks after delivery, sometimes within hours after delivery. It's a major cause of premature delivery, because if the mom gets pretty sick and is only going to get sicker and sometimes is very dangerously sick, we have to get her delivered, even if the baby isn't ready.
We don't have great treatments, other than treating the blood pressure problem at the core of the disease, and that doesn't always work, so doctors have been looking for a prevention. It's hard to know a prevention when we barely even know the cause of this ancient and common disease of pregnancy.
So who can get it? Any woman who is pregnant can get and it usually shows up in the second half of pregnancy, mostly in the third trimester. It's more common in first moms and older moms. It's more common in African American moms. It's most common in woman with underlying medical conditions like high blood pressure, diabetes, clotting problems and auto immune disease. It's also more common in women with more than one baby on board or diabetes in pregnancy.
Many preventative treatments have been tried over the years; calcium supplements, low salt diets, blood letting. Didn't they try that on Lady Sybil? Vitamins, none have worked. Recently however, there have been enough studies of low dose aspirin to start at the beginning of pregnancy, to make the suggestion that all women who are at risk of preeclampsia take low dose aspirin after 12 weeks. The U.S. Preventative Services Task Force, the scientific group for all things about medical preventions, has made this recommendation for low dose aspirin, 81 mg, in women at risk, and studies show it decreases the risk of preeclampsia by about 25%. Now that's not perfect, but it's good and it's not risky for the pregnancy, the mom, or the baby or the baby later.

So if all women are at risk and you don't know if you're going to get it until after you've got it, who should start their pregnancy with low dose aspirin? Well women who've had preeclampsia before, women with more than one baby on board, women who have diabetes or blood pressure at conception. Other groups of women may also benefit and those are women with a family history of preeclampsia, women who are obese, women over 35 and African American women.
This is a little bit of good news, and important news. Preeclampsia can be very dangerous for Mom and baby. Keep your OB appointments, they check for this condition every visit with blood pressure check and a urine check. And if you think you're at risk, ask you doctor about low dose aspirin. Thanks for joining us on The Scope.