First Trimester Of Pregnancy – Needed Tests

The thought that you will become a mother brings you happiness, emotions, but also the need to find some answers. It is important for the mother to come into contact with the family doctor or obstetrician as soon as possible after hearing the news that she is pregnant or has a suspicion that she might be pregnant. Then, what is called the “first prenatal” checkup will be performed which is of great importance as it helps the doctor after a detailed medical history and further investigations to establish if the pregnancy presents any risks.

Although pregnancy and childbirth are physiological, they are an “adventure of nature”. According to the most current medical guidelines, in practice there are some investigations that should be performed according to gestational age throughout pregnancy, which helps early detection and treatment of possible disorders, which left untreated can harm both the mother and baby.

Pregnancy test

First trimester (1-14 weeks of pregnancy) is very important for both mother and embrio in terms of physical and mental health, and includes the first prenatal checkup mentioned above.

Once the pregnancy was confirmed (physical, biochemical, ultrasound), during the first consultation  a complete medical history of the patient will be carried out by  the specialist, by which be physiological and pathological aspects will be highlighted, the biological background on which the pregnancy is installed and the risk factors will be determined. A general and obstetric clinical examination and some laboratory and laboratory explorations will be performed also.

The First Tests Will Include

• Hemoleucogram
• Blood type + Rh for both partners
• Blood glucose level
• Transaminases – assess liver function
• Uric acid, urea, creatinine – assess renal function
• Coagulation
• Serology for syphilis (RBW, VDRL, TPHA) – test is repeated preferably between 28-32 weeks of pregnancy
• Tests to detect HIV-AIDS infection, HBsAg and AgVHC (for Hepatitis B And Hepatitis C virus)
• Urinalysis – if any changes are present urocultures with antibiotics sensibility testing is recommended
• Examination of vaginal discharge (bacterial, fungal, parasitological)
• Babes-Papanicolau cytology (Pap smear)
• Ultrasound – after this first ultrasound that confirmed the existence of intrauterine pregnancy, another is performed at 12 weeks of pregnancy, an ultrasound test that correlates with the double HCG and Estriol test and, which together calculate the risk for Down syndrome (trisomy 21) .

Pregnancy test

In addition (in case of a history of miscarriage, premature birth, fetal death in utero, birth defects)  a series of medical tests that detect the presence of active infections: rubella, cytomegalovirus, toxoplasma, herpes virus, chlamydia, ureaplasma, mycoplasma will be performed.

For neural tube malformations prevention (spina bifida, anencephaly) folic acid 5 mg mom (1-2 pills/day) within 14 weeks of pregnancy. Moreover, if any of the above investigations indicate a particular problem, treatment will be specialized in maternal and fetal interests.

After the first consultation during pregnancy, the pregnant women will return to the doctor every month, the first two trimesters of pregnancy, and bimonthly in the last quarter. At each visit, a particular higher importance is attributed to weighing and measuring the pregnant woman blood pressure and measurement of uterine bottom and abdominal circumference .

Ways To Improve Immune System Function

Maintaining optimal function of the immune system is one of the best things anyone can do to improve his health status. Many people do not contribute to stimulating the immune system and expect that this vital function to act at its highest level of performance without taking any action. There are ten effective and natural ways that any person can be able to improve and keep the immune system keep healthy.

How To Boost The Immune System

Healthy food – Each person is virtually what he eats and there are several foods that can boost the immune system, encourage healthy growth and cell repair.

Physical activity – Exercise allows cells to grow and function normally and even supports the formation of cells that fight infection, along with maintaining a healthy weight.

Enough rest – enough sleep helps reduce stress, inflammation and gives your body enough time to make necessary repairs due to damage caused by various influences of everyday life.

Relaxation – Stress is an enemy of the immune system. It has a direct effect on most things that contribute to maintaining a healthy life and learning some relaxation techniques may be useful for maintaining every day general health.

Immune System Boost

Vitamin supplements – sometimes it can be difficult to obtain all the necessary vitamins from your diet alone, so a daily multivitamin supplement for the immune system can be a good choice.

Fight against free radicals – Free radicals are the body’s pollutants that can damage cells, causing trouble for the immune system . By eating foods that contain antioxidants, cells that fight infections and which are designed to keep the body healthy are produced.

Laughter – Studies have shown that endorphins are released during laughter, stress is reduced and the number of white blood cells that support the immune system are increased.

Optimism – A healthy mind is the basis of a healthy body and general health status state should increase the level of optimism of an individual

Lifestyle changes – Smoking, alcohol, improper diet and a sedentary lifestyle can adversely affect the immune system.

Medical help – When all the above methods fail, see your doctor to find out other ways that could improve your immune system function and lead a healthier life.  

Immune System

Eating healthy is an ideal way by which you will provide the nutrients the body needs, immune system supplements are also a good alternative.

Vitamin C – one of the most important immune system stimulants. It is found naturally in fruits and vegetables, but can be purchased in supplement form also. Vitamin C helps white blood cells multiply, which prevents different infections and also helps in lowering the blood pressure values.

Vitamin E – is essential for the immune system to produces cells that fight naturally against cancer cells.  With the help of supplements containing vitamin E you can slow the aging process and reduce cardiovascular disease risks.

Zinc – zinc supplements are recommended especially for the elderly as the immune system weakens as the body ages. Zinc is known to increase the production of white blood cells that fight infection.

Vitiligo

Vitiligo is defined as a chronic skin disease characterized by the appearance of white spots with precise contour on different body parts. These depigmented spots are caused by a destruction of melanocytes (the cells that are responsible for skin pigmentation). Depigmentation may be more or less important, and affected areas have variable sizes. The origin of disease yet unknown, but it is considered an autoimmune disease in which antibodies produced by the body attack and destroy its own melanocytes. Vitiligo first appears in the form of small depigmented spots that extend and grow in size over time. These changes in skin appearance usually leads stress and anxiety. The areas of ??skin affected by vitiligo have a high sensitivity to sunlight and it is therefore advisable to stay away from direct sunlight, as lack of pigment makes defenseless against solar radiation. As a result of sun exposure burns with hyperpigmented spots around may appear.

Hand Vitiligo

Vitiligo affects about 1% – 3% of the population and generally occurs before the age of 20  (about half of those affected) but vitiligo can affect children of any race or ethnic group. The skin on the back of the hands, face and armpits is more commonly affected. Vitiligo may occur in both sexes, from late childhood (9 to 12 years) to middle-aged adults.

Vitiligo Causes

The cause of this disease is unknown. It can accompany Addison’s disease (a rare endocrine disease, which consists of a hormone deficiency, characterized by weight loss, muscle weakness, low blood pressure and skin darkening whether or not it was exposed to sunlight), diabetes, pernicious anemia (vitamin B12 deficiency) and thyroid dysfunction.

Vitiligo cause theories are diverse. One theory states that vitiligo is a disease of the entire body caused by many factors, mainly by disorders arising in tissue nutrition and metabolism. White spots on the skin is only a warning, an external signal that announces a a more severe disturbance. In some people, it seems that an event (sunburn, a strong emotional shock or stress) led to the onset of vitiligo. On the other hand, there is no proof  that one of these factors are causes of vitiligo. Generally, vitiligo is often present along with another disease like those described above.

Vitiligo Symptoms

The main sign of disease is the appearance of white patches on the skin with well-defined shape. Although any region of the body can be affected by vitiligo, depigmentation occurs in particular:

• On the genitals
• In the armpits
• On sun-exposed areas: hands, feet, face and lips
• The areas subject to friction (knee)

Vitiligo seems to be more frequent in females but not statisticaly important. Vitiligo can occur anytime from birth to senescence although onset is generally observed between 10-30 years. Vitiligo rarely occurs in children or elderly persons and almost all cases of vitiligo are observed during early adolescence. Average age of onset is somewhere around 19 years. The most common form of vitiligo includes depigmentated macules or patches surrounded by healthy skin. Macules are milky white and well-defined. Lesions are not so obvious in white people, however they can highlighted after a Wood lamp examination.

Vitiligo patches look like hypopigmented or white macules, well demarcated, round, oval or may have a linear form. The edges may be convex, lesions increase centrifugal in time and range from mm to cm in diameter. Initial lesions occur more frequently on hands, feet and face, around the mouth and eyes

Vitiligo

Lesions may be localized or generalized but the generalized form is more common. Localized vitiligo is limited to an area while generalized vitiligo is involving more than one area. In this situation macules can be found on both sides of the trunk, symmetrical or asymmetrical. Areas most affected are the patient’s face, scalp and neck. Many  vitiligo developing areas are zones of repeated trauma. Mucosal involvement is frequent in generalized vitiligo. Scalp skin vitiligo consists of localized spots of white or gray hair, but total depigmentation of the scalp can occur (leucotrichia). Scalp involvement is commonly followed by the eyebrows, pubic hair and underarm hair depigmentation. Leucotrichia indicates a bad prognosis for repigmentation as spontaneous repigmentation of depigmented hair does not occur

Urinary Tract Infection

Urgent need to go to the bathroom, burning during urination, are just two of the very unpleasant symptoms of urinary tract infection (UTI). According to records, women will have at least one urinary tract infection during life and at least 1 from 5 women with a urinary tract infection has another infection. Recurrent infection is found in relatively few cases. The main symptoms of urinary tract infection are frequent urination in small amounts, dark or reddish urine, if blood is also present in urine and pressure or pain in the pelvis, lower abdomen or back, fever, nausea and/or vomiting.

Normally, urine is sterile, usually does not include bacteria, viruses or fungi, but is composed of fluids, salt and toxins. Urinary tract infection occurs when bacteria reaches the urethra from the digestive tract. Women suffer from urinary tract infections more often than man because their urethra is shorter and the bacteria can ascend more easily.

Urinary Tract Infection

In many cases, urinary infection is caused by a bacterium known as E. coli. This bacterium lives in the digestive tract, but can cause urinary tract infections it reaches urinary tract. If the infection is present only in the ureter, the condition is called urethritis and if bacteria reaches the bladder and multiples forward it is called cystitis. If the treatment is not administered properly, the bacteria can reach the kidneys, causing pyelonephritis. Urinary tract infection can be caused by other microorganisms, including chlamydia and mycoplasma. Unlike E. coli, chlamydia and mycroplasma are considered sexually transmitted, requiring treatment for both sexual partners.

Prevent UTI

Eliminate bacteria. Drink enough fluids, 6 to 8 glasses of water are sufficient, reduce drinking coffee and alcohol (can irritate the bladder). Pay attention to your natural needs and go to the bathroom at the first signs, postponing the moment may provide the bacteria the chance to grow. Also, urinate after each sexual act to eliminate any bacteria that may have entered the urethra.

Intimate hygiene. After using the toilet, wipe from the intimate area to the anal area to avoid attracting bacteria to the urethra. This rule is especially important after defecation. As children are also at risk of developing an urinary tract infection, their education is important in terms of intimate hygiene because in children, constipation is considered to be directly related to the development of urinary tract infections, which is why you should be alert for any of your child symptoms.

Create an unfriendly environment for bacteria. Blueberries are considered fighters against urinary tract infection and E. coli bacteria. Introduce blueberries into your daily menu in the form of juice or supplements, but not before consulting your doctor regarding kidney health and medical history of kidney stones or low hemoglobin concentration, situations in which blueberries can be contraindicated.

Protect the urethra. Urethral irritation may increase the risk of infection. Irritation may be caused by oil or bubble bath, perfumes and different intimate care products or poor intimate zine hygiene. Some doctors recommend replacing the internal buffer with sterile dressings, swabs giving bacteria the opportunity to enter the body and irritate the urethra.

Maintain a balanced flora. A woman’s vagina contains a series of natural protective bacteria that fight against infection by maintaining an ideal vaginal pH. In situations in which vaginal flora is disrupted, the vagina is exposed to harmful bacteria that increase the risk of urinary tract infection. Intimate hygiene products, shower gels, sprays and powders can create imbalances of the normal vafinal flora. On the other hand, consumption of probiotic bacteria – found in fermented milk-based products helps reduce the risk of urinary tract infection.

Do not neglect intercourse and contraception. Sexual intercourse can lead to irritation of the urethra and can be one of the reasons why women are more likely to develop an urinary tract infection. After each intercourse, urination is recommended – to clean the urethra and eliminate bacteria that may be introduced into the body after sexual contact. The contraceptive choice may also increase the risk of orinary tract infection.

• Diaphragms may compress the urethra, making it hard to drain the bladder. Urine that persists long periods of time in the bladder can lead to a growing number of bacteria.
• Use of spermicides can increase the access of bacteria by disrupting the natural vaginal flora.

Pay attention to clothing. Casual clothes and natural fibers inhibit bacterial growth, on the other hand, tight jeans (slim) creates an environment for their development.

Atherosclerosis

The term atherosclerosis comes from Greek words Atheros (“mush”) and Skleros (“hard”). This term is used to describe the formation of fat and cholesterol deposits on the artery walls. The process of atherosclerosis or narrowing of arteries can occur in any artery in the body. When this process occurs in the arteries that supply the heart with blood, we talk about coronary artery disease the main cause of bouts of ischemia. The same process is carried out in cerebral arteries – cerebral atherosclerosis, condition which can lead to strokes.

Large cholesterol condensation in blood vessels that carry blood to the legs, can cause painful cramps in legs and feet (so-called intermittent claudication) even after short walks. Regardless of the arteries, atherosclerosis is caused by the same factors.

Atherosclerosis Causes

The main cause of atherosclerosis is the tendency to produce excess hormones during feeding – a tendency that increases with age. If high levels of insulin in the blood is maintained for a long time, a series of unpleasant processes occur: excess fluid retention, high blood pressure, accumulation of fat and increased diabetes risk.

In addition, there are other disorders that are associated with atherosclerosis: for example, high levels of insulin stimulate the liver to produce large quantities of cholesterol and triglycerides, the main “fats” contained in the blood. Increased insulin levels forces the body to produce small amounts of HDL cholesterol (“good” cholesterol) and large amounts of LDL-cholesterol, which increases the risk of heart disease.

Moreover, high levels of insulin contribute to changes in the structure of cholesterol molecule, which accelerates depositing on artery walls and cause atherosclerosis. If you add other factors that contribute to the development of atherosclerosis, such as smoking, you may have all chances to suffer from it.

Atherosclerosis Diet

Choosing a proper diet plays an important role in reducing atherosclerosis risk. If you follow a diet that provides the necessary amount of lean protein, contains more dietary fiber (cellular tissue), is rich in vegetables with minimum starch, balanced amounts of animal fats and vegetables, you will be able to stop the narrowing of the arteries

• Varying the kinds of protein consumed, especially using poultry meat on the menu and regularly adding seafood and freshwater fish, dairy fat, pork and lean beef and egg whites you will ensure 30% of your normal daily calorie need . Then eat enough vegetables: green, yellow and dark green leaves, rice and oats, to get 40% of daily calories.
• Limit consumption of wheat, maize and potatoes, although not necessary to exclude them completely from the diet, as starch, like sugar stimulates insulin production. Last  30% of daily calories can be obtained from animal and vegetable fats. Be sure to consume vegetable oils produced by cold pressing methods and make sure the amount of animal fat is not too large (about 10% of normal daily calories).

Do not use for dough preparation hidrogenizate vegetable oils such as margarine or solid vegetable fats, as they contribute effectively to the development of atherosclerosis. And do not fry anything! Even the highest quality fats, originally harmless to health, change their chemical structure when they are subject to very high temperatures.

Food rich in cellular tissues lower cholesterol levels, since the fibers have the ability to immobilize cholesterol in the intestine and thus may reduce its absorption. Following a certain diet, composed by the principles listed above you will now be on the right track, providing the body an increasing amount of dietary fiber.

The body uses essential fatty acids as raw material to produces an entire family of chemicals called eicosanoids. Like other families of chemicals, some eicosanoids can be considered “good” and others “bad.” Good eicosanoid, among other useful features, tend to reduce the risk of cardiovascular disorders (heart disease and narrowing of arteries) and high blood pressure. You can start with a diet based on the recommendations proposed above, to prepare the body for the next treatment:  linoleic acid and fish oil in the ratio 1:4, 1-3 times per day.

Diets high in refined sugar and starch contribute to the development of atherosclerosis, increasing the amount of insulin levels. Exclude or reduce drastically refined starch consumption: wheat and corn flour, all kinds of sugar and all foods containing these substances.

Excessive consumption of alcohol may increase the risk of atherosclerosis. You should limit your daily consumption of alcohol at a level no more than one glass of wine.

Useful Supplements

Folic acid deficiency may increase the risk of developing atherosclerosis, as the body needs this vitamin to create an amino acid called homocysteine (contained by protein molecules that contributes to narrowing of the arteries), into another amino acid, methionine, it does not have this feature.

Insufficient vitamin B6 (pyridoxine) may also influence the development of atherosclerosis so as group B vitamins and folic acid. Vitamin B6 converts homocysteine into another amino acid, also harmless, called cistationine. In the absence of vitamin B6, homocysteine sticks to artery walls, which increases the probability cholesterol deposition.

B12 deficiency also has the effect of homocysteine on artery walls, for the same reason, common to all vitamins of group B. Vitamin B12 transforms homocysteine into harmless cistationine.

Vitamin C deficiency leads to the formation of “patches” on the walls of damaged arteries These “patches” can become centers of accumulation of cholesterol that will reduce the diameter of the artery.

Daily administration of vitamin E may reduce risk of heart disease (in all likelihood, including atherosclerosis).

Calcium deficiency may contribute to atherosclerosis process due to several reasons: it can contribute to higher levels of cholesterol and triglycerides, as well as predisposition for submission of platelets (special blood cells that gather on the damaged artery wall to stop blood flow by thrombus formation)

Normal amount of calcium intake can prevent such problems, but do not exaggerate. Too much calcium can have the reverse effect. Daily calcium intake should be approximately 1500 mg (contained in food or special preparations). Calcium and magnesium act as a couple and are often prescribed combined.

Chromium deficiency may contribute to the development of atherosclerosis and its administration can normalize cholesterol levels, as it can increase the amount of “good” cholesterol – HDL and reduce the amount of “bad” cholesterol – LDL.

Insufficient magnesium increases the risk of atherosclerosis, heart attacks and heart rhythm disorders. Magnesium supplements can prevent calcification (narrowing) of blood vessels throughout the body. Magnesium aspartate is administered in daily doses of 200-500 mg.

Selenium is needed for synthesis of glutation peroxidaze, an enzyme that releases free radicals, selenium deficiency may increase the risk of tissue damage by free radicals. Oxidation of LDL cholesterol cells (destruction by free radicals) may also contribute to their introduction in blood vessels walls.

Daily administration of beta-carotene reduces the risk of heart disease. Increase consumption of foods containing beta-carotene, such as green vegetables and yellow vegetables and dark green leaves.

Some research has demonstrated the qualities of coenzyme Q10 in reducing the risk of atherosclerosis and the ability . If the diameter of calcified arteries narrows due to congestion of cholesterol, even a small thrombus can close the artery and stop the blood flow with devastating effects.

Ectopic Pregnancy

Ectopic pregnancy is defined as pregnancy that develops in other places than the uterine cavity. An ectopic pregnancy occurs in about  1-3% of pregnancies. Different types of ectopic pregnancy – in 96% of cases, the egg is implanted in one fallopian tube (tubal pregnancy). Other locations, more rare, are ovaries or the abdominal cavity.

Ectopic Pregnancy

Ectopic Pregnancy Risk Factors

Risk factors that explain the increased frequency of ectopic pregnancies are grouped into several categories:

• Increasing frequency of sexually transmitted diseases (STDs) is an important factor: a history of infection multiplys by 6 times the risk of ectopic pregnancy by suppressing the cilia which normally form the lining of the fallopian tube and facilitate the movement of the egg.
• IUD (intrauterine devices), although effective as contraceptives, IUDs  increase the risk of ectopic pregnancy by 6 times in relation to oral contraceptive methods. IUDs containing progesterone increase the risk  6 to 7 times. This risk, which increases after two years of use of IUDs is reversible when the IUD is removed. Instead, IUDs do not increase the frequency of ectopic pregnancies compared with a population of women who are not using contraception.
• Tobacco is a risk factor for ectopic pregnancy, the more a woman smokes, the greater the risk of ectopic pregnancy.
• Maternal age is a also problem: the risk is 2 times higher for women between 35 and 39 years and almost 4 times for age greater  than 40 years.
• Infertility surgery, even if it restores permeability of tubes, it leave scars and does not repair the pre-existing mucosal lesions.
• Medically assisted procreation, in vitro fertilization and intratubal gamete transfer (consisting of introduction of sperm and egg in a fallopian tube), increases the risk of ectopic pregnancy.
• Other factors that increase frequency of ectopic pregnancies are micro pills (low dose oral contraceptives)
• Ectopic pregnancy in history

Ectopic Pregnancy Symptoms And Signs

An ectopic pregnancy is manifested by abdominal pain and uterine bleeding occurring after a delay of the menstrual flow of 3 to 6 weeks, in general. In fact, the egg develops into a tissue that is not made to stretch. When the egg is grafted in the ampulla the pregnancy can continue longer, and embryo can continue its development in the abdomen.

Ectopic Pregnancy Diagnosis And Evolution

Early diagnosis of ectopic pregnancy is provided by two exams, often associated in hospitals:

• Dosage, in urine or plasma, of the specific hormone of pregnancy, chorionic gonadotrophic hormone (hCG), secreted by the  placenta, organs that feed the egg, indicating a generally lower level than expected for the gestational age.
• Ultrasound can identify an embryonic cardiac activity outside the uterus. Besides the direct signal, the examination can identify an empty uterus that does not correspond with the pregnancy date.

The danger lies in an ectopic pregnancy tube rupture, which can lead to internal bleeding more or less important and also the origin of irreversible lesions. However, this complication, which is a surgical emergency has become exceptional.

Ectopic Pregnancy Treatment And Prognosis

An ectopic pregnancy by spontaneous regression must be supervised due to the tube rupture risk. All other cases require radical surgery (tube ablation) or conservative surgery (keeping the tube), respectively. Opening the abdomen is indicated in case of a sudden internal bleeding that precedes the tube rupture or when the blood effusion formed clots and adhesions. Ovarian and abdominal pregnancies have an indication for opening the abdominal cavity. In other cases surgery performed under endoscopic control allows the doctor to intervene without large incisions. More recently, some surgical teams have treated  ectopic pregnancy using puncture under ultrasound surveillance, associated with local injection of an antimitotic drug, designed to destroy the ectopic cells.

When this diagnosis is established, the patient must be treated in a hospital in order to prevent a possible complications (tube rupture, in particular).

Thyroid Nodules Treatment

Thyroid nodules treatment depends on the negative effects of these nodules. If the thyroid nodule is benign and does not cause any heath problems, it will be closely monitored without using any treatment . If symptoms are present drugs or surgery may be necessary. Antithyroid drugs and radioactive iodine can treat nodules that cause hyperthyroidism.

Surgery is required only if the thyroid node is so great that it interferes with normal breathing or swallowing or if it the thyroid nodule is malignant. After surgical removal of a malignant nodule, administration of radioactive iodine to destroy any remaining tissue or cancer cells that create problems may be also necessary. If total thyroidectomy is needed (excision of the whole thyroid gland)  thyroid hormones will be given for life.

Thyroid Nodules Initial Treatment

1. Observation of a benign nodule which can be followed every 6 or 12 months for any change in shape (many thyroid nodes doe not change in size or diminish without any treatment)
2. Thyroid Biopsy: Your doctor may drain fluid with a needle from a cystic nodule, sometimes after drainage the thyroid nodule may disappear, but most thyroid nodules recover
3. Thyroidectomy, which is not always necessary, and is required if:

• Node appears or is cancerous
• Due to the size the thyroid node interferes with breathing or swallowing
• Cystic nodule recovers after drainage

4.  Hormone suppression therapy is used to shrink a nodule if:

• Thyroid nodule is benign
• Node appears or is cancerous, but the patient can not withstand surgery

5. Radioactive iodine can be used to destroy thyroid tissue if:

• The thyroid nodule is benign but is producing too much thyroid hormone, causing hyperthyroidism, and if this situation occurs during pregnancy, treatment with radioactive iodine is not indicated
• Multinodular goiter is present and surgery can not be performed due to other diseases, radioactive iodine will shrink nodules that interfere with breathing or swallowing, though they can recover after completing therapy.

Thyroid Nodules Maintenance Treatment

• Follow the prescribed hormone therapy at the same time every day, without omitting any dose
• Call your doctor if symptoms of hyperthyroidism, such as nervousness, tachycardia, sweating, and weight loss, are present (sometimes hyperthyroidism occurs after taking thyroid hormones or when a node produce excess thyroid hormones)
• Call your doctor if symptoms of hypothyroidism, such as fatigue, feeling cold, unmotivated and weight gain (hypothyroidism can occur after treatment with radioiodine or after surgery)
• Schedule regular checkups to a specialist as even benign nodules should be examined by the doctor.

Treatment if the condition gets worse

• Hormonal treatment is administered at the same time every day;
• Pursue any symptoms of hyperthyroidism, such as nervousness, tachycardia and palpitations, sweating and weight loss, a benign nodule can produce excess thyroid hormones causing hyperthyroidism, as well as hormonal medication
• Pursue hipotirodism symptoms as fatigue, sensitivity to cold and weight gain. The specialist will announce the appearance of these symptoms, radioactive iodine or surgery may be needed in this case.

If no the thyroid nodule does not change it can be kept under observation. Any change in size will require another biopsy may, hormone testing and even excision of the nodule (thyroidectomy). Partial or total removal of the thyroid gland will also require radioactive iodine to destroy any remaining tissue. Hormone suppression therapy to prevent recurrence and growth of other cancer cells.

Thyroid Nodules Drug Treatment

Most thyroid cancers grow slowly and disseminate slowly, so surgery can be delayed for a short period of time, if the thyroid node does not cause symptoms. If you choose to postpone surgery, the thyroid nodule should be evaluated regularly by an endocrinologist. Sometimes thyroid nodules are treated using hormone suppression therapy (levohyroxin) to stop the body from producing the hormone and prevent the thyroid gland from growing.

This therapy is recommended if

• Health does not allow surgery for a nodule that is suspected to be malignant
• Intervention was performed by excision of multiple thyroid nodules. Suppressive therapy is sometimes used to prevent recurrence of thyroid nodules.

Medication Choices

Thyroid Hormone suppression therapy is done with:

• Levothyroxine sodium
• Liothyronine sodium.

Mode of action of suppressive therapy on the benign nodules is not fully elucidated. Hormone suppression may increase the risk of heart or bone problems, especially if they existed prior to the thyroid pathology. If you heart disease is present this therapy may aggravate chest pain or heart rhythm disorders. It also increases the risk of stroke. If you have osteoporosis, hormone suppression therapy may worsen bone demineralization.

Hormone suppression therapy, even in small doses often causes hyperthyroidism, especially if there multiple thyroid nodules are present (multinodular goiter). Therefore regular visits to your doctor will be required for dose adjustment and hyperthyroidism prevention. If a lump is benign, but produce excess hormones that lead to hyperthyroidism, before radioactive iodine treatment, antithyroid medication is mandatory.

Thyroid Nodules Surgical Treatment

Surgical excision is recommended for cystic nodules that recur, especially those more than 4.1 centimeters in diameter. Hypothyroidism occurs in about 10%,  5 years after treatment with radioactive iodine. Thus thyroid hormone levels will be reviewed regularly post-therapy.

It is the best treatment option for thyroid nodules that are:

• Malignant (cancer)
• Suspected to be malignant
• Benign but large enough to interfere with breathing and swallowing

People who develop thyroid nodules after radioactive therapy of the head, neck or chest, most likely will require surgery because the risk of developing thyroid cancer is higher although most nodules in  irradiated people are benign.

See also:  “Thyroid Nodules Causes, Symptoms And Risk Factors”

Thyroid Nodules

Thyroid nodules are abnormal growths or lumps that occur in the thyroid gland. Most thyroid nodules are not cancerous (are benign) and usually do not create problems. Many do not require treatment. Only about 5% of nodules are cancerous. They must be excised after a surgrical procedure. In rarely cases thyroid nodules can cause thyroid problems. When a node is producing too much thyroid hormone (hyperthyroidism), the thyroid gland is overactive.

Thyroid Nodules Causes

The exact cause of thyroid nodules is yet unknown. It is known however that those exposed to radiation have higher risk of developing thyroid nodules. Exposure to environmental radiation or radiation therapy prior to the head, neck or chest (especially during childhood) increases risk of thyroid nodules. Scientists estimated that thyroid nodules are transmitted genetically. So if a parent had thyroid nodules, children have a higher risk of developing thyroid nodules. If another disorder og the thyroid gland is associated (goiter for example) the risk of thyroid nodules is higher.

Thyroid

Thyroid Nodules Symptoms

Most nodules are asymptomatic and go unnoticed. Thyroid nodules are often discovered during a routine examination or investigations such as computed tomography or ultrasound performed for other health problems. If your thyroid nodules are large enaugh they can be palpated or you can notice an increase in volume of the neck.

In rare cases you may feel:

• Pain or feeling of fullness in the neck
• Difficulty in swallowing
• Difficulty in breathing
• Nervousness, tachycardia, sweating, weight loss or other symptoms of hyperthyroidism (excess thyroid hormone)
• Fatigue or depression, memory problems, constipation, dry skin, feeling cold or other symptoms of thyroid hormones deficiency.

Other conditions that cause similar symptoms are hyperthyroidism and thyroiditis.

Most thyroid nodules are benign and are not causing any problems. Are often difficult to observe as thyroid nodules are usually very small. Many people have thyroid nodules that are not discovered or treated. There are three types of thyroid nodules: solid nodules, filled with fluid (cystic) and partially cystic nodules. Solitary or multiple thyroid nodules may be present (multinodular goiter). Also, solid and cystic nodules can coexist. Solid nodules often grow more slowly. Rarely cystic nodules can bleed, which may lead to a sudden increase in volume and causes pain. Thyroid nodules usually do not interfere with the function of the gland.

Thiroid Nodules

However, sometimes a benign nodule can cause:

• Hyperthyroidism, when one or more nodules produce thyroid hormones, hyperthyroidism is treated with antithyroid medication, possibly radioactive iodine and rarely surgery, hyperthyroidism caused by thyroid nodules is rare (occurs in less than 1 in 100 people with thyroid nodules)
• Difficulty breathing or swallowing, when one or more nodules press on the tracheea sau esophagus, these nodules need surgical excision. Only about 5% of nodules are malignant. Thyroid cancer is usually discovered and treated early, so most people evolve favorably.

Thyroid Nodules Risk Factors

Possible risk factors:

• Age, thyroid nodules are more common in older people
• Female sex
• Exposure to radiation: environmental radiation or previous radiotherapy to the neck, head or chest (especially during childhood) increases the risk of thyroid nodules
• Iodine deficiency, which can lead to goiter with or without nodules
• Hashimoto thyroiditis, that causes underactive thyroid (hypothyroidism);
• One or both parents with thyroid nodules.

Thyroid nodules are more likely to be malignant if:

• The patient was exposed to radiation, although rare, thyroid cancer can occur after 20 years of radiation or exposure to environmental radiation.
• Family members with cancer of the endocrine glands, including thyroid.
• Thyroid nodules that occur in people under 20 or over 60 years.
• Male sex.
• Thyroid Nodules increase rapidly (weeks or months), however just because a thyroid nodule grew in volume it does not mean it is necessarily malignant.
• Thyroid nodules that occur during pregnancy.
• Graves Basedow disease is present.
• Hashimoto’s thyroiditis in history.

You should see a specialist if you notice any of the following thyroid nodules symptoms:

• Any swelling in the neck that does not disappear in two weeks;
• Hoarseness in the absence of cold or throat infection that persists more than one month
• Difficulty in swallowing;
• Symptoms of thyroid dysfunction (fatigue, weakness or sudden weight loss).

In the case of surgical extirpation of a portion of the thyroid gland due to a benign node, regular medical checks for evidence of possible changes will be needed.

Also see: Thyroid Nodules Diagnosis

Premature Labor

Triggered premature labor can be difficult to recognize. The patient should contact the emergency doctor if signs portend a possible premature labor. In any period of pregnancy the specialist advice is required if there is any increase in vaginal discharge quantity, there is a sudden and large fluid loss (fluid loss can be confused with bladder incontinence or excess cervical mucus), vaginal bleeding or spotting (small blood spots on underwear), dysuria occurs (difficulty in urination), pollakiuria (frequent urination), cloudy urine, or foul-smelling urine.

Premature Labor

Between 20 and 37 weeks of pregnancy, see your gynecologist if you have:

• Regular contractions (with or without pain), 4 in 20 minutes or 8 per hour, which last longer than 2 hours and which do not resolve after changing position or after ingestion of liquids
• Back pain or pelvic pressure, apparently without explanation
• Intestinal cramps with or without diarrhea
• Uterus sensitivity, unexplained fever (febrile syndrome of unknown etiology), weakness (possible symptoms of infection), the baby stops moving or moves less than usual.

Premature Labor Diagnosis

Mother Investigations

Sensitivity of the pregnant uterus will be investigated. The pulse, temperature, respiratory rate will also be checked. Depending on your symptoms, one or more of the following tests will be performed:

• Vaginal examination to check if the cervix is opened (dilated)
• Vaginal sample from secretions for evidence of vaginal infections, as they can lead to infections of the uterus and can cause premature labor or severe infections in the newborn (pregnant women with bacterial vaginosis have a double risk of giving birth prematurely, compared with those without this condition)
• Highlighting the amniotic fluid, amniotic sac has ruptured
• Fetal fibronectin whose absence indicates that the labor has not started, this test is not specific only for premature labor, but for all births.
• Other tests to detect a possible infection: full blood count, using a blood sample, urinary cultures using a urine sample. If an infection is detected the pregnant women will receive antibiotics.

Fetus Investigations

Fetal heart rate monitor is an electronic device which will record uterine contractions and shows the reaction of the fetus. Fetal ultrasound is used to:

• To check the uterus for multiple fetuses
• Estimation of gestational age, fetal weight and position
• Position and degree of maturation of the placenta
• Length of the cervix: a short cervix is a sign for labor onset
• Amniocentesis consists of taking a sample of amniotic fluid, this investigation is useful for: signs of infection, detection of substances that indicate the baby’s ability to breathe without assistance, in case of premature births.

All this information helps your doctor and midwife to decide whether to intervene and delay delivery or not.

Premature Labor Treatment

The treatment for premature labor is started if:

• Gestational age, pregnancy is between 23 and 34 weeks
• Uterine contractions lasting more than 45 seconds and occurring at intervals of 2 to 10 minutes
• Cervix is opened (dilated) more than 2 cm.

Triggered premature labor does not always require treatment. If the pregnancy is near term (more than 37 weeks) or when the mother and fetus are in pain, doctors will let the pregnant woman give birth. To decide whether or not to intervene, the doctor will take into account the following:

• Age and fetal weight: ideally triggered premature labor will be delayed until the fetus becomes mature enough so risk of complications is low after birth (over 34 weeks gestation)
• The health status of the pregnant woman : severe hypertension and preeclampsia, HELLP syndrome, chronic diseases, infection or bleeding.
• Health of the fetus: development of signs of fetal distress require immediate delivery
• Spontaneous premature rupture of membranes
• Labor stage and rate of progression: for example, when the cervix is well dilated over 4 cm, tocolytic medication, used to delay labor is no longer effective
• Distance to a hospital equipped with intensive care unit for newborns, labor delaying can be done during transport to the nearest hospital
• Tocolytic medication-administration, used to delay childbirth can be dangerous for mother and fetus.

Treatment of premature labor

Premature labor requires hospitalization. Whether membranes were ruptured before or after the beginning of contractions, pregnant women will be led to the delivery room. If the amniotic sac has not been broken yet, the patient will be placed under observation for another hour or two, for the doctor to see if your cervix is dilated and the contractions continue:

• If the cervix does not change and the contractions cease the pregnant women can be discharged
• If the cervix changes, pregnant women will be led in the delivery room.

If pregnant is headed to the delivery room, the doctor may take one of the following decisions:

1. To use medication to stop or slow contractions and to prevent deletion and cervix dilation, short-term use of tocolytic drugs is the most common form of therapy, if proven effective when delivery can be delayed for more than 48 hours
2. To treat or prevent infections by administering antibiotics
3. Help mature the fetal lungs quickly using antenatal corticosteroids (administered to the mother), these drugs must be administered 24 to 48 hours before birth to be effective.

Keep in mind!

Dehydration is a common cause of contractions. At the first sign of contractions, the pregnant woman is advised to drink fluids. If this was the reason the contractions will stop. Tocolytic medications can delay the birth 1 or 2 days, offering other drugs (corticosteroids) the chance to help fetal lungs mature faster. However, there is no evidence that proves that tocolytic medication prolongs pregnancy and improves fetal survival when administered over a longer period of time. They may also have notable side effects on both mother and fetus.

Ineffective treatments for premature labor

• Bed rest: strict rest in bed for 3 days or more increases the risk of thrombosis (blood clots in vessels) located in the legs and lungs. There is no evidence that prolonged bed rest can prevent premature birth
• Cervical cerclage is surgical closure of incompetent cervix (a rare cause of premature birth). While some researchers suggest that cerclage reduces the likelihood of premature birth before 33 weeks in women at risk, others believe that it has no effect; A recent study showed that cerclage used to close a shortened cervix is ineffective in preventing premature labor and birth, also it increases the risk of infection and spontaneous abortion.
• Fetal-monitoring at home: research has shown that fetal monitoring at home is expensive and ineffective in delaying the onset of premature birth.

Premature Labor

A normal pregnancy lasts 37 to 42 weeks, calculated from the first day of the last menstrual cycle. Premature birth is defined as labor starting before 37 weeks, but after 20 weeks of gestation. Most premature births are triggered spontaneously. However, 1 of 4 premature births are induced by the physician, due to complications caused by pregnancy, such as preeclampsia or placental abruption or  abruptio placentae (premature detachment of the placenta). These are absolute indications for labor onset. Triggered birth before 20 weeks of gestation, is called miscarriage.

Premature Labor Causes

Premature birth can be caused by  fetus, mother or both mother and fetus problems. Most of the times  premature labor is determined by a combination of several factors and in about 25-30% of cases no specific cause can be identified.

The causes of premature labour include:

• A history of multiple births is the cause of approximately 30% of premature labors:
• Twin pregnancies are generally at high risk for complications, both maternal and fetal – usually born after a premature labor
• Infections can trigger premature labor or premature rupture of membranes
• Placental abruption, premature separation of placenta from uterus
• Drugs, like cocaine or methamphetamine
• Uterus or cervix problems such as a short cervix, uterine fibroids or an abnormally shaped uterus.
• Some pregnancy complications endanger the mother and fetus, so it is necessary to trigger premature labor. These are indications for induction of premature birth and represent 15% to 20% of all preterm births. Whenever possible, in these cases, drugs will be used to trigger the natural birth. However, there are situations where natural childbirth is contraindicated, so Caesarean section remains the only option.

Premature Labor Symptoms

Premature labor is most common triggered without obvious symptoms. However, one or more of the following premature labor symptoms:

• Cramps like those during the menses, with or without diarrhea
• Feeling of pressure in the pelvis and lower abdomen
• Persistent pain in the back, pelvis, lower abdomen or thighs
• Changes in vaginal discharge, which may increase in volume or become pink or red
• Contractions are persistent, regular, 4 in 20 minutes or 8 per hour, these contractions may be painless, but make the abdomen firm to palpation.
• Fever
• Fatigue
• Uterus sensitivity

It is sometimes difficult to distinguish between Braxton – Hicks contractions and premature labor. These symptoms are not always equivalent with the onset of premature labor. However, if you notice any of these symptoms you should address your gynecologist.

Premature Labor Causes And Risk Factors

It is difficult to predict if a pregnant woman is at risk of premature birth. While in some women with risk factors for premature labor, pregnancy ends normally, others without premature labor risk factors give birth prematurely. In all pregnancy cases with premature labor (before 37 weeks and without membranes ruptured spontaneously), half will be born at term.

Labor and premature birth

In some cases, medical intervention is needed to induce birth as the mother and child are in danger. Premature birth is most likely triggered by a combination of risk factors. The most common causes and risk factors premature labor are listed below:

• Pregnancies with twins, triplets or more fetuses, (use of assisted reproductive techniques or superovulation increases the risk of multiple pregnancies and premature labor implicitly)
• History of premature labor
• Vaginal bleeding in the second trimester
• Urinary tract infections or sexually transmitted diseases
• Age under 18
• Low-weight or height of the mother
• Smoking during pregnancy
• Frequent contractions.

Other factors that increase the risk of premature labor are:

• Cocaine or methamphetamine
• Excess amniotic fluid (polyhydramnios)
• A significantly shortened cervix, viewed during ultrasonography exam.

Less common premature labor risk factors are:

• Unclosed cervix (incompetent cervix)
• History of two or more abortions on demand in history, the risk increases with each additional abortion
• New pregnancy –  3 months after birth
• Uterus disorders, such as an abnormally shaped uterus (the presence of twins can break  the uterus and the amniotic sac)
• Previous surgery on the cervix, cervical conization
• Exposure to DES (diethylstilbestrol – U.S. drug used in the ’40s until the ’70s to treat impending abortion)
• Insufficient weight gain during pregnancy
• Jobs physically or mentally exhausting , for example a job that requires standing for long periods of time (in factories, sales or nursing)
• Consumption of large amounts of licorice, more than 230 g of licorice per week may increase the risk for premature labor
• Severe emotional stress during pregnancy
• Unbalanced diet.

Triggering premature labor when needed

Approximately 1 in 4 births are induced early by doctors due to different complications. These are called pregnancies with indication for premature labor.

• Preeclampsia
• Fetal suffering
• Insufficient growth of the fetus, threatening its survival
• Placental abruption (premature separation of the placenta from the uterine wall).