Ultrasounds during pregnancy

a woman's belly receiving ultrasound

Ultrasound is the most crucial investigation for assessing the wellbeing of your baby. You will have multiple ultrasounds throughout your pregnancy, mostly with me. Two of your ultrasounds will be referred to an ultrasound specialist.

An ultrasound is really important at the first appointment

It confirms that the pregnancy is growing well, the due date for the pregnancy, and whether there are twins. At 8–9 weeks, the ultrasound can almost always be done through your abdomen, making an internal ultrasound unnecessary. I’ll do the ultrasound myself in the consulting room.

Seeing your baby on the screen for the first time is incredibly exciting, and something you’ll never forget. You will be sent images and videos from your ultrasound direct to your mobile phone.

Subsequent ultrasounds

At each appointment you have with me, I will perform an ultrasound. The purpose of the ultrasound varies depending on where you are up to in the pregnancy, but will involve checking the following:

  • Viability — checking the fetal heart beat
  • Growth assessment — checking how big the baby is, and whether it is growing correctly
  • Wellbeing — this involves complicated Doppler blood flow measurements on the baby and the placenta to check that the baby is healthy and the placenta is functioning normally.

I always try and take some nice images and videos of your baby for you to share — if the baby cooperates! I can also check the gender for you at 18 weeks, and sometimes even at 14 weeks.

Recent studies have shown that serial ultrasound during your pregnancy is far better than fundal height (i.e. measuring the outside of your abdomen with a tape measure) at detecting dangerous growth restriction. Early detection reduces the danger to your baby by allowing me to instigate close monitoring and help ensure a timely delivery.

Referral ultrasounds

You will be referred for an ultrasound at a specialist clinic at 12 and 20 weeks.

Both the 12 and 20 week ultrasounds give important information; an anatomy (organ) survey of the baby, assessment of the baby’s growth, a check of where the placenta is growing and how long your cervix is. Because the baby is much bigger and more developed at 20 weeks, more detail can be detected at this ultrasound. The advantage of the 12 week ultrasound is that major issues can often be diagnosed at an earlier stage in the pregnancy.

Occasionally additional specialist ultrasounds are required later in the pregnancy.

Why choose a specialist women’s ultrasound clinic?

I highly recommend that you have each of your ultrasounds at a specialist women’s clinic. You can be sure if you go to one of my recommended clinics that you will be getting the most accurate and reliable scan possible.

Specialist ultrasound clinics can be a little more expensive than a non-specialist clinic (although non-specialist clinics often charge significant out-of-pocket fees, too) but it is money wisely spent. It eliminates the need for repeat ultrasounds should the first show an abnormality or if the non-specialist ultrasonographer is simply not sure what they are seeing. This can end up being more stressful, too.

To make an appointment, call (03) 9418 8299 or book online.

Exercise, pain and periods – what’s normal?

woman in running outfit jogging up a flight of stairs

Everyone knows that regular, vigorous exercise is great for your health and wellbeing. But is too much exercise bad for your body? Should you exercise when you have your period? And what should you do when pain makes it hard to stay active?

When it comes to high-intensity training and fitness, women have specific health needs that need attention. In this article, I’ll explain the common issues I see in my patients.

High-intensity exercise can change your menstrual cycle

If you do intense physical activity often or for extended lengths of time, your periods may become irregular or not occur at all (known as amenorrhoea). This is the result of you using more energy than what you’re getting from your diet, which tells your body to stop making hormones that normally regulate your cycle. Irregular or absent periods caused by exercising too much are quite common.

Unless you are trying to get pregnant, you may think it doesn’t matter that your period is occuring less often or not at all. Unfortunately, there are long-term health consequences associated with prolonged amenorrhoea. When your body doesn’t go through the menstrual cycle, your levels of oestrogen go down. This leads to loss of calcium from your bones, changing your bone density and making it more likely that you will suffer from fractures in later life (a condition known as osteoporosis).

If you have irregular periods, it’s extremely important that you seek medical help. While the cause may be exercising too much (in which case your doctor may advise changing your training regime or diet), other health conditions can also make your periods irregular or absent, so it’s important to have a full assessment as soon as possible.

Your cycle may affect your exercise performance

Though there have been many studies investigating how the menstrual cycle affects exercise performance, there’s no clear evidence that women’s strength or endurance changes significantly at different stages of the cycle.

That being said, as your hormone levels change during your cycle, you may experience physical shifts in your body that change how well you perform. For example, you may feel bloated and lethargic or have cramps in the days leading up to your period. These symptoms can make it difficult to give it your all in your athletic endeavours.

Pain that makes it hard to stay active can be managed

The good news is that there are ways to manage your period and associated pain so you can perform at your peak. In fact, the most common reason I see female athletes is for pain that is affecting their training and physical performance. I’ve addressed the issue of severe period pain in a previous article, which you can read here. But even if you suffer mild-to-moderate period pain that gets in the way of you staying active, it is worth seeking medical help.

Some serious health conditions such as endometriosis and fibroids can also be the cause of pain and severe cramps, so it’s important to have a full assessment with a gynaecologist if you are suffering from these symptoms. They will discuss your treatment and pain management options to help you stay active.

Exercise can relieve period pain

It’s perfectly safe and recommended that you continue to exercise during your period. If your period is causing cramps, nausea or back pain you probably feel like curling up on the couch, but gentle exercise can actually relieve period cramps and other symptoms. This is because it increases blood flow and releases endorphins, which reduces the pain you feel.

Sports gynaecology: specialist care for female athletes

In recent years, the importance of specialist healthcare for female athletes has been recognised, which has led to the role of the sports gynaecologist. In fact, I was recently appointed as the team gynaecologist for the Melbourne Football Club’s AFLW team. My role is to help the team manage their health so that they can optimise their performance on the oval.

Don’t let pain get in the way of your performance

If you have concerns about exercise and your reproductive health, please don’t hesitate to book an appointment for a full assessment of your situation. Be assured that you don’t need to be a professional athlete to receive specialist care so that you can stay fit and healthy.

To make an appointment with me, call (03) 9418 8299 or book online.

Hysteroscopy

person holding a red heart shape with heart-shaped hands in front of their belly

A hysteroscopy is a procedure to examine the inner lining of the uterus. It is performed using a long thin telescope that is passed through the opening of the cervix into the uterus. No cutting or incisions are required. The pictures from inside the uterus are displayed on a television screen.

Hysteroscopy is commonly used to assess the lining of the uterus in the event of:

  • Abnormal or heavy bleeding
  • Bleeding after menopause
  • Sub-fertility
  • Polyps found on ultrasound (a polyp is a small dangly piece of tissue on a stalk, often found by ultrasound when investigating abnormal bleeding)
  • Pelvic pain or discomfort
  • Recurrent miscarriage.

At the same time as a hysteroscopy, a biopsy of the lining is always taken. This is called a curette, and is sometimes referred to as a clean-out. If polyps are present, they can be removed at the same time, which is quite a simple procedure called a polypectomy.

Hysteroscopy is a day surgery procedure

A hysteroscopy is done in hospital as a day case. This means you are well enough to go home shortly after the operation. It requires a general anaesthetic, meaning you will be fully asleep with a breathing tube in your throat. Once you are asleep, the operation takes less than 15 minutes.

What to expect after the procedure

After the operation, most patients feel a bit groggy from the anaesthetic. This generally lasts the whole day, and occasionally into the next day (most people only need to take one day off work for the operation). Some patients have light bleeding for up to a week, but mostly this is a few days or less. Crampy period pain can be present immediately after the operation, but normally resolves with panadol and Nurofen tablets.

It is not normal to be in pain for days after the operation, and you should come in for an assessment if this is the case. You should also be assessed if you have heavy bleeding or fevers following your procedure.

To make an appointment, call (03) 9418 8299 or book online.

Routine prenatal tests

a pregnant belly with a physician holding a stethoscope up to it

In addition to regular ultrasounds, there are a number of routine prenatal tests that I recommend having at the beginning of the pregnancy. They are all screening tests. This means I am not particularly concerned that you might have these conditions, only that they are conditions commonly seen in pregnant women and are important to the outcome of the pregnancy.

Routine tests

  • Full blood count (FBE)
  • Blood group and antibody screen
  • Infectious disease screen (Hepatitis B & C, HIV, syphilis, varicella and rubella)
  • Urine test for infection (MSU)
  • Thyroid test (TSH)
  • Vitamin D level
  • Cervical screening test (if due)

Other tests

In special circumstances, I’ll also recommend other prenatal tests and will discuss them with you as needed.

Genetic screening

It is now possible to check if your baby has a chance of inheriting some genetic conditions. This type of test is known as carrier screening and it determines if either parent is carrying a certain genetic variant that they could pass on to the baby, which could cause a serious health condition.

The conditions that testing is currently available for are:

  • Cystic fibrosis
  • Spinal muscular atrophy
  • Fragile X syndrome.

The standard genetic screening test costs about $350 per person tested for all three conditions. It is usual to test the mother or the father first, then arrange testing for the partner if a copy of the gene is found, so there is potential that both parents would need the test.

To make an appointment, call (03) 9418 8299 or book online.

Tips on exercise during pregnancy

a pregnant woman sitting cross-legged on exercise mat

Exercise is great for your health and wellbeing – especially when you are pregnant. It’s safe and healthy for you to exercise during pregnancy and staying active has considerable benefits for you and your baby.

Before you give tiredness or discomfort as a reason to skip that workout session while you’re pregnant, take note that exercise actually helps to prevent or reduce backache, pelvic pain, swollen feet, cramps, headaches and constipation. Regular exercise during pregnancy can also increase your energy levels. So, ironically, if you’re feeling too tired to exercise, exercise might be precisely what you need.

The benefits don’t end there.

Exercise during pregnancy helps both you and bub

Staying fit during pregnancy can help prepare your body for the physical demands of labour and also help to ensure a fast recovery after your bub is born. Moreover, studies have shown that women who did moderate-intensity exercise regularly throughout their pregnancy were less likely to have a difficult labour leading to emergency caesarean section. There is also evidence that regular exercise during pregnancy can lower your risk of complications such as pre-eclampsia and pregnancy-induced hypertension.

Your baby benefits too. Exercise improves circulation, increasing blood flow to the placenta, which is great for your baby’s growth and development.

And when it comes to feeling good mentally while you are pregnant, exercise plays an important role. In addition to helping you sleep better and manage insomnia, regular exercise during pregnancy can help to relieve stress and reduce the risk of anxiety and depression.

An added benefit of working out while pregnant is that it will help you maintain a healthy weight, which has short- and long-term health benefits for you and your baby (find out more about the importance of healthy pregnancy weight gain here).

Stay fit and active, but don’t overdo it

While you are pregnant, aim for ‘moderate intensity’ exercise. What exactly counts as moderate? The aim is to be challenged but not breathless – a good gauge is that you should be able to keep up a conversation, but being puffed is fine. Also apply moderation to the length and frequency of your workout sessions. Aim to be active for at least 30 minutes on most days of the week and, to avoid overdoing it, keep it to less than an hour per day. Always drink plenty of water to stay hydrated while you are exercising.

Women who have a high-risk pregnancy or complications may need to adapt their exercise regime and should speak to their doctor for advice specific to their situation. Women with a low-risk, uncomplicated pregnancy should try for a mix of aerobic and strengthening exercises.

As your body changes throughout your pregnancy, you’ll need to adapt the types of exercise you do.

Get into good exercise habits

In your first 12 weeks, the amount of exercise you should do depends on your pre-pregnancy routine. Women who had a good exercise routine prior to becoming pregnant can keep going with that (for more information on the benefits of exercising to prepare for pregnancy, click here). Recent research has shown that runners can continue this type of exercise during pregnancy (moderately, of course), but for those new to running, pregnancy is not the time to start.

If you’re beginning to exercise while you’re pregnant, start gently and build up your fitness. Try to make a realistic routine you can stick to. A good first step is 30–40 minutes of brisk walking, making sure that you’re hot and puffed after. Yoga and Pilates are excellent exercises to improve strength and are particularly good at reducing the chance of pelvic and back pain later in the pregnancy.

While most types of exercise are fine in these early stages of pregnancy, you should avoid hot conditions (e.g. hot yoga) and avoid contact sports to protect your bump.

Adapt your exercise routine to suit your pregnancy

In the second trimester, your growing bump may mean certain exercises become more difficult and should be avoided (e.g. crunches and sit-ups). Your blood pressure also drops in this trimester, so avoid rapid changes of position to prevent dizzy spells. And remember to always do a slow, controlled cool-down.

Your centre of gravity shifts as your bump grows throughout your pregnancy, making it more likely that you could fall or lose your balance. For this reason, it’s a good idea to stick to exercises where you are more stable (e.g. brisk walking, swimming or using a spin bike).

Another reason to aim for more stable exercises is that ligaments loosen during pregnancy, which increases your risk of joint injuries. Avoid activities where you need to change direction quickly or jump around (e.g. netball and basketball). Always stretch in a slow and controlled manner.

To build strength, do exercises that use light weights, your body weight or elasticised resistance bands with moderate intensity. Don’t use heavy weights or perform activities that make you strain or hold your breath while you are pregnant.

Keep it up in your final trimester

Staying active gets a little trickier as you near the end of your pregnancy. With added weight and swollen feet, it may be harder to motivate yourself to keep going. But don’t stop now! One of the best options at this point is gentle swimming – you can get your cardio done while feeling light as a feather. Other good options include walking, cycling and rowing at the gym.

After 26 weeks, you shouldn’t lie on your back for longer than a few minutes as your growing uterus disrupts blow flow in this position. Adapt exercises to a sitting or standing posture.

There are plenty of exercise classes specifically designed for pregnant women, where the poses or activities are modified to suit pregnancy. Group classes can be a great way to keep motivated to exercise. Take a look here for some examples.

Always listen to your body

While it’s very important that you exercise while you’re pregnant, it’s even more important that you listen to your body and don’t force it. If you experience any of these warning signs or if something doesn’t feel right, stop immediately and seek medical advice:

  • Dizziness, faintness or headache
  • Chest pain
  • Muscle weakness
  • Unexplained shortness of breath
  • Calf pain, swelling or redness
  • Sudden swelling of your face, hands or ankles
  • Vaginal bleeding or loss of amniotic fluid
  • Decreased movement of your baby
  • Uterine contractions or pain in the lower back, pelvic area or abdomen.

Strengthen your pelvic floor muscles

My last piece of advice will help you prevent or manage urinary incontinence. The weight of the growing baby puts excessive strain on your pelvic floor muscles, and when those muscles are weak it can cause incontinence and other problems. Performing pelvic floor strengthening exercises before and during pregnancy will strengthen these muscles and can help avoid future problems. You’ll be grateful for your efforts in the future.

Make your exercise routine work for you

Good luck with your exercise goals and remember, moderation is key. If you have any questions or concerns about how to exercise during pregnancy, feel free to raise these with me at your next antenatal appointment or, as always, you’re welcome to call my rooms on (03) 9418 8299 between appointments for advice.

Recurrent miscarriage

wooden sculpture resembling a woman with the cutout of a child in the centre

A miscarriage is when a pregnancy ends on its own before a woman has been pregnant for 20 weeks. Miscarriage most commonly occurs in the very early stages of the pregnancy, and is uncommon after 10 weeks.

Recurrent miscarriage refers to when a miscarriage has occurred two or more times, without any normal pregnancies in between. If you have experienced recurrent miscarriage, it is important to consult with a fertility specialist for an assessment of potential causes.

What causes recurrent miscarriage?

Sometimes no cause is identified for recurrent miscarriage, but causes that should be considered include:

  • A problem with the genetic makeup of the pregnancy, such as a chromosomal abnormality. This can be due to a genetic abnormality of either the egg or sperm
  • A problem with how the pregnancy implants in the uterus. This can be due to problems with the lining of the uterus or sometimes the shape of the uterus (due to a fibroid, polyp or septum)
  • General medical conditions in the mother, such as clotting problems, diabetes or thyroid disease.

When I see a couple who are experiencing recurrent miscarriage, it is very important to take into account the age of the couple, a thorough history of all pregnancies in the past and medical conditions, as well as a family history of recurrent miscarriage. After this discussion, I usually order investigations to check for a potential cause.

It is important to understand that most commonly there is no cause found for recurrent miscarriage. While this can be frustrating, having no identified cause confers a good prognosis.

How do you determine the cause?

When determining the cause of recurrent miscarriage, I usually arrange the following tests:

  • Pelvic ultrasound scan – to check for polyps and fibroids as well as ovarian reserve (egg numbers)
  • Genetic tests – a karyotype blood test to check for chromosome imbalances for both the man and woman
  • Hormone tests – blood tests for thyroid or similar hormone problems
  • Haematology tests – blood tests checking for clotting problems
  • Sperm test.

When I care for a patient who has had a miscarriage, I usually send the pregnancy tissue for testing, as this often gives clues for why the miscarriage has occurred.

I sometimes also recommend that the woman have one of the following operations:

  • Hysteroscopy – where I put a camera inside her uterus to check its shape
  • Laparoscopy – where I put a camera through her belly button to check for abnormalities of the tubes, called a hydrosalpinx.

How do you treat recurrent miscarriage?

If a cause for recurrent miscarriage is found, it can be treated to reduce the chance of more miscarriages. The treatment is sometimes medications, such as aspirin, or surgery in the case of abnormalities within the uterus or a hydrosalpinx.

Where no cause is found, I offer the couple an individualised plan including vitamins, hormonal supplements and very close surveillance. This usually involves blood tests performed weekly, then when the pregnancy is big enough at about 7 weeks’ gestation, weekly ultrasounds in my office.

Additional treatments that might be suitable in certain situations are:

  • Progesterone supplementation
  • Aspirin
  • Specialist drug injections
  • Endometrial scratch
  • IVF with blastocyst transfer
  • IVF with preimplantation genetic screening (PGS).

Remember, the most likely pregnancy outcome by far following recurrent miscarriage is a live baby – so it’s important to never give up trying!

To make an appointment, call (03) 9418 8299 or book online.

A healthy pregnancy diet – which foods to eat and avoid

spread of food on a table including berries, nuts, beans, salmon, olive oil and broccoli

The guidelines around what you should and shouldn’t eat during pregnancy may seem overwhelming to navigate. And it can feel especially difficult to stick to them at this time of year, with the many summer parties, picnics and BBQs that are happening. A healthy diet during pregnancy is vital to give your baby the right type and amount of nutrients needed for its development. Some vitamins and minerals (e.g. iron, folate, iodine) are needed in higher amounts than usual during pregnancy, which you need to factor into your diet. There are also certain foods that you should avoid while you are pregnant, because they can be harmful to your developing baby.

Maintaining a healthy diet during pregnancy will also help you meet your nutritional needs and manage your weight gain.

Eat a variety of healthy foods

To give you and your baby the right amount of energy and nutrients, it is best to eat a varied diet full of healthy foods. Although you should not ‘diet’ (i.e. restrict your energy intake) while you are pregnant, I do recommend keeping your intake of foods that are high in sugar or carbohydrates to a minimum, and instead eating more protein and healthy fats. This diet established by researchers at the CSIRO is an example of a low-carb diet that you can follow before and during pregnancy.

Try to base your diet during pregnancy around the following types of food:

  • Vegetables: eat plenty of fresh vegetables while you are pregnant as they are a great source of vitamins, minerals and fibre. Try to eat vegetables that are low in carbs and sugars, such as broccoli, cauliflower, tomato, cucumber and celery, and keep your intake of starchy vegetables (e.g. potatoes) to a minimum.
  • Protein: eat a mix of protein-rich foods. Choose from red meats, poultry, fish, eggs, tofu, nuts, seeds, legumes and beans. These foods are an important source of iron and other nutrients. Don’t be too worried about the fat content.
  • Healthy fats: to get enough calcium and vitamin D for your developing baby, make sure to eat multiple serves of dairy foods each day (i.e. milk, cheese, yoghurt or dairy alternatives), but stick to those that are low in sugar or sugar-free. Also include foods containing healthy oils in your diet (e.g. olive oil, avocado, nuts).

Many established guidelines for a healthy diet during pregnancy also recommend eating several serves of grains (e.g. bread, pasta, noodles, oats, cereals) each day. However, these foods are high in carbohydrates and may lead to weight gain, which is not good for you or your baby. Try to avoid eating these types of food and if you are eating grain foods, choose wholegrain and/or high-fibre varieties where possible because these are the healthiest options. Also keep fruit intake to a minimum because fruits are high in sugar.

Supplements can help you get the right nutrients for pregnancy

Some pregnant women struggle to get the necessary amounts of vitamins and minerals through their diet alone – specific dietary requirements (e.g. vegetarian, gluten-free, lactose-free) and busy lifestyles can make it even harder to achieve. Fortunately, there are supplements available that can help bridge this gap. All pregnant women should take folate and iodine supplements throughout the pregnancy, but other requirements will depend on personal diet and lifestyle factors.

Though vitamins are good for you, they can become toxic if taken in large amounts. This could happen if you take a specific vitamin as well as a multivitamin that contains it, or if your diet is already providing sufficient levels of a vitamin and you also take a supplement. Always check with your doctor or pharmacist before starting any kind of supplement if you are pregnant.

Avoid foods that can harm a developing baby

You’ve probably heard that you should not eat raw fish or soft cheeses while you are pregnant. The reason for this is that certain bacteria are found in unpasteurised and raw foods. Bacteria can also start to grow on food that has been sitting around for a while, making pre-prepared foods risky as well.

The main culprit is called Listeria monocytogenes, which causes listeria infection. If a healthy adult is infected with this bug they will be fine and won’t show any symptoms. However, if a developing baby is exposed to listeria it can lead to miscarriage, stillbirth or premature labour.

Salmonella is another type of bacteria that can cause food poisoning, generally from raw eggs or undercooked poultry. If a pregnant woman is infected with salmonella, it can trigger miscarriage.

For these reasons, it’s recommended that pregnant women avoid eating the following foods:

  • Soft cheeses (e.g. brie, feta, ricotta), unless they are cooked and served hot
  • Raw meat or seafood (including sushi)
  • Cold meats and deli foods (e.g. salami, ham, pate)
  • Unpasteurised dairy products
  • Pre-cut and packaged fruit and vegetables or pre-prepared salads
  • Raw eggs (e.g. in home-made mayo, aioli, mousse, cake batter).

Use my handy guide for an extensive list of foods to eat and avoid during pregnancy.

Do not drink alcohol while you are pregnant

We know that heavy drinking can be harmful to a growing baby. The effect that low-to-moderate alcohol intake has on a foetus is less clear, but many studies suggest that these amounts may also be harmful. For the safety of your baby, it’s best to avoid drinking altogether while you’re pregnant.

Moderate your caffeine intake

Studies suggest that small amounts of caffeine are safe for a developing baby, however large amounts (more than 4 cups per day) can lead to an increase in miscarriage. It is best to limit your caffeine intake to one cup of coffee per day while you are pregnant. Avoid energy drinks (e.g. V or Red Bull) because they contain high levels of caffeine.

Watch what types of fish you eat

It’s safe and healthy to include cooked fish in your diet during pregnancy as it gives your baby essential fatty acids needed for development. However, some fish species have high levels of mercury, which can be harmful to a developing baby. While you’re pregnant, the best fish to eat are salmon, sardines, tuna, herring and mackerel. Avoid eating (or eat no more than once per fortnight) flake, broadbill, swordfish, marlin, orange roughy and catfish.

Limit vitamin A intake

Too much vitamin A can cause harm to a foetus by interfering with developmental processes. Liver is a rich source of vitamin A, so pregnant women should only eat small amounts of liver during pregnancy. There is no risk of excessive intake of vitamin A for other foods, but you should check with your pharmacist or doctor if you are taking supplements to make sure you are not having too much vitamin A.

Are you finding it tricky to navigate the pregnancy diet?

If you need guidance on what foods you should eat during your pregnancy, or if you would like advice about taking pregnancy supplements, don’t hesitate to raise these topics at your next antenatal appointment. This includes if you need a special diet during pregnancy because of specific dietary requirements. Between appointments, you are always welcome to call my rooms for advice on (03) 9418 8299.