Pregnancy & Infant Loss Awarenss Day ~ October 15th...

Pregnancy & Infant Loss Remembrance Day is today, October 15th. Thousands and thousands of precious babies are lost before, during and after birth for a host of reasons. These enormous numbers are a "solid epidemic" according to Edwin Mitchell, MD, Professor pf Pediatrics, University of Auckland, Chair, ISPID, New Zealand.

 

By allowing these numbers to skyrocket is, "A measure of how we fail the greatness in our country", states Michael C. Lu, MD, MS, MPH, Associate Administrator, Maternal and Child Health, Health Resources and Services Administration, U.S. Department of Health and Human Services, USA.

Let's all make a difference where we can and educate all moms to recognize the signs of a baby in distress. Let's be educated, proactive and vigilant, thereby, giving all of our babies the chance to be great.

Please light a candle this evening at 7 pm remembering all our little ones. As for the families who live with the loss ~ "After ~ the test of courage is not to die but to live", Steve, Scully, SIDS & Stillbirth Dad, Senior Executive Producer and Political Editor, C-SPAN, USA...xo

Pregnancy ~ Bacterial & Viral Infections ~ Should YOU Be Concerned???

Well, should you? As Iris affirms to Arthur in one of my favorite films, The Holiday; “Arthur, this is a big deal.” Group B Strep (GBS) & Cytomegalovirus (CMV) infections are something every pregnant mom should know and be concerned about. 

Who knew? I certainly didn’t. In today’s fast paced world, when you are expecting a baby, you really need to pick and choose what you read and digest. Empowerment is the key. So, you may ask, “How do I become empowered?”

Empowerment comes from becoming educated, proactive and vigilant about the safety of the baby you are carrying. It means getting all the facts and having the cards stacked in your favor. It means never hesitating to call and ask your health care team about any concerns or questions you may have. Remember, your health care team is there to educate and inform you ~ that’s their job. And always ~ you should trust your gut. 

Due to the hustle and bustle of your health care team’s office, the time is not always available for them to explain to you what exactly you should be doing and looking out for to insure the wellbeing of your baby from trimester to trimester.

Dr. James McGregor, Researcher, MDCM, Professor of OB-GYN, Division of Perinatology, University of Southern California, Keck School of Medicine, and Marti Perhach, Group B Strep International’s Co Founder, share amazing information which may even save the life of your baby and/or let your little one lead a totally normal life if you educate yourself. You can help avoid the risk of bacterial and viral infections by taking some very simple steps.

It all begins during your first trimester with your first visit to your health care team at approximately 8 weeks gestation. Your first health care check up is extremely important. During this visit your urine will be cultured for GBS. So, you may wonder, “What is the big deal about GBS???”

Did you know approximately 10% - 30% of pregnant women are contaminated with GBS and, roughly 2% of these pregnant moms will pass these germs during delivery to their babies. You may say, “Well 2% ~ that’s not a lot.”

If infected, babies will show signs of GBS infection between 6 hours and 7 days of birth, although late onset after the first week of baby’s life may also result according to the U.S. Centers for Disease Control and Prevention (CDC). GBS may cause infections in your baby’s spinal cord, lungs, blood (sepsis) or brain. Although fatal in 5% of the infants carrying GBS, this bacterium is the prime cause of infectious death among newborns. Moms who are under the age of 21, black or Hispanic are at an increased risk.

If your urine culture is positive for Group B Strep (GBS) or for an asymptomatic bacteriuria at this visit, antibiotics will/should be prescribed. Make sure you ask for the results of your urine culture on your next visit, and have a test of cure (TOC) done if positive, to insure the infection has resolved, once your antibiotics are finished. Discuss with your health care team how GBS will impact your birth plan and the IV medication which will be required during labor and delivery.

If your urine is negative for GBS, you will have a rectovaginal swab taken at 35 – 37 weeks gestation and cultured in accordance with The American College of Obstetricians and Gynecologists (ACOG) National Guidelines. This test is extremely important as the use of preventative antibiotics for moms who test positive for GBS must be given during labor to prevent the transmission of this underlying yet potentially lethal germ to their babies.

The CDC confirms and reminds us 1 in 4 pregnant women carry GBS, the most common cause of life-threatening infections in newborns. “Women should have accurate information to know how to best protect their babies”, states Perhach. If you would like further information on GBS, please go to, www.groupbstrepinternational.org or the Facebook Group page, Group B Strep International.

According to Dr. McGregor, any infection can be “potentially” life threatening to the baby. Cytomegalovirus (CMV) poses a major risk to pregnant women who are around babies and young children. So, moms who are child care providers, daycare workers, preschool teachers, therapists, and nurses need to take extra precautions as preschoolers are the majority of carriers. CMV is present in saliva, urine, feces, tears, blood, mucus and other bodily fluids. You cannot catch CMV by simply being in the same room with someone, unless bodily fluids are exchanged. Additionally, there is no information to indicate CMV is transmitted in the air.

OB/GYNs, for the most part, do not warn women of childbearing age about this infection and how to avoid it. ACOG and the CDC recommend OB/GYNs counsel women on basic prevention measures to guard against CMV. But according to a 2007 survey, fewer than half (44%) of OB/GYNs reported counseling their patients about preventing CMV. Were you told about CMV???

CMV is very prevalent among healthy children 1 to 3 years of age who are at high risk for contracting CMV. As CMV can be transmitted to an unborn child from a pregnant mother experiencing a primary or recurrent CMV infection, how can you minimize your risk? Very easily ~ here are a few simple steps you can proactively incorporate into your daily routine as outlined at www.stopcmv.org:

-     Wash your hands often with soap and water for 15-20 seconds, especially after changing diapers, feeding a young child, wiping a young child's nose or drool, and handling children's toys.

-     Do not share food, drinks, or eating utensils used by young children.

-     Do not put a child's pacifier in your mouth.

-     Do not share a toothbrush with a young child.

-     Avoid contact with saliva when kissing a child.

-     Clean toys, countertops, and other surfaces that come into contact with children's urine or saliva.

Remember, in following the above steps, you can be proactive and help prevent your baby from being born with CMV which may lead to permanent medical conditions and disabilities such as deafness, blindness, cerebral palsy, mental and physical disabilities, seizures, and death. While congenital (before birth) CMV in baby is more common than Down’s Syndrome with only 14% of moms having ever heard of CMV, more children have disabilities due to congenital CMV than other well-known infections and syndromes including Down’s Syndrome, Fetal Alcohol Syndrome, Spina Bifida, and Pediatric HIV/AIDS.

FitPregnancy.com’s section, Protect Your Baby From a Tot-Borne Virus, by Kim Acosta in 2008, advises moms to kiss their tots on their heads ~ and not on their mouths cheeks to avoid CMV. FitPregnancy’s December/January 2012 “Q & A” magazine segment asks the haunting question, “Should I worry about CMV? After reading the magazine’s response by Amanda Kallen, M.D., a Yale University School of Medicine clinical instructor who co-authored a 2010 review on the topic, the reply is definitely, “YES!!!” Both website and magazine sites give great information ~ and both are must reads. 

Be your baby’s guardian of the womb today by taking an active role in your personal hygiene and healthcare decisions. Consult with your health care team about the best ways to avoid  CMV if you:

-       Are concerned about CMV infection during pregnancy.

-       You develop a mononucleosis or flu-like illness during pregnancy.

-       You feel you may be a candidate for CMV screening and / or treatment.

 If you would like further information on CMV, please go to www.stopcmv.org, where I have gathered a lot of my information.

In preventing infections which may prove harmful to you and your baby, Dr. McGregor also advocates:

a.     Good dental hygiene and care

b.     Reporting any vaginal bleeding, discharge or fluid    leakage to your health care team.

c.     Avoiding membrane stripping to induce labor.

 Moms, please check out the websites above. Empowerment comes when you are educated, proactive and vigilant. Remember, a sweet little life is depending on you…xo

Have You EVER Heard of CAN Syndrome!!!

Lots of information has spurred me to moving on and beginning new endeavors in my quest to reach all parents to be. As a new and exciting project is in the works, I want to continue writing about the wonderful information the researchers presented at the Stillbirth Summit last October.

Morarji Peesay, MD, FAAP is a neonatologist at Montgomery General Hospital affiliated with Georgetown University Hospital in Washington, DC. While quietly spoken, compassionate and driven to understand the long term implications of his concept: Cord Around the Neck (CAN) Syndrome, his passion for the babies he treats enables him to echo the words, “Every woman should have a stillbirth screening.”

Although there is no definitive test to detect stillbirth, Dr. Peesay is referring to his personal version of criteria, the Stillbirth Scoring System. Quite simply, when different hallmarks of his system are added up to total “9”, the potential for stillbirth exists. Various results from the Quad Marker Screen, performed between 14 and 24 weeks gestation, are also used in determining Peesay’s Scoring System.

Defined, “CAN Syndrome is a cluster of cardio-respiratory and neurological signs and symptoms associated with unique physical features that occur secondary to tight cord-round-the-neck.” Peesay points out there are cord abnormalities seen in 1/3 of all live births. He cites the definite connection through scientific research linking quadriplegic cerebral palsy with CAN Syndrome as he queries the correlation between CAN Syndrome, autism and ADHD, as well.


This paragraph is researcher heavy so please read slowly!!! Peesay states it is proven scientifically Intermittent Cord Occlusion causes low venous return in the umbilical vein which causes low H2O, low PH and increased CO2 which causes altered brain protein synthesis and degradation. WHEW!!! So, the amazing discovery is CAN Syndrome has the same brain abnormalities as Intermittent Cord Occlusion!!!


A Harvard study in 2007 identified Umbilical Cord Accidents (UCA) causing placental abnormalities as being responsible for 16% of stillbirth deaths in this study. In this study, concluded 44% of the stillbirths had unknown causes and 40% had other causes. However, a retrospective review of this study informs us, the 44% of stillbirths due to unknown causes were determined to be UCA causing placental abnormalities. Therefore, actually 42% of the original study was found to be the consequence of UCA causing placental abnormalities. WHAT!!!

Peesay explains, when there is umbilical vein compression, fetal thrombotic (FTV) vasculopathy gives the baby one of two outcomes: neurological problems or DEATH (stillbirth). Peesay queries if children living today with cerebral palsy of any degree, autism, or any neurological disorders including ADHD are the “victims” of missed umbilical cord compromises / injuries which did not result in stillbirth???

This diabolical medical uncertainty, claiming 30,000 our “littlest victims” yearly in the USA alone, remains unchanged. Quite frankly, it demands to be researched by the experts; it begs to be answered by the families…

The Stillbirth Summit continued to gain momentum early in the morning with Uma Reddy, MD, MPH, Medical Officer, Pregnancy & Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD presenting Thrombosis and Adverse Pregnancy Outcomes. Dr. Reddy is a wealth of knowledge and at times I am sure the researchers understood a lot more than I certainly did!!!

Venous thromboembolism and adverse pregnancy outcomes are potential complications of pregnancy. Numerous studies have evaluated both the risk factors for and the prevention and management of these outcomes in pregnant patients. Reddy stated the American College of Obstetricians and Gynecologists (ACOG) just came out with their new recommendations for Preventing Thromboembolism in pregnant women. Please read and digest these article which breaks down the new guidelines. She also informed us aspirin and lovenox (a blood thinner) are indicated to be given for the duration of a pregnancy for women with prior thromboembolic disease ~ and ~ may be given safely.

Women who have had any thromboembolic disease should have a full coagulation profile performed. Prescribing anticoagulants to pregnant women can be difficult and stressful. Maternal and fetal concerns must be considered at all times, with a careful assessment of the risks and benefits of anticoagulant therapy in each patient. Further research should help to clarify who should receive thromboprophylaxis, how to prevent adverse pregnancy outcomes in women with various thrombophilias, and how best to treat pregnant women who have a prosthetic heart valve.

The Stillbirth Summit ~ The Momentun & Amazing Information Continue...

The Stillbirth Summit continued to gain momentum early in the morning with Uma Reddy, MD, MPH, Medical Officer, Pregnancy & Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD presenting Thrombosis and Adverse Pregnancy Outcomes. Dr. Reddy is a wealth of knowledge and at times I am sure the researchers understood a lot more than I certainly did!!!


Venous thromboembolism and adverse pregnancy outcomes are potential complications of pregnancy. Numerous studies have evaluated both the risk factors for and the prevention and management of these outcomes in pregnant patients. Reddy stated the American College of Obstetricians and Gynecologists (ACOG) just came out with their new recommendations for Preventing Thromboembolism in pregnant women. Please read and digest this information which breaks down the new guidelines. She also informed us aspirin and lovenox (a blood thinner) are indicated to be given for the duration of a pregnancy for women with prior thromboembolic disease ~ and ~ may be given safely.

Women who have had any thromboembolic disease should have a full coagulation profile performed. Prescribing anticoagulants to pregnant women can be difficult and stressful. Maternal and fetal concerns must be considered at all times, with a careful assessment of the risks and benefits of anticoagulant therapy in each patient. Further research should help to clarify who should receive thromboprophylaxis, how to prevent adverse pregnancy outcomes in women with various thrombophilias, and how best to treat pregnant women who have a prosthetic heart valve.

The Stillbirth Summit Introduces the New Pregnancy Buzz Phrase ~ EPV!!!

Bear with me ~ to write about all the researchers and their findings present at the Stillbirth Summit in one sitting would require lots of time and several glasses of wine!!! So, I have decided to introduce you to one researcher per blog and write about what I took away from their lectures in my notes. If you are confused by my interpretation ~ you can Google it, research it & digest it. Take it or leave it; pass it on or delete it. Just know, these men and women will change the face of stillbirth with their passion and fire. They will pull stillbirth from the shadows and place it brightly in the light of day. They will find answers for us; prevention is their intention.

The Stillbirth Summit opened the eyes of all who attended. Dr. Alexander Heazell, MBChB, PhD, MRCOG, Maternal & Fetal Health Research Centre, University of Manchester, UK, delivered the simple yet poignant statement during the first presentation of a colleague, “We understand stillbirth very badly.” There was no pretentiousness. There were no scholarly noses looking down at us. The cards were on the table for everyone to see. Over the next 3 days the researchers would share their passion, frustrations and greatly needed research with us all.

When you listen to Dr. Harvey Kliman, MD, PhD, Director of Reproductive and Placental Unit, Yale University School of Medicine, you come away with one word embedded deeply in your brain: PLACENTA!!! The man is amazing and quick to state, “It is the simple things, tissue etc. which ends up in the pathology lab to be looked at. The information in it tells us why this loss happened.” Kliman is emphatic ~ the placenta is the key to what’s going on in a “loss” investigation and the placenta "must go to pathology."

While all eyes are on the fetus, Kliman explains a small fetus means a small abnormal placenta and “Doctors should know about abnormal placentas. Not knowing anything about the placenta is like driving a car without any gas!!!”

The “small” placenta is one major placental issue. The small placenta does not happen “all of the sudden.” The normal ratio of the fetus to placenta is 6:1. Once it goes beyond 7:1 or 8:1 it crashes. The placentas falling in the 10th to 90th percentiles are optimal. It is the ones which are in the < 10% or > 90% which will pose the problem. The baby and placenta tend to grow at the same rate and ratio up to 36 weeks. But what happens when the placenta is small and cannot supply the growing fetus? Intrauterine Growth Restriction (IUGR) develops. This concern plays a large part in delivering small and low birth weight babies, decreasing amniotic fluid (the amniotic fluid index) within the uterus, and putting your baby at risk for intrauterine death ~ if not detected. The extremes of a lesser ratio or a greater ratio between the baby and placenta indicate the need for diligent monitoring, care and concern.

One sign of a small and insufficient placenta is the onset of decreased fetal movements:

Can your heath care provider know about this beforehand? Yes.

Can something be done about it? Yes.

This can be detected by using standard ultrasound equipment. The measurement is called Estimated Placental Volume (EPV). Or, now there is even an EPV app, http://itunes.apple.com/us/app/epv-calculator/id406708196?mt=8, for your phone. According to Dr. Kliman, EPV should be incorporated in prenatal care and would take all of 15 seconds to do!!! The app costs a mere $29.99!!! So ~ why is Estimated Placental Volume not being calculated by every doctor, midwife and health care member who sees a pregnant woman for her OB appointment? The overriding reason for using this simple and inexpensive device can mean the difference between life and death for your baby. If a small placenta is detected, mom and baby will be monitored closely and a happy healthy outcome is easily achievable as baby can be delivered early if necessary.

According to Kliman, the placenta is part of the fetus and should be checked at a 10 week ultrasound. It should then be checked by ultrasound around 18 weeks. If the placenta is small at this time, there is nothing to do but keep an eye on it. When the placenta is small or large, the need  for closer monitoring is needed. 

Sounds to me ~ Estimated Placental Volume deserves to be the new pregnancy buzz phrase of 2012. If you are pregnant, why not ask to have your baby’s EPV checked the next time you visit your doctor, midwife or health care team? You may ask, “Why?” Quite simply, your baby’s life might just be depending on it…

C’mon Pregnant MOMMIES ~ Enlighten All Your Health Care Team ~ NOW!!!

So, you’re pregnant ~ or not ~ and you have heard about stillbirths but you have also heard the possibility of you or anyone you know actually delivering a baby born still is one in a million or extremely unlikely - RIGHT??? Well, the correct answer to the above statement is actually - WRONG.

A stillbirth occurs once in every 200 births in the USA. There are 30,000 every year in our country according to Dr. Jason Collins, MD of The Pregnancy Institute in New Roads, LA. This equates to about 85 each and every day in our highly medically and extremely technically advanced hospitals and country. Maybe you have seen articles, posts or blogs on stillbirth and quickly flipped the page, clicked to the next entry or exited the post. Maybe you read the information in front of you thinking, "This will never happen to me" and you let the information leave your mind as fast as you let it enter. Well, the time has come for us all ~ parents to be, family & friends, as well as, the medical community - to embrace the information in front of us and demand the resources to extinguish the flame of stillbirth be available to us all.


According to The Lancet's series, STILLBIRTHS, at least 50% of our world’s almost 3 million stillbirths are completely preventable. The statistics used in The Lancet consider a stillborn baby, "the death of a baby at 28 weeks’ gestation or more." What does that mean to us? It means simple interventions may save the life of a precious baby ~ if you are told what to do and what to look out for. At The Star Legacy Foundation we call it empowering and educating parents to be and their health care team.


Dr. Ruth Fretts, OB-GYN and assistant professor at Harvard Medical School in Boston, believes the risk of stillbirth increases late in pregnancy and many could be prevented. "We don't do a very good service to women by not informing them of the risks and giving them options to be evaluating the baby's well being". In the 2010 October/ November Issue, of Fit Pregnancy Magazine, the article “the whole 9 months” section, “Baby likes to move it”, Fretts states, “Most women who notice a decrease in movement will still have a healthy outcome…The biggest concern is when it happens repeatedly.”


The Royal College of Obstetricians and Gynecologist in the United Kingdom, whose stillbirth rates are one of the most dire for a country which is not considered to be one of the 98% low or middle income countries with abysmally high stillbirth rates, just issued a statement on reduced feta movement, "Clinicians should be aware (and should advise women) that although fetal movements tend to plateau at 32 weeks of gestation, there is no reduction in the frequency of fetal movements in the late third trimester."


Dr. Craig Rubens, MD PhD, Co-Founder & Executive Director GAPP states, "Why focus on the last 1/2% of pregnancy during Labor and Deliver to understand why women have adverse outcomes during pregnancy. We need to focus on and study more the 99.5% of pregnancy that's going on currently."


So, what can we do? Although the American College of Obstetricians and Gynecologists support kick counting ~ it is rarely mentioned or explained to pregnant women in the office or during prenatal classes. Don’t take it for granted everyone caring for you and delivering your baby is aware of kick counting and the important role it can play in assuring a happy, healthy and hearty delivery day. Make it your passion to educate all young men and women, moms and dads to be, their doctors, midwives and health care team to the importance of baby's movements from 20 weeks onwards and the importance of daily kick counting from 28 weeks onwards. Visit See Me, Feel Me now. Educate and empower yourself not only on the importance of baby's movements but also on the importance of a 20 & 28 week ultrasound with special attention being paid to the umbilical cord and placenta. Then, pass this vital information on to all so they can become baby's "in utero" advocate as well.


Don't wait until the tragedy of stillbirth strikes ~ and you think to yourself, "Oh yeah, I heard about that somewhere.” Don’t take it for granted your doctor, midwife or health care team is educated to the frequency of stillbirth and the ways to ascertain and address a possibly compromised baby. Write down the link or print out The Lancet series, Stillbirths and your My Kicks Count chart and take them to your appointment!!!

Now you have been told. Now you have the tools. Now spread the word and empower moms, dads, friends, family and the medical community across the globe. Remember ~ a sweet little baby's life will be depending on you...