Dr Amrinder Kaur Bajaj, MD

I am in my thirty sixth week of pregnancy and have been diagnosed to be a case of placenta previa. The doctor has said that I will need a cesarean section and blood for the same. This has scared me for I know a lot of people who have had a cesarean section but did not need blood. Kindly enlighten me.

Occasionally the placenta is attached to the lower part of the uterus and is labeled as a low lying placenta as seen on ultrasounds done in the first half of pregnancy. As pregnancy advances, the uterus usually takes the placenta up with it. Only in a small percentage of cases it remains low – before the baby’s head. This can separate during sex, internal examination or during the painless uterine contractions that occur throughout pregnancy, leading to vaginal bleeding. The severity of the bleed depends upon the degree of placenta previa and the amount of separation and can cause grave complications. Usually a cesarean section is the best option for pregnancies with placenta previa and arranging blood beforehand in patients who are expected to bleed makes sound clinical sense.

I am two months pregnant and have a morbid fear of delivering an abnormal baby. Are there tests to remove my doubts?

All women have a 3 per cent chance of having a baby with a birth defect. Most of them are so minor that they can either be ignored or treated by surgical procedures. A lot of abnormalities can be detected during pregnancy with the help of ultrasound, blood tests like double marker/ triple marker/quad test but these are not fool proof. If an abnormality is detected with the above the doctor will discuss the pros and cons, the necessity of terminating the pregnancy if the condition is life threatening or need to just ignore it. As this is the exception not the rule, just relax and enjoy your pregnancy.

I am eight months pregnant and have developed a swelling around my ankles and feet. What is it due to and what should be done to prevent it? 

Swelling, or edema, is a very common discomfort of pregnancy. When the weather is warm, or you have been standing on your feet for awhile, or even by the end of your day, you may notice that your feet feel tight and swollen. In general swelling is nothing to be alarmed about. The swelling usually subsides after a good night’s rest. Increase your intake of water to at least eight glasses of water a day.

While people believe that swelling is caused by excessive intake of salt in the diet, the opposite is also true so, moderation is the key to balance. To reduce the swelling you should wear comfortable shoes, slip on types are best. Put your feet up when possible. If you stand at work, try to move around slightly or get a stool to prop a foot up. Don’t wear elastic topped socks; try support stockings.

If the swelling is accompanied by increased blood pressure and albumin in the urine, it is not normal and needs medical management.

This is my first conception. As my time draws near my fears are getting compounded as people have told me that small women have a small pelvis and this makes it difficult for the baby to pass through. As a result there are increased chances of cesarean delivery. I do want to deliver normally.

This is a blanket statement and not entirely true. A lot depends upon the size of the baby for the space available in the pelvis should be adequate in relation to the baby you are carrying. If the size of your baby too is small, the small pelvis will not be an impediment to delivery and you may very well have a normal delivery.

However one must remember that CPD – cephalopelvic disproportion – difficulty of the baby’s head to pass through a narrow pelvis, is not the only reason for cesarean section. Quite a few tall women with an adequate pelvis end up in a cesarean section for a multitude of other reasons like fetal distress, breech presentation (baby is bottom first) etc.

I smoked till I was three months pregnant as I did not know that I was pregnant. Now I have tried stopping but when I don’t smoke I become very irritable and moody which makes things unpleasant at home. I take a few drags now and then but do not smoke as I used to do. Will this affect my baby?

Not only is smoking harmful to your baby, but being around people who smoke is as bad, if not worse for the nicotine is passed on to the baby as carbon monoxides. The risks of smoking to the baby include stillbirths, prematurity, low birth weight, asthma and sudden infant death syndrome. Ideally you should give up the habit before you get pregnant but if that has not occurred do so now, no matter how irritable or moody you have become. Take professional help if needed to do so.

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