PREMATURE BABIES

A premature baby, or preemie, is born before the 37th week of pregnancy. Premature birth occurs in between 8 percent to 10 percent of all pregnancies in the United States. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop. Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.

As Australia's mothers get older, their chances of a premature birth are rising too. Neo-natal specialists say parents should be better prepared for an early arrival.

Around one in 12 Australian babies are now born more than three weeks before the full pregnancy term of 40 weeks, and the number is growing. Premature births increased by 20 per cent over the decade between 1995 and 2005, while births overall rose by only 5 per cent.

Dr Kei Lui, Director of the Newborn Care Unit at Sydney's Royal Hospital for Women, says that while much of the cause of increased prematurity is uncertain, the increased age of first-time mothers is thought to be a contributing factor.

"We have many more older mums…leading people to have problems with fertility and then they are moving towards IVF, we are getting more multiple births – these are all compounding factors."

But despite the rising trend in early arrivals, few pregnant women are prepared for an early birth, says Fiona Dixon, whose second child, Airlie, was born at 27 weeks gestation, despite a normal first pregnancy.

"People don't think about it until it happens to them, and it can have implications for all sorts of things – like parental leave and health insurance cover," she says.

And while there is widespread public education for other risks in pregnancy –such as listeriosis and rubella – Dixon says there is far less information given to pregnant women about prematurity.

"We need to raise the education level about the risks of prematurity and also about the issues that lead to prematurity," she says.

Dixon suffered from pre-eclampsia, a serious pregnancy-induced condition that causes raised blood pressure in the mother and affects around 10 per cent of pregnancies. It is one of the most common causes of premature birth.

"I was OK at 24 weeks, but then I had symptoms like swelling in my hands and feet and bad headaches for a couple of weeks," she says.
Dixon believes that, if she had known more about the early signs of pre-eclampsia, she may have been able to access treatment in time to prevent her baby arriving quite so early.

How early?

The majority of premature babies (US estimates suggest about 84 per cent) are born between 32 and 36 weeks gestation. A further 10 per cent of premature babies are born between 28 and 31 weeks, and the remaining six per cent are born before 28 weeks.
Most babies born before 37 weeks will spend some time in neo-natal intensive care or in the special care nursery. They are more vulnerable to infection than babies born at full term, and many will need help with feeding.
Most babies born before 30 weeks need help with breathing until their lungs develop.

The grey zone

Around one per cent of births in Australia are classed as 'extremely premature' – that is, between 23 and 25 weeks. Babies born in this early period, referred to as 'the grey zone' at the limits of viability, need high-level intensive care for a number of months if they are to survive.

It is these babies that cause the most heartache. Many weigh close to one kilogram at birth and their parents face an agonising decision: whether to agree to lengthy intensive care treatment to save their child, with the possibility of long-term serious disability, or to stop treatment and allow their baby to die.

In some countries, regulations determine treatment decisions; in Holland, for example, doctors do not routinely administer intensive care to babies born before 25 weeks of pregnancy. In Australia, decisions about the level of intervention and treatment are left to doctors and parents and made on a case-by-case basis.

But survival rates have lifted significantly, especially at the 25-week mark. Australian statistics released in 2006 show that more than three-quarters of babies born at 25 weeks will survive and more than 80 per cent will not have a major disability – and prospects improve for each day that a baby is born closer to their due date.

Good news on outcomes

Dr Lui points out that advances in technology and medical care are good news for premature babies.
"Despite the increase in survival rate for premature babies, we are not trading survival for injured children; we are actually also seeing a drop in the rate of disability," he says.
"If you compare the morbidity and mortality rates of neo-natal intensive care with adult intensive care, it is far more cost-efficient. Younger patients tend to do much better; those who survive are doing very well."

Survive Cancer, Have Baby

The emerging field of oncofertility offers hope to patients who worried that they couldn't conceive.

When Annie Dauer's oncologist told her she'd need a stem-cell transplant to cure her non-Hodgkin's lymphoma, Dauer's first thought wasn't about death but about life. "I asked what would happen to my fertility," she says. Her oncologist dismissed the question: " 'Honey, you're fighting for your life; forget the fertility at this point,' she told me." But Dauer, then 30 and newly married, pressed the subject until the oncologist referred her to a fertility specialist. Since Dauer's chemotherapy regimen would most likely destroy her body's egg supply, the specialist, in an experimental procedure, removed one of her ovaries, froze it and reimplanted it when Dauer recovered. Three years later, Dauer, now cancer-free, and her husband, Greg, have a 2-year-old daughter, Sienna, and a second baby on the way.

Welcome to the burgeoning world of oncofertility. As cancer survival rates climb and patients focus on quality-of-life issues, especially fertility, Dauer and others like her are forcing two very different medical specialties—oncology and assisted reproduction—to come together. "The narrative of cancer is no longer that it's a death sentence; it's a bump in your medical history that you overcome and go back to what we hope is a healthy lifestyle," says Teresa Woodruff of Northwestern University's Feinberg School of Medicine, who last fall received a first-of-its-kind $21 million NIH grant to develop ways of protecting cancer patients' reproductive health.

Of the 125,000 people under the age of 45 who are diagnosed with cancer each year, roughly half will receive treatments that will affect their fertility. The cancers that most commonly strike the young—leukemias, lymphomas and breast cancers—require some of the most toxic forms of chemotherapy, which target rapidly growing and fragile cells like hair follicles, sperm and eggs. The good news: patients who would like to become parents have a growing array of options. Men are benefiting from a procedure that allows urologists to find a single live sperm to bank, which can then be used in an in vitro fertilization method that requires just one sperm. Women can freeze eggs or ovarian tissue, though success rates are still low. Those with partners (or donor sperm) can freeze embryos, the procedure with the best track record, though, like egg freezing, it's available only to patients who have two to six weeks before starting treatment. On the horizon are less toxic chemotherapy agents as well as methods of shielding eggs and sperm from harm.

Up to now, few oncologists passed this vital information to patients, either because they were not aware of fertility advances, or because they were understandably preoccupied with saving lives. As the field grows (at least 50 centers now provide oncofertility services), more cancer docs are tackling the issue, and even altering treatments to aid fertility. Advocacy groups like Fertile Hope, which educate cancer patients about assisted reproduction, deserve credit for spreading the word. "It's being talked about more," says Nancy Lin, an oncologist at Boston's Dana-Farber Cancer Institute. "There's a growing awareness among doctors, and patients are more proactive."

Two years after Dauer completed her cancer treatment, her doctor, Kutluk Oktay, founder of New York City's Institute for Fertility Preservation, sutured a one-inch strip of ovary, containing tens of thousands of microscopic eggs, under the skin just below Dauer's belly button. "Every month, I would feel little eggs, sometimes pea-sized, sometimes as big as a quarter," says Dauer. Normally, Oktay, who pioneered this procedure, would have harvested mature eggs, fertilized them with Greg's sperm and implanted them into Dauer's uterus. But in an unexpected development, Dauer became pregnant naturally; somehow, the implanted ovary jump-started her remaining, inactive ovary and she began to ovulate. Oktay is at a loss for an explanation. "The healthy ovary may contain signals or hormones that may enable the [dormant] ovary to regenerate eggs," says Oktay. "That's the theory, other than a miracle."

When cancer's involved, even joy can be shadowed by uncertainty. Ronny Villarreal, 32, survived breast cancer, then, with her oncologist's OK, stopped a common hormone-suppressing treatment early in order to conceive. Unfortunately, the cancer recurred during her second trimester of pregnancy. Villarreal's daughter, Maddy Hunt, now 4 months old, is healthy, but Villarreal is facing more chemotherapy and a cloudy prognosis. "We are trying our hardest to stay positive," she says. "We have so much to live for." More, certainly, than if she never had the chance to get pregnant at all.

© 2008

http://services.newsweek.com/

How To Get Pregnant...???

Is There something wrong with me?

Am I fertile?

Pregnancy (latin graviditas) is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female human. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies. Obstetrics is the medical field that studies and treats pregnant patients.

Childbirth usually occurs about 38 weeks from fertilization, i.e., approximately 40 weeks from the start of the last menstruation. Thus, pregnancy lasts about nine months, although the exact definition of the English word “pregnancy” is a subject of controversy.

These are questions that come up a lot with those of you who have been trying to figure out exactly how to get pregnant for several months now and have not yet had any success.

At first there is not much doubt, you stop using contraception and imagine that within a few months you will become pregnant and that's it. After three or four months of trying you will be faced with the reality of the situation that you are not pregnant yet and your mind will begin to ask if everything is ok with you and your partner.

To put your mind at rest, when you are trying for a baby it is quite normal to have to wait up to and beyond 12 months before finally becoming pregnant.

To be able to become pregnant there are certain facts that you should be aware of that when applied to your lifestyle and your lovemaking will dramatically increase your ability to become pregnant:

• You should be aware of how your body works and exactly what your body is doing at every step of your monthly cycle. Get to know the tell tale signs that you are about to ovulate. With a little practice you should be making love just as you ovulate.
  
  
• Know when to make love. You need to know about male ejaculation and about how sperm can become more or less active. Plan it so that you make love just as you ovulate with the highest quality sperm. Also you need to learn about how female orgasms can help in conception if timed right.
  
  
• Preparing your body with the correct minerals and vitamins is very important. Not only for trying to conceive but once conception has occurred then you will need to have prepared yourself to be able to nourish the unborn in the first few weeks. There is a lot to be said ion this subject.
  
  
• You should also be asking yourself if you are really prepared to bring a child into this world, do you have the means to support it and nurture it?... I personally believe that whatever our situation, as a survival instinct most of us will somehow be able to find all that we will need to bring up a healthy and happy baby but if you personally are not really that sure then this thinking will bear a direct influence on your physical body and will play tricks with your ovulation and menstrual cycle which will make it that much more difficult to become pregnant.

Getting pregnant is a gift, the fact is that some women are just not able to and that is sad. There are however many women who believe they cannot become pregnant when really all that they need is a little clarity and the explanation of certain facts and they will be able to become pregnant just as easily as anybody else.

Terminology

One scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes referred to as a gravida. Both words are rarely used in common speech. Similarly, the term "parity" (abbreviated as "para") is used for the number of previous successful live births. Medically, women who have never been pregnant are referred to as "nulliparous" ("gravida 0, para 0"), during a first pregnancy as a "primigravida" ("gravida 1, para 0") and in subsequent pregnancies as "multigravida" or "multiparous". Hence during a second pregnancy a woman would be described as "gravida 2, para 1" and

upon delivery as "gravida 2, para 2". Incomplete pregnancies of abortions, miscarriages or stillbirths account for parity values being less than the gravida number, whereas a multiple birth will increase the parity

The term embryo is used to describe the developing offspring during the first eight weeks following conception, and the term foetus is used from about two months of development until birth.

In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or foetus). During the second trimester, the development of the foetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of viability, or the ability of the foetus to survive, with or without medical help, outside of the uterus.

Characteristics

Pregnancy occurs as the result of the female gamete or oocyte (egg) being penetrated by the male gamete spermatozoon in a process referred to, in medicine, as "fertilization", or more commonly known as "conception". The fusion of male and female gametes usually occurs through the act of sexual intercourse. However, the advent of artificial insemination has also made achieving pregnancy possible in such cases where sexual intercourse is not potentially fertile (through choice or male/female infertility).

A number of medical signs are associated with pregnancy. These signs typically appear, if at all, within the first few weeks after conception. Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they make a presumptive diagnosis of pregnancy. These signs include the presence of human chorionic gonadotropin (hCG) in the blood and urine, missed menstrual period, implantation bleeding that occurs at implantation of the embryo in the uterus during the third or fourth week after last menstrual period, increased basal body temperature sustained for over two weeks after ovulation, Chadwick's sign (darkening of the cervix, vagina, and vulva), Goodell's sign (softening of the vaginal portion of the cervix), Hegar's sign (softening of the Vaginal fornix), and Linea nigra, (darkening of the skin in a vertical line on the abdomen, caused by hyperpigmentation resulting from hormonal changes; it usually appears around the middle of pregnancy).

Duration

Though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period (acronym = LMP), or from the date of conception (if known). Starting from one of these dates, the expected date of delivery (acronym = EDD) can be calculated. Counting from the LMP, pregnancy usually lasts between 37 and 42 weeks, with the EDD at 40 weeks, 38 weeks after conception. 40 weeks is a little more than nine months and six days, which forms the basis of Naegele's rule for estimating date of delivery.

Pregnancy is considered 'at term' when gestation attains 37 complete weeks but is less than 42 (between 259 and 294 days since LMP). Events before completion of 37 weeks (259 days) are considered pre-term; from week 42 (294 days) events are considered post-term. When a pregnancy exceeds 42 weeks (294 days), the risk of complications for mother and fetus increases significantly. As such, obstetricians usually prefer to induce labour, in an uncomplicated pregnancy, at some stage between 41 and 42 weeks.

Recent medical literature prefers the terminology pre-term and post-term to premature and post-mature. Pre-term and post-term are unambiguously defined as above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy.

Though these are the averages, the actual length of pregnancy depends on various factors. For example, the first pregnancy tends to last longer than subsequent pregnancies. Fewer than 10% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks.

Accurate dating of pregnancy is important, because it is used in calculating the results of various prenatal tests (for example, in the triple test). A decision may be made to induce labour if a fetus is perceived to be overdue. Due dates are only a rough estimate, and the process of accurately dating a pregnancy using the LMP method is complicated by the fact that not all women have 2

Diagnosis

Obstetrics (from the Latin obstare, "to stand by") is the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (the period shortly after birth). Midwifery is the equivalent non-surgical specialty. Most obstetricians are also gynaecologists. See Obstetrics and gynaecology.

The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed placenta. Clinical blood and urine tests can detect pregnancy soon after implantation, which is as early as 6-8 days after fertilization. Home pregnancy tests are personal urine tests, which normally cannot detect a pregnancy until at least 12-15 days after fertilization. Both clinical and home tests can only detect the state of pregnancy, and cannot detect its age.

In the post-implantation phase, the blastocyst secretes a hormone named human chorionic gonadotropin which in turn, stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman.

An early sonograph can determine the age of the pregnancy fairly accurately. In practice, doctors typically express the age of a pregnancy (i.e. an "age" for an embryo) in terms of "menstrual date" based on the first day of a woman's last menstrual period, as the woman reports it. Unless a woman's recent sexual activity has been limited, or she has been charting her cycles, or the conception is as the result of some types of fertility treatment (such as IUI or IVF) the exact date of fertilization is unknown. Absent symptoms such as morning sickness, often the only visible sign of a pregnancy is an interruption of her normal monthly menstruation cycle, (i.e. a "late period"). Hence, the "menstrual date" is simply a common educated estimate for the age of a fetus, which is an average of two weeks later than the first day of the woman's last menstrual period. The term "conception date" may sometimes be used when that date is more certain, though even medical professionals can be imprecise with their use of the two distinct terms. The due date can be calculated by using Naegele's rule. The expected date of delivery may also be calculated from sonogram measurement of the fetus. This method is slightly more accurate than methods based on LMP. The beginning of labour, which is variously called confinement or childbed, begins on the day predicted by LMP 3.6% of the time and on the day predicted by sonography 4.3% of the time

Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to around 100,000 mIU/mL by 10 weeks of gestation. (wikipedia.com)

authorship: wikipedia/pregnataid