True Birth

Platelets, also called thrombocyotes, are a component of red blood cells. They are fragments of cytoplasm that are derived from the bone marrow and are essential for blood clotting. Blood clotting is exteremly important in pregnancy and labor and delivery to prevent excessive bleeding (hemorrhage).

Should a woman keep an eye on her platelet levels during pregnancy? The resounding answer is yes. Find out how and why platelets matter on this weeks episode of True Birth.

Key Highlights:

[01:54] What are platelets and how are they important to the body?

[05:55] What is the job of platelets in the body?

[06:35] What happens if you don't have good platelet function?

[07:50] The normal platelet count

[08:40] Causes of low platelets count during pregnancy

[09:37] #1 cause: haemodilution

[12:54] How women get misdiagnosed as having thrombocytopenia

[15:10] Different types of thrombocytopenia

[18:15] Why is it a problem to have platelets levels below 100k/ml?

[21:24] Paralysis during an epidural: why is it rare?

[24:32] Epidural alternatives

[25:30] Why cancer leads to low platelet levels.

[27:49] #2 cause: preeclampsia

[28:58] Some treatments to boost your platelets.

[32:03] Should you worry about DIC when you have low platelets?

[32:21] Can the baby also have low platelets?

[34:46] How to determine the baby's platelet levels

[38:14] What is alloimmune thrombocytopenia?

[40:49] Thrombocytosis and treatment

[42:43] Summary of the episode

[43:45] Do women on Heparin or Lovenox have to worry about low platelets?

[44:50] Is there anything you can do with your diet to increase your platelets?

[45:46] Why platelets transfusion is not recommended

[47:00] Does it mean you have low platelets if you regularly have nose or gum bleeds?

• Platelets are one of the most important things in the human body. Their job is to stop bleeding.
• Platelets' job is to keep blood where it's supposed to be and not let it escape when any damage occurs.
• 5-10% of women will have platelets under 150,000/ml just because they're pregnant.
• If you have a c-section and your platelets are 50,000/ml, you are in trouble. You might not stop bleeding from the surgery.
• The average platelets only last 7-10 days.
• Anything that's going to build your kidneys and bone marrow will build your platelets.

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How long is it necessary to wait to get pregnant after a pregnancy in various circumstances? There is no uniform or immediate answer. In this episode, we explore what is recommend in each circumstance: miscarrarriage, vaginal delivery and cesarean birth. What is the interval between pregnancies that is safe? Tune in this week to find out.

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Put on your Columbo jackets! When a patient tells the story of what happened in their labor and delivery experience, they often leave clues as to what truly happened from a medical perspective. Every clinician understands that patients are not necessarily coming from a medical background when they recount their own experiences with healthcare. The pertinent medical information can be colored by the patient's own perceptions of what was happening we and what they were informed of at the time. A good physician will be able to piece together the puzzle and find the medical facts in the story to crack the case of what really happened in any labor and delivery room. In this creative and interesting episode, Dr. Abdelhak walks us through how he puts on his Sherlock Holmes' cap and can make accurate deductions from fragments of information in a patients story and medical records. True Birth presents : Forensic Obstetrics

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In this episode, we talk about Group B Strep bacteria found on the lower genital tract. The reason why Group B Strep is a problem, how to know the women with Group B Strep, how to treat women with the bacteria and, why women with Group B Strep are not given antibiotics before labor.

Timestamps

[01:38] About Group B Strep bacteria

[03:31] The reason why the bacteria is a problem

[05:30] How to know the women with Group B Strep

[07:12] How to treat women with the bacteria

[09:34] Why women with Group B Strep are not given antibiotics before labor

[12:12] The test for Group B Strep

• Group B Strep is part of the normal vaginal flour.
• The main reason why Group B Strep is a problem is that rarely, it can get into the nose and mouth of a newborn that is passing through the birth canal and cause a Neonatal infection.
• Women with Group B Strep are given antibiotics in labor, usually ampicillin.
• Once the water breaks, the baby might be exposed to the bacteria in the vaginal canal.

Group B Strep

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What was the c-section rate in 1970 compared to what the c-section rate is now? It's much higher. The c-section rate in the United States has been as high as 35% and even higher for first time moms. Dr. Abdelhak speaks to the 5 main causes of the multifactorial cesarean epidemic .

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This episodes walks through the different types of lacerations and how they are repaired.

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Our practice website can be found at:

Maternal Resources: https://www.maternalresources.org/

Remember to subscribe wherever you get your podcasts. Please consider leaving us a review on iTunes

Our Social Channels are as follows

Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources IG: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB

The round ligaments are ligaments that sit near the uterus and, pass near the inguinal canal and end in the labia majora. It is a very common report in pregnancy to experience pain in the round ligament area. The pain is most common in the second trimester and can be on either the right or left side and often described as a pulling sensation. It is thought to be caused by irritation of the nerve fibers along the ligament. In this episode, we discuss treatments and the best course of action in pregnancy.

Pregnancy is a remarkable journey, but it can come with its fair share of discomforts. One common discomfort experienced by many expectant mothers is round ligament pain. In this blog post, we will delve into the causes, symptoms, and methods of relief for round ligament pain, providing insights to help pregnant women better manage this discomfort.

Round ligament pain is a common complaint during pregnancy, especially during the second trimester. The round ligaments are bands of tissue that support the uterus and stretch as the baby grows. As the ligaments stretch and accommodate the expanding uterus, they can become strained, leading to pain. This pain is often described as sharp, stabbing, or aching, and typically occurs on one or both sides of the lower abdomen or groin area.

The primary cause of round ligament pain is the stretching and pulling of the round ligaments to accommodate the growing uterus. Activities that involve sudden movements, such as coughing, sneezing, laughing, or changing positions quickly, can trigger or exacerbate the pain. Physical exertion, such as exercise or lifting heavy objects, may also contribute to the discomfort.

Round ligament pain is characterized by sharp or stabbing pain on one or both sides of the lower abdomen or groin. The pain is often short-lived but can sometimes last for several minutes. It is typically more pronounced when transitioning from a resting to an active state. While round ligament pain is usually harmless, it is important to consult with a healthcare provider to rule out other potential causes of abdominal pain and ensure an accurate diagnosis.

Several strategies can help alleviate round ligament pain and provide relief to expectant mothers. These include:

1. Rest and Relaxation: Take breaks throughout the day to rest and avoid activities that may strain the ligaments.

2. Gentle Exercise: Engage in low-impact exercises, such as prenatal yoga or walking, to maintain muscle tone and improve flexibility.

3. Change Positions Slowly: Avoid sudden movements that can strain the ligaments. When transitioning between positions, do so gradually.

4. Supportive Clothing: Wear supportive maternity belts or garments that provide gentle compression and support to the abdomen.

5. Warm Compresses: Applying a warm compress to the affected area can help relax the muscles and alleviate pain.

Round ligament pain is a common discomfort experienced during pregnancy, caused by the stretching and pulling of the round ligaments supporting the growing uterus. By understanding the causes, recognizing the symptoms, and adopting appropriate strategies for relief, expectant mothers can manage this discomfort and continue to embrace the joy of their pregnancy journey with greater ease

Our practice website can be found at:

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Induction of labor has been a topic of debate and study in the field of obstetrics for many years. One of the key discussions surrounding this practice is its potential impact on the rate of cesarean delivery. In this blog post, we will explore the findings of the landmark ARRIVE Trial and discuss why induction of labor can reduce the chance of cesarean delivery.

The ARRIVE Trial, published in the New England Journal of Medicine in 2018, was a randomized control trial involving over 6,100 patients, 41 hospitals, and a duration of 40 months. It focused on comparing induction of labor at 39 weeks gestation with expectant management among low-risk nulliparous women. The study found no difference in the primary outcome of perinatal morbidity or mortality between the induction and expectant management groups. However, what caught the attention of many was the significantly lower cesarean rate in the induction group.

The trial's results were groundbreaking, as they challenged previous studies that suggested induction of labor increased the risk of cesarean delivery. The relative risk of cesarean delivery was reduced from 22.2% to 18.6% in the induction group, which was statistically significant. This finding aligned with the philosophy and practice of individualized induction of labor recommended by many obstetricians.

It is important to note that the ARRIVE Trial did not address the individualization of induction. Each patient's case should be evaluated based on factors such as estimated fetal weight by ultrasound, maternal height/pelvis, and the readiness of the cervix (Bishop score). The patient's comfort and preferences regarding induction should also be taken into account.

To understand why the results of the ARRIVE Trial differed from earlier studies, we need to examine the flaws in those studies. Early studies comparing induction of labor to spontaneous labor used an incorrect control group for comparison. They compared women who underwent induction at a specific gestational age to women who went into spontaneous labor at the same gestation age. However, the alternative to induction is not spontaneous labor but conservative management. This flaw in the study design led to inaccurate conclusions.

Moreover, early studies were observational and lacked the rigorous design of randomized controlled trials (RCTs). RCTs are considered the gold standard in clinical trials as they involve random assignment of patients to different groups and prospectively study outcomes. RCTs eliminate bias in patient selection and provide more reliable results.

Let's dive into the advantages of labor induction and how it mitigates the likelihood of cesarean delivery. By initiating labor at 39 weeks in an uncomplicated pregnancy, we facilitate prompt intervention when unexpected complications may arise. This proactive approach prevents excessive fetal growth, which can lead to labor difficulties and potential obstruction. Moreover, induction minimizes the potential risks associated with aging placenta, thus safeguarding the baby's well-being throughout the labor process

While induction of labor can be beneficial in reducing the risk of cesarean delivery, it should be used judiciously and with thorough patient consultation. Protocols often require continuous monitoring and the use of medications like pitocin, limiting the freedom of movement during labor. The intensity of labor may also increase, potentially leading to the need for an epidural. Therefore, patients with a preference for natural labor may approach induction more cautiously.

The ARRIVE Trial and subsequent research have shed light on the benefits of induction of labor in reducing the chance of cesarean delivery. However, individualization is key when considering this intervention, taking into account various factors that can influence the success and safety of the induction process. Shared decision-making between healthcare providers and patients remains crucial to ensure the best outcomes for both mothers and babies

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What happens in a digital cervical exam done in pregnancy? What is the purpose and what to expect are all reviewed in this podcast. Dilation, effacement, station, position, consistency and all the components of the bishop score are reviewed.

During pregnancy, healthcare providers employ various assessments to gauge the progress of labor and determine the most appropriate course of action. One crucial evaluation is the cervical exam, which involves assessing the cervix for signs of readiness for childbirth. In this blog post, we will delve into the details of a cervical exam, its significance in labor management, and the role of the Bishop score in assessing cervical readiness.

The Cervical Exam: A Key Tool in Labor Assessment: A cervical exam is a medical procedure performed by healthcare providers to evaluate the cervix's condition in preparation for childbirth. It involves manually examining the cervix to assess its dilation, effacement (thinning), consistency, and position within the birth canal. By closely monitoring these parameters, healthcare providers can determine the progress of labor and make informed decisions regarding interventions or the need for further assessment.

Some charts are included for reference:

The Bishop score is a standardized system developed by Dr. Edward Bishop in the 1960s to assess the readiness of the cervix for labor induction. This scoring system evaluates five key components: cervical dilation, effacement, consistency, position, and the station of the baby's head in the birth canal. Each component is assigned a score ranging from 0 to 3, with a higher score indicating favorable conditions for a successful induction.

Understanding the Bishop Score Components

1. Cervical Dilation: This component measures the opening of the cervix in centimeters. A score of 0 indicates no dilation, while a score of 3 signifies full dilation (10 cm).

2. Cervical Effacement: Effacement refers to the thinning of the cervix. A score of 0 indicates no effacement, while a score of 3 indicates complete effacement (100%).

3. Cervical Consistency: The consistency of the cervix is assessed to determine its readiness for labor. A score of 0 suggests a firm cervix, while a score of 3 indicates a soft and ripe cervix.

4. Cervical Position: The position of the cervix is evaluated in terms of its anterior, posterior, or midposition within the birth canal.

5. Station of the Baby's Head: This component assesses the baby's descent into the birth canal. A score of -3 indicates the highest position, while a score of +3 suggests the lowest position just before delivery.

A higher Bishop score (8 or above) indicates a favorable cervix for induction, suggesting a higher likelihood of a successful induction and vaginal delivery. Conversely, a lower Bishop score may indicate the need for further cervical ripening or alternative approaches to labor management. Healthcare providers use the Bishop score as a valuable tool in decision-making, guiding the timing and method of labor induction.

The cervical exam and Bishop score play a critical role in assessing the readiness of the cervix for labor induction. By evaluating specific cervical parameters, healthcare providers gain valuable insights to guide informed decisions and optimize the management of labor and delivery.

Our practice website can be found at:

Maternal Resources: https://www.maternalresources.org/

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