pregnancy

Q. It’s been 10 months that I have been married and want to have a baby now. My wife has a family history of asthma and wheezing. She takes Asthalin 2 mg rarely and some capsules, which is put in a tube and then she inhales it. She also needs to inhale it sometimes when she has chocolates or is exposed to dust. I wanted to know whether she could conceive. If yes, what care has to be taken and should she undergo any treatment before she conceives? Please help.

A. Asthma and/or wheezing in itself is not a problem for conception and pregnancy.

I would suggest that as per best clinical practices, it is better to use anti-asthmatic medications by inhalation rather than by oral route. Very little medicine gets absorbed into the body system when taken by inhalation thus reducing side effects. For example Asthalin (salbutamol) is also available in inhalation form.

Selection of most appropriate and relatively safer medicine is also very important. For example salbutamol (Asthalin) crosses placenta and reaches the foetus. Due to obvious ethical reasons, clinical trials to determine the safety and efficacy of salbutamol during pregnancy have not been conducted. However large doses in animals were found to result in the birth of deformed offsprings. The relevance of this animal studies to humans is not known. It is recommended that salbutamol during pregnancy should only be used if the benefits clearly exceed possible risks. The US Food and Drug Administration (USFDA) has categorized salbutamol as Category B.

Terbutaline (trade name: Bricanyl Misthaler) via inhalational route is similar to asthalin but its has been categorized as A by USFDA i.e. safe during pregnancy.

The patient should naturally avoid taking chocolates and keep away from dust to the extent it is possible so that minimal medication is required.

No treatment is necessary before conception.

A. You have not given details of tests performed to confirm the diagnosis. This is crucial since you are in the first trimester of pregnancy. The best way would be to send your blood for isolation of germs and antibiotic sensitivity test (AST) to determine the best treatment.

Many typhoid germs have now become resistant to chloramphenicol (sold under the trade name of Paraxin, Chloromycetin etc). About 10 years ago this was the drug of choice for confirmed typhoid because germs were sensitive to it. Now one has to test before prescribing.

We cannot locate the trade name Pflomac in the data bank of quality medicines in

India

. May be there is mistake in spellings. You should check its composition. If it contains pefloxacin, then there has to be very strong scientific justification for using two antibiotics i.e. chloramphenicol and pefloxacin at the same time. Besides, the adverse effects of pefloxacin have not been studied during human pregnancy.

In case Pflomac contains some other ingredients, please advise us so and the name of the manufacturer so that we give further consideration.

Polybion is a usual vitamin/tonic. What you need is folic acid to prevent birth defects and iron to take care of anaemia. You can take Globac-Z Softules one daily till the end of pregnancy. Folic acid is absolutely essential.

Once properly treated, there is no problem with pregnancy or fetus.

Q. My wife is taking oral contraceptives pills (Ovaral-G) since last one year daily. During this period she gained enough weight (7-8 kg). I recently read an article/advertisement of Hindustan latex company’s oral contraceptives pills-Saheli, which is launched recently that it has to be taken only 2 in a week for first 3 months & after that only 1 tablet per week. Is this tablet safe? What are the side effects of this tablet? Also, I heard about some injections, which can be taken once in 3 months. I also want to know that what is the best method for avoiding pregnancy is for next 2-3 years as our baby is only 2 years old. Please suggest best method such that weight gain problem may be eliminated.

A. The best way to plan family is for men to use condoms.

Oral hormonal contraceptives are not the best or safest due to both short term (weight gain, high blood pressure etc) and long term side effects (clotting leading to heart attacks, strokes etc).

Saheli is as good, or as bad, as other hormonal agents.

Depo-Provera, also a hormonal contraceptive agent, is given once every three months. Its long life is due to the fact that it is depot preparation. It has a large number of side effects including depression, acne, hirsutism (male pattern growth of hair on the face), breast tenderness, cervical erosion, back pain, weight gain, risk of reduced bone mineral density, jaundice, etc.

A. From your history it seems you have a problem with ovulation (egg formation). However, unless you are examined, it is difficult to prescribe all tests. Factors that essential for conception are proper ovulation, proper formation of corpus luteum with adequate production of progesterone, patent tubes, proper uterus, good cervical mucus, compatibility between your cervical mucus and your husband's sperms, and also, no problem with your husband's semen. I suggest you consult a senior obstetrician in any one of the major hospitals in Bangalore. However, let me advise you that both of you should be free of work commitments and family (parents, etc) commitments when you go for work up and treatment. Remember, you should not expect results within 1 or 2 visits. If you are living in Bellary, you should consult a gynaecologist there- there is a medical college there, so there would be experienced obstetricians in Bellary.

What happens if a woman is Hepatitis B positive during pregnancy?

Q. I am 28 years old and this is the 14th week of my first pregnancy. When we had the first blood test (I am O negative), I was found to be positive for Hepatitis B. When we did the same test last year, I was normal. Is this a big problem? What is the preferred diet for me?

A. It is important to know whether or not you are positive for hepatitis B virus (surface antigen). In case you are positive, the newborn baby will require to be protected against this infection. Moreover, your husband also needs to be vaccinated. There is no special diet you need to be on.

Caesarean section

Q. I have completed 36 weeks of pregnancy. Recently an ultrasound examination showed a loop of umbilical cord around the baby's neck. The doctors say there is no cause for worry and that the loop would move on its own. The baby's heartbeat, placenta and weight are normal. Please advise if I should have a caesarean section done or wait for a normal labour.

A. Having the cord round the neck is not an uncommon condition and the incidence is about 20%. As long as the baby's movements are good and the fluid around the baby (amniotic fluid) is normal there should be no danger to the baby during the pregnancy. However, during labour the baby's heartbeat should be monitored frequently to detect any sign of cord compression which can lead to reduced oxygen supply to the baby. Caesarean section is performed only if the baby is showing signs of distress.

Sex during pregnancy

Q. My wife is two months pregnant. Is it safe to have sex during pregnancy? What effect, if any, does it have on the baby?

A. Sex during pregnancy is absolutely safe if it is a non-complicated pregnancy. The couple can have sex right upto the last month. However, you may have to opt for a position that does not put too much pressure on the mother's abdomen. The woman on top position may be helpful. Since during the 4th month, no major changes in the body proportions have yet occurred, all positions are usually safe. The baby is protected by a chorionic sac which minimises the risk of transfer of infections.

Sex should only be avoided if the doctor has advised against it or the mother has had some bleeding during pregnancy. So relax and enjoy your sex life, though a consultation with the doctor would be advisable to rule out any complications.

Weight gain after delivery

Q. I had a caesarian delivery in August 2000 and subsequently gained a lot of weight. How can I get back in shape?

A. You should have started your exercises a week to ten days after your caesarean. It will take you a little longer to get the desired results. Some tips to be kept in mind are:

· You may get some muscle pain in the beginning; it's quite a normal reaction.

· Start with five counts building it up gradually to ten counts.

Exercises

Static abdominals: Lie in your back with your knees bent. Pull your stomach in so that your spine is touching flat on the floor. Relax.
The leg slide: Lie on your back with knees bent. Pull your stomach in and straighten one leg and then the other alternately. Relax.
Curling up: Lie down on the back with knees bent and hands crossed over your chest. Pull your stomach in and try to get up half way and go back. Relax.
Side ways curl up: Lie down with your knees bent with hands on sides. Cross your right hand over your abdomen and try to get up to touch the side of your left knee. Come back. Relax. You can do the same with the left hand and right knee.
The twist: Sit on the floor, legs crossed. Extend your right hand behind you at shoulder level and turn your head and body to look at your hand. Similarly, repeat with the left hand.
The hammock: Lie on the floor with knees bent. Lift your bottoms up with feet pressing the floor and come down. Relax.
Stand on your toes at one end of the room. Pull your stomach in. Walk on your toes from one end of the room to the other breathing in and out.
You can do indoor cycling for about fifteen minutes three times a week.
You can also do brisk walking for fifteen minutes five times a week.