РЕЗУС-ФАКТОР И БРЕМЕННОСТ

RHESUS FACTORS AND PREGNANCY

Rhesus factor is the name of several proteins found on the erythrocyte membrane. The most important of these is the D-antigen, which determines whether our blood group is Rh (+) or Rh (-).

BLOOD TYPES AND PREGNANCY

One form of blood type incompatibility between the mother and the fetus is Rh incompatibility. It occurs when the Rh negative mother is pregnant with an Rh-positive fetus. To determine the probability of the fetus being Rh (+), the father’s blood gets tested. If he is Rh (-), there is no risk of immunological conflict between the mother and the fetus, as the fetus will also have Rh (-) blood.

During pregnancy, the mother’s blood doesn’t come into contact with the blood of the fetus. When this occurs (at birth, abortion, etc.), the mother’s body makes antibodies against the Rh antigen on the baby’s erythrocytes.

This isn’t dangerous to the baby if this is the first pregnancy. In subsequent pregnancies with an Rh (+) fetus, these antibodies can cross the placenta and start attacking the erythrocytes of the fetus. This can easily be prevented by injecting a drug called anti-D gamma globulin at 28 weeks. After birth, the baby’s blood has to be tested. If it’s Rh(+), the mother gets another dose of anti-D gammaglobulin.

It is important that prophylaxis with anti-D gammaglobulin is done even after an abortion, as it also leads to the formation of antibodies.

The second case of blood type incompatibility between mother and fetus is when the mother’s blood type is 0 and the fetus’s blood type is A, B or AB. Natural anti-A or anti-B antibodies from the mother’s blood may pass through the placenta only when their molecule is smaller (IgG class). Although rare, when it happens the baby is born with transient anemia and jaundice that are treatable.

HEMOLYTIC DISEASE OF THE NEWBORN

It develops when prophylaxis with anti-D gammaglobulin is not performed. In milder cases, babies are born with jaundice and hepatomegaly (enlarged liver). Serious forms are life-threatening, resulting in premature birth, anemia, oedema, and intense jaundice.

THE RAREST BLOOD TYPE

Those people don’t have any antigens of the Rh system on their red blood cells. This makes their blood compatible with any Rh phenotype. Only 44 people in the world are known to have the «golden» blood.

АНТИМЮЛЕРОВ ХОРМОН

ANTI-MÜLLERIAN HORMONE

Anti-Müllerian hormone (AMH) is produced by the woman’s ovaries and the man’s testicles. Its concentration in the blood depends on the person’s sex and age. It is used to evaluate a woman’s remaining fertility.

During intrauterine development, AMH secretion stimulates the formation of testes instead of ovaries in boys. AMH levels remain high until puberty, then they drop.

In girls, AMH remains low until puberty when the ovaries begin to release mature eggs. From the age of 25 until menopause, the concentration of AMH gradually decreases until it’s barely detectable.

WHEN IS AN AMH TEST NEEDED?

Anti-Müllerian hormone is secreted from the granulosa cells of the ovarian follicles. Its concentration is proportional to the number of follicles. Therefore, the more the follicles, the higher the concentration of AMH.

AMH testing in combination with ovarian ultrasound is the gold standard for determining the ovarian reserve. This study is needed when your doctor suspects premature ovarian failure, or they want to predict whether controlled ovarian hyperstimulation (COHS) will be successful. If the ovarian reserve is depleted, AMH levels in the blood will be too low for your age and you should consider getting pregnant through donor eggs.

The polycystic ovarian syndrome is very common nowadays. In patients with PCOS, AMH levels are higher. This test is very informative but not conclusive.

In some ovarian tumors, the concentration of AMH in the blood is significantly increased. Changes in it can tell whether the treatment has been successful or there has been a relapse.

AMH testing is also useful for determining the sex of a baby with ambiguous genitalia. These cases are extremely rare, and genetic testing has the final say.

HOW IS THE TEST PERFORMED?

AMH testing is done by a simple blood test. The blood sample can be taken on any day of the menstrual cycle as AMH levels remain relatively stable. No special preparation is required before taking the blood sample. Pregnancy and hormonal contraceptives do not affect the result.

СПИРАТ ЛИ ПЪТУВАНИЯТА СЛЕД РАЖДАНЕТО?

DOES TRAVELLING STOP AFTER CHILDBIRTH?

Parenting comes with many duties, but staying at home all the time is not one of them. It’s summer and it’s normal to think about whether it’s time for the new family member’s first trip. Why not? With a little more planning everything is possible.

WHEN CAN I TRAVEL?

How long you will recover after childbirth depends on many factors such as the delivery method (vaginal or c-section). It is advisable to wait 2-3 weeks after vaginal delivery and at least a month after Caesarean section. Consult with your GP and listen to your body.

Women are predisposed to deep vein thrombosis 6-8 weeks after childbirth. This is especially true for those who had a c-section. Though rare, you should take this into consideration if you are going on a long trip. Drink plenty of water, get up and stretch on the plane or stop for a rest if you’re planning to travel by car.

WHEN CAN THE BABY TRAVEL?

Babies receive antibodies from breast milk that protect them from many diseases. However, they are much more susceptible to disease than adults. It is desirable to wait at least a month before you go with your baby on a longer trip. Some pediatricians recommend waiting for up to 3-6 months. During this time, you can start with day trips.

ABROAD WITH A BABY

Even if they’re one month old, the baby must have a passport. It can be issued when you receive the birth certificate and make an address registration of your child. If the baby is going to travel with only one of the parents, a notarized declaration is required.

One of the benefits of traveling with a baby is that it is free or only a small fee is paid. Each airline has its own requirements that you need to get acquainted with in advance so that there will be no surprises. With some airlines, children up to 24 months of age travel for free as long as they sit in the lap of their parent. This is a good way to save money, but it can be tiring when the flight is longer. In this case, it is recommended to purchase a separate seat for the child.

HOW TO SURVIVE THE FLIGHT?

Some babies sleep throughout the flight and others may cry for hours. How your child will behave is hard to predict. Changing the daily regime, air pressure all the different noises can be the source of stress for the youngest and can lead to crying and restlessness.

Select a seat next to the window — so the child will be entertaining himself with the view. Take his favorite toys and books, but only those that do not make sounds (the other passengers will be grateful). Children get nervous when they are hungry, so be sure to bring snacks. If possible, choose a flight that matches the child’s usual sleeping time. In this way, the likelihood of sleeping through it is greater.

Traveling with a baby is not for everyone, but it’s worth trying at least once. It definitely has its difficult moments, but in the end, everything is a matter of attitude.

ПРОФИЛАКТИЧНИ ПРЕГЛЕДИ

ANNUAL PHYSICAL EXAMS AND WHY YOU SHOULDN’T SKIP THEM

ANNUAL PHYSICAL EXAMS AND WHY YOU SHOULDN’T SKIP THEM

Many diseases are asymptomatic for a long time. The only way they can be diagnosed early is your annual physical exam performed by your family doctor. If you’re Bulgarian and you pay your health insurance, getting an annual checkup is not only your right but also an obligation.

WHAT DO THEY INCLUDE?

Roughly, the exam consists of patient history, getting your weight and blood pressure measured, an electrocardiogram, blood tests (complete blood count), and a urine test with test strips.

If you fall into a risk group for a given disease, you are eligible for a secondary checkup by your GP. High-risk patients will be referred to a specialist (cardiologist, endocrinologist, etc.) , which is mandatory. At the discretion of the GP, you may also be given a referral for other tests, such as blood sugar and TSH.

People in certain age groups are eligible for even more tests. This is the PSA test for prostate cancer in men over 50  and a mammogram for women over 50.

CHECKUPS AT YOUR GYNECOLOGIST’S

It is advisable for every woman to visit her gynecologist once a year. The doctor will perform a pelvic exam, an ultrasound, a Pap smear, and an STI test. It is important to get examined each year because many gynecological issues like cervical cancer are asymptomatic but highly treatable at the beginning. The lack of treatment of some infections may be a cause of infertility.

PROPHYLAXIS AND THE BULGARIAN

The annual physical exam in Bulgaria is mandatory. Missing it will cost you up to 100lv and deprivation of your healthcare insurance rights for a month.

Unfortunately, a large part of the Bulgarian population regularly misses their annual exams. Many people believe that you shouldn’t go to the doctor unless your symptoms are severe. Until then, a lot of people rely on home remedies. Another impediment is the perception that the exam is associated with many extra costs. In fact, you only have to pay the consumer fee.

Prevention is much more effective than intervention. It is always better to go to your annual physical exam and find out that you are healthy than to postpone it until it is too late.

ВЕГАН ИЛИ ВЕГЕТАРИАНЕЦ?

VEGAN OR VEGETARIAN

VEGAN OR VEGETARIAN

A healthy diet means something different to everyone. Nowadays being vegan or vegetarian is the trend. However, is cutting whole food groups out of your diet that beneficial to your health? The short answer is: neither yes, nor no.

WHAT’S THE DIFFERENCE BETWEEN VEGANS AND VEGETARIANS?

While vegetarians do not consume meat (some might still consume fish), vegans don’t eat anything that has come from an animal. This includes eggs, dairy, even honey. Some vegans extend this philosophy to their daily lives by not using any leather, wool or cosmetics with animal products. The reasons for this can be ethical, ecological, religious or financial.

BENEFITS OF GOING VEGAN OR VEGETARIAN

Vegans and vegetarians consume more fruits and vegetables and with them more vitamins (A, E, Folic Acid), magnesium and fiber. They usually have lower blood sugar, blood pressure, and LDL (bad) cholesterol. This is a prerequisite for a reduced risk of heart attack and other types of heart disease. These diets are suitable for optimizing weight and reducing the risk of developing type 2 diabetes.

This diet is particularly beneficial for people with kidney disease due to lower protein intake.

According to hundreds of studies, fruits and vegetables reduce the risk of developing certain cancers. However, there is no clear evidence that switching to a fully plant-based diet will protect you from cancer better.

ARE THERE ANY RISKS?

To get the most out of a vegan or vegetarian diet, you have to keep it balanced. For example, French fries and energy drinks are vegan but not good for you.

Because of the consumption of eggs and milk, vegetarians rarely experience protein, some vitamin (B12, D3, and K) and omega-3 fatty acid deficiencies. There is some risk for vegans and this is why they might need to take dietary supplements.

VEGAN BABY

Children need a lot of energy. When they are on a plant-based diet, it is possible that they might get full before being able to consume all the calories and vitamins they need. If their food is not properly selected, they can easily suffer from malnutrition, vitamin B12, and D3 deficiency, as well as some minerals. Such experiments sometimes end in the emergency room. Be very careful about your children’s diet and always consult with a pediatrician.

РАЗЛИЧНИ ХРАНИ ПРЕЗ БРЕМЕННОСТТА

FOOD CRAVINGS DURING PREGNANCY

FOOD CRAVINGS DURING PREGNANCY

Pregnancy comes with a lot of changes especially in the way you perceive different kinds of food. Food cravings are mostly nothing but bizarre although sometimes they might indicate a more serious problem.

There are a couple of theories regarding food cravings. Estrogens and progesterone undoubtedly play a role here. They are believed to change the perception of different tastes. Along with food cravings come food aversions. They are thought to protect the fetus from potentially harmful substances.

Some nutritionists believe that certain cravings are linked to vitamin or mineral deficiencies. For example, if you crave chocolate, you might need more magnesium or vitamin B. If you’re hungry for ice cream or dairy products, then you might be deficient in calcium.

An interesting fact is that very few pregnant women crave healthy foods like fruit and vegetables. A craving for peaches might be a sign of beta carotene deficiency.

ARE THERE ANY RISKS?

Excessive weight during pregnancy is a serious issue that can lead to a whole list of complications. Most food cravings are for “unhealthy “, high-calorie foods. This can lead to you overeating without even realizing it. Although we strongly believe in indulging in your cravings, it should be done in moderation. That’s why more and more future moms consult with a nutritionist for a personalized dietary plan.

DANGEROUS CRAVINGS

In some rare occasions, pregnant women crave non-food items like ice, dirt or nails. This is a dangerous condition, prompting to a severe iron deficiency and anemia. If you find yourself in such a situation, please, tell your OBGYN immediately so that they can start treatment.

GIRL OR BOY?

If you crave sweets, it’s a girl. If you crave savory or sour foods, it’s a boy. Of course, this is just an old wives’ tale. Today ultrasound can tell you the sex of your baby quite easily. Whether food preferences can really work in this way, is up to you to say.

VITAMINS B12 AND D3

VITAMINS B12 AND D3: WHY ARE THEY SO IMPORTANT?

Vitamin D3 and B12 are needed for the proper function of many metabolic processes. Illnesses associated with a deficit are diverse and should be known so that treatment could be sought.

WHY DO WE NEED VITAMIN B12?

It is extremely important for fast-dividing cells and especially for erythrocytes due to its involvement in the synthesis of DNA and RNA. Without it, over 100 enzymes, proteins, hormones and lipids cannot be produced.

If you have a B12 deficiency, you’ll develop anemia. Neurological symptoms could appear as well. It sounds scary, but the treatment is easy and affordable. During pregnancy and lactation, a vitamin B12 supplement must be taken together with Folic Acid to prevent maternal anemia.

VITAMIN B12 — WHAT HAPPENS IF YOU’RE DEFICIENT?

Only fat-soluble vitamins (A, D, K) are stored in the liver. There is one exception — vitamin B12, which is water soluble. Its reserves are sufficient for 2-4 years.

Low levels of vitamin B12 are usually due to dietary mistakes. It happens often to vegans and vegetarians who do not supplement it.

To be absorbed, B12 has to be bind with a protein called the «intrinsic factor». It is produced in the stomach. Problems arise when there is an autoimmune process against the  intrinsic factor or other gastric disease — usually chronic gastritis.

WHAT ARE THE EFFECTS OF VITAMIN D3?

Vitamin D3 synthesis requires ultraviolet light and cholesterol. Unlike vitamin B12, it can hardly be obtained from food alone. No need to go to the tanning bed — only 13 minutes in the sun 3 times a week are enough. The best time to do so is at noon when UVB rays are the strongest.

It is both a vitamin and a steroid hormone. Its main function is to stimulate the absorption of calcium and phosphorus from food in the small intestine. It regulates the immune system and suppresses inflammation as well. There’s a correlation between vitamin D3 blood levels and the chance of getting pregnant. It is important for the development of the fetus and the newborn, so it should be taken by pregnant women and nursing mothers.

VITAMIN D3 DEFICIENCY

Vitamin D3 deficiency is common. Since it cannot be absorbed in the intestine, calcium is extracted from the bones. This affects their structure and strength. Children develop rachitis, and adults — osteomalacia.

Other signs of vitamin D 3 deficiency include frequent infections, fatigue, depression, muscle pain.

Do not forget that excess intake of vitamins is heavy both the body and the budget. Luckily, now you can get tested to see if you really need them.

Кофеинови напитки

CAFFEINE DRINKS

Caffeine is part of almost everyone’s diet. It has both positive and negative effects on the body, depending on the dose.

No matter if it comes from coffee, tea or dark chocolate, caffeine can speed up your metabolism, make you more alert and improve your memory. It also makes your blood pressure higher, increases your heart rate and works as a diuretic.

CAFFEINE AND FERTILITY

There’s no conclusive data on whether caffeine affects fertility. Scientists assume it can make it harder for women to get pregnant and it can change the DNA structure in sperm cells. It’s estimated that those effects come from other habits associated with caffeine consumption (for example, coffee and cigarettes).

CAFFEINE DURING PREGNANCY

The caffeine molecule can pass through the placenta. Unfortunately, the fetus can’t metabolize it the way adults can. It can cause disturbance in its sleeping pattern and cause excessive fetal movements. Caffeine is a vasoconstrictor which can lead to decreased blood flow to the fetus. This can lead to preterm birth and low birth weight.

Some gynecologists allow their patients to take in minimal amounts of caffeine during pregnancy (less than 200mg daily). However, since caffeine is found not only in coffee, you should avoid the delicious beverage as much as possible.

ENERGY DRINKS — A MODERN ALTERNATIVE?

The amount of caffeine in a can of energy drink can greatly surpass the one  in cup of coffee. Manufacturers usually do not disclose how much caffeine their drink contains which can lead to a fatal overdose. Many of those products are filled with sugar. They might also have been enriched with some vitamins. This should not fool you, the harms are more than the benefits.

CAFFEINE OVERDOSE — HOW TO RECOGNIZE IT?

Everyone’s tolerance for caffeine is different. When you consume a too large an amount of caffeine too fast you might experience nausea, vomiting, heart palpitations and arrhythmia. People with cardiac disease are at a greater risk. Although symptoms usually go away in a few hours, you should not underestimate the situation and seek medical treatment.

ФОЛИЕВА КИСЕЛИНА ПРИ БРЕМЕННОСТ

FOLIC ACID AND PREGNANCY

FOLIC ACID AND PREGNANCY

Folic acid or vitamin B9 is necessary for the proper functioning of many enzymes and cell division. Its intake is important to everyone, and the need for it is doubled in pregnancy.

WHY IS IT SO IMPORTANT?

Folic acid is needed by both the baby and the mother. It protects the fetus from neural tube defects such as spina bifida and anencephaly. Its use is associated with a reduced risk of premature birth and other birth defects. Folic acid stimulates the formation of erythrocytes in the mother, thus preventing anemia.

WHEN SHOULD YOU TAKE IT?

It takes some time to reach the optimal levels of folic acid in the body. If you are planning to get pregnant, you should start taking it 2-3 months before conception.

About 80% of pregnancies around the world are unplanned. Women find out that they are pregnant around the sixth gestational week when the fetal nervous system has begun its development. For this reason, experts advise that women of reproductive age should take a dietary supplement with folic acid. In the US, they deal with the problem by fortifying pastries with it.

HOW SHOULD YOU TAKE IT?

Some people carry a genetic mutation that makes metabolizing folic acid more difficult. The likelihood that you have this mutation should not scare you. All you have to do is choose supplements containing L-methylfolate.

Last but not least, the dose is important. Pregnant women need about 500 micrograms of folic acid daily, and may continue to take it during lactation. Many foods (spinach, nuts, beans, etc.) are rich in folic acid. Unfortunately, the amount needed is difficult to obtain through food, so choosing the right prenatal vitamins is essential.

ИНДИКАЦИИ ПРИ СЕКЦИО

INDICATIONS FOR CESAREAN SECTION

Modern medicines development has made cesareans a routine procedure. There are numerous indications for this kind of surgery and for many women it is the only way to give birth safely.

WHEN IS A CESAREAN SECTION PERFORMED?

Some women suffer from conditions that can render a normal delivery dangerous. These include eclampsia that doesn’t respond to medication or heart failure. Insulin treatment for diabetes can make the baby overweight and a vaginal delivery impossible. If you have myopia over 3 diopters there’s a risk that pushing can cause retinal detachment.

Anomalies of the placenta (placenta praevia, accreta or an abrubtion) or birth canal issues are indications for a c -section as well.

When the baby is in an oblique or transverse position or the umbilical cord has prolapsed into the vagina, a c-section should be performed. If the baby is breech, natural delivery can be attempted. If you’re pregnant with twins and the first twin isn’t breech you can try giving birth vaginally.

EMERGENCY CESAREAN SECTION

Deliveries are a very dynamic process and changes can occur at any moment. Sometimes in the course of a natural delivery a c-section might be needed after careful assessment by the medical team. This usually happens due to fetal distress or in cases of a prolonged labor. After your water breaks, the baby is no longer protected by the amniotic sac and the risk of infection increases.

ELECTIVE CESAREAN SECTION

When there are no indications for a c-section, vaginal delivery should be encouraged. Some mothers want a specific birth date for their baby. Such a practice can lead to dangerous consequences for the baby as it might not be ready to be delivered.

If you’re afraid to give birth naturally, please discuss the matter with your OBGYN or even a psychologist. Vaginal deliveries are much easier on the mom in the long run and it is even suggested that they strengthen babies’ immune system. This happens as the baby comes into contact with the vaginal flora.

However, If this is your final decision, it should be respected by your healthcare provider.

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