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She was angry, frustrated and depressed. She had just failed her attempt at IVF. “Doc, I have been spending so much time and money trying to conceive. I always think that IVF should work for me as both my partner and I are healthy. In my IVF cycle, my doctor has retrieved 6 “good” eggs from my right ovary and had two of them fertilized after injecting my husband’s sperm into the eggs. The embryos were then transferred to my womb without a hitch," she recounted with tears in her eyes. “Can you tell me what went wrong?” D, a 36-year-old lady had been married for 4 years and had problems conceiving. Her reproductive system was normal but her husband’s semen analysis was slightly below par. IVF was her last resort as other methods of helping her conceive had failed. Though she had been counselled regarding the chances of success with IVF, she still felt grief and loss. There are many reasons why IVF fails. The common reasons are as follows: 1.The aging egg: As the woman ages, the quality of the egg deteriorates. This will affect the chances of pregnancy with IVF. The younger the patient, the higher the chances of success with IVF. For women aged 25, the success rate of IVF is around 30-35 %, but for those aged 40 and above, it is around 5%. Even if the egg retrieved appears normal under the microscope, the genetic material present may not be good. 2. The imperfect sperm: The DNA within the sperm may be defective even though the semen analysis is normal. Injecting a single sperm into the egg (ICSI) can increase the chance of fertilization but does not ensure that a normal sperm has been chosen. Fertilizing an egg with an abnormal sperm can result in an abnormal embryo. 3.The defective embryo: Embryo quality is an important contributing factor to IVF failure. Many defective embryos are unable to implant after transfer to the uterus. Embryos that look healthy in a lab may have genetic or chromosomal defects that prevent them from developing.  These abnormal embryos are often the reason behind miscarriages and implantation failure during IVF. Some research studies have suggested that defective embryos can account for 50 % of IVF failure. 4. Poor Implantation site: If the uterine lining is injured during a difficult embryo transfer or if the womb is congenitally malformed with a partition(septum), the embryo may not get implanted. Other implantation issues include the presence of polyps, multiple fibroids, thin lining of the womb and intrauterine adhesions from previous womb surgery. In addition to the above reasons, there are many other factors that can impact one’s chances for a successful pregnancy with IVF.  These include the response of the ovary to stimulation, lifestyle factors of the patient such as body weight and smoking, laboratory techniques and the skill of the specialists performing the egg retrieval and embryo transfer. After D listened to my explanation with regards to the intricacies and complexities of the IVF process, she finally came to terms with her grief. “Thanks doc. I will take some time to think through and decide what I will do next,” she said.

B had been having irregular vaginal bleeding for the past two months. She came from a neighbouring country and had a hormonal implant placed in her arm about 6 months ago. “Doc, I have been taking oral contraceptive pills on and off for a while,” she said, “but I tend to forget taking them regularly.  So, my gynecologist suggested that I have the hormonal implant instead. She told me that it is just as effective as the pill and compliance is 100 per cent guaranteed. I did not have any problems initially, but I started to experience spotting for a week to 10 days after the third month. My husband also noticed that I had become a bit temperamental with occasional mood swings. I would argue with him over small trivial matters. What upsets me now is the prolonged bleeding I have been having for the past few months.” B had the contraceptive implant called Implanon on the underside of her upper left arm. It is a soft flexible plastic rod about the size of a matchstick and contains a hormone, progestogen, which is slowly released into the body. The hormone prevents the ovaries from releasing the egg. It also thickens the secretion around the cervix, thus preventing the sperm from entering the uterus. It is more than 99% effective at preventing pregnancy and can last for up to three years. Implanon has to be inserted by a trained doctor. The skin of the upper arm is first numbed by the local anesthetic and a small incision made. A needle with the implant is then inserted under the skin. The needle is then withdrawn and the incision covered with a gauze without stitching. As in B’s case, the most common side effect is irregular menstrual periods or having no periods. This occurs most often during the first year after the implant has been inserted. Other side effects include: Headache Bloating Depression Mood changes Sore /tender breasts DizzinessAcn Changes in appetite Weight gain As B was adamant in removing the implant, I did it for her straightaway under local anesthesia. All the side effects were gone and her vaginal bleeding had stopped  after about a week. She felt happier on her subsequent review.

The thought of having intimacy after birth may make many mothers cringe in pain. This is because most mothers are tired, anxious and exhausted. They are also deprived of sleep from nursing the newborn baby. Many couples may resume sex  between one to six months postpartum. Most obstetricians would advise them to wait at least six weeks to allow tissues to heal. According to the American College of Obstetricians and Gynaecologists (ACOG), there is no set "waiting period" as long as the stitches of the wound have healed and the lochia has cleared. The most important thing is that the couple must be physically and emotionally ready. Some new mothers may experience pain during sex. According to a study, almost 9 out of 10 mothers who had sex by 12 months postpartum experienced pain during their first encounter. The highest numbers were seen in women who had sex three months post-delivery. Painful sex may be due to one or more of the following factors: · Vaginal dryness from low levels of female hormones due to breastfeeding · Lack of lubrication from anxiety, tiredness  and /or low sex drive · Tenderness in the wound that is healing · Vaginal infection · Thick scars in the perineum from tears during delivery There are few things that may help minimize the pain: · Communication: the couple should communicate well so that the husband can allay any anxiety the wife may have. His support and patience are important in making sexual intimacy a pleasurable experience. · Use lubrication.  This can help with vaginal dryness · Sexual positions: Experiment with a few until a pleasurable position is attained · Go slow. Take it easy, especially during the first few times. · Kegel exercises: The postpartum period is an important time to strengthen the pelvic floor muscles. Having the muscles tight may help in relieving the pain. · Pain relief: A pain killer can be taken prior to having sex. A warm bath beforehand can also help relax the body.

G had gone through menopause. She was alarmed and troubled when she saw blood dripping from the swelling at her vagina. The source? A bleeding ulcer at the apex of the lump. “For the first few years after menopause, I have noticed a swelling 'coming out' of my vagina whenever I strain during defecation or lifting heavy objects and it disappears after I lie down and rest.” She said. “As it is painless, I did not pay much attention to it. But the lump has become bigger with time and has not receded for the past 5 months. It has caused more and more discomfort whenever I walk. I feel as if something is stuck at my bottom.” After she saw the bleeding, she called her daughter straightaway who promptly brought her to see me. “Doc, I am scared. Could this be a sign of cancer?” She asked, looking worried. Examination revealed that G had half of her uterus prolapsed outside her vagina. The ulcer was a result of the friction between the uterus and her underwear. I reassured her that it was not cancer. However, to resolve her problem, I told her that her uterus had to be removed by surgery. G was suffering from a gynaecological condition called uterine prolapse which is quite common after menopause when the pelvic muscles and ligaments which support the uterus are weakened from the falling levels of the female hormones. As a result, the uterus slips down and protrudes out of the vagina. Women who have delivered many children or have given birth to big babies vaginally are more prone to this condition. Other risk factors include obesity, chronic constipation, repeated heavy lifting, previous pelvic surgery and a family history of weakness in connective tissue . Symptoms of uterine prolapse vary. There may be no symptoms when the condition is mild. In severe cases like G’s, a large and uncomfortable lump will protrude outside the vagina. There may be urinary leakage (incontinence) or an inability to empty the bladder or bowel completely. The sensation of heaviness or pulling in the pelvis may also be present and the patient may feel “looseness” in the vagina during sexual intimacy . In treating mild uterine prolapse, Kegel exercises to strengthen pelvic muscles usually suffice. But when the condition causes discomfort or disrupts normal activity, surgical removal of the uterus with repair of the weakened pelvic floor tissues is the treatment of choice. In patients who are not suitable for surgery, the use of a vaginal pessary, which is a plastic or rubber ring, can be inserted into the vagina to support the bulging tissues. G accepted my advice and had a successful operation . After the wound had healed, I told her to do Kegel exercises regularly and to control her weight. She was also advised to avoid constipation and heavy lifting.

He watched me anxiously at the foot of the bed while I set up an intravenous drip on the arm of his wife M, who was at her 8 weeks of gestation.  She had been experiencing nausea with occasional vomiting for the past two weeks, being worse in the mornings. The symptoms had gradually worsened and she had been vomiting after almost every meal for the past 2 days. “Doc, we thought it was quite common to have morning sickness," he said. I could sense that he  felt  sorry for not asking her to seek medical attention earlier. “Doc, will the baby be alright?“ he whispered, looking worried. M was severely dehydrated on admission. I had to infuse 2 pints of isotonic fluid to correct her fluid and electrolyte imbalance. Fortunately, ultrasound examination of the womb revealed that her baby’s heart beat was still present. M was suffering from hyperemesis gravidarum, a severe form of protracted nausea and vomiting during pregnancy. The exact cause of this condition is not known. It is believed to be due to the rapidly rising blood levels of pregnancy hormone, human chorionic gonadotropin (HCG) released by the placenta. Hyperemesis gravidarum is not common, occurring in 1 to 3% of pregnancies. It can affect any pregnancy and is more common in patients with multiple pregnancy. Besides severe nausea and vomiting, other symptoms include · Weight loss of more than 5% of body weight · Dehydration resulting in patient passing dark urine, having dry skin, weakness, or fainting · Vomiting blood. Besides intravenous fluid, M was also given anti-vomiting medications, vitamins and nutrients through the drip. Blood levels of electrolytes were checked every day. Medications were also given to prevent reflux and inflammation of the gullet (oesophagus) and stomach. She responded very well to the treatment and was discharged home well after 5 days in the hospital. However, I warned her that the nausea and vomiting might return She was advised to have adequate rest and to eat many small meals instead of one large meal. I also advised her to take a small amount of dry snacks between meals and to drink plenty of water in small quantities each time to avoid dehydration. I encouraged her to include some ginger in her cooking as this may relieve her symptoms. Her food should be bland with very little oil and spices. I also prescribed acupressure wrist bands for her to wear in addition to the anti-vomiting medications. With encouragement and support from her husband, M reported only occasional vomiting bouts during her subsequent reviews.  She is now in her second trimester and the symptoms have since gone.

She rushed into my clinic in pain. “Doc, I have a swelling at the bottom for a few days. It has become bigger this morning and is excruciatingly painful this afternoon. I can hardly sit or walk. Can you please do something ?” she pleaded. She had a painful tender lump about the size of a walnut at the right side of the vulva near the vaginal opening. The surrounding skin was inflamed and red. It was a Bartholin’s abscess that required immediate medical attention. With antibiotic coverage and under general anaesthesia, I drained the abscess surgically by a procedure called marsupialisation, A small hole was made over the abscess cavity to drain the pus and the edges stitched with absorbable sutures. Bartholin’s abscess is fairly among women of reproductive age. It arises from Bartholin’s glands which are located on either side of the vagina. These glands secrete fluid that lubricate the vagina during sexual intimacy. When the opening of these glands get blocked, fluid starts to collect in them. This may result in the formation of a relatively painless swelling called a Bartholin's cyst. If the cyst becomes infected, it will develop into an abscess with a collection of pus surrounded by inflamed tissue. Besides the symptoms of painful lumps and discomfort, some patients may have fever if the infection is severe. A number of bacteria may cause the infection, including Escherichia coli (E. coli) and bacteria that cause sexually transmitted infections such as gonorrhoea and chlamydia. When I saw her the next day after the operation, she was very relieved. “Thank you, doc, the pain has gone. See, I can sit up right now,”she smiled. I asked her to have a sitz bath several times a day. Her vulva had to be soaked in a tub filled with a few inches of warm water mixed with an antiseptic solution. This would help drain the pus and promote wound healing. I also warned her that the cyst may recur and that good hygiene habits before sex may help prevent infection of the cyst. She remained well when she returned for a review a month after her operation.

“Doc, it is really amazing how the surgery went so smoothly. I could hardly feel any pain today," she remarked, pointing to the three puncture wounds on her abdomen. She was smiling and sitting up in bed, and enjoying her breakfast when I saw her the next morning after the operation. I had removed her womb by key-hole surgery. Key-hole surgery or minimally invasive surgery is a surgical procedure in which the surgeon can access the inside of the abdomen and pelvis using a tiny lighted telescope (laparoscope)through a small cut instead of a large one in the abdomen as in conventional open surgery. The operation is carried out under general anaesthesia. The abdomen is first inflated with carbon dioxide which will push the pelvic organs away from the abdominal wall. A small cut about 0.5 to 1 cm is usually made in the umbilicus and the laparoscope inserted into the abdomen. The laparoscope, which is connected to a camera, will then relay images of the pelvic organs to a television monitor. The operation is then performed using surgical instruments which are placed inside the abdomen via other small incisions.  After the procedure, the gas is let out and the incisions closed with sutures. The patient can go home on the same day or stay a day or two in the hospital. This procedure has been used by gynaecologists for years in the diagnosis and treatment of various conditions. The advantages of key-hole surgery are as follows: 1. Less adhesions: As the incisions are small, chances of abdominal organs like intestines sticking to the abdominal wall by scar tissues and adhesions are reduced.  Adhesion bands can cause persistent abdominal cramps and discomfort, intestinal obstruction and infertility. 2. Less post-operative pain and disability: Since there is less trauma to the skin and muscles, patients require less painkillers and can ambulate earlier. As a result, the recovery time is faster and the hospital stay shorter. Most patients are able to return to normal activities in 1 to 2 weeks. 3. Less risk of infection. This is because pelvic organs are not exposed to the air of the operating room over long periods of time as in conventional operation. 4. Better dissection of the diseased tissues and less damage to the surrounding organs:  Video magnification offers surgeons better exposure of the diseased organ and its surrounding structures. As a result, delicate manoeuvres can be performed. However, there are disadvantages too. They include the following: 1. The equipment is more expansive and they are usually disposable. 2. The surgeon needs to be trained. The learning curve, the skills and experience vary from person to person. 3. Safety issues: Minor complications such as infection or minor bleeding and bruising around the incision can occur. Serious complications are not common. They are estimated to occur in 1 out of every 1,000 operations. They include: • Damage to the surrounding organs such as bowel or bladder. This   could result in the loss of organ function • Damage to major blood vessels which may result in serious internal haemorrhage. • Deep vein thrombosis or DVT, in which a blood clot develops in a vein in one or both the legs. The clot may break off and block the blood flow in one of the blood vessels in the lungs. This condition is called pulmonary embolism and can be life-threatening. As my patient recovered well post-operatively, she was discharged home the next day.

“Doc, can you give me pills that can enlarge my penis? I think mine is rather small compared to others that I have seen in the changing room,” M spoke to me sheepishly during the premarital check. “I have seen advertisements on the internet on penis enlargement pills. Do they really work?” he asked. M, 30, was getting married in a few months’ time. He was worried that he may not satisfy his bride. Clinical examination showed that his male genital system was normal and he had no problem in erection and ejaculation. Men differ in their perception of the penis size.  Many studies have confirmed that penises, when rigid, have a fairly uniform size regardless of their ethnic origin. The average size of an erect penis is about 14-16 cm in length and 12-13 cm in circumference. But like M, there are many who are anxious about the size of their manhood.  This has spawned a multi-million dollars industry in clinically unproven "male enhancement products". The sales figures are further boosted by internet depictions of large penises. One can be easily fooled by the images on the internet which portray unusually large penises as the norm. Many men often overestimate the average size of a penis and wrongly believe that theirs are below average. Those who worry excessively about the size of their penises are generally having body image issues. They tend to focus their poor body image on their penis. The pills or lotions that are sold in the internet are mostly ineffective, expensive and potentially harmful. These products usually contain vitamins, minerals, herbs or hormones Despite their impressive claims, there is absolutely no clinical evidence that these products work. According to a study in the US, some of these products are found to have traces of lead, pesticides, E. coli bacteria and animal faeces. I referred M to a psychologist who counselled him on building up his self-esteem and correcting his distorted views about body image. With this approach, M had changed his perception of the size of his penis after a few sessions. He is now a proud father of a son who is just a month’s old. He does not talk about the penis enlargement pills anymore.

I am 34 weeks pregnant. I had a last trimester ultrasound scan recently and was told that my baby’s umbilical cord was wrapping round the neck. Is this a serious condition? Do I have to undergo Caesarean section? please advise. A: The umbilical cord is a flexible tube-like structure that connects the developing baby to its mother. It is attached to the baby’s belly button (umbilicus) at one end and to the mother’s womb through the placenta at the other. It is the lifeline for the foetus as it carries oxygen and nutrients from the mother to the baby and transfers carbon dioxide and waste products in the opposite direction to the mother to be excreted. The umbilical cord is formed around the fifth week of pregnancy and can grow up to 50cm long at birth. It is a tough, sinewy cord with a soft, gelatinous filling called “Wharton’s jelly”. This jelly is designed to support the blood vessels running in the cord and to prevent them from being compressed. It also keeps the cord from forming knots when the foetus moves or somersaults in the mother’s womb. The foetus is constantly moving in the womb. These movements may cause the umbilical cord to wrap round the baby’s neck either once or multiple times. This condition is called the nuchal cord. It is present in about 25 to 40% of babies at birth. As in your case, most parents are anxious to know whether the nuchal cord will compromise the oxygen supply to the foetus and should caesarean section be done for safe delivery. Amazingly, in most cases, the blood vessels in the cord are not compressed and the foetal well being is not affected. Normal delivery can be accomplished if the foetal heartbeat is properly monitored during labour. Caesarean section is only indicated during labour if the cardiotocograph (CTG), an electronic means of monitoring foetal heart rate and uterine contractions, indicates that the baby is in distress. In rare occasions- one in 2,000 births- the nuchal cord may form a “true knot”. This may pose certain risks during delivery. However, in the majority of cases, the cord would not tighten too much and normal delivery can still be achieved. Follow Dr.Peter Chew’s articles on aLife’s facebook page https://www.facebook.com/alife.org.sg as well as http://alife.org.sg/articles/.

If you are planning to conceive, the best time to partake in lovemaking would be during ovulation when your ovary releases an egg. Studies have shown that ovulation is controlled by the hormone LH, which is secreted by the pituitary gland, a small pea-sized organ at the base of the brain. Normally, blood levels of LH are low throughout the menstrual cycle. But 24-36 hours before impending ovulation, LH secretion suddenly rises to very high levels. By identifying the LH surge, you can predict ovulation more accurately and choose the correct time to conceive. LH surge can be detected in the blood or urine. For convenience and practical reasons, urine estimation of LH using ovulation prediction kits (OPKs) is preferred by patients. These kits are readily available in most pharmacies or may be purchased online. Most ovulation tests may be done at any time of the day. Some manufacturers suggest using the test with the first morning urine while others suggest doing the test around noon time or in the evening. For better accuracy and consistency, the test should be done about the same time each day. As the urinary levels of the LH fluctuate with fluid intake, it is best to hold the urine for 4 hours before testing, A positive result indicates the LH surge which signals the “fertile window” for conception in the next 24-48 hours. As the surge usually lasts less than 24 hours, it is important to do the urine tests in sequence around ovulation in order to detect this crucial period. As most OPKs are quite expensive, it is not necessary to do the test daily or multiple times a day until you get the positive result. You can use your cycle length to gauge approximately the likely period of ovulation and figure out when to start testing. In this way, you can reduce the cost of testing. In some women with irregular periods, it may be difficult to know when to start doing the tests. In this situation, it is best to consult your gynaecologist or look for other fertility signs such as assessment of cervical mucus before you begin testing. OPKs only measure the LH surge. It does not confirm that you have actually ovulated. Occasionally, an egg fails to emerge from its follicle after the LH surge, a condition known as luteinized unruptured follicle syndrome. OPKs also do not work when certain fertility drugs such as FSH or hCG are present in the urine. They are also not reliable in perimenopause and in women with polycystic ovary syndrome (PCOS) when the LH levels are persistently high. Although in most cases, OPKs provide an accurate forecast of your LH surge and subsequent ovulation, they are most effective when used together with other methods. Combine OPK testing with cervical mucus detection and basal body temperature, and your chances of becoming pregnant will be greatly enhanced. Follow Dr.Peter Chew’s articles on aLife’s facebook page https://www.facebook.com/alife.org.sg as well as http://alife.org.sg/articles/.

1. Can endometriosis be detected early or must we only perform the scan together with surgery? Was told by a professional that it is a one time process. Early detection of endometriosis is by clinical suspicion based on history and physical examination and confirmed by laparoscopy. Early stage without endometriotic cyst cannot be seen by ultrasound scan. 2. Typically, my menses is around 30-35 days but around 3 times a year, it will be longer than 40 days i.e 40 plus and 50 plus days. I have went through all medical checks, no issues. Doctor also ruled PCOS out. What could be the root cause other than stress? There are many causes of irregular periods and Stress and PCOS are some of the causes. Thyroid glands dysfunction (hypo- or hyperthyroidism), increased milk hormone (prolactin) from the pituitary, chronic medical illnesses like diabetes or kidney problems are some of the causes of irregular menses. 3. How long would you recommend couples in early 30s to try naturally before taking ART? There is no hard and fast rule on how long one should try naturally before resorting to ART. It depends on the cause of infertility. For example, if the tubes are blocked, one should resort to ART straightaway. Normally, if the female is in early 30s , she should try naturally for about 6 months without contraception. If conception does not occur, she should seek medical help to find out the cause so that appropriate treatment can be given. 4. How long after conceiving then you will have early pregnancy symptoms? Normally you get your period about 4 weeks from the start of your last period, but if you're pregnant, the sign at this point is a missed period. Many women still feel fine after getting overdue for a week, but others may notice sore breasts, fatigue, frequent urination, and nausea. 5. My wife is undergoing TB treatment, what is the risk of pregnancy? If the TB responds to the treatment and after doctor has declared her well after treatment , she can try to get pregnant. However, if she is pregnant and treatment is in progress, then you should consult the chest physician with regards to the safety profiles of the medications with reference to the unborn foetus. 6. Can adenomyosis be treated? Please refer to the website article on Q&A adenomyosis. 7. What are the tests that you will suggest for the couple before trying for a baby? Pl refer to the Q&A fertility tests in the website. 8. What are the possible causes for non fertilization during ICSI? Few reasons: Technical failure Poor egg quality Poor sperm quality The egg may not have survived after the injection. The DNA of the sperm head may remain ‘locked’ The egg may not have been activated and didn’t participate in the intracellular steps of fertilization. 9. If ovulation tests (ovulation test kit) was done daily during the female’s ovulation period (using menses calender app) but the result always negative. What could be the possible reason? Few reason: The OPK is faulty Urine does not contain enough LH Technical fault Luteinized Unruptured follicular syndrome Pl refer to the Q&A on ovulation kit. 10. If the menses is regular (average 36 days for every cycle) but flow is very little, does it affect the plantation of the embryo or fertility? Is there anyway to improve the menses flow? Scanty flow may indicate a thin uterine lining and this may affect implantation of the embryo. It may indicate dysfunction of ovulation or poor corpus luteal formation You should find out the cause and treat it appropriately. 11. After miscarriage, does it affect chances of conception? Usually, one previous miscarriage does not affect chances of having a subsequent pregnancy. But if there are 2 or more recurrent miscarriages, subsequent chances of conception may be affected 12. What can I do to regulate my cycle? You should find out the cause of the irregular periods so that appropriate treatment can be given. Please refer to the article on Q&A irregular periods in our website. 13. My wife got pregnancy 8 weeks and 4 days over, but no vomiting. Is it problem or no worries, please guide me. About 20 % of pregnant women has no vomiting. As long as the baby is viable with the presence of heart beats, do not worry. 14. Is it unadvisable to go to Japan if you’re planning to conceive? Also does mint or alcohol affect sperm count? There is no reason to advise you against travelling to Japan if you are planning to conceive.Alcohol do affect sperm quality and quantity if you take it in excess. 15. Does anything affect egg count? Egg count can be affected by many factors such as age, life styles, STDs,BMI, endocrine diseases and medications. 16. What are the chances of natural pregnancy if one is diagnosed with teratozoospermia? Morphology is only 1%. Must we go thru ART or can still try natural? It depends on the quantity of the sperm. E.g. 1% of 100 million/ml is better than 10% of 1million/ml.Besides, this percentage can change day by day and varies from laboratory to laboratory. You can still try naturally. 17. What is the main cause of ED problem, how to overcome the ED? What is testosterone symptom that affect man? Please refer to the article in our website Q&A Erectile dysfunction. 18. My wife in early 40s, her period is reduce from 7 days to now 2 days since recently? What is the cause? Please refer to the article in our website Q&A scanty periods. 19. What happens if the morphology is only 2%? Is there any treatment? Morphology is about the shape of the sperm. If the sperm is misshaped, it can’t penetrate the egg effectively and so conception becomes compromised. To improve: Regular exercise Balanced diet with plenty of vitamins, antioxidants and micronutrients like zinc and selenium. Avoid processed food Reduce exposure to chemicals and pesticides Stop smoking and reduce alcohol intake Avoid heat like spa, hot baths and saunas Check for varicoceles. Varicoceles are varicose veins around the testicles

I am 30 weeks pregnant and have been diagnosed with gestational diabetes. My obstetrician tells me that my tummy is big with excessive “amniotic fluid”. He says that I have “polyhydramnios”? What is Amniotic fluid? What does it do? What are the causes of polyhydramnios? Is it serious? A. When you are pregnant, your baby grows in a bag filled with fluid. The sac is called amniotic sac and the fluid, amniotic fluid. Initially, amniotic fluid is produced by the mother through the blood circulation. Soon, the baby starts to swallow the fluid and passes it out into the amniotic sac as urine. He or she will then swallow the fluid again and this process is repeated every few hours. Thus the amount of amniotic fluid is controlled by the baby to a large extent. If this regulatory system gets out of hand, excessive amount of fluid or too little fluid may result. The former condition is called polyhydramnios and the latter, oligohydramnios. Normally, the amount of amniotic fluid increases as pregnancy progresses. It reaches its peak at around 34 to 36 weeks, measuring about 800ml. It then gradually decreases to about 600 mL at 40 weeks of gestation. Amniotic fluid is important in maintaining a healthy environment for foetal development as it contains many nutrients, hormones and bacteria-fighting antibodies. Some of its important functions are as follows: · It acts as a shock absorber protecting your baby from outside pressures. · It helps your baby’s lungs and digestive system to develop. By breathing and swallowing the amniotic fluid, your baby will develop the muscles of these systems as it grows · It insulates your baby, keeping it warm and maintaining a constant temperature · The antibodies in the fluid will help protecting your baby against infection · It prevents the umbilical cord from being compressed. · It allows your baby to move freely in the amniotic sac, thus allowing the muscles and bones to develop properly Polyhydramnios may be present in the following conditions: 1. Foetal factor: · Digestive system: e.g. blockage of the food pipe (oesophageal atresia) · Nervous system e.g. absence of a portion of the brain and skull, (anencephaly) · Genetic abnormalities · Infection · Hydrops fetalis - a condition in which an abnormal level of water builds up inside many areas of the body · Multiple pregnancies 2. Maternal factor · Gestational diabetes. I presume your baby has been examined by ultrasound and is presumably normal. The “Polyhydramnios” that you have is probably due to the gestational diabetes. Your obstetrician will monitor the levels of your blood sugar and the amniotic fluid closely. This is to prevent complications such as premature labour and premature rupture of membranes from happening. Should you go into labour, you will be watched closely for cord prolapse (umbilical cord falls through the womb before delivery) and placental abruption (early placental separation). Both conditions may require immediate caesarean section. After the baby is delivered, your obstetrician may give you medication to make the womb contract as your risk of postpartum haemorrhage is higher. Follow Dr.Peter Chew’s articles on aLife’s facebook page https://www.facebook.com/alife.org.sg as well as http://alife.org.sg/articles/. Pregnancy