Obstetrics

The questions below were raised by visitors to the STOMP (Straits Times Online Mobile Print) website in the AskST section of the website. eMenders doctors provided the answers to the questions raised as a public health education project. The information provided below is of a general nature and should not be treated as a replacement for medical advice. You should seek consultation from a medical or healthcare professional about your specific medical condition.

Q A

This assumption is incorrect. Chickenpox is caused by a first (or primary) infection with the varicella zoster virus (VZV). After a first infection, the virus can remain dormant in nerve roots for long periods.Subsequently, itmay reactivate to cause a painful rash called herpes zoster (or shingles).If contracted in pregnancy,the virus cancross the placenta to cause a primary infection inthe fetus. Reactivation of the virus whilethe fetusis still in its mother’s wombcausesthe fetal varicella syndrome (FVS), or fetal shingles.

The fetus is at risk of FVS if the mother contracts chickenpox before 20 weeks’ pregnancy. FVS in the fetus gives rise toa typical skin scar, eye defects such as cataracts,shortenedlimbs, bladder and bowel problems, andmental retardation.The chance of fetal infection is just1-2%. The baby is unlikely to have problems in the womb if maternal infection occurs between 20-36 weeks of pregnancy. However,the virusmay reactivate to give rise tochildhoodherpes zoster (shingles).

If maternal infection occurs between 1-4 weeks of delivery,the baby has a 50% chance of acquiring a primary (or first) infection with VZV. Of these babies,up tohalf will be born with severe chickenpox (congenital varicella zoster).

Pregnant patients who may have contracted chicken pox in pregnancy should call their doctors as soon as possible. Early diagnosis and treatmentof the mother may helpminimize infection in the fetus.

Contributed by Dr Yeoh Swee Choo, eMenders Obstetrician and Gynaecologist.

Panadol, when taken at recommended dosages, should be safe for breastfeeding. It should not affect human breast milk production.

It is possible that your breast milk production fell because you were ill, and breastfeeding much less frequently during this time.

With patience and determination, you may be able to rebuild your milk supply. Put your baby to both the breasts during each feed. Comfort between feedings are also encouraged. Preparations which may further increase breast milk production include fenugreek, available from many health food stores and metoclopromide. The latter can only be dispensed with a prescription from a registered medical practitioner.

Contributed by Dr Yeoh Swee Choo, Obstetrician and Gynaecologist.

Group B streptococcus (GBS, Streptococcus agalactiae) is abacterial species commonly foundin the vagina and rectum. These organisms usually do not cause any harm.25% of pregnant women in the United Kingdomare carriers ofvaginal GBS.Babieswho come into contact with GBS during labour and delivery may become colonised with GBS.

Mostbabies are not harmed by contact with GBS at birth. However, about 1 in 2000 babies develop severe GBSinfection, oftenwithin 12 hours of delivery. Themortality rate is about 10%.

Infected babies are weak and unresponsive, and do not feed well. In addition, such babies may have breathing difficulties, fever and irritability.

Mothers who are carriers of GBS may, if thedoctordeems necessary,be treated with antibiotics in labour, and if the membranes are ruptured.Babies are more likely to have serious infections if the mother:

  1. has a high fever during labour, or
  2. is in pre-term (early) labour, or
  3. is delivered >18 hours after the membranes have ruptured.

Mothers who are carriers of GBS and who have planned caesarean delivery(i.e. before the onset of labour pains or membrane rupture) do not require treatmentfor GBS. In these cases, the riskof neonatal GBS infection is verylow.

Contributed by Dr Yeoh Swee Choo, Obstetrician and Gynaecologist.