Pregnancy Planning

If you are planning pregnancy or would like preconception counselling, Yinka Akinfenwa offers private consultations and specialist expertise in supporting women prior to conception or in early pregnancy where medical history or complications may impact conception or pregnancy.


General advice - planning pregnancy.
When you are planning pregnancy the general advice for keeping in good health and improving your chances of conception is to avoid alcohol, stop smoking and eat a healthy diet: well balanced, low in salt and saturated fats and high in fibre, fruit and fresh vegetables. Other recommendations would be to limit caffeine intake.

Exercise is of immense benefit. Regularly exercising improves cardiovascular function and lowers blood pressure. It can also improve your fitness and body tone, which will help you adapt to the physical changes of pregnancy, and make the birthing process easier.

When pregnancy is being planned, it's also useful to take a background history of immunization and vaccination, especially with respect to rubella. Where necessary, appropriate immunization can be arranged.


Pre-existing Medical problems
If you have a pre-existing medical condition, Yinka will discuss this with you in detail. Pregnancy may worsen an existing condition; alternatively an existing condition may carry a risk of adversely affecting pregnancy. Yinka will assess your condition and the optimal way to treat and/or manage it during pregnancy, taking into account any implications it may have for your baby’s health and for the birth. Yinka’s many years of experience supporting women who require specialist pregnancy care allows him to give expert support and treatment, coupled with a sensitive and supportive approach.
Careful management of pregnancy, often with pre-pregnancy planning and treatment, is needed in the following cases:
  • Pregnancy following previous surgery (eye surgery, orthopaedic surgery, trauma surgery)
  • Past pregnancy disorders (chromosomal disorders, abnormal thyroid function, diabetes)
  • Past Obstetric History (including infection, cervical incompetence, caesarean, difficult delivery, previous neonatal admission)
  • Gynaecological Problems (including fibroids, uterine prolapse, ectopic & molar pregnancy)

Pre-existing Surgical Problems

Eye surgery
As certain forms of eye surgery may be associated with complications at birth, a clear history of the clinical condition and type of procedure is required. A letter from the ophthalmic surgeon who carried out your surgery will help Yinka as he plans the most appropriate obstetric care for you. In certain situations, elective delivery with a Ventouse or a Caesarean section will be required.

Orthopaedic Surgery
If you have had surgical treatment for spinal problems in the past this needs to be carefully reviewed; Yinka will thoroughly evaluate the potential effect of your treatment on your pregnancy. A management plan will be made that best suits your personal situation.

Trauma Surgery
A past history of a major accident requiring trauma surgery may present serious limitations to obstetric management. It is important to have as much information as possible about the treatment to help with planning management during pregnancy and making plans for your baby’s delivery.
 
Past Pregnancy disorders

Chromosomal disorders
For couples who have previously had a baby affected by a developmental or genetic abnormality or where there is a family history of genetic disease, preconception counselling is important. The goal of counselling is to evaluate the risk of recurrence of the condition. Yinka is a fetal medicine specialist and will discuss your unique situation with you.

Thyroid dysfunction
Abnormal thyroid function will be thoroughly assessed. The aim is to achieve normal function prior to embarking on pregnancy; levels of thyroid hormone will be monitored during the course of pregnancy, with appropriate treatment recommended where needed.

Diabetes
For women known to have diabetes mellitus it is important to achieve normal blood sugar levels prior to embarking on a pregnancy. During pre-pregnancy counselling Yinka will answer your questions and discuss the effects of diabetes on pregnancy. Your personal situation will be closely assessed, and blood sugar targets will be set. Abnormal blood sugar levels during pregnancy can have a detrimental effect on a developing baby; careful management of your diabetes will minimise the risk of 'teratogenic effects'. With careful management and close monitoring, a diabetic pregnancy can proceed without problems.
 

Significant Past Obstetric History

Bacterial Vaginosis
Infections such as bacterial vaginosis, which can increase the risk of preterm delivery, can be screened for as part of a prenatal consultation.

Group B Streptococcus
Where there has been a previous pregnancy affected by group B Streptococcus, Yinka will take a close history and devise a management plan for future pregnancies.

Cervical sutures
In cases where one or more previous pregnancies have resulted in an early (preterm) birth, Yinka will take a careful history of the previous situation and plan careful management to minimise the risk of this occurring again. A management plan may include screening for the infections named above, inserting a cervical cerclage or suture, or monitoring the length of cervix by ultrasound scans  during the pregnancy.

Previous caesarean birth
If you have had a previous Caesarean birth, the history of your previous pregnancy is very important. Yinka will consider the circumstances surrounding the previous delivery and the indications for a Caesarean section. Taking all the factors into consideration will enable effective planning for birth in the future. In certain circumstances a repeat Caesarean section is the safest and most logical course of action; in others, vaginal birth may be possible.

Vaginal birth after Caesarean section (VBAC)
Yinka supports and manages vaginal births following a previous caesarean; however, each case will be taken individually.
It is important to review the previous obstetric history carefully, and consider a range of factors in order to assess the level of medical risk that is involved in a vaginal birth. Of particular significance is the type of uterine scar from a previous caesarean. Any previous rupture of a uterine scar or multiple myomectomy would be reasons to consider a repeat Caesarean section as the safest option. In special circumstances where there has been a vaginal delivery either before or following a Caesarean section, an individualised risk assessment regarding suitability of a repeat vaginal birth will be made.

Previous difficult instrumental delivery
When a previous birth has involved a difficult instrumental delivery, Yinka will consider factors including the circumstances of the previous pregnancy and birth and the weight of the baby, and form a plan for the next birth. On occasion, a plan for an elective Caesarean section can be decided at this stage.

Previous suboptimal outcome (prolonged Neonatal unit admissions)
In most cases, prolonged neonatal admissions are due to premature births, or difficult deliveries. The history of previous pregnancies will be carefully evaluated as Yinka considers the implications for your current or planned pregnancy, and discusses a management plan with you; this will depend on the cause of the previous premature birth or difficult delivery.


Gynaecology History

Polycystic ovarian disease
Polycystic ovarian disease can on occasions be associated with early miscarriage or difficulty conceiving. Preconception consultation with Yinka will involve a careful assessment of your personal situation, wtih the aim of maximising your pregnancy success.

Uterine fibroids
Uterine fibroids are relatively common benign tumours of the uterine muscle which can cause heavy, painful periods. In pregnancy, fibroids have a tendency to grow; they can undergo degeneration, causing pain, and on occasion fibroids can obstruct the birth canal and interfere with a normal vaginal delivery. A pre-pregnancy consultation is important to assess the likely impact of the fibroids on pregnancy, and to discuss care during pregnancy and plans for the birth.

Uterine prolapse
If you have been diagnosed with uterine prolapse, Yinka will assess your condition and discuss the likely effects of pregnancy on your prolapsed uterus, as well as any implications for a pregnancy.

Ectopic gestation
If you have previously experienced an ectopic pregnancy, early pregnancy ultrasound examination is essential to establish the site of implantation and ensure that this pregnancy is correctly located. The ultrasound assessment can be combined with blood tests to arrive at a definite diagnosis.

Molar pregnancy
If you have previously experienced a molar pregnancy, an early pregnancy ultrasound examination in the next pregnancy is essential. Yinka typically recommends that the ultrasound investigation is combined with blood tests to give accurate information about the development of the pregnancy.
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