Archive for category Pregnancy'

Hypertension in Pregnancy

Hypertension is the most common medical problem of pregnancy, affecting 10% of all pregnant women. The condition can lead to devastating outcomes with significantly increased risks of placental abruption, disseminated intravascular coagulation (disseminated intravascular coagulopathy), cerebral hemorrhage, hepatic failure, and acute renal failure. Hypertensive disorders of pregnancy are a significant cause of maternal and perinatal morbidity and mortality, and therefore require accurate diagnosis and proper medical management. CAM treatments for hypertensive disorders during pregnancy should always accompany proper medical management in conjunction with the care of an obstetrician. Hypertensive disorders of pregnancy are divided into four categories according to the National High Blood Pressure Education Program (NHBPEP) 2000 Working Group: 1. Preeclampsia-eclampsia 2. Chronic hypertension 3. Preeclampsia superimposed on chronic hypertension 4. Gestational (transient) hypertension Hypertension itself is defined as a sustained increase in blood pressure > 140 / 90. Elevated blood pressure should be documented on at least two consecutive occasions greater than 6 hours apart, using the appropriate-size Read more […]

Descriptions of Hypertensive Disorders of Pregnancy

Descriptions of Hypertensive Disorders of Pregnancy by Classification and General Conventional Treatment Approaches A great deal of debate and uncertainty surrounds the etiology, classification, and medical treatment of pregnancy hypertensive disorders. The following discussion provides a brief overview of the salient points of each of the pregnancy hypertensive disorders and their specific medical treatments based on current recommendations. Preeclampsia Preeclampsia is a disease specific to pregnancy, with “cure” occurring only upon delivery of the placenta. The etiology of preeclampsia remains unknown, although there are numerous theories. It appears that it is a complex, multifactorial condition with genetic factors, immunologic factors, altered inflammatory pathways, insulin resistance (obesity, hyperlipidemia, glucose intolerance), endothelial dysfunction, macronutrient and micronutrient deficiencies, altered placental angiogenesis, and subclinical infections possibly participating in the risk of developing this condition. Advanced maternal age, first pregnancy, poor nutrition, residence at high altitudes, and lack of adequate prenatal care have also been associated with increased risk. There is a common thread Read more […]

Botanical Treatment Of Hypertension In Pregnancy

Improperly treated pregnancy hypertensive disorders can have dire consequences to the mother and baby. It is not recommended that pregnant women attempt self-medication for pregnancy hypertension, nor that this be done by inexperienced practitioners. The best treatment is obstetric medical care accompanied, when appropriate, by prudent use of herbal medicines as adjunct therapy, under the guidance of an herbalist, nat-uropath, or midwife trained in the use of botanical medicines in pregnancy. Although popular for the treatment of hypertension in the nonpregnant population, herbal diuretics such as dandelion leaf (Taraxacum officinale) are not appropriate for the treatment of pregnancy hypertensive disorders, and may potentially cause exacerbation. The herbs discussed in the following are those commonly used for treating gestational and chronic hypertension that are considered generally safe for use during pregnancy. Botanical treatment for preeclampsia is not recommended and has not been investigated. Cramp Bark and Black Haw Cramp bark and black haw have been used by midwives as part of herbal antihypertensive protocol for gestational hypertension. Traditionally, they have been used as mus-culoskeletal relaxants Read more […]

Group B Strep Infection In Pregnancy

In the 1970s, Group B Streptococcus (GBS), infection with Streptococcus agalactiae, emerged as a leading cause of pneumonia, sepsis, and meningitis in newborns. Group B Streptococcus is a normal inhabitant of the intestinal tract and colonizes the vaginal tracts of many women; it can be demonstrated by culture of combined rectal and vaginal swabs in 15% to 40% of pregnant women on random sampling. Most bacterial transmission to the neonate occurs during birth via passage of the baby through the birth canal, or via ascendant bacteria during labor with ruptured membranes. Premature babies and babies of mothers with premature or prolonged rupture of membranes (PROM) are at higher risk of infection. Group B Streptococcus can also cross the membranes, so cesarean section is not protective and carries additional surgical risks to the mother. Infection is categorized as either early or late onset. Early-onset disease symptoms manifest within a few hours, and up to a week after birth. Antibiotic prophylaxis administered to the mother during labor, as is discussed in the following, is used to prevent early-onset infection in the neonate. Late-onset disease develops through contact with hospital nursery personnel and usually Read more […]

Conventional Treatment Approaches

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention (CDC) published guidelines in 1996 recommending a risk-based (screening) approach, to determine when to recommend intravenous (IV) antibiotic prophylaxis during labor. It was determined that women with the following risk factors should be offered (IV) antibiotics during labor and delivery, not before labor: • fever during labor • rupture of membranes 18 hours or more before delivery • labor or rupture of membranes before 37 weeks As of 2002, the CDC revised the 1996 guidelines, recommending routine screening for all pregnant women between 35 and 37 weeks gestation, and universal treatment for women who test positive for group B Streptococcus during pregnancy (Box CDC 2002 group B Streptococcus Treatment Guidelines). CDC 2002 group B Streptococcus Treatment Guidelines • All pregnant women should be screened at 35 to 37 week gestation for vaginal and rectal group B Streptococcus colonization. At the time of labor or rupture of membranes, intrapartum chemoprophylaxis should be given to all pregnant women identified as group B Streptococcus carriers. Colonization Read more […]

Botanical Treatment of Group B Streptococcus

Choosing to Use Botanical Therapies for Reducing group B Streptococcus Infection during Pregnancy Despite the 2002 revised protocol, many pregnant women prefer to avoid routine antibiotic prophylaxis for a variety of reasons including: • philosophic reasons (i.e., they prefer to minimize medical intervention or want a “natural” approach), • due to concern about sequelae (i.e., development of resistant infections, increased likelihood of neonatal Candida infection (thrush)) • or choice of birth setting (i.e., home birth, making it difficult if not impossible to access antibiotic prophylaxis in labor) For women choosing to birth naturally at home, the use of prophylactic intravenous antibiotics in labor is sometimes not a realistic option — most home birth midwives do not administer intravenous medications. Home birth midwifery protocol therefore continues to follow the risk-assessment model, transporting to the hospital for intravenous antibiotic prophylaxis should indications arise, including rupture of membranes longer than 18 to 24 hours (length of time varies with the protocol of different medical and midwifery communities) or any signs of infection. Group B Streptococcus-positive women planning Read more […]

Constipation During Pregnancy

Constipation is defined as having bowel movements fewer than three times per week. The stools are typically hard, dry, small in size, and difficult to eliminate. Constipation may be accompanied by straining, pain, bloating, cramping, and the sensation of a full bowel. It is a bothersome common complaint of pregnancy, particularly in the second and third trimesters. Women who are habitually constipated may become more so during pregnancy. The prevalence of constipation in pregnancy is reported to be 11% to 38%. It has been generally accepted that decreased gastric motility in pregnancy is a result of increased circulating progesterone levels. More recent experimental evidence suggests that elevated estrogen concentrations are involved in delayed motility through an enhancement of nitric oxide release. Slow transit time of food through the intestinal tract leads to increased water absorption and thereby to constipation. Dietary factors, particularly inadequate fiber intake and lack of exercise, contribute to constipation, as does increased pressure of the growing uterus on the rectum as pregnancy becomes advanced. Ignoring the urge to have a bowel movement can also contribute to the problem. Iron-deficiency anemia can Read more […]

Botanical Treatment For Constipation

Botanical treatment for constipation relies on a combination of the practical dietary and lifestyle changes presented on the preceding page, and gentle herbs that increase bulk and moisture in the bowel, or gently stimulate bowel activity. These herbs may be used singly, or in combination, and are combined with a carminative herb — one that relieves gas and griping — to prevent side effects sometimes associated with laxatives. Examples of carminatives that can be safely used for short durations during pregnancy include ginger root and anise seed. Stimulant laxatives are used only for short durations (up to 2 weeks) to avoid dependence. When using herbal bulking laxatives, it is important to make sure the patient is drinking plenty of water, because the bulk laxative will absorb large amounts of water from the colon. There have been few studies evaluating the safety or efficacy of natural laxatives in pregnancy. A number of herbal preparations available in health food and grocery stores contain herbs that are not appropriate or safe for use in pregnancy, including cascara sagrada, aloe, and buckthorn (see Case History 1). Aloe may be teratogenic, whereas the other herbs are associated with increased uterine activity. Read more […]

Heartburn

Heartburn (Gastroesophageal Reflux) In Pregnancy Heartburn is caused by a reflux of gastric acids into the lower esophagus, usually occurring after meals or when lying down. The gastric acids irritate the esophagus, causing a burning sensation behind the sternum that may extend into the neck and face, and may be accompanied by regurgitation, nausea, and hypersalivation. Inflammation and ulceration of the esophagus may result. Up to two-thirds of women experience heartburn during pregnancy. Only rarely it is an exacerbation of preexisting disease. Symptoms may begin as early as the first trimester and cease soon after birth. Most women first experience reflux symptoms after 5 months of gestation; however, many women report the onset of symptoms only when they become very bothersome, long after the symptoms actually began. The prevalence and severity of heartburn progressively increases during pregnancy. The exact causes(s) of reflux during pregnancy include relaxed lower esophageal tone, secondary to hormonal changes during pregnancy, particularly the influence of progesterone, and mechanical pressure of the growing uterus on the stomach which contributes to reflux of gastric acids into the esophagus. However, some Read more […]

Heartburn: Botanical Treatment

Herbal treatment for heartburn during pregnancy focuses on simple lifestyle and dietary modification, and the use of gentle herbs to soothe and protect the esophageal epithelium (Table Botanical Treatment Strategies for Heartburn). A mild antacid herb may also be included in more bothersome cases. Nervines (e.g., cha-momile, skullcap, or passion flower) can be added to a protocol if heartburn is causing sleeping problems or if stress is contributing to digestive difficulties. Herbs for treating heartburn are best taken as teas or lozenges (e.g., slippery elm bark lozenges) rather than as tinctures, both to bathe the alimentary canal as they are ingested, and avoid the potentially irritating effects of alcohol in the tinctures. Further, demulcent herbs are best extracted in water for maximum efficacy. Botanical Treatment Strategies for Heartburn Therapeutic Goal Therapeutic Activity Botanical Name Common Name Relieve esophageal irritation and inflammation Demulcents Althea officinalis Marshmallow root Ulmus fulva Slippery elm bark Improve esophageal sphincter tone Unknown Amygdalis communis Almonds   General Recommendations for Preventing / Relieving Heartburn A Read more […]