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Placenta Previa

9/15/2025

What Exactly Is Placenta previa?
Placenta previa is when the placenta implants low in the uterus, covering all or part of the cervix, which is the opening of the uterus. Normally, the placenta attaches to the top or side of the inner uterine wall.

The way the placenta covers the cervix can vary, leading to different classifications:

• Placenta previa: This refers to when the placenta completely or partially covers the cervical opening. The placenta implants over or near the internal os of the cervix.
• Marginal placenta previa: This means the placenta is near the cervix (specifically, within 2 centimeters) but doesn't cover it.
• Low-lying placenta: Here, the placental edge does not cover the internal opening but is within 2 cm of it, or sometimes defined as 2 to 3.5 cm away from it.

Placenta previa is estimated to affect around 1 in 200 pregnant women at some point during pregnancy. In the majority of cases, approximately 90%, especially with low-lying placentas, the condition resolves on its own by the third trimester. As your uterus grows and changes, the placenta appears to "migrate"—it doesn't actually move, but rather grows towards the richer blood supply at the top of the uterus, while the lower uterine segment grows, increasing the distance from the cervix. This means that only about 1 in 800 pregnant women continue to have placenta previa at the time of delivery.

What are the symptoms of placenta previa?
Placenta previa may not cause any noticeable symptoms and may be discovered incidentally during a routine second-trimester ultrasound, such as your anatomy scan. However, the primary sign, if it does occur, is sudden, painless vaginal bleeding. This bleeding is typically bright red and usually happens after 20 weeks of pregnancy, often in the second or third trimester. The bleeding can sometimes be accompanied by uterine contractions.

How is suspected placenta previa confirmed?
A transvaginal ultrasound is considered the best way to confirm the exact location of the placenta.

Is home birth an option for someone with placenta previa?
For most cases where placenta previa persists until delivery, a cesarean delivery is the safest for both Mom and baby. However, there are specific circumstances where home birth might be an option. If the placenta is classified as a low-lying placenta, homebirth may be an option. Careful monitoring of the position of the placenta is an important tool in deciding what type of birth will be best for Mom and baby.

Sources:
https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc-20352768
https://www.ncbi.nlm.nih.gov/sites/books/NBK539818/
https://www.yalemedicine.org/conditions/placenta-previa
https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/placenta-previa

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Chickenpox and Pregnancy

9/1/2025

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What is Chickenpox?
Chickenpox is a very contagious viral infection caused by the varicella-zoster virus (VZV), which is a form of the herpes virus. It typically causes an itchy rash that turns into fluid-filled blisters, which then scab over. Other symptoms can include fever, headache, tiredness, and muscle soreness. Getting chickenpox during pregnancy has risks for Mom and baby.

How do I know if I’m immune?

Prior Infection: Most people develop immunity to chickenpox if they have had the disease earlier in life.
Vaccination: Another common way to become immune is by receiving the chickenpox vaccine.
Blood Test: The chickenpox vaccine came out in 1995, so it’s less likely that people may have had chicken pox in childhood. For this reason, I like to check immunity when clients have pregnancy labs run.

What are the risks of getting chicken pox during pregnancy?
The maternal risks of chickenpox:

The most common serious complication is pneumonia, which can be very severe and even life-threatening.

The risks of chickenpox for baby depend on when the infection happens during pregnancy.

In the first 20 weeks of pregnancy: There's a small risk (about 1 in 50 chance) for the baby to develop a rare group of serious birth defects called congenital varicella syndrome (CVS). The risk is highest between eight and 20 weeks. CVS can cause:
- Scars on the skin
- Problems with muscles, bones, arms and legs including malformed or paralyzed limbs
- Small head size and brain issues leading to intellectual disabilities
- Eye problems like blindness or cataracts
- Seizures
- Gastrointestinal issues
- Low birth weight
Immediately before or right after birth (from 5 days before to 2 days after birth): This is a critical time! Up to 3 in 10 newborns will be infected, and they'll likely develop a rash 5 to 10 days after birth. This condition is called neonatal varicella and can be life-threatening if not treated.
If Mom has a rash between 6 and 21 days before birth, the baby has some risk of mild infection. If the infection happens between 2 weeks before birth to 2 weeks after birth, the infection in your baby is usually mild. Babies born prematurely (before 37 weeks) may also be at higher risk for complications

What can I do to reduce the risk of getting chicken pox?
The best way to protect yourself and your baby is to prevent chickenpox in the first place.

Get vaccinated before pregnancy: If you haven't had chickenpox or the vaccine, talk to your healthcare provider about getting the chickenpox vaccine before you try to get pregnant. It's a two-dose vaccine, and it's recommended to wait at least one month after your second dose before trying to conceive.
Avoid exposure during pregnancy: If you're pregnant and not immune, stay away from anyone who has chickenpox or shingles (which is caused by the same virus). Chickenpox spreads easily through coughs, sneezes, saliva, or by touching the rash.

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Ferritin

8/15/2025

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Iron deficiency is a condition far more common than many realize, especially for women, and especially during pregnancy. You've likely heard of anemia, a condition where your body doesn't have enough hemoglobin. Hemoglobin is used by your red blood cells to carry oxygen to every part of your body. When you're anemic, your body isn't getting enough oxygen.

There are two components to iron levels:
• Hemoglobin: This tells you how much oxygen your red blood cells are carrying right now.
• Ferritin: This is your body’s iron stores. It’s what you have in reserve for your body to pull from to make hemoglobin.

Anemia is the end-stage result of iron deficiency. Your body prioritizes making sure your red blood cells have enough iron for hemoglobin.This means that iron deficiency can progress through multiple stages before your hemoglobin levels actually drop and you become anemic. Your ferritin stores could be close to empty, even while your body is still trying its best to keep your red blood cells supplied with enough hemoglobin. Once you no longer have ferritin, you will become anemic. Because your body prioritizes hemoglobin production, a standard hemoglobin test isn't sensitive enough to catch iron deficiency in its earlier, non-anemic stages. Simply put, your hemoglobin may be fine, but your ferritin can be low. Checking your hemoglobin level is not enough. Checking both hemoglobin and ferritin is necessary to give a complete picture of your body’s iron status.

Ignoring low ferritin, even when you're not yet anemic, carries significant risks for both Mom and baby:
• For Mom:
◦ Increased fatigue.
◦ Higher risk of developing iron deficiency anemia later in pregnancy.
◦ Associated with abnormal placenta growth and hypothyroidism.
◦ Increased risk of postpartum depression.
◦ More difficult to fight infections.
◦ Increased risk of preterm delivery, low birth weight, and hemorrhage after birth. • For Baby:
◦ Greater risk for anemia later in infancy.
◦ Fetal iron deficiency which can negatively affect the baby's brain development.

I want my clients to have a healthy pregnancy and feel their best throughout pregnancy. Because ferritin is so important to Mom’s and baby’s health, I like to check it when we start care, and again around 30 weeks gestation so if we need to take steps to address low ferritin, we have time to make changes that will be beneficial.

Sources:
https://www.ajog.org/article/S0002-9378(20)30328-8/fulltext
https://pmc.ncbi.nlm.nih.gov/articles/PMC9669178/
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/anemia-during-pregnancy/art-20114455

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Preeclampsia

8/1/2025

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What is preeclampsia?
Preeclampsia is a serious condition that usually starts after 20 weeks of pregnancy, in most cases symptoms start in the third trimester. Sometimes, it can occur after baby is born. It is a life threatening condition both for Mom and baby if left untreated.

How common is preeclampsia?
Preeclampsia occurs in approximately 2% to 8% of pregnancies worldwide, and the cases of preeclampsia in the United States match the global percentages.

Who is at risk?
Certain factors can increase your chance of developing preeclampsia:
• Having had preeclampsia in a previous pregnancy.
• Being pregnant with more than one baby (like twins or triplets).
• Having chronic high blood pressure (before pregnancy).
• Having Type 1 or Type 2 diabetes before pregnancy.
• Having kidney disease.
• Having certain autoimmune disorders (like lupus).
• Obesity (having a high BMI).
• This being your first pregnancy.
• Being 35 years old or older, or being very young (under 15).
• Having a family history of preeclampsia (like your mother or sister had it).
• Using in vitro fertilization.
• Race or ethnicity (studies show a higher risk for Black women and Indigenous women in North America, though this may be linked to differences in healthcare access and social factors).

What causes preeclampsia?
We don’t know what causes preeclampsia. There are theories but nothing definitive. Inadequate blood volume expansion may be a cause or contributing factor. Research indicates impaired blood flow to the placenta is a possible cause. The impaired blood flow could be caused by an issue with the placenta itself, or the mother may have heart problems that are made worse by the demands of pregnancy.

What are the symptoms of preeclampsia?
• Severe headaches that don't go away with regular pain medicine.
• Changes in your vision, like blurry vision, seeing spots, or being sensitive to light.
• Pain in your upper belly, usually under your ribs on the right side.
• Shortness of breath, which can be caused by fluid building up in your lungs.
• Nausea or vomiting that's worse than typical morning sickness.
• Sudden weight gain or swelling in your face and hands (some swelling in feet is normal during pregnancy, but sudden, noticeable swelling can be a red flag).

Other signs providers look for include low levels of blood cells called platelets (thrombocytopenia), or higher-than-normal liver enzymes or kidney problems shown in blood tests.

What is the treatment for preeclampsia?
The only way to truly stop or "cure" preeclampsia is to deliver the baby. However, the timing of delivery depends on how severe the preeclampsia is and how far along the pregnancy is.
Before delivery, management often includes:
• Medications to lower blood pressure: Common choices are labetalol, nifedipine, and hydralazine.
• Magnesium sulfate to prevent seizures: This medication is very important for preventing eclampsia (seizures related to preeclampsia) and is often given intravenously.
If preeclampsia is severe or the mother or baby's health worsens, early delivery may be recommended, sometimes even before the baby is full-term.

What can I do to decrease my risk of preeclampsia?
Since we are unsure what causes preeclampsia, we can’t definitively say what lowers the risk. The consensus is to eat nutrient dense foods, eat enough protein to support your pregnancy, exercise on a regular basis and have regular prenatal care.

Sources:
https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745
https://www.ncbi.nlm.nih.gov/books/NBK570611/
https://www.health.harvard.edu/a_to_z/preeclampsia-and-eclampsia-a-to-z
https://pmc.ncbi.nlm.nih.gov/articles/PMC9962022/
https://pubmed.ncbi.nlm.nih.gov/37762960/
https://pmc.ncbi.nlm.nih.gov/articles/PMC9962022/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10779413/

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All About SIDS

7/15/2025

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SIDS is the sudden, unexplained death of a baby younger than 1 year old. It's called "unexplained" because even after doctors do a full check-up, look at where the baby was sleeping, and review the family's medical history, they still can't find a reason for why the baby died. SIDS is the leading cause of death for children between 1 month and 1 year of age. Sudden Unexpected Infant Death (SUID) is a broader term that describes any sudden and unexpected death occurring during infancy, whether it is explained or unexplained. In the United States, about 3,700 infants died from SUID in 2022, 1,529 of those deaths were from SIDS.
What Causes SIDS?
Doctors and researchers don't know the exact cause of SIDS, but they have some ideas. One idea is called the Triple-Risk Model. This model suggests that three things need to happen together for SIDS to occur:
1. An "at-risk" baby: This means a baby has a hidden problem, like a brain difference or a genetic change, that no one knows about.
2. A special time in the baby's growth: This is usually during the first 6 months of life when babies are growing super fast and their bodies are learning to control things like breathing and heart rate.
3. Things in the environment that cause stress: These are outside things like sleeping on their tummy, getting too hot, or being around cigarette smoke.
Scientists believe that if only one or two of these things are present, SIDS might not happen. But when all three happen at the same time, the chances of SIDS are higher. Since we often don't know if a baby has a hidden problem or when they are in that "special time of growth," the best way to lower the risk is to remove or reduce the environmental stressors.
Ways to Reduce the Risk of SIDS
• Always put babies to sleep on their back.
Once a baby can roll over by themselves from back to stomach and stomach to back, you can let them stay in the position they choose after you've put them on their back to start.
• Avoid overheating.
Dress the baby in layers, and generally, no more than one layer more than an adult would wear to be comfortable. Watch for signs of overheating like sweating or flushed skin.
• Avoid smoke.
Exposure to smoke is a huge risk factor for SIDS.
• Breastfeed your baby.
Breastfeeding can reduce the risk of SIDS. Any amount of breastfeeding helps, and the longer you breastfeed, the more protection there is.
• Don't rely on home monitors for SIDS prevention.
Devices that monitor a baby's heart rate or breathing at home haven't been shown to reduce the risk of SIDS.

The “Back to Sleep” campaign was started in 1994. Since the campaign started, the number of newborns sleeping on their back has tripled, and the rate of SIDS has been cut in half. The dramatic decrease in SIDS as more newborns are sleeping on their backs shows that what position newborns sleep in is a big key in preventing SIDS.

Sources:
https://www.nichd.nih.gov/health/topics/factsheets/sids
https://safetosleep.nichd.nih.gov/reduce-risk/back-sleeping
https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022?autologincheck=redirected
https://journals.lww.com/jaapa/Fulltext/2018/11000/Preventing_sudden_infant_death_syndrome_and_other.3.aspx
https://pmc.ncbi.nlm.nih.gov/articles/PMC8424793/
https://pubmed.ncbi.nlm.nih.gov/34496779/
https://www.eurosafe.eu.com/measures-to-promote-a-safe-sleeping-environment-and-to-reduce-the-risk-of-all-sleep-related-infant
https://www.cdc.gov/sudden-infant-death/data-research/data/index.html

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