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Dr. Liudmyla Serko, Lusaka (2025)

13/07/2024

❌❌❌❌What happens if the umbilical cord is around my baby’s neck?
⭕️ An umbilical cord is a lifeline for a baby in the womb. Running from the baby’s abdomen to the placenta, the umbilical cord usually contains three blood vessels and is about 21” long. It provides oxygen, blood, and nutrients to the developing fetus. However, later in pregnancy many women fear the thought of the umbilical cord wrapping around the baby’s neck and the possibility of problems during delivery or even a stillbirth.

Pregnant women: Breathe a sigh of relief. Nuchal cords are surprisingly common and unlikely to cause problems during pregnancy or at birth. Estimates suggest that 20 to 30 percent of all deliveries involve a nuchal cord. And a 2018 study in the American Journal of Obstetrics and Gynecology reports that, the majority of time, babies do just fine when one is present.

What causes nuchal cords?

Random fetal movement is the primary cause of a nuchal cord. Other factors that might increase the risk of the umbilical cord wrapping around a baby’s neck include an extra-long umbilical cord or excess amniotic fluid that allows more fetal movement.

Nuchal cords typically are discovered at birth. Occasionally, patients ask if we can see them on ultrasound, which sometimes we can. There’s no way yet to prevent nuchal cords or unwind them from a baby’s neck in the womb. But when a baby is born with a nuchal cord, your doctor will know what to do because it happens so frequently.
❌❌❌❌ When is a nuchal cord dangerous?

If the cord is looped around the neck or another body part, blood flow through the entangled cord may be decreased during contractions. This can cause the baby’s heart rate to fall during contractions. Prior to delivery, if blood flow is completely cut off, a stillbirth can occur.

In the 2018 study, 12 percent of deliveries had a nuchal cord. Most babies with a nuchal cord had just a single loop around the neck. Fortunately, there was no increased risk for growth problems, stillbirth, or lower Apgar scores in this group.

❌❌❌❌What happens during delivery?

Since the vast majority of time we don’t know if a baby will have a nuchal cord, it is routine that the doctor will check the baby’s neck for a nuchal cord after the baby’s head is delivered. Usually the cord is loose and can be slipped over the baby’s head. At times it might be too tight to easily slip over the head, and the doctor or midwife will clamp and cut the cord before the baby’s shoulders are delivered. This keeps the cord from tearing away from the placenta when the rest of the baby’s body is delivered.

Remember, a nuchal cord is common, and complications caused by the condition are rare, and definitely is not indication for c/section.

19/06/2024

❌❌Polycystic O***y Syndrome (PCOS) impacts roughly one in ten women. However, this hormonal disorder is frequently undiagnosed and many people who suffer from the condition don’t know they have it.

⁉️❓❓What is polycystic o***y syndrome?

PCOS can typically result in:

Irregular menstruation Weight gain Acne Elevated androgen levels (male hormones) Polycystic ovaries - the ovaries become enlarged and contain fluid-filled sacs. These sacs are immature follicles, often incapable of releasing an egg, leading to missed periods.

While the exact cause is unknown, PCOS often runs in families and is linked to abnormal hormone levels in the body, including elevated insulin levels.

Due to poor diagnosis rates and limited resources, many women with PCOS seek alternative methods to manage their symptoms. Millions of TikTok videos from PCOS sufferers seek community support and answers, with numerous doctors offering advice on the platform.

Recently, PCOS sufferers have been questioning whether weight loss drugs like Ozempic could alleviate their symptoms, particularly after researchers found that the medication might reduce the risk of heart attacks and strokes.

⁉️⁉️⁉️What is Ozempic, and can it assist with PCOS?

🆘❌❌Ozempic is a drug used for managing diabetes. The medication "mimics" the action of a hormone called glucagon-like peptide-1 (GLP-1). Ozempic is primarily used to lower blood sugar levels in people with type 2 diabetes by:

Stimulating insulin secretion Reducing glucagon secretion (a hormone that increases blood sugar) Slowing gastric emptying Helping to regulate blood sugar levels.

This is particularly relevant for PCOS sufferers, who often experience insulin resistance as a significant part of their condition.

⁉️⁉️⁉️How are insulin resistance and PCOS related?

In women with PCOS, insulin resistance is frequently a crucial factor in the development and progression of the condition. Insulin resistance can lead to elevated insulin levels, which can then stimulate the ovaries to produce more androgens, worsening the symptoms of PCOS. By enhancing insulin sensitivity and reducing insulin levels, GLP-1 receptor agonists like Ozempic may help alleviate some symptoms of PCOS, such as irregular periods and excessive hair growth."

❗️❗️Ozempic has also been shown to aid weight loss, which can be beneficial for people with PCOS by improving insulin sensitivity and lowering androgen levels.There is early evidence" that Ozempic can help with PCOS symptoms, primarily by targeting excess weight and insulin resistance.

❗️❗️Ozempic appears to hold potential for enhancing PCOS symptoms and overall metabolic health in patients. Some women have reported that Ozempic helps in regulating their menstrual cycles. However, more studies are necessary to comprehensively understand the drug's effects.

❌❌❌It's important to highlight that Ozempic has not received FDA or MHRA approval for treating PCOS. Nevertheless, managing weight is essential for PCOS management. Around 70% of individuals with PCOS who are obese or overweight experience reduced insulin sensitivity, contributing to weight gain and challenges in losing weight.

By addressing these underlying issues, Ozempic may help improve symptoms associated with PCOS and increase the chances of ovulation and fertility. While Ozempic may hold promise for women with PCOS, it is important to be aware of potential side effects.

13/06/2024

This information is for you if you have been told that there is a higher chance of your baby being small, or you are pregnant and have been told your baby may be smaller than expected.

❗️⁉️I’ve been told my baby is small – what does this mean?

If the estimated weight of your baby by ultrasound scan is in the lowest 10% of babies (the smallest 10 out of every 100 babies, or less than the 10th centile), they are considered to be small.

⁉️ What could cause my baby to be small?

There are different reasons why your baby may be small. Most babies do not have any health problems but are just smaller than others and this is normal for them.

However, sometimes babies are small because they have not grown as well as expected. This is called being ‘growth restricted’. The smaller your baby is, the more likely they are to be growth restricted. Causes of growth restriction include:
⭕️Your placenta not working as well as it should – this could be because of medical problems such as having high blood pressure, or complications of pregnancy such as pre-eclampsia.
⭕️Infection: If you catch certain infections (such as toxoplasmosis or CMV) while you are pregnant it can sometimes affect the growth of your baby
⭕️Having a baby with an underlying developmental or genetic condition.

⁉️⁉️What does being small mean for my baby?
If your baby is small and healthy, they will have a lower chance of complications than if they are small and are known to have an underlying health problem.

The earlier in pregnancy and the more severely your baby’s growth is affected, the more likely it is that they will have complications. Babies whose growth is only affected later in pregnancy are less likely to have severe complications.

If your baby is growth restricted, they have a higher chance of being stillborn (dying before birth), being unwell at birth or dying shortly after birth. They may also need to be born prematurely (less than 37 weeks) or to be cared for in the neonatal unit.

⁉️⁉️Can I do anything to reduce my chance of having a small baby?
Stopping smoking is one of the best things you can do for your health and your baby’s health. Your healthcare professional can help you find support to stop smoking. If you can stop smoking by the time you are 15 weeks pregnant your chance of having a small baby will reduce to being similar to that of a non-smoking woman. You should be offered professional support to help you to stop.

Reduce your caffeine intake - (the current recommended maximum intake is 200mg per day, for example, two mugs of instant coffee)
Maintain a healthy weight
If you are at increased risk of having problems with your placenta or of developing pre-eclampsia, you should be advised to take low-dose aspirin (150 mg once each evening) from 12 weeks of pregnancy until 36 weeks of pregnancy

⁉️⁉️ If my baby is thought to be small or not growing, what will happen?
What happens will depend on how small your baby is and how early in the pregnancy your baby has been found to be small. You may be offered the following tests to check your baby’s wellbeing:

❌An umbilical artery Doppler scan – this is an ultrasound scan which measures the flow of blood through the umbilical cord. It can help to tell whether your baby is at risk of becoming unwell and whether they may need to be born early
More frequent growth scans
❌Additional Doppler scans checking the blood flow in the baby’s brain and abdomen
❌A computerised cardiotocograph (cCTG) – this is a tracing of your baby’s heart rate.
❌You may be referred to a specialist doctor (a fetal medicine specialist) for more frequent and detailed scans if:
your baby is very small,
they have been found to be small early in the pregnancy, or,
the umbilical artery Doppler scan is not normal.
❌Depending on your individual circumstances you may be offered additional investigations. For example, you may be offered a test to check whether your baby has any genetic or chromosomal conditions (an amniocentesis), or blood tests to check for infections.

❌Your blood pressure and urine will be checked regularly to see if you are developing pre-eclampsia.

❌You will be advised to go straight to hospital to be checked if you are ever concerned that your baby is not moving normally.
⁉️⁉️⁉️When is the best time for my baby to be born?

This will depend on your individual circumstances. The latest you will be advised to give birth if your baby is small is between 39 weeks and your due date (which is 40 weeks). If there are other concerns that your baby is growth restricted, you will be advised to give birth sooner. An individual plan of care will be made with you depending on your circumstances but birth is likely to be recommended at 37 weeks.

Sometimes if your baby is very small or if the umbilical artery Doppler measurements are not normal, you may be advised to give birth prematurely. Your healthcare team will discuss the risks and benefits of this with you.

⁉️⁉️ Where should I have my baby?
You will be advised to give birth to your baby in a hospital where there is a neonatal unit.

Whether your baby will need to be looked after in the neonatal unit after they are born will depend on: their birthweight,
whether they were born prematurely,
whether they have any other health concerns.
You should have an opportunity to talk to one of the neonatal team before the birth of your baby if it is likely that they will need special care. You and your birth partner may also wish to visit the neonatal unit before your baby is born.
⁉️⁉️⁉️ How will I have my baby?

How your baby is born will depend on your individual circumstances and choices. If your baby is small but their umbilical artery Doppler measurements are normal on scan, you can choose to give birth vaginally. This often means your labour will need to be induced. Your baby’s heart rate will be monitored continuously during your labour. If the umbilical artery Doppler measurements are abnormal, you may be advised to have a caesarean birth.
❌❌
You should attend hospital straight away if:
you go into labour
your waters (the sac of fluid that surrounds your baby) break, or
your baby’s movements have reduced or changed
For more info and right follow up contact