Second Pregnancy

I'm writing again after my last post which was after my sister's wedding. It was like back in December 2012. It may be due to my hectic schedule for year 2013 plus my problematic pregnancy. Hahahahha..due to that, I had increase my knowledge in Biology by reading from Uncle Google.

I knew I was pregnant even without the "pee stick". Mother instinct perhaps...

Though it was the second time having something moving inside the womb, things were never be the same. Nausea and vomit were not as bad as first pregnancy. But my belly looked very weird and it made me curious. After my 16 weeks, I had my first appointment with my gynae , Dr Seri Suniza. She confirmed that I had an Anterior Placenta.

What is Anterior Placenta?

It means my baby is taking a backseat to the placenta. The term refers to the location of the placenta within uterus. 

Does the location of  placenta make any difference? Not to the baby, who doesn't care which side of the uterus he is lying on, and it certainly makes no difference to him  where the placenta lies. 

However, there were less communication between mama and abah with you inside the tummy because the placenta will serve as a cushion between baby and tummy. :(

Luckily the placenta was not lying low which can caused a condition names Placenta Previa. Placenta previa can lead to bleeding during pregnancy and there are high possibility of c-sect..

Also, a little bit history of my first pregnancy, I had a mysterious itchiness which if I highlighted to other experienced mommies, they will say that it is normal bla bla bla..But my itchy was like underneath my skin and the itchiness was very painful and unexplainable . The most itchy part was on palms and soles. Also it it will get worst at night. It happened again during my second pregnancy. The same feeling and symptoms. No rashes at all. My gynae decided to take this problem seriously this time around which she asked my to do blood test and get it tested for hepatitis B and psoriasis. After waited for few weeks, I was diagnosed with Obstetric Cholestasis.

What is Obstetric Cholestasis?
Obstetric cholestasis (OC) is an uncommon pregnancy condition that affects your liver and makes you feel itchy, sometimes intensely so.

Obstetric cholestasis is a condition of the liver which occurs in some pregnant women. Cholestasis means there is a reduced flow of bile down the bile ducts in the liver. Some bile then leaks out into the bloodstream, in particular the bile salts. These circulate in the bloodstream and can cause symptoms. Obstetric cholestasis is also called intrahepatic cholestasis of pregnancy by some doctors.

Obstetric cholestasis occurs in less than 1 in 100 pregnancies in the UK. It is more common in women carrying twins, triplets, or more. Mothers, daughters and sisters of affected women have a higher than average risk of also being affected when pregnant. If you have obstetric cholestasis in one pregnancy, you have a high chance that it will occur in future pregnancies.

The exact cause is not clear. Hormonal and genetic factors may be responsible:

• Hormonal factors. Pregnancy causes an increase in oestrogen and progestogen hormones. These can affect the liver in a way which slows down the rate of bile passing out along the tiny bile ducts. Some pregnant women may be more sensitive to these hormonal effects.
• Genetic factors. Obstetric cholestasis seems to run in some families (although it may skip some generations). One theory is that women who develop obstetric cholestasis may inherit a slight problem with the way bile is made and passes down the bile ducts. This does not matter when not pregnant. However, the high level of hormones made during pregnancy may tip the balance to cause a much reduced flow of bile.

There may be other environmental factors which contribute. However, whatever the underlying cause, the pregnancy triggers the problem. Within a week or so after giving birth the symptoms clear and there is no long-term problem with the liver. What are the symptoms?

Typically, symptoms occur after 24 weeks of pregnancy when the hormone levels are at their highest. Sometimes it develops earlier in pregnancy.

Itch is the most common symptom. The itch can be all over, but it is often worst on the hands and feet. Commonly, itch is the only symptom. It tends to get worse until you have the baby. The itch can become severe and affect sleep, concentration and mood. It can become distressing. The symptoms can be unpleasant for the mother - in particular the itch. But whether obstetric cholestasis causes an increased risk of harm to mother or baby is still being debated. If there is a risk, it is thought to be small, but the concerns are as follows.

For the unborn baby

Until recently it had been thought that obstetric cholestasis caused a small increased risk of stillbirth. The risk of stillbirth in a normal pregnancy is about 1 in 100. The risk if you have obstetric cholestasis was thought to be a little more than this. The evidence is still not clear and further research is being done.

There is an increased risk of your baby being born too early (prematurely). This is usually because your obstetrician may decide that your baby should be delivered early rather than waiting for you to go into labour naturally.

There is also an increased risk of your baby passing meconium (like poo) whilst they are in the womb. This can irritate the baby's lungs if breathed in during delivery.

More research is currently underway into the risks and effects of the condition and treatment. If you have obstetric cholestasis you should have a good discussion with your obstetrician and midwife about how big the risks are and how they can be prevented.

For the mother

There is possibly an increased risk of serious bleeding from the womb just after giving birth. However, again the studies are not conclusive and there may be no increased risk of this.

Not to risk my baby, Dr Seri Suniza advised me to take out the baby latest by 38 weeks. From my medical history, I delivered my first baby on week 37 via induction as there were sign of meconium inside the womb. Dr Seri confirmed that the first pregnancy also was the obstetric cholestasis effect. And as expected, on the day I was induced which on week 38, my baby already poo poo inside the womb. Thank you Doctor. It will always be a right decision from you.

Gallstone

Not to forget, on top of anterior placenta and obstetric cholestasis, I also had few medium size of gallstones inside my gallbladder.  

The function of the gallbladder is to store bile (a substance that aids in the digestion of fat), which is produced by the liver. When the bile contains too much cholesterol and not enough bile salts, or when the gallbladder doesn't empty properly, the gallbladder can form stones.

Until now, it remains there. I was hoping that it can disappear on its own :)